Abstract:Chronic pancreatitis is a progressive inflammatory disease of the pancreas, often accompanied by the deterioration of pancreatic endocrine and exocrine function, which seriously endangers the health of patients. At present, the diagnosis of chronic pancreatitis mainly depends on specific imaging findings and/or histopathological examination, but imaging examination has false negative rate and misdiagnosis rate, and histopathological examination is invasive and the biopsy procedure is difficult. Thus, the early diagnosis of chronic pancreatitis and the differential diagnosis with pancreatic cancer and other diseases are still difficult. Recent studies have found that pancreatic enzyme, exosomes, microRNA, metabolomics, plasma soluble receptors and other markers play a certain role in the diagnosis and differential diagnosis of chronic pancreatitis, with good sensitivity and specificity. This article reviews the research progress of diagnostic markers for chronic pancreatitis, so as to provide new insights for the diagnosis and differential diagnosis of chronic pancreatitis.

Abstract:Objective To investigate the association between cognitive and emotional impairment and early apathy in patients with non-disabling ischemic cerebrovascular events (NICE). Methods A total of 244 NICE patients, 156 males and 88 females, aged (63.1±9.7) years, admitted to The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jun. 2021 to Dec. 2022 were enrolled. Based on the apathy evaluation scale-clinician version (AES-C) scores at admission, patients were categorized into apathy group (score ≥ 33, n=64) and non-apathy group (score<33, n=180). Demographic data, blood test results, and imaging data were collected. According to the imaging examination results, the etiology was divided into transient ischemic attack and mild stroke, and the latter was further classified using the Trial of Org 10172 Acute Stroke Treatment (TOAST). The Fazekas scale was used to evaluate the white matter damage. Within 2 weeks of symptom onset, assessments including the Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment (MoCA), auditory verbal learn test (AVLT), digit span test (DST), digit symbol substitution test (DDST), trail making test (TMT), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were conducted. The differences of the general information and indicators between the 2 groups were compared, and multivariate logistic regression analysis was performed to identify factors influencing apathy. Results The incidence of early apathy in NICE patients was 26.2% (64/244). Compared with the non-apathy group, the patients in the apathy group were older, and had lower body mass index (BMI) and lower level of education (all P<0.05). There were no significant differences in gender, smoking, alcohol consumption, or history of hypertension between the 2 groups (all P>0.05). The results of the first blood test at admission indicated that there was no significant difference in thyroid hormone levels between the 2 groups (P>0.05), and the imaging evaluation results showed that there was no difference in the etiology between the 2 groups (all P>0.05). The results of Fazekas score showed that the degree of white matter injury in the apathy group was significantly higher than that in the non-apathy group (P=0.004). The cognitive function test results indicated that the apathy group had a significantly higher prevalence of cognitive impairment (MoCA total score<26) than that in the non-apathy group (46.1% [83/180] vs 59.4% [38/64], P=0.047). The language function, verbal fluency, abstraction, delayed recall, and orientation of the patients in the apathy group were significantly decreased (all P<0.05), while no significant differences were found in visuospatial/executive function, naming, or attention between the 2 groups (all P>0.05). Furthermore, the apathy group had higher PSQI, HAMA, and HAMD scores compared to the non-apathy group, accompanied by significantly prevalences of sleep disorders, anxiety, and depression (all P<0.05). Multivariate logistic regression analysis revealed that HAMD score, age, and the completion time of TMT-A were risk factors of apathy after NICE (all P<0.05). Conclusion Patients with early apathy have a higher prevalence of cognitive impairment and are more susceptible to sleep disorders, anxiety, and depression. HAMD score, age, and the completion time of TMT-A are risk factors of early apathy after NICE.

