Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial.

In this randomized controlled trial, 74 patients scheduled for gynecological laparoscopic surgery (American Society of Anesthesiologists grade I/II) were enrolled and randomly divided into two study groups: (i) Group C (control), received sufentanil (0.3 µg/kg) and saline, followed by sufentanil (0.1 µg/kg∙h) and saline; and (ii) Group F (OFA), received esketamine (0.15 mg/kg) and lidocaine (2 mg/kg), followed by esketamine (0.1 mg/kg∙h) and lidocaine (1.5 mg/kg∙h). The primary outcome was the 48-h time-weighted average (TWA) of postoperative pain scores. Secondary outcomes included time to extubation, adverse effects, and postoperative sedation score, pain scores at different time points, analgesic consumption at 48 h, and gastrointestinal functional recovery. The 48-h TWAs of pain scores were 1.32 (0.78) (95% CI 1.06-1.58) and 1.09 (0.70) (95% CI 0.87-1.33) for Groups F and C, respectively. The estimated difference between Groups F and C was - 0.23 (95% CI - 0.58 - 0.12; P = 0.195). No differences were found in any of the secondary outcomes and no severe adverse effects were observed in either group. Balanced OFA with lidocaine and esketamine achieved similar effects to balanced anesthesia with sufentanil in patients undergoing elective gynecological laparoscopic surgery, without severe adverse effects.Clinical Trial Registration: ChiCTR2300067951, www.chictr.org.cn 01 February, 2023.

Relationship between Dietary Inflammatory Index and Blood Glucose Changes in Patients with Pre-diabetes Mellitus.

Objective: The objective of this study was to assess the association between the dietary inflammatory index (DII) and blood glucose changes in patients diagnosed with pre-diabetes mellitus (Pre-DM). Methods: The study participants were 111 patients diagnosed with Pre-DM at Taizhou People's Hospital of Jiangsu Province Hospital between January 2019 and December 2021. Patients' initial BG data were collected and recorded. A dietary assessment was performed on all Pre-DM patients, and the DII of each participant was calculated to explore the relationship between DII and BG changes. DII was calculated based on the relation between food and interleukin serum IL-1ß, IL-4, IL-6, IL-10 and CRP. Results: The fasting (FBG), 1-hour postprandial (1hPBG) and 2-hour postprandial blood glucose (2hPBG) levels were (5.43±0.88) mmol/L, (10.67±3.05) mmol/L, and (8.65±2.89) mmol/L, respectively, with statistical significance among them (n=111, F=222.987, P < .001). Multivariate linear regression models were established with FBG, 1hPBG, 2hPBG, and BG changes (2hPBG-FBG and 1hPBG-FBG) as dependent variables. In Model 5, the coefficient (B value) of DII and its 95% (CI) were 0.324 (0.018~0.658) (P = .031), indicating a positive correlation between DII and BG concentration that the change of BG concentration increased by 0.456 mmol/L for every 1 unit increase in DII. Conclusions: DII is a risk factor for Pre-DM patients, so attention should be paid to the content of inflammatory components in the diet, and more intake of anti-inflammatory components is helpful to prevent the occurrence of diabetes further.

50% efficacy dose of intravenous lidocaine in supressing sufentanil-induced cough in children: a randomised controlled trial.

BACKGROUND: Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists' concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients. METHODS: A total of 188 patients aged 3-12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5. RESULTS: The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively. CONCLUSIONS: Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of Yichang Central People's Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006).

Change of epidemiological characteristics of four respiratory viral infections in children before and during COVID-19 pandemic.

