Objective To investigate the impact of vestibular dysfunction on various domains of cognitive function, providing a basis for developing comprehensive vestibular-cognitive intervention strategies. Methods A total of 33 patients with confirmed unilateral vestibular dysfunction treated at Eye & ENT Hospital, Fudan University between June 2024 and December 2024. Vestibular function was assessed using vestibular evoked myogenic potential (VEMP), caloric testing, video head impulse test (vHIT), and sensory organization test (SOT). Cognitive function was evaluated using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), Stroop color-word test, trail making test (TMT), and auditory verbal learning test (AVLT). Subjective symptoms were assessed using dizziness handicap inventory (DHI). Results In the vestibular function assessment of patients, abnormalities in caloric testing, utricle VEMP and saccule VEMP results were most common, with rates of 87.9%, 57.6%, and 66.7%, respectively; SOT abnormality primarily characterized by impaired vestibular function (21.2%). Spearman correlation analysis showed age, years of education, hearing ability, and emotional state were associated with overall or specific domains of cognitive function in patients. Greater vestibular dysfunction severity was associated with longer TMT-A time (r＝0.443，P＝0.010), most severe damage of short-term (r＝－0.405，P＝0.019) and long-term delayed recalls (r＝－0.537，P＝0.001). Patients with 31-60 of DHI scores showed longer TMT-A time than patients with 0-30 of DHI scores (P＝0.033). Conclusions Patients with vestibular dysfunction exhibit significant impairment in low-frequency semicircular canal and utricle function, which affects attention allocation, information processing speed, and memory performance in cognitive tasks.

OBJECTIVE: To observe the effect of electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) on hippocampal neuronal ferritinophagy mediated by the nuclear receptor coactivator 4 (NCOA4)/ferritin heavy chain 1 (FTH1) signaling pathway in vascular dementia (VD) rats, and to explore the potential mechanisms of electroacupuncture for VD. METHODS: A total of 60 male rats of SPF grade were randomly divided into a blank group (12 rats), a sham surgery group (12 rats) and a modeling group (36 rats). In the modeling group, the modified 4-vessel occlusion method was used to establish the VD model. The 24 successfully modeled rats were randomly divided into a model group and an electroacupuncture group, with 12 rats in each group. In the electroacupuncture group, electroacupuncture was applied at left and right "Sishencong" (EX-HN1), and bilateral "Fengchi" (GB20), with continuous wave, in frequency of 2 Hz and current intensity of 1 mA, 30 min a time, once daily for 21 consecutive days. The learning and memory abilities were assessed using the Morris water maze test before modeling, after modeling and after intervention, as well as the novel object recognition test after intervention. After intervention, the neuronal morphology in the hippocampus was observed by Nissl staining; the iron deposition was observed by Prussian blue staining; the reactive oxygen species (ROS) level was detected by dihydroethidium (DHE) fluorescence staining; the levels of iron, malondialdehyde (MDA) and superoxide dismutase (SOD) in the hippocampal tissue were measured by the colorimetric assay, TBA method, and WST-1 method, respectively; the positive expression of NCOA4, FTH1 and glutathione peroxidase 4 (GPX4) was detected by immunohistochemistry; the protein expression of NCOA4, FTH1, GPX4, and the ratio of microtubule-associated protein 1 light chain 3B (LC3B) Ⅱ/Ⅰ in the hippocampus were detected by Western blot. RESULTS: Compared with the sham surgery group, in the model group, the escape latency was prolonged, and the number of platform crossings reduced (P<0.01), the recognition index (RI) was decreased (P<0.01); the hippocampal neurons displayed a blurred laminar structure, disorganized cellular arrangement, and the number of Nissl bodies was decreased (P<0.01); the percentage of iron deposition area in the hippocampus was increased (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were increased (P<0.01), the SOD level, and the protein expression of FTH1 and GPX4 were decreased (P<0.01). Compared with the model group, in the electroacupuncture group, the escape latency was shortened and the number of platform crossings was increased (P<0.01), the RI was increased (P<0.01); the hippocampal neurons exhibited more regular morphology, better-organized cellular structure, and the number of Nissl bodies was increased (P<0.05); the percentage of iron deposition area in the hippocampus reduced (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were decreased (P<0.01, P<0.05), the SOD level, and the protein expression of FTH1 and GPX4 were increased (P<0.01). CONCLUSION Electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) can improve learning and memory abilities in VD rats, and its mechanism may be associated with the regulation of the hippocampal NCOA4/FTH1 signaling pathway, inhibition of ferritinophagy, and alleviation of oxidative stress damage.
Animals ; Electroacupuncture ; Dementia, Vascular/genetics* ; Male ; Rats ; Signal Transduction ; Humans ; Memory ; Rats, Sprague-Dawley ; Nuclear Receptor Coactivators/genetics* ; Ferritins/genetics* ; Learning ; Hippocampus/metabolism* ; Acupuncture Points

