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Journal of Clinical and Nursing Research 2023年第4期7卷 45-50页

作者： Xiaoyan Sun Jian Shen Supply Center of Operating Room Jiangsu Province HospitalNanjing 210029Jiangsu ProvinceChina department of anesthesiology and Perioperative Medicine Jiangsu Province HospitalNanjing 210029Jiangsu ProvinceChina

Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.

关键词： WeChat platform PBL teaching method Anesthesiology Department Resident physician Traditional teaching

The superiority and feasibility of 2,3,5-triphenyltetrazolium chloride-stained brain tissues for molecular biology experiments based on microglial properties

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Animal Models and Experimental Medicine 2023年第2期6卷 111-119页

作者： Yajuan Wang Qingrong Zhang Shuchi Zhang Jiangtao Qi Li Li department of anesthesiology Huashan HospitalFudan UniversityShanghaiChina department of anesthesiology Tongji HospitalTongji UniversityShanghaiChina

Background:TTC(2,3,5-triphenyltetrazolium chloride)staining is the most commonly used method in identifying and assessing cerebral infarct volumes in the transient middle cerebral artery occlusion model.Given that microglia exhibit different morphologies in different regions after ischemic stroke,we demonstrate the superiority and necessity of using TTC-stained brain tissue to analyze the expression of various proteins or genes in different regions based on microglia character.Methods:We compared brain tissue(left for 10 min on ice)from the improved TTC staining method with penumbra from the traditional sampling method.We identified the feasibility and necessity of the improved staining method using real time(RT)-PCR,Western blot,and immunofluorescence analysis.Results:There was no protein and RNA degradation in the TTC-stained brain tissue group.However,the TREM2 specifically expressed on the microglia showed a significant difference between two groups in the penumbra region.Conclusions:TTC-stained brain tissue can be used for molecular biology experiments without any restrictions.In addition,TTC-stained brain tissue shows greater superiority due to its precise positioning.

关键词： ischemic brain injury microglia transient middle cerebral artery occlusion TTC staining

Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery:a cohort study

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Chinese Medical Journal 2023年第1期136卷 65-72页

作者： Wei Zhao Caijuan Zhang Dongliang Mu Fan Cui Huiqun Jia department of anesthesiology The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China department of anesthesiology Peking University First HospitalBeijing 100034China department of anesthesiology Tangshan Gongren HospitalTangshanHebei 063000China

Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm,m

关键词： Association Lung neoplasms Muscular tissue oxygenation One-lung ventilation Post-operative complications Pneumonia Propofol Oxygen saturation

Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery:A secondary analysis of a prospective observational study

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Chinese Medical Journal 2023年第19期136卷 2330-2339页

作者： Guojun Wang Shuting He Mengyao Yu Yan Zhang Dongliang Mu Dongxin Wang department of anesthesiology Peking University First HospitalBeijing 100034China department of anesthesiology Peking University Cancer HospitalBeijing 100142China

Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyper

关键词： Hypothermia Hyperthermia Emergence delirium Pain measurement Cognitive dysfunction Non-cardiac surgery Aged Post-anesthesia care unit

Effects of anesthetic depth on postoperative pain and delirium:a meta-analysis of randomized controlled trials with trial sequential analysis

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Chinese Medical Journal 2022年第23期135卷 2805-2814页

作者： Yuqin Long Xiaomei Feng Hong Liu Xisheng Shan Fuhai Ji Ke Peng department of anesthesiology First Affiliated Hospital of Soochow UniversitySuzhouJiangsu 215006China Institute of anesthesiology Soochow UniversitySuzhouJiangsu 215006China department of anesthesiology University of Utah HealthSalt Lake CityUTUSA department of anesthesiology and Pain Medicine University of California Davis HealthSacramentoCA

