Objective To evaluate the changes of perivascular space(PVS)in patients with subacute ischemic stroke(IS),as well as the relationship between PVS and cognitive dysfunction in IS patients,and to analyze the relationship between PVS indicators and cognitive function in subacute IS patients of different ages.Methods A total of 44 healthy controls(HC)and 39 patients with subacute IS were prospectively included.Automated quantitative analysis of MRI data was conducted to determine pPVS in the white matter and subcortical regions.Differences in pPVS between patients with subacute IS and HC were compared.Correlations between age,pPVS,and cognitive dysfunction were analyzed and modeled.Results Compared with the HC,the white matter pPVS in patients with subacute IS was significantly reduced(t=-2.21,P=0.031).In patients with subacute IS,the white matter pPVS showed a significant positive correlation with lesion volume(r=0.42,P=0.030)and mini-mental state examination(MMSE)scores(r=0.44,P=0.018).Both white matter pPVS(r=-0.42,P=0.010)and MMSE scores(r=-3.82,P=0.000 7)were negatively correlated with age.When age was over 61.35 years,there was a positive correlation between the white matter pPVS and MMSE scores.Conclusion PVS are closely related to cognitive impairment in patients with subacute IS.Age is a significant modulating factor in the relationship between PVS and cognitive dysfunction.Early monitoring of PVS and targeting it for intervention may positively impact the improvement of cognitive dysfunction following IS.

Objective To evaluate the changes of perivascular space(PVS)in patients with subacute ischemic stroke(IS),as well as the relationship between PVS and cognitive dysfunction in IS patients,and to analyze the relationship between PVS indicators and cognitive function in subacute IS patients of different ages.Methods A total of 44 healthy controls(HC)and 39 patients with subacute IS were prospectively included.Automated quantitative analysis of MRI data was conducted to determine pPVS in the white matter and subcortical regions.Differences in pPVS between patients with subacute IS and HC were compared.Correlations between age,pPVS,and cognitive dysfunction were analyzed and modeled.Results Compared with the HC,the white matter pPVS in patients with subacute IS was significantly reduced(t=-2.21,P=0.031).In patients with subacute IS,the white matter pPVS showed a significant positive correlation with lesion volume(r=0.42,P=0.030)and mini-mental state examination(MMSE)scores(r=0.44,P=0.018).Both white matter pPVS(r=-0.42,P=0.010)and MMSE scores(r=-3.82,P=0.000 7)were negatively correlated with age.When age was over 61.35 years,there was a positive correlation between the white matter pPVS and MMSE scores.Conclusion PVS are closely related to cognitive impairment in patients with subacute IS.Age is a significant modulating factor in the relationship between PVS and cognitive dysfunction.Early monitoring of PVS and targeting it for intervention may positively impact the improvement of cognitive dysfunction following IS.

Berberine is an antipyretic and detoxicating drug commonly used in clinical practice,and it is currently used for the routine treatment of gastrointestinal diseases such as bacterial gastroenteritis and diarrhea.However,several recent studies have shown that berberine can exert a therapeutic effect on the diseases such as autoimmune hepatitis,viral hepatitis,nonalcoholic fatty liver disease,and liver cancer by regulating the AMPK and TGF-β pathways and altering the composition of intestinal flora.This provides new drugs for the treatment of these diseases,expands the potential indications of berberine,and provides clues for the follow-up research and development of similar drugs.This article summarizes the therapeutic effect and mechanism of berberine on various liver diseases,in order to provide a reference for effective clinical application.

Objective To analyze the risk factors of intraoperative hypothermia in patients undergoing radical thyroidectomy under laparoscopy and to construct a nomogram prediction model. Methods A total of 336 patients who underwent laparoscopic radical thyroidectomy were selected as study subjects. According to intraoperative body temperature, they were divided into hypothermia group (195 cases) and normal temperature group (141 cases). The risk factors of intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy were analyzed using the Logistic regression model. The nomogram prediction model was constructed using R software. The prediction performance of the nomogram prediction model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness-of-fit test. Results There were significant differences in age, intraoperative blood loss, amount of fluid infusion, and operation time between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that age>60 years, intraoperative blood loss >60 mL, amount of fluid infusion>1 000 mL, and operation time>2.5 h were risk factors for intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy (P < 0.05). A nomogram prediction model was constructed based on the four risk factors. The ROC curve showed that the area under the curve was 0.912 (95%CI, 0.884 to 0.941). The calibration curve and Hosmer-Lemeshow goodness-of-fit test showed that the slope of the calibration curve was close to 1 (χ²=9.140, P=0.243). Conclusion The nomogram prediction model based on age, intraoperative blood loss, amount of fluid infusion, and operation time has good predictive value for intraoperative hypothermia in patients undergoing laparoscopic radical thyroidectomy.

