Effects of lumber luerector spinae plane block on postoperative delirium and early outcome in older adult patients undergoing hip arthroplasty / 中国基层医药

Objective:To investigate the effects of ultrasound-guided lumbar erector spinae plane block (L-ESPB) combined with general anesthesia using a laryngeal mask airway on postoperative delirium and early outcome in older adult patients undergoing hip arthroplasty.Methods:Sixty older adult patients who underwent unilateral total hip arthroplasty under general anesthesia using a laryngeal mask airway from August 2020 to May 2021 were included in this study. They were randomly assigned to observation and control groups, with 30 patients in each group. All patients underwent general anesthesia using a laryngeal mask airway. In the observation group, L-ESPB with 30 mL 0.375% ropivacaine was performed before induction of general anesthesia. Patient-controlled intravenous analgesia was performed in all patients after surgery. The Visual Analogue Scale score was > 4 points, and dezocine was intravenously injected for rescue analgesia. The amount of general anesthetics, the rate of use of vasoactive drugs, the time to pull out the laryngeal mask airway, length of stay in postanesthesia care unit, and the incidence of restlessness during the recovery period were recorded. Resting-state VAS score and Bruggrmann comfort scale score at 4, 8, 12, 24 and 48 hours after surgery, effective times of pressing the analgesia pump, the rate of rescue analgesia, the incidence of anesthesia-related adverse reactions at 48 hours after surgery, Pittsburgh Sleep Quality Index (PSQI) score at 1 day before and 1, 3 and 5 days after surgery, the incidence of postoperative delirium within 5 days after surgery, the time to get out of bed the first time, and the incidence of pulmonary infection were recorded.Results:The amount of remifentanil and propofol used during surgery were significantly lower in the observation group than those in the control group ( t = -6.80, -5.23, both P < 0.05). The rate of use of urapidil and esmolol were significantly lower in the observation group than those in the control group ( χ2 = 4.32, 5.46, both P < 0.05). The time to pull out the laryngeal mask airway, length of stay in postanesthesia care unit, and the time to get out of bed the first time in the observation group were (14 ± 2) minutes, (21 ± 2) minutes and (2.4 ± 0.5) days respectively, which were significantly shorter than those in the control group [(18 ± 2) minutes, (26 ± 3) minutes and (2.8 ± 0.7) days, t = -6.64, -7.18, -2.51, all P < 0.05]. The incidence of restlessness during the recovery period, postoperative delirium, and pulmonary infection in the observation group were 0.0%, 3.3% and 0.0% respectively, which were significantly lower than those in the control group [20.0%, 26.7%, 20.0%, all P < 0.05]. Resting-state VAS score at each time point was significantly lower in the observation group than that in the control group ( t = 3.32, 2.97, 4.33, 3.81, 3.10, all P < 0.05). Bruggrmann comfort scale score at each time point was significantly higher in the observation group than that in the control group ( t = 9.20, 8.62, 5.73, 5.72, 6.28, all P < 0.05). The effective times of pressing the analgesia pump, the rate of rescue analgesia, and the incidence of nausea and vomiting at 48 hours after surgery in the observation group were 0 (0, 0), 10.0% and 6.7% respectively, which were significantly lower than those in the control group [1(0, 2), 33.3% and 30.0%, Z = -3.41, χ2 = 4.81, 5.46, all P < 0.05]. PSQI score measured at 1, 3, and 5 days after surgery were significantly increased compared with those measured 1 day before surgery in each group ( F = 116.80, 325.64, both P < 0.001). PSQI measured at 1, 3 and 5 days after surgery was significantly lower than those in the control group ( t = -7.26, -6.41, -11.17, all P < 0.001). There were no significant differences in the incidence of dizziness, drowsiness, urinary retention and atelectasis between the two groups ( P > 0.05). Conclusion:Ultrasound-guided L-ESPB combined with general anesthesia using a laryngeal mask airway for hip arthroplasty in older adult patients can decrease the incidences of postoperative delirium and complications, which are conducive to early postoperative outcomes.

