[The predictive values of platelet mitochondrial mass and quantity during the perioperative period in elderly patients on the occurrence of postoperative delirium].

Objective: To investigate the changes of platelet mitochondrial mass and quantity during perioperative period in elderly patients, and assess their predictive values on the occurrence of postoperative delirium (POD). Methods: In this prospective study, 162 elderly patients scheduled for abdominal surgery under general anesthesia were enrolled from November 2021 to January 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them, 20 patients [10 males, 10 females, aged (71.4±6.8) years] developed POD within 3 days after surgery (POD group), and another 20 patients[12 males, 8 females, aged (67.7±5.3) years] who did not develope POD were selected as controls (control group) using propensity score matching method. Blood samples were collected preoperatively, at the end of surgery and on the first postoperative day. Platelets were extracted and mitochondrial mass was detected with flow cytometry. Transmission electron microscopy was used to determine mitochondrial quantity. The receiver operating characteristic (ROC) curve was drawn to analyze the value of mitochondrial mass and quantity in predicting the occurrence of POD. Results: The mean fluorescence intensities of platelet mitochondrial mass were 193±46, 236±61, 264±53 preoperatively, at the end of surgery and on the first postoperative day in the POD group, respectively. The corresponding values were 209±61, 191±67 and 201±56 in the control group. The platelet mitochondrial mass of patients in the POD group was significantly increased on the first postoperative day compared to preoperative levels (P<0.001). In contrast, there was no significant difference in the control group (P=0.410). Patients in the POD group had higher platelet mitochondrial mass than patients in the control group on the first postoperative day(P=0.002). Meanwhile, platelets from patients in the POD group showed significantly higher number of mitochondria than platelets from patients in the control group [3 (2, 4) vs 2 (1, 2), P<0.001]. According to the ROC curve of platelet on the first postoperative day, at a mitochondrial mass cut-off value of>275.35, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 55%, 90% and 0.800 (95%CI: 0.666-0.934, P<0.001). At a mitochondrial quantity cut-off value of>2, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 53%, 78% and 0.680 (95%CI: 0.584-0.776, P<0.001). Conclusions: Patients who developed POD show higher platelet mitochondrial mass after surgery compared to preoperative levels. The mitochondrial mass of platelets on the first postoperative day has good predictive value on the occurrence of POD.

[Risk factors of pain after CT-guided preoperative localization of pulmonary nodules with four-hook needle].

Objective: To identify the risk factors of pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. Methods: The clinical data of 212 patients, who underwent CT-guided preoperative localization of single pulmonary nodule with 4-hook needle in Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School from September 2021 to February 2022 were retrospectively analyzed. All patients, including 83 males and 129 females with an age of (54±12) years, were divided into mild pain group (n=163) and moderate-severe pain group (n=49) according to numeric rating scale (NRS) for assessment of pain intensity. The gender, age, body mass index, smoking history, American Society of Anesthesiologists physical status (ASA), nodule location, nodule size, nodule distance from pleura, needle tip distance from pleura, localization-related complications (pneumothorax, pulmonary hemorrhage) and NRS for assessment of pain intensity after pulmonary nodules localization were collected and compared between the two groups. Univariate analysis and multivariate binary logistic regression analysis were performed to identify the risk factors of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. Results: The success rate of preoperative localization was 100%. The rates of pneumothorax and pulmonary hemorrhage were 22.6% and 17.0%, respectively. Univariate analysis showed that there was no significant difference in gender, age, body mass index, smoking history, ASA physical status, nodule location, nodule size, nodule distance from pleura and localization-related complications (pneumothorax, pulmonary hemorrhage) between the two groups (P>0.05), while needle tip distance from pleura of moderate-severe pain group was significantly less than that of mild pain group [7(6, 11) mm vs 15(12, 19) mm, P<0.001]. Multivariate binary logistic regression analysis showed that needle tip distance from pleura was the only risk factor for moderate-severe pain (OR=0.645, 95%CI: 0.562-0.739, P<0.001). According to receiver operating characteristic (ROC) curve analysis, when the cut-off value of needle tip distance from pleura was 9.5 mm, the sensitivity was 69.4%(34/49), the specificity was 90.2%(147/163), and the area under the curve (AUC) was 0.878 (95%CI: 0.820-0.935, P<0.001). Conclusions: Needle tip distance from pleura was the independent risk factor of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. The less needle tip distance from pleura is, the higher risk of moderate-severe pain occurs.

