Parkinson's disease （PD） challenges us to assess the disease due to the lack of definitive biomarkers. Currently， PD patients have been found to contract several gastrointestinal comorbidities such as constipation and intestinal inflammation that precede its symptomatic manifestations. These conditions are intricately linked to proliferative metabolisms of the gut microbiota， which are manifested to be some primary changes in the gut microbiota or other changes involved in medication during treatment. In this paper we review the recent research on gut microbiota biomarkers in PD， arguing for the clinical relevance of gut microbiota as a marker in the progression of PD and prospecting the potential efficacy of fecal microbiota transplantation as an intervention in managing PD.

Parkinson's disease （PD） is a common neurodegenerative disease with a complex pathogenesis， and a large number of studies have shown that mitochondrial dysfunction is an important causative factor for PD， whereas dysregulation of mitochondrial quality control is a key factor leading to mitochondrial dysfunction， and that aberrant mitochondrial biogenesis， fusion/fission imbalance， and mitochondrial hyperautophagy are closely associated with the onset of PD， but the role of the mitochondrial quality control system in the progression of PD is unclear. Therefore， this paper reviews the mechanism of mitochondrial quality control system in PD， with the aim of providing new ideas and theoretical basis for the clinical prevention and treatment of PD.

Objective To investigate the correlations of serum Aβ1?42， P?Tau181， and Hcy levels with sleep disorders in patients with Parkinson's disease （PD）. Methods A total of 80 PD patients were divided into a normal sleep group （< 7 points） and a sleep disorder group （≥ 7 points） based on the evaluations with Pittsburgh Sleep Quality Index （PSQI）. Univariate and multivariate logistic regression analyses were performed to investigate the correlations between the levels of serum Aβ1-42， P-Tau181， and Hcy levels and sleep disorders. Receiver operating characteristic （ROC） curves were used to analyze the efficacy parameters of different indicators in predicting sleep disorders in those patients. Results Univariate and multivariate logistic regression analyses showed that serum Aβ1-42 and Hcy were protective and independent risk factors for sleep disorders in the PD patients， respectively （P < 0.05）. The predictive AUCs of serum Aβ1-42 and Hcy levels for sleep disorders in the PD patients were 0.757 （95% CI： 0.652 ~ 0.861） and 0.796 （95% CI： 0.688 ~ 0.905）， respectively. Conclusion The levels of serum Aβ1-42 and Hcy in PD patients are closely related to sleep disorders. Therefore， they can be used as predictive factors for clinical diagnosis of PD with sleep disorders.

Objective To investigate the efficacy of transcranial direct current stimulation （tDCS） on sleep disorder in patients with Parkinson's disease （PD）. Methods From July 2021 to July 2023， patients with PD and sleep disorders in the Department of Neurosurgery of the Second People's Hospital of Guangdong Province were selected. The enrolled patients were divided into sham stimulation group （n = 28 ） and true stimulation group （tDCS） （n = 29） according to the inclusion and exclusion criteria. MDS-UPDRS， PDSS and other rating scales were used to evaluate the patients. Before and after tDCS treatment， MS-11 was used for intelligent sleep monitoring. The baseline and improvement of sleep disorders in the two groups before and after treatment were analyzed. Results Before tDCS treatment， there was no significant difference in general conditions and scale scores between the two groups （P > 0.05）. There was no significant difference in polysomnographic monitoring results between the two groups before treatment （P > 0.05）. Compared with pre-treatment， there was no significant difference in sleep monitoring results in the sham stimulation group （P > 0.05）， while the sleep duration and sleep efficiency significantly increased， the nighttime awakening duration， nighttime awakening frequency， MDS-UPDRS-III score， and LEDD dose significantly decreased in the true stimulation group， with statistical significance （P < 0.05）. Conclusion Pharmacological treatment combined with tDCS treatment is effective for sleep disorders and motor function in patients with PD， which could increase the sleep duration and sleep efficiency of PD patients with sleep disorders to a certain extent， reduce the nighttime awakening duration and frequency， thereby improving the fatigue symptoms during the daytime， and improving the efficacy of conventional pharmacological treatment for PD.

