[Effect of reducing-opioids consumption on postoperative delirium incidence in elderly patients after gastric cancer surgery].

Objective: To evaluate the effect of reducing-opioids on postoperative delirium (POD) incidence in elderly patients with gastric cancer surgery. Methods: From July 2016 to September 2021, 130 elderly patients undergoing scheduled gastric cancer surgery in Zhejiang Cancer Hospital were selected and divided into conventional opioid general anesthesia group (group A) and reducing-opioids general anesthesia group (group B) according to random number table. Postoperative analgesic pump formula: group A: 0.2% ropivacaine and 1 µg/ml sufentanil solution; Group B: 0.2% ropivacaine solution. POD assessment was performed once daily between 8 am and 8 pm for 3 days after surgery. The primary outcome measures were POD incidence 3 days after surgery, and the secondary outcome measures included anaesthesia related adverse events 3 days after surgery, such as nausea and vomiting, postoperative fever and fatigue. Results: Among the 130 patients, 7 patients were excluded because they did not comply with the POD test after operation. Finally, 123 elderly patients completed the study. There were 59 cases in group A, aged (73±5) years, including 45 males, and 64 cases in group B, aged (71±6) years, including 56 males. The incidence of total POD 3 days after surgery in group A and B was 30.5% (18/59) and 18.8% (12/64), respectively, with no statistical significance (P>0.05). However, POD incidence at 48 and 72 h after operation in group A [27.1% (16/59) and 16.9% (10/59)] was higher than that in group B [10.9% (8/64) and 4.7% (3/64), both P<0.05]. The incidence of nausea and vomiting in group A was higher than that in group B [15.3% (9/59) vs 1.6% (1/64), P<0.05]. Conclusion: Reducing-opioids consumption have no effect on the incidence of total POD 3 d after gastric cancer surgery in elderly patients, but can reduce the risk of POD 48-72 h after surgery.

[Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province].

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ2 test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

Clinical epidemiology and molecular profiling of human bocavirus in faecal samples from children with diarrhoea in Guangzhou, China.

To understand the clinical epidemiology and molecular characteristics of human bocavirus (HBoV) infection in children with diarrhoea in Guangzhou, South China, we collected 1128 faecal specimens from children with diarrhoea from July 2010 to December 2012. HBoV and five other major enteric viruses were examined using real-time polymerase chain reaction. Human rotavirus (HRV) was the most prevalent pathogen, detected in 250 (22·2%) cases, followed by enteric adenovirus (EADV) in 76 (6·7%) cases, human astrovirus (HAstV) in 38 (3·4%) cases, HBoV in 17 (1·5%) cases, sapovirus (SaV) in 14 (1·2%) cases, and norovirus (NoV) in 9 (0·8%) cases. Co-infections were identified in 3·7% of the study population and 23·5% of HBoV-positive specimens. Phylogenetic analysis revealed 14 HBoV strains to be clustered into species HBoV1 with only minor variations among them. Overall, the detection of HBoV appears to partially contribute to the overall detection gap for enteric infections, single HBoV infection rarely results in severe clinical outcomes, and HBoV sequencing data appears to support conserved genomes across strains identified in this study.

A simple empirical model for the clarification-thickening process in wastewater treatment plants.

In wastewater treatment plants (WWTPs), activated sludge is thickened in secondary settling tanks and recycled into the biological reactor to maintain enough biomass for wastewater treatment. Accurately estimating the activated sludge concentration in the lower portion of the secondary clarifiers is of great importance for evaluating and controlling the sludge recycled ratio, ensuring smooth and efficient operation of the WWTP. By dividing the overall activated sludge-thickening curve into a hindered zone and a compression zone, an empirical model describing activated sludge thickening in the compression zone was obtained by empirical regression. This empirical model was developed through experiments conducted using sludge from five WWTPs, and validated by the measured data from a sixth WWTP, which fit the model well (R² = 0.98, p < 0.001). The model requires application of only one parameter, the sludge volume index (SVI), which is readily incorporated into routine analysis. By combining this model with the conservation of mass equation, an empirical model for compression settling was also developed. Finally, the effects of denitrification and addition of a polymer were also analysed because of their effect on sludge thickening, which can be useful for WWTP operation, e.g., improving wastewater treatment or the proper use of the polymer.

[Efficacy of recombinant human growth hormone treatment in children born small for gestational age with syndromic and non-syndromic short stature].

