Objective To investigate the application value of full-length lower extremity CT scans performed at different noise index(NI)in terms of image quality and radiation dose for robot-assisted total knee arthroplasty(RTKA).Methods Eighty patients who underwent RTKA were selected and randomly divided into four groups based on different NI:NI=8,NI=18,NI=28,and NI=38.Subjective scores were assigned to the full-length lower extremity CT images and the three-dimensional skeletal models generated by volume rendering(VR)post-processing.Objective evaluations were performed using three indicators:dose length product(DLP),volume CT dose index(CTDIvol),and hip-knee-ankle angle(HKA).The application value of full-length lower extremity CT scans in RTKA was analyzed.Results(1)As the NI value increased,the subjective scores of thin-slice images decreased.Images with NI between 8 and 18 met the imaging diagnostic standards,while those with NI higher than 18 were unacceptable.(2)As the NI value increased,all VR skeletal models met the acceptance criteria for RTKA.(3)As the NI value increased,DLP and CTDIvol gradually decreased,with statistically significant differences(P<0.05),However,in the comparison between the NI=28 and NI=38 groups,the difference was not statistically significant(P>0.05).Conclusion Performing full-length lower extremity CT scans with an NI of 28 not only meets the preoperative planning requirements for RTKA but also minimizes the radiation dose.

Objective To investigate the application value of full-length lower extremity CT scans performed at different noise index(NI)in terms of image quality and radiation dose for robot-assisted total knee arthroplasty(RTKA).Methods Eighty patients who underwent RTKA were selected and randomly divided into four groups based on different NI:NI=8,NI=18,NI=28,and NI=38.Subjective scores were assigned to the full-length lower extremity CT images and the three-dimensional skeletal models generated by volume rendering(VR)post-processing.Objective evaluations were performed using three indicators:dose length product(DLP),volume CT dose index(CTDIvol),and hip-knee-ankle angle(HKA).The application value of full-length lower extremity CT scans in RTKA was analyzed.Results(1)As the NI value increased,the subjective scores of thin-slice images decreased.Images with NI between 8 and 18 met the imaging diagnostic standards,while those with NI higher than 18 were unacceptable.(2)As the NI value increased,all VR skeletal models met the acceptance criteria for RTKA.(3)As the NI value increased,DLP and CTDIvol gradually decreased,with statistically significant differences(P<0.05),However,in the comparison between the NI=28 and NI=38 groups,the difference was not statistically significant(P>0.05).Conclusion Performing full-length lower extremity CT scans with an NI of 28 not only meets the preoperative planning requirements for RTKA but also minimizes the radiation dose.

Hereditary spastic paraplegia type 58 is rare, caused by pathogenic variations in KIF1C gene. Here, a case diagnosed in Qilu Hospital, Shandong University, was reported. The 15-year-old female suffered tremor in bilateral upper limbs which was aggravated gradually since age 8. Cerebellar ataxia, positive pyramidal tract sign and dystonic tremor were prominent on physical examination. The brain magnetic resonance imaging showed T 2-hyperintense signals in bilateral pyramidal tracts, optic radiations and superior cerebellar peduncles, with mild cerebellar atrophy. Whole exon sequencing revealed the unreported homozygous c.425_426delTG (p.V142Gfs*10) mutation which was presumed pathogenic.

