Objective To investigate the effect of dexmedetomidine versus sevoflurane to perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods A total of 135 patients (90 males,45 females,aged 45-82 years,ASA grade Ⅱ or Ⅲ) with coronary heart disease,undergoing endoscopic thoracic and abdominal surgery,were divided into control group (group C),dexmedetomidine group (group D) and sevoflurane group (group S) by random number table.Anesthesia induction and maintenance were adopted by etomidate 0.2 mg/kg,propofol 0.5 mg/kg,atracuronium sulfonate 0.2-0.3 mg/kg and fentanyl 5.0-6.0 μg/kg.Dexmedetomidine was given the continuous injection from 10 min before the start of the operation to the end in group D.Equal volume of saline was given in group C.Sevoflurane was inhaled from the induction of anesthesia 30 min before the end of surgery.ST segment changes of electrocardiogram were recorded for diagnosis of myocardial ischemia during the operation and postoperative 72 hours.Results The incidence of myocardial ischemia in group C,group D and group S were 26.7% (12 cases),6.7% (3 cases),8.9% (4 cases) during the operation and 13.3% (6 cases),8.9% (4 cases) and 8.9% (4 cases) postoperative 72 hours.Conclusion Dexmedetomidine and sevoflurane can improve the balance of blood oxygen supply and demand to reduce cardiovascular complications of non-cardiac surgery in patients with coronary heart disease.

Objective:To determine whether dexmedetomidine (Dex) improves oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease (COPD) during lung cancer surgery.Methods:Fifty-six patients with moderate COPD were randomly allocated to a control group and a Dex group (n=28 each).In the Dex group,dexmedetomidine was given as an initial loading dose at 1.0 μg/kg lasting for 10 min followed by a maintenance dose at 0.5 μg/(kg-h) during OLV while the control group was administered an equal volume of 0.9％ saline accordingly.Results:Patients in the Dex group had a significantly higher oxygenation index (P＜0.05) and higher dynamic lung compliance at Dex-30 and Dex-60 (P＜0.05) compared with those in the control group.In the Dex group,oxygenation index in the postoperative period was significantly higher (P=0.025) and postoperative complications were lower than those in the control group.Conclusion:Dex administration may provide dinically relevant benefits by improving oxygenation index and lung mechanics,and reducing postoperative pulmonary complications in patients with moderate COPD underwent lung cancer surgery.

Objective To explore the characteristics of intestinal Microbiota in T2DM patients by two molecular fingerprint technologies,and investigate the correlation of intestinal microbiota and T2DM,and evaluate the application value of two fin-gerprint technologies.Methods Fecal samples of 8 healthy groups and 7 diabetes patients were collected.Then the total DNA of gut microbiota was extracted.Through the analysis of products by two molecular fingerprints of ERIC-PCR and DGGE-PCR,ecological characteristics of diversity and similarity of gut microbiota were obtained in healthy groups and dia-betes patients.Results Compared to healthy groups,the number of bands and Shannon-Wiener index of gut microbiota in di-abetes patients was decreased but no statistical significance.The similarity in patients group was declining(P <0.05),and the construction of gut microbiota was inclined to differ.Two fingerprint technologies of ERIC and DGGE could directly re-flect the diversity of gut microbiota and were the modern molecular biological techniques without depending on cultivation. ERIC was simple and convenient,had a better reflection of microbial diversity,but gel band cutting and regarded asa proper approach with higher diffraction efficiency and excellent repetition to studysequencing couldn’t be performed since there were more influencing factors on the experiment.DGGE could better reflect the ecological characteristics such as microbial diversity and similarity,and selecting bands,gel band cutting and sequencing could be done.Conclusion The composition and construction of gut microbiota in diabetes patients were changed,which suggests the occurrence of the disease had the correlation with gut microbiota.ERIC and DGGE is regarded as a proper approach with higher diffraction efficiency and ex-cellent repetition to study intestinal microbiota,but also gel band cutting,sequencing,bacteria identification can be performed by DGGE,both can be used in combination.

Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.

