Objective:To explore the effect of hyperbaric oxygen (HBO) on the blood-brain barrier via the silent information regulator 1 (SIRT1)/Forkhead box O1(FoxO1) signaling pathway after cerebral ischemia and reperfusion using a rat model.Methods:Forty Wistar rats were randomly assigned into sham, cerebral ischemia-reperfusion (CIR), CIR+ HBO and CIR+ HBO+ EX527 groups, each of 10. The cerebral ischemia-reperfusion model was established in all groups except the sham group by right middle cerebral artery occlusion using the modified thread-occlusion method. The sham group was not ligated. Both the CIR+ HBO and CIR+ HBO+ EX527 groups were given HBO 1, 9, 21, 45 and 69 hours after the reperfusion. The CIR+ HBO+ EX527 group was additionally injected with 5mg/kg of EX527(a SIRT1inhibitor) peritoneally 4, 12, 24, 48 and 72 hours after the reperfusion. Then 2% Evens blue (EB) was injected into the tail vein an hour before the rats were sacrificed. The content of EB and the expression of SIRT1, FoxO1, ZO-1, Occludin, Claudin-5 mRNA and their proteins were determined using spectrophotometry, reverse transcription-polymerase chain reactions and Western blotting.Results:The average EB content of the hippocampal brain tissue from the CIR, CIR+ HBO and CIR+ HBO+ EX527 rats was significantly greater than the Sham group′s average 72h after reperfusion. The average expression of SIRT1, FoxO1, ZO-1, Occludin and Claudin-5 mRNA and their proteins was significantly lower, with the CIR + HBO + EX 527 group′s average significantly lower than that of the CIR+ HBO group.Conclusions:HBO can increase the expression of tight junction protein via the SIRT1/FoxO1 pathway. It helps to protect the blood-brain barrier in CIR injury situations.

Objective:To evaluate the effects of dexamethasone and etomidate on cortisol secretion in elderly patients undergoing general anesthesia.Methods:One hundred and twenty-five elderly patients of either sex, aged 66-90 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergoing minor and medium elective surgeries under general anesthesia, were allocated into 4 groups using a random number table method: propofol and normal saline group (group PN, n=31), propofol and etomidate group (group PD, n=31), etomidate and normal saline group (group EN, n=33) and etomidate and dexamethasone group (group ED, n=30). In PN and EN groups, propofol (2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.In PD and ED groups, etomidate (0.2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.The serum cortisol concentrations were measured at 8: 00 after entering the operating room on the morning of operation (T 1), 1 h after the start of anesthesia (T 2), 2 h after the start of anesthesia (T 3), 8: 00 on the next day ofoperation (T 4) and 8: 00 on the 2nd day of operation (T 5). Blood glucose concentrations were measured at T 1-T 3, and the hypotension during the peri-anesthesia period, nausea and vomiting in post-anesthesia care unit, and nausea and vomiting scores were recorded at 24 h after operation. Results:A total of 122 patients completed the trial.Compared with PN group, the concentration of serum cortisol was significantly decreased at T 2-T 5, blood glucose concentrations were increased at T 2 and T 3 ( P<0.05), and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in PD group ( P>0.05), and the concentration of serum cortisol was significantly decreased at T 2-T 4, the incidence of hypotension was decreased ( P<0.05), and no significant change was found in the blood glucose concentrations, incidence of nausea and vomiting or nausea and vomiting scores in EN group ( P>0.05). Compared with ED group, the serum cortisol concentration was significantly increased at T 2 and T 3, the incidence of hypotension was increased, the incidence of nausea and vomiting and nausea and vomiting scores were decreased ( P<0.05), and no significant change was found in the blood glucose concentrations in PD group ( P>0.05), and the serum cortisol concentration was significantly decreased at T 2 and T 3 and increased at T 4 and T 5, the serum cortisol concentration was decreased at T 2 and T 3, and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in EN group ( P>0.05). Conclusions:Combination of etomidate and dexamethasone significantly enhances the duration and degree of inhibition of cortisol secretion in elderly patients than etomidate or dexamethasone alone.