[Risk factors of massive introperative blood loss in posterior spinal fusion for adolescent idiopathic scoliosis].

Objective: To investigate the risk factors and prognostic impact of massive introperative blood loss in posterior spinal fusion (PSF) surgery for adolescent idiopathic scoliosis (AIS). Methods: Clinical data were collected of 1 896 AIS patients who underwent PSF surgery under general anesthesia in Drum Tower Hospital Affiliated to Nanjing University Medical School from November 2010 to October 2019 and retrospectively analyzed. According to the volume of intraoperative blood loss, the patients were divided into the massive introperative blood loss group [estimated blood loss (EBL)/estimated blood volume (EBV)≥30%] and the non-massive introperative blood loss group (EBL/EBV<30%). The perioperative parameters between the two groups were compared, single factor analysis and multivariate logistic regression analysis was performed to identify independent risk factors related to massive introperative blood loss in PSF surgery. Results: A total of 1 896 AIS patients who underwent PSF surgery were included in the study. There were 298 males and 1 598 females, with an age of (14.5±1.7) years. Among them, 633 (33%) experienced massive intraoperative blood loss. The factors significantly related to the massive blood loss during PSF surgery in this study are: sex, body mass index(BMI), preoperative blood platelet count (PLT), prothrombin time, international normalized ratio(INR), preoperative Cobb angle, duration of operation, the number of fused levels, the number of screws, thoracoplasty, intraoperative use of tranexamic acid and dexmedetomidine; The independent factors included duration of operation longer than 4 hours(OR=4.311,P<0.001), the number of fused levels to be more than 10(OR=4.044,P<0.001), thoracoplasty (OR=2.174,P=0.019), BMI lower than 18.1 kg/m2(OR=2.094,P<0.001), preoperative PLT less than 186.5×109/L(OR=1.480,P=0.009), preoperative INR larger than 1 (OR=1.531,P=0.003) and preoperative Cobb angle larger than 53°(OR=1.306,P=0.036) ;Intraoperative use of tranexamic acid (OR=0.770, P=0.047) and dexmedetomidine (OR=0.653, P=0.008) are protective factors for massive intraoperative blood loss. In addition, in the massive intraoperative blood loss group, length of postoperative hospital stay (P<0.001), volume of postoperative incision drainage (P<0.001), postoperative allogeneic blood transfusion rate (22.7% vs 14.3%, P<0.001), incidence of postoperative hypoalbuminemia (90.3% vs 80.7%, P<0.001) and the number of rescue opioid analgesic requirements after surgery (P=0.006) were significantly higher than those in the non-massive introperative blood loss group. Conclusions: Longer operation duration, higher number of fusion levels, lower BMI, lower preoperative PLT, higher INR, larger preoperative Cobb angle and intraoperative thoraplasty are independent risk factors for massive intraoperative blood loss in AIS patients undergoing PSF surgery. Intraoperative use of tranexamic acid and dexmedetomidine can reduce the risk of massive blood loss in PSF surgery. Massive intraoperative blood loss significantly affects the patient's prognosis.

Anti-nociceptive effects of caloric restriction on neuropathic pain in rats involves silent information regulator 1.

