Abstract:Objective To investigate the clinical effects of repetitive transcranial magnetic stimulation(rTMS)combined with proprioceptive neuromuscular facilitation(PNF)training in patients with stroke hemiplegia.Methods A total of 60 elderly patients with post-stroke hemiplegia admitted to our hospital from January 2022 to September 2023 were enrolled and randomly assigned into two groups.On the basis of routine rehabilitation,the control group received PNF training,while the experimental group received PNF training combined with rTMS.The treatment efficacy,upper and lower limb Fugl-Meyer Assessment(FMA)scores,Berg Balance Scale(BBS)scores,Modified Barthel Index(MBI),Trunk Impairment Scale(TIS),and Functional Ambulation Classification(FAC)were compared between the two groups.Results The overall effective rate in the experimental group was 96.67％,significantly higher than 80.00％in the con-trol group(P＜0.05).After treatment,the experimental group showed higher upper limb FMA scores(48.21±6.96)and lower limb FMA scores(27.50±3.42)compared with the control group(43.67±6.54 and 24.83±3.56,respec-tively),with both groups showing significant improvements compared with baseline(P＜0.05).Post-treatment BBS scores in the experimental group were also significantly higher than those in the control group(P＜0.05),with both groups improving compared with pretreatment(P＜0.05).Similarly,the experimental group showed significantly higher post-treatment MBI,TIS,and FAC scores than the control group(P＜0.05),and all these indices improved signifi-cantly compared with baseline in both groups(P＜0.05).Conclusion In elderly patients with stroke hemiplegia,rTMS combined with PNF training can enhance motor function,improve balance,and increase daily living activities,showing substantial clinical value.

Abstract:Objective To investigate the early warning value of serum decoy receptor 3(DcR3)combined with urinary liver-type fatty acid-binding protein(L-FABP)for patients with acute exacerbation of chronic obstructive pul-monary disease(AECOPD)complicated by respiratory failure undergoing noninvasive ventilation(NIV).Methods A total of 125 AECOPD patients with respiratory failure receiving NIV treatment from April 2023 to January 2025 were en-rolled.Demographic characteristics and clinical assessment indicators were collected.Serum DcR3 and urinary L-FABP levels were measured before NIV treatment,and at 24 h and 72 h after treatment.Patients were followed up dynamically for 30 days after discharge and divided into a favorable prognosis group and an unfavorable prognosis group.Multivariate logistic regression models were established:Model 1 including demographic and clinical indicators,Model 2 including post-treatment DcR3 and urinary L-FABP levels,and a combined model.Receiver operating characteristic(ROC)curves were used to evaluate predictive performance.Results Among the 125 patients,97(77.6％)had favorable prog-nosis,and 28(22.4％)had unfavorable prognosis.The unfavorable prognosis group had longer COPD duration,longer treatment duration,lower FEV1％and PaO2,and higher mMRC,APACHE Ⅱ,PaCO2,serum creatinine,and IPAP compared with the favorable prognosis group(all P＜0.05).DcR3 and urinary L-FABP levels decreased over time in both groups(P＜0.05),but levels at 24 h and 72 h post-treatment were significantly higher in the unfavorable prognosis group(P＜0.001).The AUC(95％CI),sensitivity,and specificity of the combined model were 0.904(0.857-0.942),98.4％,and 88.6％,respectively,outperforming Model 1(AUC 0.744)and Model 2(AUC 0.801).The AUC,sensitivity and specificity of Model 2 were significantly higher than those of Model 1(0.801 vs.0.744,85.0％vs.73.5％,78.2％vs.59.0％,P＜0.05).Conclusion Serum DcR3 combined with urinary L-FABP has significant early warning value for prognosis in AECOPD patients with respiratory failure receiving NIV.The combined model provides better predictive accuracy than single models.Dynamic monitoring of these biomarkers may help identify high-risk pa-tients and guide early therapeutic interventions.

