OBJECTIVE To observe the clinical efficacy of Ziyu Prescription in the treatment of polycystic ovary syndrome relat-ed infertility of kidney deficiency and its effect on endometrial receptivity.METHODS A total of 120 patients with polycystic ovary syndrome related infertility of kidney deficiency were enrolled and randomly divided into a control group and a treatment group,with 60 cases in each group.After excluding dropout cases and excluded cases,56 cases were completed in each group.The control group was treated with letrozole and placebo,while the treatment group was treated with letrozole and Ziyu Prescription.The treatment course of both groups was 3 menstrual cycles.The clinical pregnancy rate and ultrasound Salle score during the implantation window were the main outcome indicators.The traditional Chinese medicine(TCM)syndrome score and serum estradial(E2),testosterone(T),anti-Müllerian hormone(AMH),luteinizing hormone(LH),follicle-stimulating hormone(FSH),homeostatic model assessment of insulin resistance(HOMA-IR),serum E2 and progesterone(P)levels during the implantation window were used as secondary outcome indica-tors.Multivariate Logistic regression and ROC curve analysis were used to evaluate the effect and predictive ability of ultrasound Salle score on pregnancy outcome.Multiple linear regression was used to evaluate the effect of estrogen and progesterone levels during the implantation window on ultrasound Salle score.RESULTS After treatment,the clinical pregnancy rate and ultrasound Salle score during the implantation window in the treatment group were significantly higher than those in the control group(P＜0.05,P＜0.01).The total TCM syndrome score of the treatment group was significantly lower than that of the control group(P＜0.01);the ser-um T,LH/FSH,and HOMA-IR levels of the treatment group were significantly lower than those of the control group(P＜0.05,P＜0.01);the serum E2 and P levels of the treatment group were significantly higher than those of the control group during the implanta-tion window period(P＜0.01).Multivariate Logistic regression analysis and ROC curve analysis showed that ultrasound Salle score was significantly positively correlated with pregnancy rate and had a high predictive value for pregnancy outcome.Multiple linear regression analysis found that there was a linear relationship between the ultrasound Salle score and E2 and P during the implantation window peri-od,and the P level had a greater impact.CONCLUSION Ziyu Prescription can improve the clinical pregnancy rate of patients with polycystic ovary syndrome related infertility of kidney deficiency,effectively improve their endometrial receptivity,regulate the levels of sex hormones and glucose metabolism,reduce the TCM syndrome score,and improve the reproductive quality of patients.

OBJECTIVE: To investigate the effectiveness of knee arthroscopy with wire anchor nailing composite double pulley technique in the treatment of anterior cruciate ligament (ACL) tibial avulsion fracture involving the anterior root of the lateral meniscus (LM). METHODS: Clinical data of 35 patients with ACL tibial avulsion fracture involving the anterior root of the LM admitted between January 2019 and September 2023 and met the selection criteria were retrospectively analysed. There were 20 males and 15 females; ages ranged from 10 to 57 years, with a mean of 29 years. The time from injury to surgery ranged from 3 to 20 days, with a mean of 9.6 days. Meyers-McKeever classification included 5 cases of type Ⅱ, 12 cases of type Ⅲ, and 18 cases of type Ⅳ. Preoperative anterior knee instability Lachman test and anterior drawer test were positive. The anterior root of the LM as well as the avulsion fracture block were fixed using suture anchor nails compounded with double pulley technique under arthroscopy. Postoperative X-ray films were performed to assess fracture healing; knee stability was assessed using the anterior drawer test and Lachman test, anterior laxity of the knee was measured by KT-2000, and knee function was assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score; at last follow-up, the recovery of the meniscus was assessed using the McMurry test and knee hyperextension test. RESULTS: All the patients were successfully operated, the operation time ranged from 56 to 78 minutes,with an average of 67.6 minutes, and there was no nerve or blood vessel injury during operation. Thirty-five cases were followed up 12-18 months with an average of 15.1 months. During the follow-up, there was no infection, knee stiffness, loosening of internal fixation, fracture displacement, or re-fracture. The fractures all healed, with a clinical healing time of 8-15 weeks, averaging 10.9 weeks. At last follow-up, 4 patients had weakly positive anterior drawer test and Lachman test, and the rest were negative; McMurry test and knee hyperextension test were negative; no patient complained of knee extension pain or straightening obstacles, and all the patients resumed their normal life or sports and labour; 16 patients with unclosed epiphyses did not have any epiphyseal injuries or growth disorders. Lysholm score, IKDC score, and KT-2000 anterior knee laxity at last follow-up significantly improved when compared with preoperative ones ( P<0.05). CONCLUSION The treatment of ACL tibial avulsion fracture involving the anterior root of the LM with suture anchor composite double pulley technique can effectively fix the anterior root of the LM while fixing the avulsion fracture block, and better restore the function and stability of the knee joint.
Humans ; Male ; Female ; Adult ; Arthroscopy/methods* ; Adolescent ; Retrospective Studies ; Tibial Fractures/surgery* ; Young Adult ; Middle Aged ; Fractures, Avulsion/surgery* ; Fracture Fixation, Internal/instrumentation* ; Anterior Cruciate Ligament Injuries/surgery* ; Child ; Treatment Outcome ; Suture Anchors ; Menisci, Tibial/surgery* ; Tibial Meniscus Injuries/surgery* ; Bone Nails ; Knee Joint/surgery*

