Prognosis analysis of marginal heart donor in heart transplantation / 中华胸心血管外科杂志

Objective:To investigate the prognosis of marginal donor heart in heart transplantation.Methods:The clinical data of consecutive heart transplant recipients and donors in Zhengzhou 7th. People’s Hospital from April 2018 to November 2022 were retrospectively included. According to the definition of marginal donor hearts, the patients were divided into conventional donor hearts group (117 cases) and marginal donor hearts group ( 62 cases), the data before and after heart transplantation of the two groups were analyzed.Results:The main reason for the formation of marginal donor hearts was the cold ischemia time of donor hearts >6 h; it was easier to receive marginal donor hearts with ECMO and MV before operation; the use of marginal donor hearts in heart transplantation increased postoperative mechanical ventilation time, surgical post-intensive care unit length of stay; patients with marginal donors had lower survival than conventional donors, but did not produce a significant difference in survival after heart transplantation.Conclusion:The application of marginal donor heart in heart transplantation is an effective method to solve the shortage of heart organs and reduce the death of transplant waiting persons.

Association between the magnitude of systolic blood pressure reduction after successful endovascular thrombectomy with outcomes and post-procedure symptomatic intracranial hemorrhage in acute large vessel occlusion stroke patients / 中国脑血管病杂志

Objective To explore the association of the magnitude of systolic blood pressure reduction(SBPr)with post-procedure 24 h symptomatic intracranial hemorrhage(sICH)and 90-day clinical outcomes in patients with successful endovascular thrombectomy(EVT).Methods Consecutively registered patients with EVT caused by anterior circulation large vessel occlusion stroke(LVOS)in the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital)between July 2015 and April 2023 and patients with successful reperfusion were analyzed.Demographic data,medical history(hypertension,diabetes),the trial of Org 10172 in acute stroke treatment(TOAST)classification,the baseline National Institutes of Health Stroke Scale(NIHSS)score and the baseline Alberta stroke early CT(ASPECT)score of patients were collected.And procedure related parameters(including time from onset to puncture,time from onset to reperfusion,occluded site[internal carotid artery,M1 segment of middle cerebral artery,M2 segment of middle cerebral artery],collateral circulation status[determined based on preoperative occluded angiography showing the range of collateral circulation in the occluded vessel area,defined as good collateral circulation with a reflux range of ≥ 50％and poor collateral circulation with a reflux range of＜50％]),immediate postoperative reperfusion status(evaluated using the modified thrombolysis for cerebral infarction[mTICI]grading,successful reperfusion defined as mTICI grading of 2b-3),24 hours sICH,and 90 days clinical outcomes(evaluated using the modified Rankin scale score at 90days after EVT,with a score ≤ 2indicating a good prognosis and a score＞2indicating a poor prognosis).SBPr was defined as(baseline SBP-mean SBP)/baseline SBP x 100％.According to the the magnitude of SBPr,SBPr is divided into 5 categories(＜-10％,-10％-10％,＞10％-20％,＞20％-30％and＞30％).Based on the clinical outcomes at 90 days and the occurrence of sICH at 24 hours after EVT,patients were divided into a good prognosis group and a poor prognosis group,as well as an sICH group and a non-sICH group.The relationship between SBPr and postoperative 90 days clinical prognosis or sICH was analyzed using a binary Logistic regression model.Subgroup analysis was conducted based on a history of hypertension(yes and no),continuous intravenous hypotensive therapy(yes and no),baseline ASPECT scores(3-5 and 6-10),and collateral circulation status(good and bad).Using a restricted cubic plot to depict the relationship between SBPr and sICH and clinical prognosis at 90days.Results(1)In total,731 patients were included.The median age was 71(62,77)years and 424(58.0％)were men.The median baseline NIHSS score was 14(12,18),the median baseline ASPECT was 9(7,10),405(55.4％)patients achieved 90-day modified Rankin scale score 0-2,and 35 patients(4.8％)developed sICH.(2)Multivariate analysis showed that the older age(OR,1.036,95％CI 1.017-1.056),the higher baseline NIHSS score(OR,1.095,95％CI1.049-1.144),the lower baseline ASPECT score(OR,0.704,95％CI 0.636-0.780),diabetes(OR,1.729,95％CI 1.084-2.758),bad collateral circulation(good collateral circulation vs.bad collateral circulation,OR,0.481,95％CI 0.332-0.696)and SBPr＞30％(SBPr-10％-10％as a reference,OR,2.238,95％CI 1.230-4.071),the higher the risk of poor clinical outcomes at 90 days(all P＜0.05).Continuous intravenous hypotensive therapy is a risk factor for postoperative 24 h sICH(OR,2.278,95％CI 1.047-4.953;P=0.038),while SBPr 20％-30％is associated with a lower risk of postoperative 24 h sICH(SBPr-10％-10％as a reference,OR,0.362,95％CI0.131-0.998;P=0.049).(3)The restrictive cube plot shows that there is a U-shaped relationship between SBPr after EVT and poor clinical outcomes at 90 days,while there is a nearly linear relationship with the occurrence of sICH.The more SBP reduction,the lower the incidence of sICH.(4)In the subgroup analyses,in the non-hypertension history and the good collateral circulation group,SBPr＞30％has a higher risk of poor clinical outcomes compared to SBPr-10％-10％(OR and 95％CI were 2.921[1.000-8.528]and 2.363[1.078-5.183],respectively,with P=0.05 or P＜0.05);After EVT,the group receiving continuous intravenous hypotensive therapy and the baseline ASPECT score 6-10 groups showed a significant correlation between SBPr＞30％and poor clinical outcomes at 90 days(SBPr-10％-10％as a reference,OR and 95％CI were 2.646[1.168-5.993]and 2.481[1.360-4.527],respectively,with P＜0.05).The correlation between SBPr and lower incidence of sICH was only found in the subgroup of poor collateral circulation(SBPr-10％-10％as a reference,SBPr＞20％-30％:OR,0.133,95％CI 0.027-0.652;SBPr＞30％:OR,0.104,95％CI 0.013-0.864;all P＜0.05).Conclusions Among patients who achieved successful reperfusion with EVT,SBPr might be related to a worse functional outcome at 90 days and sICH 24 h after operation.However,the relationship may exhibit significant heterogeneity across different subgroups.Baseline ASPECT score,history of hypertension,collateral circulation,and the use of continuous venous hypertension after EVT have been highlighted in individualized blood pressure management after EVT.

