Objective:To investigate the application effect of quadratus lumborum block (QLB) combined with less opioid anesthesia analgesia in laparoscopic total hysterectomy (LTH) in elderly patients with uterine prolapse.Methods:A total of 86 elderly patients with uterine prolapse who received LTH in the Langfang People’s Hospital from Jan. 2021 to Oct. 2023 were prospectively selected and divided into group A ( n=42) and group B ( n=44) according to the random number table method. Group A received transversus abdominis block (TAPB) + general anesthesia, and group B received QLB combined with less opioid anesthesia + general anesthesia. The pain duration at different time points after operation [Numeric Rating Scale (NRS) method to evaluate resting incision and visceral pain] was compared between the two groups. The dosage of opioids and the additional analgesia rate were compared between the two groups. The sleep quality of the two groups before and 72 hours after operation was compared, and the adverse reactions of anesthesia were counted. Results:Compared with 6 h after operation, NRS scores of resting incision pain and visceral pain in the two groups decreased gradually at 12, 24 and 48 h after operation, and it was lower in group B than in group A. There were statistically significant differences between groups ( P<0.05) . Dosage of sufentanil and remifentanil in group B was lower than that in group A, and the postoperative additional analgesia rate in group B (9.09%) was lower than that in group A (28.57%) ( P<0.05) . 72 hours after surgery, the sleep efficiency and total sleep time of patients in both groups were lower than those before surgery, and they were higher in group B than in group A; The awakening time and number of awakenings in both groups were higher than those before surgery, while they were lower in group B than in group A ( P<0.05) . The total incidence of adverse reactions in group B was 4.76% (2/44) , lower than 23.81% (10/42) of group A ( P<0.05) . Conclusion:QLB combined with less opioid anesthesia analgesia can effectively reduce the degree of incision and visceral pain after LTH in elderly patients with uterine prolapse, reduce the amount of opioids used during operation and the rate of additional analgesia, and reduce the incidence of adverse reactions of anesthesia.

Helicobacter pylori(H.pylori)infection is a prevalent global health issue that can lead to indiges-tion,peptic ulcer disease,and gastric cancer.With ongoing research advancements,significant progress has been made in the eradication of H.pylori.Based on these important findings from North America,the American College of Gastroenterology(ACG)has released updated clinical practice guideline(CPG),published in the American Journal of Gastroenterology in September 2024.Compared to previous guidelines,key updates include:increased resistance rates to critical antibiotics used for H.pylori treatment,such as clarithromycin and levofloxacin,which have reduced the efficacy of common treatment regimens containing these antibiotics;and research on novel treat-ment options for newly diagnosed patients,including new antibiotic alternatives(e.g.,rifampicin)or more potent next-generation gastric acid inhibitors(e.g.,potassium-competitive acid blockers,PCABs).These updates provide the latest evidence and reference for the clinical management of H.pylori infection.

Objective:To observe the effects of peptidylarginine deiminase 2 (PAD2) inhibitor AFM-30a on silicotic mice and its possible mechanisms.Methods:In May 2022, 40 SPF male C57BL/6J mice were randomly divided into control group, AFM-30a group, silicosis model group and AFM-30a treatment group, with 10 mice in each group. Silicosis model group and AFM-30a treatment group were perfused with silicon dioxide (SiO 2) suspension (10 mg/piece, 50 μl), and the other groups were perfused with an equal amount of sodium chloride solution. After 2 weeks, AFM-30a group and AFM-30a treatment group were intraperitoneally injected AFM-30a (20 mg/kg, 100 μl) daily, and mice of other groups were injected with equal amounts of sodium chloride solution for 4 weeks. Mouse RAW264.7 monocytes/macrophages were cultured in vitro and divided into