Objective To investigate the effects of permissive hypercapnia(PHC)combined with remote ischemic preconditioning(RIPC)on regional brain oxygen saturation(rSO2)and postoperative cognitive function in patients undergoing thoracoscopic radical resection for lung cancer.Methods A total of 80 patients who underwent thoracoscopic lung cancer resection in Jinhua Municipal Central Hospital from January to December 2022 were selected and divided into control group,RIPC group,PHC group and PHC+RIPC group according to random number table method,with 20 cases in each group.rSO2 levels were observed before anesthesia induction(T0),before unilateral ventilation(T1),10min after unilateral ventilation(T2),30min after unilateral ventilation(T3),at the end of after unilateral ventilation(T4)and after surgery(T5)in four groups.The level of serum interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α)and cognitive function at T0,T4,the first day after surgery(T6)and the third day postoperative(T7)were recorded.Results After surgery,the levels of IL-6,TNF-α,and IL-10 in four groups first increased and then decreased(P＜0.05).At T4 and T6,there were statistically significant differences in IL-6 levels among four groups(P＜0.05),and the IL-6 level of control group was significantly higher than that of other three groups(P＜0.05).At T4,T6 and T7,there were statistically significant differences in IL-10 and TNF-α levels among four groups(P＜0.05),and the IL-10 level in control group was significantly lower than that in other three groups,and the TNF-α level was significantly higher than that in other three groups.At T2,T3,T4 and T5,there were statistically significant differences in rSO2 between four groups(P＜0.05),and PHC+RIPC group＞RIPC group＞PHC group＞control group.At T6,the score of mini-mental state examination scale of control group was significantly lower than that of other three groups(P＜0.05).Conclusion PHC combined with RIPC can improve rSO2 and postoperative cognitive function in patients with thoracoscopic lung cancer resection,reduce the level of inflammatory factors,and reduce the occurrence of postoperative cognitive dysfunction.

Objective To investigate the effects of permissive hypercapnia(PHC)combined with remote ischemic preconditioning(RIPC)on regional brain oxygen saturation(rSO2)and postoperative cognitive function in patients undergoing thoracoscopic radical resection for lung cancer.Methods A total of 80 patients who underwent thoracoscopic lung cancer resection in Jinhua Municipal Central Hospital from January to December 2022 were selected and divided into control group,RIPC group,PHC group and PHC+RIPC group according to random number table method,with 20 cases in each group.rSO2 levels were observed before anesthesia induction(T0),before unilateral ventilation(T1),10min after unilateral ventilation(T2),30min after unilateral ventilation(T3),at the end of after unilateral ventilation(T4)and after surgery(T5)in four groups.The level of serum interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α)and cognitive function at T0,T4,the first day after surgery(T6)and the third day postoperative(T7)were recorded.Results After surgery,the levels of IL-6,TNF-α,and IL-10 in four groups first increased and then decreased(P＜0.05).At T4 and T6,there were statistically significant differences in IL-6 levels among four groups(P＜0.05),and the IL-6 level of control group was significantly higher than that of other three groups(P＜0.05).At T4,T6 and T7,there were statistically significant differences in IL-10 and TNF-α levels among four groups(P＜0.05),and the IL-10 level in control group was significantly lower than that in other three groups,and the TNF-α level was significantly higher than that in other three groups.At T2,T3,T4 and T5,there were statistically significant differences in rSO2 between four groups(P＜0.05),and PHC+RIPC group＞RIPC group＞PHC group＞control group.At T6,the score of mini-mental state examination scale of control group was significantly lower than that of other three groups(P＜0.05).Conclusion PHC combined with RIPC can improve rSO2 and postoperative cognitive function in patients with thoracoscopic lung cancer resection,reduce the level of inflammatory factors,and reduce the occurrence of postoperative cognitive dysfunction.

Objective To evaluate the relationship between perioperative myocardial injury(PMI)and serum N/OFQ levels in elderly patients with coronary heart disease.Methods Totally 120 elderly patients who underwent hip fracture surgery under general anesthesia from January 2022 to May 2023 were included,including 60 patients with coronary heart disease(CHD group)and 60 patients without coronary heart disease(control group).The venous blood of patients was collected 10 minutes before anesthesia induction(T0),12 hours after surgery(T1)and 24 hours after surgery(T2)to detect the content of N/OFQ and high-sensitivity myocardial troponin I(hs-cTnI)in serum.Record perioperative adverse cardiovascular events(PACE)and the use of vasoactive drugs during surgery.Results Compared with the control group,the N/OFQ and hs cTnI levels at T0 and T1 in the CHD group were significantly increased(P<0.05).There was a positive correlation between N/OFQ and hs-cTnI levels at T1 and T2 in CHD and control group(P<0.05).The use of PACE and intraoperative vasoactive drugs in the CHD group was higher than that in the control group(P<0.05).Conclusion There is a correlation between the increased N/OFQ content and PMI in elderly patients with coronary heart disease after surgery,which may become an early predictive indicator of PMI.

