Objective To analyze the efficacy and safety of different minimally invasive operations[endoscopic re-trogradebiliary drainage(ERBD)、endoscopic nasobiliary drainage(ENBD)、percutaneous transhepatic cholangial drainage(PTCD)] for choledocholithiasis complicated with acute cholangitis to provide reference for clinical treatment retrospectively. Methods A total of 151 patients with choledocholithiasis complicated with acute cholangitis at Department of Emergency Surgery in our hospital from January 2019 to December 2020 were included and divided into four groups based on the four treatment strategies, including non-surgical treatment. Changes in leukocyte count, bilirubin levels, and liver function before and after treatment, as well as postoperative recovery, complication rates, length of hospital stay, and prognosis were compared among patients who underwent different surgical treatments. Results There were significant improvements in leukocyte count, percentage of neutrophils, and liver function of the patients underwent ENBD or ERBD operation (P<0.05). The total bilirubin and direct bilirubin were significantly reduced after ERBD, ENBD, and PTCD operations (P<0.05). Patients undergoing ERBD, ENBD, or PTCD demonstrated faster recovery times, fewer complications, shorter hospital stays, and lower mortality rates compared to those managed conservatively. Conclusions ERBD and ENBD as minimally invasive therapeutic modalities for the management of choledocholithiasis complicated with acute cholangitis, exhibit remarkable clinical efficacy, coupled with a high degree of safety and reliability. These techniques significantly enhance the long-term minimally invasive cure rate, thereby establishing them as the preferred treatment strategies. Tailored to the patient's specific clinical conditions, such as the severity of infection, stone dimensions, and the use of oral anticoagulant therapy, clinicians can formulate individualized minimally invasive treatment strategies, facilitating the optimal attainment of therapeutic objectives.

Objective:To explore the hemodynamic characteristics of the middle cerebral artery (MCA) in atherosclerotic stenosis using four-dimensional flow (4D Flow) MRI, and combining high-resolution magnetic resonance vessel wall imaging (HR VW-MRI) to analyze the relationship between hemodynamics and the degree of stenosis, as well as the morphological characteristics of plaques.Methods:The study was a cross-sectional study. A total of 24 patients with middle cerebral artery(MCA) M1 atherosclerotic stenosis and 10 age and sex matched healthy controls (HC group) were prospectively recruited from September 2018 to March 2021 at Beijing Tiantan Hospital, Capital Medical University. All subjects underwent MRI examination. The hemodynamic of MCA were collected by 4D Flow MRI, and the hemodynamic parameters of proximal and distal MCA stenosis were calculated by blood flow post-processing software, including average blood flow rate (FR avg), average blood flow velocity (V avg), peak blood flow velocity (V pk), time average wall shear stress (TAWSS), minimum wall shear stress (WSS min) and oscillatory shear index (OSI). The differences in hemodynamic parameters among the proximal and distal ends of MCA stenosis and the HC group were compared using one-way ANOVA or Kruskal-Wallis H test. The stenosis rate and characteristics of MCA plaque were analyzed by HR VW-MRI, including remodeling index (RI), normalized wall index (NWI) and plaque length. Pearson or Spearman correlation analysis was used to explore the correlation between stenosis rate and hemodynamic parameters. Taking the stenosis rate as the control variable, partial correlation analysis was used to explore the correlation between plaque morphological characteristics and hemodynamic parameters. Results:There were statistically significant differences in FR avg, V avg, V pk, TAWSS, OSI, WSS min among the proximal and distal stenosis of MCA and HC groups ( P<0.05). The proximal end of the MCA stenosis had significantly higher FR avg, V avg, TAWSS and WSS min than those of the distal end of the stenosis ( P<0.01). The FR avg, V avg, V pk, TAWSS, and WSS min in the distal end of MCA stenosis were lower than those in the HC group, while the OSI was higher than that in the HC group ( P<0.01). The correlation analysis results showed that the MCA proximal V pk ( r=-0.425, P=0.027) and distal V pk ( r=-0.538, P=0.004) were negatively correlated with the diameter stenosis rate. When the stenosis rate was taken as the control factor, in the MCA proximal stenosis, V avg ( r=0.553, P=0.003), TAWSS ( r=0.543, P=0.004) and WSS min ( r=0.547, P=0.004) were positively correlated with RI, proximal OSI was negatively correlated with RI ( r=-0.492, P=0.011), and was positively correlated with the plaque length ( r=0.437, P=0.026). At the distal end of the stenosis, V pk was negatively correlated with NWI ( r=-0.556, P=0.003), OSI was negatively correlated with RI ( r=-0.511, P=0.008), NWI ( r=-0.390, P=0.049). TAWSS was positively correlated with RI ( r=0.393, P=0.047). Conclusions:The 4D Flow MRI demonstrates characteristic hemodynamic changes in the proximal and distal ends of the stenotic MCA. The local hemodynamic characteristics of the stenotic MCA are correlated with plaque morphological parameters, including lumen stenosis, plaque load, and RI. It suggests an interaction between the occurrence and development of MCA plaque and local hemodynamic changes.

