Objective: To investigate the doseresponse relationship between the risk of elevated blood pressure and body mass index (BMI) in primary and secondary school students in Shibei District, Qingdao, so as to provide a reference for precise interventions of elevated blood pressure. Methods: Statistical analysis was conducted on the health examination data of 92 091 primary and secondary school students in Shibei District, Qingdao, in 2022. Overweight and obesity were assessed using the standards from the Screening for Overweight and Obesity among Schoolaged Children and Adolescents, and blood pressure levels were evaluated using the Reference of Screening for Elevated Blood Pressure among Children and Adolescents Aged 7-18 Years. The relationship between BMI and elevated blood pressure was examined using analysis of variance, Chisquare test, multifactorial Logistic regression, and a combination of restricted cubic spline after data cleaning. Results: Based on the standardized scores under different age and gender, BMI was classified into 5 categories. Compared with the group of BMIZ scores 0-<1, the risk of developing high blood pressure gradually decreased with BMIZ scores (OR=0.55, 0.53, P<0.05). Conversely, the risk of developing high blood pressure increased with increasing BMIZ scores (OR=1.90, 3.71, P<0.05). Stratified analyses showed that BMI was positively associated with elevated blood pressure by gender (male, female), age (aged 7-8, 9-11, 12-14, 15-16), and waisttohip ratio (≤0.83, >0.83) (OR=1.18, 1.19, 1.15, 1.22, 1.19, 1.18, 1.19, 1.18, P<0.01). There were multiplicative interactions between BMI and gender, between BMI and age, between BMI and waisttohip ratio (OR=1.53, 1.08, 2.31, P<0.01). Restricted cubic spline analysis showed that as BMI levels increased, the risk of developing elevated blood pressure showed a nonlinear increasing trend in both the 7yearold and the 10 to 16yearold (χ2=27.56, 10.69, 6.10, 27.26, 18.32, 25.71, 10.53, 6.14, P<0.05). Conclusions The risk of elevated blood pressure in primary and secondary school students increases with BMI, showing a nonlinear doseresponse relationship. The blood pressure should be monitored regularly, and comprehensive and effective measures should be implemented to control elevated blood pressure in children and adolescents.

Objective:To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy and establish the risk graph model of pancreatic fistula.Methods:The clinical data of 147 patients undergoing pancreaticoduodenectomy from Jan. 2018 to Jan. 2021 in Department of Hepatobiliary Surgery of Northern Theater Command General Hospital were retrospectively analyzed. The independent risk factors for postoperative pancreatic fistula were determined by univariate and multivariate analysis, and the linear graph model for predicting individual pancreatic fistula was drawn. The area under the subject operating characteristic curve was used to evaluate the model differentiation, the calibration curve was used to evaluate the model calibration, and finally the clinical application value of the model was evaluated by the clinical decision curve (DCA) .Results:The incidence of pancreatic fistula was 38.1%, including grade B pancreatic fistula in 49 cases and Grade C pancreatic fistula in 7 cases. Univariate analysis showed that operation method, body mass index (BMI), pancreatic texture, pancreatic duct diameter and lesion location were the related factors for postoperative pancreatic fistula. Multivariate analysis showed that BMI>25 kg/m 2, pancreatic soft texture, pancreatic duct diameter ≤3 mm and non-pancreatic diseases were independent risk factors for postoperative pancreatic fistula. According to the results of multiple factors, a prediction model of the nomogram was drawn, and the area under the subject operating characteristic curve of the model was calculated as AUC=0.792 (95% CI: 0.718-0.867). The calibration curve was drawn through internal verification of re-sampling, and the fitting curve swung around the 45° reference line, showing a high calibration degree; Clinical decision curve (DCA) analysis showed that the threshold probability was between 15% and 75% for maximum net benefit. It had good clinical application value. Conclusions:BMI>25 kg/m 2, soft pancreas, pancreatic duct diameter ≤3 mm and non-pancreatic diseases are independent risk factors for pancreatic fistula after pancreaticoduodenectomy. The established line graph model has good predictive efficiency and can effectively predict the occurrence of postoperative pancreatic fistula.