Background:Whether anesthetic depth affects postoperative outcomes remains controversial.This meta-analysis aimed to evaluate the effects of deepvs.light anesthesia on postoperative pain,cognitive function,recovery from anesthesia,complications,and mortality.Methods:PubMed,EMBASE,and Cochrane CENTRAL databases were searched until January 2022 for randomized controlled trials comparing deep and light anesthesia in adult surgical patients.The co-primary outcomes were postoperative pain and delirium(assessed using the confusion assessment method).We conducted a meta-analysis using a random-effects model.We assessed publication bias using the Begg’s rank correlation test and Egger’s linear regression.We evaluated the evidence using the trial sequential analysis and Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.We conducted subgroup analyses for pain scores at different postoperative time points and delirium according to cardiac or non-cardiac surgery.Results:A total of 26 trials with 10,743 patients were included.Deep anesthesia compared with light anesthesia(a mean difference in bispectral index of-12 to-11)was associated with lower pain scores at rest at 0 to 1 h postoperatively(weighted mean difference=-0.72,95%confidence interval[CI]=-1.25 to-0.18,P=0.009;moderate-quality evidence)and an increased incidence of postoperative delirium(24.95%vs.15.92%;risk ratio=1.57,95%CI=1.28-1.91,P<0.0001;high-quality evidence).No publication bias was detected.For the exploratory secondary outcomes,deep anesthesia was associated with prolonged postoperative recovery,without affecting neurocognitive outcomes,major complications,or mortality.In the subgroup analyses,the deep anesthesia group had lower pain scores at rest and on movement during 24 h postoperatively,without statistically significant subgroup differences,and deep anesthesia was associated with an increased incidence of delirium after non-cardiac and cardiac surgeries,without statistically significant subgroup differences.Conclusion

关键词： Anesthetic depth GRADE level of evidence Postoperative delirium Postoperative pain Trial sequential analysis

MiR-214-3p Prevents the Development of Perioperative Neurocognitive Disorders in Elderly Rats

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Current Medical Science 2022年第4期42卷 871-884页

作者： Yu-hao WANG Yong-wang CHEN Wan-li XIAO Xue-lian LI Lan FENG Yu-lin LIU Xiao-xia DUAN department of anesthesiology the Affiliated Hospital of Southwest Medical UniversityLuzhou 646000China Laboratory of anesthesiology Southwest Medical UniversityLuzhou 646000China department of anesthesiology Southwest Medical UniversityLuzhou 646000China

Objective:This study aimed to identify microRNAs(miRNAs)involved in the development of perioperative neurocognitive disorders(PND).Methods:Plasma exosomal miRNA expression was examined in patients before and after cardiopulmonary bypass(CPB)using microarray and qRT-PCR and these patients were diagnosed as PND later.Elderly rats were subjected to CPB,and the cognitive functions were examined.Bioinformatics analysis was conducted to predict the targets of miR-214-3p.Rats were administered rno-miR-214-3p agomir before or after CPB to investigate the role of miR-214-3p in PND development.Results:We identified 76 differentially expressed plasma exosomal miRNAs in PND patients after surgery(P0.58),including the upregulated hsa-miR-214-3p(P=0.002399392).Prostaglandin-endoperoxide synthase 2(PTGS2)was predicted as a miR-214-3p target.In rats,CPB reduced the platform crossing numbers and target quadrant stay time,accompanied with hippocampal neuronal necrosis.The rno-miR-214-3p level was significantly increased in plasma exosomes but decreased in rat hippocampus after surgery,exhibiting a negative correlation(P<0.001,r=-0.762).A negative correlation between miR-214-3p and PTGS2 protein expression was also observed in the hippocampus after surgery.Importantly,rno-miR-214-3p agomir treatment,before or after surgery,significantly increased the platform crossing numbers(P=0.035)and target quadrant stay time(P=0.029)compared with negative control.Hippocampal PTGS2 protein level was increased in the untreated surgery group and decreased in response to rno-miR-214-3p agomir treatment before or after surgery(both P<0.05 vs.negative control).Conclusion:These data suggest that miR-214-3p/PTGS2 signaling contributes to the development of PND,serving as a potential therapeutic target for PND.

