AIM: To investigate the effect of chronic intermittent hypobaric hypoxia (CIHH) on the activity of adrenergic receptor(AR) in rabbit sino-atrial node (SAN) by intracellular recording.METHODS: New Zealand rabbits were randomly divided into three groups: control group (Con), 14 d CIHH treatment group (CIHH14) and 28 d CIHH treatment group (CIHH28). The CIHH rabbits were exposed to a simulated 5 000 m (oxygen 11.1%) hypobaric hypoxia in hypoxic chamber for 14 d or 28 d (6 h/d), respectively. SAN preparation was used and the transmembrane action potential was recorded by micropipettes. Isoproterenol hydrochloride (ISO, agonist of β-AR) and phenylephrine (PE, agonist of α_1-AR) at different concentrations (0.01, 0.1 and 1 μmol/L) were applied cumulatively to investigate the electrophysiological effect of the drugs on the rabbit SAN among Con, CIHH14 and CIHH28 groups, respectively. RESULTS: (1) CIHH didnt change the parameters of action potential of SAN recorded under basic condition. (2) ISO changed some parameters of AP significantly in a dose-dependent manner, including increases in the amplitude of AP (APA), maximal rate of depolarization (V_(max)), the velocity of diastolic (phase 4) depolarization (VDD), and rate of pacemaker firing (RPF). (3) The response of AP to ISO in CIHH rabbits was decreased significantly compared to that in Con animals. Under 1 μmol/L of ISO, the increases in VDD, RPF, APA and V_(max) in CIHH animals were smaller than those in Con animals (P<0.05). (4) No effect of PE (0.01, 0.1 and 1 μmol/L) on the parameters of action potential was observed. CONCLUSION: CIHH decreases the reactivity of β-AR, but has no effect on α_1-AR in SAN of rabbit.

Objective: To estimate the blood concentration of isoflurane with the inspired andexpired concentrations during laparoscopic surgery. Methods: 2 sections were divided in this experiment: section 1:23 adult patients (ASA I～II)were received abdominal surgeries,of whom,12 patients for non-laparoscopic surgeries and the others for laparoscopic surgeries. Central venous blood samples were collected for gas chromatography determination 20, 40, 60, 80 min after inhalating isoflurane . We could receive two different F value (the fraction of uptake of isoflurane)through the formula. Section 2: 27 patients were recruited for abdominal surgeries, 13 for laparoscopic surgeries and the others for non-laparoscopic surgeries. All of the processes were the same as the former. Then we confirm the results obtained from section1. Results: The F was 0.52 in the laparoscopic surgeries and 0.44 in the nonlaparoscopic surgeries. In the laparoscopic surgeries, the bias (MDPE) was 17% , accuracy (MDAPE)was 22.88% and the wobble was 11.7% .The correlation coefficient (r)was 0.83. In the nonlaparoscopic surgeries, the MDPE was 5.37% , the MDAPE was 16.02% , the wobble was 15.86% .The correlation coefficient was 0.90. Conclusion: The formula could be used in abdominal surgeries to evaluate the concentration of isoflurane according to the clinical standard of MDPE

Objective:To investigate the effect of ultrasound-guided thoracic paravertebral nerve block (TPNB) on anesthesia efficacy and stress response in middle-aged and elderly patients undergoing radical surgery for lung cancer.Methods:A total of 104 lung cancer patients who underwent thoracoscopic radical resection for lung cancer at Qingdao Traditional Chinese Medicine Hospital from November 2020 to May 2023 were selected and randomly divided into an observation group (52 cases) and a control group (52 cases) using a random number table method. The observation group received general anesthesia combined with ultrasound-guided TPNB anesthesia during surgery, while the control group received general anesthesia. Two groups of patients were compared in terms of surgical time, intraoperative blood loss, remifentanil and propofol dosage, fluctuation trends of mean arterial pressure (MAP) and heart rate (HR), pain levels in resting and coughing states after surgery, differences in serum stress response indicators [fasting plasma glucose (FPG), cortisol (Cor), norepinephrine (NE), epinephrine (E)] before and after surgery, and adverse reactions.Results:There was no statistically significant difference in surgical time, intraoperative blood loss, and single lung ventilation time between the observation group and the control group (all P>0.05). The usage of remifentanil and propofol in the observation group was lower than that in the control group, and the difference was statistically significant (all P<0.05). The MAP fluctuation changes at four time points before anesthesia induction, 30 minutes during surgery, 90 minutes during surgery, and after surgery in the observation group were smaller than those in the control group. Among them, the MAP at 30 minutes during surgery and 90 minutes during surgery was higher than that in the control group (all P<0.05); There was no statistically significant difference in HR fluctuations between the observation group and the control group at the four time points (all P>0.05). The Visual Analog Scale (VAS) scores of the observation group patients in resting and coughing states at 12 and 24 hours after surgery were lower than those of the control group at the same time point (all P<0.05). The serum Cor and E levels in the observation group were lower than those in the control group at 12 hours after surgery, and the serum NE levels were lower than those in the control group at 12 and 24 hours after surgery (all P<0.05). The incidence of adverse reactions caused by anesthesia in the observation group was lower than that in the control group ( P<0.05). Conclusions:The use of ultrasound-guided TPNB combined with general anesthesia in patients undergoing radical surgery for lung cancer is beneficial in reducing intraoperative blood pressure fluctuations, alleviating postoperative pain and stress response, and reducing adverse reactions caused by anesthesia.

Objective:To evaluate the healthcare accessibility and quality of diagnosis and treatment services of Internet hospitals in China.Methods:One hundred and eighty Internet hospitals in 60 cities were seleted based on the sampling of development levels in the eastern, central and western regions of China. From April to May 2023, standardized patients methodology was applied to evaluate the accessibility(including the number of Internet hospitals, functional settings, online doctor status, the doctor′s attending rate and consultation fees) and diagnosis and treatment service quality(including the diagnosis and treatment services quality, response speed and patient′s evaluation) of Internet hospitals.Results:The average opening rate of Internet hospitals in China was 52.9% (560/1 058), the average online rate of doctors was 64.2% (1 099/1 713), the average doctor′s attending rate was 33.6% (112/333), the average consultation fee was 4.85 yuan, the average score of consultation was 1.92 out of 9, the average score of diagnosis and treatment was 1.12 out of 4, the average score of the response speed was 1.70 out of 3, and patient satisfaction was 2.73 out of 3.Conclusions:The Internet hospital accessibility in China is unevenly developed, and the overall quality of diagnosis and treatment is low. It is recommended to accurately position and optimize the function of Internet hospital, establish the incentive mechanism for online consultation doctors, construct and improve the regulatory system of Internet hospital diagnosis and treatment, so as to improve the accessibility and quality of diagnosis and treatment of Internet hospitals.

Antibodies, Neutralizing ; Antibodies, Viral/isolation & purification* ; B-Lymphocytes/virology* ; COVID-19/virology* ; Humans ; Immunity/genetics* ; RNA, Viral/immunology* ; SARS-CoV-2/pathogenicity* ; Single-Cell Analysis