Objective: To investigate the influence of medical environment familiarity on preoperative anxiety, anesthesia induction compliance, and emergence agitation (EA) in children undergoing adenotonsillectomy in a day surgery setting. Methods: A retrospective analysis was conducted on children undergoing elective adenotonsillectomy in a day surgery setting under general anesthesia at the Second Affiliated Hospital of Wenzhou Medical University between January 2018 and December 2019, October 2020 and November 2022, and March and December 2023. The children were divided into three groups according to their familiarity with the medical environment: the control group (Group C), which included children from January 2018 to December 2019; the familiar group (Group F), which comprised children from October 2020 to November 2022; and the fairly familiar group (Group FF), which encompassed children from March to December 2023. The modified Yale preoperative anxiety scale (m-YPAS) score, parental separation anxiety scale (PSAS) score, open vein compatibility score, and induction compliance checklist (ICC) score were compared among the three groups. Multivariate logistic regression analysis was performed to identify factors associated with preoperative anxiety and the occurrence of EA. Results: A total of 754 children aged (4.8±1.3)years were included, with 485 boys and 269 girls. There were 289, 206, and 259 children in group C, F, and FF, respectively. The incidence of EA was lower in the group F [33.0% (68/206)] and group FF [17.0% (44/259)] compared to the group C [65.4% (189/289)] (all P<0.001). Multivariate logistic regression analysis showed that compared to the control group, familiar and fairly familiar with the medical environment were protective factors associated with lower m-YPAS score (OR=0.227, 95%CI: 0.155-0.333; OR=0.292, 95%CI: 0.205-0.416), lower PSAS score (OR=0.239, 95%CI: 0.158-0.364; OR=0.137, 95%CI: 0.087-0.213), lower ICC score (OR=0.118, 95%CI: 0.071-0.194; OR=0.224, 95%CI: 0.166-0.359), and a lower risk of EA (OR=0.511, 95%CI: 0.298-0.877; OR=0.161, 95%CI: 0.084-0.307). Additionally, these factors were associated with higher open vein compatibility score (OR=3.858, 95%CI: 2.624-5.672; OR=6.807, 95%CI: 4.569-10.141) (all P<0.05). Conclusions: Familiarity with the medical environment significantly influenced the psychological and behavioral outcomes of children undergoing surgery. Greater familiarity was associated with reduced preoperative parental separation anxiety, improved cooperation during anesthesia induction, and a lower incidence of EA.

PurposeThis study compared the efficacy and acceptability of a ready-to-use intranasal dexmedetomidine spray (DS) versus traditional drops administered by syringe (DD) in pediatric patients undergoing elective surgery.Patients and MethodsEighty-six preschool children were enrolled in a prospective, randomized, controlled study. Children were randomly assigned to receive either DS or DD. For children weighing between 10.5 and 18.5 kg, a dexmedetomidine dosage of 30 μg (two sprays) was administered, while those weighing between 18.5 and 25.5 kg received 45 μg (three sprays). In the DD group, dexmedetomidine was administered at a dose of 2 μg/kg based on body weight. The primary outcome was the proportion of children achieving a Ramsay sedation scale (RSS) score of ≥3 within 30 min. Secondary outcomes included acceptance of intranasal medication, anxiety at parental separation and prior to induction, and compliance with induction.ResultsA total of 83 cases were analyzed. The proportion of children achieving an RSS score of ≥3 within 30 min was similar between the DS and DD groups (90.7% vs. 77.5%, respectively). However, the acceptance score was significantly better in the DS group (mean difference [95%]: −0.9 [−1.267 to −0.5325], P < 0.001). No significant differences were observed between the groups in terms of successful child-parent separation (88.4% vs. 85%) or satisfactory anxiolytic effect prior to induction (95.3% vs. 92.5%). Compliance with induction was comparable, with 53.5% in the DS group and 40.0% in the DD group demonstrating “optimal” compliance.ConclusionBoth intranasal spray and syringe drop methods were highly effective in providing sedation and anxiolysis, but the ready-to-use intranasal dexmedetomidine spray was more acceptable to children, offering a viable alternative to the syringe method.Clinical Trial RegistrationChiCTR.org.cn, identifier ChiCTR2400089374.

