Transient receptor potential vanilloid 1 involved in the analgesic effects of total flavonoids extracted from Longxuejie ().

OBJECTIVE: To evaluate the analgesic effects of total flavonoids of Longxuejie (Resina Dracaenae Cochinchinensis) (TFDB) and explore the possible analgesic mechanism associated with transient receptor potential vanilloid 1 (TRPV1). METHODS: Whole-cell patch clamp technique was used to observe the effects of TFDB on capsaicin-induced TRPV1 currents. Rat experiments in vivo were used to observe the analgesic effects of TFDB. Western blot and immunofluorescence experiments were used to test the change of TRPV1 expression in DRG neurons induced by TFDB. RESULTS: Results showed that TFDB inhibited capsaicin-induced TRPV1 receptor currents in acutely isolated dorsal root ganglion (DRG) neurons of rats and the half inhibitory concentration was (16.7 ± 1.6) mg/L. TFDB (2-20 mg/kg) showed analgesic activity in the phase Ⅱ of formalin test and (0.02-2 mg per paw) reduced capsaicin-induced licking times of rats. TFDB (20 mg/kg) was fully efficacious on complete Freund's adjuvant (CFA)-induced inflammatory thermal hyperalgesia and capsaicin could weaken the analgesic effects. The level of TRPV1 expressions of DRG neurons was also decreased in TFDB-treated CFA-inflammatory pain rats. CONCLUSION: All these results indicated that the analgesic effect of TFDB may contribute to their modulations on both function and expression of TRPV1 channels in DRG neurons.

Application of balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty / 中国组织工程研究

BACKGROUND:At present,measurement osteotomy technique and gap balance technique are the two main surgical methods in total knee arthroplasty.Both methods have their advantages and disadvantages.By adjusting the osteotomy angle,the gap balance technique can reduce the release of soft tissue and obtain a more balanced flexion and extension space.The clinical efficacy of gap balance technique is superior,but this surgical method lacks tools and is easily influenced by the surgeon's surgical experience and subjective judgment,with more errors.Measurement osteotomy technique has a short learning curve,but it relies on anatomic markers and is prone to many complications due to inaccurate positioning.In recent years,many instrument companies have successively developed and launched tools that can improve the quality of surgery.However,there are still few reports about the tool. OBJECTIVE:To compare the clinical efficacy of gap balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty,and explore the value of Offset Repo-Tensor in total knee arthroplasty. METHODS:The medical records of 85 patients with total knee arthroplasty were collected and divided into two groups according to the operation method.Group A consisted of 44 patients who underwent total knee arthroplasty using a gap balance technique combined with Offset Repo-Tensor.Group B consisted of 41 patients who underwent total knee arthroplasty using measurement osteotomy technique.Surgical time,American Knee Society Score,knee range of motion,changes in lower limb alignment,and postoperative complications were compared between the two groups to evaluate the clinical efficacy of gap balance technique combined with Offset Repo-Tensors in total knee arthroplasty. RESULTS AND CONCLUSION:(1)All 85 patients were followed up.(2)Postoperative knee range of motion in both groups was higher than that before surgery(P<0.05),and the improvement in group A was more significant than that in group B(P<0.05).(3)American Knee Society Score in both groups after surgery was higher than that before surgery(P<0.05),and the American Knee Society Score in group A was higher than that in group B at 2 weeks,1,3 months,and the last follow-up(P<0.05).(4)The operation time of group A was slightly shorter than that of group B,but the difference was not significant(P>0.05).(5)The lower limb alignment in both groups was improved after operation,but there was no significant difference between the two groups(P>0.05).(6)The complication rate of group A(2%)was lower than that of group B(7%),but there was no significant difference between the two groups(P>0.05).(7)It is indicated that compared with the measurement osteotomy technique,the combination of Offset Repo-Tensor and gap balance technique can elevate the clinical effect and improve the function and motion range of the knee joint.