Abstract:Objective To compare the analgesic effects of liposomal bupivacaine and ropivacaine in transversus abdominis plane(TAP)block for postoperative pain management in elderly patients undergoing abdominal surgery.Meth-ods A total of 200 elderly patients who underwent abdominal surgery at our hospital from April 2024 to June 2025 were enrolled and randomly assigned(1∶1)into the control group(ropivacaine TAP block)and the observation group(liposo-mal bupivacaine TAP block),with 100 patients in each group.Safety parameters and laboratory indices before and after surgery were compared.Visual analog scale(VAS)pain scores at 6,12,24,48,and 72 hours postoperatively,as well as postoperative pain treatment satisfaction scale(PTSS)scores at 48 hours,were assessed.Opioid consumption,patient-controlled analgesia(PC A)press times,rescue analgesia frequency,recovery-related indicators,adverse reactions,and complications were also recorded and compared.Results Mean arterial pressure(MAP)and heart rate increased signifi-cantly at 72 h postoperatively compared with baseline in both groups,but were lower in the observation group than in the control group(P＜0.05).Resting and dynamic VAS scores decreased sequentially in both groups from 6 to 72 h postoper-atively,with significantly lower scores in the observation group(P＜0.05).PTSS scores were higher in the observation group(P＜0.001).Serum CRP,IL-6,and cortisol levels at 24 h postoperatively were elevated in both groups but were lower in the observation group(P＜0.05).The observation group also showed reduced opioid consumption,fewer PCA press times,and fewer rescue analgesia events,as well as shorter times to first flatus,bowel sound recovery,ambulation,and hospital stay(P＜0.05).The incidence of overall adverse events and complications was not significantly different be-tween groups(P=0.547,0.259).Conclusion In elderly patients undergoing abdominal surgery,liposomal bupiva-caine for TAP block provides superior analgesic efficacy compared with ropivacaine,improves pain control satisfaction,at-tenuates inflammatory responses,and promotes postoperative recovery without increasing adverse events.

Abstract:Liposomal bupivacaine(LB)is a novel,long-acting local anesthetic that has attracted attention for its unique advantages in postoperative pain management.Compared with traditional bupivacaine,LB can provide continu-ous analgesia for up to 72 hours,reducing opioid consumption,which is particularly important for pediatric surgical pa-tients.With increasing concerns about opioid dependence and abuse,the use of LB in pediatric surgery has become a top-ic of interest.This article reviews recent literature on LB in pediatric surgery,analyzing its effects on pain control,opioid consumption,length of stay(LOS),safety,and adverse events,aiming to provide guidance for clinical application.

Abstract:Objective To retrospectively analyze the risk factors for venous thromboembolism(VTE)in patients after surgery for gynecologic malignancies and to evaluate the predictive value of the Caprini risk assessment model for postoperative VTE,thereby providing clinical evidence for diagnosis and treatment.Methods Clinical data of 37 pa-tients who developed VTE after surgery for gynecologic malignancies between January 1,2022 and December 31,2024 were collected retrospectively.A control group was selected at a 1∶2 ratio by randomly choosing patients with pathological-ly confirmed gynecologic malignancies who underwent surgery during the same period but did not develop VTE postopera-tively.The incidence and clinical characteristics of VTE were analyzed.Results Among the VTE patients,cervical cancer was the most common underlying malignancy.Univariate analysis showed significant group differences in age,pres-ence of hypertension,preoperative D-dimer,postoperative fibrinogen(FIB),postoperative D-dimer,surgery duration,intraoperative blood loss,and whether the surgery was performed via laparotomy.Multivariate binary logistic regression identified advanced age(OR=1.089,95％CI:1.024-1.159)and elevated postoperative D-dimer(OR=1.317,95％CI:1.037-1.673)as independent risk factors for postoperative VTE(P＜0.05).The AUC for age and postopera-tive D-dimer in ROC analysis were 0.739 and 0.731,respectively,showing some predictive value for postoperative VTE in gynecologic cancer patients.A significantly higher proportion of patients in the VTE group were classified as Caprini ex-tremely high-risk(≥5 points):21 cases(56.8％)vs.24 cases(32.4％)in the control group.However,the Caprini score alone had limited predictive power(AUC=0.622).When combined with age and postoperative D-dimer,the pre-dictive value increased significantly(AUC=0.810).Conclusion Advanced age and elevated postoperative D-dimer are independent risk factors for VTE in patients with gynecologic malignancies.While the Caprini score has some value in assessing VTE risk,its predictive accuracy is limited.A combined model incorporating Caprini score,age,and postopera-tive D-dimer yields improved predictive performance.

