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 To investigate the therapeutic efficacy of artesunate(AS)on polycystic ovary syndrome(PCOS)in mice and explore the potential mechanism primarily.Methods Twenty-five female C57BL/6J mice were randomly divided into Control group,model group(PCOS group),low-and high-dose AS groups(AS15 and AS30 groups)and metformin group(Met group).In addition to the Control group,the mouse model of PCOS was established by subcutaneous injection of dehydroepiandrosterone(DHEA,60 mg/kg)following by a high-fat diet for 21 d.After modeling,AS of 15 and 30 mg/kg was intraperitoneally injected into the mice of the AS 15 and AS30 groups,respectively,and 200 mg/kg Met was given to those of the Met group by gavage,once per day,for 6 weeks.ELISA was used to detect serum testosterone(T),fasting insulin(FINS),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and the LH/FSH ratio was calculated.The levels of fasting blood glucose(FBG),triglyceride(TG)and total cholesterol(TC)were detected by automatic biochemical analyzer,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The estrous cycle was observed,and HE staining was performed for pathological changes in the ovary and uterus.Immunofluorescence assay was employed to measure the expression of p-eIF2α,ATF4 and CHOP in the ovarian tissue.After steroidogenic human granulosa-like tumor cell line KGN were exposed to 100 μmol/L DHEA to simulate the hyperandrogen environment of PCOS,and then treated with 5 and 10 μg/mL AS for 24 h,the protein levels of endoplasmic reticulum stress signaling pathway was detected by Western blotting.Results Compared with the Control group,the PCOS mice had disturbed estrous cycle,polycystic changes in the ovaries,and significantly increased serum T level and LH/FSH ratio(P＜0.05),and obviously elevated HOMA-IR,TC and TG levels in terms of metabolism(P＜0.01).The expression levels of p-eIF2α,ATF4 and CHOP were notably up-regulated in the ovarian granulosa cells of PCOS mice and KGN cells after DHEA exposure(P＜0.05).Additionally,AS treatment attenuated the pathological changes of ovary and uterine expression,decreased the serum T level and the LH/FSH ratio(P＜0.05),and reduced HOMA-IR,TC and TG levels(P＜0.05)when compared with the PCOS mice.Moreover,the expression levels of p-eIF2α,ATF4 and CHOP were significantly down-regulated after AS treatment in both ovarian granulosa cells of PCOS mice and KGN cells(P＜0.05).Conclusion AS significantly improves glycolipid metabolic disorder and reproductive dysfunction in PCOS mice,which may be associated with its suppressing endoplasmic reticulum stress by inhibiting the PERK/eIF2α/ATF4/CHOP pathway.

Objective To explore the potential of CS-AI technique in accelerating cranial three-dimensional double inversion recovery(3D DIR)sequence imaging.Methods Twenty-six healthy volunteers were prospectively recruited for brain sagittal 3D DIR sequence scanning.The 3D DIR sequences were accelerated with four different acceleration factor(AF)(4,6,8,10)and reconstructed using the traditional compressed sensing(CS)algorithm and a new CS-AI algorithm.Subjective image quality was assessed by two observers using a 5-point Likert scale.Objective image quality was evaluated by calculating contrast(CN)and contrast-to-noise ratio(CNR).Firstly,using CS 4 as the standard,the optimal CS AF was derived after comparing the CN,CNR and subjective scores of CS 4 with those of CS 6,8 and 10 images in a comprehensive judgement,and then further comparing the optimal CS AF with images of CS-AI with different AF to validate the efficacy of the CS-AI,and to select the final optimal CS-AI AF.Results The comparison results between CS 4 and different CS AF indicated that CS 6 was selected as the optimal AF for CS.In further comparisons between CS and different CS-AI AF,the CS-AI technique outperformed the CS technique overall.CS-AI 8 was the maximum applicable AF.Conclusion The CS-AI is overall even better in terms of image quality with higher acceleration potential than the CS.The CS-AI 8 serves as the optimal AF and reduces scanning times by up to 50％while maintaining image quality.

