1.Biomechanical effect of alveolar bone graft resorption on the maxillary alveolar process in a patient with unilateral cleft lip and palate
WANG Xiaoyu ; WANG Hao ; LI Song
Journal of Prevention and Treatment for Stomatological Diseases 2025;33(2):120-128
Objective :
To investigate the biomechanical effect of alveolar bone graft (ABG) resorption on the maxillary alveolar process under occlusal force in a patient with unilateral cleft lip and palate (UCLP) and provide evidence for the clinical application of ABG.
Methods:
A 3D finite element maxillary model of an 11-year-old female patient with UCLP was generated. The occlusal force was applied to six models with different ABG resorption, namely non-resorption, upper 1/3 resorption, upper 2/3 resorption, lower 1/3 resorption, lower 2/3 resorption, and upper&lower 1/3 resorption. The properties of structures in all models were set to be linear, elastic, and isotropic. The displacement and Von Mises stress of each reference node of the alveolar process were compared and analyzed.
Results:
Under occlusal force, the most significant displacement of the alveolar process was located in the anterior area, and it decreased gradually from anterior area to both sides in all groups. The displacement values of the alveolar process under cleft side lateral occlusion were as follows: non-resorption group < lower 2/3 resorption group < upper&lower 1/3 resorption group < lower 1/3 resorption group < upper 2/3 resorption group < upper 1/3 resorption group. The displacement values of the alveolar process under centric occlusion were as follows: non-resorption group < lower 1/3 resorption group < upper&lower 1/3 resorption group < upper 2/3 resorption group < lower 2/3 resorption group < upper 1/3 resorption group. The displacement values of the alveolar process under non-cleft side lateral occlusion were as follows: non-resorption group < lower 1/3 resorption group < upper 1/3 resorption group < lower 2/3 resorption group < upper&lower 1/3 resorption group < upper 2/3 resorption group. The stress was concentrated on the premolar area on the functional side of the alveolar process, followed by the canine and molar areas in all groups. The stress values of the alveolar process under cleft side lateral occlusion were as follows: non-resorption group < lower 2/3 resorption group < upper&lower 1/3 resorption group < upper 2/3 resorption group < lower 1/3 resorption group < upper 1/3 resorption group. The stress values of the alveolar process under centric occlusion were as follows: non-resorption group < upper 1/3 resorption group < lower 1/3 resorption group < lower 2/3 resorption group < upper&lower 1/3 resorption group < upper 2/3 resorption group. The stress values of the alveolar process under non-cleft side lateral occlusion were as follows: non-resorption group < lower 2/3 resorption group < upper&lower 1/3 resorption group < lower 1/3 resorption group < upper 2/3 resorption group < upper 1/3 resorption group. Under occlusal force, the displacement and stress of the alveolar process in the non-resorption model were significantly lower than those in other models. The displacement and stress of the alveolar process in the models with resorption in the lower area of the ABG were significantly lower than those in the models with resorption in the upper-middle areas of the ABG.
Conclusion
After unilateral complete cleft lip and palate bone grafting, the integrity and continuity of the middle and upper parts of the alveolar process bone grafting play a key role in the biomechanical status of the alveolar process. If bone resorption occurs in the above parts, bone grafting should be considered.
