Donut-like MOFs of copper/nicotinic acid and composite hydrogels with superior bioactivity for rh-bFGF delivering and skin wound healing.

BACKGROUND: Skin injury and the resultant defects are common clinical problems, and usually lead to chronic skin ulcers and even life-threatening diseases. Copper, an essential trace element of human body, has been reported to promote the regeneration of skin by stimulating proliferation of endothelial cell and enhance angiogenesis. RESULTS: Herein, we have prepared a new donut-like metal-organic frameworks (MOF) of copper-nicotinic acid (CuNA) by a simple solvothermal reaction. The rough surface of CuNA is beneficial for loading/release basic fibroblast growth factor (bFGF). The CuNAs with/without bFGF are easily processed into a light-responsive composite hydrogel with GelMA, which not only show excellent mechanical properties, but also display superior biocompatibility, antibacterial ability and bioactivity. Moreover, in the in vivo full-thickness defect model of skin wound, the resultant CuNA-bFGF@GelMA hydrogels significantly accelerate the wound healing, by simultaneously inhibiting the inflammatory response, promoting the new blood vessels formation and the deposition of collagen and elastic fibers. CONCLUSIONS: Considering the superior biocompatibility, antibacterial ability and bioactivity, the CuNA and its composite light-responsive hydrogel system will be promising in the applications of skin and even other tissue regeneration.

Newly discovered COLQ gene mutation and its clinical features in patients with acetyl cholinesterase deficiency.

To investigate the relationship between acetyl cholinesterase associated collagen gene (COLQ) mutation in patients with acetyl cholinesterase deficiency and its clinical characteristics. Serum and red blood cell acetyl cholinesterase from patients with acetyl cholinesterase deficiency (n=6) and normal controls (n=20) were measured by butyryl thiocholine substrate. COLQ gene variations were detected by sequencing. And the cholinesterase (ChE) genotypes were measured by dibucaine inhibition in vitro. The distributions of ChE surrounded the blood vessels and nerve fibers in lung or pancreas tissues were detected by immunohistochemical staining and indirect immunofluorescence. Serum lactic acid, ammonia and other clinical data were analyzed. Serum ChE in patients with acetyl cholinesterase deficiency were only 1/50 to 1/1000 fold of normal controls. Comparing to controls, dibucaine inhibition values of patients were significantly lower, while there were no differences in red blood cells acetyl cholinesterase. Serum lactic acid and ammonia in patients were significantly higher than controls. Inser 1281-1282 GC of COLQ gene was found in 2 patients, while IVS 6 + 21 T > A, IVS 6 + 30 G > T, IVS 6 + 34 T > C and IVS66 + 12 inser T mutations were found in the other 4 patients, respectively. In addition, the patients with COLQ gene mutation were resistant to regular doses of anesthetics. COLQ gene mutation may be an important reason for the lack of serum ChE in patients with acetyl cholinesterase deficiency.

A Modified GC-MS Analytical Procedure for Separation and Detection of Multiple Classes of Carbohydrates.

A modified GC-MS analytical procedure based on trimethylsilyl-dithioacetal (TMSD) derivatization has been established for a simultaneous determination of thirteen carbohydrates. Different from previous approaches, the current GC-MS method was featured by a powerful practicability for simultaneous detection of aldoses, uronic acids, ketoses, and amino sugars; simplifying GC-MS chromatograms and producing a single peak for each derivatized sugar, as well as high resolution, sensitivity, and repeatability. An additional liquid-liquid extraction from derivatization mixtures was performed not only to increase the detection sensitivity of amino sugars but also to decrease the by-products of derivatization. Contrarily, three amino sugars were detected at a very low intensity or not detected at all. The effect of time on monosaccharide- mercaptalated reaction was systematically investigated. The effect of trimethylsilylation on the formation of TMSD was also optimized. The established GC-MS based on TMSD derivatization was suitable for complex carbohydrate analysis and has been successfully applied for the detection of free carbohydrates in water extracts of Anemarrhena asphodeloides roots and determination of monosaccharides in Glossy ganoderma polysaccharides.

Simultaneous Determination of Multiple Classes of Hydrophilic and Lipophilic Components in Shuang-Huang-Lian Oral Liquid Formulations by UPLC-Triple Quadrupole Linear Ion Trap Mass Spectrometry.

