Abstract:The circadian clock is an important mechanism that links individual rhythm with external time. It can predict and respond to time, determine sleep-wake cycle, and participate in the regulation of circadian rhythms of various physiological behavior changes, including food intake and hormone balance in the body. The central circadian clock in mammals can regulate the peripheral circadian clocks of the gut, liver, and pancreas and other organs to maintain homeostasis and synchronize the operation of each organ, which can induce circadian changes in the structure, number, and colonization behavior of gut microbes by regulating feeding and sleep. Gut microbiota are the core part of intestinal microecology, which can regulate the physiology and functions of multiple organs and systems, including the brain, and have been proved to be the driving factors of the rhythmic expression of host clock molecules and a variety of circadian rhythm activities. In the past few years, the relationship between mammalian gut microbiota and circadian clock and their impact on diseases have been partially revealed, but further research is still needed to explore the specific mechanism of their cooperation in the context of human diseases. This paper reviews the current research progress on the bidirectional regulation between mammalian circadian clock and gut microbiota and the specific molecular mechanisms involved, hoping to provide new interventions and therapeutic targets for the treatment of diseases.

Abstract:Objective To investigate the influencing factors of post-stroke depression (PSD) 90 d after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with effective reperfusion. Methods The clinical data of AIS paitents with effective reperfusion in Neurovascular Center, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2019 to Dec. 2020 were retrospectively analyzed. Effective reperfusion was defined as successful recanalization (modified thrombolysis in cerebral infarction grade≥2b) and good functional prognosis (modified Rankin scale score≤3) 90 d after MT. The baseline data of patients at admission were collected, including inflammatory indicators such as white blood cell (WBC) count and lymphocyte-to-monocyte ratio (LMR), and clinical data related to MT. The depression of patients was evaluated by patient health questionnaire-9 (PHQ-9). The patients were divided into PSD group (PHQ-9 score≥10) and non-PSD group (PHQ score＜10), and the differences of clinical characteristics between the 2 groups were analyzed. Multivariate binary logistic regression model was used to analyze the independent influencing factors of PSD, and receiver operating characteristic (ROC) curve was used to analyze the value of LMR alone and multivariate combination in predicting PSD. Results A total of 206 AIS patients with effective reperfusion were enrolled, including 68 patients (33.01%) in PSD group and 138 patients (66.99%) in non-PSD group. Multivariate binary logistic regression analysis showed that age (odds ratio ［OR］ ＝0.946, P＝0.011), Alberta Stroke Program early computed tomography score (ASPECTS) before thrombectomy (OR＝0.707, P＝0.008), WBC at admission (OR＝0.729, P＝0.006) and LMR at admission (OR＝0.596, P＝0.003) were independent influencing factors for PSD 90 d after MT in AIS patients with effective reperfusion. The ROC curve analysis showed that the area under curve (AUC) value of combination of the above 4 factors in predicting PSD was 0.795, and the AUC value of LMR alone in predicting PSD was 0.711. The optimal cut-off value of LMR was 2.96, with a sensitivity of 71.0% and a specificity of 64.7%. The incidence of PSD 90 d after MT in patients with LMR≤2.96 (86 cases) and LMR＞2.96 (120 cases) was 51.16% (44/86) and 20.00% (24/120), respectively, and the difference was statistically significant (χ²＝22.00, P＜0.001). Conclusion About 1/3 of AIS patients with effective reperfusion will develop PSD. Young age, large ischemic area at the beginning of onset, and low LMR and WBC count at admission are independent risk factors for PSD.

