Gastroscopic treatment of acute gastric variceal rupture through the right lateral position.

Acute variceal bleeding is a life-threatening condition and a common cause of cirrhosis-related death, severe acute bleeding is difficult to treat and has a high mortality rate, drug treatment is often ineffective. We encountered a patient with cirrhosis with ruptured and bleeding gastroscopic varices requiring emergency endoscopic surgical treatment. However, in the routine left lateral position the treatment was interfered with by a fresh blood clot obscuring the gastric fundus. We were able to expose the gastric fundus by turning the patient to the right lateral position and eventually successfully treated the patient. This provides a new idea for the endoscopic treatment of acute gastric varices and may improve the success rate of treatment.

Sociodemographic predictors of successful screening and subsequent randomization in a digital health hypertension intervention.

Introduction: Clinical trials often enroll nonrepresentative participant samples, limiting generalizability of trial findings. The current analysis explores the influences of remote recruitment and screening protocols on participation in a digital health intervention (DHI) to promote the evidence-based Dietary Approaches to Stop Hypertension (DASH) eating pattern. Methods: Nourish was a 12-month randomized controlled trial comparing the effectiveness of a DHI to an attention control arm among US adults with hypertension. Participants were recruited using digital approaches; eligible individuals completed several screening steps. We examined associations between sociodemographics and mobile technology use and completion of each screening step and compared those characteristics between randomized and nonrandomized participants (those consented but were screened out before randomization). Results: A total of 678 adults consented to participate in Nourish; 44% of those consented were randomized (n = 301). Those randomized possessed a higher education level (p < 0.0001); were more likely to use health-related apps (p < 0.0001) and wearables (p < 0.0001); and were older (p = 0.01) than nonrandomized individuals. Randomized adults were more likely to use a desktop/laptop/tablet for Internet access (vs mobile phones) (p = 0.01). No significant association was observed existed between sex, race, ethnicity, income, or geographic density of residence and subsequent randomization. Conclusions: Participants with lower education levels or limited experience in using mobile technologies may require additional support to participate in DHIs. Future research is needed to evaluate remote clinical trial procedures and impacts on generalizability to achieve equitable clinical trial participation.

A comprehensive review on pharmacokinetic mechanism of herb-herb/drug interactions in Chinese herbal formula.

Oral administration of Chinese Herbal Medicine (CHM) faces various challenges in reaching the target organs including absorption and conversion in the gastrointestinal tract, hepatic metabolism via the portal vein, and eventual systemic circulation. During this process, factors such as gut microbes, physical or chemical barriers, metabolic enzymes, and transporters play crucial roles. Particularly, interactions between different herbs in CHM have been observed both in vitro and in vivo. In vitro, interactions typically manifest as detectable physical or chemical changes, such as facilitating solubilization or producing precipitates when decoctions of multiple herbs are administered. In vivo, such interactions cause alterations in the ADME (absorption, distribution, metabolism, and excretion) profile on metabolic enzymes or transporters in the body, leading to competition, antagonism, inhibition, or activation. These interactions ultimately contribute to differences in the therapeutic and pharmacological effects of multi-herb formulas in CHM. Over the past two thousand years, China has cultivated profound expertise and solid theoretical frameworks over the scientific use of herbs. The combination of multiple herbs in one decoction has been frequently employed to synergistically enhance therapeutic efficacy or mitigate toxic and side effects in clinical settings. Additionally combining herbs with increased toxicity or decreased effect is also regarded as a remedy, a practice that should be approached with caution according to Traditional Chinese Medicine (TCM) physicians. Such historical records and practices serve as a foundation for predicting favorable multi-herb combinations and their potential risks. However, systematic data that are available to support the clinical practice and the exploration of novel herbal formulas remain limited. Therefore, this review aims to summarize the pharmacokinetic interactions and mechanisms of herb-herb or herb-drug combinations from existing works, and to offer guidance as well as evidence for optimizing CHM and developing new medicines with CHM characteristics.

Light-Induced Complete Reversal of Ferroelectric Polarization in Sliding Ferroelectrics.

