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Objective:To observe the effect of ventilator-induced lung injury (VILI) on blood-brain barrier permeability in rats.Methods:Forty-eight healthy clean male Sprague-Dawley (SD) rats were randomly divided into sham operation (Sham) group, low tidal volume (LVT) mechanical ventilation group (LVT group), normal tidal volume (NVT) mechanical ventilation group (NVT group) and high tidal volume (HVT) mechanical ventilation group (HVT group) with 12 rats in each group. After anesthesia, rats in the Sham group were intubated and kept spontaneous breathing. The rats in different tidal volume (VT) groups were mechanically ventilated by endotracheal intubation with VT of 6 mL/kg (LVT group), 10 mL/kg (NVT group), and 20 mL/kg (HVT group), respectively. The inspiration-expiration ratio of the three groups was 1∶1, the ventilation frequency was 40 times/min, and the ventilation time was 3 hours. At the end of the experiment, the bronchoalveolar lavage fluid (BALF) of rats was collected, and the levels of pro-inflammatory factors [tumor necrosis factor-α (TNF-α), interleukins (IL-1β and IL-6)] in BALF were detected by enzyme-linked immunosorbent assay (ELISA). The lung tissues of rats were collected, and the lung wet/dry weight (W/D) ratio was calculated. The pathological changes of lung tissues were observed under light microscopy after hematoxylin-eosin (HE) staining, and lung injury scores were performed. The brain tissue of rats was taken to measure the brain water content, and the Evans blue (EB) content of brain tissue was measured to reflect the permeability of the blood-brain barrier. The tight junction proteins in the brain tissues were detected by Western blotting.Results:After 3 hours of mechanical ventilation, with the increase of VT, the degree of lung injury in VILI rats gradually increased. When VT reached 20 mL/kg, lung tissue structure was significantly injured, alveolar wall edema, alveolar congestion, lung interstitial thickening, a large number of inflammatory cells infiltrated, and the lung injury score, lung W/D ratio, and the levels of TNF-α, IL-1β and IL-6 in BALF were significantly higher than those in the Sham group [lung injury score: 10.6±1.1 vs. 1.4±1.0, lung W/D ratio: 6.6±0.8 vs. 3.7±0.6, TNF-α(ng/L): 832.9±97.9 vs. 103.8±23.3, IL-1β (ng/L): 68.9±14.1 vs. 15.7±2.6, IL-6 (ng/L): 70.8±16.4 vs. 20.3±5.4, all P < 0.05]. Lung injury in rats was accompanied by aggravating brain injury. When VT reached 20 mL/kg, brain water content and EB content in brain tissue were significantly higher than those in the Sham group [brain water content: (85.4±3.6)% vs. (68.7±2.7)%, EB content in brain tissue (μg/g): 887±78 vs. 97±14, both P < 0.05], and the protein expressions of claudin-5, occluding and zonula occluden-1 (ZO-1) in the brain tissue were significantly lower than those in the Sham group [claudin-5 protein (claudin-5/β-actin): 0.67±0.12 vs. 1.45±0.19, occludin protein (occludin/β-actin): 0.48±0.11 vs. 0.99±0.21, ZO-1 protein (ZO-1/β-actin): 0.13±0.03 vs. 0.63±0.12, all P < 0.05]. Conclusion:VILI can induce brain edema and increase blood-brain barrier permeability in rats, which may be related to the down-regulation of tight junction protein expression in the brain tissue.
