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The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed., During the COVID-19 outbreak, international and Chinese anesthesiologists have been making efforts and taking speedy actions, which are gathering lessons and inspirations in response to devastating contagious diseases nationwide.

Objective. To investigate the value of guidewire-assisted reduction technology (which increases the stiffness of a catheter through the use of a guidewire, thereby protecting the puncture point and distal vein from breakage) combined with postural reduction for malpositioned catheters in the internal jugular vein during peripherally inserted central venous catheter catheterisation. Methods. From January 2015 to August 2020, we used ultrasound to perform guided puncture and monitoring. We identified the tip of the catheter as malpositioned in the internal jugular vein in 99 patients during the catheterisation process. These patients were divided randomly into a control group and an experimental group. In the control group, 43 cases received guidewire-assisted reduction technology, while in the experimental group, 56 patients received guidewire-assisted reduction technology combined with an upright posture. This study compared the efficacy of these two methods. Results. The results showed that 30 catheters were reduced successfully in the control group, with a success rate of 69.8%. In the experimental group, 53 cases were successfully reduced, with a success rate of 94.6%. The catheter reduction success rate in the experimental group was significantly higher than in the control group; this was a statistically significant difference ( P = 0.001 ). Conclusion. Guidewire-assisted reduction technology combined with postural reduction can improve the success rate of the reduction of malpositioned catheters in the internal jugular vein.

BACKGROUND: Catheter jamming is an emerging and possibly underrated complication. OBJECTIVE: To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (εf) of Peripheral Inserted Central Catheters (PICC). METHOD: We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted. RESULTS: The fracture tension of catheter in sections A and B were 5.8917 ± 1.0095 and 6.0670 ± 0.8066 Newtons respectively (p= 0.393) and the fracture strain of catheter in sections A and B were 6.0611 ± 1.0810 and 6.2543 ± 0.7187 Newtons respectively (p= 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 ± 0.9414 and 5.9192 ± 0.8972 Newtons respectively (p= 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 ± 0.7227 and 6.2584 ± 1.0212 respectively (p= 0.301). CONCLUSION: It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Ischaemic stroke is a severe disease worldwide. Restoration of blood flow after ischaemic stroke leads to cerebral ischaemia–reperfusion injury (CIRI). Various operations, such as cardiac surgery with deep hypothermic circulatory arrest, predictably cause cerebral ischaemia. Diabetes is related to the occurrence of perioperative stroke and exacerbates neurological impairment after stroke. Therefore, the choice of anaesthetic drugs has certain clinical significance for patients with diabetes. Isoflurane (ISO) exerts neuroprotective and anti-neuroinflammatory effects in patients without diabetes. However, the role of ISO in cerebral ischaemia in the context of diabetes is still unknown. Toll-like receptor 4 (TLR4) and NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome activation play important roles in microglia-mediated neuroinflammatory injury. In this study, we treated a diabetic middle cerebral artery occlusion mouse model with ISO. We found that diabetes exacerbated cerebral ischaemia damage and that ISO exerted neuroprotective effects in diabetic mice. Then, we found that ISO decreased TLR4-NLRP3 inflammasome activation in microglia and the excessive autophagy induced by CIRI in diabetic mice. The TLR4-specific agonist CRX-527 reversed the neuroprotective effects of ISO. In summary, our study indicated that ISO exerts neuroprotective effects against the neuroinflammation and autophagy observed during diabetic stroke via the TLR4-NLRP3 signalling pathway.

Objective: To compare the clinical application effects of peripherally inserted central catheter (PICC) and deep venous catheters placed through the lower limbs in adults, and to explore the advantages of ultrasound-guided PICC through the lower limbs in adults. Methods: A retrospective study was conducted on 27 bedridden patients with advanced malignant tumor between February 2017 and February 2019. The success rate of one-time catheterization, the length of catheterization puncture time, the number of catheterizations, and the occurrence of catheter-related complications of the two methods were compared. Results: Results of the study showed that ultrasound-guided PICC through the lower limbs has a higher success rate than deep venous catheterization. The average length of puncture time in adults with PICC through the lower limbs under ultrasound guidance was shorter than that in the femoral vein group. There was no significant difference in the incidence of catheter-related complications between the two groups. Conclusion: The indications for PICC through the lower limbs in adults include patients with advanced malignant tumor after bilateral breast cancer lymphadenectomy or superior vena cava obstruction syndrome, and mainly bedridden patients. This technique has certain advantages over deep venous catheterization and is an effective choice for venous access.

