Background: Individualized positive end- expiratory pressure (PEEP) guided by dynamic compliance improves oxygenation and reduces postoperative atelectasis in nonobese patients. The authors hypothesized that dynamic compliance-guided PEEP could also reduce postoperative atelectasis in patients undergoing bariatric surgery. Methods: Patients scheduled to undergo laparoscopic bariatric surgery were eligible. Dynamic compliance-guided PEEP titration was conducted in all patients using a downward approach. A recruitment maneuver (PEEP from 10 to 25 cm H2O at 5-cm H2O step every 30 s, with 15-cm H2O driving pressure) was conducted both before and after the titration. Patients were then randomized ( 1:1) to undergo surgery under dynamic compliance-guided PEEP (PEEP with highest dynamic compliance plus 2 cm H2O) or PEEP of 8 cm H2O. The primary outcome was postoperative atelectasis, as assessed with computed tomography at 60 to 90 min after extubation, and expressed as percentage to total lung tissue volume. Secondary outcomes included Pao(2)/inspiratory oxygen fraction (Fio(2)) and postoperative pulmonary complications. Results: Forty patients (mean +/- SD; 28 +/- 7 yr of age; 25 females; average body mass index, 41.0 +/- 4.7 kg/m(2)) were enrolled. Median PEEP with highest dynamic compliance during titration was 15 cm H2O (interquartile range, 13 to 17; range, 8 to 19) in the entire sample of 40 patients. The primary outcome of postoperative atelectasis (available in 19 patients in each group) was 13.1 +/- 5.3% and 9.5 +/- 4.3% in the PEEP of 8 cm H2O and dynamic compliance-guided PEEP groups, respectively ( intergroup difference, 3.7%; 95% CI, 0.5 to 6.8%; P = 0.025). Pao(2)/Fio(2) at 1 h after pneumoperitoneum was higher in the dynamic compliance-guided PEEP group (397 vs. 337 mmHg; group difference, 60; 95% CI, 9 to 111; P = 0.017) but did not differ between the two groups 30 min after extubation (359 vs. 375 mmHg; group difference, -17; 95% CI, -53 to 21; P = 0.183). The incidence of postoperative pulmonary complications was 4 of 20 in both groups. Conclusions: Postoperative atelectasis was lower in patients undergoing laparoscopic bariatric surgery under dynamic compliance-guided PEEP versus PEEP of 8 cm H2O. Postoperative Pao(2)/Fio(2) did not differ between the two groups.

Objective: To observe the efficacy and significance of hyperbaric oxygen at different pressures in the treatment of diffuse axonal injury (DAI). Methods: Sixty patients with DAI were randomly divided into 1.8 ATA group (30 cases) and 2.2 ATA group (30 cases). The routine treatment for each group was the same. The 1.8 ATA group received hyperbaric oxygen therapy under 1.8 ATA on the basis of routine treatment, whereas the 2.2 ATA group received hyperbaric oxygen therapy under 2.2 ATA on the basis of routine treatment. The therapy was given once a day over 3 consecutive courses, with each course having 10 sessions. The Glasgow Coma Scale (GCS) on day 10, day 20, and day 30 after treatment, as well as the Glasgow Outcome Scale (GOS) after 6 months were compared between the two groups. Results: The mean GCS on day 10, day 20, and day 30 after treatment, as well as the mean GOS after 6 months of treatment in the 2.2 ATA group were significantly higher than those in the 1.8 ATA group (p < 0.05). Conclusion: For patients with diffuse axonal injury, hyperbaric oxygen therapy is more effective with 2.2 ATA compared with 1.8 ATA.

Objective: To analyze the efficacy of hyperbaric oxygen at different pressures in the treatment of sudden deafness. Methods: Eighty-two patients with sudden deafness treated in the Affiliated Hospital of Hebei University from September 2019 to September 2021 were selected as the research subjects. The patients were randomly divided into study group 1 and study group 2, and they were treated with hyperbaric oxygen on the basis of routine treatment, in which the pressure used was 1.8 ATA and 2.2 ATA, respectively. Oxygen was delivered via the pressure stabilizing mask for 60 minutes. The patients received two courses of treatment, each lasting 10 days. The changes in hearing (pure tone audiometry) and the clinical efficacy of both the groups were compared before and after treatment. The data obtained were statistically analyzed using SPSS 19.0. Results: The total effective rate of study group 1 was 90.00%, while that of study group 2 was 76.19%. The differences between the two groups were statistically significant (p < 0.05). Conclusion: For patients with sudden deafness treated with hyperbaric oxygen, the clinical efficacy of 1.8 ATA is more significant than that of 2.2 ATA.

