Objective:To assess the value of cerebral small vessel disease (CSVD) burden in predicting prognosis in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO) after endovascular therapy (EVT).Methods:The study was a cross-sectional study. A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022. The clinical and imaging data of all patients were analyzed retrospectively. On follow-up MRI within 7 days after EVT, CSVD features [white matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed, cerebral atrophy] and CSVD burden score (0-5) was evaluated. Modified Rankin scale (mRS) score at 90 days after EVT was assessed. Patients were categorized into a mild burden group (0-1 points) and a moderate-severe burden group (2-5 points) based on CSVD burden score. Meanwhile, patients were categorized into a good prognosis group (0-2 points) and a bad prognosis group (3-6 points) based on mRS score at 90 days after EVT. Mann-Whitney U test and χ2 test were used to compare the difference of clinical and imaging indexes between the 2 groups, and variables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis. Results:There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients. Compared with the good prognosis group, age, incidence of hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) scores, incidence of hemorrhagic conversion, CSVD burden scores, incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2, and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher, and the incidence of complete recanalization was lower (all P<0.05). Multivariate analysis showed hyperlipemia ( OR=8.438, 95% CI 1.691-42.119, P=0.009), baseline NIHSS score ( OR=1.103, 95% CI 1.047-1.162, P<0.001), complete recanalization ( OR=0.131, 95% CI 0.038-0.454, P=0.001) and hemorrhage transformation ( OR=1.952, 95% CI 1.031-3.697, P=0.040) were independent factors for the prognosis of EVT in patients with LVO AIS. There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group. The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group ( Z=-2.24, P=0.025). Conclusion:CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.

Objective To evaluate the clinical value of optic nerve sheath diameter(ONSD)measured on thin-slice CT scan in the diagnosis and prognostic assessment of cerebral venous sinus thrombosis(CVST).Methods The clinical data of patients with CVST,who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive treatment from January 1,2016 to December 31,2022,were retrospectively analyzed.The difference in ONSD was compared between CVST patients and normal population,the postoperative changes in ONSD was analyzed.Results A total of 49 patients with CVST(CVST group)and 49 normal persons having no brain disorders(control group)were enrolled in this study.In CVST group,the preoperative ONSD was(5.33±0.50)mm,which was significantly higher than(4.40±0.40)mm in control group(P＜0.001),the postoperative ONSD remarkably decreased to(4.98±0.59)mm(P＜0.01).The difference value between postoperative ONSD and preoperative ONSD in the patients receiving pure anticoagulation treatment was not statistically significant different from that in the patients receiving endovascular treatment[(-0.43±0.22)mm vs.(-0.40±0.42)mm,P=0.84].The preoperative ONSD in the patients having intracranial hemorrhage and in the patients having no intracranial hemorrhage was(5.26±0.51)mm and(5.41±0.49)mm respectively(P=0.31),and the difference value between postoperative ONSD and preoperative ONSD was(-0.39±0.40)mm and(-0.45±0.25)mm respectively(P=0.66).At the three-month follow-up visit,the difference in ONSD between the patients having a good prognosis(mRS score being 0-2 points)and the patients having a poor prognosis was not statistically significant(P＞0.05).Conclusion ONSD that is measured on plain head CT scan can be used as a response indicator of elevated intracranial pressure in CVST patients,which can be used to monitor the changes in intracranial pressure before and after treatment,but its value in assessing the curative efficacy of different therapeutic methods needs to be further explored.

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.

