Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

Objective This prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system(Beijing Surgerii Technology Co.,Ltd.,Beijing,China),a novel purpose-built robotic system,in single-port robotic radical prostatectomy.Methods Sixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system.The demographic and baseline data,surgical,oncological,and functional outcomes as well as follow-up data were recorded.Results The mean operative time was 226.3(standard deviation[SD]52.0)min,and the mean console time was 183.4(SD 48.3)min,with the mean estimated blood loss of 116.3(SD 90.0)mL.The mean length of postoperative hospital stay was 4.50(SD 0.97)days.Two patients had postoperative complications(Clavien-Dindo Grade II),and both patients improved after conservative treatment.All patients’postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge.The mean prostate-specific antigen level further decreased to a mean of 0.0219(SD 0.0641)ng/mL 6 months after surgery.Thirty days postoperatively,12 out of 16 patients reported using no more than one urinary pad per day,and all patients reported satisfactory urinary control without the need for pads 6 months after surgery.Conclusion The SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches.Tumor control and urinary continence were satisfying for patients enrolled in.The next phase involves conducting a large-scale,multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor

Objective： To observe the advantage of total intravenous anesthesia for transurethral resection of bladder tumor （TURBT）. Methods.. Sixty ASA Ⅰ-Ⅱ patients undergoing TURBT were randomly assigned to 2 groups. Spinal anesthesia with 0. 75% pure bupivacaine （8-12 rag） was applied to patients in Group Ⅰ （n= 30）. Patients in Group Ⅱ （n=30） received total intravenous anesthesia with continuous infusion of Propofol and Remifentanil ; and a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side effects were monitored and recorded. Results ： The patients in group Ⅱ experienced more stable hemodynamics than those in group Ⅰ . Obturator nerve reflex was observed in 15 （50. 0%） patients in Group Ⅰ , but none （0%） in Group Ⅱ （P〈0. 01）. Conclusion.. Total intravenous anesthesia with laryngeal mask is a safe, reliable, controllable and simple manual for patient undergoing TURBT.

Impact of parenchyma-preserving surgical methods on treating patients with solid pseudopapillary neoplasms:A retrospective study with a large sample size

BACKGROUND Solid pseudopapillary neoplasm of the pancreas(SPN)is a rare neoplasm that mainly affects young women.AIM To evaluate the impact of parenchyma-preserving surgical methods(PPMs,including enucleation and central pancreatectomy)in the treatment of SPN patients.METHODS From 2013 to 2019,patients who underwent pancreatectomy for SPNs were retrospectively reviewed.The baseline characteristics,intraoperative index,pathological outcomes,short-term complications and long-term follow-up data were compared between the PPM group and the conventional method(CM)group.RESULTS In total,166 patients were included in this study.Of them,33 patients(19.9%)underwent PPM.Most of the tumors(104/166,62.7%)were found accidentally.Comparing the parameters between groups,the hospital stay d(12.35 vs 13.5 d,P=0.49),total expense(44213 vs 54084 yuan,P=0.21),operation duration(135 vs 120 min,P=0.71),and intraoperative bleeding volume(200 vs 100 mL,P=0.49)did not differ between groups.Regarding pathological outcomes,tumor size(45 vs 32 mm,P=0.07),Ki67 index(P=0.53),peripheral tissue invasion(11.3%vs 9.1%,P=0.43)and positive margin status(7.5%vs 6%,P=0.28)also did not differ between groups.Moreover,PPM did not increase the risk of severe postoperative pancreatic fistula(3.8%vs 3.0%,P=0.85)or tumor recurrence(3.0%vs 6.0%,P=0.39).However,the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group(21.8%vs 3%,P=0.024).CM was identified as an independent risk factor for pancreatic exocrine insufficiency(odds ratio=8.195,95%confident interval:1.067-62.93).CONCLUSION PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.

