Objective:To investigate the association between intraoperative hypotension and postoperative cerebral ischemia in patients undergoing malignant brain tumor resection.Methods:The study was a secondary analysis of a randomized, double-blind, placebo-controlled trial. Four hundred and eighty patients with malignant brain tumor from November 2018 to September 2022 in Beijing Tiantan Hospital, Capital Medical University were selected. All patients were treated with selective supratentorial tumor resection. The demographic characteristics, perioperative indexes, postoperative outcomes and intraoperative hypotension characteristics were recorded. The cerebral ischemia during postoperative hospitalization (within 10 d after operation) was documented, and the patients were categorized based on the occurrence of postoperative cerebral ischemia.Results:Among 480 patients, 28 cases (5.83%) developed postoperative cerebral ischemia (cerebral ischemia group), while 452 cases did not experience cerebral ischemia during hospitalization (non-cerebral ischemia group). The proportion of WHO grade Ⅲ to Ⅳ, secondary surgery rate and postoperative hospital stay in cerebral ischemia group were significantly higher than those in non-cerebral ischemia group: 96.43% (27/28) vs. 81.19% (367/452), 10.71% (3/28) vs. 1.99% (9/452) and 13 (10, 16) d vs. 10 (8, 14) d, and there were statistical differences ( P<0.05); there were no statistical differences in gender composition, age, body mass index, medical history, medication history, American Society of Anesthesiologists classification, Charlson comorbidity index, preoperative Karnofsky performance status score, tumor laterality, tumor volume, midline shift, operative time, operative time >5 h, fluid intake, red blood cell transfusion, plasma transfusion, blood loss, urine output, fluid balance, serum urea, serum creatinine, glomerular filtration rate, β 2-microglobulin, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen, postoperative complications, ICU admission, ICU stay duration, mechanical ventilation and hospitalization costs between the two groups ( P>0.05). There were also no statistical difference in the duration, time-weighted average and cumulative area under the threshold curve for mean arterial pressure (MAP) at 65, 70 and 75 mmHg (1 mmHg = 0.133 kPa), nor in the duration, time-weighted average and cumulative area under the threshold curve for relative reductions of 20%, 30% and 40% in MAP between the two groups ( P>0.05). Conclusions:The patients undergoing malignant brain tumor resection have the higher risk of postoperative cerebral ischemia. The association between intraoperative hypotension and postoperative cerebral ischemia is not significant. Maintenance of intraoperative circulation should be guided by individualized monitoring and target values, which requires further interventional studies for validation.

Objective:To investigate the association between intraoperative hypotension and postoperative cerebral ischemia in patients undergoing malignant brain tumor resection.Methods:The study was a secondary analysis of a randomized, double-blind, placebo-controlled trial. Four hundred and eighty patients with malignant brain tumor from November 2018 to September 2022 in Beijing Tiantan Hospital, Capital Medical University were selected. All patients were treated with selective supratentorial tumor resection. The demographic characteristics, perioperative indexes, postoperative outcomes and intraoperative hypotension characteristics were recorded. The cerebral ischemia during postoperative hospitalization (within 10 d after operation) was documented, and the patients were categorized based on the occurrence of postoperative cerebral ischemia.Results:Among 480 patients, 28 cases (5.83%) developed postoperative cerebral ischemia (cerebral ischemia group), while 452 cases did not experience cerebral ischemia during hospitalization (non-cerebral ischemia group). The proportion of WHO grade Ⅲ to Ⅳ, secondary surgery rate and postoperative hospital stay in cerebral ischemia group were significantly higher than those in non-cerebral ischemia group: 96.43% (27/28) vs. 81.19% (367/452), 10.71% (3/28) vs. 1.99% (9/452) and 13 (10, 16) d vs. 10 (8, 14) d, and there were statistical differences ( P<0.05); there were no statistical differences in gender composition, age, body mass index, medical history, medication history, American Society of Anesthesiologists classification, Charlson comorbidity index, preoperative Karnofsky performance status score, tumor laterality, tumor volume, midline shift, operative time, operative time >5 h, fluid intake, red blood cell transfusion, plasma transfusion, blood loss, urine output, fluid balance, serum urea, serum creatinine, glomerular filtration rate, β 2-microglobulin, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen, postoperative complications, ICU admission, ICU stay duration, mechanical ventilation and hospitalization costs between the two groups ( P>0.05). There were also no statistical difference in the duration, time-weighted average and cumulative area under the threshold curve for mean arterial pressure (MAP) at 65, 70 and 75 mmHg (1 mmHg = 0.133 kPa), nor in the duration, time-weighted average and cumulative area under the threshold curve for relative reductions of 20%, 30% and 40% in MAP between the two groups ( P>0.05). Conclusions:The patients undergoing malignant brain tumor resection have the higher risk of postoperative cerebral ischemia. The association between intraoperative hypotension and postoperative cerebral ischemia is not significant. Maintenance of intraoperative circulation should be guided by individualized monitoring and target values, which requires further interventional studies for validation.

