Objective:To investigate the effect of ultrasound-guided lower transverse abdominal muscle plane (TAP) block combined with esketamine intravenous controlled analgesia on postoperative patients with colorectal cancer (CRC) .Methods:A total of 120 CRC patients admitted to Linyi Central Hospital from Aug. 2022 to Aug. 2024 were selected and divided into control group and observation group according to random number table method, with 60 cases in each group. The control group received esketamine intravenous controlled analgesia, and the observation group was combined with TAP under ultrasound guidance on the basis of the control group. The postoperative recovery, pain numerical score (NRS), heart rate and mean arterial pressure of 1h, 8h and 48h were compared between the two groups. The levels of serum interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1 β (IL-1 β) and adverse reactions were compared before anesthesia (T0), 24h (T1) and 48h (T2) after surgery. Results:The feeding time and the first exhaust time in the observation group were shorter than those in the control group ( P<0.05). The NRS scores of the observation group were lower than those of the control group at 1h, 8h and 48h after operation ( P<0.05). The heart rate and mean arterial pressure of both groups increased at 8h and 48h after surgery, and the observation group was lower than the control group ( P<0.05). Serum IL-6, IL-10 and IL-1 β in both groups were higher than those in T0 at T1 and T2, and IL-6 and IL-1 β in observation group were lower than those in control group, and IL-10 was higher than those in control group ( P<0.05). The incidence of adverse reactions in observation group was lower than that in control group ( P<0.05) . Conclusion:Ultrasound-guided TAP combined with esketamine intravenous controlled analgesia can effectively accelerate the postoperative recovery of CRC patients, reduce the level of pain, and alleviate the inflammatory response of the body, with high safety.

Objective:To investigate the effect of ultrasound-guided lower transverse abdominal muscle plane (TAP) block combined with esketamine intravenous controlled analgesia on postoperative patients with colorectal cancer (CRC) .Methods:A total of 120 CRC patients admitted to Linyi Central Hospital from Aug. 2022 to Aug. 2024 were selected and divided into control group and observation group according to random number table method, with 60 cases in each group. The control group received esketamine intravenous controlled analgesia, and the observation group was combined with TAP under ultrasound guidance on the basis of the control group. The postoperative recovery, pain numerical score (NRS), heart rate and mean arterial pressure of 1h, 8h and 48h were compared between the two groups. The levels of serum interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1 β (IL-1 β) and adverse reactions were compared before anesthesia (T0), 24h (T1) and 48h (T2) after surgery. Results:The feeding time and the first exhaust time in the observation group were shorter than those in the control group ( P<0.05). The NRS scores of the observation group were lower than those of the control group at 1h, 8h and 48h after operation ( P<0.05). The heart rate and mean arterial pressure of both groups increased at 8h and 48h after surgery, and the observation group was lower than the control group ( P<0.05). Serum IL-6, IL-10 and IL-1 β in both groups were higher than those in T0 at T1 and T2, and IL-6 and IL-1 β in observation group were lower than those in control group, and IL-10 was higher than those in control group ( P<0.05). The incidence of adverse reactions in observation group was lower than that in control group ( P<0.05) . Conclusion:Ultrasound-guided TAP combined with esketamine intravenous controlled analgesia can effectively accelerate the postoperative recovery of CRC patients, reduce the level of pain, and alleviate the inflammatory response of the body, with high safety.

