Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study.

OBJECTIVE: This study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA). METHODS: In this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS. RESULT: In total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (ß = 0.48; 95% CI, 0.09-0.87; P = 0.015), diabetes mellitus (DM) (ß = 0.8; 95% CI, 0.33-1.27; P = 0.001), congestive cardiac failure (CCF) (ß = 4.1; 95% CI, 2.02-6.17; P < 0.001), perioperative blood transfusion (ß = 5.71; 95% CI, 4.86-6.56; P < 0.001), creatinine > 2 mg/dL (ß = 4.54; 95% CI, 2.46-6.62; P < 0.001), ASA status (III) (ß = 1.72; 95% CI, 0.72-2.71; P = 0.001), general anesthesia (ß = 0.78; 95% CI, 0.41-1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (ß = - 1.12; 95% CI, - 1.66 to - 0.58; P < 0.001), patients with BMI ≤ 25 kg/m2 (ß = - 1.92; 95% CI, - 2.73 to - 1.11; P < 0.001) or ≥ 30 kg/m2 (ß = - 0.58; 95% CI, - 1.1 to - 0.06; P = 0.029). CONCLUSION: Our findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2 receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2.

Inhibition of miR-185-3p Confers Erlotinib Resistance Through Upregulation of PFKL/MET in Lung Cancers.

Erlotinib (ER), as an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), has a significant therapeutic effect in lung cancers. However, EGFR TKI resistance inevitably occurs after treatment for approximately 12 months, which weakens its antitumor effect. Here, we identified miR-185-3p as a significantly downregulated microRNA responsible for acquired EGFR TKI resistance in cells and patients with lung cancer. qRT-PCR and Western Blot were performed to determine the relative expression of miR-185-3p in ER-resistant tumor tissues and cells. The viability and apoptosis of lung cancer cells were evaluated by Cell Counting Kit-8 (CCK8) assay and flow cytometry, respectively. The binding between miR-185-3p and liver-type phosphofructokinase (PFKL) was verified by dual luciferase assay. It was found that overexpression of miR-185-3p conferred ER sensitivity in lung cancer cell lines. MiR-185-3p was downregulated in ER-resistant lung cancer cells (H1299/ER and A549/ER). MiR-185-3p inhibited proliferation and induced cell apoptosis in ER-resistant cells. Mechanistically, miR-185-3p downregulation contributed to ER resistance through upregulating the PFKL. Moreover, Mesenchymal to epithelial transition (MET) oncoprotein promoted EGFR-TKI resistance by regulating miR-185-3p and PFKL. These findings revealed a novel mechanism in which downregulation of miR-185-3p may induce overexpression of PFKL and MET and confer ER resistance in lung cells. Combination of PFKL/MET inhibitors and EGFR TKIs could be a rational therapeutic approach for lung cancer patients with EGFR mutation.

Gut-Brain Axis: Possible Role of Gut Microbiota in Perioperative Neurocognitive Disorders.

Aging is becoming a severe social phenomenon globally, and the improvements in health care and increased health awareness among the elderly have led to a dramatic increase in the number of surgical procedures. Because of the degenerative changes in the brain structure and function in the elderly, the incidence of perioperative neurocognitive disorders (PND) is much higher in elderly patients than in young people following anesthesia/surgery. PND is attracting more and more attention, though the exact mechanisms remain unknown. A growing body of evidence has shown that the gut microbiota is likely involved. Recent studies have indicated that the gut microbiota may affect postoperative cognitive function via the gut-brain axis. Nonetheless, understanding of the mechanistic associations between the gut microbiota and the brain during PND progression remains very limited. In this review, we begin by providing an overview of the latest progress concerning the gut-brain axis and PND, and then we summarize the influence of perioperative factors on the gut microbiota. Next, we review the literature on the relationship between gut microbiota and PND and discuss how gut microbiota affects cognitive function during the perioperative period. Finally, we explore effective early interventions for PND to provide new ideas for related clinical research.

