Application value of opioid-free anesthesia in renal cyst decompression by laparoscopy.

Objective: The objective of the study was to analyze the application value of opioid-free anesthesia (OFA) in renal cyst decompression by laparoscopy. Method: A total of 124 patients undergoing renal cyst decompression by laparoscopy in our hospital were selected and divided into opioid anesthesia (OA) and OFA groups (n = 62). Fentanyl and remifentanil were used for anesthesia induction in the OA group, while lidocaine and dexmedetomidine were employed for anesthesia induction in the OFA group. The homeostasis indicators (cortisol [Cor], adrenocorticotropic hormone [ACTH], C-reactive protein [CRP], and interleukin-6 [IL-6]) were also compared 10 min before anesthesia (Ta), at the end of operation (Tb), and 24 h after operation (Tc). Results: At T1-T3, heart rate, mean arterial pressure, mean airway pressure, and partial pressure of end-tidal carbon dioxide were all lower in OFA group than those in OA group (p < 0.05). At Tb-Tc, the levels of Cor, ACTH, CRP, and IL-6 were all higher in both groups than those at Ta (p < 0.05), while they were lower in OFA group than those in OA group (p < 0.05). Conclusion: OFA is more beneficial to the respiratory and circulatory system and homeostasis of patients, and has higher anesthetic safety.

Asparaginyl endopeptidase contributes to cetuximab resistance via MEK/ERK signaling in RAS wide-type metastatic colorectal cancer.

BACKGROUND: Cetuximab, a monoclonal antibody targeting epidermal growth factor receptor (EGFR), is effective for RAS wild-type metastatic colorectal cancer (mCRC) patients. However, cetuximab resistance often occur and the mechanism has not been fully elucidated. The purpose of this study was to investigate the role of asparaginyl endopeptidase (AEP) in cetuximab resistance. METHODS: Differentially expressed genes between cetuximab responders and non-responders were identified by analyzing the gene expression profile GSE5851, retrieved from Gene Expression Omnibus (GEO). The potential genes were further validated in cetuximab-resistant CRC cell lines. The expression of AEP in the peripheral blood and tumor tissues of mCRC patients in our hospital were detected by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry, respectively. The survival analysis was carried out by Kaplan-Meier method. The function and associated pathways of AEP were further investigated by lentivirus transfection, CCK8 assay, colony formation assay, real-time polymerase chain reaction (qPCR) and western blot. RESULTS: Through bioinformatics analysis, we found that the expression of AEP gene was related to progress free survival (PFS) of mCRC patients treated with cetuximab alone (P = 0.00133). The expression of AEP was significantly higher in the cetuximab-resistant CRC cell lines, as well as in mCRC patients with shorter PFS treated with cetuximab-containing therapy. Furthermore, AEP could decrease the sensitivity of CRC cells to cetuximab in vitro. And the phosphorylation level of MEK and ERK1/2 was increased in AEP overexpression cells. The downregulation of AEP using specific inhibitors could partially restore the sensitivity of CRC cells to cetuximab. CONCLUSION: The higher expression of AEP could contribute to the shorter PFS of cetuximab treatment in mCRC. The reason might be that AEP could promote the phosphorylation of MEK/ERK protein in the downstream signal pathway of EGFR.

Nursing influences on motor function recovery in patients on post stroke hemiplegia / Influências da enfermagem na recuperação da função motora em pacientes com hemiplegia pós-ave / Influencias de la enfermería en la recuperación de la función motora en pacientes con hemiplejia post ictus

