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The intraoperative effects of mechanical ventilation with individualized positive end-expiratory pressure guided by dynamic compliance on right heart function remains undefined.To investigate whether individualized ventilation is superior to standard ventilation in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg position.Forty patients who underwent abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric positive end-expiratory pressure [PEEP]) and Group I (intentional PEEP, 5 cmHNo significant difference in the tricuspid annular plane systolic excursion or early-to-late filling ratio of the right ventricle was noted between the groups during the whole procedure (P0.05). We noticed an increase in right ventricular end-diastolic area/left ventricular end-diastolic area ratio at TIntraoperative lung-protective ventilation with dynamic compliance-guided PEEP does not have obvious side effects on the right heart function when compared with standard protective ventilation during laparoscopic surgery in the Trendelenburg position.

An acceptor FEH2C8-2Cl is designed by introducing the isomerized side chains and the corresponding photovoltaic module with the active layer area 25 cm2 yields an efficiency of 11.71%.

General anesthesia might disrupt neuronal network communications measured by functional connectivity (FC; undirected connectivity) and directional information flow (directed connectivity). We sought to characterize the state-dependent effects of propofol on cortico-cortical undirected and directed FC.We collected 256-channel high-density EEGs from 14 patients undergoing surgery while awake (AWA) or in propofol-induced moderate sedation (SED) or loss of consciousness (LOC) states. Using source-space EEG, we estimated neuronal oscillatory activity for 68 cortical regions of interest. FC was analyzed using the weighted phase lag index. Directed connectivity was computed using directed phase transfer entropy (dPTE) as a measure of information flow in the bilateral prefrontal, frontal, parietal, and occipital areas.FC strength evidently reduced during LOC compared with those during the AWA and SED states. The dPTE analysis showed significant propofol-induced changes in directed connectivity. In the alpha band, the prefrontal-to-frontal information flow was significantly stronger in the AWA than in the SED (p = 0.033) and LOC states (p = 0.033). The parietal-to-frontal dPTE was significantly weaker during LOC than during the AWA (p = 0.033) and SED states (p = 0.007). Finally, a loss of occipital-to-frontal connectivity occurred during LOC but not the AWA state (p = 0.001). In the beta band, the dominant occipital-to-frontal direction of information flow in the AWA state was gradually converted to a frontal-to-occipital direction during LOC.Propofol-induced unconsciousness is marked by a decrease in FC and posterior-to-anterior (feedforward) directed connectivity, which may be useful as a measure to discriminate different conscious states caused by propofol administration.The study demonstrates that propofol produces state-dependent effects on cortico-cortical undirected and directed FC, supporting the idea that propofol induces loss of consciousness may through disrupting network interactions and cortical coordination.

Three isomeric acceptors FOM-1, FOM-2 and FOM-3 incorporating the fluorene center are designed and synthesized.

Graphene-based metal-free aerogel is desirable for lightweight electromagnetic wave (EMW) absorbing materials. However, the weak van-der-Waals combination between graphene sheets, accompanied by the repulsion from surface oxygen-related polar groups, significantly hinder the transfer of electrons between the sheets, and lead to poor mechanical strength. These become bottlenecks for the further improvement of EMW absorption and have a huge impact on achieving multi-functions. Here, we used an iodine modification strategy to fabricate reduced graphene oxide (RGO) aerogel, in which graphene sheets are bridged by iodine cations (I+). Meanwhile, iodine promotes the conversion of epoxy groups to hydroxyl groups on graphene, thereby facilitating the adhension of I+ on the surface. These iodine cations rather than iodine anions are essential to strengthen the interconnection between graphene sheets, which enables the RGO aerogel to exhibit higher electrical conductivity, larger mechanical strength, higher thermal stability, and significantly improved EMW absorbing capability. With the improvement in conduction loss and impedance matching, the iodine-bridged RGO aerogel exhibits a maximium reflection loss of −52.8 dB and an effective absorption bandwidth of 7.2 GHz at 2 wt% filler loading, which are 3.8 and 1.5 times of pure RGO, respectively. Besides, the improved mechanical strength and resistance to temperature change benefit expanding the application fields of this aerogel.

