Objective:To investigate the effects of ultrasound-guided intermuscular brachial plexus anesthesia on shoulder arthroscopic surgery.Methods:A total of 300 patients who underwent shoulder arthroscopic surgery at Dongyang Hospital of Traditional Chinese Medicine from January 2022 to January 2023 were prospectively included in this study. A randomized controlled trial design was used. The patients were divided into an observation group ( n = 150) and a control group ( n = 150) using a random number table method. The control group received intravenous general anesthesia, while the observation group underwent intermuscular brachial plexus nerve block combined with intravenous general anesthesia. The clinical efficacy, surgical indicators, hemodynamic levels, and incidence of adverse reactions were compared between the two groups. Results:The Visual Analog Scale (VAS) scores and the muscle strength scores for elbow and wrist flexion in the observation group at 2 and 3 h postoperatively were (4.12 ± 0.21), (2.32 ± 0.62), (3.35 ± 0.61), and (4.19 ± 0.57), respectively. There values were significantly superior to those in the control group [(6.54 ± 0.32), (1.21 ± 0.23), (4.62 ± 0.21), (3.25 ± 0.63), t = 77.44, 20.56, -24.11, 13.55, all P < 0.01]. The intraoperative lavage fluid volume, remifentanil dosage, propofol dosage, and duration of surgery in the observation group were (6.32 ± 2.11) L, (0.13 ± 0.03) μg·kg?1·min?1, (0.11 ± 0.03) mg·kg?1·h?1, and (73.23 ± 15.86) min, respectively, all of which were significantly lower than those in the control group [(8.52 ± 3.23) L, (0.15 ± 0.02) μg·kg?1·min?1, (0.15 ± 0.02) mg·kg?1·h?1, and (79.88 ± 15.56) min, t = 6.98, -6.79, -13.59, -3.67, all P < 0.01]. The clarity of the surgical field in the observation group was rated at (1.02 ± 0.21) points, which was significantly higher than that in the control group [(1.75 ± 0.32) points, t = -23.36, P < 0.01]. At the start of surgery (T1) and 30 min into the procedure (T2), the systolic blood pressures in the observation group were (106.65 ± 7.12) mmHg (1 mmHg = 0.133 kPa) and (97.02 ± 5.01) mmHg, which were significantly lower than those in the control group [(108.69 ± 7.21) mmHg, (98.26 ± 5.12) mmHg, t = -2.47, -2.12, both P < 0.05]. The heart rates in the observation group at T1, T2, 60 min into the procedure (T3), and 10 min post-extubation (T4) were (71.69 ± 5.32) beats/min, (62.32 ± 4.85) beats/min, (61.12 ± 4.25) beats/min, and (79.28 ± 3.52) beats/min, all of which were significantly lower than those in the control group [(91.23 ± 5.21) beats/min, (90.12 ± 4.63) beats/min, (92.21 ± 4.31) beats/min, (92.32 ± 3.51) beats/min, t = -32.14, -50.78, -62.91, -32.13, all P < 0.01]. The total incidence of adverse reactions, including allergies, nausea, vomiting, and dizziness, in the observation group was 28.67% (43/150), which was significantly lower than that in the control group [45.33% (68/150), χ2 = 8.94, P < 0.01]. Conclusions:Ultrasound-guided intermuscular brachial plexus anesthesia improves intraoperative anesthetic effects, reduces the volume of lavage fluid, remifentanil, and propofol used, shortens duration of surgery, and enhances the clarity of the surgical field. Additionally, it also effectively controls blood pressure and hemodynamic changes, leading to a reduction in adverse reactions.

