Objective To study the expression of PLA2G2A and its significance in vaginal wall tissue of patients with pelvic organ pro-lapse(POP).Methods Twenty-three patients without POP(control group)and 26 patients with POP(POP group)admitted to the Third Affiliated Hospital of Zhengzhou University,between June 2023 and September 2024,were selected.Histological features were observed using hematoxylin and eosin and Masson's trichrome staining.Localization of PLA2G2A was detected using immunofluorescence.The PLA2G2A expression level was assessed using immunohistochemistry,real-time PCR,and Western blotting.After transfecting fibroblasts with silenced PLA2G2A,changes in collagen Ⅰ and collagen Ⅲ were measured.Results The histological structure of the vaginal wall in the POP group was significantly different from that in the control group.PLA2G2A was expressed in fibroblasts,with protein and mRNA expression levels higher than those in the control group(P＜0.05).After silencing PLA2G2A,collagen Ⅰ and collagen Ⅲ expression were upregulated.Conclusion High expression of PLA2G2A in vaginal wall tissue of patients with POP.Increased PLA2G2A expression may be closely related to the development and presence of POP.

Objective:To investigate the inhibitory effect of tripartite motif-containing 25 (TRIM25) on the replication of Japanese encephalitis virus (JEV) in cells and its molecular mechanism.Methods:Human glioma cells (U251 cells) and Kunming mice were infected with JEV, and then the cells and brain tissue samples were collected. The transcription levels of six TRIM genes were detected by real-time PCR, and the expression of TRIM25 in cells was detected by Western blot. U251 and A549 cells overexpressed with TRIM25 and U251 cells knocked out with TRIM25 gene were constructed. Cells were infected with JEV, and the replication of JEV was detected by viral plaque assay, real-time PCR and Western blot. The interaction of TRIM25 with viral proteins was investigated by co-immunoprecipitation (Co-IP) and indirect immunofluorescence assay. The expression of IFN-β in overexpressed TRIM25 cells was detected by real-time PCR and ELISA.Results:JEV infection promoted the expression of TRIM25 in cells and mouse brain tissues. TRIM25 overexpression restricted JEV replication in U251 and A549 cells, while TRIM25 knockout enhanced JEV replication. TRIM25 overexpression upregulated the level of IFN-β in cells. TRIM25 interacted with JEV capsid protein and promoted the degradation of capsid protein.Conclusion:TRIM25 can inhibit the replication of JEV in cells by upregulating IFN-β and promoting the degradation of JEV C protein.

Objective:To evaluate the effectiveness of opioid-free anesthesia on postoperative outcomes in elderly patients following laparoscopic cholecystectomy.Methods:In this randomized controlled trial, 90 patients of either sex, aged 65-75 yr, with a body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=45 each) using a table of random numbers: conventional general anesthesia group (GA group) and opioid-free anesthesia group (OFA group). Anesthesia was induced with intravenous etomidate, sufentanil and cisatracurium besylate and maintained with infusion of propofol and remifentanil combined with inhalation of sevoflurane in GA group. In OFA group, bilateral ultrasound-guided transversus abdominis plane block was performed via the posterior gluteal approach (injection of 0.25% ropivacaine 20 ml respectively) before anesthesia induction, anesthesia was induced with intravenous dexmedetomidine, esketamine, etomidate and cisatracurium besylate and maintained with infusion of dexmedetomidine, esketamine and propofol combined with inhalation of sevoflurane. In both groups, mechanical ventilation was performed with a laryngeal mask airway after anesthesia induction, and ketorolac tromethamine 30 mg (for postoperative analgesia) and metoclopramide 10 mg (to prevent postoperative nausea and vomiting) were intravenously injected at the end of surgery. The intraoperative adverse cardiovascular events, emergence time, laryngeal mask airway removal time, time of postanesthesia care unit stay, and postoperative rescue analgesia, nausea and vomiting and delirium were recorded. Results:No gallbladder cardiac reflex was found during operation in either group. Compared with GA group, the incidence of intraoperative bradycardia (11% versus 22%) was significantly increased ( P<0.05), the incidence of intraoperative hypotension and postoperative nausea, vomiting and delirium (17% versus 8%, 29% versus 16%, 16% versus 4% and 18% versus 4%), and requirements for rescue analgesia and antiemetics (31% versus 7% and 13% versus 4%) were decreased ( P<0.05), the postoperative emergence time, time of laryngeal mask airway removal and time of postanesthesia care unit stay were prolonged ( P<0.05), and no statistically significant difference was found in discharge time in OFA group ( P>0.05). Conclusions:The results of this study, as a single-center, small-sample randomized controlled trial, indicate that referenced to conventional general anesthesia, opioid-free anesthesia (esketamine-dexmedetomidine based anesthesia combined with bilateral transversus abdominis plan block) can improve the short-term postoperative outcomes to a certain extent in elderly patients following laparoscopic cholecystectomy.