Objective: To analyse the efficacy of recombinant human growth hormone (rhGH) treatment in children born small for gestational age (SGA) with syndormic and non-syndormic short stature. Methods: The clinical data of 59 children born SGA who were diagnosed as short stature and admitted to the Center of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital from July 2012 to June 2021 were collected and analyzed. According to the 2019 consensus on short stature, they were divided into syndromic group and non-syndromic group. Before treatment and 6, 12, 18 and 24 months after treatment, height standard deviation score (Ht-SDS), difference of height standard deviation (∆Ht-SDS) and homeostasis model assessment-insulin resistance index (HOMA-IR) were compared between groups, while Ht-SDS and HOMA-IR were compared before and after treatment. Independent t test or Kruskal-Wallis test were used for comparison between the 2 groups, and paired t test or Mann-Whitney U test were used for the intra-group comparison. Results: Among the 59 cases, 37 were males and 22 females, aged (5.5±2.3) years. There was no significant difference in Ht-SDS after 12 months of treatment between 2 groups (0.9±0.4 vs. 1.2±0.4, t=1.68, P=0.104) or in height SDS after 24 months of treatment (1.4±0.7 vs. 1.9±0.5, t=1.52, P=0.151). After 12 months of treatment, the insulin resistance index of the non-syndromic group was significantly higher than that of the syndromic group (2.29 (1.43, 2.99) vs. 0.90 (0.55, 1.40), Z=-2.95, P=0.003). There were significant differences in Ht-SDS between 6 months and before treatment, 12 months and 6 months in syndromic type (Z=7.65, 2.83 P<0.001, P=0.020), but all were significant differences in non-syndromic type between 6 months and before treatment, 12 months and 6 months, 18 months and 12 months, 24 months and 18 months (Z=11.95, 7.54, 4.26, 3.83, all P<0.001). Conclusion: The efficacy of rhGH treatment in children born SGA is comparable between syndromic and non-syndromic short stature cases, but non-syndromic children treated with rhGH need more frequent follow-up due to the risk of insulin resistance.

Current progress of the biological single-ion microbeam at FUDAN.

A biological microbeam for precisely positioned single-ion/single cell irradiation is built in the Institute of Modern Physics in Fudan University, Shanghai, China, based on the tandem accelerator (2 × 3MV) in the laboratory. In this paper, the developing progress of the FUDAN microbeam is reported, including the newly constructed beam line, the microbeam collimator, the ion detection system, and the cell-imaging and targeting systems. Statistical models are proposed for evaluating the spatial resolution and dosage precision of the microbeam. By taking the collimated ions as a Gaussian beam, the spatial resolution can be evaluated by the full width at half maximum of the 2-D Gaussian distribution, which is determined by fitting the proportions of peripheral pits outside specific radii in the pit clusters etched on ion track detectors to a 2-D Gaussian distribution. In the preset hitting of defined ion number, by taking the real delivered number of ions as an independent identically distributed random variable (iidrv), according to the Law of Large Numbers and Central Limit Theorem, the expected value µ and standard deviation σ of the real delivered ion number in a preset N-ion hitting can be determined by approaching the normal distribution of N (µ, σ (2)/n) with the proportions of the mean counts of pits in multiple pit clusters on ion track detectors. By the values of µ, σ and additional assumptions, statistical dosage precision evaluations can be made on the preset hitting. From the linear fit curve of µ(N) and the power function fit curve of σ(N) on different preset ion numbers, characteristic factors k, b, A, p can be extracted for a precision evaluation independent of the specific preset ion number.

A region-matching method for pulse transit time estimation: potential for improving the accuracy in determining carotid femoral pulse wave velocity.

Carotid femoral pulse wave velocity (cfPWV) is the 'gold standard' for assessment of arterial stiffness. The reliability of cfPWV measurement depends on the estimation of pulse transit time (PTT). This study aimed to validate a region-matching method for determining PTT and cfPWV against the existing 'foot-to-foot' methods. A cohort of 81 subjects (33 males and 48 females) aged 25-80 (45.1±15.7 years) were studied. PTTs were estimated by the region matching and 'foot-to-foot' methods ('diastole minimum', 'maximum first derivative', 'maximum second derivative' and 'tangent intersection' methods) with manual identification as the reference method and were subsequently used to calculate cfPWV. In a subgroup of 30 individuals, the measurements were repeated after 1 h. There were excellent correlations between cfPWV obtained by the reference method and all the estimated methods (r>0.9, P<0.001 for all), except the diastole minimum method (r=0.793, P<0.001). The region-matching method yielded cfPWV with a better accuracy (mean difference=-0.161 m s(-1), limits of agreement: -0.79 to 0.46 m s(-1)) and repeatability (mean difference=-0.228 m s(-1), intraclass correlation coefficient=0.957) comparing with the 'foot-to-foot' methods. These results demonstrate that the proposed region-matching method is more accurate and suitable for PTT estimation and cfPWV measurement.

