Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective To investigate biomarkers for sepsis-induced lung injury based on results of proteomics combined with transcriptomics analyses.Methods A total of 70 patients with sepsis and 70 patients with sepsis-induced lung injury were included as research objects.These patients were di-vided into experimental group and validation group.The experimental group included 10 patients with sepsis and 10 patients with sepsis-induced lung injury.Proteomics was used to analyze differentially expressed proteins in plasma,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed.The dataset GSE10474 of sepsis-induced lung injury was downloaded from the Gene Expression Omnibus(GEO),and GEO2R online database was used to analyze differential transcriptomics data for sepsis-induced lung injury.A Venn diagram was used online to analyze common differentially expressed genes related to sepsis-induced lung injury in pro-teomics and transcriptomics.The validation group included 60 patients with sepsis(sepsis group)and 60 patients with sepsis-induced lung injury(sepsis-induced lung injury group).Enzyme-linked immunosorbent assay(ELISA)was used to detect and compare the differences in protein expression level in peripheral blood between the sepsis group and the sepsis-induced lung injury group.Receiv-er operating characteristic(ROC)curve was used to analyze the clinical value of differential protein expression level in distinguishing sepsis and sepsis-induced lung injury.Results Proteomics results confirmed the presence of 239 significantly differentially expressed proteins in the plasma of patients with sepsis and sepsis-induced lung injury.Compared with patients with sepsis,there were 96 sig-nificantly upregulated proteins and 143 significantly downregulated proteins in patients with sepsis-induced lung injury.The results of GO enrichment analysis of differentially expressed proteins in-cluded cytoplasm,microtubule binding,adenosine triphosphate(ATP)binding,defense response to virus,and immune response.The results of KEGG enrichment analysis included metabolic path-ways,interleukin-17(IL-17)signaling pathway,and phosphatidylinositol-3-kinase-protein kinase B(PI3K-Akt)signaling pathway.In the GSE10474 dataset,compared with patients with sepsis,there were 77 significantly upregulated genes and 142 significantly downregulated genes in patients with sepsis-induced lung injury.The Venn diagram results showed that there were 6 common differential-ly expressed genes in proteomics and transcriptomics,namely BTNL8,FCGR2B,TAK1,KCNC1,TREM1,and SEC31A.Compared with the sepsis group,the levels of TAK1 and TREM1 proteins in the peripheral blood of the sepsis-induced lung injury group were significantly increased(P＜0.01).ROC curve showed that the areas under the curve(AUC)for the expression levels of TAK1 and TREM1 proteins in serum to distinguish sepsis and sepsis-induced lung injury were 0.925 and 0.785 respectively;when the cut-off value for TAK1 was 71.28 pg/mL,the sensitivity and specific-ity were 94.45％and 97.89％respectively;when the cut-off value for TREM1 was 58.22 mg/mL,the sensitivity and specificity were 83.43％and 82.19％respectively.Conclusion Proteomics and transcriptomics results confirm that the activation of TAK1,TREM1 and multiple inflammatory signa-ling pathways may play important roles in the progression of sepsis-induced lung injury.

