Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.

Ghrelin improves delayed gastrointestinal transit in alloxan-induced diabetic mice

AIM: To investigate the effects of ghrelin on delayed gastrointestinal transit in alloxan-induced diabetic mice. METHODS: A diabetic mouse model was established by intraperitoneal injection with alloxan. Mice were randomized into two main groups: normal mice group and diabetic mice group treated with ghrelin at doses of 0, 20, 50, 100 and 200 μg/kg ip. Gastric emptying (GE), intestinal transit (IT), and colonic transit (CT) were studied in mice after they had a phenol red meal following injection of ghrelin. Based on the most effective ghrelin dosage, atropine was given at 1 mg/kg 15 min before the ghrelin injection for each measurement. The mice in each group were sacrificed 20 min later and their stomachs, intestines, and colons were harvested immediately. The amount of phenol red was measured. Percentages of GE, IT, and CT were calculated. RESULTS: Percentages of GE, IT, and CT were significantly decreased in diabetic mice as compared to control mice (22.9 ± 1.4 vs 28.1 ± 1.3, 33.5 ± 1.2 vs 43.2 ± 1.9, 29.5 ± 1.9 vs 36.3 ± 1.6, P < 0.05). In the diabetic mice, ghrelin improved both GE and IT, but not CT. The most effective dose of ghrelin was 100 μg/kg and atropine blocked the prokinetic effects of ghrelin on GE and IT.CONCLUSION: Ghrelin accelerates delayed GE and IT but has no effect on CT in diabetic mice. Ghrelin may exert its prokinetic effects via the cholinergic pathway in the enteric nervous system, and therefore has therapeutic potential for diabetic patients with delayed upper gastrointestinal transit.

增殖性糖尿病视网膜病变玻璃体切割术后高眼压的研究

目的:探讨增殖性糖尿病视网膜病变玻璃体切割术后高眼压发生率及相关因素。方法:选取2014-02/2016-02收治的110例160眼的PDR患者进行回顾性分析,统计术后不同分期PDR患者视力改善情况、高眼压发生率,分析手术引发高眼压的危险因素。结果:Ⅳ期、Ⅴ期、Ⅵ期PDR患者术后视力改善情况比较,差异有统计学意义(P<0.01)。共发生47眼高眼压,其中术后1～2mo发生7眼、3～4mo发生12眼、5～6mo发生13眼、7～8mo发生7眼、9～10mo发生5眼、11～12mo发生3眼,总发生率29.4%。患者21眼(44.7%)经常规药物治疗后,眼压得到有效控制。6眼(12.8%)再做虹膜周边切除术重塑前后房交通后眼压恢复正常。7眼(14.9%)患者放出部分气体,眼压恢复正常;6眼(12.8%)患者取出部分硅油眼压恢复正常。7眼(14.9%)患者行手术切除术配合局部糖皮质激素,眼压恢复正常。术前PDR分期、术前是否合并视网膜脱离、术中是否联合晶状体切除、术中是否眼内填充、术中是否行全视网膜光凝因素与术后高眼压发生有关(P<0.05)。经多因素Logistic回归分析,术前合并视网膜脱离及术中眼内填充是引起玻璃体切割术后高眼压的独立危险因素(P<0.05)。结论:合并视网膜脱离、术中联合晶状体切除、术中眼内充填、术中行全视网膜光凝与DR玻璃体切割术后高眼压相关,其中术中联合晶状体切除、术中眼内填充与PDR分期是独立危险因素。临床应结合患者实际情况给予标准化、个性化预防措施,竭力降低术后高眼压。

Apoptosis of human gastric carcinoma cells induced by Euphorbia esula latex

AIM: To investigate the effect of Euphorbia esula(E. esula) extract in inhibiting proliferation and inducing apoptosis in SGC-7901 cells.METHODS: E. esula extract at different concentrations was used to inhibit proliferation and induce apoptosis of human gastric carcinoma SGC-7901 cells. Inhibition of proliferation was detected with thiazolyl blue assay, and apoptosis was detected with fluorescence microscopy, transmission electron microscopy, and flow cytometry. The mechanisms were studied by measurement of caspase-3 and caspase-8 activities and Bax and Bcl2 m RNA expression.RESULTS: The thiazolyl blue assay showed that SGC-7901 cell viability and proliferation were inhibited significantly by E. esula extract in a timeand concentration-dependent manner. Fluorescence microscopy revealed that the cell nuclei showed the characteristic changes of apoptosis, such as uneven staining and chromatin marginalization. Some key features of apoptosis were also observed undertransmission electron microscopy, which included cellular shrinkage and the foaming or bubbling phenomenon. When the cells were analyzed by flow cytometry, a sub-G1 peak could be seen clearly. Spectrophotometric assay of caspase-3 and caspase-8 activities in the treated cells showed an approximately two-fold increase. Reverse transcriptase polymerase chain reaction showed that Bax m RNA expression was upregulated, while Bcl2 m RNA expression was downregulated.CONCLUSION: E. esula extract inhibited proliferation and induced apoptosis in SGC-7901 cells, in a caspasedependent manner, involving upregulation of Bax and downregulation of Bcl2.

