Potential of semen coicis in enhancing the anti-tumor effects of PD-1 inhibitor on A549 cell lines by blocking the PI3K-AKT-mTOR pathway.

BACKGROUND: The objective of this research was to investigate how the combination of semen coicis extract and PD-1 inhibitors can potentially work together to enhance the anti-tumor effects, with a focus on understanding the underlying mechanism. METHODS: We obtained the active components and specific targets of semen coicis in the treatment of NSCLC from various databases, namely TCMSP, GeneCard, and OMIM. By utilizing the STRING database and Cytoscape software, we established a protein interaction network (PPI) for the active ingredient of semen coicis and the target genes related to NSCLC. To explore the potential pathways involved, we conducted gene ontology (GO) and biological pathway (KEGG) enrichment analyses, which were further supported by molecular docking technology. Additionally, we conducted cyto-inhibition experiments to verify the inhibitory effects of semen coicis alone or in combination with a PD-1 inhibitor on A549 cells, along with examining the associated pathways. Furthermore, we investigated the synergistic mechanism of these two drugs through cytokine release experiments and the PD-L1 expression study on A549 cells. RESULTS: Semen coicis contains two main active components, Omaine and (S)-4-Nonanolide. Its primary targets include PIK3R1, PIK3CD, PIK3CA, AKT2, and mTOR. Molecular docking experiments confirmed that these ingredients and targets form stable bonds. In vitro experiments showed that semen coicis demonstrates inhibitory effects against A549 cells, and this effect was further enhanced when combined with PD-1 inhibitors. PCR and WB analysis confirmed that the inhibition of the PI3K-AKT-mTOR pathway may contribute to this effect. Additionally, semen coicis was observed to decrease the levels of IFN-γ, IL-6, and TNF-α, promoting the recovery of the human anti-tumor immune response. And semen coicis could inhibit the induced expression of PD­L1 of A549 cells stimulated by IFN­Î³ as well. CONCLUSION: Semen coicis not only has the ability to kill tumor cells directly but also alleviates the immunosuppression found in the tumor microenvironment. Additionally, it collaboratively enhances the effectiveness of PD-1 inhibitors against tumors by blocking the activation of PI3K-AKT-mTOR.

Evaluation of knee cartilage based on MRI artificial intelligence reconstruction model of knee joint / 中华骨科杂志

Objective:To explore the feasibility of the AI intelligent reconstruction model based on knee joint magnetic resonance data developed by Nuctech Company Limited for evaluating knee cartilage injury.Methods:Thirty-three patients (a total of forty-one knees) who were hospitalized with severe knee osteoarthritis in Beijing Tsinghua Changgung Hospital from May 2021 to April 2022 were selected. All of them were planned to be performed total knee arthroplasty (TKA) for the treatment of knee osteoarthritis. Fifteen males with an average age of 71±5 years old and twenty six females with an average age of 71±9 years old were included in this study. There were 19 cases of left knee and 22 cases of right knee. Thin layer MRI examination on the patients' knee joints was performed before the surgery, and artificial intelligence model based on the thin layer MRI data of the knee joint was reconstructed. The cartilage part of the model was selected and corrected by Principal Component Analysis (PCA) in order to realize model straightening. The tibial plateau cartilage of knee joint which intercepted during operation was classified according to the International Cartilage Repair Society (ICRS). Finally the results were compared with the ICRS classification results of knee artificial intelligence reconstruction model and artificial recognition of knee joint MRI images.Results:Compared with the grade of cartilage injury intercepted during our operation which was according to the ICRS classification, the sensitivity of artificial intelligence reconstruction model for the diagnosis of cartilage injury with ICRS classification grade four was 93.1%. The specificity of artificial intelligence reconstruction model was 91.4%. The positive predictive value (PPV) of artificial intelligence reconstruction model was 92.2%. And the negative predictive value (NPV) of artificial intelligence reconstruction model was 80.3%. The area under ROC curve (AUC) was 0.92. The ICRS classification consistency between artificial intelligence model and physical inspection results was good with kappa value 0.81 ( P<0.001) . In the aspect of artificial recognition of cartilage injury grading in MRI images, the sensitivity of artificial recognition was 92.10% compared with the manual identification of cartilage injury classification in MRI images. The specificity of artificial recognition was 91.60%. The positive predictive value (PPV) of artificial recognition was 97.20% and the negative predictive value (NPV) of artificial recognition was 78.8%. The kappa value of the cartilage injury classification in MRI images consistency between artificial recognition and manual identification was 0.79 ( P<0.001). Conclusion:Based on the evaluation of cartilage injury by AI reconstruction model of knee joint, the sensitivity and specificity of the diagnosis of ICRS grade IV cartilage injury can be acceptable, but still needs to be improved.