blank control group, AFM-30a group (5 μmol/L), SiO 2 group (200 μg/ml), and SiO 2+AFM-30a group (200 μg/ml SiO 2 induction for 12 h, followed by 5 μmol/L AFM-30a treatment for 12 h). As well as blank control group, vimentin (Vim) group (2 μg/ml), citrullinated vimentin (Cit-Vim) group (2 μg/ml), and Cit-Vim+TLR4-C34 group (10 μmol/L TLR4-C34 treatment for 1 h, followed by 2 μg/ml Cit-Vim induction for 24 h). Hematoxylin Eosin (HE) and Masson staining were used to observe the pathological morphology of lung. The lung fieldclarity and lung texture of each group was observed by micro-CT. The number of positive cells was detected by tartrate resistant acid phosphatase (TRAP) staining. The localization and expression levels of PAD2, Cit-Vim, toll-like receptor 4 (TLR4) signaling and receptor activator of nuclear factor-κB ligand (RANKL) signaling proteins were measured by Immunofluorescence staining and Western blotting in vitro and in vivo. The experimental data were all presented as Mean±SD. A completely random design of one-way analysis of variance was used among the groups. The pduo comparison was performed using LSD test for homogeneity of variance and Tamhane's test for inconsistency. Results:Compared with the control group, the silicosis model group showed the formation of silicon nodules accompanied by collagen deposition, the silicosis model group showed thickened, and several high-density shadows of varying sizes in the lung field, and the number of TRAP positive cells in silicosis model group were increased significantly, the expression levels of PAD2, Cit-Vim, TLR4 and RANKL signal-related proteins were also significantly increased in silicosis groupmodel ( P<0.05). Compared with the silicosis model group, the AFM-30a treatment group reduced deposition of collagen in lung, and the number of TRAP positive cells was decreased in AFM-30a treatment group. The expression levels of PAD2, Cit-Vim, TLR4 and RANKL signaling related proteins were significantly decreased in AFM-30a treatment group ( P<0.05). In vitro, compared with the blank control group, the number of TRAP positive cells and the expression levels of PAD2, Cit-Vim, TLR4 and RANKL signaling related proteins in the SiO 2 group were significantly increased ( P<0.05). Compared with the SiO 2 group, the number of TRAP positive cells and the expression levels of PAD2, Cit-Vim, TLR4 and RANKL signaling related proteins in the SiO 2+AFM-30a group were significantly decreased ( P<0.05). Compared with the blank control group, the expression levels of TLR4 and RANKL signaling related proteins in the Cit-Vim group were significantly increased ( P<0.05). Compared with the Cit-Vim group, the expression levels of TLR4 and RANKL signaling related proteins in the Cit-Vim+TLR4-C34 group were significantly decreased ( P<0.05) . Conclusion:PAD2 inhibitor AFM-30a may play an antagonisticrole in silicotic fibrosis in mice by potentialregulating TLR4 and RANKL signaling pathways.

Objective:Screening of hypertrophic cardiomyopathy-related signature genes and analysis of immune cell infiltra-tion characteristics by bioinformatics methods.Methods:The dataset was downloaded from the GEO database,and multiple algo-rithms in R language were used to analyze differentially expressed genes,construct weighted gene co-expression networks to obtain clinical relevance module,screen core genes,identify signature genes,identify signature gene prognosis efficacy and perform func-tional enrichment to explore immune cell infiltration.Results:A total of 117 differential genes and a core module containing 32 genes were screened,and 19 core genes were obtained.Among them,ABCA5,DNAJC16,LGALS14,MGAT4A,SLC30A8 were identified as signature genes.Statistically significant changes in the levels of macrophages,eosinophils,and plasmacytoid dendritic cells in the plasma of patients with hypertrophic cardiomyopathy compared with healthy controls were observed(P<0.05).Conclusion:The char-acteristic genes ABCA5,DNAJC16,LGALS14,MGAT4A and SLC30A8 may serve as prognosis markers for hypertrophic cardiomyop-athy,immune cells such as macrophages and eosinophils may be involved in the occurrence and development of hypertrophic cardio-myopathy.

