Changes in early postoperative outcomes and complications observed in a single center during the 2022 COVID-19 pandemic wave in China: A single-center ambispective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients.@*METHODS@#An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level.@*RESULTS@#The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching.@*CONCLUSION@#Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications.@*REGISTRATION@#NCT05677815 at https://clinicaltrials.gov/ .

Application effect of immersive experiential teaching strategies in the teaching of clinical anesthesiology for undergraduates / 中华医学教育探索杂志

Objective:To explore the application effect of immersive experiential teaching strategies in the teaching of clinical anesthesiology for undergraduates.Methods:Undergraduates majoring in 5-year clinical medicine in Air Force Medical University from January 2022 to May 2022 were enrolled as the research objects. Students were randomly divided into the immersive teaching group and the traditional teaching group, with 35 students in each. Students in the immersive teaching group underwent immersive experiential teaching strategies and the traditional teaching group received lecture-based teaching strategies. After classes, all students in these two groups took the same theoretical and operational examination, and conducted a teaching satisfaction survey and a comprehensive ability evaluation. The results were analyzed by t-test and Chi-square test using SPSS 22.0 software. Results:Students in the immersive teaching group were more satisfied with teaching (88.32±7.28 vs.70.15±7.11) ( P=0.001), and had higher scores of theorical examination (86.34±7.42 vs. 77.31±5.32) ( P=0.020) and operational examination (92.23±5.33 vs. 81.21±4.98) ( P=0.022) than those in the traditional teaching group. In addition, the scores of communication ability ( P=0.026), response ability ( P<0.001) adaptability ( P=0.007), and critical thinking ( P<0.001) in the immersive teaching group were higher than those in the traditional teaching group. Conclusion:The immersive experiential teaching strategies can effectively improve the theoretical and practical operational ability of undergraduates after completing courses of clinical anesthesiology, and can effectively stimulate the enthusiasm of students. It is worthy to be popularized in subsequent teaching abilities.

Arousal mechanism after sevoflurane anesthesia in rats: orexinergic modulation in dorsal raphe nucleus by optogenetic and chemogenetic techniques / 中华麻醉学杂志

Objective:To investigate the arousal mechanism after sevoflurane anesthesia using orexinergic modulation in dorsal raphe nucleus(DRN) by optogenetic and chemogenetic techniques in rats.Methods:Forty-five healthy male Hcrt-Cre rats, aged 10-12 weeks, weighing 220-250 g, were divided into 6 groups by the random number table method: optical-excitatory group (CHR2 group, n=5), optical-inhibitory group (eNpHR group, n=5), optical-control group (O-CON group, n=5); chemogenetic-excitatory group (hm3Dq group, n=10), chemogenetic-inhibitory group (hm4Di group, n=10) and chemogenetic-control group (C-CON group, n=10). The optogenetic or chemogenetic techniques were used in each group. Three weeks after injecting the rat virus, anesthesia was induced and maintained with 2.7% sevoflurane anesthesia in 1.5 L/min O 2, and the EEG data were continuously recorded throughout the process. The burst suppression ratio (%BSR) was recorded at 2 min before and of laser stimulation. Combining optogenetic and chemogenetic strategies, it was investigated that whether activation of orexinergic projection to DRN could modulate anesthetic behaviors during sevoflurane anesthesia. Results:Compared with C-CON group, the recovery of righting reflex (RORR) time was significantly shortened after sevoflurane anesthesia in hm3Dq group ( P<0.05), and the RORR time was significantly prolonged after sevoflurane anesthesia in hm4Di group and eNpHR group ( P<0.05). Compared with O-CON group or the baseline at 2 min before light stimulation, the %BSR was significantly decreased during 473nm laser stimulation in CHR2 group ( P<0.05), and no statistically significant change was found in the %BSR during 473nm laser stimulation in eNpHR group ( P>0.05). Compared with O-CON group, the RORR time was significantly shortened after sevoflurane anesthesia in CHR2 group ( P<0.05). Conclusions:Lateral hypothalamic area orexin-DRN neural circuit plays a key role in promoting arousal from general anesthesia in rats.

