Research progress on prevention and local intervention of oral mucositis in patients with hematopoietic stem cell transplantation / 中华口腔医学杂志

Oral mucositis (OM) is a common complication during hematopoietic stem cell transplantation. When OM occurs, with the destruction of oral mucosal barrier function, the formation of oral bacterial environment is accelerated, which has a negative impact on the life quality and clinical outcomes of patients. OM can be prevented by keeping the oral cavity clean, using the mouthwash properly, and limiting the delivery of cytotoxic drugs to oral tissues. This review describes the research progress on the prevention and local intervention of OM in patients with hematopoietic stem cell transplantation, in order to provide ideas for the selection of clinical intervention and management strategies on OM, and to provide references for exploring effective management methods for OM.

Causes and Countermeasures of Complications After Bariatric Surgery / 中国医学科学院学报

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy characterized by simple operation and few postoperative complications have gradually become the two most commonly used surgical methods in clinical practice.A series of complications often occur after bariatric surgery,including gallstone disease,anemia,malnutrition,gastroesophageal reflux disease,kidney stones,and birth defects in offspring of women of childbearing age.There are controversies regarding the causes and countermeasures of these complications.This article mainly reviews the risk factors and countermeasures for the complications after bariatric surgery.

A medium term analysis on of therapeutic effects of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients / 中国骨伤

OBJECTIVE@#To retrospectively study medium term follow up outcomes effects of effect of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients.@*METHODS@#Total of 32 elderly patients with the osteoporotic intertrochanteric fractures were treated with bio-lengthend stem hemiarthroplasty from Jan. 2016 to Jan. 2019 including 14 males and 22 females, aged from 85 to 95 years old with an average of (89.5±4.5) years old. According to classification of Evans, there were 12 cases with type Ⅲ, 11 with type Ⅳ and 9 with type Ⅳ. The time from injury to operation ranged from 0.5 to 9 days with an average of (4.5±3.9) days. The operation time, blood loss and postoperative complications were analyzed. Functional outcome was assessed by Parker Palmer mobility score(PPMS) and Harris hip score.@*RESULTS@#Four patients died within one year after operation, and the mortality was 12.5%. The follow up time for the rest 28 patients ranged from 24 to 60 months with an average of (28.5±4.5) months. The mean operative time was (54.2±22.5) min;the mean blood loss (hidden blood loss+obvious blood loss) was (450±140) ml;the first weight bearing was (3.35±1.35) days. No perioperative death occurred. PPMS were(6.63±1.25), (6.94±1.18), (7.11±0.83), (7.32±1.11) and Harris scores were(67.85±6.19), (71.42±5.57), (73.41±5.62), (77.32±5.24) respectively at 1, 3, 6 months and the final follow-up after operation. There were no significant difference in PPMS and Harris score at 1, 3, 6 months after operation and the final follow-up(P>0.05). There were no complications such as joint dislocation and prosthesis loosening occure at the final follow-up.@*CONCLUSION@#On the premise of strictly mastering the case selection criteria, the bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients has a satisfied medium term follow-up outcomes. It can restore hip function in the early stage and improve the quality of life of patients.

Expression of Cyclooxygenase-2 in Patients With Snow-White Sign of Advanced Colorectal Adenomas / 中国医学科学院学报

