This study presents a case of a girl of three year and 4 month old with ataxia and severe sen-sorineural hearing loss for 2 years.In order to improve hearing,she was hospitalized in the PUMC Hospital.Ge-netic testing performed found compound heterozygous variants of c.1186C＞T(p.P396S)and c.1357C＞T(p.R453W)in TWNK gene.After a multidisciplinary discussion of the case,the team suspected mitochondrial DNA depletion syndrome type 7(hepatocerebral type).The patient has shown nervous system impairment in-volvement but no evidence of liver dysfunction.The efficacy of cochlear implantation is uncertain and general anesthesia if applied will accelerate the progress of encephalopathy and might lead to multiple organ failure.Unsure of the perioperative safety,the parents of the girl did not chose the option of hearing intervention tempo-rarily,but chose oral symptomatic supportive treatment with coenzyme Q10,folate,levocarnitine,and complex vitamins as recommended.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Objective:To determine the median effective dose (ED 50) of remimazolam for preoperative sedation in pediatric patients of different ages. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification I or Ⅱ pediatric patients, aged 1-6 yr, scheduled for elective surgery in our hospital from July to December 2023, in whom the preoperative anxiety was still not relieved after non-drug intervention (preoperative separation anxiety score [PSAS]≥3), were selected. According to the age, the children were divided into 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group. A child's PSAS score = 1 at the time of separation from parents was classified as satisfactory sedation, and a PSAS score ≥ 2 was classified as unsatisfactory sedation. The initial dose of remimazolam in each group was 0.3 mg/kg, dose ratio 1.15. If the child was satisfactorily sedated, the next patient received a lower dose of remimazolam, or conversely if the child was not satisfactorily sedated, a higher dose was given in the next patient. The test was ended when 7 alternating waveforms appeared. The Dixon-Massey method was used to calculate the ED 50 and 95% confidence interval. Results:In 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group, a total of 120 children were included in this study, with 26, 23, 21, 27 and 23 cases, respectively, and the ED 50 (95% confidence interval) of remimazolam for preoperative sedation was 0.152 (0.126-0.178), 0.159 (0.135-0.183), 0.171 (0.147-0.196), 0.150 (0.126-0.174), and 0.146 (0.121-0.170) mg/kg, respectively. There was no significant difference between the groups ( P>0.05). Conclusions:The ED 50 of remimazolam for preoperative sedation is 0.152, 0.159, 0.171, 0.150 and 0.146 mg/kg for every 1 yr in children aged 1-6 yr, and the age factor does not affect the preoperative sedative effect of remimazolam in children of this age group.

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 evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

Objective:To investigate the pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual in infants and young children undergoing daytime surgery.Methods:One hundred and four pediatric patients of either sex, aged 3-36 months, of American Society of Anesthesiologists Physical Status classification Ⅱ, with body mass index of 18.5-28.0 kg/m 2, diagnosed with oblique inguinal hernia and/or hydrocele, scheduled for laparoscopic high ligation of hernia sac and/or high ligation of sphingoid surgery, were included in the study. Intraoperative neuromuscle relaxation was assessed by transdermal stimulation of the ulnar nerve in the wrist using a TOF Guard monitor. Rocuronium 0.9 mg/kg, propofol 3 mg/kg, and sufentanyl 0.5 μg/kg were intravenously injected for anesthesia induction, and propofol 6-8 mg·kg -1·h -1 was intravenously infused to maintain anesthesia. The pediatric patients were divided into Ⅰgroup and Ⅱ group according to the degree of postoperative neuromuscular block. In group Ⅰ, sugammadex 2 mg/kg was intravenously injected when TOF returned to T 2 recurrence. In group Ⅱ, sugammadex 4 mg/kg was intravenously injected when the single stimulation count was 1 or 2 after tetanic stimulation. At 2 and 10 min after rocuronium administration, at the end of operation, 2 and 10 min after sugammadex administration, and when the children met the standard of leaving the resuscitation room, venous blood samples were collected for determination of plasma concentrations of rocuronium and sugammadex using ultra-high performance liquid chromatography-mass spectrometry. Pharmacokinetic parameters were determined using the Pheonix WinNonlin software. The onset of rocuronium and time for recovery of TOF ratio to 90% were recorded. Results:The pharmacokinetics of sugammadex was fitted to the nonlinear mixed-effect satrioventricular model.There was no significant difference in the peak concentration, area under the drug concentration-time curve, elimination half-life, apparent clearance, apparent volume of distribution, mean retention time, and time for TOF ratio returning to 90% between the two groups ( P> 0.05). Conclusions:The pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual is fitted to a nonlinear mixed-effect satrioventricular model, and sugammadex 2 and 4 mg/kg have similar pharmacokinetics in infants and young children undergoing daytime surgery.

