Cerebral microbleeds are new biomarkers of the cerebral small vascular disease.With the development of neuroimaging techniques,the related research of cerebral microbleeds has been paid more and more attention.The research of the correlation between cerebral microbleeds and cognitive impairment and stroke,imaging features,pathological changes,and clinical outcomes can provide an important basis for clinical treatment decisions.

Despite a recent American Heart Association (AHA) consensus statement emphasizing the importance of resistant hypertension (RH), its control is still a challenge for conventional medicine. The Chinese herbal formula, Qutan Huayu Fang, has been used effectively to assist antihypertensive agents in blood pressure control, but its effect for RH patients is still unclear. This pilot study aims to explore the effects of taking the formula in addition to antihypertensive medication in the management of RH.

This study was based on the project prophase of expert consultation and literature consult, and aimed to analyze the medicine establishment from the perspective of traditional Chinese medicine (TCM) doctors, in order to further study the influence of medical insurance on the development of TCM. Detailed suggestions were made in or-der to promote the benign development trend of TCM and medical insurance. Questionnaire survey was used in the investigation on perceptions of TCM related with medical insurance among 253 TCM doctors in appointed medical institution of medical insurance. Data was processed with frequency statistics. The results showed that after becoming the appointed medical institution of medical insurance, the medical insurance patients have become the main service group (73.5%) of hospitals (68.4%) and incomes of TCM doctors (41.9%) have increased, which contribute to TCM hospitals of becoming bigger and stronger (63.6%). The medical insurance patients have chosen TCM treatment main-ly for its curative effect (37.9%) and safety (24.1%). The influence of reimbursement ratio in medical insurance was relatively low (1.2%). The reimbursement range of TCM medical insurance needs to be further expanded, such as Chinese medicine nosocomial preparation (90.5%), decoction preparation fee (78.3%), and etc. It was concluded that under the background of universal health coverage, medical insurance plays a more and more important role in the development of TCM. And TCM should ensure its safety and improve its curative effect through the standardization of TCM and other measures. Meanwhile, the formulation of medical security policy and medical insurance management service standards should also consider the characteristics of TCM, and encourage the service of TCM.

Objective To explore the perioperative management and surgical outcomes of fracture-dislocation of the upper cervical spine complicated with vertebral artery injury.Methods We retrospectively analyzed the clinical data of 19 patients diagnosed with fracture-dislocation of the upper cervical spine complicated with vertebral artery injury who had been treated at our department from January 2008 through December 2012.They were 14 males and 5 females,aged from 22 to 53 years (mean,35.2 years).All the patients had fractures of the atlas and/or axis,and disordered atlanto-axial relationship as well.According to Frankel grading system,8 cases were Grade D and 11 Grade E.The cervical posterior fixation with pedicle screws was adopted for all and hemostasis was conducted for those with bleeding from the broken vertebral artery.Their Frankel grade,Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) score were compared between preoperation and final follow-up.Results Intraoperative hemorrhage occurred in 2 patients from the injured vertebral artery.Hemostasis was achieved through direct tamponade with bone wax and gelatin sponge in one and through endovascular intervention after bleeding control by direct tamponade in another.Neither of them presented with symptoms of posterior circulation ischemia after operation.The mean operation time was 153.5 min,and the mean blood loss was 542.1 mL.All the patients were followed up for an average time of 28 months.Bony union was obtained in all after an average time of 13.5 weeks.Follow-ups revealed no ischemic stroke in this series.Symptoms of transient ischemic attack,like transient dizziness and blurred vision,appeared in 2 patients.At the final follow-up,all the patients were assessed as Frankel Grade E.Their mean JOA and VAS scores were significantly improved from 8.1 ± 1.2 and 7.0 ± 1.7 preoperatively to 12.7 ± 1.6 and 1.3 ± 1.2,respectively (P ＜ 0.05).Conclusions Angiography examination is routinely indicated for the patients with fracture-dislocation of the upper cervical spine perioperatively.Preoperative evaluation of the vertebral artery and its adjacent structures and effective intraoperative hemostasis can avoid uncontrollable bleeding during operation,reduce postoperative complications,and improve surgical outcomes.