Objective To evaluate the efficacy of oxycodone for improvement of general anesthesia for laparoscopic cholecystectomy in elderly patients.Methods A total of 160 patients of both sexes,aged 65-75 yr,with body mass index ＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy,were divided into 2 groups (n =80 each) using a random number table method:general anesthesia group (group GA) and oxycodone + general anesthesia group (group OX+GA).Anesthesia induction:propofol was given by closed-loop infusion at the initial target plasma concentration of 2 μg/ml,the target bispectral index (BIS) value was set at 50,and 2 min later remifentanil was given by target-controlled infusion at the target plasma concentration of 4 ng/ml,and cisatracurium 0.2 mg/kg was intravenously injected when BIS value was decreased to 70.Laryngeal mask airways were inserted and the patients were mechanically ventilated when BIS value was decreased to 50 and TOF ratio was decreased to 25％,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Anesthesia maintenance:propofol was given by closed-loop infusion,the target BIS value was set at 50,cisatracurium 0.1 mg/kg was intravenously injected when TOF ratio was increased to 10％;remifentanil was given by target-controlled infusion at the target plasma concentration of 4-6 ng/ml.Oxycodone 0.07 mg/kg was intravenously injected at 5 min before stretching internal organs.Before anesthesia,at 5 min after laryngeal mask airway placement,at skin incision and while stretching internal organs,analgesia nociception index value and perfusion index value were recorded,the development of intraoperative cardiovascular events,emergence time,time for removal of laryngeal mask airway,time of post-anesthesia care unit stay and development of nausea and vomiting and back and shoulder pain within 48 h after surgery were also recorded.Results Compared with group GA,the analgesia nociception index value and perfusion index value were significantly increased while stretching internal organs,and the incidence of intraoperative hypertension,tachycardia,and nausea and vomiting and back and shoulder pain within 48 h after surgery were decreased in group OX-GA (P＜0.05).Conclusion Oxycodone can inhibit nociceptive stimuli,is helpful in maintaining stable hemodynamics and reduces postoperative complications in elderly patients undergoing laparoscopic cholecystectomy under combined general anesthesia.

Objective:To study the influence of periventricular-intraventricular hemorrhage (PVH-IVH) on cerebral blood flow (CBF) of preterm infants in the late postnatal period using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From January 2023 to June 2023, 65 preterm infants (gestational age <32 weeks, birth weight <1 500 g) who were born in the Department of Obstetrics, Third Affiliated Hospital of Zhengzhou University and transferred to the Neonatal Intensive Care Unit were included in the prospective study.They were examined by the brain MRI and ASL at the corrected gestational age of 35-40 weeks.According to the results of the brain ultrasound within 1 week after birth, they were divided into the mild IVH group (25 cases) and the non-IVH group (40 cases). The CBF values in regions of interest (frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, and basal ganglia) on ASL images were compared.Multiple linear regression analysis was used to analyze the effect of PVH-IVH on CBF values in different ASL regions of interest, including frontal cortex, temporal cortex, parietal cortex, occipital cortex, thalamus, and basal ganglia.Results:Compared with those of non-IVH group, infants in the mild IVH group presented significantly older gestational age [29.0 (28.5, 30.4) weeks vs.28.2 (27.0, 31.0) weeks, Z=-2.398, P=0.016], higher hematocrit (HCT) in the latest examination prior to the brain MRI [29.6(26.4, 32.3)% vs.27.8 (25.6, 30.5)%, Z=-2.155, P=0.031], and larger body weight at the time of examination [2 015.0 (1 930.0, 2 127.5) g vs.1 950.0 (1 900.0, 1 997.5) g, Z=-3.314, P=0.001]. After adjustment for confounding factors of gestational age at birth, latest HCT and weight at the time of examination, the multivariable linear regression analysis showed that CBF values in the frontal lobe (95% CI: -8.367--4.042; P<0.001), temporal lobe (95% CI: -19.077--2.854; P=0.008), parietal lobe (95% CI: -8.344--3.502; P<0.001), occipital lobe (95% CI: -9.446--3.645; P<0.001), basal ganglia (95% CI: -7.543--1.963; P=0.001) and thalamus (95% CI: -8.051--2.372; P<0.001) were significantly lower in infants of the mild IVH group than those of non-IVH group. Conclusions:At the same corrected gestational age, mild IVH is correlated with low CBF values in local cerebral cortex and subcortical gray matter in premature infants.However, the predictive potential of CBF values in long-term neurological prognosis requires further explorations.