Objective To investigate whether the mechanism of action of electro-acupuncture in MPTP-induced Parkinson's disease （PD） model mice is related to neuroinflammation mediated by the forkhead box protein O1 （FoXO1）/NOD-like receptor heat protein structural domain-related protein 3 （NLRP3） signaling pathway. Methods Thirty mice were randomly divided into control （Ctrl）， model （MPTP）， and electro-acupuncture （EA） groups， with 10 mice in each group. PD mouse model was prepared by intraperitoneal injection of 1-methyl-4-phenyl-1，2，3，6-tetrahydropyridine （MPTP） 30 mg/（kg·d） for 7 d consecutively. Behavioral changes of mice were observed by open field and pole-climbing experiments； α-synuclein （α-syn） expression in the substantia nigra of the midbrain was observed by immunohistochemistry； FoXO1， NLRP3， ASC， and Caspase-1 were determined by Western blot； and the expression of inflammatory factors such as tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β） was detected by ELISA in the substantia nigra of the midbrain. Results Mice in the MPTP group showed significant behavioral deficits， with a significant increase in midbrain substantia nigra α-syn （P < 0.01）， elevated levels of Iba-1， FoXO1， NLRP3， ASC， and Caspase-1 proteins （P < 0.05 and P < 0.01， respectively）， and a significant increase in the levels of TNF-α， and IL-1β （P < 0.01）.The treatment of EA was effective in improve the dyskinesia of PD mice， improve motor balance and coordination （P < 0.01）， reduce the abnormal aggregation of α-syn （P < 0.01）， reduce the abnormal activation of microglia， and alleviate neuroinflammation （P < 0.05）. Conclusion Electro-acupuncture may play a protective role in PD by modulating FoXO1/NLRP3 pathway-mediated neuroinflammation.

Postoperative cognitive dysfunction （POCD） is a common complication affecting elderly patients after anaesthesia. It is characterised by acute or persistent impairments of attention， learning and memory after surgery. This cognitive disorder can lead not only to an increase in postoperative complications and prolonged hospital stays， but also to an increased societal burden and waste of medical resources. Stellate ganglion block （SGB） is a commonly used nerve block technique in clinical practice. It works to block neural signals from stellate ganglion to control pain or treat certain conditions primarily by injecting local anaesthetics. This article summarises the mechanisms by which SGB improves POCD， focusing on the regulation of cerebral vasculature， oxidative stress and inflammatory responses. It aims to provide elderly patients with an approach to safer and more effective postoperative recovery and seek new therapies to alleviate the burden of POCD.

Objective To explore the effect of mixed antibiotics on the intestinal flora of mice to affect the immune regulation of the body， explore the role of intestinal flora in the development of obesity， and provide new ideas and ways for the prevention and treatment of obesity. Methods Seventy-two 10-week-old male C57BL/6 mice were randomly divided into blank control （Ctrl） group， high-fat diet （HF） group， antibiotic （ABX） group， and combined （COMB） group （n = 18）. At the first 2 weeks （lavage intervention weeks）， Ctrl and HF group were given normal saline gavage； ABX and COMB group were given mixed antibiotics gavage， and the gavage volume was 0.2 mL/ animal/day. For the following 8 weeks （feeding weeks）， Ctrl and ABX group were fed with ordinary diet， HF and COMB group were fed with high-fat diet. Body weight was measured weekly， and fasting blood glucose was measured before and after gavage， and at the 4th and 8th week of feeding. Oral glucose tolerance test was performed at the end of the experiment. The organ coefficient was measured and the cell morphology of white and brown adipose tissue was observed. Serum was collected for the determination of free fatty acid， high-density lipoprotein， low-density lipoprotein， triglyceride， and total cholesterol. Serum TNF-α， IL-10， IL-4， IL-13， IL-33 and MCP-1 was detected by ELISA. The stool of mice was collected for second generation sequencing. Results High-fat diet increased body weight， serum total cholesterol， low-density lipoprotein， IL-13， IL-33， TNF-α， MCP-1 content， and decreased glucose tolerance and organ coefficient in mice （P < 0.05）. From the first feeding week to the end of the experiment， body weight in COMB group was significantly lower than that in HF group（P < 0.05）. The level of glucose tolerance， serum total cholesterol， low density lipoprotein， IL-13， IL-33， TNF-α and MCP-1 in COMB group was lower than those in HF group （P < 0.05）. The α diversity of intestinal flora in ABX group was lower than that in Ctrl group （P < 0.05）. Congestion and bleeding in WAT were obvious in HF group， but not in COMB group. The microbial community composition of ABX and HF group was similar to that of Ctrl and COMB group， respectively. Conclusion High-fat diet induces obesity， disorder of glucose and lipid metabolism and inflammation in mice. Short-term mixed antibiotic use can regulate the intestinal flora of mice， mediate increased expression of related anti-inflammatory factors， up-regulate host immunity， and improve glucose and lipid metabolism in mice.

