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OBJECTIVE To analyze the research status， hotspots and trends in the research of intravenous thrombolytic drugs in the treatment of acute ischemic stroke. METHODS The original studies related to intravenous thrombolytic drugs for acute ischemic stroke were collected by searching the Web of Science core database； the authors， countries/regions， institutions and keywords of the literature were visualized and analyzed using CiteSpace 6.1.R6 software. RESULTS A total of 1 810 articles were included， and the number of articles published showed an increasing trend year by year， with the United States （556 articles） having the largest number of articles， and China ranking the second （339 articles， with centrality of 0）. The most published author was Ahmed of Sweden （32 articles）， and the most published institution was the University of Calgary in Canada （80 articles）. The current research status and hotspots were mainly the application and therapeutic exploration of new thrombolytic drugs， and the frontier and development trend were the adverse prognosis of neurological deterioration and hemorrhagic transformation accompanied by intravenous thrombolytic drug treatment. CONCLUSIONS The research hotspots and frontier about intravenous thrombolytic drugs for acute ischemic stroke are mainly the third generation of intravenous tissue plasminogen activator， and the exploration of new intravenous thrombolytic drugs and their safety and effectiveness will be the future research hotspots. Chinese scholars and research teams should strengthen cooperation and exchanges with other countries， which can be strengthened by carrying out multi-center clinical trials.
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OBJECTIVE Insomnia is the most fre-quent sleep disorder worldwide and the clinical applica-tion of therapeutic drugs has various adverse effects.In recent years,drugs developed from natural herbs have become potential alternative therapies for insomnia.Nuciferine,one of the main bioactive components obtained from the lotus leaves,has been reported to possess extensive pharmacological activities.However,its hypnotic and sleep regulatory effects have rarely been reported.Hence,this study was intended to investigate the pharma-cological effects of nuciferine and its mechanisms of action in insomnia.METHODS The hypnotic and seda-tive effects of nuciferine were investigated using the eval-uation of locomotor activity test and pentobarbital-induced sleep test in normal and serotonin(5-HT)depletion-induced insomniac mice.Furthermore,the sleep regulatory effects,including sleep time,sleep architecture,and δ-wave power spectral density,were explored using elec-troencephalography/electromyogram(EEG/EMG)-based sleep profiling in normal rats.Finally,the mechanisms of the hypnotic and sedative effects of nuciferine were explored usingin vivoand in silico experiments.RESULTS Nuciferine reduced locomotor activity and prolonged pen-tobarbital-induced sleep time in a dose-dependent man-ner in normal and insomniac model mice.Nuciferine sig-nificantly increased the total sleep time and non-rapid eye movement(NREM)sleep time,inhibited NREM sleep fragmentation,and improved delta power between 0.5 Hz and 1 Hz in normal rats.The results of molecular experiments showed that nuciferine could increase the 5-HT content and 5-HT1A receptor level in the hypothala-mus of insomnia model mice.CONCLUSION This study combined network pharmacological prediction and experi-mental pharmacological techniques to discover the seda-tive-hypnotic effect of nuciferine for the first time Nucif-erine can ameliorate sleep disorder in mice with insom-nia,possibly via serotonergic system.Nuciferine may rep-resent a novel treatment that alleviate the insomnia-like symptoms by modulating 5-HT system.
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Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.