Objective:To investigate the anatomical characteristics of the atlantoaxial joint associated with nonuniform settlement of the C 2 lateral mass (C 2LM-NUS) and its correlation with atlantoaxial osteoarthritis. Methods:A retrospective analysis was conducted on clinical and imaging data of 522 hospitalized patients (288 males, 234 females; mean age 60.8±11.2 years; range 18-83 years) who underwent CT scans of the head/neck or cervical spine at the Second Affiliated Hospital of Army Medical University between January 1, 2022 and December 31, 2022. Multiplanar reconstruction of CT data was performed to measure the settlement of the C 2 lateral mass (C 2LMS). Patients with a difference in bilateral C 2LMS (d-C 2LMS) >1.4 mm were classified into the C 2LM-NUS group (137 cases; 71 males, 66 females; mean age 63.3±11.6 years), while the normal group included 385 patients (217 males, 168 females; mean age 59.9±11.0 years). Imaging parameters of the atlantoaxial joint were measured, including the C 1, 2 coronal inclination angle (C 1, 2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval (LADI), coronal deviation angle of the odontoid (Od-CDA), and C 1, 2 relative rotation angle (C 1, 2 RRA). Osteoarthritis prevalence was recorded. A normal C 0-C 3 finite element (FE) model was constructed using CT data from a 48-year-old female in the normal group. A C 2LM-NUS FE model was developed based on anatomical differences between the C 2LM-NUS and normal groups, and stress distribution on the C 2 lateral mass articular surface was analyzed under flexion-extension, lateral bending, and axial rotation torques. Results:The C 2LM-NUS group exhibited asymmetric atlantoaxial joint morphology, with bilateral differences in C 1, 2CI and LADI of 8.5°(5.8°, 11.3°) and 0.8(0.1, 1.4) mm, respectively, significantly greater than those in the normal group [1.7°(0.8°, 2.7°) and 0.2(0.1, 0.5) mm, P<0.05]. Od-CDA and C 1, 2RRA were 3.9°(2.0°, 5.4°) and 7.2°(5.0°, 10.0°) in the C 2LM-NUS group, exceeding the normal group's values [0°(0°, 1.0°) and 0°(0°, 5.5°), P<0.05]. The prevalence of C 2LM-NUS was 37.8% in the atlantoaxial osteoarthritis group, significantly higher than in the non-osteoarthritis group (22.8%, P<0.05). Significant differences were observed in age (68.3±9.4 vs. 58.6±10.8 years), sex distribution (50/69 vs. 238/165), and C 1, 2RRA [5.6°(0°, 8.2°) vs. 3.8°(0°, 6.2°)] between the osteoarthritis and non-osteoarthritis groups ( P<0.05). After adjusting for age, sex, and C 1, 2RRA, binary logistic regression identified C 2LM-NUS as an independent risk factor for atlantoaxial osteoarthritis [ OR=2.024, 95% CI (1.300, 3.150), P<0.001]. FE analysis demonstrated a reduced C 1, 2 range of motion in the C 2LM-NUS model, with elevated stress concentrations on the settled side lateral mass during simulated flexion-extension, lateral bending, and rotation. Conclusions:The study indicated that C 2LM-NUS is associated with asymmetric anatomical changes in the atlantoaxial joint, increasing the risk of osteoarthritis. Stress concentration on the C 2 lateral mass articular surface, caused by C 2LM-NUS, is a biomechanical contributor to this heightened risk.

Objective To investigate the accuracy of the quantity of tumors combined with vesical imaging reporting and data system(VI-RADS)score in predicting bladder cancer(BCa)muscle invasion.Methods The multiparametric magnetic resonance imaging(mpMRI)and clinical data of 91 patients with BCa confirmed by pathology were analyzed retrospectively.The differences in detection indicators between patients with muscle invasive bladder cancer(MIBC)and non-muscle invasive bladder cancer(NMIBC)were com-pared by univariate logistic regression analysis.The independent risk factors of BCa muscle invasion were screened by multivariate logis-tic regression analysis.The receiver operating characteristic(ROC)curve were plotted for the identified independent risk factors,and the area under the curve(AUC)was calculated to analyze their diagnostic efficacy.Results There were 54 cases of MIBC and 37 cases of NMIBC.The results of univariate logistic regression analysis showed that the quantity of tumors,hematuria,age,apparent diffusion coefficient(ADC),tumor contact length(TCL),and VI-RADS score were statistically significant between the two groups(P＜0.05).The results of multivariate logistic regression analysis showed that the quantity of tumors and VI-RADS score were independent risk fac-tors for MIBC.ROC curve analysis showed that VI-RADS score≥ 4 points was the best threshold for predicting BCa muscle inva-sion.The accuracy of VI-RADS score combined with the quantity of tumors in predicting BCa muscle invasion was better than that of the quantity of tumors and VI-RADS score alone,and the difference was statistically significant(P＜0.05).Conclusion VI-RADS score combined with the quantity of tumors further improves the accuracy of predicting BCa muscle invasion.

