Objective To explore the relationship between sleep quality,serum S100 calcium-binding proteinβ subunit(S100β)level,soluble CD40 ligand(sCD40L)level and the severity of cerebral small vessel disease.Methods According to the total imaging load score,60 cerebral small vessel disease patients were divided into severe disease group(22 cases)and mild-to-moderate disease group(38 cases).The general clinical data,Pittsburgh sleep quality index(PSQI),Epworth sleepiness scale(ESS)score,insomnia severity index(ISI)score and the levels of S100β and sCD40L were compared between the two groups.Binary Logistic regression analysis was used to evaluate the correlation between the difference index between the groups and the severity of the disease in patients with cerebral small vessel disease.Results The rate of hypertension in severe disease group was significantly higher than that in mild-to-moderate disease group(P＜0.05).The ESS and ISI scores in severe disease group were significantly higher than those in mild-to-moderate disease group(all P＜0.001).The levels of serum S100β and sCD40L in severe disease group were significantly higher than those in mild-to-moderate disease group(all P＜0.001).Univariate Logistic regression analysis showed that hypertension,ESS score,ISI score,S100β level and sCD40L level were potentially correlated with the severity of cerebral small vessel disease(all P＜0.05).Multivariate Logistic regression analysis showed that ESS score,ISI score,S100β level and sCD40L level were closely related to the severity of cerebral small vessel disease(all P＜0.05).Conclusions The severity of sleepiness and insomnia and the levels of serum S100β and sCD40L in patients with cerebral small vessel disease are closely related to the severity of the disease.Paying attention to the sleep status and the body's inflammatory state of patients is conducive to a more accurate assessment of the severity of cerebral small vessel disease.

Objective To explore the relationship between sleep quality,serum S100 calcium-binding proteinβ subunit(S100β)level,soluble CD40 ligand(sCD40L)level and the severity of cerebral small vessel disease.Methods According to the total imaging load score,60 cerebral small vessel disease patients were divided into severe disease group(22 cases)and mild-to-moderate disease group(38 cases).The general clinical data,Pittsburgh sleep quality index(PSQI),Epworth sleepiness scale(ESS)score,insomnia severity index(ISI)score and the levels of S100β and sCD40L were compared between the two groups.Binary Logistic regression analysis was used to evaluate the correlation between the difference index between the groups and the severity of the disease in patients with cerebral small vessel disease.Results The rate of hypertension in severe disease group was significantly higher than that in mild-to-moderate disease group(P＜0.05).The ESS and ISI scores in severe disease group were significantly higher than those in mild-to-moderate disease group(all P＜0.001).The levels of serum S100β and sCD40L in severe disease group were significantly higher than those in mild-to-moderate disease group(all P＜0.001).Univariate Logistic regression analysis showed that hypertension,ESS score,ISI score,S100β level and sCD40L level were potentially correlated with the severity of cerebral small vessel disease(all P＜0.05).Multivariate Logistic regression analysis showed that ESS score,ISI score,S100β level and sCD40L level were closely related to the severity of cerebral small vessel disease(all P＜0.05).Conclusions The severity of sleepiness and insomnia and the levels of serum S100β and sCD40L in patients with cerebral small vessel disease are closely related to the severity of the disease.Paying attention to the sleep status and the body's inflammatory state of patients is conducive to a more accurate assessment of the severity of cerebral small vessel disease.

