Background: Intraoperative hypercapnia reduces the time to emergence from volatile anesthetics, but few clinical studies have explored the effect of hypercapnia on the emergence time from intravenous (IV) anesthesia. We investigated the effect of inducing mild hypercapnia during the recovery period on the emergence time after total IV anesthesia (TIVA). Methods: Adult patients undergoing transurethral lithotripsy under TIVA were randomly allocated to normocapnia group (end-tidal carbon dioxide [ETCO2] 35–40 mmHg) or mild hypercapnia group (ETCO2 50-55 mmHg) during the recovery period. The primary outcome was the extubation time. The spontaneous breathing-onset time, voluntary eye-opening time, and hemodynamic data were collected. Changes in the cerebral blood flow velocity in the middle cerebral artery were assessed using transcranial Doppler ultrasound. Results: In total, 164 patients completed the study. The extubation time was significantly shorter in the mild hypercapnia (13.9 ± 5.9 min, P = 0.024) than in the normocapnia group (16.3 ± 7.6 min). A similar reduction was observed in spontaneous breathing-onset time (P = 0.021) and voluntary eye-opening time (P = 0.008). Multiple linear regression analysis revealed that the adjusted ETCO2 level was a negative predictor of extubation time. Middle cerebral artery blood flow velocity was significantly increased after ETCO2 adjustment for mild hypercapnia, which rapidly returned to baseline, without any adverse reactions, within 20 min after extubation. Conclusions Mild hypercapnia during the recovery period significantly reduces the extubation time after TIVA. Increased ETCO2 levels can potentially enhance rapid recovery from IV anesthesia.

Background: Intraoperative hypercapnia reduces the time to emergence from volatile anesthetics, but few clinical studies have explored the effect of hypercapnia on the emergence time from intravenous (IV) anesthesia. We investigated the effect of inducing mild hypercapnia during the recovery period on the emergence time after total IV anesthesia (TIVA). Methods: Adult patients undergoing transurethral lithotripsy under TIVA were randomly allocated to normocapnia group (end-tidal carbon dioxide [ETCO2] 35–40 mmHg) or mild hypercapnia group (ETCO2 50-55 mmHg) during the recovery period. The primary outcome was the extubation time. The spontaneous breathing-onset time, voluntary eye-opening time, and hemodynamic data were collected. Changes in the cerebral blood flow velocity in the middle cerebral artery were assessed using transcranial Doppler ultrasound. Results: In total, 164 patients completed the study. The extubation time was significantly shorter in the mild hypercapnia (13.9 ± 5.9 min, P = 0.024) than in the normocapnia group (16.3 ± 7.6 min). A similar reduction was observed in spontaneous breathing-onset time (P = 0.021) and voluntary eye-opening time (P = 0.008). Multiple linear regression analysis revealed that the adjusted ETCO2 level was a negative predictor of extubation time. Middle cerebral artery blood flow velocity was significantly increased after ETCO2 adjustment for mild hypercapnia, which rapidly returned to baseline, without any adverse reactions, within 20 min after extubation. Conclusions Mild hypercapnia during the recovery period significantly reduces the extubation time after TIVA. Increased ETCO2 levels can potentially enhance rapid recovery from IV anesthesia.

Background: Intraoperative hypercapnia reduces the time to emergence from volatile anesthetics, but few clinical studies have explored the effect of hypercapnia on the emergence time from intravenous (IV) anesthesia. We investigated the effect of inducing mild hypercapnia during the recovery period on the emergence time after total IV anesthesia (TIVA). Methods: Adult patients undergoing transurethral lithotripsy under TIVA were randomly allocated to normocapnia group (end-tidal carbon dioxide [ETCO2] 35–40 mmHg) or mild hypercapnia group (ETCO2 50-55 mmHg) during the recovery period. The primary outcome was the extubation time. The spontaneous breathing-onset time, voluntary eye-opening time, and hemodynamic data were collected. Changes in the cerebral blood flow velocity in the middle cerebral artery were assessed using transcranial Doppler ultrasound. Results: In total, 164 patients completed the study. The extubation time was significantly shorter in the mild hypercapnia (13.9 ± 5.9 min, P = 0.024) than in the normocapnia group (16.3 ± 7.6 min). A similar reduction was observed in spontaneous breathing-onset time (P = 0.021) and voluntary eye-opening time (P = 0.008). Multiple linear regression analysis revealed that the adjusted ETCO2 level was a negative predictor of extubation time. Middle cerebral artery blood flow velocity was significantly increased after ETCO2 adjustment for mild hypercapnia, which rapidly returned to baseline, without any adverse reactions, within 20 min after extubation. Conclusions Mild hypercapnia during the recovery period significantly reduces the extubation time after TIVA. Increased ETCO2 levels can potentially enhance rapid recovery from IV anesthesia.

