This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into 2 groups: (1) nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral, and inferomedial genicular nerve, 2 ml 0.5% ropivacaine each nerve.) before the general anesthesia, (2) control group: no intervention before the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity (Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first 2 nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was measured by visual analogue scale (VAS) (A 10-point VAS, 0 points painless, 10 points severe pain) and median (interquartile range). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared with the control group, the nerve block group had a lower pain VAS score at rest [2 (2-2) vs. 3 (2-4), P<0.01] at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had a lower intraoperative dosage of sufentanil (20 +/- 4.8 vs. 28.5 +/- 5.1 mg; P<0.001), lower requirement for analgesics for pain and lower postoperative nausea and vomiting throughout the 72-hour observation period. There were no significant differences in the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.

To evaluate and compare the performance of four Large Language Models (LLMs) in anesthesia decision-making for critically ill obstetric and geriatric patients and analyze their decision reliability across different surgical specialties. Prospective comparative analysis using standardized case evaluations. Four LLMs (ChatGPT-4o, Claude 3.5 Sonnet, DeepSeek-R1, and Grok 3). Thirty complex surgical cases (10 obstetric, 20 geriatric; 8 specialties) were analyzed. A 12-dimensional framework tested the models using unified prompts and decision points. Five trained anesthesiologists independently evaluated the models across six dimensions (patient assessment, anesthesia plan, risk management, individualization, contingency planning, decision logic; 1–10 scale, total 6–60). Overall, DeepSeek performed best (51.43 ± 2.74 points), significantly outperforming other models (P < 0.001). For obstetric cases, the mean scores were: DeepSeek (52.00 ± 1.83), Grok (49.40 ± 3.06), ChatGPT (47.60 ± 2.88), and Claude (46.60 ± 2.17). For geriatric cases, scores were: DeepSeek (51.15 ± 3.10), Grok (48.60 ± 2.33), ChatGPT (47.35 ± 2.50), and Claude (45.75 ± 2.05). Across specialties, all models performed best in hepatobiliary surgery, burn surgery, and thoracic surgery. DeepSeek demonstrated consistent performance across all dimensions, with notable advantages in decision logic (8.80 ± 0.40) and contingency planning (8.27 ± 0.45). All LLMs demonstrated strong anesthesia decision-making capabilities, with DeepSeek showing the best overall performance. Exploratory analysis revealed performance variations across specialties, although small sample sizes preclude definitive conclusions. Clinical implementation should consider specialty-specific factors and decision process characteristics.

BACKGROUND:Depression is a disease with a significant global social burden. Single nucleotide polymorphisms (SNPs) are correlated with the development of depression. This study investigates the relationship between polymorphisms in the GPHN and ATP6V1D gene promoter regions and susceptibility to depression in the Chinese population. AIM:To provide new insights into identifying SNPs for predicting depression in the Chinese population. METHODS:We conducted a case-control study involving 555 individuals with depression and 509 healthy controls. GPHN rs8020095 and ATP6V1D rs3759755, rs10144417, rs2031564, and rs8016024 in the promoter region were genotyped using next-generation sequencing. Dual luciferase reporter genes were employed to assess the transcriptional activity of promoter regions for each SNP genotype, with transcription factors binding to each site predicted using the JASPAR database. RESULTS:Compared to healthy controls, the ATP6V1D promoter rs10144417 AG genotype (P = 0.015), rs3759755 AC/CC genotype (P = 0.036), and GPHN gene rs8020095 GA and AA genotypes (GA: P = 0.028, GG: P = 0.025) were significantly associated with a lower prevalence of depression. Linked disequilibria were present in five SNPs, with the AGATA haplotype frequency in patients significantly lower than in healthy subjects (P = 0.023). Luciferase activity of the rs3759755-A recombinant plasmid was significantly higher than that of the rs3759755-C recombinant plasmid (P = 0.026), and the rs8020095-A recombinant plasmid activity was significantly higher than that of the rs8020095-G recombinant plasmid (P = 0.001). Transcription factors orthodenticle homeobox 2, orthodenticle homeobox 1, forkhead box L1, NK homeobox 3-1, and nuclear factor, interleukin 3 regulated demonstrated binding affinity with rs3759755A > C and rs8020095A > G. CONCLUSION:This study demonstrates that SNPs (rs3759755 and rs10144417) in the promoter region of the ATP6V1D and SNP (rs8020095) of GPHN are indeed associated with susceptibility to depression.

