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: To investigate the effect of hepatitis B virus (HBV) X gene integration on expression of zinc finger protein ZBTB20 in chronic hepatitis B (CHB) patients complicated with hepatocellular carcinoma (HCC). Methods: Eighteen CHB patients complicated with HCC who underwent surgical treatment in Taizhou Enze Medical Center Enze Hospital and Taizhou Central Hospital from July 2015 to June 2017 were enrolled. Samples of carcinoma tissue, para-carcinoma tissue and corresponding normal liver tissue were collected from each case. DNA was extracted from three kinds of tissue samples. HBV-Alu-polymerase chain reaction (PCR) was used to amplify the integrated HBVX fragments and their bilateral flanking sequences in human genomic DNA. The integrated HBV fragments were determined by PCR products sequencing. Protein was extracted from three kinds of tissue samples.The level of expression of ZBTB20 was detected by protein imprinting. Statistical analysis was performed using t test, analysis of variance, and χ² test. Results: Among the 18 CHB patients complicated with HCC, integration of HBVX gene was found in 13 carcinoma tissue samples, 16 para-carcinoma tissue samples and 9 corresponding normal liver tissue samples. The difference was statistically significant (χ²=6.353, P=0.037). Of the 18 patients, the protein expressions of ZBTB20 in carcinoma tissue, para-carcinoma tissue and corresponding normal tissue were (50.14±11.25)%, (40.71±7.17)% and (39.06±5.17)%, respectively, which was statistically different (F=9.420, P<0.01). HBVX gene integration was detected at ZBTB20 locus in five patients. The expression levels of ZBTB20 in patients with HBVX gene integration at this locus in carcinoma tissue, para-carcinoma tissue and corresponding, normal liver tissue were all significantly lower than those in patients without HBVX gene integration (carcinoma tissue (37.37±10.30)% vs (55.06±7.06)%, para-carcinoma tissue (32.06±2.61)% vs (44.04±5.24)%, corresponding normal tissue (34.66±5.59)% vs (40.76±4.04)%, t=4.205, 4.821 and 2.589, respectively, all P<0.05). Conclusions Incidence of HBVX integration in para-carcinoma tissue is higher than that in carcinoma tissue in CHB patients complicated with HCC.The expression level of ZBTB20 in carcinoma tissue is higher than that in para-carcinoma tissue. Integration of HBVX gene at ZBTB20 locus may decreases the expression of ZBTB20.

Objective: To examine epidemiology of self-injurious behavior and explore the association between self-injurious behavior and parental rearing styles, to provide the theoretical basis for the identification, prevention and occurrence of the self-injurious behaviors among adolescents. Methods: Stratified cluster sampling was used to survey 3 683 students from three colleges in Wuhu and Huainan by using questionnaire response. Egna Minnen avBarn-dosnauppforstran(EMBU) and demographic characteristics were used by college students to assess their selfinjurious behavior and parental rearing styles. Results: For college students, the detection rate of reporting of 1-2 self-injurious behavior was 30.4%, and the rate of reporting of 3 or more self-injurious behavior was 11.8%. In terms of the occurrences of self-injurious behavior, gender(χ2=76.98), classification of colleges and universities(χ2=153.71) and the relationship with father (χ2=47.48) and with mother (χ2=40.01) were markedly different(P<0.05). Correlation and regression analysis indicated that the risks leading to self-injurious behavior were involved in medical students, overprotection from father and preference from mother(OR=2.05, 95%CI=1.64-2.55; OR=1.13, 95%CI=1.06-1.20; OR=1.05, 95%CI=1.01-1.09). Conclusion Female students and medical students can be inclined to self-injurious behavior. Parental rearing styles were related to the self-injurious behaviors of college students. Strengthening interaction between students and parents, providing appropriate emotional warmth as well as encouraging the establishment of a good family atmosphere may reduce the occurrence of self-injurious behavior in current college students.

Objective To evaluate the efficacy of laparoscopic Habib 4X (Habib 4X,Angio Dynamics US),a new bipolar radiofrequency (RF) device,in laparoscopic liver resection.Methods Thirty one patients who underwent laparoscopic liver resection using the laparoscopic Habib 4X from Sept 2009 to Apr 2012 were studied retrospectively.Results The laparoscopic Habib 4X was success fully used in 30 patients (malignant,n=18; benign,n=12).The procedures performed included left lateral sectionectomy (n=12),left hemi-hepatectomy (n=1),Ⅴ or Ⅵ segmentectomy (n=9),Ⅴ and Ⅵ bi-segmentectomy (n=2) and wedge exclusion (n=6).The time required for precoagulation and resection was 10～68 min (median 24 min).The mean intraoperative blood loss was 145±75ml (range 8-370 ml).Mild abnormal liver function which returned to normal in 3 to 5 days was detected postoperatively.The mean hospital stay was 7.8±2.6 d (range 3～12 days).There was no patient who developed postoperative bleeding,bile leakage or abdominal abscess.For cancer patients,there was no local recurrence on follow-up.Conclusion Laparoscopic Habib 4X,a device when used in laparoscopic liver resection,resulted in minimal blood loss and quick recovery.It had only mild effect on liver function and it had low morbidity.In addition,it might reduce the risk of local recurrence in malignant tumours.

Objective To explore the method and clinical effect of laparoscopic anatomical right liver resections. Method The candidates for laparoscopic right hepatic lobectomys were 4 cases including 3 cases of liver hemangioma and 1 case of hepatorrhexis. Results The laparoscopic right hepatic lobectomy we performed saccess bully in all the 4 patients, operation time was (470±42.7)min. The blood loss in operation was ( 1950± 881.3) ml. The postoperative hospital stay was ( 15 ± 2.9) days.There was not complcation. Conclusions Laparoscopic right hepatic libectomy is feasible and safe.For the patients with benign liver disease, it is an operation with less operation wound.

Objective To evaluate the feasibility of laparoscopic hepatectomy.Methods A total of 27 patients received laparoscopic hepatectomy by using laparoscopic Peng's multifunctional operative dissector(LPMOD).Among the patients,13 underwent anatomic hepatectomy(resection of the Ⅱ and Ⅲ segments in 3,Ⅴ segment in 1,Ⅵ in 7,Ⅴ and Ⅵ in 1,and Ⅴ,Ⅵ,Ⅶ,and Ⅷ segments in 1),and 14 received partial hepatectomy.Results The laparoscopic hepatectomy was accomplished successfully in all the patients without converting to open surgery.The mean operation time was 35-360 min [mean,(178.0?78.4) min];intraoperative blood loss was 35-1200 ml [mean,(451.7?332.6) ml];and the postoperative hospital stay was 2-14 d [mean,(8.4?3.0) d].No severe complication occurred after the operation.The postoperative pathological examinations showed hepatic hemangioma in 15,focal hyperplasia of the liver in 2,hepatocelluar carcinoma complicated with liver cirrhosis in 6,intrahepatic bile duct stone complicated with hyperplasia of the bile duct in 2,liver(hematoma) fibrosis in 1,and hepatic angiomyolipoma in 1.The patients were followed up for 1-26 months [mean,(7.9?7.4) months] by using B-ultrasonography or CT.No recurrence of hemangioma or carcinoma,tumor implantation at the puncture site,or residual stones in the intrahepatic bile duct was found in this series.Conclusion By using LPMOD,laparoscopic hepatectomy is safe and feasible for selected patients.