ObjectiveToll-like receptor 4 （TLR4）， a receptor for pathogen-associated molecular patterns of innate immunity， is associated with neurodegenerative diseases. Interleukin （IL）-6， IL-1β， and tumor necrosis factor-α （TNF-α） as common pro-inflammatory cytokines and high-sensitivity C-reactive protein （hs-CRP） are related to inflammatory responses. This study evaluated the clinical efficacy and possible mechanisms of therapeutic effects of Fengyintang on early and mid-stage PD with excessive heat generating wind by observing the effects of Fengyintang on the serum levels of TLR4， IL-6， IL-1β， TNF-α， and hs-CRP in the patients with PD. MethodsSixty-eight PD patients who met the inclusion criteria were randomly assigned into the control group and the observation group （n=34）. Both groups were treated with anti-PD Western medicine and the observation group was additionally treated with Fengyintang. Both groups were treated for 8 weeks. Before and after 8 weeks of treatment， the patients in the two groups were measured for their TCM symptom scores， International Movement Disorder Society Unified Parkinson's Disease Rating Scale （MDS-UPDRS） score， Parkinson's Disease Non-Motor Symptom Scale （NMSS） score， Patient Assessment of Constipation Symptom （PAC-SYM） score， Pittsburgh Sleep Quality Index （PSQI）， Hamilton Anxiety Scale （HAMA） score， Hamilton Depression Scale （HAMD） score， and changes in serum TLR4， IL-6， IL-1β， TNF-α， and hs-CRP levels. ResultsOne case in the control group was removed due to loss of visit， and a total of 67 PD patients （33 in the control group and 34 in the observation group） who met the criteria were included for analysis. After treatment， patients in the observation group showed decreases in scores of TCM symptoms， MDS-UPDRS， NMSS， PAC-SYM， PSQI， HAMA， and HAMD （P<0.05， P<0.01）. Moreover， the observation group had lower scores of TCM symptoms， MDS-UPDRS， NMSS， PAC-SYM， PSQI， HAMA， and HAMD than the control group （P<0.05， P<0.01）. The observation group showed higher efficacy in terms of TCM symptoms and MDS-UPDRS score than the control group （Z=-0.57， P<0.05）. The overall response rate was higher in the observation group than in the control group （Z=-0.62， P<0.05， P<0.01）. The serum TLR4， TNF-α， IL-1β， IL-6， and hs-CRP levels of the observation group were lower than those of the control group （P<0.05， P<0.01）. ConclusionFengyintang combined with Western medicine can safely and effectively alleviate the clinical symptoms， reduce the levels of inflammatory factors， improve the quality of life， and delay the disease progression of PD patients by inhibiting peripheral TLR4 expression and thus suppressing the downstream inflammatory response.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objective This study quantitatively analyzed the initial displacement and stress distribution of maxillary teeth and periodontal ligaments(PDLs)under different traction positions of Class Ⅱ elastics in the anterior region of fixed multibracket appliances,aiming to provide references for the optimal application of Class Ⅱ elastics.Methods A finite element model of the maxilla with Class Ⅱ elastics was established.Based on whether tooth extraction was performed and the traction positions of Class Ⅱ elastics in the maxillary anterior region,the models were divided into 4 groups and 8 working conditions.A 1.2 N load was applied between the maxillary anterior region and the tube of the mandibular first molar.The initial displacement of maxillary teeth and the von Mises stress of maxillary PDLs were analyzed.Results The finite element model of the maxilla with Class Ⅱelastics was successfully constructed.Class Ⅱ elastics induced lingual inclination,eruption,and retraction of maxillary anterior teeth.Variations in the traction positions of Class Ⅱ elastics resulted in differences in the initial displacement of maxillary teeth and the von Mises stress of PDLs.The maximum von Mises stress of PDLs ranged from 5.8 to 12.2 kPa across all working conditions.Conclusions Different traction positions of Class Ⅱelastics alter the torque,induce distinct deformation trends in the archwire,and thus affect tooth movement.Compared with attaching Class Ⅱ elastics to the maxillary canine bracket,attaching them to the hooks increases the tendency toward deep overbite,and this tendency is more pronounced in extraction models.For patients with Class Ⅱ,Division 1 malocclusion,anterior tooth protrusion,and a tendency toward open bite,applying Class Ⅱelastics on the occlusal side of the hooks may be more beneficial in alleviating open bite and enhancing the smile arc.However,the actual efficacy requires clinical verification.

