Objective To investigate the effect of the use of glycopyrrolate before anesthesia on the perioperative circulation of patients undergoing laparoscopic cholecystectomy(LC).Methods 88 patients undergoing LC from March to June in 2024 were enrolled and randomly divided into two groups:the glycopyrrolate group(group G)and the control group(group C),with 44 patients in each.Three patients from group G and four from group C were excluded,leaving 41 patients in group G and 40 patients in group C.Ten minutes before anesthesia induction,group G received an intravenous dose of 4 μg/kg glycopyrrolate diluted to 5 mL with normal saline.The control group received an equal volume of normal saline.Both groups then received an intravenous infusion of dexmedetomidine at 1 μg/kg over 10 minutes.Heart rate(HR)and mean arterial pressure(MAP)were monitored immediately before infusion of glycopyrrolate/saline(T0),5 min after infusion(T1),10 min after infusion(T2),1 min after tracheal intubation(T3),immediately at skin incision(T4),2 min after pneumoperitoneum(T5),dissociating the cholecyst(T6),and 1 min after tracheal tube drawing(T7).Intraoperative amounts of propofol,rocuronium bromide,sufentanil,remifentanil,oral secretion score,PACU stay time,first postoperative flatus time and the occurrence of perioperative adverse reactions were observed.Results HR at T2,T3,T4,T5,and T6 time points was significantly higher in group G than in group C,while MAP at T1,T2,T3,T4,T5 time points was also significantly higher in group G(P<0.05).HR at T2 time points in Group G was significantly lower than that at T0,while T7 was significantly higher than that at T0 time points.In Group C,HR at T1,T2,T4,T5,and T6 time points was significantly lower than that at T0 time points,while T7 time points was significantly higher than that at T0 time points,with the differences being statistically significant(P<0.05).In Group G,MAP at T1 and T2 time pointswas significantly higher than that at T0,and MAP at T6 was significantly lower than that at T0 time points,and in Group C,MAP at T4,T5 and T6 time points was significantly lower than that at T0 time points,and the differences were all statistically significant(P<0.05);Oral secretion was lower in group G compared to group C,with a significant difference(P<0.05).The incidence of bradycardia was significantly lower in group G compared to group C(P<0.05).The incidence of oral dryness within 24 h postoperatively was higher in group G compared to group C(P<0.05).There were no significant differences of HR at T0,T1,and T7 time points,MAP at T0,T6,and T7 time points between the two groups(P>0.05);There were no significant differences of operation time,propofol usage,sufentanil usage,remifentanil usage,rocuronium bromide usage during operation,rate of atropine use,incidence of intraoperative hypotension,PACU stay time,first postoperative flatus,and nausea vomiting rate between the two groups(P>0.05);No delirium occurred in either group of patients 24 h after the operation.Conclusion Use of glycopyrrolate before anesthesia can be effectively applied to patients undergoing LC,is beneficial in reducing the incidence of bradycardia,maintaining the stability of intraoperative circulation,and has no significant effect on the incidence of postoperative delirium and nausea and vomiting.It is a worthy clinical application.