The Shuang-Huang-Lian (SHL) oral liquid is a combined herbal prescription used in the treatment of acute upper respiratory tract infection, acute bronchitis and pneumonia. Multiple constituents are considered to be responsible for the therapeutic effects of SHL. However, the quantitation of the multi-components from multiple classes is still unsatisfactory because of the high complexity of constituents in SHL. In this study, an accurate, rapid, and specific UPLC-MS/MS method was established for simultaneous quantification of 18 compounds from multiple classes in SHL oral liquid formulations. Chromatographic separation was performed on a HSS T3 (1.8 µm, 2.1 mm × 100 mm) column, using a gradient mobile phase system of 0.1% formic acid in acetonitrile and 0.1% formic acid in water at a flow rate of 0.2 mL·min-1; the run time was 23 min. The MS was operated in negative electrospray ionization (ESI-) for analysis of 18 compounds using multiple reaction monitoring (MRM) mode. UPLC-ESI--MRM-MS/MS method showed good linear relationships (R² > 0.999), repeatability (RSD < 3%), precisions (RSD < 3%) and recovery (84.03-101.62%). The validated method was successfully used to determine multiple classes of hydrophilic and lipophilic components in the SHL oral liquids. Finally, principal component analysis (PCA) was used to classify and differentiate SHL oral liquid samples attributed to different manufacturers of China. The proposed UPLC-ESI--MRM-MS/MS coupled with PCA has been elucidated to be a simple and reliable method for quality evaluation of SHL oral liquids.

A New UPLC-MS/MS Method for the Characterization and Discrimination of Polysaccharides from Genus Ephedra Based on Enzymatic Digestions.

Ephedra sinica polysaccharides have been reported to possess important activities, so quality evaluation of polysaccharides from the genus Ephedra is urgent. In this study, enzymatic digestions were performed to establish multiple saccharide fingerprints by ultra-performance liquid chromatography with electrospray ionization triple quadrupole linear ion trap mass spectrometry (UPLC-ESI-TQ-MS/MS) based on a multiple-reaction monitoring in negative mode. Under optimum UPLC-ESI⁻-TQ-MS/MS conditions, excellent separation and quantification of 21 constituents were achieved within 20 min on a solid core column with a 1.6 µm particle using pre-column derivatization with a PMP reagent. This method, coupled with enzymatic digestions and principal component analysis, has been successfully applied to characterize and discriminate Ephedra polysaccharides attributed to different species and plant parts. The results suggest that the proposed analytical strategy could achieve a quality evaluation of plant polysaccharides from traditional Chinese medicines.

Serum CRP and urinary trypsin inhibitor implicate postoperative cognitive dysfunction especially in elderly patients.

PURPOSE: Postoperative cognitive dysfunction (POCD) characterized as the decline of memory and executive function after major surgery is not well illustrated. The aim of this study is to discover whether inflammatory cytokines and urinary trypsin inhibitor (uTi) contribute to the development of POCD. METHOD: Sixty-three patients undergoing lumber discectomy and 47 age-matched control volunteers were involved in this study. The level of C-reaction protein (CRP) and uTi/urine creatinine (Ucr) was measured by immunoturbidimetry and enzyme-inhibition assay, respectively. Meanwhile, ELISA was involved to detect the level of IL-6, IL-10, MMP-9 in serum. Montreal Cognitive Assessment (MoCA) test was used to determine the cognitive decline of the patients and age-matched controls. RESULT: In POCD group, the level of IL-6, IL-10, CRP, MMP-9 in serum and uTi /Ucr in urine was significantly higher than that in the group without POCD. The POCD was more frequently observed in elderly group than in the middle-aged group (43.75% versus 19.35%, p = 0.038). After logistic regression analysis adjusted by the age, only serum CRP at 72 h postoperation and urinary uTi /Ucr at 24 h postoperation were the independent risk factors of POCD. CONCLUSION: Age-related increasing proinflammatory postoperation may result in higher occurrence of POCD in the elderly. Additionally, patients with extremely high concentrations of CRP in serum at 72 h postoperation and uTi /Ucr in urine at 24 h postoperation are more likely to experience POCD, especially in the elderly.