Objective:To analyze temporal trends of diet-attributable cancer mortality in China (1990-2021), compare patterns between China and regions with varying development levels, and explore gender-specific characteristics to inform targeted prevention strategies. Study design:Cross-sectional and time-series analyses. Methods:We conducted cross-sectional and time-series analyses of nine dietary risk factors across China, the global region, and five Socio-demographic Index (SDI) - stratified regions. Joinpoint regression models quantified temporal trends through Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Results:Diet-attributable cancer deaths in China decreased from 9.9% (95% CI: 2.2-20.5%) to 6.3% (95% CI: 2.1-12.8%) during 1990-2021. China's 2021 attribution (6.3%) was below the global average (6.8%), exceeding high-SDI regions (5.8%) but below middle-SDI regions (7.4%). Low vegetable intake showed the largest decline (3.0 to 0.3%), while high red meat consumption increased (1.6 to 2.0%). Red meat's impact was greater in females, while inadequate plant consumption affected males more significantly. Dietary factors most influenced colorectal cancer in China (39.2%). China's diet-attributable cancer mortality decreased by 53.0% (from 18.4 to 8.7 per 100,000), exceeding global reductions (35.5%). Conclusion:This study identified distinct regional patterns in diet-attributable cancer mortality. China's profile reflects its transition between development levels-decreasing vegetable-deficiency risks while increasing red meat consumption. Globally, attribution patterns are shifting from plant food inadequacy toward animal product excess, with persistent gender disparities.

Background: While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective: This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design: A prospective randomized double-blinded trial. Setting: The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants: Patients aged 18 – 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions: Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures: Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results: Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 – 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. Conclusion: Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registration: chictr.org.cn, ChiCTR2200059424.

Background Depression is a common chronic debilitating disease with a heavy social burden. single nucleotide polymorphisms (SNPs) can affect the function of microRNAs (miRNAs), which is in turn associated with neurological diseases. However, the association between SNPs located in the promoter region of miR-17-92 and the risk of depression remains unclear. Therefore, we investigated the association between rs982873, rs9588884 and rs1813389 polymorphisms in the promoter region of miR-17-92 and the incidence of depression in a Chinese population. Methods we used GWAS (Genome-wide association study) and NCBI (National Center for Biotechnology Information) to screen three SNPs in the miR-17-92 cluster binding sites. A case-control study (including 555 cases and 541 controls) was conducted to investigate the relationship between the SNPs and risk of depression in different regions of China. The gene sequencing ii was used to genotype the collected blood samples. Results the following genotypes were significantly associated with a reduced risk of depression: rs982873 TC (TC vs TT: OR = 0.72, 95% CI, 0.54–0.96, P = 0.024; TC/CC vs TT: OR = 0.74, 95% Cl, 0.56–0.96, P = 0.025); CG genotype of rs9588884 (CG vs CC: OR = 0.74, 95% CI, 0.55–0.98, P = 0.033; CG/GG vs CC: OR = 0.75, 95% Cl, 0.57–0.98, P = 0.036); and AG genotype of rs1813389 (AG vs AA: OR = 0.75, 95% CI, 0.57-1.00, P = 0.049; AG/GG vs AA: OR = 0.76, 95% Cl, 0.59-1.00, P = 0.047). Stratified analysis showed that there was no significant correlation between the three SNPS and variables such as family history of suicidal tendency (P > 0.05). Conclusions our findings suggest that rs982873, rs9588884, and rs1813389 polymorphisms may be associated with protective factors for depression.

