Objective:To investigate the effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer.Methods:A prospective randomized-controlled trial was conducted. A total of 88 elderly patients with colorectal cancer who underwent elective laparoscopic surgery at Benxi Central Hospital from June 2022 to December 2023 were selected. According to random number table method, all patients were randomly divided to the experimental group and the control group, with 44 cases in each group. Anesthesia in the experimental group was induced with oxycodone 0.2-0.3 mg/kg, intraoperative oxycodone was maintained at 0.1-0.15 mg·kg -1·h -1; oxycodone was intravenously injected with analgesia pump after surgery. In the control group, anesthesia was induced with sufentanil 0.2-0.3 μg/kg, remifentanil was intraoperatively maintained at 0.1-0.3 μg·kg -1·min -1, sufentanil was intravenously injected with analgesia pump after surgery. Blood pressure and heart rate before anesthesia induction (T 0), at tracheal intubation (T 1), at skin incision (T 2), and at extubation (T 3) of both groups were compared; numerical rating scale (NRS) at 30 minutes, 6 h, 24 h, and 48 h after surgery were scored, the confusion assessment method (CAM) and the mini-mental state examination (MMSE) score at day 1, 3, 7 after surgery were used to assess the postoperative early cognitive decline and other adverse reactions. Results:Finally, 81 patients were included in the study. There were 41 cases in the experimental group including 20 males and 21 females with the age of (76±3) years, and 40 cases in the control group including 19 males and 21 females with the age of (75±2) years. There were no statistically significant differences in gender composition, age, body mass index, operative time, intraoperative blood loss (all P > 0.05). There were statistically differences in blood pressure [(91±8) mmHg (1 mmHg = 0.133 kPa) vs. (89±10) mmHg at T 0, (92±9) mmHg vs. (90±8) mmHg at T 2, (93±9) mmHg vs. (92±9) mmHg at T 3] and heart rate [(70± 15) times/min vs.(69±16) times/min at T 0, (68±12) times/min vs. (67±12) times /min at T 2, (70± 15) times/min vs. (69±14) times/min at T 3] between the experimental group and the control group (all P > 0.05). Blood pressure and heart rate [(101±9) mmHg, (83±15) times /min] at T 1 in the experimental group were higher than those in the control group [(93±11) mmHg, (70±17) times /min], and the differences were statistically significant ( t values were 3.73, 3.77; all P < 0.001). There were no statistically significant differences in NRS scores [(2.6±1.2) scores vs. (2.8±1.1) scores at 30 min, (2.8±1.6) scores vs. (2.9±1.3) scores at 6 h, (1.8±1.2) scores vs. (2.1±1.3) scores at 24 h, and (1.5±0.7) scores vs. (1.5±0.7) scores at 48 h after surgery] between the experimental group and the control group (all P > 0.05). The incidence of postoperative early cognitive decline [4.9% (2/41) vs. 22.5% (9/40)], nausea and vomiting after surgery [7.3% (3/41) vs. 25.0% (10/40)] in the experimental group was lower than that in the control group, and the difference was statistically significant ( χ2 values were 5.36, 4.70; P values were 0.021, 0.030, respectively). Conclusions:The application of oxycodone during laparoscopic surgery can meet the needs of perioperative analgesia and improve the postoperative early cognitive function of elderly patients with colorectal cancer.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective To investigate the biomechanical effects of implant-anchored retraction and intrusion of maxillary anterior teeth under different force systems using three-dimensional finite element analysis(3D-FEA),by constructing models simulating both normal periodontium and mild alveolar bone resorption.Methods Cone-beam computed tomography(CBCT)data from a patient with skeletal protrusion and gummy smile was utilized.3D finite element models integrating micro-implants anchorage(MIA)and a straight-wire ap-pliance for en-mass retraction of maxillary anterior teeth were established using Mimics,Geomagic,SolidWorks,and Ansys software.Six experimental groups were designed based on alveolar bone height and vertical positioning of posterior MIA.Groups A1,A2,A3:Normal alveolar bone height.Groups B1,B2,B3:Mild alveolar bone resorption.Posterior MIA were placed between the first molar and second premolar at vertical heights of 4,6,and 8 mm(relative to the cementoenamel junction),respectively,each loaded with 200 g retraction force.Anterior MIA between the central and lateral incisors delivered 50 g intrusion force.Stress distribution,anterior tooth displacement patterns,and torque changes were analyzed and compared across all groups.Results Under varying force conditions,greater torque loss was observed in the anterior teeth of the mild alveolar bone resorption group compared to the periodontally healthy group.Differential displacement patterns emerged among central incisors,lateral incisors,and canines when posterior MIA were placed at different vertical heights.The center of resistance in the resorption group shifted apically,resulting in undesirable extrusion and com-promised torque control during intrusion-retraction of maxillary anterior teeth.Conclusion Anterior torque control is more challenging in the alveolar bone resorption group than in the periodontally normal group.Elevating posterior MIA height promotes bodily movement of central incisors,thereby mitigating the ＂bowing effect＂ to a clinically relevant extent.