OBJECTIVE To investigate the efficacy and safety of ropivacaine combined with oxycodone for the analgesia of iliac fascia nerve block in patients undergoing hip replacement. METHODS Sixty-six patients who underwent hip replacement at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from October 2023 to April 2024 were selected and randomly divided into observation group and control group， with 33 cases in each group. Before induction of anesthesia， ultrasound-guided iliac fascial nerve block was performed. Patients in the observation group were treated with 0.33% ropivacaine+0.1 mg/kg oxycodone injection mixture 30 mL， and patients in the control group were treated with 0.33% ropivacaine injection 30 mL. The time of first postoperative rescue analgesia， 24 h postoperative analgesic drug consumption， sensory block and motor block effective and maintenance time， satisfaction degree， numerical rating scale （NRS） pain score， Ramsay sedation score， muscle strength score， heart rate （HR）， mean arterial pressure （MAP）， oxygen saturation（SpO2）， sleep score， anxiety score， and the occurrence of adverse reactions in the two groups were all recorded. RESULTS Compared with the control group， the first rescue analgesia time after operation was significantly prolonged in the observation group， and 24 h postoperative analgesic drug consumption after operation decreased； the effective time of sensory block was significantly shortened， and the maintenance time of sensory block was significantly prolonged， and the satisfaction score was higher； the NRS pain score after iliac fascia nerve block was lower， HR and MAP were lower， and the anxiety score and sleep score 24 and 48 h after operation were lower （P＜0.05）. In terms of safety， patients in both groups had adverse reactions after operation， such as hypertension， nausea， vomiting， and dizziness， but there was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS Oxycodone combined with ropivacaine shows good efficacy and safety for iliac fascial nerve block analgesia in patients undergoing hip replacement， can significantly prolong the analgesic time of ropivacaine， reduce postoperative analgesic drug consumption， improve the sleep quality of patients， and promote the rapid recovery of patients.

ObjectiveTo explore the molecular mechanism of Sanhuang Xiexintang （SHXXT） in protecting stress gastric ulcer （SGU） in rats through network pharmacology， molecular docking， and animal experiments. MethodThe active ingredients and corresponding targets in SHXXT were collected and screened from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， Traditional Chinese Medicine Information Database （TCMID）， Bioinformation Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine （BATMAN-TCM）， and Swiss Target Prediction database. SGU-related targets were screened from the Online Mendelian Inheritance in Man （OMIM）， Therapeutic Target Database （TTD）， GeneCards database， and PharmGKB database. Herbal-ingredient-target （H-C-T） network was constructed by using Cytoscape 3.9.1 software. Protein-protein interaction （PPI） of drug and disease intersection targets was analyzed by using the Protein Interaction Platform （STRING） database. Gene ontology （GO） enrichment analysis and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis were conducted through the Database for Annotation Visualization and Integrated Discovery （DAVID）. The active ingredients and key targets were validated using AutodockVina 1.2.2 molecular docking software， and the experimental results were further validated through animal experiments. ResultThe 55 active ingredients were screened， and 255 potential target genes for SHXXT treatment of SGU were predicted. The PPI analysis showed that protein kinase B （Akt）， phosphatase and tensin homolog deleted on chromosome ten （PTEN）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and cyclooxygenase-2 （COX-2） are the core targets of SHXXT for protecting SGU. GO and KEGG analyses showed that SHXXT may affect the development of SGU by regulating various biological processes such as the phosphoinositide 3-kinase （PI3K）/Akt signaling pathway and inflammatory processes. The molecular docking results showed that both the active ingredients and key targets had good binding ability. Animal experiments showed that compared with the blank group， the ulcer index （UI） of the model group was significantly increased （P<0.01）， and the serum levels of TNF-α and IL-1β significantly increased （P<0.01）. The phosphorylation level of PTEN in gastric mucosal tissue was significantly down-regulated （P<0.05）. The phosphorylation levels of PI3K， Akt， and nuclear factor kappa-B （NF-κB） were significantly up-regulated （P<0.05）. Compared with the model group， the UI of the treatment group was significantly reduced （P<0.01）， and the serum levels of TNF-α and IL-1β were significantly reduced （P<0.01）. The phosphorylation level of PTEN in gastric mucosal tissue was significantly up-regulated （P<0.01）， and the phosphorylation levels of PI3K， Akt， and NF-κB were significantly downregulated （P<0.01）. ConclusionThe application of network pharmacology prediction， molecular docking simulation， and animal experimental validation confirms that SHXXT regulates the PI3K/Akt/NF-κB signaling pathway to regulate the inflammatory response of rats and thus protects the gastric mucosa of SGU rats.

