Objective To evaluate the clinical efficacy and safety of Compound Danshen Dripping Pills combined with Tirofiban in alleviating myocardial ischemia-reperfusion injury(MIRI)in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods Ninety-two patients with acute STEMI of qi stagnation and blood stasis syndrome who were admitted to the Chest Pain Center of Shunde Hospital,Guangzhou University of Chinese Medicine between March 2023 and October 2023 were equally randomized into a control group and a treatment group using a random number table,with 46 cases in each group.The control group received intracoronary loading dose of Tirofiban during PCI combined with postoperative intravenous micro-pump injection of Tirofiban,while the trial group additionally received Compound Danshen Dripping Pills orally,the treatment course lasted for 4 weeks.Before treatment or immediately after surgery and after 4 weeks of treatment,the two groups were observed in the changes in traditional Chinese medicine(TCM)syndrome scores,cardiac function parameters[including left ventricular ejection fraction(LVEF),cardiac output(CO),and left ventricular end-diastolic diameter(LVEDD)],and levels of inflammatory markers of C-reactive protein(CRP)and brain natriuretic peptide(BNP),as well as safety indicators such as liver and kidney function and coagulation parameters in both groups.The peak values of myocardial necrosis markers of creatine kinase-MB(CK-MB)and troponin I(cTnI)and other myocardial enzyme profiles between the two groups were compared.After treatment,the TCM syndrome efficacy of improvement,the therapeutic effect on improving ST-segment resolution(STR)of electrocardiogram,and the incidence of adverse cardiovascular events in both groups were assessed.Results(1)There were 3 patients dropping out during the trial,with a final total of 89 cases included in the efficacy analysis(44 cases in the control group and 45 cases in the trial group).(2)After 4 weeks of treatment,the total effective rate in the trial group was 95.56%(43/45)and that in the control group was 79.55%(35/44).Intergroup comparison by chi-square test showed that TCM syndrome efficacy in the trial group was significantly superior to that in the control group(P＜0.05).(3)After 4 weeks of treatment,the total effective rate for improving STR in the trial group was 93.33%(42/45)and that in the control group was 75.00%(33/44).Intergroup comparison(tested by chi-square test)demonstrated that the trial group had significantly stronger STR improvement efficacy than the control group(P＜0.05).(4)After 4 weeks of treatment,the serum levels of CRP and BNP in both groups were lower than those immediately after surgery(P＜0.05),and the trial group exhibited significantly greater reductions in both CRP and BNP levels than the control group(P＜0.01).(5)The peak values of myocardial necrosis markers of CK-MB and cTnI in the trial group were significantly lower than those in the control group,with statistically significant differences(P＜0.05).(6)After 4 weeks of treatment,the trial group showed significant improvements in LVEF and CO compared to immediate postoperative values(P＜0.05),while LVEDD demonstrated an improving trend without statistical significance(P＞0.05).The control group showed no significant improvements in LVEF,CO,or LVEDD(P＞0.05).The intergroup comparison revealed that the trial group had significantly better improvements in LVEF and CO than the control group(P＜0.05 or P＜0.01).(7)After 4 weeks of treatment,both groups showed reductions in the scores of chest pain,chest tightness,palpitations,emotional depression,hypochondriac distension,and dull complexion,as well as the total syndrome scores when compared to pretreatment values(P＜0.05),and the trial group presented significantly greater reductions than the control group(P＜0.05).(8)No statistically significant differences were shown in the parameters of liver/kidney function or coagulation between the two groups before and after treatment(P＞0.05).(9)The incidence of postoperative adverse cardiovascular events in the control group was 13.64%(6/44)and that in the trial group was 6.67%(3/45),and the intergroup comparison(tested by Fisher's exact test)showed no statistically significant difference(P＞0.05).Conclusion The combination therapy of Compound Danshen Dripping Pills and Tirofiban demonstrates significant efficacy in improving TCM syndromes,ST-segment elevation,myocardial necrosis markers,and cardiac function in STEMI patients after PCI,with good safety.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.