关键词： perioperative neurocognitive disorder sexosome hippocampus miR-214-3p prostaglandin-endoperoxide synthase 2

Silencing miRNA-324-3p protects against cerebral ischemic injury via regulation of the GATA2/A1R axis

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Neural Regeneration Research 2022年第11期17卷 2504-2511页

作者： An-Qi Zhang Lu Wang Yi-Xiu Wang Shan-Shan Hong Yu-Shan Zhong Ru-Yi Yu Xin-Lu Wu Bing-Bing Zhou Qi-Min Yu Hai-Feng Fu Shuang-Dong Chen Yun-Chang Mo Qin-Xue Dai Jun-Lu Wang department of anesthesiology The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina department of anesthesiology Wenzhou Central HospitalWenzhouZhejiang ProvinceChina

Previous studies have suggested that miR-324-3p is related to the pathophysiology of cerebral ischemia,but the mechanism underlying this relationship is unclea r.In this study,we found that miR-324-3p expression was decreased in patients with acute ischemic stroke and in in vitro and in vivo models of ischemic stro ke.miR-324-3p agomir potentiated ischemic brain damage in rats subjected to middle cerebral artery occlusion,as indicated by increased infarct volumes and cell apoptosis rates and greater neurological deficits.In a PC12 cell oxygen-glucose deprivation/reoxygenation model,a miR-324-3 p mimic decreased cell viability and expression of the anti-apoptotic protein BCL2 and increased expression of the pro-apoptotic protein BAX and rates of cell apoptosis,whereas treatment with a miR-324-3p inhibitor had the opposite effects.Silencing miR-324-3p increased adenosine A1 receptor(A1R)expression thro ugh regulation of GATA binding protein 2(GATA2).These findings suggest that silencing miR-324-3p reduces ischemic brain damage via the GATA2/A1R axis.

关键词： acute ischemic stroke adenosine A1 receptor apoptosis cerebral ischemia-reperfusion injury cortical neurons GATA2 middle cerebral artery occlusion miR-324-3p oxygen-glucose deprivation/reoxygenation PC12 cells

High-frequency spinal cord stimulation produces longlasting analgesic effects by restoring lysosomal function and autophagic flux in the spinal dorsal horn

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Neural Regeneration Research 2022年第2期17卷 370-377页

作者： Zhi-Bin Wang Yong-Da Liu Shuo Wang Ping Zhao department of anesthesiology and Pain Management Shengjing Hospital of China Medical UniversityShenyangLiaoning ProvinceChina department of anesthesiology Zhongshan HospitalFudan UniversityShanghaiChina

High-frequency spinal cord stimulation(HF-SCS) has been established as an effective therapy for neuropathic pain. However, the analgesic mechanisms involved in HF-SCS remain to be clarified. In our study, adult rat neuropathic pain was induced by spinal nerve ligation. Two days after modeling, the rats were subjected to 4 hours of HF-SCS(motor threshold 50%, frequency 10,000 Hz, and pulse width 0.024 ms) in the dorsal horn of the spinal cord. The results revealed that the tactile allodynia of spinal nerve-injured rats was markedly alleviated by HFSCS, and the effects were sustained for 3 hours after the stimulation had ceased. HF-SCS restored lysosomal function, increased the levels of lysosome-associated membrane protein 2(LAMP2) and the mature form of cathepsin D(matu-CTSD), and alleviated the abnormally elevated levels of microtubule-associated protein 1 A/B-light chain 3(LC3)-II and sequestosome 1(P62) in spinal nerve-injured rats. HF-SCS also mostly restored the immunoreactivity of LAMP2, which was localized in neurons in the superficial layers of the spinal dorsal horn in spinal nerve-injured rats. In addition, intraperitoneal administration of 15 mg/kg chloroquine for 60 minutes reversed the expression of the aforementioned proteins and shortened the timing of the analgesic effects of HF-SCS. These findings suggest that HF-SCS may exhibit longlasting analgesic effects on neuropathic pain in rats through improving lysosomal dysfunction and alleviating autophagic flux. This study was approved by the Laboratory Animal Ethics Committee of China Medical University, Shenyang, China(approval No. 2017 PS196 K) on March 1, 2017.