Background and Aims: Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requires further validation. This meta-analysis evaluates the effectiveness of this method and uses trial sequential analysis (TSA) to assess evidence reliability and identify the need for further research. Methods: A comprehensive literature search was conducted across PubMed, Medline, Embase, Cochrane CENTRAL, Ovid, ISI Web of Science, and the Wanfang Database from 2014 to 2023. The included studies assessed diaphragmatic ultrasonography for predicting extubation success. Successful extubation is defined as maintaining spontaneous breathing for at least 48 hours post-extubation. Data extraction and quality assessment were performed using a random-effects model. Quality was assessed via the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated through funnel plots and Egger’s test. Cumulative meta-analysis, sub-group analyses, and TSA were used to explore heterogeneity and assess evidence reliability. Results: Fourteen studies were included, demonstrating high quality. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were significant predictors of extubation success. The diagnostic odds ratio (DOR) was 4.80 [95% confidence interval (CI): 3.86, 5.97)], with a sensitivity of 81.48% and a specificity of 86.86%. Significant heterogeneity was observed (I2 =85%, χ2 =87.19, P < 0.00001). TSA indicated that the cumulative evidence was insufficient. Conclusions: Diaphragmatic ultrasound, particularly DE and DTF, is useful for predicting extubation success, but current evidence is inconclusive. Further research is required to confirm these findings.

This study was conducted to explore whether liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block can provide noninferior postoperative analgesia and reduced hemidiaphragmatic paralysis (HDP) versus traditional interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery. Patients were divided into a suprascapular nerve and axillary nerve block group (SSANB group) and an interspinal brachial plexus block group (IBB group) via a random number table. The local anesthetic used was a mixture of 1.33 www.chictr.org.cn on June 28, 2024 (registration number: ChiCTR2400086331).

Objective: To compare the postoperative analgesic effect of modified superior trunk block and traditional interscalene brachial plexus block in arthroscopic rotator cuff repair. Methods: A total of 40 patients undergoing arthroscopic rotator cuff repair in the Second Affiliated Hospital of Wenzhou Medical University from October to November 2023 were prospectively included, whose American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅱ. They were divided into modified superior trunk block group (group S) and interscalene brachial plexus block group (group I) by random number table according to different nerve block methods, with 20 cases in each group. Local anesthetics was a mixture of 1.33% liposomal bupivacaine and 0.5% levobupivacaine hydrochloride injection in equal volume. Patients in group S were injected 5 ml mixture for ultrasound-guided modified superior trunk block, and patients in group I were injected with 15 ml mixture for ultrasound-guided traditional interscalene block respectively. Both groups underwent superficial cervical plexus block (5 ml mixture). Standardized general anesthesia and standardized postoperative analgesia were followed. The primary outcome measures included 48 h resting numerical rating scale (NRS) scores after surgery and the incidence of hemidiaphragmatic paralysis (HDP) at 30 min after block. The secondary outcome measures included resting NRS scores during the post anesthesia care unit (PACU), 12, 24, and 36 h after surgery, postoperative opioid consumption and satisfaction with analgesia, pulse oxygen saturation (SpO2) at 30 min after block, sensory and motor block duration, and the incidence of perioperative adverse reactions. The non-inferiority cut-off value of resting NRS scores for patients in group S was set as"1 point"at each observation time point after surgery. Results: In group S, one patient was excluded because the target nerve was blocked by the subclavian vein and could not be blocked, nineteen patients [11 males and 8 females, aged (52.2±9.0) years] were eventually included. In group I, there were 7 males and 13 females, aged (55.0±5.1) years. Resting NRS scores of group S and Group I at 48 h after surgery were 0 (0, 0) and 0 (0, 0.8) point, respectively, with no statistical significance (P>0.05). The median difference was 0 (95%CI:0-0) point and the upper 95%CI was 0 point, which was lower than the preset non-inferiority cut-off value"1 point"(non-inferiority P<0.001). The incidence of HDP in group S and group I were 5% (1/19) and 75% (15/20), respectively, with statistically significant (P<0.001). There were no significant differences in resting NRS scores at PACU and 12, 24, 36 h after surgery, opioid dosage, satisfaction with analgesia, SpO2 at 30 min after block, sensory and motor block duration between two groups (all P>0.05). No respiratory adverse events such as hypoxemia and airway spasm occurred in two groups after extubation. One patient in group I showed symptoms of breath shortness when entering PACU, and 3 patients felt uncomfortable due to prolonged numbness and weakness of the blockade limb (>2 days). No nerve block procedures and opioid drugs relative adverse reactions and no neurological complications happened in both groups. Conclusion: Liposomal bupivacaine usage for modified superior trunk block can provide long-term postoperative analgesic effects which is noninferior to traditional interscalene brachial plexus block and causes less HDP in patients undergoing arthroscopic rotator cuff repair.

