OBJECTIVE To investigate the effects and mechanisms of oliceridine fumarate （TRV130） in improving postoperative cognitive dysfunction （POCD） in elderly rats based on the Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB） pathway. METHODS Rats were randomly divided into the control group （normal saline）， the model group （normal saline）， the TRV130 group （2.8 mg/kg）， the TLR4/NF-κB pathway inhibitor （TAK-242） group （3 mg/kg）， the β -arrestin inhibitor （Barbadin） group （3 mg/kg）， and the traditional opioid drug （morphine） group （2.8 mg/kg）， with 15 rats in each group. Except for the control group， POCD models were established in all other groups. From the first day after surgery， drugs/normal saline were administered via caudal vein injection once daily for 3 consecutive days. After the last administration， the pathological damage of hippocampal tissue was observed； the cognitive function， serum inflammatory factor levels， hippocampal neurons apoptosis rate， and the expression of ionized calcium-binding adapter molecule 1 （Iba-1）， glial fibrillary acidic protein （GFAP）， and TLR4/NF-κB pathway-related mRNA and protein in hippocampal tissue were detected. RESULTS In the model group， the neurons in the CA1 region of the hippocampus were disordered and sparse， with decreased number， pyknotic and fragmented nuclei accompanied by inflammatory cell infiltration. Compared with the control group， the escape latency， serum levels of tumor necrosis factor α （TNF-α）， interleukin-6 （IL-6）， and IL-1β， hippocampal neurons apoptosis rate， average fluorescence intensities of Iba-1 and GFAP， mRNA expression levels of TLR4 and NF-κB p65， and their protein expression/phosphorylation levels in hippocampal tissue were significantly increased/elevated in the model group （ P ＜0.05）； the time spent in the target quadrant and the number of platform crossings were significantly shortened/decreased （ P ＜0.05）. Compared with the model group， the cognitive function， pathological， inflammatory， and apoptosis-related indicators were significantly improved in the TRV130 group， TAK-242 group， and Barbadin group （ P ＜0.05）； the mRNA expression levels of TLR4 and NF-κB p65 and their protein expression/phosphorylation levels were significantly decreased in the TRV130 group and TAK-242 group （ P ＜0.05）. CONCLUSIONS TRV130 may improve POCD in elderly rats by inhibiting the TLR4/NF-κB pathway and alleviating postoperative central nervous system inflammatory responses.

Objective:To explore the value of lumbar volumetric bone mineral density (vBMD) measured by quantitative computed tomography (QCT) in predicting coronary artery calcification (CAC).Methods:This retrospective, cross-sectional study included a total of 991 patients (504 male and 487 female) who underwent coronary artery CT angiography (CTA) and chest, abdomen, or lumbar spine CT examinations at Taihe County People′s Hospital from January 2023 to June 2024. Lumbar vBMD was measured by QCT. The coronary artery calcification score (CACS) was calculated using an artificial intelligence-assisted diagnostic system. Patients were categorized into a low calcification group (CACS≤100, 592 cases) and a moderate-to-severe calcification group (CACS>100, 399 cases). Independent-sample t-tests, Mann-Whitney U tests, or χ2 tests were employed to analyze the differences in clinical data and lumbar vBMD between the two groups. Binary logistic regression was employed to control confounding factors and analyze the correlation between lumbar vBMD and moderate-to-severe CAC. Multivariate binary logistic regression was used to identify independent predictors of moderate-to-severe CAC and construct a combined prediction model. The receiver operating characteristic curve was used to evaluate the efficacy of lumbar vBMD and the combined model in predicting moderate-to-severe CAC. The comparison of the area under the curve (AUC) was conducted using the DeLong test. Results:The age, incidence of diabetes, hypertension, and osteoporosis were significantly higher in the moderate-to-severe calcification group than in the low calcification group, while lumbar vBMD was significantly lower in the former group (all P<0.05). The body mass index, smoking history, and hyperlipidemia had no statistical differences between the two groups (all P>0.05). Following adjustment for potential confounding variables, the results of binary logistic regression analysis revealed that lumbar vBMD was not significantly associated with the presence of moderate-to-severe CAC in the overall study population or in male ( OR=0.998, 95% CI 0.993-1.003, P=0.379; OR=1.000, 95% CI 0.993-1.006, P=0.918). However, lumbar vBMD was a statistically significant predictor in females ( OR=0.992, 95% CI 0.985-0.999, P=0.032). Multivariate binary logistic regression analysis further demonstrated that age ( OR=1.048, 95% CI 1.019-1.077, P=0.001), hypertension ( OR=2.649, 95% CI 1.719-4.082, P<0.001), and lumbar vBMD ( OR=0.992, 95% CI 0.984-0.999, P=0.022) were independent predictors of moderate-to-severe CAC in women. The AUC of lumbar vBMD for predicting moderate-to-severe CAC in female patients was 0.684 (95% CI 0.641-0.725), and the AUC of the combined model was 0.746 (95% CI 0.705-0.784), with a statistically significant difference ( Z=3.26, P=0.001). Conclusions:Lumbar vBMD measured by QCT is an independent predictor of moderate-to-severe CAC in women and demonstrates moderate predictive value. The predictive performance can be enhanced by integrating age and hypertension into a combined predictive model.

