ObjectiveTo develop a scale for evaluating the syndrome of internal retention of dampness and turbidity in nonalcoholic fatty liver disease （NAFLD） that combines disease and syndrome and has the characteristics of traditional Chinese medicine （TCM）. MethodsAn item pool was established for evaluating the syndrome of internal retention of dampness and turbidity in nonalcoholic fatty liver disease （NAFLD） with reference to the guideline for developing international scales. A clinical survey was conducted among the outpatients and inpatients who were diagnosed with NAFLD and had the syndrome of internal retention of dampness and turbidity in Department of Hepatology and Spleen-Stomach， The First Affiliated Hospital of Henan University of Chinese Medicine， from June to August， 2023， and the items were screened based on the classical test theory and the item response theory. An expert questionnaire was developed， and expert discussions were conducted using the Delphi method to identify the items for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD. Finally， the scale was given scientific scores. ResultsA preliminary item pool was established， with 16 primary items and 22 secondary items， and it was divided into the two dimensions of disease and syndrome type. Clinical pre-survey suggested to retain 9 primary items and 14 secondary items， while the Delphi expert questionnaire recommended to retain 11 primary items and 15 secondary items， and tongue manifestation and pulse manifestation were no longer used for assessing the severity of syndrome. After hierarchical analysis and scientific assignment of scores， the scale for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD had a total score of 123 points and 9 important items， i.e.， discomfort in the hypochondrium， abdominal fullness and distension， obesity， heaviness of the head and body， loose stool， anorexia， coughing up phlegm， nausea with a tendency to vomit， and lethargy. ConclusionA preliminary scale is established for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD， which fills the gap in this research field and provides a basis for further clinical application.

OBJECTIVE To compare the clinical efficacy and safety of remimazolam and propofol in general anesthesia induction and maintenance for elderly patients undergoing thoracoscopic lobectomy. METHODS A total of 86 elderly lung cancer patients who underwent thoracoscopic lobectomy at Chongqing University Three Gorges Hospital from February to July 2024 were selected and divided into the propofol group and the remimazolam group according to the randomized numerical table method， with 43 cases in each group. During anesthesia induction， patients in the propofol group and the remimazolam group were intravenously administered 2 mg/kg of Propofol medium- and long-chain fat emulsion injection or 0.25 mg/kg of Remimazolam tosilate for injection， respectively； during anesthesia maintenance， the two groups received intravenous infusion of 6-10 mg/（kg·h） of Propofol medium- and long- chain fat emulsion injection or 1-3 mg/（kg·h） of Remimazolam tosilate for injection， respectively. The anesthesia effects， anesthesia-related indicators， intraoperative opioid and muscle relaxant dosages， Ramsay sedation score， numerical rating scale （NRS） score， and hemodynamic parameters were compared between the two groups， and the occurrence of adverse drug reactions was recorded. RESULTS A total of 41 patients in the propofol group and 43 patients in the remimazolam group completed the trial. The proportion of patients with grade Ⅰ anesthesia effect in the remimazolam group was significantly higher than that in the propofol group， while the proportion of patients with grade Ⅱ anesthesia effect was significantly lower than that in the propofol group （P＜0.05）. In this group， the disappearance time of eyelash reflex， the time taken for the bispectral index to drop to 60， and the Ramsay sedation scores （2 and 6 hours after operation） were all significantly prolonged or increased， while the recovery time， NRS scores （2 and 6 hours after operation）， and the incidence of intraoperative hypotension were all significantly shortened or reduced； moreover， the improvements of the above sedation/NRS scores exhibited a time-dependent pattern within 2 to 24 hours after operation （P＜0.05）. Compared with before anesthesia induction （T0）， the heart rate [except at 2 min after medication （T1）， 60 min after anesthesia （T4）， and at the end of surgery （T5） in the remimazolam group] and mean arterial pressure [except at T1 in the remimazolam group] of patients in both groups significantly decreased at T1， 5 min after medication （T2）， at the start of surgery （T3）， T4， and T5 （P＜0.05）. Meanwhile， regional cerebral oxygen saturation significantly increased in both groups. Furthermore， the heart rate and mean arterial pressure of patients in the remimazolam group were significantly higher than those in the propofol group at T1， T2 and T4 （P＜0.05）. No statistically significant differences were observed between the two groups in terms of postanesthesia care unit stay time， dosage of opioids and muscle relaxants， regional cerebral oxygen saturation， or peripheral oxygen saturation at various time points （P＞0.05）. CONCLUSIONS Compared to propofol， remimazolam demonstrates superior anesthesia effects when used for the induction and maintenance of general anesthesia in elderly patients undergoing thoracoscopic lobectomy. It not only provides more stable intraoperative hemodynamics and shortens the postoperative recovery time but also effectively reduces the incidence of intraoperative hypotension.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Biliary fibrosis (BF) is the result of pathological repair of bile tract injury, characterized by thickening and sclerosis of the bile duct wall and progressive stricture of the lumen, which may ultimately lead to serious adverse outcomes such as biliary obstruction, biliary cirrhosis, liver failure, and hepatobiliary malignancies. Current research describes BF as a pathological feature of certain bile tract diseases, lacking a systematic summary of its etiology, pathophysiology, molecular mechanisms, and treatment. BF is a common but easily neglected disease state in biliary system, which may promote the development and progression of hepatobiliary diseases through abnormal repair mechanism after pathological biliary tract injury. Based on the latest research progress from both domestic and international perspectives, the authors review the concept, clinical manifestation, etiology, pathogenesis, and therapeutic strategies of BF to provide a reference for clinical physicians.