Continuous sciatic nerve block via lateral popliteal approach with single shot femoral nerve block under ultrasound guidance for enhanced recovery after ankle and foot surgery / 中国医师杂志

Objective To explore the feasibility of continuous sciatic nerve block via lateral poplit eal approach with single shot femoral nerve block for enhanced recovery after surgery in ankle and foot surgery.Methods Sixty adult patients scheduled for elective ankle and foot surgery were randomly assigned into 2 group (n =30 each):Group A received sciatic nerve block via lateral popliteal approach with a catheter placed and a single shot femoral nerve block under ultrasound guidance followed by patient-controlled postoperative analgesia with 0.2％ ropivacaine through the perineural catheter;Group B received the routine epidural puncture and a catheter placement at L2-3 level followed by postoperative analgesia with 0.2％ ropivacaine through the catheter.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart beat (HR) were recorded before and after anesthesia.The block efficacy,the volume of fluid influsion during operation and the usage of ephedrine were recorded.The pain severity at rest and upon movement with a 0-10 numeric rating scale (NRS,0 =no pain and 10 =worst possible pain),the modified Bromage score of the motor block of the affected extremity,the number of effective patient-controlled bolus of ropivacaine and the number of need for opioid rescue within 48 h after surgery were assessed.The first time of leaving bed after operation,the length of hospital stay and the occurring of complication related to puncture and analgelsia were also recorded.Results SBP and DBP at each time point after anesthesia were higher in group A than those in group B (P ＜ 0.05).The volume of fluid infusion during operation and the occurence of ephedrine use were less in group A than those in group B (P ＜0.05).There was no indifference in terms of the NRS scores at rest and upon movement,the number of effective patient-controlled bolus of ropivacaine and the number of need for opioids rescue (P ＞ 0.05),but the complications such as nausea and vomiting,urinary retention occurred more in group B (P ＜0.05).The modified Bromage score of the motor block at each time point within 24 h after surgery was lower in group B than that in group B (P ＜ 0.05).The first time of leaving bed after operation and the length of hospital stay were shorter in group A than those in group B (P ＜ 0.05).Conclusions Ultrasound-guided continuous sciatic nerve block via lateral popliteal approach with single shot femoral nerve block can provide exact anesthetic effect with minimal interference on haemodynamics and excelent postoperative analgesia with less influence on movement.It's helpful in the ankle and foot surgery to improve the recovery after surgery.

Isoflurane Preconditioning Induces Neuroprotection by Up-Regulation of TREK1 in a Rat Model of Spinal Cord Ischemic Injury

This study aimed to explore the neuroprotection and mechanism of isoflurane on rats with spinal cord ischemic injury. Total 40 adult male Sprague-Dawley rats were divided into the four groups (n=10). Group A was sham-operation group; group B was ischemia group; group C was isoflurane preconditioning group; group D was isoflurane preconditioning followed by ischemia treatment group. Then the expressions of TWIK-related K⁺ channel 1 (TREK1) in the four groups were detected by immunofluorescent assay, real time-polymerase chain reactions (RT-PCR) and western blot. The primary neurons of rats were isolated and cultured under normal and hypoxic conditions. Besides, the neurons under two conditions were transfected with green fluorescent protein (GFP)-TREK1 and lentivirual to overexpress and silence TREK1. Additionally, the neurons were treated with isoflurane or not. Then caspase-3 activity and cell cycle of neurons under normal and hypoxic conditions were detected. Furthermore, nicotinamide adenine dinucleotide hydrate (NADH) was detected using NAD+/NADH quantification colorimetric kit. Results showed that the mRNA and protein expressions of TREK1 increased significantly in group C and D. In neurons, when TREK1 silenced, isoflurane treatment improved the caspase-3 activity. In hypoxic condition, the caspase-3 activity and sub-G1 cell percentage significantly increased, however, when TREK1 overexpressed the caspase-3 activity and sub-G1 cell percentage decreased significantly. Furthermore, both isoflurane treatment and overexpression of TREK1 significantly decreased NADH. In conclusion, isoflurane-induced neuroprotection in spinal cord ischemic injury may be associated with the up-regulation of TREK1.