Objective:To investigate differences in serum lipid profiles between patients with dermatomyositis (DM) and healthy controls.Methods:A retrospective analysis was conducted on the clinical data and serum samples collected from 51 patients with DM who visited the First Affiliated Hospital, Anhui Medical University from September 2020 to January 2022. Serum samples were also collected from 66 healthy controls during the same period. Serum lipid profiles were analyzed using ultra-performance liquid chromatography-mass spectrometry in both groups. Differential lipids were screened using principal component analysis and orthogonal partial least squares-discriminant analysis. The predictive value of these differential lipids for DM was evaluated by receiver operating characteristic (ROC) curve analysis, and their correlations with clinical indicators were also evaluated.Results:A total of 51 patients with DM were enrolled, including 27 males and 24 females, with ages ( M[ Q1, Q3]) of 55.00 (47.00, 66.00) years and body mass index (BMI) values of 22.64 (19.79, 24.75) . The control group included 66 healthy individuals (33 males and 33 females) , with ages of 51.00 (43.75, 56.00) years and BMI values of 23.60 (21.18, 25.19) . No significant differences were observed between the two groups in terms of sex, age, or BMI (all P > 0.05) . A total of 341 lipid metabolites were identified, and 16 lipid metabolites such as ceramides (Cer) , sphingomyelins, phosphatidylcholines (PC) , phosphatidylethanolamines, lysophosphatidylcholines (LPC) , and triglycerides (TG) significantly differed between the DM group and the control group, of which 8 were upregulated and 8 were downregulated in the DM group. ROC curve analysis identified 7 differential lipids with area under the curve (AUC) values of > 0.9, of which 2 were Cer, 3 were TG, 1 was phosphatidylethanolamine, and 1 was LPC. In the DM patients, serum LPC (22∶1) levels were negatively correlated with creatine kinase isoenzyme MB levels ( r = -0.276, P < 0.05) , serum PC (15∶1/16∶0) levels were negatively correlated with aspartate aminotransferase levels ( r = -0.305, P < 0.05) , and serum Cer (d18∶1/18∶0) levels were positively correlated with C-reactive protein levels ( r = 0.283, P < 0.05) . Significant differences in serum lipid levels were observed between some DM subgroups (all P < 0.05) : sphingomyelin (d24∶0) levels significantly differed between anti-Sj?gren syndrome type A/Ro52 antibody-positive and -negative DM patients; LPC (17∶1) levels significantly differed between anti-PM-SCL75 antibody-positive and -negative DM patients; LPC (20∶0) and PC (32∶1p) levels significantly differed between anti-Mi-2 antibody-positive and -negative DM patients; LPC (22∶1) and TG (9∶0/9∶0/9∶0) levels significantly differed between anti-TIF1-γ antibody-positive and -negative DM patients; Cer (d18∶1/18∶0) levels significantly differed between DM patients with and without Heliotrope's sign. Conclusion:Lipid profiles were significantly altered in DM patients compared with healthy controls, and some lipids showed potential diagnostic value for DM.

Objective To study the relationship between vaginal microecological balance and serum T cell subsets,Toll-like receptor 2(TLR2)and Toll-like receptor 4(TLR4)after hysterectomy.Methods The clinical data of 120 patients who underwent laparoscopic total hysterectomy in Daxing Teaching Hospital of Capital Medical University from June 2020 to June 2022 were retrospectively analyzed.The patients were assigned to normal group(n=50)and unbalanced group(n=70)according to postoperative vaginal microecological changes.General information,such as age,body mass index(BMI),disease type,expression of CD+4,CD+8,CD+4/CD+8,TLR2,and TLR4 were compared between the two groups.The risk factors affecting vaginal microecological balance after hysterectomy were analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of serum T cell subsets,TLR2,and TLR4 in predicting vaginal microecological imbalance after hysterectomy.Results The levels of CD+4 and CD+4/CD+8 in the unbalanced group were significantly lower than those in the normal group,while the levels of CD+8,TLR2 and TLR4 in the unbalanced group were significantly higher than those in the normal group(P<0.05).Multivariable Logistic regression analysis showed that CD+4,CD+8,CD+4/CD+8,TLR2 and TLR4 expression were the influence factors of vaginal microecological imbalance after hysterectomy(P<0.05).ROC analysis confirmed that the expression of CD+4,CD+8 and CD+4/CD+8 and the levels of TLR2 and TLR4 could be used to predict vaginal microecological imbalance after hysterectomy,and the areas under the curve were 0.718,0.813,0.785,0.851,and 0.945,respectively(all P<0.05).Conclusion CD+4,CD+8,CD+4/CD+8,TLR2 and TLR4 expression levels are the influence factors of vaginal microecological imbalance after hysterectomy.They can be used as biological indicators for evaluating vaginal microecological balance after hysterectomy.