Objective:To explore the value of lumbar volumetric bone mineral density (vBMD) measured by quantitative computed tomography (QCT) in predicting coronary artery calcification (CAC).Methods:This retrospective, cross-sectional study included a total of 991 patients (504 male and 487 female) who underwent coronary artery CT angiography (CTA) and chest, abdomen, or lumbar spine CT examinations at Taihe County People′s Hospital from January 2023 to June 2024. Lumbar vBMD was measured by QCT. The coronary artery calcification score (CACS) was calculated using an artificial intelligence-assisted diagnostic system. Patients were categorized into a low calcification group (CACS≤100, 592 cases) and a moderate-to-severe calcification group (CACS>100, 399 cases). Independent-sample t-tests, Mann-Whitney U tests, or χ2 tests were employed to analyze the differences in clinical data and lumbar vBMD between the two groups. Binary logistic regression was employed to control confounding factors and analyze the correlation between lumbar vBMD and moderate-to-severe CAC. Multivariate binary logistic regression was used to identify independent predictors of moderate-to-severe CAC and construct a combined prediction model. The receiver operating characteristic curve was used to evaluate the efficacy of lumbar vBMD and the combined model in predicting moderate-to-severe CAC. The comparison of the area under the curve (AUC) was conducted using the DeLong test. Results:The age, incidence of diabetes, hypertension, and osteoporosis were significantly higher in the moderate-to-severe calcification group than in the low calcification group, while lumbar vBMD was significantly lower in the former group (all P<0.05). The body mass index, smoking history, and hyperlipidemia had no statistical differences between the two groups (all P>0.05). Following adjustment for potential confounding variables, the results of binary logistic regression analysis revealed that lumbar vBMD was not significantly associated with the presence of moderate-to-severe CAC in the overall study population or in male ( OR=0.998, 95% CI 0.993-1.003, P=0.379; OR=1.000, 95% CI 0.993-1.006, P=0.918). However, lumbar vBMD was a statistically significant predictor in females ( OR=0.992, 95% CI 0.985-0.999, P=0.032). Multivariate binary logistic regression analysis further demonstrated that age ( OR=1.048, 95% CI 1.019-1.077, P=0.001), hypertension ( OR=2.649, 95% CI 1.719-4.082, P<0.001), and lumbar vBMD ( OR=0.992, 95% CI 0.984-0.999, P=0.022) were independent predictors of moderate-to-severe CAC in women. The AUC of lumbar vBMD for predicting moderate-to-severe CAC in female patients was 0.684 (95% CI 0.641-0.725), and the AUC of the combined model was 0.746 (95% CI 0.705-0.784), with a statistically significant difference ( Z=3.26, P=0.001). Conclusions:Lumbar vBMD measured by QCT is an independent predictor of moderate-to-severe CAC in women and demonstrates moderate predictive value. The predictive performance can be enhanced by integrating age and hypertension into a combined predictive model.

