Objective To observe the effect of shoulder-high head back-up position on airway ob-struction and hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.Methods A total of 170 patients undergoing painless fiberoptic bronchoscopy,97 males and 73 females,aged 18-64 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were randomly divided into two groups by ran-dom number method:observation group(group D,n=84)and control group(group C,n=83).Group D adopted the shoulder-high head back-up position,and group C adopted the supine position.All the pa-tients received intravenous general anesthesia of propfol combined with sufentanil,and were oxygenated via an ordinary endoscopic mask with an oxygen flow rate of 8-10 L/min.Fiberoptic bronchoscopy was per-formed when the modified observer assessment of alertness and sedation(MOAA/S)score was≤1 point.The number of cases in which hypoxia occurred and corrective measures were taken were recorded.The changes of HR,SBP,DBP,and SpO2 before induction of anesthesia(T1),1 minute after induction of an-esthesia(T2),endotracheal surface anesthesia(T3),at the time of examination(T4),and at the end of the examination(T5)were recorded.The degree of obstruction of the retropalatal space and retroglossal space at T2 were recorded.The level of glottic exposure and operating comfort of the endoscopist were recor-ded during the examination,and the incidence of postoperative neck discomfort,postoperative headache,postoperative dizziness,and nausea and vomiting were recorded.Results Compared with group C,the in-cidence of intraoperative moderate hypoxia,severe hypoxia,jaw support,and assisted ventilation was signifi-cantly decreased in group D(P＜0.05).Compared with T1,the HR were significantly increased at T3 and T4(P＜0.05),SBP and DBP were significantly decreased at T2,T4,and T5(P＜0.05),SpO2 was sig-nificantly increased at T2 and decreased at T4 in the two groups(P＜0.05),and SpO2 in group C was sig-nificantly decreased at T3(P＜0.05).Compared with group C,SpO2 was significantly increased at T4,the incidence of non-obstruction in the retrolingual space was significantly increased,and the incidence of com-plete obstruction in the retrolingual space was significantly decreased at T2,and the incidence of good glottic exposure was significantly increased,the incidence of poor glottic exposure was significantly decreased,and the incidence of good operating comfort of the endoscopist was significantly increased in group D(P＜0.05).There was no significant difference in the incidence of postoperative adverse events between the two groups.Conclusion Shoulder-high head back-up position can alleviate airway obstruction and reduce the incidence of hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.

Background/Aims: The accuracy of endosonographers in diagnosing gastric subepithelial lesions (SELs) using endoscopic ultrasonography (EUS) is influenced by experience and subjectivity. Artificial intelligence (AI) has achieved remarkable development in this field. This study aimed to develop an AI-based EUS diagnostic model for the diagnosis of SELs, and evaluated its efficacy with external validation. Methods: We developed the EUS-AI model with ResNeSt50 using EUS images from two hospitals to predict the histopathology of the gastric SELs originating from muscularis propria. The diagnostic performance of the model was also validated using EUS images obtained from four other hospitals. Results: A total of 2,057 images from 367 patients (375 SELs) were chosen to build the models, and 914 images from 106 patients (108 SELs) were chosen for external validation. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the model for differentiating gastrointestinal stromal tumors (GISTs) and non-GISTs in the external validation sets by images were 82.01%, 68.22%, 86.77%, 59.86%, and 78.12%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the external validation set by tumors were 83.75%, 71.43%, 89.33%, 60.61%, and 80.56%, respectively. The EUS-AI model showed better performance (especially specificity) than some endosonographers.The model helped improve the sensitivity, specificity, and accuracy of certain endosonographers. Conclusions We developed an EUS-AI model to classify gastric SELs originating from muscularis propria into GISTs and non-GISTs with good accuracy. The model may help improve the diagnostic performance of endosonographers. Further work is required to develop a multi-modal EUS-AI system.

Objective To explore influence of dexmedetomidine-assisted general anesthesia on hemodynamics,anesthetic dosage and postoperative sedation and analgesia in patients with radical gastrectomy for gastric cancer.Methods A total of 50 patients with gastric cancer were randomly divided into experimental group and control group.The experimental group was treated with dexmedetomidine before anesthesia induction,while control group was treated with the same volume of normal saline.Heart rate,mean arterial pressure,bispectral index were recorded at the time points of exploration,immediately after extubation,skin incision,before injection,immediately before intubation,before induction of anesthesia,duration of anesthesia,1 min after intubation,and doses of remifentanil and propofolwere compared,and VAS and sedation score 1 and 4 h were compared.Results Before induction of anesthesia,bispectral index of the experimental group was significantly lower than the control group (P<0.01).At the time points of induction of general anesthesia,1 min after intubation,skin incision,exploration,extubation,the mean arterial blood pressure in experimental group decreased significantly (P<0.05),and the heart rate reduced significantly (P<0.01).The dosages of remifentanil and propofol in the experimental group were significantly lower than those in the control group.The sedation scores 1 and 4 h in the experimental group were significantly higher than the control group,and the VAS score was significantly lower than the control group (P<0.05).Conclusion Dexmedetomidine can reduce the hemodynamic changes and maintain the stability of the patients during tracheal intubation and general anesthesia induction.

