OBJECTIVES: To explore the association between Chinese visceral adiposity index (CVAI) and the risk of nephrolithiasis. METHODS: This cross-sectional study analyzed data from 78 438 Chinese adults who underwent ultrasound examinations during health screening at the Health Examination Center of Affiliated Hospital of Yangzhou University. Participants were divided into quartiles (Q1-Q4 groups) based on CVAI. Multivariate logistic regression models were utilized to evaluate the association between CVAI and nephrolithiasis risk, followed by subgroup analyses to further explore potential relationships. The performance of CVAI in predicting the risk of nephrolithiasis was evaluated using receiver operating characteristic (ROC) curves. RESULTS: Increased CVAI was significantly associated with a higher risk of nephrolithiasis, with prevalence rising from 3.36% in the Q1 group to 10.67% in the Q4 group (P<0.01). In adjusted models, CVAI was positively correlated with the prevalence rate of nephrolithiasis (OR=1.002, 95%CI: 1.001-1.004, P<0.01). The risks of nephrolithiasis in the Q2, Q3, and Q4 groups were 1.196-fold (95%CI: 1.069-1.338, P<0.01), 1.260-fold (95%CI: 1.109-1.433, P<0.01), and 1.316-fold (95%CI: 1.125-1.539, P<0.01) higher than in the Q1 group, respectively. Subgroup analysis revealed that CVAI was positively associated with the risk of nephrolithiasis in male participants, individuals aged <60 years, the hypertension group, populations with or without diabetes mellitus, and the normal body mass index subgroup. Genders and age had an interaction effect on the correlation between CVAI and the risk of nephrolithiasis development (both P<0.05). The ROC curve analysis demonstrated that CVAI exhibited superior predictive efficacy compared to waist circumference, body mass index, visceral adiposity index, weight-adjusted waist index, cardiometabolic index and body shape index, with an area under the curve of 0.622. CONCLUSIONS In Chinese adults, CVAI is positively associated with the risk of nephrolithiasis development, which may serve as a potential predictive marker for nephrolithiasis.
Humans ; Nephrolithiasis/etiology* ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Adult ; Intra-Abdominal Fat ; Risk Factors ; China/epidemiology* ; Adiposity ; Aged ; Logistic Models ; Obesity, Abdominal/epidemiology* ; East Asian People

BACKGROUND:Bone relies on the close connection between blood vessels and bone cells to maintain its integrity.Bones are in a physiologically hypoxic environment.Therefore,the study of angiogenesis and osteogenesis in hypoxic environment is closer to the microenvironment in vivo. OBJECTIVE:To explore the influence of Wenshen Tongluo Zhitong(WSTLZT)formula on H-type bone microvascular endothelial cell/bone marrow mesenchymal stem cell co-culture system in hypoxia environment and its related mechanism. METHODS:Enzyme digestion method and flow sorting technique were used to isolate and identify H-type bone microvascular endothelial cells.Mouse bone marrow mesenchymal stem cells were isolated and obtained by bone marrow adhesion method.H-type bone microvascular endothelial cell/bone marrow mesenchymal stem cell hypoxic co-culture system was established using Transwell chamber and anoxic culture workstation.WSTLZT formula powder was used to intervene in each group at a mass concentration of 50 and 100 μg/mL.The angiogenic function of H-type bone microvascular endothelial cells in the co-culture system was evaluated by scratch migration test and tube formation test.The osteogenic differentiation ability of bone marrow mesenchymal stem cells in the co-cultured system was evaluated by alkaline phosphatase staining and alizarin red staining.The protein and mRNA expression changes of PDGF/PI3K/AKT signal axis related molecules in H-type bone microvascular endothelial cells in the co-cultured system were detected by Western Blotting and q-PCR,respectively. RESULTS AND CONCLUSION:(1)Compared with the normal oxygen group,the scratch mobility and new blood vessel length of H-type bone microvascular endothelial cells were significantly higher(P<0.05);the osteogenic differentiation capacity of bone marrow mesenchymal stem cells was higher(P<0.05);the expression of PDGF/PI3K/AKT axis-related molecular protein and mRNA increased(P<0.05)in the hypoxia group.(2)Compared with the hypoxia group,scratch mobility and new blood vessel length were significantly increased in the H-type bone microvascular endothelial cells(P<0.05);bone marrow mesenchymal stem cells had stronger osteogenic function(P<0.05);the expression of PDGF/PI3K/AKT axis-related molecular proteins and mRNA further increased(P<0.05)after treatment with different dose concentrations of WSTLZT formula.These findings conclude that H-type angiogenesis and osteogenesis under hypoxia may be related to the PDGF/PI3K/AKT signaling axis,and WSTLZT formula may promote H-type vasculo-dependent bone formation by activating the PDGF/PI3K/AKT signaling axis,thereby preventing and treating osteoporosis.