A study of differentially expressed proteins in Parkinson disease based on label-free quantitative proteomics / 中风与神经疾病杂志

@#Objective To investigate the biomarkers for Parkinson disease(PD) by analyzing differentially expressed proteins in the serum of patients with PD. Methods A total of 24 patients with PD who were diagnosed in Beijing Hospital were enrolled,among whom 12 patients only had a medical history of PD(group P1) and the other 12 had underlying diseases such as hypertension and diabetes(group P2). A total of 24 individuals,matched for age and sex,who underwent physical examination were enrolled as control groups C1 and C2.Serum samples were collected,and after high-abundant proteins were removed,the label-free quantitative proteomics technique was used to measure the expression of proteins in serum. The double comparison method was used for comparison between groups P1 and C1 and between groups P2 and C2 to screen for differentially expressed proteins,and the proteins with a consistent changing trend(upregulation or downregulation) were identified as the differentially expressed proteins for PD,which were analyzed and interpreted by bioinformatics methods. Results Comparison between groups identified four differentially expressed proteins,i.e. PRG4,CFHR-3,ACTG1,and HIST2H2BF,among which PRG4 and CFHR-3 showed upregulated expression and ACTG1 and HIST2H2BF showed downregulated expression in the serum of PD patients,and a certain degree of interaction was observed. Conclusion Label-free quantitative proteomics can be used to identify the differentially expressed proteins in PD,which may have a certain value in the diagnosis of PD.

A comparative study on the clinical characteristics of senile Parkinson's disease with depression and unipolar depression in older adults / 中华老年医学杂志

Objective:To explore the difference of clinical characteristics between senile Parkinson's disease(PD)with depression and unipolar depression.Methods:From March 2019 to March 2020, 53 patients with Parkinson's disease depression and 57 patients with unipolar depression who were admitted to the neurology department of Beijing Hospital were continuously collected.The gender, age and education level of the patients were recorded.The course of disease and other general data of the patients with Parkinson's disease were also recorded.Depression and anxiety of the patients were evaluated by Beck Depression Inventory(BDI)and Generalized Anxiety Disorder Scale(GAD-7). Quality of life of patients with Parkinson's disease was evaluated by 8-item Parkinson's disease questionnaire(PDQ-8). Differences in the assessment results and quality of life scores between the two groups were analyzed.Results:The incidence of depression comorbid with anxiety in elderly PD patients was 52.8%(28/53), lower than that in elderly unipolar depression patients comorbid with anxiety [84.2%(48/57)]( χ2=12.664, P<0.001). The scores of activity inhibition [(1.8±0.8)points]and hyposexuality [(0.4±1.0)points]in elderly PD patients with comorbid depression were higher than that in patients with unipolar depression [(1.1±0.8)points, (0.0±0.0)points]( t=4.399, 2.942, P<0.001, =0.005). Moreover, the incidence of activity inhibition(98.1%)and hyposexuality(15.1%)in PD patients with comorbid depression was higher than that in patients with unipolar depression(78.9%, 0.0%)( χ2=9.680, 9.279, both P=0.002). The scores of self-blame [(1.0±0.8)points]and pain [(1.0±0.8)points]in elderly patients with unipolar depression were higher than those in PD patients with comorbid depression [(0.5±0.7)points, (0.9±0.7)points]( t=-3.902, -2.486, P<0.001, =0.014). Moreover, the incidence of self-blame(66.7%), irritability(78.9%)and image distortion(56.1%)in elderly patients with unipolar depression was higher than that in PD patients(35.8%, 56.6%, 35.8%)( χ2=10.447, 6.320, 4.547, P=0.001, 0.012, 0.033). The scores of PDQ-8 in PD patients with comorbid depression and anxiety [14.8(10.8, 19.0)points]( Z=-3.544, P<0.001)were higher than those in PD patients with depression only [7.0(4.8, 11.0)points]. Conclusions:The focus of depression in elderly PD patients is different from that in elderly unipolar depression patients.Elderly patients with unipolar depression are more likely to be comorbid with anxiety.Depression reduces the quality of life in PD patients, and the comorbidity of anxiety further reduces the overall quality of life in PD patients with depression.

