Objective To investigate the influencing factors of delirium after cardiac valve replacement went under car-diopulmonary bypass(CPB)with propofol sedation.Methods A total of 152 patients underwent cardiac valve replacement under CPB in Nanyang Central Hospital from January 2020 to December 2022 were selected as research objects,and they were randomly divided into observation group A[50 ≤bispectral index(BIS)＜60]and observation group B(35≤BIS＜45)according to the depth of propofol sedation,with 76 cases in each group.The clinical data such as age,gender,body mass index(BMI),diabetes,hypertension,coronary heart disease,chronic obstructive pulmonary disease,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,preoperative cardiac insufficiency,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,excessive pain,postoperative left ventricular ejection fraction(LVEF),surgical method and CPB time were collected,and the incidence of postoperative delirium of patients was evaluated by the confusion assessment method of intensive care unit(CAM-ICU)method.The incidence of postoperative delirium of patients between observation group A and observation group B was compared.The influencing factors of postoperative delirium occurrence was analyzed by using univariate and multivariate logis-tic regression analysis.Results Among the 152 patients underwent heart valve replacement,36 patients experienced postoperative delirium,with an incidence of 23.68％.The incidence of postoperative delirium of patients in the observation group A and the observation group B was 38.16％(29/76),9.21％(7/76),respectively;the incidence of postoperative delirium of patients in the observation group A was significantly higher than that in the observation group B(x2=17.617,P＜0.05).The gender,BMI,diabetes,hypertension,coronary heart disease,cognitive disorder,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,and surgical method were not related to postoperative delirium(P＞0.05);the age,chronic obstructive pulmonary disease,preoperative heart failure,excessive pain,postoperative LVEF,and CPB time were associated with postoperative delirium(P＜0.05).Multivariate logistic regression analysis showed that age 60 years,preoperative cardiac dysfunction,excessive pain,and CPB time≥100 minutes were risk factors for postoperative delirium(P＜0.05),while postoperative LVEF≤50％and propofol sedation depth of 35≤BIS＜45 were protective factors for postoperative delirium(P＜0.05).Conclusion Propofol sedation depth of 35≤BIS＜45,postoperative LVEF ≥50％can effectively reduce the risk of postoperative delirium after cardiac valve replacement under CPB.Age≥60 years old,preoperative cardiac insufficiency,excessive pain,and CPB time≥100 min can increase the risk of postoperative delirium.

Cancer is a severe threat to human life and health.The over-activation of oncogenes is the main reason for poor treatment and prognosis of cancer patients.Most of these over-activated oncogenes are protein tyrosine kinase(PTK).Among many PTKs,non-receptor tyrosine kinase(NRTK)is an important signaling molecule that regulates cell proliferation and migration as the primary driver of intracellular signaling pathway transduction.Targeting NRTK has become the focus and difficulty in developing anti-tumor drugs.Traditional Chinese medicine(TCM),with its characteristics of multi-channel,multi-link,multi-target,and low toxicity,plays a significant advantage in treating adjuvant tumors.So far,it has been found various traditional TCM monomers can inhibit NRTK from playing an anti-tumor role.This review summarized the part of Src,Jak,Abl,Fak families,the prominent members of NRTK in tumor progression,as well as the TCM monomers acting on these members.We aimed to provide a theoretical basis for the anti-tumor therapy targeting NRTK and a reference for the search for TCM monomer inhibitors of NRTK.

Objective To investigate the effects and potential mechanisms of Marsdeniae Tenacissimae Caulis(Tongguanteng)injection and extract in human osteosarcoma cells proliferation,migration,invasion,and apoptosis.Methods MNNG/HOS,Saos-2 osteosarcoma cells,and normal bone marrow mesenchymal stem cells(BMSC)were cultured in vitro.Cells were incubated with different concentrations of Tongguanteng injection and Tongguanteng extract(40,60,80 mg/mL).Cell proliferation was evaluated by CCK-8 assay and plate colony formation assay.Cell migration and invasion were evaluated by scratch assay and Transwell assay.Cell apoptosis was evaluated by Hoechst33342 staining and Annexin-V/PI double staining assay.Bax,Bcl-2 and Caspase-3 mRNA expression were detected using RT-qPCR.The protein expressions of JAK1,p-JAK1,STAT3,p-STAT3 and MMP9 were detected by Western blot.Results Compared with the control group,both Tongguanteng injection and extract significantly decreased the survival rate of MNNG/HOS and Saos-2 cells,inhibited cell clone formation,migration,and invasion,induced cell apoptosis(P<0.05,P<0.01),promoted Bax mRNA and protein expression,inhibited Bcl-2 mRNA and protein expression,and up-regulated Caspase-3 mRNA and Cleaved Caspase-3 protein expression.Tongguanteng injection could significantly down-regulate the expressions of p-JAK1,p-STAT3 and MMP9 protein expression in Saos-2 cells(P<0.05,P<0.01).Conclusion Both Tongguanteng injection and Tongguanteng extract can significantly inhibit proliferation,migration and invasion of human osteosarcoma MNNG/HOS and Saos-2 cells,and induce apoptosis,with no significant difference in anti-tumor effect.The mechanism may be related to the inhibition of the activation of JAK1/STAT3 signaling pathway.