BACKGROUND:There is a central sensitization mechanism for lumbar disc herniation-specific pain sensitization,and it is unclear whether cyclic RNAs in the paraventricular nucleus brain region are involved in lumbar disc herniation-specific pain sensitization.OBJECTIVE:To investigate the mechanism by which cyclic RNA circ05188 in the paraventricular nucleus of rats with lumbar disc herniation regulates the participation of microRNAs in pain sensitization.METHODS:Fifty-two Sprague-Dawley rats were randomly divided into a sham operation group,a lumbar disc herniation group,a knockdown control group and a circ05188 knockdown group,with 13 rats in each group.Except for the sham operation group,the lumbar disc herniation model was established in the other three groups.On the 7th day after modeling,the hypothalamic paraventricular nucleus of the knockdown control group and circ05188 knockdown group were injected with siRNA-NC and siRNA-circ05188,respectively,at 1 day intervals,for a total of three injections.On the 7th day after modeling,high-throughput sequencing technology was used to detect the expression of differential circRNAs in the hypothalamic paraventricular nucleus of rats in the sham operation group and the lumbar disc herniation group,and RT-qPCR was used to detect the expression of circ05188 and miR-199a-5p in the hypothalamic paraventricular nucleus.On the 3rd,7th,14th,21st,and 28th days after modeling,we detected the mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot in the modeled side of rats in the sham operation group and the lumbar disc herniation group.On the 3rd day after siRNA injection,immunofluorescence staining was used to detect the expression of c-Fos in the hypothalamic paraventricular nucleus of rats in the knockdown control group and circ05188 knockdown group;RT-qPCR was used to detect the expression of circ05188 and miR-199a-5p in the hypothalamic paraventricular nucleus of rats in the knockdown control group and circ05188 knockdown group;on the 5th day after siRNA injection,mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot were detected in the knockdown control group and circ05188 knockdown group.Bioinformatics analysis and dual luciferase reporter elucidated the underlying molecular mechanism of circ05188 in pain sensitization after lumbar disc herniation.RESULTS AND CONCLUSION:High-throughput sequencing results showed that circRNAs were differentially expressed in the paraventricular nucleus brain region of rats with lumbar disc herniation.The expression of circ05188 was higher in the lumbar disc herniation group than in the sham operation group(P<0.05),the expression of miR-199a-5p was lower than in the sham operation group(P<0.05),and the mechanical and thermal mechanical paw withdrawal thresholds of the hindfoot were lower than those of the sham operation group at 3,7,14,and 21 days after modeling.RT-qPCR results showed that compared with the knockdown control group,the expression of c-Fos and circ05188 was lower in the circ05188 knockdown group(P<0.05),while the expression of miR-199a-5p was higher(P<0.05).The mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot in the circ05188 knockdown group were higher than those in the knockdown control group at 1,2,and 3 days after injection.Bioinformatics analysis and dual luciferase reporter assay results showed that miR-199a-5p had a binding site with circ05188 and circ05188/miR-199a-5p competitive endogenous RNA axis.To conclude,lumbar disc herniation induces an increase in circ05188 expression in the paraventricular nucleus of the hypothalamus,which produces central sensitization through the inhibition of miR-199a-5p and ultimately triggers neuropathic pain.

