BACKGROUND:The management of asymptomatic patients with severe aortic stenosis (AS) remains challenging. While transcatheter aortic valve replacement (TAVR) is established for symptomatic AS, its objective functional benefits in asymptomatic individuals are not well-defined. AIMS:To evaluate the safety and hemodynamic efficacy of TAVR in asymptomatic patients with severe aortic stenosis and to objectively quantify their functional recovery using cardiopulmonary exercise testing (CPET). METHODS:In this single-center retrospective study, 156 asymptomatic patients with severe AS undergoing TAVR with the VitaFlow valve were enrolled. Safety endpoints were adjudicated per Valve Academic Research Consortium (VARC-3) criteria. Efficacy was assessed via serial echocardiography and brain natriuretic peptide (BNP) levels at baseline, 1 day, 7 days, 3 months, and 12 months. Functional capacity was objectively quantified using CPET at baseline, 1 month, and 12 months. RESULTS:Procedural success was 100% with no mortality, stroke, or major complications. Hemodynamics improved immediately (mean gradient: 51.6 ± 11.7 to 13.7 ± 7.2 mmHg, p < 0.001) and remained stable at 12 months. BNP levels decreased significantly from 7 days onward (p < 0.05). CPET revealed substantial improvements in functional capacity: peak oxygen uptake (VO₂) increased from 15.6 ± 3.6 to 19.8 ± 4.0 mL/kg/min (p < 0.001), anaerobic threshold (AT) increased, and ventilatory efficiency (VE/VCO₂ slope) decreased (all p < 0.001). The incidence of exercise-induced adverse events also significantly declined. CONCLUSIONS:TAVR is a safe and highly effective intervention for asymptomatic severe AS, resulting in immediate hemodynamic improvement and sustained, objective enhancement of functional capacity, as rigorously quantified by CPET.

As excitatory neurotransmitters, glutamic acid (Glu) and aspartic acid (Asp) may play a key role in the pathological process of traumatic spinal cord injury. The purpose of this study was to investigate the dynamic changes of Glu and Asp concentrations in blood and spinal fluid of patients with secondary spinal cord injury and their correlation with prognosis, so as to provide evidence for disease monitoring and treatment. In this study, 62 patients with secondary spinal cord injury admitted from January 2021 to December 2023 were selected as study subjects. Blood and spinal fluid samples were collected at 1, 3, 7, 14, and 28 days after injury, and the concentrations of Glu and Asp were determined by high-performance liquid chromatography. At the same time, the neurological functions of the patients at admission and 3 months after injury were evaluated using the American Spinal Cord Injury Association (ASIA) scoring criteria, and the patients were divided into a good prognosis group (ASIA score increased by >= 10 points) and a poor prognosis group (ASIA score increased by <10 points). Repeated measurement ANOVA was used to compare the differences of Glu and Asp concentrations in blood and spinal fluid of patients and the control group at different time points, and Spearman correlation analysis was used to explore the correlation between Glu and Asp concentrations and changes in ASIA score. Logistic regression analysis was performed to determine the risk factors affecting the prognosis of patients, and a receiver operating characteristics (ROC) curve was drawn to evaluate the diagnostic value of relevant indicators for prognosis. The concentrations of Glu and Asp in blood and spinal fluid of patients with poor prognosis were higher than those of patients with good prognosis at all time points (p < 0.05). The concentrations of Glu and Asp in blood and spinal fluid of patients with poor prognosis were higher than those of patients with good prognosis at all time points (p < 0.05). Spearman correlation analysis showed that Glu and Asp concentrations in blood and spinal fluid were significantly negatively correlated with ASIA score (r = -0.65, p < 0.01; r = -0.58, p < 0.01). Logistic regression analysis showed that Glu concentration (OR = 2.58, 95% CI: 1.56-4.29) and Asp concentration (OR = 2.25, 95% CI: 1.32-3.84) in spinal fluid 7 days after injury were independent risk factors for prognosis. ROC curve showed that the area under the curve of the combined detection of Glu and Asp in spinal fluid at 7 days after injury was significantly higher than that of single index (p < 0.01). The concentrations of Glu and Asp in the blood and spinal fluid of patients with acute traumatic spinal cord injury increase first and then decrease, and are closely related to the prognosis of patients. Early monitoring of these neurotransmitter concentrations after injury is helpful to evaluate the prognosis of patients and provide a reference for the formulation of personalized treatment plans. ROC curve analysis further clarified the diagnostic efficacy of relevant indicators in prognostic judgment.