Chinese Association for the Study of Pain:Expert consensus on chronic postsurgical pain

Chronic postsurgical pain is a common surgical complication that severely reduces a patient’s quality of life.Many perioperative interventions and management strategies have been developed for reducing and managing chronic postsurgical pain.Under the leadership of the Chinese Association for the Study of Pain,an editorial committee was formed for chronic postsurgical pain diagnosis and treatment by experts in relevant fields.The editorial committee composed the main content and framework of this consensus and established a working group.The working group conducted literature review(1989-2020)using key words such as“surgery”,“post-surgical”,“post-operative”,“pain”,“chronic”,and“persistent”in different databases including MEDLINE,EMBASE,PubMed,Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews.Only publications in the English language were included.The types of literature included systematic reviews,randomized controlled studies,cohort studies and case reports.This consensus was written based on clinical practice combined with literature evidence.The first draft of the consensus was rigorously reviewed and edited by all the editorial committee experts before being finalized.The level of evidence was assessed by methodological experts based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence.The strength of recommendation was evaluated by all editorial committee experts,and the opinions of most experts were adopted as the final decision.The recommendation level“strong”generally refers to recommendations based on high-level evidence and consistency between clinical behavior and expected results.The recommendation level“weak”generally refers to the uncertainty between clinical behavior and expected results based on low-level evidence.

Characteristics of global cerebral ischemia models constructed by modified four-vessel occlusion in rats

