Objective:To evaluate the effect of Lactobacillus-derived extracellular vesicles (Lac-EVs) on lipopolysaccharide (LPS)-induced activation of microglia and proteomic analysis.Methods:BV2 microglia obtained from mice with good growth status were divided into 3 groups ( n=12 each) using a random number table method: control group (group C), LPS group (group L) and LPS+ Lac-EVs group (group L+ E). Group C was commonly cultured. Group L was incubated for 24 h with LPS (final concentration 1 μg/ml). Group L+ E was incubated for 24 h with Lac-EVs (final concentration 2.5 μg/ml) after being treated with LPS for 24 h. The expression of CD86 and CD206 was detected using immunofluorescence staining. Cell precipitates were taken from L and L+ E groups, and proteomics were used to screen for differentially expressed proteins between the two groups. The differentially expressed proteins were analyzed by the bioinformatics analysis, and two differentially expressed proteins, apolipoprotein A1 and G protein-coupled receptor kinase 2, were verified by quantitative real-time polymerase chain reaction and Western blot. Results:Compared with group C, the expression of CD86 was significantly up-regulated, and the expression of CD206 was down-regulated in group L ( P<0.05). Compared with group L, the expression of CD86 was significantly down-regulated, and the expression of CD206 was up-regulated in L+ E group ( P<0.05). One hundred and twenty-five differentially expressed proteins were identified using proteomics (FC=2.0, P<0.05), of which the expression of 66 proteins was up-regulated and the expression of 59 proteins was down-regulated. The results of GO analysis indicated that these differentially expressed proteins were mainly involved in biological processes such as endothelial cell proliferation, SDNA damage detection, and lipoprotein transport. The results of KEGG analysis indicated that there were differences in PPAR signaling pathway, endocytosis, metabolic pathway, MAPK signaling pathway, etc. The expression trends of the differentially expressed proteins determined by Western blot and quantitative real-time polymerase chain reaction were consistent with the results of proteomics. Conclusions:Lac-EVs can inhibit LPS-induced microglial polarization toward M1 phenotype, and the mechanism may be related to the up-regulated differential proteins apolipoprotein A1 and G protein-coupled receptor kinase 2.

Objective:To identify the factors influencing acute kidney injury (AKI) following abdominal surgery in elderly patients and develop a predictive model based on the LASSO regression.Methods:The medical records of American Society of Anesthesiologists (ASA) Physical Status classificationⅠ-Ⅳ patients, aged ≥60 yr, with operation time ≥ 2 h, undergoing elective abdominal surgery under anesthesia in the General Hospital of Ningxia Medical University from May 2021 to May 2023, were retrospectively collected. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes organization guidelines. The patients were divided into 2 groups based on whether AKI occurred within 7 days after surgery: AKI group and non-AKI group. The least absolute shrinkage and selection operator algorithm was performed to reduce the dimension of unbalanced factors between AKI group and non-AKI group and the known risk factors for AKI. A nomogram prediction model was developed by integrating the optimized features derived from the LASSO regression model into multivariate logistic regression analysis. Internal validation was performed using the Bootstrap method, and the predictive ability and accuracy of the prediction model were assessed through the calibration curve, area under the receiver operating characteristic curve, Brier index and decision curve analysis.Results:Five hundred and ninety patients were finally included in this study, with 62 cases (10.5%) suffered postoperative AKI. The results of multivariate logistic regression analysis showed that increased age ( OR=1.06, 95% confidence interval [ CI] 1.01-1.11, P=0.048), higher ASA classification ( OR=2.32, 95% CI 1.21-4.45, P=0.011), preoperative coronary heart disease ( OR=1.89, 95% CI 1.01-3.61, P=0.049), and longer surgical duration ( OR=1.01, 95% CI 1.01-1.02, P=0.004) were risk factors for AKI after abdominal surgery, and the intraoperative use of dexmedetomidine ( OR=0.22, 95% CI 0.08-0.59, P=0.003) and increased postoperative albumin concentrations ( OR=0.91, 95% CI 0.85-0.98, P=0.017) were protective factors for postoperative AKI in elderly patients ( P<0.05). A risk prediction model was constructed based on the 9 identified factors of age, ASA classification, Charlson Comorbidity Index, preoperative coronary heart disease, preoperative hemoglobin concentration, preoperative estimated glomerular filtration rate, surgical duration, intraoperative use of dexmedetomidine and postoperative albumin concentration. A nomogram was plotted to visualize the model and verify it, showing that the Brier score of the model was 0.079, with a discrimination of 0.844, sensitivity of 84.4%, and specificity of 70.2%. Two hundred bootstrap resamples were used for internal validation, yielding a receiver operating characteristic curve of 0.821 with a 95% confidence interval of 0.79 to 0.90. The clinical decision curve indicated significant net benefits when the threshold probability of the model was between 0.03 and 0.45. Conclusions:Increased age, higher ASA classification, preoperative coronary heart disease, and longer surgical duration are risk factors, and the intraoperative use of dexmedetomidine and increased postoperative albumin concentrations are protective factors for postoperative AKI in elderly patients. The AKI prediction model following abdominal surgery developed based on age, ASA classification, Charlson Comorbidity Index, preoperative coronary heart disease, preoperative hemoglobin concentration, preoperative estimated glomerular filtration rate, surgical duration, intraoperative use of dexmedetomidine and postoperative albumin concentration has good predictive value in elderly patients.