Objective:To investigate the early- and mid-term clinical, functional and radiographic outcomes of patellofemoral arthroplasty (PFA).Methods:A retrospective analysis was conducted in 64 patients (80 knees) who suffered from severe patellofemoral osteoarthritis (PFOA) and underwent PFA from January 2013 to December 2020. These patients were aged 60.50±8.82 (range from 27 to 82) years, including 9 males (12 knees) and 55 females (68 knees). All enrolled individuals presented typical PFOA. Unilateral PFA was performed in 48 cases, bilateral PFA in 16 cases, including one-stage PFA in 9 cases and two-stage PFA in 7 cases. The visual analogue scale (VAS), Hospital for Special Surgery (HSS) knee score and Oxford knee score (OKS) of patients with more than 5 years' follow-up were assessed to evaluate the clinical effects of PFA at the time before surgery, 1 year and 5 years after surgery. In addition, the patellar tilt angle (PTA) and hip-knee-ankle (HKA) angle were measured and analyzed to evaluate the improvement of patellar tracking and progression of tibiofemoral osteoarthritis, based on axial X-ray imaging (skyline view) of knee and the full length standing X-ray imaging of the lower limbs at before surgery and 5 years after surgery. Meanwhile, the complications of all patients that related to the operation were recorded.Results:A total of 64 patients were followed up for 4.31±1.79 (range, 1.5 to 8.2) years. Twenty-five patients (32 knees) who followed up more than 5 years were analyzed. The VAS, HSS and OKS improved from 5.91±0.82, 68.06±6.03 and 21.22±3.46 preoperatively to 0.88±1.01, 90.09±3.30 and 39.06±3.37 at 1 year after surgery, and to 0.41±0.76, 94.53±2.99 and 42.13±3.17 at 5 years after surgery, respectively ( F=89.38, 81.47, 56.73, P<0.001). Additionally, comparing to the preoperative radiological data, the patellar tract was improved with the PTA decreased from 8.21°±3.14° preoperatively to 3.58°±4.48°at 5 years after surgery ( t=4.96, P<0.001). The HKA angle changed from 179.01°±1.43° preoperatively to 178.77°±1.67° at 5 years follow up ( t=1.71, P=0.096). There was no case of prosthesis loosening or wear and no case of obvious progression of tibiofemoral osteoarthritis that needed revision in all patients. Conclusion:Satisfied early- and mid-term clinical outcomes could be achieved by PFA in treating severe PFOA patients. PFA could relieve pain and improve function of knee joint.

To investigate the inhibitory effect of sildenafil on Caco-2 cell proliferation and its anti-inflammatory effect on menadione-induced NCM460 cell inflammation model, MTT assay was used to determine cell proliferation. Intracellular reactive oxygen species(ROS)and nitric oxide(NO)levels were detected by fluorescent probe. Western blot was used to detect the expression of eNOS/ERK/JNK pathway related proteins in Caco-2 cells and correlated inflammatory cytokines in NCM460 cells. The effect of sildenafil on the growth of two probiotics was determined by spectrophotometry. Results showed that sildenafil signi-ficantly inhibited the proliferation of Caco-2 cells and enhanced the expression levels of eNOS, p-eNOS, p-JNK1/2 and p-ERK1/2 proteins in Caco-2 cells; while after adding NG-nitro-L-arginine methyl ester(L-NAME), the expression levels of eNOS, p-eNOS, p-JNK1/2 and p-ERK1/2 proteins were significantly lower than those of the sildenafil group. Compared with the menadione group, sildenafil significantly reduced ROS levels in NCM460 cells and inhibited the expression levels of IL-6, IL-1β, p62, and TNF-α. Moreover, high concentrations of sildenafil had no obvious toxic effects on Lactobacillus casei and Lactobacillus rhamnosus. Thus, the results indicated that sildenafil could effectively inhibit the intestinal inflammatory response without affecting the balance of the intestinal flora, and prevent colorectal cancer by reducing the oxidative stress responses in the intestinal cells.

Objective:To investigate the correlation between mild cognitive impairment(MCI)and sleep disorder in the elderly.Methods:A total of 220 elderly patients in our hospital from March 2018 to April 2020 were enrolled in this study, including 65 single amnestic patients, 97 multiple amnestic patients and 58 non-amnestic patients.The Pittsburgh Sleep Quality Index (PSQI)and Epworth sleepiness scale(ESS)were used to evaluate subjective sleep patterns.The quality of sleep were monitored and analyzed through polysomnography.The Spearman univariate correlation between MCI and sleep disorder was analyzed.Results:The average PSQI score of 220 patients was(17.1±3.9)points.The Spearman univariate correlation analysis showed the following results.(1)In the single amnestic group, MCI was positively correlated with the sleep quality, sleep time, daytime dysfunction, total PSQI score, arousal index and ESS score( rs=0.356, 0.324, 0.351, 0.412, 0.361 and 0.327, respectively, all P<0.05). (2)In the multiple amnestic group, MCI was positively correlated with the sleep quality, sleep time, sleep disorder score, hypnotic drug score, total PSQI score, arousal index, light sleep period and ESS score( rs=0.283, 0.323, 0.346, 0.401, 0.379, 0.412, 0.228, 0.251, all P<0.05). (3)In the non-amnestic group, MCI was positively correlated with the sleep time, hypnotic drug score, total score of PSQI, REM sleep disorder and light sleep period( rs=0.348, 0.307, 0.391, 0.355 and 0.228, all P<0.05). Conclusions:There are correlations between the MCI types and sleep disorders in the elderly, and different MCI types are associated with different factors on sleep disorder.