Research progress on perioperative nutritional management for gastric cancer / 实用肿瘤学杂志

Gastric cancer is one of the common tumors in the world and a major cause of cancer death.Although the 5-year survival rate of gastric cancer patients has increased greatly with the improvement levels of diagnosis and treatment,the high malnutri-tion rate of gastric cancer patients still has a significant impact on their overall survival and quality of life.Malnutrition is considered an independent prognostic factor for cancer patients,early detection of malnutrition in gastric cancer patients and more reasonable peri-operative nutritional support play an important role in the survival and prognosis of gastric cancer patients.This article combines exist-ing research at domestic and abroad to review the nutritional risk screening and assessment of gastric cancer patients during periopera-tive period,as well as the research progress of perioperative nutritional support and immunonutrition,in order to provide more compre-hensive nutritional management strategies for patients with gastric cancer during the perioperative period.

Safety and efficacy analysis of endovascular thrombectomy in patients with large vascular occlusion with low Alberta Stroke Program Early Computed Tomography Score / 中华内科杂志

Objective:To evaluate the safety and efficacy of endovascular thrombectomy (EVT) in acute anterior circulation large vessel occlusive stroke (ALVOS) and explore the related influencing factors for prognoses in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECT).Methods:Patients with acute ALVOS who underwent EVT in Yijishan Hospital of Wannan Medical College from January 2019 to June 2022 were sequentially enrolled. (1) Patients were divided into a low ASPECT group (0-5) and a non-low ASPECT group (6-10), and the differences between the two groups were compared with respect to incidence of perioperative complications and good prognosis rate [modified Rankin scale (mRS) score≤2] 90 days after onset. (2) According to the prognoses 90 days after onset, the low ASPECT group was divided into the good prognosis (mRS score≤2) and poor prognosis (mRS score>2) subgroup. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent risk factors for prognoses of the low ASPECT patients after EVT.Results:A total of 582 patients [age 26-94(69±11) years, 345 male patients (59.3%)] were enrolled for analysis. The baseline ASPECT score was 8 (7, 10), and the baseline NIHSS score was 14 (11, 18). Among them, 102 (17.5%) patients were in the low ASPECT score group and 480 (82.5%) patients were in the non-low ASPECT score group. In the total cohort, patients in the low ASPECT score group had a higher incidence of symptomatic intracranial hemorrhage, lower 90-day good prognosis rate, and higher 90-day mortality rate. Further, propensity score matching statistical analysis showed that patients in the low ASPECT score group had a significantly higher incidence of malignant brain edema after EVT treatment (40.0% vs. 17.6%, χ2=9.13, P=0.003), and a significantly lower 90-day good prognosis rate (24.7% vs. 41.6%, χ2=4.96, P=0.026), but there was no significant difference in the incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (40.3% vs. 26.0%, χ2=3.55, P=0.060). Among 102 patients with low ASPECT score, 22 (21.6%) patients had good prognosis and 80 (78.4%) had poor prognosis. Multivariate logistic regression analysis showed that history of atrial fibrillation ( OR=4.478, 95% CI 1.186-16.913, P=0.027) was an independent risk factor for poor prognosis of EVT in patients with low ASPECT score, while good collateral circulation (grade 2 vs. grade 0: OR=0.206, 95% CI 0.051-0.842, P=0.028) was a protective factor for good prognosis of EVT in patients with low ASPECT score. Conclusions:Although the 90-day good prognosis rate of EVT treatment for patients with low ASPECT score was lower than that of the non-low ASPECT group, 21.6% patients still benefitted from EVT treatment, especially patients with non-atrial fibrillation and good collateral circulation. Future studies involving more patients are needed to validate our observations.

