ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.

BACKGROUND:The plantarflexor weakness is a common muscle defect in patients with spastic cerebral palsy and Charcot-Marie-Tooth,which clinically manifests abnormal gaits,and the relationship between plantarflexor weakness and abnormal gaits is unclear. OBJECTIVE:To explore the biomechanical behavior of the lower limb under the action of a single factor of plantarflexor weakness to reveal the mechanism of abnormal gait induced by plantarflexor weakness and to provide guidance for the rehabilitation training of patients with plantarflexor weakness. METHODS:A predictive framework of musculoskeletal multibody dynamics in the sagittal plane was established based on OpenSim Moco to predict lower limb joint angles and muscle activation changes during walking in normal subjects.The validity of the framework was verified by combining the inverse kinematics and electromyogram activation time of the experimental data.Reduced isometric muscle forces were used to model plantarflexor weakness and to compare predicted lower extremity joint angles,joint moments,and muscle energy expenditure with normal subjects to analyze the effects of plantarflexor weakness on lower extremity biomechanics. RESULTS AND CONCLUSION:(1)The Moco-based prediction framework realistically predicted the biomechanical changes of the lower limbs during walking in normal subjects(joint angles:normalized correlation coefficient≥0.73,root mean square error≤7.10°).(2)The musculoskeletal model used a small stride support phase to increase the"heel-walking"gait during plantarflexor weakness.When the plantarflexor weakness reached 80%,the muscle energy expenditure was 5.691 4 J/kg/m,and the maximum activation levels of the gastrocnemius and soleus muscles were 0.72 and 0.53,which might cause the plantarflexor weakness patients to be more prone to fatigue when walking.(3)Muscle energy expenditure was significantly higher when the weakness of plantarflexors exceeded 40%,and the joint angles and moments of the lower limbs deteriorated significantly when the weakness of plantarflexors exceeded 60%,suggesting that there may be a"threshold"for the effect of plantarflexor weakness on gait,which may correspond to the point at which health care professionals should intervene in the clinical setting.

Objective: To understand the unhealthy listening habits and related factors hearing on impairment among primary and middle school students in Jilin Province, so as to provide a scientific basis for the prevention of hearing impairment in children and adolescents. Methods: From September to November 2021, a stratified cluster random sampling method was employed to select 12 847 primary and middle school students in nine cities of Jilin Province who use headphones for more than 0.5 hours daily for a questionnaire survey. Data on unhealthy listening habits, lifestyle habits and hearing impairment were collected. The data were analyzed using the χ 2 test and Logistic regression. Results: Totally 1 702 students(13.25%) experienced hearing impairment within the last month. There were statistical differences between the sexes with the average daily headphone use, the times of using headphones ≥1 h every day for one week use in all environment or noisy environment ( χ 2=47.86, 57.60, 66.31, P <0.01). Logistic regression analysis results showed that factors related to the occurrence of hearing impairment among primary and secondary school students included:average daily headphone use of 1-2 h and more than 2 h ( OR=1.74, 95%CI =1.60-1.90; OR=1.73, 95%CI =1.59-1.90), times of using headphones ≥1 h every day for one week were 1-2 times and >2 times ( OR=1.71, 95%CI =1.59- 1.84 ; OR=1.83, 95%CI =1.71-1.97), the times of using headphones≥1 h every day for one week being 1-2 times and >2 times in noisy environment per week ( OR=1.48, 95%CI =1.40-1.56; OR=1.72, 95%CI =1.61-1.86), economic underdevelopment ( OR=1.85, 95%CI =1.76-1.96), boarding （OR=1.78, 95%CI =1.69-1.89), single parent family ( OR=1.72, 95%CI =1.60- 1.87 ), daily activity duration less than 1 h ( OR=1.71, 95%CI =1.63-1.81), sedentary behavior duration more than 6 h per day ( OR=1.88, 95%CI =1.79-1.98) ( P <0.05). Conclusions The behavior of ear protection among primary and middle school students in Jilin Province needs to be enhanced, focusing on students in economically underdeveloped areas, boarding schools and single parent families. It is necessary to guide primary and middle school students to improve their bad ear habits, increase outdoor activities and reduce the time of sitting.

