Access to cyclohexadiene and benzofuran derivatives via catalytic arene cyclopropanation of α-cyanodiazocarbonyl compounds.

The arene cyclopropanation between diazo compounds and benzene is well known to produce a tautomeric mixture of norcaradiene and cycloheptatriene in favour of the latter species. Nevertheless, previous studies have suggested that the initially formed norcaradiene can be stabilized by a C-7 cyano group with prevention of its 6π-electrocyclic ring opening. According to this feature, a synthetic route to functionalized cyclohexadienes has been designed using α-cyanodiazoacetates and α-diazo-ß-ketonitriles as the starting materials, respectively. The Rh2(esp)2-catalyzed arene cyclopropanation of α-cyanodiazoacetates in benzene afforded the expected 7-alkoxycarbonyl-7-cyanonorcaradienes as isolable compounds, which then served as templates for the second cyclopropanation with ethyl diazoacetate or α-cyanodiazocarbonyls to enable the formation of bis(cyclopropanated) adducts. Their subsequent treatment with SmI2 triggered a double ring-opening process, allowing for the generation of 1,4- and/or 1,3-cyclohexadienes as either regio- or diastereomeric mixtures. On the other hand, the norcaradienes generated from phenyl- or methyl-substituted α-diazo-ß-ketonitriles were found to undergo an in situ rearrangement to yield dihydrobenzofurans that could be converted to benzofuran derivatives by DDQ oxidation.

Selenium Nanoparticles: Revolutionizing Nutrient Enhancement in Aquaculture - A Review.

Aquaculture, a cornerstone of global food production, confronts myriad challenges including disease outbreaks and environmental degradation. Achieving nutritionally balanced aquafeed is critical for sustainable production, prompting exploration into innovative solutions like selenium nanoparticles (SeNPs). SeNPs offer potent antimicrobial, antioxidant, and growth-promoting properties, bolstering gut immunity and digestive capacity in aquatic animals. Their high bioavailability and ability to traverse gut barriers make them promising candidates for aquafeed supplementation. This study investigates SeNPs as a cutting-edge solution to enhance nutrient supply in aquaculture, addressing key challenges while promoting environmental stewardship and food security. By synthesizing current research and highlighting future directions, this review provides valuable insights into sustainable aquaculture practices. SeNPs hold promise for revolutionizing aquaculture feed formulations, offering a pathway to improved production outcomes and environmental sustainability.

Thermodynamic Origin-Based In Situ Electrochemical Construction of Reversible p-n Heterojunctions for Optimal Stability in Potassium Ion Storage.

Heterojunctions in electrode materials offer diverse improvements during the cycling process of energy storage devices, such as volume change buffering, accelerated ion/electron transfer, and better electrode structure integrity, however, obtaining optimal heterostructures with nanoscale domains remains challenging within constrained materials. A novel in situ electrochemical method is introduced to develop a reversible CuSe/PSe p-n heterojunction (CPS-h) from Cu3PSe4 as starting material, targeting maximum stability in potassium ion storage. The CPS-h formation is thermodynamically favorable, characterized by its superior reversibility, minimized diffusion barriers, and enhanced conversion post K+ interaction. Within CPS-h, the synergy of the intrinsic electric field and P-Se bonds enhance electrode stability, effectively countering the Se shuttling phenomenon. The specific orientation between CuSe and PSe leads to a 35° lattice mismatch generates large space at the interface, promoting efficient K ion migration. The Mott-Schottky analysis validates the consistent reversibility of CPS-h, underlining its electrochemical reliability. Notably, CPS-h demonstrates a negligible 0.005% capacity reduction over 10,000 half-cell cycles and remains stable through 2,000 and 4,000 cycles in full cells and hybrid capacitors, respectively. This study emphasizes the pivotal role of electrochemical dynamics in formulating highly stable p-n heterojunctions, representing a significant advancement in potassium-ion battery (PIB) electrode engineering.

Pharmacokinetics of toltrazuril and its metabolite, toltrazuril sulfone, in suckling piglets following oral and intramuscular administrations.