关键词： autolysosome dorsal horn of spinal cord dysfunction electrical stimulation high-frequency spinal cord stimulation neuropathic pain spinal nerve ligation

Transcutaneous Electrical Acupoint Stimulation Improves Postoperative Cognitive Function in Senior Patients Undergoing Video-Assisted Thoracoscopic Surgery:A Randomized Controlled Trial

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Chinese Journal of Integrative Medicine 2022年第8期28卷 730-735页

作者： WEI Hua HUANG Jun-sheng ZHAO Fang XIE Zhi-qiang XIA Zhi-yang GAN Jian-hui department of anesthesiology Tangshan People’s HospitalTangshanHebei Province063000China department of anesthesiology Tangshan Central HospitalTangshanHebei Province063000China

Objective:To evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation(TEAS)for improving postoperative cognitive function in senior patients undergoing video-assisted thoracoscopic surgical(VATS).Methods:From January to December 2020,97 participants were randomly assigned to the TEAS group(49 cases)and the control group(48 cases)by a random number table.The patients in the TEAS group received TEAS,at the bilateral Neiguan(PC 6)and Zusanli(ST 36)acupoints.The control group received sham TEAS.The stimulation was started from 30 min before surgery until the end of the operation.The primary outcome was the incidence of pstoperative cognitive dysfunction(POCD),diagnosed based on the changes in the Mini-Mental Status Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scores.The secondary outcomes were plasma levels of S100β protein and neuron-specific enolase(NSE).Results:The incidence of POCD on day 1 and 3 after surgery in the TEAS group was significantly lower than that in the control group[day 1 after surgery:28.3%(13/46)vs.52.3%(23/44),P=0.028;day 3 after surgery:21.7%(10/46)vs.40.9%(18/44),P=0.043].Compared with baseline,the MMSE and MoCA scores decreased to various extents in both groups.The MMSE scores on day 1,3,and 5 after surgery and MoCA scores on day 1,3,5,and 7 after surgery in the TEAS group were higher than those in the control group(all P<0.05)in both groups.Compared with baseline,the plasma levels of S100β and NSE were significantly increased at 4,8,12,24 h after surgery(all P<0.05).Compared with the control group,the plasma levels of S100β and NSE were lower in the TEAS group at 4,8,12,and 24 h after surgery(all P<0.05).No obvious adverse events were found during the trial.Conclusion:Application of TEAS in senior patients after VATS could reduce incidence of POCD and improve postoperative cognitive function.

关键词： transcutaneous electrical acupoint stimulation video-assisted thoracic surgery senior postoperative cognitive dysfunction

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

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Chinese Medical Journal 2023年第1期136卷 88-95页

作者： Yin Zhou Zhiyu Geng Linlin Song Dongxin Wang department of anesthesiology Peking University First HospitalBeijing 100034 China

Background:No convincing modalities have been shown to completely prevent postdural puncture headache(PDPH)after accidental dural puncture(ADP)during obstetric epidural procedures.We aimed to evaluate the role of epidural administration of hydroxyethyl starch(HES)in preventing PDPH following ADP,regarding the prophylactic efficacy and side effects.Methods:Between January 2019 and February 2021,patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital.The development of PDPH,severity and duration of headache,adverse events associated with prophylactic strategies,and hospital length of stay postpartum were reported.Results:A total of 105 patients experiencing ADP received a re-sited epidural catheter.For PDPH prophylaxis,46 patients solely received epidural analgesia,25 patients were administered epidural HES on epidural analgesia,and 34 patients received two doses of epidural HES on and after epidural analgesia,respectively.A significant difference was observed in the incidence of PDPH across the groups(epidural analgesia alone,31[67.4%];HES-Epidural analgesia,ten[40.0%];HES-Epidural analgesia-HES,five[14.7%];P<0.001).No neurologic deficits,including paresthesias and motor deficits related to prophylactic strategies,were reported from at least 2 months to up to more than 2 years after delivery.An overall backache rate related to HES administration was 10%.The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP(OR=0.030,95%confidence interval:0.006-0.143;P<0.001).Conclusions:The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP.This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES,respectively,on and after epidural analgesi

关键词： Accidental dural puncture Epidural analgesia Hydroxyethyl starch Postdural puncture headache Prophylaxis