BackgroundPatients with diabetes face an increased risk of postoperative pulmonary infection (PPI). However, precise predictive models specific to this patient group are lacking.ObjectiveTo develop and validate a machine learning model for predicting PPI risk in patients with diabetes.MethodsThis retrospective study enrolled 1,269 patients with diabetes who underwent elective non-cardiac, non-neurological surgeries at our institution from January 2020 to December 2023. Predictive models were constructed using nine different machine learning algorithms. Feature selection was conducted using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression. Model performance was assessed via the Area Under the Curve (AUC), precision, accuracy, specificity and F1-score.ResultsThe Ada Boost classifier (ADA) model exhibited the best performance with an AUC of 0.901, Accuracy of 0.91, Precision of 0.82, specificity of 0.98, PPV of 0.82, and NPV of 0.82. LASSO feature selection identified six optimal predictive factors: postoperative transfer to the ICU, Age, American Society of Anesthesiologists (ASA) physical status score, chronic obstructive pulmonary disease (COPD) status, surgical department, and duration of surgery.ConclusionOur study developed a robust predictive model using six clinical features, offering a valuable tool for clinical decision-making and personalized prevention strategies for PPI in patients with diabetes.

BACKGROUND:The effectiveness and safety of preoperative oral carbohydrate (POC) for people with diabetes remain controversial. METHODS:We systematically reviewed studies comparing POC to fasting or placebo in elective surgery for diabetic adults, focusing on gastric volume, postoperative complications, hospital stay, and glycemic control. RESULTS:Fourteen studies (n = 1870 patients) were included. POC did not significantly increase gastric volume or aspiration risk in well-controlled type 2 diabetes. Effects on perioperative glucose control varied. POC improved patient comfort and reduced preoperative hypoglycemia in gestational diabetes. Limited evidence suggested potential benefits in cardiac surgery patients. CONCLUSION:POC is safe for well-controlled type 2 diabetics, enhancing comfort and reducing preoperative hypoglycemia without increasing aspiration risk. However, its effects on glucose control and postoperative outcomes vary. Personalized approaches are crucial, particularly for poorly controlled diabetes.

Purpose: The aim of this study was to analysis of the opioid use of opioid native zoster-related pain (ZRP) patients to evaluate the impact of opioid use on pain control and quality of life improvement based on the clinical database.Patients and Methods: We conducted a retrospective cohort study to identify opioid native patients who were hospitalized in the pain department between May 1, 2020, and May 1, 2021. The primary outcomes were persistent opioid use after discharge, visual analogue scale (VAS) at the admission, VAS remission rate during hospitalization, VAS score and quality of life at follow-up. Then, we assessed patient-level risk factors for persistent opioid use after the discharge.Results: A total of 350 patients met the inclusion criteria. Of those patients, 255 (72.9%) were administered with opioid during hospitalization, and 95 (27.1%) patients were not. Opioid prescription during hospitalization was independently associated with increased odds of persistent use after the discharge (adjusted odds ratio, 20.74; 95% CI, 4.504-95.474; P < 0.01). In the two groups, the VAS score at admission and the VAS score at follow-up were different. In the group with opioids during hospitalization, the persistent opioid use after discharge was more common (38% vs 2.1%) compared to patients without opioids, and VAS remission rate during hospitalization was less, restrictions on daily life, work or housework, and social activities were more common, and mood, diet and sleep were worse, respectively.Conclusion: Opioids prescription during hospitalization might increase the risk of chronic opioid use in opioid native ZRP patients, and it has limited benefits in pain control and quality of life improvement. Even though PHN was painful and intractable, the use of opioids should also be more cautious, and strict follow-up, management in this population.

患者，女性，年龄24岁，体质量27 kg，身高165 cm。因"反复腹痛17个多月，加重伴恶心、呕吐1个多月"入院。患者17个月前，无明显诱因出现下腹部疼痛，在当地诊断为"急性阑尾炎"，行"阑尾切除术"，术后腹痛缓解出院。之后反复出现脐周隐痛，伴食欲减退、腹泻等，多次就诊于当地医院，均对症治疗后好转出院。1个月前再次出现脐周疼痛不适，伴恶心呕吐，呕吐为非喷射性，呕吐物为非咖啡色胃内容物，每日呕吐约4~5次，量少，吐后疼痛缓解。入院血常规结果示：白细胞计数17.22×10 9/L、中性粒细胞计数15.33×10 9/L、血红蛋白97 g/L、血小板计数452×10 9/L、白蛋白28.6 g/L，血清电解质：Na + 129.9 mmol/L、Cl - 91 mmol/L、K + 2.98 mmol/L。胸部CT和心电图结果未见异常。入院以来睡眠、饮食、二便、体重无明显变化。曾在"日间无痛检查中心"行胃镜检查术，因胃镜置入困难而失败。患者因严重营养不良，且有钠、钾等电解质失衡，改在手术室内全麻气管插管术后再次行胃肠镜检查术。患者除了明显营养不良外，心、肺等主要脏器功能尚好，体格检查无特殊阳性体征。气道评估：张口度大于三横指，Mallampati分级Ⅱ级，甲颏距离> 3.5 cm，头颈活动度正常。

