Objective:To evaluate the effectiveness of opioid-free anesthesia on postoperative outcomes in elderly patients following laparoscopic cholecystectomy.Methods:In this randomized controlled trial, 90 patients of either sex, aged 65-75 yr, with a body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=45 each) using a table of random numbers: conventional general anesthesia group (GA group) and opioid-free anesthesia group (OFA group). Anesthesia was induced with intravenous etomidate, sufentanil and cisatracurium besylate and maintained with infusion of propofol and remifentanil combined with inhalation of sevoflurane in GA group. In OFA group, bilateral ultrasound-guided transversus abdominis plane block was performed via the posterior gluteal approach (injection of 0.25% ropivacaine 20 ml respectively) before anesthesia induction, anesthesia was induced with intravenous dexmedetomidine, esketamine, etomidate and cisatracurium besylate and maintained with infusion of dexmedetomidine, esketamine and propofol combined with inhalation of sevoflurane. In both groups, mechanical ventilation was performed with a laryngeal mask airway after anesthesia induction, and ketorolac tromethamine 30 mg (for postoperative analgesia) and metoclopramide 10 mg (to prevent postoperative nausea and vomiting) were intravenously injected at the end of surgery. The intraoperative adverse cardiovascular events, emergence time, laryngeal mask airway removal time, time of postanesthesia care unit stay, and postoperative rescue analgesia, nausea and vomiting and delirium were recorded. Results:No gallbladder cardiac reflex was found during operation in either group. Compared with GA group, the incidence of intraoperative bradycardia (11% versus 22%) was significantly increased ( P<0.05), the incidence of intraoperative hypotension and postoperative nausea, vomiting and delirium (17% versus 8%, 29% versus 16%, 16% versus 4% and 18% versus 4%), and requirements for rescue analgesia and antiemetics (31% versus 7% and 13% versus 4%) were decreased ( P<0.05), the postoperative emergence time, time of laryngeal mask airway removal and time of postanesthesia care unit stay were prolonged ( P<0.05), and no statistically significant difference was found in discharge time in OFA group ( P>0.05). Conclusions:The results of this study, as a single-center, small-sample randomized controlled trial, indicate that referenced to conventional general anesthesia, opioid-free anesthesia (esketamine-dexmedetomidine based anesthesia combined with bilateral transversus abdominis plan block) can improve the short-term postoperative outcomes to a certain extent in elderly patients following laparoscopic cholecystectomy.

Objective To investigate the drug resistance of Mycobacterium tuberculosis(MT)in Shaanxi Province in the past five years.Methods A total of 744 patients with culture-positive sputum specimens at the former Shaanxi Provincial Institute for Tuberculosis Control and Prevention from January 2019 to December 2023 were selected as the study subjects,and the results of their strain identification and drug susceptibility tests were collected to analyze the resistance to six antituberculosis drugs.Results The overall resistance rate of the MT complex of 726 strains was 33.33%(242/726).The rates of mono-resistance,multi-resistance,multi-drug resistance and extensive resistance were 12.95%(94/726),7.44%(54/726),12.95%(94/726)and 0.41%(3/726).The resistance rate was 31.73%(204/643)in primaries and 45.78%(38/83)in retreatment patients,and the difference between the resistance rates of primaries and retreatment patients was statistically significant(χ2=6.536,P=0.011).The resistance rates of the 6 antituberculosis drugs,in descending order,were as follows:streptomycin(SM)22.87%(166/726),isoniazid(INH)22.73%(165/726),rifampicin(RFP)15.15%(110/726),ofloxacin(OFX)9.09%(66/726),ethambutol(EMB)7.30%(53/726),kanamycin(KM)2.89%(21/726).The resistance rates for each year from 2019～2023 were 39.61%(61/154),33.33%(44/132),34.47%(81/235),24.54%(40/163)and 38.10%(16/42),respectively,and the difference in resistance rates between years was not statistically significant(χ2=8.967,P=0.062).Conclusion The burden of drug-resistant tuberculosis remains heavy in Shaanxi,and the situation of multidrug-resistant tuberculosis,in particular,is more serious,and control measures need to be strengthened and improved to reduce the incidence and spread of drug-resistant tuberculosis.