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ObjectiveTo screen and validate key enzyme genes affecting the polysaccharide content in different Polygonatum species and perform in-depth amino acid sequence analysis by transcriptomic analysis of P. zanlanscianense， P. kingianum， and P. cyrtonema rhizomes to enrich the transcriptome data of Polygonatum plants and provide references for polysaccharide biosynthesis mechanism and genetic improvement. MethodThe Polygonatum transcriptome was sequenced and analyzed using the Illumina NovaSeq high-throughput sequencing platform， and the differences in the transcriptomes of the three Polygonatum species were compared and according to the annotations of Nr， Gene Ontology （GO）， and Kyoto Encyclopedia of Genes and Genomes （KEGG） databases. The key enzymes in the polysaccharide metabolism pathway were screened， and the expression of key enzyme genes was clustered and correlated with the polysaccharide content. Finally， Real-time polymerase chain reaction （Real-time PCR） was performed to validate the eight key enzyme genes， and the key genes of polysaccharide biosynthesis were further screened for homologous gene sequence analysis in combination with sequencing results， followed by constructing phylogenetic trees， predicting motifs， conserved structural domains， protein sequence isoelectric points， and molecular weights， and constructing 3D protein structures by using homology modeling method. ResultThe annotation of the Nr database revealed that three Polygonatum species had the highest gene homology with Asparagus officinalis. GO database annotation results showed that three Polygonatum species differed significantly in binding， catalytic activity， metabolic processes， and cellular components， while the KEGG pathway annotation results indicated that three Polygonatum species differed significantly in the starch and sucrose metabolic pathway and galactose metabolic pathway. According to clustering analysis， correlation analysis， Real-time PCR， expression profiles， and structural and functional predictions of amino acid sequences， the key enzyme significantly affecting the polysaccharide content in different Polygonatum species was inferred to be β-fructofuranosidase （sacA）. ConclusionSacA may be the main influencing factor for the difference in polysaccharide content of Polygonatum， and is also an important reason why Polygonatum polysaccharides are mainly fructans.
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As an important measure starting for hospital management, hospital accreditation can effectively guide hospitals to improve their comprehensive service capabilities and management level. The accreditation results of 38 tertiary general hospitals in Jiangsu province from 2018 to 2020 showed that there were weaknesses existing in the development of hospitals, including the radiosity and influence of tertiary hospitals, patient service mode, construction of medical technology capabilities and disciplines, medical quality and safety, nursing quality management and specialized nursing, and information construction. The author suggested that hospitals should return to functional positioning, improve the service quality, strengthen construction of hospital disciplines and technical projects, consolidate the foundation of quality and safety management, improve the level of information technology construction, for references for promoting the high-quality sustainable development of tertiary general hospitals.
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Objective:To review the concept of science and technology ethics, analyze the problems faced by science and technology ethics governance from the perspective of collaborative governance, and then propose suggestions.Methods:Using the literature review method, we searched and screened relevant literature on science and technology ethics governance, extracted the research content and results of such literature for systematically review and summarization.Results:The problems of China′s science and technology ethics governance include slow legalization progress, unclear disciplinary standards, unsound governance systems, and weak scientific and technological ethics awareness among researchers.Conclusions:Strengthening the governance of science and technology ethics requires a multi-level approach, including strengthening the legislation of science and technology ethics, improving the governance mechanism, and improving the awareness of science and technology ethics among the scientists and technologists.
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Objective:To explore the implementation path of scientific and technological achievement empowerment for researchers in public hospitals.Methods:Through literature research, theoretical research, policy research, etc, current situation and progress of the ownership management reform of scientific and technological achievements at home and abroad were sorted out, and the difficult problems in the empowerment of scientific and technological achievements were summarized in combination with its practice in domestic public hospitals.Results:The following problems existed in the empowerment of scientific and technological achievements in public hospitals: weak awareness of medical staff′s ownership protection imperfect empowerment system, lagging construction of management personnel, and constraints of state-owned assets management.Conclusions:It is suggested to improve the coordination mechanism of government departments, optimize related policy and law environment and innovation atmosphere, implement a categorized and tiered empowerment strategy for job scientific and technological achievements, set up a management platform of medical scientific and technological achievements, build a complete support service system, establish a mechanism for cultivating and producing high-value achievements, and strengthen the construction of achievement management personnel.