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Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and surgery for circumferential superficial esophageal squamous cell neoplasm.Methods:A retrospective analysis was performed on 153 patients with superficial esophageal squamous cell neoplasm who underwent ESD or surgery at Cancer Hospital, Chinese Academy of Medical Sciences from November 2013 to October 2021. There were 116 cases in ESD group and 37 cases in the surgical group. The en block resection rate, complete resection rate, operation time, perioperative complication incidence, postoperative quality of life, postoperative disease-free survival and overall survival were compared.Results:In the ESD group, the en block resection rate was 100.0% (116/116) and the complete resection rate was 96.6% (112/116). The longitudinal diameter of lesion had no significant correlation with complications or complete resection rate ( P>0.05). The operation time of the ESD group was significantly shorter than that of the surgical group (175.1±52.2 min VS 266.7±88.2 min, t=-5.991, P<0.001). There was no significant difference in the incidence of perioperative complications between the ESD group and surgical group [5.2% (6/116) VS 8.1% (3/37), P=0.452]. According to EORTC-QLQ-C30 and EORTC-QLQ-OES18, emotional function ( P=0.008),cognitive function ( P=0.013) and the total health level ( P<0.001) of the ESD group were significantly higher than those in the surgical group. Fatigue ( P=0.002), pain ( P<0.001), dyspnea ( P<0.001), insomnia ( P<0.001), anorexia ( P<0.001), diarrhea ( P<0.001) and reflux ( P<0.001) in the surgical group were significantly higher than those in ESD group. There was no significant difference in disease-free survival or overall survival between the two groups ( P>0.05). Polyglycolic acid combined with autologous esophageal mucosal transplantation combined with temporary esophageal stent implantation could reduce the rate of esophageal scar stenosis after ESD [53.3% (24/45) VS 100.0% (55/55), P<0.001] and significantly reduce the number of postoperative dilation [1.00 (0.00, 5.00) VS 9.00 (5.00, 14.00), P<0.001] compared with balloon dilation alone. Conclusion:ESD is superior to traditional surgery for the treatment of circumferential superficial esophageal squamous cell neoplasm because of high operational safety, shorter operation time, less trauma, better postoperative life quality. Postoperative esophageal stenosis can still be well cured after endoscopic treatment. Therefore, ESD can be used as the first choice for the treatment of circumferential superficial esophageal squamous cell neoplasm.
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Ferroptosis is a new type of programmed cell death that is closely associated with the pathophysiological process of ischemic stroke. Ferroptosis inhibitors can improve neurological function and provide neuroprotection after cerebral ischemia. Therefore, the role of ferroptosis in ischemic stroke and the regulation of ferroptosis to intervene in the occurrence and development of ischemic stroke have become a research hotspot. This article reviews the molecular mechanism and potential therapeutic targets of ferroptosis during ischemic stroke, hoping to provide new perspectives for the treatment of ischemic stroke.
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Objective:To compare the clinical effect of three indwelling methods of plastic biliary stent on relieving obstructive jaundice caused by unresectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on data of 61 patients with obstructive jaundice caused by unresectable hilar cholangiocarcinoma from April 2014 to December 2020 in Cancer Hospital, Chinese Academy of Medical Sciences. Plastic biliary stent placement was used to relieve jaundice, including 18 cases of intragastric indwelling at the end of biliary stent, 31 cases of duodenal papilla indwelling at the end of biliary stent, and 12 cases of horizontal portion of duodenum indwelling at the end of biliary stent. Incidence of fever within 2 weeks, perioperative mortality, 90-day obstruction rate, and median stent patency period were followed up and the results were analyzed.Results:The incidence of fever within 2 weeks of the three groups were significantly different [66.7% (12/18), 58.1% (18/31) and 16.7% (2/12), χ2=7.30, P=0.026]. There were no statistically differences in the perioperative mortality [0 (0/16), 3.2% (1/31) and 0 (0/10), χ2=1.09, P=1.000], 90-day obstruction rate [52.9% (9/17), 48.3% (14/29) and 40.0% (4/10), χ2=1.91, P=0.589], or median stent patency period (66.0 d, 91.5 d and 94.0 d, Z=4.96, P=0.084) among three groups. Conclusion:Patients with biliary plastic stents with ends placed at the horizontal portion of the duodenum show lower incidence of fever within two weeks after implantation, and similar median stent patency period, 90-day obstruction rate and perioperative mortality compared with intragastric indwelling and duodenal papilla indwelling groups. Therefore, biliary plastic stents with ends placed at the horizontal portion of the duodenum should be recommended as the preferred procedure.
