Effect of Dexmedetomidine and Two Different Doses of Esketamine Combined Infusion on the Quality of Recovery in Patients Undergoing Modified Radical Mastectomy for Breast Cancer - A Randomised Controlled Study.

Purpose: This study evaluated the effect of a combined infusion of dexmedetomidine and esketamine on the quality of recovery in patients undergoing modified radical mastectomy. Methods: A total of 135 patients were randomly divided into three groups: dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion), dexmedetomidine plus low-dose esketamine group (group DE1) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 2 µg/kg/min infusion), dexmedetomidine plus high-dose esketamine group (group DE2) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 4 µg/kg/min infusion). The primary outcome was the overall quality of recovery-15 (QoR-15) scores at 1 day after surgery. The secondary endpoints were total QoR-15 scores at 3 days after surgery, propofol and remifentanil requirement, awaking and extubation time, postoperative visual analogue scale (VAS) pain scores, rescue analgesic, nausea and vomiting, bradycardia, excessive sedation, nightmares, and agitation. Results: The overall QoR-15 scores were much higher in groups DE1 and DE2 than in groups D 1 and D 3 days after surgery (P < 0.05). VAS pain scores at 6, 12, 24 h postoperatively, propofol and remifentanil requirements were significantly lower in groups DE1 and DE2 than in group D (P < 0.05). Compared with group D, awaking time, extubation time, and post-anesthesia care unit (PACU) stay were significantly prolonged in groups DE1 and DE2 (P < 0.05) and were much longer in group DE2 than in group DE1 (P < 0.05). The proportion of postoperative rescue analgesics and bradycardia was higher and the incidence of excessive sedation was lower in group D than in groups DE1 and DE2 (P < 0.05). Conclusion: Dexmedetomidine plus esketamine partly improved postoperative recovery quality and decreased the incidence of bradycardia but prolonged awaking time, extubation time, and PACU stay, especially dexmedetomidine plus 4 µg/kg/min esketamine.

Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study.

Purpose: The aim of this study was to compare the effects of remimazolam and propofol on emergence agitation (EA) in elderly patients undergoing hip replacement. Methods: A total of 60 elderly patients undergoing hip replacement were recruited for this prospective, single-center, clinical, randomized, controlled study from February to April 2023. They were randomly assigned to two groups: the remimazolam group (group R) and the propofol group (group P). In group R, remimazolam was administered intravenously during the induction and maintenance of anesthesia, In group P, propofol was used during the induction and maintenance of anesthesia. The incidence of EA was recorded as the primary indicator. Secondary indicators included heart rate (HR) and mean arterial pressure (MAP) values at the following moments: 5 min prior to anesthetic induction (T0), 1 min following induction (T1), 5 min after the laryngeal mask was inserted (T2), the beginning of surgery (T3), the moment the laryngeal mask was removed (T4), and the overall incidence of postoperative adverse events (bleeding or splitting of the surgical incision, removal of the intravenous infusion needle, falling off the bed, hypoxemia, and hypertension). Results: The incidence of EA was significantly lower in group R than in group P (10% vs 33%, P < 0.05). At T1, T2, and T3, the HR and MAP values of group R were higher than those of group P (P < 0.05). The overall incidence of postoperative adverse events was significantly lower in group R than in group P (P < 0.05). Conclusion: Remimazolam further reduced the incidence of emergence agitation when compared to propofol during geriatric hip replacement. Moreover, it has a minor hemodynamic effect and lower the incidence of postoperative adverse events.

When does paternalistic control positively relate to job satisfaction and citizenship behavior in Taiwan? The role of follower expectation.

Although prior research predicts mainly that followers expect leaders to exert less paternalistic control (such as emphasis on discipline, didactic instruction, and belittling followers), we argue that such an expectation may not be stable overtime or across settings. Based on the connectionist perspectives of implicit leadership theories, we propose a follower expectation model of paternalistic control, in which followers compare their perceived with expected levels of paternalistic control. Two inconsistent conditions-insufficient and excessive control-are identified, and the consistency between perceived and expected paternalistic control is predicted to relate to favorable follower outcomes. We examine this model by conducting two daily experience sampling studies in Taiwan. Our findings indicate that insufficient control is as unfavorable as excessive control in lowering followers' job satisfaction and citizenship behavior, and this pattern is particularly salient in terms of emphasis on discipline and the belittling of followers. A supplemental, qualitative analysis additionally demonstrated the conditions under which the expectation-perception consistency regarding belittling followers relates to favorable follower responses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Refinement of the Fusion Tag PagP for Effective Formation of Inclusion Bodies in Escherichia coli.