Estrogen Receptor-A in Medial Preoptic Area Contributes to Sex Difference of Mice in Response to Sevoflurane Anesthesia / 神经科学通报·英文版

A growing number of studies have identified sex differences in response to general anesthesia; however, the underlying neural mechanisms are unclear. The medial preoptic area (MPA), an important sexually dimorphic structure and a critical hub for regulating consciousness transition, is enriched with estrogen receptor alpha (ERα), particularly in neuronal clusters that participate in regulating sleep. We found that male mice were more sensitive to sevoflurane. Pharmacological inhibition of ERα in the MPA abolished the sex differences in sevoflurane anesthesia, in particular by extending the induction time and facilitating emergence in males but not in females. Suppression of ERα in vitro inhibited GABAergic and glutamatergic neurons of the MPA in males but not in females. Furthermore, ERα knockdown in GABAergic neurons of the male MPA was sufficient to eliminate sex differences during sevoflurane anesthesia. Collectively, MPA ERα positively regulates the activity of MPA GABAergic neurons in males but not in females, which contributes to the sex difference of mice in sevoflurane anesthesia.

Clinical characteristics and pathogenesis of sleep disorder in patients with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Post-traumatic stress disorder(PTSD) caused by various natural disasters and man-made events has gradually become the highlight of neuroscientists. Sleep disorders after PTSD can impair the effect of treatment and affect the patient's prognosis. In addition, treatment for sleep problems can be effective in improving outcomes for people with PTSD, which indicates that it is significant to pay attention to sleep disorders after PTSD. However, current studies have focused more on the incidence of PTSD and severity of related symptoms after a traumatic event, and less on the occurrence and mechanism of sleep disorders after PTSD. A number of articles on stress and sleep disorders published in recent years provide reliable clues to understand the probable mechanisms of sleep disorders after PTSD. After summarizing the latest research results, this article finds that the occurrence of sleep disorder after PTSD may be related to the changes of connectivity between insula, hippocampus and medial-prefrontal cortex. Apart from that, decline in the mean phase difference of slow spindles in PTSD patients may reflect pathological changes in the thalamic cortical circuit, which may contribute to the objective diagnosis of PTSD and the development of sleep-focused interventions. This paper provides a systematic review of changes in sleep characteristics and possible neural circuitry mechanisms after PTSD from clinical and basic perspectives, which may provide potential directions for future researches on the pathological mechanism of sleep disorders after PTSD and screening novel intervention targets.

Preliminary report of preclinical trial of multi-genome engineering pig-to-macaque heart, liver and kidney transplantation / 器官移植

Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.

Lateral Hypothalamic Area Glutamatergic Neurons and Their Projections to the Lateral Habenula Modulate the Anesthetic Potency of Isoflurane in Mice / 神经科学通报·英文版

The lateral hypothalamic area (LHA) plays a pivotal role in regulating consciousness transition, in which orexinergic neurons, GABAergic neurons, and melanin-concentrating hormone neurons are involved. Glutamatergic neurons have a large population in the LHA, but their anesthesia-related effect has not been explored. Here, we found that genetic ablation of LHA glutamatergic neurons shortened the induction time and prolonged the recovery time of isoflurane anesthesia in mice. In contrast, chemogenetic activation of LHA glutamatergic neurons increased the time to anesthesia and decreased the time to recovery. Optogenetic activation of LHA glutamatergic neurons during the maintenance of anesthesia reduced the burst suppression pattern of the electroencephalogram (EEG) and shifted EEG features to an arousal pattern. Photostimulation of LHA glutamatergic projections to the lateral habenula (LHb) also facilitated the emergence from anesthesia and the transition of anesthesia depth to a lighter level. Collectively, LHA glutamatergic neurons and their projections to the LHb regulate anesthetic potency and EEG features.

A retrospective study of comparison of different methods of anesthesia for awake craniotomy / 中华麻醉学杂志

