Between PFO and ischemic stroke has been confirmed， and the concept of PFO-AS was officially established in 2020. Contradictory embolism is considered the main pathogenesis of PFO-AS. Fibrinogen， a coagulation factor mainly synthesized by the liver， is closely related to thrombosis and is also an important risk factor for occurrence and recurrence of ischemic stroke， Its level is closely related to polymorphism of fibrinogen promoter. Currently analyzed fibrinogen β（FGβ） there more than 10，which HindⅢ（β-148C/T） gene polymorphism in the FGβ gene promoter region is closely related to plasma fibrinogen level and ischemic stroke. Therefore， a better understanding of genetic variation and susceptibility gene may be one of the best methods to help us prevent，diagnose，treat and improve the prognosis of stroke in the early stages.

Objective To investigate the expression of disulfidptosis-related genes in hepatocellular carcinoma(HCC)and the prognostic value of disulfidptosis in HCC,to construct a prognostic model,and to analyze its impact on the biological processes of HCC and sorafenib resistance.Methods The TCGA-LIHC database was used to collect the mRNA expression profiles and corresponding clinical data of HCC patients,and the LASSO-Cox regression algorithm was used to construct a four-gene predictive model for prognosis in the TCGA cohort.The external datasets ICGC and GSE14520 were used to validate the prognostic efficacy of the model,and the Cancer Drug Sensitivity Genomics(GDSC)data were used to investigate the value of the disulfidptosis model in predicting sorafenib treatment response,and gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analyses were used to investigate the biological functions of disulfidptosis-related genes.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier curve and the log-rank test were used to evaluate the difference in prognosis,and univariate and multivariate Cox regression analyses were used to investigate whether risk score was an independent influencing factor for patient prognosis.Results The univariate Cox regression analysis in the TCGA cohort showed that seven known disulfidptosis-related genes were significantly associated with overall survival(OS)in HCC(all P<0.05).The LASSO-Cox regression analysis was used to construct a prognostic model based on disulfidptosis-related genes(DRG),and the risk score RS-DRG was calculated as RS-DRG=(0.061 6)×GYS1 expression level+(0.152 8)×LRPPRC expression level+(0.268 3)×RPN1 expression level+(0.183 5)×SLC7A11 expression level.The log-rank test showed that the patients with a high risk score based on the disulfidptosis model had a significantly lower OS than those with a low risk score(P<0.001).Based on the results of the multivariate Cox regression analysis,risk score was an independent predictive factor for OS in both TCGA and ICGC cohorts(TCGA:hazard ratio[HR]=1.869,P=0.002;ICGC:HR=3.469,P=0.004).The Spearman correlation analysis showed that RS-DRG was significantly positively correlated with the infiltration level of various immune cells(including B lymphocytes,CD4+T lymphocytes,neutrophils,macrophages,and dendritic cells)in tumor microenvironment(all P<0.05).The patients in the high-risk score group had a significantly lower IC50 value of sorafenib and were more sensitive to sorafenib(P<0.001).The KEGG/GO enrichment analysis showed that the differentially expressed disulfidptosis-related genes were significantly enriched in various mitosis-related molecular functions.Conclusion This study constructed a novel prognostic model based on disulfidptosis-related genes,which has a potential clinical value in predicting the prognosis of HCC,and targeting disulfidptosis-related genes may provide a promising approach for HCC treatment.