Objective To explore the effects of relaxation therapy combined with music intervention on pain degree and mental state of patients with impacted tooth extraction.Methods A total of 76 patients who were diagnosed with low impacted mandibular third molar and confirmed to be in need of extraction in The Second Affiliated Hospital of Naval Medical University from January 2022 to March 2023 were selected as research objects.The patients were randomly divided into observation group and control group by random number table method,with 38 cases in each group.All the surgeries were operated by the same deputy chief physician.The same anesthesia and operation methods were used.The control group received routine nursing,and the observation group received routine nursing,relaxation therapy and music intervention.The pain degree,mental state(Hamilton anxiety scale[HAMA]and Hamilton depression scale[HAMD]),heart rate,systolic blood pressure and diastolic blood pressure were compared between the two groups.Results Postoperative pain in the observation group was significantly less than that in the control group(P<0.05).The HAMA and HAMD scores in the observation group were significantly lower than those in the control group after surgery(P<0.05).Intraoperative heart rate,systolic blood pressure and diastolic blood pressure in the observation group were significantly lower than those in the control group(P<0.05).Conclusion This intervention method can obtain good outcomes in patients with impacted tooth extraction.It can not only alleviate the pain of patients to a large extent,but also significantly reduce the negative emotions of patients.It can also have good effects on the blood pressure and heart rate of patients,and is worthy of clinical application.