Objective To investigate the effects of allergens on the expressions of IL-18， IL-18BPa and IL-18Rα protein in peripheral blood CD4⁺ Th1 cells of healthy control subjects （HC） and patients with allergic rhinitis （AR）， and on the expressions of IL-18， IL-18BPa and IL-18Rα mRNA in the peripheral blood CD4⁺ T cells. Methods Blood samples were collected from patients with rhinitis for negative skin prick test （AR^-）， rhinitis for positive skin prick test （AR⁺） and HC. Flow cytometry was used to evaluate the effects of allergens on the expressions of IL-18， IL-18BPa and IL-18Rα protein in CD4⁺ Th1 cells. The expressions of IL-18， IL-18BPa and IL-18Rα mRNA in CD4⁺ T cells were determined by qPCR. Results Compared with HC， increased IL-18 while decreased IL-18BPa expressions in Th1 cells of AR^- and AR⁺ patients were observed， increased IL-18Rα expression in Th1 cells of AR⁺ patients was also found. Additionally， allergens induced elevated expression of IL-18Rα protein in Th1 cells of HC， and induced elevated mRNA expressions of IL-18， IL-18BPa and IL-18Rα in isolated blood CD4⁺ T cells of AR⁺ patients and HC. Conclusion Allergens may be involved in the pathogenesis of AR by inducing the expressions of IL-18 and IL-18Rα in blood CD4⁺ Th1 cells.

Objective To investigate the expression of Thymosinβ10 （TMSB10） in gastric cancer and its molecular mechanism in promoting the progression of gastric cancer. Methods We collected pathological sections of 70 patients with gastric cancer in our hospital， detected expression of TMSB10 in gastric adenocarcinoma by immunohistochemistry， and analyzed its prognostic effect. In order to study the mechanism of action， the effects of TMSB10 on the proliferation and glycolysis of gastric cancer cells and its related mechanism were observed by transfection technique， CCK8 test， EDU assay， Transwell assay， scratch test， glycolysis assay and Western blot. Results Immunohistochemistry showed that TMSB10was highly expressed in gastric cancer， while the expression level of TMSB10 was correlated with tumor size （P = 0.032）， TNM stage （P = 0.002） and distant metastasis. In the mechanism study， we found that overexpression of TMSB10 promoted the proliferation， invasion， migration and glycolytic phenotype of gastric cancer cells through in vitro CCK-8 test， EDU assay， Transwel assay and glycolysis assay， and vice versa. Western blot results showed that overexpression of TMSB10 may regulate the occurrence of gastric cancer through up-regulation of the AMPK/mTOR signaling pathway. Conclusions TMSB10 promotes the proliferation， invasion， migration and glycolysis gastric cancer through the AMPK/mTOR signaling pathway.

Objective This study aimed to investigate the effect of Dapagliflozin on the hypertrophy and apoptosis of cardiomyocytes induced by angiotensinⅡ（Ang Ⅱ）. Methods Primary rat neonatal cardiomyocytes were isolated， cultured and randomly divided into 4 groups： control group， Ang Ⅱ group， dapagliflozin group 1 （0.5 μmol/L）， and dapagliflozin group 2 （2 μmol/L）. α-actin staining was used to detect cell area. qPCR was applied to detect embryonic gene transcription. Tunel staining was adopted to detect cell apoptosis level. The caspase3 kit was used to detect caspase3 activityand western blotting was used to detect classical signal molecules. Results The cell surface area of the Ang Ⅱ group was significantly larger than that of the control group （P < 0.05）. The cell surface area of the dapagliflozin group 1 and the dapagliflozin group 2 was significantly lower than that of the Ang Ⅱ group （P < 0.05）. The results of qPCR showed that the fetal gene transcription of Ang Ⅱ group was significantly higher than that of the control group （P < 0.05）； the fetal gene transcription of dapagliflozin group 1 and dapagliflozin group 2 was lower than that of Ang Ⅱ group （P < 0.05）. Tunel staining showed that the number of apoptosis in the Ang Ⅱ group was higher than that in the control group （P < 0.05）； the number of apoptosis in the dapagliflozin group 1 and the Dapagliflozin group 2 was lower than that in the Ang Ⅱ group （P < 0.05）. The caspase3 activity of the cells in the Ang Ⅱ group was higher than that of the control group （P < 0.05）but lower in dapagliflozin group 1 and the dapagliflozin group 2 （P < 0.05）. The results of Western blotting showed that the activation of insulin-like growth factor 1 receptor （IGF1R） and Akt in the Ang Ⅱ group was lower than that in the control group （P < 0.05）but increased in the dapagliflozin group 1 and 2 cells （P < 0.05）. Conclusion Dapagliflozin could directly act on cardiomyocytes to protect them from Ang Ⅱ-induced damage.

