Effect of Postoperative Prolonged sedation with Dexmedetomidine after successful reperfusion with Endovascular Thrombectomy on long-term prognosis in patients with acute ischemic stroke (PPDET): study protocol for a randomized controlled trial

BACKGROUND

Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion. Hypertension and increased blood pressure variability within the first 24 h after successful reperfusion are related to a higher risk of symptomatic intracerebral hemorrhage and higher mortality. AIS patients might suffer from ischemia-reperfusion injury following reperfusion, especially within 24 h. Dexmedetomidine (DEX), a sedative commonly used in EVT, can stabilize hemodynamics by inhibiting the sympathetic nervous system and alleviate ischemia-reperfusion injury through anti-inflammatory and antioxidative properties. Postoperative prolonged sedation for 24 h with DEX might be a potential pharmacological approach to improve long-term prognosis after EVT.

METHODS

This single-center, open-label, prospective, randomized controlled trial will include 368 patients. The ethics committee has approved the protocol. After successful reperfusion (modified thrombolysis in cerebral infarction scores 2b-3, indicating reperfusion of at least 50% of the affected vascular territory), participants are randomly assigned to the intervention or control group. In the intervention group, participants will receive 0.1~1.0 μg/kg/h DEX for 24 h. In the control group, participants will receive an equal dose of saline for 24 h. The primary outcome is the functional outcome at 90 days, measured with the categorical scale of the modified Rankin Scale, ranging from 0 (no symptoms) to 6 (death). The secondary outcome includes (1) the changes in stroke severity between admission and 24 h and 7 days after EVT, measured by the National Institute of Health Stroke Scale (ranging from 0 to 42, with higher scores indicating greater severity); (2) the changes in ischemic penumbra volume/infarct volume between admission and 7 days after EVT, measured by neuroimaging scan; (3) the length of ICU/hospital stay; and (4) adverse events and the all-cause mortality rate at 90 days.

DISCUSSION

This randomized clinical trial is expected to verify the hypothesis that postoperative prolonged sedation with DEX after successful reperfusion may promote the long-term prognosis of patients with AIS and may reduce the related socio-economic burden.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04916197. Prospectively registered on 7 June 2021.

Airway management for a patient with tracheobronchomegaly undergoing lobectomy: a case report

BACKGROUND

Tracheobronchomegaly (TBM) is a rare disorder mainly characterized by dilatation and malacia of the trachea and major bronchi with diverticularization. This will be a great challenge for airway management, especially in thoracic surgery requiring one-lung ventilation. Using a laryngeal mask airway and a modified double-lumen Foley catheter (DFC) as a "blocker" may achieve one-lung ventilation. This is the first report introducing this method in a patient with TBM.

CASE PRESENTATION

We present a 64-year-old man with TBM receiving left lower lobectomy. Preoperative chest computed tomography demonstrated a prominent tracheobronchial dilation and deformation with multiple diverticularization. The most commonly used double-lumen tube or bronchial blocker could not match the distorted airways. After general anesthesia induction, a 4# laryngeal mask was inserted, through which the modified DFC was positioned in the left main bronchus with the guidance of a fiberoptic bronchoscope. The DFC balloon was inflated with 10 ml air and lung isolation was achieved without any significant air leak during one-lung or two-lung ventilation. However, the collapse of the non-dependent lung was delayed and finally achieved by low-pressure artificial pneumothorax. The surgery was successful and the patient was extubated soon after the surgery.

CONCLUSIONS

Using a laryngeal mask airway with a modified double-lumen Foley catheter acted as a bronchial blocker could be an alternative method to achieve lung isolation.

Transcutaneous electrical acupoint stimulation in adult patients receiving gastrectomy/colorectal resection: A randomized controlled trial

BACKGROUND

Acupuncture promotes the recovery of gastrointestinal function and provides analgesia after major abdominal surgery. The effects of transcutaneous electrical acupoint stimulation (TEAS) remain unclear.

AIM

To explore the potential effects of TEAS on the recovery of gastrointestinal function after gastrectomy and colorectal resection.

METHODS

Patients scheduled for gastrectomy or colorectal resection were randomized at a 2:3:3:2 ratio to receive: (1) TEAS at maximum tolerable current for 30 min immediately prior to anesthesia induction and for the entire duration of surgery, plus two 30-min daily sessions for 3 consecutive days after surgery (perioperative TEAS group); (2) Preoperative and intraoperative TEAS only; (3) Preoperative and postoperative TEAS only; or (4) Sham stimulation. The primary outcome was the time from the end of surgery to the first bowel sound.

RESULTS

In total, 441 patients were randomized; 405 patients (58.4 ± 10.2 years of age; 247 males) received the planned surgery. The time to the first bowel sounds did not differ among the four groups (P = 0.90; log-rank test). On postoperative day 1, the rest pain scores differed significantly among the four groups (P = 0.04; Kruskal-Wallis test). Post hoc comparison using the Bonferroni test showed lower pain scores in the perioperative TEAS group (1.4 ± 1.2) than in the sham stimulation group (1.7 ± 1.1; P = 0.04). Surgical complications did not differ among the four groups.

CONCLUSION

TEAS provided analgesic effects in adult patients undergoing major abdominal surgery, and it can be added to clinical practice as a means of accelerating postoperative rehabilitation of these patients.

