Thoracic paravertebral nerve block combined laryngeal mask airway with preservation of spontaneous breathing can accelerate postoperative recovery.

OBJECTIVE: This study aimed to examine the potential benefits of Thoracic Paravertebral Nerve Block (TPVB) coupled with Laryngeal Mask Airway (LMA) and the maintenance of spontaneous breathing anesthesia, in contrast to general anesthesia utilizing double-lumen endobronchial intubation, on promoting recovery following thoracoscopic surgery. PATIENTS AND METHODS: A randomized controlled trial was carried out involving sixty patients set for Video-Assisted Thoracoscopic Surgery (VATS) at the Affiliated People's Hospital of Jiangsu University from February 2021 to January 2022. Patients were randomized to either the TPVB and LMA with spontaneous breathing anesthesia group (non-intubation group, NI group) or the general anesthesia with double-lumen endobronchial intubation group (Intubation group, I group). The primary outcome measured was the duration of hospitalization. Secondary outcomes included early postoperative rehabilitation indicators, postoperative complications, Visual Analogue Score (VAS), and inflammatory response markers. RESULTS: Patients in the NI group experienced significantly shorter hospital stays than those in the I group (p < 0.05). Early postoperative recovery, assessed by metrics including the first exhaust time, food intake time, first ambulation time, and duration of chest-tube placement, was superior in the NI group (p < 0.05). Postoperative complications such as nausea and vomiting, pulmonary infection, atelectasis, sore throat, and hoarseness, along with cortisol and C-reactive protein (CRP) levels at the end of the operation and 24 h post-operation, and VAS values within the first 12 h post-operation, were significantly lower in the NI group (p < 0.05). However, blood loss, operation time, and VAS values at 24 h and 48 h post-surgery showed no significant differences between the two groups. CONCLUSIONS: Our findings suggest that TPVB, in conjunction with LMA and spontaneous breathing anesthesia, may expedite postoperative recovery in patients undergoing VATS.

Nrf2-ARE signaling pathway regulates the expressions of A1R and ENT1 in the brain of epileptic rats.

OBJECTIVE: To explore the behavioral changes and the expressions of the A1 receptor (A1R) and balanced nucleoside transporter-1 (ENT1) in the brain of epileptic rats after activating the NF-E2-related factor 2 (Nrf2)-ARE signaling pathway. MATERIALS AND METHODS: Adult male Sprague-Dawley (SD) rats were randomly divided into normal control group, epilepsy group, and t-butylhydroquinone (tBHQ) group, with 10 rats in each group. Lithium-pilocarpine induced epilepsy model in rats was established. The first epileptic latency and seizure frequency within 1 hour were observed in each group using the Racine scoring system. HE (Hematoxylin and Eosin) staining was used to observe the pathological lesions in the brain tissue of each group. The expressions of A1R, ENT1, and relative genes in Nrf2-ARE pathway in rat hippocampus was detected by immunohistochemistry and Western blot. RESULTS: Compared with rats in epileptic group, the first seizure latency was prolonged and the seizure frequency decreased in tBHQ group (p<0.05). The degree of brain lesions in tHBQ group was lighter than that of epilepsy group. ENT1 expression in rat hippocampus of epileptic group was significantly upregulated than that of normal control group and tBHQ group. Besides, the protein levels of A1R, Nrf2, HO-1, and ARE in rat hippocampus of epilepsy group markedly decreased compared with those of normal control group. However, protein expressions of A1R, Nrf2, HO-1, and ARE proteins in rat hippocampus of tBHQ group were markedly upregulated. CONCLUSIONS: Activation of the Nrf2-ARE signaling pathway can reduce the pathological damage of rat hippocampal neurons, prolong the latency of seizures, and reduce the degree of epileptic seizure in rats.

Down-regulation of JARID1B expression inhibits cell proliferation, induces apoptosis and blocks cell cycle in human acute lymphoblastic leukemia cells.