Objective To investigate the characteristics of heart rate variability(HRV)in obese patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS).Methods We retrospectively analyzed 78 patients with severe OSAHS diagnosed by polysomnography(PSG)in The Second Affiliated Hospital of Xi'an Jiaotong University from April 2018 to May 2022.According to body mass index(BMI),the patients were divided into obese with severe OSAHS group(43 cases)and non-obese with severe OSAHS group(35 cases).All patients received 24-hour Holter monitoring while on polysomnography monitoring.The differences in HRV indexes between the groups and the correlation between HRV and clinical indicators were analyzed.Results In terms of basic data and PSG indexes,the analysis results showed that compared with those in the non-obese OSAHS group,weight,BMI,neck circumference,waist circumference,and AHI in obese with severe OSAHS group were significantly higher,while the standard deviation of the 24-hour normal R-R interval(SDNN),the standard deviation of the 5-minute mean(SDANN),the triangle index(TI),the heart rate deceleration force(DC),the standard deviation of the normal R-R interval(awake SDNN),and high frequency during sleep in the obese with severe OSAHS group were significantly lower(P＜0.05).The correlation results showed that among obese with severe OSAHS patients,root mean square of the difference of adjacent R-R interval(rMSSD)was negatively correlated with the course of hypertension;TI and DC were negatively correlated with AHI.After adjusting for neck circumference and waist circumference,the linear regression analysis showed that SDNN,SDANN,and rMSSD were correlated with systolic blood pressure(P＜0.05).Conclusion There is significant decrease in HRV index in obese patients with severe OSAHS,suggesting that deterioration of cardiac autonomic nervous regulation function may increase the risk of cardiovascular disease.

Objective: To explore the expression and distribution of μ-opioid receptors(MOR) in intracardiac ganglia(ICG) and the effect of its agonists on atrial fibrillation(AF). Methods: (1) The chemical anatomical characteristics of ICG in normal SD rats were studied by immunofluorescence single staining. The expression and distribution of MOR in ICG were detected by using immunofluorescence double staining, Western blot, and RT-PCR.(2) Forty male SD rats weighing 250-300 g were randomly divided into 5 groups: normal group, AF model group(AF group), solvent control group(AF-NS group), MOR-specific agonist endomorphin-2(EM2) drug group(AF-EM2 group) and DAMGO drug group(AF-DAMGO group). The AF model was established by tail vein injection of acetylcholine(Ach) and CaCl2, and drug intervention was given during modeling. The duration of AF before and after drug administration was monitored by collecting electrocardiograms. The protein and mRNA expression of MOR in ICG and connexin 43(CX43) in atrial tissue were detected by the method of Western blot and qRT-PCR. Results: (1) Peptide nerve fibers positive for substance P and calcitonin gene-related peptide were found in the ICG, along with parasympathetic neurons positive for acetylcholine transferase and sympathetic neurons positive for tyrosine hydroxylase. The mRNA transcripts and protein of MOR were expressed in the atrial posterior wall tissue. MOR immunoreactive products were mainly distributed in the cell bodies of ICG neurons, primarily in parasympathetic and sympathetic neurons.(2) Compared with the Normal group, the expression ofMORmRNA and protein in ICG of the AF rat decreased(P<0.05). Compared with the AF-NS group, the duration of AF was shortened in the AF-EM2 group and AF-DAMGO group, and the expression of CX43 increased(P<0.05). Conclusion MOR is mainly expressed in sympathetic and parasympathetic neurons in ICG. The expression of MOR decreases in AF rats. MOR agonists alleviate AF.

Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intra-aortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocar-dial infarction during PCI process.Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected.Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group,the patients under support of only intra-aortic balloon pump were selectedin the control group.The differ-ences of clinical features and prognosis were compared.Results A total of 40 patients were enrolled,11 were in the observation group and 29 in the control group.Compared with control group,more patients were complicated with old myocardial infarction(5/11 vs.2/29,P=0.016),more patients were diagnosed as non-ST elevated myocardial infarction(8/11 vs.11/29,P=0.049)and left ventricular ejecting fraction was lower[(38.5±10.10)vs.(48.55±8.86),P=0.01]in observation group.Moreover,the proportion of patients with EF＜35％was higher in the observation group(5/11 vs.3/29,P=0.01).The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group(multi-vessel disease:10/11 vs.11/29,P=0.02;Syntax score:[(33.36±13.37)vs.(25.74±5.75),P=0.015];the observation group exhibited a higher proportion of patients achieving complete revascularization(9/11 vs.8/29,P=0.002).Mechanical complications were higher in observation group(6/11 vs.5/29,P=0.02),The survive rate in observation group is higher than that in control group(91.00％vs.55.17％,P=0.03)at one-year follow-up.Conclusion Compared with only IABP,ECMO com-bined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome,although it has rela-tively higher mechanical complications.