OBJECTIVE:To explore the effects of short-term application of atorvastatin combined with ezetimibe on efficacy and related indicators of patients with primary nephrotic syndrome with hyperlipidemia. METHODS:Data of 50 patients with prima-ry nephrotic syndrome with hyperlipidemia were retrospectively collected and divided into combination group and control group ac-cording different treatment,25 cases in each group. All patients received low-salt,low-fat ,high-quality protein,giving prednisone 1 mg/(kg·d),po,qd,combined with anticoagulation,diuretic,anti-infection,taking cytotoxic drugs if necessary. Based on it, control group received Atorvastatin calcium tablet 20 mg before going to bed,qd;combination group received Atorvastatin calcium tablet(the same dosage and usage with control group)+Ezetimibe tablet 10 mg,qd. They were treated for 2 weeks. Lipid-lowering efficacy and low-density lipoprotein(LDL-C),triglyceride(TG),cholesterol(TC),high-density lipoprotein(HDL-C),24 h uri-nary protein (M-TP),serum albumin,alanine aminotransferase (ALT),aspartate aminotransferase (AST),serum creatinine and blood urea nitrogen before and after treatment in 2 groups were observed and the incidence of adverse reaction was recorded. RE-SULTS:There was no significant differences in the total effective rate of Lipid-lowering in 2 groups(P>0.05). After treatment, LDL-C,TC and HDL-C in 2 groups were significantly lower than before,Alb in combination group and ALT in 2 groups were sig-nificantly higher than before,with statistical significance(P<0.05),while there were no significant difference in 2 groups(P>0.05). And there was no significant difference in the TG,M-TP,AST,serum creatinine and blood urea nitrogen before and after treatment(P>0.05). CONCLUSIONS:Atorvastatin combined with ezetimibe can improve the blood lipid of patients with primary nephrotic syndrome with hyperlipidemia,while showing similar efficacy and safety with atorvastatin alone in a short term.

OBJECTIVE:To evaluate the biological compatibility and clinical therapeutic effect of the medical sterilized bone wax.METHODS:Embedding test and pathological test as well as hemolytic test were performed by using rabbits as test animal.12531case-times were investigated in respect to the therapeutic effect,prognosis and satisfactory rate.RESULTS:The embedded bone wax was coated by connective tissue and has not been absorbed without surrounding inflammation,edema or necrosis.The bone wax could not be absorbed after stanching bleeding of the bone broken surface.No hemolytic phenomena were observed.The wound healing obtained a satisfactory rate of99.1%.CONCLUSION:The sterilized medical bone wax has good biological compatibility and is safe and effective to stanch bleeding.It is convenient to use due to its singer dose sterilized packaging.

Objectives To observe the effect ofGuizhi-Fuling capsule on the expression of AngⅡand eNOS.Methods 72 male Sprague-Dawley(SD) rats, aged three months, were randomly divided into three groups: a sham-operated group(n=24),a model group (n=24) and a treatment group (n=24). Renal tubulointerstitial fibrosis model was established via unilateral ureteral obstruction(UUO). Rats in the treatment group were treated withGuizhi-Fulingcapsule (125mg/kg),and the same volume of normal saline were given to the rats in the sham -operated group and the model group at the same time. Rats were put to death at day 7, 14, 21 Immunohisto-chemistry staining was performed to investigate both the expression of AngⅡ, eNOS in TIF. Results 1 Renal interstitium injury was seen in the model group and the treatment group rats at day 7. The degree of renal interstitium fibrosis in rats from the treatment group was lighter than that of the model group at day 7, 14, 21 (P< 0.01).2 At day 7,14 and 21, the expression of AngⅡin rats from the model group and the treatment group were higher than that of the sham-operated group (P<0.01), but those of the treatment group was lower than those of the model group (P< 0.01). The expression of AngⅡ in rats from the model and the treatment groups were increasing,the highest in the 21th day (P<0.01).3 At day 7, 14 and 21, the expression of eNOS in rats from the model group and the treatment group were lower than that of the sham-operated group  (P<0.01).ConclusionsGuizhi-Fuling capsule can alleviate the lesion of renal tissue in obstructive kidney and delay the development of TIF.

