Objective To investigate the impacts of sevoflurane combined with lung protective ventilation strategy on pulmonary ventilation function and lung compliance in obese patients undergoing laparoscopic weight loss surgery.Methods 60 obese patients underwent laparoscopic weight loss surgery were randomly divided into two groups.The control group was given lung protective ventilation intervention alone during anesthesia,and the study group was given sevoflurane inhalation anesthesia combined with lung protective ventilation intervention.Arterial blood was collected before tracheal intubation(T0),5 min after tracheal intubation(T1),40 min after tracheal intubation(T2)and 5 min after tracheal extubation(T3)for blood gas analysis.The pulmonary ventilation function and lung compliance of patients in the two groups were compared.Results Peak airway pressure(Ppeak)and plateau airway pressure(Pplat)at T2 were lower in the study group than those in the control group,and the differences were statistically significant(P<0.05);At T2 and T3 time points,the dynamic lung compliance(Cldyn)of the study group was higher than that of the control group,and the differences were statistically significant(P<0.05);7 days after surgery,the forced vital capacity(FVC)and forced expiratory volume in one second(FEV1)in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05);At time points T1,T2 and T3,the levels of serum transforming growth factor-β1(TGF-β1),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the study group were lower than those in the control group(P<0.05);After surgery,the awakening time,spontaneous breathing recovery time,and extubation time in the study group were shorter than those in the control group,the number of adverse events during the recovery period was less than that in the control group,after awakening,the Ramsay score was lower than that in the control group(P<0.05).Conclusion The combination of sevoflurane and lung protective ventilation strategy can reduce inflammatory response,improve pulmonary ventilation function,and improve lung compliance in obese patients undergoing laparoscopic weight loss surgery,with good safety and fast postoperative recovery.

Objective To investigate the effects of pressure controlled ventilation-volume guaranteed(PCV-VG)mode on respiratory mechanics and gas exchange index in pediatric patients underwent laparoscopic herniorrhaphy.Methods 90 patients,scheduled for elective laparoscopic herniorrhaphy under general anesthesia of tracheal intubation,were randomly divided into 3 groups(n=30 each)using a random number table method:PCV-VG group,pressure controlled ventilation(PCV)group and volume controlled ventilation(VCV)group.At 5 min before pneumoperitoneum(T1),10 min after pneumoperitoneum(T2)and 5 min after release of pneumoperitoneum pressure(T3),respiratory mechanical indexes[inspiratory tidal volume(VTinsp),peak airway pressure(Ppeak),mean airway pressure(Pmean),dynamic lung compliance(Cldyn)]were recorded and gas exchange index[alveolar-artery oxygen partial pressure gradient(PA-aO2),respiratory index(RI)and oxygenation index(OI)]were recorded in three groups.The occurrence of pulmonary complications were recorded within 7 d after operation in three groups.Results Compared with the VCV group,Ppeak was significantly decreased and Cldyn was significantly increased at T2 and T3 time points in PCV-VG group and PCV group,the differences were statistically significant(P<0.05);Compared with PCV group,Ppeak was decreased at T2 and T3 time points in PCV-VG group,the difference was statistically significant(P<0.05).Compared with T1 time points,Ppeak and Pmean were increased and Cldyn was decreased at T2 and T3 time points in VCV group,Ppeak and Pmean were increased and Cldyn was decreased at T2 in PCV-VG group and PCV group,the differences were statistically significant(P<0.05).There were no significant differences in PA-aO2,RI and OI among three groups at T1,T2 and T3 time points(P>0.05).Compared with T1 time point,PA-aO2 and RI were increased and OI was decreased at T2 and T3 time points in three groups,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications among the three groups(P>0.05).Conclusion PCV-VG mode can effectively reduce Ppeak and improve lung compliance,which is suitable for laparoscopic herniorrhaphy in pediatric patients.