Objective To explore the effects of remote ischemic preconditioning combined with permissive hypercapnia on brain oxygen saturation and postoperative cognition in patients which undergoing thoracoscopic lung cancer surgery.Methods A collection of 64 patients elective requiring thoracoscopic lung cancer surgery who were divided into control group and combined group according to the randomized grouping method,with 32 cases in each group.The PaCO2 in the control group of patient was maintained at normal,and patients in the combination group were given permissive hypercapnia ventilation strategies and performed remote ischemic preconditioning,PaCO2 is maintained at 45-50mmHg(1mmHg=0.133kPa).Record the cerebral oxygen saturation(rSO2)at the five time points before operation(T0),10min after one lung ventilation(T1),30min after one lung ventilation(T2),10 min after lung recruitment(T3)and the end of surgery(T4),measured the internal jugular venous blood oxygen saturation(SjvO2)and calculated cerebral arteriovenous blood oxygen content difference(CaO2-CjvO2),brain oxygen uptake rate(CERO2).Monitored the average arterial pressure(MAP)and heart rate(HR)of the hemodynamic indicators at the above five time points.The scores of cognitive function were recorded 1 day before operation and 1 day and 3 days after operation;detected the levels of serum neuron-specific enolase(NSE),amyloid β(Aβ)and S100β protein(S100β)in 1 day before surgery,24hours after surgery and 48hours after surgery;Comparison of postoperative related indicators and adverse reactions between the patients of two groups.Results The rSO2 and SjvO2 of combined group were higher than control group in the T1-T4,but CaO2-CjvO2 and CERO2 were lower than those of control group.There was no significant difference in HR and MAP between two groups from T0-T4.The mini-mental state examination(MMSE)score of the combined group was significantly higher than that of the control group on the 1 day after operation.The level of serum NSE,Aβ and S100β in the combined group was lower than those of control group at 24hours and 48hours after operation.There was no significant difference in incidence of postoperative adverse reactions and postoperative related indexes between the two groups.Conclusion Permissive hypercapnia combined with remote ischemic preconditioning can increase cerebral oxygen saturation in patients undergoing thoracoscopic lung cancer surgery,improve cerebral oxygen metabolism and reduce the levels of serum neuron-specific enolase,β-amyloid protein and S100β protein,decrease the postoperative cognitive dysfunction.

Objective To investigate the effects of Qingguang'an Ⅱ Formula(QGA Ⅱ)on the gut micro-biota of mice with chronic high intraocular pressure(IOP)model,and explore its key micro-biota for protecting the optic nerve.Methods A total of 10 specific pathogen free(SPF)grade female DBA/2J mice were random-ly divided into model group and QGA Ⅱ group(n=5 for each group),while additional 5 SPF-grade female C57BL/6J mice were assigned to control group.Mice presented spontaneous high IOP and showed elevated approximately at the age of seven months.The high IOP was maintained until week 38,when gavage was initiated.Mice in control group underwent the same intragastric treatment,while those in QGA Ⅱ group were gavaged with QGA Ⅱ(9.67 g/kg),once a day for four weeks.Retinal morphology was examined using hematoxylin and eosin(HE)staining,with the number of retinal ganglion cells(RGCs)counted.The expression level of Brn3a protein,a specific marker for RGCs,was detected by immunofluorescence,with the mean optical density(OD)measured for quantitative analysis.In addition,16S rDNA se-quencing was leveraged to analyze changes in the diversity of gut microbiota,including their α-diversity(Chao1,Shannon,Pielou's evenness,and observed species index)and β-diversity.Venn diagrams and linear discriminant analysis effect size(LEfSe)analysis was employed to investigate the number of amplicon sequence variants(ASVs),the abundance of differential gut microbiota species,and the classification of species at both the phylum and genus levels within the three groups of mice.Results HE staining revealed that compared with control group,model group showed signif-icant reduction in the number of RGCs(P<0.01),with intracellular vacuolar degeneration and nuclear pyknosis.After QGA Ⅱ treatment,the number of RGCs was significantly in-creased compared with model group(P<0.01),with notable improvements in intracellular vacuolar degeneration.Immunofluorescence analysis showed that the mean OD of Brn3a protein was significantly decreased in model group compared with control group(P<0.01),while QGA Ⅱ treatment significantly elevated its expression level(P<0.01).Analysis of α-diversity showed that after QGA Ⅱ intervention,the Chao1,Shannon,and Pielou's evenness indices were significantly increased(P<0.01),and the observed species index was elevated(P<0.05).β-Diversity analysis demonstrated distinct clustering among the three groups,indicating relatively low similarity in bacterial community structures.ASV clustering identi-fied a total of 14 061 ASVs across all groups,with 9 514 ASVs shared between model and QGA Ⅱ groups.At the phylum level,the abundance of Bacteroidetes was significantly decreased in model group compared with control group(P<0.01),while Firmicutes and the Firmicutes/Bacteroidetes(F/B)ratio were significantly increased(P<0.01).QGA Ⅱ treatment significantly reduced both Firmicutes abundance and the F/B ratio(P<0.01).At the genus level,Lactobacillus was dominant across all groups,with its abundance significantly in-creased in model group(P<0.01)and subsequently decreased following QGA Ⅱ intervention(P<0.05).Conclusion QGA Ⅱ restructured the gut microbiota of DBA/2J mice with chronic high IOP,bringing changes in their diversity and abundance of components.Firmicutes,Bacteroidetes,Lactobacillus,along with their associated microorganisms,are likely critical components of the gut microbiota that contribute to the optic neuroprotective effects of QGA Ⅱ on chronic high IOP mice.

