Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

OBJECTIVE To investigate the effect of individualized repositioning maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo(PC-BPPV)with limited neck movement.METHODS There were 163 patients with PC-BPPV admitted to the Department of Otolaryngology of Xiaolan People's Hospital of Zhongshan from January,2019 to July,2022 who were selected and divided into observation group(57 cases)and control group(106 cases)according to whether there was neck movement limitation or not.The control group was divided into control group 1(51 cases)and control group 2(55 cases)based on different reduction methods.The control group 1 were treated with modified Epley maneuver,and the observation group and the control group 2 were treated with individualized Epley maneuver.The cure rate and effective rate were compared among the three groups.The scores of vestibular symptom index(VSI),Berg balance scale(BBS)and the dimension scores of vertigo handicap inventory(DHI)were compared among the three groups before and after treatment.RESULTS There was no significant difference in the cure rate(84.37%vs.81.82%vs.80.70%)and effective rate(11.76%vs.10.91%vs.12.28%)among the three groups(P>0.05).After treatment,the scores of each dimension of VSI and DHI of PC-BPPV patients of the three groups decreased(P<0.01),and the scores of BBS increased(P<0.01),and there was no statistically significant difference in the scores of VSI(23.19±3.88 vs.23.70±4.01 vs.23.46±3.92),BBS(45.56±5.02 vs.45.14±4.98 vs.44.84±5.11)and each dimension of DHI among the three groups(P>0.05),respectively.CONCLUSION The individual Epley maneuver can effectively improve the vertigo status of patients with PC-BPPV with limited neck movement.

Objective To investigate the safety and feasibility of peripheral vascular intervention via the ipsilateral transulnar access(TUA)due to failure of transradial access(TRA)puncture.Methods The clinical data of 2546 peripheral vascular interventions via TRA,which were performed at authors'hospital between January 2019 and December 2021,were retrospectively analyzed.Among the 2546 interventions,TRA puncture failed in 37 procedures,and in 27 of these patients the ipsilateral TUA puncture had to be adopted.The puncture success rate,surgical success rate and puncture approach-related complications of TUA of the 27 patients receiving ipsilateral TUA puncture were analyzed.Results The success rate of ipsilateral TUA puncture after TRA puncture failed was 96.3％(26/27),and in one patient transfemoral access(TFA)puncture had to be substituted because of the ulnar artery spasm.The total success rate of interventional procedures was 96.3％(26/27).No serious complications occurred,and the incidence of minor complications was 19.2％(5/26).Conclusion Preliminary results indicate that for the experienced TRA operators,using ipsilateral TUA puncture due to failure of TRA puncture is a safe and feasible strategy choice.