BACKGROUND: Caloric restriction (CR) increases both average and maximum lifespan, retards physiological signs of ageing, and delays the onset of several diseases and may mediate neuropathic pain. Neuropathic pain seriously affects the quality of life of patients. In this study, we investigated whether CR exerts anti-nociceptive effects on neuropathic pain, and probed its potential mechanisms. METHODS: Adult rats were divided into two dietary groups: an ad libitum (AL)-fed group and a CR group, which was provided with 60% of the food intake of AL rats for 6 weeks. The effects of 6-week CR on pain behaviour and neuro-inflammation induced by chronic constriction injury of the sciatic nerve were evaluated. RESULTS: Rats subjected to a CR diet had reduced hypersensitivity to mechanical and thermal stimuli after nerve-constriction injury. CR increased the silent information regulator 1 (SIRT1) expression, and suppressed the nerve-constriction-induced production of mitochondrial-derived reactive oxygen species and activation of nuclear factor kappa B accompanied by suppression of mature interleukin-1ß production in the ipsilateral spinal cord dorsal horn. The inhibition of SIRT1 reversed the effects of caloric restriction on pain behaviours. Moreover, CR decreased the phosphorylation of N-methyl-d-aspartate receptor subunits and the mitogen-activated protein kinase family, decreased the sensory neurone excitability, and inhibited the nerve-constriction-induced glial-cell activation. CONCLUSIONS: These results suggest that the effects of CR on pain behaviours in a rat model of nerve injury are via inhibition of excessive neuro-inflammation induced by the injury. CR may be of benefit in patients with neuropathic pain.

Precision Control of the Electron Longitudinal Bunch Shape Using an Emittance-Exchange Beam Line.

We report on the experimental generation of relativistic electron bunches with a tunable longitudinal bunch shape. A longitudinal bunch-shaping (LBS) beam line, consisting of a transverse mask followed by a transverse-to-longitudinal emittance exchange (EEX) beam line, is used to tailor the longitudinal bunch shape (or current profile) of the electron bunch. The mask shapes the bunch's horizontal profile, and the EEX beam line converts it to a corresponding longitudinal profile. The Argonne wakefield accelerator rf photoinjector delivers electron bunches into a LBS beam line to generate a variety of longitudinal bunch shapes. The quality of the longitudinal bunch shape is limited by various perturbations in the exchange process. We develop a simple method, based on the incident slope of the bunch, to significantly suppress the perturbations.

Molecular detection and in vitro antioxidant activity of S-allyl-L-cysteine (SAC) extracted from Allium sativum.

It is well known that Allium sativum has potential applications to clinical treatment of various cancers due to its remarkable ability in eliminating free radicals and increasing metabolism. An allyl-substituted cysteine derivative - S-allyl-L-cysteine (SAC) was separated and identified from Allium sativum. The extracted SAC was reacted with 1-pyrenemethanol to obtain pyrene-labelled SAC (Py-SAC) to give SAC fluorescence properties. Molecular detection of Py-SAC was conducted by steady-state fluorescence spectroscopy and time-resolved fluorescence method to quantitatively measure concentrations of Py-SAC solutions. The ability of removing 1,1-diphenyl-2-picrylhydrazyl (DPPH) and hydroxyl radical using Py-SAC was determined through oxygen radical absorbance capacity (ORAC). Results showed the activity of Py-SAC and Vitamin C (VC) with ORAC as index, the concentrations of Py-SAC and VC were 58.43 mg/L and 5.72 mg/L respectively to scavenge DPPH, and 8.16 mg/L and 1.67 mg/L to scavenge •OH respectively. Compared with VC, the clearance rates of Py-SAC to scavenge DPPH were much higher, Py-SAC could inhibit hydroxyl radical. The ability of removing radical showed a dose-dependent relationship within the scope of the drug concentration.

Positive feedback regulation between microRNA-132 and CREB in spinal cord contributes to bone cancer pain in mice.

