OBJECTIVE To investigate the effects of subanesthetic dose of esketamine on postoperative anxiety and recovery in patients undergoing laparoscopic cholecystectomy. METHODS A total of 200 patients scheduled for laparoscopic cholecystectomy at Suzhou Ninth Hospital Affiliated to Soochow University from January 2023 to December 2024 were randomly assigned to control group （n＝100） and observation group （n＝100）. One minute before the initiation of anesthesia， patients in the control group received intravenous injections of Propofol emulsion injection， Sufentanil citrate injection， and Succinylcholine chloride injection. On this basis， patients in the observation group received an intravenous injection of Esketamine hydrochloride injection. The anxiety status of patients in both groups was compared， along with their general intraoperative conditions （including sufentanil dosage， duration of pneumoperitoneum， operative time， anesthesia time， and extubation time）， postoperative recovery， incidence of adverse reactions， and the need for dezocine rescue analgesia. Heart rate and mean arterial pressure， entropy index （state entropy and response entropy）， inflammatory marker levels [interleukin-6 （IL-6） and C-reactive protein （CRP）]， numerical rating scale （NRS） for pain intensity were compared between the two groups at different time points. RESULTS No significant differences were found between the two groups in pneumoperitoneum duration， operative time， anesthesia time，extubation time， incidence of postoperative dry mouth， entropy index or length of stay in the post-anesthesia care unit （P＞0.05）. Compared with the control group， the observation group showed significantly lower postoperative STAI-S scores， reduced intraoperative sufentanil consumption， decreased incidence of postoperative nausea， vomiting， and shivering， the need for dezocine rescue analgesia， as well as lower plasma IL-6 and CRP levels at 24 h after surgery， and NRS （P＜0.05）. The heart rate and mean arterial pressure of patients in the observation group at the start of surgery， end of surgery， and during extubation were all significantly higher than those in the control group （P＜0.05）. CONCLUSIONS Subanesthetic dose of esketamine can effectively alleviate postoperative anxiety， reduce intraoperative opioid consumption， suppress postoperative inflammatory response， relieve postoperative pain， and promote recovery in patients undergoing laparoscopic cholecystectomy.

Objective This study aimed to observe the effects of Yin-Yang balancing acupotomy intervention on knee-joint function and lower limb biomechanics in a rat model of knee osteoarthritis(KOA),and to explore the mechanisms of acupotomy when treating KOA.Methods Forty SD rats were randomly divided into a blank group,a model group,an acupotomy group,and a medication group.Except for the blank group,KOA models were established by injecting a mixed solution of 4%papain and 0.03 mol/L L-cysteine into the left knee-joint cavity.The acupotomy group received Yin-Yang balancing acupotomy interventions targeting the medial/lateral collateral ligaments and patellar ligament.The medication group received daily oral celecoxib(10 mg/(kg·d)).Interventions began on day 7 post-modeling,and occurred once weekly for 4 weeks.All rats were assessed pre-and post-intervention using the modified Lequesne MG knee-joint grading system and rotarod fatigue test.Post-intervention,in vivo DR imaging was used to measure joint space width.Cartilage morphology was evaluated via HE and safranin O-fast green staining.Ligament biomechanical tensile testing was performed.Serum and cartilage tissues were analyzed by ELISA and Western Blot for matrix metalloproteinase-13(MMP-13)expression.Results(1)Compared with the blank group,the model group showed increased modified Lequesne MG scores,reduced rotarod endurance time,and narrowed joint space(P＜0.01).(2)Compared with the model and medication groups,the acupotomy group exhibited lower Lequesne MG scores,prolonged rotarod endurance time(P＜0.05),and expanded joint space(P＜0.05).(3)The elastic modulus of ligaments in the acupotomy group showed no significant difference from those in the model group but was higher than those in the medication group.Yield strength,maximum strain,and yield-to-tensile strength ratio in the acupotomy group were higher than those in the model and medication groups(P＜0.05).(4)HE and Safranin O-Fast green staining revealed minimal inflammatory infiltration in the acupotomy group compared with the model group.Cartilage surfaces in the acupotomy group were smoother than those in the medication group.(5)ELISA showed reduced serum MMP-13 levels in the acupotomy group versus the model group(P＜0.01),and no significant differences between levels in the drug and acupotomy groups.(6)Cartilage MMP-13 expression in the acupotomy group was significantly lower than that in the model group(P＜0.01)and lower than that in the medication group(P＜0.05).Conclusions Acupotomy intervention enhances knee joint stability,improves lower limb mechanical alignment,and suppresses MMP-13 expression in KOA rats.