Objective:To evaluate the effect of buccal acupuncture on analgesia after tonsilloadenoidectomy in pediatric patients.Methods:This was a randomized controlled study. One hundred and twenty-six American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ pediatric patients, aged 3-12 yr, weighing 12-34 kg, with body mass index <30 kg/m 2, undergoing elective tonsilloadenoidectomy with general anesthesia, were divided into 2 groups ( n=63 each) by the random number table method: buccal acupuncture group (group B) and control group (group C). All pediatric patients received the same anesthesia induction and intraoperative anesthesia maintenance. The concentration of sevoflurane was adjusted to keep the fluctuation amplitude of vital sign parameters within 20% of the baseline value. After surgery, the drug was immediately stopped and the children were transferred to the postanesthesia care unit for resuscitation under general anesthesia. In group B, the bilateral neck points, upper neck points, hologram points on the head and Zhongjiao points were selected before removal of the tracheal catheter, and disposable acupuncture needles were inserted directly into the acupoints and remained for 20-30 min. Group C received no buccal acupuncture. The pain Assessment Scale (FLACC) was used to assess the severity of postoperative pain. The postoperative agitation score was evaluated by Aono four-point rating method to evaluate the occurrence of agitation. The effective pressing times of patient-controlled analgesia, rescue analgesia and occurrence of nausea and vomiting within 48 h after operation were recorded. The occurrence of bleeding, infection and broken needle at acupuncture sites was recorded. Results:Compared with group C, the effective pressing times of patient-controlled analgesia and incidence of nausea and vomiting were significantly decreased in group B ( P<0.05). There was no significant difference in the rate of rescue analgesia and incidence of postoperative agitation between the two groups ( P>0.05). No infection or broken needle was found at acupuncture sites after buccal acupuncture, only 2 cases had slight bleeding at the puncture site, and there was no abnormality after pressing in group B. Conclusions:Buccal acupuncture can enhance the analgesic effect after tonsilloadenoidectomy in pediatric patients.

Objective:To investigate molecular mechanisms underlying the inflammatory response induced by Cutibacterium acnes ( C. acnes) biofilms in human primary keratinocytes. Methods:A C. acnes biofilm model was established in vitro, and confocal fluorescence microscopy was performed to examine its three-dimensional structure. The cultured human primary keratinocytes were divided into 3 groups: a dimethyl sulfoxide (DMSO) control group (treated with 0.01% DMSO alone), a C. acnes suspension group (co-incubated with C. acnes suspensions), and a C. acnes biofilm group (co-incubated with C. acnes biofilms). Real-time fluorescence-based quantitative PCR (RT-qPCR) was performed to determine the relative mRNA expression of interleukin (IL) -6, IL-8, and tumor necrosis factor (TNF) -α in the groups after 6-hour culture, enzyme-linked immunosorbent assay to detect the free protein levels of IL-6, IL-8, and TNF-α in the groups after 24-hour culture, and Western blot analysis to determine the protein expression of Toll-like receptor 2 (TLR2) in keratinocytes. In addition, some human primary keratinocytes were pretreated with key molecular blockers targeting the TLR2/mitogen-activated protein kinase (MAPK) /nuclear factor (NF) -κB signaling pathway (C29, ST2825, BAY11-7082, SB203580, U0126-EtOH), and then co-incubated with C. acnes biofilms; the DMSO control group and the C. acnes biofilm group receiving no pretreatment were simultaneously set as negative and positive controls, respectively. The mRNA and free protein expression levels of IL-6, IL-8, and TNF-α were then detected in the above groups. One-way analysis of variance was used for comparisons among multiple groups, and the Bonferroni method was used for multiple comparisons. Results:Confocal fluorescence microscopy demonstrated a three-dimensional C. acnes biofilm structure resembling a lawn, and the biofilm grew well. RT-qPCR and ELISA showed significant differences in the mRNA and free protein expression levels of IL-6, IL-8, and TNF-α among the C. acnes biofilm group, C. acnes suspension group and DMSO control group (mRNA: F = 89.70, 312.17, 46.09, respectively, all P < 0.001; free protein: F = 886.12, 634.25, 307.01, respectively, all P < 0.001) ; in detail, the mRNA and free protein expression levels of IL-6, IL-8, and TNF-α were significantly higher in the C. acnes biofilm group than in the C. acnes suspension group and DMSO control group (all P < 0.001) ; the C. acnes suspension group showed significantly increased expression levels of IL-6 mRNA and TNF-α free protein compared with the DMSO control group ( P < 0.001, = 0.003, respectively), while there were no significant differences in the expression of IL-6 free protein, TNF-α mRNA, or IL-8 mRNA and free protein between the 2 groups (all P > 0.05). Western blot analysis showed that the TLR2 protein expression was significantly higher in the C. acnes suspension group and C. acnes biofilm group than in the DMSO control group. After the pretreatment with molecular blockers targeting the MAPK/NF-κB signaling pathway and co-incubation with C. acnes biofilms, the mRNA and free protein expression levels of IL-6, IL-8 and TNF-α were all significantly lower in the C29 group, ST2825 group, BAY11-7082 group, SB203580 group, U0126-EtOH group, as well as in the DMSO control group compared with the C. acnes biofilm group (all P < 0.05) . Conclusion:The C. acnes biofilms exhibited a strong ability to induce inflammatory responses in human keratinocytes, possibly through the activation of the TLR2/MAPK/NF-κB signaling pathway.

