Analysis of the efficacy of subclinical doses of esketamine in combination with propofol in non-intubated general anesthesia procedures - a systematic review and meta-analysis.

BACKGROUND: The number of non-intubated general anesthesia outside the operating room is growing as the increasing demand for comfort treatment. Non-intubated general anesthesia outside the operating room requires rapid onset of anesthesia, smoothness, quick recovery, and few postoperative complications. Traditional anesthetic regimens (propofol alone or propofol and opioids/dezocine/midazolam, etc.) have severe respiratory and circulatory depression and many systemic adverse effects. In this paper, we compare the effectiveness and safety of propofol and subclinical doses of esketamine with other traditional regimens applied to non-intubated general anesthesia through a systematic review and meta-analysis. METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and Sinomed databases for the period from January 2000 to October 2022. We rigorously screened the literature according to predefined inclusion and exclusion criteria, while risk assessment of the studies was performed using The Cochrane Collaboration's tool, and statistical analysis of the data was performed using RevMan 5.4 software. The main outcome indicators we evaluated were the various hemodynamic parameters and incidence of various adverse effects between the experimental and control groups after induction of anesthesia. RESULTS: After a rigorous screening process, a total of 14 papers were included in the final meta-analysis. After risk bias assessment, three of the papers were judged as low risk and the others were judged as having moderate to high risk. Forest plots were drawn for a total of 16 indicators. Meta-analysis showed statistically significant differences in HR' WMD 3.27 (0.66, 5.87), MAP' WMD 9.68 (6.13, 13.24), SBP' WMD 5.42 (2.11, 8.73), DBP' WMD 4.02 (1.15, 6.88), propofol dose' SMD -1.39 (-2.45, -0.33), hypotension' RR 0.30 (0.20, 0.45), bradycardia' RR 0.33 (0.14, 0.77), hypoxemia or apnea' RR 0.45 (0.23, 0.89), injection pain' RR 0.28 (0.13, 0.60), intraoperative choking' RR 0.62 (0.50, 0.77), intraoperative body movements' RR 0.48 (0.29, 0.81) and overall incidence of adverse reactions' RR 0.52 (0.39, 0.70).The indicators that were not statistically different were time to wake up' WMD - 0.55 (-1.29, 0.19), nausea and vomiting 0.84' RR (0.43, 1.67), headache and dizziness' RR 1.57 (0.98, 2.50) and neuropsychiatric reaction' RR 1.05 (0.28, 3.93). The funnel plot showed that the vast majority of studies fell within the funnel interval, but the symmetry was relatively poor. CONCLUSION: In non-intubated general anesthesia, the combination of subclinical doses of esketamine and propofol did reduce circulatory and respiratory depression, injection pain, and other adverse effects, while the incidence of esketamine's own side effects such as neuropsychiatric reactions did not increase, and the combination of the two did not cause the occurrence of new and more serious adverse reactions, and the combination of the two was safe and effective. TRIAL REGISTRATION: PROSPREO registration number: CRD 42022368966.

Bamboo Plant Part Preference Affects the Nutrients Digestibility and Intestinal Microbiota of Geriatric Giant Pandas.

Bamboo part preference plays a critical role in influencing the nutrient utilization and gastrointestinal microbiota composition of captive giant pandas. However, the effects of bamboo part consumption on the nutrient digestibility and gut microbiome of geriatric giant pandas remain unknown. A total of 11 adult and 11 aged captive giant pandas were provided with bamboo shoots or bamboo leaves in the respective single-bamboo-part consumption period, and the nutrient digestibility and fecal microbiota of both adult and aged giant pandas in each period were evaluated. Bamboo shoot ingestion increased the crude protein digestibility and decreased the crude fiber digestibility of both age groups. The fecal microbiome of the bamboo shoot-fed giant pandas exhibited greater alpha diversity indices and significantly different beta diversity index than the bamboo leaf-fed counterparts regardless of age. Bamboo shoot feeding significantly changed the relative abundance of predominant taxa at both phylum and genus levels in adult and geriatric giant pandas. Bamboo shoot-enriched genera were positively correlated with crude protein digestibility and negatively correlated with crude fiber digestibility. Taken together, these results suggest that bamboo part consumption dominates over age in affecting the nutrient digestibility and gut microbiota composition of giant pandas.

