OBJECTIVE: To evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets

Increasing evidence shows that the early lesions of Parkinson's disease (PD) originate from gut, and correction of microbiota dysbiosis is a promising therapy for PD. FLZ is a neuroprotective agent on PD, which has been validated capable of alleviating microbiota dysbiosis in PD mice. However, the detailed mechanisms still need elucidated. Through metabolomics and 16S rRNA analysis, we identified glycoursodeoxycholic acid (GUDCA) was the most affected differential microbial metabolite by FLZ treatment, which was specially and negatively regulated by Clostridium innocuum, a differential microbiota with the strongest correlation to GUDCA production, through inhibiting bile salt hydrolase (BSH) enzyme. The protection of GUDCA on colon and brain were also clarified in PD models, showing that it could activate Nrf2 pathway, further validating that FLZ protected dopaminergic neurons through promoting GUDCA production. Our study uncovered that FLZ improved PD through microbiota-gut-brain axis, and also gave insights into modulation of microbial metabolites may serve as an important strategy for treating PD.

Although enteric glial cell (EGC) abnormal activation is reported to be involved in the pathogenesis of Parkinson's disease (PD), and inhibition of EGC gliosis alleviated gut and dopaminergic neuronal dysfunction was verified in our previous study, the potential role of gut microbiota on EGC function in PD still need to be addressed. In the present study, fecal microbiota transplantation revealed that EGC function was regulated by gut microbiota. By employing 16S rRNA and metabolomic analysis, we identified that 3-indolepropionic acid (IPA) was the most affected differential microbial metabolite that regulated EGC gliosis. The protective effects of IPA on PD were validated in rotenone-stimulated EGCs and rotenone (30 mg/kg i.g. for 4 weeks)-induced PD mice, as indicated by decreased inflammation, improved intestinal and brain barrier as well as dopaminergic neuronal function. Mechanistic study showed that IPA targeted pregnane X receptor (PXR) in EGCs, and inhibition of IL-13Rα1 involved cytokine-cytokine receptor interaction pathway, leading to inactivation of downstream JAK1-STAT6 pathway. Our data not only provided evidence that EGC gliosis was critical in spreading intestinal damage to brain, but also highlighted the potential role of microbial metabolite IPA in alleviating PD pathological damages through gut-brain axis.

[This corrects the article DOI: 10.1016/j.apsb.2025.02.029.].

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

Objective To explore clinical effect of accessory scaphoid bone fusion in treating type Ⅱ painful accessory scaphoid bone.Methods A retrospective analysis was performed on 26 patients with type Ⅱ painful accessory navicular bone treated by accessory navicular bone fusion from January 2012 to June 2022,including 1 male and 25 females,aged from 18 to 70 years old with an average of(44.61±16.32)years old;10 patients with type Ⅱ A and 16 patients with type Ⅱ B;20 patients with simple fusion and 6 patients with fusion plus calcaneal translocation osteotomy.Changes of Meary angle,Pitch angle,an-teroposterior talar-first metatarsal angle(T1MA),talonavicular coverage angle(TCA),lateral talocalcaneal angle(LTCA)be-fore operation and 6 months after operation were observed and compared,and American Orthopedic Foot and Ankle Society(AOFAS)foot and ankle score and visual analogue scale(VAS)were used to explore clinical effect.Results All 26 patients were followed up for 7 to 24 months with an average of(10.72±3.94)months.Meary angle,Pitch angle,T1MA,TCA and LTCA were improved from(9.20±2.57)°,(16.45±3.57)°,(33.34±5.02)°,(22.42±5.86)°,(48.89±4.43)° before opertaion to(3.33±1.06)°,(22.33±4.56)°,(23.89±3.48)°,(11.83±2.67)°,(36.50±3.50)° at 6 months after operation,the difference were statistically significant(P＜0.01).Postoperative AOFAS foot and ankle score were(86.24±4.33)and(93.18±6.02)for type Ⅱ A and type Ⅱ B at 6 months,which were significantly improved compared with those for type Ⅱ A and type Ⅱ B before op-eration(67.34±6.55)and(65.12±9.51),and the difference was statistically significant(P＜0.01);20 patients got excellent re-sult,5 good and 1 poor.Preoperative VAS of type ⅡA(5.67±1.58)and type Ⅱ B(5.77±1.49)were improved to(2.13±1.01)and(1.43±0.68)at 6 months after operation,with statistical significance(P＜0.01).Conclusion Fusion of accessory navicular bone in patients with type Ⅱ painful accessory navicular bone combined with internal calcaneal osteotomy in patients with par-tial calcaneal valvaration could effectively correct flat foot deformity and relieve pain,and could be used as a clinical treatment for painful accessory navicular bone.