Effects on endogenous acetaldehyde production by disulfiram and ethanol feeding on rat pancreas.

Exogenous acetaldehyde infusion can induce pancreatitis-like injury of the pancreas in some isolated pancreas models, whereas in vivo such treatment has failed to induce pancreatitis. In vivo exogenous acetaldehyde may not be effective because it is rapidly metabolized. The aim of this study was to investigate whether endogenous acetaldehyde accumulates in the pancreas after ethanol feeding when acetaldehyde metabolism is blocked by disulfiram, and whether this treatment can induce pancreatitis-like injury in the rat. The liver was studied for comparison. In part I of the experiment, adult male Wistar rats were given water (n = 24), ethanol (n = 24), disulfiram (n = 24), and ethanol plus disulfiram for 1 week (n = 24) or 3 weeks (n = 24) and for 3 weeks with (n = 6) and without (n = 6) hypovolemia. In part II of the experiment, rats were given water (n = 6), ethanol (n = 6), and high-dose disulfiram (n = 6) and ethanol plus high-dose disulfiram (n = 6). Ethanol and acetaldehyde concentrations in blood, liver, and pancreas were measured. Animal behavior was monitored, and weight changes, plasma amylase activity, water content, and histomorphology of the pancreas and liver were studied without knowing the group. No increases in plasma amylase activity and no histomorphologic changes in the pancreas were observed under light or electron microscopy in part I of the experiment. In part II, treatment with ethanol induced acetaldehyde accumulation in the liver (33.6 +/- 2.6 micromol/L), but to a lesser degree in the blood (9.6 +/- micromol/L) and pancreas (5.0 +/-.2 micromol/L). Ethanol plus disulfiram induced marked accumulation of acetaldehyde in the liver (83.2 +/- 15.9 micromol/L), blood (280.0 +/- 47.4 micromol/L), and pancreas (43.6 +/- 4.7 micromol/L). When tissue acetaldehyde levels reached 30 to 40 micromol/L, we found a decrease in zymogen granules along with formation of small intracytoplasmic vacuolizations in the acinar cells and accumulation of lipid droplets in the hepatocytes, whereas physiologic signs of pancreatitis (hyperamylasemia, edema) or increases in liver enzymes did not develop. High levels of acetaldehyde accumulate in the liver and pancreas with the treatment described. Although this was accompanied by lipid degeneration of the hepatocytes and some subcellular changes in the acinar cells, physiologic signs of pancreatitis did not develop. Thus acetaldehyde accumulation alone, or in combination with hypovolemia, is not responsible for the induction of acute pancreatitis.

Peripheral field stimulation affects foveal flicker, but not color, sensitivity.

Human observers have different thresholds for flicker detection and color detection of a rapidly flickering spectral stimulus presented on a steady white background. A flickering surround, which did not overlap the stimulus or background, reduced flicker sensitivity but not color sensitivity for both monocular and binocular viewing. However, a flickering surround presented to one eye had no influence upon either color or flicker thresholds of the other eye.

Perceived surface shape not features determines correspondence strength in apparent motion.

Previous psychophysical studies have revealed that shape similarity can affect apparent motion correspondence. Such results however, do not specify the level of representation, at which shape similarity is defined. We sought to understand this question by using a 2 x 2 competitive apparent motion paradigm. We manipulated the binocular disparity of the motion stimuli (tokens) relative to adjacent squares to selectively change the internal surface representation of the tokens while keeping early filtered representation intact. When two sets of differently oriented tokens (45 degrees,-45 degrees bars) were used, there was a preference for seeing motion between tokens having the same orientation. However, such a motion bias was reduced when tokens became part of a large surface square seen either as amodally occluded in the background or as a transparent surface modally completed in front. Since shape differences at the early filtering level remain essentially intact (i.e. + 45 degrees vs -45 degrees) our findings support the surface level hypothesis. Perceived surface shape rather than shape defined by early filters largely determines motion correspondence.

Luminance sensitivity recovers quickly in monocularly deprived cats.

