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围术期神经肌肉阻滞的管理:欧洲麻醉和重症监护学会临床指南

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中华麻醉学杂志 2024年第6期44卷 641-656页

作者： Thomas Fuchs-Buder Carolina S.Romero Heidrun Lewald Massimo Lamperti Arash Afshari Ana-Marjia Hristovska Denis Schmartz Jochen Hinkelbein Dan Longrois Maria Popp Hans Dde Boer Massimiliano Sorbello Radmilo Jankovic peter Kranke 法国南锡大学医学院附属医院麻醉学、重症监护与围术期医学科法国南锡54000 巴伦西亚大学综合医院麻醉与重症监护科西班牙巴伦西亚46014 慕尼黑工业大学麻醉学与重症监护科德国慕尼黑80333 克利夫兰阿布扎比诊所麻醉学研究所阿联酋阿布扎比31250 哥本哈根大学医院小儿和产科麻醉科丹麦哥本哈根2100 哥本哈根大学医院麻醉学与重症监护科丹麦赫维德2650 布鲁塞尔自由大学Erasme医院麻醉科比利时布鲁塞尔1070 科隆大学医院麻醉学与重症监护科德国科隆50937 巴黎大学附属比查特克劳德伯纳德医院麻醉学与重症监护医学科法国巴黎75018 维尔茨堡大学医院麻醉学、危重病医学、急诊医学和疼痛医学科德国维尔茨堡97080 格罗宁根大学医院麻醉学、疼痛医学与程序性镇静与镇痛科荷兰格罗宁根9713 GZ 卡坦尼亚大学医院麻醉与重症监护科意大利卡坦尼亚95123 尼什大学医学院尼什临床中心麻醉学与重症治疗科塞尔维亚尼什18000

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(Europea... 详细信息

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(European Society of Anaesthesiology and Intensive Care,ESAIC)首次发布围术期神经肌肉阻滞管理临床指南,旨在为临床医生提供最佳医疗管理的循证建议,以提高围术期患者安全。本指南主要聚焦在3个临床问题:肌松药是否有助于成人气管插管?神经肌肉阻滞深度是否影响腹部手术患者的预后?肌松药残留阻滞的诊断和治疗策略有哪些?根据PICO原则(患者、干预、对照、结局;patient,intervention,comparator,outcome;PICO)构建临床问题并进行文献检索。初始纳入的临床研究为24 000篇,采用逐步筛选策略,最终临床研究88篇纳入指南分析。应用GRADE方法学(Grading of Recommendations,Assessment,Development and Evaluation,GRADE)对结局指标证据、质量等级进行评价。运用两轮德尔菲法收集专家组建议并形成统一推荐:R1推荐应用肌松药辅助气管插管(1A)。R2推荐应用肌松药以减少气管插管导致的咽部和(或)喉部损伤(1C)。R3推荐在快速顺序诱导插管(rapid sequence induction intubation,RSII)时使用短效肌松药,例如琥珀胆碱1 mg/kg或罗库溴铵0.9~1.2 mg/kg(1B)。R4推荐在需要改善外科手术条件时,加深神经肌肉阻滞深度(1B)。R5尚无足够的证据推荐深度神经肌肉阻滞可减轻术后疼痛或降低围术期并发症的发生率(2C)。R6推荐在拇内收肌处刺激尺神经,定量监测神经肌肉阻滞深度以排除肌松药残留阻滞(1B)。R7推荐应用舒更葡糖钠逆转甾体类肌松药(罗库溴铵、维库溴铵)诱导的深、中及浅度神经肌肉阻滞(1A)。R8推荐在使用新斯的明前,TOFr自行恢复至>0.2,并继续定量监测神经肌肉功能,直至TOFr超过0.9(1C)。

关键词：神经肌肉阻滞神经肌肉功能肌松药临床指南罗库溴铵琥珀胆碱外科手术定量监测

Multi-omic Analyses Shed Light on The Genetic Control of High-altitude Adaptation in Sheep

