At present,mechanical thrombectomy(MT)is the most effective means of achieving vascular recanalization in treating acute ischemic stroke(AIS)caused by large vessel occlusion.However,the monitoring and management of the patient's complications after MT has become a thorny clinical problem and it has attracted wide attention.Being of its non-invasive,flexible and quick diagnosis,and other advantages,the neurosonography has already established a perfect system in the evaluation and monitoring field of cerebral hemodynamic and structural pathology.With the innovation in technology and equipment,the guiding mode for non-invasive monitoring of intracranial pressure,autoregulation of cerebral blood flow,monitoring of intracranial hemorrhage and detection of other space-occupying lesions has been used for AIS patients,which has gradually become an important tool for the postoperative management of MT.This paper aims to make a comprehensive review about the application of neurosonography monitoring technology in AIS patients after MT,so as to provide a basis for the clinical implementation of prospective interventions,to enable AIS patients to obtain the maximum benefits from the postoperative management of MT,and to reduce the mortality of AIS patients.

ObjectiveThis study aims to explore risk factors for the development of major adverse cardiovascular and cerebrovascular events （MACCEs） in middle-aged and elderly patients with type 2 diabetes mellitus complicated with stable angina pectoris （T2DM-SAP） based on real-world clinical data in traditional Chinese medicine （TCM）， so as to develop a COX proportional risk prediction model and visualize the predicted results using a nomogram. MethodBased on the clinical scientific research information sharing system， the medical records of 586 T2DM-SAP patients （45-94 years old） were collected from January 2012 to December 2019， including age， gender， course of disease， major medical history， laboratory examination， tongue image， pulse image， TCM syndrome， and major treatment drugs. MACCE outcome indicators of patients were obtained by telephone follow-up and re-hospitalization records. The data was divided into a training set and a validation set according to 7∶3. In the training set， COX univariate analysis was used to determine the risk factors for MACCE in T2DM-SAP patients， and then variables were screened by forward-backward stepwise regression method， so as to establish a MACCE risk prediction model and construct a nomogram. The predictive efficacy of the model was reflected by the C-index， receiver operating characteristic （ROC） curve， calibration map， and clinical decision curve. ResultThe history of cerebrovascular disease ［Hazard ratio （HR）=1.983， 95% confidence interval （CI，1.314-2.993）］， low-density lipoprotein （LDL-C/mmol·L^-1）≥4.1［HR=2.683， 95%CI（1.461-4.925）］， dull red tongue ［HR=1.955， 95%CI（1.273-3.002）］， dull purple tongue ［HR=4.214， 95%CI（2.017-8.803）］， white thick coating ［HR=3.030， 95%CI（1.634-9.293）］， thin and weak pulse ［HR=2.233， 95%CI（1.283-3.888）］， and syndrome of wind-phlegm blocking collaterals ［HR=2.007， 95%CI（1.179-3.418）］ were found to be risk factors in middle-aged and elderly T2DM-SAP patients. Insulin ［HR=0.604， 95%CI（0.399-0.914）］， glycosidase inhibitor ［HR=0.627， 95%CI（0.409-0.962）］， and TCM treatment ［HR=0.328， 95%CI（0.214-0.503）］ were protective factors in middle-aged and elderly T2DM-SAP patients. The prediction model was constructed based on the above risk factors. The C-index of the model was 0.818 （95% CI 0.777 -0.859） in the training set and 0.814 （95% CI 0.773-0.855） in the validation set， and the change of C-index over time was plotted. The AUC of patients for 5， 10， 15 years in the training set was 0.71， 0.67， and 0.61. The AUC of patients for 5， 10， and 15 years in the validation set was 0.60， 0.68， and 0.63， respectively. The calibration map and clinical decision curves of 5， 10， 15 years were drawn in the training set and the validation set， respectively. The model was well calibrated and clinically effective. ConclusionThe history of cerebrovascular disease， LDL， dull red tongue， dull purple tongue， white thick coating， thin and weak pulse， and syndrome of wind-phlegm blocking collaterals are risk factors for MACCE in middle-aged and elderly T2DM-SAP patients， and insulin， glycosidase inhibitors， TCM treatment are protective factors for MACCE in middle-aged and elderly T2DM-SAP patients. A clinical prediction model is established accordingly. This model has good discrimination， calibration degree， and clinical effectiveness and provides a scientific basis for the prevention and treatment of MACCE in middle-aged and elderly T2DM-SAP patients.