Objective This study aimed to observe the effects of Yin-Yang balancing acupotomy intervention on knee-joint function and lower limb biomechanics in a rat model of knee osteoarthritis(KOA),and to explore the mechanisms of acupotomy when treating KOA.Methods Forty SD rats were randomly divided into a blank group,a model group,an acupotomy group,and a medication group.Except for the blank group,KOA models were established by injecting a mixed solution of 4%papain and 0.03 mol/L L-cysteine into the left knee-joint cavity.The acupotomy group received Yin-Yang balancing acupotomy interventions targeting the medial/lateral collateral ligaments and patellar ligament.The medication group received daily oral celecoxib(10 mg/(kg·d)).Interventions began on day 7 post-modeling,and occurred once weekly for 4 weeks.All rats were assessed pre-and post-intervention using the modified Lequesne MG knee-joint grading system and rotarod fatigue test.Post-intervention,in vivo DR imaging was used to measure joint space width.Cartilage morphology was evaluated via HE and safranin O-fast green staining.Ligament biomechanical tensile testing was performed.Serum and cartilage tissues were analyzed by ELISA and Western Blot for matrix metalloproteinase-13(MMP-13)expression.Results(1)Compared with the blank group,the model group showed increased modified Lequesne MG scores,reduced rotarod endurance time,and narrowed joint space(P＜0.01).(2)Compared with the model and medication groups,the acupotomy group exhibited lower Lequesne MG scores,prolonged rotarod endurance time(P＜0.05),and expanded joint space(P＜0.05).(3)The elastic modulus of ligaments in the acupotomy group showed no significant difference from those in the model group but was higher than those in the medication group.Yield strength,maximum strain,and yield-to-tensile strength ratio in the acupotomy group were higher than those in the model and medication groups(P＜0.05).(4)HE and Safranin O-Fast green staining revealed minimal inflammatory infiltration in the acupotomy group compared with the model group.Cartilage surfaces in the acupotomy group were smoother than those in the medication group.(5)ELISA showed reduced serum MMP-13 levels in the acupotomy group versus the model group(P＜0.01),and no significant differences between levels in the drug and acupotomy groups.(6)Cartilage MMP-13 expression in the acupotomy group was significantly lower than that in the model group(P＜0.01)and lower than that in the medication group(P＜0.05).Conclusions Acupotomy intervention enhances knee joint stability,improves lower limb mechanical alignment,and suppresses MMP-13 expression in KOA rats.

Stent entrapment is a rare complication of percutaneous coronary intervention.In recent years,with the development of distal radial artery puncture technology,the rare complications related to distal radial artery have been gradually understood.This article describes a patient who underwent coronary intervention through a distal radial approach,and the stent was dislodged and trapped in the far radial artery.The patient came to our hospital for stent implantation because of acute extensive anterolateral myocardial infarction.During the intervention,the balloon could not be filled when the stent was released from the left anterior descending artery,and the retracting stent could not be used to remove the guide catheter.The stent was dislodged and embedded in the distal vessel.The sheath was inserted through the proximal radial reverse puncture,and the stent was captured with a snare and removed.

Periodontitis as a common chronic inflammatory oral disease,seriously threatens oral and systemic health.Currently,the clinical conventional treatment options for periodontitis mainly include mechanical therapy and drug therapy.Mechanical treatment,such as scaling and curettage,can to some extent remove dental plaque and tartar,but it was difficult to completely remove bacteria in deep periodontal pockets,leading to inflammation that was prone to recurrence.Traditional drug treatments,such as the use of antibiotics,have limited long-term use due to issues such as drug resistance and side effects,while restricted its long-term use.As an important derivative of artemisinin,artemether has various unique pharmacological activities such as anti-inflammatory,antibacterial,immune regulation,and promotion of tissue repair.Currently,multiple basic studies have shown that artemether can be used for the treatment of periodontitis.This article reviews the pharmacological effects of artemether in the prevention and treatment of periodontitis,aiming to provide theoretical basis for the clinical treatment of periodontitis and assist in the development of new treatment plans.