Objective:To evaluate the effect of different doses of compound sodium chloride injection combined with norepinephrine on prevention of hypotension after lumbar anesthesia in the patients undergoing caesarean section.Methods:A total of 150 patients with a singleton fetus, aged 18-45 yr, at ≥37 weeks of gestation, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with height ≥150 cm, weighing ≤100 kg, with body mass index < 40 kg/m 2, scheduled for elective caesarean section under lumbar anesthesia, were divided into 3 groups ( n=50 each) by the random number table method: compound sodium chloride injection 4, 8 and 12 ml·kg -1·h -1 groups (group A, group B, group C). Compound sodium chloride injection 4 ml/kg was intravenously injected for liquid preload before lumbar anesthesia, and 0.5% hyperbaric bupivacaine 12.5 mg was injected to the subarachnoid space for lumbar anesthesia. Norepinephrine was intravenously injected at a dose of 6 μg immediately after intrathecal injection, followed by an infusion of 0.05 μg·kg -1·min -1, and infusion was stopped at 5 min after delivery. Compound sodium chloride injection was intravenously infused simultaneously at a rate of 4, 8 and 12 ml·kg -1·h -1 in A, B and C groups, respectively. The maximum diameter of inferior vena cava (IVCmax) and the minimum diameter of inferior vena cava (IVCmin) were measured by ultrasound, and inferior vena cava collapse index (IVC-CI) was calculated at 1 min before fluid preload (T 1), immediately after fluid preload (T 2), at 5 min after anesthesia (T 3), at 5 min after fetal delivery (T 4) and immediately before leaving the operating room (T 5). The incidence of intraoperative adverse events (hypotension, severe hypotension, bradycardia, hypertension, nausea, and vomiting) and neonatal outcomes (umbilical artery blood gas index and Apgar score at 1 and 5 min after birth) were recorded. Results:Compared with group A, IVCmin was significantly increased and IVC-CI was decreased at T 5 in group B, and IVCmin and IVCmax were significantly increased and IVC-CI was decreased at T 5 in group C ( P<0.05). There was no significant difference in IVCmax, IVCmin and IVC-CI at each time point between group B and group C ( P>0.05). There was no significant difference in the incidence of hypotension, severe hypotension, bradycardia, hypertension, nausea and vomiting among the three groups ( P>0.05). There was no significant difference in the results of blood gas analysis of the umbilical artery and Apgar score at each time point after birth among the three groups ( P>0.05). Conclusions:Compound sodium chloride injection 4, 8 and 12 ml·kg -1·h -1 combined with norepinephrine can effectively prevent the occurrence of hypotension after lumbar anesthesia in the patients undergoing caesarean section without increasing maternal and infant adverse events, and the effect of 8 and 12 ml·kg -1·h -1 for volume supplementation is better than that of 4 ml·kg -1·h -1.

