ObjectiveTo explore the correlation between general anesthesia and mild cognitive impairment in older adults so as to provide new ideas for early prevention and timely intervention of mild cognitive impairment（MCI）. MethodsBased on the baseline survey of the Hubei memory and aging cohort study（2018-2023）， the participants completed a thorough neuropsychological assessment and physical examination， and self-reported a history of general anesthesia and surgery. The association of general anesthesia and MCI in the elderly was analyzed using the logistic regression model. In addition， the stratification and interaction analysis of anesthesia history， anesthesia number and physical intellectual exercise were conducted separately. ResultsA total of 5 069 older adults aged 65 and above were included in this study， including 3 692 city dwellers and 1 377 rural people， among whom were 2 584 women （51%）. Out of the 1 472 participants with history of general anesthesia， 249 people （17.4%） had MCI. After controlling for confounding factors， there was a 39.6% increased risk of MCI in older adults who underwent general anesthesia ［OR=1.396，95%CI（1.169，1.668），P<0.001］， suggesting that general anesthesia may be an independent influence on MCI. For the older adults who had one general anesthesia ［OR=1.235，95%CI（1.001，1.523），P=0.049］， two general anesthesia ［OR=1.779，95%CI （1.292，2.450），P<0.001］， and three OR more general anesthesia ［OR=2.395，95%CI （1.589，3.610），P<0.001］， their risks of MCI were increased by 23.5%， 77.9%， and 139.5%， respectively. Compared with the older adults without a history of general anesthesia who did not exercise， the risk of developing MCI was significantly negatively correlated with the exercise group， cognitive exercise group， and combined exercise and cognitive exercise groups （all P<0.001）. The risk of developing MCI in the exercise group was 60.2% of that in the no exercise group ［OR = 0.602， 95% CI（0.456， 0.795）］， the risk in the cognitive exercise group was 42.4% of that in the no exercise group ［OR = 0.424， 95% CI（0.294， 0.613）］， and the risk in the combined exercise and cognitive exercise group was 27.0% of that in the no exercise group ［OR = 0.270， 95% CI （0.208， 0.353）］. In the older adults with a history of general anesthesia， compared with the no exercise group， the risk of developing MCI was significantly negatively correlated with the cognitive exercise group and the combined exercise and cognitive exercise group （all P < 0.05）. The risk of developing MCI in the cognitive exercise group was 47.7% of that in the no exercise group ［OR=0.477， 95% CI （0.256，0.892）］， the risk in the combined exercise and cognitive exercise group was 34.5% of that in the no exercise group ［OR=0.345， 95% CI （0.220， 0.540）］， while the risk in the exercise-only group did not show a significant difference. ConclusionThe risk of MCI increased significantly in older adults with a history of general anesthesia， and this risk increased with the times of anesthesia. Physical and mental exercise reduces the risk of MCI. it is recommended that older adults with a history of anesthesia incorporate physical and mental exercise into their daily lives to prevent mild cognitive impairment.

Objective To investigate the clinical value of WNT1 inducible signaling pathway protein 1(WISP-1)and vascular endothelial growth factor-A(VEGF-A)as novel molecular markers of esophageal squamous cell carcinoma(ESCC)in elderly patients.Methods Elderly patients with ESCC were divided into 65-70 years old group and>70 years old group.Immunohistochemical staining and RT-PCR were used to detect the expression levels of WISP-1 and VEGF-A proteins and mRNAs,respectively.Log rank test was used to analyze correlation between clinicopathological features and prognosis of ESCC in the elderly.Results The positive expression rate of WISP-1 in ESCC tissues was significantly higher than that in para-cancer tissues(53.33% vs.35.42%,P=0.045).The positive expression rate of WISP-1 in patients over 70 years old and with lymph node metastasis was significantly higher than that in patients aged 65-70 years and without lymph node metastasis(P=0.047 and 0.032).The positive expression rate of VEGF-A protein in ESCC tissues was significantly higher than that in para-cancer tissues(50.00% vs.20.83%,P=0.001).The positive expression rate of VEGF-A in patients with depth of infiltration T3-T4 stage,lymph node metastasis,and TNM Ⅲ-Ⅳ stage was significantly higher than that in patients with T1-T2 stage,no lymph node metastasis,andⅠ-Ⅱ stage(P=0.030,0.006,and 0.010,respectively).The mRNA expression levels of these two molecules were significantly higher in ESCC tissues than in para-cancer tissues(P<0.05),and the results of univariate analysis showed that the expression levels of WISP-1 and VEGF-A were correlated with the prognosis of ESCC in the elderly(P<0.05).The results of multivariate analysis showed that lymph node metastasis was the independent risk factor affecting the prognosis of elderly patients with ESCC.Conclusion WISP-1 and VEGF-A are associated with malignant behavior in elderly patients with ESCC.The expression of WISP-1 increased with age,and it has potential as a novel molecular marker of ESCC in elderly patients.

