Objective:To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4.5 h in patients with acute ischemic stroke.Methods:A retrospective analysis was performed; 180 acute ischemic stroke patients admitted to Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen. Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0.4; good collateral circulation: HIR>0.4); clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4.5 h in patients with acute ischemic stroke. Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke. Role of HIR as agency between SIR and onset time was explored. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4.5 h in acute ischemic stroke patients.Results:Of the 180 patients, 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group; compared with the good collateral circulation group, the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia, larger DWI infarction volume before treatment, larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR ( P<0.05). In these 180 patients, 76 had onset time≤4.5 h and 104 had onset time>4.5 h. Univariate Logistic regression analysis showed that hyperlipidemia, DWI infarct volume before treatment, DWI-FLAIR mismatch, HIR and SIR were influencing factors for onset time≤4.5 h in acute ischemic stroke patients ( P<0.05). Multivariate Logistic regression analysis showed that hyperlipidemia ( OR=6.654, 95% CI: 5.751-8.824, P<0.001), HIR ( OR=0.724, 95% CI: 0.521-1.321, P=0.041) and SIR ( OR=739.881, 95% CI: 383.296-14 258.065, P<0.001) were independent influencing factors for onset time≤4.5 h in acute ischemic stroke patients. Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke ( r=0.420, P<0.05), and SIR was positively correlated to onset time in patients from poor collateral circulation group ( r=0.781, P<0.05). ROC curve showed that AUC of SIR in predicting onset time≤4.5 h was 0.917 (95% CI: 0.814-1.000, P<0.001) and that of DWI-FLAIR mismatch in predicting onset time≤4.5 h was 0.530 (95% CI: 0.509-0.757, P=0.075) in poor collateral circulation group, enjoying significant difference in predictive efficacy. Conclusion:Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4.5 h; SIR can more accurately predict the onset time in these patients with poor collateral circulation.

Objective To explore the influence of longitudinal and oblique hollow lag screw internal fixation on interphalangeal range of motion,metacarpal range of motion and complications in patients with transverse fractures of proximal phalanges.Methods Retrospective analysis was performed on 102 patients with transverse fractures of proximal phalanges admitted to department of orthopedics of our hospital from June 2021 to February 2022.According to treatment methods,the patients were divided into longitudinal group and oblique group.The longitudinal group was given longitudinal hollow lag screw internal fixation while the oblique group was treated with oblique hollow lag screw internal fixation.The baseline data of the enrolled subjects were excluded from the influence of confounding factors according to the propensity matching scoring method(caliper value=0.02),and 51 patients with comparable baseline data were obtained in each group.The surgical status(surgical time and healing time),ranges of motions of interphalangeal and metacarpal joints,excellent and good rate of hand function(total active movement,TAM)and complications at 18 months after surgery were compared between the two groups.Results All patients successfully completed the surgery,and at least 18 months of follow-up data were obtained.There was no statistical significance in the surgical time or follow-up time between the two groups(P＞0.05).The healing time in oblique group(6.57±1.22)weeks,was significantly shorter than that in longitudinal group(7.82±1.54)weeks(P＜0.05).At 18 months after surgery,the interphalangeal range of motion was significantly higher in oblique group(82.62±3.41)° than that in longitudinal group(77.45±7.46)°(P＜0.05),but there was no statistical difference in metacarpal range of motion between the two groups(P＞0.05).The excellent and good rate of hand function in oblique group(94.12％)at 18 months after surgery was significantly higher than that in longitudinal group(80.39％)(P＜0.05).The incidence of complications revealed no statistical significance between oblique group(1.96％)and longitudinal group(3.92％)(P＞0.05).Conclusion In the hollow lag internal screw fixation treatment of patients with transverse fractures of proximal phalanges,both longitudinal and oblique screw methods have good effects,but the oblique screw method is more beneficial to the recovery of hand function.