Previous experiments have provided evidence of sliding ferroelectricity and photoexcited interlayer shear displacement in two-dimensional materials, respectively. Herein, we find that a complete reversal of vertical ferroelectric polarization can be achieved within an astonishing 0.5 ps in h-BN bilayer by laser illumination. Comprehensive analysis suggests that ferroelectric polarization switching originates from laser-induced interlayer sliding triggered by selective excitation of multiple phonons. The interlayer electron excitation from the p_{z} orbitals of the upper layer N atoms to the p_{z} orbitals of the lower layer B atoms produces desirable and directional interlayer forces activating the in-plane optical TO-1 and LO-1 phonon modes. The atomic motions driven by the coupling of TO-1 and LO-1 modes are coherent with ferroelectric soft mode, thus modulating the dynamical potential energy surface and resulting in ultrafast ferroelectric polarization reversal. Our work provides a novel microscopic insight into ultrafast polarization switching in sliding ferroelectrics.

Targeting KRAS in gynecological malignancies.

Cervical, endometrial, and ovarian cancers stand prominently as the leading gynecological malignancies of the female reproductive system. The conventional therapeutic modalities for gynecological malignancies have predominantly encompassed surgery, chemotherapy, and radiotherapy. However, efficacy of these approaches remains limited in cases of relapse or drug resistance. KRAS is one of the most frequently mutated oncogenes in human cancers. The KRAS gene encodes a small guanosine triphosphatase protein that acts as a molecular switch for crucial intracellular signaling pathways. KRAS mutations are deeply involved in the occurrence and development of gynecological malignancies. The present review aims to expound upon the role of oncogenic KRAS as a biomarker, elucidating various therapeutic approaches under investigation targeting the KRAS pathway in gynecological tumors.

Light δD apatites reveal deep origin water in North China Craton intracontinental granites and basalts.

Water is essential to the formation of intracontinental granites, but its origin remains elusive. Here we address this scientific problem by analyzing D/H isotopes of apatites, hydrous minerals in Jurassic and Early Cretaceous granites and basalts from eastern North China Craton, where water was previously interpreted as derived from subducting slab. Results reveal extremely low δD values in pristine Early Cretaceous granitic (-203‰ to -127‰) and basaltic (-197‰ to -107‰) apatites, contrasting with relatively high δD values (-137‰ to -47‰) in Jurassic granites. Given the depth-dependent D/H isotopic fractionation during slab dehydration and high-water contents in coeval primitive mafic magmas, the Early Cretaceous magma water is attributed to the stagnant slab within the mantle transition zone. Secular change in the depth of water aligns with steepening of subducting Paleo-Pacific plate from Jurassic to Early Cretaceous, demonstrating the potential of apatite H isotopes in tracing water origin in granites and basalts.

Plasma niacin is inversely associated with hyperlipidemia in participants with diabetes among Chinese adults.

Evidence is limited regarding the association of plasma niacin with the risk of hyperlipidemia in participants with diabetes. We aimed to determine the relationship between plasma niacinamide/nicotinic acid and hyperlipidemia in participants with/without diabetes. Plasma niacinamide/nicotinic acid concentrations were measured using high-performance liquid chromatography-tandem mass spectroscopy. Multivariable logistic regression analyses were performed to evaluate the association between plasma niacin and hyperlipidemia in participants with diabetes and nondiabetes in a cross-sectional study. Compared to the first quartile, plasma nicotinamide, nicotinic acid, and niacin (nicotinamide plus nicotinic acid) were associated with a 54%, 50%, and 52% lower risk of hyperlipidemia in diabetic participants, respectively, but no significant association was observed in nondiabetic participants. These inverse associations persisted across subgroups stratified by sex, age, body mass index, smoking status, alcohol consumption, and physical activity. In addition, the fully adjusted odds ratios (95% confidence intervals) for hypercholesterolemia and hypertriglyceridemia among diabetic participants were 0.54 (0.38, 0.77) and 0.61 (0.44, 0.85), respectively, when comparing to the first quartile of plasma niacin concentrations (all Ptrend < .001). This study of 2647 participants observed that plasma niacin was inversely associated with hyperlipidemia in those with diabetes.

Behavioral observation and assessment protocol for language and social-emotional development study in children aged 0-6: the Chinese baby connectome project.

