AIM: To investigate the correlation between fundus blood flow parameters and carotid artery ultrasound blood flow parameters in patients with hypertensive retinopathy(HRP).METHODS: A total of 50 patients(22 left eyes and 28 right eyes)with HRP admitted to our hospital from June 2021 to June 2023 were retrospectively included as the experimental group, and 50 healthy physical examination subjects(22 left eyes and 28 right eyes)during the same period were included as the healthy group. Pearson correlation was used to analyze the correlation between fundus blood flow parameters and carotid artery ultrasound blood flow parameters.RESULTS: The AUC values of fundus blood flow parameters and carotid artery ultrasound blood flow parameters and their combined diagnosis of HRP were 0.853, 0.844 and 0.935, respectively. Pearson correlation analysis showed that carotid systolic peak blood flow velocity was negatively correlated with foveal avascular zone(FAZ)area, FAZ circumference and non-circularity index, and positively correlated with macular vascular density(all P<0.05). The end-diastolic blood flow velocity was positively correlated with FAZ area and macular vascular density(all P<0.05). The internal carotid artery resistance index was positively correlated with FAZ area(P<0.05).CONCLUSION: The combination of fundus blood flow parameters and carotid artery ultrasound blood flow parameters in the diagnosis of HRP has good application value in the diagnosis of HRP.

Acquired cerebral amyloid angiopathy,as a cerebrovascular disease discovered in recent years,mainly spreads through iatrogenic factors.This paper focuses on acquired cerebral amyloid angiopathy and delves into the new applications and profound implications of the"toxins damaging brain collaterals"theory proposed by academician WANG Yongyan in stroke research.Starting from the perspective of"toxins damaging brain collaterals",it comprehensively analyzes the causes and pathological mechanisms of acquired cerebral amyloid angiopathy,emphasizing the importance of external toxins,latent toxins,and turbid toxins in understanding the pathogenesis of the disease.It reveals that"toxins damaging brain collaterals"is the core mechanism of acquired cerebral amyloid angiopathy.On this basis,it proposes a new connotation of"toxins damaging brain collaterals":first,"toxin"includes both internal and external toxins;second,the organic integration of"external wind theory"and"toxins damaging brain collaterals"guides the improvement of theoretical research,clinical treatment,and prevention strategies for stroke,and promotes a deeper understanding of the disease.This approach to understanding acquired cerebral amyloid angiopathy from the perspective of"toxins damaging brain collaterals"not only demonstrates the effective integration of traditional Chinese medicine theory and modern biomedical science,but also provides insights and references for the clinical diagnosis and treatment of the disease.

Objective:To systematically review, assess, extract, and summarize the most effective evidence on non-pharmacological traditional Chinese medicine interventions for promoting pulmonary rehabilitation in stable patients with chronic obstructive pulmonary disease, aiming to provide a theoretical foundation for clinical nurses to implement traditional Chinese medicine nursing interventions.Methods:According to the "6S" evidence model, relevant evidence on non-pharmacological traditional Chinese medicine interventions for stable chronic obstructive pulmonary disease was retrieved from domestic and foreign databases, guideline websites and professional society websites, including clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus, etc. The retrieval time was from January 1, 2018 to August 10, 2023. Two researchers evaluated the quality of the included literature, and extracted data and summarized evidence.Results:A total of 23 articles were included, including 6 guideline, 1 evidence summary, 7 systematic reviews, 8 Meta analysis and 1 expert consensus. The 37 evidences were summarized from 11 aspects, including target population, intervention focus, moxibustion therapy, acupoint sticking therapy, transcutaneous electrical acupoint stimulation, acupuncture therapy, acupoint injection therapy, traditional Chinese exercises, diet therapy, follow-up procedures, safety considerations.Conclusions:This study summarizes the evidences of traditional Chinese medicine non-drug pulmonary rehabilitation in the stable stage of chronic obstructive pulmonary disease. When applying the evidence in clinical practice, the traditional Chinese medicine nursing ability of nurses and the actual situation of patients should be fully considered to formulate an individualized traditional Chinese medicine nursing plan.

