Ischemia reperfusion injury (IRI), a common clinical complication, can cause severe adverse prognosis. However, the mechanism of injury has not been fully elucidated, and the clinical therapeutic effect is still not ideal. As a programmed cell death that can lead to inflammatory response, pyroptosis is closely related to organ IRI. This article briefly describes the molecular characteristics and mechanisms of pyroptosis, reviews the relationship between pyroptosis and IRI in organs such as heart, brain and kidney. Also, we describes the interaction between pyroptosis and apoptosis in IRI, as well as summarizing the current treatment methods for pyroptosis. The target of this article is aim to provide the theoretical basis for the prevention and treatment of organ IRI, so as to better guide clinical work.

Background: Dexmedetomidine is considered an adjunct to local anaesthesia (LA) to prolong peripheral nerve block time. However, the results from a previous meta-analysis were not sufficient to support its use in paravertebral block (PVB). Therefore, we performed an updated meta-analysis to evaluate the efficacy of dexmedetomidine combined with LA in PVB. Methods: We performed an electronic database search from the date of establishment to April 2022. Randomized controlled trials (RCTs) investigating the combination of dexmedetomidine and LA compared with LA alone for PVB in adult patients were included. Postoperative pain scores, analgesic consumption, and adverse reactions were analyzed. Results: We identified 12 trials (701 patients) and found that the application of dexmedetomidine as a PVB adjunct reduced the postoperative pain severity of patients 12 and 24 h after surgery compared to a control group. Expressed as mean difference (MD) (95% CI), the results were −1.03 (−1.18, −0.88) ( p < 0.00001, I 2 = 79%) for 12 h and −1.08 (−1.24, −0.92) ( p < 0.00001, I 2 = 72%) for 24 h. Dexmedetomidine prolonged the duration of analgesia by at least 173.27 min (115.61, 230.93) ( p < 0.00001, I 2 = 81%) and reduced postoperative oral morphine consumption by 18.01 mg (−22.10, 13.92) ( p < 0.00001, I 2 = 19%). We also found no statistically significant differences in hemodynamic complications between the two groups. According to the GRADE system, we found that the level of evidence for postoperative pain scores at 12 and 24 h was rated as moderate. Conclusion: Our study shows that dexmedetomidine as an adjunct to LA improves the postoperative pain severity of patients after surgery and prolongs the duration of analgesia in PVB without increasing the incidence of adverse effects.

慢性阻塞性肺疾病(COPD)是一种常见的老年肺部疾病,主要表现为肺部呼吸力学发生改变;而手术麻醉或常规机械通气会导致肺部呼吸力学的进一步变化,易发生严重的肺部并发症.因此,根据COPD患者的呼吸力学特点及机械通气时呼吸力学的改变,选择个体化的通气策略、采取不同的呼吸力学监测方式优化人机相互作用以达到肺保护的目的,对于COPD患者至关重要.本文对COPD患者生理状态下和机械通气时的呼吸力学特点以及不同呼吸力学监测方式的应用进展进行综述,以期为临床COPD患者的机械通气管理提供参考.

Objective:To explore the influence of driving pressure-guided individualized positive end-expiratory pressure (PEEP) titration on lung protection and postoperative atelectasis in children undergoing laparoscopic surgery.Methods:From June 2021 to October 2021, a total of 46 children undergoing laparoscopy at Second Hospital of Lanzhou University were selected as research subjects.They were divided randomly into two groups of fixed PEEP and driving pressure-guided individualized PEEP ( n=23 each). Fixed PEEP group: 5 cmH 2O (1 cmH 2O=0.098 kPa) PEEP was set until end of operation.Driving pressure-guided individualized PEEP group: PEEP started from 2 cmH 2O with an increment of 1 cmH 2O and each PEEP level was maintained for 10 breathing cycles until the lowest driving pressure.There was a hourly repetition.Plateau pressure (Pplat), PEEP, driving pressure, lung dynamic compliance, mean arterial pressure (MAP) and heart rate (HR) were recorded at 5 min after tracheal intubation (T 1), 5 min after pneumoperitoneum (T 2), 4 min after PEEP (T 3) and end of operation (T 4); Lung Ultrasound Score (LUS) at T 1, /T 4/T 5 (out of PACU) and intraoperative pneumoperitoneum time, pneumoperitoneum pressure, mechanical ventilation duration and operative duration were analyzed. Results:As compared with T 1, pulmonary dynamic compliance of two groups declined and driving pressure spiked obviously at T 2.And the difference was statistically significant ( P<0.05). As compared with T 2, lung dynamic compliance and driving pressure of two groups improved markedly at T 3 and T 4 ( P<0.05). As compared with fixed PEEP group, driving pressure-guided individualized PEEP group offered more advantages of improving lung dynamic compliance and reducing driving pressure and lung ultrasound score ( P<0.05); no inter-group statistical difference existed in HR/MAP changes at different timepoints. Conclusion:For ASA Ⅰ-Ⅱ children aged 1-6 years undergoing laparoscopy, driving pressure-guided individualized PEEP ventilation strategy can significantly improve lung dynamic compliance and reduce driving pressure and postoperative lung ultrasound scores.

