Objective:To investigate the association of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) with the severity of white matter hyperintensities (WMHs) and its spatial distribution.Methods:Patients admitted to the Department of Neurology, Jiangning Hospital Affiliated to Nanjing Medical University due to various chronic diseases or physical examinations between January 2023 and December 2024 were included retrospectively. Past medical history, clinical and imaging data were collected. The Fazekas scale was used to assess the severity of WMHs. According to the scoring results of periventricular WMHs (PVWMHs) and deep WMHs (DWMHs), WMHs were divided into no/mild group (0-1 points) and moderate/severe group (2-3 points). Multivariate logistic regression analysis was used to determine independent correlation factors for the severity of WMHs, PVWMHs, and DWMHs. Results:A total of 357 patients were included, aged 65.42±9.95 years, with 198 males (55.5%). There were 193 patients (54.1%) in the no/mild group and 164 (45.9%) in the moderate/severe group. Univariate analysis showed that the proportion of patients with hypertension, diabetes, history of cerebral infarction and cerebral hemorrhage, carotid plaque, and age, serum creatinine, monocyte count and MHR in the moderate/severe group were significantly higher than those in the no/mild group (all P<0.05). Multivariate logistic regression analysis showed a significant positive correlation between MHR and the severity of WMHs (odds ratio 3.138, 95% confidence interval 1.042-9.451; P=0.042). Further analysis showed a significant positive correlation between MHR and PVWMHs (odds ratio 3.384, 95% confidence interval 1.111-10.305; P=0.032), but no independent correlation with DWMHs. In addition, age and hypertension, diabetes, history of cerebral infarction and cerebral hemorrhage were significantly positively correlated with the severity of WMHs, PVWMHs and DWMHs. Conclusion:MHR is correlated with the severity of WMHs, and higher MHR is significantly associated with PVWMHs, but not with DWMHs.

Objective:To investigate the correlation between body mass index (BMI)/high-density lipoprotein cholesterol (HDL-C) ratio and cerebral small vessel disease (CSVD) in middle-aged and elderly people.Methods:Consecutive middle-aged and elderly patients (aged ≥40 years) who were hospitalized for chronic disease examinations in the Department of Neurology, Jiangning Hospital Affiliated to Nanjing Medical University between February 2022 and May 2024 were included prospectively. According to the overall burden score of CSVD, they were divided into CSVD group (≥1) and non-CSVD group (0). According to age, they divided into middle-aged group (40-59 years old) and elderly group (≥60 years old). The demographic characteristics and clinical data were collected. Binary multivariate logistic regression analysis was used to determine the independent correlation between BMI/HDL-C ratio and CSVD. Forest plot was used to analyze the correlation between BMI/HDL-C ratio and CSVD in different age groups. Results:A total of 710 patients were included, with an age of 66.0±10.0 years and 361 were males (50.8%). There were 261 patients (36.8%) in the CSVD group and 449 (63.2%) in the non-CSVD group. The BMI/HDL-C ratio in the CSVD group was significantly higher than that in the non-CSVD group (23.60±7.00 vs. 20.78±6.40; P<0.001). Multivariate logistic regression analysis showed that BMI/HDL-C ratio was an independent risk factor for CSVD in middle-aged and elderly populations (odds ratio 1.046, 95% confidence interval 1.027-1.064; P<0.001). There were 475 patients in the elderly group, of which 198 (41.7%) had CSVD; there were 235 patients in the middle-aged group, of which 63 (26.8%) had CSVD. Forest plot analysis showed that the association between BMI/HDL-C ratio and CSVD still had statistical significance in different age groups, but the effect intensity was higher in the elderly group than in the middle-aged group. Conclusion:The BMI/HDL-C ratio is independently correlated with CSVD in middle-aged and elderly population, particularly significant in the elderly population.