Objective:To analyze the association between the triglyceride-glucose(TyG)index and the risk of nephrolithiasis across various demographic and clinical subgroups,aiming to enhance early di-agnosis and treatment of nephrolithiasis and promote personalized care in diverse populations.Methods:This cross-sectional study analyzed the medical records of 84 968 adults,stratified into three categories(low,middle,high)according to their TyG index scores.To evaluate the association between the TyG index and nephrolithiasis risk,multivariable Logistic regression models were employed,adjusting for po-tential confounders.Additionally,piecewise linear regression models were used to investigate the non-linear dynamics of the TyG index's relationship with nephrolithiasis risk.Subgroup analyses were per-formed to explore variations in the effects of the TyG index across different demographic and clinical populations.Results:Increasing TyG index was associated with a higher risk of nephrolithiasis,rising from 4.36％in the low group to 8.96％in the high group(P＜0.001).In adjusted models,males in the middle and high TyG index categories demonstrated significantly elevated risks of nephrolithiasis,with odds ratios of 1.18(95％CI:1.07-1.31,P=0.002)and 1.29(95％CI:1.15-1.45,P＜0.001),respectively.Conversely,in females,the association was not statistically significant post-adjustment(OR=0.98,95％CI:0.82-1.16,P=0.778).Among males,for each unit increment in the TyG index be-low the critical threshold of 8.98,there was a notable 40％escalation in the risk of developing nephroli-thiasis(OR=1.40,95％CI:1.24-1.58,P＜0.001).Surpassing this threshold,the TyG index no longer conferred a significant increase in risk(OR=0.91,95％CI:0.78-1.06,P=0.24).Subgroup analyses indicated that this association remained stable regardless of age,BMI,or hypertension status.Conclusion:The TyG index is positively associated with the risk of nephrolithiasis in males,demonstra-ting a nonlinear dose-response relationship that becomes especially pronounced at certain index levels.This biomarker could potentially serve as a valuable clinical tool for identifying males who are at a high risk of developing nephrolithiasis,thereby enabling targeted preventive strategies.Further research is urgently needed to explore the underlying mechanisms and to verify the applicability of these results across different populations.

Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

OBJECTIVE To study the intervention effects of Wenshen Tongluo Zhitong Recipe(WTZR)on macrophage senes-cence and senile osteoporosis.METHODS The senescent macrophage model was established using hydrogen peroxide(H2 O2)and subsequently divided into four groups:control,model,low-dose drug-treated serum,and high-dose drug-treated serum.β-galactosidase staining,Western blot and qPCR were employed to evaluate the mRNA expression of senescence markers p21 and p53.ROS staining and JC-1 staining were applied to assess mitochondrial function in macrophages.The mRNA levels of Interleukin(IL)-6,IL-10,CD206,and inducible nitric oxide synthase(iNOS)were determined by qPCR analysis.Immunofluorescence was used to evaluate argi-nase(ARG1)and iNOS protein expressions for assessing the impact of drug-containing serum on macrophage polarization.qPCR analy-sis was conducted to measure osteocalcin(OCN),collagen type Ⅰ alpha 1(Col1a1),runt-related transcription factor 2(Runx2)mRNA levels as osteoblast-related markers;ALP staining along with alizarin red staining were performed to evaluate the effect of macrophage conditioned medium treated with drug-containing serum on bone marrow mesenchymal stromal cell(BMSC)osteogenic differentiation.C57BL/6J mice were randomly allocated into four groups:control group,model group,WTZR low-dose group,and WTZR high-dose group.The senile osteoporosis(SOP)mouse model was established by D-galactose.Micro-CT scanning analyzed fe-mur microstructure while HE staining detected pathological changes in femur bone tissue samples collected from each experimental con-dition.Furthermore,Western blot was used to detect the senescence-related molecules p21 and p53 and the osteogenesis-related mark-ers OCN and Runx2,qPCR analysis measured