Objective To analyze the microanatomical characteristics of the internal carotid artery(ICA)bifurcation through the lateral orbital keyhole(LOK)approach,thereby providing anatomical support for clipping the ICA bifurcation aneurysm.Methods A total of 15 cases(30 sides)of frozen cadaveric head specimens fixed with 10%formaldehyde and infused with red and blue latexes were selected.Craniotomy was performed by simulated LOK approach.The structure,and the course and quantity of the surrounding major perforator vessels of the ICA bifurcation were observed under the microscope,and the relevant data were recorded.Results The terminal diameter of ICA was(5.40±0.65)mm,and the length of ICA above the optic nerve plane was(11.99±1.86)mm.The proximal diameter of A1 was(1.85±0.26)mm,and the length of A1 was(12.90±3.13)mm;meanwhile,the proximal diameter of M1 was(3.64±0.64)mm,and the length of M1 was(15.54±2.10)mm.There were significant differences in the proximal diameter and length between A1 and M1(P<0.05).The angle between A1 and ICA was(77.61±19.43)°,while the angle between M1 and ICA was(137.93±10.31)°,and the difference between the two was statistically significant(P<0.001).There was no obvious linear relationship between the diameter ratio of A1 and ICA and the angle between A1 and ICA,and there was no obvious linear relationship between the diameter ratio of M1 and ICA and the angle between M1 and ICA.The peripheral perforator branches mainly consisted of 8.50(5.00,12.00)branches deriving from the proximal end of A1,0.50(0,3.25)branch deriving from the proximal end of M1,0(0,0.25)branch deriving from the distal end of ICA,(8.80±2.40)branches deriving from the posterior communicating artery,and(9.60±3.80)branches deriving from the anterior choroidal artery.The recurrent artery of Heubner was found in 28 sides,its main body could be the single trunk(30.00%),double trunk(43.00%),and triple trunk(20.00%).Conclusion The main structure and perforator branches of the ICA bifurcation can be clearly exposed through the LOK approach.When applying the LOK approach,it should be combined with the bifurcation angle,perforator branches distribution,and vascular variation characteristics of ICA bifurcation to optimize the aneurysm clipping plan,thereby thoroughly treating the lesion and minimizing the injury risk of perforator branches.

Objective To analyze the microanatomical characteristics of the internal carotid artery(ICA)bifurcation through the lateral orbital keyhole(LOK)approach,thereby providing anatomical support for clipping the ICA bifurcation aneurysm.Methods A total of 15 cases(30 sides)of frozen cadaveric head specimens fixed with 10%formaldehyde and infused with red and blue latexes were selected.Craniotomy was performed by simulated LOK approach.The structure,and the course and quantity of the surrounding major perforator vessels of the ICA bifurcation were observed under the microscope,and the relevant data were recorded.Results The terminal diameter of ICA was(5.40±0.65)mm,and the length of ICA above the optic nerve plane was(11.99±1.86)mm.The proximal diameter of A1 was(1.85±0.26)mm,and the length of A1 was(12.90±3.13)mm;meanwhile,the proximal diameter of M1 was(3.64±0.64)mm,and the length of M1 was(15.54±2.10)mm.There were significant differences in the proximal diameter and length between A1 and M1(P<0.05).The angle between A1 and ICA was(77.61±19.43)°,while the angle between M1 and ICA was(137.93±10.31)°,and the difference between the two was statistically significant(P<0.001).There was no obvious linear relationship between the diameter ratio of A1 and ICA and the angle between A1 and ICA,and there was no obvious linear relationship between the diameter ratio of M1 and ICA and the angle between M1 and ICA.The peripheral perforator branches mainly consisted of 8.50(5.00,12.00)branches deriving from the proximal end of A1,0.50(0,3.25)branch deriving from the proximal end of M1,0(0,0.25)branch deriving from the distal end of ICA,(8.80±2.40)branches deriving from the posterior communicating artery,and(9.60±3.80)branches deriving from the anterior choroidal artery.The recurrent artery of Heubner was found in 28 sides,its main body could be the single trunk(30.00%),double trunk(43.00%),and triple trunk(20.00%).Conclusion The main structure and perforator branches of the ICA bifurcation can be clearly exposed through the LOK approach.When applying the LOK approach,it should be combined with the bifurcation angle,perforator branches distribution,and vascular variation characteristics of ICA bifurcation to optimize the aneurysm clipping plan,thereby thoroughly treating the lesion and minimizing the injury risk of perforator branches.

