OBJECTIVE: To observe the clinical efficacy of acupuncture based on the "head qijie" theory combined with endovascular intervention in the treatment of ischemic stroke (IS). METHODS: Sixty-six IS patients were randomly divided into an experimental group (33 cases, 3 cases dropped out) and a control group (33 cases, 3 cases dropped out). The control group received endovascular intervention. On the basis of the treatment in the control group, the experimental group received acupuncture based on the "head qijie" theory starting from the second day after surgery, Baihui (GV20) and bilateral Fengchi (GB20), Tianzhu (BL10), etc. were selected, once a day, 6 times a week for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Barthel index (MBI) and modified Rankin scale (mRS) were observed in the two groups, the clinical efficacy and safety were evaluated. RESULTS: After treatment, the NIHSS and mRS scores were decreased compared with those before treatment in both groups (P<0.01), the NIHSS and mRS scores in the experimental group were lower than those in the control group (P<0.05). After treatment, the MBI scores were increased compared with those before treatment in both groups (P<0.01), the MBI score in the experimental group was higher than that in the control group (P<0.05). The total effective rate in the experimental group was 86.7% (26/30), which was higher than 66.7% (20/30) in the control group (P<0.05). The incidence of adverse events in the experimental group was 6.7% (2/30), which was lower than 13.3% (4/30) in the control group (P<0.05). CONCLUSION Acupuncture based on the "head qijie" theory combined with endovascular intervention in treating IS has good efficacy, improves neurological function, and enhances daily living ability.
Humans ; Male ; Female ; Acupuncture Therapy ; Middle Aged ; Aged ; Ischemic Stroke/therapy* ; Acupuncture Points ; Endovascular Procedures ; Treatment Outcome ; Adult ; Combined Modality Therapy

Objective:To investigate the therapeutic efficacy and safety of conditioning regimen with oral melphalan in tandem autologous hematopoieticstem cell transplantation (ASCT) for patients with malignant plasma cell diseases.Methods:A retrospective case series study was conducted. The clinical data of 13 patients with malignant plasma cell diseases who underwent tandem ASCT between October 2019 and March 2024 in the First Affiliated Hospital of Xi'an Jiaotong University were collected. Compared with the use of intravenous melphalan as conditioning regimen for the first ASCT, hematopoietic reconstruction after transplantation, the therapeutic effects, adverse reactions after drug usage and survival of conditioning regimen with oral melphalan after tandem ASCT were analyzed.Results:Among the 13 patients, there were 10 males and 3 females, with a median age [ M ( Q1, Q3)] of 53 (48, 61) years; 11 cases were multiple myeloma and 2 cases were plasma cell leukemia. Before the first ASCT, tandem ASCT was performed 2-6 months later. The median reconstruction time of neutrophils after the first and second ASCT were both 9 (9, 10) d, and the median reconstruction time of platelets after the first and second ASCT were both 10 (9, 11) d, and there were no statistically significant differences in reconstruction rate of granulocytes on day 9 [69.2% (9/13) vs. 61.5% (8/13)] and platelets on day 10 [46.2% (6/13) vs. 53.8% (7/13)] between the first and second transplantation (all P > 0.05). There were 4 cases of strict complete remission (sCR), 3 cases of complete remission (CR), 4 cases of very good partial remission (VGPR), and 2 cases of partial remission (PR) before the first ASCT. After the first ASCT 1 month later, 1 case achieved VGPR, 1 case achieved PR, 11 cases achieved sCR; all 13 patients achieved sCR at 6 months after second ASCT. Compared with conditioning regimen of intravenous melphalan for the first ASCT, the non-hematological adverse reactions such as nausea (7 cases vs. 9 cases), vomiting (4 cases vs. 13 cases), diarrhea (4 cases vs. 13 cases) and oral mucositis (2 cases vs. 9 cases) in the conditioning regimen of oral melphalan after the second ASCT was reduced, and the differences were statistically significant (all P < 0.01). After the 2 transplantation conditioning regimen with melphalan, Ⅳ degree myelosuppression occurred in 13 cases. After the second ASCT, the median follow-up time was 14 (10, 22) months, 7 patients received maintenance therapy containing lenalidomide, 3 patients received maintenance therapy containing bortezomib, 2 patients received pomalidomide maintenance therapy, and 1 patient received maintenance therapy containing CD38 monoclonal antibody. At the last follow-up, all patients survived, among which 6 multiple myeloma patients relapsed; and the median recurrence time was 13 (10, 22) months after the second ASCT. The estimated 5-year progression-free survival rate was 28.6%. Conclusions:Conditioning regimen with oral melphalan for the second ASCT is safe and well tolerated, and it may further improve the efficacy of the first transplantation.