Periodontitis as a common chronic inflammatory oral disease,seriously threatens oral and systemic health.Currently,the clinical conventional treatment options for periodontitis mainly include mechanical therapy and drug therapy.Mechanical treatment,such as scaling and curettage,can to some extent remove dental plaque and tartar,but it was difficult to completely remove bacteria in deep periodontal pockets,leading to inflammation that was prone to recurrence.Traditional drug treatments,such as the use of antibiotics,have limited long-term use due to issues such as drug resistance and side effects,while restricted its long-term use.As an important derivative of artemisinin,artemether has various unique pharmacological activities such as anti-inflammatory,antibacterial,immune regulation,and promotion of tissue repair.Currently,multiple basic studies have shown that artemether can be used for the treatment of periodontitis.This article reviews the pharmacological effects of artemether in the prevention and treatment of periodontitis,aiming to provide theoretical basis for the clinical treatment of periodontitis and assist in the development of new treatment plans.

Stent entrapment is a rare complication of percutaneous coronary intervention.In recent years,with the development of distal radial artery puncture technology,the rare complications related to distal radial artery have been gradually understood.This article describes a patient who underwent coronary intervention through a distal radial approach,and the stent was dislodged and trapped in the far radial artery.The patient came to our hospital for stent implantation because of acute extensive anterolateral myocardial infarction.During the intervention,the balloon could not be filled when the stent was released from the left anterior descending artery,and the retracting stent could not be used to remove the guide catheter.The stent was dislodged and embedded in the distal vessel.The sheath was inserted through the proximal radial reverse puncture,and the stent was captured with a snare and removed.

This study utilized ultra-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS) to rapidly analyze and identify the chemical constituents in five processed products of Strychni Semen(raw, sand-roasted, fried, urine-soaked, and vinegar-processed products). Using PeakView software to extract compound information, 50 chemical components were identified based on retention time, accurate molecular ion peaks, secondary mass spectrometry data, and comparison with reference standards and relevant literature. Specifically, 41 components were identified in raw Strychni Semen, 48 in sand-roasted, 43 in fried, 41 in urine-soaked, and 40 in vinegar-processed products. Principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA) were employed to identify differential components among the processed products, with variable importance in projection(VIP) values>1 and a t-test with P<0.05 as criteria. PCA revealed significant differences among the five processed products, demonstrating good clustering and separation. OPLS-DA identified 13 differential components, including brucine, strychnine, loganic acid, and chlorogenic acid. The results indicated that S. nux-vomica primarily contained alkaloids, organic acids, and glycosides, with significant compositional differences among the various processed products. Notably, the content of key components such as brucine and strychnine decreased after processing, with the most significant reduction observed in vinegar-processed Strychni Semen. In conclusion, this study provides a comprehensive comparison of the effects of different processing methods on the chemical composition of Strychni Semen, exploring the differences in the material basis of the processed products and offering data to support the scientific rationale behind the processing of Strychni Semen.
Chromatography, High Pressure Liquid/methods* ; Drugs, Chinese Herbal/analysis* ; Mass Spectrometry/methods* ; Strychnos/chemistry* ; Principal Component Analysis