Background:Most preschool children are distressed during anesthesia induction. While current pharmacological methods are useful, there is a need for further optimization to an “ideal” standard. Remimazolam is an ultra-short-acting benzodiazepine, and intranasal remimazolam for pre-induction sedation may be promising.Methods:This study included 32 preschool children who underwent short and minor surgery between October 2022 and January 2023. After pretreatment with lidocaine, remimazolam was administered to both nostrils using a mucosal atomizer device. The University of Michigan Sedation Score (UMSS) was assessed for sedation 6, 9, 12, 15, and 20 min after intranasal atomization. We used Dixon’s up-and-down method, and probit and isotonic regressions to determine the 50% effective dose (ED50) and 95% effective dose (ED95) of intranasal remimazolam for pre-induction sedation. Results: Twenty-nine pediatric patients were included in the final analysis. The ED50 and ED95 of intranasal remimazolam for successful pre-induction sedation, when processed via probit analysis, were 0.65 (95% confidence interval [CI], 0.59–0.71) and 0.78 mg/kg (95% CI, 0.72–1.07), respectively. In contrast, when processed by isotonic regression, they were 0.65 (95% CI: 0.58–0.72 mg/kg) and 0.78 mg/kg (95% CI: 0.69–1.08 mg/kg), respectively. At 6 min after intranasal remimazolam treatment, 81.2% (13/16) of “positive” participants were successfully sedated with a UMSS ≧ 1. All the “positive” participants were successfully sedated within 9 min.Conclusion:Intranasal remimazolam is feasible for preschool children with a short onset time. For successful pre-induction sedation, the ED50 and ED95 of intranasal remimazolam were 0.65 and 0.78 mg/kg, respectively.

Objective To analyze the risk factors for early oral intake nausea and vomiting（EOINV）after pediatric non-gastrointestinal day-case surgery. Methods A total of 306 children, 206 males and 100 females, aged 1-12 years, weighting 5-60 kg, ASA physical status Ⅰ or Ⅱ, who underwent non-gastrointestinal day-case surgery under general anesthesia without postoperative nausea and vomiting before eating from June 2020 to March 2022 were included. Children’s gender, age, weight, preoperative fasting and drinking time, anesthesia methods, intraoperative opioids use, muscle relaxant and muscle relaxant antagonistuse, the type of surgery, the operative time and the anesthesia time were collected. The incidence of EOINV within 24 hours after surgery was followed up, and the children were divided into two groups: EOINV group and non-EOINV group. Univariate and multivariate Logistic regression model was performed to analyze the independent risk factors of EOINV. Results EOINV occurred in 46 children（15.0%）. There were no significant differences in the gender, age, weight, preoperative fasting and drinking time, anesthesia methods, intraoperative muscle relaxant and its antagonist use, the operative time and the anesthesia time between the two groups. Compared with non-EOINV group, the use rate of intraoperative opioids and the proportion of intraoral surgery in EOINV group were significantly higher（P ＜ 0.05）. Binary logistic regression analyses showed that intraoperative opioids use（OR = 3.7, 95% CI 1.0-12.5, P = 0.048）and intraoral surgery（OR = 4.8, 95% CI 1.3-16.7, P = 0.017）were the independent risk factors for EOINV. ConclusionIntraoperative opioids use and intraoral surgery were the independent risk factors for EOINV after pediatric non-gastrointestinal day-case surgery.

