Objective:To explore the value of intraoperative multimodal monitoring in superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in evaluating hemodynamic parameters and blood-brain barrier disruption, as well as their correlations with postoperative perfusion changes.Methods:A retrospective case series study was performed; 60 patients with ischemic cerebrovascular diseases admitted to Department of Neurosurgery, Lianyungang Clinical Medical College of Nanjing Medical University (Lianyungang First People's Hospital) from March 2023 to October 2024 were selected, including 17 patients with moyamoya disease and 43 patients with chronic internal carotid artery occlusion and/or chronic symptomatic MCA stenosis/occlusion. All patients were confirmed by CTA or DSA and underwent STA-MCA M4 segment bypass surgery. Intraoperatively, microvascular Doppler ultrasound (MDU), sodium fluorescein angiography, and indocyanine green angiography combined with Flow800 (ICG-Flow800) were used to monitor the blood-brain barrier disruption grade, as well as the peak systolic velocity (PSV) and blood flow direction of the STA and recipient artery before and after arterial anastomosis. Cerebral blood perfusion improvement was reexamined by CT perfusion (CTP) 7 days and 1 month after surgery. These 60 patients were divided into a group with blood flow into the sylvian fissure (inflow group, n=27) and a group with blood flow out of the sylvian fissure (outflow group, n=33) according to the direction of recipient artery blood flow before arterial anastomosis, and further subdivided into subgroups with PSV≤10 cm/s and >10 cm/s based on the recipient artery PSV. Clinical and imaging data of these patients were collected and analyzed as follows: (1) CTP parameters such as cerebral blood volume, cerebral blood flow, mean transit time, and time to peak before surgery, 7 days after surgery, and 1 month after surgery were compared; (2) differences between the recipient artery PSV before arterial anastomosis and recipient artery exiting sylvian fissure velocity (RA.EXV) or recipient artery entering sylvian fissure velocity (RA.ESV) of the recipient artery after anastomosis were compared; (3) differences in ICG-Flow800 fluorescence intensity curve parameters such as delay time, rise time, curve slope, time to peak, and maximum fluorescence intensity of the cerebral surface veins before and after arterial anastomosis were compared; (4) spearman rank correlation was used to analyze the correlation of recipient artery PSV before arterial anastomosis with preoperative CTP parameters in all patients, the correlations of RA.ESV in the inflow group or RA.EXV in the outflow group with CTP parameters 7 days after surgery, and the correlations of blood-brain barrier disruption grade with preoperative CTP parameters, recipient artery PSV before arterial anastomosis, and RA.ESV or RA.EXV after arterial anastomosis in all patients. Results:(1) The blood flow direction of all recipient arteries became bidirectional after surgery. Cerebral blood perfusion improved to varying degrees after surgery: the mean transit time 7 days and 1 month after surgery, and cerebral blood flow 1 month after surgery were significantly higher compared with those before surgery ( P<0.05). (2) Regardless of the blood flow direction (into or out of the sylvian fissure), the RA.ESV or RA.EXV after anastomosis was significantly higher than the recipient artery PSV before anastomosis when the recipient artery PSV≤10 cm/s ( P<0.05). (3) For all patients, the ICG-Flow800 fluorescent intensity curve parameters of cerebral surface veins after anastomosis improved significantly compared with that before anastomosis ( P<0.05). (4) Preoperative recipient artery PSV was positively correlated with preoperative CBF in all patients ( rs=0.445, P=0.020). In the inflow group, postoperative RA.ESV was positively correlated with Tmax 7 days after surgery ( rs=0.490, P=0.009). The blood-brain barrier disruption grade was positively correlated with preoperative Tmax in all patients ( rs=0.478, P=0.012). Conclusion:Intraoperative multimodal monitoring in STA-MCA bypass surgery can provide surgeons with detailed hemodynamic parameters and blood-brain barrier disruption data, enabling real-time evaluation of surgical outcomes to optimize operative decision-making.