Objective To analyze the causes of acute intestinal obstruction after intracerebral hemorrhage,and the therapeutic effect of rectal dripping with Dachengqi decoction and Fusu agent on acute intestinal obstruction complicated with septic shock.Methods The clinical data of a patient with acute intestinal obstruction complicated with septic shock after intracerebral hemorrhage,who was admitted to the Hospital of Chengdu University of Traditional Chinese Medicine(TCM)on March 5,2022,were retrospectively analyzed.The study aimed to observe the effects of rectal dripping with TCM on the recovery of intestinal function and improvement of shock.Results The patient was a 52-year-old male who underwent"left temporal craniotomy intracranial decompression,craniocerebral hematoma removal,cerebrospinal fluid leak repair"on February 19,2022 due to cerebral hemorrhage.On the 7th day after operation,the patient had hiccups and abdominal distension,and after treatment,the patient developed fever,consciousness disorders,hypotension and other symptoms.Abdominal CT showed extensive intestinal fluid,gas and expansion.Hemodynamic monitoring indicated high discharge and low resistance,intra-abdominal pressure was 21 cmH2O(1 cmH2O≈0.098 kPa),and laboratory examination showed increased inflammatory indexes and abnormal biochemical indexes.The western medicine diagnosis was acute intestinal obstruction complicated with septic shock,and the symptomatic treatments such as organ support(lung,circulation,kidney),anti-infection,fluid resuscitation,analgesia and sedation were given.The TCM diagnosis was intestinal knot(yangming visceral substantive,sudden collapse of yang-qi),with treatment principles focusing on tongfu heat relief,wenshen qianyang,Dachengqi decoction and Fusu agent was added and reduced according to the syndrome differentiation,with medications administered rectally.After the use of TCM decoction,the patient's defecation volume increased significantly,the intra-abdominal pressure decreased to the normal range,abdominal distension was significantly reduced,and the shock was relieved.On the 17th day after the operation,the patient's symptoms improved,the respiratory cycle was stable,and the patient was successfully transferred out of intensive care unit(ICU).Conclusion The treatment of acute intestinal obstruction complicated with septic shock by rectal dripping with Dachengqi decoction and Fusu agent can quickly relieve the condition and promote the recovery of intestinal function.

Embolic stroke of undetermined source （ESUS） is currently considered to be a subtype of cryptogenic stroke featuring embolic stroke on imaging but with no specific or recognized cause of stroke identified after careful diagnostic evaluation. It was speculated that anticoagulant therapy was more effective than antiplatelet therapy for secondary prevention of stroke in patients with ESUS. However， in fact， several ESUS trials showed that anticoagulant therapy was neither safer nor more effective compared with aspirin. Therefore， a more accurate understanding and determination of the etiology of ESUS is the key to treatment. In this paper， we discuss the background， definition， and diagnosis of ESUS， and analyze its etiology and the relationship between emboli and ESUS from the perspective of embolus source， with the aim to improve clinicians'understanding of ESUS.

Objective To evaluate the impact of overall burden of cerebral small vessel disease(CSVD)combined with intracranial large artery atherosclerosis(ICAS)on cognitive function in very old patients.Methods A total of 178 advanced elderly patients admitted to Department of General Medicine of Wuhan Central Hospital between January 2013 and December 2022 were re-cruited in this retrospective study.According to the results of Montreal Cognitive Assessment Scale,they were divided into dementia group(n=83)and non-dementia group(n=95).All pa-tients underwent brain MRI imaging,MRI susceptibility weighted imaging and cerebral angiogra-phy.Based on these imaging findings of MRI,the effect of total burden score of CSVD and athero-sclerosis on cognition were evaluated.The volumes of 14 different gyri in the left and right brain were measured in the patients with CSVD burden score ≤2 and those ≥3.Results There were significantly more patients with numbers of microbleeding foci＞10 and lacunar foci ≥5 in the dementia group than the non-dementia group(P＜0.01).But,no statistical difference was seen in intracranial and extracranial arterial stenosis between the two groups(P＞0.05).The volumes of left and right anterior cingulate gyrus,left and right paracingulate cortex,right hippocampus,left parahippocampal gyrus,right transverse temporal gyrus and left inferior temporal gyrus were no-tably smaller in the CSVD score ≥3 group than the CSVD ≤2 group(1723.444 vs 1867.167,1590.167 vs 1595.670,1481.466 vs 1509.540,1543.831 vs 1585.505,1038.345 vs 1305.831,1220.525 vs 1392.352,P＜0.05).Conclusion Cognitive function in the advanced elderly is mainly affected by the burden of CSVD,and atherosclerotic stenosis of large arteries is not the main fac-tor affecting cognitive function.The total burden of CSVD is correlated with atrophy of some gyri.

