BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic ...BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.展开更多
General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relyin...General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.展开更多
Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environm...Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.展开更多
Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized reside...Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.展开更多
BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nur...BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.展开更多
BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of periop...BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.展开更多
Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare...Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.展开更多
General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreas...General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.展开更多
Thymic tumors may invade the superior vena cava(SVC)and cause superior vena cava syndrome.Traditionally,such patients tend to choose conservative treatments because of contraindication for surgical treatment.However,t...Thymic tumors may invade the superior vena cava(SVC)and cause superior vena cava syndrome.Traditionally,such patients tend to choose conservative treatments because of contraindication for surgical treatment.However,there were no significant benefits to the patients.In recent years,doctors and scholars have reexamined the value of surgical treatments,and some have performed extended resections of thymic tumors combined with artificial blood vessel replacement,which have achieved compelling effectiveness[1–5].展开更多
Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inad...Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inadequacies which have stimulated the search for an alternative technique which can be effective, such as microdose intrathecal spinal analgesia that can be recommended in limited resources environment. Aim: This work aims to contribute to the improvement of anesthetic techniques for incomplete abortion by MVA. Methodology: We conducted a prospective comparative study, type single blind non-inferiority randomized trial with an analytical aim. The study counted 2 parts: 1) Descriptive observational component (KET): Ketamine narcosis. 2) Experimental component, single-blind non-inferiority randomized clinical trial (RAS) microdose intrathecal spinal analgesia. Three hundred and twenty expected cases per randomized arms. Excel Software 2022, SPSS, Open Epi, and XL-SAT were used for data encoding and analysis. Results: A total of 322 cases were retained and analyzed: 1) 161 cases per randomized arm, the majority age group was between 18 - 50 years in the 2 groups and there was no correlation between the two. Protocols with the sociodemographic characteristics studied, ASA class, type of intervention, history of MVA, variation in heart rate, temperature, appearance of hypotension, cost of the anesthetic procedure and admission to intensive care. 2) Effectiveness of the RAS protocol: Judged easier by anesthetists at 99.38% compared to 93.79% for KET with significant difference (p = 0.0104), allows them to be more mobile during the procedure at 98.76 % against 68.32% with significant difference (p < 0.0001) and the overall assessment was in favor of the RAS protocol at a rate of 32.92% against 5.58% for the anesthetists, 90.68% for the patients and 100% for gynecologists who find it excellent compared to the KET protocol with significant difference (p < 0.0001). 3) Weaknesses of the KET protocol: unconsciousness in all patients during the procedure and provides more tachypnea (17.39%) compared to the RAS protocol with difference p = 0.0008, moderate hemorrhages (55.28%), severe (9.94%) with p = 0.0006, higher material cost with p = 0.0018, occurrence of vomiting (10.56%), delay in waking up (22.36%), post-MVA pain (21.74%), and a slight change in the modified Aldrete score at the 30th min post-MVA (70.19%) compared to RAS (81.61%) p = 0.0002. 4) No patient died during the study period in both protocols. Conclusion: Intrathecal spinal analgesia microdosed with bupivacaine 0.1% and Fentanyl 50 µg/cc according to the process used in this study, has proven its effectiveness compared to Ketamine narcosis, currently recommended and not different in terms of effectiveness from other anesthetic techniques recommended for MVA indicated for incomplete abortion and can therefore be recommended as the anesthetic practice of choice in this area in a resource-limited setting.展开更多
Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is pri...Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is primarily caused by the deposition of amyloid-β(Aβ), which drives tau phosphorylation, neuroinflammation, and neurodegeneration in the brain. The amyloid hypothesis is strengthened by the significant and moderate benefit of lecanemab, a humanized antibody through an anti-amyloid mechanism,showing slowed clinical decline(van Dyck et al.,2023). The recent positive results of anti-amyloid trials have brought back focus on the amyloid hypothesis through biochemical, genetic, and pharmacological approaches(Zhang, 2023).展开更多