BACKGROUND: cAMP response element-binding protein (CREB)-dependent gene expression plays an important role in central sensitization. CREB-regulated transcription coactivator 1 (CRTC1) dramatically increase CREB-mediated transcriptional activity. microRNA-132 (miR-132), which is highly CREB-responsive, functions downstream from CREB/CRTC1 to mediate activity-dependent synaptic plasticity and in turn loops back to amplify CREB/CRTC1 signalling. This study aimed to investigate the positive feedback regulation between miR-132 and CREB in spinal cord in the maintenance of bone cancer pain. METHODS: Osteosarcoma cells were implanted into the intramedullary space of the right femurs of C3H/HeNCrlVr mice to induce bone cancer pain. We further investigated effects of repeated intrathecal administration with Adenoviruses expressing CREB-siRNA or miR-132 antisense locked nucleic acid (LNA), respectively, on nociceptive behaviours and on the activity of CREB/CRTC1 signalling. RESULTS: Intramedullary inoculation of osteosarcoma cells resulted in up-regulation of spinal p-CREB, CRTC1 and CREB-target genes (NR2B and miR-132). Repeated intrathecal administration with Adenoviruses expressing CREB-siRNA or miR-132 LNA-AS, respectively, attenuated bone cancer-evoked pain behaviours, reduced the activity of CREB/CRTC1 signalling and down-regulated CREB-target gene NR2B expression in spinal cord. CONCLUSIONS: These findings suggest that activation of spinal CREB/CRTC1 signalling may play an important role in bone cancer pain. Interruption to the positive feedback regulation between CREB/CRTC1 and its target gene miR-132 can effectively relieved the bone cancer-induced mechanical allodynia and spontaneous pain. WHAT DOES THIS STUDY ADD?: The positive feedback regulation between CREB/CRTC1 and its target gene miR-132 in spinal cord plays an important role in bone cancer pain.

Preservation effect of meat product by natural antioxidant tea polyphenol.

1% of tea polyphenol, chitosan solution and potassium sorbate were used as film-forming materials to coat chilled mutton. Total coliforms, TVB-N value and pH value were determined and used as the mutton fresh-keeping indexes. The results showed that after 12th day at the end of the storage, mutton coated with tea polyphenol had best effects comparing chitosan solution and potassium sorbate. pH value of mutton coated by tea polyphenol was 6.0, TVB-N and the total coliforms were both significantly lower than the meat coated by chitosan solution and potassium sorbate. Also, mutton coated by tea polyphenol accorded with the requirements of national standards about fresh meat quality. In summary, the tea polyphenol film was the most suitable film on chilled mutton coating preservation among the three chemicals used in this research.

The activation of spinal astrocytes contributes to preoperative anxiety-induced persistent post-operative pain in a rat model of incisional pain.

BACKGROUND: Preoperative anxiety, a clinically significant problem for many patients undergoing surgery, is associated with prolonged and exacerbated post-operative pain. To date, the mechanisms of preoperative anxiety-induced persistent post-operative pain remain unclear. The present study aimed to provide a rat model of preoperative anxiety-induced persistent post-operative pain using the single-prolonged stress (SPS) procedure to induce preoperative anxiety-like behaviours, and to explore the role of spinal astrocytes in this phenomenon. METHODS: Rats were exposed to the SPS procedure to induce preoperative anxiety-like behaviours. Subsequently, acute post-operative pain was developed using a 1-cm longitudinal incision through skin and fascia of the plantar aspect of the right hindpaw. Mechanical allodynia was measured before and after the incision. Immunofluorescence assay was used to assess the expression of glial fibrillary acidic protein and the activation of astrocytes in spinal dorsal horn. RESULTS: The SPS performed before the incision resulted in (1) enhanced preoperative anxiety-like behaviours as revealed by the elevated plus maze tests; (2) exacerbated and prolonged mechanical allodynia that lasted for at least 28 post-operative days; and (3) activation of astrocytes in the lumbar spinal dorsal horn. CONCLUSIONS: The data suggest that this rat model, which could mimic the clinical persistent post-operative pain induced by preoperative anxiety, may be a useful tool to explore the mechanisms as well as effective prevention and treatment for this problem. Furthermore, spinal astrocytes activation may contribute to the development of post-operative hyperalgesia in this model.

First observation of the exchange of transverse and longitudinal emittances.

