Postoperative cognitive dysfunction(POCD)is the common postoperative complications in elderly patients,significantly affects their postoperative recovery and quality of life.With the intensification of population aging,how to effectively prevent and treat POCD has become an important topic in clinical re-search.Esketamine(ISLAT)serves as a new anesthetic drug and its potential in improving postoperative cog-nitive function has gradually attracted people's attention.Previous studies have shown that that esketamine can not only alleviate postoperative pain,but may also protect the neurons and reduce the incidence of POCD in elderly patients by regulating the balance of neurotransmitters and reducing inflammatory responses,and has potential clinical application value.However,the researches on the specific mechanisms of action and relat-ed signaling pathways of esketamine is still limited and requires further exploration.This article aims to inves-tigate the role of esketamine in reducing POCD in elderly patients and its related signaling pathway,clarifies the clinical usage strategy and precautions to provide a theoretical basis for clinical application.

Objective Through a non-inferiority trial design,to verify whether the efficacy of transcuta-neous electrical acupoint stimulation(TEAS)in intervening with nausea and vomiting after painless gastros-copy and colonoscopy was not inferior to that of ondansetron,and evaluate its effect on patient recovery.Meth-ods A total of 112 patients who experienced nausea and vomiting after painless gastroscopy and colonoscopy in the gastroscopy and colonoscopy center of the hospital from March 2022 to March 2023 were selected as the research subjects,and divided into the TEAS group(n=56)and the control group(n=56)according to the random number table method.The TEAS group received TEAS intervention,while the control group received ondansetron hydrochloride injection intervention.The non-inferiority margin was set at 10.0％.The interven-tion effective rate of nausea and vomiting after examination,as well as heart rate,blood pressure,length of stay,satisfaction,and visual analogue score(VAS)were compared between the two groups.Results The in-tervention effective rate of the TEAS group was close to that of the control group[82.4％(46/56)vs.80.4％(45/56)],risk difference(RD)=2.0％(95％CI:-9.8％to 13.8％),the lower limit of 95％CI(-9.8％)was higher than the preset cut-off value(-10.0％),and non-inferiority was established(P=0.032).Com-pared with before the examination,the heart rates of the two groups were slower,and the levels of systolic blood pressure(SEP)and diastolic blood pressure(DBP)were lower during the examination,and the differ-ences were statistically significant(P＜0.05).There was no statistically significant difference in the two groups of heart rate,SBP,DBP,length of stay[(69.9±14.2)min vs.(75.3±22.8)min],satisfaction score(9.8±0.6 vs.9.2±2.0),VAS(1.5±0.5 vs.2.1±0.5,P＞0.05).Conclusion The efficacy of TEAS in in-tervening with nausea and vomiting after painless gastroscopy and colonoscopy is not inferior to that of ondan-setron.

Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.

The aortic dissection is a critical emergency in cardiovascular surgery and can be classified as Stanford type A and type B aortic dissection depending on whether the ascending aorta is involved. Currently, the mainstream treatment option for type A aortic dissection is open surgery, while type B dissection can be treated by interventional therapy, open surgery, or optimal medical therapy depending on the situation. However, regardless of the treatment option, it is difficult to resolve all the problems at once. As a result, residual aortic dissection is commonly found in patients with aortic dissection. This article will review the hot issues of aortic remodeling in terms of the definition, prognosis, and risk factors.

Objective To analyze the development status of intelligent pharmaceutical services for traditional Chinese medicine,to summarize the practical experience of intelligent pharmaceutical services for traditional Chinese medicine,and to explore its technical requirements and development direction.Methods The Affiliated Hospital of Chengdu University of traditional Chinese medicine launched the Smart Traditional Chinese Medicine Room project in January 2018 and established a Smart Traditional Chinese Medicine Pharmacy to undertake pharmaceutical services such as outpatient dispensing,decoction,and distribution of traditional Chinese medicine decoction pieces.Results A total of 5.572 million pairs of traditional Chinese medicine decoction pieces were delivered until May 2023,and 231 400 patients were served in 2022.The service process was more straightforward;there was no need to wait for medication or go to the hospital again.The service efficiency was high,improving the patient's medical experience.Conclusions Intelligent pharmaceutical services for traditional Chinese medicine are developing rapidly.A comprehensive intelligent service system will be established based on technological progress in the future.