Abstract Background: The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique aiming to provide better hip analgesia without hampering motor function . However, the factor of pain on muscle strength cannot be ruled out and unexpected motor block has still been observed clinically. So it is unknown whether the motor-reservation is partly due to the effect of pain reduction and it is unknown whether this unexpected motor block is caused by the inappropriate dose of ropivacaine.Methods: We investigated the ropivacaine volume and concentration effect on muscle strength and analgesia. With ethical committee approval, 90 consenting patients undergoing surgical treatment of hip fractures were randomly allocated to receive one of three volume/concentration combinations of ropivacaine (20 ml/0.5%, 20 ml/0.25% and 10 ml/0.5%). The primary outcome measure was postoperative quadriceps strength using the knee extension test and Oxford muscle strength grading 12, with grouped scores of intact (5/5), reduced (1-4/5) and absent (0/5) measured at 6 and 12 hours postoperatively. Secondary outcomes included postoperative pain scores (0-10 numeric rating scale), blood pressure, patient movement assessments, patient satisfaction and side effects.Results: Overall, 10 ml of 0.5% ropivacaine resulted in a lower incidence of quadriceps motor block at 6 hours (76.7% vs. 40.0% vs. 46.7%; p<0.05), 12 hours (86.7% vs. 53.3% vs. 53.3%; p<0.05). No intergroup differences were found in terms of postoperative pain scores at any interval (p>0.05). Similarly, we found no significant differences in resting pain or exercise pain among the three groups . Conclusions: As for the PENG block, the effect of pain on muscle strength can be ruled out. Unexpected motor block of PENG block may be caused by inappropriate dose of ropivacaine. We found that 10 ml 0.5% ropivacaine resulted in better muscle strength, considering the significance of rapid rehabilitation, we recommend performing PENG block with 10 ml 0.5%Trial registration: ChiCTR2100052511 . Register Date 2021/10/30

ObjectiveThis study aimed to explore transcranial electrical stimulation (tES) to relieve peripartum anxiety and depressive symptoms in women undergoing cesarean section with combined spinal–epidural anesthesia.MethodsThis double-blind, randomized, sham-controlled trial was conducted in the Affiliated Hospital of Xuzhou Medical University from March 2021 and May 2021. One hundred and forty-eight full-term parturients giving birth by elective cesarean section were selected, and 126 were included in the intent-to-treat analysis. Parturients were provided standardized anesthesia and randomized to the active-tES (a-tES) group and sham-tES group. Parturients and outcome assessors were blinded to treatment allocation. The primary outcome was the changes in peripartum mental health disorders, including anxiety, assessed by the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Secondary outcomes included peripartum depressive symptoms, assessed by the Edinburgh Postnatal Depression Scale (EPDS), maternal satisfaction, fatigue level, sleep quality index, and pain score during and after operation. Data were collected before entering the operating room (T0), between post-anesthesia and pre-surgery (T1), before leaving the operating room (T2), and at 24 h post-surgery (T3).ResultsOne hundred and twenty-six eligible parturients were enrolled in the two groups: a-tES group (N = 62) and sham-tES group (N = 64). Treatment with tES resulted in significantly lower scores of anxiety compared with sham-tES (T2: P < 0.001; T3: P = 0.001). Moreover, the a-tES groups showed a significant reduction in depression scores (T2: P = 0.003; T3: P = 0.032).ConclusionIn this randomized pilot study, tES treatment is efficacious in alleviating peripartum anxiety and depressive symptoms in women undergoing cesarean section and has been demonstrated to be a novel strategy for improving peripartum mental health disorders.Clinical Trial Registration[www.chictr.org.cn], identifier [ChiCTR2000040963].

