Case report: Anesthetic management for removal of tumor thrombus in the inferior vena cava and pulmonary artery in renal cell carcinoma.

Anesthetic management of patients with renal cell carcinoma with tumor thrombus in the inferior vena cava (IVC) is challenging. This paper reports the experience of anesthesia management in a patient with advanced renal cell carcinoma with thrombus accumulation in the IVC, right atrium, and pulmonary artery who underwent radical nephrectomy and tumor thrombus removal assisted by cardiopulmonary bypass. The emboli, measuring approximately 3 × 6 cm in the left inferior pulmonary artery and 4 × 13 cm in the right main pulmonary artery, were removed completely. During incision of the IVC under systemic heparinization, significant blood loss occurred in the surgical field. The surgery took 724 min, and cardiopulmonary bypass took 396 min. Intraoperative blood loss was 22,000 ml. The patient was extubated 39 hours after surgery and stayed in intensive care unit for 3 days. At 1 year follow-up, the patient was in good health and leading a normal life.

Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy.

BACKGROUND: Double-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. METHODS: Patients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. RESULTS: A total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). CONCLUSION: Our study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. TRIAL REGISTRATION: Chinese Clinical Trail Register (ChiCTR2200062989).

De novo transcriptome analysis reveals the molecular regulatory mechanism underlying the response to excess nitrogen in Azolla spp.

Phytoremediation potential of Azolla in removal of nitrogen from wastewater has been promising. However, little is known about the response of Azolla to high concentrations of nitrogen. In this study, the responses of four Azolla species to different concentrations of total nitrogen ranging from 0 to 180 mg L-1 were examined. The responses varied among different species, and the high nitrogen-tolerant species A. caroliniana and A. microphylla could remove nitrogen from aqueous solutions with higher efficiencies. We further performed transcriptome analysis to explore the molecular mechanism underlying the response to high nitrogen stress in Azolla. RNA-seq analysis revealed a synergistic regulatory network of differentially expressed genes (DEGs) involved in nitrogen transport and metabolism in A. microphylla, mainly in the roots. Under high nitrogen treatment, the DEGs encoding nitrate transporters or nitrate transporter 1/peptide transporters (NRTs/NPFs), ammonium transporters (AMTs), nitrate reductase (NIA), nitrite reductase (NIR) and glutamine synthetases/glutamate synthases (GSs/GOGATs) were down-regulated, and the DEGs encoding glutamate dehydrogenases (GDHs) were up-regulated, suggesting that A. microphylla possessed high tolerance against excess nitrogen through down-regulation of nitrate and ammonium uptake and fine regulation of nitrogen assimilation in the roots. Our results provided a theoretical foundation for better utilization of Azolla for wastewater treatment.

Challenges in the surgical treatment of undiagnosed functional paragangliomas: A case report.

INTRODUCTION: Paragangliomas (PGs) or extra-adrenal pheochromocytomas are rare neuroendocrine neoplasms of ubiquitous distribution. Those that produce excess catecholamine are categorized as functional, and those that do not are categorized as nonfunctional. Although modern medical technology is becoming more widespread, there are still substantial risks of misdiagnosis or missed diagnosis of PGs. CASE PRESENTATION: A 38-year-old woman who lived in an autonomous region of inner Mongolia presented complaining of having experienced coughing for approximately the past month. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a lesion on the right side of thoracic vertebra 5-8 of approximately 66 mm × 54 mm, and it was deemed to be a mediastinal tumor that required surgical treatment. The patient exhibited severe hemodynamic instability during the operation, resulting in substantial challenges and risks with regard to anesthesia management. CONCLUSION: When a patient is suspected having PG, whether the surgery should be continued or not depends on their overall condition and whether hemodynamic fluctuation can be controlled to within the normal range. Both are factors that should be considered during intraoperative management. Communication between the surgeon and anesthesiologist is necessary, in order to accurately assess the risks associated with the operation. The combination of central venous pressure and the Flotrac/Vigileo system may provide precise guidance for complementary liquid therapy and reduce cardiopulmonary complications. After the operation, hemodynamic changes should be monitored continuously in the intensive care unit, and vasoactive drugs are required to avoid postoperative hypotension. Dramatic hemodynamic changes are certainly a challenge for patients and anesthesiologists, regardless of their origin, and sufficient attention should be paid to avoid serious consequences.

Highly sensitive and selective sensing platform based on π-π interaction between tricyclic aromatic hydrocarbons with thionine-graphene composite.