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

【Objective】 To explore the influence of common methods of reducing non-viral nucleic acid on the abundance of plasma virus group. 【Methods】 Three kinds of library construction, five kinds of centrifugation conditions, two kinds of filters, four kinds of enzymes and four concentrations of chloroform were used to treat plasma samples added quantitatively 2.16 mL of pseudorabies virus(PRV) and 2.16 mL of porcine parvovirus(PPV). A total of 21.6 mL of plasma samples were processed, including 54 samples. Subsequently, nucleic acid was extracted, mitochondrial DNA(mtDNA) and two viruses were quantitated, the library of the next generation sequencing was constructed, Illumina NovaSeq 6000 was used for the next generation sequencing. The sequencing data were compared with Kraken Py 2.0 software, and the species annotation analysis was conducted. The corresponding species classification information of each segment was obtained to analyze the impact of different reducing non-viral nucleic acid methods on the relative abundance of microorganisms and two indicator viruses. 【Results】 After sequencing by Illumina NovaSeq 6000, 306.27 GB raw data and 193.17 GB clean data were obtained, with Q20>90%, Q30>85%, Error Rate of 0.03%, and average GC Content of 45.02%. The DNA library construction process significantly increased the proportion of microbial sequences and the PRV abundance [(91.8±0.5)%](P<0.05); RNA library construction and combined library construction can increase the abundance of Pestivirus, an RNA virus, and the PRV abundance was(17.7±3.3)% and(8.1±1.5)% respectively. The Ct value of mtDNA was increased and the proportion of human sequence decreased to less than(89.5±1)%, while the proportion of microbial sequence increased to (2.4±0.03)% after treatment of five centrifugation conditions(P<0.05); After centrifugation at 4℃, 100 g, 30 min, the PRV abundance was increased to (40.6±6)%, and centrifugation at 4℃, 4 000 g, 45 min reduced the PRV abundance to (4.1±0.01)%(P<0.05). Both of 0.22-μm filter and 0.45-μm filter increased the Ct value of mtDNA to above 25.56±0.13, decreased the proportion of human sequence to less than (86.1±0.6)%, increased the proportion of microbial sequence to (3.1±0.1)% and (3.4±0.2)%, and decreased the PRV abundance to (1.6±0.3)% and (4.1±0.7)%(P<0.05), while there was no statistical difference in the effect on PPV concentration and abundance. DNase Ⅰ and Benzonase increased the Ct value of PPV to 25.65±0.06 and 25.36±0.45, decreased the proportion of human sequence to (81.7±5.6)% and (72.8±6.7)%, and increased the proportion of microbial sequence and PRV abundance to (11.0±4.1)% and (16.1±4.7)%, (55.8±2.3)% and (39.0±8.9)%, respectively(P<0 05); After treatment with RNase A, the Ct value of PRV increased to 25.20±0.11, and the human sequence proportion decreased to (85.4±5.6)%(P<0 05); Lysozyme had no effect on removing non-viral nucleic acid. The chloroform of 1%, 5%, 10% and 20% increased Ct value of PRV and mtDNA to no less than 27.17±0.21 and 25.68±0.04; Only 10% chloroform increased the proportion of microbial sequences to (3.1±1.2)%(P<0.05); The abundance of PRV with 1% and 5% chloroform treatment was increased to (48.7±13.3)% and (42.1±5.5)%(P<0.05), while 10% and 20% chloroform reduced PRV abundance to (1.0±0.5)% and (3.4±2.8)%(P<0.05). There was no statistical difference in the effect of chloroform with four contents on PPV abundance. 【Conclusion】 Centrifugation at 4℃, 5 000 g, 10 min is suitable for increasing the overall abundance of virus, and centrifugation at 4℃, 100 g, 30 min is suitable for increasing the content of virus similar to PRV. 0.45-μm filter, DNase Ⅰ, Benzonase and low concentration chloroform can effectively reduce the proportion of non-viral nucleic acid sequence in plasma to increase the abundance of the indicated virus group. Thus, the enrichment effect of plasma meta-virome is closely related to the nature of the virus, and the appropriate virus enrichment method should be selected according to the research purpose to establish the corresponding enrichment strategy.