Objective To investigate the expression of neutrophil extracellular traps (NETs) and phagocytic function in the peripheral blood of patients with hepatic alveolar echinococcosis (HAE), and to examine their correlations with clinical inflamma tory indicators and liver functions. Methods A total of 50 patients with HAE admitted to Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qinghai University from August 2022 to June 2023 were enrolled, while 50 age- and gender-matched healthy individuals from the Centre for Healthy Examinations of the hospital during the same period served as controls. The levels of NETs markers neutrophil myeloperoxidase (MPO) and neutrophil elastase (NE) were measured using enzyme-linked immunosorbent assay (ELISA). Peripheral blood neutrophils were isolated using density gradient centrifugation, stimulated in vitro using phorbol 12-myristate 13 acetate (PMA), and the levels of MPO and citrullination histone H3 (CitH3) released by neutrophils were quantified using flow cytometry. The phagocytic functions of neutrophils were examined using flow cytometry. In addition, the correlations of MPO and NE levels with clinical inflammatory indicators and liver biochemical indicators were examined using Spearman correlation analysis among HAE patients. Results The peripheral blood plasma MPO［(417.15 ± 76.08) ng/mL vs. (255.70 ± 80.84) ng/mL; t = 10.28, P < 0.05］, NE［(23.16 ± 6.75) ng/mL vs. (11.92 ± 3.17) ng/mL; t = 10.65, P < 0.05］and CitH3 levels［(33.93 ± 18.93) ng/mL vs. (19.52 ± 13.89) ng/mL; t = 4.34, P < 0.05］were all significantly higher among HAE patients than among healthy controls, and a lower phagocytosis rate of neutrophils was detected among HAE patients than among healthy controls［(70.85 ± 7.32)% vs. (94.04 ± 3.90)%; t = 20.18, P < 0.05］, and the ability to produce NETs by neutrophils was higher among HAE patients than among healthy controls following in vitro PMA stimulation. Pearson correlation analysis showed that the phagocytosis rate of neutrophils correlated negatively with platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6) level and C-reactive protein (CRP) level (r_s = −0.515 to −0.392, all P values < 0.05), and the MPO and NE levels positively correlated with inflammatory markers NLR, PLR, CRP and IL-6 (r_s = 0.333 to 0.445, all P values < 0.05) and clinical liver biochemical indicators aspartic transaminase, alanine aminotransferase, direct bilirubin and total bilirubin among HAE patients (r_s = 0.290 to 0.628, all P values < 0.001). Conclusions Excessive formation of NETs is found among HAE patients, which affects the phagocytic ability of neutrophils and results in elevated levels of inflammatory indicators. NETs markers may be promising novel biomarkers for early diagnosis, monitoring, and severity assessment of liver disease.

Objective To explore the effectiveness and safety of guiding painless gastroscopic entry with plica aryepiglottica movement as the mark.Methods A total of 200 patients with elective painless gas-troscopic examination from January 2022 to August 2022 were selected,92 males and 108 female,aged 18-60 years old,BMI 18-30 kg/m2 and ASA grade Ⅰ-Ⅲ.The patients were divided into the two groups:the con-trol group (group C) and observation group (group O) by adopting the random number table method,100 ca-ses in each group.The disappearance of eyelash reflex in the group C served as the entry timing of gastrosco-py,while the plica aryepiglottica non-movement under the gastroscopic view in the group O served as the en-try timing of gastroscopy.The bispectral index (BIS) value during gastroscopic operation persistently main-tained 40-60.The main observation indicators were the adverse reactions caused by gastroscopic operation (body movement reactions,bucking,hiccup,laryngeal spasm,etc.),and the secondary observation indicators were:general data of the two groups,SpO2,HR,SBP and DBP values after entering the room (T0),at the en-try time of gastroscopy (T1),3 min after gastroscopic entry (T2),6 min after gastroscopic entry (T3) and at the time of gastroscopic retraction (T4),and the time of medication to gastroscopy,gastroscopic operation time and intraoperative medication supplementation.Results A total of 192 cases were ultimately included,99 cases in the group C and 93 cases in the group O.There was no statistically significant difference in general da-ta between the two groups (P>0.05);compared with the group C,the use amount of cyclophosphamide dur-ing anesthesia induction in the group O was increased (P<0.05).Compared with the group C,the incidence rates of body movement reaction,bucking,hiccup and total adverse reactions in the group O were decreased (P<0.05);SpO2,HR,SBP and DBP at different time points had no statistically significant differences be-tween the two groups (P>0.05).Conclusion Using the glottic movement as the marker to guide the pain-less gastroscopy entry is effective and safe,and could reduce the adverse reactions such as body movement re-action,bucking and hiccup caused by gastroscopic entry.Observing the plica aryepiglottica movement in the gastrocopic entry operation is simple and easy to perform,which could serve an objective gastroscopic entry timing mark and is worth promoting and using in clinic.