A ternary strategy is recognized as a promising approach that enjoys both the simplicity of fabrication conditions and potential to improve performance in organic solar cells. Herein, a C-shaped narrow band gap non-fullerene acceptor GL1 with a C2v symmetry based on a new core was designed and synthesized. A power conversion efficiency (PCE) of 11.43% was achieved by employing PBDB-T:GL1 as an active layer to fabricate photovoltaic devices. To further promote photovoltaic performance, following a similar-structure prescreen principle, a middle band gap acceptor F-2Cl with the same backbone shape, side-chain distribution, and dipole moment orientation as GL1 was introduced as the guest acceptor into the active layer. Thus, benefiting from the collaboration of complementary absorption, cascade energy levels, and well-modified microstructure of the active layer, a 13.17% PCE was obtained with concurrently elevated Jsc, fill factor, and stability for the optimized ternary device. This work presents a successful example of prescreening the third component to simplify the workload for a high-performance ternary device.

The dominant hole transport material (HTM) in state-of-the-art perovskite solar cells (PSCs) is Spiro-OMeTAD, which needs to be doped using hydrophilic dopants to improve its hole mobility and conductivity, resulting in inferior device stability. Here, we propose an effective molecular design strategy to construct dopant-free polymer HTMs by selecting four structurally related polymers and investigating their structure-property relationship. It is found that the donor and acceptor units with longitudinal conjugate extension, such as BDT-T and BDD, could not only enhance the planarity of the conjugated polymer backbone and tune the energy levels but also promote the face-on orientation, resulting in superior charge extraction and transport. The optimized device utilizing dopant-free polymer HTM shows a high open-circuit voltage of 1.19 V and a champion efficiency of 24.04 % with greatly improved operational stability, making it among the best performance PSCs based on dopant-free HTMs.

Although organic solar cells (OSCs) have delivered an impressive power conversion efficiency (PCE) of over 19 %, most of them demonstrated rather limited stability. So far, there are hardly any effective and universal strategies to improve stability of state-of-the-art OSCs. Herein, we developed a hybrid electron-transport layer (ETL) in inverted OSCs using ZnO and a new modifying agent (NMA), and significantly improved the stability and PCEs for all the tested devices. In particular, when applied in the D18 : N3 system, its inverted OSC exhibits so far the highest PCE (18.20 %) among inverted single-junction OSCs, demonstrating an extrapolated T

Ternary organic photovoltaic (OPV) strategy is an effective but facile approach to enhance the photovoltaic performance for single-junction devices. Herein, a series of ternary OPVs were fabricated by employing a wide bandgap donor (PBDB-TF) and two acceptor-donor-acceptor (A-D-A)-type nonfullerene small molecule acceptors (NF-SMAs, called F-2Cl and 3TT-OCIC). As the third component, the near-infrared SMA, 3TT-OCIC, has complementary absorption spectrum, narrow bandgap and well-compatible crystallization property to the host acceptor (F-2Cl) for efficient ternary OPVs. With these, the optimal ternary devices yield significantly enhanced power conversion efficiency of 15.23%, one of the very few examples with PCE higher than 15% other than Y6 systems. This is mainly attributed to the increased short-circuit current density of 24.92 mA cm−2 and dramatically decreased energy loss of 0.53 eV. This work presents a successful example for simultaneously improving current, minimizing energy loss and together with modifying the morphology of active layers in OPVs, which will contribute to the further construction of high performance ternary OPVs.

Background Positive end-expiratory pressure (PEEP) is widely used to reduce the risk of hypoxemia and atelectasis during one-lung ventilation (OLV); however, the optimal strategy for PEEP titrating remains unclear.The purpose of the study was to investigate the effects of different PEEP titrating strategies on oxygenation and respiratory mechanics during OLV. Methods Patients undergoing thoracic surgery with general anesthesia were randomly allocated into five groups. In P0 group, PEEP was set to zero; in PLIP2 group, PEEP was set to 2 cmH2O plus the pressure of lower inflection point (LIP) of pressure-volume (P-V) curve; in PLIPS group, PEEP was titrated to achieve maximum static compliance from the averaged LIP pressure value; in groups PSTAT and PDYN, the incremental PEEP values were titrated to achieve maximum static compliance or maximum dynamic compliance from 4 cmH2O. Hemodynamic measurements, respiratory mechanics, and blood gas analyses were recorded at the beginning of OLV, OLV 15 min, OLV 30 min, OLV 45 min, and OLV 60 min. Also, the intrapulmonary shunt (Qs/Qt), physiological dead space to tidal volume ratio (VD/VT), and oxygenation index (OI) were calculated and compared. Results Seventy-five patients consented to participate in this study. Dynamic compliance, peak inspiratory pressure (PIP), and plateau inspiratory pressure (Pplat) increased after PEEP titration during OLV. PIP, Qs/ Qt, and OI showed no differences among groups. Group PDYN showed lower Pplat, lower driving pressure, and higher dynamic compliance when compared with zero PEEP group. Conclusions The PEEP titrating strategy according to dynamic compliance can improve respiratory mechanics, whereas it has no significant effects on oxygenation, dead space ratio, and intrapulmonary shunt, suggesting that it is better during OLV for thoracic surgery.

