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Background To identify the effect of hemodynamic fluctuations on severe postoperative complications in patients undergoing surgery for pheochromocytoma and paraganglioma (PPGL). Methods Patients with PPGL confirmed by postoperative pathologic examination in Fujian Provincial Hospital from January 2015 to January 2021 were enrolled. Demographic characteristics, comorbidities, preoperative examinations, preoperative preparation, intraoperative data, and postoperative complications were collected. Receiver operating characteristic curve was used to calculate the cutoff point of intraoperative standard deviation of systolic blood pressure for prediction of severe postoperative complication. According to the cutoff point, patients were divided into fluctuation and nonsevere fluctuation groups. Incidence of postoperative complication, intensive care unit (ICU) admission, length of stay after the operation, and length of ICU stay between the 2 groups was compared. The cumulative incidence and hazard ratio of postoperative complications were evaluated by Kaplan�Meier method and Cox regression analysis. Results A total of 126 patients were included in the study with 41 and 85 cases in the severe fluctuation and nonsevere fluctuation groups, respectively. Compared with the nonsevere fluctuation group, the incidence of postoperative complications (58.5% vs. 16.5%, P < 0.001), ICU admission rate (26.8% vs. 10.6%, P = 0.019), postoperative hospital stay, and ICU stay (P < 0.05) were higher in the severe fluctuation group. The Kaplan–Meier curve showed a higher incidence of postoperative complications in patients with severe blood pressure fluctuations (P < 0.05). The Cox regression analysis also showed that patients in the severe fluctuation group were more susceptible to postoperative complications (hazard ratio = 3.010, 95% confidence interval 1.334–6.806). Conclusions For patients with PPGL, the intraoperative hemodynamic fluctuations are associated with an increased risk of severe postoperative complications.

Background Tracheal intubation with the patient in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. Flexible video endoscopes may facilitate intubation even when laryngeal views are poor on direct laryngoscopy because the patients are positioned laterally. Thus, this trial aims to compare the efficacy of flexible video endoscopes to Macintosh laryngoscopes for orotracheal intubation in the lateral position and to investigate their feasibility, i.e., whether the use of the two devices in combination can secure the airway when endotracheal intubation in the lateral position has failed using one device. Methods This will be a prospective, randomized, single-center, clinical trial. One hundred and seventy-four patients aged 18–65 years, who have been scheduled to undergo tracheal intubation under uniform general anesthetic techniques for elective kidney surgery in the lateral decubitus position will be randomly divided into the flexible video endoscope and the Macintosh laryngoscope groups. Primary outcomes include intubation time and intubation success rate. Secondary outcomes include overall user satisfaction (graded from 1 to 10 (1 = very poor, 10 = excellent)) and perioperative side effects and complications, such as frequency of esophageal intubation, lip or dental injury, sore throat, and hoarseness. Discussion The trial will clarify the efficacy of intubation with a Macintosh laryngoscope and a flexible video endoscope in the lateral position, and whether the two devices could be used in combination to secure the airway in cases where endotracheal intubation in the lateral position has failed with one device. Trial registration Chinese Clinical Trial Register, ChiCTR- IOR-15007175. Registered on 6 October 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3263-1) contains supplementary material, which is available to authorized users.

Background To analyze expression profiles of long noncoding RNA (lncRNA) and messenger RNA (mRNA) in patients with essential hypertension (EH) and normotensive adults. Methods The gene chip dataset GSE76845, which was generated from 5 plasma samples from patients with EH and 5 normotensives, was downloaded from the National Biotechnology Information Center Public Data Platform. Each sample (total RNA) was pooled from the total RNA of 3 age- and gender-matched subjects (EH patients or healthy controls). A ClusterProfiler package including gene set enrichment analysis (GSEA) was used to identify differentially expressed genes. The target microRNA and mRNA were predicted by microcode, microDB, microTarBase, and TargetScan databases. Finally, a competing endogenous RNAs (ceRNA) regulatory network was constructed. Results Compared with the healthy control adults, 191 differential lncRNAs (90 upregulated and 101 downregulated) and 1,187 differential mRNAs (533 upregulated and 654 downregulated) were identified in EH patients. GSEA analysis showed that 17 pathways, including ubiquinone and terpenoid-quinone biosynthesis, parathyroid hormone synthesis secretion and action, fatty acid metabolism, and steroid hormone biosynthesis are involved in hypertension. A ceRNA network consisting of 150 nodes and 488 interactive pairs was constructed. Conclusions lncRNA and mRNA profile analysis provides new insight into molecular mechanisms of EH pathogenesis and potential targets for therapeutic interventions.