Risk factors and prognostic analyses of acute kidney injury after heart transplantation / 中华器官移植杂志

Objective:This study aims to investigate the incidence, risk factors, and prognosis of acute kidney injury after heart transplantation.Methods:Clinical data of 180 recipients of heart transplantation at Zhengzhou Seventh People's Hospital from April 2018 to November 2022 are retrospectively analyzed. According to whether AKI occurred 7 days after surgery, the recipients are divided into a non AKI group(85 cases)and an AKI group(95 cases). The baseline data, general perioperative conditions, and clinical data of the two groups of recipients are compared using chi square test and rank sum test to identify possible influencing factors for AKI after heart transplantation.Determine independent risk factors through binary logistic regression.The Kaplan Meier method is used to draw survival curves to further clarify the impact of AKI on the survival and cumulative hospitalization of heart transplant recipients.Results:The incidence of postoperative AKI in 180 recipients of this study is 52.7%(95/180). Univariate analysis showed that there are statistically significant differences in recipient age, preoperative albumin, platelet count, graft cold ischemia time, and surgical time between the AKI group and the non AKI group(all P<0.05). Further multivariate analysis showes that recipient age( OR=1.021, 95% CI: 1.001~1.043, P=0.043), surgical time( OR=1.005, 95% CI: 1.001~1.008, P=0.005), platelet count( OR=0.995, 95% CI: 0.990~1.000, P=0.034), and donor cold ischemia time ( OR=0.996, 95% CI: 0.993~0.996, P=0.004)are independent risk factors for AKI after heart transplantation. Prognostic analysis showed that 35.7%(25 cases)of the AKI group received continuous renal replacement therapy(CRRT)after surgery, and 31.9%(23 cases) received aortic balloon counterpulsation(IABP)after surgery. Compared with 0 and 8.9%(7 cases)of the AKI group without AKI, the differences are statistically significant(all P<0.01). Compared with the non AKI group, the invasive mechanical ventilation time is 614 (504, 707) hours and 540 (460, 610) hours( P<0.01), the stay time in the intensive care unit is 12(8, 16)days and 10(6, 15)days( P=0.050), and the estimated glomerular filtration rate(eGFR)on the 7th day after surgery is 10(6, 15)ml/(min·1.73 m 2)and 68(57.5, 91.0)ml/(min·1.73 m 2)( P<0.01), with statistical significance. The cumulative survival rate of the AKI group after heart transplantation is lower than that of the non AKI group, and the cumulative hospitalization rate Is higher than the latter. The differences between the groups are statistically significant(all P<0.01). Conclusions:The incidence of AKI after heart transplantation is relatively high, and recipient age, platelet count, graft cold ischemia time, and surgical time are independent risk factors for AKI. Recipients with AKI after heart transplantation have a higher proportion of postoperative use of CRRT and IABP, longer invasive mechanical ventilation time and monitoring room stay time, and lower eGFR on the 7th day after surgery; at the same time, recipients with AKI after heart transplantation have a lower postoperative survival rate and a higher cumulative hospitalization rate.

Association of door-in-door-out time with clinical outcomes in patients with acute large vessel occlusion stroke of anterior circulation after early endovascular therapy / 中华神经科杂志

Objective:To investigate the association between door-in-door-out time (DIDO) and clinical outcome of patients with acute large vessel occlusion stroke (AIS-LVO) of anterior circulation after early endovascular therapy (EVT).Methods:The patients with AIS-LVO of anterior circulation who received EVT in the advanced stroke center of the Yijishan Hospital of Wannan Medical College from February 2019 to December 2021 were retrospectively analyzed. The baseline characteristics, time metrics and clinical outcomes were collected. DIDO was defined as the duration of time from arrival to referral at the primary stroke center, and the primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months after EVT. Univariate and multivariate regression analysis was used to explore the relationship between DIDO and early endovascular treatment clinical outcomes in patients with AIS-LVO.Results:A total of 320 patients [aged (69.6±10.2) years] were enrolled. The baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program early CT score were 14 (11, 18) and 8 (7, 9). The DIDO time was 76 (50, 120) minutes. DIDO was not an independent correlation factor for clinical outcomes in patients with EVT in the overall population. However, in patients receiving early EVT (onset-to-reperfusion≤300 minutes), DIDO ( OR=1.030, 95% CI 1.001-1.059, P=0.041) was an independent correlating factor of clinical outcome in patients with EVT. According to the receiver operating characteristic curve, the DIDO cutoff of 74.5 minutes can be used as an important indicator of prehospital delay in referral to EVT for large vascular occlusion stroke. Door to computed tomography time ( OR=1.393, 95% CI 1.212-1.601, P<0.001) and computed tomography to transfer time ( OR=1.386, 95% CI 1.220-1.575, P<0.001) were factors associated with DIDO≤74.5 minutes in a multivariate analysis in this time frame. Conclusions:In transferred patients undergoing EVT early, DIDO has a signifificant impact on clinical outcome. DIDO can be used as an important quality control indicator to evaluate the referral process for patients with AIS-LVO.

Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Influencing factors of early mortality after heart transplantation and constructing a prediction model / 中华器官移植杂志

Objective:To explore the risk factors for early mortality in heart transplant(HT)recipients and construct a nomogram prediction model.Methods:From 2018 to 2022, preoperative clinical data were retrospectively reviewed for 163 consecutive HT recipients.Risk factor variables were shortlisted by univariate correlation analysis based upon early(90-day)postoperative patient survival.Lasso regression was then employed for screening all variables and common variables were combined.A nomogram was constructed for predicting the probability of early mortality after considering actual circumstance.Receiver operating characteristic(ROC)curve, area under the ROC curve(AUC), Harrell's C-index and calibration curves were employed for evaluating and internally validate the performance of the model.Decision curve analysis was performed for assessing clinical utility of the model.Results:In survival and mortality groups, mechanical ventilation, nervous system lesions, use of extracorporeal membrane oxygenation, red blood cell count ≤3.52×10 12/L, mean pulmonary arterial pressure>27 mmHg, pulmonary vascular resistance>4.01 Wood Unit, albumin≤33 g/L, aspartate aminotransferase >50 U/L, hemoglobin ≤108 g/L, platelet count ≤109×10 9/L and total bilirubin>57 μmol/L demonstrated statistically significant differences( P<0.05). At the same time, according to actual situations and different variables, hemoglobin ≤108 g/L, albumin ≤33 g/L, platelet count ≤109×10 9/L, total bilirubin>57μmol/L, aspartate aminotransferase>50 U/L, nervous system lesions and average pulmonary arterial pressure >27 mmHg were seven variables.And a nomogram with relatively high reliability was constructed for predicting the probability of early mortality post-HT(nomogram model evaluation, AUC 0.917, C index 0.910 and good calibration curve). Decision curve analysis indicated that the nomogram could benefit HT recipients. Conclusions:Risk factors have been identified for early mortality in HT recipients.And the nomogram prediction model offers a simple and reliable tool for predicting early mortality post-HT.It has important implications for individualized treatment of HT candidates.

Clinical efficacy of mechanical thrombectomy in advanced age patients with acute anterior circulation large vessel occlusive stroke / 中华神经医学杂志

Objective:To evaluate the benefits and risks of advanced age patients with acute anterior circulation large vessel occlusive stroke (ALVOS) accepted mechanical thrombectomy (MT), and explore the related influencing factors for prognoses in these patients.Methods:Six hundred and eighty patients with acute anterior circulation ALVOS accepted MT in 3 comprehensive stroke centers from January 2014 to December 2020 were sequentially collected. (1) Patients were divided into advanced age group (≥80 years old) and non-advanced age group (<80 years old) according to age, and the differences between the two groups were compared in successful postoperative vascular recanalization rate, incidence of perioperative complications, and good prognosis rate (modified Rankin scale [mRS] scores≤2) and mortality 90 d after onset. (2) Patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) according to the prognoses 90 d after onset; univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the patients after MT. (3) According to the prognoses 90 d after onset, the advanced age patients were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2). Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the elderly patients after MT.Results:(1) In these 680 patients, 92 patients (13.5%) were into the advanced age group and 588 patients (86.5%) were in the non-advanced age group; patients in the advanced age group had significantly lower successful recanalization rate (67.4% vs. 77.9%), significantly lower good prognosis rate 90 d after onset (20.7% vs. 50.2%), and statically higher mortality 90 d after onset (40.2% vs. 21.1%) as compared with the non-advanced age group ( P<0.05); however, there was no significant difference between the two groups in the incidences of symptomatic intracranial hemorrhage (sICH, 15.6% vs. 10.6%) and malignant cerebral edema (MCE, 12.2% vs. 17.6%, P>0.05). The baseline data of the advanced age and non-advanced age patients were further matched with propensity score matching analysis (1:1) and statistically analyzed: the 91 elderly patients had significantly lower good prognosis rate 90 d after onset (20.9% vs. 36.3%) and MCE incidence (12.4% vs. 33.3%) than the 91 non-elderly patients ( P<0.05); there was no significant differences in successful vascular recanalization rate (67.0% vs. 71.4%), sICH incidence (15.7% vs. 17.6%) or mortality 90 d after onset (39.6% vs. 37.4%) between the two groups ( P>0.05). (2) Among the 680 patients, 314 (46.2%) had good prognosis and 366 (53.8%) had poor prognosis. As compared with the good prognosis group, the poor prognosis group had significantly higher proportion of patients at advanced age, significantly lower proportion of male patients, significantly higher proportion of patients with hypertension, diabetes or atrial fibrillation, significantly lower baseline Alberta Stroke early CT (ASPECT) scores, significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, statistically higher proportion of patients with cardiogenic embolism, significantly lower incidence of tandem lesions, significantly shorter time from onset to sheathing, statistically higher proportion of internal carotid artery occlusion, significantly lower proportion of patients with grading 2 collateral circulation, and significantly lower proportion of successful vascular recanalization ( P<0.05). Advanced age ( OR=3.144, 95%CI: 1.675-5.900, P<0.001) was an independent factor for prognoses 90 d after MT, in addition to baseline ASPECT scores, baseline NIHSS scores, diabetes mellitus, successful recanalization, and collateral circulation grading. (3) In the advanced age group, there were 19 patients (20.7%) with good prognosis and 73 patients (79.3%) with poor prognosis. As compared with the good prognosis subgroup, the poor prognosis subgroup had significantly lower proportion of male patients, significantly lower proportion of patients with grading 2 collateral circulation or complete recanalization, and significantly higher baseline NIHSS scores ( P<0.05). Baseline NIHSS score ( OR=1.482, 95%CI: 1.187-1.850, P=0.001) was an independent factor for prognoses 90 d after MT in advanced age patients. Conclusion:Although advanced age is an independent risk factor for prognoses of patients with acute anterior circulation ALVOS accepted MT, there are still some advanced age patients benefiting from MT without increased complications, especially for those with low baseline NIHSS scores.