ABSTRACT Introduction: The motor function of the lower limbs is of great importance for the recovery of hemiplegics post stroke. Objective: Study the influence of nursing during motor rehabilitation on the recovery of lower limb motor function in patients with hemiplegia after stroke. Methods: In this study, the 28 patients were treated with nursing intervention for motor rehabilitation in the experimental group, while the control group was treated only with a conventional rehabilitation program, and the results were compared before and after the experiment. Results: After eight weeks of the experiment, the FMA-LE scale score in the experimental group increased from 19.65 to 30.51; the TUGT assessment score increased from 38.45s to 28.61s; the FAC rating test was upgraded from 1.86 to 2.98. The maximum weight percentage on the hemiplegic side increased from 27.54±10.14% to 79.51±7.52%; the fastest 5m return speed increased from 0.22±0.03m/s to 0.54±0.07m/s. The improvement effect was less evident in the control group. Conclusion: Rehabilitation nursing promotes a positive effect on improving lower limb motor function in hemiplegic patients. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A função motora dos membros inferiores é de grande importância para a recuperação de hemiplégicos pós-acidente vascular encefálico. Objetivo: Estudar a influência da enfermagem durante a reabilitação motora na recuperação da função motora dos membros inferiores em pacientes com hemiplegia após o acidente vascular encefálico. Métodos: Neste estudo, os 28 pacientes foram tratados com intervenção de enfermagem para reabilitação motora no grupo experimental, enquanto o grupo controle foi tratado apenas com um programa de reabilitação convencional, sendo que os resultados foram comparados antes e depois do experimento. Resultados: Após 8 semanas do experimento, a pontuação da escala FMA-LE no grupo experimental aumentou de 19,65 para 30,51; a pontuação da avaliação TUGT aumentou de 38,45s para 28,61s; o teste de classificação FAC foi atualizado de 1,86 para 2,98. A porcentagem máxima de peso do lado hemiplégico passou de 27,54±10,14% para 79,51±7,52%; a velocidade de retorno mais rápida de 5m passou de 0,22±0,03m/s para 0,54±0,07m/s. O efeito de melhoria foi menos evidente no grupo controle. Conclusão: O trabalho de enfermagem de reabilitação tem um efeito positivo na melhoria da função motora dos membros inferiores em pacientes com hemiplegia. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La función motora de los miembros inferiores es de gran importancia para la recuperación de los hemipléjicos post ictus. Objetivo: Estudiar la influencia de la enfermería durante la rehabilitación motora en la recuperación de la función motora de los miembros inferiores en pacientes con hemiplejia post ictus. Métodos: En este estudio, los 28 pacientes fueron tratados con intervención de enfermería para la rehabilitación motora en el grupo experimental, mientras que el grupo de control fue tratado sólo con un programa de rehabilitación convencional, y se compararon los resultados antes y después del experimento. Resultados: Tras 8 semanas de experimento, la puntuación de la escala FMA-LE en el grupo experimental aumentó de 19,65 a 30,51; la puntuación de la evaluación TUGT aumentó de 38,45s a 28,61s; la prueba de valoración FAC se mejoró de 1,86 a 2,98. El porcentaje de peso máximo en el lado hemipléjico aumentó de 27,54±10,14% a 79,51±7,52%; la velocidad de retorno más rápida de 5m aumentó de 0,22±0,03m/s a 0,54±0,07m/s. El efecto de mejora fue menos evidente en el grupo de control. Conclusión: El trabajo de enfermería de rehabilitación tiene un efecto positivo en la mejora de la función motora de las extremidades inferiores en pacientes con hemiplejia. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

The effect of visfatin on inflammatory reaction in uterus of LPS-induced rats / Efecto de visfatina en la reacción inflamatoria en el útero de ratas inducidas por LPS

The present study was to investigate the effects of visfatin on the morphological structure and function of the rat uterus during inflammation. The expression and distribution of visfatin, morphological structure, eosinophils (EOS), myeloperoxidase (MPO) and cytokines in the uterus of the LPS-induced rat were studied using hematoxylin-eosin staining (HE), immunohistochemical methods, western blots and enzyme-linked immunosorbent assay (ELISA). The present study showed that visfatin positive cells dispersed widely in the uterus, and strong positive staining was observed mainly in the cell cytoplasm. Compared with saline group, in visfatin group, more uterine glands were found, EOS increased, and the difference was significant (P<0.05), MPO reduced, and the difference was significant (P<0.01). In addition, visfatin was able to increase the secretion of IL-1b, IL-6, and TNF-a (P<0.01). Compared with LPS group, in vifatin+LPS group, the uterine glands of the lamina propria increased, the myometrium became thinner, the number of EOS and MPO reduced obviously, but the difference was not significant (P>0.05), and after LPS stimulated body, visfatin decrease the level of IL-1b, IL-6, TNF-a (P<0.01). The above results suggest that visfatin could affect the morphological structure of rat uterus; Visfatin could modulate the inflammatory response in rats' uterus by regulating the quantity of inflammatory cells, such as EOS and MPO, and the level of inflammatory cytokines, such as IL-1b, IL-6, TNF-a.

El objetivo del presente estudio fue investigar los efectos de la visfatina sobre la estructura morfológica y la función del útero de la rata durante la inflamación. Se estudiaron la expresión y distribución de la visfatina, la estructura morfológica, eosinófilos, mieloperoxidasa y citoquinas en el útero de rata mediante la tinción de H&E, métodos inmunohistoquímicos, Western blots y ELISA. El estudio mostró que las células visfatina positivas se dispersan ampliamente en el útero, junto a una fuerte tinción positiva, principalmente en el citoplasma de la célula. En comparación con el grupo control, en el grupo visfatina, se encontraron más glándulas uterinas, se observó un aumento de EOS y la diferencia fue significativa (p<0,05), MPO reducida siendo esta diferencia también significativa (p<0,01). Además, la visfatina fue capaz de aumentar la secreción de IL-1b, IL-6 y TNF-a (P<0,01). En comparación con el grupo LPS, visfatina+grupo LPS, las glándulas uterinas de la lámina propia aumentaron, se observó un miometrio más delgado, y número reducido de EOS y MPO, sin embargo, la diferencia no fue significativa (P>0,05). Después de estímulo LPS en el cuerpo, se registró un nivel menor de visfatina en IL-1b, IL-6, TNF-a (P<0,01). Los resultados anteriores sugieren que visfatina podría afectar a la estructura morfológica del útero de rata. Además, podría modular la respuesta inflamatoria en el útero mediante la regulación de la cantidad de células inflamatorias, tales como EOS y MPO.

