Process optimized for production of iturin A in biofilm reactor by Bacillus velezensis ND.

In this research, to provide an optimal growth medium for the production of iturin A, the concentrations of key amino acid precursors were optimized in shake flask cultures using the response surface method. The optimized medium were applied in a biofilm reactor for batch fermentation, resulting in enhanced production of iturin A. On this basis, a step-wise pH control strategy and a combined step-wise pH and temperature control strategy were introduced to further improve the production of iturin A. Finally, the fed-batch fermentation was performed based on combined step-wise pH and temperature control. The titer and productivity of iturin A reached 7.86 ± 0.23 g/L and 65.50 ± 1.92 mg/L/h, respectively, which were 37.65 and 65.20% higher than that before process optimization.

Fracture-related wound infections following surgical treatment of fractures in HIV-positive and HIV-negative patients: A meta-analysis.

The meta-analysis aims to evaluate and compare fracture-associated wound infections (FAWIs) following surgical treatment of fractures in human immunodeficiency virus (HIV)-positive and HIV-negative patients. Examinations comparing HIV-negative to HIV-negative for fracture was among the meta-analysis from various languages that met the inclusion criteria. Using dichotomous random or fixed models, the results of these investigations were examined, and the Odds ratio (OR) with 95% confidence intervals was computed (CIs). 14 examinations from 1991 to 2023 were recruited for the current analysis including 3528 personals with fractures. HIV-positive had significantly higher FAWI before antiretroviral (OR, 3.59; 95% CI, 2.01-6.41, p < 0.001) compared to HIV-negative personals with fractures. However, no significant difference was found between HIV-positive and HIV-negative in FAWI after antiretroviral (OR, 0.58; 95% CI, 0.30-1.12, p = 0.10) in personals with fractures. The examined data revealed that HIV-positive had significantly higher FAWI before antiretroviral, however, no significant difference was found in FAWI after antiretroviral compared to HIV-negative personals with fractures. Nevertheless, caution should be exercised while interacting with its values since some of the chosen examinations were found with a low sample size and a low number of examinations were found for the comparisons studied for the meta-analysis.

B-ultrasound or CT-guided 3D-printing individualized non-coplanar template brachytherapy for the treatment of locally uncontrolled recurrent head and neck squamous cell carcinoma.

Introduction: It is worth to explore a more effective treatment method to minimize the damage for patients during the treatment process. Aim: To explore the method, feasibility and efficacy of B-ultrasound or computed tomography (CT)-guided 3D printing individualized non-coplanar template brachytherapy in the treatment of locally uncontrolled recurrent head and neck squamous cell carcinoma. Material and methods: Ten patients with locally uncontrolled recurrent head and neck squamous cell carcinoma who were treated in our department from August 2021 to February 2023 were collected and treated by 3D printing individualized non-coplanar template brachytherapy under the guidance of B-ultrasound or CT, using the 192Ir high-dose rate afterloading treatment machine of NUCLETRON Technologies GmbH. The radiation source was 192Ir, with a diameter of 0.5 mm, a length of 3.5 mm, a total dose of 10-24 Gy, 5-8 Gy/time, once a week. Results: According to the efficacy evaluation criteria, CT scan was performed after 1-6 months, followed up for 24 months, including CR 40% (4/10), PR 50% (5/10), NC 10% (5/10), PD 0 (0). The total effective rate of CR + PR was 90% (9/10), the 6-month local control rate was 90%, the 12-month local control rate was 80%, the 18-month local control rate was 70%, and the 24-month local control rate was 70%. The overall survival rate at 24 months was 100%. Conclusions: Safe and effective interpolation is used to guide the 3D printing of a single non-coplanar template with B-ultrasound or CT in the radiotherapy of local and uncontrolled recurrent head and neck squamous cell carcinoma. According to the guidance of B-ultrasound or CT, the 3D printing individualized non-coplanar template has an obvious healing effect especially in the brachytherapy, and can also protect the functional organs well, with less side effects and fewer complications. Therefore, this method is the most effective for the treatment of locally uncontrolled recurrent head and neck squamous cell carcinoma.

Magnifying image-enhanced endoscopy-only mode boosted early cancer diagnostic efficiency: a multicenter randomized controlled trial.