ObjectiveTo investigate the effect of Gegen Qinliantang on glucose and lipid metabolism in the rat model of catch-up growth （CUG） induced by a high-fat diet and the underlying mechanism. MethodA total of 60 SD rats were randomized into a normal control group （n=18） and a modeling group （n=42）. The rat model of CUG was established with a restricted diet followed by a high-fat diet， and the changes of general status and body weight were observed. The levels of fasting blood glucose （FBG）， fasting insulin （FINS）， triglyceride （TG）， and total cholesterol （TC） were measured in 6 rats in each group at the end of the 4^th and 8^th week， respectively. The homeostasis model assessment of insulin resistance index （HOMA-IR） was calculated， and the insulin sensitivity and body composition changes of CUG rats were evaluated. The successfully modeled rats were assigned into 6 groups： normal control， model， high-， medium-， and low-dose Gegen Qinliantang （2.5， 5， 10 g·kg^-1）， and pioglitazone （3.125 mg·kg^-1）. The rats were administrated with corresponding drugs by gavage for 6 weeks， and the normal control group and model group were administrated with the same amount of normal saline. During the experiment period， the changes of body weight were recorded， and the FBG， FINS， HOMA-IR， TG， and TC were determined at the end of the experiment. Hematoxylin-eosin （HE） staining was employed to observe the pathological changes of skeletal muscle in rats. The levels of reactive oxygen species （ROS） and malondialdehyde （MDA） in the skeletal muscle were measured strictly according to the manuals of the reagent kits. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was performed to measure the mRNA levels of silencing information regulator 1 （SIRT1）， peroxisome proliferator-activated receptor-gamma coactivator1α （PGC1α）， and nuclear respiratory factor 1 （Nrf1） in the skeletal muscle. Western blot and immunohistochemistry were employed to assess the expression of SIRT1， PGC1α， and Nrf1 in the skeletal muscle. ResultCompared with the normal control group， the model group presented elevated levels of FBG， FINS， TG， and TC （P<0.05， P<0.01）， increased HOMA-IR （P<0.01）， increased diameter of muscle fibers and adipocytes between muscle cells in the skeletal muscle， rising levels of ROS and MDA in the skeletal muscle （P<0.01）， and down-regulated mRNA and protein levels of SIRT1， PGC1α， and Nrf1 （P<0.05， P<0.01）. Compared with the model group， Gegen Qinliantang （especially the medium and high doses） and pioglitazone decreased the body weight， FINS， HOMA-IR， and TG （P<0.05， P<0.01） and reduced interstitial components such as intermuscular fat in the skeletal muscles and the diameter of muscle fibers. Furthermore， the drugs lowerd the levels of ROS and MDA （P<0.05， P<0.01） and up-regulated the mRNA and protein levels of SIRT1， PGC1α， and Nrf1 （P<0.05， P<0.01） in the skeletal muscle. ConclusionGegen Qinliantang can ameliorate the glucose and lipid metabolism disorders and insulin resistance in CUG rats by regulating the SIRT1/PGC1α/Nrf1 signaling pathway.

Objective To study the protective effects of sevoflurane at different anesthesia depths on periperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods 96 patients with coronary undergoing noncardiac surgery were randomly divided into three groups:control group (Group C),high-concentration sevoflurane group (Group S 1) and low-concentration sevoflurane group (Group S2).Etomidate,Propofol,Cisatracurium Besilate and Fentanyl were used for intravenous anesthetic induction and maintenance of anesthesia.In addition,B ispectralindex (BIS) remained between 35 ～ 45 and 45 ～ 55 in groups S1 and S2,re spectively.BIS remained between 40 ～ 50 in group C.Perioperative hemodynamic changes,ECG ST-segment before induction of anesthesia,endotracheal immediate intubation and extubation were recorded.Plasma concentrations of cTnT,high sensitive cardiac troponin (hs-cTnT) and high sensitive ereaetive protein (hs-CRP) were detected with central venous blood before anesthesia induction and immediate extubation.Results Compared with group C,the incidences of hypertension,tachycardia,myocardial ischemia,proiosystole and atrial fibrillation were significantly reduced in groups S1 and S2 (P ＜ 0.05);The incidences of bradycardia and hypotension groups were significantly higher in group S1 (P ＜ 0.05).Compared with group S1,the incidences of hypotension,bradycardia,myocardial ischemia were significantly reduced in group S2 (P ＜ 0.05).Compared with group C,plasma concentrations of cTnT,hs-cTnT and hs-CRP were significantly reduced after endotracheal extubation in group S1 and S2 (P ＜ 0.05).Conclusion Myocardial protective effect is better and less risky for patients with coronary artery disease undergoing noncardiac surgery by inhalation of 1.0％ to 2.5％ sevoflurane to maintain BIS between 45 to 55.

Objective:To evaluate the relationship between preoperative malnutrition and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods:The elderly patients who underwent elective thoracoscopic and laparoscopic radical esophagectomy in the Affiliated Hospital of Jiangnan University were enrolled.The general clinical data and nutritional status, Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, tumor pathological stage and operation-related variables based on the Gobal Leader Initiative on Malnutrition criteria were recorded.The patients were divided into 2 groups according to whether PPCs occurred during hospitalization, and the differences between the variables were compared.Logistic regression analysis was used to identify the risk factors for PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.The accuracy of the ARISCAT score and ARISCAT score combined with malnutrition in predicting the occurrence of PPCs was evaluated by receiver operating characteristic curve.Results:A total of 256 elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy were included, and the incidence of PPCs was 23.8%.There were no significant differences between patients with and without PPCs in FEV 1/FVC, age, American Society of Anesthesiologists physical status, chronic obstructive pulmonary disease ratio, malnutrition ratio and ratio of patients with high ARISCAT score ( P<0.05). The results of logistic regression analysis showed that increasing age, chronic obstructive pulmonary disease, malnutrition and high ARISCAT score were independent risk factors for PPCs.The area under the receiver operating characteristic curve of ARISCAT score and malnutrition combined with ARISCAT score in predicting the occurrence of PPCs was 0.722 and 0.777, respectively, and the difference was statistically significant ( P<0.05). Conclusions:Preoperative malnutrition is an independent risk factor for the occurrence of PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy, which is helpful in improving the accuracy of ARISCAT score in predicting the occurrence of PPCs.

