Objective To investigate the protective effect of paravertebral nerve block combined with general anesthesia on liver injury after laparoscopic hepatectomy(LH).Methods A randomized controlled trial was conducted on 51 patients undergoing LH in our hospital between April and August 2024.They were randomly divided into control group(n=25,general anesthesia)and paravertebral block group(n=26,paravertebral nerve block before general anesthesia induction).Beside anesthesia,they received same other medical treatment.The following indicators were compared between the 2 groups,that is,serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and albumin(ALB),and systemic-immune inflammation(SII)index within 7 d before and on the 1st and 2nd days after surgery;heart rate and mean arterial pressure(MAP)before anesthesia induction(T1),before pneumoperitoneum establishment(T2),pneumoperitoneum establishment(T3),and at the first hilar occlusion(T4);usages of intraoperative norepinephrine,sevoflurane,and analgesic drugs 24 h postoperatively;as well as operation time,extubation time,and lengths of postanesthesia care unit(PACU)stay and hospital stay.Results The paravertebral block group had significantly lower ALT on the 1st day after surgery[178.40(126.55,325.86)vs 292.20(197.20,468.95)U/L],SII on the 2nd day after surgery[704.13(486.61,1 078.59)vs 1 075.09(753.80,1 614.38)],and amount of analgesic drugs in 24 h after surgery[29.70(27.37,32.07)vs 31.99(28.92,40.81)mg],and decreased MAP level at T3 and T4,early extubation,and shorter lengths of PACU stay and hospital stay when compared with the control group(all P<0.05).Conclusion Paravertebral nerve block combined with general anesthesia can reduce inflammatory responses,relieve postoperative pain,stabilize hemodynamics for patients undergoing LH,and thereby alleviate postoperative liver injury in them.

AIM:To elucidate the possible biological mechanism of silica-induced acute lung injury in rats.METHODS:Sixteen Male Sprague-Dawley rats were divided into control and acute silicosis model groups,and instilled intratracheally with 1 mL of normal saline and 50 g/L silica suspension,respectively.After 7 d,the rats were sacrificed for collection of lung tissue and serum.The serum levels of interleukin-1β(IL-1β),IL-18 and tumor necrosis factor-α(TNF-α)were measured by using ELISA.The protein expression levels of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)and gasdermin D(GSDMD)were measured by immunohistochemistry.Bacterial DNA was ex-tracted from the lung tissue for 16S ribosomal RNA gene sequencing to characterize changes in the composition of lung flo-ra.The differences in the structure of bacterial flora between control and model groups were analyzed by bioinformatic analy-ses.RESULTS:Immunohistochemical analysis showed that the protein expression levels of NLRP3 and GSDMD were higher in the lungs of the rats in model group.In addition,serum cytokine profiling showed that IL-1β,IL-18 and TNF-α levels were significantly higher in model group.The most abundant bacterial genera in the lung flora of the rats in model group were Bifidobacterium,Clostridium sensu stricto 1,and Parasutterella.The NLRP3 and GSDMD levels in the lung tissue and IL-1β and TNF-α levels in serum were positively correlated with the abundance of Parasutterella.CONCLU-SION:The alterations in lung flora structure and increased inflammation levels may be the actual biological mechanisms underlying silica-induced acute lung injury.The modulation of lung flora may provide a basis for the prevention and treat-ment of silica-induced acute lung injury.

Objective:To evaluate the effects of biorhythm factors on the occurrence of acute kidney injury (AKI) after cardiac surgery using cardiopulmonary bypass.Methods:This was a retrospective cohort study. Data from patients undergoing heart surgery involving cardiopulmonary bypass from June 2018 to December 2019 were collected and divided into 2 groups ( n=125 each) based on the time of anesthesia operation: morning rhythm group (group Ⅰ) and afternoon rhythm group (group Ⅱ). Anesthesia operation was performed from 8: 00 to 12: 00 in group Ⅰ. Anesthesia was performed from 14: 00 to 18: 00 in group Ⅱ. The occurrence of postoperative AKI and other postoperative complications (pulmonary infection, sepsis, cerebral infarction) was recorded. Results:Compared with group Ⅱ, the incidence of postoperative AKI was significantly increased, the relative risk was 3.2 (95% confidence interval 1.31-7.70), and no significant change was found in the incidence of pulmonary infection, sepsis and cerebral infarction in group Ⅰ ( P>0.05). Conclusions:Biorhythm factors affect the development of AKI after cardiac surgery using cardiopulmonary bypass, and performing surgeries in the afternoon rather than the morning helps reduce the risk of postoperative AKI.

