Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

Background and ObjectiveThoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research.MethodsWe searched PubMed and Google Scholar databases from inception to May 2021 using the terms “thoracic surgery”, “thoracic surgery AND pain management”, “thoracic surgery AND analgesia”, “thoracic surgery AND regional anesthesia”, “thoracic surgery AND epidural”. We considered articles written in English and available to the reader.Key Content and FindingsThere is a wide variety of strategies for treating acute pain after thoracic surgery, including multimodal opioid and non-opioid systemic analgesics, regional anesthesia including TEA and paravertebral blocks (PVB), and a recent expansion in the use of novel fascial plane blocks especially for thoracoscopy. The body of literature on the effectiveness of different approaches for thoracotomy and thoracoscopy is a rapidly expanding field and area of active debate.ConclusionsThe optimal analgesic approach for thoracic surgery may depend on patient factors, surgical factors, and institutional factors. Although TEA may provide optimal analgesia after thoracotomy, PVB and emerging fascial plane blocks may offer effective alternatives. A tailored approach using multimodal systemic therapies and regional anesthesia is important, and future studies comparing techniques are necessary to further investigate the optimal approach to improve patient outcomes.     

Magnetoacoustic Wave Scattering and Dynamic Stress Concentration around the Elliptical Opening in Exponential-Gradient Piezomagnetic Materials

Based on the theory of magnetoacoustic coupled dynamics, the purpose of this paper is to evaluate the dynamic stress concentration near an elliptical opening in exponential-gradient piezomagnetic materials under the action of antiplane shear waves. By the wave function expansion, the solutions for the acoustic wave fields and magnetic fields can be obtained. Stress analysis is performed by the complex function method and the conformal mapping method, which are used to solve the boundary conditions problem, and is used to express the dynamic stress concentration coefficient (DSCC) theoretically. As cases, numerical results of DSCCs are plotted and discussed with different incident wave numbers and material parameters by numerical simulation. Compared with circular openings, elliptical openings are widely used in material processing techniques and are more difficult to solve. Numerical results show that the dynamic stress concentration coefficient at the elliptical opening is strongly dependent on various parameters, which indicates that the elliptical opening is more likely to cause crack and damage to exponential-gradient piezomagnetic materials.     

Generation of liquid metal double emulsion droplets using gravity-induced microfluidics

Several microfluidic applications are available for liquid metal droplet generation, but the surface oxidation of liquid metal has placed limitations on its application. Multiphase microfluidics makes it possible to protect the inner droplets by producing the structure of double emulsion droplets. Thus, the generation of liquid metal double emulsion droplets has been developed to prevent the surface oxidation of Galinstan. However, the generation using common methods faces considerable challenges due to the gravity effect introduced from the high density of liquid metal, making it difficult for the shell phase to wrap the inner phase. To overcome this obstacle, we introduce an innovative method – a gravity-induced microfluidic device – to creatively generate controllable liquid metal double emulsion droplets, achieved by altering the measurable inclination angle of the plane. It is found that when the inclination angle ranges from 30° to 45°, the device manages to generate liquid metal double emulsion droplets with perfect double sphere-type configuration. Additionally, the core–shell liquid metal hydrogel capsules present potential applications as multifunctional materials for controlled release systems in drug delivery and biomedical applications. By regulating pH or imposing mechanical force, the hydrogel shell can be dissolved to recover the electrical conductivity of Galinstan for applications in flexible electronics, self-healing conductors, elastomer electronic skin, and tumor therapy.

An innovative method – a gravity-induced microfluidic device – to generate liquid metal double emulsion droplets to prevent the formation of an oxide layer on the liquid metal is introduced.     

脂蛋白脂酶活化剂NO-1886抑制糖尿病兔动脉粥样硬化的形成

目的　合成化合物NO 1886 ,一种脂蛋白脂酶活化观察脂蛋白脂酶活化剂是否降低高脂 /高蔗糖饲料诱发的糖尿病新西兰兔的血浆葡萄糖并减轻其动脉粥样硬化。方法　给予高脂 /高蔗糖饲料升高新西兰兔血浆总胆固醇 ,甘油三酯和葡萄糖及降低高密度脂蛋白胆固醇而导致动脉粥样硬化。饲料中加入 1 0 %NO 1886进行治疗观察。分别在 0、4、8、12、16、2 0及 2 4wk从禁食过夜的兔耳静脉抽取血样测定葡萄糖和脂质水平。第 2 4周末 ,处死动物 ,分离主动脉 ,经苏丹Ⅳ染色固定脂质后 ,计算脂纹病变面积。结果　应用NO 1886后 ,实验动物血浆葡萄糖 ,总胆固醇和甘油三酯降低 ,高密度脂蛋白胆固醇增加。对动脉粥样硬化的发展具有抑制作用。结论　NO 1886不仅可改善脂质紊乱 ,而且可降低血浆葡萄糖 ,减轻糖尿病兔动脉粥样硬化     

