Magnesium sulfate enhances the effect of the peripheral analgesic cocktail in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Purpose: Although magnesium sulfate (MgSO4) is widely used as an analgesic adjuvant to peripheral analgesic cocktails, its efficacy in total knee arthroplasty (TKA) is still controversial. Therefore, we systematically reviewed and meta-analyzed the literature to assess the analgesic efficacy of MgSO4 as an adjuvant to the analgesic cocktail in TKA. Methods: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched. The meta-analysis was performed according to the PRISMA guidelines. Data were qualitatively synthesized or meta-analyzed using a random-effects model. Results: Five randomized controlled trials involving 432 patients were included. Meta-analyses detected significant differences between the MgSO4 and control groups in the visual analog scale (VAS) pain scores (rest) at 6, 12, and 24 h postoperatively; VAS pain scores (motion) at 12, 24, and 48 h postoperatively; morphine consumption within 24 h, 24-48 h, and during the total hospitalization period; time to first rescue analgesia after TKA; and length of hospital stay. Regarding the functional recovery, the meta-analysis demonstrated significant differences between groups in terms of knee range of motion on postoperative day 1; daily mobilization distance on postoperative day 1; and daily mobilization distance. There was no significant intergroup difference in surgical complications. Conclusion: The findings suggest that MgSO4 is a promising adjunct to the analgesic cocktail, achieving significant improvements in pain scores and total opioid consumption during the early postoperative period after TKA.

Decision-making conflicts regarding hematopoietic stem cell transplantation in patients with hematological neoplasms: A descriptive qualitative study.

PURPOSE: To explore and understand the conflict in decision-making of hematopoietic stem cell transplantation in patients with hematological neoplasms. METHODS: A descriptive qualitative study of 16 patients with hematologic neoplasms in the hematology department was conducted between February 2022 and May 2022. Purposive sampling was used to select participants. Face-to-face in-depth personal interviews were performed. Interviews were recorded, transcribed, and coded. This descriptive qualitative study adhered to the COREQ checklist. RESULTS: All patients indicated difficulties in making decisions regarding hematopoietic stem cell transplantation. Five themes were identified: (1) weighing the pros and cons of HSCT, (2) financial burden versus desire for rebirth, (3) treatment urgency versus being unprepared, (4) saving oneself versus damaging loved ones, and (5) family companionship versus emotional isolation. These themes reflect the contradictions, entanglements, and realistic conflicts in decision-making regarding hematopoietic stem cell transplantation for patients with hematological neoplasms. CONCLUSIONS: This study identified multiple conflicts of decision-making in patients with hematologic neoplasms regarding decisions on hematopoietic stem cell transplantations. Healthcare workers should provide patients with disease knowledge, doctor-patient and intra-family communication, and access to financial support in order to resolve their conflicts and ultimately help them make the decision that is most optimum for them.

Aucubin suppresses TLR4/NF-κB signalling to shift macrophages toward M2 phenotype in glucocorticoid-associated osteonecrosis of the femoral head.

In this study, we investigated whether the ability of aucubin to mitigate the pathology of GONFH involves suppression of TLR4/NF-κB signalling and promotion of macrophage polarization to an M2 phenotype. In necrotic bone tissues from GONFH patients, we compared levels of pro-inflammatory M1 macrophages and anti-inflammatory M2 macrophages as well as levels of TLR4/NF-κB signalling. In a rat model of GONFH, we examined the effects of aucubin on these parameters. We further explored its mechanism of action in a cell culture model of M1 macrophages. Necrotic bone tissues from GONFH patients contained a significantly increased macrophage M1/M2 ratio, and higher levels of TLR4, MYD88 and NF-κB p65 than bone tissues from patients with hip osteoarthritis. Treating GONFH rats with aucubin mitigated bone necrosis and demineralization as well as destruction of trabecular bone and marrow in a dose-dependent manner, based on micro-computed tomography. These therapeutic effects were associated with a decrease in the overall number of macrophages, decrease in the proportion of M1 macrophages, increase in the proportion of M2 macrophages, and downregulation of TLR4, MYD88 and NF-κB p65. These effects in vivo were confirmed by treating cultures of M1 macrophage-like cells with aucubin. Aucubin mitigates bone pathology in GONFH by suppressing TLR4/NF-κB signalling to shift macrophages from a pro- to anti-inflammatory phenotype.