Lower urinary tract symptoms in Parkinson's disease and multiple system atrophy / 中华老年医学杂志

Parkinson's disease(PD)and multiple system atrophy(MSA)are two common Parkinsonian syndromes with overlapping clinical manifestations, and clinical differential diagnosis is difficult.Lower urinary tract symptoms are one of the common non-motor symptoms of the two diseases.The incidence of lower urinary tract symptoms in MSA is higher, the onset is earlier, and the micturition period is more prominent.The urinary dysfunction in patients with PD is mainly caused by the central mechanism, leading to overactive bladder.MSA has more extensive lesions with both central and peripheral involvement, leading to overactive bladder and severe voiding dysfunction.Urodynamics can be used to evaluate bladder and urethral function.MSA has more prominent weak detrusor activity, residual urine volume, and early changes of urethral sphincter.The treatment of lower urinary tract symptoms in patients with PD is mainly based on anticholinergic drugs to improve overactive bladder, while in MSA patients with increased residual urine volume, intermittent catheterization is the main method to improve lower urinary tract symptoms.This article reviewed the epidemiology, pathological mechanism, urodynamics and treatment of lower urinary tract symptoms of the two diseases, so as to assist in their differential diagnosis and treatment.

Pay attention to the multidisciplinary management of Parkinson′s disease / 中华神经科杂志

Parkinson′s disease (PD) is a complex and heterogeneous neurodegenerative disease that involves multiple systems from prodromal to advanced stages over several decades. More and more evidences have showed that multidisciplinary team (MDT) has practical value in improving patients′ clinical symptoms, quality of life, and influencing disease progression. This article elaborates how to select reasonable disciplines to compose PD-MDT, the existing PD multidisciplinary management model and development trend, as well as the evaluation of the core value of PD multidisciplinary management, striving to provide more comprehensive diagnosis and treatment for PD patients, and provide more opportunities to cure diseases in the future.

A comparative clinical study of non-motor symptoms in early Parkinson′s disease patients with body-first subtype and brain-first subtype / 中华神经科杂志

Objective:To investigate the incidence of various non-motor symptoms (NMS) in early stage of Parkinson′s disease (PD) patients and the differences between the body-first and brain-first subtypes.Methods:A total of 121 patients with PD (Hoehn-Yahr stage 1-2) were recruited from PD Clinic, Department of Neurology, Beijing Hospital from January 2012 to January 2015. The general information and clinical features of the patients were collected. The minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised were used to diagnose rapid eye movement sleep behavior disorder (RBD).According to the sequence of RBD and motor symptoms, the patients were divided into 2 groups: body-first subtype and brain-first subtype. NMS was evaluated by the Non-Motor Symptom Questionnaire (NMSQuest). The clinical features and the incidence of various NMS were compared between the 2 groups. The Unified Parkinson′s Disease Rating Scale (UPDRS) was used to evaluate the severity of the disease, and its third part (UPDRS-Ⅲ) was used to evaluate the motor function of the patients. Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA) were used to evaluate the depression and anxiety status of the patients. The sleep status of patients was assessed by Parkinson′s Disease Sleep Scale (PDSS). The quality of life of the patients was assessed by 39-item Parkinson′s Disease Questionnaire (PDQ-39).Results:Of all the patients, 49.59% (60/121) had the body-first subtype and 50.41% (61/121) had the brain-first subtype of PD. There was no significant difference in UPDRS-Ⅲ score between the 2 groups. The average number of NMS in all PD patients was 10.97±4.88. Body-first subtype patients had higher NMS incidence than brain-first subtype in difficulty in swallowing [46.7% (28/60) vs 23.0% (14/61), χ 2=7.507, P=0.006], nausea and vomiting [16.7% (10/60) vs 3.3% (2/61), χ 2=6.069, P=0.014], constipation [85.0% (51/60) vs 55.7% (34/61), χ 2=12.393, P<0.001], fecal incontinence [8.3% (5/60) vs 0 (0/61), χ 2=5.302, P=0.021], difficulty in remembering recent events [58.3% (35/60) vs 32.8% (20/61), χ 2=7.962, P=0.005], loss of interest [43.3% (26/60) vs 24.6% (15/61), χ 2=4.743, P=0.029], inattention [45.0% (27/60) vs 19.7% (12/61), χ 2=8.884, P=0.003], depression [55.0% (33/60) vs 34.4% (21/61), χ 2=5.181, P=0.023], intense vivid dreams [73.3% (44/60) vs 39.3% (24/61), χ 2=14.196, P<0.001] and restless legs [53.3% (32/60) vs 27.9% (17/61), χ 2=8.140, P=0.004]. The differences were significant. Body-first subtype and NMSQuest ( r=-0.489, P<0.001), UPDRS ( r=-0.189, P=0.038), HAMD ( r=-0.231, P=0.011), HAMA ( r=-0.298, P=0.001) and PDQ-39 scores ( r=-0.276, P=0.002) were negatively correlated. Body-first subtype and PDSS score was positively correlated. NMSQuest (Δ R2=0.265, P<0.001) was the main determinant of PDQ-39 score. Conclusions:PD patients are accompanied by various NMS, which is a major factor affecting the quality of life. Compared with brain-first subtype, body-first subtype might have more NMS burden and higher incidence rate in most NMS in early PD patients.