Objective:To assess the value eosin-nigrosine(E-N)staining and hypo-osmotic swelling test(HOST)in the diag-nosis of necrospermia and investigate the correlation of the degree of sperm necrosis with sperm DNA fragmentation index(DFI)and high DNA stainability(HDS).Methods:Using computer-assisted sperm analysis(CASA),we examined the sperm motility of 7 333 males seeking medical care in Maternal and Child Health Hospital of Hunan Province from May 2023 to July 2024,detected the sperm viability of those with asthenozoospermia by E-N staining and HOST,and measured the sperm DFI and HDS of those with necro-spermia by sperm chromatin structure assay(SCSA).Based on sperm progressive motility(PR％),we divided the asthenozoospermia patients into three groups(PR％20％-＜30％,PR％10％-＜20％and PR％＜10％),assessed the value of E-N staining and HOST in the diagnosis of necrospermia,and analyzed the correlation of the severity of sperm necrosis with sperm DFI and HDS.Results:Asthenozoospermia was diagnosed in 1 374(18.74％)of the 7 333 males.The incidence rates of necrospermia revealed by E-N staining in the mild,moderate and severe asthenozoospermia groups were 0.55％(5/913),3.80％(12/316)and 35.86％(52/145),respectively,with a total incidence of 0.94％(69/7333),while those detected by HOST were 0.99％(9/913),6.96％(22/316)and 46.21％(67/145),respectively,with a total incidence of 1.34％(98/7333).There were no statistically significant differences in the results of diagnosis between the two methods(x2=0.97,P＞0.05).Both E-N staining and HOST showed that sperm DFI in the necrospermia males was negatively correlated with sperm viability(r=-0.366,r=-0.333,P＜0.05),and so was sperm HDS,though with no statistically significant difference(P＞0.05).Conclusion:For males with PR％＜30％,sperm viability test should be conducted,with E-N staining as the choice of priority for the diagnosis of necrospermia.Sperm necrosis and sperm nuclear chromatin damage may be interactive risk factors.

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.

Objective To evaluate the clinical efficacy of Xiaojianzhong Decoction plus Dachaihu Decoction in the treatment of chronic atrophic gastritis(CAG),and to provide scientific evidence for the clinical application of the formula.Methods The clinical observation was carried out in 80 CAG patients with spleen deficiency and stasis-heat syndrome of normal-people pulse type(the ratio of patients'pulse to the number of respirations within one minute being 4-5 evaluated by Changsangjun pulse-taking method)who attended the clinic of the Department of Gastroenterology of Shunde Hospital,Guangzhou University of Chinese Medicine,from January 2020 to December 2023.According to the treatment method,the patients were divided into the treatment group and the control group,with 40 cases in each group.The control group was given conventional western medicine treatment,and the treatment group was given Xiaojianzhong Decoction plus Dachaihu Decoction.Seven days constituted one course of treatment,and the treatment covered 6 months.The changes of traditional Chinese medicine(TCM)syndrome score,gastroscopy score,pathological score and gastric function indicators in the two groups were observed before and after the treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)After 6 months of treatment,the total effective rate of the treatment group was 90.00%(36/40),and that of the control group was 60.00%(24/40).The intergroup comparison(tested by chi-square test)showed that the efficacy of the treatment group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the scores of TCM syndromes in the two groups were significantly lower than those before treatment(P＜0.05),and the decrease of the scores in the treatment group was superior to that in the control group(P＜0.05).(3)After treatment,the gastroscopy scores of the two groups were significantly lower than those before treatment(P＜0.05),but there was no significant difference between the two groups after treatment(P＞0.05).(4)After treatment,the total pathological scores of the two groups and the scores of the gastric mucosal atrophy and intestinal metaplasia of the gastric antrum,gastric angle and gastric body in the treatment group were significantly improved compared with those before treatment(P＜0.05),and the improvement of the gastroscopy scores in the treatment group was significantly superior to that in the control group(P＜0.05).No statistically significant differences were presented in the scores of the gastric mucosal dysplasia and chronic inflammation of gastric antrum,gastric angle and gastric body in the two groups and in the scores of the gastric mucosal atrophy and intestinal metaplasia of gastric antrum,gastric angle and gastric body in the control group when compared with those before treatment(P＞0.05).(5)After treatment,the serum levels of gastric function indicators of pepsinogen Ⅰ(PGⅠ),pepsinogen Ⅱ(PGⅡ)and gastrin 17(G-17)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease in the treatment group was significantly superior to that in the control group(P＜0.05).(6)There were no obvious adverse reactions occurring in the two groups during the treatment,with high safety.Conclusion Xiaojianzhong Decoction plus Dachaihu Decoction can significantly enhance the clinical efficacy of CAG patients with spleen deficiency and stasis-heat syndrome of normal-people pulse type,significantly improve the gastrointestinal function and pathological scores of the patients,and has high safety.