Biliary atresia （BA） is characterized by progressive inflammation and fibrous obstruction of bile ducts， ultimately leading to cholestatic liver cirrhosis. Kasai surgery is the standard procedure for the treatment of BA， and early diagnosis is a key influencing factor for the prognosis of BA. Indocyanine green （ICG） is a near-infrared photosensitive dye that is efficiently and selectively absorbed by hepatocytes after intravenous injection， and it enters the intestine via bile and is excreted with the feces in the free form， with a favorable safety profile. In addition， ICG can emit fluorescence under near-infrared light， which can be captured by camera instruments and converted into visual images， and ICG fluorescence imaging technology can reflect the intraoperative situation in real time and significantly improve the success rate of the surgical procedure. This article reviews the advances in the application of ICG in early preoperative diagnosis， intraoperative imaging， and postoperative liver function assessment in recent years.

Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.

Objective To screen monoclonal antibodies against different binding sites of connexin 43(Cx43) and establish a double antibody sandwich ELISA method for quantitative detection of Cx43 protein in order to further study the structure,function and subcellular localization of full-length and truncated Cx43 protein.Methods The sequence of Cx43 protein was analyzed by bioinformatics method. The peptide fragments were designed and synthesized for different domains, and coupled with keyhole limpet hemocyanin(KLH) protein, which were used as immunogen to immunize 15 female BALB/c mice.Hybridoma cells were prepared by cell fusion technology, and cell lines stably secreting monoclonal antibodies against Cx43 protein were screened. The antibodies were purified by Protein G affinity chromatography, and its subtype, affinity and specificity were identified. Two high affinity monoclonal antibodies were used as capture antibody and detection antibody respectively(labeled with HRP) to establish a double antibody sandwich ELISA method. The sealing solution(5% milk-PBS, 3%BSA-PBS), washing solution [0. 01 mol/L PBS(pH 7. 2), 0. 01 mol/L PBS-0. 5% Tween 20(pH 7. 2)(i. e., PBST)] and sample diluent [3% BSA-PBS and 0. 01 mol/L PBS(pH 7. 2)]were optimized, and the method was verified for the linear range, sensitivity, specificity, precision and accuracy. The content of Cx43 protein in mouse brain tissue, intestine tissue, femur tissue and MC3T3-E1 mouse embryonic osteoblast lysate was detected by the established method.Results Three hybridoma cell lines secreting monoclonal antibodies against Cx43 were screened and named as 1-1E2, 2-1G11 and 3-2G12 respectively. The antibody subtypes were IgG1, IgG1 and IgG2b respectively, and the antibody sensitivity reached 0. 002 μg/mL, among which 2-1G11 and 3-2G12 had higher affinity. A double antibody sandwich ELISA was developed with 2-1G11 as capture antibody and HRP-labeled 3-2G12 as detection antibody. The optimum sealing solution was 3% BSA-PBS, washing solution was PBST, and sample diluent was 0. 01 mol/L PBS(pH 7. 2). Cx43 protein standard showed a good linear relationship with the mean value of A_(450)in the concentration range of 3. 12-200 ng/mL, R~2> 0. 98. Cx43 protein could be specifically detected by this method, and there was no cross reaction with KLH protein, bone morphogenetic protein-2(BMP-2) and human recombinant TGM2 protein. The CV of precision verification was 7. 72%. The recovery rates of high, medium and low concentrations of test samples were all in the range of 85%-115%. The content of Cx43 protein in MC3T3-E1 mouse embryonic osteoblasts was higher(58. 03 ng/mL), while the content in osteogenic tissue was lower(38. 4 ng/mL).Conclusion Specific monoclonal antibodies against different epitopes of human Cx43 were successfully prepared, and a double antibody sandwich ELISA method with high sensitivity and strong specificity for quantitative detection of Cx43 protein was established, which provided a reliable detection method for the study of structure and function of Cx43 protein.

Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes.Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder.However,its therapeutic dosage closely approaches toxic levels.Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L,typically giving rise to gastrointestinal and central nervous system reactions.Cardiac toxicity is rare but serious in cases of lithium poisoning.The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers.This resulted in symptoms such as arrhythmia,shock,impaired consciousness,and coarse tremors.Following symptomatic supportive treatment,including blood dialysis,the patient's physical symptoms gradually improved.It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