Objective:To investigate the mid-term efficacy of prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS), urinary retention (UR) or hematuria secondary to benign prostatic hyperplasia (BPH).Methods:This was a retrospective study conducted from February 2014 to December 2018 in 140 patients who underwent PAE for LUTS, UR or hematuria secondary to BPH, including 85 patients with LUTS (60 patients with LUTS and 25 LUTS combined with hematuria), 52 patients with UR (50 patients with UR and 2 UR combined with hematuria) and 3 patients with hematuria. All patients were followed up for 24 months. Clinical success rates were evaluated. Friedman test was performed to compare the differences in International Prostate Symptom Score (IPSS), quality of life (QoL) score, and prostatic volume (PV) between baseline and follow-up time points (3, 6, 12 and 24 months). A post hoc test was performed by the Bonferroni method.Results:Significant differences in IPSS, QoL score and PV between baseline and follow-up time points were observed in 85 patients with LUTS ( P<0.001 for all), and clinical success rates at 3, 6, 12, 24 months after PAE were 95.3% (81/85), 91.8% (78/85), 87.1%(74/85), 83.5%(71/85). The success rate of extubation in patients with UR within 1 month after PAE was 98.1% (51/52). The average interval from PAE to catheter-independence was (6.8±3.7) days, and clinical success rates were 94.1% (48/51), 92.2% (47/51), 88.2% (45/51), 84.3% (43/51), respectively. The interval from PAE to the resolution of hematuria was (3.4±2.5) days, and clinical success rates were 90.0%(27/30), 90.0%(27/30), 83.3%(25/30), 80.0%(24/30), respectively. Conclusions:PAE was an effective treatment option for symptoms secondary to BPH in mid-term follow up.

To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.

Objective Toevaluatetheclinicaleffectofinterventionaltreatmentfordelayedhemorrhageinpatientsafterabdominal surgery.Methods Dataof76patients,undergoingangiographyduetodelayedpostoperativehemorrhage,wereanalyzedretrospectively. Theexclusioncriteriaincludedpositiveangiographywithoutembolizationorhaemorrhagecausedbyothercauses(urologicaland reproductivesystemdiseases).Basedonendovascularprocedures,thepatientsweredividedintoembolizedgroup (positiveangiography withembolization)andnon-embolizedgroup(negativeangiographywithoutembolization).Theoutcomesoftreatmentwerecompared betweentwogroupsandfactorsassociatedwithrebleedingwerealsoanalyzed.Results Angiogramswerepositivein70% (53/76)of patients,andintravascularembolizationswereperformed.Intheembolizationgroup,technicalsuccessrateandclinicalsuccessrate were98.1%(52/53)and71.7%(38/53),respectively.Noseverecomplications,suchasgastrointestinalorhepaticischemicnecrosis wereobservedinallpatients.Therebleedingrateswere28.3%and52.2%intheembolizationgroupandthenon-embolizationgroup, respectively(P＝0.046).Multivariateanalysisshowedthatuseofvasopressoragentsbeforesurgerywasanindependentriskfactor forrebleeding (P＝0.022).Conclusion Intravascularinterventionaltherapyisasafeandeffectivemethodfordelayedhemorrhageafter abdominalsurgery.Useofvasopressoragentsbeforesurgerymayincreasetheriskofpostoperativerebleeding.

Objective: To explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation(CI). Methods: Total 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups: the group with unilateral CI(cochlear implant alone, n= 15), and the bimodal group with CI and contralateral fitting hearing aid(n= 20). Their auditory and speech abilities were estimated at the different time points after switch-on(the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively) using Infant Toddler-Meaningful Auditory Integration Scale(IT-MAIS), Meaningful Use of Speech Scale(MUSS), Categories of Auditory Performance(CAP), and Speech Intelligibility Rating(SIR) scores. Results: The IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group(the 0.5th, 1st, 3rd, 6th, 12th, and 18th month), the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively(P<0.05). The CAP scores of bimodal group before CI operation and after switch-on(the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month)were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on(P<0.05). The MUSS scores of bimodal group after switch-on were higher than unilateral CI group(the 1st, 3rd, 6th, 12th, 18th and 24th month), the statistical significances were found at the 12th, 18th and 24th month, respectively(P<0.05). The SIR scores of bimodal group after switch-on were higher than unilateral CI group(the 3rd, 6th, 12th, 18th and 24th month), and significant differences appeared at the 12th, 18th and 24th month after switch-on(P<0.05). Conclusion Bimodal intervention could be helpful to the development of auditory and speech ability of infants.