BACKGROUND： Pulsinelli et al developed a kind of rat models with four-vessel occlusion-induced global cerebral ischemia, Because the histo-pathological changes and severe cerebral ischemia reproducibility of this model are good and the stability of this model in circulation respiration is superior to that of other models, so four-vessel occlusion method has become a classic modeling method for global cerebral ischemia model, This model has been improved in some laboratories to meet different requirements in different studies. OBJECTIVE： To establish a highly reproducible rat model of reversible forebrain ischemia by modifying four-vessel occlusion model introduced by Pulsinelli et al, and to investigate its neurophysiological and pathological changes and the characteristics of modified operation. DESIGN ： Completely randomized grouping, controlled tria. SETTING ： Department of Anesthesiology,Changhai Hospital, Second Military Medical University of Chinese PLA. MATERIALS ： A total of 65 male healthy SD rats, weighing 250-300 g, were provided by the Experimental Animal Center of Second Military Medical University of Chinese PLA. VSM hemodynamic monitor and temperature monitor （Thermal ert TH-5, U.S.A） were used. METHODS ： The trial was conducted in the Department of Anesthesiology, Changhai Hospital, Second Military Medical University of Chinese PLA from January 2005 to March 2006. ① Experimental grouping： Sixty-five rats were randomly divided into the following 7 groups： sham-operation group （n =9）： given the same operation, without occlusion of vessels; 5 minutes ischemia group （n =9）： ischemia 5 minutes and reperfusion 72 hours; 10 minutes ischemia group （n =8）： ischemia 10 minutes and reperfusion 72 hours; 15 minutes ischemia group （n =9）： ischemia 15 minutes and reperfusion 72 hours; 20 minutes ischemia group （n =8）： ischemia 20 minutes and reperfusion 72 hours; 30 minutes ischemia group （n =7）; ischemia 30 minutes and reperfusion 72 hours; ischemia control group （n =15）： ischemia 15 minutes and reperfusion 180 minutes. ② Preparation of the model of global cerebral ischemia： Four-vessel occlusion- induced global cerebral ischemia rat models were modified, Le. bilateral vertebral arteries could be electrocauterized and blocked, and bilateral common carotid arteries were enclosed with 10-0 suture loosely. On the second day, keeping the animal awake, the suture was tightened and kept tense to block the blood flow of bilateral common carotid artery. After certain duration of ischemia, the suture was cut off and drawn out, thus the reperfusion of bilateral common carotid artery was resumed. ③Observation of physiological indexes： VSM hemodynamic monitor and temperature monitor （Thermal ert TH-5,U.S.A） were used to record and measure the changes of blood pressure, rectal temperature, brain temperature ,arterial blood gas and other physiological indexes of the rats in the control group before, 5 and 15 minutes after ischemia and 10,30,60,120 and 180 minutes after reperfusion. ④Preparation of brain tissue pathological samples： Except for ischemia control group, rats of other groups were anesthetized and their brain tissues were harvested and subjected to haematoxylin and eosin staining at 72 hours after reperfusion. ⑤ Evaluation of pathological change of brain tissue： The coronal plane of anterior commissure of cerebrum was used to evaluate corpora striatum, and the coronal plane of anterior hippocampus was used to evaluate hippocampal CAl/2 region, CA3 region and CA4 region, subiculum, superior pyramidal lobe and inferior pyramidal lobe of dentate gyrus as well as neocortex. Irreversible neuronal damage included pyknotic cells with eosinophilic cytoplasm and trachychromatic nucleus, homogenous cytoplasm and naked nucleus. Neurons without the above changes were considered to be normal. The number of normal neurons in the above-mentioned brain regions was counted under the microscope. MAIN OUTCOME MEASURES： ① The changes of blood pressure, rectal temperature, brain temperature, arterial blood gas and other physiological indexes of rats before, 5 and 15 minutes after ischemia and 10,30,60,120 and 182 minutes after reperfusion. ②The number of normal neurons in hippocampal CA1/2 region, CA3 region, CA4 region, subiculum, superior pyramidal lobe and inferior pyramidal lobe of dentate gyrus as well as neocortex at 72 hours of ischemia. RESULTS： Sixty-five SD rats were involved in the result analysis. ①Changes in the physiological indexes of rats during cerebral ischemia/reperfusion： Changes in arterial blood pressure： arterial blood pressure at 5 minutes after ischemia was significantly higher than that before ischemia [（132.82±12.38） mm Hg vs. （118.58±5.85） mm Hg, 1 mm Hg=0.133 kPa, P〈 0.01], and there was no significant difference in arterial blood pressure between at ischemia 15 minutes, reperfusion 10,30,60,120 and 180 minutes and before ischemia （P 〉 0.05）; Changes in arterial blood gas： pH value at 15 minutes after ischemia was significantly higher than that before ischemia （7.56±0.05 vs. 7.47±0.09, P 〈 0.01）, PaO2 value at 15 minutes after ischemia was significantlyhigher than that beischemia [（1.71 ±0.04） kPa vs. （1.56±0.08） kPa, P 〈 0.01], and PaCO2 value at 5 and 15 minutes after ischemia was significantly rower than that before ischemia [（0.44±0.04）, （0.37±0.04）. （0.57± 0.04） kPa, P 〈 0.01];Changes in rectal temperature and brain temperature： Brain temperature at 5 and 10 minutes after ischemia and at 10 and 30 minutes after reperfusion was significantly lower than that before ischemia [（37.01±0.43）. （36.44±0.35）, （36.81 ±0.45）, （37.23±0.24）, （37.74±0.28） ℃, P 〈 0.01], and rectal temperature at 10 minutes after reperfusion was significantry lower than that before ischemia [（36.76±0.21）,（37.37± 0.19） ℃, P〈 0.01]. ② Changes in the normal neurons in different encephalic regions of rats at different time after ischemia and 72 hours after reperfusion： At 5,10,15,20 and 30 minutes after ischemia, the number of normal neurons in subiculum was 86% ,73%, 11% ,8%, 6% of that in the sham-operation, respectively （P 〈 0.05- 0.01）, the number of normar neurons in internal segment of hippocampal CA1/2 region was 74% ,53% ,8%, 5% ,5% of that in the sham-operation group （P 〈 0.01）,the number of normal neurons in middle segment of hippocampal CA1/2 was 73%,48%, 11% ,8% ,6% of that in the sham-operation group, respectively （P 〈 0.01 ）, and the number of normar neurons in external segment of hippocampal CAl/2 region was 90% ,72% ,37%, 31% ,22% of that in the sham-operation group, respectively （P 〈 0.01）; At 10,15,20 and 30 minutes after ischemia, the number of normal neurons in hippocampal CA3 region was 80% ,67% ,47% ,40% of that in the sham-operation group respectivery （P 〈 0.01 ）, the number of normal neurons in hippocampar CA4 region was 79% ,70%,60% ,43% of that in the sham-operation group, respectivery （P 〈 0.01 ） and the number of normal neurons in superior pyramidal lobe of dentate gyrus was 85%,75%,59%, 52% of that in the sham-operation group, respectivery （P 〈 0.05,0.01）. At 15,20 and 30 minutes after ischemia, the number of normar neurons in inferior pyramidal lobe of dentate gyrus was 80% ,70% ,59% of that in the sham-operation group （P 〈 0.01 ） and the number of normar neurons in the neocortex was 79%, 72%,61% of that in the sham-operation group （P〈 0.05,0.01）. CONCLUSION ： To construct cerebral ischemia rat model with modified four-vessel occrusion can cause severe cerebral ischemia.rt has a few influences on arterial brood pressure and arterial blood gas of model rat and is easy for brocking and opening carotid artery system.