Objective To analyze the indications and prognosis of the D-J tube internal drainage method in pediatric pyeloplasty surgery.Methods We conducted a retrospective analysis of cases of unilateral pyeloplasty performed in the urology department of the Capital Institute of Pediatrics from January 2012 to January 2022.They were divided into the D-J tube group(396 cases)and the py-elostomy group(334 cases)according to different postoperative drainage methods.The propensity score matching method was used to e-venly match the baseline data of the two groups of cases,and the complications and prognosis of the two drainage methods were compared.Results D-J tube drainage could significantly reduce the average hospitalization time,reduce pain,alleviate skin scars,and improve the quality of medical care and care.D-J tube could increase the risk of postoperative urinary tract infection and re-obstruction in chil-dren,and clinical application should be cautious.A predictive model was established for urinary tract infections after D-J tube implanta-tion,including gender,side profile,height,renal parenchymal thickness,and blood urea nitrogen.Conclusion The D-J tube internal drainage method can significantly reduce the length of hospital stay and nursing burden after pediatric pyeloplasty surgery.Although it may increase the risk of urinary tract infection in the near and medium term,the risk of urinary tract infection can be predicted.The use of D-J tubes should be carefully selected in males,small infants,and severe hydronephrosis.

Purpose To investigate the effect of CD147 on the proliferation,invasion and migration of cervical cancer cells and its potential molecular mechanism.Methods The expres-sion data of BSG gene(encoding CD147 protein)in cervical cancer samples were downloaded from UCSC database,and the prognosis of different groups of samples was evaluated by Log-rank test.Western blot was used to detect CD147 expression in the Siha and Hela and H8 cells.The expression of CD147 was downregulated by the lentivirus transfection into Hela cells and its transfection efficiency was verified.Western blot was used to detect the expression of p-Akt,p-mTOR,ACC1,FASN,E-cad-herin and N-cadherin in each group.The content of fatty acids in the cells was detected by BODIPY staining and fatty acid kit.Cell proliferation,invasion and migration were detected by CCK-8,plate cloning and Transwell assay.The cell proliferation,in-vasion and migration ability were detected by plate cloning ex-periment and Transwell test.Results The expression of CD147 in cervical cancer tissues was higher than that in normal cervical tissues(P＜0.01).Patients with overexpression of CD147 had poor prognosis.Western blot results showed that compared with H8 cells,the expression of CD147 protein in Siha and Hela cells was increased(P=0.011).After down-regulation of CD147,the protein expression of CD147,ACC1 and FASN in the sh-CD147 group was decreased compared with those in the Hela group(P＜0.001).BODIPY fluorescence staining was weak-ened and fatty acid content was decreased(P＜0.001).The a-bility of cell colony formation,invasion and migration was de-creased.The expression of E-cadherin protein in sh-CD147 group was increased,and the expression of N-cadherin,p-Akt and p-mTOR was decreased.Compared to sh-CD147,after treatment with Akt agonist SC-79(sh-CD147-SC79),the ex-pression of p-Akt,p-mTOR,ACC1,FASN,N-cadherin in cells was increased,and the expression of E-cadherin was decreased,and the results of lipid staining and fatty acid content were con-sistent with the expression of key enzymes(P＜0.01),and the cell proliferation,invasion and migration ability were significant-ly enhanced.Conclusion CD147 through Akt/mTOR signaling pathways regulating the fatty acid synthesis promotes cervical cancer cell proliferation,invasion and migration.