Abstract:Objective To explore the efficacy of different forms of repetitive transcranial magnetic stimulation (rTMS) on post-stroke non-fluent aphasia. Methods A total of 45 patients with post-stroke non-fluent aphasia who were hospitalized in Neurovascular Center of The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2021 to Oct. 2022 were randomly assigned (1:1:1) to pseudo-stimulus group, unilateral rTMS treatment group, or bilateral rTMS treatment group. Patients in the pseudo-stimulus group received conventional language training, patients in the unilateral rTMS treatment group received unilateral rTMS therapy on the basis of conventional language training, and patients in the bilateral rTMS treatment group received bilateral rTMS therapy on the basis of conventional language training. The spontaneous speech score, listening comprehension score, naming score, retelling score and the aphasia quotient (AQ) in the Western aphasia battery (WAB) of the 3 groups were compared before and after treatment. Results Before treatment, there were no significant differences in WAB scores (spontaneous speech, listening comprehension, naming, or retelling) or AQ among the 3 groups (all P>0.05). After treatment, the WAB scores (spontaneous speech, listening comprehension, naming, or retelling) and AQ of the 3 groups were significantly increased (all P<0.05); the WAB scores (spontaneous speech, listening comprehension, naming, or retelling) and AQ of the 2 treatment groups were significantly higher than those of the pseudo-stimulus group (all P<0.05), but there were no significant differences in the above indexes between the unilateral or bilateral rTMS treatment groups (all P>0.05). Conclusion Conventional language training combined with rTMS therapy can significantly improve the language function of patients with post-stroke non-fluent aphasia, but the effect of bilateral rTMS is not superior to that of unilateral rTMS.

Abstract:Objective To establish and validate methods for differentiating gastrointestinal stromal tumor (GIST) from non-GIST based on endoscopic ultrasound radiomics and machine learning. Methods A total of 435 eligible patients were enrolled, and 3 279 endoscopic ultrasound images of GIST (257 cases) and non-GIST (including 145 cases of gastric leiomyoma and 33 cases of schwannoma) were collected and assigned (case proportion, 7:3) to training set or test set. Pyradiomics software was used to extract tumor radiomics features, and principal component analysis (PCA), least absolute shrinkage and selection operator (LASSO), extreme gradient boosting (XGBoost), random forest, and recursive feature elimination (RFE) algorithms were used to design feature screening schemes. Based on the selected features, the models were established by support vector machine classifier. Receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the models for GIST and non-GIST. Results The radiomics prediction models were established based on the selected features. The area under curve values of 5 models based on different feature screening methods (PCA, PCA+LASSO, PCA+XGBoost, PCA+random forest, and PCA+RFE) were 0.581, 0.870, 0.874, 0.860, and 0.661, respectively. Conclusion PCA+XGBoost algorithm has the best feature screening effect. A model based on the radiomics and machine learning methods in this study for distinguishing GIST from non-GIST can be used for preoperative prediction of patients.

Abstract:Objective To investigate the application value of artificial intelligence (AI) system AI-SONIC^TM Thyroid 5.3.3.0 based on ultrasound image analysis in the risk assessment of malignant thyroid nodules. Methods A total of 573 thyroid nodules were selected from 453 patients who were admitted to The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2019 to Jan. 2021. With the postoperative pathology as the gold standard, the differential diagnostic efficacies of preoperative AI system examination for benign and malignant thyroid nodules in different gender groups, different age groups, and different nodule size groups were evaluated by χ² test and receiver operating characteristic (ROC) curve. The efficacies of preoperative AI system examination and conventional ultrasonography by different seniority ultrasound physicians before operation in diagnosing benign and malignant thyroid nodules were compared by DeLong test. Results Of the 573 thyroid nodules examined before operation, 411 (76.5%) were malignant and 162 (23.5%) were benign as confirmed by pathology after operation. The sensitivity, specificity, and accuracy of conventional ultrasonography in diagnosing benign and malignant thyroid nodules were 85.2% (350/411), 55.6% (90/162), and 76.8% (440/573), respectively, with an area under curve (AUC) of 0.721 (95% confidence interval [CI] 0.672-0.771) in the junior ultrasound physicians; the sensitivity, specificity, and accuracy were 93.9% (386/411), 74.1% (120/162), and 88.3% (506/573), respectively, with an AUC of 0.865 (95% CI 0.825-0.904) in the senior ultrasound physicians. The sensitivity, specificity, and accuracy of the AI system were 92.5% (380/411), 69.1% (112/162), and 85.9% (492/573), respectively, with an AUC of 0.809 (95% CI 0.764-0.854). DeLong test results showed that the AUC of the AI system in diagnosing benign and malignant thyroid nodules was significantly higher than that of the junior ultrasound physicians (P=0.032), and there was no significant difference between the AI system and senior ultrasound physicians (P>0.05). There was no significant difference in the accuracy of the AI system in diagnosing benign or malignant thyroid nodules among patients with different genders or different ages (P>0.05). For nodules of different sizes, when the maximum diameter of nodules was 10-<15 mm, the AUC of the AI system was the highest, being 0.882 (95% CI 0.723-0.916). Conclusion AI-SONIC^TM Thyroid 5.3.3.0 can identify benign and malignant features of thyroid nodules, and its diagnostic efficiency is close to that of senior ultrasound physicians. It is expected to be a practical tool to predict the risk of malignant thyroid nodules before clinical operation.