OBJECTIVE: Acute lymphocytic leukemia (ALL) is a multi-factorial blood disease with unknown pathogenesis. Histone H3K4 methylation was significantly reduced in ALL patients, whereas jumonji AT-rich interactive domain 1B (JARID1B) was the specific demethylase of H3K4me. This study explores the expression level of JARID1B in ALL patients and down-regulated JARID1B expression in ALL cells to explore the function of JARID1B in ALL. PATIENTS AND METHODS: JARID1B mRNA expression level in ALL patients was detected by Real-time PCR. The peripheral blood mononuclear cells from healthy volunteers were selected as control. JARID1B shRNA was transfected with MOLT-4 cells and BALL-1 cells. JARID1B protein expression and H3K4me2 and H3K4me3 levels were detected by Western blot assay. Cell proliferation was assessed by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. Cell apoptosis and cell cycle were determined by flow cytometry. Bcl-2, Bax, Procaspase 3, and cyclin P21 expressions were evaluated by Western blot assay. RESULTS: JARID1B mRNA expression in primary bone marrow cells from ALL patients was significantly higher than that of healthy volunteers (p<0.05). The levels of histone H3K4me3 and H3K4me2 were up-regulated after JARID1B shRNA transfection. JARID1B shRNA significantly inhibited the proliferation of MOLT-4 and BALL-1 cells, induced apoptosis, and blocked cell cycle in G0/G1 phase compared with the control group (p<0.05). CONCLUSIONS: JARID1B is highly expressed in ALL. Down-regulating its expression inhibited leukemia cell proliferation, promoted apoptosis, and blocked cell cycle in G0/G1 phase through histone H3K4 methylation. JARID1B is an oncogene in ALL.

Serum proteomic spectral characteristics of acute myeloid leukemia and their clinical significance.

We investigated the differences between the serum proteomic spectral characteristics of acute myeloid leukemia (AML) patients and those of healthy people. We collected peripheral blood serum samples from 62 AML patients and 15 healthy controls. After removing high-abundance proteins, low-abundance serum proteins were separated using two-dimensional gel electrophoresis to identify differences between AML patients and healthy people. We investigated the different protein dots by mass fingerprint analysis, and evaluated the results using the Masort retrieval program provided by the MSDB protein bank. To further investigate the relationship between standard chemotherapy treatment efficacy and differences in protein patterns, we divided 21 patients into two groups (A and B) according to the efficacy of standard chemotherapy. Compared with the healthy cases, the AML patients demonstrated significant abnormal expression in 14 proteins (P < 0.05); α1-trypsin inhibitor (P < 0.01), prealbumin (P < 0.01), apolipoprotein E (P < 0.010), and apolipoprotein A-IV (P < 0.01) expression decreased, whereas haptoglobin HP2 (P < 0.05), serum exogenous lectin (P < 0.05), H factor homologue protein (P < 0.05), and serum amyloid A1 (P < 0.01) expression increased. Further stratified analysis revealed that patients with high serum lectin expression had poor outcomes. The study revealed various proteins with differential expression levels in the peripheral blood of AML patients, and the difference in serum lectin expression is related to the efficiency of standard chemotherapy. Therefore, these proteins are potential diagnosis markers or prognostic indicators of AML.

Comparative study: efficacy of closed-looptarget controlled infusion of cisatracurium and other administration methods for spinal surgery of elderly patients.