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Objective:To study the characteristics and patterns of medical research integrity cases reported by the Ministry of Science and Technology, and to explore the countermeasures to strengthen the management of medical research integrity.Methods:20 batches of 555 cases of scientific research integrity cases publicly reported by the Ministry of Science and Technology of the People's Republic of China from June 2021 to May 2022 were taken as the research objects, and the papers involved, regional distribution, scientific research dishonesty and disciplinary measures were classified and analyzed.Results:Data falsification was the most common problem of scientific research dishonesty, accounting for 47.39%. Shandong Province was the province with the most reported cases, accounting for 50.81%. 27.67% of the corresponding authors received 5 disciplinary measures, and 26.28% of the first authors received 6 disciplinary measures. Among the disciplinary measures, the proportion of suspension of applications for various scientific research projects was the highest, with 87.60% of corresponding authors and 91.42% of first authors receiving this punishment. The corresponing authors with 5 years suspension accounted for 49.24% of all years, and the first authors accounted for 57.48%.Conclusions:To promote the integrity governance of medical research, we should strengthen the supervision of medical journals, promote regional exchanges, encourage active error correction, and improve the construction of scientific research integrity database.
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Objective:Through text mining, to clarify the change characteristics and evolution patterns of China's scientific research integrity policies, thereby providing a reference basis for the formulation and implementation of medical scientific research integrity governance policies.Methods:Using cost-CM6 and SPSS software, co-word analysis, social semantic network, and cluster analysis methods, data mining was conducted on 297 national scientific research integrity policy texts from 2002 to 2021.Results:China′s research integrity policies have experienced three development stages: academic ethics construction period(2002-2008), research integrity construction period(2009-2015), and academic environment optimization period(2016-2021), with the rapid development of both quantity and quality of policies, gradual clarification of rules for investigation and handling of research integrity cases, continuous improvement of accountability mechanism, and more powerful disciplinary measures for dishonesty. The construction of scientific research integrity formed a joint force pattern under the leadership of the central government and coordinated governance of multiple departments. Research misconduct incidents and public concern accelerated the improvement of the scientific research credibility policy system. Adhere to" no exclusion zone, full coverage, zero tolerance" has become the work guide of scientific research integrity governance.Conclusions:It is suggested to continuously improve the effectiveness of medical research integrity governance by strengthening medical integrity education and enhancing self-discipline consciousness, improving supervision mechanisms, strengthening process management and plagiarism checking of medical achievements, and adopting a two-pronged approach of " severe punishment" and " good governance" .
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Objective:To establish an artificial neural network (ANN) model for predication of postoperative fatigue syndrome (POFS) in patients with painless colonoscopy.Methods:The out-patients received painless colonoscopy from October 2016 to February 2017 were selected.A total of 38 factors influencing POFS during perioperative period were collected.Christensen postoperative fatigue score was performed when resuscitation achieved the standard.The patients were divided into POFS group (Christensen score≥3) and non-POFS group (Christensen score<3) according to whether POFS occurred.Logistic regression predication model and ANN predication model were established and tested, respectively.The areas under the receiver operating characteristic curve were used to compare the efficacy of the two models for predication of POFS.Results:The error rates of the ANN prediction model training set and test set were 23.1% and 28.1%, respectively.The sensitivity and specificity of the training set were 88.6% and 52.7%, respectively.The sensitivity and specificity of the test set were 91.6% and 71.1%, respectively.The areas under the curves of logistic regression predication model and ANN predication model were 0.698 and 0.776, respectively.Conclusion:ANN prediction model has been successfully established, which provides better efficacy than logistic regression predication model for predication of POFS in patients with painless colonoscopy .
