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@#Objective Verify the improvement effect of rhomboid intercostal and sub-serratus plane block on the quality of early postoperative recovery in patients undergoing thoracoscopic radical resection of lung cancer;Comparison of the differences in the effect of regional block at different timing on improving the quality of early postoperative recovery.Methods A total of 75 patients,aged 18 to 75 years,with ASA gradeⅠ-Ⅱ,who were scheduled to undergo thoracoscopic radical resection of lung cancer from January 2022 to January 2023 were selected.Randomly divided into three groups:blank control group(Group C),preoperative block group(PR group),and postoperative block group(PO group).The PR group and the PO group received ultrasound guided rhomboid intercostal and sub-serratus plane block in the preoperative anesthesia preparation room and postoperative anesthesia recovery room,respectively,with a dosage of 0.375％ropivacaine 30ml.Evaluate the postoperative recovery quality of patients at 24 and 48 hours using the postoperative recovery quality rating scale(QoR-40)scoring scale.Record numeric rating scale(NRS)pain scores in resting and active states at 0.5h,1h,2h,4h,8h,12h,24h,and 48h after surgery.Record the consumption of opioid drugs during and after surgery,the effective number of postoperative patient-controlled intravenous analgesia(PCIA)compressions,and the incidence of nausea and vomiting.Results Compared with Group C,the consumption of opioids during surgery in the PR group was significantly reduced.The QoR-40 score at 24 hours after surgery was significantly higher in the PR and PO groups.Significant reduction in NRS scores between 1-8 hours of rest and 1-12 hours of activity after surgery,and the effective times of PCIA compressions and opioid consumption were significantly reduced(P<0.05).Compared with the PR group,the PO group consumed more opioids during surgery and had a higher NRS score at 0.5 hours after surgery(P<0.05).There was no significant difference in postoperative QoR-40 scores,PCIA effective compressions,and opioid consumption;There was no statistically significant difference in the incidence of postoperative nausea and vomiting among the three groups.Conclusion Rhomboid intercostal and sub-serratus plane block can improve the early recovery quality of patients undergoing thoracoscopic radical resection of lung cancer,reduce the postoperative pain level of patients,and reduce the amount of opioids used in perioperative period,and its effectiveness has nothing to do with the blocking time.
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Originating but free from chromosomal DNA, extrachromosomal circular DNAs (eccDNAs) are organized in circular form and have long been found in unicellular and multicellular eukaryotes. Their biogenesis and function are poorly understood as they are characterized by sequence homology with linear DNA, for which few detection methods are available. Recent advances in high-throughput sequencing technologies have revealed that eccDNAs play crucial roles in tumor formation, evolution, and drug resistance as well as aging, genomic diversity, and other biological processes, bringing it back to the research hotspot. Several mechanisms of eccDNA formation have been proposed, including the breakage-fusion-bridge (BFB) and translocation-deletion-amplification models. Gynecologic tumors and disorders of embryonic and fetal development are major threats to human reproductive health. The roles of eccDNAs in these pathological processes have been partially elucidated since the first discovery of eccDNA in pig sperm and the double minutes in ovarian cancer ascites. The present review summarized the research history, biogenesis, and currently available detection and analytical methods for eccDNAs and clarified their functions in gynecologic tumors and reproduction. We also proposed the application of eccDNAs as drug targets and liquid biopsy markers for prenatal diagnosis and the early detection, prognosis, and treatment of gynecologic tumors. This review lays theoretical foundations for future investigations into the complex regulatory networks of eccDNAs in vital physiological and pathological processes.