Objective To explore the mechanism of Marsdenia tenacissima in the treatment of breast cancer through network pharmacology and experimental verification.Methods Literature retrieval was conducted to obtain the active components of Marsdenia tenacissima.The SwissTargetPrediction database was used to predict the potential targets of these active components.Targets of breast cancer were obtained from GeneCards,GEPIA2,OMIM,PharmGKB and TTD databases.The intersection targets were obtained,and a Marsdenia tenacissima-breast cancer-targets network was constructed using Cytoscape 3.9.0 software.The core targets were identified through protein-protein interaction(PPI)network analysis,followed by GO and KEGG pathway enrichment analysis to screen relevant signaling pathways.Molecular docking validation was performed for the top 10 key targets and major active components.The human breast cancer cell line MDA-MB-231 was treated with Marsdenia tenacissima injection in vitro.Cell proliferation ability was detected by CCK-8 assay and colony formation assay.Cell apoptosis was detected by Calcein-AM/PI staining and flow cytometry.Cell migration ability was detected by Transwell assay.Western blot experiment was used to validate the PI3K-AKT signaling pathway.Results Totally 37 active components and 276 potential targets against breast cancer were screened from Marsdenia tenacissima,including 11alpha-O-Benzoyl-12beta-O-acetyl tenacigenin B,Caffeic acid,Drevogenin A and Kaempferol.25 core targets were screened by PPI network such as AKT1,EGFR,TNF,CTNNB1 and IL-6,which mainly affected the estrogen signaling pathway,ErbB signaling pathway,HIF-1 signaling pathway and PI3K-AKT signaling pathway,etc.The molecular docking results showed that the main active components of Marsdenia tenacissima exhibited good binding activities with the core targets AKT1,ALB,CASP3,ESR1 and TNF.The results of in vitro experiments showed that Marsdenia tenacissima injection could inhibit the proliferation and migration ability of MDA-MB-231 cells(P<0.01,P<0.001)and induce apoptosis(P<0.001),as well as inhibit the activation of PI3K-AKT signaling pathway(P<0.05,P<0.01).Conclusion Marsdenia tenacissima may exert its anti-breast cancer effects through multiple targets and pathways,and the mechanism may be related to the inhibition of PI3K-AKT signaling pathway.

Objective To analyze the main active components and potential molecular mechanism of Sophora flavescens against breast cancer based on network pharmacology and molecular docking. Methods The chemical constituents were collected and screened by TCMSP, ETCM database and literature review. The targets of active ingredients were predicted by Swiss Target Prediction database. Breast cancer-related targets were collected by GeneCards, TTD, Drugbank and OMIM. The anti-breast cancer targets of Sophora flavescens were screened by Venny 2.1.0 software. Cytoscape software was used to construct the network diagram of Sophora flavescens-key active ingredients-targets. STRING database was used to analyze the common targets, and PPI network diagram was constructed. GO function enrichment analysis and KEGG pathway enrichment analysis of key target proteins were performed by DAVID database and Hiplot online platform. Schrodinger software was used to calculate the molecular docking between the active ingredients and targets. Molecular biological methods were used to verify the key targets. Results A total of 36 active components with clear structures were screened from Sophora flavescens. 70 anti-breast cancer targets of Sophora flavescens were screened out. 12 core targets including EGFR, AKT1, ESR1, SRC, CYP19A1, AR and ABCB1 participate in endocrine resistance, EGFR tyrosine kinase inhibitors and estrogen signaling pathways in breast cancer. Moreover, the docking score between the core component and the key target AR is the highest. In vitro experiments showed that the extract of Sophora flavescens can inhibit the proliferation of breast cancer cells, induce cell apoptosis and up-regulate AR protein expression. Conclusion It was revealed that Sophora flavescens plays an anti-breast cancer role by regulating complex biological processes through multiple components acting on multiple targets and signaling pathways. The upregulation of AR protein by Sophora flavescens may become a new therapeutic strategy for the treatment of breast cancer.