Ischemia is a significant factor affecting the repair of peripheral nerve injuries,while exosomes have been shown to promote angiogenesis.To further investigate the detailed processes and efficacy of exosome thera⁃py ...Ischemia is a significant factor affecting the repair of peripheral nerve injuries,while exosomes have been shown to promote angiogenesis.To further investigate the detailed processes and efficacy of exosome thera⁃py for ischemic peripheral nerve injuries,this study utilized glucose-modified near-infrared-II(NIR-II)quantum dots(QDs)to label adipose-derived stem cell exosomes(QDs-ADSC-Exos),enabling long-term in vivo NIR-II imaging of exosome treatment for ischemic peripheral nerve damage.Experimental results confirmed that QDs can be used for non-invasive in vitro labeling of exosomes,with QDs-ADSC-Exos exhibiting strong fluorescence signals in the NIR-II window and demonstrating favorable NIR-II imaging characteristics in vivo.Notably,QDsADSC-Exos showed accumulation at the site of nerve injury in cases of ischemic peripheral nerve damage.Func⁃tional neurological assessments indicated that QDs-ADSC-Exos effectively promoted neural regeneration.This study highlights the potential of exosomes in treating ischemic peripheral nerve injuries and elucidates the spatio⁃temporal characteristics of exosome therapy,providing objective evidence for the further optimization of exosomebased treatment protocols.展开更多
Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the med...Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the medical school, and the university hospital will require that anesthesia departments operate with maximal operational efficiency. Maintenance or expansion of institutional infrastructural support of the university anesthesia department will be necessary to achieve operational efficiencies, and to ensure that the safety of our patients is in no way compromised by financial concerns. Previous studies have documented increasing need for monetary institutional supports of academic anesthesia departments [1]. The purpose of this study is to delineate non-monetary institutional support afforded to academic anesthesia departments by their University Hospitals. After IRB approval, we electronically solicited the response to a 63 question survey (43 of which were used for the present study) from all 133 chairpersons of academic anesthesia departments in the United States. The remaining 20 questions were unrelated to the topics presented in this manuscript. 62 responded electronically, for an overall response rate of 46.6%. This study establishes the current state of infrastructural support afforded to academic anesthesia departments in the United States.展开更多
Digital health is transforming healthcare by integrating advanced technologies to make healthcare more accessible,efficient,and personalized.From electronic health records,telemedicine,wearable devices,and artificial ...Digital health is transforming healthcare by integrating advanced technologies to make healthcare more accessible,efficient,and personalized.From electronic health records,telemedicine,wearable devices,and artificial intelligence to the recent smart hospitals,digital health is improving patient care and outcomes while reducing healthcare costs.However,the integration of digital health faces several challenges,including data privacy,cybersecurity risks,and inequitable access to technology.This article provides an overview of the current state of digital health,key challenges in implementation,and potential solutions to maximize the benefits of digital health and ensure efficient,equitable,and patient‐centered healthcare in the future.展开更多
Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the cl...Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.Methods We reviewed the operating procedures and duration of stay in 1865 HOR cases.The actual procedures of each case were summarized into 5 application types,and numerical assignment was used to distinguish the dependence of each type on our HOR:surgical procedures combined with interventional procedures(4 points,the highest dependence),surgical procedures combined with imaging procedures(3 points),interventional procedures(2 points),imaging procedures(1 point),and surgical procedures(0 points,the lowest dependence).Results A novel scale that could score 1865 cases into those 5 grades was developed.The percentages by grade were as follows:4 points,4.24%;3 points,4.88%;2 points,20.75%;1 point,69.38%;and 0 points,0.75%.The cumulative usage time was 4241.9 h,the duration of which was as follows:4 points,16.17%;3 points,15.50%;2 points,31.32%;1 point,35.62%;and 0 points,1.39%.Conclusions The HOR serves as a multifunctional room to treat neurosurgical diseases.The scale helps to quickly prioritize cases that rely more on HOR,providing guidelines for surgical scheduling.Although our HOR is unsuitable for emergency cases,it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.展开更多
BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative ...BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate,improving post-operative biochemical markers,and enhancing postoperative recovery outcomes.AIM To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery.It also sought to compare infection rates and biochemical markers between the obser-vation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.METHODS A retrospective analysis was conducted.Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group,with 48 cases in each.The observation group received disinfection and isolation measures during the perioperative period,whereas the control group received standard nursing care.The incidence of infection,white blood cell count,C-reactive protein levels,hemoglobin levels,and liver function markers(alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen)were monitored postoperatively in both groups.RESULTS The postoperative infection rate in the observation group was significantly lower than that in the control group(P<0.05).White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group(P<0.05).Alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3,showing a significant difference(P<0.05).CONCLUSION Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers,thereby enhancing recovery outcomes.This study provides a valuable basis for postoperative infection control and has significant clinical applications.展开更多