ObjectiveTo construct a macro-evaluation tool for dampness syndrome （DS） animal model， which will provide a basis for experimental research on dampness syndrome in traditional Chinese medicine （TCM）. MethodsConceptual framework of this study was clarified through discussions within the core working group， and dimensions of the evaluation of the animal model of DS were identified according to TCM principles. We searched CNKI， Wanfang， VIP and SinoMed databases from the inception to June 30th， 2023， on experiments involving dampness syndrome animals to create a pool of items about DS animal models. The core items were selected and extracted for factor analysis and cluster analysis. An expert importance rating questionnaire was developed based on the results of the literature review， analyzing the distribution of item scores， importance averages， and coefficient of variation. Through a comprehensive analysis of literature， expert importance scoring， and specific expert opinions， items that did not meet anyone of the criteria of average importance rating ≥2.04， coefficient of variation ≤30%， or literature eva-luation frequency ≥2% were removed， thereafter， the macro-evaluation tool for DS animal model was preliminarily constructed. ResultsSpirit and body state， autonomic activity state， body surface characteristics， diet， urination and defecation， tongue manifestation， and motor behavior assessment were constructed as the seven dimensions in the evaluation of DS animal model. A total of 348 papers about animal experiments were included and analyzed， resulting in a saturated pool of 72 items， which was refined to 38 core items of DS animal models. Factor analysis obtained 16 common factors， which were further clustered into two categories， named dampness transforming from heat syndrome and dampness transforming from cold syndrome. The expert importance scoring showed that the Kendall harmony coefficient was 0.359 （P＜0.05） indicating a high level of agreement， coordination and reliability among the experts. Notably， 50% or more of the experts considered the items thick and greasy tongue coating， unclean perianal area， loose stools， lethargy， unformed stools， and listless expression as very important. The median scores for all items were 2.04（1.73， 2.37）， with a coefficient of variation ranging from 19.73% to 53.38%. After expert evaluation， the macro-evaluation tool for DS animal model in TCM with 33 items and corresponding criteria for assessing the formation of DS models was finally contructed. ConclusionThe Macro-evaluation tool for DS animal model in TCM is highly scientific， credible， and operable， and can be utilized in DS animal experiments after its characteristics are actually evaluated.

Objective:To explore the anatomical parameters of the ideal trajectory for pedicle screw fixation through the lamina in the treatment of L 5 spondylolysis. Methods:CT data from 40 male patients with bilateral L 5 spondylolysis (age, 24.95±4.01 years; range, 20-36 years), treated at the 940th Hospital of PLA Joint Logistics Support Force between January 2021 and June 2024, were analyzed. Three-dimensional vertebral models were reconstructed using this data. Measurements included the lumbosacral angle, the thickness at the midpoint of the superior and inferior lamina edges, mid-lamina thickness, the distance from the lateral edge of the lamina to the spinous process midline, the thickness at the defect of the pars interarticularis, and the vertical diameter of the defect. The screws were inserted from the inferior edge of the lamina, passing through the pars interarticularis defect, and exiting at the superior edge of the pedicle. In the vertical direction of the lamina, the inferior and superior edges of the lamina were divided into three zones, named A, B, C (for the inferior lamina edge) and 1, 2, 3 (for the superior pedicle edge). Seven trajectories (A2, A3, B1, B2, B3, C2, and C3) were designed by combining these zones. Screws with diameters of 5.0, 4.5, 4.0, and 3.5 mm were sequentially inserted along each trajectory. Screw trajectories with an insertion success rate ≥95% were selected and evaluated for feasibility. Parameters such as screw length, medial inclination angle, caudal inclination angle, and entry point position were measured. The ideal trajectory and screw dimensions were determined by considering anatomical features, screw characteristics, and insertion safety. Results:The measurement results from the 3D model showed that the lumbosacral angle was 36.22°±5.23°, and the midpoint thickness of the superior lamina edge was 4.14±0.66 mm (left) and 4.18±0.65 mm (right), the mid-lamina thickness was 6.73±0.72 mm (left) and 6.72±0.70 mm (right), the midpoint thickness of the inferior lamina edge was 6.50±0.56 mm (left) and 6.50±0.66 mm (right), the distance from the lateral edge of the lamina to the spinous process midline was 25.95±2.86 mm (left) and 26.39±3.10 mm (right), the thickness at the pars defect was 9.67±0.57 mm (left) and 9.67±0.51 mm (right), and the vertical diameter of the pars defect was 18.76±2.16 mm (left) and 19.26±2.03 mm (right). No statistically significant differences were found between the left and right sides for these parameters ( P>0.05). The trajectories considered feasible and with an insertion success rate ≥95% were B2, B3, C2, and C3. Safe screw diameters were B2 (4.5 mm), B3 (4.0 mm), C2 (4.0 mm), and C3 (3.5 mm). Corresponding screw lengths were B2 (38.28±2.34 mm), B3 (37.03±2.99 mm), C2 (38.37±2.42 mm), and C3 (36.88±2.87 mm). The caudal inclination angles were B2 (52.73°±5.29°), B3 (55.06°± 4.46°), C2 (49.09°±3.92°), and C3 (50.18°±4.36°). The medial inclination angles were B2 (21.21°±3.01°), B3 (5.11°±1.58°), C2 (22.55°±2.46°), and C3 (12.59°±1.80°). The distances from the entry point to the spinous process midline were B2 (13.23±1.68 mm), B3 (13.15±1.46 mm), C2 (11.12±0.64 mm), and C3 (11.09±0.65 mm). The distances from the entry point to the root of the spinous process were B2 (8.23±1.46 mm), B3 (8.21±1.31 mm), C2 (6.65 ±0.76 mm), and C3 (6.67±0.72 mm). Differences in screw length, caudal inclination angle, medial inclination angle, and entry point position across trajectories were statistically significant ( P<0.05). Conclusion:The ideal screw trajectory for L 5 spondylolysis involves insertion through the midpoint of the entry zone, passing through the pars defect, and exiting at the midpoint of the superior edge of the pedicle. The optimal entry point is located on the inferior edge of the lamina, 8.23±1.46 mm from the root of the spinous process and 13.23±1.68 mm from the spinous process midline. The screw should be placed at a caudal inclination angle of 52.73°±5.29° and a medial inclination angle of 21.21°±3.01°. The recommended screw length is 38.28±2.34 mm, with a diameter of 4.5 mm (range, 4.5-5.0 mm).