Ginkgolide B improved postoperative cognitive dysfunction by inhibiting microgliosis-mediated neuroinflammation in the hippocampus of mice

Background

Postoperative cognitive dysfunction (POCD) are a common complication of the central nervous system following surgery and anesthesia. The specific pathogenesis and effective therapeutics of POCD need to be further studied. Ginkgolide B (GB), a platelet-activating factor receptor-specific antagonist, has been suggested to have strong anti-inflammatory effects. Here we tested the effects and mechanism of GB on POCD of aged rats.

Methods

Neurobehavioral tests were used to investigate the effect of GB pretreatment on POCD. The hippocampus were harvested to test the expression of proinflammatory cytokines by ELISA. The expression of the microglial marker ionized calcium-binding adaptor molecule-1 (Iba-1) in the hippocampus was evaluated by western blot assay and immunohistochemistry. A Nissl staining experiment was used to detect the neuronal numbers in the hippocampus.

Results

Surgery might result in the overexpression of platelet activating factor (PAF) in the plasma and hippocampus and might cause hippocampus-dependent memory impairment. GB pretreatment, inhibited the activation of microglia, reduced the levels of IL-1β and TNF-α, decreased the loss of neurons after surgery, and prevented POCD in aged rats.

Conclusion

Our findings suggested that PAF was involved in the development of POCD. Improvement of POCD by PAF antagonist GB was associated with the inhibition of microgliosis-mediated neuroinflammation and neuronal apoptosis in aged rats.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01750-1.

[Impact of enhanced recovery after surgery strategy on early postoperative quality of recovery in patients undergoing laparoscopic surgery for gynecologic malignancy]

Objective: To investigate the impact of perioperative anesthesia management with enhanced recovery after surgery (ERAS) strategy on postoperative recovery in patients undergoing laparoscopic surgery for gynecologic malignancy. Methods: Ninety patients undergoing laparoscopic surgery for gynecologic malignancies from April 2018 to April 2019,aged 18-65 years,with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, were recruited and randomly divided into two groups (n=45) using a random number table:ERAS group (group E) and control group (group C). Patients in group E received general anesthesia combined with transverses abdominis plane block and a series of interventions to optimize anesthetic and perioperative management, while patients in group C were treated with routine anesthesia management. Quality of Recovery-40 questionnaire (QoR-40) was administered to assess the early postoperative quality of recovery on 1 day before surgery, and at 24 and 48h after surgery. C-reactive protein (CRP) before and after the operation were evaluated. The incidence of nausea, vomiting and shivering, the time of first exhaust, ambulation, resumption of normal diet, postoperative hospital stay and complications were recorded. Results: The scores of QoR-40 [M(Q₁, Q₃)] in Group E were 175(171, 179) and 185(183, 189) at 24 h and 48 h after operation, which were higher than those in group C [162(160, 167) and 180(179, 183)] (both P<0.01). The levels of CRP in both group E and group C increased at 24 h and 72 h after operation. Moreover, the extent of increasing level of CRP in group C was much higher than that in group E [(39.8±18.0) mg/L vs (13.4±6.3) mg/L, (16.6±8.6) mg/L vs (6.7±2.5) mg/L] at 24 h and 48 h after operation (both P<0.01). Compared with group C, the numerical rating scale (NRS) for nausea decreased significantly in group E [0(0, 2) vs 3 (0, 5), P<0.01]. Meanwhile, the incidence of vomiting and shivering in group E was lower than that in group C [8.9% (4/45) vs 26.7% (12/45); 11.1% (5/45) vs 31.1% (14/45); both P<0.05]. The time of first exhaust, ambulation and resumption of normal diet in group E was (14±6) h, 6(6, 13) h and 1(1, 2) d, respectively, which was markedly shorter than that in group C [(25±10) h, 21(19, 27) h and 3(2, 3) d] (all P<0.01). Overall, the postoperative length of hospital stay reduced significantly for patients who followed the ERAS protocol [7(5, 11) d vs 10(7, 14) d, P<0.01]. The incidence of postoperative complications was 17.8% (8/45) and 37.8% (17/45) in group E and group C, respectively, with a significant difference (P<0.05). Conclusion: Implementation of ERAS anesthesia management in gynecologic oncology patients undergoing minimally invasive surgery alleviates perioperative discomfort, decreases surgical stress response, and improves the early postoperative quality of recovery.

ED50 for intravenous midazolam-induced amnesia and its duration in surgical patients

BACKGROUND

Intraoperative awareness is a serious adverse event under general anesthesia. Midazolam has a good anterograde amnesia-inducing effect, can prevent and reduce the occurrence of intraoperative awareness. However, if the dosage of midazolam is improperly controlled, it may not produce forgetting effect, or bring obvious adverse side effects, such as respiratory depression, and delay of recovery. However, the half maximal effective dose (ED50 ) of midazolam for amnesia, the duration of amnesia and the factors affecting the duration of amnesia are still inconclusive. Therefore, it is of great clinical significance to observe and determine the dose, duration and influencing factors of amnesia induced by midazolam METHODS: A total of 106 patients who underwent ASA grades I-II elective operation under spinal-epidural anesthesia were intravenously injected with different doses of midazolam at 10 minutes after spinal-epidural anesthesia, every 5 minutes, the patient was presented with pictures or sounds as memory content, and heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), blood oxygen saturation (SpO2), bispectral index (BIS), OAA/S and adverse events were recorded. The patient's forgetfulness was followed up in the early morning after operation.