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Genomics, Proteomics & Bioinformatics 2024年第2期22卷 43-56页

作者： Chao Li Bingchun Chen Suo Langda Peng Pu Xiaojia Zhu Shiwei Zhou peter Kalds Ke Zhang Meenu Bhati Alexander Leonard Shuhong Huang Ran Li Awang Cuoji Xiran Wang Haolin Zhu Yujiang Wu Renqin Cuomu Ba Gui Ming Li Yutao Wang Yan Li Wenwen Fang Ting Jia Tianchun Pu Xiangyu Pan Yudong Cai Chong He Liming Wang Yu Jiang Jian-Lin Han Yulin Chen Ping Zhou Hubert Pausch Xiaolong Wang International Joint Agriculture Research Center for Animal Bio-Breeding Ministry of Agriculture and Rural Affairs/Key Laboratory of Animal GeneticsBreeding and Reproduction of Shaanxi ProvinceCollege of Animal Science and TechnologyNorthwest A&F UniversityYangling 712100China Animal Genomics ETH ZürichZürich 8092Switzerland Institute of Animal Science Tibet Academy of Agricultural and Animal Husbandry SciencesLhasa 850009China School of Biological and Pharmaceutical Engineering Lanzhou Jiaotong UniversityLanzhou 730070China College of Life Sciences Shaanxi Normal UniversityXi’an 710119China Zoology and Evolutionary Biology Department of BiologyUniversity of Konstanz78457 KonstanzGermany College of Life and Geographic Sciences Kashi UniversityKashi 844000China Beijing Key Laboratory of Captive Wildlife Technologies Beijing ZooBeijing 100044China Department of Medical Research Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Key Laboratory of Agricultural Internet of Things Ministry of Agriculture and Rural Affairs/Shaanxi Key Laboratory of Agricultural Information Perception and Intelligent ServiceCollege of Information EngineeringNorthwest A&F UniversityYangling 712100China Institute of Animal Husbandry and Veterinary Medicine Xinjiang Academy of Agricultural and Reclamation SciencesShihezi 832000China State Key Laboratory of Sheep Genetic Improvement and Healthy Production Xinjiang Academy of Agricultural and Reclamation SciencesShihezi 832000China CAAS-ILRI Joint Laboratory on Livestock and Forage Genetic Resources Institute of Animal ScienceChinese Academy of Agricultural SciencesBeijing 100193China Livestock Genetics Program International Livestock Research InstituteNairobi 00100Kenya

Sheep were domesticated in the Fertile Crescent and then spread globally,where they have been encountering various environmental *** Tibetan sheep has adapted to high altitudes on the Qinghai-Tibet Plateau over the past 3000 *** explore genomic variants associated with high-altitude adaptation in Tibetan sheep,we analyzed Illumina short-reads of 994 whole genomes representing∼60 sheep breeds/populations at varied altitudes,PacBio High fidelity(HiFi)reads of 13 breeds,and 96 transcriptomes from 12 sheep *** testing between the inhabited altitudes and 34,298,967 variants was conducted to investigate the genetic architecture of altitude *** accurate HiFi reads were used to complement the current ovine reference assembly at the most significantly associatedβ-globin locus and to validate the presence of two haplotypes A and B among 13 sheep *** haplotype A carried two homologous gene clusters:(1)HBE1,HBE2,HBB-like,and HBBC,and(2)HBE1-like,HBE2-like,HBB-like,and HBB;while the haplotype B lacked the first *** high-altitude sheep showed highly frequent or nearly fixed haplotype A,while the low-altitude sheep dominated by haplotype *** further demonstrated that sheep with haplotype A had an increased hemoglobin–O2 affinity compared with those carrying haplotype *** highly associated genomic region contained the EGLn1 gene which showed varied expression between high-altitude and low-altitude *** results provide evidence that the rapid adaptive evolution of advantageous alleles play an important role in facilitating the environmental adaptation of Tibetan sheep.