Adrenal tuberculosis is still the main cause of primary adrenal insufficiency (Addison Disease) in China. A case of bilateral adrenal tuberculosis without PAI symptoms was admitted to Department of Urology, Shanxi Provincial People’s Hospital. Pathological report showed adrenal tuberculosis. We present an overview and discuss how to diagnose early adrenal tuberculosis and reduce misdiagnosis rate so as to preserve residual adrenal function to the greatest extent.

Objective:To examine the safety and complications of two methods of establishing retroperitoneal cavity in urology.Methods:Totally 83 patients undergoing retroperitoneal laparoscopic surgery in Department of Urology, Shanxi Bethune Hospital from January 2020 to June 2021 were analyzed retrospectively. There were 47 males and 36 females, aged (48.3±11.3) years (range: 35 to 71 years). Forty-three cases in Hasson group(the first Trocar channel was selected at the junction of the 12 th rib and the posterior axillary line or lumbar triangle), 40 cases in modified Hasson group(the first Trocar channel is selected at 1.5 cm above the iliac crest on the mid-axillary line). The t test, χ2 test, and Fisher exact test were used to compare the surgical safety indicators and complications of the two groups of patients. Results:There was no statistical difference between the two groups in gender, age, body mass index, waist length, and height ( P>0.05). The comparison of safety indicators, included the time from skin incision to establishment of the retroperitoneal cavity and the amount of bleeding from the cavity were statistical difference between the two groups ( P<0.05). Compared to that in Hasson group, the time from skin incision to establishment of the abdominal cavity in modified Hasson group was shorter ((8.56±2.64) minutes vs. (5.32±1.36) minutes, t=6.949, P<0.01), the blood loss of establishment was less ((15.32±6.09) ml vs. (9.85±3.55) ml, t=4.951, P<0.01). In terms of complication indicators, the incidence of Trocar hernia and the number of subcutaneous emphysema in modified Hasson group were lower than that in Hasson group (20.9% (9/43) vs. 2.5% (1/40), P=0.015, 18.6% (8/43) vs. 2.5% (1/40), P=0.030). Conclusions:The modified Hasson group is a safe method of establishing retroperitoneal cavity. The technique is simple and fast. It provides urologists with a more effective and easy-to-implement option with fewer complications.

