Triphyrin(2.1.1) with Tunable Skeletons and Properties Based on the Confusion Approach.

The N-confused [14]triphyrin(2.1.1) 1 was facilely synthesized and readily converted into N-confused triphyrinone(2.1.1) 2 and α-methoxy-substituted 1-OMe. Subsequent acid-promoted ring-opening of 1-OMe afforded vacatatriphyrin(2.1.1) 3. Further treatment of 3 with CuCl2·2H2O resulted in ring-closure and tetrachlorination to furnish 2H-triphyrin(2.1.0) 4. As a result of the diverse structures achieved through the confusion approach, the aromaticity, absorption, and electrochemical properties could be effectively tuned.

Adjustable Regioselectivity for the Diels-Alder Reactions of Sulfolenodipyrrins upon Molecular Engineering on H-Bonds.

The Diels-Alder reactions of sulfolenodipyrrins prove to be an efficient way to construct aromatic ring-fused dipyrrins. However, adjustable annulation is still hard to achieve. To address this, molecular engineering on the H-bond has been employed. The α-position aryl group-modified sulfolenodipyrrins have been synthesized to react with various dienophiles in Diels-Alder reactions, affording the monoannulation products with different regioselectivity in good yields (45-76%). The remaining sulfolenopyrrole in monoadducts can undergo further fusion in the presence of dienophiles and TEMPO, giving the bisadducts with a lactam subunit in an appropriate yield. According to the crystal structures and theoretical calculations, the intramolecular H-bonds between the α-substituent and the nearby pyrrole confine the conjugation pathway of the dipyrrin core. With respect to the normal NH-sulfolenopyrrole, the imino-type one features low aromaticity, from which SO2 extrusion generates more stable dipyrrin-diene, achieving regioselectivity. In addition, aromatic ring fusion results in red-shifted absorption and emission spectra, and the annulation units regulate the emission intensity. This work shows the versatility of intramolecular H-bonds in regulating the reaction through confinement of the conjugation system.

A Class of Heptaphyrins with NIR Absorption Modulated by Metal Coordination and Nucleophilic Substitution.

The intensive interest in expanded porphyrins can be attributed to their appealing photoelectric and coordination behavior. In this work, an N-confused heptaphyrin 1 was synthesized by an acid-catalyzed [3+4] condensation reaction. The introduction of an N-confused pyrrolic unit into the heptaphyrin macrocycle led to the formation of a figure-eight-like conformation with nonsymmetrical "NNNN" and "NNNC" coordination cavities employable for bimetallic coordination. As a result, chelation of 1 with Zn(II) and Cu(II) afforded mono-Zn(II) complex 2 and bis-Cu(II) complex 3, respectively, with the metal atoms exhibiting distorted square-planar geometries. In complex 3, an oxygen atom is attached to the α-C atom of N-confused pyrrole D, and thus the N and C atoms of ring D participate in coordination within the two cavities. Interestingly, treatment of 1 with Cs2CO3 in MeOH resulted in regioselective substitution of all the seven para-F atoms in the meso-C6F5 groups as well as the α-H of ring D by eight methoxy moieties. Complex 3 displays a red-shifted absorption band edge of ca. 2200 nm, compared to that of ca. 1600 nm observed for 1. This work provides an example of incorporating an N-confused pyrrole to construct expanded porphyrins with distinctive coordination behavior and tunable NIR absorption.

Pd(II) and Cu(III) Complexes of Multiply Fused Pentaphyrin Isomers with Tunable Structures and NIR Absorption.

