Background. Intravenous infusion of lidocaine as an anesthesia adjuvant can improve patient outcomes, but its impact on intrapulmonary shunt during one-lung ventilation (OLV) has not been clarified. Objectives. To determine the effect of intravenous lidocaine infusion on intrapulmonary shunt during OLV and postoperative cognitive function in video-assisted thoracoscopic surgery (VATS). Materials and methods. Sixty patients who underwent OLV for thoracic surgery were randomized to receive intravenous infusion of lidocaine (lidocaine group, n = 30) or normal saline (control group, n = 30) for anesthesia induction. Arterial and venous blood gases were measured during two-lung ventilation and at 15 and 30 min after OLV (OLV + 15 and OLV + 30). The Mini-Mental State Examination was administered before the surgery and at postoperative 12 months to assess patient cognitive function. Results. No significant difference was found in intrapulmonary shunt fraction (Qs/Qt) between the lidocaine group and the control group at OLV + 15 (p = 0.493) and OLV + 30 (p = 0.754). The lidocaine group used significantly lower doses of propofol and remifentanil compared to the control group (both p < 0.001). Furthermore, no significant difference was observed in the incidence of postoperative cognitive dysfunction between the lidocaine group and the control group at 1 year post-operation (3.3% vs 6.7%, p = 0.554). Conclusions. Intravenous lidocaine administered in VATS had no significant impact on intrapulmonary shunt during OLV or postoperative cognitive function. However, it significantly reduced the doses of anesthetics used during the surgery.

Background: The intraoperative effects of mechanical ventilation with individualized positive end-expiratory pressure guided by dynamic compliance on right heart function remains undefined. Objectives: To investigate whether individualized ventilation is superior to standard ventilation in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg position. Methods: Forty patients who underwent abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric positive end-expiratory pressure [PEEP]) and Group I (intentional PEEP, 5 cmH(2)O). Parameters of right ventricular function were measured using transesophageal echocardiography, which included tricuspid annular plane systolic excursion, early-to-late filing ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area ratio during mechanical ventilation. Results: No significant difference in the tricuspid annular plane systolic excursion or early-to-late filling ratio of the right ventricle was noted between the groups during the whole procedure (P > 0.05). We noticed an increase in right ventricular end-diastolic area/left ventricular end-diastolic area ratio at T-0 vs. T-2 in Group T (0.53 +/- 0.02 vs. 0.60 +/- 0.06, respectively; P = 0.0208) and Group I (0.54 +/- 0.01 vs. 0.62 +/- 0.06, respectively; P = 0.0018). Conclusions: Intraoperative lung-protective ventilation with dynamic compliance-guided PEEP does not have obvious side effects on the right heart function when compared with standard protective ventilation during laparoscopic surgery in the Trendelenburg position. (c) 2022 Published by Elsevier Inc.

Objective: The aim of this study was to evaluate the effect of dexmedetomidine on lung compliance in patients under general anesthesia with desflurane.Methods: This prospective, randomized, double-blind, controlled trial included 51 patients who received general anesthesia undergoing lower limb fracture surgery. Participants were assigned to either the experimental (loading dose of 0.25 & mu;g/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.3 & mu;g/kg/h until the end of the surgery) or control (0.9% saline) group. Anesthesia was maintained with desflurane, analgesics and muscle relaxants. The two groups were compared for hemodynamic parameters, dynamic lung compliance, oxygenation index, and postoperative complications.Results: While dynamic lung compliance showed no significant difference between the two groups at T1 (P = 0.321), it was significantly higher in the experimental group at all other time points (all P < 0.001). In the control group, Cdyn at T4, T5, T6, and T7 were lower than that at T1 (P = 0.032, 0.043, 0.032 and 0.018, respectively). There were no significant between-group differences in the mean arterial pressure and heart rate. Compared to the control group, the experimental group had a higher oxygenation index at T1 (P < 0.001), T2 (P < 0.001), T3 (P < 0.001), T4 (P = 0.02), and T5 (P = 0.016) and significantly lower peak airway pressure at all time points (all P < 0.001). Both groups had comparable postoperative outcomes.Conclusions: Dexmedetomidine infusion at a loading dose of 0.25 & mu;g/kg and maintenance dose of 0.3 & mu;g/kg/h improved dynamic lung compliance in patients receiving desflurane during general anesthesia.