Objective:To investigate the clinical and pathological characteristics of primary thoracic synovial sarcoma (PTSS).Methods:Forty-two PTSS cases diagnosed at the Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from October 2011 to April 2024 were analyzed. All cases were retrospectively studied using hematoxylin-eosin staining and immunohistochemistry. Their clinicopathological features were also reviewed. SS18 rearrangement was assessed in 28 cases using fluorescence in situ hybridization (FISH). Next generation sequencing (NGS) was performed on 8 cases.Results:Among the 42 cases, there were 23 biopsies and 19 surgically-removed specimens. One case was a specimen resected after neoadjuvant chemotherapy. There were 22 males and 20 females, with an age ranging from 6 to 68 years. Twenty-nine cases occured in the lung, 6 in mediastinum, 4 in pericardium, 1 in visceral pleura, and 1 in right atrium. One case did not show any unequivocal primary site. Computed tomography showed the tumors were manifested as a cystic mass, a solid mass, or thickening of the pleura and pericardium. Thirty-two cases had respiratory symptoms, while 19 had pleural effusion. One case had a history of radiotherapy for papillary thyroid carcinoma. Nineteen patients were treated with surgery, while 19 were treated with chemotherapy without surgery. Four patients were diagnosed and discharged, without specific treatment on the record. Morphologically, 1 case was biphasic type, 39 cases were monophasic type, and 2 cases were poorly differentiated type. In addition to the typical morphology of synovial sarcoma, tumors also showed pulmonary bullous changes, stromal collagen hyalinization, hemangiopericytoma-like vasculature, stromal edematous myxoid changes, and microcystic structure. Immunohistochemically, all cases were diffusely positive for TRPS1 (22/22), TLE1 (21/22), CD99 (26/26), SS18-SSX (25/25) and INI1 (12/12), including 3 cases with decreased expression of INI1. Twenty-one cases were focally positive for EMA (21/30), 4 cases for SMA (4/23), 2 cases for S-100 (2/28), and 2 cases (2/35) for CKpan. Twenty-eight cases (28/28) had SS18 rearrangement displaying a split signal on FISH analysis. Eight cases were found to have mutations in SMC1A, NOTCH2, CDK12, SPRY4, BRCA1, STK11, NF2, and PDGFRα genes using NGS. Eighteen of the 29 patients survived and 16 showed disease progression.Conclusions:PTSS is more commonly found in the lungs than other sites and has non-classical morphological features of various types, which need to be differentiated from other tumors. TRPS1 is highly expressed in PTSS and has certain diagnostic values. The diagnosis of PTSS also requires combination of patient′s medical history with thorough imaging studies.

Objective:To investigate the clinical and pathological characteristics of primary thoracic synovial sarcoma (PTSS).Methods:Forty-two PTSS cases diagnosed at the Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from October 2011 to April 2024 were analyzed. All cases were retrospectively studied using hematoxylin-eosin staining and immunohistochemistry. Their clinicopathological features were also reviewed. SS18 rearrangement was assessed in 28 cases using fluorescence in situ hybridization (FISH). Next generation sequencing (NGS) was performed on 8 cases.Results:Among the 42 cases, there were 23 biopsies and 19 surgically-removed specimens. One case was a specimen resected after neoadjuvant chemotherapy. There were 22 males and 20 females, with an age ranging from 6 to 68 years. Twenty-nine cases occured in the lung, 6 in mediastinum, 4 in pericardium, 1 in visceral pleura, and 1 in right atrium. One case did not show any unequivocal primary site. Computed tomography showed the tumors were manifested as a cystic mass, a solid mass, or thickening of the pleura and pericardium. Thirty-two cases had respiratory symptoms, while 19 had pleural effusion. One case had a history of radiotherapy for papillary thyroid carcinoma. Nineteen patients were treated with surgery, while 19 were treated with chemotherapy without surgery. Four patients were diagnosed and discharged, without specific treatment on the record. Morphologically, 1 case was biphasic type, 39 cases were monophasic type, and 2 cases were poorly differentiated type. In addition to the typical morphology of synovial sarcoma, tumors also showed pulmonary bullous changes, stromal collagen hyalinization, hemangiopericytoma-like vasculature, stromal edematous myxoid changes, and microcystic structure. Immunohistochemically, all cases were diffusely positive for TRPS1 (22/22), TLE1 (21/22), CD99 (26/26), SS18-SSX (25/25) and INI1 (12/12), including 3 cases with decreased expression of INI1. Twenty-one cases were focally positive for EMA (21/30), 4 cases for SMA (4/23), 2 cases for S-100 (2/28), and 2 cases (2/35) for CKpan. Twenty-eight cases (28/28) had SS18 rearrangement displaying a split signal on FISH analysis. Eight cases were found to have mutations in SMC1A, NOTCH2, CDK12, SPRY4, BRCA1, STK11, NF2, and PDGFRα genes using NGS. Eighteen of the 29 patients survived and 16 showed disease progression.Conclusions:PTSS is more commonly found in the lungs than other sites and has non-classical morphological features of various types, which need to be differentiated from other tumors. TRPS1 is highly expressed in PTSS and has certain diagnostic values. The diagnosis of PTSS also requires combination of patient′s medical history with thorough imaging studies.