Objective To explore influence of dexmedetomidine-assisted general anesthesia on hemodynamics,anesthetic dosage and postoperative sedation and analgesia in patients with radical gastrectomy for gastric cancer.Methods A total of 50 patients with gastric cancer were randomly divided into experimental group and control group.The experimental group was treated with dexmedetomidine before anesthesia induction,while control group was treated with the same volume of normal saline.Heart rate,mean arterial pressure,bispectral index were recorded at the time points of exploration,immediately after extubation,skin incision,before injection,immediately before intubation,before induction of anesthesia,duration of anesthesia,1 min after intubation,and doses of remifentanil and propofolwere compared,and VAS and sedation score 1 and 4 h were compared.Results Before induction of anesthesia,bispectral index of the experimental group was significantly lower than the control group (P<0.01).At the time points of induction of general anesthesia,1 min after intubation,skin incision,exploration,extubation,the mean arterial blood pressure in experimental group decreased significantly (P<0.05),and the heart rate reduced significantly (P<0.01).The dosages of remifentanil and propofol in the experimental group were significantly lower than those in the control group.The sedation scores 1 and 4 h in the experimental group were significantly higher than the control group,and the VAS score was significantly lower than the control group (P<0.05).Conclusion Dexmedetomidine can reduce the hemodynamic changes and maintain the stability of the patients during tracheal intubation and general anesthesia induction.

Objective To provide theoretical reference for clinical therapy of pulmonary adenocarcinoma by evaluating the effects of polysaccharides and pioglitazone on mouse model of pulmonary adenocarcinoma and to explore the relationship between inflammation and pulmonary adenocarcinoma. Methods One hundred mice were averagely divided into five groups, including control group, model group, polysaccharides group, pioglitazone group, polysaccharides and pioglitazone group (unite group). Polysaccharides solution (500 mg/kg) was given to polysaccharides group, pioglitazone solution (15 mg/kg) was given to pioglitazone group, polysaccharides solution (500 mg/kg) and pioglitazone solution (15 mg/kg) were given to unite group;and the equal volume of saline (10 mL/kg) was given to control and model group (1 t/d, 5 d/w, continuously 20 w ). The pulmonary adenocarcinoma induced by urethane was evaluated in each group at different time points. The levels of NF-κB, TNF-α, IL-1β and IL-6 were measured in each group at the 12th week and the 20th week respectively. Results The body weights were increased in the control group, which were decreased in other groups during urethane-injection, but increased continuously after the injection. At the 20th week, nodules were found in lung surfaces in all mice except mice of control group. The lung index was higher in all mice except mice of control group. The levels of NF-κB, TNF-α, IL-1βand IL-6 were significantly higher at 12th week and 20th in model group, polysaccharides group, pioglitazone group, polysaccha?rides and pioglitazone group than those of control group. The levels of NF-κB, TNF-α, IL-1βand IL-6 were significantly lower in polysaccharides group, pioglitazone group, polysaccharides and pioglitazone group than those of model group. Con?clusion Sustained inflammatory response is one of the risk factors for the development of lung adenocarcinoma. Polysaccha?rides and pioglitazone can reduce the level of inflammation in mouse lung adenocarcinoma, suggesting that both of them can be used as potential adjuvant in the clinical treatment of lung adenocarcinoma.

The rapid development of second-generation sequencing technology and bioinformatics has enabled us to find out more about the components of the microbiome throughout the respiratory tract,including bacteria,fungi and viruses.A growing number of studies have shown that there is a close relationship between respiratory microorganisms and various respiratory diseases,which provides new areas of research relating to asthma,cystic fibrosis (CF),chronic obstructive pulmonary disease (COPD),lung cancer and influenza.In this paper,research progress in respiratory microbiome (bacteria, fungi and viruses)and related diseases is reviewed.

Background and objective Screen dierentially expressed proteins in patients with non-small cell lung cancer (NSCLC), and aim to identify biomarkers for early screening, monitoring prognosis and evaluating therapy of NSCLC. Methods Urinary samples were collected from 40 newly diagnosed NSCLC patients, 8 patients with lung benign disorders and 22 healthy people. 0.9% sodium dodecylsulfate- polyacrylamide gel electrophoresis (1D SDS-PAGE) and MS-ermo-Orbi-trap-Velos were applied to separate, extract and identify proteins in urinary samples from non-neoplastic groups and NSCLC patients, in order to find out dierentially expressed proteins in patients with NSCLC. en, sensitivity and specificity of can-didate proteins were tested by certain experiments. Finally, biomarkers related to NSCLC could be determined. Results e dierences of urinary proteins between non-neoplastic groups and NSCLC patients mainly focused on 90 kDa, 60 kDa and 20 kDa-30 kDa stripes. Four dierently expressed proteins were found in urinary proteins in NSCLC group, including LRG1, CA1 (up-regulating proteins) and VPS4B, YWHAZ (down-regulating proteins). e sensitivity of these four proteins for biomarker of NSCLC was relatively low when they were used to screen or diagnose independently. e sensitivity and specificity of LRG1 was 83.0% (25/30) and 90.0% (18/20), respectively; 60.0% (18/30) and 90.0% (18/20) for CA1; 73.3% (22/30) and 90.0%(18/20) for VPS4B; 60.0% (18/30) and 95.0% (19/20) for YWHAZ. However, the sensitivity and specificity would increase to 96.7% (29/30) and 85% (17/20) aer the four biomarkers were combined. Conclusion LRG1 and CA1 are abundant in urine in patients with NSCLC, while VPS4B and YWHAZ are low-abundance proteins. ey could be regarded as biomarkers for early screening, monitoring prognosis and evaluating therapy of patients with NSCLC because of dierential expression. e sensitivity of the four biomarkers of NSCLC is relatively low when they are used to screen or diagnose independently, while significantly improvement if they were in combined paern, which will be of excellent applications to clinical diagnosis and treatment.