Corticotrophin-releasing hormone (CRH) neurons in the hypothalamic paraventricular nucleus (PVN) play a critical role in the modulation of the hypothalamic-pituitary-adrenal (HPA) axis. Early-life exposure to di-(2ethylhexyl) phthalate (DEHP) has been associated with an increased risk of developing psychiatric disorders in adulthood. The present work was designed to explore the impact of neonatal exposure to DEHP on adult PVN CRH neuronal activity. DEHP or vehicle was given to male rat pups from PND16 to PND22. Then, anxiety-like behaviors, serum corticosterone and testosterone, immunohistochemistry, western blotting, fluorescence in situ hybridization and acute ex vivo slice electrophysiological recordings were used to evaluate the influence of DEHP on adult PVN secretory CRH neurons. Neonatal DEHP-exposed rats exhibited enhanced anxiety-like behaviors in adults, with an increase in CORT. Secretory CRH neurons showed higher spontaneous firing activity but could be inhibited by GABAAR blockers. CRH neurons displayed fewer firing spikes, prolonged first-spike latency, depolarizing shifts in GABA reversal potential and strengthened GABAergic inputs, as indicated by increases in the frequency and amplitude of sIPSCs. Enhancement of GABAergic transmission was accompanied by upregulated expression of GAD67 and downregulated expression of GABABR1, KCC2 and GAT1. These findings suggest that neonatal exposure to DEHP permanently altered the characteristics of secretory CRH neurons in the PVN, which may contribute to the development of psychiatric disorders later in life.

An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients. With further research, a treatment algorithm can be developed to potentially identify patients at high risk of preoperative mortality.INTRODUCTION:Red blood cell distribution width (RDW) is an independent predictor of various disease states in elderly individuals, but its association with the prognosis of elderly hip fracture patients is controversial. This study aimed to evaluate the prognostic value of RDW in such patients, construct a prediction model containing RDW using random survival forest (RSF) and Cox regression analysis, and compare RDW in patients with and without anemia.METHODS:We retrospectively analyzed the data of elderly patients who underwent hip fracture surgery, selected the best variables using RSF, stratified the independent variables by Cox regression analysis, constructed a 1-year mortality prediction model of elderly hip fracture with RDW, and conducted internal validation and external validation.RESULTS:Two thousand one hundred six patients were included in this study. The RSF algorithm selects 12 important influencing factors, and Cox regression analysis showed that eight variables including preoperative RDW (pre-RDW) were independent risk factors for death within 1-year after hip fracture surgery in elderly patients. Stratified analysis showed that pre-RDW was still independently associated with 1-year mortality in the non-anemia group and not in the anemia group. The nomogram prediction model had high differentiation and fit, and the prediction model constructed by the total cohort of patients was also used for validation of patients in the anemia patients and obtained good clinical benefits.CONCLUSION:An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients.

Emulsified isoflurane was designed to circumvent the deficiencies of inhalation anesthetics, which have a longer time to onset, result in a higher drug consumption, and for which a specific anesthesia machine is required for clinical use. The aim of this study was to compare the efficacy and safety of emulsified isoflurane with propofol for anesthesia induction in adults patients. This multicenter, randomized, double-blind, positive-controlled, non-inferiority, phase III clinical trial compared the efficacy and safety of emulsified isoflurane with propofol for anesthesia induction. Each patient in the emulsified isoflurane group received a single bolus injection of 12 www.chictr.org.cn ).