Abstract:Objective To evaluate the analgesic effect of four-point local infiltration with different local anes-thetics combined with patient-controlled intravenous analgesia(PCIA)after mixed hemorrhoid surgery.Methods A to-tal of 80 patients undergoing L4-5 spinal anesthesia for mixed hemorrhoid surgery were randomly assigned into two groups.The study group(B,n=40)received four-point perianal infiltration of liposomal bupivacaine 266 mg(20 mL)at 3,6,9,and 12 o'clock positions,while the control group(C,n=40)received 0.375％bupivacaine 20 mL in the same man-ner.Both groups received sufentanil 1 μg/mL via PCIA,with intravenous flurbiprofen axetil 50 mg for rescue analgesia.Outcomes included PC A pump first press time,total presses within 72 h,sufentanil consumption,flurbiprofen use,VAS pain scores at 8-72 h,and adverse events(dizziness,nausea,vomiting,drowsiness,respiratory depression).Results VAS scores at 0-12 h were similar between groups.At 24 h,48 h,72 h,the B group showed significantly lower VAS scores,longer first PCA press time,fewer total PC A presses,and lower sufentanil consumption than the C group(P＜0.01).Flurbiprofen rescue doses and incidence of nausea,vomiting,and dizziness were lower in B group(P＜0.01).No respiratory depression or significant drowsiness occurred.Hospital stay was shorter in B group[(5.4±2.3)d]com-pared with C group[(7.3±2.9)d,P＜0.01].One-month follow-up showed no difference in Wexner anal function scores(P＞0.05).Conclusion Four-point perianal infiltration with liposomal bupivacaine provides effective postoper-ative analgesia for mixed hemorrhoid surgery,reduces PCIA opioid consumption,shortens hospital stay,and has minimal adverse effects,making it a favorable clinical option.

Abstract:Objective To investigate the effect of long non-coding RNA cancer susceptibility candidate 2(ln-cRNA CASC2)adsorbing miR-K11-3p to regulate STAT-induced STAT inhibitor 1(SSI-1)on the JAK-STAT sig-naling pathway.Methods Bioinformatics analysis was used to predict the targeting relationships between CASC2 and miR-K11-3p,as well as between miR-K11-3p and SSI-1,which were then verified by dual-luciferase reporter assays.The effects of CASC2 on SSI-1 expression via miR-K11-3p were detected using Western blotting and dual-luciferase assays.After overexpressing CASC2,the protein and mRNA expression levels of Janus kinase(JAK),Signal transducer and activator of transcription(STAT),and tyrosine kinase 2(TYK2)were measured using Western blotting and q-PCR.Results CASC2 could adsorb miR-K11-3p(P＜0.01),and SSI-1 was confirmed as a target gene of miR-K11-3p(P＜0.01).CASC2 regulated SSI-1 expression through miR-K11-3p(P＜0.01).After overex-pressing CASC2,both the protein and mRNA expression levels of JAK,STAT,and TYK2 were decreased(P＜0.01).Conclusion lncRNA CASC2 regulates SSI-1 expression by adsorbing miR-K11-3p,thereby affecting the JAK-STAT signaling pathway.This suggests that CASC2 may serve as a potential therapeutic target for Kaposi's sarcoma.