Research has shown that the concurrent presence of Diabetes Mellitus (DM) and Thyroid Dysfunction (TD) can exacerbate diabetes-related complications and impose a significant economic burden on healthcare systems. Therefore, this study aimed to develop a nomogram model for predicting the risk of TD in patients with Type 2 Diabetes Mellitus (T2DM) and to validate its predictive performance. A total of 1853 patients with T2DM diagnosed at the First Hospital of Hebei Medical University from 2019 to 2024 were included in the study. The dataset was randomly divided into a training set (n = 1297) and a validation set (n = 556) at a 7:3 ratio using the R software. Univariate and multivariate logistic regression analyses were conducted to identify predictors of TD, and these predictors were used to construct the nomogram model. The model was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC), calibration curve, the Hosmer-Lemeshow test, and decision curve analysis (DCA). HDL-C, BUN, gender, GLU, Hypertension, Hyperuricemia, Coronary Heart Disease, and Liver disease were identified as predictors of TD. A nomogram model was constructed based on these eight factors. The model demonstrated good discrimination in both the training and validation sets. The calibration curves indicated a good fit of the model in both datasets. The decision curve analysis showed that the model had good clinical applicability. The nomogram developed in this study can predict the risk of developing TD in patients with T2DM. It enables clinicians to identify T2DM patients at high risk of concurrent TD, which may help facilitate the development of effective preventive measures and improve patient prognosis.

This study aims to evaluate the therapeutic effect of Vericiguat through cardiopulmonary exercise testing (CPET) in patients with chronic heart failure and reduced ejection fraction (HFrEF). A prospective observational study was conducted from May 2022 to May 2023, focusing on patients with HFrEF admitted to our hospital. Eligible patients were sequentially numbered and enrolled based on specific inclusion and exclusion criteria. They were divided into two groups: one receiving standard heart failure therapy and the other receiving standard therapy plus Vericiguat. Data were collected at baseline and at 1, 3, and 6 months post-discharge, including NT-proBNP, sST2, and echocardiographic assessments. All patients underwent CPET before discharge and again six months post-discharge for within-subject comparisons. The study enrolled 158 patients, with 79 in each treatment arm. No significant baseline differences were observed in the Weber Functional Classification or CPET parameters. At six months, the Vericiguat group exhibited a significant reduction in patients classified as C (from 31.6 to 7.5

Sepsis-induced lung injury is a serious complication that contributes to the high morbidity and mortality rates in septic patients. This study aims to identify genes associated with sepsis-induced lung injury and evaluate the role of cathepsin B (CTSB) in this process. Here, by analyzing three data sets of sepsis-induced lung injury in mouse models, we identified 23 common differentially expressed genes and performed enrichment analyses. Further experiments demonstrated that CTSB expression was significantly upregulated in the sepsis mouse model, and pre-treatment with the CTSB inhibitor CA-074 markedly improved the survival rate of the mice from 21.05 to 78.95