Toltrazuril (TZR) is currently the only registered chemotherapeutic drug in the European Union for the treatment of Cystoisospora suis. This study investigated the comparative pharmacokinetics and tissue concentration-time profiles of TZR and its active metabolite, toltrazuril sulfone (TZR-SO2 ), after oral (per os, p.o.) and intramuscular (i.m.) administration to suckling piglets. Following a single administration of TZR orally at 50 mg/piglet or intramuscularly at 45 mg/piglet, higher concentrations of TZR and TZR-SO2 were observed in all three investigated tissues after p.o. administration. The mean TZR concentration in serum peaked at 14 µg/mL (34.03 h) and 5.36 µg/mL (120 h), while TZR-SO2 peaked at 14.12 µg/mL (246 h) and 9.92 µg/mL (330 h) after p.o. and i.m. administration, respectively. TZR was undetectable in the liver after p.o. administration (18 days) and in the jejunum (24 days) after i.m. injection, while TZR-SO2 was still detectable in all three tissues after 36 days regardless of administration routes. This study showed that p.o. formulation exhibited faster absorption and higher serum/tissue TZR/TZR-SO2 concentrations than i.m. formulation. Both formulations generated sufficient therapeutic concentrations in the serum and jejunum, and sustained enough time to protect against Cystoisospora suis infection in the piglets.

Automated identification and quantification of metastatic brain tumors and perilesional edema based on a deep learning neural network.

PURPOSE: This paper presents a deep learning model for use in the automated segmentation of metastatic brain tumors and associated perilesional edema. METHODS: The model was trained using Gamma Knife surgical data (90 MRI sets from 46 patients), including the initial treatment plan and follow-up images (T1-weighted contrast-enhanced (T1cWI) and T2-weighted images (T2WI)) manually annotated by neurosurgeons to indicate the target tumor and edema regions. A mask region-based convolutional neural network was used to extract brain parenchyma, after which the DeepMedic 3D convolutional neural network was in the segmentation of tumors and edemas. RESULTS: Five-fold cross-validation demonstrated the efficacy of the brain parenchyma extraction model, achieving a Dice similarity coefficient of 96.4%. The segmentation models used for metastatic tumors and brain edema achieved Dice similarity coefficients of 71.6% and 85.1%, respectively. This study also presents an intuitive graphical user interface to facilitate the use of these models in clinical analysis. CONCLUSION: This paper introduces a deep learning model for the automated segmentation and quantification of brain metastatic tumors and perilesional edema trained using only T1cWI and T2WI. This technique could facilitate further research on metastatic tumors and perilesional edema as well as other intracranial lesions.

Epidemiology of Severe Fever with Thrombocytopenia Syndrome in Dogs and Cats in Taiwan.

Severe Fever with Thrombocytopenia Syndrome (SFTS), caused by the SFTS Virus (SFTSV), is a global health threat. SFTSV in Taiwan has only been reported in ruminants and wild animals. Thus, we aimed to investigate the infection statuses of dogs and cats, the animals with closer human interactions. Overall, the SFTSV RNA prevalence was 23% (170/735), with dogs showing a 25.9% (111/429) prevalence and cats at 19.3% (59/306) prevalence. Noticeably, the prevalence in stray animals (39.8% 77/193) was significantly higher than in domesticated ones (17.2%, 93/542). Among the four categories analyzed, the highest SFTSV prevalence was found in the stray dogs at 53.9% (120/193), significantly higher than the 24.2% prevalence noted in stray cats. In contrast, domesticated animals exhibited similar prevalence rates, with 17.1% for dogs and 17.2% for cats. It is noteworthy that in the domesticated animal groups, a significantly elevated prevalence (45%, 9/20) was observed among cats exhibiting thrombocytopenia compared to those platelet counts in the reference range (4.8%, 1/21). The high infection rate in stray animals, especially stray dogs, indicated that exposure to various outdoor environments influences the prevalence of infections. Given the higher human interaction with dogs and cats, there is a need for proactive measures to reduce the risk associated with the infection of SFTSV in both animals and humans.

Serotypes, virulence factors and multilocus sequence typing of Glaesserella parasuis from diseased pigs in Taiwan.