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Objective@#To evaluate the role of microRNA-125b (miR-125b) on ventilator-induced lung injury (VILI) in mice.@*Methods@#Forty healthy male C57BL/6 male mice, weighing 25-30 g, aged 2-3 months, were divided into 4 groups (n=10 each) using a random number table method: sham operation group (group Sham), group VILI, VILI plus miR-125b negative control group (group VILI+ NC), and VILI plus miR-125b overexpression group (group VILI+ miR-125b agomir). In VILI+ NC and VILI+ miR-125b agomir groups, miR-125b negative control and miR-125b agomir transfection complex 50 μl were intratracheally instilled, respectively, and 48 h later VILI model was established.The animals were mechanically ventilated for 4 h with high tidal volume (40 ml/kg) to induce VILI.Blood samples were obtained from the femoral artery at 4 h of mechanical ventilation for detection of PaO2, then animals were sacrificed, lungs were removed for determination of wet to dry weight ratio (W/D ratio) and for examination of pathological changes (with a light microscope), and lung injury was scored.In VILI+ NC and VILI+ miR-125b agomir groups, bronchoalveolar lavage fluid (BALF) was collected to measure the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay.The cell apoptosis of lung tissues was measured using TUNEL, apoptosis index was calculated, the caspase-3 expression was detected by Western blot, and the miR-125b expression was detected by real-time polymerase chain reaction.@*Results@#Compared with Sham group, PaO2 was significantly decreased, and W/D ratio and lung injury score were increased in VILI, VILI+ NC and VILI+ miR-125b agomir groups, and the expression of miR-125b was down-regulated in VILI and VILI+ NC groups (P<0.05). Compared with VILI group, PaO2 was significantly increased, W/D ratio and lung injury score were decreased, the expression of miR-125b was up-regulated (P<0.05), the pathological changes of lung tissues were significantly attenuated in group VILI+ miR-125b agomir, and no significant change was found in the parameters mentioned above in group VILI+ NC (P<0.05). Compared with group VILI+ NC, the concentrations of TNF-α and IL-6 in BALF and apoptotic index were significantly decreased, and the expression of caspase-3 was down regulated in group VILI+ miR-125b agomir (P<0.05).@*Conclusion@#MiR-125b is involved in the endogenous protective mechanism of VILI in mice.
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Objective@#To identify the risk factors for postoperative fatigue syndrome (POFS) in outpatients with painless gastroscopy.@*Methods@#The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview, intraoperative recording, and telephone follow-up.POFS occurrence, score and outcomes were evaluated.The patients were divided into POFS group (groupⅠ) and non-POFS group (groupⅡ) according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors.@*Results@#Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS, and the incidence was 28.0%, the initial fatigue score was (5.2±2.4), and the duration of POFS was 3(9) h. The mean consumption of propofol (according to anesthesia time, mg/min) was an independent risk factor for POFS.@*Conclusion@#The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.
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Influenza is an acute respiratory infection that seriously harms the world and public health. Because influenza viruses are prone to mutations and difficult to predict, the World Health Organization has been promoting global continuous strengthening of influenza surveillance to monitor the level of influenza activity and epidemic trends in real time. Establishing baselines and thresholds for influenza epidemic helps to gauge the start and severity of influenza seasons. At present, there are various methods for calculating baseline and threshold, such as annual median value, percentile approach, moving epidemic method, and control chart method. This paper will summarize the methods of establishing influenza baseline or threshold at home and abroad, and hope to provide reference for the establishment of baseline or threshold of influenza in China.
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Objective To explore the importance of establishing and improving modern hospital science and technology management system in public hospitals,as well as the ways of establishing such system,analyze the key points that need consideration in order to provide reference for establishing modern hospital science and technology management system in public hospitals.Methods Starting from the reform requirements and perspectives of the construction of modern hospital management system,and based on the theory of innovative governance,this paper probes into the innovative practice and achievements of our hospital in implementing the internal scientific and technological management system of modern hospitals from three aspects:the incentive mechanism,the restraint mechanism and the coordination mechanism of innovative governance of scientific and technological management system.Results Through the establishment and improvement of internal scientific and technological management system,such as reward policies for scientific research work,reward and punishment for papers,layout fee management guidelines,management methods for scientific research funds,project evaluation policies,selection and training of subject leaders,temporary management methods for medical research institutes,and implementation methods for scientific research integrity construction,the effect of talent aggregation is gradually presented,and the discipline,team and technology are stable.Step by step development;innovative achievements are increasingly fruitful,and the quality of connotation is constantly improving.Conclusions The key to the establishment of modern hospital science and technology management system is to continuing innovative exploration of the system of science and technology management and to build a good operation mechanism of science and technology innovation.