We measured increment thresholds, using a reaction time or two-choice behavioral technique, in three cats monocularly deprived of normal vision for 14-16 months. Luminance increment thresholds could be obtained as early as nine days after lid opening and improved by 0.5-2.0 log units over the next few weeks. Also, visual reaction times decreased during the sensitivity improvement. When compared to the data for grating discrimination, these results suggest that visual recovery from monocular deprivation may proceed at different rates for different psychophysical discriminations.

Perceiving textures: beyond filtering.

Classical texture segregation theory and current visual filtering models suggest that rapid texture segregation is determined by the properties of early cortical filtering. To examine this assumption, we manipulated the binocular disparity of texture elements (an L vs a bar) relative to adjoining squares. Such a manipulation has little effect on the early cortical filtered representations of the stimuli but can have a strong influence on surface representation. In particular, it can determine whether an image patch is seen as a distinct surface, in front, or part of a larger occluded surface, in back. When seen as part of an occluded surface, the distinctive shape of each texture element is reduced. Accordingly, we found that texture discrimination performance was impaired when the texture elements had uncrossed disparities ("back" case). Additional experiments indicated that this result was not due to the disparity manipulation alone, but occurred only when each texture element was perceived as part of an occluded surface. We conclude that in rapid texture discrimination, the visual system cannot ignore information regarding surface layout. This suggests that for purposes of texture perception, either: (a) the visual system has no access to the filtered image or (b) one cannot entertain the concept of a filtered image uninfluenced by higher order surface processing.

Sensory eye dominance.

BACKGROUND: Sensory eye dominance is revealed in tasks like the Red Lens test and binocular rivalry. To understand its neural basis, we used a new protocol based on binocular rivalry to quantify its consequent interocular imbalance. Then we investigated whether the extent or sign of interocular imbalance is correlated with the difference in monocular contrast responses at threshold and suprathreshold and with the observer's motor eye dominance. METHODS: To evaluate sensory eye dominance, the stimulus intensity in each eye during rivalry was adjusted to achieve equal predominance. The difference in stimulus intensity constitutes the interocular imbalance. Standard procedures were used to measure monocular spatial contrast sensitivity, suprathreshold brightness judgment, and motor eye dominance. RESULTS: There was no positive correlation between interocular imbalance (sensory eye dominance) and motor eye dominance. No systematic correlation was found between interocular imbalance and monocular contrast sensitivities at 1 and 3 cycles/degree. Correlation coefficient between interocular imbalance and monocular suprathreshold brightness judgment was close to significant, suggesting that a difference in monocular brightness percept might (in part) account for interocular imbalance. But this explanation is only partial, since the difference in the monocular brightness percept was too small to account for the interocular imbalance. CONCLUSIONS: Interocular imbalance is a sensory eye dominance that cannot be equated with motor eye dominance. It manifests largely as a binocular phenomenon, which bears little relationship with the monocular neural mechanisms of contrast detection and brightness perception.

[The qualitative and quantitative diagnostic significance of P-VEP in the evaluation of glaucomatous visual function damage].

The pattern visual evoked potential (P-VEP) and the central visual field in 63 cases (95 eyes) of primary glaucoma were simultaneously measured with the American Compact Four electrophysiology apparatus and the Chinese TBC-IA central field analyzer. The data showed that the mean latency of P1 in the glaucomatous eyes was significantly lengthened, and this occurred before the visual field and disk abnormalities, indicating that VEP is sensitive in the detection of early glaucoma. Furthermore, the VEP changes were consistent with the central visual field defects qualitatively and quantitatively. Therefore, the latency of P1 can be a useful quantitative index in the evaluation of glaucomatous visual function damage. The difference in diagnostic sensitivity to glaucoma between VEP and visual field changes were discussed. The authors suggest that combination of the two may be a more useful index.

The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate, based on 10 years of experience and 1072 flaps.

The aim of this study was to assess the effectiveness of early exploration of anterolateral thigh (ALT) free flap compromise in head and neck reconstruction and to correlate this with the salvage success rate. The perioperative data of 1051 patients with 1072 ALT flap reconstructions were reviewed retrospectively for the period January 2002 to December 2012. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion, and salvage rate. The success rate of free flap reconstruction was 97.3% (1043/1072). Of the 29 failures, 21 were complete and eight were partial failures (10-40% of the flap). Venous occlusions occurred in 39 flaps (83.0%) and arterial occlusions in five flaps (17.0%). Six cases were detected within 8h postoperatively, 13 at 8-16 h postoperatively, seven at 16-24h postoperatively, and 18 at 24-48 h postoperatively, with respective salvage rates of 66.7%, 61.5%, 28.6%, and 22.2%; three cases detected after 48 h failed. The salvage rate at ≤16 h (62.2%) was much higher than that at >16 h (21.4%, P=0.0039). Early detection, re-exploration, and effective handling of the flap crisis increases the rate of flap salvage tremendously.