Objective:To evaluate the effectiveness of opioid-free anesthesia on postoperative outcomes in elderly patients following laparoscopic cholecystectomy.Methods:In this randomized controlled trial, 90 patients of either sex, aged 65-75 yr, with a body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=45 each) using a table of random numbers: conventional general anesthesia group (GA group) and opioid-free anesthesia group (OFA group). Anesthesia was induced with intravenous etomidate, sufentanil and cisatracurium besylate and maintained with infusion of propofol and remifentanil combined with inhalation of sevoflurane in GA group. In OFA group, bilateral ultrasound-guided transversus abdominis plane block was performed via the posterior gluteal approach (injection of 0.25% ropivacaine 20 ml respectively) before anesthesia induction, anesthesia was induced with intravenous dexmedetomidine, esketamine, etomidate and cisatracurium besylate and maintained with infusion of dexmedetomidine, esketamine and propofol combined with inhalation of sevoflurane. In both groups, mechanical ventilation was performed with a laryngeal mask airway after anesthesia induction, and ketorolac tromethamine 30 mg (for postoperative analgesia) and metoclopramide 10 mg (to prevent postoperative nausea and vomiting) were intravenously injected at the end of surgery. The intraoperative adverse cardiovascular events, emergence time, laryngeal mask airway removal time, time of postanesthesia care unit stay, and postoperative rescue analgesia, nausea and vomiting and delirium were recorded. Results:No gallbladder cardiac reflex was found during operation in either group. Compared with GA group, the incidence of intraoperative bradycardia (11% versus 22%) was significantly increased ( P<0.05), the incidence of intraoperative hypotension and postoperative nausea, vomiting and delirium (17% versus 8%, 29% versus 16%, 16% versus 4% and 18% versus 4%), and requirements for rescue analgesia and antiemetics (31% versus 7% and 13% versus 4%) were decreased ( P<0.05), the postoperative emergence time, time of laryngeal mask airway removal and time of postanesthesia care unit stay were prolonged ( P<0.05), and no statistically significant difference was found in discharge time in OFA group ( P>0.05). Conclusions:The results of this study, as a single-center, small-sample randomized controlled trial, indicate that referenced to conventional general anesthesia, opioid-free anesthesia (esketamine-dexmedetomidine based anesthesia combined with bilateral transversus abdominis plan block) can improve the short-term postoperative outcomes to a certain extent in elderly patients following laparoscopic cholecystectomy.

Objective To analyze the efficacy of autologous tissue repair for rectocele through the perineal approach in treating constipation and fecal incontinence in patients.Methods From January 2021 to November 2022,23 female patients with symptomatic rectal protrusion were treated with perineal autologous tissue repair.Preoperatively and at 12 months postoperatively,the Cleveland Clinic Constipation Score(CCCS),Cleveland Clinic Incontinence Score(CCIS),and Patient Assessment of Constipation Quality of Life(PAC-QOL)questionnaires were used to assess postoperative outcomes and quality of life.Results Among the 23 patients,with a median follow-up time of 12.6 months,CCCS decreased from 17.09±1.68 to 3.96±2.08(P＜0.05);CCIS decreased from 1.52±4.15 to 0.52±1.41(P＞0.05);PAC-QOL:physical discomfort decreased from 13.00±1.51 to 4.74±1.98;psychological discomfort decreased from 20.96±3.27 to 5.74±2.67;concern and anxiety decreased from 26.13±4.37 to 8.78±3.14;satisfaction decreased from 15.39±2.35 to 4.60±1.59(P＜0.05).All patients showed significant improvement in constipation and incontinence symptoms postoperatively,with no serious postoperative complications and a marked improvement in postoperative quality of life.Conclusion Rectocele repair with perineal approach using autologous tissue is an effective and safe method,avoiding potential potential complications associated with grafts.

