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BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome. Although the incidence of carbon dioxide embolism (CDE) during endoscopic thyroidectomy is very low, it is potentially fatal. The clinical manifestations of CDE vary, and more attention should be paid to this disorder. CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach. The patient had no other diseases or surgical history. During the operation, he developed a CDE following inadvertent injury of the anterior jugular vein. The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide, and his remaining vital signs were stable. In addition, loud coarse systolic and diastolic murmurs were heard over the precordium. The patient was discharged on day 4 after surgery without complications. CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.

A nerve stimulation-guided lumbar plexus block is a well-established technique. It is not clear whether ultrasound guidance has additional value for this deep block technique. This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space (PMTS-ITS) approach in combination with nerve stimulation reduces the onset time of a complete sensory block. Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score (UVS) of ≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group (group U-N) or nerve stimulation group (group N) in this prospective, randomized, parallel-group, active-controlled study. The primary outcome was the onset time of a complete sensory block. The results showed that the onset time of a complete sensory block to pinprick and cold was 10 (10-40) min and 10 (10-40) min in group U-N, respectively, and 30 (10-40) min and 20 (10-40) min in group N (P=0.005, P=0.004), respectively. The performance time was 658±87 s in group U-N and 528±97 s in group N (P 0.05). In conclusion, ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS ≥10. Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system. At present, surgery is the most important treatment strategy. After esophagectomy and gastric esophagoplasty, the patients are prone to regurgitation. However, these patients currently do not receive much attention, especially from anesthesiologists. CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy. The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior. Although the patient had fasted for > 17 h, unexpected aspiration still occurred during induction of general anesthesia. Throughout the operation, oxygen saturation was 98%-100%, but the airway pressure was high (35 cmH2O at double lung ventilation). The patient was sent to the intensive care unit after surgery. Bedside chest radiography was performed, which showed exudative lesions in both lungs compared with the preoperative image. After surgery, antibiotics were given to prevent lung infection. On day 2 in the intensive care unit, the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia. CONCLUSION After esophagectomy, patients are prone to regurgitation. We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

Mercury (Hg), as a highly harmful environmental pollutant, poses severe ecological and health risks even at low concentrations. Accurate and sensitive methods for detecting Hg2+ ions in aquatic environments are highly needed. In this work, we developed a highly sensitive fluorescence sensor for Hg2+ detection with an integrated use of biosynthetic CdSe/CdS quantum dots (QDs) and liposome carrier signal amplification. To construct such a sensor, three single-stranded DNA probes were rationally designed based on the thymine-Hg2+-thymine (T-Hg2+-T) coordination chemical principles and by taking advantage of the biocompatibility and facile-modification properties of the biosynthetic QDs. Hg2+ could be determined in a range from 0.25 to 100 nM with a detection limit of 0.01 nM, which met the requirements of environmental sample detection. The sensor also exhibited a high selectivity for Hg2+ detection in the presence of other high-level metal ions. A satisfactory capacity of the sensor for detecting environmental samples including tap water, river water, and landfill leachate was also demonstrated. This work opens up a new application scenario for biosynthetic QDs and holds a great potential for environmental monitoring applications.

A nerve stimulation-guided lumbar plexus block is a well-established technique. It is not clear whether ultrasound guidance has additional value for this deep block technique. This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space (PMTS-ITS) approach in combination with nerve stimulation reduces the onset time of a complete sensory block. Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score (UVS) of ≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group (group U-N) or nerve stimulation group (group N) in this prospective, randomized, parallel-group, active-controlled study. The primary outcome was the onset time of a complete sensory block. The results showed that the onset time of a complete sensory block to pinprick and cold was 10 (10-40) min and 10 (10-40) min in group U-N, respectively, and 30 (10-40) min and 20 (10-40) min in group N (P=0.005, P=0.004), respectively. The performance time was 658±87 s in group U-N and 528±97 s in group N (P0.001). There was no (0%) patient who required 5 or more needle passes in group U-N and 6 (27.3%) in group N (P=0.028). The block failure rate was 9.1% in group U-N and 31.8% in group N (P0.05). In conclusion, ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS ≥10. Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

Highly efficient catalytic asymmetric [2,3]-sigmatropic rearrangements of propargyl ammonium salts have been accomplished under mild reaction conditions. In the presence of the chiral isothiourea catalyst, a wide range of allenyl α-amino amide derivatives were obtained in generally good yields (up to 99%) with excellent enantioselectivities (up to 96% ee).

Aim: Multi factors contribute to the development of postoperative cognitive dysfunction POCD , of which the most important mechanism is neuroinflammation. Prostaglandin E2 (PGE2) is a key neuroinflammatory molecule and could modulate hippocampal synaptic transmission and plasticity. This study was designed to investigate whether PGE2 and its\ud receptors signaling pathway were involved in the pathophysiology of POCD.\ud \ud Methods: Sixteen month old male C57BL/6J mice were exposed to laparotomy. Cognitive function was evaluated by fear conditioning test. The levels of PGE2 and its four distinct receptors (EP1 4) were assessed by biochemical analysis Pharmacological or genetic methods were further applied to investigate the role of the specific PGE2 receptors.\ud \ud Results: Here, we found that the transcription and translation level of EP3 receptor in hippocampus increased remarkably, but not EP1, EP2 or EP4. Immunofluorescence results showed EP3 positive cells in the hippocampal CA1 region were mainly neurons. Furthermore, pharmacological blocking or genetic suppression of EP3 could alleviate surgery induced hippocampu dependent memory deficit , and rescued the expression of plasticity related proteins, including cAMP response element binding protein (CREB), activity regulated cytoskeletal associated protein (Arc) and brain derived neurotrophic factor (BDNF)in hippocampus. Conclusion: This study showed that PGE2 EP3 signaling pathway was involved in the progression of POCD and identified EP3 receptor as a promising treatment target.