Volume 103 · Issue 41 · 2023

The acceleration of aging process in China bring challenges for the anesthesia management of elderly patients. The co-morbidity, decreased function and high risk of postoperative severe complications and mortality are the main reasons of resultant lower anesthesia and surgery rate,higher medical expenses for elderly patients. The transformation from anesthesia clinic service to comprehensive anesthesia and multi-disciplinary evaluation, consultation,pre-rehabilitation and follow-up center in outpatient is a new medical mode to resolve the problem, which depends on the collaboration among hospital, disciplines and government to undertake the task.

Perioperative organ injury is a leading risk factor for mortality in surgical patients. Given the current limitations in the timeliness and accuracy of markers for perioperative organ injury, this article proposes a comprehensive early-warning assessment system that jointly monitors the macro-circulation, micro-circulation, and mitochondrial homeostasis. Macro-circulation monitoring allows for real-time evaluation of key indicators such as blood pressure and cardiac output, while micro-circulation monitoring aids in assessing the status of microvascular perfusion. Monitoring of mitochondrial homeostasis provides timely insights into cellular energy metabolism. These three facets are interconnected and collectively determine the balance between tissue oxygenation and energy supply and demand. This article will elucidate commonly used monitoring methods and clinically valuable assessment models within this system, offering theoretical and technical guidance to deepen our understanding of the pathological processes of perioperative organ injury, enhance surgical safety and success rates, and improve patient prognosis and quality of life.

Based on the changes of the classification and nomenclature in the fifth edition of the World Health Organization (WHO) classification of thyroid neoplasms, the third edition Bethesda system for reporting thyroid cytopathology (TBSRTC) was revised in June 2023. Two new chapters have been added: one addressing the clinical perspectives and imaging findings in thyroid disease and another summarizing the molecular test for thyroid cytology. A discussion of risk of malignancy (ROM) and clinical management algorithms for pediatric thyroid carcinoma have been added. The third edition provides an average ROM for each category, in addition to the expected range of cancer risk. This paper aims to interpret the main changes in the third edition TBSRTC and to provide guidelines for the clinical management of thyroid nodules.

To evaluate the effectiveness of whole-course multimodal analgesia on postoperative pain and rapid recovery in elderly patients undergoing radical resection of urological tumors.

The 132 geriatric patients (aged≥65 years) with urological tumors undergone laparoscopic surgery in Peking University Third Hospital from January to June 2022 were analyzed retrospectively. Patients were divided into three groups based on the perioperative analgesia protocol. Group C [n=54, 45 males and 9 females, aged 72 (68, 76) years]: patients were treated with local anesthetic wounds infiltration (LAWI) and non-steroidal anti-inflammatory drugs (NSAIDs). Group P [n=36, 26 males and 10 females, aged 70 (67, 72) years]: patients received patient-controlled intravenous analgesia (PCIA) on the basis of LAWI and NSAIDs. Group M [n=42, 30 males and 12 females, aged 70 (68, 73) years]: patients received whole-course multimodal analgesia, including peripheral nerve block (PNB) preoperatively and PCIA+NSAIDs for postoperative analgesia. The postoperative resting pain (numerical rating scale, NRS) on postoperative day 1 and 2, the rate of demand for analgesic rescue and sleep aid medication, the incidence of postoperative nausea and vomiting within 48 hours after surgery were collected and analyzed. Postoperative recovery conditions included the laboratory indicators within 24 hours after surgery, the defecation time, the drainage tube removal time, the activities of daily living (ADL) score at discharge, the postoperative complications and the length of hospital stay.

