Clinical Observation of Shenxie Zhitong Capsule in Treating Diabetic Peripheral Neuropathy of Stagnant Blockade of Collaterals / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of Shenxie Zhitong capsule in the treatment of diabetic peripheral neuropathy（DPN） of stagnant blockade of collaterals， and evaluate its effectiveness and safety. Method:The 104 patients were randomly divided into the Shenxie Zhitong capsule treatment group （the treatment group， 53 patients） and the alpha lipoic acid group （control group， 51 patients）， and two groups were compared by random and contrast test. The changes of the Toronto clinical scoring system （TCSS）， utah early neuropathy scores （UENS）， traditional Chinese medicine（TCM）syndrome scores， visual analysis scale （VAS）， ankle brachial index （ABI）， vibrating perception threshold （VPT） before and after treatment were compared between two groups， and the endpoint events， such as foot ulcers， percutaneous coronary intervention （PCI）， death and composite endpoint events， related indicators of glucose and lipid metabolism and safety indicators were recorded among patients. Result:Compared with the data before treatment， the scores of TCSS， UENS， and TCM syndromes in two groups were significantly reduced （<italic>P</italic><0.01） after treatment， and VAS and glycosylated haemoglobin A1c （HbA1c） were significantly reduced （<italic>P</italic><0.05）， during follow-up visit， the levels of right ABI，total cholesterol （TC）， and low-density lipoprotein （LDL） in two groups were significantly reduced （<italic>P</italic><0.05）， and high-density lipoprotein （HDL） level was significantly increased （<italic>P</italic><0.05）. control group in control group， the 2-hour postprandial plasma glucose （2 h PG） and HbA1c levels were significantly increased （<italic>P</italic><0.05）. Compared with control group， the VAS of the treatment group after treatment was significantly reduced （<italic>P</italic><0.05）. After treatment and during follow-up visit， compared with control group， the 2 h PG levels of the right toe in the treatment group were significantly reduced （<italic>P</italic><0.05）. There was no statistically significant difference in endpoint events and safety indicators between two groups， but the incidence trend of composite endpoint events in the treatment group was lower than that in control group. Conclusion:Shenxie Zhitong capsule has definite clinical curative effect in treating diabetic peripheral neuropathy， which is more safe and effective than alpha lipoic acid in improving pain symptoms.

Mechanically assisted intra-arterial thrombolysis in acute cerebral infarction.

The aim of this study was to assess the clinical efficacy and safety of mechanically assisted thrombolysis in the treatment of acute cerebral infarction. Mechanically assisted intra-arterial urokinase thrombolysis was conducted on 28 patients with acute cerebral infarction with a disease onset time of 90-450 min. The maximum level of urokinase was 1,150,000 units. Thrombus disruption with a microwire, retrieval with a microcatheter and stent-assisted revascularization were performed. The recanalization rate, bleeding complications and modified Rankin scale (mRS) score were observed within 3 months of surgery. Our results showed that mechanically assisted thrombolysis was successfully conducted on 23 patients, with a recanalization rate of 82.1% (23/28), average recanalization time of 65.22 min and mRS score ≤3.5. Five cases of recanalization were invalid, including 2 cases of mortality, 1 case with an mRS score of 4 and 2 cases with an mRS score ≤3. In the recanalization group, the mechanically assisted thrombolysis did not increase the number of bleeding complications. Our study demonstrated that the safety of mechanically assisted thrombolysis for the treatment of acute cerebral infarction is equivalent to that of simple intra-arterial thrombolysis, but that the former has a higher efficiency. Mechanically assisted thrombolysis is able to reduce the urokinase dosage and recanalization time, and increase the recanalization rate.

Individualized prostate biopsy strategy for Chinese patients with different prostate-specific antigen levels.

AIM: To evaluate the best individualized prostate biopsy strategies for Chinese patients with suspected prostate cancer. METHODS: The present study included 221 Chinese patients who underwent transrectal ultrasound guided prostate biopsies for the first time. All patients underwent the same 10-core biopsy protocol. In addition to the Hodge sextant technique, four more biopsies were obtained from the base and middle regions of bilateral peripheral zones. The differences between 10-core and sextant strategies in cancer detection among patients with different prostate specific antigen (PSA) levels were evaluated. The relationship between PSA level, number of positive biopsy cores and organ-confined cancer rate in prostate cancer patients was also analyzed. RESULTS: The overall prostate cancer detection rate was 40.7% in the 221 patients. The 10-core strategy increased cancer detection by 6.67% (6/90) in our patients (P < 0.05). The increased cancer detection rates decreased significantly when the patient PSA level increased from 0-20 ng/mL to 20.1-50 ng/mL and > 50 ng/mL (P < 0.01). The number of positive biopsy cores in prostate cancer patients increased significantly with increasing patient PSA level (P < 0.01). The rate of organ-confined prostate cancer decreased significantly with increasing patient PSA level (P < 0.01). CONCLUSION: The extended 10-core strategy is recommended for Chinese patients with PSA = or < 20 ng/mL and the sextant strategy is recommended for those with PSA > 50 ng/mL. For patients with PSA ranging from 20.1 ng/mL to 50 ng/mL, the 10-core strategy should be applied in patients with life expectancy = or > 10 years and the sextant strategy should be applied in those with life expectancy < 10 years.