Early neurological deterioration(END)occurs in patients with acute cerebral infarction after recombinant tissue-plasminogen activator(rt-PA)intravenous thrombolysis,which seriously affects the prognosis of patients and even causes death.However,there is no effective treatment.This report describes two patients with acute ischemic stroke presenting with right-sided limb weakness within 4.5 hours of onset.Brain CT ruled out cerebral hemorrhage and both patients were diagnosed with acute ischemic stroke.END occurred within 24 hours after intravenous thrombolysis with rt-PA.Reexamine Brain CT showed no evidence of cerebral hemorrhage.The patients were treated with continuous tirofiban infusion for 48 hours,overlapping with oral antiplatelet therapy for 4 hours and 6 hours,respectively.After discontinuation of tirofiban,no further neurological deterioration was observed.At the 3-month follow-up,there was no recurrence,and the modified Rankin scale(mRS)scores were 1 and 3,respectively.This study delineates the diagnostic and therapeutic trajectories of two paradigmatic cases to inform clinical decision-making for analogous presentations,thereby contributing to evidence-based management strategies.

Early neurological deterioration(END)occurs in patients with acute cerebral infarction after recombinant tissue-plasminogen activator(rt-PA)intravenous thrombolysis,which seriously affects the prognosis of patients and even causes death.However,there is no effective treatment.This report describes two patients with acute ischemic stroke presenting with right-sided limb weakness within 4.5 hours of onset.Brain CT ruled out cerebral hemorrhage and both patients were diagnosed with acute ischemic stroke.END occurred within 24 hours after intravenous thrombolysis with rt-PA.Reexamine Brain CT showed no evidence of cerebral hemorrhage.The patients were treated with continuous tirofiban infusion for 48 hours,overlapping with oral antiplatelet therapy for 4 hours and 6 hours,respectively.After discontinuation of tirofiban,no further neurological deterioration was observed.At the 3-month follow-up,there was no recurrence,and the modified Rankin scale(mRS)scores were 1 and 3,respectively.This study delineates the diagnostic and therapeutic trajectories of two paradigmatic cases to inform clinical decision-making for analogous presentations,thereby contributing to evidence-based management strategies.

Objective:To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system.Methods:A retrospective analysis was performed; 117 DLSS patients with imaging manifestations as non-segmental lumbar instability, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system. These patients were followed up for 6-50 months. Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays, CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up. Modified MacNab criteria were used to evaluate the efficacy at the last follow-up. Results:Among the 117 patients, unilateral laminectomy for unilateral decompression was performed in 56 patients (47.9%) and unilateral laminotomy for bilateral decompression in 61 (52.1%). Single segment decompression was performed in 109 patients (93.2%) and double segment decompression in 8 (6.8%). Dural sac rupture occurred in 4 patients (3.5%), and immediate occlusion was given; no cerebrospinal fluid leakage was noted after decompression. All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression. After 18 (13, 24) months of follow-up, VAS scores of the patients at the last follow-up decreased from (5.96±0.85) 1 d before decompression and (1.75±0.61) 1 week after decompression to (1.01±0.59), and lumbar ODI decreased from (63.22±8.33)% 1 d before decompression and (17.66±5.20)% 1 week after decompression to (10.64±3.44)%, with significant differences ( P<0.05). At the last follow-up, modified MacNab criteria indicated 46 patients (39.3%) as excellent, 66 (56.4%) as good, 3 (2.6%) as fair, and 2 (1.7%) as poor, with an excellent/good therapeutic rate of 95.7%. Conclusion:For surgical treatment of DLSS patients without evidenced preoperative spinal instability, personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results.

