ObjectiveTo explore the value of combined echocardiography and brain natriuretic peptide (BNP) levels in acute pulmonary embolism (APE) treated by thrombolysis.Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload.Results Twenty-six patients with thrombolysis effective,after thrombolysis,the pulmonary artery systolic pressure decreased from (57.3 ± 18.2)mm Hg to (40.4 ± 15.4)mm Hg (P= 0.003) ,the right ventricular diastolic diameter reduced from (40.6 ± 6.1)mm to (35.4 ± 6.0)mm (P ＜0.01) ,the pulmonary artery diameter reduced from (27.2 ± 4.9)mm to (22.5 ± 4.4)mm (P = 0.004) ,the left ventricular diastolic diameter increased from (42.4 ± 7.2)mm to (43.1 ± 6.9)mm (P = 0.42),septal contradiction were reduced from 20 cases to 10 cases (P = 0.02),plasma BNP levels decreased from (278.8 ± 43.3)ng/L to (119.1 ± 40.4)ng/L (P = 0.000 01).Five patients with thrombolysis ineffective,there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography,however,plasma BNP levels increased from (431.8 ± 57.7) ng/L to (496.4 ± 70.3) ng/L(P = 0.03).Plasma BNP levels and pulmonary artery systolic pressure had a better relationship(r = 0.62,P ＜0.01).Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy.Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.

Objective To assess the effect of continuous renal replacement therapy (CRRT) on severe acute pancre-atitis (SAP). Methods According to the collaborative search strategy, MEDLINE (1966-2013.9), Embase(1974-2013.9), Chinese Wanfang database(1996-2013.9), CNKI(1979-2013.9) and the clinical control test database of Cochrane Library were searched.Published and unpublished literature and meeting summary were searched manually.Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was performed using RevMan 5.2. Results A total of 15 reports were identified which met the inclusion criteria, in which include data of 652 patients.Com-pared with control group, serum amylase decreased in CRRT group (WMD=-140.76, 95%CI was-212.42 to-69.11, P=0.000 1). Mediators of inflammatory mediators were scavenged effectively and APACHEⅡscore decreased in CRRT group (WMD=-2.97, 95%CI was-4.01 to-1.93, P<0.001). The overall survival rate was significantly higher in CRRT group than that in control group (RR=1.35, 95%CI 1.19-1.52, P<0.001). Conclusion Continuous renal replacement therapy could ef-fectively improve the survival rate of patients with severe acute pancreatitis.

Objective: To compare the dosimetric differences in forward intensity-modulated radiotherapy using field-in-field (FIF-F-IMRT) and inverse intensity-modulated radiotherapy (I-IMRT) for the left-sided breast cancer. Methods: A total of 18 patients with left-sided breast cancer undergoing breast-conserving surgery in Shanxi Provincial People's Hospital from January to July 2015 were enrolled. For each patient, two treatment plans were designed. The plans were compared by means of target dose distribution and dose for organ at risk. Results: The two methods met the requirements of the prescribed doses. There were no differences for maximal dose (D_max), mean dose (D_mean), and 100%, 105%, 110% prescription dose percent volume (V₁₀₀, V₁₀₅, V₁₁₀) of the target (all P > 0.05). The percentage volume of heart receiving 5 Gy (V₅), 20 Gy (V₂₀), 30 Gy (V₃₀), D_mean of heart of FIF-F-IMRT [(11±4)%, (7±4)%, (8±3)%, (15±3) Gy] were lower than those of I-IMRT [(42±8)%, (14±10)%, (14±4)%, (18±7) Gy] (t values were 29.457, 5.542, 5.064, 4.165, all P = 0.000). V₅ of left-sided lung of FIF-F-IMRT [(26±6)%] was lower than that of I-IMRT [(47±12)%] (t = 6.708, P = 0.000), but there was no significant difference between the two groups in V₂₀, V₃₀, V₄₀, D_mean of left-sided lung (all P≥0.05). V₅ of right-sided lung and right-sided breast, D_mean of right-sided lung of FIF-F-IMRT [(7±4)%, (26±5)%, (60±19) Gy] were lower than those of I-IMRT [(31±9)%, (48±11)%, (489±67) Gy] (t values were 12.304, 6.708, 42.489, all P = 0.000). The number of the monitor units and spending time of FIF-F-IMRT were lower than those of I-IMRT (t values were 12.214 and 29.899, both P = 0.000). Conclusion FIF-F-IMRT has a good dose distribution in the target volume, and could reduce the dose for organ at risk, especially reduce the unnecessary low dose irradiation, and consume less planning time and equipment consumption.

