Cognitive impairment （CI） is a clinical syndrome characterized by progressive decline in advanced cognitive functions such as memory， thinking， and judgment. Its etiology and pathogenesis are complex， and there is currently a lack of specific drug interventions. Metformin， as a first-line hypoglycemic drug for type 2 diabetes， not only lowers blood glucose levels but also improves CI. This article reviews and summarizes the pharmacological effects and mechanisms of metformin in improving Alzheimer’s disease， diabetes cognitive impairment， cognitive impairment after chemotherapy， in order to provide novel insights and approaches for the treatment of CI-related diseases. Studies have shown that the mechanism by which MET intervenes in CI mainly includes regulating β-amyloid protein and tau protein metabolism， reducing insulin resistance， inhibiting neuroinflammation， improving synaptic plasticity， improving mitochondrial dysfunction， regulating gut microbiota and lipid metabolism， etc. Future research needs to be conducted through interdisciplinary collaboration， fully integrating multiple omics data， and combining advanced technologies to further reveal their mechanisms of effect.

We previously identified a unique nucleus, the cerebrospinal fluid (CSF)-contacting nucleus. This study aims to understand its gene architecture and preliminarily suggest its functions. The results showed that there were about 19,666 genes in this nucleus, of which 913 were distinct from the dorsal raphe nucleus (non-CSF contacting). The top 40 highly-expressed genes are mainly related to energy metabolism, protein synthesis, transport, secretion, and hydrolysis. The main neurotransmitter is 5-HT. The receptors of 5-HT and GABA are abundant. The channels for Cl^-, Na⁺, K⁺, and Ca²⁺ are routinely expressed. The signaling molecules associated with the CaMK, JAK, and MAPK pathways were identified accurately. In particular, the channels of transient receptor potential associated with nociceptors and the solute carrier superfamily members associated with cell membrane transport were significantly expressed. The relationship between the main genes of the nucleus and life activities is preliminarily verified.
Rats ; Animals ; Rats, Sprague-Dawley ; Serotonin/metabolism* ; Signal Transduction ; Cerebrospinal Fluid/metabolism*

Objective:To explore the correlation between the anatomical features of shoulder joint and the re-tear rate after surgical repair for small and medium-sized rotator cuff tears.Methods:From June 2017 to June 2019, 55 patients who were diagnosed with small or medium-sized rotator cuff tears and treated with arthroscopic single-row repair were enrolled. Demographics including age, sex, disease course, history of smoking and diabetes mellitus, re-tear rates, Constant-Murley score, University of California, Los Angeles score (UCLA) at 6-month, 1-year, 2-year and 3-year after operation were collected. Postoperative critical shoulder angle (CSA) and acromial index (AI) were measured and calculated based on CT scan. The patients were divided into two groups: patients who got re-tear history during follow-up were included into endpoint re-tear (ER) group, and those who got no re-tear history during follow-up were included into endpoint non-tear (EN) group. One-way Anova was used to compare the CSA\AI among different follow-up point. Fisher's exact test was used to compare sex, morbidity of smoking and diabetes between the ER and EN groups. Two independent samples t-test were used to compare age, disease course, CSA and AI at 1-day after operation, functional scores at each follow-up point between the two groups. Binomial logistic regression analysis was performed to test CSA and AI at 1-day after operation as the risk factors of rotator cuff re-tear at 6-month, 1-year, 2-year and 3-year after operation. The predictive efficacy of CSA and AI at 1-day after operation on re-tear rate at 3-year after operation were evaluated by receiver operating characteristic (ROC) curves, Pearson correlation analysis was used to evaluate the correlation between postoperative CSA/AI and postoperative functional recovery. Results:The CSA and AI of ER group were insignificantly different among all follow-up point ( P>0.05), the CSA and AI of EN group were significantly different among all follow-up point ( F=14.163, P<0.001; F=4.635, P<0.001). The re-tear rates at 6-month, 1-year, 2-year and 3-year after operation were 3.6%, 7.3%, 12.7%, 18.2%. The Constant-Murley score and UCLA scores of ER group at 3-year after operation were 93.60±2.84 and 32.30±1.49, respectively while in EN group, they were 92.11±4.10 and 33.18±1.27, respectively, there were no difference of the Constant-Murley score and UCLA score between ER and EN group at 3-year after operation ( P>0.05). CSA at 1-day after operation was the risk factor to re-tear at 1-year, 2-year and 3-year after operation [ OR=4.622, 95% CI (1.01, 21.06), P=0.048; OR=7.071, 95% CI (1.52, 32.87), P=0.013; OR=3.40, 95% CI (1.42, 8.12), P=0.006]. CSA and AI at 1-day after operation had certain predictive efficacy for rotator cuff re-tear at 3-year after rehabilitation, and CSA was more specific than AI, the optimal cutoff values of CSA and AI at 1-day after operation for predicting rotator cuff re-tear at 3-year after operation were 35.3°and 0.69, the AUC were 0.87 [ OR=3.40, 95% CI (1.42, 8.12), P<0.001]、0.77 [ OR=1.33, 95% CI (0.87, 2.02), P=0.008] respectively. CSA and AI had no relationship with postoperative functional recovery. Conclusion:Greater CSA and AI were predictive factors of small and medium-sized rotator cuff re-tear 1-3 years after surgery with CSA being more specific than AI. However, CSA and AI had no relationship with postoperative functional recovery.

