Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.

Objective To study the clinical efficacy of Xiaoqinglong decoction combined with the conventional protocol of western medicine in the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)presenting with exterior cold and interior fluid retention syndrome,and to evaluate its effect on the short-term prognosis of patients.Methods A total of 124 AECOPD patients presenting exterior cold and interior fluid retention syndrome were divided into an observation group(62 cases)and a control group(62 cases)using a random number table.Patients in the control and observation groups were managed with conventional western medicine treatment protocols consisting of bronchodilators,glucocorticoids,and antibacterial drugs.In addition,patients in the observation group were also given Xiaoqinglong decoction at one dose per day for 10 days in succession.The primary outcome indicators included the total effective treatment rate and the main traditional Chinese medicine(TCM)syndrome scores before treatment and after 10 days of Xiaoqinglong decoction treatment.The secondary outcome indicators included infection and inflammatory indicators,including white blood cell count(WBC),procalcitonin(PCT),interleukin(IL)-6,C-reactive protein(CRP),and arterial blood gas indicators,including arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),and arterial oxygen saturation(SaO2),measured before treatment and after 10 days of treatment,adverse drug reactions during treatment,and the severity of dyspnea assessed by the modified Medical Research Council(mMRC)dyspnea scale at the 1-month follow-up after discharge.Results Compared with baseline findings for the same group before treatment,the main TCM syndrome scores and the total score were reduced in both groups after treatment(P<0.05).After treatment,compared with those of the control group,the syndrome scores for cough,aversion to cold,nasal congestion,and runny nose,and the total score in the observation group were lower(P<0.05).The total effective treatment rate in the observation group(94.91%)was significantly higher than that in the control group(82.76%)(P<0.05).After 10 days of treatment,the levels of PaCO2,WBC,PCT,IL-6,and CRP in both groups were significantly reduced compared with those before treatment(P<0.05).After treatment,the levels of PaCO2,WBC,PCT,IL-6,and CRP in the observation group were lower than those in the control group(P<0.05).Compared with those before treatment,PaO2 and SaO2 levels in both groups increased significantly after 10 days of treatment(P<0.05).During the course of treatment,no severe adverse reactions,such as liver or kidney dysfunction,occurred in either group.No adverse reactions associated with Xiaoqinglong decoction were observed.No patients in either group reached mMRC grade 4 at the 1-month follow-up after discharge.The mMRC grades in both groups declined at the 1-month follow-up after discharge compared to those before treatment(P<0.05).At the 1-month follow-up after discharge,the mMRC grades of patients in the observation group were lower than those of the control group(P<0.05).Conclusion Xiaoqinglong decoction combined with the conventional protocol of western medicine deminstrates good clinical efficacy in treating patients with AECOPD of exterior cold and interior fluid retention syndrome,and can effectively improve the TCM syndromes,relieve the symptoms of dyspnea,reduce the inflammatory response,promote the resolution of infection,delay disease progression,improve short-term prognosis,and shows better safety.

Objective To explore the efficacy and safety of anterior cervical discectomy and fusion assisted with microscope.Methods Thirty-seven patients with cervical spondylosis were included to be retrospectively ana lyzed,including 21 males and 16 females.All these patients had accepted anterior cervical discectomy and fusion (ACDF) assisted with microscope from October,2015 to February,2018,and they were aged from 22 to 77 years old (51.5±6.2 years on the average).In these patients,30 cases were operated on single segment,6 cases were operated on double segments,and 1 case was operated on 3 segments.Among all the patients,15 patients of which (40.54％) had cervical spondylotic myelopathy and 22 patients of which (59.46％) sufferered from cervical spondylotic radicu lopathy.All the operations were performed with a conventional transverse anterior cervical incisions,an intervertebral distractor was placed.The decompression was completed under the microscope,and the fixation was performed under direct vision.Moreover,the operative time,intraoperative blood loss and surgery-related complications were recorded.Follow-up was carried out at different times,including 7 days,1 month,3 months,6 months and every year after operation.Japanese Orthopaedic Association (JOA) score was used to calculate the rate of improvement in neurological function,which can evaluate the clinical efficacy.And cervical dysfunction index (NDI) was used to assess cervical function.Results All patients in this group underwent successful decompression under the microscope.The operation time was 90-160 min,with an average of (110.67±36.42) min;The intraoperative blood loss was 20-110 ml,with an average of (36.00±29.11) ml.All patients were followed-up for 12-31 months,with an average of (15.2±4.7) months.The JOA score improved from 8.37±3.26 preoperatively to 15.96 ± 1.50 at the last follow-up,and its difference had signifi cance in statistics (t=8.592,P=0.000).Neurological function improvement rate could be graded:excellent in 31 cases and good in 6 cases,the excellent and good rate was 100％;NDI was reduced from 19.01 ± 6.47 preoperatively to 5.81 ± 2.58 at the last follow-up,with statistical significant difference (t=5.127,P=0.000).During the follow-up,1 screw was found loosened and slightly withdrawn in 1 female patient at 3 months after operation,of whom had not obvious discomfort.The patient was continuously observed and there was no screw withdrawal again.Moreover,there were no complications such as cerebrospinal fluid leakage,hoarseness and difficulty in swallowing.Conclusion Microscope-assisted ACDF can provide safe and adequate decompression without significantly extending the operation time,which is satisfactory in clinical results.Even in some cases of 1 or 2 segments of intervertebral disc nucleus prolapse,it is possible to avoid a more traumatic ACDF.And it is worthy of clinical promotion.