Objective:To evaluate the relationship between spinal kindlin-1/Wnt3a signaling pathway and inflammatory response in a rat model of neuropathic pain (NP).Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 10-12 weeks, weighing 250-280 g, were divided into 4 groups ( n=6 each) using a random number table method: sham operation group (SH group), NP group, kindlin-1 shRNA group (K group) and Wnt3a inhibition group (W group). NP was induced by chronic constrictive injury in anesthetized animals.At 21 days before operation, kindlin-1 shRNA adenovirus vector 10 μl was intrathecally injected in group K, and empty viral vector 10 μl was intrathecally injected in SH, NP and W groups.Wnt inhibitor IWP-2 10 μl was intrathecally injected in group W, and artificial cerebrospinal fluid 10 μl was intrathecally injected in SH, NP and K groups at 1-3 days after operation.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before operation and 4 and 7 days after operation, respectively.At the end of pain threshold measurement at 7 days after operation, the animals were sacrificed and the lumbar segments (L 4-6) of the spinal cord were obtained for determination of the contents of tumor necrosis factor (TNF)-α and interleukin (IL)-1β (IL-1β) (using enzyme-linked immunosorbent assay) and the expression of kindlin-1 and Wnt3a (by Western blot). Results:Compared with group SH, MWT was significantly decreased, TWL was shortened at 4 and 7 days after operation, and the contents of TNF-α and IL-1β in spinal cord were increased in NP, K, and W groups, the expression of kindlin-1 and Wnt3a was up-regulated in NP and W groups, and expression of Wnt3a was up-regulated in group K ( P<0.05). Compared with group NP, MWT was significantly increased and TWL was prolonged at 4 and 7 days after operation in K and W groups, the contents of TNF-α and IL-1β in spinal cord were decreased, and the expression of kindlin-1 and Wnt3a was down-regulated in group K, the contents of TNF-α and IL-1β in spinal cord were decreased, and the expression of Wnt3a was down-regulated in group W ( P<0.05), and no significant change was found in kindlin-1 expression ( P>0.05). Conclusion:Spinal kindlin-1 regulates the inflammatory response by up-regulating the expression of Wnt3a, and it is involved in the maintenance of NP in rats.

Objective:To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods:A total of 117 pediatric patients with congenital heart disease, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 3-36 months, weighing 5-20 kg, scheduled for elective transthoracic echocardiography under outpatient sedation, were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine: Dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure: auricular acupressure with Wang Bu Liu Xing (semen vaccariae) seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min, dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.After the examination, auricular acupoint pressure therapy was continued at home, and pressing-rubbing at the acupoints was manipulated for 3 times daily, one of which was performed at 30 min before going to bed, for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score ≥2 within 30 min after giving dexmedetomidine, sedation was considered to be successful.The onset time of sedation, examination time, waiting time, recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia, hypotension, hypertension, hypoxemia, nausea and vomiting, respiratory depression, restlessness, hyperactivity, action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results:Compared with intranasal dexmedetomidine, the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased ( P<0.05), and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure ( P>0.05). Conclusion:Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.

