Chang Feng

Purpose Various methods have been formulated to reduce pain and relieve immunosuppression in order to improve prognosis. The current study aimed to evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the postoperative analgesia and perioperative cell-mediated immunity in patients underwent laparoscopic radical gastrectomy. Patients and methods A total of 54 patients scheduled for laparoscopic radical gastrectomy were randomly evenly assigned into both groups. The participants in Group Q received US-guided QLB 3 bilaterally with ropivacaine (0.25%, 30 mL on each side) before surgery along with GA, and those in Group C received GA without any special treatment. Both groups were given patient-controlled intravenous analgesia postoperatively. The primary outcomes were the T-cell subsets and Natural killer (NK) cell level at 30 min before surgery (T0) and at 0, 12, 24, and 48 h postoperatively (T1, T2, T3, and T4) were measured. The secondary outcomes were as fellows: the visual analog scale (VAS) pain score (rest and movement) at T1, T2, T3, and T4. In addition, the opioid consumption, and the incidence of postoperative adverse reactions. Results The level of CD3 + , CD4 + T, and natural killer (NK) cells, besides the CD4 + /CD8 + ratio showed less reduction at T1, T2, T3, and T4 in Group Q (P < 0.05). The VAS pain scores (at rest and on movement) were significantly lower in Group Q at T1-T4 (P < 0.05). Opioid consumption and the incidence of adverse reactions were lower in Group Q (P < 0.05). Conclusion For patients undergoing LRG, the ultrasound-guided QLB 3 could alleviate perioperative cell-mediated immunity suppression, improve postoperative analgesia, decrease opioid consumption, and reduce the incidence of adverse reactions. Clinical trial registration number The Chinese Clinical Trial Registry (ChiCTR2000034592). Graphical abstract

Background: The combination of different anesthesia techniques or adjuvant drugs can relieve the stress response to surgery, reduce adverse reactions and improve the clinical outcome. We investigated the effects of subcostal anterior quadratus lumborum block (SQLB) with and without dexmedetomidine (DEX) on postoperative rehabilitation for laparoscopic renal surgery (LRS). Methods: We included 90 patients in this single-center study. All were scheduled for elective laparoscopic radical or partial nephrectomy under general anesthesia (GA). We randomly and evenly assigned them to three groups: Group GA (GA alone), Group QG (SQLB with 30 mL of 0.25% ropivacaine and GA), and Group DQG (SQLB with 30 mL of 0.25% ropivacaine plus 1 μg/kg DEX and GA). The primary outcomes were serum creatinine (Cr) and blood urea nitrogen (BUN) levels; the secondary outcomes included the average numeric rating scale (NRS) scores at rest and during activity within 48 h postoperatively; perioperative opioid consumption; the time to first ambulation, exhaust, and fluid intake, and postoperative adverse reactions. Results: The serum Cr and BUN levels in Group DQG decreased significantly compared with Group GA (P < 0.05). The average NRS scores in Group DQG were significantly lower than other two groups (P < 0.05). Furthermore, the indexes reduced significantly in Group QG compared with Group GA (P < 0.05). Groups DQG and QG had lower consumption of opioid compared with Group GA (P < 0.05). The recovery indicators in Groups DQG and QG were higher quality than Group GA (P < 0.05). The incidences of adverse reactions in Group DQG was significantly lower than the other groups (P < 0.05). Conclusion: SQLB with and without DEX could attenuate postoperative pain, reduce opioids requirement and side effects, as well as facilitate postoperative early rehabilitation. More interesting, SQLB with DEX could confer kidney protection. Clinical Trial Registration Number: The Chinese Clinical Trial Registry (ChiCTR2200061554).