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Objective To identify the risk factors for postoperative fatigue syndrome(POFS)in outpatients with painless gastroscopy.Methods The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview,intraoperative recording,and telephone follow-up.POFS occurrence,score and outcomes were evaluated.The patients were divided into POFS group(groupⅠ)and non-POFS group(groupⅡ)according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors.Results Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS,and the incidence was 28.0％,the initial fatigue score was(5.2±2.4),and the duration of POFS was 3(9)h.The mean con-sumption of propofol(according to anesthesia time,mg/min)was an independent risk factor for POFS.Conclusion The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.
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Objective To evaluate the role of microRNA-125b (miR-125b) on ventilator-induced lung injury (VILI) in mice.Methods Forty healthy male C57BL/6 male mice,weighing 25-30 g,aged 2-3 months,were divided into 4 groups (n=10 each) using a random number table method:sham operation group (group Sham),group VILI,VILI plus miR-125b negative control group (group VILI+NC),and VILI plus miR-125b overexpression group (group VILI+miR-125b agomir).In VILI+NC and VILI+miR-125b agomir groups,miR-125b negative control and miR-125b agomir transfection complex 50 μl were intratracheally instilled,respectively,and 48 h later VILI model was established.The animals were mechanically ventilated for 4 h with high tidal volume (40 ml/kg) to induce VILI.Blood samples were obtained from the femoral artery at 4 h of mechanical ventilation for detection of PaO2,then animals were sacrificed,lungs were removed for determination of wet to dry weight ratio (W/D ratio) and for examination of pathological changes (with a light microscope),and lung injury was scored.In VILI+NC and VILI+miR-125b agomir groups,bronchoalveolar lavage fluid (BALF) was collected to measure the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay.The cell apoptosis of lung tissues was measured using TUNEL,apoptosis index was calculated,the caspase-3expression was detected by Western blot,and the miR-125b expression was detected by real-time polymerase chain reaction.Results Compared with Sham group,PaO2 was significantly decreased,and W/D ratio and lung injury score were increased in VILI,VILI+NC and VILI+miR-125b agomir groups,and the expression of miR-125b was down-regulated in VILI and VILI+NC groups (P＜0.05).Compared with VILI group,PaO2 was significantly increased,W/D ratio and lung injury score were decreased,the expression of miR-125b was up-regulated (P＜0.05),the pathological changes of lung tissues were significantly attenuated in group VILI+miR-125b agomir,and no significant change was found in the parameters mentioned above in group VILI+NC (P＜0.05).Compared with group VILI+NC,the concentrations of TNF-α and IL-6 in BALF and apoptotic index were significantly decreased,and the expression of caspase-3 was down regulated in group VILI+miR-125b agomir (P＜0.05).Conclusion MiR-125b is involved in the endogenous protective mechanism of VILI in mice.
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Objective To evaluate the accuracy of variation of the end-tidal pressure of carbon dioxide (△PETCO2) in predicting the fluid responsiveness in patients undergoing resection of gastrointestinal tumor.Methods Forty-six patients of both sexes,aged 40-64 yr,with body mass index of 20-24 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective resection of gastrointestinal tumor with general anesthesia,were enrolled in the study.When the change in mean arterial pressure was less than 10％ within 5 min after anesthesia induction,250 ml Ringer's solution was rapidly infused over 10 min via the peripheral vein.Increase in cardiac index after volume expansion ≥ 15％ was considered to be a positive response.The receiver operating characteristic curve for △PETCO2 in determining fluid responsiveness was drawn.Results The results of receiver operating characteristic curve analysis showed that the area under the curve for △PETCO2 in determining fluid responsiveness (95％ confidence interval) was 0.826 (0.730-0.942,P＜0.05),the critical value 21.9％,sensitivity 76.5％,specificity 90.9％.Conclusion △PETCO2 can accurately predict the fluid responsiveness in patients undergoing resection of gastrointestinal tumor.