BACKGROUND This study analyzed the dental follicle and alveolar bone of two patients with tooth eruption disorders,aiming to provide some reference for exploring the etiology and selecting treatment plans of this dise...BACKGROUND This study analyzed the dental follicle and alveolar bone of two patients with tooth eruption disorders,aiming to provide some reference for exploring the etiology and selecting treatment plans of this disease from the perspective of the influence of extracellular matrix on osteoclasts differentiation in dental follicle.CASE SUMMARY Collect dental follicle and alveolar bone tissue from one patient with single tooth eruption disorder and one patient with full permanent tooth eruption disorder,respectively.Simultaneously collect the dental follicle and alveolar bone tissue of obstructed teeth that need to be extracted due to orthodontic treatment as the control group.Hematoxylin and eosin(HE)staining was used to observe the morphology of dental follicle cells.Immunohistochemical staining was used to observe the expression of periostin,receptor activator of nuclear factor kappa B ligand(RANKL),and osteoprotegerin(OPG)protein in dental follicle and alveolar bone tissue.And observe the eruption of teeth after removing resistance from the crown of the permanent tooth germ.CONCLUSION HE staining of two cases of dental follicle tissues showed that the volume of dental follicle cells decreased,the nuclei were condensed,and there seemed to be cellular fibrosis.The immunohistochemical staining showed that both the dental follicle and alveolar bone tissue exhibited increased expression of periostin,decreased expression of RANKL and OPG proteins,and decreased RANKL/OPG ratio.After removing resistance,the permanent tooth germ often appears to have normal eruption.Tooth eruption disorders may be accompanied by abnormal remodeling of periostin,which affects the differentiation function of osteoclasts in the dental follicle and leads to metabolic imbalance of alveolar bone,resulting in tooth eruption disorders.Whether it is a single or full permanent tooth eruption disorder,once the coronal resistance is removed,the teeth can often erupt normally.展开更多
BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live k...BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.展开更多
BACKGROUND Intestinal injury is the most common complication of sepsis,and the mitigation of intestinal damage is crucial for treating sepsis.AIM To examine the use of ozone-rich water and its action in preventing int...BACKGROUND Intestinal injury is the most common complication of sepsis,and the mitigation of intestinal damage is crucial for treating sepsis.AIM To examine the use of ozone-rich water and its action in preventing intestinal damage caused by sepsis.METHODS Through histological analysis,immunohistochemistry,immunofluorescence assays,and Western blot detection,we evaluated the therapeutic efficacy of ozone in mitigating intestinal injury during sepsis.Additionally,by conducting 16S rRNA sequencing and untargeted metabolomics analysis on fecal samples,we identified alterations in the gut microbiota and specific metabolites in septic mice following ozone treatment.This comprehensive approach aims to further elucidate the mechanistic underpinnings of ozone therapy in alleviating sepsis-induced intestinal damage.RESULTS Our results demonstrate that ozonated water significantly ameliorates pathological damage in intestinal tissues,enhances the expression of tight junction proteins,and inhibits the polarization of intestinal macrophages,thereby reducing the expression of inflammatory cytokines in intestinal tissues of cecal ligation and puncture-induced septic mice.16S rRNA sequencing analysis revealed that ozonated water increased the abundance of beneficial bacteria and alleviated gut microbiota dysbiosis.Studies using broad-spectrum antibiotic-treated mice indicated that the protective effects of ozonated water on intestinal injury are dependent on the gut microbiota.Furthermore,metabolomic analysis identified an increase in the tryptophan metabolite DL-tryptophan in the ozonated water treatment group.This suggests that ozonated water protects against intestinal injury by activating the aryl hydrocarbon receptor and suppressing necroptosis in intestinal epithelial cells.CONCLUSION Ozone protected against sepsis-induced intestinal injury through regulation of the gut microbiota and tryptophan metabolism,inhibiting necrotic apoptosis of intestinal epithelial cells through activation of the aryl hydrocarbon receptor.展开更多
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
文摘BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.
基金supported by grants from the Shanghai Municipal Health Commission(2023ZDFC0203)the National Natural Science Foundation of China(32171044).
文摘General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.
文摘Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.
文摘Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.