An experimental program to demonstrate a novel phase-space manipulation in which the horizontal and longitudinal emittances of a particle beam are exchanged has been completed at the Fermilab A0 Photoinjector. A new beam line, consisting of a TM(110) deflecting mode cavity flanked by two horizontally dispersive doglegs has been installed. We report on the first direct observation of transverse and longitudinal emittance exchange.

Tunable subpicosecond electron-bunch-train generation using a transverse-to-longitudinal phase-space exchange technique.

We report on the experimental generation of a train of subpicosecond electron bunches. The bunch train generation is accomplished using a beam line capable of exchanging the coordinates between the horizontal and longitudinal degrees of freedom. An initial beam consisting of a set of horizontally separated beamlets is converted into a train of bunches temporally separated with tunable bunch duration and separation. The experiment reported in this Letter unambiguously demonstrates the conversion process and its versatility.

Making and repairing the mammalian brain--signaling toward neurogenesis and gliogenesis.

Neural stem cells (NSCs) are subscribed extraordinary potential in repair of the damaged nervous system. However, the molecular identity of NSCs has not been established. Most NSC cultures contain large numbers of multipotent, bipotent, and lineage restricted neural progenitors, the majority of which appear to lose neurogenic potential after expansion. This review first discusses the neurogenic to gliogenic switch that is characteristic of progenitor development in vivo and in NSC cultures, and then the cell intrinsic and extrinsic mechanisms regulating the sequential differentiation of neurons and glia. Finally, we discuss potential methods for maintaining the neurogenic potential of NSC cultures after expansion.

[Manometric study of the esophagus and intrathoracic stomach after partial esophagectomy for carcinoma].

The pressure in the residual esophagus and in the thoracic stomach was measured by using SG-II computer manometer in 25 patients who underwent resection of esophageal cancer. Thirty normal mean were chosed as controls. The results indicated that a high pressure zone was present above the esophago-gastric anastomosis. It may be helpful in preventing and reducing reflux esophagitis. We stress that the prevention of gastroesophageal reflux after the operation is related to the operative method and the topography of the stomach.

[Surgical treatment of middle lobe carcinoma of the lung].

From February 1965 to April 1993, 88 patients with middle lobe carcinoma of the lung were treated surgically. It constituted 7.7% of the total patients of operated lung cancer in our hospital. Clinical symptoms were mainly fever, cough, bloody-sputum and chest pain. 84 of 88 patients were treated by wedge resection, lobectomy and pneumonectomy. Exploration was preformed in 4 patients. The 1, 3, 5 and 10-year survival rates of the 78 patients followed up were 87.18%, 43.08%, 38.18% and 24.13% respectively. It related to four clinical features of middle lobe cancer of the lung were treated surgically is discussed.

[Video-assisted thoracic surgery: preliminary results of 25 cases].

From Oct 1992 to Dec 1993, 25 cases were done by VATS. They were: Wedge resection of the lung (5), biopsy of mediastinal mass (4), pleural biopsy (4), removal of mediastinal cyst (3), resection of pulmonary bullae and pleurodesis (2), removal of intrathoracic foreign body (2), lobectomy (2), removal of clotted blood of hemothorax (1), resection of malignant mesothelioma (1), and esophageal tumor (1). There was no severe complication. Three procedures of VATS needed to be converted to thoracotomy. All 25 patients were recovery well. The comment was done for indications and contraindications of VATS.

[Study on motor function of the esophagus by SG-II computer manometer].

The manometric studies of esophageal motility were performed on 30 normal subjects. Pressures were detected with a 3-microtransducer catheter following wet swallow. The measure, record and data processing were performed with the computer. The values obtained by us were compared with those reported by other laboratories. We consider that this method is simple, quick and accurate.

[Surgical treatment of esophageal stricture after chemical burn].

26 patients with esophageal stricture caused by chemical burn were treated from Nov. 1972 to Nov. 1990. No operative death occurred. Follow-up showed good therapeutic effects 92.3% of the patients. We believe that surgical treatment using colonic interposition as the main procedure may bring about satisfactory results. The indications for dilatation of esophageal stricture, preoperative treatment and selection of reconstruction of the esophagus are discussed.