Acute kidney injury (AKI) is a common serious complication after acute ischemic stroke (AIS), which is associated with an increased mortality and disability. However, the clinical prevalence is often underestimated or overlooked. This article reviews the pathogenesis, risk factors, predictive factors, and predictive models of AKI in patients with AIS, in order to provide a basis for early clinical identification and diagnosis of AKI in patients with AIS.

Objective:To develop a risk prediction model for acute kidney injury (AKI) in young, middle-aged and elderly patients with acute ischemic stroke (AIS), and verify the predictive ability of the model.Methods:Patients admitted to the Department of Neurology, Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2018 to August 2022 were retrospectively included as a modeling cohort, and patients with AIS from September 2022 to September 2023 were prospectively included as a validation cohort. Independent risk factors for AKI were determined by multivariate logistic regression analysis, and risk prediction models for AKI in young AIS patients group and middle-aged and elderly AIS patients group were developed. The predictive power of the model was tested using the receiver operating characteristic (ROC) curve. Results:The young group included 760 patients with AIS, of which 584 (76.84%) were in the modeling cohort, and 146 (25.00%) had AKI. Multivariate logistic regression analysis showed that anemia, systolic blood pressure, homocysteine, alcohol consumption, blood urea nitrogen, and National Institutes of Health Stroke Scale (NIHSS) score were independent risk factors for AKI (all P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.938 (95% confidence interval 0.912-0.963), the Youden index was 0.747, and the optimal cut-off value was 0.249. The sensitivity and specificity of predicting AKI were 84.8% and 89.9%, respectively. A total of 1 417 patients with AIS were included in the middle-aged and elderly group, of which 833 patients (58.79%) were in the modeling cohort and 230 (27.61%) had AKI. Multivariate logistic regression analysis showed that hypertension, atrial fibrillation, previous stroke history, smoking, infection, triglycerides, NIHSS score, use of antihypertensive drugs, use of loop diuretics, serum creatinine, and blood urea nitrogen were the independent risk factors for AKI ( P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.838 (95% confidence interval 0.808-0.868), the Youden index was 0.539, the optimal cut-off value was 0.242, and the predictive sensitivity and specificity were 78.3% and 75.6%, respectively. The Hosmer-Lemeshow goodness of fit test showed the predictive accuracy of the model was in good agreement with the actual occurrence of risk (the young group: χ2=8.968, P=0.345; the middle-aged and elderly group: χ2=11.250, P=0.188). The validation cohort analysis shows that the model had high prediction accuracy and credibility in two groups. Conclusion:The model can specifically predict the risk of AKI in young, middle-aged and elderly patients with AIS, with high sensitivity and specificity.

Objective:To evaluate the efficacy of implant surface culture in identification of pathogens for fracture device-related infection.Methods:A prospective study was conducted to include the eligible patients who were diagnosed with infection after fracture fixation and needed surgical removal of the implants according to treatment principles at Division of Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Nanfang Hospital from November 2020 to January 2023. With informed consent, after rinsing with aseptic normal saline twice, their implants were gently covered with a thin layer of tryptone soy agar medium. Thereafter, the implants were incubated at 37 ℃ with 5% CO 2. Changes on the surface and in the surroundings of the implants were observed every day for consecutive 2 weeks to avoid drying up by supplementing the medium when necessary. Once pathogen colonies formed, samples were collected at 3 independent sites using sterile swabs for laboratory identification. Comparisons were made between the samples from implant surface culture and the intraoperative multisite samples from conventional culture. Results:Included were a total of 75 patients [56 males and 19 females with an age of (46.2±15.4) years]. The most common infection site was the tibia (37 cases), and the most common type of implants was plate and screw (59 cases). The positive rate of implant surface culture was significantly higher than that of conventional culture (86.7% vs. 52.0%, P<0.001). 80.5% (29/36) of the negative patients detected by the conventional culture obtained positive results by the implant surface culture; three of the positive patients detected by the conventional culture obtained negative results by the implant surface culture. The culture results were positive by both culture methods in 36 patients, and consistent by both culture methods in 35 patients, yielding a consistent rate of 97.2% (35/36). The time for implant surface culture was significantly shorter than that for conventional culture [1 (1, 2) d versus 3 (3, 4) d] ( P<0.001). Of the 65 positive patients by the implant surface culture, 59 were detected with monomicrobial infection, with Staphylococcus aureus on the top (29 cases). Conclusion:As the implant surface culture, a novel method, may be superior to the conventional culture in a significantly higher positive rate and a shorter culture time, it may be used as an effective adjunct to the conventional culture in identification of pathogens for fracture device-related infection.