RESULTS

ED50 (the dose for amnesia in half of the subjects) was 0.031 mg/kg (95% CI: 0.027-0.036 mg/kg); ED95 (the dose for amnesia in 95% of the subjects) was 0.044 mg/kg (95% CI: 0.038-0.071 mg/kg). After the patients were injected intravenously with 0.04 mg/kg of midazolam, the respiratory and circulatory systems were basically stable, no serious adverse events occurred, and the forgetting rate was 88.5%. ET50 (the time for half of the subjects in a state of forgetfulness) was 23.77 minutes (95% CI: 20.18-27.07 min), and the corresponding BIS was 83.22; ET05 (the time for 5% of the subjects in a state of forgetfulness) was 53.90 minutes (95% CI: 48.54-61.47 min) and the corresponding BIS was 91.38. The amnesia-inducing effect of midazolam was correlated to sedation grade, BIS and age, and was not correlated to visual memory or auditory memory.

CONCLUSION

In this study, the ED50 , ED95 and maintenance time of the forgetting effect of intravenous midazolam were preliminarily determined.

KEY WORDS

Amnesia, Duration of amnesia, ED50, Midazolam.

The Association of Insomnia with Depression and Anxiety Symptoms in Patients Undergoing Noncardiac Surgery

OBJECTIVE

Insomnia is common in patients undergoing surgery. It can increase the rate of postoperative complications, interfere with patient recovery, and decrease hospital satisfaction. However, there are few studies on perioperative insomnia. This study was conducted to investigate the differences in the demographic, health status, and clinical characteristics of patients with and without insomnia postoperatively, and to identify the potential risk factors of insomnia.

METHODS

There were 299 non-cardiac surgery patients, 165 females, and 134 males, with a mean age of 55 years, enrolled in the study. The Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and Montreal Cognitive Assessment (MoCA) were administered to all the patients preoperatively. The Visual Analogue Scale (VAS) was used preoperatively, and at the end of the surgery, and then one day, two days, and three days after surgery. The PHQ-9, the GAD-7, and the ISI were repeated three days after surgery. Insomnia was diagnosed by the ISI as being a score of 8-28 (mild: 8-14; moderate-severe: 15-21; severe: 22-28). The patients were divided into group A (with insomnia, N=78) and group B (without insomnia, N=221) according to their ISI score three days after surgery. The general clinical data of the two groups were analyzed first, and then binary logistic regression analysis was conducted to assess the risk factors of insomnia.

RESULTS

A total of 299 non-cardiac surgery patients with a mean age of 55 years were enrolled in the study. Of the included patients, the number of females was 165 and the number of the male was 134. The incidence of insomnia at 3 days postoperatively was 26.1% (78/299). The average points that group A patients scored in the ISI, PHQ-9, and the GAD-7 were significantly higher than those in group B. The VAS score three days after surgery was significantly higher in group A. The PHQ-9 and the GAD-7 three days after surgery showed significantly higher depression and anxiety scores in group A. Logistic regression showed that the ISI (p<0.001, 95% CI=1.218-1.500) and the GAD-7 (p=0.003, 95% CI=1.041-1.218) preoperatively, and the PHQ-9 postoperatively (p<0.001, 95% CI=1.226-1.555), were risk factors of insomnia.

CONCLUSION

Insomnia is common and can worsen after surgery. The present study suggests that depression and anxiety are risk factors for insomnia after surgery. There is a need for further research and the development of strategies for depression and anxiety management to ensure better sleep quality for patients, which will be of significant benefit to their health.

CLINICAL TRIAL REGISTRATION

The study was registered at clinical trial (NCT04027751); Trial registration: clinical trial, NCT04027751. Registered 22 July 2019; https://clinicaltrials.gov/ct2/show/NCT04027751?cond=NCT04027751&cntry=CN&draw=2&rank=1.

Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients-a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients.

METHODS

The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study.

RESULTS

Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03).

CONCLUSIONS

Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.

Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation - a systematic review and meta-analysis of randomized controlled trials

Background

Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation.

Methods

The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes.

Results

Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; P=0.99; high-quality evidence). There was no heterogeneity among studies (I²=0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; P=1.00; high-quality evidence) and oral intubations (RR, 1.00; P=0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, −40.4 seconds; P<0.01; low-quality evidence). There were no differences between groups for other outcomes (P>0.05).

Conclusion

For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB.

The Role of Long Noncoding RNAs in Central Nervous System and Neurodegenerative Diseases

Long noncoding RNAs (lncRNAs) refer to a group of noncoding RNAs (ncRNAs) that has a transcript of more than 200 nucleotides in length in eukaryotic cells. The lncRNAs regulate gene expression at epigenetic, transcriptional, and post-transcriptional levels by multiple action modes. In this review, we describe the diverse roles reported for lncRNAs, and discuss how they could mechanistically be involved in the development of central nervous system (CNS) and neurodegenerative diseases. Further studies on the function of lncRNAs and their mechanism will help deepen our understanding of the development, function, and diseases of the CNS, and provide new ideas for the design and development of some therapeutic drugs.

Median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block

Objective

This study aimed to identify the median effective volume of ropivacaine 0.5% for ultrasound-guided adductor canal block (ACB).

Methods

Thirty-two patients received ultrasound-guided ACB for knee arthroscopic meniscectomy. The criterion for successful ACB was the loss of pinprick sensation in the saphenous area (medial knee, leg, and foot). The volume of ropivacaine 0.5% in each case was determined using the up-down method and used for calculating the median effective dose.

