Vascular cognitive impairment (VCI), caused by cerebrovascular dysfunction, severely impacts the quality of life in the elderly population, yet effective therapeutic approaches remain limited. Mitophagy, a selective mitochondrial quality-control mechanism, has emerged as a critical focus in neurological disease research. Accumulating evidence indicates that mitophagy modulates oxidative stress, neuroinflammation, and neuronal apoptosis. Key signaling pathways associated with mitophagy—including PINK1/Parkin, BNIP3/Nix, FUNDC1, PI3K/Akt/mTOR, and AMPK—have been identified as potential therapeutic targets for VCI. This review summarizes the mechanistic roles of mitophagy in VCI pathogenesis and explores emerging therapeutic strategies targeting these pathways, aiming to provide novel insights for clinical intervention and advance the development of effective treatments for VCI.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To explore the efficacy of enhanced recovery after surgery (ERAS) in the perioperative treatment of elderly patients with intertrochanteric fracture in a primary hospital.Methods:Retrospectively analyzed were the data of 104 elderly patients with intertrochanteric femoral fracture who had been treated by fixation with proximal femoral nail antirotation (PFNA) at Joint & Trauma Surgery, Shangyu People's Hospital of Shaoxing from January 2017 to January 2019. According to whether the ERAS concept was applied perioperatively, the patients were divided into 2 groups. In the ERAS treatment group of 53 cases, there were 27 males and 26 females with an age of (72.7±1.5) years. By the AO classification, 27 cases were type 31-A1, 16 cases were type 31-A2, and 10 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (65.8±3.9) h. In the conventional treatment group of 51 cases, there were 31 males and 20 females with an age of (72.6±1.5) years. By the AO classification, 21 cases were type 31-A1, 19 cases were type 31-A2, and 11 cases were type 31-A3. Internal diseases were complicated in 37 cases. The time from injury to operation was (111.5±5.9) h. The postoperative pain visual analogue scale (VAS), hospital stay, complications, Harris hip score at the last follow-up, and one-year mortality were compared between the 2 groups.Results:Except for the time from injury to operation, there was no significant difference in the other preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 104 patients were followed up for 12 to 24 months (average, 14.8 months) after operation. The VAS pain score [(3.2±1.2) points], hospital stay [(6.6±2.2) d], complication rate [5.7% (3/53)], and hip Harris score at the last follow-up [(90.7±1.3) points] in the ERAS treatment group were significantly better than those in the conventional treatment group [(3.9±1.0) points, (12.7±1.8) d, 19.6% (10/51), and (86.5±3.8) points] ( P<0.05). There was no significant difference in the one-year mortality between the ERAS treatment group [18.9% (10/53)] and the conventional treatment group [27.5% (14/51)] ( P>0.05). No such complications were followed up as injury to nerve or blood vessel, wound infection, fracture nonunion or femoral head necrosis in this cohort. Conclusion:In the perioperative treatment of elderly patients with femoral intertrochanteric fracture in a primary hospital, compared with conventional treatment, application of ERAS concept can shorten the patients' hospital stay, reduce the incidence of postoperative complications, achieve rapid recovery, and improve the patients' satisfaction.

Objective To examine the feasibility and early effects of unilateral pedicle screw fixation in combination with contralateral translaminar facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach for the treatment of degenerative lumbar spine diseases in elderly patients.Methods A total of 82 elderly patients with degenerative lumbar spine diseases received treatment between January 2015 and June 2016.Of these patients,25 had lumbar spinal stenosis,42 had degenerative lumbar instability,13 had giant lumbar disc herniation,and two had recurrent lumbar disc herniation;There were 69 cases of single segment and 13 cases of double segment lesions.Perioperative evaluation,imaging evaluation,and clinical evaluation were performed,and surgical complications were analyzed.Results The average length of incision was (2.6 ± 0.4) cm in cases of single segment lesions and (4.4±0.5) cm in cases of two segment lesions.The mean operation time was (98.3±19.6) minutes and peri-operation blood loss was (232.2±25.8) ml.The post-operation height of the intervertebral disc space significantly increased at the last follow-up(P ＜ 0.05);the height of the intervertebral disc space was restored and well maintained with internal fixation showing no loosening,breakage or Cage shift.The post-operation lumbar coronal Cobb angle decreased(P＜0.05)while the sagittal Cobb angle increased(P＜0.05)at the last follow-up.There was no significant difference in the area and grade of the multifidus muscle on MRI 12 months after operation.Seventy-two patients were followed up for 12-18 months (mean =16.8 months),and there were 67 cases of intervertebral fusion (93.1％).The last follow-up showed a Japanese Orthopaedic Association(JOA) score of (25.8 ± 1.7),which was significantly higher than the pre-operation score (10.6±1.3),with an excellence rate of 88.9 ％.The Oswestry Disability Index score was significantly reduced,from (50.9±21.6) at pre-operation to (9.6± 4.8) at the last follow-up.There were 78 patients with primary wound healing,three cases of superficial wound necrosis,one case of dural tear,and one case of nerve root injury.No cardiovascular or cerebrovascular incident was observed during or after operation.Conclusions Combined pedicle/facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach shows satisfactory short-term effects when used for the treatment of degenerative lumbar spine diseases in the elderly and possesses advantages such as minimal invasiveness,limited bleeding,quick recovery,high fusion rates and significantly improved clinical outcomes.However,further clinical studies are required to assess its medium-and long-term efficacy.