目的:观察麻醉诱导时单次推注芬太尼对小儿日间扁桃体腺样体切除术后镇静及苏醒期躁动(emergence agitation,EA)的影响.方法:选取2022年1-3月在温州医科大学附属第二医院择期行扁桃体腺样体切除术患儿157例,美国麻醉医师协会(ASA)I或II级,年龄3～10岁.采用随机数字表法将患儿分为两组:瑞芬太尼复合芬太尼组(RF组,78例)和瑞芬太尼组(R组,79例),RF组诱导时单次推注芬太尼1μg/kg+瑞芬太尼2.5μg/kg,R组静注等体积生理盐水+瑞芬太尼2.5μg/k g;两组均在丙泊酚诱导后行气管插管并采用七氟烷联合瑞芬太尼全身麻醉.记录患儿在麻醉恢复室(post-anesthesia care unit,PACU)EA的发生率及严重程度、Ramsay镇静评分及FLACC疼痛评分,记录拔管时间、苏醒时间、PACU停留时间、出院时间.结果:与R组相比,RF组患儿EA发生率明显下降(38.0％vs.18.0％,P=0.005),苏醒期最大小儿麻醉苏醒期躁动(pediatric anes-thesia emergence delirium,PAED)评分明显降低(7.7±3.3 vs.8.9±3.4,P=0.027),在PACU 15 min及出PACU时Ramsay镇静评分显著升高(4.4±1.1 vs.3.8±1.4,P=0.01;2.0±0.3 vs.1.8±0.4,P=0.03);而两组患儿拔管时间、苏醒时间、PACU停留时间、出院时间、疼痛评分(出PACU时和术后2 h)等指标差异均无统计学意义(P>0.05).结论:麻醉诱导单次推注芬太尼1μg/kg能增加小儿扁桃体腺样体切除术后PACU的镇静程度并降低EA发生率.

目的 探讨超细纤维支气管镜(纤支镜)定位新生儿气管导管深度的准确性.方法 80例手术室内麻醉诱导气管插管后的新生儿,分别采用超声定位(A1组)和纤支镜定位(F1组)调整气管导管的深度,各40例.另选40例新生儿ICU(NICU)拟摄床旁X线片定位气管导管深度的新生儿,随机分为拍摄X线片定位组(A2组)和纤支镜定位组(F2组),各20例.记录各组气管导管深度不当、拍摄X线片的例数,观察并记录定位前、定位时、定位后患儿心率(HR)、血压、血氧饱和度(SpO2)变化及相关并发症发生情况.结果 A1组35例(87.5％)深度合适,5例(12.5％)深度不合适;F1组30例(75％)深度合适,10例(25％)深度不合适,深度不当例数高于A1组,但差异无统计学意义(P＞0.05).A2组15例(75.0％)导管过深,均需X线片定位;F2组14例(70.0％)导管过深,2例需X线片定位,F2组X射线辐射率低于A2组(P＜0.05).与A组(A1、A2)比较,F组(F1、F2)定位过程中HR、血压略有变化,但差异均无统计学意义(均P＞0.05);F2组定位时SpO2低于定位前水平,定位后明显高于定位前水平及A2组(均P＜0.05).结论 超细纤支镜操作简便、快捷,准确性高,定位判断新生儿气管导管的深度时优于超声及传统X线摄片技术.

目的 探讨改良(超声引导下会阴入路)阴茎背神经阻滞(DPNB)联合会阴神经阻滞在儿童阴茎整形术中的效果.方法 60例行阴茎整形术患儿随机分为3组:骶管阻滞组(CB组)、改良DPNB组、改良DPNB联合会阴神经阻滞组(US组),每组20例.患儿七氟烷吸入诱导麻醉置入喉罩后并保留自主呼吸,七氟烷吸入麻醉维持.神经阻滞均采用1％利多卡因+0.25％罗哌卡因液,CB组骶管注入1ml/kg,改良DPNB组行超声引导下双侧会阴入路阴茎背神经阻滞、单侧注入0.15 ml/kg,US组行改良DPNB组相同阻滞并增加0.1 ml/kg行会阴神经阻滞.观察围术期生命体征、术中体动、呼吸抑制及增加吸入七氟烷浓度情况,苏醒期躁动、术后疼痛、尿潴留、下肢运动阻滞、恶心呕吐及术后补救镇痛等并记录.结果 US组与改良DPNB组术后镇痛时长和首次排尿时间差异均无统计学意义(均P＞0.05),术后镇痛时长明显长于CB组(P＜0.05),首次排尿时间小于CB组(P＜0.05);PACU期间、术后2 h下肢运动神经阻滞及尿潴留发生率明显少于CB组(均P＜0.05).US组、CB组术中体动、需增加吸入七氟烷浓度的例数均明显少于改良DPNB组(均P＜0.05),且术后2及4 h疼痛评分低于改良DPNB组(均P＜0.05),神经阻滞不完善率及术后补救镇痛率也低于改良DPNB组(均P＜0.05).结论 改良DPNB联合会阴神经阻滞用于儿童阴茎整形术可提高麻醉及术后镇痛效果,且优于骶管阻滞及改良DPNB,不良反应少.

