Ischemic stroke(IS)is a common cerebrovascular disease,and its pathogenesis is closely associated with brain cell death due to insufficiency of cerebral blood supply.In recent years,cell apoptosis has become a research hotspot in the pathogenesis of IS.The B-cell lymphoma-2(Bcl-2)family proteins associated with cell apoptosis are the key regulators for apoptosis and are mainly in-volved in the intrinsic apoptotic pathway,and they regulate cell apoptosis by mediating the two pathways of mitochondrial membrane permeability and Ca2? overload,thereby delaying the progression of IS.Starting from the anti-apoptotic mechanisms of Bcl-2 family proteins,this article summarizes the research advances in traditional Chinese medicine for the prevention and treatment of IS by regu-lating B-cell lymphoma-2 family proteins from the aspects of the structural features of Bcl-2 family proteins,their anti-apoptotic role in IS,and traditional Chinese medicine regulation.The results show that the anti-apoptotic strategies in IS mainly focus on the regula-tion of Bcl-2 and Bax proteins,and monomers of Chinese herbs,traditional Chinese medicine extracts,and compound traditional Chi-nese medicine prescriptions were used for treatment,which further confirms the great potential of traditional Chinese medicine in the prevention and treatment of IS and provides a theoretical basis for future experimental research and clinical treatment.

Objective To compare the efficacy of electroacupuncture in traditional Chinese medicine with the opioid adjuvant drug dezocine.Methods 122 patients undergoing elective laparoscopic cholecystectomy at the Second Affiliated Hospital of Kunming Medical University between October 12,2023,and April 05,2024,were randomly allocated into three groups:dezocine group(D group,n=40),electroacupuncture group(E group,n=42),and electroacupuncture combined with dezocine group(ED group,n=40).Patients received 10 mg dezocine,electroacupuncture,or electroacupuncture+10 mg dezocine after cholecystectomy.Pain threshold index(PTi),pain index(Pi),and visual analogue scale(VAS)scores were observed at different time points during surgery.Vital signs were recorded,and adverse reactions within 24 hours postoperatively were noted.Results There were no statistically significant differences in PTi among groups before electroacupuncture(T1)(P>0.05).At the end of electroacupuncture(T2)and after cholecystectomy(T3),the PTi values in the E and ED groups were lower than the D group(P<0.05).At the end of surgery(T4)and upon extubation(T5),the PTi values of all three groups reached a tolerable level for patients,with the E and D groups showing higher PTi values compared to the ED group(P<0.05).There were no statistically significant differences in postoperative pain scores(Pi)and VAS at various time points(P>0.05).Conclusion Electroacupuncture demonstrates analgesic efficacy non-inferior to opioid drugs and can be recommended as a postoperative pain management technique for laparoscopic cholecystectomy patients.

Objective To observe the effect of electroacupuncture(EA)on the expression of NKCC1,KCC2 and activation of microglia in spinal dorsal horn of paclitaxel(PTX)-induced neuropathic pain rats and its possible mechanism.Methods Male SD rats were randomly divided into the vehicle group(vehicle),the PTX group,the PTX+EA group and the PTX+sham EA group,with 12 rats in each group.The rat model of PTX-induced neuropathic pain was established by intraperitoneal injection of PTX.After modeling,EA was applied to"Zusanli"and"Yanglingquan"for 7 days in the PTX+EA group.Paw withdrawal threshold and paw withdrawal latency were tested at 2 days before and 1,3,5,7,14 and 21 days after PTX injection.Immunofluorescence and Western blot assay were used to detect expression levels of sodium-potassium-chloride cotransporter 1(NKCC1),potassium-chloride cotransporters 2(KCC2)and microglia markers-ionized calcium binding adapter molecule 1(Iba1)in spinal dorsal horn.Results Compared with the vehicle group,mechanical and thermal hyperalgesia of both hind feet were found in the PTX group,and the expression of NKCC1 and the number of activated microglia in dorsal horn tissue of spinal cord were increased.Compared with the PTX group,mechanical and thermal hyperalgesia were significantly improved in the PTX+EA group at day 14 and 21,and the expression levels of NKCC1 and Iba1 in dorsal horn tissue of spinal cord were decreased.There was no significant difference in KCC2 expression between the four groups.Conclusion Electroacupuncture can effectively relieve paclitaxol-induced neuropathic pain,which may be related to the inhibition of NKCC1 expression and microglia activation in spinal dorsal horn of rats.

