Objective To analyze the influence of Dapagliflozin on ventricular remodeling,soluble suppression of tumorigenicity-2(sST2)and brain natriuretic peptide(BNP)in patients with elderly ST-segment elevation myocardial infarction(STEMI)complicated with type 2 diabetes mellitus(T2DM)after percutaneous coronary intervention(PCI).Methods From April 2021 to March 2023,118 elderly patients with STEMI complicated with T2DM treated by PCI were selected from People's Hospital of Hengshui.They were divided into conventional hypoglycemic therapy control(Con,n=59)group and conventional hypoglycemic therapy combined with Dapagliflozin(Dap,n=59)group according to the treatment strategy.All the participants were treated for 24 weeks.The general data,biochemical indexes,BNP,N-terminal pro-B-type natriuretic peptide(NT-proBNP),soluble growth stimulating expression factor 2(sST2)and lipoprotein-associated phospholipase A2(LP-PLA2),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular mass index(LVMI)were compared between the two groups.Results After 24 weeks of treatment,the BNP,NT-proBNP,fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),LVEDD,LVESD,LVMI,serum sST2 and LP-PLA2 were lower in Dap group than in Con group(P<0.05),while the LVEF was higher in Dap group than in Con group(P<0.05).The total incidence rate of major adverse cardiovascular events was significantly lower in Dap group than in Con group(P<0.05).The incidence rates of adverse drug reactions were 6.78%and 5.08%in the two groups respectively(P>0.05).Conclusions Dapagliflozin can improve the cardiac function and glucose metabolism status in elderly patients with STEMI and T2DM after PCI,and alleviate the ventricular remodeling,with good safety.

Objective:To explore the longitudinal trajectory of sleep disorders and their influencing factors in newly diagnosed breast cancer patients, and provide theoretical basis for formulating intervention measures to improve sleep quality of breast cancer patients.Methods:A longitudinal study was conducted using convenience sampling to select newly diagnosed breast cancer patients from Shandong Provincial Third Hospital and Shandong First Medical University Affiliated Provincial Hospital from April 2023 to June 2024. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Concerns About Recurrence Scale (CARS), and the Distress Disclosure Index (DDI) were used for the survey. The Kruskal-Wallis H test and generalized estimating equation models were used to examine sleep disorders and their influencing factors. Results:A total of 473 valid questionnaires were collected. Among the 473 newly diagnosed breast cancer patients, 435 were female and 38 were male, aged (49.5 ± 11.0) years old. The CARS score at admission was (3.00 ± 1.12) points, with concerns about death (0.71 ± 0.67) points and concerns about female characteristics (0.81 ± 0.72) points. The DDI score at admission was (27.00 ± 10.03) points. The PSQI scores at admission, discharge, and one month after discharge were (15.34 ± 3.05), (12.12 ± 3.01), and (10.13 ± 1.78) points, respectively, the difference was statistically significant ( H =33.19, P<0.05). The PSQI scores at these three time points were positively correlated with the CARS score and concerns about death and female characteristics ( r values were 0.42-0.79, all P<0.05), and negatively correlated with the DDI score ( r =-0.41, -0.37, -0.31, all P<0.05). The generalized estimating equation model showed that female gender ( β=1.35, 95% CI 0.27-2.30), education level of junior high school or below ( β=1.89, 95% CI 0.24-3.19), severe pain ( β=1.72, 95% CI 0.32-3.12), moderate pain ( β=2.51, 95% CI 0.37-4.66), invasive special cancer ( β=2.57, 95% CI 1.67-4.07), invasive non-special cancer ( β=2.11, 95% CI 1.98-3.12), partial understanding of the condition ( β=1.91, 95% CI 1.23-3.01), concerns about death ( β=1.61, 95% CI 0.17-2.78), and concerns about femininity ( β=1.34, 95% CI 0.37-2.15) positively predicted the sleep quality index in newly diagnosed breast cancer patients (all P<0.05). Non-invasive cancer ( β=-3.82, 95% CI -6.79--3.36), lack of understanding of the condition ( β=-3.96, 95% CI -7.09--4.62), and DDI score ( β=-1.45, 95% CI -2.14--0.15) negatively predicted the sleep quality index (all P<0.05). Conclusions:The overall sleep quality of newly diagnosed breast cancer patients is low, with the lowest at admission and gradual improvement at discharge and one month after discharge. Medical staff should pay attention to high-risk patients who are female, have lower education levels, higher pain scores, poorer pathological types, and partial understanding of their condition.

