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@#Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. Methods The patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. Results A total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). Conclusion VATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.
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Postoperative delirium(POD),a common surgical complication,refers to the acute and fluctuating disturbance in attention and awareness after surgery,which seriously affects the recovery and is one of the predictors of poor prognosis of patients.At present,preoperative anxiety is common in periopera-tive patients.As the independent risk factors for POD,preoperative anxiety plays an important role in the occurrence and development of POD.Taking active and reasonable intervention measures for patients with preoperative anxiety may effectively reduce the occurrence of POD.This paper reviews the effects of preoper-ative anxiety on POD,focusing on its mechanism and prevention methods,in order to explore the relation-ship between preoperative anxiety and POD,which might provide new ideas for the clinic.
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Objective:To explore the nursing work items and the technical difficulty in post anesthesia care unit, so as to provide the basis for accurate calculation of anesthesia nursing workload and reasonable matching of human resources.Methods:The primary and secondary indicators of the nursing working system in post anesthesia care unit were determined through the literature review and group discussion. Delphi method was used to revise the indicators and evaluate the importance and difficulty degree of the indicators. Finally, analytic hierarchy process and linear weighted sum method were used to calculate the weight value and difficulty coefficient of each index.Results:The positive coefficients of the experts in the two rounds were 100.00%, the authority coefficients of the experts were 0.90 and 0.96, the variation coefficients ranged from 0.000 to 0.342 and 0.042 to 0.307, and the Kendall coefficients were 0.239 and 0.273 (both P<0.01). The evaluation index system of the difficulty of nursing work in post anesthesia care unit was finally composed of 10 primary indicators and 85 secondary indicators. The weight of the primary index ranged from 0.016 4 to 0.186 4, and the weight of the secondary index ranged from 0.000 8 to 0.064 3. The standardized difficulty coefficient of the secondary index ranged from 1.02 to 1.59. Conclusions:The evaluation index system of the difficulty of nursing work items in post anesthesia care unit was comprehensive and the difficulty coefficient was in line with the actual clinical work in this study, which provides reference for the follow-up scientific calculation of nursing workload and human resources matching in post anesthesia care unit.
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Objective To determine risk factors of postoperative pulmonary complications within 1 month in patients undergoing thoracic surgery in Day Care Unit.Methods The total of 200 patients routinely scheduled for VATS under centralized management were enrolled in this study.On the postoperative day 1,lung ultrasound(LUS)was conducted by one physician in the ward.The patients received at least once Chest X-ray or CT in outpatient department within 30 days after discharge.The composite of out-of-hospital PPCs,and the value of LUSS in predicting the PPCs was appraised.Furthermore,we identified the perioperative risk factors associated with PPCs in VATS patients.Results Of 200 recruited VATS patients eligible in the Nanjing Drum Tower Hospital,188 participants received LUS examination and finally completed the 30 days follow-up.Of whom,68 patients developed the varied types of PPCs.Multivariable Logistic regression analysis indicated that comorbidity of immune system disease(P = 0.021),lobar resection(P = 0.031)and the postoperative 24 hours LUSS(P = 0.002)were independent risk factors for PPCs within 30 days after VATS.Conclusion Comorbidity of immune system disease,lobar resection and the postoperative 24 h LUSS were independent risk factors for PPCs within 30 days after VATS.
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Chronic pain patients are often accompanied with anxiety disorder, which promote the development of each other's disease process to a certain extent and seriously affect the quality of life of patients.However, the mechanism regulating the comorbidity between the two has not been clarified.Synaptic remodeling is the alteration of synaptic structure and function, which affects the transmission of signals between neurons.Synaptic remodeling is a hot topic in the field of chronic pain and anxiety disorders, but only few studies have explored its pathological changes in chronic pain and anxiety disorders.By summarizing the relevant researches in recent years, the occurrence of chronic pain co-anxiety disorder is closely related to changes in synaptic structure, synaptic transmission efficiency and synaptic function in brain regions.Synaptic remodeling could lead to the decline of centra pain regulation ability and aggravate the progression of chronic pain accompanied by anxiety disorder through ionic amino acid receptors, neuronal transmission and interactions between neurons and glial cells.Understanding the latest research progress of the co-morbidity mechanism of chronic pain and anxiety disorder is helpful to provide theoretical basis and potential new targets for its treatment.
