Objective To observe the effects of Guanxinning tablet on atherosclerotic plaque,renal function,hemorheology,blood homocysteine(Hcy)and immunoinflammation in patients with blood stasis type chronic renal failure complicated by hemodialysis and carotid atherosclerosis.Methods According to the diagnosis,inclusion and exclusion criteria,67 patients with blood stasis type chronic renal failure complicated with carotid atherosclerosis and undergoing hemodialysis from Lishui Second People's Hospital and Lishui Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected and randomly divided into control group(33 cases)and observation group(34 cases).The control group received routine treatment of chronic renal failure and hemodialysis.In the observation group,Guanxinning tablet was added to the basic treatment,and the levels of carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy and immunoinflammation were detected in both groups before and after treatment.Results There were no significant differences in general information,carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy level and immunoinflammation level between the two groups before treatment(P>0.05).After treatment,the observation group was superior to the control group in reducing carotid plaque,improving carotid intimedia thickening,improving renal function,reducing inflammatory index level and improving immune function(P<0.05),but there was no significant difference in reducing blood Hcy level compared with the control group(P>0.05).Conclusion Guanxinning tablet can improve the chronic inflammation in the body of patients with blood stasis type chronic renal failure combined with hemodialysis and carotid atherosclerosis,reduce blood viscosity,inhibit red blood cell aggregation,thereby improving carotid atherosclerosis,reducing carotid atherosclerotic plaque,improving renal function and improving immune function of patients,but does not reduce blood Hcy level.

Objective:To explore the application of virtual patient in the reexamination of clinical medical professional masters (hereinafter referred to as "clinical masters"), and to provide reference for the reform of clinical masters reexamination.Methods:The correlation between the clinical thinking scores of 97 candidates (Western medicine) in the reexamination of clinical masters in a university in 2019, the scores of comprehensive ability of clinical medicine (Western medicine) in the initial test and the interview scores in the reexamination was analyzed, and the differences between the clinical thinking scores of current and previous candidates were compared. SPSS 21.0 software was conducted for t test, chi-square test and Pearson correlation analysis. Results:The Person correlation analysis showed that the correlation coefficient between the scores of clinical thinking and the scores of comprehensive clinical medicine (Western medicine) and the scores of interview in the reexamination were 0.09 and -0.05 respectively( P>0.05). At the same time, there was no statistically significant difference between the clinical thinking scores of current and previous candidates ( P >0.05). Conclusion:There was a poor correlation between the scores of clinical thinking and the scores of comprehensive clinical medicine (Western medicine) and the scores of interview in the reexamination. The consideration is concerned with the difference in the purpose of the three assessment forms. It can provide references for other medical colleges to optimize the evaluation content of postgraduate reexamination.

Objective To analyze the effects of Xueshuantong and alprostadil combined with hyperbaric oxygen ( HBO ) on clinical efficacy, hemodynamics and serum inflammatory indexes in elderly patients with lower extremity arteriosclerosis occlusion. Methods One hundred and eighteen patients with lower extremity arteriosclerosis occlusion admitted into the surgical department of the hospital from May 2017 to January 2019 were randomly divided into the combined medication group (n=59) and the control group (n=59). The control group was just treated with alprostadil injection, while the combined medication group was treated with Xueshuantong and alprostadil combined with HBO treatment. Clinical efficacy after treatment, changes in atherosclerosis indexes, hemodynamic indexes ( whole blood viscosity, plasma viscosity and fibrinogen), the levels of serum inflammatory indexes, such as hs-CRP, interleukin-6, interleukin 8 and tumor necrosis factor-α( TNF-α) before and after treatment were compared between the patients of the 2 groups. Results The total effective rate of the combined medication group was 93. 22％, which was significantly higher than 79. 66％ of the control group(P<0. 05). The blood flow of dorsal pedal artery, ankle-brachial indexes and toe-brachial indexes in the patients of the 2 groups after treatment were all significantly higher than those before treatment (P<0. 05), and the combined medication group was obviously superior to the control group, with statistical significance (P <0. 05). The whole blood viscosity, plasma viscosity and fibrinogen (FIB) levels in the patients of the 2 groups after treatment all significantly decreased as compared with those before treatment (P<0. 05), and the indexes of the combined medication group were significantly lower than those of the control group, also with statistical significance(P<0. 05). The levels of TNF-a, hs-CRP, IL-6 and IL-8 in the patients of the 2 groups after treatment were significantly lower than those before treatment (P<0. 05), and the combined medication group was also obviously superior to the control group, with statistical significance (P<0. 05). Conclusion Xueshuantong and alprostadil combined with HBO in the treatment of elderly patients with peripheral arterial disease ( PAD) could achieve significant clinical effects, and in the meantime could evidently delay the occurrence of lower extremity arteriosclerosis, improve hemodynamics, relieve inflammation reactions. For this reason, it is worth further clinical extension.

Objective To analyze the effects of Xueshuantong and alprostadil combined with hyperbaric oxygen ( HBO ) on clinical efficacy, hemodynamics and serum inflammatory indexes in elderly patients with lower extremity arteriosclerosis occlusion. Methods One hundred and eighteen patients with lower extremity arteriosclerosis occlusion admitted into the surgical department of the hospital from May 2017 to January 2019 were randomly divided into the combined medication group (n=59) and the control group (n=59). The control group was just treated with alprostadil injection, while the combined medication group was treated with Xueshuantong and alprostadil combined with HBO treatment. Clinical efficacy after treatment, changes in atherosclerosis indexes, hemodynamic indexes ( whole blood viscosity, plasma viscosity and fibrinogen), the levels of serum inflammatory indexes, such as hs-CRP, interleukin-6, interleukin 8 and tumor necrosis factor-α( TNF-α) before and after treatment were compared between the patients of the 2 groups. Results The total effective rate of the combined medication group was 93. 22％, which was significantly higher than 79. 66％ of the control group(P<0. 05). The blood flow of dorsal pedal artery, ankle-brachial indexes and toe-brachial indexes in the patients of the 2 groups after treatment were all significantly higher than those before treatment (P<0. 05), and the combined medication group was obviously superior to the control group, with statistical significance (P <0. 05). The whole blood viscosity, plasma viscosity and fibrinogen (FIB) levels in the patients of the 2 groups after treatment all significantly decreased as compared with those before treatment (P<0. 05), and the indexes of the combined medication group were significantly lower than those of the control group, also with statistical significance(P<0. 05). The levels of TNF-a, hs-CRP, IL-6 and IL-8 in the patients of the 2 groups after treatment were significantly lower than those before treatment (P<0. 05), and the combined medication group was also obviously superior to the control group, with statistical significance (P<0. 05). Conclusion Xueshuantong and alprostadil combined with HBO in the treatment of elderly patients with peripheral arterial disease ( PAD) could achieve significant clinical effects, and in the meantime could evidently delay the occurrence of lower extremity arteriosclerosis, improve hemodynamics, relieve inflammation reactions. For this reason, it is worth further clinical extension.

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.