OBJECTIVE:To compare the effects of three types of ultrasound-guided nerve blocks on post-operative recovery quality in patients undergoing modified radical mastectomy for unilateral breast cancer.METHODS:In this randomized double-blinded trial (chictr.org.cn, ChiCTR2200059428), 150 female patients were equally assigned to S group (serratus anterior plane block, SAPB) group, P group (paravertebral block, PVB) or ST group (serratus anterior combined with transverse thoracic muscle plane blocks, SA-TTMPB). The primary outcome was QoR-15 at five time points after surgery. Secondary outcomes were pain scores, time of first rescue analgesic and chronic pain incidence at 3 months.RESULTS:The QoR-15 total score of S group at 24 h, 48 h, 72 h and 7 days post-surgery was significantly lower in groups P and ST, while there was no significant difference between groups P and ST (S vs. P vs. ST, 100.29 ± 6.20 vs. 108.51 ± 7.46 vs. 106.46 ± 6.95; 105.59 ± 6.18 vs. 113.06 ± 7.44 vs. 111.22 ± 6.56; 112.51 ± 6.32 vs. 119.88 ± 6.44 vs. 117.62 ± 6.09; 123.00 ± 5.78 vs. 128.86 ± 5.96 vs. 126.92 ± 5.72, p < 0.05). The dynamic and rest NRS scores at 6 and 12 h post-surgery were significantly higher in group S than in groups P and ST.CONCLUSION:Serratus anterior plane block combined with transverse thoracic muscle plane block and paravertebral block both have better effects than serratus anterior plane block alone in improving patients' early post-operative recovery quality, and also have an advantage in improving early post-operative pain.CLINICAL TRIAL REGISTRATION:chictr.org.cn (ChiCTR2200059428).DATE OF REGISTRATION:29 April 2022.SIGNIFICANCE:Serratus anterior combined with transverse thoracic muscle plane block may be a safer, easier, and equally effective nerve block strategy than paravertebral block in patients undergoing modified radical mastectomy for unilateral breast cancer.

Abstract Background: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA. Methods: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients’ satisfaction and side effects. Results: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = −0.71, 95% confidence interval [CI]: −1.01 to −0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = −1.22, 95% CI: −1.58 to −0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35–1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35–0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients’ satisfaction (OR = 1.13, 95% CI: 0.88–1.44; P = 0.33; I2 = 72%) and drug consumption (MD = −5.55, 95% CI: −14.18 to 3.08; P = 0.21; I2 = 93%). Conclusion: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries. Registration: PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

Non-human primate monkey model of myocardial ischemic infarction is precious for translational medicine research. Ligation of the left anterior descending (LAD) artery is a common procedure to induce myocardial ischemic infarction. However, the consistency of the myocardial infarction thus generated remains problematic. The present study was undertaken to critically evaluate the monkey model of myocardial ischemic infarction to develop a procedure for a consistent cross-study comparison. Forty male Rhesus monkeys were divided into 4 groups and subjected to LAD artery ligation at different levels along the artery. In addition, the major diagonal branch was selectively ligated parallel to the ligation site of the LAD artery according to the diagonal branch distribution. Analyses of MRI, echocardiography, cardiac hemodynamics, electrocardiography, histopathology, and cardiac injury biomarkers were undertaken to characterize the monkeys with myocardial infarction. Ligation at 40% of the total length of the artery, measured from the apex end, produced variable infarct areas with inconsistent functional alterations. Ligation at 60% or above coupled with selective ligation of diagonal branches produced a consistent myocardial infarction with uniform dysfunction. However, ligation at 70% caused a lethal threat. After a thorough analysis, it is concluded that ligation at 60% of the total length coupled with selective ligation of diagonal branches, enables standardization of the location of occlusion and the subsequent ischemic area, as well as avoids the influence of the diagonal branches, are ideal to produce a consistent monkey model of myocardial ischemic infarction.

