The causality of gut microbiota on onset and progression of sepsis: a bi-directional Mendelian randomization analysis.

Background: Several observational studies have proposed a potential link between gut microbiota and the onset and progression of sepsis. Nevertheless, the causality of gut microbiota and sepsis remains debatable and warrants more comprehensive exploration. Methods: We conducted a two-sample Mendelian randomization (MR) analysis to test the causality between gut microbiota and the onset and progression of sepsis. The genome-wide association study (GWAS) summary statistics for 196 bacterial traits were extracted from the MiBioGen consortium, whereas the GWAS summary statistics for sepsis and sepsis-related outcomes came from the UK Biobank. The inverse-variance weighted (IVW) approach was the primary method used to examine the causal association. To complement the IVW method, we utilized four additional MR methods. We performed a series of sensitivity analyses to examine the robustness of the causal estimates. Results: We assessed the causality of 196 bacterial traits on sepsis and sepsis-related outcomes. Genus Coprococcus2 [odds ratio (OR) 0.81, 95% confidence interval (CI) (0.69-0.94), p = 0.007] and genus Dialister (OR 0.85, 95% CI 0.74-0.97, p = 0.016) had a protective effect on sepsis, whereas genus Ruminococcaceae UCG011 (OR 1.10, 95% CI 1.01-1.20, p = 0.024) increased the risk of sepsis. When it came to sepsis requiring critical care, genus Anaerostipes (OR 0.49, 95% CI 0.31-0.76, p = 0.002), genus Coprococcus1 (OR 0.65, 95% CI 0.43-1.00, p = 0.049), and genus Lachnospiraceae UCG004 (OR 0.51, 95% CI 0.34-0.77, p = 0.001) emerged as protective factors. Concerning 28-day mortality of sepsis, genus Coprococcus1 (OR 0.67, 95% CI 0.48-0.94, p = 0.020), genus Coprococcus2 (OR 0.48, 95% CI 0.27-0.86, p = 0.013), genus Lachnospiraceae FCS020 (OR 0.70, 95% CI 0.52-0.95, p = 0.023), and genus Victivallis (OR 0.82, 95% CI 0.68-0.99, p = 0.042) presented a protective effect, whereas genus Ruminococcus torques group (OR 1.53, 95% CI 1.00-2.35, p = 0.049), genus Sellimonas (OR 1.25, 95% CI 1.04-1.50, p = 0.019), and genus Terrisporobacter (OR 1.43, 95% CI 1.02-2.02, p = 0.040) presented a harmful effect. Furthermore, genus Coprococcus1 (OR 0.42, 95% CI 0.19-0.92, p = 0.031), genus Coprococcus2 (OR 0.34, 95% CI 0.14-0.83, p = 0.018), and genus Ruminiclostridium6 (OR 0.43, 95% CI 0.22-0.83, p = 0.012) were associated with a lower 28-day mortality of sepsis requiring critical care. Conclusion: This MR analysis unveiled a causality between the 21 bacterial traits and sepsis and sepsis-related outcomes. Our findings may help the development of novel microbiota-based therapeutics to decrease the morbidity and mortality of sepsis.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice.

In this editorial, we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case. Pulmonary meningothelial proliferative lesions, including primary pulmonary meningiomas, minute pulmonary meningothelial-like nodules, and metastatic pulmonary meningiomas are rare pulmonary lesions. These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations. Herein, we briefly introduce the clinical, imaging, and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Exploration of factors affecting hemodynamic stability following pheochromocytoma resection - cohort study.