Objective:To evaluate the effect of dexmedetomidine on the viability of dopaminergic neurons in the ventral tegmental area (VTA) of morphine-addicted mice.Methods:Experiment Ⅰ Thirty SPF healthy adult male C57BL/6 mice, aged 8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using the random number table method: normal saline group (NS group), dexmedetomidine 50 μg/kg group (DEX50 group), and dexmedetomidine 100 μg/kg group (DEX100 group). A morphine addiction model was established by intraperitoneal injection of increasing doses of morphine (10, 20, 30, 40, 50 and 50 mg/kg) for 6 consecutive days in mice. After the successful establishment of the model, dexmedetomidine 50 and 100 μg/kg were intraperitoneally injected for 14 consecutive days in group DEX50 and group DEX100 respectively, while normal saline was given instead in group C. The conditioned place preference (CPP) experiment was conducted every other day. Experiment Ⅱ Thirty SPF healthy adult male C57BL/6 mice, aged 8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) by the random number table method: control group (C group), morphine group (Mor group) and dexmedetomidine 50 μg/kg group (DEX50 group). Normal saline was intraperitoneally injected for 10 consecutive days in group C. Morphine with increasing doses was intraperitoneally injected for 6 days, and then normal saline was intraperitoneally injected for 4 consecutive days in group Mor. Morphine with increasing doses was intraperitoneally injected for 6 days, and then dexmedetomidine 50 μg/kg was intraperitoneally injected for 4 consecutive days in group DEX50. The mice were anesthetized at 90 min after the last intraperitoneal injection, brain tissues were harvested, and the corresponding brain slices of the VTA were selected for c-Fos immunofluorescence staining. Experiment Ⅲ Ten dopamine transporter-Cre recombinase mice were divided into 2 groups ( n=5 each) by the random number table method: morphine group (Mor group) and morphine+ dexmedetomidine 50 μg/kg group (Mor+ DEX group). Stereotaxic viral injection was performed in the brain. rAAV-EF1α-DIO-GCaMP6s was injected into the VTA and an optical fiber was implanted. Three weeks later, a morphine addiction model was established based on Experiment Ⅰ for the CPP experiment, morphine was intraperitoneally injected in group Mor, and morphine and dexmedetomidine were intraperitoneally injected in group Mor+ DEX. The viral fluorescence signals were recorded at 5 min before and 20 min after the drug administration in the three groups. Results:Experiment Ⅰ There was no statistically significant difference in the CPP scores after developing the morphine addiction model among the three groups ( P>0.05). Compared with group NS, the CPP scores were significantly decreased at 4-14 days of the continuous administration in group DEX50 and group DEX100 ( P<0.05). Experiment Ⅱ Compared with group C, the number of c-Fos positive cells in the VTA was significantly increased in group Mor ( P<0.05). Compared with group Mor, the number of c-Fos positive cells in the VTA was significantly decreased in group DEX ( P<0.05). Experiment Ⅲ Compared with that before administration, the calcium signals of dopaminergic neurons in the VTA were significantly enhanced in group Mor ( P<0.05), and no statistically significant difference was found in the calcium signals of dopaminergic neurons in the VTA in group Mor+ DEX ( P>0.05). Compared with group Mor, no statistically significant difference was found in the calcium signals of dopaminergic neurons in the VTA before drug administration ( P>0.05), and the calcium signals of dopaminergic neurons in the VTA were significantly weakened after administration in group Mor+ DEX ( P<0.05). Conclusions:The mechanism by which dexmedetomidine promotes the extinction of morphine addiction is related to the inhibition of the viability of dopaminergic neurons in the VTA of mice.

Objective To observe the analgesic and rehabilitation effects of non μ-opioids anesthesia/analgesia(NΜOA)based on quadratus lumborum block(QLB)in emergency cesarean section under general anesthesia.Methods The retrospective study method was adopted,50 pregnant women undergoing hysterectomy under emergency general anesthesia in Langfang People's Hospital from January 2023 to December 2024 were selected as the study objects.The patients were divided into μ-opioids anesthesia/analgesia(ΜOA)group and NΜOA group according to different anesthesia/analgesia methods,25 cases in each group.ΜOA group received ΜOA;NΜOA group received NΜOA+QLB.Incisional pain and uterine contraction pain numerical rating scale(NRS)at out of the post-anesthesia care unit(T1),intravenous injection of oxytocin(T2),press the palace bottom 24 hours(T3),out of bed activity after operation(T4)and first analgesic time of incision pain,first analgesic time of uterine contraction pain,first no vomiting eating time,first exhaust time was observed and recorded.The incidence of vasoactive agents during the anesthetic period,rescue analgesia,rescue antiemetic,constipation,sleep disturbance after operation within 48 hours after operation were also recorded.Results The NRS scores at T1,T2,T3 and T4 in ΜOA group were significantly higher than those in NΜOA group(incisional pain 3.36±1.25 vs.1.12±0.97,3.68±1.18 vs.2.00±0.91,5.76±1.67 vs.4.20±1.00,4.48±1.29 vs.3.32±0.95;uterine contraction pain 3.72±1.49 vs.1.24±1.05,4.64±1.60 vs.3.04±1.27,7.56±1.71 vs.5.16±1.37,3.56±0.22 vs.2.56±0.16,all P<0.05).The first analgesic time of incision pain,first analgesic time of uterine contraction pain in ΜOA group were significantly less than that in NΜOA group(hours:3.06±2.02 vs.17.48±10.93,2.68±2.22 vs.15.80±11.39,both P<0.05),the first no vomiting eating time,first exhaust time in ΜOA group were significantly longer than those in NΜOA group(hours:8.56±0.57 vs.6.32±0.14,15.44±1.42 vs.10.16±1.14,both P<0.05),the incidence of vasoactive agents,rescue analgesia,rescue antiemetic,constipation,sleep disturbance after operation within 48 hours in ΜOA group were significantly higher than those in NΜOA group[64.0%(16/25)vs.32.0%(8/25),48.0%(12/25)vs.20.0%(5/25),44.0%(11/25)vs.16.0%(4/25),64.0%(16/25)vs.36.0%(9/25),60.0%(15/25)vs.32.0%(8/25),all P<0.05].Conclusion NΜOA based on QLB safely and effectively reduced side effects of μ-opioids and enhanced recovery compared to ΜOA on emergency cesarean section patients undergoing general anesthesia.

