To investigate the protective effect of paravertebral nerve block combined with general anesthesia on liver injury after laparoscopic hepatectomy (LH).

A randomized controlled trial was conducted on 51 patients undergoing LH in our hospital between April and August 2024. They were randomly divided into control group (n=25, general anesthesia) and paravertebral block group (n=26, paravertebral nerve block before general anesthesia induction). Beside anesthesia, they received same other medical treatment. The following indicators were compared between the 2 groups, that is, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB), and systemic-immune inflammation (SII) index within 7 d before and on the 1st and 2nd days after surgery;heart rate and mean arterial pressure (MAP) before anesthesia induction (T1), before pneumoperitoneum establishment (T2), pneumoperitoneum establishment (T3), and at the first hilar occlusion (T4); usages of intraoperative norepinephrine, sevoflurane, and analgesic drugs 24 h postoperatively; as well as operation time, extubation time, and lengths of postanesthesia care unit (PACU) stay and hospital stay.

The paravertebral block group had significantly lower ALT on the 1st day after surgery [178. 40 (126. 55, 325. 86) vs 292. 20 (197. 20, 468. 95) U/L], SII on the 2nd day after surgery [704. 13 (486. 61, 1 078. 59) vs 1 075. 09 (753. 80, 1 614. 38)], and amount of analgesic drugs in 24 h after surgery [29. 70 (27. 37, 32. 07) vs 31. 99 (28. 92, 40. 81) mg], and decreased MAP level at T3 and T4, early extubation, and shorter lengths of PACU stay and hospital stay when compared with the control group (all P<0. 05).

Paravertebral nerve block combined with general anesthesia can reduce inflammatory responses, relieve postoperative pain, stabilize hemodynamics for patients undergoing LH, and thereby alleviate postoperative liver injury in them.

To explore the occurrence of acute kidney injury (AKI) in patients with Stanford type A aortic dissection (TAAD) after surgical treatment, analyze the risk factors, and construct a prediction model.

A retrospective case-control study was conducted on 138 TAAD patients undergoing surgical treatment in our hospital from January 2016 to June 2024. After Kidney Disease Improving Global Outcomes (KDIGO) criteria was performed within 1 week after surgery, they were divided into AKI (n=95) and non-AKI (n=43) groups. Univariate and multivariate logistic regression analyses were performed to identify the perioperative risk factors. Then a nomogram model were constructed, and receiver operating characteristic (ROC) curve was plotted to analyze its predictive efficacy.

The incidence of postoperative AKI was 68.84% (95 cases) in the TAAD patients, including 51.58% (49 cases) of stage 3 AKI and 38.95% (37 cases) requiring continuous renal replacement therapy. The length of ICU stay, time to extubation, and abandonment of treatment were significantly higher in the AKI group than the non-AKI group (P<0.001). Multifactorial analysis showed that the monocyte count on postoperative day 1 (OR=3.521) and preoperative creatinine level (OR=1.019) were independent risk factors for AKI, postoperative uric acid level (OR=1.005) was correlated with AKI, and intraoperative urine volume (OR=0.739) and globulin level at 1 d postoperatively (OR=0.781) were protective factors. The area under the ROC curve of the constructed model was 0.866, with a sensitivity of 0.811 and a specificity of 0.791.

Postoperative AKI occurrence can be reduced in TAAD patients by optimizing the intraoperative urine output, modulating the postoperative inflammatory response, and strengthening nutritional support. Our prediction model for AKI risk is of significance for early clinical identification of high-risk patients in TAAD patients after surgical treatment.

To investigate the effects of methionine restriction (MR) on macrophages in lipopolysaccharide (LPS)-induced acute lung injury (ALI) and to explore the underlying mechanism.

According to the random number table method, 36 male C57BL/6J mice (6~8 weeks old, 23±2 g) were divided into 3 groups with 12 mice in each group: the sham group, the LPS group and the LPS+MR group. HE staining and pathological scoring of lung injury were performed in lung tissues. The expression of LPS-binding protein (LBP) and Toll-like receptor-4 (TLR4) was detected by RT-qPCR and Western blotting. Macrophage-colony stimulating factor (M-CSF), granulocyte-macrophage-colony stimulating factor (GM-CSF) and chemokine C-C motif ligand 3(CCL3) which are all macrophage-associated chemokines were analyzed by immunohistochemistry.

Compared with the sham group, the pathological score of lung injury in the LPS group was significantly increased (P < 0.01); The mRNA and protein expression levels of LBP and TLR4 were significantly increased; The number of positive cells of CD11b, F4/80, M-CSF, GM-CSF and CCL3 were significantly increased (P < 0.01). MR significantly improved LPS-induced ALI, and decreased the pathological score of lung injury (P < 0.01); The mRNA and protein expression levels of LBP and TLR4 were decreased; Compared with the LPS group, the number of positive cells of CD11b, F4/80, M-CSF, GM-CSF and CCL3 were reduced in the LPS+MR group (P < 0.01).

MR could attenuate LPS-induced ALI by inhibiting the expression of macrophage chemokines and preventing infiltration and activation of macrophage to lungs.

To explore and summarize our experience of perioperative anesthesia management for pregnant patients with pulmonary arterial hypertension（PAH）undergoing cesarean section.