Purpose: Surgery is the only way to cure pheochromocytoma; however, postoperative hemodynamic instability is one of the main causes of serious complications and even death. This study's findings provide some guidance for improved clinical management. Patients and methods: This study was to investigate the factors leading to postoperative hemodynamic instability in the postoperative pathology indicated pheochromocytoma from May 2016 to May 2022. They were divided into two groups according to whether vasoactive drugs were used for a median number of days or more postoperatively. The factors affecting the postoperative hemodynamics in the perioperative period (preoperative, intraoperative, and postoperative) were then evaluated. Results: The median number of days requiring vasoactive drug support postoperatively was three in 234 patients, while 118 (50.4%) patients required vasoactive drug support for three days or more postoperatively. The results of the multivariate analysis indicated more preoperative colloid use (odds ratio [OR]=1.834, confidence interval [CI]:1.265-2.659, P=0.001), intraoperative use of vasoactive drug (OR=4.174, CI:1.882-9.258, P<0.001), and more postoperative crystalloid solution input per unit of body weight per day (ml/kg/d) (OR=1.087, CI:1.062-1.112, P<0.001) were risk factors for predicting postoperative hemodynamic instability. The optimal cutoff point of postoperative crystalloid use were 42.37 ml/kg/d. Conclusion: Hemodynamic instability is a key issue for consideration in the perioperative period of pheochromocytoma. The amount of preoperative colloid use, the need for intraoperative vasoactive drugs, and postoperative crystalloid solution are risk factors for predicting postoperative hemodynamic instability (registration number: ChiCT2300071166).

Natural and anthropogenic controls on environmental change during the Holocene based on a multi-proxy record obtained from subalpine peatland in southern China.

The interactions between past climate, human activity and environmental change in subtropical mountainous areas are poorly understood due to the lack of reliable records in South China. In this study, the evolution of the East Asian summer monsoon (EASM) during the Holocene, and the interactions between regional human activity and environmental change, were studied using multi-proxy records from a subalpine peat core recovered from South China. The chronology of this peat core has been well-constrained by 10 AMS 14C dates of peat stems. A series of proxy indicators, including carbon isotopes (δ13C), loss on ignition (LOI), magnetic susceptibility (MS), the chemical index of alteration (CIA), and geochemical elements from the Shiwangutian (SWGT) peatland were used to reconstruct the palaeohydrological changes during the Holocene. Regional moisture levels showed a generally arid-wet-arid pattern, and three phases of climatic change were detected as follows. 1) Between 11,600 and 9000 cal yr BP, the EASM was weak and a relatively dry climate developed. 2) Between 9000 and 4000 cal yr BP, the prevalence of humid climatic conditions was associated with a strong summer monsoon. 3) After 4000 cal yr BP, the climate shifted to relatively dry conditions. Further comparisons and analysis suggested that solar insolation, migration of the Intertropical Convergence Zone (ITCZ), and El Niño-Southern Oscillation (ENSO) activity played an important role in determining the variations in Holocene EASM intensity. In addition, the increase in both MS and heavy metal concentrations over the last 1000 years is consistent with an increase in the population of Hunan Province. Therefore, it can be inferred that population growth and the associated expansion of cropland and mining led to an increase in soil erosion and metal tool use. These findings suggest that the impact of human activity generally outweighed the natural climatic controls on the environment and landscape in the mountainous region of southern China over the last 1000 years.

Knowledge Mapping of Primary Dysmenorrhea: Hotspots, Knowledge Structure, and Theme Trends.

Purpose: The global incidence of primary dysmenorrhea is continuously increasing, and understanding its research trends is crucial for effective pain management and women's health. Therefore, this study aims to perform a comprehensive bibliometric analysis of primary dysmenorrhea research to identify hotspots, explore emerging trends, and provide valuable insights for future research endeavors. Material and Methods: All of the relevant studies on primary dysmenorrhea in the Web of Science™ Core Collection database were searched for bibliometric analysis. Biclustering analysis using gCLUTO software was performed to identify research hotspots. Social network analysis with Ucinet was employed to reveal knowledge structure. Evolutionary analysis using SciMAT was utilized to predict thematic trends. Results: A total of 903 papers were analyzed, indicating a gradual increase in research on primary dysmenorrhea in recent years, with the scope of research expanding and diversifying. We identified seven hotspots, three treatment nodes, and four thematic trends. Research hotspots focused on epidemiological studies, adolescent primary dysmenorrhea, drug and non-drug treatments. Within the realm of treatments, we have identified three treatment nodes: acupuncture, acupressure, and ibuprofen. The evolution of research has witnessed a shift from traditional epidemiological studies toward a more diverse research landscape. Adolescent primary dysmenorrhea is expected to remain a prominent research topic while dietary supplements and lifestyle are predicted to gain more attention. An emerging theme is the study of variation and polymorphism of circadian rhythm genes concerning primary dysmenorrhea. Conclusion: This bibliometric analysis provides valuable insights into the current state of research on primary dysmenorrhea, offering a clearer understanding of the field's landscape. The identified hotspots, knowledge structure, and thematic trends can serve as valuable references for future investigations in this area. The research holds significant scientific importance and innovative value in elucidating the mechanisms of primary dysmenorrhea and finding more effective treatment approaches.

