Background: To investigate the effects of intraoperative application of dexmedetomidine (Dex) on early gastrointestinal motility after laparoscopic resection of colorectal cancer. Methods: In this prospective, randomized double-blind investigation, 60 patients who underwent laparoscopic resection of colorectal cancer were randomly allocated to receive Dex (DEX group, n = 30) or saline (CON group, n = 30). In the DEX group, Dex was loaded (1 μg/kg) before anesthesia induction and was infused (0.3 μg/kg/h) during surgery. Time to postoperative first flatus (FFL) and first feces (FFE), and time to regular diet were recorded. Serum diamine oxidase (DAO) activity and intestinal fatty acid-binding protein (I-FABP) were detected. Results: Both the time to the FFL (44.41 ± 4.51 hours vs 61.03 ± 5.16 hours, P = 0.02) and the time to the FFE (60.67 ± 4.94 hours vs 82.50 ± 6.88 hours, P = 0.014) were significantly shorter in the DEX group than the CON group. Furthermore, the time to regular diet of the DEX group was shorter than that of the CON group (76.15 ± 4.11 hours vs 91.50 ± 5.70 hours, P = 0.037). Both DAO and I-FABP increased significantly from beginning of surgery to postoperative day 1 in the CON group (2.49 ± 0.41 ng/mL vs 4.48 ± 0.94 ng/mL for DAO, P = 0.028, 1.32 ± 0.09 ng/mL vs 2.17 ± 0.12 ng/mL for I-FABP, P = 0.045, respectively), whereas no significant change was observed in the DEX group. Furthermore, patients in the DEX group had stable hemodynamics and shorter hospital stay than those in the CON group. Conclusion: Dex administration intraoperatively benefits recovery of gastrointestinal motility function after laparoscopic resection of colorectal cancer with stable hemodynamics during surgery though further studies are needed to explore the mechanisms of Dex on gastrointestinal motility.
Background Postoperative sepsis is one of the main causes of mortality after liver transplantation (LT). Our study aimed to develop and validate a predictive model for postoperative sepsis within 7 d in LT recipients using machine learning (ML) technology.Methods Data of 786 patients received LT from January 2015 to January 2020 was retrospectively extracted from the big data platform of Third Affiliated Hospital of Sun Yat-sen University. Seven ML models were developed to predict postoperative sepsis. The area under the receiver-operating curve (AUC), sensitivity, specificity, accuracy, and f1-score were evaluated as the model performances. The model with the best performance was validated in an independent dataset involving 118 adult LT cases from February 2020 to April 2021. The postoperative sepsis-associated outcomes were also explored in the study.Results After excluding 109 patients according to the exclusion criteria, 677 patients underwent LT were finally included in the analysis. Among them, 216 (31.9%) were diagnosed with sepsis after LT, which were related to more perioperative complications, increased postoperative hospital stay and mortality after LT (all p < .05). Our results revealed that a larger volume of red blood cell infusion, ascitic removal, blood loss and gastric drainage, less volume of crystalloid infusion and urine, longer anesthesia time, higher level of preoperative TBIL were the top 8 important variables contributing to the prediction of post-LT sepsis. The Random Forest Classifier (RF) model showed the best overall performance to predict sepsis after LT among the seven ML models developed in the study, with an AUC of 0.731, an accuracy of 71.6%, the sensitivity of 62.1%, and specificity of 76.1% in the internal validation set, and a comparable AUC of 0.755 in the external validation set.Conclusions Our study enrolled eight pre- and intra-operative variables to develop an RF-based predictive model of post-LT sepsis to assist clinical decision-making procedure.