Objective:To investigate the relationship between spinal long chain noncoding RNA (lncRNA) and kindlin-1/Wnt3a signaling pathway in a rat model of neuropathic pain (NP).Methods:The experiment was performed in two parts.Experiment Ⅰ Sprague-Dawley rats of both sexes, aged 7 days, weighing 15-20 g, were selected.Rats were sacrificed, the dorsal horn of spinal cord was removed, and the primary astrocytes were extracted and cultured.Lipopolysaccharide 1 μg/ml was added to induce the activation of astrocytes for 24 h. The lncRNA binding to kindlin-1 was identified using PCR immunoprecipitation method.The localization of lncRNA FOXF1-AS1 in astrocytes was observed by fluorescence in situ hybridization, and the binding between lncRNA FOXF1-AS1 and kindlin-1 was detected by biotin-labeled magnetic bead method.Experiment Ⅱ Thirty clean-grade healthy male Sprague-Dawley rats, aged 10-12 weeks, weighing 250-280 g, were divided into 5 groups ( n=6 each) using a random number table method: sham operation control group (group C), NP group, lncRNA FOXF1-AS1 overexpression group (group F), lncRNA FOXF1-AS1 overexpression plus kindlin-1 shRNA group (group FK) and lncRNA FOXF1-AS1 overexpression + Wnt inhibitor group (group FW). NP was induced by chronic constrictive injury in anesthetized animals.In group F, lncRNA FOXF1-AS1 overexpression lentivirus 10 μl was intrathecally injected at 28 days before operation, and vector virus 10 μl was intrathecally injected in the other groups.In FK group, kindlin-1 interfering shRNA interference adenovirus 10 μl, and vector virus 10 μl was intrathecally injected in the other groups.In group FW, Wnt inhibitor IWP-2 10 μl was intrathecally injected at 1-3 days after operation, artificial cerebrospinal fluid 10 μl was intrathecally injected at the same time point in the other groups.Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured at 1 day before operation, at 4 days and 7 days after operation.The animals were sacrificed at the end of measurement of pain threshold at 7 days after operation, and the spinal cord tissues were taken for determination of the expression of kindlin-1, Wnt3a and glial fibrillary acidic protein (GFAP) (by Western blot) and the contents of tumor necrosis factor (TNF)-α and interleukin (IL)-1β (IL-1β) (using enzyme-linked immunosorbent assay). Results:ExperimentⅠ lncRNA FOXF1-AS1, which was expressed in the cytoplasm of astrocytes, combined with kindlin-1.Experiment Ⅱ Compared with C group, MWT was significantly decreased, TWL was shortened at 4 and 7 days after operation, the expression of kindlin-1, Wnt3a and GFAP in spinal cord was up-regulated, and the contents of TNF-α and IL-1β were increased in group NP ( P<0.05). Compared with NP group, MWT was significantly decreased, TWL was shortened at 4 and 7 days after operation, the expression of kindlin-1, Wnt3a and GFAP in spinal cord was up-regulated, and the contents of TNF-α and IL-1β were increased in F group, MWT was increased, TWL was prolonged at 4 and 7 days after operation, and the contents of TNF-α and IL-1β were decreased in group FK and group FW, the expression of kindlin-1, Wnt3a and GFAP was down-regulated in group FK, and the expression of kindlin-1 was up-regulated, and expression of Wnt3a and GFAP was down-regulated in group FW ( P<0.05). Compared with group F, MWT was significantly increased, TWL was prolonged at 4 and 7 days after operation, and the contents of TNF-α and IL-1β were decreased in group FK and group FW, the expression of spinal kindlin-1, Wnt3a and GFAP was down-regulated in group FK, and expression of Wnt3a and GFAP was down-regulated in group FW ( P<0.05). Conclusion:lncRNA FOXF1-AS1 can up-regulate kindlin-1 expression, activate Wnt3a signaling pathway, promote astrocyte activation, and then regulate inflammatory responses and is involved in the process of neuropathic pain in rats.

OBJECTIVE: To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring. METHODS: Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded. RESULTS: No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)( CONCLUSIONS In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.
Anesthesia, General/adverse effects* ; Bodily Secretions ; Child ; Child, Preschool ; Circadian Rhythm ; Humans ; Melatonin ; Snoring