When does cognitive crafting matter more in enhancing employee thriving at work? The moderating role of skill variety and job autonomy.

The job crafting literature has not devoted much attention to the effects of specific forms of job crafting, particularly cognitive crafting. The present study builds on Conservation of Resources theory to explain how cognitive crafting might influence work meaningfulness for employees, and in turn, increase their experienced thriving at work. Moreover, we hypothesise that the impact of cognitive crafting on these outcomes is influenced by two motivational job characteristics: skill variety and job autonomy. To test our hypotheses, we collected three-wave survey data from 223 employees employed in a variety of occupations and industries in China. Results indicate that engaging in cognitive crafting enhances employees' work meaningfulness, resulting in thriving at work. Furthermore, skill variety and job autonomy are crucial moderators of these relationships. Specifically, when employees perceived low levels of skill variety or job autonomy, engaging in cognitive crafting was more likely to lead to enhanced work meaningfulness, which in turn resulted in higher levels of thriving at work. Implications for research, theory and practice are discussed.

Strengthened Surface Modification for High-Performance Inorganic Perovskite Solar Cells with 21.3% Efficiency.

Metal halide inorganic perovskites show excellent thermal stability compared to organic-inorganic perovskites. However, the performance of inorganic perovskite solar cells (PSCs) is far from theoretical values, together with unsatisfactory stability, mainly due to the poor interfacial properties. In this work, a facial but effective method is reported to realize high-performance inorganic PSCs by post-modifying the perovskite surface with 2-thiophene ethylamine (TEA). It is found that amine group from TEA can favorably interact with the undercoordinated Pb2+ via Lewis acid-based coordination, while thiophene ring with electron-rich sulfur assists such interaction by functioning as an electron donor. The synergetic interaction allows TEA to passivate perovskite film defects more efficiently, as compared to phenethylamine (PEA) with less electron-donating ability. Moreover, perovskite valence band is slightly upward shift to match with hole transport material and facilitate hole transfer. These combinations result in a reduced non-radiative charge recombination and improved charge carrier lifetime. Consequently, PSCs with TEA modification shows a drastic improvement of VOC by 54 mV, yielding a champion PCE of 21.3%, much higher than the control PSCs (19.3%), along with improved ambient stability. This work demonstrates that surface modifier with an electron-rich moiety is critical for achieving efficient and stable inorganic PSCs.

Ecological Effects of Predator Harvesting and Environmental Noises on Oceanic Coral Reefs.

Coral reefs provide refuge for prey and are important for the preservation of an oceanic ecosystem. However, they have been experiencing severe destruction by environmental changes and human activities. In this paper, we propose and analyze a tri-trophic food chain model consisting of coral, Crown-of-thorns starfish (CoTS), and triton in deterministic and stochastic environments. We investigate the effects of harvesting in the deterministic system and environmental noises in the stochastic system, respectively. The existence of possible steady states along with their stability is rigorously discussed. From the economic perspective, we examine the existence of the bionomic equilibrium and establish the optimal harvesting policy. Subsequently, the deterministic system is extended to a stochastic system through nonlinear perturbation. The stochastic system admits a unique positive global solution initiating from the interior of the positive quadrant. The long-time behaviors of the stochastic system are explored. Numerical simulations are provided to validate and complement our theoretical results. We show that over-harvesting of triton is not beneficial to coral reefs and modest harvesting of CoTS may promote sustainable growth in coral reefs. In addition, the presence of strong noises can lead to population extinction.

Copper-Zinc Bimetallic Single-Atom Catalysts with Localized Surface Plasmon Resonance-Enhanced Photothermal Effect and Catalytic Activity for Melanoma Treatment and Wound-Healing.