One hundred eighty-four cases of awake craniotomy in Xijing Hospital from September 2010 to June 2019 were retrospectively included in the study.Patients were divided into Asleep-Awake-Asleep (AAA) group and monitored anesthesia care (MAC) group.In AAA group, general anesthesia was used in the early arousal period, sedatives and analgesics were stopped during the arousal period, and the bispectral index (BIS) value was maintained at 60-80 in the late arousal period.In MAC group, dexmedetomidine and remifentanil were intravenously infused in the early arousal period, and the BIS value was maintained at 60-80 in the late arousal pericd.Dexmedetomidine and remifentanil infused were reduced or stopped according to the Observer′s Assessment of Altertness/Sedation score during the arousal period, so that the patient could be awakened at any time, and the BIS value was maintained at 60-80 in the late arousal period.Compared with AAA group, the consumption of local anesthetic and remifentanil was significantly decreased, the operation and anesthesia time was shortened, the requirement for rescue analgesia was decreased, mean arterial pressure, end-tidal pressure of carbon dioxide (P ETCO 2) and partial pressure of arterial carbon dioxide (PaCO 2) were increased and partial pressure of arterial oxygen (PaO 2) was decreased after laryngeal mask insertion or sedation, and heart rate and PaO 2 were decreased, P ETCO 2 and PaCO 2 were increased after awakening in group MAC ( P<0.05). There were no significant differences in anesthesia failure rate in the awake craniotomy, incidence of adverse events during the arousal period, intraoperative incidence of tachycardia/bradycardia and hypertension/hypotension, Observer′s Assessment of Alertness/Sedation score during the arousal period, rate of postoperative visual analogue scale score>5 after surgery, postoperative requirement for rescue analgesia, neurological deficit rate and rehabilitation discharge rate between the two groups ( P>0.05). Compared with those after laryngeal mask insertion or after sedation, mean arterial pressure, heart rate, P ETCO 2 and PaCO 2 were significantly increased, and PaO 2 was decreased after awakening in AAA group ( P<0.05), and no statistically significant change was found in the parameters mentioned above after awakening in MAC group ( P>0.05). In summary, MAC shortens the operation and anesthesia time, no artificial airway is required, and it is suitable for the short time and minor operation.AAA has a better hemodynamics and oxygenation in the early arousal period, but the patient′s stress is more obvious after awakening, and effective prevention and intervention are needed.

Neuroprotective Autophagic Flux Induced by Hyperbaric Oxygen Preconditioning is Mediated by Cystatin C / 神经科学通报·英文版

We have previously reported that Cystatin C (CysC) is a pivotal mediator in the neuroprotection induced by hyperbaric oxygen (HBO) preconditioning; however, the underlying mechanism and how CysC changes after stroke are not clear. In the present study, we demonstrated that CysC expression was elevated as early as 3 h after reperfusion, and this was further enhanced by HBO preconditioning. Concurrently, LC3-II and Beclin-1, two positive-markers for autophagy induction, exhibited increases similar to CysC, while knockdown of CysC blocked these elevations. As a marker of autophagy inhibition, p62 was downregulated by HBO preconditioning and this was blocked by CysC knockdown. Besides, the beneficial effects of preserving lysosomal membrane integrity and enhancing autolysosome formation induced by HBO preconditioning were abolished in CysC rats. Furthermore, we demonstrated that exogenous CysC reduced the neurological deficits and infarct volume after brain ischemic injury, while 3-methyladenine partially reversed this neuroprotection. In the present study, we showed that CysC is biochemically and morphologically essential for promoting autophagic flux, and highlighted the translational potential of HBO preconditioning and CysC for stroke treatment.

Thalamic paraventricular nucleus mediates orexinergic neurons-induced promotion of emergence from general anesthesia in mice: evaluation using optogenetics method / 中华麻醉学杂志

Objective To evaluate whether the thalamic paraventricular nucleus mediates orexiner-gic ( orexin ) neurons-induced promotion of emergence from general anesthesia by using the optogenetics method in mice. Methods Twenty healthy male Hcrt-cre mice, aged 8-10 weeks, weighing 20-25 g, were divided into 4 groups ( n=5 each) using a random number table method: retrograde labeled viruses channelrhodopsin group ( R group) , anterograde labeled viruses channelrhodopsin group ( A group) , retro-grade labeled viruses control group ( RC group ) , and anterograde labeled viruses control group ( AC group) . The optogenetics technique was used in each group. Anesthesia was induced and maintained through inhaling 1％ isoflurane and pure oxygen 1. 0 L∕min. Electroencephalogram was monitored througout the procedure with the PowerLab monitoring system. The burst suppression ratio ( BSR) was recorded at 1 min before light stimulation and during light stimulation. Results Compared with RC group or the baseline at 1 min before light stimulation, the BSR was significantly decreased during light stimulation in R group ( P<0. 05) . Compared with AC group or the baseline at 1 min before light stimulation, the BSR was signifi-cantly decreased during light stimulation in group A ( P<0. 05) . Conclusion Optogenetics technique ap-plication once again confirms that orexin neurons can promote emergence from general anesthesia through thalamic paraventricular nucleus in mice.