Objective To investigate the characteristics of transient remission of islet function and its influence on long-term prognosis in different onset age patients with type 1 diabetes mellitus(T1DM).Methods 156 newly diagnosed T1DM patients who received treatment and completed follow-up were retrospectively chosen from January 2014 to January 2018.All patients were grouped according to the onset age including childhood group(n=18),adolescent group(n=108),adult group(n=30).The transient remission and retention rate of islet function of three groups were compared.The relationship between onset age and c-peptide level was analyzed.Results BMI,FC-P,and 2 hC-P levels in adolescent group were higher than those in childhood group(P<0.05).The positivity rates of protein tyrosine phosphatase and zinc transporter 8 antibodies in adult group were lower than those in childhood group(P<0.05).The incidence of transient remission of pancreatic function in adolescent group was higher than that in childhood and adult groups(P<0.05).The duration of transient remission of pancreatic function in adolescent and adult groups was lower than that in childhood group(P<0.05).The islet function retention rates in adolescent group after 1 and 4 years from onset were higher than those in childhood and adult groups(P<0.05).Generalized estimation equation analysis showed that the long-term FC-P and 2 hC-P in adolescent group were higher than those in childhood and adult groups(P<0.05).The FC-P and 2 hC-P levels in adult patients with previous transient remission were higher than those in childhood group(P<0.05).Conclusions Adolescent onset T1DM patients are more likely to have transient remission of islet function,while childhood onset patients have longer transient remission of islet function.In addition,the adult T1DM patients had the best long-term islet function in transient remission population.

Objective:To compare the clinical effects of liraglutide and benaglutide in adjuvant treatment of type 2 diabetes mellitus (T2DM) patients complicated with nonalcoholic fatty liver disease (NAFLD).Methods:From January 2017 to January 2019, 110 T2DM patients complicated with NAFLD were chosen in the Fifth People's Hospital of Datong and divided into two groups according to the random digital table method, with 55 patients in each group.On the basis of metformin, the control group was given liraglutide, and the observation group was given benaglutide.The levels of BMI, waist circumference, fasting blood glucose(FPG), postprandial 2h blood glucose(2 h PG), glycosylated hemoglobin(HbA1c), fasting insulin(FINS) release level, insulin resistance index(HOMA-IR), total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), levels of glutamate aminotransferase(ALT), aminotransferase(AST), controlled attenuation parameter(CAP) and liver stiffness(LSM) before and after treatment of the two groups were compared.Results:After treatment, the levels of BMI, waist circumference, FBG, 2 h PG, HbA1c, FINS, HOMA-IR, lipid index, ALT, AST, CAP and LSM of the two groups were significantly better than those before treatment( t=3.17, 3.80; 4.95, 5.66; 3.41, 3.50; 3.85, 5.06; 4.43, 4.60; 3.55, 4.17; 3.91, 4.07; 3.26, 3.59; 4.10, 5.27; 4.01, 4.89; 3.62, 3.20; 3.97, 4.62; 4.01, 5.37; 4.66, 5.13; 4.95, 5.87; all P<0.05). After treatment, the levels of BMI, waist circumference, 2 h PG, ALT, AST, CAP and LSM of the control group were (22.01±0.98)kg/m 2, (1.63±0.38)cm, (7.04±1.71)mmol/L, (39.31±4.92)U/L, (31.40±4.94)U/L, (197.48±36.39)dB/m, (7.42±1.34)kPa, respectively, which were significantly worse than those of the observation group [(19.87±0.76)kg/m 2, (0.89±0.21)cm, (6.29±1.10)mmol/L, (36.17±3.16)U/L, (28.63±3.59)U/L, (152.77±30.18)dB/m, (6.17±1.06)kPa] ( t=2.74, 3.55, 2.81, 3.02, 2.76, 2.89, 3.15, all P<0.05). Conclusion:Compared with liraglutide, benaglutide in adjuvant treatment of T2DM patients complicated with NAFLD can efficiently decrease body weight, improve postprandial blood sugar levels, protect liver function and is helpful to inhibit liver fat deposition.

OBJECTIVETo observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis.

METHODSTwenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath.

RESULTSThe patients showed no significant variations in MAP, HR, or SpO₂after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another.

CONCLUSIONSBilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.

Amides ; Anesthetics, Local ; Brachial Plexus Block ; Diaphragm ; Humans ; Lidocaine ; Orthopedic Procedures ; Pain Measurement ; Periarthritis ; diagnostic imaging ; surgery ; Shoulder Joint ; diagnostic imaging ; physiopathology ; Ultrasonography