Objective To analyze the risk factors of short-term re-obstruction after plastic stent placement by endoscopic retrograde cholangiopancreatography(ERCP)in patients with hilar malignant biliary obstruction.Methods A retrospective study was performed on clinical data of 93 patients with hilar malignant biliary obstruction who underwent ERCP biliary plastic stent placement from January 2015 to January 2024.Understanding the effects of general information,clinical characteristics,operative-related factors,and laboratory-related indicators on postoperative short-term re-obstruction.The dependent variable was whether biliary stent re-obstruction in short-term after operation,univariate and multivariate Logistic regression analysis were used to analyze the risk factors for the patients with hilar malignant biliary obstruction occurred re-obstruction in short-term after ERCP plastic stent placement.Results Among the 93 patients,49 patients had short-term recurrent biliary stent obstruction after plastic stent placement by ERCP and the recurrence rate was 52.7%.Univariate analysis showed that gender,types of malignant biliary strictures,preoperative cholangitis,no drainage before operation and endoscopic sphincterotomy(EST)during ERCP plastic stent placement,location of stent placement,fever within 24 h after ERCP plastic stent placement,the decrease less than 50%of total bilirubin(TBiL)at 2 weeks after operation,the decrease less than＜50%of γ-glutamyl transpeptidase(GGT)at 2 weeks after operation,GGT and alkaline phosphatase(ALP)by less than 50%at 2 weeks after operation were potential risk factors affecting for short-term re-obstruction after ERCP plastic stent placement in patients with hilar malignant biliary obstruction.Multivariate analysis showed that,no drainage before operation(O＾R=5.738,P=0.013),preoperative cholangitis(O＾R=5.347,P=0.025)and place stents on the left or on the right(O＾R=6.739,P=0.014;O＾R=9.719,P=0.005)were independent risk factors for short-term re-obstruction after ERCP plastic stent placement.Conclusion No drainage before operation,preoperative cholangitis,place stents on the left or on the right are independent risk factors for short-term re-obstruction after ERCP plastic stent placement in patients with hilar malignant biliary obstruction.Early identification of risk groups and timely intervention of risk factors in clinical practice are of great significance for the prevention of short-term re-obstruction after ERCP plastic stent placement in such patients.

Objective To investigate the clinical efficacy of different stents placement under endoscopic retrograde cholangiopancreatography(ERCP)in patients with malignant biliary obstruction(MBO)and the effect on patient survival time.Methods Clinical data of MBO patients treated with ERCP stent placement between January 2020 and March 2024 were collected,divided into recyclable stent group(33 cases),metal stent group(42 cases),and ordinary stent group(34 cases).Comparation of the three groups of preoperative and postoperative changes in liver function,complications of long-term cholangitis and pancreatitis,stent patency time,success rate of stent removal with a single clamping,survival time,monitoring follow-up situation.Results There was no statistically significant difference in the liver function of the three groups of patients before stent placement(P>0.05);One week after stent placement,the difference compared with preoperative between direct bilirubin(DBiL)and total bilirubin(TBiL)in the recyclable stent group and the metal stent group was significantly higher than that in the ordinary stent group,and the difference between the ordinary stent group and other two groups was statistically significant(P<0.05).The incidence of cholangitis in the recyclable stent group was the lowest,followed by the ordinary plastic biliary stent,and the metal biliary stent had the highest incidence of cholangitis,the incidence of cholangitis in the long term after stent placement was compared among the three groups of patients with a statistically significant difference(P<0.05).The incidence of postoperative pancreatitis in the three groups was not statistically significant(P>0.05).The success rate of stent removal with a single clamping was higher in the recyclable stent group than the ordinary stent group.Comparison of median stent patency time among the three groups,the difference was statistically significant(P<0.05).The metal stent group had the longest median patency time of 194.0 d,recyclable plastic stent had the second longest median patency time of 126.0 d,and ordinary plastic biliary stent had the shortest median patency time of 92.0 d.Median survival time among the three groups was statistically significant(P<0.05).The recyclable plastic biliary stent had the longest median survival time of 590.0 d,metal biliary stent had the second longest median survival time of 476.0 d,and ordinary plastic biliary stent had the shortest median survival time of 453.0 d.Conclusion Recyclable plastic biliary stent has a faster decrease in bilirubin index compared with the ordinary stent group after operation.And the recyclable plastic stent group has lower incidence of long-term cholangitis,higher success rate of one-time clamping of the stent,and more advantages in time to stent patency and survival time compared with ordinary plastic biliary stent,which is an effective choice of stenting modality for ERCP stent placement in patients with MBO.