Objective:To investigate the prognoses of patients with medial medullary infarction (MMI) or lateral medullary infarction (LMI) and their influencing factors.Methods:A retrospective analysis was performed; 489 patients with acute medullary infarction admitted to Department of Neurology, Tianjin Huanhu Hospital from January 2017 to January 2024 were enrolled. Among them, 186 patients had MMI, which was divided into isolated MMI group ( n=126) and group of MMI with other infarcts ( n=60); 303 patients had LMI, which was divided into isolated LMI group ( n=176) and group of LMI with other infarcts ( n=127). Prognosis 90 days after onset was assessed by modified Rankin Scale (mRS, scores of 3-6 as poor prognosis). Clinical data, prognosis and mortality 90 days after onset, early neurological deterioration, respiratory failure, and complications were compared between isolated MMI group and group of MMI with other infarcts and between isolated LMI group and group of LMI with other infarcts. Univariate and multivariate Logistic regression analyses were used to identify the independent influencing factors for poor prognosis 90 days after onset in patients with MMI or LMI. Results:(1) Compared with isolated MMI group, group of MMI with other infarcts had significantly lower rates of alcohol history and sensory symptoms but higher rates of Horner's syndrome, dysphagia, dysarthria, and facial palsy ( P<0.05). Compared with isolated LMI group, group of LMI with other infarcts had significantly lower rates of sensory symptoms but higher rates of dizzy and dysarthria, and statistically different Trial of ORG 10172 in Acute Stroke Treatment types ( P<0.05). (2) The poor prognosis rate 90 days after onset in patients with MMI was significantly higher than that in patients with LMI (31.8% vs. 18.8%, P<0.05). Compared with isolated MMI group, group of MMI with other infarcts had significantly higher rates of respiratory failure, urinary retention, and pulmonary infection ( P<0.05). Compared with isolated LMI group, group of LMI with other infarcts had significantly higher rates of poor prognosis 90 days after onset, mortality 90 days after onset, early neurological deterioration, respiratory failure, stress ulcers, and pulmonary infection ( P<0.05). (3) Multivariate Logistic regression analysis revealed that dyskinesia ( OR=10.522, 95% CI: 1.246-88.853, P=0.031) and vertical multi-level involvement ( OR=4.585, 95% CI: 1.405-14.962, P=0.012) were independent influencing factors for poor prognosis in isolated MMI patients 90 days after onset; age ( OR=1.089, 95% CI: 1.017-1.166, P=0.015), vertical multi-level involvement ( OR=9.429, 95% CI: 1.625-54.502, P=0.012) were independent influencing factors for poor prognosis in MMI patients with other infarcts 90 days after onset; age ( OR=1.069, 95% CI: 1.006-1.136, P=0.031) and vertical multi-level involvement ( OR=7.125, 95% CI: 2.243-22.636, P<0.001) were independent influencing factors for poor prognosis in isolated LMI patients 90 days after onset; diabetes ( OR=2.807, 95% CI: 1.056-7.461, P=0.038), dysphagia ( OR=6.821, 95% CI: 1.978-23.518, P=0.002), and temporal-occipital infarcts ( OR=3.419, 95% CI: 1.133-10.302, P=0.029) were independent influencing factors for poor prognosis in LMI patients with other infarcts. Conclusion:Patients with LMI had better prognosis compared with patients with MMI; however, LMI patients with other infarcts had poorer prognosis compared with LMI patients; LMI patients with diabetes mellitus, dysphagia or temporal-occipital infarcts are prone to have poor prognosis.