Fused porphyrinoids have received increasing interest in light of their extended conjugation and unique coordination behavior. On the basis of our previously reported multiply fused pentaphyrin isomers 1 and 2, a novel isomer 3 has been synthesized in this work. 3 possesses a hexacyclic fused moiety with a nearly coplanar CCNN cavity involving an inverted pyrrole, which is slightly different from the CNNN ones of 1 and 2 involving an N-confused pyrrole. 1-3 possess cavities with three depronatable protons and thus they all can generate Cu(III) complexes. However, only 3Cu is stable under ambient conditions. On the other hand, 3 remains intact upon treatment with Pd(II) ions, while 1 and 2 could undergo structural rearrangement to accommodate Pd(II), affording 1Pd and 2Pd accompanied by the formation of a lactone ring and the addition of a methoxy group, respectively. Compared with the free bases, the complexes show distinct aromaticity and more intense near-infrared (NIR) absorption up to ca. 1600, 1170, and 1500 nm, respectively. The results indicate that the subtle modification of the linking modes between the pyrrolic units in the fused pentaphyrinoids is effective in modulating the coordination behavior for synthesizing complexes with tunable aromaticity and NIR absorption.

Electrocatalytic Synthesis of Urea: An In-depth Investigation from Material Modification to Mechanism Analysis.

Industrial urea synthesis production uses NH3 from the Haber-Bosch method, followed by the reaction of NH3 with CO2, which is an energy-consuming technique. More thorough evaluations of the electrocatalytic C-N coupling reaction are needed for the urea synthesis development process, catalyst design, and the underlying reaction mechanisms. However, challenges of adsorption and activation of reactant and suppression of side reactions still hinder its development, making the systematic review necessary. This review meticulously outlines the progress in electrochemical urea synthesis by utilizing different nitrogen (NO3 -, N2, NO2 -, and N2O) and carbon (CO2 and CO) sources. Additionally, it delves into advanced methods in materials design, such as doping, facet engineering, alloying, and vacancy introduction. Furthermore, the existing classes of urea synthesis catalysts are clearly defined, which include 2D nanomaterials, materials with Mott-Schottky structure, materials with artificially frustrated Lewis pairs, single-atom catalysts (SACs), and heteronuclear dual-atom catalysts (HDACs). A comprehensive analysis of the benefits, drawbacks, and latest developments in modern urea detection techniques is discussed. It is aspired that this review will serve as a valuable reference for subsequent designs of highly efficient electrocatalysts and the development of strategies to enhance the performance of electrochemical urea synthesis.

Facile preparation of highly adhesive yet ultra-strong poly (vinyl alcohol)/cellulose nanocrystals composite hydrogel enabled by multiple networks structure.

Poly (vinyl alcohol) (PVA) hydrogel showed potential applications in bioengineering and wearable sensors fields. It is still a huge challenge to prepare highly adhesive yet strong poly (vinyl alcohol) hydrogel with good biocompatibility. Herein, we prepared a highly self-adhesive and strong poly (vinyl alcohol)/tannic acid@cellulose nanocrystals (PVA/TA@CNCs) composite hydrogel using TA@CNCs as functional nanofiller via facile freezing-thawing method. Multiple networks consisting of hydrogen bonding and coordination interactions endowed the hydrogel with high mechanical strength, excellent flexibility and fracture toughness with adequate energy dissipation mechanism and relatively dense network structure. The tensile strength of PVA/TA@CNCs hydrogel reached the maximum of 463 kPa, increasing by 367 % in comparison with pure PVA hydrogel (99 kPa), demonstrating the synergistic reinforcing and toughening effect of TA@CNCs. The hydrogel exhibited extremely high adhesion not only for various dry and wet substrates such as plastic, metal, Teflon, rubber, glass, leaf, but also sweaty human skin, showing good adhesion durability. The highest adhesion strength to silicone rubber, steel plate and pigskin could reach 197 kPa, 100 kPa and 46.9 kPa, respectively. Meanwhile the hydrogel had negligible cytotoxicity to cells and showed good biocompatibility.

Recent advances in the approaches for improving the photovoltaic performance of porphyrin-based DSSCs.