FAT1 inhibits the proliferation of DLBCL cells via increasing the m6A modification of YAP1 mRNA.

Emerging evidence shows that FAT atypical cadherin 1 (FAT1) mutations occur in lymphoma and are associated with poorer overall survival. Considering that diffuse large B cell lymphoma (DLBCL) is the category of lymphoma with the highest incidence rate, this study aims to explore the role of FAT1 in DLBCL. The findings demonstrate that FAT1 inhibits the proliferation of DLBCL cell lines by downregulating the expression of YAP1 rather than by altering its cellular localization. Mechanistic analysis via meRIP-qPCR/luciferase reporter assays showed that FAT1 increases the m6A modification of YAP1 mRNA 3'UTR and the subsequent binding of heterogeneous nuclear ribonucleoprotein D (HNRNPD) to the m6A modified YAP1 mRNA, thus decreasing the stability of YAP1 mRNA. Furthermore, FAT1 increases YAP1 mRNA 3'UTR m6A modification by decreasing the activity of the TGFß-Smad2/3 pathway and the subsequent expression of ALKBH5, which is regulated at the transcriptional level by Smad2/3. Collectively, these results reveal that FAT1 inhibits the proliferation of DLBCL cells by increasing the m6A modification of the YAP1 mRNA 3'UTR via the TGFß-Smad2/3-ALKBH5 pathway. The findings of this study therefore indicate that FAT1 exerts anti-tumor effects in DLBCL and may represent a novel target in the treatment of this form of lymphoma.

[Comparison of blockage effect of axillary brachial plexus block between ultrasound guidance alone and ultrasound guidance plus neurostimulation].

OBJECTIVE: To compare the blockage effect of multiple injection axillary brachial plexus blockage between ultrasound guidance alone and ultrasound guidance plus neurostimulation. METHODS: Upon the approval of institutional ethical committee, a total of 166 patients underwent hand, forearm and distal arm operations under axillary brachial plexus blockage from January to May in 2011 at Department of Hand Surgery, Beijing Jishuitan Hospital. They were randomly allocated to receive either ultrasound guidance plus nerve stimulation (group US-NS, n = 83) or ultrasound guidance alone (group US, n = 83) for nerve localization. Ten milliliter ropivacaine 0.5% was administered separately on each nerve. Blockage time, needle frequency, success rate, onset of sensory and motor blocks, procedure-related complications (vascular puncture, acute nerve injury and tourniquet pain, etc.) and patient satisfaction were recorded. RESULTS: The procedure time was shorter in US group than in US-NS group [(3.3 ± 1.5) vs (5.3 ± 2.0) min, P < 0.01]. The median (range) number of needle frequency of group US was lower than that of group US-NS [(4.3 ± 0.7) vs (5.6 ± 1.4) temps, P < 0.01]. No intergroup difference existed in success rate. The onset of complete block was shorter in group US-NS than that in group US [(10.6 ± 6.4) vs (12.7 ± 6.9) min, P < 0.05]. Vascular puncture proportion was higher in group US-NS than group US (16/83 vs 1/83, P < 0.01). There was no occurrence of tourniquet pain. Patient acceptance was similar in two groups. CONCLUSION: Multiple injection axillary blockage with ultrasound guidance yield similar success rates whether or not combined with nerve stimulation guidance. There appears to be a lower incidence rates of complications for ultrasound guidance alone versus ultrasound guidance plus neurostimulation.

[Application of dexmedetomidine for brain nuclei lesion of patients with Parkinson's disease].