Objective:To investigate the correlation between anatomical features of shoulder joint and postoperative stiffness after rotator cuff repair.Methods:212 patients diagnosed with rotator cuff injury undergoing rotator cuff repair in Civil Aviation General Hospital from March 2016 to December 2021 were enrolled. There were 97 male and 115 female with an average age of 58.87±9.69 years old (range, 41-72). The patients were divided into stiffness group (SG) and non-stiffness group (NG) according to the range of shoulder joint motion at 3-month after operation. Preoperative and postoperative joint anatomical features including critical shoulder angle (CSA), acromial index (AI), lateral acromion angle (LAA) were measured and calculated through CT scan and 3-dimension reconstruction. Age, sex, course of disease, body mass index, tendon fatty infiltration degree, type of rotator cuff injury according to DeOrio & Cofield classification, suture method, and preoperative and 3-month postoperative range of shoulder motion (flexion, abduction, and external rotation), preoperative stiffness condition were collected. All factors between two groups were compared, and binomial logistic regression analysis was performed to find out the risk factors of postoperative joint stiffness. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive efficacy of postoperative CSA, AI, and LAA for postoperative joint stiffness.Results:43 patients were enrolled in SG and 169 patients were enrolled in NG. Age, sex, course of disease, body mass index, tendon fatty infiltration degree, type of rotator cuff injury according to DeOrio & Cofield classification, suture method, and preoperative range of shoulder motion (flexion, abduction, and external rotation) between two groups were insignificantly different ( P>0.05). The ratio of patients with preoperative stiffness in SG is higher than that in NG (χ 2=40.38, P<0.001). Postoperative CSA and AI of SG were greater than those of NG ( t=5.44, P<0.001; t=4.89, P<0.001), and postoperative LAA of SG was smaller than that of NG group ( t=-5.86, P<0.001). Preoperative stiffness, large postoperative AI and small postoperative LAA were all risk factors of joint stiffness after rotator cuff suture [ OR=9.32, 95% CI(3.44, 25.27), P<0.001; OR=2.39, 95% CI(1.58, 3.62), P<0.001; OR=0.64, 95% CI(0.46, 0.91), P=0.012]. Postoperative CSA, AI and LAA had a certain predictive effect on postoperative joint stiffness (AUC>0.70). LAA was the most sensitive factor and CSA was the most specific factor. The optimal cutoff values of CSA, AI and LAA were 34.4°, 0.70 and 74.5° respectively, and the AUC for predicting postoperative joint stiffness were 0.76 [ OR=0.98, 95% CI(0.69, 0.84), P<0.001]、0.78[ OR=2.39, 95% CI(0.70, 0.84), P<0.001]、0.76[ OR=0.64, 95% CI(0.68, 0.83), P<0.001]. Conclusion:Postoperative CSA, AI and LAA had predictive efficacy on joint stiffness after rotator cuff repair. The greater postoperative CSA and AI or smaller postoperative LAA indicates increased risk of postoperative joint stiffness. LAA was the most sensitive factor and CSA was the most specific factor.