Traumatic spinal cord injury (TSCI) often leads to respiratory dysfunction, in which the impaired diaphragm function is one of the main causes. Respiratory muscle rehabilitation training can be used to improve respiratory function, but its effect on diaphragm function has not been deeply investigated. This study employed ultrasound monitoring to assess how respiratory muscle rehabilitation training affects diaphragmatic function in TSCI patients. In this prospective randomized controlled trial (RCT) study, 56 patients with spinal cord injury were randomly divided into experimental group and control group, 28 cases in each group. The experimental group received respiratory muscle rehabilitation training twice a day for 15 min each time; and the control group received only the usual care. The diaphragm thickness, diaphragm movement and diaphragm contraction speed of the two groups were measured by ultrasound before and after training. Compared to the control group, the experimental group had significant improvements. Diaphragm thickness increased from 2.05 ± 0.25 mm to 2.38 ± 0.30 mm in the experimental group (P < 0.001), while the control group changed minimally from 2.02 ± 0.22 mm to 2.05 ± 0.23 mm (P = 0.338). Diaphragm movement increased from 1.52 ± 0.20 mm to 1.85 ± 0.25 mm in the experimental group (P < 0.001), versus a small change from 1.50 ± 0.18 mm to 1.53 ± 0.20 mm in the control group (P = 0.315). Diaphragm contraction speed accelerated from 1.20 ± 0.15 cm/s to 1.45 ± 0.20 cm/s in the experimental group (P < 0.001), while the control group changed slightly from 1.18 ± 0.13 cm/s to 1.20 ± 0.15 cm/s (P = 0.380). Respiratory frequency decreased from 20.3 ± 3.4 times/min to 16.0 ± 2.5 times/min in the experimental group (P < 0.001), and the control group changed less from 19.5 ± 2.1 times/min to 18.2 ± 2.3 times/min (P = 0.070). Ventilator removal time was significantly reduced in the experimental group (14.1 ± 1.5 days) compared to the control group (20.2 ± 2.0 days, P = 0.002). Respiratory muscle rehabilitation significantly enhances diaphragm function and respiratory parameters in spinal cord injury patients. Ultrasound monitoring effectively evaluates these improvements, providing a valuable, novel clinical approach for TSCI rehabilitation. While this preliminary RCT demonstrates positive outcomes, the sample size limitation (n = 56) and absence of long-term follow-up should be acknowledged. These aspects will be addressed through larger sample sizes and extended observation periods in subsequent research.

BACKGROUND Cirrhotic patients with acute-on-chronic liver failure (ACLF) in the intensive care unit (ICU) have a poor but variable prognoses. Accurate prognosis evaluation can guide the rational management of patients with ACLF. However, existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy. AIM To develop a new prognostic model for patients with ACLF in ICU. METHODS Data from 938 ACLF patients in the Medical Information Mart for Intensive Care (MIMIC) database were used to develop a new prognostic model (MIMIC ACLF) for ACLF. Discrimination, calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve (AUROC), calibration curve and decision curve analysis (DCA), respectively. MIMIC ACLF was then externally validated in a multiple-center cohort, the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China. RESULTS The MIMIC ACLF score was determined using nine variables: ln (age) × 2.2 + ln (white blood cell count) × 0.22 - ln (mean arterial pressure) × 2.7 + respiratory failure × 0.6 + renal failure × 0.51 + cerebral failure × 0.31 + ln (total bilirubin) × 0.44 + ln (internationalized normal ratio) × 0.59 + ln (serum potassium) × 0.59. In MIMIC cohort, the AUROC (0.81/0.79) for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF (0.76/0.74), Model for End-stage Liver Disease (MELD; 0.73/0.71) and MELD-Na (0.72/0.70) (all P < 0.001). The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores. The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50% threshold probability. The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts. CONCLUSION We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU. The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.

