Objective To evaluate the role of serine-threonine kinase (Akt)/glycogen synthase kinase-3 beta (GSK-3β) signaling pathway in isoflurane preconditioning-induced inhibition of mitochondrial permeability transition pore protein (mPTP) opening during myocardial ischemia-reperfusion (I/R) in rats.Methods Ninety-six male Sprague-Dawley rats,aged 3-4 months,weighing 200-250 g,were randomly divided into 4 groups (n =24 each) using a random number table:control group (group C);I/R group;isoflurane preconditioning group (group IPC);Akt inhibitor MK-2206 group (group MK).Myocardial I/R was induced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by 2 h of reperfusion.In group IPC,1.5％ isoflurane was inhaled for 30 min followed by 45 min washout,and then the model of myocardial I/R injury was established.In group MK,MK-2206 300 μg/kg (in dimethyl sulfoxide) was injected intraperitoneally at 30 min before isoflurane inhalation.At 2 h of reperfusion,8 rats were selected and sacrificed,and the hearts were removed for determination of myocardial infarct size.At 2 h of reperfusion,8 rats were selected,and blood samples were collected from the right internal jugular vein for determination of serum cardiac troponin Ⅰ (cTnI) concentrations.The rats were then sacrificed,and myocardial specimens were obtained for determination of the expression of phosphorylated GSK-3β (p-GSK-3β) in cytoplasm and mitochondria (by Western blot) and co-expression of p-GSK-3β with adenine nucleotide translocator (ANT),voltage-dependent anion channel or cyclophilin D in myocardial tissues (using co-immunoprecipitation).At 2 h of reperfusion,8 rats were selected and sacrificed,myocardial cells were obtained,and the opening time of mPTP was determined with a laser scanning confocal microscope.Results Compared with group C,the myocardial infarct size and serum cTnI concentrations were significantly increased,and the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated in I/R and IPC groups,the co-expression of p-GSK-3β with ANT was significantly down-regulated,and the opening time of mPTP was shortened in group I/R,and the co-expression of p-GSK-3β with ANT was significantly up-regulated,and the opening time of mPTP was prolonged in group IPC (P＜0.05).Compared with group I/R,the myocardial infarct size and serum cTnI concentrations were significantly decreased,the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated,the co-expression of p-GSK-3β with ANT was significantly up-regulated,and the opening time of mPTP was prolonged in group IPC,and the opening time of mPTP was significantly prolonged (P＜0.05),and no significant change was found in the other parameters in group MK (P＞0.05).Compared with group IPC,the myocardial infarct size and serum cTnI concentrations were significantly increased,the expression of p-GSK-3β in cytoplasm and mitochondria was up-regulated,the co-expression of p-GSK-3β with ANT was significantly down-regulated,and the opening time of mPTP was shortened in group MK (P＜0.05).No co-expression of p-GSK-3β with voltage-dependent anion channel or cyclophilin D was found in myocardial tissues.Conclusion The mechanism by which isoflurane preconditioning inhibits mPTP opening during myocardial ischemia-reperfusion is partially related to activation of Akt/GSK-3β signaling pathway in rats.

Objective To evaluate the effect of prefilling blood reservoir with mannitol-adeninephosphate MAP) solution on the damage to erythrocytes in intraoperative salvaged blood in patients.Methods One hundred and fifty blood samples were collected from 150 patients who were scheduled for elective spinal surgery requiring blood salvage,and were equally and randomly divided into 5 groups (n =30 each) using a random number table:group N,group N1,group N2,group M1 and group M2.The blood reservoir was not prefilled before surgery in group N,while the blood reservoirs in N1,N2,M1 and M2 groups were prefilled with normal saline (NS) 100 ml,NS 200 ml,MAP solution 100 ml and MAP solution 200 ml,respectively.Blood sauples were obtained for erythrocyte osmotic fragility test after the salvaged blood was washed,and hemolysis rates in different concentrations of hypotonic NaCl solution were calculated.The concentration of free hemoglobin in the clear supernatant liquid (FHb) of washed blood placed for 0 h (T0),1 h (T1) and 2 h (T2) were detected.Results Compared with N and N1 groups,the hemolysis rate of washed erythrocytes under 0.48％ 0.68％ NaCl solutions was significantly decreased,the concentration of FHb at T1 was decreased,and no significant change was found in FHb at T2 in group M1.Compared with N and N2 groups,the haemolysis rates of washed erythrocytes under 0.48％-0.68％ NaCl solutions were significantly decreased,and the concentrations of FHb at T1,2 were decreased in group M2.The concentration of FHb was significantly lower at T2 in group M2 than in group M1.Conclusion Prefilling blood reservoir with MAP solution can mitigate the damage to erythrocytes in the intraoperative salvaged blood in patients,and the efficacy of prefilling of 200 ml is superior to that of prefilling of 100 ml.