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The incidence of emotion disability-related diseases in adolescents is increasing year by year, causing great harm to their physical and mental health, even affecting them until adulthood. However, the mechanism of this has not been fully clarified. The default mode network is a brain network composed of brain regions that are still active in the resting state. DMN is a hot pot in the field of resting state brain function research, but few studies have focused on its pathological changes in the adolescents with emotion disability-related diseases. In recent years, a number of articles related to adolescent emotion disorders have provided clues for understanding the characteristics and potential mechanisms of adolescent emotion disorders from the perspective of imaging. This paper summarized the related research over the years and found that the occurrence of emotion disorders is closely related to the activation of the default mode network brain regions, cortical thickness, gray matter volume or density, and changes in functional connections between brain areas.Some changes in brain structure and function can be used as predictive factors. In this paper, by summarizing the changes in brain imaging of these emotion disorders, we hope to explore new neuroimaging landmark changes, which can provide theoretical basis for the prevention, diagnosis and treatment of emotion disorders related diseases in adolescents.
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Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) in elderly patients undergoing hip surgery.Methods:The medical records of elderly patients, aged ≥ 65 yr, of American Society of Anesthesiologists (ASA) physical statusⅠ-Ⅳ, who underwent hip surgery from June 2013 to May 2019, were retrospectively collected.The patients′ sex, age, body weight, preoperative comorbidities, history of smoking and alcohol, results of the last laboratory test before surgery; mode of anesthesia, intraoperative medication, body temperature monitoring, fluid intake and output, operation time, anesthesia time; postoperative PPCs and postoperative nausea and vomiting, requirement for rescue analgesia, length of hospital stay, and perioperative blood transfusion were all collected.According to the occurrence of PPCs, patients were divided into PPCs group and non-PPCs group.Multivariable logistic regression was used to determine the risk factors for PPCs.Results:A total of 1 204 patients were finally enrolled in this study, 75 patients developed PPCs, and the incidence was 6.22%.The results of multivariate logistic regression showed that ASA physical status Ⅲ or Ⅳ, preoperative respiratory disease, postoperative transfer to intensive care unit, and perioperative blood transfusion were risk factors for PPCs, and general anesthesia combined with nerve block was a protective factor for PPCs in elderly patients undergoing hip surgery ( P<0.05). Conclusions:ASA physical status Ⅲ or Ⅳ, preoperative respiratory disease, postoperative transfer to intensive care unit, and perioperative blood transfusion are risk factors for PPCs, and general anesthesia combined with nerve block is a protective factor for PPCs in elderly patients undergoing hip surgery.
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Objective:To combine micro-course and flipped classroom, integrate the application of online WeChat group and teaching video, build a new teaching framework, and seek the application of flipped classroom based on "micro-course" in clinical skills training of general anesthesia and tracheal intubation for medical students.Methods:A total of 82 clinical medicine intern students of Batch 2015 and 2016 from Nnajing Drum Tower Hospital were selected as the research subjects to complete the internship (for two weeks). The teaching reform group (44 people) adopted the flipped classroom based on "micro-course"; the traditional group (38 people) adopted traditional teaching. Organized by the undergraduate teaching and research department, the number of tracheal intubation cases and the number of excellent scores were recorded during the two-week internship in anesthesia. After the rotation, a questionnaire survey was conducted to evaluate the mastery of endotracheal intubation operation and satisfaction with the teaching and training arranged by the department. SPSS 23.0 was used to conduct t test and non-parametric test. Results:The number of outstanding cases of tracheal intubation in the teaching reform group was higher than that in the traditional group, and the number of outstanding cases of tracheal intubation in girls was higher than that in boys, and the difference was statistically significant ( P<0.05). The self-assessed scores of the students' mastery of tracheal intubation and the satisfaction with clinical practice training in the teaching reform group were higher than those in the traditional group, and the difference was statistically significant ( P<0.05). Conclusion:Compared with traditional teaching, the flipped classroom based on "micro-course" has more advantages in the clinical skills training of medical tracheal intubation.