Non-puerperal mastitis(NPM)is a group of chronic inflammatory diseases with breast pain,lumps,abscesses and sinus tracts/fistulas as the main clinical manifestations,which is easily confused with breast cancer or other benign breast diseases.NPM always leads to a long treatment cycle and high recurrence rate,which may cause a large economic and psychological burden to patients.At present,the etiology and pathogenesis of NPM are still unclear,but it has a certain correlation with immune abnormality,bacterial infection,hormone disorder and other factors.Although several diagnostic methods available,the diagnosis of NPM relies on histopathological examination mainly.The treatment methods of the disease include observation and follow-up,pharmacotherapy,surgical treatment,etc.,but there is still no unified standard for specific treatment timing and treatment selection.In view of the controversy over etiology and treatment selection of NPM,this paper comprehensively summarizes the latest research progress in disease characteristics,clinical diagnosis and treatment of NPM based on domestic and foreign literature,aiming to provide reference and inspiration for the selection of reasonable clinical diagnosis and treatment.

AIM: To investigate the correlation between the ocular demodex infection and the composition of meibum lipid flora.METHODS: A non-interventional and observational study was performed on recruited 39 patients in our hospital between July 2020 and February 2021. They were divided into control group(n=14), meibomian gland dysfunction(MGD)group(n=14), and demodex group(FM, n=11)according to the presence or absence of demodex infection or MGD. High-throughput sequencing of V3-V4 fragment of 16S rRNA gene was performed on the meibomian ester samples of the three groups of subjects, and bioinformatics analysis was performed on the sequencing data to study the composition and difference of meibum lipid flora in the subjects of ocular demodex.RESULTS: Pseudomonas and Comamonas in FM group were significantly higher than those in control group and MGD group(P<0.05), while Ralstonia in Demodex infection group was significantly lower than that in control group and MGD group(P<0.05). The microbial richness and community diversity of meibum lipid flora of the MGD group and the FM group were significantly higher than those of the control group(P<0.05).CONCLUSION: Ocular demodex infection changed the composition of meibum lipid flora and increased the microbial richness and community diversity of meibum lipid flora.