目的 研究个体化呼气末正压(PEEP)通气策略对肥胖患者腹腔镜胃减容术后肺部并发症(PPCs)的影响.方法 选择行全身麻醉腹腔镜胃减容术的成年肥胖患者40例,男15例,女25例,年龄18～44岁,BMI 35～55 kg/m2,ASAⅡ或Ⅲ级.采用随机数字表法分为两组:个体化PEEP组(I组)和固定PEEP组(C组),每组20例.I组在诱导插管后依据肺动态顺应性(Cdyn)个体化滴定最佳PEEP并维持此PEEP进行术中通气,C组以PEEP 8 cmH2O进行术中通气.记录插管后5 min、气腹后1 h的氧合指数、分流率以及气道峰压、气道平台压、驱动压、Cdyn等呼吸力学参数,记录术中低血压发生情况、输液量、血管活性药用量、机械通气时间和术后住院时间,记录术后第1天、第2天、第3天、第8天PPCs的发生情况以及术后8 d内PPCs累积发生率.结果 I组PPCs累积发生率明显低于C组[13例(65％)vs 19例(95％),P<0.05].气腹后1 h时I组氧合指数、气道峰压、气道平台压、Cdyn均明显高于C组(P<0.05),I组驱动压明显低于C组(P<0.05).两组术中低血压发生率、输液量、去氧肾上腺素用量、机械通气时间和术后住院时间差异无统计学意义.结论 个体化PEEP能够降低腹腔镜胃减容术患者PPCs发生率,并在不影响血流动力学稳定性的同时降低术中驱动压,改善氧合.

Purpose:To investigate the effect of intravenous infusion of lidocaine compared with ultrasound-guided transverse abdominal plane (TAP) block on the quality of postoperative recovery and analgesic effect in patients undergoing bariatric surgery. Patients and Methods:Ninety-nine ASA II-III patients scheduled for elective laparoscopic bariatric surgery were randomized into the lidocaine group (group L), transverse abdominal plane block group (group T), and control group (group C). Group L: a loading dose of 1.5 mg/kg lidocaine was given at induction, followed by 2 mg·kg-1·h-1 maintenance until the end of surgery. Group T: ultrasound-guided bilateral administration of 0.25% ropivacaine in the transverse abdominal plane was given after induction of general anesthesia. Group C: no additional treatment was performed. Quality of recovery-40 (QoR-40) was assessed at 24 h after surgery. Consumption of propofol and remifentanil, visual analog scale (VAS) pain scores at rest at 0, 6, 12, and 24 h postoperatively, time to return of intestinal function, use of remedial analgesics within 24 h after surgery, adverse reactions were recorded. Results:Compared with Group C, Group L and Group T had higher QoR-40 scores at 24 h postoperatively, and the difference was statistically significant (P=0.002 and P=0.003, respectively). However, there was no difference between Group L and Group T (P=0.128). In addition, compared with those of Group T and Group C, VAS scores at 12 h and 24 h postoperatively were lower in Group L (P <0.0166). Conclusion:Both intravenous infusion of lidocaine and ultrasound-guided TAP block provided good postoperative recovery and postoperative analgesia for patients with bariatric surgery, and intravenous infusion of lidocaine provided better analgesia at 12 h and 24 h postoperatively compared with TAP block.

Abstract Background and aims Sepsis is one of the most common causes of death in intensive care units. Numerous studies have been performed on lymphocyte immunity in sepsis patients, but they seldom pay attention to whether lactate levels and T lymphocytes affect sepsis immunity. This study focused on how well lactate levels and CD3+ T cells will influence the outcome of sepsis patients. Methods This is a single-center retrospective investigation. All of the participants satisfied the diagnostic standards for sepsis 3.0. We collected the results of the lymphocyte subset within 24 hours of admission to ICU as well as the first lactate levels and other medical indicators.Followed up the patients for 28 days, we separated the participants into survival and mortality groups and then we processed uni-variate and multivariate analyses. Results A total of 132 sepsis patients who were older than 18 years old and met the diagnostic standards for sepsis 3.0 were included. Only 107 patients, including 53 in the survival group and 54 in the mortality group, were enrolled into statistical analysis. Based on uni-variate and multivariate analysis results, lactate levels and the quantity of CD3+ T cells were independent predictive markers that affected 28-day mortality in sepsis patients. ConclusionInitial lactate levels at ICU admission may predict outcomes in sepsis patients, and CD3+ T-lymphocyte will influence how well a patient will respond to treatment. Patients with elevated lactate levels and overall lower CD3+ T-cell counts at ICU admission should receive greater care and powerful medication. Trial registration：retrospectively registered