Objective To analyze the relationship between soluble α-Klotho(SKL)levels and continuous glucose monitoring(CGMS)-derived measures of glycemic management in diabetic kidney disease(DKD)patients.Methods A total of 140 T2DM patients admitted to the Department of General Medicine Affiliated Hospital of Yan'an University from May 2020 to May 2022 were selected and divided into two groups according to the levels of UACR:T2DM group(UACR<30 mg/g,n=60),DKD group(UACR≥30 mg/g,n=80)and 45 healthy persons(NC group)who received physical examination in the hospital during the same period were the NC group.Results The SKL level of DKD group was lower than that of T2DM group and NC group(P<0.05).Spearman correlation analysis showed that SKL was positively correlated with eGRF and TIR(P<0.01),and negatively correlated with Scr,UACR,CysC,β2-MG,FPG,HbA1c,MG,TAR and GMI(P<0.01).Multiple linear regression analysis showed that HbA1c and GMI were the influencing factors of SKL.Conclusion The level of SKL in DKD patients is correlated with HbA1c and GMI.

Objective:To investigate risk factors for decompressive craniectomy (DC) after endovascular therapy (EVT) in patients with acute anterior circulation ischemic stroke.Methods:Patients underwent EVT due to acute anterior circulation large vessel occlusion in Liaocheng Brain Hospital from January 2018 to January 2020 were retrospectively included. They were divided into DC group and non-DC group. Univariate and multivariate logistic regression analyses were used to determine risk factors for DC after EVT. Results:A total of 207 patients were enrolled, 126 were male (60.87%), and their age was 66.22±11.24 years old. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 19.84±9.20, and the Alberta Stroke Program Early CT Score (ASPECTS) was 7.98±0.66. The immediate postoperative modified Treatment In Cerebral Ischemia (mTICI) blood flow grade in seven patients (5.80%) was ≤2a, 30 (14.49%) experienced hemorrhagic transformation (HT) after procedure, and 28 (13.5%) received DC. There were statistically significant differences between the DC group and the non-DC group in terms of past stroke history, preoperative NIHSS score and ASPECTS, vascular occlusion site, EVT time, immediate postoperative mTICI ≤2a, and HT (all P<0.05). Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [ OR] 3.202, 95% confidence interval [ CI] 1.335-9.796; P=0.011), previous stroke history ( OR 2.655, 95% CI 1.016-6.938; P=0.046), high preoperative NIHSS score ( OR 1.074, 95% CI 1.026-1.124; P=0.002), internal carotid artery occlusion ( OR 4.268, 95% CI 1.399-13.024; P=0.011), longer EVT time ( OR 1.010, 95% CI 1.003-1.016; P=0.003), mTICI grade ≤2a ( OR 5.342, 95% CI 1.565-18.227; P=0.007) and postoperative HT ( OR 3.036, 95% CI 1.024-9.004; P=0.045) were independent risk factors for DC. Conclusions:It is not uncommon for patients with acute anterior circulation ischemic stroke to need DC after EVT. Previous stroke history, atrial fibrillation, high baseline NIHSS score, internal carotid artery occlusion, prolonged blood EVT time, mTICI grade ≤2a and postoperative HT are independent predictors of needing DC after EVT.

Objective:To evaluate the real-world short-term effectiveness of ixekizumab in the treatment of psoriasis, and to investigate factors influencing the effectiveness.Methods:Baseline data and short-term effectiveness evaluation results were retrospectively collected from patients with psoriasis, who received ixekizumab treatment in Department of Dermatology, Xiangya Hospital from November 2019 to September 2021. A descriptive analysis was performed on the baseline characteristics of patients, continuous data were described as median (lower quartile, upper quartile), and categorical data were described as percentages. Comparisons of disease severity scores before and after the treatment with ixekizumab were performed using Wilcoxon signed-rank test or paired McNemar test. Multivariable logistic regression analysis was conducted to explore factors influencing the effectiveness of 4-week ixekizumab treatment.Results:A total of 118 patients with psoriasis were included, including 94 males and 24 females, and their age [ M ( Q1, Q3) ] was 43.4 (32.5, 53.0) years; plaque psoriasis (99 cases, 83.9%) and severe psoriasis (72 cases, 68.6%) predominated among the 118 patients, and skin lesions were mainly located on the scalp (59/116, 50.9%). Among the 49 patients who had received 2-week ixekizumab treatment, 27 (55.1%) achieved a 50% improvement in the psoriasis area and severity index (PASI) score (PASI50) ; after 4-week treatment, 44 (89.8%), 30 (61.2%), 13 (26.5%) and 10 (20.4%) patients achieved PASI50/75/90/100 respectively, and their PASI scores (2.1 [1.1, 7.1]), involved body surface area (3.9% [0.5%, 14.5%]), dermatology life quality index scores (1.0 [0.0, 2.0]) and physician global assessment (PGA) scores (1.0 [1.0, 3.0]) were significantly lower than the corresponding scores at baseline (12.4 [8.8, 23.2], 22.0% [11.3%, 43.4%], 6.0 [3.0, 11.0], 4.0 [3.0, 5.0], respectively; all P < 0.001]. Multivariable logistic regression analysis showed that the baseline body mass index was significantly associated with the PASI75 response rate ( OR = 0.814, 95% CI: 0.659 - 0.958, P = 0.029) and the proportion of patients with PGA0/1 ( OR = 0.743, 95% CI: 0.562 - 0.917, P = 0.017) after 4-week ixekizumab treatment, and the baseline BSA score was significantly associated with the proportion of patients with PGA0/1 after 4-week ixekizumab treatment ( OR = 0.924, 95% CI: 0.870 - 0.968, P = 0.003) . Conclusion:The 4-week ixekizumab treatment significantly decreased the severity of psoriasis, and may be more effective in patients with lower disease severity and lower body mass index at baseline.

