Effect of individualized PEEP titration based on open-lung strategy on intraoperative thoracic fluid content in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy / 中华麻醉学杂志

Objective:To evaluate the effect of individualized positive end-expiratory pressure (PEEP) titration based on open-lung strategy on the intraoperative thoracic fluid content (TFC) in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy (TULIP).Methods:Eighty-six American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, patients, aged 65-80 yr, with body mass index of 18-28 kg/m 2, scheduled for elective TULIP, were divided into 2 groups ( n=43 each) by the random number table method: fixed PEEP group (group C) and individualized PEEP titration group (group P). PEEP was set at 4 cmH 2O after routine mechanical ventilation in group C. Patients underwent pulmonary recruitment maneuvers combined with individualized PEEP titration during surgery in group P. TFC was measured using a non-invasive cardiac output monitor at 5 min after tracheal intubation (T 0), 30 min after PEEP titration and ventilation (T 1), 5 min before surgery (T 2), and 5 min before leaving the recovery room (T 3). Cardiac output, oxygenation index and stroke volume index were recorded from T 0-T 2, arterial blood gas analysis was simultaneously performed to record peak airway pressure and dynamic lung compliance, and oxygenation index was calculated. The duration of postanesthesia care unit stay, pulmonary complications within 7 days after surgery, and length of hospital stay were also recorded. Results:Eighty-three patients were finally included, with 42 in group C and 41 in group P. Compared with group C, TFC was significantly decreased at T 1-T 3, cardiac index, cardiac output and stroke volume index were decreased at T 1, dynamic lung compliance, PaO 2 and oxygenation index were increased at T 1 and T 2, PaCO 2 was decreased, the incidence of postoperative pulmonary complications was reduced, and the duration of postanesthesia care unit stay and postoperative length of hospital stay were shortened in group P ( P<0.05). Conclusions:Individualized PEEP titration based on open-lung strategy can effectively decrease TFC and improve intraoperative oxygenation and prognosis in elderly patients undergoing TULIP.

The impact of lung protective ventilation strategy on elderly emergency surgical patients / 中国现代医生

Objective To observe the effects of implementing lung protective ventilation strategies on lung dynamic compliance and oxygenation function in elderly emergency surgery patients.Methods A total of 126 elderly patients undergoing emergency surgery admitted to Northern Jiangsu People's Hospital from December 2021 to December 2022 were selected.They were randomly divided into an observation group and a control group,with 63 patients in each group,using a random number table method.All selected cases underwent general anesthesia mechanical ventilation during surgery.The control group chose conventional ventilation mode,while the observation group adopted lung protective ventilation.The lung dynamic compliance,oxygenation function,inflammatory indicators,and complications of the two groups of patients were compared.Results Within 30 minutes of surgery,the mean airway pressure(Pmean)and peak airway pressure(Ppeak)levels of both groups of patients increased compared to preoperative levels.The observation group had a smaller increase than the control group(P<0.05),and the pulmonary dynamic compliance(Cdyn)levels were lower than preoperative levels.The observation group had a lower increase than the control group(P<0.05).After 2 hours of surgery,the levels of Pmean and Ppeak in both groups of patients decreased compared to 30 minutes during surgery,and the decrease in the observation group was smaller than that in the control group(P<0.05).The levels of Cdyn in both groups decreased compared to before surgery,and the observation group was lower than that in the control group(P<0.05).24 hours after surgery,the blood oxygen saturation(SpO2)and arterialpartial pressure of oxygen(PaO2)levels in both groups of patients decreased compared to before surgery,and the observation group was lower than the control group(P<0.05).The alveolar-arterial oxygen partial pressure difference[P(A-a)DO2]levels between the two groups increased compared to preoperative levels,and the observation group was higher than the control group(P<0.05).48 hours after surgery,the SpO2 and PaO2 levels in the observation group were higher than those in the control group,and the P(A-a)DO2 levels were lower than those in the control group(P<0.05).24 hours after surgery,the serum C-reactive protein(CRP)and white blood cell(WBC)levels in both groups were significantly increased compared to preoperative levels,and the observation group was higher than those in the control group(P<0.05).48 hours after surgery,the serum CRP and WBC levels of both groups of patients decreased compared to 24 hours after surgery,and the observation group was lower than the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(7.94％vs.25.40％)(P<0.05).Conclusion Implementing lung protective ventilation strategies for elderly emergency surgical patients is beneficial for improving lung dynamic compliance and oxygenation function,inhibiting the release of inflammatory cytokines,reducing the incidence of postoperative pulmonary complications,and effectively exerting lung protective effects.

Tumor cell-derived exosomes mediating hsa_circ_0001739/lncRNA AC159540.1 facilitate liver metastasis in colorectal cancer.

