Objective:To develop and validate a predictive model for delayed emergence in patients undergoing thoracoscopic radical lung cancer surgery with general anesthesia.Methods:A total of 1 468 patients admitted to the anesthesia recovery room after thoracoscopic radical lung cancer surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from August 2020 to August 2021 were selected via convenience sampling. Patients who underwent surgery between August 2020 and June 2021 ( n=1 213) were assigned to the modeling group, while those from July to August 2021 ( n=255) were used as the validation group. Logistic regression analysis was used to identify risk factors for delayed emergence and to establish a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve ( AUC) and the Hosmer-Lemeshow goodness-of-fit test. Results:Among the modeling group, 200 patients experienced delayed emergence, with an incidence of 16.49% (200/1 213). Logistic regression analysis revealed that the use of reversal agents, use of neostigmine, albumin level, presence of shivering, pain score≥4 points, extubation time, partial pressure of CO 2, partial pressure of oxygen, serum potassium level, and intraoperative fentanyl dosage were significant influencing factors ( P<0.05). The predictive model demonstrated good performance with an AUC of 0.864 [95% CI (0.828, 0.899) ], a Hosmer-Lemeshow test χ 2=5.299 ( P=0.725), cut-off value of 0.442, sensitivity of 0.794, and specificity of 0.769. In the validation group, delayed emergence occurred in 44 cases (17.25%). The model showed good validation performance with an AUC of 0.852 [95% CI (0.826, 0.878) ], Hosmer-Lemeshow χ 2=5.912 ( P=0.336), cut-off value of 0.754, sensitivity of 0.674, and specificity of 0.877. Conclusions:The predictive model constructed in this study demonstrates strong performance and can assist clinicians in the early identification of patients at risk of delayed emergence following thoracoscopic radical lung cancer surgery under general anesthesia.

Radiotherapy is an important part of the standard treatment regimen for rectal cancer, bringing survival benefits and improved quality of life to patients with rectal cancer. However, the radiotherapy resistance of rectal cancer patients greatly limits the effectiveness of treatment and affects the prognosis of patients. The emergence of nanoparticles provides a new way to improve radiotherapy resistance of rectal cancer, which can overcome radiotherapy resistance by inhibiting DNA damage repair, affecting cell cycle, targeting delivery, enhancing DNA damage, and regulating tumor microenvironment, etc. In this article, complex coordination mechanism leading to radiotherapy resistance in rectal cancer was reviewed, current relevant studies on nanoparticles in improving radiotherapy response in rectal cancer were summarized, and the feasibility and future research direction of the combination of nanoparticles and radiotherapy in clinical treatment of rectal cancer were discussed.

Radiotherapy is an important part of the standard treatment regimen for rectal cancer, bringing survival benefits and improved quality of life to patients with rectal cancer. However, the radiotherapy resistance of rectal cancer patients greatly limits the effectiveness of treatment and affects the prognosis of patients. The emergence of nanoparticles provides a new way to improve radiotherapy resistance of rectal cancer, which can overcome radiotherapy resistance by inhibiting DNA damage repair, affecting cell cycle, targeting delivery, enhancing DNA damage, and regulating tumor microenvironment, etc. In this article, complex coordination mechanism leading to radiotherapy resistance in rectal cancer was reviewed, current relevant studies on nanoparticles in improving radiotherapy response in rectal cancer were summarized, and the feasibility and future research direction of the combination of nanoparticles and radiotherapy in clinical treatment of rectal cancer were discussed.