The resting NRS [M (Q₁, Q₃)] on the 1st and 2nd day postoperatively for patients in group M were 2 (1, 3) and 1 (0, 2) respectively. In contrast, patients in group C had NRS of 4 (3, 5) and 2 (1, 4), while those in group P had scores of 3 (2, 4) and 2 (1, 3). Compared with group C and group P, the resting NRS of patients in group M was significantly decreased (all P<0.001). The incidence of resting NRS≥4 in group M on the 1st and 2nd day postoperatively were 23.8% (10/42) and 11.9% (5/42) respectively, which were lower than those of 51.9% (28/54), 35.2% (19/54) in group C and 33.3%(14/36), 16.7% (7/36) in group P (all P<0.05). The demand rate for analgesic rescue and sleep aid medication within 48 hours after surgery, the incidence of postoperative complications and the postoperative hospital stay were 47.6% (20/42), 9.5% (4/42), 21.4% (9/42), and 5 (4, 6) d in group M, which were lower than those of 72.2% (39/54), 29.6% (16/54), 46.3% (25/54), 6 (5, 9) in group C, and 66.7% (24/36), 27.8% (10/36), 27.8% (10/36), 6 (5, 7) in group P (all P<0.05). There were no statistically significant differences in the incidence of postoperative nausea and vomiting, the laboratory indicators within 24 hours after surgery, the defecation time, the drainage tube removal time, the ADL score and the length of hospital stay among three groups (all P>0.05).

For elderly patients with urological tumors undergoing radical surgery, whole-course multimodal analgesia can improve postoperative pain within 48 hours, reduce postoperative complications, shorten postoperative hospital stay, and accelerate patient recovery.

To investigate the effects of preoperative quetiapine on postoperative delirium (POD) and sleep quality in elderly orthopedic patients.

Prospectively, 111 elderly patients, American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ, scheduled to undergo knee or hip surgery in the Affiliated Huangyan Hospital of Wenzhou Medical University under continuous spinal anesthesia from August 2021 to March 2023, were selected and randomly divided into two groups by random number table: control group (group C, 1 h preoperative placebo) and quetiapine group (group Q, 1 h preoperative quetiapine 12.5 mg). In group C, 54 cases were enrolled, including 25 males and 29 females, with an average age of (73.5±4.9) years. In group Q, 57 cases were enrolled, including 26 males and 31 females, with an average age of (74.8±5.0) years. The primary outcome measures were the incidence of POD evaluated by using confusion assessment method (CAM) at 24, 48, and 72 hours after surgery, and the secondary outcome measures included Pittsburgh sleep quality index (PSQI) scores at 24 and 48 hours after surgery and satisfaction of pain management within 24 hours after surgery.

The incidence of POD at 24, 48, and 72 h after surgery in group Q was 5.4% (3/57), 12.5% (7/57), 14.3% (8/57), respectively, while that in group C was 18.2% (10/54), 21.8% (12/54), 21.8% (12/54), respectively. The incidence of POD at 24 h after surgery in group Q was lower than that in group C (P=0.036). There was no significant difference in the incidence of POD at 48 and 72 h after surgery between two groups (all P>0.05). The PSQI score of patients in group Q at 24 and 48 h after surgery were (3.8±1.2) and (6.9±1.1) scores, respectively, which in group C were (10.5±2.8) and (7.3±1.3) scores, respectively. Compared with group C, the PSQI score of patients in group Q at 24 h after surgery was significantly higher (P<0.001), but there was no significant difference at 48 h after surgery (P=0.068). The satisfaction scores of pain management at 24 h after surgery in group Q was (91±7) scores, which was higher than that in group C of (81±6) scores (P<0.001).

Oral intake of low-dose quetiapine 1 h preoperatively can reduce the incidence of POD, improve postoperative sleep quality and enhance postoperative satisfaction of pain management at 24 hours after surgery in elderly orthopedic patients undergoing knee or hip surgery.

To investigate the changes of platelet mitochondrial mass and quantity during perioperative period in elderly patients, and assess their predictive values on the occurrence of postoperative delirium (POD).

In this prospective study, 162 elderly patients scheduled for abdominal surgery under general anesthesia were enrolled from November 2021 to January 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them, 20 patients [10 males, 10 females, aged (71.4±6.8) years] developed POD within 3 days after surgery (POD group), and another 20 patients[12 males, 8 females, aged (67.7±5.3) years] who did not develope POD were selected as controls (control group) using propensity score matching method. Blood samples were collected preoperatively, at the end of surgery and on the first postoperative day. Platelets were extracted and mitochondrial mass was detected with flow cytometry. Transmission electron microscopy was used to determine mitochondrial quantity. The receiver operating characteristic (ROC) curve was drawn to analyze the value of mitochondrial mass and quantity in predicting the occurrence of POD.

