Objective To observe the effects of acetyl-l-carnitine (ALC) on autophagy, apoptosis and motor function after acute spinal cord injury (ASCI) in rats. Methods Thirty-six adult female Sprague-Dawley rats were randomly divided into sham operation group (Sham group, n=12), simple spinal cord injury group (SCI group, n=12), ALC treatment group (ALC group, n=12). Spinal cord injury model at the level of T10 segment was established using Allen's method. They were assessed with Basso-Beattle-Bresnahan (BBB) scale three days after injury. Then the rats were sacrificed, and the expression of microtubule associated protein 1 light chain 3 (LC3)-II in spinal cord was detect-ed with Western blotting and immunofluorescent labeling, and the number of apoptotic cells were assessed with TUNEL staining. Results The expression of LC3-II and the number of apoptotic cells increased in SCI group compared with those in Sham group (P<0.01), while the BBB score decreased (P<0.001). The expression of LC3-II increased and the number of apoptotic cells decreased in ALC group compared with those in SCI group (P<0.001), while the BBB score increased (P<0.01). Conclusion ALC may promote autophagy, and inhibit apopto-sis to improve the locomotor function after ASCI.

Objective:To systematically review the effect of bilateral thoracic paravertebral nerve block (TPVB) on postoperative analgesia in the patients undergoing coronary artery bypass grafting (CABG) under general anesthesia (GA) using a meta-analysis.Methods:A systematic search of PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases was performed, with a limited search period ending in December 2023. Randomized controlled trials regarding bilateral TPVB combined with GA versus GA alone for postoperative analgesia following CABG were included. The primary outcome was the rate of 24 h postoperative rescue analgesia. Secondary outcomes were intraoperative opioid consumption, incidence of intraoperative adverse reactions, indicators related to postoperative recovery, and incidence of postoperative adverse reactions. This meta-analysis was performed by using the " meta" package in R studio software.Results:A total of 9 papers ( n=788) were included. Compared to GA, bilateral TPVB combined with GA reduced intraoperative opioid consumption ( SMD=-1.88, 95% confidence interval [ CI] -2.80--0.96), decreased the rate of 24 h postoperative rescue analgesia ( RR=0.17, 95% CI 0.06-0.46) and the incidence of postoperative adverse reactions ( RR=0.39, 95% CI 0.25-0.60) and shortened postoperative extubation time ( MD=-1.52, 95% CI -2.01--1.03), postoperative intensive care unit stay ( MD=-4.40, 95% CI -5.29--3.51) and postoperative hospitalization time ( MD=-0.70, 95% CI -1.37--0.04). Conclusions:Bilateral TPVB can enhance the postoperative analgesic effect in the patients undergoing CABG under general anesthesia.

Objective To observe and analyze the effect of HbA1c level on macular microcirculation in patients with type 2 diabetes mellitus (T2DM).Methods A cross-sectional study.One hundred and twenty-four T2DM patients (124 eyes) without diabetic retinopathy who diagnosed by the examination of fundus color photography in Lixiang Eye Hospital Of Soochow University during September to December 2017 were enrolled in this study.There were 59 males (59 eyes) and 65 females (65 eyes),with the mean age of 65.06±7.99 years old.All patients underwent BCVA,fundus color photography,and OCT angiography (OCTA).The history of diabetes,hypertension and dyslipidemia were recorded in detail.According to the HbA 1 c level,patients were divided into three groups,HbA1c ideal control group (group A,HbA1c ＜7％,67 eyes),HbA1c control group (group B,7％≤HbA1c≤9％,44 eyes),and HbA1c poor control group (group C,HbA1c＞9％,13 eyes),respectively.The 3 mm × 3 mm range of the macular area was scanned by OCTA instrument.The vascular density (VD) and skeleton density (SD) of nonsegmented retinal layer (NRL),superficial retinal layer (SRL) and deep retinal layer (DRL) in the macular area and foveal avascular zone (FAZ) area,non-circularity index,axial rate (AR) of SRL were measured.The correlation between HbA1c,BCVA and VD,SD ofNRL,SRL,DRL was analyzed statistically with Spearman correlation test.The correlation between systemic factors and the above indicators was analyzed statistically with linear regression analysis.Results The results of linear regression analysis showed that HbA1 c was significantly correlated with VD (t=-3.237,-3.156,-2.050) and SD (t=-0.3.45,-3.034,-2.248) of NRL,SRL and DRL (P＜0.05);but no correlation with FAZ,non-circularity index and AR (t=1.739,0.429,1.155;P＞0.05).The differences of VD (F=6.349,5.981,3.709),SD (F=7.275,6.085,1.904) and AR (F=0.027) of NRL,SRL and DRL in group A,B and C were statistically significant (P＜0.05);but the differences of FAZ (F=1.904),non-circularity index (F=0.280) was not statistically significant (P＞0.05).Significant differences (P＜0.05) of VD and SD of NRL were found between group A and B (t=1.987,2.201),group A and C (t=3.365,3.572),group B and C (t=2.010,2.076).Significant differences (P＜0.05) of VD and SD of SRL were found between group A and B (t=2.087,2.168),group A and C (t=3.197,3.194).There were significant differences (P＜ 0.05) in SD of DRL between group A and B (t=2.239),group A and C (t=-2.519).There was significant difference in VD of DRL between group A and C (t=2.363).The results of Spearman correlation analysis showed that HbA1c was negatively correlated with VD (r=-0.273,-0.255,-0.222;P=0.002,0.004,0.013) and SD (r=-0.275,-0.236,-0.254;P＜0.05) ofNRL,SRL,DRL;positively correlated with FAZ and BCVA (r=0.221,0.183;P＜0.05).BCVA was negatively correlated with VD (r=-0.210,-0.190,-0.245) and SD (r=-0.239,-0.207,-0.296) of NRL,SRL,and DRL (P＜0.05),but not correlated with FAZ (r=0.099,P＞0.05).Conclusion The decrease of macular perfusion and the morphological change of FAZ accompanied by HbA1c increased.