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Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for early hypopharyngeal carcinoma and precancerous lesions.Methods:Clinical data of 41 patients who received ESD for early hypopharyngeal carcinoma and precancerous lesions from August 2013 to August 2019 in the Department of Endoscopy of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively analyzed. Main outcome measurements included operation completion rate, operation time, en bloc resection rate, R0 resection rate, complication rate and recurrence.Results:ESD was successfully completed in all 41 cases, with a success rate of 100.0% and a mean time of 49.1 min (ranged 10-110 min). Fifty-four lesions underwent en bloc resection, with an en bloc resection rate of 98.2% (54/55), of which 41 had negative horizontal and vertical margins, and the R0 resection rate was 74.5% (41/55). During the operation of 55 lesions, there was a small amount of blood oozing on the wound surface, and electrocoagulation with thermal biopsy forceps could successfully stop the bleeding. No perforation occurred, and 2 cases (4.3%) had delayed bleeding after ESD, and hemostasis was successful under emergency endoscopy. Postoperative endoscopy showed that 1 case (2.2%) had esophageal entrance stenosis, and the obstruction was relieved after repeated water balloon dilatation. The follow-up period ranged from 3 to 72 months, and the median time was 18 months. One case was found to have mucosal lesions in the same part of the hypopharynx and received ESD treatment again. Follow-up to October 2020, no residual lesions and recurrence were found.Conclusion:ESD is a safe and effective option for the treatment of early hypopharyngeal carcinoma and precancerous lesions, which is worthy of clinical application.
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Objective:To investigate the changes of blood pressure and serum circadian clock protein levels after cerebral ischemia-reperfusion in spontaneously hypertensive rat (SHR) and their correlation.Methods:The middle cerebral artery occlusion method was used to prepare the SHR cerebral ischemia-reperfusion model at zero point of Zeitgeber Time (ZT), and the systolic blood pressure within 24 h was continuously monitored after the model was made. The tail vein blood of rats was taken every 3 h, and the changes in serum circadian clock proteins (CLOCK, BMAL1, PER1 and CRY1) levels were detected by enzyme-linked immunosorbent assay. Pearson correlation analysis was used to determine the relationship between blood pressure circadian rhythm pattern and circadian clock protein level fluctuation after cerebral ischemia-reperfusion.Results:In the sham operation group, there were various blood pressure patterns, including dipper (53%), non-dipper (27%), super dipper (13%), and reverse dipper (7%), and the main pattern was dipper. In contrast, the degree of blood pressure disorder in the model group was aggravated, and the non-dipper was the main type, with the proportion as high as 40%. The proportion of super dipper and reverse dipper increased to 27% and 13% respectively; proportion of dipper blood pressure decreased to 20%. The serum level of CLOCK in the model group was relatively stable, while the circadian rhythm of BMAL1, PER1 and CRY1 was significantly changed compared with the sham operation group. Pearson analysis showed that PER1 was negatively correlated with the dipper ( r=-0.565, P=0.002) and super dipper ( r=-0.531, P=0.001) blood pressure patterns, and positively correlated with the non-dipper blood pressure pattern ( r=0.620, P<0.001). Conclusion:The circadian rhythm pattern of blood pressure in SHR after cerebral ischemia-reperfusion was obviously disordered, which was closely associated with the regulation of Per1 gene.
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Rhythm of blood pressure refers to the circadian variation of blood pressure, which is regulated by clock genes. However, the rhythm disorder of blood pressure increases the risk of stroke. Taking the process of blood pressure regulation as a clue and focusing on the clock gene pathway, this article explores the possible mechanism of period gene regulating renin-angiotensin-aldosterone system in rhythm of blood pressure, so as to provide reference for the in-depth study of the relevant mechanism of rhythm disorder of blood pressure and search for a new target for the primary prevention of cerebrovascular diseases.
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Ischemic stroke patients are often accompanied by complications such as gastrointestinal bleeding, microbiological disorders, and constipation, while intestinal microbiological disorders can affect the progress and prognoses of ischemic stroke. Researchers have found two-way communication between the brain and the intestines, and they communicate with each other through various mechanisms, called gut-brain axis or brain-gut axis. However, researches on ischemic stroke and brain-gut axis are still in its infancy, and further understanding of the potential relation between ischemic stroke and brain-gut axis may be helpful in developing new methods for the treatments of ischemic stroke. This paper reviews the relation between ischemic stroke and brain-gut axis to open up new ideas for preventions and treatments of ischemic stroke.