OBJECTIVE To observe the clinical efficacy of Ziyu Prescription in the treatment of polycystic ovary syndrome relat-ed infertility of kidney deficiency and its effect on endometrial receptivity.METHODS A total of 120 patients with polycystic ovary syndrome related infertility of kidney deficiency were enrolled and randomly divided into a control group and a treatment group,with 60 cases in each group.After excluding dropout cases and excluded cases,56 cases were completed in each group.The control group was treated with letrozole and placebo,while the treatment group was treated with letrozole and Ziyu Prescription.The treatment course of both groups was 3 menstrual cycles.The clinical pregnancy rate and ultrasound Salle score during the implantation window were the main outcome indicators.The traditional Chinese medicine(TCM)syndrome score and serum estradial(E2),testosterone(T),anti-Müllerian hormone(AMH),luteinizing hormone(LH),follicle-stimulating hormone(FSH),homeostatic model assessment of insulin resistance(HOMA-IR),serum E2 and progesterone(P)levels during the implantation window were used as secondary outcome indica-tors.Multivariate Logistic regression and ROC curve analysis were used to evaluate the effect and predictive ability of ultrasound Salle score on pregnancy outcome.Multiple linear regression was used to evaluate the effect of estrogen and progesterone levels during the implantation window on ultrasound Salle score.RESULTS After treatment,the clinical pregnancy rate and ultrasound Salle score during the implantation window in the treatment group were significantly higher than those in the control group(P＜0.05,P＜0.01).The total TCM syndrome score of the treatment group was significantly lower than that of the control group(P＜0.01);the ser-um T,LH/FSH,and HOMA-IR levels of the treatment group were significantly lower than those of the control group(P＜0.05,P＜0.01);the serum E2 and P levels of the treatment group were significantly higher than those of the control group during the implanta-tion window period(P＜0.01).Multivariate Logistic regression analysis and ROC curve analysis showed that ultrasound Salle score was significantly positively correlated with pregnancy rate and had a high predictive value for pregnancy outcome.Multiple linear regression analysis found that there was a linear relationship between the ultrasound Salle score and E2 and P during the implantation window peri-od,and the P level had a greater impact.CONCLUSION Ziyu Prescription can improve the clinical pregnancy rate of patients with polycystic ovary syndrome related infertility of kidney deficiency,effectively improve their endometrial receptivity,regulate the levels of sex hormones and glucose metabolism,reduce the TCM syndrome score,and improve the reproductive quality of patients.

