Globally, over 300 million surgeries are performed each year, and more than 50% of surgeries involve patients aged 65 and older. Aging poses significant challenges to perioperative brain health, as the deterioration of brain structure and function increases susceptibility to postoperative neurological complications. Protecting perioperative brain health remains a worldwide clinical challenge. With senescence, the brain undergoes a progressive decline in homeostasis across various molecular, cellular, and regional functions. Anesthetics and surgical stimuli may accelerate the disruption of brain homeostasis and exacerbate age-related neurodegeneration. This review provides a framework for understanding how anesthesia and surgery can affect brain health in the aging population and contribute to postoperative neurological complications, with a particular focus on perioperative neurocognitive disorder.

PBK is a cancer/testis antigen that exhibits absent expression in various normal human tissues,but undergoes aberrant overexpression upon cellular transformation,thereby promoting the initiation,metastasis and even drug resistance of cancer.Consequently,it represents a novel target for tumor immunotherapy.In this study,PBK-Nitrath,a protein vaccine specifically designed to target PBK by fusing nitrated T epitope with the PBK protein was developed,using the IFN-γ ELISpot method to evaluate the activation level of PBK antigen-specific T cells in the spleen of immunized mice,and conducting in vitro cytotoxicity T cell killing efficacy test to evaluate the killing ability against H22 hepatic carcinoma cells;the anti-tumor activity was evaluated using a H22 hepatic carcinoma subcutaneous transplantation tumor model,and the differentiation of peripheral blood and spleen T lymphocytes and tumor immune infiltration were analyzed by flow cytometry.Results showed that PBK-Nitrath could efficiently induce the activation of antigen-specific T cells against PBK while enhancing cytotoxic T lymphocyte-mediated killing capacity,significantly impede hepatic carcinoma progression in mice and increase the ratio of CD8+CD107a+T cells within peripheral blood and spleen,and facilitate tumor lymphocyte infiltration.Our findings reveal the potential utility of PBK-Nitrath as an effective candidate for tumor vaccine.

Objective:To investigate the application effect of the thinking pattern of "Six Thinking Hats" combined with case-based learning-reference induced self-education (CBL-RISE) teaching in clinical practice teaching of thoracic surgery.Methods:A total of 122 interns who received clinical practice teaching in Department of Thoracic Surgery in the Second Xiangya Hospital of Central South University were selected as subjects, and according to the admission order, they were divided into control group (61 interns receiving routine teaching) and observation group (61 interns receiving the thinking pattern of "Six Thinking Hats" combined with CBL-RISE teaching). After teaching, the two groups were compared in terms of assessment scores, self-learning ability, clinical thinking ability, self-expression ability, and recognition of teaching. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:The observation group had significantly higher theoretical and skill assessment scores than the control group [mastery of basic knowledge: (55.42±3.65) vs. (49.57±3.23), P<0.05; case analysis: (20.13±2.19) vs. (16.42±2.74), P<0.05; medical record writing: (18.29±2.17) vs. (15.12±2.05), P<0.05; operational ability: (20.32±2.04) vs. (17.51±1.89), P<0.05; performance score: (30.34±3.24) vs. (27.19±3.07), P<0.05]. After practice teaching, both groups had increases in the scores of self-learning ability and clinical thinking ability, and the observation group had significantly higher scores than the control group [self-learning ability: (90.73±6.88) vs. (85.54±6.53), P<0.05; clinical thinking ability: (105.62±10.19) vs. (100.47±10.45), P<0.05]. Compared with the control group, the observation group had a significantly better self-expression ability ( P<0.05) and a significantly higher degree of recognition of teaching ( P<0.05). Conclusions:The thinking pattern of "Six Thinking Hats" combined with CBL-RISE teaching can improve the assessment scores of interns in thoracic surgery and stimulate their learning ability, thinking ability, and self-expression ability.