Abstract:Objective To investigate the risk factors of lumbar degenerative diseases among fighter pilots, and develop targeted prevention and treatment strategies. Methods Pilots were assessed by a questionnaire and spinal imaging data (including lumbar magnetic resonance imaging and X-ray scans). The questionnaire covered general information, lifestyle, flight training, and other exposure factors. Pilots with lumbar degenerative diseases were categorized into the degenerative group, while others were classified as healthy group. The risk factors of lumbar degenerative diseases were screened by univariate analysis and logistic regression model. Results The overall prevalence of lumbar degenerative diseases was 45.8% (66/144) among the fighter pilots. Sedentary lifestyle (odds ratio [OR]=2.714, 95% confidence interval [CI] 1.351-5.375, P=0.004), lack of lumbar and back muscle exercise (OR=3.136, 95% CI 1.536-6.037, P=0.001), static postural discomfort during flight (OR=8.160, 95% CI 3.152-21.120, P<0.001), lumbar sagittal misalignment during flight (OR=8.397, 95% CI 3.367-20.942, P<0.001), and lumbar coronal misalignment during flight (OR=2.744, 95% CI 1.102-6.831, P=0.030) were risk factors of lumbar degenerative diseases among fighter pilots. Conclusion The prevalence of lumbar degenerative diseases is high among fighter pilots, primarily due to continuous static postural discomfort and lumbar coronal and sagittal instability during flight. Reducing sedentary lifestyle and strengthening lumbar and back muscle exercise are crucial preventive measures against the development of lumbar degenerative diseases.

Abstract:Objective To establish a BALB/c mouse model infected with tick-borne encephalitis virus (TBEV) via intraperitoneal injection, and observe the infection symptoms and replication characteristics of TBEV in mice. Methods Six-week-old female BALB/c mice were randomly assigned (1:1:1) to control group, 1×10³ plaque-forming unit (PFU) TBEV infected group (infected by intraperitoneal injection of 1×10³ PFU per mouse), or 1×10⁴ PFU TBEV infected group (infected by intraperitoneal injection of 1×10⁴ PFU per mouse). The infection symptoms, body weight changes, and survival rates of the mice were monitored. The pathological changes in the brain and spleen of the mice were observed by hematoxylin-eosin (H-E) staining. The expression of TBEV protein in the brain and spleen of the mice was detected by immunohistochemistry. The dynamic changes of TBEV titers in the brain and spleen of the mice were detected by plaque assay. Results The infected mice developed arched back and hind limb paralysis on day 6 in the 1×10⁴ PFU TBEV infected group and on day 7 in the 1×10³ PFU TBEV infected group. Compared with the control group, the body weight of mice was significantly decreased from day 5 in the 1×10⁴ PFU TBEV infected group and from day 6 in the 1×10³ PFU TBEV infected group (P<0.05). The mice died from day 7 post-infection, and all died on day 8 in the 1×10⁴ PFU TBEV infected group and on day 9 in the 1×10³ PFU TBEV infected group. The H-E staining results showed that on day 5 and 7 after TBEV infection, only a small amount of neuronal nucleus pyknosis and deep staining were observed in the brain cortex of the mice, and no infiltration of inflammatory cells was observed. On day 5, the red pulp of spleen showed mild congestion and neutrophils; on day 7, neutrophils were increased. The immunohistochemical staining results showed that TBEV protein was expressed in the brain and spleen of mice on day 5 after TBEV infection, and was increased on day 7. On day 7 post-infection with 1×10³ PFU TBEV, TBEV titers were (1.3±0.6)×10⁵ PFU/mL in the brain of mice and (1.3±0.6)×10³ PFU/mL in the spleen. Conclusion A BALB/c mouse model infected with TBEV has been successfully established by intraperitoneal injection, and TBEV can proliferate and be pathogenic in mice.