BACKGROUND: The global rise in developmental delays underscores the critical need for a thorough understanding and timely interventions during early childhood. Addressing this issue, the Chinese Baby Connectome Project (CBCP)'s behavior branch is dedicated to examining language acquisition, social-emotional development, and environmental factors affecting Chinese children. The research framework is built around three primary objectives: developing a 0-6 Child Development Assessment Toolkit, implementing an Intelligent Coding System, and investigating environmental influence. METHODS: Utilizing an accelerated longitudinal design, the CBCP aims to enlist a minimum of 1000 typically developing Chinese children aged 0-6. The data collected in this branch constitutes parental questionnaires, behavioral assessments, and observational experiments to capture their developmental milestones and environmental influences holistically. The parental questionnaires will gauge children's developmental levels in language and social-emotional domains, alongside parental mental well-being, life events, parenting stress, parenting styles, and family relationships. Behavioral assessments will involve neurofunctional developmental evaluations using tools such as the Griffiths Development Scales and Wechsler Preschool and Primary Scale of Intelligence. Additionally, the assessments will encompass measuring children's executive functions (e.g., Head-Toe-Knee-Shoulder), social cognitive abilities (e.g., theory of mind), and language development (e.g., Early Chinese Vocabulary Test). A series of behavior observation. experiments will be conducted targeting children of different age groups, focusing primarily on aspects such as behavioral inhibition, compliance, self-control, and social-emotional regulation. To achieve the objectives, established international questionnaires will be adapted to suit local contexts and devise customized metrics for evaluating children's language and social-emotional development; deep learning algorithms will be developed in the observational experiments to enable automated behavioral analysis; and statistical models will be built to factor in various environmental variables to comprehensively outline developmental trajectories and relationships. DISCUSSION: This study's integration of diverse assessments and AI technology will offer a detailed analysis of early childhood development in China, particularly in the realms of language acquisition and social-emotional skills. The development of a comprehensive assessment toolkit and coding system will enhance our ability to understand and support the development of Chinese children, contributing significantly to the field of early childhood development research. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov NCT05040542 on September 10, 2021.

Aberrant serum-derived FN1 variants bind to integrin ß1 on glomerular endothelial cells contributing to thin basement membrane nephropathy.

The glomerular basement membrane (GBM) is a critical component of the glomerular filtration barrier (GFB), with its thickness directly influencing renal function. While a uniformly thinned GBM can cause hematuria while preserving normal renal function, this condition is typically diagnosed as thin basement membrane nephropathy (TBMN). However, the pathogenesis and potential progression to renal insufficiency of TBMN are not fully understood. In this study, we analyzed clinical cohorts presenting with microscopic hematuria who underwent genetic testing and identified five novel pathogenic FN1 mutations. Through bioinformatics analysis of these variants, expression localization analysis of GBM-related molecules in renal biopsies, and functional studies of the mutants, we found that these variants exhibited gain-of-function characteristics. This led to the excessive deposition of aberrant serum-derived FN1 variants on glomerular endothelial cells rather than cell-type-specific variants. The deposition competitively binds FN1 variants to Integrin ß1, disrupting the interaction with Laminin α5ß2γ1 and subsequently reducing the expression of key GBM components, resulting in TBMN. This study elucidated, for the first time, the genetic pathogenesis of TBMN caused by FN1 variants. It provides a crucial foundation for understanding the progression of renal dysfunction associated with simple hematuria, highlights the potential for targeted therapeutic strategies, and differentiates TBMN from early-stage Alport syndrome.

Phase imaging through a single multimode fiber.

Phase imaging techniques are pivotal for achieving high-contrast visualization of unstained biological specimens in vitro, which is typically not applicable in narrow spaces. Recently, multimode fiber (MMF) has shown promise in enabling high-resolution in vivo endoscopy in biological research. Herein, we introduce a novel, to the best of our knowledge, phase imaging microscopy technique employing a single multimode fiber, showcasing remarkable capabilities in high-contrast imaging and quantitative shape reconstruction through frequency-domain modulation. Our method, validated through comparisons with reflection and phase-contrast results, demonstrates exceptional ability in imaging diverse samples, including microspheres, semiconductor chips, and oral epithelial cells. Notably, the quantitative reconstruction of surface shape achieves a sensitivity of less than 100 nm, enabling the extraction of three-dimensional information from single focal plane images. Moreover, our technique excels in contrast enhancement and defocused background suppression, presenting a promising avenue for minimally invasive, high-contrast, label-free in vivo phase imaging.