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Objective:To evaluate the effect of α-ketoglutarate (AKG) on postoperative delirium (POD) in aged mice.Methods:Eighty male C57BL/6N mice, aged 18 months, weighing 30-35 g, were divided into 4 groups ( n=20 each) using a random number table method: control+ solvent group (group C), control+ AKG group (group C+ AKG), surgery+ solvent group (group S) and surgery+ AKG group (group S+ AKG). Dimethyl 2-oxoglutarate 0.6 mg/kg was injected intraperitoneally for 3 consecutive days before surgery in C+ AKG and S+ AKG groups, while the equal volume of normal saline was given in C and S groups.Exploratory laparotomy was performed under anesthesia with isoflurane to establish POD model.The behaviors of mice in each group were tested at 24 h before surgery and 6, 9 and 24 h after surgery using buried food test (the latency to eat food), open field test (total distance, latency to the center, time and freezing time spent in the center) and Y maze test (duration in the novel arm and the number of entries into the novel arm), respectively.Then the animals were sacrificed at 6 h after operation, hippocampal tissues were removed for determination of the expression of microglia-specific marker ionized calcium binding adaptor molecule-1 (Iba-1), the number of Iba-1 positive cells (using immunofluorescence staining), and the expression of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in hippocamapus (by Western blot). Results:Compared with group C, the latency to eat food at eath time point was significantly prolonged, latency to the center at 6 and 9 h after surgery was prolonged, time spent in the center at 6 and 9 h after surgery was shortened, freezing time at 6, 9 and 24 h after surgery was shortened, the number of entries into the novel arm at 6 and 9 h after surgery was decreased, duration in the novel arm at 6 h after surgery was shortened, the expression of Iba-1 was up-regulated, the number of Iba-1 positive cells was increased, and the expression of IL-1β and TNF-α in hippocampus was up-regulated in group S ( P<0.05), and no significant change was found in the behaviors indexes in group C+ AKG ( P>0.05). Compared with group S, the latency to eat food at each time point was significantly shortened, latency to the center at 9 h after surgery was shortened, time spent in the center at 6 and 9 h after surgery was prolonged, freezing time at 9 and 24 h after surgery was prolonged, the number of entries in the novel arm at 9 h after surgery was increased, the expression of Iba-1was down-regulated, the number of Iba-1 positive cells was decreased, and the expression of IL-1β and TNF-α in hippocampus was down-regulated in group S+ AKG ( P<0.05). Conclusion:AKG can alleviate POD, and the mechanism may be related to inhibiting the activation of microglia and and thus reducing inflammatory responses in aged mice.
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This study was a single-center large-sample case-control study.Data of 1 106 elderly patients who underwent unilateral total hip arthroplasty from June 2013 to May 2019 were collected, including items such as patient′s baseline characteristics, comorbidities, perioperative medication, intraoperative blood pressure, and postoperative outcomes.Patients were divided into postoperative nausea and vomiting(PONV)group and non-PONV group according to whether nausea and vomiting occurred within 24 h after operation.Logistic regression analysis was used to determine the risk factors for PONV.The incidence of PONV was 11.03%.Female, intraoperative use of dezocine, and intraoperative hypotension(duration>3 min or cumulative time>6 min)are independent risk factors for PONV, while femoral neck fractures and intraoperative use of dexamethasone are protective factors.
