Endoplasmic reticulum (ER) stress plays an important role in the occurrence and development of various liver diseases. However, there are no effective prevention and treatment strategies. We aimed to ...determine the role of heat shock factor 2 binding protein (HSF2BP) in ER stress.
HSF2BP expression in mice and cultured hepatocytes was measured during ER stress induced by tunicamycin, and its importance in ER stress was evaluated in hepatocyte-specific HSF2BP transgenic (TG) and knockout (KO) mice. The effects and mechanisms of HSF2BP on ER stress were further probed in hepatic ischemia-reperfusion (I/R) injury.
HSF2BP expression was significantly upregulated during tunicamycin-induced ER stress in mice and cultured hepatocytes. Liver injury and ER stress were reduced in HSF2BP overexpressing mice after treating with tunicamycin, but were aggravated in HSF2BP knockout mice compared to the controls. In hepatic I/R injury, HSF2BP expression was significantly upregulated, and HSF2BP overexpressing mice had reduced liver injury and inflammation. These improvements were associated with ER stress inhibition. However, these results were reversed in hepatocyte-specific HSF2BP knockout mice. HSF2BP overexpression increased cytoplasmic CDC73 levels and inhibited the JNK signaling pathway. CDC73 knockdown using siRNA eliminated the protection exerted by HSF2BP overexpression in hypoxia/reoxygenation (H/R)-induced ER stress in hepatocytes.
HSF2BP is a previously uncharacterized regulatory factor in ER stress-likely acts by regulating CDC73 subcellular localization. The feasibility of HSF2BP-targeted treatment in ER stress-related liver disease deserves future research.
Intraoperative physiological monitoring generates a large quantity of time-series data that might be associated with postoperative outcomes. Using a deep learning model based on intraoperative ...time-series monitoring data to predict postoperative quality of recovery has not been previously reported.
Perioperative data from female patients having laparoscopic hysterectomy were prospectively collected. Deep learning, logistic regression, support vector machine, and random forest models were trained using different datasets and evaluated by 5-fold cross-validation. The quality of recovery on postoperative day 1 was assessed using the Quality of Recovery-15 scale. The quality of recovery was dichotomized into satisfactory if the score ≥122 and unsatisfactory if <122. Models' discrimination was estimated using the area under the receiver operating characteristics curve (AUROC). Models' calibration was visualized using the calibration plot and appraised by the Brier score. The SHapley Additive exPlanation (SHAP) approach was used to characterize different input features' contributions.
Data from 699 patients were used for modeling. When using preoperative data only, all four models exhibited poor performance (AUROC ranging from 0.65 to 0.68). The inclusion of the intraoperative intervention and/or monitoring data improved the performance of the deep leaning, logistic regression, and random forest models but not the support vector machine model. The AUROC of the deep learning model based on the intraoperative monitoring data only was 0.77 (95% CI, 0.72-0.81), which was indistinct from that based on the intraoperative intervention data only (AUROC, 0.79; 95% CI, 0.75-0.82) and from that based on the preoperative, intraoperative intervention, and monitoring data combined (AUROC, 0.81; 95% CI, 0.78-0.83). In contrast, when using the intraoperative monitoring data only, the logistic regression model had an AUROC of 0.72 (95% CI, 0.68-0.77), and the random forest model had an AUROC of 0.74 (95% CI, 0.73-0.76). The Brier score of the deep learning model based on the intraoperative monitoring data was 0.177, which was lower than that of other models.
Deep learning based on intraoperative time-series monitoring data can predict post-hysterectomy quality of recovery. The use of intraoperative monitoring data for outcome prediction warrants further investigation.
This trial (Identifier: NCT03641625 ) was registered at ClinicalTrials.gov by the principal investigator, Lingzhong Meng, on August 22, 2018.
The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled ...trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S). The duration of pain during coughing median (interquartile range) was significantly lower in Group P than in Group M or Group S 26.0 (5.8-48.0) vs. 48.0 (30.0-55.5) vs. 48.0 (36.0-58.5) h;
= 0.025. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S 5.5 (3.8-21.0) vs. 24.0 (6.0-28.0) vs. 22.0 (5.8-36.0) h;
= 0.009. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (
= 0.050) and 24 h (
= 0.009) as well as at rest at 12 h (
= 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.
Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, ...and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion.
Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children's Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO
and SstO
) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO
and SstO
were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO
and SstO
were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO
).
Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO
was significantly lower than SctO
before aortic opening and significantly higher than SctO
after aortic opening. SstO
correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO
correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO
/SstO
's correlation with PaCO
; when the measurements during SCP were excluded, SctO
positively correlated with PaCO
(r=0.65, p<0.0001), while SstO
negatively correlated with PaCO
(r=-0.53, p<0.0001).
SctO
and SstO
have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO
/SstO
's correlations with MAP and PaCO
are confounded by SCP. The outcome impact of combined SctO
/SstO
monitoring remains to be studied.