Objective To investigate the clinical characteristics of adult secondary hemophagocytic syndrome(sHLH)and analyze the changes and significance of TH17/Treg cells and lymphocyte subsets,providing favorable references for clinical work.Methods 82 a-dult sHLH patients admitted to our hospital from April 2021 to March 2023 were selected.On the second day of admission,we observed their clinical characteristics and detected the levels of TH17/Treg cells(TH17,Treg,TH17/Treg)and lymphocyte subsets(CD3+,CD4+,CD8+,CD19+,CD16+CD56+).The patients were given the HLH-2004 treatment regimen and followed up for 6 months.Ac-cording to the treatment results,they were divided into the survival group(n=57)and fatality group(n=25).The levels of TH17/Treg cells and lymphocyte subsets on the second day of admission between the two groups were compared.The correlation between TH17/Treg cells and lymphocyte subsets and the value of TH17/Treg cells in evaluating the fatality of adult sHLH patients were ana-lyzed.Results All 82 adult sHLH patients had elevated serum beta-2 microglobulin and ferritin levels,and more than 90%of patients had clinical characteristics such as persistent irregular high fever,serous cavity effusion,decreased blood cells,and liver function dam-age.The levels of TH17,TH17/Treg,CD3+,and CD8+T cells on the second day of admission,1 month,2 months,and 3 months after treatment in the survival group were significantly lower than those in the fatality group(P<0.05),while the levels of Treg,CD4+,and CD16+CD56+lymphocytes were the opposite(P<0.05).The area under the reciever operating characteristics curve(AUCROC)of TH17/Treg cells combined with lymphocyte subsets in predicting the fatality of adult sHLH patients was 0.853(95%CI:0.758-0.922),which was higher than that of each individual indicator(P<0.05).Conclusion The clinical characteristics of adult sHLH are complex and diverse,with significant immune dysfunction of TH17/Treg and lymphocyte subsets.The TH17/Treg cells combined with lympho-cyte subsets have high efficacy in predicting the prognosis of adult sHLH patients.

Objective To accurately encode pelvic organ prolapse and ensure data accuracy.Methods ICD-10 coding analysis was performed in combination with the professional knowledge of the International Classification of Diseases(ICD-10)and specific clinical cases of pelvic organ prolapse.Results Vaginal anterior wall prolapse,regardless of severity,was encoded as N81.1;vaginal posterior wall prolapse,regardless of severity,as N81.6;uterine prolapse grade Ⅰ and Ⅱ,regardless of the presence or absence of vaginal anterior and posterior wall prolapse,as N81.2;uterine prolapse grade Ⅲ,whether the prolapse of the anterior and posterior vaginal walls is combined,or what level of the severity of the prolapse,as N81.3;cervical prolapse staging,regardless of severity or presence of vaginal anterior and posterior wall prolapse,as N81.2.In addition,the N81.-code does not include genital prolapse complicating pregnancy(O34.5),prolapse and hernia of ovary and fallopian tube(N83.4),vaginal fornix prolapse after hysterectomy(N99.3).Conclusion To ensure accurate coding,the composite coding rules must be cross-checked with volume one.ICD-10 failed to reflect the severity of vaginal prolapse in clinical practice.To consider the severity,coding should be extended in the N81.-segment.It is essential for coders to actively acquire clinical knowledge,rein-force professional knowledge,and enhance their responsibility to improve their coding proficiency and ensure data accuracy.