Objective:To explore our self-designed classification system of irreducible intertrochanteric fractures based on reduction stage and bone block position and to evaluate the reduction techniques guided by the classification system.Methods:A retrospective study was conducted to analyze the data of 115 patients with irreducible intertrochanteric fracture who had been admitted to Department of Orthopedics, Beijing Hospital from September 2014 to November 2022. There were 24 males and 91 females with a mean age of (80.9±11.0) years. The reduction for the fractures was divided into a diaphysis reduction stage (Phase Ⅰ) and a cortical reduction stage (Phase Ⅱ). Based on the relative positions of the intraoperative bone blocks, Phase Ⅰ was divided into an anterior and posterior interlocking type (Phase Ⅰa) and a distal bone block sinking displacement type (Phase Ⅰb) while Phase Ⅱ into a proximal lifting type (Phase Ⅱa), a posterior angulation type (Phase Ⅱb), a positive support type (Phase Ⅱc), and a negative support type (Phase Ⅱd). Depending on the difficulties encountered in different reduction stages, corresponding close reduction strategies (such as top rod support, percutaneous prying, and Joystick technique) were adopted to restore the proximal femoral neck shaft angle, anteversion angle, anterior medial cortex, and length of the affected limb before fixation with intramedullary nails. Recorded were the patient's surgical time, intraoperative bleeding, quality of postoperative reduction, fracture union time, and complications.Results:The surgical time for this group of patients was 70.0(60.0, 92.0) minutes, and the intraoperative blood loss 200.0 (170.0, 200.0) mL. According to the standards by Baumgaertner et al., the quality of postoperative reduction was evaluated as excellent in 103 cases and as good in 12 cases, with an excellent and good rate of 100.0% (115/115). Of the 115 patients, 86 were followed up for more than 6 months to reveal fracture union in all after a duration of 6.0 (4.0, 8.0) months. One patient died of an acute cardiovascular event in the hospital 5 days after surgery. Two patients lost their mobility within 3 months after surgery due to acute cerebral infarction. There was no internal fixation failure requiring secondary surgery or no incision infection.Conclusion:Guided by our self-designed classification system of irreducible intertrochanteric fractures based on the intraoperative reduction stage and the relative position of bone block, real time intraoperative fluoroscopy images can be used to effectively clarify the difficulty of fracture reduction in stages so that corresponding reduction strategies can be adopted, leading to fine clinical efficacy.

ObjectiveTo study the medication rules of Professor. WANG Xingkuan and inherit his academic experience in the treatment of chest stuffiness and pain with the aid of the Traditional Chinese Medicine Inheritance Computing Platform V3.0 （TCMICS V3.0）. MethodThe original medical records of patients with angina pectoris in coronary heart disease （CHD） diagnosed and treated by Prof. WANG in the outpatient department of Hunan University of Chinese Medicine from 2017 to 2020 were collected and entered into the TCMICS V3.0. The rules of prescriptions and drugs were analyzed by the software. ResultA total of 1 044 prescriptions of Prof. WANG for the treatment of chest stuffiness and pain were collected. Most of the drugs were sweet and bitter in flavor and mainly acted on the lung meridian， followed by heart， spleen， liver， stomach， and kidney meridians. Among the prescriptions， Shengmaisan was the most commonly used classic prescription， and Xintongling No. Ⅲ was the top experienced prescription. High-frequency drugs mainly included Ophiopogonis Radix， Pinelliae Rhizoma， Salviae Miltiorrhizae Radix et Rhizoma， Trichosanthis Pericarpium， Coptidis Rhizoma， Schisandrae Chinensis Fructus， and Bupleuri Radix. The common doses of drugs were 3， 5， 10， and 15 g. The analysis of formulation rules revealed 129 combinations of common drugs， 58 combinations with confidence > 0.99， and the core drugs of common syndromes. Six core drug combinations were obtained by drug clustering. ConclusionProfessor WANG treats chest stuffiness and pain based on syndrome differentiation following the principles of benefiting Qi， nourishing Yin， eliminating phlegm， resolving stasis， soothing liver， and promoting bile secretion， reflecting his academic idea of "regulation of multiple organs and comprehensive treatment". The core prescriptions can be used for reference by clinical practitioners， but further clinical and experimental studies are still needed to verify their efficacy.