Heavy metal pollution in agricultural soils from surrounding industries with low emissions: Assessing contamination levels and sources.

The potential for heavy metal (HM) pollution in agricultural soils adjacent to industries with elevated HM emissions has long been recognized. However, industries with relatively lower levels of HM emissions, such as alumina smelting and glass production, may still contribute to the pollution of surrounding agricultural soils through continuous, albeit low-level, emissions. Despite this, this issue has not garnered adequate attention thus far. Therefore, this study aimed to assess the extent of HM pollution in agricultural soils adjacent to an alumina smelting and a glass production factory, identifying contamination levels and potential sources through the analysis of input fluxes, isotope fingerprints, and receptor models. Results showed moderate cadmium (Cd) contamination in surface soil, exceeding standards at a rate of 86.36 %. Further analysis revealed that atmospheric deposition was the primary route for Cd input in both paddy fields (89.20 %) and dryland soils (91.61 %). Additionally, the δ114/110Cd values in surface soils indicated that dust played a role in influencing Cd levels in distant surface soils, while raw materials and slags were identified as primary sources near the factory. Industrial sources were considered the primary contributors of Cd in soil accounting for approximately 73.38 % and 82.67 %, respectively, according to the positive matrix factorization model (PMF) and absolute principal component scores-multiple linear regression model (APCS-MLR). Overall, this study underscores the importance of monitoring HMs from industries with relatively low emissions and provides a scientific basis for effectively managing HMs pollution in agricultural soils, ensuring the preservation of agricultural soil quality.

Neuroinflammation in a Mouse Model of Alzheimer's Disease versus Auditory Dysfunction: Machine Learning Interpretation and Analysis.

Background: Auditory dysfunction, including central auditory hyperactivity, hearing loss and hearing in noise deficits, has been reported in 5xFAD Alzheimer's disease (AD) mice, suggesting a causal relationship between amyloidosis and auditory dysfunction. Central auditory hyperactivity correlated in time with small amounts of plaque deposition in the inferior colliculus and medial geniculate body, which are the auditory midbrain and thalamus, respectively. Neuroinflammation has been associated with excitation to inhibition imbalance in the central nervous system, and therefore has been proposed as a link between central auditory hyperactivity and AD in our previous report. However, neuroinflammation in the auditory pathway has not been investigated in mouse amyloidosis models. Methods: Machine learning was used to classify the previously obtained auditory brainstem responses (ABRs) from 5xFAD mice and their wild type (WT) littermates. Neuroinflammation was assessed in six auditory-related regions of the cortex, thalamus, and brainstem. Cochlear pathology was assessed in cryosection and whole mount. Behavioral changes were assessed with fear conditioning, open field testing and novel objection recognition. Results: Reliable machine learning classification of 5xFAD and WT littermate ABRs were achieved for 6M and 12M, but not 3M. The top features for accurate classification at 6 months of age were characteristics of Waves IV and V. Microglial and astrocytic activation were pronounced in 5xFAD inferior colliculus and medial geniculate body at 6 months, two neural centers that are thought to contribute to these waves. Lower regions of the brainstem were unaffected, and cortical auditory centers also displayed inflammation beginning at 6 months. No losses were seen in numbers of spiral ganglion neurons (SGNs), auditory synapses, or efferent synapses in the cochlea. 5xFAD mice had reduced responses to tones in fear conditioning compared to WT littermates beginning at 6 months. Conclusions: Serial use of ABR in early AD patients represents a promising approach for early and inexpensive detection of neuroinflammation in higher auditory brainstem processing centers. As changes in auditory processing are strongly linked to AD progression, central auditory hyperactivity may serve as a biomarker for AD progression and/or stratify AD patients into distinct populations.

Exploring the experience of undergraduate nursing students following placement at psychiatric units in China: A phenomenological study.