We write in to response to the comments provided by Orrock and Ward [1] and Inoue et al. [2] on our article [3]. In our preliminary research, we did not conduct a strict randomised controlled trial. Instead, we recruited 15 volunteers to evaluate the comfort, visual satisfaction and overall satisfaction of using different laryngoscopes for tracheal intubation. We acknowledge the difficulty of blinding operators in such studies and the limitations of using models in airway studies, particularly their lack of tissue plasticity. This can affect blade lifting and require the operator to be closer to the model for an appropriate glottic view. Currently, we are conducting a randomised controlled trial to assess the clinical usability and efficacy of the augmented reality laryngoscope. Regarding the concerns about image bias and non-standard tracheal intubation techniques, the positions depicted in our article, although different from those preferred by Orrock and Ward, are used commonly in our clinical practice. A review of relevant recent tracheal intubation videos on the internet revealed similar techniques, suggesting that these variations may be due to individual practice habits [4, 5]. We agree that musculoskeletal strain related to laryngoscopy is a common issue in anaesthesia, and propose a multifaceted approach to mitigate this [6]. This includes standardised training; adopting the head-up (semi-Fowler's) position; using pillows/neck supports for optimal cervical flexion/extension; adjusting the operating table height; and designing novel laryngoscopes and tracheal intubation protocols using artificial intelligence [7, 8]. Inoue et al. have also rightly pointed out the potential influence of practitioner experience on the ergonomics and effectiveness of augmented reality laryngoscopes, a factor our initial study did not address. Novice practitioners tend to exhibit greater forward flexion and head movement during tracheal intubation compared to experts, regardless of the laryngoscope used. This difference is particularly evident when comparing Macintosh and videolaryngoscopes, with novices often requiring more substantial adjustments to achieve an adequate glottic view. However, experienced anaesthetists also exhibit variations in their tracheal intubation techniques due to factors including habit and vision issues. We appreciate the insights and agree that failing to account for operator experience could limit the applicability of our findings. Augmented reality technology may offer greater benefits to less experienced practitioners by providing a more intuitive and visual representation of the laryngeal anatomy. Viewing an enlarged, three-dimensional image of the larynx without adjusting posture could facilitate learning and improve technique among novice anaesthetists. The use of videolaryngoscopes with articulable and rotatable screens is noted. However, during our clinical use of an integrated videolaryngoscope, the screen is not at eye level, requiring downward head movement for adequate visualisation. The screen's size necessitates proximity for clear viewing, highlighting the difference from augmented reality glasses that allow for eye-level operation. Further exploration of the impact of practitioner experience on the use of augmented reality laryngoscopes is essential. Future studies should include a broader range of participants, encompassing both novice and experienced anaesthetists, to comprehensively assess the benefits and challenges of this emerging technology. This will help tailor the design and training protocols for augmented reality laryngoscopes to meet the needs of practitioners at all skill levels. We share the concern about using industrial endoscopes instead of clinically designed devices. In our ongoing research, we are collaborating with manufacturers to develop a clinical grade augmented reality laryngoscope tailored for patient use. Tracheal intubation practices can vary widely across regions; experience levels; clinical settings; and operational constraints. Our goal was not to dismiss the clinical value of direct or videolaryngoscopes but to introduce an innovative augmented reality laryngoscope and compare it with existing tools. We believe our augmented reality laryngoscope represents a novel concept that could revolutionise tracheal intubation practices. We are eager to collaborate with anaesthetists worldwide to create a portable, fully developed head-mounted display system for augmented reality laryngoscopy, enhancing the tracheal intubation experience and safeguarding the wellbeing of both anaesthetists and patients.