Objective To compare the clinical application effects of peripherally inserted central catheter (PICC) and deep venous catheters placed through the lower limbs in adults with malignancy obviating the use of upper limb PICC. Study design Descriptive study. Place and duration of study Department of Oncology, Beijing Shijingshan Hospital, Capital Medical University, Beijing, China between February 2017 and February 2019. Methodology The patients enrolled in this study were assigned to PICC under ultrasound guidance group and deep venous catheterisation group. The inclusion criteria were patients with advanced malignant tumor after bilateral breast cancer lymphadenectomy or superior vena cava obstruction syndrome; bedridden patients; and patients without mental disorders; who could understand the content of this study and agreed to participate in this study. Patients with high-risk thrombosis and venous thrombosis of lower limbs were excluded. The success rate of one-time catheterisation, the length of catheterisation puncture time, the number of catheterisations, and the occurrence of catheter-related complications of the two groups were compared. Results Ultrasound-guided PICC through the lower limbs had a higher success rate than deep venous catheterization (84.6% vs. 42.9%, p=0.046). The average length of puncture time in adults with PICC through the lower limbs under ultrasound guidance was shorter than that in the femoral vein group (24.69 ± 4.35 vs. 29.14 ± 6.02, p=0.038). No catheter-related infection was found in the two groups of patients. Conclusion The indications for PICC through the lower limbs in adults include patients with advanced malignant tumor after bilateral breast cancer lymphadenectomy or superior vena cava obstruction syndrome, and mainly bedridden patients. This technique has certain advantages over deep venous catheterisation and is an effective choice for venous access. Key Words: Lower limb PICC, Deep venous catheterisation, Advanced malignant tumor, Bedridden.

Bupivacaine has been shown to induce neurotoxicity through inducing excessive reactive oxygen species (ROS), but the underlying mechanism remains unclear. NOX2 is one of the most important sources of ROS in the nervous system, and its activation requires the membrane translocation of subunit p47phox. However, the role of p47phox in bupivacaine-induced neurotoxicity has not been explored. In our in vitro study, cultured human SH-SY5Y neuroblastoma cells were treated with 1.5 mM bupivacaine to induce neurotoxicity. Membrane translocation of p47phox was assessed by measuring the cytosol/membrane ratio of p47phox. The effects of the NOX inhibitor VAS2870 and p47phox-siRNA on bupivacaine-induced neurotoxicity were investigated. Furthermore, the effect of VAS2870 on bupivacaine-induced neurotoxicity was assessed in vivo in rats. All these changes were reversed by pretreatment with VAS2870 or transfection with p47phox-siRNA in SH-SY5Y cells. Similarly, pretreatment with VAS2870 attenuated bupivacaine-induced neuronal toxicity in rats. It is concluded that enhancing p47phox membrane translocation is a major mechanism whereby bupivacaine induced neurotoxicity and that pretreatment with VAS2870 or local p47phox gene knockdown attenuated bupivacaine-induced neuronal cell injury.

The NLRP3 (nucleotide-binding oligomerization domain-like receptor [NLR] family pyrin domain-containing 3) inflammasome is a member of the NLR family of innate immune cell sensors. These are crucial regulators of cytokine secretions, which promote ischemic cell death and insulin resistance. This review summarizes recent progress regarding the NLRP3 inflammasome as a potential treatment for ischemic stroke in patients with diabetes, two complicated diseases that often occur together. Stroke worsens glucose metabolism abnormalities, and the outcomes after stroke are more serious for diabetic patients compared with those without diabetes. Inflammation contributes to organ injury after ischemic stroke and diabetes. Recent research has focused on inhibiting the activation of inflammasomes and thus reducing the maturation of proinflammatory cytokines such as interleukin (IL)-1β and IL-18. Studies suggest that inhibition of NLRP3 prevents or alleviates both ischemic stroke and diabetes. Targeting against the assembly and activity of the NLRP3 inflammasome is a potential and novel therapy for inflammasome-associated diseases, including ischemic stroke concomitant with diabetes.

