Background With the aging of China's population, cognitive impairment in the elderly is receiving increasing public attention. Screening and intervention of people with mild cognitive impairment (MCI) are of great significance to prevent and reduce the occurrence of cognitive impairment. Objective To understand the prevalence and explore potential influencing factors of MCI in the elderly in Songjiang District, Shanghai, and to provide scientific basis for promoting early screening of cognitive impairment and precise intervention of MCI in the elderly in this area. Methods A cross-sectional study design was adopted. From August to October 2022, using multi-stage random sampling, 1800 elderly residents aged 60 years and above were screened for cognitive impairment in 6 neighborhood/village committees in 6 towns in Songjiang District. The survey questionnaires included a sociodemographic questionnaire, a health status and lifestyle questionnaire, the Instrumental Activities of Daily Living (IADL), the Patient Health Questionnaire (PHQ-9), and the Mini-Mental State Examination (MMSE). Prevalence rates of MCI among the elderly by selected social demographic characteristics, health status, and lifestyle were estimated, and potential influencing factors of MCI were evaluated by binary logistic regression. Results A total of 209 elderly residents with MCI and 1591 healthy elderly residents were detected, and the prevalence of MCI in the elderly aged 60 and above was 11.6% in Songjiang District. Being physically active (OR=0.556, 95%CI: 0.399, 0.774) reduced the risk of MCI. Illiteracy (OR=1.810, 95%CI: 1.239, 2.644), primary school education level (OR=3.454, 95%CI: 2.342, 5.092), non-participation in social activities (OR=1.945, 95%CI: 1.360, 2.781), IADL damaged (OR=3.173, 95%CI: 2.137, 4.712), and depression (OR=1.957, 95%CI: 1.112, 3.443) increased the risk of MCI (P＜0.05). Conclusion The prevalence of MCI among the elderly in Songjiang District is lower than the national average. Educational level, physical activity, participation in social activities, IADL, and depression may be the influencing factors of MCI in the elderly. It is recommended to carry out early screening, early detection, and early intervention for cognitive impairment in the elderly. Improving involvement in physical exercise and increasing participation in social activities are encouraged. Special attention should be paid to the needs of vulnerable groups such as low education level and disabled elderly during a community MCI intervention program.

Objective:To investigate and compare the clinical outcomes of the arterial pre-occlusion technique(APOT) and the traditional technique in the surgery of locally advanced pancreatic cancer with arterial involvement after conversion therapy.Methods:This is a retrospective cohort study. The clinical data of 145 patients with locally advanced pancreatic cancer with arterial involvement admitted to the Department of Hepato-Biliary-Pancreatic Surgery of the First Hospital Affiliated to Naval Medical University,from January 2020 to December 2022 were retrospectively analyzed. All patients completed neoadjuvant therapy for tumors, and the feasibility of radical surgical treatment was determined by a multidisciplinary collaborative team evaluation before surgery. According to whether the intraoperative artery was pre-occluded, 145 patients were divided into two groups, including 28 cases in the APOT group(16 males, 12 females, aged (59.0±9.4) years), and 117 cases in the routine surgery group(76 males, 41 females, aged (55.1±8.2) years). To ensure comparability of baseline data between the APOT group and the routine surgery group, a 1∶2 match was performed using the propensity score matching method, and the caliper value was 0.006 45. The t-test,the Mann-Whitney U test, χ2 test or Fisher′s exact test were used to compare the data between the two groups,respectively. Results:After matching the propensity score,there were 28 cases in the APOT group and 56 cases in the routine surgery group. There were no significant differences in gender,age,preoperative comorbidities,preoperative body mass index,surgical approaches,chemotherapy regimen,stereotactic body radiation therapy ratio,tumor markers,and type of invaded artery between the two groups (all P>0.05).The arterial occlusion time M(IQR) in the APOT group was 7.0(3.8)minutes(range:3 to 15 minutes),and no ischemic manifestations were observed in the distal target organs that blocked blood vessels after surgery. The operation time was (170.3±57.7)minutes in the APOT group and (235.0±80.2)minutes in the routine surgery group,and the difference was statistically significant ( t=-3.800, P<0.01). The APOT group also experienced less intraoperative blood loss(650(588)ml vs. 800(600)ml; U=1 026.500, P=0.021). No significant differences were found between the groups in combined vein resection and reconstruction,celiac trunk resection,early postoperative complications, readmission rates at 30 days,and postoperative length of stay(all P>0.05). Extra-arterial dissection was performed in all patients,with arterial resection and reconstruction in 3 cases: 2 cases in the APOT group(1 case involving the superior mesenteric artery and 1 case involving the common hepatic artery) and 1 case in the routine group(involving the common hepatic artery). Postoperative abdominal bleeding occurred in 4 cases,with 3 cases in the routine group,1 case in the routine group. The R0 resection rate was 85.7%(24/28) in the APOT group and 80.4%(45/56) in the routine group,without significant differences between the groups( P=0.763). The median overall survival time was 27.6 months for the APOT group and 22.5 months for the routine group,while the median disease-free survival was 11.7 months and 16.8 months,respectively,with no significant differences between the two groups( P=0.532, P=0.927). Conclusion:The arterial pre-occlusion technique can be used for extra-arterial dissection in patients with locally advanced pancreatic cancer involving the arteries,reducing surgery time and intraoperative blood loss.