OBJECTIVE: To observe the sedative and analgesic effects of dexmedetomidine (Dex) and its influence on respiration and blood pressure, evaluate electrophysiological monitoring and explore the optimal dose of Dex for brain nuclei lesion in Parkinson's disease (PD) patients. METHODS: Approved by hospital ethics committee, 60 PD patients undergoing brain nuclei lesion ablation were randomly allocated into 3 groups (n = 20 each). No sedative anesthetic was used in group A; In group B, Dex 0.3 µg/kg intravenously for initial bolus (duration 15 min) and then 0.3 µg·kg(-1)·h(-1) continuous infusion; In group C, Dex 0.5 µg/kg intravenously (duration 15 min) for initial load and then 0.3 µg·kg(-1)·h(-1) continuous infusion. The parameters of mean arterial pressure (MAP), heart rate (HR), pressure of end-tidal carbon dioxide (P ETCO2), respiratory rate, blood oxygen saturation (SpO2), observer's assessment of alertness/sedation (OAA/S) and verbal rating score (VRS) were recorded at 0 min (baseline), 5 min (T1), 10 min (T2), 15 min (T3), 20 min (T4), 30 min (T5) and 60 min (T6) after the dosing of Dex. RESULTS: HR and respiratory rate decreased in groups B and C compared with baseline. In group C, P ETCO2 was much higher, compared with baseline (P < 0.05). Blood pressures of three groups were well-controlled. The incidence of pain (VRS ≥ 1) in group A was significantly higher than those of groups B and C (P < 0.05). And the incidence of sedation (OAA/S > 1) in group C was much higher than those of groups A and B. The electrophysiological signal of two patients in group C was severely affected. CONCLUSION: At an initial intravenous dose of Dex 0.3 µg/kg and a maintenance dose of 0.3 µg ·kg(-1)·h(-1), electrophysiological monitoring for surgery is not affected in PD patients undergoing brain nuclei lesion ablation. With a minimal interference of breath, Dex has not only well-controlled effects on sedation, analgesia and blood pressure, but also makes patients comfortable.

[The feasibility of training anesthesiologists with hemodynamic models of miniature pigs].

OBJECTIVE: To investigate the feasibility of training anesthesiologists with hemodynamic models of miniature pigs. METHODS: Eight miniature experimental pigs were chosen; ECG, SpO2, PetCO2, ABP, CVP, SV, SVV and PAP were monitored after anesthesia. The research was divided into two parts. Part one: the blood of pig was taken from its artery, air was injected into its body thought jugular vein, 15%KCl and 0.75% bupivacaine were given by peripheral vein respectively. The resuscitation would not be implemented unless the monitoring data changes were significantly and were recorded. Trainees looked on only during that time. Part two: Trainees were trained for placement of Swan-Ganz catheter after the sheath had been success- fully intubated into pig's right jugular vein. Trainees were trained for placement of femoral artery guided by ultrasound.Scores related to trainees' performance were written down. RESULTS: (1) Monitoring data (ABP, SV, SVV, CVP, PetCO2, PAP, SpO2 , ECG) changes were significantly ( P < 0.05 or P < 0.01), which indicated that the models had been successfully established. The evaluation scale displays: 81.3% of trainees thought this research improved their under- standing of hemodynamic changes; 78.2% thought that it helped them know how to deal with these circumstances; 71.9% thought this training was meaningful. (2) It was improved for students' skill to place Swan-Ganz catheter (P < 0.05), whereas the skill for placement of artery catheter by ultrasound was not significantly improved (P > 0.05). CONCLUSION: It was feasible to use a hemodynamic model of miniature pigs as an assisted teaching method to improve resident anesthesiologists' ability to understand and cope with clinical hemodynamic changes.

Comprehensive analysis of natural polysaccharides from TCMs: a generic approach based on UPLC-MS/MS.

Here, we report a new application using liquid chromatography-electrospray mass spectrometry (UHPLC-ESI-MS) using aldononitrile acetate derivatives for simultaneous baseline separation and detection of eight neutral saccharides, two uronic acids, one ketose, and eight alditols within 14 min. The separation was performed on a Cortecs C18 column using acetonitrile (A) and water (B) as the mobile phase with gradient elution. The target components were detected in selected ion monitoring (SIM) mode by mass spectrometry with an electrospray ionization (ESI) source operating in positive ionization mode. A comparison with traditional methods was used to determine the validity of the results. The UHPLC-ESI-MS method was used for quantitative analysis of free carbohydrates in water extracts of Crataegus pinnatifida as well as determination of Polygonatum cyrtonema and Glossy ganoderma monosaccharides in polysaccharides. The results demonstrate that this protocol is a comprehensive and effective technique for qualitative and quantitative analysis of plant polysaccharides from TCMs.

Prediction of risk factors for intraoperative hypotension during general anesthesia undergoing carotid endarterectomy.