OBJECTIVE To analyze the metabolites of Zhideke granules and speculate its metabolic pathway in rats in vivo. METHODS Male SD rats were randomly divided into blank group and administration group （Zhideke granules， 9.45 g/kg）； they were given ultrapure water or relevant medicine， twice a day， every 6-8 h， for 3 consecutive days. Serum， urine and feces samples of rats were collected， and their metabolites were identified by UPLC-Q-Exactive-MS technique after intragastric administration of Zhideke granules； their metabolic pathways were speculated. RESULTS After intragastric administration of Zhideke granules， 16 prototype components （i.g. irisflorentin， baicalin， chlorogenic acid） and 11 metabolites （i.g. hydration products of kaempferol or luteolin， methylation products of chlorogenic acid， and hydroxylation products of baicalin） were identified in serum， urine and feces of rats. Among them， 8 prototype components and 4 metabolites were identified in serum samples； 10 prototype components and 7 metabolites were identified in urine samples； 8 prototype components and 5 metabolites were identified in the fecal samples. CONCLUSIONS The metabolites of Zhideke granules in rats mainly include baicalin， irisflorentin，chlorogenic acid， and the main metabolic pathways included methylation， hydroxylation， glucuronidation.

Objective To investigate the association between intraoperative hypotension and post-operative acute kidney injury(AKI)in patients undergoing brain tumor resections.Methods A total of 428 patients undergoing elective craniotomy for tumor resection were selected,276 males and 152 females,aged≥18 years,BMI 15-36 kg/m2,ASA physical statusⅡ orⅢ.Based on postoperative occurrence of AKI,the patients were divided into two groups:the AKI group and the control group.This study defined three thresholds for hypotension,including MAP during surgery below 65 mmHg,60 mmHg,and 55 mmHg.Multivariate logistic regression was used to analyze the correlation between intraoperative hypotension and postoperative AKI under three thresholds.Results A total of 107 patients had postoperative AKI.The re-sults of multivariable regression analysis indicated that intraoperative MAP＜65 mmHg(OR = 1.11,95%CI 1.03-1.20,P = 0.010)and intraoperative MAP＜60 mmHg(OR = 1.12,95%CI 1.02-1.23,P = 0.017)were associated with postoperative AKI.Conclusion Intraoperative MAP＜65 mmHg or 60 mmHg is associated with postoperative AKI in patients undergoing brain tumor resection.

Objective:To explore the evaluation of 256 slice spiral computed tomography angiography(CTA)of coronary,serum lipoprotein associated phospholipase A2(Lp-PLA2)and angiopoietin like protein 3(ANGPTL3)on the severity of coronary artery stenosis of patients with coronary heart disease.Methods:A total of 102 patients with coronary heart disease who were diagnosed and treated at Hebei Chest Hospital from July 2022 to March 2023 were selected as the study subjects.According to the Gensini score about the severity of coronary artery stenosis,they were divided into mild stenosis group(0 score≤Gensini score≤20 scores),moderate stenosis group(20 scores60 scores),with 34 cases in each group.The minimum lumen diameter(MLD),percentage of area of stenosis(%AS),percentage of diameter of stenosis(%DS),minimum lumen area(MLA),Lp-PLA2 and ANGPTL3 among three groups were compared.The diagnostic efficiency of the severity of coronary artery stenosis was predicted according to receiver operating characteristic(ROC)curve.Results:The MLA and MLD values in severe stenosis group were significantly lower than those in moderate and mild stenosis groups,while%AS and%DS were significantly higher than those in moderate and mild stenosis groups(t=6.905,4.083,5.871,6.976,3.387,2.198,2.668,3.505,P<0.05),respectively.The Lp-PLA2 and ANGPTL3 values in severe stenosis group were significantly higher than those in moderate and mild stenosis groups(t=4.164,8.220,2.575,3.050,P<0.05),respectively.ROC curve analysis showed that the area under curve(AUC)values of MLA,MLD,%AS,%DS,CCTA comprehensive parameter,LpPLA2 and ANGPTL3 were respectively were 0.838,0.690,0.742,0.801,0.904,0.808 and 0.807 in predicting the severity of coronary artery stenosis.The sensitivities of them were respectively 91.20%,91.20%,64.70%,94.10%,97.10%,70.60%and 88.20%.The specificities of them were respectively 76.50%,57.40%,75.00%,50.00%,70.60%,97.10%and 70.60%.The AUC value of CCTA comprehensive parameter was respectively higher than that of LpPLA2 and ANGPTL3,but the difference was not statistically significant(P>0.05).Conclusion:256 slice spiral CCTA,serum Lp-PLA2 and ANGPTL3 have a certain efficiency in assessing the severity of coronary artery stenosis of coronary heart disease,and 256 slice spiral CCTA has higher predictive efficiency.