Background: Intraoperative hypercapnia reduces the time to emergence from volatile anesthetics, but few clinical studies have explored the effect of hypercapnia on the emergence time from intravenous (IV) anesthesia. We investigated the effect of inducing mild hypercapnia during the recovery period on the emergence time after total IV anesthesia (TIVA). Methods: Adult patients undergoing transurethral lithotripsy under TIVA were randomly allocated to normocapnia group (end-tidal carbon dioxide [ETCO2] 35–40 mmHg) or mild hypercapnia group (ETCO2 50-55 mmHg) during the recovery period. The primary outcome was the extubation time. The spontaneous breathing-onset time, voluntary eye-opening time, and hemodynamic data were collected. Changes in the cerebral blood flow velocity in the middle cerebral artery were assessed using transcranial Doppler ultrasound. Results: In total, 164 patients completed the study. The extubation time was significantly shorter in the mild hypercapnia (13.9 ± 5.9 min, P = 0.024) than in the normocapnia group (16.3 ± 7.6 min). A similar reduction was observed in spontaneous breathing-onset time (P = 0.021) and voluntary eye-opening time (P = 0.008). Multiple linear regression analysis revealed that the adjusted ETCO2 level was a negative predictor of extubation time. Middle cerebral artery blood flow velocity was significantly increased after ETCO2 adjustment for mild hypercapnia, which rapidly returned to baseline, without any adverse reactions, within 20 min after extubation. Conclusions Mild hypercapnia during the recovery period significantly reduces the extubation time after TIVA. Increased ETCO2 levels can potentially enhance rapid recovery from IV anesthesia.

Nonalcoholic fatty liver disease （NAFLD） is an abnormal lipid metabolic disorder of the liver characterized by accumulation of a large amount of lipids in the liver， and it is currently the most common liver disease around the world. Mendelian randomization （MR） incorporates genomic data into traditional epidemiological study designs to infer the causal relationship between exposure factors and disease risk. In recent years， MR has been widely used in studies on inference of the etiology of NAFLD. This article systematically summarizes the advances in the application of MR in NAFLD research， so as to provide new ideas for understanding the nature of the disease and scientific interventions.

Objective To explore the mediating role of depression between uremic toxins and cognitive function in end-stage renal disease(ESRD)patients,so as to provide a basis for early clinical intervention.Methods A retrospective study involved 49 predialysis ESRD patients diagnosed in the Nephrology Department of The First Affiliated Hospital of Xi'an Jiaotong University between August 2018 and October 2021,along with 50 healthy controls(HC).General information of the two groups was collected.Montreal Cognitive Assessment(MoCA),Auditory Verbal Learning Test-Huashan Version(AVLT-H),Trail Making Test A(TMT-A),Beck Depression Inventory(BDI),and Beck Anxiety Inventory(BAI)were used to collect data on cognitive function,anxiety,and depression in both groups.Serological indicators in the ESRD group were used to clarify the impact of uremic toxins on cognitive function.PROCESS v3.4.1 was applied to explore the relationship between uremic toxins,depression,and cognitive function,as well as the mediating effect of depression.Results Significant differences were found between the ESRD group and the HC group in MoCA total score(P＜0.001),AVLT-H(word learning;short-term delay;long-term delay,P＜0.001;word recognition,P=0.001),TMT-A(P＜0.001),BDI(P＜0.001),and BAI(P=0.009).Cystatin C was a negative influencing factor for short-term delay in AVLT-H(B＝-0.834,P=0.019),while BDI was a negative influencing factor for long-term delay in AVLT-H(B=-0.102,P=0.002),word recognition in AVLT-H(B=-0.071,P＜0.001),and MoCA total score(B=-0.135,P=0.002).BDI partially mediated the effect of cystatin C on short-term delay in AVLT-H(total effect,c=-0.3346;direct effect,c'=-0.223 5;mediating effect,a×b=-0.111 0;and mediating effect proportion,33.2％)and long-term delay in AVLT-H(total effect,c=-0.318 7;direct effect,c'=-0.218 8;mediating effect,a×b=-0.099 9;and mediating effect proportion,31.3％).Conclusion ESRD patients experience cognitive decline as well as anxiety and depression.Cystatin C and depression are both negative influencing factors for cognitive decline in ESRD patients.Cystatin C indirectly affects cognitive function in ESRD patients through depression.

