In the context of an aging society,the number of elderly cancer patients is constantly increasing,and geriatric oncology has garnered significant attention in recent years.Given the heterogeneity in the health status of older patients,it has become increasingly important to provide individualized diagnosis,treatment,follow-up,and care.Thus,it must be emphasized the Comprehensive Geriatric Assessment(CGA)for elderly patients,which encompasses their physical function,nutritional status,cognitive function,emotional state,comorbidities,polypharmacy,social situation,and treatment preferences.This article provides consensus recommendations on CGA tools for elderly patients prior to anticancer treatment,offering valuable references and insights for clinical practice in China.

Objective To compare the effectiveness between ultrasound-guided paravertebral block(PVB)and general anesthesia in percutaneous nephrolithotomy(PCNL).Methods Clinical data of 284 patients who underwent PCNL in our hospital from January 2023 to March 2024 were collected.These were 78 cases of PVB(PVB group)and 206 cases of general anesthesia(general anesthesia group).A total of 61 cases in each of the two groups were matched with propensity score,and the operative time,intraoperative fluid infusion volume,postoperative haemoglobin changes,postoperative visual analogue scale(VAS),hospital stay,hospital costs,and incidence of postoperative complications were compared.Results The operations were completed in both groups of patients successfully,with stable vital signs during the operation and no intraoperative anesthetic complications such as bradycardia,respiratory depression,or hypotension.There were significant differences between the two groups in heart rate(HR)before the start of surgery[(66.5±10.4)beats/min vs.(77.5±11.7)beats/min,t=-5.471,P=0.000],HR at the end of surgery[(60.5±8.4)beats/min vs.(71.0±12.3)beats/min,t=-5.472,P=0.000],mean arterial pressure(MAP)before the start of surgery[(97.2±11.9)mm Hg vs.(103.1±12.3)mm Hg,t=-2.694,P=0.008],MAP at the end of surgery[(85.2±8.8)mm Hg vs.(94.3±11.6)mm Hg,t=-4.892,P=0.000],pulse oxygen saturation(SpO2)before the start of surgery[(99.0±1.1)％vs.(99.6±0.6)％,t=-3.347,P=0.001]and SpO2 at the end of surgery[(99.2±1.1)％vs.(99.8±0.4)％,t=-4.122,P=0.000].The operative time was significantly shorter in the PVB group than that in the general anesthesia group[55.0(41.5,75.5)min vs.95.0(65.0,130.0)min,Z=-5.173,P=0.000].The postoperative haemoglobin changes[5(2,11)g/L vs.8(4,11)g/L,Z=-2.099,P=0.036],postoperative VAS score[1(1,1)points vs.1(1,2)points,Z=-3.342,P=0.001],postoperative hospital stay[3(2,3)dvs.4(3,6)d,Z=-6.016,P=0.000]and hospital costs[(14 499.4±2141.0)yuan vs.(19 634.2±3846.8)yuan,t=-9.109,P=0.000]were statistically lower in the PVB group than those in the general anesthesia group.Comparison of intraoperative fluid infusion volume[600(600,600)ml vs.600(600,1100)ml,Z=-1.800,P=0.072],postoperative venting time[1(1,1)d vs.1(1,1)d,Z=-1.045,P=0.296],and phase Ⅰ stone removal rate[88.5％(54/61)vs.82.0％(50/61),x2=1.043,P=0.307]showed no significant differences between the two groups.The incidence of postoperative complications in the PVB group was significantly lower than that in the general anesthesia group[6.6％(4/61)vs.19.7％(12/61),x2=4.604,P=0.032].Conclusion Ultrasound-guided PVB in PCNL maintains stable intraoperative vital signs,reduces operative time and bleeding,alleviates postoperative pain,reduces postoperative complications and postoperative hospital stay,and saves medical costs,having a good safety and efficacy.

