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Recently, a new handheld ultrasound-based device, called Accuro, has been commercialized with a real-time automated interpretation of lumbar ultrasound images. We hypothesized that the handheld ultrasound device would improve the efficacy and safety of combined spinal-epidural anesthesia (CSEA) for cesarean delivery in obese parturients. Eighty parturients with a body mass index > 30 kg∙m−2 scheduled for elective cesarean delivery were randomly allocated equally (palpation group and ultrasound group). The primary outcome was the first insertion success rate. Secondary outcomes were the time taken to identify the needle puncture site, duration of CSEA procedure, the total time, the rate of parturients who require needle redirections, the number of skin punctures, changes in the intended interspace, and the incidence of complications. Compared to the palpation group, the first insertion success rate was significantly higher (72.5% vs. 40.0%; P = 0.003), and time taken to identify the needle puncture site was less (30 [26–36] vs. 39 [32–49] seconds; P = 0.001) in the ultrasound group. The rate of parturients who required needle redirections (40.0% vs. 72.5%; P = 0.003) and the incidence of paresthesia were both lower (7.5% vs. 45.0%; P

Imbalance of macrophage polarization plays an indispensable role in acute lung injury (ALI), which is considered as a promising target. Matrix metalloproteinase-9 (MMP-9) is expressed in the macrophage, and has a pivotal role in secreting inflammatory cytokines. We reported that saquinavir (SQV), a first-generation human immunodeficiency virus-protease inhibitor, restricted exaggerated inflammatory response. However, whether MMP-9 could regulate macrophage polarization and inhibit by SQV is still unknown. We focused on the important role of macrophage polarization in CLP (cecal ligation puncture)-mediated ALI and determined the ability of SQV to maintain M2 over M1 phenotype partially through the inhibition of MMP-9. We also performed a limited clinical study to determine if MMP-9 is a biomarker of sepsis. Lipopolysaccharide (LPS) increased MMP-9 expression and recombinant MMP-9 (rMMP-9) exacerbated LPS-mediated M1 switching. Small interfering RNA to MMP-9 inhibited LPS-mediated M1 phenotype and SQV inhibition of this switching was reversed with rMMP-9, suggesting an important role for MMP-9 in mediating LPS-induced M1 phenotype. MMP-9 messenger RNA levels in peripheral blood mononuclear cells of these 14 patients correlated with their clinical assessment. There was a significant dose-dependent decrease in mortality and ALI after CLP with SQV. SQV significantly inhibited LPS-mediated M1 phenotype and increased M2 phenotype in cultured RAW 264.7 and primary murine bone marrow-derived macrophages as well as lung macrophages from CLP-treated mice. This study supports an important role for MMP-9 in macrophage phenotypic switching and suggests that SQV-mediated inhibition of MMP-9 may be involved in suppressing ALI during systemic sepsis.