Objective:To develop and validate a predictive model for delayed emergence in patients undergoing thoracoscopic radical lung cancer surgery with general anesthesia.Methods:A total of 1 468 patients admitted to the anesthesia recovery room after thoracoscopic radical lung cancer surgery at the First Affiliated Hospital of Zhejiang University School of Medicine from August 2020 to August 2021 were selected via convenience sampling. Patients who underwent surgery between August 2020 and June 2021 ( n=1 213) were assigned to the modeling group, while those from July to August 2021 ( n=255) were used as the validation group. Logistic regression analysis was used to identify risk factors for delayed emergence and to establish a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve ( AUC) and the Hosmer-Lemeshow goodness-of-fit test. Results:Among the modeling group, 200 patients experienced delayed emergence, with an incidence of 16.49% (200/1 213). Logistic regression analysis revealed that the use of reversal agents, use of neostigmine, albumin level, presence of shivering, pain score≥4 points, extubation time, partial pressure of CO 2, partial pressure of oxygen, serum potassium level, and intraoperative fentanyl dosage were significant influencing factors ( P<0.05). The predictive model demonstrated good performance with an AUC of 0.864 [95% CI (0.828, 0.899) ], a Hosmer-Lemeshow test χ 2=5.299 ( P=0.725), cut-off value of 0.442, sensitivity of 0.794, and specificity of 0.769. In the validation group, delayed emergence occurred in 44 cases (17.25%). The model showed good validation performance with an AUC of 0.852 [95% CI (0.826, 0.878) ], Hosmer-Lemeshow χ 2=5.912 ( P=0.336), cut-off value of 0.754, sensitivity of 0.674, and specificity of 0.877. Conclusions:The predictive model constructed in this study demonstrates strong performance and can assist clinicians in the early identification of patients at risk of delayed emergence following thoracoscopic radical lung cancer surgery under general anesthesia.

Objective:To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer.Methods:A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up.Results:The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery.Conclusion:Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.

Insomnia disorder is a common disease in acupuncture clinics.There is a tendency for the theory to solidify and lag behind the clinic.In this paper,we examined insomnia disorder from the perspective of acupuncture and moxibustion theory.Based on the general law of acupuncture and moxibustion to recognize the disease,we concerned that the basic understanding of the disease has commonality between ancient and modern medical practitioners,and the theory can be deconstructed as follows:the theory of"yin and yang"is the starting point and the root of the theory,the theory of"spirit regulars the sleep"is the directly related theory,the theory of internal organs is the basis of the disease mechanism,the theory of meridians and acupoints is the key to diagnosis and treatment,and the theory of acupuncture and moxibustion is the key to treatment.The improvement and development of the theory of acupuncture for insomnia disorder can be carried out on this basis.

Insomnia disorder is a common disease in acupuncture clinics.There is a tendency for the theory to solidify and lag behind the clinic.In this paper,we examined insomnia disorder from the perspective of acupuncture and moxibustion theory.Based on the general law of acupuncture and moxibustion to recognize the disease,we concerned that the basic understanding of the disease has commonality between ancient and modern medical practitioners,and the theory can be deconstructed as follows:the theory of"yin and yang"is the starting point and the root of the theory,the theory of"spirit regulars the sleep"is the directly related theory,the theory of internal organs is the basis of the disease mechanism,the theory of meridians and acupoints is the key to diagnosis and treatment,and the theory of acupuncture and moxibustion is the key to treatment.The improvement and development of the theory of acupuncture for insomnia disorder can be carried out on this basis.

