Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA₂DS₂-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.
Aged ; Aged, 80 and over ; Atrial Appendage/surgery* ; Atrial Fibrillation/surgery* ; Echocardiography, Transesophageal ; Humans ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Renal Dialysis ; Stroke ; Thromboembolism ; Treatment Outcome

Objective To use World Health Organization Family International Classifications (WHO-FICs) to explore the framework and approaches of development and research of guidelines of rehabilitation at levels of policies, community and services.Methods The important documents and tools of rehabilitation at international level, including United Nations Convention on the Rights of Persons with Disabilities, WHO World Report on Disability, Community-based Rehabilitation Guideline, Rehabilitation in Health Service System, and International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHI) of WHO-FICs, had been discussed.Results The framework, classifications, diagnosis and description of diseases and functioning, coding, intervention and functioning evaluation based on ICD-11, ICF and ICHI-β-2 had been established for development and implementation of rehabilitation guidelines and Cochrane rehabilitation.Conclusion The framework and systematic approaches of ontology, classification, terminology, coding, diagnosis and description of diseases and functioning, interventions and evaluations for the development and implementation of rehabilitation guidelines had been developed.

Objective: To observe the clinical efficacy of auricular point pricking-bloodletting plus auricular point sticking therapy for acne vulgaris. Methods: A total of 66 patients with acne vulgaris were randomized into an observation group and a control group by the random number table, with 33 cases in each group. The observation group was treated with auricular point pricking-bloodletting plus auricular point sticking therapy, and the control group was treated only with auricular point sticking therapy. The treatments of both groups were performed twice a week, 4 weeks as a course of treatment, for 3 courses in total. The scores of skin lesions and dermatology life quality index (DLQI) scores were recorded before and after treatment to assess the clinical efficacy. Results: During the trial, there were 3 cases of drop-out both in the observation group and the control group. After 3 courses of treatment, the total effective rate of the observation group was 96.7％, while that of the control group was 76.7％. The difference between the two groups was statistically significant (P<0.05). The intra-group comparison showed that the scores of skin lesion and DLQI were both decreased with the increase of treatment times, that was, the scores were lower than those at the previous time point (allP<0.05). After 1, 2, and 3 courses of treatment, the scores of skin lesion and DLQI of both groups were statistically different from those of the same group before treatment (allP<0.05). At every time point during the treatment, the scores of skin lesion and DLQI of the observation group were lower than those of the control group, and the differences between the two groups were statistically significant (all P<0.05). Conclusion: Auricular point pricking-bloodletting plus auricular point sticking has a better curative effect than auricular point sticking therapy alone in the treatment of acne vulgaris, and has a time-effect correlation.

OBJECTIVETo investigate the application and effect of minimally invasive percutaneous anterior pelvic pubic ramus screw fixation in Tile B fractures.

METHODSA retrospective review was conducted on 56 patients with posterior pelvic ring injury combined with fractures of anterior pubic and ischiadic ramus treated between May 2010 and August 2015, including 31 males and 25 females with an average age of 36.8 years old ranging from 35 to 65 years old. Based on the Tile classification, there were 13 cases of Tile B1 type, 28 cases of Tile B2 type and 15 cases of Tile B3 type. Among them, 26 patients were treated with sacroiliac screws combined with external fixation (external fixator group) and the other 30 patients underwent sacroiliac screw fixation combined with anterior screw fixation (pubic ramus screw group). Postoperative complications, postoperative ambulation time, fracture healing, blood loss, Majeed pelvic function score and visual analogue scale(VAS) were compared between two groups.

RESULTSFifty-four patients were followed up from 3 to 24 months with a mean of 12 months. There were no significant difference in the peri-operative bleeding and operation time between two groups(>0.05). The postoperative activity time and fracture healing time of pubic ramus screw group were shorter than those of the external fixator group, the differences were statistically significant(<0.05). The Majeed score, VAS score of pubic ramus screw group were higher than those of the external fixator group, the differences were statistically significant(<0.05). The incidence of postoperative complications of pubic ramus screw was lower than that of the external fixator group, the difference was statistically significant (<0.05).

CONCLUSIONSPercutaneous iliosacral screws fixation combined with the pubic ramus screw is an effective and safty treatment method to the Tile B pelvic fracture. It has advantages of early ambulation, relief of the pain and few complications.