Objective: Carotid endarterectomy (CEA) has been considered as "gold standard" treatment for patients with significant carotid stenosis Intra-operative hypotension was a risk factor for post-operative complications in patients undergoing CEA. This study aimed to investigate the predictors for intra-operative hypotension during CEA. Methods: This retrospective study included consecutive patients underwent CEA from June 1, 2020 to May 31, 2021 in the neurosurgery department of Xuanwu Hospital, Capital Medical University. The intraoperative hypotension was defined as blood pressure (BP) of 20% below standard value for longer than 5 min. Univariable and multivariable analyses were performed to identify the prediction of risk factors for intraoperative hypotension. Results: Overall, 367 patients were included, and 143 (39.0%) patients had hypotension during CEA procedure. Univariate analysis indicated Grade 3 hypertension (P = 0.002), peripheral artery disease (P = 0.006) and shunting (P = 0.049) were associated with occurrence of intraoperative hypotension during CEA procedure. On multivariable analysis, Grade 3 hypertension (P = 0.005), peripheral artery disease (P = 0.009), and shunting (P = 0.034) were all found to be independent predicting factors of hypotension during the CEA process. Conclusion: Intraoperative hypotension is a dynamic phenomenon may be affected by patients with grade 3 hypertension, peripheral artery disease and intra-operative shunting. It is necessary to pay special attention to these patients, both intraoperatively and postoperatively, to improve the final clinical outcome.

Multimodal Analgesia With Sevoflurane Provides Enhanced Intraoperative Analgesic Effects in Percutaneous Nephrolithotomy: A Randomized, Blinded Clinical Trial.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the first-line and guideline-recommended treatment for large renal calculi. Multimodal analgesia (MMA) comprising a combination of different analgesics is an increasingly popular method for pain control as it has been shown to reduce postoperative pain and reduce opioid use and the risk of opioid misuse, with a shorter recovery time in various procedures and patient populations. OBJECTIVE: In this study, we tested the hypothesis that MMA with propofol and sevoflurane (PS) can decrease pain intensity during surgery and used IoC2 as a real-time index of the analgesic effect of sevoflurane. STUDY DESIGN: Prospective, single-center, double-blind, randomized controlled clinical trial. SETTING: Xuanwu Hospital of Capital Medical University. METHODS: Patients scheduled for elective percutaneous nephrolithotomy from January 2020 to July 2020 were randomized into 2 groups, standard multimodal analgesia (propofol + sevoflurane group) and control (propofol [P] group). The PS group received propofol 2.5 mg/kg/h along with 1% sevoflurane after induction for 30 minutes during the main anesthetic procedure, and the P group received propofol 5 mg/kg/h by intravenous infusion during the operation. Index of consciousness 2 (IoC2), namely nociception index, intraoperative hemodynamic fluctuation, bispectral index (BIS), electromyography, postanesthesia care unit (PACU) length of stay, visual analog scale (VAS) score, and Aldrete and Steward scores were recorded. RESULTS: A total of 153 patients undergoing PCNL were enrolled. The demographic and clinical characteristics were similar between the 2 groups. IoC2 was reduced in the PS group compared to the P group at T10, T11, T12, T13, T14, and T15 time points, indicating that analgesia was more effective in the former. The BIS of the PS group did not differ significantly from that of the P group except at T12, T13, T14, and T15. PACU length of stay was shorter in the PS group than in the P group (mean [SD]: 54.35 [16.61] vs 47.39 [13.15], P = 0.04). VAS pain scores did not differ significantly between the 2 groups. CONCLUSION: MMA with propofol and sevoflurane provided better analgesia than propofol alone and may be an effective method to reduce stress and the intraoperative nociceptive stimulus response in patients undergoing PCNL, thereby promoting rapid postoperative recovery.

O-Arm-Navigated, Robot-Assisted Versus Conventional CT Guided Radiofrequency Ablation in Treatment of Osteoid Osteoma: A Retrospective Cohort Study.

