The Relationship Between Early Exposure to General Anesthesia and Neurobehavioral Deficits.

In contemporary medical practice, general anesthesia plays an essential role in pediatric surgical procedures. While modern anesthetic protocols have demonstrated safety and efficacy across various pathological conditions, concerns persist regarding the potential neurotoxic effects associated with early exposure to general anesthesia. Current research primarily examines the neurocognitive developmental impacts, with limited focus on neurobehavioral developmental disorders. This review presents a comprehensive analysis of clinical trial results related to five critical neurobehavioral developmental disorders: fine motor disability, attention-deficit-hyperactivity disorder (ADHD), impulse control disorders (ICDs), autism spectrum disorder (ASD), and developmental coordination disorder (DCD). Furthermore, the review synthesizes insights from basic research on the potential toxicological mechanisms of general anesthetic agents that could influence clinical neurobehavioral changes. These findings provide valuable guidance for the prudent and safe utilization of anesthetic agents in pediatric patients.

Adolescents and Children Age Estimation Using Machine Learning Based on Pulp and Tooth Volumes on CBCT Images.

OBJECTIVES: To estimate adolescents and children age using stepwise regression and machine learning methods based on the pulp and tooth volumes of the left maxillary central incisor and cuspid on cone beam computed tomography (CBCT) images, and to compare and analyze the estimation results. METHODS: A total of 498 Shanghai Han adolescents and children CBCT images of the oral and maxillofacial regions were collected. The pulp and tooth volumes of the left maxillary central incisor and cuspid were measured and calculated. Three machine learning algorithms (K-nearest neighbor, ridge regression, and decision tree) and stepwise regression were used to establish four age estimation models. The coefficient of determination, mean error, root mean square error, mean square error and mean absolute error were computed and compared. A correlation heatmap was drawn to visualize and the monotonic relationship between parameters was visually analyzed. RESULTS: The K-nearest neighbor model (R2=0.779) and the ridge regression model (R2=0.729) outperformed stepwise regression (R2=0.617), while the decision tree model (R2=0.494) showed poor fitting. The correlation heatmap demonstrated a monotonically negative correlation between age and the parameters including pulp volume, the ratio of pulp volume to hard tissue volume, and the ratio of pulp volume to tooth volume. CONCLUSIONS: Pulp volume and pulp volume proportion are closely related to age. The application of CBCT-based machine learning methods can provide more accurate age estimation results, which lays a foundation for further CBCT-based deep learning dental age estimation research.

Clinical efficacy of wet dressing combined with chitosan wound dressing in the treatment of deep second-degree burn wounds: A prospective, randomised, single-blind, positive control clinical trial.

To evaluate the efficacy and safety of wet dressing combined with chitosan wound dressing for deep II degree burn wounds, and provide the basis for clinical application. From October 2019 to October 2021, 80 patients with second-degree deep burn treated in the Department of burn and plastic surgery of our hospital were selected as the research objects. Patients were randomly divided into two groups. The control group (40n) was treated with wet compress, and the study group (40n) was treated with wet compress combined with chitosan wound dressing. The wound healing time, wound healing percentage and pain score were used as the effectiveness indexes, and the incidence of adverse events and serious adverse events and the detection rate of bacterial culture of wound exudates were used as the safety indexes. The efficacy and safety of the two groups were compared. The wound healing time of the study group (19.53 ± 2.74 days) was shorter than that of the control group (24.78 ± 4.86 days), the difference was significant (t = 3.571, P = 0.015). The percentage of wound healing at the 14th after treatment in the study group was higher than that in the control group (65.00% versus 37.50%) (X2  = 6.054, P = 0.014). There was no significant difference in pain scores between the two groups at each time point. The scar growth was observed 3 months after wound healing. The scar score of the study group (6.00 ± 0.98) was lower than that of the control group (8.77 ± 1.19) (t = 2.571, P = 0.031). The positive rate of wound secretion culture on the 7th and 14th day was statistically significant (X2  = 4.528, P = 0.033; X2  = 6.646, P = 0.010), and the study group was lower than the control group (29.03% versus 81.82%; 8.11% versus 42.86%). There was no significant difference in treatment cost between the study group and the control group (1258.7 ± 223.6 versus 1248.9 ± 182.3) (t = 1.571, P = 0.071). No adverse events or serious adverse events occurred in both groups. Chitosan wound dressing can significantly shorten the time of wound healing and reduce wound pain and wound infection in patients with deep second-degree burns. And it can effectively improve the situation of scar hyperplasia, which is worthy of clinical application.