Objective:To examine the safety and complications of two methods of establishing retroperitoneal cavity in urology.Methods:Totally 83 patients undergoing retroperitoneal laparoscopic surgery in Department of Urology, Shanxi Bethune Hospital from January 2020 to June 2021 were analyzed retrospectively. There were 47 males and 36 females, aged (48.3±11.3) years (range: 35 to 71 years). Forty-three cases in Hasson group(the first Trocar channel was selected at the junction of the 12 th rib and the posterior axillary line or lumbar triangle), 40 cases in modified Hasson group(the first Trocar channel is selected at 1.5 cm above the iliac crest on the mid-axillary line). The t test, χ2 test, and Fisher exact test were used to compare the surgical safety indicators and complications of the two groups of patients. Results:There was no statistical difference between the two groups in gender, age, body mass index, waist length, and height ( P>0.05). The comparison of safety indicators, included the time from skin incision to establishment of the retroperitoneal cavity and the amount of bleeding from the cavity were statistical difference between the two groups ( P<0.05). Compared to that in Hasson group, the time from skin incision to establishment of the abdominal cavity in modified Hasson group was shorter ((8.56±2.64) minutes vs. (5.32±1.36) minutes, t=6.949, P<0.01), the blood loss of establishment was less ((15.32±6.09) ml vs. (9.85±3.55) ml, t=4.951, P<0.01). In terms of complication indicators, the incidence of Trocar hernia and the number of subcutaneous emphysema in modified Hasson group were lower than that in Hasson group (20.9% (9/43) vs. 2.5% (1/40), P=0.015, 18.6% (8/43) vs. 2.5% (1/40), P=0.030). Conclusions:The modified Hasson group is a safe method of establishing retroperitoneal cavity. The technique is simple and fast. It provides urologists with a more effective and easy-to-implement option with fewer complications.

Objective:To explore the influencing factors of postoperative chronic kidney disease (CKI) in patients with primary aldosteronism (PA).Methods:The clinical data of 103 patients who underwent adrenalectomy for PA in our center from August 2018 to August 2019 were analyzed retrospectively. There were 53 males and 50 females, aged (47.02±10.06) years old, including 27 diabetes patients (26.2%). The body mass index (BMI) were (24.47±3.24) kg/m 2, tumor maximum diameter were (15.61±5.66) mm, preoperative systolic blood pressure were (166.93±12.22) mmHg(1 mmHg=0.133 kPa), preoperative blood potassium were (3.35 ± 0.48) mmol/L, plasma aldosterone concentration (PAC) were (55.75±8.56)ng/dl, aldosterone-renin ratio(ARR) were (165.13±38.21) and preoperative glomerular filtration rate (GFR) were (77.96±14.77) ml/(min·1.73m 2). All patients underwent laparoscopic adrenalectomy. The operation time and bleeding volume were recorded. The GFR, blood potassium, PAC and ARR were recorded at the third month after surgery. The paired sample t test was used to compare GFR before and after surgery. Pearson correlation analysis was used to evaluate the correlation between the parameters and GFR after surgery. The independent predictors of GFR≤60ml/(min·1.73 m 2) were analyzed by univariate and multivariate logistic regression. Results:The surgery time were (85.37±21.66) min, and the bleeding volume were (10.54±4.84) ml. GFR (62.66±8.53) ml/(min·1.73 m 2) at 3 months after surgery was significantly different from that before surgery ( P<0.01). Univariate analysis showed that age ( OR=1.36, P<0.01), preoperative GFR ( OR=0.81, P<0.01), preoperative blood potassium ( OR=2.95, P=0.02), preoperative PAC ( OR=1.28, P<0.01) and preoperative ARR ( OR=1.08, P<0.01) were significantly correlated with postoperative CKI. In Pearson analysis, older age ( r=-0.51, P<0.01), lower preoperative GFR ( r=0.62, P<0.01), lower preoperative blood potassium( r=0.41, P=0.02), higher preoperative PAC ( r=-0.49, P<0.01) and higher preoperative ARR ( r=-0.56, P<0.01) increased the risk of CKI. Multivariate logistic regression analysis showed that age ( OR=1.26, P=0.05), preoperative GFR ( OR=0.79, P=0.02) and preoperative PAC( OR=1.29, P=0.01) were independent risk factors for postoperative CKI. Conclusions:CKI may occur in PA patients after adrenalectomy. PA patients with older age, higher preoperative PAC, higher preoperative ARR, lower preoperative blood potassium and lower preoperative GFR are more likely to have CKI. Age, preoperative GFR and preoperative PAC were independent predictors of CKI.