The aim of this study was to analyze the effect of optimal pulmonary compliance titration of PEEP regimen on cardiac function and hemodynamics in patients undergoing laparoscopic surgery. 120 patients undergoing elective laparoscopic radical resection of colorectal cancer were included as the study subjects and randomly divided into the experimental group ( n = 60 ) and the control group ( n = 60 ). The control group had a fixed positive end-expiratory pressure PEEP = 5 cmH2O. The experimental group had transesophageal ultrasound monitoring through on an improved noise reduction algorithm (ONLM) based on nonlocal mean filtering (NLM) according to optimal pulmonary compliance titration of PEEP. There was significant difference in cerebral oxygen saturation and blood glucose level at T4-T6 between the experimental group and the control group ( P < 0.05 ); the signal-to-noise ratio (SNR), figure of merit (FOM), and structural similarity (SSIM) of ONLM algorithm were significantly higher than those of NLM algorithm and Bayes Shrink denoising algorithm, and the differences were statistically significant ( P < 0.05 ); there was significant difference in stroke volume (SV) and cardiac output (CO) at T4-T6 between the experimental group and the control group ( P < 0.05 ); there was significant difference in pH, partial pressure of carbon dioxide (PCO2), and PO2 at T4-T6 between the experimental group and the control group ( P < 0.05 ); pH was higher, and PCO2 and PO2 were lower in the experimental group. The results showed that transesophageal ultrasound based on the ONLM algorithm can accurately assess cardiac function and hemodynamics in patients undergoing laparoscopic surgery. In addition, optimal pulmonary compliance titration of PEEP could better maintain arterial acid-base balance during perioperative period and increase cerebral oxygen saturation and CO, but this strategy had no significant effect on hemodynamics.

Aims: Dexmedetomidine (Dex) as a highly selective α2-adrenoceptor agonist, was widely used anesthetic in perioperative settings, whether Dex induces cardiac hypertrophy during perioperative administration is unknown. Methods: The effects of Dex on cardiac hypertrophy were explored using the transverse aortic constriction model and neonatal rat cardiomyocytes. Results: We reported that Dex induces cardiomyocyte hypertrophy with activated ERK, AKT, PKC and inactivated AMPK in both wild-type mice and primary cultured rat cardiomyocytes. Additionally, pre-administration of Dex protects against transverse aortic constriction induced-heart failure in mice. We found that Dex up-regulates the activation of ERK, AKT, and PKC via suppression of AMPK activation in rat cardiomyocytes. However, suppression of mitochondrial coupling efficiency and membrane potential by FCCP blocks Dex induced AMPK inactivation as well as ERK, AKT, and PKC activation. All of these effects are blocked by the α2-adrenoceptor antagonist atipamezole. Conclusion: The present study demonstrates Dex preconditioning induces cardiac hypertrophy that protects against heart failure through mitochondria-AMPK pathway in perioperative settings.

Background Diaphragm dysfunction could be induced by sepsis with subsequent ventilatory pump failure that is associated with local infiltration of inflammatory factors in the diaphragm. It has been shown that the administration of anticonvulsant agent, magnesium sulfate (MgSO4) could decrease systematic inflammatory response. We recently reported that MgSO4 could inhibit macrophages high mobility group box 1 (HMGB1) secretion that confirms its anti-inflammatory properties. Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signal pathway appears to be involved in the pathology of septic experimental animal's inflammatory response and involve in the pathogenic mechanisms of sepsis-induced diaphragm dysfunction. Thus, in this study, we are aiming to explore whether MgSO4 could ameliorate sepsis-induced diaphragm dysfunction via TLR4/NF-κB pathway in a rodent model with controlled mechanical ventilation (CMV) and subsequent septic challenge. Methods Rats were randomly assigned into (1) control group: having an identical laparotomy but without ligation or puncture in the cecum; (2) CLP group: cecal ligation and puncture (CLP) with continuous saline infusion; (3) CLP + MgSO4 group: CLP with continuous MgSO4 administration; and (4) MgSO4 group: a sham surgery with MgSO4 administration. After surgery, all rats were submitted to CMV for 18 h. After completion of the study protocol, blood inflammatory cytokine/chemokine was detected by ELISA, as well as diaphragm contractility, TLR4, NF-κB (p65), phospho-NF-κB (p65) and HMGB1 protein expression. Results The level of inflammatory cytokine/chemokine includes interleukin-6, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-2 (MIP-2) and HMGB1 in blood were significantly increased at 18-h post-CLP compared with the control group. We found that rats in the CLP group had substantial diaphragm dysfunction with a distinct downshift of the force-frequency curve. Furthermore, expression of HMGB1, TLR4, NF-κB (p65) and phospho-NF-κB (p65) in diaphragm were significantly increased in the CLP group. In contrast, MgSO4 attenuated the septic inflammation reaction in diaphragm and serum and preserved diaphragm function. Conclusion MgSO4 protects against sepsis-induced diaphragm dysfunction. This may be associated with its anti-inflammatory effect on HMGB1/TLR4/NF-κB signal pathway.