Abstract:Objective To investigate the risk factors of cognitive impairment in patients with acute ischemic stroke (AIS). Methods A total of 100 AIS patients in Neurovascular Center, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Aug. to Dec. 2022 were enrolled. According to the mini mental status evaluation (MMSE) score, the patients were divided into normal cognitive group (59 cases) and impaired cognitive group (41 cases). The basic clinical data, laboratory and imaging examination data, Montreal cognitive assessment (MoCA), patient health questionnaire-9 (PHQ-9), Lubben social network scale (LSNS-6) and University of California, Los Angeles loneliness scale-version 3 (UCLA-3) of the patients in the 2 groups were collected. Binary logistic regression model was used to analyze the risk factors of cognitive impairment in AIS patients. Results Compared with the normal cognitive group, the impaired cognitive group was older (P＝0.012), had lower level of education (P＝0.045), higher proportion of diabetes mellitus history (P＝0.026), and lower MMSE score (P＜0.001), MoCA score (P＜0.001) and LSNS-6 score (P＝0.012), and higher PHQ-9 score (P＜0.001) and UCLA-3 score (P＝0.002). Moreover, there was significant difference in Oxfordshire Community Stroke Project (OCSP) classification (P＝0.031) between the 2 groups. Binary logistic regression analysis showed that age (odds ratio ［OR］ ＝1.070, 95% confidence interval ［CI］ 1.020-1.123, P＝0.005) and total anterior circulation infarct (OR＝55.633, 95% CI 2.041-1 516.526, P＝0.017) were risk factors for cognitive impairment in AIS patients. Conclusion Age and total anterior circulation infarct are risk factors of cognitive impairment in AIS patients.

Abstract:Objective To explore the role of cognitive reserve in predicting cognitive impairment in patients with acute ischemic stroke (AIS). Methods From Nov. 2021 to Oct. 2022, a total of 291 AIS patients admitted to Neurovascular Center of The First Affiliated Hospital of Naval Medical University (Second Military Medical University) and Stroke Center of Air Force Hospital of PLA Eastern Theater Command were selected by convenience sampling method. Cognitive reserve and cognitive function were assessed using cognitive reserve index questionnaire and Montreal cognitive assessment, respectively. General information was obtained from the patients’ medical records or bedside assessment by neurologists. Multivariate binary logistic regression was used to analyze the predictive effect of cognitive reserve on cognitive impairment in AIS patients. Results The average age of 291 AIS patients was (65.9±10.4) years old. The National Institutes of Health stroke scale (NIHSS) score at admission was 5 (2, 10), the total scores of cognitive reserve and cognitive function were 97±16 and 23 (17, 27), respectively, and 218 patients (74.9%) had cognitive impairment. After adjusting for age, type of residency, NIHSS score at admission, diabetes mellitus, degree of cerebral vascular stenosis, and depression symptom, cognitive reserve was a protective factor for post-stroke cognitive impairment; AIS patients with high cognitive reserve level were 0.156 times more likely to have cognitive impairment than those with low cognitive reserve level (95% confidence interval ［CI］ 0.045-0.538, P＝0.003) and patients with moderate level of cognitive reserve were 0.272 times more likely to have cognitive impairment than those with low cognitive reserve level (95% CI 0.113-0.654, P＝0.004). Conclusion A higher level of cognitive reserve is a protective factor for AIS patients with cognitive impairment. Improving the level of cognitive reserve is expected to be one of the potential strategies for early cognitive intervention in stroke patients.

