Objective The volume and cortical thickness of gray matter in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO) were compared and analyzed by voxel⁃based morphometry (VBM) and surface⁃based morphometry (SBM), and the differences in the structural changes of gray matter in the two diseases were discussed. Methods A total of 21 MS patients, 16 NMO patients and 19 healthy controls were scanned by routine MRI sequence. The data were processed and analyzed by VBM and SBM method based on the statistical parameter tool SPM12 of Matlab2014a platform and the small tool CAT12 under SPM12. Results Compared with the normal control group (NC), after Gaussian random field (GRF) correction, the gray matter volume in MS group was significantly reduced in left superior occipital, left cuneus, left calcarine, left precuneus, left postcentral, left central paracentral lobule, right cuneus, left middle frontal, left superior frontal and left superior medial frontal (P<0. 05). After family wise error (FWE) correction, the thickness of left paracentral, left superiorfrontal and left precuneus cortex in MS group was significantly reduced (P<0. 05). Compared with the NC group, after GRF correction, the gray matter volume in the left postcentral, left precentral, left inferior parietal, right precentral and right middle frontal in NMO group was significantly increased (P<0. 05). In NMO group, the volume of gray matter in left middle occipital, left superior occipital, left inferior temporal, right middle occipital, left superior frontal orbital, right middle cingulum, left anterior cingulum, right angular and left precuneus were significantly decreased (P<0. 05). Brain regions showed no significant differences in cortical thickness between NMO groups after FWE correction. Compared with the NMO group, after GRF correction, the gray matter volume in the right fusiform and right middle frontal in MS group was increased significantly(P<0. 05). In MS group, the gray matter volume of left thalamus, left pallidum, left precentral, left middle frontal, left middle temporal, right pallidum, left inferior parietal and right superior parietal were significantly decreased (P<0. 05). After FWE correction, the thickness of left inferiorparietal, left superiorparietal, left supramarginal, left paracentral, left superiorfrontal and left precuneus cortex in MS group decreased significantly (P<0. 05). Conclusion The atrophy of brain gray matter structure in MS patients mainly involves the left parietal region, while NMO patients are not sensitive to the change of brain gray matter structure. The significant difference in brain gray matter volume between MS patients and NMO patients is mainly located in the deep cerebral nucleus mass.

Background An association between atmospheric fine particulate matter (PM_2.5) exposure and Parkinson's disease (PD) has been suggested by previous studies, but the results of current epidemiological studies are still inconclusive. Objective To systematically evaluate the relationship between exposure to ambient PM_2.5 and the risk of PD, as well as to explore potential influencing factors, aiming to provide scientific evidence for formulating early prevention strategies for PD. Methods Cochrane Library, PubMed, Web of Science, Medline, Embase, China National Know-ledge Infrastructure (CNKI), Wanfang Database, and VIP Chinese Science and Technology Journal Database were queried. The search terms included Parkinson's disease, particulate matter 2.5, and PM_2.5 in both Chinese and English. Cohort studies examining the association between atmospheric PM_2.5 exposure and the risk of PD were collected and searched from the inception of each database to June 26, 2023. The identified literature was screened, and the basic information of the included studies and their research subjects, outcome indicators, quantitative results of each study, as well as the information required by bias risk assessment were extracted. The Newcastle-Ottawa Scale was employed to assess the risk of literature bias. Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias analysis were conducted in Stata 15.0 software. Results Twelve cohort studies were identified. A total of 17443136 participants with follow-up periods ranging from 3.5 to 22 years were included in the analysis. The meta-analysis, utilizing a random-effects model, revealed that PD risk was elevated by 6% after exposure to PM_2.5 [HR=1.06 (95%CI: 1.02, 1.11), P=0.006]. The subgroup analysis demonstrated that exposure to PM_2.5 increased PD risk by 6% in North America [HR=1.06 (95%CI: 1.00, 1.12), P=0.033] and by 17% in East Asia [HR=1.17 (95%CI: 1.02, 1.33), P=0.020]. However, the effect was not statistically significant in Europe. PD risk exhibited a 7% rise [HR=1.07 (95%CI: 1.02, 1.14), P=0.011] in individuals aged 60 years and older, which was different from that in individuals younger than 60 years. Exposure to various concentrations of PM_2.5 was observed to associate with an elevated risk of PD. The inclusion of adjustments for PD-related comorbidities did not alter the conclusion that ambient PM_2.5 exposure might elevate the risk of PD. The studies with a follow-up duration exceeding 5 years and reporting more than 1000 PD cases suggested a significant increase in the risk of PD due to ambient PM_2.5 exposure [HR=1.06 (95%CI: 1.01, 1.12), P=0.012; HR=1.06 (95%CI: 1.01, 1.11), P=0.027, respectively]. Conversely, no significant association was identified between ambient PM_2.5 exposure and the risk of PD within the cohorts with a follow-up duration of less than 5 years and reporting fewer than 1000 PD cases [HR=1.09 (95%CI: 0.95, 1.26), P=0.214; HR=1.12 (95%CI: 0.98, 1.02), P=0.092, respectively]. The sensitivity analysis showed that the results were stable. The publication bias analysis and the combined trim-and-fill method showed that the results were robust. Conclusion The risk of PD could be increased by ambient PM_2.5 exposure and influenced by age and area. The research results might be affected by the duration of follow-up and the quantity of PD cases reported.

AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg

Objective To explore the effect of taking silicone oil at different time points in intestinal preparation.Methods A total of 330 patients who underwent colonoscopy at the First Affiliated Hospital of Wenzhou Medical University from January to December 2022 were selected as the study subjects.The patients were divided into three groups according to random number method,namely,A,B,and C,with 110 patients in each group.Group A patients received silicone oil 1 hour before colonoscopy,Group B received silicone oil 2 hours before colonoscopy,and Group C received silicone oil 4 hours before colonoscopy.Compare the score of air bubbles in the intestinal lumen,the amount of saline irrigation,and the satisfaction of the surgeon in the operation among the three groups of patients.Results There were statistically significant differences among the three groups in the content of air bubbles in the intestinal lumen,the amount of saline irrigation,and the satisfaction of the surgeon with the procedure(P<0.05).But group B has the best results.Conclusion Oral administration of silicone oil 2 hours before colonoscopy can significantly reduce air bubbles in the intestinal lumen,improve the clarity of the observation field of colonoscopy,and improve the satisfaction of the operating physician.

Objective To compare anesthetic effects between erector spinae plane block(ESPB)and intercostal nerve block(ICNB)in thoracoscopic lung wedge resection guided by surgical pleth index(SPI).Methods A total of 46 patients who underwent thoracoscopic lung wedge resection in Wenzhou People's Hospital from July 2020 to June 2022 were selected and divided into ICNB group and ESPB group according to random number table method,with 23 cases in each group.Remifentanil infusion rate,propofol dosage and intraoperative vital signs were compared between two groups.Results The intraoperative remifentanil infusion rate in ESPB group was significantly lower than that in ICNB group(P<0.05).There was no significant difference in intraoperative propofol dosage between two groups(P>0.05).The SPI,bispectral index and mean arterial pressure in ESPB group during lung wedge resection were significantly lower than those in ICNB group(P<0.05).There was no significant difference in heart rate between two groups(P>0.05).Conclusion Under the guidance of SPI,patients undergoing thoracoscopic lung wedge resection with preoperative ESPB had low opioid consumption and stable vital signs.

Objective To study the effect of PDCA cycle on the image quality of oral photography in patients with periodontal disease.Methods Totally 94 patients with periodontal disease admitted to our hospital from February to July 2022 were selected.47 patients who took oral photography images from February to April 2022 were included in the control group,and 47 patients who took oral photography images from May to July 2022 were included in the PDCA group.At the same time,9 nursing staff in the periodontal department of our hospital were selected.The patients in the control group were taken conventional photography,PDCA group used PDCA cycle on the basis of the control group.The image quality of the two groups of patients with periodontal disease and their satisfaction with the oral photography process were compared.The deduction of points for photography technology of nursing staff before and after the implementation of PDCA cycle were compared.Results The rate of reaching the standard of image quality in PDCA group was significantly higher than that in the control group(P<0.05).The satisfaction of PDCA group with oral photography was significantly higher than that of the control group(P<0.05).After the implementation of PDCA cycle,the deduction of points of material preparation,frontal,lateral,lingual,maxillofacial,maxillofacial,photography time and photography technology of nursing staff were significantly lower than those before the implementation(P<0.05).Conclusion PDCA circulation can effectively improve the rate of reaching the standard of oral photography image quality of patients with periodontal disease,increase their satisfaction with the photography process,and improve the nursing staff's photography technology score.

Objective To explore the predictive value of slow apparent diffusion coefficient(ADCslow),fast apparent diffusion coefficient(ADCfast)and perfusion fraction(f)value of intravoxel incoherent motion in body diffusion-weighted imaging(IVIM-DWI)sequence in early lumbar disc degeneration in young people.Methods The IVIM-DWI technique was used as quantitative magnetic resonance imaging for 120 patients(596 lumbar intervertebral discs)with lower back pain included in Wenzhou People's Hospital.The ADCslow,ADCfast and f values of all lumbar intervertebral discs were measured,and then they were divided into 3 groups according to the Pfirrmann grading standard.SPSS 20.0 statistical software was used to analyze the data.Results The ADCfast value has statistical significance in distinguishing the lumbar intervertebral discs of each group:The area under the curve(AUC)of the normal group vs.the early degenerative group was 0.766,with a sensitivity of 64.2%and a specificity of 78.5%;The AUC of the normal group vs.the mid to late stage degenerative group was 0.822,with a sensitivity of 67.9%and a specificity of 91.3%;The AUC of the early degeneration group vs.the middle and late stage degeneration group was 0.797,with a sensitivity of 62.1%and a specificity of 92.1%.The ADCslow value has statistical significance in distinguishing the lumbar intervertebral discs of each group:AUC=0.707 in the normal group vs.the early degenerative group,with a sensitivity of 83.6%and a specificity of 61.0%;The AUC of the normal group vs.the mid to late stage degenerative group was 0.701,with a sensitivity of 84.5%and a specificity of 58.6%;The AUC of the early degeneration group vs.the middle and late stage degeneration group was 0.668,with a sensitivity of 86.6%and a specificity of 51.0%.The f value cannot distinguish between different groups of lumbar intervertebral discs.Conclusion ADCslow and ADCfast of IVIM-DWI sequence have certain accuracy and specificity in distinguishing the early degeneration of lumbar intervertebral disc in young people,which provides a reliable basis for early clinical treatment.