OBJECTIVE To provide reference for basic analysis of the pharmacodynamic substance in Stahlianthus involucratus. METHODS Overall 24 SD male rats were randomly divided into blank group （purified water）， and administration group （ethanol extract of S. involucratus， 15.75 g/kg， calculated by crude drug）， with 12 rats in each group. They were given drug liquid/purified water intragastrically， twice a day， every 6-8 h， for consecutive 3 days. After medication， the blood， urine and fecal samples were collected from two groups of rats. UPLC-Q-Exactive-MS technology was used to identify the chemical constituents in the ethanol extract of S. involucratus， and metabolites in the blood， urine and fecal of rats after intragastrical administration of the ethanol extract of S. involucratus. Multivariate statistical analysis was employed to screen various serum metabolites. Metabolic pathways were analyzed by MetaboAnalyst 5.0 platform. RESULTS A total of 38 chemical constituents were identified from the ethanol extract of S. involucratus， including fourteen prototype components and three metabolites identified from 5 urine samples， nine prototype components identified from fecal samples， and ten prototype components and one metabolite identified from serum samples. A total of 71 differential metabolites were screened from two groups of rat serum samples， of which 44 differential metabolites， such as ferulic acid， glycyrrhizin， were up-regulated and 27 differential metabolites， such as arachidonic acid， phenylacetylglutamine， were down-regulated. The 71 differential metabolites were mainly enriched in 11 metabolic pathways， including phenylalanine metabolism， linoleic acid metabolism， arachidonic acid metabolism， and tryptophan metabolism. CONCLUSIONS Ferulic acid， liquiritigenin， isofraxidin and formononetin may be the material basis that directly exert pharmacological effects of S. involucratus. S. involucratus may exert anti-inflammatory effects by affecting metabolic pathways， including arachidonic acid metabolism and tryptophan metabolism.

Objective:To explore the effect of ultrasound-guided superficial cervical plexus block on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach.Methods:A single-center, randomized, double-blind, parallel controlled trial was conducted on 106 consecutive patients who underwent selective resection of acoustic neuromas in the cerebellopontine angle through the suboccipital retrosigmoid approach in Beijing Tiantan Hospital, Capital Medical University from November 2019 to April 2021. The patients were divided into experimental group and control group by random number table method, with 53 cases in each group. The patients in experimental group underwent superficial cervical plexus block with 0.5% ropivacaine under ultrasound-guided, and the patients in control group received an equal volume of 0.9% sodium chloride. Three months after surgery, the patients were followed up for chronic postoperative pain and the chronic postoperative pain rating scale (NRS) score via telephone. The nature of chronic pain was evaluated using the short-form McGill pain questionnaire-2 (SF-MPQ-2).Results:The incidence of chronic postoperative pain and the NRS score of chronic postoperative pain in experimental group were slightly lower than those in control group: 39.6% (21/53) vs. 50.9% (27/53) and 0 (0, 2) scores vs. 1 (0, 3) scores, but there were no statistical difference between the two groups ( P>0.05). There were no statistical difference in SF-MPQ-2 various scores and total score after surgery between the two groups ( P>0.05). Conclusions:Ultrasound-guided superficial cervical plexus block has a certain analgesic effect on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach, but it still requires further verification through an adequate sample size.