Objective To investigate the effect of transmembrane protein CD147 expression on AIM2 inflammasome-mediated pyroptosis and proliferation of cervical cancer cells.Methods Western Blot was used to detect the expression of CD147 in cervical cancer cell lines SiHa(HPV+)and C33a(HPV-)and normal cervical epithelial cells H8(HPV+)and HCer Epic(HPV-).SiHa cells were transfected with lentivirus to down-regulate the expression of CD147.According to the different treatments,SiHa cells were divided into SiHa group,negative control group(shCD147-NON),knockdown group 1(shCD147-1)and knockdown group 2(shCD147-2).The transfection effect was verified by Western Blot,RT-qPCR and green fluorescence expression.The protein and mRNA expressions of AIM2,Caspase-1,IL-18 and GSDMD were detected by Western Blot and RT-qPCR.The lactate dehydrogenase(LDH)release was measured in the cell culture supernatant,and the cell morphology was observed under the fluorescence inverted microscope;the proliferation ability of cells was measured by CCK-8 and the colony formation ability was measured by cell cloning experiments.Results Western Blot results showed that CD147 protein expression in SiHa cells was the highest compared with that in HCerEpic cells.CD147 low expression lentivirus effectively down-regulated the expression of CD147 in SiHa cells.The results of Western Blot and RT-qPCR experiments showed that the expression of AIM 2,Caspase-1,IL-18,GSDMD protein and mRNA increased in shCD147-1 and shCD147-2 group(P<0.05).Lactate dehydrogenase(LDH)release assay showed that compared with the SiHa group,the shCD147 group had a significant increase in LDH release(P<0.05).Fluorescence inverted microscope showed that the shCD147 group had swelling and vacuolization,showing typical pyroptosis.Compared with the SiHa group,the shCD147-1 and shCD147-2 groups had significantly reduced the cell proliferation and colony formation ability(P<0.05).Conclusion Low expression of CD147 effectively up-regulates the expression of AIM2 inflammation-related factors in cervical cancer SiHa cells,induces the pyroptosis,and inhibits the cell proliferation and cloning.

Objective:To investigate the role and mechanism of molecular hydrogen in lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods:Balb/c male mice were randomly(random number) divided into control group, control+H 2, LPS and LPS+H 2 group with 6 mice in each group. The levels of malondialdehyde (MDA) and Fe 2+ in lung tissue were detected by kits. The lung tissue morphology was observed. The infiltration levels of F4/80 positive macrophages in lung tissue were detected by immunofluorescence staining. A549 cells were divided into control, control+H 2, erastin and erastin+H 2 group. The reactive oxygen species (ROS), malondialdehyde, (MDA), lactate dehydrogenase (GSH), number of cell death and lactate dehydrogenase (LDH) release in each group were detected by kits. Nrf2, GPX4, and HO-1mRNA were quantified by real-time PCR, the protein expression level of Nrf2 was detected by western blot, and the nuclear translocation level of Nrf2 was observed by immunofluorescence. The chi-square test was performed before the measurement data were counted. One-way analysis of variance was used to compare differences between multiple groups. Results:Compared with the control group, the histopathological damage was aggravated, and the levels of MDA, Fe 2+ significantly increased in the LPS group, and F4/80 positive immune cells infiltration significantly increased (all P<0.05). Compared with LPS group, the degree of lung injury in LPS+H 2 group significantly reduced (all P<0.05). In vitro experiments, compared with the control group, the ROS, MDA levels, number of cell death and LDH release significantly increased in erastin group (all P<0.05), while GSH, and GPX4 mRNA levels decreased (all P<0.05). HO-1mRNA and Nrf2 nuclear translocation levels increased (all P<0.05). Compared with erastin group, ROS, MDA levels, cell death number and LDH release decreased in earstin+H 2 group (all P<0.05). The levels of GSH, GPX4 mRNA, Nrf2 mRNA, HO-1 mRNA and Nrf2 nuclear translocation levels increased (all P<0.05). Conclusions:Molecular hydrogen attenuates LPS-induced ALI by promoting Nrf2 nuclear translocation to inhibit ferroptosis of alveolar epithelial cells.