Objective To evaluate the efficacy and safety of extracorporeal shockwave therapy (ESWT) for postherpetic neuralgia. Design Randomized single-blind clinical study. Patients Patients with postherpetic neuralgia. Methods Patients were randomly divided into the control group and the ESWT group. The control group received conventional treatment while the ESWT group received conventional treatment and ESWT. The primary outcome is pain degree as assessed by the numeric rating scale (NRS), and secondary outcomes include brief pain inventory (BPI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and at weeks 1, 4, and 12. Linear mixed-effects models were applied to repeated measurement data. Results The scores on the NRS, BPI, SAS, SDS, and PSQI decreased over time in both groups. The NRS and SDS scores of the ESWT group were statistically lower than the control group. There was no time × group interaction in the mixed model analysis. Baseline age was correlated with NRS scores and BPI scores, and invasive treatment was related to PSQI scores, with no interaction effect for baseline confounders observed. No adverse events were observed during the process of this trial. Conclusion Extracorporeal shockwave therapy combined with conventional treatment could relieve pain and improve the psychological state in patients with postherpetic neuralgia without serious adverse effects.

Objective:To investigate the effects of different doses of dexmedetomidine on intestinal mucosal barrier function, cognitive function and brain protection in patients undergoing heart valve replacement.Methods:The clinical data of 135 patients with heart valve replacement from April 2019 to April 2020 in the First Affiliated Hospital of Chengdu Medical College were retrospectively analyzed. Among them, 54 patients received low-dose of dexmedetomidine after induction of anesthesia (low-dose group), 38 patients received high-dose of dexmedetomidine (high-dose group), and 43 patients did not use dexmedetomidine (control group). Before surgery (T 1), 1 h after surgery (T 2), end of surgery (T 3) and 72 h after surgery (T 4), the levels of intestinal mucosal barrier function indexes D-lactate and diamine oxidase (DAO) were detected by spectrophotometry, the levels of brain injury indexes central nervous system specific protein (S100β) and neuron-specific enolase (NSE) were detected by double antibody sandwich enzyme-linked immunosorbent assay; before surgery and 3 d after surgery, the cognitive function was assessed by the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scale before and 3 days after surgery. Result:There was no statistical difference in T 1, T 2 and T 4 D-lactic acid among 3 groups ( P>0.05); the T 3 D-lactic acid in low-dose group was significantly lower than that in high-dose group and the control group: (7.87 ± 1.59) mg/L vs. (8.99 ± 1.82) and (9.32 ± 1.74) mg/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 2 DAO among 3 groups ( P>0.05); the T 3 and T 4 DAO in low-dose group was significantly lower than that in high-dose group and control group: (2.77 ± 0.23) kU/L vs. (3.58 ± 0.25) and (4.30 ± 0.26) kU/L, (2.08 ± 0.25) kU/L vs. (2.40 ± 0.20) and (2.71 ± 0.23) kU/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There were no statistical differences in MMSE score and MoCA score before surgery among 3 groups ( P>0.05); the MMSE score and MoCA score 3 d after surgery in low-dose group were significantly higher than those in high-dose group and control group: (22.76 ± 0.54) scores vs. (21.41 ± 0.47) and (20.21 ± 0.43) scores, (24.90 ± 0.51) scores vs. (24.01 ± 0.48) and (23.12 ± 0.49) scores, the high-dose group was significantly higher than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1, T 2 and T 4 S100β among 3 groups ( P>0.05); the T 3 S100β in low-dose group was significantly lower than that in high-dose group and control group: (4.09 ± 2.01) μg/L vs. (5.48 ± 1.10) and (6.10 ± 1.58) μg/L, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 4 NSE among 3 groups ( P>0.05); the T 2 and T 3 NSE in low-dose group was significantly lower than that in high-dose group and control group: (17.20 ± 4.13) μg/L vs. (20.29 ± 3.77) and (22.35 ± 3.80) μg/L, (19.40 ± 3.92) μg/L vs. (23.46 ± 5.26) and (25.18 ± 5.32) μg/L, and there were statistical differences ( P<0.05). Conclusions:Administration of 0.5 μg/(kg·h) dexmedetomidine during heart valve replacement under cardiopulmonary bypass can reduce intestinal mucosal damage, protect brain against injury in a certain degree, and improve cognitive function.

