Efficacy of intraoperative subanesthetic dose of ketamine/esketamine in preventing postoperative cognitive dysfunction: a systematic review and meta-analysis.

Background: Postoperative cognitive dysfunction (POCD) is a common complication after anesthesia surgery, especially in older people, that can persist weeks or months after surgery as a short-term impairment of cognitive abilities, or even for a prolonged duration over years, potentially progressing into permanent cognitive dysfunction. However, the pathogenesis of POCD is not fully understood, and therefore an optimal solution for preventing POCD has yet to be established. Some studies have shown that intraoperative ketamine/esketamine reduces the incidence of POCD, but this remains controversial. Objectives: We evaluated the effect of intraoperative subanesthetic doses of ketamine/esketamine versus no intervention in adults undergoing general anesthesia surgery on the incidence of POCD. Data Sources: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the PubMed, Embase, Ovid, Cochrane, Scopus, and Web of Science databases for the MeSH terms 'ketamine', 'esketamine', and 'Postoperative Cognitive Complications' from database inception to 25 June 2023. Results: We found no statistically significant difference in the incidence of POCD within 7 days for intraoperative subanesthetic dose of ketamine/esketamine compared with the control group [relative risk (RR) = 0.57, 95% confidence interval (CI): 0.32, 1.01], and the results from the subgroup analysis based on age (>60 years) also revealed that the difference was not statistically significant (RR = 0.49, 95% CI: 0.23, 1.04). Conclusion: Compared with controls, intraoperative subanesthetic dose of ketamine/esketamine has no advantage in preventing POCD in patients, or in elderly patients. This study provides reference data for POCD research and clinical drug intervention strategies. Registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023401159).

The Development and Validation of Multi-dimensional Resilience Scale for People Living with HIV in China.

The study aimed to provide a measurement tool for the assessment of resilience among people living with HIV (PLHIV) in China. The study period was from April 2019 to October 2020: first, 14 PLHIV were interviewed to build an item pool; 15 experts were invited to evaluate the scale items. The test-retest reliability of the scale was carried out with 29 PLHIV. Online and field investigation were used, and convenience sampling was conducted in Luzhou and Zigong. A pool of 31 items was formed and the Scale-Level Content Validity Index average was 0.96, while the that intra-class correlation coefficient for test-retest reliability was 0.816. From the exploratory factor analysis, four factors (Acceptance; Disease Management; Emotion Regulation; and Reconstruction) with 19 items were extracted. The Cronbach's alpha value of the Resilience Scale was 0.88. This scale could prove useful as a measuring tool for evaluating the level of resilience for PLHIV.

RESUMEN: El estudio tuvo como objetivo proporcionar una herramienta de medición para la evaluación de la resiliencia entre las personas que viven con el VIH (PVVIH) en China. El período de estudio fue de abril de 2019 a octubre de 2020: primero, se entrevistó a 14 PVVIH para construir un grupo de artículos; 15 expertos fueron invitados a evaluar los ítems de la escala. La confiabilidad test­retest de la escala se realizó con 29 PVVIH. Se utilizaron investigaciones en línea y de campo, y se realizó un muestreo de conveniencia en Luzhou y Zigong. Se formó un conjunto de 31 ítems y el índice de validez de contenido a nivel de escala promedio fue de 0,96, mientras que el coeficiente de correlación intraclase para la confiabilidad test­retest fue de 0,816. Del análisis factorial exploratorio se extrajeron cuatro factores (Aceptación; Manejo de la Enfermedad; Regulación de las Emociones y Reconstrucción) con 19 ítems. El valor alfa de Cronbach de la Escala de Resiliencia fue de 0,88. Esta escala podría resultar útil como herramienta de medición para evaluar el nivel de resiliencia de las PVVIH.

Salvianolic acid B inhibits RAW264.7 cell polarization towards the M1 phenotype by inhibiting NF-κB and Akt/mTOR pathway activation.

M1 macrophages secrete a large number of proinflammatory factors and promote the expansion of atherosclerotic plaques and processes. Salvianolic acid B (Sal B) exerts anti-inflammatory, antitumor and other effects, but no study has addressed whether Sal B can regulate the polarization of macrophages to exert these anti-atherosclerotic effects. Therefore, we investigated the inhibition of Sal B in M1 macrophage polarization and the underlying mechanism. The effects of different treatments on cell viability, gene expression and secretion of related proteins, phenotypic markers and cytokines were detected by MTT and western blot assays, RT‒qPCR and ELISAs. Cell viability was not significantly changed when the concentration of Sal B was less than 200 µM, and Lipopolysaccharide (LPS) (100 ng/mL) + interferon-γ (IFN-γ) (2.5 ng/mL) successfully induced M1 polarization. RT‒qPCR and ELISAs indicated that Sal B can downregulate M1 marker (Inducible Nitric Oxide Synthase (iNOS), Tumor Necrosis Factor-α (TNF-α), and Interleukin-6 (IL-6)) and upregulate M2 marker (Arginase-1 (Arg-1) and Interleukin-10 (IL-10)) expression. Western blotting was performed to measure the expression of Nuclear Factor-κB (NF-κB), p-Akt, p-mTOR, LC3-II, Beclin-1, and p62, and the results suggested that Sal B inhibits the M1 polarization of RAW264.7 macrophages by promoting autophagy via the NF-κB signalling pathway. The study indicated that Sal B inhibits M1 macrophage polarization by inhibiting NF-κB signalling pathway activation and downregulating Akt/mTOR activation to promote autophagy.

