Autoimmune pancreatitis is a special type of chronic pancreatitis that can lead to abnormal pancreatic exocrine function in patients. Autoimmune pancreatitis comorbid with pancreatic exocrine insufficiency has a complex pathogenesis， and there is limited research on this topic， leading to the lack of understanding of such patients in clinical practice. This article introduces the epidemiology of autoimmune pancreatitis， briefly describes the pathogenesis of pancreatic exocrine insufficiency caused by autoimmune pancreatitis， and summarizes the various detection methods for pancreatic exocrine function， nutritional assessments， lifestyle management， and drug therapy， in order to strengthen the understanding of autoimmune pancreatitis comorbid with pancreatic exocrine insufficiency and improve the clinical diagnosis and treatment of pancreatic exocrine insufficiency.

Symptomatic intracranial atherosclerotic stenosis (sICAS) is an important cause of ischemic stroke, and its hemodynamic changes play an important role in the pathogenesis of stroke. Computational fluid dynamics (CFD), as a powerful numerical simulation tool, can accurately simulate and evaluate the hemodynamic state within blood vessels, providing a new perspective for a deeper understanding of the hemodynamic mechanism and clinical significance of sICAS. This article reviews the application of CFD in evaluating the stroke mechanism and secondary prevention of stroke in patients with sICSA.

Objectives:To evaluate the difference in biomechanical properties of lumbar spine between tradi-tional trajectory(TT)and modified cortical bone trajectory(MCBT)pedicle screws in different osteoporotic condi-tions using finite element analysis.Methods:CT scanning was used to obtain lumbar spinal tomographic im-ages of osteoporotic patients,and then the L4 lumbar spine structure was reconstructed in three dimensions and validated.Two nail channels were constructed by varying the bone density as osteopenia(A1),moderate osteoporosis(A2),and severe osteoporosis(A3),respectively.One was a conventional double-threaded pedicle screw used in TT with a diameter of 6mm and an overall length of 45mm(TT group),the other was a vari-able-diameter,all-cortical bone threaded pedicle screw used in MCBT with a diameter of 4-5.5mm and an overall length of 45mm(MCBT group).The effects of the two designs on screw pullout resistance,stability(load-displacement ratio of upward,downward,left and right working conditions,defined as the ratio of load value to displacement when screw tail end displaced 0.1mm upward,downward,left and right towards its vertical axis)and lumbar spine mobility(when forward flexion,backward extension,lateral bending and axial rotation)were analyzed under different osteoporotic conditions.Results:In terms of axial pullout force,the MCBT group significantly improved 93.5％,96.5％,and 98.5％than the TT group in A1,A2,and A3,respec-tively.In terms of stability,at upward,downward,left,and right working conditions,the load-displacement ratios of the screws in the MCBT group were improved in comparison with the TT group in A1,A2,and A3,respectively,by 42.2％,40.8％,41.7％;49％,49％,51.5％;82.4％,81.5％,85.2％;73.1％,70.8％,72.5％.In terms of lumbar spine mobility,at forward flexion,under A1,A2,and A3,the TT group increased by 25％,26.6％and 28.7％compared to the MCBT group,respectively;at backward extension,the TT group increased by 24.5％and 22.9％compared to the MCBT group under A1 and A2,respectively,whereas under A3,the difference was not significant(P＞0.05);at lateral bending and axial rotation,the MCBT group had a slightly slight increase compared to the TT group under A1,A2,and A3(P＞0.05).Conclusions:Under different degrees of osteoporosis grading,MCBT technique was inferior in stability to TT technique only in spinal axial rotation and lateral flexion,while it outperformed TT technique in axial pull-out force,screw stability,and spinal stability during forward flexion and backward extension.