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Personalized management of ischemic stroke prevention and treatment remains a top priority in the field of neurology. The purpose of this article is to elucidate the role of nontraditional lipid profile and traditional lipids in the pathogenesis and recurrence of acute ischemic stroke in order to provide new indicators for stroke prevention, risk grading and high-risk population screening, and attempt to discuss the potential predictive value of nontraditional lipid indicators.
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Blood pressure management is an important and complex part of the treatment of acute ischemic stroke. There is no consensus on blood pressure management options for patients with acute ischemic stroke receiving intravenous thrombolysis. Blood pressure levels and blood pressure variability before and after thrombolysis, and timing of blood pressure interventions have significant effects on hemorrhagic transformation, functional outcome, and recurrence risk in patients with acute ischemic stroke. This article reviews the necessity, safety, goals of blood pressure management before and after thrombolysis, and its impact on the outcomes in acute ischemic stroke.
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Almost all life on Earth has a 24 h circadian rhythm. The circadian clock that controls the circadian rhythm is an important regulator of physiology and disease. Disturbance of circadian rhythm can negatively affect physiological homeostasis at the molecular, cellular, organ system, and whole organism levels. The circadian clock rhythm disorders are considered to be involved inmany cardiocerebrovascular diseases, such as ischemic stroke and myocardial infarction. Ischemic stroke is one of the main causes of long-term disability and death worldwide. The incidence is higher in the daytime and lower at night, but the exact mechanism of this time distribution is unclear. This article discusses the role of the circadian clock in stroke pathophysiological mechanism and the specific molecular mechanism of clock gene regulation. It is expected that molecular time can be used or changed to open up new targets for stroke treatment.
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Objective:To explore whether endoscopic surgery can achieve the same effect on thyroid cancer as open surgery.Method:44 cases were selected to endoscopic thyroidectomy with breast areola approach, who were prepared to accept the surgical treatment of thyroid cancer with cT1N0 stages, female, ≤60 years old, no history of neck surgery and beauty desire. Fifty patients with the same conditions undergoing thyroid open surgery were as the control group.Results:Operative time of endoscopic group[ (170.0±28.0) min] was longer than that of the open operation group[ (90.0±21.0) min ( t=15.610, P=0.000) ]. There was no significant difference between the two groups in surgical complications ( P>0.05) . There was no statistical difference between the number of paratracheal and anterior tracheal lymph nodes of endoscopic group (6.0 ±4.2) and open surgery group (5.5 ±3.7) ( t=0.692, P>0.05) . There was no statistical difference between the number of anterior laryngeal lymph nodes of endoscopic group (0.7 ±1.1) and open surgery group (0.5 ±0.9) ( t=1.186, P>0.05) . Conclusion:The breast areola approach endoscopic thyroidectomy is safe and reliable in treatment of thyroid cancer, and the central cervical lymph node dissection is sufficient, which can be used as the choice of operation mode for thyroid cancer patients in cT1N0 stage.
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Abstract@#From 1949 to 2020, school-based sexuality education in China gradually established its legal status and received more policy support. During these 70 years of development, the attitudes of Chinese government departments towards school-based sexuality education, the direction of policy advocacy, school age of sexuality education and the development of local sexuality education have changed substantially. This editorial describes characteristics of the development of school-based sexuality education policy in China, aiming to depict development paths of school-based sexuality education policy in China so far, and provides inspiration for more policy support for schoolbased sexuality education in China.
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Abstract@#From 1949 to 2020, research in the field of school-based sexuality education in China witnessed substantial development with the support of relevant policies. With the continued investment of social resources, school-based sexuality education has gradually been accepted and recognized by the public. During those 70 years of development, government departments, academic institutions, and social organizations were all exploring and looking for localized programs suitable for the development of school-based sexuality education in China. This paper overviewed characteristics of the development of school-based sexuality education research as well as of social resource support in China, in order to outline the development context of school-based sexuality education research, and to bring inspiration to the future development of school-based sexuality education research in China.
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Objective@#To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction.@*Methods@#The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed.@*Results@#The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012).@*Conclusion@#As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.