Objective:To investigate the clinical outcome of endovascular treatment vs. drug treatment in patients with symptomatic non-acute long-segment occlusion of the internal carotid artery. Methods:Based on prospective cohort registration research data, patients with symptomatic non-acute long-segment occlusion of internal carotid artery were retrospectively included. They were divided into a drug treatment group and an endovascular treatment group according to the actual treatment received. The latter was further divided into a successful recanalization group and an unsuccessful recanalization group. The endpoint events included ipsilateral ischemic stroke, any stroke, and all-cause death. Multivariate logistic regression analysis was used to compare the endpoint events between groups during the perioprocedural period (within 30 days), and multivariate Cox proportional hazards model was use to compare the endpoint events between the groups during the long-term follow-up. Results:A total of 684 patients were included, of which 570 (83.33%) were male, median aged 63 years (interquartile range, 56-70 years). Three hundred and fifty-three patients (51.6%) received drug treatment; 331 (48.4%) received endovascular treatment, of which 161 (48.6%) had successful recanalization. The median follow-up time was 1 223 days (interquartile range, 646.5-2 082 days), with 109 patients (15.9%) experiencing stroke recurrence events (including 87 ipsilateral ischemic stroke) and 78 (11.4%) experiencing all-cause mortality. The risk of any stroke during the perioprocedural period in the successful recanalization group was significantly higher than that in the drug treatment group (odds ratio 3.679, 95% confidence interval 1.038-13.036; P=0.044), but the risk of ipsilateral ischemic stroke recurrence (risk ratio 0.347, 95% confidence interval 0.152-0.791; P=0.012) and all-cause mortality (risk ratio 0.239, 95% confidence interval 0.093-0.618; P=0.003) during the long-term follow-up were significantly lower than those in the drug treatment group. Conclusions:In patients with symptomatic non-acute long-segment occlusion of the internal carotid artery, endovascular treatment can increase the risk of stroke recurrence within 30 days, but successful recanalization can reduce the risks of long-term ipsilateral ischemic stroke recurrence and all-cause mortality.

Objective:To investigate predictive factors for successful endovascular recanalization in patients with non-acute symptomatic internal carotid artery occlusion (SICAO), to develop a decision tree model using the Classification and Regression Tree (CART) algorithm, and to evaluate the predictive performance of the model.Methods:Patients with non-acute SICAO received endovascular therapy at 8 comprehensive stroke centers in China were included retrospectively. They were randomly assigned to a training set and a validation set. In the training set, the least absolute shrinkage and selection operator (LASSO) algorithm was used to screen important variables, and a decision tree prediction model was constructed based on CART algorithm. The model was evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and confusion matrix in the validation set.Results:A total of 511 patients with non-acute SICAO were included. They were randomly divided into a training set ( n=357) and a validation set ( n=154) in a 7:3 ratio. The successful recanalization rates after endovascular therapy were 58.8% and 58.4%, respectively. There was no statistically significant difference ( χ2=0.007, P=0.936). A CART decision tree model consisting of 5 variables, 5 layers and 9 classification rules was constructed using the six non-zero-coefficient variables selected by LASSO regression. The predictive factors for successful recanalization included fewer occluded segments, proximal tapered stump, ASITN/SIR collateral grading of 1-2, ischemic stroke, and a recent event to endovascular therapy time of 1-30 d. ROC analysis showed that the area under curve of the decision tree model in the training set was 0.810 (95% confidence interval 0.764-0.857), and the optimal cut-off value for predicting successful recanalization was 0.71. The area under curve in the validation set was 0.763 (95% confidence interval 0.687-0.839). The accuracy was 70.1%, precision was 81.4%, sensitivity was 63.3%, and specificity was 79.7%. The Hosmer-Lemeshow test in both groups showed P>0.05. Conclusion:Based on the type of ischemic event, the time from the latest event to endovascular therapy, proximal stump morphology, the number of occluded segments, and the ASITN/SIR collateral grading constructed the decision tree model can effectively predict successful recanalization after non-acute SICAO endovascular therapy.

Objective:To observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling.Methods:A single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was -14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ 2 test. Results:Compared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery ( t=-2.208, -3.435,-4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different ( P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=-1.595,-1.698,-1.966; P=0.125, 0.104, 0.062. P2: t=-1.622,-1.654,-1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. Conclusions:PPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.

