Objective:To investigate the short-term clinical efficacy of two fixation methods, mini-titanium plate fixation and suture suspension, in cervical posterior unilateral laminoplasty, and to explore the relationship between changes in the cervical sagittal sequence and therapeutic outcomes.Methods:A retrospective analysis was conducted on 55 patients who underwent cervical posterior unilateral laminoplasty with mini-titanium plate fixation and 50 patients with suture suspension at the First People's Hospital of Lianyungang from September 2020 to January 2023. All patients were followed up for 12 months, and the axial symptoms was recorded. The main clinical efficacy evaluations included before surgery and 12 months after surgery visual analog score (VAS) for neck pain, Japanese Orthopaedic Association score (JOA) and neck disability index (NDI). Four parameters were recorded before surgery and 12 months after surgery to assess the sagittal sequence: C 2-7 sagittal vertical axis (C 2-7SVA), T 1 slope angle (T 1s), C 2-7Cobb angle and cervical range of motion. Results:The mini-titanium plate fixation group had 5 cases of axial symptoms, while the traditional suture suspension group had 16 cases; the postoperative VAS, JOA and C 2-7Cobb angle in the mini-titanium plate fixation group were all less than those in the suture suspension group, with statistically significant differences ( P<0.05). Specifically, the postoperative VAS in the mini-titanium plate fixation group was (1.93 ± 1.42) points, and (2.67 ± 2.15) points in the suture suspension group ( P = 0.049); the JOA was (10.39 ± 2.20) points in the mini-titanium plate fixation group and (9.62 ± 1.52) points in the suture suspension group ( P = 0.012); the C 2-7Cobb angle was (21.087 ± 3.564)° in the mini-titanium plate fixation group and (23.092 ± 1.265)° in the suture suspension group ( P = 0.003). There was no statistical difference in operation time and blood loss between two groups ( P>0.05). The postoperative C 2-7SVA, T 1s and range of motion in the traditional suture suspension group were less than those in the mini-titanium plate fixation group, with statistically significant differences ( P<0.05). Specifically, the postoperative C 2-7SVA was (25.700 ± 3.035) mm in the mini-titanium plate fixation group and (23.946 ± 3.079) mm in the suture suspension group ( P = 0.004); the postoperative T 1s was (28.770 ± 2.361)° in the mini-titanium plate fixation group and (26.746 ± 3.198)° in the suture suspension group ( P = 0.004); the postoperative range of motion was (32.651 ± 4.995)° in the mini-titanium plate fixation group and (28.672 ± 5.874)° in the suture suspension group ( P = 0.003). Conclusions:Cervical posterior unilateral laminoplasty with mini-titanium plate fixation can effectively improve VAS, JOA, and restore neurological function, maintaining the cervical spine's sagittal balance, stability, and maximum range of motion.

Objective To compare the clinical efficacy and safety of early endovascular treatment(EVT)for the stroke patients caused by large vessel occlusion(LVO)due to intracranial atherosclerosis(ICAS)or due to cardioembolism(CE).Methods The clinical data of 488 patients with acute anterior circulation LVO stroke,who received early endovascular treatment at the Yijishan Hospital of Wannan Medical College of China from October 2015 to December 2023,were retrospectively analyzed.According to the cause of disease,the patients were divided into ICAS group(n=108)and CE group(n=380).The clinical data,mainly including the proportion of patients having a good prognosis at 90 days after operation(modified Rankin Scale score ≤2 points),the incidence of symptomatic intracranial cerebral hemorrhage(sICH),and the mortality of patients at 90 days after operation.Multivariate logistic regression analysis was used to analyze the factors influencing patient's prognosis.Results Of the 488 patients,29(5.9％)developed postoperative sICH,242(49.6％)achieved a good prognosis at 90 days after the operation,and 91(18.6％)died.The above outcomes in the ICAS group were one,66,and 11 patients respectively,which in the CE group were 28,176,and 80 respectively,and the differences between the two groups were statistically significant(all P＜0.05).Multivariate logistic regression analysis indicated that good prognosis at 90 days after the operation(OR=0.962,95％CI:0.404-2.288,P=0.930)and the postoperative 90-day mortality(OR=1.379,95％CI:0.436-4.362,P=0.584)were not the factors influencing prognosis,while the postoperative sICH(OR=19.132,95％CI:1.332-274.791,P=0.030)was the factor influencing prognosis.Conclusion In CE group,the incidence of sICH and the postoperative 90-day mortality are higher,while in ICAS group,the postoperative 90-day good prognosis rate is higher.The postoperative sICH is the factor influencing prognosis.