Objectives:To evaluate the difference in biomechanical properties of lumbar spine between tradi-tional trajectory(TT)and modified cortical bone trajectory(MCBT)pedicle screws in different osteoporotic condi-tions using finite element analysis.Methods:CT scanning was used to obtain lumbar spinal tomographic im-ages of osteoporotic patients,and then the L4 lumbar spine structure was reconstructed in three dimensions and validated.Two nail channels were constructed by varying the bone density as osteopenia(A1),moderate osteoporosis(A2),and severe osteoporosis(A3),respectively.One was a conventional double-threaded pedicle screw used in TT with a diameter of 6mm and an overall length of 45mm(TT group),the other was a vari-able-diameter,all-cortical bone threaded pedicle screw used in MCBT with a diameter of 4-5.5mm and an overall length of 45mm(MCBT group).The effects of the two designs on screw pullout resistance,stability(load-displacement ratio of upward,downward,left and right working conditions,defined as the ratio of load value to displacement when screw tail end displaced 0.1mm upward,downward,left and right towards its vertical axis)and lumbar spine mobility(when forward flexion,backward extension,lateral bending and axial rotation)were analyzed under different osteoporotic conditions.Results:In terms of axial pullout force,the MCBT group significantly improved 93.5％,96.5％,and 98.5％than the TT group in A1,A2,and A3,respec-tively.In terms of stability,at upward,downward,left,and right working conditions,the load-displacement ratios of the screws in the MCBT group were improved in comparison with the TT group in A1,A2,and A3,respectively,by 42.2％,40.8％,41.7％;49％,49％,51.5％;82.4％,81.5％,85.2％;73.1％,70.8％,72.5％.In terms of lumbar spine mobility,at forward flexion,under A1,A2,and A3,the TT group increased by 25％,26.6％and 28.7％compared to the MCBT group,respectively;at backward extension,the TT group increased by 24.5％and 22.9％compared to the MCBT group under A1 and A2,respectively,whereas under A3,the difference was not significant(P＞0.05);at lateral bending and axial rotation,the MCBT group had a slightly slight increase compared to the TT group under A1,A2,and A3(P＞0.05).Conclusions:Under different degrees of osteoporosis grading,MCBT technique was inferior in stability to TT technique only in spinal axial rotation and lateral flexion,while it outperformed TT technique in axial pull-out force,screw stability,and spinal stability during forward flexion and backward extension.

Objective:To explore the relationship between constitutional types of Chinese medicine and Alzheimer's disease (AD) and to construct an early warning model for AD risk.Methods:In the established multimodal interventions to delay dementia and disability in rural China (MIND-China) study, 4 033 elderly subjects aged ≥60 years old were included. The data including demographic, underlying disease and neuropsychological data were collected.The Chinese medicine service record form for the elderly was used to assess constitutional types of Chinese medicine and to apply the NIA-AA diagnostic criteria published by the National Institute on Aging and the Alzheimer's Association in 2011 for the diagnosis of clinically likely AD. Logistic regression analysis and AD risk prediction models were constructed using R statistical software, and the final prediction results were presented using columnar plots.Results:The MIND-China cohort was dominated by the abnormal constitution (69.28%), of which Phlegm-wetness type was the most common (58.05%), followed by Yang-deficiency type (23.85%). The most constitutional type of Chinese medicine among AD patients was Phlegm-wetness type (54.35%), followed by Qi-depression type (38.04%). Multi-factorial logistic regression analysis suggested that increasing age ( β=0.101, P<0.001, OR=1.107, 95% CI=1.069-1.146) and Qi-depression type ( β=0.622, P=0.016, OR=1.862, 95% CI=1.116-3.076) were able to increase the risk of developing AD, while education ( β=-1.047, P<0.001, OR=0.351, 95% CI=0.205-0.584) was able to reduce the risk of developing AD. By using the risk score model to calculate the total risk score for each subject and plotting the receiver operating characteristic curve (ROC), the area under the ROC was 0.769 and the calibration curve showed excellent consistency between prediction and reality. Conclusion:Older adults with Qi-depression type are significantly associated with an increased likelihood of AD.

Objective:To investigate the relationship of interleukin (IL)-37, osteoprotegerin with coronary artery disease and its stenosisdegree.Methods:The prospective research method was used. From April 2018 to June 2019, two hundred and eleven suspected or diagnosed coronary artery disease patients who had chest pain or discomfort in Dalian Friendship Hospital were selected. The patients underwent selective percutaneous coronary angiography and completed coronary stenosis score (Gensini score). According to the degree of coronary stenosis, 211 patients were divided into the control group(coronary stenosis<50%, 45 cases), single-vessel stenosis group (single-vessel stenosis ≥ 50%, 52 cases), double-vesselstenosis group (double-vesselstenosis ≥ 50%, 58 cases), and triple-vessel stenosis group (triple-vessel stenosis ≥ 50%, 56 cases). The levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein a, uric acid, creatinine were measured by the automatic biochemical analyzer. The serum levels of IL-37 and osteoprotegerin were detected by enzyme-linked immunosorbent assay.Results:There were no statistical differences in FBG, uric acid, creatinine, TC, TG, LDL-C, HDL-C, ApoA1 and ApoB among 4 groups ( P>0.05). In the control group, single-vessel stenosis group, double-vessel stenosis group and triple-vessel stenosis group, lipoprotein a was (0.266 ± 0.060), (0.283 ± 0.070), (0.289 ± 0.066) and (0.307 ± 0.084) mg/L respectively; coronary stenosis score was (8.27 ± 7.08), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) scores respectively; IL-37 was (342.27 ± 122.36), (437.45 ± 98.47), (493.72 ± 125.19) and (522.61 ± 149.34) ng/L respectively; osteoprotegerin was (378.29 ± 111.95), (458.39 ± 115.37), (502.50 ± 116.88) and (533.39 ± 139.83) ng/L respectively; and there were statistical differences among 4 groups ( P<0.05 or <0.01). IL-37, osteoprotegerin and lipoproteina were positively correlated with coronary stenosis score ( r = 0.43, 0.42 and 0.23, P<0.05), the osteoprotegerin was positively correlated with IL-37( r = 0.73, P<0.05). The multivariate linear regression analysis result showed that the IL-37 and osteoprotegerin were independent protective factors of coronary stenosis degree( β = 0.07 and 0.07, t = 2.72 and 2.57, P<0.01 or <0.05),and lipoproteina was independent risk factor of coronary stenosis degree ( β = 0.97, t = 2.89, P<0.01). Conclusions:IL-37 and osteoprotegerin are positively correlated with the degree of coronary stenosis. They are anti-inflammatory and protective factors of coronary heart disease.