Results

The mean age, weight, and height of patients were 28.6 ± 7.1 years, 68.2 ± 10.6 kg, and 172.5 ± 6.4 cm, respectively. Among patients who received 18- and 15-mL doses, ACB was successful in all four cases. Among patients who received a 12-mL dose, ACB was effective in eight and ineffective in two cases. Among patients who received a 10-mL dose, ACB was successful in six and unsuccessful in seven cases. In patients who received an 8-mL dose, ACB was ineffective in all five cases. The median effective volume of ropivacaine 0.5% was 10.4 mL (95% confidence interval, 9.1–11.4 mL). In all effective cases, the median quadriceps strength was grade 5.

Conclusions

The median effective volume of ropivacaine 0.5% is 10.4 mL for ultrasound-guided ACB.

MiR-7684-5p leads to surgery-induced cognitive decline in mice probably through the downregulation of SorLA

BACKGROUND

Postoperative cognitive dysfunction is a postoperative severe complication caused by many factors. However, its specific pathogenesis remains unclear. MicroRNAs (miRNAs), which are involved in the pathogenesis of neurodegenerative diseases, may also affect POCD.

METHODS

In this research, microarray technology was used to screen 26 miRNAs that had a differential expression in the hippocampus of mouse between the surgery group and control group. The qRT-PCR verification on the hippocampuses of 10 pairs of mouse testifies the high expression of miR-7684-5p in the surgery group (identical with the result of chip).

RESULTS

Surgical trauma was found to induce the expression of miR-7684-5p with the accumulation of Aβ in the hippocampus. Furthermore, miR-7684-5p knockdown effectively reduced the levels of Aβ triggered by surgery, and attenuated hippocampal-dependent memory impairment. Moreover, we testify that sorLA is a target gene of miR-7684-5p through bioinformatics prediction and dual-luciferase report gene experiment.

CONCLUSIONS

Our data indicate that decreased postoperative cognitive function may be caused by the increased generation of Aβ by reducing sorLA expression. Our work implicates miR-7684-5p as a potential biomarker and a novel therapeutic target.

Research progress on the roles of microRNAs in governing synaptic plasticity, learning and memory

The importance of non-coding RNA involved in biological processes has become apparent in recent years and the mechanism of transcriptional regulation has also been identified. MicroRNAs (miRNAs) represent a class of small regulatory non-coding RNAs of 22bp in length that mediate gene silencing by identifying specific sequences in the target messenger RNAs (mRNAs). Many miRNAs are highly expressed in the central nervous system in a spatially and temporally controlled manner in normal physiology, as well as in certain pathological conditions. There is growing evidence that a considerable number of specific miRNAs play important roles in synaptic plasticity, learning and memory function. In addition, the dysfunction of these molecules may also contribute to the etiology of several neurodegenerative diseases. Here we provide an overview of the current literatures, which support non-coding RNA-mediated gene function regulation represents an important but underappreciated, layer of epigenetic control that facilitates learning and memory functions.

Ozonated autohemotherapy modulates the serum levels of inflammatory cytokines in gouty patients

Objectives

Ozonated autohemotherapy (O3-AHT) has been used to effectively treat gout, but the underlying therapeutic mechanisms remain unknown. In this study, as an initial effort to understand the therapeutic mechanisms of O3-AHT, we aim to examine the effect of O3-AHT on serum inflammatory cytokine levels in gouty patients.

Patients and methods

Three groups of patients and healthy subjects were recruited, including the gouty (n=10), hyperuricemia (n=10), and healthy control (n=11) groups. Cytometric bead array was applied to examine 12 cytokines before (T0), during (T1), and after (T2) therapies.

Results

Three cytokines, IL-8, IL-12, and MCP-1, were detectable in all participants. Before O3-AHT, the average serum levels of IL-8 and MCP-1 were higher in the gout group than in the hyperuricemia and healthy control groups, confirming the inflammation status in gouty patients. After the 5th course of O3-AHT (T1), IL-8 level was significantly increased compared to that at T0. IL-12 level was also raised at T1, although the difference did not reach statistical significance. After completing the therapy, both IL-8 and IL-12 levels decreased to levels lower than those at T0. MCP-1 level remained essentially unchanged during and after treatment.

Conclusion

Our results indicate that O3-AHT induces a significant change in serum cytokine levels, suggesting that modulating the inflammatory process is one of the therapeutic mechanisms underlying O3-AHT. In addition, the sensitive response of serum IL-8 and IL-12 levels to O3-AHT suggests that these cytokines may be developed as biomarkers to evaluate the therapeutic effect of O3-AHT in gouty patients.

Changes in duration of action of rocuronium following decrease in hepatic blood flow during pneumoperitoneum for laparoscopic gynaecological surgery

Background

A moderate insufflation pressure and deep neuromuscular blockade (NMB) have been recommended in laparoscopic surgery in consideration of the possible reduction in splanchnic perfusion due to the CO₂-pneumoperitoneum. Since the liver is the major organ for rocuronium metabolism, the question of whether NMB of rocuronium would change with the variation of liver perfusion during pneumoperitoneum during laparoscopic surgery merits investigation.

Methods

In this prospective study, a total of sixty female patients scheduled for either selective laparoscopic gynaecological surgery (group laparoscopy) or laparotomy for gynaecological surgery (group control) were analyzed. Rocuronium was administered with closed-loop feedback infusion system, which was also applied to monitor NMB complied with good clinical research practice (GCRP). The onset time, clinical duration, and recovery index were measured. Hepatic blood flow was assessed by laparoscopic intraoperative ultrasonography before insufflation/after entering the abdominal cavity (T1), 5 min after insufflation in the Trendelenburg position/5 min after skin incision (T2), 15 min after insufflation in the Trendelenburg position/15 min after skin incision (T3), 30 min after insufflation in the Trendelenburg position/30 min after skin incision (T4), and 5 min after deflation/before closing the abdomen (T5) in group laparoscopy/group control respectively. The relationship between the clinical duration of rocuronium and portal venous blood flow was analyzed using linear or quadratic regression.