Objective:To observe the lipid-lowering effect of atorvastatin on patients with acute cerebral infarction with different ATP-binding cassette subfamily B member 1(ABCB1) genotypes, and thus to provide clinical research evidence for individual application of atorvastatin in patients with acute cerebral infarction.Methods:From March 2021 to December 2021, 131 patients with acute cerebral infarction admitted to the Department of Neurology of Xuchang Central Hospital were included. The ABCB1 G2677T gene polymorphism rs2032582 of patients was detected by fluorescence staining in situ hybridization.Based on the detection results, patients were divided into GG group, GT group and TT group.All patients were given atorvastatin (20 mg/d) for lipid-lowering treatment.The levels of low density lipoprotein cholesterol(HDL-C), high density lipoprotein cholesterol(HDL-C), total cholesterol(TC)and triglyceride(TG) in serum of patients in the three groups before and 2 months after treatment were recorded and analyzed.The adverse drug reactions in the three groups were recorded. When the serum LDL-C level was less than 1.8 mmol/L, it was considered that the lipid-lowering treatment was effective.The binary Logistic regression analysis was used to explore the influencing factors of atorvastatin lipid lowering therapy.The software of SPSS 25.0 was used for statistical analysis.Results:There were 50 (38.17%), 49 (37.40%) and 32 (24.43%) patients in GG group, GT group and TT group, respectively. The serum TC levels of patients in GG group, GT group and TT group after treatment were (3.47±0.70) mmol/L, (3.59±1.09) mmol/L and (3.48±1.02) mmol/L, respectively, which were lower than those before treatment ((4.27± 0.99) mmol/L, (4.02±0.98) mmol/L and (4.03±1.31) mmol/L), all of which were statistically significant ( t=7.652, 3.092, 5.593, all P<0.01). The serum LDL-C levels in GG group, GT group and TT group after treatment were (1.89±0.53) mmol/L, (2.07±0.92) mmol/L and (1.96±0.79) mmol/L, respectively, which were lower than those before treatment ((2.87±0.92) mmol/L, (2.56±0.89) mmol/L and (2.55±1.11) mmol/L) ( t=9.896, 4.055, 5.980, all P<0.001). The differences of serum LDL-C level before and after treatment in GG group, GT group and TT group were (-0.97±0.69) mmol/L, (-0.50±0.86) mmol/L and (-0.59±0.56) mmol/L, respectively. The difference of serum LDL-C level before and after treatment in the three groups was statistically significant ( F=5.614, P=0.005). The difference of TC, TG and HDL-C before and after treatment was not statistically significant( F=2.783, 0.490, 1.677, all P>0.05). The binary Logistic regression analysis showed that ABCB1 G2677T gene type and staying up late were independent influencing factors for atorvastatin lipid-lowering therapy. The probability of effective lipid-lowering in GT patients with ABCB1 G2677T gene was 27.9% of that in GG patients ( OR=0.279, 95% CI: 0.110-0.709, P=0.007), and the probability of TT type patients was 33.8% of GG type patients ( OR=0.338, 95% CI: 0.121-0.943, P=0.038). The probability of effective lipid-lowering in patients who had the habit of staying up late was 26.4% of the patients who did not stay up late ( OR=0.264, 95% CI: 0.118-0.591, P=0.001). There was no significant difference in the total incidence of adverse drug reactions among the three groups( χ2=0.868, P=0.648). Conclusion:The lipid-lowering effect in patients with GG type of ABCB1 G2677T is better than that of GT type and TT type when atorvastatin is used to treat patients with acute cerebral infarction.

OBJECTIVE：To study the ef fects of Gegen qinlian decoction （GGQLD）on blood lipid and blood glucose of hyperlipidemia（HLP）model rats ，and to explore its mechanism from the perspective of intestinal flora. METHODS ：Totally 48 rats were randomly divided into blank control group （n＝8）and modeling group （n＝40）. For consecutive 5 weeks，model group was given high-lipid diet to induce HLP model ；blank control group was given routine diet. After modeling ，30 modeling rats were randomly divided into model group ，simvastatin group （positive control ，10 mg/kg），GGQLD high-dose ，medium-dose and low-dose groups （14.85，4.95，1.65 g/kg，by crude drug ），with 6 rats in each group. Blank control group and model group were given constant volume of normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day，for consecutive 11 weeks. At the same time ，each group was continuously given corresponding diet. After the last medication ， body mass and body length of rats were determined ，and Lee ’s index was calculated. Serum levels of TG ，TC，HDL-C，LDL-C and fasting blood glucose （FBG）were determined in rats. DNA of rat caecum content was extracted for 16S rRNA V 3-V4 region sequencing. The Two-part model was used to analyze the correlation between intestinal flora with lipids and blood glucose. RESULTS：After 11 weeks of administration ，compared with blank control group ，the body mass ，body length ，Lee’s index ， serum levels of TC ，TG，HDL-C and FBG of model group were increased significantly （P＜0.05 or P＜0.01），while the level of HDL-C was decreased significantly （P＜0.05）. Compared with model group ，body mass and Lee ’s index and serum levels of TG ， FBG of rats in GGQLD high-dose group ，and serum levels of TC ，TG in GGQLD medium-dose group ，as well as serum level of TG of rats in GGQLD low-dose group was decreased significantly （P＜0.05 or P＜0.01）. Correlation analysis with intestinal flora showed that TC and TG shared 3 operational taxonomic units （OTU），including OTU 559，OTU701 and OTU 135（OTU135 was also shared with FBG ），which were all positively correlated with the level of TC ，TG and FBG （P＜0.01）. The three OTU were annotated as Tyzzerella of Spirillaceae ，Anaerotruncus of Verrucaceae and Peptoclostridium of Streptococcidae ，respectively. High-dose and low-dose GGQLD had a down-regulating effect on Tyzzerella and Anaerotruncus（P＜0.05 or P＜0.01），while had up-regulating effect on Peptoclostridium（P＜0.01）. CONCLUSIONS ：High-dose GGQLD （14.85 g/kg）can effectively reduce the body mass and blood lipid of HLP model rats ，and can prevent the abnormal increase of blood glucose of model rats. The mechanism may be associated with that the reduction of intestinal flora （Tyzzerella，Anaerotruncus）content.

