Objective:To explore the predictive value of leukocyte derived markers for postoperative delirium (POD) in patients undergoing cardiac valve surgery.Methods:A prospective cohort study was conducted. The patients who underwent cardiac valve surgery admitted to Beijing Anzhen Hospital of Capital Medical University from October 2021 to March 2023 were enrolled. The demographic, baseline and perioperative data were collected, and the neutrophil to lymphocyte ratio (NLR) and platelet to white blood cell ratio (PWR) were calculated before operation and within 24 hours after operation. Delirium assessment was conducted twice a day for patients within 1-5 days after surgery or discharged within 5 days. According to the evaluation results, the patients were divided into delirium group and non-delirium group. The clinical indexes between the two groups were compared. Multivariate Logistic regression analysis was used to screen the independent risk factors of POD, and the POD predictive model was constructed. The predictive value of POD predictive model was evaluated by receiver operator characteristic curve (ROC curve).Results:A total of 235 patients were enrolled in the analysis, of which 83 patients had POD (35.32%) and 152 patients did not have POD (64.68%). Compared with the non-delirious group, the patients in the delirious group had higher Charlson comorbidity index (CCI) score and lower mini-mental state examination (MMSE) score. In terms of perioperative data, compared with the non-delirium group, the patients in the delirium group had longer operative time, duration of cardiopulmonary bypass, length of intensive care unit (ICU) stay, duration of mechanical ventilation, and postoperative hospital stay, higher incidence of perioperative atrial fibrillation, and lower discharge life score. In terms of leukocyte derived markers, NLR within 24 hours after surgery in both groups were significantly higher than those before surgery, and PWR were significantly lower than those before surgery. The NLR within 24 hours after surgery, PWR difference and NLR difference in the delirium group were significantly higher than those in the non-delirium group. Multivariate Logistic regression analysis showed that CCI score [odds ratio ( OR) = 1.394, 95% confidence interval (95% CI) was 1.038-1.872, P = 0.027], perioperative atrial fibrillation ( OR = 3.697, 95% CI was 1.711-7.990, P < 0.001), duration of cardiopulmonary bypass ( OR = 1.008, 95% CI was 1.002-1.015, P = 0.016), length of ICU stay ( OR = 1.006, 95% CI was 1.002-1.010, P = 0.002), NLR difference ( OR = 1.029, 95% CI was 1.009-1.050, P = 0.005) and PWR difference ( OR = 1.044, 95% CI was 1.009-1.080, P = 0.013) were independently correlated with POD. POD predictive model was constructed by multivariate Logistic regression analysis result: POD predictive model index = -4.970+0.336×CCI score+1.317×perioperative atrial fibrillation+0.009×duration of cardiopulmonary bypass+0.006×length of ICU stay+0.030×NLR difference+0.044×PWR difference. ROC curve analysis showed that the area under the ROC curve (AUC) of NLR difference for predicting POD was 0.659 (95% CI was 0.583-0.735), the optimal critical value was 16.62, the sensitivity was 60.2%, and the specificity was 70.4% ( P < 0.05). The AUC of PWR difference for predicting POD was 0.608 (95% CI was 0.528-0.688), the optimal critical value was 25.68, the sensitivity was 51.8%, and the specificity was 75.7% ( P < 0.05). The AUC of POD predictive model for predicting POD was 0.805 (95% CI was 0.745-0.865), the optimal critical value was 0.39, the sensitivity was 74.7%, and the specificity was 79.6% ( P < 0.05). Conclusion:The differences of NLR and PWR are independently related to POD, which has potential value in predicting POD after cardiac valve surgery.

Objective To study the influence of cell-extracellular matrix (ECM) adhesion on migration of tumor cells regulated by ECM stiffness. Methods The cellular Potts model (CPM) was established to simulate tumor cell growth and cellular immune feedback system. The effects from mechanical behavior of cells on cell-ECM adhesion were observed, and the migration of tumor cells under different ECM was analyzed. Results The ECM stiffness could influence the migration rate of tumor cells. The change of ECM stiffness regulated the adhesion force between cells and ECM, and the change of adhesion force would influence the migration rate of cells. Conclusions The migration and distribution patterns of cells are closely related to the adhesion and stiffness of ECM. The increase in ECM stiffness can effectively promote the migration rate of tumor cells, and the further increase in ECM stiffness inhibits the migration of tumor cells. These findings may further reveal dynamic changes of ECM, adhesion and mechanical performance of tumor cell migration.