Objective:To investigate the feasibility of classifying imaging patterns of dermatomyositis/polymyositis-related interstitial lung disease (DM/PM-ILD) into subtypes based on chest CT radiomics features and a model was constructed by machine learning algorithms.Methods:From November 2011 to November 2020, 107 patients diagnosed with PM/DM-ILD at the First Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. A total of 315 cases with chest CT were collected. Doctors pre-classified image patterns, including 105 cases with non-specific interstitial pneumonia (NSIP), 90 cases with organizing pneumonia (OP), and 66 cases with non-specific interstitial pneumonia combined with organizing pneumonia (NSIP+OP), 35 cases with common interstitial pneumonia (UIP), and 19 cases with diffuse alveolar damage (DAD), ANOVA was used to test the difference of baseline clinical information among the imaging classification groups. All images were divided into the training set and the est set by stratified random sampling at a ratio of 4∶1. In each CT scan, 3D slicer was used to segment each lung lobe, and then reconstructed into 3 mm 3 of voxels, and Pyradiomics library was used to extract the radiomic features of the whole lung and each lobe. The multi-classification goal was achieved by constructing random forest base classifiers for each of the five groups and then voting as the final model. In the process of constructing the base classifier, firstly, the balance between sample groups was achieved by SMOTETomek comprehensive sampling, and the optimal feature set was selected by independent sample t test and L1 regularized least absolute shrinkage and selection operator (LASSO) regression. In this study, the Radiomics model was constructed based on chest CT radiomics features, and the Radiomics + model was constructed by introducing gender and age information. The base classifier and the integration model use the mean accuracy and the area under the receiver operator characteristics analysis curve (AUC) to evaluate the performance, respectively. Results:There was a statistically significant difference ( P<0.05) between the ages of the NSIP, OP, NSIP+OP, UIP, and DAD groups [(57±13),(53±8),(54±10),(44±11), and (46±8)years old, respectively], F=11.82, P<0.001. In the Radiomics model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.87, 0.91, 0.91, 0.96, and 0.99, respectively, and the AUC of the test set were 0.81, 0.82, 0.79, 0.93, 0.89. In the final Radiomics + model, for each group of NSIP, OP, NSIP+OP, UIP, and DAD, the AUCs of the training set were 0.89, 0.91, 0.92, 0.97, and 0.99, respectively, and the AUCs of the test set were 0.84, 0.82, 0.78, 0.94, 0.90. Conclusion:Based on chest CT radiomics features and key clinical features (sex, age), the Radiomics + model constructed by machine learning has good classification performance for the imaging patterns of PM/DM-LD.