基金Supported by the Autonomous Region Key R&D Program Project“Research on the Prevention and Treatment System and Key Technologies of Elderly Related Diseases",No.2022B03009-4.
文摘BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.
文摘BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.
文摘Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.
文摘General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.
文摘Thymic tumors may invade the superior vena cava(SVC)and cause superior vena cava syndrome.Traditionally,such patients tend to choose conservative treatments because of contraindication for surgical treatment.However,there were no significant benefits to the patients.In recent years,doctors and scholars have reexamined the value of surgical treatments,and some have performed extended resections of thymic tumors combined with artificial blood vessel replacement,which have achieved compelling effectiveness[1–5].
文摘Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inadequacies which have stimulated the search for an alternative technique which can be effective, such as microdose intrathecal spinal analgesia that can be recommended in limited resources environment. Aim: This work aims to contribute to the improvement of anesthetic techniques for incomplete abortion by MVA. Methodology: We conducted a prospective comparative study, type single blind non-inferiority randomized trial with an analytical aim. The study counted 2 parts: 1) Descriptive observational component (KET): Ketamine narcosis. 2) Experimental component, single-blind non-inferiority randomized clinical trial (RAS) microdose intrathecal spinal analgesia. Three hundred and twenty expected cases per randomized arms. Excel Software 2022, SPSS, Open Epi, and XL-SAT were used for data encoding and analysis. Results: A total of 322 cases were retained and analyzed: 1) 161 cases per randomized arm, the majority age group was between 18 - 50 years in the 2 groups and there was no correlation between the two. Protocols with the sociodemographic characteristics studied, ASA class, type of intervention, history of MVA, variation in heart rate, temperature, appearance of hypotension, cost of the anesthetic procedure and admission to intensive care. 2) Effectiveness of the RAS protocol: Judged easier by anesthetists at 99.38% compared to 93.79% for KET with significant difference (p = 0.0104), allows them to be more mobile during the procedure at 98.76 % against 68.32% with significant difference (p < 0.0001) and the overall assessment was in favor of the RAS protocol at a rate of 32.92% against 5.58% for the anesthetists, 90.68% for the patients and 100% for gynecologists who find it excellent compared to the KET protocol with significant difference (p < 0.0001). 3) Weaknesses of the KET protocol: unconsciousness in all patients during the procedure and provides more tachypnea (17.39%) compared to the RAS protocol with difference p = 0.0008, moderate hemorrhages (55.28%), severe (9.94%) with p = 0.0006, higher material cost with p = 0.0018, occurrence of vomiting (10.56%), delay in waking up (22.36%), post-MVA pain (21.74%), and a slight change in the modified Aldrete score at the 30th min post-MVA (70.19%) compared to RAS (81.61%) p = 0.0002. 4) No patient died during the study period in both protocols. Conclusion: Intrathecal spinal analgesia microdosed with bupivacaine 0.1% and Fentanyl 50 µg/cc according to the process used in this study, has proven its effectiveness compared to Ketamine narcosis, currently recommended and not different in terms of effectiveness from other anesthetic techniques recommended for MVA indicated for incomplete abortion and can therefore be recommended as the anesthetic practice of choice in this area in a resource-limited setting.
基金supported by the Massachusetts General Hospital Scientific Projects to Accelerate Research and Collaboration (SPARC) awardCure Alzheimer’s Fund (to CZ)the National Institutes of Health (NIH),including R01NS102190,RF1NS120947,and R01HL161253 (to MBW),RF1NS120947 (to RJT)。
文摘Introduction:Alzheimer 's disease(AD) is a common neurodegenerative disorder and the primary cause of dementia. Considerable evidence supports the “amyloid hypothesis,” stating that the pathogenesis of AD is primarily caused by the deposition of amyloid-β(Aβ), which drives tau phosphorylation, neuroinflammation, and neurodegeneration in the brain. The amyloid hypothesis is strengthened by the significant and moderate benefit of lecanemab, a humanized antibody through an anti-amyloid mechanism,showing slowed clinical decline(van Dyck et al.,2023). The recent positive results of anti-amyloid trials have brought back focus on the amyloid hypothesis through biochemical, genetic, and pharmacological approaches(Zhang, 2023).
基金Supported by the National Natural Science Foundation of China(82371373,W2412120)the Shanghai Natural Science Foundation(21ZR1436100).
