Analgesic efficacy of an opioid-free postoperative pain management strategy versus a conventional opioid-based strategy following open major hepatectomy: an open-label, randomised, controlled, non-inferiority trial.

Background: Convincing clinical evidence regarding completely opioid-free postoperative pain management using erector spinae plane block (ESPB) in patients undergoing open major hepatectomy (OMH) is lacking. Herein, we aimed to compare the postoperative analgesic efficacy of the visualised continuous opioid-free ESPB (VC-ESPB) and conventional intravenous opioid-based postoperative pain management in hepatocellular carcinoma (HCC) patients undergoing OMH. Methods: This open-label, randomised, controlled, non-inferiority trial enrolled patients with HCC undergone open major hepatectomy in Fujian Provincial Hospital and compared the postoperative analgesic efficacy of VC-ESPB (VC-ESPB group) and conventional intravenous opioid-based pain management regimen (conventional group). Patients were randomly assigned (1:1) to VC-ESPB group and conventional group. Patients were not masked to treatment allocation. The VC-ESPB group was treated with intermittent injections of 0.25% ropivacaine (bilateral, 30 mL each side) given every 12 h through catheters placed in the space of erector spinae and an opioid-free intravenous pump (10-mg tropisetron diluted to 100 mL with 0.9% normal saline [NS]) for postoperative pain management. The conventional group did not receive ESPB and was treated with a conventional intravenous opioid-based pump (2.5-µg/kg sufentanil and 10-mg tropisetron diluted to 100 mL with 0.9% NS). Patients in the VC-ESPB group underwent magnetic resonance imaging (MRI) to identify local anaesthetic diffusion after ESPB was performed under ultrasound guidance. The primary outcome was postoperative analgesic efficacy, which was indicated by the cumulative area under the curve (AUC) of the pain visual analogue scale scores (range, 0-10; a higher score indicates more pain) obtained at rest and at movement until 48 h postoperatively after leaving the post-anaesthesia care unit (PACU). Herein, an AUC of 26.5 was set as the noninferiority margin, which needed to be satisfied for both cumulative AUCPACU-48 h at rest and cumulative AUCPACU-48 h at movement. Per protocol participants were included in primary and safety analyses. This trial was registered with ChiCTR.org.cn (ChiCTR1900026583). Findings: Between October 30, 2019, and May 1, 2023, 106 patients were enrolled and randomly assigned to the VC-ESPB group (n = 53) and the conventional group (n = 53). After the dropout (n = 5), a total of 101 patients (VC-ESPB group, n = 50; conventional group, n = 51) were analysed. Both the level of cumulative AUCPACU-48 h (at rest: 160.08 ± 38.00 vs. 164.94 ± 31.00; difference [90% CI], -4.861 [-16.308, 6.585]) and cumulative AUCPACU-48 h (at movement: 209.64 ± 28.98 vs. 212.59 ± 33.11; difference [90% CI], -2.948 [-13.236, 7.339]) were similar between the VC-ESPB and control groups within the first postoperative 48 h. The upper limit of the 90% CIs for the difference in cumulative ACUPACU-48 h at rest and at movement did not reach the upper inferiority margin (26.5). During the first postoperative 48 h, the rate of nonsteroidal anti-inflammatory drug rescue analgesia was similar between the VC-ESPB group and conventional group (n = 16, 32.0% vs. n = 11, 21.6%; P = 0.236). Treatment-related death was not observed in the VC-ESPB group (n = 0, 0%) and conventional group (n = 0, 0%). In VC-ESPB group, local site paralysis (n = 1, 2.0%) was observed in one patient and rash (n = 1, 2.0%) was observed in another patient. One patient in the conventional group was observed with rash preoperatively (n = 1, 2.0%). The VC-ESPB group had significantly lower rates of postoperative nausea (n = 2, 4.0%, vs. n = 9, 17.6%, P = 0.028), vomiting (n = 1, 2.0% vs. n = 8, 15.7%, P = 0.031) and lower incidence of major complications (n = 4, 8.0% vs. n = 6, 11.8%; P = 0.033). Interpretation: This study demonstrates the noninferiority of VC-ESPB when compared with the conventional opioid-based approach for postoperative pain management after OMH, suggesting that it is feasible to achieve opioid-free postoperative pain management for OMH. Funding: The Joint Funds for the Innovation of Science and Technology, Fujian Province, China; the Youth Scientific Research Project of Fujian Provincial Health Commission; the Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare; and the Key Clinical Specialty Discipline Construction Program of Fujian, China.

The Impact of Prenatal Environmental Tobacco Smoking (ETS) and Exposure on Chinese Children: A Systematic Review.