The mean fluorescence intensities of platelet mitochondrial mass were 193±46, 236±61, 264±53 preoperatively, at the end of surgery and on the first postoperative day in the POD group, respectively. The corresponding values were 209±61, 191±67 and 201±56 in the control group. The platelet mitochondrial mass of patients in the POD group was significantly increased on the first postoperative day compared to preoperative levels (P<0.001). In contrast, there was no significant difference in the control group (P=0.410). Patients in the POD group had higher platelet mitochondrial mass than patients in the control group on the first postoperative day(P=0.002). Meanwhile, platelets from patients in the POD group showed significantly higher number of mitochondria than platelets from patients in the control group [3 (2, 4) vs 2 (1, 2), P<0.001]. According to the ROC curve of platelet on the first postoperative day, at a mitochondrial mass cut-off value of>275.35, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 55%, 90% and 0.800 (95%CI: 0.666-0.934, P<0.001). At a mitochondrial quantity cut-off value of>2, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 53%, 78% and 0.680 (95%CI: 0.584-0.776, P<0.001).

Patients who developed POD show higher platelet mitochondrial mass after surgery compared to preoperative levels. The mitochondrial mass of platelets on the first postoperative day has good predictive value on the occurrence of POD.

To investigate the relationship between intraoperative electroencephalogram burst suppression (BS) and emergence delirium (ED) in elderly patients undergoing elective laparoscopic surgery under total intravenous anesthesia (TIVA).

From October 2017 to September 2019, a total of 358 elderly patients who underwent elective laparoscopic surgery under TIVA at Xiangya Hospital, Central South University, were included. Patients were divided into two groups based on the confusion assessment method for the intensive care unit (CAM-ICU) assessment conducted before leaving the post-anesthesia care unit (PACU): the ED group [n=63, 46 males, 17 females, average age of (70.8±0.6) years] and the non-ED group [n=295, 220 males, 75 females, average age of (69.7±0.2) years]. Preoperative general information, intraoperative conditions, and intraoperative electroencephalogram BS status were collected. A multivariate logistic regression model was employed to identify risk factors associated with ED.

In the ED group, the duration of surgery, intraoperative blood loss, the burst suppression ratio (BSR)>10% lasting for more than 1 minute were (224.4±9.6) min, (240.8±33.9) ml, 36.5% (23/63), respectively, which were higher than those of the non-ED group [(204.7±3.6) min, (150.5±9.2) ml, 21.7% (64/295), all P<0.05]. Multivariate logistic regression analysis revealed that a longer duration of education was a protective factor for ED (OR=0.904, 95%CI: 0.833-0.982,P=0.016), whereas increased intraoperative blood loss (OR=1.002, 95%CI: 1.000-1.003, P=0.013) and BSR>10% lasting for more than 1 minute (OR=2.131, 95%CI: 1.004-4.524,P=0.049) were identified as risk factors for ED.

In elderly patients undergoing laparoscopic surgery under TIVA, intraoperative electroencephalogram BS may be a risk factor for ED.

To investigate the incidence and related factors of chronic neuropathic pain (CNP) in elderly patients after thoracoscopic surgery.

A total of 463 elderly patients (aged≥60 years) who underwent elective video-assisted thoracoscopic surgery from November 2020 to May 2021 at Peking Union Medical College Hospital were prospectively recruited. Among them, 283 were males and 180 were females, with an average age of (66.6±4.8) years. Chronic postsurgical pain (CPSP) was assessed by telephone at 6 months after surgery, and then the patients with CNP were screened using the ID-pain scale. Multivariable logistic regression was used to analyze the related factors for CNP in elderly patients after thoracoscopic surgery.

The incidence of CPSP was 41.9% (194/463), and the incidence of CNP was 18.8% (87/463). Multivariable logistic regression analysis showed that incision number<3 (OR=0.385, 95%CI: 0.156-0.949, P=0.038) and intraoperative N₂O inhalation (OR=0.506, 95%CI: 0.304-0.842, P=0.009) were protective factors for CNP in elderly patients after thoracoscopic surgery, but high numeric rating scale (NRS) score on the first day after surgery (OR=1.180, 95%CI: 1.056-1.318, P=0.003) was a risk factor.

The incidence of CNP in elderly patients after thoracoscopic surgery is 18.8%. Incision number<3 and intraoperative N₂O inhalation are protective factors for CNP, but high NRS score on the first day after surgery is a risk factor.

