Objective To explore the method of anesthesia and intra-operative management for robotic thoracic surgery. Methods Twelve patients who underwent robotic thoracic surgery using the Da Vinci surgical system were anesthetized with general anesthesia combined with T4-8 paravertebral block. After induction of anesthesia, a double-lumen endotracheal tube was positioned by bronchofibroscope to allow onelung ventilation during intra-operative procedure. Hemodynamics and respiratory function were routinely monitored and arterial blood gas (ABG) were tested during operation. Results All patients could tolerate the anesthesia for robotic thoracic surgery and there was no hospital mortality. The arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after induction were (35.2 ± 3.6) mm Hg( 1 mm Hg =0.133 kPa) and (213.3 ± 57.5) mm Hg respectively; PaCO2 and PaO2 30 min after one -lung ventilation were (37.9 ± 4.8) mm Hg and ( 125.3 ± 36.5) mm Hg respectively. When the one-lung ventilation started about 58% (7/12) of the patient developed temporarily low SpO2 (over 0.90) and recovered to 0.95 soon when using 3 - 5 cm H2O( 1 cm H2O = 0.098 kPa) positive end expiratory pressure (PEEP). The anesthesia time was ( 291.5 ± 99.4) min, the time for one-lung ventilation was (206.3 ± 93.4) min, the volume of blood loses in operation was ( 171.7 ± 110.3 ) ml and the tracheal catheter extration time was ( 16.3 ± 4.5 ) min, all the patients left ICU on the second day after surgery. Conclusions The anesthesia for robotic thoracic surgery with Da Vinci surgical system is multiplicity, the hemodynamics and respiratory function can be instable, it is a new challenge for the technology and management of anesthesia. Good one-lung ventilation is important for this surgery, ventilation parameter need to be adjusted when hypoxia occurred and PEEP could be used to the ventilated lung. General anesthesia combined with paravertebral block will be a good option for postoperative pain control and minimal hemodynamics disturb ance.

Objective To investigate the risk factors of postoperative delirium in elderly patients with intertrochanteric facture.Methods This retrospective analysis was conducted on 256 patients aged over 65 years treated with internal fixation of intertrochanteric facture between January 2012 and December 2013.Incidence and risk factors of postoperative delirium were documented.Results Incidence of postoperative delirium was 14.8％ (38/256).Risk factors of postoperative delirium included body mass index (BMI) less than 20 kg/m2 (P ＜ 0.05),preoperative hemoglobin (Hb) less than 100 g/L (P ＜ 0.05),atrial fibrillation (P ＜ 0.05),low sodium (P ＜ 0.05),preoperative total protein less than 60 g/L (P ＜ 0.05),preoperative waiting time more than 4 days (P ＜ 0.05),preoperative cognitive impairment (P ＜ 0.05),operation time more than 2.5 hours (P ＜ 0.05),perioperation blood loss more than 1,000 ml (P ＜ 0.05),and more than two kinds of medical conditions (P ＜ 0.05).Logistic regression identified three independent factors for postoperative delirium:preoperative waiting time more than 4 days (P ＜ 0.05,OR =2.74),BMI less than 20 kg/m2 (P ＜ 0.05,OR =13.27),preoperative cognitive impairment (P ＜ 0.05,OR =4.47),and operation time more than 2.5 hours (P ＜ 0.05,OR =4.56).Conclusions Risk factors of postoperative delirium in elder patients with femoral intertrochanteric fracture are complicated.Therefore,overall situation should be taken into consideration and comprehensive and effective treatment should be formulated to prevent the occurrence of postoperative delirium.

Inflammatory caspase-11 senses and is activated by intracellular lipopolysaccharide (LPS) leading to pyroptosis that has critical role in defensing against bacterial infection, whereas its excess activation under pathogenic circumstances may cause various inflammatory diseases. However, there are few known drugs that can control caspase-11 activation. We report here that scutellarin, a flavonoid from Erigeron breviscapus, acted as an inhibitor for caspase-11 activation in macrophages. Scutellarin dose-dependently inhibited intracellular LPS-induced release of caspase-11p26 (indicative of caspase-11 activation) and generation of N-terminal fragment of gasdermin D (GSDMD-NT), leading to reduced pyroptosis. It also suppressed the activation of non-canonical nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome as evidenced by reduced apoptosis-associated speck-like protein containing a CARD (ASC) speck formation and decreased interleukin-1 beta (IL-1β) and caspase-1p10 secretion, whereas the NLRP3-specific inhibitor MCC950 only inhibited IL-1β and caspase-1p10 release and ASC speck formation but not pyroptosis. Scutellarin also suppressed LPS-induced caspase-11 activation and pyroptosis in RAW 264.7 cells lacking ASC expression. Moreover, scutellarin treatment increased Ser/Thr phosphorylation of caspase-11 at protein kinase A (PKA)-specific sites, and its inhibitory action on caspase-11 activation was largely abrogated by PKA inhibitor H89 or by adenylyl cyclase inhibitor MDL12330A. Collectively, our data indicate that scutellarin inhibited caspase-11 activation and pyroptosis in macrophages at least partly via regulating the PKA signaling pathway.