Objective:To explore the application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath (EBUS-GS-TBCB) in diagnosis of nonresolving pneumonias.Methods:Sixty patients with nonresolving pneumonias from March 2019 to July 2020 in Dalian Municipal Central Hospital were selected. The patients were divided into EBUS-GS-TBCB group (31 cases) and transbronchial forcep lung biopsy guided by endobronchial ultrasound sheath(EBUS-GS-TBLB) group (29 cases) by random digits table method.Results:The diagnostic rate of nonresolving pneumonias in EBUS-GS-TBCB group was significantly higher than that in EBUS-GS-TBLB group: 87.10% (27/31) vs. 65.52% (19/29), and there was statistical difference ( χ2 = 3.90, P = 0.048). There were no statistical difference in sensitivity, specificity, accuracy, positive predictive value and negative predictive value between 2 groups ( P>0.05). There were no statistical difference inthe shortest distance from lesions to pleura, incidence of pneumothorax and incidence of bleeding between EBUS-GS-TBCB group and EBUS-GS-TBLB group: (27.42 ± 2.88) mm vs. (27.01 ± 2.37) mm, 6.45%(2/31) vs. 3.45%(1/29) and 22.58%(7/31) vs. 13.79% (4/29), P>0.05. Among the causes of nonresolving pneumonias, infectious factors accounted for 21.67% (13/60), non infectious factors accounted for 66.67% (40/60), and uncertain causes accounted for 11.67% (7/60). Conclusions:The diagnostic rate of EBUS-GS-TBCB in nonresolving pneumonias is significantly higher than EBUS-GS-TBLB, and the complications such as bleeding and pneumothorax do not increase significantly.

Objective:To investigate the clinical characteristics and risk factors for the progression of acute-on-chronic liver failure(ACLF)associated with hepatitis B in elderly patients.Methods:A total of 168 elderly patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)at Tianjin Third Central Hospital who met the diagnostic criteria of the Asian Pacific Association for the Study of the Liver(APASL)-ACLF were enrolled, 176 non-elderly HBV-ACLF patients served as the control group during the same period, and their baseline and progression data were recorded.At the same time, the elderly group was divided into the progressive subgroup and the non-progressive subgroup based on the diagnostic criteria of the European Society for the Study of the Liver(EASL)-ACLF, and their baseline and progression data were recorded.Independent risk factors for HBV-ACLF progression in the elderly were analyzed using multivariate Cox proportional risk model regression.Results:Compared with non-elderly patients with HBV-ACLF, elderly patients were more likely to progress to meet the EASL-ACLF diagnostic criteria and have higher mortality.Multivariate Cox proportional risk model regression analysis showed that baseline arterial lactic acid levels( HR=1.77, 95% CI: 1.36-2.30, P<0.01), secondary nosocomial infections( HR=13.90, 95% CI: 3.73-51.87, P<0.01), rates of change in maximum total bilirubin( HR=1.08, 95% CI: 1.01-1.15, P=0.04), rates of change in maximum MELD( HR=4.06, 95% CI: 1.53-10.77, P=0.01)and rates of change in maximum CLIF-SOFA( HR=12.74, 95% CI: 2.46-66.08, P<0.01)were independent risk factors for progression of HBV-ACLF in elderly patients. Conclusions:Compared with non-elderly patients, elderly patients with HBV-ACLF have more advanced disease and higher mortality.Therefore, risk factors should be identified as soon as possible and treatment plans should be formulated as soon as possible to further reduce the mortality.

