Objective:To explore the characteristics and evolutionary features of cognitive impairment and clinical transformation in early-stage Parkinson′s disease (PD) patients.Methods:Based on the cohort of patients with primary unmedicated PD admitted to the Parkinson′s Specialized Outpatient Clinic of Affiliated Brain Hospital of Nanjing Medical University from November 2018 to July 2022, follow-up was conducted for PD patients who completed the baseline assessment and had a follow-up time of 1.5 years or more, and a total of 87 patients finally completed the follow-up and were included in the study. At follow-up, the 87 patients were divided into a cognitively impaired group ( n=36) and a cognitively normal group ( n=51) according to the norm proposed by Professor Jia Jianping and colleagues in 2011 for the Chinese elderly population. Differences in baseline clinical characteristics between the 2 groups were compared, and binary Logistic regression analysis was used to explore risk factors for cognitive impairment in PD patients. In addition, transformed grouping according to cognitive assessment results at baseline and follow-up was used to compare differences in patients′ baseline clinical characteristics among the 3 groups: a reversal group [Parkinson′s disease-mild cognitive impairment (PD-MCI), reverting to Parkinson′s disease-cognitively normal (PD-CN); n=15], a non-reversal group (persistent PD-MCI; n=24), and a stable group (stable PD-CN; n=36). Results:Cognitive reversal occurred at follow-up in 36.6% (15/41) of patients with cognitive impairment at baseline, and 21.7% (10/46) of patients with normal cognition at baseline had cognitive impairment at follow-up. At the end of the follow-up, the 87 patients with PD had higher Unified Parkinson′s Disease Rating Scale Ⅱ (UPDRS-II) scores [8 (6, 11)], Unified Parkinson′s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) scores [23 (16, 30)], and Hoehn-Yahr stages [2.0 (1.5, 2.5)] than those at baseline [7(4, 10), 19(14, 25), 1.5(1.0, 2.0)]. The differences were statistically significant ( Z=-2.498, P=0.012; Z=-3.039, P=0.002; Z=-4.436, P<0.001). The cognitively impaired group had lower Montreal Cognitive Assessment scores [22.00(19.00, 23.75)] and fewer years of education [9.00(8.00, 11.75) years] but higher Parkinson′s Disease Non-Motor Symptoms Questionnaire (PD-NMSQ) scores [8.00(5.25, 12.00)] than the cognitively normal group [25.00(24.00, 27.00), 12.00(9.00, 15.00) years, 6.00(3.00, 8.00)], and the differences were statistically significant ( Z=-4.764, P<0.001; Z=-3.016, P=0.003; Z=-3.281, P=0.001). Multivariate Logistic regression showed that years of education ( OR=0.829, 95%CI 0.715-0.960, P=0.012) and PD-NMSQ scores ( OR=1.200, 95%CI 1.040-1.384, P=0.012) were independent predictors of cognitive impairment in patients with PD. There were statistically significant differences among the reversal, non-reversal, and stable groups in years of education ( F=5.366, P=0.010), PD-NMSQ scores ( H=10.795, P=0.005), and UPDRS-Ⅱ scores ( H=6.957, P=0.031). Pairwise comparisons showed lower PD-NMSQ scores [4.00(3.00, 7.00) vs 8.00(6.25, 12.75); Z=-2.989, P=0.003] and lower UPDRS-Ⅱ scores [6.00(3.00, 6.00) vs 7.00(6.00, 10.00); Z=-2.756, P=0.006] in the reversal group than in the non-reversal group, indicating better baseline quality of life in cognitive reversal patients. Conclusions:Low educational level and severe non-motor symptoms were risk factors predicting cognitive impairment in PD patients. Conversely, mild non-motor symptoms with high quality of life (lower UPDRS-Ⅱ scores) were important factors for cognitive reversal.