BACKGROUND: The current study probed into how tumor cell-derived exosomes (Exos) mediated hsa_circ_0001739/lncRNA AC159540.1 to manipulate microRNA (miR)-218-5p/FTO-N6-methyladenosine (m6A)/MYC signal axis in liver metastasis in colorectal cancer (CRC). METHODS: hsa_circ_0001739 and lncRNA AC159540.1 were identified as the upstream regulator of miR-218-5p using ENCORI and LncBase databases. Expression patterns of miR-218-5p, hsa_circ_0001739, lncRNA AC159540.1, FTO, and MYC were detected, accompanied by loss-and-gain-of function assays to examine their effects on CRC cell biological functions. SW480 cells-derived Exos were purified, followed by in vitro studies to uncover the effect of hsa_circ_0001739/lncRNA AC159540. RESULTS: miR-218-5p was downregulated while hsa_circ_0001739/lncRNA AC159540.1 was upregulated in CRC tissues and cells. Silencing of hsa_circ_0001739/lncRNA AC159540.1 restrained the malignant phenotypes of CRC cells. Exos-mediated hsa_circ_0001739/lncRNA AC159540.1 competitively inhibited miR-218-5p to elevate FTO and MYC. The inducing role of Exos-mediated hsa_circ_0001739/lncRNA AC159540.1 in CRC was also validated in vivo. CONCLUSION: Conclusively, Exos-mediated circ_0001739/lncRNA AC159540.1 regulatory network is critical for CRC, offering a theoretical basis for CRC treatment.

Effects of lung protective ventilation on brain function in patients with traumatic brain injury / 中华急诊医学杂志

Objective:To evaluate the effect of individualized positive end-expiratory pressure (PEEP) ventilation strategy guided by driving pressure on intraoperative intracranial pressure in patients with moderate traumatic brain injury (TBI).Methods:Total of 111 patients aged 18-65 years old, with BMI of 17-28 kg/m 2, ASA grade of Ⅲ-Ⅳ, and Glasgow coma score of 9-11 before operation were treated with evacuation of intracranial hematoma in emergency. The patients were randomly divided into 0 cmH 2O PEEP group (Group 0 PEEP), 5 cmH 2O PEEP group (Group 5 PEEP) and individualized PEEP ventilation group (Group P) guided by driving pressure. The volume control ventilation mode is adopted, VT is 6 mL/kg, FiO 2 is 60%, and the inspiratory expiratory ratio is 1:2. Patients in Group 0 PEEP and Group 5 PEEP were given PEEP 0 or 5 cmH 2O for ventilation after tracheal intubation until the end of the operation. Patients in Group P were given individualized PEEP titration ventilation strategy guided by driving pressure after intubation. Blood gas analysis was performed at 5 min (T1) after tracheal intubation, 60 min (T3) after operation, and 5 min (T4) after operation. PaO 2, PaCO 2, and dynamic compliance (Cdyn) were recorded. The optic nerve sheath diameter (ONSD) was measured before anesthesia induction (T0), after PEEP titration in group P (T2, 10 min after ventilation in group 0 PEEP and 5 PEEP) and at T4; Serum neuron specific enolase (NSE) concentration was measured by ELISA before and 1 day and 3 days after operation; The occurrence of nervous system complications (intracranial infection, intracranial hypertension, epilepsy, brain edema, etc.) within 30 days after operation was followed up. Results:Compared with group 0 PEEP and 5 PEEP, Cdyn and PaO 2 in group P increased at T3-4 ( P<0.05), ONSD was not significantly different among the three groups ( P>0.05), NSE in group P decreased significantly at 1 and 3 days after operation, and the incidence of neurological complications in the three groups was not significantly different at 30 days after operation ( P>0.05). Conclusions:Individualized PEEP ventilation strategy guided by driving pressure can help improve lung and brain function in TBI patients.

Effect of berberine on morphine-induced activation of BV2 microglial cells / 中华麻醉学杂志

Objective:To evaluate the effect of berberine (BBR) on morphine-induced activation of BV2 microglial cells.Methods:The BV2 microglial cells were divided into 3 groups ( n=12 each) using a random number table method: control group (C group), morphine group (Mor group)and morphine+ BBR group (Mor+ BBR group). The Mor group was treated for 24 h with a final concentration of 200 μmol/L morphine, while C group was treated for 24 h with an equal volume of PBS buffer. Mor+ BBR group was first treated for 2 h with a final concentration of 20 μmol/L berberine, followed by treatment with a final concentration of 200 μmol/L morphine for another 24 h. The viability of BV2 microglial cells was determined using the CCK-8 assay, the concentrations of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and IL-10 in supernatant were measured using enzyme-linked immunosorbent assay, and the expression of CD86 and NF-κB proteins in microglial cells was detected using Western blot. Results:Compared with group C, the BV2 microglial cell viability and concentrations of IL-1β and TNF-α were significantly increased, the concentrations of IL-10 were decreased, and the expression of CD86 and NF-κB in microglial cells was up-regulated in Mor group ( P<0.05). Compared with Mor group, the BV2 microglial cell viability and concentrations of IL-1β and TNF-α were significantly decreased, the concentrations of IL-10 were increased, and the expression of CD86 and NF-κB in microglial cells was down-regulated in Mor+ BBR group( P<0.05). Conclusions:BBR can inhibit morphine-induced activation of BV2 microglial cells.