Idiopathic hypoparathyroidism is a rare endocrine disease. It is often manifested as neuropsychiatric symptoms, especially epileptic seizures. Thus, it is easy to be misdiagnosed as primary epilepsy. The following case report details the diagnosis of a 17-year-old girl who had been misdiagnosed as primary epilepsy for a long time. She was found hypoparathyroidism during the hospitalization for the operation of ovarian mixed germ cell tumor. After whole exome sequencing, she was ultimately diagnosed as 22q11.2 deletion syndrome. This case suggested that clinicians should be aware of the possibility of hypoparathyroidism in adolescent epilepsy, especially hereditary hypoparathyroidism. At the same time, the possible high risk of tumors should also be considered in hereditary hypoparathyroidism.

Objective:To investigate the clinical outcomes of arthroscopic adhesiolysis on patients with primary frozen shoulder and its effect on shoulder joint function.Methods:The clinical data of 54 patients with primary frozen shoulder who visited Civil Aviation General Hospital from March 2017 to July 2018 were retrospectively analyzed. According to different treatment regimens, the patients were divided into a study group and a control group, with 27 patients in each group, there were 11 males and 43 females, aged (47.6±3.4) years, and the age ranged from 41 to 64 years. Patients in the control group were treated with conventional conservative treatment measures, and patients in the study group were treated with loose adhesion under arthroscope on the basis of the control group. The shoulder joint activity (range of motion angles for flexion, abduction and lateral rotation), Constant score, UCLA score and VAS score as well as the complications of the two groups were compared. The measurement data were expressed as mean±standard deviation ( Mean± SD), the t test was used for comparison between groups. The count data were expressed as percentage and the chi-square test was used for comparison between groups. Results:In the study group, postoperative anterior flexion, abduction, lateral external rotation were (160.2±20.7)°, (163.6±20.1)°, (50.5±8.9)°, respectively. The patients in the control group experienced (119.5±19.5)° of anterior flexion, (121.2±19.5)° of abduction, (35.6±6.4)° of lateral external rotation. After treatment, the activity of the shoulder joint in the study group was significantly better than that in the control group, there were statistically significant differences between the two groups( P<0.05). In the study group, the postoperative Constant score was (83.1± 9.3) scores, VAS score was (2.8±0.3) scores, UCLA score was (31.7±3.1) scores; in the control group, the postoperative Constant score was (71.7±9.7) scores, VAS score was (4.4±0.3) scores, UCLA score was (22.8±3.6) scores ( P<0.05). Compared with the control group, the Constant score and UCLA score in the study group were significantly higher, and the VAS score was significantly lower, differences were statistically significant( P<0.05). The difference in the incidence of complications between the two groups was not statistically significant ( P>0.05). Conclusions:For patients with primary frozen shoulder, arthroscopic adhesiolysis can significantly improve the shoulder function of patients. At the same time, this operation has significant clinical treatment effect, which is conducive to the clinical application and promotion.

Methotrexate (MTX)has dual effects of anti-inflam-matory and immune suppression,and its pharmacological mecha-nism is complex,diverse and synergistic.This paper summari-zes the main anti-inflammatory mechanism of low-dose MTX,in-cluding inhibition of JAK/STAT pathway,inhibition of inflam-matory reaction and immune response,increasing the accumula-tion of adenosine and the function of intracellular metabolites (methotrexate polyglutamate).In addition,low-dose MTX can inhibit oxidation by decreasing the level of lipid peroxidation, suppress the inflammatory response to secondary spinal cord in-jury,reduce spinal cord ischemia reperfusion injury and neuro-pathic pain,thus playing a neuroprotective role by a series of pharmacological mechanism.The anti-inflammatory mechanism of low-dose MTX and its application in spinal cord injury were reviewed,to guide the further research on the anti-inflammatory effect of MTX,and provide a theoretical basis for new drugs for clinical treatment of spinal cord injury.