Objective To assess the marginal microleakage of specimens following aging simulation of adhesive restorations for dental defects using methacryloxylethyl cetyldimethyl ammonium chloride(DMAE-CB)and nanoparticles of amorphous calcium phosphate(NACP)binder.Methods DMAE-CB and NACP were synthesized in the laboratory.Eight groups were formed by varying the mass fraction ratios of the two components in the adhesive according to previous experiments,A:binder+3％DMAE-CB+25％NACP,B:binder+4％DMAE-CB+35％NACP,C:binder+1％DMAE-CB+15％NACP,D:binder+4％DMAE-CB+15％NACP,E:binder+1％DMAE-CB+35％NACP,F:binder+3％DMAE-CB,G:binder+25％NACP,H:SBMP binder as the control group.Forty human third molars were collected and randomly divided into 8 groups to prepare standardized Class Ⅱ preparations.Subsequent-ly,dental defect adhesive restoration specimens were made by using the 8 groups of binder,and aging simulation was performed through thermal cycling.After thermal cycling,the specimens were immersed in the dye solution.Each specimen was sectioned into 4 parts of dentin tissue slices along the gingival,proximal,and occlusal walls using a low-speed cutting machine,and the depth of dye penetration was observed under a stereomicroscope and recorded according to a unified standard for microleakage level.Finally,one randomly selected adhesive specimen from each of the 8 groups was subjected to gold sputtering and observed under scanning electron microscopy(SEM)to measure the gap width between the resin and dental tissue.Results Penetration staining showed that there were no statistically significant differences in the depth of marginal microleakage between the experimental and control groups on the gingival and occlusal walls(P＞0.05).However,there was a statistically significant difference in microleakage depth between the gingival and occlusal walls(P＜0.05).Scanning electron microscopy(SEM)results,after averaging particle size measurements,revealed no statistically significant differences in the gap width between the filling restorations and dental hard tissues between the experimental and con-trol groups(P＞0.05).Conclusion Dentin adhesives modified with DMAE-CB and NACP increase antibacterial and remineralization properties without affecting marginal microleakage in adhesive restorations,providing reliable theoretical support for their clinical appli-cation.

Objective To comparatively analyze the friction wear performance,fracture resistance,and displacement resistance before and after aging of full crowns made from PEEK,cobalt-chromium alloy,and zirconia,providing a theoretical basis for the future application of PEEK in crown fabrication.Methods Standard anatomical full crowns of PEEK,cobalt-chromium alloy,and zirconia were fabricated by preparing the upper first premolar and taking silicone rubber impressions,resulting in 25 crowns of each material.The crowns were divided into three groups:Group A(15 crowns,5 from each material),Group B(30 crowns,10 from each materi-al),and Group C(30 crowns,10 from each material,serving as a control).Group A underwent 120 000 chewing simulations under simulated oral physiological conditions,using a stereomicroscope and Micro-image Analysis & Process system to assess and compare wear of antagonists(opposing talc ceramic balls)and material wear.Group B underwent 10 000 thermal cycling aging tests and Group C were served as the control.Universal testing machines were used to evaluate and compare the fracture resistance and displacement re-sistance of Groups B and C.Results ①The wear heights of full crown materials were as follows:cobalt-chromium alloy(0.61±0.05)mm,zirconia(0.81±0.07)mm,and PEEK(0.96±0.04)mm,with PEEK＞zirconia＞cobalt-chromium alloy(P＜0.05).For antagonist wear,the wear heights were cobalt-chromium alloy＞zirconia＞PEEK(P＜0.05).②The fracture resistance of cobalt-chromium alloy be-fore and after aging was(3 665.645±71.166)N and(2 906.830±225.143)N,respectively;for zirconia it was(2 447.825±316.961)N and(1 829.229±72.046)N;and for PEEK crowns it was(1 632.378±53.046)N and(1 074.872±105.491)N,showing cobalt-chromi-um alloy＞zirconia＞PEEK(P＜0.05).The displacement resistance for cobalt-chromium alloy before and after aging was(1 604.630±95.680)N and(1 092.137±77.869)N;for zirconia it was(1 768.851±56.273)N and(1 381.618±62.326)N;and for PEEK crowns it was(1 148.811±70.417)N and(931.723±64.454)N,indicating zirconia＞cobalt-chromium alloy＞PEEK(P＜0.05).The aging degradation of cobalt-chromium alloy's fracture and displacement re-sistance was(758.815±157.734)N and(512.492±34.530)N,re-spectively;for zirconia,it was(618.597±251.281)N and(387.233±7.947)N;and for PEEK crowns,it was(557.506±61.950)N and(217.089±14.589)N,with anti-aging performance:PEEK＞zirconia＞cobalt-chromium alloy(P＜0.05).Conclusion The wear re-sistance,fracture resistance,and displacement resistance of PEEK meet the clinical standards for full crown materials,and PEEK demonstrates good anti-aging performance while effectively protecting opposing teeth.Therefore,PEEK has the potential to become a novel material for full crown fabrication.