Methods for efficient insoluble protein production require further exploration. PagP, an Escherichia coli outer membrane protein with high ß-sheet content, could function as an efficient fusion partner for inclusion body-targeted expression of recombinant peptides. The primary structure of a given polypeptide determines to a large extent its propensity to aggregate. Herein, aggregation "hot spots" (HSs) in PagP were analyzed using the web-based software AGGRESCAN, leading to identification of a C-terminal region harboring numerous HSs. Moreover, a proline-rich region was found in the ß-strands. Substitution of these prolines by residues with high ß-sheet propensity and hydrophobicity significantly improved its ability to form aggregates. Consequently, the absolute yields of recombinant antimicrobial peptides Magainin II, Metchnikowin, and Andropin were increased significantly when expressed in fusion with this refined version of PagP. We describe separation of recombinant target proteins expressed in inclusion bodies fused with the tag. An artificial NHT linker peptide with three motifs was implemented for separation and purification of authentic recombinant antimicrobial peptides. IMPORTANCE Fusion tag-induced formation of inclusion bodies provides a powerful means to express unstructured or toxic proteins. For a given fusion tag, how to enhance the formation of inclusion bodies remains to be explored. Our study illustrated that the aggregation HSs in a fusion tag played important roles in mediating its insoluble expression. Efficient production of inclusion bodies could also be implemented by refining its primary structure to form a more stable ß-sheet with higher hydrophobicity. This study provides a promising method for improvement of the insoluble expression of recombinant proteins.

Acyl carrier protein tag can enhance tobacco etch virus protease stability and promote its covalent immobilisation.

Fusion expression is widely employed to enhance the solubility of recombinant proteins. However, removal of the fusion tag is often required due to its potential impact on the structure and activity of passenger proteins. Tobacco etch virus (TEV) protease is widely used for this purpose due to its stringent sequence recognition. In the present work, fusion to the acyl carrier protein from E. coli fatty acid synthase (ACP) significantly increased the yield of recombinant soluble TEV, and the ACP tag also greatly improved TEV stability. The cleavage activity of TEV was not affected by the ACP fusion tag, and ACP-TEV retained high activity, even at unfavourable pH values. Moreover, ACP-TEV could be efficiently modified by co-expressed E. coli holo-ACP synthase (AcpS), leading to covalent attachment of 4'-phosphopantetheine (4'-PP) group to ACP. The sulfhydryl group of the long, flexible 4'-PP chain displayed high specific reactivity with iodoacetyl groups on the solid support. Thus, TEV could be immobilised effectively and conveniently via the active holo-ACP, and immobilised TEV retained high cleavage activity after a long storage period and several cycles of reuse. As a low-cost and recyclable biocatalyst, TEV immobilised by this method holds promise for biotechnological research and development. KEY POINTS: • The ACP tag greatly increased the soluble expression and stability of TEV protease. • The ACP tag did not affect the cleavage activity of TEV. • The holo-ACP Tag effectively mediated the covalent immobilisation of TEV.

Lamina Variation and Its Relationship with Sedimentary Facies in Alkaline Lacustrine, Permian Fengcheng Formation, Junggar Basin, Northwest China.

