Effects of Soothing Music on the Intraoperative Management of Patients Undergoing Tension-Free Herniorrhaphy: A Retrospective Study.

BACKGROUND: Noise pollution in the operating room can have adverse effects on the physical and mental well-being of patients. Since the mid-20th century, music therapy has been increasingly used in clinical practice. Soothing music has a beneficial effect in maintaining the efficacy of intraoperative sedation and regulating patients' emotions. OBJECTIVE: To investigate the effects of soothing music on the intraoperative management of patients undergoing tension-free herniorrhaphy. METHODS: We retrospectively analyzed the clinical data of 244 patients who underwent open tension-free herniorrhaphy under local anesthesia at the Fourth Affiliated Hospital of Nanchang University from June 2019 to May 2021. According to the different included time periods, the hospital implemented soothing music management from June 2020 to May 2021, and 110 patients admitted during this period were classified as the study group. One hundred thirty-four patients who underwent clinical routine management from June 2019 to May 2020 were classified as the control group. The patients in the two groups received corresponding management modes during surgery. The perioperative indicators, stress response, anxiety, depression, and clinical efficacy of the two groups were analyzed. RESULTS: No significant differences in the operative time, intraoperative blood loss, postoperative off-bed activity time, and hospitalization time between the two groups (P > 0.05). The study group exhibited lower postoperative cortisol (213.30 (203.40, 229.00) nmol/L) and anxiety (9.00 (7.00, 12.00) points) levels than the control group (246.85 (230.50, 258.40) nmol/L; 14.00 (12.00, 15.00) points) (P < 0.001). Moreover, no significant differences were noted in the norepinephrine and depression levels and the severity of illness, global improvement, and efficacy index scores between the two groups (P > 0.05). CONCLUSION: Soothing music therapy, as a clinical auxiliary method, has a positive impact on the intraoperative management of patients undergoing open tension-free herniorrhaphy, leading to reduced cortisol levels and alleviation of anxiety.

Feasibility Analysis of Wearables Guiding Scientific Movements and Promoting Health.

Wearable devices have gradually integrated into people's healthy lives because of their mobility, portability, and other characteristics, and have shown their value and status in sports and health. Wearable devices can be used to capture a large amount of human body activity data, but how to effectively use these data to serve people and help people form a healthy lifestyle is a problem to be considered. In order to further study the feasibility of wearable devices to guide scientific movements and promote health, a new layered motion recognition algorithm is proposed in this study. In this study, a C4.5-based decision tree algorithm is used to identify the state layer, and only the mean and variance features are extracted from the acceleration sensor data. Three corresponding BP neural network classifiers are constructed and classified. Each classifier is responsible for identifying actions in the corresponding states and verifying the method in this study through experiments. The experimental results in this study show that the recognition rate of the mRMR feature selection recognition algorithm is 1.13% higher than the BE algorithm and 2.02% higher than the recognition method without any feature selection algorithm. In addition, the research in this article found that wearable devices can realize the real-time detection of the physiological indicators of the wearer throughout the day to evaluate the efficacy of the drug and apply it to the early detection and treatment of diseases, which may improve patient compliance and promote health to a certain extent.

Impact of Sevoflurane Versus Propofol Anesthesia on Post-Operative Cognitive Dysfunction in Elderly Cancer Patients: A Double-Blinded Randomized Controlled Trial.

BACKGROUND Research on the clinical outcomes of surgical patients anaesthetized with sevoflurane and the association of sevoflurane with post-operative cognitive dysfunction (POCD) is scarce. We evaluated whether sevoflurane-based anesthesia increased the incidence of POCD and worsened prognosis compared to propofol-based anesthesia in elderly cancer patients. MATERIAL AND METHODS This single-center, prospective, double-blind randomized controlled trial included 234 patients aged 65 to 86 years undergoing tumor resection who received sevoflurane-based (Group S) or propofol-based (Group P) anesthesia during surgery. A series of neuropsychological tests was performed to evaluate cognitive function before surgery and at 7 days and 3 months post-operation, and the results were compared to those of healthy controls. RESULTS At 7 days post-operation there were no significant differences in the incidence of POCD between patients who received sevoflurane-based or propofol-based anesthesia during surgery: Group S was at 29.1% (32 out of 110 patients) versus Group P at 27.3% (30 out of 110), P=0.764. At 3 months, Group S was at 11.3% (12 out of 106 patients) versus Group P at 9.2% (10 out of 109), P=0.604. During the first 2 days post-operation, the QoR-40 global score was significantly lower in Group S compared to Group P [POD 1: P=0.004; POD 2: P=0.001]. There were no significant differences in in-hospital post-operative complications, post-operative length of hospital stay, all-cause mortality at 30 days, and 3 months post-operation, or post-operative quality of life at 3 months between patients in Group S and Group P. CONCLUSIONS Sevoflurane-based anesthesia did not increase the incidence of POCD compared to propofol-based anesthesia at 7 days or 3 months post-operation or impact short-term post-operative prognosis.

[Study on Rac1/MAPK/ERK pathway mediated mechanism and role in rats with ventilator induced lung injury].

OBJECTIVE: To investigate the role of Ras-related C3 botulinum toxin substrate 1/mitogen-activated protein kinase/extracellular signal-regulated kinase (Rac1/MAPK/ERK) signal pathway in rats with ventilator induced lung injury (VILI) and its mechanism. METHODS: Thirty Sprague-Dawley (SD) rats were randomly divided into spontaneous respiration group, normal tidal volume (VT) group and high VT group with 10 rats in each group. The rats in spontaneous respiration group were kept their spontaneous breathing. The rats in normal VT group and high VT group were performed tracheal intubation after tracheostomy, and underwent mechanical ventilation on bilateral lungs with 6 mL/kg and 40 mL/kg VT respectively with maintenance anesthesia. After 4-hour ventilation, heart blood, bronchoalveolar lavage fluid (BALF) and lung tissues were harvested. The levels of interleukins (IL-1ß, IL-6), tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO) and macrophage inflammatory protein-2 (MIP-2) in serum and BALF were determined by enzyme linked immunosorbent assay (ELISA). Lung wet/dry radio (W/D) was determined. The lung tissues were stained with hematoxylin and eosin (HE), and pathological changes were observed, and pathological scores were evaluated. The ultra structure changes in type II alveolar epithelial cells (AEC II) were observed with transmission electron microscope. The positive expressions of phosphorylation of extracellular signal-regulated kinase (p-ERK) were determined by immunohistochemistry, and those of Rac1 and F-actin were determined by immunofluorescence. The mRNA expressions of ERK and Rac1 were determined by real-time fluorescent quantitation reverse transcription-polymerase chain reaction (RT-qPCR), and protein expressions of Rac-1, p-ERK and F-actin were determined by Western Blot. RESULTS: (1) Compared with spontaneous breathing group, lung W/D in both mechanical ventilation groups was significantly increased, with more significant increase in the high VT group (6.64±0.88 vs. 1.79±0.36, P < 0.01). (2) There was no obvious pathological changes in the lung tissue and AEC II of the spontaneously breathing group. In the normal VT group, there was slight edema and infiltration of inflammatory cells; AEC II had less lamellar bodies and uniform distribution of the villi of the alveolar epithelium. In the high VT group, the edema of the lung tissue, the widening of the pulmonary septum, the alveolus congestion, the infiltration of inflammatory cells, and alveolar structure disorder were found; and AEC II was irregular, the number of lamellar bodies in the plastids was decreased and was unevenly distributed. The pulmonary histopathological score in the high VT group was significantly higher than that in the spontaneous breathing group and the normal VT group (12.00±2.00 vs. 6.00±1.51, 8.50±0.53, both P < 0.01). (3) Compared with spontaneous breathing group, IL-1ß, IL-6, TNF-α, MPO, and MIP-2 in serum and BALF in both mechanical ventilation groups were significantly increased, with more significant increase in the high VT group [serum IL-1ß (ng/L): 104.2±15.1 vs. 20.3±8.3, IL-6 (ng/L): 46.6±11.5 vs. 22.7±7.5, TNF-α (ng/L): 39.4±6.5 vs. 5.4±1.9, MPO (ng/L): 0.66±0.24 vs. 0.06±0.03, MIP-2 (ng/L): 109.2±25.8 vs. 22.8±8.4; BALF IL-1ß (ng/L): 121.5±25.6 vs. 24.0±7.5, IL-6 (ng/L): 136.7±32.7 vs. 31.4±10.5, TNF-α (ng/L): 98.0±14.8 vs. 10.1±2.6, MPO (ng/L): 0.80±0.31 vs. 0.08±0.04, MIP-2 (ng/L): 144.4±28.9 vs. 41.2±20.7; all P < 0.01]. (4) There were only a few p-ERK, Rac1 and F-actin positive expressions in the spontaneous breathing group. The positive expressions in normal VT group were increased. In high VT group, the positive expression of p-ERK was significantly increased; Rac1 and F-actin were mainly distributed in the cell membrane and cytoplasm respectively, the positive expressions were further enhanced. (5) The gene expressions of ERK and Rac1, and protein expressions of p-ERK, Rac1 and F-actin in the high VT group were significantly higher than those in the spontaneous breathing group and normal VT group [ERK mRNA (2-ΔΔCt): 8.23±2.83 vs. 1, 3.02±1.38, p-ERK protein (gray value): 1.15±0.36 vs. 0.61±0.23, 0.88±0.22; Rac1 mRNA (2-ΔΔCt): 4.45±2.26 vs. 1, 1.22±0.39, Rac1 protein (gray value): 0.91±0.16 vs. 0.48±0.11, 0.55±0.10; F-actin protein (gray value): 0.70±0.09 vs. 0.49±0.08, 0.55±0.04; all P < 0.01]. CONCLUSIONS: F-actin expression in lung tissue was up-regulated in rats with VILI, which resulted in reconstruction of AEC II cyto-skeleton, and variation of cell membrane permeability through Rac1/MAPK/ERK signaling pathway during VILI.