Objective To clarify the anti-inflammatory effect of chlorogenic acid on lipopolysaccharide(LPS)-induced inflamma-tion in macrophage RAW264.7,and to reveal its possible molecular mechanism.Methods The cellular activity of RAW264.7 after the intervention of different concentrations of chlorogenic acid was detected by CCK-8 method;the macrophage RAW264.7 was stimulated by LPS to preset cellular inflammatory state.The blank control group(K group,n=3),the model control group(L group,n=3),and the experimental group(S group,n=3)were administered separately,and the cell morphology was dynamically observed;cell precipita-tion and supernatants were obtained at 24 h and 48h,respectively.The concentrations of inflammatory cytokine interleukin(IL)-1β,monocyte chemoattractant protein-1(MCP-1),and arginase-1(Arg-1)in the cell supernatants were detected by enzyme-linked immunosorbent assay(ELISA);the mRNA expression of prostaglandin endoperoxide synthase 2(PTGS2),transforming growth factor-β1(TGF-β1),high mobility histone 1(HMGB1),and nuclear transcription factor-κB(NF-κB)were detected by quantitative real-time PCR(RT-qPCR).Results RAW264.7 cellular inflammatory state was successfully preset with 1 μg/ml LPS;12.5～200.0μg/ml chlorogenic acid had no distinct toxicity on RAW264.7.Chlorogenic acid at 50μg/ml and 200μg/ml had obvious proliferation effects on RAW264.7 cells(P＜0.05).Compared with the model control group,the content of IL-1 β protein in the supernatant of the experimental group was significantly decreased,while the content of Arg-1 was significantly increased(P＜0.05).Compared with the model control group,50μg/ml of chlorogenic acid significantly decreased the mRNA expressions of NF-κB,TGF-β1,PTGS2,and HMGB1 in LPS-induced inflammatory cells(P＜0.05).Conclusion Chlorogenic acid has a distinct inhibitory effect on LPS-induced RAW264.7 inflammatory response,which may be achieved by regulating molecular expression of the HMGB1-mediated NF-κB pathway.

Objective:To investigate the diagnostic efficacy of ultrasound in pregnancy associated breast cancer (PABC) under different breast ultrasound background echotextures.Methods:The ultrasonic images of 269 female patients with breast diseases who underwent breast surgery in Fudan University Shanghai Cancer Center from January 2016 to September 2023 and were pregnant or within one year postpartum at the time of onset were retrospectively reviewed. Breast ultrasound background echotextures were classified according to two criteria: the first classification was homogeneous-fat, homogeneous-fibroglandular, and heterogeneous; the other classification was hypoechoic dominated and hyperechoic dominated. The comparison of the diagnostic value of ultrasound in PABC under different backgrounds was conducted by the receiver operating characteristic(ROC) curves.Results:Among 269 patients, 67 patients(24.91%)were during pregnancy and 202 patients(75.09%) were within one year postpartum. Pathologically, 47 patients (17.47%) were confirmed as benign, 222 patients (82.53%) were malignant. According to the first classification, 138 patients were homogeneous-fibroglandular and 131 patients were heterogeneous, with the diagnostic sensitivity of ultrasound in PABC were 88.70% and 59.81% respectively, and the specificity were 91.30% and 83.33% respectively, the areas under the ROC curves were 0.940 and 0.826 respectively ( P=0.022). According to the second classification, 119 were hypoechoic dominated and 150 patients were hyperechoic dominated, the sensitivity were 60.21% and 85.27% respectively, the specificity 84.62% and 90.48% respectively, the areas under the ROC curves were 0.826 and 0.925 ( P=0.042). Conclusions:The heterogeneous background echotextures of the breast may cause decrease of the diagnostic efficiency of ultrasound in PABC, and hypoechoic dominated background was more unfavorable for the diagnosis of PABC compared to the hyperechoic dominated background.