ObjectiveTo explore the classification, limb salvage strategy and treatmental results following resection of malignant bone tumors around the shoulder girdle. Methods28 patients with malignant bone tumors of the shoulder girdle underwent a limb-sparing resection according to Malawer's surgical classification system of shoulder girdle. Various limb-salvage procedures were performed for all patients. They were evaluated with survival, recrudesce, and metastasis. The function outcome was assesssed with Enneking Function Evaluation System. Results25 patients were followed-up with a mean time of 54 months (ranged 9～96 months)．6 patients recrudesced, 11 patients died．According to Enneking Function Evaluation System, the mean score of the upper extremity was 23 in reimplantation of tumor-bearing bone after alcohol devitalization group, 24 in osteoarticular allograft group, 24 in free periosteum vascularized clavicle group, 26 point in endoprosthesis group, 25 in the total scapulectomies and the head of humerus slinging group, 28.5 in the partial scapulectomies group respectively. ConclusionThe malignant bone tumors around the shoulder girdle can be resected completely. There were a variety of limb-salvage procedures following tumors resection, with which hand function can be preserved in the majority of patients with relieved pain and good function shoulder.

OBJECTIVE:To prepare the sterilized medical bone wax and to establish the standard of quality control.METHODS:The bone wax was identified with chemical approach and the quality of bone wax was evaluated by saponification value.RESULTS:The bone wax was appropriate in formula,feasible in preparing technique and satisfactory in therapeutic efficacy with a satisfication rate of 98%.CONCLUSION:There are no obvious differences between the bone wax developed by our hospital and imported bone wax in quality,therefore the prepared bone wax can take the place of imported products.

Objective:To explore the effect of neurolysis and tendon transplantation in functional reconstruction of the upper limb with severe thermal crush injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 12 patients with thermal crush injuries of the upper limb admitted to Changhai Hospital of Naval Medical University from January 2014 to December 2018. There were 9 males and 3 females, aged 22-54 years (mean, 38 years). The percentage of total body surface area (TBSA) burn ranged from 3% to 8% [(4.9±1.4)%], and wound depth was III degree. According to the damage condition of nerve/tendon and whether there was any dysfunction of the affected limb after wound healing, 12 patients received 2 to 4 times of neurolysis and tendon transplant-related surgeries, with an average surgery of 2.7 times. Among them, a total of 18 times of neurolysis were performed, including 7 times of radial neurolysis, 6 times of median nerve neurolysis and 5 times of ulnar neurolysis, and 14 times of tendon transplantation were done, including 6 times of anastomosis of superficial flexor tendon and long thumb extensor tendon, 5 times of tendon repair transplantation and 3 times of anastomosis of lateral wrist extensor tendon and long thumb extensor tendon. The time interval of each operation was 3-6 months [(4.5±1.0) months]. The Changhai pain ruler, disability of arm-shoulder-hand table (DASH) and joint activity assessment table were assessed before the first operation, 3 months and 6 months after the last operation.Results:All the patients were followed up for 6-12 months (mean, 9.2 months). The score of Changhai pain ruler in the affected limb improved from 3 (2, 3)points before surgery to 1 (0.5, 1)points 3 months after surgery and 1 (0, 1)points 6 months after surgery ( P<0.01). The score of DASH improved from (69.9±2.7) points before surgery to (35.1±1.7) points 3 months after surgery and (33.8±2.0) points 6 months after surgery ( P<0.01). The range of motion score was improved from (1.3±0.5) points before surgery to (2.4±0.5) points 3 months after surgery and (2.8±0.4) points 6 months after surgery ( P<0.01). Conclusion:Neurolysis and tendon transplantation in the treatment of severe thermal crush injuries of the upper limb can alleviate pain in the affected limbs, improve upper limb dysfunction, increase mobility of the palm and upper limb joints, and enhance the quality of life of the patients.