Abstract:Objective To explore the effects of family function of chronic ischemic stroke patients and their primary family caregivers on depression and quality of life of patients. Methods Convenience sampling method was used to select 124 pairs of chronic ischemic stroke patients who were hospitalized in Stroke Center of Air Force Hospital of PLA Eastern Theater Command from Apr. to Dec. 2020 and their primary family caregivers, and they were followed up 6 months after discharge. Demographic sociological data and disease-related data of patients with chronic ischemic stroke and their primary family caregivers were collected using the self-maded demographic sociological data and disease-related data questionnaires, respectively. Family function of patients and their primary family caregivers was assessed using family assessment device (FAD), depression symptoms of patients were measured by center for epidemiological studies depression scale (CES-D), and quality of life level of patients was assessed by the stroke specific quality of life (SS-QOL) scale. Chi-square test was used to investigate the differences in family function between patients and their primary family caregivers. Multivariate logistic regression analysis and multiple linear regression analysis were used to explore the correlations of family function with depression and quality of life of patients. Results Among the 124 chronic ischemic stroke patients, 75 (60.5%) were males and 49 (39.5%) were females, with an age of (65.5±8.9) years old. The total score of FAD was 136.6±19.7 in patients and 137.4±21.3 in primary family caregivers. The CES-D score of the patients was 14.2±10.6, of which 54 cases (43.5%) had depressive symptoms. The average score of SS-QOL (191.3±46.3) was generally at a medium level. There were significant differences in the dysfunction rate of dimensions of problem solving, roles, affective response, affective involvement, behavioral control, and general function (31.5% ［39/124］ vs 32.3% ［40/124］, 43.5% ［54/124］ vs 47.6% ［59/124］, 60.5% ［75/124］ vs 46.8% ［58/124］, 76.6% ［95/124］ vs 71.0% ［88/124］, 91.1% ［113/124］ vs 93.5% ［116/124］, and 65.3% ［81/124］ vs 62.9% ［78/124］) between the patients and primary family caregivers (all P＜0.01). Multivariate logistic regression analysis and multiple linear regression analysis showed that the role function reported by primary family caregivers was correlated with depressive symptoms (odds ratio＝3.152, 95% confidence interval 1.142-8.702, P＝0.027) and quality of life (b＝－20.642, P＝0.029). Conclusion The role dysfunction of primary family caregivers may increase the risk of depressive symptoms in patients with chronic ischemic stroke and reduce their quality of life.

Abstract:Objective To investigate the effect and mechanism of mannose exposure on the hyperlipidemia in apolipoprotein (Apo)E-deficient mice. Methods Ten ApoE-deficient mice (6 weeks old, male) were divided into control group and mannose group (5 in each group). A hyperlipidemia model was established using high fat and high cholesterol purified feed. The mice in the control group were fed with drinking water, while the mice in the mannose group were fed with drinking water containing 2% mannose (w/v). Plasma total cholesterol and triglyceride concentrations were measured using their respective kits. Plasma lipoproteins were separated by fast protein liquid chromatography, and the Apo and cholesterol levels were measured. The mRNA and protein expression levels of lipoprotein metabolism-related genes in the liver and jejunum were detected by quantitative polymerase chain reaction and Western blotting, respectively. Results Compared with the control group, the levels of plasma triglyceride and total cholesterol of mice in the mannose group were significantly increased (P＜0.05, P＜0.01), accompanied by significantly higher levels of cholesterol and ApoB100 protein in very low-density lipoprotein and lower levels of ApoA1 and ApoA4 in high-density lipoprotein. The expression of ApoA1 protein in the liver and jejunum of mice in the mannose group was downregulated compared to the control group, while the downregulation of ApoA4 protein expression was only observed in the jejunum. Conclusion Mannose exposure affects lipoprotein metabolism and aggravates the hyperlipidemia in ApoE-deficient mice.

Abstract:Objective To investigate the effects of exposure to 32% oxygen-68% nitrogen (mixed gas) with different protocols on the lung function, blood gas indicators and inflammatory factors in rats undergoing fast ascent. Methods Thirty male SD rats were randomly divided into 5 groups (n＝6): normal control group, group 1 (rats were pressured with mixed gas at 40 m for 4 h, followed by rapid decompression, and lung function was detected at 0, 3 and 24 h after decompression), group 2 (the hyperbaric exposure protocol was the same as that in group 1, but rats were sacrificed immediately after decompression, and then blood was collected for detection of the blood gas indicators, inflammatory factors ［interleukin 1β, tumor necrosis factor α, and transforming growth factor β］ and oxidative stress indicator ［4-hydroxynonenal］), group 3 (the hyperbaric exposure protocol was the same as that in group 1, but rats were exposed to normobaric 100% oxygen for 30 min after decompression. After the examination of the lung function, rats were sacrificed, and blood was collected for the examination of the blood gas indicators, inflammatory factors and oxidative stress indicator), and group 4 (rats were exposed to 100% oxygen at 7 m for 30 min, then to mixed gas at 15 m for 3 h and finally to mixed gas at 40 m for 10 min, followed by rapid decompression. After the examination of the lung function, rats were sacrificed, and blood was collected for the examination of the blood gas indicators, inflammatory factors and oxidative stress indicator). The lung function of the rats was examined by a whole body plethysmography system, blood gas analysis was performed by a blood gas analyzer, and the blood inflammatory factors and oxidative stress indicator of the rats were detected by kits. Results Fast ascent after hyperbaric exposure increased the respiratory rate, shortened the time of inspiration and expiration, increased the peak inspiratory and expiratory flow rates, and elevated the minute ventilation. Normobaric oxygen exposure after fast ascent improved the lung dysfunction, but the respiratory resistance was still increased as compared to baseline level. Fast ascent after hyperbaric exposure with oxygen inhalation at shallower water and increase of depth step by step could also cause damage to the lung function, which was characterized by the increase of expiratory and inspiratory resistance. Conclusion In the diving with semi-closed circuit rebreather, fast ascent may cause damage to the lung, which may be improved to a limited extent by short-term oxygen breathing in initial shallow water or normobaric 100% oxygen afetr fast ascent.