Gallstone disease is a common and frequently seen disease of digestive system, and is a common cause of inflammation of gallbladder and bile duct, biliary tract tumor and obstructive jaundice, however, its pathogenesis is not yet fully understood. Recent studies have revealed that intestinal flora and immunity play important roles in the formation of gallstones. This paper reviewed the relationship between the abundance and composition of intestinal flora, immuno - globulins, mucins and immune cells, as well as the interactions between intestinal flora and biliary immunity and gallstone formation for providing new ideas and methods for gallstone prevention and treatment.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) in the treatment of active Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Clinical data of 45 patients with active CD at the Sixth Affiliated Hospital of Sun Yat-sen University from November 2020 to May 2022 were analyzed. All of the patients received VDZ at the dose of 300 mg per time at 0, 2th, 6th weeks and subsequently once every 8 weeks. The clinical response and remission were evaluated by Crohn′s disease activity index (CDAI) . The endoscopic response and remission were evaluated by simple endoscopic score for Crohn′s disease (SES-CD) . All of the adverse effects occurred during the treatment of VDZ were recorded in order to evaluate the safety. The primary endpoint was the clinical remission rate at 22 weeks after treatment. The secondary endpoints included the clinical response rate at 22 weeks after treatment, the clinical response rate and clinical remission rate at 52 weeks after treatment, the endoscopic response rate and remission rate at (22 ± 8) weeks after treatment. Thirty-one patients who had previously used infliximab (IFX) and adalimumab (ADA) were set as non-Bio-Na?ve group, and 14 patients who had not previously used biologics were set as Bio-Na?ve group. The differences of the primary endpoint and some secondary endpoints between the two groups were compared.Results:At 22 weeks after treatment, the CDAI score of 45 patients decreased from baseline (261.4 ± 98.3) points to (166.6 ± 93.5) points, the difference was statistically significant ( t = 4.6, P<0.01) . Among them, 64.4% (29/45) patients achieved clinical response and 46.7% (21/45) patients achieved clinical remission. There were no significant difference in clinical response rate [71.4% (10/14) vs. 61.3% (19/31) , χ 2 = 0.4, P = 0.4] and clinical remission rate [42.9% (6/14) vs. 48.4% (15/31) , χ 2 = 0.1, P = 0.8] between the Bio-Na?ve group and non-Bio-Na?ve group at 22 weeks after treatment. At 52 weeks after treatment, the CDAI score of 33 patients decreased from baseline (306.9 ± 130.7) points to (126.6 ± 92.7) points, the difference was statistically significant ( t = 8.5, P<0.01) . Among them, 39.4% (13/33) of the patients achieved clinical response, 33.3% (11/33) of the patients achieved clinical remission, but 41.4% (12/29) of the patients had secondary loss of response. At (22 ± 8) weeks after treatment, the SES-CD score of 25 patients in active phase under endoscopy at baseline decreased from baseline 13.0 (7.0, 19.0) points to 8.0 (2.5, 18.5) points, the difference was statistically significant ( Z = -2.6, P<0.05) . Among them, 40.0% (10/25) patients achieved endoscopic response and 20.0% (5/25) patients achieved endoscopic remission. The new facial rash occurred in 1 patient (2.2%) , new joint pain in 2 (4.4%) and there was no new active tuberculosis and hepatitis B virus infection during the treatment of VDZ for 45 patients. Conclusions:Single drug of VDZ has a good effect on inducing remission in patients with mild to moderate CD and has a good safety. The previous use of IFX or ADA does not affect the efficacy of VDZ, but part of patients still have secondary loss of response.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) in the treatment of active Crohn′s disease (CD) .Methods:A retrospective cohort study was conducted. Clinical data of 45 patients with active CD at the Sixth Affiliated Hospital of Sun Yat-sen University from November 2020 to May 2022 were analyzed. All of the patients received VDZ at the dose of 300 mg per time at 0, 2th, 6th weeks and subsequently once every 8 weeks. The clinical response and remission were evaluated by Crohn′s disease activity index (CDAI) . The endoscopic response and remission were evaluated by simple endoscopic score for Crohn′s disease (SES-CD) . All of the adverse effects occurred during the treatment of VDZ were recorded in order to evaluate the safety. The primary endpoint was the clinical remission rate at 22 weeks after treatment. The secondary endpoints included the clinical response rate at 22 weeks after treatment, the clinical response rate and clinical remission rate at 52 weeks after treatment, the endoscopic response rate and remission rate at (22 ± 8) weeks after treatment. Thirty-one patients who had previously used infliximab (IFX) and adalimumab (ADA) were set as non-Bio-Na?ve group, and 14 patients who had not previously used biologics were set as Bio-Na?ve group. The differences of the primary endpoint and some secondary endpoints between the two groups were compared.Results:At 22 weeks after treatment, the CDAI score of 45 patients decreased from baseline (261.4 ± 98.3) points to (166.6 ± 93.5) points, the difference was statistically significant ( t = 4.6, P<0.01) . Among them, 64.4% (29/45) patients achieved clinical response and 46.7% (21/45) patients achieved clinical remission. There were no significant difference in clinical response rate [71.4% (10/14) vs. 61.3% (19/31) , χ 2 = 0.4, P = 0.4] and clinical remission rate [42.9% (6/14) vs. 48.4% (15/31) , χ 2 = 0.1, P = 0.8] between the Bio-Na?ve group and non-Bio-Na?ve group at 22 weeks after treatment. At 52 weeks after treatment, the CDAI score of 33 patients decreased from baseline (306.9 ± 130.7) points to (126.6 ± 92.7) points, the difference was statistically significant ( t = 8.5, P<0.01) . Among them, 39.4% (13/33) of the patients achieved clinical response, 33.3% (11/33) of the patients achieved clinical remission, but 41.4% (12/29) of the patients had secondary loss of response. At (22 ± 8) weeks after treatment, the SES-CD score of 25 patients in active phase under endoscopy at baseline decreased from baseline 13.0 (7.0, 19.0) points to 8.0 (2.5, 18.5) points, the difference was statistically significant ( Z = -2.6, P<0.05) . Among them, 40.0% (10/25) patients achieved endoscopic response and 20.0% (5/25) patients achieved endoscopic remission. The new facial rash occurred in 1 patient (2.2%) , new joint pain in 2 (4.4%) and there was no new active tuberculosis and hepatitis B virus infection during the treatment of VDZ for 45 patients. Conclusions:Single drug of VDZ has a good effect on inducing remission in patients with mild to moderate CD and has a good safety. The previous use of IFX or ADA does not affect the efficacy of VDZ, but part of patients still have secondary loss of response.

