Objective:To investigate possible neuromodulatory mechanisms involved in the involvement of parvalbu-min(PV)expression in the basal ganglia output nuclei,entopeduncular nucleus(EPN)and substantia nigra pars etic-ulata(SNr),in exercise-induced chronic fatigue impairs working memory capacity.Methods:Male SD rats were divid-ed into control group and Fatigue group by random number method,and a three-stage incremental load treadmill training program was selected to establish a chronic exhaustion exercise-induced fatigue rat model.The working memory ability of rats was assessed by the Y-maze autonomous alternation experiment.Immunohistochemical staining was used to ob-serve the expression of parvalbumin(PV)positive neurons and cysteine aspartate-specific protease-3(caspase-3)in EPN and SNr of rats.Results:The accuracy of voluntary alternation in the fatigue group was obviously lower than that in control group(P＜0.05).The results of immunohistochemical staining showed that the density of PV positive neu-rons and the degree of positive fiber staining in EPN and SNr in the fatigue group were obviously lower than those in the control group(P＜0.05,P＜0.01).The number of caspase-3 positive cells per unit area of EPN and SNr in the fa-tigue group was obviously higher than that in the control group(P＜0.05,P＜0.01).Conclusion:The mechanism of impairing working memory in rats caused by exercise-induced chronic fatigue may be related to the apoptosis of PV posi-tive neurons in EPN and SNr.

Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019 to December 2021 were enrolled in this study.They were divided into elderly group(≥60 years old,99 cases)and non-elderly group(＜60 years old,95 cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA2DS2-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P＜0.05,P＜0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3％vs 8.4％,P=0.001).Postoperative complications in the elderly group in-cluded 1 case of pericardial effusion and 2 cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7％vs 69.5％,P=0.763)or recurrence rate during blanking period(21.2％vs 21.1％,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95％CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95％CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1 year after ablation.

Objective To investigate the efficacy of concurrent carotid artery stenting(CAS)in emergency endovascular treatment of anterior circulation tandem lesions and related influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical data of 121 patients with anterior circulation tandem lesions who underwent emergency endovascular treatment in Linyi People's Hospital from January 2020 to December 2021,and intraoperative CT reperfusion injury was observed to decide whether concurrent CAS should be performed.The modified Rankin Scale(mRS)score on day 90 after surgery was used for evaluation,and then the patients were divided into good prognosis group(an mRS score of 0?2)and poor prognosis group(an mRS score of 3?6).The logistic regression analysis was used to investigate the influencing factors for the clinical prognosis of patients with anterior circulation tandem lesions after emergency endovascular treatment,including concurrent CAS.Results General clinical data were compared between the good prognosis group and the poor prognosis group,and the univariate analysis and multivariate binary logistic regression analysis showed that that preoperative CT ASPECTS score[odds ratio(OR)=1.207,95%confidence interval(CI)1.001?1.456,P=0.049],time from disease onset to recanalization(OR=0.997,95%CI 0.995?0.999,P=0.012),and symptomatic intracranial hemorrhage(OR=-3.057,95%CI 0.005?0.411,P=0.006)were independent influencing factors for the prognosis of patients with anterior circulation tandem lesions after emergency endovascular treatment.Conclusion Exclusion of reperfusion injury based on intraoperative CT and concurrent CAS for anterior circulation tandem lesions do not increase the risk of hemorrhage,and presence of the risk of reperfusion injury based on intraoperative CT without stenting does not increase the risk of occlusion within a short period of time.There are no significant differences in 90-day good prognosis rate and mortality rate between the non-CAS group and the CAS group.High ASPECTS score is a protective factor for good prognosis in patients with anterior circulation tandem lesions,while a longer time from disease onset to recanalization and symptomatic intracranial hemorrhage are influencing factors for good prognosis.