Objective To characterize the features of patent foramen ovale(PFO)-related cryptogenic stroke using diffusion-weighted imaging(DWI)and to investigate the correlation between infarct size and cardiac CT characteristics of PFO.Methods A retrospective,consecutive cohort study was conducted on acute ischemic stroke patients admitted to Neurology Department of Xuanwu Hospital,Capital Medical University from January 2022 to September 2024.Patients were categorized into PFO group,arterio-arterial embolism(AAE)group,and atrial fibrillation(AF)group based on etiological diagnosis.Baseline clinical data,including age,height,body mass index,admission National Institutes of Health stroke scale(NIHSS)score,history of old cerebral infarction,hypertension,diabetes mellitus,coronary heart disease,dyslipidemia,and smoking history were collected and compared.All patients underwent head MR within 24 h of admission.DWI was used to analyze and compare infarct characteristics across the three groups,including lesion number(single or multiple),location(cortical+subcortical,deep white matter,cortical+subcortical+deep white matter,cerebellum+thalamus+brainstem),size(≥15 mm or＜15 mm,based on maximum transverse diameter;for multiple lesions,if any lesion had a maximum diameter≥15 mm,it was categorized as≥15 mm),infarcted vascular territory(anterior,posterior,or both circulations),and specific arterial supply(anterior cerebral artery,middle cerebral artery,posterior cerebral artery,basilar artery,posterior inferior cerebellar artery,superior cerebellar artery,anterior choroidal artery,or multiple arteries).Patients in the PFO group additionally underwent cardiac CT to measure PFO-related parameters:tunnel length,width,height,septum secundum thickness,and fossa ovalis length.Spearman correlation analysis was performed to evaluate the relationship between infarct size and PFO cardiac CT features.Results A total of 232 acute ischemic stroke patients were included(mean age[57±17]years,ranged 19-86 years;141 males,91 females),comprising 116 in the PFO group,36 in the AAE group,and 80 in the AF group.(1)The proportion of males in the PFO group was higher than that in the AF group,it was lower than that in the AAE group.The age,body mass index and proportions of patients with hypertension,diabetes,hyperlipidemia,coronary heart disease were all lower than those in the other two groups(both P＜0.016 7),while other baseline characteristics showed no significant differences(all P＞0.05).(2)The PFO group exhibited a higher proportion of multiple infarcts compared to the AAE group(83.62％[97/116]vs.61.11％[22/36],P＜0.016 7),but a lower proportion than the AF group(83.62％[97/116]vs.98.75％[79/80],P＜0.016 7).The PFO group also showed a significantly higher proportion of cortical+subcortical infarcts(47.41％[55/116]vs.11.11％[4/36]and 6.25％[5/80],respectively,both P＜0.016 7)and infarcts with a maximum diameter＜15 mm compared to both AAE and AF groups(66.38％[77/116]vs.36.11％[13/36]and 11.25％[9/80],respectively,both P＜0.016 7).Furthermore,the PFO group had a lower proportion of anterior circulation infarcts(27.59％[32/116]vs.69.44％[25/36]in AAE group and 67.50％[54/80]in AF group,both P＜0.016 7),but a higher proportion of posterior circulation infarcts(62.07％[72/116]vs.16.67％[6/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).Specifically,middle cerebral artery infarcts were less common in the PFO group(18.97％[22/116]vs.66.67％[24/36]in AAE group and 52.50％[42/80]in AF group,both P＜0.016 7),while posterior cerebral artery infarcts were more common(48.28％[56/116]vs.8.33％[3/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).(3)Spearman correlation analysis revealed that infarct size was negatively correlated with PFO tunnel length(rs=-0.429,P=0.029),fossa ovalis length(rs=-0.408,P=0.038),and septum secundum thickness(rs=-0.525,P=0.006),but not correlated with PFO width or height(both P＞0.05).Conclusions PFO-related cryptogenic stroke is predominantly characterized by multiple small infarcts,primarily located in the cortical+subcortical regions and posterior circulation.Infarct size was found to be negatively correlated with PFO tunnel length,fossa ovalis length,and septum secundum thickness.Comprehensive assessment integrating DWI and cardiac CT features may facilitate the identification of PFO-related stroke.These findings warrant further validation through larger,prospective studies.