Objective:To evaluate the effect of superficial temporal artery to middle cerebral artery (STA-MCA) bypass on cognitive function, cerebral perfusion, and integrity of white matter tracts by comparing cognitive function scores, fractional anisotropy (FA), time to maximum (T max), and cerebral blood flow (CBF) at different time points before and after STA-MCA bypass, and analyze the relations of cognitive function with cerebral perfusion and white matter tract integrity so as to provide evidences for treatment of moyamoya disease (MMD) patients with mild cognitive impairment. Methods:A retrospective analysis was performed; 30 MMD patients with mild cognitive impairment received STA-MCA bypass at Department of Neurosurgery, Lianyungang Hospital Affiliated to Xuzhou Medical University (Lianyungang First People's Hospital) from January 2023 to August 2024 were enrolled. Before and 1, 3, and 6 months after STA-MCA bypass, all patients accepted Montreal cognitive assessment (MoCA), CT perfusion imaging, and diffusion tensor imaging (DTI). Differences in MoCA score, CBF, T max, and FA at different time points before and after surgery were compared. Spearman rank correlation was used to analyze the correlation of MoCA score with cerebral perfusion parameters and FA. Results:(1) In these MMD patients with mild cognitive impairment, CBF 3 and 6 months after STA-MCA bypass was significantly increased compared with that before STA-MCA bypass, and CBF 6 months after STA-MCA bypass was significantly higher than that 1 and 3 months after STA-MCA bypass ( P<0.05); T max 1, 3 and 6 months after STA-MCA bypass was significantly shortened compared with that before STA-MCA bypass, and T max 6 months after STA-MCA bypass was significantly shortened than that 1 and 3 months after STA-MCA bypass ( P<0.05); FA 6 months after STA-MCA bypass was significantly increased compared with that before, and 1 and 3 months after STA-MCA bypass ( P<0.05); MoCA score 6 months after STA-MCA bypass was significantly increased compared with that before and 1 month after STA-MCA bypass ( P<0.05). (2) In MMD patients with mild cognitive impairment, the preoperative MoCA score was positively correlated with preoperative CBF and FA ( r s=0.428, P=0.018; r s=0.438, P=0.015) and negatively correlated with preoperative T max ( r s=-0.380, P=0.039); 6 months after STA-MCA bypass, the MoCA score was positively correlated with CBF and FA ( r s=0.365, P=0.047; r s=0.400, P=0.028) and negatively correlated with T max ( r s=-0.371, P=0.043). Conclusion:STA-MCA bypass can improve cerebral perfusion, white matter fiber tract repair and cognitive function in MMD patients with mild cognitive impairment, and improvement of cognitive function is related to cerebral perfusion and white matter fiber tract repair.

Objective:To explore the value of intraoperative multimodal monitoring in superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in evaluating hemodynamic parameters and blood-brain barrier disruption, as well as their correlations with postoperative perfusion changes.Methods:A retrospective case series study was performed; 60 patients with ischemic cerebrovascular diseases admitted to Department of Neurosurgery, Lianyungang Clinical Medical College of Nanjing Medical University (Lianyungang First People's Hospital) from March 2023 to October 2024 were selected, including 17 patients with moyamoya disease and 43 patients with chronic internal carotid artery occlusion and/or chronic symptomatic MCA stenosis/occlusion. All patients were confirmed by CTA or DSA and underwent STA-MCA M4 segment bypass surgery. Intraoperatively, microvascular Doppler ultrasound (MDU), sodium fluorescein angiography, and indocyanine green angiography combined with Flow800 (ICG-Flow800) were used to monitor the blood-brain barrier disruption grade, as well as the peak systolic velocity (PSV) and blood flow direction of the STA and recipient artery before and after arterial anastomosis. Cerebral blood perfusion improvement was reexamined by CT perfusion (CTP) 7 days and 1 month after surgery. These 60 patients were divided into a group with blood flow into the sylvian fissure (inflow group, n=27) and a group with blood flow out of the sylvian fissure (outflow group, n=33) according to the direction of recipient artery blood flow before arterial anastomosis, and further subdivided into subgroups with PSV≤10 cm/s and >10 cm/s based on the recipient artery PSV. Clinical and imaging data of these patients were collected and analyzed as follows: (1) CTP parameters such as cerebral blood volume, cerebral blood flow, mean transit time, and time to peak before surgery, 7 days after surgery, and 1 month after surgery were compared; (2) differences between the recipient artery PSV before arterial anastomosis and recipient artery exiting sylvian fissure velocity (RA.EXV) or recipient artery entering sylvian fissure velocity (RA.ESV) of the recipient artery after anastomosis