Objective:To evaluate the relationship between physical activity (PA) and postoperative delirium (POD) in elderly patients undergoing knee or hip arthroplasty.Methods:The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort, which was a nested case-control study. Medical records from elderly patients undergoing elective knee or hip arthroplasty under spinal-epidural anesthesia at Qingdao Municipal Hospital from August 2022 to August 2023 were collected. The patients were divided into a POD group ( n=89) and a non-POD group ( n=221) based on the occurrence of POD. Peripheral blood samples were collected before surgery, and the cerebrospinal fluid (CSF) 2 ml was extracted after successful puncture under spinal-epidural anesthesia for determination of the concentrations of amyloid-β 42 (Aβ 42), total tau protein (t-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay. Logistic regression was used to analyze the influencing factors of POD, and the mediation analysis was conducted to examine the mediating role of CSF biomarker in the relationship between PA and POD. Results:Logistic regression analysis showed that the increased concentration of CSF biomarkers Aβ 42 ( OR=0.997, P=0.006), elevated ratio of Aβ 42/t-tau ( OR=0.642, P=0.003), elevated ratio of Aβ 42/p-tau ratio ( OR=0.872, P=0.001) and PA ( OR=0.374, P=0.001) were protective factors for POD, while the elevated concentrations of t-tau ( OR=1.006, P=0.001) and p-tau ( OR=1.030, P=0.011) were risk factors for POD after adjusting for multi-confounders such as hypertension, diabetes, history of drinking, years of education and Mini-Mental State Examination score. The results of the mediation analysis showed that Aβ 42 (20%), t-tau (16%), Aβ 42/t-tau (23%) and Aβ 42/p-tau (28%) played mediating roles in the relationship between PA and POD. Conclusions:PA is a protective factor for POD in elderly patients undergoing knee or hip arthroplasty and CSF biomarkers may play a mediating role in the relationship between PA and POD.

Left ventricular assist device (LVAD) has become an important means in the treatment of end-stage heart failure.The incidence of RVF in LVAD recipientsis as high as 10% to 40%, and the mortality rate is as high as 50%.Therefore, it is important to reduce right ventricular dysfunction and improve prognosis if all relevant factors can be monitored and evaluated before operation and timely intervention and perioperative management can be strengthened. This article will review the predictive factors, management strategies and application of devices for RVF after LVAD operation.

The prevalence of hyperuricemia and gout is continuously increasing on a global scale,leading to increased social burden through complications such as chronic kidney disease,cardiovascular diseases,and joint disorders.Several studies have reported gender differences in the onset of gout,but the relationship between sex hormones as biologic markers and hyperurice-mia or gout has just gained attention in recent years,with ongoing debates on its authenticity and mechanisms.This article com-prehensively elaborates on the research progress in the impact of estrogen,androgen,progesterone,and sex hormone-binding globulin(SHBG)on hyperuricemia and gout,as well as underlying mechanisms.It will provide a basis for further understanding of uric acid metabolism and early prevention and treatment of gout.

The evaluation of acute alcohol impairment is an important basis for evaluating the physiological and psychological status of patients and judging their treatment and nursing measures.There is a large number of research on acute alcohol impairment by foreign researchers,but there are few relevant research reports in China.This article reviews the origin,development and the evaluation tools of acute alcohol impairment in the context of emergency treatment,and summarizing its advantages and disadvantages by comparing the content,evaluation methods,applicable population,reliability and validity of each evaluation tool,in order to provide scientific references for the evaluation,treatment and nursing care of acute alcohol impairment for emergency departments in China.

Alzheimer Disease(AD) presently remains an irreversible disease.Consequently,with current research findings and clinical practices,we propose a new prevention and treatment perspective,summarized in four aspects:early-stage,comprehensive,systematic,and long term,which are interrelated and yet show varying significance depending on the circumstances.We hope this view will help improve AD-related practices in prevention,clinical management,research and education,better equipping us to face challenges posed by AD.