Objective To assess the impact of ultrasound-guided fascia iliaca compartment block on major cardiovascular events and postoperative prognosis in patients with lower limb aortoiliac occlusive disease （ASO）. Methods This study was a retrospective study including 353 patients with lower limb arterial reconstruction surgery for ASO at Xiamen Hospital Affiliated to Zhongshan Hospital of Fudan University from January 2018 to January 2022. Patients were divided into two groups based on different anesthesia： the group receiving ultrasound-guided fascia iliaca block combined with sciatic nerve block （Group B） and the group receiving monitored anesthesia care （MAC） （Group M）. The primary outcome was the occurrence of major adverse cardiovascular events after lower limb arterial reconstruction surgery in ASO patients. The secondary outcomes included the incidence of non-cardiac postoperative myocardial injury， postoperative amputation， and other adverse reactions such as postoperative delirium， nausea， and vomiting as well as postoperative laboratory indicators. By using propensity score matching to balance baseline characteristics before surgery， the impact of different anesthesia methods on the occurrence of MACE and prognosis after surgery in ASO patients was analyzed. Results After propensity score matching， the incidence of MACE in Group B was lower compared with Group M （10% vs. 3.4%， P = 0.038）； The incidence of MINS in Group B （33% vs. 25%， P = 0.200）； The amputation rate of Group B （4.2% vs. 3.4%， P > 0.99）； The incidence of complications in Group B was （6.8% vs. 4.2%， P = 0.39）； There was no statistically significant difference in postoperative laboratory indicators between the two groups （P > 0.05）. Multivariate analysis showed that nerve block （OR = 0.25， 95%CI：0.05 ~ 0.93）， postoperative HBG （OR = 0.95， 95%CI：0.91 ~ 0.99） were independent factors in reducing the incidence of MACE. Conclusion Ultrasound-guidance fascia iliaca compartment block and sciatic nerve block could reduce the risk of major adverse cardiovascular events in patients undergoing lower limb arterial revascularization surgery.

Objective The aim of this study was to compare the effect of injection of indocyanine green （ICG） through peripheral vein and gallbladder in laparoscopic cholecystectomy （LC） of difficult gallbladder. Methods Patients with difficult gallbladder who underwent LC by the same surgical team from May to October 2023 in the Department of Hepatobiliary Surgery， the First Affiliated Hospital of Anhui University of Science and Technology were divided into three groups according to A random number table. Group A was injected ICG through peripheral vein before operation， group B was injected ICG through gallbladder during operation， and group C was the control group. The differences of operation time， intraoperative blood loss， hospitalization time， hospitalization cost and postoperative complications among the three groups were compared， and the effects of fluorescence mode cholangiogram in group A and group B were compared. One-way analysis of variance was used to compare the normal distribution of the measurement data among groups， and LSD-t test was used to compare the two groups. The counting data was compared by chi-square test. The Boferroni test was appied to compare the two groups. Results There were no differences in length of stay， hospitalization cost and postoperative complications among the three groups （P > 0.05）. The operative time and intraoperative blood loss of group A and group B were lower than those of group C （P < 0.05）， but there was no difference between group A and group B （P > 0.05）. The total imaging rate of the first three tubes of free gallbladder triangle（early stage） in group A was 41.67%， which was significantly lower than that in group B （63.89%） （P < 0.05）. Conclusion ICG is beneficial for the identification of extrahepatic bile duct structures during LC of difficult gallbladder， and ICG injection through the gallbladder is helpful for the early identification of extrahepatic bile duct.