Background: Osteoid osteoma is a common benign bone tumor, and clinically there is severe local pain that typically worsens at night. The conventional CT-guided radiofrequency ablation (RFA) was widely used in the treatment of osteoid osteoma (OO), which could result in some radiation-related and imprecise complications due to the overdose of radiation exposure. This study aimed to compare the surgical effect of robot-assisted RFA with O-arm navigation and conventional CT-guided RFA in the treatment of OO. Methods: Sixty-two patients who underwent robot-assisted RFA with O-arm navigation (Robot-RFA, n = 24) or CT-guided RFA (CT-RFA, n = 38) were included in this retrospective cohort study. The mean follow-up time was 23.3 months. The intra-operative data, primary technical success rate, visual analog scale (VAS), and post-operative complications were analyzed. Results: Primary technical success was obtained in 23 patients who had robot-assisted RFA, and 35 patients who had conventional CT-guided RFA. One patient in Robot-RFA group and three patients in CT-RFA group with pain recurrence received repeat-RFA and had a secondary success. Mean operation time and dose of radiation exposure were lower in Robot-RFA group than that in CT-RFA group. The Robot-RFA group took fewer K-wire adjustment times for each patient than the CT-RFA group. There was a statistically significant difference in the mean operation time, dose of radiation exposure, and K-wire adjustment times between the groups (p < 0.05). No complications associated with the procedure were reported in the two groups during the follow-up period. Conclusion: Robot-assisted RFA with O-arm navigation is a safer and more precise strategy in the treatment of osteoid osteoma with less operation time and radiation exposure compared with the conventional CT-guided radiofrequency ablation.

Hypothermia selectively protects the anterior forebrain mesocircuit during global cerebral ischemia.

Hypothermia is an important protective strategy against global cerebral ischemia following cardiac arrest. However, the mechanisms of hypothermia underlying the changes in different regions and connections of the brain have not been fully elucidated. This study aims to identify the metabolic nodes and connection integrity of specific brain regions in rats with global cerebral ischemia that are most affected by hypothermia treatment. 18F-fluorodeoxyglucose positron emission tomography was used to quantitatively determine glucose metabolism in different brain regions in a rat model of global cerebral ischemia established at 31-33°C. Diffusion tensor imaging was also used to reconstruct and explore the brain connections involved. The results showed that, compared with the model rats established at 37-37.5°C, the rat models of global cerebral ischemia established at 31-33°C had smaller hypometabolic regions in the thalamus and primary sensory areas and sustained no obvious thalamic injury. Hypothermia selectively preserved the integrity of the anterior forebrain mesocircuit, exhibiting protective effects on the brain during the global cerebral ischemia. The study was approved by the Institutional Animal Care and Use Committee at Capital Medical University (approval No. XW-AD318-97-019) on December 15, 2019.

[Application of sedation with a low dose of dexmedetomidine during intrathecal anesthesia in elderly patients].

OBJECTIVE: To explore the feasibility and safety of sedation with a low dose of dexmedetomidine (DEX) during intrathecal anesthesia in the elderly patients. METHODS: Thirty elderly patients were randomly divided into the DEX group (n = 15) and the control group (n = 15). There were 13 males and 17 females with a mean age of 77 years old (range: 65 - 89 years old). After an induction of intrathecal anesthesia, the patients in the DEX group received an infusion of 0.4 µg×kg(-1)×h(-1) for 10 min. Then the infusion speed was adjusted between 0.2 and 0.4 µg×kg(-1)×h(-1) to maintain the values of bispectral index (BIS) at around 80. An equivalent volume of normal saline was administered in the control group. Blood pressure, heart rate, respiratory rate, pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (P(ET)CO(2)) and BIS were recorded at the beginning of DEX infusion, 10, 20, 30 and 60 min after DEX infusion beginning and at the end of surgery. The observer's assessment of alertness/sedation (OAA/S) scores and the clinical responses were also recorded. A statistical analysis was performed. RESULTS: All intraoperative hemodynamic and respiratory parameters were within the normal range in both groups. Compared with the beginning after infusion, blood pressure at the point of 10 min after infusion decreased about 10% - 15% (P < 0.05) in the DEX group. But there was no such change in the control group. The values of BIS also decreased significantly at each time point after 10 min infusion versus the beginning of administration (P < 0.05); as compared with the control group, the values of BIS also decreased significantly at 30, 60 min and the end of infusion (P < 0.05). The 95%confidence interval (CI) of BIS values were 70 - 95 in the DEX group and 80 - 100 in the control group (P < 0.05). In the DEX group, the OAA/S scores were significantly lower at the points of 20, 30, 60 min and the end of infusion versus the beginning after infusion. And it was also lower in the DEX group than that in the control group (95%CI: 3 - 4 vs 4 - 5, P < 0.05). No bradycardia occurred in the DEX group. Two of three patients with concurrent atrial fibrillation were converted to sinus rhythm after the administration of DEX. Patients with severe lung diseases (pulmonary fibrosis, asthma or chronic obstructive pulmonary disease) maintained normal cardiopulmonary functions in the DEX group. DEX showed a good sedation effect in 1 patient with mental diseases. CONCLUSION: Sedation with a small dose of DEX during intrathecal anesthesia in elderly patients is both feasible and efficacious. But studies of larger sample sizes are warranted to confirm its safety.