Effectiveness and accuracy of a domestic continuous non-invasive blood pressure device in monitoring intraoperative blood pressure / 中华麻醉学杂志

Objective To evaluate the effectiveness and accuracy of a domestic continuous non-invasive blood pressure (NIBP) device in monitoring intraoperative blood pressure.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective surgery under general anesthesia,were included in the study.The invasive blood pressure (IBP) and NIBP were simultaneously measured in the radial artery.Systolic and diastolic blood pressure (SBP,DBP) was continuously recorded,and the paired data and data of waveform were collected.For paired data,the agreement was evaluated using Bland-Altman analyses between the two monitoring methods.For waveform data,Pearson linear correlate analysis was performed between the two monitoring methods.Results For paired data,the bias of NIBP value from IBP value were (-2.1±5.4) mmHg (95％ CI-3.5-0.7 mmHg) and (2.6±6.4) mmHg (95％ CI 1.0-4.3 mmHg) for SBP and DBP,respectively.The 95％ limit of agreement of bias between the two methods was-12.6-8.5 mmHg for SBP and-10.0-15.3 mmHg for DBP.For waveform data,the bias of NIBP value from IBP value were (-2.1±6.5) mmHg (95％ CI-3.7-0.4 mmHg) and (3.1±6.8) mmHg (95％ CI 1.3-4.8 mmHg) for SBP and DBP,respectively.The correlation coefficient between the two methods was O.82 for SBP and 0.88 for DBP,P＜0.01.Conclusion The effectiveness and accuracy of this domestic continuous NIBP monitoring device in monitoring intraoperative blood pressure is clinically acceptable.

Efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy / 中华麻醉学杂志

Objective To evaluate the efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy.Methods A total of 140 patients,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were enrolled and randomly assigned to ropivacaine group (group R)and routine analgesia group (group C).Three-port laparoscopic procedure was carried out.Before inserting trocars,incision infiltration was performed with ropivacaine with a total volume of 16 ml,6 ml for epigastric port,6 ml for umbilical port and 4 ml for working port.The equal volume of normal saline was given instead of ropivacaine in group C.Parecoxib 40 mg was intravenously injected before surgery in both groups or after surgery as rescue analgesic when necessary.The requirement for rescue analgesia was recorded within 24 and 48 h after surgery.The visual analogue scale (VAS) scores at rest and during activity were recorded at 2,4,6,8,12,18,24 and 48 h after surgery,and the area under curve (AUC) of VAS scores was calculated in each time point after surgery.The development of no pain at rest was recorded at 24 h after surgery.Parents'satisfaction with analgesia was assessed and scored at 24 and 48 h after surgery.Wound healing was evaluated and scored at 48 h after surgery,and the development of poor wound healing was recorded.The development of chronic pain and VAS scores were recorded at day 90 after surgery.Results There were 130 patients who completed the study,with 66 cases in group R and 64 cases in group C.Compared with group C,the AUC of VAS scores at rest in 0-8 h and 0-24 h periods after surgery was significantly decreased,the AUC of VAS scores at rest in 0-6 h,0-8 h,0-12 h,0-24 and 0-48 h periods after surgery was decreased,the requirement for rescue analgesia was reduced at 24 h after surgery,satisfaction scores were increased (P＜0.05),and no significant change was found in the rate of no pain at rest after surgery,wound healing score,incidence of poor wound healing,incidence of chronic pain at day 90 after surgery or VAS score at day 90 after surgery in group R (P＞0.05).Conclusion Incision infiltration with ropivacaine before incision can effectively alleviate acute pain within 48 h after laparoscopic cholecystectomy with a higher safety and exerts no effect on chronic pain after surgery.