The Permian Fengcheng Formation in the Mahu Sag was deposited in a volcanic-alkaline lacustrine evaporative environment and contains a unique variety of fine-grained sediments. This study examines, at a millimeter-scale, the influence of sedimentary microfacies on variability of lamina quality in fine-grained sediments in the second member of the Fengcheng Formation (P1f2). The methods used include thin-section identification, X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM), nitrogen adsorption, and nuclear magnetic resonance (NMR). Six types of lamina were identified in two different lithofacies: fan-delta front facies (FDFF) and semideep/deep lacustrine facies (SDDLF). The laminae in FDFF are predominantly feldspar-quartz laminae (FQL), reedmergnerite laminae (RL), shortite laminae (SL), alkaline mineral laminae (AML), and chert laminae (CL). The laminae in SDDLF are predominantly FQL, RL, SL, CL, and dolomite laminae (DOL). Variations in reservoir quality, oil-bearing properties, and the fracability of laminae in different sedimentary facies are determined by the combined effects of lamina density, mineral composition, rock structure, organic matter abundance, and microfractures. Analysis of these factors indicates superior reservoir qualities in FDFF. In SDDLF, the pore structure is limited by high lamina density, chert content, and fine grain size with the NMR porosities of FQL, RL, SL, and CL being 1.32, 0.18, 0.84, and 0.39%, respectively. However, in FDFF, the combination of high organic matter content, feldspar, pyrite, and clay minerals has a superior effect on the organic matter and minerals deposited resulting in better pore structure and more storage space for shale oil. The NMR porosities of FQL, RL, SL, and CL are 2.81, 2.53, 1.80, and 1.12%, respectively. Overall, analysis of lamina variations and their relationships with sedimentary facies indicates that the reservoir in FDFF may offer more favorable targets for "sweet spot" evaluation.

Effect of co-administration of intravenous lidocaine and dexmedetomidine on the recovery from laparoscopic hysterectomy: a randomized controlled trial.

BACKGROUND: Some evidences have reported that intravenous lidocaine and dexmedetomidine alone can improve the quality of recovery after surgery. The main purpose of our study to explore whether co-administration of lidocaine and dexmedetomidine infusion could further improve the quality of recovery after laparoscopic hysterectomy compared to either lidocaine or dexmedetomidine administration. METHODS: A total of 160 subjects were randomly allocated to four groups: the control group (group C) received an equal volume of normal saline, the lidocaine group (group L) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg for bolus over 10 min before induction of anesthesia, 0.4 µg/kg/h for continuous infusion), the lidocaine plus dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion) and dexmedetomidine combined infusion (0.5 µg/kg for bolus over 10 minutes before induction of anesthesia, 0.4 µg/kg/h for continuous infusion). The primary endpoint was the quality of recovery-40 (QoR-40) scores on postoperative day 1 (POD1). The quality of sleep on POD1, remifentanil total dose, visual analog scale (VAS) pain scores, the number of patients with self-press the pump, time to open eye and extubation, length of postanesthesia care unit (PACU) stay, the incidence of intraoperative bradycardia, hypotension, arrhythmias, hypoxemia in the PACU, and nausea or vomiting within 24 h after surgery were regarded as the secondary outcomes. RESULTS: The total QoR-40 scores were significantly increased in groups L, D, and LD on POD1 compared with group C (all P<0.05). The total QoR-40 scores were the highest in group LD on POD1 compared to other three groups (all P<0.001). Sleep quality was significantly improved in group LD compared to other three groups on POD1 (all P<0.05). The VAS pain scores were obviously reduced at 8 h in group L and at 4, 8 h in group D after surgery compared to group C and were the lowest in group LD (all P<0.05). The number of patients with self-press the pump was significantly reduced in groups D and LD compared to group C (8(20.0%) and 27(67.5%), P<0.001; 2(5.0%) and 27(67.5%), P<0.001, respectively). Length of PACU stay significantly prolonged in groups D (21.7±3.0) and LD (25.5±4.0) compared to group C (19.6±3.3) (P=0.028, P<0.001). The incidence of intraoperative bradycardia was significantly higher in groups D and LD than in groups C and L (all P<0.001). The rate of hypoxemia was higher in groups D (55.0%) and LD (70.0%) than in groups C (15.0%) and L (20.0%) (all P<0.05). The incidence of nausea was lower in group LD (10.0%) than in group C (37.5%) (P<0.05). CONCLUSIONS: Co-administration of lidocaine plus dexmedetomidine infusion improved to some extent the quality of recovery on POD1 compared to lidocaine and dexmedetomidine alone, but it significantly increased the incidence of intraoperative bradycardia and hypoxemia in the PACU, and prolonged the length of PACU stay.

Comparison of rotational and standard methods of i-gel® insertion in patients of advanced age undergoing general anesthesia: a randomized clinical trial.