Objective:To investigate the differences of the glymphatic system (GS) function between patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) and healthy controls and between different seizure types by using diffusion tensor imaging along perivascular space (DTI-ALPS), and to analyze the correlation between GS function and the course of disease, as well as the efficacy of predicting the surgical outcome.Methods:This study was a cross-sectional study. A total of 171 patients with mTLE-HS (mTLE-HS group) and 75 healthy volunteers (HC group) were retrospectively enrolled from July 2009 to July 2021 at Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University. The general information of all subjects, such as seizure type (partial seizure, secondary generalized seizure), surgical outcome, etc., was analyzed. The 3D magnetization prepared rapid gradient echo T 1WI and DTI sequence images were collected. The VBM analysis method was used to segment cerebrospinal fluid and calculate the volume. The ALPS index of the bilateral brain was calculated using the Atlas-based DTI-ALPS method. Independent sample t-test or paired t test were used to compare the ALPS index between the mTLE-HS group and HC group, and between patients with different seizure types. Pearson correlation analysis was used to analyze the correlation between bilateral ALPS index and disease duration in mTLE-HS group. The predictive value of the ALPS index for surgical outcomes was evaluated by receiver operating characteristics curve and area under the curve. Results:Among the 171 mTLE-HS patients, 98 patients were mTLE with left-side HS (mTLE-LHS) and 73 patients were mTLE with right-side HS (mTLE-RHS); 37 patients underwent surgical treatment, including 27 with good prognosis and 10 with poor prognosis. Compared with the HC group, the left-side ALPS index of mTLE-LHS and mTLE-RHS were both decreased ( P<0.05). The right-side ALPS index in mTLE-RHS was lower than that in the HC group ( P<0.001). There was no significant difference in the right-side ALPS index between mTLE-LHS and HC group ( P=0.080). The ALPS index on the affected side of patients with secondary generalized seizures was significantly lower than that of patients with only partial seizures (all P<0.05), but the difference in ALPS index on the healthy side was not statistically significant( P>0.05). The left-side and right-side ALPS index in mTLE-LHS were negatively correlated with disease duration ( r=-0.272, P=0.007; r=-0.307, P=0.002), but no significant correlation was found between the left-side or right-side ALPS index in mTLE-RHS (all P>0.05). The DTI-ALPS index on the affected side in mTLE-HS patients exhibited good diagnostic accuracy for surgical outcome classification, with an area under the curve of 0.778. Conclusions:The patients with mTLE-HS exhibit dysfunction of the GS, and the degree of impairment is related to the type of seizure and the course of epilepsy. The ALPS index, which characterizes the function of GS, demonstrates good diagnostic accuracy for classifying surgical outcomes.

The occurrence and development of a variety of retinal diseases are related to inflammatory responses,and various inflammatory cells play an important role in retinal damage,which can lead to vision impairment,vision loss,and blindness.Microglia are resident immune cells in the retina,distributed in the inner layer of the retina.They mainly maintain the normal homeostasis of the retina,regulate the apoptosis of neurons,and play an immune surveillance role in the retina.Under inflammatory stimulation,microglia in the retina are activated,secrete a variety of inflammatory factors,engulf neurons and photoreceptors,and destroy the blood-retinal barrier,aggravating retinal damage.This article reviews the physiological function of microglia and the changes in microglia under the inflammatory effects of various retinal diseases.It also discusses how to inhibit microglia from damaging the retina and promote microglia to control retinal inflammation,thereby providing a basis for the clinical treatment of various retinal diseases.

Objective:To explore the effect of health status on the elder care choice,providing empirical evidence to optimize care provision and deepen the understanding of family risk-coping mechanisms.Method:Multinomial Logit model was used to examine the effects of health stock and health changes on the elder care choice,followed by an income heterogeneity analysis.Results:The impact of health status on the choice of elder care arrangements exhibited clear pathway differentiation and group heterogeneity.In the long-term effect,poor baseline cognitive ability was a key factor driving the elderly to turn to their children for elderly care,with each one-point decrease in the MMSE score increasing this probability by an average of 0.5 percentage points.In the short-term effect,an acute deterioration in either physical function(ΔADL)or cognitive ability(ΔMMSE)significantly increased the likelihood of transitioning to living with children,with the probabilities increasing by an average of 1.7 and 0.3 percentage points,respectively.In contrast,transitioning to institutional care—in both the long and short term—was driven solely by the deterioration of physical function,increasing the probability by 0.4 and 0.3 percentage points,respectively.The heterogeneity analysis further revealed that these clear decision pathways hold primarily for the high-income group,while the elder care choice of the low-income group was less sensitive to health indicators.Conclusion:The elder care choice is not solely determined by health risks but is a social process where health status and family economic resources are closely intertwined,ultimately manifesting as a divergence between the"strategic choices"of high-income groups and the"constrained reactions"of low-income groups.