Abstract:Objective To investigate the effects of running wheel training on motor and neurological function,mi-croglial polarization,and the regulation of pyroptosis-related proteins in rats with cerebral ischemic injury.Methods Thirty adult male SD rats were randomly assigned to three groups(n=10 each):sham-operated group,ischemic injury group,and ischemic injury+running wheel training group.Cerebral ischemia was induced by middle cerebral artery liga-tion.The training group received additional running wheel intervention.After injury,motor and neurological function were assessed by suspension time,Zea-Longa score,and Grip test score.Infarct volume was measured.Western blot was used to detect expression of brain-derived neurotrophic factor(BDNF),NLR family pyrin domain containing 3(NLRP3),cleaved-caspase 3,Gasdermin D,interleukin-1 β(IL-1 β),interleukin-18(IL-18),inducible nitric oxide synthase(iNOS),tumor necrosis factor-α(TNF-α),arginase-1(Arg-1),and interleukin-10(IL-10)in brain tissue.Microglial cells were isolated and analyzed by flow cytometry to determine the proportions of CD86+and CD206+microglia.Results Compared with the sham group,both the ischemic injury group and the running wheel training group showed reduced suspension time,Grip test score,and BDNF levels,while Zea-Longa scores,infarct vol-ume,NLRP3,cleaved-caspase 3,Gasdermin D,IL-1 β,IL-18,proportion of CD86+microglia,iNOS,and TNF-α were significantly increased(all P＜0.05).Expression of Arg-1,IL-10,and proportion of CD206+microglia were significantly decreased(all P＜0.05).Compared with the ischemic injury group,the running wheel training group dem-onstrated increased suspension time,Grip test score,BDNF,CD206+microglia proportion,Arg-1,and IL-10 levels,while Zea-Longa score,infarct volume,NLRP3,cleaved-caspase 3,Gasdermin D,IL-1 β,IL-18,CD86+micro-glia proportion,iNOS,and TNF-α were significantly reduced(all P＜0.05).Conclusion Running wheel training al-leviates neurological deficits and reduces infarct volume in rats with cerebral ischemic injury.These effects are associated with regulation of microglial polarization,suppression of M1-type polarization and pyroptosis,and promotion of M2-type polarization,thereby exerting neuroprotective benefits.

Abstract:Objective To investigate the analgesic effect of liposomal bupivacaine(LB)via suprainguinal fascia iliaca compartment block(S-FICB)in elderly patients undergoing intertrochanteric fracture surgery,and to compare it with conventional bupivacaine hydrochloride.Methods A randomized,double-blind controlled study enrolled 36 pa-tients aged 60-75 years with intertrochanteric fracture.Patients were randomly assigned to the liposomal bupivacaine group(LB group)or the bupivacaine hydrochloride group(BH group).Both groups received ultrasound-guided S-FICB.The LB group was administered 40 mL of 0.332 5％liposomal bupivacaine(133 mg),while the BH group re-ceived 40 mL of 0.1％bupivacaine hydrochloride.The primary outcomes were Numerical Rating Scale(NRS)pain scores at rest and during movement at 24 h postoperatively.Secondary outcomes included NRS scores at rest and during move-ment at 12,48,and 72 h postoperatively,opioid(sufentanil)consumption,QOR-15 satisfaction score,incidence of ad-verse events,and length of hospital stay.Results At 24 h postoperatively,both resting and movement NRS scores were significantly lower in the LB group compared to the BH group(resting NRS:LB=2.0 vs.BH=4.0,P＜0.001;move-ment NRS:LB=3.0 vs.BH=6.0,P＜0.001).At 12,48,and 72 h postoperatively,NRS scores at rest and during movement were consistently lower in the LB group than in the BH group(P＜0.001).Opioid consumption was signifi-cantly reduced in the LB group at all time points(P＜0.000 1);the cumulative sufentanil dose at 72 h was(40.22±3.75)μg in the LB group versus(86.56±6.45)μg in the BH group,representing a 53.5％reduction(P＜0.001).The incidence of nausea and vomiting was significantly higher in the BH group compared to the LB group(61.1％vs.16.7％,P＜0.05).QOR-15 scores were significantly higher in the LB group(134.78 vs.111.67;difference 23.11 points,P＜0.000 1).There was no significant difference in hospital stay between groups(P=0.78).Conclusion Li-posomal bupivacaine administered via S-FICB provides continuous analgesia for up to 72 h in elderly patients undergoing intertrochanteric fracture surgery.It significantly reduces opioid consumption,lowers the incidence of adverse events,and improves patient satisfaction and recovery quality.