tibial expression levels of senescence-related molecules(p21,p53)as well as macro-phage polarisation-related molecules(IL-6,iNOS,CD206,and IL-10)to assess the effect of this compound on a mouse model simula-ting SOP.RESULTS Following intervention with serum containing WTZR,there was a significant decrease in the number of senes-cent positive cells compared to the model group.Additionally,there was a notable decrease in p21 and p53 mRNA and proteins expres-sion(P＜0.05,P＜0.01,P＜0.001).Furthermore,drug-containing WTZR effectively inhibited ROS production induced by H2 O2 and mitigated mitochondrial membrane potential reduction in macrophages(P＜0.05,P＜0.001).Treatment with drug-containing WTZR re-sulted in down-regulated mRNA expression of M1-related gene iNOS(P＜0.05)while up-regulating mRNA expression of M2-related genes CD163 and CD206(P＜0.05).The drug-containing WTZR significantly reduced fluorescence intensity for iNOS(P＜0.01)while increasing ARG1(P＜0.05)fluorescence intensity.Moreover,conditioned medium from macrophages treated with drug-containing ser-um increased ALP positive cell count(P＜0.01,P＜0.001),alizarin red positive area(P＜0.05),as well as Col1a1,Runx2 and OCN mRNA expression levels(P＜0.05,P＜0.01).The Tb.N,BMD,and BV/TV were significantly higher in the WTZR group compared to the model group(P＜0.05,P＜0.01,P＜0.001);meanwhile,Tb.Sp was notably lower than that observed in the model group(P＜0.05,P＜0.01);bone trabeculae were significantly improved,increased in number and widened.Additionally,the compound could significantly inhibit the D-galactose induced up-regulation of tibial senescence-related genes and proteins p21 and p53(P＜0.05,P＜0.001,P＜0.0001),promote the expression of osteogenesis-related markers OCN and Runx2 protein(P＜0.01,P＜0.0001),promote the down-regulation of M1 related genes IL-6 and iNOS(P＜0.05),and promote the expression of M2 related genes IL-10 and CD206(P＜0.05,P＜0.01).CONCLUSION Wenshen Tongluo Zhitong Recipe may play an anti-osteoporosis effect by inhibiting macrophage senescence and promoting the osteogenic differentiation of BMSC.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective:To explore the ultrasonic hemodynamic characteristics of early allograft dysfunction after left lateral lobe liver transplantation in children with biliary atresia.Methods:A total of 546 children with biliary atresia who underwent related left lateral lobe liver transplantation at Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, according to the early functional recovery of the transplanted liver, it was divided into a normal function recovery group (non-EAD group) and an early allograft dysfunction group (EAD group). The hepatic artery peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), resistance index (RI), portal vein diameter (PVD), portal vein flow velocity (PVV), portal vein flow (PVF), left hepatic vein diameter (LHVD) and left hepatic vein velocity (LHVV) were measured 1 to 7 days after surgery (a total of 3 703 ultrasound examination results), and the differences in ultrasound hemodynamic parameters between the two groups were compared. Binary logistic regression analysis was used to determine the correlation between hepatic artery RI=1.0, PSV<25 cm/s, PVV<15 cm/s, LHVV<15 cm/s and the occurrence of EAD within 7 days after surgery.Results:① Among the 546 children with biliary atresia, 262 children developed EAD after liver transplantation, and 284 children did not develop EAD. ②The portal vein flow of children in the EAD group was lower than that of the non-EAD group on 3 days, 4 days, 6 days and 7 days after surgery [3 days: 783 (560, 1 170) ml/(min·100 g) vs 942 (597, 1 381) ml/(min·100 g), P=0.006; 4 d: 862(594, 1 443) ml/(min·100 g) vs 1 068(748, 1 606) ml/(min·100 g), P=0.001; 6 d: 1 024 (631, 1 447) ml/(min·100 g) vs 1 141 (777, 1 709) ml/(min·100 g), P=0.005; 7 d: 937 (619, 1 408) ml/(min·100 g) vs 1 066 (670, 1 557) ml/(min·100 g), P=0.018]. The hepatic artery blood flow parameter RI was higher than that in the non-EAD group 7 days after surgery [0.72 (0.65, 0.79) vs 0.70 (0.63, 0.76), P=0.025]. There were no statistically significant differences in hepatic venous blood flow parameters