The impact of banks' financial performance on environmental performance in Africa.

To better understand Africa's banks and the environment, this study investigates the impact of financial performance on environmental performance in Africa. We examined financial performance, environmental performance, and some control indicators dated from 2000 to 2016 by applying panel quantile regression and panel vector autoregressive techniques. Our results indicate that (i) in North African countries, carbon emission had a significant negative impact on financial performance on the 25th quantile and (ii) in the South, carbon emission had a statistically positive impact on financial performance on the 25th and 50th quantiles with the marginal effect increases from the lower quantile to the highest quantile. Also, bank deposits statistically negatively impacted financial performance on the 25th and 50th quantiles for both North and South economies. The dynamic panel quantile results show dissimilar effects at different quantiles. Also, the panel vector autoregressive results show that in North Africa carbon emission had a positive impact. Our results validate the stability test of the panel vector autoregressive model. The granger causality results in the North show a bilateral causal link between carbon emission and bank credit, carbon emission, and bank deposit. Since sustainability has become one of our era's most thorny issues, this paper provides extensive policy directives to assist African nations in boosting a greener future.

Grey matter alterations in patients with Parkinson′s disease with different sleep disorders / 中华神经科杂志

Objective:To investigate the grey matter alterations of Parkinson′s disease (PD) patients with and without sleep disorders, and to explore the relationship between different sleep-related problems and clinical variables as well as grey matter volume (GMV) in PD.Methods:Forty-six PD patients and 38 healthy controls (HCs) were recruited from January 2018 to December 2021 in the Department of Neurology, Beijing Hospital. PD patients were divided into PD with sleep disorders (PD-S, n=26) and PD without sleep disorders (PD-nS, n=20) subgroups (cutoff points of 82 for Parkinson′s Disease Sleep Scale or less than 5 for each item was considered as an indicator of substantial sleep disorder). The Mini-Mental State Examination (MMSE), the third part of the Unified Parkinson′s Disease Rating Scale (UPDRS-Ⅲ), Hamilton Rating Scale for Anxiety (HAMA), Hamilton Rating Scale for Depression (HAMD), Non-Motor Symptoms Questionnaire (NMSQ), and Parkinson′s Disease Questionnaire-39 (PDQ-39) were used to evaluate cognitive function, motor symptoms, anxious and depressive symptoms, non-motor symptoms, and the quality of life of the patients. Optimized voxel-based morphometry was applied to the magnetic resonance imaging brain images in all participants,and multiple linear regression analysis was used to test the correlation between GMV and sleep quality in patients with PD. Results:Compared with the HCs, PD-nS patients showed decreased GMV in bilateral limbic lobe, parahippocampal gyrus, amygdala, cingulate gyrus, hippocampus, right cerebellum, bilateral frontotemporal lobe, bilateral occipital lobe and the left parietal lobe. PD-S group exhibited reduced GMV in bilateral limbic lobe, parahippocampal gyrus, amygdala, right cerebellum, bilateral frontotemporal lobe and bilateral parietal-occipital lobe, compared to the HCs. Compared with PD-nS, PD-S patients revealed higher depressive (HAMD score: 12.19±5.59 vs 6.95±3.19, t=-4.01, P<0.001), anxious (HAMA score: 12.04±5.32 vs 7.25±4.68, t=-3.18, P=0.003), and non-motor symptoms scores (NMSQ score: 12.92±5.18 vs 9.90±4.10, t=-2.14, P=0.038), poorer quality of life (PDQ-39 score: 35.31±22.01 vs 22.40±9.00, t=-2.71, P=0.010), and reduced GMV in the left insula, frontal, and parietal lobe ( P<0.001, uncorrected, cluster>100). There was a marked relationship between sleep quality and the reduced GMV of the right medial temporal gyrus (β=0.006, 95% CI 0.002-0.010, P=0.003), left middle frontal gyrus (β=0.006, 95% CI 0.002-0.010, P=0.002), the right cerebellum (β=0.014, 95% CI 0.005-0.023, P=0.003), and the right medial occipital gyrus (β=0.017, 95% CI 0.011-0.024, P<0.001). Significant grey matter changes were associated with nocturnal restlessness, mainly within the left limbic lobe, bilateral occipital lobe, the right cerebellum, and parietal lobe (β=0.008, 95% CI 0.006-0.010, P<0.001). Furthermore, nocturia in PD was related to certain grey matter atrophy, including bilateral limbic lobe, the right inferior parietal gyrus, and bilateral frontal lobe (β=0.010, 95% CI 0.008-0.013, P<0.001). The symptom of daytime dozing was correlated with GMV reduction in the right occipital lobe, the left temporal lobe (β=0.014, 95% CI 0.010-0.019, P<0.001). There were also several compensatory brain regions, including bilateral frontal lobe, the left limbic lobe and cingulate ( P<0.001, uncorrected, cluster>60). Conclusions:Sleep disturbance is common in PD, which is related to the anxious and depressive symptoms, non-motor symptoms, and the quality of life. PD patients with different sleep disorders show grey matter alterations in severeal brain regions, which are associated with sleep quality, nocturnal restlessness, psychosis, and daytime dozing.