To study flavanoids extracted from onion (FEO) on the number of activated microglia and the release of proinflammatory factors in intracerebral hemorrhage (ICH) model rat at different time points, and to explore its possible mechanism for treating ICH.Totally 100 Wistar rats were used for preparing ICH model, and ICH model was successfully established in 90 of them. The 90 rats were randomly divided into the sham-operation group (n =10) , the ICH group (n =40) , the FEO group (n =40). Totally 100 [L autoblood was injected from fixed position to rats in the ICH group and the FEO group during modeling. Meanwhile, FEO at 0. 2 mL/10 g was given to rats in the FEO group, twice daily. No drug intervention was given to rats in the ICH group and the sham-operation group. Each group was further sub-divided into 5 sub-groups according to different time points such as 6, 24, 48, 72 h, and 7 days. There were 8 rats in each sub-group of the ICH group and the FEO group, 10 groups in total. There were 2 rats in each subgroup of the sham-operation group, 5 groups in total. Neurological functions at different time points were observed by Garcia JH. The injury degree of brain tissue was observed at dif- ferent time points using HE staining. Activated microglia around hematoma were observed at different time points after ICH by using immunohistochemical staining. Expressions of TNF-α and IL-1 β at different time points after ICH was detected using ELISA.In the ICH group, degenerated and necrotic zone occurred around hematoma after injecting autoblood, cells were untidily arranged with irregular nucleus, partial nucleus were shrunken with lamellar interstitial edema of the medulla. As time went by, degenerated and necrotic zone was dilated; vacant zone occurred around cells; cells were unevenly distributed with reduced neuron numbers. Meanwhile, infiltration of lymphocytes and neutrophils occurred. In the FEO group after FEO intervention, necrotic cells were lesser, cell arrangement and nucleus morphology were obviously alleviated, and infiltration of inflammatory cells was reduced at corresponding time points. Compared with the sham-operation group, behavioral scores at 5 time points all decreased, the number of activated microglia was added, and expressions of TNF-α and IL-1 β in hematoma tissue increased in the ICH group (P0. 01). Compared with the ICH group, behavioral scores at 48 and 72 h, as well as day 7 all increased, the number of activated microglia was reduced, and expressions of TNF-α and IL-1β in hematoma tissue decreased in the FEO group (P0. 01).FEO using the ethanol reflux method could improve symptoms of ICH model rats possibly by inhibiting activation of microolia and the release of proinflammatory factors around the hematoma.

It is well known that grain-refinement has a positive impact on the mechanical properties of WC-Co cemented carbide. The effect of VC inhibitor and microwave on density, microstructure and mechanical properties of the sintered WC–12wt%Co alloy was investigated in the present study. The ball milled WC-12wt%Co-xVC composites were compressed and fabricated by using microwave sintering method. The experimental results indicate that the microwave sintering cycle was significantly shorter to that of vacuum processing, and the density of bulk alloys increased with VC inhibitor contents and microwave sintering temperatures. Moreover, the microstructure observation of the sintered samples suggests that VC inhibitor had prominent inhibitory action on WC grains in microwave exposure, and the WC average grain size of alloy with 0.7wt%VC inhibitor was 0.43μm when the sintering temperature reached 1420°C. It is also evident that WC-12wt% alloys with an appropriate proportion of VC inhibitor exhibited higher hardness (92.1HRA) and better transverse rupture strength (2380MPa). And finally the mechanism of inhibitory effects on WC grains under microwave irradiation was discussed.

As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.

Local anaesthetics (LAs) may lead to neurological complications, but the underlying mechanism is still unclear. Many neurotoxicity research studies have examined different LAs, but none have comprehensively explored the distinct mechanisms of neurotoxicity caused by amide- (bupivacaine) and ester- (procaine) type LAs. Here, based on a CCK8 assay, LDH assay, Rhod-2-AM and JC-1 staining, 2′,7′-dichlorohy-drofluorescein diacetate and dihydroethidium probes, an alkaline comet assay, and apoptosis assay, we show that both bupivacaine and procaine significantly induce mitochondrial calcium overload and a decline in the mitochondrial membrane potential as well as overproduction of ROS, DNA damage and apoptosis (P 0.05). However, to our surprise, the superoxide anionic level after treatment with bupivacaine, which leads to more severe DNA damage, was higher than the level after treatment with procaine, while procaine produced more peroxidation than bupivacaine. Some of these results were also affirmed in dorsal root ganglia neurons of C57 mice. The differences in the superoxidation and peroxidation induced by these agents suggest that different types of LAs may cause neurotoxicity via different pathways. We can target more accurate treatment based on their different mechanisms of neurotoxicity.

Under H 2 atmosphere, the green strips were prepared from Al–5.8Zn–1.63Mg–2.22Cu–0.12Zr (mass fraction, %) powders by the semi-solid rolling process with a relative density from 76.1% to 88.0%. The role of temperature on microstructure and mechanical properties was investigated. With increasing rolling temperature from 580 to 610 °C, the disappearance of primary powder boundary and isolated pores, inter-diffusion of species and the change of grain boundary were accelerated. Moreover, the mechanism of microstructure evolution changes from the densification dominant regime to the coarsening dominant regime; the amount of η (MgZn 2 ) phase decreased and more Al 2 Cu particles precipitated at grain boundaries. The optimum temperature for semi-solid rolling of Al–5.8Zn–1.63Mg–2.22Cu–0.12Zr powders was determined. The liquid fraction in the range of 53% to 67% corresponds with a high density level of green strips. The present experimental analysis suggests that semi-solid powder rolling can be optimized to manufacture strips with high mechanical properties.