文摘Ischemia is a significant factor affecting the repair of peripheral nerve injuries,while exosomes have been shown to promote angiogenesis.To further investigate the detailed processes and efficacy of exosome thera⁃py for ischemic peripheral nerve injuries,this study utilized glucose-modified near-infrared-II(NIR-II)quantum dots(QDs)to label adipose-derived stem cell exosomes(QDs-ADSC-Exos),enabling long-term in vivo NIR-II imaging of exosome treatment for ischemic peripheral nerve damage.Experimental results confirmed that QDs can be used for non-invasive in vitro labeling of exosomes,with QDs-ADSC-Exos exhibiting strong fluorescence signals in the NIR-II window and demonstrating favorable NIR-II imaging characteristics in vivo.Notably,QDsADSC-Exos showed accumulation at the site of nerve injury in cases of ischemic peripheral nerve damage.Func⁃tional neurological assessments indicated that QDs-ADSC-Exos effectively promoted neural regeneration.This study highlights the potential of exosomes in treating ischemic peripheral nerve injuries and elucidates the spatio⁃temporal characteristics of exosome therapy,providing objective evidence for the further optimization of exosomebased treatment protocols.
文摘Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the medical school, and the university hospital will require that anesthesia departments operate with maximal operational efficiency. Maintenance or expansion of institutional infrastructural support of the university anesthesia department will be necessary to achieve operational efficiencies, and to ensure that the safety of our patients is in no way compromised by financial concerns. Previous studies have documented increasing need for monetary institutional supports of academic anesthesia departments [1]. The purpose of this study is to delineate non-monetary institutional support afforded to academic anesthesia departments by their University Hospitals. After IRB approval, we electronically solicited the response to a 63 question survey (43 of which were used for the present study) from all 133 chairpersons of academic anesthesia departments in the United States. The remaining 20 questions were unrelated to the topics presented in this manuscript. 62 responded electronically, for an overall response rate of 46.6%. This study establishes the current state of infrastructural support afforded to academic anesthesia departments in the United States.
文摘Digital health is transforming healthcare by integrating advanced technologies to make healthcare more accessible,efficient,and personalized.From electronic health records,telemedicine,wearable devices,and artificial intelligence to the recent smart hospitals,digital health is improving patient care and outcomes while reducing healthcare costs.However,the integration of digital health faces several challenges,including data privacy,cybersecurity risks,and inequitable access to technology.This article provides an overview of the current state of digital health,key challenges in implementation,and potential solutions to maximize the benefits of digital health and ensure efficient,equitable,and patient‐centered healthcare in the future.
基金supported by the Technology Innovation Special Major Project of Hubei Province(grant number 2022BCA003).
文摘Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.Methods We reviewed the operating procedures and duration of stay in 1865 HOR cases.The actual procedures of each case were summarized into 5 application types,and numerical assignment was used to distinguish the dependence of each type on our HOR:surgical procedures combined with interventional procedures(4 points,the highest dependence),surgical procedures combined with imaging procedures(3 points),interventional procedures(2 points),imaging procedures(1 point),and surgical procedures(0 points,the lowest dependence).Results A novel scale that could score 1865 cases into those 5 grades was developed.The percentages by grade were as follows:4 points,4.24%;3 points,4.88%;2 points,20.75%;1 point,69.38%;and 0 points,0.75%.The cumulative usage time was 4241.9 h,the duration of which was as follows:4 points,16.17%;3 points,15.50%;2 points,31.32%;1 point,35.62%;and 0 points,1.39%.Conclusions The HOR serves as a multifunctional room to treat neurosurgical diseases.The scale helps to quickly prioritize cases that rely more on HOR,providing guidelines for surgical scheduling.Although our HOR is unsuitable for emergency cases,it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.
文摘BACKGROUND The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate,improving post-operative biochemical markers,and enhancing postoperative recovery outcomes.AIM To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery.It also sought to compare infection rates and biochemical markers between the obser-vation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.METHODS A retrospective analysis was conducted.Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group,with 48 cases in each.The observation group received disinfection and isolation measures during the perioperative period,whereas the control group received standard nursing care.The incidence of infection,white blood cell count,C-reactive protein levels,hemoglobin levels,and liver function markers(alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen)were monitored postoperatively in both groups.RESULTS The postoperative infection rate in the observation group was significantly lower than that in the control group(P<0.05).White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group(P<0.05).Alanine aminotransferase,aspartate aminotransferase,creatinine,and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3,showing a significant difference(P<0.05).CONCLUSION Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers,thereby enhancing recovery outcomes.This study provides a valuable basis for postoperative infection control and has significant clinical applications.
