Objective To evaluate the application effect of positive end-expiratory pressure(PEEP)guided by driving pressure on intraoperative oxygenation and postoperative complications in patients undergoing orthotopic liver transplantation(OLT).Methods A total of 118 patients underwent OLT from January 2020 to September 2023,89 males and 29 females,aged 18-70 years,BMI＜28 kg/m2,ASA physical status Ⅲ or Ⅳ.Patients were divided into two groups using the random number table method:drive pressure group(group D)and PEEP group(group P),59 patients in each group.Volume controlled ventilation was used during general anesthesia in two groups,I:E 1:2,VT 6 ml/kg(ideal body weight),RR 10-15 beats/minute.In group D,the PEEP titration test was started after 5 minutes of mechanical ven-tilation,gradually increasing PEEP from 2 to 10 cmH2O,selecting the PEEP that produced the lowest driv-ing pressure,and maintaining this PEEP until the end of the surgery.In group P,the PEEP was maintained at 5 cmH2O during surgery.The amount of intraoperative out put and intake,and the use of vasoactive drugs were recorded.The HR,SBP,DBP,peak airway pressure(Ppeak),airway plateau pressure(Pplat),PEEP,and blood gas analysis results were recorded 5 minutes after intubation(T1),during the anhepatic phase(T2),during the neohepatic phase(T3),and at the end of the operation(T4),and driving pres-sure,dynamic pulmonary compliance(Cdyn),oxygenation index(OI),and dead space fraction(VD/VT)were calculated.The occurrence of postoperative pulmonary complications(PPCs)within 7 days after opera-tion was recorded.Results Compared with group P,the amount of crystalloid and the usage frequencies of norepinephrine,phenylephrine,and epinephrine in group D were significantly increased(P＜0.05).Com-pared with T2,HR was significantly decreased,SBP and DBP were significantly increased at T1,T3,and T4 in the two groups(P＜0.05).Compared with T1,Ppeak,Pplat,driving pressure,and OI were signifi-cantly increased at T2-T4,and Cdyn was significantly decreased at T3 and T4 in the two groups(P＜0.05).Compared with group P,the incidence of PPCs in group D was significantly decreased(P＜0.05).There were no significant differences in other indexes between the two groups.Conclusion The driving pressure guided PEEP ventilation improves intraoperative oxygenation and reduces the incidence of PPCs in patients undergoing OLT,but the use of intraoperative vasoactive drugs increases.

Objective:To evaluate the effect of nicorandil on cardiac function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods:Forty patients of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, with New York Heart Association class Ⅱ or Ⅲ, with body mass index of 18-25 kg/m 2, scheduled for elective cardiac valve replacement under general anesthesia and CPB, were divided into conventional group( n=20) and nicorandil group( n=20) according to a randomized number table method.In nicorandil group, nicorandil 10-60 μg·kg -1·h -1 was intravenously infused starting from the end of anesthesia induction until the the end of operation.Mean arterial pressure was maintained at 60-80 mmHg in two groups.Venous blood samples were collected before induction of anesthesia (T 0) and at 6, 12, 24, 48 and 72 h after operation (T 1-5) and at the time of discharge (T 6) to determine the serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.The occurrence of myocardial ischemic events or arrhythmia before and after operation was recorded.The defibrillation during intraoperative restoration of spontaneous heart beat, restoration of spontaneous heart beat, medication during restoration of spontaneous heart beat, and cardiac rhythm after restoration of spontaneous heart beat were recorded.The intra- and post-operative requirements for cardiovascular drugs were recorded.The mechanical ventilation time and intensive care unit stay time were also recorded. Results:Compared with conventional group, the serum NT-proBNP concentration was significantly decreased at T 5 and T 6, the mechanical ventilation time and intensive care unit stay time were shortened, the consumption of intraoperative norepinephrine and postoperative dobutamine was decreased ( P<0.05), and no significant change was found in the incidence of postoperative myocardial ischemic events or arrhythmias, defibrillation rate during restoration of spontaneous heart beat, rate of spontaneous recovery of heart beat, cardiac rhythm after restoration of spontaneous heart beat or medication during restoration of spontaneous heart beat in nicorandil group ( P>0.05). Conclusion:Intravenous infusion of nicorandil can improve the cardiac function and is helpful in improving short-term prognosis in the patients undergoing cardiac valve replacement under CPB.