Exploration and practice of blended teaching of cell biology experiments during the COVID-19 epidemic.

Since 2019, new coronavirus pneumonia has been widespread worldwide and has had a direct impact on human life. Meanwhile, it also has a huge impact on teaching in universities and hospitals, especially in experimental courses. Cell biology is not only an important part of biology but also one of the most dynamic frontier branches of modern life science, which is also a science based on experiments. It is necessary to promote the online and offline teaching during this special period. To explore and evaluate the blended teaching modes during the COVID-19 epidemic, we changed the previous single teaching mode of "teaching + experiment" and published courseware and learning requirements online before class, this kind of mode takes "theory + virtual demonstration experiment" in class as the main body and the reviewing and thinking after class as the summary. We also carried out offline practice on a small scale when the epidemic allowed and actively explored the comprehensive online and offline teaching modes, in and out of class. Through the hybrid teaching, the percentage distribution of students in high and moderate scores ranges were greatly increased, the blended teaching mode also greatly improves students' subjective initiative and highlights the development of students' personalized thinking and scientific research ability. The practice of this model not only ensures the health of teachers and students during the epidemic but also provides a new teaching exploration model and thinking for the development of experimental courses during the epidemic.

Pharmacodynamics and Pharmacokinetics of HSK3486, a Novel 2,6-Disubstituted Phenol Derivative as a General Anesthetic.

Background: The purpose of this study was to characterize the novel sedative/hypnotic agent HSK3486, a 2,6-disubstituted alkylphenol analogue. Methods: The mechanism of action of HSK3486 was studied in competitive binding assays and whole-cell patch clamp assays. HSK3486 was administered by bolus intravenous injection to dogs and rats, and the loss of righting reflex as well as effects on the cardiovascular and respiratory systems were assessed. The in vitro metabolism of HSK3486 was analyzed by CYP450 genotyping and enzyme inhibition. Results: HSK3486 competed with t-butylbicycloorthobenzoate (TBOB) and t-butylbicyclophosphorothionate (TBPS) for binding to the gamma-aminobutyric acid type A (GABAA) receptor. HSK3486 potentiated GABA-evoked chloride currents at lower concentrations while activating GABAA receptor at higher concentrations. HSK3486 induced hypnosis in rats and dogs, and had a higher therapeutic index than propofol in rats. The hypnotic potency of HSK3486 was approximately 4-5 fold higher than that of propofol. HSK3486 exerted minimal effects on the cardiovascular system. Conclusions: HSK3486 is a positive allosteric regulator and direct agonist of GABAA receptor. It has a promising sedative/hypnotic effect and good in vivo pharmacokinetic properties, which justify further studies towards its clinical application.

A systematic review and meta-analysis of the influence of case analysis teaching in clinical anesthesia education.

BACKGROUND: The success or failure of anesthesia determines the success or failure of surgery. Therefore, more attention should be paid to the training of students majoring in clinical anesthesia. Traditional teaching methods rely on teacher explanation, and thus students depend greatly on their teachers. In recent years, case analysis teaching has become increasingly popular as an educational mode and is widely praised by students. Many studies have shown that case analysis teaching can not only improve students' enthusiasm but also enable students to apply what they have learned into clinical practice. METHODS: The English databases PubMed, Embase, and Ovid MEDLINE were searched from database establishment to April 2021, with the keywords "case analysis teaching", "clinical anesthesia teaching", and "effect analysis". Review Manager 5.3 was used for meta-analysis of experimental data. RESULTS: A total of 3 documents involving 143 students were analyzed to investigate the influence of case analysis teaching in clinical anesthesia education. The results showed that after case analysis teaching, students in the experiment group scored significantly higher than those in the control group, and the difference was statistically significant (MD =2.50, 95% CI: 1.84-3.16, Z=7.41, P<0.00001). DISCUSSION: Studies have found that case analysis teaching allows students to better master knowledge. This meta-analysis analyzed 3 previous studies to investigate the influence of case analysis teaching in clinical anesthesia education.

Systematic review and meta-analysis of the efficacy of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery.

