Abstract:Alopecia areata is a common complication of endovascular treatment for acute ischemic stroke,which is often underestimated or overlooked in clinical practice.This article reviews the pathophysiological mechanism,risk factors,predictive factors and predictive models of alopecia areata after endovascular therapy for acute ischemic stroke and tries to find out the correlation factors between alopecia areata and endovascular therapy,providing new ideas and methods for clinical work.

Abstract:With the accumulation of experience among neurosurgeons and their teams,the use of Pipeline embolization devices(PEDs)under local anesthesia has been increasingly explored.The primary advantage of local anesthesia lies in the ability to perform real-time neurological assessments during the procedure,facilitating the early detection and management of surgery-related complications.Additionally,it avoids the need for endotracheal intubation,thereby reducing the risk of cardiac and pulmonary complications,which is particularly beneficial for high-risk patients with medical comorbidities.Here,we report a case of an unruptured ophthalmic segment internal carotid artery aneurysm treated with a PED under local anesthesia,aiming to provide a new perspective for neurointerventional practice.

Abstract:Recently,significant progress has been made in clinical trials in the field of intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke.New research results continuously expanded the indications for both intravenous thrombolysis and mechanical thrombectomy.Based on these advancements,the Writing Group of Chinese Stroke Association Guidelines on Reperfusion Therapy for Acute Ischemic Stroke 2024 invited experts in the field of stroke in China to extensively discuss the existing evidence on reperfusion therapy for acute ischemic stroke,resulting in graded recommendations.This guideline outlines the latest screening criteria for intravenous thrombolysis and mechanical thrombectomy and summarizes the current evidence on different thrombolytic drug options,in order to provide a reference for decision-making on reperfusion therapy of acute ischemic stroke.

Abstract:Objective Through regression analysis,to explore the differences in risk factors between age groups of acute myocardial infarction(AMI)patients,so as to develop personalized nursing strategies.Methods A retrospective analysis was conducted in a total of 427 AMI patients who visited the Department of Cardiology of Jiangsu Provincial People's Hospital from June 2023 to March 2024.They were divided into the<60-year-old group and the≥60-year-old group according to the age.Binary regression analysis was used to evaluate the independent effects of various factors on the occurrence of AMI.Results In the<60-year-old group,smoking(OR=6.69,95%CI:2.88～15.60),alcohol consumption(OR=5.35,95%CI:2.68～12.66),and exercise(OR=5.64,95%CI:0.22～10.88)were all important independent risk factors for AMI.It could be seen that lifestyle factors had particularly significant impacts on AMI patients in this group.In the≥60-year-old group,hyperglycemia(OR=4.95,95%CI:1.35～18.29),history of hypertension(OR=5.47,95%CI:2.48～12.08),history of diabetes(OR=6.37,95%CI:2.15～18.83),and coronary artery lesions(especially multi-vessel lesions,OR=33.00,95%CI:8.70～125.90)played dominant roles in the onset of AMI.The main difference between the two groups was that the onset of AMI in the<60-year-old group was mainly related to lifestyle factors(such as smoking and alcohol consumption),while the≥60-year-old group was more affected by the burden of chronic diseases(such as hypertension,diabetes,etc.)and arteriosclerosis.Conclusion Intervention strategies should vary for patients of different ages.For younger patients,the stragegy should prioritize strengthening lifestyle interventions,while for older patients the strategy needs to focus on chronic disease management and prevention of atherosclerosis.

Abstract:Objective To investigate the current status of knowledge,attitudes and practices(KAP)regarding refeeding syndrome(RFS)among intensive care unit(ICU)nurses and analyze the influencing factors.Methods In October 2024,a cross-sectional study was conducted in 246 ICU nurses in Lianyungang City.Data were collected using a general information questionnaire and the"Nursing KAP Questionnaire on Enteral Nutrition Refeeding Syndrome".Independent samples t-tests,one-way ANOVA,and multiple linear regression were used for statistical analysis.Results The total KAP score of ICU nurses regarding RFS was(79.51±8.14),with knowledge(14.59±5.77),attitude(30.10±3.61),and practice(34.51±3.31)dimensions all at moderate levels.Univariate analysis showed that education level,professional title,specialist nurse status,and prior RFS training significantly influenced KAP scores(P<0.05).Multiple regression analysis indicated that higher education level(β=0.388,P<0.001),higher professional title(β=0.207,P=0.024),and receiving RFS training(β=0.375,P<0.001)were independent positive predictors of KAP levels.Conclusion The KAP level of ICU nurses regarding RFS needs improvement.It is recommended to implement stratified training for nurses with lower education levels and junior professional titles,and to incorporate RFS knowledge into continuing education programs to optimize clinical practice.