Objective To comparatively analyze the friction wear performance,fracture resistance,and displacement resistance before and after aging of full crowns made from PEEK,cobalt-chromium alloy,and zirconia,providing a theoretical basis for the future application of PEEK in crown fabrication.Methods Standard anatomical full crowns of PEEK,cobalt-chromium alloy,and zirconia were fabricated by preparing the upper first premolar and taking silicone rubber impressions,resulting in 25 crowns of each material.The crowns were divided into three groups:Group A(15 crowns,5 from each material),Group B(30 crowns,10 from each materi-al),and Group C(30 crowns,10 from each material,serving as a control).Group A underwent 120 000 chewing simulations under simulated oral physiological conditions,using a stereomicroscope and Micro-image Analysis & Process system to assess and compare wear of antagonists(opposing talc ceramic balls)and material wear.Group B underwent 10 000 thermal cycling aging tests and Group C were served as the control.Universal testing machines were used to evaluate and compare the fracture resistance and displacement re-sistance of Groups B and C.Results ①The wear heights of full crown materials were as follows:cobalt-chromium alloy(0.61±0.05)mm,zirconia(0.81±0.07)mm,and PEEK(0.96±0.04)mm,with PEEK＞zirconia＞cobalt-chromium alloy(P＜0.05).For antagonist wear,the wear heights were cobalt-chromium alloy＞zirconia＞PEEK(P＜0.05).②The fracture resistance of cobalt-chromium alloy be-fore and after aging was(3 665.645±71.166)N and(2 906.830±225.143)N,respectively;for zirconia it was(2 447.825±316.961)N and(1 829.229±72.046)N;and for PEEK crowns it was(1 632.378±53.046)N and(1 074.872±105.491)N,showing cobalt-chromi-um alloy＞zirconia＞PEEK(P＜0.05).The displacement resistance for cobalt-chromium alloy before and after aging was(1 604.630±95.680)N and(1 092.137±77.869)N;for zirconia it was(1 768.851±56.273)N and(1 381.618±62.326)N;and for PEEK crowns it was(1 148.811±70.417)N and(931.723±64.454)N,indicating zirconia＞cobalt-chromium alloy＞PEEK(P＜0.05).The aging degradation of cobalt-chromium alloy's fracture and displacement re-sistance was(758.815±157.734)N and(512.492±34.530)N,re-spectively;for zirconia,it was(618.597±251.281)N and(387.233±7.947)N;and for PEEK crowns,it was(557.506±61.950)N and(217.089±14.589)N,with anti-aging performance:PEEK＞zirconia＞cobalt-chromium alloy(P＜0.05).Conclusion The wear re-sistance,fracture resistance,and displacement resistance of PEEK meet the clinical standards for full crown materials,and PEEK demonstrates good anti-aging performance while effectively protecting opposing teeth.Therefore,PEEK has the potential to become a novel material for full crown fabrication.