Objective:To investigate the clinical efficacy of open anterior myofascial repair surgery on abdominal wall incision hernia.Methods:The retrospective cohort study was conducted. The clinical data of 188 patients who underwent open anterior myofascial repair surgery on abdo-minal wall incision hernia at three medical centers, including Xiangya Hospital of Central South University et al, from December 2016 to December 2024 were collected. There were 85 males and 103 females, aged (62±12)years. Of the 188 patients, 55 cases had large incisional hernia and 133 cases had non-large incisional hernia. Observation indicators: (1) intraoperative conditions; (2) postopera-tive conditions; (3) follow-up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact test. Comparison of ordinal data between groups was conducted using the nonparametic test. Results:(1) Intra-operative conditions. The operation time of the 55 patients with large incisional hernia was (145±40)minutes, and the volume of intraoperative blood loss was 40.0(22.5,55.0)mL, cases with fascial defect located in the central anterior abdominal wall, the superolateral quadrant, the inferolateral quadrant were 26, 7, 22, the fascial defect area was 140(99,169)cm2, cases used with self-fixating mesh and flat mesh were 29, 26. The above indicators of the 133 patients with non-large incisional hernia were (124±34)minutes, 35.0(30.0,45.0)mL, 47, 26, 60, 25(12,40)cm2, 67, 66, respectively. There were significant differences in operation time and fascial defect area between patients with large incisional hernia and non-large incisional hernia ( t=-3.651, Z=-10.339, P<0.05), and there was no significant difference in the volume of intraoperative blood loss, defect quadrant distribution, and mesh type ( Z=-0.501, χ2=2.692, 0.086, P>0.05). (2) Postoperative conditions. Of the 55 patients with large incisional hernia, 7 cases developed postoperative seroma, including 5 cases combined with concomitant surgical-site infection, and 4 additional cases developed with surgical-site infection. Of the 133 patients with non-large incisional hernia, 15 cases developed postoperative seroma, including 3 cases combined with concomitant surgical-site infection. There was a significant difference in surgical-site infection between patients with large incisional hernia and non-large incisional hernia ( χ2=10.707, P<0.05), and there was no significant difference in postoperative seroma ( χ2=0.079, P>0.05). The duration of postoperative hospital stay was 7(6, 9)days for the 55 patients with large incisional hernia and 5(4, 6)days for the 133 patients with non-large incisional hernia, showing a significant difference between them ( Z=-6.292, P<0.05). (3) Follow-up. All 188 patients were followed up for 43(range, 29-67)months. During the follow-up, 9 patients experienced hernia recurrence, including 7 patients with large incisional hernia and 2 patients with non-large incisional hernia. For the 7 patients of large incisional hernia with hernia recurrence, 4 cases underwent reoperation and 3 cases received conservative treatment. All 2 patients of non-large incisional hernia with hernia recurrence received conservative treatment. There was no significant difference in hernia recurrence between patients with large incisional hernia and non-large incisional hernia ( χ2=8.432, P<0.05). Results of chronic pain score at postoperative 3 month showed that among 55 patients with large incisional hernia, 40 cases had mild pain, 7 cases had moderate pain, and 8 cases had severe pain. Among 133 patients with non-large incisional hernia, the above indicators were 102, 28, and 3, respectively. There was no significant difference in chronic pain score at postoperative 3 month between patients with large incisional hernia and non-large incisional hernia ( Z=-0.968, P>0.05). Conclusions:Open anterior myofascial repair surgery can be used for the treatment of abdominal wall incision hernia. Compared with non-large incisional hernia, patients with large incisional hernia have longer operation time, are more prone to surgical-site infection, have longer postoperative hospital stay, and are more likely to experience hernia recurrence.

