Prospective case-control study on pain intensity after the use of promethazine in patients undergoing videothoracoscopy.

Objective: Effective and secure pain management following video-assisted thoracoscopic surgery (VATS) is crucial for rapid postoperative recovery. This study evaluated analgesic and sedative effects of sufentanil and promethazine in patient-controlled intravenous analgesia (PCIA) post-thoracic surgery, along with potential adverse reactions. Methods: In this prospective, randomized, controlled, double-blind, clinical study, 60 patients (American Society of Anesthesiologists status I-III) undergoing VATS were enrolled. The patients were randomized into experimental (Group P) or control (Group C) groups. PCIA was administered post-general anesthesia using a double-blind method. Group P received sufentanil (3 µg/kg) + promethazine (1 mg/kg) + 0.9% sodium chloride solution (100 mL total), while Group C received sufentanil (3 µg/kg) + 0.9% sodium chloride solution (100 mL total). PCIA settings included a 1-mL bolus and 15-min locking time. The primary outcomes were the visual analog scale (VAS) at rest and during coughing and sedation (Ramsay) scores at 6, 12, 24, and 48 h. The secondary outcomes were rescue drug use rate, hemodynamic parameters (mean arterial pressure and heart rate), percutaneous oxygen saturation, respiratory rate, and occurrence of adverse reactions. Results: Group P exhibited lower resting and coughing VAS scores at 6, 12, 24, and 48 h, plus decreased incidence of nausea and vomiting within 48 h post-surgery compared with Group C (p < 0.05). No significant differences were observed in pruritus, sedation (Ramsay) scores, mean arterial pressure, heart rate, oxygen saturation, or respiratory rate between the two groups (p > 0.05). Discussion: The combination of sufentanil and promethazine for postoperative intravenous analgesia could effectively reduce adverse effects such as nausea and vomiting, contributing to postoperative pain relief.

Evaluation of the effect of fluid management on intracranial pressure in patients undergoing laparoscopic gynaecological surgery based on the ratio of the optic nerve sheath diameter to the eyeball transverse diameter as measured by ultrasound: a randomised controlled trial.

BACKGROUND: During gynecological laparoscopic surgery, pneumoperitoneum and the Trendelenburg position (TP) can lead to increased intracranial pressure (ICP). However, it remains unclear whether perioperative fluid therapy impacts ICP. The purpose of this research was to evaluate the impact of restrictive fluid (RF) therapy versus conventional fluid (CF) therapy on ICP in gynecological laparoscopic surgery patients by measuring the ratio of the optic nerve sheath diameter (ONSD) to the eyeball transverse diameter (ETD) using ultrasound. METHODS: Sixty-four patients who were scheduled for laparoscopic gynecological surgery were randomly assigned to the CF group or the RF group. The main outcomes were differences in the ONSD/ETD ratios between the groups at predetermined time points. The secondary outcomes were intraoperative circulatory parameters (including mean arterial pressure, heart rate, and urine volume changes) and postoperative recovery indicators (including extubation time, length of post-anaesthesia care unit stay, postoperative complications, and length of hospital stay). RESULTS: There were no statistically significant differences in the ONSD/ETD ratio and the ONSD over time between the two groups (all p > 0.05). From T2 to T4, the ONSD/ETD ratio and the ONSD in both groups were higher than T1 (all p < 0.001). From T1 to T2, the ONSD/ETD ratio in both groups increased by 14.3%. However, the extubation time in the RF group was shorter than in the CF group [median difference (95% CI) -11(-21 to -2) min, p = 0.027]. There were no differences in the other secondary outcomes. CONCLUSION: In patients undergoing laparoscopic gynecological surgery, RF did not significantly lower the ONSD/ETD ratio but did shorten the tracheal extubation time, when compared to CF. TRIAL REGISTRATION: ChiCTR2300079284. Registered on December 29, 2023.

Semi-quantitative study on the secondary compression characteristics of municipal solid waste in aerobic and anaerobic bioreactors.

Aeration plays a crucial role in accelerating the secondary compression of municipal solid waste (MSW) for the scientific implementation of aerobic bioreactor technology. There are few comparative reports on the secondary compaction characteristics of MSW in aerobic and anaerobic bioreactors. In this study, six long-term compression tests were conducted to analyze the impact of aeration on MSW compression characteristics, considering two degradation conditions (i.e. aerobic and anaerobic conditions) and three overburden stresses (i.e. 30, 50 and 100 kPa). Model-fitting analysis was employed to examine the data from the tests and exiting literatures. The results showed that aeration effectively increased the rate of secondary compression, and slightly enhanced the steady-state secondary compression strain. In addition, these enhancements tended to decrease with increasing stresses. The increment ratio of the secondary compression rate constant (Rk) was concentrated in the range of 25 % to 100 %, and increases with the increase of aeration rate. The increment ratio of the steady-state secondary compression strain (Rε) ranged from 10 % to 90 %, for the MSW with higher content of paper and wood exhibited higher Rε. The advance ratio of the secondary compression stabilization time (Rt) fell within the range of 20-50 %, and Rt is higher when the moisture content is in the range of 50-65 %. These findings provide valuable guidance on the accelerated stabilization in aerobic bioreactors, providing practical references for the application of aerobic technology to informal landfills.

Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery.

BACKGROUND: To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. METHODS: The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. RESULTS: A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. CONCLUSION: The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.

Prospective comparison of the effects of intraoperative goal-directed fluid therapy and restrictive fluid therapy on complications in thoracoscopic lobectomy.

OBJECTIVE: Restrictive fluid therapy is recommended in thoracoscopic lobectomy to reduce postoperative pulmonary complications, but it may contribute to hypovolemia. Goal-directed fluid therapy (GDFT) regulates fluid infusion to an amount required to avoid dehydration. We compared the effects of GDFT versus restrictive fluid therapy on postoperative complications after thoracoscopic lobectomy. METHODS: In total, 124 patients who underwent thoracoscopic lobectomy were randomized into the GDFT group (group G, n = 62) or restrictive fluid therapy group (group R, n = 62). The fluid volume and postoperative complications within 30 days of surgery were recorded. RESULTS: The total fluid volume in groups G and R was 1332 ± 364 and 1178 ± 278 mL, respectively. Group R received a smaller colloid fluid volume (523 ± 120 vs. 686 ± 180 mL), had a smaller urine output (448 ± 98 vs. 491 ± 101 mL), and received more norepinephrine (120 ± 66 vs. 4 ± 18 µg) than group G. However, there were no significant differences in postoperative pulmonary complications, acute kidney injury, length of hospital stay, or in-hospital mortality between the two groups. CONCLUSION: Restrictive fluid therapy performs similarly to GDFT in thoracoscopic lobectomy but is a simpler fluid strategy than GDFT.Trial registration: This study has been registered at the Chinese Clinical Trial Registry (ChiCTR2100051339) (http://www.chictr.org.cn/index.aspx).

Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section.

OBJECTIVE: To investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia. METHODS: This was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally. RESULTS: There were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns' Apgar scores between the groups. CONCLUSION: Adding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.

Analytical model for organic contaminant transport through GMB/CCL composite liner with finite thickness considering adsorption, diffusion and thermodiffusion.

A new analytical model for organic contaminant transport through GMB/CCL (geomembrane and compacted clay liner) composite liner is developed, which can consider adsorption, diffusion and thermodiffusion processes and is applicable for typical bottom boundary conditions. The separation of variables method is adopted to derive the solution. The present model is first verified against experimental results and a numerical model. The influence of thermodiffusion on organic contaminant transport in composite liner is then investigated. Toluene is adopted as the representative organic contaminant. The results reveal that when the Soret coefficient ST is not less than 0.01 K-1, the effect of thermodiffusion should be taken into account on the contaminant transport in GMB/CCL composite liner in wet landfills. When the Soret coefficient ST is 0.03 K-1, the breakthrough time of a GMB + 0.75 m CCL composite liner and a 2 m CCL would be overestimated by 20% to 76% due to omitting of the effect of thermodiffusion. Namely, the barrier performance would be greatly overestimated if the effect of thermodiffusion is neglected in these cases. In other aspects, the thermal conductivity of GMB and CCL has little effect on the contaminants transport in GMB/CCL composite liners, so there is no need to modify the materials for this parameter. The present model is an applicable tool for evaluating the barrier performance of the GMB/CCL composite liner, and can provide valuable advices for improving the liner materials.

Transient analytical solution for one-dimensional transport of organic contaminants through GM/GCL/SL composite liner.

Analytical solution for transport of organic contaminants through composite liner consisting of a geomembrane (GM), a geosynthetic clay liner (GCL), and a soil liner (SL) with finite thickness is presented. The transient diffusion-advection processes in the whole composite liner and adsorption in GCL and SL can be described by the present method. The method is successfully verified against analytical solution to a coupling transient diffusion-advection problem in double-layer porous media. The rationality of the steady-state transport assumption in GM and GCL and the semi-infinite bottom boundary assumption, which are widely adopted in the existing works, is comprehensively investigated. The overestimated zone, underestimated zone and no difference zone caused by the two assumptions under various conditions are identified. With the increase of elapsed time, the overestimated zone disappears, and the underestimated zone becomes smaller and smaller and finally is overwhelmed by the no difference zone. Moreover, the equivalency between GM/GCL/SL and GM/CCL composite liners is also properly assessed by the present method. GM/GCL/SL composite liner performs better than GM/CCL composite liner under high leachate level condition.

Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: A randomized controlled trial.

OBJECTIVE: Goal-directed fluid therapy (GDFT) was associated with improved outcomes after surgery. Noninvasive Cardiac Output Monitoring (NICOM) has proved to be a good choice for guiding GDFT. This study evaluated the effect of GDFT based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor. METHODS: Fifty patients scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancer in Yongchuan Hospital of Chongqing Medical University between November 2014 and December 2015 were included and randomly divided into two groups: conventional fluid therapy (group C, n=25) and goal-directed fluid therapy (group G, n=25). The primary outcome was moderate or severe postoperative complications within 30 days. RESULTS: Finally, 45 patients successfully completed the study (group G, n=22; group C, n=23). There were no difference of the duration of surgery, the requirement of vasoactive agents and the bleeding volume between two groups (P>0.05). Total fluids infused were 2956±629 ml (group C) and 2259±454 ml (group G) (P<0.05), while the requirement of colloid was increased in group G (1103±285ml vs 855±226ml) (P<0.05). The MAP and the mean CI were higher in group G (P<0.05). Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened in group G (12.6±2.4day vs17.2±2.6day), the incidence of postoperative complications were significantly lower in group G (P<0.05). CONCLUSIONS: Goal-directed fluid therapy based on NICOM was significantly associated with improvement of prognosis in elderly patients undergoing resection of gastrointestinal tumor which reduced postoperative complications.

Effects of epidural anesthesia combined with inhalation anesthesia or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation.

OBJECTIVE: To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation. METHODS: Eighty patients, aged 35-75, American Society of Anesthesiology (ASA) classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group (group Pro), propofol combined with epidural anesthesia group (group Pro+Epi), isoflurane group (group Iso) and isoflurane combined with epidural anesthesia group (group Iso+ Epi), 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position (T1), 30min after bilateral lung ventilation (T2), 15min after one lung ventilation (T3), 30min after one lung ventilation (T4), 60min after one lung ventilation (T5), 180min after one lung ventilation (T6), intrapulmonary shunt (Qs/Qt) was calculated according to the correlation formula. RESULTS: Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 (P< 0.05); PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 (P< 0.05). Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 (P< 0.05). There was no significant difference in PaO2 between groups (P> 0.05). CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 (P<0.05), and were significantly higher than that of propofol group (P<0.05). MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 (P <0.05). Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi (P <0.05). CONCLUSION: One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen.

LPS Pretreatment Attenuates Cerebral Ischaemia/Reperfusion Injury by Inhibiting Inflammation and Apoptosis.

BACKGROUND/AIMS: Lipopolysaccharide (LPS) pretreatment has a strong neuroprotective effect on cerebral ischaemia/reperfusion injury (IRI), but the mechanism has not been fully elucidated to date. This study investigated the effect of LPS pretreatment on the pathway mediated by endoplasmic reticulum (ER) stress-CCAAT/enhancer-binding protein- homologous protein (CHOP) and the role of this pathway on cerebral ischaemia/reperfusion (I/R)-induced inflammation and apoptosis. METHODS: Healthy male BALB/c mice were randomised into four groups as follows: sham operation group (sham group, n=30); LPS group (BALB/c mice treated with LPS, n=30); ischaemia/reperfusion group (I/R group, n=30) and I/R+LPS group (BALB/c mice treated with LPS before ischaemia, n=30). The mice were pre-treated with LPS (0.2 mg/kg) intra-peritoneally for three days prior to cerebral ischaemia. After 24 hours, the neurological deficit score, TTC staining and TUNEL assay were used to assess the neuroprotective effect of the LPS pretreatment against cerebral IRI. To assess whether the ER stress-CHOP pathway participated in the LPS-pretreatment neuroprotective mechanism, the expression levels of related proteins (GRP78, CHOP, caspase-12 and caspase-3) from the ischaemic cortical penumbra were detected via a western blot analysis. An immunohistochemical study was used to detect the expression and location of CHOP in the cortical penumbra. To further assess the protective effect of the LPS pretreatment, the concentrations of inflammatory factors (TNF-α, IL-6, IL-1ß and IL-10) in the cortical penumbra were measured by ELISA, and ER stress-CHOP pathway inflammation-related caspase-11 was analysed through western blot analysis. RESULTS: As demonstrated by the experiments, the pretreatment with LPS significantly reduced the neurological deficit score and the infarct size of cerebral IRI. The expression levels of ER stress-CHOP pathway related proteins (GRP78, CHOP, caspase-12 and caspase-3) from the cortical penumbra were significantly decreased by LPS, as well as the level of apoptosis in the cells in the brain. Immunohistochemistry showed that the expression of CHOP significantly decreased after the LPS pretreatment. Furthermore, the concentrations of inflammatory factors (TNF-α, IL-1ß, IL-6) were reduced after the LPS pretreatment, whereas the anti-inflammatory cytokine IL-10 was upregulated. In addition, ER stress-CHOP pathway inflammation-related caspase-11 expression was significantly suppressed after the pretreatment with LPS. CONCLUSIONS: LPS pretreatment significantly ameliorates the effects of cerebral IRI by inhibiting inflammation and apoptosis, and the potential mechanism of the neuroprotective effect may be associated with the ER stress-CHOP mediated signalling pathway.