were compared; (3) differences in ICG-Flow800 fluorescence intensity curve parameters such as delay time, rise time, curve slope, time to peak, and maximum fluorescence intensity of the cerebral surface veins before and after arterial anastomosis were compared; (4) spearman rank correlation was used to analyze the correlation of recipient artery PSV before arterial anastomosis with preoperative CTP parameters in all patients, the correlations of RA.ESV in the inflow group or RA.EXV in the outflow group with CTP parameters 7 days after surgery, and the correlations of blood-brain barrier disruption grade with preoperative CTP parameters, recipient artery PSV before arterial anastomosis, and RA.ESV or RA.EXV after arterial anastomosis in all patients. Results:(1) The blood flow direction of all recipient arteries became bidirectional after surgery. Cerebral blood perfusion improved to varying degrees after surgery: the mean transit time 7 days and 1 month after surgery, and cerebral blood flow 1 month after surgery were significantly higher compared with those before surgery ( P<0.05). (2) Regardless of the blood flow direction (into or out of the sylvian fissure), the RA.ESV or RA.EXV after anastomosis was significantly higher than the recipient artery PSV before anastomosis when the recipient artery PSV≤10 cm/s ( P<0.05). (3) For all patients, the ICG-Flow800 fluorescent intensity curve parameters of cerebral surface veins after anastomosis improved significantly compared with that before anastomosis ( P<0.05). (4) Preoperative recipient artery PSV was positively correlated with preoperative CBF in all patients ( rs=0.445, P=0.020). In the inflow group, postoperative RA.ESV was positively correlated with Tmax 7 days after surgery ( rs=0.490, P=0.009). The blood-brain barrier disruption grade was positively correlated with preoperative Tmax in all patients ( rs=0.478, P=0.012). Conclusion:Intraoperative multimodal monitoring in STA-MCA bypass surgery can provide surgeons with detailed hemodynamic parameters and blood-brain barrier disruption data, enabling real-time evaluation of surgical outcomes to optimize operative decision-making.

Objective:To evaluate the effect of superficial temporal artery to middle cerebral artery (STA-MCA) bypass on cognitive function, cerebral perfusion, and integrity of white matter tracts by comparing cognitive function scores, fractional anisotropy (FA), time to maximum (T max), and cerebral blood flow (CBF) at different time points before and after STA-MCA bypass, and analyze the relations of cognitive function with cerebral perfusion and white matter tract integrity so as to provide evidences for treatment of moyamoya disease (MMD) patients with mild cognitive impairment. Methods:A retrospective analysis was performed; 30 MMD patients with mild cognitive impairment received STA-MCA bypass at Department of Neurosurgery, Lianyungang Hospital Affiliated to Xuzhou Medical University (Lianyungang First People's Hospital) from January 2023 to August 2024 were enrolled. Before and 1, 3, and 6 months after STA-MCA bypass, all patients accepted Montreal cognitive assessment (MoCA), CT perfusion imaging, and diffusion tensor imaging (DTI). Differences in MoCA score, CBF, T max, and FA at different time points before and after surgery were compared. Spearman rank correlation was used to analyze the correlation of MoCA score with cerebral perfusion parameters and FA. Results:(1) In these MMD patients with mild cognitive impairment, CBF 3 and 6 months after STA-MCA bypass was significantly increased compared with that before STA-MCA bypass, and CBF 6 months after STA-MCA bypass was significantly higher than that 1 and 3 months after STA-MCA bypass ( P<0.05); T max 1, 3 and 6 months after STA-MCA bypass was significantly shortened compared with that before STA-MCA bypass, and T max 6 months after STA-MCA bypass was significantly shortened than that 1 and 3 months after STA-MCA bypass ( P<0.05); FA 6 months after STA-MCA bypass was significantly increased compared with that before, and 1 and 3 months after STA-MCA bypass ( P<0.05); MoCA score 6 months after STA-MCA bypass was significantly increased compared with that before and 1 month after STA-MCA bypass ( P<0.05). (2) In MMD patients with mild cognitive impairment, the preoperative MoCA score was positively correlated with preoperative CBF and FA ( r s=0.428, P=0.018; r s=0.438, P=0.015) and negatively correlated with preoperative T max ( r s=-0.380, P=0.039); 6 months after STA-MCA bypass, the MoCA score was positively correlated with CBF and FA ( r s=0.365, P=0.047; r s=0.400, P=0.028) and negatively correlated with T max ( r s=-0.371, P=0.043). Conclusion:STA-MCA bypass can improve cerebral perfusion, white matter fiber tract repair and cognitive function in MMD patients with mild cognitive impairment, and improvement of cognitive function is related to cerebral perfusion and white matter fiber tract repair.