BACKGROUND AND AIMS: Magnifying image-enhanced endoscopy (MIEE) is an advanced endoscopy with image enhancement and magnification used in preoperative examination. However, its impact on the detection rate is unknown. METHODS: We conducted an open-label, randomized, parallel (1:1:1), controlled trial in 6 hospitals in China. Patients were recruited between February 14, 2022 and July 30, 2022. Eligible patients were aged ≥18 years and undergoing gastroscopy in outpatient departments. Participants were randomly assigned to the MIEE-only mode (o-MIEE) group, white-light endoscopy-only mode (o-WLE) group, and MIEE when necessary mode (n-MIEE) group (initial WLE followed by switching to another endoscope with MIEE if necessary). Biopsy sampling of suspicious lesions of the lesser curvature of the gastric antrum was performed. Primary and secondary aims were to compare detection rates and positive predictive value (PPV) of early cancer and precancerous lesions in these 3 modes, respectively. RESULTS: A total of 5100 recruited patients were randomly assigned to the o-MIEE (n = 1700), o-WLE (n = 1700), and n-MIEE (n = 1700) groups. In the o-MIEE, o-WLE, and n-MIEE groups, 29 (1.51%; 95% confidence interval [CI], 1.05-2.16), 4 (.21%; 95% CI, .08-.54), and 8 (.43%; 95% CI, .22-.85) early cancers were found, respectively (P < .001). The PPV for early cancer was higher in the o-MIEE group compared with the o-WLE and n-MIEE groups (63.04%, 33.33%, and 38.1%, respectively; P = .062). The same trend was seen for precancerous lesions (36.67%, 10.00%, and 21.74%, respectively). CONCLUSIONS: The o-MIEE mode resulted in a significant improvement in diagnosing early upper GI cancer and precancerous lesions; thus, it could be used for opportunistic screening. (Clinical trial registration number: ChiCTR2200064174.).

The SWGEDWGEIW from Soybean Peptides Reduces Insulin Resistance in 3T3-L1 Adipocytes by Activating p-Akt/GLUT4 Signaling Pathway.

Diabetes mellitus, a group of metabolic disorders characterized by persistent hyperglycemia, affects millions of people worldwide and is on the rise. Dietary proteins, from a wide range of food sources, are rich in bioactive peptides with anti-diabetic properties. Notably, the protective mechanism of the single peptide SWGEDWGEIW (TSP) from soybean peptides (SBPs) on insulin resistance of adipocytes in an inflammatory state was investigated by detecting the lipolysis and glucose absorption and utilization of adipocytes. The results showed that different concentrations of TSP (5, 10, 20 µg/mL) intervention can reduce 3T3-L1 adipocytes' insulin resistance induced by inflammatory factors in a dose-dependent manner and increase glucose utilization by 34.2 ± 4.6%, 74.5 ± 5.2%, and 86.7 ± 6.1%, respectively. Thus, TSP can significantly alleviate the lipolysis of adipocytes caused by inflammatory factors. Further mechanism analysis found that inflammatory factors significantly reduced the phosphorylation (p-Akt) of Akt, two critical proteins of glucose metabolism in adipocytes, and the expression of GLUT4 protein downstream, resulting in impaired glucose utilization, while TSP intervention significantly increased the expression of these two proteins. After pretreatment of adipocytes with PI3K inhibitor (LY294002), TSP failed to reduce the inhibition of p-Akt and GLUT4 expression in adipocytes. Meanwhile, the corresponding significant decrease in glucose absorption and the increase in the fat decomposition of adipocytes indicated that TSP reduced 3T3-L1 adipocytes' insulin resistance by specifically activating the p-Akt/GLUT4 signal pathway. Therefore, TSP has the potential to prevent obesity-induced adipose inflammation and insulin resistance.

The SWGEDWGEIW from Soybean Peptides Reduce Oxidative Damage-Mediated Apoptosis in PC-12 Cells by Activating SIRT3/FOXO3a Signaling Pathway.

The goal of the investigation was to study the protective effects of the SWGEDWGEIW (the single peptide, TSP) from soybean peptides (SBP) on hydrogen peroxide (H2O2)-induced apoptosis together with mitochondrial dysfunction in PC-12 cells and their possible implications to protection mechanism. Meanwhile, the SBP was used as a control experiment. The results suggested that SBP and TSP significantly (p < 0.05) inhibited cellular oxidative damage and ROS-mediated apoptosis. In addition, SBP and TSP also enhanced multiple mitochondrial biological activities, decreased mitochondrial ROS levels, amplified mitochondrial respiration, increased cellular maximal respiration, spare respiration capacity, and ATP production. In addition, SBP and TSP significantly (p < 0.05) raised the SIRT3 protein expression and the downstream functional gene FOXO3a. In the above activity tests, the activity of TSP was slightly higher than that of SBP. Taken together, our findings suggested that SBP and TSP can be used as promising nutrients for oxidative damage reduction in neurons, and TSP is more effective than SBP. Therefore, TSP has the potential to replace SBP and reduce neuronal oxidative damage.