Abstract:Objective To construct an adult-derived thyroid organoid (ADTO) model and optimize its culture protocol in vitro. Methods Normal thyroid tissue from adult patients with papillary thyroid cancer (PTC) was digested and separated to obtain thyroid cells. The cells were embedded with Matrigel. Different conditioned culture media were designed and added. The forming efficiency and budding number of the first- and second-generation organoid were observed under microscope. Hematoxylin-eosin (H-E) staining was used to observe the histological morphology of the organoid model; immunohistochemical staining was used to detect the expression of thyroid specific markers, including NK2 homeobox protein 1 (NKX2.1), paired-box 8 (PAX8), and thyroglobulin (TG), to evaluate the consistency between the organoid model and normal thyroid tissue. Thyroxine (T4) and triiodothyronine (T3) levels in the supernatant of the ADTO models were detected by enzyme-linked immunosorbent assay (ELISA) to verify whether they have hormone secretion function or not. Results Eight ADTO models were successfully established from the surgical specimens of 7 PTC patients. In the ADTO culture system, after increasing the concentrations of Noggin and epidermal growth factor and combination of multiple small molecule inhibitors, the first- and second-generation organoid models had more buds, larger spheres, and higher efficiency of organoid formation. H-E staining showed that a large number of follicular structures surrounded by monolayer cubic epithelial cells could be seen in the ADTO model, which was similar to the structural characteristics of human thyroid tissue. Immunohistochemical staining showed positive NKX2.1, PAX8, and TG, which was consistent with the primary tissue. The results of ELISA showed T3 and T4 in the supernatant of the ADTO models, indicating that it had thyroid hormone secretion function. Conclusion The ADTO model established from human thyroid tissue is stable, which provides insights into regenerative medicine to treat hypothyroidism.

Abstract:Objective To investigate the role of autophagy in ischemia/reperfusion injury (I/RI) caused by testicular torsion in rats. Methods Forty healthy male SD rats were randomly assigned (1:1:1) to sham group, model (I/RI) group, I/RI+rapamycin (RAPA) group, or I/RI+3-methyladenine (3-MA) group. Left testicular torsion (720°, 1 h) reduction rat models were established in the latter 3 groups. The rats in the I/RI+RAPA group and I/RI+3-MA group were intervened with autophagy agonist RAPA and autophagy inhibitor 3-MA before modeling, respectively. At 12 h after testicular reduction, the left testis and epididymis of rats in each group were collected for sperm quality analysis. The histopathological changes of testicular tissue were observed by hematoxylin-eosin (H-E) staining. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), and total antioxidant capacity (T-AOC) in testicular tissue were measured by kits. The level of apoptosis in testicular tissue was detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL). The expression levels of autophagy-related proteins (Beclin1 and p62) and apoptosis-related proteins (Bcl2, Bax, and cleaved caspase 3) in testicular tissue were detected by Western blotting. Results Compared with the rats in the sham group, the rats in the I/RI group had poorer sperm quality, loosened testicular varicocele arrangement, fewer and shed germ cells, significantly lower SOD activity, T-AOC level, and p62 and Bcl2 expression levels (all P<0.05), significantly higher MDA content and expression levels of Beclin1, Bax, and cleaved caspase 3 (all P<0.05), and more apoptotic germ cells. Compared with the rats in the I/RI group, the rats in the I/RI+RAPA group had better sperm quality, normalized testicular varicocele arrangement, significantly higher SOD activity, T-AOC level, Beclin1 and Bcl2 expression levels (all P<0.05), significantly lower MDA content, p62, Bax and cleaved caspase 3 expression levels (all P<0.05), and fewer apoptotic germ cells; the rats in the I/RI+3-MA group had poorer sperm quality, loosened testicular varicocele arrangement, significantly lower SOD activity, T-AOC level, Beclin1 and Bcl2 expression levels (all P<0.05), significantly higher MDA content, p62, Bax and cleaved caspase 3 expression levels (all P<0.05), and more apoptotic germ cells. Conclusion Activation of autophagy can improve the sperm quality and testicular histopathological damage in I/RI rats, alleviate oxidative stress, and inhibit germ cell apoptosis.