Objective:To explore the role of peroxisome proliferator-activated receptor (PPAR) signaling pathway in the pathogenesis of acne inversa (AI) .Methods:Skin tissue samples were obtained from 8 AI patients and 4 healthy controls from Hospital of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College from 2013 to 2019, and high-throughput sequencing was performed for tissue-specific mRNA expression profiling. Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and Gene Set Enrichment Analysis (GSEA) were carried out. Real-time fluorescence-based quantitative PCR (qPCR) and Western blot analysis were performed to verify the results of high-throughput sequencing.Results:Analysis of the specific expression profiles showed that 2 738 differentially expressed genes were screened out in the AI patients compared with the healthy controls, of which 1 328 genes were significantly up-regulated and 1 410 genes were significantly down-regulated. GO analysis demonstrated that the positive regulation of interferon γ secretion, T cell receptor complex and C-X-C chemokine receptor activity were significantly enriched in the AI lesions. KEGG analysis demonstrated that the signaling pathways associated with primary immuno‐deficiency, PPAR, and chemokine-chemokine receptor interaction were significantly enriched in the AI lesions. GSEA demonstrated that the PPAR signaling pathway was significantly weakened in the AI lesions. The mRNA expression levels of PPARA and PPARG were significantly lower in the AI patients (0.336 ± 0.120, 0.253 ± 0.078, respectively) than in the healthy group (1.000 ± 0.146, 1.000 ± 0.172, t = 3.50, 3.95, respectively, both P < 0.05), so were their protein levels. However, there was no significant difference in the PPARD mRNA expression level between the two groups ( t = 0.34, P = 0.750). The mRNA expression levels of nuclear hormone receptor 9-cis retinoid X receptor alpha (RXRA), RXRG and fatty acid-binding protein 4 were significantly lower in the AI patients than in the healthy controls ( t = 2.96, 2.96, 4.62, respectively, all P < 0.05) . Conclusion:The PPAR signaling pathway was restrained and lipid metabolism was disordered in AI patients.