BACKGROUND: The intraoperative cardiorespiratory effect of ventilation with individualised positive end-expiratory pressure guided by dynamic compliance (Cdyn) remains undefined. We investigated whether individualised protective ventilation would protect the heart and lung more efficiently than standard protective ventilation during abdominal laparoscopic surgery with Trendelenburg positioning.METHODS: Forty patients undergoing abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric PEEP) and Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured via transoesophageal echocardiography, including tricuspid annular plane systolic excursion (TAPSE), early filling-to-late filling ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) ratio. Cdyn, driving pressure (∆P), ratio of dead space to tidal volume (VD/VT), and partial pressure of arterial oxygen to inspiratory oxygen fraction (PF) ratio were measured during mechanical ventilation.RESULTS: The RVEDA/LVEDA ratio in all patients increased significantly at T2 compared with T0, but there were no significant differences in TAPSE or E/A ratio between groups during the whole procedure (P>0.05). Cdyn, ∆P, and VD/VT ratios in Group T were significantly improved compared to those in Group I at T2 (P0.05).CONCLUSIONS: Intraoperative lung-protective ventilation with Cdyn-guided PEEP improved Cdyn, ∆P, and VD/VT ratio without obvious side effects on right ventricular function compared to standard protective ventilation during laparoscopic surgery with Trendelenburg positioning, which suggests that it is a circulation-friendly way to titrate PEEP for intraoperative lung protective ventilation.TRIAL REGISTRATION: Trial registration date: 13/09/2020; Trial registration number: ChiCTR2000038212.

Plastic film mulch (PFM) is a double-edged-sword agricultural technology, which greatly improves global agricultural production but can also cause severe plastic pollution of the environment. Here, we characterized and quantified the amount of macro- and micro-plastics accumulated after 32 years of continuous plastic mulch film use in an agricultural field. An interactive field trial was established in 1987, where the effect of plastic mulching and N fertilization on maize yield was investigated. We assessed the abundance and type of macroplastics (5 mm) at 0-20 cm soil depth and microplastic (5 mm) at 0-100 cm depth. In the PFM plot, we found about 10 times more macroplastic particles in the fertilized plots than in the non-fertilized plots (6796 vs 653 pieces/m

A ternary strategy is recognized as a promising approach that enjoys both the simplicity of fabrication conditions and potential to improve performance in organic solar cells. Herein, a C-shaped narrow band gap non-fullerene acceptor GL1 with a C

BACKGROUND Fentanyl-induced cough (FIC) during general anesthesia induction and postoperative nausea and vomiting are common complications, yet the risk factors for FIC remain controversial. This retrospective study was conducted at a single center in China and aimed to investigate the risk factors for fentanyl-induced cough following general anesthesia in adults. MATERIAL AND METHODS A total of 601 adult patients undergoing elective surgery were enrolled, and the incidence of FIC during general anesthesia induction and postoperative adverse events were recorded. The risk factors for FIC during general anesthesia induction and postoperative nausea and vomiting were assessed using multivariate logistic regression analysis. RESULTS The incidence of FIC, nausea, and vomiting were 21.8%, 6.3%, and 4.5%, respectively. The results of multivariate logistic regression analysis indicated that pharyngitis history was associated with an increased risk of FIC during general anesthesia induction (odds ratio [OR]: 2.852; 95% confidence interval [CI]: 1.698-4.792; P

Objectives: To observe the expression of nicotinic acetylcholine receptor (AChR) subunits in normal orbicularis oris and gastrocnemius muscles and to explore the relationships between the e...