Objective:To develop the Perioperative Blood Glucose Management Knowledge Questionnaire for Surgical Nurses and test its reliability and validity.Methods:From January to June 2019, the questionnaire item pool was constructed through literature review, and 13 experts were included in two rounds of Delphi consultation using purposive sampling. In July 2019, convenience sampling was used to select 50 clinical nurses from the surgical ward of the First Affiliated Hospital of Xi'an Jiaotong University as the research subject. A preliminary survey was conducted to form an initial Perioperative Blood Glucose Management Knowledge Questionnaire for Surgical Nurses. From August to September 2019, 110 clinical nurses from this ward were selected as the research subject again, and the questionnaire was subjected to item screening and reliability and validity testing.Results:The final Perioperative Blood Glucose Management Knowledge Questionnaire for Surgical Nurses included five dimensions of factors influencing blood glucose abnormalities, hazards of blood glucose abnormalities, preoperative and postoperative nursing observation points, emergency treatment of perioperative critical conditions, and key points for perioperative blood glucose management, with a total of 19 items. In the two rounds of consultation, the positivity coefficients of experts were both 100.00% (13/13), the authority coefficient of experts was 0.88, and the coefficients of variation for two rounds of consultation were 0 to 0.30 and 0 to 0.17. Exploratory factor analysis extracted five common factors, with a cumulative variance contribution rate of 66.70%. The Cronbach's α coefficient of the total questionnaire was 0.92, the test-retest reliability coefficient was 0.97, and the scale-level content validity index was 0.98.Conclusions:The Perioperative Blood Glucose Management Knowledge Questionnaire for Surgical Nurses has good scientific and practical significance, and can be used as an effective tool to evaluate the perioperative blood glucose management knowledge among surgical nurses.

Objective To develop a blood glucose management knowledge questionnaire for perioperative patients with hyperglycemia and test its reliability and validity.Methods The initial questionnaire was formed through literature review,expert consultation,two rounds of Delphi letter consultation,and pre-survey.From August to September 2019,a total of 125 perioperative patients with hyperglycemia who were hospitalized in the surgical ward of the First Affiliated Hospital of Xi'an Jiaotong University were selected as the survey objects by the convenient sampling method.The items of the questionnaire were screened and the reliability and validity were tested.Results A total of 125 questionnaires were distributed and 115 valid questionnaires were returned,with an effective recovery rate of 92.0%.The blood glucose management knowledge questionnaire for perioperative patients with hyperglycemia included five dimensions(17 items in total),including influencing factors and hazards of abnormal blood glucose,key points of preoperative and postoperative nursing observation,perioperative blood glucose control goals,perioperative blood glucose management points,and emergency treatment of perioperative critical conditions.The effective recovery rates for both rounds of inquiry are 100.00%,the expert authority coefficient was 0.880 and the average coefficient of variation was 0.086 and 0.065(P＜0.01).Exploratory factor analysis extracted a total of five common factors,and the cumulative variance contribution rate was 79.895%.The Cronbach's α coefficient of the questionnaire was 0.905,the test-retest reliability was 0.955,and the content validity index was 0.968.Conclusions The blood glucose management knowledge questionnaire for perioperative patients with hyperglycemia is scientific and practical,which can be used as an effective tool to evaluate the blood glucose management knowledge level during perioperative period.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Cerebrovascular disease is a common disease that seriously endangers the health of Chinese people. White matter hyperintensities (WMHs) are the most common in elderly patients. Intravenous thrombolysis is currently the most effective drug treatment for acute ischemic stroke. Hemorrhagic transformation (HT) is the most common serious complication after intravenous thrombolysis in patients with acute ischemic stroke. The destruction of blood-brain barrier in patients of WMHs can increase the risk of HT after intravenous thrombolysis. Matrix metalloproteinases and S100B jointly participate in the destruction process of blood-brain barrier in WMHs and HT after intravenous thrombolysis. At present, the pathogenesis of WHM and HT is not completely clear, and whether mild and moderate WMHs will aggravate HT is still controversial. Nevertheless, WMHs are still the independent risk factor for HT.