Thoracic paravertebral block versus epidural anesthesia combined with moderate sedation for percutaneous nephrolithotomy

Objective: To investigate the feasibility of thoracic paravertebral block [TPVB] for percutaneous nephrolithotomy [PCNL] in comparison with epidural anesthesia [EA] combined with moderate sedation

Subjects and Methods: One hundred American Society of Anesthesiologists [ASA] I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic [PCIA] device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and X2 test as appropriate

Results: Patients who received TPVB consumed more propofol during ureteroscopy [56.2 +/- 28.4 vs. 42.9 +/- 27.5 mg, p < 0.05] and more sufentanil during ureteroscopy [9.7 +/- 4.8 vs. 3.9 +/- 2.7 microg, p < 0.05] and during PCNL [7.0 +/- 4.3 vs. 1.9 +/- 1.8 microg, p < 0.05] than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA [854 +/- 362 vs. 1,320 +/- 468 ml, p < 0.05]. Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups

Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB

Efficacy of laryngeal mask airway Classic, Streamlined Liner of Pharyngeal Airway and laryngeal mask airway ProSeal in patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective To compare the efficacy of the laryngeal mask airway Classic (CLMA), Streamlined Liner of Pharyngeal Airway (SLIPA) and laryngeal mask airway ProSeal (PLMA) in patients undergoing laparoscopic surgery. Methods One hundred and twenty-three ASA Ⅰ or Ⅱ patients aged 20-64 yr undergoing elective laparoscopic surgery were randomly divided into 3 groups: CLMA group (group C, n =41 ), SLIPA group (group S, n =42) and PLMA group (group P, n =40). Laryngeal mask was inserted after induction of anesthesia with sufentanil 0.3 μg/kg, atracurium 0.5 mg/kg and propofol 2 mg/kg. Mll the patients were ventilated with intermittent positive-pressure ventilation. Anesthesia was maintained with contiunous infusion of propofol 6-8 mg· kg-1· h-1 and with supplementary administration of sufentsnil 0.1-0.2 μg/kg and atracurium 0.2 mg/kg as required. The degree of difficulty in inserting the laryngeal mask was evaluated. The rate of successful placement at first attempt, device placement time, recovery time and complications were recorded . Peak inspiratory pressure (PIP) and the number of patients with an airway sealing pressure less than PIP were recorded before pneumoperitoneum and when intra-abdominal pressure achieved 12 mm Hg. Results The placement was easier and the placement time and recovery time were significantly shorter in group S, and the placement time was significantly longer,the airway sealing pressure was significantly higher and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group C ( P ＜ 0.05). The placement time and recovery time were significantly longer, the placement was harder, the airway sealing pressure was significantly higher, and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group S ( P ＜ 0.05). PIP was significantiy higher when intra-abdominal pressure achieved 12 mm Hg than that before pneumoperitoneum in all the three groups ( P ＜ 0.05). There was no significant difference in the incidence of complications and rate of successful placement at first attempt among the three groups ( P ＞ 0.05). Conclusion All the three airway devices can provide adequate ventilation during operation, with fewer complications. SLIPA placement is easiest. PLMA can assure good airway sealing and is most suitable for patients undergoing laparoscopic surgery.