Objective To analyze the influence of Dapagliflozin on ventricular remodeling,soluble suppression of tumorigenicity-2(sST2)and brain natriuretic peptide(BNP)in patients with elderly ST-segment elevation myocardial infarction(STEMI)complicated with type 2 diabetes mellitus(T2DM)after percutaneous coronary intervention(PCI).Methods From April 2021 to March 2023,118 elderly patients with STEMI complicated with T2DM treated by PCI were selected from People's Hospital of Hengshui.They were divided into conventional hypoglycemic therapy control(Con,n=59)group and conventional hypoglycemic therapy combined with Dapagliflozin(Dap,n=59)group according to the treatment strategy.All the participants were treated for 24 weeks.The general data,biochemical indexes,BNP,N-terminal pro-B-type natriuretic peptide(NT-proBNP),soluble growth stimulating expression factor 2(sST2)and lipoprotein-associated phospholipase A2(LP-PLA2),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular mass index(LVMI)were compared between the two groups.Results After 24 weeks of treatment,the BNP,NT-proBNP,fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),LVEDD,LVESD,LVMI,serum sST2 and LP-PLA2 were lower in Dap group than in Con group(P<0.05),while the LVEF was higher in Dap group than in Con group(P<0.05).The total incidence rate of major adverse cardiovascular events was significantly lower in Dap group than in Con group(P<0.05).The incidence rates of adverse drug reactions were 6.78%and 5.08%in the two groups respectively(P>0.05).Conclusions Dapagliflozin can improve the cardiac function and glucose metabolism status in elderly patients with STEMI and T2DM after PCI,and alleviate the ventricular remodeling,with good safety.

Objective:To investigate the clinical efficacy of open anterior myofascial repair surgery on abdominal wall incision hernia.Methods:The retrospective cohort study was conducted. The clinical data of 188 patients who underwent open anterior myofascial repair surgery on abdo-minal wall incision hernia at three medical centers, including Xiangya Hospital of Central South University et al, from December 2016 to December 2024 were collected. There were 85 males and 103 females, aged (62±12)years. Of the 188 patients, 55 cases had large incisional hernia and 133 cases had non-large incisional hernia. Observation indicators: (1) intraoperative conditions; (2) postopera-tive conditions; (3) follow-up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact test. Comparison of ordinal data between groups was conducted using the nonparametic test. Results:(1) Intra-operative conditions. The operation time of the 55 patients with large incisional hernia was (145±40)minutes, and the volume of intraoperative blood loss was 40.0(22.5,55.0)mL, cases with fascial defect located in the central anterior abdominal wall, the superolateral quadrant, the inferolateral quadrant were 26, 7, 22, the fascial defect area was 140(99,169)cm2, cases used with self-fixating mesh and flat mesh were 29, 26. The above indicators of the 133 patients with non-large incisional hernia were (124±34)minutes, 35.0(30.0,45.0)mL, 47, 26, 60, 25(12,40)cm2, 67, 66, respectively. There were significant differences in operation time and fascial defect area between patients with large incisional hernia and non-large incisional hernia ( t=-3.651, Z=-10.339, P<0.05), and there was no significant difference in the volume of intraoperative blood loss, defect quadrant distribution, and mesh type ( Z=-0.501, χ2=2.692, 0.086, P>0.05). (2) Postoperative conditions. Of the 55 patients with large incisional hernia, 7 cases developed postoperative seroma, including 5 cases combined with concomitant surgical-site infection, and 4 additional cases developed with surgical-site infection. Of the 133 patients with non-large incisional hernia, 15 cases developed postoperative seroma, including 3 cases combined with concomitant surgical-site infection. There was a significant difference in surgical-site infection between patients with large incisional hernia and non-large incisional hernia ( χ2=10.707, P<0.05), and there was no significant difference in postoperative seroma ( χ2=0.079, P>0.05). The duration of postoperative hospital stay was 7(6, 9)days for the 55 patients with large incisional hernia and 5(4, 6)days for the 133 patients with non-large incisional hernia, showing a significant difference between them ( Z=-6.292, P<0.05). (3) Follow-up. All 188 patients were followed up for 43(range, 29-67)months. During the follow-up, 9 patients experienced hernia recurrence, including 7 patients with large incisional hernia and 2 patients with non-large incisional hernia. For the 7 patients of large incisional hernia with hernia recurrence, 4 cases underwent reoperation and 3 cases received conservative treatment. All 2 patients of non-large incisional hernia with hernia recurrence received conservative treatment. There was no significant difference in hernia recurrence between patients with large incisional hernia and non-large incisional hernia ( χ2=8.432, P<0.05). Results of chronic pain score at postoperative 3 month showed that among 55 patients with large incisional hernia, 40 cases had mild pain, 7 cases had moderate pain, and 8 cases had severe pain. Among 133 patients with non-large incisional hernia, the above indicators were 102, 28, and 3, respectively. There was no significant difference in chronic pain score at postoperative 3 month between patients with large incisional hernia and non-large incisional hernia ( Z=-0.968, P>0.05). Conclusions:Open anterior myofascial repair surgery can be used for the treatment of abdominal wall incision hernia. Compared with non-large incisional hernia, patients with large incisional hernia have longer operation time, are more prone to surgical-site infection, have longer postoperative hospital stay, and are more likely to experience hernia recurrence.