Objective To investigate the effect of the use of glycopyrrolate before anesthesia on the perioperative circulation of patients undergoing laparoscopic cholecystectomy(LC).Methods 88 patients undergoing LC from March to June in 2024 were enrolled and randomly divided into two groups:the glycopyrrolate group(group G)and the control group(group C),with 44 patients in each.Three patients from group G and four from group C were excluded,leaving 41 patients in group G and 40 patients in group C.Ten minutes before anesthesia induction,group G received an intravenous dose of 4 μg/kg glycopyrrolate diluted to 5 mL with normal saline.The control group received an equal volume of normal saline.Both groups then received an intravenous infusion of dexmedetomidine at 1 μg/kg over 10 minutes.Heart rate(HR)and mean arterial pressure(MAP)were monitored immediately before infusion of glycopyrrolate/saline(T0),5 min after infusion(T1),10 min after infusion(T2),1 min after tracheal intubation(T3),immediately at skin incision(T4),2 min after pneumoperitoneum(T5),dissociating the cholecyst(T6),and 1 min after tracheal tube drawing(T7).Intraoperative amounts of propofol,rocuronium bromide,sufentanil,remifentanil,oral secretion score,PACU stay time,first postoperative flatus time and the occurrence of perioperative adverse reactions were observed.Results HR at T2,T3,T4,T5,and T6 time points was significantly higher in group G than in group C,while MAP at T1,T2,T3,T4,T5 time points was also significantly higher in group G(P<0.05).HR at T2 time points in Group G was significantly lower than that at T0,while T7 was significantly higher than that at T0 time points.In Group C,HR at T1,T2,T4,T5,and T6 time points was significantly lower than that at T0 time points,while T7 time points was significantly higher than that at T0 time points,with the differences being statistically significant(P<0.05).In Group G,MAP at T1 and T2 time pointswas significantly higher than that at T0,and MAP at T6 was significantly lower than that at T0 time points,and in Group C,MAP at T4,T5 and T6 time points was significantly lower than that at T0 time points,and the differences were all statistically significant(P<0.05);Oral secretion was lower in group G compared to group C,with a significant difference(P<0.05).The incidence of bradycardia was significantly lower in group G compared to group C(P<0.05).The incidence of oral dryness within 24 h postoperatively was higher in group G compared to group C(P<0.05).There were no significant differences of HR at T0,T1,and T7 time points,MAP at T0,T6,and T7 time points between the two groups(P>0.05);There were no significant differences of operation time,propofol usage,sufentanil usage,remifentanil usage,rocuronium bromide usage during operation,rate of atropine use,incidence of intraoperative hypotension,PACU stay time,first postoperative flatus,and nausea vomiting rate between the two groups(P>0.05);No delirium occurred in either group of patients 24 h after the operation.Conclusion Use of glycopyrrolate before anesthesia can be effectively applied to patients undergoing LC,is beneficial in reducing the incidence of bradycardia,maintaining the stability of intraoperative circulation,and has no significant effect on the incidence of postoperative delirium and nausea and vomiting.It is a worthy clinical application.

The nursing experience of buttonhole cannulation for an autogenous arteriovenous fistula with an Eluvia drug-eluting stent in a patient undergoing maintenance hemodialysis was summarized.Key nursing points included:developing a scientific and rational buttonhole cannulation plan for the autogenous arteriovenous fistula stent based on its characteristics post-stent implantation;conducting preoperative ultrasonic evaluations of the arteriovenous fistula and stent;establishing and maintaining a buttonhole tunnel at the stent site;regularly monitoring and following up on the cannulation site and the condition of the autogenous arteriovenous fistula;strengthening the observation and prevention of potential complications.Through rigorous and standardized assessments,procedures,and nursing care,the patient maintained good autogenous arteriovenous fistula function without stent-related complications such as fracture,stenosis,or infection over a 14-month follow-up period.

