Objective:To identify the risk factors for poor prognosis following interventional treatment in the patients with postherpetic neuralgia (PHN) and construct a predictive model.Methods:The medical records from patients with PHN undergoing interventional therapy at the First Affiliated Hospital of Soochow University from March 2020 to August 2023 were retrospectively collected, including basic characteristics, past medical and surgical history, symptoms, medication therapy, clinical pain score, neutrophil/lymphocyte ratio (NLR) before interventional treatment and interventional treatment methods. Logistic regression analysis was used to identify the risk factors associated with poor prognosis following interventional treatment in PHN patients, and a nomogram predictive model for poor prognosis was constructed. The discrimination and calibration of the nomogram predictive model were evaluated using the C-index and Hosmer-Lemeshow test. Calibration curves and clinical decision curves were drawn to further verify the accuracy of the predictive model.Results:The results of the multivariate logistic regression analysis show that increasing age, prolonged disease duration, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency were independent risk factors for poor prognosis following intervention treatment in PHN patients ( P<0.05). The nomogram predictive model for poor prognosis following PHN interventional treatment constructed based on these factors had a C-index of 0.844. Calibration curves showed good consistency between predicted probability of poor prognosis and actual incidence of poor prognosis. Clinical decision curves indicated that the predictive model provided good accuracy and net benefit. Conclusions:Increasing age, prolonged disease course, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency are independent risk factors for poor prognosis following interventional treatment in the patients with PHN. The nomogram predictive model based on these factors can effectively predict the occurrence of poor prognosis in PHN patients undergoing interventional treatment.

Objective:To evaluate the relationship between preoperative plasma trimethylamine oxide (TMAO) concentrations and postoperative delirium (POD) in elderly patients.Methods:One hundred and eighty patients, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with body mass index of 17-30 kg/m 2, scheduled for elective hip replacement, were enrolled in this study. Venous blood samples were collected at 1 day before surgery, and the plasma TMAO concentrations were measured by high throughput liquid chromatography-tandem mass spectrometry. The patients were divided into 3 groups according to the concentrations of TMAO: low-concentration TMAO group (group L, ≤1.2 μmol/L), moderate-concentration TMAO group (group M, 1.3-1.9 μmol/L), and high-concentration TMAO group (group H, ≥2.0 μmol/L). All patients received superior inguinal fascia iliaca compartment block combined with intravenous general anesthesia. POD was identified by the Confusion Assessment Method-Chinese Reversion scale at 1, 2, 3 and 7 days after operation. The patients were divided into POD group and non-POD group according to whether POD occurred. Binary logistic regression analysis was used to evaluate the relationship between different plasma TMAO concentrations and POD. The receiver operating characteristic curve was used to evaluate the efficacy of plasma TMAO concentrations in predicting the occurrence of POD. Results:There were 60 cases in L group, 67 cases in M group and 53 cases in H group, and the incidence of POD was 12%, 22% and 32% in L, M and H groups, respectively. The incidence of POD was significantly higher in group H than in group L ( P<0.05). The plasma TMAO concentration was significantly higher in POD group than in non-POD group ( P<0.05). Logistic regression analysis showed that the risk of POD was 3.91 times higher in group H than in group L ( P<0.05). The area under the receiver operating characteristic curve of preoperative plasma TMAO concentrations in predicting POD was 0.754 (95% confidence interval 0.671-0.838, P<0.05). When the Youden index was 0.426, the optimal cut-off value of plasma TMAO concentrations was 1.625 μmol/L, and the specificity and sensitivity were 0.795 and 0.631, respectively. Conclusions:Elevated preoperative plasma TMAO concentration is associated with an increased risk of POD in elderly patients, and it has a good predictive value for POD.

Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.