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Objective To evaluate the influencing factors and early recovery quality in elderly patients with gastrointestinal tumor resection by the quality of recovery-40 questionnaire (QoR-40 questionnaire). Methods One hundred and forty- two elderly patients who had underwent gastrointestinal tumor resection from February to June 2017 were selected. The patients were over 65 years old. Their body mass index was (22.98 ± 3.20) kg/m2, and American Society of Anesthesilogists (ASA) wasⅡorⅢgrade. The patients were assessed with QoR-40 questionnaire on the first and second day after operation, and the factors affecting the total score of QoR-40 questionnaire on the first and second day after operation were analyzed. Results Compared with those on the first day after operation, the scores of emotional status, physical comfort, psychological support, physical independence, pain and total score of QoR-40 questionnaire on the second day after operation were significantly higher: 42 (39, 43) scores vs. 40 (38, 42) scores, 53 (52, 54) scores vs. 52 (50, 53) scores, 35 (35, 35) scores vs. 35 (34, 35) scores, 15 (13, 15) scores vs. 14 (12, 15) scores, 34 (33, 35) scores vs. 33 (32, 34) scores and 178 (173, 182) scores vs. 174 (169, 177) scores, and there were statistical differences (P<0.01). On the first day after operation, the total score of the QoR-40 questionnaire was related with the type of operation (P<0.05), and it was not related with age, sex and anesthesia (P>0.05);on the second day after operation, the total score of QoR-40 questionnaire was related with age and operation type (P<0.05), and it was not related with sex and anesthesia (P > 0.05). Conclusions The early postoperative period score of QoR-40 questionnaire in patients with colorectal tumor resection and age less than 70 years old is higher, and the recovery quality after operation is relatively good, suggesting that the operation type and age may be an important factor affecting the early recovery quality of the elderly patients with gastrointestinal tumor resection.
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Objective To investigate the expression of insulin-like growth factors-1(IGF-1)in ser-um and phosphorylated IGF-1 receptor in spinal cord in mouse model of bone cancer pain. Methods Sixty male C3H/HeJ mice weighed 18-22 g were randomly divided into Sham group(n=30)and Tumor group(n=30). The mice in Tumor group were inoculated with NCTC fibrosarcoma cells in the right femur bone marrow cavity. Paw withdrawl mechanical threshold(PWMT)and the number of spontaneous flinches(NSF)were measured on 1d before inoculation and on 4 d,7 d,10 d,14 d,21 d after inoculation(n=8). At each time point,the mice of each group were taken blood by removal eyeball and the samples of blood were obtained to detect the expression of IGF-1 by enzyme-linked immunosorbent assay(n=4). The mice after taken blood on 14 d after inoculation were perfused and the samples of spinal cord lumber(L3~5)segment were obtained to detect the expression of phosphorylated IGF-1 receptor by immunofluorescence assay(n=6). Results Com-pared with Sham group,PWMT was significantly decreased(P<0.05)and NSF was significantly increased(P<0.05)on 7~21 d after inoculation. Compared with baseline value and Sham group(baseline value(27.33± 0.52)pg/ml,Sham group(29.11±1.86)pg/ml,(24.51±3.61)pg/ml,(23.33±4.59)pg/ml,(25.29±2.99) pg/ml),the expression of IGF-1 in serum was significantly increased on 7~21 d after inoculation in Tumor group((39.76±3.92)pg/ml,(36.93±2.18)pg/ml,(38.85±2.40)pg/ml,(39.70±2.62)pg/ml). The mean fluorescence intensity of phosphorylated IGF-1 receptor was significantly higher on 14d after inoculation in Tumor group(2.40±0.11)compared with Sham group(0.05±0.01). Conclusion Expression of IGF-1 in serum and phosphorylated IGF-1 receptor in spinal cord were significantly increased in mice with bone cancer pain,and this change may be involved in the development and maintenance of bone cancer pain.