Purpose: Various adjuvants for prolongation of intra-operative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta-analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade, duration of motor blockade, 2-segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application. Methods: Databases, including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang, and Viper, were searched for eligible studies. Data were extracted according to the proposed inclusion and exclusion criteria, RevMan version 5.3 and Stata 16 were selected to perform meta-analysis. Results: Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two-segment sensory regression time (mean difference [MD] = 24.31; 95% confidence interval [CI] = 19.61-29.00, p < 0.001) and the duration of analgesia (MD = 118.11; 95% CI = 71.34-164.89, p < 0.001) without significantly increasing the incidence of adverse reactions in comparison to normal saline group. In addition, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension (risk ratio [RR] = 0.35, 95% CI = 0.18-0.68, p < 0.01), the occurrence of shivering (RR = 0.19, 95% CI = 0.08-0.43, p < 0.01), and the occurrence of pruritus (RR = 0.23, 95% CI = 0.10-0.53, p < 0.01) was lower than the potent opioid group. Conclusions: Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. In addition, the analgesic efficacy of nalbuphine served as an adjunct to local anesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering, and pruritus was lower than the potent opioids.

INTRODUCTION:The blood-brain barrier (BBB) disruption contributes to postoperative delirium, but cost-effective and non-invasive assessment of its permeability is not practicable in the clinical settings. Urine albumin to creatinine ratio (UACR), reflecting systemic vascular endothelial dysfunction, may be a prognostic and predictive factor associated with postoperative delirium. The aim was to analyze the relationship between UACR and postoperative delirium in elderly patients undergoing elective non-cardiac surgery.MATERIALS AND METHODS:Through stratified random sampling, a cohort of 408 individuals aged 60 years and older scheduled for elective non-cardiac surgery were included between February and August 2019 in the single-center, prospective, observational study. The presence of delirium was assessed using the Confusion Assessment Method (CAM) or Confusion Assessment Method for the ICU (CAM-ICU) on the day of surgery, at 2 h after the surgery ending time and on the first 3 consecutive days with repeated twice-daily, with at least 6-h intervals between assessments. Urine samples were collected on one day before surgery, and 1st day and 3rd day after surgery. The primary outcome was the presence of postoperative delirium, and association of the level of UACR with postoperative delirium was evaluated with unadjusted/adjusted analyses and multivariable logistic regression.RESULTS:Postoperative delirium was observed in 26.75% (107 of 400) of patients within 3 days post-surgery. UACR-Pre (OR, 1.30; 95% CI, 1.14-1.49, p < 0.001), UACR-POD1 (OR, 1.20; 95% CI, 1.13-1.27, p < 0.001), and UACR-POD3 (OR, 1.14; 95% CI, 1.08-1.20, p < 0.001) between the delirium and non-delirium groups show a significant difference, even after adjusting for age, education levels, and other factors.CONCLUSION:As the marker of endothelial dysfunction, the high perioperative UACR value may be linked to the postoperative delirium in elderly patients undergoing elective non-cardiac surgery.

Low tidal volume ventilation strategy may lead to atelectasis without proper positive end-expiratory pressure (PEEP) and recruitment maneuver (RM) settings. RM followed by individualized PEEP was a new method to optimize the intraoperative pulmonary function. We conducted a systematic review and network meta-analysis of randomized clinical trials to compare the effects of individualized PEEP + RM on intraoperative pulmonary function and hemodynamic with other PEEP and RM settings. The primary outcomes were intraoperative oxygenation index and dynamic compliance, while the secondary outcomes were intraoperative heart rate and mean arterial pressure. In total, we identified 15 clinical trials containing 36 randomized groups with 3634 participants. Ventilation strategies were divided into eight groups by four PEEP (L: low, M: moderate, H: high, and I: individualized) and two RM (yes or no) settings. The main results showed that IPEEP + RM group was superior to all other groups regarding to both oxygenation index and dynamic compliance. LPEEP group was inferior to LPEEP + RM, MPEEP, MPEEP + RM, and IPEEP + RM in terms of oxygenation index and LPEEP + RM, MPEEP, MPEEP + RM, HPEEP + RM, IPEEP, and IPEEP + RM in terms of dynamic compliance. All comparisons were similar for secondary outcomes. Our analysis suggested that individualized PEEP and RM may be the optimal low tidal volume ventilation strategy at present, while low PEEP without RM is not suggested.