AIM: To explore undergraduate nursing students' experiences of psychiatric placements. BACKGROUND: Placement is an important learning phase for undergraduate nursing students and the placement experiences may affect their career choices. However, nursing students' experiences of psychiatric placements have not been fully explored in China. DESIGN: This study adopted a descriptive, phenomenological design. METHODS: After psychiatric placement, a semi-structured interview was conducted in June 2022 among 22 final-year undergraduate nursing students using purposive sampling. The data were analysed using Colaizzi's seven-step analysis method. RESULTS: Five themes were identified: i) destigmatising mental illness; ⅱ) beneficial communication; ⅲ) gaining confidence; iv) disappointment and sadness; and v) fear and discomfort. CONCLUSION: Nursing students experienced various positive experiences and negative emotions during their psychiatric placement. Further research should explore and validate appropriate educational strategies to optimise students' placement experiences to increase their career interest in psychiatric nursing.

Nursing students' expectations and career preferences before clinical placement in mainland China: A qualitative exploration.

AIM: To explore nursing students' expectations and career preferences before their clinical placements. BACKGROUND: Clinical placement is an important adaptation stage through which nursing students become nurses. Nursing students' expectations of clinical placement are not always met. There is a huge demand-supply gap in the nursing labor force and ensuring successful nursing placements could offset this gap. DESIGN: This study adopted a descriptive qualitative design. METHODS: Each participant was interviewed in the weeks before the start of their clinical placement. Interviews were semi-structured and audio recorded. Data were analyzed using Clarke and Braun's thematic analysis. RESULTS: This study included 25 students (11 males and 14 females; age 20-21 years), which was sufficient to reach data saturation. We identified 138 codes and six themes emerged: a) expectations of role transition; b) expectations of self-enhancement; c) expectations of teaching styles; d) fears and worries; e) preliminary career preferences; and f) motivating and obstacle factors of engaging in a nursing career. CONCLUSIONS: Nursing students had various expectations of their upcoming clinical placements alongside certain worries and fears. More predictive and targeted strategies need to be considered to ensure the success of clinical nursing placements. Further research should explore and verify strategies to meet nursing students' expectations and promote their preference for a nursing career.

Brassica napus Mediator Subunit16 Induces BnMED25- and BnWRKY33-Activated Defense Signaling to Confer Sclerotinia sclerotiorum Resistance.

The plant mediator is a highly conserved protein complex that interacts with transcription factors (TFs) and RNA polymerase II (RNAP II) to relay regulatory information during transcription. Plant immune response is one of the biological processes that is orchestrated by this regulatory mechanism. Brassica napus, an important oil crop, is severely attacked by a devastating disease Sclerotinia stem rot. Here, we explored broad-spectrum disease resistant roles of B. napus mediator subunit 16 (BnMED16) and its host defense mechanism against fugal pathogen Sclerotinia sclerotiorum. We found that BnMED16 expression was significantly increased by S. sclerotiorum infection, and its homologous overexpression resulted in rapid and comprehensive defense responses from the beginning to the end. This affected signal transduction with multiple channels including pathogen recognition, intracellular Ca2+ concentration, reactive oxygen species (ROS) accumulation and clearance, and activation of mitogen-activated protein kinase (MAPK) signaling cascades initially. Subsequently, pathogen-/defense-related genes and hormone-responsive pathways were highly activated, which resulted in enhanced cell wall and secretion of defense proteases. Furthermore, the biochemical analysis showed that BnMED16 interacts with BnMED25 and BnWRKY33. Additionally, BnMED25 also interacts with TFs BnMYC2, BnCOI1, and BnEIN3 of the JA/ET signal transduction pathway. Taken together, we proposed a hypothetical model that BnMED16 confers S. sclerotiorum resistance by enhancing BnMED25-mediated JA/ET defense pathways and BnWRKY33-activated defense signaling in B. napus. The BnMED16 overexpressing lines with enhanced broad-spectrum disease resistance could be useful for breeding Sclerotinia-resistant oilseed rape varieties, as well as serving as basis for further strategy development in resistance breeding.