Knowledge mapping of chronic insomnia: a bibliometric analysis (2000-2023).

BACKGROUND: Recently, significant scientific research breakthroughs have been witnessed in the treatment of chronic insomnia. However, it seems that there is currently no bibliometric analysis of this. Therefore, we hope to comprehensively review and analyze the scholarly system and research focus in the field of chronic insomnia treatment through bibliometric methods. METHODS: Between 2000 and 2023, we explored various papers in relation to the treatment of chronic insomnia in the Web of Science Core Collection(WOSCC) database. Subsequently, the collected papers were subjected to bibliometric analysis utilizing CiteSpace, VOSviewer, and the "bibliometric" package in R language. RESULTS: With China and the United States(USA) among them, a total of 2937 papers were published across 49 countries. Publications related to the treatment of chronic insomnia were increasing year by year. The Laval University, Washington University, Pittsburgh University, and Stanford University were key research institutions. The journal Sleep was widely popular in the field and was also one of the most cited journals. These papers came from 148 authors, with Morin, Charles M., Roth, Thomas, Espie, Colin A., Harvey, Allison G., and Buysse, Daniel J. publishing the most papers and Morin, cm being co-cited the most. The treatment process of chronic insomnia can be divided into three main stages: drug intervention, diseases related to chronic insomnia, and cognitive behavioral therapy and mental health. Keywords such as "children and adolescents", "novel coronavirus pneumonia" (COVID-19), "mental health" and "heart failure" have become the focus of current research. CONCLUSIONS: We carried out a detailed bibliometric review of the development trends and research results of chronic insomnia research through this study for the first time. The information it provides reveals recent research hotspots and cutting-edge issues, providing valuable reference materials for researchers focusing on the treatment of chronic insomnia.

Heme protects intestinal mucosal barrier in DSS-induced colitis through regulating macrophage polarization in both HO-1-dependent and HO-1-independent way.

Hemoglobin-derived heme was reported to play protective roles in hemorrhagic diseases by modulating the macrophages toward recovery. Mucosal bleeding is one of the pathological features of inflammatory bowel diseases (IBD). However, whether heme provides anti-inflammatory profiles in macrophages, thus contributing to the intestinal mucosal barrier protection, is unclear. In the current study, we investigated the beneficial effects of heme on DSS-induced colitis mice and explored the underlying mechanisms. In vivo, systemic heme supplementation by hemin injection relieved intestinal inflammation and remedied intestinal mucosal barrier damage by correcting abnormal intestinal macrophage polarization. In vitro, we confirmed the reciprocally regulating effects of hemin on M1/M2 macrophage polarization in BMDM. Intriguingly, with knockdown of HO-1, the inhibiting effects of hemin on M1 polarization were maintained, while the promoting effects on M2 polarization were reversed. Further research proved that hemin repressed the inflammatory profiles in macrophages through inhibiting the translocation of NF-κB p65 by disrupting IRF5-NF-κB p65 complex formation in Spi-C-dependent way. In conclusion, these results showed that the modification of colon tissue microenvironment with heme supplementation plays a protective role in DSS-induced colitis mice through regulating the macrophage polarization in both HO-1-dependent and HO-1-independent way, indicating a new choice to therapeutically modulate the macrophage function and prevent IBD.

Triptolide analog LLDT-8 ameliorates psoriasis-like dermatitis in BALB/c mice via suppressing the IL-36α signaling pathway.