Objective:To retrospectively analyze the incidence and distribution characteristics of anesthesia-related complications in the cesarean delivery.Methods:The maternal data of cesarean section from the Department of Obstetrics of General Hospital of Ningxia Medical University were collected from 2011 to 2016 using the Electronic Medical Record Management System, and anesthesia-related complications were obtained according to discharge diagnosis, anesthesia records and disease records.Statistical analysis of the development of various anesthesia-related complications was performed.Stratified analysis of the distribution of anesthesia-related complications was performed according to different years, ages (≤19 years old, 20-29 years old, 30-39 years old, ≥40 years old), American Society of Anesthesiologists physical status (Ⅰ-Ⅵ), types of anesthesia (neuraxial anesthesia and general anesthesia) and types of plan (planned and unplanned), and complications with scar uterus.Results:A total of 7 595 parturients were included in this study, and 92 cases (1.21%) developed at least one anesthesia-related complication.There were 91 cases who developed central nervous system complications, including 89 cases (97.81%) with headache after neuraxial anesthesia and 2 cases (2.19%) with transient neurological symptoms.One case developed non-specific systemic complications (laryngospasm). There were no significant differences in the incidence of anesthesia-related complications in parturients of different years, ages, American Society of Anesthesiologists physical status, types of anesthesia and types of plan and with scar uterus ( P>0.05). Conclusion:The incidence of anesthesia-related complications is low in the cesarean delivery, and central nervous system complications are the main complications.

Objective To evaluate the effect of labor analgesia on maternal and neonatal outcomes. Methods The medical records of mature puerperas with singleton pregnancy from October 2018 to April 2019 at the General Hospital of Ningxia Medical University were retrospectively reviewed. Puerperas were divided into non-labor analgesia group ( NLA) and labor analgesia group ( LA) according to whether or not puerperas received labor analgesia. Maternal and neonatal outcomes were analyzed. Maternal outcomes in-cluded delivery mode, complications, intrapartum hemorrhage and blood loss at 24 h after birth, duration of the second stage of labor and prolongation, episiotomy and length of hospital stay after birth. Neonatal outcomes included Apgar score at 1, 5 and 10 min after birth, cases of Apgar score＜7 at 5 min after birth, and the proportion and reason of transfer to pediatrics unit. Results A total of 839 puerperas were includ-ed, with 551 cases in NLA group and 288 cases in LA group. Compared with NLA group, the second stage of labor was significantly prolonged ( P＜0. 01) , and no significant change was found in the other maternal or neonatal outcomes in LA group ( P＞0. 05) . Conclusion Labor analgesia can prolong the second stage of labor and exerts no effect on the neonatal outcomes.

Objective To evaluate the effect of Iduna protein overexpression on poly(ADP-ribose) polymerase 1 ( PARP-1)∕apoptosis-inducing factor ( AIF) pathway during oxygen-glucose deprivation (OGD)-induced damage to hippocampal neurons in neonatal rats. Methods Primarily cultured hippocam-pal neurons of healthy Sprague-Dawley rats born within 24 h were isolated and cultured. Hippocampal neu-rons were divided into 4 groups (n = 40 each) using a random number table: control group (group C), OGD group ( group O), negative control lentivirus group ( group NL) and Iduna protein overexpression group (group IO). OGD was induced by incubating the neurons in glucose-free medium and hypoxic envi-ronment. Negative control lentivirus and recombinant lentivirus overexpressing Iduna were added at 48 h be-fore establishing the model in NL and IO groups, respectively. Neurons were cultured in the normal culture medium for 24 h in group C. The cell survival rate was detected using methyl thiazolyl tetrazolium assay, the lactic dehydrogenase (LDH) leakage rate was measured using colorimetric method, the comet assay was used to detect DNA content in the tail of neurons, and the expression of PARP-1, cytochrome C (Cyt c) and AIF in the nucleus was detecteded by Western blot. Results Compared with group C, the survival rate of neurons was significantly decreased, the LDH leakage rate and DNA content in the tail of neurons were increased, and the expression of PARP-1, Cyt c and AIF was up-regulated in the other three groups (P<0. 05). Compared with group O, the survival rate of neurons was significantly increased, the LDH leakage rate and the DNA content in the tail of neurons was decreased, and the expression of PARP-1, Cyt c and AIF was down-regulated in group IO (P<0. 05), and no significant change was found in group NL (P>0. 05). Compared with the group NL, the survival rate of neurons was significantly increased, and the LDH leakage rate and DNA content in the tail of neurons were decreased, and the expression of PARP-1, AIF and Cyt c was down-regulated in the group IO (P<0. 05). Conclusion Iduna protein overexpression reduces OGD-induced damage to hippocampal neurons through inhibiting PARP-1∕AIF pathway in neonatal rats.