Purpose To explore effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis. Methods 83 elderly patients with spinal stenosis were randomly classified into two groups: control group (n = 40) and GDFT group (n = 43). The Montreal Cognitive Assessment (MoCA) score, IL-6 and S100β levels, hemodynamic parameters, cerebral oxygen saturation (rSO 2 ), arterial lactic acid values, output of surgery, operation time and cases of hypotension, intraoperative complications within 7 days were recorded for all patients. Results The incidence of postoperative cognitive dysfunction (POCD) was about 21.67% in this study. The MoCA scores, inflammatory mediators, perfusion indexes (rSO 2 and lactic acid)and intraoperative hemodynamics(HR, MAP, and CI)were not all the same at different time points ( P P P P P Conclusions GDFT can maintain the stability of perioperative hemodynamics in the prone position of elderly patients with spinal stenosis, improve the balance between perfusion of tissue and organ and supply and demand of oxygen, reduce the inflammatory response, and reduce the incidence of early POCD in this type of surgery.

Kai Zeng,* Yanzhen Li,* Min Liang, Youguang Gao, Hongda Cai, Caizhu LinDepartment of Anesthesia, the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China*These authors contributed equally to this workPurpose: We aimed to investigate the influence of perioperative goal-directed fluid therapy (GDFT) on the prognosis of elderly patients with gastric cancer and hypertension. Methods: Sixty elderly patients (>60 years old) with primary hypertension who received gastric cancer radical surgery and who were American Society of Anesthesiologists (ASA) class II or III were enrolled in the current study. Selected patients were divided randomly into two arms, comprising a conventional intraoperative fluid management arm (arm C, n=30) and a GDFT arm (arm G, n=30). Patients in arm C were infused with crystalloids or colloids according to the methods of Miller’s Anesthesia (6th edition), while those in arm G were infused with 200mL hydroxyethyl starch over 15 minutes under the FloTrac/Vigileo monitoring system, with stroke volume variation between 8% and 13%. Hemodynamics and tissue perfusion laboratory indicators in patients were recorded continuously from 30 minutes before the operation to 24hours after the operation. Results: Compared with arm C, the average intraoperative intravenous infusion quantity in arm G was significantly reduced (2,732±488 mL versus 3,135±346 mL, P

Phosphocreatine (PCr) mobilizes high-energy phosphates in cardiac muscles, which is potentially useful as a cardioprotective agent in patients with spinal cord injury (SCI). The cardioprotective effects of PCr on myocardial cell ultrastructure and calcium-sensing receptor (CaSR) expression following high-level spinal cord injury (SCI) were investigated. Healthy adult male Sprague-Dawley (SD) rats (n=54) weighing 250-300 g were subjected to C7 SCI injury by Allen's method with or without treatment by abdominal injection of PCr (200 mg/kg) at 6, 12, 24 or 48 h (SCI + treatment and SCI-only groups, respectively; 6 rats/group/time point). Right apical tissues were sampled 2 h following each time interval. Surgeries without SCI were performed in 6 control rats (sham operation group). Cardiac troponin I (cTnI), serum creatine kinase (CK) and creatine kinase (CK-MB) levels were assessed automatically. Myocardial morphology was examined by transmission electron microscopy (TEM). Quantitative real‑time polymerase chain reaction (qRT-PCR) and western blot analysis were used to determine myocardial tissue calcium-sensing receptor (CaSR) mRNA and protein expression, respectively. Normal myocardial ultrastructure was observed in the sham operation group, while SCI-only groups exhibited progressive and extensive damage to myofibrils, sarcomere structure, mitochondrial membranes and vacuole structures, occasionally accompanied by punctured cell membranes, nuclear chromatin condensation and cavitation. SCI + treatment groups, however, exhibited significantly relieved ultrastructural abnormalities and reduced the levels of CaSR, cTnI, CK and CK-MB mRNA and protein expression at all time intervals (P

Aberrant neuronal activity in injured peripheral nerves is believed to be an important factor in the development of neuropathic pain (NPP). Channel protein pCREB of that activity has been shown to mitigate the onset of associated molecular events in the nervous system, and sodium hydrosulfide (NaHS) could inhibit the expression of pCREB. However, whether NaHS could relieve the pain, it needs further experimental research. Furthermore, the clinical potential that NaHS was used to relieve pain was limited so it would be required. To address these issues, the rats of sciatic nerve chronic constriction injury (CCI) were given intraperitoneal injection of NaHS containing hydrogen sulfide (H2S). The experimental results showed that NaHS inhibited the reduction of paw withdrawal thermal latency (PWTL), mechanical withdrawal threshold (MWT), and the level of pCREB in CCI rats in a dose-dependent manner and they were greatly decreased in NaHSMgroup (P< 0.05). NaHS alleviates chronic neuropathic pain by inhibiting expression of pCREB in the spinal cord of Sprague-Dawley rats.