Objective:To analyze the differences in paraspinal muscles between patients with degenerative lumbar spinal stenosis (DLSS) with or without spondylolisthesis and to assess the correlation between these differences and lumbar facet joint degeneration.Methods:The data of 68 patients with DLSS who underwent surgical treatment in our hospital from January 2021 to April 2023 was retrospectively analyzed. Of these, 22 were male (32.4%) and 46 were female (67.6%), with an average age of 69.7±5.9 years (range: 56-80 years). The DLSS group included 35 patients without spondylolisthesis [13 males (37.1%) and 22 females (62.9%)], average age 68.5±5.9 years (range: 56-80 years), while the DLSS+degenerative spondylolisthesis (DS) group included 33 patients with spondylolisthesis [9 males (27.3%) and 24 females (72.7%)], average age 70.9±5.7 years (range: 58-80 years). Magnetic resonance imaging (MRI) scans of the L 3-S 1 intervertebral disc levels were collected from all patients. Using ImageJ software, the cross-sectional area (CSA) and percentage of fat infiltration area (FIA%) of the erector spinae and multifidus muscles were measured. Additionally, the facet joint angle (FJA), facet overhang (FO), and facet effusion (FE) were evaluated using Surgimap software, and their correlation with CSA and FIA% of the paraspinal muscles was analyzed. Results:The FJA and FO in the DLSS+DS group (50.16°±11.08° and 7.67±2.25 mm) were significantly larger than those in the DLSS group (43.51°± 7.75° and 3.88±1.98 mm) ( P<0.05). However, differences in FE between the two groups were not statistically significant. The cross-sectional areas of the multifidus muscles at L 3, 4, L 4, 5, and L 5S 1 in the DLSS+DS group (576.66±112.70 mm 2,, 782.72±141.49 mm 2, and 817.88±185.22 mm 2,, respectively) were significantly smaller than those in the DLSS group (647.37±165.44 mm 2,, 881.20±202.10 mm 2,, and 995.06±211.25 mm 2,, respectively) ( P<0.05). The FIA% of the erector spinae at L 3, 4, L 4, 5, and L 5S 1 in the DLSS+DS group (11.47%±5.14%, 14.84%±6.15%, 20.82%±7.41%) were significantly higher than those in the DLSS group (6.27%±2.83%, 10.81%±4.84%, 16.17%±5.88%) ( P<0.05). Similarly, the FIA% of the multifidus muscles at L 3, 4, L 4, 5, and L 5S 1 in the DLSS+DS group (18.04%±5.88%, 19.67%±5.78%, 19.31%±8.61%) were significantly higher than those in the DLSS group (9.85%±4.39%, 12.27%±3.70%, 14.65%±3.82%) ( P<0.05). No statistically significant differences were found in the CSA of the erector spinae at these levels between the two groups. The CSA of the multifidus muscles at L 3, 4, L 4, 5, and L 5S 1 in both groups were negatively correlated with FJA and FO ( r=-0.318, P=0.008; r=-0.381, P=0.001; r=-0.439, P<0.001; r=-0.290, P=0.016; r=-0.315, P=0.009; r=-0.479, P<0.001). The FIA% of the erector spinae at L 3, 4, L 4, 5, and the multifidus muscles at L 4, 5 and L 5S 1 were positively correlated with FJA ( r=0.352, P=0.003; r=0.344, P=0.004; r=0.300, P=0.013; r=0.359, P=0.003). Additionally, the FIA% of the erector spinae at L 3, 4, L 4, 5, and L 5S 1, and the multifidus muscles at L 3, 4 and L 4, 5 were positively correlated with FO ( r=0.409, P=0.001; r=0.248, P=0.042; r=0.277, P=0.022; r=0.500, P<0.001; r=0.447, P<0.001). There was no correlation between FE and CSA or FIA% of the erector spinae and multifidus muscles at L 3, 4, L 4, 5, and L 5S 1 in either group. Furthermore, FJA was positively correlated with FO ( r=0.369, P=0.002), but no correlation was observed between FE and FJA or FO. Conclusion:Compared to patients with lumbar spinal stenosis, those with degenerative lumbar spinal stenosis with spondylolisthesis exhibit more severe paraspinal muscle atrophy, a more sagittal orientation of the facet joints, and a higher degree of facet joint osteoarthritis. Patients with larger FJA and FO show more severe paraspinal muscle atrophy.

Objective:To explore the challenges in the implementation of drug centralized volume-based procurement policies in hospitals and propose corresponding optimization suggestions.Methods:From August to December 2023, a purposive sampling was conducted to select 11 pharmaceutical experts from tertiary hospitals in China for Delphi method. The survey content included " policy recommendations for promoting the acceleration and expansion of national drug centralized procurement and retaining surplus medical insurance funds for centralized procurement" .Results:Survey participants gave feedback on a set of existing problems found in the implementation of drug centralized procurement policies and proposed corresponding optimization methods. Kendall′s W coefficient of the specialist consultation was 0.332( P<0.05), demonstrating good consistency and concentration of the expert opinions. Among the problems, the score of drug supply guarantee was the highest(mean value of importance was 4.45). At the same time, the recommendation of strengthening monitoring and early warning, coordination and dispatch, and effectively ensuring the supply of centralized drug procurement had the highest score and concentration(mean value of importance was 4.91, coefficient of variation was 0.06). Conclusions:Through Delphi method, this study revealed issues and optimization methods in the implementation of drug centralized procurement policies in hospitals. The findings could provide valuable insights for improvements in the pharmaceutical sector and future policy adjustments.