Triptolide has shown a good immunosuppressive effect on autoimmune diseases. However, the toxicity limited its widely clinical practice. In this study, we investigated the effects and underlying mechanisms of (5R)-5-hydroxytriptolide (LLDT-8), a novel triptolide derivative, on a murine psoriasis-like dermatitis model and related cell lines. Here, we showed that LLDT-8 significantly attenuated symptoms of psoriasis-like dermatitis induced by imiquimod (IMQ, a TLR7 agonist) by reducing the psoriasis area and severity index (PASI) score and inflammatory parameters. The action of LLDT-8 was involved in down-regulated interleukin (IL)-36α expression and blocked IL-36α pathway by LC-MS-based label-free quantitative (LFQ) proteomic approach and further experiments. Meanwhile, we observed that LLDT-8 significantly inhibited the expression of IL-36α in R837-treated bone marrow-derived dendritic cells (BMDCs). In conclusion, LLDT-8 notably alleviated IMQ-induced psoriasis-like skin inflammation via suppressing the IL-36α signaling pathway, suggesting LLDT-8 might be a potential drug for the treatment of psoriasis.

General Identifiability Condition for Network Topology Monitoring with Network Tomography.

Accurate knowledge of network topology is vital for network monitoring and management. Network tomography can probe the underlying topologies of the intervening networks solely by sending and receiving packets between end hosts: the performance correlations of the end-to-end paths between each pair of end hosts can be mapped to the lengths of their shared paths, which could be further used to identify the interior nodes and links. However, such performance correlations are usually heavily affected by the time-varying cross-traffic, making it hard to keep the estimated lengths consistent during different measurement periods, i.e., once inconsistent measurements are collected, a biased inference of the network topology then will be yielded. In this paper, we prove conditions under which it is sufficient to identify the network topology accurately against the time-varying cross-traffic. Our insight is that even though the estimated length of the shared path between two paths might be "zoomed in or out" by the cross-traffic, the network topology can still be recovered faithfully as long as we obtain the relative lengths of the shared paths between any three paths accurately.

Cholinesterase inhibitors for the treatment of delirium in non-ICU settings.

BACKGROUND: Delirium is a common clinical syndrome defined as alterations in attention with an additional disturbance in cognition or perception, which develop over a short period of time and tend to fluctuate during the course of the episode. Delirium is commonly treated in hospitals or community settings and is often associated with multiple adverse outcomes such as increased cost, morbidity, and even mortality. The first-line intervention involves a multicomponent non-pharmacological approach that includes ensuring effective communication and reorientation in addition to providing reassurance or a suitable care environment. There are currently no drugs approved specifically for the treatment of delirium. Clinically, however, various medications are employed to provide symptomatic relief, such as antipsychotic medications and cholinesterase inhibitors, among others. OBJECTIVES: To evaluate the effectiveness and safety of cholinesterase inhibitors for treating people with established delirium in a non-intensive care unit (ICU) setting. SEARCH METHODS: We searched ALOIS, which is the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 26 October 2017. We also cross-checked the reference lists of included studies to identify any potentially eligible trials. SELECTION CRITERIA: We included randomised controlled trials, published or unpublished, reported in English or Chinese, which compared cholinesterase inhibitors to placebo or other drugs intended to treat people with established delirium in a non-ICU setting. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were duration of delirium, severity of delirium, and adverse events. The secondary outcomes were use of rescue medications, persistent cognitive impairment, length of hospitalisation, institutionalisation, mortality, cost of intervention, leaving the study early, and quality of life. For dichotomous outcomes, we calculated the risk ratio (RR) with 95% confidence intervals (CIs); for continuous outcomes we calculated the mean difference (MD) with 95% CIs. We assessed the quality of evidence using GRADE to generate a 'Summary of findings' table. MAIN RESULTS: We included one study involving 15 participants from the UK. The included participants were diagnosed with delirium based on the Confusion Assessment Method (CAM) criteria. Eight males and seven females were included, with a mean age of 82.5 years. Seven of the 15 participants had comorbid dementia at baseline. The risk of bias was low in all domains.The study compared rivastigmine with placebo. We did not find any clear differences between the two groups in terms of duration of delirium (MD -3.6, 95% CI -15.6 to 8.4), adverse events (nausea, RR 0.30, 95% CI 0.01 to 6.29), use of rescue medications (RR 0.13, 95% CI 0.01 to 2.1), mortality (RR 0.10, 95% CI 0.01 to 1.56), and leaving the study early (RR 0.88, 95% CI 0.07 to 11.54). Evidence was not available regarding the severity of delirium, persistent cognitive impairment, length of hospitalisation, cost of intervention, or other predefined secondary outcomes.The quality of evidence is low due to the very small sample size. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the use of cholinesterase inhibitors for the treatment of delirium in non-ICU settings. No clear benefits or harms associated with cholinesterase inhibitors were observed when compared with placebo due to the lack of data. More trials are required.