Objective:To investigate differences in serum lipid profiles between patients with dermatomyositis (DM) and healthy controls.Methods:A retrospective analysis was conducted on the clinical data and serum samples collected from 51 patients with DM who visited the First Affiliated Hospital, Anhui Medical University from September 2020 to January 2022. Serum samples were also collected from 66 healthy controls during the same period. Serum lipid profiles were analyzed using ultra-performance liquid chromatography-mass spectrometry in both groups. Differential lipids were screened using principal component analysis and orthogonal partial least squares-discriminant analysis. The predictive value of these differential lipids for DM was evaluated by receiver operating characteristic (ROC) curve analysis, and their correlations with clinical indicators were also evaluated.Results:A total of 51 patients with DM were enrolled, including 27 males and 24 females, with ages ( M[ Q1, Q3]) of 55.00 (47.00, 66.00) years and body mass index (BMI) values of 22.64 (19.79, 24.75) . The control group included 66 healthy individuals (33 males and 33 females) , with ages of 51.00 (43.75, 56.00) years and BMI values of 23.60 (21.18, 25.19) . No significant differences were observed between the two groups in terms of sex, age, or BMI (all P > 0.05) . A total of 341 lipid metabolites were identified, and 16 lipid metabolites such as ceramides (Cer) , sphingomyelins, phosphatidylcholines (PC) , phosphatidylethanolamines, lysophosphatidylcholines (LPC) , and triglycerides (TG) significantly differed between the DM group and the control group, of which 8 were upregulated and 8 were downregulated in the DM group. ROC curve analysis identified 7 differential lipids with area under the curve (AUC) values of > 0.9, of which 2 were Cer, 3 were TG, 1 was phosphatidylethanolamine, and 1 was LPC. In the DM patients, serum LPC (22∶1) levels were negatively correlated with creatine kinase isoenzyme MB levels ( r = -0.276, P < 0.05) , serum PC (15∶1/16∶0) levels were negatively correlated with aspartate aminotransferase levels ( r = -0.305, P < 0.05) , and serum Cer (d18∶1/18∶0) levels were positively correlated with C-reactive protein levels ( r = 0.283, P < 0.05) . Significant differences in serum lipid levels were observed between some DM subgroups (all P < 0.05) : sphingomyelin (d24∶0) levels significantly differed between anti-Sj?gren syndrome type A/Ro52 antibody-positive and -negative DM patients; LPC (17∶1) levels significantly differed between anti-PM-SCL75 antibody-positive and -negative DM patients; LPC (20∶0) and PC (32∶1p) levels significantly differed between anti-Mi-2 antibody-positive and -negative DM patients; LPC (22∶1) and TG (9∶0/9∶0/9∶0) levels significantly differed between anti-TIF1-γ antibody-positive and -negative DM patients; Cer (d18∶1/18∶0) levels significantly differed between DM patients with and without Heliotrope's sign. Conclusion:Lipid profiles were significantly altered in DM patients compared with healthy controls, and some lipids showed potential diagnostic value for DM.

Objective:To analyze the prognosis of glucose metabolism and its impacting factors at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy.Methods:In this cross-sectional study, a total of 192 patients with abnormal blood glucose during pregnancy enrolled and delivered in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from December 1, 2019 to December 31, 2020 were collected. The 75 g oral glucose tolerance test (OGTT) was applied for diabetes screening at 6-12 weeks after delivery. According to the results of postpartum blood glucose, the patients were divided into two groups: postpartum normal blood glucose group (148 cases) and abnormal blood glucose group (44 cases). Hypothesis testing was used to compare the clinical data before, during and after the pregnancy between the two groups. Multi-factor logistic regression was performed to analyze the influencing factors of postpartum abnormal blood glucose in patients with abnormal blood glucose during pregnancy.Results:Among the 192 patients with abnormal blood glucose during pregnancy, the incidence of postpartum abnormal blood glucose was 22.92% (44/192), including 6 cases of diabetes mellitus (DM) (13.64%), 38 cases of impaired glucose tolerance (IGT) (86.36%). Neck circumference, waist circumference, multiparous women and insulin use during pregnancy in postpartum abnormal blood glucose group were all significantly higher than those in postpartum normal blood glucose group [34.25(33.00, 36.00) vs 33.55 (32.00, 35.00) cm, 87.00 (82.00, 93.00) vs 84.00 (78.00, 90.00) cm, 54.55% vs 37.16%, 18.18% vs 6.76%] (all P<0.05). Neck circumference ( OR=1.315, 95% CI: 1.026-1.685), multiparous women ( OR=2.261, 95% CI: 1.057-4.836), insulin use during pregnancy ( OR=3.767, 95% CI: 1.236-11.478) were positively correlated with the occurrence of postpartum abnormal blood glucose (all P<0.05). Conclusions:The incidence of postpartum abnormal blood glucose is high at 6-12 weeks postpartum in patients with abnormal blood glucose during pregnancy. Neck circumference, waist circumference, parity and insulin use during pregnancy are important impacting factors of postpartum abnormal blood glucose.