Objective To assess the marginal microleakage of specimens following aging simulation of adhesive restorations for dental defects using methacryloxylethyl cetyldimethyl ammonium chloride(DMAE-CB)and nanoparticles of amorphous calcium phosphate(NACP)binder.Methods DMAE-CB and NACP were synthesized in the laboratory.Eight groups were formed by varying the mass fraction ratios of the two components in the adhesive according to previous experiments,A:binder+3％DMAE-CB+25％NACP,B:binder+4％DMAE-CB+35％NACP,C:binder+1％DMAE-CB+15％NACP,D:binder+4％DMAE-CB+15％NACP,E:binder+1％DMAE-CB+35％NACP,F:binder+3％DMAE-CB,G:binder+25％NACP,H:SBMP binder as the control group.Forty human third molars were collected and randomly divided into 8 groups to prepare standardized Class Ⅱ preparations.Subsequent-ly,dental defect adhesive restoration specimens were made by using the 8 groups of binder,and aging simulation was performed through thermal cycling.After thermal cycling,the specimens were immersed in the dye solution.Each specimen was sectioned into 4 parts of dentin tissue slices along the gingival,proximal,and occlusal walls using a low-speed cutting machine,and the depth of dye penetration was observed under a stereomicroscope and recorded according to a unified standard for microleakage level.Finally,one randomly selected adhesive specimen from each of the 8 groups was subjected to gold sputtering and observed under scanning electron microscopy(SEM)to measure the gap width between the resin and dental tissue.Results Penetration staining showed that there were no statistically significant differences in the depth of marginal microleakage between the experimental and control groups on the gingival and occlusal walls(P＞0.05).However,there was a statistically significant difference in microleakage depth between the gingival and occlusal walls(P＜0.05).Scanning electron microscopy(SEM)results,after averaging particle size measurements,revealed no statistically significant differences in the gap width between the filling restorations and dental hard tissues between the experimental and con-trol groups(P＞0.05).Conclusion Dentin adhesives modified with DMAE-CB and NACP increase antibacterial and remineralization properties without affecting marginal microleakage in adhesive restorations,providing reliable theoretical support for their clinical appli-cation.

Objective:To explore the characteristics and evolutionary features of cognitive impairment and clinical transformation in early-stage Parkinson′s disease (PD) patients.Methods:Based on the cohort of patients with primary unmedicated PD admitted to the Parkinson′s Specialized Outpatient Clinic of Affiliated Brain Hospital of Nanjing Medical University from November 2018 to July 2022, follow-up was conducted for PD patients who completed the baseline assessment and had a follow-up time of 1.5 years or more, and a total of 87 patients finally completed the follow-up and were included in the study. At follow-up, the 87 patients were divided into a cognitively impaired group ( n=36) and a cognitively normal group ( n=51) according to the norm proposed by Professor Jia Jianping and colleagues in 2011 for the Chinese elderly population. Differences in baseline clinical characteristics between the 2 groups were compared, and binary Logistic regression analysis was used to explore risk factors for cognitive impairment in PD patients. In addition, transformed grouping according to cognitive assessment results at baseline and follow-up was used to compare differences in patients′ baseline clinical characteristics among the 3 groups: a reversal group [Parkinson′s disease-mild cognitive impairment (PD-MCI), reverting to Parkinson′s disease-cognitively normal (PD-CN); n=15], a non-reversal group (persistent PD-MCI; n=24), and a stable group (stable PD-CN; n=36). Results:Cognitive reversal occurred at follow-up in 36.6% (15/41) of patients with cognitive impairment at baseline, and 21.7% (10/46) of patients with normal cognition at baseline had cognitive impairment at follow-up. At the end of the follow-up, the 87 patients with PD had higher Unified Parkinson′s Disease Rating Scale Ⅱ (UPDRS-II) scores [8 (6, 11)], Unified Parkinson′s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) scores [23 (16, 30)], and Hoehn-Yahr stages [2.0 (1.5, 2.5)] than those at baseline [7(4, 10), 19(14, 25), 1.5(1.0, 2.0)]. The differences were statistically significant ( Z=-2.498, P=0.012; Z=-3.039, P=0.002; Z=-4.436, P<0.001). The cognitively impaired group had lower Montreal Cognitive Assessment scores [22.00(19.00, 23.75)] and fewer years of education [9.00(8.00, 11.75) years] but higher Parkinson′s Disease Non-Motor Symptoms Questionnaire (PD-NMSQ) scores [8.00(5.25, 12.00)] than the cognitively normal group [25.00(24.00, 27.00), 12.00(9.00, 15.00) years, 6.00(3.00, 8.00)], and the differences were statistically significant ( Z=-4.764, P<0.001; Z=-3.016, P=0.003; Z=-3.281, P=0.001). Multivariate Logistic regression showed that years of education ( OR=0.829, 95%CI 0.715-0.960, P=0.012) and PD-NMSQ scores ( OR=1.200, 95%CI 1.040-1.384, P=0.012) were independent predictors of cognitive impairment in patients with PD. There were statistically significant differences among the reversal, non-reversal, and stable groups in years of education ( F=5.366, P=0.010), PD-NMSQ scores ( H=10.795, P=0.005), and UPDRS-Ⅱ scores ( H=6.957, P=0.031). Pairwise comparisons showed lower PD-NMSQ scores [4.00(3.00, 7.00) vs 8.00(6.25, 12.75); Z=-2.989, P=0.003] and lower UPDRS-Ⅱ scores [6.00(3.00, 6.00) vs 7.00(6.00, 10.00); Z=-2.756, P=0.006] in the reversal group than in the non-reversal group, indicating better baseline quality of life in cognitive reversal patients. Conclusions:Low educational level and severe non-motor symptoms were risk factors predicting cognitive impairment in PD patients. Conversely, mild non-motor symptoms with high quality of life (lower UPDRS-Ⅱ scores) were important factors for cognitive reversal.