Background Sevoflurane anesthesia induces Tau phosphorylation and cognitive impairment in neonatal but not in adult mice. This study tested the hypothesis that differences in brain Tau amounts and in the activity of mitochondria–adenosine triphosphate (ATP)–Nuak1–Tau cascade between the neonatal and adult mice contribute to the age-dependent effects of sevoflurane on cognitive function. Methods 6- and 60-day-old mice of both sexes received anesthesia with 3% sevoflurane for 2 h daily for 3 days. Biochemical methods were used to measure amounts of Tau, phosphorylated Tau, Nuak1, ATP concentrations, and mitochondrial metabolism in the cerebral cortex and hippocampus. The Morris water maze test was used to evaluate cognitive function in the neonatal and adult mice. Results Under baseline conditions and compared with 60-day-old mice, 6-day-old mice had higher amounts of Tau (2.6 ± 0.4 [arbitrary units, mean ± SD] vs. 1.3 ± 0.2; P < 0.001), Tau oligomer (0.3 ± 0.1 vs. 0.1 ± 0.1; P = 0.008), and Nuak1 (0.9 ± 0.3 vs. 0.3 ± 0.1; P = 0.025) but lesser amounts of ATP (0.8 ± 0.1 vs. 1.5 ± 0.1; P < 0.001) and mitochondrial metabolism (74.8 ± 14.1 [pmol/min] vs. 169.6 ± 15.3; P < 0.001) in the cerebral cortex. Compared with baseline conditions, sevoflurane anesthesia induced Tau phosphorylation at its serine 202/threonine 205 residues (1.1 ± 0.4 vs. 0.2 ± 0.1; P < 0.001) in the 6-day-old mice but not in the 60-day-old mice (0.05 ± 0.04 vs. 0.03 ± 0.01; P = 0.186). The sevoflurane-induced Tau phosphorylation and cognitive impairment in the neonatal mice were both attenuated by the inhibition of Nuak1 and the treatment of vitamin K2. Conclusions Higher brain Tau concentrations and lower brain mitochondrial metabolism in neonatal compared with adult mice contribute to developmental stage–dependent cognitive dysfunction after sevoflurane anesthesia. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Sevoflurane, a commonly used anesthetic, may cause agitation in patients. However, the mechanism underlying this clinical observation remains largely unknown. We thus assessed the effects of sevoflurane on neuronal activation and behaviors in mice. Ten-day-old mice received 2% sevoflurane, 1% isoflurane, or 6% desflurane for 10 minutes. The behavioral activities were recorded and evaluated at one minute after the loss of righting reflex in the mice, which was about two minutes after the anesthetic administration. The neuronal activation was evaluated by c-Fos expression and calcium imaging at one minute after the anesthetic administration. Propofol, which reduces neuronal activation, was used to determine the cause-and-effect of sevoflurane. We found that sevoflurane caused an increase in neuronal activation in primary somatosensory cortex of young mice and behavioral hyperactivity in the mice at one minute after the loss of righting reflex. Desflurane did not induce behavioral hyperactivity and isoflurane only caused behavioral hyperactivity with borderline significance. Finally, propofol attenuated the sevoflurane-induced increase in neuronal activation and behavioral hyperactivity in young mice. These results demonstrate an unexpected sevoflurane-induced increase in neuronal activation and behavioral hyperactivity in young mice. These findings suggest the potential mechanisms underlying the sevoflurane-induced agitation and will promote future studies to further determine whether anesthetics can induce behavioral hyperactivity via increasing neuronal activation.

Fully utilizing solar energy for catalysis requires the integration of conversion mechanisms and therefore delicate design of catalyst structures and active species. Herein, a MOF crystal engineering method was developed to controllably synthesize a copper-ceria catalyst with well-dispersed photoactive Cu-[O]-Ce species. Using the preferential oxidation of CO as a model reaction, the catalyst showed remarkably efficient and stable photoactivated catalysis, which found practical application in feed gas treatment for fuel cell gas supply. The coexistence of photochemistry and thermochemistry effects contributes to the high efficiency. Our results demonstrate a catalyst design approach with atomic or molecular precision and a combinatorial photoactivation strategy for solar energy conversion.