基金Supported by The Xuzhou Medical University Affiliated Hospital Development Fund Support Project,No.XYFM202457the 521 Scientific Research Project of Lianyungang City,No.LYG 06521202362.
文摘BACKGROUND This study analyzed the dental follicle and alveolar bone of two patients with tooth eruption disorders,aiming to provide some reference for exploring the etiology and selecting treatment plans of this disease from the perspective of the influence of extracellular matrix on osteoclasts differentiation in dental follicle.CASE SUMMARY Collect dental follicle and alveolar bone tissue from one patient with single tooth eruption disorder and one patient with full permanent tooth eruption disorder,respectively.Simultaneously collect the dental follicle and alveolar bone tissue of obstructed teeth that need to be extracted due to orthodontic treatment as the control group.Hematoxylin and eosin(HE)staining was used to observe the morphology of dental follicle cells.Immunohistochemical staining was used to observe the expression of periostin,receptor activator of nuclear factor kappa B ligand(RANKL),and osteoprotegerin(OPG)protein in dental follicle and alveolar bone tissue.And observe the eruption of teeth after removing resistance from the crown of the permanent tooth germ.CONCLUSION HE staining of two cases of dental follicle tissues showed that the volume of dental follicle cells decreased,the nuclei were condensed,and there seemed to be cellular fibrosis.The immunohistochemical staining showed that both the dental follicle and alveolar bone tissue exhibited increased expression of periostin,decreased expression of RANKL and OPG proteins,and decreased RANKL/OPG ratio.After removing resistance,the permanent tooth germ often appears to have normal eruption.Tooth eruption disorders may be accompanied by abnormal remodeling of periostin,which affects the differentiation function of osteoclasts in the dental follicle and leads to metabolic imbalance of alveolar bone,resulting in tooth eruption disorders.Whether it is a single or full permanent tooth eruption disorder,once the coronal resistance is removed,the teeth can often erupt normally.
文摘BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.
基金Supported by the National Natural Science Foundation of China,No.81971814Pudong New Area Health Talent Training Program,No.2025PDWSYCBJ-04Shanghai’s 2023“Technology Innovation Action Plan”Medical Innovation Research Project,No.23Y11908300。
文摘BACKGROUND Intestinal injury is the most common complication of sepsis,and the mitigation of intestinal damage is crucial for treating sepsis.AIM To examine the use of ozone-rich water and its action in preventing intestinal damage caused by sepsis.METHODS Through histological analysis,immunohistochemistry,immunofluorescence assays,and Western blot detection,we evaluated the therapeutic efficacy of ozone in mitigating intestinal injury during sepsis.Additionally,by conducting 16S rRNA sequencing and untargeted metabolomics analysis on fecal samples,we identified alterations in the gut microbiota and specific metabolites in septic mice following ozone treatment.This comprehensive approach aims to further elucidate the mechanistic underpinnings of ozone therapy in alleviating sepsis-induced intestinal damage.RESULTS Our results demonstrate that ozonated water significantly ameliorates pathological damage in intestinal tissues,enhances the expression of tight junction proteins,and inhibits the polarization of intestinal macrophages,thereby reducing the expression of inflammatory cytokines in intestinal tissues of cecal ligation and puncture-induced septic mice.16S rRNA sequencing analysis revealed that ozonated water increased the abundance of beneficial bacteria and alleviated gut microbiota dysbiosis.Studies using broad-spectrum antibiotic-treated mice indicated that the protective effects of ozonated water on intestinal injury are dependent on the gut microbiota.Furthermore,metabolomic analysis identified an increase in the tryptophan metabolite DL-tryptophan in the ozonated water treatment group.This suggests that ozonated water protects against intestinal injury by activating the aryl hydrocarbon receptor and suppressing necroptosis in intestinal epithelial cells.CONCLUSION Ozone protected against sepsis-induced intestinal injury through regulation of the gut microbiota and tryptophan metabolism,inhibiting necrotic apoptosis of intestinal epithelial cells through activation of the aryl hydrocarbon receptor.