Investigation and analysis of cognition and clinical practice status of ERAS among anesthesiologists in secondary hospitals in China / 中华麻醉学杂志

Objective:To investigate the cognition and clinical practice status of Enhanced Recovery After Surgery (ERAS) among anesthesiologists in secondary hospitals in China using a questionnaire, trying to provide some references for the promotion and popularization of ERAS across China.Methods:From April to November 2021, anesthesiologists in secondary public hospitals across the country were enrolled by convenience sampling and investigated by a self-designed questionnaire on the cognition, clinical practice status and their teaching needs about ERAS.Influencing factors of ERAS cognition were then analyzed.Results:Totally 879 questionnaires were sent out, 864 were effectively received with effective recovery of 98.3%.The anesthesiologists in this survey were distributed in 31 provincial administrative regions across the country.The score of the ERAS cognition (total score of 18) was 12.00 (3.75), and 563 participants (65.2%) were qualified on cognitive status (score ≥ 12). Geographic region, age, educational qualification, professional title and length of occupation were found to have significant influence on ERAS cognition ( P<0.05). Among the anesthesiologists who participated in the survey, 817 participants (94.6%) recognized that ERAS management was beneficial to patients, and 778 (90.0%) of them agreed that ERAS management should be carried out as much as possible in secondary hospitals.Two hundred and fifty-five (29.5%) participants had never implemented ERAS management in clinic anesthesia.There were significant differences in the ERAS practice status among participants from different geographical regions in China ( P<0.05). Eight hundred and forty-eight (98.1%) anesthesiologists who participated in the survey expressed their willingness to receive further systematic training on ERAS, and taking online courses and reading books were the current main ways to obtain related knowledge. Conclusions:The cognition and clinical practice status of ERAS need to be improved among anesthesiologists in secondary hospitals in our country.Sustained ERAS education programs with various forms should be carried out in subgrade medical care centers in order to continuously promote the extensive practice of ERAS across China.

Risk Factors of Bleeding-related Perioperative Cardiac Arrest / 中国医学科学院学报

Objective To reveal the incidence,mortality,and risk factors of bleeding-related perioperative cardiac arrest(POCA). Methods We carried out a single-center retrospective case-control study which enrolled all the POCA cases reported from January 2010 to September 2020 in the patient safety incident reporting system of Peking Union Medical College Hospital.For the screening of risk factors,the patients were respectively assigned into the POCA group and the control group at a ratio of 1∶3 according to the same sex,age,American Society of Anesthesiologists(ASA)physical status,and type of surgery in the same month.Potential risk factors for POCA were first selected by univariate analysis.The significant risk factors were then checked based on the clinical experience and further included in the multivariate Logistic regression model. Results Totally 16 bleeding-related POCA cases were collected from the patient safety incident reporting system among the study period,with an overall incidence of 0.36/10 000.The blood loss volume of POCA group and control group was(7 037.50±5 477.70)ml and(375.63±675.14)ml,respectively(P<0.001),and 14(87.5%)patients suffering from bleeding-related POCA died within three days after anesthesia.According to the univariate analysis,patients' body mass index[(21.79±3.57)kg/m2 vs.(24.26±3.91)kg/m2,P=0.043],hemoglobin level[(113.44±31.08)g/L vs.(131.75±19.70)g/L,P=0.039],and alanine aminotransferase level[(17.31±7.73)U/L vs.(26.91±24.73)U/L,P=0.022]were significantly lower in the POCA group than in the control group.Further Logistic regression analysis showed that smaller body mass index and lower preoperative hemoglobin level were independently associated with the occurrence of bleeding-related POCA. Conclusions Bleeding-related POCA rarely occurred but had high mortality.Adequate precautions should be taken for the patients who are to receive surgeries with high risk of intraoperative massive bleeding.Elevating preoperative hemoglobin level might decrease the incidence of bleeding-related POCA.

