AIM: To explore the treatment methods of severe migraine. METHODS: 51 cases of severe migraine patients were treated with the combination of radix salviae militiorrhizae, diclofenac and sodium aescinate, and another 62 cases of severe migraine patients were treated with diclofenac alone. RESULTS: The efficacy of the combination is better than that of diclofenac alone (P

AIM:To evaluate the efficacy and safety of gabapentin in the treatment of migraine.METHODS:A randomized,double-blind,placebo-controlled study was taken.104 patients(aged 18 to 60 year)with migraine were randomly assigned to receive placebo(control group,49 patients)or gabapentin(experimental group,55 patients)for 4 weeks.The efficacy,side effects,TCD and EEG were assessed at the beginning of trials,and 4th,8th weeks.RESULTS:Comparing with the placebo group,the frequency,duration and intensity of migraine were markedly decreased in gabapentin group,there was significant difference between groups(P0.05).CONCLUSION:Gabapentin is an effective and safe agent from migraine.

Objective Systematically evaluate the efficacy of probiotics in treating osteoporosis.Methods Computer search of Cochrane Library,Web of Science,PubMed,Embase,VIP,CNT and Wanfang data knowledge service platform,the search time limit of August 15,2023,included as a randomized controlled experiment of probiotics for the treatment of osteoporosis.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included literature.The effects of probiotic treatment on BMD,blood calcium,vitamin D,parathyroid hormone,osteocalcin,bone alkaline phosphatase and adverse reactions were analyzed by using Stata A.14 and Revman.5.4 software.Results Eight articles were finally included,Including 744 study subjects,The results of the Meta-analysis showed that,Add probiotics to traditional drug therapy,Can increase hip bone mineral density in patients[WMD 0.05(0.01,0.10)]g/cm3,Increase the calcium ion concentration in the patient's blood[WMD 0.26(0.02,0.50)]mmol/L mmol/L,Increase the concentration of blood osteocalcin[WMD 1.84(0.60,3.07)]ng/mL,Lower the bone-specific alkaline phosphatase concentration[SMD-1.06(-2.06,-0.07)],And reduce the incidence of nausea and diarrhea,However,there was no significant change in vitamin D and parathyroid hormone.Conclusion The addition of probiotics on the basis of routine treatment may improve the level of bone mineral density and reduce the adverse reactions of gastrointestinal tract,which is beneficial to the prognosis of patients.

ObjectiveTo explore the association between triglyceride-glucose （TyG） index and major adverse cardiovascular events （MACEs） risk in coronary heart disease （CHD） patients with blood stasis syndrome after percutaneous coronary intervention （PCI）. MethodsA total of 857 CHD patients with blood stasis syndrome after PCI were enrolled and divided into four groups according to the baseline TyG index quartiles， Q1 （TyG ＜ 8.51）， Q2 （8.51 ≤ TyG ＜ 8.88）， Q3 （8.88 ≤ TyG ＜ 9.22）， and Q4 （TyG ≥ 9.22）. The clinical outcome was defined as a compound endpoint of cardiovascular events including cardiac death， non-fatal myocardial infarction， unplanned revascularization， in-stent restenosis and stroke. The machine learning Boruta algorithm was used for feature selection related to MACEs risk. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to compare the differences in MACEs risk among the four groups. Restricted cubic spline （RCS） and subgroup analysis were performed to determine the relationship between the TyG index and MACEs risk. The area under the receiver operating characteristic （ROC） curve （AUC）， calibration curve and Hosmer-Lemeshow test， and decision curve analysis （DCA） were plotted to evaluate the predictive value of the TyG index for MACEs risk. ResultsThe median follow-up time of the included patients was 2.45 years. During the follow-up period， 313 cases （36.52%） of new MACEs occurred. The incidence of MACEs in Q1， Q2， Q3， Q4 group was 28.17% （60/213）， 29.05% （61/210）， 39.45% （86/218） and 49.07% （106/216）， respectively. Kaplan-Meier survival analysis suggested statistically significant differences in MACEs risk among the four groups （P＜0.001）. Cox proportional hazards regression model analysis found that the risk of MACEs in patients with high TyG index increased by 60.1% （P＜0.01）. Using Q1 as the reference， the MACEs risk in Q2， Q3 and Q4 groups gradually increased， and the trend was statistically significant （P＜0.05）. RCS model suggested that the TyG index was nonlinearly associated with the MACEs risk （P＜0.001）. The TyG index had a good predictive performance for MACEs risk according to ROC analysis （AUC=0.758， 0.724-0.792） and Hosmer-Lemeshow test （χ² = 4.319， P = 0.827）. Additionally， DCA analysis also suggested a good clinical efficacy of the TyG index for predicting MACEs. Subgroup analysis showed that different baseline TyG index was positively correlated with the MACEs risk in the stratification of age， male， BMI， history of diabetes and hypertension， and low-density lipoprotein cholesterol （LDL-C）≥1.8 mmol·L^-1（P＜0.05）. ConclusionThe elevated TyG index is closely corrected with an increased risk of MACEs in CHD patients with blood stasis syndrome after PCI， indicating a guiding significance for early risk stratification and clinical decisions.