Objective:To analyze the genetic etiology of idiopathic short stature(ISS) children, and to investigate the clinical characteristics of Noonan syndrome caused by PTPN11 gene mutation, and the response to recombinant human growth hormone(rhGH) as well.Methods:Genomic DNA was extracted from the peripheral blood of 232 ISS patients, and the genome was detected by whole exon sequencing. The gene variation was analyzed according to the guideline of American College of Medical Genetics and Genomics(ACMG), and clinical baseline data and follow-up data of rhGH treatment were collected from PTPN11 gene pathogenic patients.Results:Among 232 ISS patients, 6 were found to have PTPN11 pathogenic gene variants(c.1507G>C, c. 317A>G, c. 923A>G, c. 922A>G, c. 236A>G, c. 922A>G), diagnosed as Noonan syndrome. Together with 3 cases of Noonan syndrome patients(all PTPN11 gene variation C. 1510A>G) previously diagnosed in our hospital, the clinical characteristics of patients were analyzed. Among the 9 Noonan syndrome patients, 7 were boys and 2 were girls. The average age was 10.2(4.5, 14.7) years old, and their height standard deviation score was -3.06 SD(95% CI -2.29 SD--3.94 SD). Among them, 4 patients received rhGH treatment with an average treatment duration of 2.25(1.5, 3.5) years. After treatment, their height increased by 14.3(8.6, 23.9) cm, and the change in height standard deviation score improved by 0.21 SD(95% CI 0.12 SD-0.27 SD). Conclusion:Noonan syndrome has a wide range of clinical phenotypes. For children with short stature, heart defects and cryptorchidism, the possibility of Noonan syndrome should be considered. PTPN11 is the common pathogenic gene for Noonan syndrome, and genetic testing facilitates the early diagnosis, treatment, and follow-up prognosis of Noonan syndrome patients.

Objective:To investigate the characteristics of clinical, muscle pathology and gene mutation in patients with nemaline myopathy caused by NEB gene mutation.Methods:The clinical and pathological data of patients with nemaline myopathy caused by NEB gene were collected from Neuromuscular Center of Jiaozuo People′s Hospital from January 1997 to January 2020. The next generation sequencing was preformed to detect NEB gene in all patients, and characteristics of gene mutation were analyzed.Results:Among the 11 patients, there were 8 males and 3 females, and 6 of them came from 2 families. The age of seeing a doctor ranged from 11 to 52 years, the age of onset was from 6 to 23 years, and the course of disease ranged from 5 to 35 years. Neurological examination showed that among the 11 patients, 8 patients had high palatal arch and long face. The muscle tone of both upperlimbs was normal, the tendon reflex was depressed, the proximal muscle strength was grade Ⅲ-Ⅴ, and the distal muscle strength was grade Ⅴ. The muscle tone of both lower extremities was reduced and the tendon reflex was absent. The proximal muscle strength was grade Ⅱ-Ⅳ and the distal muscle strength was grade Ⅲ-Ⅴ. No dysphagia or respiratory muscle involvement was found. Muscle biopsies were performed in 7 of the 11 patients, the pathological changes were muscle fibers of different sizes, circular atrophic muscle fibers and compensatory hypertrophic fibers, and occasionally denatured and necrotic muscle fibers were found. Different degrees of rod aggregation could be seen in all the 7 patients. Electron microscopic examination of 5 patients showed that there was rod aggregation between myofibrils, and most of them were located near the Z band, but no intranuclear rod was found. NEB gene was found in all 11 patients, and a total of 9 different mutation sites were detected, including 8 in exon region and 1 in intron region. Among them, c.21522+3A>G was found in 10 cases, c.1623delT was found in 3 cases and c.17611C>T was found in 3 cases. There was 1 case of c.4417C>T, c.2549delA, c.21065dupA, c.3520G>A, c.20943G>A, c.192G>A respectively.Conclusions:The clinical phenotype of nemaline myopathy caused by NEB gene has great heterogeneity. Muscle pathology shows that rod aggregation is an important basis for the diagnosis of this disease. Mutation c.21522+3A>G in intron is the most common mutation in this group of NEB gene. And the novel mutation sites of NEB gene are respectively c.17611C>T, c.2549delA, c.3520G>A, c.21065dupA, c.20943G>A and c.192G>A.

Cardiomyopathy, Dilated/metabolism* ; Humans ; Microfilament Proteins/metabolism* ; Models, Cardiovascular ; Mutation ; Myocytes, Cardiac ; Pluripotent Stem Cells/metabolism* ; Transcription Factors/metabolism* ; Troponin T/metabolism*