Objective To evaluate percutaneous transampulla stent implantation in treating lower malignant obstructive jaundice, and to discuss the related factors that may influence the stent patency time. Methods The clinical data of a total of 104 patients with lower malignant obstructive jaundice, who received percutaneous transampulla stent implantation during the period from January 2010 to March 2016, were retrospectively analyzed. The parameters, including gender, age, primary tumor type, preoperative external drainage, total bilirubin (TBIL), albumin (ALB), glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), white blood cell (WBC) count, platelet (PLT) count, hemoglobin (HGB) and length of biliary stricture, were used to evaluate the risk factors related to postoperative patency time. Results Single Cox regression analysis showed that primary tumor type, ALB, WBC count, length of biliary stricture were the related factors that significantly affected the stent patency time. The Cox regression analysis further indicated that primary tumor type and length of biliary stricture were the important related factors that significantly affected the stent patency time. Conclusion In treating lower malignant obstructive jaundice with percutaneous transampulla stent implantation, primary tumor type and length of biliary stricture may be the important related factors that affect the stent patency time. These parameters are of great value in estimating the stent patency time.

Objective To establish the rabbit model of main portal vein VX2 tumor thrombus by using orthotopic implantation and to observe its radiological and pathological features.Methods 24 New Zealand white rabbits were randomly divided into study group (n=16) and control group (n=8).In study group,VX2 tumor tissue fragments were fixed on the inner wall of the main portal vein by using a surgical approach.In control group, autologous muscle fragments were fixed on the inner wall of the main portal vein in the same way.CT examinations were performed in both group on 7 days, 14 days, 21 days and 28 days after the procedure.At each observation point,3 rabbits of the study group were inspected by using digital subtraction angiography (DSA),and then sacrificed for histologic examination.Meanwhile,1 rabbit of the control group was sacrificed for histologic examination after CT scanning.The survival time of the remaining rabbits were recorded.Results Among 16 rabbits of the study group, successful implantations were achieved in 15 rabbits (93.8%).Tumor thrombus formed in the main portal vein successfully for all these 15 rabbits.The mean survival time of the remaining 3 rabbits in the study group was (39.3±2.1) days.The imaging characteristic of tumor thrombus could be demonstrated by CT and DSA examinations.Tumor thrombus and the inner neovascularization were confirmed by histological examination.Conclusion It is feasible to establish an animal model of main portal vein tumor thrombus by orthotopic implantation.The radiological and pathological features of animal model are similar to hepatocellular carcinoma patients with portal vein tumor thrombus.

Objective To evaluate the feasibility and safety of establishing benign proliferative esophageal stenosis model by using stent implantation in experimental rats.Methods A customized self-expanding,metallic and straight tubular stent was used in this experiment (5 mm in diameter and 15 mm in length),on both sides at the stent's middle part there was a protruding barb that was used as a fixation device.Twelve healthy Sprague Dawley (SD) rats were randomized divided into group A (blank control group) and group B (stent implantation group),with 6 rats in each group.Esophageal stent implantation was employed in the rats of group B,and esophageal radiography was separately performed immediately,one and 4 weeks after stent implantation.All the experimental rats were sacrificed 4 weeks after stent implantation.The normal esophageal tissue of the rats in group A and the esophageal tissue at stent site of the rats in group B were collected and sent for pathological examinations,including gross morphology,light microscopy,etc.Results Successful stent implantation was achieved in all rats of group B,and the esophageal radiography performed immediately,one and 4 weeks after stent implantation showed no esophageal stent displacement;no severe complications occurred during the operation or follow-up period.Compared with group A,esophageal radiography reexamination performed 4 weeks after stent implantation in group B revealed that esophageal stricture at stent segment,caused by benign tissue hyperplasia,could be observed.The esophageal stent segment was taken out,its lumen was obviously narrowed under gross observation,and typical benign hyperplasia could be seen under optical microscope examination.Conclusion Using esophageal stent implantation to establish esophageal stenosis model is safe and feasible in experimental rats.The use of esophageal stent with barbs can significantly reduce the incidence of stent displacement.