Objective To evaluate the effectiveness of exercise for people with Parkinson's disease on sleep quality.Methods Computerized retrieval of PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,CN-KI,WanFang Data,VIP,CBM was conducted to collect randomized controlled trials about the effect of exercise on people with Parkinson's disease from inception to December,2022.There were 2 researchers who independently screened the literature,extracted the data and evaluated the risks of bias in the included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of 13 studies were included,with 874 patients.The result of meta-analysis show that the overall effect size of exercise intervention on sleep quality for people with Parkin-son's disease is significant(SMD=-0.54,95％CI=[-0.90,-0.19],P＜0.01).Subgroup analysis show that the maxi-mum effect size of intervention frequency is 4-5 times/week(SMD=-0.75);the maximum effect size of exercise intensity is light intensity(SMD=-2.19);the maximum effect size of a single intervention time is 40-55 minutes(SMD=-0.69);the maximum effect size of exercise type is traditional Chinese exercise(SMD=-0.63);the maximum ef-fect size of intervention cycle is 12 weeks(SMD=-0.66).Conclusion Exercise intervention has significantly ef-fects to improve sleep quality on Parkinson's disease patients.It is a more effective way to improve sleep quality by exercising 4-5 times per week,while each exercise lasts about 40-55 min for 12 weeks in Traditional Chinese Medicine exercise with light intensity.

Objective To investigate the predictive value of preoperative blood inflammatory markers for the recurrence risk in patients with basal cell carcinoma(BCC).Methods A total of 225 patients with BCC were divided into the high-risk recurrence group(155 cases)and the low-risk recurrence group(70 cases).General information and preoperative hematological indicators were collected in the two groups of patients.The neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),systemic inflammation marker(SIM)and platelet-to-lymphocyte ratio(PLR)were calculated.Receiver operating characteristic(ROC)curves were used to determine the predictive value of hematological markers with statistically significant differences between the two groups for BCC recurrence and to establish optimal cutoff values.Univariate and multivariate Logistic regression analyses were conducted to identify factors influencing BCC recurrence.A multivariate Logistic regression model was established to predict the recurrence risk of BCC.Area under the curve(AUC)and the Hosmer-Lemeshow test were used to evaluate the prediction efficiency and goodness-of-fit of the model.Results ROC analysis identified that optimal cutoff values for LMR and SIM were 5.12 and 0.86,respectively.Univariate Logistic regression analysis showed that LMR,SIM,ulceration at the primary tumor site,UV exposure and tumor maximum diameter were factors influencing BCC recurrence.Multivariate Logistic regression revealed that SIM≥0.86,tumor maximum diameter≥2.0 cm and UV exposure were risk factors for BCC recurrence,while LMR≥5.12 had a protective effect.The Logistic prediction model for BCC recurrence risk was Logit(P)=-1.598-1.517×LMR+1.323×SIM+2.406×UV exposure+3.465×tumor maximum diameter,with good model fit(P=0.725)and an AUC of 0.869(95%CI:0.822-0.917)for predicting BCC recurrence risk.Conclusion Monitoring preoperative LMR and SIM levels can assist in assessing the risk of recurrence in BCC patients and provide important guidance for clinical decision-making.

Objective:To systematically evaluate the efficacy and safety of general anesthesia versus conscious sedation in patients with endovascular therapy for acute ischemic stroke.Methods:Databases, including English databases PubMed, Embase and Cochrane, as well as Chinese databases Wan Fang Data and CNKI, were screened for randomized controlled trials (RCT) of general anesthesia versus conscious sedation on the effect of endovascular treatment for acute anterior circulation ischemic stroke. The searching period was from the establishment of databases to July 14, 2022. Two researchers independently screened literatures, extracted data and evaluated the risk of bias. And meta-analysis was performed using RevMan5.3 software.Results:A total of 7 RCTs involving 923 patients were included, with 461 in the general anesthesia group and 462 in the other. As the meta-analysis showing, general anesthesia could significantly improve the good outcomes (modified Rankin Scale score≤2) at 3 months after endovascular treatment in comparison with conscious sedation ( OR=1.34, 95% CI 1.01-1.78, P=0.04), and significantly increased the rate of successful revascularization ( OR=1.87, 95% CI 1.32-2.65, P<0.001). In addition, there were no statistically significant differences between the two groups in mortality ( OR=0.93, 95% CI 0.66-1.29, P=0.65), symptomatic intracranial hemorrhage ( OR=0.88, 95% CI 0.57-1.35, P=0.55) and intervention-related complications ( OR=0.83, 95% CI 0.50-1.36, P=0.46). However, general anesthesia was associated with higher risk for both 20% reduction in mean arterial pressure ( OR=4.76, 95% CI 1.49-15.19, P=0.008) and pneumonia ( OR=2.58, 95% CI 1.51-4.39, P<0.001). Conclusions:Compared with conscious sedation, endovascular treatment under general anesthesia in patients with acute anterior circulation ischemic stroke may contribute to better outcomes and higher successful revascularization. However, this method will lead to the risk of blood pressure variability and the incidence of pneumonia.