To explore the effect of high-flow nasal catheter oxygen inhalation in preventing hypoxemia during endoscopic retrograde cholangiopancreatography (ERCP) surgery in elderly patients.

From September 2021 to September 2022, 116 elderly patients (aged ≥ 70 years) who underwent elective ERCP in the Northern Theater General Hospital were prospectively selected, then divided into general nasal catheter oxygen inhalation group [group C, 31 males and 27 females, aged (79.8±6.4) years] and high-flow nasal catheter oxygen inhalation group [group H, 33 males and 25 females, aged (81.4±6.7) years], with 58 patients in each group. All patients were monitored for anesthesia by target-controlled infusion of propofol and remifentanil. The main outcome index was the incidence of intraoperative subclinical hypoxemia (90% ≤ SpO₂ < 95%, duration >5 s), hypoxemia (75% < SpO₂ < 90%, 5 s < duration ≤ 60 s) and severe hypoxemia (SpO₂ < 75% or SpO₂ < 90%, duration > 60 s). Secondary observation measures were SpO₂ from T₀ to T₅ (T₀, before anesthesia induction; T₁, immediately after anesthesia induction; T₂, endoscopic introduction; T₃, duodenal papula intubation; T₄, endoscopic withdrawal; T₅, postoperative awakening), the arterial oxygen partial pressure (PaO₂), carbon dioxide partial pressure (PaCO₂) and pH at T₀, 15 min after the induction and T₅.

The incidence of intraoperative subclinical hypoxemia in group C and group H was 12.0% (7/58) and 3.4% (2/58) respectively, which showed no significant statistical difference (P=0.165) from each other. The incidence of intraoperative hypoxemia in group H was 8.6% (5/58), which was significantly lower than 31.0% (18/58) of group C (P=0.003). Neither group had intraoperative severe hypoxemia. SpO₂ of group H were (98.2±0.9)%, (98.2±0.9)%, (97.8±1.7)% and (97.7±1.7)% at T₁, T₂, T_3, T₄, which were higher than (96.8±2.1)%, (96.4±3.0)%, (96.1±2.9)% and (96.4±3.4)% in group C (all P<0.05). PaO₂ at 15 min after induction in group H was (240.5±46.7) mmHg (1 mmHg=0.133 kPa), which was higher than that of group C (170.6±33.4) mmHg (P<0.001). There was no statistically significant difference in pH and PaCO₂ between the two groups of patients at each timepoint.

High flow nasal catheter oxygen can effectively reduce the incidence of hypoxemia in ERCP in elderly patients.

To investigate the value of radiomics models based on magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps in distinguishing benign and malignant thyroid nodules.

A cross-sectional study. Clinical data of 148 thyroid nodules (50 benign, 98 malignant) from 140 patients who underwent thyroid MRI examination in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences between January 2019 and December 2022 were retrospectively analyzed. The nodules were used as the study units, and a leave-one-out method was used to randomly divide the nodules into a training set and a test set at a 7∶3 ratio. Region of interest was segmented and radiomics features were extracted from the DWI and ADC images. In the training set, feature selection was performed using inter-observer agreement analysis, U-test, least absolute shrinkage and selection operator algorithm, and correlation analysis. Four classifiers, including support vector machine (SVM), random forest (RF), k-nearest neighbors (KNN) and logistic regression (LR) were used to build models with the selected features, including the DWI models, ADC models, and combined models. The models were independently tested in the test set. The performance of the radiomics models in distinguishing benign and malignant thyroid nodules was evaluated using the receiver operating characteristic (ROC) curve, with pathological results as the gold standard.

Of the 140 patients, there were 40 males and 100 females, with a mean age of (38.4±12.2) years. After feature selection, 11 DWI features and 11 ADC features were used to build the models. In the training set, the AUC values of the combined models were higher than those of the corresponding DWI and ADC models. In the test set, the SVM combined model showed the best predictive performance, with an AUC of 0.873 (95%CI:0.740-0.954), accuracy of 75.6%, sensitivity of 46.7%, specificity of 90.0%, positive predictive value (PPV) of 70.0% and negative predictive value (NPV) of 77.1%, while the RF combined model had an AUC of 0.836 (95%CI:0.695-0.929), accuracy of 77.8%, sensitivity of 40.0%, specificity of 96.7%, PPV of 85.7% and NPV of 76.3%, the KNN combined model had an AUC of 0.832 (95%CI:0.691-0.927), accuracy of 77.8%, sensitivity of 33.3%, specificity of 100%, PPV of 100% and NPV of 75.0%, the LR combined model had an AUC of 0.813 (95%CI:0.669-0.914), accuracy of 77.8%, sensitivity of 60.0%, specificity of 86.7%, PPV of 69.2% and NPV of 81.3%.