Effect of sevoflurane preconditioning on function of sarcoplasmic reticulum in cardiomyocytes during ischemia-reperfusion in isolated rat hearts / 中华麻醉学杂志

Objective To evaluate the effect of sevoflurane preconditioning on the function of sar-coplasmic reticulum in cardiomyocytes during ischemia-reperfusion (I∕R) in isolated rat hearts. Methods Healthy adult male Sprague-Dawley rats, weighing 270-300 g, were anesthetized with intraperitoneal pen-tobarbital. Their hearts were excised and perfused in a Langendorff apparatus with K-H solution saturated with 95％ O2-5％ CO2 at 37 ℃ . Twenty-four isolated rat hearts successfully perfused in the Langendorff ap-paratus were divided into 3 groups (n= 8 each) using a random number table: control group (group C), I∕R group and sevoflurane preconditioning group (group SP). Myocardial ischemia was induced by interrup-ting perfusion for 30 min followed by 120 min reperfusion. In group SP, the hearts were perfused with 2. 4％ sevoflurane for 10 min starting from 10 min before ischemia. Left ventricular developed pressure (LVDP) and left ventricular end-diastolic pressure (LVEDP) were recorded at 5, 10, 15, 30 and 60 min of reperfusion. Coronary effluent was collected at 10 min before reperfusion for measurement of the levels of lactate dehydrogenase (LDH) and cardiac troponin I (cTnI). Myocardial specimens were obtained at 120 min of reperfusion for examination of the pathological changes (using HE staining) and for determination of myocardial infarct size (by TTC staining), sarcoendoplasmic reticulum Ca2+-ATPase (SERCA2a) activity (with a spectrophotometer) and expression of Bcl-2, Bax and SERCA2a ( by Western blot). Results Compared with group C, LVDP was significantly decreased and LVEDP was increased at each time point, myocardial infarct size was increased, the levels of LDH and cTnI in coronary effluent were increased, the expression of Bax was up-regulated, the expression of Bcl-2 and SERCA2a was down-regulated, and the activity of SERCA2a was decreased in group I∕R (P<0. 01). Compared with group I∕R, LVDP was signifi-cantly increased and LVEDP was decreased at each time point, myocardial infarct size was decreased, the levels of LDH and cTnI in coronary effluent were decreased, the expression of Bax was down-regulated, the expression of Bcl-2 and SERCA2a was up-regulated, the activity of SERCA2a was increased (P<0. 01), and the pathological changes were significantly attenuated in group SP. Conclusion The mechanism by which sevoflurane preconditioning reduces I∕R injury in isolated rat hearts may be related to improving the function of sarcoplasmic reticulum in cardiomyocytes.

Role of hippocampal PI3K∕Akt signaling pathway in exogenous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice / 中华麻醉学杂志

Objective To evaluate the role of hippocampal phosphatidylinositol 3-kinase∕serine-threonine kinase (PI3K∕Akt) signaling pathway in exogenous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice. Methods A total of 100 pathogen-free healthy adult male C57BL∕6 mice, aged 8-12 weeks, weighing 20-25 g, in which the lateral ventricle was catheter-ized, were divided into 5 groups (n = 20 each) using a random number table: control group (group C), isoflurane group (group I), orexin A group (group OA), orexin A plus dimethyl sulfoxide group (group OA+D) and orexin A plus PI3K inhibitor LY294002 group (group OA+LY). Normal saline was administra-ted in group C and group I. Orexin A 1. 5 mmol∕L was given in group OA. Orexin A 1. 5 mmol∕L (dissolved in dimethyl sulfoxide) was given in group OA+D. Orexin A 1. 5 mmol∕L and LY29400210 mmol∕L were given in group OA+LY. Group C only inhaled pure oxygen for 2 h (oxygen flow rate 2 L∕min), all the rest groups inhaled 1. 4％ isoflurane for 2 h, and the corresponding drug 2 μl was injected into the lateral cere-bral ventricle according to the concentration mentioned above at 15 min before the end of anesthesia. Twelve mice were randomly selected from each group and trained for contextual fear conditioning test, and then fear memory retrieval was conducted at 24 h after training. The rest 8 mice in each group were sacrificed at 2 h after the end of anesthesia and their brains were removed for determination of the expression of PI3K, Akt and phosphor-Akt (p-Akt) protein by Western blot. Results Compared with group C, the freezing time was significantly shortened, the expression of PI3K, Akt and p-Akt was down-regulated, and p-Akt∕Akt ratio was decreased in group I (P<0. 05). Compared with group I, the freezing time was significantly pro-longed, the expression of PI3K, Akt and p-Akt was up-regulated, and p-Akt∕Akt ratio was increased in group OA (P<0. 05). There was no significant difference in each parameter mentioned above between group OA and group OA+D (P>0. 05). Compared with group OA+D, the freezing time was significantly short-ened, the expression of PI3K, Akt and p-Akt was down-regulated, and p-Akt∕Akt ratio was decreased in group OA+LY (P<0. 05). Conclusion Hippocampal PI3K∕Akt signaling pathway is involved in exoge-nous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice.

Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery / 临床麻醉学杂志

Objective To observe whether transcutaneous electrical acupoint stimulation (TEAS) could improve the emergence and recovery of patients undergoing robotic gynecologic surgery,and to explore the mechanism behind it.Methods Patients (aged 18-65 years,BMI 18-30 kg/m2,ASA grade Ⅰ or Ⅱ) scheduled for elective robotic gynecologic surgery were screened and randomized into three groups:group TEAS (groups T),no acupoint group (group N) and control group (group C),receiving TEAS (ST-36,SP6,BL59,BL60),stimulation at bilateral hips and no-stimulation respectively.Stimulations were given from 30 min before anesthesia induction to the end of surgery.Recovery measurements during emergence,PACU stay and 24 h after surgery were recorded.Levels of serum AQP4,MMP9 and S100β were analyzed.Results Time to response to verbal command and time to extubation in group T [(18.3± 6.7) min and (19.4 ± 6.6) min respectively] were significantly shorter than those in group C [(21.9±7.3) min and (23.1±7.3) min respectively] (P ＜0.05).Maximum VAS scores during PACU stay were significantly lower in group T than that in groups C and N (P＜0.05).Postoperative AQP4 level in group T significantly decreased compared with baseline (P＜0.05).However,postoperative MMP9 and S100β level in group C significantly in creased compared with the baseline (P＜0.05 or P＜0.01).Conclusion TEAS could fasten emergence of patients after robotic gynecologic surgery and improve postoperative analgesia.Mechanisms involving AQP4,MMP9 and S100β may be involved.

Effects of sevoflurane anesthesia on sleep architecture of rats / 中华麻醉学杂志

Objective To evaluate the effects of sevoflurane anesthesia on the sleep architecture of rats.Methods Sixteen pathogen-free healthy male Sprague-Dawley rats,aged 10-12 weeks,weighing 300-350 g,were divided into 2 groups (n=8 each) using a random number table:control group (group C) and sevoflurane group (group S).Each rat was implanted with a transmitter for recording electromyogram and electroencephalogram via telemetry.The rats were exposed to 2.4％ sevoflurane and pure oxygen 1.5 L/min for 5.5 h followed by 0.5 h washout with pure oxygen in group S,and the rats were exposed to pure oxygen 1.5 L/min for 6 h in group C.Then the rats were taken into the sleep monitoring box,and the 24 h after anesthesia was divided into 4 time periods according to the circadian rhythm:L1 (14:00-20:00),D1 (20:00-02:00),D2 (02:00-08:00) and L2 (08:00-14:00).The total time spent on wakefulness,on non-rapid eye movement (NREM) sleep and on REM sleep,the number of wakefulness,NREM sleep and REM sleep,and the time spent on wakefulness,on NREM sleep and on REM sleep during each time period were recorded using Version 3.0 Neurosore software.Results Compared with group C,the total time spent on wakefulness was significantly shortened,the total time spent on REM sleep was prolonged,the number of NREM sleep was increased,the time spent on REM sleep in L1 and D1 time periods was prolonged,the time spent on wakefulness in D2 time period was shortened,the time spent on NREM sleep was prolonged (P＜0.05),and no significant change was found in the total time spent on NREM sleep or the number of REM sleep and wakefulness in group S (P＞0.05).Conclusion Sevoflurane anesthesia can change the stability of sleep architecture,increase REM sleep and reduce wakefulness in rats.

Effect of microinjection of orexin-A and orexin-B into cerebral ventricle on the release of histamine in hypothalamus / 临床麻醉学杂志