Abstract Postoperative acute kidney injury (AKI) is a severe complication after liver transplantation (LT). Its deterioration and magnification lead to the increase in mortality. Connexin43 (Cx43) mediates direct transmission of intracellular signals between neighboring cells, always considered to be the potent biological basis of organ damage deterioration and magnification. Thus, we explored the effects of Cx43 on AKI following LT and its related possible mechanism. In this study, alternations of Cx43 expression were observed in 82 patients, receiving the first-time orthotopic LT. We built autologous orthotopic liver transplantation (AOLT) models with Sprague–Dawley (SD) rats in vivo, and hypoxia-reoxygenation (H/R) or lipopolysaccharide (LPS) pretreatment models with kidney tubular epithelial cells (NRK-52E) in vitro, both of which were the most important independent risk factors of AKI following LT. Then, different methods were used to alter the function of Cx43 channels to determine its protective effects on AKI. The results indicated that patients with AKI suffering from longer time of tracheal intubation or intensive care unit stay, importantly, had significantly lower survival rate at postoperative 30 days and 3 years. In rat AOLT models, as Cx43 was inhibited with heptanol, postoperative AKI was attenuated significantly. In vitro experiments, downregulation of Cx43 with selective inhibitors, or siRNA protected against post-hypoxic NRK-52E cell injuries caused by H/R and/or LPS, while upregulation of Cx43 exacerbated the above-mentioned cell injuries. Of note, alternation of Cx43 function regulated the content of reactive oxygen species (ROS), which not only mediated oxidative stress and inflammation reactions effectively, but also regulated necroptosis. Therefore, we concluded that Cx43 inhibition protected against AKI following LT through attenuating ROS transmission between the neighboring cells. ROS alternation depressed oxidative stress and inflammation reaction, which ultimately reduced necroptosis. This might offer new insights for targeted intervention for organ protection in LT, or even in other major surgeries.
Background: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic since late 2019. Strict policies for timely isolation and treatment can help reduce the spread of coronavirus disease 2019 (COVID-19).We aimed to investigate whether a shorter symptom onset to admission time could improve outcomes of COVID-19 patients and provide an effective strategy for COVID-19 control.Methods: A systematic review and meta-analysis were performed to identify studies published between December 1, 2019 and April 15, 2020. Additionally, clinical data of COVID-19 patients diagnosed between January 20 and February 20, 2020 at the First Affiliated Hospital of the University of Science and Technology of China were retrospectively analyzed. The symptom onset to admission time and severity of illness in patients with COVID-19 were used as effect measures. Propensity score matching was applied to adjust for confounding factors in the retrospective study. The random effects model was used to analyze the heterogeneity across studies. Categorical data were compared using the Fisher's exact test. We compared the differences in laboratory characteristic vary times using a two-way nonparametric, Scheirer-Ray-Hare test. P < 0·05 was considered statistically significant.Findings: Eleven studies including 2503 cases were finally enrolled in this meta-analysis. Among which, 500 cases were combined with adverse outcomes: 245 deaths, 36 intensive care unit admissions, and 219 with severe disease. Patients with adverse outcomes had a longer symptom onset to admission time (I 2 =39%, mean difference=0·88, 95% confidence interval=0·47–1·30).Interpretation: Shortening the symptom onset to admission time may help reduce the possibility of mild patients with COVID-19 progressing to severe illness.Funding Statement: The study was funded by the Natural Science Foundation Project of Guangdong Province, China, (No.2018A030313618), and the Postdoctoral Science Foundation of China (Grant No. 2019M663260 & 2020T130148ZX).Declaration of Interests: All authors declare that they have no conflicts of interest.Ethics Approval Statement: This study was approved by the Research Ethics Commission of the First Affiliated Hospital of the University of Science and Technology of China (approval no. 2020-P-018). The requirement for informed consent was waived because it was a retrospective study, and the patients could not be identified.
Genetic control of height has been widely explored using genome-wide association studies (GWAS) in multi-ethnic populations (1-4). Although familial short stature (FSS) is the most common type of short stature, its genetic profile and impact on bone metabolism remains to be investigated. This GWAS study identifies 10 novel common genetic variants associated with FSS in 1163 Han Chinese subjects with FSS.
