Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients.

Introduction: The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown. Methods: In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision. Results: There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 µg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 µg·kg-1·min-1) and Group A (0.06 ± 0.02 µg·kg-1·min-1) (p = 0.004). Conclusion: Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.

Luminescence thermometry driven by a support vector machine: a strategy toward precise thermal sensing.

Luminescence thermometry is a promising non-contact temperature measurement technique, but improving the precision and reliability of this method remains a challenge. Herein, we propose a thermal sensing strategy based on a machine learning. By using Gd3Ga5O12: Er3+-Yb3+ as the sensing medium, a support vector machine (SVM) is preliminarily adopted to establish the relationship between temperature and upconversion emission spectra, and the sensing properties are discussed through the comparison with luminescence intensity ratio (LIR) and multiple linear regression (MLR) methods. Within a wide operating temperature range (303-853 K), the maximum and the mean measurement errors actualized by the SVM are just about 0.38 and 0.12 K, respectively, much better than the other two methods (3.75 and 1.37 K for LIR and 1.82 and 0.43 K for MLR). Besides, the luminescence thermometry driven by the SVM presents a high robustness, although the spectral profiles are distorted by the interferences within the testing environment, where, however, LIR and MLR approaches become ineffective. Results demonstrate that the SVM would be a powerful tool to be applied on the luminescence thermometry for achieving a high sensing performance.

Efficacy of pretreatment with remimazolam on prevention of propofol-induced injection pain in patients undergoing gastroscopy.

To evaluate the efficacy of remimazolam pretreatment in preventing propofol-induced injection pain (PIP) in patients undergoing gastroscopy. One hundred and forty patients (ASA I-II, aged 18-65 years, BMI 18-28 kg/m2) who were to undergo gastroscopy were randomized into either a saline group (group S) or a remimazolam group (group R) (n = 70 for each) on a computer-generated random number basis. The patients in group S received normal saline (0.1 ml/kg) and those in group R were administered remimazolam (0.1 mg/kg) via intravenous infusion for 60 s. 30 s after the injection of normal saline or remimazolam, patients received intravenously propofol (0.5 ml/s) until loss of consciousness. A different anesthesiologist who was unaware of the pretreatment was responsible for maintaining the outcome. The primary endpoint of our study was the incidence of PIP, which was measured using a 4-point scale. Secondary endpoints include the intensity of PIP, vital signs, characteristics of surgery and recovery, and adverse events. The incidence of PIP was significantly lower in group R than in group S (13 vs 51%, p < 0.001), and a lower percentage of patients presented with moderate PIP (3 vs 20%, p < 0.001). Moreover, lower consumption of propofol, shorter recovery time, and greater patient satisfaction were observed in group R than in group S. Pretreatment with remimazolam can effectively reduce the incidence and intensity of PIP in gastroscopy and shorten the recovery time without severe adverse effects.Clinical Trials Registration: Trial Registration: Chinese Clinical Trial Registry (identifier: ChiCTR2200063793). Registry time: 16/09/2022. Registry name: Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Gastroscopy. The date of patient enrollment began from 2022-9-17 to 2022-10-10. The link to the registration: https://www.chictr.org.cn/showproj.html?proj=176004 .

Primary adrenal diffuse large B cell Lymphoma with Tumor thrombus in central adrenal vein: a case report and literature review.

BACKGROUND: Primary adrenal lymphoma (PAL) is a rare disease confined wholly or chiefly to extramural involvement. Tumor thrombus in the central adrenal vein, renal vein, and inferior vena cava has been reported in adrenal pheochromocytoma, adrenocortical carcinoma, adrenal metastasis carcinoma, and adrenal leiomyosarcoma. Primary adrenal diffuse large B cell lymphoma with tumor thrombus in the central adrenal vein has rarely been reported in the current study. ( We searched in PubMed, Web of Science databases, Embase, and Medline in the English language from 1970 to December 2022. The keywords used were "Primary adrenal lymphoma " and " tumor thrombus".) CASE PRESENTATION: In this report, we discuss the case of a 57-year-old woman who complained of abdominal discomfort following cold stimulation, low back pain, anorexia, fatigue, and weight loss for 1 year. Contrast-enhanced spiral computed tomography (CT) showed mild-to-moderate enhancement of the bilateral masses and central adrenal vein tumor thrombus. After an exhaustive study, the patient was diagnosed with primary adrenal diffuse large B-cell lymphoma. In the diagnosis of PAL, the possibility of a tumor embolism in the central adrenal vein, renal vein, or inferior vena cava should be considered, although this is rare.

Series fusion of scatter correction techniques coupled with deep convolution neural network as a promising approach for NIR modeling.