The relieving role of dezocine in pain after surgery was previously reported, while the potential mechanism was not completely clear. Therefore, the current research probed into the regulatory mechanism of dezocine in pain after surgery. A postoperative pain model was established by performing plantar incision surgery on the juvenile Sprague–Dawley rats. After the rats were treated with dezocine or SC79 (Akt1 activator), the paw withdrawal threshold and paw withdrawal latency of rats were detected to evaluate the mechanical allodynia and thermal hyperalgesia. After the plantar tissue, dorsal root ganglions, and spinal cord of rats were collected, the expressions of Akt1, p-Akt1, GSK-3β, and p-GSK-3β in the tissues were determined by western blot to evaluate the activation state of the Akt1/GSK-3β pathway. After surgery, the paw withdrawal threshold and paw withdrawal latency of rats were lessened, whereas the ratios of p-Akt1/Akt1 and p-GSK-3β/GSK-3β were augmented in rat plantar tissue, dorsal root ganglions, and spinal cord. After treatment with dezocine alone, the paw withdrawal threshold and paw withdrawal latency of postoperative rats were elevated, but ratios of p-Akt1/Akt1 and p-GSK-3β/GSK-3β were reduced. After co-treatment with dezocine and SC79, SC79 reversed the effects of dezocine on elevating the paw withdrawal threshold and paw withdrawal latency, and reducing the ratios of p-Akt1/Akt1 and p-GSK-3β/GSK-3β in postoperative rats. Dezocine ameliorated the postoperative hyperalgesia in rats via repressing the hyper-action of Akt1/GSK-3β pathway.

Objective The present study aimed to evaluate the impact of 1.5 mg/kg succinylcholine or 1.2 mg/kg rocuronium, vs. 1.0 mg/kg succinylcholine on apnea duration in patients underwent rapid sequence induction (RSI). Methods This prospective cohort study was conducted in the Department of Anesthesiology in Shanghai General Hospital from July 2020 to November 2020. Apnea duration was defined as the time from apnea prompted by the P ET CO 2 waveform to the time the point of oxygen saturation declined to 90% (T90) and 95% (T95) after succinylcholine or rocuronium administration. The primary outcome included T90 and T95 changes in 1.5 mg/kg vs. 1.0 mg/kg succinylcholine groups and 1.5 mg/kg succinylcholine vs. 1.2 mg/kg rocuronium groups. Results A total of 265 participants were subjected for analysis. The succinylcholine (1.0 mg/kg) group had a significantly longer T90 (50.72, 95% confidence interval [CI, 7.60, 94.38], P = 0.015) and T95 (48.09, 95% CI [7.11, 89.07], P = 0.012) than the succinylcholine (1.5 mg/kg) group. In addition, significantly longer T90 (56.84, 95% CI [16.24, 97.44], P = 0.003) and T95 (50.57, 95% CI [12.58, 88.57], P = 0.003) were observed in the rocuronium (1.2 mg/kg) group than those in the succinylcholine (1.5 mg/kg) group. No severe side events were observed during the operation. Conclusion Rocuronium and the lower dose of succinylcholine may be recommended to patients underwent RSI.