Objective:To investigate the efficacy of percutaneous vertebroplasty through unilateral transverse process-pedicular for postmenopausal lumbar osteoporotic fractures.Methods:Retrospective analysis included 102 patients with postmenopausal lumbar osteoporotic fracture admitted to Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from Jan. 2023 to Jan. 2024, who were divided into unilateral transverse process-pedicular group (UTPP group, n=48) and unilateral transverse pedicular group (UTP group, n=54) by means of approach. The changes of surgery-related indexes, imaging indexes and postoperative lumbar function recovery of the two groups were observed, and the patients were followed up for 1 year to record the incidence of secondary fracture of injured vertebra, fracture of adjacent vertebra and diffusion of bone cement. Results:The bone cement leakage rate in UTPP group was lower than that in UTP group ( P < 0.05), and there was no statsistically significant difference in operation time, fluoroscopy times, intraoperative blood loss, bone cement injection amount and hospital stay between the two groups ( P > 0.05). Before surgery, 3 months and 6 months after surgery, vertebral anterior margin height, middle vertebral height and sagittal cobb Angle between the two groups showed no significant differences ( P > 0.05). Visual analogue score (VAS) and oswestry disability index (ODI) between the two groups before surgery and 3 months after surgery had no statistically significant differences ( P > 0.05) ; VAS and ODI scores in UTPP group were lower than those in UTP group 6 months after surgery ( P < 0.05). The incidence of secondary fracture in UTPP group was lower than that in UTP group, while the height diffusion rate of bone cement was higher (all P < 0.05). The incidence of adjacent vertebral fracture between the two groups showed no statistically significant difference ( P > 0.05) . Conclusions:In postmenopausal patients with lumbar osteoporotic fractures, percutaneous vertebroplasty through unilateral transverse process-pedicular can effectively reduce the rate of intraoperative bone cement leakage, and has certain advantages in improving postoperative pain, promoting the recovery of postoperative lumbar function and reducing the risk of secondary fractures.

Objective:To explore the hemodynamic characteristics of the middle cerebral artery (MCA) in atherosclerotic stenosis using four-dimensional flow (4D Flow) MRI, and combining high-resolution magnetic resonance vessel wall imaging (HR VW-MRI) to analyze the relationship between hemodynamics and the degree of stenosis, as well as the morphological characteristics of plaques.Methods:The study was a cross-sectional study. A total of 24 patients with middle cerebral artery(MCA) M1 atherosclerotic stenosis and 10 age and sex matched healthy controls (HC group) were prospectively recruited from September 2018 to March 2021 at Beijing Tiantan Hospital, Capital Medical University. All subjects underwent MRI examination. The hemodynamic of MCA were collected by 4D Flow MRI, and the hemodynamic parameters of proximal and distal MCA stenosis were calculated by blood flow post-processing software, including average blood flow rate (FR avg), average blood flow velocity (V avg), peak blood flow velocity (V pk), time average wall shear stress (TAWSS), minimum wall shear stress (WSS min) and oscillatory shear index (OSI). The differences in hemodynamic parameters among the proximal and distal ends of MCA stenosis and the HC group were compared using one-way ANOVA or Kruskal-Wallis H test. The stenosis rate and characteristics of MCA plaque were analyzed by HR VW-MRI, including remodeling index (RI), normalized wall index (NWI) and plaque length. Pearson or Spearman correlation analysis was used to explore the correlation between stenosis rate and hemodynamic parameters. Taking the stenosis rate as the control variable, partial correlation analysis was used to explore the correlation between plaque morphological characteristics and hemodynamic parameters. Results:There were statistically significant differences in FR avg, V avg, V pk, TAWSS, OSI, WSS min among the proximal and distal stenosis of MCA and HC groups ( P<0.05). The proximal end of the MCA stenosis had significantly higher FR avg, V avg, TAWSS and WSS min than those of the distal end of the stenosis ( P<0.01). The FR avg, V avg, V pk, TAWSS, and WSS min in the distal end of MCA stenosis were lower than those in the HC group, while the OSI was higher than that in the HC group ( P<0.01). The correlation analysis results showed that the MCA proximal V pk ( r=-0.425, P=0.027) and distal V pk ( r=-0.538, P=0.004) were negatively correlated with the diameter