Abstract:Objective To screen the best anti-inflammatory active fraction of Yunüjian in vitro, analyze its chemical composition, and explore its substance basis. Methods Yunüjian decoction was extracted by water. The extract was concentrated, separated by D101 macroporous resin and divided into 4 elution fractions:water elution, 30% ethanol-water elution, 60% ethanol-water elution, and 95% ethanol-water elution. The anti-inflammatory activity of Yunüjian water extract and other elution fractions was evaluated by lipopolysaccharide-induced mouse macrophage inflammation model. Cell viability and nitric oxide (NO) production were evaluated by methyl thiazolyl tetrazolium (MTT) and Griess method. Then, we validated the anti-inflammatory activity of the best active fraction screened. Interleukin (IL)-1β, tumor necrosis factor α, and IL-6 levels were detected by enzyme-linked immunosorbent assay (ELISA), cell morphology was observed by dark-field microscopy, and intracellular nuclear factor κ B (NF-κB) p65 was detected by immunofluorescence staining. Finally, the chemical components of the best active fraction were separated by middle chromatogram isolated gel column separation combined with activity tracking method and identified by nuclear magnetic resonance spectrometer. Results The water extract, water elution fraction, 30% ethanol-water elution fraction, and 60% ethanol-water elution fraction of Yunüjian had anti-inflammatory activity. The anti-inflammatory activities of the water elution fraction and 30% ethanol-water elution fraction were weaker than that of the water extract. The anti-inflammatory activity of the 60% ethanol-water elution fraction was the highest, and the 95% ethanol-water elution fraction had no anti-inflammatory activity. The 60% ethanol-water elution fraction was the most effective in inhibiting the changes of cell morphology and the expression and nuclear translocation of NF-κB p65 induced by lipopolysaccharide. Five compounds (sonnerphenolic B, (+)-nyasol, broussonin A, 2,4-dimethylbenzoic acid, and 2,4-dihydroxybenzoic acid) were isolated from the 60% ethanol-water elution fraction, and 3 of them were from Anemarrhena asphodeloides. Conclusion The 60% ethanol-water elution fraction is the best anti-inflammatory active fraction of Yunüjian, and the main anti-inflammatory activity may be owed to Anemarrhena asphodeloides.

Abstract:Hydrogen is a colorless, odorless, and bioactive reducing small molecule gas with anti-inflammatory, antioxidant, anti-apoptosis, and other biological functions, and it can be used in the adjuvant treatment of a variety of diseases. The application of hydrogen is not only for inhalation, but also for hydrogen water drinking, hydrogen solution injection, hydrogen dialysate dialysis, etc., and its biological role has been widely studied. This article reviews the role of hydrogen in chronic obstructive pulmonary disease, asthma, lung cancer, coronavirus disease 2019, acute lung injury, pulmonary fibrosis, and other respiratory diseases, and discusses the recent research progress.