BACKGROUND: Classical guided bone regeneration (GBR) treatments can achieve favorable clinical results for ridge defects. However, extensive bone augmentation in the non-esthetic area in the posterior region for minor ridge defects is unnecessary. Therefore, this study used a collagen and Platelet-rich fibrin (PRF) mixture for bone augmentation on minor posterior ridge defects and evaluated the effects. METHODS: 22 Seibert Class I ridge defects were treated with BC and covered with a PRF membrane (simplified guided bone regeneration, simplified GBR) and other 22 were treated with Bio-Oss and covered with Bio-Gide (classical GBR). Cone-beam computed tomography imaging was conducted 6 months post-surgery to compare the ridge’s horizontal width (HW) and buccal ridge’s horizontal width to assess the osteogenic effect. In addition, the buccal ridge contour morphology was studied and classified. RESULTS: The buccal ridge contour of simplified GBR was Type A in 14 cases, Type B in 7 cases, and Type C in 1 case and it of classical GBR was Type A in 11 cases, Type B in 8 cases, and Type C in 3 cases. The mean HW significantly increased by 1.50 mm of simplified GBR treatment, while it increased by 1.83 mm in classical GBR treatment. CONCLUSION The combined use of BC and PRF had a significant effect on bone augmentation and this treatment exhibited promising clinical results for correcting posterior Seibert Class I ridge defects. The morphological classification of the reconstructive effect in this study can be utilized in future clinical work.

Objective:Rosin alcohol two glycosidase (pinores inoldiglucoside, PDG) effect on the improvement of the osteoporosis in mice and the possible mechanism of action.Methods:A mouse model of osteoporosis was established by removing bilateral ovaries. According to the random number table method, 50 mice were divided into model (MOD) group (equal volume of normal saline), positive control (PC) group (0.2 mg/kg estradiol), PDG-low dose (L) group (5 mg/kg) PDG), PDG-high dose (H) group (10 mg/kg PDG by gavage) and PDG-H+ML385 group (10 mg/kg PDG by gavage after intramuscular injection of 30 mg·kg-1 ML385), 10 mice in each group; Another 10 mice without any ovarian treatment were selected as sham group (intragastric administration of the same amount of normal saline). After 3 weeks of drug intervention, the serum alkaline phosphatase (ALP), tartrate resistant acid phosphatase (TRAP), interleukin-6 (IL-6) and tumor necrosis factor were detected by enzyme-linked immunosorbent assay (ELISA) -α (TNF-α). The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by dual energy X-ray. The mRNA and protein expression levels of nuclear factor related factor 2 (Nrf2), oxidase heme oxygenase 1 (HO-1), quinone oxidoreductase 1 (NQO1) were detected by real-time fluorescence quantitative PCR (qRT-PCR) and Western blot, respectively.Results:The serum ALP levels in Sham, MOD, PC, PDG-L, PDG-H and PDG-H + ML385 groups were (25.88±3.42), (47.42±5.32), (36.20±3.37), (38.95±3.24), (29.66±2.64), (39.57±2.06) U/dL, respectively; The serum trap levels were (2.18±0.40), (4.69±0.83), (3.58±0.38), (3.67± 0.48), (2.93±0.26), (3.81±0.49) U/L, respectively; BMD (153.04±12.96), (86.25±6.71), (126.53±8.99), (119.77±8.84), (139.18±15.94), (92.09±4.17) mg/cm 2; The expression levels of Nrf2 mRNA were 1.00±0.00, 0.35±0.04, 0.67±0.05, 0.54±0.03, 0.82±0.08 and 0.48±0.04, respectively; The expression levels of HO-1 mRNA were 1.00±0.00, 0.25±0.03, 0.56±0.03, 0.47± 0.03, 0.71±0.04 and 0.37±0.04, respectively; The expression levels of nqo1mrna were 1.00±0.00, 0.38± 0.02, 0.63±0.03, 0.58±0.04, 0.79±0.05 and 0.44±0.03, respectively; Nrf2 protein expression levels were 0.98±0.08, 0.26±0.04, 0.52 ±0.06, 0.46±0.03, 0.86±0.07, 0.45±0.05. HO-1 protein expression levels were 0.39±0.02, 0.09±0.01, 0.15 ±0.03, 0.17±0.03, 0.26±0.03, 0.12±0.02. NQO1 protein expression levels were 0.53±0.03, 0.21±0.02, 0.38±0.04, 0.29±0.02, 0.55±0.03, 0.24±0.04, respectively; The levels of serum IL-6 were (104.25±11.35), (515.38±74.48), (351.78± 65.12), (364.73±36.64), (246.18±17.52), (408.93±32.56) pg/ml, respectively; The levels of serum TNF-α were (33.79±3.55), (170.11±19.24), (76.09±8.99), (84.95±6.12), (66.98±3.73), (119.04±9.75) pg/mL, respectively; The serum SOD levels were (258.47±19.25), (72.15±8.12), (187.60±14.63), (152.61±12.36), (204.22±19.65), (138.01±13.62) U/mL, respectively; The serum MDA levels were (2.02±0.27), (4.75±0.73), (3.19±0.46), (3.7±0.49), (2.91±0.42), (4.10 ±0.25) μmol/L respectively. There were significant differences between MOD group and Sham group, or PC, PDG-L, PDG-H, PDG-H+ML385 group and MOD group,or PDG-H+ML385 group and PDG-H ( P<0.05) . Conclusion:PDG can reduce bone inflammation and oxidative stress by activating Nrf2 pathway and improve the state of osteoporosis.