OBJECTIVES: Viruses are the main infectious agents of acute respiratory infections (ARIs) in children. We aim to describe the changes in epidemic characteristics of viral ARIs in outpatient children before and during the COVID-19 pandemic. PATIENTS AND METHODS: From 2017 to 2022, the results of viral detection in oral pharyngeal swabs in 479,236 children with ARIs in the outpatient department of Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV) were detected by the colloidal gold method. RESULTS: The median age was 3.4 (1.6-5.6) years. Among all the children, 159,895 cases (33.4 %) were positive for at least one virus. The total positive rate for ADV, FLUA and FLUB during the pandemic period was lower than during the pre-pandemic period in every season (pre-pandemic period vs. pandemic period11.7 % vs. 4.7 %, 13.9 % vs. 9.2 %, 7.0 % vs. 5.2 %, respectively, with overall p value < 0.001). However, the positive rate fir RSV was not significantly different between the pre-pandemic period and the pandemic period (5.6 % vs. 5.8 %, p = 0.117). Atypical timing of RSV (summer-autumn 2021) and FLUA (summer 2022) was noted. CONCLUSIONS: Public health interventions for different pathogens are maximally effective. While positive rates for ADV, FLUA and FLUB decreased during the COVID-19 pandemic period, positive rates for RSV remained similar. In RSV and FLUA, off-season outbreaks were observed. Measures need to be taken to protect children from possible infection surges due to immunity debt having accrued over the last three years.

ED95 of remimazolam in nasal administration for attenuating preoperative anxiety in children.

Background: Preoperative anxiety often prevails in children at higher levels than adults, which is a common impediment for surgeons and anesthesiologists. It is of great necessity to explore an appropriate medication to improve this situation. Remimazolam, a type of benzodiazepine drug, has been indicated for the induction and maintenance of procedural sedation in adults since 2020. To date, rare studies were reported to investigate the effect of remimazolam on children. In this study, we investigated the safety and efficacy of intranasal drops of remimazolam and tried to determine the 95% effective dose (ED95) of remimazolam in single intranasal administration in attenuating preoperative anxiety in children. Methods: In this study, 114 children were enrolled who underwent laparoscopic high-level inguinal hernia ligation between January 2021 and December 2022 and were divided into an early childhood children group and a pre-school children group. The biased coin design (BCD) was used to determine the target doses. A positive response was defined as the effective relief of preoperative anxiety (modified Yale Preoperative Anxiety Scale, mYPAS < 30). The initial nasal dose of remimazolam was 0.5 mg·kg-1 in the two groups. An increment or decrement of 0.1 mg·kg-1 was applied depending on the sedative responses. Isotonic regression and bootstrapping methods were used to calculate the ED95 and 95% confidence intervals (CIs), respectively. Results: A total of 80 children completed the study, including 40 in the early childhood group and 40 in the pre-school children group. As statistical analysis indicated, the ED95 of a single intranasal infusion of remimazolam for the relief of preoperative anxiety is 1.57 mg·kg-1 (95% CI: 1.45-1.59 mg·kg-1) in early childhood children and 1.09 mg·kg-1 (95% CI: 0.99-1.11 mg·kg-1) in pre-school children, and the CIs did not overlap each other. Conclusion: Remimazolam is an effective medication to relieve preoperative anxiety in children. Moreover, the ED95 of single nasal administration of remimazolam for effective relief of preoperative anxiety was 1.57 and 1.09 mg·kg-1 in early childhood children and pre-school children, respectively.

Correlation between Mean Platelet Volume and Gensini Score in Patients with Coronary Heart Disease in Different Diabetic States.

SUBJECT: To investigate the correlation between mean platelet volume (MPV) levels and Gensini scores in stable coronary heart disease (CHD) patients with or without diabetes. METHODS: A retrospective analysis was conducted on 2525 patients with stable CHD in Zhongshan Hospital, Fudan University. There were 1274 in the low MPV group and 1251 in the high MPV group, divided by a median MPV level of 10.9 fL. In the total population, 1605 patients were non-diabetic and 920 were diabetic. The severity of coronary artery disease was quantified using the Gensini score. RESULTS: The Gensini score was significantly higher in the high MPV group than in the low MPV group (p < 0.001). MPV levels increased significantly with the number of stenotic (>50%) coronary vessels (p < 0.001). The Spearman analysis showed a positive correlation between MPV and Gensini score (r = 0.189, p < 0.001), which was more significant in the diabetic subgroup (r = 0.232, p < 0.001). Receiver operating characteristic (ROC) curves were employed to assess the predictive value of MPV for high Gensini scores, using the median value of 32 points as the cutoff. MPV levels in the diabetes cohort exhibited a higher predictive value for high Gensini scores (area under the curve: 0.635 [0.614-0.657], p < 0.001). Multivariate linear regression analysis showed that diabetes and MPV were independently associated with Gensini scores. CONCLUSION: MPV levels in stable CHD patients can predict the severity of coronary artery stenosis. This correlation is more significant in the presence of diabetes.