Objective:To investigate the application effect of quadratus lumborum block (QLB) combined with less opioid anesthesia analgesia in laparoscopic total hysterectomy (LTH) in elderly patients with uterine prolapse.Methods:A total of 86 elderly patients with uterine prolapse who received LTH in the Langfang People’s Hospital from Jan. 2021 to Oct. 2023 were prospectively selected and divided into group A ( n=42) and group B ( n=44) according to the random number table method. Group A received transversus abdominis block (TAPB) + general anesthesia, and group B received QLB combined with less opioid anesthesia + general anesthesia. The pain duration at different time points after operation [Numeric Rating Scale (NRS) method to evaluate resting incision and visceral pain] was compared between the two groups. The dosage of opioids and the additional analgesia rate were compared between the two groups. The sleep quality of the two groups before and 72 hours after operation was compared, and the adverse reactions of anesthesia were counted. Results:Compared with 6 h after operation, NRS scores of resting incision pain and visceral pain in the two groups decreased gradually at 12, 24 and 48 h after operation, and it was lower in group B than in group A. There were statistically significant differences between groups ( P<0.05) . Dosage of sufentanil and remifentanil in group B was lower than that in group A, and the postoperative additional analgesia rate in group B (9.09%) was lower than that in group A (28.57%) ( P<0.05) . 72 hours after surgery, the sleep efficiency and total sleep time of patients in both groups were lower than those before surgery, and they were higher in group B than in group A; The awakening time and number of awakenings in both groups were higher than those before surgery, while they were lower in group B than in group A ( P<0.05) . The total incidence of adverse reactions in group B was 4.76% (2/44) , lower than 23.81% (10/42) of group A ( P<0.05) . Conclusion:QLB combined with less opioid anesthesia analgesia can effectively reduce the degree of incision and visceral pain after LTH in elderly patients with uterine prolapse, reduce the amount of opioids used during operation and the rate of additional analgesia, and reduce the incidence of adverse reactions of anesthesia.

Objective:To evaluate the effect of dexmedetomidine on the viability of dopaminergic neurons in the ventral tegmental area (VTA) of morphine-addicted mice.Methods:Experiment Ⅰ Thirty SPF healthy adult male C57BL/6 mice, aged 8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using the random number table method: normal saline group (NS group), dexmedetomidine 50 μg/kg group (DEX50 group), and dexmedetomidine 100 μg/kg group (DEX100 group). A morphine addiction model was established by intraperitoneal injection of increasing doses of morphine (10, 20, 30, 40, 50 and 50 mg/kg) for 6 consecutive days in mice. After the successful establishment of the model, dexmedetomidine 50 and 100 μg/kg were intraperitoneally injected for 14 consecutive days in group DEX50 and group DEX100 respectively, while normal saline was given instead in group C. The conditioned place preference (CPP) experiment was conducted every other day. Experiment Ⅱ Thirty SPF healthy adult male C57BL/6 mice, aged 8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) by the random number table method: control group (C group), morphine group (Mor group) and dexmedetomidine 50 μg/kg group (DEX50 group). Normal saline was intraperitoneally injected for 10 consecutive days in group C. Morphine with increasing doses was intraperitoneally injected for 6 days, and then normal saline was intraperitoneally injected for 4 consecutive days in group Mor. Morphine with increasing doses was intraperitoneally injected for 6 days, and then dexmedetomidine 50 μg/kg was intraperitoneally injected for 4 consecutive days in group DEX50. The mice were anesthetized at 90 min after the last intraperitoneal injection, brain tissues were harvested, and the corresponding brain slices of the VTA were selected for c-Fos immunofluorescence staining. Experiment Ⅲ Ten dopamine transporter-Cre recombinase mice were divided into 2 groups ( n=5 each) by the random number table method: morphine group (Mor group) and morphine+ dexmedetomidine 50 μg/kg group (Mor+ DEX group). Stereotaxic viral