Objective To investigate the effects of electronic biofeedback combined with nursing intervention and conventional drug treatment on cognitive function in patients with vascular cognitive impairment-no dementia (VCIND). Methods A total of 102 patients with VCIND treated in the Department of Neurology from January 2021 to May 2022 were enrolled and divided into the routine treatment group and biofeedback group according to different treatment methods. The routine treatment group was given conventional drug therapy and nursing intervention; for the biofeedback group, electronic biofeedback therapy was added, based on the routine treatment group. The Montreal Cognitive Assessment, (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale, (ADAS-cog), and Hamilton Depression Scale (HAMD) were checked before treatment, 2 weeks after treatment, and 3 months after treatment. Results At 3 months of treatment, the scores of the MoCA and ADAS-cog scales in the biofeedback group were better than those in the routine treatment group, while no difference was detected in the HAMD scores before and after treatment and between the two groups. Conclusion Electronic biofeedback therapy for VCIND can significantly improve the MoCA score, reduce the ADAS-cog score and improve the cognitive level of patients and can be used as a complementary treatment for VCIND.

Purpose: Pericoronary adipose tissue (PCAT) attenuation is a non-invasive biomarker of coronary perivascular inflammation. This study aims to explore the relationship between pericoronary adipose tissue mean attenuation (PCATMA) and volume with the severity of coronary artery stenosis and plaque characteristics. Methods We conducted a retrospective study of 370 patients diagnosed with or suspected of coronary artery disease (CAD). We investigated differences in PCATMA and PCAT volume among different degrees of vessel stenosis. Receiver operating characteristic curve analysis was performed to assess the efficacy of PCATMA in predicting non-calcified plaques and severe vessel stenosis, determining the optimal cutoff values. Logistic regression analysis was utilized to study the impact of PCATMA on severe vessel stenosis and non-calcified plaques. Results Patients with more severe stenosis in the left circumflex artery (LCX) had higher PCATMA compared to those with milder stenosis. Vessels with non-calcified plaques exhibited higher PCATMA than those with calcified plaques (-79.3 ± 8.8 HU vs. -85.8 ± 8.8 HU, P < 0.001). Multivariate logistic regression analysis revealed that higher PCATMA specific to LAD, LCX, and RCA vessels was an independent risk factor for predicting non-calcified plaques. LCX-PCATMA ≥ -71.6 HU was an independent risk factor for predicting LCX stenosis ≥ 75% (OR = 2.465, 95% CI 1.387–4.382, P = 0.002) and ≥ 90% (OR = 2.821, 95% CI 1.422–5.596, P = 0.003). Conclusions Vessel-specific PCATMA serves as an independent predictor for the presence of non-calcified plaques, and LCX-PCATMA is an independent risk factor for predicting severe LCX stenosis.

OBJECTIVE:The primary objective of this study was to assess the diagnostic potential of galectin-3 (Gal-3), fractalkine (FKN), interleukin (IL)-6, microRNA(miR)-21, and cardiac troponin I (cTnI) in patients with ischemic cardiomyopathy (ICM). METHOD:A total of 78 ICM patients (Case group) and 80 healthy volunteers (Control group) admitted to our hospital for treatment or physical examination from Aug. 2018 to Feb. 2020 were included in the current study. The serum concentration of Gal-3, FKN, IL-6, miR-21, and plasma expression of cTnI of both groups were determined. The severity of ICM was classified using New York Heart Association (NYHA) scale. RESULTS:When compared with the control group, the case group had a significantly high blood concentration of Gal-3, FKN, IL-6, miR-21, and cTnI (P < 0.001). NYHA class II patients had lower blood levels of Gal-3, FKN, IL-6, miR-21, and cTnI than that in patients of NYHA class III and IV without statistical significance (P > 0.05). However, statistical significance could be achieved when comparing the above-analyzed markers in patients classified between class III and IV. Correlation analysis also revealed that serum levels of Gal-3, FKN, IL-6, miR-21, and cTnI were positively correlated with NYHA classification (R = 0.564, 0.621, 0.792, 0.981, P < 0.05). CONCLUSION:Our study revealed that up-regulated serum Gal-3, FKN, IL-6, miR-21, and cTnI levels were closely related to the progression of ICM. This association implies that these biomarkers have diagnostic potential, offering a promising avenue for early detection and monitoring of ICM progression.