Application of digital subtraction angiography in canine hindlimb arteriography.

OBJECTIVES: Research in the field of lower extremity vascular disease has increased in popularity over the years. To adequately characterize and validate the effectiveness of vascular interventions, in vivo experimentation in large animals is required. Thus, it is necessary to find a method to detect the shape and density of blood vessels in the lower extremities that can evaluate and verify the treatment measures' effectiveness and have high accuracy and repeatability. This study characterized factors that determined both the accuracy and overall value of digital subtraction angiography in lower limb arteriography using a canine animal model. METHODS: Six beagle dogs were anesthetized and immobilized on the motorized table. The femoral artery was accessed using an indwelling needle. A bolus of contrast agent was injected into the access site, and digital subtraction angiography with bolus chase technology was used to collect contrast images for analysis. At the end of the procedure, the anesthetized dogs were euthanized using an overdose of potassium chloride. After confirming the euthanasia of the dogs, the cadavers were taken to the experimental animal center of Xinjiang Medical University and processed by qualified institutional personnel. RESULTS: The final arteriographic images of the hind limbs from all six dogs were precise, and the branches of small vessels could be distinguished without any visible artifacts. CONCLUSIONS: These results suggested that arteriography using digital subtraction angiography could reveal the shape and density of blood vessels in canine animal models. This method has great potential to significantly improve research related to limb ischemia due to its simple and reproducible results.

Outcomes of modified chevron osteotomy for hallux valgus.

PURPOSE: This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up. METHODS: Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The minimum follow-up duration was five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes. RESULTS: The AOFAS score improved from 54.40 ( ± 4.58) preoperatively to 94.30 ( ± 2.15) six weeks postoperatively (p < 0.001) and 96.95 ( ± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 ( ± 1.17) preoperatively to 0.15 ( ± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° ( ± 2.20°) preoperatively to 4.15° ( ± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° ( ± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° ( ± 5.34°) preoperatively to 4.80° ( ± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° ( ± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years. CONCLUSION: A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up.

Transcriptome analysis of Penaeus vannamei hepatopancreas reveals differences in toxicity mechanisms between phoxim and prometryne.

Due to overuse and terrestrial input, there are large quantities of phoxim and prometryne residues in some aquatic environments. In the present study, the effects of these compounds on Penaeus vannamei hepatopancreas were analysed at the transcriptome level to investigate toxicity in this nontarget aquaculture organism. Twelve normalised cDNA libraries were constructed using RNA from phoxim and prometryne treatment groups, and an untreated control group. A total of 667,750,902 clean reads were obtained. Analysis of differentially expressed genes (DEGs) identified 449 in control vs phoxim groups, 185 in control vs prometryne groups, and 183 in prometryne vs phoxim groups. In the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, arachidonic acid metabolism, pancreatic secretion, linoleic acid metabolism, and beta-alanine metabolism pathways were significantly enriched in control vs phoxim groups. In control vs prometryne groups, lysosome, pentose and glucuronate interconversion, antigen processing and presentation, and glycosaminoglycan degradation pathways were significantly enriched. In prometryne vs phoxim groups, protein digestion and absorption, extracellular matrix (ECM)-receptor interaction, PI3K-Akt signalling, cell adhesion molecule (CAM), AGE-RAGE signalling related to diabetic complications, focal adhesion, and renin secretion pathways were significantly enriched. In further detailed analysis, glutathione S-transferase (GST), glutathione peroxidase and basic phospholipase A2 were downregulated in the phoxim treatment group, indicating that phoxim damaged hepatopancreas. Upregulation of phospholipase A2 (secretory phospholipase A2-like) indicates possible inflammatory pathological injury to hepatopancreas caused by phoxim. Meanwhile, downregulation of CD63 indicates that prometryne affect the immune system.