Objective:To evaluate devascularized bone surface culture for identification of microorganisms for osteomyelitis.Methods:A prospective study was conducted to include the eligible patients who were diagnosed with osteomyelitis and treated at Division of Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Nanfang Hospital from December 2021 to January 2023. Their infected bone tissues were collected for both bone sample culture (BSC) and general sample culture (GSC). For BSC, the devascularized bone fragments, harvested intraoperatively, were put flat on sterile culture plates with solidified agar, their surface was gently covered with cooled and molten tryptone soy agar, and then the plates with bone samples were incubated at 37 ℃ with 5% CO 2. Meanwhile, 5 suspected samples of infected bone tissue were randomly harvested by 5 independent instruments for laboratory GSC. The culture time, bacterial species, and bacterial positive rate were compared between the 2 culture methods. Results:Included were a total of 73 patients [59 males and 14 females with an age of 49.0(31.0, 58.5) years]. The culture time for BSC [1 (1, 1) d] was significantly shorter than that for GSC [3 (2, 3) d], and the total positive rate of BSC [78.1% (57/73)] was significantly higher than that of GSC [61.6% (45/73)] ( P<0.05). The bacterial species cultured by GSC were consistent with those cultured by BSC. Conclusion:In identification of microorganisms for osteomyelitis, since BSC may be quicker and lead to a higher positive rate of bacterial culture than GSC, it can be used as an optional choice besides GCS.

As the most effective treatment for acute ischemic stroke, intravenous thrombolysis can not only improve the outcome of patients, but also affect post-stroke depression (PSD) through direct or indirect mechanisms. Therefore, it is of great clinical significance to explore the effect of intravenous thrombolysis on PSD. This article reviews the characteristics of PSD, the possible impact and mechanisms of intravenous thrombolysis on PSD, and the prevention and treatment of PSD.

Objective:To investigate the effect of psychological support during perithrombotic period on post-stroke depression (PSD) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 1, 2021 to July 31, 2021 were enrolled prospectively. The intervention group received one-to-one individual psychological support therapy in the perithrombolytic period on the basis of receiving standard intravenous thrombolytic therapy. At 30 d after onset, Hamilton Depression Scale was used to assess whether PSD occurred. Multivariate logistic regression analysis was used to evaluate the independent influencing factor of PSD. Results:A total of 126 patients with AIS were enrolled, and 86 of them were male (68.25%). Their age was 63.65±10.46 years; 65 were in the intervention group and 61 were in the control group. The incidence of PSD in the intervention group was significantly lower than that in the control group (20.00% vs. 36.07%; χ2=4.049, P=0.044). Multivariate logistic regression analysis showed that psychological intervention (odds ratio [ OR] 0.333, 95% confidence interval [ CI] 0.132-0.838; P=0.020] was an independent protective factor for PSD, while ischemic heart disease ( OR 4.510, 95% CI 1.181-17.217; P=0.028), alcohol consumption ( OR 3.421, 95% CI 1.317-8.888; P=0.012), anticoagulation therapy ( OR 3.145, 95% CI 1.155-8.567; P=0.025) and modified Rankin Scale score before thrombolysis ( OR 1.627, 95% CI 1.142-2.317; P=0.007) were the independent risk factors for PSD. Conclusion:Perithrombolytic psychological support may reduce the incidence of PSD.