The relationship between periprocedural thrombus migration and clinical outcomes in patients with acute large vessel occlusion after mechanical thrombectomy / 中华神经科杂志

Objective:To investigate the early predictive factors of periprocedural thrombus migration and the relationship between periprocedural thrombus migration and prognosis after mechanical thrombectomy (MT) in stroke patients.Methods:The patients with anterior circulation acute large vessel occlusion stroke (ALVOS) who underwent MT in the Stroke Center of Yijishan Hospital of Wannan Medical College from May 2015 to December 2019 were retrospectively analyzed. The baseline characteristics, procedural and clinical outcomes were collected. Univariate and multivariate regression analysis was used to explore the risk factors of thrombus migration and the relationship between thrombus migration and prognosis of patients.Results:There were 302 ALVOS patients [(68.8±11.0) years old and 166 males (55.0%)] included, of whom thrombus migration was identified in 80 patients (26.5%), including 60 cases (75.0%) of proximal migration. Cardiogenic stroke ( OR=2.722, 95% CI 1.367-5.418, P=0.004) and clot burden score (CBS; OR=0.849, 95% CI 0.745-0.968, P=0.015) were independent risk factors of thrombus migration. Proximal migration ( OR=2.822, 95% CI 1.220-6.528, P=0.015) was an independent risk factor of 90-day clinical outcome, while the effect of distal migration on 90-day clinical outcome was not statistically significant. Conclusions:Cardiogenic stroke and lower CBS score are independent predictors of periprocedural thrombus migration in ALVOS patients who underwent MT. Proximal migration is an independent risk factor for the prognosis of patients, which has important clinical intervention significance.

Clinical-radiomics combined model in prediction of early hematoma expansion after spontaneous intracerebral hemorrhage / 中华神经医学杂志

Objective:To explore the risk factors for early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH), and construct a clinical-radiomics combined model to predict HE after sICH.Methods:From April 2014 to September 2020, 339 patients with sICH who underwent plain CT scans in Radiology Department of our hospital were recruited. Patients were divided into HE group and non-HE group according to whether HE occurred (HE was defined as an increase in hematoma volume>33% or 6 mL on the follow-up CT within 24 h). The clinical data of non-HE group and HE group were compared, and multivariate Logistic regression analysis was used to detect independent risk factors for HE. The radiomics features were extracted from the regions of interest of the hematoma in the first CT scan images; the optimal radiomics features were selected using least absolute shrinkage and selection operator (LASSO) regression model and 10-fold cross-validation method, and then, the radiomics scores (R-score) were calculated; the risk factors for HE (clinical data) and R-score (radiomics data) were used to construct the clinical model, R-score model, and clinical-radiomics combined model; receiver operating characteristic (ROC) curve was performed to evaluate the prediction performance of clinical model, R-score model, and clinical-radiomics combined model; the best model was visualized as a nomogram and a calibration curve was drawn to evaluate the prediction accuracy of this model.Results:As compared with patients in the non-HE group, patients in the HE group had shorter time from sICH onset to first CT, higher percentage of patients with diabetes, lower platelet count, lower Glasgow Coma Scale (GCS) scores, and larger baseline hematoma volume in CT image, with significant differences ( P<0.05). Multivariate Logistic regression analysis showed that baseline hematoma volume ( OR=1.015, 95%CI: 1.000-1.030, P=0.046), GCS scores ( OR=0.914, 95%CI: 0.839-0.995, P=0.039), time from sICH onset to first CT ( OR=0.855, 95%CI: 0.741-0.987, P=0.032), and diabetes ( OR=0.522, 95%CI: 0.311-0.875, P=0.014) were independent risk factors for HE. By using LASSO regression and 10-fold cross-validation method, 20 optimal radiomics features were finally selected. The area under ROC curve of clinical model, R-score model, and clinical-radiomics combined model were 0.650, 0.860, and 0.870, respectively. The calibration curve showed that the prediction accuracy of clinical-radiomics combined model in early HE had good consistency with the actual occurrence probability. Conclusion:The clinical-radiomics combined model could effectively predict early HE with good calibration, which is helpful in individualized clinical assessment of risk of early HE in SICH patients.

Qualitative research of initial motivation of undergraduate nursing students participating in aged nursing voluntary service in aged care facility / 中国实用护理杂志

Objective:To explore the initial motivation of nursing students to engage in voluntary service for the aged, and to provide scientific basis for the formulation of strategies and measures of voluntary service for the aged.Methods:Totally 25 nursing students volunteers who regularly participated in the volunteer service for the aged in Changsha First Welfare Home were selected by objective sampling method for semi-structured in-depth interviews, and the data were analyzed by Colaizzi phenomenological 7-step analysis method.Results:Four themes of nursing students' initial motivation to participate in voluntary service for the aged were extracted: self-interest motivation, altruistic motivation, affinity motivation and achievement motivation. Among them, self-interest motivation included two sub-themes: enriching college life and life experience, improving one's own ability and gaining professional experience; altruistic motivation included two sub-themes: accompanying and helping the elderly and eliminating loneliness of the elderly; affinity motivation included two sub-themes: establishing emotional sustenance and making up for the lack of emotion; achievement motivation included two sub-themes: facing challenges bravely, acquiring a sense of achievement, serving society and others, and realizing one's own value.Conclusion:Nursing students have a clear initial motivation to participate in the voluntary service for the aged of the aged care facilities, and schools can strengthen the relevant education for students to participate in voluntary service in the training of nursing talents. The voluntary service for the aged can formulate corresponding development strategies and incentives according to the initial motivation of nursing students, so that promote the expansion and stability of the voluntary service for the aged team, and promote the development and improvement of voluntary service for the aged.