Cerebral hemorrhage is a common disease of older adults, which could increase the risk of cognitive impairment. Electroencephalogram (EEG) characteristics can be analyzed to investigate the applied value in the assessment of cognitive impairment of the patients with cerebral hemorrhage. One hundred eighty-two patients (including patients with cognitive impairment [CHCI] and patients with cognitive normality [CHNC] with cerebral hemorrhage, and 120 normal healthy persons [control; CN]) were recruited between July 2008 to March 2012 at the department of neurology. All patients were analyzed by EEG, and analysis results were compared to the Montreal Cognitive Assessment (MoCA) scale, using the methods of correlation analysis, clustering analysis, and concordance analysis. The results indicated that patients with CHCI had significantly lower EEG beta power (0.814 ± 0.113 mcV2) relative to CHNC (1.601 ± 0.186 mcV2, P < .01) or CN group (1.713 ± 0.201 mcV2, P < .01). Significant negative correlation was found between the beta power and hemorrhage region, age, hemorrhage size, hemorrhage amount ( r1 = −.92223, r2 = −.81084, r3 = −.79258, r4 = −.84961, respectively, all P < .001). There was good concordance between K-means clustering algorithm calculating the beta power and MoCA scoring (Kappa = 0.899, P < .001). In conclusion, the preliminary findings suggest that the recognition techniques of EEG hold considerable promise for the assessment of cognitive impairment post cerebral hemorrhage, which negatively related to the hemorrhage region, hemorrhage size, hemorrhage amount, and age.

OBJECTIVE: To compare the incidence of postoperative nausea and vomiting (PONV) and postoperative pain in thyroidectomy patients undergoing general anaesthesia, with or without bilateral superficial cervical plexus block (BSCPB). METHODS: In this prospective, randomized, double-blind study, adult patients scheduled for thyroid surgery under general anaesthesia were randomized to receive BSCPB with 20 ml 0.5% ropivacaine (ropivacaine group) or placebo (20 ml saline; saline group) before surgery. The incidence of PONV and postoperative pain, and the need for rescue antiemetics were assessed at 0 – 24 h postoperatively. RESULTS: Data from 135 patients were evaluated and the incidence of PONV, the need for rescue antiemetics and the number of patients needing additional perioperative pain relief in the postanaesthetic care unit were significantly lower in the ropivacaine group compared with the saline group. Early postoperative (0 – 8 h) visual analogue scale pain scores were significantly lower in the ropivacaine group compared with the saline group. CONCLUSIONS: BSCPB with 0.5% ropivacaine administered before surgery can significantly reduce the incidence of PONV and early postoperative pain and also reduce perioperative opioid requirements in thyroidectomy patients undergoing general anaesthesia.

Human interleukin-10 (hIL-10) is a cytokine synthesis inhibitory factor, which is involved in various immune responses. The purpose of this study was to construct an adenoviral vector carrying the hIL-10 gene for expression of biologically active hIL-10 in rat bone marrow mesenchymal stem cells (rMSCs).A pSNAV2.0-hIL10 plasmid was used as a template to obtain a hIL-10 cDNA fragment that was subcloned by restriction enzyme digestion and ligation into a pDC316-IRES-EGFP-lacZ alpha plasmid carrying an enhanced green fluorescent protein (EGFP) marker gene. The pDC316-hIL-10-IRES-EGFP plasmid was linearized by PmeI digestion and used to transfect HEK293 packaging cells using the adenovirus packaging system AdMax. Virus particles were amplified by repeatedly infecting HEK293 cells with the seed virus and then purified by ion exchange. After the number of virus particles and titer was determined, rMSCs were infected with the adenoviral vector. The infection rate was determined by fluorescence microscopy and flow cytometry, and hIL-10 protein expression in rMSCs was measured by Western blotting.The virus particle concentration, OD260/280 value and virus titer of the amplified and purified recombinant adenovirus were 3.2 × 10(11) VP/ml, approximately 2.0, and 1.1 × 10(10) TCID50/ml, respectively. Bright green fluorescence was observed by fluorescence microscopy and flow cytometry in the recombinant adenovirus-infected rMSCs. GFP expression was considered the multiplicity of infection (MOI) and was time-dependent. The infection rate was 92.9% at 100 MOI.A bicistronic recombinant adenoviral vector for hIL-10 and EGFP gene expression were successfully constructed. The infection rate of rMSCs by the adenovirus was high (92.9% at 100 MOI) and the target gene hIL-10 was highly expressed in cells. The present study provides an experimental basis for further research of immunosuppressive therapy using hIL-10. The expression level of hIL-10 protein as detected by Western blotting was also MOI- and time-dependent.