Objective To investigate the effects of propofol and remimazolam on the proliferation of prostate cancer cells and related mechanisms.Methods Human prostate cancer cell lines DU145 and PC3 were selected and cultured to the logarithmic growth phase.Cells were randomly divided into four groups:the control group(group C),the propofol group(group P),the remimazolam group(group R),and the propofol combined with remimazolam group(group PR).Group C was cultured with complete medium,groups P and R were cultured with semi-inhibitory concentrations(IC50)of propofol and remimazolam(IC50 of propofol in DU145 and PC3 cells were 120 μg/ml and 100 μg/ml,IC50 of remimazolam were 500 μmol/L and 400 μmol/L),and DU145 cells in group PR were co-cultured with low concentration propofol 100 μg/ml and remimazolam 400 μmol/L,PC3 cells were co-cultured with low concentrations of propofol 80 μg/ml and remimazolam 300 μmol/L.The absorbance of 0,6,12,24,and 36 hours after incubation of the wells was determined by CCK-8.The number of colonies of 14 days after incubation was calculated by colony for-mation assay.qPCR and Western blot were used to detect the expression of mRNA and protein of c-Myc and cyclin D1.The key target genes of propofol and remimazolam on prostate cancer cells were identified by net-work pharmacological analysis,and the expression of mRNA and protein of the target gene were detected by qPCR and Western blot.Results Compared with group C,the absorbance at 36 hours,the number of colo-nies and the expression of mRNA and protein of c-Myc and cyclin D1 were decreased significantly in groups P,R,and PR of DU145 and PC3 cells(P＜0.05).Compared with group P,in DU145 cells,the absor-bance at 36 hours and the expression of mRNA of cyclin D1 in groups R and PR were significantly reduced,the expression of mRNA of c-Myc in group R was increased significantly,the number of colonies and the ex-pression of protein of c-Myc in group PR were significantly reduced(P＜0.05).In PC3 cells,the expres-sion of mRNA and protein of cyclin D1 in the group R were significantly reduced,the absorbance at 36 hours and the expression of mRNA and protein of c-Myc and cyclin D1 in group PR were significantly re-duced(P＜0.05).Compared with group R,the number of colonies and the expression of mRNA and pro-tein of c-Myc in group PR of DU145 and PC3 cells were significantly reduced(P＜0.05).The results of network pharmacological analysis showed that the common target of propofol,remimazolam and prostate cancer was signal transducer and activator of transcription 3(STAT3).Compared with group C,the expres-sion of mRNA and protein of STAT3 were decreased significantly in groups P,R,and PR in DU145 and PC3 cells(P＜0.05).Compared with group P,in DU145 cells,the expression of mRNA and protein of STAT3 were increased significantly in group R,the expression of protein of STAT3 was increased signifi-cantly in group PR(P＜0.05).In PC3 cells,the expression of mRNA of STAT3 was decreased significant-ly in group R(P＜0.05).Compared with group R,the expression of protein of STAT3 was decreased sig-nificantly in group PR in DU145 cells(P＜0.05).Conclusion The proliferation of prostate cancer cells can be inhibited by propofol and remimazolam alone or synergistically and they can also reduce the expres-sion of mRNA and protein of c-Myc and cyclin D1,the mechanism may be related to the inhibition of ex-pression of STAT3 which is the member of the HIF-1α pathway.

Post-traumatic stress disorder (PTSD) is a psychiatric disease that seriously affects brain function. Currently, selective serotonin reuptake inhibitors (SSRIs) are used to treat PTSD clinically but have decreased efficiency and increased side effects. In this study, nasal cannabidiol inclusion complex temperature-sensitive hydrogels (CBD TSGs) were prepared and evaluated to treat PTSD. Mice model of PTSD was established with conditional fear box. CBD TSGs could significantly improve the spontaneous behavior, exploratory spirit and alleviate tension in open field box, relieve anxiety and tension in elevated plus maze, and reduce the freezing time. Hematoxylin and eosin and c-FOS immunohistochemistry slides showed that the main injured brain areas in PTSD were the prefrontal cortex, amygdala, and hippocampus CA1. CBD TSGs could reduce the level of tumor necrosis factor-