Research progress of anterior circulation tandem lesions / 中华神经科杂志

Tandem lesions are relatively rare type of acute large vascular occlusion. At present, the clinical treatment strategy of tandem lesions is still unclear and lack of definite evidence-based medicine. This article reviews the characteristics, endovascular treatment strategy and clinical prognosis of anterior circulation tandem lesions, and looks forward to the treatment of tandem lesions.

Noncontrast Computed Tomography-Based Radiomics Analysis in Discriminating Early Hematoma Expansion after Spontaneous Intracerebral Hemorrhage

Objective@#To determine whether noncontrast computed tomography (NCCT) models based on multivariable, radiomics features, and machine learning (ML) algorithms could further improve the discrimination of early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH). @*Materials and Methods@#We retrospectively reviewed 261 patients with sICH who underwent initial NCCT within 6 hours of ictus and follow-up CT within 24 hours after initial NCCT, between April 2011 and March 2019. The clinical characteristics, imaging signs and radiomics features extracted from the initial NCCT images were used to construct models to discriminate early HE. A clinical-radiologic model was constructed using a multivariate logistic regression (LR) analysis. Radiomics models, a radiomics-radiologic model, and a combined model were constructed in the training cohort (n = 182) and independently verified in the validation cohort (n = 79). Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate the discriminative power. @*Results@#The AUC of the clinical-radiologic model for discriminating early HE was 0.766. The AUCs of the radiomics model for discriminating early HE built using the LR algorithm in the training and validation cohorts were 0.926 and 0.850, respectively.The AUCs of the radiomics-radiologic model in the training and validation cohorts were 0.946 and 0.867, respectively. The AUCs of the combined model in the training and validation cohorts were 0.960 and 0.867, respectively. @*Conclusion@#NCCT models based on multivariable, radiomics features and ML algorithm could improve the discrimination of early HE. The combined model was the best recommended model to identify sICH patients at risk of early HE.

Differential expression of miR-30a-5p in post stroke depression and bioinformatics analysis of the possible mechanism / 浙江大学学报·医学版

OBJECTIVE@#To investigate the differential expression of miR-30a-5p in patients with poststroke depression and explore the possible mechanism.@*METHODS@#We obtained the target microRNAs through searching PubMed using the online software VENNY2.1. We collected the baseline demographic, clinical and radiographic data from consecutive patients with first-ever acute ischemic stroke on admission in our department from October, 2018 to March, 2019. From each patient, 5 mL peripheral venous blood was collected upon admission. Hamilton Depression Scale (HAMD-17) was used to evaluate the degree of depression at the end of the 3-month follow-up. The patients with a HAMD-17 score≥7 were diagnosed to have depression according to the diagnostic criteria of the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV). The patients were divided into post-stroke depression group (PSD group, =11) and non-post-stroke depression group (non-PSD group, =25), and their plasma levels of miR-30a-5p were detected using qPCR. The STARBASE Database ENCORI miRNA-mRNA module and Comparative Toxicogenomics Database were used to predict and screen the possible target genes related to miR-30a-5p, and the possible mechanism of the target genes was further analyzed through bioinformatics.@*RESULTS@#miR-30a-5p was identified by cross-screening as the target miRNA associated with stroke and depression and showed obvious differential expression between PSD and non-PSD patients (2.462±0.326 1±0.126, < 0.0001). ROC curve analysis showed that the AUC of miR-30a-5p for predicting PSD was 0.869 (95%: 0.745-0.993, =0.0005) at the cutoff value of 1.597, with a sensitivity and specificity of 0.727 and 0.840, respectively. The target proteins of miR-30a-5p involved a wide range of biological processes, including signal transduction, intercellular communication, regulation of nucleobase, nucleoside, nucleotide and nucleic acid metabolism. KEGG pathway enrichment analysis showed that the target proteins affected mainly the neural nutrient signaling pathway, axon guidance signaling pathway and insulin signaling system. We also identified the top 20 HUB genes that might be associated with post-stroke depression.@*CONCLUSIONS@#Plasma miR-30a-5p is differentially expressed in PSD and can serve as a new blood marker for diagnosis and also a therapeutic target of PSD.