Identification and expression analysis of apple PDHB-1 gene family / 生物工程学报

Pyruvate dehydrogenase E1 component subunit beta-1 (PDHB-1) is a gene encoding the β-subunit of pyruvate dehydrogenase complex, which plays an important role in fruit acid accumulation. The aim of this study was to investigate the evolution characteristics of apple PDHB-1 family and its expression in apples with different acid contents. Bioinformatics analysis was performed using databases including NCBI, Pfam and software including ClustalX, MEGA, and TBtools. By combining titratable acid content determination and quantitative real-time PCR (qRT-PCR), the expression of this family genes in the peel and pulp of apple 'Asda' and 'Chengji No.1' with different acid content were obtained, respectively. The family members were mainly located in chloroplast, cytoplasm and mitochondria. α-helix and random coil were the main factors for the formation of secondary structure in this family. Tissue-specific expression profiles showed that the expression of most members were higher in fruit than in other tissues. qRT-PCR results showed that the expression profile of most members was consistent with the profile of titratable acid contents. In the peel, the expression levels of 14 members in 'Asda' apples with high acid content were significantly higher than that in 'Chengji No.1' apples with low acid content, where the expression difference of MdPDHB1-15 was the most significant. In the pulp, the expression levels of 17 members in 'Asda' apples were significantly higher than that in 'Chengji No.1' apples, where MdPDHB1-01 was the most highly expressed. It was predicted that PDHB-1 gene family in apple plays an important role in the regulation of fruit acidity.

Effects of open-lung strategy on postoperative delirium in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of open-lung strategy (OLS) on postoperative delirium (POD) in elderly patients undergoing laparoscopic surgery.Methods:Seventy-four elderly patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective laparoscopic radical rectal cancer or radical prostate cancer surgery under general anesthesia, were divided into 2 groups ( n=37 each) by the random number table method: OLS group and non-OLS (NOLS) group. Patients in OLS group received small tidal volume ventilation, recruitment maneuvers, and individualized positive end-expiratory pressure. Fixed positive end-expiratory pressure 5 cmH 2O was given in NOLS group. Cerebral regional oxygen saturation (rSO 2), pH value, PaO 2, PaCO 2 and PaO 2/FiO 2 were recorded before induction of anesthesia (T 0, baseline value), at 10 min after tracheal intubation (T 1), at 1 and 2 h after pneumoperitoneum (T 2, 3) and at 10 min after extubation (T 4). The levels of serum interleukin-6 (IL-6), IL-10 and calcium-binding protein (S100β) were measured by enzyme-linked immunosorbent assay before surgery, at the end of surgery, and at 1 day after surgery. The development of POD was assessed using the delirium assessment scale at 1-3 days after surgery. Results:Compared with NOLS group, the pH value was significantly decreased at T 3, PaCO 2 was increased, PaO 2, PaO 2/FiO 2 and rSO 2 were increased at T 2-4, serum IL-6 and S100β concentrations were decreased after surgery and at 1 day after surgery, the serum IL-10 concentration was increased, and the incidence of POD was decreased in OLS group ( P<0.05). Conclusions:OLS can increase rSO 2, reduce the systemic inflammatory response, and decrease the risk of POD in elderly patients undergoing laparoscopic surgery.

Risk factor for prolonged post-anesthesia care unit stay in elderly patients after painless gastrointestinal endoscopy / 中华麻醉学杂志

Objective:To identify the risk factor for prolonged post-anesthesia care unit (PACU) stay in elderly patients after painless gastrointestinal endoscopy.Methods:The elderly patients received painless gastrointestinal endoscopy from March to June 2021 in our hospital were included in this study. The information such as preoperative interview, patient′s general condition, current and past medical history, intraoperative conditions, and conditions in the PACU was collected. Patients were divided into non-prolonged group (group N) and prolonged group (group D) based on whether PACU stay was prolonged, and the risk factors for prolonged PACU stay were identified by logistic regression analysis.Results:There were 257 patients in group D and 716 cases in group N, and the incidence of prolonged PACU stay was 26.4%. Compared with group N, the proportion of preoperative frailty, smoking, intraoperative hypotension, and ratio of hypotension, somnolence and dizziness in PACU were significantly increased in group D ( P<0.05). The results of logistic regression analysis showed that preoperative frailty, smoking, intraoperative hypotension, and hypotension, somnolence and dizziness in PACU were independent risk factors for prolonged PACU stay( P<0.05). Conclusions:Preoperative frailty, smoking, intraoperative hypotension, and hypotension, somnolence and dizziness are independent risk factors for prolonged PACU stay in elderly patients after painless gastrointestinal endoscopy.