Schistosomiasis was once hyper-endemic in Yunnan Province. Following concerted efforts for over 70 years, remarkable achievements have been made for schistosomiasis control in the province. In 2004, the Mid- and Long-term Plan for Schistosomiasis Prevention and Control in Yunnan Province was initiated in Yunnan Province, and the target for transmission control of schistosomiasis was achieved in the province in 2009. Following the subsequent implementation of the Outline for Key Projects in Integrated Schistosomiasis Control Program (2009—2015) and the 13th Five - year Plan for Schistosomiasis Control in Yunnan Province, no acute schistosomiasis had been identified in Yunnan Province for successive 12 years, and no local Schistosoma japonicum infections had been detected in humans, animals or Oncomelania hupensis snails for successive 6 years in the province by the end of 2020. The transmission of schistosomiasis was interrupted in Yunnan Province in 2020. This review summarizes the history of schistosomiasis, changes in schistosomiasis prevalence and progress of schistosomiasis control in Yunnan Province, and proposes the future priorities for schistosomiasis control in the province.

Objective To predict the potential geographic distribution of Oncomelania hupensis in Yunnan Province using random forest (RF) and maximum entropy (MaxEnt) models, so as to provide insights into O. hupensis surveillance and control in Yunnan Province. Methods The O. hupensis snail survey data in Yunnan Province from 2015 to 2016 were collected and converted into O. hupensis snail distribution site data. Data of 22 environmental variables in Yunnan Province were collected, including twelve climate variables (annual potential evapotranspiration, annual mean ground surface temperature, annual precipitation, annual mean air pressure, annual mean relative humidity, annual sunshine duration, annual mean air temperature, annual mean wind speed, ≥ 0 ℃ annual accumulated temperature, ≥ 10 ℃ annual accumulated temperature, aridity and index of moisture), eight geographical variables (normalized difference vegetation index, landform type, land use type, altitude, soil type, soil textureclay content, soil texture-sand content and soil texture-silt content) and two population and economic variables (gross domestic product and population). Variables were screened with Pearson correlation test and variance inflation factor (VIF) test. The RF and MaxEnt models and the ensemble model were created using the biomod2 package of the software R 4.2.1, and the potential distribution of O. hupensis snails after 2016 was predicted in Yunnan Province. The predictive effects of models were evaluated through cross-validation and independent tests, and the area under the receiver operating characteristic curve (AUC), true skill statistics (TSS) and Kappa statistics were used for model evaluation. In addition, the importance of environmental variables was analyzed, the contribution of environmental variables output by the models with AUC values of > 0.950 and TSS values of > 0.850 were selected for normalization processing, and the importance percentage of environmental variables was obtained to analyze the importance of environmental variables. Results Data of 148 O. hupensis snail distribution sites and 15 environmental variables were included in training sets of RF and MaxEnt models, and both RF and MaxEnt models had high predictive performance, with both mean AUC values of > 0.900 and all mean TSS values and Kappa values of > 0.800, and significant differences in the AUC (t = 19.862, P < 0.05), TSS (t = 10.140, P < 0.05) and Kappa values (t = 10.237, P < 0.05) between two models. The AUC, TSS and Kappa values of the ensemble model were 0.996, 0.954 and 0.920, respectively. Independent data verification showed that the AUC, TSS and Kappa values of the RF model and the ensemble model were all 1, which still showed high performance in unknown data modeling, and the MaxEnt model showed poor performance, with TSS and Kappa values of 0 for 24%(24/100) of the modeling results. The modeling results of 79 RF models, 38 MaxEnt models and their ensemble models with AUC values of > 0.950 and TSS values of > 0.850 were included in the evaluation of importance of environmental variables. The importance of annual sunshine duration (SSD) was 32.989%, 37.847% and 46.315% in the RF model, the MaxEnt model and their ensemble model, while the importance of annual mean relative humidity (RHU) was 30.947%, 15.921% and 28.121%, respectively. Important environment variables were concentrated in modeling results of the RF model, dispersed in modeling results of the MaxEnt model, and most concentrated in modeling results of the ensemble model. The potential distribution of O. hupensis snails after 2016 was predicted to be relatively concentrated in Yunnan Province by the RF model and relatively large by the MaxEnt model, and the distribution of O. hupensis snails predicted by the ensemble model was mostly the joint distribution of O. hupensis snails predicted by RF and MaxEnt models. Conclusions Both RF and MaxEnt models are effective to predict the potential distribution of O. hupensis snails in Yunnan Province, which facilitates targeted O. hupensis snail control.