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Objective:To observe the effect of clinical pharmacists on the pain education in the patients with fracture. Methods:A total of 122 fracture patients with ASAⅠ/Ⅱaged 18-80 years were randomly divided into the intervention group (n=61) and the control group(n=61). The control group received the conventional orthopedic treatment..Flurbiprofen was injected for the postopera-tive analgesia,and if the pain VAS score was above 6,pethidine solution was given at the dose of 50 mg immediately. Based on the conventional treatment,the patients in the intervention group were educated by clinical pharmacist one day before the surgery,and then strengthened education was given after the surgery.The pain VAS score,and sleeping quality at 6h,24h,48h and 72h and satisfaction of pain management were compared between the groups.Results:The VAS score of the intervention group was significantly lower than that of the control group at 6 h,24 h,48 h and 72 h after the operation (P<0.05). The scores of sleeping quality in the intervention group at 6 h and 24 h after the operation were higher than those in the control group (P<0.05). The scores of patients' satisfaction were significantly higher in the intervention group than those of the control group (P<0.05). Conclusion: The clinical pharmacist's pain education can improve the degree of pain control and sleeping quality,increase the patients' satisfaction with pain control to a cer-tain extent.
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Objective To identify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery in elderly patients. Methods Four hundred and thirty patients, aged ≥ 65 yr, undergoing elective lower extremity fracture surgery from January 2010 to December 2014, were selected. Age, gender, American Society of Anesthesiologists (ASA) physical sta-tus, preoperative comorbidities (diabetes mellitus, cardio-cerebrovascular events and hemiplegia), preop-erative anemia, surgical site (hip and femur, knee joint and the site below the knee), anesthesia method (general anesthesia, neuraxial anesthesia), surgery time, intraoperative hypertension and hypotension, intraoperative blood loss, postoperative Hb≤90 g∕L in hospital and volume of postoperative drainage, post-operative pneumonia and admission to the intensive care unit after operation were recorded. The patients were divided into either cardio-cerebrovascular event group or non-cardio-cerebrovascular event group ac-cording to whether the patients developed cardio-cerebrovascular events after surgery in hospital. The pa-tients were divided into either survival group or dead group according to the living status 1 yr after surgery. The risk factors of which P values were less than 0. 05 would enter the multi-factor logistic regression analy-sis to stratify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following low-er extremity fracture surgery. Results Three hundred and seventy-two patients completed the study. A-mong the 372 patients, 35 patients developed postoperative cardio-cerebrovascular events in hospital, and the incidence was 9. 4％, logistic regression analysis showed that the preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ were risk factors for in-hospital postoperative cardio-cerebrovascular events. Thirty-three patients died within 1 yr after surgery, the mortality rate was 8. 9％, and logistic re-gression analysis showed that age≥75 yr, preoperative hemiplegia and development of cardio-cerebrovascu-lar events after surgery in hospital were postoperative 1-year mortality-related risk factors. Conclusion Preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ are the independent risk factors for in-hospital cardio-cerebrovascular events following lower extremity fracture surgery in elderly patients;age≥75 yr, preoperative hemiplegia and in-hospital postoperative cardio-cerebrovascular events are the in-dependent risk factors for 1-year mortality after surgery.
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Objective To evaluate the role of programmed cell death ligand-1 (PD-L1) in a mouse model of bone cancer pain.Methods Ninety-six male C3H/HeN mice (20-25 g,4-6 weeks old),which inoculated with osteolytic NCTC 2472 cells,were used to build the model of bone cancer pain.Part one:sixtyfour male C3H/HeJ mice were randomly divided into sham group (group Sham,n =32) and tumor group (group Tumor,n=32).Part two:Twenty-four male C3H/HeJ mice which were inoculated with osteolytic NCTC 2472 cells were randomly divided into group T (tumor,n=8),group PD-L1 (intrathecal injection with PLX3397,1 μg/5μl,n=8) and group NS (intrathecal injection with normal saline,n=8).Also,there were eight male C3H/HeJ mice in group S which were intra-femur inoculated with α-MEM.The pain behaviors of Sham group and Tumor group were observed and the expression of PD-L1 was detected before inoculation and on 4,7,10,14 and 21 days after inoculation,including paw withdrawal mechanical threshold (PWMT) and the number of spontaneous flinches (NSF).On 14 d after inoculation,the mice of group PD-L1 and group NS were intrathecal injected with drugs respectively.Pain behaviors were observed before injection and 2,4,6,24h after injection.Results Compared with group Sham,PWMT was significantly decreased and NSF was increased on 7～ 21 d after inoculation in group Tumor (P＜0.05).Compared with baseline and group S (baseline (0.38±0.06),group Sham (0.35±0.08),(0.38±0.08),(0.36±0.07)),the expression of PDL1 was up-regulated on 10-21 d after inoculation in group Tumor ((0.77±0.06),(1.21±0.04),(1.18±0.06)) (P＜0.05).Compared with group NS,PWMT was significantly increased (group NS (0.25t0.12),(0.25±0.12),(0.31±0.12),group PD-L1 (1.43±0.49),(1.35±0.44),(0.95±0.26)),and NSF was decreased on 2-6 h after injection in group PD-L1 (group NS(11.74± 1.31),(13.78±0.0.91),(13.63±1.06),group P D-L1 (4.90± 0.82),(4.15± 0.71),(7.65±0.56)) (P＜0.05).Conclusion Expression of PD-L1 in spinal cord was up-regulated in the mouse model of bone cancer pain.Intrathecal injection of recombinant PD-L1 has an analgesic effect on mice with bone cancer.