Background: Glaesserella parasuis (G. parasuis) belongs to the normal microbiota of the upper respiratory tract in the swine, but virulent strains can cause systemic infections commonly known as Glässer's disease that leads to significant economic loss in the swine industry. Fifteen serotypes of G. parasuis have been classified by gel immunodiffusion test while the molecular serotyping based on variation within the capsule loci have further improved the serotype determination of unidentified field strains. Serovar has been commonly used as an indicator of virulence; however, virulence can be significantly differ in the field isolates with the same serotype. To date, investigations of G. parasuis isolated in Taiwan regarding antimicrobial resistance, serotypes, genotypes and virulence factors remain unclear. Methods: A total of 276 G.parasuis field isolates were collected from 263 diseased pigs at the Animal Disease Diagnostic Center of National Chiayi University in Taiwan from January 2013 to July 2021. Putative virulence factors and serotypes of the isolates were identified by polymerase chain reaction (PCR) and antimicrobial susceptibility testing was performed by microbroth dilution assay. Additionally, the epidemiology of G. parasuis was characterized by multilocus sequence typing (MLST). Results: Serotype 4 (33.3%) and 5 (21.4%) were the most prevalent, followed by nontypable isolates (15.9%), serotype 13 (9.4%), 12 (6.5%), 14 (6.2%), 7 (3.3%), 1 (1.8%), 9 (1.1%), 11 (0.7%) and 6 (0.4%). Nine out of 10 putative virulence factors showed high positive rates, including group 1 vtaA (100%), fhuA (80.4%), hhdA (98.6%), hhdB (96.0%), sclB7 (99.6%), sclB11 (94.9%), nhaC (98.2%), HAPS_0254 (85.9%), and cirA (99.3%). According to the results of antimicrobial susceptibility testing, ceftiofur and florfenicol were highly susceptible (>90%). Notably, 68.8% isolates showed multidrug resistance. MLST revealed 16 new alleles and 67 new sequence types (STs). STs of these isolated G. parasuis strains were classified into three clonal complexes and 45 singletons by Based Upon Related Sequence Types (BURST) analysis. All the G. parasuis strains in PubMLST database, including strains from the diseased pigs in the study, were defined into two main clusters by Unweighted Pair Group Method with Arithmetic Mean (UPGMA). Most isolates in this study and virulent isolates from the database were mainly located in cluster 2, while cluster 1 included a high percentage of nasal isolates from asymptomatic carriers. In conclusion, this study provides current prevalence and antimicrobial susceptibility of G. parasuis in Taiwan, which can be used in clinical diagnosis and treatment of Glässer's disease.

Sensory cortex plasticity supports auditory social learning.

Social learning (SL) through experience with conspecifics can facilitate the acquisition of many behaviors. Thus, when Mongolian gerbils are exposed to a demonstrator performing an auditory discrimination task, their subsequent task acquisition is facilitated, even in the absence of visual cues. Here, we show that transient inactivation of auditory cortex (AC) during exposure caused a significant delay in task acquisition during the subsequent practice phase, suggesting that AC activity is necessary for SL. Moreover, social exposure induced an improvement in AC neuron sensitivity to auditory task cues. The magnitude of neural change during exposure correlated with task acquisition during practice. In contrast, exposure to only auditory task cues led to poorer neurometric and behavioral outcomes. Finally, social information during exposure was encoded in the AC of observer animals. Together, our results suggest that auditory SL is supported by AC neuron plasticity occurring during social exposure and prior to behavioral performance.

The Use of Tricaine Methanesulfonate (MS-222) in Asian Seabass (Lates calcarifer) at Different Temperatures: Study of Optimal Doses, Minimum Effective Concentration, Blood Biochemistry, Immersion Pharmacokinetics, and Tissue Distributions.

This study was conducted to determine the optimal doses and minimum effective concentrations (MECs) of tricaine methanesulfonate (MS-222) in marketable-size Asian seabass reared at two temperatures (22 and 28 °C). Serum biochemical parameters, pharmacokinetics, and tissue distributions of MS-222 following immersion at the determined optimal doses were also evaluated in order to delineate possible mechanisms dictating the temperature difference. The definition of optimal dose is set as the dose when fish attain stage III anesthesia within 5 min, sustain this stage for 3 min, and re-attain equilibrium within 5 min. The MEC is the fish serum MS-222 concentration when stage III anesthesia is reached. The results showed that water temperature exerted no or minimal impact on the designated parameters. The optimal doses at 22 and 28 °C were 140 and 150 µg/mL, while the MECs were 70.48 and 78.27 µg/mL, respectively. Fish exposed to the optimal doses of MS-222 had significantly elevated blood concentrations of lactate, glucose, calcium, magnesium, and sodium, while the blood pH was significantly decreased. The fish eliminated MS-222 faster at 28 °C than at 22 °C, with serum half-lives of 18.43 and 37.01 h, respectively. Tissue-specific distribution patterns were evident. Irrespective of water temperature, MS-222 peaked at 5 min for the brain and gill but peaked slightly later at 10-20 min for the liver and kidney. Most tissues exhibit a gradual decline of drug concentration except for the gill, which was maintained at a steady level. Muscle is the least perfused tissue with the lowest drug concentration throughout the 90 min period. This study provided physiological and pharmacokinetic evidence contributing to a better understanding of the actions of MS-222 in Asian seabass at different temperatures.