The Plasma Load of Inoculated EIAV Vaccine Strain EIAV_(FDDV) Was Not Boosted by Immune Suppression / 生物化学与生物物理进展

The attenuated Chinese equine infectious anemia virus (EIAV) vaccine is the first lentiviral vaccine that provides solid protective immunities to vaccinated horses. To investigate properties of EIAV vaccine, especially the relationship between its replication and the immunity, viral plasma loads of an EIAV vaccine strain EIAVFDDV in immune suppressed horses were detected. Three horses, which were immunized with EIAVFDDV for 16 months, were treated with dexamethasone for 14 days to suppress their immunities. Reduced immune response in these animals was confirmed by significantly declined lymphocyte proliferation rate detected after 10 days of the drug treatment. The plasma viral loads of EIAVFDDV, which was indicated by the genomic RNA copy numbers, in horses before and after the treatment of dexamethasone were monitored by real time RT-PCR. Results revealed that the viral plasma loads in two of three immune-suppressed horses were kept a steady low level around 103～ 104 copies/ml. The load was increased by 10 folds in the third horse, but was still among the standard levels for EIAVFDDV vaccinated horses. As a positive control, the viral copy number of an asymptomatic carrier of EIAV virulent strain EIAVLiao was jumped nearly 25 000-fold higher after being treated with dexamethasone. The typical clinical symptoms of EIA, characterized by febrile episodes and thrombocytopenia, were also appeared in this horse. These results clearly indicate that it is the unique biological feature of the attenuated EIAV vaccine, but not the immunity, resulted in EIAVFDDV remaining in low levels in the body harmlessly. In addition, the steady low level of viremia and the inability to cause clinical symptoms of EIAVFDDV in immune-suppressed hosts further demonstrated the safety of attenuated Chinese EIAV vaccines. The data provide a new sight for studies on the immunity to lentiviruses.

Study on Immune Efficacy of Single and Double Fusion DNA Vaccine from Mycobacterium bovis / 中国生物工程杂志

The DNA fragments of ag85b、esat-6、hsp65、mpb64 and ag85b-esat-6、hsp65-esat-6、mpb64-esat-6 were amplified by PCR and SOE technique.These seven fragments were inserted into pCDNA3.1(+)vector to construct recombinant plasmids pCA、pCE6、pCH、pCM、pCAE、pCHE and pCME.The seven plasmids were transfected into SP2/0 cell in vitro to detect the expression of target genes.BALB/c mice were intramuscularly vaccinated with the seven plasmids and the control vector pCDNA3.1(+)and PBS respectively.The serum antibodies and the spleen lymphocyte proliferation(SLP)and secreted IFN～? of spleen were tested.The results of indirect ELISA showed the levels of antibodies in all recombinant plasmids groups were significantly higher than the two control groups(P

Cloning of AE1-c-end cDNA and construction of its expression plasmid for yeast two-hybrid system / 生物医学工程学杂志

In this study, about 350 bp cDNA fragment was amplified by PCR. After being sequenced, the AE1-c-end gene fragment was cloned into EcoR I-Pst I site of pGADT7 to form AD ends in the yeast two-hybrid system. The recombinant plasmid was transformed into yeast AH109, and the expression in the yeast was observed. The results demonstrate that AE1-c-end was obtained. pGADT7-AE1-c-end has no toxic effect on the yeast. It can serve as a target gene of yeast two-hybrid system.

Proviral Genomic Variation of EIAV Envelop gp 90 Gene Observed in Experimentally Infected Horse / 中国兽医学报

The present experiment was designed to observe the genetic variation of equine infectious anemia virus (EIAV) envelop gp 90 gene in infected horse. One horse was infected experimentally with P337-V70 strain and showed no clinical signs after being infected at twice with the same virus strain. Seventeen proviral sequences covering principal neutralizing domain (PND) of EIAV gp 90 gene were obtained from the buffy coat and liver of the horse through PCR amplification and cloning. Comparative analysis of the sequences revealed that some sequences contained the nucleotide insertions in the PND region. The insertions might be generated by direct repeat and strand displacement of sequence segment in their PND gene, showing different lenghts.