Effect of teacher-assisted jaw thrust maneuver on learning effectiveness of Bonfils fiberscope-guided tracheal intubation for beginners / 中华麻醉学杂志

Objective:To evaluate the effect of teacher-assisted jaw thrust maneuver on the learning effectiveness of Bonfils fiberscope-guided tracheal intubation for the beginners.Methods:Forty-eight accompanying physicians who were receiving residents standardized training in the Department of Anesthesiology, Peking Union Medical College from April, 2020 to March 2021 and served as trainees were enrolled in this study.The trainees received Bonfils fiberscope training and were randomly divided into independent group ( n=24) and assisted group ( n=24). After induction of general anesthesia, the trainees independently performed the Bonfils fiberscope-guided endotracheal intubation operation in independent group, and trainees performed the operation with the assistance of the teacher′s jaw thrust maneuver in assisted group.The success of intubation at first attempt, duration of intubation, times of teachers′ guidance and scores for trainees′ learning confidence were recorded. Results:Compared with independent group, the success rate of intubation at first attempt was significantly increased, the duration of intubation was shortened, scores for trainees′ learning confidence was increased ( P<0.05), and no significant change was found in the times of teachers′ guidance in assisted group ( P>0.05). Conclusion:For the beginners learning Bonfils fiberscope-guided tracheal intubation, teacher-assisted jaw thrust maneuver is helpful in raising the learning effectiveness and increasing the beginners′ learning confidence.

Evaluation of Burnout Among Anesthesiologists Working in Tibet, China: Altitude and Attitude / 中国医学科学杂志(英文版)

Objective Burnout is a triad of emotional exhaustion, depersonalization, and reduced personal accomplishment resulting from job stress. Although with distinct regional and cultural characteristics, burnout among anesthesiologists in the Tibet has not been described. This study aimed to explore the prevalence of burnout among anesthesiologists in Tibet and its associated factors. Methods A cross-sectional survey was conducted in Tibet, China, with an anonymous questionnaire. Social-demographic characteristics, work status, three dimensions of burnout assessed by the Maslach Burnout Inventory-Human Service Survey were collected and analyzed. Results A total of 133 individuals from 17 hospitals completed the survey from March to June 2018. The prevalence of moderate- to high-level of emotional exhaustion, depersonalization, and burnout in personal accomplishment was 65.4% (95%

Head and Face Protection of the Health Care Workers in the Operating Room of Peking Union Medical College Hospital during the Corona Virus Disease-19 Pandemic / 中国医学科学院学报

Objective To investigate the understanding of the head and face protection of the health care workers in operating room of Peking Union Medical College Hospital during the corona virus disease-19(COVID-19) pandemic.Methods The knowledge of head and face protection of health care workers in the operating room was evaluated based on the non-registered questionnaires for protection measures collected on-line.Results The survey was conducted in two phases.In the first phase(COVID-19 outbreak),153 questionnaires were collected.In the second phase(when Beijing lowered the emergency response to level 3 and normalized the epidemic prevention and control),101 questionnaires were collected.The results showed that 98% of health care workers had used any form of protective devices during the pandemic and anesthesiologists had the highest usage rate(93.0%)of ear-loop face mask with eye shield.During the pandemic,health care workers mainly used goggles(71.2%)for protection to diagnose and treat the patients with fever and ear-loop face mask with eye shield(56.2%)for protection to diagnose and treat the non-fever patients.In the first-and second-phase survey,43% and 68% of health care workers still used protection,and they mainly used face shield(50.0% and 56.5%)and ear-loop face mask with eye shield(56.1% and 68.1%).Conclusions During the pandemic,more than 90% of the health care workers in the operating room of Peking Union Medical College Hospital were aware of head and face protection.Different healthcare workers in the operating room had different choices of head and face protection,and more than 40% of them would still keep such protection during the normalized stage of pandemic prevention and control.

Regulation of the Paneth cell niche by exogenous L-arginine couples the intestinal stem cell function.

Although previous studies show that exogenous nutrients regulate the stem cell function, little is known about the effects of L-arginine on intestinal stem cells (ISCs). In this study, we utilize mice, small intestinal (SI) organoids, and ISC-Paneth cell co-cultured models to clarify the role of L-arginine in ISC function. We find that exogenous L-arginine is essential for ISCs proliferation and intestinal epithelial renewal. Our data show that Paneth cells, a critical component of the ISCs niche, augment the ISCs function in response to L-arginine. Moreover, enhanced the expression of Wnt3a in Paneth cells, which is a ligand of the Wnt/ß-catenin signaling pathway, mediates the effects of L-arginine on ISCs function. Pre-treatment with L-arginine enhances the ISCs pool and protects the gut in response to injury provoked by murine tumor necrosis factor α (TNF-α) and 5-Fluorouracil (5-FU). Our findings establish that the regulation of Wnt3a in the Paneth cell niche by exogenous L-arginine couples ISCs function and favours a model in which the ISCs niche couples the nutrient levels to ISCs function.