In view of the high incidence of malignant diseases such as malignant arrhythmias in the elderly population, accidental injuries such as falls, and the problem of no witnesses when danger occurs, the study developed a human vital signs and body posture monitoring and positioning alarm system. Through the collection and analysis of electrocardiogram (ECG), respiration (RESP) and acceleration (ACC) signals, the system monitors human vital signs and body posture in real time, automatically judges critical states such as malignant arrhythmias and accidental falls on the local device side, and then issues alarm information, opens the positioning function, and uploads physiological information and patient location information through 4G communication. Experiments have shown that the system can accurately determine the occurrence of ventricular fibrillation and falls, and issue position and alarm information.
Humans ; Aged ; Arrhythmias, Cardiac/diagnosis* ; Ventricular Fibrillation ; Electrocardiography ; Accidental Falls ; Vital Signs ; Posture ; Monitoring, Physiologic

Objective:To investigate the diagnosis and differential diagnosis methods of chronic mature small B-cell lymphoma involving the bone marrow and peripheral blood.Methods:The clinical data of 27 patients with mature small B-cell lymphoma involving the bone marrow and peripheral blood (seven subtypes phase IV) who received treatment in the Kunshan Third People's Hospital from February 2015 to June 2021 were retrospectively analyzed. The application value of different detection methods in the diagnosis of mature small B-cell lymphoma involving the bone marrow and peripheral blood was analyzed.Results:The majority of patients' peripheral blood was mainly characterized by an increase in the ratio or absolute value of lymphocytes. In terms of cell morphology, mature lymphocytes were mainly small to medium in size. A few bone marrow smears or peripheral blood smears show characteristic changes in cell morphology. Flow cytometry results showed that among the cohort of 15 patients presenting CD5 expression, 11 patients had chronic lymphocytic leukemia, 1 patient had mantle cell lymphoma, 1 patient had splenic diffuse red pulp small B-cell lymphoma, and 2 patients had B-cell chronic lymphoproliferative disorders (unclassified). Among 12 patients presenting no CD5 expression, 8 had Waldenstr?m's macroglobulinemia, 3 had splenic marginal zone lymphoma, and 1 had follicular lymphoma. Among the 2 patients presenting CD5-CD10 expression, 1 patient had follicular lymphoma, and 1 patient had Waldenstr?m's macroglobulinemia. One patient with splenic diffuse red pulp small B-cell lymphoma expressed CD5, CD11c, and CD103 in addition to pan-B-cell markers, while BRAF V600E mutation detection and immunohistochemical staining for tartrate-resistant acid phosphatase and annexin-1A showed negative expression.Conclusion:This type of lymphoproliferative disease is a general term for lymphoma that has various different molecular and biological characteristics. Its diagnosis and differential diagnosis need to comprehensively consider the clinical characteristics of the patient, relevant laboratory tests, cell morphology, flow cytometry detection results, reasonable use of fluorescence in situ hybridization, molecular biology, special chemistry, and bone marrow immunohistochemistry. In a few cases, diagnosis of the lymphoproliferative disease still relies on non-bone marrow involvement and tissue biopsy.

Objective:To prepare a fluorescent probe Cetuximab-IRDye800CW targeting epidermal growth factor receptor (EGFR) and investigate its application value in surgical navigation of glioblastoma (GBM).Methods:The fluorescence properties of Cetuximab-IRDye800CW were determined by fluorescence spectrophotometer. The specificity of Cetuximab-IRDye800CW bound to GBM cells was verified by Western blot. The competitive binding method of enzyme-linked immunosorbent assay (ELISA) was used to prove whether the probe could achieve tumor targeting by binding to EGFR. Subcutaneous models of 6 nude mice of GBM were divided into experimental group ( n=3; injected with Cetuximab-IRDye800CW) and control group ( n=3; injected with IRDye800CW), and images were obtained at 5 min, 24 h, 48 h and 72 h after injection. Differences of mean fluorescence intensity (MFI) and tumor to background ratio (TBR) between experimental group and control group were compared. In situ models of GBM nude mice were established ( n=6), and MRI and intraoperative navigation were conducted, which were compared with pathological distribution. Independent-sample t test was used to analyze the data. Results:The maximum emission wavelength of Cetuximab-IRDye800CW was 820 nm, which could be received by near infrared fluorescence imaging equipment. Western blot showed that Cetuximab-IRDye800CW was only bound to GBM cells. The competitive binding of ELISA showed that Cetuximab-IRdye800CW could achieve tumor targeting by binding with EGFR. At 5 min, 24 h, 48 h and 72 h after injection of fluorescent materials, the MFI values of experimental group were 109.00±3.81, 73.36±9.93, 55.24±8.82, 37.71±6.11, which were higher than those of control group (91.32±4.17, 42.91±5.39, 25.08±6.05, 8.33±1.00; t values: 4.36-9.40, P values: 0.011-0.049). The TBR of experimental group was higher than that of control group at 24 h and 48 h after injection (24 h: 2.40±0.28 vs 1.57±0.07, t=4.94, P=0.039; 48 h: 2.07±0.12 vs 1.22±0.08, t=9.85, P=0.010). GBM in situ model was successfully constructed and verified by MRI, and the tumor was visualized under the fluorescence device navigation. Pathological distribution of the tumor with HE staining was consistent with fluorescence imaging. Conclusion:Cetuximab-IRDye800CW has fluorescence imaging capability and can identify tumor boundaries in intraoperative navigation of GBM, which has potential clinical application value.