Objective:To examine the early and mid-term results of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) in the treatment of diffuse coronary artery stenosis.Methods:The clinical data and follow-up results of 248 patients who underwent CE+CABG surgery from January 2010 to January 2019 at Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 201 males and 47 females, aged (65.6±8.5) years (range: 43 to 79 years). The on-pump group included 156 patients and the off-pump group included 92 patients. CABG was performed after CE. CE was performed on 248 patients who represented 269 target coronary lesions, of which 108 were located on the left anterior descending artery and sub-branches, 140 were located on the right coronary artery and sub-branches, and 21 were located on the left circumflex artery and obtuse marginal artery. A total of 872 bypass grafts were performed, including 248 left internal thoracic arteries, 48 radial arteries, and 576 great saphenous veins, with (3.5±0.8) grafts (range:2 to 6 grafts) per patient.The grafts had satisfactory bridge blood flow after CE, with the graft flow rates of (26±8) ml/min (range: 13 to 59 ml/min) and the pulsatility index value of 3.1±0.8 (range: 2.0 to 6.7). The t test and χ 2 test was used to compare the surgical results and graft patency rate between patients in on-pump and off-pump group, respectively. Results:The number of graft vessels of on-pump group and off-pump group was 3.6±0.9 and 3.2±0.7, respectively( t=1.637, P=0.085). There were 3 deaths during the perioperative period, with a mortality rate of 1.2%. Two people died of renal failure, and one case was due to postoperative refractory low cardiac output. Perioperative myocardial infarction occurred in 9 cases. The follow-up time was (41.8±21.4) months (range:1 to 68 months). The all graft patency rate was 78.4%(812/232) in 1 year and 69.8%(162/232) in 3 years postoperatively. The left coronary graft patency rate was significantly higher than the right coronary graft patency rate(1-year: 87.4% vs.73.1%, χ2=6.533, P=0.011, 3-year: 78.2% vs. 64.8%, χ2=4.588, P=0.032). There was no significant difference in graft patency rates between the on-pump group and off-pump group (1-year: 80.0% vs. 76.9%, χ2=0.277, P=0.599, 3-year:71.5% vs. 67.9%, χ2=0.300, P=0.584). Conclusions:CE+CABG is a safe and feasible technique for patients with diffuse coronary artery disease to get more satisfied complete revascularization, with good early and medium-term results and graft patency rates. The outcomes of on-pump or off-pump CE+CABG are similar.