OBJECTIVE: This study was performed to compare the performance of rotational versus standard insertion of the i-gel® (Intersurgical, Wokingham, Berkshire, England) in patients of advanced age. METHODS: This single-center, randomized, double-blind trial involved 140 patients of advanced age undergoing general anesthesia. The patients were randomized into the standard group and rotational group. The primary objective of this study was to compare the success rate of the first attempt. The secondary outcome indicators were the insertion time and postoperative complications. RESULTS: The placement success rate on the first attempt was significantly higher in the rotational group than in the standard group (92% vs. 73%, respectively). The overall success rate was 100% for the rotational method and 95% for the standard method. The mean ± standard deviation insertion times were similar (15 ± 7.34 vs. 14 ± 7.26 s, respectively). The incidence rates of blood staining of the i-gel®, hoarseness, and sore throat did not increase with the rotational technique and were not significantly different from those of the standard method. CONCLUSION: Compared with the standard method, the rotational method of i-gel® insertion had a higher success rate and did not increase the insertion time and complications in patients of advanced age.Trial registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000038763, Date of registration: 30/09/2020).

Effects of the Different Doses of Esketamine on Postoperative Quality of Recovery in Patients Undergoing Modified Radical Mastectomy: A Randomized, Double-Blind, Controlled Trial.

Purpose: This study aims to investigate the effects of the different doses of esketamine on postoperative quality of recovery in patients undergoing modified radical mastectomy. Methods: Ninety-nine female patients were randomly allocated to three groups: the low-dose esketamine group (group E1) (0.5 mg/kg loading, 2 µg/kg/h infusion), the high-dose esketamine group (group E2) (0.5 mg/kg loading, 4 µg/kg/h infusion), the control group (group C) (received normal saline). The primary outcome was the quality of recovery-15 (QoR-15) scores on postoperative day 1 (POD1) and days 3 (POD3). The secondary outcomes were the sleep quality scores on POD1, bispectral index (BIS) value at 10, 30, and 60 min after operation, numeric rating scale (NRS) pain scores within 24 h after surgery, nausea, vomiting, drowsiness, nightmare, and intraoperative awareness. Results: The total QoR-15 scores were higher in group E1 and group E2 than in group C on POD1 and POD3 (P<0.05). The sleep quality scores on POD1 and BIS value at 10, 30, and 60 min after operation were higher in group E1 and group E2 than in group C (P<0.05). The NRS pain scores at 2, 4 and 6 h after surgery in group E1 and at 2, 4, 6, 12 and 24 h after surgery in group E2 were lower than in group C (P<0.05). The NRS pain scores at 6, 12 and 24 h after surgery in group E2 were lower than in group E1 (P<0.05). The incidence of drowsiness was higher in group E1 and group E2 than in group C (P<0.05). Conclusion: Esketamine infusion improved to some extent the quality of recovery on POD1 and POD3 in patients undergoing modified radical mastectomy, especially 4 µg/kg/h esketamine was better, but the BIS value and incidence of drowsiness were significantly increased.

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial.

INTRODUCTION: Surgical management is commonly used for thyroid cancer. We evaluated the effects of systemic lidocaine versus dexmedetomidine on the recovery quality and analgesia after thyroid cancer surgery. METHODS: A total of 120 patients with thyroid cancer were randomly allocated to group L (received lidocaine 1.5 mg/kg loading, continuously infused 1.5 mg/kg per hour), group D (received dexmedetomidine 0.5 µg/kg loading, continuously infused 0.5 µg/kg per hour) and group C (received normal saline), with 40 cases in each group. Anaesthesia induction and maintenance were performed using target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome of the quality of recovery-15 (QoR-15) score was recorded on the day before surgery and postoperative day 1 (POD1). Secondary outcomes included the consumption of remifentanil during surgery, time to first required rescue analgesia, number of patients requiring rescue analgesia, postoperative cumulative consumption of tramadol, visual analogue scale (VAS) pain score, incidence of postoperative nausea or vomiting (PONV) and side effects. RESULTS: The total score of the QoR-15 at POD1 (median, IQR) was higher in group L (128.0, 122.0-132.8) and group D (127.5, 122.5-132.5) compared to group C (118.5, 113.0-123.5) (P = 0.000). Compared to group C, systemic lidocaine and dexmedetomidine reduced cumulative consumption of remifentanil and VAS pain score (P = 0.000). The time to first required rescue analgesia (mean, SD) was longer in group L (8.1 h, 1.2 h) and group D (8.5 h, 1.9 h) than group C (5.9 h, 0.9 h) (P = 0.000). The number of patients requiring rescue analgesia was lower in group L (8/40, 20%) and group D (6/40, 15%) than group C (16/40, 40%) (P = 0.029), and cumulative consumption of tramadol (mean, SD) was lower in group L (44.0 mg, 17.1 mg) and group D (51.7 mg, 14.1 mg) than group C (73.9 mg, 18.4 mg) (P = 0.000). The incidence of PONV in group L (7/40, 17.5%) and group D (9/40, 22.5%) was lower than group C (18/40, 45.0%) (P = 0.016). Bradycardia (heart rate less than 50 beats/min or lower) was noted in 25 patients (25/40, 62.5%), which was reversed by intravenous administration of atropine 0.5 mg. CONCLUSION: Systemic lidocaine and dexmedetomidine had similar effects on enhancing the quality of recovery, alleviating the intensity of pain and reducing the incidence of PONV after thyroid cancer surgery. However, dexmedetomidine may result in bradycardia. Therefore, lidocaine was superior to dexmedetomidine. TRIAL REGISTRATION: ChiCTR.org.cn (ChiCTR2000038442). Registered on September 22, 2020.

