Objective To explore the nursing effects of self-care body posture in patients after modified radical mastectomy. Methods The clinical data of 102 patients with modified radical mastectomy were randomly divided into the study group and the control group, all patients met the following standard:clear consciousness, effective communication, no paralysis of limbs, no fracture. In the study group, according to Orem"self-care theory" concept, patients carried out self-care body posture with mainly focus on self-emancipated and the body center of gravity position, in the control group patients were given traditional posture care with mainly emancipated assistance. The first time getting out-of-bed, the occurrence of various complications, the comfort level of emancipation and posture, as well as nursing satisfaction on the first day after surgery were observed and compared between the two groups. Results The two groups showed significant difference in the first time out-of-bed, anxiety, the comfort level of emancipation and posture, as well as nursing satisfaction. There was no significant difference between the two groups in dizziness, limb swelling, flap effusion, flap necrosis. No pressure ulcer occurred. Conclusions Making use of self-care body posture in patients after modified radical mastectomy can improve the satisfaction and comfort of the patients, and improve the patients' recovery, without increasing the complication, which is worth promoting.

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

Objective To purify and rejuvenate the plant of Curcama kwangsiensis,improve the transplantation survival rate of cultivars,and make the convenience of storagement and management for the cultivars production.Methods The rhizome plantlet formation of C.kwangsiensis was induced by regulating both of macro-element and sucrose concentration in the MS culture medium.Results Both of them were very important influence factors on the rhizome plantlet formation of C.kwangsiensis.Media 1/2 MS and 6% sucrose were adaptable to the rhizome plantlet formation of C.kwangsiensis,had the best effects on the formation rate of the rhizome plantlet,diameter and direct transplanting rate of the rhizome plantlet.Both plantlet and root system development were stronger.Conclusion In the present research,it is successful in inducing the rhizome plantlet formation of C.kwangsiensis.

Objective To investigate the effect of esketamine on depression and improvement of postoperative cognitive function in patients with major depressive disorder treated by electroconvulsive therapy(ECT).Methods A total of 115 patients with major depressive disorder,37 males and 78 fe-males,aged≥12 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ were selected to receive ECT.The patients were randomly divided into two groups using a random number table:the esketamine group(group E,n=56)and the control group(group C,n=59).Group E received esketamine,propofol,and succincholine during anesthesia induction,and group C received propofol and succincholine during an-esthesia induction.ECT indicators(including EEG twitch time,twitch time,stimulus intensity,and twitch energy index)were recorded during each ECT session.Montreal cognitive assessment(MoCA)and Mini-mental state examination(MMSE)were used to evaluate cognitive function at baseline and after ECT treat-ment.Hamilton depression(HAMD)scale was used to score depression.The occurrence of headache,nau-sea,vomiting,dizziness,delirium,and other adverse reactions were recorded.Results Compared with group C,the EEG convulsion time in group E was significantly prolonged(P＜0.05),the incidence of Mo-CA score decreased by≥1 point and MMSE score decreased by≥1 point in group E after the end of ECT treatment was significantly reduced(P＜0.05),the incidence of nausea,vomiting,and dizziness were sig-nificantly decreased(P＜0.05).Conclusion Using esketamine in ECT for the treatment of major depres-sive disorder can improve cognitive function after ECT.

Objective To observe the changes in intradiscal internal internal pressure before and after percutaneous nucleoplasty (PN) in the patients with discogenic low back pain (DLBP),and to explore the mechanism of PN for alleviating DLBP.Methods Thirty patients definitely diagnosed as DLBP undergoing PN in the orthopedic department of this hospital from June 2023 to October 2023 were selected.The internal pressure of the lumbar disc was measured before and after the surgery.The visual analog scale (VAS),Japa-nese orthopedic association score (JOA) and Oswestry disability index (ODI) were used to assess the pain level of the patients before operation and at postoperative 1 d,1 month,3 months.The surgical efficacy was e-valuated by using the modified MacNab criteria.The linear correlation analysis was used to observe the relation-ship between the internal pressure of lumbar disc and changes in each pain score,and the factors possibly affecting postoperative effect was analyzed by using the multivariate logistic regression analysis.Results Compared with be-fore the surgery,the immediate postoperative internal pressure of lumbar disc in the patients was significantly decreased.The JOA scores at postoperative 1 d,1 month and 3 months were significantly increased,while the VAS and ODI scores were significantly decreased,and the differences were statistically significant (P<0.05). The excellent rates of surgical efficacy at postoperative 1 d,1 month and 3 months were 66.7％,73.3％ and 63.3％,respectively.The internal pressure of lumbar disc difference value between before operation and on postoperative 1 d and internal pressure of lumbar disc decrease rate had no significant correlation with the change value of each pain score (P>0.05).The multivariate logistic regression analysis showed that the dis-ease duration and the decrease rate of internal pressure of lumbar disc were the influencing factors of clinical efficacy in PN (P<0.05).Conclusion The occurrence of DLBP may be related with the increase of internal pressure of lumbar disc.PN could effectively reduce internal pressure of lumbar disc and achieve the goal of pain relief.

