Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium

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

Research on hidden fire source detection in goaf of Hengyi coal mine

Coal fires cause waste of coal resources, air pollution, and threaten the safe production of coal mines, but concealed fire source detection is difficult, and a single detection method has limitations, which makes it difficult to accurately determine the location of fire source. In order to verify the detection effect of the composite detection method on the concealed fire source, according to the isotope radon detection method and magnetic detection principle, the proton magnetometer and radon meter were used to detect the hidden fire source detection area of Hengyi Coal Mine. According to the verification of subsequent anomalous area drilling, the results show that when detecting hidden fire sources, a variety of fire source detection methods can improve the accuracy and efficiency of fire source detection. The exploration and research in Hengyi Coal Mine has laid a solid foundation for the subsequent work of extinguishing coal fires, which is conducive to the safe production of coal mines

SCREENING FOR KEY GENES INVOLVED IN PROPOFOL-INDUCED NEUROTOXICITY BASED ON METABOLOMICS AND TRANSCRIPTOMICS

Objective To screen for the key genes involved in propofol-induced neurotoxicity based on metabolomics and transcriptomics. Methods HT22 cells were cultured with propofol at concentrations of 0, 25, 50, 75, and 100 mg/L for 24 h and were established as Ctrl, P25, P50, P75, and P100 groups, respectively, and CCK-9 assay was used to measure cell viability in each group. HT22 cells were collected after 24 h of treatment to extract RNA and metabolites for metabolite detection and transcriptome analysis. The extracted HT22 cell metabolites were analyzed by liquid chromatography-mass spectrometry (LC-MS), differentially expressed metabolites, and trend analysis to obtain the key metabolites. The RNA of HT22 cells was analyzed by sequence alignment and differentially expressed genes to obtain the differentially expressed genes. Weighted gene co-expression network analysis (WGCNA) and protein-protein interaction (PPI) analysis were performed for the above key metabolites and differentially expressed genes to obtain the key genes involved in propofol-induced neurotoxicity. Results The viability of HT22 cells decreased with the increase in propofol concentration (t=11.40-97.25,P<0.05). LC-MS was performed for the metabolites of HT22 cells and a total of 2 701 metabolites were identified, and 49 key metabolites were obtained through further differential ana-lysis and trend analysis. A sequence alignment analysis of the extracted HT22 cell RNA showed that the number of sequences in each group of HT22 cells could meet the requirements for data analysis, and there were 1 254 differentially expressed genes between the Ctrl group and the P25 group, 4 695 differentially expressed genes between the Ctrl group and the P50 group, 4 923 differentially expressed genes between the Ctrl group and the P75 group, and 5 031 differentially expressed genes between the Ctrl group and the P100 group. WGCNA and PPI analyses were performed for the key metabolites and the differentially expressed genes, and a total of 15 key genes were obtained, namely NTNG2, ENG, SEMA4G, JAG2, FGF11, SERPINE1, GDF15, GADD45G, F3, NGF, FGF21, PGF, EGFL7, SEMA6D, and LRFN1. Conclusion The key genes involved in propofol-induced neurotoxicity may include NTNG2, ENG, SEMA4G, JAG2, FGF11, SERPINE1, GDF15, GADD45G, F3, NGF, FGF21, PGF, EGFL7, SEMA6D, and LRFN1. These genes provide a theoretical basis for the subsequent research on the molecular mechanism of propofol-induced neurotoxicity and research directions for the development of preventive and therapeutic drugs for propofol-induced neurotoxicity

The potential anti-tumor effect of anesthetics on cancer by regulating autophagy

Autophagy is a conserved, cellular self-degradation system that is essential for maintaining intracellular homeostasis. Increasing evidence suggests that autophagy plays an important dual regulatory role in the development of many human diseases, such as cancer. Recent studies have shown that the autophagy process in tumor cells can be regulated by various stimuli from both intracellular and extracellular environments, including the effects of anesthesia. Anesthetics have been shown to not only have clinical anesthetic and sedative effects but also play important roles in the progression of tumors. The effects of different types of anesthetics on tumors differ. In this review, we summarize the basic information on autophagy, the regulatory function of autophagy in cancer, currently used autophagy-targeted tumor therapy, and the effects of different types of anesthetics on tumor progression. We focus on the molecular mechanisms by which anesthetics exert tumor-inhibiting effects by activating or inhibiting autophagy. Herein, we also explore the potential application of the anesthetic/autophagy system in clinical tumor treatment. These findings provide a theoretical basis for the use of anesthetics during the perioperative period to suppress tumor development and provide insights for autophagy-targeted cancer treatment and drug development

Endothelial Glycocalyx in Aging and Age-related Diseases

10.14336/AD.2023.0131AGING AND DISEASE14

Comparison of the Efficacy and Safety of Adamgammadex with Sugammadex for Reversal of Rocuronium-Induced Neuromuscular Block: Results of a Phase II Clinical Trial

This current phase II clinical trial was to compare the effect and safety of adamgammadex, a new cyclodextrin-based selective relaxant binding agent, with sugammadex to reverse rocuronium-induced neuromuscular block. Patients were randomised to receive adamgammadex (4 or 6 mg kg−1) or sugammadex (2 mg kg−1, as a positive control group) at the reappearance of the second twitch (T2) in response to TOF stimulation. The standard safety data were collected. The 4 mg kg−1 (n = 16) and 6 mg kg−1 (n = 20) adamgammadex- and 2 mg kg−1 (n = 20) sugammadex-induced recovery time of TOF ratio to 0.9 were 2.3, 1.6, and 1.5 min, respectively (p = 0.49). The 4 mg kg −1 adamgammadex-induced median recovery time was longer than that of 2 mg kg−1 sugammadex (p = 0.01), and there was no difference between the 6 mg kg −1 adamgammadex group and 2 mg kg−1 sugammadex group (p = 0.32). Then, the number of patients who experienced adverse events (AEs) was 6, 11, and 14 for adamgammadex at 4, 6 mg kg−1 and sugammadex at 2 mg kg−1, respectively. The treatment emergent AEs that occurred more than twice were detailed as follows: incision site pain, hypotension, emesis, fever, throat pain, blood bilirubin increase, abnormal T-wave of ECG, dizziness, incision site swelling, postoperative fever, expectoration, and nausea. For drug-related AEs, the increased urine acetone bodies and first-degree atrioventricular block were observed in two patients from sugammadex group. Then, the previously reported AEs were not observed in this study, including anaphylaxis, haemorrhage, recurarization, abnormal basic vital signs, or lengthened QRS intervals and QT intervals. Adamgammadex was found to be effective for reversal of rocuronium-induced neuromuscular block as sugammadex