Serotype and multilocus sequence typing of Streptococcus suis from diseased pigs in Taiwan.

Streptococcus suis (S. suis) infection can cause clinically severe meningitis, arthritis, pneumonia and septicemia in pigs. To date, studies on the serotypes, genotypes and antimicrobial susceptibility of S. suis in affected pigs in Taiwan are rare. In this study, we comprehensively characterized 388 S. suis isolates from 355 diseased pigs in Taiwan. The most prevalent serotypes of S. suis were serotypes 3, 7 and 8. Multilocus sequence typing (MLST) revealed 22 novel sequence types (STs) including ST1831-1852 and one new clonal complex (CC), CC1832. The identified genotypes mainly belonged to ST27, ST94 and ST1831, and CC27 and CC1832 were the main clusters. These clinical isolates were highly susceptible to ceftiofur, cefazolin, trimethoprim/sulfamethoxazole and gentamicin. The bacteria were prone to be isolated from cerebrospinal fluid and synovial fluid in suckling pigs with the majority belonging to serotype 1 and ST1. In contrast, ST28 strains that corresponded to serotypes 2 and 1/2 were more likely to exist in the lungs of growing-finishing pigs, which posted a higher risk for food safety and public health. This study provided the genetic characterization, serotyping and the most current epidemiological features of S. suis in Taiwan, which should afford a better preventative and treatment strategy of S. suis infection in pigs of different production stages.

The Satisfaction With Care of Patients With Schizophrenia in Taiwan: A Cross-Sectional Survey of Patient-Centered Care Domains.

BACKGROUND: Pharmacological interventions combined with nonpharmacological treatments such as patient-centered care (PCC)-related activities are widely used to enhance outcomes in patients with schizophrenia. However, few studies have examined and identified the PCC factors essential to achieving better outcomes in patients with schizophrenia. PURPOSE: This study was designed to identify the Picker-Institute-identified PCC domains associated with satisfaction and to determine which of these domains are most important in the context of schizophrenia care. METHODS: Data were collected using patient surveys in outpatient settings and record reviews at two hospitals in northern Taiwan between November and December 2016. PCC data were collected in five domains: (a) support of patient autonomy; (b) goal setting; (c) collaboration and integration of healthcare services; (d) information, education, and communication; and (e) emotional support. The outcome measure was patient satisfaction. The study controlled for demographic factors, including age, gender, education, occupation, marriage, and urbanization level in the respondent's area of residence. Clinical characteristics included the Clinical Global Impressions severity and improvement index scores, previous admission, previous emergency department visit, and readmission within 1 year. Methods were adopted to prevent common method variance bias. Multivariable linear regression with stepwise selection and the generalized estimating equation were used to analyze the data. RESULTS: After controlling for confounding factors, the generalized estimating equation model found only three PCC factors significantly associated with patient satisfaction, which differed slightly from the results of the multivariable linear regression. These three factors are as follows, in order of importance: information, education, and communication (parameter = 0.65 [0.37, 0.92], p < .001); emotional support (parameter = 0.52 [0.22, 0.81], p < .001); and goal setting (parameter = 0.31 [0.10, 0.51], p = .004). CONCLUSIONS: The three critical PCC-related factors were evaluated in terms of enhancing patient satisfaction in patients with schizophrenia. Practicable strategies related to these three factors should also be developed for implementation in clinical settings.

The First Nationwide Surveillance of Severe Fever with Thrombocytopenia Syndrome in Ruminants and Wildlife in Taiwan.