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis.

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.

Distribution and expression of visfatin-positive cells in the spleen of lipopolysaccharide-stimulated piglets / Distribución y expresión de células visfatin positivas en el bazo de lechones estimulados con lipopolisacáridos

The histological changes in the spleen and the immunohistochemical expression of visfatin in lipopolysaccharide-stimulated piglets are reported to examine the relation between visfatin and inflammation. The results are as follows: (1) After LPS treated, the spleen displayed thicker capsules and trabecula, the thinner periarterial lymphatic sheath, and the more expandable splenic sinusoid, with an increase in the number of splenic nodules, lymphocytes, ellipsoids of the marginal zone, red blood cells and macrophagocytes. (2) Visfatin-positive cells were mainly distributed in the red pulp of the spleen, with less in splenic nodules and periarterial lymphatic sheath. In the LPS-treated group, the signal intensity and quantity of the visfatin-positive cells were significantly higher in the red pulp and the ellipsoids of the spleen (P<0.01), whereas lower in the periarterial lymphatic sheath. These results indicate that LPS stimulation induces inflammation, causing the histological changes of the piglet spleen and activating humoral immune response. Moreover, variation of visfatin in the spleen suggests that lymphocytes and macrophages are the potent source of visfatin which participates in the humoral immune response in the inflammation.

Se presentan los cambios histológicos en el bazo y la expresión inmunohistoquímica de visfatin en lechones estimulados mediante lipopolisacáridos (LPS) con el objetivo de estudiar la relación entre visfatin e inflamación. Los resultados fueron los siguientes: (1) Después del tratamiento por LPS se observaron en el bazo cápsulas más gruesas y trabéculas, una vaina linfática periarterial más delgada, y más sinusoides esplénicos expandible, con un aumento en el número de nódulos esplénicos, linfocitos, elipsoides de la zona marginal, como también un aumento de las células rojas de la sangre y los macrofagocitos. (2) Las células visfatina-positivas se distribuyeron principalmente en la pulpa roja del bazo, con una cantidad menor en los nódulos esplénicos y la vaina linfática periarterial. En el grupo tratado con LPS, la intensidad de la señal y número de células positivas fueron significativamente mayor en la pulpa roja y los elipsoides del bazo (P<0,01), mientras que estas fueron menores en la vaina linfática periarterial. Estos resultados indican que la estimulación con LPS induce la inflamación provocando cambios histológicos del bazo de los lechones y la activación de la respuesta inmune humoral. Por otra parte, la variación de visfatin en el bazo sugiere que los linfocitos y los macrófagos son una fuente potente de visfatin en la respuesta inmune humoral de la inflamación.

Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis

Premedication is important in pediatric anesthesia. This meta-analysis aimed to investigate the role of dexmedetomidine as a premedicant for pediatric patients. A systematic literature search was conducted to identify randomized controlled trials comparing dexmedetomidine premedication with midazolam or ketamine premedication or placebo in children. Two reviewers independently performed the study selection, quality assessment and data extraction. The original data were pooled for the meta-analysis with Review Manager 5. The main parameters investigated included satisfactory separation from parents, satisfactory mask induction, postoperative rescue analgesia, emergence agitation and postoperative nausea and vomiting. Thirteen randomized controlled trials involving 1190 patients were included. When compared with midazolam, premedication with dexmedetomidine resulted in an increase in satisfactory separation from parents (RD = 0.18, 95% CI: 0.06 to 0.30, p = 0.003) and a decrease in the use of postoperative rescue analgesia (RD = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003). Children treated with dexmedetomidine had a lower heart rate before induction. The incidence of satisfactory mask induction, emergence agitation and PONV did not differ between the groups. Dexmedetomidine was superior in providing satisfactory intravenous cannulation compared to placebo. This meta-analysis suggests that dexmedetomidine is superior to midazolam premedication because it resulted in enhanced preoperative sedation and decreased postoperative pain. Additional studies are needed to evaluate the dosing schemes and long-term outcomes of dexmedetomidine premedication in pediatric anesthesia.