Effect of liposomal bupivacaine for preoperative erector spinae plane block on postoperative pain following video-assisted thoracoscopic lung surgery: a protocol for a multicenter, randomized, double-blind, clinical trial.

Background: There is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery. Methods: This multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis. Discussion: We hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.

Resveratrol alleviates ischemia/reperfusion injury of diabetic myocardium via inducing autophagy.

The rising incidence and complications of diabetes constitutes a major public health issue. The mortality rate of diabetes-induced myocardial ischemia/reperfusion (I/R) injury is significantly elevated. Resveratrol (RSV) is a naturally occurring polyphenol considered to be a potent cardioprotective compound. The aim of the present study was to explore the function and molecular mechanism of RSV on diabetes-induced myocardial I/R injury. Left anterior descending coronary artery ligation was performed to stimulate myocardial I/R injury in streptozotocin-induced diabetic rats. Heart electrical activity was monitored through an electrocardiogram to confirm successful models. The myocardial infarct volume was detected via 2,3,5-triphenyltetrazolium chloride staining. Western blotting was employed to examine the levels of autophagy markers. It was found that the injection of RSV mitigated the ischemia- or I/R injury-induced myocardial damage on hemodynamic function and infarct size, but the autophagy inhibitor 3-methyladenine significantly blocked the function of RSV. Furthermore, the application of RSV significantly enhanced the expression of Beclin-1 and LC-3II but inhibited the serum levels of tumor necrosis factor-α and interleukin-6. These findings revealed an alleviating effect of RSV on diabetes-induced myocardial I/R injury and provided new evidence for the successful application of RSV on the diabetic myocardium.

Lidocaine inhibits proliferation and induces apoptosis in colorectal cancer cells by upregulating mir-520a-3p and targeting EGFR.

Lidocaine is a conventional local anesthetic which is shown antiproliferative of colorectal cancer (CRC) in patients. MicroRNAs (miRNAs) have been consistently demonstrated to be involved in CRC, and miR-520a-3p could suppress CRC migration, promote apoptosis by targeting epidermal growth factor receptor (EGFR). However, the mechanism by which lidocaine regulated CRC proliferation and apoptosis remains unknown. In this study, quantitative RT-PCR were used to measure miR-520a-3p and EGFR expression levels, and western blotting assays ware performed to measure EGFR expression in CRC cells. Luciferase reporter assay was employed to validate the direct targeting of EGFR by miR-520a-3p. Cell proliferation and apoptosis assays ware utilized to analyze the role of lidocaine in CRC cells. The results indicated that 500 and 1000 µM lidocaine over 24 h inhibited proliferation and induced apoptosis of CRC cells. Compared with the control group, the expression of EGFR was suppressed by lidocaine (500 µM) in CRC cells. Furthermore, miR-520a-3p could directly targets EGFR in CRC cells. Lidocaine (500 µM) increased the expression of miR-520a-3p and rescued the reduction of miR-520a-3p caused by miR-520a-3p inhibitor. The results suggested that lidocaine could suppress the expression of EGFR by upregulating miR-520a-3p, and it could induce apoptosis and inhibit proliferation in CRC cells. Lidocaine may serve as potential therapeutic regimen for colorectal cancer.

Imaging the Infant Chest without Sedation: Feasibility of Using Single Axial Rotation with 16-cm Wide-Detector CT.

Purpose To compare image quality, patient preparation time, and radiation dose using a single axial rotation with 16-cm wide-detector computed tomography (CT) in imaging the infant chest without sedation with those in infants examined by using a 64-row CT and sedation. Materials and Methods Thirty-two infants (group 1) were prospectively enrolled to undergo nonenhanced chest CT without sedation using a single axial rotation on a 16-cm wide-detector CT scanner. Patients were imaged with automatic tube current modulation and tube voltages of 80 kVp for patients weighing 5 kg or less and 100 kVp for patients weighing more than 5 kg. Patient preparation time, CT dose index (CTDI), dose-length product (DLP), and image quality were compared with those in a historical control group consisting of 30 infants (group 2) who underwent conventional helical scanning with sedation performed by using a 64-row volume CT scanner. The Student t test for independent samples was used to assess continuous variables. The Mann-Whitney rank test and the κ test were used to evaluate image quality. Results There was no statistically significant difference in body weight, age, mean CT attenuation value, image noise, and subjective image quality score between the two groups. However, compared with the group scanned by using a 64-row volume CT scanner (group 2), group 1 experienced significantly reduced scan time by 83% (0.35 second vs 2.01 seconds ± 0.21 [standard deviation]), preparation time by 57% (41.25 minutes ± 103.78 vs 96.5 minutes ± 151.77), CTDI by 42% (2.03 mGy ± 0.4 vs 3.52 mGy ± 0.03), and DLP by 52% (27.07 mGy·cm ± 6.97 vs 55.84 mGy·cm ± 6.46) (P < .05 for all). Conclusion Compared with conventional 64-row helical CT with sedation, use of a single axial rotation with 16-cm wide-detector CT in imaging the infant chest without sedation can reduce radiation dose, preparation time, and total scan time, while providing comparable image quality. © RSNA, 2017.