Abstract:Vascular injury has a high incidence in modern battlefield, and it is a major cause of war-related disability and death. This article analyzes the characteristics of vascular injury in modern battlefield, including causative factors, sites, and complications of injury, introduces the current progression and limitations of first-aid equipment of vascular injury and war trauma, and discusses the research and development orientation of the first-aid equipment of vascular injury and war trauma.

Abstract:Decompression sickness (DCS) is a series of symptoms and signs caused by bubbles in blood vessels or tissue with dissolved inert gas due to the rapid or excessive reduction of environmental pressure, which can threaten life safety in severe case. At present, recompression oxygen inhalation therapy is the main treatment of DCS, but it cannot meet the treatment needs of severe DCS, and drug adjuvant therapy is still needed. However, the optional drugs for the prevention and treatment of DCS are limited, and no specific drugs have been found. Over the years, scholars have been constantly exploring drugs for the DCS therapy, such as antiplatelet drugs, anti-inflammatory drugs, antioxidant drugs, bubble ablation drugs, and traditional Chinese medicine. Among them, traditional Chinese medicine may be a new direction in the field of prevention and treatment of DCS. This paper reviews the research progress of drug treatment of DCS since 1980s.

Abstract:Exercise intervention is effective in preventing falls in patients with Parkinson's disease. However, there are different types of exercise intervention with inconsistencies in the intensity and frequency, and controversy over the efficacy. Through a comprehensive review of literatures and systematic analysis, this paper compared the effects of different exercise intervention methods on preventing falls in patients with Parkinson's disease. It was found that Tai Ji was the most effective method in reducing falls in patients with mild to moderate Parkinson's disease, followed by balance training, while progressive resistance strength training was less effective. As a new intervention method, cognitive gait dual task training has certain advantages and is worthy of further studies.

Abstract:Various novel strategies and tactics and high-tech weapons have made the modern warfare extremely cruel and complicated, which consequently leads to acute increase of combat stress reaction and psychological disorders among soldiers. With the diversification of modern war demands and military tasks, the mental health care needs of the Navy have become increasingly prominent. Although the research on military mental health started late, substantial progress has been achieved in recent years, and initial progress has been made by a variety of measures, which directly provide reference for the mental health care of the Navy. It is suggested that the navy mental health care should be vigorously carried out by normalizing the navy mental health care units of all levels, building a unified psychological assessment platform, strengthening psychological training during peacetime, and emphasizing military post-traumatic stress disorder research and emergency treatment of traumatic stress during wartime, so as to improve the war capacity of our troops.

Abstract:As an important branch promoting the overall development of medicine in China, special medicine has accumulated many multi-source heterogeneous data since its emergence, but how to accurately analyze and efficiently apply the knowledge is still an urgent problem. Knowledge graph has the advantages of structured organization, management and application of massive big data to achieve knowledge reasoning, and it is a key technology to promote medical digitization. This paper mainly discusses the advantages of knowledge graph in knowledge association to solve the problem of data processing and application in special medical field, summarizes the key technologies involved in the construction of medical knowledge graph, analyzes the progress of knowledge graph in various branches of special medical field, and finally discusses the limitations and directions of knowledge graph in a sub-field of special medicine-cold region medicine.

Abstract:Objective To explore the application of a state transition queue model in the research of injury evolution of the wounded during wartime, so as to predict the number and state of the wounded at different phases and to evaluate the therapeutic effects of different treatment plans. Methods Taking common naval combat injuries as an example, we used the expert interview method to obtain the outcome probability data of the wounded at different time points and with different treatment plans. A state transition queue model comprising 3 states (death, pending evacuation, and returning to duty) was established to predict the evolution and outcomes of the wounded with different treatment plans. Results Assuming an initial state of 100 wounded pending evacuation, a comparative analysis of 7 treatment plans by the medical teams of the ship formation was conducted. The results showed that Plan 4 (primary first-aid within 10 min after the injury, advanced first-aid within 1 h, and early treatment within 3 h) resulted in the fewest deaths (21.4 individuals) and the highest number of returning to duty (53.8 individuals), indicating the most significant treatment effect. Conclusion The state transition queue model has potential value in studies of the injury evolution of the wounded during wartime, offering effective decision support for developing support plans and regulating support actions, but it still needs further refinement.