Introduction: Type 2 diabetes mellitus (T2DM) is an independent risk factor of Alzheimer’s disease (AD), and populations with mild cognitive impairment (MCI) have high incidence to suffer from AD. Therefore, discerning who may be more vulnerable to MCI, among the increasing T2DM populations, is important for early intervention and eventually decreasing the prevalence rate of AD. This study was to explore whether the change of plasma β-amyloid (Aβ) could be a biomarker to distinguish MCI (T2DM-MCI) from non-MCI (T2DM-nMCI) in T2DM patients.Methods: Eight hundred fifty-two T2DM patients collected from five medical centers were assigned randomly to training and validation cohorts. Plasma Aβ, platelet glycogen synthase kinase-3β (GSK-3β), apolipoprotein E (ApoE) genotypes, and olfactory and cognitive functions were measured by ELISA, dot blot, RT-PCR, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test based on the diluted butanol, and Minimum Mental State Examination (MMSE) test, respectively, and multivariate logistic regression analyses were applied.Results: Elevation of plasma Aβ1-42/Aβ1-40 is an independent risk factor of MCI in T2DM patients. Although using Aβ1-42/Aβ1-40 alone only reached an AUC of 0.631 for MCI diagnosis, addition of the elevated Aβ1-42/Aβ1-40 to our previous model (i.e., activated platelet GSK-3β, ApoE ε4 genotype, olfactory decline, and aging) significantly increased the discriminating efficiency of T2DM-MCI from T2DM-nMCI, with an AUC of 0.846 (95% CI: 0.794–0.897) to 0.869 (95% CI: 0.822–0.916) in the training cohort and an AUC of 0.848 (95% CI: 0.815–0.882) to 0.867 (95% CI: 0.835–0.899) in the validation cohort, respectively.Conclusion: A combination of the elevated plasma Aβ1-42/Aβ1-40 with activated platelet GSK-3β, ApoE ε4 genotype, olfactory decline, and aging could efficiently diagnose MCI in T2DM patients. Further longitudinal studies may consummate the model for early prediction of AD.

Renewable and sustainable betaine-based catalysts (BX) derived from the betaine sugar industry or ChCl were developed for the production of 5-hydroxymethylfurfural (HMF) from various carbohydrates. The HMF yields in the BX-based media reached up to 88 %, 66 %, 37 % and 53 %, for the conversion of fructose, glucose, cellulose, and lignocellulosic biomass, respectively. In addition, choline-O-sulfate was synthesized and demonstrated to be an efficient catalyst for the conversion of fructose to HMF. From the perspective of green and sustainable chemistry, this work demonstrates benefits not only in the preparation of sustainable catalysts but also the green production of HMF from biomass.

Based on experiment and simulation results, we find that the spatial power spectrum pattern gray-level distortion has much influence on the CDI reconstruction, and the acquired pattern distortion rate should be less than 0.1.

Super-resolution hyperspectral imaging is a key technology for many applications, especially in the fields of remote sensing, military, agriculture, and geological exploration. Recovering a high resolution image needs enormous data, which puts forward very high requirements on image system hardware. Compressed sampling spectral imaging technology could well solve this problem and achieve high-resolution objects with low-resolution compressed data. In this paper, the method of a compressed sampling spectral imaging based on push-broom coded aperture and dispersion prism is proposed. A spectral aliasing image is formed when the object passing through the dispersive prism. According to the prism dispersion condition and the CCD pixel size, the visible spectrum can be divided into N spectral bands, and the measurement matrix of the coded aperture is respectively calibrated for the center wavelength of each spectral band. By controlling a stepper to implement the push broom of the coded aperture to change the measurement matrix, multiple spectral aliasing images can be obtained. The pixel size of the coded aperture becomes half of the CCD by a relay lens, which means the pixel of CCD is low-resolution for the coded aperture. The super-resolution hyperspectral image of the object is obtained by the improved LS reconstruction algorithm. Simulation results show that, the recovered hyperspectral image has twice resolution compared with the low-resolution CCD image, and the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) increase with the increasing compressed sampling hyperspectral images. For N=31, the average PSNR and SSIM recovered from six aliasing images is 22.019 and 0.235, respectively. The average PSNR and SSIM of the recovered 31 bands are also increasing with increasing aliasing images. While the aliasing imaging is 156, The average PSNR and SSIM exceeds 38 and 0.9. This method proves that super-resolution hyperspectral imaging can be achieved by capturing less low-resolution object images.