Since the first discovery of severe fever with thrombocytopenia syndrome virus (SFTSV) in China in 2009, SFTSV has rapidly spread through other Asian countries, including Japan, Korea, Vietnam and Pakistan, in chronological order. Taiwan reported its first discovery of SFTSV in sheep and humans in 2020. However, the prevalence of SFTSV in domestic and wildlife animals and the geographic distribution of the virus within the island remain unknown. A total of 1324 animal samples, including 803 domestic ruminants, 521 wildlife animals and 47 tick pools, were collected from March 2021 to December 2022 from 12 counties and one terrestrial island. The viral RNA was detected by a one-step real-time reverse transcription polymerase chain reaction (RT-PCR). Overall, 29.9% (240/803) of ruminants showed positive SFTSV RNA. Sheep had the highest viral RNA prevalence of 60% (30/50), followed by beef cattle at 28.4% (44/155), goats at 28.3% (47/166), and dairy cows at 27.5% (119/432). The bovine as a total of dairy cow and beef cattle was 27.8% (163/587). The viral RNA prevalence in ticks (predominantly Rhipicephalus microplus) was similar to those of ruminants at 27.7% (13/47), but wild animals exhibited a much lower prevalence at 1.3% (7/521). Geographically the distribution of positivity was quite even, being 33%, 29.1%, 27.5% and 37.5% for northern, central, southern and eastern Taiwan, respectively. Statistically, the positive rate of beef cattle in the central region (55.6%) and dairy cattle in the eastern region (40.6%) were significantly higher than the other regions; and the prevalence in Autumn (September-November) was significantly higher than in the other seasons (p < 0.001). The nationwide study herein revealed for the first time the wide distribution and high prevalence of SFTSV in both domestic animals and ticks in Taiwan. Considering the high mortality rate in humans, surveillance of other animal species, particularly those in close contact with humans, and instigation of protective measures for farmers, veterinarians, and especially older populations visiting or living near farms or rural areas should be prioritized.

Effects of starvation on the pharmacokinetics and optimal dosages of florfenicol and associated serum biochemistry in Asian seabass (Lates calcarifer).

Starvation has influence on physiology and pharmacokinetic (PK) characteristics of many drugs in land animals. However, similar PK information in fish is lacking. The current study examined the effects of starvation on fish PK, taking florfenicol (FF) in Asian seabass as an example. FF was orally administered at a single dose of 10 mg/kg into 35-day starved fish reared at 25 and 30°C and the serum FF concentration was analyzed by HPLC-FLD. At 30°C, the absorption and elimination half-lives of the starved fish were increased by 30% (from 0.44 to 0.57 h) and 55% (from 7.2 to 11.18 h), respectively. The volume of distribution, clearance, and area under the curve were changed from 1.25 to 0.71 L/kg, 0.120 to 0.044 L/kg/h, and 88 to 228 h·µg/ml, respectively. Similar starvation-induced PK changes were also observed at 25°C. The serum biochemical parameters, mainly the alanine aminotransferase, aspartate aminotransferase, and glucose levels, were significantly reduced in the starvation group. Overall, FF absorption, distribution, and elimination rates were reduced by starvation, resulting in four to five times lower optimal dosage than the non-starved fish. Drug treatment in starved fish should be treated with caution as overdosing and/or tissue residues could perceivably occur.

Pharmacokinetics, optimal dosages and withdrawal time of florfenicol in Asian seabass (Lates calcarifer) after oral administration via medicated feed.

Asian seabass (Lates calcarifer) is an economically important fish in Asian and Australian markets, but few pharmacokinetic (PK) data of antimicrobial drugs in this species is available. The present study investigated the PK behaviour of florfenicol (FF) through medicated feed in Asian seabass cultured at 25°C. The serum and muscle/skin concentrations of FF and its metabolite florfenicol amine (FFA) were determined by the HPLC-FLD method and analysed by one-compartmental model. The optimal dosages were determined by pharmacokinetic-pharmacodynamic (PK-PD) approach and the linear regression analysis was used to determine the withdrawal time (WDT). The PK study following a single oral administration of 15 mg/kg FF via medicated feed revealed that the absorption half-life (t1/2Ka ), elimination half-life (t1/2K ), peak concentration (Cmax ), area under the concentration-time curve (AUC), volume of distribution (Vd/F) and clearance (CL/F) were 1.47 h, 8.07 h, 8.61 µg/ml, 146.41 h·µg/ml, 1.19 L/kg and 0.102 L/kg/h, respectively. The muscle/skin concentration-time profile was similar to that of the serum, suggesting well distribution but only a small fraction of FF was metabolized to FFA. The optimal dosage for a minimum inhibitory concentration of 2 µg/ml was calculated as 13.38 mg/kg/day. The appropriate WDT after multiple oral medications with 15 mg/kg FF once daily for 7 days was determined as 8 days. Information obtained from the current study can potentially be applied for the treatment of bacterial diseases in farming Asian seabass.

Effects of temperature on the pharmacokinetics, optimal dosage, tissue residue, and withdrawal time of florfenicol in asian seabass (lates calcarifer).