Objective To analyze the expression of cyclooxygenase-2 (COX-2) in the patients with snow-white sign of advanced colorectal adenoma (ACA) and explore its clinical significance.Method Western blotting was employed to determine the expression of COX-2 in the adenoma tissue and the normal tissue adjacent to the adenoma tissue (>5 cm away from the distal end of the adenoma tissue) of 40 ACA patients with snow-white sign and 40 ACA patients without snow-white sign.Results The appearance of snow-white sign in ACA patients was associated with patient age (P=0.001) and not associated with sex,smoking history,drinking history,ethnic groups,family history of colorectal cancer,abdominal pain,diarrhea,constipation,fecal occult blood,or tumor markers (all P>0.05).Snow-white sign mainly appeared in the ACA patients with multiple adenomas (P=0.004),large adenomas (P=0.006),adenomas in distal colon (P=0.015),protruding polyps (P=0.044),and late-stage pathology (P=0.010).The occurrence of snow-white sign showed no difference in the ACA patients with different results of Japan NBI Expert Team classification (P=0.502).The expression of COX-2 in the adenoma tissue was higher than that in the adjacent normal tissue in the patients with and without snow-white sign (P<0.001,P=0.004).The patients with snow-white sign had higher expression of COX-2 protein in the adenoma tissue than the patients without snow-white sign (P=0.001).The expression of COX-2 protein in the adjacent healthy tissue had no significant difference between the patients with and without snow-white sign (P=0.603).Conclusions Snow-white sign is more like to appear in the ACA patients with young age,multiple and large adenomas,adenomas in distal colon,protruding polyps,and late-stage pathology.Moreover,the expression of COX-2 in the ACA patients with snow-white sign is significantly higher than that in the ACA patients without snow-white sign.The adults with snow-white sign are prone to cancerization than those without snow-white sign.

Effects of transcutaneous electrical acupoint stimulation on the postoperative sleep quality and inflammatory factors in frail elderly patients / 中国针灸

OBJECTIVE@#To observe the effects of transcutaneous acupoint stimulation (TEAS) on sleep quality and inflammatory factor in frail elderly patients undergoing laparoscopic colorectal cancer surgery.@*METHODS@#A total of 100 frail elderly patients undergoing elective laparoscopic colorectal cancer surgery were randomly divided into an observation group and a control group, 50 cases in each one. Patients in the observation group received TEAS, 30 min before surgery until the end of surgery, at 18:00 on the day of surgery and on the 1st, 2nd and 3rd day after surgery (30 min each time). TEAS was delivered at bilateral Neiguan (PC 6), Shenmen (HT 7) and Hegu (LI 4). The disperse-dense wave of 2 Hz/100 Hz was selected, and the maximal stimulation intensity depended on patient's tolerance. The operation procedure in the control group was same as the observation group, but without electric stimulation exerted. The 1st day before surgery and on the 1st, 3rd and 7th day after surgery, the scores of Pittsburgh sleep quality index (PSQI) and Athens insomnia scale (AIS), as well as the serum levels of C reactive protein (CRP) and interleukin-6 (IL-6) were observed in the patients of two groups. At 24 h, 48 h and 72 h after surgery, the score of pain visual analogue scale (VAS) was recorded in the two groups, as well as the pressing times of analgesic pump and the usage of flurbiprofen axetil during analgesic stage. The occurrence of post operative adverse reactions was observed in the patients of two groups.@*RESULTS@#On the 1st and 3rd day after surgery, except the usage of hypnotic drug scores, the scores of each item and the total scores of PSQI, as well as AIS scores were all increased in the two groups compared with those of 1 day before surgery (P<0.05); and the scores in the observation group were lower than those in the control group (P<0.05). On the 7th day after surgery, the scores of each item and the total scores of PSQI, and AIS scores were not different statistically in comparison between the two groups (P>0.05). On the 1st, 3rd and 7th day after surgery, serum levels of CRP and IL-6 were all increased in the patients of two groups when compared with those of 1 day before surgery (P<0.05), serum levels CRP and IL-6 in the patients of the observation group were lower than those of the control group (P<0.05). The VAS scores of 24 h, 48 h and 72 h after surgery, the pressing times of analgesic pump, the frequency and dosage of the remedies were not different statistically between the two groups (P>0.05).@*CONCLUSION@#TEAS can effectively improve sleep quality and reduce inflammatory reaction in frail elderly patients undergoing laparoscopic colorectal cancer surgery.