2.Dynamics of eosinophil infiltration and microglia activation in brain tissues of mice infected with Angiostrongylus cantonensis
Fanna WEI ; Renjie ZHANG ; Yahong HU ; Xiaoyu QIN ; Yunhai GUO ; Xiaojin MO ; Yan LU ; Jiahui SUN ; Yan ZHOU ; Jiatian GUO ; Peng SONG ; Yanhong CHU ; Bin XU ; Ting ZHANG ; Yuchun CAI ; Muxin CHEN
Chinese Journal of Schistosomiasis Control 2025;37(2):163-175
Objective To investigate the changes in eosinophil counts and the activation of microglial cells in the brain tissues of mice at different stages of Angiostrongylus cantonensis infection, and to examine the role of microglia in regulating the progression of angiostrongyliasis and unravel the possible molecular mechanisms. Methods Fifty BALB/c mice were randomly divided into the control group and the 7-d, 14-d, 21-day and 25-d infection groups, of 10 mice in each group. All mice in infection groups were infected with 30 stage III A. cantonensis larvae by gavage, and animals in the control group was given an equal amount of physiological saline. Five mice were collected from each of infection groups on days 7, 14, 21 d and 25 d post-infection, and 5 mice were collected from the control group on the day of oral gavage. The general and focal functional impairment was scored using the Clark scoring method to assess the degree of mouse neurological impairment. Five mice from each of infection groups were sacrificed on days 7, 14, 21 d and 25 d post-infection, and 5 mice from the control group were sacrificed on the day of oral gavage. Mouse brain tissues were sampled, and the pathological changes of brain tissues were dynamically observed using hematoxylin and eosin (HE) staining. Immunofluorescence staining with eosinophilic cationic protein (ECP) and ionized calcium binding adaptor molecule 1 (Iba1) was used to assess the degree of eosinophil infiltration and the counts of microglial cells in mouse brain tissues in each group, and the morphological parameters of microglial cells (skeleton analysis and fractal analysis) were quantified by using Image J software to determine the morphological changes of microglial cells. In addition, the expression of M1 microglia markers Fcγ receptor III (Fcgr3), Fcγ receptor IIb (Fcgr2b) and CD86 antigen (Cd86), M2 microglia markers Arginase 1 (Arg1), macrophage mannose receptor C-type 1 (Mrc1), chitinase-like 3 (Chil3), and phagocytosis genes myeloid cell triggering receptor expressed on myeloid cells 2 (Trem2), CD68 antigen (Cd68), and apolipoprotein E (Apoe) was quantified using real-time quantitative reverse transcription PCR (RT-qPCR) assay in the mouse cerebral cortex of mice post-infection. Results A large number of A. cantonensis larvae were seen on the mouse meninges surface post-infection, and many neuronal nuclei were crumpled and deeply stained, with a large number of bleeding points in the meninges. The median Clark scores of mouse general functional impairment were 0 (interquartile range, 0), 0 (interquartile range, 0.5), 6 (interquartile range, 1.0), 14 (interquartile range, 8.5) points and 20 (interquartile range, 9.0) points in the control group and the 7-d, 14-d, 21-d and 25-d groups, respectively (H = 22.45, P < 0.01), and the median Clark scores of mouse focal functional impairment were 0 (interquartile range, 0), 2 (interquartile range, 2.5), 7 (interquartile range, 3.0), 18 (interquartile range, 5.0) points and 25 (interquartile range, 6.5) points in the control group and the 7-d, 14-d, 21-d and 25-d groups, respectively (H = 22.72, P < 0.01). The mean scores of mice general and focal functional impairment were all higher in the infection groups than in the control group (all P values < 0.05). Immunofluorescence staining showed a significant difference in the eosinophil counts in mouse brain tissues among the five groups (F = 40.05, P < 0.000 1), and the eosinophil counts were significantly higher in mouse brain tissues in the 14-d (3.08 ± 0.78) and 21-d infection groups (5.97 ± 1.37) than in the control group (1.00 ± 0.28) (both P values < 0.05). Semi-quantitative analysis of microglia immunofluorescence showed a significant difference in the counts of microglial cells among the five groups (F = 17.66, P < 0.000 1), and higher Iba1 levels were detected in mouse brain tissues in 14-d (5.75 ± 1.28), 21-d (6.23 ± 1.89) and 25-d infection groups (3.70 ± 1.30) than in the control group (1.00 ± 0.30) (all P values < 0.05). Skeleton and fractal analyses showed that the branch length [(162.04 ± 34.10) μm vs. (395.37 ± 64.11) μm; t = 5.566, P < 0.05] and fractal dimension of microglial cells (1.30 ± 0.01 vs. 1.41 ± 0.03; t = 5.266, P < 0.05) were reduced in mouse brain tissues in the 21-d infection group relative to the control group. In addition, there were significant differences among the 5 groups in terms of M1 and M2 microglia markers Fcgr3 (F = 48.34, P < 0.05), Fcgr2b (F = 55.46, P < 0.05), Cd86 (F = 24.44, P < 0.05), Arg1 (F = 31.18, P < 0.05), Mrc1 (F = 15.42, P < 0.05) and Chil3 (F = 24.41, P < 0.05), as well as phagocytosis markers Trem2 (F = 21.19, P < 0.05), Cd68 (F = 43.95, P < 0.05) and Apoe (F = 7.12, P < 0.05) in mice brain tissues. Conclusions A. cantonensis infections may induce severe pathological injuries in mouse brain tissues that are characterized by massive eosinophil infiltration and persistent activation of microglia cells, thereby resulting in progressive deterioration of neurological functions.
