RESUMO
OBJECTIVES: Pediatric patients undergoing cardiac surgery usually experience significant surgical pain. Additionally, the effect of poor surgical analgesia creates a pain continuum that extends to the postoperative period. Transversus thoracic muscle plane block (TTMPB) is a novel plane block technique that can provide analgesia to the anterior chest wall. The analgesic role of TTMPB in pediatric cardiac surgery is still uncertain. A meta-analysis was conducted to determine the analgesic efficacy of this procedure. DESIGN AND SETTING: Systematic review and meta-analysis. PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure were searched to November 2023, and the Grading of Recommendations Assessment, Development, and Evaluation approach was followed to evaluate the certainty of evidence. PARTICIPANTS: Eligible studies enrolled pediatric patients from 2 months to 12 years old scheduled to undergo cardiac surgery, and randomized them to receive a TTMPB or no block/sham block. MEASUREMENTS AND MAIN RESULTS: Six studies that enrolled 601 pediatric patients were included. Low-certainty evidence from randomized trials showed that, compared with no block or sham block, TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative modified objective pain score at 12 hours (weighted mean difference [WMD] -2.20, 95% CI -2.73 to -1.68) and 24 hours (WMD -1.76, 95% CI -2.09 to -1.42), intraoperative opioid consumption (WMD -3.83, 95% CI -5.90 to -1.76 µg/kg), postoperative opioid consumption (WMD -2.51, 95% CI -2.84 to -2.18 µg/kg), length of intensive care unit (ICU) stay (WMD -5.56, 95% CI -8.30 to -2.83 hours), and extubation time (WMD -2.13, 95% CI -4.21 to -0.05 hours). Retrospective studies provided very low certainty that the results were consistent with the randomized trials. CONCLUSION: Very low- to low-certainty evidence showed that TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative pain, opioid consumption, ICU length of stay, and extubation time.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Bloqueio Nervoso , Estudos Observacionais como Assunto , Dor Pós-Operatória , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Bloqueio Nervoso/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estudos Observacionais como Assunto/métodos , CriançaRESUMO
BACKGROUND: Congenital heart disease (CHD) frequently manifests as a complex phenotype and approximately one-third of cases may be caused by genetic factors. BCOR, an X-linked gene encoding the corepressor of BCL6, has been demonstrated to be closely involved in human heart development. However, whether BCOR variants represent the genetic etiology underlying CHD needs further investigation. METHODS: We performed whole exome sequencing on CHD nuclear families and identified a candidate gene, BCOR, by robust bioinformatic analysis and medical literature searches. Targeted DNA sequencing of the candidate gene was conducted and then the association between variants and the risk of developing CHD was analyzed. The effects of BCOR mutations on gene expression, localization, protein interaction, and signaling pathways were evaluated in vitro. RESULTS: We identified a BCOR hemizygous missense variant (c.1448C>T, p.Pro483Leu) in a male proband presented with CHD/heterotaxy. Sanger sequencing confirmed that this variant was inherited from his asymptomatic mother. Interestingly, through literature searches, we observed another novel BCOR hemizygous missense variant (c.1619G>A, p.Arg540Gln) in a CHD patient with heterotaxy, supporting the pathogenic evidence of BCOR variants. Functional experiments conducted in vitro revealed that the variant p.Pro483Leu altered the subcellular localization of BCOR protein, disrupted its interaction with BCL6, and significantly promoted cell proliferation, whereas the variant p.Arg540Gln displayed no obvious effects. Nevertheless, transcriptional analysis revealed that down-regulation of BCOR substantially enhanced the activities of mitogen-activated protein and phosphoinositide 3-kinase-AKT signaling pathways, which are closely attributed to heart development. Targeted sequencing of 932 sporadic CHD patients enriched nine variants of BCOR predicted as likely rare and damaging and a septal defect was present in 81.8% (9/11) of them, including the two probands, which was consistent with the possible phenotype caused by BCOR defects. CONCLUSIONS: The findings of the present study indicate that variants in BCOR may predispose individuals to CHD in the Chinese Han population.