Correlation analysis of serum MMP-1 and MMP-2 levels with lower extremity deep venous thrombosis after operation for lower limb fracture / 中国骨伤

OBJECTIVE@#To investigate the relationship between serum matrix metalloproteinase-1(MMP-1) and matrix metalloproteinase-2(MMP-2) and the formation of deep venous thrombosis(LDVT) in lower extremity patients after surgery for lower extremity fracture, and to analyze the value of MMP-1 and MMP-2 in predicting the occurrence of LDVT after lower extremity fracture.@*METHODS@#From June 2018 to December 2021, 352 patients who planned to receive surgical treatment of lower limb fracture in our hospital were selected as the research objects. Venous blood was collected at 1, 2 and 3 days after surgery, respectively, and serum MMP-1 and MMP-2 levels were detected. The incidence of LDVT during hospitalization was analyzed, and the risk factors of postoperative LDVT in patients with lower limb fracture surgery and the predictive value of MMP-1 and MMP-2 for LDVT were analyzed.@*RESULTS@#LDVT occurred in 40 patients (LDVT group), the incidence of LDVT was 11.36%, and 312 patients did not occurred(no occurred group). The serum levels of MMP-1 and MMP-2 in LDVT group increased gradually after surgery; the serum levels of MMP-1 and MMP-2 in the no occurred group increased slightly after surgery at 2 days and then decreased at 3 days after surgery (P<0.01);the serum levels of MMP-1 and MMP-2 in LDVT group were higher than those in the no occurred group at 2 days and 3 days after surgery (P<0.05). Serum levels of MMP-1 and MMP-2 were positively correlated with serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor -α (TNF-α) in LDVT patients at 2 days and 3 days postoperatively (P<0.05). Operative time, MMP-1 and MMP-2 postoperative 3 days were related to the occurrence of LDVT after lower limb fracture (P<0.01). The area under the curve(AUC) predicted by MMP-1 and MMP-2 postoperative 3 days for LDVT after lower limb fracture was 0.738 and 0.744 respectively, and the AUC predicted by combined MMP-1 and MMP-2 was 0.910, which was higher than that predicted by single indicator(Z=2.819 and 2.025, P<0.05).@*CONCLUSION@#High levels of MMP-1 and MMP-2 after lower extremity fracture are closely related to the occurrence of LDVT, and 3 d mMP-1 and MMP-2 after surgery maybe used as evaluation indexes for LDVT risk prediction.

Chemical constituents of Helleborus thibetanus / 中国中药杂志

The chemical constituents of Helleborus thibetanus were isolated and purified by silica gel column chromatography, Sephadex LH-20 gel column chromatography, and semi-preparative RP-HPLC, and the structures of all compounds were identified by modern spectrographic technology(MS, NMR). The MTT method was used to measure the cytotoxicity of compounds 1-8. Twelve compounds were isolated from the roots and rhizomes of H. thibetanus and were identified as(25R)-22β,25-expoxy-26-[(O-β-D-glucopyranosyl)oxy]-1β,3β-dihydroxyfurosta-5-en(1), β-sitosterol myristate(2), β-sitosterol lactate(3), β-sitosterol 3-O-β-D-glucopyrannoside(4), 4,6,8-trihydroxy-3,4-dihydronaphthalen-1(2H)-one(5), 1,3,5-trimethoxybenzene(6), 7,8-dimethylbenzo pteridine-2,4(1H,3H)-dione(7), 1H-indole-3-carboxylic acid(8), p-hydroxy cinnamic acid(9), lauric acid(10), n-butyl α-L-arabinofuranoside(11) and methyl-α-D-fructofuranoside(12), respectively. Among them, compound 1 is a new compound and named thibetanoside L; compounds 2, 5-8, 11 are first isolated from the family Ranunculaceae; compound 12 is isolated from the genus Helleborus for the first time. The results of MTT assay showed that the IC_(50) values of compounds 1-8 against HepG2 and HCT116 cells were greater than 100 μmol·L~(-1).