Objective To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis. Methods A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio ( HR ) and 95% confidence interval ( CI ), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC. Results After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group ( P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy ( P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) ( H =36.429, P < 0.001), liver stiffness measurement (LSM) ( H =13.983, P =0.004), Ishak score ( χ 2 =23.060, P < 0.001), and HAI score ( P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT ( H =7.193, P =0.028), LSM ( H =6.238, P =0.045), Ishak score ( χ 2 =7.986, P < 0.001), HAI score ( P =0.002), and HCC ( P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification ( HR =24.21, 95% CI : 0.46-177.99, P =0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC ( HR =12.69, 95% CI : 4.63-34.80, P =0.002). Conclusion Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.

Objective:To investigate the potential risk factors for cryptogenic stroke (CS) in patients with patent foramen ovale (PFO).Methods:Patients underwent PFO closure in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University from June 2018 to December 2021 were enrolled retrospectively. Transesophageal echocardiography was used to evaluate the morphological characteristics of foramen ovale and right-to-left shunt (RLS). Multivariate logistic regression analysis was used to determine the independent risk factors for CS in patients with PFO. Results:A total of 203 patients with PFO were enrolled. Their age was 41.9±14.3, and 116 patients (57.1%) were male. There were 102 patients in CS group and 101 patients in non-stroke group. The age, body mass index, systolic blood pressure and diastolic blood pressure, and the constituent ratios of male, hypertension, diabetes, hyperlipidemia and smoking of the CS group were significant higher than those of the non-stroke group (all P<0.05). The PFO channel of the CS group was longer, wider and more combined with resting RLS (all P<0.05). Multivariate logistic regression analysis showed that systolic blood pressure (odds ratio [ OR] 1.065, 95% confidence interval [ CI] 1.022-1.111; P=0.003), PFO length ( OR 1.124, 95% CI 1.004-1.258; P=0.043) and resting RLS ( OR 5.449, 95% CI 2.283-13.004; P<0.001) were the independent risk factors for CS in patients with PFO. Conclusion:Systolic blood pressure, PFO length and the presence of resting RLS are the independent risk factors for CS in patients with PFO.

Objective:To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy.Methods:A retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed.Results:Before surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups ( P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery ( P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery ( P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. Conclusion:MB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.

Cryptogenic stroke (CS) is a type of stroke that can not find the exact cause after using the standard clinical examination procedure of stroke. In recent years, many studies have shown that patent foramen ovale (PFO) is closely associated with CS, and its main pathogenesis is paradoxical embolism. In clinical practice, ultrasound is often used for PFO screening. In the context of PFO, the secondary prevention of CS includes drug therapy and PFO closure, but the choice of treatment is still controversial. Screening and evaluation of possible PFO will help to develop secondary prevention strategies for patients with CS, especially those who can benefit from PFO closure.

Objective:To explore the effect of nursing based on enhanced recovery after surgery (ERAS) in the perioperative period of children with hydronephrosis who underwent robot-assisted laparoscopic pyeloplasty.Methods:From March 2020 to March 2021, convenience sampling was used to select 60 children with hydronephrosis who underwent robot-assisted laparoscopic pyeloplasty in the First Affiliated Hospital of Zhengzhou University as the research object. According to the random number table method, the children were divided into the control group and the observation group, 30 cases in each group. The control group was given routine perioperative nursing. On this basis, the observation group conducted nursing based on ERAS. The postoperative recovery and postoperative complications of the two groups were compared.Results:The time of first eating after surgery, the time of extubation of wound drainage tube after surgery, and the average hospital stay of the observation group were shorter than those of the control group, and the differences were statistically significant ( P<0.01) . The total incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The nursing based on ERAS can effectively reduce the incidence of postoperative complications in children with hydronephrosis after robot-assisted laparoscopic pyeloplasty, and promote the postoperative recovery of children, which is worthy of clinical promotion.