One hundred and twenty maintenance hemodialysis patients with secondary hyperparathyroidism were randomly assigned to receive cinacalce,calcitriol or combination of cinacalce and cacitriol for treatment,with 40 cases in each group.Patients were followed up for 12 months;and the blood tests,echocardiography,examinations for osteoporosis and soft tissue calcification were performed every month.After 3 months of treatment,the serum levels of parathyroid hormone were decreased in all three groups (P ＜ 0.01);while the parathyroid hormone decreased more markedly with less influence on serum calcium and phosphorus levels in combination group.There were no significant changes in alkaline phosphatase,osteoporosis and cardiac valve calcification after treatment,compared with before treatment.There were no cases of hypercalcemia and hypocalcemia appearing in combination group after treatment.The study indicates that the combination of cinacalcet with calcitriol has better therapeutic effect for treatment of secondary hyperparathyroidism in maintenance dialysis patients.

In order to study the effect of middle ear malformations on energy absorbance, we constructed a mechanical model that can simulate the energy absorbance of the human ear based on our previous human ear finite element model. The validation of this model was confirmed by two sets of experimental data. Based on this model, three common types of middle ear malformations,
Ear Ossicles ; Humans ; Incus ; Malleus

ObjectiveTo investigate the effects of Guizhi Jia Longgu Mulitang on the expression difference of interleukin-10 （IL-10） and tumor necrosis factor -α （TNF-α） in related organs of insomnia rats with sensory dysfunction dominated by lung and study the mechanism of Guizhi Jia Longgu Mulitang in improving insomnia. MethodSD rats were randomly divided into the blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group， with 10 rats in each group. The rats were deprived of sleep by shallow water environment method in a long platform， and the modeling lasted for 42 d. The blank group and model group were given 0.05 mL·kg^-1 normal saline by gavage， and the western medicine group and TCM group were given drugs during modeling. To be specific， the western medicine group was given 0.105 mg·kg^-1 dexzopiclone tablet by gavage， while the TCM group was given 7 600 mg·kg^-1 Guizhi Jia Longgu Mulitang by gavage， both lasting for 28 days. After successful modeling， the Morris water maze experiment was performed on the 42nd day to detect the motion and spatial memory ability of rats. The levels of IL-10 and TNF-α in serum were detected by enzyme-linked immunosorbent assay （ELISA）. The protein expression of IL-10 and TNF-α in the lung and brain tissue of rats was detected by Western blot. The levels of IL-10 and TNF-α in the lung and brain tissue of rats were detected by immunohistochemistry. ResultCompared with the blank group， the sleep stages non-rapid eye movement ( NREM ) and rapid eye movement ( REM ) of the model group were significantly shortened （P<0.5， P<0.01）， and the wake stage was significantly increased （P<0.01）. The total time and distance of platform exploration were significantly increased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly decreased （P<0.01）. ELISA results showed that the serum IL-10 level was significantly decreased （P<0.01）， and TNF-α level was significantly increased （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain and lung tissue of rats was significantly decreased （P<0.01）， and the protein expression of TNF-α was significantly increased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in the brain and lung tissue of rats was significantly decreased （P<0.01）， and that of TNF-α was significantly increased （P<0.01）. Compared with the model group， the NREM stage and REM stage of the western medicine group and the TCM group were significantly increased （P<0.5， P<0.01）， and the wake stage was shortened （P<0.5）. The total time and distance of platform exploration were significantly decreased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly increased （P<0.05， P<0.01）. The serum IL-10 level was significantly increased （P<0.01）， and the serum TNF-α level was significantly decreased according to the ELISA results （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.01）， and the protein expression of TNF-α was significantly decreased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.05， P<0.01）， and the expression of TNF-α was significantly decreased （P<0.05， P<0.01）. ConclusionGuizhi Jia Longgu Mulitang can improve the expression of IL-10 and TNF-α in brain and lung tissue of insomnia rats with sensory dysfunction dominated by lung， prolong sleep time， and then improve insomnia. The mechanism may be related to improving the expression level of inflammatory factors.

BACKGROUND: The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS: The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS: A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION: The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
Humans ; Middle Aged ; Sirolimus/therapeutic use* ; Drug-Eluting Stents/adverse effects* ; Prospective Studies ; Cohort Studies ; Treatment Outcome ; Risk Factors ; Time Factors ; Percutaneous Coronary Intervention/adverse effects* ; Cardiovascular Agents/therapeutic use* ; Coronary Artery Disease/therapy* ; Myocardial Infarction/etiology* ; Thrombosis/complications* ; Polymers ; Registries