Objective This study quantitatively analyzed the initial displacement and stress distribution of maxillary teeth and periodontal ligaments(PDLs)under different traction positions of Class Ⅱ elastics in the anterior region of fixed multibracket appliances,aiming to provide references for the optimal application of Class Ⅱ elastics.Methods A finite element model of the maxilla with Class Ⅱ elastics was established.Based on whether tooth extraction was performed and the traction positions of Class Ⅱ elastics in the maxillary anterior region,the models were divided into 4 groups and 8 working conditions.A 1.2 N load was applied between the maxillary anterior region and the tube of the mandibular first molar.The initial displacement of maxillary teeth and the von Mises stress of maxillary PDLs were analyzed.Results The finite element model of the maxilla with Class Ⅱelastics was successfully constructed.Class Ⅱ elastics induced lingual inclination,eruption,and retraction of maxillary anterior teeth.Variations in the traction positions of Class Ⅱ elastics resulted in differences in the initial displacement of maxillary teeth and the von Mises stress of PDLs.The maximum von Mises stress of PDLs ranged from 5.8 to 12.2 kPa across all working conditions.Conclusions Different traction positions of Class Ⅱelastics alter the torque,induce distinct deformation trends in the archwire,and thus affect tooth movement.Compared with attaching Class Ⅱ elastics to the maxillary canine bracket,attaching them to the hooks increases the tendency toward deep overbite,and this tendency is more pronounced in extraction models.For patients with Class Ⅱ,Division 1 malocclusion,anterior tooth protrusion,and a tendency toward open bite,applying Class Ⅱelastics on the occlusal side of the hooks may be more beneficial in alleviating open bite and enhancing the smile arc.However,the actual efficacy requires clinical verification.

Objective To characterize the features of patent foramen ovale(PFO)-related cryptogenic stroke using diffusion-weighted imaging(DWI)and to investigate the correlation between infarct size and cardiac CT characteristics of PFO.Methods A retrospective,consecutive cohort study was conducted on acute ischemic stroke patients admitted to Neurology Department of Xuanwu Hospital,Capital Medical University from January 2022 to September 2024.Patients were categorized into PFO group,arterio-arterial embolism(AAE)group,and atrial fibrillation(AF)group based on etiological diagnosis.Baseline clinical data,including age,height,body mass index,admission National Institutes of Health stroke scale(NIHSS)score,history of old cerebral infarction,hypertension,diabetes mellitus,coronary heart disease,dyslipidemia,and smoking history were collected and compared.All patients underwent head MR within 24 h of admission.DWI was used to analyze and compare infarct characteristics across the three groups,including lesion number(single or multiple),location(cortical+subcortical,deep white matter,cortical+subcortical+deep white matter,cerebellum+thalamus+brainstem),size(≥15 mm or＜15 mm,based on maximum transverse diameter;for multiple lesions,if any lesion had a maximum diameter≥15 mm,it was categorized as≥15 mm),infarcted vascular territory(anterior,posterior,or both circulations),and specific arterial supply(anterior cerebral artery,middle cerebral artery,posterior cerebral artery,basilar artery,posterior inferior cerebellar artery,superior cerebellar artery,anterior choroidal artery,or multiple arteries).Patients in the PFO group additionally underwent cardiac CT to measure PFO-related parameters:tunnel length,width,height,septum secundum thickness,and fossa ovalis length.Spearman correlation analysis was performed to evaluate the relationship between infarct size and PFO cardiac CT features.Results A total of 232 acute ischemic stroke patients were included(mean age[57±17]years,ranged 19-86 years;141 males,91 females),comprising 116 in the PFO group,36 in the AAE group,and 80 in the AF group.