Objective:To explore the effects of esketamine combined with ultrasound-guided pectoral nerve block (PECS) on postoperative analgesia, fatigue and immune function in patients with breast cancer.Methods:A total of 80 female patients who underwent selective radical mastectomy in the Department of Anesthesiology, Yan’an People’s Hospital from Jan. 2019 to Jan. 2024 were chosen and separated into the observation group (n=40, esketamine + PECS) and the control group ( n=40, PECS) by random number table method. The analgesic effect [visual analogue scale (VAS) ], degree of sedation (Ramsay score) , immune function (CD3+, CD4+, CD8+) , fatigue [cancer fatigue scale (CFS) ] and cognitive function [mini mental state evaluation (MMSE) ] of the two groups were compared at different times. Results:VAS scores between two groups, at different time points and interaction had statistically significant differences ( Finter-group, time, interaction=0.52, 43.65, 0.83, P<0.05) ; Ramsay score between groups at different time points showed statistically significant differences ( Ftime=1.77, P<0.05) , but the comparison between groups and interaction did not ( Finter-group, interaction=0.47, 0.03, P>0.05) ; There were statistically significant differences in the intergroup, time point and interaction of CD3+ and CD4+ between the two groups, and in the time point and interaction of CD8+ ( Finter-group, time, interaction=33.35, 6.49, 12.76, 22.55, 8.37, 7.25, Ftime, interaction=6.94, 3.74, P<0.05) , while no statistically significant differences in the intergroup of CD8+ ( Finter-group = 0.48, P>0.05) ; At 12h (T 3) after surgery, the observation group had significantly lower CFS scores than before surgery (T 0) and the other group ( t=4.34、2.71、3.51、3.43、3.59、5.66, P<0.05) ; The comparison of MMSE scores between groups, at different time points and interaction showed statistically significant differences ( Finter-group, time, interaction = 42.86, 27.37, 19.85, P<0.05) . Conclusion:Esketamine combined with PECS has a good effect in breast cancer patients, which can reduce postoperative pain and fatigue, and has less effect on postoperative cognitive function.

Objective:To explore the effects of esketamine combined with ultrasound-guided pectoral nerve block (PECS) on postoperative analgesia, fatigue and immune function in patients with breast cancer.Methods:A total of 80 female patients who underwent selective radical mastectomy in the Department of Anesthesiology, Yan’an People’s Hospital from Jan. 2019 to Jan. 2024 were chosen and separated into the observation group (n=40, esketamine + PECS) and the control group ( n=40, PECS) by random number table method. The analgesic effect [visual analogue scale (VAS) ], degree of sedation (Ramsay score) , immune function (CD3+, CD4+, CD8+) , fatigue [cancer fatigue scale (CFS) ] and cognitive function [mini mental state evaluation (MMSE) ] of the two groups were compared at different times. Results:VAS scores between two groups, at different time points and interaction had statistically significant differences ( Finter-group, time, interaction=0.52, 43.65, 0.83, P<0.05) ; Ramsay score between groups at different time points showed statistically significant differences ( Ftime=1.77, P<0.05) , but the comparison between groups and interaction did not ( Finter-group, interaction=0.47, 0.03, P>0.05) ; There were statistically significant differences in the intergroup, time point and interaction of CD3+ and CD4+ between the two groups, and in the time point and interaction of CD8+ ( Finter-group, time, interaction=33.35, 6.49, 12.76, 22.55, 8.37, 7.25, Ftime, interaction=6.94, 3.74, P<0.05) , while no statistically significant differences in the intergroup of CD8+ ( Finter-group = 0.48, P>0.05) ; At 12h (T 3) after surgery, the observation group had significantly lower CFS scores than before surgery (T 0) and the other group ( t=4.34、2.71、3.51、3.43、3.59、5.66, P<0.05) ; The comparison of MMSE scores between groups, at different time points and interaction showed statistically significant differences ( Finter-group, time, interaction = 42.86, 27.37, 19.85, P<0.05) . Conclusion:Esketamine combined with PECS has a good effect in breast cancer patients, which can reduce postoperative pain and fatigue, and has less effect on postoperative cognitive function.