Among other photovoltaic techniques including perovskite solar cells and organic solar cells, dye-sensitized solar cells (DSSCs) are considered to be a potential alternative to conventional silicon solar cells. Porphyrins are promising dyes with the properties of easy modification and superior light-harvesting capability. However, porphyrin dyes still suffer from a number of unfavorable aspects, which need to be addressed in order to improve the photovoltaic performance. This feature article briefly summarizes the recent progress in improving the Voc and Jsc of porphyrin-based DSSCs in terms of molecular engineering by modifying the porphyrin macrocycle, donor and acceptor moieties of the porphyrin dyes, coadsorption of the porphrin dyes with bulky coadsorbents like chenodeoxycholic acid (CDCA), and cosensitization of the porphyrin dyes with metal-free organic dyes. Notably, concerted companion (CC) dyes are described in detail, which have been constructed by linking a porphyrin dye subunit and a metal-free organic dye subunit with flexible alkoxy chains to achieve panchromatic absorption and concerted enhancement of Voc and Jsc. In one sentence, this article is expected to provide further insights into the development of high performance DSSCs through the design and syntheses of efficient porphyrin dyes and CC dyes in combination with device optimization to achieve simultaneously elevated Voc and Jsc, which may inspire and promote further progress in the commercialization of the DSSCs.

Cyclocarya paliurus leaves alleviate high-sucrose diet-induced obesity by improving intestinal metabolic disorders.

High-sucrose diets are common in daily life but harmful to human health. Cyclocarya paliurus leaves (CPL) are a kind of tea used to alleviate metabolic diseases and are widely used in China. However, the effects of CPL on high-sucrose-induced obesity are unknown. This study aimed to describe the changes in gut metabolism induced by a high-sucrose diet and to reveal the potential mechanisms through which CPL alleviate high-sucrose diet-induced obesity. A high-sucrose-induced obesity model was generated in C57BL/6J and KM mice. The effects of CPL on obese mice were evaluated, and changes in the gut microbiota and intestinal metabolites induced by CPL treatment were observed. Furthermore, the fecal microbiota transplantation (FMT) method was used to prove that the effects of CPL on high-sucrose induced obesity depend on the changes of gut microbiota. The results of the C57BL/6J mouse experiment revealed that high-sucrose intake induced fat deposition and altered the gut microbiota. CPL treatment decreased fat deposition and alleviated disorders of the gut microbiota. Furthermore, CPL treatment increased the utilization of amnio acids, long fatty acids and saccharides and produced more bile acids, indole derivatives and less trimethylamine (TMA). A confirmatory experiment in KM mice also revealed that CPL can alleviate obesity, ameliorate intestinal metabolic disorders, and upregulate the expression of tight junction proteins in the intestinal mucosa. These results demonstrated that CPL could prevent high sucrose-induced obesity and generate more beneficial intestinal microbial metabolites but less harmful intestinal microbial metabolites.

A Hydraulic Haptic Actuator for Simulation of Cardiac Catheters.

This article presents a haptic actuator made of silicone rubber to provide both passive and active haptic forces for catheter simulations. The haptic actuator has a torus outer shape with an ellipse-shaped inside chamber which is actuated by hydraulic pressure. Expansion of the chamber by providing positive pressure can squeeze the inside passage to resist the catheter traveling through. Further expansion can hold and push back the catheter in the axial direction to render active haptic forces. The size of the catheter passage is increased by providing negative pressure to the chamber, allowing various diameters of the actual medical catheters to be used and exchanged during the simulation. The diameter of the catheter passage can be enlarged up to 1.6 times to allow 5 to 7 Fr (1 Fr = 1/3 mm) medical catheters to pass through. Experiment results show that the proposed haptic actuator can render 0 to 2.0 N passive feedback force, and a maximum of 2.0 N active feedback force, sufficient for the cardiac catheter simulation. The haptic actuator can render the commanded force profile with 0.10 N RMS (root-mean-squares) and 10.51% L2-norm relative errors.

Myosteatosis is associated with poor survival after kidney transplantation: a large retrospective cohort validation.