Clinical characteristics of subjective cognitive decline in patients with Parkinson′s disease and its relationship with affective symptoms: a preliminary study / 中华神经科杂志

Objective:To investigate the characteristics and clinical related factors of Parkinson′s disease (PD) patients with subjective cognitive decline (SCD).Methods:Ninety-nine PD patients with normal cognitive function enrolled in Beijing Hospital from January to December 2018 were collected for the study. Patients with PD were divided into groups with ( n=57) and without ( n=42) SCD using the first question in Part 1 of the Unified Parkinson′s Disease Rating Scale (UPDRS). All patients were assessed by Montreal Cognitive Assessment (MoCA), modified Hoehn-Yahr grading, UPDRS, Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Parkinson′s Disease Sleep Scale, Ability of Daily Living Scale and 39-item Parkinson′s Disease Questionnaire (PDQ-39). Levodopa equivalent dose conversion was performed for patients taking anti-PD drugs. Patients′ self-reported years of formal education were collected. Results:The proportion of PD with SCD in this group was 57.58% (57/99). There were statistically significant differences in MoCA [28.00 (27.00, 29.00) vs 28.00 (27.00, 29.00) ,Z=-2.28, P=0.023], HAMD [6.00 (5.00, 8.50) vs 5.00 (2.00, 8.00), Z=-2.23, P=0.026], HAMA [7.00 (6.00, 11.00) vs 6.00 (3.00, 8.25) , Z=-2.70, P=0.007], PDQ-39-emotional health [2.00 (0, 5.00) vs 1.00 (0, 3.00), Z=-2.03, P=0.042] and PDQ-39-cognitive scores [4.00 (2.00, 5.00) vs 2.00 (0, 4.00), Z=-3.42, P=0.001] between PD with and without SCD groups. SCD was correlated with MoCA ( r=-0.23, P=0.022), HAMD ( r=0.23, P=0.025) and HAMA ( r=0.27, P=0.006) scores to varying degrees. When controlling for HAMD and HAMA scores, the correlation between SCD and MoCA scores ( r′=-0.18, P=0.084) was no longer existed. Conclusions:SCD is common in PD patients with normal cognitive function and is associated with poorer cognitive performance and more severe symptoms of depression and anxiety. In this group of patients, the relationship between SCD and affective symptoms may be greater than that of objective overall cognitive function, which is worthy of further studies.

Clinical features of corticobasal syndrome and associated chronic pain:analysis of 8 cases / 中华全科医师杂志