Objective:To evaluate the effects of different subanesthetic doses of esketamine on lung injury in elderly patients undergoing robot-assisted radical prostatectomy.Methods:Ninety American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-27 kg/m 2, scheduled for elective robot-assisted radical prostatectomy under general anesthesia, identified as having middle and high risk using the Assess Respiratory Risk in Surgical Patients in Catalonia, were divided into 3 groups ( n=30 each) using a random number table method: low-dose esketamine group (ES1 group), extremely low-dose esketamine group (ES2 group) and control group (C group). In ES1 group, esketamine was intravenously injected as a bolus of 0.2 mg/kg during anesthesia induction followed by an infusion of 0.125 mg·kg -1·h -1 until 30 min before the end of operation. In ES2 group, esketamine was intravenously injected as a bolus of 0.1 mg/kg during anesthesia induction followed by an infusion of 0.015 mg·kg -1·h -1 until 30 min before the end of operation. The equal volume of normal saline was given instead in C group. Radial artery blood samples were collected before anesthesia induction (T 0) and at the end of operation for determination of concentrations of Clara cell secretory protein (CC-16) and soluble form of advanced glycation end products receptor (sRAGE) in serum by enzyme-linked immunosorbent assay. The parameters of respiratory mechanics such as the driving pressure, dynamic lung compliance and mechanical power were recorded at 5 min after mechanical ventilation (T 1), and at 1 and 2 h after Trendelenburg position combined with pneumoperitoneum (T 2-3), and at 5 min before the end of operation (T 4). Blood samples were collected from the radial artery at T 0, T 1, T 3 and in the postanesthesia care unit for blood gas analysis, and the alveolar-arterial partial oxygen pressure difference and oxygenation index were recorded. The adverse reactions within 24 h after operation and the occurrence of postoperative pulmonary complications within 7 days after operation were recorded. Results:Compared with C group, the serum CC-16 and sRAGE concentrations were significantly decreased at the end of operation, the oxygenation index was increased and the alveolar-arterial partial oxygen pressure difference was decreased in the postanesthesia care unit, and the incidence of postoperative nausea reactions within 24 h after operation was decreased in ES1 and ES2 groups ( P<0.05 or 0.01). Compared with ES2 group, the serum CC-16 and sRAGE concentrations were significantly decreased at the end of operation in ES1 group ( P<0.05). There were no statistically significant differences in the driving pressure, dynamic lung compliance and mechanical power at T 1-4 and the incidence of postoperative pulmonary complications within 7 days after surgery among the three groups ( P>0.05). Conclusions:Esketamine given as a subanesthetic bolus of 0.2 mg/kg during anesthesia induction followed by an infusion of 0.125 mg·kg -1·h -1 can alleviate lung injury in elderly patients undergoing robot-assisted radical prostatectomy.

Objective·To construct an mRNA vaccine encoding hemagglutinin(HA)of influenza A H1N1 virus,and explore the protective effects of different booster vaccination strategies.Methods·Firefly luciferase(Fluc)was used as the reporter gene to construct Fluc mRNA vaccine enveloped in lipid nanoparticles(LNP).The in vivo expression of Fluc mRNA-LNP after intramuscular injection was determined by live imaging assay in mice.Furthermore,M15-HA mRNA-LNP derived from H1N1 subtype(A/Michigan/45/2015)was constructed.Mice were immunized with 20,10,5,or 1 μg doses of M15-HA mRNA-LNP twice(with an interval of 3 weeks)through intramuscular injection.Serum antibody titers were measured by enzyme-linked immunosorbent assay(ELISA)at 2 weeks and 4 weeks after the second immunization,and functional antibody levels were detected by hemagglutination inhibition test.The third booster vaccination was performed 40 d after the second immunization in 1 μg dose group with 1 μg M15-HA mRNA-LNP or 10 μg HA subunit vaccine.The levels of specific antibody and functional antibody were detected by ELISA and hemagglutination inhibition test,respectively 2 weeks and 4 weeks later.Results·Live imaging assay showed that luciferase activity could be detected in mice 1 d after injection of Fluc mRNA-LNP.At 2 weeks and 4 weeks after the second immunization of M1 5-HA mRNA-LNP,HA-specific antibodies were significantly higher than those before the immunization in all vaccination groups at different doses(P=0.000).The hemagglutination inhibition test showed that the levels of functional antibodies in the 20 μg dose and 10 μg dose groups were significantly higher than those in the PBS control group(P＜0.05).After 1 μg dose group mice were immunized with HA protein or M15-HA mRNA-LNP,higher levels of HA-specific antibody and functional antibody were induced and maintained for a long time.There was no significant difference between the two different booster immunization strategies.Conclusion·M15-HA mRNA-LNP vaccine is constructed with immunogenicity and antibody neutralization activity.Low-dose mRNA priming vaccination followed by both homologous mRNA vaccine and heterologous protein subunit vaccine booster vaccination can induce stronger immune recall responses.