Mechanism of pregnancy-induced thymus involution and regeneration and medication rules of postpartum prescriptions / 中国中药杂志

In order to prevent the maternal immune defenses to the semi-allogeneic fetus, the maternal body will present a special adaptive immune system change represented by acute thymic involution(ATI) during pregnancy, which can be quickly regenerated after delivery. The ATI during pregnancy is related to the level of sex hormones, which is mainly caused by progesterone. Pregnancy-induced ATI is manifested as the continuous shrinkage of thymus volume, especially the cortex, and the wrinkle and phagocytosis of the subcapsular cortical thymic epithelial cells(cTECs), while other thymic epithelial cells(TECs) remain unchanged. The postpartum thymus is regenerated by the co-mediation of forkhead box N1(FOXN1) as well as its target genes chemokine(C-C motif) ligand 25(CCL25), chemokine(C-X-C motif) ligand 12(CXCL12), δ-like ligand 4(DLL4), cathepsin L(CTSL), and serine protease 16(PRSS16). Once the postpartum thymus is poorly repaired, immune dysfunction of the maternal body and several puerperal diseases will be induced, seriously endangering the survival of the mother and the newborn. In traditional Chinese medicine(TCM), Qi and blood are the cornerstone of pregnancy, and the thymus plays a key role in regulating Qi and blood. The deficiency of Qi and blood during pregnancy and childbirth is closely related to the abnormal ATI during pregnancy and the poor regeneration of the postpartum thymus. Based on this theory, TCM has profound academic ideas and rich clinical experience in postpartum recuperation. Based on the systematic description of the mechanism of ATI regeneration during pregnancy, as well as data mining and analysis of two classic gynecological works of TCM, Wan's Gynecology and Fu Qing-zhu's Treatise on Gynecology, this study found that the commonly used TCM for postpartum included Angelicae Sinensis Radix, Ginseng Radix et Rhizoma, Glycyrrhizae Radix et Rhizoma, and Chuanxiong Rhizoma. Among them, Ginseng Radix et Rhizoma, Angelicae Sinensis Radix, and Chuanxiong Rhizoma are high-frequency TCMs with positive effects on postpartum recovery.However, the mechanism of these TCMs in promoting postpartum thymus regeneration needs further investigation.

Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit / 中华儿科杂志

Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.

Effects of transcutaneous electrical acupoint stimulation on emergence agitation in patients undergoing thoracoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on emergence agitation in the patients undergoing thoracoscopic surgery.Methods:Eighty patients of both sexes, aged 25-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective thoracoscopic surgery under general anesthesia, were divided into 2 groups ( n=40 each) by a random number table method: TEAS group (group T) and control group (group C). In group T, the Hegu (L14), Zusanli (ST36) and Sanyinjiao (SP6) were stimulated starting from 30 min before induction of anesthesia until the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.In group C, stimulating electrodes were placed at the same acupoints before induction, but no electrical stimulation was applied.Ramsay sedation score and VAS score were recorded.and emergence agitation was assessed using RSS agitation score.Blood samples from the median cubital vein or internal jugular vein were collected before anesthesia induction (T 1), at the end of surgery (T 2), immediately after removal of tracheal tube (T 3) and at 15 min after removal of tracheal tube (T 4) for determination of serum interleukin-6 (IL-6) and IL-10 concentrations by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil was recorded.Adverse reactions such as tachycardia, bradycardia, hypertension, hypotension, respiratory depression, delay of awakening and nausea and vomiting were recorded after operation. Results:Compared with group C, the amount of intraoperative remifentanil consumed was significantly decreased, serum IL-6 concentrations were decreased, and the serum IL-10 concentration was increased T 2-4, Ramsay sedate score was increased, and the incidence of agitation was decreased in group T ( P<0.05). There was no significant difference in VAS score and incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:TEAS can reduce the development of emergence agitation in the patients undergoing thoracoscopic surgery, which is related to inhibition of inflammatory responses.

c-MYC-mediated TRIB3/P62+ aggresomes accumulation triggers paraptosis upon the combination of everolimus and ginsenoside Rh2