Objective:To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the hippocampal lipidome in a rat model of chronic unpredictable stress(CUS).Methods:Twenty-four SD rats were randomly assigned to the following 3 groups ( n=8 for each group): sham group, CUS group and CUS+ rTMS group. The sham group received only sham stimulation and rats in the CUS and CUS+ rTMS group were subjected to CUS stimulation. Then, rats received 5 Hz rTMS (5 Hz, 1.26 Tesla) or sham rTMS for 7 days. After the last stimulation, all rats underwent sucrose preference test, open filed test and forced swimming test so as to observe the effect of rTMS on depressive behavior. Then, rats were sacrificed, and the levels of lipid composition in hippocampus were determined by high performance liquid chromatography mass spectrometry and analyzed by lipid search software version 4.1 and SIMCA-P 14.1.The software of SPSS 19.0 was used for statistical analysis. Univariate analysis of variance was used for comparison among groups, and Tukey test was used for multiple comparison. Results:(1)There were significant differences in open field test, sugar preference test and forced swimming test among the three groups( F=6.853-7.466, all P<0.05). In the open field experiment, the exploring time and percentage of movement distance in central area of rats in CUS group((50.72±6.38)s, (11.41±1.55)%) was significantly less than that of sham group ((86.06±7.31)s, (18.60±1.21)%) and CUS+ rTMS group((79.87±7.87)s, (16.74±1.27)%)(all P<0.05). The results of sucrose preference test showed that the percentage of sucrose intake of rats in CUS group ((37.63±6.06)%) was significantly lower than that in sham group ((68.30±6.39)%) and CUS+ rTMS group ((62.68±5.50)%)(both P<0.05) . In forced swimming test, the immobility time of rats in CUS group ((137.60±13.36)s) was significantly longer than that of sham group ((80.57±10.36)s)) and CUS+ rTMS group ((86.14±11.49)s) (both P<0.05). (2)The levels of lipid composition in hippocampus were significantly different in the three groups( F=3.826-15.440, all P<0.05). The contents of phosphatidylethanolamine (PE) ((20 850±956.56)×10 7, (24 133.33±1 242.04)×10 7), phosphatidylinositol (PI) ((788.78±136.11)×10 7, (953.65±131.26)×10 7), lysophosphatidylcholine (LPC) ((340.29±35.66)×10 7, (275.32±35.78)×10 7), creatine phosphate (CerP) ((239.65±18.14)×10 7, (293.82±38.28)×10 7), sphingosine (So) ((22.96±4.04)×10 7, (15.36±3.87)×10 7), diglyceride (DG) ((3.35±0.85)×10 7, (4.57±1.02)×10 7) and monoglyceride (MG) ((6.71±0.82)×10 7, (7.94±0.91)×10 7)in hippocampus of rats in CUS group were significantly higher than those of sham group(all P<0.05), while the phosphatidic acid(PA) ((424.52±33.38)×10 7, (509.22±42.09)×10 7) and acyl carnitine(AcCa) ((2.68±0.33)×10 7, (3.39±0.33)×10 7) decreased(both P<0.05). Compared with CUS group, the contents of PE(21 816.67±928.26)×10 7, PI(83.16±91.52)×10 7, LPC(323.59±33.91)×10 7, CerP(236.39±32.02)×10 7, So(23.35±4.46)×10 7, DG(3.16±0.85)×10 7 and MG(7.03±0.26)×10 7 in the hippocampus of CuS+ rTMS group decreased, while the contents of PA(421.55±44.28)×10 7 and ACCA(2.56±0.32)×10 7 in the hippocampus of CUS+ rTMS group increased (all P<0.05). Conclusion:The levels of glycerophospholipids, glyceroglycerides, sphingolipids, fatty acids and other lipids in the hippocampus of CUS model rats are abnormal. And the 5 Hz rTMS intervention can ameliorate the depression like behavior and the disturbances of lipid in hippocampus of CUS model rats.

Objective:To explore the effect of multidisciplinary team (MDT) based emergency nursing pathway in patients with traumatic shock.Methods:A total of 200 patients with traumatic shock who were admitted to Emergency Room of Emergency Department in the First People's Hospital of Lianyungang from January 2018 to December 2019 were selected as research objects. Among them, 112 patients admitted from January to December 2018 were set as the control group and they were given routine emergency nursing measures, and 108 patients admitted from January to December 2019 were set the observation group and implemented the emergency nursing pathway based on MDT. The differences in rescue response time, rescue results and family satisfaction were compared between the two groups.Results:The rescue intervention time of the observation group was (8.4±5.8) min, the emergency stay time was (15.0±4.3) min and the preoperative preparation time was (10.4±3.2) min, which was lower than (14.1±6.7) , (19.7±4.1) , (13.6±3.5) min of the control group, and the differences were statistically significant ( P<0.05) . The success rate of rescue of the observation group was higher than that of the control group (90.7% vs. 73.2%) , the incidence of multiple organ dysfunction syndrome was lower than that of the control group (7.4% vs. 17.0%) and the incidence of asphyxia was lower than that of the control group (4.6% vs. 13.4%) , and the differences were statistically significant ( P<0.05) . The satisfaction score of family members of the observation group was higher than that of the control group [ (40.8±3.6) vs. (37.4±3.8) ], and the differences were statistically significant ( P<0.05) . Conclusions:MDT-based emergency nursing pathway can significantly shorten the rescue response time of patients with traumatic shock, improve the success rate of rescue and satisfaction of family members and reduce occurrence rate of complications.