Effect of preoperative visiting operation room on emergence agitation in preschool children under sevoflurane anesthesia.

BACKGROUND: Emergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia. METHODS: Sixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group. General anesthesia was induced and maintained with sevoflurane. Parental separation status score, mask acceptance score, Aono's four point score and pediatric anesthesia emergence delirium (PAED) score and incidence of EA were recorded. PAED score >10 were regarded as EA. Recovery profile and adverse events were also recorded. RESULT: Parental separation status score and mask acceptance score in group PV was significantly lower than that in group RV and group RP (P < 0.05); Aono's four point score, PAED score and incidence of EA in group PV and group RP was significantly lower than that in group RV (P < 0.05); Time to extubation and time to interaction in group PV and group RV was significantly shorter than that in group RP (P < 0.05); POV and rescue by fentanyl in group PV and group RP was significantly lower than that in group RV(P < 0.05). CONCLUSION: PVOR can effectively reduce the incidence of EA as well as administration of propofol without additional medical expenses and other adverse effects.

[Clinical characteristics and prognostic factors of children with critical hand-foot-mouth disease treated with mechanical ventilation].

OBJECTIVE: To investigate the clinical characteristics of children with critical hand-foot-mouth disease (HFMD) who were treated with mechanical ventilation and to explore the risk factors for poor prognosis. METHODS: The clinical data of 63 children with critical HFMD who were admitted to the pediatric intensive care unit between April 2012 and September 2013 and needed mechanical ventilation were retrospectively analyzed. RESULTS: Among the 63 children, 43 were boys and 20 were girls, and their mean age was 25 ± 18 months, with 81% under 3 years old. The four death cases were all under three years old. Compared with the cured cases, the death cases had a significantly lower mean age (8 ± 3 months vs 25 ± 18 months; P<0.05). Poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage were all closely related to death (P<0.01). The death cases and cured cases had significantly different peripheral white blood cell counts, blood lactic acid, and blood glucose (24 ± 11× 109/L vs 12 ± 5×109/L; 6.6 ± 1.8 mmol/L vs 3.6 ± 1.7 mmol/L; 16.4 ± 2.5 mmol/L vs 10.0 ± 3.0 mmol/L). The cases with critical illness score <90 had a significantly higher death risk (P<0.01). CONCLUSIONS: Children with critical HFMD are mainly under 3 years old. The children face extremely high risk of death when they suffer from poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage. Significant increases in peripheral white blood cell counts, blood lactic acid, and blood glucose are risk factors for poor prognosis. Critical illness score is also related to poor prognosis.

N-acetylcysteine attenuates cardiopulmonary bypass-induced lung injury in dogs.

BACKGROUND: Cardiopulmonary bypass (CPB) is usually associated with inflammatory response that leads to various degrees of organ dysfunction in multiple systems, including lung injury. Our previous study showed that transforming growth factor beta1 (TGFß1) was involved in CPB-induced lung injury. N-acetylcysteine (NAC) is an antioxidant and is able to prevent CPB-induced pneumocyte apoptosis through scavenging radical. Therefore, we investigated whether NAC may attenuate CPB-induced lung injury by inhibiting TGFß1 expression. METHODS: Fifty-four 18 to 24-month-old mongrel dogs (15-16 kg) were randomly divided into control group, CPB group and NAC group (n = 18). Six dogs in each group were killed prior to, as well as 30 and 60 minutes after the operation (T0, T1 and T2). Lung injury was evaluated by hematoxylin and eosin (H&E) staining. Respiratory index (RI), oxygenation index (OI), malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the lung were determined at each time point. TGFß1 expression was determined using real time RT-PCR and immunohistochemistry. RESULTS: A serious lung injury was observed after CPB in dogs. RI and MDA content were increased significantly after CPB, whereas OI and SOD activity were decreased. H&E staining showed that NAC treatment obviously attenuated CPB-induced lung injury. NAC treatment upregulated OI and SOD activity and downregulated RI and MDA content in the lung tissues of dogs after CPB. Treatment with NAC significantly suppressed the TGFß1 expression in the lung tissues at both mRNA and protein levels. CONCLUSION: Our results suggest that NAC is a potent agent against CPB-induced acute lung injury through inhibiting TGFß1 expression.

Expression of transforming growth factor beta 1 in lung tissue during cardiopulmonary bypass-induced lung injury in dogs.

