Image1_Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium.TIF

BackgroundSingle atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to cardiopulmonary complications in childhood. Herein, we focused on anesthesia management for noncardiac surgery in patients with single atrium.Case presentationA 58-year-old male with a history of bilateral varicocele underwent laparotomy for high-position ligation of the spermatic vein. The patient also had a history of single atrium, atrial fibrillation, chronic heart failure, pulmonary hypertension (PH), and complete right bundle branch block (CRBBB). Given the significant complications associated with general anesthesia in patients with PH, we preferred to use low-dose epidural anesthesia for this patient. Transthoracic echocardiography was used to assess cardiac function before and during surgery and guide perioperative fluid therapy. To limit the stress response, we used a regional nerve block for reducing postoperative pain. Furthermore, we used norepinephrine to appropriately increase the systemic vascular resistance in response to the reduction of systemic vascular resistance caused by epidural anesthesia.ConclusionLow-dose epidural anesthesia can be safely used in patients with single atrium and PH. The use of perioperative transthoracic echocardiography is helpful in guiding fluid therapy and effectively assessing the cardiac structure and function of patients. Prophylactic administration of norepinephrine before epidural injection may make it easier to maintain the patient’s BP.</p

Image2_Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium.TIF

BackgroundSingle atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to cardiopulmonary complications in childhood. Herein, we focused on anesthesia management for noncardiac surgery in patients with single atrium.Case presentationA 58-year-old male with a history of bilateral varicocele underwent laparotomy for high-position ligation of the spermatic vein. The patient also had a history of single atrium, atrial fibrillation, chronic heart failure, pulmonary hypertension (PH), and complete right bundle branch block (CRBBB). Given the significant complications associated with general anesthesia in patients with PH, we preferred to use low-dose epidural anesthesia for this patient. Transthoracic echocardiography was used to assess cardiac function before and during surgery and guide perioperative fluid therapy. To limit the stress response, we used a regional nerve block for reducing postoperative pain. Furthermore, we used norepinephrine to appropriately increase the systemic vascular resistance in response to the reduction of systemic vascular resistance caused by epidural anesthesia.ConclusionLow-dose epidural anesthesia can be safely used in patients with single atrium and PH. The use of perioperative transthoracic echocardiography is helpful in guiding fluid therapy and effectively assessing the cardiac structure and function of patients. Prophylactic administration of norepinephrine before epidural injection may make it easier to maintain the patient’s BP.</p

Flowchart of this study.

The following datasets were used for the identification of potential diagnostic genes and mechanisms associated with the development of sepsis: GSE106292, GSE26051, GSE167226.</p

The WGCNA analysis of GSE106292 data set.

(A)Tree of all gene expressions based on the Difference Measure (1-TOM) cluster (B)The heat maps of correlations between modules feature genes and samples, with each cell containing correlation coefficients and P values (C)The expression calorimetry and feature vector histogram of PURPRE module (D)The expression calorimetry and feature vector histogram of Skyblue2 module.</p

The gene differential expression analysis of GSE26051 and GSE167226 data set.

(A) Whole gene expression heat map: Whole gene expression heat map of tendon tissue, with high expression in red and low expression in blue (B) The DEG Volcano map shows upregulated genes in red and down-regulated genes in blue.</p

The potential key genes of tendinopathy were screened by LASSO regression model.

In Fig 7A and 7B, the ordinate is the value of the coefficient, the lower abscissa is log(λ), and the upper abscissa is the number of non-zero coefficients in the model at this time. (A) Selection of the best parameter (number of non-zero coefficients in the model at this timet (B) LASSO coefficient spectrum of 18 differentially expressed genes selected by optimal (s timeti (C) Comparison of ROC curves between training set and validation set for gene signature.</p

Baseball figure of differential gene enrichment analysis.

The horizontal axis represents the proportion of differential genes in GO and KEGG enrichment analysis, and the vertical axis represents the enrichment category. (A)Up-regulated GO enrichment distribution of differentially expressed genes (B) Down-regulated GO enrichment distribution of differentially expressed genes (C) Up-regulated differential gene KEGG enrichment distribution (D) Down-regulated differential gene KEGG enrichment distribution.</p

The screening criteria of WGCNA.

(A)Soft Threshold (Power) represents the weight, and the vertical axis shows the scale-free topology fitting index R^2 (B) Soft Threshold (Power) represents the weight, and the vertical axis shows the average connectivity of the network (C) Distribution of node connectivity K (D) Correlation graph of K and P (K).</p

6 potential hub gene display.

6 potential hub gene display.</p

Displays the patterns of AUC and 262143 logistic regression model based on Gaussian finite mixture model.

(A)The pattern of the logistic regression model is related to the AUC score and is determined by Gaussian mixture (B) The waterfall diagrams of 6 key genes in different genes.</p