Objective: To investigate the incidence and risk factors of postoperative acute renal injury (AKI) in patients after primary unilateral hip and knee replacement. Methods: Between January 2016 and July 2018, A total of 1 490 patients underwent hip and knee arthroplasty were enrolled. There were 507 male and 983 female with a median age of 66 years (range: 18 to 95 years). There were 201 patients underwent femoral head replacement, 897 total hip arthroplasty and 392 total knee arthroplasty, respectively. The creatinine value was 68.79 μmol/L preoperatively. Demographic, perioperative and postoperative data were recorded. The development of AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The demographic information, comorbidities, preoperative medication, type of surgery, type of anesthesia, intraoperative anesthetics, operation time, intravenous fluid type and dose, amount of bleeding and postoperative creatinine values were recorded. Predictors associated with AKI and postoperative creatinine was determined by multiple regressions. Results: There were 80 cases developed AKI with the incidence of AKI 5.4%. Among the AKI patients, there were 69 cases (4.6%) in AKI stage 1, 7 cases (0.5%) in AKI stage 2, and 4 cases (0.3%) in AKI stage 3. The creatinine value was 72.03 μmol/L after surgery. The length of postoperative hospital stay was 9 days. There were 5 patients died in hospital. The independent risk factors of AKI after hip and knee arthroplasty included old age, a higher American Society of Anesthesiologists (ASA) grade and preoperative diabetes (P<0.05). The risk of postoperative AKI in patients aged 60-69 years, 70-79 years, and older than 80 years was 2.259, 2.798, and 6.049 times than that of patients under 60 years of age, respectively. The risk of postoperative AKI in patients with ASA grade II, III, and IV was 3.749, 9.023, and 21.595 times than that of ASA grade I patients, respectively. The risk of AKI in patients with diabetes before surgery was 2.377 times higher than that in non-diabetics. Age, diabetes, hypertension and preoperative serum creatinine were positively correlated with postoperative creatinine values (P<0.05). Intensive care unit admissions were greater in AKI patients than that in non-AKI patients (25.0%, 5.6%, χ²=-6.774, P<0.001). Compared with non-AKI patients, the postoperative length of hospital stay was longer in AKI patients (Z=-3.904, P<0.001). Conclusion The incidence of postoperative AKI after primary hip and knee replacement was 5.4%. The older age, ASA grade, and diabetes were independently associated with risk of AKI. Old age, male, preoperative diabetes, hypertension and a higher preoperative creatinine value can predict postoperative increased creatinine levels at postoperation. The risk factors for AKI included old age, a higher ASA grade and diabetes. The postoperative length of hospital stay was longer in AKI patients.

Objective To evaluate the relationship between sevoflurane-induced cognitive impairment and α1B adrenoceptors (ADRA1B) and ADRA1D in the cerebral cortex of rats.Methods Forty-eight SPF adult Sprague-Dawley rats (half male,half female),weighing 220-260 g,were divided into control group (C group,n =24) and sevoflurane group (S group,n =24) using a random number table method.Group C and group S inhaled air and 3％ sevoflurane,respectively,for 5 h.Eight rats in each group were sacrificed immediately after anesthesia,and the cerebral cortex was removed.Eight rats in each group were selected on days 1 and 7 after anesthesia and underwent Barnes maze test.The rats were then sacrificed,and the cerebral cortex was removed.The expression of ADRA1B and ADRA1D protein and mRNA in cerebral cortex tissues was detected by Western blot and fluorescent quantitative real-time polymerase chain reaction,respectively.Results Compared with group C,the number of entering incorrect holes was significantly increased at 1 and 7 days after anesthesia,the latency and total distance to enter the target hole were prolonged,and the expression of ADRA1B and ADRA1D protein and mRNA in cerebral cortex was down-regulated immediately after anesthesia and at 1 and 7 days after anesthesia in group S (P＜0.05).Conclusion The mechanism underlying sevoflurane-induced cognitive impairment may be related to the down-regulated expression of ADRA1B and ADRA1D in cerebral cortex of rats.