Objective:To explore the effects of intravenous lidocaine infusion on intrapulmonary shunt and inflammatory response in patients with one-lung ventilation (OLV) undergoing thoracoscopic surgery.Methods:According to random number table method, sixty patients who underwent thoracoscopic pulmonary surgery under elective general anesthesia were divided into the lidocaine group (group L) and the control group (group C), with 30 cases in each group. While other anesthetics used in patients of the two groups are all the same, the patients in group L received lidocaine 1.5 mg/kg intravenously, followed by a continuous infusion of 1.5 mg·kg -1·h -1, and group C received an intravenous injection of the same amount of normal saline. Records of two groups of patients with general information and intraoperative situation. Heart rate, mean artery pressure (MAP) before tracheal intubation, 1 min after intubation, and immediately after extubation of patients in two groups were recorded. Heart rate, MAP, hemoglobin (Hb), partial pressure of oxygen (PaO 2), and the pressure of carbon dioxide (PaCO 2) of patients were recorded at the time of two-lung ventilation (T 0), 15 min of OLV (T 1), 30 min of OLV (T 2), and the intrapulmonary shunt rate was calculated. Serum interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α) levels were detected at T 0 and the end of surgery (T 3). Results:Compared with before tracheal intubation, the MAP and heart rate of patients in the two groups increased 1 min after intubation and immediately after extubation ( P<0.05). The MAP and heart rate of group L are lower at 1 min after intubation and immediately after extubation than the parameters in group C ( P<0.05). Compared with T 0, the levels of IL-6, IL-8 and TNF-α in the two groups were increased at T 3 ( P<0.05). The levels of IL-6, IL-8 and TNF-α in group L were lower at T 3 than the levels of the group C ( P<0.05). There was no significant difference in PaO 2, PaCO 2, intrapulmonary shunt rate, Hb, MAP and heart rate between the two groups at each time point ( P>0.05). Compared with T 0, the intrapulmonary shunt rate increased, and PaO 2 decreased at T 1 and T 2 in both groups ( P<0.05). Conclusions:Intravenous infusion of lidocaine can effectively inhibit the stress response during double-lumen bronchial intubation and extubation, reduce the release of inflammatory factors during surgery, and has no significant effect on intrapulmonary shunt in patients with OLV.

Dezocine is an opioid receptor agonist - antagonist gaining popularity in clinical practice. It is both mu-receptor agonist and antagonist activities. This study was designed to investigate the effects of dezocine on the CNS oxidative and inflammation in mice. Eight-week old female BALB/c mice were obtained from Shanghai General Hospital of Nanjing Medical University animal center. All animal procedures were approved by the Animal Care and Use Committee of Nanjing Medical University. We found that increasing dose of dezocine induced oxidative stress and inflammation in multiple brain regions, including the prefrontal cortex, cerebellum, temporal cortex, and striatum. Elevated expression levels of anti-oxidants (NRF2, SOD-1 and HO-1), KEAP-1, GSH and MDA were found in the prefrontal cortex and striatum. Elevated HO-1 and NRF2 levels were detected in the cerebellum and temporal cortex in the 3.0 mg/kg dezocine treated group. The SOD-1, HO-1, KEAP-1, NRF2, GSH and MDA levels were similar among groups in the olfactory bulb. The prefrontal cortex and striatum showed the most elevated oxidative stress (NRF2, SOD-1, and HO-1) marker levels. The number of PV-positive interneurons was decreased in the 1.5 mg/kg dezocine treated group, while the number of PNNs steadily increased over 3.0 mg/kg dezocine treated.

The aim of this study was to analyze the effect of optimal pulmonary compliance titration of PEEP regimen on cardiac function and hemodynamics in patients undergoing laparoscopic surgery. 120 patients undergoing elective laparoscopic radical resection of colorectal cancer were included as the study subjects and randomly divided into the experimental group (n = 60) and the control group (n = 60). The control group had a fixed positive end-expiratory pressure (PEEP) = 5 cmH2O. The experimental group had transesophageal ultrasound monitoring through on an improved noise reduction algorithm (ONLM) based on nonlocal mean filtering (NLM) according to optimal pulmonary compliance titration of PEEP. There was significant difference in cerebral oxygen saturation and blood glucose level at T4-T6 between the experimental group and the control group (P < 0.05); the signal-to-noise ratio (SNR), figure of merit (FOM), and structural similarity (SSIM) of ONLM algorithm were significantly higher than those of NLM algorithm and Bayes Shrink denoising algorithm, and the differences were statistically significant (P < 0.05); there was significant difference in stroke volume (SV) and cardiac output (CO) at T4-T6 between the experimental group and the control group (P < 0.05); there was significant difference in pH, partial pressure of carbon dioxide (PCO2), and PO2 at T4-T6 between the experimental group and the control group (P < 0.05); pH was higher, and PCO2 and PO2 were lower in the experimental group. The results showed that transesophageal ultrasound based on the ONLM algorithm can accurately assess cardiac function and hemodynamics in patients undergoing laparoscopic surgery. In addition, optimal pulmonary compliance titration of PEEP could better maintain arterial acid-base balance during perioperative period and increase cerebral oxygen saturation and CO, but this strategy had no significant effect on hemodynamics.