OBJECTIVE： To construct prediction model for initial dose of levothyroxine （L-T4） in differentiated thyroid cancer （DTC） patients after surgery. METHODS： A total of 100 DTC patients underwent surgery were selected from thyroid and breast surgery department in Nanjing Drum Tower Hospital. General information of patients such as gender， age， height， body mass， body mass index （BMI） and regular follow-up information after discharge were collected. Related data of thyroid function and adjusted dose of L-T4 were recorded. Single factor variance analysis and t-test were used to analyze the predictors that had significant correlation with the initial dose of L-T4. The prediction model of L-T4 initial dose was established by linear regression analysis， and was verified by prospective experiments. RESULTS： The initial dose of L-T4 in DTC post-surgery patients were significantly correlated with age （P＝0.01，F＝3.993）， body weight （P＜0.001，F＝6.910） and BMI （P＜0.001，F＝7.698）. Linear regression analysis showed that prediction model of initial dose of L-T4 was L-T4（μg/kg）＝2.971-0.033×BMI-0.005×age. DTC post-operative patients were given L-T4 empirically， and only 16％ （16/100） of the patients met the criteriaat the first follow-up  of thyroicl function. In the validation test， L-T4 was given at the initial dose calculated by the prediction model， and 63.7％      （44/69） of the patients reached the standard at the first follow-up. CONCLUSIONS： The established prediction model of L-T4 initial dose after DTC surgery has a certain practicality.

【Objective】 To explore the relevant risk factors of Henoch-Schonlein purpura (HSP) recurrence so as to provide some theoretical basis for early identification of children prone to recurrence. 【Methods】 The clinical data of 417 children with HSP hospitalized in Department of Pediatrics, The First Affiliated Hospital of Xi’an Jiaotong University, in the past five years were collected and followed up. They were divided into recurrent group and non-recurrent group. Cox regression analysis was used for univariate and multivariate analysis, and finally the independent risk factors for HSP recurrence were screened. 【Results】 A total of 417 children with initial onset of HSP were included in the study. During the follow-up period of 14 to 60 months, 78 cases recurred, and the recurrence rate was 18.7%. 94.9% of the children had relapse within 1 year. The results of univariate Cox regression analysis showed that age >7 years old at the time of onset, history of infection, history of strenuous exercise, duration of rashes more than 4 weeks, high level of neutrophil-to-lymphocyte ratio (NLR), and high level of platelet-to-lymphocyte ratio (PLR) were all risk factors for HSP recurrence (P<0.05). The prolongation of activated partial thromboplastin time (APTT) was the protective factor for HSP recurrence (P<0.05). Multivariate Cox regression analysis showed that age >7 years old at the time of onset, history of infection, history of strenuous exercise, duration of rashes for more than 4 weeks at the first onset, and high PLR level were independent risk factors for HSP recurrence (P<0.05). 【Conclusion】 The recurrence rate of HSP was 18.7%, and 94.9% of the recurrent children had HSP recurrence within 1 year. Therefore, children with HSP should be followed up for at least one year. For children aged > 7 years at the time of onset, with a history of infection, vigorous exercise, rashes lasting more than 4 weeks, and high PLR level, nursing should be strengthened after discharge to avoid infection and vigorous exercise and increase the frequency of follow-up.