Children and adults differ significantly in physiology,biochemistry and immune function,which leads to sig-nificant differences in blood transfusion strategies between children and adults.To guide the clinical transfusion practice of pediatric patients and improve the prognosis of children,the National Health Commission organized the formulation and re-lease of the health industry standard Guideline for Pediatric Transfusion(WS/T 795-2022).This paper will briefly introduce some concepts that help understand of the Standard and the preparation process of the Standard,and explain and interpret the preparation of the"scope","general provisions"and"factors to consider"of the Standard,hoping to contribute to the understanding and implementation of the Standard.

Objective: To explore school counselors' attitude and decision-making towards dual relationship and confidentiality. Methods: Totally 123 school counselors (27 males and 96 females, aged 20 to 60 years old, 41 primary and secondary counselors, 82 college counselors) filled up of self-designed Questionnaire for School Psychological Consultants on Dual Relationship and Confidentiality Rules, and the related factors which could influence the school counselors' attitude and their decision-making in dual relationship and confidentiality in the counseling work. Results:Totally 71.5％ (n =88) school counselors chose not to accept other relationships with students after counseling, 14.6％ (n = 18) school counselors chose to accept other relationships with students after counseling. The school counselors who had not accepted supervisioneasier to answer as "accept other relationship may raise clients self-esteem or feelings" than those had got supervision (P <0.05). The school counselor believed that the confidentiality agreement should be breached of the top 3(suicide attention, drug use and bad gangs). Counselors easier to breach confidentiality agreements on situation of students had suicide plans than situation of students had plans to run away from home(P <0.001). Conclusion:This study shows that two factors, including supervision and differential clients "issue may have effect on school counselors" attitudes and decision-making towards dual relationship and confidentiality situation in their counseling practice.

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare,critical and complicated cyanotic congenital heart disease,the natural mortality rate is high,if not treated,50％ of newborns died within 2 weeks after birth,about 85％ of newborns will die within six months.In recent years,with cardiac surgery procedures,catheter intervention and other treatment levels improved,the survival rate of newborns after surgery has improved.Over the past decade,the disease 5-year survival rate increased by 75％ or more.In this paper,PA/IVS cardiac surgery procedures,catheter intervention and hybrid treatment were reviewed,aimed at providing a reference for clinical treatment.