Objective To evaluate the preventive effects of Haishe capsules on the conversion of amnestic mild cognitive impairment (aMCI) to Alzheimer's disease(AD).Methods Patients (n=120) with aMCI from our department were recruited and randomly divided into the treatment group and the control group (n=60 in each group).The treatment group was given 0.9 gram of Haishe capsules three times a day while the control group received no drug treatment.Data on the conversion ratio,memory and cognitive function were comparedbetween the groups in a 24-months follow-up.Results By the end of the study,12 patients in the treatment group and 15 in the control group dropped out.Valid data for 93 patients were available for statistical analysis (48 in the treatment group and 45 in the control group).The number of aMCI patients who converted to AD was 6,with a conversion ratio of 12.5％ (6/48);and the number of patients who went through conversion in the control group was 13,with a conversion ratio of 28.8％ (13/45).The difference in conversion between the two groups was statistically significant (x2 =3.83,P＜0.05).After 24 months,MMSE scores for the treatment group (25.52± 1.07) had no significant change compared with baseline levels,while MMSE scores for the control group decreased significantly(24.75--1.49) and were markedly lower than thosefor the treatment group (t=2.85,P＜0.05).MoCA scores for the treatment group (19.39 ±2.01) did not show decline until the end of the study,while those for the control group started to decrease about half way through the study and were lower than scores for the treatment group (t =2.41,P＜0.05).Compared with baseline levels,ADAS-Cogscores for the treatment group (7.62± 1.06) did not increase significantly during the course of the study.ADAS-Cogscores forthe control group were higher at both half way (7.70±0.75) and the end of the study (8.18±0.80)than base line levels,and there was a statistically significant difference in end-of-study ADAS-Cog scores between the two groups(t =-2.6,P＜ 0.05).Conclusions Haishe capsules not only effectively maintain memory and cognitive function,but also delay the conversion from aMCI to AD.

Objective To investigate the influence of portal hypertension (PHT) on the postoperative complications after hepatectomy for patients with hepatocellular carcinoma (HCC). Methods Clinical data of 152 HCC patients undergoing hepatectomy in Sun Yat-sen University Cancer Center from March 2003 to October 2005 were retrospectively analyzed. The patients were divided into the PHT and non-PHT groups. There were 76 patients in the PHT group including 62 males and 14 females, with a mean age of (49±11) years. There were 76 patients in the non-PHT group including 66 males and 10 females, with a mean age of (49±12) years. The informed consents of all patients were obtained and the local ethical committee approval had been received. After hospitalization, all patients received routine examination. The incidence of postoperative complications in two groups was observed and the independent risk factors for postoperative complications were evaluated. Normally distributed data were compared using t test. Non-normally distributed data were compared using Z test. The comparison of rate was conducted using Chi-square test. Independent risk factors for the incidence of postoperative complications were analyzed by Logistic multivariate regression test. Results The incidence of postoperative complications was 42%(32/76) and the liver function-related complications was 36% (27/76) in the PHT group, and were 20% (15/76), 16% (12/76) respectively in the non-PHT group, significant difference was observed between two groups (χ2=8.901, 7.760;P<0.05). No signiifcant difference was observed in the percentage of patients with grade I-II complications between PHT group [75%(24/32)] and non-PHT group [73%(11/15)] (χ2=0.015, P>0.05). No significant difference was observed in the 90-day mortality between PHT group [7%(5/76)] and non-PHT group [3%(2/76)] (χ2=0.599, P>0.05). Logistic regression analysis revealed that PHT complication (OR=3.376, 95%CI:1.564-7.287, P<0.05) and number of tumors>2 (OR=1.984, 95%CI:1.248-3.154, P<0.05) were the independent risk factors for postoperative complications. PHT complication (OR=3.231, 95%CI:1.431-7.298, P<0.05), number of tumors>2 (OR=1.832, 95%CI:1.137-2.952, P<0.05) and intraoperative transfusion > 400 ml (OR=2.776, 95%CI: 1.123-6.864, P<0.05) were the independent risk factors for liver function-related complications. Conclusions PHT can increase the incidences of postoperative complications and liver function-related complications after hepatectomy in HCC patients and is the independent risk factor for both complications. However, PHT will not increase the severity of postoperative complications or postoperative mortality.

Objective:To retrospectively investigate the efficiency of Jinlong capsule combined with transarterial chemoemboli-zation for the treatment of advanced pancreatic carcinoma. Methods: Sixty advanced pancreatic carcinoma patients between January 2009 and May 2013 were randomly assigned into the experimental group (n=30, Jinlong capsule combined with transarterial chemoem-bolization) and the control group (n=30, transarterial chemoembolization). Both groups were subjected to superselective pancreas artery chemotherapy with GEMZAR at a dose of 1.0 g/m2. Results:The overall response rate (CR+PR) was 53.3%and the control rate was 70%(CR+PR+SD) (CR 0, PR 16, SD 5) in the experimental group, whereas those in the control group were 36.7%and 56.7%(CR 0, PR 11, SD 6), respectively. The short-term therapeutic efficacy was higher in the experimental group than in the control group (P<0.05). No significant difference in adverse reactions, including digestive reactions and myelosuppression, almost I-II degree, was observed be-tween the two groups (P>0.05). No significant difference in the Karnofsky performance status was observed between the two groups af-ter the treatment (P<0.05). The 24-month survival rate of the experimental group was 50.0%, whereas that of the control group was 33.3%(P<0.05). Conclusion:The application of Jinlong capsule combined with transarterial chemoembolization for the treatment of advanced pancreatic carcinoma showed good clinical effects. The patients also showed good tolerance to this treatment.