Relationship between blood pressure after early endovascular treatment and clinical prognoses in patients with acute large vessel occlusion stroke of anterior circulation / 中华神经医学杂志

Objective:To explore the influence of blood pressure (BP) profiles 24 h after early endovascular treatment (EVT), including mean blood pressure and blood pressure variability, in clinical prognoses of patients with acute large vessel occlusion stroke (ALVOS) of anterior circulation 90 d after EVT.Methods:Clinical data and blood pressure profiles of patients with ALVOS of anterior circulation who received EVT in our hospital from July 2014 to February 2019 were prospectively collected. The 90-d modified Rankin scale (mRS) scores were used as clinical prognosis evaluation, and modified thrombdysis in cerebral infarction (mTICI) was used as evaluation criteria for recanalization of postoperative occlusive blood vessels. Multivariate Logistic regression analysis was used to determine the independent influencing factors for prognoses 90 d after EVT.Results:(1) Two hundred and sixteen patients were collected; 159 patients were with successful recanalization and 57 patients were with unsuccessful recanalization; 90 d after EVT, 95 patients (44%) had good prognosis and 121 patients (56%) had poor prognosis. As compared with patients in the good prognosis group, patients in the poor prognosis group had signficantly advanced age, signficantly higher proportion of patients with atrial fibrillation, signficantly higher baseline NIHSS scores, and signficantly lower baseline ASPECT scores ( P<0.05); and the differences of occlusion locus were statistically significant between patients from the good and poor prognosis groups ( P<0.05). Patients in the poor prognosis group had significantly higher baseline systolic blood pressure (SBP), mean SBP, max SBP, and significantly higher standard deviation, variable coefficient, and continuous variation of SBP, and statistically higher standard deviation, variable coefficient, and continuous variation of diastolic blood pressure (DBP) as compared with those in the good prognosis group ( P<0.05). Multivariable Logistic regression analysis showed that the standard deviation and continuous variation of SBP were independent influencing factors for clinical prognoses 90 d after EVT ( OR=1.116, 95%CI: 1.002-1.243, P=0.047; OR=1.116, 95%CI: 1.016-1.227, P=0.022). (2) In patients with successful recanalization, as compared with patients in the good prognosis subgroup, patients in the poor prognosis subgroup had signficantly advanced age, statistically higher proportions of patients with diabetes mellitus and atrial fibrillation and baseline NIHSS scores, and statistically lower baseline ASPECT scores ( P<0.05); and the differences of occlusion locus and first choices of treatment were statistically significant between patients in the good and poor prognosis subgroups ( P<0.05). Patients in the poor prognosis subgroup had significantly higher baseline SBP and max SBP, and significantly higher standard deviation, variable coefficient, and continuous variation of SBP, and statistically higher variable coefficient of DBP as compared with those in the good prognosis subgroup ( P<0.05). Multivariable Logistic regression analysis showed the standard deviation, variable coefficient, and continuous variation of SBP were independent influencing factors for clinical prognoses 90 d after EVT ( OR=1.164, 95%CI: 1.021-1.326, P=0.023; OR=1.191, 95%CI: 1.007-1.409, P=0.041; OR=1.141, 95%CI: 1.018-1.279, P=0.024). However, in patients with unsuccessful recanalization, there were no significant differences in blood pressure proliles between the good prognosis subgroup and poor prognosis subgroup ( P>0.05). Conclusion:The blood pressure variability 24 h after EVT is correlated with the clinical prognoses of patients with ALVOS of anterior circulation 90 d after EVT.

The effect of ovariectomy on bone mineral density and bone microstructure of SOST gene knockout mice / 中国医师杂志

Objective:To observe the changes in bone mineral density and microstructure parameters in sclerostin (SOST) gene knockout (SOST -/-) mice after ovariectomy. Methods:Twelve 4-week-old SOST knockout mice were randomly divided into two groups ( n=6): ovariectomized group (SOV), sham operated group (SSO). Twelve wild-type mice were randomly divided into two groups ( n=6): wild-type ovariectomized group (WTO), wild-type sham operated group (WTS). Twelve weeks later, mice were sacrificed and one lumbar vertebra of each mouse was selected for micro-CT analysis. The bone mineral density, trabecular volume fraction, trabecular number and trabecular thickness were observed and compared in the 4 groups. Results:There was no difference in bone mineral density, trabecular volume fraction, trabecular number and trabecular thickness between SOV and SSO groups. Bone mineral density, trabecular volume fraction, trabecular number and trabecular thickness in SOV and SSO groups were significantly higher than those in WTO and WTS groups ( P<0.001). Bone mineral density, trabecular volume fraction and trabecular number in WTO group were significantly lower than those in WTS group ( P=0.017, 0.039, 0.021, respectively). There was no difference in trabecular thickness between WTO and WTS groups. Conclusions:Sclerostin knockout mice showed high bone mass, and ovariectomy did not lead to bone loss and bone microstructure degeneration, which indicates that slerostin is a potential therapeutic target for postmenopausal osteoporosis.

Risk factors of malignant brain edema after successful recanalization of acute large vascular occlusion stroke / 中华神经科杂志