[Feasibility analysis of wavelet index for monitoring the depth of anesthesia in patients undergoing general anesthesia].

OBJECTIVE: To evaluate the value of wavelet index (WLI) in general anesthesia through a comparison of WLI with bispectral index (BIS). METHODS: A total of 53 patients scheduled for elective surgery with ASA (American Society of Anesthesiologists) I-II were selected to undergo general anesthesia. The monitoring probes of BIS, WLI and muscle relaxation were connected in awaking patients. The values of WLI and BIS were recorded at 10 min (T1) entering OR (operating room), immediate before anesthesia induction (T2), when the OAA/S (observer's assessment of alertness/sedation) score declined gradually to 5(T3), 4(T4), 3(T5), 2(T6), 1(T7) after the infusion of propofol, after vecuronium given when the TOF value decreased to 100 (T8), 75(T9), 50 (T10), 25 (T11), 0 (T12) after the injection of vecuronium, tracheal intubation (T13), 1 min (T14), 3 min (T15) and 5 min (T16) after the completion of tracheal intubation, immediate before initiating surgical procedure (T17), beginning the operation (T18), 1 min (T19), 3 min (T20), 5 min (T21) post-operation, skin suturing (T22), end of surgery (T23), tracheal extubation (T24), 1 min (T25) and 5 min (T26)cd post-extubation, immediate before exiting OR (T27). RESULTS: The value of WLI at T10-T13, T22-T27 was more than BIS (P < 0.05). The Bland-Altman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia. The bias was -2.99, 95% limits of agreement -29.97% to 21.56%. The correlation coefficients of OAA/S score with BIS and WLI were: r(BIS) = 0.884, r(WLI) = 0.757 (P = 0.000). CONCLUSION: WLI index is feasible for monitoring the depth of general anesthesia.

[Modelling of cerebral hyper-perfusion after chronic forebrain ischemia in rats].

OBJECTIVE: To establish the cerebral hyper-perfusion model after chronic forebrain ischemia in rats. METHODS: A total of 72 male rats were equally randomized into 2 modeling groups. The ligation of bilateral common carotid artery could induce chronic forebrain ischemia. And 36 rats were randomly grouped by ischemia duration: control group (n = 9), sham group (n = 9), 2-week ischemia group (n = 9) and 4-week ischemia group (n = 9). The blood flow in frontal lobe was measured at pre- and post-ligation. The neurological score and cerebral infarction area were also compared among the groups. The cerebral reperfusion was concurrently undertaken with an infusion dose of phenylephedrine at 4 µg×kg(-1)×min(-1) via tail vein to produce cerebrally hyperperfused blood flow rate over 200% of baseline following chronic ischemia. According to cerebral hyper-perfusion duration, 36 rats were randomly assigned into 4 groups: control group (n = 9), saline infusion group (n = 9), 30-minute cerebral hyper-perfusion group (n = 9) and 2-hour cerebral hyper-perfusion group (n = 9). The blood flow in frontal lobe was measured before and after cerebral hyper-perfusion. The neurological score, blood-brain barrier permeability and dry-wet weight ratio of brain also were compared among the groups. RESULTS: The forebrain blood flow decreased by 67% ± 2% after the ligation of bilateral common carotid artery. There was significant difference between cerebral hyper-perfusion and saline infusion groups (P < 0.01). No statistic difference was observed in neurological score and cerebral infarction area between 2-week ischemia and control groups. But it was obvious between 4-week ischemia and control groups. The permeability in blood-brain barrier of rats significantly increased in 2-hour hyper-perfusion group (P < 0.05). CONCLUSION: The 2-hour duration of cerebral hyper-perfusion following a 2-week ligation of bilateral common carotid artery may establish a reliable cerebral hyper-perfusion model in rats.