Recent studies revealed the emerging role of excess uptake of lipids in the development of hypothyroidism. Both dietary high-fat lard intake in rats and diet-induced obese mice displayed thyroid hypofunction (1,2). However, the underlying mechanism is largely unknown. We investigated the effect of high fat diet (HFD) on thyroid function and the role of endoplasmic reticulum (ER) in HFD induced hypothyroidism. Male Sprague Dawley rats were fed with HFD or control diet (CD) for 18 weeks. HFD rats showed increased serum TSH (n=15-16) and decreased T4 (n=15-16) compared to CD rats. Thyroid function was also evaluated by thyroid radioiodine uptake for 24 hours in vivo. Consistently, HFD decreased thyroid iodine uptake (-60%, n=5). To understand the molecular mechanism, we assessed the expression of proteins critical to thyroid production via Western blotting. Compared to CD, HFD rats showed significantly decreased thyroglobulin (Tg) (-40%, n=4), whereas TPO and NIS showed no difference. Meanwhile, luminal swelling of ER in thyroid epithelial cell of HFD rats was observed via transmission electron microscopy. Furthermore, We found PERK/eIF2a/ATF4 -- one of three traditional UPR pathways triggered under ER stress -- was activated in HFD rat thyroid glands compared to CD (n=4). In vitro, ER stress was induced in primary human thyrocytes by palmitate. Under the treatment of palmitate, Tg was degraded more rapidly than the control, indicating the activating of the ER-associated protein degradation pathway under ER stress. In addition, alleviation of ER stress by applying 4-phenyl butyric acid (4-PBA) in HFD rats or by the withdrawal of HFD improved the decrease of Tg (n=4-6) and thyroid function (n=3-6). In conclusion, we demonstrate that ER stress mediates the HFD induced hypothyroidism, probably by impairing the production of Tg, and attenuation of ER stress improves thyroid function. Reference: (1) Shao et al., Acta Pharmacol Sin 2014, 35: 1411-1420. (2) Lee et al., Endocrinology 2015, 156: 1181-1193. Conflict of interest: The authors declare they have no conflicts of interest. Sources of Research Support: National Natural Science Foundation of China (81430020, 81230018, 81600604, 81300644, and 81670720) and the Natural Science Foundation of Shandong Province (ZR2016HB07).