Objective:To investigate the feasibility of varicocele ligation with mobile phone microscope.Methods:The high-performance mobile phone and mobile phone stand were combined to act as a mobile phone microscope.And the varicocele ligation was performed under the mobile phone microscope.Results:All five patients successfully underwent varicocelectomy under the guidance of a mobile phone microscope.The average operation time was(112.8±52.2)with ranged from 74.0 to 195.0 minutes.Three pa-tients completed the follow-up after the operation with the proportion of improved sperm quality reaching 100.0％(3/3).Conclusion:High-performance mobile phone microscope can be used for varicocele ligation.

Objective To explore the identification method,pathogenesis,clinical characteristics and individualized pharmacotherapy of asymptomatic hyperuricemia after renal transplantation.Methods The pharmacist was on duty at the organ transplant outpatient clinic.During this time,they analyzed and sorted out the medications,identified and differentiated a case of asymptomatic hyperuricemia related to spironolactone in a patient who had undergone a renal transplant,and provided comprehensive care throughout the entire process.Results The asymptomatic hyperuricemia in this patient might be associated with spironolactone,and the adverse reactions of the patient were alleviated by pharmacists through optimizing clinical treatment.Up to now,no hyperuricemia occurred.Conclusions Pharmacists are required to collaborate closely with clinicians to establish medication profiles for patients under long-term follow-up and to closely monitor and evaluate drug-related adverse reactions.Additionally,they should assess the renal function and immune status of transplant recipients promptly and formulate individualized treatment plans in order to enhance the long-term survival of both the transplanted kidneys and the recipients.

Objective To investigate the accuracy of the quantity of tumors combined with vesical imaging reporting and data system(VI-RADS)score in predicting bladder cancer(BCa)muscle invasion.Methods The multiparametric magnetic resonance imaging(mpMRI)and clinical data of 91 patients with BCa confirmed by pathology were analyzed retrospectively.The differences in detection indicators between patients with muscle invasive bladder cancer(MIBC)and non-muscle invasive bladder cancer(NMIBC)were com-pared by univariate logistic regression analysis.The independent risk factors of BCa muscle invasion were screened by multivariate logis-tic regression analysis.The receiver operating characteristic(ROC)curve were plotted for the identified independent risk factors,and the area under the curve(AUC)was calculated to analyze their diagnostic efficacy.Results There were 54 cases of MIBC and 37 cases of NMIBC.The results of univariate logistic regression analysis showed that the quantity of tumors,hematuria,age,apparent diffusion coefficient(ADC),tumor contact length(TCL),and VI-RADS score were statistically significant between the two groups(P＜0.05).The results of multivariate logistic regression analysis showed that the quantity of tumors and VI-RADS score were independent risk fac-tors for MIBC.ROC curve analysis showed that VI-RADS score≥ 4 points was the best threshold for predicting BCa muscle inva-sion.The accuracy of VI-RADS score combined with the quantity of tumors in predicting BCa muscle invasion was better than that of the quantity of tumors and VI-RADS score alone,and the difference was statistically significant(P＜0.05).Conclusion VI-RADS score combined with the quantity of tumors further improves the accuracy of predicting BCa muscle invasion.

BACKGROUND:Relatively or absolutely active bone resorption function of osteoclasts is one of the causative factors of osteoporosis. Therefore,how to inhibit the formation of osteoclasts and reduce the bone resorption activity is a key element in the prevention and treatment of osteoporosis. Liquiritin,which is derived from licorice,plays a role in the clinical treatment of bone diseases,but there are fewer studies addressing the application of liquiritin in osteoporosis and the mechanism is unknown.OBJECTIVE:To confirm,through both in vivo and in vitro experiments,that liquiritin inhibits osteoclast differentiation and alleviates bone loss.METHODS:Cell counting kit-8 was used to detect whether Liquiritin exerts toxic or proliferative effects on mouse bone marrow-derived macrophages,and tartrate-resistant acid phosphatase staining was performed to observe the effect of liquiritin in inhibiting osteoclast differentiation. The affinity of liquiritin binding to proteins related to osteoclast differentiation was verified by network pharmacology. RT-PCR and western blot assays were performed to detect the inhibitory effects of liquiritin on osteoclast-specific protein and gene expression as well as relevant signaling pathways. Finally,the mitigating effect of liquiritin on bone loss was verified in the C57BL/6J mouse osteoporosis model.RESULTS AND CONCLUSION:Liquiritin,at concentrations of 20 μmol/L and below,could inhibit the formation and differentiation of osteoclasts. Concurrently,it exhibited a high affinity with osteoclast-specific proteins such as nuclear factor of activated T-cells 1,Cathepsin K,c-Fos,and matrix metalloproteinase 9,and reduced the relative expression levels of these genes and proteins. Liquiritin could also effectively lower the phosphorylation expression level of JNK in the MAPK signaling pathway at the 15th,30th,45th,and 60th minutes,and it could salvage the degradation of nuclear factor-κB inhibitor α in the nuclear factor-κB signaling pathway at the 60th minute. In vivo experiments demonstrated that liquiritin could mitigate bone loss caused by osteoclasts and improve parameters related to trabecular bone. To conclude,liquiritin possesses the capacity to inhibit osteoclast differentiation and alleviate bone loss,thereby exerting a protective role against osteoporosis.