Objectives:To investigate the relationship between QRS duration and its changes during hospitalization and long-term all-cause mortality in patients with chronic heart failure.Methods:A total of 3 580 patients who attended three tertiary hospitals in Shanxi Province(First Hospital of Shanxi Medical University,Shanxi Cardiovascular Hospital,Shanxi Bethune Hospital)and were diagnosed with chronic heart failure from March 2014 to November 2021,were enrolled in this study.QRS duration at admission and discharge were collected,and the changes in QRS duration during hospitalization(ΔQRS)and the ΔQRS ratio(ΔQRS/admission QRS duration×100% )were calculated.Patients were divided into three group according to tertiles of ΔQRS:the group with decreasing QRS duration(n=1 364),the group with stable QRS duration(n=1 248),and the group with progressing QRS duration(n=968).Telephone follow-up was conducted at months 1,3,6,12,and every 6 months thereafter after discharge till May 1,2023,long-term all-cause mortality was the primary endpoint.Survival curves were plotted using the Kaplan-Meier method,and comparisons between groups were made using the log-rank method.Cox proportional risk regression model was used for prognostic analysis,and restricted cubic spline curves were calculated to evaluate QRS duration-related variables during hospitalization and the risk of long-term all-cause mortality in patients with chronic heart failure.Results:The median follow-up was 71(56,92)months,and all-cause mortality occurred in 502(14.0% )patients.Long-term all-cause mortality was lower in the group with decreasing QRS duration and the group with stable QRS duration compared with the progressing QRS duration group(13.9% vs.10.7% vs.18.6%,χ2=28.607,P<0.001).Multifactorial Cox regression analysis showed that admission QRS duration(HR=1.005,95% CI:1.002-1.009,P=0.003)and higher ΔQRS ratio during hospitalization(HR=2.071,95% CI:1.247-3.440,P=0.005)were independent influencing factors of long-term all-cause mortality in chronic heart failure patients.Restricted cubic spline curves showed that when the admission QRS duration was>96.36 ms,the longer the QRS duration,the higher the risk of all-cause mortality;when the admission QRS duration fluctuated from 89.32-96.36 ms,the QRS duration was a protective factor for long-term all-cause mortality in patients with chronic heart failure;and when the ΔQRS ratio during hospitalization was≥3.40%,higher ΔQRS ratio was linked with increased risk of all-cause mortality.Conclusions:QRS duration and ΔQRS ratio during hospitalization are independent predictors of long-term all-cause mortality in patients with chronic heart failure.Admission QRS duration>96.36 ms and ΔQRS ratio during hospitalization≥3.40% are associated with increased risk of long-term all-cause mortality in patients with chronic heart failure.

Objective To analyze the efficacy of autologous tissue repair for rectocele through the perineal approach in treating constipation and fecal incontinence in patients.Methods From January 2021 to November 2022,23 female patients with symptomatic rectal protrusion were treated with perineal autologous tissue repair.Preoperatively and at 12 months postoperatively,the Cleveland Clinic Constipation Score(CCCS),Cleveland Clinic Incontinence Score(CCIS),and Patient Assessment of Constipation Quality of Life(PAC-QOL)questionnaires were used to assess postoperative outcomes and quality of life.Results Among the 23 patients,with a median follow-up time of 12.6 months,CCCS decreased from 17.09±1.68 to 3.96±2.08(P＜0.05);CCIS decreased from 1.52±4.15 to 0.52±1.41(P＞0.05);PAC-QOL:physical discomfort decreased from 13.00±1.51 to 4.74±1.98;psychological discomfort decreased from 20.96±3.27 to 5.74±2.67;concern and anxiety decreased from 26.13±4.37 to 8.78±3.14;satisfaction decreased from 15.39±2.35 to 4.60±1.59(P＜0.05).All patients showed significant improvement in constipation and incontinence symptoms postoperatively,with no serious postoperative complications and a marked improvement in postoperative quality of life.Conclusion Rectocele repair with perineal approach using autologous tissue is an effective and safe method,avoiding potential potential complications associated with grafts.