N-methyl-D-aspartate Receptor:Potential Role in TreatingNeuraxial Opioid Induced Pruritus / 中国医学科学院学报

Neuraxial opioid administration is one of the most common methods of anesthesia and analgesia,while itching is the most troublesome adverse effect.The current treatments for neuraxial opioid-induced pruritus still have certain limitations.This article reviews the current treatments and basic scientific findings(including neurotransmitters,opioid receptors,and signaling pathways)of pruritus caused by neuraxial opioids.Based on our recent findings on N-methyl-D-aspartate(NMDA)receptors and pruritus caused by neuraxial opioids,we provide new ideas for the treatment of itching caused by neuraxial opioids.Since NMDA receptors may play a key role in neuraxial opioid-induced pruritus,NMDA receptor antagonists can have certain therapeutic advantages.

Research Advances in Mitogen-activated Protein Kinases in Central and Peripheral Sensitization of Diabetic Neuropathic Pain / 中国医学科学院学报

Mitogen-activated protein kinases(MAPKs)are Ser/Thr kinases consisting of extracellular regulated protein kinases(ERK)1/2,c-Jun N-terminal kinase 1/2/3,p38 isoforms(α,β,γ,and δ),and ERK5,which mediate a range of cellular activities including proliferation,differentiation,apoptosis,immunity,and inflammation. Pain sensitization is a remodeling mechanism of central and peripheral nociceptor. A growing number of evidences have indicated that MAPKs are extensively activated in the spinal dorsal cord and dorsal root ganglions in the animal models of diabetic neuropathic pain(DNP)and play an important role in the central and peripheral sensitization of DNP. In addition,some drugs can alleviate DNP by suppressing MAPKs activation of central and peripheral nervous system. This article summarizes the research progress of MAPKs in central and peripheral sensitization of DNP.

Effects of Simvastatin on Diabetic Neuropathic Pain and Systematic Inflammation in Diabetic Rat Models and Their Molecular Mechanisms / 中国医学科学院学报

Objective To investigate the effects of simvastatin on diabetic neuropathic pain and systematic inflammation in diabetic rats and explore their molecular mechanisms.Methods Totally 24 rats were equally randomized into the normal+vehicle(NV)group,diabetic+vehicle(DV)group,and diabetic+simvastatin(DS)group using the random number table.Streptozotocin(STZ)was used to establish the rat models of diabetes.Blood glucose,body mass,paw withdrawal mechanical threshold(PWMT),and paw withdrawal thermal latency(PWTL)in each group were observed on days 7,14,21,and 28 after STZ injection.On day 28 after STZ injection,rats were sacrificed,and the lumbar spinal dorsal horn and serum were collected.Western blotting was used to detect the expression of receptor for advanced glycation end products(RAGE)and the phosphorylation levels of protein kinase B(AKT),extracellular signal-regulated kinase(ERK),p38,and c-Jun N-terminal kinase(JNK)in the spinal dorsal horn of rats in each group.Enzyme-linked immunosorbent assay was performed to determine the serum concentrations of oxidized low density lipoprotein(ox-LDL)and interleukin-1β(IL-1β).Results On days 14,21 and 28 after STZ injection,the PWMT in DV group were(8.6 ± 0.8),(7.1 ± 1.6),and(7.8 ± 0.8)g respectively,which were significantly lower than (12.0 ± 0.9)(=8.482, =0.000),(11.6 ± 1.5)(=11.309, =0.000),and(11.7 ± 1.5)g(=9.801, =0.000)in NV group.The PWMT in DS group on days 21 and 28 were(9.4 ± 1.4)(=5.780, =0.000)and(9.7 ± 0.9)g(=4.775, =0.003),respectively,which were significantly improved comparing with those of DV group.On days 7,14,21,and 28,there were no significant differences in PWTL among these three groups (all <0.05).The expression of RAGE in the spinal dorsal horn of DV group was significantly higher than those of NV group(=6.299, =0.000)and DS group(=2.891, =0.025).The phosphorylation level of AKT in the spinal dorsal horn of DV group was significantly higher than those of NV group(=8.915,=0.000)and DS group(=4.103,=0.003).The phosphorylation levels of ERK( =8.313,=0.000),p38( =2.965, =0.022),and JNK(=7.459, =0.000)in the spinal dorsal horn of DV group were significantly higher than those of NV group;the phosphorylation level of JNK in the spinal dorsal horn of DS group was significant lower than that of DV group(=3.866, =0.004);however,there were no significant differences in the phosphorylation levels of ERK(=1.987,=0.122)and p38(=1.260,=0.375)in the spinal dorsal horn between DS group and DV group.The serum concentrations of ox-LDL and IL-1β in DV group were(41.86 ± 13.40)ng/ml and(108.16 ± 25.88)pg/ml,respectively,which were significantly higher than those in NV group [(24.66 ± 7.87)ng/ml(=3.606,=0.003)and(49.32 ± 28.35)pg/ml(=5.079,=0.000)] and DS group [(18.81 ± 5.62)ng/ml (=4.833, =0.000)and(32.73 ± 11.73)pg/ml(=6.510, =0.000)].Conclusions Simvastatin can relieve the mechanical allodynia of diabetic rats possibly by inhibiting the activation of RAGE/AKT and the phosphorylation of JNK in the spinal dorsal horn.Simvastatin can also decrease the serum concentrations of ox-LDL and IL-1β in diabetic rats,which may contribute to the relief of systematic inflammation.