Radiomics models based on DWI and ADC image features can effectively distinguish benign and malignant thyroid nodules. The SVM combined model had the best prediction performance.

To investigate the expression of neuraminidase-1 (NEU1) in Ewing sarcoma (ES) tissue and its effect on the proliferation and migration of ES cells.

To obtain datasets of ES from the National Center for Biotechnology Information′s High-Throughput Gene Expression Omnibus (GEO) for the analysis of NEU1 expression in ES; to acquire ES patient dataset from the International Cancer Genome Consortium (ICGC) database and apply Kaplan-Meier survival analysis to investigate the relationship between NEU1 and the prognosis of ES patients; adopting both univariate and multivariate Cox regression analysis to determine whether NEU1 is a prognostic factor for ES; adopting the Kyoto Encyclopedia of Genes and Genomes (KEGG) annotation to analyze the potential mechanism of NEU1 in regulating the malignant biological behavior of ES; adopting the real-time fluorescence quantitative polynucleotide chain reaction (RT-qPCR) to verify the expression of NEU1 in the human bone marrow mesenchymal stem cells (hBMSC) and the ES cell line RD-ES; adopting the transfection technology to knock down the expression of NEU1 in ES cell lines and divide them into two groups: shRNA-NEU1 and shRNA-NC to explore the effects of altered NEU1 expression on ES malignant behavior; adopting the cell counting kit (CCK-8) and cell clone formation experiment to detect the proliferation ability of two groups of cells; adopting the scratch healing experiment to test the cell migration ability of the two groups.

We retrieved and analyzed data from the GEO database, including GSE17674 (44 ES tissues and 18 normal tissues) and GSE17679 (87 ES tissues and 18 normal tissues), and found that NEU1 expression was significantly higher in ES tissues compared to normal control tissues (P<0.001). The complete gene expression and clinical information of 56 ES patients obtained from the ICGC database revealed that the ES patients with high NEU1 expression (n=28) had a significantly lower overall survival rates at different time points compared to those with low NEU1 expression (n=28) (HR=2.830, 95%CI:1.324-6.051, P=0.005). Univariate analysis indicated that NEU1 could impact ES patient prognosis (HR=1.049, 95%CI: 1.008-1.092, P=0.019), and multivariate analysis further suggested that NEU1 could serve as a risk factor for ES prognosis (HR=1.087, 95%CI: 1.028-1.148, P=0.003). KEGG results show that MAPK signaling pathway and cell adhesion molecule signaling pathway were potential mechanisms regulating the malignant process of ES. The RT-qPCR results showed that the expression level of NEU1 in the RD-ES cell line is significantly higher than that in the control cell hBMSC (2 184.23±527.32 vs 1.00±0.08, P<0.001). The CCK-8 experiment results show that the proliferation of RD-ES cells in the NEU1 knockdown group was lower than that in the control group at 24, 48, and 72 hours (0.494±0.126 vs 0.696±0.118, 0.657±0.096 vs 1.142±0.182, 1.053±0.064 vs 1.980±0.146, all P<0.001). The results of single cell clone formation experiment show that the number of colony formation in the low expression NEU1 group was significantly lower than that in the control group (184.2±123.9 vs 362.8±78.0, P=0.021). The cell scratch healing experiment finds that the average scratch distance of the NEU1 knockdown group was significantly lower than that of the control group (19.6%±5.7% vs 56.0%±7.6%, P<0.001).

NEU1 may be a prognostic factor in ES, and its abnormal expression in ES can affect the proliferation and migration ability of the ES cells, leading to poor prognosis in ES patients.

To analyze the PET/CT imaging features of fluoride ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) in patients with various types of Parkinson′s syndrome (PS), and to establish a "diagnostic tree" model of ¹⁸F-FDG PET/CT for PS.