Effect of transcutaneous electrical acupoint stimulation with midnight-noon ebb-flow acupoint selection on postoperative delirium in patients undergoing radical resection of colorectal cancer / 中华麻醉学杂志

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation with midnight-noon ebb-flow acupoint selection on postoperative delirium (POD) in the patients undergoing radical resection of colorectal cancer.Methods:A total of 93 patients of either sex, aged ≥18 yr, with body mass index <30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ, scheduled for elective radical resection of colorectal cancer under general anesthesia, were divided into 3 groups ( n=31 each) using a random number table method: control group (group C), common TEAS group (group CT), and midnight-noon ebb-flow acupoint selection TEAS group (group MT). The patients received TEAS at bilateral Hegu, Quchi and Shousanli acupoints at 6: 00 in group MT and at 18: 00 in group CT on the day of operation and 1-3 days after surgery, with a frequency of 2/100 Hz, disperse-dense waves, intensity the maximum current that could be tolerated, and each TEAS lasted for 30 min. In group C, only the electrodes were pasted at the same acupoints without electric current at 6: 00 am. The POD was evaluated by the Confusion Assessment Method (CAM) at 1, 3 and 5 days after operation (T 1-3). Blood samples were collected for determination of serum interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) concentrations at 1 day before operation and at T 1. The time to first flatus and defection and adverse reactions after operation were recorded. Results:Compared with group C, the CAM scores at each time point and incidence of POD were significantly decreased, the concentrations of IL-1β, TNF-a and IL-6 in serum were decreased at T 1, the time to the first flatus and defecation was shortened, and the incidence of abdominal distension after surgery was decreased in MT and CT groups ( P<0.05). Compared with group CT, the CAM scores at T 3 and incidence of POD were significantly decreased, the concentrations of TNF-a and IL-6 at T 1 were decreased, and the time to first defecation after operation was shortened in group MT ( P<0.05). Conclusions:TEAS guided by midnight-noon ebb-flow acupoint selection provides better efficacy than common TEAS in decreasing the risk of POD in the patients undergoing radical resection of colorectal cancer, which is helpful for the early postoperative recovery of patients.

Gastric emptying in patients with cholelithiasis and in patients following cholecystectomy: measurement by ultrasonography / 中华麻醉学杂志

Objective:To evaluate the gastric emptying in the patients with cholelithiasis and in the patients following cholecystectomy by ultrasonography.Methods:Thirty patients with cholelithiasis, 30 post-cholecystectomy patients and 30 healthy volunteers, of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, were selected and divided into cholelithiasis group (group CH), post-cholecystectomy group (group PC) and healthy volunteer group (group HV). The indigestion scores of the enrolled subjects in the past 3 months were assessed; the subjects took a semi-solid test meal (300 kcal) in the fasting state, and the cross-sectional area (CSA) of the gastric sinus was measured using ultrasound at fasting (T 0) and 5, 15, 30, 45, 60, 90 and 120 min after the test meal was taken (T 1-7). The gastric emptying fraction at T 5, 6 was calculated. The gastric half-emptying time and remaining area of the gastric sinus at T 7 were also calculated. Results:Compared with group HV, dyspepsia scores were significantly increased within the past 3 months ( P<0.05), the CSA of the gastric sinus was increased at T 3-7, the gastric emptying fraction was decreased at T 5-6, the gastric half-emptying time was prolonged, and the remaining area of the gastric sinus was increased at T 7 in group CH and group PC ( P<0.05). Compared with group CH, the CSA of the gastric sinus was significantly increased at T 4-7, the gastric emptying fraction was decreased at T 5, 6, the gastric half-emptying time was prolonged, and the remaining area of the gastric sinus was increased at T 7 in group PC ( P<0.05). Conclusions:Gastric emptying time is longer in the patients with cholelithiasis and in the patients following cholecystectomy than in healthy subjects and is further prolonged after cholecystectomy in the patients.

Relationship between SIRT1 and ferroptosis during curcumin-induced reduction of acute lung injury in a mouse model of sepsis / 中华麻醉学杂志