PURPOSE: We aim to establish diagnostic thresholds of sarcopenia and myosteatosis based on CT measurements, and to validate their prognostic value in a large cohort of kidney transplant recipients. METHODS: Local healthy population with abdominal CT between 2010 and 2022, and patients underwent kidney transplantation between 2015 and 2019 at our center were retrospectively included. The skeletal muscle index and muscle attenuation of abdominal muscles were calculated based on CT image at the middle of the third lumbar vertebra. Primary endpoints included all-cause mortality and death censored allograft survival. RESULTS: Age- and sex-specific thresholds for sarcopenia and myosteatosis were established based on 1598 healthy local population. The final patient cohort consisted of 992 kidney transplant recipients (median age 34 years, interquartile range 28-44 years; 694 males), including 33 (3.3%) with sarcopenia and 95 (9.5%) with myosteatosis. Multivariate analysis revealed myosteatosis (adjusted hazard ratio = 3.08, p = 0.022) was an independent baseline risk factor of mortality after adjusting for age, the history of cancer, and the history of cardiovascular event. Multivariate analysis found preemptive transplantation (adjusted hazard ratio = 0.36, p = 0.037) was an independent protective factor of allograft loss. No difference was found in the prognosis between kidney transplant recipients with and without sarcopenia. CONCLUSION: Myosteatosis was an independent risk factor of mortality after kidney transplantation, but sarcopenia was not. Neither sarcopenia nor myosteatosis was associated with graft loss.

Mono- and bis-Pd(ii) complexes of N-confused dithiahexaphyrin(1.1.1.1.1.0) with the absorption and aromaticity modulated by Pd(ii) coordination, macrocycle contraction and ancillary ligands.

To further enrich the coordination chemistry of hexaphyrins and probe the underlying property-structural correlations, N-confused dithiahexaphyrin(1.1.1.1.1.0) (1) with 26 π-electron Hückel aromaticity was synthesized. Based on its unprecedented two unsymmetrical cavities, five palladium complexes 2, 3, 4-Ph, 4-Cl and 5 have been successfully synthesized under various coordinations. Thus, two mono-Pd(ii) complexes 2 and 3 with the Pd(ii) atom coordinated in the two different cavities were obtained by treating 1 with palladium reagents PdCl2, and (PPh3)2PdCl2 respectively. On this basis, bis-Pd(ii) complexes 4-Ph and 4-Cl were synthesized by treating 2 and 3 with (PPh3)2PdCl2 and PdCl2, respectively. As a result, both 4-Ph and 4-Cl contain two Pd(ii) atoms coordinated within the two cavities, with one of the Pd(ii) atoms further coordinated to a triphenylphosphine ligand in addition to an anionic ancillary ligand of Ph- and Cl-, respectively. Notably, a further contracted mono-Pd(ii) complex 5 was synthesized by treating 1 with Pd(PPh3)4 by eliminating one of the meso-carbon atoms together with the corresponding C6F5 moiety. These complexes present tunable 26 π aromaticity and NIR absorption up to 1060 nm. This work provides an effective approach for developing distinctive porphyrinoid Pd(ii) complexes from a single porphyrinoid, without resorting to tedious syntheses of a series of porphyrinoid ligands.

Syntheses of Thiophene-Thiophene-Linked Corrorin Dimers with Tunable Near-Infrared Absorption and Distinctive Reactivity.

Thiahexaphyrinone 1 and thia-dipyrrin-appended corrorin 2 have been synthesized. Surprisingly, further oxidation of compound 2 with 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) in dichloromethane afforded dimer 3 with two molecules of compound 2 linked at the α-carbon atoms of the thienyl units. Treatment of compound 3 with DDQ in MeOH and SnCl2 in tetrahydrofuran/H2O afforded the dimethoxy-attached dimer 4 and hydrogenated dihydroxy-attached dimer 5, respectively. These results provide the first examples for synthesizing thiophene-linked porphyrinoid dimers with tunable near-infrared absorption and chirality.

Schizophrenia in the genetic era: a review from development history, clinical features and genomic research approaches to insights of susceptibility genes.