The corona virus disease 2019 (COVID-19) caused by the new coronavirus (SARS-CoV-2) has spread rapidly around the world,posing a serious threat to the public"s health. As of September 30,2020,the number of infected people in the world has reached 33 million,causing more than 1 million deaths. Normalized nucleic acid detection methods based on lab have long turnaround time and high cost. Therefore,there is an urgent need to develop a convenient method to detect SARS-CoV-2,so as to achieve rapid testing and timely control of the epidemic when resources are limited.This review summarizes the point-of-care testing (POCT) methods developed for SARS-CoV-2 in terms of extraction,amplification and detection,and briefly introduces commercial POCT instruments that integrate these three steps,in order to provide references for emergency response and rapid deployment of COVID-19 and other emerging infectious diseases.

Objective:To compare the efficacy of arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons in the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament (ATFL) tissue.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with chronic ankle instability treated at Huashan Hospital Affiliated to Fudan University from January 2018 to August 2020, including 34 males (34 ankles) and 3 females (3 ankles); aged 18-57 years [(32.2±7.2)years]. The time from injury to operation ranged from 3-360 months [48(12, 120)months]. All patients underwent arthroscopic all-inside ankle stabilization surgery, of which 19 underwent ligament repair with suture augmentation (augmented repair group) and 18 underwent traditional ligament reconstruction with allograft/autograft tendons (tendon reconstruction group). The degree of ATFL injury and intra-articular lesions (osteophytes, loose bodies and cartilage damage) were recorded during the operation. The Karlsson scale and Tegner scale were evaluated before operation and at the last follow-up. The number of patients who were able to complete partial weight-bearing/return to normal walking/return to sports postoperatively and the time required were compared between the two groups. Postoperative complications were observed.Results:All patients were followed up for 12-32 months [21(16, 28)months]. There were no significant differences in the degree of ATFL injury and intra-articular lesions (osteophytes, loose bodies and cartilage damage) seen during the operation between the two groups (all P>0.05). At the last follow-up, the Karlsson score in augmented repair group and tendon reconstruction group [95.0(90.0, 98.5)points and 95.0(87.8, 99.3)points] was significantly higher than the preoperative level [65.0(51.0, 75.0)points and 65.0(53.3, 78.0)points] (all P<0.01). At the last follow-up, the Tegner score in augmented repair group and tendon reconstruction group [5.0(3.5, 6.0)points and 5.0(3.3, 6.0)points] were significantly higher than the preoperative level [3.0(2.0, 4.0)points and 2.5(1.3, 4.0)points] (all P<0.01). There were no significant differences in Karlsson score and Tegner score between the two groups (all P>0.05). All patients completed partial weight-bearing after 3.0(2.0, 4.0)weeks in augmented repair group and 4.0(3.5, 6.0)weeks in tendon reconstruction group. All patients returned to normal walking after 8.0(6.0, 9.0)weeks in augmented repair group and 8.0(5.5, 12.0)weeks in tendon reconstruction group. A total of 13 patients (63%) in augmented repair group and 13 patients (72%) in tendon reconstruction group successfully returned to sports postoperatively and the time required was 6.0(3.5, 8.0) months and 6.0(4.5, 12.0)months, respectively. There were no significant differences in the above indicators between the two groups (all P>0.05), but augmented repair group had a trend of faster completion of partial weight-bearing than tendon reconstruction group. There was 1 patient [5%(1/19)] in augmented repair group and 1 patient [6%(1/18)] in tendon reconstruction group who reported feelings of instability during exercise postoperatively ( P>0.05). None of the patients in augmented repair group had limited ankle range-of-motion, not different from 1 patient [6%(1/18)] in tendon reconstruction group ( P>0.05). Conclusion:In the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament (ATFL) tissue, both arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons can improve the short-term postoperative ankle function and activity level of the patients, and the former one has advantages such as simple operative procedures and none use of grafts.

