[The predictive value of melanin-concentrating hormone combined with other related biomarkers in cerebrospinal fluid in preoperative cognitive dysfunction of elderly patients].

Objective: To explore the predictive value of cerebrospinal fluid melanin-concentrating hormone (MCH) combined with other related biomarkers in preoperative cognitive dysfunction of elderly patients. Methods: A total of 80 patients who underwent elective hip or knee replacement under intravertebral anesthesia in Chifeng Municipal Hospital, Inner Mongolia, from March to November 2022 were prospectively included, with 32 males and 48 females, and aged 65-85 (70.7±5.2) years old. According to the evaluation results of the Montreal Cognitive Assessment (MoCA), patients were divided into the preoperative cognitive dysfunction (n=23) and control (n=57) groups. The levels of MCH, amyloid-ß 40 (Aß40), amyloid-ß 42 (Aß42), and phosphorylated tau protein (p-tau) in cerebrospinal fluid were determined by enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each biomarker separately or in combination for preoperative cognitive dysfunction. Spearman's rank correlation analysis was utilized to test the correlation between the level of each biomarker and MoCA scores. Results: The levels of MCH, Aß40, Aß42, p-tau, and Aß42/p-tau in the preoperative cognitive dysfunction group were (35.53±5.94) µg/L, (39.21±9.18) ng/L, (221.83±43.17) ng/L, (42.64±9.74) ng/L, and 5.53±1.92, and the levels of these biomarkers in the control group were (28.74±4.90) µg/L, (36.37±7.87) ng/L, (280.23±45.67) ng/L, (35.00±9.27) ng/L, and 8.62±2.78, respectively. Compared with the control group, the levels of cerebrospinal fluid MCH and p-tau in the preoperative cognitive dysfunction group were significantly increased (all P<0.01), and the levels of Aß42 and Aß42/p-tau were significantly decreased (all P<0.001). MCH and Aß42/p-tau provided higher predictive values. The area under the curve (AUC) of MCH and Aß42/p-tau were 0.807 (95%CI: 0.703-0.911) and 0.842 (95%CI: 0.741-0.943), the sensitivity were 78.3% and 87.0%, and the specificity were 75.4% and 94.7%. MCH combined with Aß42/p-tau have the higher AUC of 0.915 (95%CI: 0.837-0.992), the sensitivity (87.0%) and specificity (86.0%) were both high, which had a higher predictive value. The levels of cerebrospinal fluid MCH and p-tau were negatively correlated with MoCA score (r=-0.467, -0.321, all P<0.01), and the levels of Aß42 and Aß42/p-tau were positively correlated with MoCA score (r=0.480, 0.520, all P<0.001). Conclusion: The increase in cerebrospinal fluid MCH levels is associated with preoperative cognitive dysfunction in elderly patients. MCH combined with Aß42/p-tau has the greatest predictive value.

[Prognosis factors for non-reversal of defunctioning ileostomy in patients with radical resection of rectal cancer].

Objective: To examine the prognosis factors for non-reversal of defunctioning ileostomy in rectal cancer surgery. Methods: The data of 234 patients with rectal cancer undergoing radical resection and defunctioning ileostomy in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2013 to June 2020 was analyzed retrospectively. There were 166 males and 68 females, aging (M(IQR)) 62(12) years (range: 33 to 89 years). Telephone following-up was conducted intensively in July 2021 to investigate whether stoma was reversed, causes of reversal failure, and tumor recurrence or metastasis after surgery. The non-reversal stoma was defined as stoma not being reversed during the follow-up period (more than 12 months). The χ2 test or Fisher's exact test was used to conduct a univariate analysis of clinical data related to reversal failure, and the factors with P<0.05 were selected into Logistic regression for multivariate analysis. Results: A total of 165 patients received stoma reversal postoperatively with an interval time of (6.5±2.4) months (range: 0.9 to 17.8 months), but 69 patients failed to closure of stoma. Univariate analysis showed that age, concomitant diseases, surgical methods, preoperative hemoglobin, preoperative carcinoembryonic antigen, tumor maximum diameter, depth of invasion, lymph node metastasis, TNM stage, anastomotic-related complications, postoperative tumor local recurrence or distant metastasis were associated with non-reversal of diverting ileostomy in rectal cancer surgery (all P<0.05). Multivariate analysis showed that age (OR=2.270, 95%CI: 1.150 to 4.479, P=0.018), open surgery (OR=7.249, 95%CI: 1.977 to 26.587, P=0.003), preoperative hemoglobin<120 g/L (OR=3.092, 95%CI: 1.566 to 6.105, P<0.01), anastomotic-related complications (OR=4.375, 95%CI: 1.686 to 11.349, P=0.002), postoperative local recurrence or distant metastasis (OR=7.065, 95%CI: 2.591 to 19.264, P<0.01) were independent prognosis factors for reversal failure of defunctioning stoma in rectal cancer surgery. Conclusions: There is a high risk of reversal failure of defunctioning ileostomy among rectal cancer patients with age>65 years, open surgery, preoperative hemoglobin<120 g/L, anastomotic-related complications, postoperative local recurrence or distant metastasis. Colorectal surgeons should fully evaluate the outcome and risk of reversal failure before making a decision of diverting ileostomy. Reducing anastomotic complications is helpful to the successful return of preventive ileostomy.