3.Curcumin attenuates IL-1β-induced chondrocyte damage by modulating the DUSP1/p38 MAPK pathway
Fei Song ; Xuefei Fan ; Nannan Liu ; Suhuan Chen ; Min Jiang ; Guangyi Chen ; Wuqi Chen ; Xiaoyu Chen ; Jian Zhou
Acta Universitatis Medicinalis Anhui 2024;59(11):1903-1910
Objective:
To investigate the inhibitory effect of curcumin(Cur) on IL-1β-induced cartilage damage and to study the relationship between the regulatory mechanisms of the DUSP1/p38 MAPK signalling pathway in the above process.
Methods:
Chondrocytes(C28/I2) and postoperative primary chondrocytes from osteoarthritis patients were divided into control and experimental groups, and the experimental group was treated with different concentrations of Cur(0, 10, 20, 40, 60, 80 μmol/L) after applying the inflammatory induction treatment with IL-1β(10 μg/L). The cell proliferation inhibition rate was determined by cell viability assay(CCK-8), the apoptosis rate was detected by flow cytometry assay. Real-time fluorescence quantitative PCR(qRT-PCR), Western blot, and immunofluorescence assay were used to detect type II collagen α1 chain(Collagen Ⅱ), matrix metallopeptidase 13(MMP13), interleukin-1β(IL-1β), BCL2-related X protein(Bax), B lymphocytoma-2(Bcl-2), dual-specificity phosphatase 1(DUSP1), p38 mitogen-activated protein kinase(p38), and phosphorylated p38 mitogen-activated protein kinase(p-p38) RNA and protein expression levels. The role of the DUSP1/p38 MAPK axis in the inhibition of chondrocyte oxidative stress, apoptosis and inflammation by Cur was further validated using DUSP1 interfering RNA and p38 MAPK pathway inhibitor(SB).
Results:
Cur significantly inhibited the IL-1β-induced decrease in chondrocyte viability and significantly reduced the levels of oxidative stress, apoptosis, and inflammation in chondrocytes; Cur inhibited the expression of MMP13, IL-1β, Bax, and p-p38 proteins, while the expression of Collagen II, Bcl-2, and DUSP1 proteins significantly increased; IL-1β and interfering RNA silencing DUSP1 activated the p38 pathway, while Cur inhibited the activation of the p38 pathway; the use of p38 MAPK pathway inhibitors reduced cellular inflammation.
Conclusion
Cur attenuates IL-1β-induced oxidative stress, apoptosis and inflammation in chondrocytes by promoting the expression of DUSP1 protein and inhibiting the activation of p38 MAPK pathway.
