Postinterventional cerebral hyperdensities Alberta Stroke Program Early CT Score predicts symptomatic intracranial hemorrhage in patients with ischemic stroke / 国际脑血管病杂志

Objective:To evaluate the distribution characteristics of postinterventional cerebral hyperdensities (PCHDs) in patients with acute anterior circulation large vessel occlusive stroke after interventional therapy using the Alberta Stroke Program Early CT Score (ASPECTS) and to investigate its predictive value for symptomatic intracranial hemorrhage (sICH).Methods:Consecutive patients with acute anterior circulation large vessel occlusive stroke underwent endovascular mechanical thrombectomy (EMT) in the Stroke Center of Dongguan People's Hospital from January 2018 to December 2020 were retrospectively enrolled. The clinical, imaging and follow-up data were collected. The immediate PCHDs-ASPECTS after endovascular therapy were analyzed. Multivariate logistic regression analysis and receiver operator characteristic (ROC) curve were used to investigate its predictive value for sICH. Results:A total of 161 patients were enrolled in the study, including 115 males (71.4%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.6±5.6; 66 patients (41.0%) developed PCHDs and 35 (21.7%) had sICH. The baseline NIHSS score, the proportion of patients with severe stroke, the number of retrieval attempts and the detection rate of PCHDs in the sICH group were significantly higher than those in the non-sICH group, while diffusion weighted imaging-ASPECTS and PCHDs-ASPECTS were significantly lower than those in the non-sICH group (all P<0.05). Multivariate logistic regression analysis showed that PCHDs had a significant independent positive correlation with sICH (odds ratio 6.036, 95% confidence interval 1.45-25.123; P=0.013), and PCHDs-ASPECTS had a significant independent negative correlation with sICH (odds ratio 0.70, 95% confidence interval 0.496-0.992; P=0.045). ROC analysis showed that the area under the curve predicted by PCHDs-ASPECTS was 0.832 ( P<0.05). When its cut-off value was 8 points, the sensitivity and specificity were 74.3% and 83.3% respectively. Conclusions:In patients with acute anterior circulation large vessel occlusive stroke treated with EMT, the immediate postoperative PCHDs is an independent predictor of sICH, and PCHDs-ASPECTS can early predict the risk of sICH after EMT.

Research on the effectiveness between high flow nasal oxygen cannula and non-rebreather oxygen face mask in post-extubation patients / 中华急诊医学杂志

Objective To compare the clinical effects of high flow nasal cannula (HFNC) and non-rebreathing oxygen face mask (NRB) in post-extubation patients.Methods 88 critically ill patients with machinery ventilations were divided into HFNC group and NRB group randomly.Blood gas analysis and hemodynamic parameters were assessed 1 hour prior to extubation and 6 hours after extubation.The primary clinical outcomes measured were ventilation-free days,re-intubation patient numbers,length of stay in ICU (Intensive Care Unite),total duration of hospitalization and mortality.The scant of breath degree and comfortableness of patient were recorded according to the Visual analogue scale.The measurement data were described by mean ± standard deviation ((x) ± s) and analyzed with t test,enumeration data were described by number of cases and composition ratio and analyzed with X2test,P ＜ 0.05 was considered to have statistical difference.Results There was no significant difference in clinical features between the two groups,The oxygenation index of HFNC group is significantly higher than that of NRB group after extubation [(251.4 ±43.9) vs.(201.7 ±60.7),P =0.037)].There were more ventilator-free days in the HFNC group than NRB group [(4.2 ± 2.1) vs.(3.4 ± 2.8),P =0.037)] and fewer patients required reintubation (P =0.028).The rate of ventilator associated pneumonia is also lower than NRB group (P =0.024).The patients' scant of breath feeling were obviously allevated comparing with the NRB group [(2.9 ± 1.1) vs.(3.7 ± 1.8),P =0.042)].The oxygenation index of NRB group significantly decreased after extubation [(242.9 ±68.4vs.201.7 ±60.7 P =0.048)].The two groups demonstrated similar hemodynamic patterns before and after extubation.And there were no statistically significant clinical differences in PaCO2,length of ICU stay,total duration of hospitalization or mortality.Conclusions Compared with NRB,HFNC is a more safe and effective clinical tool in the prevention and treatment of critical adult patients with extubation failure.

Reader association participation-based crowd sourcing of virtual reference service in medical college and university libraries / 中华医学图书情报杂志

As a brand new service mode on Internet,crowd sourcing can solve the problems that need high cost and professionals by drawing on the wisdom of tens of thousands of Internet users. Medical college and university libraries should thus strengthen their virtual reference service teams and further improve their virtual reference service level by introducing the crowd sourcing concept,depending on the support of reader association and drawing on the wisdom of readers.

Video-Assisted Thoracoscopic Resection of Posterior Mediastinal Benign Neurogenic Tumors:An Analysis of 40 Cases / 中国微创外科杂志

Objective To evaluate the therapeutic value of video-assisted thoracoscopy in treating posterior mediastinal benign neurogenic tumors.Methods From May 1994 to May 2006,40 patients received thoracoscopic resection of posterior mediastinal benign neurogenic tumor.Double lumen endotrocheal intubation was applied and 3 trocars were placed according to the location of the tumor.A mini-incision was used if the tumor was too large to be safely resected.Results The complete resections were successfully finished in 34 cases while the remaining 6 cases needed a 6 cm mini-incision to complete the surgery.Pathological examination showed 20 cases of neurilemoma,14 cases of neurofibroma,and 6 cases of paraganglioma.The average diameter of these tumors was 4.7 cm(range:2-12 cm).The average thoracic drainage time was 2.2 days(1-7 days).And the average postoperative hospital stay was 4.8 days(3-13 days).Only 2 cases experienced minor complications.There was no death in this study.The time of follow-up was 9 months to 12 years,in which 16 cases were followed for less than 3 years,12 cases for 3-5 years and 7 cases for over 5 years,5 cases lost contact.Only one patient received re-resection due to local recurrence.Conclusions Video-assisted thoracoscopic resection of posterior mediastinal benign neurogenic tumor is safe,reliable and minimally invasive,and can thus be regarded as the therapy of first choice.

Primary experience of 13 cases of lung volume reduction surgery using domestic staplers and autologous tissue / 中国微创外科杂志

Objective To evaluate the results of lung volume reduction surgery (LVRS) using domestic staplers and autologous tissue. Methods Thirteen male patients received LVRS from June 2000 to March 2006 in this hospital. The age range was 56~68 years (mean, 60.5 years). The patients had a history of chronic obstructive pulmonary disease (COPD) for 2~16 years (mean, 11 years). The operation was performed under general anesthesia, with single lung ventilation. A muscle sparing thoracotomy in the 5th intercostal space was conducted. The “target area” was identified by combination of observation and palpation during operation and preoperative CT scans. The cutting edge was stapled with domestic staplers buttressed with autologous tissue. Results All the procedures were successfully accomplished. Follow-up observations for 8 months ~ 5 years showed no dyspnea and improved activities. At 6 months after operation, the FEV_1 and the PaO_2 were increased by 94.4%?21.2% and 12.5%?3.1%, while the RV and TLC were decreased by 24.1%?7.8% and 20.8%?5.1%, respectively. All the abovementioned parameters were significantly changed before and after operation (P