Objective:To evaluate the clinical effect of Guanxin Tongmai plaster combined with conventional western medicine in the treatment of phlegm and blood stasis syndrome of coronary heart disease and angina pectoris.Methods:A total of 60 patients in the Department of Cardiology of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine (TCM) from February to August 2020 who met the inclusion criteria were randomly divided into two groups with 30 in each group. Both groups were treated with conventional western medicine. On this basis, Guanxin Tongmai plaster was applied at the acupoints in the treatment group and placebo plaster was applied in the control group. TCM syndrome score was performed before and after treatment, angina score was evaluated from three aspects of angina attack frequency, duration and pain degree, and blood lipid TG, TC, LDL-C and HDL-C were detected by enzyme quantitative method. The blood homocysteine (Hcy) was detected by enzyme circulation method, the ECG and the nitroglycerin reduction rate were recorded, and the safety index was detected according to the ECG changes.Results:In the treatment period, 2 patients in the treatment group fell off, 3 in the control group. A total of 28 patients in the treatment group and 27 in the control group were analyzed. The total effective rate of ECG efficacy in the treatment group was 67.9% (19/28) and the control group was 48.1% (13/27). There was significant difference between the two groups ( χ2=4.46, P=0.040). After treatment, the TCM syndrome score and angina score in the treatment group were significantly lower than those in the control group ( t values were 9.12 and 4.45, P values were 0.004 and 0.042, respectively). The reduction rate of nitroglycerin in the treatment group was 82.1% (23/28) and 55.6% (15/27) in the control group. There was significant difference between the two groups ( χ 2=4.72, P=0.030). After treatment, the plasma TG, TC, LDL-C in the treatment group were significantly lower than those in the control group ( t values were 4.17, 6.57 and 6.52, P<0.05 or P<0.01), the level of HDL-C was significantly higher than that of the control group ( t=7.07, P=0.010), and the level of plasma Hcy was significantly lower than that in the control group ( t=6.70, P=0.012). There was no significant difference in liver, kidney and coagulation function between the two groups. Conclusion:Guanxin Tongmai plaster combined with conventional western medicine can improve the clinical symptoms of patients with coronary heart disease and angina pectoris, reduce the level of blood lipid and Hcy, and improve the clinical curative effect.

Objective: To conduct the integrated management of hospital, community and family for patients with insulin injection at home, in order to explore the influence of this trinity health education model on the knowledge of medical waste and the standard disposal of discarded needles. Methods: The self-designed questionnaire was used to investigate the knowledge and disposal of medical waste in outpatients, and the causes were analyzed carefully after the problems were found. The hospital, community and family were timely communicated and fed back to the ward and community. After 1, 3 and 6 months of educational intervention, the disposal of insulin needles, the knowledge of medical waste and the recovery of sharp instrument boxes were observed. Results: After 1, 3 and 6 months of health education, the final rate of insulin needles mixed into domestic waste was 51.8% (144/278), 15.1% (42/278) and 4.7% (13/278), respectively. Compared with the first result of 99.6% (277/278), the difference was statistically significant (χ²=173.046, 406.136, 502.346, P<0.01); The first survey found that the correct rate of responding to medical waste knowledge items was low. After health education for 1, 3 and 6 months, the correct rate of medical waste related knowledge items was significantly higher than that of the first survey, and the difference was statistically significant (OR=3.016-3 548.810; 95%CI 2.108-917.869, 4.315-19 777.062; χ²=25.180-524.895; P<0.01) ; After 1, 3 and 6 months of health education, the qualified rate of medical waste knowledge was 82.4% (229/278),75.9% (211/278) and 97.1% (270/278), respectively, which was significantly higher than the first result of 6.5% (18/278). The difference was statistically significant (χ²=324.328, 273.712, 453.832, P<0.01). The sharp box recovery of hepatitis B patients was relatively good. Conclusion Hospital-community-family Trinity health education model can improve the breadth and depth of education objects, not only can improve the knowledge of medical waste related to insulin injection patients at home, but also can improve the standardized disposal ability of insulin waste needles. With the passage of time, the effect of health education continues to be good. This integrated health education model is worth popularizing in clinic.

