麻醉药物对组织细胞线粒体质量影响的研究进展

近年来,临床常用麻醉药物通过影响线粒体质量进而影响整体生理状态的研究受到广泛关注。常用麻醉药物可以通过改变线粒体的形态与动力、功能与代谢以及线粒体蛋白表达等多种方式影响组织细胞的线粒体质量,直接或间接地影响围术期患者的临床结局。这种影响既有可能带来保护作用,也可能造成损伤,取决于药物种类、剂量、应用时间以及患者的状态等多种因素。本综述系统回顾了静脉麻醉药物、吸入麻醉药物、镇痛药物、局部麻醉药物等不同类型麻醉药物对组织细胞线粒体质量的影响及其潜在机制,为选择更安全的麻醉方案、减少术后并发症、优化术后恢复、制定新的治疗策略和优化围术期管理提供帮助。

Central environmental protection inspection and carbon emission reduction: A tripartite evolutionary game model from the perspective of carbon neutrality

Since the carbon neutrality target was proposed,many countries have been facing severe challenges to carbon emission reduction sustainably.This study is conducted using a tripartite evolutionary game model to explore the impact of the central environmental protection inspection(CEPI)on driving carbon emission reduction,and to study what factors influence the strategic choices of each party and how they interact with each other.The research results suggest that local governments and manufacturing enterprises would choose strategies that are beneficial to carbon reduction when CEPI increases.When the initial willingness of all parties increases 20%,50%—80%,the time spent for the whole system to achieve stability decreases from 100%,60%—30%.The evolutionary result of“thorough inspection,regulation implementation,low-carbon management”is the best strategy for the tripartite evolutionary game.Moreover,the smaller the cost and the larger the benefit,the greater the likelihood of the three-party game stability strategy appears.This study has important guiding significance for other developing countries to promote carbon emission reduction by environmental policy.

血管外肺水联合中心静脉-动脉二氧化碳分压差在脓毒性休克早期目标导向性治疗中的应用研究

目的:探讨动态监测血管外肺水(extravascular lung water,EVLW)联合中心静脉-动脉二氧化碳分压差(central venousarterial difference of CO2partial pressure,P(cv-a)CO2)在脓毒性休克早期目标导向性治疗中的意义。方法:选择2015至2018年重庆医科大学附属二院和重庆市中医院ICU入住的脓毒性休克患者80例,采用随机分组的原则将患者分为早期目标导向治疗组(EGDT组)和EVLW联合P(cv-a)CO2目标导向组(EP组)。EGDT组按照常规方案进行液体复苏,EP组在脉搏指数连续心排量监测技术(pulse-induced contour cardiac output,Pi CCO)监测下行液体复苏。比较2组复苏6 h达标率、复苏液体量、去甲肾上腺素用量、每小时公斤体质量尿量、乳酸清除率、P(cv-a)CO2、EVLW及28 d病死率。结果:EP组每小时公斤体质量尿量和乳酸清除率均明显高于EGDT组(P<0.05);复苏6 h液体量、CVP、血管活性药物用量、P(cv-a)CO2、EVLW和28 d病死率均明显低于EGDT组(P<0.05);2组间复苏6 h达标率、MAP、Scv O2无统计学差异(P>0.05)。结论:EVLE联合P(cv-a)CO2指导脓毒性休克早期目标导向性治疗,能尽早且更准确地判断脓毒性休克患者的组织灌注状态和容量负荷状态,指导合理的液体复苏治疗,降低患者病死率。

感染性心内膜炎合并室壁瘤的二尖瓣置换术麻醉管理1例

感染性心内膜炎(infective endocarditis,IE)可造成心脏瓣膜严重损害,导致患者心、肺等重要脏器功能障碍,甚至死亡[1]。二尖瓣前叶收缩期前向运动(systolic anterior motion,SAM)会造成左心室流出道狭窄,甚至梗阻,使心脏的泵血功能受损[2]。感染性心内膜炎患者同时存在二尖瓣重度反流、室壁瘤、SAM的情况较为罕见,且相关的麻醉管理鲜有报道。重庆医科大学附属第二医院收治了1例感染性心内膜炎合并左室室壁瘤患者,于术中监测到SAM,在成功实施二尖瓣置换术后患者康复出院,现将其麻醉管理情况报告如下。

Stretchable on-skin touchless screen sensor enabled by ionic hydrogel

Screen sensors are the most commonly used human-machine interfaces in our everyday life,which have been extensively applied in personal electronics like cellphones.Touchless screen sensors are attracting growing interest due to their distinct advantages of high interaction freedom,comfortability,and hand hygiene.However,the material compositions of current touchless screen sensors are rigid and fragile,hardly meeting the needs of wearable and stretchable on-skin electronics development.Additionally,these touchless screen sensors are also restricted by high power consumption,limited gesture types of recognition,and the requirement of light conditions.Here,we report a stretchable on-skin touchless screen sensor(OTSS)enabled by an ionic hydrogel-based triboelectric nanogenerator(TENG).Compared with current touchless screen sensors,the OTSS is stretchable,self-powered,and competent to recognize diverse gestures by making use of charges naturally carried on fingers without the need of sufficient light conditions.An on-skin noncontact screen operating system is further demonstrated on the basis of the OTSS,which could unlock a cellphone interface in touchless operation mode on the human skin.This work for the first time introduces the on-skin touchless concept to screen sensors and offers a direction to develop new-generation screen sensors for future cellphones and personal electronics.

Genuinely Multidimensional Physical-Constraints-Preserving FiniteVolume Schemes for the Special Relativistic Hydrodynamics

This paper develops the genuinely multidimensional HLL Riemann solver for the two-dimensional special relativistic hydrodynamic equations on Cartesian meshes and studies its physical-constraint-preserving(PCP)property.Based on the resulting HLL solver,the first-and high-order accurate PCP finite volume schemes are proposed.In the high-order scheme,the WENO reconstruction,the third-order accurate strong-stability-preserving time discretizations and the PCP flux limiter are used.Several numerical results are given to demonstrate the accuracy,performance and resolution of the shock waves and the genuinely multi-dimensional wave structures etc.of our PCP finite volume schemes.

脾脏酪氨酸激酶促进肝肺综合征大鼠肺血管新生

本研究旨在研究脾脏酪氨酸激酶(spleen tyrosine kinase,Syk)在肝肺综合征(hepatopulmonary syndrome,HPS)血管新生过程中的作用及其机制。Sprague Dawley(SD)大鼠随机分为3组:假手术组(Sham组)、胆总管结扎(common bile duct ligation,CBDL)5周组(5W组)和R788药物干预组(R788组),通过CBDL术进行HPS造模,R788组大鼠在CBDL术后每日腹腔注射1次R788(20 mg/kg)至第5周。用Western blot和免疫组织化学法检测Syk、p-Erk1/2、p-Akt在肺组织中的表达和分布情况,用免疫荧光染色法观察Syk在肺中的定位和肺组织血管新生数目。结果显示,相对Sham组,5W组大鼠Syk蛋白表达水平显著上调,Erk1/2和Akt磷酸化水平显著上调,肺微血管数量显著增加;相对5W组,R788组大鼠Syk蛋白表达水平显著下调,Erk1/2和Akt磷酸化水平显著下调,肺微血管数量显著减少。以上结果表明,Syk可能通过激活下游Erk1/2和Akt信号转导通路促进HPS模型大鼠肺内血管新生,这为HPS的临床治疗提供了理论依据和潜在药物治疗靶点。