Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery

BACKGROUND A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact,general anesthesia can easily induce complications such as cognitive dysfunction,which is not conducive to postoperative recovery.AIM To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery.METHODS A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group(49 cases) and observation group(49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation.The postoperative recovery and adverse events of the two groups were statistically analyzed.RESULTS Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h(P < 0.05);the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation(P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation(P < 0.05).The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation(P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group(P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade Ⅱ muscle strength, recovery time of grade Ⅲ muscle strength and hospitalization time in the observation group were shorter than those in the control group(P < 0.05).CONCLUSION Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body’s inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.

Pediatric living donor liver transplantation decade progress in Shanghai:Characteristics and risks factors of mortality

BACKGROUND Pediatric living donor liver transplantation(LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, and surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.AIM To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.METHODS We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.RESULTS The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%,and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period(74.47% vs 90.74%;hazard ratio: 2.92;95% confidence interval(CI): 2.16–14.14;P = 0.0004). Median duration of mechanical ventilation in the intensive care unit(ICU) was 18 h [interquartile range(IQR), 15.25–20.25], median ICU length of stay was 6 d(IQR:4.80–9.00), and median postoperative length of stay was 24 d(IQR: 18.00–34.00).Forty-seven(8.60%) of 544 patients did not receive red blood cell transfusion during the operation.CONCLUSION Pediatric end-stage liver disease score, anesthesia duration, operation duration,intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score,operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.

Effect of remote ischemic preconditioning among donors and recipients following pediatric liver transplantation:A randomized clinical trial

BACKGROUND Studies suggested that remote ischemic preconditioning(RIPC)may effectively lessen the harmful effects of ischemia reperfusion injury during organ transplantation surgery.AIM To investigate the protective effects of RIPC on living liver donors and recipients following pediatric liver transplantation.METHODS From January 2016 to January 2019 at Renji Hospital Affiliated with Shanghai Jiao Tong University School of Medicine,208 donors were recruited and randomly assigned to four groups:S-RIPC group(no intervention;n=55),D-RIPC group(donors received RIPC;n=51),R-RIPC group(recipients received RIPC,n=51)and DR-RIPC group(both donors and recipients received RIPC;n=51).We primarily evaluated postoperative liver function among donors and recipients and incidences of early allograft dysfunction,primary nonfunction and postoperative complications among recipients.RESULTS RIPC did not significantly improve alanine transaminase and aspartate aminotransferase levels among donors and recipients or decrease the incidences of early allograft dysfunction,primary nonfunction,and postoperative complications among recipients.Limited protective effects were observed,including a lower creatinine level in the D-RIPC group than in the S-RIPC group on postoperative day 0(P<0.05).However,no significant improvements were found in donors who received RIPC.Furthermore,RIPC had no effects on the overall survival of recipients.CONCLUSION The protective effects of RIPC were limited for recipients who received living liver transplantation,and no significant improvement of the prognosis was observed in recipients.

Calibration of X-ray telescope prototypes at PANTER

We report on a ground X-ray calibration of two X-ray telescope prototypes at the PANTER X-ray Test Facility, operated by the Max-Planck-Institute for Extraterrestrial Physics, in Neuried, Germany.The X-ray telescope prototypes were developed by the Institute of Precision Optical Engineering(IPOE)of Tongji University, in a conical Wolter-I configuration, using thermal glass slumping technology.Prototype #1 with three layers and Prototype #2 with 21 layers were tested to assess the prototypes’ onaxis imaging performance. The measurement of Prototype #1 indicates a Half Power Diameter(HPD) of 82′′ at 1.49 keV. As for Prototype #2, we performed more comprehensive measurements of on-axis angular resolution and effective area at several energies ranging from 0.5–10 keV. The HPD and effective area are111′′ and 39 cm^2 at 1.49 keV, respectively, at which energy the on-axis performance of the prototypes is our greatest concern.

Association of different central venous pressure levels with outcome of living-donor liver transplantation in children under 12 years

Background Pediatric liver transplantation is an important modality for treating biliary atresia.The overall survival(OS)rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago,but it is still unsatisfactory.The anesthesia strategy of maintaining low central venous pressure(CVP)has shown a positive effect on prognosis in adult liver transplantation.However,this relationship remains unclear in pediatric liver transplantation.Thus,this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of recipients.Methods This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure:low CVP(LCVP)(≤10 cmH2O,n=470)and high CVP(HCVP)(>10 cmH2O,n=242).The primary outcome measured in the study was the overall survival rate.The secondary outcomes included the duration of mechanical ventilation in the intensive care unit(ICU),length of stay in the ICU,and postoperative stay in the hospital.Patient demographic and perioperative data were collected and compared between the two groups.Kaplan-Meier curves were constructed to determine the associations of different CVP levels with the survival rate.Results In the study,712 patients,including 470 in the LCVP group and 242 in the HCVP group,were enrolled.After propensity score matching,212 pairs remained in the group.The LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses(P=0.018),and the HCVP group had a hazard ratio of 2.445(95%confidence interval,1.163–5.140).Conclusion This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay.

Supramolecular Radical Switches Regulated by Host-Guest Chemistry

Water-soluble thermal initiators are important radical sources to be applied in various fields.However,the uncontrolled radical generation from the high sensitivity of initiators may cause disadvantages in the applications.Here,we present a series of supramolecular radical switches regulated by the host-guest chemistry between initiators and cucurbit[8]uril(CB[8]).Thermal initiators(VA-044,VA-056,VA-057)can be spontaneously encapsulated into the cavity of CB[8]to“turn off”their radical-generation ability.Their activity will instantaneously“turn on”in the presence of other competitors such as 1-adamantylamine(ADA).Further,we demonstrated the free radical polymerization of N-isopropylacrylamide using initiators,inhibiting its activity by binding with CB[8]and initiating reaction by adding ADA.These novel supramolecular radical switches provide a facile strategy to control the generation of free radicals in a“plug-and-play”manner,which may arouse research interests in polymerization,catalysis,and the biomedical field.

经自然腔道取标本手术(NOSES)治疗胃癌的国际共识(2019)

At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.