stenosis rate. When the stenosis rate was taken as the control factor, in the MCA proximal stenosis, V avg ( r=0.553, P=0.003), TAWSS ( r=0.543, P=0.004) and WSS min ( r=0.547, P=0.004) were positively correlated with RI, proximal OSI was negatively correlated with RI ( r=-0.492, P=0.011), and was positively correlated with the plaque length ( r=0.437, P=0.026). At the distal end of the stenosis, V pk was negatively correlated with NWI ( r=-0.556, P=0.003), OSI was negatively correlated with RI ( r=-0.511, P=0.008), NWI ( r=-0.390, P=0.049). TAWSS was positively correlated with RI ( r=0.393, P=0.047). Conclusions:The 4D Flow MRI demonstrates characteristic hemodynamic changes in the proximal and distal ends of the stenotic MCA. The local hemodynamic characteristics of the stenotic MCA are correlated with plaque morphological parameters, including lumen stenosis, plaque load, and RI. It suggests an interaction between the occurrence and development of MCA plaque and local hemodynamic changes.

BACKGROUND:There is a central sensitization mechanism for lumbar disc herniation-specific pain sensitization,and it is unclear whether cyclic RNAs in the paraventricular nucleus brain region are involved in lumbar disc herniation-specific pain sensitization.OBJECTIVE:To investigate the mechanism by which cyclic RNA circ05188 in the paraventricular nucleus of rats with lumbar disc herniation regulates the participation of microRNAs in pain sensitization.METHODS:Fifty-two Sprague-Dawley rats were randomly divided into a sham operation group,a lumbar disc herniation group,a knockdown control group and a circ05188 knockdown group,with 13 rats in each group.Except for the sham operation group,the lumbar disc herniation model was established in the other three groups.On the 7th day after modeling,the hypothalamic paraventricular nucleus of the knockdown control group and circ05188 knockdown group were injected with siRNA-NC and siRNA-circ05188,respectively,at 1 day intervals,for a total of three injections.On the 7th day after modeling,high-throughput sequencing technology was used to detect the expression of differential circRNAs in the hypothalamic paraventricular nucleus of rats in the sham operation group and the lumbar disc herniation group,and RT-qPCR was used to detect the expression of circ05188 and miR-199a-5p in the hypothalamic paraventricular nucleus.On the 3rd,7th,14th,21st,and 28th days after modeling,we detected the mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot in the modeled side of rats in the sham operation group and the lumbar disc herniation group.On the 3rd day after siRNA injection,immunofluorescence staining was used to detect the expression of c-Fos in the hypothalamic paraventricular nucleus of rats in the knockdown control group and circ05188 knockdown group;RT-qPCR was used to detect the expression of circ05188 and miR-199a-5p in the hypothalamic paraventricular nucleus of rats in the knockdown control group and circ05188 knockdown group;on the 5th day after siRNA injection,mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot were detected in the knockdown control group and circ05188 knockdown group.Bioinformatics analysis and dual luciferase reporter elucidated the underlying molecular mechanism of circ05188 in pain sensitization after lumbar disc herniation.RESULTS AND CONCLUSION:High-throughput sequencing results showed that circRNAs were differentially expressed in the paraventricular nucleus brain region of rats with lumbar disc herniation.The expression of circ05188 was higher in the lumbar disc herniation group than in the sham operation group(P<0.05),the expression of miR-199a-5p was lower than in the sham operation group(P<0.05),and the mechanical and thermal mechanical paw withdrawal thresholds of the hindfoot were lower than those of the sham operation group at 3,7,14,and 21 days after modeling.RT-qPCR results showed that compared with the knockdown control group,the expression of c-Fos and circ05188 was lower in the circ05188 knockdown group(P<0.05),while the expression of miR-199a-5p was higher(P<0.05).The mechanical and thermal mechanical paw withdrawal thresholds of the rat's hindfoot in the circ05188 knockdown group were higher than those in the knockdown control group at 1,2,and 3 days after injection.Bioinformatics analysis and dual luciferase reporter assay results showed that miR-199a-5p had a binding site with circ05188 and circ05188/miR-199a-5p competitive endogenous RNA axis.To conclude,lumbar disc herniation induces an increase in circ05188 expression in the paraventricular nucleus of the hypothalamus,which produces central sensitization through the inhibition of miR-199a-5p and ultimately triggers neuropathic pain.

