Aim To analyze the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)in patients with different types of acute coronary syndrome(ACS)undergoing coronary artery rotational atherec-tomy(RA)within two years.Methods 268 patients with ACS who underwent RA in the Department of Cardiology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School of Nanjing University,between November 2011 and December 2022 were retrospectively included.According to whether ST-segment elevation myocardial infarction(STEMI)occurred,they were divided into 25 cases in the ST-segment elevation myocardial infarction(STEMI)group and 243 cases in the non-ST-segment elevation acute coronary syndrome(NSTE-ACS)group.The NSTE-ACS group included unstable angina pectoris(UAP)and non-STEMI(NSTEMI).The basic information and intraoperative data related to percutaneous coronary intervention(PCI)in the two groups were collected,and the occurrence of MACCE(including car-diovascular death,non fatal myocardial infarction,worsening heart failure,ischemic stroke and target vessel revasculariza-tion)within two years after RA was followed up and analyzed.Results Compared with the NSTE-ACS group,the STEMI group had a higher incidence of MACCE and cardiovascular mortality during the two-year follow-up period(10.3％and 0.4％vs.28.0％and 8.0％;P＜0.05).There was no statistical difference between the incidence of target vessel revascularization,nonfatal infarction,ischemic stroke and worsening heart failure between the two groups(P＞0.05).According to subgroup analysis based on enrollment periods,the results showed that over time(2011-2017 compared to 2018-2022),the incidence of MACCE in all patients within two years after RA showed a decreasing trend(18.97％vs.6.58％).Combined with previous studies,gender,hypertension,diabetes,renal insufficiency,smoking and left ven-tricular ejection fraction(LVEF)were included in the Cox regression model.It was found that the use of intravascular ul-trasound(IVUS)was an independent factor to reduce the incidence of MACCE in ACS patients within two years after RA(HR=0.333,95％CI:0.153～0.723,P＜0.01).Kaplan-Meier analysis showed that among ACS patients undergoing RA,the cumulative incidence of MACCE events was higher in the STEMI group than that in the NSTE-ACS group(P＜0.05).Conclusion STEMI patients have a higher incidence of MACCE and cardiovascular mortality within two years after RA compared to NSTE-ACS patients,and the use of IVUS during RA surgery can reduce the incidence of MACCE in ACS patients after RA.

Aim To investigate the association of triglyceride-glucose(TyG)index with microvascular obstruction(MVO)after percutaneous coronary intervention(PCI)in patients with ST-segment elevated myocardial infarction(STEMI).Methods Individual patient-data were pooled from 310 patients with STEMI underwent emergency PCI in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from June 2018 to June 2021 for a prospective analysis.A week following the operation,cardiac magnetic resonance imaging was used to evaluate the MVO region and the patients were divided into two groups based on whether MVO occured after PCI:the MVO group(n=183)and the non-MVO group(n=127).The clinical data of the two groups were compared,and the linear relationship between TyG index and MVO was described using restricted cubic splines(RCS).Univariate and multivariate Logistic regression analysis were used to correct for confounding factors and identify independent risk factors for MVO occurrence.Results After adjustment for confounding factors,TyG index was an independent risk factor for MVO after emergency PCI in STEMI patients,and every 1-unit increased in TyG index,the risk of MVO increased by 1.24 times(OR=2.24,95％CI:1.07～4.71,P=0.033).The RCS curve analysis results showed that there was a linear re-lationship between the TyG index and the occurrence of MVO after emergency PCI(non-linear correlation test P=0.47).When the TyG index was greater than 9.5,the risk of MVO after emergency PCI significantly increased.Conclusion An increased TyG index is postively associated with the incidence of MVO in STEMI patients who have undergone PCI,and has clinical significantce for early prevention and risk stratification of MVO in STEMI patients.