Background: There is considerable evidence to support the association between exposure to environmental tobacco smoke (ETS) and children's burden of disease. However, the literature on the health outcomes of prenatal ETS exposure among Chinese children has not yet been comprehensively reviewed. Objective: This systematic review examines the currently available evidence and identifies gaps for further research on the health consequences of prenatal ETS exposure on Chinese children. Methods: Following the JBI systematic-scoping review methodological framework, we conducted a computer-aided search of three electronic databases-PubMed, EBSCOhost, and ProQuest to include studies from January 2011 to May 2023 that addressed the health outcomes of Chinese children whose mothers were exposed to ETS at any stage of pregnancy. Furthermore, a methodological quality assessment of the selected articles was conducted using JBI critical appraisal checklists. Results: A total of 30 articles were reviewed, including eleven high-quality studies and nineteen moderate-quality studies. Five main themes, including hypertension, fetal and children's development, behavioural disorders, respiratory outcomes, and "other health outcomes", were encompassed. The majority of the studies showed a positive link between prenatal ETS exposure and an increased risk of preterm birth, and moderate risk of fetal growth restriction. A few studies explored other potential adverse outcomes of ETS, including hypertension, respiratory morbidity, lung function, and asthma in children. Conclusions: The currently available evidence on prenatal ETS exposure in Chinese children has unveiled a wide range of health outcomes, including preterm birth, fetal development, behavioural disorders, and much more. However, Chinese studies in this area are still lacking and a gap still exists in relation to the strength of association between prenatal ETS exposure and some health risks. Efficient anti-smoking policies and smoking cessation programs should be developed to promote maternal and child health. Further research is also needed to provide better evidence in this field.

System to screen and purify active ingredients from herbal medicines using hydrogel-modified human umbilical vein endothelial cell membrane chromatography coupled with semi-preparative high-performance liquid chromatography-offline-high-performance liquid chromatography-mass spectrometry.

Analytical screening and validation systems based on a combination of cell membrane chromatography and two-dimensional chromatography-tandem mass spectrometry are incapable of providing prepared samples containing the active ingredients found in traditional Chinese medicine; therefore, these samples cannot be directly used in subsequent studies. In this study, a semi-preparative cell membrane chromatography column was developed using a hydrogel-modified carrier and human umbilical vein endothelial cells to optimize prepared conditions, such as hydrogel polymerization, cell fragmentation, and cell membrane volume. This increased the binding ratio of membrane protein and carrier to 15.79 mg/g. The column was systematically evaluated using multitarget tyrosine kinase inhibitors that displayed good specificity and reproducibility. Subsequently, using the column coupled with a semi-preparative high-performance liquid chromatography-offline-high-performance liquid chromatography-mass spectrometry system, 15 active ingredients were screened and purified from Indigo naturalis, and five main components were identified: l-lysine, oxyresveratrol, tryptanthrin, isorhamnetin, and indirubin. Furthermore, the pharmacological effects of the ingredients were confirmed using cell proliferation and apoptosis assays. Results revealed potent proliferation-inhibiting and apoptosis-promoting abilities on human chronic myelogenous leukemic cells and human promyelocytic leukemic cells (p < 0.001). Overall, the system presented screening and purification functions that could be used to prepare I. naturalis samples acting on the epidermal growth factor receptor and vascular endothelial cell growth factor.

Recent progress in nanomaterial-based assay for the detection of phytotoxins in foods.

Phytotoxins refers to toxic chemicals derived from plants. They include both secondary metabolites that are dose-dependently toxic and allergens that can cause anaphylactic shock in sensitive individuals. Detecting phytotoxins in foods is increasingly important. Conventional methods for detecting phytotoxins lack sufficient sensitivity and operational convenience. Nanomaterial-based determination assays show great competence in fast and accurate sensing of trace substances. In the present review, representative phytotoxin categories of alkaloids, cyanides, and proteins are discussed. Application of notable nanomaterials, e.g. carbon nanotubes, graphene oxide, magnetic nanoparticles, metal-based nanotools, and quantum dots, in specific sensing strategies to fit the physiochemical properties of the target toxins are summarized. Nanomaterials mainly play four roles in phytotoxin detection: 1) analyte enricher; 2) sensor structure mediator; 3) target recognizer or reactant; 4) signaling agent. Great achievements have been made in the detection of trace plant-derived toxins in food matrices, yet there are still challenges awaiting further investigation.

The optimum dose of intranasal remifentanil for laryngeal mask airway insertion during sevoflurane induction in children: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to determine the optimum dose of intranasal remifentanil required to produce satisfactory laryngeal mask airway (LMA) insertion conditions during inhalation induction of anesthesia using 5% sevoflurane in children. METHODS: Seven-five American Society of Anesthesiologists physical status (ASA) I subjects, aged 2-5 years, scheduled for minor elective surgery were randomly allocated to receive one of five doses of intranasal remifentanil (nil, 0.25, 0.5, 0.75 and 1.0 µg·kg(-1)) during 5% sevoflurane induction. Laryngeal mask insertion was attempted 120 s after intranasal remifentanil administration and the response of subjects was classified as either 'Failure' or 'Success'. "Success" was defined as a relaxed mandible without coughing, gapping, swallowing, laryngospasm or gross purposeful movement. Secondary outcomes included the duration of apnea, hemodynamic changes and complications. RESULTS: For each groups (nil, 0.25, 0.5, 0.75 or 1.0 µg·kg(-1) remifentanil), the incidence of satisfactory LMA insertion conditions was 0, 33.3%, 60%, 86.7% and 100% respectively. None of subjects suffered from any serious complications such as laryngospasm,or hypotension and bradycardia. CONCLUSION: The ED50 and ED95 of intranasal remifentanil for successful LMA insertion in children were estimated to be 0.36 and 0.998 µg·kg(-1) during 5% sevoflurane inhalation induction for 3 min.

Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective, randomized, double-blind, placebo-controlled trial.

BACKGROUND: We conducted a prospective, randomized, double-blind, placebo-controlled study to verify the hypothesis that intranasal dexmedetomidine premedication can reduce the minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion in children. METHODS: Ninety American Society of Anesthesiologists (ASA) physical status I subjects, aged 3-7 years, were randomized to three equal groups to receive saline (Group S), dexmedetomidine 1 µg · kg(-1) (Group D1 ), or dexmedetomidine 2 µg · kg(-1) (Group D2 ) approximately 45 min before anesthesia. The minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane was determined according to the Dixon's up-and-down method. Emergence delirium was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale in the postanesthesia care unit (PACU). RESULTS: Dexmedetomidine premedication of 1 and 2 µg · kg(-1) was associated with reduction in sevoflurane from 1.92% to 1.53% and 1.23%, corresponding to decrease of 20% and 36%, respectively. The peak PAED scores (median [IQR]) were 9 [8-11.5], 5 [3-5.3], and 3 [2-4] in Group S, Group D1, and Group D2 , respectively. The incidence of emergence delirium (defined as peak PAED score ≥ 10) was significantly lower in Groups D1 and D2 than in Group S (P < 0.001). Simultaneously, the induction qualities and the parent's satisfaction scores were significantly higher in Groups D1 and D2 than in Group S (P < 0.001). CONCLUSION: Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane and emergence delirium in the PACU.

Quantification of DNA through a fluorescence biosensor based on click chemistry.

A simple, sensitive and selective fluorescence biosensor for determination of DNA using CuS particles based on click chemistry is reported. Biotin-modified capture DNA was modified on Streptavidin MagneSphere Paramagnetic Particles (PMPs) and hybridized with target DNA (hepatitis B virus DNA had been chosen as an example), then bound target DNA was hybridized with DNA-CuS particles and formed a sandwich like structure. CuS particles on the sandwich structures can be destroyed by acid to form Cu(II), and Cu(II) can be reduced to Cu(I) by sodium ascorbate, which in turn catalyzes the reaction between a weak-fluorescent 3-azido-7-hydroxycoumarin and propargyl alcohol to form a fluorescent 1,2,3-triazole compound. Using this method, target DNA concentration can be determined by a change in the fluorescence intensity of the system. It is found that the fluorescence increase factor has a direct linear relationship to the logarithm of target DNA concentrations in the range of 0.1 to 100 nM, and the detection limit is 0.04 nM (S/N = 3). The proposed sensor not only allows high sensitivity and good reproducibility, but also has a good selectivity to single-nucleotide mismatches.

Fluorescence spectrometric study on the interaction of tamibarotene with bovine serum albumin.

The interaction between tamibarotene and bovine serum albumin (BSA) was studied using fluorescence quenching technique and ultraviolet-visible spectrophotometry. The results of experiments showed that tamibarotene could strongly quench the intrinsic fluorescence of BSA by a dynamic quenching mechanism. The apparent binding constant, number of binding site and corresponding thermodynamic parameters at different temperatures were calculated respectively, and the main interaction force between tamibarotene and BSA was proved to be hydrophobic force. Synchronous fluorescence spectra showed that tamibarotene changed the molecular conformation of BSA. When BSA concentration was 1.00 × 10⁻6mol L⁻¹, the quenched fluorescence ΔF had a good linear relationship with the concentration of tamibarotene in the range 1.00 × 10⁻6 to 12.00 × 10⁻6 mol L⁻¹ with the detection limit of 6.52 × 10⁻7 mol L⁻¹.

Flow-injection analysis for meloxicam based on tris(2,2'-bipyridine) ruthenium(II)-Ce(IV) chemiluminescent system.

It was found that meloxicam could enhance the chemiluminescence (CL) of the tris(2,2'-bipyridine) ruthenium(II)-Ce(IV) system in the medium of sulfate acid. Based on this phenomenon a new flow-injection system with chemiluminescent detection has been proposed for determination of meloxicam. Under optimum conditions, meloxicam had a good linear relationship with the CL intensity in the concentration range of 6.0 10(-4) to 1.0 microg/mL and the detection limit was 3.7 x 10(-4 )microg/mL. The proposed method was applied to detect meloxicam in tablets and a satisfactory recovery was obtained. The possible mechanism for this CL system is also discussed in this paper.