Controlled co-immobilisation of proteins via 4'-phosphopantetheine-mediated site-selective covalent linkage.

In Escherichia coli, acyl carrier protein (ACP) is posttranslationally converted into its active holo-ACP form via covalent linkage of 4'-phosphopantetheine (4'-PP) to residue serine-36. We found that the long flexible 4'-PP arm could react chemoselectively with the iodoacetyl group introduced on solid supports with high efficiency under mild conditions. Based on this finding, we developed site-selective immobilisation of proteins via the active holo-ACP fusion tag, independently of the physicochemical properties of the protein of interest. Furthermore, the molecular ratios of co-immobilised proteins can be manipulated because the tethering process is predominantly directed by the molar concentrations of diverse holo-ACP fusions during co-immobilisation. Conveniently tuning the molecular ratios of co-immobilised proteins allows their cooperation, leading to a highly productive multi-protein co-immobilisation system. Kinetic studies of enzymes demonstrated that α-amylase (Amy) and methyl parathion hydrolase (MPH) immobilised via active tag holo-ACP had higher catalytic efficiency (kcat/Km) in comparison with their corresponding counterparts immobilised via the sulfhydryl groups (-SH) of these proteins. The immobilised holo-ACP-Amy also presented higher thermostability compared with free Amy. The enhanced α-amylase thermostability upon immobilisation via holo-ACP renders it more suitable for industrial application.

Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial.

BACKGROUND: Parathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy. METHODS: Eighty-two uremia patients who underwent parathyroidectomy and exhibited SHPT were randomly allocated to the BSCPB group or the control group (CON group). The patients received ultrasound-guided BSCPB with 7.5 ml of ropivacaine 0.5% on each side (BSCPB group) or equal amount of 0.9% normal saline (CON group). The primary outcome of the Quality of Recovery-40(QoR-40) score was recorded on the day before surgery and postoperative day 1(POD1). Secondary outcomes including total consumption of remifentanil, time to first required rescue analgesia, number of patients requiring rescue analgesia, and total consumption of tramadol during the first 24 h after surgery were recorded. The occurrence of postoperative nausea or vomiting (PONV) and the visual analogue scale (VAS) scores were assessed and recorded. RESULTS: The scores on the pain and emotional state dimensions of the QoR-40 and the total QoR-40 score were higher in the BSCPB group than in the CON group on POD1 (P = 0.000). Compared with the CON group, the total consumption of remifentanil was significantly decreased in the BSCPB group (P = 0.000). The BSCPB group exhibited longer time to first required rescue analgesia (P = 0.018), fewer patients requiring rescue analgesia (P = 0.000), and lower postoperative total consumption of tramadol during the first 24 h after surgery (P = 0.000) than the CON group. The incidence of PONV was significantly lower in the BSCPB group than in the CON group (P = 0.013). The VAS scores in the BSCPB group were lower than those in the CON group at all time-points after surgery (P = 0.000). CONCLUSION: Ultrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV in uremia patients with SHPT following parathyroidectomy. TRIAL REGISTRATION: ChiCTR1900027185 . (Prospective registered). Initial registration date was 04/11/2019.

Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial.