Objective:To investigate the levels and clinical significance of serum leptin and transforming growth beta 1 (TGF-β1) in silicosis patients.Methods:A total of 52 patients with silicosis (already identified as occupational diseases) were enrolled in the Department of Respiratory and Critical Disease Medicine, the First Hospital of Shanxi Medical University from June 2018 to July 2019. These patients were regarded as silicosis group. They were divided into 25 patients with first stage silicosis, 22 patients with second stage silicosis and 5 patients with third stage silicosis. At the same time, 30 patients with no history of dust exposure in the same period of physical examination were selected as control group. Serum leptin and TGF-β1 levels were measured by enzyme-linked immunosorbent assay in all investigators. At the same time, the comparison and correlation analysis between groups were carried out, and the diagnostic value was judged by receive operating characteristic (ROC) curve.Results:The serum levels of leptin and TGF-β1 in silicosis patients were higher than those in the control group, the differences were statistically significant ( P<0.05) . The serum levels of leptin in patients with second stage and third stage silicosis were higher than those in the control group and first stage, the differences were statistically significant ( P<0.05) . Serum levels of TGF-β1 in all stage silicosis patients were higher than those in the control group, and third stage silicosis was higher than first stage, the differences were statistically significant ( P<0.05) . There was a positive correlation between serum levels of leptin and TGF-β1 in silicosis group ( r s=0.400, P<0.05) . The ROC area of leptin and TGF-β1 combined to predict silicosis was 0.826, with the sensitivity and specificity were 73.10% and 80.00%. Conclusion:The levels of serum leptin and TGF-β 1 are related to different stages of silicosis, and the combined detection of leptin and TGF-β 1 can assist the diagnosis of silicosis.

Objective:To investigate the levels and clinical significance of serum leptin and transforming growth beta 1 (TGF-β1) in silicosis patients.Methods:A total of 52 patients with silicosis (already identified as occupational diseases) were enrolled in the Department of Respiratory and Critical Disease Medicine, the First Hospital of Shanxi Medical University from June 2018 to July 2019. These patients were regarded as silicosis group. They were divided into 25 patients with first stage silicosis, 22 patients with second stage silicosis and 5 patients with third stage silicosis. At the same time, 30 patients with no history of dust exposure in the same period of physical examination were selected as control group. Serum leptin and TGF-β1 levels were measured by enzyme-linked immunosorbent assay in all investigators. At the same time, the comparison and correlation analysis between groups were carried out, and the diagnostic value was judged by receive operating characteristic (ROC) curve.Results:The serum levels of leptin and TGF-β1 in silicosis patients were higher than those in the control group, the differences were statistically significant ( P<0.05) . The serum levels of leptin in patients with second stage and third stage silicosis were higher than those in the control group and first stage, the differences were statistically significant ( P<0.05) . Serum levels of TGF-β1 in all stage silicosis patients were higher than those in the control group, and third stage silicosis was higher than first stage, the differences were statistically significant ( P<0.05) . There was a positive correlation between serum levels of leptin and TGF-β1 in silicosis group ( r s=0.400, P<0.05) . The ROC area of leptin and TGF-β1 combined to predict silicosis was 0.826, with the sensitivity and specificity were 73.10% and 80.00%. Conclusion:The levels of serum leptin and TGF-β 1 are related to different stages of silicosis, and the combined detection of leptin and TGF-β 1 can assist the diagnosis of silicosis.

