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Background. Resting-state functional magnetic resonance imaging (rs-fMRI) is a promising method for the study of brain function. Typically, rs-fMRI is performed on anesthetized animals. Although different functional connectivity (FC) in various anesthetics on whole brain have been studied, few studies have focused on different FC in the aged brain. Here, we measured FC under three commonly used anesthesia methods and analyzed data to determine if the FC in whole brain analysis were similar among groups. Methods. Twenty-four male aged Wistar rats were randomly divided into three groups (n = 8 in each group). Anesthesia was performed under either isoflurane (ISO), combined ISO + dexmedetomidine (DEX) or α-chloralose (AC) according to the groups. Data of rs-fMRI was analyzed by FC in a voxel-wise way. Differences in the FC maps between the groups were analyzed by one-way analysis of variance and post hoc two-sample t tests. Results. Compared with ISO + DEX anesthesia, ISO anesthesia caused increased FC in posterior brain and decreased FC in the middle brain of the aged rat. AC anesthesia caused global suppression as no increase in FC was observed. Conclusion. ISO could be used as a substitute for ISO + DEX in rat default mode network studies if the left temporal association cortex is not considered important.

Purpose Pauwels type-3 femoral neck fractures are challenging injuries to manage with high rates of complications after internal fixation and no consensus has been reached regarding the optimal fixation construct. The current study aims to evaluate the effect of dynamic limited axial compression in parallel screws combined with medial buttress plate (SMBP) or lateral compression plate (LCP) fixation of Pauwels type-3 femoral neck fractures. Methods We performed a retrospective analysis of 51 cases of Pauwels type-3 femoral neck fractures who were fixed by SMBP or LCP. Specifically, the screw fixing the femoral head in the buttress plate was omitted. Postoperative complications and functional outcomes were mainly studied. Results With a mean follow-up of 19.9 months, the rate of neck shortening was higher in the LCP group than that in SMBP group (32.1% vs. 8.7%, p = 0.04). Neither nonunion nor avascular necrosis was observed in both groups. Good-to-excellent Harris hip score accounts for 95.2% in SMBP group and 89.3% in LCP group (p = 0.40). Moreover, older age, fracture comminution and compression plate fixation predispose to neck shortening. Conclusion Dynamic limited axial compression by SMBP or LCP fixation was effective to improve the functional outcome of patients with Pauwels type-3 femoral neck fractures.

Proximal femoral plating serves as a good alternative for the fixation of femoral neck fractures, but fixation loss still occurs. This study aimed to evaluate the effect of a hybrid configuration of short- and long-threaded cannulated screws in proximal femoral plating in terms of decreasing varus collapse of femoral neck fractures.We retrospectively analyzed 86 patients with femoral neck fractures who were fixed by proximal femoral plating from January 2015 to June 2019. These patients were divided into two groups according to screw configuration: short- and long-threaded cannulated screws (SLTS, n = 38) and short-threaded cannulated screws (STS, n = 48). Radiological and clinical outcomes including screw withdraw, nonunion, avascular necrosis, caput-collum-diaphysis (CCD) angle, amount of femoral neck shortening (FNS), and Harris Hip Score (HHS) were compared between the groups.Preoperative characteristics including age, gender, Garden type, duration of surgery, and reduction quality were not significantly different between the two groups (p 0.05). Less decreased CCD angle was observed in the SLTS group (-0.4° (-1.4 - 1.8)) compared with that in the STS group (7.9° (6.3 - 11.0)) (p 0.001). The SLTS group also presented with fewer amount of FNS (3.2 (2.7 - 3.8) mm vs. 5.1 (4.2 - 5.9) mm, p 0.001). Bone union was achieved in all patients and no avascular necrosis was observed during the follow-up. The HHS was higher in the SLTS group (86.4 ± 5.1) than that in the STS group (81.5 ± 4.5) (p 0.001).The hybrid configuration of short- and long-threaded screws in proximal femoral plating offers better resistance against varus collapse and yields better functional outcomes in femoral neck fractures.