Configuration of short- and long-threaded cannulated screws in proximal femoral plating decreases varus collapse of femoral neck fractures: A retrospective cohort study.

OBJECTIVES: Proximal femoral plating serves as a good alternative for the fixation of femoral neck fractures, but fixation loss still occurs. This study aimed to evaluate the effect of a hybrid configuration of short- and long-threaded cannulated screws in proximal femoral plating in terms of decreasing varus collapse of femoral neck fractures. MATERIALS AND METHODS: We retrospectively analyzed 86 patients with femoral neck fractures who were fixed by proximal femoral plating from January 2015 to June 2019. These patients were divided into two groups according to screw configuration: short- and long-threaded cannulated screws (SLTS, n = 38) and short-threaded cannulated screws (STS, n = 48). Radiological and clinical outcomes including screw withdraw, nonunion, avascular necrosis, caput-collum-diaphysis (CCD) angle, amount of femoral neck shortening (FNS), and Harris Hip Score (HHS) were compared between the groups. RESULTS: Preoperative characteristics including age, gender, Garden type, duration of surgery, and reduction quality were not significantly different between the two groups (p > 0.05). Less decreased CCD angle was observed in the SLTS group (-0.4° (-1.4 - 1.8)) compared with that in the STS group (7.9° (6.3 - 11.0)) (p < 0.001). The SLTS group also presented with fewer amount of FNS (3.2 (2.7 - 3.8) mm vs. 5.1 (4.2 - 5.9) mm, p < 0.001). Bone union was achieved in all patients and no avascular necrosis was observed during the follow-up. The HHS was higher in the SLTS group (86.4 ± 5.1) than that in the STS group (81.5 ± 4.5) (p < 0.001). CONCLUSION: The hybrid configuration of short- and long-threaded screws in proximal femoral plating offers better resistance against varus collapse and yields better functional outcomes in femoral neck fractures.

Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial.

Background: Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis are vulnerable to postoperative delirium, a complication frequently associated with poor outcome. This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA. Methods: This single-center, prospective, randomized clinical trial on 255 patients receiving CEA under general anesthesia compared the outcomes of patient state index (PSI) monitoring [SEDLine Brain Function Monitor (Masimo, Inc, Irvine, CA)] (standard group, n = 128) with PSI combined with density spectral array(DSA) -guided monitoring (intervention group, n = 127) to reduce the risk of intraoperative EEG burst suppression. All patients were monitored by continuous transcranial Doppler ultrasound (TCD) and near-infrared spectroscopy (NIRS) to avoid perioperative cerebral hypoperfusion or hyperperfusion. According to the surgical process, EEG suppression time was calculated separately for three stages: S1 (from anesthesia induction to carotid artery clamping), S2 (from clamping to declamping), and S3 (from declamping to the end of surgery). The primary outcome was incidence of postoperative delirium according to the Confusion Assessment Method algorithm during the first 3 days post-surgery, and secondary outcomes were other neurologic complications and length of hospital stay. Results: There were no episodes of cerebral hypoperfusion or hyperperfusion according to TCD and NIRS monitoring in either group during surgery. The incidence of postoperative delirium within 3 days post-surgery was significantly lower in the intervention group than the standard group (7.87 vs. 28.91%, P < 0.01). In the intervention group, the total EEG suppression time and the EEG suppression time during S2 and S3 were shorter (Total, 0 "0" vs. 0 "1.17" min, P = 0.04; S2, 0 "0" vs. 0 "0.1" min, P < 0.01; S3, 0 "0" vs. 0 "0" min, P = 0.02). There were no group differences in incidence of neurologic complications and length of postoperative hospital stay. Conclusion: Processed electroencephalogram-guided general anesthesia management, consisting of PSI combined with DSA monitoring, can significantly reduce the risk of postoperative delirium in patients undergoing CEA. Patients, especially those exhibiting hemodynamic fluctuations or receiving surgical procedures that disrupt cerebral perfusion, may benefit from the monitoring of multiple EEG parameters during surgery. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03622515.