ObjectiveTo observe the clinical effect of modified Huanglian Wendantang on cardiovascular risk factors in patients with metabolic syndrome under the guidance of treating disease before its onset. MethodsA total of 82 patients with metabolic syndrome treated in the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from July 2023 to July 2024 were selected and allocated into an observation group （41 cases） and a control group （41 cases） by the random number table method. The control group received routine treatment， and the observation group was treated with modified Huanglian Wendantang on the basis of routine treatment. Both groups were treated for 8 weeks. The therapeutic effects on TCM symptoms after treatment in the two groups were evaluated. The levels of obesity degree indicators， blood pressure indicators， glucose and lipid metabolism indicators， inflammatory factors， and vascular endothelial function indicators before and after treatment in the two groups were measured， and the treatment safety was evaluated. ResultsAfter treatment， the total response rate of TCM symptoms in the observation group was 97.56% （40/41）， which was higher than that （87.80%， 36/41） in the control group （χ²=5.205， P<0.05）. After treatment， both groups showed declines （P<0.05） in systolic blood pressure （SBD）， diastolic blood pressure （DBP）， triglyceride （TG）， total cholesterol （TC）， low density lipoprotein cholesterol （LDL-C）， fasting blood glucose， 2-hour postprandial blood glucose （2 h PG）， glycosylated hemoglobin （HbA1c）， fasting insulin （FINS）， Homeostatic Model Assessment for Insulin Resistance （HOMA-IR）， body mass index （BMI）， waist circumference （WC）， waist-to-hip ratio （WHR）， leptin （LEP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， endothelin-1 （ET-1）， and inducible nitric oxide synthase （iNOS）. Moreover， the declines in the observation group were more obvious than those in the control group （P<0.05， P<0.01）. After treatment， both groups showed elevated levels of high density lipoprotein cholesterol （HDL-C）， adiponectin （ADP）， nitric oxide （NO）， and endothelial nitric oxide synthase （eNOS） （P<0.05）， and the above indexes in the observation group were higher than those in the control group （P<0.01）. ConclusionUnder the guidance of the thought of treating disease before its onset， modified Huanglian Wendantang was used to treat patients with metabolic syndrome. The decoction improved the clinical efficacy by ameliorating IR to improve insulin sensitivity， reducing inflammation， and protecting the vascular endothelial function. It inhibits cardiovascular risk factors without inducing adverse reactions， being worthy of clinical application and promotion.

Objective:To analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

Objective:To analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods:The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery, the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed. There were 49 male and 47 female patients, aged (59.2±13.9) years. The 96 patients were randomly divided into two groups according to the surgical methods: the flexible ureteroscope group ( n=48) and the choledochotomy group ( n=48), patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group; patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group. Clinical data including operation time, intraoperative blood loss, postoperative intestinal function recovery time, abdominal drainage tube removal time, postoperative hospital stay and postoperative complications were compared between the two groups. Results:Compared with the choledochotomy group, the operation time [150 (120, 176) min vs. 197 (165, 240) min], intraoperative blood loss [20 (10, 30) ml vs. 30 (20, 50) ml], postoperative intestinal function recovery time [2 (1, 2) d vs. 3 (2, 4) d], abdominal drainage tube removal time [6 (4, 7) d vs. 7 (6, 8) d], and postoperative hospital stay [8 (6, 9) d vs. 16 (13, 17) d] in the flexible ureteroscope group were all reduced, and the differences were statistically significant (all P<0.05). The incidence of postoperative complications in the choledochotomy group was 10.4% (5/48), compared with 2.1% (1/48) in the flexible ureteroscope group. There was no statistically significant difference ( χ2=1.60, P=0.206). Conclusion:Compared with laparoscopic choledocholithotomy plus T-tube drainage, laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope can shorten the hospital stay of patients with choledocholithiasis, offering a minimally invasive, safe and effective treatment method.

Acute myocardial infarction(AMI)is a serious disease that endangers human life and health,timely opening of the infarct vessel is the main means of successful treatment.Emergency percutaneous coronary intervention(PCI)is the most effective treatment at present,which can quickly restore myocardial blood supply and save patients'lives.With the maturity of PCI treatment,the survival rate of patients with AMI has improved significantly.However,in recent years,emergency PCI operators have encountered a significant challenge:rare and fatal complications associated with coronary artery injury during emergency PCI are not promptly recognized and treated,leading to an increase in perioperative mortality.At present,there is no unified plan for the management of critical complications during PCI at home and abroad.Therefore,this paper mainly reviews the management measures of complications related to coronary artery injury during surgery,such as coronary artery perforation,non-reflow,coronary artery dissection,and stent thrombosis,and summarizes the progress of relevant treatment measures at home and abroad to help surgeons deal with emergencies timely and correctly and save more patient lives.