Objective:To improve the multiple-link operation efficiency, effect and satisfaction of transaxillary dual-plane breast augmentation by optimizing and upgrading the configuration of auxiliary tools.Methods:From January 2019 to May 2021, breast augmentation was performed in 130 female patients (aged 32±8 years) in the Cosmetic and Plastic Center of the First Affiliated Hospital of Harbin Medical University. The study was conducted among 63 patients who were eligible for the criteria of high configuration surgery. 67 patients underwent standard configuration surgery. The average operation time, intraoperative blood loss, drainage volume (24 hours after operation), postoperative visual analog scale (VAS) pain score and satisfaction were statistically analyzed.Results:The data of high configuration method and standard configuration method were compared as follows: average operation time was (78.6±12.2) min / (93.1±12.1) min ( t=15.73, P<0.05); the average intraoperative blood loss was (3.1±1.0) ml / (14.4±3.5) ml ( t=13.83, P<0.05); the drainage volume (24 hours after operation) was (37.2±8.2) ml / (61.4±10.9) ml ( t=20.82, P<0.05); the pain score on the first day after surgery was (6.1±1.7) points / (7.5±1.6) points ( t=8.57, P<0.05). The overall satisfaction rate was 97.1±1.6 / 95.6±2.0 ( t=5.58, P>0.001), at 6 months after operation. No severe complications were found during the follow-up period, such as capsular contracture, hematoma, infection and double bubble deformity. Conclusions:The use of ultrasonic knife with delivery bag is an effective optimization and upgrade of the endoscopic assisted transaxillary dual plane breast augmentation. The advantages of this method are obvious, highly efficient, safe, effective and satisfactory. It is worthy of clinical application and promotion.

Purpose: Vascular calcification (VC) is a common complication of end-stage renal disease (ESRD). This study aimed to examine changes in the expression of miR-21-5p in ESRD patients with VC and to explore its clinical value in predicting the occurrence and progression of uremic VC. Materials and Methods: 120 ESRD patients were divided into patients without VC group (n=38) and patients with VC group (n=82). All patients were followed up for 2 years to evaluate VC progression. qRT-PCR was used to detect serum miR-21-5p levels.Receiver operating characteristic curves were constructed to assess diagnostic value. Kaplan-Meier and log-rank methods were utilized to calculate associations between VC progression and risk factors. Results: Serum miR-21-5p levels were significantly higher in ESRD patients with VC than in those without VC and increased progressively with increasing disease severity. Serum miR-21-5p levels were able to distinguish patients with VC from those without VC, with an area under the curve value of 0.883, a sensitivity of 81.7%, and a specificity of 84.2%. After 2 years of follow-up, miR-21-5p expression had increased in patients with worse VC severity, compared with those with stable VC severity. Patients with high miR-21-5p levels were more likely to develop more severe VC, indicating an association between miR-21-5p and VC progression (log-rank p=0.002). Multivariable Cox regression analysis suggested that serum miR-21-5p is an independent predictive factor of VC progression in ESRD patients (hazard ratio=2.064, 95% confidence interval=1.225–3.478, p=0.006). Conclusion miR-21-5p is overexpressed in the serum of ESRD patients with VC. Our results suggest that overexpression of miR-21-5p is closely associated with VC progression.

