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The Journal of Biomedical Research 2024年第1期38卷 66-75页

作者： Mingfeng He Chanjuan Gong Yinan Chen Rongting Chen Yanning Qian Department of anesthesiology and perioperative medicine the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

关键词： remimazolam propofol elderly patients hypotension left ventricular systolic function systematic vascular resistance

Lactate:a prospective target for therapeutic intervention in psychiatric disease

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Neural Regeneration Research 2024年第7期19卷 1473-1479页

作者： Yanhui Cai Haiyun Guo Tianle Han Huaning Wang Department of Psychiatry Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina Department of anesthesiology and perioperative medicine Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina

Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.

关键词： antidepressant anxiety bipolar disorder depression lactate psychiatric disease psychopharmacology schizophrenia signal molecular therapeutics

Neuroprotective effects of chaperone-mediated autophagy in neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1291-1298页

作者： Qi Jia Jin Li Xiaofeng Guo Yi Li You Wu Yuliang Peng Zongping Fang Xijing Zhang Department of anesthesiology and perioperative medicine and Department of Intensive Care Unit Xijing Hospital The Fourth Military Medical University Department of Critical Care medicine Translational Research Institute of Brain and Brain-Like Intelligence Shanghai Fourth People's Hospital School of Medicine Tongji University

Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins. Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis, while providing nutrients and support for cell survival. Chaperone-mediated autophagy activity can be detected in almost all cells, including neurons. Owing to the extreme sensitivity of neurons to their environmental changes, maintaining neuronal homeostasis is critical for neuronal growth and survival. Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases. It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction. Under certain conditions, regulation of chaperone-mediated autophagy activity attenuates neurotoxicity. In this paper, we review the changes in chaperone-mediated autophagy in neurodegenerative diseases, brain injury, glioma, and autoimmune diseases. We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.

关键词： chaperone-mediated autophagy neurodegenerative disease neuronal homeostasis neuroprotection

Effects of sevoflurane on left ventricular function by speckletracking echocardiography in coronary bypass patients: A randomized trial

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The Journal of Biomedical Research 2024年第1期38卷 76-86页

作者： Chanjuan Gong Xiaokai Zhou Yin Fang Yanjuan Zhang Linjia Zhu Zhengnian Ding Department of anesthesiology and perioperative medicine the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China Department of Cardiology the First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China.

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.

关键词： coronary artery bypass grafting speckle-tracking echocardiography sevoflurane transesophageal echocardiography

Latest assessment methods for mitochondrial homeostasis in cognitive diseases

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Neural Regeneration Research 2024年第4期19卷 754-768页

作者： Wei You Yue Li Kaixi Liu Xinning Mi Yitong Li Xiangyang Guo Zhengqian Li Department of anesthesiology Peking University Third Hospital Peking University Third Clinical Medical College Beijing Center of Quality Control and Improvement on Clinical Anesthesia Anesthesia and perioperative medicine Branch of China International Exchange and Promotive Association for Medical and Health Care(CPAM)

Mitochondria play an essential role in neural function,such as supporting normal energy metabolism,regulating reactive oxygen species,buffering physiological calcium loads,and maintaining the balance of morphology,subcellular distribution,and overall health through mitochondrial dynamics.Given the recent technological advances in the assessment of mitochondrial structure and functions,mitochondrial dysfunction has been regarded as the early and key pathophysiological mechanism of cognitive disorders such as Alzheimer’s disease,Parkinson’s disease,Huntington’s disease,mild cognitive impairment,and postoperative cognitive dysfunction.This review will focus on the recent advances in mitochondrial medicine and research methodology in the field of cognitive sciences,from the perspectives of energy metabolism,oxidative stress,calcium homeostasis,and mitochondrial dynamics(including fission-fusion,transport,and mitophagy).

关键词： cognitive disorders mitochondrial dysfunction mitochondrial energy metabolism mitochondrial dynamics mitochondrial transport mitophagy mitochondrial biogenesis oxidative stress calcium homeostasis

Inhaled volatile anesthetics in the intensive care unit

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World Journal of Critical Care medicine 2024年第1期13卷 28-39页

作者： Erin D Wieruszewski Mariam ElSaban Patrick M Wieruszewski Nathan J Smischney Department of Pharmacy Mayo ClinicRochesterMN 55905United States anesthesiology and perioperative medicine Mayo ClinicRochesterMN 55905United States Department of anesthesiology&perioperative medicine Mayo ClinicRochesterMN 55905United States

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century.Recently,a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres,finding diverse applications in intensive care settings.In the dynamic landscape of intensive care,volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements,managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus,conditions of high sedative requirements including burns,high opioid or alcohol use and neurological conditions such as status epilepticus.Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry,providing intensivists with multiple options to tailor therapy.Furthermore,their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy,mitigating risks associated with conventional sedation modalities.Despite the amounting enthusiasm for the use of these therapies,barriers to widespread utilization include expanding equipment availability,staff familiarity and training of safe use.This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology,administration considerations in intensive care settings,complication considerations,and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

关键词： Anesthesia Critical care Mechanical ventilation Sedation Volatile anesthetics Sedative

Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty:a prospective,double-blind,pilot,randomised controlled trial

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General Psychiatry 2024年第2期37卷 224-233页

作者： Jie Yang Mingshu Tao Rongguang Liu Jiaxing Fang Chunyan Li Dexian Chen Qi Wei Xingyu Xiong Wenxin Zhao Wen Tan Yuan Han Hongxing Zhang He Liu Song Zhang Junli Cao Department of anesthesiology The Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina Department of anesthesiology Hospital of Chengdu University of Traditional Chinese Medicine&Traditional Chinese Medicine Hospital of Sichuan ProvinceChengduSichuanChina NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs&Jiangsu Province Key Laboratory of anesthesiology&Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia Xuzhou Medical UniversityXuzhouJiangsuChina Department of anesthesiology Eye&ENT Hospital of Fudan UniversityShanghaiChina Department of anesthesiology&Clinical Research Center for Anesthesia and perioperative medicine&Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University||Huzhou Central Hospital||The Affiliated Huzhou HospitalZhejiang University School of Medicine||Affiliated Central Hospital Huzhou UniversityHuzhouZhejiangChina Department of anesthesiology Renji Hospital School of MedicineShanghai Jiao Tong UniversityShanghaiChina

Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.