Drug behavior in the bodies of fish is largely influenced by the water temperature. Antimicrobial drugs are needed for the control of bacterial outbreaks in farmed fish including Asian seabass (Lates calcarifer). However, little is known about the temperature effect on appropriate drug uses in this species. The purpose of this study was to investigate the differences in pharmacokinetics (PK), optimal dosages, tissue depletion, and withdrawal time (WDT) of florfenicol (FF) in Asian seabass reared at 25 and 30 °C. In the PK study, the fish were administered with a single oral dose of 10 mg/kg FF. The optimal dosing regimen was determined by the pharmacokinetic-pharmacodynamic (PK-PD) approach. In the tissue depletion and WDT study, FF was administered at the optimal dosages once daily for 5 days and the WDT was determined by linear regression analysis based on the sum of FF and its metabolite florfenicol amine (FFA) in the muscle/skin. When the temperature was increased from 25 to 30 °C, the elimination half-life of FF was significantly decreased from 11.0 to 7.2 h. While the other PK parameters were not changed significantly, the calculated optimal dosages for the target minimum inhibitory concentration (MIC) of 2 µg/mL were 10.9 and 22.0 mg/kg/day, respectively for 25 and 30 °C. The sum of FF + FFA is a preferable marker residue for WDT determination because differential FF metabolism was observed at different temperatures. The depletion half-life of the muscle/skin was shortened from 41.1 to 32.4 h by the 5 °C temperature increase. Despite different absolute amounts of FF given between the two temperature levels, the WDTs were very similar at 6-7 days. Thus, it appears that a single temperature-independent WDT can potentially be assigned when the drug was applied at the optimal dosage.

Healthy Eating Enhances Intrinsic Capacity, Thus Promoting Functional Ability of Retirement Home Residents in Northern Taiwan.

Healthy aging is defined as the process of developing and maintaining functional ability in older age with intrinsic capacity, the composite of all the physical and mental capacities of an individual, being the core. This study was conducted to explore the intervention effects of improved dietary quality on intrinsic capacity. A prospective single-group interventional quasi-experimental study with 59 functional independent older adults from retirement homes were recruited. Texture-modified plant-based dietary supplements were provided. In addition, dietary intake, functional ability, and intrinsic capacity in vitality, locomotion, cognition, and psychological capacity were assessed. Vitality was captured by nutritional status, muscle strength, and cardiorespiratory endurance. Locomotor capacity was assessed based on the performance of physical fitness in backscratch test, chair-sit-and-reach test, chair-stand test, one-foot-standing test, and gaits peed. Psychomotor capacity and cognition were measured by using 15-item Geriatric Depression Scale (GDS-15) and Mini-Mental State Examination (MMSE), respectively. In a 4-month of intervention, after controlling for baseline values and covariates, participants with higher dietary intervention adherence showed a significant improvement over time in vitality captured by cardiorespiratory endurance (Pinteraction = 0.009) and significant improvement in locomotion captured by gait speed (Pclusters = 0.034). A significant decrease in the chair-stand test (Ptime = <0.001) and MMSE (Ptime = 0.022) was observed during the four months of intervention. Enhanced intrinsic capacity further contributed to the improvement of ADL over time (Pinteraction = 0.034). In conclusion, healthy eating enhances intrinsic capacity in vitality and locomotion thus promoting functional ability among older adults.

Systematic Review and Meta-Analysis of Inguinal Versus Classic Obturator Nerve Block.

Obturator nerve block (ONB) has been widely applied in transurethral resection of bladder tumor and knee surgery to prevent serious complications such as bladder perforation or to improve the quality of anesthesia during knee surgery. The classic/pubic and inguinal ONB methods are the two primary approaches used. The classic and inguinal ONB methods are two techniques for anesthetizing the obturator nerve, and each method may result in different respective outcomes. We aimed to compare the efficacy of the classic and inguinal methods. We presumed the inguinal approach to be an overall superior technique because it was recently invented and has been reported to provide numerous benefits. This study included randomized controlled trials comparing classic and inguinal approaches to ONB. Two independent investigators extracted study-level data for a random-effects meta-analysis of the comparison between the classic approach and inguinal approaches. We identified five studies comprising 312 patients. The pooled results revealed a higher success rate (risk ratio, 1.15; 95% confidence interval [CI], 1.04-1.27), fewer puncture attempts (mean difference, -0.84; 95% CI, -1.55 to -0.12), and shorter procedure time (mean difference, -28.87; 95% CI, -47.19 to -10.54) for patients given inguinal ONB. The inguinal approach is, overall, the superior method for performing the ONB procedure. The inguinal method resulted in a higher success rate, fewer puncture attempts, and shorter procedure time.