Clinical epidemiological studies have shown that vitamin D deficiency is associated with infectious diseases, which is confirmed by recent studies implying the role of vitamin D as a key regulator of host defense against infections. Bioactive vitamin D triggers antimicrobial pathways against pathogens in mucous membrane and cells of the human innate immune system. In addition, vitamin D also attenuates excessive inflammation and acquired immunity, and thus limits collateral tissue damage. The observed effects of vitamin D on infectious diseases, particularly airway infections, should be addressed in the management of viral infections. Findings from cross-sectional studies should be confirmed by prospective research. In this review, we summarize the current knowledge regarding the effect of vitamin D on innate and acquired host defense against infections.

Objective:To explore the effects of secondary pulmonary hypertension(SPH)on postoperative outcomes of lung transplant recipients.Methods:The hospitalization data of 309 patients undergoing lung transplant were retrospectively analyzed. They were divided into normal(mPAP <25 mmHg, 56 cases), low-pressure(mPAP: 25 mmHg≤mPAP<40 mmHg, 155 cases)and high pressure(mPAP ≥40 mmHg, 98 cases)groups.Three groups were compared with regards to general profiles, intraoperative status, postoperative outcomes and survival rates. The postoperative patient survival was plotted by Kaplan-Meier curve and log-rank test performed. Multivariate Cox regression analysis was performed to explore the influencing factors of postoperative survival.Results:The distribution of chronic lung disease(CLD)was statistically different among 3 groups( χ2=30.837, P=0.001). Patients with different levels of pulmonary artery pressure had different decisions supported intraoperatively by extracorporeal membrane oxygenation(ECMO)( χ2=28.205, P<0.001). The 2-year survival rates of normal, low-pressure and high-pressure groups were 58.9 %, 63.9 % and 69.4 % respectively and there were no statistically significant differences( P=0.513). Multivariate Cox regression analysis indicated that preoperative cardiac function was an independent risk factor for postoperative survival. The postoperative risk of mortality was 1.796 (95 %CI: 1.078~2.991)folds higher in patients with cardiac function grade Ⅲ/Ⅳ than those with grade Ⅰ/Ⅱ( P=0.025). Conclusions:Preoperative classification of cardiac function should be emphasized in SPH patients. And surgery during early decompensated stage of cardiac function may confer a better survival.

Objective:To evaluate the effect of donor dexmedetomidine preconditioning on the renal function of patients undergoing living-related kidney transplantation.Methods:Sixty American Society of Anesthesiologists physical status Ⅲ-Ⅳ patients, regardless of gender, aged 20-64 yr, with body mass of 18.5-28.0 kg/m 2, undergoing living-related kidney transplantation, were selected.Sixty corresponding donors, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, regardless of gender, aged 20-64 yr, with body mass index of 18.5-28.0 kg/m 2, were selected.The patients and donors were divided into 2 groups using a random number table method: control group (group C) and dexmedetomidine group (group D), with 30 pairs in each group.Before induction of anesthesia, dexmedetomidine was intravenously infused over 10 min in a loading dose of 1 μg/kg followed by an intravenous infusion of 0.5 μg·kg -1·h -1 until the time point when the renal artery was blocked immediately in the donors of group D, while the equal volume of normal saline was given instead until the time point when the renal artery was blocked immediately in the donors of group C. In both groups, total intravenous anesthesia was applied in donors and recipients, Nacotrend values were maintained at 40-60 during operation, mean arterial pressure and heart rate were maintained within the normal range, and dopamine was intravenously infused when necessary.The warm ischemia time and cold ischemia time of donor kidneys were recorded in the two groups.Peripheral venous blood samples were collected from the donors immediately before renal artery occlusion and from the recipients before renal artery opening (T 0) and at 1, 12 and 24 h after renal artery opening (T 1-3) to determine the serum creatinine (Cr), urea nitrogen (BUN) and cysteine protease inhibitor C (CysC) concentrations.The intraoperative volume of fluid infused, urine volume and consumption of propofol, remifentanil and dopamine were recorded in the receptors of two groups. Results:There was no significant difference in the concentrations of Cr, BUN and CysC and warm ischemia time and cold ischemia time of kidneys in between the two groups of donors ( P>0.05). There was no significant difference in the consumption of propofol, remifentanil and dopamine, volume of fluid infused and urine volume during surgery between the two groups of recipients ( P>0.05). Compared with group C, the concentrations of Cr, BUN and CysC were significantly decreased in at T 1 in group D ( P<0.05). Conclusion:Donor dexmedetomidine preconditioning is helpful in improving the perioperative renal function of patients undergoing living-related kidney transplantation.