Moyamoya disease is a cerebrovascular disease characterized by progressive stenosis of the distal end of the internal carotid artery, followed by the formation of an abnormal vascular network in the skull base. At present, the main treatment approach is to perform superficial temporal artery to middle cerebral artery bypass grafting to increase cerebral blood flow and improve the symptoms of patients. Cerebral hyperperfusion syndrome (CHS) is a common complication after revascularization, which can lead to more severe complications such as transient neurological events and intracranial hemorrhage. Therefore, predicting the occurrence of CHS through multimodal intraoperative monitoring is crucial for improving the outcomes of patients. This article reviews various common intraoperative monitoring techniques for predicting CHS.

The occurrence of obesity has increased across the whole world. Many epidemiological studies have indicated that obesity strongly contributes to the development of cancer, cardiovascular diseases, type 2 diabetes, liver diseases and other disorders, accounting for a heavy burden on the public and on health-care systems every year. Excess energy uptake induces adipocyte hypertrophy, hyperplasia and formation of visceral fat in other non-adipose tissues to evoke cardiovascular disease, liver diseases. Adipose tissue can also secrete adipokines and inflammatory cytokines to affect the local microenvironment, induce insulin resistance, hyperglycemia, and activate associated inflammatory signaling pathways. This further exacerbates the development and progression of obesity-associated diseases. Although some progress in the treatment of obesity has been achieved in preclinical and clinical studies, the progression and pathogenesis of obesity-induced diseases are complex and unclear. We still need to understand their links to better guide the treatment of obesity and associated diseases. In this review, we review the links between obesity and other diseases, with a view to improve the future management and treatment of obesity and its co-morbidities.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective To investigate the correlation between iron metabolism index and intelligence development of Dongxiang and Han students in Dongxiang county and Lanzhou city of Gansu province.Methods A total of 396 students aged from 6 to 11 years old were randomly selected for venous blood collection from two primary schools with Dongxiang and Han children in Dongxiang county and Lanzhou city.Blood routine and serum iron metabolism indicators were detected and iron metabolism indicators from different ethnic groups were analyzed.Students diagnosed with iron deficiency anemia(IDA) named as IDA group,and students without IDA who had similar background were enrolled in the control group.The correlation between iron metabolism index and intelligence quotient was analyzed.Results The ferritin level of Dongxiang students (51.81 μg/L)was lower than that of Han students(65.73 μg/L),and total iron binding capacity of students in Dongxiang county [(65.04 ± 6.68) μ mol/L] was higher than that of students in Lanzhou city [(59.92 ±5.91) μmol/L].The transferrinsaturation of students in Dongxiang county [0.23 (0.19 ～ 0.30)] was lower than that of students in Lanzhou city[0.26(0.20 ～0.32)].The differences were statistically significant(P ＜0.05).Analysis of multiple linear regression showed that ferritin and serum iron were correlated to intelligence quotient score of the IDA students (P ＜ 0.05).Conclusion Ferritin and serum iron are associated with primary school students' intelligence quotient.Religious practice,regional economic and cultural level have a certain influence on iron metabolism of local primary school students.It is very important to strengthen the supplement of dietary iron in primary school students in Dongxiang County and reduce the prevalence of iron deficiency.