Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

BACKGROUND:Icariin,with antiinflammatory,antioxygenatory and immunoregulatory effects,can be a potential drug for preventing and treating acute liver injury. OBJECTIVE:To investigate the protective effect and possible mechanism of icariin in mice with acute liver injury induced by carbon tetrachloride. METHODS:Thirty-two Kunming mice were equally and randomly divided into the following groups:normal,model,low-dose icariin and high-dose icariin groups.The low-and high-dose icariin groups were continuously gavaged with icariin(100 and 200 mg/kg,respectively)once a day for 7 continuous days.The normal group and model group were injected with physiological saline(10 mL/kg)at the same time point.After the last administration,all the groups except for the normal group were injected with carbon tetrachloride to induce acute liver injury.The mice were killed 24 hours later,and the liver index was detected.Serum levels of alanine aminotransferase and aspartate aminotransferase were detected by automated biochemical analysis.Tumor necrosis factor α and interleukin 6 levels in serum were detected using ELISA.The levels of superoxide dismutase,glutathione peroxidase and malondialdehyde in liver tissue were detected through a reagent kit.The histopathology changes of the liver were observed by hematoxylin-eosin staining.TUNEL method was used to detect the apoptosis in hepatocytes.Western blot was performed to detect the expression levels of glucose-regulated protein 78 kDa,endoplasmic reticulum stress-related protein(C/-EBP homologous protein),mixed lineage kinase domain-like protein and Caspase-3 in liver tissue. RESULTS AND CONCLUSION:Compared with the normal group,the liver index and serum levels of alanine aminotransferase,aspartate aminotransferase,tumor necrosis factor α and interleukin 6 were increased in the model group(P＜0.05).Compared with the model group,the above indexes were decreased in the low-dose and high-dose icariin groups(P＜0.05).Compared with the normal group,the activities of superoxide dismutase and glutathione peroxidase in the liver tissue of mice were decreased in the model group(P＜0.05)and the level of malondialdehyde was increased(P＜0.05).Compared with the model group,the activities of superoxide dismutase and glutathione peroxidase were increased in the low-and high-dose icariin groups(P＜0.05)and the level of malondialdehyde was decreased(P＜0.05).Hematoxylin-eosin and TUNEL staining showed that mice in the model group had severe structural destruction of liver tissue,extensive necrosis of hepatocytes and high apoptotic rate of hepatocytes,while the structural destruction of liver tissue and the area of necrosis of hepatocytes in the low-and high-dose icariin groups were significantly milder than those in the model group,and the apoptotic rate of hepatocytes was lower than that in the model group(P＜0.05).Western blot assay showed that the protein expression of glucose-regulated protein 78 kDa,C/-EBP homologous protein,mixed lineage kinase domain-like protein and Caspase-3 in liver tissue of mice in the model group was increased compared with that in the normal group(P＜0.05),while the expression levels of these proteins in liver tissue of mice were significantly reduced after low-and high-dose icariin intervention(P＜0.05).To conclude,icariin can produce a protective effect against carbon tetrachloride-induced acute liver injury,and its mechanism may be related to the regulation of endoplasmic reticulum stress and reduction of programmed necrosis.

Objective To search,evaluate and summarize the relevant evidence of management on xerostomia and thirst of maintenance hemodialysis(MHD)patients,and provide the evidence for clinical medical staff to relieve the symptoms of xerostomia and thirst in MHD patients.Methods We search guideline websites such as the BMJ Best Practice,UpToDate,NICE,GIN,NGC,CMA Infobase,Medlive,and databases such as Cochrane Library,JBI,PubMed,Embase,CINAHL,CNKI,Wanfang,VIP,SinoMed related to interventions on xerostomia and thirst of MHD patients.The literature types include guidelines,expert consensuses,clinical decisions,best practice,evidence summaries,systematic reviews,randomized controlled trials.The search period is from January 1,2013 to September 30,2023.Results A total 12 pieces of the literature were included,including 3 systematic reviews and 9 randomized controlled trials.A total of 19 pieces of evidence were summarized in 6 aspects,including evaluation,basic interventions,oral local interventions,auricular acupressure,dialysis scheme,Chinese herbal medicine combined with acupoint therapy and Chinese herbal medicine therapy.Conclusion Blood purification medical staff should comprehensively consider MHD patients and specific clinical situations,and make interventions to relieve the symptoms of xerostomia and thirst of MHD patients,relieve their physical and mental pain and improve their quality of life.