This report presents an 84 year-old patient admitted into our hospital for dizziness with a history of Hashimoto's thyroiditis,chronic gastritis and vitiligo.Physical examinations showed skin depigmentation.Laboratory tests revealed anemia,positive intrinsic factor antibodies and normal adrenal function.This patient was finally diagnosed with autoimmune polyglandular syndromes(APS) type Ⅲ B +C.Recurrent anemia was mainly attributed to malabsorption caused by autoimmune gastritis.This article reviews the common clinical manifestations of APS,in order to call for geriatricians' attention to APS.APS Ⅲ B+C should be considered if vitiligo combined with anemia occurs in elderly patients.

Alzheimer's disease (AD)is most common in all dementia types in the elderly.Various researches have been done for studying its pathogenesis,but no single mechanism can explain all its pathological changes.AD is currently incurable and no effective treatment measures are available.So it is of prime importance to prevent the occurrence of AD.In the process of exploring the pathogenesis and treatment of AD,more and more attention is being paid to the role of diet and nutrition in the occurrence and development of AD.Mediterranean diet(MeDi)has been proved to have an unvarying role in the occurrence and development of Alzheimer's disease.This paper reviewed the relevant literatures and summarized the role of MeDi in AD,in order to provide the theoretical supports for dietary intervention and nutritional therapy in AD treatment.

Objective To investigate the influence of the different degree of internal carotid stenosis on the white matter lesion and cognition of Binswanger disease.Methods A total of 108 elderly patients with Binswanger disease from Department of Geriatric Neurology of Qilu Hospital were recruited during December 2013 and June 2014.At the end of follow-up,6 cases showed acute eerebrovaseular disease,39 (＜ 10 ％) had no internal carotid stenosis,31 (10 ％-49 ％) had mild internal carotid stenosis,32 (50％-70％)had moderate internal carotid stenosis through B ultrasound examination and MRI and MRA examination on internal carotid artery and brain.The B ultrasound examination of internal carotid artery included intima-media thickness (IMT),plaque index and the peak systolic velocity (PSV).Cognitive function of Binswagner disease was assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA).The white matter lesion was assessed by reformed visual Scheltens scale.The relationship among IMT,plaque index,PSV,white matter lesion,and cognitive function was investigated.The variation of cognition was observed after 1 year.Results There were statistically significant differences in IMT,PSV,plaque index,reformed Scheltens scale scores between groups of non,mild,moderate internal carotid stenosis (all P ＜0.05).The IMT was thicker in moderate internal carotid stenosis group than in mild internal carotid stenosis group (P＜0.05).The differences in PSV,plaque index,and reformed Scheltens scale scores between mild and moderate internal carotid stenosis groups were not significant (P＞0.05).There were positive correlation between PSV and reformed Scheltens scale scores (r=0.630,P =0.020).There were negative correlation between PSV and MMSE scores (r=-0.970,P=0.040).The scores of MMSE and MOCA both were declined after 1 year in three groups (0.61 ± 0.60,0.68 ± 0.81),(0.70±0.60,0.93±0.69),(1.06±0.68,1.13±0.76).The declination of MMSE and MOCA of BD patients was higher in moderate internal carotid stenosis group than in non internal carotid stenosis group (P＜0.05).The differences in the declination of MMSE and MOCA between moderate and mild internal carotid stenosis groups were not significant (P＞ 0.05).Conclusions Internal carotid stenosis is one of risk factors for the cognitive impairment of BD,the abnormal IMT and PSV are both correlated with white matter lesion and cognitive impairment in BD.Early standardized therapy can postpone the rate of cognitive impairment in BD.