Objective To evaluate diagnostic value of head upright tilt testing (HUTT) on orthostatic hypotension (OH) in patients with senile hypertension,and explore its efficacy and safety.Methods One hundred and sixty-six patients with senile hypertension were selected,and the patients were divided into 2 groups according to HUTT:experiment group (completed HUTT,86 cases) and control group (unfinished HUTT,80 cases).The blood pressure change was observed.The detection rate of OH and incidence of unexpected event were compared between 2 groups.Results The detection rate of OH in experiment group was 31.4％ (27/86),in control group was 17.5％ (14/80),and there was statistical difference (P ＜ 0.05).The incidence of unexpected event in experiment group was 0,in control group was 6.2％ (5/80),including 3 patients with dizziness amaurosis,unstable presyncope symptoms and fall,and 2 cases with syncope and sudden fall.There was statistical difference in incidence of unexpected event between 2 groups (P ＜ 0.05).Conclusions The use of HUTT in patients with senile hypertension can significantly improve the detection rate of OH,but also significantly reduce the incidence of unexpected event.The method is safe,effective,worthy of clinical promotion.

Objective To explore the effect of 3M Tegaderm transparent film on prevention of puncture complications in patients underwent aortocranial angiography via the femoral artery.Methods A retrospective analysis was carried out on 200 patients underwent aortocranial angiography via the femoral artery from February 2012 to February 2014.Eighty patients without using the transparent dressing paste were as the control group,and other 120 patients using 3M Tegaderm transparent film for fixation of arterial sheath were as the observation group.The occurrences of complications,such as arterial sheath breakage,angiographic tube breakage,femoral artery spasm,bruises at the puncture site and subcutaneous hematoma were analyzed,and the feasibility and effectiveness of 3M Tegaderm transparent film for fixation of arterial sheath were assessed.Results The incidence rate of arterial sheath breakage,angiographic tube breakage,femoral artery spasm,bruises at the puncture site and subcutaneous hematoma were significantly reduced in observation group compared with those in control group [5.8％ (7/120) vs.26.2％ (21/80)] (P ＜ 0.05).Conclusion Application of 3M Tegaderm transparent film with a low price and good security for fixation of femoral artery sheath can effectively reduce the occurrence of complications related to femoral artery puncture,which is worthy of wide spreading.

Objective To explore the efficacy and safety of arterial embolectomy with Solitaire AB stent in treatment of acute intracranial large artery occlusion.Methods The clinical data of 11 patients with acute intracranial large artery occlusion receiving arterial embolectomy with Solitaire AB stent from March to December 2013 were analyzed retrospectively.Among them,5 cases were with simple middle cerebral artery occlusion,1 case combined with occlusion in the intracranial part of the internal carotid artery,4 cases had simple basilar artery occlusion,and 1 case had occlusion in the intracranial portion of the vertebral arteries extending to intracranial portion of the basilar artery.Revascularization and postoperative hemorrhage were analyzed,and nosocomial as well as clinical outcomes after 3 months were evaluated.Results Ten patients showed successful revascularization,of which 8 cases reached the standard of perfect revascularization.After embolectomy,there was obvious stenosis in offending vessel of 4 cases,who were given balloon dilatation then.In 3 cases,the vessels were still narrow,so Solitaire AB stent was placed in the stenosis area to correct stenosis with the residual stenosis rate of less than 40％.Thus electrolytic interruption was given.There was no symptomatic intracranial hemorrhage.Three months after the operation,5 cases recovered,among whom 2 cases had obvious curative effect instantly,1 case had complete remissions in 1 week,and 1 case remained hemiplegia.Five cases died,and 4 cases discharged from the hospital because their family gave up the subsequent treatment.Conclusions Arterial embolectomy with Solitaire AB stent to treat patients with acute intracranial large artery occlusion has a relatively higher revascularization rate.The clinical outcome after 3 months can be significantly improved.Thus,it provides a safe and effective endovascular treatment for patients with acute intracranial large artery occlusion.

