Comparison of two cardiac output monitors, qCO and LiDCO, during general anesthesia

Background: Optimization of cardiac output (CO) has been evidenced to reduce postoperative complications and to expedite the recovery. Likewise, CO and other dynamic cardiac parameters can describe the systemic blood flow and tissue oxygenation state and can be useful in different clinical fields. This study aimed to validate the qCO monitor (Quantium Medical, Barcelona, Spain), a new device to estimate CO and other related parameters in a continuous, fully non-invasive way using advanced digital signal processing of impedance cardiography. Methods: The LiDCOrapidv2 (LiDCO Ltd, London, UK) was used to compare the performance of the qCO in 15 patients during major surgery under general anesthesia. Full surgeries were recorded and cardiac output obtained by both devices was compared by using correlation and Bland-Altman analysis. Results: The Bland-Altman analysis showed sufficient agreement with a mean bias of -0.03 ± 0.71 L/min. Conclusions: The findings showed that both systems offered comparable values and thus the non-invasive measurement of CO with qCO is a promising, feasible method. Further investigation will be required to validate this new device against calibrated devices and outcome studies would also be highly recommended.Postprint (author's final draft

Effect of perioperative use of parecoxib on chronic post-surgical pain in elderly patients after hepatectomy: a prospective randomized controlled study

Abstract Background Chronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients. This study aimed to test the superiority of parecoxib vs. placebo in preventing chronic post-hepatectomy pain in elderly patients under combined general-epidural anesthesia. Methods A total of 105 elderly patients undergoing hepatectomy under combined general-epidural anesthesia were randomized into the parecoxib or placebo group. The primary outcome was the proportion of patients with CPSP 3 months postoperatively. The secondary outcomes included the Short-Form McGill Pain Questionnaire score in CPSP-positive responders, acute pain intensity, postoperative analgesic demand, inflammatory markers change, and postoperative complications within 28 days. Results The parecoxib group provided a non-significant absolute 9.1% reduction in the rate of CPSP compared to the placebo group (P = 0.34). The average chronic pain visual analog scale in the parecoxib group was lower than that in the placebo group (P = 0.04). Significantly less moderate-to-severe acute pain at rest (P = 0.04) and with coughing (P  0.05) and postoperative complications (P = 0.65). Conclusions Parecoxib reduced the prevalence of CPSP in elderly patients after hepatectomy under combined general-epidural anesthesia from 44.4 to 35.3% with no statistical significance. Moreover, significantly alleviated CPSP intensity and improved acute pain management were observed. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn/edit.aspx?pid=56961&htm=4 ) on August 3, 2020 ( ChiCTR-2,000,035,198 )

Retrieval of Consolidated Spatial Memory in the Water Maze Is Correlated with Expression of pCREB and Egr1 in the Hippocampus of Aged Mice

Objective: To study the relationship of the expression of phosphorylated cyclic AMP response element-binding protein (pCREB) and early growth response protein 1 (Egr1) in the hippocampus of aged mice with retrieval of consolidated spatial memory in a water maze. Methods: Twenty-four aged mice were allocated into no training or probe test (naïve), no training but exposed to the same probe test (NTPRT), received training and probe test (PRT), and received training but no probe test (NPRT) groups. Twelve mice were trained in a water maze over 14 days. After the final probe trial on day 15, all mice were anesthetized and the brains were removed. pCREB immunoreactivity (pCREB-ir) and Egr1 immunoreactivity (Egr1-ir) in the hippocampal CA1 and CA3 areas were examined. Results: pCREB-ir and Egr1-ir in the CA1 and CA3 areas of the NPRT and PRT groups were significantly higher than those of the naïve and NTPRT groups, and those in the PRT group were significantly higher than in the NPRT group. In all groups, pCREB-ir was significantly higher in the CA3 area compared to the CA1 area, while Egr1-ir was significantly higher in the CA1 area compared to the CA3 area. Conclusion: Retrieval, as well as formation, of consolidated spatial memory in the water maze is correlated with expression of pCREB and Egr1 in the hippocampus of aged mice