Objective:To investigate the effects of ultrasound-guided intermuscular brachial plexus anesthesia on shoulder arthroscopic surgery.Methods:A total of 300 patients who underwent shoulder arthroscopic surgery at Dongyang Hospital of Traditional Chinese Medicine from January 2022 to January 2023 were prospectively included in this study. A randomized controlled trial design was used. The patients were divided into an observation group ( n = 150) and a control group ( n = 150) using a random number table method. The control group received intravenous general anesthesia, while the observation group underwent intermuscular brachial plexus nerve block combined with intravenous general anesthesia. The clinical efficacy, surgical indicators, hemodynamic levels, and incidence of adverse reactions were compared between the two groups. Results:The Visual Analog Scale (VAS) scores and the muscle strength scores for elbow and wrist flexion in the observation group at 2 and 3 h postoperatively were (4.12 ± 0.21), (2.32 ± 0.62), (3.35 ± 0.61), and (4.19 ± 0.57), respectively. There values were significantly superior to those in the control group [(6.54 ± 0.32), (1.21 ± 0.23), (4.62 ± 0.21), (3.25 ± 0.63), t = 77.44, 20.56, -24.11, 13.55, all P < 0.01]. The intraoperative lavage fluid volume, remifentanil dosage, propofol dosage, and duration of surgery in the observation group were (6.32 ± 2.11) L, (0.13 ± 0.03) μg·kg?1·min?1, (0.11 ± 0.03) mg·kg?1·h?1, and (73.23 ± 15.86) min, respectively, all of which were significantly lower than those in the control group [(8.52 ± 3.23) L, (0.15 ± 0.02) μg·kg?1·min?1, (0.15 ± 0.02) mg·kg?1·h?1, and (79.88 ± 15.56) min, t = 6.98, -6.79, -13.59, -3.67, all P < 0.01]. The clarity of the surgical field in the observation group was rated at (1.02 ± 0.21) points, which was significantly higher than that in the control group [(1.75 ± 0.32) points, t = -23.36, P < 0.01]. At the start of surgery (T1) and 30 min into the procedure (T2), the systolic blood pressures in the observation group were (106.65 ± 7.12) mmHg (1 mmHg = 0.133 kPa) and (97.02 ± 5.01) mmHg, which were significantly lower than those in the control group [(108.69 ± 7.21) mmHg, (98.26 ± 5.12) mmHg, t = -2.47, -2.12, both P < 0.05]. The heart rates in the observation group at T1, T2, 60 min into the procedure (T3), and 10 min post-extubation (T4) were (71.69 ± 5.32) beats/min, (62.32 ± 4.85) beats/min, (61.12 ± 4.25) beats/min, and (79.28 ± 3.52) beats/min, all of which were significantly lower than those in the control group [(91.23 ± 5.21) beats/min, (90.12 ± 4.63) beats/min, (92.21 ± 4.31) beats/min, (92.32 ± 3.51) beats/min, t = -32.14, -50.78, -62.91, -32.13, all P < 0.01]. The total incidence of adverse reactions, including allergies, nausea, vomiting, and dizziness, in the observation group was 28.67% (43/150), which was significantly lower than that in the control group [45.33% (68/150), χ2 = 8.94, P < 0.01]. Conclusions:Ultrasound-guided intermuscular brachial plexus anesthesia improves intraoperative anesthetic effects, reduces the volume of lavage fluid, remifentanil, and propofol used, shortens duration of surgery, and enhances the clarity of the surgical field. Additionally, it also effectively controls blood pressure and hemodynamic changes, leading to a reduction in adverse reactions.

ObjectiveTo investigate the therapeutic effect of Scutellariae Radix-Coptidis Rhizoma （SRCR） on atherosclerosis （AS） in mice and the effect of SRCR on macrophage pyroptosis in plaques via NOD-like receptor thermal protein domain-associated protein 3 （NLRP3） inflammasomes. MethodApoE^-/- mice were fed with a high-fat diet for the modeling of AS and randomized into model， atorvastatin （5 mg·kg^-1）， and low-， medium-， and high-dose （1.95， 3.9， 7.8 g·kg^-1， respectively） SRCR groups. Normal C57BL/6J mice were selected as the control group. After 8 weeks of administration， hematoxylin-eosin staining was used to observe the pathological status of the aortic plaque. The lipid accumulation in aortic plaque was observed by oil red O staining. The serum levels of total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） in mice were measured. Immunofluorescence double staining was employed to detect the co-localized expression of EGF-like module-containing mucin-like hormone receptor-like 1 （EMR1）/NLRP3 and EMR1/gasdermin D （GSDMD）. The serum levels of interleukin-1β （IL-1β） and interleukin-18 （IL-18） were determined by enzyme-linked immunosorbent assay （ELISA）. The protein levels of NLRP3， apoptosis-associated