Objective:To investigate the correlation of serum visfatin and resistin levels with cardiometabolic index (CMI) and bone mineral density (BMD) in elderly patients with essential hypertension (EH) complicated with osteoporosis (OP) .Methods:From Feb. 2021 to Feb. 2023, 120 elderly patients with EH complicated with OP in Department of Cardiovascular Medicine, Hangzhou Hospital of Traditional Chinese Medicine were chosen (the EH complicated with OP group), and 50 healthy physical examination subjects (the NC group) and 50 EH complicated with low bone mass (the EH complicated with low bone mass group) were chosen as the control. Venous blood samples were collected from all patients, serum visfatin and resistin levels were measured, and CMI and BMD were tested. Statistical methods were used to analyze the data.Results:In EH patients with decreased bone mass or OP, the level of serum visfatin was often low, but resistin was elevated, which showed significant differences compared with that in the NC group ( F visfatin = 26.02, F resistin = 9.50, P < 0.001). The CMI in NC group was lower than that in the other two groups ( F = 52.54, P < 0.001). In terms of bone mass, BMD in NC group was higher than that in the other two groups, especially in the key parts of lumbar spine ( F=21.44, P < 0.001), femoral neck ( F=10.54, P < 0.001), Chinese triangle ( F=12.30, P < 0.001) and femoral trochanter ( F=4.87, P < 0.001), etc. BMD in EH complicated with low bone mass was also higher than that in EH complicated with OP group, including lumbar spine ( t=4.60, P < 0.001), femoral neck ( t=2.32, P=0.022), Chinese triangle ( t=4.58, P < 0.001) and femoral trochoid ( t=4.33, P < 0.001). In addition, visfatin was positively correlated with bone mass ( P < 0.05), lumbar spine ( r=0.36, P < 0.001), femoral neck ( r=0.38, P < 0.001), Chinese triangle ( r=0.28, P=0.020) and femoral trochoid ( r=0.37, P < 0.001), while resistin was negatively correlated with bone mass, lumbar spine ( r=-0.40, P < 0.001), femoral neck ( r=-0.50, P < 0.001), and femoral trochanter ( r=-0.40, P < 0.001). However, there was no significant correlation between CMI and visfatin ( r=0.06, P > 0.05) and resistin ( r=0.11, P > 0.05). Logistic analysis showed that visfatin level was a risk factor of OP in EH patients ( P < 0.001), and resistin was a protective factor ( P = 0.008) . Conclusion:Serum visfatin and resistin levels in elderly EH patients complicated with OP are correlated with BMD, suggesting that they may play an important role in disease development and treatment.

Objective:To investigate the efficacy of posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system in cervical spondylotic radiculopathy (CSR).Methods:A total of 38 patients with CSR, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from September 2019 to October 2022 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system. The patients were followed up for (15.71±7.50) months, ranging from 3 to 36 months. The pain visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores were recorded and the results of X-ray, CT and MRI of cervical spines were analyzed 1 d before decompression, before discharge and at the last follow-up. C 2-7 sagittal vertical axis (SVA) was measured and compared on CT reconstruction images before decompression and at the last follow-up. The clinical efficacy of these patients was determined according to the formula of improvement rate=([JOA at the last follow-up-preoperative JOA]/[17-preoperative JOA])×100%: 100% improvement rate was defined as cure, improvement rate>60% as significant effect, 25%

Objective:To investigate the role of NG2 cells in generating and maintaining neuropathic pain in rats after spinal cord injury (SCI).Methods:According to random number table method, 100 healthy adult male SD rats were divided into control group ( n=20, without any intervention), sham-operated group ( n=40, exposed T 10 segment without spinal cord impact) and SCI group ( n=40, exposed T 10 segment and constructed SCI model by improved Allen's method). One d before, and 14, 21 and 28 d after surgery, Von Frey fiber probe was used to detect the rat hindlimb mechanical withdrawal threshold (MWT); immunofluorescent staining was used to detect the proportion of NG2-positive cells in spinal dorsal horn cells; Western blotting was used to detect chondroitin sulfate proteoglycan (CSPG) expression in spinal dorsal horn of rats. Results:Fourteen, 21 and 28 d after surgery, SCI group had significantly lower hindlimb MWT, and significantly higher proportion of NG2-positive cells in spinal dorsal horn cells and CSPG expression in spinal dorsal horn than control group and sham-operated group ( P<0.05). One d before, and 14, 21 and 28 d after surgery, in SCI group, hindlimb MWT decreased firstly and increased secondly, proportion of NG2-positive cells in spinal dorsal horn cells increased firstly and decreased secondly, and CSPG expression in spinal dorsal horn increased firstly and decreased secondly. Except for those 21 and 28 d after surgery, hindlimb MWT, proportion of NG2-positive cells in spinal dorsal horn cells, and CSPG expression in spinal dorsal horn showed significant differences between each two time points ( P<0.05). In SCI group, hindlimb MWT was negatively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=-0.876, P<0.001), and CSPG expression was positively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=0.927, P<0.001). Conclusion:NG2 cell proliferation and increased CSPG expression secreted by NG2 cells in spinal cord tissues after SCI generate and maintain neuropathic pain.