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Male , Female , Animals , Humans , Swine , DNA, Circular/genetics , Genital Neoplasms, Female , Semen , DNA , ReproductionABSTRACT
Objective To explore the effect of Yizheng Recipe on pyroptosis of alveolar epithelium in rats with recurrent respiratory tract infection(RRTI)based on HMGB1/TLR4/NF-κB signal pathway.Methods SD rats were firstly grouped into normal group and model group.In the model group,the RRTI rat model of spleen-Qi deficiency and lung- Qi deficiency was induced by fatigue combined with diet disorder and shavings and tobacco leaf smoking.Then,the rats in the model group were grouped into:RRTI model group(gavaged with normal saline 0.5 mL·100 g-1·d-1)and Yupingfeng Powder control treatment group(gavaged with Yupingfeng Powder suspension 0.5 mL·100 g-1·d-1),Yizheng Recipe high,medium and low-dose treatment groups(gavaged with Yizheng Recipe 0.75,0.5,0.25 mL·100 g-1·d-1),the normal group(gavaged with normal saline 0.5 mL·100 g-1·d-1).The general activities of the rats were observed and the pulmonary function of the rats was detected by the AniRes2005 animal pulmonary function analysis system;the expression of inflammatory factors in rat serum was detected by ELISA;HE,PAS and TUNEL staining were applied to detect the pathological changes of lung tissue;Western blot was applied to detect cell pyroptosis and the expression of HMGB1/TLR4/NF-κB signaling pathway-related proteins.Results Compared with the normal group,the lung function of the RRTI model group was weakened;the inflammatory response increased,and the lung tissue damage,edema and apoptosis were obviously increased;meantime,the pyroptosis was aggravated,and the HMGB1/TLR4/NF-κB pathway was activated(P<0.05).Compared with the RRTI model group,the Yupingfeng Powder control treatment group and the Yizheng Recipe high-dose,medium-dose and low-dose treatment groups all had different degrees of remission in lung function;inflammatory response reduced,the lung tissue damage,edema and apoptosis reduced;meantime,the pyroptosis and HMGB1/TLR4/NF-κB pathway were inhibited(P<0.05).Yizheng Recipe high-dose treatment group and Yupingfeng Powder control treatment group had similar curative effect on RRTI model rats(P>0.05);and Yizheng Recipe was dose-dependent in treating RRTI model rats(P<0.05).Conclusion Yizheng Recipe may inhibit the pyroptosis of alveolar epithelial cells in RRTI model rats by reducing the inflammatory response,and then protecting the lung tissue from damage,this process may be related to the HMGB1/TLR4/NF-κB pathway.
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The cyclic GMP-AMP synthase (cGAS)-stimulator of interferon gene (STING) signal pathway is a classical pathway of STING activation, and in recent years, its role in stimulating innate immunity has gradually attracted wide attention. Besides, cGAS can recognize and combine endogenous or exogenous DNA, then catalyze ATP and GTP to synthesize cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), subsequently activate STING signal to promote type I interferon and inflammatory factors, finally induce natural and adaptive immunity. Existing studies have indicated that cGAS-STING signal pathway plays an important role in infections, inflammations and tumors, especially in high-grade gliomas with poor clinical treatment efficacy. Here, we briefly summarize the cGAS-STING signal pathway and its mechanism in brain tumors to provide new ideas for exploring therapeutic targets and drugs for brain tumors.
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As an essential trace element in living organisms, copper is actively involved in normal physiological processes in various systems and is maintained at low level to achieve copper homeostasis. Copper homeostasis, once being disrupted, would induce cell death, and this new form of cell death is known as copper death. In recent years, copper death has been increasingly recognized as an important factor mediating the onset and progression of central nervous system (CNS) diseases. Therefore, we review the pathogenic mechanism of copper death in CNS diseases, as well as its therapeutic strategies so as to deepen the understanding of researchers.