Objective:To evaluate the relationship between silent information regulator 1 (SIRT1) and ferroptosis during curcumin-induced reduction of acute lung injury in a mouse model of sepsis.Methods:One hundred and fifty-two SPF-grade male C57BL/6J mice, aged 8 weeks, weighing 23-27 g, were divided into 4 groups ( n=38 each) using a random number table method: sham operation group (C group), sepsis group (S group), curcumin group (Cur group) and curcumin plus SIRT1 inhibitor EX527 group (CE group). Curcumin 200 mg/kg was administered by intragastric gavage every day in Cur group. Curcumin 200 mg/kg was administered by intragastric gavage every day and EX527 5 mg/kg was intraperitoneally injected in CE group. The equal volume of solvent dimethyl sulfoxide (DMSO) was given in C group and S group. Sepsis model was developed by cecal ligation and puncture (CLP) after 5 days of consecutive administration in anesthetized animals. Twenty mice in each group were randomly selected to observe the survival condition within 7 days after CLP. The bronchoalveolar lavage fluid (BALF) was collected at 24 h after developing the model to determine the concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), IL-6 and IL-18 (by enzyme-linked immunosorbent assay), and the lung tissues were obtained for microscopic examination of the pathological changes which were scored and for determination of wet-to-dry lung weight (W/D) ratio, contents of glutathione (GSH), malondialdehyde (MDA) and iron (by colorimetry), and expression of SIRT1, glutathione peroxidase 4 (GPX4) and Acyl-CoA synthetase long chain family member 4 (ACSL4) (by Western blot). Results:Compared with C group, the 7-day survival rate after CLP was significantly decreased, the concentrations of TNF-α, IL-1β, IL-6 and IL-18 in BALF, W/D ratio and lung injury score were increased, the content of GSH in lung tissues was decreased, the contents of MDA and iron were increased, the expression of SIRT1 and GPX4 was down-regulated, and the expression of ACSL4 was up-regulated in S group ( P<0.05). Compared with S group, the 7-day survival rate after CLP was significantly increased, the concentrations of TNF-α, IL-1β, IL-6 and IL-18 in BALF, W/D ratio and lung injury score were decreased, the content of GSH was increased, the contents of MDA and iron were decreased, the expression of SIRT1 and GPX4 was up-regulated, and the expression of ACSL4 was down-regulated in Cur group ( P<0.05). Compared with Cur group, the 7-day survival rate after CLP was significantly decreased, the concentrations of TNF-α, IL-1β, IL-6 and IL-18 in BALF, W/D ratio and lung injury score were increased, the content of GSH was decreased, the contents of MDA and iron were increased, the expression of SIRT1 and GPX4 was down-regulated, and the expression of ACSL4 was up-regulated in CE group ( P<0.05). Conclusions:The mechanism by which curcumin attenuates acute lung injury may be related to activation of SIRT1 and further inhibition of ferroptosis in mice.

Development and validation of a predictive model for PACU hypotension in elderly patients undergoing painless gastrointestinal endoscopy / 中华麻醉学杂志

Objective:To develop and validate a predictive model for post-anesthesia care unit (PACU) hypotension in elderly patients undergoing painless gastrointestinal endoscopy.Methods:The medical records of elderly patients of both sexes, aged ≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing painless gastrointestinal endoscopy at the Endoscopy Center of Subei People′s Hospital from March to June 2021, were retrospectively collected. The patients were randomly divided into training and validation sets according to the ratio of 3∶1. In the training set, the characteristic variables associated with PACU hypotension were screened by Lasso regression, and the independent risk factors for PACU hypotension were identified by multivariate logistic regression analysis of the characteristic variables, according to which a nomogram model predicting the risk for PACU hypotension was established.The discrimination, calibration and accuracy of the model were evaluated by calibration curve and receiver operating characteristic(ROC)curve. And the clinical practicability of the model was determined by decision curve analysis and further assessed by external validation.Results:Of the 973 patients ultimately included, 378 patients experienced PACU hypotension, with an incidence of 38.8%. Multivariate logistic regression analysis showed that age, prolonged preoperative water deprivation time, increased percentage of changes in SBP before and after induction, and intraoperative MAP <65 mmHg were independent risk factors for hypotension in the PACU, and intraoperative use of norepinephrine was a protective factor. The nomogram model was then developed based on the results. The area under the ROC curve was 0.710 (95% confidence interval [ CI] 0.672-0.748) in training set and 0.778 (95% CI 0.720-0.837) in validation set. In training and validation sets, the calibration curves were tested by Hosmer-Lemeshow good of fit test, the P values were 0.590 and 0.950, respectively. The decision curve analysis curve showed that the risk threshold of the prediction model in the training and validation sets were between 20% and 82% and between 18% and 92%, respectively, in the external validation. Conclusions:The nomogram model for prediction of PACU hypotension is successfully established based on age, prolonged preoperative water deprivation, percentage of change in SBP before and after induction, intraoperative MAP <65 mmHg and use of norepinephrine in elderly patients undergoing painless gastrointestinal endoscopy, and the model can visually and individually predict the risk of PACU hypotension.

Effect of transcutaneous electrical acupoint stimulation on postoperative pulmonary function in patients undergoing robot-assisted radical resection of colon cancer / 中华麻醉学杂志