4.Forty years of changes and thinking on China’s drug regulation
Ruilin SONG ; Xinyi LI ; Fan ZHANG ; Yangyang ZHANG ; Xiaoyu PEI
China Pharmacy 2024;35(24):2965-2971
Since the first Drug Administration Law was issued in 1984, the drug regulation of China has undergone a forty- year process. During these four decades, China’s drug regulatory system has gradually transitioned from being extensive to refined, and the concept of supervision has become increasingly scientific. This paper first outlines the historical evolution of China’s drug regulatory laws and regulations since the founding of the People’s Republic of China, with a focus on the historical origins of the revision of the Drug Administration Law during 1984-2001. It also clarifies the new challenges faced by drug regulation as the industry innovates and develops, as well as the corresponding reform of the drug review and approval system. The paper summarizes the reform achievements of drug regulation. By studying and analyzing the challenges faced by drug regulation in terms of regulatory capacity, regulatory resources, and regulatory system in the context of internationalization of the industry, the paper proposes policy suggestions such as establishing a cross-regional regulatory system, reforming the review mechanism, strengthening the construction of the review team, and enhancing transparency in regulatory practices, with the aim of promoting the high-quality development of the pharmaceutical industry.
5.Treatment of Neurological Diseases with Tianma Goutengyin: A Review
Jianping DUAN ; Jie ZHANG ; Xu WANG ; Xiaoyu SONG ; Simin LI ; Pingping DUAN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(11):255-264
Neurological diseases are common and frequent in clinical practices, which are the main reasons that affect the quality of life and physical and mental health of patients seriously. Tianma Goutengyin (TGY) is from the New Significance of Patterns and Treatment in Miscellaneous Diseases, which was compiled by a famous doctor, HU Guangci. TGY is widely used in clinical practice and has the effects of calming the liver and calming the wind, clearing heat and activating the blood, tranquilization, and nourishing the liver and kidneys. Clinical studies have confirmed that modified TGY can be used either alone or in combination with acupuncture or western medicine to treat dementia, headache, vertigo, hypertension, insomnia, Parkinson's disease, stroke, epilepsy, and other common neurological diseases, with significant curative effect, few side effects, and high safety. The main active constituents of single flavor drugs in the composition of TGY mainly include gastrodin, gastrodia elata blume polysaccharides, p-hydroxybenzyl alcohol, rhynchophylline, baicalein, leonurine, stachydrine, geniposide, 2,3,5,4,-tetrahydroxystilbene-2-Ο-β-D-glucoside, pinoresinol diglucoside, pachymic acid, β-ecdysteroid, avicularin, etc. It has been found that TGY and these constituents have the effects of ferroptosis inhibition, anti-apoptosis, anti-inflammation, and oxidation resistance, and they can regulate neurotransmitters and autophagy, reduce cerebral edema reduction, lower blood lipid and blood pressure, and improve blood circulation through multiple targets and pathways. This paper reviewed the clinical application of and the mechanism of the whole prescription and single flavor drugs of TGY in the treatment of neurological diseases, so as to provide a theoretical basis for the clinical application of TGY and offer ideas for the follow-up mechanism research of this prescription.