Objective:To observe the effect of Tangtong formula on the expression of autophagy pathway proteins PI3K, Akt and mTOR in sciatic nerve of DPN rats, and to explore its mechanism. Methods:There were 60 male SD rats, 15 of which were randomly selected as the normal group, and the other rats were used to establish DPN model with STZ + ischemia-reperfusion method. Then they were divided into model group, Tangtong formula low-dose group and Tangtong formula high-dose group, with 15 rats in each group with random number table method. 36.67 g/kg Tangtong formula was administered by gavage in the high-dose group and 18.33 g/kg Tangtong formula was administered by gavage in the low-dose group, once a day. After 8 weeks of continuous gavage, the conduction velocity of sciatic nerve was detected. The mRNA and protein expression levels of PI3K, Akt and mTOR were detected by PCR and Western blot. The structure of sciatic nerve fibers was observed by HE staining. Results:Compared with the model group, the motor nerve conduction velocity, sensory nerve conduction velocity, muscle compound action potential and sensory nerve action potential in the low-dose Tangtong formula group and high-dose Tangtong formula group were increased ( P<0.05). The expression of PI3K mRNA(6.05±0.18, 3.36±0.29 vs. 11.57±1.93), Akt mRNA(1.26±0.13, 0.64±0.04 vs. 1.86±0.06), mTOR mRNA(1.82±0.11, 0.92±0.06 vs. 2.68±0.18) of sciatic nerve in rats of the low-dose and high-dose group were increased ( P<0.05). The expression of PI3K(0.40±0.00, 0.19±0.02 vs. 0.61±0.03), Akt(0.64±0.02, 0.45±0.01 vs. 0.83±0.02), mTOR(0.17±0.01, 0.09±0.00 vs. 0.34±0.01)of sciatic nerve in rats of the low-dose and high-dose group were increased ( P<0.05). The model group's nerve fibers were loose and swollen, myelin sheath became thin, and the axis Atresia, the neuromorphology of the low-dose and high-dose group tended to be normal, and the morphology of myelin sheath and axon were better. Conclusions:Tangtong formula could improve the conduction velocity and potential amplitude of sciatic nerve in DPN rats, reduce nerve injury and demyelinating changes, improve axon morphology and protect nerve fiber structure. Its mechanism might be related to activating PI3K/Akt/mTOR signal pathway and inhibiting excessive autophagy.

Objective To investigate the effect of phenformin combined with hexokinase inhibitor 2-deoxyglucose (2-DG) on the treatment of triple-negative breast cancer cell lines 4T1 and MDA-MB-231. Methods Following treatment with phenformin, 2-DG or phenformin combined with 2-DG on 4T1 and MDA-MB-231 cells for 48 h, the cell proliferation in each group was detected by SRB and the apoptosis of cells was detected by flow cytometry. The concentration of glucose and lactic acid in cell culture supernatant was detected by ELISA. The activity of mitochondrial respiratory chain complex Ⅰ was detected by FlexStation3 and the mitochondrial oxygen consumption (OCR) was assayed with the Seahorse X Fe Analyzer. Results The hexokinase expression (4.6±0.17,3.73±0.21), glucose consumption (356±31，397±42) μg/10⁵ cells , Lactic acid concentration (5.59±0.52, 7.83±0.78) μmol/L in the supernatant of 4T1 and MDA-MB-231 cells in Phenformin group were higher than that in control group ( 1±0.15，1±0.12 ) , ( 289±25，301±32) μg/10⁵cells , ( 2.37±0.18，4.01±0.45) μmol/L (P < 0.01). Even if the dose was reduced by 90%, the cell viability of phenformin combined with 2-DG group (64.63±2.28, 51.97±2.29) % was still higher than that of phenformin group (86.70±1.83, 85.53±1.46) % (P<0.001). The combination of the two drugs significantly promoted the apoptosis of 4T1 and MDA-MB-231. In addition, compared with the phenformin group (5.59±0.52, 7.83±0.78) μmol/L, the phenformin combined with 2-DG group (3.46±0.37, 5.18±0.62) μmol/L cell lactic acid production also greatly reduced (P<0.01). Compared with the phenformin or 2-DG single-drug group, the phenformin combined with 2-DG group can significantly inhibit the growth rate of tumors in tumor-bearing mice (P<0.01). The median survival time of tumor-bearing mice in the phenformin combined with 2-DG group was 72.5 d, which was higher than that in the phenformin group 57 d and 2-DG group 55.5 d (P<0.01). Conclusion Hexokinase inhibitor 2-DG significantly enhances the therapeutic effects of phenformin on triple-negative breast cancer cells.