Objective:To compare the short-term clinical efficacy and patient satisfaction of single-port assisted endoscopic breast-conserving surgery versus open approach in the treatment of female breast cancer patients.Methods:This study retrospectively analyzed the clinical data of 129 female breast cancer patients admitted to Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University from March 2022 to June 2023. In this study, 56 patients underwent breast-conserving surgery assisted by single-port endoscopy (endoscopic group) and 73 patients underwent conventional open breast-conserving surgery (conventional group).Results:Compared to the conventional group (73 cases), the endoscopic group (56 cases) had slightly longer operation time [(200.0±43.2) min vs. (185.3±56.5) min] and intraoperative blood loss [(34.0±25.4) ml vs. (27.2±21.8) ml, P>0.05]. The endoscopic group had a significantly shorter surgical incision length than the conventional group [(4.7±0.7) cm vs. (8.0±1.1) cm, P<0.05], the difference in postoperative tumor margin was not significant (endoscopic group: 3.5% vs. conventional group: 5.7%, P>0.05). In terms of postoperative complications, the endoscopic group had a significantly lower incidence of radiation-related skin reactions than the conventional group ( P<0.05). The endoscopic group had a higher satisfaction rate in terms of postoperative aesthetics (73.2% vs. 56.2%, P<0.05). Conclusions:The short-term clinical efficacy of breast-conserving surgery for female breast cancer by single-port assisted endoscopy is not inferior to that of conventional open breast-conserving surgery, with added better cosmetic results.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Objective:To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods:This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results:No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group ( Z=-4.511, P<0.01). Conclusions:Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Objective:To explore the prevalence, clinical features, genetic characteristics and prognosis of Citrin deficiency in Henan province of China.Methods:A total of 986 565 neonates screened by tandem mass spectrometry at the Third Affiliated Hospital of Zhengzhou University from January 2013 to December 2021 were retrospectively analyzed. Analysis of SLC25A13 gene variants and parental verification were carried out for neonates suspected for Citrin deficiency by next-generation sequencing. The clinical, biochemical and genetic characteristics of Citrin deficiency patients were integrated to guide the diet treatment and follow up the growth and development. Paired- t test was used to compare the amino acid levels in the peripheral blood samples before and after the treatment. Results:Nine cases of Citrin deficiency were diagnosed among the 986 565 neonates. Specific elevation of citrulline was observed in all of the 9 cases. Six variants were detected by genetic sequencing, among which c. 852_855delTATG, c. 615+ 5G>A, c. 550C>T and IVS16ins3kb were known pathogenic variants, whilst c. 1111_1112delAT and c. 837T>A were unreported previously. The detection rate for c. 852_855delTATG was the highest (61.6%, 11/18), followed by IVS16ins3kb (16.7%, 3/18). The clinical symptoms of all patients were relieved after the treatment, and the blood amino acid profile and biochemical parameters were significantly improved by gradually falling within the normal range. By June 2022, all patients had shown a good prognosis.Conclusion:The prevalence of Citrin deficiency among neonates from Henan Province by tandem mass spectrometry is 1/109 618, and the carrier rate for the pathogenic variants of the SLC25A13 gene was 1/166. The c. 852_855delTATG may be a hot spot variant among the patients. Discovery of the novel variants has enriched the mutational spectrum of the SLC25A13 gene. Above results have provided a basis for the early diagnosis, treatment, prognosis and genetic counseling for the affected families.