关键词： Environmental adaptation High altitude Hypoxia Selection signature Sheep

Characterization of Gibberellin Receptor Mutants of Barley （Hordeum vulgare L.）

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Molecular Plant 2008年第2期1卷 285-294页

作者： peter M. Chandler Carol A. Harding Anthony R. Ashton Mark D. Mulcair nicholas E. Dixonb Lewis n. Manderb CSIRO Plant Industry GPO Box 1600 Canberra ACT 2601 Australia Research School of Chemistry Australian National University Canberra ACT 0200 Australia

The sequence of Gidl （a gene for a gibberellin （GA） receptor from rice） was used to identify a putative orthologue from barley. This was expressed in E. coil, and produced a protein that was able to bind GA in vitro with both structural specificity and saturability. Its potential role in GA responses was investigated using barley mutants with reduced GA sensitivity （gsel mutants）. Sixteen different gsel mutants each carried a unique nucleotide substitution in this sequence. In all but one case, these changes resulted in single amino acid substitutions, and, for the remaining mutant, a substitution in the 5＇ untranslated region of the mRnA is proposed to interfere with translation initiation. There was perfect linkage in segregating populations between new mutant alleles and the gsel phenotype, leading to the conclusion that the putative GID1 GA receptor sequence in barley corresponds to the Gsel locus. Determination of endogenous GA contents in one of the mutants revealed enhanced accumulation of bioactive GA1, and a deficit of C20 GA precursors. All of the gsel mutants had reduced sensitivity to exogenous GA3, and to AC94377 （a GA analogue） at concentrations that are normally ＇saturating＇, but, at much higher concentrations, there was often a considerable response. The comparison between barley and rice mutants reveals interesting differences between these two cereal species in GA hormonal physiology.

关键词： Characterization Gibberellin Receptor Mutants

The HIF-1α/PLOD2 axis integrates extracellular matrix organization and cell metabolism leading to aberrant musculoskeletal repair

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Bone Research 2024年第2期12卷 289-301页

作者： Heeseog Kang Amy L.Strong Yuxiao Sun Lei Guo Conan Juan Alec C.Bancroft Ji Hae Choi Chase A.Pagani Aysel A.Fernandes Michael Woodard Juhoon Lee Sowmya Ramesh Aaron W.James David Hudson Kevin n.Dalby Lin Xu Robert J.Tower Benjamin Levi Center for Organogenesis Regeneration and TraumaDepartment of SurgeryUniversity of Texas SouthwesternDallasTX 75390USA Section of Plastic Surgery Department of SurgeryUniversity of MichiganAnn ArborMI 48109USA Quantitative Biomedical Research Center Peter O’Donnell Jr.School of Public HealthUniversity of Texas SouthwesternDallasTX 75390USA Department of Orthopedics and Sports Medicine University of WashingtonSeattleWA 98195USA Division of Chemical Biology and Medicinal Chemistry College of PharmacyUniversity of Texas at AustinAustinTX 78712USA Department of Pathology Johns Hopkins UniversityBaltimoreMD 21218USA

While hypoxic signaling has been shown to play a role in many cellular processes,its role in metabolism-linked extracellular matrix(ECM)organization and downstream processes of cell fate after musculoskeletal injury remains to be ***(HO)is a debilitating condition where abnormal bone formation occurs within extra-skeletal *** andhypoxia-inducible factor 1α(HIF-1α)activation have been shown to promote ***,the underlying molecular mechanisms bywhich the HIF-1αpathway in mesenchymal progenitor cells(MPCs)contributes to pathologic bone formation remain to ***,we used a proven mouse injury-induced HO model to investigate the role of HIF-1αon aberrant cell ***-cell RnA sequencing(scRnA-seq)and spatial transcriptomics analyses of the HO site,we found that collagen ECM organizationis the most highly up-regulated biological process in *** mesenchymal cell-specific deletion of Hif1α(Hoxa11-CreER^(T2);Hif1a^(fl/fl))significantly mitigated HO in ***-seq analysis of these Hoxa11-CreER^(T2);Hif1a^(fl/fl)mice identified the PLOD2/LOXpathway for collagen cross-linking as downstream of the HIF-1αregulation of ***,our scRnA-seq data and mechanisticstudies further uncovered that glucose metabolism in MPCs is most highly impacted by HIF-1α*** a translational aspect,a pan-LOX inhibitor significantly decreased HO.A newly screened compound revealed that the inhibition of PLOD2 activity in MPCssignificantly decreased osteogenic differentiation and glycolytic *** suggests that the HIF-1α/PLOD2/LOX axis linked tometabolism regulates HO-forming MPC *** results suggest that the HIF-1α/PLOD2/LOX pathway represents a promisingstrategy to mitigate HO formation.