Objective:To conduct a scoping review of current research on home-based volume management in patients with heart failure, in order to provide evidence for future research and nursing practice.Methods:A systematic search was performed in China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, CINAHL, and Embase for studies related to home-based volume management in patients with heart failure. The search covered literature published from the inception of each database to January 5, 2024. The included studies were synthesized and analyzed.Results:A total of 26 studies were included. The results indicated that the ability of patients with heart failure to manage volume at home is relatively weak, and they often have negative experiences with volume management. Volume management is influenced by individual factors, social support, and environmental and resource-related factors. Relevant interventions were mainly carried out at home or through a combination of home and outpatient settings. Intervention formats included remote and in-person volume management. Core components of the interventions included information support and guidance, monitoring of volume-related signs and indicators, and peer support. Evaluation indicators covered six aspects: volume and cardiac function indicators, self-care ability and behavior, diet and nutrition, clinical outcomes, psychological status, and self-efficacy. A total of three different integrated assessment tools for home-based volume management were identified.Conclusions:The ability and experience of home-based volume management in patients with heart failure still require improvement. In the future, appropriate behavior change interventions should be adopted to enhance patients' adherence to and satisfaction with home-based volume management. Furthermore, enriching the content and formats of interventions and improving the evaluation system will help enhance the quality of volume management and stabilize the disease condition.

Objective : To observe the brain tissue injury during hypoxia-ischemia, as well as the pathological changes and the expression of ferroptosis-related factors after the use of Shenfu injection(SFI), and to explore the protective effect of SFI on hypoxic-ischemic brain injury(HIBD) by inhibiting ferroptosis. Methods : An animal model of HIBD in SD rats was constructed and intervened with SFI. Pathologic changes in brain tissue were observed by HE staining methods. Nissen staining was used to observe neuron survival. Glutathione Peroxidase 4(GPX4) and Divalent Metal Transporter 1(DMT1) expression were detected in brain tissue by Western blot, immunohistochemistry and immunofluorescence. Reduced Glutathione(GSH), Lactate Dehydrogenase(LDH), Malondialdehyde(MDA), Superoxide Dismutase(SOD) and tissue iron content were determined with the kits. BV-2 microglial cell line(BV2) cells were culturedin vitroand divided into control group(Ctrl group), oxygen-glucose deprivation group(OGD group), iron ferroptosis-inducing group(Erastin group), iron ferroptosis-inhibiting group(Fer-1 group), Shenfu injection group(SFI group), and Erastin+Shenfu injection group(Erastin+SFI group). 2′,7′-Dichlorodihydrofluorescein diacetate(DCFH-DA) reactive oxygen species(ROS) fluorescent probe was used to detect the ROS release level; Immunofluorescence was used to observe intracellular GPX4, DMT1 expression. Results : Compared with the Sham group, rats in the HIBD group showed significant neuronal cell damage in brain tissue, decreased GPX4 expression(P<0.01), increased DMT1 expression(P<0.01), decreased GSH and SOD levels(P<0.01), and increased LDH, MDA and tissue iron levels(P<0.05,P<0.05,P<0.01). In contrast, after the intervention of SFI, GPX4 expression was elevated(P<0.01), DMT1 expression decreased(P<0.01), GSH and SOD levels were elevated(P<0.01), and LDH, MDA, and tissue iron levels decreased(P<0.05,P<0.05,P<0.01). The cells experiments showed that compared with the Ctrl group, the OGD group had a significantly higher ROS content and a decrease in the expression of GPX4 fluorescence intensity, and an increase in the fluorescence intensity of DMT1(P<0.01), compared with the OGD group, the ROS content was reduced in the SFI group, while the expression of GPX4 was elevated and the expression of DMT1 was reduced(P<0.01). Conclusion Hippocampal and cortical regions are severely damaged after HIBD in neonatal rats, and their brain tissues show decreased expression of GPX4 and increased expression of DMT1. The above suggests that ferroptosis is involved in HIBD brain injury in neonatal rats. In contrast, Shenfu injection has a protective effect on HIBD experimental animal model and BV2 cell injury model by reducing iron aggregation and ROS production.

Objective: To treat malignant and non-malignant hematological diseases, allogeneic hematopoietic stem cell transplantation(alloSCT) is widely used. However, its application is limited by the risk of graft-versus-host disease(GVHD), difficulties in donor matching, and the high incidence of transplantation-related mortality due to myeloablative conditioning regimens. Therefore, there is an urgent need to develop new strategies that reduce the intensity of conditioning while enhancing donor engraftment efficiency. Methods: In an alloSCT model, minor histocompatibility antigen-specific donor central memory T cells(miHA-TM) combined with a CD40 agonist were adoptively transferred to evaluate donor bone marrow engraftment under different irradiation doses. Results: Minor histocompatibility antigen(miHA)-specific donor-derived central memory T cells(TM) facilitated recipient immune reconstitution without inducing GVHD. Donor-derived TM cells, however, underwent exhaustion during the process of recipient immune reconstitution, which compromised complete donor engraftment under reduced-intensity conditioning. At a low irradiation dose(4 Gy), the combination of miHA-TM and a CD40 agonist significantly promoted donor bone marrow engraftment. Conclusion miHA-TM facilitates immune reconstitution in recipients without inducing graft-versus-host disease.