6.Peripheral blood eosinophil/neutrophil as an independent risk factor for recurrence after treatment in children with bronchial asthma
Qinying FENG ; Xiaoyu SONG ; Xinzhong ZHOU ; Zhihao CHEN
International Journal of Laboratory Medicine 2024;45(2):150-154
Objective To investigate the effect of eosinophil(EOS)/neutrophil(NER)in peripheral blood on asthma recurrence in children with bronchial asthma(BA)after treatment.Methods A prospective cohort study was conducted in the study.BA children admitted to the hospital from February 2020 to February 2022 were selected as the research objects.All children were treated regularly and their condition was under con-trol.After a follow-up of 6 months,the recurrence of the children was recorded.EOS/NER,interleukin(IL)-4 and IL-5 of children with and without relapse before treatment and at 1 week of treatment were compared.Lo-gistic regression analysis model was established to test the effect of EOS/NER on the recurrence of asthma in children with BA after treatment.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of EOS/NER,IL-4 and IL-5 before treatment for the recurrence risk of BA children after treatment.Results A total of 128 children with BA were included.25 cases recurred after 6 months of follow-up,with a recurrence rate of 19.53%.EOS/NER,IL-4 and IL-5 of BA children after 1 week of treatment were lower than those before treatment(P<0.05).EOS/NER,IL-4 and IL-5 of recurrent children before treat-ment and 1 week after treatment were higher than those of non-recurrent children(P<0.05).There were no statistically significant differences in EOS/NER,IL-4,IL-5 levels between children of different genders,age groups,and treatment regimens before and after 1 week of treatment(P>0.05).Increased EOS/NER,in-creased level of IL-4 and increased level of IL-5 had effect on the recurrence of BA children after treatment and may be risk factors for recurrence(OR>1,P<0.05).The ROC curve showed that area under the curve of EOS/NER before treatment for predicting the recurrence was 0.810(95%CI:0.724-0.896,P<0.001)in BA patients after 6 months of treatment,with moderate predictive value.Conclusion EOS/NER before treat-ment in BA children may be an independent risk factor for recurrence after treatment,and has moderate pre-dictive value for recurrence risk.
7.Discussion on the Pathogenesis and Treatment of Children Enuresis Based on the Theory "Kidney-Marrow-Brain" Axis and "Yin Heel Channel (阴跷脉)"
Bo ZHANG ; Xianqing REN ; Wen FU ; Yuying SUN ; Xiaoyu LIU ; Chundong SONG ; Xia ZHANG ; Qingyin GUO ; Ying DING
Journal of Traditional Chinese Medicine 2024;65(9):909-914
Guided by the theory of "kidney generates marrow", the study elaborates the viewpoint that the route of Yin Heel Channel (阴跷脉) is consistent with the "kidney-marrow-brain" axis from the perspective of the circulation of the meridians and the relationship between the zang-fu organs. Accordingly, it is believed that disease of Yin Heel Channel and dysfunction of the "kidney-marrow-brain" axis are the core pathogenesis of children enuresis, and it is elaborated from the following three major aspects, firstly, insufficient kidney essence, dysfunction of the "kidney-marrow-brain" axis, secondly, disease of Yin Heel Channel and deficiency and cold in lower jiao, and thirdly, disease of Yin Heel Channel and loss of nourishment of Chong Vessel. It is proposed to use the mode of "firstly needle, secondly moxibustion, and lastly consolidation" to treat children enuresis. Needle is to adjust yin and yang, warm yang and tonify kidney, and wake up the brain and open the orifices. The acupoints in Yin Heel Channel such as Zhaohai (KI 6), Jiaoxin (KI 8) and confluence points of the eight extraordinary vessels such as Waiguan (TE 5), Zulinqi (GB 41) are used, together with Baihui (GV 20), Yintang (EX-HN 3), Guanyuan (CV 4), Qixue (KI 13), Dazhong (KI 4). Moxibustion is to reinforce healthy qi and warm yang, bank up the root and consolidate the original qi by moxibustion at Shenque (CV 8), Mingmen (GV 4), and Xuanshu (GV 5). Consolidation is to use acupoints application to consolidate the therapeutic effect, and Guanyuan (CV 4) & Pangguangshu (BL 28), Qihai (CV 6) & Zhishi (BL 52), and Shenque (CV 8) & Ciliao (BL 32) are commonly used as the three groups of acupoints to warm the kidney and stop collapse, regulate and tonify the qi and blood.
8.Tracking observation of fine motor development in children aged 6-8 with attention deficit hyperactivity disorder
Chinese Journal of School Health 2024;45(6):831-834
Objective:
To examine the developmental trajectory of fine motor ability in schoolage children with attention deficit hyperactivity disorder (ADHD) for two years, so as to provide scientific evidence to promote motor development in ADHD children.