OBJECTIVE：To investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and cerebral function in patients undergoing intracranial aneurysm embolization. METHODS ：Totally 44 patients undergoing intracranial aneurysm embolization in the First Affiliated Hospital of Hunan University of TCM during Jun. 2017-Aug. 2019 were collected and randomly divided into group D （22 cases）and group C （22 cases）. Ten minutes before anesthesia induction ，group D was given intravenous injection of Dexmedetomidine hydrochloride injection 1 μg/kg；group C was given buffered normal saline 20 μL. Both groups were induced with Propofol emulsion injection+Midazolam injection+Fentanyl citrate injection+Cisatracurium besylate for injection. During the operation ，group D was given Dexmedetomidine hydrochloride injection 0.5 μg（/ kg·h）+Fentanyl citrate injection+Benzsulfosum atracurium for injection+Propofol emulsion injection to maintain anesthesia ；group C was continuously pumped with buffered normal saline 0.5 μg（/ kg·h）+Fentanyl citrate injection + Benzsulfosum aratracurium for injection Propofol emulsion injection to maintain anesthesia. Before anesthesia induction （T0）， immediately after anesthesia。induction （T1）， 1 min after tracheal intubation （T2）， immediately after operation finished （T3），immediately afte extubation（T4），the mean arterial pressure（MAP），heart rate 中国药房 2021年第32卷第7期 China Pharmacy 2021Vol. 32 No. 7 ·865· （HR），regional cerebral oxygen satur ation（rSO2）were observed in 2 groups. The levels of neuron specific enolase （NSE）and S100 β protein in serum were measured at T1，T3，6 h after operation （T6）. The recovery time ，intraoperative blood loss ， nitroglycerin amount and the occurrence of ADR were recorded. RESULTS ：MAP and HR of group D at T 2-T4 were significantly lower than those at T 0；MAP and HR of group C at T 2-T4 were significantly higher than those at T 0；the group D were significantly lower than the group C at the same period （P＜0.05）；there was no statistical significance in rSO 2 between 2 groups at T 0-T4（P＞ 0.05）. The levels of serum NSE and S 100β protein in 2 groups at T 3 were significantly higher than at T 1；those in 2 groups at T 6 were significantly lower than at T 3，but those of group D were significantly lower than the group C at T 3（P＜0.05）；there was no statistical significance in the levels of serum NSE or S 100β protein between 2 groups at T 1（P＞0.05）. The recovery time of anesthesia，the amount of nitroglycerin ，the incidence of tachycardia ，nausea and vomiting ，restlessness，shivering and cough in group D were significantly shorter or lower than group C （P＜0.05）；there was no statistical significance in the intraoperative blood loss between 2 groups（P＞0.05）. CONCLUSIONS ：Dexmedetomidine can maintain the hemodynamic stability of patients with intracranial aneurysm embolization during the perioperative period ，has little effect on rSO 2 and brain function ，and has good safety.