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Objective To investigate the effect of Shenfu injection preconditioning on ventilator-induced brain injury in rats.Methods Sixty healthy adult male Sprague-Dawley rats,weighing 300-320 g,were divided into 3 groups (n=20 each) using a random number table:control group (group C),ventilator-induced brain injury group (group VIBI) and Shenfu injection group (group SF).Rats were mechanically ventilated for 6 h with tidal volume of 40 ml/kg in VIBI and SF groups.Rats were mechanicaliy ventilated for 6 h with tidal volume of 10 ml/kg in group C.Shenfu injection 20 ml/kg was injected intraperitoneally at 30 min before ventilation in group SF.Blood samples were collected at 2 and 6 h of ventilation for measurement of the concentrations of serum S100β protein (by enzyme-linked immunosorbent assay).Then the rats were sacrificed at the end of ventilation,and brains were removed for determination of the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-o) (by enzyme-linked immunosorbent assay) and expression of glutamate decarboxylase (GAD) and γ-aminobutyric acid type A (GABAA) receptor in brain tissues (by Westem blot).Results Compared with group C,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly increased,and the expression of GAD and GABAA receptor was down-regulated in VIBI and SF groups (P＜0.05).Compared with group VIBI,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly decreased,and the expression of GAD and GABAA receptor was up-regulated in group SF (P＜0.05).Conclusion Shenfu injection preconditioning can relieve ventilator-induced brain injury in rats,and the mechanism may be related to inhibiting inflammatory responses and activating GABA signaling pathway.
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Objective To evaluate the changes in activation of γ?aminobutyric acid(GABA)sig?naling pathway during ventilator?induced brain injury in rats. Methods Thirty?six pathogen?free adult male Sprague?Dawley rats, weighing 280-320 g, were divided into 3 groups(n=12 each)using a random number table: low tidal volume group(LV group), ventilation with high tidal volume for 2 h group(HV1 group)and ventilation with high tidal volume for 6 h group(HV2group). The rats were mechanically ven?tilated for 2 h with the tidal volume set at 10 ml∕kg and the respiratory rate 40 breaths∕min in group LV. The rats were mechanically ventilated for 2 h with the tidal volume set at 40 ml∕kg and the respiratory rate 40 breaths∕min in group HV1. The rats were mechanically ventilated for 6 h with the tidal volume set at 40 ml∕kg and the respiratory rate 40 breaths∕min in group HV2. Blood samples were collected at the end of ven?tilation for determination of serum neuron?specific enolase(NSE)and S100β protein concentrations by en?zyme?linked immunosorbent assay. Six rats were then sacrificed and their brains were removed for determi?nation of interleukin?1β(IL?1β)and tumor necrosis factor?α(TNF?α)contents(by enzyme?linked im?munosorbent assay)and expression of glutamic acid decarboxylase(GAD)and GABAAreceptors(by Western blot). Morris water maze test was performed on 2nd day after the end of ventilation. Results Compared with group LV, the serum concentrations of NSE and S100β protein and contents of IL?1β and TNF?α were significantly increased, the expression of GAD and GABAAreceptors was up?regulated, the es?cape latency was prolonged, and the percentage of swimming distance at the original platform was decreased in HV1and HV2groups(P<0.05). Compared with group HV1, the serum concentrations of NSE and S100β protein and contents of IL?1β and TNF?α were significantly increased, the expression of GAD and GABAAreceptors was up?regulated, the escape latency was prolonged, and the percentage of swimming distance at the original platform was decreased in group HV2(P<0.05). Conclusion Activation of GABA signaling pathway is enhanced during ventilator?induced brain injury, which may be involved in the patho?physiological mechanism of ventilator?induced brain injury in rats.