Tibial spine fractures (TSFs) is a special type of intra-articular fracture, which is more common in children and adolescents. In recent years, the incidence of avulsion fractures in adults have been on the rise with the increase in road traffic injuries and sports injuries such as skiing. Once a fracture occurs, aggressive clinical interventions are needed to avoid joint dysfunction. According to the Meyers-McKeever classification, TSFs can be classified into types I-IV, and with the development of magnetic resonance imaging technology and the increase in the understanding of concomitant injuries of fractures, a new classification system has been proposed. The treatment modalities for different fracture types and concomitant injuries are different, and the type of internal fixation material to be used for the same type of fracture is also controversial. Based on this, this article reviews three aspects of fracture diagnosis and classification, associated injuries, and treatment, taking into account the new research advances on TSFs in recent years.

AIM: To evaluate the changes in corneal epithelial thickness(CET)and corneal optical density(CD)after smart pulse technology(SPT)-assisted transepithelial photorefractive keratectomy(TPRK)and analyze their correlation.METHODS: The prospective study included 60 patients(120 eyes)with myopia and myopic astigmatism who underwent SPT-TPRK in the ophthalmology department at the First Affiliated Hospital of Xinxiang Medical University between February and August 2023. Changes in CET and CD were evaluated preoperatively and at 1 wk, 1 and 3 mo postoperatively.RESULTS: A total of 14 cases(28 eyes)were lost to follow-up, and 3 patients(6 eyes)with postoperative haze were excluded from this study, resulting in a final inclusion of 43 patients(86 eyes). At 1 wk after SPT-TPRK, CET had statistically significantly thickened compared to preoperative levels(P<0.05), particularly in the CET at 0-2 mm central corneal area(P<0.05). At 1 mo after SPT-TPRK, the CET at 0-2 mm area had statistically significantly decreased(P<0.05). At 3 mo after SPT-TPRK, the CET at 0-2 mm had essentially reached preoperative levels. Postoperative CD values increased, with a positive correlation between CET in the 0-2 mm area and CD in the whole 0-2 mm area(r=0.256, P<0.05), and a positive correlation between CET in the 2-5 mm area and CD in the anterior 2-6 mm area(r=0.319, P<0.05).CONCLUSION: Corneal epithelial remodeling takes 3 mo in areas within 2 mm of the central cornea; areas with thinner CET have faster postoperative corneal epithelial remodeling and greater thickening in the early postoperative period; CD increases in the early postoperative period compared to the preoperative value, and in some areas, there is a positive correlation between CET and CD value.

Objective::To evaluate the feasibility, safety, and effectiveness of a novel edge-to-edge mitral valve repair system (the NovoClasp system) in patients with severe mitral regurgitation.Methods::In this prospective, single-arm, first-in-human study conducted at Beijing Anzhen Hospital, data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system. The study candidates were patients exhibiting a mitral regurgitation severity of 3+ or more and were at high-risk or contraindicated for surgical intervention. Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes. Other safety and efficacy outcomes were prospectively assessed at device implantation, discharge, and 30 d, 6 months, and 12 months post-procedure.Results::Between October 1, 2021, and January 31, 2022, 11 patients were treated for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the NovoClasp system. All patients had a baseline New York Heart Association functional class of III-IV, with 7/11 exhibiting complex mitral valve disease. All patients achieved the primary endpoints of technical and device success, with a post-operative 30-d mitral regurgitation grade reduction to 2+ or lower, which was maintained at 12 months. One patient had minor bleeding and hematoma at the access site before discharge, and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge. No additional cases of death, adverse cerebral or cardiovascular events, or device-related complications was observed during the follow-up.Conclusion::This study suggested the potential feasibility and safety of the NovoClasp system, showing a promising technical and device success rate, along with a decrease in mitral regurgitation severity. A further pivotal study is needed to assess the procedural and long-term outcomes.