Objective:To investigate the clinical features and associated chronic pain in corticobasal syndrome (CBS).Methods:Clinical data of 8 patients diagnosed as probable CBS or possible CBS admitted to Beijing Hospital during January 2010 to June 2020 were retrospectively analyzed. The clinical information included sex, age, course of disease, chief complaint, neurological examination, blood biochemistry, tumor marker, infection and other laboratory tests; the neuropsychological evaluation included Mini-Mental State Examination (MMSE) scale and Hamilton Depression Scale (HAMD); the imaging studies included cranial magnetic resonance imaging (MRI) and/or 18F-Fluorodeoxyglucose positron emission tomography ( 18F-FDG PET). Results:The main clinical manifestations were asymmetrical movement disorders, including rigidity, tremor, myoclonus and abnormalities in posture and gait. Patients showed poor response to levodopa treatment. Among 8 patients, 7 had apraxia, 5 patients had alien hand, and 5 patients had various degrees of cognitive dysfunction. The cranial MRI demonstrated mild cerebral atrophy which was slightly more severe in the contralateral side of the initially affected limb in 7 of the 8 patients. The 18F-FDG PET scan revealed asymmetric decreased metabolism in the frontal, parietal, temporal, and occipital lobe, as well as in basal ganglia, which was more severe in the contralateral side of the initially affected limb in 5 of the 8 patients. Six of the 8 patients were associated with pain, including dystonic pain in 3 patients, neuropathic pain in 1 patient, musculoskeletal pain in 1 patient, and unexplained pain in 1 patient. Pain was the onset symptom in 1 patient and pain was relieved by taking levodopa in another patient. Conclusions:CBS is characterized by asymmetric dyskinesia and cognitive impairment, and often associated with apraxia, cortical sensory deficits, and alien limb. The MRI and PET are helpful for CBS diagnosis. Pain may be one of the common non-motor symptoms in CBS.

Depressive status in patients with Parkinson′s disease and its related factors / 中华全科医师杂志

Objective:To investigate the accurrence and related factors of depression in patients with parkinson's disease (PD).Methods:One hundred PD patients with Parkinson′s disease (PD) were enrolled in Department of Neurology in Beijing Hospital from March to June 2019. The depressive mood, sleep status and health-related quality of life of PD patients were evaluated by Beck Depression Scale (BDI), Parkinson′s Disease Sleep Scale 2 (PDSS-2), and 8 items of Parkinson′s Disease Questionnaire (PDQ-8). Spearman correlation analysis and multivariate regression analysis were used to analyze the related factors of PD depression. Nonparametric test was used to analyze the differences between different sleep disorder domains in PD patients with depression.Results:The total score of BDI in 100 PD patients ranged from 0 to 44, with an average of 9.9±8.6 points; the total score of PDSS-2 ranged from 0 to 43, with an average of 12.0±9.2; the total scores of PDQ-8 ranged from 0 to 24, with an average of 6.4±6.0 points. The detection rate of depression in 100 PD patients was 42.0% (42/100), and the total BDI score of 22 patients with mild depression ranged from 10 to 15 with an average of 13.0±1.9; the total BDI score of 14 patients with moderate depression ranged from 16 to 25, with an average of 19.1±3.0; the total BDI score of 6 patients with major depression ranged from 28 to 44 points, with an average of 33.3±6.4. The depression in PD patients was positively correlated with PDQ-8 score ( t=8.908, P<0.01) and PDSS-2 score ( t=2.286, P=0.02); and 85.7% (36/42) of PD patients with depression had sleep disturbance. The score of sleep disturbance domain of PD patients with depression (9.8±3.9) was higher than that of nocturnal motor symptom domain (4.8±4.5) and nocturnal PD non-motor symptom domain (4.1±3.3) ( P<0.01). The scores of emotional health, relationship with loved ones, attention, communication ability dimensions of PDQ-8 were positively correlated with PD depression ( P<0.05). Conclusion:Depression is a common non-motor symptom of PD patients; and PD patients with depression suffer from reduced quality of life and are more prone to sleep disorders.

Kugel procedure through the primary incision in treatment of recurrent inguinal hernia with chronic pain after anterior repair of transversalis fascia / 中华全科医师杂志

Clinical data of 67 patients with recurrent inguinal hernia and chronic pain after anterior repair of transversalis fascia who underwent Kugel procedure through the primary incision in Wenling First People′s Hospital between June 2015 and January 2019 were retrospectively reviewed. During the operation the surrounding scar tissue and previous mesh or plug were removed, the transversalis fascia was separated and the patch was placed to overlay myopectineal orifice. The mean operative time was 57 min (51-85 min).The peritoneum rupture occurred during the operation in 6 cases (8.9%), and seroma was developed in 5 patients(7.5%). After a mean 18 months of follow-up, no recurrence occurred in all patients. Three months after operation, the mild, moderate or severe pain in all 67 patients were all improved remarkably with a total pain relief rate of 92.5%. The results show that Kugel procedure through the primary incision is safe and effective in treatment of recurrent inguinal hernia with chronic pain after anterior repair of transversalis fascia.