Objective To investigate the value of preoperative platelet count (Plt) in predicting prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy. Methods Clinical data of 399 patients who underwent hepatic resection for HCC in Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center from January 1987 to December 1994 were analyzed retrospectively. The informed consents of all patients were obtained and the ethics committee approval was received. Of the 399 patients, 356 cases were male, and 43 cases were female with age ranging from 21 to 78 years old and a median age of 48 years old. The relations between preoperative Plt and patients' gender, age, gamma-glutamyl transpeptidase (GGT), hepatitis B surface antigen (HBsAg), alpha fetal protein (AFP), cirrhosis, tumor encapsulation, tumor diameter, tumor number, vascular invasion and histological differentiation were observed. Patients were divided into 3 groups according to the level of preoperative Plt:group 1 (<100×109/L, n=41), group 2 (100×109/L-300×109/L, n=321), group 3 (>300×109/L, n=37). Survival analysis of patients in 3 groups was conducted. The relations between preoperative Plt and clinicopathological parameters were compared using t test. Survival analysis was conducted using Kaplan-Meier method and Log-rank test. Survival prognosis was analyzed using Cox's proportional hazard model. Results Preoperative Plt was associated with HBsAg, AFP, and tumor diameter (t=2.069, 2.222,-3.911;P<0.05). The 5-, 10-, 15-year cumulative survival rates were 41.2%, 25.2%, 11.8%in group 1, 33.7%, 23.0%, 18.1%in group 2, and 11.4%, 8.6%, 5.7%in group 3 respectively. The survival rate in group 3 was signiifcantly lower than those in group 1 and group 2 (χ2=5.706, 11.361;P<0.05). Increasing preoperative Plt was an independent risk factor for postoperative prognosis. The prognosis in group 3 was poorer than those in group 1 and group 2 (HR=1.761, 1.845;P<0.05). Conclusions Increasing preoperative Plt is an independent risk factor for postoperative prognosis of patients with HCC after hepatectomy. Patients with increasing preoperative Plt have poor prognosis.

Objective To study the effect of baicalin on the apoptosis and cell cycle of colorectal cancer cells in orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.Methods Sixty orthotopic transplantation mice models of human colorectal cancer cell line HCT1 16 expressing green fluorescent protein (GFP) were established,and were randomly divided into the control group and the 50,100,200 mg/kg baicalin groups according to the random number table.Mice in the 50,100,200 mg/kg baicalin groups received intragastric infusion of baicalin at the corresponding dosages twice a day,while mice in the control group received intragastric infusion of 5％ NaHCO3.Cell cycles and apoptotic rates of the HCT116-GFP cells were detected by flow cytometry and TUNEL method respectively.Differences between the 2 groups were analyzed using the analysis of variance or chi-square test,and differences within each group were analyzed using the LSD-t test.Results The orthotopic transplantation mice models of human colorecta] cancer were successfully constructed,and there was no significant difference in the body weight of the mice and tumor size among the 4 groups (F =0.343,0.107,P ＞0.05).The proportion of HCT116-GFP cells in the G2/M phase in the 50,100,200 mg/kg baicalin groups were 22％±6％,18％±7％ and 19％±6％,which were significantly higher than 7％ ±5％ of the control group (t =5.421,3.483,3.575,P ＜0.05).There were no significant differences in the proportion of HCT116-GFP cells in the G2/M phase among the 50,100,200 mg/kg baicalin groups (F =1.291,P ＞ 0.05).The apoptotic rates of HCT116-GFP cells in the 50,100,200 mg/kg baicalin groups were significantly higher than the control group (t =7.163,3.703,2.688,P ＜0.05).The apoptotic rate of the 50 mg/kg baicalin group was significantly higher than that of the 200 mg/kg baicalin group (t =2.259,P ＜ 0.05).Conclusions Baicalin significantly inhibits tumor growth in the orthotopic transplantation mice model with mismatch repair gene hMLH1 deficient.After treated with baicalin,the cell cycle is arrested at the G2/M phase,thus the tumor growth is inhibited.