目的 总结脑保护装置下行颈动脉支架成形术的术中精细化护理经验,为提升介入护理人员的业务水平提供参考.方法 分析2019年1月—2021年6月海军军医大学第一附属医院血管外科收治的189例脑保护装置下行颈动脉支架成形术的颈动脉狭窄患者的临床资料.结果 手术期间通过术前指导、心理护理、保暖护理、病情观察、静脉给药等精细化护理后,189例手术患者均成功,手术时间缩短至66±24 min,造影剂用量减少至186±50 ml,出血量减少至37±22 ml.其中58例患者术中出现一过性颈动脉窦反射,予以阿托品处理后恢复;2例患者术中因支架置入后压迫颈动脉窦压力感受器而引起血压下降,经予以血管活性药物对症处理后,术后第2天均恢复;所有患者在手术期间未出现脑梗死、严重高灌注等相关并发症.结论 护士在手术期间除了做好患者的术前指导、用药指导、心理护理、保暖护理等精细化护理外,还需在术中密切观察患者的血压、心率、神经系统症状,以及静脉给药后的反应,不但可以减少术中造影剂的使用剂量和手术期间脑梗死、严重高灌注等并发症的发生,而且也可以缩短手术时间,减少出血量,促进患者的术后恢复.

Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.

It is well known that the sense of smell has significant impacts on human moods, therefore olfactory effects have been widely applied to psychological adjustment as well as clinical treatment. Unlike other senses, smell works through the molecules of olfactory stimuli acting on the human nervous system to elicit psychological effects, which is difficult to be accurately described and measured. This makes the commonly used methods hardly applicable to olfactory affective computation. Through analysis of the neural mechanism of human emotions evoked by olfactory sense, this paper specifically designed an EEG experiment to obtain the neural activity data of olfactory stimuli, and compares the clustering characteristics of neural feature data with self-reported scores in PAD emotional space. Thereout, the LS-SVR estimator based on the feature parameters extracted from EEG signal data is proposed for olfactory affective computation. It shows better distinguishing performance and potential reliability than self-reported data, and thus provides an enlightening exploration of this issue.

There are six major techniques for endovascular treatment, i.e., percutaneous endovascular balloon angioplasty, endovascular stent angioplasty, endovascular graft exclusion for artery dilatations, endovascular thrombolysis, endovascular embolectomy, and minimally invasive endovascular replacement of cardiac valves, none of which can do without continuous improvement and innovation of endovascular devices. While Seldinger percutaneous vascular puncture has opened the first chapter of endovascular treatment, percutaneous endovascular balloon angioplasty is the first step of endovascular treatment. It has experienced the stages of catheter dilatation, classical balloon dilation, special drug-eluting balloon, and so forth, having laid the foundation of endovascular treatment. Similarly, stent, a representative of endovascular implants, has also undergone continuous innovations of bare stent, drug-eluting stent, and absorbable stent. However, when it comes to comparing the long-term advantages and disadvantages of stents of different configurations and materials after having been applied at different sites of the human body, more clinical researches are required for further confirmation. Besides progress in peripheral arterial devices, fast-changing innovations are also being carried out on devices used for the endovascular treatment of aortic diseases. As for endovascular devices applied to aortic dilatations, from the coating materials at the beginning, through the small-caliber delivery systems, to the innovations in the overall configurations of stent grafts, more and more aortic diseases which could not handle minimally invasive endovascular treatment in the past can now be cured through endovascular treatment. In short, endovascular devices adopt further minimally invasive treatment, higher disease adaptability and better long-term effectiveness as their development directions, and the endless emergence of new design concepts (such as individualized customization), new materials and new manufacturing processes forecasts the accelerated arrival of an era in which all vascular diseases can be cured through minimally invasive endovascular treatment.

With the development of information technology and social media, people are getting used to sharing experiences on social platforms. Social media like Weibo and online forums usually carries a large amount of comments about medical and health treatments, and provides valuable supplementary information for comprehensive understanding of the practical effects as well as the social attitudes of those treatments. In this paper, we aim to explore the above social evaluation method of medical and health treatments based on big data analytics. Due to the characteristics of non-standard expressions, rich variations, and complex contexts of the comments on social media, it’s difficult to conduct a precise content analysis for social evaluation. Therefore, we adopt the sentiment analysis and affective computing technique to deal with the comment texts, and present an effective evaluation method which can better reflect the overall social feelings and attitudes to a certain medical and health treatment. The proposed method and its big data analytics are studied and applied to the cases of treatment evaluations of lung cancer, hepatitis B, and diabetes mellitus in this paper.

The purpose of the study was to provide an endovascular strategy of treating patent reentries adjacent to visceral branches in the management of aortic dissections. A 45-year-old male who had received endovascular treatment for a type B aortic dissection was again admitted for his intermittent abdominal pain. Distal tears located in the reno-visceral segment were left untreated in the initial procedure and were thought to be related to the expansion of the false lumen during follow-up. Another endovascular surgery aiming at sealing these reentries was then performed using the concept of low-porosity flow-diverting stents and coiling technique. Postoperative angiogram revealed a significant decrease in inflow rate through the distal tears, and further computed tomography scan showed a decrease in maximum aortic diameter during the follow-up. With the assistance of coils, the low-porosity bare stents showed the potential to significantly decrease the inflow rate and accelerate the thrombosis of the false lumen. Clinical success achieved in this case study proposes an endovascular strategy in treating the reentries without disturbing the adjacent branches, while its safety and efficacy are still waiting for the verification.

Objective To summarize the experience of AngioJet mechanical thrombectomy for the treatment of acute arterial embolism (AE). Methods Clinical data of 39 patients with acute AE treated by AngioJet mechanical thrombectomy during December 2013 and April 2015 were analyzed retrospectively. Clinical symptom was graded based on pre- and post-treatment angiography.Follow-up was performed by Doppler ultrasound and clinical evaluation. Results All the patients received mechanical thrombectomy with AngioJet. The average length of hospitalization was (4.3 ±1.5) days. The average operation time was (1.3±0.4) hours. Thirty three patients were treated with AngioJet thrombolysis, which failed in 6 patients who subsequently received catheter-directed thrombolysis (CDT). Immediate technique success rate was 79.5%. However, after percataneoustransluminal angioplasty and bare stents implantation to treat arterial stenosis, a technique success rate of 94.9% was achieved. The average reduction of hemoglobin was (7.6± 2.7)g/L. Fifteen patients had myoglobinuria to different extent. During follow-up of more than one year , the treated lesions remained patent in 32 patients. Three patients had reoccurence of limb ischemia. Conclusion AngioJet is safe and effective for treating acute AE with or without angioplasty. The short-term follow-up is satisfactory, when long-term follow-up is needed.