Nanomaterials with photothermal combined chemodynamic therapy (PTT-CDT) have attracted the attention of researchers owing to their excellent synergistic therapeutic effects on tumors. Thus, the preparation of multifunctional materials with higher photothermal conversion efficiency and catalytic activity can achieve better synergistic therapeutic effects for melanoma. In this study, a Cu-Zn bimetallic single-atom (Cu/PMCS) is constructed with augmented photothermal effect and catalytic activity due to the localized surface plasmon resonance (LSPR) effect. Density functional theory calculations confirmed that the enhanced photothermal effect of Cu/PMCS is due to the appearance of a new d-orbital transition with strong spin-orbit coupling and the induced LSPR. Additionally, Cu/PMCS exhibited increased catalytic activity in the Fenton-like reaction and glutathione depletion capacity, further enhanced by increased temperature and LSPR. Consequently, Cu/PMCS induced better synergistic anti-melanoma effects via PTT-CDT than PMCS in vitro and in vivo. Furthermore, compared with PMCS, Cu/PMCS killed bacteria more quickly and effectively, thus facilitating wound healing owing to the enhanced photothermal effect and slow release of Cu2+ . Cu/PMCS promoted cell migration and angiogenesis and upregulated the expression of related genes to accelerate wound healing. Cu/PMCS has potential applications in treating melanoma and repairing wounds with its antitumor, antibacterial, and wound-healing properties.

Recent Advancements in Physiological, Biochemical, and Multimodal Sensors Based on Flexible Substrates: Strategies, Technologies, and Integrations.

Flexible wearable devices have been widely used in biomedical applications, the Internet of Things, and other fields, attracting the attention of many researchers. The physiological and biochemical information on the human body reflects various health states, providing essential data for human health examination and personalized medical treatment. Meanwhile, physiological and biochemical information reveals the moving state and position of the human body, and it is the data basis for realizing human-computer interactions. Flexible wearable physiological and biochemical sensors provide real-time, human-friendly monitoring because of their light weight, wearability, and high flexibility. This paper reviews the latest advancements, strategies, and technologies of flexibly wearable physiological and biochemical sensors (pressure, strain, humidity, saliva, sweat, and tears). Next, we systematically summarize the integration principles of flexible physiological and biochemical sensors with the current research progress. Finally, important directions and challenges of physiological, biochemical, and multimodal sensors are proposed to realize their potential applications for human movement, health monitoring, and personalized medicine.

Effect of nutrient supply on cell size evolution of marine phytoplankton.

The variation of nutrient supply not only leads to the differences in the phytoplankton biomass and primary productivity but also induces the long-term phenotypic evolution of phytoplankton. It is widely accepted that marine phytoplankton follows Bergmann's Rule and becomes smaller with climate warming. Compared with the direct effect of increasing temperature, the indirect effect via nutrient supply is considered to be an important and dominant factor in the reduction of phytoplankton cell size. In this paper, a size-dependent nutrient-phytoplankton model is developed to explore the effects of nutrient supply on the evolutionary dynamics of functional traits associated with phytoplankton size. The ecological reproductive index is introduced to investigate the impacts of input nitrogen concentration and vertical mixing rate on the persistence of phytoplankton and the distribution of cell size. In addition, by applying the adaptive dynamics theory, we study the relationship between nutrient input and the evolutionary dynamics of phytoplankton. The results show that input nitrogen concentration and vertical mixing rate have significant effects on the cell size evolution of phytoplankton. Specifically, cell size tends to increase with the input nutrient concentration, as does the diversity of cell sizes. In addition, a single-peaked relationship between vertical mixing rate and cell size is observed. When the vertical mixing rate is too low or too high, only small individuals are dominant in the water column. When the vertical mixing rate is moderate, large individuals can coexist with small individuals, so the diversity of phytoplankton is elevated. We predict that reduced intensity of nutrient input due to climate warming will lead to a trend towards smaller cell size and will reduce the diversity of phytoplankton.

Tailored Cysteine-Derived Molecular Structures toward Efficient and Stable Inorganic Perovskite Solar Cells.

