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BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).
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Anestésicos por Inhalación , Anestésicos Intravenosos , Procedimientos Quirúrgicos Cardíacos , Desflurano , Complicaciones Posoperatorias , Propofol , Humanos , Propofol/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Anestésicos Intravenosos/efectos adversos , Anestésicos por Inhalación/efectos adversos , Anciano , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/prevención & control , Adulto , Sevoflurano/efectos adversos , Anestesia Intravenosa/métodos , China/epidemiología , Tiempo de Internación/estadística & datos numéricos , Anestesia por Inhalación/métodos , Anestesia por Inhalación/efectos adversos , Resultado del TratamientoRESUMEN
Ischemia-reperfusion (IR) injury commonly arises during cardiac surgery involving Cardiopulmonary Bypass (CPB), and it has relationship with ferroptosis in mice. However, the exact role of ferroptosis in the human cardiac damage caused by cardiac surgery remains unclear. Basic patient data and perioperative period information were collected, and clinic indicators related to cardiac function were detected to assess the extent of cardiac injury. Cardiac tissue samples were collected to determine histopathological changes, ultrastructure of mitochondrial and hallmarks of ferroptosis. 25 patients were involved in this study. In the present study, we observed a significant increase in the clinical indicator hs-cTnT, with levels rising more than 1393 ± 242 folds (P < 0.0001) following the cardiac surgery. Masson staining revealed a notable increase in fibrosis levels by 2.282 ± 0.259% (P = 0.0009). Furthermore, there was a significant elevation in lipid peroxidation, as evidenced by a 61.42 ± 17.33% increase in MDA (P = 0.0006). Additionally, we observed notable swelling, decreased mitochondrial crista, and even fragmented mitochondria. Notably, changes in the marker gene of ferroptosis were observed, with PTGS2 showing a 6.437 ± 0.81 folds increase (P < 0.0001). Furthermore, key regulators such as SLC7A11 and GPX4 proteins exhibited a reduction of 97.33 ± 25.78% (P = 0.0068) and 60.59 ± 14.93% (P = 0.0071), respectively, indicating the occurrence of ferroptosis following the surgery. Ferroptosis exists in myocardial IR injury caused by cardiac surgery with CPB, indicating that targeting ferroptosis could serve as a potential strategy for myocardial protection against CPB-induced IR injury. The trial has been registered in Chinese Clinical Trial Registry (ChiCTR, No. ChiCTR2200061995) on July 16th, 2022.
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Puente Cardiopulmonar , Ferroptosis , Daño por Reperfusión , Humanos , Puente Cardiopulmonar/efectos adversos , Masculino , Persona de Mediana Edad , Femenino , Daño por Reperfusión/metabolismo , Daño por Reperfusión/etiología , Daño por Reperfusión/patología , Peroxidación de Lípido , Anciano , Daño por Reperfusión Miocárdica/metabolismo , Daño por Reperfusión Miocárdica/etiología , Daño por Reperfusión Miocárdica/patología , Ciclooxigenasa 2/metabolismo , Ciclooxigenasa 2/genética , Miocardio/patología , Miocardio/metabolismo , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Fosfolípido Hidroperóxido Glutatión Peroxidasa/metabolismoRESUMEN
Insects that can perform flapping-wing flight, climb on a wall, and switch smoothly between the 2 locomotion regimes provide us with excellent biomimetic models. However, very few biomimetic robots can perform complex locomotion tasks that combine the 2 abilities of climbing and flying. Here, we describe an aerial-wall amphibious robot that is self-contained for flying and climbing, and that can seamlessly move between the air and wall. It adopts a flapping/rotor hybrid power layout, which realizes not only efficient and controllable flight in the air but also attachment to, and climbing on, the vertical wall through a synergistic combination of the aerodynamic negative pressure adsorption of the rotor power and a climbing mechanism with bionic adhesion performance. On the basis of the attachment mechanism of insect foot pads, the prepared biomimetic adhesive materials of the robot can be applied to various types of wall surfaces to achieve stable climbing. The longitudinal axis layout design of the rotor dynamics and control strategy realize a unique cross-domain movement during the flying-climbing transition, which has important implications in understanding the takeoff and landing of insects. Moreover, it enables the robot to cross the air-wall boundary in 0.4 s (landing), and cross the wall-air boundary in 0.7 s (taking off). The aerial-wall amphibious robot expands the working space of traditional flying and climbing robots, which can pave the way for future robots that can perform autonomous visual monitoring, human search and rescue, and tracking tasks in complex air-wall environments.