Methods:
From April to June 2019, 31 children aged 6-8 years old were selected from a public elementary school. They were diagnosed with ADHD by two psychiatric professionals according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Additionally, 31 typical developmental children, matched for age, sex and IQ with the ADHD group, were recruited as the control group. Fine motor ability was assessed with tasks of hand manual dexterity in Movement Assessment Battery for Children-2 (MACB-2), and a followup assessment was conducted from April to June 2021. The development changes of fine motor ability between two groups of children were compared by using t test and repeated measures analysis of variance.
Results:
Between baseline and followup periods after two years, the total score of hand fine motor in the ADHD group did not show significant improvement (7.4±3.0, 8.0±3.4; t=-1.05, P>0.05), while there was a small effect size improvement in typically developing control group (9.5±2.1, 10.5±2.4; t=-2.12, effect size=0.38, P<0.05). Followup after two years, coin/peg throwing scores with dominant hand improved between ADHD group and control group (7.0±3.3, 9.5±3.2; 8.4±2.8, 11.6±1.6) (t=-3.74, -6.33, P<0.01; effect size=0.67, 1.14), with a smaller improvement in the ADHD group. The score for threading beads/threads decreased in between ADHD group and control group (7.9±2.4, 5.8±3.1; 9.2±1.1, 8.2±1.9) (t=3.89, 2.78, P<0.01; effect size=0.70, 0.50), with a greater decrease in the ADHD group.
Conclusions
The development speed of fine motor ability in children with ADHD aged 6-8 is slow and continues to lag behind normal developmental children. Fine motor development in children with ADHD should be closely monitored, and targeted interventions should be implemented when necessary.
9.Optimization of oral fat tolerance test
Yilin HOU ; Qian MA ; Guangyao SONG ; Xiaoyu HOU ; Yamin LU ; Peipei TIAN ; Tingxue ZHANG ; Dandan LIU ; Shaojing ZENG ; Jinrui JI ; Luping REN
Chinese Journal of Endocrinology and Metabolism 2024;40(3):204-211
Objective:To compare the effects of different test meals on postprandial triglycerides and to optimize the standard meal composition and the blood sampling protocol for the oral fat tolerance test.Methods:This study is a prospective, open-label, randomized, cross-over trial. In March 2023, 36 volunteers were recruited in Hebei General Hospital. They underwent a health examination and oral glucose tolerance test. Twenty-six healthy volunteers(11 males and 15 females) were included in this study, with an average age of(39.08±4.56) years. Each volunteer received 75 g protein meal, 75 g fat meal, 700 kcal fixed-calorie high-fat mixed meal, and a high-fat mixed meal with energy adjusted based on 10 kcal/kg body weight. A one-week washout period of regular diet was applied before each trial. Blood was collected at fasting status and 1, 2, 3, 4, 5, and 6 hours after a meal to detect serum triglycerides, total cholesterol, low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol(HDL-C), glucose, and insulin. The variations of postprandial metabolic indicators over time following the consumption of different test meals were analyzed. The disparities in postprandial metabolic responses between the two types of mixed meals were compared.Results:The protein meal, fat meal, fixed-calorie high-fat mixed meal, and adjusted-calorie high-fat mixed meal resulted in postprandial triglyceride increases of 22.45%, 115.40%, 77.14%, and 63.63%, and insulin increase of 560.43%, 85.69%, 554.18%, and 598.97%, respectively, and with reductions in total cholesterol, LDL-C, and HDL-C ranging from 5.64%-21.81%, respectively. The blood glucose changed slightly. Changes in metabolic indicators mainly occured within 4 hours. The comparison of the characteristics of postprandial triglycerides between the two high-fat mixed meals showed no statistically significant differences( P>0.05). Conclusion:A standardize protocol with a 700 kcal fixed-calorie high-fat mixed meal as test meal, and blood lipid levels measured at fasting and at 1, 2, 3, and 4 hours after consumption, can serve as an optimized approach for oral fat tolerance test.