between the two groups from 1 to 7 days (all P>0.05). ③Both the PVV and PVF in the EAD group and the non-EAD group showed an overall upward trend over time from 1 to 7 days after surgery, but compared with the non-EAD group, the portal vein flow in the EAD group increased more slowly from 3 to 7 days [PVF change rate: 0.01 (-0.25, 0.62)% vs 0.06 (-0.41, 0.41)%, P=0.003], while PSV, EDV and LHVV had no significant fluctuations. ④In the ultrasound hemodynamic abnormality index, the EAD group has a higher probability of transplanted hepatic artery RI=1.0 than the non-EAD group. Binary logistic regression analysis showed that hepatic artery RI=1.0 within 7 days after surgery was correlated with the occurrence of EAD [Exp(B)=2.413, P=0.005]. Conclusions:After left lateral lobe liver transplantation in children with biliary atresia, the portal vein of children with EAD showed a relatively low flow state.Abnormal ultrasound hemodynamic index hepatic artery RI=1.0 in children within 7 days after surgery can indicate the occurrence of EAD. Ultrasound examination can provide hemodynamic basis for early clinical detection of the presence of EAD.

Objective:To explore the characteristics of postoperative hemodynamic changes in patients with early allograft dysfunction (EAD), and to provide clinical imaging support for the early diagnosis of EAD.Methods:A total of 907 patients who underwent liver transplantation in Tianjin First Central Hospital from December 2012 to June 2021 were retrospectively selected, and they were divided into EAD group (361 cases) and non-EAD group (546 cases) according to EAD diagnostic criteria. The peak systolic velocity(PSV) of the hepatic artery, end-diastolic velocity(EDV) of the hepatic artery, resistance index(RI), S/D(PSV/EDV), diameter of the portal vein(PVD), velocity of the portal vein(PVV), diameter of the middle hepatic vein(MHVD), velocity of the middle hepatic vein(MHVV), the diameter of the right hepatic vein(RHVD), and the velocity of the right hepatic vein (RHVV) were collected from 1 to 7 days after operation (a total of 5 573 ultrasound examination results), and the differences in ultrasound hemodynamic parameters were compared between the two groups. The correlation of S/D<2, PSV<25 cm/s, PVV<15 cm/s, MHVV or RHVV<15 cm/s within 3 days after operation with the occurence of EAO were analyzed by multivariate Logistic regression analysis.Results:①The PSV and EDV of the hepatic artery in the EAD group and the non-EAD group showed a slow upward trend at 1-7 days after operation, while the hepatic artery RI and PVV showed a downward trend, the MHVV and RHVV did not fluctuate significantly. ②The hepatic artery in the EAD group showed low-resistance blood flow in the early postoperative period, and the EDV were significantly higher than that in the non-EAD group on 1 d, 2 d, 3 d and 5 d, RI was significantly lower than that of the non-EAD group (all P<0.05); At 4 d, 6 d and 7 d, there was no significant differences of EDV and RI between the two groups(all P>0.05). The PSV of the EAD group was higher than that of the non-EAD group on 3 d ( P<0.05). Among the parameters of portal vein blood flow, the PVV in the EAD group was significantly higher than that in the non-EAD group on 1 d ( P<0.05), and there was no significant difference of PVD between the two groups at day 1-7. Among the parameters of hepatic venous blood flow, the MHVV and RHVV in the EAD group were significantly lower than those in the non-EAD group (all P<0.05), there was no significant difference between the two groups of MHVD and RHVD at 1-7 days. ③The incidence of grafted hepatic artery S/D<2 within 3 days after operation in EAD group was higher than that in non-EAD group. Binary Logistic regression multivariate analysis showed that the occurrence of grafted hepatic artery S/D<2 within 3 days after operation was significantly correlated with the occurrence of EAD[Exp(B)=1.878, P<0.05]. Conclusions:Patients who develop EAD after liver transplantation show low-resistance blood flow in the hepatic artery during the perioperative period, and the occurrence of hepatic artery S/D<2 within 3 days after operation can early predict the occurrence of EAD.

