Objective:To conjecture the correlation between fetal hydrothorax(FHT)and pregnancy outcome through the analysis of 95 fetuses with hydrothorax and their mothers.Methods:In this case series study, 95 FHT patients admitted to the Third Affiliated Hospital of Zhengzhou University from January 2016 to October 2022 were retrospectively analyzed.According to the pregnancy outcome, these patients were divided into the induced labor group (13 patients) and the delivery group (82 patients). General data and genetic examinations of patients in the induced labor group were analyzed to explore their pathogenesis and genetics.According to the neonatal Apgar score, patients in the delivery group were divided into the normal group and the asphyxia group.Fifteen indicators including the maternal age, gestational week at first diagnosis, maternal complications, FHT location, FHT severity, FHT outcome during pregnancy, fetal ascites, hydrops fetalis, other abnormal fetal structures, amniotic fluid volume, intrauterine treatment, gestational week of delivery, mode of delivery, sex of the newborn, and newborn birth weight in the 2 groups were comparatively analyzed by the chi-square test.With the neonatal Apgar score as the dependent variable, variables that had statistical significance during the univariate analysis were included in the regression analysis, and a multivariate binary Logistic regression equation was established to explore the factors affecting the pregnancy outcome.Results:There were significant differences in the FHT outcome during pregnancy (16/22/13 cases vs.2/18/11 cases, χ2=6.994, P=0.030), FHT severity (27/24 cases vs.9/22 cases, χ2=4.475, P=0.034), hydrops fetalis (14/37 cases vs.23/8 cases, χ2=17.012, P=0.001), amniotic fluid volume (21/30 cases vs.24/7 cases, χ2=10.228, P=0.001), intrauterine treatment (19/32 cases vs.2/29 cases, χ2=9.603, P=0.002), gestational week of delivery[(38.15±2.05) weeks vs.(34.83±3.14) weeks, t=5.748, P=0.001], and newborn birth weight[(3 325.00±637.41) g vs.(2 714.58±837.99) g, t=3.727, P=0.001]between the normal and asphyxia groups(all P<0.05). Among them, hydrops fetalis ( OR=7.070, P=0.020) and severe FHT ( OR=6.927, P=0.043) were risk factors for neonatal Apgar scores.Intrauterine treatment ( OR=0.062, P=0.027) and gestational week of delivery( OR=0.577, P=0.022) could be used as a protective factor for neonatal Apgar scores. Conclusions:Diagnosis of FHT during the early gestational weeks and multiple fetal structural abnormalities, especially hydrops fetalis, have higher probabilities of abnormal genetic examinations, and the fetal prognosis was poor.It is recommended to carry out chromosomal karyo type and microarray tests, as well as whole exome sequencing and detection of genetic syndromes(if necessary), to avoid unnecessary fetal treatment and improve the survival rate of perinatal infants after intrauterine treatment.The poor prognosis is related to hydrops fetalis and severe FHT; however, timely intrauterine treatment and prolonging pregnancy can improve the pregnancy outcome and increase the survival rate of perinatal infants.

Objective:The sensory processing measure-preschool scale(SPM-P)was transformed into Chinese,and its re-liability and validity were tested in preschool children. Method:According to Brislin's translation model,the SPM-P source scale was translated into Chinese and the Chinese version of SPM-P scale was formed.From September 2021 to December 2021,395 preschool children were investigated by cluster stratified random sampling method to test the reliability and validity of the scale. Result:The Chinese version of the SPM-P scale includes 8 dimensions of social participation,vision,hear-ing,touch,body awareness,balance and movement,planning and conception,and overall sensory system,with a total of 75 items.Cronbach alpha coefficient for the overall scale was 0.899,the split half reliability coefficient was 0.700;the test-retest reliability coefficient was 0.899.The item content validity(I-CVI)value was 0.920,the average content validity(S-CVI/Ave)value was 0.984,and the content validity was good;the results of confirmatory factor analysis showed that the construct validity was good;The results of confirma-tory factor analysis showed that the construct validity was good(x2/df=2.41,CFI=0.992,TLI=0.960,RMSEA=0.060,SRMR=0.046);The Chinese version of SPM-P scale was negatively correlated with the corresponding evaluation dimensions of the screening questionnaire for children's sensory integration disorder,and the correla-tion coefficient was between-0.585 and-0.399,with good criterion validity. Conclusion:The Chinese version of SPM-P scale has good reliability and validity and can be used for stan-dardized evaluation of sensory integration ability of preschool children in China.