10.Effect of esketamine combined with transversus thoracis plane block on stress response and inflammation level in patients undergoing cardiac valve replacement
Xiaoyu KANG ; Siming SONG ; Yulin ZHONG ; Liuyu LU ; Xiaotong QIN ; Yonghao WANG ; Yang LU ; Zheng GONG
The Journal of Practical Medicine 2024;40(21):3082-3089
Objective To investigate the impact of esketamine hydrochloride in combination with ultrasound-guided transverse thoracic muscle plane block on stress response and inflammatory levels in patients undergoing cardiac valve replacement under general anesthesia.Methods A total of 120 patients who underwent elective extra-corporeal circulation-supported median open heart valve replacement were selected and randomly assigned into four groups using the random number table method:general anesthesia alone(Group G),general anesthesia with intrave-nous administration of esketamine(Group E),general anesthesia with transverse thoracic plane block(Group T),and esketamine combined with transverse thoracic muscle plane block(Group ET);each group consisted of 30 cases.Patients in group E and group ET received a continuous infusion of esketamine hydrochloride injection at a rate of 0.2 mg/kg-1?h-1 until the completion of the surgical procedure,while patients in group G and group T received an equivalent volume of saline solution until the completion of the surgical procedure.After the induction of general anesthesia,patients in group T and group ET underwent ultrasound-guided bilateral transverse thoracic muscle plane block,while patients in group G and group E did not receive any specific intervention.All four groups received identical protocols for anesthesia induction and maintenance,with self-controlled intravenous analgesic pumps administered to all patients postoperatively.The following time points were recorded:1 day prior to surgery(T0),pre-induction of anesthesia(T1),1 minute post-tracheal intubation(T2),1 minute post-median sternotomy(T3),1 minute prior to initiation of cardiopulmonary circulation(T4),1 minute after cessation of cardiopulmonary circula-tion(T5),1 minute after completion of surgery(T6),1 day post-surgery(T7),2 days post-surgery(T8),and 3 days post-surgery(T9).Mean Arterial Pressure(MAP)and Heart Rate(HR)were continuously monitored from T1 to T6.The levels of blood glucose and lactate were measured and recorded at T1,T4 to T6.The levels of White Blood Cells(WBC)and C-Reactive Protein(CRP)were assessed at T0,as well as at T7 to T9.The occurrence of postoperative adverse reactions was documented in all four groups.Results(1)Comparison of hemodynamics among the four groups:Compared with group G,there was a significant decrease in MAP and HR at T3 in group T(P<0.05).At the T5 time point,MAP was lower in group ET compared to group E,while HR was higher in group ET compared to group T(P<0.05).(2)The lactate and blood glucose levels of the four patient groups after extracorporeal circulation transfer were higher than those at the T1 time point(P<0.05).Patients in group E had lower lactate values at the T5 time point and lower blood glucose values at the T6 time point compared to group G(P<0.05).Additionally,patients in group E exhibited lower lactate and blood glucose values at both the T5 and T6 time points compared to those in group T(P<0.05).(3)Compared to T0,the levels of white blood cells(WBC)and C-reactive protein(CRP)were increased in all four groups after surgery(P<0.05).At the T7 time point,the WBC levels in group E and group T were significantly lower than those in group G(P<0.05).Furthermore,compared to group E and group T,the level of WBC in group ET was significantly lower at T7,while the level of CRP was significantly lower at T8(P<0.05).(4)There were no significant differences observed in postoperative adverse reactions among the four groups(P>0.05).Conclusion Combining low-dose esketamine hydrochloride with transverse thoracic muscle plane block under general anesthesia during open heart valve replacement surgery can effectively stabilize the patient's hemodynamics,mitigate perioperative stress response and postoperative inflammation levels,thereby demonstrating significant clini-cal utility.


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