Cerebellum ; Basal Ganglia

Objective:To analyze the feasibility and clinical efficacy of reperfusion-expanding-thrombectomy-stenting (RETS) technique in the endovascular treatment of acute carotid artery tandem lesion.Methods:The general clinical data of 88 patients with carotid artery tandem lesion who received emergency endovascular treatment from January 2018 to December 2020 in Department of Neurology, Linyi People′s Hospital were reviewed, the Modified Rankin Scale (mRS) was used as the evaluation standard for the prognosis of patients at 90 days after endovascular treatment, and the clinical data were analyzed, including the recanalization (modified thrombolysis in cerebral infarction ≥2b), perioperative complications and 90-day prognosis, and good prognosis was defined as a mRS score of 0-2.Results:A total of 88 patients with tandem carotid artery disease were included,48 of whom were treated with RETS technique, 40 were treated with anterograde approach. Compared with antegrade recanalization, RETS technique had significant differences in the time from puncture to recanalization [(72.06±17.29) min vs (98.88±26.09) min, t=-5.56, P<0.001] and the primary recanalization rate [35/48(73.0%) vs 21/40(52.5%),χ2=3.93 ,P=0.047], with statistically significant difference. There was no significant difference in clinical prognosis and surgical complications between the two methods (all P>0.05). Conclusions:RETS technique can shorten the operation time and increase the primary recanalization rate. RETS technique is safe and feasible for the treatment of carotid tandem lesions.

Brucellosis is a kind of animal epidemic disease that can be transmitted to human beings through skin, mucous membrane, digestive tract, respiratory tract and other ways. In recent years, the incidence of brucellosis has increased. Its pathogenesis is relatively complicated. In addition to bacteria, toxins and other factors, genetic susceptibility has gradually attracted the attention of scholars. In this paper, we summarized the previous reports and reviewed the relationship between interleukin gene polymorphism and susceptibility to brucellosis.

Objective:To explore the clinical prognoses of acute ischemic stroke (AIS) patients with large core infarction after endovascular therapy (EVT) and their influencing factors.Methods:Totally, 139 AIS patients with large area core infarction (volume of infarction core area≥70 mm3) admitted to our hospital from November 2019 to December 2020 were enrolled in our study; their clinical data were analyz ed retrospectively. These patients were divided into EVT group ( n=78) and non-EVT group ( n=61) according to whether endovascular treatment was performed, and the clinical prognoses of patients from the 2 groups were compared. According to the 3-month modified Rankin scale (mRS) scores, the patients in the EVT group were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2); univariate and multivariate Logistic regressions were used to analyze the independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Results:As compared with those in the non-EVT group, patients in the EVT group had significantly higher good prognosis rate (11.48% vs. 42.31%), and significantly lower proportion of patients with neurological deterioration, cerebral hernia and death ( P<0.05). As compared with the poor prognosis subgroup, the good prognosis subgroup had significantly lower percentage of patients with atrial fibrillation, significantly higher percentage of conscious patients, significantly higher Alberta stroke program early CT scale (ASPECT) scores, statistically lower volume of infarction core areas, and significantly higher percentage of patients with grading 2-4 in collateral circulation ( P<0.05). ASPECT scores ( OR=4.164, 95%CI: 2.081-8.332, P=0.000), volume of infarction core areas ( OR=0.917, 95%CI: 0.855-0.984, P=0.016), and collateral circulation grading ( OR=5.113, 95%CI: 1.104-23.683, P=0.037) were independent influencing factors for prognoses of AIS patients with large area core infarction after EVT. Conclusion:EVT can effectively improve the prognoses and reduce the complication rate of AIS patients with large area core infarction; patients with high ASPECT scores, low infarct core volume, and high collateral circulation grading get great benefits.