Objective: To analyze the related factors that affect the one-year mortality in elderly patients following hip fracture surgery. Methods: The clinical data of the elderly patients who needed a surgery for hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to April 2018 were retrospectively analyzed. According to the inclusion criteria of the study, 489 cases were included. Then the information of patients including age, sex, Charlson comorbidity index, type of fracture, Braden score at admission, American Society of Anesthesiologists (ASA) score, length of hospital stay, type of anesthesia, whole blood cells analysis were collected. Univariate and multivariate Cox regression analyses were conducted to investigate the factors related to one-year mortality of patients. Results: After excluding 39 patients, 450 patients were finally included. Patients in this cohort study had a mortality rate of 3.33% (15/450) at 1 month, 7.78% (35/450) at half a year, and 10.89% (49/450) at 1 year after surgery. Univariate analysis showed that age, sex, ASA score, type of fracture, Charlson comorbidity index, Braden score at admission, type of analgesia, preoperative hemoglobin concentration, preoperative albumin concentration, postoperative delirium of high activity correlated with one-year mortality after surgery. Further, multivariate Cox regression analysis revealed that age>80 years old (HR=2.32, 95%CI: 1.11-4.85, P=0.025), Charlson comorbidity index ≥ 3 (HR=3.24, 95%CI:1.75-6.03, P<0.001), Braden score at admission ≤16 (HR=1.93, 95%CI:1.03-3.57, P=0.040) and postoperative delirium of high activity (HR=2.49, 95%CI:1.16-5.35, P=0.019) were risk factors for one-year mortality. Conclusions: The current study indicates that one-year mortality rate of elderly patients following hip fracture surgery is 10.89%. Meanwhile, age>80 years, Charlson comorbidity index ≥ 3, Braden score at admission ≤ 16, postoperative delirium of high activity are risk factors for one-year mortality.

Objective:To establish a prediction model of postoperative 1-year mortality risk in elderly patients undergoing hip fracture surgery and verify its efficacy.Methods:Patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, who underwent an operation for traumatic hip fracture in the Second Affiliated Hospital of Wenzhou Medical University from January 2017 to December 2018, were enrolled and randomly assigned to model group and verification group in a ratio of 3∶1.The demographic characteristics, clinical data and results such as laboratory examinations were collected.In model group, the logistic regression analysis was used to recognize the independent risk factors for 1-year mortality after procedure, and the prediction model was established.In verification group, the prediction efficacy was analyzed using the receiver operating characteristic curve, and the degree of fitting was evaluated by Hosmer-Lemeshow goodness-of-fit test.Results:Multivariate logistic analysis indicated that age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital ≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L were the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients ( P<0.05). The prediction model was established based on the risk factors mentioned above.The area under receiver operating characteristic curve was 0.870, and the sensitivity and specificity were 82.8% and 80.0%, respectively.The prediction model showed good fitting ( χ2=4.672, P=0.700). Conclusion:Age ≥84 yr, Charlson comorbidity index ≥2 points, Braden score on admission to hospital≤16 points, preoperative urea nitrogen ≥8.8 mmol/L and postoperative albumin ≤ 29.6 g/L are the independent risk factors for 1-year mortality after hip fracture surgery in elderly patients, and the prediction model established based on the above indicators has good efficacy.