Objective To compare the clinical efficacy and imaging results of uniportal interlaminar endoscopy （UIE） and unilateral biportal endoscopy （UBE） for the treatment of lumbar disc herniation. Methods The clinical information for 50 patients diagnosed with lumbar disc herniation was collected，and treated by UIE endoscopic surgery and UBE endoscopic surgery in the The First People's Hospital of Hefei city from March 2021 to October 2022 were retrospectively analyzed. The patients were divided into two groups， UIE group and the UBE group. Perioperative indexes including incision length， operation time， intraoperative blood loss， and surgical complications， clinical efficacy indexes including VAS scores of low back pain and leg pain before surgery， 3 days after surgery， 3 months after surgery， 6 months after surgery， and 12 months after surgery， ODI scores of dysfunction index， and imaging results including spinal canal area， vertebral space height， before surgery and 1 year after surgery were recorded and compared between the two groups. Results Both groups completed the procedure and were followed up for 12 ~ 18 months， with an average of 15 months. 1 case was dural injury， no nerve root injury， and no nerve root symptoms during the follow-up. The symptoms of lumbar and leg pain were all relieved in both groups after the procedure. The UBE groups hawed larger surgical incisions， more intraoperative blood loss， and shorter operative time compared to the UIE group （P < 0.05， respectively）. Both groups had significant developments in the VAS scores， ODI scores of back， and leg pain at 3 days， 3 months， 6 months， and 12 months after the operation（all P < 0.05）. The UIE group showed significant developments in the VAS scores and ODI scores of back and leg pain at 3 days and 3 months after the operation， as compared to the UBE group （P < 0.05）. The imaging analysis did not showed significant changes in the height of intervertebral space and the angle of lumbar lordosis， but a significantly larger increase in the dural sac area in both groups one year after the procedure， and the UBE group had even a larger increase than the UIE group （P < 0.05）. Conclusion Both UIE and UBE have good clinical efficacy and imaging results in the treatment of lumbar disc herniation via interlaminal approach. However， the UIE group is superior to the UBE group in terms of the operation time， intraoperative blood loss， postoperative VAS score of low back pain as well as the decompression effectiveness.

Objective We tried to investigate the difference of respiratory symptoms， quality of life， blood routine examination and bone metabolism in patients with newly diagnosed chronic obstructive pulmonary disease with and without hypertension. Methods A total of 92 newly diagnosed patients with chronic obstructive pulmonary disease and hypertension treated in our hospital from January 2019 to April 2022 were selected as the observation group， and 92 newly diagnosed patients with COPD without hypertension were selected as the control group. The modified British Medical Research Council Respiratory Questionnaire （mMRC）， Chronic Obstructive Pulmonary Disease Self Assessment Test Questionnaire （CAT）， Global Initiative for Chronic Obstructive Pulmonary Disease （GOLD）， SF-36 scale scores， blood routine examination and bone metabolism indexes were different. Results The rate of mMRC grade ≥ 2 and CAT score of the observation group were significantly higher than those of the control group （P < 0.05）， while the SF-36 score was significantly lower than that of the control group （P < 0.05）. The GOLD grading of the observation group was significantly higher than that of the control group （P < 0.05）. The forced vital capacity （FVC） and the first second expiratory volume （FEV1） in the observation group were significantly lower than those in the control group （P < 0.05）. There was no significant difference between the observation group and the control group in white blood cell count （WBC）， neutrophil count （NEUT） and lymphocyte count （LYM） etc （P > 0.05）. The bone mineral density of the femoral neck and blood calcium in the observation group were significantly lower than those in the control group （P < 0.05）， while the parathyroid hormone （PTH） and osteocalcin （BGP） were significantly higher than those in the control group （P < 0.05）. The levels of C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， IL-4， and IL-10 in the observation group were significantly higher than those in the control group （P < 0.05）. The hypertension grade in the observation group was positively correlated with mMRC grade， CAT score and GOLD grade （r_s = 0.455， 0.302 and 0.501， P < 0.05）， but negatively correlated with FVC and FEV1 （r_s = -0.311 and -0.334， P < 0.05）. Conclusion The newly diagnosed patients with chronic obstructive pulmonary disease and hypertension have severe respiratory symptoms， poor quality of life， and an increased risk of osteoporosis， and the patient's blood pressure is related to the degree of respiratory symptoms.

Objective This study aimed to investigate the differential effects of sevoflurane and propofol on perioperative HIF-1α levels and postoperative recovery in patients undergoing bariatric surgery. Methods A total of 40 obese patients （BMI ≥ 44 kg/m2） were randomly allocated into two groups： sevoflurane （n = 21） group and propofol （n = 19） group. The quantitative measurement of HIF-1α levels in human serum at different time points was conducted using ELISA. The assessment of redness， swelling， pain， exudation， and prognosis-related indicators of the patient's umbilical incision was performed at 24 and 48 hours after surgery. Results On the day following surgery， there was a significant increase in HIF-1α levels in the sevoflurane group and a significant decrease in the propofol group. The frequency and type of opioid analgesics used in the sevoflurane group were significantly lower than those used in the propofol group after surgery. Conclusions Compared with propofol， sevoflurane is more suitable for maintaining anesthesia in obese patients undergoing bariatric surgery. Sevoflurane can promote enhanced recovery after surgery by reducing postoperative analgesic consumption and upregulating HIF-1α levels.