OBJECTIVE: To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/ hyperactivity disorder (ADHD) with comorbid disruptive, impulse-control, and conduct disorders (DICCD). METHODS: Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding. RESULTS: In Golden Stroop test, the interference scores (IGs) of errors and reaction time both differed significantly among the groups ( < 0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time (MRT) showed significant differences among the groups ( < 0.05); the MRT of positive- congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative- incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group. CONCLUSIONS The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.
Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; physiopathology ; Attention Deficit and Disruptive Behavior Disorders ; diagnosis ; physiopathology ; Case-Control Studies ; Child ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Emotions ; Humans ; Reaction Time ; Stroop Test

Objective To evaluate the relationship between sevoflurane-induced cognitive decline and α1A norepinephrine receptor (ADRA1A) in the cerebral cortex of rats.Methods Forty-eight cleangrade healthy adult Sprague-Dawley rats (24 male,24 female),weighing 220-260 g,aged 3-4 months old,were divided into 2 groups (n =24 each) using a random number table method:control group (group C) and sevoflurane group (S group).Group S inhaled 3％ sevoflurane for 5 h.Rats underwent the Barnes maze test on days 1 and 7 after anesthesia.Rats were sacrificed immediately after anesthesia and on days 1 and 7 after anesthesia,and the cerebral cortex was removed for determination of the expression of ADRA1A protein and mRNA (by Western blot or fluorescent quantitative real-time polymerase chain reaction).Results Compared with group C,the number of entering incorrect holes was significantly increased,and the latency of entering the target hole and the distance were prolonged,and the expression of ADRA1A protein and mRNA in cerebral cortex was down-regulated at each time point in group S (P＜0.05).Conclusion The mechanism of sevoflurane-induced cognitive decline is related to down-regulated expression of ADRA1A in the cerebral cortex of rats.

Objective To evaluate the effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅳ patients,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table method:control group and nicorandil group.Nicorandil was intravenously infused at 10-60 μg · kg-1 · h-1 (3-15 ml/h) after anesthesia induction until the end of surgery in nicorandil group.Before anesthesia induction (To) and at 6,12,24,48 and 72 h after surgery (T1-5),and when the patients were discharged from hospital (T6),venous blood samples were obtained for determination of the concentrations of serum cardiac troponin I (cTnI) and brain natriuretic peptide.The events of myocardial ischemia or development of arrhythmia before and after surgery,development of defibrillation during restoration of heart beat,spontaneous heart beat,drug administration during restoration of heart beat,heart rhythm after restoration of heart beat,and the requirement for cardiovascular drugs during and after surgery were recorded.The mechanical ventilation time,duration of intensive care unit stay,and length of postoperative hospital stay were also recorded.Results Compared with control group,the concentrations of serum cTnI at T2,3 and brain natriuretic peptide at T2-6 were significantly decreased,the consumption of intraoperative norepinephrine and postoperative dobutamine was reduced,and the ventilation time and duration of intensive care unit stay were shortened (P＜0.05),and no significant change was found in the rate of defibrillation,restoration of spontaneous heart beat,requirement for drugs during restoration,heart rhythm after restoration or duration of postoperative hospital stay in nicorandil group (P ＞ 0.05).Conclusion Continuously infusing nicorandil during surgery can reduce myocardial injury and improve early prognosis in patients undergoing cardiac valve replacement with CPB.