Result

The clinical duration and RI of rocuronium were both prolonged significantly in group laparoscopy (36.8 ± 8.3 min; 12.8 ± 5.5 min) compared to group control (29.0 ± 5.8 min; 9.8 ± 4.0 min) (P < 0.0001; P = 0.018). A significant decrease was found in portal venous blood flow during the entire pneumoperitoneum period in group laparoscopy compared with group control (P < 0.0001). There was a significant correlation between the clinical duration of rocuronium and portal venous blood flow (Y = 51.800-0.043X + (1.86E-005) X²; r² = 0.491; P < 0.0001).

Conclusion

Rocuronium-induced NMB during laparoscopic gynaecological surgery might be prolonged due to the decrease in portal venous blood flow induced by CO₂-pneumoperitoneum. Less rocuronium could be required to achieve a desirable NMB in laparoscopic gynaecological surgery.

Trial registration

ChiCTR. Registry number: ChiCTR-OPN-15007524. Date of registration: December 4, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-017-0335-1) contains supplementary material, which is available to authorized users.

Propofol may protect PC12 cells from β-amyloid₂₅₋₃₅ induced apoptosis through the GSK-3β signaling pathway

BACKGROUND

There are two major pathological hallmarks of Alzheimer's disease. One is the progressive accumulation of beta-amyloid (Aβ) in the form of senile plaques; the other is hyperphosphorylated tau, causing neuronal apoptosis. Some inhalation anesthetics, such as isoflurane and desflurane, have been suggested to induce Aβ accumulation and cause AD-like neuropathogenesis. Whether intravenous anesthetics have similar effects is still unclear. We therefore set out to determine the relationship between propofol and AD-like pathogenesis.

METHODS

PC12 cells were cultured in serum-free medium for 12 hours prior to drug treatment. Various concentrations from 5 µmol/L to 80 µmol/L of aggregated Aβ25-35 were added to determine a proper concentration for further study. After exposure to 10 µmol/L Aβ25-35 alone or with 20 µmol/L propofol for 6 hours, PC12 cell viability was determined by MTT assay. Western blotting and immunocytochemical staining were performed to observe the protein expression of the Bcl-2 family, tau phosphorylation at different sites, and tau protein kinases and phosphatases.

RESULTS

Aβ25-35 induced a decrease in PC12 cell viability in a dose-dependent manner. Exposure to 10 µmol/L Aβ25-35 for 6 hours resulted in the mild cell survival, accompanied by a decline in Bcl-2, and an increase in phosphorylation of GSK-3β and tau at different sites. Compared with the Aβ25-35 group, cells treated with propofol alone showed no significant difference, while cells co-incubated with propofol and Aβ25-35 showed a significantly higher survival rate (P < 0.01 or P < 0.05). Tau phosphorylation at Ser396, Ser404 and Thr231 and the level of GSK-3β in PC12 cells increased after exposure to 10 µmol/L Aβ25-35. Co-incubation with propofol attenuated cellular apoptosis by inhibiting tau phosphorylation.

CONCLUSIONS

These data indicate that propofol may protect PC12 cells from Aβ25-35-induced apoptosis and tau hyperphosphorylation through the GSK-3β pathway, therefore it may be a safer anesthesia for AD and elderly patients.

Pneumonia relevant to lung transplantation and pathogen distribution

BACKGROUND

Pneumonia is the most common cause of morbidity and mortality in lung transplant (LT) recipients. The aim of the present study was to evaluate the incidence, etiology, risk factors and prognosis of pneumonia in LT recipients.

METHODS

The LT cohort consisted of 28 recipients receiving LT in Beijing Chao-Yang Hospital from August 2005 to April 2011. Data collected included demographic data, underlying disorders, time and type of transplant, follow-up information, date of last follow-up, and patient status. A retrospective analysis was made of observational data that were prospectively collected.

RESULTS

Twenty-two patients of 28 LT recipients had 47 episodes of pneumonia throughout the study period. Thirtyeight episodes of pneumonia in 19 recipients occurred post-LT with a median follow-up of 257.5 days (1-2104 days), the incidence of pneumonia was 192.4 episodes per 100 LT/year and its median time of onset was 100.5 days (0-946 days) post-transplantation. Bacteria, virus and fungi accounted for 62%, 16% and 15% of the microbial pathogens, respectively. The most frequent were Pseudomonas aeruginosa (20%), cytomegalovirus (CMV) (15%), and Aspergillus fumigatus (10%). A total of 29% (11/38) of pneumonias occurred in the first month post-LT, and then the incidence decreased gradually. The incidence of CMV pneumonia was 25% (7/28) with a median time of 97 days (10-971 days). More than one bacterial infection and CMV infection were independent risk factors for aspergillus infection. The incidence of pulmonary tuberculosis (TB) was 18% (5/28), and the history of TB was a risk factor for TB relapse. There were 58% (7/12) of recipients who died of infection, and 71% (5/7) of these died in the first year after LT.

CONCLUSIONS

Pneumonia is still a major cause of morbidity and mortality in LT recipients. The most frequent microorganisms were Pseudomonas aeruginosa, CMV, and Aspergillus fumigates. The incidence of CMV pneumonia decreases with a delayed median time of onset. More than one incidence of bacterial infection and CMV infection are independent risk factors for aspergillus infection. LT recipients are at high risk for TB, and the history of TB is a risk factor for TB relapse.