Anorectal functional outcome after repeated transanal endoscopic microsurgery

AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients at postoperative month 6 （χ2 = 0.141, P = 0.707）. Endo- sonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary inconti- nence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm （1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000） at postoperative month 3 and increased to 1.8 ± 0.5 mm （1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239） at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm （3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510） at month 3 and then increased to 3.6 ± 0.4 mm （3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123） at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 pa- tients. With regard to the QoL, the physical and mental health status scores （SF-36） were 56.1 and 46.2 （50 in the general population）, respectively.CONCLUSION： The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.

玻璃体腔注射雷珠单抗联合全视网膜光凝术后行小梁切除术治疗新生血管性青光眼

目的:评价玻璃体腔注射(IVR)雷珠单抗联合全视网膜光凝(PRP)术后行传统小梁切除手术治疗新生血管性青光眼的有效性及安全性。方法:回顾性分析2015/08~2018/11在我院收治的27例27眼新生血管性青光眼(NVG)患者的病例资料。所有患眼均在接受IVR联合PRP治疗后,再行传统小梁切除手术。主要观察指标为眼压(IOP)控制情况、最佳矫正视力(BCVA)变化以及手术并发症。结果:术后随访时间至少18(平均21.7±4.3)mo。末次随访时,平均IOP由治疗前的45.7±5.1mmHg下降至18.4±3.6mmHg,BCVA(LogMAR)由治疗前2.42±0.68提高至1.77±0.93。术后3mo至末次随访,周边虹膜前粘连(PAS)≤50%的患眼手术成功率高于PAS>50%的患眼。主要的并发症包括术后早期发生的前房积血(11.1%)、低眼压伴浅前房(14.8%),以及术后中、晚期发生的滤过泡包裹(37.0%)。未观察到严重的术中和术后并发症。结论:IVR联合PRP术后进行传统小梁切除手术治疗NVG安全有效,特别适用于PAS≤50%的患眼。术前进行IVR和PRP治疗有助于提高小梁切除手术的成功率。

Association of hypomethylation of LINE-1 repetitive element in blood leukocyte DNA with an increased risk of hepatocellular carcinoma

Global DNA hypomethylation has been associated with increased risk for cancers of the colorectum,bladder,breast,head and neck,and testicular germ cells.The aim of this study was to examine whether global hypomethylation in blood leukocyte DNA is associated with the risk of hepatocellular carcinoma (HCC).A total of 315 HCC cases and 356 age-,sex-and HBsAg status-matched controls were included.Global methylation in blood leukocyte DNA was estimated by analyzing long interspersed element-1 (LINE-1) repeats using bisulfite-polymerase chain reaction (PCR) and pyrosequencing.We observed that the median methylation level in HCC cases (percentage of 5-methylcytosine (5mC)=77.7%) was significantly lower than that in controls (79.5% 5mC) (P=0.004,Wilcoxon rank-sum test).The odds ratios (ORs) of HCC for individuals in the third,second,and first (lowest) quartiles of LINE-1 methylation were 1.1 (95% confidence interval (CI) 0.7-1.8),1.4 (95% CI 0.8-2.2),and 2.6 (95% CI 1.7-4.1) (P for trend <0.001),respectively,compared to individuals in the fourth (highest) quartile.A 1.9-fold (95% CI 1.4-2.6) increased risk of HCC was observed among individuals with LINE-1 methylation below the median compared to individuals with higher (>median) LINE-1 methylation.Our results demonstrate for the first time that individuals with global hypomethylation measured in LINE-1 repeats in blood leukocyte DNA have an increased risk for HCC.Our data provide the evidence that global hypomethylation detected in the easily obtainable DNA source of blood leukocytes may help identify individuals at risk of HCC.

Microstructure of stress-induced martensite in nanocrystalline NiTi shape memory alloy

The microstructure of stress-induced martensite （SIM） in the nanocrystalline NiTi alloy was investigated by means of transmission electron microscopy （TEM）. The result shows that the multi-variant structure of the martensite is suppressed and only single-variant martensitic twins form after tensile deformation when the grain size is smaller than 80 nm. The normal directions of the （001）B19, twin planes are all. within the range of 45° from the axial direction of the wire. The angle between twin crystals （111）M and （111）x of the SIM is also found to be smaller than that of thermally induced martensite in nanocrystalline NiTi.