The occurrence and development of a variety of retinal diseases are related to inflammatory responses,and various inflammatory cells play an important role in retinal damage,which can lead to vision impairment,vision loss,and blindness.Microglia are resident immune cells in the retina,distributed in the inner layer of the retina.They mainly maintain the normal homeostasis of the retina,regulate the apoptosis of neurons,and play an immune surveillance role in the retina.Under inflammatory stimulation,microglia in the retina are activated,secrete a variety of inflammatory factors,engulf neurons and photoreceptors,and destroy the blood-retinal barrier,aggravating retinal damage.This article reviews the physiological function of microglia and the changes in microglia under the inflammatory effects of various retinal diseases.It also discusses how to inhibit microglia from damaging the retina and promote microglia to control retinal inflammation,thereby providing a basis for the clinical treatment of various retinal diseases.

Objective:To explore the effect of health status on the elder care choice,providing empirical evidence to optimize care provision and deepen the understanding of family risk-coping mechanisms.Method:Multinomial Logit model was used to examine the effects of health stock and health changes on the elder care choice,followed by an income heterogeneity analysis.Results:The impact of health status on the choice of elder care arrangements exhibited clear pathway differentiation and group heterogeneity.In the long-term effect,poor baseline cognitive ability was a key factor driving the elderly to turn to their children for elderly care,with each one-point decrease in the MMSE score increasing this probability by an average of 0.5 percentage points.In the short-term effect,an acute deterioration in either physical function(ΔADL)or cognitive ability(ΔMMSE)significantly increased the likelihood of transitioning to living with children,with the probabilities increasing by an average of 1.7 and 0.3 percentage points,respectively.In contrast,transitioning to institutional care—in both the long and short term—was driven solely by the deterioration of physical function,increasing the probability by 0.4 and 0.3 percentage points,respectively.The heterogeneity analysis further revealed that these clear decision pathways hold primarily for the high-income group,while the elder care choice of the low-income group was less sensitive to health indicators.Conclusion:The elder care choice is not solely determined by health risks but is a social process where health status and family economic resources are closely intertwined,ultimately manifesting as a divergence between the"strategic choices"of high-income groups and the"constrained reactions"of low-income groups.

Objective:To investigate the short-term clinical efficacy of two fixation methods, mini-titanium plate fixation and suture suspension, in cervical posterior unilateral laminoplasty, and to explore the relationship between changes in the cervical sagittal sequence and therapeutic outcomes.Methods:A retrospective analysis was conducted on 55 patients who underwent cervical posterior unilateral laminoplasty with mini-titanium plate fixation and 50 patients with suture suspension at the First People's Hospital of Lianyungang from September 2020 to January 2023. All patients were followed up for 12 months, and the axial symptoms was recorded. The main clinical efficacy evaluations included before surgery and 12 months after surgery visual analog score (VAS) for neck pain, Japanese Orthopaedic Association score (JOA) and neck disability index (NDI). Four parameters were recorded before surgery and 12 months after surgery to assess the sagittal sequence: C 2-7 sagittal vertical axis (C 2-7SVA), T 1 slope angle (T 1s), C 2-7Cobb angle and cervical range of motion. Results:The mini-titanium plate fixation group had 5 cases of axial symptoms, while the traditional suture suspension group had 16 cases; the postoperative VAS, JOA and C 2-7Cobb angle in the mini-titanium plate fixation group were all less than those in the suture suspension group, with statistically significant differences ( P<0.05). Specifically, the postoperative VAS in the mini-titanium plate fixation group was (1.93 ± 1.42) points, and (2.67 ± 2.15) points in the suture suspension group ( P = 0.049); the JOA was (10.39 ± 2.20) points in the mini-titanium plate fixation group and (9.62 ± 1.52) points in the suture suspension group ( P = 0.012); the C 2-7Cobb angle was (21.087 ± 3.564)° in the mini-titanium plate fixation group and (23.092 ± 1.265)° in the suture suspension group ( P = 0.003). There was no statistical difference in operation time and blood loss between two groups ( P>0.05). The postoperative C 2-7SVA, T 1s and range of motion in the traditional suture suspension group were less than those in the mini-titanium plate fixation group, with statistically significant differences ( P<0.05). Specifically, the postoperative C 2-7SVA was (25.700 ± 3.035) mm in the mini-titanium plate fixation group and (23.946 ± 3.079) mm in the suture suspension group ( P = 0.004); the postoperative T 1s was (28.770 ± 2.361)° in the mini-titanium plate fixation group and (26.746 ± 3.198)° in the suture suspension group ( P = 0.004); the postoperative range of motion was (32.651 ± 4.995)° in the mini-titanium plate fixation group and (28.672 ± 5.874)° in the suture suspension group ( P = 0.003). Conclusions:Cervical posterior unilateral laminoplasty with mini-titanium plate fixation can effectively improve VAS, JOA, and restore neurological function, maintaining the cervical spine's sagittal balance, stability, and maximum range of motion.