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Objective@#To provide empirical evidence on the effectiveness of comprehensive sexuality education (CSE) on sexual knowledge and sexual attitudes improvement among college students.@*Methods@#Sexual knowledge and attitudes questionnaire survey was implemented among college students in Beijing, who later received the CSE for a full semester. Sexual knowledge and attitude were evaluated after intervention and were compared with control students.@*Results@#The average score of sexual knowledge was low among college students in Beijing. Most students held neutral attitudes towards "AIDS community" and "masturbation behavior" and positive attitudes towards "LGBT"(58.85%, 68.75%, 61.98%). Compared with the control group, after one semester of CSE curriculum intervention, the average scores of the five dimensions on sexual knowledge in the intervention group was significantly improved(11.79±1.16, 9.36±1.23, 4.84±0.88, 4.91±1.00, 5.35±1.03)(t=11.25, 15.74, 10.37, 5.59, 8.17, P<0.01), and the attitudes towards "sexual minorities", "AIDS communities" and "masturbation behavior" were also significantly improved(30.59±3.91, 17.70±3.41, 10.12±2.17)(t=5.16, 5.83, 2.97, P<0.01).@*Conclusion@#College students’ knowledge of sexuality is not optimistic. The attention to proper sexual attitudes is in great need. Systematic and comprehensive sexuality education curriculum could improve college students’ sexual knowledge and attitudes.
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Objective@#To analyze the influence of sexuality education on primary school students’ attitude towards homosexuality, and provide practical teaching evidence of intervening campus bullying based on sexual orientation.@*Methods@#A primary school offering school-based sexuality education curriculums in Beijing was selected as an experimental school, another school with similar location, nature and scale, quality of teachers and teaching environment was selected as a control school. The graduates in experimental school received 6 years of sexuality education in grade 1 to grade 6 of primary school. A survey was conducted in Jun. 2018 among all the graduates in grade 6 of the two schools through an attitude scale on homosexuality adopting cluster sampling.@*Results@#The scores of attitude towards homosexuality in experimental school and control school were (42.85±15.46) and (60.17±12.54) respectively, with significantly statistical difference(t=-9.47, P<0.01). There were interaction effects on attitudes of primary school students towards homosexuality between gender and experience of sexuality education (P<0.05). There was no significant difference in attitude towards homosexuality between male and female students in control school(t=0.58, P>0.05), but in experimental school, the attitude scores of male and female students respectively were (47.64±14.31) and (38.13±15.19), with significantly statistical difference(t=3.47, P<0.01). There was no significant difference in attitude towards different sexual orientation between experimental school students and control school students(t=0.10，1.53，P>0.05).@*Conclusion@#Sexuality education curriculum can help improve attitude towards homosexuality of primary school students, which has better intervention effects on female students than male students, attitudinal difference in gay and lesbian has not formed in primary school students.
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Objective To explore the independent risk factors of the prolonged time of retention ICU after type A aortic dissection operation,to establish a corresponding perioperative risk assessment system.Methods A total of 509 consecutive patients with type A aortic dissection were enrolled in the study from September 2011 to May 2016,among which,418 patients received emergency operation.The prolonged retention time of ICU was considered as endpoint event.A perioperative assessment system was established through the analysis of related risk factors of the most common complications after type A aortic dissection operation.The possible risk factors of prolonged retention time of ICU were introduced into a single factor analysis.The meaningful variables in the single factor analysis were introduced into logistic regression analysis.The independent risk factors which were obtained from logistic regression analysis were used to establish risk prediction modeL,and the ROC curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the model.Results The perioperative mortality rate was 8.64％,the prolonged retention time of ICU was 5.06 days,and 98 cases exceeded 7 days.The results of logistic regression analysis showed that age,the history of stroke,obesity,emergency operation,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,renal inadequacy,massive transfusion,hypoxemia,and pulmonary infection were the independent risk factors for prolonged retention time of ICU.Accordingly,a mathematical model was established.The area under ROC cure for prediction model(AUC) =0.761,Hosmer-Lemeshow goodness of fit test P =0.512.Conclusion The logistic model estabhshed in this study can successfully predict ICU retention time after type A aortic dissection operation,and the efficacy was predicted satisfactorily.