ObjectiveTo explore the relationship between snoring and hypertension in middle-aged and elderly residents in Yangpu District， Shanghai. MethodsThe data of this study were obtained from the project of “early screening and comprehensive intervention for high-risk of cardiovascular diseases” carried out by the National Cardiovascular Disease Center in Yangpu District in 2017. Questionnaire survey， physical examination and laboratory test were conducted among permanent residents aged 35‒75 years. Logistic regression model was used to analyze the influence of sleep snoring on hypertension. ResultsA total of 11 100 people with complete data were included in the analysis， The self-reported snoring rate of male was significantly higher than female （48.12% vs 36.21%， χ²=137.70， P<0.01）. The proportion of self-reported occasional snoring， frequent snoring and daily snoring were 14.67%（1 628/11 100）， 7.59%（843/11 100） and 17.50% （1 943/11 100）， respectively， and the prevalence of hypertension gradually increased with the increase of snoring frequency （≤60 years，male： χtrend2=51.83，P<0.01；female： χtrend2=95.01， P<0.01； >60 years， male： χtrend2=9.22， P<0.01； female： χtrend2=27.10， P<0.01）. Multivariate logistic regression analysis showed that in people aged ≤60 years， both men and women， snoring frequency was significantly associated with hypertension after adjusting for education， total family income， smoking， alcohol consumption， diabetes， body mass index （BMI） and waist circumference. In the males： occasional snoring OR （95%CI） was 1.95 （1.36，2.80）， frequent snoring OR （95%CI） was 1.55 （1.04，2.31）， daily snoring OR （95%CI） was 1.92 （1.43，2.59）. In the females： occasional snoring OR （95%CI） was 1.31 （1.08，1.59）， frequent snoring OR （95%CI） was 1.41 （1.07，1.88）， daily snoring OR （95%CI） was 1.63 （1.32，2.00）. But in people aged >60 years， the significant association between snoring frequencies and hypertension did not exist， after adjusting for education， total family income， smoking， alcohol consumption， diabetes， BMI and waist circumference. In the males： occasional snoring OR （95%CI） was 1.31 （0.97，1.78）， frequent snoring OR （95%CI） was 1.22 （0.87，1.73）， daily snoring OR （95%CI） was 1.19 （0.94，1.73）. In the females： occasional snoring OR （95%CI） was 1.06 （0.87，1.29）， frequent snoring OR （95%CI） was 1.30 （0.99，1.72）， daily snoring OR （95%CI） was 1.19 （0.97，1.46）. ConclusionIn people ≤60 years old， snoring is significantly associated with hypertension， so more attention should be paid to sleep snoring monitoring in middle-aged people for early detection of hypertension.

Paclitaxel is the first-line chemotherapy drug for a variety of cancers. However， the paclitaxel resistance greatly reduced the efficacy in the later treatment stage， which seriously increased the mortality and recurrence rate of cancer and limited the clinical application of paclitaxel. At present， Chinese medicine compound prescription， proprietary Chinese medicine， and Chinese medicine injection are widely used as the adjuvant chemotherapy drugs for the treatment of cancer in clinic. Chinese medicine has shown unique advantages in improving the efficacy of chemotherapy drugs and the prognosis of chemotherapy， and reducing the toxic and side effects. However， the specific mechanism and effective monomer composition of Chinese medicine for reversing the resistance of chemotherapy drugs are unclear， and the application of Chinese medicine in different types of cancer is also limited， which are worthy of further exploration. This review summarized the composition of Chinese medicine monomer with synergistic antitumor effect combined with paclitaxel in recent years. The specific mechanism and pharmacological activities of Chinese medicine monomer reversing paclitaxel resistance were classified. This review found that through acting on the membrane transport protein， Chinese medicine monomer promoted the accumulation of paclitaxel in tumor cells， inhibited the expressions of protein and metabolic enzyme related to multidrug resistance and the metabolism of paclitaxel， and regulated the levels of apoptosis genes and factors and apoptosis-related pathways to promote the inhibitory effect of paclitaxel on cell proliferation. Chinese medicine monomer also significantly improved paclitaxel chemotherapy sensitivity by regulating the expression levels of micro ribonucleic acid （microRNA） and long non-coding ribonucleic acid RNA （lncRNA）， inhibiting the characteristics of tumor stem cells and tumor metabolic reprogramming， improving tumor microenvironment， and triggering tumor cell death autophagy and oxidative stress response. This review provides a theoretical basis for clarifying the specific anti-tumor mechanism of Chinese medicine monomer combined with paclitaxel， which is of great significance for the development of new Chinese medicine and the clinical research of the drugs combined with paclitaxel， and has certain value for the application of Chinese medicine combined with other chemotherapy drugs.

Objective:To study the clinical efficacy of 3D total hip arthroplasty in elderly patients with acetabular fracture.Methods:A total of 43 patients with non-obsolete acetabular fractures admitted to Xining First People's Hospital from May 2016 to December 2018 were randomly divided into the control group (22 cases) and the observation group (21 cases) for a perspective study. The control group received routine surgery and the observation group was treated with total hip arthroplasty combined with 3D printing. The patient's operation time, intraoperative blood loss, and hospitalization time were recorded. The hip function was assessed by Harris Hip Scale (HHS) after 6 months of follow-up. The patient's quality of life was assessed using the short form 36 item health survey questionnaire (SF-36) before and 6 months after surgery. The complications of the patients during operation and follow-up were recorded.Results:The operation time, hospital stay and intraoperative blood loss were significantly lower in the observation group than those in the control group ( P<0.05). At 6 months after operation, the hip joint function of the observation group was significantly better than that of the control group ( P<0.05); the quality of life scores were significantly higher than the control group ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P<0.05). Conclusions:3D printed total hip arthroplasty can effectively improve the operation and hip function of elderly patients with non-obsolete acetabular fracture and the quality of life of patients without increasing adverse reactions.