The mutual recognition of medical examination results is significant for improving the utilization efficiency of limited resources in large public hospitals,promoting the sharing of quality medical resources,alleviating the high costs and diffi-culties of healthcare for the public,reducing pressure on medical insurance funds,and enhancing the efficiency of fund utiliza-tion.This study reviews the research on mutual recognition of medical examination results in China,analyzing it from four as-pects:regulatory norms,platform construction,policy awareness,and performance distribution.It identifies research hotspots and directions related to mutual recognition,clarifies the challenges and key points in the implementation of relevant policies,and suggests future research directions,including strengthening theoretical research,improving empirical studies,and innovating re-search methods.

Objective To systematically evaluate the efficacy and safety of Kangfuxin liquid combined with conventional treatment in postoperative patients with gastrointestinal endoscopy.Methods PubMed,Embase,Cochrane Library,CNKI,WanFang Data,VIP databases were electronically searched to collect randomized controlled trials(RCTs)about Kangfuxin liquid combined with conventional treatment versus conventional treatment for postoperative complications of gastrointestinal endoscopy,from inception to December 31,2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias in the included studies.Meta-analysis was then performed by using RevMan 5.3 software and Stata 14 software.Results A total of 14 RCTs involving 1 359 patients were included.The results of Meta-analysis showed that compared with the conventional treatment group,the Kangfuxin liquid combination group could improve postoperative ulcer complete healing rate(RR=1.32,95％CI 1.07 to 1.61,P=0.009)and postoperative clinical symptomatic relief rate(RR=1.20,95％CI 1.13 to 1.27,P＜0.001),but there was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Subgroup analyses showed that the ulcer complete healing rate in the Kangfuxin liquid combination group was higher than that in the conventional treatment group at 2 weeks postoperatively(RR=1.56,95％CI 1.28 to 1.92,P＜0.001),but there was no statistically significant difference in ulcer complete healing rate between the two groups at 4 weeks postoperatively(P＞0.05);the efficacy of oral administration(RR=1.19,95％CI 1.11 to 1.27,P＜0.001)and transendoscopic topical spray administration(RR=1.23,95％CI 1.09 to 1.39,P＜0.001)of Kangfuxin liquid groups were better than those of the conventional treatment group in relieving postoperative clinical symptoms.Conclusion Combining Kangfuxin liquid treatment with conventional medication after gastrointestinal endoscopy may further improve clinical efficacy,especially in promoting the ulcer complete healing within 2 weeks after surgery and relieving postoperative clinical symptoms,but there is insufficient evidence on whether it reduces the incidence of adverse effects.Due to the limitations of the number and quality of included studies,the above conclusions are yet to be validated by more high-quality studies.