Objective To investigate the mechanism of action of Ginkgo biloba extract on schizophrenia based on oxidative stress-mediated damage to PV interneurons.Methods 54 SPF grade male mice were selected as experimental subjects,divided into blank group,model group,ginkgo biloba extract 50 mg·kg-1,100 mg·kg-1,150 mg·kg-1 group,and risperidone group.Schizophrenic mouse models were established by intraperitoneal injection of MK-801 0.3 mg·kg-1,and behavioral(open field experiment,Y-maze,forced swimming)tests were conducted.Blood samples and brain tissue were collected 24 h after the last dose,Immunofluorescence staining was used to detect changes in PV neurons in the mouse brain;Detect the content of MAD,GSH Px,and SOD in serum using a reagent kit;ELISA method was used to detect the levels of iron and lipid peroxidation in mouse brain tissue;Western blot was used to detect the protein level of GPX4 in the mouse brain.Results Compared with the model group,the Ginkgo biloba leaf extract 150 mg·kg-1 group and the risperidone group significantly reduced the spontaneous alternation rate of the Y maze and significantly shortened the immobility time of forced swimming(P<0.05);PV neuron staining with varying degrees of enhanced fluorescence intensity;The MDA content in the serum of mice was significantly reduced(P<0.01),while the contents of SOD and GSH px were significantly increased(P<0.05);The iron content in the mouse brain was significantly reduced(P<0.05),the ROS content was significantly reduced(P<0.05),and the GPX4 content in the mouse brain was significantly increased(P<0.05).Conclusion Ginkgo biloba extract has a significant improvement effect on negative symptoms and cognitive impairment in MK-801 induced schizophrenia mouse models,and can also improve PV neuron damage in the prefrontal cortex of schizophrenia mice.Its mechanism may be related to the inhibition of iron death mediated oxidative stress by Ginkgo biloba extract.

Objective To investigate the mechanism of action of Ginkgo biloba extract on schizophrenia based on oxidative stress-mediated damage to PV interneurons.Methods 54 SPF grade male mice were selected as experimental subjects,divided into blank group,model group,ginkgo biloba extract 50 mg·kg-1,100 mg·kg-1,150 mg·kg-1 group,and risperidone group.Schizophrenic mouse models were established by intraperitoneal injection of MK-801 0.3 mg·kg-1,and behavioral(open field experiment,Y-maze,forced swimming)tests were conducted.Blood samples and brain tissue were collected 24 h after the last dose,Immunofluorescence staining was used to detect changes in PV neurons in the mouse brain;Detect the content of MAD,GSH Px,and SOD in serum using a reagent kit;ELISA method was used to detect the levels of iron and lipid peroxidation in mouse brain tissue;Western blot was used to detect the protein level of GPX4 in the mouse brain.Results Compared with the model group,the Ginkgo biloba leaf extract 150 mg·kg-1 group and the risperidone group significantly reduced the spontaneous alternation rate of the Y maze and significantly shortened the immobility time of forced swimming(P<0.05);PV neuron staining with varying degrees of enhanced fluorescence intensity;The MDA content in the serum of mice was significantly reduced(P<0.01),while the contents of SOD and GSH px were significantly increased(P<0.05);The iron content in the mouse brain was significantly reduced(P<0.05),the ROS content was significantly reduced(P<0.05),and the GPX4 content in the mouse brain was significantly increased(P<0.05).Conclusion Ginkgo biloba extract has a significant improvement effect on negative symptoms and cognitive impairment in MK-801 induced schizophrenia mouse models,and can also improve PV neuron damage in the prefrontal cortex of schizophrenia mice.Its mechanism may be related to the inhibition of iron death mediated oxidative stress by Ginkgo biloba extract.

Objective To compare the effectiveness between ultrasound-guided paravertebral block(PVB)and general anesthesia in percutaneous nephrolithotomy(PCNL).Methods Clinical data of 284 patients who underwent PCNL in our hospital from January 2023 to March 2024 were collected.These were 78 cases of PVB(PVB group)and 206 cases of general anesthesia(general anesthesia group).A total of 61 cases in each of the two groups were matched with propensity score,and the operative time,intraoperative fluid infusion volume,postoperative haemoglobin changes,postoperative visual analogue scale(VAS),hospital stay,hospital costs,and incidence of postoperative complications were compared.Results The operations were completed in both groups of patients successfully,with stable vital signs during the operation and no intraoperative anesthetic complications such as bradycardia,respiratory depression,or hypotension.There were significant differences between the two groups in heart rate(HR)before the start of surgery[(66.5±10.4)beats/min vs.(77.5±11.7)beats/min,t=-5.471,P=0.000],HR at the end of surgery[(60.5±8.4)beats/min vs.(71.0±12.3)beats/min,t=-5.472,P=0.000],mean arterial pressure(MAP)before the start of surgery[(97.2±11.9)mm Hg vs.(103.1±12.3)mm Hg,t=-2.694,P=0.008],MAP at the end of surgery[(85.2±8.8)mm Hg vs.(94.3±11.6)mm Hg,t=-4.892,P=0.000],pulse oxygen saturation(SpO2)before the start of surgery[(99.0±1.1)％vs.(99.6±0.6)％,t=-3.347,P=0.001]and SpO2 at the end of surgery[(99.2±1.1)％vs.(99.8±0.4)％,t=-4.122,P=0.000].The operative time was significantly shorter in the PVB group than that in the general anesthesia group[55.0(41.5,75.5)min vs.95.0(65.0,130.0)min,Z=-5.173,P=0.000].The postoperative haemoglobin changes[5(2,11)g/L vs.8(4,11)g/L,Z=-2.099,P=0.036],postoperative VAS score[1(1,1)points vs.1(1,2)points,Z=-3.342,P=0.001],postoperative hospital stay[3(2,3)dvs.4(3,6)d,Z=-6.016,P=0.000]and hospital costs[(14 499.4±2141.0)yuan vs.(19 634.2±3846.8)yuan,t=-9.109,P=0.000]were statistically lower in the PVB group than those in the general anesthesia group.Comparison of intraoperative fluid infusion volume[600(600,600)ml vs.600(600,1100)ml,Z=-1.800,P=0.072],postoperative venting time[1(1,1)d vs.1(1,1)d,Z=-1.045,P=0.296],and phase Ⅰ stone removal rate[88.5％(54/61)vs.82.0％(50/61),x2=1.043,P=0.307]showed no significant differences between the two groups.The incidence of postoperative complications in the PVB group was significantly lower than that in the general anesthesia group[6.6％(4/61)vs.19.7％(12/61),x2=4.604,P=0.032].Conclusion Ultrasound-guided PVB in PCNL maintains stable intraoperative vital signs,reduces operative time and bleeding,alleviates postoperative pain,reduces postoperative complications and postoperative hospital stay,and saves medical costs,having a good safety and efficacy.