Objective:To investigate the anatomical characteristics of the atlantoaxial joint associated with nonuniform settlement of the C 2 lateral mass (C 2LM-NUS) and its correlation with atlantoaxial osteoarthritis. Methods:A retrospective analysis was conducted on clinical and imaging data of 522 hospitalized patients (288 males, 234 females; mean age 60.8±11.2 years; range 18-83 years) who underwent CT scans of the head/neck or cervical spine at the Second Affiliated Hospital of Army Medical University between January 1, 2022 and December 31, 2022. Multiplanar reconstruction of CT data was performed to measure the settlement of the C 2 lateral mass (C 2LMS). Patients with a difference in bilateral C 2LMS (d-C 2LMS) >1.4 mm were classified into the C 2LM-NUS group (137 cases; 71 males, 66 females; mean age 63.3±11.6 years), while the normal group included 385 patients (217 males, 168 females; mean age 59.9±11.0 years). Imaging parameters of the atlantoaxial joint were measured, including the C 1, 2 coronal inclination angle (C 1, 2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval (LADI), coronal deviation angle of the odontoid (Od-CDA), and C 1, 2 relative rotation angle (C 1, 2 RRA). Osteoarthritis prevalence was recorded. A normal C 0-C 3 finite element (FE) model was constructed using CT data from a 48-year-old female in the normal group. A C 2LM-NUS FE model was developed based on anatomical differences between the C 2LM-NUS and normal groups, and stress distribution on the C 2 lateral mass articular surface was analyzed under flexion-extension, lateral bending, and axial rotation torques. Results:The C 2LM-NUS group exhibited asymmetric atlantoaxial joint morphology, with bilateral differences in C 1, 2CI and LADI of 8.5°(5.8°, 11.3°) and 0.8(0.1, 1.4) mm, respectively, significantly greater than those in the normal group [1.7°(0.8°, 2.7°) and 0.2(0.1, 0.5) mm, P<0.05]. Od-CDA and C 1, 2RRA were 3.9°(2.0°, 5.4°) and 7.2°(5.0°, 10.0°) in the C 2LM-NUS group, exceeding the normal group's values [0°(0°, 1.0°) and 0°(0°, 5.5°), P<0.05]. The prevalence of C 2LM-NUS was 37.8% in the atlantoaxial osteoarthritis group, significantly higher than in the non-osteoarthritis group (22.8%, P<0.05). Significant differences were observed in age (68.3±9.4 vs. 58.6±10.8 years), sex distribution (50/69 vs. 238/165), and C 1, 2RRA [5.6°(0°, 8.2°) vs. 3.8°(0°, 6.2°)] between the osteoarthritis and non-osteoarthritis groups ( P<0.05). After adjusting for age, sex, and C 1, 2RRA, binary logistic regression identified C 2LM-NUS as an independent risk factor for atlantoaxial osteoarthritis [ OR=2.024, 95% CI (1.300, 3.150), P<0.001]. FE analysis demonstrated a reduced C 1, 2 range of motion in the C 2LM-NUS model, with elevated stress concentrations on the settled side lateral mass during simulated flexion-extension, lateral bending, and rotation. Conclusions:The study indicated that C 2LM-NUS is associated with asymmetric anatomical changes in the atlantoaxial joint, increasing the risk of osteoarthritis. Stress concentration on the C 2 lateral mass articular surface, caused by C 2LM-NUS, is a biomechanical contributor to this heightened risk.