Objective To study the expression of PLA2G2A and its significance in vaginal wall tissue of patients with pelvic organ pro-lapse(POP).Methods Twenty-three patients without POP(control group)and 26 patients with POP(POP group)admitted to the Third Affiliated Hospital of Zhengzhou University,between June 2023 and September 2024,were selected.Histological features were observed using hematoxylin and eosin and Masson's trichrome staining.Localization of PLA2G2A was detected using immunofluorescence.The PLA2G2A expression level was assessed using immunohistochemistry,real-time PCR,and Western blotting.After transfecting fibroblasts with silenced PLA2G2A,changes in collagen Ⅰ and collagen Ⅲ were measured.Results The histological structure of the vaginal wall in the POP group was significantly different from that in the control group.PLA2G2A was expressed in fibroblasts,with protein and mRNA expression levels higher than those in the control group(P＜0.05).After silencing PLA2G2A,collagen Ⅰ and collagen Ⅲ expression were upregulated.Conclusion High expression of PLA2G2A in vaginal wall tissue of patients with POP.Increased PLA2G2A expression may be closely related to the development and presence of POP.

Objectives:To investigate the relationship between QRS duration and its changes during hospitalization and long-term all-cause mortality in patients with chronic heart failure.Methods:A total of 3 580 patients who attended three tertiary hospitals in Shanxi Province(First Hospital of Shanxi Medical University,Shanxi Cardiovascular Hospital,Shanxi Bethune Hospital)and were diagnosed with chronic heart failure from March 2014 to November 2021,were enrolled in this study.QRS duration at admission and discharge were collected,and the changes in QRS duration during hospitalization(ΔQRS)and the ΔQRS ratio(ΔQRS/admission QRS duration×100% )were calculated.Patients were divided into three group according to tertiles of ΔQRS:the group with decreasing QRS duration(n=1 364),the group with stable QRS duration(n=1 248),and the group with progressing QRS duration(n=968).Telephone follow-up was conducted at months 1,3,6,12,and every 6 months thereafter after discharge till May 1,2023,long-term all-cause mortality was the primary endpoint.Survival curves were plotted using the Kaplan-Meier method,and comparisons between groups were made using the log-rank method.Cox proportional risk regression model was used for prognostic analysis,and restricted cubic spline curves were calculated to evaluate QRS duration-related variables during hospitalization and the risk of long-term all-cause mortality in patients with chronic heart failure.Results:The median follow-up was 71(56,92)months,and all-cause mortality occurred in 502(14.0% )patients.Long-term all-cause mortality was lower in the group with decreasing QRS duration and the group with stable QRS duration compared with the progressing QRS duration group(13.9% vs.10.7% vs.18.6%,χ2=28.607,P<0.001).Multifactorial Cox regression analysis showed that admission QRS duration(HR=1.005,95% CI:1.002-1.009,P=0.003)and higher ΔQRS ratio during hospitalization(HR=2.071,95% CI:1.247-3.440,P=0.005)were independent influencing factors of long-term all-cause mortality in chronic heart failure patients.Restricted cubic spline curves showed that when the admission QRS duration was>96.36 ms,the longer the QRS duration,the higher the risk of all-cause mortality;when the admission QRS duration fluctuated from 89.32-96.36 ms,the QRS duration was a protective factor for long-term all-cause mortality in patients with chronic heart failure;and when the ΔQRS ratio during hospitalization was≥3.40%,higher ΔQRS ratio was linked with increased risk of all-cause mortality.Conclusions:QRS duration and ΔQRS ratio during hospitalization are independent predictors of long-term all-cause mortality in patients with chronic heart failure.Admission QRS duration>96.36 ms and ΔQRS ratio during hospitalization≥3.40% are associated with increased risk of long-term all-cause mortality in patients with chronic heart failure.