Parkinson disease(PD)and dystonia share a common pathophysiological mechanism.In the later stage of the disease,PD-related dystonia can seriously impact the quality of life of patients and increase the burden of caregivers.This article reviews the common pathophysiological mechanism of PD and dystonia and the manifestations of PD-related dystonia.

Objective:To evaluate the autogenous arteriovenous fistula(AVF) insufficiency by ultrasound monitoring of brachial artery resistance index(RI).Methods:The brachial artery RI and blood flow volume(FV) data of 828 patients who underwent color-Doppler ultrasound detection after AVF in the General Hospital of Western Theater Command from January 2019 to June 2021 were retrospectively analyzed. The patients were grouped according to the adequacy of clinical dialysis, including 668 patients in the group with normal AVF function and 160 patients in the group with insufficient AVF function. The general information and ultrasonic measurement parameters were compared between the two groups. The correlation between brachial artery FV and RI was analyzed. The evaluation of brachial artery flow RI for AVF insufficiency was analyzed by ROC curve.Results:There were statistically significant differences between the two groups in brachial artery RI and FV(both P<0.001). The results of Pearson correlation analysis showed that brachial artery FV was negatively correlated to RI ( r=-0.657, P<0.001). The area under ROC curve for assessing AVF function by brachial artery RI was 0.970, with 95% CI was 0.955-0.986, the optimal cut-off value was 0.665, and the sensitivity and specificity were 0.888 and 0.955, respectively. Conclusions:Brachial artery RI in patients with AVF insufficiency is significantly higher than that in patients with normal AVF function. The optimal cutoff value of brachial artery RI can be used as an evaluation parameter for rapid screening of AVF function.

Objective:To investigate the effect and mechanism of treadmill training on Purkinje cells in the cerebellum of the rats with spinal cord injury(SCI). Method:Total of 108 female SD rats were randomly divided into 3 groups:the sham-operated group,the SCI group,and the SCI+treadmill training(TT)group.The rats in the SCI exercise group started treadmill train-ing after surgery,and BBB scores were used to assess the hindlimb motor function of rats with spinal cord in-jury.The cerebellum tissues were collected on the 3,7 and 14 day after surgery respectively,and the number and morphological changes of Purkinje cells in the cerebellum were detected by HE staining and Nissler stain-ing.The expression of caspase-9 and mGluR1 in Purkinje cells was detected by immunohistochemistry;the ex-pression of caspase-3 and mGluR1 was detected by immunofluorescence;the expression of apoptosis-related proteins Bax,Bcl-2,Cyt-C,caspase-9 and caspase-3 in cerebellar tissue was detected by Western Blot. Result:Compared with the sham-operated group,the BBB scores in SCI and SCI+TT groups were significant-ly decreased(P＜0.05).The number of Purkinje cells in cerebellum was reduced,and the size was reduced and lost the normal morphology.The expression levels of apoptosis-related proteins Bax,Cyt-C,activated caspase-9,and activated caspase-3 proteins in cerebellum were significantly increased(P＜0.05),and Bcl-2 expression was significantly decreased;caspase-9 and caspase-3 expression was increased and mGluR1 expression was decreased in Purkinje cells(P＜0.05).Compared with the SCI group,there was no significant difference in the BBB scores of the SCI+TT group(P＞0.05);the number and normal morphology of Purkinje cells in cerebellum increased;the expression levels of apoptosis-related proteins Bax,Cyt-C,activated caspase-9 and activated caspase-3 de-creased(P＜0.05),and the expression of Bcl-2 increased;the expression levels of caspase-9 and caspase-3 in Pur-kinje cells were decreased,and the expression level of mGluR1 was significantly increased(P＜0.05). Conclusion:Treadmill training can reduce the apoptosis of Purkinje cells in the cerebellum of the rats with spi-nal cord injury through the mitochondrial apoptosis pathway.