Monorhinal and Birhinal Odor Processing in Humans: an fMRI investigation.

The olfactory nerve, also known as cranial nerve I, is known to have exclusive ipsilateral projections to primary olfactory cortical structures. However, the lateralization of olfactory processes is known to depend on the task and nature of stimuli. It still remains unclear whether olfactory system projections in humans also correspond to functional pathways during olfactory tasks without any trigeminal, perceptual or cognitive-motor components. Twenty young healthy subjects with a normal sense of smell took part in an olfactory functional magnetic resonance imaging (fMRI) study. We used two types of nostril specific stimulation, passive (no sniffing) and active (with sniffing), with phenyl ethyl alcohol, a pure olfactory stimulant, to investigate fMRI activity patterns in primary and secondary olfactory-related brain structures. Irrespective of the stimulated nostril and the type of stimulation, we detected symmetrical activity in primary and secondary olfactory-related brain structures such as the primary olfactory cortex, entorhinal cortex, and orbitofrontal cortex. In the absence of perceptual or cognitive-motor task demands, the perception of monorhinally presented pure odors is processed bilaterally in the brain.

Structure-based virtual screening of novel chitin synthase inhibitors for the control of Phytophthora sojae.

BACKGROUND: Chitin synthase (CHS) is an important target for pesticide development as chitin biosynthesis is essential for the survival and reproduction of various organisms, such as oomycetes, fungi and insects. Small-molecule inhibitors of CHS have potential applications for the control of agricultural pests and diseases. RESULTS: In this study, exploiting the cryo-EM structures of PsChs1, the CHS indispensable to the sporangial production and virulence of soybean root rot pathogenic oomycete Phytophthora sojae, a virtual screening method combining by molecular docking, inhibitory activity measurement and biological activity determination was conducted, to identify novel small-molecule inhibitors of CHS. A chemical library containing ≈1.8 million compounds was screened, and four potent inhibitors (HS-20, HS-24, HS-36 and HS-40) were identified. Amongst these compounds, HS-20 showed the most potent inhibitory activity with a Ki value of 4.2 ± 0.2 µM. Besides inhibitory activities towards PsChs1, these compounds were effective in decreasing sporangial production and preventing zoospore infection. When inoculated with zoospores, HS-20 and HS-24 completely inhibited the growth of P. sojae, suggesting their potential in its prevention and control. CONCLUSION: This study identified four new compounds with potent chitin synthase (CHS) inhibitory activity, all of which significantly reduce sporangia production and zoospore infection. It also presents promising in silico techniques and small molecule candidates for the design and development of novel CHS inhibitors. © 2024 Society of Chemical Industry. Published by John Wiley & Sons Ltd.

The general glycan profiling of Dendrobium officinale and their protective effects on MIN6 cells via ERK signaling pathway.

Based on structural elucidation of natural and hydrolyzed glycans, the general glycans profiling of D. officinale were unequivocally established for the first time as follows: The results indicated that the structure of D. officinale glycans with low degree of polymerization (DP ≤ 22) was linear α-D-1,4-glucan, whereas the structure of glycans with high degree of polymerization (DP > 24) was linear acetylated 1,4-glucomannan. The content of acetyl groups and mannose to glucose (M/G) ratio increased with the degree of polymerization of D. officinale glycans. In addition, this study showed that natural D. officinale glycans protected pancreatic ß-cell damage induced by glucotoxicity through the extracellular signal-regulated kinase (ERK)1/2 pathway.

VEGFB promotes adipose tissue thermogenesis by inhibiting norepinephrine clearance in macrophages.

Adipokines play key roles in adaptive thermogenesis of beige adipocytes, though its detailed regulatory mechanisms are not fully understood. In the present study, we identify a critical function of vascular endothelial growth factor B (VEGFB)/vascular endothelial growth factor receptor 1 (VEGFR1) signaling in improving thermogenesis in white adipose tissue (WAT). In mouse subcutaneous WAT (scWAT), thermogenesis activation leads to the up-regulation of VEGFB in adipocytes and its receptor VEGFR1 in macrophages. Ablation of adipocyte VEGFB results in deficiency in murine WAT browning. Meanwhile, supplementation of VEGFB promotes WAT thermogenesis, but this effect is blocked by knockout of macrophage VEGFR1. Mechanistic studies show that the VEGFB-activated VEGFR1 inhibits p38 MAPK signaling through its dissociation with receptor for activated C kinase 1, thereby preventing norepinephrine transporter (solute carrier family 6 member 2) and norepinephrine-degrative monoamine oxidase a mediated norepinephrine clearance in macrophages. Our findings demonstrate that VEGFB/VEGFR1 circuit contributes to the WAT thermogenesis.