Aim To investigate the association of triglyceride-glucose(TyG)index with microvascular obstruction(MVO)after percutaneous coronary intervention(PCI)in patients with ST-segment elevated myocardial infarction(STEMI).Methods Individual patient-data were pooled from 310 patients with STEMI underwent emergency PCI in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from June 2018 to June 2021 for a prospective analysis.A week following the operation,cardiac magnetic resonance imaging was used to evaluate the MVO region and the patients were divided into two groups based on whether MVO occured after PCI:the MVO group(n=183)and the non-MVO group(n=127).The clinical data of the two groups were compared,and the linear relationship between TyG index and MVO was described using restricted cubic splines(RCS).Univariate and multivariate Logistic regression analysis were used to correct for confounding factors and identify independent risk factors for MVO occurrence.Results After adjustment for confounding factors,TyG index was an independent risk factor for MVO after emergency PCI in STEMI patients,and every 1-unit increased in TyG index,the risk of MVO increased by 1.24 times(OR=2.24,95％CI:1.07～4.71,P=0.033).The RCS curve analysis results showed that there was a linear re-lationship between the TyG index and the occurrence of MVO after emergency PCI(non-linear correlation test P=0.47).When the TyG index was greater than 9.5,the risk of MVO after emergency PCI significantly increased.Conclusion An increased TyG index is postively associated with the incidence of MVO in STEMI patients who have undergone PCI,and has clinical significantce for early prevention and risk stratification of MVO in STEMI patients.

Aim To analyze the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)in patients with different types of acute coronary syndrome(ACS)undergoing coronary artery rotational atherec-tomy(RA)within two years.Methods 268 patients with ACS who underwent RA in the Department of Cardiology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School of Nanjing University,between November 2011 and December 2022 were retrospectively included.According to whether ST-segment elevation myocardial infarction(STEMI)occurred,they were divided into 25 cases in the ST-segment elevation myocardial infarction(STEMI)group and 243 cases in the non-ST-segment elevation acute coronary syndrome(NSTE-ACS)group.The NSTE-ACS group included unstable angina pectoris(UAP)and non-STEMI(NSTEMI).The basic information and intraoperative data related to percutaneous coronary intervention(PCI)in the two groups were collected,and the occurrence of MACCE(including car-diovascular death,non fatal myocardial infarction,worsening heart failure,ischemic stroke and target vessel revasculariza-tion)within two years after RA was followed up and analyzed.Results Compared with the NSTE-ACS group,the STEMI group had a higher incidence of MACCE and cardiovascular mortality during the two-year follow-up period(10.3％and 0.4％vs.28.0％and 8.0％;P＜0.05).There was no statistical difference between the incidence of target vessel revascularization,nonfatal infarction,ischemic stroke and worsening heart failure between the two groups(P＞0.05).According to subgroup analysis based on enrollment periods,the results showed that over time(2011-2017 compared to 2018-2022),the incidence of MACCE in all patients within two years after RA showed a decreasing trend(18.97％vs.6.58％).Combined with previous studies,gender,hypertension,diabetes,renal insufficiency,smoking and left ven-tricular ejection fraction(LVEF)were included in the Cox regression model.It was found that the use of intravascular ul-trasound(IVUS)was an independent factor to reduce the incidence of MACCE in ACS patients within two years after RA(HR=0.333,95％CI:0.153～0.723,P＜0.01).Kaplan-Meier analysis showed that among ACS patients undergoing RA,the cumulative incidence of MACCE events was higher in the STEMI group than that in the NSTE-ACS group(P＜0.05).Conclusion STEMI patients have a higher incidence of MACCE and cardiovascular mortality within two years after RA compared to NSTE-ACS patients,and the use of IVUS during RA surgery can reduce the incidence of MACCE in ACS patients after RA.