Background: Remote ischemic preconditioning (RIPC) has cardioprotective effects. This study was designed to evaluate the effectiveness and potential influencing factors of RIPC for myocardial ischemia-reperfusion injury (MIRI) in rats and mice. Methods: The PubMed, Web of Science, Embase, and Cochrane Library databases were searched to identify animal model studies that explored the effect of RIPC on MIRI. The primary outcome was myocardial infarct size, and secondary outcomes included serum cardiac markers, vital signs, hemodynamic parameters, and TUNEL-positive cells. Quality was assessed using SYRCLE's Risk of Bias Tool. Results: This systematic review and meta-analysis included 713 male animals from 37 studies. RIPC significantly protected against MIRI in small animal models by reducing infarct size, decreasing serum myocardial marker levels and cell death, and improving cardiac function. Subgroup analysis indicated that RIPC duration and sites influence the protective effect of RIPC on MIRI. Meta-regression suggested that study type and staining method might be sources of heterogeneity. The funnel plot, Egger's test, and Begg's test suggested the existence of publication bias, but results of the sensitivity analysis and nonparametric trim-and-fill method showed that the overall effect of RIPC on MIRI infarct size was robust. Conclusions: RIPC significantly protected against MIRI in small animal models by reducing infarct size, decreasing serum myocardial markers and limiting cell death, and improving cardiac function. RIPC duration and site influence the protective effect of RIPC on MIRI, which contributes in reducing confounding factors and determines the best approach for human studies.

Background Herpes zoster (HZ)-associated pain can lead to severe pain and reduced quality of life. Exploring effective treatment and the risk factors of zoster-associated pain has become important. Methods Interventions including nerve block, radiofrequency, and thermocoagulation were used for zoster-associated pain. The data of 131 patients with HZ and 230 patients with postherpetic neuralgia (PHN) were collected at baseline, 2 weeks, 3, 6, and 12 months after the intervention. Visual analog scale (VAS) and Brief Pain Inventory (BPI) scores at different time points were analyzed by two-way repeated measures ANOVA with Group as the between-subject variable (different pain durations and areas), Time as the within-subject variable (baseline, 2 weeks, 3 months, 6 months, and 12 months), and Group × Time as the two-way interaction. Besides, the effective rate, adverse effects, and medication were also recorded. The risk factors of PHN were analyzed by logistic regression. Results A total of 25 (19.08%) patients with HZ continued to have pain in the initially affected area after 3 months. The VAS scores and the BPI quality of life scores of patients with HZ-associated pain were significantly reduced from baseline to 2 weeks, 3, 6, and 12 months after the interventions. There was no significant difference in VAS and BPI scores in different pain areas and pain durations. No significant Group × Time interaction was observed. Age, diabetes mellitus, and immune-related diseases were risk factors of PHN. Conclusion Interventions could significantly improve the pain degree and life quality of patients with zoster-associated pain, and the positive effect of intervention did not change with pain duration and area. Advanced age, diabetes, and immune-related diseases are risk factors of PHN.