Deep convolution neural network (CNN) with one-dimensional (1D) convolution structure is a potential and effective nonlinear method for near infrared (NIR) spectroscopy analysis. However, it is also a challenge to build a reliable CNN calibration model since industrial NIR data present serious scattering effect which will seriously interfere with important information. Thus, this paper proposed a promising approach, namely series fusion of scatter correction technologies (SCSF), where CNN built on the series splicing data of normalized raw spectra, standard normal variable (SNV) spectra and first derivative (1d) spectra. Two real NIR cases (one is the identification of alcohols/diesel blends and the other is the prediction of methanol and ethanol content in alcohols/diesel blends) were introduced to explore the feasibility and effectiveness of the presented model. Through the comparative analysis with CNN based on raw spectra, SNV spectra and 1d spectra, as well as common support vector machine (SVM) and BP neural network, the proposed SCSF coupled with CNN cannot only achieve 97.73 % recognition rate for three types of diesel, but also significantly improve the prediction accuracy of methanol and ethanol. Satisfactory results show that SCSF approach can be regarded as series boosting of multiple scatter correction technologies to improve overall performance without mastering data prior information and professional knowledge. Further, the proposed SCSF applied to CNN deep learning is simple and efficient, and can be recommended for actual implementation in industrial NIR applications.

Validation of a system for automatic quantitative analysis of laboratory mice behavior based on locomotor pose.

Automatic recognition and accurate quantitative analysis of rodent behavior play an important role in brain neuroscience, pharmacological and toxicological. Currently, most behavior recognition systems used in experiments mainly focus on the indirect measurements of animal movement trajectories, while neglecting the changes of animal body pose that can indicate more psychological factors. Thus, this paper developed and validated an hourglass network-based behavioral quantification system (HNBQ), which uses a combination of body pose and movement parameters to quantify the activity of mice in an enclosed experimental chamber. In addition, The HNBQ was employed to record behavioral abnormalities of head scanning in the presence of food gradients in open field test (OFT). The results proved that the HNBQ in the new object recognition (NOR) experiment was highly correlated with the scores of manual observers during the latent exploration period and the cumulative exploration time. Moreover, in the OFT, HNBQ was able to capture the subtle differences in head scanning behavior of mice in the gradient experimental groups. Satisfactory results support that the combination of body pose and motor parameters can regard as a new alternative approach for quantification of animal behavior in laboratory.

Rapid and accurate determination of diesel multiple properties through NIR data analysis assisted by machine learning.

The rapid and accurate detection of diesel multiple properties is an important research topic in petrochemical industry that is conducive to diesel quality assessment and environmental pollution mitigation. To that end, this paper developed a new machine learning model for near infrared (NIR) spectroscopy capable of simultaneously determining diesel density, viscosity, freezing point, boiling point, cetane number and total aromatics. The model combined improved XY co-occurrence distance (ISPXY) and differential evolution-gray wolf optimization support vector machine (DEGWO-SVM) to attain the goal of rapidity and accuracy. Experimental results indicated that the average recovery, mean square error, mean absolute percentage error and determination coefficient of the presented method outperformed those of the existing machine learning methods. The proposed hybrid model provides superior solution to the problem of low efficiency and high cost of diesel quality detection, and has the potential to be utilized as a promising tool for diesel routine monitoring.

Anastomotic occlusion after laparoscopic low anterior rectal resection: a rare case study and literature review.

BACKGROUND: With the development of laparoscopic techniques and the broad clinical application of various anastomotic types, anal-preserving low anterior rectal resection and ultra-low anterior rectal resection have been popularized. Some patients with rectal cancer have retained their anus and improved their quality of life. Nevertheless, the incidence of postoperative anastomotic stenosis remains high, and anastomotic occlusion is even rarer. CASE PRESENTATION: We report a case of anastomotic occlusion in a patient with rectal cancer, which occurred after undergoing laparoscopic low anterior rectal resection + prophylactic terminal ileal fistulation at our department. Under endoscopy, we used a small guidewire to break through the occluded anastomosis, thereby finding the lacuna. After endoscopic balloon dilation, digital anal dilatation, and continuous dilator-assisted dilation, the desired efficacy was achieved, ultimately recovering ileal stoma. Postoperative follow-up condition was generally acceptable, without symptoms like abdominal pain, bloating, or difficulty in defecation. CONCLUSION: Numerous factors cause postoperative anastomotic stenosis in patients with rectal cancer. Complete occlusion of anastomosis occurs relatively rare in clinical practice, and is challenging to treat. This case was our first attempt to remove the anastomotic occlusion successfully, which avoided re-operation or pain from the permanent fistula.

Rare isolated extra-hepatic bile duct injury: A case report.

BACKGROUND: Extra-hepatic bile duct injury (EHBDI) is very rare among all blunt abdominal injuries. According to literature statistics, it only accounts for 3%-5% of abdominal injuries, most of which are combined injuries. Isolated EHBDI is more rare, with a special injury mechanism, clinical presentation and treatment strategy, so missed diagnosis easily occurs. CASE SUMMARY: We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic segment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up. CONCLUSION: This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed.

Blockage of RelB expression by gene silencing enhances the radiosensitivity of androgen­independent prostate cancer cells.