CX3CR1 Mediates Nicotine Withdrawal-Induced Hyperalgesia via Microglial P38 MAPK Signaling.

Previously, we reported that nicotine withdrawal (NT) significantly increased pain sensitivity in rats. Recent reports suggest that fractalkine is involved in the spinal cord neuron-to-microglia activation via CX3CR1 signaling. However, its contribution to NT-induced hyperalgesia and the underlying mechanisms have yet to be elucidated. In the present study, a rat model of NT was used to test the changes in CX3CR1 expression in the spinal cord. We also evaluated the effect of the CX3CR1 neutralizing antibody on spinal microglial activity, the expression of phosphorylated p38-mitogen-activated protein kinase (p-p38-MAPK) and heat-induced pain responses. We established a NT model via subcutaneous injection of pure nicotine (3 mg/kg), three times daily for 7 days. The expression of CX3CR1 was studied by Western blot and immunofluorescence staining. Following NT, the rats received daily intrathecal injections of CX3CR1 neutralizing antibody for 3 days. The change in paw withdrawal latency (PWL) was observed. The activation of microglia and the expression of p-p38-MAPK were investigated by Western blot and immunofluorescence staining. The expression of CX3CR1 was significantly increased after NT and co-localized with IBA-1. NT rats treated with CX3CR1 neutralizing antibody showed significantly increased PWL on day 4 after NT. Furthermore, the activation of microglia and the expression of p-p38-MAPK in the spinal cord were suppressed. These results indicate that microglial CX3CR1/p38MAPK pathway is critical for the development of pain hypersensitivity after NT.

The effect of mitochondrial calcium uniporter opener spermine on diazoxide against focal cerebral ischemia--reperfusion injury in rats.

BACKGROUND: Recent research has indicated that mitochondrial adenosine triphosphate-sensitive potassium channels play an important role in cerebral protection, which involves in attenuating the calcium of mitochondria. However, the effect of diazoxide on cerebral ischemia-reperfusion and the role of spermine, the agonist of mitochondrial calcium uniporter (MCU), remain unknown. OBJECTIVE: We investigated the effect of MCU opener spermine on diazoxide against focal cerebral ischemia-reperfusion injury in rats. METHODS: Adult male Wistar rats were randomly divided into 5 groups: the Sham group, the I/R group, the Dzx + I/R group, the Dzx + Sper + I/R group, and the Sper + I/R group. Rats were exposed to 2-hour ischemia and 24-hour reperfusion. Diazoxide were administrated 30 minutes before ischemia, and spermine were given 10 minutes before reperfusion. Rats in the Sham group did not experience the process of ischemia-reperfusion. After 24-hour reperfusion, rats were given neurological performance tests, overdosed with general anesthesia, and then their brains were excised for infarct volume, pathological changes, and biochemical evaluation and analysis. RESULTS: Rats in the Dzx + I/R group displayed improved neurological deficits and decreased infarct volume and oxidative stress (evidenced by decreased nitric oxide and malondialdehyde but increased antioxidant enzymes [eg, glutathione peroxide and superoxide dismutase]) caused by ischemia-reperfusion. The beneficial effects of diazoxide were significantly attenuated by spermine treatment. Rats in the Sper + I/R group displayed worse neurological deficits, larger infarct volume and more oxidative stress, and less antioxidant enzymes than those in the Dzx + I/R. CONCLUSIONS: Our results suggested that diazoxide, which improved neurological deficits and decreased infarct volume and oxidative stress against ischemia-reperfusion injury, is mediated by spermine.