Objective:To evaluate the effects of dexmedetomidine on the enhancement of fear memory by propofol in rats with post-traumatic stress disorder (PTSD).Methods:Two hundred and twenty clean-grade healthy male Sprague-Dawley rats, weighing 300-400 g, aged 12-16 weeks, underwent conditioned fear memory training, and PTSD model was developed.One hundred and twenty rats were divided into 6 groups ( n=20 each) by a random number table method: control group (C group), PTSD group, propofol group (P1 group), and propofol + different doses of dexmedetomidine groups (P1+ DEX10 group, P1+ DEX20 group and P1+ DEX40 group). In group C, only sound was played and no electric shock was given during conditioned fear memory training.After conditioned fear memory training, sesame oil 1 ml/kg was intraperitoneally injected in PTSD group, propofol 1 ml/kg was intraperitoneally injected in group P1, and dexmedetomidine 10, 20 and 40 μg/kg were intraperitoneally injected in P1+ DEX10, P1+ DEX20 and P1+ DEX40 groups, respectively.After drug administration, conditioned fear memory test was performed to record the time of rigid behavior within 90 s, and the percentage of time of rigid behavior was calculated.The development of SpO 2<90% was recorded during administration.One hundred Sprague-Dawley rats were divided into 5 groups ( n=20 each) by the random number table method: propofol group (P2 group), and propofol+ dexmedetomidine given at different timings groups (P2+ DEX T0 group, P2+ DEX T30 group, P2+ DEX T60 group and P2+ DEX T90 group). After the conditioned fear memory training, propofol 1 ml/kg was intraperitoneally injected in 5 groups, an then dexmedetomidine 20 μg/kg was intraperitoneally injected at 0, 30, 60 and 90 min after propofol administration in P2+ DEX T0, P2+ DEX T30, P2+ DEX T60 and P2+ DEX T90 groups, respectively.Conditioned fear memory test was performed after drug administration to record the time of rigid behavior within 90 s, and the percentage of time of rigid behavior was calculated. Results:Only 6 rats developed SpO 2<90% during the administration period in P1+ DEX40 group.Compared with C group, the percentage of time of rigid behavior was significantly increased in PTSD group ( P<0.05). Compared with PTSD group, the percentage of time of rigid behavior was significantly increased in P1 group ( P<0.05). Compared with P1 group, the percentage of time of rigid behavior was significantly decreased in P1+ DEX20 and P1+ DEX40 groups ( P<0.05), and no significant change was found in the percentage of time of rigid behavior in P1+ DEX10 group ( P>0.05). Compared with P2 group, the percentage of time of rigid behavior was significantly decreased in P2+ DEX T0 and P2+ DEX T30 groups ( P<0.05), and no significant change was found in the percentage of time of rigid behavior in P2+ DEX T60 and P2+ DEX T90 groups ( P>0.05). Conclusions:Dexmedetomidine can attenuate propofol-induced enhancement of fear memory in a rat model of PTSD, and the best effect is achieved in early administration of moderate dose (20 μg/kg, within 30 min after propofol administration).

Objective:To evaluate the effect of preoperative cognitive behavioral therapy (CBT) on pain catastrophizing in the patients with orthopedic trauma.Methods:A total of 120 patients with lower extremity bone trauma, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18-28 kg/m 2, with Pain Catastrophic Scale (PCS) score on admission >16, scheduled for surgical treatment, were enrolled.The patients were divided into 2 groups ( n=60 each) by the stratified randomization method based on the type of fracture: CBT group and routine group (group R). Group CBT received CBT for pain through the internet on the day of admission and one day before operation.The patients in both groups underwent reduction and internal fixation of lower extremity fractures under combined spinal-epidural anesthesia.The PCS scores were recorded immediately after admission and on the morning of the operation day.The effective pressing times of the patient-controlled analgesia pump, consumption of analgesics for rescue analgesia, and occurrence of nausea and vomiting within 48 h after operation were recorded.The visual analogue scale score of the surgical site during activity and occurrence of the score >3 at 3 months after operation and use of opioids within 3 months after operation were recorded. Results:Compared with group R, the PCS score was significantly decreased on the morning of the operation day, the pressing times of the patient-controlled analgesia pump, consumption of analgesics for rescue analgesia and incidence of nausea and vomiting within 48 h after operation were decreased, the requirement for opioids within 3 months after operation was decreased ( P<0.05), and no significant change was found in VAS score during activity and occurrence of the score >3 at 3 months after operation in group CBT ( P>0.05). Conclusions:Preoperative CBT can reduce the degree of pain catastrophizing and is helpful in increasing the quality of postoperative analgesia in the patients with orthopedic trauma.

Objective:To screen the risk factors for post-traumatic stress disorder (PTSD) after emergency trauma surgery in the patients.Methods:The medical records of emergency surgical trauma patients (traffic accident, fall, engineering accident, etc.) were retrospectively collected.The general condition and perioperative clinical indicators of the patients were recorded.The patients were divided into PTSD group and non-PTSD group according to whether PTSD occurred within 1 month after surgery.Multivariate logistic regression analysis was used to screen the risk factors for PTSD.Results:A total of 312 patients were enrolled, and the incidence of PTSD at 1 month after surgery was 19.9%.There were significant differences in preoperative VAS score, ratio of gender, intraoperative use of propofol, intraoperative use of dexmedetomidine, and postoperative ICU transfer rate between PTSD group and non-PTSD group ( P<0.05). The results of logistic regression analysis showed that intraoperative use of propofol, preoperative high VAS score and postoperative admission to ICU were independent risk factors for PTSD, and intraoperative use of dexmedetomidine was a protective factor for the prevention of PTSD ( P<0.05). Conclusions:Intraoperative use of propofol, preoperative high VAS score and postoperative transfer to ICU are independent risk factors for postoperative PTSD in the patients with emergency trauma, and intraoperative use of dexmedetomidine is a protective factor for the prevention of PTSD.