Objective:To explore the predictive value of secretogranin II (SCG2) for the prognosis of pancreatic neuroendocrine tumors (pNET) and to construct a nomogram prediction model based on SCG2.Methods:One hundred and thirty-three patients with pNET who underwent radical surgery at the Fourth Hospital of Hebei Medical University from August 2013 to December 2021 were retrospectively collected. The cohort, including 60 males and 73 females with a mean age of (53.70±12.08) years, was divided into a training set ( n=93) and a validation set ( n=40). Clinical data such as gender, age, tumor size, lymph node metastasis, TNM stage, liver metastasis, surrounding tissue invasion, tumor histological grade, and carcinoembryonic antigen (CA) 19-9 levels were gathered. Immunohistochemical staining was performed to detect SCG2 expression. Patient survival information was obtained through outpatient records or telephone follow-up. The Cox proportional hazard model was used to analyze prognostic factors. A nomogram was created based on the multivariate Cox regression analysis results. The calibration curve and the area under the receiver operating characteristic (ROC) curve were used to evaluate the nomogram's accuracy and discrimination. Results:The SCG2 expression in pNET patients with AJCC stage Ⅲ-Ⅳ was higher than in those with stage Ⅰ-Ⅱ. Similarly, patients with histological grade G3 had higher SCG2 levels compared to those with grades G1-G2. SCG2 expression was also elevated in patients older than 60 years compared to those 60 years or younger, and in patients with CA19-9>30 U/L compared to those with CA19-9≤30 U/L. These differences were all statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that lymph node metastasis ( HR=3.132, 95% CI: 1.212-8.096, P=0.017), liver metastasis ( HR=2.685, 95% CI: 1.002-7.192, P=0.049), histological grade G3 ( HR=3.692, 95% CI: 1.229-11.088, P=0.011), and high SCG2 expression ( HR=52.181, 95% CI: 38.476-108.118, P=0.002) were associated with significantly higher risks of shorter disease free survival. Additionally, patients with longer tumor diameters ( HR=1.297, 95% CI: 1.088-1.545, P=0.004), histological grade G3 ( HR=19.625, 95% CI: 5.276-88.634, P<0.001), and high SCG2 expression ( HR=39.454, 95% CI: 17.317-97.263, P<0.001) had a higher risk of shorter overall survival. A nomogram prediction model was constructed using these above factors. The calibration curve demonstrated good alignment between predicted and actual outcomes in both the training and validation sets. The areas under the ROC curves for the disease-free survival and overall survival nomogram models for predicting 1-, 3-, and 5-year survival of pNET patients in both sets were above 0.8. Conclusion:High SCG2 expression is an independent risk factor for poor prognosis in pNET patients. The nomogram model based on SCG2 has high predictive efficacy for pNET patient prognosis.

Objective:To explore the predictive value of secretogranin II (SCG2) for the prognosis of pancreatic neuroendocrine tumors (pNET) and to construct a nomogram prediction model based on SCG2.Methods:One hundred and thirty-three patients with pNET who underwent radical surgery at the Fourth Hospital of Hebei Medical University from August 2013 to December 2021 were retrospectively collected. The cohort, including 60 males and 73 females with a mean age of (53.70±12.08) years, was divided into a training set ( n=93) and a validation set ( n=40). Clinical data such as gender, age, tumor size, lymph node metastasis, TNM stage, liver metastasis, surrounding tissue invasion, tumor histological grade, and carcinoembryonic antigen (CA) 19-9 levels were gathered. Immunohistochemical staining was performed to detect SCG2 expression. Patient survival information was obtained through outpatient records or telephone follow-up. The Cox proportional hazard model was used to analyze prognostic factors. A nomogram was created based on the multivariate Cox regression analysis results. The calibration curve and the area under the receiver operating characteristic (ROC) curve were used to evaluate the nomogram's accuracy and discrimination. Results:The SCG2 expression in pNET patients with AJCC stage Ⅲ-Ⅳ was higher than in those with stage Ⅰ-Ⅱ. Similarly, patients with histological grade G3 had higher SCG2 levels compared to those with grades G1-G2. SCG2 expression was also elevated in patients older than 60 years compared to those 60 years or younger, and in patients with CA19-9>30 U/L compared to those with CA19-9≤30 U/L. These differences were all statistically significant (all P<0.05). Multivariate Cox regression analysis revealed that lymph node metastasis ( HR=3.132, 95% CI: 1.212-8.096, P=0.017), liver metastasis ( HR=2.685, 95% CI: 1.002-7.192, P=0.049), histological grade G3 ( HR=3.692, 95% CI: 1.229-11.088, P=0.011), and high SCG2 expression ( HR=52.181, 95% CI: 38.476-108.118, P=0.002) were associated with significantly higher risks of shorter disease free survival. Additionally, patients with longer tumor diameters ( HR=1.297, 95% CI: 1.088-1.545, P=0.004), histological grade G3 ( HR=19.625, 95% CI: 5.276-88.634, P<0.001), and high SCG2 expression ( HR=39.454, 95% CI: 17.317-97.263, P<0.001) had a higher risk of shorter overall survival. A nomogram prediction model was constructed using these above factors. The calibration curve demonstrated good alignment between predicted and actual outcomes in both the training and validation sets. The areas under the ROC curves for the disease-free survival and overall survival nomogram models for predicting 1-, 3-, and 5-year survival of pNET patients in both sets were above 0.8. Conclusion:High SCG2 expression is an independent risk factor for poor prognosis in pNET patients. The nomogram model based on SCG2 has high predictive efficacy for pNET patient prognosis.