Objective:To evaluate the predictive effect of the loss of signal (LOS) on the recurrent laryngeal nerve (RLN) injury.Methods:The literatures on PubMed, Web of Science, CNKI, and Wanfang Medical Network database were published before 30 April 2023. English search terms included "thyroid gland surgery" "thyroidectomy" "intraoperative neuromonitoring" "intraoperative nerve monitoring" and "recurrent laryngeal nerve". Chinese search terms included "thyroidectomy", "thyroid surgery" "recurrent laryngeal nerve" "intraoperative nerve monitoring". Two evaluators screened the literature, extracted the materials and evaluated the risk of bias of the study independently. If there were different opinions, researchers should resolve which through consultation and ask the third-party researcher when necessary. The Meta-analysis was performed with the Review Manager 5.4 software.Results:A total of thirty-three studies were included and were all analyzed for primary outcome measures while only twenty-six of which were analyzed for secondary outcome measures. Meta-analysis showed that the positive predictive value of LOS in intraoperative nerve monitoring (IONM) was 65% [ OR=1.88, 95% CI: 1.36-2.60]. Then these thirty-three articles included in IONM were divided into I-IONM, C-IONM and mixed groups. Subgroup analysis showed that the positive predictive value of LOS in I-IONM, C-IONM and mixed groups were 62% [ OR=1.63, 95% CI: 1.05-2.52], 75% [ OR=2.93, 95% CI: 1.64-5.22] and 70% [ OR=2.38, 95% CI: 1.77-3.12] respectively. When these thirty-three included articles were divided into Asian, European, North American and Oceania, subgroup analysis showed that the positive predictive value of LOS was 50% [ OR=1.01, 95% CI: 0.44-2.31], 70% [ OR=2.29, 95% CI: 1.60-3.28], 82% [ OR=4.68, 95% CI: 3.79-5.78] and 83% [ OR=4.81, 95% CI: 3.10-7.46] respectively. Meta-analysis of secondary outcome measures in twenty-six articles showed that the negative predictive value of LOS was 99.6% [ RD=1.51, 95% CI: 1.48-1.53], with the sensitivity of 89% [ RD=1.24, 95% CI: 1.11-1.37] and specificity of 98%[ RD=1.43, 95% CI: 1.40-1.47]. Conclusion:The occurrence of LOS during IONM in thyroidectomy has a positive prediction effect and a higher negative prediction effect, sensitivity and specificity on RLN injury.

Objective:To evaluate safety and efficacy of B-type suture method ileostomy.Methods:Clinical data from 204 patients undergoing laparoscopic low anterior resection combined with protective ileostomy was analysed. Patients were divided into B-type suture ileostomy group ( n=67) and traditional ileostomy group ( n=137). Results:compared with traditional ileostomy group, B-type suture ileostomy group showed statistically significant differences in total operation time [(164±26) min vs. (172±24) min, t=2.229, P=0.027], ileostomy time [(12.7±2.3) min vs. (14.8±2.2) min, t=-6.565, P<0.001], blood loss [(57±20) ml vs. (69±31) ml, t=-2.797, P=0.006], postoperative hospital stay [(10.2±1.9) d vs. (11.8±2.3) d, t=-4.851, P<0.001], specimen incision infection rate (0 vs. 5.1%, P=0.047), postoperative body pain [82 (79-84) vs. 78 (76-80), Z=-5.805, P<0.001], and ileostomy incorporation time [(46±11) min vs. (51±12) min, t=-2.540, P=0.012]. Conclusion:B-type suture ileostomy for prophylactic ileostomy in laparoscopic low anterior resection for rectal cancer is safe and feasible.

Objective:To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after laparoscopic complete mesocolic excision (CME) for right colon cancer.Methods:The clinical data of 358 patients who underwent laparoscopic CME for right colon cancer were retrospectively analyzed. Univariate and multivariate logistics regression were used to analyze the independent risk factors for PGS.Results:PGS occurred in 19 patients (4.8%). Logistic regression analysis showed that preoperative anxiety score (PAS-7)≥14 ( OR=6.450, P=0.039), preoperative serum albumin<35 g/L ( OR=9.302, P=0.011), colon cancer at hepatic flexura ( OR=9.782, P=0.007), No.206 group lymph node dissection ( OR=8.317, P=0.004), and intra-abdominal infection ( OR=5.755, P=0.043) were independent risk factors for PGS. Conclusion:Patient's preoperative health status, tumor location, scope of lymph node dissection and postoperative intra-abdominal infection are all risk factors related to PGS after CME for right colon cancer.