Laparoscopic sleeve gastrectomy under general anesthesia in severely obese patients: a single-centered retrospective study

Background This study aims to summarize and analyze the clinical characteristics and outcomes of severely obese patients who underwent laparoscopic sleeve gastrectomy (LSG) under general anesthesia with multidisciplinary collaboration. Methods A retrospective analysis was performed for 100 severely obese patients who were hospitalized in Zhongshan Hospital, Fudan University from January 2017 to December 2019, and included preoperative general information, laboratory examinations, anesthesia and outcomes. Results A total of 100 patients (46 males, 54 females) were admitted to the department of endocrinology: 100 had hepatic steatosis (100%), 43 had sleep apnea hypopnea syndrome (43%), 25 had hypertension (25%), 11 had type 2 diabetes (11%) and 8 had polycystic ovary syndrome (14% of women). The mean age and BMI were 31.52 ± 10.53 years and 43.31 ± 6.80 kg/m2, respectively. Visual laryngoscope intubation was successfully performed with routine intravenous induction in the optimum sniffing position at one time. The surgeries were successfully performed under general anesthesia, without conversion, and the operation time was 140.92 ± 31.23 min. The follow-up data for 41 patients were obtained. The postoperative BMI showed a downward trend. The BMI at 1 month and 3 months after surgery were 38.40 ± 6.77 kg/m2and 35.52 ± 7.94 kg/m2, respectively. Conclusions Multidisciplinary collaboration may contribute to better management and recovery during the perioperative period. Visual laryngoscope intubation with intravenous induction was performed successfully in the optimum sniffing position at one time

Quantitative Relationships between Pulmonary Function and Residual Neuromuscular Blockade

Background. Neuromuscular blockade is a risk factor for postoperative respiratory weakness during the immediate postoperative period. The quantitative relationships between postoperative pulmonary-function impairment and residual neuromuscular blockade are unknown. Methods. 113 patients who underwent elective laparoscopic cholecystectomy were enrolled in this study. They all had a pulmonary-function test (PFT) during the preoperative evaluation. Predictive values based on demographic data were also recorded. The train-of-four ratio (TOFR) was recorded at the same time as the PFT and at every 5 minutes in the qualified 98 patients in the postanesthesia care unit (PACU). We analyzed the degree of PFT recovery when the TOFR had recovered to different degrees. Results. There was a significant difference (P<0.05) between the preoperative baseline value and the postoperative forced vital capacity at each TOFR point, except at a TOFR value of 1.1. There was also a significant difference (P<0.05) between the preoperative baseline value and the postoperative peak expiratory flow at each TOFR point. Conclusions. Postoperative residual neuromuscular blockade was common (75.51%) after tracheal extubation, and pulmonary function could not recover to an acceptable level (85% of baseline value), even if TOFR had recovered to 0.90. Trial Registration. Chinese Clinical Trial Register is ChiCTR-OOC-15005838

High-fat diet aggravates postoperative cognitive dysfunction in aged mice

Abstract Background Silent Information Regulator 1 (Sirt1) and apoptosis play key roles in postoperative cognitive dysfunction (POCD). Consuming a high-fat diet (HFD), a prevalent type of diet in modern society, has been increasingly recognized as contributing to neurodegenerative diseases. Although Sirt1 and apoptosis are significant responders to HFD in the brain, little is known regarding the functional correlations between HFD and POCD. Methods Thirty-two aged C57BL/6 male mice were randomly divided into 2 groups: an ad libitum (AL) group (fed a regular diet) and high-fat diet (HF) group (fed a high-fat diet). After 8 weeks, the animals were divided into four sub-groups: an ad libitum control (ALC) group, ad libitum surgery (ALS) group, high-fat diet control (HFC) group, and high-fat diet surgery (HFS) group. The ALS and HFS groups were exposed to 3% sevoflurane in 33% oxygen for 3 h and were subsequently subjected to exploratory surgery to establish the POCD model. The ALC and HFC groups were treated with 33% oxygen for 3 h without surgery. After 48 h, the learning and memory abilities of mice in each group were tested using the Morris water maze (MWM). The expression levels of Sirt1, Bcl-2, Bax and caspase-3 cleaved were detected by western blot. Results The MWM and western blotting results showed that the learning and memory abilities were decreased in the HFC group compared with the ALC group. The learning and memory abilities and the expression of Sirt1 in the hippocampus in the HFS group were significantly decreased compared with the other groups. A significant decrease in Sirt1 expression was also observed in the HFC group compared with the ALS group. The level of Bcl-2 was lower in the HFS group than in the HFC and ALC groups. The expression levels of caspase-3 cleaved and Bax increased in the HFS group compared with the HFC group. Moreover, the expression of caspase-3 cleaved was higher in the HFC group than in the ALS group. Conclusion HFD can aggravate POCD in aged C57BL/6 mice, an effect that may be related to the inhibition expression of Sirt1 and the promotion of neuronal apoptosis

