Objective:To investigate the relationship between lifestyle factors and stroke in the elderly.Methods:Data were obtained from a natural cohort of the Multimodal Intervention to Delay Dementia and Disability in Rural China(MIND-China)study.A total of 5 009 participants aged 60 years and above were enrolled, of whom 954(19.05%)had experienced a stroke.Logistic regression analyses were conducted to assess the association between five lifestyle factors(smoking, drinking, physical exercise, social activity and sleep quality)and the incidence of stroke.Results:In model 1, after adjusting for age, sex and education, only social activity( OR=0.783, 95% CI: 0.668-0.917)and good sleep quality( OR=0.731, 95% CI: 0.621-0.860)emerged as protective factors against stroke(both P<0.05).No statistically significant associations were found between other lifestyle factors and stroke.Analysis of a variety of healthy lifestyle practice combinations showed that having 3( OR=0.639, 95% CI: 0.433-0.944), 4( OR=0.620, 95% CI: 0.409-0.941)and 5( OR=0.397, 95% CI: 0.197-0.799)healthy lifestyle practices were protective factors against stroke(all P<0.05).In model 2, after adjusting for age, sex, education, body mass index, diabetes, hyperlipidemia, hypertension, and the APOE genotype, the results were consistent with those of Model 1. Conclusions:Lifestyle factors are significantly associated with the risk of stroke in the elderly population.The healthier lifestyle practices are adopted, the lower the risk of stroke will be.

Alzheimer disease(AD)is a common neurodegenerative disease characterized by cognitive decline and is the most common cause of dementia in the elderly.At present,the pathogenesis of AD remains unclear,and there is still a lack of effective treatment methods for etiologies.Apolipoprotein E(APOE)is currently the only risk gene recog-nized for AD,and the ApoE protein encoded by ApoE plays an important role in the pathological processes of AD,such as amyloid β-protein deposition,excessive phosphorylation of tau protein,and neuroinflammatory reaction.This article re-views the structure and function of ApoE and its role in the pathological processes of AD,in order to provide ideas and di-rections for finding new intervention targets for AD.

Objective:To summarize and analyze the modalities and experience of retrograde distal perfusion with distal perfusion catheter (DPC) via cannulation of the posterior tibial artery in veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods:The clinical data of 15 patients who were treated with V-A ECMO and underwent DPC placement via the posterior tibial artery in our hospital from January 2022 to June 2023 were retrospectively analyzed.Results:The V-A ECMO catheterization method in 15 patients was percutaneous puncture catheterization, and all of them underwent surgical incision to indwelling retrograde DPC through the posterior tibial artery: 6 cases of preventive catheterization, 9 cases of remedial catheterization, the success rate of one-time catheterization was 93.33%, and the type of catheter was mainly 6 F sheath (66.67%). There was no ALI in preventive catheterization, and one case of osteofascial compartment syndrome occurred in remedial catheterization, and the catheterization time was (20.73 ± 3.47) min.Conclusions:In V-A ECMO, placement of DPC via the posterior tibial artery for retrograde distal perfusion is perfectly feasible, and has a high success rate, which can prevent or treat lower extremity ischemia.

Cerebral small vessel disease （CSVD） is a series of clinical， imaging， and pathological syndromes mainly caused by small vessel lesions， and it often has an insidious onset， diverse manifestations， and a low rate of early identification， which are the common reasons for gradual progression to cognitive impairment. It is worth noting that CSVD-related cognitive impairment is not limited to vascular cognitive impairment， and it can also involve other neurodegenerative diseases such as Alzheimer disease and Parkinson disease dementia. Therefore， precise identification， early diagnosis， and intervention are of great importance in controlling the development and damage of CSVD-related cognitive impairment. Given the complex pathological mechanisms and classifications of CSVD and the fact that the association between CSVD and the progression of cognitive impairment cannot be neglected， this article provides a comprehensive understanding of the etiology， pathogenesis， pathology， and imaging subtypes of CSVD and reviews the association between CSVD and various cognitive impairment diseases， so as to provide a reference for the clinical multimodal evaluation， prevention， and treatment of CSVD-related cognitive impairment.