ObjectiveTo evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk(5 patients),in right main bronchus( 1 patient),in trachea and left main bronchus (4 patients),in trachea and right main bronchus (3 patients),in main tracheal trunk and bilateral main bronchus(5 patients).The degree of stenosis was rated 51％ to 70％ in 7 cases,71％ to 90％ in 11 cases.All patients,17 patients of ASA grade 1V and 1 patient of grade Ⅲ,presented with severe dyspnea. Under general anaesthesia,implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance.The NBP,ECG,RR,SaO2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure,relief of dyspnea,complications related to anesthesia and operation were recorded. Results The success rate of stent placement was 18/18,and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 cases.The stent was obstructed by sputum in 1case,and the patient was treated with medication.There were no severe complications.The operative course were rated 11 to 9 in 17 cases,and 6 to 8 in 1 case.All 18 patients were cooperative during the procedure.Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable.Respiratory rate (RR) and heart rate (HR) decreased in all patients after the operation [ ( 37.1 ± 2.8 )/min and ( 106.5 ± 14.2 ) bpm before the operation respectively,( 18.6 ± 1.4)/min and ( 73.2 ± 7.6) bpm after the operation respectively ],t =17.81 and 3.80,P ＜ 0.01.Pulse oxygen saturation ( SaO2 ) during the operation [ ( 91.2 ± 1.8 ) ％ ]increased [ (76.3 ± 8.6 )％ before the operation ] and increased further after the operation [ (94.5 ±4.3 ) ％ ],t =2.06 and 2.26,P ＜ 0.01.Blood pressure (BP) showed no changes throughout the operation (P ＞ 0.05 ).The conprehensive assessment of operation were favorable in all patients. Conclusion With careful preoperative evaluation and planning, tracheal stent implantation under general anaesthesia in patients with malignant tracheal stenosis is feasible and safe.

Objective: To evaluate the effect of nicotinamide adenine dinucleotide phosphate (NADPH) on myocardial ischemia-reperfusion (I/R) injury in rats. Methods: Fifty-six SPF adult male Sprague-Dawley rats, weighing 220-320 g, aged 1-2 months, were divided into 4 groups (n=14 each) using a random number table method: sham operation group (Sham group), myocardial I/R group (I/R group), NADPH group (N group) and diltiazem group (D group). The model of myocardial I/R injury was established by ligation of the left anterior descending branch for 30 min followed by 2-h reperfusion in anesthetized rats.NADPH 16 mg/kg was intravenously infused over 5 min starting from 5 min of reperfusion in N group.Diltiazem 5 mg/kg was infused through the internal jugular vein starting from 10 min before ischemia until the end of ischemia.At 2 h of reperfusion, blood samples were taken from the internal jugular vein for measurement of serum LDH and cTnI concentrations, and myocardial tissues were taken for determination of infarct size and ROS level. Results: Compared with Sham group, the serum LDH and cTnI concentrations, myocardial infarction size and ROS levels were significantly increased in I/R group (P<0.05). Compared with I/R group, the serum LDH and cTnI concentrations, myocardial infarction size and ROS levels were significantly decreased in N and D groups (P<0.05). Compared with N group, the LDH concentration was significantly decreased (P<0.05), and no significant change was found in the cTnI concentration, myocardial infarction size or ROS level in D group (P>0.05). Conclusion NADPH can reduce myocardial I/R injury through antioxidant effect in rats.