The present study aimed to elucidate the effects of dexmedetomidine on kidney injury of parturients with preeclampsia (PE) undergoing cesarean section. Total 134 cesarean delivery women with PE were randomly divided into intervention group (IG) and control group (CG). Both groups underwent combined spinal and epidural anesthesia (CSEA), the IG was treated with 0.4 μg/(kg·min) dexmedetomidine for 10 min before surgery. The CG was treated with equivalent saline. Heart rate (HR), blood pressure, oxygen saturation (SpO2) of the two groups were measured at different time point after administration. Level of inflammatory factors were detected by enzyme-linked immunosorbent assay (ELISA). Visual analogue score (VAS), Ramsay sedation score (RSS), and kidney injury related indexes were evaluated at different time points. The plasma-drug concentration of patients was determined by High Performance Liquid Chromatography (HPLC) method. Compared with CG, HR, PE, and diastolic blood pressure (DBP) showed lower level while SpO2 showed higher level in IG. Furthermore, expression of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and IL-10 in IG was decreased after drug administration, the contents of β2-MG, KIM-1 and urine protein were also decreased in contrast to the CG (all P

Aim of review: Inhibitory interneurons, including GABAergic neurons and glycine neurons, regulate nociceptive information and non-nociceptive information in spinal dorsal horn. Emerging evidence showed that disinhibition of inhibitory interneurons of neuronal circuit in spinal dorsal horn is a pivotal mechanism of neuropathic pain after nerve injury.Method: In this view, we summarized the recent researches of the structure of inhibitory neurons in spinal dorsal horn and disinhibition of inhibitory interneurons after nerve injury and discussed the primary mechanism.Recent findings: Much progress has been made with the construction of inhibitory neuronal network in spinal dorsal horn and the dysfunction of inhibitory interneurons in these networks since inhibitory interneurons in spinal dorsal horn firstly integrate nociceptive information and non-nociceptive information from primary afferent fiber and separate non-nociceptive stimuli from nociceptive information. Disinhibitory of inhibitory interneurons underlies hyperalgesia and allodynia after nerve injury.Summary: Loss of inhibitory function of neurons in inhibitory network in the dorsal horn contributes to hyperalgesia and allodynia. The findings of these inhibitory networks provide a new evidence for preventing and curing neuropathic pain. Citation: Hui-Qun Fu, Tian-Long Wang. The inhibitory neuronal circuit of spinal cord in neuropathic pain. J Anesth Perioper Med 2016; 3: 132-141. doi: 10.24015/JAPM.2016.0018This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Background: The present study sought to establish the use of a novel model of cerebral ischaemia in which to investigate the neuroprotective effects of xenon based on organotypic hippocampal slice cultures.Methods: Organotypic hippocampal slices, derived from 7-10 days post-natal C57B16 mouse pups, were placed and cultured for 10-14 days on membranous inserts. Neuronal injury of cultures was provoked with media deprived with oxygen and glucose (OGD) for 2 hours. Cultures were exposed to 25% xenon or 50% xenon and 20% oxygen and 5% carbon dioxide (CO2) balanced with nitrogen (N2) 24 hours before OGD insult (preconditioning) for 2 hours or 75% xenon and 5% CO2 balanced with oxygen 4 hours after OGD for 2 hours. Cell death was quantified by assessment of propidium iodide (PI) uptake before and after OGD up to 72 hours in the CA1 and the dentate gyrus (DG) of the hippocampus.Results: Xenon preconditioning at concentrations of 25% and 50% resulted in a significant reduction in PI uptake in the CA1 region of the hippocampus compared with the control group (P

BackgroundPrevious studies in mice and humans have implicated the lipoprotein receptor SRB1 in association with atherosclerosis and lipid levels. In our previous proteomics research, the expression of ITGB2 has differences between epicardial and subcutaneous adipose tissue. However, the association between the reported variants and risk of coronary heart disease (CHD) was not confirmed.MethodsWe conducted a case–control study consisted of 496 CHD patients and 367 controls. The two groups are adjusted for age, sex, body mass index, diabetes status and the proportion of dyslipidemia. The genotypes and allele frequency of variants rs838880,rs5888,rs5889 in SRB1 and rs235326,rs2070947,rs2070946 in ITGB2 were determined using Sequenom Mass-ARRAY technology.ResultsThe genotypes frequencies of all the six SNPs were consistent with Hardy-Weinberg Equilibrium test. For gene SRB1 rs838880, there was a significant difference in the alleles frequency(p=0.017), genotype frequency(p=0.0028), recessive model (p=0.000672) between CHD group and control group. For gene ITGB2 rs2070947, there was a significant difference in the recessive model (p=0.03). By comparing the clinical and serum metabolic indexes of SNP sites by genotype we find that among three genotypes of SRB1 rs5888,there were significant difference in the level of dyslipidemia history and serum LPA, among three genotypes of ITGB2 rs235236,there were significant difference in the levels of serum HDL,APOA1 and hypertension history, among three genotypes of ITGB2 rs2070947,there were significant difference in the level of serum APOA1,hsCRP.ConclusionsOur findings indicated that SNP rs838880 of gene SRB1 and rs2070947 of gene ITGB2 are associated with the risk of CHD in Chinese han population.