Objective To analyze the characteristics of alcohol-related brain damage according to 18F-fluorodeoxy-glucose (18F-FDG) position emission tomography-computer tomography (PET-CT).Methods Excessive alcohol consumption patients accepted 18F-FDG PET-CT in our hospital from August 2016 to November 2018 were chosen as excessive alcohol consumption group and non-drinking patients accepted 18F-FDG PET-CT in our hospital at the same time were chosen as non-drinking group according to 1:4 ratio.The 18F-FDG PET-CT imaging data were analyzed;the characteristics of abnormal changed rate of CT sequences after stratification by age and the relations of alcohol consumption with abnormal CT sequences and PET sequences were compared between the two groups.Results A total of 52 patients with excessive alcohol consumption and 200 non-drinking patients were chosen.Among patients aged 45-59 years,the abnormal changed rate of CT sequences in the excessive alcohol consumption group was significantly higher than that in the non-drinking group (P＜0.05).In the CT sequences,33 patients in the 2 groups presented abnormalities,mainly including cerebral atrophy and lacunar infarction.In the PET sequences,62 patients in the two groups presented abnormalities,mainly manifesting as reduced metabolism level of bilateral frontal and parietal lobes.Among the 52 patients from excessive alcohol consumption group,those with abnormal CT sequences were older,had longer drinking history and had higher total drinking amount than those with normal CT sequences,and the differences were statistically significant (P＜0.05).As compared with those in patients with normal PET sequences,those with abnormal PET sequences had higher weekly and total alcohol consumption,and longer drinking history,and the differences were statistically significant (P＜0.05).Conclusion Excessive alcohol consumption is an important risk factor for structural damages in middle-aged men,which can cause a decrease of glucose metabolism level in the frontal and parietal lobes.

Objective To investigate the clinical efficacy of PPH and vaginal repair to strengthen recto-cele in the treatment of ODS patients. Methods 87 patients with rectocele were divided into and groups A and B according to the principle of randomization. They were treated by vaginal repair and PPH repair respectively. The two groups were compared in term of curative effect and Longo′s ODS score,operation time,intraoperative blood loss,postoperative pain score,the number of analgesics needed,hospitalization time and hospitalization expenses. Results The heal rates together with marked efficacy rate at months 1 and 3 in group B were significantly higher than those of group A(87.5%,90% vs.77.5%,80%,P<0.05).There were no differences in hospital stay and in-traoperative blood loss.Group B was significantly superior to group A in postoperative pain score,number of analge-sics needed and hospitalization expenses.Conclusion PPH is more complete and more effective in treating consti-pation caused by RC.

Objective To discuss the correlation between serum uric acid (SUA) level and the severity of coronary borderline lesions in acute coronary syndrome (ACS) and the prognosis of percutaneous coronary intervention (PCI).Methods The 192 patients who were diagnosed as coronary borderline lesions in ACS and PCI were measured.All Patients were divided into two groups:hyperuricemia group and normal SUA group.The severity of coronary arterial lesions and flow in PCI was compared.The cardiac function changes and incidence of major adverse cardiovascular events (MACE) were recorded.Results The results of correlation analysis showed the positive correlation of SUA level and Gensini score (r =0.710,P ＜ 0.05).Patients with hyperuricemia group had a significantly higher prevalence of no-reflow on angiography,in-hospital and six-month prevalence of MACEs compared with the normal SUA group (P ＜ 0.05).The UA on admission has an independent association with coronary slow flow following primary PCI and in-hospital MACEs among patients with ACS (P ＜ 0.05).Conclusion The patients has higher the level of SUA of ACS borderline lesions patients will has more serious the coronary arterial lesions.The risk of coronary slow flow increased in the patients complicated with hyperuricemia who underwent PCI.

AIM:To explore the effects of PPARγon the elevated level of reactive oxygen species ( ROS) in-duced by high glucose and its mechanism .METHODS:Human umbilical vein endothelial cells ( HUVECs) were cultured with DMEM containing high glucose (33 mmol/L D-glucose), and DMEM containing lower glucose (5.5 mmol/L D-glu-cose) was used as control .Superoxide anion and nitric oxide fluorescence probes were used to observe the effects of PPAR γagonist on ROS and NO productions in the HUVECs .The uncoupling protein 2 (UCP2) protein level in the HUVECs was detected by Western blotting .RESULTS:PPARγagonist pioglitazone inhibited the ROS generation and prevented the de-crease in NO level under high glucose condition , and these effects were reversed by pretreatment with PPARγantagonist GW9662.The results of Western blotting indicated that PPARγagonist pioglitazone up-regulated the UCP2 expression un-der high glucose condition , and this effect was also blocked by GW 9662.Inhibition of UCP2 by genipin attenuated the effect of pioglotazone on the ROS production .CONCLUSION: Activation of PPARγinhibits ROS generation under high glucose condition , and this effect may mediate by up-regulation of UCP2.