Objective To observe the effect of dexmedetomidine combined with goal-directed fluid therapy(GDFT)on hemodynamics and cerebral oxygen supply of patients undergoing cerebral aneurysm clipping.Methods A total of 78 patients undergoing cerebral aneurysm clipping surgery in Jinhua Municipal Central Hospital from January 2021 to December 2022 were selected and divided into control group and observation group according to random number table method,with 39 cases in each group.The patients in control group received conventional fluid therapy,and the patients in observation group received dexmedetomidine pump +GDFT.Mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),brain metabolic markers,neuron specific enolase(NSE),S100β levels and mini mental status examination(MMSE)scores at different time points[before anesthesia induction(T0),immediately after tracheal intubation(T1),beginning of surgery(T2),opening meninges(T3),immediately after aneurysm clipping(T4),end of surgery(T5),24h after surgery(T6),72h after surgery(T7)],and fluid intake and outflow of two groups were compared.Results MAP at T1-T4 and CI at T1-T3 in observation group were significantly higher than those in control group(P<0.05).The colloid volume,total infusion volume and urine volume in observation group were significantly higher than those in control group(P<0.05).The serum levels of NSE and S100β at T5-T7 were significantly higher than those at T0 in both groups(P<0.05).The levels of serum NSE and S100β at T5 and T6 in observation group were significantly lower than those in control group(P<0.05).The oxygen content in jugular venous blood(CjvO2)at T1-T4 was significantly lower than that at T0 in control group(P<0.05).Cerebral oxygen extraction ratio at T1 was significantly higher than that at T0 in both groups(P<0.05).CjvO2 at T3-T4 in observation group were significantly higher than those in control group(P<0.05).At T6 and T7,MMSE scores in two groups were significantly lower than at T0 in this group(P<0.05).MMSE score at T6 of observation group was significantly higher than that of control group(P<0.05).Conclusion Dexmedetomidine combined with GDFT can effectively improve preload and brain function,stabilize intraoperative circulatory function,and improve early postoperative cognitive function in patients undergoing cerebral aneurysm clipping.