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pulmonary function in the patients undergoing robot-assisted radical resection of colon cancer.Method:Ninety-four patients of either sex, aged 50-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with ARISCAT grade of medium risk, undergoing elective robot-assisted radical resection of colon cancer, were enrolled in this study. The patients were divided into TEAS group (group T, n=47) and sham-TEAS group (group S, n=47) using a random number table method. In group T, patients received 30 min of TEAS at Hegu (LI4), Quchi (LI11), Zusanli (ST36) and Feishu (BL13) between 5: 00 and 7: 00 a. m. from 1st day before operation to 3rd day after operation, with disperse-dense wave 2/100 Hz, and the stimulation intensity was the maximum intensity that the patient could tolerate. Patients in group S were also connected to the device without electrical stimulation. Both groups adopted lung-protective ventilation strategy during operation. The oxygenation index was calculated at the time of entering the operating room (T 0), 5 min after anesthesia induction (T 1), 5 min of pneumoperitoneum (T 2), 5 min after changing to Trendelenburg position (T 3) and immediately after the end of pneumoperitoneum (T 4). Peak airway pressure, plateau airway pressure, driving pressure and dynamic lung compliance were recorded at T 0-T 4. The serum concentration of lung Clara cell 16 kDa protein was recorded using enzyme-linked immunosorbent assay at T 0, T 4 and 2 h after extubation (T 5). On 1 day before operation and 1, 3 and 7 days after operation, the forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured, and the FEV 1/FVC was calculated, and the concentrations of serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation were simultaneously determined using enzyme-linked immunosorbent assay. The occurrence of pulmonary complications within 7 days after operation was recorded. Results:There was no significant difference in pH values, PaCO 2, oxygenation index, peak airway pressure, plateau airway pressure, driving pressure, and dynamic lung compliance at each time point between the two groups ( P>0.05). Compared with S group, the serum Clara cell 16 kDa protein concentrations were significantly decreased at T 5, FEV 1 and FVC were increased at 3 and 7 days after operation, the serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation concentrations were decreased at 1, 3 and 7 days after operation, the incidence of unexpected oxygen supply and total incidence of postoperative pulmonary complications were decreased ( P<0.05), and no significant change was found in FEV 1/FVC at each time point in T group ( P>0.05). Conclusions:TEAS can improve lung function in the patients undergoing robot-assisted radical resection of colon cancer.

Effect of ventilator-induced lung injury on blood-brain barrier permeability in rats / 中华危重病急救医学

Objective:To observe the effect of ventilator-induced lung injury (VILI) on blood-brain barrier permeability in rats.Methods:Forty-eight healthy clean male Sprague-Dawley (SD) rats were randomly divided into sham operation (Sham) group, low tidal volume (LVT) mechanical ventilation group (LVT group), normal tidal volume (NVT) mechanical ventilation group (NVT group) and high tidal volume (HVT) mechanical ventilation group (HVT group) with 12 rats in each group. After anesthesia, rats in the Sham group were intubated and kept spontaneous breathing. The rats in different tidal volume (VT) groups were mechanically ventilated by endotracheal intubation with VT of 6 mL/kg (LVT group), 10 mL/kg (NVT group), and 20 mL/kg (HVT group), respectively. The inspiration-expiration ratio of the three groups was 1∶1, the ventilation frequency was 40 times/min, and the ventilation time was 3 hours. At the end of the experiment, the bronchoalveolar lavage fluid (BALF) of rats was collected, and the levels of pro-inflammatory factors [tumor necrosis factor-α (TNF-α), interleukins (IL-1β and IL-6)] in BALF were detected by enzyme-linked immunosorbent assay (ELISA). The lung tissues of rats were collected, and the lung wet/dry weight (W/D) ratio was calculated. The pathological changes of lung tissues were observed under light microscopy after hematoxylin-eosin (HE) staining, and lung injury scores were performed. The brain tissue of rats was taken to measure the brain water content, and the Evans blue (EB) content of brain tissue was measured to reflect the permeability of the blood-brain barrier. The tight junction proteins in the brain tissues were detected by Western blotting.Results:After 3 hours of mechanical ventilation, with the increase of VT, the degree of lung injury in VILI rats gradually increased. When VT reached 20 mL/kg, lung tissue structure was significantly injured, alveolar wall edema, alveolar congestion, lung interstitial thickening, a large number of inflammatory cells infiltrated, and the lung injury score, lung W/D ratio, and the levels of TNF-α, IL-1β and IL-6 in BALF were significantly higher than those in the Sham group [lung injury score: 10.6±1.1 vs. 1.4±1.0, lung W/D ratio: 6.6±0.8 vs. 3.7±0.6, TNF-α(ng/L): 832.9±97.9 vs. 103.8±23.3, IL-1β (ng/L): 68.9±14.1 vs. 15.7±2.6, IL-6 (ng/L): 70.8±16.4 vs. 20.3±5.4, all P < 0.05]. Lung injury in rats was accompanied by aggravating brain injury. When VT reached 20 mL/kg, brain water content and EB content in brain tissue were significantly higher than those in the Sham group [brain water content: (85.4±3.6)% vs. (68.7±2.7)%, EB content in brain tissue (μg/g): 887±78 vs. 97±14, both P < 0.05], and the protein expressions of claudin-5, occluding and zonula occluden-1 (ZO-1) in the brain tissue were significantly lower than those in the Sham group [claudin-5 protein (claudin-5/β-actin): 0.67±0.12 vs. 1.45±0.19, occludin protein (occludin/β-actin): 0.48±0.11 vs. 0.99±0.21, ZO-1 protein (ZO-1/β-actin): 0.13±0.03 vs. 0.63±0.12, all P < 0.05]. Conclusion:VILI can induce brain edema and increase blood-brain barrier permeability in rats, which may be related to the down-regulation of tight junction protein expression in the brain tissue.