A Single-center Retrospective Cohort Study on Cesarean Section under General Anesthesia / 中国医学科学杂志(英文版)

Objective Neuraxial block is the most common anesthesia method for cesarean section (CS). However, for some urgent and high-risk cesarean delivery, general anesthesia (GA) also plays a very important role. We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes. Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2016. Clinical data (baseline maternal status, preoperative status, perioperative information, maternal and fetal outcomes) of parturients and neonates were collected and analyzed. We summarized the common reasons for applying general anesthesia, and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists (ASA) grade, gestational weeks and intraoperative blood loss, as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks. Results There were 98 cases of CS under GA enrolled in the study. Among the maternal and fetal factors, pregnancy with internal or surgical diseases is the most common reason (59 cases, 60.2%) for choosing GA, followed by the placenta and fetal membrane abnormalities (38 cases, 38.8%) and the pregnancy-specific disorders (36 cases, 36.7%). ASA grade Ⅲ-Ⅳ of parturients (χ 2=44.3, P<0.05), gestation period < 37 weeks (χ 2=23.4, P<0.05), and blood loss > 800 ml (χ 2=5.5, P<0.05) were related to the higher postoperative intensive care unit (ICU) rate in parturients. ASA grade Ⅲ-Ⅳ of parturients (t=-2.99, P<0.05), gestation period < 37 weeks (t=2.47, P<0.05) were related to the longer hospital stay. ASA grade Ⅲ-Ⅳ of parturients (t=2.21, P=0.01) and gestation period < 37 weeks (t=-3.21, P=0.002) were related to the lower one-minute Apgar score of neonates. Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS. High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.

Application of two different out-of-plane ultrasound-guided needling techniques / 临床麻醉学杂志

Objective To compare simulated training of "45° tilting insertion" and the "dynamic scan" needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were re corded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with "45° tilting insertion" technique,"dynamic scan" resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety (P＜0.05 or P＜0.01).The confidence scores of performing the two technique were similar.20 (40％) volunteers chose to use "dynamic scan",8 (16％) chose to use "45° tilting insertion" and 22 (440％) chose to use both technique in their clinical work.100％ of them considered the training was greatly helpful or helpful.Conclusion The technique of "dynamic scan" produced a higher first-attempt successful rate and was easier and safer than "45° angle insertion".The combination of the two techniques might be a new technique that is worth trying.