Hidradenitis suppurativa (HS) /acne inversa (AI) is a chronic, recurrent and inflammatory skin disease caused by follicular atresia with varying clinical manifestations, and there is no unified classification criteria for it in China and other countries. Based on its clinical characteristics, gene mutations and their correlations, researchers have enriched the subtype classification of HS/AI. This review summarizes recent advances in clinical phenotypes and genotypes of HS/AI as well as their relationships, in order to help clinicians better understand the disease, and provide a theoretical basis for correct diagnosis and individualized treatment strategies.

Objective:To investigate the inhibitory effect of deoxyribonuclease Ⅰ (DNaseⅠ) on Cutibacterium acnes biofilms. Methods:Cutibacterium acnes biofilms were constructed, and then were divided into 4 groups (negative control group, 5, 10 and 20 U/ml DNase Ⅰ groups) to be treated with DNase Ⅰ at different concentrations of 0, 5, 10 and 20 U/ml respectively. The biofilm viability was evaluated by tetrazolium salt colorimetric assay, the biofilm content was determined by crystal violet staining-based semi-quantitative analysis, the biofilm structure was observed by confocal laser scanning microscopy, and the live/dead bacteria ratio was calculated. One-way analysis of variance was used to analyze differences between groups. Results:After the treatment with DNase Ⅰ, the biofilm viability was significantly inhibited in the 5, 10 and 20 U/ml DNaseⅠ groups (1.882 ± 0.421, 1.653 ± 0.287, 1.473 ± 0.154, respectively) compared with the negative control group (2.668 ± 0.245), and the inhibitory effect was gradually enhanced with the increase in concentrations of DNase Ⅰ ( F = 9.68, P = 0.005). Crystal violet semi-quantitative analysis showed that the biofilm content was also significantly lower in the 5, 10 and 20 U/ml DNaseⅠ groups (1.039 ± 0.003, 0.489 ± 0.079, 0.147 ± 0.034, respectively) than in the negative control group (1.359 ± 0.071), and the higher the DNase Ⅰ concentration, the lower the biofilm content ( F = 174.40, P < 0.001). Confocal laser scanning microscopy showed that the biofilm structure was destroyed in the 5, 10 and 20 U/ml DNase Ⅰ groups compared with the negative control group, and the higher the DNase Ⅰ concentration, the more severe the destruction of biofilm structure. Additionally, the live/dead bacteria ratio was significantly lower in the 5, 10 and 20 U/ml DNaseⅠ groups (2.303 ± 0.457, 1.534 ± 0.526, 1.263 ± 0.354, respectively) than in the negative control group (4.475 ± 0.146), and the ratio decreased with the increase in concentrations of DNase Ⅰ ( F = 56.75, P < 0.000 1) . Conclusion:DNase Ⅰ had a destructive effect on the structure of Cutibacterium acnes biofilms, and could inhibit their viability.