Objective:To investigate the value of brain functional connectivity density (FCD) derived from resting-state functional magnetic resonance imaging (rs-fMRI) in differentially diagnosing 2 subtypes of Parkinson's disease (PD): tremor dominant (TD) and non-tremor dominant (nTD), as well as its correlation with clinical symptom scores.Methods:A retrospective analysis was performed; 45 PD patients (25 with TD and 20 with nTD), admitted to Department of Neurology, Drum Tower Hospital Affiliated to Medical School of Nanjing University were chosen; and 24 middle-aged and elderly volunteers matched in age, gender and years of education at the same time were chosen as normal controls (NCs). The rs-fMRI data were collected and FCD map of the whole brain was computed. The FCD differences in whole brain and brain regions enjoying different FCD were compared among the 3 groups. ROC curve was used to analyze the differential diagnostic efficacy of FCD in brain regions enjoying different FCD in TD and nTD. Correlations of FCD in brain regions enjoying different FCD with disease course, Hoehn-Yahr (H-Y) grading, unified Parkinson's disease rating scale (UPDRS) III scores, tremor scores and non-tremor scores were analyzed by Pearson or Spearman correlation analyses.Results:Brain regions enjoying different FCD among the TD, nTD, and NC groups were the right lingual gyrus, right orbital medial frontal gyrus, right insula, left superior temporal gyrus, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus, and left angular gyrus. FCD in the right orbital medial frontal gyrus and left angular gyrus of TD group was significantly higher than that in the nTD group ( P<0.05); while FCD in the right insula, right anterior central gyrus, left posterior central gyrus and right medial and paracingulate gyrus of TD group was significantly lower than that in the nTD group ( P<0.05). Area under the curve of combined application of FCD in brain regions enjoying different FCD in differentially diagnosing TD and nTD was 0.842, with sensitivity and specificity of 80.0%. FCD in the left superior temporal gyrus and left posterior central gyrus was positively correlated with H-Y grading ( P<0.05), while FCD in the left angular gyrus was negatively correlated with H-Y grading ( P<0.05). FCD in the left superior temporal gyrus was positively correlated with UPDRS III scores ( P<0.05). FCD in the right lingual gyrus, right insula, left insula, right anterior central gyrus, left posterior central gyrus, right medial and paracingulate gyrus was negatively correlated with tremor scores ( P<0.05). FCD in the left superior temporal gyrus, right medial and paracingulate gyrus was positively correlated with non-tremor scores ( P<0.05), whereas that in the left angular gyrus was negatively correlated with non-tremor scores ( P<0.05). Conclusion:Abnormalities in FCD exist in certain brain regions of PD patients, with disparities between TD and nTD. Combined application of FCD in brain regions enjoying different FCD can effectively differentiate TD and nTD, and this FCD is also partially correlated with the symptom scores of PD patients.

With the continuous advancement of the deepening reform of the medical security system, the medical insurance payment method, as an important part of it, has become the focus of the reform. As one of the main types of innovative payment methods, payment for performance combines payment and medical service quality to improve the efficiency of medical and health services and patient satisfaction. In order to accelerate the clinical application of new medical technologies, improve patients′ access to innovative technologies, and reduce the disease economic burden of patients, Shanghai has carried out a pilot reform of paying for performance for three new technologies including Cryoablation in the treatment of cancer, Da Vinic Robotic Surgical System and Plasma MicroRNA Panel detection. Through multiple rounds of expert consultation and on-the-spot investigation, the positive detection rate, complication rate and tumor reduction rate were finally determined as the performance evaluation indicators of the three technologies, and the corresponding payment standards were defined. The pilot reform in Shanghai could provide reference for other regions to carry out performance based payment.