Schizophrenia is a devastating neuropsychiatric disorder affecting 1% of the world population and ranks as one of the disorders providing the most severe burden for society. Schizophrenia etiology remains obscure involving multi-risk factors, such as genetic, environmental, nutritional, and developmental factors. Complex interactions of genetic and environmental factors have been implicated in the etiology of schizophrenia. This review provides an overview of the historical origins, pathophysiological mechanisms, diagnosis, clinical symptoms and corresponding treatment of schizophrenia. In addition, as schizophrenia is a polygenic, genetic disorder caused by the combined action of multiple micro-effective genes, we further detail several approaches, such as candidate gene association study (CGAS) and genome-wide association study (GWAS), which are commonly used in schizophrenia genomics studies. A number of GWASs about schizophrenia have been performed with the hope to identify novel, consistent and influential risk genetic factors. Finally, some schizophrenia susceptibility genes have been identified and reported in recent years and their biological functions are also listed. This review may serve as a summary of past research on schizophrenia genomics and susceptibility genes (NRG1, DISC1, RELN, BDNF, MSI2), which may point the way to future schizophrenia genetics research. In addition, depending on the above discovery of susceptibility genes and their exact function, the development and application of antipsychotic drugs will be promoted in the future.

Safinamide alleviates hyperalgesia via inhibiting hyperexcitability of DRG neurons in a mouse model of Parkinson's disease.

Pain is a widespread non-motor symptom that presents significant treatment challenges in patients with Parkinson's disease (PD). Safinamide, a new drug recently introduced for PD treatment, has demonstrated analgesic effects on pain in PD patients, though the underlying mechanisms remain unclear. To investigate the analgesic and anti-PD effect of safinamide, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD mouse model was used, and rasagiline as positive control on motor symptoms. Notably, only safinamide alleviated hyperalgesia in MPTP mice. Whole-cell patch-clamp recordings of dorsal root ganglion (DRG) neurons revealed hyperexcitability in MPTP mice, which safinamide counteracted in a concentration-dependent manner. The voltage clamp further demonstrated that sodium current in DRG neurons of MPTP mice was enhanced and safinamide reduced sodium current density. RT-qPCR identified upregulated Nav1.7 and Nav1.8 transcripts (Scn9a and Scn10a) in DRG neurons of MPTP mice. Our results suggest that safinamide could relieve hyperalgesia by inhibiting DRG neuron hyperexcitability in MPTP mice.

Aromatic Ring-Fused Dipyrrins: Programmed [4 + 2]-Cycloaddition Pathway with Regio-selectivity upon Alkylamino-Substitution.

Sulfolenodipyrrins are employed as building blocks to concisely and efficiently construct aromatic rings (e.g., naphthoquinone, anthraquinone, fullerenes, and phthalimide) from fused dipyrrins by programmed [4 + 2]-cycloaddition reactions. Notably, alkylamino-substitution at the α-position not only enhances the reactivity of sulfolenodipyrrins but also results in the regio-selectivity of the cycloaddition reactions. Theoretical calculations in terms of frontier orbitals of dienes, energy of dienes, steric hindrance, and aromaticity have been conducted to understand the reason in depth. Additionally, the fusion of aromatic groups enables bathochromic absorption with up to ∼130 nm for the monoadducts and to ∼200 nm for the bis-adducts. The phthalimide annulation dipyrrin displays red emission, while the other mono- or bis-adducts do not, owing to the presence of typical acceptors such as quinone analogs or fullerene.

Construction of Zr-Metal-Organic Frameworks-Based Composite Materials toward Anhydrous Proton Conduction and Photocatalytic CO2 Reduction.

Metal-organic frameworks constructed from Zr usually possess excellent chemical and physical stability. Therefore, they have become attractive platforms in various fields. In this work, two families of hybrid materials based on ZrSQU have been designed and synthesized, named Im@ZrSQU and Cu@ZrSQU, respectively. Im@ZrSQU was prepared through the impregnation method and employed for proton conduction. Im@ZrSQU exhibited terrific proton conduction performance in an anhydrous environment, with the highest proton conduction value of 3.6 × 10-2 S cm-1 at 110 °C. In addition, Cu@ZrSQU was synthesized via the photoinduction method for the photoreduction of CO2, which successfully promoted the conversion of CO2 into CO and achieved the CO generation rate of up to 12.4 µmol g-1 h-1. The photocatalytic performance of Cu@ZrSQU is derived from the synergistic effect of Cu NPs and ZrSQU. Based on an in-depth study and discussion toward ZrSQU, we provide a versatile platform with applications in the field of proton conduction and photocatalysis, which will guide researchers in their further studies.