Objective:To investigate and compare the clinical outcomes of the arterial pre-occlusion technique(APOT) and the traditional technique in the surgery of locally advanced pancreatic cancer with arterial involvement after conversion therapy.Methods:This is a retrospective cohort study. The clinical data of 145 patients with locally advanced pancreatic cancer with arterial involvement admitted to the Department of Hepato-Biliary-Pancreatic Surgery of the First Hospital Affiliated to Naval Medical University,from January 2020 to December 2022 were retrospectively analyzed. All patients completed neoadjuvant therapy for tumors, and the feasibility of radical surgical treatment was determined by a multidisciplinary collaborative team evaluation before surgery. According to whether the intraoperative artery was pre-occluded, 145 patients were divided into two groups, including 28 cases in the APOT group(16 males, 12 females, aged (59.0±9.4) years), and 117 cases in the routine surgery group(76 males, 41 females, aged (55.1±8.2) years). To ensure comparability of baseline data between the APOT group and the routine surgery group, a 1∶2 match was performed using the propensity score matching method, and the caliper value was 0.006 45. The t-test,the Mann-Whitney U test, χ2 test or Fisher′s exact test were used to compare the data between the two groups,respectively. Results:After matching the propensity score,there were 28 cases in the APOT group and 56 cases in the routine surgery group. There were no significant differences in gender,age,preoperative comorbidities,preoperative body mass index,surgical approaches,chemotherapy regimen,stereotactic body radiation therapy ratio,tumor markers,and type of invaded artery between the two groups (all P>0.05).The arterial occlusion time M(IQR) in the APOT group was 7.0(3.8)minutes(range:3 to 15 minutes),and no ischemic manifestations were observed in the distal target organs that blocked blood vessels after surgery. The operation time was (170.3±57.7)minutes in the APOT group and (235.0±80.2)minutes in the routine surgery group,and the difference was statistically significant ( t=-3.800, P<0.01). The APOT group also experienced less intraoperative blood loss(650(588)ml vs. 800(600)ml; U=1 026.500, P=0.021). No significant differences were found between the groups in combined vein resection and reconstruction,celiac trunk resection,early postoperative complications, readmission rates at 30 days,and postoperative length of stay(all P>0.05). Extra-arterial dissection was performed in all patients,with arterial resection and reconstruction in 3 cases: 2 cases in the APOT group(1 case involving the superior mesenteric artery and 1 case involving the common hepatic artery) and 1 case in the routine group(involving the common hepatic artery). Postoperative abdominal bleeding occurred in 4 cases,with 3 cases in the routine group,1 case in the routine group. The R0 resection rate was 85.7%(24/28) in the APOT group and 80.4%(45/56) in the routine group,without significant differences between the groups( P=0.763). The median overall survival time was 27.6 months for the APOT group and 22.5 months for the routine group,while the median disease-free survival was 11.7 months and 16.8 months,respectively,with no significant differences between the two groups( P=0.532, P=0.927). Conclusion:The arterial pre-occlusion technique can be used for extra-arterial dissection in patients with locally advanced pancreatic cancer involving the arteries,reducing surgery time and intraoperative blood loss.