Objective:To construct a temperature-sensitive hydrogel (PF-CA@AS-IV hydrogel) composed of Pluronic F-127 (PF-127)/calcium alginate (CA) loaded with astragaloside IV (AS-IV), and to explore its repair effect and potential mechanism on diabetic skin ulcers (DSU).Methods:The PF-CA@AS-IV hydrogel loaded with AS-IV and gelling at 37 ℃ was prepared. Its temperature sensitivity, rheological properties, and morphology were characterized. A rat model of DSU was established, and the rats were randomly divided into blank control group, model group, AS-IV spray group, PF-CA hydrogel group, and PF-CA@AS-IV hydrogel group ( n=5 each). After 21 days of intervention, the wound healing rate of each group was evaluated. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of granulation tissue, and immunohistochemistry was applied to detect the expression level of CD34, a marker of new blood vessels. Results:Rheological analysis showed that the storage modulus (G′) of PF-CA@AS-IV hydrogel began to exceed the loss modulus (G″) at 33 ℃, and a stable three-dimensional network structure was formed at 37 ℃. Scanning electron microscopy confirmed its loose and porous microstructure. Animal experiment results indicated that compared with the blank control group, the model group had a significantly lower wound healing rate, massive infiltration of inflammatory cells, and fewer new capillaries and CD34 expression (all P<0.05). Compared with the model group, each treatment group can promote wound healing, reduce inflammatory infiltration and increase the positive expression of CD34 to varying degrees (all P<0.05), and the curative effect of PF-CA@AS-IV hydrogel group is the most significant, which is better than that of AS-IV spray group and PF-CA hydrogel group (all P<0.05). Conclusions:PF-CA@AS-IV hydrogel can effectively regulate inflammatory response and promote angiogenesis through sustained release of AS-IV, thereby accelerating DSU healing, and has good translational potential in the field of chronic wound repair.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To construct a temperature-sensitive hydrogel (PF-CA@AS-IV hydrogel) composed of Pluronic F-127 (PF-127)/calcium alginate (CA) loaded with astragaloside IV (AS-IV), and to explore its repair effect and potential mechanism on diabetic skin ulcers (DSU).Methods:The PF-CA@AS-IV hydrogel loaded with AS-IV and gelling at 37 ℃ was prepared. Its temperature sensitivity, rheological properties, and morphology were characterized. A rat model of DSU was established, and the rats were randomly divided into blank control group, model group, AS-IV spray group, PF-CA hydrogel group, and PF-CA@AS-IV hydrogel group ( n=5 each). After 21 days of intervention, the wound healing rate of each group was evaluated. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of granulation tissue, and immunohistochemistry was applied to detect the expression level of CD34, a marker of new blood vessels. Results:Rheological analysis showed that the storage modulus (G′) of PF-CA@AS-IV hydrogel began to exceed the loss modulus (G″) at 33 ℃, and a stable three-dimensional network structure was formed at 37 ℃. Scanning electron microscopy confirmed its loose and porous microstructure. Animal experiment results indicated that compared with the blank control group, the model group had a significantly lower wound healing rate, massive infiltration of inflammatory cells, and fewer new capillaries and CD34 expression (all P<0.05). Compared with the model group, each treatment group can promote wound healing, reduce inflammatory infiltration and increase the positive expression of CD34 to varying degrees (all P<0.05), and the curative effect of PF-CA@AS-IV hydrogel group is the most significant, which is better than that of AS-IV spray group and PF-CA hydrogel group (all P<0.05). Conclusions:PF-CA@AS-IV hydrogel can effectively regulate inflammatory response and promote angiogenesis through sustained release of AS-IV, thereby accelerating DSU healing, and has good translational potential in the field of chronic wound repair.