Levels of the nuclear factor­kappa B (NF­κB) alternative pathway member RelB have been shown to correlate with the effect of radiation therapy in prostate cancer. RelB expression was evaluated by immunohistochemistry in normal prostate, benign prostate hyperplasia and prostate cancer specimens. RM­1 cells were pretreated with RelB siRNA prior to radiation therapy, and RelB expression in cytoplasmic and nuclear extracts was detected by real­time polymerase chain reaction and western blot analysis. The apoptotic rates of experimental RM­1 cell groups were assessed by flow cytometry. A clonogenic growth array was used to evaluate the radiosensitivity of RM­1 cell groups. The NF­κB family member RelB was expressed at a high level in prostate cancer specimens. Compared with irradiated control cells, RM­1 cells transfected with RelB siRNA and treated with radiation therapy demonstrated a significant downregulation of RelB expression in the cytoplasm and nucleus. Notably, flow cytometry revealed that pretreatment of RM­1 cells with RelB siRNA enhanced the apoptotic rate in response to radiation therapy compared with controls. Clonogenic growth assay results revealed enhanced radiosensitivity of RelB siRNA cells at various dosage points compared with control groups. Blockage of the alternative NF­κB pathway via RelB silencing is a promising approach to enhance the radiosensitivity of prostate cancer.

[Study of spectrum characteristic of humidity sensor based on series coupled two micro-ring resonators].

A novel humidity sensor of polyimide (PI) based on the series coupled two-micro-ring resonators is proposed in the present paper. The transfer function of the micro ring resonator was calculated by using the transfer matrix method and the coupled mode theory. The authors compared the output spectrum characteristics of the traditional single micro-ring and series coupled two-micro-ring with different radii. The refractive index of the PI waveguide changes with different environmental humidity and this will lead to the drift of the output spectrum of the micro-ring resonator. By detecting the drift of the output spectrum we can measure the humidity, and the sensitivity and the sensing-range of the sensor are acquired accordingly. We also analyzed the output spectrum characteristics of resonators at different humidity sensing part. The theoretical results show the good performance of humidity sensor which could be used as the optimum sensing unit when the whole structure of the series coupled two-micro-ring resonators serves as the sensing part. The sensing-range and sensitivity of the system are improved by series micro-ring resonators of different radii compared to the conventional sensor with single micro-ring resonator. The free spectral range (FSR) of resonator reaches to 0.15 µm, the sensing-range is 10% RH-80% RH, and the sensitivity is 0.001 7 µm (% RH)(-1). Series coupled two-micro-ring with different radii gives theoretical instruction for producing integrated humidity sensor with low-cost, simple structure and high sensitivity.

Tolerogenic dendritic cells generated by RelB silencing using shRNA prevent acute rejection.

It is well known that adoptive transfer of donor-derived tolerogenic dendritic cells (DCs) helps to induce immune tolerance. RelB, one of NF-κB subunits, is a critical element involved in DC maturation. In the present study, our results showed tolerogenic DCs could be acquired via silencing RelB using small interfering RNA. Compared with imDCs, the tolerogenic DCs had more potent ability to inhibit mixed lymphocyte reaction (MLR) and down-regulate Th1 cytokines and prompt the production of Th2 cytokines. They both mediated immune tolerance via the increased of T cell apoptosis and generation of regulatory T cells. Administration of donor-derived tolerogenic DCs significantly prevented the allograft rejection and prolonged the survival time in a murine heart transplantation model. Our results demonstrate donor-derived, RelB-shRNA induced tolerogenic DCs can significantly induce immune tolerance in vitro and in vivo.

Lentiviral-mediated shRNA against RelB induces the generation of tolerogenic dendritic cells.

OBJECTIVE: Lentiviral-mediated shRNA against RelB was used to produce tolerogenic dendritic cells from murine bone marrow derived dendritic cells (BMDCs). METHOD: RelB expression in the BMDCs was silenced by lentivirus carrying RelB shRNA. The apoptosis rate and surface markers of DCs were assessed by flow cytometry. IL-12,IL-10,TGF-ß1 secreted by DCs and DNA binding capacity of NF-κB subunits in the nucleus were measured by ELISA, independently. MLR was used to analyze the capacity of DCs to inhibit immune response. RESULTS: RelB expression was significantly inhibited in DCs following lentiviral mediated delivery of RelB specific shRNA. The RelB shRNA-DC produced lower IL-12 and higher IL-10 than mature dendritic cells (mDCs) and silencing control DCs. There was no difference in the apoptosis rate between shRNA RelB-DCs and mDCs. The expression levels of co-stimulatory molecules (CD80, CD86 and CD83) and MHC-II class molecule were lower in the RelB shRNA-DCs than in the mDCs and silencing control DCs. In addition, RelB shRNA also inhibited the RelB DNA binding capacity but had no effect on other NF-κB subunits. The shRNA RelB-DCs can significantly inhibit mixed lymphocyte reaction (MLR) and down-regulate Th1 cytokines and prompt the production of Th2 cytokines. CONCLUSION: Our results indicate RelB shRNA transfection of DCs can induce the immature status, and produce tolerogenic DCs.