Background Both type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) are common age-associated disorders and T2DM patients show an increased risk to suffer from AD, however, there is currently no marker to identify who in T2DM populations will develop AD. Since glycogen synthase kinase-3β (GSK-3β) activity, ApoE genotypes and olfactory function are involved in both T2DM and AD pathogenesis, we investigate whether alterations of these factors can identify cognitive impairment in T2DM patients. Methods The cognitive ability was evaluated using Minimum Mental State Examination (MMSE) and Clinical Dementia Rating (CDR), and the mild cognitive impairment (MCI) was diagnosed by Petersen's criteria. GSK-3β activity in platelet, ApoE genotypes in leucocytes and the olfactory function were detected by Western/dot blotting, the amplification refractory mutation system (ARMS) PCR and the Connecticut Chemosensory Clinical Research Center (CCCRC) test, respectively. The odds ratio (OR) and 95% confidence intervals (95% CI) of the biomarkers for MCI diagnosis were calculated by logistic regression. The diagnostic capability of the biomarkers was evaluated by receiver operating characteristics (ROC) analyses. Findings We recruited 694 T2DM patients from Jan. 2012 to May. 2015 in 5 hospitals (Wuhan), and 646 of them met the inclusion criteria and were included in this study. 345 patients in 2 hospitals were assigned to the training set, and 301 patients in another 3 hospitals assigned to the validation set. Patients in each set were randomly divided into two groups: T2DM without MCI (termed T2DM-nMCI) or with MCI (termed T2DM-MCI). There were no significant differences for sex, T2DM years, hypertension, hyperlipidemia, coronary disease, complications, insulin treatment, HbA1c, ApoE ε2, ApoE ε3, tGSK3β and pS9GSK3β between the two groups. Compared with the T2DM-nMCI group, T2DM-MCI group showed lower MMSE score with older age, ApoE ε4 allele, higher olfactory score and higher rGSK-3β (ratio of total GSK-3β to Ser9-phosphorylated GSK-3β) in the training set and the validation set. The OR values of age, ApoE ε4 gene, olfactory score and rGSK-3β were 1.09, 2.09, 1.51, 10.08 in the training set, and 1.06, 2.67, 1.47, 7.19 in the validation set, respectively. The diagnostic accuracy of age, ApoE ε4 gene, olfactory score and rGSK-3β were 0.76, 0.72, 0.66, 0.79 in the training set, and 0.70, 0.68, 0.73, 0.79 in the validation set, respectively. These four combined biomarkers had the area under the curve (AUC) of 82% and 86%, diagnostic accuracy of 83% and 81% in the training set and the validation set, respectively. Interpretation Aging, activation of peripheral circulating GSK-3β, expression of ApoE ε4 and increase of olfactory score are diagnostic for the mild cognitive impairment in T2DM patients, and combination of these biomarkers can improve the diagnostic accuracy., Highlights • ApoE ε4 gene, platelet GSK-3β activation, olfactory dysfunction and aging are non-invasive, affordable and accessible biomarkers for diagnosing mild cognitive impairment in type 2 diabetes mellitus patients, and the combination of these non-invasive, affordable and accessible biomarkers can improve the accuracy of the diagnosis. Epidemiological studies show that type 2 diabetes mellitus is an independent risk factor of Alzheimer disease, and a large proportion of diabetic patients will develop Alzheimer disease, but no early diagnostic tool to identify them. We find that ApoE ε4 gene, platelet GSK-3β activation, olfactory dysfunction and aging are early markers for dementia in type 2 diabetes patients, and combination of these non-invasive markers can improve the diagnostic accuracy. These findings shed light on the early identification in type 2 diabetes population who will develop Alzheimer disease and thus enable early intervention to this currently incurable neurodegenerative disorder.

Based on experiment and simulation results, we find that the spatial power spectrum pattern gray-level distortion has much influence on the CDI reconstruction, and the acquired pattern distortion rate should be less than 0.1.

We report a novel variable-aperture Fourier ptychography based on 4-f optical system for reconstructing high-resolution images. Simulations and experiments are performed to demonstrate that the method is tolerant to aperture’s inaccurate positioning and shape error.

We present a multimodal deep-learning structure that automatically predicts phases of the trauma resuscitation process in real-time. The system first pre-processes the audio and video streams captured by a Kinect’s built-in microphone array and depth sensor. A multimodal deep learning structure then extracts video and audio features, which are later combined through a “slow fusion” model. The final decision is then made from the combined features through a modified softmax classification layer. The model was trained on 20 trauma resuscitation cases (>13 hours), and was tested on 5 other cases. Our results showed over 80% online detection accuracy with 0.7 F-Score, outperforming previous systems.

Metabolic disorders are classified clinically as a complex and varied group of diseases including metabolic syndrome, obesity, and diabetes mellitus. Fat toxicity, chronic inflammation, and oxidative stress, which may change cellular functions, are considered to play an essential role in the pathogenetic progress of metabolic disorders. Recent studies have found that cells secrete nanoscale vesicles containing proteins, lipids, nucleic acids, and membrane receptors, which mediate signal transduction and material transport to neighboring and distant cells. Exosomes, one type of such vesicles, are reported to participate in multiple pathological processes including tumor metastasis, atherosclerosis, chronic inflammation, and insulin resistance. Research on exosomes has focused mainly on the proteins they contain, but recently the function of exosome-associated microRNA has drawn a lot of attention. Exosome-associated microRNAs regulate the physiological function and pathological processes of metabolic disorders. They may also be useful as novel diagnostics and therapeutics given their special features of non-immunogenicity and quick extraction. In this paper, we summarize the structure, content, and functions of exosomes and the potential diagnostic and therapeutic applications of exosome-associated microRNAs in the treatment of metabolic disorders.