Objective To investigate the diagnosis and treatment of active adrenal tuberculosis.Method The clinical data of 1 patients with adrenal tuberculosis was retrospectively analyzed and the related literatures were reviewed.The male patient,54 years old,complained abuot the dry cough and intermittent fever for 9 months.He was found the left adrenal gland tumor for 1 weeks and admitted to our hospital on November 1st,2016.The physical examination showed the obvious left kidney percussion tellderness.The local hospital,considered the left adrenal tumor.The pathological diagnosis of left adrenal tumor by biopsy was chronic inflammation.The patient accepted anti-inflammatory therapy,but his symptom was not relieved.In our hospital,blood bacterial culture and urine bacterial culture and PPD was negative.Blood tuberculosis antibody was positive.Triple acid-fast bacilli were negative in urine.Chest CT did not exclude the interstitial pulmonary tuberculosis.Adrenal contrast-enhanced CT showed mild enhancement,strip calcification shadow.Primary diagnosis was left adrenal tumor,which the abscess and tuberculosis could not to be excluded.Then,the patient accepted regularly anti-tuberculosis therapy (Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d).Mter 3 days,his temperature returned to normal.Since the left adrenal mass was too large,which was about 6.8 cm × 5.5 cm,to distinguish with the tumor,the patient accepted successfully retroperitoneal adrenal tumor resection two weeks later.The left adrenal tumor surface was greyish and yellow,which was adherent with spleen and pancreas.After carefully separating,the tumor was successfully removed.Result The operation was successful,which last 85 min.Intraoperative blood loss was about 50 ml.Pathological report showed adrenal tuberculosis.The patients accepted regularly antituberculosis therapy(Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d) for half a year,and followed up for 1 year after operation.No further hormone replacement therapy was used.No fever was noticed and his rhythm cortisol level was normal.Conclusions Adrenal mass associated with recurrent fever,should be suspected as adrenal tuberculosis if antibiotic therapy is not effective.If the adrenal CT showed adrenal calcification associated with the ectepic tuberculosis,patient should be diagnosised active adrenal tuberculosis.They should accept anti-tuberculosis treatment.However,if the volume of tuberculosis is large,or not to exclude tumor possibility,we recommend to proceed adrenal tumor resection for diagnosis.

Objective To analysis the clinical features,diagnosis,treatment and prognosis of adrenal eosinophilic tumor with low testosterone levels.Methods The clinical data of a 22 years old male patient with adrenal eosinophilic tumor and low testosterone levels was analyzed.Blood pressure was 151/88 mmHg.The patient got bilateral gynecomastia.His bilateral testicular was soft and became smaller,with short penisr.Endocrine examination results showed:Estradiol 666 pg/ml,Prolactin 19.08 ng/ml,Testosterone 0.18 ng/ml,follicle stimulating hormone ＜ 0.2 U/L.The CT showed the mass density of soft tissue in the left adrenal region with diameter 7 cm,which was inhomogeneous and enhanced.There were many small vessels enhanced in the CT arterial phase,and the blood flow in the tumor was abundant.Clinical diagnosis of left adrenal tumor was pheochromocytoma.The patient underwent laparoscopic left adrenal tumor resection.The left adrenal gland was located in the superior pole of the left kidney,and there was an independent supply of the artery.Results Pathological result showed the tumor weigh was 60 g,7 cm in diameter and brown in section.The tumor cells were arranged in solid nests or acini,with more eosinophilic granules in cytoplasm.The nuclei was round and the nucleoli was located in the center,had clusters of pleomorphic and clustered cells.The tumor was wrapped in a thick fibrous envelope,mainly consisted of eosinophils,granulation tissue.There was no necrosis,mitosis,and vascular invasion.Immunohistochemical staining showed that the expression of CD56 and syn protein was positive.Pathological diagnosis was left adrenal eosinophilic tumor.After 4 months,the blood testosterone levels rose to 3.90 ng/ml,the blood pressure returned to normal (118/75 mmhg).The estradiol (21 pg/ml) was significantly inhibited.The patient began to appear beards and breasts became smaller.There were no signs of clinical or imaging recurrence.After 16 months follow-up,serum testosterone was 4.68 ng/ml and serum estrogen levels dropped to 33 pg/ml.Semen routine showed no sperm.Conclusions The clinical morbidity of functional adrenocortical oncocytoma with low testosterone levels and high estradiol levels is low.The pathological components are mainly eosinophilic granulation tissue.The adrenocortical oncocytoma are rare and preoperative diagnosis is difficult.Clinical manifestation,imaging examination and adrenal biochemistry examination should be considered to determine the localization and qualitative of tumor.Minimally invasive surgery is an effective treatment.The close follow-up after operation is essential.