Objective To explore the diagnostic value of serum cystitis C(CysC),urinary transferrin (UTRF)and urinary α1 microglobulin(α1MG)in the diagnosis of early diabetic nephropathy(DKD).Methods Totally 165 patients with diabetic mellitus treated in the hospital from January 2016 to January 2017 were selected,and then assigned to diabetic mellitus group(DM group)and diabetic kidney disease group(DKD group)based on urinary albumin excretion rate(UAER).83 healthy people were enrolled and assigned to con-trol group.The level of serum CysC,serum creatinine(SCr)and blood urea nitrogen(BUN)were detected by automatic biochemical analyzer,the level of UTRF,α1MG and microalbuminuria(MALB)were detected by lmmunoturbidimetry and then compare the variance in each group.Results Compared with the control group and DM group,the level of serum CysC,UTRF,α1MG and MALB were significantly increased in DKD group (P<0.05);The level of SCr and BUN in DKD group were increased but had no statistical significance com-pared with DM group(P> 0.05).Meanwhile,the positive detection rate of serum CysC,UTRF and α1MG were significantly higher than SCr and BUN(P<0.05).Serum Cys C,UTRF and α1MG showed positive cor-relation with MALB,SCr and BUN,the level of serum Cys C also showed a positive correlation with α1MG. The sensitivity of serum Cys C,UTRF and α1MG combined detection was 92.9%,which significantly higher than single maker detection(P<0.05).Conclusion The combined detection of serum cystitis C,urinary trans-ferrin and urinary α1 microglobulin have important value in the diagnosis of early diabetic kidney disease.

Objective To observe the characteristics of magnetic resonance angiography of(MRA) ophthalmic artery in patients with diabetic retinopathy (DR).Methods A total of 36 eyes of DR patients (DR group) diagnosed by clinical examination were included in the study.Among them,there were 42 eyes in 21 males and 15 eyes in 15 females.The average age was 55.2 years old.The average duration of diabetes was 7.56 years.All eyes were examined by MRA and fluorescein fundus angiography (FFA) in the ophthalmic artery.At the same time,24 eyes of 12 patients were examined by computed tomography angiography (CTA).Twenty-two healthy volunteers with age and gender matching were selected as the control group.Among them,there were 13 males and 9 females.All patients underwent MRA examination of the ophthalmic artery;at the same time,5 eyes of 5 eyes were examined by CTA.MRA and CTA were classified into three grades according to the development condition and shape change of the ophthalmic artery.0 grade:no abnormality;grade Ⅰ:mild lesion;grade Ⅱ:obvious lesion.According to the results of FFA examination,it was divided into no obvious disease stage,background stage,proliferative stage,proliferative stage.The morphological features of the MRA of the ophthalmic artery in the DR group and the control group were compared.The relationship between the MRA grading of the ophthalmic artery and the FFA staging was observed in the DR group.The consistency analysis between the MRA and CTA grades of the ophthalmic artery in the DR group was performed by Kappa test;the relationship between the MRA grade and the FFA staging of the ophthalmic artery was analyzed by Spearson correlation analysis of the same data with two-way ordered attributes.Results In 44 eyes of the control group,the MRA in grade 0 and Ⅰ of the ophthalmic artery were 41 and 3 eyes,respectively;all eyes of the CTA examination of the ophthalmic artery were grade 0.In 72 eyes of the DR group,the MRA in grade 0,Ⅰ,and Ⅱ of the ophthalmic artery were 28,28,and 16 eyes,respectively.Among the 24 eyes examined by CTA,there were 13,6,and 5 eyes in grade 0,Ⅰ,and Ⅱ,respectively.In the DR group,the classification of MRA and CTA of the ophthalmic artery was highly consistent (Kappa value =0.86).There were significant differences in the number of eyes with different grades of MRA in the DR group and the control group (Z=-5.74,P=0.000).In 72 eyes of the DR group,there were 8,12,22,and 30 eyes in no obvious disease stage,background stage,proliferative stage,and proliferative stage,respectively.Correlation analysis showed that there was a significant correlation between MRA grading and FFA staging in the DR group (r=0.405,P=0.000).Conclusions MRA can show the changes of ophthalmic artery morphology and reflect DR staging to a certain extent.It has a high consistency with FFA vascular changes.