Spinal anesthesia, which is commonly used in cesarean deliveries, is often difficult to perform in obese parturients because of poorly palpable surface landmarks and positioning challenges. This study aimed to evaluate the benefits of ultrasound-assisted technology for performing spinal anesthesia in obese parturients.Parturients with a body mass index (BMI) ≥30 kg/m scheduled for elective cesarean delivery were randomized to undergo spinal anesthesia using the conventional landmark location technique (landmark group, n = 40) or prepuncture ultrasound examination (ultrasound group, n = 40). All participants underwent spinal anesthesia in the lateral position. The primary outcome was the first-attempt success rate. Secondary outcomes were the number of skin punctures and needle passes, procedure times, patient satisfaction, changes in the intended interspace, and incidence of complications.The ultrasound group had a significantly higher first-attempt success rate (87.5% vs 52.5%; P = .001), fewer cases requiring10 needle passes (1 vs 17; P.001), and fewer skin punctures and needle passes (P.001 for both). There was no statistically significant difference in the time taken to identify the needle insertion site between the 2 groups (202.5 vs 272.0 seconds; P = .580). Both the spinal injection time and total procedure time were significantly longer in the landmark group (P.001). Patient satisfaction scores were significantly higher in the ultrasound group (P = .001). Among patients with BMI between 30 and 34.9 kg/m, there was no statistically significant difference in the first-attempt success rate (P = .407), number of cases with10 needle passes (P = .231), spinal injection time (P = .081), or total procedure time (P = .729); however, more time was required to identify the needle insertion site in the ultrasound group (P.001). For patients with BMI between 35 and 43 kg/m, the ultrasound group had a significantly higher first-attempt success rate (P ≤ .041), fewer cases with10 needle passes (P ≤ .01), and shorter procedure times, including the time required to identify the needle insertion site (P.001).Prepuncture ultrasound examination can facilitate spinal anesthesia in the lateral position in obese parturients (35 kg/m ≤ BMI ≤ 43 kg/m) by improving the first-attempt success rate, reducing the number of needle passes and puncture attempts, shortening the total procedure time, and improving patient satisfaction.

With only one piece of the power-spectrum pattern, the single-shot coherent power-spectrum imaging can provide a clear object image for real-time applications even if the object is hidden by opaque scattering media, in which the feedback coefficient &beta, value for the reconstruction with least retrievals and fastest speed has to be pre-estimated through time-consuming iterative loops. Here we report a method for estimating the optimal &beta, value from the captured raw power-spectrum images adaptively to optimize the single-shot coherent power-spectrum imaging for practical exposure conditions. The results demonstrate that, based on exposure level analysis of the captured raw power-spectrum images even of underexposure, moderate exposure, and overexposure cases, the &beta, value could be quickly determined with a compact expression for the algorithm to achieve clear reconstruction output efficiently. The proposed method helps to push ahead of the coherent diffractive imaging devices for real-time imaging through turbid mediums in Artificial Intelligence (AI), driving assistance, and flight assistance applications.

Background: Ginkgo biloba extract EGb761 has shown the neuroprotective effects on Alzheimer's disease (AD) through the protection against the Aβ-induced neurotoxicity. However, it is not completedly clear whether EGb761 attenuates tau hyperphosphorylation, another of the most prominent mechanisms underlying the pathology of AD. Methods: we employed hyperhomocysteinemia (HHcy) to mimic AD like pathological alterations and memory deficits in rats as model, and injected EGb761 with or after HHcy injection as prevention and treatment, injected saline as control. We measured the status of oxidative damage and spatial and learning memory in rats. Then we detected the level of memory-related proteins, tau phosphorylation and the level and activity of tau kinase (GSK-3β) and phosphatase (PP2A) by Western blotting and Immunohistochemistry. Results: We found that EGb761 could significantly antagonize HHcy-induced oxidative damage, recover PP2Ac and GSK3β activities deregulated by HHcy. Furthermore, tau was hyperphosphorylated at Thr231, Ser262, Ser396, and Ser404, most common PP2Ac and GSK3β targeted sites in the hippocampus and prefrontal cortex of HHcy rats, whereas EGb761 recovered the tau phosphorylation at those sites. Behavioral tests revealed that EGb761 rescued HHcy-induced spatial reference memory deficit and upregulated the expression of synapse-associated protein PSD95 and synapsin-1. Conclusion: EGb761 might be a promising drug to treat AD through its anti-oxidative activity and decreasing tau hyperphosphorylation besides the protection against the Aβ-induced neurotoxicity.