Objective To observe the characteristics of brain activation of multiple sclerosis (MS) patients and healthy controls at functional magnetic resonance imaging (fMRI) with olfactory stimulation,determine the locations of activation in areas of olfactory center and explore the MS olfactory related network.Methods Eighteen MS patients from the Affiliated Hospital of North Sichuan Medical College from February 2017 to March 2018 were enrolled as MS group,and 20 matched healthy adults during the same period served as controls.The Visual Analogue Scale was used to evaluate olfactory function in all subjects,the rest structure MRI was performed first,and volatile gases of lavender and rose solution were used to alternately stimulate olfactory during fMRI scanning.The brain activation was obtained by using matlab2013a and SPM8 softwares.The distribution and quantity of demyelination lesions were counted on T2 weighted image,and Spearman correlation analysis was done with SPSS 17.0 software package.Results The activated brain areas in the healthy control group included bilateral middle frontal gyrus,bilateral insula,bilateral supramarginal gyrus,bilateral orbitofrontal gyrus,right thalamus,right central anterior gyrus,bilateral cingulated gyrus,bilateral hippocampus,bilateral amygdala and bilateral superior frontal gyrus (t =2.11,P＜0.05).The activated brain areas in the MS group included right cerebellum,left insula,left superior temporal gyrus,right inferior frontal gyrus (t=2.19,P＜0.05).Compared with the control group,the MS group showed statistically significant decrease in activated values in right insula,right amygdala,right inferior frontal gyrus,right frontal middle gyrus,and the left supramarginal gyrus (t=2.04,P＜0.05).The distribution and number of demyelination lesions and major activation of brain regions with olfactory in the MS group demonstrated no significant correlation (r=-0.524,P=0.054).Conclusions Multiple brain areas involved in the olfactory processing and olfactory-related brain network existed.The activation of olfactory center had dominance in the right brain.The activation of the brain area in the MS group was significantly reduced,and the activation voxel and activation intensity were weakened.The olfactory-related brain network changed in MS patients.The distribution and number of demyelination lesions had no significant effect on the major activation of brain regions with olfactory stimulation.

Objective To investigate the levels of trace element in calcium, magnesium, zinc, iron and copper in maternal blood of pregnant women of different pregnancy and ages of pregnant women , and its relation to the pregnancy the age of pregnant women. Methods Calcium, magnesium, zinc, iron and copper in serum in 10 131 cases of pregnant women (3 565 cases in the first pregnancy, 6 566 cases in second pregnancy) were measured. All cases (both first pregnancy and second pregnancy) were analysed according to three age periods (less than or equal to 25, 25 to 35 years old, more than or equal to 35). Results (1)Comparing to the cases in second pregnancy, Copper in serum of the cases in first pregnancy was lower, while zinc, magnesium and iron were higher (P < 0.05). But the level of calcium had no difference (P > 0.05). (2) For the cases in the first pregnancy in different age periods, all 5 kinds of trace elements were compared. Only the zinc level in serum in the groups of 25 ~ 35 years old and more than or equal to 35 years old was higher than that in the group of less than or equal to 25 years old (P < 0.05). No difference was found in the rest of trace elements in different age groups (P > 0.05). (3) For the cases in the first pregnancy in different age stages , all 5 kinds of trace elements were compared basis on the age periods. the zinc and iron levels in serum in the groups of 25 to 35 years and more than or equal to 35 years old were higher than those in less than or equal to 25 years old (P < 0.05). No difference (P > 0.05) was found in the other three kinds of trace elements in different age periods. Conclusions (1)There are differences in trace elements, magnesium, zinc, iron and copper, and no difference in calcium in the first and second pregnancy. (2)Trace elements in serum of pregnant women in different age periods are different. (3)According to the characteristics of various trace elements in serum of pregnant women of different pregnancy and age periods, trace elements shall be supplemented to meet the needs of the pregnant women and fetus.