关键词： metabolism skeletal aberrant

Idempotent Completions of Operator Partial Matrices

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Acta Mathematica Sinica,English Series 1999年第3期15卷 333-346页

作者： Heydar Radjavi peter Rosenthal Department of Mathematics Shanxi Teachers University Linfen 041004 P. R. ChinaDepartment of Mathematics Statistics and Computing Science Dalhousie University Halifax N.S. B3H 3J5 Canada Department of Mathematics University of Toronto Toronto On M5S 1A1 Canada

necessary and sufficient conditions are obtained for operator partial 2×2 matrices to have an idempotent completion, and all such completions are parametrically represented.

关键词： Hilbert space Operator matrix Idempotent operator

Commentary on"An alternative surgical technique for varicoceles:a preliminary experience of the microsurgical spermatic(distal end)-inferior or superficial epigastric vein anastomosis in symptomatic varicoceles associated with perineal pain"

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Asian Journal of Andrology 2022年第6期24卷 680-680页

作者： peter n Schlegel Weill Cornell Medicine New YorkNY10021USA

In the article by Wan et al.,the authors have described a different surgical approach limited to the treatment of men with varicoceles and pelvic floor congestion associated with perineal *** discuss the procedure used,which is essentially a decompression of the varicocele via anastomosis of the distal spermatic veins to the superficial epigastric veins and postoperative *** intervention is distinctly different from the standard approach of occlusion of spermatic veins(surgically or by embolization)typically at the subinguinal,inguinal,or retroperitoneal level.

关键词： superficial surgical varicocele

Promise and pitfalls of modeling grassland soil moisture in a free-air CO_(2) enrichment experiment(BioCOn)using the SHAW model

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Pedosphere 2021年第5期31卷 783-795页

作者： Raquel H.FLInKER M.Bayani CARDEnAS Todd G.CALDWELL Gerald n.FLERCHInGER Roy RICH peter B.REICH Department of Geological Sciences The University of Texas at AustinAustin 78712(USA) Bureau of Economic Geology The University of Texas at AustinAustin 78713(USA) Agricultural Research Service United States Department of AgricultureBoise 83712(USA) Smithsonian Environmental Research Center Edgewater 20137(USA) Department of Forest Resources University of MinnesotaSt.Paul 55108(USA) Hawkesbury Institute for the Environment Western Sydney UniversitySydney 2753(Australia)

Free-air carbon dioxide(CO_(2))enrichment(FACE)experiments provide an opportunity to test models of heat and water flow under novel,controlled situations and eventually allow use of these models for hypothesis *** study assesses whether the United States Department of Agriculture SHAW(Simultaneous Heat and Water)numerical model of vertical one-dimensional soil water flow across the soil-plant-atmosphere continuum is able to adequately represent and explain the effects of increasing atmospheric CO_(2) on soil moisture dynamics in temperate *** in a FACE experiment,the Bio COn(Biodiversity,CO_(2),and nitrogen)experiment,in Minnesota,USA,were compared with results of vertical soil moisture *** scenarios represented by different plots were assessed:bare,vegetated with ambient CO_(2),and similarly vegetated with high CO_(2).From the simulations,the bare plot soil was generally the wettest,followed by a drier high-CO_(2) vegetated plot,and the ambient CO_(2) plot was the *** SHAW simulations adequately reproduced the expected behavior and showed that vegetation and atmospheric CO_(2) concentration significantly affected soil moisture *** differences in modeled soil moisture amongst the plots were largely due to transpiration,which was low with high CO_(2).However,the modeled soil moisture only modestly reproduced the ***,while SHAW is able to replicate and help broadly explain soil moisture dynamics in a FACE experiment,its application for point-and time-specific simulations of soil moisture needs further *** typical design of a FACE experiment makes the experimental observations challenging to model with a one-dimensional distributed *** addition,FACE instrumentation and monitoring will need improvement in order to be a useful platform for robust model *** after this can we recommend that models such as SHAW are adequate for process interpretation of datasets from FACE exp