Objective:To compare the efficiency and characteristics of different carrier proteins and signal sequences in delivering antigens into Escherichia coli outer membrane vesicles (OMVs). Methods:The fusion protein F1V, which consisted of the main protective antigen of Yersinia pestis F1 and LcrV, was expressed using the carrier proteins such as cytolysin A (ClyA), outer membrane protein A (OmpA), or β-lactamases (Bla) signal sequence as a carrier protein. The expression, localization, and content of F1V protein in OMVs were compared and analyzed. Results:All three delivery methods successfully incorporated F1V protein into OMVs and localized it on the surface of OMVs. Notably, when OmpA was used as the carrier protein, the F1V fusion protein constituted up to 30% of the total protein in OMVs. The highest yield of OMVs, reaching 4.2 mg/L, was achieved when Bla signal sequence was used as the carrier.Conclusions:There is a significant difference in the efficiency of different carrier proteins in delivering the F1V antigen into OMVs of Escherichia coli. Considering both the yield of OMVs and the proportion of antigen in the total protein of OMVs, the carrier Bla signal sequence demonstrated the highest efficiency in delivering F1V into OMVs, showing a potential for the future development of OMVs-based plague vaccines.

Objective:To compare the efficiency and characteristics of different carrier proteins and signal sequences in delivering antigens into Escherichia coli outer membrane vesicles (OMVs). Methods:The fusion protein F1V, which consisted of the main protective antigen of Yersinia pestis F1 and LcrV, was expressed using the carrier proteins such as cytolysin A (ClyA), outer membrane protein A (OmpA), or β-lactamases (Bla) signal sequence as a carrier protein. The expression, localization, and content of F1V protein in OMVs were compared and analyzed. Results:All three delivery methods successfully incorporated F1V protein into OMVs and localized it on the surface of OMVs. Notably, when OmpA was used as the carrier protein, the F1V fusion protein constituted up to 30% of the total protein in OMVs. The highest yield of OMVs, reaching 4.2 mg/L, was achieved when Bla signal sequence was used as the carrier.Conclusions:There is a significant difference in the efficiency of different carrier proteins in delivering the F1V antigen into OMVs of Escherichia coli. Considering both the yield of OMVs and the proportion of antigen in the total protein of OMVs, the carrier Bla signal sequence demonstrated the highest efficiency in delivering F1V into OMVs, showing a potential for the future development of OMVs-based plague vaccines.

Objective:To evaluate the effectiveness of opioid-free anesthesia on postoperative outcomes in elderly patients following laparoscopic cholecystectomy.Methods:In this randomized controlled trial, 90 patients of either sex, aged 65-75 yr, with a body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=45 each) using a table of random numbers: conventional general anesthesia group (GA group) and opioid-free anesthesia group (OFA group). Anesthesia was induced with intravenous etomidate, sufentanil and cisatracurium besylate and maintained with infusion of propofol and remifentanil combined with inhalation of sevoflurane in GA group. In OFA group, bilateral ultrasound-guided transversus abdominis plane block was performed via the posterior gluteal approach (injection of 0.25% ropivacaine 20 ml respectively) before anesthesia induction, anesthesia was induced with intravenous dexmedetomidine, esketamine, etomidate and cisatracurium besylate and maintained with infusion of dexmedetomidine, esketamine and propofol combined with inhalation of sevoflurane. In both groups, mechanical ventilation was performed with a laryngeal mask airway after anesthesia induction, and ketorolac tromethamine 30 mg (for postoperative analgesia) and metoclopramide 10 mg (to prevent postoperative nausea and vomiting) were intravenously injected at the end of surgery. The intraoperative adverse cardiovascular events, emergence time, laryngeal mask airway removal time, time of postanesthesia care unit stay, and postoperative rescue analgesia, nausea and vomiting and delirium were recorded. Results:No gallbladder cardiac reflex was found during operation in either group. Compared with GA group, the incidence of intraoperative bradycardia (11% versus 22%) was significantly increased ( P<0.05), the incidence of intraoperative hypotension and postoperative nausea, vomiting and delirium (17% versus 8%, 29% versus 16%, 16% versus 4% and 18% versus 4%), and requirements for rescue analgesia and antiemetics (31% versus 7% and 13% versus 4%) were decreased ( P<0.05), the postoperative emergence time, time of laryngeal mask airway removal and time of postanesthesia care unit stay were prolonged ( P<0.05), and no statistically significant difference was found in discharge time in OFA group ( P>0.05). Conclusions:The results of this study, as a single-center, small-sample randomized controlled trial, indicate that referenced to conventional general anesthesia, opioid-free anesthesia (esketamine-dexmedetomidine based anesthesia combined with bilateral transversus abdominis plan block) can improve the short-term postoperative outcomes to a certain extent in elderly patients following laparoscopic cholecystectomy.