ObjectiveTo explore the mechanism of Dihuang Yinzi in improving astrocyte injury and glycolysis in Alzheimer's disease （AD） mice via regulating the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， thereby improving the cognitive function of AD mice. MethodForty male APP/PS1 transgenic mice aged four months were randomly divided into a model group and a model + Dihuang Yinzi （0.25 g·kg^-1） group， with 20 mice in each group. Forty C57BL/6J mice with the same background and same age were randomly divided into a control group and a control + Dihuang Yinzi （0.25 g·kg^-1） group， with 20 mice in each group. The mice in the control + Dihuang Yinzi group and the model + Dihuang Yinzi group were administered with Dihuang Yinzi by gavage， and those in the control group and the model group received an equal volume of sterilized normal saline， once a day for 150 days. Morris water maze test was performed to test the ability of navigation and space exploration of mice. The protein expression of p-PI3K， PI3K， p-Akt， Akt， phosphofructokinase-1 （PFK-1）， and aldehyde dehydrogenase 3 family member B2 （ALDH3B2） in mouse brain tissues was measured by Western blot. An immunofluorescence assay was performed to detect astrocyte morphology and the expression level of ALDH3B2. ResultAs compared with the control group， the model group showed prolonged escape latency during the 2^nd to 5^th days of the location-based navigation （P<0.05， P<0.01）， reduced number of times crossing the target area of the platform， shortened residence time in the target quadrant （P<0.05， P<0.01）， prolonged residence time in the opposite quadrant （P<0.05）， increased surface area of the cell body and total length of cell protrusions of astrocytes （P<0.05， P<0.01）， and down-regulated protein expression of p-PI3K， p-Akt， ALDH3B2， and PFK-1 （P<0.01）， while the above experimental indexes were not significantly different in the control + Dihuang Yinzi group. Compared with the model group， the model + Dihuang Yinzi group showed shortened escape latency of APP/PS1 mice during the 2^nd to 5^th days of the location-based navigation （P<0.05， P<0.01）， increased number of times crossing the platform， prolonged target quadrant residence time （P<0.05， P<0.01）， shortened residence time in the opposite quadrant （P<0.05）， reduced surface area of the cell body and total length of cell protrusions of astrocytes （P<0.05）， and up-regulated protein expression of p-PI3K， p-Akt， ALDH3B2， and PFK-1 （P<0.01）. ConclusionDihuang Yinzi can improve the learning and memory ability of AD mice by activating the PI3K/Akt signaling pathway and up-regulating the protein expression of PFK-1 and ALDH3B2 to protect against astrocyte injury in brain tissues and improve glycolysis.

ObjectiveTo explore the mechanism of Dihuang Yinzi （DHYZ）in improving astrocyte injury in the brain and regulating energy metabolism and autophagy disorder in Alzheimer's disease （AD） model mice. MethodForty male APP/PS1 transgenic mice aged four months were randomly divided into a model group and a model + DHYZ group （2.5 g·kg^-1）， with 20 mice in each group. Forty C57BL/6J mice with the same background and same age were randomly divided into a control group and a control + DHYZ group （2.5 g·kg^-1）， with 20 mice in each group. The mice in the control group and the model group were administered with an equal volume of sterilized normal saline by gavage， once a day for 150 days. Novel object recognition test and step-down test were performed to evaluate the learning and memory ability of mice. The expression of glial fibrillary acidic protein （GFAP） in astrocytes was detected by immunofluorescence and Western blot. High-performance liquid chromatography （HPLC） was used to detect adenosine triphosphate （ATP）， adenosine diphosphate （ADP）， and adenosine monophosphate （AMP） in brain tissues of mice， and the data obtained were used to calculate energy charge （EC） levels. The phosphorylation levels of liver kinase B1 （LKB1）， adenosine 5′-monophosphate （AMP）-activated protein kinase （AMPK）， UNC-51-like kinase 1 （ULK1）， and mammalian target of rapamycin （mTOR） and the expression levels of autophagy-related proteins Beclin-1， microtuble-associated protein 1 light chain 3 （LC3）-Ⅱ/LC3-Ⅰ， and p62 in mouse brain were measured by Western blot. ResultCompared with the control group， the model group showed decreased novel object recognition index， shortened retention latency， increased error times in the step-down test， up-regulated protein expression of GFAP， decreased content of ATP， ADP， and EC in brain tissues， elevated AMP ， increased levels of p-AMPK， p-LKB1， and p-mTOR， and protein expression of p62 ， and down-regulated p-ULK1 level and protein expression of Beclin-1 and LC3-Ⅱ/LC3-Ⅰ（P<0.01）， while the above experimental indexes were not significantly different in the control + DHYZ group. Compared with the model group， the model + DHYZ group showed increased novel object recognition index（P<0.05）， prolonged retention latency（P<0.01）， decreased error times（P<0.01） in the step-down test， reduced protein expression of GFAP（P<0.05）， increased content of ATP， ADP， and EC in brain tissues （P<0.05， P<0.01）， decreased AMP content（P<0.05）， reduced p-AMPK， p-LKB1， and p-mTOR levels and protein expression of p62， and up-regulated p-ULK1 level and protein expression of Beclin-1 and LC3-Ⅱ/LC3-Ⅰ（P<0.01）. ConclusionBy protecting astrocytes， DHYZ can improve energy metabolism and autophagy disorder in AD mice to improve the learning and memory ability of model mice.

