To investigate whether aberrant DNA methylation of ubiquinol-cytochrome C reductase core protein 1 (UQCRC1) is related to cognitive impairment caused by neonatal sevoflurane exposure.

A total of 94 SPF C57 mice of either sex, aged 6 d, and weighing 4~6 g, were randomly divided into 7 groups: control group (Con, n=6), sevoflurane-6 and -24 h exposure groups (Sev-6 and -24 h, n=6), control+DMSO group (Con+DMSO, n=19), control+5-aza-2'-deoxycytidine (5-AZA, methylation inhibitor) group (Con+5-AZA, n=19), sevoflurane+DMSO group (Sev+DMSO group, n=19), and sevoflurane+5-AZA group (Sev+5-AZA group, n=19). From 6 to 8 d after birth, the mice of the Sev-6 and -24 h exposure groups were exposed to 3% sevoflurane daily (with 97% oxygen, 2 L/min, 2 h per day), while those from the Con groups were given exposure of 100% oxygen (2 L/min, 2 h per day). For the mice of the 5-AZA and DMSO groups, 1 mg/kg of 5-AZA or an equal volume of DMSO was injected intraperitoneally 30 min before daily exposure. In 6 and 24 h after the last exposure to sevoflurane, 6 mice from the Con, Sev-6 h, and Sev-24 h groups were euthanized for biochemical analysis, and in 24 h post-exposure, 6 mice from the Con+DMSO, Con+5-AZA, Sev+DMSO, and Sev+5-AZA groups were randomly selected for biochemical analysis, while another 3 mice from above each group were also randomly selected for morphological analysis. The remaining 10 mice in these groups underwent behavioral testing (open field test, novel object test, and Y-maze test) at 30~33 d after birth to assess cognitive function, and were euthanized in 24 h after the final behavioral test. RT-qPCR and Western blotting were used to detect the hippocampal expression of UQCRC1, DNA methyltransferases (Dnmts), and methyl CpG binding protein 2 (Mecp2) at mRNA and protein levels, respectively. Immunofluorescence assay was employed to observe the distribution and expression of UQCRC1 in the hippocampus. Bisulfite sequencing PCR (BSP) was applied to measure the methylation in the UQCRC1 promoter region.

Compared with the Con group, the mRNA and protein levels of UQCRC1 were down-regulated (P < 0.05), and the mRNA level of Dnmts was up-regulated (P < 0.05) in both the Sev-6 h and Sev-24 h exposure groups, while the methylation level in the UQCRC1 promoter region was enhanced in the Sev-24 h exposure group (P < 0.05). Additionally, the Sev+5-AZA group had obviously increased mRNA and protein levels of UQCRC1 (P < 0.05), and notable improvement in cognitive impairment (P < 0.05) when compared with the Sev+DMSO group.

Hypermethylation of UQCRC1 promoter region and thus down-regulating its mRNA and protein expression might be the main mechanism by which repeated neonatal sevoflurane exposure induces cognitive impairment later in life.

To explore the effect of intraoperative blood pressure management on the time of extubation after awakening from laparoscopic gastrointestinal tumor surgery in patients with high cardiovascular risk.

Clinical data of 198 patients who underwent laparoscopic gastrointestinal tumor surgery from July 2020 to November 2021 and met the inclusion criteria were collected from the medical record system of our hospital. According to the intraoperative blood pressure management, they were divided into routine blood pressure group（intraoperative mean arterial pressure ≥65 mmHg）and intensive blood pressure group（intraoperative mean arterial pressure ≥80 mmHg）. Their extubation time, Steward recovery score, sleep, incidence of nausea and vomiting, hoarseness, pain and other conditions were recorded. For sensitivity analysis, multiple linear regression, inverse probability of treatment weighting（IPTW）and overlap weighting were respectively used to balance the influence of confounding factors, and the differences of main observation indexes of different blood pressure levels were analyzed. Standard mean difference（SMD）was used as the evaluation index of the equilibrium between groups. Linear regression was performed after propensity matching. To judge the relationship between intraoperative blood pressure management and postoperative extubation time, P<0.05 was considered statistically significant.

The extubation time was significantly shorter in the intensive blood pressure group than the routine blood pressure group（42.56±25.88 vs 79.15±39.45 min, P<0.001）.