As a prescription for tonifying kidney yang， Youguiwan accords with the pathogenesis of osteoarthritis. Professor LIU Yuan-lu from the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine found that modified Youguiwan had a significant effect on the clinical conservative treatment of osteoarthritis pain with Chinese medicine. There are teams studying the mechanism of Youguiwan in the treatment of osteoarthritis in China， but the profound study of the compound needs the mechanism of each component as support. Youguiwan contains 10 kinds of Chinese medicine， including Rehmanniae Radix Praeparata， Aconiti Lateralis Radix Praeparata， Cinnamomi Cortex， Dioscoreae Rhizoma， Corni Fructus， Cuscutae Semen， Angelicae Sinensis Radix， Eucommiae Cortex， Cervi Cornus Colla， and Lycii Fructus. With more and more attention to the study of Chinese medicine monomer， the amount of related research in this field is increasing. Therefore， it is of great significance to summarize the mechanism of Youguiwan in the treatment of osteoarthritis. Based on the sovereign， minister， assistant， and guide of Chinese medicine in Youguiwan， this paper used China National Knowledge Infrastructure （CNKI）， Pharmacopoeia of the People's Republic of China （2020 edition Vol. 1）， and ChemicalBook platform to understand the active components of each kind of Chinese medicine， and used PubMed to search. The latest research progress of effective monomers that had an intersection with the mechanism of osteoarthritis was summarized， and there were five pharmacological effects including anti-inflammation， pain inhibition， chondrocyte apoptosis， oxidative stress， and extracellular matrix degradation， involving several signaling pathways. The theory of sovereign， minister， assistant， and guide and the molecular mechanism were integrated and discussed， respectively， and finally， they were combined with traditional Chinese medicine theory， providing theoretical references for further study in this direction.

Objective:To explore the relationship between constitutional types of Chinese medicine and Alzheimer's disease (AD) and to construct an early warning model for AD risk.Methods:In the established multimodal interventions to delay dementia and disability in rural China (MIND-China) study, 4 033 elderly subjects aged ≥60 years old were included. The data including demographic, underlying disease and neuropsychological data were collected.The Chinese medicine service record form for the elderly was used to assess constitutional types of Chinese medicine and to apply the NIA-AA diagnostic criteria published by the National Institute on Aging and the Alzheimer's Association in 2011 for the diagnosis of clinically likely AD. Logistic regression analysis and AD risk prediction models were constructed using R statistical software, and the final prediction results were presented using columnar plots.Results:The MIND-China cohort was dominated by the abnormal constitution (69.28%), of which Phlegm-wetness type was the most common (58.05%), followed by Yang-deficiency type (23.85%). The most constitutional type of Chinese medicine among AD patients was Phlegm-wetness type (54.35%), followed by Qi-depression type (38.04%). Multi-factorial logistic regression analysis suggested that increasing age ( β=0.101, P<0.001, OR=1.107, 95% CI=1.069-1.146) and Qi-depression type ( β=0.622, P=0.016, OR=1.862, 95% CI=1.116-3.076) were able to increase the risk of developing AD, while education ( β=-1.047, P<0.001, OR=0.351, 95% CI=0.205-0.584) was able to reduce the risk of developing AD. By using the risk score model to calculate the total risk score for each subject and plotting the receiver operating characteristic curve (ROC), the area under the ROC was 0.769 and the calibration curve showed excellent consistency between prediction and reality. Conclusion:Older adults with Qi-depression type are significantly associated with an increased likelihood of AD.

Alzheimer's disease (AD) is the most common cause of dementia. With population aging, AD has become one of the urgent public health problems worldwide. The retina as a " window" to the brain dysfunction. Studies based on optical coherence tomography/ optical coherence tomography angiography(OCT/OCTA) imaging technology have shown that retinal vascular and structure were significantly changed in patients with clinical and preclinical AD. The changes of retinal vascular and structure were also significantly correlated with cognitive scores, cerebral degeneration, and the decline of cognitive function. These findings suggest that ocular structure and vascular changes based on OCT/OCTA imaging can provide non-invasive, inexpensive and practical biomarkers for early diagnosis of AD. This article reviews the research status and limitations of retinal structure and vascular changes in AD based on OCT/OCTA, in order to provide new ideas and methods for early dingnosis of AD.