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Objective To investigate the effect of parecoxib sodium combined with dexmedetomi-dine on postoperative levels of plasma excitatory aminoacid and beta-amyloid protein(β-AP)in jugular bulb venous of elderly patients. Methods A total of 135 patients of either sex, aged 65-79 yr, weighing 47-76 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective open reduc-tion and internal fixation after tibial fracture and hip replacement, were divided into 3 groups(n=45 each) using a random number table: parecoxib sodium group(group P), dexmedetomidine group(group D)and parecoxib sodium combined with dexmedetomidine group(group PD). In group P, parecoxib sodium 40 mg (diluted to 5 ml in normal saline)was injected intravenously at 15 min before induction of anesthesia. In group D, dexmedetomidine was intravenously infused at a loading dose of 05 μg∕kg over 15 min starting from 15 min before induction of anesthesia, followed by an infusion of 05 μg·kg-1·h-1until the end of surgery. In group PD, parecoxib sodium 40 mg(diluted to 5 ml in normal saline)was intravenously injec-ted at 15 min before induction of anesthesia, and dexmedetomidine was intravenously infused at a loading dose of 05 μg∕kg over 15 min followed by an infusion of 05 μg·kg-1·h-1until the end of surgery at the same time. At 15 min before induction of anesthesia(T0), at the end of surgery(T1)and at 24, 48 and 72 h after surgery(T2-4), jugular bulb venous blood samples were taken for determination of concentrations of glutamate and aspartate in plasma(by reversed phase high-performance liquid chromatography)and β-AP(by enzyme-linked immunosorbent assay). Cognitive function was assessed at 1 day before surgery and 7 days after surgery using a battery of neuropsychologic tests including Wechsler Memory Scale, Digit Span (Forward and Backward), visual recognition and associative learning, Wechsler Adult Intelligence Scale and Trail Making Test Part A. The occurrence of postoperative cognitive dysfunction was recorded at 7 days after surgery. Results Compared with P and D groups, the concentrations of plasma glutamate at T2-3, plasma aspartate at T2and β-AP at T1and incidence of postoperative cognitive dysfunction were significantly decreased in group PD(P< 005). Conclusion The mechanism by which parecoxib sodium combined with dexmedetomidine decreases the occurrence of POCD may be related to inhibiting the levels of excitatory aminoacid and β-AP in brain tissues of elderly patients.
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Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction.Methods Sixty ASA Ⅱ or Ⅲ patients aged 65-76 years [mean (70.4±6.3) years],weighing 50-75 kg,with moderate and severe pulmonary dysfunction,who were scheduled for elective radical operation for esophageal cancer,were randomly divided into 3 groups (n=20,each) by using a random number table:the control group (group C),RIPC group (group OR) and RIPC plus dexmedetomidine group (group ORD).At 10 min after endotracheal intubation,group ORD was induced by three cycles of 5 min of lower extremity ischemia followed by 5 min of reperfusion,at the same time a loading dose of dexmedetomidine 0.5 μig / kg was infused iv over 15 min,and then was infused at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.Group OR was induced by three cycles of 5 min of lower extremity ischemia followed by 5min of reperfusion without dexmedetomidine.Group C received only the equal volume of normal saline.Blood samples were obtained from radial artery immediately before anesthesia induction (T0),before one lung ventilation (T1),at 1 h after one lung ventilation (T2),the end of surgery (T3) and 24 h after operation (T4).Blood gas analysis was done at T1,T2,and T3.Plasma superoxide dismutase (SOD) activity and concentration of malonyldialdehyde (MDA),matrix metallo-proteinase-9 (MMP-9),interleukin-6(IL-6) and white blood cell (WBC) and neutrophil granulocyte (PMN) counts were measured at T0,T2,T3 and T4.The complications including pulmonary infection and atelectasis were recorded at 1,3 and 7 days after operation.Results At T2-3,PaO2 was higher in groups of OR and ORD than in group C Group ORD had higher PaO2 than did group OR [(265±15) mmHg,(305±23) mmHg vs.(231±17) mmHg,(273±21)mmHg,(312±24) mmHg vs.(242±18) mmHg,F=34.791 and 31.813,P＜0.01].At T2-3,RI was lower in groups of OR and ORD than in group C,and group ORD had lower RI than did group OR [(1.48±0.16),(1.14 ±0.14) vs.(1.86±0.18);(1.35±0.13),(0.96±0.09) vs.