Objective To investigate the value of combining preoperative magnetic resonance imaging（MRI） and postoperative pathological assessment of lymph node metastasis in predicting overall survival in rectal cancer patients. Methods This retrospective study collected clinical， pathological and image information of 2610 patients histopathologically confirmed with rectal adenocarcinoma at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2021. All patients underwent MRI scans and were divided into three groups according to lymph node status assessed by preoperative MRI（ _MRI N） and postoperative pathology（ _P N）： _MRI N+ but _P N-（ _MRI N+ group）， _P N+ but _MRI N-（ _P N+ group）， _MRI N+ and _P N+（ _MRI-P N+ group）. Inverse probability weighting（IPW） was used to adjust for confounding factors. Kaplan-Meier curves were used to estimate overall survival and log-rank tests were used to compare the difference. Univariate Cox regression models were used to analyze the correlation between tumor characteristics and overall survival， and bidirectional stepwise Cox regression models were used to identify independent risk factors for overall survival. Results The _MRI-P N+ group showed higher tumor staging， more frequent perineural invasion， more distant metastases， and a higher risk of death compared to the _P N+ group and _MRI N+ group（all P < 0.05）. Kaplan-Meier curves showed that the 3-year survival rates for the _MRI N+ group， _P N+ group， and _MRI-P N+ group were 90.5%， 79.1%， and 76.4%， respectively； the 5-year survival rates were 85.7%， 71.5%， and 59.2%， respectively. Stepwise Cox regression showed that age， tumor location， carcinoembryonic antigen， carbohydrate antigen 19-9， lymph nodes number， pathological tumor stage， lymphovascular invasion， perineural invasion， distant metastasis， neoadjuvant therapy and adjuvant therapy， and MRI-pathology lymph node status were independent risk factors for overall survival in rectal cancer（all P < 0.05）. Conclusion Evaluating the lymph node status by combining preoperative MRI and postoperative pathology helps predict overall survival in rectal cancer patients more accurately.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low?dose and standard?dose recombinant tissue plasminogen activator （rt?PA） in the elderly patients （aged over 80 years） with acute ischemic stroke （AIS）. Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt?PA low?dose group （n = 93， 0.6 mg/kg） and rt?PA standard?dose group （n = 108， 0.9 mg/kg）. The incidence of intracranial hemorrhage， symptomatic intracranial hemorrhage， fatal intracranial hemorrhage， neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety. The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness. A stratified analysis of 90?day outcomes was performed based on stroke severity and age. Results The incidence of intracranial hemorrhage， symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt?PA low?dose group was lower than that in rt?PA standard?dose group （P < 0.05）. There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index. The 90?day good prognosis rate of moderate stroke sub?group and of ≥ 90 years of age sub?group in rt?PA low?dose group were both higher than that of rt?PA standard?dose group （P < 0.05）. Conclusions For AIS patients with moderate stroke and aged over 90 years， intravenous thrombolytic therapy with rt?PA 0.6 mg/kg is recommended.

Objective To observe the effects of different administration doses of dexmedetomidine on the circulatory system and stress response in patients undergoing extracorporeal coronary artery bypass grafting （OPCABG）. Methods Ninety-six patients who underwent OPCABG in our hospital from October 2021 to October 2023 were selected and divided into two groups using simple randomization method. Group A was administered dexmedetomidine at a dose of 0.5 μg/kg over 10 minutes before anesthesia induction， followed by a maintenance dose of 0.5 μg/（kg·h） infused until the end of the surgery， while group B was administered dexmedetomidine at a dose of 0.8 μg/kg for 10 min before anesthesia induction， followed by a maintenance dose of 0.8 μg/（kg·h） until the end of the operation. The two groups were compared in terms of cardiac index （CI）， heart rate， mean arterial pressure （MAP）， intrathoracic blood volume index （ITBI）， bispectral index （BIS）， and systemic peripheral vascular resistance index （SVRI） before anesthesia started （T0）， at the immediate moment of intubation （T1）， at the immediate moment of the start of the surgery （T2）， at the time of sawing of the sternum （T3）， and at the immediate moment of extubation （T4）. Additionally， the two groups were compared in terms of cortisol （Cor）， Angiotensin Ⅱ （Ang Ⅱ） levels， safety and postoperative awakening time. Results The two groups showed no differences in operation time， anaesthesia time， bleeding and urine volume （P > 0.05）， but group B demonstrated less intraoperative use of cisatracurium compared to group A （P < 0.05）. At T0， the two groups showed no difference in heart rate and MAP （P > 0.05）， but higher heart rate and MAP at T1 and T3 than at T0. Group A was observed to have higher heart rate and MAP at T4 than at T0， while group B showed no significant differences in heart rate and MAP at T4 compared to them at T0 （P > 0.05）. At T2 and T4， Group B showed significantly lower heart rate and MAP compared to group A （P < 0.05）. At T0， the two group had no differences in terms of CI， CO， ITBI， and SVRI （P > 0.05）. Both groups showed significantly lowered levels of CI， CO， ITBI， and SVRI at T1-T4 than at T0 （P < 0.05）， but demonstrated no differences in the levels of CI， CO， ITBI， SVRI at T0-T4 （P > 0.05）. At T0， both groups had no difference in BIS values （P > 0.05）， but showed significantly decreased BIS values at T1-T4 compared with those at T0 （P < 0.05）. At T2-T4， group A showed significantly lower BIS values compared with group A （P < 0.05）. The two groups had no difference in postoperative awakening time compared with group A （8.12 ± 1.88 min vs. 8.05 ± 1.97 min， P > 0.05）. Preoperatively， the two groups had no differences in Cor and Ang Ⅱ（P > 0.05）. However， at 6 h postoperatively， both groups showed significantly elevated Cor and AngⅡ values compared to preoperatively （P < 0.05）， and group B showed signifantly lower values of Cor and AngⅡ compared to group A （P < 0.05）. The two groups had no difference in the adverse reactions （6.25% vs. 8.33%， P > 0.05）. Conclusion Dexmedetomidine administered at the dose of 0.8 μg/（k·h） rather than at the dose of 0.5 μg/（k·h） for managing OPCABG results in more stable hemodynamics during surgery， yielding better sedative effect， milder postoperative stress response， and no increase in adverse reactions.