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Objective To evaluate the effects of lung-protective ventilation on the cerebral oxygen metabolism and postoperative cognitive function in elderly patients requiring one-lung ventilation (OLV).Methods Sixty patients of both sexes,aged 65-80 yr,weighing 45-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective radical resection for esophageal cancer performed via video-assisted thoracoscope with general aneshesia,were divided into 2 groups (n =30 each)using a random number table:volume-controlled ventilation group (group VCV) and protective ventilation group (group PV).In group VCV,the tidal volume (VT) was set at 10 ml/kg during two-lung ventilation (TLV) and at 7 ml/kg during OLV.In group PV,the VT was set at 7 ml/kg during TLV and at 5 ml/kg during OLV with positive end-expiratory pressure of 5 cmH2O,and lung recruitment maneuver was performed every 45 min with inspiratory pressure at 15,20 and 25 cmH2O,PEEP 5 cmH2O,3 breaths per pressure,5 s/breath.Before induction of anesthesia (T1),at 10 min of TLV (T2),at 30 min of OLV (T3) and at 15 min after restoration of TLV (T4),blood samples were taken from the radial artery and jugular bulb for blood gas analysis,and pH value,arterial oxygen partial pressure (PaO2),arterial carbon dioxide partial pressure (PaCO2),arterial oxygen saturation (SaO2) and jugular venous oxygen saturation (SjvO2) were recorded.Oxygenation index (OI),intrapulmonary shunt (Qs/Qt),arteriovenous blood O2 content difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated at the same time.Cognitive function was assessed using Mini-Mental State Examination at 7 days and 1 month after operation,and the development of postoperative cognitive dysfunction was recorded.Results PaO2,DajvO2,CERO2 and Qs/Qt were significantly higher and SjvO2 and OI were lower at T2-4 than at T1 in two groups (P＜0.05).PaO2,SjvO2 and OI were significantly lower and Qs/Qt and CERO2 were higher at T3 than at T2,and Da-jvO2 was higher at T3-4 than at T2 in two groups (P＜0.05).Compared with group VCV,PaO2,PaCO2,SjvO2 and OI were significantly increased and Qs/Qt,Da-jvO2 and CERO2 were decreased at T3,the Mini-Mental State Examination scores were increased on postoperative day 7,and the incidence of postoperative cognitive dysfunction was decreased in group PV (P＜O.05).Conclusion Lungprotective ventilation is helpful in improving postoperative brain function of elderly patients requiring OLV.
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Objective To evaluate the effect of mechanical stretch preconditioning on pathological stretch-induced activation of γ-aminobutyric acid (GABA) signaling pathway in human type Ⅱ alveolar epithelial cells (AEC Ⅱ).Methods AEC Ⅱ cell line (A549 cells) culturedin vitro were divided into control group (group C), pathological stretch group (group P1) and mechanical stretch preconditioning group (group P2). In group C, A549 cells were cultured routinely. In group P1, A549 cells were exposed to 20% cyclic stretch for 6 hours. In group P2, A549 cells were exposed to 5% cyclic stretch for 60 minutes, and then exposed to 20% cyclic stretch for 6 hours. The cells were harvested for determination of the cell viability by methyl thiazolyl tetrazolium assay, lactate dehydrogeuase (LDH) release was determined by colorimetric method, the levels of interleukin (IL-1β and IL-6) and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA), the mRNA expressions of IL-1β, IL-6 and TNF-α were determined by reverse transcription-polymerase chain reaction (RT-PCR), and the protein expressions of glutamic acid decarboxylase (GAD) and γ-aminobutyric acid A receptor (GABAAR) were determined by Western Blot.Results Compared with group C, the cell viability of group P1 was significantlydecreased (A value: 0.196± 0.071 vs. 0.886±0.107), the release rate of LDH was significantly increased [(12.3±2.4)% vs. (1.9±0.5)%]; the contents and mRNA expressions of IL-1β, IL-6 and TNF-α in cell culture medium were significantly increased [IL-1β (ng/L): 138.6±19.7 vs. 32.7±7.4, IL-6 (ng/L): 196.5±31.7 vs. 55.4±13.8, TNF-α (ng/L): 111.3±21.8 vs. 20.8±7.6; IL-1β mRNA (2-ΔΔCT): 2.79±0.44 vs. 0.83±0.12, IL-6 mRNA (2-ΔΔCT): 1.99±0.25 vs. 0.56±0.11, TNF-α mRNA (2-ΔΔCT): 2.54±0.37 vs. 0.72±0.09]; the protein expressions of GAD and GABAAR were significantly decreased [GAD (gray value): 0.38±0.12 vs. 1.75±0.45, GABAAR (gray value): 0.29±0.09 vs. 1.68±0.39; allP < 0.05]. Compared with group P1, the cell viability of group P2 was significantly increased (A value: 0.523±0.132 vs. 0.196±0.071),the release rate of LDH was significantly decreased [(6.9±1.7)% vs. (12.3±2.4)%]; the contents and mRNA expressions of IL-1β, IL-6 and TNF-α in cell culture medium were significantly decreased [IL-1β (ng/L): 79.2±11.6 vs. 138.6±19.7, IL-6 (ng/L): 89.6±15.6 vs. 196.5±31.7, TNF-α (ng/L): 55.9±11.4 vs. 111.3±21.8; IL-1β mRNA (2-ΔΔCT): 1.92±0.36 vs. 2.79±0.44, IL-6 mRNA (2-ΔΔCT): 1.09±0.18 vs. 1.99±0.25, TNF-α mRNA (2-ΔΔCT): 1.77±0.25 vs. 2.54±0.37]; the protein expressions of GAD and GABAAR were significantly increased [GAD (gray value): 1.26±0.33 vs. 0.38±0.12, GABAAR (gray value): 1.04±0.15 vs. 0.29±0.09; allP < 0.05]. Conclusion The mechanism by which mechanical stretch preconditioning attenuates pathological stretch-induced injury in human AECⅡ is related to the activation of GABA signaling pathway.
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Objective To evaluate the lung-protective effect of lung-protective ventilation (LPV) combined with ventilatory mode pressure-controlled ventilation-volume guaranteed (PCV-VG) in elderly patients undergoing one-lung ventilation (OLV).Methods Eighty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients,aged 65-80 yr,with body mass index of 15-28 kg/m2,scheduled for elective radical resection for esophageal cancer performed via video-assisted thoracoscope,were divided into 4 groups (n=20 each) using a random number table:control group (group C),PCV-VG group,LPV group and LPV combined with PCV-VG group (group LPV+PCV-VG).At 20 min after changing the body position during two-lung ventilation (T1),30 min of OLV (T2) and 20 min after restoration of two-lung ventilation (T3),blood samples were collected from the radial artery for blood gas analysis and for determination of peak airway pressure (Ppeak),mean airway pressure (P) and dynamic lung compliance (Cdyn).Alveolar-arterial oxygen gradient,intrapulmonary shunt (Qs/Qt),dead space fraction (Vd/VT) and respiratory index were calculated at T2.Blood samples were collected from the radial artery before induction of anesthesia and at the end of operation for determination of plasma neutrophil elastase (NE) concentrations by enzyme-linked immunosorbent assay.The Clinical Pulmonary Infection Score (CPIS) was assessed at 1 and 7 days after operation,and the development of pulmonary complications such as respiratory failure,pulmonary atelectasis and pulmonary infection was recorded within 7 days after operation.Results Compared with group C,Ppeak was significantly decreased,and P was increased in group PCV-VG,Ppeak and PaCO2 were significantly increased and pH value,Vd/VT and Qs/Qt were decreased in group LPV,Ppeak,Vd/VT,Qs/Qt,pH value and postoperative CPIS were significantly decreased,and P Cdyn and PaO2 were increased in group LPV+PCV-VG,and the NE concentration at the end of operation was significantly decreased in PCV-VG,LPV and LPV+PCV-VG groups (P＜0.05).Compared with group PCV-VG,P Cdyn and PaO2 were significantly increased,and pH value,Qs/Qt,NE concentration at the end of operation and CPIS were decreased in group LPV+PCV-VG (P＜0.05).Compared with group LPV,Ppeak,Qs/Qt,NE concentration at the end of operation and CPIS were significantly decreased,and Cdyn was increased in group LPV+PCV-VG (P＜0.05).Pulmonary complications such as respiratory failure,pulmonary atelectasis and pulmonary infection were not observed after operation in the four groups.Conclusion LPV combined with PCV-VG can optimize the lung-protective effect in elderly patients undergoing OLV.