Background: A large right subcostal incision performed by open hepatectomy is associated with significant post-operative pain and distress. However, post-operative analgesia solutions still need to be devised. We investigated the effects of intra- and post-operative infusion of dexmedetomidine (Dex) combined with oxycodone during open hepatectomy.Methods: In this prospective, randomized and double-blind investigation, 52 patients undergoing selective open hepatectomy were divided into Dex group (DEX infusion at an initial loading dose of 0.5 μg⋅kg-1 over 10 min before intubation then adjusted to a maintenance dose of 0.3 μg⋅kg-1⋅h-1 until incision suturing) or control (Con) group (0.9% sodium chloride was administered). Patient-controlled analgesia was administered for 48 h after surgery (Dex group: 60 mg oxycodone and 360 μg DEX diluted to 120 ml and administered at a bolus dose of 2 ml, with 5 min lockout interval and a 1 h limit of 20 ml. Con group: 60 mg oxycodone alone with the same regimen). The primary outcome was post-operative oxycodone consumption. The secondary outcomes included requirement of narcotic and vasoactive drugs, hemodynamics, incidence of adverse effects, satisfaction, first exhaust time, pain intensity, and the Ramsay Sedation Scale.Results: Post-operative oxycodone consumption was significantly reduced in Dex group from 4 to 48 h after surgery (P < 0.05). Heart rate in Dex group was statistically decreased from T1 (just before intubation) to T6 (20 min after arriving at the post-anesthesia care unit), while mean arterial pressure was significantly decreased from T1 to T3 (during surgical incision; P < 0.05). The consumption of propofol and remifentanil were significantly decreased in Dex group (P < 0.05). The VAS scores at rest at 1, 4, and 8 h and with cough at 24, and 48 h after surgery were lower, the first exhaust time were shorter, satisfaction with pain control was statistically higher and the incidence of nausea and vomiting was less in Dex group than in Con group (all P < 0.05).Conclusion: The combination of DEX and oxycodone could reduce oxycodone consumption and the incidence of nausea and vomiting, enhance the analgesic effect, improves patient satisfaction and shorten the first exhaust time.

Traumatic coagulopathy is a complicated pathophysiological process. The management of traumatic coagulopathy should cover the whole process from pre-hospital to after discharge. The recommendations on management of coagulopathy following trauma in this guideline are practical, but there are still many circumstances we don’t know how to deal with. To manage traumatic coagulopathy, we believe that there is still a long way to go. Citation: Hua Feng, Tian-Long Wang. Dealing with Traumatic Coagulopathy: A Long Way to Go. J Anesth Perioper Med 2017; 4: 195-7. doi:10.24015/JAPM.2017.0055 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Background: Retroperitoneal laparoscopy provides less morbidity and faster recovery period. However, long-term pneumoperitoneum increases the risk of hypercapnia that may induce severe postoperative complications, especially in elderly patients. Our study aims at investigating the sensitivity and reliability of continuous transcutaneous carbon dioxide (TcPCO2) monitoring in diagnosing hypercapnia during retroperitoneoscopic surgery in elderly patients and evaluating the effect of positive end-expiratory pressure (PEEP) against retroperitoneum induced hypercapnia.Methods: Fifty-five patients aged over 65 years who were scheduled for selective retroperitoneoscopic surgery under general anesthesia were enrolled. The correlations between TcPCO2, end-tidal partial pressure of CO2 (PETCO2) and arterial CO2 (PaCO2) were evaluated before pneumoperitoneum as well as 30 and 60 minutes after establishment of pneumoperitoneum (time 0, 1 and 2), respectively. Patients were randomly assigned to 5 groups accepting different levels of PEEP: 0, 4, 6, 8 and 10 cm H2O (group I, II, III, IV and V). PaCO2 and PETCO2 were measured at 80 minutes following pneumoperitoneum (time 3). Heart rate (HR), arterial pressure, airway pressure were evaluated throughout surgery.Results: There was a significant correlation between TcPCO2 and PaCO2 (r=0.87, P

