Objective:To summarize and analyze the modalities and experience of retrograde distal perfusion with distal perfusion catheter (DPC) via cannulation of the posterior tibial artery in veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods:The clinical data of 15 patients who were treated with V-A ECMO and underwent DPC placement via the posterior tibial artery in our hospital from January 2022 to June 2023 were retrospectively analyzed.Results:The V-A ECMO catheterization method in 15 patients was percutaneous puncture catheterization, and all of them underwent surgical incision to indwelling retrograde DPC through the posterior tibial artery: 6 cases of preventive catheterization, 9 cases of remedial catheterization, the success rate of one-time catheterization was 93.33%, and the type of catheter was mainly 6 F sheath (66.67%). There was no ALI in preventive catheterization, and one case of osteofascial compartment syndrome occurred in remedial catheterization, and the catheterization time was (20.73 ± 3.47) min.Conclusions:In V-A ECMO, placement of DPC via the posterior tibial artery for retrograde distal perfusion is perfectly feasible, and has a high success rate, which can prevent or treat lower extremity ischemia.

Objective To explore the mediating role of depression between uremic toxins and cognitive function in end-stage renal disease(ESRD)patients,so as to provide a basis for early clinical intervention.Methods A retrospective study involved 49 predialysis ESRD patients diagnosed in the Nephrology Department of The First Affiliated Hospital of Xi'an Jiaotong University between August 2018 and October 2021,along with 50 healthy controls(HC).General information of the two groups was collected.Montreal Cognitive Assessment(MoCA),Auditory Verbal Learning Test-Huashan Version(AVLT-H),Trail Making Test A(TMT-A),Beck Depression Inventory(BDI),and Beck Anxiety Inventory(BAI)were used to collect data on cognitive function,anxiety,and depression in both groups.Serological indicators in the ESRD group were used to clarify the impact of uremic toxins on cognitive function.PROCESS v3.4.1 was applied to explore the relationship between uremic toxins,depression,and cognitive function,as well as the mediating effect of depression.Results Significant differences were found between the ESRD group and the HC group in MoCA total score(P＜0.001),AVLT-H(word learning;short-term delay;long-term delay,P＜0.001;word recognition,P=0.001),TMT-A(P＜0.001),BDI(P＜0.001),and BAI(P=0.009).Cystatin C was a negative influencing factor for short-term delay in AVLT-H(B＝-0.834,P=0.019),while BDI was a negative influencing factor for long-term delay in AVLT-H(B=-0.102,P=0.002),word recognition in AVLT-H(B=-0.071,P＜0.001),and MoCA total score(B=-0.135,P=0.002).BDI partially mediated the effect of cystatin C on short-term delay in AVLT-H(total effect,c=-0.3346;direct effect,c'=-0.223 5;mediating effect,a×b=-0.111 0;and mediating effect proportion,33.2％)and long-term delay in AVLT-H(total effect,c=-0.318 7;direct effect,c'=-0.218 8;mediating effect,a×b=-0.099 9;and mediating effect proportion,31.3％).Conclusion ESRD patients experience cognitive decline as well as anxiety and depression.Cystatin C and depression are both negative influencing factors for cognitive decline in ESRD patients.Cystatin C indirectly affects cognitive function in ESRD patients through depression.

Objective:To investigate the change of D-Dimer (D-D), cardiac troponin I (cTnI) and vasoactive-inotropic score (VIS) after Stanford type A aortic dissection (TAAD) and thier predictive effect on death outcome.Methods:120 patients with TAAD who were treated in the Affiliated Hospital of Jining Medical College from January 2019 to January 2022 were retrospectively selected and divided into death group ( n=17) and survival group ( n=103) according to the 28-day survival after operation. The difference of clinical data between the two groups was compared, and the influencing factors of postoperative death in TAAD patients were analyzed by logistic regression method. Results:The age, deep hypothermic circulatory arrest time, D-D and cTnI of the patients in the death group were (60.50±5.42)years old, (30.40±9.92)min, (15.65±5.52)g/L and (3.32±0.82)mg/L, respectively, which were significantly higher than those in the survival group (all P<0.05). The VIS score and change of VIS score in the death group at 24 hours after operation were (9.66±1.10)points and (4.50±0.91)points respectively, which were significantly higher than those in the survival group (all P<0.05). Logistic regression analysis showed that age, D-D, cTnI and change of VIS score were the influencing factors of death after TAAD (all P<0.05). The area under the receiver operating characteristic (ROC) curve predicted by the D-D, cTnI and change of VIS score for death in TAAD patients was 0.718, 0.691 and 0.789 respectively (all P<0.05). Conclusions:Postoperative death of TAAD patients is affected by their age, D-D, cTnI and change of VIS score. The D-D, cTnI and change of VIS score have certain application value in predicting postoperative death of patients.