Objective:To investigate the clinical characteristics and risk factors of alcoholic liver disease (ALD) combined with type 2 diabetes mellitus (T2DM).Methods:The clinical data of 70 patients with ALD combined with T2DM (ALD + T2DM group) who received treatment from March 2015 to March 2020 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. The clinical data of 69 patients with ALD (ALD group) and 69 patients with T2DM (T2DM group) who concurrently received treatment were also analyzed. Sex, age, body mass index, drinking habits and other basic information in the three groups were collected. The risk factors of ALD combined with T2DM were evaluated by logistic regression analysis.Results:The daily alcohol intake and years of drinking in the ALD + T2DM group were (110.97 ± 79.78) g/d and (25.17 ± 10.05) years, respectively, which were significantly higher than (91.48 ± 64.26) g/d and (21.78 ± 8.91) years respectively in the ALD group ( t = 1.699, 2.102, both P < 0.05). The incidence of metabolic syndrome in the ALD + T2DM group was 34.3% (24/70), which was significantly higher than 15.9% (11/69) in the ALD group ( χ2 = 6.210, P < 0.05). The activity ratio of aspartate aminotransferase/alanine aminotransferase, total bilirubin level, gamma glutamyl transpeptidase activity in the ALD + T2DM group were 1.59 ± 0.93, (64.73 ± 39.90) μmol/L, (522.93 ± 353.66) U/L, respectively, which were significantly higher than (1.04 ± 0.53), (10.37 ± 4.51) μmol/L, (35.73 ± 23.99) U/L, respectively in the T2DM group ( t = 4.280, 3.780, 5.045, all P < 0.05). Triacylglycerol level in the ALD + T2DM group was significantly higher than that in the ALD group [(1.69 ± 1.04) mmol/L vs. (1.28 ± 0.87) mmol/L, t = 2.523, P < 0.05). Prothrombin time and lactate dehydrogenase activity in the ALD + T2DM group were (13.13 ± 2.79) s and (226.17 ± 79.93) U/L, respectively, which were significantly higher than (10.41 ± 0.84) s, (172.63 ± 39.34) U/L, respectively in the T2DM group ( t = 7.715, 4.969, both P < 0.05). Multivariate Logistic regression analysis showed that prothrombin time, triacylglycerol level, years of drinking, gamma glutamyl transpeptidase activity, and amount of drinking were the main risk factors for ALD combined with T2DM ( OR = 2.010, 3.270, 1.230, 1.060, 1.006, all P < 0.05). Conclusion:Patients with ALD combined with T2DM are prone to metabolic syndrome and lipid disorders, which may aggravate the disease. Prothrombin time, triacylglycerol level, years of drinking play an important role in the development of ALD combined with T2DM.

Objective:To explore the effects of diary research-based communication pattern on migration stress of first-degree relatives of elderly patients transferred out of ICU.Methods:Totally 86 elderly patients transferred out of ICU postoperatively at the 2nd Affiliated Hospital of Wenzhou Medical University from October 2017 to April 2018 were selected by convenient sampling and divided into the control group ( n=43, admitted between October and December 2017) and the observation group ( n=43, admitted between January and April 2018) according to admission time. Patients in the control group underwent routine communication, while patients in the observation group conducted communication based on diary research. The migration stress levels of the first-degree relatives were compared between the two groups. Results:There was no significant difference in migration stress levels between the first-degree relatives of the two groups before the intervention ( P>0.05) . After the intervention, the level of migration stress of the first-degree relatives in the observation group was lower than that in the control group, and the difference was statistically significant ( t=3.598, P<0.01) . Conclusions:The communication model based on diary research can effectively reduce the level of migration stress among the first-degree relatives of elderly patients who are transferred out of ICU postoperatively.

Skull deformity is common ailment of infants,and maybe cause developmental deformity,with high incidence in China.In this article,we reviewed the related factors,prevention and treatment for skull deformity,aimed at providing references for its further application.

Objective To explore the prognostic value of ADC tot of diffusion-weighted magnetic resonance imaging with multiple diffusion gradient factor ( b) values ( Mb DWI) in predicting overall survival (OS) of patients with locally advanced pancreatic cancer (LAPC) undergoing CyberKnife and sequential S-1. Methods Forty-one LAPC patients were enrolled (28 male and 13 female), who had routine pancreatic MRI and multiple b value DWI (Mb DWI, b value =0, 25, 50, 75, 100, 150, 200, 400, 600, 800 and 1000 s/mm2) scan (3.0 T) prior to radiotherapy.ADCtot value was calculated using single index model .Two independent radiologists on abdominal radiology manually drew the target area of interest and measured ADC tot at 1-month interval, and the interclass correlation coefficient (ICC) was calculated.The median ADCtot was used as a standard to divided the data into high value and low value .The survival was analyzed by Kaplan-Meier method and compared by log rank test .Cox proportional hazard model was employed to identify predictive factors for OS.Results The median ADCtot value by two independent radiologists was (1.54 ±0.27) ×10 -3 and(1.55 ±0.28) ×10 -3 mm2/s, respectively.The ICC was 0.994, and the consistency was good.Pre-treatment ADC tot value was the independent prognostic factor for the OS of patients who received CyberKnife and S-1 (HR: 1.083, 95％CI 1.083-12.554,P=0.0368), indicating that the mortality increased by 1.083 times as ADCtot increased by 1 unit.Similarly, CyberKnife combined with S-1 was also the independent prognostic factor for the OS (HR:0.329, 95％CI 0.142-0.765, P=0.0098), indicating that the mortality of patients treated by CyberKnife and S-1 was 0.329 times of that of patients who did not take S-1. Conclusions The pre-treatment ADC tot was an independent predictor for OS of LAPC patients treated by CyberKnife and sequential S-1, which had a certain prognostic value .