Background and Aim: Current treatments for refractory benign esophageal strictures (BESs) often take several years and have poor effects. The authors propose a novel method of self-help inflatable balloon (SHIB) and evaluate its efficacy and safety. Methods: A prospective, multicenter study was conducted from January 2019 to March 2022. All enrolled patients were diagnosed with refractory BESs and received SHIB. The primary endpoint was the clinical success rate at 12 months after removing SHIB. The secondary endpoints were the number of days of placing SHIB, and changes from baseline in BMI and health-related quality of life at 1, 3, 6, and 12 months. Results: The clinical success rate was 51.2% (21/41) with the median days of placing SHIB being 104.0 days (range: 62.0-134.5 days), which was higher in the endoscopic group compared to the caustic and surgery groups (63.3 vs. 28.6% vs. 0, P=0.025). All patients (100%) showed significant improvement in dysphagia scores during placing SHIB. Although 20 patients (48.8%) experienced recurrent stricture, the median stricture length was decreased (P<0.001) and the median intervention-free interval was prolonged (P<0.001). In all patients, the mean BMI at and health-related quality of life at 1, 3, 6, and 12 months were significantly increased compared with baseline (P<0.05). On multivariate analysis, stricture etiology and wearing time were independent predictors of recurrent stricture. Conclusions: The SHIB has high efficacy and safety in treating refractory BESs of different origins, especially for endoscopic resection. Stricture etiology and wearing time were independent predictors of recurrent stricture.

目的 观察慢性心力衰竭(简称心衰)合并肾功能不全患者应用沙库巴曲缬沙坦后容量状态变化及其对心脏结构和功能的影响.方法 连续纳入 2020 年 12 月至 2022 年 3 月秦皇岛市第一医院收治的慢性心衰合并肾功能不全患者84 例,分为沙库巴曲缬沙坦组(n=48)和对照组(n=36).沙库巴曲缬沙坦组给予沙库巴曲缬沙坦,对照组接受单一的缬沙坦治疗.测量 2 组患者服药 6 个月后 24h尿量、利尿剂用量,检测血浆B型脑钠肽(BNP)水平,随访纽约心脏病协会(NYHA)分级变化,并以超声心动图评估心脏结构及功能变化情况.结果 与对照组比较,服药后沙库巴曲缬沙坦组患者24h尿量明显增多[(1514.38±694.73)和(1003.33±178.92)ml;P<0.01];NYHA分级明显改善(P=0.032).与服药前比较,服药后沙库巴曲缬沙坦组患者服用利尿剂剂量[(19.38±7.55)和(23.75±7.89)mg]、BNP 水平[811(250,1481)和1980(727,5014)pg/ml]明显降低(均P<0.01);24 h尿量[(1514.38±694.73)和(890.63±121.45)ml]明显增加(P<0.01).与对照组比较,服药后沙库巴曲缬沙坦组患者左室射血分数(LVEF)[(36.87±6.16)%和(33.08±7.59)%]、二尖瓣环E峰与A峰比值(E/A)[1.30(1.25,1.82)和 1.04(0.59,2.53)]、每搏输出量(SV)[(102.39±20.85)和(77.98±18.51)ml]、心输出量(CO)[(7.39±2.18)和(5.84±1.72)L/min]均明显升高(均P<0.05),左房内径(LA)[(42.97±6.01)和(48.17±5.17)mm]缩小(P<0.05);与服药前比较,服药后沙库巴曲缬沙坦组患者左室收缩末内径[50.5(50.0,56.1)和 54.0(48.3,61.9)mm]、左室舒张末内径[(64.9±10.3)和(69.0±12.1)mm]、LA[(42.97±6.01)和(47.61±8.06)mm]均明显缩小(均 P<0.01);SV[(102.39±20.85)和(68.13±29.96)ml]、CO[(7.39±2.18)和(5.66±2.49)L/min]、E/A[1.30(1.25,1.82)和 0.93(0.88,1.10)]、LVEF[(36.87±6.16)%和(27.26±6.24)%]均明显升高(均P<0.01).结论 与单一使用缬沙坦比较,沙库巴曲缬沙坦可明显改善合并肾功能不全的慢性心衰患者的容量超负荷,优化容量管理措施,改善心脏收缩及舒张功能.