Abstract:Objective To propose a neurological function classification (NFC) for lumbar degenerative disease (LDD) and to preliminarily explore its clinical significance. Methods Totally 163 patients with LDD admitted to Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Mar. 2019 to Dec. 2020 were enrolled and divided into the following 5 types according to the corresponding diagnostic criteria: radicular type (n＝50), spinal cord and cauda equina type (n＝42), mixed type (n＝38), cauda equina syndrome type (CEST, n＝7), and focal type (n＝26). All patients were treated with modified transforaminal lumbar interbody fusion, and the clinical effects and postoperative complications were statistically analyzed. Results The follow-up period was (19.92±4.95) months. According to the Nakai criteria, 68 cases (41.72%) were excellent, 82 cases (50.31%) were good, 8 cases (4.91%) were fair, and 5 cases (3.07%) were poor. The excellent and good rate was 92.02% (150/163). The proportion of patients with poor surgical effects in patients with CEST was significantly higher than those in patients with other types of LDD (all P＜0.05), while there was no significant difference among other types (all P＞0.05). Conclusion According to the medical history and imaging data, it is helpful to determine the NFC of LDD before operation, so as to select appropriate surgical methods and achieve ideal results.

Abstract:Objective To evaluate the clinical significance of plasma exosomal vacuolar protein sorting-associated protein 37C (VPS37C) combined with serum tumor markers carbohydrate antigen 125 (CA125) and alkaline phosphatase (ALP) in distinguishing patients with metastatic colorectal cancer (mCRC) or non-metastatic colorectal cancer (nmCRC). Methods A total of 85 patients who were diagnosed with colorectal cancer through pathology and imaging in Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from Dec. 2020 to Sep. 2022 were selected, including 46 patients with nmCRC and 39 with mCRC. Another 17 volunteers who underwent physical examination in Shuguang Hospital, Shanghai University of Traditional Chinese Medicine during the same period were selected as healthy controls. The exosomes isolated from circulating plasma were identified by transmission electron microscopy and Western blotting. The levels of plasma exosomal VPS37C, serum CA125 and ALP were detected, and the clinical diagnostic efficacies of these 3 indicators alone or in combination for mCRC were analyzed using receiver operating characteristic curves. Results The levels of plasma exosomal VPS37C, serum CA125 and ALP were increased in the mCRC patients (P＜0.05, P＜0.01). The expression of the 3 indicators in colorectal cancer TNM stage Ⅳ patients was higher than that in TNM stage 0-Ⅲ patients (P＜0.05, P＜0.01). The diagnostic efficacy of the combination of the 2 or 3 indicators for mCRC was higher than that of any single indicator. The combination of the 3 indicators had the best diagnostic efficacy, with a specificity of 90.91%, an accuracy of 78.69%, and an area under curve of 0.813 9 (95% confidence interval 0.697 0-0.930 7, P＜0.000 1). Conclusion Circulating plasma exosomal VPS37C may be a valuable diagnostic marker for mCRC, and its combination with serum CA125 and ALP has better clinical diagnostic value.