Short-Term Postoperative Depression and Anxiety in Patients with Differentiated Thyroid Carcinoma: Assessment of Potential Oncologic-Psycho Relevance.

Objective: To understand whether TSH suppressive therapy affect short-term postoperative cancer-related depression and anxiety among DTC patients. To evaluate short-term postoperative psychological problems and its relationship with baseline parameters, fatigue, sleep quality, illness perception, and patients' quality of life. Study Design and Methods: This was a prospective, observational, single center study. This study involved 831 TC patients who consecutively admitted to the inpatient department of hospital between 1st June 2020 and 31th February 2021. Results: Mean scores of the self-rated anxiety scale (SAS) (49.04 vs. 40.69) and self-rated depression scale (SDS) (44.61 vs. 39.86), as well as the incidence of anxiety (41.5% vs. 22.1%) and depression (22.5% vs. 2.4%) significantly decreased 3 months after surgery. For personal and clinical characteristics, low educational background (SAS, ß = 1.392; SDS, ß = 1.622; and p < 0.05), without children (SAS, ß = 4.068; SDS, ß = 1.873, and p < 0.01), FNAC (SAS, ß = -0.981; SDS, ß = -2.583; and p < 0.05), and multifocal tumor (SAS, ß = -1.287; SDS, ß = -2.681; and p < 0.05) were the main effects for both short-term postoperative anxiety and depression. Multiple linear regression analysis identified the serum TSH level as a significant variable associated with worse SAS (Beta = -0.695 and p=0.043) and SDS (Beta = -3.133 and p < 0.001) scores 3 months after surgery. FT4 was independently associated with SAS scores (Beta = -0.202 and p < 0.001). Patients with middle ATA risk had a significantly higher level of SDS scores (p=0.033). Conclusion: We confirmed that cancer-related anxiety and depression among DTC patients significantly alleviated 3 months after surgery. TSH suppression therapy has profound effects on cancer-related anxiety and depression, and the degree of anxiety and depression significantly deteriorated with the decrease of TSH level.

Department-specific patterns of bacterial communities and antibiotic resistance in hospital indoor environments.

The hospital indoor environment has a crucial impact on the microbial exposures that humans encounter. Resistance to antibiotics is a mechanism used by bacteria to develop resilience in indoor environments, and the widespread use of antibiotics has led to changes in the ecological function of resistance genes and their acquisition by pathogens. By integrating the 16S rRNA Illumina sequencing and high-throughput-quantitative PCR approaches with water and air dust samples across seven departments in Peking University Shenzhen Hospital, China, this study yields intriguing findings regarding the department-specific variations, correlations and source tracing of bacteria, antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) within the hospital indoor environment. A notable observation was the pivotal role played by seasonal variations in shaping the bacterial composition across the entire hospital indoor environment. Another department-specific finding was the correlation between ARGs and MGEs abundance, which was evident in the overall hospital indoor environment, but not found in the blood test room, ophthalmology, and gynecology departments. Notably, as an important source of bacteria and ARGs/MGEs for the blood test room, the gynecology department also presented a close link between bacterial communities and the presence of ARGs/MGEs. Additionally, the results reiterate the importance of surveillance and monitoring of antibiotic resistance, specifically in Legionella spp. in man-made water systems, and highlight the significance of understanding genetic elements like Tp614 involved in gene transfer and recombination, and their impact on antimicrobial treatment efficacy. KEY POINTS: • The department-specific variations, correlations and source tracing of bacteria, ARGs, and MGEs were uncovered in the hospital's indoor environment. • Although each department exhibited consistent seasonal impacts on bacterial compositions, the co-occurrence between the presence of ARGs and MGEs was exclusively evident in the emergency, surgery, pneumology and otolaryngology departments. • The gynecology department emerged as a crucial source of bacteria, ARGs and MGEs within the hospital. Additionally, it was found to exhibit a significant correlation between bacterial communities and the presence of ARGs and MGEs.