ZHU Lian is a deceased famous acupuncture and Moxibustion specialist, the first director and the founder of institute of Acupuncture-Moxibustion of China Academy of Chinese Medical Sciences. This article discusses the thought and idea of education and teaching of acupuncture-moxibustion from the following three aspects: diversified education and training mode, teaching idea of new acupuncture-moxibustion with a lot of characteristics, and the founding of professional acupuncture-moxibustion college. All above have both distinct characteristics of the times and positively enlightening significance of reality.
Acupuncture ; education ; history ; Acupuncture Therapy ; history ; China ; Education, Medical ; history ; History, 20th Century ; Humans ; Teaching ; history

OBJECTIVETo explore the repair of Xiangsha Liujunzi Decoction (XSLJZD) on interstitial cells of Cajal (ICC) and gap junction (GJ) in the gastric muscular layer of rats of Pi-qi deficiency syn- drome (PQDS).

METHODSPQDS was established using purgative method with bitter and cold drugs in 30 healthy Wistar rats. After successful modeling they were randomly divided into the treatment group and the model group, 15 in each group. Another 15 healthy Wistar rats were recruited as the healthy control group. Rats in the treatment group were gastric administered with XSLJZD at 2 mL/100 g body weight, once daily for 14 successive days. Equal volume of normal saline was gastrically administered to those in the healthy control group and the model group. The gastric muscle tissues were taken out before modeling, before intervention, and after intervention, respectively. Ultrastructural changes of ICC and GJ were observed using transmission electron microscope (TEM). The number and distribution of Connexin43 (Cx43) were detected using immunohistochemistry.

RESULTSResults of TEM indicated that compared with the healthy control group, both ICC and GJ in the model group showed obvious injury. ICC and GJ were apparently repaired after intervention in the treatment group. Compared with the same group before modeling, the integrated optical density (IOD) of the Cx43 expression significantly decreased in the model group before and after intervention (P <0.05). Compared with before intervention, the IOD of the Cx43 expression significantly increased in the treatment group (P <0.05). Compared with the healthy control group, the IOD of the Cx43 expression significantly decreased in the model group before and after intervention (P <0.05). Compared with the model group, the IOD of the Cx43 expression significantly increased in the treatment group (P <0.05).

CONCLUSIONSUltrastructures of ICC and GJ in the gastric muscular layer of rats of PQDS were obviously damaged. XSLJZD could repair the structural damage of ICC and GJ in the gastric muscle tissues of rats of PQDS.

Animals ; Connexin 43 ; Drugs, Chinese Herbal ; pharmacology ; Gap Junctions ; Interstitial Cells of Cajal ; drug effects ; Leydig Cells ; Male ; Muscle, Smooth ; Qi ; Rats, Wistar ; Syndrome

Objective To evaluate the safety of high pressure injection of iodine contrast material into the external jugular vein.Methods 50 cases who accepted the CM injection via upper extremity veins were chosen as the control group,40 cases injected CM via external jugular vein were assigned to the observation group all of whose upper extremity veins were difficult to puncture.We designed an evaluation table to compare the two different high pressure vein injection methods,the observation indexes included:success rate of puncture,total time spend of puncture process,leakage ratio,dose of CM,injection speed,lag time,image quality,adverse effect incidence,heart rate and blood pressure changes before and after injection.Results There was 1puncture failure in the control group,the success rate of puncture was 98％ with no leakage cases.There was no puncture failure in the observation group except for two remaining needles slipped off after successful puncture.The variations of heart rate before and after puncture were[ (3.25 ± 11.53 ) beats/min vs( - 1.31±7.91) beats/min ],diastolic pressure[ ( - 6.75 ± 24.24 ) mm Hg vs( 3.04 ± 8.82 ) mm Hg ] in the control group and observation group,respectively,with no significant difference( t =1.59,- 1.91; both P ＞ 0.05 ).However,the changes of systolic pressure were[ ( - 2.60 ± 13.09 ) mm Hg vs ( 7.39 ± 13.52 ) mm Hg ],with statistically significant difference( t =- 2.52,P ＜ 0.05 ).No iodine contrast material related adverse effects happened in the two groups.The image quality were very high; Choosing external jugular vein puncture could improve the success rate of puncture,shorten the total time spend of puncture process and ease the pain of the patients,and the only added job was to adjust the dose of iodine contrast material and the lag time of screening.Conclusions Iodine injection via external jugular vein route is safe for patients with normal cardiac function,and it is an important method for those with poor vein condition.