BACKGROUND: A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia. METHODS: A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period. RESULTS: The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0-2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0-2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2-24 and 24-48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05). CONCLUSIONS: Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0-2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03809923 ), registered on January 18, 2019.

Groundwater geochemical signatures and implication for sustainable development in a typical endorheic watershed on Tibetan plateau.

Groundwater resource is significantly important for sustainable development of the world, especially for arid endorheic watersheds. A total of 28 groundwaters were collected for hydrogeochemical analysis from the arid Chaka watershed on Tibetan plateau to illustrate the hydrochemical evolution, formation mechanisms and feasibility of groundwater in small arid endorheic watersheds where groundwater is much scarcer. The results showed groundwater has a slightly alkaline nature, and varies from soft fresh HCO3-Ca type to hard brackish/saline Cl-Na type along the groundwater flow path in the watershed with the total hardness in the range of 270-2,127 mg/L and the total dissolved solids in the range of 282-41,770 mg/L. Nitrogen and fluoride in phreatic water are found sporadically exceeding the permissible limits with the maximum value of 118 mg/L for nitrate, 1.2 mg/L for ammonia and 1.2 mg/L for fluoride. Hydrochemistry of phreatic and confined groundwater is naturally governed by water-rock interactions including minerals (halite, gypsum and anhydrite) dissolution, silicate weathering and cation-exchange reaction. The salinity of phreatic water is also dominantly controlled by the strong evaporation. Human activity is one of the important mechanisms influencing the hydrochemical signature of groundwater regardless of the depth. Groundwater has a great hydrogeochemical discrepancy spatially across the watershed and varies from excellent to extremely poor quality in phreatic aquifers. A better water quality that under the good to medium categories was observed in the confined aquifers with 80% of samples having the EWQI value less than 100 and others in the range of 100-150. Phreatic groundwater away from the river and in the downstream area has a relatively poor quality for domestic and agricultural purposes, and should be avoided to direct utilization. This research can improve the understanding of groundwater hydrogeochemical feature, genesis, and its constraints on the availability and feasibility of groundwater resources in small arid watersheds worldwide.

Effects of intravenous lidocaine, dexmedetomidine, and their combination on IL-1, IL-6 and TNF-α in patients undergoing laparoscopic hysterectomy: a prospective, randomized controlled trial.

BACKGROUND: Surgical-related inflammatory responses have negative effects on postoperative recovery. Intravenous (IV) lidocaine and dexmedetomidine inhibits the inflammatory response. We investigated whether the co-administration of lidocaine and dexmedetomidine could further alleviate inflammatory responses compared with lidocaine or dexmedetomidine alone during laparoscopic hysterectomy. METHODS: A total of 160 patients were randomly allocated into four groups following laparoscopic hysterectomy: the control group (group C) received normal saline, the lidocaine group (group L) received lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD) received a combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The levels of plasma interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) at different time points were the primary outcomes. Secondary outcomes included hemodynamic variables, postoperative visual analogue scale (VAS) scores, time to first flatus, and incidence of nausea and vomiting after surgery. RESULTS: The levels of plasma IL-1, IL-6, and TNF-α were lower in groups D and LD than in group C and were lowest in group LD at the end of the procedure and 2 h after the operation (P < 0.05). The VAS scores were decreased in groups D and LD compared with group C (P < 0.05). The heart rate (HR) was decreased at the end of the procedure and 2 h after the operation in groups D and LD compared to groups C and L (P < 0.001). The mean blood pressure (MBP) was lower at 2 h after the operation in groups L, D, and LD than in group C (P < 0.001). There was a lower incidence of postoperative nausea and vomiting (PONV) in group LD than in group C (P < 0.05). CONCLUSIONS: The combination of lidocaine and dexmedetomidine significantly alleviated the inflammatory responses, decreased postoperative pain, and led to fewer PONV in patients undergoing laparoscopic hysterectomy. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03276533 ), registered on August 23, 2017.

A quantum circuit simulator and its applications on Sunway TaihuLight supercomputer.