Objective To investigate the mechanism of Yiqi Huoxue Huazhuo Jiedu Prescription in regulating the endoplasmic reticulum stress PERK/ATF4 signaling pathway to improve cerebral ischemia reperfusion injury in rats.Methods A total of 48 male SD rats were randomly divided into sham-operation group,model group,TCM group and edaravone group,with 12 rats in each group.Cerebral ischemia reperfusion injury rat model was prepared using middle cerebral artery occlusion method,and administration 24 hours after modeling.The edaravone group was given intraperitoneal injection of 1.4 mg/mL edaravone injection,TCM group was given 55 g/(kg·d)of Yiqi Huoxue Huazhuo Jiedu Prescription for gavage,while the sham-operation group and model group were given equal volumes of normal saline for gavage,twice a day for 3 consecutive days.The neurological deficit scores of the rats in each group were observed,TTC staining was used to detect the volume of cerebral infarction,HE staining was used to observe the morphology of brain tissue in the ischemia-reperfusion area,immunohistochemistry staining was used to detect the positive expressions of glucose regulated protein 78(GRP78),protein kinase R-like endoplasmic reticulum kinase(PERK)and transcription activator factor(ATF)4 in the ischemia-reperfusion area brain tissue,RT-PCR was used to detect the mRNA expressions of GRP78,PERK and ATF4 in the ischemia-reperfusion area brain tissue,Western blot was used to detect the protein expressions of GRP78,PERK and ATF4 in the ischemia-reperfusion area brain tissue.Results Compared with the sham-operation group,the neurological deficit score of the model group rats increased,the volume of cerebral infarction increased,the number of neurons in the ischemia-reperfusion area decreased,the arrangement was loose,and the nuclei were condensed,the mRNA and protein expressions of GRP78,PERK and ATF4 increased,with statistical significance(P<0.05).Compared with the model group,the neurological deficit score of TCM group and edaravone group decreased,the cerebral infarction volume decreased,the number and arrangement of neurons of the brain tissue in the ischemia reperfusion area increased,and nuclear condensation decreased in rats,the mRNA and protein expressions of GRP78,PERK and ATF4 were all reduced,with statistical significance(P<0.05).There was no statistical significance in various indicators between TCM group and the edaravone group(P>0.05).Conclusion Yiqi Huoxue Huazhuo Jiedu Prescription can improve cerebral ischemia reperfusion injury,and its mechanism may be related to down-regulating the expression of PERK/ATF4 signaling pathway and alleviating endoplasmic reticulum stress.

Objective To investigate the mechanism of Yiqi Huoxue Huazhuo Jiedu Prescription in regulating the endoplasmic reticulum stress PERK/ATF4 signaling pathway to improve cerebral ischemia reperfusion injury in rats.Methods A total of 48 male SD rats were randomly divided into sham-operation group,model group,TCM group and edaravone group,with 12 rats in each group.Cerebral ischemia reperfusion injury rat model was prepared using middle cerebral artery occlusion method,and administration 24 hours after modeling.The edaravone group was given intraperitoneal injection of 1.4 mg/mL edaravone injection,TCM group was given 55 g/(kg·d)of Yiqi Huoxue Huazhuo Jiedu Prescription for gavage,while the sham-operation group and model group were given equal volumes of normal saline for gavage,twice a day for 3 consecutive days.The neurological deficit scores of the rats in each group were observed,TTC staining was used to detect the volume of cerebral infarction,HE staining was used to observe the morphology of brain tissue in the ischemia-reperfusion area,immunohistochemistry staining was used to detect the positive expressions of glucose regulated protein 78(GRP78),protein kinase R-like endoplasmic reticulum kinase(PERK)and transcription activator factor(ATF)4 in the ischemia-reperfusion area brain tissue,RT-PCR was used to detect the mRNA expressions of GRP78,PERK and ATF4 in the ischemia-reperfusion area brain tissue,Western blot was used to detect the protein expressions of GRP78,PERK and ATF4 in the ischemia-reperfusion area brain tissue.Results Compared with the sham-operation group,the neurological deficit score of the model group rats increased,the volume of cerebral infarction increased,the number of neurons in the ischemia-reperfusion area decreased,the arrangement was loose,and the nuclei were condensed,the mRNA and protein expressions of GRP78,PERK and ATF4 increased,with statistical significance(P<0.05).Compared with the model group,the neurological deficit score of TCM group and edaravone group decreased,the cerebral infarction volume decreased,the number and arrangement of neurons of the brain tissue in the ischemia reperfusion area increased,and nuclear condensation decreased in rats,the mRNA and protein expressions of GRP78,PERK and ATF4 were all reduced,with statistical significance(P<0.05).There was no statistical significance in various indicators between TCM group and the edaravone group(P>0.05).Conclusion Yiqi Huoxue Huazhuo Jiedu Prescription can improve cerebral ischemia reperfusion injury,and its mechanism may be related to down-regulating the expression of PERK/ATF4 signaling pathway and alleviating endoplasmic reticulum stress.