Abstract:Objective To investigate the prognostic value of a combined model based on peripheral blood helper T lymphocyte 1/helper T lymphocyte 2(Th1/Th2)cytokines and pneumonia severity index(PSI)scores in patients with severe pneumonia.Methods A total of 120 patients with severe pneumonia admitted from January 2021 to August 2023 were included and followed up for 1 year.According to survival during follow-up,patients were divided into a survival group(n=82)and a non-survival group(n=38).Demographic data,laboratory parameters,and PSI scores were com-pared between groups.Multivariate logistic regression analysis was performed to identify independent risk factors for mor-tality.A logistic regression prediction model was constructed,and receiver operating characteristic(ROC)curves were used to assess the predictive performance,with area under the curve(AUC)calculated.Results Compared with the sur-vival group,the non-survival group had significantly higher mean age[(80.62±10.41)years vs.(70.18±18.30)years],neutrophil-to-lymphocyte ratio(NLR)(13.60±2.45 vs.10.79±6.12),and PSI score(127.64±22.18 vs.113.59±20.61)(t=3.275,2.726,3.299;P＜0.05).Hospital stay[(11.15±10.03)days vs.(18.45±11.26)days]and peripheral blood Th1/Th2 cytokine ratio(4.02±1.02 vs.5.01±1.62)were lower in the non-surviv-al group(t=3.146,3.458;P＜0.05).Multivariate logistic regression identified age(OR=1.613,95％CI:1.744-3.498),hospital stay(OR=1.603,95％CI:1.729-3.525),NLR(OR=1.793,95％CI:1.837-3.844),Th1/Th2 ratio(OR=1.840,95％CI:1.806-4.200),and PSI score(OR=1.817,95％CI:1.818-4.034)as independ-ent risk factors for mortality.The logistic regression prediction model was constructed as follows:logistic(P)=-4.516+0.610×(Th1/Th2)+0.597×(PSI score).The model showed a sensitivity of 79.85％,specificity of 90.65％,and AUC of 0.912 for predicting mortality.Conclusion The combined model of peripheral blood Th1/Th2 cytokine ratio and PSI score demonstrates high sensitivity,specificity,and AUC in predicting mortality in patients with severe pneumonia,providing valuable guidance for clinical prognosis assessment.

Abstract:Objective To evaluate the analgesic efficacy of hydromorphone combined with butorphanol in inten-sive care unit(ICU)patients undergoing mechanical ventilation after cesarean section.Methods A total of 65 post-cesarean section patients receiving mechanical ventilation in the ICU of the Third Affiliated Hospital of Guangzhou Medical University between January 2023 and August 2024 were enrolled.Patients were randomly divided into a monotherapy group(n=32,treated with butorphanol alone)and a combination therapy group(n=33,treated with butorphanol plus hydro-morphone).Pain was assessed using the Critical-Care Pain Observation Tool(CPOT),and sedation was measured with the Richmond Agitation-Sedation Scale(RASS).Vital signs,hemodynamic parameters,and select laboratory indicators were recorded.Results The analgesia achievement rate was significantly higher in the combination group compared to the monotherapy group[(79.70±9.60)％vs.(73.86±11.30)％,P＜0.05].RASS and CPOT scores at all time points post-medication were significantly lower than baseline in both groups(P＜0.05),but no significant differences were found between groups(P＞0.05).Propofol dosage was significantly lower in the combination group[(337.45±85.2)mg vs.(662.50±188.68)mg,P＜0.05].There were no significant differences between the two groups in terms of me-chanical ventilation duration[(25.64±9.82)h vs.(27.26±29.63)h,P＞0.05]or morphine-equivalent analgesic dosage[(123.92±56.02)mg vs.108.44±63.70 mg,P＞0.05].Heart rate,mean arterial pressure,and respiratory rate decreased significantly after medication in both groups(P＜0.05),but intergroup differences were not significant(P＞0.05).The incidence of adverse events did not differ significantly between groups(P＞0.05).Conclusion Hydromor-phone combined with butorphanol provides effective analgesia in ICU patients undergoing mechanical ventilation after ce-sarean section.The combination allows for reduced propofol dosage without prolonging intubation duration or increasing ad-verse effects,thereby facilitating postpartum recovery.

Abstract:Postoperative pain management has long been a central focus in clinical practice.Current multimodal analgesia strategies mainly target the first 48 hours after surgery,often relying on opioids or conventional local anesthetics with relatively short durations of action.However,these approaches fail to address the need for sustained analgesia lasting 3-7 days postoperatively.Liposomal bupivacaine,the only ultra-long-acting analgesic currently available in clinical practice,achieves controlled release through multivesicular liposomal encapsulation.It has demonstrated certain efficacy in fascial plane blocks and peripheral nerve blocks.Although its superiority over conventional local anesthetics remains in-conclusive,its availability has broken the longstanding bottleneck of long-acting perioperative analgesia,marking a mile-stone in the field.In addition,other long-acting formulations such as bupivacaine gel solution(Posimir)and bupiva-caine implant(Xaracoll)have been approved,offering new options for perioperative pain control.Looking ahead,the fu-ture of ultra-long-acting perioperative analgesia will require a focus on achieving patient-acceptable pain states.Pro-gress will rely on innovations in drug delivery systems,the development of novel compounds,and integration with neuro-modulation techniques,thereby advancing analgesia strategies to improve patients' perioperative experience.