Abstract:A 45-year-old male patient was admitted due to a 10-day history of paroxysmal chest pain,which worsened approximately 3 hours before presentation.The patient had a 7-year history of hypertension without regular treatment.Initial electrocardiogram indicated an acute ST-segment elevation myocardial infarction(STEMI)involving the inferior and posterior walls.Coronary angiography revealed complete occlusion of the left circumflex artery(LCX),and percutaneous coronary intervention(PCI)was performed with successful stent placement.Approximately 10 hours post-PCI,the patient suddenly developed drowsiness,right-sided hemiparesis and aphasia,indicating a possible acute ischemic stroke.Brain imaging confirmed occlusion of the left internal carotid artery and middle cerebral artery.Given the recent coronary intervention and contraindications to thrombolysis,emergency mechanical thrombectomy was performed,achieving successful recanalization.Postoperatively,the patient showed significant neurological recovery with improved right-sided muscle strength.This case underscores the importance of vigilance for cerebrovascular complications following coronary stenting,and emphasizes the critical role of multidisciplinary collaboration and timely intervention in improving patient outcomes.

Abstract:Vertebral artery dissecting aneurysms are the most common type of spontaneous intracranial dissection.This paper reports a case of an unruptured vertebral artery V4 segment dissecting aneurysm on the right side in a 51-year-old male patient,successfully treated with pipeline flow diverter-assisted coil embolization under local anesthesia.During the procedure,the patient's vital signs remained stable,and no discomfort was reported.The surgery was completed smoothly without any perioperative complications.This case demonstrates the feasibility and safety of using the pipeline flow diverter for treating vertebral artery V4 segment dissecting aneurysms under local anesthesia and provides valuable insights for the clinical management of similar cases.

Abstract:Objective To systematically review the effect of Restraint Decision Wheel in the implementation of restraints in critically ill patients.Methods Pubmed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure,China Biomedical Literature Database,VIP,and Wanfang databases were searched to collect literature published before December 2024 on the implementation of restraints in critically ill patients based on the Restraint Decision Wheel.RevMan 5.3 software was used for meta-analysis.Results Nine articles were finally included,including 7 Chinese articles and 2 English articles.The results of meta-analysis showed that the implementation of restraints in critically ill patients based on the Restraint Decision Wheel could effectively reduce the unplanned extubation rate of patients[OR=0.34,95%CI(0.15,0.74),P<0.01],reduce the incidence of complications[OR=0.30,95%CI(0.21,0.41),P<0.01],and shorten the restraint time[OR=-12.33,95%CI(-13.98,-8.19),P<0.01].Conclusion For critically ill inpatients who need restraint,the restraint strategy based on the Restraint Decision Wheel is superior to conventional restraint care,in that it can effectively reduce the unplanned extubation rate of patients,reduce the incidence of complications,and shorten the restraint time.Clinical medical staff can use the Restraint Decision Wheel to implement restraints in critically ill patients.

Abstract:The prevalence of cardiovascular disease(CVD)in China is on the rise.It is estimated that there are 330 million people with CVD,including 13 million cases of stroke,11.39 million cases of coronary heart disease(CHD),8.9 million cases of heart failure(HF),5 million cases of pulmonary heart disease,4.87 million atrial fibrillation,2.5 million cases of rheumatic heart disease,2 million cases of congenital heart disease,45.3 million cases of peripheral arterial disease(PAD)and 245 million cases of hypertension.In 2021,the total number of discharges of patients with cardiovascular and cerebrovascular diseases in China was 27,649,800,accounting for 15.36%of the total number of discharges(including all inpatient diseases)in the same period,including 14,872,300 CVDs(accounting for 8.26%),and 12,777,500 cerebrovascular diseases(accounting for 7.10%).The economic burden of CVD on residents and society continues to increase,and the inflection point of CVD prevention and treatment has not yet arrived.