Objective To discuss the surgical strategy and clinical effects of robotic assisted laparoscopic antegrade inguinal lymphadenectomy for penile cancer.Methods We retrospectively analyzed the clinical data and surgical strategy on the 7 cases,who undergoing robotic assisted laparoscopic antegrade inguinal lymphadenectomy,from August of 2016 to August of 2017.The mean age of 7 patients was (49.7 ± 7.5) years old,ranged from 40 to 62 years old,the mean BMI was (27.97 ± 3.86) kg/m2,ranged from 21.76 to 33.21 kg/m2 . There were 4 cases of T1,2 cases of T2,1 case of T3,1 case of N1,3 cases of N2,3 cases of N3 according to TNM stages.Preoperative preparation was as follows,preoperative cardiopulmonary assessment,inguinal and pelvic CT or MRI,ultrasound of lower extremity venous,bowel preparation.The patients were placed in a supine position,with an indwelling catheter,with the head positioned lower than the hip at an angle of about 15 degrees,legs were spread apart around 45 degrees,and both knees were slightly bent and externally rotated.The da Vinci robotic patient cart was pushed forward between legs of the patient.A blunt separation was carried out between Scarpa's fascia and the surface of the aponeurosis of the obliquus externus abdominis prior,then subcutaneous space was established by a self-made balloon dilatation.Results 7 cases were completed successfully without robot reposition without any conversion.Operative time of each side ranged from 50 to 90 min (70.0 ± 12.5)min.The blood loss of each side was less than 10 ml.In the 7 cases,the number of nodes removed from left inguinal region ranged from 7 to 18 (14.0 ±3.3).The number of nodes removed from right ranged from 5 to 21 (11.0 ± 3.3).Pelvic lymphadenectomy was completed in the meantime by original trocar site on 4 cases.Till now,no perioperative complications,such as flap necrosis,delayed healing of incision,cellulitis,occurred in inguinal region,except lymphorrhagia in 3 cases.During a follow-up within 3-14 months,there was no recurrence or metastasis in 6 cases except one died from tumor progression with systemic metastasis.Conclusions Antegrade inguinal lymphadenectomy for penile cancer by using Da Vinci robotic surgical system is safe and effective.This technique also appears to diminish the wound related complications associate with the standard open approach.Compared with the similar surgery,we conducted bilateral inguinal lymphadenectomy without patient cart reposition,which simplify the procedure and reduce the using of trocar.According to individual clinical conditions,pelvic lymphadenectomy also can be completed in the meantime by original trocar.

SIRT6 is a NAD(+)-dependent histone deacetylase and has been implicated in the regulation of genomic stability, DNA repair, metabolic homeostasis and several diseases. The effect of SIRT6 in cerebral ischemia and oxygen/glucose deprivation (OGD) has been reported, however the role of SIRT6 in oxidative stress damage remains unclear. Here we used SH-SY5Y neuronal cells and found that overexpression of SIRT6 led to decreased cell viability and increased necrotic cell death and reactive oxygen species (ROS) production under oxidative stress. Mechanistic study revealed that SIRT6 induced autophagy via attenuation of AKT signaling and treatment with autophagy inhibitor 3-MA or knockdown of autophagy-related protein Atg5 rescued H2O2-induced neuronal injury. Conversely, SIRT6 inhibition suppressed autophagy and reduced oxidative stress-induced neuronal damage. These results suggest that SIRT6 might be a potential therapeutic target for neuroprotection.
Adenine ; analogs & derivatives ; toxicity ; Autophagy ; drug effects ; Autophagy-Related Protein 5 ; antagonists & inhibitors ; genetics ; metabolism ; Blotting, Western ; Cell Line, Tumor ; Humans ; Hydrogen Peroxide ; toxicity ; Microtubule-Associated Proteins ; metabolism ; Oxidative Stress ; drug effects ; Proto-Oncogene Proteins c-akt ; metabolism ; RNA Interference ; RNA, Messenger ; metabolism ; RNA, Small Interfering ; metabolism ; Reactive Oxygen Species ; metabolism ; Real-Time Polymerase Chain Reaction ; Signal Transduction ; drug effects ; Sirtuins ; antagonists & inhibitors ; genetics ; metabolism ; Transfection