脊髓脱髓鞘性疾病是神经内科较常见的疾病，大多数患者需要激素及丙种球蛋白治疗，但在非外伤性脊髓病变治疗过程中并发急性心肌梗死，目前尚少见报道。笔者现对1例胸髓炎性脱髓鞘性病变患者经甲强龙冲击及静脉注射丙种球蛋白治疗过程中并发急性心肌梗死后，经冠状动脉取栓治疗后好转的诊疗过程进行报道，以丰富临床同道的认识。

目的 探讨基于达标理论的护理干预方案对肠造口患儿及照顾者的影响.方法 便利抽样选取北京市某儿童医院肠造口患儿及照顾者206例纳入研究,分为对照组102例和干预组104例.对照组给予常规护理,干预组在常规护理基础上给予达标理论干预方案护理,比较两组出院准备度、照顾者照护能力、非计划再次入院率与并发症发生情况.结果 干预组的患儿照顾者出院准备度各维度得分和总分高于对照组(P<0.01),照顾者照护能力各维度得分和总分高于对照组(P<0.01).干预组非计划再入院率明显低于对照组,并发症总发生率低于对照组(P<0.05).结论 基于达标理论的护理干预方案可提高肠造口患儿及照顾者的出院准备度,提升照顾者照护能力,减少非计划的再次入院和并发症的发生,为做好出院准备提供实践基础.

目的 探索ST段抬高心肌梗死直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)术后微循环障碍对左心室舒张功能的影响.方法 选取2017年1月至2018年1月92例于河北省秦皇岛市第一医院行PPCI的ST段抬高心肌梗死患者,依据支架术后即刻血流分级心肌灌注帧数评分将患者分为合并微循环障碍的观察组和无微循环障碍的对照组,观察并比较两组患者临床基线参数和超声舒张功能指标:二尖瓣舒张早期血流速度(E峰)、二尖瓣舒张晚期血流速度(A峰)、二尖瓣环舒张期运动速度(e')、左心房容积指数并计算E/A、E/e',观察患者PPCI术后1周及3个月左心室舒张功能变化.结果 对照组E峰、E/A、e'于3个月复查时较1周时显著升高,而E/e'较1周时显著降低(P<0.05);观察组术后3个月时左心房容积指数较1周时显著增高,差异有显著性(P<0.05);观察组Ⅱ级、Ⅲ级左心室舒张功能患者比例明显高于对照组(P<0.05);E/e'同心肌灌注帧数具有显著相关性(r=0.852,P<0.05).结论 微循环障碍可导致急性心肌梗死患者PPCI术后左心室舒张功能减低且恢复不良,微循环障碍与左心室舒张功能明显相关.

目的 评估内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌(early gastric cancer,EGC)的有效性及安全性,了解非治愈性切除的相关危险因素及预后情况.方法 收集接受ESD治疗的EGC患者的相关临床资料及随访预后情况,分为治愈性切除组和非治愈性切除组.结果 纳入99例患者,40岁后病例数明显增多,65岁左右达到高峰,病变直径(2.32±1.73)cm,病变部位以位于胃上1/3为主.整块切除99例(100.0％),完全切除79例(79.8％),治愈性切除71例(71.7％).治愈性切除组与非治愈性切除组病变直径、术后病理、浸润深度差异有统计学意义(P<0.05).Logistic回归分析,结果显示,术后病理、浸润深度是非治愈性切除的危险因素(P<0.05).术后随访,进行eCura评分分层的患者中,8例追加外科手术,3例低风险组,5例中风险组,其中1例发现局部癌残留及区域淋巴结转移属于中风险组.结论 对EGC患者进行术前评估时应更加注意病变直径、术前病理分型及浸润深度的判断,把握适应证标准.非治愈性切除患者术后治疗方案或许可参考eCura评分系统.