PACAP/PAC1-R activation contributes to hyperalgesia in 6-OHDA-induced Parkinson's disease model rats via promoting excitatory synaptic transmission of spinal dorsal horn neurons.

Pain is a common annoying non-motor symptom in Parkinson's disease (PD) that causes distress to patients. Treatment for PD pain remains a big challenge, as its underlying mechanisms are elusive. Pituitary adenylate cyclase-activating polypeptide (PACAP) and its receptor PAC1-R play important roles in regulating a variety of pathophysiological processes. In this study, we investigated whether PACAP/PAC1-R signaling was involved in the mechanisms of PD pain. 6-hydroxydopamine (6-OHDA)-induced PD model was established in rats. Behavioral tests, electrophysiological and Western blotting analysis were conducted 3 weeks later. We found that 6-OHDA rats had significantly lower mechanical paw withdrawal 50% threshold in von Frey filament test and shorter tail flick latency, while mRNA levels of Pacap and Adcyap1r1 (gene encoding PAC1-R) in the spinal dorsal horn were significantly upregulated. Whole-cell recordings from coronal spinal cord slices at L4-L6 revealed that the frequency of spontaneous excitatory postsynaptic currents (sEPSCs) in dorsal horn neurons was significantly increased, which was reversed by application of a PAC1-R antagonist PACAP 6-38 (250 nM). Furthermore, we demonstrated that intrathecal microinjection of PACAP 6-38 (0.125, 0.5, 2 µg) dose-dependently ameliorated the mechanical and thermal hyperalgesia in 6-OHDA rats. Inhibition of PACAP/PAC1-R signaling significantly suppressed the activation of Ca2+/calmodulin-dependent protein kinase II and extracellular signal-regulated kinase (ERK) in spinal dorsal horn of 6-OHDA rats. Microinjection of pAAV-Adcyap1r1 into L4-L6 spinal dorsal horn alleviated hyperalgesia in 6-OHDA rats. Intrathecal microinjection of ERK antagonist PD98059 (10 µg) significantly alleviated hyperalgesia in 6-OHDA rats associated with the inhibition of sEPSCs in dorsal horn neurons. In addition, we found that serum PACAP-38 concentration was significantly increased in PD patients with pain, and positively correlated with numerical rating scale score. In conclusion, activation of PACAP/PAC1-R induces the development of PD pain and targeting PACAP/PAC1-R is an alternative strategy for treating PD pain.

Efficient Solar Cells Based on Porphyrin and Concerted Companion Dyes Featuring Benzo 12-Crown-4 for Suppressing Charge Recombination and Enhancing Dye Loading.

In recent years, various porphyrin dyes have been designed to develop efficient dye-sensitized solar cells (DSSCs). Based on our previously reported porphyrin dye XW43, which contains a phenothiazine donor with two diethylene glycol (DEG)-derived substituents, we herein report a porphyrin dye XW89 by introducing a benzo 12-crown-4 (BCE) unit onto the N atom of the phenothiazine donor. On this basis, XW90 and XW91 have been synthesized by replacing a DEG chain in XW89 with two DEG chains and a 12-crown-4 unit, respectively. For iodine electrolyte-based DSSCs, dyes XW89-XW91 exhibit VOC values of 765-779 mV, higher than that of XW43 (755 mV), which may be related to the strong capability of the BCE group in binding Li+ and thus suppressing the downward shift of the TiO2 conduction band and interfacial charge recombination. Moreover, the smaller size of 12-crown-4 than the DEG unit enables higher adsorption amounts of the dyes than XW43, contributing to an enhanced JSC value. Due to the presence of two BCE units, dye XW91 exhibits the highest dye loading amount and JSC of 1.86 × 10-7 mol cm-2 and 19.79 mA cm-2, respectively, affording a high PCE of 11.1%. To further enhance the light-harvesting ability, a concerted companion (CC) dye XW92 has been constructed by linking the two subdye units corresponding to the porphyrin dye XW91 and an organic dye. As a result, XW92 affords an enhanced JSC and efficiency. Further coadsorption of XW92 with chenodeoxycholic acid achieved the highest efficiency of 12.1%. This work provides an effective approach for fabricating efficient DSSCs sensitized by porphyrin and CC dyes based on the introduction of crown ether units with smaller sizes and stronger Li+ affinities.