OBJECTIVE To study the dynamic changes of cellular immune function in peripheral blood of trauma patients and its role in the evaluation of traumatic complications. METHODS A prospective cohort study design was conducted. Patients with blunt trauma admitted to Chongqing Emergency Medical Center from November 2019 to January 2020 were consecutively enrolled. The peripheral blood samples were collected at 1, 3, 5, 7, and 14 days after injury. The expressions of CD64, CD274, and CD279 on the surface of neutrophils, lymphocytes, and monocytes as well as CD3+, CD4+ and CD8+ T lymphocyte subsets were measured by flow cytometry. The trauma patients were divided into different groups according to the injury severity score (ISS) and sepsis within 28 days after injury, respectively. The dynamic changes of cellular immune function in different time points after injury and differences between different groups were compared. Furthermore, the correlation with acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and ISS were evaluated by Pearson correlation analysis. RESULTS A total of 42 patients with trauma were finally enrolled, containing 8 severe trauma patients with ISS greater than 25 scores, 17 patients with ISS between 16 and 25 scores, and 17 patients with ISS less than 16 scores. The sepsis morbidity rates were 14.3% (n = 6) within 28 days after injury. CD64 index and CD4+ T lymphocyte subsets were significantly increased at different time points after trauma (H = 15.464, P = 0.004; F = 2.491, P = 0.035). The CD64 index and positive rates of CD279 in neutrophils, lymphocytes, and monocytes were increased with the severity of injury at day 1 and day 3 after injury, respectively. At the first day after injury, CD64 index were 2.81±1.79, 1.77±0.92, 3.49±1.09; positive rate of CD279 in neutrophils were 1.40% (0.32%, 2.04%), 0.95% (0.44%, 2.70%), 12.73% (3.00%, 25.20%); positive rate of CD279 in lymphocytes were 3.77% (3.04%, 5.15%), 4.71% (4.08%, 6.32%), 8.01% (4.59%, 11.59%); positive rate of CD279 in monocytes were 0.57% (0.24%, 1.09%), 0.85% (0.22%, 1.25%), 6.74% (2.61%, 18.94%) from mild to severe injury groups, respectively. The CD64 index in severe injury group was significantly higher than that in moderate group, and the positive rates of CD279 in neutrophils, lymphocytes and monocytes of severe injury patients were higher than those in other two groups (all P < 0.05). At 3rd day after injury, compared to moderate group, severe injury patients had significantly higher CD64 index and positive rate of CD279 in lymphocytes [4.58±2.41 vs. 2.43±1.68, 7.35% (5.90%, 12.28%) vs. 4.63% (3.26%, 6.06%), both P < 0.05]. Compared with the non-sepsis patients, the sepsis patients had significantly higher CD64 index and positive rate of CD279 in monocytes at day 1 after injury [4.06±1.72 vs. 2.36±1.31, 3.29% (1.14%, 12.84%) vs. 0.67% (0.25%, 1.48%), both P < 0.05], and positive rate of CD279 in lymphocytes significantly higher at 3rd day after injury [8.73% (7.52%, 15.82%) vs. 4.67% (3.82%, 6.21%), P < 0.05]. In addition, correlation analysis showed that positive rate of CD279 in lymphocytes was positively correlated with SOFA and ISS, respectively (r values were 0.533 and 0.394, both P < 0.05), positive rate of CD279 in monocytes was positively correlated with APACHE II, SOFA and ISS scores, respectively (r values were 0.579, 0.452 and 0.490, all P < 0.01), positive rate of CD279 in neutrophils was positively correlated with APACHE II and ISS, respectively (r values were 0.358 and 0.388, both P < 0.05). CONCLUSIONS CD64 index and CD279 expression in neutrophils, lymphocytes, and monocytes are significantly related to the severity and prognosis of trauma. Dynamic monitoring the cellular immune function may be helpful for assessing the prognosis of trauma patients.