Background: The appropriate doses of remimazolam combined with remifentanil were investigated in anesthesia gastroscopy by observing the effect of two methods of administration in fixed doses and dosed by ideal weight on success rate and recover effect in painless gastroscopy. Methods: A total of 400 patients underwent the anesthesia of gastroscopy were randomized to divide into five groups (W1, W2, F1, F2 and C Group) in endoscopy center, with 80 cases in each group. All patients were given 0.25ug/kg of remifentanil before gastroscopy. The success rate, the quality of anesthesia resuscitation, heart rate, blood pressure, Pulse oxygen saturation, perioperative adverse events and Modified observer’ s assessment of alert/sedation (MOAA/S) diachronic changes were recorded. Results: In terms of anesthetic effects of the first dose of the drug( P <0.05), the patients in F1 group showed be lack of sedation obviously. The success rate of induction in F2 group was higher than that in F1 group. The success rate of sedation in W2 groups was highest (96%). The control group was second to W2 Group. Blood pressure in W2 Group was lower than W1 Group after first administration( P <0.05). There was no significant difference in next several minutes. There was no difference in blood pressure between W2 Group and C Group at T1( P >0.05). There was no difference in the changes of heart rate, recovery time and discharge time( P >0.05). The incidence of cough in F1 and W1 is high( P <0.05). Conclusions: Remimazolam combined with remifentanil used were safe, and 0.3mg/kg of remimazolam combined with 0.25ug/kg of remifentanil by ideal body weight is better in painless gastroscopy. Trial registration: The trial was registered on ClinicalTrials.gov: ChiCTR2100041759, registered 4 January 2021.

Abstract Rationale: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant. Patient concerns: A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks’ gestation due to the rapid deterioration of the mother. Diagnoses: The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria. Interventions: Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure. Outcomes: This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications. Lessons: Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.

Sepsis-induced lung injury is a clinical syndrome characterized by injury of alveolar epithelium cells (AECs). Previous investigations illustrate that exosomes secreted from adipose-derived stem cells (ADSCs) have therapeutic effects in a variety of disease treatments, but roles and mechanisms regarding ADSC-derived exosomes in sepsis-induced lung injury are unclear. In this study, high-throughput sequencing was used to explore the molecular delivery of ADSC exosomes. A sepsis-induced lung injury mouse model and a lipopolysaccharide-induced AEC damage model were used for mechanistic analysis. The results showed that ADSC exosomes have high levels of the circular RNA (circ)-Fryl. Downregulation of circ-Fryl suppressed ADSC protective effects exosomes against sepsis-induced lung injury by decreasing apoptosis and inflammatory factor expression. Bioinformatics and luciferase reporting experiments showed that miR-490-3p and SIRT3 are downstream targets of circ-Fryl. miR-490-3p overexpression or SIRT3 silencing reversed ADSC exosome protective effects. Studying the mechanism showed that overexpression of circ-Fryl promoted autophagy activation by inducing SIRT3/AMPK signaling. Autophagy activation can suppress sepsis-induced lung injury by decreasing apoptosis and inflammatory factor expression. Taken together, our results suggest that exosomes derived from ADSCs attenuate sepsis-induced lung injury by delivery of circ-Fryl and regulation of the miR-490-3p/SIRT3 pathway.