Objective To explore preliminarily the role of the E2 subunit of pymvate dehydrogenase (PDC-E2) modified by xenobiotics (e.g.2-octynic acid,2-OA) in the pathogenesis of primary biliary cirrhosis (PBC).Methods Patients of PBC (102 cases),primary sclerosing cholangitis (PSC,34 cases) and healthy controls (HC,50 cases) were selected.The anti-PDC-E2,anti-2-OA and anti-lipoic acid (LA) antibody in the peripheral blood of the 3 groups were tested by enzyme linked immunosorbent assay (ELISA).By inhibitive ELISA (iELISA),30 of the 102 PBC patients with anti-PDC-E2 antibody but without anti-2-OA antibody were selected to detect whether there was any new epitope on the PEC-E2 conjugated with 2-OA.The chi-square test and Fisher exact test were taken to analyze the enumeration data.The two-tailed unpaired t test with Welch's correction was used to compare the measurement data.Spearman rank correlation analysis was also employed for proper test.Results The positive rate of anti-PDC-E2,anti-LA and anti-2-OA antibody in PBC patients was 94.1％(96/102),73.5％(73/102) and 53.9％(55/102) respectively,all of which were statistically significantly higher than those in healthy controls group but were of no significant difference between PSC and healthy controls group.There was no significant relevance between the levels of Anti-LA and anti-2-OA antibody in the PBC group (r=-0.065,P=0.520).The iELISA results showed that the antibody,which only identified the epitopes on 2-OA-PDC-E2 induced by the 2-OA conjugation with PDC-E2,existed in 40％(12/30) of the PBC patients,and more interestingly,this antibody was predominantly appeared in PBC patients at their early clinical stage.Conclusion There are anti-LA antibody and anti-2-OA antibody in PBC patients,which have shown no significant association with each other.It is very likely that new antigenic conformational epitopes on PDC-E2 modified by 2-OA would emerge,which might led to the immune response in the individuals who are susceptible to PBC,and thus contribute for the breaking of PDC-E2 immune tolerance,and PBC occurrence finally.

Objective To investigate the expression of CD55 and myeloperoxidase (MPO) on neutrophils in patients with MPO-specific anti-neutrophil cytoplasmic antibody associated vasculitis(MPO-AAV), and analyze the relationship between the expression and clinical manifestation.Methods Forty untreated patients with active MPO-AAV (patient group) and 30 healthy volunteers (control group) were enrolled in this study.The CD55 on neutrophils and both membrane and cytoplasmic MPO were detected by flow cytometry.Serum fragment-from the activated complement factor B(Ba) and MPO were measured by ELISA.The clinical activity of vasculitis was valued by Birmingham vasculitis activity score-version 3(BVAS-V3).The significance of laboratory data was evaluated by Spearman correlation test and multivariate linear regression analysis.Results (1)The mean fluorescence intensity(MFI) of CD55 expressed on neutrophils was significantly higher than that in control group[4 068.6±2 306.0 vs 2 999.5±1 504.9,P=0.033].Similar results of serum MPO and Ba in patient group were found compared to controls [500.0(381.0, 612.7) IU/L vs 286.9(225.5, 329.1) IU/L,P<0.001;35.2(25.2, 79.5) ng/L vs 18.0(15.0, 28.0) ng/L,P<0.001], respectively.However, MIF of cytoplasmic MPO in patients was significantly lower than that of control group(1 577.1±1 175.9 vs 3 105.3±2 323.0,P=0.003).(2) In patient group, cytoplasmic intensity of MPO was negatively associated with the serum levels of MPO(r=-0.710,P<0.001) and Ba (r=-0.589,P=0.001).Moreover, serum MPO was positively associated with serum Ba(r=0.691,P<0.001).Membrane intensity of CD55 on neutrophils was positively correlated with patient age (r=0.514, P=0.001), C reactive protein (r=0.376, P=0.018), peripheral neutrophils count (r=0.485, P=0.001) and BVAS-V3 (r=0.484, P=0.002), whereas negative correlation between membrane CD55 and disease duration was seen (r=-0.403,P=0.01).(3) The result of multiple linear regression analysis showed there was statistically significant positive correlation between MFI of CD55 expressed on neutrophils and BVAS-V3 (β=0.001,P=0.027).Conclusions In MPO-AAV,CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking AAV, CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking by complement alternative pathway.Activated neutrophils release more MPO and lysosome to intensify the inflammation reaction and aggravate the disease.Thus CD55 might become a new potential target for the treatment of this disease in the future.