Objective:This study aimed to assess left atrial function in adults across various age groups using 4-dimensional automated left atrial quantification(4D Auto LAQ)technology.The study also aimed to compare the differences in two-dimensional(2D)and four-dimensional(4D)strains of the left atrium among different age groups, with the goal of enhancing the clinical utility of 4D Auto LAQ.Methods:A total of 409 healthy volunteers were recruited for the research.Two-dimensional and four-dimensional images were obtained using a GE Vivid E95 ultrasound system with a 4Vc four-dimensional probe.The study examined variations in 2D and 4D ultrasound parameters across various age groups.Furthermore, the relationship between left atrial reservoir strain(LASr), Left atrial conduit strain(LAScd), left atrial contraction strain(LASct), and age was explored.Results:The study involved 409 volunteers, with 217 males and 192 females, who were categorized into three age groups: young(18-45 years, n=56), middle-aged(46-65 years, n=202), and elderly(>65 years, n=151).Conventional ultrasound measurements indicated changes in left atrial anterior-posterior diameter with age progression: (31.70±3.65)mm for the young group, (34.02±3.91)mm for the middle-aged group, and(35.2±4.37)mm for the elderly group( P<0.01).The 2D and 4D left atrial parameters across the age groups were as follows: LASr(2D)(%): 37.48±7.51, 30.95±8.23, 26.9±7.56( P<0.01); LA VImax(ml/m 2): 23.54±5.79, 26.33±7.6, 28.99±8.15( P<0.01); LASr(%): 31.2±17.07, 22.5±8.59, 19.49±7.47( P<0.01).Both 2D and 4D left atrial parameters exhibited significant associations with age.Specifically, the correlations between LASr(2D)(%), LAScd(2D)(%), LASr(%), LAScd(%), and age were -0.429, 0.580, -0.354, 0.298, respectively( P<0.01). Conclusions:The 4D Auto LAQ technology is efficient in assessing left atrial function across various age groups, with age playing a significant role in influencing left atrial parameters.When compared to other ultrasound parameters, both 2D and 4D left atrial strain parameters have the ability to detect differences at an early stage, making them suitable for the early screening, evaluation, and monitoring of age-related left atrial dysfunction, especially in the elderly population.

Objective To investigate the effects of fentanyl citrate on pain in aged rats with hip fracture and its underlying mechanisms. Methods Thirty aged rats with hip fracture were divided into model group (n=10), fentanyl citrate group (n=10), and fentanyl citrate + Sar-SP group (n=10). Additionally, healthy rats from the same period were included as normal group (n=10).Rats in the fentanyl citrate group received intravenous tail injection of 10 μg/kg fentanyl citrate, while those in the fentanyl citrate + Sar-SP group underwent intrathecal injection of 10 μL Sar-SP for fentanyl citrate intervention. Rats in the normal and model groups received intravenous tail injection of an equal volume of saline. Pain threshold, weight-bearing capacity, temperature, and dorsoventral thickness of the hind paws were measured before treatment (0 h) and at 1, 6, 24, and 168 h post-treatment. Enzyme-linked immunosorbent assay (ELISA) was used to detect levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β), and glutamic acid (Glu) in the spinal cord tissue of rats. Immunohistochemical staining was employed to observe the positive expression rates of ionized calcium-binding adapter molecule 1 (Iba-1), glial fibrillary acidic protein (GFAP), and substance P (SP) in the spinal cord tissue. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was conducted to detect the relative expression levels of SP and tachykinin receptor 1 (TACR1) mRNA in the hippocampus tissue of rats. Western blot analysis was performed to assess the relative expression levels of vimentin (VIM), nuclear receptor corepressor 1 (NOCR), ciliary neurotrophic factor receptor (CNTFR), and epidermal growth factor receptor (EGFR) proteins in the spinal cord tissue. Results Compared with the normal group, rats in the model group exhibited decreased pain threshold and weight-bearing capacity, increased hind paw temperature and dorsoventral thickness, as well as elevated levels of TNF-α, IL-6, IL-1β, and Glu, increased positive expression rates of Iba-1 and GFAP, heightened positive expression rate and relative mRNA expression levels of SP and TACR1, and augmented relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 0 h before treatment and at 1, 6, 24, and 168 h post-treatment (P < 0.05). Compared with the model group, rats in the fentanyl citrate group showed increased pain threshold and weight-bearing capacity, decreased hind paw temperature and dorsoventral thickness, as well as reduced levels of TNF-α, IL-6, IL-1β, and Glu, decreased positive expression rates of Iba-1 and GFAP, lowered positive expression rate and relative mRNA expression levels of SP and TACR1, and decreased relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 1, 6, 24, and 168 h post-treatment(P < 0.05). Compared with the fentanyl citrate group, rats in the fentanyl citrate+Sar-SP group demonstrated decreased pain threshold and weight-bearing capacity, increased hind paw temperature and dorsoventral thickness, elevated levels of TNF-α, IL-6, IL-1β, and Glu, increased positive expression rates of Iba-1 and GFAP, heightened positive expression rate and relative mRNA expression levels of SP and TACR1, and elevated relative protein expression levels of VIM, NOCR, CNTFR, and EGFR in the spinal cord tissue at 1, 6, 24, and 168 h post-treatment(P < 0.05). Conclusion The improvement in pain in aged rats with hip fracture by fentanyl citrate may be associated with the reduction of SP expression in the spinal cord that inhibits glial cell activation and exhibits anti-inflammatory effects.