The effect of interdisciplinary and diversified health education combined with personalized nutrition intervention on FPG, 2hPG, SDS, SAS scores and the pregnancy outcomes of gestational diabetes mellitus.

OBJECTIVES: This study aimed to explore the effect of interdisciplinary and diversified health education combined with personalized nutrition intervention on FPG, 2hPG, SDS, SAS scores and pregnancy outcome of gestational diabetes mellitus (GDM). MATERIAL AND METHODS: A total of 180 GDM patients, who were admitted to our hospital between June 2019 and June 2020, were enrolled as the research subjects and randomly divided into two groups: a research group and a control group (n = 90, each). The patients in the control group received routine care while the patients in the research group received interdisciplinary and diversified health education combined with personalized nutrition intervention. The fasting blood-glucose (FPG), two-hour postprandial blood glucose (2hPBG), glycated hemoglobin (HbA1C), SDS, SAS scores, and pregnancy outcome of the two groups of pregnant women were analyzed and compared. RESULTS: The differences in the levels of FBG, 2hPBG and HbA1C between the two groups before nursing were not statistically significant. After nursing, the levels of FBG, 2hPBG, and HbA1C of the two groups of patients decreased, and the differences in each group before and after intervention were statistically significant. These indexes were lower in the research group than in the control group, the differences being statistically significant. There were no significant differences between the two groups in SAS and SDS scores before nursing, but there were statistically significant differences after nursing. The incidence of unfavorable pregnancy outcome was lower in the research group (8.89%) than in the control group (14.44%), but the difference was not statistically significant (p > 0.05). CONCLUSIONS: Interdisciplinary and diversified health education combined with personalized nutrition intervention can effectively reduce FPG, 2hPG, SDS, and SAS scores in GDM women.

Epidemiological characteristics of four common respiratory viral infections in children.

BACKGROUND: Viruses are the main infectious agents of acute respiratory infections in children. We aim to describe the epidemiological characteristics of viral pathogens of acute respiratory tract infections in outpatient children. METHODS: From April 2018 to March 2019, the results of viral detection using oral pharyngeal swabs from 103,210 children with acute respiratory tract infection in the outpatient department of the Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV), were detected by the colloidal gold method. RESULTS: At least one virus was detected in 38,355 cases; the positivity rate was 37.2%. A total of 1910 cases of mixed infection with two or more viruses were detected, and the positivity rate of multiple infection was 1.9%. The ADV positivity rate was highest in the 3-6-year-old group (18.7%), the FLUA positivity rate was highest in the > 6-year-old group (21.6%), the FLUB positivity rate was highest in the > 6-year-old group (6.6%), and the RSV positivity rate was highest in the < 1-year-old group (10.6%). There was a significant difference in the positivity rate of viral infection among different age groups (χ2 = 1280.7, P < 0.001). The rate of positive viral infection was highest in winter (47.1%). The ADV infection rate was highest in spring (18.2%). The rates of FLUA and FLUB positivity were highest in winter (28.8% and 3.6%, respectively). The rate of RSV positivity was highest in autumn (17.4%). The rate of positive viral infection in different seasons was significantly different (χ2 = 6459.1, P < 0.001). CONCLUSIONS: Viral infection rates in children differ for different ages and seasons. The positivity rate of ADV is highest in the preschool period and that of RSV is highest in infants; that of FLU increases with age. The total positive rate of viral infection in different seasons is highest in winter, as is the rate of FLU positivity.

