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.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective To compare the safety of laparoscopic pancreatoduodenectomy(LPD)and open pancreatoduodenectomy(OPD)and analyze the learning curve and safety at different stages of LPD.Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024,and intraoperative and postoperative conditions were compared.The Cumulative Sum(CUSUM)analysis method was used to analyze the technical nodes of the LPD learning curve.Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group(P＞0.05).There was also no significant difference in the incidence rates of pancreatic fistula(grade B and C),delayed gastric emptying,postoperative bleeding,biliary fistula and intra-abdominal infection between the LPD group and the OPD group(P＞0.05).A time series plot of operation time was drawn based on the patient's operation time and surgical sequence,yielding a fitted curve.Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases.The LPD learning curve could be divided into three stages:stage Ⅰ characterized as the initial stage(cases 1 to 17),stage Ⅱ characterized as the stable stage(cases 18 to 24),and stage Ⅲ characterized as the proficient stage(cases 25 to 50).The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ,and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ(P＜0.05).There was no significant difference in the incidence of complications among the three stages(P＞0.05).Conclusion LPD and OPD show no significant differences in indications and safety.The LPD learning curve can be divided into three stages.As the number of surgeries completed increa-ses,the operation time of physicians gradually shortens,and the incidence of complications of patients gradually decreases.

Dental caries is the most common oral disease in children,not only impairing chewing,speech,and other functions while also impacting maxillofacial development and overall health.Recent researches have established the"ecological plaque theory",which posits that an imbalance in the oral plaque microecology leads to the demineralization of teeth hard tissues,as the widely ac-cepted etiology of dental caries.However,the significant variability in the composition and function of children's plaque microorgan-isms,influenced by primary tooth eruption and replacement,changes in diet,and increase in social interactions,makes traditional culture methods inadequate for studying this complex micro-ecosystem.Advances in multi-omics technologies have recently created new opportunities for studiing complex microecology.High-throughput sequencing technologies,such as 16S rRNA gene sequencing and metagenomics,allow for the exploration of microbial diversity and the analysis of genomic functions and their associations with dental caries.Mass spectrometry-based technologies,including metabolomics and proteomics,might elucidate the molecular mecha-nisms of dental caries by analyzing differential metabolites and pathways.This review focuses on the application of multi-omics tech-nologies to explore the relationships between the structure,function,and metabolic state of oral microbial communities and pediatric dental caries.It further discusses the future of oral microorganisms as diagnosis and therapeutic targets for caries,and is expected to provide novel strategies for the prevention and treatment of pediatric dental caries.

Coronary CT angiography(CCTA)plays an important role in study of coronary atherosclerotic plaques,which can be used to assess plaque composition and vulnerability,hence predicting major adverse cardiovascular events.Furthermore,CCTA combined with radiomics analysis is helpful for optimizing cardiovascular risk stratification.The research progresses in CCTA of coronary atherosclerotic plaques were reviewed in this article.

Dental caries is the most common oral disease in children,not only impairing chewing,speech,and other functions while also impacting maxillofacial development and overall health.Recent researches have established the"ecological plaque theory",which posits that an imbalance in the oral plaque microecology leads to the demineralization of teeth hard tissues,as the widely ac-cepted etiology of dental caries.However,the significant variability in the composition and function of children's plaque microorgan-isms,influenced by primary tooth eruption and replacement,changes in diet,and increase in social interactions,makes traditional culture methods inadequate for studying this complex micro-ecosystem.Advances in multi-omics technologies have recently created new opportunities for studiing complex microecology.High-throughput sequencing technologies,such as 16S rRNA gene sequencing and metagenomics,allow for the exploration of microbial diversity and the analysis of genomic functions and their associations with dental caries.Mass spectrometry-based technologies,including metabolomics and proteomics,might elucidate the molecular mecha-nisms of dental caries by analyzing differential metabolites and pathways.This review focuses on the application of multi-omics tech-nologies to explore the relationships between the structure,function,and metabolic state of oral microbial communities and pediatric dental caries.It further discusses the future of oral microorganisms as diagnosis and therapeutic targets for caries,and is expected to provide novel strategies for the prevention and treatment of pediatric dental caries.

Coronary CT angiography(CCTA)plays an important role in study of coronary atherosclerotic plaques,which can be used to assess plaque composition and vulnerability,hence predicting major adverse cardiovascular events.Furthermore,CCTA combined with radiomics analysis is helpful for optimizing cardiovascular risk stratification.The research progresses in CCTA of coronary atherosclerotic plaques were reviewed in this article.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective To discuss the clinical safety,feasibility and efficacy of transcatheter arterial infusion chemotherapy(TAI)combined with lipiodol chemoembolization in the treatment of advanced colorectal cancer(CRC).Methods The clinical data of 37 patients with advanced CRC,who received TAI combined with lipiodol chemoembolization at the First Affiliated Hospital of Zhengzhou University of China between June 2016 and December 2022,were retrospectively analyzed.The clinical efficacy was evaluated,the progression-free survival(PFS)and the serious complications were recorded.Results A total of 55 times of TAI combined with lipiodol chemoembolization procedures were successfully accomplished in the 37 patients.The mean used amount of lipiodol emulsion was 2.9 mL(0.8-10 mL).No serious complications such as bleeding and intestinal perforation occurred.The median follow-up time was 24 months(range of 3-48 months).The postoperative one-month,3-month,6-month and 12-month objective remission rates(ORR)were 67.6%(25/37),67.6%(25/37),64.9%(24/37)and 56.8%(21/37)respectively,and the postoperative one-month,3-month,6-month and 12-month disease control rates(DCR)were 91.9%(34/37),91.9%(34/37),89.2%(33/37)and 81.1%(30/37)respectively.The median PFS was 16 months(range of 2-47 months).As of the last follow-up,22 patients survived and 15 patients died of terminal stage of tumor.Conclusion Preliminary results of this study indicate that TAI combined with lipiodol chemoembolization is clinically safe and effective for advanced CRC,and it provide a new therapeutic method for patients with advanced CRC.

Herpes simplex viruses type 1(HSV1)is among the most ubiquitous human pathogens that cause a wide variety of disease states.The latent infection of the central nervous system and sporadically reactivation is the central part of HSV1 pathogenesis,which also brings challenges to antiviral therapies.At present,the mechanism of establishing,maintaining and reactivation of HSV1 has not been fully clarified,whereas it has been generally accepted that the epigenetic regulation may play an important role.Accumulating researches have also indicated that the lytic and latent viral genomes exhibit the different chromatin structures,and the accumulation of diverse post-translational modifies the histones endow viral genes with transcriptional activation or repression features.In addition,the latency-associate transcripts of virus may also participate in the genome epigenetic modification.In this review,we summarize the research progress of epigenetic regulation of HSV1 and highlight the critical role of chromatin remodeling in HSV1 lytic proliferation and establishment of latent infection.