Surface-defect-triggered non-radiative charge recombination and poor stability have become the main roadblock to continued improvement in inorganic perovskite solar cells (PSCs). Herein, the main culprits are identified on the inorganic perovskite surface by first-principles calculations, and to purposefully design a brand-new passivator, Boc-S-4-methoxy-benzyl-l-cysteine (BMBC), whose multiple Lewis-based functional groups (NH, S and CO) to suppress halide vacancies and coordinate with undercoordinated Pb2+ through typical Lewis baseacid reactions. The tailored electron-donating methoxyl group (CH3 O-) can cause an increased electron density on the benzene ring, which strengthens the interaction with undercoordinated Pb2+ via electrostatic interactions. This BMBC passivation can reduce the surface trap density, enlarge grains, prolong the charge lifetime, and cause a more suitable energy-level alignment. In addition, the hydrophobic tert-butyl in butoxycarbonyl (Boc-) group ensures that BMBC is uniformly covered and prevents harmful aggregation through steric repulsion at the perovskite/hole-transporting layer (HTL) interface, thus providing a hydrophobic umbrella to resist moisture invasion. Consequently, the combination of the above increases the efficiency of CsPbI3-x Brx PSC from 18.6% to 21.8%, the highest efficiency for this type of inorganic metal halide PSCs so far, as far as it is known. Moreover, the device exhibits higher environmental and thermal stability.

GATA-binding protein 4 promotes neuroinflammation and cognitive impairment in Aß1-42 fibril-infused rats through small nucleolar RNA host gene 1/miR-361-3p axis.

Aging with dysregulated metabolic and immune homeostasis stimulates pyroptosis, neuroinflammation, and cellular senescence, thus contributing to etiopathogenesis of Alzheimer's disease. GATA-binding protein 4 (GATA4) functions as a transcriptional factor in response to DNA damage, and is associated with neuroinflammation and cellular senescence. The role of GATA4 in Alzheimer's disease was investigated. GATA4 was elevated in hippocampus of Aß1-42 fibril-infused rats. Injection with shRNA targeting GATA4 reduced escape latency with increase of time in target quadrant and number of platform crossings in Aß1-42 fibril-infused rats. Moreover, knockdown of GATA4 ameliorated morphological changes of hippocampus and reduced amyloid plaque deposition in Aß1-42 fibril-infused rats. Silence of GATA4 repressed neuroinflammation and apoptosis in Aß1-42 fibril-infused rats. Loss of GATA4 in Aß1-42 fibril-infused rats reduced the expression of specificity protein 1 (Sp1) to downregulate long noncoding RNA small nucleolar RNA host gene 1 (SNHG1) and upregulated miR-361-3p. Loss of SNHG1 ameliorated learning and memory impairments in Aß1-42 fibril-infused rats. Overexpression of Sp1 attenuated GATA4 silence-induced decrease of escape latency, increase of time in target quadrant, and number of platform crossings in Aß1-42 fibril-infused rats. In conclusion, silence of GATA4 ameliorated cognitive dysfunction and inhibited hippocampal inflammation and cell apoptosis through regulation of Sp1/SNHG1/miR-361-3p.

A copper-metal organic framework enhances the photothermal and chemodynamic properties of polydopamine for melanoma therapy.