Objective:To investigate the differences of the glymphatic system (GS) function between patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) and healthy controls and between different seizure types by using diffusion tensor imaging along perivascular space (DTI-ALPS), and to analyze the correlation between GS function and the course of disease, as well as the efficacy of predicting the surgical outcome.Methods:This study was a cross-sectional study. A total of 171 patients with mTLE-HS (mTLE-HS group) and 75 healthy volunteers (HC group) were retrospectively enrolled from July 2009 to July 2021 at Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University. The general information of all subjects, such as seizure type (partial seizure, secondary generalized seizure), surgical outcome, etc., was analyzed. The 3D magnetization prepared rapid gradient echo T 1WI and DTI sequence images were collected. The VBM analysis method was used to segment cerebrospinal fluid and calculate the volume. The ALPS index of the bilateral brain was calculated using the Atlas-based DTI-ALPS method. Independent sample t-test or paired t test were used to compare the ALPS index between the mTLE-HS group and HC group, and between patients with different seizure types. Pearson correlation analysis was used to analyze the correlation between bilateral ALPS index and disease duration in mTLE-HS group. The predictive value of the ALPS index for surgical outcomes was evaluated by receiver operating characteristics curve and area under the curve. Results:Among the 171 mTLE-HS patients, 98 patients were mTLE with left-side HS (mTLE-LHS) and 73 patients were mTLE with right-side HS (mTLE-RHS); 37 patients underwent surgical treatment, including 27 with good prognosis and 10 with poor prognosis. Compared with the HC group, the left-side ALPS index of mTLE-LHS and mTLE-RHS were both decreased ( P<0.05). The right-side ALPS index in mTLE-RHS was lower than that in the HC group ( P<0.001). There was no significant difference in the right-side ALPS index between mTLE-LHS and HC group ( P=0.080). The ALPS index on the affected side of patients with secondary generalized seizures was significantly lower than that of patients with only partial seizures (all P<0.05), but the difference in ALPS index on the healthy side was not statistically significant( P>0.05). The left-side and right-side ALPS index in mTLE-LHS were negatively correlated with disease duration ( r=-0.272, P=0.007; r=-0.307, P=0.002), but no significant correlation was found between the left-side or right-side ALPS index in mTLE-RHS (all P>0.05). The DTI-ALPS index on the affected side in mTLE-HS patients exhibited good diagnostic accuracy for surgical outcome classification, with an area under the curve of 0.778. Conclusions:The patients with mTLE-HS exhibit dysfunction of the GS, and the degree of impairment is related to the type of seizure and the course of epilepsy. The ALPS index, which characterizes the function of GS, demonstrates good diagnostic accuracy for classifying surgical outcomes.