Objective:To explore the anatomical parameters of the ideal trajectory for pedicle screw fixation through the lamina in the treatment of L 5 spondylolysis. Methods:CT data from 40 male patients with bilateral L 5 spondylolysis (age, 24.95±4.01 years; range, 20-36 years), treated at the 940th Hospital of PLA Joint Logistics Support Force between January 2021 and June 2024, were analyzed. Three-dimensional vertebral models were reconstructed using this data. Measurements included the lumbosacral angle, the thickness at the midpoint of the superior and inferior lamina edges, mid-lamina thickness, the distance from the lateral edge of the lamina to the spinous process midline, the thickness at the defect of the pars interarticularis, and the vertical diameter of the defect. The screws were inserted from the inferior edge of the lamina, passing through the pars interarticularis defect, and exiting at the superior edge of the pedicle. In the vertical direction of the lamina, the inferior and superior edges of the lamina were divided into three zones, named A, B, C (for the inferior lamina edge) and 1, 2, 3 (for the superior pedicle edge). Seven trajectories (A2, A3, B1, B2, B3, C2, and C3) were designed by combining these zones. Screws with diameters of 5.0, 4.5, 4.0, and 3.5 mm were sequentially inserted along each trajectory. Screw trajectories with an insertion success rate ≥95% were selected and evaluated for feasibility. Parameters such as screw length, medial inclination angle, caudal inclination angle, and entry point position were measured. The ideal trajectory and screw dimensions were determined by considering anatomical features, screw characteristics, and insertion safety. Results:The measurement results from the 3D model showed that the lumbosacral angle was 36.22°±5.23°, and the midpoint thickness of the superior lamina edge was 4.14±0.66 mm (left) and 4.18±0.65 mm (right), the mid-lamina thickness was 6.73±0.72 mm (left) and 6.72±0.70 mm (right), the midpoint thickness of the inferior lamina edge was 6.50±0.56 mm (left) and 6.50±0.66 mm (right), the distance from the lateral edge of the lamina to the spinous process midline was 25.95±2.86 mm (left) and 26.39±3.10 mm (right), the thickness at the pars defect was 9.67±0.57 mm (left) and 9.67±0.51 mm (right), and the vertical diameter of the pars defect was 18.76±2.16 mm (left) and 19.26±2.03 mm (right). No statistically significant differences were found between the left and right sides for these parameters ( P>0.05). The trajectories considered feasible and with an insertion success rate ≥95% were B2, B3, C2, and C3. Safe screw diameters were B2 (4.5 mm), B3 (4.0 mm), C2 (4.0 mm), and C3 (3.5 mm). Corresponding screw lengths were B2 (38.28±2.34 mm), B3 (37.03±2.99 mm), C2 (38.37±2.42 mm), and C3 (36.88±2.87 mm). The caudal inclination angles were B2 (52.73°±5.29°), B3 (55.06°± 4.46°), C2 (49.09°±3.92°), and C3 (50.18°±4.36°). The medial inclination angles were B2 (21.21°±3.01°), B3 (5.11°±1.58°), C2 (22.55°±2.46°), and C3 (12.59°±1.80°). The distances from the entry point to the spinous process midline were B2 (13.23±1.68 mm), B3 (13.15±1.46 mm), C2 (11.12±0.64 mm), and C3 (11.09±0.65 mm). The distances from the entry point to the root of the spinous process were B2 (8.23±1.46 mm), B3 (8.21±1.31 mm), C2 (6.65 ±0.76 mm), and C3 (6.67±0.72 mm). Differences in screw length, caudal inclination angle, medial inclination angle, and entry point position across trajectories were statistically significant ( P<0.05). Conclusion:The ideal screw trajectory for L 5 spondylolysis involves insertion through the midpoint of the entry zone, passing through the pars defect, and exiting at the midpoint of the superior edge of the pedicle. The optimal entry point is located on the inferior edge of the lamina, 8.23±1.46 mm from the root of the spinous process and 13.23±1.68 mm from the spinous process midline. The screw should be placed at a caudal inclination angle of 52.73°±5.29° and a medial inclination angle of 21.21°±3.01°. The recommended screw length is 38.28±2.34 mm, with a diameter of 4.5 mm (range, 4.5-5.0 mm).