关键词： carbon dioxide FACE experiment soil water flow vadose zone vegetation

Generalized Anxiety and Major Depressive Symptoms of General Public in South Korea during the Early COVID-19 Pandemic

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International Journal of Mental Health Promotion 2021年第3期23卷 303-317页

作者： Kye S.Kim peter M.Kang He Sook n.Kim Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA 02215USA Department of Child&Family Studies Yonsei UniversitySeoul03722South Korea

The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each *** are overall increased mental health concerns in many countries but it is unclear what the general public individuals who do not have heighten vulnerability to stressors for existing mental diseases or significant physical illnesses were experiencing during the *** evaluated the stressors and mental health of general public in South Korea that has a relatively low confirmed cases and *** on the on-line survey questions were used to assess the mental and physical symptoms in association with individuals’reported *** with the symptoms of the generalized anxiety disorder(GAD)were reported in 58.9%,and major depression(MD)in 23.2%,mostly in minimal to mild degrees,cut-off scores of 5 and 10,respectively by the validated screening tools,GAD-7 and *** GAD and MD symptoms were in 21.5%of the *** total number of stress had significant association with the scores of GAD-7,PHQ-9,physical symptoms,sleep difficulties and resilience(pnd raising young children(pn,and educational level(pns of the study include small sample size,usage of smartphone or email,potential under-reporting by stigma in the socio-cultural context and evolving nature of *** conclude that keeping careful watch for mental symptoms,stressors,sleep difficulties and other physical symptoms are important even for the individuals without previous mental illnesses during the pandemic era.

关键词： Generalized anxiety disorder symptoms major depression symptoms sleep difﬁculties physical symptoms pandemic stressors South Korea generalized anxiety disorder-7(GAD-7) patient health questionnaire-9(PHQ-9)

Testis sperm extraction

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Asian Journal of Urology 2015年第2期2卷 79-84页

作者： Kirsten J.C.Janosek-Albright peter n.Schlegel Ali A.Dabaja Department of Urology Vattikuti Urology InstituteHenry Ford HospitalDetroitMIUSA Department of Urology Weill Cornell Medical CollegeNew YorkNYUSA

The last 20 years have produced developments in the treatment for patients with non-obstructive azoospermia(nOA)who were once considered to be *** combination of intracytoplasmic sperm injection together with various testicular sperm retrieval techniques,including conventional testicular sperm extraction(TESE),microdissection TESE(micro-TESE)and fine needle aspiration(FnA),have revolutionized treatment for these *** men with nOA,isolated regions of spermatogenesis within the testis are *** goal for all types of sperm retrieval procedures is locating the focal region(s)of spermatogenesis,and harvesting the sperm for assisted *** review article explores the surgical management of men with nOA and describes all techniques that can be used for testicular sperm retrieval.A PubMed search was conducted using the key words:“sperm extraction”,“nOA”,“testicular FnA”,“testicular mapping”,“TESE”,and“testicular biopsy”.All articles were *** were included if they provided data on sperm retrieval *** methods for performing sperm retrieval rates and outcomes of the various techniques are ***-TESE has a higher sperm retrieval rates with fewer postoperative complications and negative effects on testicular function compared with conventional TESE.

关键词： non-obstructive azoospermia Microdissection testicular sperm extraction Fine needle aspiration Sperm retrieval