Salvianolic acid B improves autophagic dysfunction and decreases the apoptosis of cholesterol crystal­induced macrophages via inhibiting the Akt/mTOR signaling pathway.

Progressive macrophage dysfunction and apoptosis are some of the major events that occur during atherogenesis. To further investigate the intrinsic association between atherosclerosis (AS) and macrophage apoptosis and autophagy, cholesterol crystals (CHCs) were used to stimulate RAW264.7 macrophages to establish a macrophage model of advanced AS. Cells in the CHC group were treated with salvianolic acid B (Sal B) to evaluate its protective effects and reveal its underlying molecular mechanism. The results demonstrated that treatments with Sal B significantly improved autophagy dysfunction and reduced the apoptotic rate of CHC­induced macrophages. Furthermore, Sal B significantly attenuated CHC­induced release of proinflammatory factors (TNF­α and IL­6) by macrophages. Treatment of macrophages with a specific inhibitor of autophagy (3­methyladenine) significantly reversed Sal B­mediated effects on autophagy, suggesting that Sal B­induced autophagy may display a protective effect in CHC­induced macrophages. Furthermore, pretreatment of CHC­induced macrophages with insulin significantly decreased Sal B­induced autophagy, indicating that the Akt/mTOR signaling pathway may serve as a critical mediator in regulating Sal B­mediated cell death. Taken together, the present study demonstrated that Sal B improved autophagic dysfunction and reduced the apoptosis of CHC­induced macrophages via inhibiting the Akt/mTOR signaling pathway.

Abdominal hemorrhage after peritoneal dialysis catheter insertion: A rare cause of luteal rupture: A case report.

BACKGROUND: Abdominal hemorrhage is a complication of peritoneal dialysis catheter (PDC) insertion that cannot be neglected, and its causes are mainly related to surgical injury. This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis (PD) insertion. CASE SUMMARY: A 37-year-old woman was surgically placed a Tenckhoff catheter because of end-stage renal disease. On the third postoperative day, the color of the abdominal drainage fluid was pink, and deepened gradually. It turned pale after initiating conservative treatment. On the tenth postoperative day, the color of the abdominal drainage fluid suddenly turned dark red, and the color progressively deepened. The patient's hemoglobin dropped from 88 g/L to 57 g/L. Abdominal computed tomography (CT) indicated abdominal effusion and a high-density shadow in the abdominal cavity. The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed. The gynecologist repaired the ovary and performed a bilateral oophoroplasty. After the operation, the patient stopped bleeding and hemodialysis was temporarily stopped. PD was resumed after half a month. The patient's condition improved, and she was discharged 14 d after the laparotomy. CONCLUSION: If abdominal hemorrhage occurs in women of childbearing age after PDC insertion, luteal rupture should be considered as the cause.

Roxadustat as treatment for a blood transfusion-dependent maintenance hemodialysis patient: A case report and review of literature.

BACKGROUND: Erythropoiesis-stimulating agents (ESAs) have revolutionized the therapeutic strategy for anemia in chronic kidney disease. However, some cases are resistant or hyporesponsive to ESAs. Roxadustat is an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Here, we describe a hemodialysis patient with refractory anemia who did not respond to traditional treatments and depended on blood transfusion for more than 1 year. After applying Roxadustat, the patient's anemia improved significantly. CASE SUMMARY: A 44-year-old man was diagnosed with uremia accompanied by severe anemia with a hemoglobin (Hb) level ranging from 30-40 g/L. His anemia did not improve after sufficient dialysis or high doses of active ESAs; other causes of anemia were excluded. The patient required approximately 600-1000 mL of red blood cell suspension every 15-30 d for more than 1 year. After accepting Roxadustat therapy, the patient's anemia symptoms improved significantly; his Hb level gradually increased to 50 g/L, and no further blood transfusions were administered. His Hb level reached 69 g/L by the 34th week. Although a Hb level of 60-70 g/L cannot be considered satisfactory, he no longer required blood transfusions and his quality of life was substantially improved. Roxadustat showed good efficacy and safety in this case. CONCLUSION: Roxadustat represents an innovative and effective agent for the clinical treatment of renal anemia caused by multiple complex factors.