Objective:To observe the incidence, risk factors of malignant brain edema (MBE) and the influence of MBE on outcomes after early successful recanalization of acute large vascular occlusion stroke (ALVOS).Methods:A total of 149 patients (age (68±11) years, male 85 (57.0%)) with ALVOS who underwent early endovascular treatment and achieved successful recanalization at the First Affiliated Hospital of Wannan Medical College from July 2014 to February 2019 were retrospectively analyzed. Baseline data, perioperative data, and 90-day prognostic information were collected from patients enrolled in the study. Univariate and multivariate analyses were used to explore the relationship between MBE and outcomes, and the risk factors of MBE.Results:Among the 149 patients, baseline National Institutes of Health Stroke Scale score was 16 (13, 20), baseline Alberta Stroke Project early CT score was 9 (8, 10), the time of onset-to-puncture was (248.3±61.3) minutes, and the onset-to-recanalization time was (312.4±69.7) minutes. MBE occurred in 23 patients (15.4%, 23/149). The 90-day favorable outcome (90-day modified Rankin Scale score≤ 2) in patients with MBE was significantly lower than those without MBE (17.4% (4/23) vs 61.1% (77/126), χ 2=14.985, P<0.001), and the 90-day mortality in patients with MBE was significantly higher than those without MBE (43.5% (10/23) vs14.3% (18/126), χ 2=10.861, P=0.003). MBE was shown to be an independent predictor of 90-day poor outcome (adjusted OR=12.078, 95 %CI 1.934-75.443, P=0.008) and death (adjusted OR=4.146, 95 %CI 1.060-16.216, P=0.041). Multivariate Logistic regression analysis showed that the collateral circulation status was related to the incidence of MBE in patients with ALVOS after successful recanalization (level 2 vs level 0, adjusted OR=0.109, 95 %CI 0.021-0.563, P=0.008). Conclusions:MBE is an independent risk factor of ALVOS patients with poor outcome or death in 90 days. For patients with ALVOS, even if the occlusive vessels have been successfully recanalized after early endovascular treatment, MBE is still not uncommon. The collateral circulation state is an independent predictive factor of the development of MBE after recanalization by early endovascular treatment in patients with ALVOS.

Differential expression of miR-30a-5p in post stroke depression and bioinformatics analysis of the possible mechanism / 南方医科大学学报

OBJECTIVE@#To investigate the differential expression of miR-30a-5p in patients with poststroke depression and explore the possible mechanism.@*METHODS@#We obtained the target microRNAs through searching PubMed using the online software VENNY2.1. We collected the baseline demographic, clinical and radiographic data from consecutive patients with first-ever acute ischemic stroke on admission in our department from October, 2018 to March, 2019. From each patient, 5 mL peripheral venous blood was collected upon admission. Hamilton Depression Scale (HAMD-17) was used to evaluate the degree of depression at the end of the 3-month follow-up. The patients with a HAMD-17 score≥7 were diagnosed to have depression according to the diagnostic criteria of the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV). The patients were divided into post-stroke depression group (PSD group, =11) and non-post-stroke depression group (non-PSD group, =25), and their plasma levels of miR-30a-5p were detected using qPCR. The STARBASE Database ENCORI miRNA-mRNA module and Comparative Toxicogenomics Database were used to predict and screen the possible target genes related to miR-30a-5p, and the possible mechanism of the target genes was further analyzed through bioinformatics.@*RESULTS@#miR-30a-5p was identified by cross-screening as the target miRNA associated with stroke and depression and showed obvious differential expression between PSD and non-PSD patients (2.462±0.326 1±0.126, < 0.0001). ROC curve analysis showed that the AUC of miR-30a-5p for predicting PSD was 0.869 (95%: 0.745-0.993, =0.0005) at the cutoff value of 1.597, with a sensitivity and specificity of 0.727 and 0.840, respectively. The target proteins of miR-30a-5p involved a wide range of biological processes, including signal transduction, intercellular communication, regulation of nucleobase, nucleoside, nucleotide and nucleic acid metabolism. KEGG pathway enrichment analysis showed that the target proteins affected mainly the neural nutrient signaling pathway, axon guidance signaling pathway and insulin signaling system. We also identified the top 20 HUB genes that might be associated with post-stroke depression.@*CONCLUSIONS@#Plasma miR-30a-5p is differentially expressed in PSD and can serve as a new blood marker for diagnosis and also a therapeutic target of PSD.

Protective effect and mechanism of Jinshuibao tablet on acute kidney injury induced by cisplatin in rats / 中国药科大学学报

@#This study aimed to observe the therapeutic effect and mechanism of Jinshuibao tablet on acute renal injury induced by cisplatin. Acute renal injury models in SD rats were induced separately by single intraperitoneal injection of cisplatin(5 mg/kg)and intravenous injection for 5 consecutive days at a dosage of 2 mg/kg per day. The renal function and renal histopathological changes were observed in rat acute renal injury models after prevention and treatment with Jinshuibao tablet, respectively. The content of tumor necrosis factor(TNF-α)and reactive oxygen species(ROS), the activity of Caspase 3 and the expression of t-p38, p-p38, Bax and Bcl-2 in the kidneys were detected. The results showed that preventive and therapeutic administration of Jinshuibao tablets could both significantly inhibit the increase of the blood urea nitrogen(BUN)and creatinine(CRE), increase the creatinine clearance rate, reduce the contents of TNF-α and ROS, and decrease the activity of Caspase 3 in acute renal injury models induced by cisplatin. The renal histopathological results showed that Jinshuibao tablets could significantly reduce renal histopathology scores, ameliorate renal tubule degeneration and inflammatory infiltration. Western blot results showed that Jinshuibao tablets could significantly decrease the expression of t-p38 and p-p38, while increasing the Bcl-2/Bax ratio in the kidneys. These results suggested that preventive and therapeutic administration of Jinshuibao tablets could both improve renal function and pathological changes of renal tissue, which might be related to the inhibition of TNF-α and the ROS-p38 MAPK-Caspase3 pathway and thus inhibition of apoptosis.