Objective:To evaluate the lung protection of pressure-controlled ventilation volume guaranteed (PCV-VG) in elderly patients undergoing laparoscopic surgery in Trendelenburg position.Methods:Sixty patients of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, aged 65-80 yr, with body mass index of 19-27 kg/m 2, scheduled for elective laparoscopic radical prostatectomy or laparoscopic radical cystectomy, were allocated into 2 groups ( n=30 each) by a random number table method: VCV group (group V) and PCV-VG group (group P). Tracheal intubation was performed after induction of anesthesia.The anesthesia machine was connected to perform mechanical ventilation with tidal volume of 7 ml/kg (corrected body weight), positive end-expiratory pressure at 5 cmH 2O, inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 50%, fresh gas flow at 2 L/min and respiratory rate 12-15 breaths/min in two groups.Recruitment maneuver was performed with a pressure of 30 cmH 2O, lasting for 30 s, starting from 5 min before the end of administration.The airway peak pressure (P peak), airway plateau pressure (P plat), driving pressure (DP), and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T 1), 5 min after changing position (T 2), 5, 30, 60, 90 and 120 min of pneumoperitoneum (T 3-7) and 5 min after restoring the supine position and after the end of pneumoperitoneum (T 8). Blood samples were collected from the radial artery for blood gas analysis at T 1, T 4 and T 6 and when modified Aldrete score reached 10 in postanesthesia care unit, and pH value, partial pressure of arterial oxygen (PaO 2), partial pressure of arterial carbon dioxide (PaCO 2), arterial oxygen saturation (SaO 2) and alveolar-arterial oxygen gradient (P A-aO 2) were recorded.Blood samples were collected from the radial artery before induction of anesthesia and at the end of surgery for determination of concentrations of Clara cell protein (CC-16), interleukin-6 (IL-6) and neutrophil elastase (NE) in serum by enzyme-linked immunosorbent assay.The development of pulmonary complications was recorded within 7 days after surgery. Results:Compared with group V, P peak was significantly decreased at T 1-8, P plat and DP were decreased at T 5-7, Cdyn was increased at T 2-7, P A-aO 2 was decreased at T 1, 4, 6, serum CC-16, IL-6 and NE concentrations were decreased at the end of surgery ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after surgery in group P ( P>0.05). Conclusion:PCV-VG can produce lung protection to some extent in elderly patients undergoing laparoscopic surgery in Trendelenburg position.

Objective: To evaluate the efficacy and prognostic factors in core binding factor (CBF) acute myeloid leukemia (AML) under current therapy modalities, therefore optimizing the treatment strategies. Methods: Standard cytological and immune methods including next generation sequencing (NGS) were used for risk stratification. Complete remission (CR) rate, disease-free survival (DFS) and overall survival (OS) were assessed by multivariate Logistic and Cox regression models in a total of 206 adults (aged 16-65 years) with CBF-AML, including 152 AML patients with t(8;21) and 54 with inv(16). Results: The CR rate of inv(16) patients after first course was 54/54(100%), significantly higher than that of t(8;21) patients [127/147(86.4%), P=0.005]. The fusion transcript level and KIT mutation were independent factors related to CR rate in t(8;21) patients (P=0.044 and 0.027; respectively). DFS and OS in inv(16) patients tended to be more superior than that in t(8;21) patients (P=0.066 for DFS; P=0.306 for OS; respectively). Multivariate Cox identified negative expression of CD₁₉ and female gender the independent predictors of inferior DFS in t(8;21) patients (P=0.000 for CD₁₉; P=0.006 for sex; respectively). Analysis of combining CD₁₉ with gender indicated that females/CD₁^9-subpopulation had significantly poor DFS than did males/CD₁₉⁺ ones (Bonferroni-P<0.000 01). The number of mutations in each patient, FLT3-ITD and additional karyotype abnormalities did not affect CR rate and DFS (all P>0.05). Conclusions Patients with inv(16) have better induction response than those with t(8;21). High level of fusion transcripts and positive KIT mutation are associated with low CR rate in t(8;21) patients. Negative CD₁₉ expression and female gender are independent predictors of inferior DFS in t(8;21) patients.

Objective To determine the median effective dose (EDs0) of etomidate inducing electroencephalogram (EEG) burst suppression (BS) in the patients with non-intracranial diseases.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 19-27 kg/m2,scheduled for elective non-intracranial surgery,were enrolled in this study.ED50 of etomidate was determined by Dixon's up-and-down sequential method.Etomidate was intravenously injected for 30 s at an initial dose of 0.30 mg/kg.The BS ratio was recorded within 6 min following the end of injection.Each time ED50 increased/decreased in the next patient depending on whether or not BS occurred.The difference between the two successive doses was 0.05 mg/kg.Successful induction of BS was defined as BS ratio＞ 10％,lasting more than 1 min.Probit analysis was used to calculate the ED50 and 95％ confidence interval of etomidate inducing EEG BS in the patients with non-intracranial diseases.Results The ED50 of etomidate inducing EEG BS was 0.70 mg/kg,and the 95％ confidence interval was 0.65-0.81 mg/kg in the patients with non-intracranial diseases.Conclusion The ED50 of etomidate inducing EEG BS is 0.70 mg/kg in the patients with non-intracranial diseases.