Mitochondrial calcium uniporter opener spermine attenuates the cerebral protection of diazoxide through apoptosis in rats.

BACKGROUND: It is reported that ischemic penumbra is a dynamic process, in which irreversible necrosis in the center of ischemia propagates to the neighboring tissue over time. Recent research has indicated that mitochondrial adenosine triphosphate (ATP)-sensitive potassium channels (mitoKATP) opener diazoxide plays an important role in cerebral protection; however, the role of mitochondrial calcium uniporter (MCU) in the effect of diazoxide on penumbra and infarct core remains unclear. METHODS: Adult male Wistar rats were randomly divided into 5 groups: the Sham group, the ischemia-reperfusion (I/R) group, the diazoxide and ischemia-reperfusion (Dzx + I/R) group, the diazoxide and spermine and ischemia-reperfusion (Dzx + Sper + I/R) group, and the spermine and ischemia-reperfusion (Sper + I/R) group. The animals were exposed to 24-hour reperfusion after 2-hour ischemia. Diazoxide and spermine were administrated at 30 minutes or 10 minutes before the beginning of ischemia or reperfusion, respectively. After 24-hour reperfusion, animals were given neurologic performance tests and when overdosed with general anesthesia their brains were excised for infarct volume, apoptosis, and immunohistochemical. RESULTS: Rats in the Dzx + I/R group displayed improved neurologic deficits, decreased infarct volume in cortex but not in subcortex, and apoptosis (evidenced by decreased terminal deoxynucleotidyl transferase-mediated dUTP nick end lebeling-positive percentage and the immunohistochemistry of cytochrome c) in cortex caused by ischemia/reperfusion. Rats in the Dzx + Sper + I/R group displayed worse neurologic deficits, larger infarct volume in cortex but not in subcortex, and more apoptosis both in penumbra and infarct core of cortex than those in the Dzx + I/R group. CONCLUSIONS: Results in our study suggested that diazoxide improved neurologic deficits, decreased infarct volume in cortex but not in subcortex, and apoptosis in cortex against ischemia/reperfusion injury is mediated by spermine.

Establishment and validation of a predictive nomogram for polyuria during general anesthesia in thoracic surgery.

BACKGROUND: To develop and evaluate a predictive nomogram for polyuria during general anesthesia in thoracic surgery. METHODS: A retrospective study was designed and performed. The whole dataset was used to develop the predictive nomogram and used a stepwise algorithm to screen variables. The stepwise algorithm was based on Akaike's information criterion (AIC). Multivariable logistic regression analysis was used to develop the nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the model's discrimination ability. The Hosmer-Lemeshow (HL) test was performed to check if the model was well calibrated. Decision curve analysis (DCA) was performed to measure the nomogram's clinical usefulness and net benefits. P < 0.05 was considered to indicate statistical significance. RESULTS: The sample included 529 subjects who had undergone thoracic surgery. Fentanyl use, gender, the difference between mean arterial pressure at admission and before the operation, operation type, total amount of fluids and blood products transfused, blood loss, vasopressor, and cisatracurium use were identified as predictors and incorporated into the nomogram. The nomogram showed good discrimination ability on the receiver operating characteristic curve (0.6937) and is well calibrated using the Hosmer-Lemeshow test. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS: Individualized and precise prediction of intraoperative polyuria allows for better anesthesia management and early prevention optimization.

Establishment and Validation of Risk Prediction Models for Postoperative Pain After Endoscopic Submucosal Dissection: A Retrospective Clinical Study.