Objective:To observe the effect of Lingshao-Zaoren Decoction on urodynamics and the expression of Piezo1 if overactive bladder (OAB) rats. Methods:Thirty SPF grade female SD rats were randomly divided into blank group, model group, Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups, with 6 rats in each group. The OAB rats were modeled by intraperitoneal injection of Cyclophosphamide. After the successful modeling, Tolterodine control group was given 0.36 mg/kg Tolterodine tartrate, the low-dose and high-dose Lingshao-Zaoren Decoction groups were given 1.59 and 3.18 g/kg Lingshao-Zaoren Mianjian granules by gavage, the blank group and model group were given the same amount of distilled water, once a day for 14 days. After 14 days, the urodynamics of rats in each group were detected. The bladder volume and maximum bladder pressure were observed respectively. The pathological changes of bladder tissue were observed by HE staining. The expression of Piezo1 protein in bladder tissue was detected by immunohistochemistry and Western blot. The expression of Piezo1 mRNA in bladder tissue was detected by qPCR. Results:Compared with the blank group, the body weight, bladder volume and maximum bladder pressure of the model group were significantly reduced ( P<0.01). HE staining result showed that the model group had hyperplasia of urinary tract epithelium, degeneration, necrosis and abscission of epithelial cells, infiltration of a large number of inflammatory cells in stroma, vascular proliferation, thickening of vascular wall, hyperplasia of mucosal smooth muscle, disorder of arrangement, and significant up regulation of Piezo1 protein expression ( P<0.01). Compared with the model group, the weight [(244.83 ± 6.05) g, (233.33 ± 11.76) g vs. (219.00 ± 9.70) g] of rats in the Tolterodine control group and high-dose group of Lingshao-Zaoren Decoction significantly increased ( P<0.01), and the bladder volume [(0.93 ± 0.31) ml, (1.17 ± 0.17) ml, (1.21 ± 0.23) ml vs. (0.50 ± 0.16) ml] and maximum bladder pressure [(42.00 ± 3.03) cmH 2O, (45.83 ± 7.19) cmH 2O, (46.83 ± 8.23) cmH 2O vs. (30.50 ± 5.47) cmH 2O] of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly increased ( P<0.01); the bladder epithelial hyperplasia and degeneration degree, interstitial inflammatory cell infiltration degree and vascular hyperplasia degree of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups significantly increased. The expression of Piezo1 mRNA (1.50 ± 0.04, 2.05 ± 0.08, 1.44 ± 0.10 vs. 2.56 ± 0.11) and protein in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly decreased ( P<0.01). Conclusion:Lingshao-Zaoren Decoction can increase the bladder volume and maximum bladder pressure of urinary incontinence caused by detrusor overactivity in rats with overactive bladder, which may be related to reduction of Piezo1 expression.

OBJECTIVE: To investigate the effect of the combination of atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) on cardiac function and the success rate of AF ablation. METHODS: We retrospectively analyzed the data of 56 patients with AF undergoing a one-stop procedure for AF ablation and LAAC in our hospital between May, 2015 and May, 2019. Propensity score matching (PSM) at the ratio of 1:1 was used to select 56 control patients undergoing AF ablation at high risk of stroke, for matching with the hybrid procedure group. The perioperative complications, thromboembolic events, recurrence of atrial arrhythmia and cardiac function were compared between the groups. RESULTS: The two groups of patients were comparable for age, gender, BMI, duration and type of AF, concomitant diseases, CHA2DS2-VASc and HAS-BLED scores ( CONCLUSIONS The combination of AF ablation and LAAC is safe but does not improve the success rate of AF ablation. The one-stop procedure can improve cardiac function of the patients, but AF ablation alone can achieve better improvement of cardiac function.
Atrial Appendage/surgery* ; Atrial Fibrillation/surgery* ; Catheter Ablation ; Humans ; Retrospective Studies ; Treatment Outcome