The mammalian target of rapamycin (mTOR) pathway is abnormally activated in lung cancer. However, the anti-lung cancer effect of mTOR inhibitors as monotherapy is modest. Here, we identified that ginsenoside Rh2, an active component of Panax ginseng C. A. Mey., enhanced the anti-cancer effect of the mTOR inhibitor everolimus both in vitro and in vivo. Moreover, ginsenoside Rh2 alleviated the hepatic fat accumulation caused by everolimus in xenograft nude mice models. The combination of everolimus and ginsenoside Rh2 (labeled Eve-Rh2) induced caspase-independent cell death and cytoplasmic vacuolation in lung cancer cells, indicating that Eve-Rh2 prevented tumor progression by triggering paraptosis. Eve-Rh2 up-regulated the expression of c-MYC in cancer cells as well as tumor tissues. The increased c-MYC mediated the accumulation of tribbles homolog 3 (TRIB3)/P62+ aggresomes and consequently triggered paraptosis, bypassing the classical c-MYC/MAX pathway. Our study offers a potential effective and safe strategy for the treatment of lung cancer. Moreover, we have identified a new mechanism of TRIB3/P62+ aggresomes-triggered paraptosis and revealed a unique function of c-MYC.

A Rapid Method for the Separation and Enrichment of Exosomes from Tissues / 中国生物化学与分子生物学报

The study demonstrates a quick approach for isolating exosomes with substantial concentration. To achieve quality and substantial concentration and purification of exosomes, the target tissue wasmechanically chopped and introduced to tissue digesting enzyme for tissue digestion and filtration. Thetissue cell solution was then subjected to differential centrifugation, ultra-separation, SEC exclusion, andultrafiltration. The protein contents of enzymatic treatment of dissociated tissue were higher as compared toprotein elution of exosome tissue dissociation method. The nanoparticles were traced and seen using atransmission electron microscope after enrichment of exudate to mouse heart, liver, kidney, human coloncancer, human breast cancer, and atherosclerotic tissues. The finding of the study demonstrated that thediameter of the exocrine body was within 30-150 nm, and the structure was obvious and distinct. Westernblots analysis showed that CD9, Alix, and CD63 expression were high, whereas, the TSG101 expressionwas low but calnexin was negative. However, in comparison to other ways, whole process takes only 4-5hours and saves time for quantification and functional analysis of exosomes. The isolated exosomes hashigher purification with less soluble heteroprotein contamination. Advances in isolation exosomes frommicro tissue samples can be employed for nanoparticle size tracking, Western blotting, transmission electron microscopy, and transcriptomic analysis for future studies.

Improved efficacy of ultrasoud-guided superior laryngeal nerve block in elderly patients undergoing short surgery with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the improved efficacy of ultrasonography-guided superior laryngeal nerve block (SLNB) in elderly patients undergoing short surgery with general anesthesia.Methods:Sixty-four patients of both sexes, aged≥65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective percutaneous balloon compression under general anesthesia, were divided into 2 groups ( n=32 each) using a random number table method: control group (group C) and ultrasound-guided SLNB group (group S). The patients received bilateral SLNB under ultrasound guidance, and 1% lidocaine 3 ml was injected on each side in group S, while the equal volume of normal saline was given instead in group C. Anesthesia was induced with midazolam, sufentanil, etomidate and mivacurium, and then the patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained with propofol, remifentanil, and sevoflurane.Cardiovascular response to endotracheal intubation was defined as SBP or HR increased by more than 30% of baseline from the time point immediately after intubation to 2 min after intubation, and the occurrence was recorded.Venous blood samples were collected to detect the plasma concentrations of norepinephrine and cortisol before anesthesia induction and at 5 min after intubation.The development of bucking was recorded during emergence, and the time of tracheal extubation and occurrence of sore throat, throat numbness and hoarseness after tracheal extubation were recorded. Results:Compared with group C, the incidence of cardiovascular response to endotracheal intubation was significantly decreased, the plasma concentrations of norepinephrine and cortisol were decreased at 5 min after intubation, and the incidence of bucking during emergence and sore throat after tracheal extubation was decreased in group S ( P<0.05). Conclusions:Ultrasound-guided SLNB can inhibit the stress response during endotracheal intubation and reduce the occurrence of adverse events during emergence in elderly patients undergoing short surgery with general anesthesia.