Objective To investigate the influencing factors for acute multiple vessels occlusion(MVO)and its impact on the prognosis of patients with anterior circulation acute large vessel occlusion stroke(ALVOS)who achieved successful recanalization after endovascular treatment(EVT).Methods Patients with anterior circulation ALVOS who received successful EVT at the Yijishan Hospital of Wannan Medical College between July 2015 and April 2023 were retrospectively analyzed.Baseline data,including age,sex,onset-to-puncture time(OTP),onset-to-recanalization time(OTR),medical history(including atrial fibrillation,diabetes,hypertension),alcohol and smoking history,admission blood pressure(systolic and diastolic),Alberta stroke program early CT score(ASPECTS),National Institutes of Health stroke scale(NIHSS)score,trial of Org 10172 in acute stroke treatment(TOAST)classification(atherosclerotic type,cardioembolic type,and other etiology types),and 90-day modified Rankin scale(mRS)score were collected.Collateral circulation was assessed based on the degree of contrast agent reflux observed in the occluded arterial supply area during delayed DSA,and patients were classified into poor and good collateral circulation groups.Malignant cerebral edema was defined as a midline shift of ≥5 mm on the follow-up CT scan performed on day 3 post-surgery.The primary endpoint(efficacy indicator)was the 90-day mRS score,with mRS score≤ 2 considered as a good prognosis and mRS score＞2 considered as a poor prognosis.The secondary endpoint(safety indicator)was the 90-day mortality rate.All patients were divided into MVO and non-MVO groups based on whether they had single or multiple intracranial vessel occlusions.Acute MVO was defined as the detection of acute occlusion of other large or medium vessels,in addition to the main vessels(internal carotid artery or M1/M2 segments of the middle crebral artery[MCA]),in CT angiography,MR angiography,or DSA,resulting in ischemia in brain regions distinct from the main occlusion area.Factors that showed statistically significant differences in univariate analysis were further analyzed using multivariate Logistic regression to identify the risk factors for the occurrence of acute MVO and the factors associated with the prognosis of ALVOS patients.Results A total of 846 patients with ALVOS were included,with ages ranging from 26 to 94 years(mean age[69±11]years).The proportion of male patients was 57.2％(484/846).The median admission ASPECTS was 8(7,9)and the median admission NIHSS score was 14(12,18).The incidence of malignant cerebral edema at 3 days post-surgery was 13.4％(112/835),and the 90-day mortality rate was 19.1％(162/846).(1)Among the 846 ALVOS patients,810(95.7％)were in the non-MVO group and 36(4.3％)were in the MVO group.Univariate analysis showed significant differences between the MVO and non-MVO groups in terms of atrial fibrillation,malignant cerebral edema,admission ASPECTS,admission NIHSS scores,TOAST classification,collateral circulation,rate of complete recanalization,and 90-day poor prognosis rate(all P＜0.05).However,there was no statistically significant difference in 90-day mortality between the two groups(P=0.193).Multivariate Logistic regression analysis showed that TOAST classification of cardioembolic type(OR,16.089,95％CI 1.835-141.061,P=0.012)and other etiology types(OR,9.768,95％CI 1.078-88.540,P=0.043)were associated with the occurrence of MVO.(2)Among the 846 ALVOS patients,445 had a good prognosis at 90days,and 401 had a poor prognosis.Univariate analysis showed that,compared to the good prognosis group,the poor prognosis group had a lower proportion of males and smokers,and a higher proportion of patients with older age,higher baseline systolic blood pressure,hypertension,diabetes,and atrial fibrillation(all P＜0.01).Additionally,the poor prognosis group had higher admission NIHSS scores(P＜0.01),lower admission ASPECTS,lower rates of good collateral circulation and complete recanalization,higher rates of malignant cerebral edema and MVO,and statistically significant differences in TOAST classification distribution(all P＜0.01).Multivariate Logistic regression analysis showed that MVO was associated with poor 90-day prognosis in ALVOS patients after EVT(OR,3.368,95％CI 1.149-9.878,P=0.027).Furthermore,older age(OR,1.045,95％CI 1.025-1.066),diabetes(OR,1.719,95％CI 1.080-2.734),higher baseline systolic blood pressure(OR,1.012,95％CI 1.004-1.019),lower admission ASPECTS(OR,0.746,95％CI 0.674-0.826),higher admission NIHSS score(OR,1.115,95％CI 1.070-1.162),without immediate postoperative complete recanalization(OR,0.413,95％CI 0.290-0.592),poor collateral circulation(OR,0.594,95％CI 0.415-0.851),and malignant cerebral edema(OR,6.191,95％CI 3.026-12.670)were all associated with poor 90-day prognosis after EVT in ALVOS patients(all P＜0.05).Conclusions The TOAST classification of cardioembolic type and other etiology types is associated with MVO.MVO is a risk factor for poor outcomes after successful EVT in ALVOS patients.