Intraoperative intensive blood pressure management strategy can shorten the postoperative extubation time after laparoscopic gastrointestinal tumor surgery.

To investigate the accuracy of surgical pleth index (SPI) in monitoring patients with nociceptive stimulation and its predictability for cardiovascular response to nociceptive stimulation in total intravenous anesthesia (TIVA).

A total of 102 patients (aged 18 to 65 years, ASA Ⅰ to Ⅱ, and BMI of 18.5 to 30 kg/m²) who underwent elective thyroid surgery in our hospital from February to June 2022 were enrolled in this study. Each patient was induced by intravenous anesthesia, maintained by target-controlled infusion of propofol and remifentanil, and monitored by SPI for analgesia depth. The absolute values of SPI, heart rate (HR) and mean arterical pressure (MAP) of patients 2 min before and during nociceptive stimulation and the maximum values of SPI, HR and MAP within 2 min after nociceptive stimulation were recorded. Receiver operating characteristic (ROC) curve was used to analyze the accuracy of SPI, HR and MAP in monitoring nociceptive stimulation and the predictability of SPI in cardiovascular response to nociceptive stimulation.

ROC curve analysis indicated that SPI (AUC=0.931, Cutoff value=30) was superior to HR (AUC=0.804, Cutoff value=68) and MAP (AUC=0.759, Cutoff value=80) in monitoring accuracy of tracheal intubation stimulation, ΔSPI (AUC=0.990, Cutoff value=4) was better than ΔHR (AUC=0.972, Cutoff value=3) and ΔMAP (AUC=0.854, Cutoff value=3), ΔSPI was better than SPI, ΔHR was better than HR, and ΔMAP was better than MAP, with their AUC values statistically different (P<0.05). In terms of monitoring the accuracy of skin incisions, SPI (AUC=0.925, Cutoff value=43) was superior to HR (AUC=0.587, Cutoff value=65) and MAP (AUC=0.804, Cutoff value=76), ΔSPI (AUC=0.998, Cutoff value=7) was better than ΔHR (AUC=0.833, Cutoff value=1) and ΔMAP (AUC=0.943, Cutoff value=3), ΔSPI was better than SPI, ΔHR was better than HR, and ΔMAP was better than MAP, and the above AUC differences were statistically significant (P<0.05); SPI had predictive value for the cardiovascular response stimulated by tracheal intubation (AUC=0.662, Cutoff value=17, P<0.05), but had no predictive significance for the cardiovascular response stimulated by skin incisions (P>0.05).

The absolute value and change of SPI are better than the traditional hemodynamic indexes HR and MAP in monitoring the accuracy of nociceptive stimulation, which can accurately monitor nociceptive stimulation during operation. SPI has predictive value for the cardiovascular response stimulated by intubation stimulation, and has important clinical significance for judging the appropriate timing of intubation.

To explore the relationship between spicy food intake during pregnancy and sleep quality after cesarean section (CS) in order to provide reference for early postoperative recovery.

A total of 332 clinical cases who underwent elective CS in our hospital from May 2018 to May 2019 were retrospectively analyzed. According to the frequency of spicy food consumption during pregnancy, the patients were divided into the frequency of spicy food consumption <2 days/week (group A) and frequency of ≥2 days /week (group B). Propensity score matching (PSM), logistic regression and subgroup analysis were used to analyze the effects of different frequency of spicy food consumption on severe sleep disorders after CS.

After confound adjustment by PSM, 114 patients in each group were included in the analysis. The results showed that the incidences of sleep disorders and severe sleep disorders on the night after surgery were 83.3% and 26.3% respectively, in group B, which were higher than those in group A (70.2% and 7.9%, P<0.05). The anal exhaust rate in the first 24 h after operation was 34.2% and 15.8% in group A and group B (P<0.05). Binary logistic regression analysis showed that high-frequency of spicy food intake during pregnancy (OR=3.310, 95%CI: 1.550~7.068, P=0.002) was an independent risk factor for severe sleep disorders on the night after CS. The results of subgroup analysis indicated that the incidence of severe sleep disturbance on the night after CS was higher in group B than group A for the first CS, the second CS, and the previous CS ≥2 times (22.1% vs 7.7%, P=0.139; 20.1% vs 8.0%, P=0.014; 37.5% vs 12.5%, P=0.569).

High frequency of spicy food consumption during pregnancy may be related to the sleep disorders after CS.