Effect of low-dose esketamine on postoperative delirium in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor / 中华麻醉学杂志

Objective:To evaluate the effect of low-dose esketamine on postoperative delirium (POD) in elderly frail patients undergoing laparoscopic radical resection of the gastrointestinal tumor.Methods:Ninety-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ frail patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2 and preoperative Fried frailty phenotype scale score≥3, scheduled for elective laparoscopic radical resection of the gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=47 each) using a random number table method: control group (group C) and low-dose esketamine group (group K). In group K, esketamine 0.5 mg/kg was given during induction of anesthesia, and esketamine 0.25 mg·kg -1·h -1 was continuously infused during operation until the end of operation.In group C, the equal volume of normal saline was given at the corresponding time point.After induction of anesthesia and before skin incision (T 1), at 1 day after operation (T 2) and at 3 days after operation (T 3), blood samples from the internal jugular vein were collected for determination of the concentrations of S100β protein and neuron-specific enolase (NSE) in serum by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded.POD was evaluated by Confusion Assessment Method within 3 days after operation. Results:Compared with the baseline at T 1, the concentrations of serum S100β and NSE were significantly increased at T 2, 3 in both groups ( P<0.05). Compared with group C, the incidence of POD was significantly decreased (30% vs.13%), the intraoperative consumption of propofol and remifentanil was decreased, and concentrations of serum S100β protein and NSE were decreased at T 2, 3 in group K ( P<0.05). Conclusions:Low-dose esketamine can decrease the occurrence of POD in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor.

Improvement in strategy of anesthesia for laparoscopic radical resection of colorectal cancer in elderly patients: dexmedetomidine-based balanced anesthesia / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of dexmedetomidine-based balanced anesthesia for laparoscopic radical resection of colorectal cancer in elderly patients from the perspective of postoperative outcomes.Methods:A total of 112 patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer under general anesthesia, were divided into 2 groups ( n=56 each) using a random number table method: conventional general anesthesia group (group C) and dexmedetomidine-based balanced anesthesia group (group D). In D group, dexmedetomidine was intravenously infused with a loading dose of 0.5 μg/kg over 10 min starting from the beginning of anesthesia induction, and then midazolam, sufentanil, etomidate and cis-atracurium were injected sequentially, and anesthesia was maintained with sevoflurane, remifentanil and propofol, and dexmedetomidine 0.5 μg·kg -1·h -1 was continuously infused until 30 min before the end of surgery.In group C, the equal volume of normal saline was given instead of dexmedetomidine, and the other anesthetics were similar to those previously described in group D. Venous blood samples were collected on 1 day before surgery and 2 and 7 days after surgery for routine blood test to determine the neutrophil-to-lymphocyte ratio.The consumption of intraoperative anesthetics, anesthesia-related postoperative complications, and time to postoperative first flatus and first feces were recorded. Results:Compared with group C, the consumption of intraoperative propofol and remifentanil was significantly reduced, neutrophil-to-lymphocyte ratio was decreased on 2 and 7 days after surgery, the incidence of postoperative delirium, nausea and vomiting was decreased, and the time to postoperative first flatus and first feces was shortened in group D ( P<0.05). Conclusions:Dexmedetomidine-based balanced anesthesia has a certain improvement in the efficacy and is more helpful for early postoperative outcomes than conventional general anesthesia when used in elderly patients undergoing laparoscopic radical resection of colorectal cancer.

Effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy / 中华麻醉学杂志

Objective:To evaluate the effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy.Methods:Eighty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, scheduled for elective carotid endarterectomy under general anesthesia, were divided into 2 groups ( n=41 each) using a random number table method: control group (group C) and nimodipine group (group N). Nimodipine 7.5 μg·kg -1·h -1 was intravenously infused starting from the beginning of surgery until the end of surgery in group N, while the equal volume of normal saline was given in group C. Before infusing nimodipine (T 1), before placing the the shunt (T 2), at 10 min after placing the the shunt (T 3) and at 10 min after releasing carotid artery (T 4), blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular venous blood oxygen content, arterio-jugular difference of oxygen content, and cerebral oxygen extraction ratio were calculated.The concentrations of S100β protein in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) Scale (Chinese version) at 1 day before surgery and 1, 3 and 7 days after surgery, and the occurrence of cognitive dysfunction (MoCA score<26) was recorded within 7 days after operation. Results:Compared with group C, MoCA scores were significantly increased at each time point after surgery, and the incidence of cognitive dysfunction was decreased (27% vs.17%), and the jugular venous blood oxygen content was increased, and arterio-jugular difference of oxygen content, cerebral oxygen extraction ratio, and concentrations of serum S100β protein were decreased at T 2-4 in group N ( P<0.05). Conclusions:Nimodipine can improve the cognitive function after carotid endarterectomy, which may be related to the improvement in intraoperative cerebral oxygen metabolism and reduction of brain injury in elderly patients.