Objective To measure mechanical properties of calcified tissues from human aortic valve by nanoindentation test. Methods Leaflets from 5 patients with aortic stenosis were collected. Elastic modulus and hardness of the calcified leaflets were obtained by nanoindentationtest. Results The elastic modulus and hardness of the calcified leaflets were (15.69±3.89) GPa and (0.59±0.15) GPa, respectively. Conclusions The elastic modulus and hardness of the calcified valve tissues can be obtained by nanoindentationtest, which provides experimental data for biomechanical research of the valve.

Objective:To evaluate the efficacy and safety of dl-3-butylphthalide ( NBP) injection and soft capsules in the treat-ment of acute middle cerebral artery infarction. Methods:Sixty-one patients with acute cerebral infarction in the left middle cerebral artery in 72 hours of onset of ischemic stroke with score of 5-25 according to the national institutes of health stroke scale ( NIHSS) were randomly divided into the observation group (n=31) and the control group (n=30). The control group was treated with the routine treatment, while the observation group was sequentially treated with NBP injection and soft capsules additionally. The treatment course was 90 days. Before the treatment, the NIHSS score was evaluated in both groups to compare the neurologic impairment degree. After the treatment, the daily living skills assessment was performed by Barthel index ( BI) and modified Rankin score ( mRS) , and the ad-verse reactions were recorded. Results:Before the treatment, the NIHSS score in the two groups had no statistical significance ( P>0. 05). After the treatment, the BI in the observation group and the control group was (88. 55 ± 16. 74) and (70. 67 ± 26. 18), and mRS was (1. 87 ± 1. 02) and (2. 53 ± 1. 40), respectively, suggesting the observation group had more favorable outcome than the con-trol group (P≤0. 05). The incidence of adverse reactions had no significant difference between the groups. Conclusion: dl-3-Bu-tylphthalide sequential therapy should be regarded as an effective and safe method for acute cerebral infarction, which can improve the daily living skills and 90-day outcome of patients.

Objective To investigate the relation between 25-hydroxyvitamin D3[25(OH)D3] and coronary artery disease. Methods Three hundred and ten patients with selective coronary angiogram (CAG) were enrolled in this study and they were divided into two groups: non-coronary artery stenosis group with 76 patients and coronary artery stenosis group with 234 patients. The degree of coronary artery stenosis was evaluated by the international general Gensini integration system. The levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) were detected by automatic biochemistry analyzer. The level of 25(OH)D3 was detected by tandem mass spectrometry. The relationship of Gensini integration scores and risk factors were analyzed. Logistic regression analysis was used in multicity factors analysis. Results The levels of age, Gensini integration scores, 25(OH)D3, FPG and LDL-C in non-coronary artery stenosis group and coronary artery stenosis group had significant differences (P<0.05). The number of coronary stenosis and Gensini integration scores in 25(OH) D3 deficiency group were significantly higher than those in non-25 (OH)D3 deficiency group (P<0.01). Logistic regression analysis showed that age, FPG and 25(OH)D3 levels were risk factors for coronary artery stenosis (P<0.01 or<0.05), and the level of 25(OH)D3 had negative correlation with coronary artery stenosis (B =- 0.100), and it was a protection factor (OR =0.904, 95%CI:0.911-0.983, P=0.000). Conclusions 25(OH)D3 deficiency is one of the risk factor of coronary artery disease.

This study was performed to investigate the chemical constituents in the twigs and leaves of Harrisonia perforate. Six compounds were isolated from the 95% EtOH extract of the twigs and leaves of Harrisonia perforate by silica gel, ODS, Sephadex LH-20 column chromatographies and preparative HPLC. On the basis of chemical properties and spectra data, these compounds were identified as harriperfin E (1), kihadanin A (2), kihadanin B (3), 6α-acetoxyobacunol acetate (4), gardaubryone C (5), and β-sitosterol methyl ether (6), respectively. Compound 1 is a new chromone, and compounds 2-6 are isolated from this plant for the first time.