Simultaneous determination of fosaprepitant and its metabolite aprepitant in human plasma by liquid chromatography-tandem mass spectrometry / 药学学报

An LC-MS/MS method was developed for the simultaneous determination of fosaprepitant and aprepitant in human plasma, and applied to a pharmacokinetic study of 150 mg fosaprepitant dimeglumine injection to 12 Chinese healthy volunteers. The analytes and internal standards were extracted from plasma by protein precipitation with acetonitrile and separated on a Cortex C18+ (50 mm×2.1 mm, 2.7 μm) column using a gradient elution procedure. Mass spectrometry was performed in negative MRM mode, and parent-to-produce transitions were as follows:m/z 613.1→78.9 for fosaprepitant, m/z 617.0→78.9 for d4-fosaprepitant, m/z 533.2→275.1 for aprepitant and m/z 537.2→279.1 for d4-aprepitant. Plasma sample was basified to stabilize fosaprepitant. The standard curves were demonstrated to be liner in the range of 15.0 to 6 000 ng·mL-1 for fosaprepitant and 10.0 to 4 000 ng·mL-1 for aprepitant. The intra-day precisions and inter-day precisions and accuracy were within the acceptable limits for all concentrations.

Effects of Continuous Intravenous Intraoperative Lidocaine Infusion on Opioids Consumption and Postoperative Recovery in Patients Undergoing Video-assisted Thoracoscopic Lobectomy / 中国医学科学院学报

Objective To investigate whether continuous intravenous intraoperative lidocaine infusion can reduce the opioids dosage and improve postoperative recovery in patients undergoing video-assisted thoracoscopic(VATS) lobectomy. Methods Totally 60 patients undergoing VATS lobectomy were enrolled in this single-center randomized controlled study.The patients were equally randomized into lidocaine continuous pumping group(lidocaine group) and control group by computer-based random numbers.The patients had double-lumen catheter intubation,and total intravenous anesthesia was administrated intraoperatively.In the lidocaine group,patients continuously received intravenous pumping of lidocaine [2 mg/(kgdh) ] after a loading doses(1 mg/kg) until the end of the operation.We recorded the basic characteristics,preoperative examination,intraoperative medications,and postoperative recovery of both groups.Results The basic characteristics and preoperative examination findings were comparable between these two groups(all P>0.05).Compared with the control group,the intraoperative sufentanil consumption significantly decreased in the lidocaine group [(32.3±7.5) μg vs.(40.9±10.2) μg,P<0.001].Significantly more patients were given esmolol intraoperatively in the control group to lower heart rate(P=0.010).The incidence of postoperative nausea within 24 hours was significantly lower in the lidocaine group(P=0.045).There was no significant difference between the two groups in postoperative recovery(all P>0.05).Conclusion Intravenous continuous pumping of lidocaine during operation can reduce opioids consumption and lower the incidence of postoperative nausea without extra adverse or toxic reaction in patients undergoing VATS lobectomy.

Retrospective Analysis of 16 Cases Receiving Cardiopulmonary Resuscitation in the Operating Room among 127 053 Anesthetics Undergoing Non-cardiac Surgeries / 中国医学科学院学报

Objective To identify the high-risk factors of cardiac arrest during non-cardiac surgery and to provide experience for the effective cardiopulmonary resuscitation (CPR). Method The baseline data,co-morbidities,causes of cardiac arrest,treatment responsees,and survivals of 16 patients undergoing CPR among 127 053 patients receiving non-cardiac surgeries in our center from January 2013 to December 2016 were retrospectively analyzed. Results The main causes of intraoperative CPR included the co-existing cardiovascular diseases,massive intraoperative blood loss/high-risk surgical procedures,and allergy-related factors. Nine patients survived after immediate CPR in the operating room,with a 30-day survival rate of 77.8%. Conclusions Intraoperative cardiac arrest is a rare but potentially catastrophic event during non-cardiac surgeries. The success rate of CPR decreases in elderly patients undergoing high-risk emergency surgeries,especially when massive blood loss occurs during the surgery.

Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass and recommendations for enhanced recovery after surgery protocol pathway / 中华麻醉学杂志

Objective The mediastinal mass usually posed higher risk of anesthesia and surgery due to its especial anatomical position,and this study aimed to analyze the perioperative anesthetic management of 3 patients undergoing resection of huge mediastinal mass,to identify the potential risks for this type of surgery and to summarize the corresponding perioperative anesthetic management protocol.Methods Three cases recently underwent resection of huge mediastinal mass in our hospital were reviewed.Their preoperative assessment and preparation,intraoperative anesthetic management,postoperative pain management and special interventions needed in the perioperative period were summarized and analyzed retrospectively.The enhanced recovery after surgery (ERAS) protocol was established for this type of surgery based on the analysis mentioned above,evidence reported at home and abroad and currently available ERAS protocols for other surgeries.Results Pleural malignant solitary fibrous tumor,thymus squamous cell carcinoma and malignant mixed germ cell tumor were the three mediastinal masses.The preoperative assessment focused on the impact of tumor on other vital organs within the mediastinum;anesthesiologists focused on massive hemorrhage and severe complications such as cardiac insufficiency and respiratory insufficiency;all the three patients were sent to the intensive care unit after surgery for further treatment,successfully recovered and were discharged;improving postoperative analgesia was helpful for recovery after resection of huge mediastinal mass.Conclusion Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass is related to high risk,and establishing specific ERAS protocol is helpful in reducing complications and in promoting recovery after surgery based on the currently available evidence and characteristics of this type of surgery.