Altered local connectivity in chronic pain: A voxel-wise meta-analysis of resting-state functional magnetic resonance imaging studies.

BACKGROUND: A number of studies have used regional homogeneity (ReHo) to depict local functional connectivity in chronic pain (CP). However, the findings from these studies were mixed and inconsistent. METHODS: A computerized literature search will be performed in PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), WanFang, and SinoMed databases until June 15, 2019 and updated on March 20, 2020. This protocol will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software will be used for this voxel-wise meta-analysis. RESULTS: This meta-analysis will identify the most consistent ReHo alterations in CP. CONCLUSIONS: To our knowledge, this will be the first voxel-wise meta-analysis that integrates ReHo findings in CP. This meta-analysis will offer the quantitative evidence of ReHo alterations that characterize brain local functional connectivity of CP. PROSPERO REGISTRATION NUMBER: CRD42019148523.

Cortical thickness in chronic pain: A protocol for systematic review and meta-analysis.

BACKGROUND: Numerous studies using a variety of non-invasive neuroimaging techniques in vivo have demonstrated that chronic pain (CP) is associated with brain alterations. Cortical thickness (CTh) via surface-based morphometry (SBM) analysis of magnetic resonance imaging data is a valid and sensitive method to investigate the structure of brain gray matter. Many studies have employed SBM to measure CTh difference between patients with CP and pain-free controls and provided important insights into the brain basis of CP. However, the findings from these studies were inconsistent and have not been quantitatively reviewed. METHODS: Three major electronic medical databases: PubMed, Web of Science, and Embase were searched for eligible studies published in English on April 3, 2020. This protocol was prepared based on the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The Seed-based d Mapping with Permutation of Subject Images software package will be employed to conducted a coordinate-based meta-analysis (CBMA) to identify consistent CTh differences between patients with CP and pain-free controls. Several complementary analyses, including sensitivity analysis, heterogeneity analysis, publication bias, subgroup analysis, and meta-regression analysis, will be further conducted to test the robustness of the results. RESULTS: This CBMA will tell us whether CP with different subtypes shares common CTh alterations and what the pattern of its characterized alterations is. CONCLUSIONS: To the best of our knowledge, this will be the first CBMA of SBM studies that characterizes brain CTh alterations in CP. The CBMA will provide the quantitative evidence of common brain cortical morphometry of CP. The findings will help us to understand the neural basis underlying CP. TRIAL REGISTRATION NUMBER: INPLASY202050069.

MicroRNA­103 modulates tumor progression by targeting KLF7 in non­small cell lung cancer.

Numerous studies have identified that microRNAs (miRs) play a crucial role in the tumorigenesis of non­small cell lung cancer (NSCLC). However, to the best of our knowledge, the physiological function of miR­103 in NSCLC is not fully understood. Experiments in the present study revealed that miR­103 expression was increased in NSCLC cell lines. In addition, a series of methods, including MTT, colony formation, 5­ethynyl­2'­deoxyuridine, Transwell, wound healing, flow cytometric, reverse transcription­quantitative PCR and western blot assays, were performed, which revealed that overexpression of miR­103 enhanced cell growth, migration, invasion and epithelial­mesenchymal transition (EMT), and suppressed apoptosis of A549 and H1299 cells. Additionally, a dual­luciferase reporter assay indicated that miR­103 directly targets the 3'­untranslated region of Kruppel­like factor 7 (KLF7), and KLF7 expression was negatively regulated by miR­103 expression. Furthermore, the present findings demonstrated that miR­103 promoted EMT via regulating the Wnt/ß­catenin signaling pathway in NSCLC. Collectively, the current results demonstrated that miR­103 serves a tumorigenesis role in NSCLC development by targeting KLF7, at least partly via the Wnt/ß­catenin signaling pathway. Consequently, these findings indicated that miR­103/KLF7/Wnt/ß­catenin may provide a novel insight into underlying biomarkers for improving the diagnosis and treatment of NSCLC.