By examining the records related to the Fengfu （GV 16） acupoint in BIAN Que Heart Book （《扁鹊心书》） compiled by the Song Dynasty physician DOU Cai， this study analyzed various aspects， including the differentiation of conditions treated with Fengfu （GV 16） acupoint， the theoretical foundation for selection of Fengfu （GV 16） acupoint， the application of needling manipulation， and the sensation of obtaining qi during acupuncture. The findings suggest that DOU Cai's approach to utilizing Fengfu （GV 16） acupoint differs from traditional methods， particularly emphasizing the effectiveness of achieving a sensation of heat and numbness. His unique techniques include transverse insertion at Fengfu （GV 16） acupoint and penetrated insertion to Fengchi （GB 20） and Yifeng （TE 17） acupoints. The records of Fengfu （GV 16） acupoint in BIAN Que Heart Book provide a valuable reference for its modern clinical application and further development.

OBJECTIVE To intr oduce multidisciplinary collaborative blood glucose management mode （hereinafter referred as to blood glucose management mode of the whole hospital ）of the whole hospital with the participation of clinical pharmacists ，and to evaluation it effects on the blood glucose management of perioperative diabetes patients. METHODS The process of blood glucose management mode of the whole hospital in Drum Tower Hospital Affiliated to Medical School of Nanjing University and the work content of clinical pharmacists were introduced. Three hundred patients with type 2 diabetes mellitus who underwent elective surgery were included and randomly divided into general consultation group （control group ）and hospital-wide glucose management group （intervention group ）. The effect of glucose management and indicators such as preoperative waiting time and total length of stay were compared between 2 groups. RESULTS In the blood glucose management team of the whole hospital ，the physicians，clinical pharmacists and nurses of blood glucose management in endocrinology department were the core members ，and the management process was divided into initial management ，daily management ，discharge management and follow-up. As the team secretary ，the clinical pharmacists were mainly responsible for daily summarizing and managing the blood glucose level and special conditions of patients ，regularly evaluating the management effect ，carrying out pharmaceutical ward rounds ，medical order review， pharmaceutical care ， timely assessing the blood glucose of patients and guiding the rational use of drugs. Compared with before intervention ， after 3 days ofintervention，the levels of fasting plasma glucose （FPG）and postprandial blood glucose （PBG） were decreased significantly in 2 groups（P＜0.05）；intervention group was significantly lower than control group （P＜0.05）. Compared with control group ， the fluctuation of blood glucose in intervention group was significantly reduced （P＜0.05），standard deviation of blood glucose had reached the targeted control level ， and the postprandial glucose excursion and the largest amplitude of glycemic excursion were close to the targeted control level ；the rate of bl ood glucose reaching the standard before operation and at discharge were significantly increased （P＜0.05）；the preoperative waiting time and hospitalization days were significantly shortened （P＜0.05）. CONCLUSIONS The multidisciplinary collaborative blood glucose management mode of the whole hospital with the participation of clinical pharmacists can control the blood glucose level of diabetic patients in the perioperative period more stably and effectively ，and has practical significance for the disease treatment and prognosis of patients.

ObjectiveTo establish and validate a clinical prediction model for 1-year major adverse cardiovascular events（MACEs）risk after percutaneous coronary intervention （PCI） in coronary heart disease （CHD） patients with blood stasis syndrome. MethodThe consecutive CHD patients diagnosed with blood stasis syndrome in the Department of Integrative Cardiology at China-Japan Friendship Hospital from September 1， 2019 to March 31， 2021 were selected for a retrospective study， and basic clinical features and relevant indicators were collected. Eligible patients were classified into a derivation set and a validation set at a ratio of 7∶3， and each set was further divided into a MACEs group and a non-MACEs group. The factors affecting the outcomes were screened out by least absolute shrinkage and selection operator （Lasso） and used to establish a logistic regression model and identify independent prediction variables. The goodness-of-fit of the model was evaluated by the Hosmer-Lemeshow test， and the area under curve （AUC） of the receiver operating characteristic （ROC） curve， calibration curve， decision curve analysis （DCA）， and clinical impact curve （CIC） were employed to evaluate the discrimination， calibration， and clinical impact of the model. ResultA total of 731 consecutive patients were assessed and 404 eligible patients were enrolled， including 283 patients in the derivation set and 121 patients in the validation set. Lasso identified ten variables influencing outcomes， which included age， sex， fasting plasma glucose （FPG）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， homocysteine （Hcy）， brachial-ankle pulse wave velocity （baPWV）， flow-mediated dilatation （FMD）， left ventricular ejection fraction （LVEF）， and Gensini score. The multivariate Logistic regression preliminarily identified age， FPG， TG， Hcy， LDL-C， LVEF， and Gensini score as the independent variables that influenced the outcomes. Of these variables， male， high FMD and high LVEF were protective factors， and the rest were risk factors. The prediction model for 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome showed χ²=12.371 （P=0.14） in Hosmer-Lemeshow test and the AUC of 0.90. With the threshold probability > 10%， the model showed better prediction performance for 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome than for that in all the patients. With the threshold probability > 60%， the estimated value was much closer to the real number of patients. ConclusionThe established clinical prediction model facilitates the early prediction of 1-year MACEs risk after PCI in CHD patients with blood stasis syndrome， which can provide ideas for the precise treatment of CHD patients after PCI and has guiding significance for improving the prognosis of the patients. Meanwhile， multi-center studies with larger sample sizes are expected to further validate， improve， and update the model.