[Application of three-in-one intelligent screening in outpatient department of children's hospital during COVID-19 epidemic].

OBJECTIVE: To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital. METHODS: We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups. RESULTS: The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s (t=13.182, P<0.01). The triage coincidence rate of the intelligent pre-inspection model was 98%, which was similar to that of traditional model (97%, χ2=0.251, P>0.05). CONCLUSIONS: The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.

Self-Care Behavior of Hemodialysis Patients With Arteriovenous Fistula in China: A Multicenter, Cross-Sectional Study.

Improving the level of arteriovenous fistula (AVF) self-care behavior by people receiving hemodialysis is an effective way to reduce the occurrence of complications and mortality. The aim of this study was to assess the self-care behavior of Chinese patients undergoing hemodialysis with arteriovenous fistula. The assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF, Portuguese version) was translated into Chinese using Brislin's translation model. The content validity was evaluated by six experts. Then we involved 301 hemodialysis patients with AVF to explore the construct validity of the Chinese version of ASBHD-AVF. Ultimately 216 patients from eight dialysis centers of general hospitals in China were recruited to evaluate the patients' self-care behavior about AVF. Measures included demographic questionnaire, and the Chinese ASBHD-AVF. The Chinese ASBHD-AVF that included 12 items has a good internal consistency (α = 0.865) and content validity (CVI = 0.979). Principal component analysis generated two factors which explained 53.525% of the total variance. About 69.9% of hemodialysis patients' AVF self-care behavior were at a low or moderate level. The level of self-care behavior and knowledge need to be improved. Nurses should give specific guidance according to the patients' own characteristics and different influence factors, in order to improve the recipients' self-care behavior.

Selenium-lentinan inhibits tumor progression by regulating epithelial-mesenchymal transition.

BACKGROUND: Selenium supplementation can be used to treat tumors. However, inorganic selenium is highly toxic, and natural organic selenium is extremely rare. Polysaccharides can improve drug bioavailability and targeting. Lentinan is a polysaccharide that has been approved as an anti-cancer drug in Japan and China. METHODS: Lentinan, an antitumor polysaccharide extracted from Lentinus edodes, was conjugated with seleninic acid to be transformed into ester (Se-lentinan) and utilized as drug carrier. The enhancement of the anti-tumor effects of Se-lentinan was evaluated by cell viability, cell cycle, migration, and transwell assays and animal xenograft models. The effects of Se-lentinan on the expression levels of epithelial-mesenchymal transition (EMT) markers were determined through immunofluorescence, Western blot, and immunohistochemistry analyses. RESULTS: Se-lentinan inhibited the invasiveness of B16-BL6 and HCT-8 cells by suppressing EMT. In vivo, Se-lentinan significantly inhibited tumor growth and metastasis of the transplanted melanoma and colon cancer cells and showed less toxicity than sodium selenite. Moreover, Se-lentinan reduced the accumulation of selenium in the liver and kidney tissues of mice and exhibited low organ toxicity. CONCLUSION: The antitumor activity of selenium was enhanced greatly, and its side effects were reduced with the use of lentinan as drug carrier.

Aptamer-modified magnetic beads in affinity separation of proteins.

Aptamers are valuable alternative ligands for affinity separations. Here, we describe the aptamer-based affinity separation of His-tagged proteins using an aptamer directed against the His-tag. The immobilization of the aptamer to magnetic beads is described as well as the aptamer-based purification and proper methods for the characterization of the process. Moreover, indications for the transfer of the process to other aptamers are given.

Aptamer-modified nanoparticles as biosensors.

Aptamers are short oligonucleotides that are capable of selectively binding to their corresponding target. Therefore, they can be thought of as a nucleic acid-based alternative to antibodies and can substitute for their amino acid-based counterparts in analytical applications, including as receptors in biosensors. Here they offer several advantages because their nucleic acid nature and their binding via an induced fit mechanism enable novel sensing strategies. In this article, the utilization of aptamers as novel bio-receptors in combination with nanoparticles as transducer elements is reviewed. In addition to these analytical applications, the medical relevance of aptamer-modified nanoparticles is described.