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To investigate the role of spinal interleukin-6-Janus kinase 2 (IL-6-JAK2) signaling transduction pathway in regulating astrocytes activation during the maintenance of bone cancer pain (BCP). Methods: NCTC 2472 fibrosarcoma cells were injected into the femur marrow cavity in C3H/HeNCrlVr male mice to establish BCP model and they were replaced by the equal volume of α-MEM in the sham model. The paw withdrawal latency (PWL) was measured after inoculation of tumor cells. The lumbar enlargement of spinal cord (L3-L5) was isolated, and Real-time RT-PCR and Western blot were used to detect the expression of spinal glial fibrillary acidic protein (GFAP) and JAK2 mRNA and protein, respectively. The expression level of spinal GFAP mRNA indirectly reflect astrocytes activation level. Pain behaviors and spinal cord GFAP mRNA and protein expression were observed at the given time points after intrathecal administration of JAK2 antagonist AG-490. Results: The PWL at 10, 14, 21 d after operation in BCP model group were significantly shorter than that in the sham group (P<0.05); the spinal GFAP and JAK2 mRNA and protein levels were higher in the BCP model group in comparison to mice in the sham group (P<0.05); intrathecal injection of JAK2 agonist AG-490 (30 or 90 nmol) significantly alleviated PWL, and downregulated the expression of spinal GFAP mRNA and protein (P<0.05). Conclusion: The IL-6-JAK2 signaling pathway plays an important role in maintaining the BCP by regulating the expression of GFAP in the spinal cord. Intrathecal injection of AG-490 can reduce the BCP, and inhibit the activation of IL-6-JAK2 signaling pathway, which may be one of the mechanisms for spinal astrocyte activation.
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Animales , Masculino , Ratones , Astrocitos , Patología , Neoplasias Óseas , Hiperalgesia , Quimioterapia , Inyecciones Espinales , Ratones Endogámicos C3H , Ratas Sprague-Dawley , Médula Espinal , Biología Celular , Patología , TirfostinosRESUMEN
American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients,aged 11-18 yr,scheduled for elective posterior orthopedic surgery for adolescent idiopathic scoliosis from November 2011 to October 2015 in our hospital,were selected,and a total of 834 patients were included in the study.Data including age,gender,body height,body weight,Cobb angles,ASA physical status,osteotomy procedure,use of dexmedetomidine,the number of operation segments,duration of operation,intraoperative blood loss,volume of blood transfused and volume of fluid infused,volume of postoperative drainage and length of postoperative hospital stay were recorded.The patients were divided into dexmedetomidine group (group D,n =508) and non-dexmedetomidine group (group ND,n =326) depending on whether or not dexmedetomidine was used.Age,gender,body mass index,Cobb angles,ASA physical status,the number of operation segments,duration of operation,osteotomy procedure and use of dexmedetomidine were served as independent variables and analyzed using Stepwise multivariate linear regression.The results of Stepwise multivariate linear regression showed that osteotomy procedures,the number of operation segments,duration of operation and Cobb angles were positively correlated with intraoperative blood loss,and use of dexmedetomidine and body mass index were negatively correlated with intraoperative blood loss.Compared with group ND,the intraoperative blood loss,volume of crystalloid solution infused,volume of blood transfused and volume of postoperative drainage were significantly reduced in group D (P＜0.05).After a propensity score matching analysis,the intraoperative blood loss and volume of crystalloid solution infused were significantly reduced in group ND when compared with group D (P＜0.05).In conclusion,intraoperative use of dexmedetomidine is helpful in reducing intraoperative blood loss during orthopedic surgery for adolescent idiopathic scoliosis.