Peroral endoscopic myotomy (POEM) has been shown to be an effective treatment for achalasia and with few adverse events. Only a few cases of delayed bleeding have been described. This current case report describes a patient with delayed bleeding in the submucosal tunnel on the eighth day after POEM. The patient was a 21-year-old woman with a 4-month history of dysphagia, vomiting and excessive weight loss. Achalasia was diagnosed according to her symptoms, barium oesophagogram, oesophageal manometry and endoscopy examination. POEM was performed by an experienced operator. On the eighth day after POEM, the patient suddenly developed continuous haematemesis presented with vomiting of fresh blood and melena. An emergency exploratory esophagogastroduodenoscopy was performed. A large number of blood clots were found at the wound and a long haematoma was found along the lining of the submucosal tunnel. Re-entry into the submucosal tunnel and exposure of the haemorrhagic site was attempted but failed because of severe submucosal tissue adhesion. An emergency angiography was undertaken and haemostasis was achieved with superselective arterial microcoil embolization.

目的 研究高龄急性大血管闭塞性卒中患者动脉内取栓治疗的特点及疗效.方法 回顾性连续纳入2018年1月至2021年8月解放军战略支援部队特色医学中心神经内科收治的诊断为急性大血管闭塞并接受动脉内取栓治疗的卒中患者.年龄均≥18岁,根据患者年龄分为两组:高龄组(年龄≥80岁)以及低龄组(年龄<80岁).详尽收集患者基线资料[包括性别、年龄、既往病史(高血压病、糖尿病、高脂血症、心房颤动、严重心肺疾病等)、基线美国国立卫生研究院卒中量表(NIHSS)评分、入院改良Rankin量表(mRS)评分、基线前循环Alberta卒中项目早期CT评分(ASPECTS)或基线后循环急性卒中预后早期CT评分(pc-ASPECTS)、急性卒中Org 10172治疗试验(TOAST)病因分型等]、治疗相关信息[是否静脉溶栓、闭塞部位、串联病变、发病至到院时间、到院至穿刺时间、穿刺至再通时间、麻醉方式、侧支循环情况、术中是否球囊扩张或置入支架、取栓次数、术后改良脑梗死溶栓(mTICI)分级、症状性颅内出血等]以及患者术后3个月的预后信息(mRS评分0～2为预后良好,3分以上为预后不良,6分为死亡)等.结果 151例符合入组条件的患者被纳入研究,中位年龄为70.0(57.5,80.0)岁,其中男94例(62.3％).高龄组患者42例[27.8％;中位年龄为83(81,86)岁],低龄组患者109例[中位年龄63(54,72)岁].与低龄组患者比较,高龄组患者基线NIHSS评分更高[19.0(14.3,23.0)分比15.0(12.0,20.0)分,Z=-2.247,P=0.025],心房颤动患者比例更高[81.0％(34/42)比33.9％(37/109),χ2=26.893,P<0.01],更多合并严重心肺疾病[50.0％(21/42)比31.2％(34/109),χ2=4.631,P=0.031].两组患者TOAST分型分布差异有统计学意义(χ2=20.193,P<0.01),低龄组患者以心源性栓塞[45.9％(50/109)]和大动脉粥样硬化型[44.0％(48/109)]为主要病因,高龄组患者以心源性栓塞[85.7％(36/42)]尤为突出.低龄组串联病变患者比例较高龄组高[22.9％(25/109)比4.8％(2/42),χ2=6.820,P=0.009],术中使用球囊扩张或置入支架的比例高于高龄组[32.1％(35/109)比9.5％(4/42),χ2=8.073,P=0.004].高龄组穿刺至再通时间较低龄组患者长[81.0(46.0,131.0)min比54.5(36.8,95.0)min,Z=-2.505,P=0.012],取栓次数也较多[3.0(1.0,4.0)次比2.0(1.0,3.0)次,Z=-2.225,P=0.026].高龄、低龄两组闭塞血管开通比例[88.1％(37/42)比84.4％(92/109)]、取栓后24 h NIHSS评分[12.0(7.0,19.5)分比8.0(4.0,16.0)分]差异均无统计学意义(均P>0.05).高龄组与低龄组患者相比,症状性颅内出血比例[19.0％(8/42)比10.1％(11/109)]、90 d mRS评分[3.0(2.0,5.0)分比3.0(1.0,4.0)分]、90d mRS评分0～2分比例[31.0％(13/42)比47.7％(52/109)]、90 d死亡比例[16.7％(7/42)比15.6％(17/109)]差异均无统计学意义(均P>0.05).结论 对于急性大血管闭塞性卒中患者,年龄≥80岁与年龄<80岁取栓预后无差异.