Objective:To investigate the predictive efficacy of global inhomogeneity (GI) index based on pulmonary electrical impedance tomography (EIT) in postoperative pulmonary infection of patients with craniocerebral trauma.Methods:A total of 90 patients with emergency craniocerebral trauma underwent surgery under general anesthesia in Suzhou Science & Technology Town Hospital. According to the complication of pulmonary infection at the 3rd day after operation, they were divided into the pulmonary infection group (P3 group) and non-pulmonary infection group (NP3 group), and according to the complication of pulmonary infection at the 7th day after operation, they were divided into the P7 group and NP7 group. The average GI index within 5 min before anesthesia induction (T 0) and 5 min after endotracheal intubation (T 1) and other clinical data in the perioperative period were collected. The prevalence of pulmonary infection at the 3rd and 7th days after operation was recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative GI index for pulmonary infection at the 3rd and 7th days after operation. Results:A total of 88 patients were included. Among them, 26 patients developed pulmonary infection within 3 days after operation, and the prevalence rate was 29.5%. Pulmonary infection occurred in 38 patients within 7 days after operation, and the prevalence rate was 43.2%. Within 3 days after operation, the preoperative Glasgow Coma Scale score in the P3 group was significantly lower than that in the NP3 group ( P < 0.05). Within 3 days after operation, GI index in the P3 group increased significantly at T 1 when compared with the NP3 group ( P< 0.001). Within 7 days after operation, GI index in the P7 group increased significantly at T 1 when compared with the NP7 group ( P < 0.05). GI index at T1 accurately predicted pulmonary infection within 3 days after operation (AUC = 0.857, P < 0.001), and the best intercept value was ≥0.4225 (sensitivity: 0.846, specificity: 0.823). GI index at T 1 predicted pulmonary infection within 7 days after operation (AUC = 0.667, P < 0.005), and the best intercept value was ≥0.4225 (sensitivity: 0.579, specificity: 0.780), but the prediction efficiency was poor. Conclusions:The average GI index within 5 min after endotracheal intubation can be used as an effective predictor of pulmonary infection within 3 days after operation.

Objective:To investigate the effects of propofol and sevoflurane on post-traumatic stress disorder (PTSD) after emergency surgery in trauma patients.Methods:A total of 160 trauma patients undergoing emergency surgery under general anesthesia were randomly divided into the propofol group and the sevoflurane group. The perioperative clinical data of the two groups were collected. The incidence of PTSD was evaluated by PCL-5 score one month after the operation in the two groups. The relevance of the injury time and PCL-5 score was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors of PTSD.Results:The incidence of PTSD in the propofol group was significantly higher than that in the sevoflurane group at postoperative 1 month (24.0% vs 10.8%, P=0.034). The injury time was negatively correlated with PCL-5 score in the propofol group ( r=0.229, P<0.01). There was no correlation between the injury time and the PCL-5 score in the sevoflurane group ( r=0.001, P=0.804). Logistic regression analysis showed that the use of propofol was an independent risk factor for PTSD ( P=0.004). Conclusions:Sevoflurane anesthesia is more effective than propofol anesthesia in reducing the occurrence of PTSD in emergency surgery for trauma patients.