Objective To explore the application effect of concept map teaching of group-discussing mode in standardized nursing training. Methods A total of 80 standardized training nurses in Wuxi No.2 People's Hospital from January 2016 to December 2016 were selected by purposive sampling and randomly divided into the intervention group and the control group, with 40 students in each. The control group was taught according to the conventional teaching method, and the intervention group was taught with the concept map teaching of group-discussing mode. The scores of the independent learning ability assessment scale and the scores of theoretical examination were compared before and after the intervention. The scores of the feedback evaluation scale of concept map teaching of group-discussing mode in the intervention group were observed. Results The score of each dimension and the total score of the independent learning ability assessment scale of the intervention group after intervention were higher than those in the control group, and the difference was statistically significant (P<0.05). The score of theoretical examination in the intervention group was higher than that in the control group with statistical difference (P<0.001). The nurses in the intervention group had a better feedback on the concept map teaching of group-discussing mode. Conclusions The concept map teaching of group-discussing mode obtains good application results in clinical nursing teaching and training, and it can improve the nurses' independent learning ability.

Objective To evaluate the effects of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy on weight control in morbidly obese patients.Methods 48 patients with morbidly obesity underwent obese surgery (laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) from Dec.2013 to Dec.2015,and 1-year follow-up study.The general situation of obesity and biochemical indicators were compared and analyzed.Results There were 20 cases in gastric bypass group and 28 cases in sleeve gastrectomy group.The excess weight loss percentage(％EWL)was 73±0.04 in gastric bypass group and 59±0.05 in sleeve gastrectomy group(P=-0.03).There was no statistical difference in weight change between the two groups.Low density lipoprotein cholesterol (LDL) level in gastric bypass group was significantly lower than that in sleeve gastrectomy group at 1 year after surgery (2.42±0.16 vs 3.29±0.20,P=0.006),while folic acid level was significantly higher than that in sleeve gastrectomy group(15.58±1.99 vs 7.59±1.59,P=0.022).Conclusions The one-year follow up shows there is no significant difference in the efficacy of weight control between the two groups.Gastric bypass group may be superior to gastrectomy group in nutrition indexes.However,it is just a short-term postoperative efficacy in morbidly obese patients,long-term weight control effects and obesity related diseases control need to be further explored.

Objective:To compare the effects of different polishing techniques on the surface roughness of ceramic surfaces,provi-ding reference to restoration polishing in clinic.Methods:70 disc-shaped ceramic specimens were randomly divided into 7 groups(n=10).The glazing treated samples were served as the controls(group 1),the rest samples were treated by white aluminum oxide stone only(group 2)or followed by the polishing head of Ceramiste(group 3),Ceramiste and Ceramaster(group 4),Komer porcelain (group 5),Komer zirconium oxide(group 6)and EVE zirconium oxide,respectively.Roughness of the ceramic samples(including Ra,Rz and Rp)was measured with surface profilometry after different process and the data were analyzed by one way ANOVA.The surface characteristics of the specimens were observed by scanning electron microscopy.Results:The Ra and Rp of group 2 and 3 was higher than those of group 1(P <0.05).The Rz of group 2,3,4 and 5 was higher than that of group 1(P <0.05).Conclusion:Polishers interspersed with diamond grit may achieve a finish equal in smoothness to the glazed surface.

OBJECTIVETo determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy.

METHODSClinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated.

RESULTSBoth the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5(range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40(10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation, and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36(6-78) months without discomfort and recurrence under gastroscopy.

CONCLUSIONESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Adenocarcinoma ; Dissection ; Gastrectomy ; Gastric Mucosa ; Gastric Stump ; Gastroscopy ; Hemostasis, Endoscopic ; Humans ; Lymph Node Excision ; Neoplasm Recurrence, Local ; Operative Time ; Retrospective Studies ; Stomach Neoplasms

Objective To explore the effect of age on the fracture healing through bioinformatical analysis of gene ex?pression data in GEO, and to screen critical molecular targets and pathways involved in this process. Methods Through R programming language, we identified different expressed genes between 26/52 week old rats and 6 week old rats in every time points of the experiment (No fracture;3 days, 1 week, 2 weeks, 4 weeks and 6 weeks after fracture). By comparison of these different expressed genes, those genes that may contribute to fracture healing were identified. Function annotation was conducted based on DAVID database and PPI network that was constructed via STRING database. Results Compared with 6 week old rat, 52 week old rat show more different genes at 2, 4 and 6 weeks after fracture as well as more than intact rats. At the time point of 6 weeks after fracture, 26 week old rat present 4 different genes while 52 week old rat present 99 differ?ent genes compared with 6 week old rat. We totally found 99 genes that might play important roles in the process of fracture healing. These genes involved in biological process related to bone healing, immune, inflammatory and etc. Also, two screened gene enriched KEGG pathways were identified: ECM-receptor interaction and Arachidonic acid metabolism. Through the analysis of PPI network, Pcna, Fn1, Casp3 and etc, who present high density connectivity in PPI network, were screened out. Conclusion Pcna, Casp3 and Fn1 and etc might play important roles in fracture healing through affecting ECM-receptor interaction and Arachidonic acid metabolism.