Value of transthoracic echocardiography to monitor and evaluate aortic insufficiency after implantation of left ventricular assist device / 中国胸心血管外科临床杂志

@#Objective    To explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD). Methods    We retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation. Results    All 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic  valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05). Conclusion    TTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.

Application of moist electrothermal coagulation for hemostasis in iatrogenic splenic injury / 中华全科医师杂志

The iatrogenic splenic injuries occurred in 49 patients who underwent abdominal surgery from January 2005 to January 2020; including grade I injury in 40 cases and grade Ⅱ injury in 9 patients. The normal saline-soaked gauze was placed on the wound surface of the injured spleen, then the high-frequency electric coagulator was employed for hemostasis. The bleeding was successfully stopped and the spleens were preserved without postoperative complications in all cases. The results show that moist electrothermal coagulation can be effectively and safely applied in treatment of grade I and grade Ⅱ injury iatrogenic splenic injuries, and no special equipment required.

Application of severing splenomental fold priorly to prevent iatrogenic splenic injury in laparoscopic radical gastrectomy / 中华全科医师杂志

A total of 521 patients underwent laparoscopic radical gastrectomy from January 2013 to January 2020 in the First People′s Hospital of Wenling. In 242 cases the splenomental fold was severed before dissecting the left half of omentum or spleen (pretreatment group), and in 279 cases the splenomental fold was not severed priorly (routine group). For pretreatment group the introoperative splenic injury occurred in 4 cases (1.65%), including 3 cases (1.24%) with class Ⅰ injury and 1 case (0.41%) with class Ⅱ injury; while for routine group splenic injury occurred in 24 cases (8.60%), including 22 cases (7.89%) with class Ⅰ injury and 2 cases (0.72%) with class Ⅱ injury, and the rupture of splenic capsule caused by tracting splenomental fold occurred in 19 cases(6.81%). There were significant differences in total number of splenic injuries, splenic injuries with class Ⅰ and rupture of splenic capsule caused by tracting splenomental fold between two groups ( P<0.05). The operation time of 28 cases with splenic injuries was (185±89) min, which was longer than that in 493 cases without splenic injuries [(172±95) min, P<0.05]. The results show that rupture of splenic capsule by tracting splenomental fold is main cause of splenic injury in laparoscopic radical gastrectomy and most of them are class Ⅰ injuries. To sever the splenomental fold priorly can reduce the incidence of iatrogenic splenic injury.

Tourism and sustainable development in China: a review.

The adaption of the open-up reform policies in China some three decades ago has resulted in a rapid economic transformation of which the tourism sector has equally witnessed fast development. Therefore, the essence of this article is to review the evolution and expansion of the tourism industry in China and its obligation to observing international sustainable development policies and practices. Indications of the current policy regime, establishment, and institutions, sustainable development strategies to ensure continuity and availability of resources for future use, environmental sustainability laws and regulations, and promotional events for the development of the tourism industry are made available in this article. In effect, this article reviews how the activities of the tourism sector impacts on the environment. The findings show that China in its quest to be a world leader of tourists' destination has impacted negatively on the environment which by extension affect the economy and society at large. On the other hand, as a leading nation in the United Nations, China has in contemporary times adapted sustainable development strategies to help safeguard the environment. However, more needs to be done in the area of advanced technology and renewable energy.

The spatial effect of tourism economic development on regional ecological efficiency.

The process of tourism economic development is accompanied by the consumption of energy and environment. It is of a big significance to measure the level of tourism economic development and regional eco-efficiency correctly to clarify the relationship between them, as it contributes to realizing the high-quality development of the tourism economy and the construction of "beautiful China". On the basis of the panel data of China's 30 provinces and cities from 2002 to 2016, the paper intends to evaluate the regional eco-efficiency and tourism economic development level by using the super-efficiency DEA model and the grey entropy weight method, and then construct spatial panel econometric model which is based on the previous data to deeply discuss the influence of tourism economy development on regional ecological efficiency and its spatial effect. The research shows that (1) regional ecological efficiency has significant spatial dependence and spatial aggregation characteristics. With the passing of time, this kind of positive spatial autocorrelation is gradually strengthened. (2) In the long-term development, tourism economic development and regional ecological efficiency show a more obvious "Kuznets curve" effect. (3) The "U"-curve relationship between urbanization, environmental regulation, and regional eco-efficiency was confirmed. (4) In the process of tourism economic transformation and development, industrial pollution control, environmental regulation, technological level, urbanization, and investment openness are the main factors that affect the improvement of ecological efficiency in the local region. (5) Tourism economic development and urbanization levels have different spatial spillover effects in different periods, while investment openness has obvious positive spillover effects.

