2020年 · 第100卷第34期

Postoperative pain is nociceptive pain that occurs immediately after surgery, and it is also the most common and urgent event in clinic. Poor postoperative analgesia can inhibit immunity, increase the incidence of cardiovascular and cerebrovascular events, prolong the hospital stay, and even further develop into chronic postoperative pain, which affects the prognosis and quality of life of patients^[1]。 With the development of surgery and anesthesia technology, more and more elderly patients are treated by surgery, and a considerable part of them are major surgery, which makes the need for postoperative analgesia in elderly patients stronger than in general patients. However, the particularity of elderly patients increases the difficulty of postoperative analgesia. Common influencing factors include: concomitant diseases and medication, age-related physiological and pharmacological changes, and difficulty in pain assessment.

Precise dose control is very important for drug-based therapy. It is well known that the regulation of blood glucose levels is a closed-loop homeostasis process. The mechanisms by which glucose stimulates insulin release from pancreatic islet beta cells include glucose absorption and metabolism, adenosine triphosphate-mediated potassium channel closure, plasma membrane depolarization, and voltage-gated calcium channel opening, leading to intracellular Ca²⁺The concentration surges while causing the rapid release of insulin from the storage vesicles. In order to accurately control the amount of insulin secreted, intervening in this process requires the use of an electrical interface that can directly program cell behavior through digital electronic input. The authors propose a cofactor-free bioelectronic interface that directly correlates radio stimulation of human cells with synthetic promoter-driven transgene expression and also with rapid secretion of constitutively expressed protein therapeutics stored in vesicles. Electrogenetic control through the L-type voltage-gated channel Ca_v1.2 and inward rectifying potassium channel K_ir2.1 Coupled ectopic expression is achieved, achieving the desired output through endogenous calcium signaling. Focusing on type 1 diabetes, the authors designed electrosensitive human beta cells (_Electrobeta cells)._ElectroBeta cells have customized bioelectronic devices inside, and radio stimulation of them can control the release of insulin in the vesicles in real time, and insulin levels can reach a peak within 10 min. Subcutaneous implantation in type 1 diabetic mice_ElectroBeta cells, an electrogenetically controlled vesicle release system that normalizes blood sugar in mice. Today, with the increasing number of patients with chronic diseases such as diabetes, precise control of drug dosage is the key to the success of drug therapy. This way of accurately controlling drug dosage through direct communication between devices and implanted cells is expected to customize individualized precision for patients. Medical care provides new exploration directions.

Understanding the health effects of heatwaves is particularly important due to the enormous burden of disease caused by heatwaves and the increased frequency and intensity of heatwaves due to climate change. Recently, researchers from the Chinese Center for Disease Control and Prevention (CDC) explored the risk of death due to the nature of heatwaves, including the season, the duration, intensity and duration of heatwaves, and the effects of changes in temperature regions.

The use of potassium chloride in substitute salt to replace part of sodium chloride in table salt may reduce the risk of hypertension. The researchers designed a ladder-wedge group randomized trial to conduct a population epidemiological study in six villages in Peru, aiming to explore the implementation and effect of salt reduction strategies by substitute salt in the population. In the families participating in the study, conventional table salt was recovered and replaced, and substitute salt containing 25% potassium chloride +75% sodium chloride was used free of charge to replace ordinary table salt. The hypotensive effect of substitute salt was evaluated by measuring 24-h urinary sodium excretion and blood pressure. A total of 2 376 Peruvian villagers participated in the study. After 4 months of intervention, analysis of intention (ITT) results showed that participants' systolic and diastolic blood pressure decreased by an average of 1.29 mmHg (95%CI: -2.17~ -0.41 mmHg) and 0.76 mmHg (95%CI: -1.39 to-0.13 mmHg). Villagers with hypertension or over 60 years old have the most obvious effect of changing salt to lower blood pressure. After excluding more than 400 hypertensive patients, those who used substitute salt had a 51% (95%) lower risk of hypertension compared with controlsCI：29%~66%）。 In 24 h urine samples, there was no evidence of change in sodium levels from baseline, with a mean difference of 0.01 g (95%CI: -0.23-0.25 g); However, at the end of the study, potassium levels were higher than baseline, with a mean difference of 0.63 g (95%CI: 0.47-0.78 g). The findings confirm the effectiveness and feasibility of the alternative salt strategy, supporting the implementation of a pragmatic, population-wide salt replacement strategy to reduce blood pressure and hypertension incidence.