Objective To evaluate the effects of flurbiprofen axetil administered at different time points on oxygenation in the patients undergoing one-lung ventilation (OLV).Methods Ninety patients of both sexes,aged 45-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective thoracoscope-assisted pulmonary lobectomy,were assigned into 3 groups (n =30 each) using a random number table:control group (group C),preoperative administration group (group F1) and intraoperative administration group (group F2).Flurbiprofen axetil (10 mg/ml) and fat emulsion 10 ml were injected intravenously at 15 min before operation in F1 and C groups,respectively.Flurbiprofen axetil 10 ml was intravenously injected immediately after the beginning of OLV in group F2.At 15 min before operation (T1),15 and 30 min of OLV (T2,3),and 15 min after restoration of two-lung ventilation (T4),airway peak pressure (Ppeak) and dynamic lung compliance (Cdyn) were recorded,arterial blood samples were collected for blood gas analysis.The arterial oxygen partial pressure (PaO2) was recorded,and the oxygenation index (OI) and intrapulmonary shunt (Qs/Qt) were calculated.The concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-K-PGF1α) in serum were measured by enzyme-linked immunosorbent assay,and TXB2/6-K-PGF1α ratio was calculated.The development of interrupting OLV due to SpO2＜90％ and postoperative dyspnea,pulmonary infection,atelectasis and length of hospital stay were recorded.Results Compared with group C,PaO2 and OI were significantly increased,and Qs/Qt was decreased at T2,3,the serum concentrations of TXB2 and 6-K-PGF1α were decreased,and TXB2/6-K-PGF1α ratio was increased at T2-4,the incidence of interrupting OLV was decreased (P＜0.05),and no significant change was found in the parameters mentioned above in group F2 (P＞0.05).Compared with group F1,PaO2 and OI were significantly decreased at T2,3,Qs/Qt was increased at T2,and the serum concentrations of TXB2 and 6-K-PGF1α were increased,and TXB2/6-K-PGF1α ratio was decreased at T2-4 in group F2 (P＜0.05).There was no significant difference in the incidence of postoperative dyspnea,pulmonary infection and atelectasis and length of hospital stay between the three groups (P＞0.05).Conclusion Flurbiprofen axetil injected at 15 min before operation can significantly improve oxygenation and prevent the development of hyoxemia in the patients undergoing OLV,however,flurbiprofen axetil administered immediately after the beginning of OLV has no such effect.

Objective To determine the optimum dose of nalbuphine prepared for patient-controlled intravenous analgesia (PCIA) after caesarean section.Methods A total of 100 parturients,aged 22-40 yr,weighing 60-90 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,at ≥ 37 weeks of gestation,scheduled for elective caesarean section,were divided into 4 groups (n=25 each) using a random number table:sufentanil 2.0 μ,g/kg group (group S),nalbuphine 1.5 mg/kg group (group N1),nalbuphine 2.0 mg/kggroup (group N2,) and nalbuphine2.5 mg/kggroup (group N3).In S,N1,N2 and N3 groups,sufentanil 2.0 μg/kg and nalbuphine 1.5,2.0 and 2.5 mg/kg were added to PCIA solution,respectively,tropisetron 12 mg was added,and PCIA solution was then diluted to 100 ml in normal saline.The PCA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 3 ml.Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ≤ 4 or during activity (cough) ≤ 6.The highest Ramsay sedation score,requirement for rescue analgesics,the number of unsuccessfully delivered doses,the number of attempts and occurrence of nausea and vomiting,pruritus and somnolence within 48 h after operation were recorded.Results Compared with group S,the number of unsuccessfully delivered doses,the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups,the incidence of somnolence and the highest Ramsay sedation scores were increased in group N3 (P＜0.05),and no significant change was found in the parameters mentioned above in group N1 (P＞ 0.05).Compared with group N1,the number of unsuccessfully delivered doses,the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups,and the incidence of somnolence and the highest Ramnsay sedation scores were increased in group N3 (P＜0.05).Compared with group N2,the incidence of somnolence and the highest Ramsay sedation scores were significantly increased (P＜0.05),and no significant difference was found in the number of unsuccessfully delivered doses,the number of attempts or requirement for rescue analgesics in group N3 (P＞0.05).Conclusion The optimum dose of nalbuphine prepared for PCIA after caesarean section is 2.0 mg/kg.