BACKGROUND: Cardiopulmonary bypass (CPB) is a necessary technique for cardiac surgery and usually induces acute lung injury. Transforming growth factor ß1 (TGFß1) has been found to play a crucial role in the pathogenesis of inflammatory diseases; however, whether TGFß1 is also involved in CPB-induced lung injury has yet to be determined. Therefore, we aimed to investigate the TGFß1 expression in the lungs of dogs after CPB. METHODS: A total of 36 healthy mongrel dogs were randomly assigned to control and CPB groups. Six dogs in each group were killed before, 30 min after the operation, and 60 min after the operation (T0, T1, and T2). Lung injury was evaluated by hematoxylin and eosin staining. Respiratory index (RI), oxygenation index (OI), malondialdehyde (MDA) content in the lung, and pulmonary permeability index (PPI) were determined at each time point. TGFß1 expression was determined using real-time reverse transcription polymerase chain reaction and immunohistochemistry. RESULTS: There was a serious lung injury observed after CPB in dogs. RI increased and OI decreased in the dogs after CPB. The MDA content significantly increased after CPB; however, no significant change of MDA occurred in the control group. A significant increase of PPI was detected in CPB group at the T1 and T2 time points compared with that at the T0 time point. TGFß1 expression in the lung was increased after CPB on both the mRNA and protein levels. Positive correlations between TGFß1 mRNA level and MDA (r = 0.867, p < 0.01) and between TGFß1 mRNA and PPI (r = 0.821, p < 0.01) were detected by linear correlation. CONCLUSION: The upregulation of TGFß1 expression plays an important role in the development and progression of CPB-induced acute lung injury.

Design of a novel non-equilibrium plasma-based water treatment reactor.

A novel non-equilibrium plasma-based water treatment reactor consisting of high voltage multi-needle electrode submerged in aqueous phase and reticulated ground electrode suspended in gas phase above water was developed and applied to treat low concentrations of methyl orange (MO). The electrode configuration was optimized. Higher number and more uniform distribution of streamers were produced in gas phase when parallel five-needle configuration with needle spacing of 10mm for high voltage electrode, macroporous ground electrode with mesh size of 0.42mm, and electrode gap of 17mm were adopted. This case corresponds to the largest amount of hydrogen peroxide and ozone produced in aqueous phase and gas phase, respectively, and air flow rate presents an economical value. The injection of wastewater above ground electrode for pretreatment and the design of fixed mesh barriers further increase the amount of ozone dissolved in aqueous solution. The conversion of MO presents a positive correlation with input voltage and the increase of pulse repetition rate is conducive for the conversion. In addition, the effect of initial solution concentration and treating volume on the conversion, energy yield and COD removal was evaluated.

Effect of granular activated carbon on degradation of methyl orange when applied in combination with high-voltage pulse discharge.

The application of a gas-liquid series electrical discharge reactor for the degradation of methyl orange (MO) in the presence of granular activated carbon (GAC1V, GAC2V, and GAC3V) was investigated and the effect of these GACs in a combined treatment was evaluated, respectively. Under the experimental conditions used in this work, MO cannot be removed completely by GAC adsorption; the MO degradation is faster by pulse discharge, but satisfactory removal of chemical oxygen demand (COD) is never achieved. The MO degradation can be increased and COD can be removed effectively in the combined treatment through both the adsorption and the catalysis of GAC. The synergy intensity value indicates that a high correlation exists between the catalytic effect of GACs and the number of basic groups on their surface. Boehm titration and FTIR studies indicate that both acidic and basic groups on the GAC surface can be increased except that basic groups of GAC2V are slightly decreased by this process. This process can also slightly decrease their surface area and micropore and macropore volume. Furthermore, the virgin and saturated GAC samples can both be regenerated in situ after repeated use.

Catalytic ozonation of phenolic wastewater with activated carbon fiber in a fluid bed reactor.

The effect of activated carbon fiber (ACF) on the ozonation of phenol in water in a fluid bed reactor was investigated. It was observed that this combined process could increase the yield of the oxidation process significantly for phenol and COD (chemical oxygen demand) removal, especially for the phenol removal. The efficiency of ozonation increased with an increase in the dose of ACF. Higher initial phenol concentration only caused a slight decrease of phenol and COD removal. The results of repeated use found that ozonation could efficiently regenerate ACF in situ in the reactor, which was considered easy to handle without the costly ex situ regeneration of the industrial treatment process. The Boehm titrations and FTIR studies indicate that the ozonation process in water can significantly change the composition of acidic surface oxygen-containing groups of ACF, leading to the increase of carboxylic, hydroxylic, and carbonylic groups and the slight decrease of the lactonic groups. Furthermore, this process can also increase the surface area and total pore volume of ACF. Due to the new micropore formation and some pore enlargement, the micropores became smaller, and the mesopores and macropores got bigger.