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective To investigate the biomechanical effects of implant-anchored retraction and intrusion of maxillary anterior teeth under different force systems using three-dimensional finite element analysis(3D-FEA),by constructing models simulating both normal periodontium and mild alveolar bone resorption.Methods Cone-beam computed tomography(CBCT)data from a patient with skeletal protrusion and gummy smile was utilized.3D finite element models integrating micro-implants anchorage(MIA)and a straight-wire ap-pliance for en-mass retraction of maxillary anterior teeth were established using Mimics,Geomagic,SolidWorks,and Ansys software.Six experimental groups were designed based on alveolar bone height and vertical positioning of posterior MIA.Groups A1,A2,A3:Normal alveolar bone height.Groups B1,B2,B3:Mild alveolar bone resorption.Posterior MIA were placed between the first molar and second premolar at vertical heights of 4,6,and 8 mm(relative to the cementoenamel junction),respectively,each loaded with 200 g retraction force.Anterior MIA between the central and lateral incisors delivered 50 g intrusion force.Stress distribution,anterior tooth displacement patterns,and torque changes were analyzed and compared across all groups.Results Under varying force conditions,greater torque loss was observed in the anterior teeth of the mild alveolar bone resorption group compared to the periodontally healthy group.Differential displacement patterns emerged among central incisors,lateral incisors,and canines when posterior MIA were placed at different vertical heights.The center of resistance in the resorption group shifted apically,resulting in undesirable extrusion and com-promised torque control during intrusion-retraction of maxillary anterior teeth.Conclusion Anterior torque control is more challenging in the alveolar bone resorption group than in the periodontally normal group.Elevating posterior MIA height promotes bodily movement of central incisors,thereby mitigating the ＂bowing effect＂ to a clinically relevant extent.

Objective:To investigate the effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer.Methods:A prospective randomized-controlled trial was conducted. A total of 88 elderly patients with colorectal cancer who underwent elective laparoscopic surgery at Benxi Central Hospital from June 2022 to December 2023 were selected. According to random number table method, all patients were randomly divided to the experimental group and the control group, with 44 cases in each group. Anesthesia in the experimental group was induced with oxycodone 0.2-0.3 mg/kg, intraoperative oxycodone was maintained at 0.1-0.15 mg·kg -1·h -1; oxycodone was intravenously injected with analgesia pump after surgery. In the control group, anesthesia was induced with sufentanil 0.2-0.3 μg/kg, remifentanil was intraoperatively maintained at 0.1-0.3 μg·kg -1·min -1, sufentanil was intravenously injected with analgesia pump after surgery. Blood pressure and heart rate before anesthesia induction (T 0), at tracheal intubation (T 1), at skin incision (T 2), and at extubation (T 3) of both groups were compared; numerical rating scale (NRS) at 30 minutes, 6 h, 24 h, and 48 h after surgery were scored, the confusion assessment method (CAM) and the mini-mental state examination (MMSE) score at day 1, 3, 7 after surgery were used to assess the postoperative early cognitive decline and other adverse reactions. Results:Finally, 81 patients were included in the study. There were 41 cases in the experimental group including 20 males and 21 females with the age of (76±3) years, and 40 cases in the control group including 19 males and 21 females with the age of (75±2) years. There were no statistically significant differences in gender composition, age, body mass index, operative time, intraoperative blood loss (all P > 0.05). There were statistically differences in blood pressure [(91±8) mmHg (1 mmHg = 0.133 kPa) vs. (89±10) mmHg at T 0, (92±9) mmHg vs. (90±8) mmHg at T 2, (93±9) mmHg vs. (92±9) mmHg at T 3] and heart rate [(70± 15) times/min vs.