Objective To investigate the clinical efficacy of ultrasound-guided and nerve stimu-lator-guided modified fascia iliaca compartment block combined with popliteal fossa sciatic nerve block in patients undergoing unilateral great saphenous varicose veins surgery.Methods Sixty patients, male 32 and female 28,aged 42-76 years,ASA Ⅰor Ⅱ,scheduled for unilateral great saphenous var-icose veins surgery were randomly divided into two groups (n =30 each):modified fascia iliaca com-partment block with popliteal fossa sciatic nerve block group(group N)and epidural anesthesia(group E).Firstly,popliteal fossa sciatic nerve block was performed in group N.Then confirmed iliac fascia and femoral nerve position on the ultrasonic image and the femoral nerve was blocked.The 1% lido-caine 10 milliliters and 0.5% ropivacaine 10 milliliters were injected in the fascia iliaca compartment block from medial border of sartorius to upward site of femoral artery.Meanwhile,the ultrasonic probe was moving inside in the level of inguinal ligament.The SBP,DBP and HR were recorded be-fore block(T0 ),10(T1 ),30(T2 )and 60 minutes(T3 )after block.The block working time and onset time of sensory block,use of ephedrine after anesthesia,anesthesia efficacy and the postoperative ad-verse reactions in the last 48 hours ,including nausea,vomiting,headache and urinary retention, were also recorded.Results Compared with T0 ,the SBP and DBP was significantly decreased at T2 in group E(P <0.05).Compared with group E at the same time,the SBP and DBP was significantly higher at T2 in group N(P <0.05).The onset time of sensory block was significantly shortened and the use of ephedrine after anesthesia was also less in group N(P <0.05 ).Group E was better than group N in the whole anesthesia efficacy (P <0.05),but there was no significant difference in the ex-cellent rate of anesthesia efficacy between the two groups.The incidence of postoperative urinary re-tention was significantly decreased in group N(P <0.05)and there was no significant difference of the rate of nausea,vomiting and headache.Conclusion Modified fascia iliaca compartment block with popliteal fossa sciatic nerve block has excellent anesthetic quality in patients undergoing unilateral great saphenous varicose veins surgery,which ensures more stable hemodynamics less side effects and more indications when compared with epidural anesthesia.

Objective To investigate the clinical effect of forced-air warming system combined with infusion heating technology on recovery quality and cellular immune.Methods Fifty patients scheduled for esophagus cancer resection randomized into two groups (n =25 each):the temperature protection group (group W)and the control group (group C).The intraoperative nasopharyngeal temperature was recorded before induction (T1 ),2 hours after operation (T2 ),the end of operation (T3 ),postoperative 2 hours (T4 ).The anesthesia wakening time,the occurrence of postoperative shivering and infection,hospitalization time were also recorded.Venous blood samples were taken at T1 ,T3 ,two days (T5 )and five days after the operation (T6 )for analysis of T-lymphocyte subsets by flow cytometry.Results Compared with T1 ,the nasopharyngeal temperature was significantly de-creased at T2 ,T3 and T4 in group C, and the nasopharyngeal temperature in group W was significantly higher than those in group C at T2 ,T3 and T4 (P <0.05).The anesthesia wakening time and the occurrence of postoperative shivering in group C was significantly more than those in group C (P <0.05).Compared with T1 ,the percentage of CD4 + cells and CD4 +/CD8 + ratio were significantly decreased and the percentage of CD8 + cells increased in both groups at T3 (P <0.05).Compared with group C at T3 ,the percentage of CD4 + cells and CD4 +/CD8 + ratio were significantly increased and the percentage of CD8 + cells decreased in group W (P <0.05).Conclusion The clinical use of forced-air warming system combined with infusion heating technology can protect the patient??s body tempera-ture,shorten the anesthesia wakening time,reduce the occurrence of postoperative shivering,which protects the patient??s immune function and accelerates recovery after surgery.

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.