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.

Effects of isoflurane and ethanol on large conductance Ca^(2+)-activated K^+ channels

Objective: To study the effect of isoflurane and ethanol on large conductance Ca 2+-activated K + channels(BK channels). Methods: The cRNA of mslo1 encoding BK channels was injected into Xenopus oocytes. Oocytes were incubated in ND96 (96 mmol/L NaCl, 2.0 mmol/L KCl, 1.8 mmol/L CaCl 2, 1.0 mmol/L MgCl 2, and 5.0 mmol/L HEPES, pH 7.4) at 4 ℃. Patch clamp recording (outside-out) were performed after 2-3 d. Isoflurane was administrated by the vaporizer driven by air, ethanol was applied by a closed, manual-controlled administration system. Different test potentials from 0 to 10 mV were given to observe changes of currents. Results: 0.7 mmol/L and 1.2 mmol/L of isoflurane could inhibit BK currents obviously at different command potentials, but 50 mmol/L, 100 mmol/L, or 200 mmol/L of ethanol had no any effect on BK currents. Conclusion: Clinical concentration of isoflurane can distinctly inhibit isolating BK currents.

A comparison of GlideScope videolaryngoscope with Macintosh laryngoscope for laryngeal views

Objective：To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods：Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features （Mallampati oropharyngeal scale, thyromenta distance and mouth opening）. In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn, and the views of the glottis at laryngoscopy （Cormack and Lehane scores） were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or GlideScope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results： There were 200 patients including 107 males and 93 females, with mean age being 52±13 years, height 164.8±11.3 cm, weight 64.0±11. 5 kg, thyromental distance 6. 9± 1.1 cm, and mouth opening 5.7±0.5 cm. There was a significant association between the preoperative view of the oropharynx （Mallampati score） and the view of the glottis at laryngoscopy for both the direct Macintosh laryngoscope （P〈0. 001） and the GlideScope （P〈0. 001）. Among 200 patients, 106 patients had the same C＆L grade, 91 of remaining patients showed improvement in the C＆L grade （P〈0. 001 ） obtained with GlideScope compared with the direct Macintosh laryngoscope. 3 of remaining patients showed better view of the glottis（C＆L grade） with the direct Macintosh laryngoscope （grade 1） than with GlideScope （grade 2）. There were no cases of failure to be intubated. There were no cases of dental or mucosal injury in all patients. Conclusion： GlideScope videolaryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the difficult airway.