(69±16) times/min at T 0, (68±12) times/min vs. (67±12) times /min at T 2, (70± 15) times/min vs. (69±14) times/min at T 3] between the experimental group and the control group (all P > 0.05). Blood pressure and heart rate [(101±9) mmHg, (83±15) times /min] at T 1 in the experimental group were higher than those in the control group [(93±11) mmHg, (70±17) times /min], and the differences were statistically significant ( t values were 3.73, 3.77; all P < 0.001). There were no statistically significant differences in NRS scores [(2.6±1.2) scores vs. (2.8±1.1) scores at 30 min, (2.8±1.6) scores vs. (2.9±1.3) scores at 6 h, (1.8±1.2) scores vs. (2.1±1.3) scores at 24 h, and (1.5±0.7) scores vs. (1.5±0.7) scores at 48 h after surgery] between the experimental group and the control group (all P > 0.05). The incidence of postoperative early cognitive decline [4.9% (2/41) vs. 22.5% (9/40)], nausea and vomiting after surgery [7.3% (3/41) vs. 25.0% (10/40)] in the experimental group was lower than that in the control group, and the difference was statistically significant ( χ2 values were 5.36, 4.70; P values were 0.021, 0.030, respectively). Conclusions:The application of oxycodone during laparoscopic surgery can meet the needs of perioperative analgesia and improve the postoperative early cognitive function of elderly patients with colorectal cancer.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

ObjectiveMetabolomics was utilized to investigate the preventive effect of notoginseng total saponins（NTS） on aspirin（acetyl salicylic acid， ASA）-induced small bowel injury in rats. MethodFifty male SD rats were randomly divided into normal and model groups， NTS high-dose and low-dose groups（62.5， 31.25 mg·kg^-1）， and positive drug group（omeprazole 2.08 mg·kg^-1+rebamipide 31.25 mg·kg^-1）， with 10 rats in each group. Except for the normal group， rats in other groups were given ASA enteric-coated pellets 10.41 mg·kg^-1 daily to establish a small intestine injury model. On this basis， each medication group was gavaged daily with the corresponding dose of drug， and the normal group and the model group were gavaged with an equal amount of drinking water. Changes in body mass and fecal characteristics of rats were recorded and scored during the period. After 14 weeks of administration， small intestinal tissues of each group were taken for hematoxylin-eosin（HE） staining， scanning electron microscopy to observe the damage， and the apparent damage of small intestine was scored. Serum from rats in the normal group， the model group， and the NTS high-dose group was taken and analyzed for metabolomics by ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap MS）， and the data were processed by multivariate statistical analysis， the potential biomarkers were screened by variable importance in the projection（VIP） value≥1.0， fold change（FC）≥1.5 or ≤0.6 and t-test P<0.05， and pathway enrichment analysis of differential metabolites was performed in conjunction with Human Metabolome Database（HMDB） and Kyoto Encyclopedia of Genes and Genomes（KEGG）. ResultAfter 14 weeks of administration， the average body mass gain of the model group was lower than that of the normal group， and the NTS high-dose group was close to that of the normal group. Compared with the normal group， the fecal character score of rats in the model group was significantly increased（P<0.05）， and compared with the model group， the scores of the positive drug group and the NTS high-dose group were reduced， but the difference was not statistically significant. HE staining and scanning electron microscopy results showed that NTS could significantly improve ASA-induced small intestinal injury， compared with the normal group， the small bowel injury score of the model group was significantly increased（P<0.01）， compared with the model group， the small bowel injury scores of the NTS low and high dose groups were significantly reduced（P<0.05， P<0.01）. Serum metabolomics screened a total of 75 differential metabolites between the normal group and the model group， of which 55 were up-regulated and 20 were down-regulated， 76 differential metabolites between the model group and the NTS groups， of which 14 were up-regulated and 62 were down-regulated. NTS could modulate three differential metabolites（salicylic acid， 3-hydroxybenzoic acid and 4-hydroxybenzoic acid）， which were involved in 3 metabolic pathways， namely， the bile secretion， the biosynthesis of folic acid， and the biosynthesis of phenylalanine， tyrosine and tryptophan. ConclusionNTS can prevent ASA-induced small bowel injury， and the underlying mechanism may be related to the regulation of bile secretion and amino acid metabolic pathways in rats.