The difficulty in the treatment of diabetic foot lies in the high rate of recurrence and difficulty in eradicating the disease, and the results of both systemic basic treatment and local surgical treatment are not ideal. In recent years, domestic scholars have applied tibial transverse transport for the treatment of diabetic foot. Tibial transverse transport is suitable for the treatment of severe diabetic foot with a good blood supply of the large and middle arteries. It has the advantages of high healing rate and low recurrence rate, and can effectively reduce the mortality and amputation rate of patients. However, postoperative complications such as tibial osteotomy fracture, pin tract infection, skin necrosis at osteotomy area, tibial deformity and osteomyelitis should be paid attention to. Domestic scholars have improved the operation of tibial transverse bone transport in terms of reducing the surgical incision, osteotomy area, and preserving the blood supply of the osteotomy site. The modified double bone flap transverse tibial bone transport and "door" shaped window technique have been derived, and related surgical instruments have also been improved in the direction of precision. At present, the research on the mechanism of tibial transverse transport in the treatment of diabetic foot mainly focuses on promoting the reconstruction of macrophage polarization balance, stem cell mobilization and angiogenesis. After tibial transverse transport, the polarization of macrophages to classical activated type was decreased, and the polarization of selective activated type was increased. The two mechanisms promoted each other to reconstruct the polarization balance of macrophages. Bone transport activated SDF-1/CXCR4/PI3K/AKT and Wnt signaling pathways to induce stem cell mobilization. At the same time, it stimulates the release of angiogenic factors, activation of endothelial progenitor cells and Ras/Raf/MEK/ERK signaling pathways to promote angiogenesis and ultimately promote the healing of diabetic foot ulcers.

The difficulty in the treatment of diabetic foot lies in the high rate of recurrence and difficulty in eradicating the disease, and the results of both systemic basic treatment and local surgical treatment are not ideal. In recent years, domestic scholars have applied tibial transverse transport for the treatment of diabetic foot. Tibial transverse transport is suitable for the treatment of severe diabetic foot with a good blood supply of the large and middle arteries. It has the advantages of high healing rate and low recurrence rate, and can effectively reduce the mortality and amputation rate of patients. However, postoperative complications such as tibial osteotomy fracture, pin tract infection, skin necrosis at osteotomy area, tibial deformity and osteomyelitis should be paid attention to. Domestic scholars have improved the operation of tibial transverse bone transport in terms of reducing the surgical incision, osteotomy area, and preserving the blood supply of the osteotomy site. The modified double bone flap transverse tibial bone transport and "door" shaped window technique have been derived, and related surgical instruments have also been improved in the direction of precision. At present, the research on the mechanism of tibial transverse transport in the treatment of diabetic foot mainly focuses on promoting the reconstruction of macrophage polarization balance, stem cell mobilization and angiogenesis. After tibial transverse transport, the polarization of macrophages to classical activated type was decreased, and the polarization of selective activated type was increased. The two mechanisms promoted each other to reconstruct the polarization balance of macrophages. Bone transport activated SDF-1/CXCR4/PI3K/AKT and Wnt signaling pathways to induce stem cell mobilization. At the same time, it stimulates the release of angiogenic factors, activation of endothelial progenitor cells and Ras/Raf/MEK/ERK signaling pathways to promote angiogenesis and ultimately promote the healing of diabetic foot ulcers.

Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disease. Given the heterogeneity of ARDS due to the wide range of etiological, clinical, and molecular manifestations, the current scientific consensus is that ARDS is not a single disease, but rather a set of diseases that require further research to properly classify and identify. Metabonomics, as a rapidly developing field of systems biology, has made many breakthroughs in science and medicine as an interdisciplinary platform. Metabonomics provides an important opportunity for the discovery and analysis of biomarkers in the diagnosis of ARDS, which is expected to reveal the biological process behind ARDS and show great potential in solving the heterogeneity and severity assessment of ARDS. This review focuses on the literature of ARDS metabonomics and summarizes the progress of ARDS metabonomics research and the main obstacles.

Objective:To explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture.Methods:A retrospective cohort study was conducted. From July 2016 to January 2020, 11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University, including 7 males and 4 females, aged 8 to 48 years. The lesions involved unilateral axilla in 9 cases and bilateral axilla in 2 cases, with the joint abduction angle of the affected shoulder ranging from 25 to 100°. The axillary fold contracture scars were excised and released, resulting in wound of 8 cm×5 cm-24 cm×20 cm. According to the condition of the residual normal skin in axilla, 2, 3, and 4-leaf propeller flaps with area of 5 cm×3 cm-24 cm×10 cm were designed to repair the wounds after scar excision and release. The donor site wound was closed by suturing directly, and the residual wound that could not be completely sutured was transplanted with free full-thickness skin grafts from the inner thigh or abdomen. The application of 2, 3, and 4-leaf propeller flaps, the joint abduction angle of the affected shoulder immediately after operation, and the survival of the flaps and skin grafts after operation were recorded. The recurrence of scar contracture, the appearance of the flaps, the joint abduction angle of the affected shoulder, and the functional recovery of the affected shoulder joint and upper arm were observed through a follow-up.Results:Among the 13 axillary propeller flaps transplanted in the 11 patients in this group, there were 9 double-leaf propeller flaps, two 3-leaf propeller flaps, and two 4-leaf propeller flaps. The joint abduction angle of the affected shoulder reached 110-165° immediately after operation. All the flaps survived after operation. Nine flap donor sites were repaired with free skin grafts, with skin grafts survived in 7 flap donor sites after operation. Scar erosion in incision and small area of skin graft necrosis developed in 2 flap donor sites. One of the wounds was debrided and repaired by transplantation of split-thickness skin grafts from inner thigh, and the other wound was healed after dressing changes. A follow-up of 6 to 24 months was conducted after surgery, and all the patients had no recurrence of axillary scar contracture; the color of the flap matched the receiving area; the elasticity of flap was good; the joint abduction angle of the affected shoulder reached 120-165°, and the joint pronation and supination, upper arm lifting and circular rotation of the affected shoulder were all good.Conclusions:Reconstruction of the axillary fold scar contracture with axillary propeller flaps has good result, with better flap appearance and recovery of the shoulder joint activity and upper arm function after operation.

Objective : To investigate the prevalence and distribution of skeletal malocclusion and axial inclination of the maxillary central incisors in short root anomaly (SRA) patients in Kunming city, to provide some reference and guidance for SRA patients′ clinical diagnosis and treatment and prevention in SRA patients. Methods: A total of 1 000 cases were randomly selected from the CBCT database of patients admitted to the author′s hospital from January 2011 to July 2019, and a retrospective analysis was performed. A total of 27 patients with SRA were diagnosed (SRA group).The control group, consisted of 100 randomly selected patients from non-SRA patients. According to the clinical data and cephalometric data, skeletal malocclusion was divided into three subgroups: Class I skeletal malocclusion, Class II skeletal malocclusion and Class Ⅲ skeletal malocclusion. Additionally, the axial inclination of the central incisors was divided into three subgroups: the lingual inclination group, labial inclination group and normal inclination group. The two groups each according to sex, skeletal malocclusion and types of axial inclination of the maxillary central incisors were discussed. Results : The prevalence rate of SRA in the selected population was 2.7%, and the prevalence of SRA in females was 3.67% (21/572) , which was higher than that in males by 1.4% (6/428), and was significantly different between sexes (χ2=4.562, P=0.033). There was a significant difference between SRA patients and control group in terms of skeletal malocclusion (χ2=8.710, P=0.013). Class Ⅲ skeletal malocclusion was the main type of skeletal malocclusion in SRA. There was a significant difference between SRA patients and control group in terms of the axial inclination of the maxillary central incisors (χ2=16.75,P<0.001). Lingual inclination of the maxillary central incisors was the main type of axial inclination of the maxillary central incisors in SRA. Conclusion There is a certain correlation between class Ⅲ skeletal malocclusion and lingual inclination of the maxillary central incisors and SRA, and the root-crown ratio and root shape of these patients should be evaluated before orthodontics are implemented.