Objective To identify meaningful objective examination methods by analyzing the results of vari-ous objective examinations of children with recurrent vertigo(RVC).Methods Fifty children with RVC(29 in ver-tigo attacking group,21 in vertigo non-attacking group)and 20 children without RVC were selected.All partici-pants underwent a series of relevant objective examinations,the results of each examination were statistically ana-lyzed and the characteristic differences of each examination between the RVC group and the control group were ob-tained.Results ① The abnormal rate of sleep SpO2,high stimulation rate ABR and AHI in the RVC group were significantly higher than those in the control group(P＜0.05).② The abnormal rate of sleep SpO2 and high stimu-lation rate ABR in the vertigo attacking group were higher than those in the vertigo non-attacking group.There was a statistical difference between the two groups(P＜0.05).③ Pure tone audiometry(or conditioned play audiome-try),acoustic immittance,cranial MRI,positional test and vHIT were normal in both RVC group and normal con-trol group.Conclusion Continuous sleep SpO2 and high stimulation rate ABR are correlated with RVC,especially RVC during vertigo attacking.AHI is correlated with RVC,but not with the onset of vertigo.Clinically,continu-ous sleep SpO2 monitoring,PSG and high stimulation rate ABR can be used as auxiliary examinations for the diagno-sis of RVC.

Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.

This experiment aims to investigate the effects of a dietary supplement of herbal tea resi-due on white feather broilers in the prospectives of growth performance,serum indexes and intesti-nal immune indexes.A total of 280 1-day-old white feather broilers with similar body mass and good health were randomly divided into 4 groups with 5 replicates per group and 14 birds per repli-cate.Group Ⅰ(control group)was fed a basal diet.Groups Ⅱ,Ⅲ and Ⅳ were fed a diet supple-mented with 2％,4％and 6％herbal tea residue powder,respectively.The feeding lasted for 49 days,and was divided into 2 phases from 1 to 21 days of age and 22 to 49 days of age.Blood,tissue and mucosa of the duodenum and jejunum were collected on 21 d and 49 d.Total cholesterol(T-CHO),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and the activities of aspartate aminotransferase(AST)and alanine amin-otransferase(ALT)in the serum were examined.The villus height and crypt depth of the jejunum were observed and measured by morphology.The mRNA expression levels of intestinal interleukin-1β(IL-1β),interleukin-2(IL-2),interleukin-4(IL-4),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)were determined by qPCR.The results showed that compared with group Ⅰ,the mass of group Ⅲ on 21 d and 49 d significantly increased(P＜0.05).The average daily feed intake of 22-49 d and 1-49 d significantly increased(P＜0.05).The average daily mass gain of 1-21 d,22-49 d and 1-49 d significantly increased(P＜0.05).In the serum of 21 d,compared with group Ⅰ,T-CHO in group Ⅱ significantly decreased(P＜0.05).TG in groups Ⅱ,m and Ⅳ significantly de-creased(P＜0.05).LDL-C and AST activity in group Ⅳ significantly decreased(P＜0.05).In the serum of 49 d,T-CHO in group Ⅲ,LDL-C in group Ⅳ,HDL-C of groups Ⅲ and Ⅳ significantly increased(P＜0.05),and the ALT activity of these two groups decreased(P＜0.05).AST activity in group Ⅱ significantly decreased(P＜0.05).In the duodenum of 21 d,compared with group Ⅰ,the expressions of TNF-α in group Ⅱ was significantly decreased(P＜0.05).In the duodenum of 49 d,the expression of IL-10 in group Ⅱ was significantly increased(P＜0.05),and the expression of IL-2 in groups Ⅲ and Ⅳ was significantly decreased(P＜0.05).In the jejunum of 49 d,the ex-pression of IL-10 in group Ⅱ was increased(P＜0.05),and the expression of IL-2 in groups Ⅲand Ⅳ was significantly decreased(P＜0.05).In conclusion,dietary herbal tea residue can regulate circulating lipid level and enhance intestinal immunity of white feather broilers without affecting their normal growth performance.This experiment also suggested that the a 2％-4％supplementa-tion of herbal tea residues to white feather broilers was of good effect.