Recombinant human insulin-like growth factor-1 promotes osteoclast formation and accelerates orthodontic tooth movement in rats

Abstract Background: IGF-1 may be an important factor in bone remodeling, but its mechanism of action on osteoclasts during orthodontic tooth movement is complex and unclear. Methodology: The closed-coil spring was placed between the left maxillary first molar and upper incisors with a force of 50 g to establish an orthodontic movement model. Eighty SD rats were randomized to receive phosphate buffer saline or 400 ng rhIGF-1 in the lateral buccal mucosa of the left maxillary first molar every two days. Tissue sections were stained for tartrate-resistant acidic phosphatase (TRAP), the number of TRAP-positive cells was estimated and tooth movement measured. Results: The rhIGF-1 group exhibited evidential bone resorption and lacuna appeared on the alveolar bone compared to the control group. Moreover, the number of osteoclasts in compression side of the periodontal ligament in the rhIGF-1 group peaked at day 4 (11.37±0.95 compared to 5.28±0.47 in the control group) after the orthodontic force was applied and was significantly higher than that of the control group (p<0.01). Furthermore, the distance of tooth movement in the rhIGF-1 group was significantly larger than that of the control group from day 4 to day 14 (p<0.01), suggesting that rhIGF-1 accelerated orthodontic tooth movement. Conclusion: Our study has showed that rhIGF-1 could stimulate the formation of osteoclasts in the periodontal ligament, and accelerate bone remodeling and orthodontic tooth movement.

Role of GPR30 in reduction of ketamine-induced long-term cognitive dysfunction by 17β estradiol in neonatal rats / 中华麻醉学杂志

Objective:To evaluate the role of G protein-coupled receptor 30 (GPR30) in reduction of ketamine-induced long-term cognitive dysfunction by 17β estradiol in neonatal rats.Methods:Thirty healthy male Sprague-Dawley rats, aged 7 days, weighing 11-18 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), ketamine group (group K), 17β estradiol plus ketamine group (group KE), GPR30 agonist G1 plus ketamine group (group G1K) and GPR30 inhibitor G15 plus 17β estradiol plus ketamine group (group G15EK). Ketamine 75 mg/kg was intraperitoneally injected in group K. In group EK, 17β estradiol 600 μg/kg was subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.In group G1K, G1 200 μg/kg was subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.In group G15EK, G15 300 μg/kg and 17β estradiol 600 μg/kg were subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.The equal volume of normal saline was intraperitoneally given in group C. The injection was performed every 24 h for 3 consecutive days.All the rats were allowed to grow up till postnatal day 60, and then Morris water maze test was performed to evaluate their spatial learning and memory function.The rats were sacrificed after the end of Morris water maze test, and hippocampi were removed for determination of contents of acetyl cholinesterase (AChE) and acetylcholine (ACh) by enzyme-linked immunosorbent assay. Results:Compared with group C, the escape latency was significantly prolonged on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were decreased, the content of AChE was increased, and the content of ACh was decreased in group K ( P<0.05). Compared with group K, the escape latency was significantly shortened on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were increased, the content of AChE was decreased, and the content of ACh was increased in EK and G1K groups ( P<0.05). Compared with EK and G1K groups, the escape latency was significantly prolonged on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were decreased, the content of AChE was increased, and the content of ACh was decreased in group G15EK ( P<0.05). Conclusion:GPR30 is involved in reduction of ketamine-induced long-term cognitive dysfunction by 17β estradiol, which is related to regulating the contents of AChE and ACh in hippocampi of neonatal rats.