Objective To explore the effects of warming-yang and tonifying-qi needling combined with electromyographic biofeedback therapy(EMGBFT)on brain image structure,surface myoelectric characteristics and neurotransmitters in patients with stroke rehabilitation.Methods A prospective research method was conducted in which 200 stroke rehabilitation patients admitted to the Third Hospital of Xingtai City from February 2021 to February 2022 were selected as the study subjects.According to the random principle,the patients were divided into a control group and an study group,with 100 cases in each group.Both groups received routine treatment for stroke,while the control group received a combination of EMGBFT.The study group received a combination of warming-yang and tonifying-qi acupuncture based on the control group,and both groups continued to receive treatment for 9 weeks.Observe the clinical efficacy of two groups of patients and compare the differences in National Institutes of Health Stroke Scale(NIHSS)scores,traditional Chinese medicine symptom scores,brain image structures,serum neurotransmitter levels,and surface electromyography levels before and after treatment,and observe the occurrence of adverse reactions.Results The effective rate of treatment in the study group was significantly higher than that in the control group(97.00％ vs.87.00％,P<0.05).After treatment,NIHSS score,traditional Chinese medicine symptom score,root-mean-square(RMS)of biceps and triceps,and synergistic contraction rate(SCR)were significantly lower than those before treatment in both groups,and the levels of cerebral blood flow(CBF)in the thalamus and frontal lobe,fractional anisotropy(FA),norepinephrine(NE),5-hydroxytryptamine(5-TH),and dopamine(DA)were significantly higher than those before treatment.After treatment,the NIHSS score(4.18±1.09 vs.6.89±1.54),traditional Chinese medicine symptom score(5.41±1.08 vs.9.46±1.55),and biceps RMS(μV:9.76±3.51 vs.16.36±3.44),triceps brachii RMS(μV:6.79±1.83 vs.10.61±2.87),and SCR[(28.08±8.73)％ vs.33.08±9.31)％]were significantly lower than those control group(all P<0.05),the CBF of the thalamus(mL·kg-1·min-1:278.97±86.32 vs.233.63±84.62),and the CBF of the frontal lobe(mL·kg-1·min-1:299.31±75.54 vs.262.81±87.18),FA(0.57±0.18 vs.0.48±0.14),serum 5-HT(ng/L:352.83±38.93 vs.306.71±32.54),NE(ng/L:160.83±17.25 vs.122.81±12.41),DA(μg/L:9.23±0.92 vs.7.36±0.71)were significantly higher than those of the control group(all P<0.05).The incidence of adverse reactions in the study group was significantly lower than that in the control group(3.00％ vs.14.00％,P<0.05).Conclusion Based on EMGBFT,the combination of warming-yang and tonifying-qi acupuncture can synergistically improve the clinical symptoms and brain image structure in stroke rehabilitation patients,and increase their serum neurotransmitter levels,with fewer adverse reactions,which is worthy of promotion.