Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II.

BACKGROUND: Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. METHODS: This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. RESULTS: The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744-0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. CONCLUSIONS: Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH.

Incidence of dreaming during ciprofol anesthesia for painless gastroscopy.

BACKGROUND: Dreaming is often reported by patients who undergo propofol-based sedation, but there have not been any studies to date focused on the incidence of dreaming and factors associated therewith following the administration of ciprofol anesthesia in patients undergoing painless gastroscopy. The present study was thus developed with the goal of assessing the incidence of dreaming. METHODS: In total, this study enrolled 200 patients undergoing painless gastroscopy. During the procedure, patients' electroencephalographic Bispectral Index (BIS), blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), and PETCO2 were monitored. When their MOAA/S score reached five after the procedure, patients were administered questionnaires including the Brice questionnaire and a five-point Likert Scale, and the content of any recalled dreams was also recorded. RESULTS: Overall, 27.5% of the participants in this study reported dreaming during the procedure, with most having experienced simple, pleasant dreams about everyday life. Identified predictors of dreaming during painless gastroscopy included lower ASA grade, preoperative knowledge of painless examination, a higher frequency of dreams in the month before the procedure, poor sleep quality during the month before the procedure, and shorter awakening time. Dreamers showed significantly lower BIS values at 2 min after endoscope insertion and following endoscope removal, and also showed lower minimum BIS values compared with non-dreamers. CONCLUSIONS: The postoperative dream recall incidence in this study was 27.5% among patients undergoing painless gastroscopy under ciprofol sedation anesthesia.

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial.

BACKGROUND: Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. METHODS: One hundred and fourteen ASA I-III patients of either gender, aged 18-65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. RESULTS: One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0-0), which was significantly lower than those in group C (1 (0-2) at 2 h, p < 0.001 ; 1 (0-1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0-1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0-2) was superior to that in group C (2 (0-2), p = 0.006) at 2 h postoperatively. CONCLUSIONS: In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Effect of reduction pretreatment on the structure and catalytic performance of Ir-In2O3 catalysts for CO2 hydrogenation to methanol.

In2O3 has been found a promising application in CO2 hydrogenation to methanol, which is beneficial to the utilization of CO2. The oxygen vacancy (Ov) site is identified as the catalytic active center of this reaction. However, there remains a great challenge to understand the relations between the state of oxygen species in In2O3 and the catalytic performance for CO2 hydrogenation to methanol. In the present work, we compare the properties of multiple In2O3 and Ir-promoted In2O3 (Ir-In2O3) catalysts with different Ir loadings and after being pretreated under different reduction temperatures. The CO2 conversion rate of Ir-In2O3 is more promoted than that of pure In2O3. With only a small amount of Ir loading, the highly dispersed Ir species on In2O3 increase the concentration of Ov sites and enhance the activity. By finely tuning the catalyst structure, Ir-In2O3 with an Ir loading of 0.16 wt.% and pre-reduction treatment under 300°C exhibits the highest methanol yield of 146 mgCH3OH/(gcat·hr). Characterizations of Raman, electron paramagnetic resonance, X-ray photoelectron spectroscopy, CO2-temperature programmed desorption and CO2-pulse adsorption for the catalysts confirm that more Ov sites can be generated under higher reduction temperature, which will induce a facile CO2 adsorption and desorption cycle. Higher performance for methanol production requires an adequate dynamic balance among the surface oxygen atoms and vacancies, which guides us to find more suitable conditions for catalyst pretreatment and reaction.

Advances in the application of robotic surgical systems to gastric cancer: A narrative review.

Gastric cancer is one of the common malignant tumors in the gastrointestinal tract, and surgery is currently an important treatment for progressive gastric cancer. With the development of technology, the simultaneous maturation of artificial intelligence (AI), fifth-generation (5G) telecommunication networks and the internet of things (IOT) has brought significant efficacy and new opportunities for the surgical treatment of gastric malignancies. The combination of 5G network and remote surgical robotic system is the future trend of radical gastric cancer surgery, and the "unmanned" treatment mode of fully automated robotic gastric cancer radical surgery will be realized soon.

Highly Selective Hydrogenation of CO2 to Ethanol via Designed Bifunctional Ir1-In2O3 Single-Atom Catalyst.

Recently, CO2 hydrogenation for the controlled growth of the carbon chain to produce high-value C2 or C2+ products has attracted great interest, where achieving high selectivity for a specific product remains a challenge, especially for ethanol. Herein, we have designed a bifunctional Ir1-In2O3 single-atom catalyst, integrating two active catalytic centers by anchoring the monatomic Ir onto the In2O3 carrier. This Ir1-In2O3 single-atom catalyst is efficient for the hydrogenation of CO2 in liquid, yielding a high selectivity for ethanol (>99%) with an excellent initial turnover frequency (481 h-1). Characterization shows that the isolated Ir atom couples with the adjacent oxygen vacancy forming a Lewis acid-base pair, which activates the CO2 and forms the intermediate species of carbonyl (CO*) adsorbed on the Ir atom. Coupling this CO* with the methoxide adsorbed on the In2O3 forms a C-C bond. The strategy of this effective bifunctional single-atom catalyst by synergistically utilizing the distinct catalytic roles of the single-atom site and the substrates provides a new avenue in catalyst design for complex catalysis.

Self-assembly of defect-rich graphene oxide nanosheets with Na2Ti3O7 nanowires and their superior absorptive capacity to toxic dyes.

Graphene sheets, a flexible 2D material with excellent absorptive capacity, have great potential as absorbing materials. However, this material has always suffered from irreversible aggregation and thus loses the abundant active sites and large surface area. In this paper, large-scale graphene oxide (GO) sheets were cut and reduced to tiny reduced graphene oxide (RGO) sheets by a cell-break sonicator, for producing numerous defects, which are the center of chemisorption. Furthermore, sodium titanate nanowires functioned as a framework to help to disperse the tiny RGO sheets uniformly. And, in turn, the flexible tiny RGO sheets glued robust nanowires into a free-standing membrane. This novel composite membrane exhibited an ultra-high decoloration efficiency of 99.8% of rhodamine B in a continuous flow mode, and an outstanding absorptive capability of 1.30 × 10-2 mol g-1 correlated to RGO content in batch reaction, which is about two orders of magnitude higher than other reported graphene-based absorbents. In addition, an efficient and feasible method without any heat treatment for regenerating the membrane is illustrated, and the recycled membrane retains superior decoloration efficiency. The excellent absorptive performance indicates the framework-based disperse strategy has great potential for the construction and application of defect-rich graphene.