Objective:This study investigates the influence of the apolipoprotein E ε4(APOE ε4)genotype on the relationship between glucose-lipid metabolism disorders and diabetes-related cognitive impairment(DCI).Methods:A case-control study was conducted involving 891 patients with type 2 diabetes mellitus(T2DM)with a mean age of(62.1±13.8)years, all of whom underwent elective surgery at the First Hospital of Shanxi Medical University between January 2017 and December 2022.Among these participants, 229 were diagnosed with DCI(case group), while 662 were cognitively normal(control group).Routine clinical information was collected, and peripheral venous blood samples were analyzed for glycated hemoglobin(HbA1c)and blood lipid levels.The single nucleotide polymorphisms rs429358 and rs7412 were analyzed to determine the presence of the APOE ε4 genotype.Stepwise Logistic regression was employed to identify independent risk factors for DCI, and subgroup analyses were performed to evaluate the effect of the APOE ε4 genotype on the relationship between HbA1c and blood lipid levels in relation to DCI risk. Results:Among all patients, female gender( OR=1.915, 95% CI: 1.393-2.631, P<0.001), longer duration of T2DM( OR=1.169, 95% CI: 1.087-1.257, P<0.001), elevated triglycerides( OR=1.161, 95% CI: 1.041-1.294, P=0.007), and being an APOE ε4 carrier( OR=1.638, 95% CI: 1.115-2.405, P=0.012)were identified as independent risk factors for developing DCI.High levels of low-density lipoprotein(LDL)were found to be independently associated with an increased risk of DCI specifically in APOE ε4 carriers( OR=1.408, 95% CI: 1.060-1.870, P=0.018), but not in non-APOE ε4 carriers( P>0.05).In contrast, elevated HbA1c was independently associated with a higher risk of DCI in non-APOE ε4 carriers( OR=1.220, 95% CI: 1.040-1.430, P=0.014), but not in APOE ε4 carriers( P>0.05).Additionally, elevated triglycerides were independently linked to an increased risk of DCI across the entire sample and within each APOE ε4 genotype subgroup. Conclusions:The APOE genotype plays a significant role in modulating the relationship between dyslipidemia and the risk of developing DCI.This highlights the critical importance of lipid metabolism disorders and APOE risk genes in both the development and progression of DCI.These findings offer valuable insights for future clinical and mechanistic studies focused on DCI.

OBJECTIVE：To establish a m ethod to determine the cont ents of 20 elements impurities in Aminomethylbenzoic acid injection ，and to investigate its compatibility in low-borosilicate glass ampoules. METHODS ：The sample was diluted with 5％ nitric acid solution ，and then determined by ICP-MS using scandium ，indium and bismuth as internal standards. The nebulizer flow（argon）was 0.92 L/min，collision gas flow （helium）was 4.5 L/min，RF power was 1 895 W，plasma flow was 18 L/min， pump speed was 40 r/min，injection delay time was 65 s. The collision mode was used as measurement mode ，the data sampling adopted peak skipping mode ，and repeated for 3 times. The accelerated test was carried out after sample was stored at 70 ℃ for 1 and 3 months，and the compatibility was investigated by comparing the change trend of element impurity content. RESULTS ：The linear range of vanadium ，cobalt，chromium，arsenic，cadmium，antimony，mercury，thallium and lead were 0.01-20 μg/L；those of magnesium ，aluminium，ferrum，nickel，copper，zinc，barium were 0.1-200 μg/L；those of boron ，silicon，potassium and calcium were 1-2 000 μg/L（r≥0.999 8）. RSDs of precision ，intermediate precision ，stability（8 h）and repeatability test were all lower than 6％. The limits of quantitation were 0.000 7-2.986 3 μg/L；the limits of detection were 0.000 2-0.895 9 μg/L. The average recoveries were 88.50％-111.00％（RSDs were 0.52％-2.33％，n＝9）. The minimum content of 20 element impurities was less than detection limits ，the maximum contents were 3 835.9 μg/L（0 month），10 448.4 μg/L（1 month），17 261.2 μg/L（3 month） in Aminomethylbenzoic acid injection from 8 manufacturers. Among the 20 elements impurities ，except that boron ， aluminum，magnesium，silicon，calcium and potassium were not specified ，the contents of other elements were less than the threshold. The research of compatibility showed that the impurity contents of seven elements such as boron ，aluminum，silicon， potassium，zinc，arsenic and barium showed an increasing trend. The silicon concentration ，silicon/aluminum concentration ratio and silicon/boron concentration ratio in the accelerated samples after stored for one and three months were significantly different from those stored for 0 month. CONCLUSIONS ：The established method is sensitive ，reproducible and accurate ，and can be used for the content determination of 20 element impurities in Aminomethylbenzoic acid injection. The interaction between low-borosilicate ampoule and Aminomethylbenzoic acid injection is obvious.

Platelets buoy up cancer metastasis via arresting cancer cells, enhancing their adhesion, and facilitating their extravasation through the vasculature. When deprived of intracellular and granular contents, platelet decoys could prevent metastatic tumor formation. Inspired by these, we developed nanoplatesomes by fusing platelet membranes with lipid membranes (P-Lipo) to restrain metastatic tumor formation more efficiently. It was shown nanoplateletsomes bound with circulating tumor cells (CTC) efficiently, interfered with CTC arrest by vessel endothelial cells, CTC extravasation through endothelial layers, and epithelial-mesenchymal transition of tumor cells as nanodecoys. More importantly, in the mouse breast tumor metastasis model, nanoplateletsomes could decrease CTC survival in the blood and counteract metastatic tumor growth efficiently by inhibiting the inflammation and suppressing CTC escape. Therefore, nanoplatelesomes might usher in a new avenue to suppress lung metastasis.