Objective To observe the effect of clemastine fumarate(CLE) on intestinal ischemia-reperfusion(I/R) injury in Balb/c mouse models and its correlation with the activation of intestinal NOD-like receptor protein 3(NLRP3) inflammasomes. Methods Balb/c mice were randomly divided into sham operation group, I/R group (established superior mesenteric artery branch clipping model, ischemia 40 min, reperfusion 2 h) and CLE group (intraperitoneal injection of CLE 5 mg/kg, 1 h before surgery). The pathological changes of intestinal mucosa were evaluated by Chiu's score; The serum levels of TNF-α, IL-1β and IL-18 were detected by ELISA; Western blot was used to detect the expressions of NLRP3, caspase-1 and Gasdermin D proteins in intestinal tissue. Results Compared with the sham group, the Chiu's score in the I/R group significantly increased (P＜0.05). The level of TNF-α, IL-1β and IL-18 in serum was increased (P＜0.05). The expression of NLRP3, caspase-1 and gasdermin D(GSDMD) proteins in intestinal tissue was increased (P＜0.05); Compared with the I/R group, the change of the above indexes from CLE group was alleviated(P＜0.05). Conclusions CLE alleviates intestinal ischemia-reperfusion injury of mouse models and the mechanism may be related to regulation of NLRP3 inflammasome activation.

Objective:To evaluate the effect of astaxanthin on neuropathic pain in rats and the role of spinal heme oxygenase-1 (HO-1).Methods:Seventy-two SPF-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, in which intrathecal catheters were successfully implanted, were divided into 6 groups ( n=12 each) by a random number table method: blank control group (group C), sham operation group (Sham group), neuropathic pain (NP) group, NP plus dimethyl sulfoxide (DMSO) group (NP + DMSO group), NP plus astaxanthin group (NP + AST group) and NP plus zinc protoporphyrin plus astaxanthin group (NP+ ZnPP+ AST group). NP was induced by chronic constriction injury in anesthetized rats.In Sham group, the sciatic nerve was only isolated without ligation.At 5 days after establishing the model, 0.5% DMSO 10 μl was intrathecally injected in NP+ DMSO group, astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ AST group, HO-1 inhibitor zinc protoporphyrin 24 μg (dissolved in 10 μl DMSO) was intrathecally injected, and 3 h later astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ ZnPP+ AST group.Injection was given once a day for 10 consecutive days in the 3 groups mentioned above.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before establishing the model and 3, 7 and 14 days after establishing the model.The rats were sacrificed at 14 days after establishing the model, and the L 4-6 lumbar segments of the spinal cord were removed for determination of the contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), superoxide dismutase (SOD) and glutathione peroxidase (GHS-PX)(by enzyme-linked immunosorbent assay) and expression of HO-1 (by Western blot). Results:Compared with group C and group Sham, the MWT was significantly decreased and TWL was shortened at each time point after establishing the model, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was up-regulated in the other four groups, the SOD and GSH-PX contents were significantly decreased in NP group, NP+ DMSO group and NP+ ZnPP+ AST group, and the SOD and GSH-PX contents were significantly increased in NP+ AST group ( P<0.05). Compared with NP group, the MWT was significantly increased and TWL was prolonged at 7 and 14 days after establishing the model, the contents of TNF-α and IL-1β were decreased, and the expression of HO-1 was up-regulated in NP+ AST group, the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05), and no significant change was found in the parameters mentioned above in NP+ DMSO group ( P>0.05). Compared with NP+ AST group, the MWT was significantly decreased and TWL was shortened at 7 and 14 days after establishing the model, the contents of SOD and GSH-PX were decreased, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05). Conclusion:Astaxanthin can reduce NP in rats, and the mechanism is related to up-regulating the expression of HO-1 in the spinal cord and inhibiting oxidative stress and inflammatory responses.