ObjectiveTo analyse the clinical characteristics of different traditional Chinese medicine （TCM） syndromes in patients with heart failure based on information from electronic medical record. MethodsA cross-sectional study was conducted to collect clinical data of all inpatients with heart failure in the Department of Cardiology， Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 1， 2019 to December 31， 2020. A database of clinical TCM data was established to explore the characteristics of clinical data of basic information， syndromes and syndrome element types， and biochemical indexes. The distribution of TCM syndromes and syndrome elements in heart failure patients were also analysed， and the basic information and biochemical indexes of the patients with top 7 different TCM syndrome types were compared. ResultsA total of 1676 inpatients with heart fai-lure were included. The top 7 TCM syndromes of heart failure were syndrome of phlegm turbidity and blood stasis （477 cases， 28.46%）， syndrome of qi deficiency and blood stasis （439 cases， 26.19%）， syndrome of qi deficiency and blood stasis with water retention （274 cases， 16.35%）， syndrome of yang deficiency with water retention （145 cases， 8.65%）， syndrome of qi and yin deficiency （104 cases， 6.21%）， syndrome of qi and yin deficiency with blood stasis （80 cases， 4.77%）， syndrome of heart yang deficiency （59 cases， 3.52%）. Among the 1676 patients， 6 syndrome elements accounted for more than 5%. Blood stasis accounted for the highest proportion of TCM syndrome element type （1292 cases， 77.09%）， followed by qi deficiency （919 cases， 54.83%）， phlegm （498 cases， 29.71%）， water retention （434 cases， 25.89%）， yang deficiency （215 cases， 12.82%） and yin deficiency （191 cases， 11.40%）. Among the 1676 patients， 1308 cases of acute heart failure mainly showed syndrome of phlegm turbidity and blood stasis （386 cases， 29.51%）， and 368 of chronic heart fai-lure mainly showed syndrome of qi deficiency and blood stasis （118 cases， 32.07%）. Patients with syndrome of phlegm turbidity and blood stasis had the shortest disease duration of 0.3 months， while those with syndrome of heart yang deficiency had the longest disease duration of 15 months. The proportion of syndrome of phlegm turbidity and blood stasis was the highest in patients with heart failure combined with coronary artery disease， the proportion of syndrome of qi deficiency and blood stasis with water retention was the highest in patients with heart failure combined with atrial fibrillation， and the proportion of patients with syndrome of qi deficiency and blood stasis with water retention and syndrome of yang deficiency with water retention in those applying diuretics during the hospital stay was the highest with more than 86%. The different 7 TCM syndromes showed statistically difference in patients with complications including coronary artery disease， old myocardial infarction， atrial fibrillation， pre and post-admission medication usage including intravenous vasodilators， cardiac stimulants， diuretics， and level of blood chloride， blood urea， blood creatinine， blood bicarbonate， blood albumin， and blood total bilirubin （P＜0.05）. ConclusionThe most common TCM syndromes in patients with heart failure are syndrome of phlegm turbidity and blood stasis and syndrome of qi deficiency and blood stasis. Different TCM syndromes have different characteristics in gender， disease complications， medication before and after admission， and blood indexes.

Objective:To compare the analgesic effects of fascia iliaca compartment block with different concentrations of liposomal bupivacaine for total hip replacement in elderly patients.Methods:This was a prospective study. Sixty-four elderly patients of either sex with hip fracture, aged 65-85 yr, with body mass index of 20-30 kg/m 2 and American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing elective total hip arthroplasty from September to December 2023 in Zhangjiagang Hospital affiliated to Soochow University, were divided into LB1, LB2, LB3 and LB4 groups ( n=16 each) using the random number table method. The fascia iliaca compartment block was performed under ultrasound guidance before anesthesia induction. Liposomal bupivacaine 66.5, 133.0, 199.5 and 266.0 mg diluted to 30 ml in normal saline were given in LB1, LB2, LB3 and LB4 groups, respectively. The consumption of intraoperative sufentanil and remifentanil and tracheal extubation time were recorded. The pain numeric rating scale (NRS) scores at rest and during activity were recorded at 4, 8, 12, 24 and 48 h postoperatively. Parecoxib sodium was intravenously injected when the NRS score≥4, and the use of parecoxib sodium was recorded. The effect of motor nerve block in the affected lower extremity was evaluated using the modified Bromage scale score at 4, 8, 12, 24 and 48 h postoperatively. The first ambulation time and duration of hospitalization were recorded. The scores for patients′ satisfaction with analgesic effects at 48 h after operation and the occurrence of adverse reactions within 48 h after operation were recorded. Results:Compared with LB1 group, the consumption of intraoperative sufentanil and remifentanil was significantly reduced, the tracheal extubation time was shortened, NRS scores at rest at 12, 24 and 48 h after operation and NRS scores during activity at 8, 12, 24 and 48 h after operation were significantly decreased, and the scores for patients′ satisfaction with analgesic effects were increased in LB2, LB3 and LB4 groups, the modified Bromage scale scores were significantly increased at 4 and 8 h after operation, and the first ambulation time and duration of hospitalization were shortened in LB2 group, and the modified Bromage scale scores were significantly increased at 4, 8, 12, 24 and 48 h after operation in LB3 and LB4 groups ( P<0.05). Compared with LB2 group, the modified Bromage scale scores were significantly increased at 12, 24 and 48 h after operation, and the first ambulation time and duration of hospitalization were prolonged in LB3 and LB4 groups ( P<0.05). There was no significant difference in the incidence of postoperative adverse reactions among the four groups ( P>0.05). Conclusions:The optimal concentration of liposomal bupivacaine for fascia iliaca compartment block is 133 mg/30 ml when used for analgesia in elderly patients undergoing total hip replacement.