Objective To detect the expressions of α-synuclein,microtubule-associated protein 1 light chain 3(LC3)and apolipoprotein A1(Apo A1)in serum of patients with Parkinson's disease(PD),and their correlations with cognitive function(CI)and disease progression.Methods Nine-ty-six PD patients were selected as research group;another 90 healthy subjects were selected as con-trol group.The patients were divided into CI group(42 cases)and cognitively normal group(54 ca-ses)according to the Montreal Cognitive Assessment Scale(MoCA)score.PD patients were divided into stages Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ according to the Hoehn-Yahr(H-Y)Staging Scale,patients in stage Ⅰ to Ⅱ were included in early PD group(57 cases),and those with stage Ⅲ to Ⅴ were in middle and late PD group(39 cases).The levels of serum α-synuclein and LC3,PD and Apo A1 pa-tients were determined.The correlations of α-synuclein,LC3,Apo A1 with H-Y staging were ana-lyzed.Logistic regression analysis was applied to screen the influencing factors of occurrence of CI in PD patients.Results Compared with the control group,the level of α-synuclein in the research group increased,and the levels of LC3 and Apo A1 decreased(P＜0.05);the level of α-synuclein in the early PD group was lower than that in the middle and late PD group,and the levels of LC3 and Apo A1 were higher than those in the middle and late PD group(P＜0.05);serum α-synuclein level was positively correlated with H-Y staging(P＜0.05).The area under the curve(AUC)of their combination to predict the occurrence of cognitive impairment in PD patients was 0.925,which was greater than prediction by α-synuclein,LC3,and Apo A1 alone(P＜0.05);α-synuclein,LC3,Apo A1,and history of hypertension were the influencing factors of CI in PD patients(P＜0.05).Conclusion α-synuclein is highly expressed in the serum of patients with PD complicated with cog-nitive impairment,while the expression of LC3 and Apo A1 are low.The three are closely related to PD cognitive function and disease progression.

Objective To detect the expressions of α-synuclein,microtubule-associated protein 1 light chain 3(LC3)and apolipoprotein A1(Apo A1)in serum of patients with Parkinson's disease(PD),and their correlations with cognitive function(CI)and disease progression.Methods Nine-ty-six PD patients were selected as research group;another 90 healthy subjects were selected as con-trol group.The patients were divided into CI group(42 cases)and cognitively normal group(54 ca-ses)according to the Montreal Cognitive Assessment Scale(MoCA)score.PD patients were divided into stages Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ according to the Hoehn-Yahr(H-Y)Staging Scale,patients in stage Ⅰ to Ⅱ were included in early PD group(57 cases),and those with stage Ⅲ to Ⅴ were in middle and late PD group(39 cases).The levels of serum α-synuclein and LC3,PD and Apo A1 pa-tients were determined.The correlations of α-synuclein,LC3,Apo A1 with H-Y staging were ana-lyzed.Logistic regression analysis was applied to screen the influencing factors of occurrence of CI in PD patients.Results Compared with the control group,the level of α-synuclein in the research group increased,and the levels of LC3 and Apo A1 decreased(P＜0.05);the level of α-synuclein in the early PD group was lower than that in the middle and late PD group,and the levels of LC3 and Apo A1 were higher than those in the middle and late PD group(P＜0.05);serum α-synuclein level was positively correlated with H-Y staging(P＜0.05).The area under the curve(AUC)of their combination to predict the occurrence of cognitive impairment in PD patients was 0.925,which was greater than prediction by α-synuclein,LC3,and Apo A1 alone(P＜0.05);α-synuclein,LC3,Apo A1,and history of hypertension were the influencing factors of CI in PD patients(P＜0.05).Conclusion α-synuclein is highly expressed in the serum of patients with PD complicated with cog-nitive impairment,while the expression of LC3 and Apo A1 are low.The three are closely related to PD cognitive function and disease progression.

Objective:To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH) treated by pulmonary endarterectomy(PEA).Methods:45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled, including 25 females and 20 males. The mean age of operation was 51.2(25-70) years old. 24(53.5%) patients were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ. The mean PVR before operation was 923(461-2 711) dyn·s·cm -5. All patients’ data were entered in a prospective database, divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC). To assess risk factors for postoperative respiratory complications and its effect on short term outcomes. Results:There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg) and PVR(from 923 dyn·s·cm -5 to 293 dyn·s·cm -5) in the entire group. The in-hospital mortality rate was 4.4%(2 cases), died due to postoperative cardiogenic circulatory failure, even with VA-ECMO treatment and mediastinal infection, respectively. Postoperative respiratory complications occurred in 32 patients(71.1%). The most common complications were reperfusion pulmonary edema 44.4%(20 cases) and residual pulmonary hypertension 11.1%(5 cases). The WRC group showed a tendency to have longer periods of mechanical ventilation, longer ICU stays and more ICU costs. Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months( OR=12.2, 95% CI: 2.1-70.7, P=0.005)and six-minute walking distance<300 m( OR=12.6, 95% CI: 1.1-138.0, P=0.0038). Conclusion:Pulmonary endarterectomy is an effective and safe treatment for CTEPH. Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status. Patients with CTEPH should consider PEA surgery early.

Objective:To investigate the effects of sedatives on the activity of the diaphragm assessed by ultrasound and the timing of extubation in elderly patients after elective surgery.Methods:All 60 eligible elderly patients were randomly divided into three groups: the propofol group, the midazolam group and the control group(n=20, each group). Remifentanil was used in the three groups to keep the Critical Care Pain Observation Tool(CPOT)score less than 3.Patients in the propofol and midazolam groups were given propofol and midazolam sedation respectively, and the Richmond Agitation Sedation Scale(RASS)score was maintained at -2.Diaphragmatic activity was measured, the time from the end of the operation to extubation was recorded, and delirium was evaluated, and the above results were compared with those of the control group, which did not receive sedatives.Results:The activity of the diaphragm was lower in the propofol and midazolam groups than in the control group[(1.10±0.12)cm, (1.17±0.30)cm vs.(1.63±0.25)cm, F=30.170, P=0.000], and there was no significant difference between the propofol group and the midazolam group( t=25.340, P=0.615). There was no significant difference in duration of extubation among the propofol, midazolam and control groups[(1.41±2.08)d, (1.25±1.53)d vs.(1.19±1.40)d, F=0.089, P=0.915]. The incidence of delirium was higher in the midazolam group than in the propofol and control groups[55.0%(11/20), 20.0%(4/20) vs.15.0%(3/20), χ2=5.230, P=0.022, χ2=7.030, P=0.008)], but the difference between the propofol group and control group was not statistically significant( χ2=0.170, P=0.677). Conclusions:The application of sedatives after elective surgery has an effect on the activity of the diaphragm in elderly patients, and the effects of propofol and midazolam are similar.However, propofol and midazolam have no influence on the duration of extubation in elderly patients after elective surgery.Compared with propofol, midazolam increases the incidence of delirium in elderly patients after elective surgery.