Childhood pentastomiasis: a report of three cases with the following-up data.

Pentastomiasis, a zoonotic parasitic disease, has been reported commonly in Africa and Asia. It is caused by pentastomes, which are annulated but unsegmented blood-sucking endoparasites. Fewer than 20 cases have been reported during the past two decades in China, and cases in children have been especially rare. Herein, we report three cases of pediatric patients with severe systemic symptoms, focusing on the clinical features, diagnosis, and therapy of this disease. The patients were two boys and one girl aged 3 to 13years. They all had a history of snake or worm ingested from snake and initial symptoms of fever, abdominal pain, diarrhea, and weight loss. Eosinophilia, anemia and elevated serum IgE levels were noted. Moreover, the large numbers of nodules, or even calcification, in the liver and/or lungs were noted by ultrasound, CT or MRI scans. These pentastomes were identified as Armillifer moniliformis, Porocephalus taiwana and Armillifer agkistrodontis. Praziquantel and mebendazole deworming treatments were adopted for the patients. Hence, pentastomiasis should be considered in the differential diagnosis for patients with multiple organ or system lesions, especially abdominal signs, that develop after the ingestion of snakes. Ultrasound, CT and MRI scans and laparoscopic approaches might be helpful for the diagnosis.

Tracheal diverticula in infants: a report of three cases.

Tracheal diverticulum is a paratracheal air cyst in connection with the trachea. It may be congenital or acquired. Congenital tracheal diverticula in infants are rare. Imaging techniques such as high-resolution computed tomography and three-dimensional reconstruction of the airway are useful for diagnosis. Here we report three cases with congenital tracheal diverticula, which were diagnosed by imaging techniques.

Takotsubo cardiomyopathy in a 90-year-old Chinese man.

A 90-year-old Chinese man was transferred to the Emergency Department of the Affiliated Shantou Hospital of Sun Yat-sen University for treatment of an acute myocardial infarction. He suffered chest pain with three days of cough, dyspnea and fever. A diagnosis of Takotsubo cardiomyopathy was made in normal coronary arteries from urgent coronary angiography and characteristic apical dyskinesis and basal hyper contractility in left ventriculography. The patient died from severe multi-organ failure on the second day of hospitalization.

Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000-2008.

BACKGROUND: Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children necessitating prompt recognition and management. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in children. METHODS: A total of 1027 patients with FBA were reviewed retrospectively. They were 626 boys and 401 girls aged from 5 months to 14 years with a median age of 17 months. The clinical manifestations, radiological findings, bronchoscopic findings and complications of the procedure were analyzed. RESULTS: Among the patients, only 53.4% had a definite history of FBA. The most frequent symptom was paroxysmal cough (84.3%), followed by stridor or wheezing, fever and dyspnea. Chest X-ray showed emphysema in 68.8% of the patients, atelectasis in 13.3% and bronchopneumonia in 56.3%. A bronchoscope was inserted intranasally in most children, but through mouth and endotracheal tube in 17 and 3 children, respectively. Foreign bodies were removed successfully by flexible bronchoscopy with disposable grasping forceps or biopsy forceps in 938 (91.3%) of the patients. The other 89 patients turned to rigid bronchoscopy. During the procedures, 132 (12.9%) of the patients showed transient hypoxia, which was alleviated by oxygen supplement and/or temporary cessation of the procedure. A small amount of bleeding was found in 17 patients and bradycardia in 3. Air leak and laryngeal edema were noted in 2 patients and relieved within 24 hours. CONCLUSIONS: Flexible bronchoscopy is useful and safe in retrieving airway foreign bodies in children. With skilled personnel and perfect equipments, flexible bronchoscopy could be considered as the first choice for the removal of airway foreign body.