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide. The Hippo signaling pathway has emerged as a significant suppressive pathway for hepatocellular carcinogenesis. The core components of the Hippo pathway constitute a kinase cascade, which inhibits the functional activation of YAP/TAZ. Interestingly, the overactivation of YAP/TAZ is commonly observed in hepatocellular carcinoma, although the inhibitory kinase cascade of the Hippo pathway is still functional. Recent studies have indicated that the ubiquitin‒proteasome system also plays important roles in modulating Hippo signaling activity. Our DUB (deubiquitinase) siRNA screen showed that USP1 is a critical regulator of Hippo signaling activity. Analysis of TCGA data demonstrated that USP1 expression is elevated in HCC and associated with poor survival in HCC patients. RNA sequencing analysis revealed that USP1 depletion affects Hippo signaling activity in HCC cell lines. Mechanistic assays revealed that USP1 is required for Hippo/TAZ axis activity and HCC progression. USP1 interacted with the WW domain of TAZ, which subsequently enhanced TAZ stability by suppressing K11-linked polyubiquitination of TAZ. Our study identifies a novel mechanism linking USP1 and TAZ in regulating the Hippo pathway and one possible therapeutic target for HCC.

Purpose: The aim was to investigate the time for intubation, adverse events and the comfort score of ultrasound-guided internal branch of superior laryngeal nerve block in patients with severe chronic obstructive pulmonary disorder (COPD) undergoing awake fibreoptic nasotracheal intubation. Methods: Sixty patients with COPD who needed awake fibreoptic nasotracheal intubation were randomly and evenly divided into the ultrasound-guided internal branch of the superior laryngeal nerve block group (group S) and the control group (group C). All patients received procedural sedation with dexmedetomidine and adequate topical anaesthesia of the upper respiratory tract. Then, bilateral block was performed (with 2 mL of 2% lidocaine or the same volume of saline) followed by fibreoptic nasotracheal intubation. The primary outcomes were time for intubation, adverse reactions and comfort score. The secondary outcomes were haemodynamic changes and serum norepinephrine (NE) and adrenaline (AD) concentrations immediately before intubation (T0); immediately after intubation to the laryngopharynx (T1); and immediately (T2), 5 min (T3) and 10 min (T4) after intubation between the groups. Results: Compared with group C, the time for intubation, the incidence of adverse reactions and the comfort score in group S were significantly lower (P< 0.01). Compared with T0, the mean arterial pressure (MAP), heart rate (HR), NE and AD were significantly higher at T1 - T4 in group C (P< 0.05), but were not obviously higher at T1 - T4 in group S (P> 0.05). MAP, HR, NE and AD at T1–T4 were significantly lower in group S than in group C (P< 0.05). Conclusion: Ultrasound-guided internal branch of the superior laryngeal nerve block can effectively shorten the time for intubation, reduce the incidence of adverse reactions, improve comfort score, maintain considerable haemodynamic stability and inhibit stress response in patients with severe COPD undergoing awake fibreoptic nasotracheal intubation.

Purpose: To investigate, in patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, the effects of ultrasound-guided quadratus lumborum block (UG-QLB) combined with general anaesthesia (GA) on the postoperative recovery compared with GA alone. Patients and Methods: The retrospective study enrolled 231 patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, including 119 patients who received UG-QLB combined with GA (Group QG), and 112 patients undergoing GA alone (Group GA). The primary endpoint was the postoperative 3-year recurrence-free survival (RFS). The secondary endpoints were the average visual analogue scale (VAS) scores within 48 h after surgery, the first time of postoperative ambulation, the first time of flatus, postoperative hospitalization, perioperative opioid requirement and adverse effects after surgery. Results: UG-QLB combined with GA did not affect the 3-year RFS in patients undergoing laparoscopic radical gastrectomy (HR 0.659, 95% CI 0.342– 1.269, P=0.212). However, the VAS ranking analysis implicated that it could significantly alleviate the postoperative pain in laparoscopic radical gastrectomy patients (P< 0.01). In addition, it dramatically facilitated the early recovery of postoperative ambulation and flatus, while shortening the duration of postoperative hospitalization (P< 0.01). The most important was it could remarkably reduce the opioid consumption (P< 0.01), which in the meanwhile, reduced the incidence of postoperative nausea and vomiting (PONV) (P=0.01). Conclusion: Although UG-QLB combined with GA did not improve the 3-year RFS for patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, it could provide satisfactory postoperative pain relief, reduce opioid consumption and adverse effects, which subsequently facilitates postoperative early rehabilitation.

