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.

Objective:To investigate the clinical characteristics and electron transfer flavoprotein dehydrogenase ( ETFDH) genetic mutations in patients with riboflavin responsive lipid storage myopathy (RR-LSM). Methods:A retrospective analysis was performed. The clinical data and muscular pathology of 26 patients with RR-LSM, admitted to our hospital from January 2009 to June 2021, were collected. Peripheral venous blood DNA was extracted, and the mutations of ETFDH gene were detected and analyzed by whole exome sequencing. Results:These 26 patients had onset of proximal limb myasthenia, 17 patients had difficulty in raising their head, 12 patients had mastication weakness, 6 had dysphagia, 5 had nausea and vomiting, and one was complicated with rhabdomyolysis and one was with reversible splenic lesion syndrome. Muscle biopsy indicated pathological deposition of lipid droplet, which type I fibers were involved mainly; degenerative necrotic muscle fibers were seen in a few cases. ETFDH gene mutations were detected in 26 patients; 23 patients had compound heterozygous mutation, two had single heterozygous mutation and one had homozygous mutation; 25 different mutation sites were found, mainly missense mutations; the C.770A>G frequency was the highest, accounting for 20% alleles (10/50); two novel mutation sites were found: c.1115A>G and c.1781T>C. Conclusion:RR-LSM is mainly characterized by proximal limb muscle weakness and fatigue intolerance, often accompanied by neck extensor and masticatory weakness; c. 770A>G is the hot site of ETFDH genetic mutations in RR-LSM patients.

Objective : To explore the application of ZnxNi1－xS@ DOX nanostructures in combined photothermal- chemotherapy treatment of tumors，and to provide new ideas for the study of tumor treatment methods． Methods: The morphology and elementary composition of ZnxNi1－xS nanostructures were characterized by scanning emission e- lectron microscopy and other methods．The photothermal properties of ZnxNi1－xS nanostructures were explored by infrared thermal camera．The release of DOX under different temperature and pH was investigated by fluorescence spectrophotometer．The biosafety of ZnxNi1－xS nanostructures and the in vitro antitumor properties of ZnxNi1－xS@ DOX nanostructures were investigated by MTT assay. Results : The as-prepared ZnxNi1－xS nanostructure had good dispersion and uniform size．The ZnxNi1－xS nanostructures had good photothermal effect．The drug release behavior showed temperature and pH responsiveness．The MTT assay showed that ZnxNi1－xS nanostructures were nontoxic to normal cells．ZnxNi1－xS@ DOX nanostructures could significantly inhibit the growth of tumor cells under near-infra- red illumination． Conclusion The as-prepared ZnxNi1－xS nanostructure has good biocompatibility，on the basis of which the ZnxNi1－xS@ DOX nanostructures achieve good antitumor performance，which can be used for combined photothermal-chemotherapy treatment of tumors.

To investigate the clinical，pathological and ETFDH gene mutation characteristics of riboflavinresponsive lipid storage myopathy（RRLSM） caused by ETFDH gene mutation.Methods The clinical and pathological data of 18 RR-LSM patients who were admitted to our hospital from January 2009 to December 2020 and confirmed by muscle biopsy pathology and gene testing were retrospectively analyzed. The Illumina NovaSeq highthroughput sequencing of peripheral blood DNA was performed for data reading and bioinformatics analysis.Results Among the 18 patients，there were 9 males and 9 females. The age of onset ranged from 9 to 60 years old（mean 29.83±13.44 years）. The course of disease ranged from 1 month to 22 years（mean 4.5 years）. The main clinical manifestations were proximal limb weakness and movement intolerance，accompanied by cervical extensor weakness in 14 cases，masticatory muscle weakness in 9 cases，dysphagia in 5 cases，nausea and poor appetite in 5 cases，and muscle pain and dyspnea in a few patients. Muscle pathology showed a large amount of lipid deposition in muscle fibers and a small amount of muscle fiber necrosis in 5 cases. Immunohistochemical staining indicated that the necrotic muscle fibers were mainly infiltrated by CD68（+） lymphophagocytes. All 18 patients were treated with riboflavin and had good efficacy. ETFDH gene mutation was detected in all cases in this study，including 15 cases（83.3%） with complex heterozygous mutation，2 cases（11.1%） with single heterozygous mutation，and 1 case（5.6%） with homozygous mutation. A total of 20 mutation sites were found，among which the most frequent mutation site was c.770A>G，accounting for 19.4%（7/36） of the allele，followed by c.1454C>G，accounting for 8.3%（3/36） of the allele. Conclusion RRLSM patients caused by ETFDH gene mutation are characterized by trunk axial muscle and masticatory muscle involvement. Muscle pathology found that there are a large number of lipid deposits in muscle fibers is an important basis for diagnosis. c.770A>G and c.1454C>G are the most common mutation sites of ETFDH gene in this grou.

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