[Objective]To explore the effect of Xuefu Zhuyu Decoction on pulmonary vascular remodeling in hypoxic pulmonary hypertension(HPH)through regulating long non-coding RNA metastasis-related lung adenocarcinoma transcript 1(lncRNA MALAT1),and further verify the specific molecular mechanism.[Methods]The HPH model of rat was established by using a low-pressure hypoxia method,and intragastric administration of Xuefu Zhuyu Decoction was performed at doses of 4.5 g/(kg·d)and 8.75 g/(kg·d).The model construction was evaluated by rat right ventricular systolic pressure and Fulton index,and then the pulmonary artery vascular remodeling was observed by hematoxylin-eosin(HE)staining and immunohistochemistry.The drug-containing serum of rats was prepared,and pulmonary artery smooth muscle cells(PASMCs)of rat were extracted.The cell model was then established under hypoxic conditions.PASMCs activity and migration capacity were detected by cell counting kit-8(CCK-8)and Transwell respectively.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect the expression of lncRNA MALAT1 and serine/arginine-rich splicing factor 1(SRSF1).Western blot was employed to analyze the expression of related proteins in cells and tissues.[Results]Compared with model group,the right ventricular systolic blood pressure and ventricular hypertrophy in Xuefu Zhuyu Decoction group were significantly relieved(P＜0.05),and the remodeling of pulmonary artery was alleviated.lncRNA MALAT1 was significantly overexpressed in the pulmonary artery tissues of rats in model group,and the downstream SRSF1/mammalian target of rapamycin complex 1(mTORC1)/eukaryotic translation initiation factor 4E-binding protein 1(4E-BP1)signaling axis was significantly activated.Compared with model group,the expressions of lncRNA MALAT1 and SRSF1/mTORC1/4E-BP1 signaling axis-related proteins in the pulmonary artery tissues of rats in Xuefu Zhuyu Decoction administrated group were significantly decreased(P＜0.05).In vitro,PASMCs treated with drug-containing serum of Xuefu Zhuyu Decoction exhibited significantly reduced proliferation(P＜0.05)and migration abilities,decreasing expression of lncRNA MALAT1(P＜0.05).Meanwhile,the expression of SRSF1/mTORC1/4E-BP1 signaling axis-related proteins was significantly decreased(P＜0.05).Furthermore,through the transfection with overexpression plasmids of lncRNA MALAT1 or SRSF1,the expression of lncRNA MALAT1 was increased(P＜0.05),the cell proliferation(P＜0.05)and migration abilities were recovered,and the expression of SRSF1/mTORC1/4E-BP1 signal axis-related proteins was increased(P＜0.05),indicating that the above inhibitory effects were significantly reversed.[Conclusion]Xuefu Zhuyu Decoction can alleviate HPH vascular remodeling by down-regulating lncRNA MALAT1 expression,and regulating SRSF1/mTORC1/4E-BP1 signaling axis.

The nursing experience of buttonhole cannulation for an autogenous arteriovenous fistula with an Eluvia drug-eluting stent in a patient undergoing maintenance hemodialysis was summarized.Key nursing points included:developing a scientific and rational buttonhole cannulation plan for the autogenous arteriovenous fistula stent based on its characteristics post-stent implantation;conducting preoperative ultrasonic evaluations of the arteriovenous fistula and stent;establishing and maintaining a buttonhole tunnel at the stent site;regularly monitoring and following up on the cannulation site and the condition of the autogenous arteriovenous fistula;strengthening the observation and prevention of potential complications.Through rigorous and standardized assessments,procedures,and nursing care,the patient maintained good autogenous arteriovenous fistula function without stent-related complications such as fracture,stenosis,or infection over a 14-month follow-up period.