Acute ischemic stroke with large vessel occlusion (AIS-LVO) refers to ischemic stroke caused by large vessel occlusion of internal carotid artery, middle cerebral artery and vertebrobasilar artery, which has the characteristics of large infarct, relatively poor outcome, higher disability and mortality. Therefore, early vascular recanalization and rescue of ischemic penumbra are the key to improve the outcome of patients with AIS-LVO. Mechanical thrombectomy (MT) has a definite effect on AIS-LVO. The current guidelines recommend that MT should be performed on the basis of IVT for AIS-LVO patients without contraindications of intravenous thrombolysis (IVT), the so-called bridging therapy. IVT can increase the risk of bleeding to a certain extent, delay MT and increase the cost of hospitalization. However, there are still many controversies about whether the patients with AIS-LVO can directly perform MT. This article reviews the comparative study of direct MT and bridging therapy in patients with anterior circulation AIS-LVO, hoping to provide reference for clinicians in the treatment of AIS-LVO.

Objective To provide more reference base for the prevention and treatment of acute cerebral infarction through the correlation study between the onset of acute cerebral infarction and meteorological factors during the same period in Dalian area.Methods From January 1,2015 to December 31,2015,the data of hospitalized medical records and meteorological data during the same period in 3 5 7 8 consecutive patients with acute cerebral infarction admitted to three tertiary hospitals in Dalian were analyzed retrospectively.The seasonal regularity of acute cerebral infarction in Dalian area was analyzed descriptively.A single retrospective 1 ∶ 1 matched case-crossover study design was used to analyze the effect of mean air temperature lag 0-3 days on the onset of acute cerebral infarction.Pearson correlation analysis was used to analyze the influence of meteorological factors of the day on the onset of acute cerebral infarction,at the same time,the relationship between stroke subtypes and meteorological factors was investigated.Results (1) The incidence of acute cerebral infarction was higher in winter (December,January,and February) and it was lower in summer (from June to August).(2) Hysteresis analysis:when the temperature was reduced by 1 ℃each time,the OR values of acute cerebral infarction lagging behind 0 and 1 d were 1.034 (95％ CI 1.012-1.056) and 1.025 (95％ CI 1.008-1.042) respectively.There was significant difference (all P ＜ 0.05).The correlation between the temperature of the day of onset and the onset of acute cerebral infarction was the highest.(3) The onset of cerebral infarction was negatively correlated with the average temperature of the day and hours of sunshine (r =-0.392,-0.260,all P ＜ 0.01),and it was positively correlated with the daily average air pressure (r =0.403,P ＜ 0.01).Among them,the correlation of the type of cardiogenic embolism and each meteorological factor was the highest.The correlation coefficients of daily average temperature,daily air pressure,and hours of sunshine were-0.836,0.733,and-0.629,respectively (all P ＜ 0.01).Conclusion A cold and high air pressure may trigger the onset of acute cerebral infarction,especially cardiogenic cerebral infarction.

Minor stroke is a common type of acute ischemic stroke. Early large-scale thrombolytic studies regarded minor stroke as a contraindication of intravenous thrombolysis. In recent years, more and more retrospective studies have shown that some minor stroke patients can still benefit from intravenous thrombolysis. Some studies are starting to identify patients who are more likely to be treated with thrombolysis, but there is still a lack of evidence-based evidence. This article summarizes the thrombolytic study of minor stroke, hoping to provide some references for nerve physicians.

Objective To explore the effects of transitional care on growth and development among late preterm infants.Methods From January 2015 to December 2016, we selected 100 late preterm infants in Hangzhou Red Cross Hospital. All of them were divided into observation group and control group with the random number table, 50 cases in each group. On discharge from hospital, control group adopted routine health guidance and telephone follow-up. Observation group carried out transitional care. And then, we compared the growth and development of infants between two groups after discharge from hospital.Results Physical growth such as weight, height and head circumference of preterm infants in observation group was higher than those in control group in the first, third and sixth month after birth (P<0.05). In the sixth month, the standard-reaching rate of physique of observation group and control group was 57.14％ and 31.91％ respectively with a significant difference (χ2=6.174,P<0.05). In the sixth month, there were two cases with readmission to hospital in observation group and 9 in control group with a significant difference (χ2=5.368,P<0.05). The parents' satisfaction of preterm infants of observation group was 87.75％ significantly higher than that of control group (χ2=20.030, P<0.001).Conclusions The model of transitional care can promote growth and development of late preterm infants, reduce the morbidity rate and readmission rate of late preterm infants, and improve parents' satisfaction.