Objective Through the combined detection method， we tried to find more sensitive biomarkers for the diagnosis of acute TBI， which might provide the exact diagnosis， treatment and monitoring indicators for the clinic. Methods A total of 156 patients with acute TBI admitted to the Emergency Traumatic Center of Yan'an Hospital of Kunming from October 2022 to June 2023 were collected and included the normal and fracture control groups. Peripheral blood samples of the enrolled patients were collected and monitored， S100β and IL-6 were tested and clinical data such as hs-CRP was collected immediately upon admission， then statistical analysisanalysis was conducted. Results Peripheral blood in patients with acute TBI， The levels of S100β， IL-6 and hs-CRP significantly increased， and the area under the ROC curve for diagnosing acute TBI was 0.944， 0.915， and 0.897. The combined detection of the three indicators showed an area under the ROC curve of up to 0.975. Person correlation analysis found a positive correlation between the three indicators， especially S100β with IL-6， The correlation coefficient between them is 0.715. Binary logistic regression analysis found that S100β， IL-6 and hs-CRP are independent risk factors for acute TBI. Conclusions The combined detection of S100β， IL-6 and hs-CRP can effectively improve the sensitivity of acute TBI diagnosis. The mutual promotion of S100β and IL-6 may aggravate the secondary craniocerebral injury caused by inflammatory mechanism， and early targeted treatment may improve the prognosis.

Objective Exploring the relationship between changes in serum Golgi apparatus transmembrane glycoprotein 73 （GP73） and chitosanase 3-like protein 1 （CHI3L1） levels and liver fibrosis and lesion severity in patients with hepatitis B （CHB）. Methods Using a case-control study， 80 patients diagnosed with CHB infection and developing liver fibrosis in the Infectious Disease Department of Changsha First Hospital from June 2020 to June 2023 were selected as the liver fibrosis group， while 120 patients diagnosed with CHB infection but not developing liver fibrosis in the Infectious Disease Department of our hospital were selected as the control group. The serum GP3， CHI3L1， liver function， and fibrosis indicators of the two groups of patients were compared， and the liver fibrosis group was divided into mild according to Scheuer system standards Perform stratified analysis on patients with significant liver fibrosis. Results The serum GP3 and CHI3L1 levels in the liver fibrosis group were significantly higher than those in the control group， with statistical significance （P < 0.05）； The ROC curves were plotted using serum GP3， CHI3L1， and GP3 + CHI3L1， respectively. The sensitivity for diagnosing liver fibrosis in CHB patients was 62.81%， 60.94%， and 96.33%， with specificity of 80.66%， 80.05%， and 75.30%. The AUC values under the curves were 0.792， 0.756， and 0.908， respectively； The levels of ALT， AST， HA， LN， PC III NP， C IV， and CG in the liver fibrosis group were higher than those in the control group， and the PLT measurement values were lower than those in the control group， with statistical significance （P < 0.05）； 49 patients with moderate to severe liver fibrosis （33 in S2 phase and 16 in S3 phase） and 31 patients with mild liver fibrosis （all in S1 phase） had significantly higher serum GP3 and CHI3L1 levels than mild patients， with statistical significance （P < 0.05）； The levels of DBIL， ALT， AST， HA， LN， PC III NP， C IV， and CG in patients with moderate to severe liver fibrosis were higher than those in the mild group， and the PLT measurement values were lower than those in the mild group， with statistical significance （P < 0.05）. Conclusion The serum GP3 and CHI3L1 levels in CHB patients with liver fibrosis are significantly elevated， and there is a certain correlation with the degree of liver fibrosis. The combination of these two indicators is beneficial for diagnosing liver fibrosis in CHB patients.