Objective:To summarize the clinical manifestations, treatment and outcome of neonatal pseudo-Bartter syndrome caused by maternal hyperemesis gravidarum.Methods:This retrospective study collected the clinical data of a set of premature twins with pseudo-Bartter syndrome who were admitted to Hebei Children's Hospital in September 2022. Clinical features of the cases were summarized with descriptive analysis.Results:The twins born with a gestational age of 30 +3 weeks required tracheal intubation and mechanical ventilation due to premature birth and respiratory distress. They were transferred to our hospital 2 h after birth. The mother suffered from hyperemesis gravidarum and even had severe vomiting complicated by hypokalemia 3 d before delivery. The blood gas analysis of the twins at 2 h after birth showed severe metabolic alkalosis, hyponatremia, hypokalemia, hypochloremia and hyperlactatemia. Hyperglycemia appeared at 6 h after birth, and scleredema neonatorum at 24 h after birth. No significant abnormalities were found in the tandem mass spectrometer analysis of blood or urine samples. Whole-exome sequencing showed no abnormalities in the genes related to the phenotype. The twins were diagnosed with neonatal pseudo-Bartter syndrome. After symptomatic and supportive treatment, metabolic alkalosis and electrolyte disorders in the twins were completely resolved 4 d after birth. They were cured and discharged 51 d after birth without recurrence. Follow-up revealed no abnormalities in the physical or neurological development of the twins at 11 months after birth. Conclusions:Maternal hyperemesis gravidarum can lead to neonatal pseudo-Bartter syndrome, characterized by severe metabolic disorders as well as respiratory and circulatory dysfunction at the early stage after birth. Timely diagnosis and treatment are conducive to good prognosis in the affected neonates.

Objective To investigate the effect of lycopene(LYC)on the oxidized low-density lipoprotein(ox-LDL)induced apoptosis of cerebral vascular endothelial cells(EC)by regulating the RAS homologous gene family member A(RhoA)/Rho-related kinase(ROCK)signaling pathway.Methods Human brain microvascular endothelial cells(HBMECs)without any treatments were de-signed as NC group;the HBMECs treated with ox-LDL were divided into ox-LDL group,LYC group(HBMECs treated with 0.5 μmol/L LYC),lysophosphatidic acid(LPA)group(HBMECs treated with 5 μmol/L RhoA/ROCK signaling pathway activator LPA),and LYC+LPA group(HBMECs treated with 0.5 μmol/L LYC and 5 μmol/L LPA);after 24 hours of treatment,they were used for subsequent experiments.Enzyme-linked immunosorbent assay(ELISA)was used to detect the cyto-kine levels of HBMECs;CCK-8 method was used to detect the proliferation of HBMECs;flow cy-tometry was used to detect the apoptosis rate of HBMECs;the Western blot was used to detect the expression levels of platelet endothelial cell adhesion molecule-1(CD31),smooth muscle(SM)22α,BCL-2 associated X protein(Bax),B-cell lymphoma/leukemia 2 protein(Bcl-2),cleaved-Caspase-3,and RhoA/ROCK pathway related proteins.Results Compared with the NC group,the levels of monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6),vascular endothelial cell adhesion molecule-1(VCAM-1),apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA and ROCK1 proteins in the ox-LDL group increased significantly,while the OD val-ue and the levels of Bcl-2 and CD31 proteins decreased significantly(P＜0.05);compared with the ox-LDL group,the levels of MCP-1,IL-6,VCAM-1,apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA,and ROCK1 proteins in the LYC group decreased significantly,while the OD value and the levels of Bcl-2 and CD31 proteins increased significantly(P＜0.05),but the trends in the LPA group were opposite;LPA weakened the improvement effect of LYC on ap-optosis of HBMECs induced by ox-LDL.Conclusion LYC may reduce apoptosis of HBMECs by inhibiting the RhoA/ROCK signaling pathway.

