Tourette syndrome (TS) is a polygenic neuropsychiatric disease. Previous studies have indicated that dysregulation in the histaminergic system may play a crucial role in disease onset. In this study, we investigated the role of the histidine decarboxylase gene (HDC) in TS susceptibility in the Chinese Han population. After genotyping 241 TS nuclear families trios, we analyzed three tag HDC single nucleotide polymorphisms (rs854150, rs854151, and rs854157) in a family-based study using the transmission disequilibrium test (TDT) and haplotype relative risk (HRR). TDT showed no over-transmission in these SNPs across the HDC region (for rs854150: χ2 = 0.472, P = 0.537, OR = 1.097, 95%CI = 0.738–1.630; for rs854151: χ2 = 0.043, P = 0.889, OR = 1.145, 95%CI = 0.767–1.709; for rs854157:χ2 = 0.984, P = 0.367, OR = 1.020, 95%CI = 0.508–2.049). HRR also showed the same tendency (for rs854150: χ2 = 0.211, P = 0.646, OR = 1.088, 95%CI = 0.759–1.559; for rs854151: χ2 = 0.134, P = 0.714, OR = 0.935, 95%CI = 0.653–1.339; for rs854157:χ2 = 0.841, P = 0.359, OR = 1.206, 95%CI = 0.808–1.799). Additionally, the haplotype-based haplotype relative risk showed a negative association. Although these findings indicate an unlikely association between HDC and TS in the Chinese Han population, a potential role for HDC cannot be ruled out in TS etiology. Future research should investigate this more thoroughly using different populations and larger samples.

Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block(PVB) combined with general anesthesia(GA) and general anesthesia regarding their effects on matrix metalloproteinase-9 (MMP-9) and postoperative pain after video-assisted thoracoscopic surgery(VATS) lobectomy.Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2 2018 and Sep 28 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcome was pain scores during postoperative 48h. The secondary outcome were plasma concentrations of MMP-9, complications, and duration of postoperative hospital stay. Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n=25) or general anesthesia (n=24). Both groups were similar regarding baseline characteristics. Pain scores were lower at 4h and 24h in PVB/GA group, compared with GA group (2.53±0.83 vs 3.4±0.91; 2.2±0.94 vs 3.0±0.93, respectively, P<0.05). There were no difference at 1h and 48h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy (P<0.05). Postoperative complications and length of stay did not differ by anesthetic technique.Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

Background Hyperbilirubinemia (HB) is a serious complication in aortic arch surgery, which is associated with acute kidney injury (AKI). The association between HB and chronic kidney disease (CKD) is unknown. The aim of this study was to investigate the impact of HB associated AKI on CKD after aortic arch surgery. Methods We reviewed 284 patients who underwent aortic arch surgery from 2016 to 2020 in our hospital. AKI was defined as a 50% increase in sCr from baseline value within the first 7 postoperative days. HB was defined as total bilirubin > 51.3 μmol/L. Patients were divided into 3 groups based on AKI and HB: HB associated AKI (HB-AKI) group (AKI patients suffered HB within the first 7 postoperative days); AKI without HB group and Non-AKI group. Results Follow-up for 204 patients ranged from 3 to 12 months. Kaplan–Meier analysis showed that the 1-year cumulative incidence of CKD was highest in HB-AKI (32.6%) than AKI without HB (17.8%) and Non-AKI (7.4%, log-rank test, p < 0.001), and the incidence of CKD was higher in HB group than that in Non-HB group (26.7% vs. 13.9%, log-rank test, p = 0.015). Preoperative sCr (HR 1.010, 95% CI 1.004–1.016, p = 0.001), AKI without HB (HR 2.887, 95% CI 1.133–7.354, p = 0.026) and HB-AKI (HR 4.490, 95% CI 1.59–12.933, p = 0.005) were associated with CKD during 1-year follow-up. Conclusions Patients suffering HB associated AKI were at more increased odds of CKD than patients suffering AKI without HB after aortic arch surgery.

Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block(PVB) combined with general anesthesia(GA) and general anesthesia regarding their effects on matrix metalloproteinase-9 (MMP-9) and postoperative pain after video-assisted thoracoscopic surgery(VATS) lobectomy. Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2 2018 and Sep 28 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcome was pain scores during postoperative 48h. The secondary outcome were plasma concentrations of MMP-9, complications, and duration of postoperative hospital stay. Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n=25) or general anesthesia (n=24). Both groups were similar regarding baseline characteristics. Pain scores were lower at 4h and 24h in PVB/GA group, compared with GA group (2.53±0.83 vs 3.4±0.91; 2.2±0.94 vs 3.0±0.93, respectively, P <0.05). There were no difference at 1h and 48h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy ( P <0.05). Postoperative complications and length of stay did not differ by anesthetic technique. Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

Background: Anesthesia induction is challenging in patients with hemodynamic instability. Esketamine has hypnotic, analgesic, and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension. Therefore, it may be more suitable for patients with hypovolemic shock.Case summary: A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours. Menstruation of the patient was regular, her self-reported urine pregnancy test was positive half a month earlier, and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test. Gynecological ultrasonography demonstrated no pregnancy sac in utero, confirming ectopic pregnancy. Emergency laparoscopy for ectopic pregnancy should be performed immediately. We administered esketamine for induction. Conclusion:Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.