Effect of ischemic preconditioning combined with dexmedetomidine on lung injury induced by limb ischemia-reperfusion in patients undergoing orthopedic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of ischemic preconditioning combined with dexmedetomidine on lung injury induced by limb ischemia-reperfusion (I/R) in patients undergoing orthopedic surgery.Methods:Seventy-five patients of both sexes, aged 50-89 yr, with body mass index of <35 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective lower extremity surgery with tourniquet, were divided into 4 groups using a random number table method: control group (group C, n=17), ischemic preconditioning group (group IP, n=19), dexmedetomidine group (group D, n=19) and ischemic preconditioning combined with dexmedetomidine group (group IPD, n=20). The patients underwent three cycles of 5 min ischemia which was induced by a tourniquet placed on the upper extremity and inflated to 200 mmHg, followed by 5 min deflation at 24 h before surgery in group IP and group IPD.In D and IPD groups, dexmedetomidine was intravenously infused at a loading dose of 0.5 μg/kg over 15 min starting from the time point after the patients were in the supine position, followed by an infusion of 0.5 μg·kg -1·h -1 until the end of surgery, while the equal volume of normal saline was given instead in group C. Before using the the tourniquet (T 0), immediately after loosing the tourniquet (T 1) and at 24 h after surgery (T 2), mean arterial pressure and heart rate (HR) were recorded.Arterial blood samples were collected for blood gas analysis at T 0 and T 1, and pH value, arterial oxygen partial pressure (PaO 2), arterial carbon dioxide partial pressure (PaCO 2) and lactic acid concentration (Lac) were recorded.Alveolar-arterial oxygen partial pressure difference (P A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated.The occurrence of acute lung injury (ALI) was recorded from T 1 to T 2.The serum concentrations of Clara cells secrete proteins 16 (CC16) and malonyldialdehyde (MDA) were determined by enzyme linked immunosorbent assay from T 1 to T 2. Results:Compared with group C, HR was significantly decreased and PaCO 2 was increased in D and IPD groups, PaO 2 and OI were increased and RI was decreased in IP and IPD groups, and CC16 and MDA concentrations were decreased ( P<0.05), and no significant change was found in the incidence of ALI in IP and D groups ( P>0.05). Compared with group IP or group D, no significant change was found in the parameters mentioned above in group IPD ( P>0.05). Conclusion:For the patients undergoing orthopedic surgery, both ischemic preconditioning and dexmedetomidine can reduce lung injury induced by limb I/R, but the effect of the combination is not enhanced significantly.

Hollow-structured nanoparticles as an anticancer drug carrier / 中国药理学与毒理学杂志

Many drug candidates identified from natural products are poorly water-soluble. The surfactants used to disperse the hydrophobic anticancer drugs in water may cause a serious of acute hypersensitivity reactions. Nanotech?nology provides an alternative strategy for delivery of anticancer drugs. Drugs can be encapsulated or attached to the nanomaterials such as lipids, polymers and solid-core nanoparticles. In the present study, porous inorganic nanoparti?cles have been utilized for delivery of water-insoluble anticancer drugs. The synthesized nanoparticles were functional?ized with different organic polymers. The porous nanoparticles were readily internalized by human glioblastoma U-87 MG cells, and didn't display cytotoxicity. The internalized nanoparticles were mainly localized in endosomes/lysosomes in cells. With the hydrophobic curcumin and carfilzomib as model drugs, intracellular delivery of hydrophobic anticancer drugs by the porous inorganic nanoparticles was studied. The porous nanoparticle-based encapsulation of hydrophobic drug provides the aqueous dispersion of the drugs. In endosomes/lysosomes mimicking buffers with a pH of 4.5-5.5, pH-dependent drug release was observed from drug loaded nanoparticles. The intracellular drug content and cytotoxicity were significantly higher for drug loaded nanoparticles than free drug. These results suggested porous inorganic nanoparticles might be a promising intracellular carrier for hydrophobic anticancer drugs.