【Objective】 Dyslipidemia has shown to be associated with cardiovascular, metabolic and renal diseases. This study aimed to investigate the association between residual cholesterol and the risk of subclinical renal damage (SRD). 【Methods】 A total of 2 342 participants were recruited from the previously established Hanzhong Adolescent Hypertension Study cohort. According to estimated glomerular filtration rate(eGFR) and urinary albumin-to-creatine ratio(uACR), the subjects were divided into SRD group and non-SRD group. The associations of residual cholesterol with eGFR, uACR, and the risk of SRD were analyzed by multiple linear and Logistic regression analyses. 【Results】 Residual cholesterol was positively correlated with uACR(r=0.081, P<0.001) but negatively correlated with eGFR (r=-0.091, P<0.001). Multiple linear regression analysis revealed that residual cholesterol was an influencing factor of uACR (β=0.075, P<0.001) and eGFR (β=-0.027, P<0.001) after adjustment for gender, age, smoke, alcohol, exercise, BMI, hypertension, diabetes and serum uric acid. In addition, Logistic regression analysis revealed that residual cholesterol was significantly associated with the risk of SRD independently of potential confounders [OR(95% CI)=1.387 (1.113-1.728), P<0.001]. Further subgroup analysis showed that residual cholesterol was significantly associated with the risk of SRD in women but not in men. 【Conclusion】 Residual cholesterol is a contributing factor in the risk of subclinical renal damage with gender-specific association.

【Objective】 4-like protein with down-regulated expression and development in neural precursor cells (NEDD4L) plays an important role in blood pressure (BP) regulation and sodium homeostasis by regulating epithelial sodium channel protein. In this study, we aimed to explore the relationship of NEDD4L gene polymorphisms with BP responses to sodium and potassium intake. 【Methods】 In 2004, 514 subjects from 124 families in Meixian County, Shaanxi Province, were recruited to establish a salt-sensitive hypertension study cohort. All the subjects received a 3-day baseline survey, a 7-day low-salt diet, a 7-day high-salt diet, and finally a 7-day high-salt and potassium supplementation. Their BP was measured and peripheral blood samples were collected at different intervention periods. The 14 gene polymorphisms of NEDD4L gene were genotyped and analyzed by MassARRAY platform. 【Results】 BP decreased on a low-salt diet, and significantly increased on a high-salt diet, and decreased again after potassium supplementation. NEDD4L SNPs rs74408486 were significantly associated with systolic BP, diastolic BP and mean arterial pressure responses to the low-salt diet. SNPs rs292449 and rs2288775 were significantly associated with pulse pressure response to the high-salt diet. In addition, SNPs rs563283 and rs292449 were significantly associated with diastolic BP, mean arterial pressure, and pulse pressure responses to high-salt and potassium supplementation diet. 【Conclusion】 NEDD4L gene polymorphisms were significantly associated with BP responses to sodium and potassium intake, suggesting that NEDD4L gene may be involved in the development of salt sensitivity and potassium sensitivity.

【Objective】 Based on our previously established salt-sensitive hypertension cohort, we aimed to examine the association of genetic variants in uromodulin with blood pressure(BP) responses to dietary interventions of sodium and potassium intake. 【Methods】 In 2004, 514 subjects from 124 families in Mei County, Shaanxi Province, were recruited to establish the salt-sensitive hypertension study cohort. Among them, 333 non-parent subjects were selected and sequentially maintained on a normal-diet for 3 days, low-salt diet for 7 days, then a high-salt diet for 7 days and a high-salt diet with potassium supplementation for another 7 days. Thirteen single nucleotide polymorphisms(SNPs) in the uromodulin gene were genotyped on the MassARRAY platform. 【Results】 BP levels decreased from the baseline to low-salt diet, increased from low-salt to high-salt diet, and decreased again from the high-salt diet to the high-salt plus potassium supplementation intervention. SNPs rs77875418 and rs4997081 of the uromodulin gene were significantly associated with diastolic BP(DBP) and mean arterial pressure(MAP) responses to high-salt diet. In addition, SNPs rs77875418, rs79245268, rs4293393, rs6497476, rs4997081, rs13333226, and rs12917707 were significantly associated with systolic BP(SBP), DBP, and MAP responses to high-salt diet with potassium supplementation. 【Conclusion】 Genetic variants in uromodulin gene are significantly associated with BP responses to sodium and potassium supplementation, suggesting that uromodulin may be mechanistically involved in BP sodium-sensitivity and potassium-sensitivity.