We propose a Deep Neural Network (DNN) structure for RFID-based activity recognition. RFID data collected from several reader antennas with overlapping coverage have potential spatiotemporal relationships that can be used for object tracking. We augmented the standard fully-connected DNN structure with additional pooling layers to extract the most representative features. For model training and testing, we used RFID data from 12 tagged objects collected during 25 actual trauma resuscitations. Our results showed 76% recognition micro-accuracy for 7 resuscitation activities and 85% average micro-accuracy for 5 resuscitation phases, which is similar to existing system that, however, require the user to wear an RFID antenna.

Integration of traditional and Western medicine (ITWM) has been widely used in China for the treatment of many diseases. ITWM may be a promising alternative for the treatment of spontaneous bacterial peritonitis (SBP). A systematic review was performed to evaluate the efficacy and safety of ITWM for the treatment of SBP in liver cirrhosis. PubMed, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched electronically from inception to July 2016 to collect all randomized controlled trials (RCTs) about ITWM for the treatment of SBP in cirrhotic patients. A total of 42 RCTs were included. Rhubarb, Red Paeony Root, and Danshen Root were the three most commonly used traditional Chinese medicine (TCM) drugs; the third-generation cephalosporins were the most commonly used antibiotics. All included studies reported the effectiveness rate (ITWM group: 58.33–96.00%; control group: 32.20–93.75%); 41 studies showed a higher effectiveness rate in the ITWM group; and 38 studies found a significant difference. All included studies reported the cure rate (ITWM group: 9.00–95.00%; control group: 3.00–77.00%); 41 studies showed a higher cure rate in the ITWM group; and 10 studies found a significant difference. Four studies reported the mortality (ITWM group: 5.10–18.33%; control group: 7.69–52.78%) and showed a lower mortality in the ITWM group; and two studies found a significant difference. Six studies reported the adverse events (ITWM group: 0.00–13.33%; control group: 0.00–59.52%); five studies showed a lower rate of adverse events in the ITWM group; and four studies found a significant difference. ITWM might be effective and safe for the treatment of SBP. Further well-designed high-quality studies are needed to confirm the effectiveness and safety of ITWM for the treatment of SBP.

Laparoscopic cholecystectomy (LC) is usually performed under general anaesthesia (GA). With the advancement of surgical and anaesthetic technique, there were many LC have been successfully performed under epidural anaesthesia in recent years. Surgeons in our hospital have performed gas-free trans-umbilical single port laparoscopic cholecystectomy since 2015. However, the description of thoracic spinal epidural anesthesia (TEA) for gas-free trans-umbilical single port laparoscopic cholecystectomy has not been reported yet. The goal of anesthetic management in gas-free trans-umbilical single port laparoscopic cholecystectomy procedures includes achieving an adequate level of sensory blockade without any respiratory compromise, providing good postoperative pain relief, and mild pain at early ambulation. Epidural anaesthesia fulfils all the mentioned criteria and can contribute to quick recovery and thus has been suggested to be a suitable alternative to general anaesthesia for laparoscopic surgeries. We present a case of the successful application of the thoracic epidural anaesthesia combined with laryngeal mask for gas-free trans-umbilical single port laparoscopic cholecystectomy and postoperative pain.