Data of patients with Parkinson′s disease (PD), patients with multiple system atrophy cerebellar type (MSA-C), and patients with multiple system atrophy Parkinson′s type (MSA-P)admitted to the Neurology Department of Huashan Hospital affiliated to Fudan University from January 2019 to December 2021. ¹⁸F-FDG PET/CT examination was conducted in all patients. Clinical and follow-up data was collected to determine clinical diagnosis. The specific patterns of brain glucose metabolism in patients with various types of Parkinsonism were observed and their utility in the differential diagnosis of the disease was analyzed. ¹⁸F-FDG PET/CT imaging"diagnostic tree"model was established and its value in the differential diagnosis of Parkinsonism was verified.

A total of 320 patients, 187 males and 133 females, aged (62±9) years, were enrolled in our study, including 80 PD, 90 PSP, 114 MSA-C and 36 MSA-P patients. The differential diagnostic features of cerebral glucose metabolism of Parkinsonism were as follows: the metabolism of putamen increased in PD patients, the metabolism of caudate nucleus, thalamus, midbrain, and frontal lobe decreased in PSP patients, the metabolism of cerebellum decreased in MSA-C patients, and the metabolism of putamen and cerebellum decreased in MSA-P patients. The sensitivity and specificity of the"diagnostic tree"model are 88.75% and 91.25% for PD diagnosis, 54.44% and 96.96% for PSP diagnosis, 87.72% and 86.41% for MSA-C diagnosis, and 55.56% and 91.55% for MSA-P diagnosis, respectively. It could correctly classify 75%(240/320) of patients.

Characteristic metabolism patterns of brain in ¹⁸F-FDG PET/CT imaging is significant for the differential diagnosis of PD, PSP, MSA-C and MSA-P. The"diagnostic tree"model is valuable for clinical diagnosis.

To analyze the efficacy of dual vein induction therapy of Ustekinumab (UST) in complex perianal fistulizing Crohn′s disease (PFCD).

Clinical data of patients diagnosed with complex PFCD in the Second Affiliated Hospital of Wenzhou Medical University from January 2022 to March 2023 were retrospectively analyzed. After sufficient single intravenous infusion of UST (6 mg/kg) at week 0 and 8, every patient received single subcutaneous injection of UST 90 mg every 8 weeks for maintenance treatment. At week 8, 16, and 22-26, clinical outcomes of anal fistula were evaluated using perianal disease activity index (PDAI), and overall activity of the patients was evaluated using Harvey Bradshaw index (HBI). At week 22-26, Van Assche Index (VAI) was used to evaluate imaging outcome of anal fistula, and simplified endoscopic score of Crohn′s disease (SES-CD) was employed to assess intestinal outcome events. The above indexes were compared in the patients before and after UST treatment. PFCD patients were divided into first-line UST treatment group and non first-line UST treatment group according to whether first-line UST treatment was used, the differences in anal fistula response rate and remission rate, intestinal response rate and remission rate as well as overall activity response rate and remission rate were compared between the two groups.

A total of 60 PFCD patients were included, including 46 males and 14 females, aged [M (Q₁, Q₃)] 25.0 (20.8, 30.0) years old. The clinical response rates of anal fistula [41.7% (25/60), 55.0% (33/60) and 63.3% (38/60), respectively, P=0.056] and the clinical remission rates of anal fistula [21.7% (13/60), 31.7% (19/60) and 43.3% (26/60), respectively, P=0.002] gradually increased at week 8, 16, 22-26. The overall activity response rates [53.3% (32/60), 70.0% (42/60), 83.3% (50/60), respectively, P=0.040] and the overall activity response rates [41.7% (25/60), 61.7% (37/60), 75.0% (45/60), respectively, P=0.001] also gradually increased at week 8, 16, 22-26. At week 22-26, the partial response rate and fistula healing rate of anal fistula imaging were 45.0% (27/60) and 38.3% (23/60), respectively. The endoscopic response rate and endoscopic response rate were 73.7% (44/60) and 45.0% (27/60), respectively. The endoscopic response rate of patients receiving first-line UST treatment [23 males and 8 females, aged 22.0 (21.0, 39.0) years] was higher than that of patients receiving non first-line UST treatment[23 males and 6 females, aged 26.5 (20.0, 30.0) years,87.1% vs 58.6%, P=0.013].