Development of practical techniques for simultaneous detection and distinction of current and emerging SARS-CoV-2 variants.

Countless individuals have fallen victim to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and have generated antibodies, reducing the risk of secondary infection in the short term. However, with the emergence of mutated strains, the probability of subsequent infections remains high. Consequently, the demand for simple and accessible methods for distinguishing between different variants is soaring. Although monitoring viral gene sequencing is an effective approach for differentiating between various types of SARS-CoV-2 variants, it may not be easily accessible to the general public. In this article, we provide an overview of the reported techniques that use combined approaches and adaptable testing methods that use editable recognition receptors for simultaneous detection and distinction of current and emerging SARS-CoV-2 variants. These techniques employ straightforward detection strategies, including tests capable of simultaneously identifying and differentiating between different variants. Furthermore, we recommend advancing the development of uncomplicated protocols for distinguishing between current and emerging variants. Additionally, we propose further development of facile protocols for the differentiation of existing and emerging variants.

The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis.

OBJECTIVE: Dexmedetomidine is a medication that has analgesic, sedative, and anti-anxiety properties. In the clinical, it is often used to prevent common complications associated with strabismus surgery, including postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex. However, its effectiveness and side effects of the present studies are different. The sample sizes of the present studies on the prevention of complications of dexmedetomidine are small. Therefore, this study evaluates the efficacy of dexmedetomidine in preventing anesthesia-related complications in strabismus surgery through a systematic review and meta-analysis. METHODS: Literature was retrieved from 10 commonly used databases and randomized controlled trials published up to May 2022 were sought. The included studies compared the intervention effects of dexmedetomidine versus placebo on anesthesia-related complications in surgery. The occurrence rates of postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex in patients undergoing strabismus surgery were evaluated. Statistical analyses and forest plots were generated using Review Manager and STATA software. Binary outcomes were measured using relative risk (RR) with a 95% confidence interval for each outcome. The Cochrane risk of bias tool was used to assess the bias and risk in the studies that met the inclusion criteria. RESULTS: A total of 13 articles were ultimately included in the analysis, comprising 1,018 patients who underwent strabismus surgery. The dexmedetomidine group, compared to the placebo group, demonstrated significant reductions in the incidence of postoperative delirium (RR = 0.73, P = 0.001), severe postoperative delirium (RR = 0.45, P = 0.005), postoperative nausea and vomiting (RR = 0.48, P < 0.0001), and the need for supplemental analgesia postoperatively (RR = 0.60, P = 0.004). Additionally, subgroup analysis revealed that intravenous administration of dexmedetomidine significantly reduced the incidence of oculocardiac reflex (RR = 0.50, P = 0.001). In contrast, intranasal administration of dexmedetomidine did not have a significant effect on the incidence of oculocardiac reflex (RR = 1.22, P = 0.15). There was a significant difference between the subgroups (P = 0.0005, I2 = 91.7%). CONCLUSION: Among patients undergoing strabismus surgery, the use of dexmedetomidine can alleviate postoperative delirium and reduce the incidence of postoperative nausea and vomiting, as well as postoperative pain. Moreover, intravenous administration of dexmedetomidine can lower the occurrence rate of the oculocardiac reflex.