The impact of foreign direct investment on sustainable development in China.

The purpose of this paper is to investigate the impact of foreign direct investment (FDI) on sustainable development (SD) in China by using a regression model. Based on a panel date ranging from 1996 to 2016, this study makes an assessment of how development is sustained by means of an impose response function model. The findings revealed that, first, FDI has an insignificant influence on environmental quality in the long run but aids in financing physical capital deficits. Second, there exists the presence of the pollution halo hypothesis. In addition, in the short-term, pollution variables (sulfur dioxide and smoke and dust) cause significant variances on the amount of FDI inflows into China. However, they significantly lose their variation effect to FDI inflows in the long run due to the utilization of advanced technologies. Lastly, it is recommended that stricter environmental policies and strategies are implemented to curtail foreign investors from defaulting.

Semi-quantitative evaluation of white matter lesions and its influencing factor in patients with Parkinson's disease / 中华老年医学杂志

Objective:To investigate the characteristics of white matter lesions(WML)found by magnetic resonance imaging(MRI)and the relationship with clinical features in patients with Parkinson's disease(PD).Methods:This was a retrospective study by using a method of MRI T2WI-FLAIR.The WML in 87 PD patients were evaluated by using the Fazekas scale and Scheltens scale.Patients were divided into the early PD group[n=47, Hoehn-Yahr(H-Y)stage 1.0-2.0] vs.the middle-advanced PD group(n=40, H-Y stage 2.5-4.0), the non-depressed PD group(n=71) vs. the depressed PD group(n=16), the non-anxions PD group(n=62) vs.the anxions PD group(n=25). An ordinal regression model was used to investigate the correlations of WML with gender, age, Mini-Mental State Examination(MMSE)score, Unified Parkinson's disease Rating Scale-Ⅲ score(UPDRS-Ⅲ), Hamilton Rating Scale for Depression score(HAMD)and Hamilton Rating Scale for Anxiety score(HAMA). Results:Compared with the early PD group, the middle-advanced PD group showed that the WML were increased in lobe of brain(5.30±4.85 vs. 3.43±3.13, P<0.05), especially in the occipital lobe(0.48±0.99 vs. 0.11±0.31, P<0.05). There was no significant difference in the WML between the non-depressed/anxions and the depressed/anxions PD group.After being evaluated by the Scheltens scale, WML in periventricular hyperintensities(PVH)regions( OR=1.13, P<0.01), in brain lobe( OR=1.10, P<0.01)and in basal ganglia regions( OR=1.15, P<0.01)were correlated with age.WML in the brain besides the PV region were correlated with MMSE score( OR=0.68, P<0.01), especially in posterior horns( OR=0.60, P<0.01)and lateral ventricles( OR=0.68, P<0.05). WML in temporal lobe was correlated with MMSE score( OR=0.68, P<0.05). WML in brain lobe was correlated with H-Y stages( OR=2.10, P<0.05), especially in the occipital lobe( OR=3.33, P<0.05). WML in parietal lobe was associated with HAMD score( OR=1.13, P<0.05). WML in basal ganglia regions was related to diabetes( OR=6.34, P<0.05), especially in the putamen( OR=6.86, P<0.01). After being evaluated by the Fazekas scale, WML in PVH region( OR=1.16, P<0.01)and deep white matter hyperintensities( OR=1.13, P<0.01)were correlated with age.WML in PVH region were associated with MMSE score( OR=0.65, P<0.01). WML scores in PD patients had no correlation with gender, hypertension, coronary heart disease, hyperlipemia, UPDRS-Ⅲ score and HAMA score. Conclusions:The WML is present in PD patients, and it is correlated with age, diabetes, severity of disease, depression and cognitive function.