Objective To discuss the clinical efficacy and safety of bilateral internal iliac artery Fogarty balloon occlusion in uterine curettage for patients with cesarean scar pregnancy(CSP).Methods The clinical data of a total of 80 CSP patients,who were admitted to the Fuyang People's Hospital of China between January 2021 and September 2022 to receive treatment,were retrospectively analyzed.The patients were divided into the observation group(n=40)and the control group(n=40).For the patients of the observation group,the hysteroscopic uterine curettage was carried out under the situation of bilateral internal iliac artery Fogarty balloon occlusion and during the operation the internal iliac artery was intermittently blocked.The embryo was removed,and the hemostasis was accomplished by electrocoagulation or surgical suture.For the patients of the control group,the hysteroscopic uterine curettage was performed within 1-2 days after uterine artery embolization(UAE).The digital subtraction angiography(DSA)fluoroscopy time,body surface radiation dose,blood loss during uterine curettage,time spent for uterine curettage,length of hospital stay,and postoperative follow-up results were compared between the two groups.Results Successful uterine curettage was accomplished and the uterus was retained in all the patients.In the observation group,no balloon-related complications occurred.In the control group,all the 40 patients developed different degrees of fever,pain at uterine area,and other post-embolization symptoms after UAE.In the observation group and the control group,the DSA fluoroscopy time was(9.2±1.1)seconds and(1 273.6±141.1)seconds respectively,the body surface radiation dose was(7.7±0.8)mGy and(1 503.8±101.8)mGy respectively,the differences between the two groups were statistically significant(both P＜0.05);the blood loss during uterine curettage was(30.3±14.7)mL and(27.5±13.2)mL respectively,the time spent for uterine curettage was(41.6±16.2)min and(42.8±15.0)min respectively,the differences between the two groups were not statistically significant(both P＞0.05);the length of hospital stay was(6.0±0.7)days and(7.3±0.8)days respectively,the difference between the two groups was statistically significant(P＜0.05).All patients were followed up for more than 3 months,the time of β-hCG turning to negative,time of vaginal bleeding,time of menstruation returning to normal,and patient satisfaction rate in the observation group were(21.1±2.4)days,(8.2±1.1)days,(29.5±2.2)days and 95.0%(38/40)respectively,which in the control group were(24.6±3.3)days,(13.6±2.6)days,(46.7±7.3)days and 67.5%(27/40)respectively,the differences in the above indexes between the two groups were statistically significant(all P＜0.05).Conclusion In performing uterine curettage for CSP patients,both bilateral internal iliac artery Fogarty balloon occlusion and UAE can significantly reduce the intraoperative blood loss,but bilateral internal iliac artery Fogarty balloon occlusion is superior to UAE in reducing radiation dose,in shortening the patient's hospital stay,the time of β-hCG turning to negative,the time of vaginal bleeding and the time of menstruation returning to normal,and in improving the patient satisfaction rate.

Objective To evaluate the postoperative analgesia efficacy and clinical safety of hydro-morphone patients-controlled intravenous analgesia(PCIA)in patients with scar pregnancy after auxiliary uterine artery embolization(UAE).Methods A total of 116 patients with scar pregnancy,who received auxiliary UAE at the Fuyang Municipal People's Hospital of China between January 2021 and September 2022,were enrolled in this study.According to the intravenous self-controlled analgesic drugs used after UAE,the patients were randomly and equally divided into observation group(n=58)and control group(n=58).Ten minutes before the procedure,intravenous injection of 2 mg hydromorphone(observation group)or 2 μg/kg sufentanyl(control group)was performed,and the PCIA pump was connected.In the observation group,the mixed solution of 10 mg hydromorphone+100 mg flurbiprofen axetil+100 mL saline was put in the analgesic pump,while in the control group,the mixed solution of 2 μg/kg sufentanyl+flurbiprofen axetil 100 mg+100 mL saline was put in the analgesic pump.The post-UAE 0.5-h,4-h,8-h,12-h,24-h and 48-h visual analogue scale(VAS)scores,the Bruggrmann comfort scale(BCS)scores,the number of pressing analgesic pump times within postoperative 48 hours,the used dosage of analgesic drugs,the adverse reactions,and the incidence of postoperative complications were recorded.Results The difference in the post-UAE 0.5-h VAS scores between the observation group and the control group was not statistically significant(P＞0.05),while the post-UAE 4-h,8-h,12-h,24-h and 48-h VAS scores in the observation group were significantly lower than those in the control group,and the differences were statistically significant(all P＜0.05).The post-UAE 0.5-h,4-h,8-h,12-h,24-h and 48-h BCS scores in the observation group were significantly higher than those in the control group,and the differences were statistically significant(all P＜0.05).The number of pressing analgesic pump times and the used dosage of analgesic drugs within postoperative 48 hours in the observation group were lower than those in the control group,and the differences were statistically significant(all P＜0.05).No statistically significant differences in the complications such as drowsiness,skin itching,hypoxia,or respiratory depression,etc.existed between the two groups,while the difference in the incidence of adverse reactions between the two groups was statistically significant(P＜0.05).Conclusion Hydromorphone and sufentanil PCIA can relieve the pain in scar pregnancy patients after UAE.Hydromorphone is superior to sufentanil in reducing the number of pressing analgesic pump times within postoperative 48 hours,reducing the used dosage of analgesic drugs,and decreasing the incidence of adverse reactions,therefore,hydromorphone PCIA has a certain promotion value.(J Intervent Radiol,2024,33:240-244)