Nalbuphine hydrochloride is an agonist-antagonist opioid that has analgesic and sedative effects,which can be used in perioperative period of pediatric patient.Nalbuphine hydrochloride reverses the adverse effects of μ receptor agonist (e.g.nausea,vomiting,itching) without influencing its analgesic effects.Due to the ceiling effect,nalbuphine does not cause respiratory depression.Nalbuphine has a higher safety factor,which makes it one of the most commonly used analgesic in paediatric patients.The application of nalbuphine is more popular in the country,thus,the indications of using nalbuphine in pediatric anesthesia should be clearly defined.The pharmacological properties of nalbuphine,clinical application of pediatric anesthesia were summarized in this review.

Abstract Background: CXC chemokine famliy genes play an important role in inflammatory and immune diseases. CXCL16 affects the occurrence and development of inflammation through leukocyte chemotaxis, leukocyte adhesion and endotoxin clearance. In this study, we selected a set of tag SNPs in the CXCL16 gene and investigated their clinical relevance to the development of sepsis and multiple organ dysfunction syndrome (MODS) in patients with major trauma in three independent Chinese Han populations.Methods: A total of 1,620 major trauma patients were enrolled in this study. Among these patients, 920 came from Chongqing in western China, 350 came from Zhejiang Province in eastern China, and 350 came from Guizhou Province in southern China. The improved multiplex ligation detection reaction (iMLDR) method was employed in the genotyping and genetic association analyses to determine the associations between CXCL16 haplotypes and sepsis morbidity rate and higher MOD scores in three cohorts.Results: The CXCL16 T123V181 haplotype was determined to be associated with increased risk for sepsis morbidity and higher MOD scores in the three cohorts. In vitro chemotactic experiments demonstrated that the T123V181 protein enhanced the chemotaxis of immunocytes. The adhesion ability of THP-1 cells expressing T123V181 to immunocytes was also stronger than those of cells with the other three haplotypes. T123 and V181 altered the structure of the CXCL16 active center, which resulted in changes in protein function and changes in the adhesion and chemotaxis of CXCL16-expressing immunocytes. These structural changes might be responsible for the increased incidence of sepsis and the higher MODS scores.Conclusions: We demonstrate that genetic variations in the CXCL16 gene regulate the sepsis morbidity rate, and we explore a paradigm for the prewarning diagnosis of sepsis tailored to the genetic information of individual patients.Trial registration: ClinicalTrials.gov, NCT01713205.

Objectives/HypothesisSystemic infusions of lidocaine have been widely used as perioperative analgesic adjuvants. The aim of this randomized, double‐blinded, controlled trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality in upper airway surgery.Study DesignProspective, randomized, double‐blinded, placebo‐controlled trial.MethodsA total of 99 patients were randomly assigned to the lidocaine group (group L) or the control group (group C). The patients received 2 mg/kg lidocaine completed within 10 minutes before the induction of anesthesia followed by continuous infusions of 2 mg/kg/hr lidocaine (group L) or the same volume of 0.9% normal saline (group C) intravenously during anesthesia. The Quality of Recovery‐40 (QoR‐40) survey was administered on the preoperative day (Pre) and postoperative days 1 (POD1) and 2 (POD2). The primary endpoint was QoR‐40 score on POD1 and POD2.ResultsCompared with Pre, global QoR‐40 scores on POD1 and POD2 were significantly lower (P < .05). Compared with group C, global QoR‐40 scores were significantly higher in group L on POD1 and POD2 (P < .05). Among the five dimensions of QoR‐40, the scores for physical comfort, emotional state, and pain were superior in group L compared to group C (P < .05). Compared with group C, the consumption of remifentanil and diclofenac as well as the incidence of postoperative nausea and vomiting (PONV) and postoperative 48‐hour numeric rating scale (NRS) scores in group L were significantly lower (P < .05).ConclusionsSystemic lidocaine infusion can improve QoR‐40 scores in patients with upper airway surgery, reduce the dosage of intraoperative opioids, decrease the incidence of PONV and NRS scores 2 days after surgery, thus improving postoperative early recovery quality.Level of Evidence1b Laryngoscope, 131:E63–E69, 2021