Objective To compare the application of sevoflurane or propofol anesthesia maintenance in liver transplantation patients and explore its effects on renal function and postoperative cognition and possible mechanisms.Methods A total of 60 patients aged 18～60 years old and ASA grade Ⅱ-Ⅲ who were scheduled to undergo orthotopic liver transplantation in our hospital were selected.They were randomly divided into two groups(n=30)according to the different maintenance schemes:group P(propofol group)and group S(sevoflurane group).Anesthesia maintenance:group P received continuous target-controlled infusion of propofol combined with remifentanil hydrochloride injection during surgery;group S received sevoflurane inhalation combined with infusion of remifentanil hydrochloride injection during surgery.The mean arterial pressure(MAP),heart rate(HR)and central venous pressure(CVP)of the two groups of patients were recorded at seven time points,including before anesthesia induction(T0),immediately after skin incision(T1),30 minutes in the anhepatic phase(T2),3 hours in the neohepatic phase(T3),12 hours after surgery(T4),24 hours after surgery(T5)and 72 hours after surgery(T6).3 mL of central venous blood was drawn from each group.The serum neutrophil gelatinase-associated lipocalin(NGAL),serum cystatin C(Cys C),kidney injury molecule 1(KIM-1),syndecan 1(SDC-1),heparin sulfate(HS),hyaluronic acid(HA)and serum concentrations of inflammatory markers(TNF-α,IL-6)were detected by ELISA at the above time points.The cognitive function was evaluated by the Mini-Mental State Exami-nation(MMSE)at T0,T5 and T6,and the occurrence of cognitive dysfunction(MMSE＜23 points)was counted.Results There were no significant differences in MAP,HR,and CVP between the two groups at each time point(P＞0.05).At T4,the serum levels of NGAL and Cys in the two groups were significantly higher than those in the other groups.C and KIM-1 increased,and the P group was significantly higher than the S group,the difference was statistically significant(P＜0.05),and there was no significant difference between the two groups at other times(P＞0.05);SDC-1,HS,and HA increased significantly in both groups at T3 and T4,and the P group was significantly higher than the S group at T4,the difference was statistically significant(P＜0.05),and there was no significant difference between the two groups at other times(P＞0.05);TNF-α and IL-6 increased significantly in both groups at T3 and T4,decreased at T5 and T6,but still higher than T0,and the P group was significantly higher than the S group at T4 and T5,the difference was statistically significant(P＜0.05);MMSE scores decreased at T5 and T6,and the P score was significantly lower than the S group at T5,the difference was statisti-cally significant(P＜0.05),and there was no significant difference at T6(P＞0.05);there was no significant difference in the incidence of postoperative cognitive dysfunction between the two groups(P＞0.05).Conclusion Compared with propofol,sevoflurane anesthesia maintenance has less effect on the degree of short-term renal injury and cognitive function changes in patients undergoing liver transplantation,which may be related to its more obvi-ous effect of inhibiting inflammatory response and reducing glycocalyx degradation.

Objective To compare the application of sevoflurane or propofol anesthesia maintenance in liver transplantation patients and explore its effects on renal function and postoperative cognition and possible mechanisms.Methods A total of 60 patients aged 18～60 years old and ASA grade Ⅱ-Ⅲ who were scheduled to undergo orthotopic liver transplantation in our hospital were selected.They were randomly divided into two groups(n=30)according to the different maintenance schemes:group P(propofol group)and group S(sevoflurane group).Anesthesia maintenance:group P received continuous target-controlled infusion of propofol combined with remifentanil hydrochloride injection during surgery;group S received sevoflurane inhalation combined with infusion of remifentanil hydrochloride injection during surgery.The mean arterial pressure(MAP),heart rate(HR)and central venous pressure(CVP)of the two groups of patients were recorded at seven time points,including before anesthesia induction(T0),immediately after skin incision(T1),30 minutes in the anhepatic phase(T2),3 hours in the neohepatic phase(T3),12 hours after surgery(T4),24 hours after surgery(T5)and 72 hours after surgery(T6).3 mL of central venous blood was drawn from each group.The serum neutrophil gelatinase-associated lipocalin(NGAL),serum cystatin C(Cys C),kidney injury molecule 1(KIM-1),syndecan 1(SDC-1),heparin sulfate(HS),hyaluronic acid(HA)and serum concentrations of inflammatory markers(TNF-α,IL-6)were detected by ELISA at the above time points.The cognitive function was evaluated by the Mini-Mental State Exami-nation(MMSE)at T0,T5 and T6,and the occurrence of cognitive dysfunction(MMSE＜23 points)was counted.Results There were no significant differences in MAP,HR,and CVP between the two groups at each time point(P＞0.05).At T4,the serum levels of NGAL and Cys in the two groups were significantly higher than those in the other groups.C and KIM-1 increased,and the P group was significantly higher than the S group,the difference was statistically significant(P＜0.05),and there was no significant difference between the two groups at other times(P＞0.05);SDC-1,HS,and HA increased significantly in both groups at T3 and T4,and the P group was significantly higher than the S group at T4,the difference was statistically significant(P＜0.05),and there was no significant difference between the two groups at other times(P＞0.05);TNF-α and IL-6 increased significantly in both groups at T3 and T4,decreased at T5 and T6,but still higher than T0,and the P group was significantly higher than the S group at T4 and T5,the difference was statistically significant(P＜0.05);MMSE scores decreased at T5 and T6,and the P score was significantly lower than the S group at T5,the difference was statisti-cally significant(P＜0.05),and there was no significant difference at T6(P＞0.05);there was no significant difference in the incidence of postoperative cognitive dysfunction between the two groups(P＞0.05).Conclusion Compared with propofol,sevoflurane anesthesia maintenance has less effect on the degree of short-term renal injury and cognitive function changes in patients undergoing liver transplantation,which may be related to its more obvi-ous effect of inhibiting inflammatory response and reducing glycocalyx degradation.