Objective To evaluate the efficacy of superficial temporal artery(STA)pressure-guided selective cerebral perfusion(SCP)during deep hypothermic circulatory arrest(DHCA)in patients undergoing aortic arch surgery.Methods Ninety-six patients of both sexes,aged 35-64 yr,with body mass index of 19-23kg/m2,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,undergoing aortic arch surgery,were divided into STA pressure group(group A)and clinical experience group(group B)using a random number table,with 48 patients in each group.In group A,STA catheterization was performed after tracheal intubation,and arterial pressure was monitored.SCP flow was adjusted to maintain the target value of STA pressure between 30 and 40mmHg during DHCA in group A.SCP flow rate was set at 5-10ml·kg-1·min-1 according to clinical experience in group B.The volume of fluid perfused during SCP,emergence time,extubation time and duration of intensive care unit stay were recorded.Neurological function was evaluated during length of hospitalization after surgery,and the development of permanent and transient neurological dysfunction and mortality in hospital were recorded.Results Compared with group B,the volume of fluid perfused during SCP was significantly decreased,the emergence time,extubation time and duration of intensive care unit stay were shortened,the incidence of permanent and transient neurological dysfunction(2% and 4%,respectively)was decreased(P < 0.05),and no significant change was found in the mortality rate in hospital in group A(P>0.05).Conclusion Maintaining STA pressure at 30-40mmHg is a reliable method for guiding SCP during DHCA in patients undergoing aortic arch surgery.

Objective To analyze the correlation between anterior circulation artery stenosis and lacune or lacunar infarct(LI) in elderly patients.Methods A retrospective analysis of data was performed in 111 patients with intracranial artery atherosclerosis,ischemic cerebral infarction or transient ischemic attack from January to December 2016 in our hospital.All the patients underwent non-contrast brain MRI or CT scan,as well as one-stop dynamic whole brain 4D CT angiography and CT perfusion scan(CTA-CTP/ perfusion).Imaging data were retrospectively analyzed.Intracranial 4D CTA was produced by using MIP and CPR post processing.The correlation of intracranial internal carotid artery(ICA)and middle cerebral artery (MCA)stenosis with lacunar infarct or lacune was analyzed by chi-square test using IBM SPSS Statistics 22.0 software.Results The average age of 111 patients was(68.4± 6.8)years.A total of 19 phases with 6080 images were obtained by one-stop scanning.The optimal phase of artery visualization was selected from 19 phases for evaluating artery stenosis.Intracranial ICA and/or MCA stenosis were revealed in 94 patients,including 73(65.8％)patients with LI or lacune and 21 patients(18.9％)without LI or lacune.17 patients without intracranial ICA or anterior circulation of MCA stenosis included 7 patients(6.3 ％)with LI or lacune and 10 patients(9.0％)without LI or lacune.Anterior circulation vessels stenosis was positively correlated with lacunar infarction or lacune(x2 =7.794,P=0.005).94 patients with anterior circulation vessels stenosis were further divided into 2 subgroups:unilateral and bilateral stenosis.39 cases showed unilateral vessels stenosis,including 25 cases (26.6 ％) with LI or lacunein,and 14 cases (14.9 ％) without LI or lacunein.And 55 cases showed bilateral vessel stenosis,including 48 cases (51.1％)with LI or lacune,and 7 case (7.4 ％) without LI or lacune.The risk for LI or lacunein was statistically higher in bilateral vessel stenosis than in unilateral vessel stenosis(x2 =7.061,P=0.008).Patients with anterior circulation vessels stenosis combined with LI or lacune were 73 cases,including 31 cases of grade Ⅰ,19 cases of grade Ⅱ,14 cases of grade Ⅲ,and 9 cases of grade Ⅳaccording to Trial criteria(NASCET)classification,with no significant difference between the different grades of anterior circulation vessels stenosis.Conclusions A correlation between ICA or MCA stenosis and lacunar infarction or lacune may exist.Risk for lacunar infarction or lacune is higher in patients with bilateral artery stenosis than in patients with unilateral artery stenosis.

Objective To analyze the endoscopic observation of gastroduodenal ulcer radioactive injury induced by pancreatic cancer radiotherapy, and to preliminary investigate the risk factors of radiation-induced ulcer after radiotherapy in patients with pancreatic cancer. Methods A total of 112 patients with pancreatic cancer who accepted gastroscopy before and after radiotherapy at Air Force General Hospital were collected. Self-comparative study of gastroscopic findings was performed on these patients. Single factor analysis and the logistic regression analysis model were used to analyze whether the clinical factors were likely to affect the radiation-induced ulcer or not. Results The total incidence of radiation-induced ulcer was 42.0 % (47/112) in 112 patients. The history of ulcer and grade 2 or more acute gastrointestinal symptoms (P= 0.036, P= 0.030) were the independent risk factors of radiation-induced ulcer. The rest clinical factors had no influence on the radiation-induced ulcer (all P>0.05). Conclusion In the radiotherapy of pancreatic cancer, patients who has the history of ulcer or grade 2 or more acute gastrointestinal symptoms should be alert to the occurrence of radiation-induced ulcer.

Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.