Objective To explore clinical effect of accessory scaphoid bone fusion in treating type Ⅱ painful accessory scaphoid bone.Methods A retrospective analysis was performed on 26 patients with type Ⅱ painful accessory navicular bone treated by accessory navicular bone fusion from January 2012 to June 2022,including 1 male and 25 females,aged from 18 to 70 years old with an average of(44.61±16.32)years old;10 patients with type Ⅱ A and 16 patients with type Ⅱ B;20 patients with simple fusion and 6 patients with fusion plus calcaneal translocation osteotomy.Changes of Meary angle,Pitch angle,an-teroposterior talar-first metatarsal angle(T1MA),talonavicular coverage angle(TCA),lateral talocalcaneal angle(LTCA)be-fore operation and 6 months after operation were observed and compared,and American Orthopedic Foot and Ankle Society(AOFAS)foot and ankle score and visual analogue scale(VAS)were used to explore clinical effect.Results All 26 patients were followed up for 7 to 24 months with an average of(10.72±3.94)months.Meary angle,Pitch angle,T1MA,TCA and LTCA were improved from(9.20±2.57)°,(16.45±3.57)°,(33.34±5.02)°,(22.42±5.86)°,(48.89±4.43)° before opertaion to(3.33±1.06)°,(22.33±4.56)°,(23.89±3.48)°,(11.83±2.67)°,(36.50±3.50)° at 6 months after operation,the difference were statistically significant(P＜0.01).Postoperative AOFAS foot and ankle score were(86.24±4.33)and(93.18±6.02)for type Ⅱ A and type Ⅱ B at 6 months,which were significantly improved compared with those for type Ⅱ A and type Ⅱ B before op-eration(67.34±6.55)and(65.12±9.51),and the difference was statistically significant(P＜0.01);20 patients got excellent re-sult,5 good and 1 poor.Preoperative VAS of type ⅡA(5.67±1.58)and type Ⅱ B(5.77±1.49)were improved to(2.13±1.01)and(1.43±0.68)at 6 months after operation,with statistical significance(P＜0.01).Conclusion Fusion of accessory navicular bone in patients with type Ⅱ painful accessory navicular bone combined with internal calcaneal osteotomy in patients with par-tial calcaneal valvaration could effectively correct flat foot deformity and relieve pain,and could be used as a clinical treatment for painful accessory navicular bone.

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

Objective:To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome (ODS).Methods:COVID-19-related ODS cases diagnosed in the Department of Neurology, Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed. And their past medical history, possible triggers, clinical manifestations, imaging manifestations, treatment and prognosis were summarized.Results:A total of 5 patients with COVID-19-related ODS were included. Electrolyte disturbances acted as an inducement of ODS in all patients (5/5),4 of whom with hyponatremia. Four of 5 patients first presented with disturbance of consciousness, followed by predominant dystonia. Imaging of all patients (5/5) showed isolated extrapontine myelinolysis (EPM). With the prolongation of the course of disease, such signal intensity could return to normal, and lesions showed atrophic changes in some patients. The patients′ clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions:COVID-19-related ODS is mostly associated with hyponatremia, and EPM is more common. COVID-19 should be considered as a risk factor for ODS.

At present,multiple renal denervation(RDN)devices with their own specific characteristics are being developed.The Iberis circular 4-electrode radiofrequency ablation catheter was used in this study,which was a new RDN device with independent intellectual property rights(produced by AngioCare Medical Technology Company,Shanghai).Recently,the efficacy has been validated in Iberis-HTN randomized,sham-operated controlled clinical trial,and the following case that was enrolled into Iberis-HTN study could elaborate its features.