Background: CXC chemokine famliy genes play an important role in inflammatory and immune diseases. CXCL16 affects the occurrence and development of inflammation through leukocyte chemotaxis, leukocyte adhesion and endotoxin clearance. We selected a set of tagSNPs in CXCL16 gene and investigated their clinical relevance in relation to the development of sepsis and MODS in patients with major trauma in three independent Chinese Han populations. Methods: A total of 1,620 major trauma patients were enrolled in this study. Among which, 920 patients came from Chongqing in western China, 350 patients came from Zhejiang province in eastern China and 350 patients came from Guizhou province in southern China. Improved multiplex ligation detection reaction (iMLDR) was used in the genotyping and genetic association study was used to analyze the association between CXCL16 haplotypes and sepsis morbidity rate and higher MOD Scores in three cohorts. Results: CXCL16 T123V181 haplotype was associated with an increased risk for sepsis morbidity rate and higher MOD Scores in three cohorts. In vitro chemotactic experiment showed that T123V181 protein enhanced the chemotaxis of immunocytes. The adhesion ability of THP-1 cells which expressing T123V181 to immunocytes was also stronger than that of the other three haplotypes. T123 and V181 altered the structure of CXCL16 active center, which led to the change of protein function and the change of adhesion and chemotaxis of CXCL16 expressing immunocytes. The structural change might be the cause of the increased incidence of sepsis and higher score of MODS. Conclusions: We demonstrate that CXCL16 genetic variation regulates sepsis morbidity rate and explore a paradigm for the prewarning diagnosis of sepsis tailored by individual genetic information. Trial registration： ClinicalTrials.gov , NCT01713205. Registered 18 October 2012, retrospectively registered.

Background Until 24:00 of April 26th 2020, 2,918,268 laboratory-confirmed cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection have been reported worldwide, including 203,528 deaths. Bacterial infection is the main cause of sepsis, however, sepsis caused by virus is often ignored. Increased awareness, early recognition of viral sepsis, rapid administration of appropriate antiviral drugs, and urgent treatment can significantly reduce deaths of viral sepsis. Objectives Given the rapid global spread of novel Corona Virus Disease (COVID-19), coupled with the high rate of missed diagnosis of viral sepsis caused by SARS-CoV-2 infection, it is urgent to evaluate the multiple organ failure score and viral sepsis in COVID-19 patients, so as to determine the clinical characteristics of viral sepsis more accurately and reveal the risk factors related to mortality. Methods Here we provide a full description of three cases of viral sepsis and subsequent multiple organ dysfunction (MODS) caused by SARS-CoV-2 infection imported to Guiyang from Wuhan. Results Complete laboratory examination, imaging data and treatment methods for the patients are analyzed. Sepsis-related Organ Failure Assessment score (SOFA score) and Multiple organ dysfunction scores (MOD score) were daily assessed, aim to elucidate the clinical feature of viral sepsis and MODS and to attract enough attention by clinicians. Conclusions Therefore, we strongly suggest to daily evaluate SOFA score and MOD score in severe and critically-ill COVID-19 patients, so as to early diagnose and prevention of sepsis and MODS.