speck-like protein （ASC）， Caspase-1， cleaved Caspase-1， GSDMD， N-terminus of GSDMD （GSDMD-NT）， pro-IL-1β， IL-1β， and IL-18 were determined by Western blot， and the mRNA levels of NLRP3， ASC， Caspase-1， GSDMD， IL-1β， and IL-18 were determined by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the control group， the model group showed obvious plaques， elevated serum levels of TG， TC， LDL-C， IL-1β， and IL-18 （P<0.01）， lowered serum level of HDL-C （P<0.01）， and up-regulated expression of NLRP3 inflammasomes and molecules related to pyroptosis in the aortic plaques （P<0.01）. Compared with the model group， SRCR， especially at the medium and high doses， alleviated the plaque pathology， reduced the lipid content in plaques （P<0.05， P<0.01）， recovered the serum lipid levels （P<0.05）， reduced the macrophage recruitment （P<0.01）， activation of NLRP3 inflammasomes， and pyroptosis in aortic root plaques （P<0.05）， lowered the serum IL-1β and IL-18 levels （P<0.01）， and down-regulated the protein levels of NLRP3， ASC， Caspase-1， cleaved Caspase-1， GSDMD， GSDMD-NT， pro-IL-1β， IL-1β， and IL-18 （P<0.05） and the mRNA levels of NLRP3， ASC， Caspase-1， GSDMD， IL-1β， and IL-18 in the aortic tissue （P<0.05）. ConclusionSRCR exerts a therapeutic effect on high-fat diet-induced AS in mice by inhibiting the activation NLRP3 inflammasomes and reducing the pyroptosis of macrophages in plaques.

Objective:To examine the impact of berberine on polycystic ovary syndrome (PCOS) in mice, and to investigate the effects of berberine on the intestinal flora and the intestinal flora on PCOS.Methods:A mouse model of PCOS was established by administering dehydroepiandrosterone in combination with high fat diet, and the mouse model was given a berberine treatment. The study consisted of a blank control group (C group), a PCOS model group (M group) and a berberine treatment group (T group). During the experiment, the mice were closely monitored through timed body weight measurements and estrous cycle monitoring; intraperitoneal glucose tolerance test and insulin tolerance test were done. Upon completion of the pharmacological intervention, the wet weights of liver, ovary and fat deposits of mice were assessed and subjected to HE staining to confirm the success of PCOS modeling and the efficacy of berberine. Additionally, fecal samples were analyzed for intestinal flora through 16S rRNA analysis.Results:The PCOS model was established successfully, berberine alleviated the disturbance of estrous cycle in mice, and significantly alleviated fat accumulation and metabolic abnormalities of glucose in mice. The cross-sectional area of fat pad cells in T group was (2 858±146) μm2, which was significantly lower than that in M group [(9 518±347) μm2], and the difference was statistically significant ( P<0.001). The blood glucose levels in T group were significantly lower than those in M group ( P<0.05). The composition and structure of intestinal flora in mice of M group with PCOS (compared with C group) and in mice of T group after berberine intervention (compared with M group) were significantly altered. However, alpha diversity did not change significantly among three groups ( P>0.05). Conclusion:Berberine could alleviate PCOS by intervening in the alterations of gut microbiota.

Objective To retrieve,evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation,and to provide a reference for clinical practice.Methods UpToDate,BMJ Best Practice,Registered Nurses'Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,SinoMed,CNKI,Wanfang Database,Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including clinical guidelines,expert consensuses,evidence summaries,systematic reviews,and well-designed original studies.The time limit for retrieval was until June 2023.The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of J BI Evidence-Based Health Care Center.Results 14 pieces of the literature were included,including 2 clinical guidelines,4 expert consensuses,5 systematic reviews,2 cohort studies and 1 case series.Totally 33 pieces of evidence were summarized,covering 7 aspects:adaptation conditions for the implementation of awake ECMO,team composition,comprehensive assessment,pre-mobilization preparation,mobilization content,prevention and control of adverse events,and effect evaluation.Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation.It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients,apply the best evidence to standardize the early mobilization process,and formulate an individualized mobilization program.