目的:探讨右美托咪定联合达克罗宁胶浆镇痛对泌尿外科全麻病人术后导尿管相关性膀胱刺激征(CRBD)发生的影响.方法:选择行全麻手术的男性病人90例,根据随机数字表法分为右美托咪定组(D组)、右美托咪定联合达克罗宁胶浆(DD组)和对照组(C组),各30例.D组和DD组于麻醉诱导前静脉泵注1.0μg/kg右美托咪定,DD组在诱导后常规消毒外阴及尿道口,经尿道注入5 mL达克罗宁胶浆镇痛,并将2 mL达克罗宁胶浆均匀涂抹于导尿管上润滑,C组给予等量0.9％氯化钠溶液,行常规导尿术.观察并比较3组病人麻醉诱导前(T0)、拔管前(T1)、拔管时(T2)及拔管后15 min(T3)时刻的血流动力学指标变化、躁动评分(RS评分)、Ramsay镇静评分、麻醉恢复时间及术后CRBD发生率与程度.结果:与T0时刻比较,C组T1、T2、T3时刻收缩压(SBP)、舒张压(DBP)、心率(HR)均明显升高(P<0.05),D组T1、T2时刻SBP、DBP、HR明显升高(P<0.05),而DD组无明显变化(P>0.05);与C组比较,D组T2、T3时刻SBP、HR和T2时刻DBP及DD组T1、T2、T3时刻SBP、HR和T2时刻DBP均较低(P<0.05),与D组比较,DD组T1、T2时刻SBP较低(P<0.05),其余比较差异均无统计学意义(P>0.05);与T0时刻比较,D组、DD组T1、T2、T3时刻RS评分、Ramsay镇静评分均明显降低(P<0.05),而C组无明显变化(P>0.05);与C组比较,D组及DD组各时间点RS评分均较低(P<0.05),Ramsay镇静评分较高(P<0.05);与D组比较,DD组各时间点RS评分差异均无统计学意义(P>0.05),Ramsay镇静评分除T0时刻无统计学意义外,其他各时间点评分均较高(P<0.05).3组呼吸恢复时间、苏醒时间及拔管时间比较差异均无统计学意义(P>0.05);与C组比较,D组及DD组术后CRBD发生率较低(P<0.01),CRBD程度较轻(P<0.01);与D组比较,DD组术后CRBD发生率较低(P<0.01),CRBD程度较轻(P<0.01).结论:右美托咪定联合达克罗宁胶浆镇痛可有效抑制泌尿外科全麻病人神经冲动,减少局部不良刺激,使麻醉过程中的血流动力学指标更平稳,减轻病人的痛苦和躁动程度,有效预防CRBD,并减轻病人的CRBD程度,增加导尿舒适性和安全性.

Recent mounting studies showed that neuroinflammation caused by surgery or anesthesia is closely related to postoperative cognitive dysfunction (POCD).This study investigated the effect of mineralocorticoid receptor (MR) on neuroinflammation and POCD.To detect the MR effect in an animal model, we randomly divided rats into control, anesthesia, and surgery groups.To determine whether the MR-specific blocker eplerenone (EPL) could improve cognitive dysfunction, we assigned other animals into the control, surgery and EPL treatment, and surgery groups.Cognitive function was detected using the Morris water maze.Serum cytokine levels were measured by ELISA, and the histopathological changes of hippocampal neurons were identified by hematoxylin/eosin and Nissl staining.Our research confirmed that anesthesia and surgical stimulation could lead to IL-1β, IL-6, and TNF-α activation and hippocampal neuronal degeneration and pathological damage.MR was upregulated in the hippocampus under cognitive impairment condition.Additionally, EPL could alleviate inflammatory activation and neuronal damage by exerting neuroprotective effects.The preclinical model of sevoflurane anesthesia/splenectomy implied that MR expression is upregulated by regulating the neuroinflammation in the brain under POCD condition.Manipulating the MR expression by EPL could improve the inflammation activation and neuronal damage.

Purpose: Previous association studies have investigated whether genetic polymorphisms in HTR1B influenced individuals' susceptibility to major depressive disorder (MDD), anti-depressant response (ADR) and suicidal behavior. However, equivocal evidence was obtained. In this meta-analysis, we aimed to examine the association of HTR1B polymorphisms with risk of MDD, ADR and suicidal behavior. Materials and Methods: Studies evaluating the association between HTR1B polymorphisms and risk of MDD, ADR and suicidal behavior were searched in Pubmed, Ovid Medline, web of science and China National Knowledge Infrastructure databases. Summary odds ratios (ORs), 95 % confidence intervals (CIs) and p -values were calculated using a fixed or random effects model. Results: Meta-analysis findings revealed a significantly increased risk of MDD with rs6296 GC and GC/CC genotypes (GC vs. GG: OR = 1.26, 95% CI, 1.07–1.48; GC/CC vs. GG: OR = 1.22, 95% CI, 1.04–1.43, respectively). Moreover, rs6298 CT genotype was significantly associated with an increased risk of suicidal behavior (CT vs. CC: OR = 1.48, 95% CI, 1.16–1.88). However, both rs6296 and rs130058 were not significant risk factors for lethal suicidal behavior. Conclusion: This meta-analysis identified that rs6296 and rs6298 in HTR1B may be significantly related to the risk of MDD and lethality of suicide attempts, respectively. Further studies are required to assess the markers in larger cohorts.