Objective To evaluate the effect of sevoflurane anesthesia on the expression of hippocampal α4 subunit-containing nicotinic acetylcholine receptor (α4nAChR) in rats.Methods One hundred and forty-four Sprague-Dawley rats of both sexes,aged 3-4 months,weighing 220-270 g,were divided into 4 groups (n =36 each) using a random number table:control group (group C),sevoflurane anesthesia for 1 h group (group S1),sevoflurane anesthesia for 3 h group (group S2) and sevoflurane anesthesia for 5 h group (group S3).Group C inhaled air,and S1,S2 and S3 groups inhaled 3％ sevoflurane for 1,3 and 5 h,respectively.Twelve rats in each group were selected at 1 and 7 days after emergence from anesthesia to undergo spatial probe test.Rats were then sacrificed immediately after anesthesia and at 1 and 7 days after emergence from anesthesia,and hippocampi were removed for determination of the expression of α4nAchR protein and mRNA in hippocampal neurons (by Western blot or real-time polymerase chain reaction).Results Compared with group C,the duration of staying at the target quadrant was significantly shortened,and the ratio of duration of staying at the original platform quadrant to the total duration and ratio of swimming distance in the original platform quadrant to the total distance were decreased on 1 and 7 days after emergence from anesthesia,the expression of α4nAchR protein and mRNA was down-regulated,and the number of positive cells was reduced in S1,S2 and S3 groups (P＜0.05).Compared with S1 and S2 groups,the duration of staying at the target quadrant was significantly shortened,the ratio of duration of staying at the original platform quadrant to the total duration and ratio of swimming distance in the original platform quadrant to the total distance were decreased on 1 day after emergence from anesthesia in group S3 (P＜0.05).There was no significant difference in the expression of α4nAchR protein and mRNA or number of positive cells at each time point between group S1,group S2 and group S3 (P＞0.05).Conclusion The mechanism by which sevoflurane anesthesia induces cognitive dysfunction may be partially related to down-regulating the expression of hippocampal α4nAchR in rats.

Through the investigation ofGentiana macrophylla in herbalism literatures, ancient prescriptions and theChinese Pharmacopoeia 2010 edition, we found that functions from ancient herbalism and prescriptions were in conformity with those from theChinese Pharmacopoeia. However, other functions recorded in ancient literatures such as dissipating wind, calming the liver to stop wind, clearing heat-fire, stopping bleeding, relieving cough were not included in theChinese Pharmacopoeia. With modern studies on pharmacodynamics and clinical applications, these functions were primarily conformed as the lost potential functions ofG. macrophylla.

This study took herbal medicinePoria cocosas an example to establish a method to explore the potential function of herbal medicine. And then, the new function was identified through the systematic study. It was able to improve the application range of herbal medicine and the clinical therapeutic effects. The established database management system ofPu-Ji-Fanghad been used for the searching ofPoria cocosin the treatment of different diseases in order to receive the compound prescription containedPoria cocos in different diseases. Then, indications recorded in herbalism literatures through dynasties and thePharmacopoeia of People’s Republic of China(Chinese Pharmacopoeia) were compared. Through statistical analysis and logical judgment, as well as the combination of modern pharmacological research results and clinical therapeutic evaluations, the overall understanding on conventional and potential functions ofPoria cocos were received. The results showed that the functions ofPoria cocos summarized through dynasties contained alleviating thirst, eliminating phlegm, enhancing memory, astringent, relieving cough and vomiting, invigorating blood circulation, promoting appetite and securing fetus, as well as treatment of deficiency, vomiting, stroke, diabetes, cough, cold damage syndrome, convulsion and other syndrome, were not recorded in theChinese Pharmacopoeia. It was concluded that tonifying kidney, relieving cough and phlegm, relieving vomiting, alleviating thirst, expelling wind, relieving convulsion and securing fetus were the potential function ofPoria cocos, which should arouse the attention from the academic community.