Abstract:Objective To summarize the surgical treatment experience of malignant penile tumors and analyze the postoperative complications and prognosis. Methods A total of 50 penile cancer patients treated in our hospital from Jan. 2015 to Dec. 2020 were retrospectively selected. The following indicators were analyzed: age, disease course, radiological examinations, surgical approaches, pathological findings, prognosis, postoperative follow-up time and outcomes, complications and their management, as well as survival status during the follow-up. Results Among the 50 patients, 46 patients underwent partial penectomy for penile cancer. Total penectomy with perineal urethrostomy were performed in 4 cases. Nineteen patients underwent lymph node dissection at the same time: 6 patients underwent bilateral modified inguinal lymphadenectomy, 7 patients underwent bilateral standard inguinal lymphadenectomy, and 6 patients underwent bilateral ilioinguinal lymphadenectomy. Postoperative pathology showed 43 cases of squamous cell carcinoma (including 19 cases with high differentiation, 23 cases with medium differentiation, and 1 case with low differentiation), 4 cases of verrucous carcinoma, 2 cases of warty carcinoma, and 1 case of squamous epithelial papilloma. The patients were regularly followed up for 3-70 months, with a median of 36.50 (25.25, 52.50) months. Ten patients experienced postoperative complications (incuding 3 cases of urethral stenosis, 1 cases of penile incision infection, 2 cases of groin incision necrosis with infection, and 4 cases of lymphedema). During the follow-up period, 5 patients died, while the rest survived well. Conclusion For patients with penile cancer, reasonable choice of surgical procedures for the resection of tumor and reasonable choice of inguinal lymph node dissection time and method according to the indications can significantly improve the survival rate and reduce complications.

Abstract:Enhanced type Ⅰ interferon (IFN-Ⅰ) signaling pathway is observed in the setting of viral infections, autoimmune abnormality, type 1 interferonopathies, etc. All these IFN-Ⅰ-related disorders can cause renal dysfunction and share common histopathological features. The underlying mechanism lies in that IFN-Ⅰ can mediate kidney injury either by directly damaging several renal cell types (including podocytes, mesangial, endothelial and parietal epithelial cells) or promoting immune-mediated glomerular injury. This emerging spectrum of kidney diseases is defined as IFN-Ⅰ-related kidney disorders. This paper reviews the pathogenesis, etiological classification, histopathological characteristics, and diagnosis and treatment of the diseases.

Abstract:Liposomal bupivacaine exparel is currently the only local anesthetic sustained-release preparation on the market. It has been approved for single-dose infiltration and interscalene brachial plexus block in adults. With the development of regional anesthesia, off-label use of exparel is gradually increasing. This article reviews the application of exparel in trunk nerve block, peripheral nerve block and intraspinal anesthesia in recent years, evaluates its safety and effectiveness, and pays attention to researches about the application of exparel in special population.

Abstract:With the gradual extension of the survival time of cancer patients, how to preserve the fertility of male cancer patients has received increasing attention. Due to the characteristics of spermatogenesis and sperm maturation, the fertility of male cancer patients is affected by many factors such as cancer itself and treatment methods. This paper mainly summarizes the process of spermatogenesis, the influence of cancer itself and related treatments on spermatogenesis, and discusses the related measures for male fertility preservation.

Abstract:In modern warfare, combat stress reaction (CSR) is a prominent problem for non-combat attrition, which even has evolved into a means of psychological warfare by the enemy. Due to constant update of combat mode and strategic tactics, training of daily psychological resilience and adjustment skills, psychological assessment and intervention in war time, and prevention and treatment of severe post-war mental disorders all need long-term research. This paper reviews the concept, classification and risk factors of CSR, sets up a basic framework of CSR intervention (including “battle mobilization-battlefield treatment-post-war intervention”) and key points of brief psychological first aid assessment for CSR personnel in war time based on the principles of PIE (proximity, immediacy, expectancy) and characteristics of our military health services and rescue skills, and puts forward further detailed coping strategies and technical research directions, with a view to promote the early prevention, scientific classification, early intervention and comprehensive rehabilitation of CSR, so as to provide new ideas and methods for our battlefield treatment.