Objective:To investigate the effects of platycodon D on proliferation, apoptosis, migration and glycolysis of colorectal cancer HT-29 cell.Methods:Human HT-29 cells were selected and randomly divided into the control group and platycodon D 25, 50, and 100 μmol/L groups. The HT-29 cells in the platycodon D 25, 50, and 100 μmol/L groups were treated with 25, 50, and 100 μmol/L platycodon D for 48 h. The cell proliferation of the cells was examined by cell counting Kit-8 (CCK-8) and colony formation assay. The apoptosis of the cells was investigated using flow cytometry and Western Blot assays were used to examine the expression of apoptosis and apoptosis-related proteins, including B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), and cleaved cystein-asparate protease-3 (cleaved Caspase-3). Transwell and Western Blot assays were used to examine cell migration, glucose consumption, and lactic acid production, as well as the expression levels of pyruvate kinase M2 (PKM2) and phosphorylated PKM2 (p-PKM2) in HT-29 cells.Results:With the increase in treatment time, the proliferation rate of HT-29 cells in the control group and platycodon D 25, 50, and 100 μmol/L groups decreased gradually. Compared with the control group, the viability of HT-29 cells in the platycodon D 25, 50, and 100 μmol/L groups was decreased (all P < 0.001). Compared with the control group, the colony number of HT-29 cells in the platycodon D 25 μmol/L (36 vs. 50), 50 μmol/L (34 vs. 50), and 100 μmol/L (16 vs. 50) groups was decreased (all P < 0.001), after treatment with platycodon D for 24 h. Compared with the control group, the apoptosis rate of HT-29 cells in the platycodon D 100 μmol/L group was increased (62% vs. 39%), the relative expression of Bax was increased (0.9 vs. 0.1), the cleaved Caspase-3 was increased (1.25 vs. 0.15), and the Bcl-2 decreased (0.12 vs. 0.75) (all P < 0.001). Compared with the control group, the per unit vision number of HT-29 cells in the platycodon D 100 μmol/L group decreased (16 vs. 48), the relative expression of Snail decreased (0.5 vs. 1.3), the relative expression of E-cadherin increased (1.2 vs. 0.1), the relative expression of glucose transporter 1 (GLUT1) decreased (0.2 vs. 1.1), the relative expression of lactate dehydrogenase A (LDHA) decreased (0.2 vs. 1.2), and the relative expression of hexokinase 2 (HK2) decreased (0.15 vs. 1.00) (all P < 0.001). Compared with the control group, glucose consumption of HT-29 cells in platycodon D 100 μmol/L group was decreased (1.9 mmol/L vs. 4.8 mmol/L), and lactic acid production was decreased (3.8 mmol/L vs. 9.2 mmol/L) (both P < 0.001). Compared with the control group, the relative expression of PKM2 in the platycodon D 100 μmol/L group was decreased (0.1 vs. 1.0), and the relative level of p-PKM2 was decreased (0.08 vs. 0.75) (both P < 0.001). Conclusions:Platycodon D can inhibit the proliferation of HT-29 cells, promote cell apoptosis, and inhibit cell migration and glycolysis.

Objective To investigate the mechanism of resveratrol(Res)-intervening dexamethasone(Dex)-induced mitochondrial autophagy in bone marrow mesenchymal stem cells(BMSCs)through SIRT2.Methods Mouse osteoblastic BMSCs were treated with Res,Dex,and the SIRT2 antagonist NAM.The mitochondria autophagosomes were observed using transmission electron microscopy(TEM).The protein and mRNA expression levels of SIRT2,LC-3,Beclin-1,TOM20,and Hsp60were determined using Western blot-ting and reverse transcription-polymerase chain reaction(RT-PCR).Results Res enhanced SIRT2 expression in BMSCs in a dose-and time-dependent manner.Dex(10-6 mol/L)inhibited the proliferation and viability of BMSCs,and significantly down-regulated the expres-sion of SIRT2mRNA and protein in BMSCs,whereas Res(10-6 mol/L)significantly inhibited the negative regulatory effects of Dex on the proliferation of and SIRT2 expression in BMSCs.Res(10-6 mol/L)significantly increased the mRNA expression of LC-3and Beclin-1(P<0.05),but significantly decreased the protein expression of TOM20 and Hsp60(P<0.05).Conclusion Res plays a role in the regulation of Dex-induced mitochondrial autophagy in BMSCs by mediating SIRT2.