目的 系统检索、评价和总结肠衰竭儿童营养支持的相关证据,为临床提供参考.方法 系统检索Up To Date、苏格兰学院间指南网、Cochrane Library、OVID、PubMed、Elsevier Science Direct、循证卫生保健中心数据库、欧洲临床营养与代谢协会官网、美国肠外肠内营养学会官网、万方数据库、中国知网关于肠衰竭儿童营养支持的所有证据.采用JBI证据预分级及推荐级别划分.检索时限为建库至2021年11月27日.结果 纳入文献共16篇,其中指南10篇、专家共识1篇、系统评价2篇、证据总结2篇、推荐实践1篇.分别为营养筛查及营养评估、肠内营养支持及监测观察、肠外营养支持及输注方案、严重并发症预防策略、多学科团队管理5个方面共30个证据.结论 该研究总结了肠衰竭儿童的营养支持最佳证据,通过合理营养支持策略为医护人员临床开展营养支持提供循证依据,降低并发症发生率,提高肠衰竭儿童存活率.

目的 系统分析早期胃癌内镜黏膜下剥离(ESD)术后出血的危险因素.方法 回顾性分析2017年1月至2021年2月于河北医科大学第二医院行内镜黏膜下剥离术且术后病理为早期胃癌的患者共计281例.依据是否出现术后出血分为对照组及术后出血组.收集既往史、住院病历、病理结果、内镜报告等资料.统计并分析患者性别、年龄、术前是否服用抗血小板药物、是否合并高血压、是否合并糖尿病、是否合并缺血性血管病、肿瘤部位、内镜下大体分型、组织学类型、肿瘤直径、手术时间、是否合并溃疡、是否合并脉管癌栓、是否为整块切除、是否为完全切除、是否出现术后出血及术后出血时间等信息,通过单因素及多因素Logstic回归分析早期胃癌患者ESD术后出血的危险因素.结果 281例早期胃癌患者中共有16例发生术后出血(5.69％),出血时间为术后第1～9日.ESD术后24小时内出血8例(50.0％),48小时内出血10例(62.5％).其中1例于术后48小时内连续出血2次,失血性休克1例,均于内镜下止血成功.术前服用抗血小板药物(OR值为0.051,95％ CI0.011～0.230,P＜0.01)、手术时间≥2 h(OR值为0.048,95％ CI 0.009～0.263,P＜0.01)、合并溃疡(OR值为0.038,95％ CI 0.007～0.193,P＜0.01)是早期胃癌患者ESD术后出血的独立危险因素.结论 手术时间≥2h、术前应用抗血小板药物、合并溃疡是早期胃癌患者ESD术后出血的独立危险因素.