Objective:To investigate the analgesic effect of intravenous anesthesia induction combined with anterior quadratus lumborum block (AQLB)and related hemodynamic changes in patients undergoing laparoscopic retroperitoneal partial nephrectomy (RPN).Methods:A total of 116 patients undergoing elective laparoscopic partial nephrectomy for renal tumors in Jinhua Central Hospital from August 2021 to February 2022 were randomly divided into two groups with 58 cases in each group. Patients in control group received intravenous anesthesia , while those in study group received intravenous anesthesia induction with AQLB. The analgesic effect was evaluated at 1, 6, 12, 24, and 48 h after the operation. The hemodynamics were monitored at the time of entering the operating room (T 0), 3 min after induction of anesthesia (T 1), at the beginning of the operation (T 2), after the operation (T 3), and leaving the operating room (T 4). Microcirculation was assessed at 1, 6, 12, 24, and 48 h after operation. Cognitive function was assessed 30min before anesthesia, 6 h, 24 h, and 72 h after operation. Results:At 1, 6, 12, 24 and 48 h after operation, the visual analogue scale (VAS) of the resting (quiet state) pain in the study group were 3.2±1.2, 2.6±0.3,2.0±0.4, 1.5±0.4 and 0.8±0.2, which were significantly lower than those in control group (4.0±1.7, 3.4±0.7, 2.9±0.5, 1.7±0.5 and 1.2±0.3) ( t=2.93, P=0.004; t=8.00, P<0.001; t=10.07, P<0.001; t=2.38, P=0.019; t=8.45, P<0.001). There was no significant difference in heart rate and mean arterial pressure (MAP) at T 0 between two groups ; no significant difference in the heart rate at T 1, T 2, T 3 and T 4. There were significant differences in MAP levels at T 1, T 2, T 3 and T 4 between study group [(80.0±8.0)mmHg (1 mmHg=0.133 kPa), (84.4±8.4)mmHg, (80.4±5.7)mmHg, (86.4±4.7)mmHg and control group (77.1±7.5)mmHg, (88.0±8.6)mmHg, (83.0±7.7)mmHg, (92.2±6.2) mmHg; t=2.01, P=0.046; t=2.28, P=0.024; t=2.07, P=0.041; t=5.68, P<0.001]. At 6, 12, 24 and 48 h after operation, the morphological scores of tube loops in the study group were 1.0±0.2, 0.8±0.2, 0.7±0.1 and 0.7±0.1, which were lower than those in the control group (1.1 ±0.2, 0.9±0.2, 0.8±0.2 and 0.8±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=3.41, P=0.001; t=5.39 , P < 0.001). The blood flow status scores of the study group were 1.1±0.2, 0.9±0.2, 0.8±0.2 and 0.6±0.1, which were lower than those of the control group (1.2±0.2, 1.0±0.2, 0.9±0.2 and 0.7±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=2.69, P=0.008; t=5.39, P<0.001). The cognitive function scores of the study group and the control group were 24.4±1.0, 27.1±0.9 and 23.5±0.9, 26.7±0.9 at 6 h and 24 h after operation ( t=5.10, P<0.001; t=2.39, P=0.018); while there were no significant at 72 h after operation between two groups (28.2±0.9 vs. 28.1±0.8, t=0.63, P=0.529). Conclusion:Intravenous anesthesia induction combined with anterior quadratus lumborum block has a good analgesic effect in patients undergoing RPN, with stable hemodynamics and microcirculation, and not affecting cognitive function of patients.

AIM: To explore the optimal dosage of dexmedetomidine for prevention of agitation induced by sevoflurane anesthesia in children. METHODS: One hundred and sixty ASA -Ⅱ pediatric patients, who underwent indirect inguinal hernia or hydrocele were randomly divided into 4 groups: C group (saline group), D0.2 group (dexmedetomidine 0.2 μg/kg), Group D0.4 (dexmedetomidine 0.4 μg/kg); D0.6 group (dexmedetomidine 0.6 μg/kg), 40 cases in each group. The dexmedetomidine was treated with intravenous infusion of the same volume of saline at 10 min before the induction of anesthesia. Observation with induction period and intraoperative hemodynamic situation, postoperative FLACC behavior score, Ramsay sedation scores, extubation time, adverse reactions, such as respiration depression (SpO2<92%), postoperative nausea and vomiting, postoperative agitation were carried out. RESULTS:The intraoperative hemodynamics of D0.4 and D0.6 groups were more stable than the groups of C and D0.2 (P<0.05). The FLACC scores of groups D0.4 and D0.6 were lower than the groups C at the time of T5, T6. The FLACC scores of group D0.6 was lower than the groups C at the time of T7 (P<0.05). The FLACC scores of groups D0.4 and D0.6 were lower than the groups D0.2 at the time of T5, T6 also (P<0.05). The Ramsay sedation score of groups D0.4 and D0.6 were higher than the group C at the time of T5, T6, T7 (P<0.05). The Ramsay sedation score of groups D0.4 and D0.6 were higher than the group D0.2 at the time of T5, T6, and the Ramsay sedation score of group D0.6 was higher than the group D0.2 at the time of T7 also (P<0.05). There was no statistically significant difference in postoperative hypoxic incidence (SpO2<92%) in the four groups (P>0.05). The case of postoperative agitation in the group D0.4 (12 cases), D0.6 (8 cases) lower than the group C (23 cases) and D0.2 (16 cases) (P<0.05). The awakening time of group D0.6 was longer than the group of C (P<0.05). The rate of other adverse reaction were no statistically significant difference in the four groups (P>0.05).CONCLUSION:The usage of 0.4 μg/kg dexmedetomidine for the pediatric inguinal hernia or hydrocele surgery under the anesthesia of sevoflurane has the characteristics of stable hemodynamics during the operation, reducing the incidence of restlessness after sevoflurane anesthesia, not affecting the recovery of children, and not increasing adverse reactions.