Objective:To examine the early and mid-term results of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) in the treatment of diffuse coronary artery stenosis.Methods:The clinical data and follow-up results of 248 patients who underwent CE+CABG surgery from January 2010 to January 2019 at Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 201 males and 47 females, aged (65.6±8.5) years (range: 43 to 79 years). The on-pump group included 156 patients and the off-pump group included 92 patients. CABG was performed after CE. CE was performed on 248 patients who represented 269 target coronary lesions, of which 108 were located on the left anterior descending artery and sub-branches, 140 were located on the right coronary artery and sub-branches, and 21 were located on the left circumflex artery and obtuse marginal artery. A total of 872 bypass grafts were performed, including 248 left internal thoracic arteries, 48 radial arteries, and 576 great saphenous veins, with (3.5±0.8) grafts (range:2 to 6 grafts) per patient.The grafts had satisfactory bridge blood flow after CE, with the graft flow rates of (26±8) ml/min (range: 13 to 59 ml/min) and the pulsatility index value of 3.1±0.8 (range: 2.0 to 6.7). The t test and χ 2 test was used to compare the surgical results and graft patency rate between patients in on-pump and off-pump group, respectively. Results:The number of graft vessels of on-pump group and off-pump group was 3.6±0.9 and 3.2±0.7, respectively( t=1.637, P=0.085). There were 3 deaths during the perioperative period, with a mortality rate of 1.2%. Two people died of renal failure, and one case was due to postoperative refractory low cardiac output. Perioperative myocardial infarction occurred in 9 cases. The follow-up time was (41.8±21.4) months (range:1 to 68 months). The all graft patency rate was 78.4%(812/232) in 1 year and 69.8%(162/232) in 3 years postoperatively. The left coronary graft patency rate was significantly higher than the right coronary graft patency rate(1-year: 87.4% vs.73.1%, χ2=6.533, P=0.011, 3-year: 78.2% vs. 64.8%, χ2=4.588, P=0.032). There was no significant difference in graft patency rates between the on-pump group and off-pump group (1-year: 80.0% vs. 76.9%, χ2=0.277, P=0.599, 3-year:71.5% vs. 67.9%, χ2=0.300, P=0.584). Conclusions:CE+CABG is a safe and feasible technique for patients with diffuse coronary artery disease to get more satisfied complete revascularization, with good early and medium-term results and graft patency rates. The outcomes of on-pump or off-pump CE+CABG are similar.

OBJECTIVEThe research regarding the central mechanism of acupuncture (arrival of ) based on functional magnetic resonance imaging (fMRI) in recent 10 years was analyzed to summarize existing research achievements and experience.

METHODSThe literature regarding fMRI-based research published from January of 2007 through December of 2016 in CNKI and PubMed databases was collected. The research content and methods, including research design, inclusion criteria, acupoint selection and evaluation, were analyzed.

RESULTSTotally 18 articles regarding the central mechanism of acupuncture based on fMRI was included. According to research content, the literature was divided into two categories: research and sensation research. In research, the differences of and not on brain functional activity were compared to summarize the central response pattern of ; in sensation research, the differences of different sensations and intensities of on central response were compared to explore the effects of different sensations and intensities of on brain functional activity. In recent 10 years, the number of research gradually increased, and the type of design was various, mainly RCT and paired design. The majority of participants was healthy people, and single acupoint was the focus of researches, including Zusanli (ST 36), Waiguan (TE 5), Hegu (LI 4), etc. The evaluation of was based on visual analogue scale (VAS). The research contents were mainly the effects of and not and different sensations on brain function activities. The present studies confirmed that and not as well as different sensations had different impacts on brain functional effects, and different acupoints had specific activated brain areas. There was a positive correlation between the degree of and the intensity of the activation of brain regions. Furthermore, tingling sensation was not included to sensations.

CONCLUSIONThe number and quality of fMRI-based research need to be improved; the research content is simple, and research method is in exploratory stage. The results obtained in the literature are the phenomena of in the central level, and it is imperative to summarize the essential link between and the central effect through these phenomena to reveal the mechanism of . The specific impact of for brain function needs more clinical exploration.