Predictors of chronic post-thoracotomy pain in rats / 基础医学与临床

Objective A rat model of chronic post-thoracotomy pain is used to study whether acute pain and pre-operative diffused noxious inhibitory controls(DNIC) can predict chronic pain and how DNIC changes when pain maintains.Methods Rats were randomly divided into three groups:naive group,sham group and model group.DNIC was constantly assessed in individual rats,along with each animal's mechanical hyperalgesia and cold allodynia after thoracotomy.Results In model group,the incidence of chronic post-thoracotomy pain was 55%(11 of 20),which was named CPTP group,and the other 9 rats without chronic pain was defined as non-CPTP group.The pre-operative DNIC was significantly weaker in CPTP group with lower mechanical threshold on 6 days after surgery and higher cold sensitivity on 6 days after surgery comparing with non-CPTP group.In the acute pain phase (day 3),DNIC was decreased in both CPTP group and non-CPTP group as compared with pre-operative period.Besides,DNIC was recovered in non-CPTP group while kept impaired in CPTP group on 21 days after surgery.Conclusions Pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP.DNIC was decreased both in acute pain and chronic state,while returned to normal when pain sense was normal.

Application of Cardiopulmonary Exercise Testing in Enhanced Recovery after Surgery / 中国医学科学院学报

Enhanced recovery after surgery (ERAS) is a new perioperative concept that aims to reduce perioperative stress response and accelerate rehabilitation of patients through a variety of optimized management. With the wider application of this concept,the effective implementation of ERAS program has become a new challenge. Cardiopulmonary exercise testing (CPET) has shown promising value in the preoperative assessment,perioperative optimization,and postoperative rehabilitation of ERAS. This article reviews the application of CPET in ERAS,with an attempt to provide evidence for more detailed and comprehensive ERAS program.

Effect of gabapentin on Cav3.2 channels in dorsal root ganglia of rats with neuropathic pain / 中华麻醉学杂志

Objective To evaluate the effect of gabapentin on Cav3.2 channels in the dorsal root ganglia ( DRG) of rats with neuropathic pain. Methods Thirty male Sprague?Dawley rats, aged 6-7 weeks, weighing 225-275 g, were divided into 3 groups ( n=10 each) using a random number table:sham operation group ( S group) , neuropathic pain group ( NP group) and gabapentin group ( G group) . In NP and G groups, neuropathic pain was induced by chronic constriction injury to the left sciatic nerve. Starting from 7th day after operation, gabapentin 100 mg∕kg in 1 ml of normal saline was injected intraper?itoneally twice a day for 7 consecutive days in group G, and the equal volume of normal saline was given twice a day for 7 consecutive days in S and NP groups. The mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal latency ( TWL) were measured on day 3 before operation and on postoperative days 3, 7 and 14. After the last measurement of pain thresholds on the postoperative day 14, 4 rats were sacrificed for determination of Cav3. 2 mRNA expression ( by real?time polymerase chain reaction) and Cav3.2 protein expression (by Western blot) in the DRG. Results Compared with S group, the MWT was significantly decreased, and TWL was significantly shortened on postoperative days 3, 7 and 14, and the expression of Cav3.2 protein and mRNA in the DRG was significantly up?regulated in group NP, and the MWT was significantly decreased, and TWL was significantly shortened on postoperative days 3 and 7 ( P0.05) . Compared with NP group, the MWT was significantly increased, and TWL was signif?icantly prolonged on the postoperative day 14, and the expression of Cav3.2 protein and mRNA in the DRG was significantly down?regulated in group G ( P<0.05) . Conclusion The mechanism by which gabapentin attenuates neuropathic pain may be related to inhibition of the function of Cav3.2 channels in the DRG of rats.