Previous studies reported that RNA-binding protein human antigen R (HuR) mediates changes in the stability of AChR β-subunit mRNA after skeletal muscle denervation; also, p38 pathway regulated the stability of AChR β-subunit mRNA in C2C12 myotubes. However, the relationship between HuR and p38 in regulating the stability of AChR β-subunit mRNA have not been clarified. In this study, we wanted to examine the effect of inhibiting p38 on HuR in denervated skeletal muscle. Denervation model was built and 10% DMSO or SB203580 were administered respectively follow denervation. Tibialis muscles were collected in 10% DMSO-administered contralateral (undenervated) leg, 10% DMSO-administered denervated leg, SB203580-administered contralateral (undenervated) leg, and SB203580-administered denervated leg, respectively. P38 protein, β-AChR mRNA and protein, HuR protein, β-AChR mRNA stability, and HuR binding with AChR β-subunit mRNAs were measured. Results demonstrated that the administration of SB203580 can inhibit the increase of β-AChR protein expression and mRNA expression and stability, and RNA-binding protein human antigen R (HuR) expression, in cytoplasmic and nuclear fractions in skeletal muscle cells following denervation. Importantly, we observed that SB203580 also inhibited the increased level of binding activity between HuR and AChR β-subunit mRNAs following denervation. Collectively, these results suggested that inhibition of p38 can post-transcriptionally inhibit β-AChR upregulation via HuR in denervated skeletal muscle.

BACKGROUND Cold-inducible RNA-binding protein (CIRP) has been identified as an inflammatory mediator that exerts its function in inflammatory diseases. However, the roles of CIRP in patients who received cardiovascular surgery necessitating cardiopulmonary bypass (CPB) are still unknown. The aim of this study was to examine CIRP levels and attempt to evaluate whether CIRP could serve as a predictor for lung dysfunction after cardiovascular surgery. MATERIAL AND METHODS Plasma CIRP levels were detected by ELISA in 31 patients who received cardiovascular surgery at different time points. Selective inflammatory cytokines (TNF-alpha, IL-6, IL-10, and TLR4) and mediators (Ang II, PAI-1, and soluble E-selectin) were also detected. Selective laboratory and clinical parameters were recorded at scheduled time points. RESULTS Compared with pre-operation levels, CIRP levels significantly increased 6 h after cardiovascular surgery with CPB. Multiple linear regression analysis showed that the length of CPB time contributed to CIRP production (P=0.013). Furthermore, CIRP was associated with Ang II (r=0.438, P=0.016), PAI-1 (r=0.485, P=0.006), and soluble E-selectin (r=0.470, P=0.008), which partly reflected lung injuries. Multiple linear regression analysis showed that CIRP levels were independently associated with PaO₂/FiO₂ ratios (P=0.021). CONCLUSIONS The length of CPB time contributed to the upregulation of CIRP in patients who received cardiovascular surgery with CPB. CIRP levels could serve as a biomarker to predict the onset of lung injury induced by cardiovascular surgery.

Background The hepatocellular carcinoma (HCC) represents a serious malignancy worldwide especially in China. Our transcriptome analysis identifies a novel long non‐coding RNA (lncRNA) termed HLNC1. However, the function of HLNC1 in HCC remains to be determined. Methods Novel lncRNAs were screened using lncRNA profiling. Relative expression was quantified by qRT‐PCR. In vitro experiments such as migration and viability assays were performed. In vivo implantation experiments were conducted to investigate tumorigenic functions. RNA‐RNA interaction assay was performed to determine USP49 as HLNC1 binding partner. Results We found that HLNC1 was markedly upregulated in HCC samples and cell lines. HLNC1 could promote viability and migration of HCC cells. Meanwhile, we could also observe an oncogenic effect of HLNC1 in vivo. By RNA‐RNA interaction assay, we unraveled USP49 transcript as the HLNC1 binding partner. HLNC1‐USP49 interaction dramatically destabilized USP49. Heat‐shock factor 1 (HSF1) was shown to directly induce HLNC1 expression. The therapeutic potential of targeting HLNC1 was investigated using antisense oligonucleotides (ASOs). The ASO construct which significantly depleted HLNC1 expression could strongly attenuate xenograft tumor growth. Conclusions Our data suggested that HLNC1 may advance HCC progression and act as a potential target for intervention., We identified a novel lncRNA termed HLNC1 and HLNC1 was significantly upregulated in HCC samples. The ASO construct which significantly depleted HLNC1 expression could strongly attenuate xenograft tumor growth. HLNC1 may advance HCC progression and act as a potential target for intervention.