Objective:To evaluate the value of cerebrospinal fluid (CSF) nerve injury-related proteins levels in predicting postoperative delirium (POD) in patients.Methods:A total of 1 000 patients of both sexes, aged 40-90 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with Mini-Mental State Examination score>24 at 1 day before operation, undergoing elective knee/hip arthroplasty under spinal-epidural anesthesia , were enrolled in this study.Cubital venous blood samples were drawn before anesthesia for detection of the concentrations of plasma total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride.CSF 2ml was extracted after successful spinal-epidural anesthesia puncture for measurement of concentrations of α-synuclein (α-syn), β-amyloid protein 1-40 (Aβ 1-40), Aβ 1-42, total-Tau (t-Tau), phosphorylated Tau (p-Tau), progranulin (PGRN) and soluble myeloid cell triggering receptor 2 (sTREM2) (by enzyme-linked immunosorbent assay). The Confusion Assessment Method was used at 1, 3 and 7 days after surgery to evaluate the occurrence of POD.The patients were divided into POD group and non-POD group according to whether POD occurred after operation.Logistic regression analysis was used to analyze the variables of which P values were less than 0.05 to analyze the risk factors for POD.The receiver operating characteristic (ROC) curve was drawn and area (AUC) under the curve was calculated to evaluate the accuracy of the related risk factors in predicting POD. Results:A total of 964 patients were enrolled in the study, and 108 patients were diagnosed with POD, and the incidence was 11.2%.The results of logistic regression analysis found that age and and increased α-syn in CSF concentration were risk factors for POD, and decreased PGRN in CSF concentration and Aβ 1-42/p-Tau in CSF were the protective factors for POD ( P<0.05). ROC curve analysis showed that α-syn (AUC 0.69, 95% confidence interval (CI) 0.634-0.748, sensitivity 57.41%, specificity 82.10%, Youden Index 0.3951), PGRN in CSF concentration (AUC 0.695, 95%CI 0.637-0.750, sensitivity 59.26%, specificity 80.86%, Youden Index 0.4012) and Aβ 1-42/p-Tau in CSF (AUC 0.635, 95%CI 0.574-0.692, sensitivity 93.52%, specificity 30.25%, Youden Index 0.2377) could predict the occurrence of POD. Conclusion:PGRN, α-syn concentration and Aβ 1-42/p-Tau in CSF can predict the occurrence of POD in patients.

Objective:To evaluate the relationship between preoperative cerebrospinal fluid/serum albumin ratio (Q-alb) and postoperative delirium (POD) in patients undergoing neuraxial anesthesia.Methods:The patients, aged 40-90 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, underwent total knee/hip replacement under combined spinal-epidural block in our hospital from January 2018 to December 2020, were collected.After admission to the operating room, venous blood and cerebrospinal fluid samples were collected for determination of cerebrospinal fluid albumin, β-amyloid (Aβ) 1-42, Aβ 1-40, total tau protein (t-Tau), phosphorylated tau protein (p-Tau) and serum albumin levels (by enzyme-linked immunosorbent assay) and for calculation of Q-alb.When Q-alb was more than 10.2, the patient was considered to have blood-brain barrier disruption.Mini-Mental State Examination scale was used to evaluate the cognitive level on 1 day before surgery. The development of POD was evaluated using Confusion Assessment Method Chinese Reversion and Memorial Delirium Assessment Scale at 1-7 days after surgery.The patients were divided into POD group (P group) and non-POD (NP group) according to whether POD occurred.The receiver operating characteristic (ROC) curve was used to analyze the accuracy of Q-alb in predicting POD. Results:There were 49 cases in each group.Compared with group NP, concentrations of Aβ 1-42 and Aβ 1-40 were significantly decreased, concentrations of t-Tau and p-Tau albumin were increased, the ratio of Q-alb and blood-brain barrier disruption was increased in group P ( P<0.05). Before and after adjusting for confounding factors, Q-alb, cerebrospinal fluid Aβ 1-42, Aβ 1-40, t-Tau and p-Tau levels were risk factors for POD ( P<0.05). There was a positive linear regression relationship between Q-alb and levels of t-Tau and p-Tauin cerebrospinal fluid (t-Tau: β=0.587, P<0.001; p-Tau: β=0.427, P<0.001), and there was a negative linear regression relationship between Q-alb and levels of Aβ 1-42 and Aβ 1-40 in cerebrospinal fluid (Aβ 1-42: β=-0.762, P<0.001; Aβ 1-40: β=-0.531, P<0.001). There was no linear regression relationship between Q-alb and level of p-Tau in group P ( P=0.121). There was no linear regression relationship between Q-alb and level of Aβ 1-40 in group NP ( P=0.467). The results of ROC curve analysis showed that the area under the curve for Q-alb in predicting POD (95% confidence interval) was 0.827 (0.738-0.896). Conclusion:Preoperative higher Q-alb is the risk factor for POD in patients undergoing neuraxial anesthesia, and is more accurate in predicting POD.