Objective To provide new evidences for understanding the mechanisms of promo-tive role of orexins in anesthetic emergence and the effect of microinjection of orexin-A/orexin-B into cerebral ventricle on the release of histamine.Methods Male SD rats were randomly divided into sa-line (control ), orexin-A and orexin-B groups. The microdialysis probe was inserted into hypothalamus under stereotaxic apparatus.The perfused fluid from the area of hypothalamic tube-romammillary nucleus was collected using in vivo microdialysis at 1 h,2 h and 3 h after 1 nmol or 5 nmol orexin-A or orexin-B microinjection into the cerebral ventricle (n =5 each).The concentrations of histamine at each time point in dialysates of perfused fluid were detected by high performance liquid chromatography (HPLC)to analyze its dynamic changes.After one week,each group was microin-jected with 10 nmol,15 nmol and 20 nmol orexin-A and orexin-B (n =5)into the cerebral ventricle respectively,dialysates was collect and histamine was detected at 1 h to analyze its dosage response. After one week,each group was microinjected 0.3 μl saline orexin-A and orexin-B (n =6)into the tu-beromammillary nucleus.Results Compared with the control group,microinjection of 1 nmol orexin-A significantly increased histamine release at 1 h,but the same dose of orexin-B had no such effect,5 nmol of orexin-A or orexin-B injections significantly facilitated histamine release at 2 h and 3 h (P <0.01).Microinjection of 10 nmol,15 nmol and 20 nmol orexin-A and orexin-B into ventricle caused an significant increase of histamine release at 1 h while the effect was the strongest in 20 nmol (P <0.05).Compared with the control group,microinjection of orexin-A significantly decreased time of the righting reflex (P <0.01),but the same dose of orexin-B had no such effect.Conclusion Micro-injection of both orexin-A or orexin-B into cerebral ventricle could promote the release of histamine, while the effect of orexin-A was stronger.Microinjection orexin-A into tuberomammillary nucleus sig-nificant facilitated recovery from isoflurane.

Effect of sevoflurane on the electric activities of inhibitory interneurons in basal forebrain area / 临床麻醉学杂志

Objective To provide new experimental evidences associated with the mechanisms of inhaled anesthetics, the effects of sevoflurane on the electric activities of inhibitory interneurons in basal forebrain area (BF) were observed.Methods C57BL/6 mice, aged 2-3 weeks, were used and BF sections were cut for whole patch-clamp recording.Artificial cerebrospinal fluid containing sevoflurane was given and action potential, inhibitory postsynaptic potential were recorded.Results Sevoflurane could increase the frequency of firing rate of inhibitory interneurons in basal forebrain area (P<0.001), which could increase the frequency of action potential caused by depolarization current (P<0.05), and increase the frequency of spontaneous inhibitory postsynaptic currents of pyramidal neurons (P<0.05), while AP-depended miniature inhibitory postsynaptic currents were not significantly changed.Conclusion The basal forebrain inhibitory interneurons are involved in the anesthetic effect of sevoflurane.

Frequency of aneathetics-related genetic polymorphism in the North-western Chinese population / 临床麻醉学杂志

Objective To investigate the incidence of genotypes related to analgesia and muscle relax effects,and to review the genetic polymorphism of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in Han population in North-western China.Methods The genotypes of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in patients born in North-western China between September,2016 and May,2017 were reviewed.North-western China was defined as Shaanxi,Gansu,Ningxia,Qinghai and Xinjiang Provinces.The distribution of genotypes was recorded.And the differences between male and female patients were compared.Results The frequency was 42.11％ for AG genotype and 12.14％ for GG genotype of OPRM1 (118A＞G).For CYP3A4 * 1G,the frequencies of CC,TT,TC and CT were 29.69％,4.17％,65.67％ and 0.47％,respectively.For ABCB1,the frequencies of CC,TT,TC and CT were 13.07％,44.60％,0.28％ and 42.05％,respectivsly.For SLCO1B1,AG genotype appeared in 37.44 ％ of the patients,GG genotype appeared in 55.21％ of the patients.There was no difference between the male and the female patients.Conclusion Genotypes related to change of susceptibility to opioids including fentanyl and rocuronium were detected in high percentage of patients in North-western China,indicating that SNP assay for instruction of anesthetic practice be of value.

Thinking for improving the teaching quality of graduate degree in clinical medicine postgraduate / 中华医学教育探索杂志

Unclear cultivating aim and training plan as well as tutors' lacking of experience are the main problems of the postgraduate education for clinical medicine professional degree,which will cause the quality of clinical postgraduate training to fall greatly.Through the analysis,the author proposes increasing management authority of rotating disciplines for graduates,establishing tutor groups in rotating disciplines,making clear training plan,increasing the clinical simulation skill training courses,training and optimizing the professional master's tutors,which is to fit the needs of the postgraduate education for clinical medicine professional degree and to provide related references.