Objective:To evaluate the effect of regional oxygen saturation (rSO 2)-guided low-dose norepinephrine on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip replacement under general anesthesia. Methods:One hundred and twenty patients of both sexes, aged 65-80 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for hip replacement under general anesthesia, were divided into 2 groups ( n=60 each) using a random number table method: control group (group C) and low-dose norepinephrine guided by rSO 2 group (group RN). The patients in both groups received superior inguinal fascial space block combined with general anesthesia under laryngeal mask placement.In group C, the fluctuation range of mean arterial pressure (MAP) was not more than 20% of the baseline, vasoactive agents were administered according to the changes in blood pressure, rSO 2 was monitored continuously, but the change rate of rSO 2 was not used as the regulating index.In group RN, norepinephrine was infused continuously via the central vein at 0.01-0.10 μg·kg -1·min -1 after anesthesia induction, the dose was adjusted according to rSO 2, the rSO 2 change rate was maintained≤10%, the fluctuation range of mean arterial pressure was not more than 20% of the baseline, and vasoactive agents were administered when necessary.MAP, end-tidal pressure of carbon dioxide (P ETCO 2) and rSO 2 were recorded after inhalation of oxygen (T 0), at 5 min after anesthesia induction (T 1), at 30 min after skin incision (T 2), at the end of surgery (T 3) and after recovery and extubation (T 4), and the change rate of rSO 2 was calculated.The occurrence of adverse events and amount of vasoactive drugs used were recorded.The cognitive function was assessed using Montreal Scale at 1 day before surgery and 7 days after surgery, and the development of postoperative cognitive dysfunction (POCD) was calculated using Z score.The postoperative hospital stay time was recorded. Results:Compared with group C, MAP and rSO 2 were significantly increased, and the change rate of rSO 2 was decreased at T 1, 2 in group RN ( P<0.05). Compared with group C, the requirement for intraoperative vasoactive drugs was significantly decreased, the consumption of norepinephrine was increased, MoCA total score, attention and delayed recall sub-score were increased at 7 days after surgery, the incidence of POCD was decreased, and the postoperative hospital stay time was shortened in group RN ( P<0.05). Conclusion:Low-dose norepinephrine guided by rSO 2 can decrease the development of POCD in elderly patients undergoing hip replacement under general anesthesia.

Objective:To explore the changes of bone mineral density (BMD) and type H vessel, which was recently identified as strongly positive for CD31 and Endomucin (CD31 hiEmcn hi) in long bone from ovariectomized (OVX) mice compared withSham group. Methods:C57BL/6Jwild-type mice were used for experiments and bone tissuewas collected. Eight-week-old female mice were randomly divided into bilateral ovariectomy (OVX) and a sham operation (Sham). The bilateral ovaries were exposed and removed in the OVX group. In the sham group, the ovaries were only exposed but left intact. After 4weeks, these mice were killed for experiment and the femurs were collected for Micro CT scanning in order to observe the changes of bone mineral density (BMD) and trabecular indexes, including bone volume (BV), total volume of interest (TV), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). The fresh tibia of each mouse was fixed, decalcified, dehydrated and embedded for immunostaining. All experimental data were analyzed with t-test. Results:Mouse femora from two groups were dissected at 4 week time points, and the attached soft tissue was completely removed for Micro CT scanning. BMD in OVX is 0.11±0.01 g/cm 3 and 0.21±0.01 g/cm 3 in Sham, which indicated the BMD in OVX significantly decreased. The results showed significant difference between the groups ( P=0.001). The microarchitecture in trabecular bone changed. BV/TV in OVX is 11.52%±1.77% and 25.87%±1.31% in Sham, which indicated the BV/TV in OVX significantly decreased. The results showed significant difference between the groups ( P<0.05). Tb.N in OVX is 1.67±0.33/mm and 2.95±0.82/mm in Sham, which indicated the Tb.N in OVX slightly decreased. The results showed no significant difference between the groups ( P=0.066). Tb.Th in OVX is 0.06±0.01 mm and 0.07±0.01 mm in Sham, which indicated the Tb.Th in OVX significantly thinned. The results showed significant difference between the groups ( P=0.021). Tb.Sp in OVX is 0.29±0.15 mm and 0.19±0.01 mm in Sham, which indicated the Tb.Sp in OVX significantly increased. The results showed significant difference between the groups ( P<0.05). In the groups BMD decreased and trabecular microstructure was broken. Both BMD and trabecular indexes (BV/TV, Tb. Th, Tb. Sp) showed significant changes in OVX group compared with Sham ( P<0.05) except Tb.N. We next examined the expression of CD31 and EMCN via immunostaining in order to observe the changes of type H vessel.By immunostaining, the percentage of HV/TV in OVX group was 9.14%±0.99% and 29.33%±1.22% in the sham-operated mice. Dramatically decreased type H vessels in the metaphysis of OVX mice were observed compared with that of Sham control mice. The results showed significant difference between the groups ( P<0.05). Conclusion:In this study, ovariectomized mice, a widely used model for postmenopausal osteoporosis, exhibited significantly reduced type H vessels accompanied by reduced BMD, which indicatedtype H vessel involved in the occurrence of postmenopausal osteoporosis.