Objective:To evaluate the relationship between preoperative frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic lobectomy.Methods:The elderly patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan University were collected.The general data, frailty status, parameters of blood and operation-related parameters were recorded.The patients were divided into PPC group and non-PPC group according to whether PPCs occurred during hospitalization, and the differences between the parameters were compared.Logistic regression analysis was used to analyze the independent risk factors for PPCs.Stratification analysis and interaction test were used to further analyze the relationship between frailty and PPCs.Results:A total of 298 elderly patients with non-small cell lung cancer undergoing thoracoscopic lobectomy were included in this study, and the incidence of PPCs was 22.8%.Compared with non-PPC group, the albumin and FEV 1/FVC were decreased, and age, blood creatinine, ratio of diabetes mellitus, ratio of chronic obstructive pulmonary disease (COPD) and rate of preoperative frailty were significantly increased in PPC group ( P<0.05). The results of logistic regression analysis showed that COPD and preoperative frailty were independent risk factors for PPCs.After adjusting all the risk variables, the frail patients had a 171% increased risk of PPCs compared with non-frail patients ( OR value=2.71, 95%CI: 1.18-4.73, P<0.05). The results of subgroup analysis showed that body mass index and operation time had effect modification on the association between frailty and PPCs (interaction P<0.05). Conclusion:COPD and preoperative frailty are independent risk factors for PPCs in elderly patients undergoing thoracoscopic lobectomy, and the frail patients with obesity or long operation time are at higher risk of PPCs.

Objective:To translate the Fremantle Knee Awareness Questionnaire (FreKAQ) into Chinese, and test its reliability and validity in patients with knee osteoarthritis.Methods:The English version of FreKAQ was translated, back translated, cross-cultural debugging, and pre survey interviews to determine the Chinese version of FreKAQ. From June 2017 to December 2020, a total of 200 patients with knee osteoarthritis admitted to the Department of Orthopedics of Lu'an Hospital of Anhui Medical University were selected by convenience sampling for investigation to test the reliability and validity of the Chinese version of FreKAQ. The critical ratio method was used to screen items, and the validity of the questionnaire was tested by content validity index, exploratory factor analysis and confirmatory factor analysis. Cronbach's α coefficient, split half reliability coefficient and retest reliability coefficient were used to test the reliability of the questionnaire.Results:Two common factors were extracted from the Chinese version of FreKAQ by the maximum variance orthogonal rotation method, and the cumulative variance contribution rate was 83.541%, including nine items. Cronbach's α coefficient of the total questionnaire was 0.905, Cronbach's α coefficients of each dimension were 0.913 and 0.905 respectively, the split half reliability coefficient of the total questionnaire was 0.903, and the retest reliability coefficient of the total questionnaire was 0.923. The content validity index of the average scale level was 0.906, and the content validity index of the item level was 0.885 to 1.000. The confirmatory factor analysis showed that the overall model fitted well.Conclusions:The Chinese version of FreKAQ has good reliability and validity, which can be used to assess the symptoms of knee awareness impairment in Chinese patients with knee osteoarthritis.

Objective:To evaluate the predictive value of preoperative frailty combined with nutritional status for prolonged postoperative ileus (PPOI) in the patients with gynecological malignancies.Methods:Patients undergoing elective surgery for gynecological malignancies in the Affiliated Hospital of Jiangnan University from April 2022 to February 2023 were selected. The Frail scale was used to evaluate the frailty within 24 h of admission, and the nutritional status was evaluated by the Controlling Nutritional Status score. The general characteristics of patients and occurrence of PPOI were recorded, and the risk factors for PPOI were analyzed by multivariate logistic regression. The ability of frailty, nutritional status and their combination to predict PPOI was assessed by the receiver operating characteristic curve.Results:Two hundred and fourteen patients were finally included, 52 cases developed of PPOI, and 98 cases were frail patients. Preoperative frailty combined with moderate to severe malnutrition was an independent risk factor for PPOI in the patients with gynecological malignancies ( P<0.05), and the area under the curve in predicting the occurrence of PPOI was 0.796 (95% confidence interval 0.736-0.857) in the patients with gynecological malignancies. Conclusions:Preoperative frailty combined with moderate to severe malnutrition has a higher accuracy in predicting PPOI in the patients with gynecological malignancies.