We are just beginning to exploit the fascinating potential of thionine, called electrochemical probe that can selectively recognize specific polycyclic aromatic hydrocarbons (PAHs), as tools for the detection of tricyclic aromatic hydrocarbons phenanthrene (PHE) and anthracene (ANT). A novel electrochemical sensing platform by modification of electroactive thionine functionalized graphene onto glass carbon electrode (Th/GRs/GCE) surface was constructed. The immobilized thionine showed a remarkable stability, which may benefit from the π-π stacking force with graphene. Under optimum conditions, the proposed electrochemical sensor exhibited high sensitivity and low detection limit for detecting PHE and ANT. The total amount of PHE and ANT could be quantified in a wide range of 10pM-0.1µM with a good linearity (R(2)=0.9979) and a low detection limit of 0.1pM (S/N=3). Compounds which possess one or two benzene rings or PAHs with more than three rings, such as benzene, naphthalene (NAP), benzo[a]pyrene (BaP) and pyrene (PYR) show little interference on the detection. Consequently, a simple and sensitive electrochemical method was proposed for the determination of PHE and ANT, which was used to determine PHE and ANT in waste water samples. The electrochemical method provides a general tool that complements the commonly used spectroscopic methods and immune method for the detection of PAHs.

[Aluminum-tolerant characteristics of different Chamaecrista genotypes].

A hydroponic culture experiment was conducted to study the responses of 40 Chamaecrista varieties (lines) to 120 mg x L(-1) of Al3+, with the correlations between the relative tolerance values of various characters of different genotypes and the comprehensive evaluation coefficient compared. Among the characters of the genotypes, the relative plant height, relative root dry mass, relative shoot dry mass, and relative root activity could be selected as the important indices for screening the Al-tolerant genotype of Chamaecrista. In the test 40 Chamaecrista varieties (lines), the 86134R2, 2208, 3170, 316, 2211, and 2232 had stronger Al-tolerant capability, belonging to Al-tolerant genotype, whereas the 34721R1, 92985, and 3184 had weaker Al-tolerant capacity, belonging to Al-sensitive genotype.

Structural and photoluminescent studies of lanthanide complexes with tripodal triRNTB (N-substituted tris(benzimidazol-2-ylmethyl)amine): ligand substituent, anionic and secondary ligand effects.

Six N-substituted NTB ligands (NTB = (tris(benzimidazol-2-ylmethyl)amine), namely, triMeNTB (L1), triEtNTB (L2), triPrNTB (L3), triBuNTB (L4), triAlNTB (L5) and triBzNTB (L6), have been synthesized through replacing the H atoms on the NH groups by methyl, ethyl, (n)propyl, (n)butyl, allyl, and benzyl groups, respectively. Their corresponding Sm(3+), Eu(3+) and Tb(3+) complexes consisting of different anions or secondary ligands have been prepared and characterized by elemental analyses, IR spectra and single-crystal X-ray diffraction measurements. Three types of structural models have been obtained: (2) where two triTNTB ligands wrap around the Ln(3+) ion with anions (ClO(4)(-) and CF(3)SO(3)(-)) free of coordination, (3) where one triRNTB ligand holds the Ln(3+) ion with anions (Cl(-), NO(3)(-) and picrate) participating in coordination, and '(3) where one triNTB ligand and three secondary antipyrine ligands coordinate with the Ln(3+) ion. The Ln(3+) ions in (2) type complexes are 8-coordinating and display a slightly distorted cubic (LnN(8)) coordination geometry. The Ln(3+) ions in (3) and '(3) types complexes show two different coordination geometries: one is 7-coordinating ((3) with Cl(-) anion and '(3)), which can be described as a severely distorted cube short of one corner (LnN(4)Cl(3) or LnN(4)O(3)), and the other is 10-coordinating ((3) with NO(3)(-) and picrate anions) which can be regarded as a severely distorted cube with one corner substituted by a three-atom cap (LnN(4)O(6)). The photoluminescent study reveals that the complexes with different Ln(3+) ions show a general luminescent intensity tendency of Tb > Eu > Sm. The modification of the NTB molecule by altering R groups tunes the triplet states of the ligands and results in differentiable photophysical properties of the complexes. The anions or secondary ligand also have remarkable effects on the luminescent properties of the complexes.

Tris(1H-benzimidazol-2-ylmethyl)amine-solvent adducts.

The tris(1H-benzimidazol-2-ylmethyl)amine (ntb) molecule crystallizes in different solvent systems, resulting in two kinds of adduct, namely the monohydrate, C24H21N7.H2O or ntb.H2O, (I), and the acetonitrile-methanol-water (1/0.5/1.5) solvate, C24H21N7.C2H3N.0.5CH4O.1.5H2O or ntb.1.5H2O.0.5MeOH.MeCN, (II). In both cases, ntb adopts a tripodal mode to form hydrogen bonds with a solvent water molecule via two N-H...O and one O-H...N hydrogen bond. In (I), the ntb.H2O adduct is further assembled into a two-dimensional network by N-H...N and O-H...N hydrogen bonds, while in (II), a double-stranded one-dimensional chain structure is assembled via N-H...O and O-H...O hydrogen bonds, with the acetonitrile molecules located inside the cavities of the chain structure.