The dual vein induction therapy of UST could effectively improve the clinical efficacy in patients with complex PFCD.

This paper reports a case of FOSMN syndrome with dysplasia as the first symptom. A 64-year-old female patient developed symptoms such as lip and facial numbness, dysarthria, salivation, choking and cough after drinking water, and weakness in raising her head. Combined with blinking reflex, muscle pathology, laboratory and imaging examinations, the patient was clinically diagnosed as FOSMN syndrome with onset of taste disorder. Neurotrophic and antioxidant therapy were given, clinical symptoms and neuroelectrophysiology were followed up, and the disease progressed slowly. This case suggests that taste disorder may be another first symptom of FOSMN syndrome, and dynamic follow-up of symptoms, signs and electrophysiological examination is of great value in diagnosis.

Cardiac myxoma is the most common benign cardiac tumor and an important source of embolus leading to cardiogenic stroke. Because cardiac myxoma is rare in clinic, the risk factors of embolism caused by cardiac myxoma are still unclear, and there are great controversies in various studies. Cardiac myxoma-related stroke mainly has central nervous system complications as the first symptom. The diagnosis of cardiac myxoma-related stroke needs to be combined with clinical manifestations, imaging and laboratory examinations, and histopathological examination is needed to confirm the diagnosis. Surgical removal of myxoma is the most effective treatment for cardiac myxoma-related stroke, but the timing of surgery is still controversial. Patients with cardiac myxoma-related stroke who can undergo surgical treatment have a favorable prognosis.

Repair after complete spinal cord injury (SCI) has always been an important topic in the field of nerve regeneration. Five years ago, the research team first discovered a method to promote axon regeneration in mice after SCI, but the motor function of mice failed to recover steadily. In order to solve this problem, the research team continued to explore and identify specific groups of neurons located in the middle thoracic spinal cord that regulate the recovery of motor function, and used chemistry to attract and guide the transverse axons of these neurons to their natural target areas, so that the walking ability of paralyzed mice after SCI was significantly recovered.

enhanced recovery after surgery (ERAS) can effectively improve postoperative outcomes, shorten hospital stay and reduce postoperative complications for surgical patients. Thoracic surgery may result in significant postoperative pain, so adequate postoperative analgesia is an important component of the ERAS protocol. Opioids are commonly used for analgesia after thoracic surgery, but may cause a range of adverse reactions. Minimally invasive techniques and the implementation of peripheral nerve blocks have helped reduce systemic opioid use, but few studies have investigated the effect of ERAS protocols on opioid use after thoracic surgery. The study evaluated postoperative opioid usage in patients undergoing lung surgery under the ERAS protocol and compared it to patients receiving conventional treatment. Patients who underwent lung surgery between August 2019 and December 2020 were included in the study. Patients in the ERAS group received an ERAS regimen focused on effective analgesia, and those who received conventional treatment regimens were classified into the traditional group. The primary study endpoint was total opioid use from surgery to discharge. Secondary endpoints included mean and highest pain scores during exercise, opioid-related adverse events, and clinical outcomes such as length of stay in the intensive care unit (ICU), length of stay, rate of readmission within 30 days, and Clavien-Dindo surgical complication grade.

Infliximab (IFX) can effectively induce and maintain remission of Crohn's disease (CD), but IFX failure to respond is an urgent clinical problem, which may be due to its immunogenicity leading to increased IFX clearance and decreased drug levels. Vitamin D, as an immunomodulatory substance, plays an important role in maintaining gut immune homeostasis. Studies have shown that CD patients are more likely to have vitamin D deficiency than normal people, and vitamin D deficiency may be related to an increased risk of hospitalization and increased use of steroids and biologics in CD patients. There are also studies that have found that vitamin D levels may affect the efficacy of IFX, but this view remains controversial. At present, there is no sufficient evidence on whether vitamin D supplementation can affect the efficacy of IFX in the treatment of CD. Therefore, the researchers conducted this retrospective study to explore: (1) whether vitamin D supplementation can increase the serum concentration of vitamins in patients with CD treated with IFX and improve the clinical response rate of patients at week 54; (2) the determinants of vitamin D supplementation to improve the efficacy of IFX; (3) Whether vitamin D supplementation affects the expression of Th cell-related cytokines in patients with CD treated with IFX.