Abstract:In the modern medical system,minimally invasive interventional diagnostic techniques,applied in cardiovascular,neurological and digestive system diseases as examples,have developed into core clinical treatment methods.The application of artificial intelligence in medical imaging diagnosis during interventional surgery can effectively shorten decision-making time for critical steps,reduce intraoperative radiation exposure,optimize treatment methods,and improve prognosis quality through standardized operational procedures.This provides a new paradigm for the intelligent development of interventional diagnostic technologies.Therefore,this paper primarily explores the integration of artificial intelligence with medical imaging diagnostic techniques in interventional surgery to promote more precise and intelligent advancements in interventional procedures.

Abstract:Objective To investigate the association between parathyroid hormone(PTH)and subclinical myocardial injury(SC-MI).Methods Based on data from the 2003-2004 National Health and Nutrition Examination Survey(NHANES),a total of 6,804 adults were included.High-sensitivity cardiac troponin I(hs-cTnI),high-sensitivity cardiac troponin T(hs-cTnT)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were used as biomarkers of SC-MI.Participants were divided into four groups(Q1-Q4)according to PTH quartiles.One-way analysis of variance(ANOVA)was used to compare the mean levels of three biomarkers among the groups.Multivariable linear regression models were applied to assess the associations between PTH and the biomarkers,adjusting for demographic,metabolic and renal function-related covariates.Stratified analyses were performed by age,sex,body mass index(BMI),serum phosphorus and creatinine levels.Results With increasing PTH levels from Q1 to Q4,the mean levels of hs-cTnI,hs-cTnT and NT-proBNP also increased significantly(ANOVA,P<0.05).Multivariable regression showed that PTH was independently and positively associated with all three biomarkers(hs-cTnI:β=0.024,P=0.003;hs-cTnT:β=0.081,P<0.001;NT-proBNP:β=2.054,P<0.001).These associations remained consistent across subgroups in stratified analysis.Conclusion PTH levels are significantly associated with SC-MI biomarkers,suggesting that PTH may be involved in the pathophysiological process of SC-MI.Further studies are needed to explore the underlying mechanisms and the intervention potential,which may provide new targets for early cardiovascular risk prevention.

Abstract:Since the introduction of flow-diverter into clinical practice,most medical centers have performed flow-diverter implantation for unruptured intracranial aneurysms under general anesthesia.This paper reports the successful treatment of a 60-year-old female patient with a giant unruptured cavernous segment internal carotid artery aneurysm using pipeline embolization device under local anesthesia.The procedure was completed without complications,with the patient maintaining stable neurological status throughout the surgery.This case demonstrates the clinical feasibility of pipeline device implantation under local anesthesia,offering an alternative anesthetic approach for the endovascular treatment of intracranial aneurysms.

Abstract:Objective To establish and evaluate a risk prediction model for early complex appendicitis in children.Methods 241 children with appendicitis from the Department of Pediatrics at the First People's Hospital of Lianyungang from 2019 to 2022 were included to establish a predictive model and nomogram,and to conduct internal verification.Results The following variables were selected:PAE,CA,NLR,AD,PCT,WBC and PN.The AUC values of the training set and validation set were 0.977(95%CI:0.961～0.992)and 0.968(95%CI:0.953～0.981),respectively.The sensitivity was 0.983 and 0.932,and the specificity was 0.894 and 0.891,respectively.The calibration curve and H-L test(P=0.956>0.05)showed good consistency between the predicted and actual values,with prediction accuracy and precision of 92.5%and 0.911%,respectively.Conclusion The model has high predictive ability and can guide the diagnosis and treatment of early complex appendicitis in children.