Effects of Sevoflurane on the discharges of wide dynamic range neurons in spinally transected rats

Objective: To study the effects of clinical concentration of sevoflurane on activity of wide dynamic range neurons. Methods: Eight Spraque-Dawley rats(male) were selected. Their spinal cords were exposed and transected at T 9-10 level. The rate of firings of single neurons in the dorsal horn in response to electrical stimulation of skin was recorded with microelectrodes. The early and late discharges were observed when rats inhaled 0.5%, 1.0%, 1.5%, and 2.0% sevoflurane. Results: Sevoflurane suppressed the early and late discharges at the concentration of 0.5%, 1.0%, 1.5%, and 2.0%. Compared with early discharges, the extent of inhibition of late discharges was wider at the concentration of 1%, 1.5%, and 2.0% of sevoflurane. Conclusion: It is indicated that sevoflurane could suppress the transmission of nociceptive and non-nociceptive stimulation at dorsal horn. The suppression on nociceptive imput is stronger than that on non-nociceptive imput when the concentration of sevoflurane is more than 1%.

Pig model of chronic myocardial ischemia and its investigation by ultrasonic integrated backscatter and Doppler tissue imaging

Objective: To construct an animal model of chronic ischemic myocardium, and evaluate it by ultrasonic integrated backscatter (IBS) and Doppler tissue imaging (DTI). Methods: An Ameroid constrictor was placed around the porcine left circumflex coronary artery (LCX). The calibrated average image intensity (%AII), cyclic variation of IBS (CVIB), transmural gradient index (TGI) of CVIB in lateral-posterior wall (LPW), and DTI spectrum of LPW in left ventricular papillary muscle level short axis view (LVPM-SAM) and apical four chamber view (AP-4CV) at normal state, 2, 4, 6 and 8 weeks postoperatively were measured. Results: Normal %AII, CVIB and TGI were 2.29±0.32, 9.69±2.22dB and 0.22±0.08, respectively. The %AII increased gradually postoperatively. The CVIB decreased also gradually, and the decrease was higher in subepicardium than in subendocardium. Most of TGI decrease occurred from 2 to 4 weeks postoperatively and became zero at 8 weeks (P<0.01); Normal V S (peak systolic velocity) of AP-4CV was higher than that of LVPM-SAM (P<0.01). V E (peak early diastolic velocity) of AP-4CV was lower than that of LVPM-SAM (P<0.05). V S and V E were all decreased after operation (P<0.01). The decrease of V S in AP-4CV was greater than that in LVPM-SAM. Conclusion: The pathological changes of the myocardium in human ischemic heart disease (IHD) are similar to that of Ameriod model. IBS and DTI can detect echo changes and ventricular wall motion in chronic ischemic myocardium, and provide more information for clinical investigation and treatment of IHD.

Deletion of G protein-coupled receptor 116 enhances neutrophil function and aggravates lung injury in mice

Acute lung injury(ALI)globally afflicts over 3 million in-dividuals every year.It can eventually develop into acute respiratory distress syndrome(ARDS)with a high mortality of up to 40%.To date,ALI has been undertreated in terms of the feeble efficacy of clinical approaches and the lack of proven pharmacological targets.1 G protein-coupled re-ceptors(GPCRs),the promising targets of modern medi-cine,participate intensively in the regulation of human physiology and pathophysiology.Among them,Gpr116,which is expressed in alveolar epithelial cells and immune cells.

An analysis of patents for anesthetic laryngoscopes

The anesthetic laryngoscope is one of the most popular medical tools for obtaining a clear view of the larynx and facilitates tracheal intubation. The number of anesthetic laryngoscope patents, coming mainly from the anesthesiologists, has rapidly increased. Each product has a specialized use for particular patients. However, it is unclear to what extent anesthetic laryngoscopy gained acceptance in operating theaters. By retrieving patent data for more than 90 countries from the Online Retrieval of Bibliographic Information Time-share(ORBIT) system, we reviewed the anesthetic laryngoscope patent literature published before July 6, 2015, and manually analyzed patent status, general development trends, areas of competition, technology patentees, and technology classifications. The study showed that the number of anesthetic laryngoscope patent applications has stayed at a high level in the last decade. Most patent activity was carried out in the USA, with China and a number of European countries trailing behind. In addition, the patent analysis provided an opportunity to understand the trends in the development of anesthetic laryngoscope technology, to identify shortcomings in clinical use of anesthetic laryngoscopes, to assist medical manufacturing specialists in improving the design and products, and to suggest to anesthesiologists modifications of the clinical signs of difficult tracheal intubation based on the new commercial anesthetic laryngoscopes applied in the front-line.

