OBJECTIVE: To evaluate the clinical efficacy and safety of Yangxue Qingnao Pills (YXQNP) combined with amlodipine in treating patients with grade 1 hypertension. METHODS: This is a multicenter, randomized, double-blind, and placebo-controlled study. Adult patients with grade 1 hypertension of blood deficiency and Gan (Liver)-yang hyperactivity syndrome were randomly divided into the treatment or the control groups at a 1:1 ratio. The treatment group received YXQNP and amlodipine besylate, while the control group received YXQNP's placebo and amlodipine besylate. The treatment duration lasted for 180 days. Outcomes assessed included changes in blood pressure, Chinese medicine (CM) syndrome scores, symptoms and target organ functions before and after treatment in both groups. Additionally, adverse events, such as nausea, vomiting, rash, itching, and diarrhea, were recorded in both groups. RESULTS: A total of 662 subjects were enrolled, of whom 608 (91.8%) completed the trial (306 in the treatment and 302 in the control groups). After 180 days of treatment, the standard deviations and coefficients of variation of systolic and diastolic blood pressure levels were lower in the treatment group compared with the control group. The improvement rates of dizziness, headache, insomnia, and waist soreness were significantly higher in the treatment group compared with the control group (P<0.05). After 30 days of treatment, the overall therapeutic effects on CM clinical syndromes were significantly increased in the treatment group as compared with the control group (P<0.05). After 180 days of treatment, brachial-ankle pulse wave velocity, ankle brachial index and albumin-to-creatinine ratio were improved in both groups, with no statistically significant differences (P>0.05). No serious treatment-related adverse events occurred during the study period. CONCLUSIONS Combination therapy of YXQNP with amlodipine significantly improved symptoms such as dizziness and headache, reduced blood pressure variability, and showed a trend toward lowering urinary microalbumin in hypertensive patients. These findings suggest that this regimen has good clinical efficacy and safety. (Registration No. ChiCTR1900022470).
Humans ; Amlodipine/adverse effects* ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Hypertension/complications* ; Middle Aged ; Treatment Outcome ; Drug Therapy, Combination ; Adult ; Blood Pressure/drug effects* ; Double-Blind Method ; Aged ; Antihypertensive Agents/adverse effects*

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Objective: To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN). Methods: The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery, Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4) years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2) years; 23 cases in combined approach group, including 13 males and 10 females, aging of (54.3±19.7) years; 8 cases in digestive tract approach group, including 5 males and 3 females, aging of (50.2±12.5) years. Results: The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1) days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6), (3.8±1.8), (3.7±2.0), (8.4±3.9) days, respectively.The incidence of complications (Clavien-Dindo grade Ⅲ and above) was 10.6%(13/123), 10.2%(6/59), 17.4%(4/23), 1/8 and the mortality was 4.9%(6/123), 3.4%(2/59), 4.3%(1/23) and 0, respectively.The overall mortality of all patients was 4.2%(9/213). The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before, and no patients was converted to open surgery. Conclusion Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.

Objective To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN).Methods The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery,Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3 ± 12.4)years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3 ± 14.2)years; 23 cases in combined approach group,including 13 males and 10 females,aging of (54.3±19.7)years;8 cases in digestive tract approach group,including 5 males and 3 females,aging of (50.2±12.5)years. Results The time from onset to operation in retro?peritoneal, omental sac, combined and digestive tract approach groups were (44.3 ± 22.8), (47.3 ± 24.3), (52.6 ± 21.2), (51.2 ± 30.1)days, respectively; the operation time was (52.3 ± 26.4), (64.3 ± 29.2), (82.8 ± 24.7), (78.2 ± 38.1)minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml,respectively;and the first time to eat after operation was (2.5±1.6),(3.8±1.8),(3.7±2.0),(8.4±3.9) days, respectively.The incidence of complications (Clavien?Dindo gradeⅢand above) was 10.6%(13/123),10.2% (6/59),17.4%(4/23),1/8 and the mortality was 4.9%(6/123),3.4%(2/59),4.3%(1/23)and 0,respectively.The overall mortality of all patients was 4.2%(9/213).The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before,and no patients was converted to open surgery.Conclusion Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.

Objective To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN).Methods The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery,Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3 ± 12.4)years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3 ± 14.2)years; 23 cases in combined approach group,including 13 males and 10 females,aging of (54.3±19.7)years;8 cases in digestive tract approach group,including 5 males and 3 females,aging of (50.2±12.5)years. Results The time from onset to operation in retro?peritoneal, omental sac, combined and digestive tract approach groups were (44.3 ± 22.8), (47.3 ± 24.3), (52.6 ± 21.2), (51.2 ± 30.1)days, respectively; the operation time was (52.3 ± 26.4), (64.3 ± 29.2), (82.8 ± 24.7), (78.2 ± 38.1)minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml,respectively;and the first time to eat after operation was (2.5±1.6),(3.8±1.8),(3.7±2.0),(8.4±3.9) days, respectively.The incidence of complications (Clavien?Dindo gradeⅢand above) was 10.6%(13/123),10.2% (6/59),17.4%(4/23),1/8 and the mortality was 4.9%(6/123),3.4%(2/59),4.3%(1/23)and 0,respectively.The overall mortality of all patients was 4.2%(9/213).The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before,and no patients was converted to open surgery.Conclusion Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.

OBJECTIVETo investigate the correlations between vessel changes and the histopathologic subtypes of lung adenocarcinoma with pure ground-glass nodule (pGGN) on computed tomography (CT).