Objective:To explore the characteristic of dynamic function network connectivity (dFNC) of resting brain networks in internet gaming disorder (IGD) adolescents.Methods:Forty-four adolescent IGD subjects (IGD group, male/female: 38/6) and fifty healthy controls (HC group, male/female: 40/10) were collected, and the subjects completed demographic questionnaires, Young internet addiction scale(YIAS), Chinese adolescents' maladaptive cognitions scale(CAMAS), and functional magnetic resonance imaging (fMRI) tests. The fMRI data were preprocessed on the Matlab platform, and the preprocessed data was divided into 64 components for group level independent component analysis.The dynamic functional connectivity of obtained 18 effective independent components was analyzed by sliding time window technique, and the difference of dynamic functional connectivity of brain triple network between the IGD group and HC group was compared using SPSS 22.0 software.Results:Four repeated dFNC states were identified through cluster analysis.Each state indicated that different functional networks had different connection strengths.State 3, the most frequent state, had been indicated that the whole brain network of the subject was in a state of weak functional connectivity.The second frequent state was state 1, which indicated enhanced functional connectivity within the subject's central executive network (CEN).State 2 had been indicated enhanced functional connectivity within the subject's salience network (SN).State 4 had been indicated generally enhanced functional connectivity in the subjects' brain networks, and this state was the least frequent.The results of non-parametric permutation test on the time attribute showed that compared with the HC group, the IGD group had a longer time score (IGD group: 0.24±0.19, HC group: 0.13±0.15, t=1.19, P<0.05, non-parametric substitution test) for state 1 with strong connectivity within the CEN, which was positively correlated with the YIAS score and game time ( r=0.418, P=0.003; r=0.515, P=0.004).Compared with HC group, the functional connectivity of ICD group between the internal insula of the SN and the dorsal anterior cingulate cortex was enhanced ( P<0.05, FDR corrected), while the average residence time in weakly connected state 3 was longer ( Z=2.09, P<0.05, nonparametric substitution test). Conclusions:The difference in dynamic functional connectivity of the triple network in the brain of IGD adolescents under resting state is mainly manifested by strong connections in CEN, functional connections between insula and dorsal anterior cingulate cortex in SN is enhanced, and weakening of overall functional connections, which may play an important role in the pathological mechanism of IGD.

Thyroid hormone resistance syndrome complicated with papillary thyroid cancer is clinically rare.Madelung's disease is a rare disorder of lipid metabolism.We analyzed the clinical data of a case of thyroid hormone resistance syndrome complicated with papillary thyroid carcinoma and Madelung's disease,performed whole-exon sequencing for the patient's peripheral blood samples,and retrospectively analyzed the relevant liter-ature.This review is expected to provide experience for clinical diagnosis and treatment.

OBJECTIVE: To explore the mechanism of electroacupuncture (EA) at "Fengchi" (GB 20) and "Sishencong" (EX-HN 1) on learning and memory impairment in vascular dementia (VD) rats by observing the influences on the N-methyl-D-aspartate receptor (NMDAR)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway and the excitotoxicity induced by hippocampal calcium overload. METHODS: Thirty-two male SD rats of SPF grade were selected and randomized into a normal group (6 rats), a sham-operation group (6 rats) and an operation group (20 rats). VD model was established with the modified Pulsinelli's four-vessel occlusion (4-VO) method. Twelve rats after successfully modeled were assigned randomly into a model group and an EA group, 6 rats in each one. In the EA group, EA was delivered at bilateral "Fengchi" (GB 20) and "Sishencong" (EX-HN 1), with the continuous wave, the frequency of 2 Hz and the electric current of 1 mA. Stimulation intensity was adjusted depending on the slightly trembling of rat head. EA was given once daily, 30 min each time; and EA intervention was delivered for 21 days continuously. Using Morris water maze test, the learning and memory function was assessed. The neuronal morphology in the hippocampal CA1 was observed with HE staining; the level of glutamate (GLU) in serum and hippocampal tissue, as well as the activity of calcium pump (Ca²⁺-ATP) in the hippocampus were detected using colorimetric method. The protein expression of NMDAR, calmodulin-dependent protein kinase Ⅱ (CaMKⅡ), phosphorylated calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ), phosphorylated cyclic phosphoradenosine effector element binding proteins (p-CREB), CREB, and BDNF in the hippocampal CA1 was detected using immunohistochemistry. The protein expression of NMDAR, CREB, p-CREB and BDNF in the hippocampal tissue was detected using Western blot method. RESULTS: Compared to the sham-operation group, in the model group, the escape latency was prolonged and the platform crossing times of rats were reduced (P<0.01), the hippocampal neuron structure was damaged to different degrees, the structure in hippocampal CA1 was loosened, the arrangement disorganized, with clear grid-like structure; the neuronal morphology was irregular, pyknosis and even dissolution occurred, glial cells increased, blood capillary was dilated and the inflammatory cells were infiltrated and scattered. The level of GLU in the serum and hippocampal tissue and the protein expression of hippocampal NMDAR were elevated (P<0.01), the activity of Ca²⁺-ATP and the protein expression of CaMKⅡ, p-CaMKⅡ, CREB, p-CREB and BDNF were reduced (P<0.01, P<0.05); and the ratio of p-CaMKⅡ/CaMKⅡ and that of p-CREB/CREB were dropped (P<0.05). In comparison with the model group, in the EA group, the escape latency was shortened and the platform crossing times of rats rose (P<0.01), the arrangement was improved in the hippocampal CA1, the neuronal morphology was intact, the nucleoli were clear relatively and the pyknosis or dissolution were attenuated, the numbers of glial cells reduced relatively, the dilation of blood capillary was alleviated. The level of GLU in the serum and hippocampal tissue and the protein expression of NMDAR were reduced in the hippocampal tissue (P<0.01), the activity of Ca²⁺-ATP and the protein expression of CaMKⅡ, p-CaMKⅡ, CREB, p-CREB and BDNF were elevated (P<0.05, P<0.01); and the ratio of p-CaMKⅡ/CaMKⅡ and that of p-CREB/CREB increased (P<0.05). CONCLUSION EA at "Fengchi" (GB 20) and "Sishencong" (EX-HN 1) can attenuate learning and memory impairment in VD rats, which may be obtained by reducing GLU level in hippocampal tissue, inhibiting hippocampal excitotoxicity, mediating protein expression related to the NMDAR/CREB/BDNF signaling pathway, and maintaining neuronal survival and growth.
Electroacupuncture ; Male ; Animals ; Rats, Sprague-Dawley ; Learning ; Memory ; Signal Transduction ; Cyclic AMP Response Element-Binding Protein/metabolism* ; Memory Disorders/therapy* ; Brain-Derived Neurotrophic Factor/metabolism* ; Receptors, N-Methyl-D-Aspartate/metabolism* ; Dementia, Vascular/therapy*