BACKGROUND: Breast cancer is a malignant tumor disease that poses a significant threat to women's health. In recent years, the incidence of breast cancer in China has been increasing. This report aims to explore the effects of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery. METHODS: A computer-based search of PubMed, Web of Science, Embase, and the Cochrane Library was performed to identify randomized controlled studies on breast cancer, general anesthesia combined with a thoracic nerve block, modified breast cancer surgery, and other breast cancer treatments. Further search criteria included postoperative pain score, postoperative morphine equivalents given 24 hours after surgery, and operation duration. After an initial selection process, the studies were evaluated using the Jadad scale and the Cochrane Handbook for Systematic Reviews of Interventions to assess their suitability for inclusion in the subsequent meta-analysis of the experimental data, which was carried out using RevMan 5.3. RESULTS: A total of 8 studies comprising a total of 624 patients were selected for inclusion in this report. According to the meta-analysis, the analytical structure of the thoracic nerve group and the control group had a mean difference (MD) of -1.27 [95% confidence interval (CI): -1.68 to -0.86], the structure of the statistical test was Z=6.08 (P<0.00001), the MD of the total analysis structure of morphine equivalents was -2.71 (95% CI: -4.98 to -0.44), and the statistical test structure was Z=2.34 (P=0.02). DISCUSSION: General anesthesia combined with a thoracic nerve block in breast cancer surgery may effectively improve postoperative pain in patients and reduce the need for analgesic drugs. However, the outcome indicators included in this study are not sufficient. It is necessary to increase both the sample size and the number of outcome indicators to provide further theoretical evidence for the subsequent application of thoracic nerve block in modified breast cancer surgery.

New 20(S)-protopanaxadiol type saponins from the leaves of Panax notoginseng and their potential anti-inflammatory activities.

Through the combination of various chromatographies, 11 new 20(S)-protopanaxadiol (PPD) type saponins, named as notoginsenosides NL-E1 - NL-E4 (1-4), NL-F1 (5), NL-F2 (6), NL-G1 (7), NL-G2 (8), NL-H1 - NL-H3 (9-11) were obtained from the leaves of Panax notoginseng. Their structures were ascertained based on the extensive spectroscopic methods and chemical reactions. Meanwhile, the 20(S)-PPD type saponins with aglycone, (20S,24ζ)-3ß,12ß,20,24,25-pentahydroxy dammarane, was only found from the leaves of P. notoginseng. The characteristic could be used to distinguish the extracts of P. notoginseng leaves from its other medicinal parts such as roots, rhizomes, flowers or seeds. Furthermore, the nitric oxide (NO) inhibitory activities of all compounds were examined in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. As a result, compounds 2-7, 10 could exert NO inhibitory activity at 25 µM without cytotoxicity. Moreover, the inhibitory activities of them were in dose-dependent manner at 1, 10, and 25 µM. Especially, notoginsenoside NL-F2 (6) still possessed strong biological activity at 1 µM.

New Dammarane-Type Triterpenoid Saponins from Panax notoginseng Leaves and Their Nitric Oxide Inhibitory Activities.

Inflammation is a very common and important pathological process that can cause many diseases. The discovery of anti-inflammatory drugs and the treatment of inflammation are particularly essential. Dammarane-type triterpenoid saponins (PNS) were demonstrated to show anti-inflammatory effects in the leaves of Panax notoginseng. Chromatographies and spectral analysis methods were combined to isolate and identify PNS. Moreover, the nitric oxide (NO) inhibitory activities of all compounds were examined in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. As a result, eleven new dammarane-type triterpenoid saponins, notoginsenosides NL-A1-NL-A4 (1-4), NL-B1-NL-B3 (5-7), NL-C1-NL-C3 (8-10), and NL-D (11) were isolated, and their structures were identified by using various spectrometric techniques and chemical reactions. Among them, compounds 4 and 11 were characterized by the malonyl substitution at 3-position. The 3-malonyl substituted dammarane-type terpennoids were first obtained from natural products. In addition, compounds 1, 2, 5, 6, and 8-10 were found to play an important role in suppressing NO levels at 50 µM, without cytotoxicity. All inhibitory activities were found to be dose-dependent.