Objective:To study the current status of critical neonatal care centers (CNCC) construction and treatment of critically-ill neonates at city- and county-level in Henan Province.Methods:A questionnaire survey was conducted in January 2022 to city- and county-level CNCC in Henan Province. The basic information of CNCC, ward settings, neonatal management in the Department of Obstetrics and the treatment of critically-ill neonates in 2019-2021 were analyzed.Results:A total of 188 questionnaires were sent and 183 (97.3%) eligible questionnaires were analyzed, including 30 from city centers and 153 from county centers. The bed occupancy rate in county centers was significantly lower than city centers (67.3%±24.1% vs. 86.1%±23.2%), and the doctor/bed ratio, doctor/rescue bed ratio and nurse/rescue bed ratio were significantly higher than city centers ( P<0.05). All city centers had set up independent Department of Neonatology and the number is 92.8% (142/153) in county center. For 80.9% (148/183) centers, neonates were managed in the Department of Obstetrics with consultations and referrals to the Department of Pediatrics and 19.1% (35/183) were managed in the Department of Pediatrics/Neonatology. The average number of deliveries and admissions to the Department of Neonatology in both city and county centers decreased year on year during 2019-2021, but the proportion of premature and low/very low birth weight infants treated in these centers increased year on year. During 2019-2021, the top three diseases treated at the city centers were neonatal respiratory distress syndrome, neonatal asphyxia and acute respiratory distress syndrome, while the top three diseases treated at the county centers were neonatal asphyxia, neonatal respiratory distress syndrome and meconium aspiration syndrome. The incidence of sudden infant death syndrome in city and county centers was (10~30)/100,000. Conclusions:The construction of CNCC in Henan Province is facing challenges such as decreased hospital admissions, increased critically-ill neonates, insufficient cooperation between Obstetrics and Pediatrics and waste of resources. Rationally allocated and optimised use of resources to improve the ability to treat critically-ill neonates is warranted.

ObjectiveTo identify causal factors of a case of severe Chlamydia psittaci pneumonia in Yangpu District and provide a scientific basis for effective prevention and control. MethodsBasic information and epidemiological data of the patient were collected through telephone interviews and field epidemiological surveys. Specimens from the patient， close contacts and the environment were collected for pathogen detection. Metagenomics next-generation sequencing （mNGS） was used to identify unknown pathogens. ResultsA 65-year-old male patient with a history of hypertension and diabetes was admitted to the hospital with symptoms of fatigue， poor appetite for a week， fever and cough for four days. A chest computer tomography （CT） scan showed scattered inflammation in the left lung with infiltration of multiple lobes. Blood gas analysis showed type I respiratory failure. The results of mNGS on the bronchoalveolar lavage fluid of the patient indicated that he was infected with Chlamydia psittaci. Epidemiological investigation showed a clear history of avian exposure， with an incubation period of 30 days. ConclusionThis serious pneumonia is a zoonotic disease caused by Chlamydia psittaci. A clear history of avian exposure and the use of mNGS technology can help in the timely diagnosis of this disease.