Objective To investigate the effect and its mechanism of Guanxinning tablet on carotid atherosclerotic plaque in a rat model.Methods The rats were randomly divided into control group,model group(to construct carot-id atherosclerosis plaque model),Guanxinning groups with low,medium and high dose of Guanxinning tablet(150,300 and 600 mg/kg),atorvastatin group(2 mg/kg),lithiumchloridemonohydrate(LiCl)(Wnt/β-catenin pathway activator)group(15 mg/kg),and Guanxinning plus LiCl group(600 mg/kg Guanxinning tablets+15 mg/kg LiCl),with 12 rats in each group.The intervention began at the third week and was administered once a day for 8 weeks.Olympus Au2700 automatic biochemical analyzer was used to detect the level of total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL)and high-density lipoprotein(HDL)in rat serum;ELISA was applied to detect the level of monocyte chemotactic protein(MCP-1)and hyper-sensitive C-reactive protein(hs-CRP)in rat se-rum;the level of oxidized low density lipoprotein(ox-LDL)and malondialdehyde(MDA)in rat serum were detected by spectrophotometry;HE staining was applied to find pathological changes in the common carotid artery of rats;Western blot was applied to detect the expression of Wnt3a,matrix metalloproteinase-9(MMP-9)and β-catenin in rat common carotid artery.Results Compared with the control group,the level of TG,TC,LDL,MCP-1,hs-CRP,ox-LDL,protein expression of MDA,MMP-9,Wnt3a,β-catenin and total plaque area/total arterial area ratio in-creased,the HDL level decreased in model group(P＜0.05);compared with the model group,the level of TG,TC,LDL,MCP-1,hs-CRP,ox-LDL,MDA,expression of MMP-9,Wnt3a,β-catenin protein and total plaque area/total arterial area ratio in the low,medium,and high dose groups of Guanxinning tablets decreased,the HDL level in-creased.The effect of Guanxinning tablets was dose-dependent,and the change trend of corresponding indicators in the LiCl group was opposite to the above(P＜0.05);compared with the high dose group of Guanxinning tablets,the TG,TC,LDL,MCP-1,hs-CRP,ox-LDL,MDA levels,MMP-9,Wnt3a,β-catenin protein expression,and total plaque area/total arterial area ratio in the high dose+LiCl group of Guanxinning tablets increased,the HDL level de-creased(P＜0.05).Conclusions Guanxinning tablet can inhibit the formation of atherosclerotic plaque in rats and the mechanismis potentially related to the regulation of Wnt/β-catenin pathway.

Objective To explore the correlation between platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR)and carotid atherosclerotic(CAS)plaque in patients with type 2 diabetes(T2DM),and the predictive value of PLR and NLR for T2DM complicated with CAS plaque.Methods A total of 369 T2DM patients admitted to the Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University from September 2019 to November 2021 were se-lected as research subjects.The clinical data such as gender,age,course of disease,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),personal history,and history of past illness of patients were collected by searching the electronic medical record system.Neutrophil(NC)count,lymphocyte count(LC)and platelet(PLT)count were detected by fully automated blood routine analyzer,and PLR,NLR were calculated;the levels of fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein-cholesterol(HDL-C)and low-density lipoprotein-cholesterol(LDL-C)were detected by biochemical analyzer;the level of glycosylated hemoglobin(HbA1c)were detected by high-performance liquid chromatography.The T2DM patients were divided into T2DM uncomplicated with CAS plaque group(n=94)and T2DM complicated with GAS plaque group(n=275)based on whether they complicated with CAS plaque or not;the general clinical data,blood indicators,and PLR,NLR of patients were compared between the two groups.The T2DM patients were divided into non plaque group(group A,n=94),1 plaque group(group B,n=79),2 plaque group(group C,n=89),and 3 or more plaques group(group D,n=107)based on the number of CAS plaques;the indicators with statistical differences between T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group of patients were compared among the four groups.According to the PLR quartile,the patients were divided into P1 group(PLR≤94.87,n=93),P2 group(94.87＜PLR≤117.30,n=91),P3 group(117.30＜PLR ≤ 148.53,n=93),and P4 group(PLR＞148.53,n=92),and the detection rate of CAS plaques of patients was compared among the four groups;according to the NLR quartile,the patients were divided into N1 group(NLR≤1.59,n=92),N2 group(1.59＜NLR≤1.93,n=92),N3 group(1.93＜NLR≤2.50,n=93),and N4 group(NLR＞2.50,n=92),and the detection rate of CAS plaque of patients was compared among the four groups.The risk factors of T2DM complicated with CAS plaque was analysed by multivariate logistic regression analysis,and the predictive efficacy of PLR and NLR for T2DM complicated with CAS plaque were evaluated by receiver operating characteristic(ROC)curve.Results The age,course of T2DM,proportion of patients combined with hyper-tension,SBP,PLR,and NLR of patients in the T2DM complicated with CAS plaque group were significantly higher than those in the T2DM uncomplicated with CAS plaque group,while LC and TG levels were significantly lower than those in the T2DM uncomplicated with CAS plaque group(P＜0.05);there was no significant difference in gender,proportion of patients com-bined with hyperlipidemia,proportion of smoking history,proportion of drinking history,and the levels of DBP,BMI,NC,PLT,TC,HDL-C,LDL-C,FBG,HbA1c between the T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,SBP,PLR,and NLR of patients in group B,group C,and group D were significantly higher than that in group A,while LC level was significantly lower than that in group A(P＜0.05).The TG level of patients in group D was significantly lower than those in group A(P＜0.05);there was no statistically significant difference in TG level of patients among group A,group B,and group C(P＞0.05).The age,proportion of patients combined with hypertension,and course of T2DM of patients in group C and group D were significantly higher than those in group B,while the SBP of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in SBP of patients between group C and group B(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,and SBP of patients in group D were significantly higher than those in group C(P＜0.05).There was no statistically significant difference in the levels of LC,TG,and PLR of patients among group B,group C,and group D(P＞0.05).The NLR of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in NLR of patients between group C and group B(P＞0.05),and there was no statistically significant difference in NLR of patients between group D and group C(P＞0.05).The detection rate of CAS plaques of patients in P1 group,P2 group,P3 group,and P4 group showed a significant increase trend(x2=30.610,P=0.000);and the detection rate of CAS plaques of patients in N1 group,N2 group,N3 group,and N4 group showed a significant increase trend(x2=35.170,P=0.000).Multivariate logistic regression analysis showed that age,PLR,and NLR were independent risk factors for T2DM complicated with CAS plaque(odds ratio=1.107,1.017,1.940;P＜0.05).The opti-mal cutoff value of PLR in predicting T2DM complicated with CAS plaque was 119.95,with an area under the curve of 0.680,a sensitivity of 54.7％,and a specificity of 76.3％;the optimal cutoff value of NLR in predicting T2DM complicated with CAS plaque was 1.97,with an area under the curve of 0.698,a sensitivity of 56.5％,and a specificity of 79.6％.Conclusion PLR and NLR are associated with T2DM complicated with CAS plaque,which are independent risk factors for T2DM compli-cated with CAS plaque,and have certain predictive value for T2DM complicated with CAS plaque.