Abstract:Objective To investigate the staphylococcal chromosome cassette mec (SCCmec) typing and drug susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) clinically isolated in Hefei, so as to understand the drug resistance phenotypic and genotypic characteristics of MRSA epidemic strains in this region. Methods Totally 264 non-replicated MRSA strains were randomly selected from 5 teaching hospitals from Jan. 2016 to Dec. 2021. MRSA was screened by cefoxitin disk diffusion method, mecA gene was amplified by polymerase chain reaction (PCR), and SCCmec typing of MRSA was performed by multiplex PCR. Software WHONET 5.6 was used to analyze the antimicrobial susceptibility of MRSA strains of different SCCmec types. Results Among the 264 MRSA strains, 156 strains (59.1%) were SCCmec type Ⅱ, 92 strains (34.8%) were type Ⅳa, 4 strains (1.5%) were type Ⅲ, and 12 strains (4.5%) were untyped. The sensitivities of SCCmec type Ⅱ and type Ⅳa MRSA to daptomycin, tigecycline, linezolid and vancomycin were all 100.0%. The resistance of SCCmec type Ⅱ MRSA to ciprofloxacin, levofloxacin, moxifloxacin and gentamicin was significantly higher than that of SCCmec type Ⅳa MRSA (all P＜0.05). There was no significant difference in the resistance of different types of MRSA strains to erythromycin, clindamycin, tetracycline, sulfamethoxazole, or rifampicin (all P＞0.05). Conclusion The SCCmec typing of MRSA strains in Hefei is dominated by types Ⅱ and Ⅳa. There is some variation in the resistance of MRSA to certain antimicrobial drugs by genotype, and dynamic monitoring of the typing and drug susceptibility of this group of bacteria is of clinical interest.

Abstract:Objective To explore the clinical significance of combined detection of serum endothelial cell-specific molecule 1 (ESM-1) and procalcitonin (PCT) in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) caused by bacterial infection. Methods A total of 200 AECOPD patients who were hospitalized in Department of Respiratory Medicine, Tinglin Hospital, Jinshan District, Shanghai from Jan. 2019 to Dec. 2021 were selected. They were divided into 2 groups based on the sputum culture reports: bacterial-infected group (n＝113) and non-bacterial-infected group (n＝87). As a control group, 100 volunteers who underwent health examination in Tinglin Hospital, Jinshan District, Shanghai during the same period were selected. The levels of serum ESM-1 and PCT in each group were detected by enzyme-linked immunosorbent assay. The diagnostic value of serum ESM-1 and PCT alone or in combination for AECOPD with bacterial infection was evaluated by receiver operating characteristic curves. Results Before the anti-infection treatment, the levels of serum ESM-1 and PCT in the AECOPD bacterial-infected group were significantly higher than those in the AECOPD non-bacterial-infected group and healthy control group (all P＜0.05). After the antibiotic treatment, the expression levels of serum ESM-1 and PCT in the AECOPD bacterial-infected group were significantly decreased (both P＜0.05). The area under curve (AUC) values of serum ESM-1 and PCT alone in the diagnosis of AECOPD with bacterial infection were 0.902 and 0.828, respectively. The optimal critical value of ESM-1 was 1.326 μg/L, and the sensitivity and specificity in the diagnosis of AECOPD with bacterial infection were 0.836 and 0.842, respectively. The optimal critical value of PCT was 0.246 μg/L, and the sensitivity and specificity were 0.542 and 0.982, respectively. The best performance was achieved in the combination diagnosis with an AUC of 0.953, a sensitivity of 0.886, and a specificity of 0.952. Conclusion The levels of serum ESM-1 and PCT are increased in AECOPD patients with bacterial infection. The detection of serum ESM-1 combined with PCT has potential clinical value in improving the diagnosis rate of bacterial infection.