Objective: Postoperative pain is a common complication in endoscopic submucosal dissection (ESD) patients. This study aimed to develop and validate predictive models for postoperative pain associated ESD. Methods: We retrospectively constructed a development cohort comprising 2162 patients who underwent ESD at our hospital between January 2015 and April 2022. The dataset was randomly divided into a training set (n = 1541) and a validation set (n = 621) in a 7:3 ratio. The bidirectional stepwise regression with Akaike's information criterion (AIC) and multivariate logistic regression analysis were used to screen the predictors of post-ESD pain and construct three nomograms. We evaluated the model's discrimination, precision and clinical benefit through receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow (HL) goodness-of-fit test and decision curve analysis (DCA) in internal validation. Results: The proportion of patients developing postoperative pain in the training and testing data set was 25.6% and 28.5%, respectively. Three nomograms were constructed according to the final logistic regression models. The clinical prediction models for preoperative risks, preoperative and intraoperative risks, and perioperative risks consisted of seven, nine and six independent predictors, respectively, after bidirectional stepwise elimination. The models demonstrated the AUC of 0.794 (95% CI 0.768-0.820), 0.823 (95% CI 0.799-0.847) and 0.817 (95% CI 0.792-0.842) in the training cohort and 0.702 (95% CI 0.655-0.748), 0.705 (95% CI 0.659-0.752) and 0.747 (95% CI 0.703-0.790) in the validation cohort. The calibration plot, HL and DCA demonstrated the model's favorable clinical applicability. Conclusion: We developed and validated three robust nomogram models, which might identify patients at risk of post-ESD pain and promising for clinical applications.

Determinants of immediate extubation in the operating room after total thoracoscopic closure of congenital heart defects.

OBJECTIVE: This study was designed to assess the factors that influence immediate extubation following totally thoracoscopic closure of congenital heart defects. SUBJECTS AND METHODS: Clinical and operational data of 216 patients (87 males, average age 13.6 ± 10.9 years) were retrospectively analyzed. Atrial (ASD, n = 90) or ventricular septal defects (VSD, n = 126) were closed via a totally thoracoscopic approach. Ultra-fast-track anesthesia (UFTA) was used in all patients. RESULTS: Immediate extubation in the operating room was successfully performed in 156 (72.2%) patients. A delayed extubation was completed in the intensive care unit in the remaining 60 (27.8%) patients. There was no significant difference in the age, sex, body weight, or type of congenital heart defect between the immediate and delayed extubation groups (p > 0.05). However, more patients in the delayed extubation group had severe preoperational pulmonary hypertension [8 (13.3%) vs. 4 (2.3%), p < 0.05]. The cardiopulmonary bypass time, aortic clamp time, and total duration of the surgery in the immediate extubation group were shorter than in the delayed extubation group (p < 0.05). Multivariate logistic regression analysis showed that preoperational pulmonary hypertension, duration of the surgery or cardiopulmonary bypass, and dosage of fentanyl used during the surgery were independent predictors for immediate extubation. CONCLUSIONS: UFTA and immediate extubation in the operating room was feasible and safe in the majority of patients undergoing totally thoracoscopic closure of ASD or VSD. Preoperational pulmonary hypertension, duration of the surgery, and the dosage of fentanyl used for UFTA were the determining factors for immediate extubation.

Effect of anesthesia assistance on the detection rate of precancerous lesions and early esophageal squamous cell cancer in esophagogastroduodenoscopy screening: A retrospective study based on propensity score matching.