Abstract:Objective To investigate the clinical efficacy of motor imagery(MI)therapy based on meridian theo-ry combined with acupuncture in the treatment of stroke patients with Liver and Kidney Yin Deficiency,aiming to provide new rehabilitation strategies and innovative methods.Methods A total of 60 stroke patients with Liver and Kidney Yin Deficiency admitted to the Department of Rehabilitation from February to December 2023 were enrolled and randomly as-signed into an experimental group and a control group(n=30 each).Both groups received standard inpatient care;the control group was treated with routine acupuncture,while the experimental group received MI based on meridian theory combined with acupuncture in addition to routine acupuncture.The treatment course lasted 8 weeks.Clinical efficacy was evaluated using Traditional Chinese Medicine(TCM)syndrome scores,Fugl-Meyer Assessment(FMA),Modified Bar-thel Index(MBI),Mini-Mental State Examination(MMSE),TecnoBody balance system(ellipse area of movement),and surface electromyography(sEMG,measured in the deltoid,triceps brachii,quadriceps femoris,and peroneus mus-cles).Results After treatment,both groups showed significant improvements in FMA,MBI,MMSE scores,ellipse area of movement,and sEMG signals compared with baseline(all P＜0.05).The improvements were significantly greater in the experimental group than in the control group(all P＜0.05).Conclusion Motor imagery therapy based on meridian theory combined with acupuncture can effectively relieve TCM symptoms of Liver and Kidney Yin Deficiency in stroke pa-tients,enhance motor function,balance ability,and cognitive performance,with good safety,demonstrating clinical appli-cation value.

Abstract:Objective To investigate the characteristics of volume-sensitive chloride currents in side population(SP)cells of the chronic myeloid leukemia(CML)cell line K562 and compare them with non-side population(NSP)cells.Methods Based on the property of SP cells to efflux the fluorescent dye Hoechst 33342,individual SP and NSP cells in K562 cultures were identified under an inverted fluorescence microscope.Whole-cell patch-clamp recordings were used to measure volume-sensitive chloride currents in SP and NSP cells.Changes in extracellular osmolarity or ap-plication of chloride channel blockers were performed to assess their effects on these currents.Results Hypotonic stimula-tion(47％)significantly activated volume-sensitive chloride currents in K562 cells(P＜0.01).Extracellular applica-tion of chloride channel blockers ATP(10 mmol/L)or NPPB(50 μmol/L)inhibited the hypotonicity-activated currents(P＜0.05),and the inhibition was reversible upon washout.The current density activated by hypotonic stimulation was higher in SP cells than in NSP cells(P＜0.05),and the latency to peak activation was shorter in SP cells(P＜0.05).Whole-cell membrane capacitance showed no significant difference between SP and NSP cells(P＞0.05).Conclusion Volume-sensitive chloride currents exist in K562 cells,and their activity is significantly higher in SP cells compared with NSP cells.

Abstract:Objective To explore the developmental trajectories of sleep disturbances in patients with pulmonary infections and to identify factors contributing to intergroup differences,thereby revealing the dynamic patterns of sleep dis-turbances in this population.Methods A total of 250 patients with pulmonary infections who received treatment in our hospital between January and December 2023 were enrolled.The Pittsburgh Sleep Quality Index(PSQI)was used to eval-uate sleep disturbances at baseline(T1),day 3 of treatment(T2),day 7 of treatment(T3),and 1 month after treatment(T4).Latent growth mixture modeling(LGMM)was applied to determine the optimal number of latent classes and classi-fy trajectories.Multivariate logistic regression was used to analyze independent influencing factors associated with trajectory class differences.Results Of the 250 patients,238 valid cases were included in the analysis.LGMM identified three distinct trajectories of sleep disturbance:low-level type(n=50,21.01％),remission type(n=132,55.46％),and high-level type(n=56,23.53％).Both univariate and multinomial logistic regression analyses revealed that age,in-fection severity,anxiety,and depression were independent predictors of trajectory class differences(P＜0.05).Conclu-sion Sleep disturbance trajectories in patients with pulmonary infections exhibit significant heterogeneity.These findings suggest that healthcare providers should consider individualized nursing interventions targeting specific influencing factors to alleviate sleep disturbances in this patient population.