Purpose: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery, and to provide new thoughts for improving the clinical outcomes. Methods: This was a retrospective study. Data were retrieved for 195 patients with lung adenocarcinoma undergoing elective radical lobectomy via video-assisted thoracoscopy between January 2018 and August 2019 in The Second Hospital of Shandong University, including 86 patients who received thoracic paravertebral block (TPVB) combined with general anaesthesia (group TG), and 109 patients who received general anaesthesia alone (group GA). All patients were given self-controlled intravenous analgesia pump for 48 h after surgery. The primary outcome was the recurrence-free survival 2 years postoperatively (the time between surgery and the earliest date of recurrence, metastasis or lung cancer-cause death). The secondary outcomes included the average numeric rating scale (NRS) scores within 48 h postoperatively, the first time of postoperative ambulation, duration of chest tube drainage, length of postoperative hospitalization, perioperative opioid consumption and the postoperative side effects. Results: There were no statistical differences in the recurrence-free survival 2 years postoperatively between groups (Multivariate hazard ratio 0.706, 95% CI 0.126– 3.941, P=0.691). The average NRS scores within 48 h postoperatively were significantly lower in group TG (P< 0.05). The first time of postoperative ambulation, duration of chest tube drainage, and length of postoperative hospitalization in group TG were significantly reduced (P< 0.05). Opioid consumption was significantly decreased in group TG (P< 0.01). Finally, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group TG (P< 0.05). Conclusion: TPVB for thoracoscopic lung adenocarcinoma surgery did not improve the recurrence-free survival 2 years postoperatively compared with general anaesthesia alone, but it significantly enhanced the postoperative analgesia effect, reduced opioid consumption as well as side effects, and accelerated postoperative early recovery. Clinical Trial Registration Number: The Chinese Clinical Trial Registry (ChiCTR-2100050454).

Purpose: To evaluate the effect of dezocine on the postoperative ratio of Th1/Th2 cytokines in patients undergoing laparoscopic radical gastrectomy. Patients and Methods: Sixty patients undergoing laparoscopic radical gastrectomy were randomly divided into two groups (n=30): dezocine group (Group D) and sufentanil group (Group S). They received patient-controlled intravenous analgesia (PCIA) after the operation with either dezocine 0.8 mg/kg (Group D) or sufentanil 2 μg/kg (Group S). Both groups also received ondansetron 8 mg diluted to 100 mL with saline. The primary outcome was the Th1/Th2 cytokines ratio at predetermined intervals, 30 min before the induction of general anaesthesia and 0, 12, 24 and 48 h after surgery. The secondary endpoints were patients’ pain scores, measured on a visual analogue scale (VAS) at predetermined intervals (0, 12, 24 and 48 h after surgery), and side effects at follow-up 48 h after surgery. Results: The Th1/Th2 cytokines ratio in Group D was significantly higher than Group S (P< 0.05) 12, 24 and 48 h after the operation. There were no significant differences in VAS pain scores between groups at 0, 12, 24 and 48 h after surgery (P> 0.05). Compared to Group S, the incidence of postoperative nausea, vomiting and lethargy was significantly lower in Group D (P< 0.05). Conclusion: Dezocine increases the ratio of Th1/Th2 cytokines, relieves postoperative pain and causes fewer side effects in patients undergoing laparoscopic radical gastrectomy.

Purpose: To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) preemptive analgesia on recovery in colon cancer patients undergoing open radical surgery and provide reference for its clinical application. Methods: From July 2019 to June 2020, according to the anesthesia method, 56 patients who received open radical colon surgery were divided into two groups: Group Q (n=27), which received QLB combined general anesthesia, and Group C (n=29), which received general anesthesia only. Both groups were given self-controlled intravenous analgesia pump after surgery. The primary outcome is a series of parameters representing postoperative recovery. The secondary outcome was VAS scores and opioid consumption. Results: The first time of getting up, flatus, taking semi-liquid diet and the postoperative hospital stay in Group Q were significantly reduced (P<0.01). The rest and active VAS scores were significantly lower in Group Q (P<0.01). The opioids consumption was significantly decreased in Group Q (P<0.05). Conclusion: The application of ultrasound-guided QLB preemptive analgesia in open radical colon cancer surgery can significantly enhance the postoperative analgesia effect, reduce opioid consumption, and accelerate the postoperative recovery of the patients. Clinical Trial Registration Number: The Chinese Clinical Trial Registry (ChiCTR2000034824).