Objective:To explore the diagnosis and treatment of intestinal endometriosis.Methods:The clinical data of 12 patients with intestinal endometriosis at the First Affiliated Hospital of Soochow University from Aug 2016 to Jan 2023 were retrospectively analyzed.Results:There were 8 cases of rectal endometriosis, 3 cases of sigmoid colon endometriosis and 1 case of ileal endometriosis. Nine cases underwent colonoscopy, 6 cases underwent CT examination, 3 cases underwent MRI examination, and 4 cases underwent transabdominal or vaginal ultrasnography. All 12 cases underwent operation, 8 cases were misdiagnosed as colorectal neoplasms and underwent intestinal resection, 1 case had right hemicolectomy because of ambiguous pathology, 2 cases with definite intestinal endometriosis underwent local intestinal resection, 1 case had transanal tumor excision with diagnosis confirmed by postoperative pathology; 5 cases underwent open surgery, 5 cases did laparoscopy, 1 case was done with robotic surgery, 1 case was by transanal surgery; 7 patients underwent more than 2 surgeries, with a maximal of 5 surgeries in one case. The hospital stay varied from 9 to 351 days, all 12 cases were cured, and follow-up found no recurrence.Conclusions:It is often difficult to make a clear diagnosis of intestinal endometriosis preoperatively.Many were misdiagnosed as colorectal neoplasms.Laparascopic exploration and biopsy help prevent inappropriate surgery.

Objective To study effects ofXiangsha Liujunzi Decoction (XSLJZ) on gastric emptying function, pepsin activity and expression of HIF-1α gene and protein of gastric mucosa in chronic atrophic gastritis (CAG) of rats with deficiency of spleen and stomach.Methods Rats were randomly divided into normal group and model group. The models of CAG rats with deficiency of spleen and stomach type were induced by synthetic methods. After the modeling, models rats were divided into model group, positive control group and XSLJZ high-, medium-, and low-dose groups. Normal group and model group were given 10 mL/kg distilled water every day for gavage; XSLJZ high-, medium-, and low-dose groups were given 24, 12, and 6 g/kg XSLJZ Decoction for gavage; positive control group was given 0.30 g/kg Vatacoenayme for gavage, for successive 120 d. Gastric emptying function and pepsin activity were detected, and HIF-1α gene and protein expression in gastric mucosa were detected by RT-qPCR and IHC. Results Compared with the normal group, the gastric emptying function and pepsin activity in the model group were much lower (P<0.01); expressions of HIF-1α gene and protein in gastric tissues was much higher (P<0.01). Compared with model group, XSLJZ could increase the gastric emptying function and pepsin activity significantly (P<0.05), and decrease expressions of HIF-1α gene and protein (P<0.05).Conclusion XSLJZ has functions of improving the gastric emptying function, promoting pepsin activity, and reducing expressions of HIF-1α gene and protein.

Objective This study was designed to evaluate the safety ,tolerability and efficacy of intravenous caspofungin for treatment of invasive candidiasis and esophageal candidiasis in Chinese adults .Methods This was a non-controlled ,multicenter ,candidiasis .All the 63 patients were included in the safety set (SS) and the full analysis set (FAS) .In the SS ,19 SAEs occurred in 14 patients .All these SAEs were unrelated to caspofungin .There were 73 caspofungin-related non-serious AEs in 31 patients (49 .2% ) .Five patients (7 .9% ) had both clinical AEs and laboratory abnormalities .Eight patients (12 .7% ) had clinical AEs (mainly rashes) ,and 27 patients (42 .9% ) had laboratory abnormalities ,mainly increases in liver enzymes alanine transaminase and aspartate transaminase and reduction in blood potassium .About 91 .7% of the clinical AEs were mild to moderate .Treatment was discontinued in 1 patient (1 .6% ,1/63) due to AEs .The overall efficacy was 58 .1% (36/62) in the FAS and 70 .0% (35/70) in the per-protocol set (PPS) .In the FAS ,the therapeutic efficacy was 57 .6% (34/59) for invasive candidiasis and 66 .7% (2/3) for esophageal candidiasis .In the PPS , the therapeutic efficacy was 68 .8% (33/48 ) for invasive candidiasis and 100% (3/3 ) for esophageal candidiasis .Conclusions The AEs of caspofungin were mostly mild to moderate in the treatment of invasive candidiasis and esophageal candidiasis in Chinese adults .Only one patient terminated therapy due to drug-related AE .Caspofungin is safe and effective for the treatment of invasive candidiasis and esophageal candidiasis in Chinese adults .