[Objective]To explore the effect of Xuefu Zhuyu Decoction on pulmonary vascular remodeling in hypoxic pulmonary hypertension(HPH)through regulating long non-coding RNA metastasis-related lung adenocarcinoma transcript 1(lncRNA MALAT1),and further verify the specific molecular mechanism.[Methods]The HPH model of rat was established by using a low-pressure hypoxia method,and intragastric administration of Xuefu Zhuyu Decoction was performed at doses of 4.5 g/(kg·d)and 8.75 g/(kg·d).The model construction was evaluated by rat right ventricular systolic pressure and Fulton index,and then the pulmonary artery vascular remodeling was observed by hematoxylin-eosin(HE)staining and immunohistochemistry.The drug-containing serum of rats was prepared,and pulmonary artery smooth muscle cells(PASMCs)of rat were extracted.The cell model was then established under hypoxic conditions.PASMCs activity and migration capacity were detected by cell counting kit-8(CCK-8)and Transwell respectively.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect the expression of lncRNA MALAT1 and serine/arginine-rich splicing factor 1(SRSF1).Western blot was employed to analyze the expression of related proteins in cells and tissues.[Results]Compared with model group,the right ventricular systolic blood pressure and ventricular hypertrophy in Xuefu Zhuyu Decoction group were significantly relieved(P＜0.05),and the remodeling of pulmonary artery was alleviated.lncRNA MALAT1 was significantly overexpressed in the pulmonary artery tissues of rats in model group,and the downstream SRSF1/mammalian target of rapamycin complex 1(mTORC1)/eukaryotic translation initiation factor 4E-binding protein 1(4E-BP1)signaling axis was significantly activated.Compared with model group,the expressions of lncRNA MALAT1 and SRSF1/mTORC1/4E-BP1 signaling axis-related proteins in the pulmonary artery tissues of rats in Xuefu Zhuyu Decoction administrated group were significantly decreased(P＜0.05).In vitro,PASMCs treated with drug-containing serum of Xuefu Zhuyu Decoction exhibited significantly reduced proliferation(P＜0.05)and migration abilities,decreasing expression of lncRNA MALAT1(P＜0.05).Meanwhile,the expression of SRSF1/mTORC1/4E-BP1 signaling axis-related proteins was significantly decreased(P＜0.05).Furthermore,through the transfection with overexpression plasmids of lncRNA MALAT1 or SRSF1,the expression of lncRNA MALAT1 was increased(P＜0.05),the cell proliferation(P＜0.05)and migration abilities were recovered,and the expression of SRSF1/mTORC1/4E-BP1 signal axis-related proteins was increased(P＜0.05),indicating that the above inhibitory effects were significantly reversed.[Conclusion]Xuefu Zhuyu Decoction can alleviate HPH vascular remodeling by down-regulating lncRNA MALAT1 expression,and regulating SRSF1/mTORC1/4E-BP1 signaling axis.

Objective:To investigate the efficacy and safety of chemotherapy combined with inetetamab and pyrotinib (triplet therapy group), and capecitabine combined with pyrotinib (doublet therapy group) in second-line treatment for HER2-positive metastatic breast cancer patients who have failed on trastuzumab.Methods:A retrospective analysis was conducted on 30 HER2-positive metastatic breast cancer patients who underwent second-line treatment with a regimen of chemotherapy plus inetetamab and pyrotinib at Fujian Provincial Tumor Hospital between Jan. 1, 2020 and Dec. 31, 2023, and on 28 HER2-positive metastatic breast cancer patients treated with capecitabine plus pyrotinib during the same period. The study analyzed the differences in ORR (objective response rate), CBR (clinical benefit rate), PFS (progression free survival), and OS (overall survival) between the two groups and documented any adverse reactions observed during treatment.Results:The three-drug group exhibited a higher ORR rate than the two-drug group (60.0% vs. 39.2%, P>0.05), and a higher CBR rate (83.3% vs. 57.1%, P<0.05). Univariate analysis and multivariate Logistic regression analysis showed that group (three drug group compared to two drug group) was the only independent prognostic factor affecting median PFS in patients ( P<0.05). The median PFS of the three drug group was higher than that of the two drug group (19 months vs. 11 months, P<0.05), but by the end of follow-up, neither group had reached the median OS ( P>0.05) .The three-drug group and the two-drug group demonstrated 1-year OS rates of 85% and 85%, 2-year OS rates of 74% and 63%, and 3-year OS rates of 56% and 52%, respectively. The most frequent hematological toxicities in the three-drug group were leukopenia, neutropenia, and anemia, with diarrhea being the most common non-hematological toxicity. No significant differences were observed in adverse reaction profiles between the two groups ( P>0.05) . Conclusion:In the second-line treatment of HER2 positive metastatic breast cancer, chemotherapy + inetetamab + pyrotinib significantly prolonged the median PFS and increased the CBR compared with the current domestic standard capecitabine + pyrotinib regimen, and did not increase the incidence of adverse reactions, demonstrating higher efficacy and safety.