In recent years, cerebral small vessel disease (CSVD) has brought great challenges to society and family, and has attracted increasing attention. Early detection and prevention of CSVD is of great significance. Retinal microvasculature is the only terminal blood vessel that can be observed in vivo and can be used as a portal for observation of brain small vessel-related diseases. In this paper, pathophysiology, quantitative and qualitative analysis were used to review the correlation between fundus lesions and CSVD, and further explore the future research direction.

Objective:To investigate the cognitive status of the elderly in rural areas and explore the characteristics and influencing factors of subjective cognitive decline (SCD).Methods:A baseline survey was conducted among 5 765 rural elderly people aged 60 years old or above from March to September 2018.Subjective cognitive decline questionnaire(SCD-Q9), mini-mental state examination(MMSE), verbal fluency test (VFT), Chinese auditory verbal learning test (CAVLT), digital span test(DST)and activities of daily living(ADL)were used in the survey.The result of the survey indicated that there were 2 654 subjects with SCD (SCD group) and 1 008 subjects with normal cognitive function (NC group). Social support rating scale (SSRS) and short version of geriatric depression scale-15(GDS-15) were used to evaluate their psychosocial status.Descriptive analysis and Logistic regression analysis were conducted by SPSS 26.0 software.Results:(1) Compared with NC group, the SCD group had the following characteristics: delayed recognition rate(8.25 ±2.51), (12.38 ±2.53), reverse digit span (2.63±1.37), (3.69±1.45), social support (69.81±8.71), (64.40±9.44), GDS-15 (2.27±2.63), (1.31±2.17), and the differences were statistically significant (all P<0.05). However, there were no significant differences in the following characteristics: MMSE score (21.62±5.73), (21.47±5.84), speech fluency (27.80±7.35), (28.25±7.56), ADL score (20.70±1.35), (20.77±1.30), all P>0.05.(2) There were no significant differences in diet structure, blood glucose, blood lipid, cerebrovascular disease, diabetes, epilepsy and coronary heart disease between SCD group and NC group (all P>0.05). (3)SCD was mainly affected by age( β=0.06, OR=2.29, 95% CI=1.09-4.85), depression( β=-0.01, OR=2.96, 95% CI=0.68-4.94), hypertension( β=-0.17, OR=1.89, 95% CI=1.11-2.15), and low level of social support( β=2.07, OR=1.49, 95% CI=1.32-2.12) (all P<0.05). Conclusion:The scores of delayed recognition and reverse digit span in patients with SCD are lower than those with normal cognitive function.The other objective cognitive functions are basically normal.Old age, low social support level, depression, low education level and hypertension are the risk factors of SCD.

Objective:To explore the impact of social support on cognitive function and depression in patients with mild cognitive impairment (MCI).Methods:From March to September 2018, 5 765 subjects over 60 years old from 52 villages in Yanlou Town, Yanggu County were selected and they were screened by mini-mental state examination (MMSE) and activities of daily living(ADL). Finally 4 750 valid questionnaires were recovered.According to the " Diagnostic and Statistical Manual of Mental Disorders" 4th Edition (DSM-Ⅳ), 733 patients with MCI (patient group) and 3 662 patients with normal cognitive function (healthy control group) were diagnosed.The social support rating scale (SSRS) and geriatric depression scale-15 (GDS-15) were used to evaluate the patients.SPSS 26.0 software was used for independent sample t-test, chi-square test, Pearson correlation analysis and linear regression analysis. Results:The total score of social support (48.55±9.72), objective social support (16.49±4.00), subjective social support (24.28±4.75) and social support utilization (7.78±2.85) in patients group were significantly lower than those in the healthy control group (total score of social support (50.94±7.66), objective social support (17.23±3.42), subjective social support (25.59±3.61) and social support utilization (8.13±2.71)). The differences were statistically significant ( t=-6.291, -4.363, -8.245, -3.068, all P<0.05) .All the dimensions of social support(total score, objective support, subjective support, support utilization) were positively correlated with cognitive function ( r=0.084, 0.062, 0.128, 0.011, all P<0.05), and negatively correlated with depression score ( r=-0.240, -0.195, -0.200, -0.169, all P<0.01). Subjective social support, objective social support and social support utilization could positively predict MMSE score of MCI patients( β=0.190, 0.007, 0.029, all P<0.05), while could negatively predict the GDS-15 score of MCI patients( β=-0.145, -0.098, -0.105, all P<0.05). Conclusion:Good social support is a protective factor for cognitive function and depression in MCI patients.