Serum proteomics of early postoperative cognitive dysfunction in elderly patients

BACKGROUND

Studies on postoperative cognitive dysfunction (POCD) have attracted extensive attention and achieved significant progress. However, the diagnosis of POCD is not very satisfactory as no specific biomarkers have been classified. The aim of the present study was to evaluate differences in serum protein composition between POCD and Non-POCD patients, identify potential biomarkers associated with early POCD, and study the mechanism underlying POCD.

METHODS

Sixty-eight elderly patients (age ≥ 65 years) received isoflurane inhalation anesthesia for arthroplasty surgeries. One day before and seven days after the surgery, these patients were subjected to a neuropsychological test and venous blood sample collection. Postoperative cognitive dysfunction was determined using Z test scores. Based on the results, the patients were divided into POCD and non-POCD groups. Twenty-five randomly chosen blood samples obtained seven days after the surgery from each group were analyzed on a Bruker ultraFlex(TM) time of flight (TOF)/TOF mass spectrophotometer. The resulting peptide fingerprints were compared with those from the pre-surgery samples to identify differences in serum protein composition. The model designed to distinguish between a non-POCD group and a POCD group were established and validated. Three proteins with the most significant changes were selected for further characterization.

RESULTS

Thirty-three cases were diagnosed as POCD. Using the Clinprotools software, 58 polypeptides were found to display differential expression (P < 0.05). Using a support vector algorithm method, seven differential peaks were isolated to establish a diagnostic model to distinguish POCD patients from normal individuals. The prediction rate and recognition rate were 96.89% and 100%, respectively. Validation of this model showed that the accuracy rates were 100% and 85% using samples from the POCD and non-POCD groups, respectively. Protein analysis also led to the identification of fibrinopeptide A (FPA) as a potential biomarker for POCD.

CONCLUSIONS

Arthroplastic surgery under isoflurane inhalation anesthesia causes differential serum protein expression in elderly patients. These differentially expressed proteins may contribute to the diagnosis of early POCD, which may provide a basis for identifying the underlying mechanism of POCD development.

[Reduced port surgery : Developing a safe pathway to single port access surgery]

"Scarfree" surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental.

Effects of the novel 6% hydroxyethyl starch 130/0.4 on renal function of recipients in living-related kidney transplantation

BACKGROUND

The optimal colloid for use during kidney transplantation is not clear. Patients undergoing living-related kidney transplantation (LRKT) were used to compare the protective effects of 6% hydroxyethyl starch 130/0.4 (HES 130/0.4) and 4% succinylated gelatine, as donor kidney procurement, ischemia time and surgical conditions are comparable. Stroke volume variation (SVV) was used to monitor intravascular volume to avoid renal allograft hypoperfusion.

METHODS

Eighty patients undergoing LRKT were divided into two groups: group H received 6% HES 130/0.4 and group G received 4% succinylated gelatine. All donors and recipients received 15 - 25 ml/kg of the relevant colloid during surgery. Arterial blood pressure (ABP), heart rate (HR), central venous pressure (CVP), SVV and cardiac index (CI), electrocardiography (ECG) and SpO2 were monitored continuously. SVV was kept between 6% - 13% and mean arterial pressure at 100 - 130 mmHg. Samples of venous blood and urine were obtained 30 minutes after unclamping and on the mornings of post-operative days (POD) 1 - 4 to measure serum and urine β2-microglobulin, urine α1-microglobulin, microalbumin and N-acetyl-β-D-glucosaminidase. Blood urea nitrogen (BUN) and creatine were determined pre-operation (t(0)), 3 hours after surgery (t(1)) and on PODs 1 (t(2)), 2 (t(3)), 4 (t(4)), 7 (t(5)) and 10 (t(6)). Urine output was recorded at t(1), t(2), t(5), t(6).

RESULTS

Age, body weight, body surface area (BSA), operation time, urine output and the colloid volume infused were comparable between the groups and hemodynamics were stable during surgery. BUN, serum creatine, serum β2-microglobulin and urine β2-microglobulin decreased significantly after surgery in both groups relative to the baseline. BUN decreased significantly in group H compared with group G at t(1), t(2) and t(4). Urine microalbumin decreased significantly in group H on POD 4 compared with group G. Urine α1-microglobulin was not significantly different between the two groups.

CONCLUSION

Both colloids can be safely used for LRKT, but HES130/0.4 was associated with a more rapid recovery of renal function.

[Correlation of hippocampal acetylcholine and learning and study capability after anesthesia in senescent rats]

OBJECTIVE

To investigate the general anesthetic's effect upon cholinergic system to examine whether the regional and progressive cholinergic changes may lead to postoperative cognitive dysfunction (POCD).

METHOD

A model of hippocampus microdialysis was established in aging rats (18 months old). The tissue levels of choline (Ch) and acetylcholine (Ach) were determined in hippocampus. The post-anesthesia learning capability and spatial memory were tested in Morris maze. Using in vivo microdialysis, the releases of Ach and Ch, functional parameters of cholinergic system, were determined in freely moving rats. The contents of both in perfusate were quantified by HPLC-ECD as described for the function of cholinergic system.

RESULTS

The learning curve of the control group demonstrated differences from the experiment group. Changes in hippocampal Ach and Ch levels were observed in both cognition markedly impaired group and cognition lightly impaired group, accompanied by performance failure in water maze test. In the experiment group, the hippocampal releases of Ach and Ch were markedly different between cognition markedly impaired group and cognition lightly impaired group.