Objective To establish and assess the new method of APTT assay based on the combinations of Mg2+and Ca2+for lupus anticoagulants(LA)measurements.Methods This prospective study included 309 trisodium citrate anticoagulated plasma samples from 244 random patients and 65 patients with different autoimmune diseases(AID)to establish and assess the method of LA measurement, respectively.Final concentrations of 0,2.0, 4.0, 8.0,16.0 mmol/L Mg2+were added into 25 mmol/L Ca2+solution, and Actin reagent was used to measured plasma APTT of 94 patients.The applied concentration of Mg2+-Ca2+solution was confirmed through the special and significant alteration of APTT from LA-positive and -negative plasma observed in the presence of Mg 2+(test solution).Based on Actin reagent use,the test solution and 25 mmol/L Ca2+solution were applied to measure APTT of patients and normal individuals, respectively, and the ratio of Mg2+-Ca2+-APTT to Ca2+-APTT(Mg2+-Ca2+-APTT indices)and normalized Mg2+-Ca2+-APTT indices(NAR)were calculated, respectively.Mixed plasma NAR was measured,and CV%was calculated to evaluate the repeatability and stability of Mg 2+-Ca2+-APTT method.APTT of 150 patients was measured with the test solution and Actin reagent to calculate Mg 2+-Ca2+-APTT indices, and normalized LA ratio was determined with dRVVT method.The applicability of Mg2+-Ca2+-APTT assay was assessed through comparisons of the results from the two methods.Finally, NAR and NLR of 65 patients with AID(including 26 SLE patients)were measured with Mg2+-Ca2+-APTT assay and dRVVT method, respectively, and ROC curve was also used to assess the efficacy of the two methods for LA measurements.Results In all LA-negative plasma,APTT increased from 28.1 ±4.5 s to 61.2 ±7.9 s in normal APTT group,47.2 ±8.9 s to 97.5 ±10.3 s in increased APTT group,and 27.6 ± 5.1 s to 61.2 ±7.9 s in ACA-positive group when Mg2+increased from 0 to 8 mmol/L in Mg2+-Ca2+solution(F=34.12, 38.9 and 28.35,P<0.01).Following increased Mg2+concentration, APTT shortened from 0 to 4.0 mmol/L, but simultaneously prolonged from 4.0 to 16.0 mmol/L in LA-positive plasma with prolonged or normal APTT(F=31.55 and 39.51, P<0.01), and APTT was significantly higher in 8.0 mmol/L than that in 4.0 mmol/L(P<0.001).The test concentration of Mg 2+/Ca2+solution was 4.0 mmol/L.The within, inter-day CV% of NAR was 1.39%,2.30%, and 3.44%, respectively. According to the judging criteria of <0.966 and >1.034 of Mg2+/Ca2+indices, there was 141 patients with increased indices and NLR <1.20, and 9 patients with decreased ones and NLR≥1.20 in all 150 patients.The area under ROC curve of NAR and NLR for LA detection was 0.913(95%CI:0.848-0.978) and 0.892(95%CI:0.817-0.966), respectively, and the cut-off value was 0.87 and 1.13, respectively. The sensitivity and specificity of NAR(85% and 77%)was higher than that of NLR(81% and 74%), respectively.The accordant rate of positive,negative,and total results between NAR and NLR was 94.4%, 98.5%,and 98%,respectively.Conclusion The method of APTT assay based on Mg2+combining Ca2+for LA measurements is feasible,and can be used to detect plasma LA of patients.

Objective To investigate the effects of miR-200c on proliferation and apoptosis of tongue squamous cell carcino-ma (TCCS)Tca8113 cells.Methods The mimics of miR-200c were transfected into Tca8113 cells using liposome.The Tca8113 cell proliferation was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)assay.The flow cytometry as-say was used to determine the cell cycle and the apoptosis rate of Tca8113 cell.The protein expression levels of Bcl-2 and Caspase-3 in Tca8113 cell was detected by Western-blot.Results The 20,40,80 nmol/L miR-200c mimics groups inhibited the growth of Tca8113 cells,the difference compared with the control group showing statistical significance(P <0.05).The greater the miR-200c mimics concentration and the longer duration of action,the more significant the inhibition effect(P <0.05).After 48h transfecting by miR-200c mimics,the Tca8113 cells were arrested in the G0/G1 phases of cell cycle,and the apoptosis rate of the miR-200c mim-ics groups was significantly increased,the difference compared with the control group showing statistical significance(P <0.05);Western blot verified that the expression amount of Bcl-2 protein in the 20,40,80 nmol/L miR-200c groups was significantly lower than that in the control group,while the expression amount of Caspase-3 protein was significantly higher than that in the control group(P <0.05).Conclusion The overexpression of miR-200c might inhibit the proliferation of Tca8113 cell and induces their ap-optosis.