Spinal cord injury can lead to partial or complete loss of spinal cord function, affecting the sensory, motor and neurological functions below the injured part. Among them, nerve function damage can lead to sensory and motor dysfunction, autonomic nervous dysfunction and other symptoms, which seriously affect the patients′ life quality. At present, the conventional treatments for neurological dysfunction after spinal cord injury include surgery, medication, and rehabilitation exercise. However, there are some shortcomings such as failure to completely repair nerve injury surgically, limited effects of medication, and long period of rehabilitation exercise. Spinal cord stimulation (SCS) is known as a treatment, in which electrodes are planted and electrical signals can be transmitted through them in the spinal cord and the peripheral nervous system, thus promoting the recovery of neurological function after spinal cord injury and improving sensory and motor functions, urination and bowel function. However, in order to promote the clinical application of SCS, the stimulation parameters remain to be optimized, the long-term effects need to be determined and the best target application population remains to be identified. To this end, the authors reviewed the research progress on the role of SCS in the recovery of neurological function after spinal cord injury and its application, so as to provide references for subsequent basic research and clinical treatment.

Spinal cord injury can lead to partial or complete loss of spinal cord function, affecting the sensory, motor and neurological functions below the injured part. Among them, nerve function damage can lead to sensory and motor dysfunction, autonomic nervous dysfunction and other symptoms, which seriously affect the patients′ life quality. At present, the conventional treatments for neurological dysfunction after spinal cord injury include surgery, medication, and rehabilitation exercise. However, there are some shortcomings such as failure to completely repair nerve injury surgically, limited effects of medication, and long period of rehabilitation exercise. Spinal cord stimulation (SCS) is known as a treatment, in which electrodes are planted and electrical signals can be transmitted through them in the spinal cord and the peripheral nervous system, thus promoting the recovery of neurological function after spinal cord injury and improving sensory and motor functions, urination and bowel function. However, in order to promote the clinical application of SCS, the stimulation parameters remain to be optimized, the long-term effects need to be determined and the best target application population remains to be identified. To this end, the authors reviewed the research progress on the role of SCS in the recovery of neurological function after spinal cord injury and its application, so as to provide references for subsequent basic research and clinical treatment.

Objective:To investigate the correlation between heart rate variability (HRV) and the progression of Parkinson's disease (PD).Methods:A total of 78 patients with PD who received treatment at the Second People's Hospital of Lianyungang from January 2020 to May 2022 were included in this study. According to Hoehn-Yahr (H&Y) staging, patients with PD were divided into three subgroups: mild PD group (H&Y stage < 2), moderate PD group (2 ≤ H&Y < 3), and advanced PD group (H&Y ≥ 3). Another 66 healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. A dynamic electrocardiogram examination was performed in each group for HRV analysis. The Spearman test was used to analyze the correlation between HRV parameters, disease course, and H&Y staging.Results:Standard deviation of all sinus R-R intervals during 24 hours (SDNN), root mean square of successive RR interval differences during 24 hours (RMSSD), percentage normal-to-normal interval deviation greater than 50 ms (PNN50%) during 24 hours, high frequency component (HF), and low frequency component (LF) in the PD group were (94.76 ± 21.65), (23.41 ± 8.67), (3.50 ± 4.32), (96.57 ± 53.84), and (124.92 ± 82.43), respectively, which were significantly lower than (115.65 ± 13.31), (32.48 ± 8.08), (5.61 ± 5.25), (109.11 ± 39.51), and (143.95 ± 72.77) in the control group ( Z = -6.17, -6.22, -3.90, -2.14, -2.53, all P < 0.05). Disease duration, H&Y staging, and the LED level in the mild PD, moderate PD, and advanced PD groups showed an upward trend (all P < 0.05). The Mini-Mental State Examination (MMSE) score in the advanced PD group was significantly higher than that in the mild PD group ( P < 0.05). There was no significant difference in MMSE score between the mild and moderate stages and between moderate and advanced stages ( P > 0.05). Both SDNN and LF in the mild PD group were (110.61 ± 18.53) and (192.02 ± 95.98), respectively, which were significantly lower than (91.97 ± 15.23) and (113.29 ± 56.71) in the moderate PD group ( t = 4.18, 3.55, both P < 0.01). SDNN and LF in the advanced PD group were (80.90 ± 21.03) and (68.10 ± 44.86) respectively, which were significantly lower than those in the moderate PD and advanced PD groups ( t = 4.88, 2.23, 5.54, 3.26, all P < 0.05). There were no significant differences in RMSSD, PNN50%, and HF among the mild PD, moderate PD, and advanced PD groups (all P > 0.05). SDNN and LF were negatively correlated with PD course ( r = -0.36, -0.37, both P < 0.05) and H&Y staging ( r = -0.46, -0.49, both P < 0.05). Conclusion:Sympathetic dysfunction in PD patients is closely related to the onset and progression of PD, and it can reflect the severity of the disease.