Abstract:Objective To investigate the correlations of the formation and stable classification of carotid atherosclerotic plaque with triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio and small and dense low-density lipoprotein cholesterol (sdLDL-C) in the elderly people with normal low-density lipoprotein cholesterol (LDL-C) level. Methods General and serological data of the elderly people with age≥65 years old and LDL-C＜3.40 mmol/L, who came to our hospital from May 2021 to May 2022, were retrospectively analyzed. According to the presence or absence of carotid plaque, the patients were divided into non-plaque group (57 cases) and plaque group (131 cases). According to the results of ultrasonic superb micro-vascular imaging (SMI), the plaque group was further divided into neovascularization group (unstable plaque group, 77 cases) and non-neovascularization group (stable plaque group, 54 cases). To further analyze the serological risk factors of carotid atherosclerotic plaque formation and neovascularization in plaque, SMI grading was conducted for neovascularization in plaque. Results TG/HDL-C ratio and HDL-C and sdLDL-C levels were significantly different among the non-plaque group, neovascularization group and non-neovascularization group (all P＜0.05). In the plaque group, the plaque thickness and sdLDL-C level of patients with SMI grade 0, SMI grade 1 and SMI grade 2 increased in turn, and the differences among the 3 SMI grades were statistically significant (both P＜0.01). Spearman rank correlation analysis showed positive correlations of SMI grade of carotid plaque with plaque thickness and sdLDL-C level in the elderly people with normal LDL-C level (r＝0.758, P＜0.01; r＝0.676, P＜0.05). When the plaque thickness, sdLDL-C, HDL-C and TG/HDL-C ratio were used as independent variables and the plaque SMI grade was used as a dependent variable for linear regression analysis, the results showed that plaque thickness and sdLDL-C were risk factors for plaque SMI grade (b＝0.779, P＜0.001; b＝0.436, P＜0.05). Conclusion HDL-C, TG/HDL-C ratio and sdLDL-C are related to the formation of carotid plaque in the elderly people with normal LDL-C level. Plaque thickness and sdLDL-C level are risk factors for neovascularization and plaque stability.

Abstract:Objective To report the reference values of spine and pelvis parameters in the normal population by analyzing the sagittal parameters in different age groups, and to explore the impact factors of maximal thoracic kyphosis (max TK) in different age groups. Methods A total of 191 asymptomatic healthy volunteers who took standing full spine anteroposterior and lateral X-rays at Center of Physical Examination, Affiliated Hospital of Shaoxing University of Arts and Sciences (101 volunteers) and The First Affiliated Hospital of Naval Medical University (Second Military Medical University) (90 volunteers) from Jan. 2015 to Jan. 2018 were enrolled. Demographic statistical data and sagittal imaging parameters of spine and pelvis were collected. The volunteers were divided into age≤40 years old group and age＞40 years old group, the sagittal parameters of different age groups were compared and analyzed, and the influencing factors of max TK in different age groups were analyzed. Results There were 94 volunteers in the age≤40 years old group with an average age of (28.5±6.4) years old, and 97 volunteers in the age＞40 years old group with an average age of (53.9±8.3) years old. In the 2 different age groups, there were significant differences in T₁ vertebral tilt (T₁ tilt; 18.6°±6.5° vs 20.6°±5.5°, P＝0.023), thoracic lower end vertebral angle (TVA; 15.3°±5.3° vs 17.5°±6.6°, P＝0.013), max TK (33.9°±8.3° vs 38.0°±9.4°, P＜0.001), maximal lumbar lordosis (max LL)-max TK (16.0° ［－9.0°-33.0°］ vs 12.0° ［－6.0°-41.0°］, P＝0.010), and sagittal vertical axis (SVA; －7.5 ［－58.0-48.0］ mm vs 9.0 ［－53.0-49.0］ mm, P＝0.005). T₁ tilt, TVA, max LL and sacral slope were positively correlated with max TK in the age≤40 years old group (all P＜0.01); age, T₁ tilt, TVA and max LL were positively correlated with max TK in the age＞40 years old group (all P＜0.01), while pelvic incidence was negatively correlated with max TK (P＜0.05). Conclusion Max TK shows a uniform increasing trend with age; especially in the population over 40 years old, max TK is positively correlated with age. The pelvic compensation for max TK changes shows different patterns at different age stages.

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