Objective To investigate the risk factors for rebleeding after emergency esophageal variceal ligation (EVL) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical and laboratory data of 290 patients with liver cirrhosis who underwent emergency EVL in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2019, and according to the presence or absence of rebleeding within 1-year follow-up, they were divided into rebleeding group and non-rebleeding group. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was performed with the statistically significant factors as independent variables to screen out the independent risk factors for rebleeding after emergency EVL, and the receiver operating characteristic (ROC) curve was plotted to obtain the indices for predicting the probability of rebleeding and establish a predictive model. Results The univariate analysis showed that there were significant differences between the two groups in platelet count ( t =-1.888, P =0.047), Child-Pugh score ( χ 2 =5.975, P =0.049), albumin level ( t =-2.229, P =0.029), and splenic vein diameter ( t =3.808, P =0.001). The multivariate logistic regression analysis showed that Child-Pugh score (odds ratio [ OR ]=0.280, 95% confidence interval [ CI ]: 0.108-0.729, P =0.009), splenic vein diameter ( OR =1.549, 95% CI : 1.197-2.005, P =0.001) and albumin level ( OR =0.832, 95% CI : 0.729-0.949, P =0.006) were independent influencing factors for rebleeding after EVL. The predictive model based on these three factors had an area under the ROC curve of 0.796, with a sensitivity of 83.7% and a specificity of 74.5% at the cut-off value of -0.086. Conclusion Child-Pugh score, albumin level, and splenic vein diameter are independent risk factors for rebleeding after emergency EVL, and the combination of the three indices has the highest sensitivity and specificity in predicting rebleeding.

ObjectiveTo observe the effect of aerobic exercise on core symptoms and executive function in children with attention deficit hyperactivity disorder (ADHD). MethodsFrom June, 2020 to December, 2021, 64 children with ADHD at outpatient in Dushu Lake Hospital were randomly divided into control group (n = 32) and observation group (n = 32). The control group sat down and watched the cartoon for 20 minutes, and the observation group performed cycling exercise while watching the cartoon, for twelve weeks. The core symptoms were assessed with Conners Parent Symptom Questionnaire (PSQ), while the inhibition, conversion and refresh functions were assessed with the psychological test software E-Prime 2.0 system. ResultsAfter twelve weeks of treatment, the PSQ factor scores decreased in the observation group (t > 4.775, P < 0.001), and were lower than that of the the control group (t > 3.184, P < 0.001). The response time and accuracy of inhibition, conversion, and refresh functions decreased in the observation group (t > 2.259, P < 0.05), and were lower than that of the control group (t > 2.007, P < 0.05). ConclusionAerobic exercise could reduce the core symptoms of poor attention and hyperactivity impulsivity, and improve the executive functioning in children with ADHD.

Objective: To observe the effect of atorvastatin combined with insulin glargine on renal function in patients with early diabetic nephropathy. Methods: From January 2016 to March 2019, 100 patients with early diabetic nephropathy admitted to Hanzhong 3201 Hospital Affiliated with Xi′an Jiaotong University Medical School were selected as subjects. According to the random number table, patients were divided into control group and observation group, with 50 cases in each group. All patients underwent diet control, blood pressure control and symptomatic treatment. Patients in the control group were treated with insulin glargine to control blood glucose. Patients in observation group were given atorvastatin on this basis. After 16 weeks of treatment, the therapeutic effects of the two groups were observed, as well as the change in urinary albumin excretion rate (UAER), serum creatinine (Scr), C-reactive protein (CRP), total cholesterol (TC), and triglyceride (TG). Adverse reactions were observed during treatment in both groups. Results: After treatment, the levels of UAER, Scr, CRP, TC and TG of the two groups were lower than those before treatment, and the above indexes of the observation group were lower than those of the control group. The difference were statistically significant (P<0.05). During the treatment period, the incidence of adverse reactions in control group and observation group was 4.00%(2/50) and 12.00%(6/50), and there was no significant difference (P>0.05). Conclusions Atorvastatin combined with insulin glargine in the treatment of early diabetic nephropathy can effectively reduce the levels of UAER, Scr, CRP, TC and TG, and has good safety.

Objective:To evaluate the clinical effect of the treatment of scar formation after severe acne type Ⅳ by acupuncture.Methods:In Henan Traditional Chinese Medicine Hospital, 60 patients with acne who met the inclusion criteria were selected and divided into observation group and control group according to the randomized controlled grouping method. The observation group(9 male and 21 female, age 18-29) was treated with fire needle and salicylic acid.The control group(10 male and 20 female, age 18-27 ) was treated with needle and salicylic acid.The patients in both groups were treated with tanshinone capsule and salicylate acne pill orally.The course of treatment was 8 weeks. The two groups of clinical efficacy, acne severity score scale (Gags) to evaluate symptom improvement, vancouver scar scale, acne scar weight score were observed and compared.Results:Eight weeks after treatment, the effect rate was 90.00% (27/30) in the observation group and 68.97% (20/29) in the control group. The scores of Vancouver scar scale were (3.66 ± 0.91) in the observation group and (5.06 ± 1.09) in the control group ( P< 0.01). The scores of acne scar weight score were (39.40 ± 16.90) in the observation group and (53.16 ± 17.19) in the control group( P< 0.01). The scores of Gags in the observation group and the control group were (10.31 ± 2.14) and (17.55 ± 2.63)( P< 0.01), respectively. Conclusions:The treatment of Ⅳ grade severe acne skin lesions by fire needle is safe, effective, reliable and easy to operate. It can safely and effectively improve the patient’s facial skin lesions, and reduce the possibility of scar formation and pigmentation, so it is worthy of clinical application.