Neuropathic pain is a complex chronic condition occurring post-nervous system damage. The transcriptional reprogramming of injured dorsal root ganglia (DRGs) drives neuropathic pain. However, few comparative analyses using high-throughput platforms have investigated uninjured DRG in neuropathic pain, and potential interactions among differentially expressed genes (DEGs) and pathways were not taken into consideration. The aim of this study was to identify changes in genes and pathways associated with neuropathic pain in uninjured L4 DRG after L5 spinal nerve ligation (SNL) by using bioinformatic analysis.The microarray profile GSE24982 was downloaded from the Gene Expression Omnibus database to identify DEGs between DRGs in SNL and sham rats. The prioritization for these DEGs was performed using the Toppgene database followed by gene ontology and pathway enrichment analyses. The relationships among DEGs from the protein interactive perspective were analyzed using protein-protein interaction (PPI) network and module analysis. Real-time polymerase chain reaction (PCR) and Western blotting were used to confirm the expression of DEGs in the rodent neuropathic pain model.A total of 206 DEGs that might play a role in neuropathic pain were identified in L4 DRG, of which 75 were upregulated and 131 were downregulated. The upregulated DEGs were enriched in biological processes related to transcription regulation and molecular functions such as DNA binding, cell cycle, and the FoxO signaling pathway. Ctnnb1 protein had the highest connectivity degrees in the PPI network. The in vivo studies also validated that mRNA and protein levels of Ctnnb1 were upregulated in both L4 and L5 DRGs.This study provides insight into the functional gene sets and pathways associated with neuropathic pain in L4 uninjured DRG after L5 SNL, which might promote our understanding of the molecular mechanisms underlying the development of neuropathic pain.
Objective
To observe and evluate the correlation of lope level with disease cognition and social support in stroke patients.
Methods
179 stroke patients treated at our department from February, 2014 to October, 2016 were selected. Herth Hope Index (HHI), Social Support Rating Scale (SSRS), Social Support Rating Scale (SSRS) Evaluation, and Questionnaire of Cognitive Level of Stroke Patients were used to evaluate the patients.
Results
Both the cognitive level of stoke and social support for the stroke patients influenced hope level. The total hope level was (35.41±5.56) . The disease cognitive level was (72.38±19.59) . The social support was (38.35±8.19) .
Conclusion
Most stroke patients hope levels are middle and high levels. Medical staff should encourage patients to improve their disease cognitive level and give full play to social support system, so as to effectively improve their hope level, quality of life, and rehabilitation.
Key words:
Stroke; Hope level; Disease cognition; Social support
Abstract Background The triglyceride-glucose (TyG) index, identified as a reliable indicator of insulin resistance (IR), was reported to be associated with stroke recurrence and morbidity in the general population and critically ill patients. However, the relationship in liver transplantation (LT) recipients remains unknown. This study aimed to investigate the correlation between the TyG index and post-LT stroke along with all-cause mortality and further assess the influence of IR on the LT recipients’ prognosis. Methods The retrospective cohort study enrolled 959 patients who underwent LT at a university-based medical centre between January 2015 and January 2021. The participants were divided into three groups according to their TyG index tertiles. The primary outcome was post-LT stroke. Multivariate logistic regression, COX proportional hazards regression, and restricted cubic spline RCS were used to examine the association between the TyG index and outcomes in LT recipients. Results With a median TyG index of 8.23 (7.78–8.72), 780 (87.18% males) patients were eventually included. The incidence of post-LT stroke was 5.38%, and the in-hospital, 1-year, and 3-year mortality rates were 5.54%, 13.21%, and 15.77%, respectively. Multivariate regression analysis showed an independent association between the TyG index and an increased risk of post-LT stroke [adjusted odds ratio (aOR), 3.398 (95% confidence interval [CI]: 1.371–8.426) P = 0. 008], in-hospital mortality [adjusted hazard ratio (aHR), 2.326 (95% CI: 1.089–4.931) P = 0.025], 1-year mortality [aHR, 1.668 (95% CI: 1.024–2.717) P = 0.039], and 3-year mortality [aHR, 1.837 (95% CI: 1.445–2.950) P = 0.012]. Additional RCS analysis also suggested a linear increase in the risk of postoperative stroke with elevated TyG index ( P for nonlinearity = 0.480). Conclusions The TyG index may be a valuable and reliable indicator for assessing stroke risk and all-cause mortality in patients undergoing LT, suggesting its potential relevance in improving risk stratification during the peri-LT period.
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