Angiotensin-Converting Enzyme 2 in the Rostral Ventrolateral Medulla Regulates Cholinergic Signaling and Cardiovascular and Sympathetic Responses in Hypertensive Rats

The rostral ventrolateral medulla(RVLM) is a key region in cardiovascular regulation. It has been demonstrated that cholinergic synaptic transmission in the RVLM is enhanced in hypertensive rats. Angiotensinconverting enzyme 2(ACE2) in the brain plays beneficial roles in cardiovascular function in hypertension. The purpose of this study was to determine the effect of ACE2 overexpression in the RVLM on cholinergic synaptic transmission in spontaneously hypertensive rats(SHRs).Four weeks after injecting lentiviral particles containing enhanced green fluorescent protein and ACE2 bilaterally into the RVLM, the blood pressure and heart rate were notably decreased. ACE2 overexpression significantly reduced the concentration of acetylcholine in microdialysis fluid from the RVLM and blunted the decrease in blood pressure evoked by bilateral injection of atropine into the RVLM in SHRs. In conclusion, we suggest that ACE2 overexpression in the RVLM attenuates the enhanced cholinergic synaptic transmission in SHRs.

Retrospective analysis on acute respiratory distress syndrome in ICU

Objective： To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome （ARDS） in intensive care unit （ICU）. Methods： A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American- European Consensus Conference （ AECC ）. Acute physiology and chronic health evaluation Ⅲ （APACHE Ⅲ）, multiple organ dysfunction syndrome score （MODS score）, and lung injury score （LIS） were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation. Resnits ： Totally, 131 patients （ 2. 5% ） developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases （62 males and 53 females, aged 22-75 years, 58 years on average ） left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was （11.27±7.24） days and APACHE HI score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE （base excess ）. The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS ≥2.76. Conclusions： ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.

MicroRNA-4661 inhibits antiviral innate immune response by targeting interferon-alpha

Effective recognition of viral infections and subsequent triggering of antiviral innate immune responses are essential for the host antiviral defense, which is tightly regulated by multiple regulators, including microRNAs （miRNAs）. A previous study showed that miR-4661 upregulates IL-IO expression in macrophages by antagonizing RNA-binding protein tristetraprolin-mediated IL-10 mRNA degradation. However, the ability of miR-4661 to regulate antiviral immune responses remains unknown. Here, we found that interferon-alpha （IFN-a） expression was repressed in Sendai virus （SeV）- and vesicular stomatitis virus （VSV）-infected macrophages and in dendritic cells transfected with miR-4661 expression. Moreover, multiple IFN-α species can be directly targeted by miR-4661 through their 3＇ untranslated region （3＇UTR）. This study has demonstrated that miR-4661 could directly target IFN-a expression to inhibit host antiviral innate immune response.

Promising gas therapies for severe COVID-19

The novel coronavirus disease 2019(COVID-19)pandemic is a worldwide catastrophe,thoroughly challenging the healthcare systems.A growing number of victims suffer from a remarkable acute respiratory distress syndrome(ARDS)that necessitates admission to the intensive care unit(ICU),but there are no satisfactory treatments.Various gas therapies including nitric oxide,ozone,hyperbaric oxygen,hydrogen,and heliox have been employed in the fight against the pandemic and have improved clinical outcomes.However,the potential roles of these gases in COVID-19 treatment need to be verified in well-designed randomized controlled trials.This paper reviews advances in gaseous therapy of COVID-19.