BACKGROUND:Exogenous neurotrophic factors or chemical induction can induce rat bone marrow mesenchymal stem cells to differentiate into neuron-like cells. However, exogenous inductors exert a short inducible action, and their chemical substances inevitably have a negative impact on cellviability to limit the application prospects of bone marrow mesenchymal stem cells to a certain extent.
OBJECTIVE:To investigate the effect of glial cellline-derived neurotrophic factor, green fluorescent protein gene transfection by adenovirus vector on biological characteristics of rat bone marrow mesenchymal stem cells, to observe the expression of glial cellline-derived neurotrophic factor and green fluorescent protein and the role of nutrition on bone marrow mesenchymal stem cells, and to explore the ability to differentiate into neuron-like cells induced by glial cellline-derived neurotrophic factor.
METHODS:The bone marrow mesenchymal stem cells at passage 3 were transfected by recombinant adenovirus (Multiplicity of infection=10, 50, 80, 100, 150, 200). The experiment had two groups according to target genes:bone marrow mesenchymal stem cells were transfected by Ad-GDNF-GFP in transfection group, and bone marrow mesenchymal stem cells were not transfected in control group. The expression of green fluorescent protein was detected by inverted fluorescence microscope. Transfection efficiency was calculated by flow cytometry. cells viability and the morphological changes of cells were compared respectively by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and inverted fluorescence microscope between the two groups. On days 5 and 10 after transfection, the expression of glial cel-derived neurotrophic factor mRNA was detected by PCR. On day 5, the expression of neuron-specific enolase was determined by immunofluorescence examination. On day 10, the expression of microtubule-associated protein 2 was identified.
RESULTS AND CONCLUSION:By the end of 12 hours after transfection, the green fluorescent protein expressed in cells, and the fluorescence intensity gradual y increased with time. When the multiplicity of infection was 100, the fluorescence intensity was strong and stable, and the transfection rate was nealy 90%on day 3 after transfection. cellviability in the transfection group was strengthened after transfection. On day 5 after transfection, bone marrow mesenchymal stem cells expressed neuron-specific enolase, and neuron-like protrusions gradual y extended. On day 10 after transfection, bone marrow mesenchymal stem cells expressed microtubule-associated protein 2 and glial cellline-derived neurotrophic factor mRNA, and exhibited neuron-like morphology and interconnected synpases. The recombinant adenovirus, Ad-GDNF-GFP, can highly transfect bone marrow mesenchymal stem cells when the multiplicity of infection is 100, and glial cellline-derived neurotrophic factor can promote the proliferation of bone marrow mesenchymal stem cells and induce bone marrow mesenchymal stem cells to differentiate into neuron-like cells.

Objective:The purpose of this study was to observe Huwang Mingmu San’s(HWMMS)effect on the experimental vitreous hemorrhage.Methods:We divided 48 rabbits randomly into the A group as the normal control group,the B group as the modal group,the C group as the traditional chinese medicine group(HWMMS)and the D group as the western medicine group(entodan).Six rabbits of the four groups were killed randomly in the 8th week and their vitreous send to TNF-?,IL-6 examination at the same time.We study the activity level of MDA,SOD,NA-K-ATP enzyme on retinal.Results: It was suggested that the TNF-?’s content in HWMMS group had significantly increased than that in the normal group and the model group but no difference was found between the HWMMS group and the entodan group.Meanwhile the results showed that the HWMMS group’s content of IL-6 and MDA was lower and SOD activity,NA-K-ATP enzyme content was higher than those in the model group and the entodan group.Conclusion:We concluded that the HEMMS had a remarkable therapeutic effect on retinal damage and in promoting absorption vitreous hemorrhage.