Objective:To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+ LC) with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+ LC) in elderly patients with concomitant gallbladder and common bile duct (CBD) stones.Methods:This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January, 2014 and December, 2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University. There were 254 males and 238 females, aged (83.9±3.0) years. These patients were divided into two groups based on their operative methods: the one-stage group (LCBDE+ LC, n=186) and the two-stage group (ERCP+ LC, n=306). Differences in surgery, stones and hospitalization costs were compared between the two groups. Results:When compared with the ERCP+ LC group, the LCBDE+ LC group had significantly higher incidences of previous gastrectomy [21.5%(40/186) vs 4.2%(13/306)], multiple stones [77.4%(144/186) vs 49.3%(151/306)], larger stone diameter [13.7(6.4, 18.6)mm vs 10.9(5.7, 16.1) mm], and increased hospitalization expenditure [(2.37±0.31) Wanyuan vs (3.26±0.44) Wanyuan] (all P<0.05). However, the rates of residual stone [2.7%(5/186) vs 1.3%(4/306)], stone recurrence [2.2%(4/186) vs 5.2%(16/306)], postoperatively overall complications [3.2%(6/186) vs 1.3%(4/306)], and total hospital stay [(10.7±6.2) d vs (11.3±5.4) d] were not significantly different between the two groups (all P>0.05). Conclusions:Allowing for the similar safety and effectiveness, and lower hospitalization expenditure, LCBDE+ LC was a preferred choice for patients aged over 80 year, especially in patients who had previous gastrectomy, multiple large CBD stones, or who could not accept endoscopic procedures for treatment of CBD stones.

Objective To investigate the effects of adenosine monophosphate-activated protein kinase (AMPK) on high-mobility group box 1 (HMGB1) release from PC12 cells after oxygen-glucose deprivation and reoxygenation (OGD/R) and its mediated inflammatory response in BV2 cells.Methods PC12 and BV2 cells were cultured,respectively.The PC12 cells were used to induce a model of oxygen glucose deprivation for 12 h and reoxygenation for 24 h.After giving 5-aminoimidazole-4-carboxamide (AICAR) 5,50 and 100 μmol/L as well as Compound C 0.1,1 and 10 μmol/L activation or inhibition of AMPK phosphorylation,respectively,methyl thiazolyl tetrazolium (MTT) was used to detect the PC12 cell activity.Enzyme-linked immunosorbent assay was used to detect the HMGB1 release level in the PC12 cell culture media.After OGD/R in each group,the PC12 culture media were acted on normal cultured BV2 cells for 24 h respectively.Westem blotting and Enzyme-linked immunosorbent assay were used to detect the NFκB inhibitory protein (inhibitor of NFκB,IκB) phosphorylation level and TNF-α release level in BV2 cells,respectively.Results After OGD/R,the PC12 cell activity was decreased significantly (68.84％±6.60％ vs.100.04％ ± 8.82％;P ＜ 0.01);the AMPK phosphorylation level was increased significantly (1.95 ±0.39 vs.1.00 ±0.20;P＜0.05),and the extracellular HMGB1 release was increased significantly (287.66 ± 26.42 pg/μl vs.53.05 ± 9.11 pg/μl;P ＜ 0.01).Compared with the OGD/R group,AICAR 100 μmol/L significantly increased the survival rate of PC12 cell after OGD/R (78.6％ ± 3.75％ vs.68.84％ ± 6.60％;P ＜ 0.05),promoted AMPK phosphorylation (3.32 ± 0.66 vs.1.95 ± 0.39;P ＜ 0.01),and reduce the release of extracellular HMGB1 (164.06 ± 12.77 pg/μl vs.287.66 ± 26.42 pg/μl;P ＜0.01).In contrast,Compound C 10 μmol/L significantly reduced the cell survival rate of PC12 (40.44％ ±3.79％ vs.68.84％ ±6.60％;P ＜0.01),inhibited AMPK phosphorylation (1.07 ± 0.21 vs.1.95 ± 0.39;P＜0.05),and increased the release of HMGB1 (337.97 ± 18.9 pg/μlvs.287.66 ± 26.42 pg/μl;P＜0.01).The conditioned medium from the AICAR 100 μmol/L group significantly inhibited IκB phosphorylation (1.68 ±0.51 vs.3.09 ± 0.10;P ＜ 0.05) and reduced the release of TNF-α (669.53 ±38.58 pg/μlvs.841.76 ± 45.82 pg/μl;P＜ 0.05) in BV2 cells.The conditioned medium from the compound C 10 μmol/L group significantly promoted IκB phosphorylation (4.98 ± 1.24 vs.3.09 ± 0.10;P ＜0.01) and increased the release of TNF-α (1 035.32 ± 128.06 pg/μl vs.841.76 ± 45.82 pg/μl;P ＜0.05) in BV2 cells.Conclusions Promoting AMPK phosphorylation activation may reduce the release of HMGB1 from PC12 cells after OGD/R,and inhibit its mediated NF-κB inflammatory pathway and reduce the release of TNF-αin BV2 cells,and thus reducing neuroinflammatory injury.On the contrary,inhibiting AMPK phosphorylation may promote the release of HMGB1 from PC12 cells after OGD/R and aggravate its mediated inflammatory reaction in BV2 cells.

Objective To investigate the effect of Xuelian injection on mice models with Parkinson' s disease (PD).Methods C57BL/6 mice were given paraquat (PQ) by peritoneal injection (10 mg/kg) to induce PD models.Then,they were randomly divided into six groups:PD group,negative control group,positive controlgroup,low-dose (0.26mL/kg·d),middle-dose (0.52 mL/kg· d) and high-dose (1.04 mL/kg· d) Xuelian injection groups.Pole test and open field activity test were used for assessment of behavior 7 weeks after the injection; the dopamine (DA) content in the substantia nigra pars compacta (SNc) was observed by high-performance liquid chromatography (HPLC).The expressions of tyrosine hydroxylase (TH),integrin o (mac-l) and tumor necrosis factor α (TNF-α) in the SNc were measured by immunohistochemical staining under optical microscope.Results Seven weeks after the injection,the movement coordination disorder was significant in the PD group,and that had partial remission in the high-dose Xuelian injection group.HPLC showed that the DA content in the PD group was significantly lower than that in the negative control group (P＜0.05); that in the high-dose Xuelian injection group ([10.90±1.04] μg/g) was significantly higher than that in the PD group (P＜0.05).Immunohistochemical staining indicated that PD group had significantly decreased number of TH positive cells and statistically increased numbers of mac-1 and TNF-α positive cells as compared with the negative control group (P＜0.05); high-dose Xuelian injection group had significantly increased number of TH positive cells (65.18±6.00) and statistically decreased numbers of mac-1 and TNF-α positive cells (93.18±5.33 and 92.73±23.21) as compared with the PD group (P＜0.05).Conclusions High-dose Xuelian injection can obviously improve the movement coordination disorder and survival of DA neurons in the SNc,whose protective effect might be related to the inhabitation of microglia mediated inflammation injury and oxidative stress.

Objective To analyze the electromyogram (EMG) changes of patients with acute flaccid paralysis (AFP) in Hetian Xinjiang.Methods Twenty-six patients with acute poliogmyelitis,admitted to our hospital from July 2011 to September 2012,were chosen in our study; their clinical data were analyzed,and they all underwent EMG examination.Results Most patients had contact with respiratory virus or digestive virus prior to illness onset.Most of patients had flaccid paralysis,muscle strength between 0 and 2 grades,tendon reflex being abated and no sensory disturbance.Fourteen patients had positive blood stool.Motor nerve conduction velocity (MCV) was abnormal,H-reflex was decreased or not educed and sensory nerve conduction velocity was normal in lower limbs of the 26 patients; EMG showed myogenic abnormality.Nerve conduction velocity was normal or low and Fwave was normal or decreased in upper limbs; EMG showed neurogenic abnormality in five of the 26 patients.Poor prognosis was concluded in all the patients.Conclusion EMG has important diagnosis value in AFP induced by polio wild-type I.