ObjectiveTo observe the effect of Jiawei Shenqi Yixin prescription on cardiovascular risk factors in the patients with heart failure with preserved ejection fraction and insulin resistance. MethodFrom January 2021 to January 2022， a total of 82 patients with heart failure with preserved ejection fraction were enrolled in the ward of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine. The patients were randomly assigned into two groups （ 41 cases） and received the same basic treatment. The observation group was additionally treated with Jiawei Shenqi Yixin prescription for 8 weeks. The clinical efficacy， traditional Chinese medicine （TCM） efficacy， cardiac function indexes ［NT-probrain natriuretic peptide （NT-proBNP） and 6-min walking test （6MWT）］， echocardiographic parameters ［left atrial volume index （LAVI）， left ventricular mass index （LVMI）， peak early diastolic to peak late diastolic mitral flow velocity （E/A） ratio］， insulin resistance-related indexes ［fasting insulin （FINS）， fasting plasma glucose （FPG）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， homeostatic model assessment of insulin resistance （HOMA-IR）， triglyceride-glucose index （TYG）， and triglyceride to high-density lipoprotein cholesterol （TG/HDL-C） ratio］， inflammatory cytokines ［tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， adiponectin （ADP）， and C-reactive protein （CRP）］， vascular endothelial function indicators ［nitric oxide （NO）， endothelial nitric oxide synthase （eNOS）， inducible nitric oxide synthase （iNOS）， and endothelin-1 （ET-1）］， and the safety of treatment were determined. In addition， Pearson correlation analysis was performed to analyze the correlations of insulin resistance， inflammatory cytokines， and vascular endothelial factors with the mitigation of heart failure. ResultIn terms of clinical efficacy， the therapy of the observation group was significantly effective in 26 patients， effective in 12 patients， ineffective in 3 patients， with the total effective rate of 92.68%， the therapy of the control group was significantly effective in 14 patients， effective in 12 patients， and ineffective in 15 patients， with the total effective rate of 63.41%. The clinical total effective rate of the observation group was higher than that of the control group （χ²=11.6， P<0.05）. In terms of TCM efficacy， the therapy of the observation group was significantly effective in 26 patients， effective in 11 patients， and ineffective in 4 patients， with the total effective rate of 90.24%； the therapy of the control group was significantly effective in 9 patients， effective in 13 patients， and ineffective in 19 patients， with the total effective rate of 53.66%. The TCM total effective rate of the observation group was higher than that of the control group （χ²=8.19， P<0.05）. Compared with those before treatment， the levels of NT-proBNP， LAVI， LVMI， FPG， FINS， HOMA-IR， TYG， TG/HDL-C， TNF-α， IL-6， CRP， ET-1， and iNOS in two groups declined after treatment （P<0.05）， while the levels of 6MWT， E/A， ADP， NO， and eNOS elevated （P<0.05）. After treatment， the observation group had lower levels of NT-proBNP， LAVI， LVMI， FPG， FINS， HOMA-IR， TYG， TG/HDL-C， TNF-α， CRP， and ET-1 （P<0.05） and higher levels of 6MWT， E/A， ADP， and NO than the control group （P<0.05）. In addition， the increase in 6MWT after treatment was positively correlated with the increase in NO and the decrease in ET-1. The decrease in LVMI after treatment was positively correlated with the increase in NO and the decrease in FINS. The increase in left ventricular ejection fraction after treatment was positively correlated with the decreases in TNF-α and TYG （P<0.05）. Adverse reactions were observed in neither group. ConclusionJiawei Shenqi Yixin prescription can significantly mitigate the symptoms， reduce inflammation， and improve vascular endothelial function in the patients with heart failure with preserved ejection fraction and insulin resistance， being safe without causing adverse reactions.

