BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

Objective:To compare the therapeutic effects of nasal high-flow oxygen therapy (HFNC) and nasal canal oxygenation (NCO) during breaks off non-invasive ventilation (NIV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore the feasibility of NIV combined with HFNC in the treatment of AECOPD.Methods:From August 2017 to July 2019, AECOPD patients with type Ⅱrespiratory failure (arterial blood gas pH <7.35, PaCO 2 > 50 mmHg) who were treated with NIV were randomly (random number) assigned to the HFNC group and NCO group at 1:1. The HFNC group received HFNC treatment during breaks from NIV and the NCO group received low-flow NCO during the NIV interval. The primary endpoint was the total respiratory support time. The secondary endpoints were endotracheal intubation, duration of NIV treatment and breaks from NIV, length of ICU stay, total length of hospital stay and so on. Results:Eighty-two patients were randomly assigned to the HFNC group and the NCO group. After secondary exclusion, 36 patients in the HFNC group and 37 patients in the NCO group were included in the analysis. The total respiratory support time in the HFNC group was significantly shorter than that in the NCO group [(74 ± 18) h vs. (93 ± 20) h, P = 0.042]. The total duration of NIV treatment in the HFNC group was significantly shorter than that in the NCO group [(36 ± 11) h vs. (51 ± 13) h, P=0.014]. There was no significant difference of the mean duration of single break from NIV between the two groups, but durations of break from NIV in the HFNC group were significantly longer than those in the NCO group since the third break from NIV ( P < 0.05). The intubation rates of the HFNC and NCO groups were 13.9% and 18.9%, respectively, with no significant difference ( P=0.562). The length of ICU stay in the HFNC group was (4.3 ± 1.7) days, which was shorter than that in the NCO group [(5.8 ± 2.1) days, P=0.045], but there was no significant difference in the total length of hospital stay between the two groups. Heart rate, respiratory rate, percutaneous carbon dioxide partial pressure and dyspnea score during the breaks from NIV in the NCO group were significantly higher than those in the HFNC group, and the comfort score was lower than that in the HFNC group ( P<0.05). Conclusion:For AECOPD patients receiving NIV, compared with NCO, HFNC during breaks from NIV can shorten respiratory support time and length of ICU stay, and improve carbon dioxide retention and dyspnea. HFNC is an ideal complement to NIV therapy in AECOPD patients.

Intracranial atherosclerosis (ICAS) is one of the main pathogenesis of acute ischemic stroke (AIS). Intravenous thrombolysis is a main therapeutic method, enjoying good effect, but the recanalization rate is low and the risk of re-occlusion is high. Endovascular therapy has developed rapidly in recent years due to its long time-window for treatment, high recanalization rate and few complications. This article reviews the pathogenesis, characteristics, main therapeutic methods, complications and rescue measures of AIS due to ICAS. And the development of intravascular therapy is highlighted.

Resident standardization training is an essential way in cultivating medical professionals. It is important for subject development and talent reserve. For cultivating high-quality resident physicians with comprehensive theory, independent clinical thinking, great practical ability, and innovative scientific idea, it recourses to both optimizing training scheme and evaluation system with highly specialization and comprehensive quality. In this study, the authors proposed incorporate training patterns includingoptimiz-ing design, innovating training, and standardized assessment based on their recent experience on resident standardization training.

Objective To investigate the relationship between maximum blood pressure and the prognosis after discharged from the hospital,among patients with ischemic stroke.Methods A cohort study was conducted which including 471 cases of ischemic stroke patients that were collected from February 2014 to December 2014 at the Second Affiliated Hospital of Harbin Medical University.Values of everyday blood pressure were measured on each patient at the first six days after admitted to the hospital.Maximum blood pressure value of the 6 days was taken as an indicator of the blood pressure levels.The ability on daily living was measured by the modified Rankin score (mRs).Data were analyzed by Chi-square test,t test and multivariate logistic regression analysis.Results Confounding factors would include age,gender,culture,physical activity,income,smoking,alcohol,hypertension,diabetes,coronary heart disease,stroke history,hospitalization mrs,lipid parameters,homocysteine and blood sugar and were adjusted.Results from multivariate logistic regression analysis showed that the maximum SBP was associated with adverse outcomes.Compared with 140-159 mmHg for SBP,OR(95％CI) was 2.51 (1.30-4.85) for 160-179 mmHg,OR (95％ CI) was 2.68 (1.27-5.65) for those pressure levels higher than 180 mmHg,after multiple factors were adjusted.Compared with 90-99 mmHg for DBP,OR(95％CI) was 1.92 (1.00-3.67) for 100-109 mmHg,OR (95％ CI) was 2.78 (1.35-5.69) for the ones higher than 110 mmHg.Conclusion Maximum blood pressure during hospitalization might be associated with adverse outcome of ischemic stroke patients.

We changed the form of literature reading from simple reading and translation to comprehensive lecture,analysis,discussion and exchange under the guidance of teachers in order to promote postgraduates' capability of learning professional English and to enhance their overall quality.The new form not only improves students' English proficiency but also enhances their overall quality,such as literature quality,teaching ability,competitive consciousness,psychological quality,etc.At the same time,it is also beneficial for teachers.

Introducing theory of constructivism to guide the clinical teaching can make us inquire into the new clinical teaching mode and improve teaching evolution and innovation.

With the increasing enrollment of high school and commonalty of higher education,it is very important to transform educational thought and concept,explore the approach and method for clinical teaching administration,improve teaching condition,enhance construction of teaching staff and emphasize the development for learning ability,practice ability and pioneering ability of clinical medical undergraduates.

Based on how teachers apply educational technique in clinical education,we sum up experiences,deepen reformation and exchange concept to enhance the teachers’technical training of mordern education,improve their bility to create and apply clinical teaching from many respects such as guiding educational practice by teaching theory,and the actual effect of application

This article discusses how to use teaching platform provided by information technique to integrate information technique with clinical teaching of college courses,strengthen material collection in clinical teaching and train students' thinking and cognitive ability.