;Objective To explore the safety and effectiveness of renal capsular artery embolization(RCAE)combined with superselective renal artery embolization(SRAE)in the treatment of traumatic renal hemorrhage(TRH).Methods A total of 50 patients with TRH were retrospectively selected.Among them,25 patients in the observation group were treated with RCAE combined with SRAE;25 patients in the control group were treated with SRAE.The patients were followed up for 3 months,in which the improvement of related indicators and symptoms during the perioperative period and the occurrence of related complications within 3 months after surgery were recorded.Results Both groups of patients successfully underwent interventional surgery to control renal bleeding.There were no statistically significant differences in the location of vascular injury,angiographic manifestations,and embolization materials used for renal artery embolization(RAE)between the two groups(P＞0.05).There were no statistically significant differences in preoperative hemoglobin(Hb),visual analogue scale(VAS)score of renal pain,serum creatinine(Scr),systolic blood pressure,postoperative 7 d Scr and postoperative 1 month systolic blood pressure between the two groups(P＞0.05).When comparing postoperative 24 h Hb and VAS score of renal pain between the two groups,the differences were statistically significant(P＜0.05).The postoperative satisfaction rate of the observation group was higher than that of the control group,and the postoperative hospitalization time was shorter than that of the control group,with statistical significance(P＜0.05).Conclusion The treatment of TRH in both groups can increase Hb 24 h after surgery and reduce VAS score of renal pain 24 h after surgery.Compared with the control group,the observation group significantly can improve postoperative 24 h Hb and patient satisfaction rate,reduce postoperative 24 h VAS score of renal pain,and reduce postoperative hospitalization time.RCAE combined with SRAE is a safe,effective,and minimally invasive hemostasis method for the treatment of TRH and is worthy of promotion.

Objective To evaluate the effect of extracorporeal membrane oxygenation combined with intra-aortic balloon pump mechanical circulatory support for patients with cardiogenic shock complicating acute myocar-dial infarction during PCI process.Methods Patients with cardiogenic shock complicating myocardial infarction who underwent PCI in the hospital from January 2015 to December 2019 were selected.Those who were under support of extracorporeal membrane oxygenation combined with intra-aortic balloon pump were enrolled in the observation group,the patients under support of only intra-aortic balloon pump were selectedin the control group.The differ-ences of clinical features and prognosis were compared.Results A total of 40 patients were enrolled,11 were in the observation group and 29 in the control group.Compared with control group,more patients were complicated with old myocardial infarction(5/11 vs.2/29,P=0.016),more patients were diagnosed as non-ST elevated myocardial infarction(8/11 vs.11/29,P=0.049)and left ventricular ejecting fraction was lower[(38.5±10.10)vs.(48.55±8.86),P=0.01]in observation group.Moreover,the proportion of patients with EF＜35％was higher in the observation group(5/11 vs.3/29,P=0.01).The observation group has significantly higher rates of multi-vessel disease and Syntax scores compared to the control group(multi-vessel disease:10/11 vs.11/29,P=0.02;Syntax score:[(33.36±13.37)vs.(25.74±5.75),P=0.015];the observation group exhibited a higher proportion of patients achieving complete revascularization(9/11 vs.8/29,P=0.002).Mechanical complications were higher in observation group(6/11 vs.5/29,P=0.02),The survive rate in observation group is higher than that in control group(91.00％vs.55.17％,P=0.03)at one-year follow-up.Conclusion Compared with only IABP,ECMO com-bined with IABP hemodynamic support during PCI process for patients with cardiogenic shock complicating acute myocardial infarction enjoys more complete revascularization and better mortality outcome,although it has rela-tively higher mechanical complications.