Abstract:Objective To evaluate the safety and effectiveness of subcutaneous "Z" suture for hemostasis at the femoral vein puncture point after removing large sheaths. Methods A total of 263 patients who were treated by atrial fibrillation cryoablation or leadless cardiac pacemaker (LCP) implantation in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from May 2020 to Dec. 2021 were enrolled. A 16-French sheath catheter was used in patients treated with atrial fibrillation cryoablation, and a 27-French sheath catheter was used in patients treated with LCP implantation. According to envelope method, the patients were randomly assigned (1:1) to 2 groups:figure-of-eight suture group (132 cases) or subcutaneous "Z" suture group (131 cases), for hemostasis at the femoral vein puncture point. The suture time, hemostasis effect, complication incidence, and patient comfort of the 2 groups were compared. Results There were no significant differences in the suture time, immediate hemostasis rate, or complication incidence between the 2 groups (all P>0.05). The physiological dimension score (17.8±1.6 vs 12.7±2.2), psychological dimension score (33.1±2.7 vs 26.4±3.5), and overall score (84.2±3.4 vs 73.5±5.6) of the Kolcaba's comfort scale in the subcutaneous "Z" suture group were significantly higher than those in the figure-of-eight suture group (all P<0.05). Conclusion Subcutaneous "Z" suture can achieve safe and effective hemostasis at the femoral vein puncture point after removing large sheaths, and the comfort of patients is higher than those with figure-of-eight suture.

Abstract:Objective To report 2 cases of artery of Percheron (AOP) infarction and conduct a literature review of 86 cases of AOP infarction, summarizing the clinical characteristics of the disease. Methods The clinical diagnosis, treatment and prognosis of 2 patients with AOP infarction who were treated in The Frist Affiliated Hospital of Xi'an Medical University were reported. The data of 86 cases of AOP infarction were obtained from the literatures at home and abroad. All the clinical data were statistically analyzed. Results A total of 88 AOP patients were enrolled, including 41 males (46.6%) and 47 females (53.4%), with an average age of (58.7±18.9) years old, ranging from 6 to 93 years old. The etiology of acute ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment classification:small artery occlusion in 23 patients (26.1%), cardiac embolism in 22 patients (25.0%), other cause in 22 patients (25.0%), and unknown cause in 21 patients (23.9%). There were 80 cases (90.9%) without intravenous thrombolysis and 83 cases (94.3%) with acute onset. There were 80 cases (90.9%) with consciousness disorder, 41 cases (46.6%) with ophthalmoplegia, 37 cases (42.0%) with speech disorder (dysarthria or thalamic aphasia), 34 cases (38.6%) with limb motor dysfunction, 34 cases (38.6%) with abnormal pupils, 15 cases (17.0%) with dizziness, 14 cases (15.9%) with memory loss, 5 cases (5.7%) with ataxia, and 3 cases (3.4%) with facial nerve paralysis. The most common infarction sites were simple thalamic infarction (44 cases, 50.0%), followed by thalamic infarction combined with mesencephalic infarction (35 cases, 39.8%). The typical midbrain "V" sign was found in 14 cases (15.9%). After treatment, 73 cases (83.0%) were improved, 11 cases (12.5%) died, 2 cases (2.3%) had recurrent infarction, and 2 cases (2.3%) had no change. The age and infarction site were related to the prognosis of patients (both P<0.01). Conclusion The early symptoms of AOP infarction are variable. Diffusion weighted imaging in the acute phase suggests that high signals can be seen in the thalamus and/or midbrain, and there may be a typical "V" sign in the midbrain. Early AOP infarction can be treated with intravenous thrombolysis and other ischemic stroke treatments. The prognosis is related to the age and infarction site.

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