Objective:To investigate the effects of carnosine(CAR)on the spatial learning and memory abilities of rats with vascular cognitive impairment(VCI),and to explore the roles of the Akt/mTOR pathway and autophagy in this process.Methods:Fifty male Sprague-Dawley(SD)rats were randomly divided into sham-operated(Sham)group,VCI group,VCI+CAR-L group,VCI+CAR-M group,and VCI+CAR-H group.The spatial learning and memory abilities of rats were evaluated by the Morris water maze experiment;Nissl staining was used to detect the damage in the hippocampal CA1 region;the nitroblue tetrazolium and thiobarbituric acid methods were used to measure the activities of superoxide dismutase(SOD)and malondialdehyde(MDA)content in hippocampal tissue;Western Blot was performed to determine the expression of p-Akt,p-mTOR,Beclin-1,and LC3B proteins,and immunofluorescent staining was con-ducted to detect changes in LC3B expression in the CA1 region.SH-SY5Y cells were divided into control group,oxy-gen-glucose deprivation/reperfusion(OGD/R)group,OGD/R+rapamycin(RAPA),OGD/R+CAR(1.2 mmol/L)group,and OGD/R+CAR+RAPA group.Methyl thiazolyl tetrazolium assay was used to detect neuronal survival rate;Western Blot was used to detect the levels of p-mTOR,Beclin-1,and LC3B in neuronal cells;immunofluorescent stai-ning was performed to assess the degree of autophagy.Results:CAR could improve the learning and memory abilities of VCI rats,reduce hippocampal tissue cell damage,and inhibit oxidative stress(P＜0.01).CAR increased the expres-sion of p-Akt,p-mTOR,and p62 proteins(P＜0.01 or P＜0.05)and decreased the expression of Beclin-1 and the ra-tio of LC3B Ⅱ/Ⅰ(P＜0.01 or P＜0.05).CAR significantly increased the survival rate of SH-SY5Y cells after OGD/R(P＜0.01)and inhibited autophagy in hippocampal neurons.Furthermore,the intervention with RAPA counteracted the therapeutic effect of CAR,reduced the survival rate of SH-SY5Y groups(P＜0.01),and enhanced autophagy.Conclusion:CAR can improve rat VCI injury,and its mechanism may involve inhibiting oxidative stress,activating the Akt/mTOR signaling pathway in neuronal cells,and thereby inhibiting excessive autophagy to exert a protective effect.

Objective::To evaluate the feasibility, safety, and effectiveness of a novel edge-to-edge mitral valve repair system (the NovoClasp system) in patients with severe mitral regurgitation.Methods::In this prospective, single-arm, first-in-human study conducted at Beijing Anzhen Hospital, data were collected from patients undergoing transcatheter edge-to-edge repair using the NovoClasp system. The study candidates were patients exhibiting a mitral regurgitation severity of 3+ or more and were at high-risk or contraindicated for surgical intervention. Technical success and device success according to the Mitral Valve Academic Research Consortium definitions were used as primary outcomes. Other safety and efficacy outcomes were prospectively assessed at device implantation, discharge, and 30 d, 6 months, and 12 months post-procedure.Results::Between October 1, 2021, and January 31, 2022, 11 patients were treated for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the NovoClasp system. All patients had a baseline New York Heart Association functional class of III-IV, with 7/11 exhibiting complex mitral valve disease. All patients achieved the primary endpoints of technical and device success, with a post-operative 30-d mitral regurgitation grade reduction to 2+ or lower, which was maintained at 12 months. One patient had minor bleeding and hematoma at the access site before discharge, and 2 patients were readmitted due to fast atrial fibrillation within 12 months post-discharge. No additional cases of death, adverse cerebral or cardiovascular events, or device-related complications was observed during the follow-up.Conclusion::This study suggested the potential feasibility and safety of the NovoClasp system, showing a promising technical and device success rate, along with a decrease in mitral regurgitation severity. A further pivotal study is needed to assess the procedural and long-term outcomes.