Objective:To evaluate the role of 1, 4, 5-inositol triphosphate receptor (IP3R) in necroptosis of hippocampal neurons induced by sevoflurane anesthesia in aged rats.Methods:Sixty healthy male Sprague-Dawley rats, aged 18 months, weighing 500-600 g, were divided into 3 groups ( n=20 each) using a random number table method: control group (group C), sevoflurane anesthesia group (group S) and sevoflurane anesthesia + IP3R antagonist group (group S+ I). S and S+ I groups inhaled 2% sevoflurane for 5 h. In group S+ I, IP3 receptor antagonist 2-APB 3 mg/kg was intraperitoneally injected at 10 min before sevoflurane inhalation, and the equal volume of dimethyl sulfoxide was intraperitoneally injected in group C and group S. Morris water maze test was used to test the cognitive function on the day after the end of sevoflurane anesthesia.Then the animals were sacrificed and the brain tissues were obtained for microscopic examination of the pathological changes after HE staining and Nissl staining (with a light microscope) and for determination of the free calcium concentration ([Ca 2+ ] i) and rate of necroptosis of hippocampal neurons (by flow cytometry) and expression of IP3R, receptor-interacting protein kinase-1 (RIPK1), receptor-interacting protein kinase-3 (RIPK3) and phosphorylated mixed lineage kinase domain-like protein (p-MLKL) (by Western blot). Results:Compared with group C, the escape latency was significantly prolonged, the times of crossing the platform were reduced, the time of staying at the target quadrant was shortened, the [Ca 2+ ] i and necroptosis rate of hippocampal neurons were increased, and the expression of IP3R, RIPK1, RIPK3 and p-MLKL in hippocampal neurons was up-regulated in group S and group S+ I ( P<0.05). Compared with group S, the escape latency was significantly shortened, the times of crossing the platform were increased, the time of staying at the target quadrant was prolonged, the [Ca 2+ ] i and necroptosis rate of hippocampal neurons were decreased, and the expression of IP3R, RIPK1, RIPK3 and p-MLKL in hippocampal neurons was down-regulated in group S+ I ( P<0.05). Conclusions:The mechanism by which sevoflurane induces cognitive dysfunction may be related to the imbalance of calcium homeostasis caused by activation of IP3R and thus inducing programmed necrosis in aged rats.

Objective To explore the tobacco control project based health education curriculum reform's effect of improving medical students' tobacco control.Method Choosing the students of two classes of students in preventive medicine specialty of Harbin Medical University as the research object, investigating the students respectively with the questionnaire prepared uniformly by 7 schools before and after the course.All data were coded by Epidata 3.0, and SPSS 18.0 was used to carry out the relevant information for the chi square test and t test.Result The sample size of baseline survey was114 and after the intervention was 87.The knowledge pass rate of the girls before and after the intervention were 87.3％ (48/55) and 98.2％ (54/55) respectively (P=0.000).The boys' awareness rate of the secondhand smoke safety level were 13.6％ (8/59) and 21.9％ (7/32) respectively, and the girls were 13.0％ (7/55) and 31.5％ (17/55) (P=0.021).Students interested in tobacco increased from 79.8％ (91/114) before intervention to 90.8％ (79/87) after intervention (P=0.033).Students willing to work in the tobacco related increased from 52.2％(59/114) before intervention to 66.7％ (58/87)after intervention (P=0.044).The girl who replied after intervention I am not smoking now, but won't smoke either when working in the disease control in the future reached as high as 96.4％ (53/55), but the students were lack of confidence to help people to stop smoking.Conclusion The reform of social practice activity curriculum designed for tobacco control project is effective, and it is urgent to strengthen the training of preventive medical students' smoking cessation skills and enhance their confidence.

Objective To observe the effect of Danshen in the treatment of severe hand-foot-and-mouth disease and investigate its mechanism.Methods One hundred and forty cases of children with severe hand foot and mouth diseases who hospitalized the intensive care unit were enrolled in the study from February 2012 to July 2014.The children were randomly divided into a control group and an observation group,with 70 cases in each group.The control group was given antiviral to reduce the intracranial pressure and intravenous immunoglobulin and the observation group was given Danshen in addition to the control group.The levels of neuron specific enolase (NSE)、S-100βprotein、TNF-α and IL-6 were detected at admission and checked again seven days after treatment.The changes of the above indicators and the clinical curative effect were compared before and after therapy.Results The total effective rate of the control group and the observation group was 80.0% and 92.9% respectively,showing statistical significance(P<0.05). After treatment, observation group of serum NSE (9.42 ± 2.56μg/Lvs. 11.71 ± 3.21μg/L,t=2.159), S-100β (177.34 ± 87.28 ng/Lvs. 286.14 ± 159.69 ng/L, t=2.315), TNF-α (15.98 ± 4.35 ng/Lvs. 23.17 ± 4.80 ng/L, t=4.297), IL-6 (41.72 ± 6.64 ng/Lvs. 52.05 ± 9.33 ng/L,t=3.492) , the level of were lower than those in the control group(P<0.05 orP<0.01). In the observation group, serum. The fever clearance time、the disappearance time of rash and the hospitalization time in the observation group (3.55 ± 1.02 d vs.4.55 ± 1.09 d, 7.14 ± 1.04 d) were shorter than those in the control group (4.46 ± 0.97 d vs.5.88 ± 1.44 d, 8.68 ± 1.06 d;t=5.409, 6.161, 8.677 respectively, P<0.01).Conclusions On the basis of conventional therapy,Danshen can effectively alleviate the systemic inflammatory response in children with severe hand foot and mouth diseases, reduce brain damage and improve the clinical efficacy.