Background: Esophagogastroduodenoscopy (EGD) screening is vital for the early diagnosis of esophageal squamous cell cancer (ESCC). However, improvement in the detection rate of precancerous lesions and early ESCC with anesthesia assistance (AA) has not yet been investigated. This retrospective study aimed to evaluate the effect of AA on the detection rate of precancerous lesions and early ESCC in patients undergoing EGD screening and identify risk factors affecting the detection rate. Methods: We reviewed patients' electronic medical records who underwent EGD screening between May 2019 and August 2020. Patients were divided into two groups based on whether they received AA: those in Group A underwent EGD screening with AA, and patients in Group O underwent EGD screening without AA. Propensity score matching (PSM) was used to account for differences in baseline characteristics. Detection rates of precancerous lesions and early ESCC were compared between the two groups following PSM. Binary logistic regression was used to identify risk factors affecting the detection rate. Results: The final analysis included 21,835 patients (Group A = 13,319, Group O = 8,516) from 28,985 patients who underwent EGD screening during the study period. Following PSM, 6009 patients remained in each group for analysis. There was no significant difference in the detection rate of precancerous lesions and early ESCC between Groups A and O (1.1% vs. 0.8%, p > 0.05). Binary logistic regression showed that age (50-59 years, 60-69 years and 70-79 years), higher endoscopist seniority, high-definition (HD) endoscopy, narrow-band imaging (NBI), and number of endoscopic images were all independent risk factors that affected the detection rate of precancerous lesions and early ESCC. Conclusion: There was no statistically significant difference in the detection rate of precancerous lesions and early ESCC between patients who underwent EGD screening with and without AA. All independent risk factors that affected the detection rate of precancerous lesions and early ESCC included the following: age (50-59 years, 60-69 years and 70-79 years), higher endoscopist seniority, HD endoscopy, NBI, and number of endoscopic images. Endoscopists should consider all these factors as much as possible when performing EGD screening.

A DUSP6 inhibitor suppresses inflammatory cardiac remodeling and improves heart function after myocardial infarction.

Acute myocardial infarction (MI) results in loss of cardiomyocytes and abnormal cardiac remodeling with severe inflammation and fibrosis. However, how cardiac repair can be achieved by timely resolution of inflammation and cardiac fibrosis remains incompletely understood. Our previous findings have shown that dual-specificity phosphatase 6 (DUSP6) is a regeneration repressor from zebrafish to rats. In this study, we found that intravenous administration of the DUSP6 inhibitor (E)-2-benzylidene-3-(cyclohexylamino)-2,3-dihydro-1H-inden-1-one (BCI) improved heart function and reduced cardiac fibrosis in MI rats. Mechanistic analysis revealed that BCI attenuated macrophage inflammation through NF-κB and p38 signaling, independent of DUSP6 inhibition, leading to the downregulation of various cytokines and chemokines. In addition, BCI suppressed differentiation-related signaling pathways and decreased bone-marrow cell differentiation into macrophages through inhibiting DUSP6. Furthermore, intramyocardial injection of poly (D, L-lactic-co-glycolic acid)-loaded BCI after MI had a notable effect on cardiac repair. In summary, BCI improves heart function and reduces abnormal cardiac remodeling by inhibiting macrophage formation and inflammation post-MI, thus providing a promising pro-drug candidate for the treatment of MI and related heart diseases. This article has an associated First Person interview with the first author of the paper.

Chemical screening links disulfiram with cardiac protection after ischemic injury.

Ischemia-reperfusion injury occurs after reperfusion treatment for patients suffering myocardial infarction, however the underlying mechanisms are incompletely understood and effective pharmacological interventions are limited. Here, we report the identification and characterization of the FDA-approved drug disulfiram (DSF) as a cardioprotective compound. By applying high-throughput chemical screening, we found that DSF decreased H2O2-induced cardiomyocyte death by inhibiting Gasdermin D, but not ALDH1, in cardiomyocytes. Oral gavage of DSF decreased myocardial infarct size and improved heart function after myocardial ischemia-reperfusion injury in rats. Therefore, this work reveals DSF as a potential therapeutic compound for the treatment of ischemic heart disease.

Technical aspects of anesthesia and cardiopulmonary bypass in patients undergoing totally thoracoscopic cardiac surgery.