Analgesic effect of different dosage of Flurbiprofen axetil in laparoscopic cholecystectomy in comparison with other analgesic drugs.

Flurbiprofen axetil is a non-selective cyclooxygenase inhibitor. It can target the aggregation with lipid micro sphere as drug carrier, and exert analgesic effect in surgical incision and inflammatory site. In laparoscopic cholecystectomy comparative study on analgesic effect of parecoxib and flurbiprofen axetil is relatively less. Therefore, this paper is mainly based on the observation of patients after resting VAS score, adverse reaction time and movement, to evaluate the analgesic effect of different drug dose of flurbiprofen and parecoxib sodium, which provides reference for clinical medication. The results show that the intravenous injection of parecoxib could provide effective analgesic effect in laparoscopic cholecystectomy. Also, compared with flurbiprofen, parecoxib shows a more significant analgesic effect.

Report - Cerebral electrical impedance value reflects brain edema caused by cardiopulmonary bypass in infants.

The study aimed to investigate if the dynamic changes in cerebral electrical impedance (CEI) values could be used to monitor brain edema during cardiopulmonary bypass (CPB) in infants. Forty infants (mean age: 1.4±0.38y) with acyanotic congenital heart disease who underwent CPB open-heart surgery between September 2009 and March 2010 were prospectively enrolled, and divided into 2 groups based on aortic cross-clamping (ACC) time: CPB-A (ACC<50 min) and CPB-B (ACC<50 min). During the same period, twenty infants (aged 1-3y) who underwent surgery for indirect inguinal hernias were selected as controls. Serum astrocyte S100 protein (S100) and neuron-specific enolase (NSE) levels were determined before and after CPB. Changes in CEI were detected using the BORN-BE system. No intraoperative death occurred. Compared with controls, left and right side CEI values, serum S100 and NSE levels in the CPB groups significantly increased from surgery beginning to end (P<0.05). After surgery, these levels decreased (P<0.05). Detection rates of cerebral edema in the CPB-B group 24h post-operative were significantly higher than in the CPB-A group (P<0.05). CEI value can be used to dynamically monitor brain edema in infants undergoing CPB, and is an index reflecting brain damage during CPB in infants.

Analysis of the impact of extracellular acidity on the expression and activity of P-glycoprotein and on the P-glycoprotein-mediated cytotoxicity of daunorubicin in cancer cell by microfluidic chip technology.

OBJECTIVE: To explore the impact of extracellular acidic environment on the expression and activity of P-glycoprotein (P-gp) and on the P-gp-mediated cytotoxicity of daunomycin in cancer cells by using microfluidic chip technology. METHODS: The A549 cells cultured on a microfluidic chip were divided into experiment group and control group. The experiment group was exposed to an acidic cell culture medium (pH 6.6), while the control group was treated with a neutral cell culture medium (pH 7.4). The expression of P-gp was detected by cell immunofluorescense analysis and the activity of P-gp was evaluated by Rhodamine 123 efflux experiment. Meanwhile, the cytotoxicity of daunomycin was analyzed by cell live/dead fluorescence staining method. RESULTS: Microfluidic chip designed in this study could provide a suitable microenvironment for the growth of A549 cells and the A549 cells reached the confluence of 90% after inoculation for 72 h. Treatment of the acidic cell culture media on A549 cells did not make a significant difference on the expression level of P-gp. However, the activity of P-gp was significantly enhancement and peaked at 6 h after treatment with acidic cell culture media. Meanwhile, the cytotoxicity of daunomycin reduced significantly after treatment with acidic cell culture medium for 6 h,and a reversal effect was obtained when synergy with verapamil. CONCLUSIONS: Microfluidic chip technology can shorten the analysis time and reduce the reagent consumption. It can be used as a new technology platform for understanding the mechanisms of multi-drug resistance and for screening highly efficient multi-drug resistance reversal agents.

The stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients.

Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine.