Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study.

Intraoperative ingestion of blood, cerebrospinal fluid, and irrigation fluid can lead to an increase in gastric volume, resulting in the potential risk of aspiration in patients after endoscopic endonasal transsphenoidal surgery (EETS). In this prospective observational study, we aimed to assess the volume of gastric contents in patients undergoing this neurosurgical procedure using ultrasound, and to determine the factors associated with volume change. Eighty-two patients diagnosed with pituitary adenoma were recruited consecutively. Semi-quantitative (Perlas scores: 0, 1 and 2) and quantitative (cross-sectional area, CSA) ultrasound assessments of the gastric antrum were performed immediately before and after surgery in the semi-recumbent and semi-recumbent right-lateral positions. Seven (8.5%) patients had antrum scores from preoperative grade 0 to postoperative grade 2; nine (11%) patients had antrum scores from preoperative grade 0 to postoperative grade 1. The mean ± standard deviation (SD) of increased gastric volume was 71.0 ± 33.1 mL and 236.5 ± 32.4 mL in postoperative grade 1 and 2 groups, respectively. Subgroup analysis showed that 11 (13.4%) patients (4 in grade 1 and all in grade 2) had postoperative estimated gastric volume > 1.5 mL kg-1 (mean ± SD 3.08 ± 1.67, range 1.51-5.01 mL kg-1). Logistic regression analysis revealed that older age, diabetes mellitus, and long surgical duration were independent risk factors for significant volume change (all P < 0.05). Our results showed a significant increase in gastric volume in some patients who underwent EETS. Bedside ultrasound measurements of gastric volume can be used to assess the postoperative aspiration risk, particularly in older diabetic patients with a longer surgical duration.

Electroacupuncture pretreatment induces tolerance against focal cerebral ischemia through activation of canonical Notch pathway.

BACKGROUND: Electroacupuncture (EA) pretreatment can induce the tolerance against focal cerebral ischemia. However, the underlying mechanisms have not been fully understood. Emerging evidences suggest that canonical Notch signaling may be involved in ischemic brain injury. In the present study, we tested the hypothesis that EA pretreatment-induced tolerance against focal cerebral ischemia is mediated by Notch signaling. RESULTS: EA pretreatment significantly enhanced Notch1, Notch4 and Jag1 gene transcriptions in the striatum, except Notch1 intracellular domain level, which could be increased evidently by ischemia. After ischemia and reperfusion, Hes1 mRNA and Notch1 intracellular domain level in ischemic striatum in EA pretreatment group were increased and reached the peak at 2 h and 24 h, respectively, which were both earlier than the peak achieved in control group. Intraventricular injection with the γ-secretase inhibitor MW167 attenuated the neuroprotective effect of EA pretreatment. CONCLUSIONS: EA pretreatment induces the tolerance against focal cerebral ischemia through activation of canonical Notch pathway.

Relationship of sleep disturbance and postoperative delirium: a systematic review and meta-analysis.

Background: Studies have investigated the relationship between sleep disturbance and postoperative delirium (PD) but have controversial results. A systematic review and meta-analysis have a high level of evidence to comprehensively evaluate the effect of sleep disturbance on PD. Our study aims to provide available evidence regarding the effect of sleep disturbance on PD. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies from database inception to April 28, 2021. The eligible studies were identified according to the "PICOS" principles. Odds ratio (OR) was used to indicate the effect index, and 95% confidence interval (CI) was applied to express the effect size. The heterogeneity was tested. Subgroup analyses, meta-regression, and sensitivity analysis were also applied. Begg's test was used to test potential publication bias. The modified Newcastle-Ottawa Scale (NOS) was used to evaluate the literature quality. Results: Totally, 18 articles including 2,714 patients were enrolled, with most of the included literature being of moderate to high quality. The results of systematic and meta-analysis suggested that sleep disturbance was associated with an increased risk of PD (OR: 3.731; 95% CI: 2.338 to 5.956). Subgroup analysis results demonstrated that sleep disturbance in patients aged <65 years (OR: 6.072; 95% CI: 3.054 to 12.071), aged ≥65 years (OR: 2.904; 95% CI: 1.487 to 5.671), and undergoing cardiac (OR: 3.390; 95% CI: 1.359 to 8.453), orthopedic (OR: 3.943; 95% CI: 2.219 to 7.008), or other surgeries (OR: 4.963; 95% CI: 2.156 to 11.420) increased the risk of PD (all P<0.005). Moreover, increased risk of PD was found for both preoperative (OR: 2.804; 95% CI: 1.517 to 5.184) and postoperative (OR: 6.302; 95% CI: 3.794 to 10.467) sleep disturbance (all P<0.005). No associations between obstructive sleep apnea (OSA; OR: 2.008; 95% CI: 0.753 to 5.354; P=0.164), insomnia (OR: 4.005; 95% CI: 0.636 to 25.203; P=0.139) and risk of PD were observed. Conclusions: Our study indicated the relationship between sleep disturbance and the risk of PD. Patients undergoing surgical treatments should pay attention to their sleep quality. However, more research is needed to confirm its relationship.