The management of surplus drugs is an important part of drug administration. At present, China′s medical institutions are in the initial exploration stage in managing surplus drugs.This study analyzed the causes, safety hazards, management policies, and management problems of surplus drugs in medical institutions, and proposed targeted countermeasures and suggestions, including establishing unified and standardized management methods, consensus or guidelines, optimizing internal management of medical institutions, improving the management awareness of medical staff, and clarifying the benefits of surplus drugs, so as to provide references for medical institutions to manage surplus drugs reasonably.

To standardize the management of surplus drugs, improve the efficiency of medical resource utilization, promote the rational use of medical insurance funds, and reduce the financial burden on patients, a large tertiary hospital implemented a practice for managing surplus drugs starting in May 2023. This practice encompassed multiple aspects, including the establishment of organizational structure, clarification of responsibilities, formulation of billing for fractional doses and a reasonable surplus drugs list, establishment of standardized management processes, and allocation of special funds for surplus drugs. These efforts had initially achieved effective management of surplus drugs. As of November 2023, the management of surplus drugs had benefited 136 908 patients, with an average savings of 873.61 yuan per patient and a cumulative savings of approximately 34.7 million yuan in medical insurance funds. This practice had effectively reduced the wastage of medical resources, and could provide references for promoting standardized management of surplus drugs in medical institutions of China. In the future, the hospital should further expand the coverage of surplus drugs, ensure patients′ rights to informed consent, and establish a comprehensive performance incentive mechanism to promote the sustainable development of surplus drug management.

The coronary artery disease is a frequent severe disease of cardiovascular system in recent years. Meanwhile, lung cancer, with its high morbidity and mortality, is the most frequent malignant tumor of respiratory system in the world. Clinical studies have shown that the incidence of coronary artery disease and lung cancer is high throughout the year, and comorbidities are becoming more common, especially in elderly patients. The incidence of lung cancer and coronary heart disease may be related. This article summarizes the common risk factors (smoking and environmental pollution, fibrinogen, estrogen, and age), and treatment (surgical treatment, neoadjuvant therapy, and targeted therapy) progress of the two diseases, providing a theoretical basis for clinical prevention and treatment.

Objective     To compare the clinical effects of coronary artery bypass grafting (CABG) via the left anterior small thoracotomy (LAST) versus lower-end sternal splitting (LESS) approach in the treatment of coronary heart disease. Methods     The patients who underwent LAST CABG in Tianjin Chest Hospital from October 2015 to December 2020 were allocated to an observation group (LAST group), and the patients who underwent LESS CABG at the same period were allocated to a LESS group. Propensity score matching method was applied with a ratio of 1∶1. The baseline data, perioperative data and grafts data were compared between the two groups after matching. Results     Before matching, there were 110 patients in the LAST group, and 206 patients in the LESS group. After matching, there were 110 patients in each group. In the LAST group, there were 83 males and 27 females with an average age of 60.6±8.3 years. In the LESS group, there were 80 males and 30 females with an average age of 61.0±9.6 years. There was no statistical difference in baseline data between the two groups after matching (P>0.05). The hospital stay time (t=2.255, P=0.025) and ventilator using time (t=−2.229, P=0.027) in the LAST group were significantly shorter than those in the LESS group. There were no statistical differences between the two groups in the postoperative hospital stay time, ICU stay time, postoperative left ventricular ejection fraction, postoperative left ventricular end-diastolic diameter, average number of grafts, secondary intubation, secondary thoracotomy, postoperative wound infection, sternal complications, postoperative atrial fibrillation, postoperative pulmonary infection or main adverse cardiovascular and cerebrovascular events (P>0.05). There was no statistical difference in the distribution of target vessels in the anterior descending branch, diagonal branch or posterior descending branch between the two groups (P>0.05). The grafts of the LAST group were significantly more than those of the LESS group in the area of obtuse marginal branch and posterior ventricular branch, and the grafts of the LESS group were significantly more than those of the LAST group in the area of right coronary artery (P<0.05). Post-operative computerized tomography angiography indicated that 1 patient in the LAST group had obtuse marginal branch vein bridge vessel occlusion, and the bridge vessels in the other patients were unobstructed. Conclusion     Minimally invasive CABG via both LAST and LESS approaches is safe and effective. LAST approach can achieve complete revascularization for multi-vessel lesions, and it is safe and reliable, with the advantages of less trauma and aesthetic appearance. However, it requires a certain learning curve of surgical techniques and certain surgical indications.