(1)The proportion of males in the PFO group was higher than that in the AF group,it was lower than that in the AAE group.The age,body mass index and proportions of patients with hypertension,diabetes,hyperlipidemia,coronary heart disease were all lower than those in the other two groups(both P＜0.016 7),while other baseline characteristics showed no significant differences(all P＞0.05).(2)The PFO group exhibited a higher proportion of multiple infarcts compared to the AAE group(83.62％[97/116]vs.61.11％[22/36],P＜0.016 7),but a lower proportion than the AF group(83.62％[97/116]vs.98.75％[79/80],P＜0.016 7).The PFO group also showed a significantly higher proportion of cortical+subcortical infarcts(47.41％[55/116]vs.11.11％[4/36]and 6.25％[5/80],respectively,both P＜0.016 7)and infarcts with a maximum diameter＜15 mm compared to both AAE and AF groups(66.38％[77/116]vs.36.11％[13/36]and 11.25％[9/80],respectively,both P＜0.016 7).Furthermore,the PFO group had a lower proportion of anterior circulation infarcts(27.59％[32/116]vs.69.44％[25/36]in AAE group and 67.50％[54/80]in AF group,both P＜0.016 7),but a higher proportion of posterior circulation infarcts(62.07％[72/116]vs.16.67％[6/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).Specifically,middle cerebral artery infarcts were less common in the PFO group(18.97％[22/116]vs.66.67％[24/36]in AAE group and 52.50％[42/80]in AF group,both P＜0.016 7),while posterior cerebral artery infarcts were more common(48.28％[56/116]vs.8.33％[3/36]in AAE group and 8.75％[7/80]in AF group,both P＜0.016 7).(3)Spearman correlation analysis revealed that infarct size was negatively correlated with PFO tunnel length(rs=-0.429,P=0.029),fossa ovalis length(rs=-0.408,P=0.038),and septum secundum thickness(rs=-0.525,P=0.006),but not correlated with PFO width or height(both P＞0.05).Conclusions PFO-related cryptogenic stroke is predominantly characterized by multiple small infarcts,primarily located in the cortical+subcortical regions and posterior circulation.Infarct size was found to be negatively correlated with PFO tunnel length,fossa ovalis length,and septum secundum thickness.Comprehensive assessment integrating DWI and cardiac CT features may facilitate the identification of PFO-related stroke.These findings warrant further validation through larger,prospective studies.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objective: To investigate the prevalence and influencing factors of hyperuricemia among adults in Xinjiang Uygur Autonomous Region, so as to provide insights into the prevention and intervention of hyperuricemia. Methods: Permanent residents at ages of 18 years and above in 8 counties (cities, districts) of Xinjiang Uygur Autonomous Region were sampled using a multi-stage cluster random sampling method from July 2018 to November. Demographic data, smoking, alcohol consumption, body mass index and serum uric acid were collected through questionnaire surveys, physical examination and laboratory testing. Factors affecting hyperuricemia were analyzed using a multivariable logistic regression model. Results: A total of 4 690 residents were collected, including 2 093 males (44.63%) and 2 597 females (55.37%), and had a mean age of (49.45±14.57) years. There were 1 795 overweight residents (38.27%), 1 198 residents with obesity (25.54%), 983 smokers (20.96%), 1 224 drinkers (26.10%), and 268 residents with hyperuricemia (5.71%). Multivariable logistic regression analysis showed that a higher risk of hyperuricemia was seen among adults who were males (OR=1.409, 95%CI: 1.036-1.917), aged 60 years and above (OR=2.092, 95%CI: 1.495-2.928), had high school education or above (high school, OR=2.003, 95%CI: 1.366-2.937; college and above, OR=4.876, 95%CI: 3.196-7.438), were overweight (OR=2.343, 95%CI: 1.618-3.395) or obese (OR=4.754, 95%CI: 3.291-6.868) and had alcohol consumption (OR=1.494, 95%CI: 1.104-2.020). Conclusion The risk of hyperuricemia may be associated to gender, age, educational level, body mass index and alcohol consumption among adults in Xinjiang Uygur Autonomous Region.