Mechanism Study on Chinese Medicine in Treatment of Nodular Goiter / 中国结合医学杂志

Nodular goiter has become increasingly prevalent in recent years. Clinically, there has been a burgeoning interest in nodular goiter due to the risk of progression to thyroid cancer. This review aims to provide a comprehensive summary of the mechanisms underlying the therapeutic effect of Chinese medicine (CM) in nodular goiter. Articles were systematically retrieved from databases, including PubMed, Web of Science and China National Knowledge Infrastructure. New evidence showed that CM exhibited multi-pathway and multi-target characteristics in the treatment of nodular goiter, involving hypothalamus-pituitary-thyroid axis, oxidative stress, blood rheology, cell proliferation, apoptosis, and autophagy, especially inhibition of cell proliferation and promotion of cell apoptosis, involving multiple signal pathways and a variety of cytokines. This review provides a scientific basis for the therapeutic use of CM against nodular goiter. Nonetheless, future studies are warranted to identify more regulatory genes and pathways to provide new approaches for the treatment of nodular goiter.

Venous thromboembolism in children with acute lymphoblastic leukemia in China: a report from the Chinese Children's Cancer Group-ALL-2015 / 医学前沿

Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.

Hyper-expression and hypomethylation of TM4SF1 are associated with lymph node metastases in papillary thyroid carcinoma patients.

Lymph node metastases (LNM) are an indicator for recurrence in papillary thyroid carcinoma (PTC) patients. However, prophylactic neck dissection (ND) cannot improve survival or recurrence rate because of increased surgical complications and occult LNM. Biomarkers are needed for the prediction of high-risk of LNM to avoid unnecessary operation and reduce the missed malignant lymph nodules. GEO database was searched for the differentially expressed genes (DEGs) between PTC patients with LNM (N1) and those without LNM (N0), transcriptional and methylation data of DEGs in THCA were examined from databases. The expression and methylation of TM4SF1 in fresh and paraffin tissues of PTC patients were examined by qRT-PCR, IHC, and MSP. TM4SF1 was the only one significantly associated with LNM. UALCAN revealed that TM4SF1 was overexpressed and hypomethylated in LNM patients. MEXPRESS presented a negative correlation between gene expression and promoter methylation of TM4SF1. DEGs were enriched in multiple pathways and the Extracellular Matrix (ECM)-receptor interaction pathway showed the greatest correlation with LNM. IHC and qRT-PCR of tissues demonstrated that the expression of TM4SF1 in the N1 group was 4.5-fold higher than that in the N0 group (p<0.05). MSP exhibited that the positive rate of aberrant promoter methylation of TM4SF1 was 8.38% in N1 and 66.7% in N0 group (p<0.05). Hyper-expression and hypomethylation of TM4SF1 are associated with lymph node metastases in PTC patients.

A new classification of maxillary defect and simultaneous accurate reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To select the preferred flaps for the reconstruction of different maxillary defects and to propose a new classification of maxillary defects. Methods: A total of 219 patients (136 males and 83 females) underwent the simultaneous reconstruction of maxillary defects in the Beijing Tongren Hospital, Capital Medical University, between January 2005 and December 2018 were reviewed. Age ranged from 16 to 78 years. Based on the proposed new classification of the maxillary defects, 22 patients with class Ⅰ defects (inferior maxillectomy), 44 patients with class Ⅱ defects (supperior maxillectomy), 132 patients with class Ⅲ defects (total maxillectomy) and 21 patients with class Ⅳ defects (extensive maxillectomy) were enrolled. Survival rate, functional and aesthetic outcomes of flaps were evaluated. Survival analysis was performed in 169 patients with malignant tumor, Kaplan-Meier method was used to calculate the survival rate, and Log-rank method was used to compare the difference of survival rate in each group. Results: A total of 234 repairs for maxillary defects were performed in 219 patients. Fibula flaps were used in 4/13 of class Ⅰ defects; temporal muscle flaps (11/24, 45.8%) and anterolateral thigh flaps (6/24, 25.0%) used in class Ⅱ defects; temporal muscle flaps (71/128, 55.5%), anterolateral thigh flaps (6/24, 25.0%) and fibula flaps (12/128, 9.4%) used in class Ⅲ defects; and anterolateral thigh flaps (8/20, 40.0%) and rectus abdominis flaps (8/20, 40.0%) used in class Ⅳ defects. The success rate of local pedicled flaps was 95.6% (109/114) and that of free flaps was 95.8% (115/120). Thrombosis(10/234,4.3%) was a main reason for repair failure. Among the followed-up 88 patients, swallowing and speech functions recovered, 82 (93.2%) of them were satisfied with appearance, and 75 (85.2%) were satisfied with visual field. The 3-year and 5-year overall survival rates were 66.5% and 63.6%, and the 3-year and 5-year disease-free survival rates were 57.1% and 46.2%, respectively, in the 169 patients with malignant tumors. Conclusion: A new classification of maxillary defects is proposed, on which suitable flaps are selected to offer patients good functional and aesthetic outcomes and high quality of life.