BACKGROUND: The intraoperative cardiorespiratory effect of ventilation with individualised positive end-expiratory pressure guided by dynamic compliance (Cdyn) remains undefined. We investigated whether individualised protective ventilation would protect the heart and lung more efficiently than standard protective ventilation during abdominal laparoscopic surgery with Trendelenburg positioning.METHODS: Forty patients undergoing abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric PEEP) and Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured via transoesophageal echocardiography, including tricuspid annular plane systolic excursion (TAPSE), early filling-to-late filling ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) ratio. Cdyn, driving pressure (∆P), ratio of dead space to tidal volume (VD/VT), and partial pressure of arterial oxygen to inspiratory oxygen fraction (PF) ratio were measured during mechanical ventilation.RESULTS: The RVEDA/LVEDA ratio in all patients increased significantly at T2 compared with T0, but there were no significant differences in TAPSE or E/A ratio between groups during the whole procedure (P>0.05). Cdyn, ∆P, and VD/VT ratios in Group T were significantly improved compared to those in Group I at T2 (P<0.05). There was no significant difference in the PF ratio between groups (P>0.05).CONCLUSIONS: Intraoperative lung-protective ventilation with Cdyn-guided PEEP improved Cdyn, ∆P, and VD/VT ratio without obvious side effects on right ventricular function compared to standard protective ventilation during laparoscopic surgery with Trendelenburg positioning, which suggests that it is a circulation-friendly way to titrate PEEP for intraoperative lung protective ventilation.TRIAL REGISTRATION: Trial registration date: 13/09/2020; Trial registration number: ChiCTR2000038212.

BACKGROUND Gastroesophageal reflux (GER) affects up to 20% of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation. GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being. However, the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear. AIM To explore independent risk factors for the incidence and extent of GER during general anesthesia induction. METHODS A retrospective study was conducted, and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University. This study recruited a total of 601 adult patients undergoing general anesthesia, and the characteristics of patients and the incidence or extent of GER were recorded. The potential risk factors for the incidence of GER were explored using multivariate logistic regression, and the risk factors for the extent of GER were evaluated using multivariate linear regression. RESULTS The current study included 601 adult patients, 82 patients with GER and 519 patients without GER. Overall, we noted significant differences between GER and non-GER for pharyngitis, history of GER, other digestive tract diseases, history of asthma, and the use of sufentanil (P < 0.05), while no significant differences between groups were observed for sex, age, type of surgery, operative time, body mass index, intraoperative blood loss, smoking status, alcohol intake, hypertension, diabetes mellitus, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, palliative strategies, propofol, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05). The results of multivariate logistic regression indicated that female sex [odds ratio (OR): 2.702; 95% confidence interval (CI): 1.144-6.378; P = 0.023], increased age (OR: 1.031; 95%CI: 1.008-1.056; P = 0.009), pharyngitis (OR: 31.388; 95%CI: 15.709-62.715; P < 0.001), and history of GER (OR: 11.925; 95%CI: 4.184-33.989; P < 0.001) were associated with an increased risk of GER, whereas the use of propofol could protect against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Finally, age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017) were significantly associated with GER time. CONCLUSION This study identified the risk factors for GER in patients undergoing general anesthesia including female sex, increased age, pharyngitis, and history of GER.

BACKGROUND Fentanyl-induced cough (FIC) during general anesthesia induction and postoperative nausea and vomiting are common complications, yet the risk factors for FIC remain controversial. This retrospective study was conducted at a single center in China and aimed to investigate the risk factors for fentanyl-induced cough following general anesthesia in adults. MATERIAL AND METHODS A total of 601 adult patients undergoing elective surgery were enrolled, and the incidence of FIC during general anesthesia induction and postoperative adverse events were recorded. The risk factors for FIC during general anesthesia induction and postoperative nausea and vomiting were assessed using multivariate logistic regression analysis. RESULTS The incidence of FIC, nausea, and vomiting were 21.8%, 6.3%, and 4.5%, respectively. The results of multivariate logistic regression analysis indicated that pharyngitis history was associated with an increased risk of FIC during general anesthesia induction (odds ratio [OR]: 2.852; 95% confidence interval [CI]: 1.698-4.792; P<0.001), whereas use of lidocaine could protect against FIC risk (OR: 0.649; 95% CI: 0.557-0.757; P<0.001). However, the characteristics of patients were not associated with the risk of postoperative nausea and vomiting. CONCLUSIONS The findings from this study showed that a history of pharyngitis increased the risk of FIC, while the use of lidocaine was associated with a reduced risk of FIC. The risk of postoperative nausea and vomiting was not affected by fentanyl use or patient characteristics.