OBJECTIVETo investigate the effect of apelin on vasodilatation of isolated pulmonary arterial rings in rats and its relationship to the nitric oxide (NO) pathway, and to observe the difference of vasodilatation between hypoxic rats and normoxic rats.

METHODSThirty-six male Sprague-Dawley (SD) rats were randomly divided into hypoxic group and normoxic group. The effects of accumulated apelin on pulmonary arterial rings preconstricted with norepinephrine (NE) were observed by using tissue organ bath system. After pulmonary arterial rings were pretreated with three methods: removing the endothelium, pretreating with nitric oxide synthase inhibitor L-NAME or soluble guanylatecyclase inhibitor ODQ, the different effect of apelin was observed. In addition, the difference of vasodilatation between hypoxic rats and normal rats were observed.

RESULTS(1) Exposure of intact endothelium pulmonary arterial rings preconstricted by NE to apelin at concentration (0.01 - 100 nmol/L) induced a significant concentration dependent relaxation. The maximal vasorelaxant effect of apelin was 10.62% +/- 2.60%, which was inhibited by removal of the endothelium (P < 0.01), pretreatment with L-NAME (P < 0.01) or ODQ (P < 0.01). (2) Response of pulmonary arterial rings from hypoxic pulmonary hypertension rats was decreased (P < 0.05). Compared to normal rats, at a concentration of 100 nmol/L, the response to apelin on arteries from hypoxic rats decreased 60.45% (P < 0.01). But the values of EC50 were not significantly different (P > 0.05).

CONCLUSIONThese results indicate that apelin relaxes the pulmonary arterial rings of rats in an endothelium dependent manner, which may have a relationship to NO signaling pathway. The response of vasodilatation is decreased in the pulmonary arterial rings from the hypoxic rats.

Animals ; Apelin ; Hypoxia ; physiopathology ; In Vitro Techniques ; Intercellular Signaling Peptides and Proteins ; pharmacology ; Male ; Nitric Oxide ; metabolism ; Pulmonary Artery ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Vasodilation ; drug effects

Objective To evaluate the sensitivity and specificity of CT perfusion(CTP)parameters in grading the astrocytic tumors.Methods Fifty-three patients with brain tumors underwent CTP examination,and the astrocytie tumors confirmed by operation and pathology(n=30)were selected and divided into high-grade group(n=19)and low-grade group(n=11).Perfusion scanning on the brain was performed by 64-slice spiral CT angiography and the data were analyzed by AW 4.2P software.Cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and permeability surface(PS)on the maximum perfusion area and the normal brain tissues in the opposite side were measured.Results High-grade group showed significantly higher CBF,CBV and PS values as compared with the low-grade group(P<0.05).However,the MTT values was not significantly different between the 2 groups(P>0.05).The under-ROC curve areas of the CBF,CBV and PS values between these 2 groups were 0.914,0.876 and 0.914,respectively;while that of MTT was only 0.455 and could not help differentiating the diagnosis.When the optimal limit values of these indicators for differentiation specificity was 81.8%,81.8% and 91.9%,respectively.Conclusion The CBF,CBV and PS values of multi-slice CTP show high sensitivity and specificity in differentiating the diagnosis of high-and low-grade astroeytic tumors.

The authors preliminarily analyze and compare influence of different stages of attack and remission, different syndrome types, and age of the patient, duration of illness, state of illness on the therapeutic effects of acupuncture and moxibustion for treatment of bronchial asthma by analysis and summarization of 381 clinical papers about acupuncture and moxibustion treatment of bronchial asthma. It is found that most studies hold that acupuncture has better therapeutic effect on asthma at acute stage, and moxibustion has a better effect at the remission stage. Acupuncture and moxibustion have a better effect on cold asthma than hot asthma, and the shorter the course of disease and the younger, the better the effect, conversely, the effect is worse. Mild asthma is the main indication of acupuncture and moxibustion, but considerable more clinical studies show that above factors have no obvious influence on the therapeutic effect, even show contrary to this result. It is indicated that in the studies from now on, only strictly design and fully consider the effects of various factors, can scientifically reveal various disease factors influencing therapeutic effect of acupuncture and moxibustion on bronchial asthma, and expound the indications of different acupuncture and moxibustion methods for treatment of bronchial asthma.
Acupuncture Therapy ; Age Factors ; Asthma ; pathology ; therapy ; Disease Progression ; Humans ; Moxibustion ; Treatment Outcome