Objective:To explore the impact of self-disclosure on demoralization syndrome in patients with permanent enterostomy for colorectal cancer, so as to provide reference for clinical nursing interventions for those patients.Methods:From January to May 2023, convenience sampling was used to select 207 patients with permanent enterostomy for colocrctal cancer of the Wound Ostomy Clinic of Laoshan Campus of the Affiliated Hospital of Qingdao University as the research subjects. A survey was conducted on patients using the General Information Questionnaire, Distress Disclosure Index, Social Support Rating Scale, and the Demoralization Scale Mandarin Version.Results:Among 207 patients with permanent enterostomy for colorectal cancer, the scores of self-disclosure, social support, and demoralization syndrome were 35.00 (26.00, 47.00) , 32.00 (26.00, 39.00) , and 35.00 (23.00, 47.00) , respectively. A total of 128 patients (61.8%) were in moderate demoralization, and 37 patients (17.9%) were in severe demoralization. Multiple linear regression analysis showed that place of residence, self-care of stoma, self-disclosure, and social support were the influencing factors for demoralization syndrome in patients with permanent enterostomy for colorectal cancer ( P<0.05) . Conclusions:Patients with permanent enterostomy for colorectal cancer have a high overall score of demoralization syndrome, and a high proportion of patients with moderate to severe demoralization. Medical and nursing staff should focus on patients in remote rural areas and those with poor self-care abilities to stomas, develop targeted intervention measures to improve patients' negative emotions, enhance their self-disclosure, and pay attention to strengthening social support to relieve their demoralization syndrome, thereby improving their quality of life.

Objective:To analyze the effect of short collection time of digital positron emission tomography/computed tomography(PET/CT)on image quality,detected lesion and semi-quantitative parameters,and explore the feasibility of clinical application of short collection time of step by step collection mode.Methods:The digital PET/CT images of 63 subjects were retrospectively analyzed.All of them adopted PET/CT scan to conduct PET/CT examination for whole body according to the collection mode of step by step type and list-mode scan protocol.The reconstruction was implemented according to the different collection time of each bed,and they were divided into 90 s/bed group,60 s/bed group,45 s/bed group and 30 s/bed group.The 90s/bed was used as control group to compare the detection rate of the small lesion of each group("the shorter diameter of smaller radioactive concentration lesion of PET image and the lesion of CT image"was less than 0.5 cm)in PET images,and to measure the objective data of original tumor lesion,and to compare the maximum value(SUVmax),peak value(SUVpeak)and mean value(SUVmean)of standardized uptake value(SUV),noise(SD),metabolic tumor volume(MTV)and total lesion glycolysis(TLG).The signal-noise ratio(SNR),contrast noise ratio(CNR)and target-to-background ratio(TBR)were calculated and compared.The one-way analysis of variance(ANOVA test)was adopted to conduct comparison of inter groups for the image data of 4 groups.The Bland-Altman consistency test was adopted to analyze semi-quantitative parameters of intra group.The Likert 5 scores method was adopted to conduct subject evaluation for the quality of images.The Kappa test was adopted to evaluate the consistency of images.Results:The subjective scores of image quality of 4 groups were all≥3 points,and the consistency of image quality among the four groups was very well(Kappa=0.8,P<0.05).Compared with 90s/bed group,the detection rate of small lesions of other three groups were 100%.The differences of SUVmax,SUVpeak,SUVmean,SD,TLG and MTV of semi-quantitative indicators among 4 groups were not significant(P>0.05).There were significant differences in CNR,SNR and TBR of objective indicators of 18F-FDG PET image quality among 4 groups(F=31.741,34.199,12.021,P<0.001),respectively.There were no significant differences in noise between 60s/bed group and 90s/bed group,and between 45s/bed group and 90s/bed group,respectively.The noise of image of 30s/bed group appeared increase.The Bland-Altman consistent analysis of intra group basically was within 95%confidence interval(CI).Conclusions:The short collection time of step by step mode of digital PET/CT has very good clinical application.