BACKGROUND:Positive end-expiratory pressure (PEEP) is widely used to reduce the risk of hypoxemia and atelectasis during one-lung ventilation (OLV); however, the optimal strategy for PEEP titrating remains unclear.The purpose of the study was to investigate the effects of different PEEP titrating strategies on oxygenation and respiratory mechanics during OLV.METHODS:Patients undergoing thoracic surgery with general anesthesia were randomly allocated into five groups. In P0 group, PEEP was set to zero; in PLIP2 group, PEEP was set to 2 cmH2O plus the pressure of lower inflection point (LIP) of pressure-volume (P-V) curve; in PLIPS group, PEEP was titrated to achieve maximum static compliance from the averaged LIP pressure value; in groups PSTAT and PDYN, the incremental PEEP values were titrated to achieve maximum static compliance or maximum dynamic compliance from 4 cmH2O. Hemodynamic measurements, respiratory mechanics, and blood gas analyses were recorded at the beginning of OLV, OLV 15 min, OLV 30 min, OLV 45 min, and OLV 60 min. Also, the intrapulmonary shunt (Qs/Qt), physiological dead space to tidal volume ratio (VD/VT), and oxygenation index (OI) were calculated and compared.RESULTS:Seventy-five patients consented to participate in this study. Dynamic compliance, peak inspiratory pressure (PIP), and plateau inspiratory pressure (Pplat) increased after PEEP titration during OLV. PIP, Qs/ Qt, and OI showed no differences among groups. Group PDYN showed lower Pplat, lower driving pressure, and higher dynamic compliance when compared with zero PEEP group.CONCLUSIONS:The PEEP titrating strategy according to dynamic compliance can improve respiratory mechanics, whereas it has no significant effects on oxygenation, dead space ratio, and intrapulmonary shunt, suggesting that it is better during OLV for thoracic surgery.

Background Diastolic dysfunction, an early manifestation and clinical symptom of heart failure with preserved ejection fraction, can be influenced by various anesthesia management strategies. Trans-esophageal echocardiography was used to undertake to assess left ventricular diastolic function during anesthesia maintenance using sevoflurane alone and sevoflurane combining with transversus abdominis plane block and rectus sheath block in elderly patients with diastolic dysfunction undergoing abdominopelvic surgery. Methods Thirty-eight patients were divided into two groups in this retrospective study, sevoflurane and sevoflurane combining with TAPB and RSB according to employing different anesthesia maintenance schemes. The parameters HR, MAP, CVP, E, A, E/A, e, a, e/a, and E/a were obtained immediately after anesthesia induction hemodynamics stability (HR1, MAP1, CVP1, E1, A1, E1/A1, e1, a1, e1/a1, and E1/a1) and 1 hour later (HR2, MAP2, CVP2, E2, A2, E2/A2, e2, a2, e2/a2, and E2/a2). Results Transmitral diastolic Doppler flow characteristics illustrated E/A significant decreases in the S group but increases in the ST group (p = 0.02 < 0.05) 1 hour after anesthesia induction hemodynamic stability. Tissue Doppler imaging characteristics showed a more significant increase e/a (P = 0.005 < 0.05) and decreases in a value (p = 0.009 < 0.05) in the ST group 1 hour after anesthesia induction hemodynamics stability. Conclusions Maintaining anesthesia with sevoflurane combining with TAPB and RSB was more suitable for protecting cardiac diastolic function than sevoflurane alone in elderly patients with diastolic dysfunction undergoing open abdominal and pelvic surgery.