CONCLUSION

Cholinergic system dysfunction in hippocampus may be responsible for behavioral abnormality in learning and spatial memory tasks in senescent rats.

Acrylic acid removal from synthetic wastewater and industrial wastewater using Ralstonia solanacearum and Acidovorax avenae isolated from a wastewater treatment system manufactured with polyacrylonitrile fiber

Ralstonia solanacearum and Acidovorax avenae were isolated from a wastewater treatment system manufactured with polyacrylonitrile fiber. The investigation goal is to elucidate the effectiveness of Ralstonia solanacearum and Acidovorax avenae in treating acrylic acid from synthetic wastewater and industrial wastewater. The results reveal that Ralstonia solanacearum and Acidovorax avenae could utilize acrylic acid from synthetic wastewater for growth, when the initial acrylic acid concentration was below 1,009.1 mg/l and 1,383.4 mg/l, respectively. When the acrylic acid concentration was below 606.8 mg/l, the acrylic acid removal ability reached 96.7% and 100%, respectively. Both strains could tolerate acrylamide toxicity, but only Ralstonia solanacearum could tolerate acrylonitrile toxicity. Ralstonia solanacearum and Acidovorax avenae could utilize acrylic acid from industrial wastewater for growth, when the initial acrylic acid concentration was below 1,741.1 mg/l and 1,431.2 mg/l, respectively. When the acrylic acid concentration was below 690.8 mg/l, the acrylic acid removal efficiency reached 83.5% and 62.2%, respectively. Whether the acrylic acid existed in synthetic wastewater or in industrial wastewater, the removal efficiency of acrylic acid by Ralstonia solanacearum exceeded that by Acidovorax avena.

Putting More Genetics into Genetic Algorithms

The majority of current genetic algorithms (GAs), while inspired by natural evolutionary systems, are seldom viewed as biologically plausible models. This is not a criticism of GAs, but rather a reflection of choices made regarding the level of abstraction at which biological mechanisms are modeled, and a reflection of the more engineering-oriented goals of the evolutionary computation community. Understanding better and reducing this gap between GAs and genetics has been a central issue in an interdisciplinary project whose goal is to build GA-based computational models of viral evolution. The result is a system called Virtual Virus (VIV). The VIV incorporates a number of more biologically plausible mechanisms, including a more flexible genotype-to-phenotype mapping. In VIV the genes are independent of position, and genomes can vary in length and may contain noncoding regions, as well as duplicative or competing genes. Initial computational studies with VIV have already revealed several emergent phenomena of both biological and computational interest. In the absence of any penalty based on genome length, VIV develops individuals with long genomes and also performs more poorly (from a problem-solving viewpoint) than when a length penalty is used. With a fixed linear length penalty, genome length tends to increase dramatically in the early phases of evolution and then decrease to a level based on the mutation rate. The plateau genome length (i.e., the average length of individuals in the final population) generally increases in response to an increase in the base mutation rate. When VIV converges, there tend to be many copies of good alternative genes within the individuals. We observed many instances of switching between active and inactive genes during the entire evolutionary process. These observations support the conclusion that noncoding regions serve a positive step in understanding how GAs might exploit more of the power and flexibility of biological evolution while simultaneously providing better tools for understanding evolving biological systems.

Putting more genetics into genetic algorithms

The majority of current genetic algorithms (GAs), while inspired by natural evolutionary systems, are seldom viewed as biologically plausible models. This is not a criticism of GAs, but rather a reflection of choices made regarding the level of abstraction at which biological mechanisms are modeled, and a reflection of the more engineering-oriented goals of the evolutionary computation community. Understanding better and reducing this gap between GAs and genetics has been a central issue in an interdisciplinary project whose goal is to build GA-based computational models of viral evolution. The result is a system called Virtual Virus (VIV). VIV incorporates a number of more biologically plausible mechanisms, including a more flexible genotype-to-phenotype mapping. In VIV the genes are independent of position, and genomes can vary in length and may contain noncoding regions, as well as duplicative or competing genes. Initial computational studies with VIV have already revealed several emergent phenomena of both biological and computational interest. In the absence of any penalty based on genome length, VIV develops individuals with long genomes and also performs more poorly (from a problem-solving viewpoint) than when a length penalty is used. With a fixed linear length penalty, genome length tends to increase dramatically in the early phases of evolution and then decrease to a level based on the mutation rate. The plateau genome length (i.e., the average length of individuals in the final population) generally increases in response to an increase in the base mutation rate. When VIV converges, there tend to be many copies of good alternative genes within the individuals. We observed many instances of switching between active and inactive genes during the entire evolutionary process. These observations support the conclusion that noncoding regions serve as scratch space in which VIV can explore alternative gene values. These results represent a positive step in understanding how GAs might exploit more of the power and flexibility of biological evolution while simultaneously providing better tools for understanding evolving biological systems.

Neuronal intestinal dysplasia presenting as an abdominal mass: report of a case

An unusual clinical presentation of a patient with neuronal intestinal dysplasia is presented. A 46-year-old male noted a palpable mass in the right lower quadrant of his abdomen for two months. A computed axial tomographic scan showed a thickened wall of the cecum with a tumor-like appearance. The excised specimen consisted of a mass caused by the thickened, edematous wall of the dilated cecum and appendix. The wall of the cecum and appendix measured up to 2.5 and 0.8 cm, respectively, in thickness. Microscopic studies showed extensive hyperplasia and hypertrophy of the ganglia and nerve plexuses and hypertrophy of the muscularis propria, consistent with neuronal intestinal dysplasia.