Effect of trans-nasal humidified rapid insufflation ventilatory exchange on reflux and micro-aspiration during induction of general anesthesia in patients undergoing laparoscopic cholecystectomy / 中华麻醉学杂志

Objective:To evaluate the effect of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) on reflux and micro-aspiration during induction of general anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 60 patients, regardless of gender, aged 18-60 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table method: routine mask ventilation group (group C) and trans-nasal humidified rapid insufflation ventilatory exchange group (group H). Patients in group C were pre-oxygenated with a mask for 5 min, oxygen flow of 6 L/min and FiO 2 100%, after the induction of anesthesia, the pressure mask was used to artificially assist positive pressure ventilation for 2 min when the patient′s consciousness disappeared, and 2 min later endotracheal intubation was performed.Patients in group H were pre-oxygenated with THRIVE for 5 min, oxygen flow of 30 L/min and FiO 2 100%.The oxygen flow was increased to 50 L/min during anesthesia induction.After anesthesia induction, the oxygen flow was increased to 70 L/min when the patient′s consciousness disappeared, and chin lift and/or jaw thrust was used during apnoea to maintain an open airway, the patient′s mouth was kept closed during the whole process, and 2 min later endotracheal intubation was performed.Ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and to monitor the occurrence of gastric insufflation, and the incidence of CSA greater than >3.4 cm 2 was recorded on admission to the operating room and immediately after tracheal intubation.Supraglottic and subglottic secretions were collected at the time of tracheal intubation using visual laryngoscopy after exposing the glottis, and the pepsin content was determined using enzyme-linked immunosorbent assay to assess reflux (content of pepsin in supraglottic secretion >216 ng/ml) and micro-aspiration (content of pepsinin subglottic secretion >200 ng/ml), and arterial blood gas analysis was simultaneously performed.The apnoea time was recorded, and P ETCO 2 at the first mechanical ventilation after tracheal intubation were recorded. Results:Compared with group C, PaO 2 was significantly increased and CSA was decreased immediately after tracheal intubation, and the incidence of CSA greater than >3.4 cm 2 immediately after tracheal intubation was decreased, and the incidence of gastric insufflation, reflux and micro-spiration was decreased, apnoea time was prolonged, and P ETCO 2 at first mechanical ventilation was increased in group H ( P<0.05). Conclusions:THRIVE applied during induction of general anesthesia can reduce the occurrence of reflux and micro-aspiration while ensuring oxygenation in the patients undergoing laparoscopic cholecystectomy.

Risk factors for postoperative delirium in frail elderly patients undergoing cardiac surgery and development of a prediction model / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative delirium (POD) in frail elderly patients undergoing cardiac surgery and develop a ROC prediction model.Methods:The medical records of patients of either sex, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, with frailty index score>0.25, underwent open heart surgery under cardiopulmonary bypass (CPB) from January 2022 to June 2022, were collected retrospectively.The patients were divided into POD group and non-POD group according to POD occurred within 7 days after operation.Clinical information such as gender, age, Mini-mental State Examination score, past medical history, results of the laboratory test before surgery, operation time, cerebral oxygen saturation (rSO 2), rSO 2 baseline (rSO 2 baseline), lowest intraoperative rSO 2 value before, during and after CPB (CPB 1rSO 2 lowest, CPB 2rSO 2 lowest, CPB 3rSO 2 lowest) , the greatest decrease in intraoperative rSO 2 from the baseline value before, during and after CPB (CPB 1rSO 2 decrease, CPB 2rSO 2 decrease, CPB 3rSO 2 decrease) were recorded.Multivariate logistic regression analysis was used to identify the risk factors for POD, and the receiver operating characteristic (ROC) curve was drawn to evaluate the accuracy of the related risk factors. Results:A total of 130 patients were enrolled, with 32 cases in POD group and 98 cases in non-POD group, and the incidence of POD was 24.6%.The results of logistic regression analysis showed that the CPB 2rSO 2 decrease, CPB 2rSO 2 lowest and operation time were independent risk factors for POD ( P<0.05). The area under the ROC curve (95% confidence interval) of CPB 2rSO 2 decrease>11.2% predicting POD was 0.655 (0.533-0.778), sensitivity 68.9%, and specificity 62.9%.The area under the ROC curve (95% confidence interval) of operation time>237.5 min predicting POD was 0.751 (0.652-0.849), sensitivity 62.5%, and specificity 78.6%. Conclusions:CPB 2rSO 2 decrease, CPB 2rSO 2 lowest and operation time are independent risk factors for POD in frail elderly patients undergoing cardiac surgery; both CPB 2rSO 2 decrease and operation time can effectively predict the occurrence of POD in frail elderly patients undergoing cardiac surgery.