Objective:To investigate the clinical efficacy of carbomer hemorrhoid gel in the treatment of second-degree internal hemorrhoid bleeding.Methods:A total of 160 anorectal outpatients with second-degree internal hemorrhoid bleeding who received treatment in Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2017 to January 2021 were included in this study. They were randomly divided into an observation group and a control group ( n = 80/group). In the observation group, carbomer hemorrhoid gel was used to plug the anus, while in the control group, a hemorrhoid suppository was used to plug the anus. All patients were treated for 7 days. Clinical efficacy was compared between the two groups. Results:After 4 days of treatment, the bleeding score in the observation group was lower than that in the control group [1(0) point vs. 2(1) points, Z = -6.70, P < 0.05). After 7 days of treatment, the bleeding score in the observation group was significantly lower than that in the control group [0(1) point vs. 1(1) point, Z = -4.73, P < 0.05]. After 4 days of treatment, there was no significant difference in the size score of the hemorrhoids between the two groups ( P > 0.05). After 4 days of treatment, the size score of hemorrhoids in the control group did not differ significantly compared with before treatment ( P > 0.05). After 4 days of treatment, the size score of hemorrhoids in the observation group differed significantly compared with before treatment ( Z = -3.16, P < 0.05). After 7 days of treatment, the size score of the hemorrhoids in the observation group was lower than that in the control group [1(1) point vs. 1(0) point, Z = -4.48, P < 0.05]. The total response rate in the observation group was significantly higher than that in the control group [97.5% (78/80) vs. 75% (60/80), Z = -4.50, P < 0.05]. Conclusion:Carbomer hemorrhoid gel is a new drug used to treat hemorrhoids. It has a new dosage form, has no stimulation to the rectum, and is safe to use. Carbomer hemorrhoid gel is highly effective on second-degree internal hemorrhoid bleeding and deserves clinical popularization.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

In response to the Opinions of the CPC Central Committee and the State Council on Promoting the Inheritance， Innovation， and Development of traditional Chinese medicine（TCM） and the spirit of the National Conference on TCM， Chinese Association of Chinese Medicine organized experts in Otorhinolaryngology Head and Neck Surgery of traditional Chinese and western medicine to discuss the clinical advantages of TCM and integrated traditional Chinese and western medicine in the treatment of allergic rhinitis （AR） and they reached a basic consensus. In recent years， the prevalence of AR has been on the rise， threatening the quality of life of patients and giving rise to a heavy burden to both the patients and the society. AR is resulted from immune imbalance rather than reduced immunity or hyperimmunity， and the imbalance is similar to the Yin-yang disharmony in TCM. In the treatment of this disease， western medicine features rapid onset. However， it is cost-intensive and causes severe surgical trauma， and the recurrence is common. TCM boasts diverse methods for AR， which can be used in all stages of this disease. It has advantages in controlling symptoms such as nasal congestion， runny nose， or dysosmia in the attack stage， preventing recurrence in the remission stage， and treating refractory AR or steroid-resistant AR. In particular， acupuncture enjoys a reputation in treatment of AR， which has been supported by evidence-based medicine and recommended by guidelines. While treating local symptoms of AR， TCM regulates the psychosomatic conditions， which facilitates chronic disease management and long-term follow-up. We should integrate the advantages of TCM and western medicine， give full play to the unique nonnegligible and irreplaceable advantages of TCM， formulate a comprehensive diagnosis and treatment scheme for learning and promotion， and summarize the research outcomes to promote the theoretical innovation of TCM on AR from the perspective of integrated traditional Chinese and western medicine.