BackgroundShock is a common severe complication of trauma and can result in multiple organ dysfunction and even death. To improve prognosis, it is crucial that clinicians intervene and treat occult shock, which shows no obvious changes in vital signs. The purpose of this study was to develop a new, nomogram-based shock prediction score model that is independent of the trauma injury severity score, abbreviated injury scale, and Glasgow coma scale. Our shock prediction score should help clinicians diagnose post-traumatic occult shock (PTOS) early and intervene promptly to improve patient outcomes.Patients and methodsThis study recruited 1005 injured patients (431 with shock and 574 without shock) from the emergency department of the Affiliated Hospital of Guizhou Medical University. Based on least absolute shrinkage and selection operator technology, 31 commonly used indicators were screened for influence on traumatic shock. We used multivariate logistic regression analysis to screen each independent influencing factor (p < 0.05), construct a nomogram-based prediction model, and formulate a PTOS score. We also estimated the predictive power of the model using C-index and the area under the receiver operating characteristic curve (AUC) of PTOS. The stability and net benefit range of this model were evaluated using a calibration diagram, internal grouping data verification, and decision curve analysis.ResultsSix individual influencing factors were selected using multivariate logistic regression to construct the nomogram-based model (systolic pressure, diastolic pressure, white blood cell count, absolute basophil count, red blood cell count, and hematocrit). The incidence of traumatic shock increased with an increase in the PTOS score. The C-index of the PTOS score in the training dataset was 0.92 (95% confidence interval [CI]: 0.90– 0.94), and the AUC was 0.92. The C-index of the validation dataset was 0.90 (95% CI: 0.86–0.94), and the AUC value was 0.90. The calibration chart showed that our model had excellent prediction. Decision curve analysis showed that the shock nomogram predictive score was clinically useful when the intervention was decided at a shock probability threshold more significant than 2%.ConclusionUsing clinical electronic medical record system data, we developed and validated a new PTOS score with high accuracy, stability, and calibration to predict the risk of shock in patients with trauma.

A 67-year-old male was diagnosed as myxoma-related cerebral aneurysm. Transthoracic echocardiogram showed a large mass in the left atrium and pathological analysis confirmed the diagnosis of myxoma. Cerebral magnetic resonance angiography revealed an aneurysm in the right internal carotid artery. However, the aneurysm was disappeared amazingly after successful resection of cardiac mass. There are a few similar case reports in the literature. Our case report illustrates that cerebral aneurysms may be associated with cardiac myxomas and that closely follow-up cerebral aneurysms after resection of myxoma is necessary.

Aim: To investigate the effects of halothane, isoflurane and enflurane on myocardial function, metabolism and oxygen free radical in ischemia-reperfusion(IR) rats. Methods: Totally 104 SD rats were randomly divided into 13 groups (8 rats in each group) by means of random number table. The 13 groups were regrouped into control group, halothane group, enflurane group and isoflurane group according to the manner of administration. 1 The control group consisted of four subgroups: 15-minute equilibrium group, 15-minute perfusion after equilibrium group, 10-minute ischemia after equilibrium and perfusion group and 25-minute reperfusion after equilibrium, perfusion and ischemia group. 2 The halothane group consisted of 3 subgroups: 15-minute perfusion with 1.5 minimal alveolar concentration(MAC) halothane group after 15-minute equilibrium, 10-minute ischemia after equilibrium and perfusion group and 30-minute reperfusion with 1.5MAC halothane after equilibrium, perfusion and 25-minute ischemia group. 3 The enflurane and isoflurane groups consisted of 3 groups administrated with the enflurane and isoflurane instead of halothane respectively. After equilibrium followed by administration or 15-perfusion and 30-perfusion, left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVEDP), left ventricular developed pressure(LVDP), +dp/dt and -dp/dt, heart rate and coronary flow (CF) were monitored. The contents of myocardial adenosine triphosphate (ATP) and malondialdehyde(MDA) and the activity of superoxide dismutase(SOD) were determined after treatment. Results: 1 Enflurane and isoflurane could obviously dilate coronary artery. Enflurane could accelerate the recovery of CF. 2 The LVDP and + dp/dt were significantly decreased, while the LVEDP was significantly increased in all the treatment groups (all P < 0.05). After IR in the halothane, enflurane and isoflurane groups, the LVDPs recovered to 57%, 62% and 59% of control value respectively(all P < 0.01), the +dp/dt results were recovered to 56%, 67% and 74% of baseline respectively(all P < 0.01), Significantly different from the LVDP(27%) and +dp/dt(13%) respectively in the control group(both P < 0.01). The myocardial ATP contents were increased in all the treatment groups. 3 The myocardial ATP content was decreased slowly after ischemia, while recovered rapidly after reperfusion. 4 The activity of SOD in the treatment groups was significantly higher than that in the control group, while myocardial MDA content in the treatment groups was significantly lower than that in the control group. Conclusion: Three kinds of volatile anesthetics inhibit myocardial systolic function in normal myocardium. After IR, the volatile anesthetics improves the recovery of function and metabolism, and increases CF and the activity of SOD, indicating that it may be one of the mechanisms of volatile anesthetics against IR injury.