OBJECTIVE: To explore early effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of migrated lumbar intervertebral disc herniation. METHODS: A retrospective analysis was conducted on 87 patients with migrated lumbar intervertebral disc herniation, who were treated with UBE technique between May 2021 and December 2022 and met the selection criteria. There were 55 males and 32 females, with an average age of 48.8 years (range, 29-74 years). The disease duration ranged from 2 to 23 months, with an average of 9.1 months. The surgical segments included 17 cases of L _{3, 4}, 32 cases of L _{4, 5}, and 38 cases of L ₅, S ₁. According to Lee's classification criteria, there were 12 cases of type 1, 17 cases of type 2, 37 cases of type 3, and 21 cases of type 4. The operation time, length of hospital stay, and complications were recorded. The visual analogue scale (VAS) score was used to assess the degree of low back and leg pain before operaion and at 3 days, 3 months, 6 months, and 12 months after operation. The Oswestry disability index (ODI) was used to evaluate the lumbar spine function. At last follow-up, the modified MacNab criteria was used to evaluate the effectiveness. According to the preoperative migrated intervertebral disc classification, the patients were allocated into groups Ⅰ to Ⅳ. The differences in VAS score and ODI were compared. RESULTS: All 87 patients successfully completed the operations. There was no nerve root injury, dural sac injury, or dural tear during operation. The operation time was (58.6±14.6) minutes and the length of hospital stay was (4.0±0.8) days. All incisions healed by first intention after operation. No symptomatic epidural hematoma occurred. All patients were followed up for 12 months. There were significant differences in VAS scores and ODI at each time point after operation when compared with those before operation ( P<0.05). There were significant differences in VAS score at 3 days after operation when compared with that at 3, 6, and 12 months after operation ( P<0.05). For ODI, except that there was no significant difference between 6 and 12 months after operation ( P>0.05), there were significant differences between other time points after operation ( P<0.05). At last follow-up, the effectiveness was rated as excellent in 66 cases, good in 13 cases, and fair in 8 cases according to the modified MacNab criteria, and the excellent and good rate was 90.8%. There was no intervertebral disc herniation recurred during follow-up period. There was no significant difference in VAS score and ODI among groups Ⅰ -Ⅳ before operation and at each time point after operation ( P>0.05). CONCLUSION The UBE technique is safe and effective in the treatment of migrated lumbar intervertebral disc herniation, with a low complication rate and satisfactory early effectiveness.
Humans ; Intervertebral Disc Displacement/surgery* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Adult ; Endoscopy/methods* ; Treatment Outcome ; Aged ; Pain Measurement ; Magnetic Resonance Imaging ; Operative Time

Hypertriglyceridemia-associated acute pancreatitis is an inflammatory disorder of exocrine pancreas caused by metabolism disturbances of triglyceride-rich lipoproteins.Currently,hypertriglyceridemia-associated acute pancreatitis is characterized by an escalating incidence rate,a tendency for more severe cases,and a lack of therapeutic drugs.Traditional Chinese medicine has distinct advantages in treating this disease,but its theoretical framework has not yet been established.Hypertriglyceridemia-associated acute pancreatitis manifests itself as a febrile disease,aberrant accumulation of fat and turbidity may stem from dietary imbalances and visceral dysfunction in ordinary individuals.The prolonged accumulation of fat and turbidity can transform into turbid pathogen,subsequently engendering heat,constituting a pivotal pathogenic factor.Throughout the progression of the disease,the fiery pathogen consumes the fat and turbidity,resulting in the generation of toxic heat,which is a crucial mechanism in the exacerbation of the disease severity.Thus,this article posits therapeutic principles aimed at averting the transformation of fat and turbidity into turbid pathogen and counteracting toxic heat in this disease.This article reviews two key theories from traditional Chinese medicine classics relevant to hypertriglyceridemia-associated acute pancreatitis:the theory of fat-turbidity associated with hypertriglyceridemia and the febrile disease related to acute pancreatitis.Combining these traditional theories with modern research on the mechanisms that intensify hypertriglyceridemia-associated acute pancreatitis and the corresponding targets of traditional Chinese medicine,it suggests that the pathogenesis of"fat-turbidity-toxic heat"serves as the theoretical basis of traditional Chinese medicine for the aggravated severity of hypertriglyceridemia-associated acute pancreatitis.The article aims to offer new insights for the treatment of hypertriglyceridemia-associated acute pancreatitis.