METHODSTotally 107 patients (116 lesions) with lung adenocarcinomas with pGGN who had undergone curative resection were included. Vessel changes included vascular convergence and/or vessel dilation or distortion within the pGGN. According to the vessel appearances within the pGGN, all patients were categorized into two groups: no change group and change group. Pearson chi-square test was used to analyze the relationships between vessel changes and histopathologic subtypes. Mann-Whitney rank test and t-test were used to identify the relationship of vessels changes with pGGN density and diameter.

RESULTSAmong these 116 pGGNs, there were 21 without vessel changes and 4 with vessel changes in 25 preinvasive lesions; 14 without vessel changes and 15 with vessel changes in 29 minimally invasive adenocacinomas; 16 without vessel changes and 46 with vessel changes in 62 invasive lung adenocarcinomas. There were statistically significant differences of vessel changes (P=0.000) among histopathologic subtypes. The lesion diameter was significantly different between these two groups (P=0.000), while the lesion density showed no significant difference (P=0.826).

CONCLUSIONVessel changes may indicate the invasiveness of lung adenocarcinoma with pGGNs and are related with the lesion diameter.

Adenocarcinoma ; classification ; pathology ; Chi-Square Distribution ; Humans ; Lung Neoplasms ; classification ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed

Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction (stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers (control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90 (SCL-90), the social support by the Social Support Rating Scale (SSRS), and medication adherence by Morisky's self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group (P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions (including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group (P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group (P<0.05, or P<0.01). Those in the "SCL-90 total scores >150 group" were significantly higher than in the "SCL-90 total scores <100 group" and the "SCL-90 total scores between 100 to 150 group" (P<0.05, or P<0.01). Those in the "SCL-90 total scores between 100 to 150 group" were significantly higher than in the "SCL-90 total scores <100 group" (P<0.05). In 90 patients with ischemic stroke, 26 (28.89%) patients obtained high medication adherence, 47 (52.22%) patients medium medication adherence, and 17 (18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17 (50.00%) patients with high medication adherence in the "SCL-90 total scores >150 group", 28 (75.67%) patients with medium medication adherence in the "SCL-90 total scores between 100 to 150 group", and 12 (61.16%) patients with low medication adherence in the "SCL-90 total scores <100 group", respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients (P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.
Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; psychology ; China ; Female ; Humans ; Infarction, Middle Cerebral Artery ; drug therapy ; psychology ; Male ; Medication Adherence ; statistics & numerical data ; Middle Aged ; Social Support ; Stress, Psychological ; etiology ; psychology ; Surveys and Questionnaires

Objective To investigate the role of HBO on the change of levels of ACA and thrombomodulin among parents with ischemic encephalopathy. Methods Patients were divided into three groups: group A (patients with atherosclerosis and thrombosis),group B (patients with cardiogenic embolism) and group C (patients with small artery lesion). All patients were treated with HBO and regular drugs. And then sss scores were recorded and levels of ACA-IgG and thrombomodulin were detected by ELISA before and after therapy of HBO. Results The index of ACA-IgG and lelvel of TM in A,B and C group were higher than those in control group,there are differences among them(P＜0.05),and the level of them were higher in B group than in A and C group.There were significant differences in SSS score for brain function using different therapies in A、B and C group (P＜0.05), but there are no differences among them(P＞0.05).There were differences in the index of ACA-IgG and thrombomodulin using different therapies in A,B and C group(P＜0.05),however,there were no differences among them (P＞0.05). Conclusion HBO can alleviate clinical symptoms and improve recovery of neuron by decreasing the level of ACA-IgG and thrombomodulin in blood,but the effect is not significantly different for ischemic encephalopathy caused by different factors.

Objective To evaluate the predictive value of ABCD2 scoring system in cerebral infarction and death events in the medium-term after transient ischemic attack (TIA) of Chinese population. Methods One hundred and seventy-nine patients with TIA having complete clinical data,admitted to our hospital from January 2008, were chosen in our perspective study. The ABCD2 scale was applied to all the patients and used to observe the 18-month cerebral infarction risk events; according to these data, patients after TIA were divided into cerebral infarction group and non-cerebral infarction group; To the end of 18 months, according to the death event, the patients were divided into survival group and death group. The age, level of blood pressure, clinical features, duration of symptoms and history of diabetes were collected and compared between each 2 groups; the cutofflevel of ABCI2 scale for anticipating cerebral infarction risk and mortality was evaluated according to receiver operating characteristic (ROC) curve. Results Among the studied 179 patients, 52 patients appeared cerebral infarctions within 18 months of TIA; patients in the cerebral infarction group had significantly higher percentage of patients with blood pressure ≥ 140/90 mm Hg (86.5％), unilateral weakness (42.3％),duration of symptoms ≥60 minutes (55.8％), or duration of symptoms 10 to 59 minutes (40.4％), and diabetes (80.8％) as compared with patients in the non-cerebral infarction group (P＜0.05). According to the ROC curve, area under curve was 0.874 of ABCD2 scale for anticipating cerebral infarction risk, 95％confidence interval (CI) was 0.817-0.931 and the cutoff level of ABCD2 scale for anticipating medium-term cerebral infarction risk was 4.5. Among the studied 179 patients, 35 patients died within 18months of TIA; no significant difference in the scores of ABCD2 scale was noted between survival group and death group (P＞0.05); according to ROC curve, area under curve was 0.492 of ABCD2 scale for anticipating mortality, and 95％ CI was 0.389-0.596. Conclusion ABCD2 scale has predictive value in cerebral infarction event, while not in death event in the medium-term of TIA.