Objective To investigate the CT features of hepatic focal nodular hyperplasia (FNH) in children.Methods Thirteen patients with FNH,which was confirmed by postoperative pathology,were enrolled retrospectively.Plain and contrast CT were performed on all patients before operation.The CT imaging features of FNH including size,shape,density,style of contrast were analyzed retrospectively and compared with pathology.Results There were 13 patients with 16 lesions,8 lesions were found in the right lobe,5 lesions in the left lobe and 3 lesions involving both lobes.The tumor size ranged from 5.5 cm to 11.5 cm (media size 7.5 cm) in diameter.Histologically,2 cases were typical type,11 cases were atypical type.The lesions were regular morphology in 12 cases and 1 case with capsule.On plain CT,the lesions were isodensity (n=1) or slightly low-density (n=12).In 2 typical type lesions,there were slit-like,stellate-shaped low density central scars.Arterial phase demonstrated that 12 cases were significantly enhanced and 1 case showed mild enhancement.The central scar was not enhanced.In 12 cases,thickened and torturous arteries were seen.The enhancement was reduced at the portal venous phase in all the lesions,with 10 cases showing slightly higher density,2cases isodensity and 1 case low-density.Two cases showed mild enhancement of the central scar.The enhancement of the solid portion in all lesions decreased at the delay phase,with 12 cases showing isodensity and 1 case slightly low density.Two cases with central scar showed delayed enhancement with slightly higher density.Conclusion The CT features of FNH in children are diversified but distinctive which are related with postoperative pathological findings.Combining with clinical symptoms and CT features can be helpful for the early diagnosis of FNH in children.

Objective To explore the CT manifestations of pediatric mesenechymal hamartoma of liver (MHL).Methods Clinical data of 15 cases with MHL confirmed by surgery and pathology were retrospectively analyzed.All children were performed with CT scans including plain and enhanced scans,and the imaging features were analyzed.Results All the lesions were solitary,and 9 masses located at the right lobe of liver,4 located at the left lobe,the others located at both right and left lobe.The maximum diameter of lesions was from 5 cm to 30 cm,with an average of (11.52±6.84) cm.Ten cases were cystic and solid mixed,5 cases were solid.After contrast administration,the solid component and the septa of the masses showed enhancement while no enhancement was observed in the cystic component.Two cases had the spot-like calcification.Conclusion MHL has some special characteristics in the CT scan before surgery,which should be differentiated from other cystic and solid tumors of live.Some MHLs can be diagnosed when combined with the clinical information and CT images.

Objective To explore the risk factors affecting T-tube sinus tract formation after common bile duct exploration and T-tube drainage by spiral computed tomography (SCT)examination.Methods The clinical data of 465 patients undergoing common bile duct exploration and T-tube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed.The residual stones and biliary stricture were detected by T-tube cholangiography,and the T-tube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2.The factors affecting sinus tract formation were analyzed,including gender,age,albumin (Alb),C-reactive protein,alanine transaminase (ALT),total bilirubin (TBil),hemoglobin (Hb),surgical method,effusion around T tube,reoperation,diabetes.Univariate analysis was done using the chi-square test.Multivariate analysis was done using the Logistic regression.Results T-tubes of 465 patients were clear without residual stones.T-tube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2.T-tubes in other patients were removed when the sinus tract formation was detected by CT reexamination at postoperative week 4.In univariate analysis,Alb,surgery method,effusion around T-tube and diabetes were important factors affecting T-tube sinus tract formation (x2 =50.750,7.671,19.022,15.373,P ＜ 0.05).Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes were independent risk factors affecting T-tube sinus tract formation in multivariate analysis [Odds ratio =1.135,0.493,0.262,0.363; 95％ confidence interval:1.061-1.214,0.280-0.865,0.104-0.658,0.156-0.843,P ＜ 0.05].Conclusions The T-tube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and T-tube drainage.Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes are independent risk factors affecting T-tube sinus tract formation.