Patients undergoing intracranial cerebrovascular surgery under general anesthesia are at risk of cerebral ischemia due to the nature of the surgery and/or the underlying cerebrovascular occlusive ...disease.It is thus imperative to reliably and continuously monitor cerebral perfusion during this type of surgery to timely reverse ischemic processes.The aim of this review is to discuss the techniques currently available for monitoring cerebral ischemia during cerebrovascular surgery with a focus on the advantages and disadvantages of each technique.
Cerebral ischemia during surgery：an overview Zhou, Zhi-Bin; Meng, Lingzhong; Gelb, Adrian W ...
Journal of Biomedical Research/Journal of biomedical research,
01/2016, Letnik:
30, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Cerebral ischemia is the pathophysiological condition in which the oxygenated cerebral blood flow is less than what is needed to meet cerebral metabolic demand.It is one of the most debilitating ...complications in the perioperative period and has serious clinical sequelae.The monitoring and prevention of intraoperative cerebral ischemia are crucial because an anesthetized patient in the operating room cannot be neurologically assessed.In this paper,we provide an overview of the definition,etiology,risk factors,and prevention of cerebral ischemia during surgery.
Introduction The high metabolic rate of oxygen in the human brain accounts for its extreme susceptibility to ischemic-hypoxic conditions.Ischemic brain injury such as stroke is a potential neurologic ...complication in a variety of surgeries,including cardiac surgery,neurosurgery,and vascular surgery,particularly in patients at high risk for ischemic stroke~（2）.In addition,ischemic brain injury accounts for
Intraoperative hypotension is common during noncardiac surgery and is associated with postoperative myocardial infarction, acute kidney injury, stroke, and severe infection. The Hypotension ...Prediction Index software is an algorithm based on arterial waveform analysis that alerts clinicians of the patient's likelihood of experiencing a future hypotensive event, defined as mean arterial pressure < 65 mmHg for at least 1 min.
Two analyses included (1) a prospective, single-arm trial, with continuous blood pressure measurements from study monitors, compared to a historical comparison cohort. (2) A post hoc analysis of a subset of trial participants versus a propensity score-weighted contemporaneous comparison group, using external data from the Multicenter Perioperative Outcomes Group (MPOG). The trial included 485 subjects in 11 sites; 406 were in the final effectiveness analysis. The post hoc analysis included 457 trial participants and 15,796 comparison patients. Patients were eligible if aged 18 years or older, American Society of Anesthesiologists (ASA) physical status 3 or 4, and scheduled for moderate- to high-risk noncardiac surgery expected to last at least 3 h.
minutes of mean arterial pressure (MAP) below 65 mmHg and area under MAP < 65 mmHg.
Analysis 1: Trial subjects (n = 406) experienced a mean of 9 ± 13 min of MAP below 65 mmHg, compared with the MPOG historical control mean of 25 ± 41 min, a 65% reduction (p < 0.001). Subjects with at least one episode of hypotension (n = 293) had a mean of 12 ± 14 min of MAP below 65 mmHg compared with the MPOG historical control mean of 28 ± 43 min, a 58% reduction (p< 0.001). Analysis 2: In the post hoc inverse probability treatment weighting model, patients in the trial demonstrated a 35% reduction in minutes of hypotension compared to a contemporaneous comparison group exponentiated coefficient: - 0.35 (95%CI - 0.43, - 0.27); p < 0.001.
The use of prediction software for blood pressure management was associated with a clinically meaningful reduction in the duration of intraoperative hypotension. Further studies must investigate whether predictive algorithms to prevent hypotension can reduce adverse outcomes.
Clinical trial number: NCT03805217. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03805217 . Principal investigator: Xiaodong Bao, MD, PhD. Date of registration: January 15, 2019.
The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required ...intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.
s
The Nexfin device allows for non-invasive beat-to-beat blood pressure monitoring (BP
NXF
). Perioperative hypotension and hypertension have been shown to be associated with poor clinical outcomes. ...The goal of the present study was to assess the ability of this device to decrease the duration of significant intraoperative hypo- or hypertension compared to standard BP monitoring by cuff (BP
CUFF
). We studied25 patients (ASA I–III) undergoing either abdominal or orthopedic surgery. BP
CUFF
was monitored every 5 min from the introduction of anesthesia, while BP
NXF
was monitored continuously on the opposite arm. When systolic BP
NXF
(SBP
NXF
) decreased or increased more than 20% relative to baseline SBP
NXF
, a standard BP
CUFF
measurement was taken to compare values. In addition, the time interval between the 20% change in SBP
NXF
and the next scheduled standard SBP
CUFF
measurement was recorded for each event. The mean length of surgery was 3.0 ± 0.3 h. Patients presented with 11 ± 4 episodes of hypotension and 12 ± 4 episodes of hypertension during the surgery. If BP
CUFF
had been used, this would have resulted in 21 ± 7 min of hypotension and 20 ± 10 min of hypertension. If hemodynamic changes seen by SBP
NXF
were appropriately treated, an average of 7 ± 1 min/h of hypotension time, 7 ± 2 min/h of hypertension time and 14 ± 3 min per hour of hypo- or hypertension time may have been identified. The Nexfin BP has the potential to decrease the time of hypotension and hypertension compared to conventional intermittent BP
CUFF
monitoring. Therefore, this device has the potential to positively impact clinical outcomes.
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