Objective:To explore the longitudinal trajectory of sleep disorders and their influencing factors in newly diagnosed breast cancer patients, and provide theoretical basis for formulating intervention measures to improve sleep quality of breast cancer patients.Methods:A longitudinal study was conducted using convenience sampling to select newly diagnosed breast cancer patients from Shandong Provincial Third Hospital and Shandong First Medical University Affiliated Provincial Hospital from April 2023 to June 2024. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Concerns About Recurrence Scale (CARS), and the Distress Disclosure Index (DDI) were used for the survey. The Kruskal-Wallis H test and generalized estimating equation models were used to examine sleep disorders and their influencing factors. Results:A total of 473 valid questionnaires were collected. Among the 473 newly diagnosed breast cancer patients, 435 were female and 38 were male, aged (49.5 ± 11.0) years old. The CARS score at admission was (3.00 ± 1.12) points, with concerns about death (0.71 ± 0.67) points and concerns about female characteristics (0.81 ± 0.72) points. The DDI score at admission was (27.00 ± 10.03) points. The PSQI scores at admission, discharge, and one month after discharge were (15.34 ± 3.05), (12.12 ± 3.01), and (10.13 ± 1.78) points, respectively, the difference was statistically significant ( H =33.19, P<0.05). The PSQI scores at these three time points were positively correlated with the CARS score and concerns about death and female characteristics ( r values were 0.42-0.79, all P<0.05), and negatively correlated with the DDI score ( r =-0.41, -0.37, -0.31, all P<0.05). The generalized estimating equation model showed that female gender ( β=1.35, 95% CI 0.27-2.30), education level of junior high school or below ( β=1.89, 95% CI 0.24-3.19), severe pain ( β=1.72, 95% CI 0.32-3.12), moderate pain ( β=2.51, 95% CI 0.37-4.66), invasive special cancer ( β=2.57, 95% CI 1.67-4.07), invasive non-special cancer ( β=2.11, 95% CI 1.98-3.12), partial understanding of the condition ( β=1.91, 95% CI 1.23-3.01), concerns about death ( β=1.61, 95% CI 0.17-2.78), and concerns about femininity ( β=1.34, 95% CI 0.37-2.15) positively predicted the sleep quality index in newly diagnosed breast cancer patients (all P<0.05). Non-invasive cancer ( β=-3.82, 95% CI -6.79--3.36), lack of understanding of the condition ( β=-3.96, 95% CI -7.09--4.62), and DDI score ( β=-1.45, 95% CI -2.14--0.15) negatively predicted the sleep quality index (all P<0.05). Conclusions:The overall sleep quality of newly diagnosed breast cancer patients is low, with the lowest at admission and gradual improvement at discharge and one month after discharge. Medical staff should pay attention to high-risk patients who are female, have lower education levels, higher pain scores, poorer pathological types, and partial understanding of their condition.