Objective To investigate the role of orexin-A in doxapram-induced promotion of emergence from general anesthesia in patients.Methods Forty-four patients of both sexes,aged 18-60 yr,with body mass index of 21-25 kg/m2,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective lumbar surgery under general anesthesia,were divided into 2 groups (n =22 each) using a random number table:control group and doxapram group.Anesthesia was induced by intravenously injecting propofol,sufentanil and cisatracurium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil.Sevoflurane inhalation and remifentanil infusion were stopped at the end of operation,oxygen flow rate was adjusted to 6 L/min,doxapram 0.5 mg/kg were intravenously injected at the same time in doxapram group,and the equal volume of normal saline was given in control group.The emergence time and extubation time were recorded.On admission to operating room (T0),at 1 h after anesthesia induction (T1) and 5 and 30 min after tracheal extubation (T2,3),arterial blood samples were collected for determination of blood glucose concentrations and plasma orexin-A concentrations (by radioimmunoassay).Results Compared with the baseline at T0,blood glucose concentrations were significantly decreased at T1 and increased at T3,and plasma orexin-A concentrations were increased at T2 in two groups (P ＜ 0.05).Compared with control group,the time to eye opening and extubation time were significantly shortened,plasma orexin-A concentrations were increased at T2 (P＜0.05),and no significant change was found in blood glucose concentrations at each time point in doxapram group (P＞0.05).Conclusion The mechanism by which doxapram promotes emergence from general anesthesia may be related to increasing plasma orexin-A concentrations in patients.

Objective To evaluate the influence of peritoneal lavage with different concentrations of povidone-iodine on hemodynamics and acid-base balance in rabbits.Methods Twenty-four clean-grade healthy adult male New Zealand white rabbits,aged 3 months,weighing 2.8-3.2 kg,were divided into 4 groups (n=6 each) using a random number table:control group (group C),povidone-iodine 1/3 of original concentration group (group TI),povidone-iodine l/2 of original concentration group (group HI) and povidone-iodine of original concentration group (group OI).Rabbits were anaesthetized with intraperitoneal 3％ pentobarbital 1.5 ml/kg,the left femoral artery was cannulated for invasive blood pressure monitoring,and the abdominal cavity was opened.Peritoneal lavage was performed with normal saline,povidone-iodine diluted with normal saline (1 ∶ 2),povidone-iodine diluted with normal saline (1 ∶ 1) and original povidone-iodine 20 ml at 10 min after opening abdominal cavity in C,TI,HI and OI groups,respectively.The fluid for peritoneal lavage was sucked out using a sterile gauze 2 min later and then the abdominal cavity was closed.Mean arterial pressure (MAP) and heart rate (HR) were recorded immediately before lavage (T0) and at 5,10 and 20 min and 1 and 2 h after the end of lavage (T1-5).Arterial blood samples were collected at T0,T4 and T5 for blood gas analysis,and the pH value,BE and lactic acid level were recorded.The duration of anesthesia before peritoneal lavage,cumulative dose of anesthetics,fluid volume and urine volume at 2 h after anesthesia,and mortality at 3 h after peritoneal lavage were recorded.Results Compared with group C,MAP at T1-5 and HR at T3-5 were significantly decreased in TI,HI and OI groups,pH value was significantly decreased and BE negative value was increased at T4,5 in HI and OI groups,the lactic acid level was significantly increased at T5 in group OI,and the mortality rate were significantly increased in HI and OI groups (P＜0.05).Compared with group TI,MAP at T4,5 and pH value at T5 were significantly decreased,BE negative value was increased at T5,and the lactic acid level was increased at T4,5 in group Ol (P＜0.05).There was no significant difference in each parameter between group OI and group HI (P＞0.05).Conclusion Peritoneal lavage with povidone-iodine dose-dependently leads to hemodynamic deterioration and acid-base imbalance in rabbits.