Abstract:Objective To retrospectively analyze the clinicopathological data of renal biopsy patients in the Bai ethnic region of Dali,and to investigate the distribution of renal pathological types,epidemiological characteristics,ethnic differences,and temporal trends,so as to provide evidence for regional kidney disease prevention and management.Methods A single-center retrospective study was conducted on 781 renal biopsy cases from September 2013 to Decem-ber 2024 at the Third Affiliated Hospital of Dali University.Clinical and pathological data were collected and analyzed by age,ethnicity,and time period to determine the distribution and temporal changes of renal pathology in the Bai popula-tion.Results Of 781 patients,the male-to-female ratio was 1.1∶1,with a mean age of(40.35±12.99)years.Young(46.86％)and middle-aged(46.74％)patients predominated,while elderly patients accounted for only 6.4％.Primary glomerulonephritis(PGN)was the leading diagnosis(69.4％),followed by secondary glomerulonephritis(SGN)(25.22％).Among PGN,the five most common subtypes were IgA nephropathy(IgAN,32.17％),membranous ne-phropathy(MN,24.35％),minimal change disease(MCD,16.23％),mesangial proliferative glomerulonephritis(MsPGN,7.75％),and focal segmental glomerulosclerosis(FSGS,3.69％).The detection rate of IgAN was higher in the Bai population compared with Han and other ethnic groups,whereas MN was more frequent in non-Bai populations.Temporal analysis revealed an increasing trend in IgAN(P=0.000),while MCD and FSGS declined(P＜0.05).The major SGN subtypes were lupus nephritis(LN,45.18％),Henoch-Schönlein purpura nephritis(HSPN,18.78％),diabetic kidney disease(DKD,11.17％),and ANCA-associated vasculitis(AAV,6.6％).Compared with Han and other groups,the Bai population had a higher prevalence of HSPN and a lower prevalence of LN.DKD showed a signifi-cant temporal increase(P=0.038).Additionally,24-hour urinary protein excretion was significantly lower in the Bai group than in the Han group(P＜0.05).Conclusion The study population was predominantly young and middle-aged.PGN was the most common renal disease,with IgAN,MN,and MCD as the major subtypes.SGN mainly comprised LN,HSPN,and DKD.Distinct ethnic differences were observed:IgAN and HSPN were more prevalent in the Bai popula-tion,while MN,FSGS,and LN were less frequent.Temporal trends demonstrated increasing detection rates of IgAN and DKD,and declining rates of MCD and FSGS,highlighting the need for targeted screening and intervention strategies.

Abstract:Postoperative acute pain caused by surgical tissue injury remains a significant clinical challenge.Data from the China Acute Postoperative Pain Study(CAPOPS)indicate that in 2023,48.7％of adult surgical patients in ma-inland China experienced moderate to severe postoperative pain,causing considerable distress and an urgent need for effec-tive analgesia.Pain management is a core competency in anesthesiology.Integrating intelligent analgesia systems with long-acting local anesthetic nerve block techniques offers a novel approach for postoperative pain control.Ultrasound-guided continuous peripheral nerve blockade with liposomal bupivacaine combined with artificial intelligence-assisted patient-controlled analgesia(Ai-PC A)can provide sustained and optimized analgesic effects while reducing total analgesic con-sumption.This strategy enables comprehensive multimodal pain management and supports the concept of a Virtual Pain Unit(VPU)for standardized care organization using intelligent analgesic devices.The combined application of intelligent analgesia and long-acting local anesthetic nerve block can enhance postoperative pain control,accelerate recovery,and improve patient comfort.Widespread implementation of this integrated approach in clinical practice is expected to provide high-quality analgesia and improve perioperative patient experience.

Abstract:Objective To investigate the analgesic effects of different local anesthetics for thoracic paravertebral block(PVB)in patients undergoing thoracic surgery.Methods A total of 62 patients undergoing single-port thoraco-scopic surgery under double-lumen endotracheal intubation general anesthesia were randomly assigned to receive T4 para-vertebral block with either ropivacaine(L group,n=31)or liposomal bupivacaine(B group,n=31).Pain scores at rest,during activity,and functional exercises(deep breathing,coughing,balloon blowing)were assessed on the day of surgery(T0)and postoperative days 1-3(T1-T3).PCA pump first press time,total presses within 72 h,opioid con-sumption,and rescue analgesia events were recorded.Postoperative adverse events including dizziness,nausea,vomiting,and orthostatic intolerance were also monitored.Results B group had significantly lower pain scores at T0-T3 for all conditions compared with L group(P＜0.05).First PCA press time was later in B group(P＜0.05),with fewer total PCA presses and lower opioid consumption(morphine equivalents,mg)than L group(P＜0.05).No significant differ-ence in rescue analgesia events was observed.Postoperative vomiting incidence was lower in B group(P＜0.05),while dizziness,nausea,and orthostatic intolerance were similar between groups.Conclusion Liposomal bupivacaine for tho-racic paravertebral block significantly reduces pain scores within 3 days postoperatively,decreases opioid consumption,and lowers the incidence of adverse events compared with ropivacaine.

Abstract:Objective To investigate the effect of vitamin D intervention on bone metabolism-related indicators in adult residents with low 25(OH)D levels in the high-cold region of Qinghai.Methods A total of 480 permanent residents from the same cohort in Qinghai's high-cold area were enrolled.A questionnaire(including age,sex,place of residence,BMI,etc.)was administered.Serum 25(OH)D,Parathyroid hormone(PTH),and bone turnover markers were measured.Participants were randomly divided into an observation group(n=240)and a control group(n=240).The observation group received oral Vitamin D3 at 800 IU/day,while the control group received placebo at the same dos-age,for 6 months.The changes in 25(OH)D,PTH,and bone turnover markers before and after intervention were com-pared between the two groups.Correlations between 25(OH)D levels and participants'physiological,biochemical,and bone metabolism indicators were analyzed.Results After 6 months of vitamin D3 supplementation,the levels of 25(OH)D,Calcium(Ca),and Phosphorus(P)increased significantly compared with baseline(P＜0.05)and were significantly higher than those in the control group(P＜0.05).The levels of PTH,C-terminal telopeptide of type Ⅰ collagen(β-CTX),and Procollagen type Ⅰ N-terminal propeptide(PI NP)decreased significantly(P＜0.01)and were signifi-cantly lower than those in the control group(P＜0.05).Before intervention,25(OH)D was negatively correlated with age,PTH,and β-CTX(r=-0.174,r=-0.408,r=-0.256,P＜0.05),and positively correlated with PINP,Ca,and P(r=0.315,r=0.323,r=0.257,P＜0.05).After intervention,25(OH)D was still negatively correlated with age,PTH,and β-CTX(r=-0.128,r=-0.438,r=-0.262,P＜0.05),and positively correlated with PINP,Ca,and P(r=0.223,r=0.330,r=0.298,P＜0.05).Conclusion Due to the long-term cold climate and insufficient sunlight exposure,adults in the Qinghai plateau generally present with deficiency or insufficiency of 25(OH)D.Interven-tion with 800 IU/day of vitamin D3 can increase serum 25(OH)D,Ca,and P levels,and decrease PTH,β-CTX,and PINP levels.

Abstract:China's elderly population is rapidly increasing,and with advancing age,the prevalence of sarcopenia is significantly rising.Nutritional intervention,through supplementation of essential nutrients,is one of the key strategies in the prevention and treatment of sarcopenia.Numerous studies have shown that increasing protein intake can improve muscle mass,strength,and function in older adults.However,there remains controversy regarding the optimal type and amount of protein supplementation,with concerns about the potential adverse effects of excessive protein intake.Addition-ally,β-hydroxy-β-methylbutyrate(HMB),a metabolite of leucine,can promote muscle protein synthesis and inhibit its breakdown,thereby significantly enhancing muscle mass in the elderly.Moreover,dysbiosis of the gut microbiota may lead to muscle aging and loss,playing a role in the pathophysiology of sarcopenia.Certain probiotics,particularly Bifidobacterium and Lactobacillus,may influence the gut-muscle axis and regulate muscle mass.Therefore,modulation of the gut microbiome presents a promising target for the prevention and treatment of sarcopenia.