To evaluate the effects of non-pharmacological interventions on cognitive function and activities of daily living in patients with post-stroke cognitive impairment (PSCI).Methods:Based on Cochrane Library, PubMed, Web of Science, Embase, CNKI, WanFang, and VIP databases, randomized controlled studies on rehabilitation therapy for PSCI patients were retrieved. And the retrieval date was from the establishment of the databases to 31 December 2021. Literature screening, data extraction, quality evaluation and data analysis were carried out.Results:A total of 26 studies were included, involving 12 interventions and 2007 patients with PSCI. The results of network Meta-analysis showed that compared with routine rehabilitation and/or routine rehabilitation care, cognitive therapy ( SMD=-1.30, 95% CI -2.09 - -0.52)、repetitive transcranial magnetic stimulation ( SMD=-1.67, 95% CI -2.54 - -0.81; SMD=-2.34, 95% CI -3.71 - -0.97), repetitive transcranial magnetic stimulation combined with cognitive therapy ( SMD=-1.56, 95% CI -2.76 - -0.36; SMD=-2.23, 95% CI -3.39 - -1.07), acupuncture combined with cognitive therapy ( SMD=-2.31, 95% CI -3.51 - -1.12; SMD=-2.98, 95% CI -4.13 - -1.84), virtual reality ( SMD=-1.01, 95% CI -1.98 - -0.04; SMD=-1.68, 95% CI -2.98 - -0.38), computer-assisted cognitive training combined with cognitive therapy ( SMD=-2.50, 95% CI -4.35 - -0.65; SMD=-3.17, 95% CI -4.99 - -1.35), music therapy ( SMD=-1.47, 95% CI -2.61 - -0.33), music therapy combined with cognitive therapy ( SMD=-2.35, 95% CI -4.04 - -0.67), recreational therapy ( SMD=-2.11, 95% CI -3.93 - -0.30), guided imagination therapy ( SMD=-2.48, 95% CI -4.00 - -0.96) had statistical significance in improving the cognitive function of PSCI patients ( P<0.05); recreational therapy ( SMD=-3.57, 95% CI -6.09 - -1.04; SMD=-3.70, 95% CI -7.22 - -0.18) had statistical significance in improving the ability of daily living activities of PSCI patients ( P<0.05). According to the area ranking results under the cumulative ranking probability graph, acupuncture combined with cognitive therapy (89.2%) and recreational therapy (85.1%) ranked first in improving cognitive function and activities of daily living, respectively. Conclusions:Acupuncture combined with cognitive therapy and recreational therapy have the best effect on improving cognitive function and activities of daily living in PSCI patients, respectively. However, considering the poor quality of the original literature included, more large samples and high-quality RCTs are needed for further verification.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.