Objective To investigate the role of microRNA-1 (miR-1) in cardiac fibroblasts induced by high glucose in rats. Methods The primary fibroblasts were cultured from the apical tissue of 1-3 day-old Sprague-Dawley (SD) rats. The cells which were passaged to generation 3 or 4, were randomly divided into normal glucose+lentivector-vehicle group (CON+Lv-Vehicle group), normal glucose+lentivector-miR-1 group (CON+Lv-miR1 group), high glucose+lentivector-vehicle group (HG+Lv-Vehicle group), high glucose+lentivector-miR-1 group (HG+Lv-miR1 group), high glucose+Lv-Vehicle+inhibitor group (HG+Lv-Vehicle+CC group), and high glucose+lentivector-miR-1+inhibitor group (HG+Lv-miR1+CC group). The myocardial fibroblasts were cultured in the concentration of 5.5 mmol/L glucose (normal glucose) or 25.0 mmol/L (high glucose) DMEM medium. Then lentiviral vector containing miR-1 silent sequence or the same volume of lentiviral vector was inoculated into the cells. The AMP activated protein kinase (AMPK) inhibitor Compound C (20 μmol/L) was added to the medium at 12 hours before sampling in inhibitor groups. The expression of phosphorylation of AMPK (p-AMPK), collagenⅠandⅢ, matrix metalloproteinase (MMP-2, MMP-9), and autophagy flux related protein LC3B-Ⅱ and p62/SQSTM1 were measured by Western Blot. Results The purity of rat myocardial fibroblasts in vitro was 97%. Compared with CON+Lv-Vehicle group, there was no significant difference in the expression of p-AMPK in CON+Lv-miR1 group, the expression of p-AMPK in HG+Lv-Vehicle group was significantly decreased (p-AMPK/t-AMPK: 44.72±3.29 vs. 100.00±7.77, 1 < 0.01). The expression of p-AMPK in HG+Lv-miR1 group was higher than that in HG+Lv-Vehicle group (p-AMPK/t-AMPK:60.52±5.16 vs. 44.72±3.29, 1 < 0.05). Compared with HG+Lv-Vehicle group, the expressions of collagen, MMP, LC3B-Ⅱand p62/SQSTM1 in HG+Lv-miR1 group were significantly decreased; after the treatment with AMPK inhibitor, the expressions of collagen, MMP, LC3B-Ⅱ, p62/SQSTM1 were significantly increased (HG+Lv-Vehicle+CC group vs. HG+Lv-Vehicle group: collagen Ⅰ/β-actin: 158.74±13.21 vs. 100.00±7.64, collagenⅢ/β-actin: 177.38± 17.31 vs. 100.00±5.18, MMP-2/β-actin: 130.09±14.31 vs. 100.00±10.47, MMP-9/β-actin: 215.54±20.92 vs. 100.00±11.28, LC3B-Ⅱ/β-actin: 159.34±13.83 vs. 100.00±6.44, p62/SQSTM1/β-actin: 201.01±24.02 vs. 100.00±8.62; HG+Lv-miR1+CC group vs. HG+Lv-miR1 group: collagenⅠ/β-actin: 108.69±9.93 vs. 80.83±7.24, collagenⅢ/β-actin: 127.68±10.46 vs. 81.56±9.97, MMP-2/β-actin: 106.66±10.21 vs. 74.80±7.43, MMP-9/β-actin: 145.65±11.56 vs. 74.63±10.55, LC3B-Ⅱ/β-actin: 150.15±13.28 vs. 22.98±2.87, p62/SQSTM1/β-actin: 130.48±10.74 vs. 49.90±2.27, all 1 < 0.05). Conclusion miR-1 gene silencing inhibits myocardial fibrosis induced by high glucose, its mechanism may be related to the up-regulation of p-AMPK, which can recover autophagy flux.