Objective To study the feasibility of laparoscopic cholecystectomy in low pneumoperitoneum pres sure and the effct of low pressure pneumoperitoneum on liver enzymes.Methods A total of 128 cases of laparoscopic gallbladder resection for gallbladder stones or chronic acalculous cholecystitis patients came from outpatient of Department of Two General Surgery of Daxing Hospital Affiliated to Capital Medical University from Jan.2010 to Apr.2015.Patients with odd hospital numbers were divided into the conventional pressure group (group A:12-14 mmHg,n =64).Patients with even numbers were divided into the low pressure group (group B:8-10 mmHg,n =64).The venous blood was respectively collected at the first day and second day preoperatively to determine and compare the contents of alanine aminotransferase (ALT) and aspartate aminotransferase(AST) in two groups.The mean and standard deviation of the above indexes and operation time of two group patients are compared.Results All patients were successfully completed surgery.The average operation time of group A was (65 ± 6.5) minutes,and group B was (61 ± 8.2) minutes,and there was no significant difference between the two groups (t =2.212,P =0.976).Compared with the A group,the B group had less effect on the aminotransferase,the data of the two groups were significantly different (P ＜ 0.05).Conclusion Laparoscopic gallbladder resection underwent the low pneumoperitoneal pressure (8-10 mmHg) is safe and feasible,doesnt extend the operation time,and helps to reduce the effect of pneumoperitoneum pressure on transaminase,which is much important for patients with abnormal aminotransferase preoperative.

ObjectiveTo investigate synergistic effect of donor livers blocked by recipient blood serum (RS) and cobra venom factor (CVF) treatment to inhibit hyperacute rejection (HAR) happened in liver xenotransplantation.MethodsThe SD rat blood serum was prepared for pre-perfusing the donor livers before experiment.24 pairs of guinea-pig (GP) and Sprague-Dawley (S.D.) rats were choiced respectively and pair-matched between GP donor and rat recipient randomly.Before transplantation,donor livers of GPs were pre-perfused by 0.5％ SD rat serum.Paired animals were divided into 4 groups randomly such as donor liver perfused by RS,recipient treated by CVF,RS+ CVF performed and Ringer solution as a control.The orthotopic liver xenotransplantations was performed with two-cuff technique.The survival time and liver function of recipients,morphological and pathological changes of rat livers were observed.ResultsThere was no piebaldism change on the recipient liver from experimental group.The survival time of recipients from RS+CVF group [(161.5±30.9) min]was longer than that of control[(45.2 ± 13.9) min] and CVF[(125.2 ± 25.5) min] or RS groups [(88.1±19.7) min] (P＜0.05).The ALT in serum of recipients from RS+CVF [(63.2±13.9)U/L]was lower than that from congtrol group [(126.1±23.3)U/L](P＜0.01) and CVF group [(79.9±18.1)U/L](P＜0.05) or RS group [(106.1±19.3)U/L](P＜0.01) The histological damages including thrombosis,interstitial bleeding and edema of recipient liver from RS+CVF group were alleviated markebly than that of other groups (P＜0.05).ConclusionThere was a synergistic effect to inhibit HAR happened in liver xenotransplantation by blocking the donor liver with recipient blood serum and CVF treatment significantly.

ObjectiveTo investigate a new way to prevent hyperacute rejection (HAR) during liver xenotransplantation through blocking the xenograft with recipient blood serum before transplantation.MethodsTwenty guinea-pig (GP) and Sprague-Dawley (SD) rats were pair-matched as donor and recipient randomly.Before transplantation,blood serum collected from other SD rats was inactivated at 45 ℃ in water bath for 30 minutes.Guinea-pig donor livers from experimental group ( n =10 ) were pre-perfused by 0.1％ solution of this blood serum,and donor livers from control group (n =10) were treated by Ringer solution.Then orthotopic liver xenotransplantations were performed by the modified two-cuff technique immediately.Liver morphology changes and survival rate and time of recipients were observed,and histopathological lesions were detected by HE staining,and liver ALT level was evaluated.ResultsThe operation time and anhepatic phases between two groups were not different significantly ( P ＞ 0.05 ).The survival rate of recipients from experimental group was higher,and its survival time was longer than that of control group significantly (P ＜ 0.01 ).The liver histological changes such as thrombosis and interstitial bleeding in experimental group was less severe than that in control group (P ＜0.01 ).The level of ALT in blood serum of rats from experimental group were lower than that from control group significantly ( P ＜ 0.05).ConclusionsThe results suggested that blocking the donor graft with recipient blood serum inhibits HAR during liver xenotransplantation.