大鼠肠道菌群对长梗冬青苷体外代谢的影响

摘 要 目的：探究体外孵育的大鼠肠道菌群对长梗冬青苷的代谢转化规律。方法: 将长梗冬青苷与大鼠肠道菌群在厌氧条件下共孵育,分别于0,4,8,12,24,48 h时取样,经乙酸乙酯萃取后采用HPLC法进行定性和定量分析。结果: 在与大鼠肠道菌群共孵育48 h后,90.8%的长梗冬青苷被代谢转化为M₂,M₂与铁冬青酸对照品通过HPLC分析时色谱行为一致,故确定M₂为铁冬青酸。结论:长梗冬青苷可以被体外孵育的大鼠肠道菌群代谢转化为铁冬青酸。     

Investigation of Potential Use of Soybean Protein Isolate–Chinese Bayberry Tannin Extract Cross-Linked Films in Packaging Applications

The possibility of using commercial bayberry tannin (BT) from a Chinese source as a cross-linker and functional additive to develop soybean protein isolate (SPI)-based films was explored in this study by using the solvent casting method. In particular, the impacts of BT loading on the tensile strength, microstructure, thermal stability, water resistance and antioxidant capacity were fully investigated. The results reveal that SPI incorporated with BT yielded a phenolic–protein hybrid whose relevant films exhibited an improvement in tensile strength of around two times greater compared with native SPI as a result of the formed interactions and covalent cross-links, which could be proven using FTIR spectroscopy. The introduction of BT also led to the compact microstructure of SPI–BT films and enhanced the thermal stability, while the water vapor permeability was reduced compared with the control SPI film, especially at high loading content of tannin. Additionally, the use of BT significantly promoted the antioxidant capacity of the SPI-based films according to DPPH radical scavenging assay results. On this basis, Chinese bayberry tannin is considered a promising natural cross-linker and multifunctional additive that can be dedicated to developing protein-derived films with antioxidant activity for food packaging applications.     

回顾十年来对秦汉时期辨证方法的研究

现存秦汉时期的医书有:<五十二病方>、<足臂十一脉灸经>、<阴阳十一脉灸经>、<武威汉代医简>、<内经>、<难经>、<神农本草经>、<伤寒杂病论>,这些书中体现的辨证方法,为中医学的发展奠定了坚实的基础.本文通过近十年来对秦汉时期经典著作中辨证方法的研究资料作一整理分析,认为诸多学者已经进行了有益的探索,总结、评价这一历史时期已经出现或建立的诸多种辨证方法,提出了许多可供参考的学术观点,尤其是对<伤寒论杂病论>的研究,资料更是丰富,故有必要对这一时期的医经原著中的辨证方法进行系统整理,梳理出一条较为清晰的、准确阐述这一重要时期辨证方法体系的源流、形成、发展和演变的学术发展史.     

卡托普利防治腹主动脉狭窄性高血压大鼠心肌肥厚的形态定量研究

方法选用腹主动脉狭窄的大鼠实验性心肌肥厚模型,采用光镜、电镜形态计量手段,定量观察了血管紧张素转换酶抑制剂卡托普利防治心肌肥厚的作用,并比较了倍他乐克对心肌肥厚的作用。结果卡托普利组大鼠的全心／体重比、心肌组织／间质比、心肌细胞横径及心肌细胞线粒体体密度与对照组类似（p＞0．05）,明显不同于心肌肥厚组（p＜0．05）,而倍他乐克组上述多指标与心肌肥厚组相似（p＞0．05）。本实验表明卡托普利通过保护心肌细胞及间质而使心肌组织免遭损伤因素刺激发生肥厚的作用,即对大鼠高血压性。心肌肥厚具有良好的防治作用。     

The total flavones from Semen cuscutae reverse the reduction of testosterone level and the expression of androgen receptor gene in kidney-yang deficient mice

OBJECTIVE: To discover the effect of the total flavones from Semen cuscutae (TFSC) on the kidney-yang deficiency male mouse, especially on hormone levels and the androgen receptor (AR) mRNA and protein level in the kidney and testicle. METHODS: ICR male mouse were separated into six groups, and, except for the normal group, hydrocortisone was injected intraperitoneally to make the kidney-yang deficiency. The groups were then treated with TFSC, methyltestosterone and Jinkui Shenqi Wan, except for the normal group and control group. 14 days after administering, testosterone levels in the total serum were analysed by radioimmunoassay, AR mRNA levels measured by real time RT-PCR and protein levels by immunohistochemistry. RESULTS: The control group had the lowest testosterone level, AR mRNA level and protein level, and the TFSC can reverse the reduction of testosterone level, AR mRNA level and protein level induced by the hydrocortisone. CONCLUSIONS: This is the first study to demonstrate that TFSC treatment may reverse kidney-yang deficiency symptoms by restoring the levels of testosterone and AR mRNA and protein expression in the kidney and testicle.