A retrospective case-control trial was performed on 45 pregnant patients with PAH who underwent cesarean section in our hospital from February 17, 2015 to May 19, 2022. The perioperative anesthesia management were analyzed and summarized.

These 45 PAH pregnant patients who underwent cesarean section completed all related examinations before operation, and the best time for delivery was determined through multidisciplinary collaborative diagnosis and treatment. Scientific anesthesia monitoring and management were carried out during the operation, and vasoactive drugs and blood volume supplementation were applied reasonably and effectively to maintain the stable vital signs during the operation. Only 1 case died of cardiac and respiratory failure due to pulmonary hypertension crisis intraoperatively, and the remaining 44 cases（97.8%）completed cesarean section safely. Among them, 33 cases（73.3%）returned to the obstetric ward, and the other 11（24.4%）were transferred to ICU for further treatment after operation. One of them with severe PAH died after being transferred to ICU due to cardiogenic shock. The higher risk grade of PAH, the incidence of adverse outcomes and adverse effects on the fetus were higher.

On the basis of multidisciplinary collaborative diagnosis and treatment and adequate preoperative assessment and preparation, combination of scientific and effective anesthesia management and especially, focusing on the puerpera with severe PAH is an important strategy for perioperative anesthesia management of pregnant PAH patients during cesarean section.

To investigate the effect of different periods of laparoscopic radical resection for colorectal cancer on rehabilitation in patients.

A retrospective cohort study was conducted on 190 patients who accepted laparoscopic radical resection of colorectal cancer in our hospital from October 2020 to September 2021. The patients were divided into 2 groups according to the starting time of the operation: the morning（8:00~12:00）operation group（n=98）and the afternoon（14:00~18:00）operation group（n=92）. The indicators were compared between 2 groups, including the duration of operation and anesthesia, the time of extubation, the volume of intraoperative blood loss, the first time of food intake, the first anal exhaust time, the first defecation time, preoperative and postoperative immune peripheral blood cells count, postoperative immune-inflammation indexes, the incidence of complications, length of stay and costs.

The afternoon surgery group had increased patients without complications and earlier first time of food intake of patients, compared with the morning surgery group（P=0.023, P=0.012）. After the surgery, white blood cell（WBC）and neutrophil（Neu）counts in the afternoon surgery group significantly increased, while lymphocytes（Lym）significantly decreased（P<0.01）. Neutrophil to lymphocytes ratio（NLR）, platelet to lymphocytes ratio（PLR）and systemic immune inflammation index（SII）in the afternoon surgery group were significantly higher than those in the morning surgery group（P<0.001）. There was no significant difference in length of stay and cost（P>0.05）.

The patients undergoing laparoscopic radical resection for colorectal cancer in the afternoon have fewer complications, earlier first time of food intake and better short-term rehabilitation.

To observe the effects of remote ischemic preconditioning (RIPC) on hemodynamic parameters and cerebral oxygen saturation in healthy adults under acute exposure to altitude.

Twenty-four healthy male cadets (24.0±1.7 years old) were recruited from Army Medical University during March and July, 2020, and equally and randomly divided into control and RIPC groups. After the hemodynamic parameters and cerebral oxygen saturation were measured at baseline for all participants, those of the RIPC group were subjected to 7 consecutive days of upper limb ischemic preconditioning with a pneumatic sphygmomanometer, while those of the control group underwent the same procedure but without ischemic treatment. A hypobaric chamber was used to simulate the oxygen partial pressure and atmospheric pressure at an altitude of 4 000 m. The changes of mentioned indexes were observed and compared between the 2 groups, before decompression and 2 h after reaching the simulated altitude. Moreover, blood samples of the participants were collected to determine the levels of norepinephrine and endothelin-1.

There were no significant differences in the baseline values and the values before decompression between the 2 groups. At 2 h after reaching simulated altitude of 4 000 m, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and systemic vascular resistance (SVR) were all decreased in the control group; while stroke volume (SV), stroke index (SI), and SBP were declined in the RIPC group (P<0.05). Among these changes, the reduction of SVR was remarkably lower in the RIPC group (1 172.8/1 130.9 dyn·s·cm^-5, 3.6%) than the control group (1 225.8/993.0 dyn·s·cm^-5, 19.8%) (P=0.009), whereas the decrease of SV in the RIPC group (99.3/84.3 mL, 17.8%) was higher than that in the control group (82.9/78.8, 4.1%) (P=0.032). All the subjects showed elevated heart rate and reduced pulse oxygen saturation and left and right cerebral oxygen saturations, with significant differences before and after decompression in both groups (P<0.01). However, the RIPC group presented smaller reduction of left cerebral oxygen saturation than the control group [(-6.0±3.5)% vs (-8.6±2.4)%, P=0.049]. Meanwhile, the RIPC group had raised level of norepinephrine when compared with the control group (7 233±1 175 vs 5 995±1 079 pmol·L^-1, P<0.05).

Remote ischemic preconditioning can effectively maintain tissue oxygen supply by relieving the decrease of SVR caused by hypobaric hypoxia, which alleviates the cardiovascular compensatory response to hypobaric hypoxia, and thus improves the early acclimatization in human under acute altitude exposure.