Objective: To investigate intratympanic steroid injection for treatment of sudden sensorineural hearing loss after failure of initial systemic therapy,and discuss the role of steroid in refractory sudden sensorineural hearing loss.Method:We included 90 patients who did not response to initial systemic therapy of sudden hearing loss.This research adopted the randomized,controlled trial of clinical research.Ninety qualified patients were divided into 3 groups,30 for each group,intratympanic budesonide for experimental group,dexamethasone for control group-1 while control group-2 did not take intratympanic steroid injection but continue another round of systemic therapy.Intratympanic injection was performed 3 times a week and last for 2 weeks.Alprostadil,mecobalamin,ginkgo biloba extract injection,PNS injection and intravenous hyperbaric oxygen fluid were used for consecutive 10 days in the control group-2.Pure tone audiometry and speech Discrimination Score was retaken at the end of each therapy.Result:The results show that the average PTA of damaged frequencies improved more than 10 dB was considered significant,we had 26.7%(8/30) patients meet this criteria in experiment group,30.0%(9/30) in the control group-1 and 6.7%(2/30) in the control group-2.And the recovery rate between these 3 groups is statistically significant(P<0.05),the average PTA improvement in the experimental group,control group-1 and control-2 was(5.0±11.1)dB,(4.2±12.5)dB and (0±3.33)dB respectively,P<0.05,control group-2 was significantly different from control group-1 and experimental group.The Speech Discrimination Score improvement rates in the experimental group,control group-1 and control-2 was 16.7%,12.0% and 4.2% respectively,but the difference in those 3 groups was not significant.Conclusion: Budesonide intratympanic injection is a save method in treating refractory sudden hearing loss ,and it is as effective as dexamethasone.Intratympanic steroids could be an option for refractory sudden sensorineural hearing loss patients.

To evaluate the clinical efficacy of Panax notoginseng extract combined with alprostadil in the treatment of arteriosclerosis occlusion and investigate its effects on the degree of atherosclerosis. CNKI, Wanfang, VIP journal database, Chinese biomedical literature database(CBM), PubMed, the Cochrane Library and Science Citation Index(SCI) database were searched between inception to December 2017 for relevant studies. Two researchers independently screened and extracted the literature in strict accordance with the inclusion criteria and exclusion criteria. The bias risk assessment method recommended by Cochrane was used to evaluate the bias risk and extract data, and then Review Manager 5.3 was used for Meta analysis. 10 RCTs involving a total of 1 032 cases were included in the study. Analysis results showed that the P. notoginseng extract combined with alprostadil had higher clinical efficacy than alprostadil alone in the treatment of arteriosclerosis occlusion disorder, with statistically significant difference(OR=6.39, 95%CI[3.97, 10.30], P<0.000 01); the atherosclerosis was obviously improved, including ankle brachial index(ABI) (MD=0.08, 95%CI[0.04, 0.13], P=0.000 3), toe brachial index(TBI) (MD=0.09, 95%CI[0.05, 0.12], P<0.000 01), and maximum walking distance(WD) (MD=471.62, 95%CI[383.54, 559.70], P<0.000 01). Studies have shown that P. notoginseng extract combined with the conventional treatment had significantly improved clinical efficacy in the treatment of arteriosclerosis occlusion, and could improve the atherosclerosis degree of lower extremities. However, the quality of the included literature was not high, in addition, due to the small number of included literature as well as bias and low-quality bias in some of the literature, more high quality RCTs are still needed to further verify the clinical effect of P. notoginseng extract in the treatment of arteriosclerosis occlusion.

Aim - to study the state of the microcirculatory bed and the endothelial system in patients at risk of developing reperfusion syndrome and suggest methods for their correction. The work included 29 patients with obliterating diseases of the abdominal aorta and lower limb arteries with a high risk of developing reperfusion complications. Two groups of patients were identified. Group I - 8 patients, preoperative preparation include the generally accepted approaches. Group II - 21 patients whose preoperative preparation included, in addition to preparations for improving rheological blood conditions, prolonged epidural anesthesia, intravenous injection of hydroxyethylstarches, korvetin and alprostadil. In patients of both groups, a study was made of the state of the level of endothelial dysfunction, changes in capillary blood flow and arterio-venular blood shunting. Revascularization of the lower limbs in patients with a high risk of developing reperfusion complications leads to a deepening of endothelial dysfunction. The latter is characterized by a 2.3-fold increase (p<0.001) in the early postoperative period of circulating endothelial cells in the blood, by 2.5 times (p <0.001) endothelin-1, while a 1.3-fold decrease (p<0,05) P-selectin and in 1,7 times (p<0,05) E-selectin. The depth of the lesion of the endothelial system is indicated by a decrease of 29.9 % (p<0.001) in the level of NO. Deepening of endothelial dysfunction after reconstructive-reconstructive surgery is reflected in violations of the function of the microcirculatory bed. It is characterized by a 1.9-fold decrease (p<0.001) of skin perfusion, 2.0 times (p<0.001) in the erythrocyte concentration index and a 14% decrease (p<0.05) in capillary blood flow. This is facilitated by an increase of 14% (p<0.05) in skin perfusion pressure and an increase of 16% (p<0.05) in the resistance index of the microcirculatory bed, which leads to a decrease in tissue oxygenation to a level 3.38±0.14 mm.hg.

Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.