Pancreatic cancer, a common digestive system tumor with high malignancy and a poor prognosis, has several treatment options. However, none of them are particularly effective because understanding the pathogenesis of pancreatic cancer remains a significant clinical challenge. Splicing isoforms mediate various biological phenotypes as an important means of regulating gene expression in eukaryotes, and their abnormalities can lead to a variety of diseases. Numb is an important cell fate determining protein whose alternative splicing has been linked to the development of various cancers. In pancreatic cancer, selective splicing of Numb can result in a variety of Numb protein subtypes, each with a different regulatory effect on the activation of various cancer-related signal pathways and tumor cell biology. This paper reviews the recent progress of Numb protein research in pancreatic cancer, with a focus on the regulatory role of its different isoforms in pathogenesis.

Objective:To compare the clinical utility of 18F-fibroblast activating protein inhibitor (FAPI)-42 and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in newly diagnosed lung cancer patients. Methods:From May 2020 to September 2021, the images of 43 lung cancer patients (32 males, 11 females, age: 37-80 years) who pathologically confirmed and received 18F-FDG and 18F-FAPI-42 PET/CT within 2 weeks in the First Affiliated Hospital of Guangzhou Medical University were prospectively analyzed. The maximum standardized uptake value (SUV max) of 18F-FDG and 18F-FAPI-42 and the number of lesions detected by 2 imaging methods were compared by using paired t test and Wilcoxon rank sum test. Results:The 43 newly diagnosed lung cancer patients included 35 adenocarcinoma, 2 squamous cell carcinoma, 4 small cell lung cancer, and 2 high-grade neuroendocrine tumors. 18F-FAPI-42 had a very high tumor uptake (SUV max: 12.24±3.97) and lesion detection rate (positive rate: 100%(37/37)) in primary lung adenocarcinoma and squamous cell carcinoma. The uptake of 18F-FAPI-42 in lymph node (10.13±5.43), pleura (6.75(4.96, 8.58)) and bone lesion (7.18(4.33, 9.66)) were significantly higher than those of 18F-FDG (6.35±3.30, 2.69(1.81, 5.00), 4.38(2.96, 6.36); t=12.19, z values: 5.47, 5.79, all P<0.001). In lung adenocarcinoma and squamous cell carcinoma, although the uptake of 18F-FAPI-42 in brain metastases was significantly lower than that of 18F-FDG (0.72(0.15, 1.82) vs 6.53(4.65, 9.34); z=6.42, P<0.001), the tumor/background (T/B) ratio was significantly higher than that of 18F-FDG (3.54(1.15, 14.88) vs 0.96(0.77, 1.04); z=6.05, P<0.001). In lung adenocarcinoma and squamous cell carcinoma, the number of lesions detected by 18F-FAPI-42 PET/CT was significantly more than that of 18F-FDG (lymph node: 6.0(2.3, 11.5) vs 4.5(2.0, 10.8); brain: 2.0(1.0, 3.0) vs 0.0(0.0, 0.0); pleura: 6.0(2.8, 10.0) vs 4.0(0.8, 5.5); z values: 2.16, 3.10, 2.04, all P<0.05). However, in high-grade neuroendocrine tumors and small cell lung cancer, the SUV max of 18F-FAPI-42 in primary lesions (8.05±2.60), lymph node lesions (5.98±2.21) and brain lesions (0.44(0.13, 0.82)) were lower than those of 18F-FDG (16.28±5.17, 12.30±5.47, 4.94(4.84, 6.25); t values: 3.58, 7.52, z=3.06, all P<0.05). Conclusions:In lung adenocarcinoma and squamous cell carcinoma, 18F-FAPI-42 has a very high tumor uptake and lesion detection rate in primary tumor. In addition, compared with 18F-FDG PET/CT, 18F-FAPI-42 PET/CT shows clearer tumor contours and more lesions. Therefore, 18F-FAPI-42 is more suitable for preliminary staging of lung adenocarcinoma and squamous cell carcinoma than 18F-FDG, while the opposite is true in small cell lung cancer and high-grade neuroendocrine tumors.