Objective To investigate the effects of long-term exposure to three new types of light emitting diode (LED) sources on the behavior, learning, and memory of rats. Methods A total of 160 specific pathogen-free SD rats were divided into eight groups as followed, trichromatic fluorescent lamps color temperature control group, violet-chip full-spectrum white LED group, blue-chip white LED group, and blue-chip full-spectrum white LED group based on the light sources types, with color temperature of 4 000 K and 6 500 K groups in each group using the 4×2 factorial design. There were 20 rats in each group, with half of the rats were males and half females. Rats were exposed to artificial lighting, and the illumination was set at 750 lx. The rats in each group were exposed to different lighting environments for 12 hours per day for 24 weeks. The open-field and step-down tests were conducted in rats after 24 weeks exposure, followed by sacrifice of rats and measurement of organ coefficients. Differences in body weight, organ coefficients, and neurobehavioral indexes of rats in different groups were compared. Results The spleen coefficient of female rats decreased in blue-chip white LED of 6 500 K color temperature group, and the liver coefficient of male rats decreased in the violet-chip full-spectrum white LED of 4 000 K color temperature, blue-chip full-spectrum white LED of 4 000 K color temperature, and blue-chip full-spectrum white LED of 6 500 K color temperature groups, compared with the same-sex rats in trichromatic fluorescent lamps with same-color temperature control group (all P<0.05). The result of different types of light sources compared in the open-field test showed that the index of total distance and movement speed of female rats in the blue-chip full-spectrum white LED group were lower than those in the other three groups, and the time cost to the central area was longer than that in the blue-chip white LED group and the violet-chip full-spectrum white LED group (all P<0.05). The total distance and movement speed of male rats in the blue-chip full-spectrum white LED group were longer or higher than those in the violet-chip full-spectrum white LED group (all P<0.05). Based on the comparison of color temperature, the time and total distance of male rats in 6 500 K color temperature group were lower than that in the 4 000 K color temperature group (both P<0.05). In the step-down test, both male and female rats in the blue-chip full-spectrum white LED group made more errors compared with other three groups with the same gender (all P<0.05). Conclusion Based on the experimental conditions of this study, the blue-chip full-spectrum white light LED affects behavior, learning and memory of the rats, and trichromatic fluorescent lamp has the lowest effect on neurobehavior. The color temperature also affects behavior of the rats, and high color temperature has higher risk.

Objective To investigate the effects of Dapagliflozin combined with insulin treatment on blood glucose index and pancreatic β-cell function in overweight/obese type 2 diabetes mellitus(T2DM) patients with different disease durations. Methods A total of 288 patients with impaired pancreatic function who were treated from June 2019 to June 2020 were selected. They were divided into three groups,short duration group (≤10 years group,n=95),medium duration group (10～20 years group,n=96) and long duration group (≥20 years group,n=97). Three groups of patients were treated with Dapagliflozin in addition to the regular insulin therapy for 6 months. Clinical efficacy,blood glucose indices,pancreatic β-cell function and complications during the treatment period were compared among the three groups. Results After treatment,there was a significant decrease in the values of three groups including WC,FPG,2 hPG,HbA1c,TC,TG,LDL-C,BMI,FIns and HOMA-IR(P<0.05). Meanwhile,HDL-C,C-P,HOMA-β and HOMA-IS values showed a significant increase(P<0.05). After treatment,WC,FPG,2 hPG,HbA1c,TC,TG,LDL-C,FIns and HOMA-IR increased in turn(P<0.05),while HDL-C,C-P,HOMA-β and HOMA-IS decreased in turn in ≤10 years group,10～20 years group,≥20 years group(P<0.05). The BMI of 10～20 years group was lower than that of ≤10 years group and ≥20 years group (P<0.05),while the BMI of ≥20 years group was higher than that of ≤10 years group (P<0.05). Conclusions In overweight/obese T2DM patients with different DM durations,Dapagliflozin combined with insulin treatment shows a significant advantage in lowering blood glucose indices and improving pancreatic β-cell function,especially for patients with a shorter disease duration.

Esketamine is a spin isomer of ketamine,which has the triple effect of sedation,analge-sia and amnesia,and is superior to ablative ketamine in terms of efficacy,controllability.It has been widely used in anesthesia,emergency and critical care in Europe and America,and is mostly used for sedation,analgesia and antidepressant in China.Esketamine is used in cardiac surgery to maintain stable hemodynam-ics,reduce the secretion of inflammatory factors and relieve postoperative pain.Its sympathomimetic effect allows it to be used for the induction of anesthesia in patients with hemodynamic instability and acute heart attack.This paper reviews the recent advance in the clinical value and limitations of esketamine in the perio-perative period of cardiovascular surgery and provides a reference for clinicians to use esketamine in the perioperative period of cardiovascular surgery.