Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Objective:To observe the morphological characteristics of urogenital hiatus in patients with gestational diabetes mellitus (GDM) after vaginal delivery.Methods:This study included 192 pregnant patients from Henan Provincial People′s Hospital who met the conditions between Jan.2020 and Aug.2021. All participants were screened for GDM by oral glucose tolerance test (OGTT) or fasting blood glucose at 24-28 weeks of pregnancy, and were divided into GDM group (34 cases) and non-GDM group (158 cases) based on the presence or absence of GDM. All participants underwent pelvic floor ultrasonography at the first trimester (6-8 gestational weeks), 3 days postpartum, 6 weeks postpartum, 6 months postpartum, and 1 year postpartum. Area of urogenital hiatus (AUH), transversal diameter of urogenital hiatus (TDUH) and anteroposterior diameter of urogenital hiatus (APDUH) were measured using Smart Pelvic. The Logistic regression model was used to calculate and match the propensity score between the GDM group and the non-GDM group.Results:In the non-GDM group, TDUH during rest maneuver at 6 weeks postpartum( P=0.319), the indicators during rest and contract maneuver at 6 months postpartum( P=0.586, 0.877, 0.164, 0.226, 0.465, 0.097), and TDUH during tension maneuver at 1 year postpartum( P=0.643) returned to the level of early pregnancy. In the GDM group, the indicators during rest maneuver and TDUH during contract maneuver at 6 months postpartum recovered to the level of early pregnancy ( P=0.647, 0.584, 0.376, 0.440), while APDUH and AUH during contract maneuver ( F=7.784, 9.785; P=0.005, <0.001) and the indicators during tension maneuver at 1 year postpartum( F=15.343, 11.974, 17.981; P<0.001) did not recover to the level of early pregnancy. After propensity score matching, APDUH and AUH during tension maneuver at 1 year postpartum in the GDM group were significantly greater than those in the non-GDM group( t=2.810, 2.926; P=0.006, 0.004). Conclusions:The pelvic floor muscles of GDM patients after vaginal delivery are more severely damaged, and the recovery speed is slower. Pelvic floor muscle exercise during pregnancy and enhanced postpartum follow-up are needed to prevent, diagnose and treat pelvic floor dysfunction early.

Objective:To observe pelvic floor muscle′s contraction in women with the second and full term natural parturition by intelligent ultrasonic examination.Methods:Ninety-five postpartum women who underwent natural parturition and post-partum check (6-9 weeks after delivery) in Henan Provincal People′s Hospital were recruited in this study from Jul to Dec 2018. Fifty-four puerpera were first parturition and 41 were second parturition. The morphology of urogenital hiatus was observed during both rest and contract maneuver by real-time 3D ultrasound. Several parameters were measured by intelligent ultrasound, such as hiatal area, anteroposterior diameter, transverse diameter, and the thickness of puborectalis muscles, and the D-values of all parameters were calculated in different maneuver. Meanwhile, the strength of pelvic muscle in two groups were measured and the ultrasonic diameters and muscle strength were compared.Results:The hiatal area, anteroposterior diameter, transverse diameter, and the thickness of bilateral puborectalis muscles between first natural parturition and second natural parturition during rest maneuver were (15.92±2.76)cm 2 vs (16.65±2.63)cm 2, (40.93±5.63)mm vs (40.27±6.21)mm, (55.54±6.05)mm vs (57.92±5.27)mm, (7.03±1.51)mm vs (7.44±1.23)mm, (7.49±1.44)mm vs (7.44±1.44)mm, there was no statistical difference( P>0.05). During contract maneuver, these data were (11.76±2.62)cm 2 vs (12.09±2.78)cm 2, (37.57±5.46)mm vs (37.18±4.71)mm, (42.21±5.69)mm vs (43.03±7.13)mm, (8.92±1.54)mm vs (8.87±1.23)mm, (8.90±1.60)mm vs (9.30±2.71)mm, there was no statistical difference( P>0.05). The D-values of all diameters were (4.16±2.38)cm 2 vs (4.43±2.70)cm 2, 3(1.00, 5.00)mm vs 1(1.00, 5.25)mm, (13.33±6.07)mm vs (14.41±6.54)mm, (1.90±1.78)mm vs (1.68±1.31)mm, 1(0.48, 2.40)mm vs 1.25(0.20, 2.13)mm, there was no statistically significant difference between two groups ( P>0.05). The non-eligibility rate of typeⅠmuscle fiber strength in two groups were 65% vs 68%(35 vs 28) and typeⅡmuscle fiber strength were 74% vs 79%(40 vs 32), there was no statistically difference between two groups ( P>0.05). Conclusions:In comparison to the primary and full term natural parturition women, there is no significant reduction of the pelvic floor muscle′s contraction by intelligent ultrasund in second and full term natural parturition women without abnormal pregancy history and complications. This could provide theoretical basis for the choice of the mode of second parturition and the rahabilitation of postpartum.

Objective To investigate the diagnostic parameters,criteria and diagnostic value of pelvic floor ultrasound in female stress urinary incontinence(SUI).Methods Simple factor logistic regression analysis was used to compare the difference of ultrasonic parameters between SUI patients(260 cases) and asymptomatic subjects(60 cases) to find the relevant diagnostic indexes,and to evaluate the diagnostic criteria and diagnostic value by the ROC curve.Results There were significant differences in urethral inclination angle and levator hiatus area in resting and bladder neck position,bladder position,urethral inclination angle,retrovesical angle,levator hiatus area in Valsalva state and urethral rotation angle,bladder neck mobility between the two groups (all P ＜ 0.05).There was no significant difference in age,BMI,bladder neck position,bladder position,retrovesical angle between resting in the two groups (all P ＞0.05).Using the ROC curve analysis,the cut-off points of urethral inclination angle and levator hiatus area in resting,bladder neck and bladder position,urethral inclination angle,retrovesical angle,levator hiatus area in Valsalva,bladder neck mobility and urethra rotation angle to diagnose SUI were 16.5°,13.5 cm2,3.5 mm,0.5 mm,29.5°,139.5°,19.5 cm2,24.5 mm,45.5°,respectively.The sensitivity/specificity were 54.6％/66.7％,49.2％/80.0％,68.1％/95.0％,64.2％/98.3％,67.3％/93.3％,73.5％/50.0％,68.8％/81.7％,70.0％/95.0％,67.2％/85.0％,respectively.The area under the curve were 0.625,0.668,0.855,0.854,0.817,0.622,0.811,0.866,0.817,respectively.Conclusions Pelvic floor ultrasound is a better way to diagnose stress urinary incontinence,and it provides an objective basis for the diagnosis of SUI.