We present two cases of glioma (WHO grade III) in pregnant females presenting in the third trimester. Gliomas during pregnancy are rare. At present, the association between gliomas and pregnancy is poorly understood and little has been reported with regard to the management of patients with gliomas in pregnancy. Management of these cases presents a medical dilemma. Gliomas during pregnancy pose a risk to maternal and fetal life. The benefit-to-risk ratio should be carefully evaluated and discussed prior to surgery. In the present cases, caesarean section (CS) followed by craniotomy was performed under the same general anesthesia at 34 weeks' gestation. The mothers received radiotherapy and chemotherapy following surgery. They have been followed up to the present date and remain in good health. These two cases indicate that early CS followed by craniotomy is an effective choice in pregnant patients with gliomas at ≥34 weeks' gestation. In the present study, we describe these two cases and review the literature with regard to gliomas during pregnancy.

Solar-coal complementary electric generation is a new way to utilize solar thermal, however, using solar thermal to replace the heat transfer of some heating surfaces will inevitably affects the stability and efficiency of boiler operation, and the running characteristics of the boiler will affects the utilization capacity of the solar thermal in turn. A 300MW unit thermal- circulation boiler has been studied. A research on calculation of heat transfer characteristic has been made. The influence of solar-energy utilization on heat transfer has been analyzed. Calculation and analysis indicate that using solar thermal to heat the feedwater can decrease coal consumption. 87.2% of the coal consumption decrement can be attributed to the replacement of coal by solar thermal, 12.8% of the coal consumption decrement is leaded by the boiler efficiency increment; Solar thermal should not be introduced into the boilers with low exhaust gas temperature and the boilers running at low load operation; Using solar thermal to heat the feedwater leads to decreasing spray water; Through the boiler calculation in this paper, the maximum solar thermal utilization capacity is 19.27MW.

Myocardial injury following carotid endarterectomy (CEA) is a common cause of morbidity and mortality, and its risk varies depending on the severity and extent of disease. However, when patients with sympotomatic severe carotid stenosis undergo CEA, the frequency and potential predictors of myocardial injury remain unknown. A total of 40 patients (32 men and 8 women) who underwent successful standard CEA were observed. Cardiac troponin I (cTnI) concentrations were assessed before surgery and on postoperative days 1, 2, and 3 in all patients. Myocardial injury was defined as the peak cTnI concentration > 0.04 ng/mL. In all, 42.5% patients had postoperative myocardial injury. Previous ischemic stroke and abnormal ST-segment changes were the preoperative predictors of myocardial injury after CEA, with odds ratios of 4.1 (95% confidence interval, 1.1-16.1; P = .04) and 5.9 (95% confidence interval, 1.3-27.7; P = .04), respectively. Sympotomatic patients with those conditions should receive more attention to myocardial injury, when presented for CEA.

Postoperative cognitive dysfunction (POCD) is reported to occur frequently after all types especially cardiac surgery in elderly patients. It can be short-term or long-term and some cases even develop into Alzheimer's disease (AD). Although multi-risk factors associated with POCD have been identified, the etiology and pathophysiological mechanisms of this surgical complication remain elusive. Therefore, developing strategies for preventing or treating POCD is still challenging. However, increasing evidence suggests that central and systemic inflammation triggered by surgery likely plays a fundamental role in POCD developing and progression. Minocycline, a tetracycline derivative with anti-inflammatory properties, has been shown to be effective in treating neuroinflammatory related conditions or neurodegenerative diseases such as AD, Parkinson's disease, Huntington's disease. Considering that inflammation may be a potential factor of POCD and minocycline is effective in improving cognitive dysfunction induced by inflammation, we hypothesize that minocycline may be useful to treat/prevent the POCD development after surgery in elderly patients.