Objective To analyze the characteristics of types of hearing curves in patients with tinnitus and the differences in tinnitus severity and treatment outcomes among patients with different types of hearing curves,to further explore the relationship between tinnitus and hearing loss,and to provide clinical evidence for exploring the etiology and treatment plans for tinnitus.Methods The basic information and the tinnitus and hearing data of the tinnitus patients who met the inclusion criteria were collected.The patients'severity of tinnitus was assessed on a scale of grades Ⅰ through Ⅴ according to the grading standards of the tinnitus evaluation questionnaire(TEQ).According to the classification criteria for the different types of hearing curves,the tinnitus patients were categorized into 6 types,including normal hearing,high-frequency descending type,low-frequency descending type,partial descending type,flat descending type,and total deafness.We analyzed in multiple aspects the tinnitus status identified at the initial diagnosis and the treatment outcomes at the last diagnoses and follow-up in patients with different types of hearing curves.Results A total of 672 patients with tinnitus were included in this study,of which 183 had normal hearing,and 489 had varying degrees of hearing loss.According to the TEQ grading criteria for tinnitus assessment,the patients'severity of tinnitus at the initial diagnosis was mainly concentrated in grades Ⅱ and Ⅲ,with 86 cases(12.79％)classified as grade Ⅰ,309 cases(45.98％)as grade Ⅱ,161 cases(23.96％)as grade Ⅲ,87 cases(12.95％)as grade Ⅳ,and 29 cases(4.32％)as grade Ⅴ.Regarding the distribution of hearing curve types,tinnitus patients had predominantly hearing curves of the high-frequency descending type.There were statistically significant differences in the distribution of tinnitus severity among patients with different types of hearing curves at the initial diagnosis(P＜0.01).Among tinnitus patients with high-frequency descending hearing curve,there was no statistically significant difference in the distribution of hearing loss severity among patients with tinnitus of different degrees of severity.After uniform treatment,there was no statistically significant difference in treatment outcomes between patients with different types of audiometry curves at the time of the last diagnosis and the follow-up.Conclusion Despite significant differences in the severity of tinnitus among patients with different types of hearing curves at the initial diagnosis in this study,no clear association was found between tinnitus treatment outcomes and hearing curve types.Furthermore,no clear association was found between tinnitus and the degree of hearing loss in patients with the same type of hearing curve.Hence,further clinical evidence is warranted to assess the efficacy of selecting tinnitus treatment plans that are similar to those for sudden deafness based on the types of hearing curves.

Objective:To investigate surgical treatment of carotid artery diseases in neck tumor surgery. Methods:A retrospective analysis of the clinical data on carotid artery treatment was conducted in the five cases of neck tumor surgeries treated at Department of Surgical Oncology, the First Peoples Hospital of Lanzhou from March 2010 to May 2020. Surgical methods, including carotid artery resection and ligation, tumor-involved artery resection and vascular reconstruction, and tumor peeling and carotid rupture repairing were used, respectively. Results:Five cases were successfully operated on. One case of carotid artery ligation was followed by intermittent dizziness and decreased contra-lateral limb strength after the surgery. The remaining patients exhibited no neurological complications. A patient with cervical low-grade myofibroblastoma developed into lung metastases 8 months after the surgery. Another patient with cervical lymph node metastases in papillary thyroid cancer developed into lung metastases 24 months after the surgery. Conclusion:Currently, surgical methods for clinical treatment of diseased carotid arteries include carotid artery resection and ligation, simple tumor peeling, tumor invasion artery resection and vascular reconstruction, and interventional therapy. Each surgical method has its own advantages and disadvantages. Therefore, the choice of treatment depends on the patient's specific conditions, physician's clinical experience, and the equipment available.
Humans ; Retrospective Studies ; Carotid Arteries/pathology* ; Head and Neck Neoplasms/pathology* ; Thyroid Neoplasms/surgery* ; Lung Neoplasms/pathology*