(1.73±0.15),F=119.260 and 164.855,P＜0.01].At T3-4,SOD activity was higher in group OR and ORD than in group C,and group ORD had higher SOD activity than did group OR [(83.6 ± 7.8) U/mg prot,(97.6± 9.5) U/mgprot vs.(70.5±7.4) U/mgprot;(73.5 ± 6.3) U/mgprot,(87.7 ± 8.9) U/mgprot vs.(61.6 ± 5.4) U/ mgprot,F=94.540 and 90.839,P＜0.01].At T3-4.plasma concentration of MDA,MMP-9,WBC and PMN counts were lower in group OR and ORD than in group C,and the above indices were lower in group ORD than in group OR [(7.5 ± 1.4) nmol/mgprot,(5.8 ± 1.0) nmol/mgprot vs.(9.5 ±1.5) nmol/mgprot;(8.2± 1.5) nmol/mgprot,(6.5 ± 1.0) nmol/mgprot vs.(10.1 ±1.6) nmol/mgprot;(205±23) μg/L,(173±21) μg/L vs.(237±26) μg/L,(179±16) μg/L,(158±12) μg/L vs.(203± 20) μg/L;(8.0±0.5) ×109/L,(7.2±0.6) × 109/L vs.(9.2±0.8)×109/L;(9.4±0.7) ×109/L,(8.2±0.6)×109/Lvs.(11.2±0.8) ×109/L;(7.4±0.7) ×109/L,(6.5±0.5) ×109/Lvs.(8.3 ±0.8) ×109/L,(7.8±0.8) ×109/L,(6.7±0.6) ×109/L vs.(9.2±0.9) ×109/L,F=98.872,52.723;198.307,47.622,20.319,36.935,18.197,35.036,respectively,all P＜0.01].At T2-4,IL-6 level was lower in groups of OR and ORD than in group C,and group ORD had lower IL-6 level than did group OR [(105±14) ng/L,(86±12) ng/L vs.(127±18) ng/L;(125±19) ng/L,(101±16) ng/ L vs.(156±22) ng/L;(110±16) ng/L,(89±12) ng/L vs.(132±20) ng/L,F=85.449,139.848,124.129,respectively,P＜0.01].The incidences of postoperative pulmonary infection and atelectasis were lower in group OR and ORD than group C,and group ORD had lower incidences of postoperative pulmonary infection and atelectasis than did group OR (x2 =6.303 and 14.545,P ＜ 0.05).Conclusions RIPC combined with dexmedetomidine can improve pulmonary function in elderly patients with thoracotomy and pulmonary dysfunction,may relieve the inflammatory reaction and oxidation reaction during perioperative period and finally help to improve the prognosis of patients.
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Objective To compare the efficacy of different doses of ropivacaine for ultrasound-guided axillary brachial plexus block in children.Methods One hundred and twenty ASA Ⅰ or Ⅱ children,aged 5-12 yr,scheduled for elective surgery for hand injury,were equally and randomly divided into 4 groups according to the doses of ropivacaine:0.35,0.3,0.25 and 0.20 ml/kg groups.The children received oral midazolam 30 min before surgery.Propofol was given by target-control infusion after admission to the operating room.When the pediatric patients lost consciousness and had no response to verbal command,axillary brachial plexus block was performed under the guidance of ultrasound.0.25 ％ ropivacaine 0.35,0.3,0.25 and 0.20 ml/kg were injected to block the radial,median,ulnar,musculocutaneous and medial antebrachial cutaneous nerves.Additional ketamine was given when needed during operation.The duration of block and consumption of general anesthesia and complications were recorded.The degree of sensory block of the region innervated by each nerve and effectiveness of block were assessed.Results The rate of effective block of the radial nerve,median nerve and musculocutaneous nerve was significantly lower,the number of patients requiring ketamine was larger and the duration of block was shorter in group 0.2 ml/kg than in 0.35,0.30 and 0.25 ml/kg groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between 0.35,0.30 and 0.25 ml/kg groups (P ＞ 0.05).No pediatric patients developed block-related complications in each group.Conclusion Ultrasound-guided axillary brachial plexus block with 0.25 ％ ropivacaine 0.25 ml/kg can provide better block in children.
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Objective To determine the median effective target plasma concentration (Cp50) of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients.Methods Pediatric patients of both sexes,aged 5-12 yr,who grown normally,scheduled for elective forearm or hand surgery,were enrolled in this study.Children were premedicated with oral midazolam 0.2 mg/kg at 30 min before anesthesia.The initial target Cp of remifentainil was 5.0 ng/ml.The target Cp was determined by up-and-down sequential method.Each time Cp increased/decreased by 20％ in the next patient depending on the response of the previous patient to puncture.The ratio between the two successive concentrations was 1.2.The puncture was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as puncture-induced movement of truncus,limbs and/or head and neck.The Cp50 and 95 ％ confidence interval of remifentainil were calculated by Dixon method.Results Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block was 3.9 ng/ml,and 95 ％ confidence interval was 3.6-4.2 ng/ml.Conclusion Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block is 3.9 ng/ml in pediatric patients.