Objective:To investigate the change of D-Dimer (D-D), cardiac troponin I (cTnI) and vasoactive-inotropic score (VIS) after Stanford type A aortic dissection (TAAD) and thier predictive effect on death outcome.Methods:120 patients with TAAD who were treated in the Affiliated Hospital of Jining Medical College from January 2019 to January 2022 were retrospectively selected and divided into death group ( n=17) and survival group ( n=103) according to the 28-day survival after operation. The difference of clinical data between the two groups was compared, and the influencing factors of postoperative death in TAAD patients were analyzed by logistic regression method. Results:The age, deep hypothermic circulatory arrest time, D-D and cTnI of the patients in the death group were (60.50±5.42)years old, (30.40±9.92)min, (15.65±5.52)g/L and (3.32±0.82)mg/L, respectively, which were significantly higher than those in the survival group (all P<0.05). The VIS score and change of VIS score in the death group at 24 hours after operation were (9.66±1.10)points and (4.50±0.91)points respectively, which were significantly higher than those in the survival group (all P<0.05). Logistic regression analysis showed that age, D-D, cTnI and change of VIS score were the influencing factors of death after TAAD (all P<0.05). The area under the receiver operating characteristic (ROC) curve predicted by the D-D, cTnI and change of VIS score for death in TAAD patients was 0.718, 0.691 and 0.789 respectively (all P<0.05). Conclusions:Postoperative death of TAAD patients is affected by their age, D-D, cTnI and change of VIS score. The D-D, cTnI and change of VIS score have certain application value in predicting postoperative death of patients.

ObjectiveTo observe the effect of aerobic exercise on core symptoms and executive function in children with attention deficit hyperactivity disorder (ADHD). MethodsFrom June, 2020 to December, 2021, 64 children with ADHD at outpatient in Dushu Lake Hospital were randomly divided into control group (n = 32) and observation group (n = 32). The control group sat down and watched the cartoon for 20 minutes, and the observation group performed cycling exercise while watching the cartoon, for twelve weeks. The core symptoms were assessed with Conners Parent Symptom Questionnaire (PSQ), while the inhibition, conversion and refresh functions were assessed with the psychological test software E-Prime 2.0 system. ResultsAfter twelve weeks of treatment, the PSQ factor scores decreased in the observation group (t > 4.775, P < 0.001), and were lower than that of the the control group (t > 3.184, P < 0.001). The response time and accuracy of inhibition, conversion, and refresh functions decreased in the observation group (t > 2.259, P < 0.05), and were lower than that of the control group (t > 2.007, P < 0.05). ConclusionAerobic exercise could reduce the core symptoms of poor attention and hyperactivity impulsivity, and improve the executive functioning in children with ADHD.

Objective:To study the expression and clinical significance of serum neutrophil elatinase-associated lipocalin (NGAL), monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) in patients with lupus nephritis (LN).Methods:97 LN patients who received treatment in Hanzhong 3201 Hospital from January 2016 to December 2019 were selected as study objects. Among them, 38 cases were in the active group and 59 cases were in the inactive group, and 51 cases for physical examination were selected as the control group. The levels of serum NGAL, MCP-1, TWEAK and LN renal function was examined and compared in each group. The diagnostic value of serum NGAL, MCP-1 and TWEAK expression on LN disease activity was evaluated by receiver operating characteristic (ROC) curve.Results:The levels of serum NGAL, MCP-1 , TWEAK, serum creatine (Scr), blood urea nitrogen (BUN), 24 h urinary protein and dsDNA in the active and inactive groups were higher than those in the control group, and the above indexes in the active group were higher than those in the inactive group ( P<0.05). Pearson correlation analysis showed that serum NGAL, MCP-1 and TWEAK levels in LN patients were positively correlated with systemic lupus erythematosus disease activity index (SLEDAI) score, Scr, BUN, 24 h urine protein and dsDNA levels ( P<0.05). ROC curve analysis showed that the area under curve (AUC) of combined serum NGAL, MCP-1 and TWEAK in predicting disease activity of LN patients was 0.865, and the specificity, sensitivity, AUC and Youden index were higher than single index. Conclusions:The expression of NGAL, MCP-1 and TWEAK in LN patients during the active period is increased and closely related to the activity of disease. It is of high application value for predicting LN activity, and can be used as biomarkers for clinical prediction of LN activity.

Objective: To observe the effect of atorvastatin combined with insulin glargine on renal function in patients with early diabetic nephropathy. Methods: From January 2016 to March 2019, 100 patients with early diabetic nephropathy admitted to Hanzhong 3201 Hospital Affiliated with Xi′an Jiaotong University Medical School were selected as subjects. According to the random number table, patients were divided into control group and observation group, with 50 cases in each group. All patients underwent diet control, blood pressure control and symptomatic treatment. Patients in the control group were treated with insulin glargine to control blood glucose. Patients in observation group were given atorvastatin on this basis. After 16 weeks of treatment, the therapeutic effects of the two groups were observed, as well as the change in urinary albumin excretion rate (UAER), serum creatinine (Scr), C-reactive protein (CRP), total cholesterol (TC), and triglyceride (TG). Adverse reactions were observed during treatment in both groups. Results: After treatment, the levels of UAER, Scr, CRP, TC and TG of the two groups were lower than those before treatment, and the above indexes of the observation group were lower than those of the control group. The difference were statistically significant (P<0.05). During the treatment period, the incidence of adverse reactions in control group and observation group was 4.00%(2/50) and 12.00%(6/50), and there was no significant difference (P>0.05). Conclusions Atorvastatin combined with insulin glargine in the treatment of early diabetic nephropathy can effectively reduce the levels of UAER, Scr, CRP, TC and TG, and has good safety.