Objective To investigate the relationship between the levels of CD4+/CD8+and D-dimer(D-D)in peripheral blood and the outcome of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis(EBV-HLH).Methods Ninety patients with EBV-HLH who were treated in Beijing Friendship Hospital from September 2021 to August 2023 were included as observation group,and additional 90 patients with infectious mononucleosis(IM)treated in the hospital contemporarily were selected as the control group.The levels of CD4+/CD8+and D-D in peripheral blood were compared between the two groups of patients to examine the correlation between the levels of CD4+/CD8+and D-D in peripheral blood and EBV-DNA load in patients with EBV-HLH,compare the outcome of patients within 3 months in terms of the levels of CD4+/CD8+and D-D in peripheral blood,evaluate the effects of CD4+/CD8+and D-D levels in peripheral blood on the risk of death from EBV-HLH,and analyze the interaction between the levels of CD4+/CD8+and D-D in peripheral blood.Results The patients in observation group showed significantly lower peripheral blood CD4+/CD8+ratio and significantly higher D-D than the patients in control group(P＜0.05).The peripheral blood CD4+/CD8+ratio was negatively correlated with EBV-DNA load(P＜0.05),and D-D was positively correlated with EBV-DNA load(P＜0.05)in EBV-HLH patients.The patients with high peripheral blood CD4+/CD8+ratio were assocaited with lower 3-month mortality rate compared to the patients with low CD4+/CD8+ratio.The patients with high D-D level were associated with higher 3-month mortality rate compared to the patients with low D-D level(P＜0.05).In EBV-HLH patients with low levels of peripheral blood CD4+/CD8+,the risk of death was 6.125 times that of the patients with high levels of CD4+/CD8+.High level D-D was associated with 14.348 times risk of death compared to the patients with low level D-D.CD4+/CD8+and D-D had synergistic effect on death of EBV-HLH patients.Conclusions Peripheral blood CD4+/CD8+levels decreased and D-D levels increased in EBV-HLH patients.Peripheral blood CD4+/CD8+levels and D-D levels and their changes may be useful for predicting the outcome of patients.

Objective:To investigate the clinical, imaging, etiological and prognostic features of patients with infarctions in different locations of the medulla oblongata.Methods:Patients with acute medullary infarction hospitalized at Tianjin Huanhu Hospital from July 2017 to July 2022 were included. The risk factors, clinical manifestation, stroke mechanism and 90-day prognosis of these patients were analyzed retrospectively.Results:Among the 256 patients enrolled, 150 (58.6%) had lateral medullary infarction (LMI), 106 (41.4%) had medial medullary infarction (MMI). The most frequent clinical manifestation of patients with LMI was dizziness (84.7%,127/150). And motor disorders (83.0%,88/106) was the most frequent clinical manifestation of patients with MMI. LMI lesions were mostly located in the middle (42.7%,64/150) and MMI lesions were mostly located in the upper (60.4%,64/106) medulla oblongata, with statistically significant difference (χ 2=47.53, P<0.001). Large artery atherosclerosis (LAA) was the main stroke mechanism in LMI and MMI [57.3%(86/150) vs 56.6%(60/106)]. Early neurological deterioration was more common in MMI (25.5%,27/106) and less common in LMI (7.3%,11/150), with statistically significant difference (χ 2=16.17, P<0.001). At discharge, more patients with MMI showed poor prognosis in short term [45.3% (48/106) vs 24.0% (36/150), with statistically significant difference (χ 2=12.76, P<0.001)] and even long term at 90-day follow-up [33.0% (35/106) vs 12.7% (19/150), also with statistically significant difference (χ 2=15.48, P<0.001)] than those with LMI. A total of 10 patients (4.0%, 10/256) developed respiratory failure during hospitalization, including 7 patients with LMI (4.7%, 7/150) and 3 patients with bilateral MMI (2.8%,3/106). Early neurological deterioration ( OR=3.38, 95% CI 1.25-9.10, P=0.016) and LAA (compared with small artery occlusion) ( OR=3.08, 95% CI 1.13-8.37, P=0.028) were independent risk factors for poor prognosis in MMI. Age ( OR=1.01, 95% CI 1.01-1.17, P=0.026) and early neurological deterioration ( OR=20.19, 95% CI=2.63-155.06, P=0.004) were independently correlated with poor outcome in LMI. Conclusions:LMI and MMI had similar etiology and significant differences in clinical manifestations, early neurological deterioration and prognosis. Further classification of medullary infarction was of great significance for diagnosis, treatment and prognosis evaluation.