Objective To study the relationship between waist-to-height ratio （WHtR） and new-onset cerebral infarction in the elderly with hypertension. Methods A total of 9 096 elderly hypertensive patients were enrolled from the Kailuan study population. Using the first occurrence of cerebral infarction as the endpoint event， a prospective cohort study was performed. According to the WHtR value of the subjects with an interval of 0.05， the subjects were divided into G1 group （WHtR < 0.45）， G2 group （0.45 ≤ WHtR < 0.50）， G3 group （0.50 ≤ WHtR < 0.55）， and G4 group （WHtR ≥ 0.55）. The cumulative incidence rate of endpoint event in each population were statistically analyzed using the life table method. Cox proportional hazards regression analysis was used to explore the role of WHtR in the occurrence of new cerebral infarction. Model 1 was a single factor Cox proportional hazards analysis model， only considering the influence of WHtR on the risk of cerebral infarction. After adjusting sex， age， body weight， serum hypersensitive C-reactive protein， systolic blood pressure， serum triglycerides， smoking history， fasting blood glucose， alcohol consumption， high-density lipoprotein cholesterol， diastolic blood pressure， exercise， low-density lipoprotein cholesterol， educational level， antihypertensive drug history， model 2 was established to observe the influence of WHtR on the occurrence of new-onset cerebral infarction. Results The follow-up lasted （9.3 ± 2.7）years. Compared to the G2 group， multivariateCox proportional hazards regression model showed that the hazard ratio HR（95%CI） for cerebral infarction in model 1 was 1.00（0.67 ~ 1.50）， 1.29 （1.05 ~ 1.60） and 1.36（1.12 ~ 1.66） respectively in G1， G3 and G4； and that in model 2 was 1.09 （0.72 ~ 1.65）， 1.24（0.99 ~ 1.54） and 1.31（1.05 ~ 1.62） respectively in G1， G3 and G4. Conclusion The risk of cerebral infarction in the elderly with hypertension is the lowest when WHtR between 0.45 ≤ WHtR < 0.50， and WHtR greater than or equal to 0.55 is associated with an increased risk of new-onset cerebral infarction.

Neural tube defects are a common neurodevelopmental disease， which can be divided into open and closed types. The main symptoms are anencephaly， encephalocele and cranial spina bifida. The relationship between Wnt signaling and neurogenesis has been a popular area in recent years. The Wnt signaling pathway includes Wnt/β-catenin， planar polar cell pathway and Wnt/Ca²⁺ pathway， which plays an important role in neural tube development. This article reviews the current state of research on the Wnt signaling pathway and elucidates the role it plays in the process of neural tube closure， providing insights for the development of drugs related to the prevention and treatment of neural tube defects.

Numerous studies have confirmed that Alzheimer's disease is a disorder related to dysfunction of blood brain barrier （BBB）. How to improve the physiological function of BBB by restoring its structural integrity， and then improve the outcome and prognosis of AD will certainly bring new perspectives and opportunities for the prevention and treatment of this chronic disease. In this article， we review the research progress on AD from three aspects including the structural and functional changes of BBB and its pathogenesis， biomarkers and therapeutic targets.

Lymphocyte-activation gene 3 （LAG-3） is an inhibitory immune checkpoint receptor that negatively regulates the function of T cells to prevent over-activation of the immune system from damaging human body. In the existence of tumors and chronic infections， persistent antigenic stimulation induces upregulation of LAG-3 expression in effector T cells， leading to T cell exhaustion and tumor immune escape. Targeting LAG-3 drugs can reactivate the anti-tumor function of T cells by specifically blocking the signaling pathway of LAG-3， and have shown promising efficacy in a variety of solid tumors， hematologic tumors and autoimmune diseases. In this paper， we summarize the current research progress on the structure， ligand and regulatory function of LAG-3， review the current status of clinical trials of LAG-3-targeted drugs， and further discuss the clinical application strategy and development direction of LAG-3-targeted drugs， with a view to providing reference for further in-depth research on LAG-3.