关键词： sleep stimulation postoperative

General anesthetic agents induce neurotoxicity through astrocytes

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Neural Regeneration Research 2024年第6期19卷 1299-1307页

作者： Yanchang Yang Tiantian Liu Jun Li Dandan Yan Yuhan Hu Pin Wu Fuquan Fang Patrick M.McQuillan Wenxin Hang Jianhang Leng Zhiyong Hu Department of anesthesiology The First Affiliated Hospital Zhejiang University School of Medicine Department of anesthesiology Ningbo Women and Children's Hospital 3. Department of Anesthesiology Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College 4. Cell Biology Department Yale University 5. Department of Anesthesiology Penn State Hershey Medical Centre Penn State College of Medicine 6. Department of Central Laboratory Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine

Neuroscientists have recognized the importance of astrocytes in regulating neurological function and their influence on the release of glial transmitters. Few studies, however, have focused on the effects of general anesthetic agents on neuroglia or astrocytes. Astrocytes can also be an important target of general anesthetic agents as they exert not only sedative, analgesic, and amnesic effects but also mediate general anesthetic-induced neurotoxicity and postoperative cognitive dysfunction. Here, we analyzed recent advances in understanding the mechanism of general anesthetic agents on astrocytes, and found that exposure to general anesthetic agents will destroy the morphology and proliferation of astrocytes, in addition to acting on the receptors on their surface, which not only affect Ca2+signaling, inhibit the release of brain-derived neurotrophic factor and lactate from astrocytes, but are even involved in the regulation of the pro-and anti-inflammatory processes of astrocytes. These would obviously affect the communication between astrocytes as well as between astrocytes and neighboring neurons, other neuroglia, and vascular cells. In this review, we summarize how general anesthetic agents act on neurons via astrocytes, and explore potential mechanisms of action of general anesthetic agents on the nervous system. We hope that this review will provide a new direction for mitigating the neurotoxicity of general anesthetic agents.

关键词： astrocytes brain-derived neurotrophic factor general anesthetic agents neuron neurotoxicity N-methyl-D-aspartate receptor perioperative neurocognition Toll-like receptor γ-aminobutyric acid receptor

Complementary and alternative medicine on cognitive defects and neuroinflammation after sepsis

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Journal of Traditional Chinese medicine 2024年第2期44卷 408-416页

作者： LI Zhenxuan WANG Xuerui Luis Ulloa Ayman Youssef BAI Yunjing XU Xiaolong LIU Qingquan Department of Infectious Diseases Beijing Hospital of Traditional Chinese MedicineCapital Medical UniversityBeijing 100010China Beijing Key Laboratory of Basic Research with Traditional Chinese medicine on Infectious Diseases Beijing 100010China Infection immunity laboratory Beijing Institute of Traditional Chinese MedicineBeijing 100010China Clinical College of Traditional Chinese medicine Capital Medical UniversityBeijing 100069China Center for perioperative Organ Protection Department of AnesthesiologyDuke University Medical CenterDurhamNorth Carolina 27710USA

Sepsis-associated encephalopathy(SAE)is a common manifestation of sepsis,ranging from mild confusion and delirium to severe cognitive impairment and deep coma.SAE is associated with higher mortality and long-term outcomes,particularly substantial declines in cognitive function.The mechanisms of SAE probably include neuroinflammation that is mediated by systemic inflammation and ischemic lesions in the brain,a disrupted blood–brain barrier,oxidative stress,neurotransmitter dysfunction,and severe microglial activation.Increasing evidence suggests that complementary and alternative medicine,especially Traditional Chinese medicine(TCM),is favorable in alleviating cognitive decline after sepsis.Here,we summarized the studies of traditional herbal remedies,TCM formulas and acupuncture therapy in animal models of neurological dysfunctions after sepsis in recent decades and reviewed their potential mechanisms.

关键词： sepsis-associated encephalopathy cognitive dysfunction complementary therapies neuroinflammatory diseases medicine Chinese traditional review

Status of biomarker development for frontotemporal dementia and amyotrophic lateral sclerosis

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Neural Regeneration Research 2024年第10期19卷 2117-2118页

作者： Yue Yang Qi Cheng Jianqun Gao Woojin Scott Kim Brain and Mind Centre&School of Medical Sciences The University of SydneySydneyNSWAustralia Department of Neurology and Neurophysiology Liverpool HospitalSydneyNSWAustralia Stroke and Neurology Research Group Ingham Institute for Applied Medical ResearchSydneyNSWAustralia Shanghai Key Laboratory of anesthesiology and Brain Functional Modulation ShanghaiChina Clinical Research Center for anesthesiology and perioperative medicine ShanghaiChina Translational Research Institute of Brain and Brain-Like Intelligence Shanghai Fourth People’s HospitalSchool of MedicineTongji UniversityShanghaiChina

Frontotemporal dementia(FTD) and amyotrophic lateral sclerosis(ALS) are neurodegenerative diseases that belong to the same disease spectrum,with overlapping of genetic and pathological features.Genetic mutations in TA... 详细信息

关键词： amyotrophic sclerosis diseases