Objective: To evaluate the efficacy of Fufang-Xuanju capsule combined with levofloxacin mesylate tablets in the treatment of chronic epididymitis. Methods: A total of 76 patients in the Urology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences who met the inclusion criteria from December 2016 to February 2019, were divided into treatment group (43 cases) and control group (33 cases). The control group was given levofloxacin mesylate tablets orally. The treatment group was given Fufang-Xuanju capsule based on the control group. Both groups were treated for 4 weeks. Chronic epididymitis symptom index (CESI) was used to evaluate the clinical efficacy by pain score and quality of life score. Results: The total effective rate was 83.7% (36/43) in the treatment group and 63.6% (26/33) in the control group. There was statistically significant difference between the two groups (χ²=4.020, P=0.045). Compared with baseline, the pain scores, quality of life scores and total scores of both groups at 2, 4 weeks after treatment were significantly lower (P<0.01). Two weeks after the treatment, the pain scores, quality of life scores and total scores in the treatment group were significantly lower than those of the control group (F value were 16.132, 9.134 and 23.681, respectively, all Ps<0.01). And 4 weeks after the treatment, the pain scores, quality of life scores and total scores of the treatment group were significantly lower than that of the control group (F value were 28.741, 74.049, 72.483, respectively, all Ps<0.01). Conclusions Fufang-Xuanju capsule combined with levofloxacin mesylate tablets can alleviate the pain of patients with chronic epididymitis, improve the quality of life and improve the clinical efficacy.

OBJECTIVETo observe the differences for knee osteoarthritis (KOA) with-deficiency and cold-stagnation syndrome among acupuncture plus ginger moxibustion at Heding (EX-LE 2) on the affected side, simple acupuncture and simple ginger moxibustion at the same acupoint.

METHODSNinety patients were randomly assigned into an acupuncture group, a ginger moxibustion group and a combination group, 30 cases in each one. Acupuncture was used in the three groups at bilateral Liangqiu (ST 34), Xuehai (SP 10), and Dubi (ST 35), Neixiyan (EX-LE 4), Yanglingquan (GB 34), Zusanli (ST 36), Yinlingquan (SP 9), Sanyinjiao (SP 6), Xuanzhong (GB 39), Taichong (LR 3) on the affected side. Acupuncture at the affected Heding (EX-LE 2) was applied in the acupuncture group; ginger moxibustion at the affected Heding (EX-LE 2) in the ginger moxibustion group; ginger moxibustion after acupuncture at Heding (EX-LE 2) in the combination group. The treatment was given once a day, and 10 treatments made one session. There were 2 days at the interval between 2 sessions. Before and after (22/30), which was significantly higher than 46.7% (14/30) of the acupuncture group and 20.0% (6/30) of the ginger moxibustion group (both<0.05), and the rate of the acupuncture group was higher than that of the ginger moxibustion group (<0.05).Based on acupuncture, ginger moxibustion at the affected Heding (EX-LE 2) after acupuncture at the same acupoint are more effective than simple acupuncture at the affected Heding (EX-LE 2) and simple ginger moxibustion at the acupoint for KOA with-deficiency and cold-stagnation syndrome. two-session treatment, knee function scores, visual analogue scale (VAS) score, and present pain intensity (PPI) score were compared in the three groups. The clinic effects were evaluated too.

RESULTSAfter treatment, the knee function scores of the three groups were all higher than those before treatment (all<0.05), and the VAS score and PPI score were lower (all<0.05). The differences before and after treatment for knee function, VAS and PPI score of the combination group were higher than those of the other two groups (all<0.05), and the differences of the acupuncture group were higher than those of the ginger moxibustion group (all<0.05). The cured and remarkable effective rate of the combination group was 73.3% (22/30), which was significantly higher than 46.7% (14/30) of the acupuncture group and 20.0% (6/30) of the ginger moxibustion group (both<0.05), and the rate of the acupuncture group was higher than that of the ginger moxibustion group (<0.05).

CONCLUSIONSBased on acupuncture, ginger moxibustion at the affected Heding (EX-LE 2) after acupuncture at the same acupoint are more effective than simple acupuncture at the affected Heding (EX-LE 2) and simple ginger moxibustion at the acupoint for KOA with-deficiency and cold-stagnation syndrome.