ObjectiveTo determine the ability of biofilm formation of Staphylococcus epidermidis isolates and study the influence of different extracellular DNA(eDNA) levels in S.epidermidis isolates on the ability of biofilm formation.MethodsDetect the biofilm-formation ability of 227 S.epidermidis isolates with adhesion assays,amplify the icaA gene fragment with PCR.The S.epidermidis isolates were divided into biofilm formation(BF) group and non-biofilm formation (NBF) group according to adhesion assays and icaA amplification.Detect eDNA levels of S.epidermidis in planktonic culture and microtitre plate static culture.The eDNA in S.epidermidis biofilms stained by AO-PI was observed by CLSM.Results26 isolates were positive in adhesion assays and 32 isolates existed icaA gene among 227 S.epidermidis isolates.Select 20 isolates with positive adhesion assays and positive icaA amplification for BF group.Select 19 isolates with negative adhesion assays and negative icaA amplification for NBF group.The eDNA levels were (32.2±10.1)μg/ml,(33.6±11.9) μg/ml,(34.3±10.0) μg/ml in BF group when cultured in planktonic condition for 2,4,6 h,while the eDNA levels in NBF group were (28.7±8.9) μg/ml,(31.5±11.7) μg/ml,(31.8±12.7) μg/ml respectively.There were no significant differences between the two groups for these three phases(P＞0.05),though the eDNA levels of BF group were higher than that of NBF group.The eDNA levels were (740.0±264.4) ng/A600 in BF group when cultured in static microtitre plate,higher than that of NBF group,(80.1 ±31.1) ng/A600,and the difference between these two groups was significant.The eDNA in BF isolate Y36 biofilms could be visualized by staining with AO and PI when observed by CLSM,while neither biofilm structure nor eDNA appeard when NBF isolate Y26 was cultured for 24 h.ConclusionS.epidermidis isolates have the ability of biofilm formation.eDNA is one of the important matrix components in the S.epidermidis biofilm-forming process.The eDNA of static culture in microtitre plate was more efficient than planktonic culture in the case of estimating the ability of biofilm formation of S.epidermidis.

Objective To study the expression of active efflux pump AdeABC,AdeIJK,AdeFGH,AbeM,AbeS,CraA,MdtL in clinical Acinetobacter baumannii isolates and whether the efflux pumps confers resistance to antibiotics.Methods Thirty-two multi-drug resistant Acinetobacter baumannii islates and 10 sensitive isolates were collected.Genes of the exporter protein were amplified by PCR.The expression of adeB,adeJ,adeG,abeM,abeS,craA,mdtL were examined by real-time fluorescence quantitative RT-PCR.The controlling genes adeRS and adeL were amplified by PCR and sequenced.Results The positivity rates of adeB,adeJ,adeG,abeM,abeS,craA,mdtL were 100％,100％,100％,96.88％,100％,100％ and 93.75％ respectively in 32 multi-drug resistant Acinetobacter baumannii isolates,and all 100％ in 10 sensitive isolates.The difference of expression of adeB,abeM and mdtL were significant( P＜0.001,P =0.001,P=0.013) between 21 multi-drug resistant isolates of C clone and 10 sensitive isolates.The mutations of adeRS existed in 2 multi-drug resistant isolates,no point mutation of adeL.Conclusion The expression of AdeABC,AbeM and MdtL may involved in the resistant mechanisms of the clinical Acinetobacter baumannii islates.

Objective To investigate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in critically ill patients complicated with sepsis. Methods Fifty-six cases of systemic inflammatory response syndrome (SIRS) who admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University between May 2009 and June 2010 were recruited. The SIRS patients were divided into two groups: sepsis group (n= 32) and non-sepsis group (n= 24). The levels of procalcitonin (PCT), C-reactive protein (CRP) were measured within 24 hours of hospitalization.Levels of sTREM-1 were measured by enzyme linked immunoabsorbant assay (ELISA). Based on the receiver operating characteristic curve (ROC), cut-off value, sensitivity and specificity of sTREM-1 in diagnosis of sepsis were calculated. Comparison between groups was done by t test and Mann-Whitney U test. Count data were compared by chi square test. ResultsThe serum level of sTREM-1 were significantly higher in sepsis group than that in non-sepsis group (250.9 ng/L vs 103.6 ng/L, Z= 12. 864,P=0. 002). Areas under the curve (AUC) of sTREM-1, PCT and CRP were 0. 935, 0. 891 and 0. 602, respectively. With a cut-off value of 135.0 ng/L, the sensitivity and specificity of sTREM-1 in diagnosing sepsis were 93. 8％ and 84. 7％, respectively. With a cut-off value of 2. 0 μg/L, the sensitivity and specificity of PCT were 84. 4％and 87. 8％, respectively.ConclusionSerum level of sTREM-1 could be used as an early indicator for diagnosing sepsis.