Comparative Study on Chemical Constituents of Medicinal and Non-Medicinal Parts of Flos Abelmoschus manihot, Based on Metabolite Profiling Coupled with Multivariate Statistical Analysis

According to Chinese Pharmacopoeia (2020 edition), Abelmoschi Corolla (AC) is the dried corolla of Flos Abelmoschus manihot (FAM). Market research has found that AC is often mixed with the non-medicinal parts in FAM, including calyx, stamen, and pistil. However, previous studies have not clarified the relationship between the medicinal and non-medicinal parts of FAM. In this study, in order to investigate whether there is any distinction between the medicinal and non-medicinal parts of FAM, the characterization of the constituents in calyx, corolla, stamen, and pistil was analyzed by UFLC-Triple TOF-MS/MS. Multivariate statistical analysis was used to classify and screen differential constituents between medicinal and non-medicinal parts of FAM, and the relative contents of differential constituents were compared based on the peak intensities. Results showed that 51 constituents in medicinal and non-medicinal parts of FAM were identified, and the fragmentation pathways to different types of constituents were preliminarily deduced by the fragmentation behavior of the identified constituents. Furthermore, multivariate statistical analysis revealed that the medicinal and non-medicinal parts of FAM differed significantly; 20 differential constituents were screened out to reveal the characteristics of metabolic differences. Among them, the relative contents of 19 differential constituents in the medicinal part were significantly higher than those in non-medicinal parts. This study could be helpful in the quality evaluation of AC as well as provide basic information for the improvement of the market standard of AC

Comparative Study on Chemical Constituents of Medicinal and Non-Medicinal Parts of Flos <i>Abelmoschus manihot</i>, Based on Metabolite Profiling Coupled with Multivariate Statistical Analysis

According to Chinese Pharmacopoeia (2020 edition), Abelmoschi Corolla (AC) is the dried corolla of Flos Abelmoschus manihot (FAM). Market research has found that AC is often mixed with the non-medicinal parts in FAM, including calyx, stamen, and pistil. However, previous studies have not clarified the relationship between the medicinal and non-medicinal parts of FAM. In this study, in order to investigate whether there is any distinction between the medicinal and non-medicinal parts of FAM, the characterization of the constituents in calyx, corolla, stamen, and pistil was analyzed by UFLC-Triple TOF-MS/MS. Multivariate statistical analysis was used to classify and screen differential constituents between medicinal and non-medicinal parts of FAM, and the relative contents of differential constituents were compared based on the peak intensities. Results showed that 51 constituents in medicinal and non-medicinal parts of FAM were identified, and the fragmentation pathways to different types of constituents were preliminarily deduced by the fragmentation behavior of the identified constituents. Furthermore, multivariate statistical analysis revealed that the medicinal and non-medicinal parts of FAM differed significantly; 20 differential constituents were screened out to reveal the characteristics of metabolic differences. Among them, the relative contents of 19 differential constituents in the medicinal part were significantly higher than those in non-medicinal parts. This study could be helpful in the quality evaluation of AC as well as provide basic information for the improvement of the market standard of AC