Objective To investigate the effect of lycopene(LYC)on the oxidized low-density lipoprotein(ox-LDL)induced apoptosis of cerebral vascular endothelial cells(EC)by regulating the RAS homologous gene family member A(RhoA)/Rho-related kinase(ROCK)signaling pathway.Methods Human brain microvascular endothelial cells(HBMECs)without any treatments were de-signed as NC group;the HBMECs treated with ox-LDL were divided into ox-LDL group,LYC group(HBMECs treated with 0.5 μmol/L LYC),lysophosphatidic acid(LPA)group(HBMECs treated with 5 μmol/L RhoA/ROCK signaling pathway activator LPA),and LYC+LPA group(HBMECs treated with 0.5 μmol/L LYC and 5 μmol/L LPA);after 24 hours of treatment,they were used for subsequent experiments.Enzyme-linked immunosorbent assay(ELISA)was used to detect the cyto-kine levels of HBMECs;CCK-8 method was used to detect the proliferation of HBMECs;flow cy-tometry was used to detect the apoptosis rate of HBMECs;the Western blot was used to detect the expression levels of platelet endothelial cell adhesion molecule-1(CD31),smooth muscle(SM)22α,BCL-2 associated X protein(Bax),B-cell lymphoma/leukemia 2 protein(Bcl-2),cleaved-Caspase-3,and RhoA/ROCK pathway related proteins.Results Compared with the NC group,the levels of monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6),vascular endothelial cell adhesion molecule-1(VCAM-1),apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA and ROCK1 proteins in the ox-LDL group increased significantly,while the OD val-ue and the levels of Bcl-2 and CD31 proteins decreased significantly(P＜0.05);compared with the ox-LDL group,the levels of MCP-1,IL-6,VCAM-1,apoptosis rate of HBMECs,the Bax,cleaved-Caspase-3,SM22α,RhoA,and ROCK1 proteins in the LYC group decreased significantly,while the OD value and the levels of Bcl-2 and CD31 proteins increased significantly(P＜0.05),but the trends in the LPA group were opposite;LPA weakened the improvement effect of LYC on ap-optosis of HBMECs induced by ox-LDL.Conclusion LYC may reduce apoptosis of HBMECs by inhibiting the RhoA/ROCK signaling pathway.

Objective:To explores the clinical efficacy and safety of carotid endarterectomy in patients with high bifurcation carotid artery stenosis.Methods:A total of 169 patients with carotid artery stenosis (147 patients with non-high bifurcation carotid artery stenosis and 22 patients with high bifurcation carotid artery stenosis), underwent carotid endarterectomy under surgical microscope in our hospital from January 2017 to January 2020, were included in the study. Patients with high bifurcation carotid artery stenosis were operated by cutting off the posterior abdomen of the digastric muscle to assist in exposing the distal end of the internal carotid artery plaque. Cervical CTA/DSA examination was performed within one week of surgery to confirm whether carotid artery stenosis was relieved; ultrasound examination of cervical vessels was performed 6 months and 1 year after surgery to determine whether restenosis was appeared in the carotid artery. The surgical efficacy, perioperative complications and re-examination results were compared between the two groups.Results:Postoperative carotid artery stenosis was relieved in both groups. The proportions of new cerebral infarction and temporary neurological impairment between the two groups (4.5% vs. 2.0%; 9.1% vs. 3.4%) showed no significant differences ( P>0.05). Carotid artery restenosis was not found in both groups. There was no obvious functional abnormality in the digastric muscles of patients with high bifurcation carotid stenosis. Conclusion:Cutting off the posterior abdomen of the digastric muscle during carotid endarterectomy can better expose the distal end of the internal carotid plaque in patients with high bifurcation carotid stenosis, and provide convenience for effective relief of carotid artery stenosis with high safety.