Objective:To identify the risk factors for postoperative septic cardiomyopathy (SCM) in septic patients.Methods:The perioperative medical records of septic patients admitted to the intensive care unit (ICU) of Second Affiliated Hospital of Soochow University, First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital after surgery from January 2017 to November 2020 were retrospectively collected.The patients were divided into SCM group and non-SCM group (NSCM group) according to whether or not SCM developed within 48 h after operation.Multivariate logistic regression analysis was used to identify the risk factors for SCM.Results:A total of 269 patients were included in this study, including 49 patients in SCM group and 220 patients in NSCM groups.Compared with group NSCM, the rate of laparoscopic surgery, the Sequential Organ Failure Assessment (SOFA) at the time of entering ICU, the serum concentration of lactate at the time of entering ICU, the highest serum concentration of lactate, the highest serum concentration of procalcitonin, the maximum consumption of norepinephrine and the highest body temperature were increased, and the minimum platelet count was decreased in group SCM ( P<0.1). The results of logistic regression analysis showed that SOFA score at the time of entering ICU and laparoscopic surgery were the risk factors for the development of postoperative SCM in septic patients ( P<0.05). The risk for SCM was increased by 34.273 times when the SOFA score at the time of entering ICU was ≥7 ( P<0.05). Conclusion:Laparoscopic surgery and SOFA score ≥7 at the time of entering ICU are the risk factors for the development of postoperative SCM in septic patients.

Objective To evaluate the effect of nicotinamide adenine dinucleotide phosphate(NADPH)on myocardial ischemia-reperfusion(I/R)injury in rats.Methods Fifty-six SPF adult male Sprague-Dawley rats,weighing 220-320 g,aged 1-2 months,were divided into 4 groups(n＝14 each)using a random number table method: sham operation group(Sham group),myocardial I/R group(I/R group),NADPH group(N group)and diltiazem group(D group).The model of myocardial I/R injury was established by ligation of the left anterior descending branch for 30 min followed by 2-h reperfusion in anesthetized rats.NADPH 16 mg/kg was intravenously infused over 5 min starting from 5 min of reperfusion in N group.Diltiazem 5 mg/kg was infused through the internal jugular vein starting from 10 min before is-chemia until the end of ischemia.At 2 h of reperfusion,blood samples were taken from the internal jugular vein for measurement of serum LDH and cTnI concentrations,and myocardial tissues were taken for deter-mination of infarct size and ROS level.Results Compared with Sham group,the serum LDH and cTnI concentrations,myocardial infarction size and ROS levels were significantly increased in I/R group(P＜0.05).Compared with I/R group,the serum LDH and cTnI concentrations,myocardial infarction size and ROS levels were significantly decreased in N and D groups(P＜0.05).Compared with N group,the LDH concentration was significantly decreased(P＜0.05),and no significant change was found in the cTnI con-centration,myocardial infarction size or ROS level in D group(P>0.05).Conclusion NADPH can re-duce myocardial I/R injury through antioxidant effect in rats.

Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.

Objective: To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures. Methods: A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018, including 130 male and 310 female patients aged 60-98 years [(79.3±6.3)years]. According to the DORSSSP scoring system, the patients were divided into low risk group (Group A, n=208), medium risk group (Group B, n=157) and high risk group without SICU transfer after operation (Group C, n=23) and high risk group with SICU transfer after operation (Group D, n=52). The risk prediction results of each group were recorded and compared with the actual complications and mortality. Results: (1)According to the prediction of DORSSSP, the number of postoperative complications in Groups A, B, C and D were 52, 60, 14 and 31, respectively, while the number of actual complications after operation was 45, 55, 13 and 16. There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P<0.01), which was not found in other three groups (P>0.05). The incidence of postoperative complications in Group D was lower than that in Group C (P<0.05). (2) According to the prediction of DORSSSP, the number of postoperative death in Groups A, B, C and D were 0, three, two and four, respectively, while the number of actual death after operation was 0, one, two and one, respectively. The predicted value and the actual value of death were significantly different in Group D (P<0.05), but were not in other three groups (P>0.05). The incidence of postoperative death in Group D was lower than that in Group C (P>0.05). Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality. Based on DORSSSP score for stratified treatment, the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.

Objective: To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients. Methods: From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed. Results: Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-hour group, but 2 in over 48-hour group; and 1 in within 48-hour group at the last follow-up. Conclusion Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.