Synthesis, Characterization and Biological Evaluation of Benzothiazole-Isoquinoline Derivative.

Currently, no suitable clinical drugs are available for patients with neurodegenerative diseases complicated by depression. Based on a fusion technique to create effective multi-target-directed ligands (MTDLs), we synthesized a series of (R)-N-(benzo[d]thiazol-2-yl)-2-(1-phenyl-3,4-dihydroisoquinolin-2(1H)-yl) acetamides with substituted benzothiazoles and (S)-1-phenyl-1,2,3,4-tetrahydroisoquinoline. All compounds were tested for their inhibitory potency against monoamine oxidase (MAO) and cholinesterase (ChE) by in vitro enzyme activity assays, and further tested for their specific inhibitory potency against monoamine oxidase B (MAO-B) and butyrylcholinesterase (BuChE). Among them, six compounds (4b-4d, 4f, 4g and 4i) displayed excellent activity. The classical antidepressant forced swim test (FST) was used to verify the in vitro results, revealing that six compounds reduced the immobility time significantly, especially compound 4g. The cytotoxicity of the compounds was assessed by the MTT method and Acridine Orange (AO) staining, with cell viability found to be above 90% at effective compound concentrations, and not toxic to L929 cells reversibility, kinetics and molecular docking studies were also performed using compound 4g, which showed the highest MAO-B and BuChE inhibitory activities. The results of these studies showed that compound 4g binds to the primary interaction sites of both enzymes and has good blood-brain barrier (BBB) penetration. This study provides new strategies for future research on neurodegenerative diseases complicated by depression.

Molecular identification and antifungal susceptibility profile of yeast from vulvovaginal candidiasis.

BACKGROUND: Accurate identification Candida is important for successful therapy and epidemiology study. The aim of research is to study API 20C yeast identification system identification rate by using molecular identification as gold standard and tested the antifungal susceptibility of Candida from patients with vulvovaginal candidiasis (VVC). METHODS: In total, 3574 yeast isolates were obtained from patients with VVC. API 20C yeast identification, molecular identification and in vitro antifungal susceptibility were performed. RESULTS: C. albicans was the predominant Candida species [2748 isolates, 76.9%] in VVC. The isolates from vaginal samples represented 22 species based on molecular identification. The API 20C system identifies only 11 of the species encountered during the study period. Based on the API 20C system, 3273 (91.78%) isolates were correctly identified to the species level. The correct identification rate of the API 20C system for rare yeast was 15.29% (26/170 isolates). Antifungal susceptibility was tested in a total of 1844 isolates of Candida from patients with VVC. C. albicans was susceptible to most of the tested antifungals. The MICs of azoles for C. glabrata were higher than those for C. albicans. The MICs of echinocandins for C. parapsilosis were higher than those for C. albicans. CONCLUSIONS: The API 20C yeast identification system can be used to reliably identify the most common Candida species while molecular methods are necessary for the identification of closely related, emerging, and rare yeast species. The results from this study suggest that much of the previous studies on the epidemiology of VVC should be re-thought. C. albicans was susceptible to most of the tested antifungals.

Clinical Characteristics and Antifungal Susceptibility of Candida nivariensis from Vulvovaginal Candidiasis.

OBJECTIVES: The aim of this work is to evaluate the susceptibility profile of the isolates against antifungal drugs and the level of virulent genes and resistant genes mRNA expression of Candida nivariensis. METHODS: We analyzed a collection of 9 C. nivariensis isolates from clinical isolates of Candida glabrata complex isolated from patients with vulvovaginal candidiasis (VVC). Antifungal susceptibilities of the isolates were assayed by using the broth microdilution method. The level of virulent genes and resistant genes mRNA expression was determined by using real-time PCR. RESULTS: At day 7-14 and day 30-35 follow-up, mycological cure of VVC caused by C. nivariensis was 5 in 9 and 4 in 9 cases. The minimum inhibitory concentration geometric means of caspofungin, fluconazole, itraconazole, and amphotericin B in C. nivariensis isolates were higher than those in Candida albicans ATCC90028 (0.340, 1.852, 0.367, and 1.587 vs. 0.124, 0.140, 0.030, and 0.891 µg/mL; p < 0.05). The level of resistant genes ERG11, CDR1, and CDR2 and virulent genes YPS1, AWP3, and EPA1 mRNA expression was higher in C. nivariensis isolates than that of C. glabrata (2.58 ± 0.78, 9.31 ± 5.19, 11.10 ± 0.76, 13.57 ± 0.54, 11.96 ± 2.93, and 14.40 ± 0.61 vs. 1.05 ± 1.19, 2.22 ± 0.27, 0.85 ± 0.48, 0.30 ± 0.37, 1.90 ± 0.43, and 2.40 ± 0.65). CONCLUSION: We conclude that patients infected with C. nivariensis were symptomatic and with a low mycological cure rate when treated with commonly used antifungal agents. Compared with C. albicans, C. nivariensis is more antifungal resistant and virulent.