The interaction of gut microbiota and its metabolites with the host not only plays an important role in maintaining gut homeostasis and host health, but also is a key link in responding to pathogen infections. A thorough understanding of the changes in gut microbiota and its metabolites during infection, as well as their role and mechanism in host defense against infection, is helpful to guide anti-infection treatment. This review focuses on the role of gut microbiota and their metabolites in host defense against bacterial, fungal, and viral infections, and reveals that they can exert anti-infection effects through resistance mechanisms (inducing antimicrobial substances, training immunity, inhibiting pathogen respiration, directly neutralizing pathogens, immune regulation) and tolerance mechanisms (altering energy metabolism patterns of microbiota, cell proliferation and tissue damage repair, maintaining physiological signal transduction in extraintestinal organs, inflammation regulation, maintaining the integrity of the intestinal barrier), and also summarizes measures to regulate gut microbiota against pathogen infections, in order to provide more ideas for novel anti-infection prevention and treatment strategies targeting gut microbiota and its metabolites.

ObjectiveTo explore new targets and herbal medicines of total ginsenosides in ameliorating alcoholic hepatitis （AH） by data mining and experimental validation and to provide new directions for the clinical treatment of AH. MethodGSE28619 was selected as the test set from the GEO database and GSE83148 and GSE103580 were selected as the validation sets. The limma package and weighted gene co-expression network analysis （WGCNA） were employed to identify the AH-related differentially expressed genes and modular genes， and Venny was used to extract the common genes. The protein-protein interaction （PPI） network was constructed and the enrichment analysis was carried out. The hub genes were further screened and evaluated for their diagnostic value. After validation with the datasets， new potential targets of AH and traditional Chinese medicine were predicted. Molecular docking between the targets and active ingredients of traditional Chinese medicine was performed， and the results were validated by experiments. Eight out of 48 SD rats were randomly selected into a blank group and received an equal amount of normal saline. The rest rats were subjected to modeling with ethanol by gavage and then randomized into low- （10 mg·kg^-1）， medium- （20 mg·kg^-1）， and high-dose （40 mg·kg^-1） total ginsenosides， model， and positive control （metadoxine， 117 mg·kg^-1） groups. After 3 weeks of gavage， serum samples were collected for the measurement of aspartate aminotransferase （AST） and alanine aminotransferase （ALT） levels， and liver samples were collected for hematoxylin-eosin （HE） staining. Western blot and Real-time PCR were employed to determine the protein and mRNA levels， respectively， of potential targets in the liver tissue. ResultData mining predicted the potential genes： Proto-oncogene FOS and collagen type Ⅰ alpha 2 （COL1A2）. Experimental validation showed that the liver injury was alleviated after drug administration compared with that after modeling. The serum AST and ALT levels were reduced after drug administration. The protein and mRNA levels of FOS were significantly up-regulated， while those of COL1A2 were down-regulated after drug administration. ConclusionTotal ginsenosides ameliorate HA via FOS and COL1A2.

Objective:To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China.Methods:The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia.Results:The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% ( HR=1.22, 95% CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% ( HR=0.67, 95% CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion:Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.