A smooth and flexible carbon film was prepared via liquid exfoliation method followed by liquid evaporation using the natural flake graphite as the starting material. The XRD and Raman results demonstrated that the obtained film is composed of chemically reduced graphene, graphene oxide and graphite. The thermal transport property of the as-obtained film was investigated by light flash measurements. It is found that the as-obtained graphene-containing composite film has a high in-plane thermal diffusivity (2157 m2/s), and the corresponding thermal conductivity (754 W/m K) is higher than the other metal and normal graphite materials, which is very promising for applications requiring 2D heat conduction.

Amorphous Ti63.7Nb21.3Zr4.5Ta1.5Fe9 powder has been designed and fabricated by mechanical alloying (MA) from a mixture of pure titanium and other elemental powders under a purified argon gas atmosphere in a stainless steel vial together with stainless steel balls. The amorphous alloy powders were examined by X-ray diffraction (XRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The results show that a transform from a well-developed dislocation substructure to a mixed nanocrystalline plus amorphous structure occurs in Ti63.7Nb21.3Zr4.5Ta1.5Fe9 when milling time increases from 0 h to 15 h. Moreover, amorphous Ti63.7Nb21.3Zr4.5Ta1.5Fe9 powders were prepared after mechanical milling for 40 h. The results obtained are of the most significance for future work of densification of the milled powders.

Spray rolling is a novel metallic semi-solid near-net-shape forming technology. This paper describes the qualitative influence of the key process parameters on the nucleation temperature during gas horizontal atomization stage in the spray rolling of 7050 aluminum alloy. The Newtonian heat transfer formulation has been coupled with heterogeneous nucleation, as well as the special solidification process. Results show that the droplet diameter has remarkable influence on nucleation temperature during spray rolling of 7050 aluminum alloy compared with that of wetting angle. The nucleation temperature approximately is 878K.

Molecular dynamics simulations were performed for investigating the thermal stability of the extremely thermophilic Thermoanaerobacter tengcongensis ribose binding protein (tteRBP) and the mesophilic homologous Escherichia coli ribose binding protein (ecRBP). The simulations for the two proteins were carried out under the room temperature (300 K) and the optimal activity temperature (tteRBP 375 K and ecRBP 329 K), respectively. The comparative analyses of the trajectories show that the two proteins have stable overall structures at the two temperatures; further analyses indicate that they both have strong side-chain interactions and different backbone flexibilities at the different temperatures. The tteRBP 375 K and ecRBP 329 K have stronger internal motion and higher flexibility than tteRBP 300 K and ecRBP 300 K, respectively, it is noted that the flexibility of tteRBP is much higher than that of ecRBP at the two temperatures. Therefore, tteRBP 375 K can adapt to high temperature due to its higher flexibility of backbone. Combining with the researches by Cuneo et al., it is concluded that the side-chain interactions and flexibility of backbone are both the key factors to maintain thermal stability of the two proteins. An animated Interactive 3D Complement (I3DC) is available in Proteopedia at http://proteopedia.org/w/Journal:JBSD:22

To assess physicians' awareness and use of guidelines for community-acquired pneumonia (CAP) published by Chinese Society of Respiratory Diseases (CSRD) and American Thoracic Society (ATS), and to investigate influences of the guidelines on the prognosis of patients with CAP.A total of 210 self-completion questionnaires about CAP guidelines were received from doctors of six hospitals in Beijing. In addition, 490 serial cases of CAP collected from these hospitals admitted from January 2002 to December 2003 were retrospectively analyzed.Most doctors had limited knowledge about atypical pathogens. For pulmonary physicians, only 46% (97/210) reported using the CSRD guideline. 82.4% of the doctors preferred to give initial empiric antibiotic therapy according to the patients' conditions. 79.5% (167/210) of the doctors ordered examination of the pathogens routinely and 84.3% (177/210) of them admitted its usefulness for choosing antibiotics. 84.5% (414/490) of the patients responded well to the initial empiric treatment. Patients who were treated according to the guidelines of CSRD and ATS were 229 cases and 131 cases respectively. There was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not. There was no significant difference in the prognosis between cases with definite pathogens and cases without.The results indicate low levels of awareness and use of guidelines for the management of CAP. Fewer than half of the patients were treated according to the guidelines. However, the treatments were effective in most of the patients, and there was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not, because broad-spectrum antibiotics were overused. More effective guideline implementation strategies are needed to encourage compliance with practice guidelines for the management of CAP.