Background The present study was conducted with the aim of clarifying the effects of protocatechualdehyde (PCA) on the endothelial function in streptozotocin (STZ)-induced diabetic rats. Methods Sprague Dawley (SD) rats were intraperitoneally injected with STZ (single dose of 60 mg/kg). Diabetic model rats were given PCA (25 mg/kg/day) via gavage feeding for 6 weeks. Vascular function was studied; superoxide anion and nitrotyrosine levels were assessed; and nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) oxidase as well as total superoxide dismutase (SOD) activity were detected. Protein expression of phosphorylated endothelial nitric oxide synthase (P-eNOS), total endothelial nitric oxide synthase (T-eNOS), p22phox, p47phox and Cu/Zn-SOD were measured by Western blot analysis. Results PCA treatment significantly ameliorated the impairment of acetylcholine- evoked endothelium-dependent relaxation, with no obvious effects observed on the blood glucose or body weight in the STZ-induced diabetic rats. Expression levels of aortic P-eNOS/T-eNOS and endothelial nitric oxide synthase (eNOS) activity were decreased in STZ-induced diabetic rats while they remained unchanged in PCA-treated rats. However, PCA treatment improved oxidative inactivation of nitric oxide (NO) and decreased the levels of superoxide anion and nitrotyrosine in the aorta of STZ-induced diabetic rats; these were achieved by reducing the level of nitrotyrosine and down-regulating p47phox and p22phox expression, as well as up-regulating Cu/Zn-SOD protein expression. Consistently, the effects observed were associated with a decrease in NADPH oxidase activity and an increase in total SOD activity. Conclusions Our results indicate that the administration of PCA may be protective against oxidative stress and may restore endothelial function by improving vascular NO oxidative inactivation in diabetic condition.

Objective: To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique. Methods: One hundred and ten pediatric patients, scheduled for elective operation in the Second Affiliated Hospital & Yuying Children's Hospital, were recruited during January and October in 2018. After sedation by inhalation of sevoflurane, the maximum (expiratory) and minimum (inspiratory) diameter of inferior vena cava (IVC(max), IVC(min)) and aorta velocity-time integral (VTI) in apical five-chamber cardiac view were measured with an ultrasound machine. Respiratory variabilities of these parameters were further calculated. Furthermore, passive leg raising (PLR) test was performed and above measurements/calculations were repeated. The correlation between the duration of fasting and IVC respiratory variations index (IVC(RVI)) or aortic VTI variability (ΔVTI) was then analyzed. Results: Before PLR, IVC(max), IVC(min) and IVC(RVI) were (0.78±0.19), (0.43±0.15) cm and 0.45±0.12, respectively. After PLR, IVC(max) and IVC(min) increased to (0.94±0.20), (0.55±0.18) cm, while IVC(RVI) decreased to 0.42±0.13, the differences were statistically significant (t=15.66, 10.85, 3.14, all P<0.05). However, IVC(max), IVC(min) and IVC(RVI) were not significantly correlated with the duration of fasting analyzed by linear regression (before PLR: r=0.052, 0.163, 0.171; after PLR, r=0.062, 0.169, 0.165, all P>0.05). Before PLR, expiratory aortic VTI (VTI(max)), inspiratory aortic VTI (VTI(min)) and ΔVTI were 21±5, 17±4 and 17±8, respectively. After PLR, the VTI(max) and VTI(min) significantly increased to 23±5 and 19±4 (t=13.60, 10.43, all P<0.05), but ΔVTI was not changed significantly, which was 17±8(t=0.34, P>0.05). Linear regression analysis showed that VTI(max), VTI(min) and ΔVTI were not significantly correlated with the duration of fasting (before PLR: r=0.111, 0.100, 0.047; after PLR: r=0.003, 0.033, 0.073, all P>0.05). Further multiple linear regression analysis indicated that, age and body weight were independent factors influencing IVC(RVI) and ΔVTI before and after PLR (IVC(RVI): β=-0.441, 0.515, -0.451, 0.507; ΔVTI: β=-0.442, 0.545, -2.422, 2.850; all P<0.05). However, the duration of fasting was not correlated with IVC(RVI) and ΔVTI after adjusting the age and weight (IVC(RVI): β=0.177, 0.160; ΔVTI: β=0.037, 0.054; all P>0.05). Conclusion: Age and weight, but not preoperative fasting duration, are correlated with respiratory variabilities of inferior vena cava diameter and aortic VTI in pediatric patients.