Purpose To explore the characteristics of gray matter(GM)volume changes in migraine patients using 7T MRI and voxel-based morphometry(VBM).Materials and Methods This prospective study enrolled 30 migraine patients and 41 age-and gender-matched healthy controls from Beijing Tiantan Hospital,Capital Medical University between November 2023 and November 2024.All participants underwent 7T MRI with 3D T1-weighted magnetization-prepared two rapid gradient-echo(MP2RAGE)sequences for structural brain imaging.VBM analysis was performed to quantify GM,white matter,cerebrospinal fluid and total brain volumes,followed by calculations of their relative percentages.The difference in GM volume between the two groups was compared to identify brain regions with characteristic GM volume changes in migraine patients.And the correlation between these characteristic GM volume alterations and clinical scales was analyzed.Results Migraine patients exhibited significantly lower total GM volume compared to healthy controls(t=2.096,P=0.040),while no group differences were observed in white matter or cerebrospinal fluid volumes(t=0.980,0.151;P=0.330,0.880).VBM analysis revealed reduced GM volume in the left orbitofrontal cortex(t=4.301,P=0.022),left hippocampus(t=5.226,P=0.006)and left parahippocampal gyrus(t=3.960,P=0.040)in the migraine group.Negative correlations were identified between:left orbitofrontal cortex GM volume and headache duration(r=-0.506,P=0.008),left hippocampal GM volume and patient health questionnaire-9 scores(r=-0.620,P=0.003),and left parahippocampal GM volume and visual analogue scale scores(r=-0.449,P=0.019).Conclusion VBM analysis based on 7T MP2RAGE data demonstrates characteristic GM volume reductions in the left orbitofrontal cortex,left hippocampus and left parahippocampal gyrus in migraine patients,with these structural alterations significantly correlate with depressive symptoms and headache burden.The observed microstructural abnormalities may reflect underlying pathophysiological mechanisms related to pain processing,emotional regulation and long-term disease burden in migraine.

Purpose To explore the characteristics of gray matter(GM)volume changes in migraine patients using 7T MRI and voxel-based morphometry(VBM).Materials and Methods This prospective study enrolled 30 migraine patients and 41 age-and gender-matched healthy controls from Beijing Tiantan Hospital,Capital Medical University between November 2023 and November 2024.All participants underwent 7T MRI with 3D T1-weighted magnetization-prepared two rapid gradient-echo(MP2RAGE)sequences for structural brain imaging.VBM analysis was performed to quantify GM,white matter,cerebrospinal fluid and total brain volumes,followed by calculations of their relative percentages.The difference in GM volume between the two groups was compared to identify brain regions with characteristic GM volume changes in migraine patients.And the correlation between these characteristic GM volume alterations and clinical scales was analyzed.Results Migraine patients exhibited significantly lower total GM volume compared to healthy controls(t=2.096,P=0.040),while no group differences were observed in white matter or cerebrospinal fluid volumes(t=0.980,0.151;P=0.330,0.880).VBM analysis revealed reduced GM volume in the left orbitofrontal cortex(t=4.301,P=0.022),left hippocampus(t=5.226,P=0.006)and left parahippocampal gyrus(t=3.960,P=0.040)in the migraine group.Negative correlations were identified between:left orbitofrontal cortex GM volume and headache duration(r=-0.506,P=0.008),left hippocampal GM volume and patient health questionnaire-9 scores(r=-0.620,P=0.003),and left parahippocampal GM volume and visual analogue scale scores(r=-0.449,P=0.019).Conclusion VBM analysis based on 7T MP2RAGE data demonstrates characteristic GM volume reductions in the left orbitofrontal cortex,left hippocampus and left parahippocampal gyrus in migraine patients,with these structural alterations significantly correlate with depressive symptoms and headache burden.The observed microstructural abnormalities may reflect underlying pathophysiological mechanisms related to pain processing,emotional regulation and long-term disease burden in migraine.