BackgroundT help 2 (Th2) cell differentiation by morphine has been verified. However, the underlying mechanism of morphine induces Th2 cell differentiation remains elusive. The aim of the present study was to explore the possible basis of morphine induced Th2 cell differentiation.MethodsFlow cytometry analysis was used to detect the content of T help 1(Th1) cell and Th2 cell. Enzyme linked immunosorbent assay (ELISA) was performed to determine the levels of IL-4 and IFN-γ. Real-time quantitative polymerase chain reaction, electrophoretic mobility shift assay and Western blotting was conducted in this study.ResultsTh2 cell subset and IL-4 level were elevated in morphine induced naïve T cells. Pathway determining found the protein phosphorylation level of PKC-θ and the expression and activity of the transcription factor GATA3 was also enhanced in the naïve T cells challenged by morphine. Moreover, inhibitor of morphine(naltrexone) or PKC-θ(AEB071) can reverse morphine-induced Th2 cell differentiation.ConclusionThese results suggested that morphine induce naïve T cell differentiation to Th2 cells via the PKC-θ/GATA3 signal pathway.

目的 探索计算流体力学(computational fluid dynamics,CFD)技术模拟机械通气状态下呼吸系统内部气流流动的可行性,为CFD技术应用于机械通气的气流流场模拟奠定基础.方法 选取1名健康的中年男性志愿者进行头颈部加胸部MRI扫描,将获得的图像保存为DICOM格式导入Mimics17.0医学图像软件中构建气道三维模型,用Geomagic Studio 12软件进行网格划分后导入Ansys 14.5软件进行CFD模拟计算,对机械通气气道内部气流流场变化进行动态分析.结果 基于MRI图像数据构建气道三维模型,划分网格后对CFD模拟施加不同流速的入口边界条件,分析流速分布、壁压力分布、流场线变化情况以及局部管壁剪切应力的变化情况.结论 基于影像数据对气道进行三维重建,通过对模型进行CFD模拟发现,入口流速与气道内流体流速分布、壁剪切应力及壁压力均呈正相关,入口高流速易在气道分叉处形成涡流.

Sepsis-induced diaphragm dysfunction (SIDD) which is mainly characterized by decrease in diaphragmatic contractility has been identified to cause great harms to patients. Therefore, there is an important and pressing need to find effective treatments for improving SIDD. In addition, acetylcholinesterase (AChE) activity is a vital property of the diaphragm, so we evaluated both diaphragmatic contractility and AChE activity. Though neuregulin-1β (NRG-1β) is known to exert organ-protective effects in some inflammatory diseases, little is known about the potential of NRG-1β therapy in the diaphragm during sepsis. Our study was aimed at exploring the effects of NRG-1β application on diaphragmatic contractility and AChE activity during sepsis. Proinflammatory cytokines, muscle injury biomarkers in serum, contractile force, AChE activity, proinflammatory cytokines, oxidative parameters, histological condition, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining, and expression of phosphoinositide 3-kinase (PI3K)/protein kinase B (PKB/Akt) signaling proteins in the diaphragm were measured and compared between nonseptic and septic groups with or without NRG-1β treatment. In vitro, the effects of NRG-1β on reactive oxygen species (ROS) production in the lipopolysaccharide- (LPS-) stimulated L6 rat muscle skeletal cells with or without the Akt inhibitor MK-2206 were detected. NRG-1β inhibited proinflammatory cytokine release and muscle injury biomarkers soaring in serum and improved the sepsis-induced diaphragm dysfunction and AChE activity decrease significantly during sepsis. Meanwhile, the inflammatory response, oxidative stress, pathological impairment, and cell apoptosis in the diaphragm were mitigated by NRG-1β. And NRG-1β activated the PI3K/Akt signaling in the diaphragm of septic rats. Elevated ROS production in the LPS-stimulated L6 rat skeletal muscle cells was reduced after treatment with NRG-1β, while MK-2206 blocked these effects of NRG-1β. In conclusion, our findings underlined that NRG-1β could reduce circulating levels of proinflammatory cytokines in rats with sepsis, adjust diaphragmatic proinflammatory cytokine level, mitigate diaphragmatic oxidative injury, and lessen diaphragm cell apoptosis, thereby improving diaphragmatic function, and play a role in diaphragmatic protection by activating PI3K/Akt signaling.