Assuntos
Cardiopatias Congênitas , Defeitos dos Septos Cardíacos , Humanos , Masculino , Genes Ligados ao Cromossomo X , População do Leste Asiático , Fosfatidilinositol 3-Quinases , Cardiopatias Congênitas/genética , Defeitos dos Septos Cardíacos/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Repressoras/genéticaRESUMO
Changes in soil nitrogen components in tea gardens affect the soil nitrogen supply capacity and nitrogen cycle. In this study, soil samples were collected from forest land, cultivated land, and tea gardens with different plantation ages (30, 50, and 70 years) to explore the changes in soil nitrogen components and their relationship with physicochemical properties and enzyme activities. The results showed that:â with the increase in tea plantation age, the silt, total phosphorus, and urease and catalase activities gradually increased, whereas the sand, clay, pH, electrical conductivity, soil organic carbon, and the activities of invertase gradually decreased. The alkaline phosphatase activity increased first and then decreased with the increase in tea plantation age, and no significant differences were observed in soil water content and acid phosphatase activity. â¡ With the increase in tea plantation age, the contents of acid ammonia nitrogen, amino acid nitrogen, and nitrate nitrogen (NO3--N) increased significantly, and the contents of total nitrogen, acid ammonia nitrogen, hydrolyzable unknown nitrogen, and non-hydrolyzable nitrogen in tea gardens were significantly higher than those in forest land. ⢠The total phosphorus, alkaline phosphatase, and urease were the main factors affecting soil nitrogen components. Among them, organic nitrogen components were significantly correlated with total phosphorus and alkaline phosphatase, and inorganic nitrogen components were significantly correlated with alkaline phosphatase, whereas total nitrogen had significant correlations with sand, silt, total phosphorus, urease, and alkaline phosphatase.
Assuntos
Fosfatase Alcalina , Solo , Solo/química , Areia , Nitrogênio/análise , Carbono , Urease , Amônia , Fósforo/análise , Chá , Microbiologia do Solo , ChinaRESUMO
Microwave ablation (MWA) is recognized as a novel treatment modality that can kill tumor cells by heating the ions and polar molecules in these cells through high-speed rotation and friction. However, the size and location of the tumor affect the effective ablation range of microwave hyperthermia, resulting in residual tumor tissue and a high recurrence rate. Due to their tunable porous structure and high specific surface area, metal-organic frameworks (MOFs) can serve as microwave sensitizers, promoting microwave energy conversion owing to ion collisions in the porous structure of the MOFs. Moreover, iron-based compounds are known to possess peroxidase-like catalytic activity. Therefore, Fe-doped Cu bimetallic MOFs (FCMs) were prepared through a hydrothermal process. These FCM nanoparticles not only increased the efficiency of microwave-thermal energy conversion as microwave sensitizers but also promoted the generation of reactive oxygen species (ROS) by consuming glutathione (GSH) and promoted the Fenton reaction to enhance microwave dynamic therapy (MDT). The in vitro and in vivo results showed that the combination of MWA and MDT treatment effectively destroyed tumor tissues via microwave irradiation without inducing significant side effects on normal tissues. This study provides a new approach for the combined application of MOFs and microwave ablation, demonstrating excellent potential for future applications.
Assuntos
Carcinoma Hepatocelular , Cobre , Ferro , Neoplasias Hepáticas , Estruturas Metalorgânicas , Micro-Ondas , Espécies Reativas de Oxigênio , Estruturas Metalorgânicas/química , Estruturas Metalorgânicas/farmacologia , Cobre/química , Cobre/farmacologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/metabolismo , Animais , Ferro/química , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/terapia , Espécies Reativas de Oxigênio/metabolismo , Camundongos , Hipertermia Induzida , Células Hep G2 , Linhagem Celular Tumoral , Glutationa/química , Glutationa/metabolismoRESUMO
OBJECTIVE: To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) at different times on the stress response during anesthesia and operation in the patients undergoing open posterior lumbar surgery. METHODS: A total of 94 patients undergoing open posterior lumbar surgery were randomly assigned to preoperative TEAS group(32 cases), intraoperative TEAS group(31 cases) and sham-TEAS group(31 cases). The same anesthetic method was used in the patients of 3 groups. Four electrodes were attached to the bilateral Hegu (LI4) and Neiguan (PC6) and connected to the electronic acupuncture instrument when patients entered the operation room. In the preoperative TEAS group, the patients received TEAS (10 to 20 mA) for 30 min before the anesthetic induction. TEAS (15 mA) was provided immediately when the operation starts till the end of ope-ration for the patients of the intraoperative TEAS group. In the sham-TEAS group, the electronic acupuncture instrument was switched on during the whole procedure of operation, but no electric current was output. Separately, at the moment of entering the operation room (T0), before endotracheal intubation (T1), at the time of endotracheal intubation (T2), 10 min after skin resection (T3), at the end of surgery (T4), recovery from anesthesia (T5) and at the time of extubation (T6), the heart rate (HR) and mean arterial pressure (MAP) were recorded. Using ELISA, the concentrations of epinephrine (E), norepinephrine (NE), dopamine (DA), cortisol (Cor) in serum were assayed at T0, T3, and T4; and blood glucose was tested with blood sugar paper at the same time points. RESULTS: Compared