目的 采用超声观察婴幼儿颈部不同平面右侧颈内静脉横径大小并分析相关因素,观察其与颈部大动脉之间的毗邻关系.方法 选择择期手术的患儿90例,年龄6个月至3岁,ASAⅠ或Ⅱ级,在全麻诱导置入合适喉罩后使用七氟醚维持麻醉深度,并保留自主呼吸.患儿均为平卧位,头转向左侧约40°.使用超声分别在环状软骨平面、锁骨上平面及两个平面之间的中间平面观察右侧颈内静脉、颈总动脉和椎动脉的短轴成像,分别在三个平面测量颈内静脉、颈总动脉和椎动脉的血管横径;记录颈总动脉或椎动脉与颈内静脉之间相对方位;观察颈总动脉与颈内静脉、椎动脉与颈内静脉之间是否重叠,如有重叠则测量重叠程度;测量椎动脉(前壁)与颈内静脉(后壁)间的垂直深度.结果 颈内静脉横径在中间平面、锁骨上平面均明显大于环状软骨平面(P<0.05).在三个平面中,颈内静脉横径大小均与患儿月龄呈正相关,其位置均位于颈总动脉前方.相对于颈内静脉,颈总动脉随着平面的下移而越来越靠近内侧(P<0.05).颈内静脉与颈总动脉重叠程度在锁骨上平面明显低于其他平面(P<0.05).颈内静脉与椎动脉重叠程度在锁骨上平面明显大于环状软骨平面(P<0.05).椎动脉均位于颈内静脉深部,两者间在锁骨上平面的垂直深度最浅(P<0.05).结论在不同颈部水平,婴幼儿右颈内静脉与颈部大动脉的相对位置不同.在右颈内静脉高位穿刺应更加警惕颈总动脉损伤的风险,而在低位需警惕椎动脉损伤的风险,同时避免使用穿透颈内静脉后壁法.

Epidermal growth factor (EGF) has many physiological roles. However, its effects on stem and progenitor Leydig cell development remain unclear. Rat stem and progenitor Leydig cells were cultured with different concentrations of EGF alone or in combination with EGF antagonist, erlotinib or cetuximab. EGF (1 and 10 ng/mL) stimulated the proliferation of stem Leydig cells on the surface of seminiferous tubules and isolated CD90 + stem Leydig cells and progenitor Leydig cells but it blocked their differentiation. EGF also exerted anti‐apoptotic effects of progenitor Leydig cells. Erlotinib and cetuximab are able to reverse EGF‐mediated action. Gene microarray and qPCR of EGF‐treated progenitor Leydig cells revealed that the down‐regulation of steroidogenesis‐related proteins ( Star and Hsd3b1 ) and antioxidative genes. It was found that EGF acted as a proliferative agent via increasing phosphorylation of AKT1. In conclusion, EGF stimulates the proliferation of rat stem and progenitor Leydig cells but blocks their differentiation.

One-lung ventilation (OLV) is a " double-edged sword" , which causes imbalanced ventilation-perfusion ratio (V/Q) and may result in lung injury to different extent. This review mainly discusses the benefits of moderate independent lung ventilation (ILV) during lung isolation, from the point of view of the pathophysiological basis of V/Q imbalance and lung injury caused by OLV. Based on relevant literature, the theoretical basis, rationale of implementation and clinical application of ILV were discussed. In addition, the method of ILV based on dividing of tidal volume and sharing of single respiratory circuit was introduced. This method is relatively simple, easy-to-use and with some advantages and application prospects in the implementation of protective lung isolation ventilation.