Objective To investigate the expression and significance of heat shock protein 70(HSP70),apoptosis-associated speck-like protein(ASC),and vitamin D in children with febrile seizures(FS).Methods A total of 200 children with FS admitted to our hospital from June 2022 to December 2023 were selected as FS group,including 158 cases of simple FS and 42 cases of complex FS.Another 200 febrile children without FS were selected as fever group,and 50 healthy children were selected as control group.The differences in HSP70,ASC mRNA,and vitamin D expression a-mong the three groups were compared.The differences in HSP70,ASC mRNA,and vitamin D ex-pression at different time points in children with different types of FS were compared.The influencing factors and predictive value of complex FS were analyzed.Results At admission,the expression lev-els of HSP70 and ASC mRNA gradually decreased,while the vitamin D levels gradually increased in the FS group,fever group,and control group,with statistically significant between-group differences(P＜0.01).One hour after admission,the levels of HSP70 and ASC mRNA in both the complex FS group and the simple FS group were lower than those at admission(P＜0.01).The levels of HSP70 and ASC mRNA in the complex FS group at admission and 1 hour after admission were higher than those in the simple FS group,while the vitamin D level was lower(P＜0.01).Multivariate Logistic regression analysis showed that elevated HSP70 and ASC mRNA levels at admission were independ-ent risk factors for complex FS(P＜0.001),while elevated vitamin D level was an independent protective factor for complex FS(P＜0.001).The area under the curve(AUC)for HSP70,ASC mRNA,and vitamin D in assessing complex FS were 0.785(95％CI,0.721 to 0.840),0.766(95％CI,0.701 to 0.823),and0.760(95％CI,0.695 to 0.817),respectively.The combined AUC of HSP70,ASC mRNA,and vitamin D for assessing complex FS was 0.915,with a sensitivity of 90.48％and a specificity of 81.65％.The AUC of combined assessment of complex FS by vari-ous factors was greater than that of HSP70,ASC mRNA,and vitamin D alone(Z=2.743,2.749,3.086,P=0.006,0.006,0.002).Conclusion The levels of HSP70 and ASC mRNA are elevat-ed,while the vitamin D level is reduced in children with complex and simple FS.The combined as-sessment of HSP70,ASC mRNA,and vitamin D at admission has high value in assessing complex FS.

Objective To investigate the drug resistance of Mycobacterium tuberculosis(MT)in Shaanxi Province in the past five years.Methods A total of 744 patients with culture-positive sputum specimens at the former Shaanxi Provincial Institute for Tuberculosis Control and Prevention from January 2019 to December 2023 were selected as the study subjects,and the results of their strain identification and drug susceptibility tests were collected to analyze the resistance to six antituberculosis drugs.Results The overall resistance rate of the MT complex of 726 strains was 33.33%(242/726).The rates of mono-resistance,multi-resistance,multi-drug resistance and extensive resistance were 12.95%(94/726),7.44%(54/726),12.95%(94/726)and 0.41%(3/726).The resistance rate was 31.73%(204/643)in primaries and 45.78%(38/83)in retreatment patients,and the difference between the resistance rates of primaries and retreatment patients was statistically significant(χ2=6.536,P=0.011).The resistance rates of the 6 antituberculosis drugs,in descending order,were as follows:streptomycin(SM)22.87%(166/726),isoniazid(INH)22.73%(165/726),rifampicin(RFP)15.15%(110/726),ofloxacin(OFX)9.09%(66/726),ethambutol(EMB)7.30%(53/726),kanamycin(KM)2.89%(21/726).The resistance rates for each year from 2019～2023 were 39.61%(61/154),33.33%(44/132),34.47%(81/235),24.54%(40/163)and 38.10%(16/42),respectively,and the difference in resistance rates between years was not statistically significant(χ2=8.967,P=0.062).Conclusion The burden of drug-resistant tuberculosis remains heavy in Shaanxi,and the situation of multidrug-resistant tuberculosis,in particular,is more serious,and control measures need to be strengthened and improved to reduce the incidence and spread of drug-resistant tuberculosis.