The oral health status and treatment needs of adults aged 65+ living independently in Ottawa-Carleton

We report the findings from a dental survey of a random sample of 299 senior citizens living in Ottawa-Carleton. Those examined were younger, less likely to have a regular dentist, and more likely to have oro-facial pain, difficulty chewing, and to perceive a need to visit a dentist compared with those responding to the enrollment phone interview. Among the 65% of seniors who were dentate, 37% had dental decay; men and seniors with low incomes had more decay (p less than 0.05). Periodontal disease was worse among older seniors, men and poor seniors (p less than 0.05). One third of all seniors reported recent oro-facial pain, 50% had difficulty chewing foods and 30% reported some social impact resulting from their oral health. The resources required to treat the prevalent disorders were considerable and differences between dentate and edentulous people were negligible. Senior citizens expressed attitudes which indicate that they value dental health and would like help to achieve it.

Interactive effects of organic and inorganic selenium with cadmium and mercury on spermatozoal oxygen consumption and motility in vitro

The effects of cadmium (Cd), mercury (Hg), and three different chemical forms of selenium (Se) (selenite, selenocystine, and selenomethionine) on ram spermatozoal motility and oxygen consumption in vitro were studied over a 4-mo period. Concentrations of 10(-6) to 10(-2) M Cd and Hg were injurious to spermatozoa as indicated by depressed motility and reduced oxygen uptake. Equimolar concentrations of Se as selenite, selenocystine, or selenomethionine counteracted the toxicity of Cd and Hg at low concentrations (10(-5) and 10(-6) M) but not at higher concentrations (10(-4) to 10(-2) M). Gel filtration (Sephadex G-75) of seminal plasma and solubilized sperm prepared from semen incubated with Cd or Hg with or without the Se compounds revealed that Cd or Hg eluted with the void volume proteins in all treatments. Incubation of ram spermatozoa with any of the three chemical forms of Se ranging from 10(-6) to 2.5 X 10(-5) M significantly improved sperm motility and oxygen consumption.

Incorporation of selenium-75 into semen and reproductive tissues of bulls and rams

After intramuscular injections of 500 muCi 75Se, semen was collected periodically over a 63-day period from a selenium-deficient and a selenium-injected ram which were then killed for collection of the reproductive organs for the gel filtration studies. Testes, accessory glands and semen were also obtained from a bull injected intravenously with 75Se. Gel filtration (Sephadex G 150) of ram testis cytosol resulted in 4 75Se peaks (Ve/Vo ratios of 1 X 1, 1 X 5, 2 X 3, 2 X 9). In the selenium-injected ram the glutathione peroxidase (GSH-Px) peak (Ve/Vo 1 X 5) predominated, but in the selenium-deficient ram, radioactivity of the GSH-Px peak was less than that of the higher molecular weight peak (Ve/Vo 1 X 1). Gel filtration chromatograms of bull testis cytosol yielded 5 75Se peaks (Ve/Vo 1 X 1, 1 X 5, 1 X 9, 2 X 4, 2 X 8). In chromatograms of ram seminal plasma on Sephacryl S-200 there were 2 major (Ve/Vo 1 X 4, 1 X 1) and 2 minor peaks (Ve/Vo 1 X 7, 2 X 4). 75Se increased with time up to 49 days after injection in all peaks. 75Se-labelled bull seminal plasma yielded 2 75Se peaks (Ve/Vo 1 X 1, 1 X 4) which corresponded to the major peaks of ram seminal plasma. Bull and ram seminal plasma GSH-Px activities per mg protein were comparable (28 and 29 nmol NADPHox/min, respectively), but when expressed per ml seminal plasma, activity of the bull was more than 7 times the highest activity of ram seminal plasma (2908 and 385 nmol NADPHox/min, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Fine structural abnormalities of spermatozoa from a subfertile bull: A case report

Spermatozoa from a nine-year-old subfertile Holstein bull were evaluated by light and electron microscopy. Morphological abnormalities observed included cytoplasmic droplet-like structures, constriction of the midpiece, missing axial filaments and abnormal spermatozoal head shapes.

Ultrastructural demonstration of cilia and ciliary rootlets in mammalian uterine tube epithelium in different functional states

Tissue from the infundibulum region of the uterine tube (oviduct) of guinea pigs, cattle, sheep, and swine was examined by electron microscopy. In all specimens, cilia and ciliary rootlets were present in variable numbers in the ciliated cells during both the follicular and the luteal phases of the estrous cycle. True degeneration of cilia was not evident during luteal phase or pregnancy. The ciliary rootlets in ruminant and nonruminant species had structural similarities to those described in people and rhesus monkeys. These organelles measured approximately 1 mum long in most species studied, but in the cow, the rootlets, extending downward into the cytoplasm from the proximal end of the basal body, reached a length of 2 mum. The rootlets had a cross-striation of thick and thin bands, the period measuring 40 to 60 nm. Mitochondria were closely associated with the rootlets. The rootlets usually formed a small angle to the axis of the cilium. These organelles probably function as anchoring or stabilizing structures for the motile cilia. Results indicated that the rootlets are more widely distributed in mammalian uterine tube cilia than previously postulated. Polyribosomes, microfilaments, microtubules, and electron-opaque fibrous granules were frequently seen in the cytoplasm of the ciliated cells. The presence of fibrous granules in close association with the basal bodies indicate that these granules have a role in the development of cilia and rootlets. Cilia and precursor fibrous granules were also seen in porcine fetal uterine tube epithelial cells.