OBJECTIVE: To observe the efficacy of traditional administration, continuous pump injection, and closed-loop target controlled infusion of cisatracurium to determine the optimal method of drug administration, and to establish the individualized and rational administration of muscle relaxants in elderly patients. PATIENTS AND METHODS: A total of 150 patients who underwent spinal surgery under tracheal intubation general anesthesia in our hospital from August 2013 to April 2015 were selected. All patients were administered with general anesthesia and randomly divided into three groups: group A (n = 50) was treated under closed-loop target controlled infusion (CLTCI), group B (n = 50) was treated under muscle relaxation monitoring, and group C (n = 50) was treated under continuous pump injection. Hemodynamic changes and blood oxygen saturation of the three groups were observed, and the muscle relaxation recovery, dosage, and bleeding of the three groups were compared. RESULTS: MAP and HR of group A were significantly lower than those of group B and group C (p < 0.05). There were no cases of insufficient muscle relaxation in group A, five cases in group C, and 14 cases in group B, and the differences between any two groups were statistically significant (p < 0.05). Regarding muscle relaxation recovery, the time (T¬¬1) of recovery from 10%-25% and 25%-75%, and the time from drug withdrawal to recovery to TOFr from 0.7-0.9 of group A were the shortest, followed by group C and group B. The differences between any two groups were statistically significant (p < 0.05). The total dosage of cisatracurium of group A was the least, followed by group C and group B, and differences between any two groups were statistically significant (p < 0.05). Moreover, the bleeding volume of group A (235.2 ± 141.3 ml) was smaller than in group B (353.1 ± 173.8 ml) and group C (316.5 ± 155.2 ml), and differences between the three groups were statistically significant (p < 0.05). CONCLUSIONS: For spinal surgery of elderly patients, closed-loop target controlled infusion of cisatracurium was superior to continuous infusion and intravenous injection. The time of muscle relaxation recovery was shortened, the dosage of cisatracurium was reduced, and the number of cases of insufficient muscle relaxation was reduced.

Surgical strategies for unexpected gallbladder carcinoma.

OBJECTIVE: To explore surgical strategies for unexpected gallbladder carcinoma (UGC). PATIENTS AND METHODS: A study of hospital records was performed in 26 patients with UGC treated in our institution from January 1990 to December 2002. The surgical therapies and disease prognosis were analyzed. RESULTS: Five cases of GBC were noted during open cholecystectomy (OC) and 15 were confirmed during minicholecystectomy (MC), while were 6 identified during laparoscopic (LC) surgery; all patients with Nevin Stage I gallbladder carcinoma (GBC) survived > 3 years; patients with Stage III GBC died within 2 years and patients with Stage IV GBC died within 1 year. CONCLUSIONS: Caution must be taken when high risk conditions and atypical ultrasonography of gallbladder are encountered. Examination of frozen sections should be performed routinely in all cases to reduce the rates of misdiagnosis. Surgery is an effective treatment for GBC.

A preliminary clinical study on high-intensity focused ultrasound therapy for tubal pregnancy.

Our aim was to explore the clinical application value of high-intensity focused ultrasound (HIFU) therapy for tubal pregnancy. Forty hospitalized patients with tubal pregnancies (28 cases of non-ruptured tubal pregnancy and 12 cases of ruptured tubal pregnancy) were selected to receive HIFU therapy. Serum human chorionic gonadotropin (ß-HCG) concentrations were compared before and after treatment. Serum ß-HCG was measured weekly and patients received observation only if the concentration decreased by 15% or more, compared with the previous value. Patients were given supplement HIFU therapy if the decrease in the serum ß-HCG was <15% within two weeks. Ultrasound was used to detect the volume changes in the ectopic lesions before and after treatment, and changes in vital signs and complications were recorded. Contrast-enhanced ultrasonography was used to assess fallopian tube patency after treatment. HIFU treatment was successful in 33 of the 40 patients (82%). Seven patients failed HIFU treatment and received surgical therapy (18%). Before and after treatment, serum ß-HCG concentrations and lesion volume were significantly different (P < 0.05, P < 0.01, respectively). Post-treatment tubal contrast-enhanced ultrasonography showed tubal patency on the affected side in 21 cases (64%) at six months and in 27 cases (82%) at 12 months. In conclusion, HIFU is safe and effective, and can be a treatment option for tubal pregnancy.

Strain relief guided growth of atomic nanowires in a Cu3N-Cu(110) molecular network.

A self-corrugated Cu(3)N-Cu(110) molecular network shows the potential to overcome the element dependence barrier as demonstrated by epitaxial growth of atomic nanowires (approximately 1 nm in width) among various 3d, 4d, and 5d elements. Scanning tunneling microscopy shows that all of the investigated atomic nanowires share an identical structure, featuring uniform width, height, orientation and the same minimum separation distance. Ab initio study reveals that the formation mechanism of atomic nanowires can be directly attributed to a strain relief guided asymmetric occupation of atoms on the originally symmetric crest zone of the corrugated network.