with T0 of the same group, HR was increased at T2 and decreased at T3 of the patients in the sham-TEAS group and the intraoperative TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, HR was decreased at T2 and increased at T3 of the patients in the preoperative TEAS group (P<0.05), and it was decreased at T6 of patients in the intraoperation TEAS group (P<0.05). HR was reduced at T2 in the preoperative TEAS group when compared with the intraoperative TEAS group. Compared with T0 of the same group, MAP was elevated at T2 and reduced at T3 and T4 in the sham-TEAS group (P<0.05); it decreased at T3, T4 and T5 in the preoperative TEAS group (P<0.05); it rose at T2 and was reduced at T3, T4 and T5 in the intraoperative TEAS group (P<0.05). When compared with the sham-TEAS group at the same time points, MAP decreased at T2 in the preoperative TEAS group (P<0.05), and at T6 in the intraoperative TEAS group (P<0.05). MAP was reduced at T2 and elevated at T6 in the preoperative TEAS group in comparison with the intraoperative TEAS group (P<0.05) at the same time points. Compared with T0 of the same group, the contents of E was increased at T3 in the sham-TEAS group and the intraoperative TEAS group (P<0.05); it was increased in all of the three groups at T4 (P<0.05); the contents of NE, DA, Cor and the blood glucose were increased at T4 in the sham-TEAS group (P<0.05). Compared with the sham-TEAS group at the same time points, the contents of E, DA at T3 and T4 and Cor at T3 in serum of the preoperative TEAS group were decreased (P<0.05); and the contents of E, NE, DA and Cor at T4 in the intraoperative TEAS group were decreased (P<0.05). CONCLUSION: TEAS-assisted general anesthesia can better maintain the stability of HR and MAP during anesthesia and operation in patients undergoing open posterior lumbar surgery, and reduce surgical stress response.
Assuntos
Estimulação Elétrica Nervosa Transcutânea , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos , Pontos de Acupuntura , Glicemia , Anestesia Geral , Frequência CardíacaRESUMO
The supplementation of soil amendments may not only improve the soil physical and chemical properties but also lead to the accumulation of heavy metals in soil. This experiment included six treatments:control (CK), organic manure (OM), polyacrylamide+organic manure (PAM+OM), straw mulching+organic manure (SM+OM), buried straw+organic manure (BS+OM), and bio-organic manure+organic manure (BM+OM) to explore the effects of different soil amendments on heavy metals and soil enzyme activities in coastal saline land and the relationship between them. The results revealed that compared with that in the CK treatment, the contents of soil Cr, Cu, Ni, and Pb exhibited an upward trend after the supplementation of soil amendments, among which the SM+OM and PAM+OM treatments had the most significant effects on the contents of soil Cr and Cu, respectively, whereas the BM+OM treatment had the most significant effects on the contents of soil Ni and Pb. Compared with those in the CK treatment, the activities of soil invertase and urease increased significantly following supplementation of soil amendments, and the BM+OM treatment had the best effect. The alkaline phosphatase activity exhibited a slightly upward trend after the supplementation of soil amendments, whereas the catalase activity did not change significantly. The redundancy analysis revealed that the first two axes cumulatively accounted for 70.3% of the variability in enzyme activities, and the importance of single soil heavy metals on soil enzyme activity was as follows:Ni>Cu>Cr>Pb.
Assuntos
Metais Pesados , Poluentes do Solo , Solo/química , Esterco/análise , Chumbo/análise , Poluentes do Solo/análise , Metais Pesados/análise , Suplementos Nutricionais/análiseRESUMO
PURPOSE: This study was designed to establish a 3-dimentional finite element system to simulate the clinical scenario where labial segment was retracted with sliding mechanism in extraction cases treated by individualized lingual orthodontics. METHODS: A typical clinical case was selected. The subject was diagnosed with Class I malocclusion with alveolar protrusion and treated with extraction of 4 first premolars. The subject was under the treatment stage of frontal retraction by eBrace system, an individualized lingual appliance. The subject was also taken cone-beam CT (CBCT) based on which digital 3D reconstruction of dentition structures was formed with Mimics software. With the aid of software platform Pro/E 4.0, the important anatomical structures were defined, and relevant lingual devices, including lingual brackets, arch-wires, mini-screws and other accessories were formed. With the aids of software platform Geomagic Studio 13.0, the 3-dimentional structural mode, featuring maxillary alveolar, upper dentition, periodontal ligament, miniscrew and lingual applicance, were constructed. With the assistance of Ansys Workbench 15.0, 3D model for finite element system was finalised by conducting model meshing and defining the mechanical properties and the interface relations of the selected materials. RESULTS: Based on the digital information drawn from CBCT image, a 3-dimentional finite element system was successfully created, featuring all the elements mimicking the clinical scenario for En masse retraction. This system enabled an insight study on the effects of various retraction modes controlling the incisal torque and maintaining the dental arch integrity. CONCLUSIONS: The creation of a finite element system in this study is based on the digital data from the CBCT image of a real patient diagnosed with prognathic malocclusion and treated by lingual appliance. The clinical scenario of labial segment retraction via sliding mechanism is simulated in this finite element model.