Gastroduodenal arterial reconstruction of the pancreaticoduodenal allograft.

Simultaneous procurement of the pancreas and liver necessitates division of vessels supplying both organs. The integrity of the pancreatic arterial supply appears to be related to surgical complications after pancreas transplantation. We have described herein three cases of gastroduodenal artery (GDA) reconstruction during pancreas transplantation, and reviewed other options for GDA reconstruction. These techniques performed safely during bench reconstruction can be applied to various clinical situations.

Cadmium directly induced mitochondrial dysfunction of human embryonic kidney cells.

Cadmium (Cd) is the major component of polluted environment, which has numerous undesirable effects on health. Cd could induce apoptosis of HEK293 cells, and the mitochondria may play a key role. However, the mode of action is unclear. In the present study, we aimed to evaluate the ability of the Cd to induce dysfunction of mitochondria. We examined the effect of cadmium chloride (1, 5 and 10 µM) on mitochondrial membrane permeability and potential as well as oxidative stress markers in mitochondria isolated from HEK293 cells. We found that Cd could directly increase in permeability and decrease in membrane potential of mitochondria, even resulted in mitochondrial swelling, and that Cd could inhibit the activities of ATPase, lactate dehydrogenase (LDH), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), enhanced the levels of reactive oxygen species (ROS) and lipid peroxidation (LPO). On the whole, the results show that Cd can directly lead to mitochondrial dysfunction of HEK293 cells, including increased permeability, inhibiting respiration and evoking oxidative stress. Thus, for the first time, this paper makes an overall analysis of Cd-induced changes of structure and function of isolated mitochondria. Our findings may also have general implications in Cd-induced apoptosis by mitochondria pathway.

Apparent motion determined by surface layout not by disparity or three-dimensional distance.

The most meaningful events ecologically, including the motion of objects, occur in relation to or on surfaces. We run along the ground, cars travel on roads, balls roll across lawns, and so on. Even though there are other motions, such as flying of birds, it is likely that motion along surfaces is more frequent and more significant biologically. To examine whether events occurring in relation to surfaces have a preferred status in terms of visual representation, we asked whether the phenomenon of apparent motion would show a preference for motion attached to surfaces. We used a competitive three-dimensional motion paradigm and found that there is a preference to see motion between tokens placed within the same disparity as opposed to different planes. Supporting our surface-layout hypothesis, the effect of disparity was eliminated either by slanting the tokens so that they were all seen within the same surface plane or by inserting a single slanted background surface upon which the tokens could rest. Additionally, a highly curved stereoscopic surface led to the perception of a more circuitous motion path defined by that surface, instead of the shortest path in three-dimensional space.

Effects of patterned backgrounds on responses of lateral geniculate neurons in cat.

In the lateral geniculate nucleus (LGN) of paralyzed cats under urethane anaesthesia, an extensive disinhibitory region (DIR) outside the inhibitory surround of the receptive field (RF) was found in both sustained and transient cells. Its extent is comparable to that of McIlwain's periphery effect (1964). The responses to a light spot, flashed into different parts of the RF center, were used to assess the effect of different background patterns, located over the DIR, on responsiveness and receptive field organization. A straight line background cutting across the RF center led to a marked shrinkage in RF size and to a suppression of the center response. In sustained cells, these influences were not due to the light flux of the background, but were mainly due to the spatial property of the line itself. This was demonstrated by comparing the effect of a straight line background with that of a zigzag line or of distributed dots. The light flux for the different patterns and their spatial weighting was the same, so that they differed from each other solely in their form. A straight line background elicited much stronger suppression of the center response and more marked shrinkage of the RF than if the component dots are dispersed over a wider area, but keeping the radial distances of the individual dots from the RF-center constant. The data suggest that the dispersion of the component dots in different backgrounds plays an important role as response amplitude and RF diameter increase proportional to the dispersive area of the background patterns. For transient cells, all backgrounds used showed similar effects on center responses and RF diameter, indicating that for them it was the light flux of the backgrounds rather than their spatial property that caused the effects.