The combination of photothermal treatment and chemodynamic therapy has attracted extensive attention for improving therapeutic effects and compensating the insufficiency of monotherapy. In this work, a copper-metal organic framework (Cu-BTC) was used to augment the photothermal effect of polydopamine (PDA) and endow it with a chemodynamic ability by constructing a Cu-BTC@PDA nanocomposite. Density functional theory calculations revealed that the plasmonic vibrations formed by the d-d transition of Cu at the Fermi level in Cu-BTC@PDA could enhance the photothermal performance of PDA. In addition, more Cu2+ released from Cu-BTC@PDA in the acidic microenvironment of the tumor was then reduced to Cu+ by glutathione (GSH) and further catalyzed H2O2 to generate more toxic hydroxyl radical (•OH), which synergized with photothermal treatment for melanoma therapy. Furthermore, Cu-BTC@PDA could quickly and effectively kill bacteria under the action of PTT, and the sustained release of Cu ions could contribute to the long-term and stable bacteriostatic ability of the material. This sustained release of Cu ions could also promote the cell migration and angiogenesis, and upregulate the expression of COL-, TGF-, and VEGF-related genes to accelerate wound healing. This multifunctional nanomaterial has potential application in the treatment of melanoma and repair of wounds. STATEMENT OF SIGNIFICANCE: We constructed a multifunctional nanoplatform (Cu-BTC@PDA) by two steps. This nanoplatform can not only perform cascade catalysis in the tumor microenvironment to generate more toxic hydroxyl radical (•OH), but also synergize with photothermal treatment for melanoma therapy. Additionally, Cu-BTC@PDA possesses enhanced photothermal performance through the plasmonic vibrations formed by the d-d transition of Cu at the Fermi level in Cu-BTC@PDA, which is revealed by DFT calculations. And Cu-BTC@PDA shows good antitumor, antibacterial, and wound healing properties in vivo and in vitro. Such a multifunctional nanomaterial has potential application in the treatment of melanoma and repair of wounds.

Effects of challenge with Clostridium perfringens, Eimeria and both on ileal microbiota of yellow feather broilers.

In the poultry industry worldwide, Clostridium perfringens has been causing major economic loss as it can cause necrotic enteritis (NE). The coccidial infection has been considered as the most important predisposing factor of NE caused by C. perfringens. In this study, we aimed to advance our knowledge on ileal microbiota of yellow feather broilers under C. perfringens and/or Eimeria challenge. Total of 80 healthy day old yellow feather broilers were randomly assigned to four groups including: Control, C. perfringens challenge group (C. Per), Eimeria challenge group (Cocc), and C. perfringens plus Eimeria challenge group (Comb). On day 14, the Cocc and Comb group broilers were orally gavaged 1 ml PBS solution containing 25,000 oocysts of Eimeria brunetti and 25,000 oocysts of Eimeria maxima. Starting on day 17, the C. Per and Comb group broilers were orally gavaged 10 mL of C. perfringens per bird (4 × 107 CFU/mL, ATCC® 13124™ Strain) every day for 6 days. 16S rRNA gene sequencing was performed on extracted DNA of ileal digesta samples. The results showed that C. perfringens alone did not affect the alpha diversity of ileal microbiome in yellow feather broilers but co-infection with Eimeria significantly decreased the diversity of ileal microbiota. C. perfringens and Eimeria challenge also decreased the relative abundance of beneficial bacteria including Bacteroidetes at the phylum level and Faecalibacterium at the genus level. At the species level, the relative abundance of Candidatus Arthromitus was significantly decreased in the Eimeria challenged groups. This microbial shift information of ileal microbiota under C. Perfringens and Eimeria challenge provide important reference data for the development of therapeutic approaches to necrotic enteritis in yellow-feather broiler chickens.

Bibliometric and Visual Analysis of the Current Status and Trends of Postoperative Pain in Children from 1950-2021.

Background: Postoperative pain in children has been overlooked for a long time. The knowledge structure, research hotspots and trends related to postoperative pain in children are unclear and have not been systematically summarized. Purpose: We aimed to analyze the current state of research on postoperative pain in children and to conduct in-depth mining of the knowledge structure. Methods: The PubMed database for publications on postoperative pain in children between 1950 and 2021 was searched. Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) was performed to obtain the co-word matrix and co-occurrence matrix. The H-index method was used to extract high-frequency main Medical Subject Headings (MeSH) terms/subheadings. Results: The high-frequency MeSH terms were analyzed by biclustering, strategic diagram and social network analyses. Totally, 4022 publications were retrieved. The analysis showed that 60 countries or regions published relevant documents, with the United States publishing the most significant number of papers. Totally, 811 journals published relevant papers, with Pediatric Anesthesia ranking first. Moreover, we extracted 43 high-frequency main MeSH terms/subheadings and clustered them into five categories: overview, aetiology and epidemiology, pharmacotherapy, opioid administration and dosing, and prevention and control of postoperative pain in children. Conclusion: Pharmacological treatments, pain prevention and control are the focus of research and are becoming increasingly mature. Opioid stewardship and regional anesthesia is the trend and focus of future research. Our study offers a better understanding of the current status and knowledge structure of postoperative pain in children and provides a reference for improving postoperative pain management in children in the future.

Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials.

Objectives: Erector spinae plane block (ESPB) has been used for many thoracic and abdominal surgeries. However, evidence of its analgesic efficacy following abdominal surgery, compared with that of thoracic analgesia, is insufficient. Our study explored the analgesic effect of ESPB after abdominal surgery. Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Primary outcomes were pain scores at 6, 12 and 24 h and 24-h opioid consumption. Secondary outcomes included time to first rescue analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV). We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for primary outcomes and mean differences (MDs) and risk ratios (RRs) with 95% CIs for secondary outcomes. Results: We systematically included 1,502 cases in 24 trials. Compared with placebo, ESPB significantly reduced pain scores at 6 h (SMD -1.25; 95% CI -1.79 to -0.71), 12 h (SMD -0.85; 95% CI -1.33 to -0.37) and 24 h (SMD -0.84; 95% CI -1.30 to -0.37) and 24-h opioid consumption (SMD -0.62; 95% CI -1.19 to -0.06) post-surgery. ESPB prolonged the time to first rescue analgesia and decreased the incidence of PONV. Compared with transversus abdominal plane block (TAPB), ESPB significantly reduced pain scores at 6, 12, and 24 h and 24-h opioid consumption and prolonged the time to first rescue analgesia postsurgically. Furthermore, subgroup analysis showed that ESPB significantly reduced pain scores at various time points and opioid consumption within 24 h after laparoscopic cholecystectomy, percutaneous nephrolithotomy and bariatric surgery. Conclusion: Compared with placebo, ESPB improves the postoperative analgesic efficacy after abdominal surgery. Furthermore, our meta-analysis confirmed that ESPB provides more beneficial analgesic efficacy than TAPB. Systematic review registration: [https://www.crd.york.ac.uk/PROSPEROFILES/301491_STRATEGY_20220104.pdf], identifier [CRD42022301491].

Global, Regional, and National Burden and Trends of Down Syndrome From 1990 to 2019.

Introduction: Down syndrome (DS) is the leading cause of genetically defined intellectual disability and congenital birth defects worldwide. A large population of people diagnosed with DS globally is posing an enormous socioeconomic burden. However, the global burden and trends of DS have not been reported. Methods: Based on the data from the Global Burden of Disease database in 2019, we analyzed the incidence, prevalence, disability-adjusted life years (DALYs), and death of DS from 1990 to 2019 according to sex, age, regions, and social-demographic index (SDI). Then, age-standardized rates (ASRs) and estimated annual percentage change (EAPC) of these aforementioned indexes were calculated to evaluate the temporal trend of DS. Finally, the association of SDI with DS epidemiological parameters was assessed. Results: In the past 30 years, the incident cases, age-standardized incident rate (ASIR), and age-standardized prevalent rate (ASPR) of DS first decreased slightly and subsequently increased globally. The number of prevalent cases increased steadily, while the number and age-standardized rate (ASRs) of DALYs and deaths decreased gradually from 1990 to 2019. In the meantime, disease burdens were different across various SDI regions. The prevalent cases and ASPR for both sexes were increasing in all SDI regions except for the high-middle SDI region. At the national level, Brunei Darussalam, Ireland, and Haiti were the top three countries with the highest ASIR in 2019. Georgia was in the top three with the highest increase in ASRs of four parameters, while Serbia was consistently ranked in the top three with fastest declining. Furthermore, we found that ASIR and ASPR were positively correlated with SDI, yet the age-standardized DALYs and age-standardized death rate (ASDR) were negatively correlated with SDI. Conclusion: In the past 30 years, the burden and trends of DS were heterogeneous across different regions and countries with different sociodemographic characteristics. Great improvements had been achieved in reducing DALYs and deaths globally. However, the increased number and ASRs of incident and prevalent cases in some regions, especially in low SDI regions, were contributing to numerous challenges to public health. The findings may provide valuable information to the development or implementation of more effective measures.