Fractional Exhaled Nitric Oxide for the Diagnosis of Childhood Asthma: a Systematic Review and Meta-analysis.

The gold standard for diagnosing asthma in children is based on clinical history of respiratory symptoms, physical examination, and respiratory function testing. Recent advances indicate that a non-invasive measure of airway inflammation, fractional exhaled nitric oxide (FeNO), provides objective data for use in asthma diagnosis. However, the diagnostic performance of FeNO in children with asthma has not been clearly defined. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of FeNO in the clinical determination of asthma in children. Databases of PubMed, the Cochrane Library, EMBASE, MEDION, and Web of Science were searched for relevant articles through March 31, 2016. A bivariate model was used for pooling estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating curves (SROC) as the main diagnostic measures. In total, eight studies met the inclusion criteria, which included 2933 subjects. The pooled estimates of sensitivity, specificity, and DOR for the detection of asthma in children were 0.79 [95 % confidence interval (CI), 0.64-0.89], 0.81 (95 % CI, 0.66-0.90), and 16.52 (95 % CI, 7.64-35.71). The SROC was 0.87 (95 % CI, 0.84-0.90). In brief, FeNO achieves a moderate diagnostic performance in the detection of asthma in children.

Gray Matter Abnormalities Associated With Chronic Back Pain: A Meta-Analysis of Voxel-based Morphometric Studies.

BACKGROUND: Studies employing voxel-based morphometry have reported inconsistent findings on the association of gray matter (GM) abnormalities with chronic back pain (CBP). We, therefore, performed a meta-analysis of available studies to identify the most consistent GM regions associated with CBP. METHODS: The PubMed, Embase, and Web of Science databases were searched from January 2000 to May 29, 2016. Comprehensive meta-analyses of whole-brain voxel-based morphometry studies to identify the most robust GM abnormalities in CBP were conducted using the Seed-based d Mapping software package. RESULTS: A total of 10 studies, comprising 293 patients with CBP and 624 healthy controls, were included in the meta-analyses. The most robust findings of regional GM decreases in patients with CBP compared with healthy controls were identified in the bilateral medial prefrontal cortex extending to the anterior cingulate cortex, the right medial prefrontal cortex extending to the orbitofrontal cortex. Regional GM decreases in the left anterior insula were less robustly observed. CONCLUSIONS: The present study demonstrates a pattern of GM alterations in CBP. These data further advance our understanding of the pathophysiology of CBP.

Gray matter abnormalities associated with fibromyalgia: A meta-analysis of voxel-based morphometric studies.

OBJECTIVES: Studies employing voxel-based morphometry (VBM) have reported inconsistent findings on the association of gray matter (GM) abnormalities with fibromyalgia. The aim of the present study is to identify the most prominent and replicable GM areas that involved in fibromyalgia. METHODS: A systematic search of the PubMed database from January 2000 to September 2015 was performed to identify eligible whole-brain VBM studies. Comprehensive meta-analyses to investigate regional GM abnormalities in fibromyalgia were conducted with the Seed-based d Mapping software package. RESULTS: Seven studies, reporting nine comparisons and including a grand total of 180 fibromyalgia patients and 126 healthy controls, were included in the meta-analyses. In fibromyalgia patients compared with healthy controls, regional GM decreases were consistently found in the bilateral anterior cingulate/paracingulate cortex/medial prefrontal cortex, the bilateral posterior cingulate/paracingulate cortex, the left parahippocampal gyrus/fusiform cortex, and the right parahippocampal gyrus/hippocampus. Regional GM increases were consistently found in the left cerebellum. Meta-regression demonstrated that age was correlated with GM anomalies in fibromyalgia patients. CONCLUSIONS: The current meta-analysis identified a characteristic pattern of GM alterations within the medial pain system, default mode network, and cerebro-cerebellar circuits, which further supports the concept that fibromyalgia is a symptom complex involving brain areas beyond those implicated in chronic pain.