ObjectiveTo observe the effect of Scutellariae Radix-Coptidis Rhizoma on plaque stability in atherosclerotic （AS） mice and to explore its possible mechanism of action based on the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor kappa B （NF-κB） signaling pathway. MethodTen normal C57BL/6J mice were used as the normal group， and the same strain of ApoE knockout （ApoE^-/-） mice were fed with a high-fat diet for 12 weeks to construct an atherosclerosis model. Mice were randomly divided into five groups， namely the model group， the atorvastatin group， and the Scutellariae Radix-Coptidis Rhizoma low-， medium-， and high-dose groups， with ten mice in each group. Then normal and model groups were given equal volume of saline gavage， and the low-， medium-， high-dose Scutellariae Radix-Coptidis Rhizoma groups were given 1.95， 3.9， 7.8 g·kg^-1 of the drug by gavage for 8 weeks， respectively. The general state of mice was observed. Hematoxylin-eosin staining was utilized to observe the pathology of aortic root plaques and calculate the percentage of plaque area. Masson staining and oil red O staining combined with immunohistochemistry of F4/80 and α-SMA were used to detect the plaque components of aortic root plaques and calculate the plaque vulnerability index. Enzyme-linked immunosorbent assay was adopted to detect the expression levels of serum tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6）. Western blot was applied to detect the protein expression levels of matrix metalloproteinase-2 （MMP-2）， matrix metalloproteinase-9 （MMP-9）， TLR4， MyD88， NF-κB p65， and phosphorylation （p） -NF-κB p65 in the aortic tissues of mice in each group. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） assay was employed to detect the expression levels of MMP-2， MMP-9， TLR4， and MyD88， NF-κB p65 mRNA. ResultCompared with the model group， the general state of the mice in each medication group was improved， and no obvious side effects were observed. Compared with the model group， the percentage of plaque area in the aortic root of AS mice was significantly reduced in the medium- and high-dose Scutellariae Radix-Coptidis Rhizoma groups （P<0.05）. The content of collagen fibers and smooth muscle cells in the plaques of the high-dose Scutellariae Radix-Coptidis Rhizoma group was significantly increased （P<0.01）， and the content of lipids and macrophages was significantly reduced （P<0.05）， the plaque vulnerability index of each dose group of Scutellariae Radix-Coptidis Rhizoma was significantly reduced， with significant reduction of the medium- and high-dose groups （P<0.01）. MMP-2 and MMP-9 protein and mRNA expression levels in aortic tissues were significantly reduced in medium- and high-dose Scutellariae Radix-Coptidis Rhizoma groups （P<0.05）. The serum levels of TNF-α and IL-6 were significantly reduced in AS mice in medium- and high-dose Scutellariae Radix-Coptidis Rhizoma groups （P<0.05）. In the medium- and high-dose Scutellariae Radix-Coptidis Rhizoma groups， the levels of TLR4， MyD88 protein， and mRNA expression in aortic tissues were significantly reduced （P<0.05）， and the level of NF-κB p65 phosphorylation in aortic tissues was significantly reduced （P<0.05）. ConclusionScutellariae Radix-Coptidis Rhizoma may play an anti-inflammatory and stabilizing role by inhibiting the TLR4/MyD88/NF-κB signaling pathway.

Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis.Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI,WanFangData,VIP,CBM,PubMed,Web of Science,Embase,Elsevier ScienceDirect and CINAHL databases.The search was conducted from the time of database construction to November 2023.Literature screening,quality assessment,and data extraction were performed independently by 2 investigators,and Meta-analysis was performed using Stata 17.0 software.Results 10 cohort studies,including 1 999 patients,were finally included,and 13 influencing factors were extracted,including advanced age(OR=1.05),female(OR=2.50),BMI(OR=0.38),diagnosis of primary pulmonary disease(OR=2.90),6MWD(OR=0.34),and lung allocation score(OR=0.69),FVC(OR=0.60),pre-transplant frailty(OR=0.81),hypoproteinemia(OR=4.12),hemoglobin(OR=0.50),anemia(OR=4.37),length of ICU stay(OR=1.24),and total length of stay(OR=1.05).Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients,with an incidence of frailty in 24％before transplantation and 50％in post-transplantation.Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients,with a pre-transplant frailty incidence of 30％.Conclusion There are many factors involved in the incidence of frailty in lung transplant patients,and nursing staff should dynamically evaluate the frailty of lung transplant patients,and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To evaluate the effect of remote interventions with digital health technologies in lung transplant patients.Methods Databases,including CKNI,Wangfang,VIP,CMB,Cochrane Library,PubMed,Embase,Web of Science,Scopus and BMJ Best Practice were searched from their inception to July 2023.There were 2 researchers who independently screened and extracted the literature,and then evaluated quality of the included studies.Meta-analysis was performed using RevMan 5.2.Results 10 studies with 1 262 patients were included.The results of meta-analysis showed that compared with conventional intervention,remote intervention based on digital health technology could improve self-monitoring compliance of lung transplant patients[0R=0.64,95％CI(0.46,0.88),P=0.006],improve quality of life including mental health status[OR=3.08,95％CI(0.41,5.74),P=0.020]and physical health status[OR=3.81,95％CI(1.19,6.43),P=0.004].In terms of the intervention forms,the application-based remote intervention had better self-monitoring compliance,and the difference was statistically significant(P=0.007).However,in terms of the comparison of readmission rate[OR=1.73,95％CI(0.98,3.04),P=0.060],anxiety[OR=-0.12,95％CI(-1.36,1.11),P=0.850],and depression[OR=0.62,95％CI(-0.80,2.03),P=0.390],the effect of intervention was unclear.Conclusion Remote intervention based on digital health technology can improve self-monitoring compliance and quality of life in lung transplant patients;applications are the optimal form of intervention.Limited by the quality and quantity of included studies and the heterogeneity of study results,more high-quality studies are needed to further verify the effects of digital health technology on readmission rates,anxiety and depression of lung transplant patients.