OBJECTIVE: To explore the relationship between physiological parameters changes and severe heatstroke induced by 5-km armed cross-country training. METHODS: A total of 521 male officers and soldiers from a special team who participated in the summer training of 5-km armed cross-country training from year 2016 to 2017 were enrolled. All trainees participated in 5-km armed cross-country training in high temperature and humidity environment of ambient temperature > 32 centigradeand (or) relative humidity > 65%. The trainees were divided into two groups according to the incidence of severe heatstroke in the course of training. The age, enlistment time, constitution score, body mass index (BMI), external environment (ambient temperature, relative humidity, wind speed, heat index) of trainees of the two groups, and the change rates of arterial blood oxygen saturation (SaO₂), body temperature, pulse and blood pressure within 5 minutes after the 5-km armed cross-country training were compared between the two groups. The risk factors of severe heatstroke were screened by two classified Logistic regression analysis, and the predictive value of various risk factors of severe heatstroke was analyzed by the receiver operator characteristic curve (ROC). RESULTS: In 521 trainees of 5-km armed cross-country training, 29 trainees suffered from severe heatstroke accounting for 5.57%. There was no significant difference in the age, enlistment time, constitution score, BMI, or external environment during 5-km armed cross-country training between severe heatstroke group and non-severe heatstroke group. Compared with those without severe heatstroke, the descending rates of body temperature, pulse, blood pressure and SaO₂ increased rate within 5 minutes after 5-km armed cross-country training of severe heatstroke trainees were significantly decreased [temperature descending rate: (0.67±0.30)% vs. (1.43±1.28)%, pulse descending rate: (7.53±5.21)% vs. (13.48±8.07)%, blood pressure descending rate: (9.28±6.84)% vs. (19.42±7.73)%, SaO₂ increased rate: (0.51±0.39)% vs. (1.50±1.43)%, all P < 0.01]. Two classification Logistic regression analysis showed that the temperature descending rate [odds ratio (OR) = 0.485, 95% confidence interval (95%CI) = 0.289-0.817], pulse descending rate (OR = 0.903, 95%CI = 0.845-0.965), blood pressure descending rate (OR = 0.841, 95%CI = 0.790-0.896), and SaO2 increased rate (OR = 0.421, 95%CI = 0.250-0.711) were the risk factors for severe heatstroke during 5-km armed cross-country training (all P < 0.01). ROC curve analysis showed that temperature descending rate [area under ROC curve (AUC) = 0.659, 95%CI = 0.604-0.714], pulse descending rate (AUC = 0.730, 95%CI = 0.762-0.900), blood pressure descending rate (AUC = 0.831, 95%CI = 0.659-0.801), SaO₂ increased rate (AUC = 0.711, 95%CI = 0.655-0.767) could be used for the incidence of severe heatstroke prediction during 5-km armed cross-country training (all P < 0.01), and the predicted value was the same. CONCLUSIONS Under the same conditions, the severe heatstroke during 5-km cross-country training is closely related to the descending rates of body temperature, pulse, and blood pressure as well as SaO₂ increased rate within 5 minutes after the training, whose predictive values for severe heatstroke were the same.
Blood Pressure ; Heart Rate ; Heat Stroke ; Hot Temperature ; Humans ; Male ; Risk Factors