Bioinformatic-Experimental Screening Uncovers Multiple Targets for Increase of MHC-I Expression through Activating the Interferon Response in Breast Cancer.

Expression of major histocompatibility complex I (MHC-I) on tumor cells is extremely important for the antitumor immune response for its essential role in activating various immune cells, including tumor-specific CD8+ T cells. Cancers of lower MHC-I expression commonly exhibit less immune cell infiltration and worse prognosis in clinic. In this study, we conducted bioinformatic-experimental screening to identify potential gene targets to enhance MHC-I expression in breast cancer (BRCA). Through a combination of MHC-I scoring, gene expression correlation analysis, survival prognostication, and Cibersort tumor-infiltrated lymphocytes (TILs) scoring, we identify 144 genes negatively correlated with both MHC-I expression and TILs in breast cancer. Furthermore, we verified partially according to KEGG functional enrichment or gene-dependency analysis and figured out multiple genes, including PIP5K1A, NCKAP1, CYFIP1, DIS3, TBP, and EXOC1, as effective gene targets for increasing MHC-I expression in breast cancer. Mechanistically, knockout of each of these genes activated the intrinsic interferon response in breast cancer cells, which not only promoted MHC-I expression but also caused immunogenic cell death of breast cancer. Finally, the scRNA-seq confirmed the negative correlation of PIP5K1A et al. with TILs in breast cancer patients. Collectively, we identified multiple gene targets for an increase in MHC-I expression in breast cancer in this study.

AMIR: a multi-omics data platform for Asteraceae plants genetics and breeding research.

As the largest family of dicotyledon, the Asteraceae family comprises a variety of economically important crops, ornamental plants and numerous medicinal herbs. Advancements in genomics and transcriptomic have revolutionized research in Asteraceae species, generating extensive omics data that necessitate an efficient platform for data integration and analysis. However, existing databases face challenges in mining genes with specific functions and supporting cross-species studies. To address these gaps, we introduce the Asteraceae Multi-omics Information Resource (AMIR; https://yanglab.hzau.edu.cn/AMIR/), a multi-omics hub for the Asteraceae plant community. AMIR integrates diverse omics data from 74 species, encompassing 132 genomes, 4 408 432 genes annotated across seven different perspectives, 3897 transcriptome sequencing samples spanning 131 organs, tissues and stimuli, 42 765 290 unique variants and 15 662 metabolites genes. Leveraging these data, AMIR establishes the first pan-genome, comparative genomics and transcriptome system for the Asteraceae family. Furthermore, AMIR offers user-friendly tools designed to facilitate extensive customized bioinformatics analyses. Two case studies demonstrate AMIR's capability to provide rapid, reproducible and reliable analysis results. In summary, by integrating multi-omics data of Asteraceae species and developing powerful analytical tools, AMIR significantly advances functional genomics research and contributes to breeding practices of Asteraceae.

Cognitive impairment induced by sevoflurane anesthesia is mediated by the cholinergic system after gastrointestinal surgery in older patients: A randomized, controlled trial.

Delayed neurocognitive recovery after surgery is associated with increased morbidity and mortality. However, its mechanism of action remains controversial and complex. A prospective, double-blind, randomized controlled trial was performed at the Affiliated Hospital of Zunyi Medical University. Older patients (aged 65 years and older) who underwent gastrointestinal surgery were randomly divided into sevoflurane-based or propofol-based anesthesia groups. The Mini-Mental State Examination was performed to evaluate cognitive function. Peripheral venous blood was collected to test the levels of choline acetyltransferase and acetylcholinesterase. A total of 75 patients were enrolled and 30 patients in each group completed the study. On Day 1 postoperation, patients in the sevoflurane group showed worse performance on the Mini-Mental State Examination than patients in the propofol group. Lower blood choline acetyltransferase concentrations and higher acetylcholinesterase concentrations were observed in patients who had sevoflurane anesthesia than in patients who had propofol anesthesia 1 day postoperative. At 3 days postoperation, patients with sevoflurane- or propofol-based general anesthesia did not differ regardless of Mini-Mental State Examination score or choline acetyltransferase and acetylcholinesterase levels. Sevoflurane-based anesthesia has short-term delayed neurocognitive recovery in older surgical patients, which may be related to central cholinergic system degeneration.