Objective:To investigate the role and related mechanisms of the LiaSR two-component system in acid tolerance and biofilm formation abilities of Streptococcus mutans (Sm) 593. Methods:The growth curves of various Sm strains in pH=5.5 brian heart infusion (BHI) medium were analyzed. And colony forming unit (CFU) was also performed to evaluate the acid tolerance of Sm. Laurdan probe, H +-K +adenosine triphosphate (ATP)ase activity analysis kit, proton permeability assay and real-time fluorescence quantitative PCR (RT-qPCR) were conducted to detect the acid tolerant mechanisms of LiaSR two-component system in Sm. Crystal violet staining, CFU, SYTOX probe and anthrone-sulfuric method were used to analyze the properties and structures of the Sm biofilms. RT-qPCR was conducted to detect the expression levels of underlying regulated genes. Results:The growth of mutants in acidic BHI were inhibited ( P<0.05). The acid tolerance of mutants significantly decreased compared to the wild-type strain ( P<0.05). In mutants, the activity of H +-ATPase (917.06±59.53 and 469.53±47.65) were elevated by 7.22-folds and 3.70-folds compared to the wild-type strain (127.00±50.71) ( P<0.001, P<0.001) and the encoded gene atpD (3.39±0.21 and 1.94±0.17) were also elevated by 3.39-folds and 1.94-folds compared to the wild-type strain (1.00±0.15) ( P<0.001, P=0.001). The Laurdan generalized polarization of mutants (0.18±0.04 and 0.18±0.05) increased significantly compared to the wild-type strain (0.08±0.05) ( P=0.006, P=0.003) and the expression levels of fabM gene were decreased in mutants (0.52±0.11 and 0.57±0.05) by 1/2 ( P=0.014, P=0.022). In liaR deletion mutant, the reduced terminal pH (4.76±0.01) can also be observed ( P<0.001). The total amount of the biofilms of three Sm didn't show significant differences ( P>0.05). But the number of viable bacteria of mutants′ biofilms were decreased [Sm 593: (12.00±2.80)×10 7 CFU/ml; Sm ΔliaS: (2.95±1.13)×10 7 CFU/ml; Sm ΔliaR: (7.25±1.60)×10 7 CFU/ml] ( P=0.001, P=0.024). The extracellular DNA were increased by 18.00-folds and 6.50-folds in mutants′ biofilms (128.73±15.65 and 46.38±5.52) compared to the wild-type strain (7.16±3.62) ( P<0.001, P=0.003). Water-soluble exopolysaccharides could be found up-regulated in liaS deletion mutant [(138.73±10.12) μg/ml] ( P=0.003) along with the expression level of gtfC gene (1.65±0.39) ( P=0.014). The expression level of gtfD were elevated by 47.43-folds and 16.90-folds in mutants ( P<0.001, P=0.010). Conclusions:The LiaSR two-component system can promote the expression of fabM gene and increase the fluidity of Sm which contributes to acid tolerance. The LiaR can also decrease the proton permeability and restrict the entrance of H +. The LiaSR two-component system can negatively regulate the production of the extracellular matrix in Sm biofilm.