Objective: To analyze the correlation between behavior and lifestyle factors and anxiety symptoms of left-behind children, and to provide evidence for mental health intervention of left-behind children. Methods: 1 188 children aged from 13 to 18 (617 non-left-behind children and 571 left-behind children) in B County of Shangrao City, Jiangxi Province were evaluated with Generalized Anxiety Disorder Scale (GAD-7). Meanwhile, physical activity, TV watching time, computer usage time, dietary behavior, sleep and other behavioral lifestyle factors of left-behind children were investigated by questionnaire. Results: The detection rate of anxiety among left-behind children (66.0%) was higher than that of non-left-behind children (60.5%). The detection rates of mild, moderate, and severe anxiety were 26.3%, 15.4% and 24.3%, respectively. Under the condition of controlling age and gender, Logistic regression analysis showed that left-behind childrens anxiety symptoms and computer usage time>3 h/d (mild anxiety, OR=3.00, 95%CI=1.27-4.16; moderate anxiety, OR=4.09, 95%CI=1.55-10.78; severe anxiety, OR=3.44, 95%CI=1.46-8.11), mobile phone usage time >3 h/d (mild anxiety, OR=4.93, 95%CI=2.71-8.94; moderate anxiety, OR=5.93, 95%CI=2.98-11.79; severe anxiety, OR=7.11, 95%CI=3.85-13.15), skipping breakfast behavior (moderate anxiety, often skipping, OR=6.09, 95%CI=1.59-23.36; severe anxiety, often skipping, OR=5.49, 95%CI =1.68-7.97, sometimes eat breakfast, OR=2.68, 95%CI=1.10-6.53) was positively correlated; with appropriate sleeping time (moderate anxiety, OR=0.28, 95%CI=0.13-0.60) was negatively correlated. Conclusion The unhealthy behavior and lifestyle of left-behind children may be a potential risk factor for anxiety symptoms.

Objective To explore the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism.Methods The data of 24 patients who underwent Solitaire stent arterial embolectomy,either alone or in combination with reorganization type tissue plasminogen activator (rt-PA) intravenous thrombolysis,to treat acute cardiogenic cerebral embolism in our hospital were collected.These results between October 2012 and March 2016 were compared with 21 control patients who were treated using only rtPA Ⅳ thrombolysis.The short-term efficacy,long-term clinical outcomes,complications,and mortality rate of these two groups were compared,and the clinical outcomes of these patients with posterior circulation infarction in the two groups were further assessed.Results The time between onset and rt-PA administration in the study group (median time:3.17 h) was significantly shorter than that in the control group (4.00 h,P＜0.05);rt-PA dose used in both two groups was 50 mg.NIHSS scores and Glasgow Coma scale scores at discharge,and modified Rankin scale (mRs) scores 3 and 6 months after treatment in the study group were significantly higher than those in the control group (P＜0.05).There were no significant differences in symptomatic intra-cerebral hemorrhage,high perfusion encephalopathy,incidence of hernia,or mortality between the two groups (P＞0.05).The mRS scores 3 months after treatment in patients with posterior circulation infarction (2) were significantly lower than those in the control group (3,P＜0.05).Conclusions As compared with simple venous thrombolytic therapy,Solitaire stent embolectomy can significantly improve short-term neurological function and long-term prognosis in patients with acute cardiogenic cerebral embolism,enhance their life quality,without increasing the complication incidence and mortality rate.It is safe and effective,and patients with posterior circulation infarction can also be treated by arterial embolectomy.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

OBJECTIVE Designing and synthesizing ursolic acid prodrugs to improve the water solubility and anti-multiple sclerosis(MS) activity of ursolic acid. METHODS succinic acid, dipeptide amino acid and the amino acids segments of side chains of isavuconazole wers selected according to the prodrug strategy, combined with 3-position hydroxyl of ursolic acid via condensation and esterification reaction. Using ultraviolet-visible spectrophotometry to determine the water solubility of prodrugs, and establish the experimental allergic encephalomyelitis mice model for its anti-MS efficacy evaluation. RESULTS Three prodrugs were synthesized and their structures were confirmed by 1H-NMR, 13C-NMR and LCMS(ESI). The water solubility of prodrugs 1 and 2 was over 110 times higher than ursolic acid, and that of prodrug 3 was over 200 times higher than ursolic acid. The in vivo anti-MS activity results showed that the three prodrugs showed significant anti-MS activity, among which prodrug 1 showed significantly better anti-MS activity than ursolic acid group. The mechanism might be through inhibition of peripheral inflammatory cell infiltration into the center and anti-demyelination, so as to exert the anti-MS activity. The metabolism of prodrug 1 in vivo showed that the exposure of prodrug 1 in vivo was 6 times that of ursolic acid, indicating that prodrug 1 might exert anti-MS activity mainly as sodium prototype. CONCLUSION Prodrug 1 has great anti-MS potential, which is worthy of further study. This study provides some basis and useful guidance for the development of ursolic acid prodrugs with anti-MS activity.