Abstract:Objective To explore the clinical manifestations of perforator artery infarction following the treatment of intracranial dissecting aneurysm(IDA)with flow diverter(FD),and to summarize the clinical management strategies for such complications.Methods A patient with a right vertebral artery V 4 segment dissecting aneurysm was treated with flow diverter,and developed perforator artery infarction postoperatively.This study summarized the case report.Results The patient presented with clinical symptoms of numbness and weakness in the left limbs.After the right vertebral artery V 4 segment dissecting aneurysm was confirmed with cerebral angiography,an intracranial aneurysm flow diverter placement procedure was performed.Intraoperatively,the patient experienced poor local stent deployment,balloon expansion molding,and subsequent poor deployment of a balloon-expandable stent which was resolved.Postoperatively,the patient developed perforator artery infarction and was transferred to the Neurological Intensive Care Unit(NICU)for conservative treatment.Conclusion For complex aneurysms with high treatment difficulty,flow diverter treatment has good efficacy,but its complications should not be overlooked.Strict adherence to technical points during surgery and enhanced perioperative management can reduce the incidence of ischemic events and improve patient prognosis.

Abstract:Transcatheter aortic valve replacement(TAVR)has reached maturity and has entered a stage of steady and stable development in China.From 2017 to 2023,the number of centers conducting TAVR in China has increased from less than 10 to over 600,and the annual implantation volume has increased from hundreds to over 10 000.The 2018 and 2021 editions of the"Expert Consensus on Clinical Pathway for Transcatheter Aortic Valve Replacement in China"played a crucial guiding role during the golden period of TAVR development in China.With significant progress in evidence-based practice,clinical experience,guideline updates,device development,and procedure technique improvements in the TAVR field,especially the important advances in technologies developed from China,protocol optimization based on Chinese clinical practices,it is necessary to update the previous clinical pathway consensus.The new version of the clinical pathway expert consensus has updated the standard procedures for preoperative clinical assessment,perioperative imaging evaluation,standardized procedural processes,comprehensive perioperative management,and postoperative rehabilitation follow-up for TAVR patients.This update aims to further promote the healthy and standardized development of TAVR technology in China and to steadily enhance the medical and scientific research capabilities with this therapeutic technology.

Abstract:Chinese Expert Consensus on the Management of Medium Vessel Occlusion in Acute Ischemic Stroke 2024 is a summary and analysis conducted by experts organized by the Chinese Interventional Neuroradiology Society of Chinese Stroke Association,based on recent advancements and new evidence-based medical findings in the field of endovascular treatment for acute intracranial medium vessel occlusion.This consensus covers the definition of intracranial medium vessels,the incidence,prognosis,diagnosis,intravenous thrombolysis/intra-arterial thrombolysis,endovascular treatment,and specific techniques of endovascular treatment.The aim is to provide guidance for professionals and social workers engaged in stroke prevention and treatment,especially those specializing in endovascular treatment,nursing,and rehabilitation of acute ischemic stroke,as well as relevant governmental agencies,healthcare administrators,pharmaceutical companies,healthcare demand parties,and other stakeholders.

Abstract:The first and main symptom of cerebral venous sinus stenosis is idiopathic intracranial hypertension.However,due to its low incidence and non-specific symptoms,it is difficult for clinicians to diagnose in time or formulate a reasonable treatment plan.In this paper,we report a case of idiopathic intracranial hypertension in a young female patient,who was diagnosed with cerebral venous sinus stenosis by DSA and treated with an interventional procedure,after which she recovered well.We hope that this case can enhance the understanding of cerebral venous diseases,and reduce the missed diagnosis or misdiagnosis,as well as bring new diagnosis and treatment ideas for patients with idiopathic cranial hypertension.

Abstract:Objective To investigate whether lung ultrasound is as valuable as high resolution CT(HRCT)in the diagnosis of rheumatoid arthritis-related interstitial lung disease.Methods 30 patients with rheumatoid arthritis-related interstitial lung disease and 32 patients with simple rheumatoid arthritis diagnosed in our hospital from January 2021 to December 2023 were separately selected for HRCT and lung ultrasound examination.The data were recorded and analyzed.Results The sensitivity(90.0%),specificity(87.5%),positive predictive value(87.1%)and negative predictive value(90.3%)of lung ultrasound in patients with rheumatoid arthritis-related interstitial lung disease were all high.McNemar test results showed that there was no statistical difference between the diagnostic results of lung ultrasound and HRCT(P=1.000),and McNemar consistency test results showed that there was a good consistency between the diagnostic results of lung ultrasound and HRCT for rheumatoid arthritis-related interstitial lung disease(Kappa=0.774,P<0.05).Conclusion Lung ultrasound is as valuable as HRCT in the diagnosis of rheumatoid arthritis-related interstitial lung disease.