Objective:To investigate the efficacy of percutaneous vertebroplasty through unilateral transverse process-pedicular for postmenopausal lumbar osteoporotic fractures.Methods:Retrospective analysis included 102 patients with postmenopausal lumbar osteoporotic fracture admitted to Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from Jan. 2023 to Jan. 2024, who were divided into unilateral transverse process-pedicular group (UTPP group, n=48) and unilateral transverse pedicular group (UTP group, n=54) by means of approach. The changes of surgery-related indexes, imaging indexes and postoperative lumbar function recovery of the two groups were observed, and the patients were followed up for 1 year to record the incidence of secondary fracture of injured vertebra, fracture of adjacent vertebra and diffusion of bone cement. Results:The bone cement leakage rate in UTPP group was lower than that in UTP group ( P < 0.05), and there was no statsistically significant difference in operation time, fluoroscopy times, intraoperative blood loss, bone cement injection amount and hospital stay between the two groups ( P > 0.05). Before surgery, 3 months and 6 months after surgery, vertebral anterior margin height, middle vertebral height and sagittal cobb Angle between the two groups showed no significant differences ( P > 0.05). Visual analogue score (VAS) and oswestry disability index (ODI) between the two groups before surgery and 3 months after surgery had no statistically significant differences ( P > 0.05) ; VAS and ODI scores in UTPP group were lower than those in UTP group 6 months after surgery ( P < 0.05). The incidence of secondary fracture in UTPP group was lower than that in UTP group, while the height diffusion rate of bone cement was higher (all P < 0.05). The incidence of adjacent vertebral fracture between the two groups showed no statistically significant difference ( P > 0.05) . Conclusions:In postmenopausal patients with lumbar osteoporotic fractures, percutaneous vertebroplasty through unilateral transverse process-pedicular can effectively reduce the rate of intraoperative bone cement leakage, and has certain advantages in improving postoperative pain, promoting the recovery of postoperative lumbar function and reducing the risk of secondary fractures.

ObjectiveTo evaluate the reliability and validity of the Dampness Syndrome Scale of Chinese Medicine （DSSCM） among patients with persistent asthma， and to explore the correlation between dampness syndrome and clinical characteristics of persistent asthma. MethodsA cross-sectional survey was conducted. Basic information， examination results， DSSCM， Asthma Control Test （ACT）， Generalized Anxiety Disorder-7 （GAD-7）， and Patient Health Questionnaire-9 （PHQ-9） scores were collected from 206 patients with persistent asthma to evaluate the reliability and validity of DSSCM and to explore the correlation between dampness syndrome and clinical characteristics. ResultsThe mean score of DSSCM among 206 patients was 14.59 ± 10.53. The overall Cronbach α coefficient and Spearman-Brown split-half reliability coefficient of the scale were both greater than 0.8， and the success rate of scale convergent and discriminant validity calibration were greater than 80%. The confirmatory factor analysis showed that the χ²/df was 2.309， and the root mean square error of approximation （RMSEA） was 0.08； the root mean square residual （RMR） was 0.049， whereas the comparative fit index （CFI）， the goodness of fit index （GFI）， the adjusted goodness of fit index （AGFI）， the normed fit index （NFI） and the incremental fit index （IFI） were less than 0.9. Correlation analysis showed that DSSCM scores were positively correlated with disease duration， GAD-7 scores， and PHQ-9 scores （P＜0.05）， and negatively correlated with ACT scores （P＜0.01）. The DSSCM scores were significantly different between patients with different disease severity （H = 10.92， P = 0.01）， and the DSSCM scores of allergic patients were higher than those of non-allergic patients （Z = -4.19， P＜0.001）. ConclusionDSSCM has acceptable reliability and validity for patients with persistent asthma. The scores of DSSCM correlated with the disease duration， ACT score， GAD-7 score， PHQ-9 score， disease severity and allergic status of persistent asthmatics.