OBJECTIVE: The use of fast-track general anesthesia in patients undergoing nonrobotically assisted and totally thoracoscopic cardiac surgeries has not been previously reported previously. DESIGN: A prospective clinical study. SETTING: A university hospital. PARTICIPANTS: Ninety-six patients (41 males; mean age, 13.2 ± 6.2 years; range, 5-47 years). INTERVENTION: Nonrobotically assisted totally thoracoscopic surgeries were performed for atrial (n = 58) or ventricular septal defect (n = 32), tetralogy of Fallot (n = 2), left atrial myxoma (n = 3), and pulmonary valve stenosis (n = 1). Fast-track general anesthesia was induced with midazolam, propofol, fentanyl, and vecuronium and was maintained with remifentanil and sevoflurane. Cardiopulmonary bypass was established peripherally through the femoral vein and artery. MEASUREMENTS AND MAIN RESULTS: All surgeries were successful. There were no perioperative mortality or major complications. The mean cardiopulmonary bypass and aortic cross-clamp times were 42 ± 21 minutes and 33 ± 8 minutes, respectively. In 82 cases, the heart regained beats automatically after the release of the aortic cross-clamp, whereas in 14 patients external defibrillation was required. Extubation was conducted in 32 patients (33.3%) in the operating room 15 minutes after the operation. The mean times of mechanical ventilation and stay in the intensive care unit were 1.5 ± 0.2 hours and 20.1 ±1.2 hours, respectively. CONCLUSIONS: Cardiopulmonary bypass for totally thoracoscopic cardiac surgery can be established through the femoral artery and femoral vein. With fast-track anesthesia, early extubation in the operating room can be achieved in more than one third of patients.

Anesthesia Assistance in Colonoscopy: Impact on Quality Indicators.

Background: Adenoma detection rate (ADR) and polyp detection rate (PDR) are both indicators for colonoscopy quality. Improving ADR or PDR is critical for reducing the incidence and mortality of colorectal cancer (CRC). Although several studies have focused on identifying the factors that may influence ADR or PDR, the evidence remains limited and inconclusive. We conducted a retrospective study to evaluate the effect of anesthesia assistance (AA) on ADR or PDR in patients undergoing colonoscopy screening and identify risk factors affecting ADR or PDR. Methods: We reviewed electronic medical records of patients who underwent colonoscopy screening between May 2019 and August 2020. Patients were divided into two groups according to whether they received AA: patients in Group A underwent colonoscopy screening with AA, whereas patients in Group O underwent colonoscopy screening without AA. Propensity score matching (PSM) was utilized to account for differences in baseline characteristics. After, ADR and PDR were compared between the two groups. Binary logistic regression was employed to identify risk factors that affected ADR or PDR. Results: Of 9432 patients who underwent colonoscopy examination during the study period, 7170 were included in the final analyses (Group A = 5756 and Group O = 1414). After PSM, 736 patients remained in each group for analyses. There was no significant difference between groups A and O (P > 0.05) in ADR or PDR. Binary logistic regression indicated that the endoscopic device version (Olympus HQ290), equipment image-based technique and number of images were independent risk factors that affected ADR, and the age (50-59 years and 60-69 years), gender (male), high-risk status, endoscopist seniority (senior endoscopist), equipment image-based technique and number of images were all independent risk factors that affected PDR. Conclusions: We discovered that AA does not affect ADR or PDR. Despite improved patient satisfaction, using AA is unnecessary for improving colonoscopy quality. Endoscopists should consider all these factors as much as possible when performing colonoscopy screening.

Flexible Bronchoscope versus Video Laryngoscope for Orotracheal Intubation During Upper Gastrointestinal Endoscopic Surgery in Left Lateral Position: A Randomized Controlled Trial.