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Objective To evaluate the role of spinal astrocytes in posttraumatic stress disorder (PTSD)-induced hyperalgesia in rats. Methods Forty pathogen-free healthy male Sprague-Dawley rats, aged 6-8 weeks,weighing 200-250 g, were divided into 4 groups(n=10 each)using a random number table:control group(group C), group PTSD, normal saline group(group NS)and fluorocitrate group (group FC).The rats were exposed to single prolonged stress for establishment of the PTSD model in PTSD, NS and FC groups. At 30 min before establishment of the model and 1-7 days after establishment of the model,normal saline 10 μl was intraperitoneally injected in group NS, and 1 nmol∕10 μl fluorocitrate 10 μl, an inhibitor of astrocyte activation, was intraperitoneally injected in group FC. The mechanical paw withdrawal threshold(MWT)was measured at 24 h before establishment of the model and on 1, 2, 3, 5 and 7 days after establishment of the model. Four rats were sacrificed after measurement of pain threshold on 1 and 7 days after establishment of the model, and the lumbar segment(L3-5)of the spinal cord was re-moved for determination of the expression of glial fibrillary acidic protein(GFAP, an astrocyte marker)u-sing Western blot. Results Compared with group C, the MWT was significantly decreased at each time point after establishment of the model,and the expression of spinal GFAP was up-regulated on 1 and 7 days after establishment of the model in PTSD,NS and FC groups(P<005). Compared with group PTSD, no significant change was found in the MWT at each time point in group NS(P>005),and the MWT was sig-nificantly increased at each time point after establishment of the model,and the expression of spinal GFAP was down-regulated on 1 and 7 days after establishment of the model in group FC(P<005).Conclusion Activation of spinal astrocytes is involved in PTSD-induced hyperalgesia in rats.
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Objective To evaluate the effects of GLYX-13 on cognitive function after long-time isoflurane anesthesia in mice. Methods A total of 192 healthy male C57∕B6J mice, aged 8 weeks, weig-hing 22-25 g, were divided into 4 groups(n=48 each)using a random number table: control group (group C), isoflurane anesthesia group(group I), GLYX-13 group(group G), and isoflurane anesthesia plus GLYX-13 group(group IG). The animals were exposed to 15% isoflurane for 6 h in I and IG groups. GLYX-13 1 mg∕kg was injected via the caudal vein at 2 h before anesthesia in G and IG groups. Novel ob-ject recognition test and contextual fear conditioning test were performed on 1st, 3rd and 7th days after an-esthesia. The expression of 2B subunits-containing NMDA receptor(NR2B)and cyclic adenosine mono-phosphate response element-binding protein(CREB)mRNA in the hippocampus was detected by quantita-tive real-time polymerase chain reaction after the end of behavioral tests on 1st, 3rd and 7th days after anes-thesia. Results Compared with group C, the percentage of time spent in exploring a novel object, dis-crimination index and percentage of freezing time were significantly decreased, and the expression of NR2B and CREB mRNA in the hippocampus was down-regulated in group I(P <005). Compared with group I, the percentage of time spent in exploring a novel object, discrimination index and percentage of freezing time were significantly increased, and the expression of NR2B and CREB mRNA in the hippocampus was up-regulated in group IG(P <005). Conclusion GLYX-13 can significantly improve the cognitive func-tion after long-time isoflurane anesthesia in mice.
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Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.