Isorhamnetin, Hispidulin, and Cirsimaritin Identified in Tamarix ramosissima Barks from Southern Xinjiang and Their Antioxidant and Antimicrobial Activities.

As a natural potential resource, Tamarix ramosissima has been widely used as barbecue skewers for a good taste and unique flavor. The polyphenolics in the branch bark play a key role in the quality improvement. The purposes of the present work were to explore the polyphenolic composition of T. ramosissima bark extract and assess their potential antioxidant and antimicrobial activities. Hispidulin and cirsimaritin from T. ramosissima bark extract were first identified in the Tamarix genus reported with UPLC-MS analysis. Isorhamnetin (36.91 µg/mg extract), hispidulin (28.79 µg/mg extract) and cirsimaritin (13.35 µg/mg extract) are rich in the bark extract. The extract exhibited promising antioxidant activity with IC50 values of 117.05 µg/mL for 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 151.57 µg/mL for hydroxyl radical scavenging activities, as well as excellent reducing power with an EC50 of 93.77 µg/mL. The bark extract showed appreciable antibacterial properties against foodborne pathogens. Listeria monocytogenes was the most sensitive microorganism with the lowest minimum inhibitory concentration (MIC) value of 5 mg/mL and minimum bactericidal concentration (MBC) value of 10 mg/mL followed by S. castellani and S. aureus among the tested bacteria. The T. ramosissima bark extract showed significantly stronger inhibitory activity against Gram-positive than Gram-negative bacteria. Nevertheless, this extract failed to show any activity against tested fungi. Overall, these results suggested that T. ramosissima shows potential in improving food quality due to its highly efficacious antioxidant and antibacterial properties.

A Thioether-Stabilized d-Proline-l-Proline-Induced ß-Hairpin Peptide of Defensin Segment Increases Its Anti-Candida albicans Ability.

We report a ß-hairpin dual stabilizing strategy: a d-proline-l-proline (d-Pro-l-Pro) dipeptide as the nucleating turn, and a thioether tether as a side-chain linkage at a precisely designed position to stabilize the ß-hairpin. This method was used to modify the C-terminal ß-hairpin moiety of the plant defensin, pv-defensin, in order to obtain a stabilized peptide with enhanced anti-Candida albicans activity (MIC 84-3.0 µm), high serum stability (50 % remaining after 48 h) and low hemolysis (<10 % at 152 µm). This modified peptide penetrated the C. albicans cell membrane within 5 min and showed high activity against clinically isolated antibiotic-resistant C. albicans and Candida glabrata strains.

Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis.

BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) has a poor therapeutic outcome and a severe impact on women and their partners, both physically and psychologically. Health-related quality of life (HRQOL) is significantly affected in patients with RVVC; however, little is known about HRQOL in patients with this disease. In this study, we aim to identify the clinical and mycological characteristics of women with RVVC and the effects of RVVC on women's HRQOL. METHODS: We designed this study as a comparative cross-sectional study. The Short-Form Health Survey (SF-36) was used to measure HRQOL in 102 patients with RVVC and 101 women seeking general health care (controls). RVVC was defined as four or more episodes of proven VVC in the previous 12-month period. VVC was defined as vulvar itching, burning, erythema, vaginal discharge, pseudohyphae or blastoconidia on a wet 10 % potassium hydroxide (KOH)-treated vaginal slide and a positive Candida culture. Group comparisons were conducted with independent samples t test. Correlation analysis was performed on the variables. RESULTS: The mean age at first diagnosis of the patients with RVVC was 30.96 years (SD 5.38), and the mean age of the controls was 29.75 years (SD 5.83; p > 0.05). The duration of the patients' complaints varied from 6 months to 10 years, with a mean duration of 22.28 (±21.75) months. The most common complaints were increased vaginal discharge (102 cases, 100 %), itching (97 cases, 95.1 %), dyspareunia (65 cases, 63.7 %), burning (79 cases, 77.5 %) and erythema (25 cases, 24.5 %). C. albicans was the predominant Candida species (86 strains, 84.3 %) in the patients, followed by C. glabrata (12 strains, 11.8 %). C. parapsilosis (1 strain, 0.9 %), C. tropicalis (1 strain, 0.9 %), C. krusei (1 strain, 0.9 %) and C. lusitaniae (1 strain, 0.9 %). The mean SF-36 dimension scores for physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health were significantly lower in the patients with RVVC than in the controls (85.20, 61.39, 77.79, 54.95, 53.17, 67.89, 52.48 and 59.17 vs. 90.20, 80.87, 87.08, 67.38, 59.69, 79.86, 68.01 and 65.38). The physical composite and mental composite scores of the patients with RVVC were 63.06 and 64.87, respectively, which were lower than those of the controls (75.01 and 74.87; p < 0.05). CONCLUSIONS: Nearly all of the patients with RVVC had clinical symptoms. In our sample, RVVC was mainly caused by C. albicans. RVVC has negative effects on women's HRQOL, as indicated by lower physical and mental composite scores among the RVVC group compared with controls.

The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis.

To compare the efficacy and safety of two doses of clotrimazole vaginal tablet 500 mg with two doses of oral fluconazole 150 mg in treating severe vulvovaginal candidiasis (SVVC), 240 consecutive patients with SVVC were studied at the Department of Obstetrics and Gynaecology of Peking University Shenzhen Hospital between June 2014, and September 2015. Patients were randomly assigned in a 1 : 1 ratio to receive treatment with either two doses of clotrimazole vaginal tablet or two doses of oral fluconazole. The clinical cure rates in the clotrimazole group and the fluconazole group at days 7-14 follow-up were 88.7% (102/115) and 89.1% (98/110) respectively; the clinical cure rates at days 30-35 in the two groups were 71.9% (82/114) and 78.0% (85/109) respectively. The mycological cure rates at days 7-14 follow-up in the two groups were 78.3% (90/115) and 73.6% (81/110) respectively. The mycological cure rates of the patients at days 30-35 in the two groups were 54.4% (62/114) and 56.0% (61/109) respectively (P > 0.05). The adverse events of clotrimazole were mainly local. This study demonstrated that two doses of clotrimazole vaginal tablet 500 mg were as effective as two doses of oral fluconazole 150 mg in the treatment of patients with SVVC and could be an appropriate treatment for this disorder.

A randomized clinical trial of the efficacy and safety of terconazole vaginal suppository versus oral fluconazole for treating severe vulvovaginal candidiasis.

Terconazole is a new, broad-spectrum, triazole antifungal agent. The aim of this study was to compare the efficacy and safety of a 6-day course of a terconazole vaginal suppository (80 mg) with two doses of oral fluconazole (150 mg) for the treatment of severe vulvovaginal candidiasis (SVVC). In this prospective, randomized case-control study, 140 consecutive patients with SVVC were enrolled at the Department of Obstetrics and Gynecology of Peking University Shenzhen Hospital from July 1, 2013, through June 31, 2014. Patients with SVVC, initially at a 1:1 ratio, were randomly assigned to receive treatment with either the terconazole vaginal suppository or oral fluconazole. The patients had follow-up visits at 7-14 days and 30-35 days following the last dose of therapy. The clinical cure rates in the terconazole group and the fluconazole group were, respectively, 81.0% (47/58) and 75.8% (50/66) at follow-up day 7-14 and 60.3% (35/58) and 56.1% (37/66) at day 30-35. The mycological cure rates in the two groups were, respectively, 79.3% (46/58) and 71.2% (47/66) at follow-up day 7-14 and 62.1% (36/58) and 53.0% (35/66) at day 30-35 (P > .05 for all). Local irritation was the primary adverse event associated with terconazole, whereas systemic side effects were associated with fluconazole; however, these effects were minimal. This study demonstrated that a terconazole vaginal suppository (80 mg daily for 6 days) was as effective as two dose of oral fluconazole (150 mg) in the treatment of patients with SVVC; as such, terconazole could be a choice for therapy of this disorder.