Classical simulation of quantum computation is vital for verifying quantum devices and assessing quantum algorithms. We present a new quantum circuit simulator developed on the Sunway TaihuLight supercomputer. Compared with other simulators, the present one is distinguished in two aspects. First, our simulator is more versatile. The simulator consists of three mutually independent parts to compute the full, partial and single amplitudes of a quantum state with different methods. It has the function of emulating the effect of noise and support more kinds of quantum operations. Second, our simulator is of high efficiency. The simulator is designed in a two-level parallel structure to be implemented efficiently on the distributed many-core Sunway TaihuLight supercomputer. Random quantum circuits can be simulated with 40, 75 and 200 qubits on the full, partial and single amplitude, respectively. As illustrative applications of the simulator, we present a quantum fast Poisson solver and an algorithm for quantum arithmetic of evaluating transcendental functions. Our simulator is expected to have broader applications in developing quantum algorithms in various fields.

Environmental risk-based hydroeconomic evaluation for alluvial aquifer management in arid river basin.

Groundwater has resource, ecology, economy and society attributes. In recent years, ecological degradation caused by intensive groundwater exploitation to support socio-economic development has been of growing concern in arid and semiarid regions. To protect the groundwater sustained ecosystem, this paper developed a novel environmental risk-based hydroeconomic model to evaluate the tradeoff between groundwater utilization and ecological environmental protection in Golmud river catchment of Qaidam basin, a typical inland river watershed and alluvial aquifer, in northwestern China. Field survey, remote sensing and groundwater level monitor were conducted to obtain the threshold of groundwater dependent ecosystem. Results show that depth to groundwater table should be larger than 25.5 m in alluvial plain to prevent downstream Golmud city urban waterlogging, depth to groundwater table should be smaller than 10 m in groundwater overflow zone and fine soil plain to sustain groundwater dependent vegetation survive, and groundwater recharge to the terminal lake should be larger than 282.0 hm3 yr-1 to maintain the minimum water surface area. Meanwhile, ecosystem services value was established according to equivalent value factors per unit area provided by different types of ecosystem in Golmud river catchment. Numerical simulations model was applied to evaluate the potential environment risk, cost and benefit of ecosystem services under different groundwater demand. The investigation results show that groundwater exploitation in 2030 with 240.9 hm3 yr-1 will cause environment risk, which is terminal lake surface area smaller than permitted minimum threshold. And the recommended maximum amount of groundwater exploitation is 219.0 hm3 yr-1. This study provides guidance for regional groundwater management to maintain environment protection and socio-economy development, especially in arid regions.

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery.

BACKGROUND: Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery. METHODS: One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 µg/kg loading, 0.4 µg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded. RESULTS: The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) (P = 0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P < 0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation (P < 0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 h after surgery (P < 0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery(P < 0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group (P < 0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group. CONCLUSION: Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed the time to awareness when compared with lidocaine and normal saline. TRIAL REGISTRATION: ChiCTR1800017482 . (Prospective registered). Initial registration date was 01/08/2018.

Recombinant Passenger Proteins Can Be Conveniently Purified by One-Step Affinity Chromatography.

Fusion tag is one of the best available tools to date for enhancement of the solubility or improvement of the expression level of recombinant proteins in Escherichia coli. Typically, two consecutive affinity purification steps are often necessitated for the purification of passenger proteins. As a fusion tag, acyl carrier protein (ACP) could greatly increase the soluble expression level of Glucokinase (GlcK), α-Amylase (Amy) and GFP. When fusion protein ACP-G2-GlcK-Histag and ACP-G2-Amy-Histag, in which a protease TEV recognition site was inserted between the fusion tag and passenger protein, were coexpressed with protease TEV respectively in E. coli, the efficient intracellular processing of fusion proteins was achieved. The resulting passenger protein GlcK-Histag and Amy-Histag accumulated predominantly in a soluble form, and could be conveniently purified by one-step Ni-chelating chromatography. However, the fusion protein ACP-GFP-Histag was processed incompletely by the protease TEV coexpressed in vivo, and a large portion of the resulting target protein GFP-Histag aggregated in insoluble form, indicating that the intracellular processing may affect the solubility of cleaved passenger protein. In this context, the soluble fusion protein ACP-GFP-Histag, contained in the supernatant of E. coli cell lysate, was directly subjected to cleavage in vitro by mixing it with the clarified cell lysate of E. coli overexpressing protease TEV. Consequently, the resulting target protein GFP-Histag could accumulate predominantly in a soluble form, and be purified conveniently by one-step Ni-chelating chromatography. The approaches presented here greatly simplify the purification process of passenger proteins, and eliminate the use of large amounts of pure site-specific proteases.