Purpose: Endoscopic submucosal dissection (ESD) has become the primary treatment for early upper gastrointestinal tract lesions. During endoscopic surgery, endotracheal intubation is generally performed in the patients' supine position, and patients are shifted to the left lateral position for endoscopic surgery. This study compared the efficacy of flexible bronchoscope-guided intubation with that of video laryngoscope-guided intubation in the left lateral position. Patients and Methods: Forty-eight patients receiving ESD were randomly divided into the flexible bronchoscope group (group F) or the video laryngoscope group (group V). Tracheal intubation was performed by a trained anesthetist with a flexible bronchoscope (group F) or unchanneled video laryngoscope (group V) in the left lateral position. Primary outcomes included the intubation duration and success rate. Secondary outcomes included the ease of intubation technique and the occurrence of complications. Results: Twenty-four (100%) patients in group F and twenty-three (95.8%) in group V were successfully intubated (P = 1.000). The median intubation time in group F was 37s (interquartile range, 33.0, 44.5), which was significantly shorter compared to group V (53s [45.5, 66.5]; P < 0.001). The flexible bronchoscope was significantly easier to manage than the video laryngoscope, as reflected by the users scoring system (9 [9, 10] vs 8 [7, 8]; P < 0.001). The presence of perioperative adverse events and complications were comparable between the two groups. Conclusion: Both flexible bronchoscope- and video laryngoscope-guided intubation in patients' left lateral position achieved high success rates and comparable complication rates. However, intubation with the flexible bronchoscope was completed more quickly.

A small-molecule cocktail promotes mammalian cardiomyocyte proliferation and heart regeneration.

Zebrafish and mammalian neonates possess robust cardiac regeneration via the induction of endogenous cardiomyocyte (CM) proliferation, but adult mammalian hearts have very limited regenerative potential. Developing small molecules for inducing adult mammalian heart regeneration has had limited success. We report a chemical cocktail of five small molecules (5SM) that promote adult CM proliferation and heart regeneration. A high-content chemical screen, along with an algorithm-aided prediction of small-molecule interactions, identified 5SM that efficiently induced CM cell cycle re-entry and cytokinesis. Intraperitoneal delivery of 5SM reversed the loss of heart function, induced CM proliferation, and decreased cardiac fibrosis after rat myocardial infarction. Mechanistically, 5SM potentially targets α1 adrenergic receptor, JAK1, DYRKs, PTEN, and MCT1 and is connected to lactate-LacRS2 signaling, leading to CM metabolic switching toward glycolysis/biosynthesis and CM de-differentiation before entering the cell-cycle. Our work sheds lights on the understanding CM regenerative mechanisms and opens therapeutic avenues for repairing the heart.

Retrospective study of perioperative cardiac arrest from a Chinese tertiary hospital.

ABSTRACT: Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) - 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.

Nicotine induces P2X4 receptor, interleukin-1 beta, and brain-derived neurotrophic factor expression in BV2 microglia cells.

OBJECTIVE: Upregulation of P2X4 receptor (P2X4R), brain-derived neurotrophic factor (BDNF), and interleukin-1 beta (IL-1ß) in activated microglia is associated with hyperalgesia. This study investigated whether nicotine increases pain hypersensitivity by altering the expression of these molecules in microglia. We also examined the role of interferon regulatory factor 8 (IRF8) in this process. METHODS: Experiments were performed in BV2 microglial cells. IRF8 was knocked down or overexpressed using lentiviruses harboring a short hairpin RNA targeting IRF8 or an IRF8 overexpression construct, respectively. P2X4R, BDNF, and IL-1ß mRNA and protein levels were evaluated by real-time PCR and western blotting, respectively, and BDNF and IL-1ß secretion was assessed by ELISA. RESULTS: Chronic nicotine exposure enhanced the expression of P2X4R, BDNF, and IL-1ß in BV2 cells, and stimulated the release of BDNF and IL-1ß in the presence of ATP. IRF8 was found to mediate the nicotine-induced increases in BDNF and IL-1ß mRNA and P2X4R protein levels in BV2 cells. CONCLUSION: Nicotine may increase pain hypersensitivity by promoting the expression of P2X4R, BDNF, and IL-1ß through modulation of IRF8 levels in microglial cells.