ObjectiveTo investigate the changes in cerebral blood perfusion in patients with acute cerebral infarction after taking Tongnaoyin， a traditional Chinese medicine， based on head and neck computed tomography （CT） angiography （CTA） combined with brain CT perfusion imaging （CTP）. MethodA total of 240 patients with cerebral infarction of phlegm and blood stasis syndrome treated in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2018 to September 2023 were randomly divided into a control group （99 cases） and a Tongnaoyin group （141 cases）. Based on the guidelines， the control group was treated with conventional treatment such as anti-aggregation， anticoagulation， lipid-lowering and plaque stabilization， brain protection， and supportive treatment. The Tongnaoyin group was treated with Tongnaoyin of 200 mL in warm conditions in the morning and evening on the basis of the control group. Both groups underwent CTA combined with CTP within 24 hours after admission， and they were reexamined by CTA and CTP in the sixth month after admission. The degree of intracranial artery stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） method. The relative cerebral blood volume （rCBV）， relative cerebral blood flow （rCBF）， mean transit time （MTT）， and time to peak （TTP） of the lesion area before and after treatment were compared. The adverse outcomes of the two groups within six months after discharge were compared. ResultCompared with the group before treatment， the degree of vascular stenosis in the Tongnaoyin group was significantly reduced， and the difference was statistically significant （Z=105.369，P<0.05）. Compared with the control group after treatment， the improvement rate of vascular stenosis in the Tongnaoyin group was higher （χ²=84.179，P<0.01）， and the curative effect was better.After treatment， the rCBV and rCBF of patients in the Tongnaoyin group were significantly increased， and the difference was statistically significant （P<0.01）. MTT and TTP showed a trend of shortening， but the difference was not statistically significant. There was no statistically significant difference in rCBV， rCBF， MTT， and TTP in the control group. Compared with those in the control group after treatment， the rCBV and rCBF in the Tongnaoyin group were significantly increased， while MTT and TTP were significantly reduced （P<0.01）. After six months of discharge， the risk of poor prognosis in the Tongnaoyin group was significantly reduced compared with the control group （P<0.05）. ConclusionTongnaoyin has a good effect on improving cerebral blood perfusion in patients with acute cerebral infarction. It can be used as an effective supplement for the conventional treatment of ischemic stroke to improve clinical efficacy.