Objective:To evaluate the clinical effect of the treatment of scar formation after severe acne type Ⅳ by acupuncture.Methods:In Henan Traditional Chinese Medicine Hospital, 60 patients with acne who met the inclusion criteria were selected and divided into observation group and control group according to the randomized controlled grouping method. The observation group(9 male and 21 female, age 18-29) was treated with fire needle and salicylic acid.The control group(10 male and 20 female, age 18-27 ) was treated with needle and salicylic acid.The patients in both groups were treated with tanshinone capsule and salicylate acne pill orally.The course of treatment was 8 weeks. The two groups of clinical efficacy, acne severity score scale (Gags) to evaluate symptom improvement, vancouver scar scale, acne scar weight score were observed and compared.Results:Eight weeks after treatment, the effect rate was 90.00% (27/30) in the observation group and 68.97% (20/29) in the control group. The scores of Vancouver scar scale were (3.66 ± 0.91) in the observation group and (5.06 ± 1.09) in the control group ( P< 0.01). The scores of acne scar weight score were (39.40 ± 16.90) in the observation group and (53.16 ± 17.19) in the control group( P< 0.01). The scores of Gags in the observation group and the control group were (10.31 ± 2.14) and (17.55 ± 2.63)( P< 0.01), respectively. Conclusions:The treatment of Ⅳ grade severe acne skin lesions by fire needle is safe, effective, reliable and easy to operate. It can safely and effectively improve the patient’s facial skin lesions, and reduce the possibility of scar formation and pigmentation, so it is worthy of clinical application.

Objective: To analyze the genetic characteristics of Coxsackievirus A4 isolated from Taian, 2017-2018. Methods: Sixty throat swab samples of the children who visited Taian Maternal and Child Health Hospital during the year 2017-2018 and were diagnosed as hand, foot and mouth disease, were collected and aseptically inoculated. Fluorescent quantitative PCR analysis was performed using the universal primer for enteroviruses. The high-throughput sequencing was applied to the enterovirus-positive samples, and the full-length genome sequences of the viruses were obtained. Phylogenetic analysis was performed using Mega5.05 and RaxML respectively, and sequence homology and amino acid mutation sites were also analyzed using Mega5.05. Results: Four whole genome sequences of CV-A4 isolated from infants aged 17-19 months old were obtained. Phylogenetic analysis of the full length CV-A4 genomes showed that apart from MG550920/AA/Henan/2016, the remaining CV-A4 strains from China (97.2%), including the four strains from Taian, fell within Group 3. The VP1 genes could be classified into four genotypes and 98.5% of the Chinese strains belonged to genotype D, and the four strains from Taian belonged to D2. It was notable that the Taian isolate A1/Taian is closely related to two strains C179 and C062 from Australia both in the complete genome and the VP1 gene, as well as one strain YT184R isolated from Yantai in 2016 by us. Compared with the prototype CV-A4 strain High Point, 18 amino acid mutations were found in the P1 region. Conclusions Both phylogenetic trees estimated using the complete genome and the VP1 gene sequences revealed that the four CV-A4 isolates from Taian fell within the same clade with the majority of CV-A4 strains circulating in China. Compared with the prototype CV-A4 strain, several amino acid variations have occurred in the P1 region, which warrants further investigation.

Objective To explore the expression of the Pendrin gene (SLC26A4) and protein in multinodular goiter.Methods Thyroid tissues were obtained from 40 multinodular goiter patients undergoing surgery while the control group were obtained from 40 nomal thyroid tissues.RT-PCR was used to test SLC26A4 gene while western blot and immunohistochemistry were used to test Pendrin protein expression and distribution.Results SLC26A4 mRNA expression in multinodular goiter tissue was significantly increased in comparison with normal nodular tissues (t=2.663,P=0.011).Pendrin protein expression in multinodular goiter group was higher than that in normal tissue (t=2.286,P=0.026).The immunohistochemistry results showed that the Pendrin protein in multinodular goiter was mainly located in cytoplasm.There was positive expression in 24 patients (60％) in multinodular goiter group,while it was in 14 patients (35％) in the normal control group.The difference was significant (X2=5.013,P=0.025).Pendrin protein mainly expressed in cytoplasm in multinodular goiter tissue while it was mainly in cytomembrane in the normal control group.Conclusion SLC26A4 mRNA and its coding protein Pendrin expression are increased in multinodular goiter group,and mainly located in cytoplasm,indicating that iodide transporter function may be damaged when multinodular goiter occurs.