BackgroundDiastolic dysfunction, an early manifestation and clinical symptom of heart failure with preserved ejection fraction, can be influenced by various anesthesia management strategies. Trans-esophageal echocardiography was used to undertake to assess left ventricular diastolic function during anesthesia maintenance using sevoflurane alone and sevoflurane combining with transversus abdominis plane block and rectus sheath block in elderly patients with diastolic dysfunction undergoing abdominopelvic surgery.MethodsThirty-eight patients were divided into two groups in this retrospective study, sevoflurane and sevoflurane combining with TAPB and RSB according to employing different anesthesia maintenance schemes. The parameters HR, MAP, CVP, E, A, E/A, e, a, e/a, and E/a were obtained immediately after anesthesia induction hemodynamics stability (HR1, MAP1, CVP1, E1, A1, E1/A1, e1, a1, e1/a1, and E1/a1) and 1 hour later (HR2, MAP2, CVP2, E2, A2, E2/A2, e2, a2, e2/a2, and E2/a2).ResultsTransmitral diastolic Doppler flow characteristics illustrated E/A significant decreases in the S group but increases in the ST group (p = 0.02 P = 0.005 p = 0.009 ConclusionsMaintaining anesthesia with sevoflurane combining with TAPB and RSB was more suitable for protecting cardiac diastolic function than sevoflurane alone in elderly patients with diastolic dysfunction undergoing open abdominal and pelvic surgery.

Anesthesia consciousness monitoring is an important issue in basic neuroscience and clinical applications, which has received extensive attention. In this study, in order to find the indicators for monitoring the state of clinical anesthesia, a total of 14 patients undergoing general anesthesia were collected for 5 minutes resting electroencephalogram data under three states of consciousness (awake, moderate and deep anesthesia). Sparse partial least squares (SPLS) and traditional synchronized likelihood (SL) are used to calculate brain functional connectivity, and the three conscious states before and after anesthesia were distinguished by the connection features. The results show that through the whole brain network analysis, SPLS and traditional SL method have the same trend of network parameters in different states of consciousness, and the results obtained by SPLS method are statistically significant (麻醉意识状态监测是神经科学基础研究及临床应用中的重要问题，受到广泛关注。本研究为寻找临床麻醉意识状态监测指标，共采集 14 位全麻手术患者在三种意识状态（清醒、中度麻醉、深度麻醉）下各 5 min 静息态脑电数据，对比采用稀疏偏最小二乘（SPLS）和传统的同步似然（SL）方法计算脑功能连接，通过连接特征来区分麻醉前后三种意识状态。通过全脑网络分析，本文 SPLS 方法与传统 SL 方法得到的不同意识状态下的网络参数变化趋势一致，并且采用 SPLS 方法所得结果的差异具有统计学意义（

Sepsis-induced lung injury is a clinical syndrome characterized by injury of alveolar epithelium cells (AECs). Previous investigations illustrate that exosomes secreted from adipose-derived stem cells (ADSCs) have therapeutic effects in a variety of disease treatments, but roles and mechanisms regarding ADSC-derived exosomes in sepsis-induced lung injury are unclear. In this study, high-throughput sequencing was used to explore the molecular delivery of ADSC exosomes. A sepsis-induced lung injury mouse model and a lipopolysaccharide-induced AEC damage model were used for mechanistic analysis. The results showed that ADSC exosomes have high levels of the circular RNA (circ)-Fryl. Downregulation of circ-Fryl suppressed ADSC protective effects exosomes against sepsis-induced lung injury by decreasing apoptosis and inflammatory factor expression. Bioinformatics and luciferase reporting experiments showed that miR-490-3p and SIRT3 are downstream targets of circ-Fryl. miR-490-3p overexpression or SIRT3 silencing reversed ADSC exosome protective effects. Studying the mechanism showed that overexpression of circ-Fryl promoted autophagy activation by inducing SIRT3/AMPK signaling. Autophagy activation can suppress sepsis-induced lung injury by decreasing apoptosis and inflammatory factor expression. Taken together, our results suggest that exosomes derived from ADSCs attenuate sepsis-induced lung injury by delivery of circ-Fryl and regulation of the miR-490-3p/SIRT3 pathway.

Rationale: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant. Patient concerns: A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks’ gestation due to the rapid deterioration of the mother. Diagnoses: The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria. Interventions: Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure. Outcomes: This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications. Lessons: Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.