Candida parapsilosis sensu stricto and the closely related species Candida orthopsilosis and Candida metapsilosis in vulvovaginal candidiasis.

This study aimed to determine the clinical characteristics and in vitro susceptibilities of Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis isolates from patients with vulvovaginal candidiasis (VVC). We analysed 63 vaginal C. parapsilosis specimens. After the molecular analyses, the isolates were characterised as C. parapsilosis sensu stricto (77.8%), C. orthopsilosis (7.9%) and C. metapsilosis (14.3%). The signs and symptoms of VVC caused by C. parapsilosis sensu lato, including itching, erythema and abnormal discharge, were milder than those caused by C. albicans. None of the C. parapsilosis sensu lato isolates were resistant to fluconazole, miconazole or itraconazole. The resistance rates of C. albicans to fluconazole, itraconazole, miconazole and clotrimazole were 2.3, 1.5, 3.1 and 0.8%, respectively. Both C. parapsilosis sensu lato and C. albicans were susceptible to nystatin. The mycological eradication rate at follow-up days 7-14 and 30-35 were 77.8% (49/63) and 76.2% (48/63), respectively, when treated with various antifungal agents and regimens. We conclude that C. parapsilosis sensu stricto and the closely related species C. orthopsilosis and C. metapsilosis were present in the vaginal samples of VVC patients. The symptoms and signs of VVC caused by C. parapsilosis are milder than those caused by C. albicans. The antifungal susceptibility and therapeutic efficacy in patients colonised by C. parapsilosis sensu lato were similar to those observed in C. albicans-colonised patients.

[Traditional Chinese Medicine Treatment of Gouty Arthritis Based on Syndrome Differentiation].

OBJECTIVE: To observe the clinical effect and safety of traditional Chinese medicine (TCM) treatment in gouty arthritis (GA) based on syndrome differentiation. METHODS: 81 patients of GA were enrolled from August 2013 to August 2014. They were divided into syndrome differentiation treatment group (27 cases), disease differentiation treatment group (27 cases) and basic treatment group (27 cases). The patients in syndrome differentiation treatment group were given corresponding TCM drug granules prescription by dialectical syndromes classification. The patients in disease differentiation treatment group were given TCM drug granules prescription. The patients in basic treatment group.were only given Diclofenac Sodium sustained-release tablets in acute phase, and Benzbromarone tablets in chronic phase. After 12 weeks treatments, all the patients received the measurements of serum uric acid (SUA), serum creatinine (SCr), blood urea nitrogen (BUN), triacylglycerol (TG), cholesterol (TC). The clinical efficacy, recurrence rate and adverse reactions were recorded and analyzed. RESULTS: Syndrome differentiation treatment group achieved higher clinical efficacy than basic treatment group and disease differentiation treatment group (P<0. 05). Moreover, syndrome differentiation treatment were superior to disease differentiation treatment in improving of recurrence rate (P<0. 05). There were no obvious adverse reactions occurred. There were no clinical significant changes in blood, urine routine analysis, and electrocardiogram examination before and 3 months after the treatments. CONCLUSION: The treatment of TCM in patients with GA based on syndrome differentiation showed definite therapeutic effects.

Increased prevalence of vertebrobasilar dolichoectasia in Parkinson's disease and its effect on white matter microstructure and network.

This study aimed to investigate the prevalence of vertebrobasilar dolichoectasia (VBD) in Parkinson's disease (PD) patients and analyze its role in gray matter changes, white matter (WM) microstructure and network alterations in PD. This is a cross-sectional study including 341 PD patients. Prevalence of VBD in these PD patients was compared with general population. Diffusion tensor imaging and T1-weighted imaging analysis were performed among 174 PD patients with or without VBD. Voxel-based morphometry analysis was used to estimate gray matter volume changes. Tract-based spatial statistics and region of interest-based analysis were used to evaluate WM microstructure changes. WM network analysis was also performed. Significantly higher prevalence of VBD in PD patients was identified compared with general population. Lower fractional anisotropy and higher diffusivity, without significant gray matter involvement, were found in PD patients with VBD in widespread areas. Decreased global and local efficiency, increased hierarchy, decreased degree centrality at left Rolandic operculum, increased betweenness centrality at left postcentral gyrus and decreased average connectivity strength between and within several modules were identified in PD patients with VBD. VBD is more prevalent in PD patients than general population. Widespread impairments in WM microstructure and WM network involving various motor and nonmotor PD symptom-related areas are more prominent in PD patients with VBD compared with PD patients without VBD.