Analysis of the Effect of Wound-Edge Microgranular Skin Grafting in the Treatment of Various Small Wounds.

Objective: To explore the clinical effect of wound edge microgranular skin grafting in the treatment of various small wounds. Methods: From September 2018 to September 2021, Yueqing people's Hospital of Wenzhou City, Zhejiang Province collected and recorded the data of 12 patients with chronic wounds and third degree burns. The method of skin grafting with particles at the edge of the wound was used to graft skin on the wound. Scar evaluation scale was used to evaluate the wound. The patients were followed up for 12 months. The preoperative and postoperative data, scar index and patient satisfaction after healing were recorded and statistically analyzed. Results: All patients in this group were followed up for 3-12 months, and the results showed that SCAR Scale score decreased gradually over time, with patient satisfaction ranging from 80% to 96%. The patient gradually healed, scar hyperplasia gradually improved, functional activities gradually returned to normal, clinical effect is satisfactory. Conclusion: Microparticle skin grafting at the edge of wound avoids skin grafting at different skin donor sites. It has the characteristics of simple anesthesia, small trauma and convenient operation. This method can be considered when treating patients with chronic wounds and burns who need skin grafting.

Efficacy evaluation and systematic review of supramalleolar osteotomy for treatment of varus-type ankle arthritis.

BACKGROUND: The current surgical treatment plan for medium-term varus-type ankle arthritis is primarily supramalleolar osteotomy (SMOT), but the reliability of this procedure still lacks high-quality evidence-based medical studies, such as randomized controlled clinical trials and meta-analyses of comparative studies. OBJECTIVE: The current study explored whether significant differences were present in the clinical effect, reoperation rate, complications, and failure rate of this type of surgery. METHOD: Two researchers searched the relevant literature in seven databases, including PubMed, Cochrane Library, EMBASE, the China Biomedical Literature Database, the China Academic Journals Full-text Database, the Wanfang database, and the Weipu Chinese Science and Technology Journal Database. The retrieval time spanned the establishment of the specific database up to September 2020, and the literature was screened to determine their final inclusion in the study. RESULTS AND CONCLUSIONS: A total of 20 studies were included, including one Chinese and 19 English language studies. The primary indicators included a definitive effect of SMOT on the treatment of medium-term varus-type ankle arthritis. Concerning secondary indicators, although the surgery effect was satisfactory, some patients may require follow-up surgery, which may be unsuccessful with complications. The study results showed that, based on existing literature reports, the effect of SMOT for varus-type ankle arthritis was a satisfactory surgical method with some clinical value for correcting the ankle force line and relieving or even reversing ankle arthritis. However, its risk of complications and failure rate were comparatively high and, accordingly, requires good preoperative planning and close communication with patients. Due to the limited sample size of this study, more data and longer follow-up times involving this type of surgery should be reviewed to confirm this conclusion.

Involvement of Noxa in mediating cellular ER stress responses to lytic virus infection.

Noxa is a Bcl-2 homology domain-containing pro-apoptotic mitochondrial protein. Noxa mRNA and protein expression are upregulated by dsRNA or virus, and ectopic Noxa expression enhances cellular sensitivity to virus or dsRNA-induced apoptosis. Here we demonstrate that Noxa null baby mouse kidney (BMK) cells are deficient in normal cytopathic response to lytic viruses, and that reconstitution of the knockout cells with wild-type Noxa restored normal cytopathic responses. Noxa regulation by virus mirrored its regulation by proteasome inhibitors or ER stress inducers and the ER stress response inhibitor salubrinal protected cells against viral cytopathic effects. Noxa mRNA and protein were synergistically upregulated by IFN or dsRNA when combined with ER stress inducers, leading to Noxa/Mcl-1 interaction, activation of Bax and pro-apoptotic caspases, degradation of Mcl-1, loss of mitochondrial membrane potential and initiation of apoptosis. These data highlight the importance of ER stress in augmenting the expression of Noxa following viral infection.