Epidemiological evidence suggests that patients with hypertension infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at increased risk of acute lung injury. However, it is still not clear whether this increased risk is related to the usage of renin-angiotensin system (RAS) blockers. We collected medical records of coronavirus disease 2019 (COVID-19) patients from the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China), and evaluated the potential impact of an angiotensin II receptor blocker (ARB) on the clinical outcomes of COVID-19 patients with hypertension. A total of 30 hypertensive COVID-19 patients were enrolled, of which 17 were classified as non-ARB group and the remaining 13 as ARB group based on the antihypertensive therapies they received. Compared with the non-ARB group, patients in the ARB group had a lower proportion of severe cases and intensive care unit (ICU) admission as well as shortened length of hospital stay, and manifested favorable results in most of the laboratory testing. Viral loads in the ARB group were lower than those in the non-ARB group throughout the disease course. No significant difference in the time of seroconversion or antibody levels was observed between the two groups. The median levels of soluble angiotensin-converting enzyme 2 (sACE2) in serum and urine samples were similar in both groups, and there were no significant correlations between serum sACE2 and biomarkers of disease severity. Transcriptional analysis showed 125 differentially expressed genes which mainly were enriched in oxygen transport, bicarbonate transport, and blood coagulation. Our results suggest that ARB usage is not associated with aggravation of COVID-19. These findings support the maintenance of ARB treatment in hypertensive patients diagnosed with COVID-19.
Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use* ; Angiotensin-Converting Enzyme 2/blood* ; Antibodies, Viral/blood* ; Antihypertensive Agents/therapeutic use* ; Biomarkers ; COVID-19/complications* ; China ; Female ; Humans ; Hypertension/drug therapy* ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Transcriptome ; Viral Load

Objective: To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. Materials and Methods: Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. Results: The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). Conclusion For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

Objective: To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. Materials and Methods: Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. Results: The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). Conclusion For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

Objective To study the protective effects ofcatalpol on cardiomyocytes in type 2 diabetic rats.Methods Based on the method of random number table,8-wee k-old SD rats were randomly divided into normal group (10 rats) and experimental group (90 rats).The rats in the experimental group that were fed with high-fat and high-sugar diet for 8 weeks were injected intraperitoneally with STZ (15 mg/kg),with fasting blood glucose≥16.7mmol/L as a model for type 2 diabetes.Then based on fasting blood glucose and body weight,the rats meeting the criteria of type 2 diabete mellitus were randomy divided into five group,namely,the model group,the control group,the low or medium and high doses of the catalpol group,and there were 12 rats in each group.The normal group and the model group were filled with distilled water (5 ml/kg·d,the control group were treated with metformin (90 mg/kg·d),and Low,medium and high dose group were intragastric administration of Catalpol(2.5,5,10 mg/kg·d).Then,the level of glucose,myocardial oxidative stress related protein,cardiac strcture and function change were measured after 12 weeks of intervention in rats.Results Compared with the model group,the level of fasting blood glucose in catalpol low,medium and high dose groups was significantly lower (P＜0.05).The levels of SOD (197.43 ± 8.85 U/ml,186.54 ± 5.89 U/ml,175.62 ± 7.67 U/ml vs.157.75 ±11.29 U/ml) in myocardial tissue of those groups significantly increased (P＜0.05),the levels of MDA (7.26 ±0.72 nmol/mg,8.58 ± 0.93 nmol/mg,10.62 ± 0.59 nmol/mg vs.14.80 ± 0.71 nmol/mg) in myocardial tissue of those groups significantly decreased (P＜0.05),the E/A value (1.25 ± 0.18,1.09 ± 0.14,0.97 ± 0.11 vs.0.51 ±0.11) in those groups significantly increased (P＜0.05),the E/E'values (12.33 ± 0.73,13.26 ± 1.07,14.73 ± 1.23 vs.20.54 ± 1.64) and the IVRT (21.90 ± 2.60 ms,22.05 ± 2.84 ms,24.42 ± 2.22 ms vs.27.40 ± 2.81 ms) in those groups significantly decreased (P＜0.05).Conclusions The catalpol can reduce oxidative stress,improve cardiac function and protect cardiomyocytes.

AIM:We investigated how AT 1-R stimulated by mechanical stresses induces cardiac fibrosis .METHODS:We produced in vivo cardiac pressure overload model in angiotensinogen knockout ( ATG-/-) mice and in vitro mechanically-stretched cell model in cultured neonatal cardiac cells of ATG-/-mice both lack the participation of Ang II .RESULTS: Pressure overload for 4 weeks in ATG-/-mice induced myocardial hypertrophy accompanied by the significant interstitial fibrosis , however , the TGF-β, a key regulatory factor of fibrosis, was not significantly increased in these ATG-/-mice.Meanwhile, the inhibitor for AT1-R significantly inhibited mechani-cal stress-induced cardiac fibrosis in these ATG-/-models whereas inhibition of TGF-βdid not.CONCLUSION:The results showed that mechanical stress-induced fibrotic responses through AT 1-R required the phosphorylation of Smad 2 but not the involvement of TGF-β.