Assuntos
Má Oclusão , Técnicas de Movimentação Dentária , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/cirurgia , Análise de Elementos Finitos , Humanos , Maxila , Técnicas de Movimentação Dentária/métodosRESUMO
PURPOSE: This study was designed to establish a 3-dimentional finite element system to simulate the clinical scenario where labial segment was retracted with sliding mechanism in extraction cases treated by individualized lingual orthodontics. METHODS: A typical clinical case was selected. The subject was diagnosed with Class I malocclusion with alveolar protrusion and treated with extraction of 4 first premolars. The subject was under the treatment stage of frontal retraction by eBrace system, an individualized lingual appliance. The subject was also taken cone-beam CT (CBCT) based on which digital 3D reconstruction of dentition structures was formed with Mimics software. With the aid of software platform Pro/E 4.0, the important anatomical structures were defined, and relevant lingual devices, including lingual brackets, arch-wires, mini-screws and other accessories were formed. With the aids of software platform Geomagic Studio 13.0, the 3-dimentional structural mode, featuring maxillary alveolar, upper dentition, periodontal ligament, miniscrew and lingual applicance, were constructed. With the assistance of Ansys Workbench 15.0, 3D model for finite element system was finalised by conducting model meshing and defining the mechanical properties and the interface relations of the selected materials. RESULTS: Based on the digital information drawn from CBCT image, a 3-dimentional finite element system was successfully created, featuring all the elements mimicking the clinical scenario for En masse retraction. This system enabled an insight study on the effects of various retraction modes controlling the incisal torque and maintaining the dental arch integrity. CONCLUSIONS: The creation of a finite element system in this study is based on the digital data from the CBCT image of a real patient diagnosed with prognathic malocclusion and treated by lingual appliance. The clinical scenario of labial segment retraction via sliding mechanism is simulated in this finite element model.
Assuntos
Carcinoma Verrucoso , Moléculas de Adesão Celular , Má Oclusão , Neoplasias Bucais , Carcinoma de Células Escamosas de Cabeça e Pescoço , Carcinoma Verrucoso/patologia , Moléculas de Adesão Celular/genética , Análise de Elementos Finitos , Humanos , Incisivo , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Técnicas de Movimentação DentáriaRESUMO
Congenital heart disease (CHD) is the most common congenital birth defect, with a prevalence of 8.98 of all live births in China. PTPN11 has been known to be closely involved in heart developments. In this research, we carried out whole-exome sequencing in nine CHD families and identified eight rare deleterious missense variants of PTPN11 gene in nine probands by stringently filtering criteria. Sanger sequencing of these probands and their unaffected familiar members revealed that six damaging variants were de novo in seven CHD families. Then, targeted sequencing was used to assess the PTPN11 exon variants in 672 sporadic CHD cases and 399 unrelated controls and identified 7 deleterious missense variants in 8 patients. Fisher's exact test reveals a significant association of PTPN11 variations with CHD (P = 0.0289). We observed the distribution of different subtypes in CHD patients with PTPN11 variants and found atrial septal defect (ASD) is a prominent phenotype (58.8%, 10/17). In vitro functional assays revealed that the predicted PTPN11 variants disturb RAS-mitogen-activated protein kinase signaling activity by influencing the phosphorylation level of pathway proteins and increasing the proliferation and migration abilities of cardiomyocytes to different extents. Our findings demonstrated that PTPN11 variants were associated with increased risk of CHD development and may be served as an important susceptible genetic event for CHD, especially the ASD subphenotype.
Assuntos
Cardiopatias Congênitas , China/epidemiologia , Cardiopatias Congênitas/genética , Humanos , Mutação de Sentido Incorreto , Fenótipo , Proteína Tirosina Fosfatase não Receptora Tipo 11/genética , Sequenciamento do ExomaRESUMO
The new bone deposition along the craniofacial sutures contributes to the overall growth of the craniofacial complex. The osteogenesis in suture is also regulated by the surrounding mechanical stress, which is the basis that orthodontic or orthopedic forces could therapeutically correct craniofacial growth abnormalities. Applying different kinds of mechanical forces, such as stretching/compression force, light/heavy force, continuous/intermittent force, could modulate the process of new bone formation in suture, by regulating the expression of a contain of growth factors. Recent researches indicated that additional biological manipulation, like physical stimulation and local administration of growth factors, could further assist the growth modification of suture upon mechanical forces. Understanding the tissue and molecular events of bone regeneration in suture upon different biological approaches could have important implications for the clinical management of craniofacial development and growth.