Objective:To investigate the influencing factors of prolonged postoperative ileus (PPOI) in patients undergoing pancreaticoduodenectomy (PD) during hospitalization.Methods:The data of 339 patients underwent PD admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2018 to September 2023 were retrospectively analyzed, including 204 males and 135 females, aged (60.6±11.2) years. Among the 339 patients, 112 (33.0%) had pancreatic tumors, 94 (27.7%) had Vater ampullary tumors, 82 (24.2%) had common bile duct tumors, and 51 (15.0%) had duodenal tumors. A total of 339 patients with PPOI were included in the PPOI group ( n=43) and those without PPOI were included in the control group ( n=296). The two groups were compared in terms of age, PD operation (open or laparoscopic), gastrojejunostomy (retrocolic or antecolic gastrojejunostomy), grade B or C pancreatic fistula, hypokalemia, and postoperative use of patient-controlled intravenous analgesia (PCIA). The index comparing P<0.05 between the two groups was further included in the multivariate logistic regression analysis to analyze the influencing factors of PPOI in PD patients. Results:There were statistically significant differences in age >70 years, PD operation, gastrojejunostomy, grade B or C pancreatic fistula, hypokalemia, and postoperative use of PCIA between the two groups (all P<0.05). Multivariate logistic regression analysis showed grade B or C pancreatic fistula ( OR=3.17, 95% CI: 1.48-6.82), open surgery ( OR=2.90, 95% CI: 1.35-6.24), retrocolic gastrojejunostomy ( OR=2.47, 95% CI: 1.23-4.95), postoperative usage of PCIA ( OR=2.61, 95% CI: 1.21-5.62), age >70 years ( OR=2.47, 95% CI: 1.71-5.19) had a high risk of PPOI during postoperative hospitalization (all P<0.05). Conclusion:Postoperative grade B or C pancreatic fistula, open surgery, retrocolic gastrojejunostomy (compares with antecolic gastrojejunostomy), postoperative using PCIA, and age >70 years are independent risk factors for PPOI in patients undergoing PD during postoperative hospitalization.

Objective:To describe disability rates of dementia in community residents aged 65 years and over in China,and explore related risk factors of disability.Methods:This study conducted an in-depth data analysis of the China Mental Health Survey.World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0)was used to assess dementia disability,Community Screening Interview for Dementia(CSID)and Geriatric Mental Status Examination(GMS)were used for dementia screening and diagnosing.Univariate analysis was used to calcu-late the weighted disability rates of dementia in population and in patients,and their population distribution.Multiple linear regression and logistic regression were used to analyze the risk factors of the occurrence of dementia disability and its severity.Results:The weighted disability rate of dementia was 2.1％in population,and 38.6％in pa-tients.The disability rates of comorbid dementia in population and in patients were higher than those of patients with only dementia.Female,older age,lower education level,lower economic status,and lower cognitive test scores in CSID had higher disability rates of dementia in population.Female and urban resident had higher disability rates of dementia in patients.Multiple linear regression showed economic status(β=0.11),gender(β=0.11),age(β=0.10),and treatment in the last 12 months(β=-0.20)were statistically associated with WHODAS 2.0 scores.Multiple logistic regression showed female(OR=2.81)and treatment in the last 12 months(OR=2.38)were statistically associated with disability.Conclusions:Persons with low economic status,female and elderly peo-ple are the high-risk groups for dementia disability.It should be paid attention to prevent dementia and its conse-quential disabilities.