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Whole genome amplification (WGA) is a technology for non-selective amplification of the whole genome sequence, first appearing in 1992. Its primary purpose is to amplify and reflect the whole genome of trace tissues and single cells without sequence bias and to provide sufficient DNA template for subsequent multigene and multilocus analysis, along with comprehensive genome research. WGA provides a method to obtain a large amount of genetic information from a small amount of DNA and provides a valuable tool for preserving limited samples in molecular biology. WGA technology is especially suitable for forensic identification and genetic disease research, along with new technologies such as next-generation sequencing (NGS). In addition, WGA is also widely used in single-cell sequencing. Due to the small amount of DNA in a single cell, it is often unable to meet the amount of samples needed for sequencing, so WGA is generally used to achieve the amplification of trace samples. This paper reviews WGA methods based on different principles, summarizes both amplification principle and amplification quality, and discusses the application prospects and challenges of WGA technology in molecular diagnosis and medicine.
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Long noncoding RNAs have been widely accepted to play important roles in acute myocardial infarction (AMI). The dysregulation of cyclin-dependent kinase inhibitor 2B antisense RNA 1 (ANRIL) was discovered in AMI patients. Nevertheless, the detailed role and molecular mechanisms of ANRIL in AMI remain indistinct. The levels of ANRIL, miR-195-5p and Bcl-2 mRNA were determined by qRT-PCR. western blot was performed to assess the expression of Bcl-2, Bax, Cyclin D1 and p21. Cell proliferation was detected by CCK-8 assay, and cell apoptosis was measured by flow cytometry. The targeted correlation between ANRIL and miR-195-5p was confirmed by the dual-luciferase reporter and RNA pull-down assays. Our data revealed that ANRIL was downregulated and miR-195-5p was upregulated in the serum of AMI patients and hypoxia/reoxygenation (H/R)-induced myocardial cells. ANRIL upregulation or miR-195-5p knockdown alleviated H/R-induced myocardial cell injury. Moreover, ANRIL sequestered miR-195-5p by acting as a sponge of miR-195-5p. ANRIL upregulated Bcl-2 expression by sponging miR-195-5p. Additionally, ANRIL overexpression alleviated H/R-induced myocardial cell injury by upregulating Bcl-2. In conclusion, our study indicated that ANRIL upregulation alleviated H/R-induced myocardial cell injury partially through sponging miR-195-5p and upregulating Bcl-2, highlighting its role as a promising mediator for new therapies for AMI treatment.
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In this paper, the decomposition method of sulfur and the determination of trace arsenic in sulfur by GFAAS with La(NO3)3-Ni(NO3)2 matrix modifier were studied in detail. The decomposition of sulfur with mixed acid HNO3-HClO4 by controlled temperature electrothermal method or pressure crucible method was efficient and safe. The sensitivity of the determination of arsenic with La(NO3)3-Ni(NO3)2 matrix modifier was higher than with Ni(NO3)2 or Mg(NO3)2 matrix modifiers. The detection limit was 0.034 microgram.mL-1 (k = 3). The analytical results of the sulfur samples were coincident with the results of determination by HG-ICP-AES. The adding recoveries were 97.5%-110% and the relative standard deviation was less than or equal to 2.1% (n = 4).