injection was performed in the brain. rAAV-EF1α-DIO-GCaMP6s was injected into the VTA and an optical fiber was implanted. Three weeks later, a morphine addiction model was established based on Experiment Ⅰ for the CPP experiment, morphine was intraperitoneally injected in group Mor, and morphine and dexmedetomidine were intraperitoneally injected in group Mor+ DEX. The viral fluorescence signals were recorded at 5 min before and 20 min after the drug administration in the three groups. Results:Experiment Ⅰ There was no statistically significant difference in the CPP scores after developing the morphine addiction model among the three groups ( P>0.05). Compared with group NS, the CPP scores were significantly decreased at 4-14 days of the continuous administration in group DEX50 and group DEX100 ( P<0.05). Experiment Ⅱ Compared with group C, the number of c-Fos positive cells in the VTA was significantly increased in group Mor ( P<0.05). Compared with group Mor, the number of c-Fos positive cells in the VTA was significantly decreased in group DEX ( P<0.05). Experiment Ⅲ Compared with that before administration, the calcium signals of dopaminergic neurons in the VTA were significantly enhanced in group Mor ( P<0.05), and no statistically significant difference was found in the calcium signals of dopaminergic neurons in the VTA in group Mor+ DEX ( P>0.05). Compared with group Mor, no statistically significant difference was found in the calcium signals of dopaminergic neurons in the VTA before drug administration ( P>0.05), and the calcium signals of dopaminergic neurons in the VTA were significantly weakened after administration in group Mor+ DEX ( P<0.05). Conclusions:The mechanism by which dexmedetomidine promotes the extinction of morphine addiction is related to the inhibition of the viability of dopaminergic neurons in the VTA of mice.

Objective To observe the analgesic and rehabilitation effects of non μ-opioids anesthesia/analgesia(NΜOA)based on quadratus lumborum block(QLB)in emergency cesarean section under general anesthesia.Methods The retrospective study method was adopted,50 pregnant women undergoing hysterectomy under emergency general anesthesia in Langfang People's Hospital from January 2023 to December 2024 were selected as the study objects.The patients were divided into μ-opioids anesthesia/analgesia(ΜOA)group and NΜOA group according to different anesthesia/analgesia methods,25 cases in each group.ΜOA group received ΜOA;NΜOA group received NΜOA+QLB.Incisional pain and uterine contraction pain numerical rating scale(NRS)at out of the post-anesthesia care unit(T1),intravenous injection of oxytocin(T2),press the palace bottom 24 hours(T3),out of bed activity after operation(T4)and first analgesic time of incision pain,first analgesic time of uterine contraction pain,first no vomiting eating time,first exhaust time was observed and recorded.The incidence of vasoactive agents during the anesthetic period,rescue analgesia,rescue antiemetic,constipation,sleep disturbance after operation within 48 hours after operation were also recorded.Results The NRS scores at T1,T2,T3 and T4 in ΜOA group were significantly higher than those in NΜOA group(incisional pain 3.36±1.25 vs.1.12±0.97,3.68±1.18 vs.2.00±0.91,5.76±1.67 vs.4.20±1.00,4.48±1.29 vs.3.32±0.95;uterine contraction pain 3.72±1.49 vs.1.24±1.05,4.64±1.60 vs.3.04±1.27,7.56±1.71 vs.5.16±1.37,3.56±0.22 vs.2.56±0.16,all P<0.05).The first analgesic time of incision pain,first analgesic time of uterine contraction pain in ΜOA group were significantly less than that in NΜOA group(hours:3.06±2.02 vs.17.48±10.93,2.68±2.22 vs.15.80±11.39,both P<0.05),the first no vomiting eating time,first exhaust time in ΜOA group were significantly longer than those in NΜOA group(hours:8.56±0.57 vs.6.32±0.14,15.44±1.42 vs.10.16±1.14,both P<0.05),the incidence of vasoactive agents,rescue analgesia,rescue antiemetic,constipation,sleep disturbance after operation within 48 hours in ΜOA group were significantly higher than those in NΜOA group[64.0%(16/25)vs.32.0%(8/25),48.0%(12/25)vs.20.0%(5/25),44.0%(11/25)vs.16.0%(4/25),64.0%(16/25)vs.36.0%(9/25),60.0%(15/25)vs.32.0%(8/25),all P<0.05].Conclusion NΜOA based on QLB safely and effectively reduced side effects of μ-opioids and enhanced recovery compared to ΜOA on emergency cesarean section patients undergoing general anesthesia.