ObjectiveTo investigate the mechanism of Dihuang Yinzi in improving astrocyte injury and protecting synaptic structure and function in the brain of Alzheimer's disease （AD） mice. MethodForty male APP/PS1 transgenic mice aged four months were randomly divided into a model group and a model + Dihuang Yinzi （0.25 g·kg^-1） group， with 20 mice in each group. Forty C57BL/6J mice with the same background and same age were randomly divided into a control group and a control + Dihuang Yinzi （0.25 g·kg^-1） group， with 20 mice in each group. The mice in the control + Dihuang Yinzi group and the model + Dihuang Yinzi group were administered with Dihuang Yinzi by gavage， and those in the control group and the model group received an equal volume of sterilized normal saline， once a day for 150 days. The learning and memory ability of mice was tested by the light-dark box test and Y-maze spontaneous alternation test. The content of glutamate （Glu） and glutamine （Gln） was measured by liquid chromatography-tandem mass spectrometry （LC-MS）. Long-term potentiation （LTP） assay was used to detect synaptic plasticity in brain tissues. The protein expression levels of excitatory amino acid transporter 2 （EAAT2）， postsynaptic density protein95 （PSD95）， and synaptophysin （SYN） in brain tissues were measured by Western blot. Immunofluorescence was used to assess the localization and expression of EAAT2. Colorimetry was performed to detect Na⁺-K⁺ ATPase activity in mouse brain tissues. ResultAs compared with the control group， the model group showed shortened residence latency （P<0.01）， increased number of errors （P<0.01） in the light-dark box test， reduced spontaneous alternation behaviors （P<0.01）， no significant difference in the total number of arm entries in the Y-maze spontaneous alternation test， down-regulated expression of EAAT2， PSD95， and SYN （P<0.01）， blunted activity of Na⁺-K⁺ ATPase （P<0.01）， up-regulated Glu level （P<0.01）， down-regulated Gln level （P<0.01）， and reduced relative population spike （PS） amplitude and the slope of excitatory postsynaptic potential （EPSP） （P<0.05， P<0.01）， while the above experimental indexes were not significantly different in the control + Dihuang Yinzi group. Compared with the model group， the model + Dihuang Yinzi group displayed prolonged residence latency （P<0.05）， decreased number of errors （P<0.01） in the light-dark box test， increased spontaneous alternation behaviors （P<0.01）， no significant difference in the total number of arm entries in the Y-maze spontaneous alternation test， up-regulated expression of EAAT2， PSD95， and SYN （P<0.01）， potentiated activity of Na⁺-K⁺ ATPase （P<0.01）， reduced Glu level （P<0.01）， up-regulated Gln level （P<0.01）， and increased PS amplitude and EPSP slope （P<0.01）. ConclusionDihuang Yinzi can improve cognitive dysfunction in AD mice by protecting astrocytes， increasing Glu uptake to reduce its abnormal accumulation， and protecting synaptic structure and function.

Objective:To explore the current situation of evidence-based practice competence of masters of nursing specialist at Class Ⅲ hospitals and its influencing factors so as to provide decision-making basis for optimizing the construction and educational management of clinical teaching base for masters of nursing specialist.Methods:From July to October 2021, 141 masters of nursing specialist of Class Ⅲ hospitals in Tianjin were selected as subjects by purposive sampling. All students were investigated with the Chinese version of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) and the Barriers to Research Utilization Scale. Multiple linear regression was used to analyze the influencing factors.Results:Among 141 masters of nursing specialist, the total scores of the EBP-COQ and the Barriers to Research Utilization Scale were 95.35 ± 11.90 and 72.52 ± 26.28 respectively. Multiple linear regression analysis showed that the influencing factors of evidence based practice competence of masters of nursing specialist included the results of availability and the awareness of evidence-based nursing ( r = -2.85, -2.41, both P<0.05). Conclusions:Masters of nursing specialist have the intermediate level of evidence-based practice competence and positive attitudes to evidence based practice, but their evidence-based knowledge and skills need to be improved. Clinical teaching base managers should pay attention to the training of evidence-based nursing practice ability of professional nursing master students, provide more supportive resources and environment, and promote the development of specialty nursing practice.