Objective:To observe the unfolding status of foldable acrylic intraocular lens (IOL) of different materials, designs and refractive powers implanted in the capsular bag during cataract surgery, and to investigate its influence on the IOL implantation procedure.Methods:An observational case series study was conducted.A total of 1 005 patients who underwent routine phacoemulsification and IOL implantation in Shaanxi Eye Hospital from February to August 2021 were enrolled.The status and unfolding time of the leading haptic, optical region, and trailing haptic of the IOL in the capsular bag and the surgeon were recorded in real-time intraoperative video.Of the 1 005 IOL implants, 681 were hydrophobic, 324 hydrophilic, 733 C-loop, 272 plate-haptic, 909 single-piece, 96 three-piece, 620 preloaded, and 385 non-preloaded.The differences in unconventional implantation factors and IOL unfolding time were compared.The factors influencing IOL implantation status were analyzed by multivariate logistic regression.Multivariate logistic regression was used to analyze the relevant factors affecting IOL implantation status.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xi'an People's Hospital (Xi'an Fourth Hospital)(No.20200035). Written informed consent was obtained from each subject.Results:There were 14(1.4%) IOLs with unconventional leading haptic status during implantation, including 7 recurved, 4 folded, 2 twisted and 1 straightened.There were 101(10.0%) IOLs with unconventional trailing haptic status during implantation, including 49 stuck in the injector, 40 folded, 10 recurved and 2 broken.There were 22(2.2%) IOLs with overlapped leading and trailing haptic requiring additional separation.There were 4(0.4%) IOLs with reversed optical regions and 2(0.2%) with damaged optical regions.The occurrence rate of unconventional leading haptic status using C-loop IOL was higher than that using plate IOL, and the difference was statistically significant ( P<0.05). The occurrence rate of unconventional trailing haptic status using hydrophilic, non-preloaded, three-piece, and C-loop IOL was higher than that using hydrophobic, preloaded, single-piece, and plate IOL, respectively, and the differences were statistically significant ( χ2=9.100, 61.400, 81.885, 7.587; all at P<0.05). The 22(2.2%) IOLs with overlapped leading and trailing haptic were hydrophobic.The 4 (0.4%) IOLs with reversed optical region were non-preloaded.The results of multivariate logistic regression analysis showed that IOL material, loading method, design and surgeons were related to the unconventional trailing haptic status in implantation ( OR=9.894, 3.720, 6.810, 1.338; all at P<0.05). The average unfolding time of hydrophobic IOL was 26.12(21.21, 30.91)s, which was significantly longer than 3.03(2.16, 4.49)s of hydrophilic IOL ( Z=-25.603, P<0.05). The average unfolding time of C-loop IOL was 25.53(19.41, 30.25)s, which was significantly longer than 2.70(2.08, 3.69) s of plate IOL ( Z=-23.764, P<0.05). Conclusions:A variety of unconventional statuses of IOL can occur during implantation into the lens capsular bag.The use of hydrophobic, preloaded, single-piece, and plate IOLs can reduce the occurrence of unconventional status.The use of hydrophilic IOLs can reduce the overlap of leading and trailing haptic.The use of preloaded IOLs can reduce the occurrence of IOL optical region reversal.The use of hydrophilic and plate IOLs can shorten the operation time.

Oxytocin is a neuropeptide produced primarily in the hypothalamus and plays an important role in the regulation of mammalian birth and lactation. It has been shown that oxytocin has important cardiovascular protective effects. Here we investigated the effects of oxytocin on vascular reactivity and underlying the mechanisms in human umbilical vein endothelial cells (HUVECs) in vitro and in rat aorta ex vivo. Oxytocin increased phospho-eNOS (Ser 1177) and phospho-Akt (Ser 473) expression in HUVECs in vitro and the aorta of rat ex vivo. Wortmannin, a specific inhibitor of phosphatidylinositol 3-kinase (PI3K), inhibited oxytocin-induced Akt and eNOS phosphorylation. In the rat aortic rings, oxytocin induced a biphasic vascular reactivity: oxytocin at low dose (10-9–10-8 M) initiated a vasorelaxation followed by a vasoconstriction at high dose (10-7 M). L-NAME (a nitric oxide synthase inhibitor), endothelium removal or wortmannin abolished oxytocin-induced vasorelaxation, and slightly enhanced oxytocin-induced vasoconstriction. Atosiban, an oxytocin/ vasopressin 1a receptor inhibitor, totally blocked oxytocin-induced relaxation and vasoconstriction. PD98059 (ERK1/2 inhibitor) partially inhibited oxytocin-induced vasoconstriction. Oxytocin also increased aortic phospho-ERK1/2 expression, which was reduced by either atosiban or PD98059, suggesting that oxytocin-induced vasoconstriction was partially mediated by oxytocin/V1aR activation of ERK1/2. The present study demonstrates that oxytocin can activate different signaling pathways to cause vasorelaxation or vasoconstriction. Oxytocin stimulation of PI3K/eNOS-derived nitric oxide may participate in maintenance of cardiovascular homeostasis, and different vascular reactivities to low or high dose of oxytocin suggest that oxytocin may have different regulatory effects on vascular tone under physiological or pathophysiological conditions.