Frailty,a multisystem syndrome in which the decrease of physiological reserve leads to the decrease of anti-stress ability,is highly prevalent among the elderly and is closely associated with ad-verse outcomes in surgical patients.Therefore,it is necessary for anesthesiologists to evaluate frailty during perioperative period.However,how to quantify frailty quickly,accurately,and objectively remains a chal-lenge.As the importance of muscle changes in the pathophysiological changes of frailty has been gradually revealed,bedside muscle ultrasound has attracted widespread attention in the assessment of weakness.This article introduces the parameters of bedside muscle ultrasoundand,the selection of parameters,and muscles for the assessment of frailty in elderly patients,which is expected to provide reference for anesthesiologists in assessing frailty during the perioperative period.

Intensive cancer treatment with drug combination is widely exploited in the clinic but suffers from inconsistent pharmacokinetics among different therapeutic agents.To overcome it,the emerging nanomedicine offers an unparalleled opportunity for encapsulating multiple drugs in a nano-carrier.Herein,a two-step super-assembled strategy was performed to unify the pharmacokinetics of a pep-tide and a small molecular compound.In this proof-of-concept study,the bioinformatics analysis firstly revealed the potential synergies towards hepatoma therapy for the associative inhibition of exportin 1(XPO1)and ataxia telangiectasia mutated-Rad3-related(ATR),and then a super-assembled nano-pill(gold nano drug carrier loaded AZD6738 and 97-110 amino acids of apoptin(AP)(AA@G))was con-structed through camouflaging AZD6738(ATR small-molecule inhibitor)-binding human serum albumin onto the AP-Au supramolecular nanoparticle.As expected,both in vitro and in vivo experiment results verified that the AA@G possessed extraordinary biocompatibility and enhanced therapeutic effect through inducing cell cycle arrest,promoting DNA damage and inhibiting DNA repair of hepatoma cell.This work not only provides a co-delivery strategy for intensive liver cancer treatment with the clinical translational potential,but develops a common approach to unify the pharmacokinetics of peptide and small-molecular compounds,thereby extending the scope of drugs for developing the advanced com-bination therapy.

Objective: To investigate the correlation between mandibular condyle volume and external ear volume in M2a type of hemifacial microsomia. Methods: 19 patients with M2a type of hemifacial microsomia diagnosed by CT scan in the Shanghai Ninth People′s Hospital from August 2017 to December 2018 were included, and the head CT data were obtained. At the same time, 19 healthy people were recruited as volunteers and obtain CT data of their heads as control. The Mimics 15.0 software was used for 3D reconstruction of CT data, measure the volume of mandibular condyle and external ear. SPSS 25.0 software was used to analyze the correlation between mandibular volume and external ear volume, as well as the difference between bilateral mandibular condyle volume (healthy side mandibular condyle volume-affected side mandibular condyle volume) and bilateral external ear volume difference (healthy side external ear volume-affected side external ear volume), and the correlation was obtained by spearman correlation coefficient analysis. P<0.05 indicates that the difference was statistically significant. Results: The data of 19 cases of M2a type of hemifacial microsomia and 19 healthy volunteers were analyzed. The left and right volume of bilateral mandibular condyle in healthy volunteers was (1 309.23±420.63) mm^3, (1 325.93±425.60) mm³(P=0.904), the left and right volume of external ear was (7 854.18±2 005.77) mm³, (7 862.63±1 994.02) mm³(P=0.990), bilateral development was synchronous, there was no statistical difference. There was a significant positive correlation between mandibular condyle volume and external ear volume in healthy volunteers (P=0.004, rs=0.772). The volume of healthy and affected mandibular condyle in the patients with M2a type of hemifacial microsomia was (1 160.89±549.07) mm^3, (509.55±303.88) mm³ (P=0.006), and the volume of healthy and affected external ear was (7 418.19±2 434.93) mm³and (2 029.99±1 080.37) mm³ (P=0.007). The development is not synchronized in the mandibular condyle and external ear in M2a type of hemifacial microsomia, but the mandibular condyle volume is significantly positively correlated with the external ear volume(healthy side: P=0.008, rs=0.740; affected side: P=0.004, rs=0.709), and the affected part of the mandibular condyle and the external ear development (the volume difference between the mandibular condyle or the external ear volume) also has the same performance(P=0.006, rs=0.753). Conclusions There is a significant positive correlation between mandibular condyle volume and external ear volume in patients with M2a type of hemifacial microsomia.

ObjectiveTo observe the effect of Buyang Huanwutang in treating diabetic peripheral neuropathy （DPN） by inhibiting pyroptosis through AMP-activated protein kinase （AMPK）/UNC-51-like kinase 1 （ULK1） mitophagy pathway. MethodSixty male SPF SD rats （6-7 weeks old） were used in animal experiments and numbered according to their body mass. They were then randomly divided into four groups by computer： normal group， model group， α-lipoic acid group（60 mg·kg^-1）， and Buyang Huanwutang group（15 g·kg^-1）， with 15 rats in each group. The diabetic model was established by injection of streptozocin （STZ）. After successful modeling， the α-lipoic acid group and the Buyang Huanwutang group were given corresponding drugs， and the normal group and the model group were given normal saline. Sensory nerve conduction velocity （SNCV） and paw withdrawal threshold （PWT） were measured at the end of administration for 12 weeks. Immunohistochemistry and Western blot were used to detect the expression of phosphorylated AMP activated protein kinase （p-AMPK）， phosphorylated UNC-51-like kinase 1 （p-ULK1）， protein involved in microtubule-associated protein 1 light chain 3 （LC3）， selective autophagy receptors （p62/SQSTM1）， Beclin1， NOD receptor protein structure domain-related proteins 3 （NLRP3）， Caspase-1 （Caspase-1）， and interleukin-1 beta （IL-1β） in dorsal root ganglia （DRG）. Immunofluorescence was used to detect the expression of the N-terminal gasdermin D （N-GSDMD）. ResultCompared with those in the normal group， rats in the model group had increased fasting blood glucose （P<0.01） and significantly reduced SNCV， PWT （P<0.01）， LC3Ⅱ/LC3Ⅰ， Beclin1， p-AMPK/AMPK， and p-ULK1/ULK1 （P<0.01）. In addition， p62， NLRP3， N-GSDMD/GSDMD， IL-1β， and cleaved Caspase-1/Caspase-1 were significantly increased （P<0.01）. Compared with those in the model group， SNCV and PWT were increased （P<0.01） in each administration group， and LC3Ⅱ/LC3Ⅰ， Beclin1， p-AMPK/AMPK， and p-ULK1/ULK1 were significantly increased （P<0.05， P<0.01）. p62， N-GSDMD/GSDMD， cleaved Caspase-1/Caspase-1， NLRP3， and IL-1β decreased （P<0.05， P<0.01）. Compared with the α-lipoic acid group， the Buyang Huanwutang group had significantly increased SNCV， PWT （P<0.05）， LC3Ⅱ/LC3Ⅰ， and p-ULK1/ULK1 （P<0.05） and significantly decreased NLRP3 and N-GSDMD/GSDMD （P<0.05）. ConclusionBuyang Huanwutang regulates mitophagy and inhibits pyroptosis through the AMPK/ULK1 pathway to prevent and treat DPN， and its therapeutic effect may be better than α-lipoic acid.