Objective To investigate the incidence and risk factors of post-transplant diabetes mellitus(PTDM)in adult lung transplant recipients.Methods Conducting a convenience sampling method,we retrospectively analyzed the clinical data of lung transplant recipients from January 2020 to December 2022 at a tertiary A hospital in Hangzhou,Zhejiang Province.According to the PTDM diagnostic criteria,lung transplant recipients are divided into a PTDM group and a non-PTDM group.The incidence rate of PTDM is calculated,and the influencing factors for PTDM occurrence are analyzed using both univariate and multivariate logistic regression methods.Results A total of 140 patients were included in this study,and 54 lung transplant recipients developed PTDM within 6 months,with an incidence of 38.57％.Univariate analysis showed that there were significant differences in age,gender,BMI,smoking history,pre-operative glycated albumin,pre-operative fasting blood glucose,early post-operative blood glucose and pre-operative creatinine between the 2 groups(P＜0.05).Multivariate Logistic analysis showed that gender(OR=5.283),BMI(OR=6.122),pre-operative glycated albumin(OR=1.330),and early post-operative blood glucose(0R=1.444)were the influencing factors.Conclusion Lung transplant recipients who were male,BMI &ge;24.0,with high levels of glycated albumin before surgery,and high blood sugar early after surgery had a higher risk of developing PTDM.Clinical nurses can formulate relevant nursing measures according to the influencing factors to prevent the occurrence of PTDM.

Objective:This study aimed to analyze differential metabolites in patients using a dual metabolic platform and to orientate early nutritional intervention in patients with cirrhosis.Methods:The skeletal muscle index (SMI) was calculated based on computed tomography (CT) measurements of skeletal muscle cross-sectional area at the third lumbar vertebra level. Pre-sarcopenia was diagnosed for males with SMI < 46.96 and for females with SMI < 32.46. Fifteen HBV-related liver cirrhosis patients with pre-sarcopenia were included as Group S while fourteen liver cirrhosis without pre-sarcopenia were Group NS. Liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) analyses were used to detect differential metabolites and disturbed pathways in the two groups.Results:Five pathways and twenty-eight pathways were defined as disturbed pathways in the plasma of liver cirrhosis patients with pre-sarcopenia by LC-MS and GC-MS, respectively. Most of these pathways are related to amino acid metabolism. Forty-two differential metabolites were imported into the disturbed pathways. Moreover, 3-hydroxypropanal, hydrocinnamic acid, betaine aldehyde, phosphohydroxypyruvic acid, (r)-3-hydroxybutyric acid, and creatinine were identified as potential biomarkers for pre-sarcopenia in HBV-related liver cirrhosis.Conclusions:The study identified a total of 33 pathways and related differential metabolites that were disturbed in HBV-related liver cirrhosis with pre-sarcopenia. The amino acid metabolism, urea cycle, and glyoxylate and dicarboxylate metabolism pathways may be associated with pre-sarcopenia in patients with HBV-related liver cirrhosis. These results provide a direction for nutritional supplementation in liver cirrhosis.