Objective To evaluate the efficacy of continuous stellate ganglion block (SGB) for prevention of cerebral vasospasm (CVS) following interventional treatment of intracranial aneurysms.Methods Forty patients of both sexes with ruptured intracranial aneurysm,aged 20-60 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Hunt-Hess grade Ⅰ-Ⅲ,scheduled for elective interventional treatment of intracranial aneurysms,were divided into 2 groups (n =20 each) using a random number table:control group (C group) and continuous SGB group (SGB group).After induction of anesthesia,patients received ipsilateral continuous SGB with 0.25％ ropivacaine 6-8 ml followed by continuous infusion of 0.2％ ropivacaine 2 ml/h for 3 days in group SGB.Transcranial Doppler ultrasound was used to measure the blood flow in bilateral middle cerebral arteries and internal carotid arteries within 3 days after operation,and the development of CVS was assessed.Before operation and at 2 and 6 h and 1 and 3 days after operation,blood samples were collected from the internal jugular vein for determination of plasma melatonin (MT) and endothelin-1 (ET-1) concentrations by enzyme-linked immunosorbent assay.Results Compared with group C,the incidence of CVS (5％) was significantly decreased,and the plasma ET-1 concentration was decreased at 2 and 6 h and 1 and 3 days after operation (P ＜ 0.05),and no significant change was found in plasma MT concentrations at each time point in group SGB (P＞0.05).Conclusion Continuous SGB can effectively prevent the development of CVS following interventional treatment of intracranial aneurysms,and the mechanism may be related to inhibited release of ET-1 from vascular endothelial cells,but not related to MT.

Objective To investigate the effects of a single exposure or multiple exposures with equivalent total duration of exposure to sevoflurane on the histological morphology and neurons ultrastructure changes in neonatal rats hippocampus CA1.Methods A total of 45 male Sprague-Dawley rats on postnatal day 7,weighing 14-18 g,were randomly divided into three groups (n=15 each): Control group (group C),single exposure to sevoflurane group (group SS),multiple exposures to sevoflurane group (group TS).In group SS,the rats inhaled 3% sevoflurane for 6 h on postnatal day 7.In group TS,the rats inhaled 3% sevoflurane for 2 h on postnatal day 7,8 and 9.In group C,the rats inhaled 60% oxygen on the corresponding day age.Rats were sacrificed and brain were seperated on postnatal day 14.CA1 pyramidal neurons pathological morphology and quantity changes were observed by Hematoxylin-Eosin (HE) and Nissl staining.In the meantime,transmission electron microscopy was used for observing neurons ultrastructure and measuring the thickness of the postsynaptic density and the length of the postsynaptic active area.Results Nissl staining and HE indicated that multiple exposures and a single 6 h exposure to sevoflurane resulted in severer neurons loss and sparse arrangement relative to group C (P<0.05),Multiple exposures to sevoflurane resulted in greater neurons loss compared with a single 6-h exposure (P<0.05).Transmission electron microscope indicated that damage of CA1 neuronal subcellular organelle induced by multiple exposures and a single 6 h exposure was severer compared with group C.Both multiple exposures and a single exposure lead to decreased thickness of the postsynaptic density and shorter length of the postsynaptic active area (P<0.05).Multiple exposures to sevoflurane caused greater damaged than a single exposure (P<0.05).Conclusion Both a single and multiple exposure to sevoflurane induced CA1 neurons loss and ultrastructure changes in neonatal rats.Compared with a single exposure,multiple exposures to sevoflurane resulted in greater neurons morphology injury.