Objective:To investigate the correlations between perfused lung volumes, visual scores (using perfusion SPECT/CT) and right-heart catheter (RHC) hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 51 consecutive CTEPH patients (17 males, 34 females, age (59±12) years) in the First Affiliated Hospital of Guangzhou Medical University between March 2015 and July 2019 were retrospectively analyzed. All patients underwent lung perfusion SPECT/CT imaging and RHC examinations. Perfused lung volumes were determined using threshold-based (15%-85%) segmentation. Visual semiquantitative scoring in each lung segment was performed using Begic method. RHC hemodynamic parameters including pulmonary artery systolic pressure (PASP), pulmonary arterial diastolic pressure (PADP), mean pulmonary artery pressure (mPAP), pulmonary arteriolar wedge pressure (PAWP), pulmonary vessel resistance (PVR), cardiac output (CO), cardiac index (CI) were recorded. Spearman correlation analysis was used to evaluate the correlations between perfused lung volumes, visual scores and hemodynamic parameters.Results:There were significant correlations between perfused lung volumes (30%-70% threshold) and mPAP ( rs values: from -0.414 to -0.302, all P<0.05). Among them, perfused lung volumes under the threshold of 40% and 45% were moderately correlated with mPAP ( rs values: -0.414, -0.412, both P<0.05). Perfused lung volume (40% threshold) was moderately negatively correlated with PASP, PADP ( rs values: -0.402, -0.440, both P<0.05), and slightly negatively correlated with PVR ( rs=-0.352, P<0.05). Visual scores were slightly positively correlated with the PADP ( rs=0.311, P<0.05), while there was no correlation between visual scores and other RHC hemodynamic parameters ( rs values: from -0.201 to 0.275, all P>0.05). Conclusion:Perfused lung volumes based on threshold-based segmentation in lung perfusion SPECT/CT imaging can accurately reflect hemodynamic status and may provide useful information for severity assessment of CTEPH.

Objective:To investigate the expression and clinical significance of thymidine kinase 1 (TK1), carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA15-3 and CA72-4 in colorectal tumors.Methods:Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immuno assay (ECLIA) were used to determine the serum TK1 levels and serum CEA, CA19-9, CA15-3, CA72-4 levels in 124 patients with colorectal cancer, 52 patients with colorectal precancerous lesions, 154 patients with benign colorectal lesions, and 106 health subjects. The relationship between serum TK1 and its clinicopathological characteristics in patients with colorectal cancer were analyzed. The diagnostic efficacy of TK1, CEA, CA19-9, CA15-3 and CA72-4 alone and combined detection for colorectal cancer was investigated.Results:The serum expression level of TK1 in patients with colorectal cancer was related to tumor stage, degree of differentiation, lymph node metastasis, distant metastasis and age (all P<0.05), but not related to the patient's gender ( P>0.05). The serum TK1 level decreased sequentially in colorectal cancer patients, precancerous lesions patients, benign lesions patients and healthy subjects. Colorectal cancer patients with high TK1 expression have a shorter survival time. The sensitivity, specificity and accuracy of the combined detection of TK1, CEA, CA19-9, CA15-3 and CA72-4 were 93.5%, 93.0%, and 93.1%, respectively. Conclusions:Serum TK1 is expected to become an independent marker for the diagnosis and prognosis of colorectal cancer. The combined detection of TK1, CEA, CA19-9, CA15-3 and CA72-4 has clinical significance in the diagnosis of colorectal cancer.

The incidence of colorectal cancer is high threatening human health. About 60％～70％cases of CRC are derived from colorectal polyps, which can be treated by endoscopic electrotomy to prevent the possibility of canceration. Therefore, in the prevention and treatment of CRC, the role of screening is of great significance. CRC screening methods include the most commonly used fecal occult blood test ( FOBT ) and the more sensitive fecal immunochemical test (FIT), cost-effective fiber sigmoidoscopy and colonoscopy, CT colonoscopy (CTC), and fecal DNA testing and immature CRC hematology screening. In this paper, the CRC screening technologies were reviewed, including the principles, characteristics and the latest research progress to provide a theoretical basis for the application and development of CRC screening technology.