Objective: To investigation HER2 status in gastric adenocarcinoma of Chinese and contributing factors to the HER2 expression. Methods: HER2 status of 40 842 gastric adenocarcinomas and clinical data were retrospectively collected from 23 hospitals dated from 2013 to 2016. The association between HER2 positivity and clinicopathologic features was analyzed. Results: Of the 40 842 patients the median age was 62 years, the male female ratio was 2.6∶1.0. The rate of HER2 positivity was 8.8% (3 577/40 842). HER2 expression was related to the tissue type, tumor location, Lauren classification and tumor differentiation (P values: 0.009, 0.001, <0.01 and <0.01, respectively). Different HER2 expression status was observed between primary and recurrent tumors in 7.6% (48/635) cases. The rates of HER2 positivity ranged from 2% to 10% among different institutions. The rates of HER2 FISH amplification were dramatically different among the 23 hospitals (0-100%) with an average rate of 10% (810/8 156) in patients with HER2 IHC 2+ . Conclusions HER2 expression is associated with clinicopathologic characteristics. HER2 re-assessment of tumor tissue and use of in situ hybridization techniques increase HER2 positivity. The current retrospective study should reflect the HER2 status in gastric adenocarcinoma of Chinese patients.

Objective To observe the analgesia effect of oxycodone hydrochloride injection successive subtraction method background infusion on postoperative analgesia in patients of lobectomy under thoracoscope.Methods Ninety lobectomy under thoracoscope patients, using the random number table method patients were randomly divided into three groups:sufentanil group (group S), the constant speed oxycodone infusion group (Q1) and the decreasing background infusion oxycodone group (Q2), 30 cases in each group. On the time of 10 minutes before the end of surgery, S group was given sufentanil 0.10 μg/kg, Q1 and Q2 group was given oxycodone 0.10 mg/kg, each patient was given intravenous patient-controlled analgesia (PCIA), the group of S set electronic pump sufentanil 2.00 μg/kg (100 ml), background infusion was 0.03 μg/(kg·h), PCA dose was 0.015 μg/kg; The group of Q1 was oxycodone 1.00 mg/kg (100 ml), background dose of 15.00 μg/(kg·h), PCA dose of 15.0 μg/kg; The group of Q2 also was oxycodone 1.00 mg/kg (100 ml), on the first 12 h after operation, the background infusion was 15.00 μg/(kg·h), every 12 h later, the background infusion decreased by 20%, PCA dose was 15.00 μg/kg, all of the pump locking time was 10 minutes, lock 4 times per hour. Recorded the number of hemodynamic on the end of operation, immediate extubation and extubation after 5 minutes. On the time of postoperative 2 h, 8 h, 12 h, 24 h, 48 h, recorded the scores of NRS?, NRS (M), Ramsay. Recorded the times of PCA compression,times of medicaments remedies,the amount of drug use, adverse reactions such as respiratory depression, nausea, vomiting, itching and satisfaction of patients to postoperative analgesia.Results The MAP and HR of three groups of patients were increased in the time of tube drawing (P < 0.05), there was no significantly difference in MAP and HR among the three groups at the end of operation, immediate extubation and after 5 minutes of extubation (P > 0.05). The score of NRS ? in the groups of Q1 and Q2 was lower than group S at the time of (T3~5) (P < 0.05), the score of NRS (M) in the groups of Q1 and Q2 was lower than group S at the time of (T3~6) also. The Ramsay score of Q1 and Q2 group was higher than the group S in the point (T3~7). Which the times of PCA and remedial drug use, sleep disturbed times in the first day and second day of group Q1 and Q2 was lower than the group S (P < 0.05). The volume of drug use at 48 h in the group of Q2 was lower than the group Q1 and S (P < 0.05). Postoperative nausea and vomiting of group Q2 was lowered than group S (P < 0.05). The satisfaction of Patients to postoperative analgesia in the group Q2 and Q1 was higher than group S (P < 0.05).Conclusion Lobectomy under thoracoscope patients with postoperative application of successive subtraction method background infusion oxycodone can obtain satisfactory analgesia effect with a smooth anesthesia recovery period, satisfied analgesic effect, reduce the dosage of drugs and reduce the adverse reaction.