The vicious cycle of frailty and pain: a two-sided causal relationship revealed.

Background: The decline in physiological functions in the older people is frequently accompanied with pain and frailty, yet the causal connection between frailty and pain remains uncertain. In this study, we utilized a two-sample Mendelian randomization (MR) approach to investigate the potential causal association between frailty and pain. Methods: Two-sample bidirectional MR was conducted using summary data from genome-wide association studies to examine the potential causal relationship between frailty (defined by the frailty index and frailty phenotype) and pain. Summary genome wide association statistics were extracted from populations of European ancestry. We also investigated the causal relationship between frailty and site-specific pain, including joint pain, limb pain, thoracic spine pain and low back pain. Causal effects were estimated using the inverse variance weighting method. Sensitivity analyses were performed to validate the robustness of the results. Results: Genetic predisposition to frailty was associated with an increased risk of pain (frailty phenotype odds ratio [OR]: 1.73; P = 3.54 × 10-6, frailty index OR: 1.36; P = 2.43 × 10-4). Meanwhile, individuals with a genetic inclination toward pain had a higher risk of developing frailty. Regarding site-specific pain, genetic prediction of the frailty phenotype increased the occurrence risk of joint pain, limb pain and low back pain. Reverse MR analysis further showed that limb pain and low back pain were associated with an increased risk of frailty occurrence. Conclusion: This study presented evidence supporting a bidirectional causal relationship between frailty and pain. We highlighted the significance of addressing pain to prevent frailty and recommend the inclusion of pain assessment in the evaluation system for frailty.

Effect of remimazolam on intra-operative hypotension: Systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Hypotension is common during anaesthesia. Increasing number of studies have reported that remimazolam may be associated with lower incidence of intra-operative hypotension compared with other anaesthetics. However, the results remain controversial. OBJECTIVE: This study aimed to evaluate the influence of remimazolam on intra-operative hypotension and its related outcomes (hypoxaemia, bradycardia and time to awake). DESIGN: A systematic review of randomised controlled trials (RCTs) with meta-analyses. DATA SOURCES: PubMed, Cocharane and Embase databases were searched to identify eligible RCTs published up to June 2024. ELIGIBILITY CRITERIA: RCTs published in English were eligible for inclusion. The study patients were 18 years or older who were administered with remimazolam and other positive control agents in either the pre-operative or intra-operative period. The incidence of intra-operative hypotension was identified in these studies. RESULTS: This study evaluated 34 trials including 4847 individuals. Basing on moderate-certainty evidence, we found that remimazolam administration reduced the incidence of intra-operative hypotension [risk ratio (RR) = 0.48, 95% confidence interval (95% CI): 0.41 to 0.57] and bradycardia (16 studies, n  = 2869, RR = 0.40, 95% CI: 0.29 to 0.54). No difference was observed in the incidence of hypoxaemia (RR = 0.70, 95% CI: 0.48 to 1.01) and time to awake (MD = -0.91, 95% CI: -2.42 to 0.60). The remarkable association between remimazolam and hypotension remained robust and significant, regardless of general anaesthesia or procedural sedation ( P  < 0.01, I2  = 82%). No significant difference was found between different control drugs ( P  = 0.97, I2  = 82%). CONCLUSION: Moderate-quality evidence shows that remimazolam administration to patients undergoing general anaesthesia or procedural sedation decreases the incidence of intra-operative hypotension and bradycardia.

Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study.

Purpose: This study aimed to investigate the analgesic effect of ultrasound-guided transversus thoracis plane block (TTPB) combined with intermediate cervical plexus block (ICPB) in the early postoperative period after trans-areolar endoscopic thyroidectomy. Patients and Methods: A total of 62 female patients undergoing trans-areolar endoscopic thyroidectomy were randomly classified to the TTPB combined with ICPB group with ropivacaine (block group) or superficial cervical plexus block group (control group). The primary outcome measures were resting visual analogue scale (VAS) in the chest area at 6 h after surgery. The secondary outcome measures included chest resting and movement VAS score, neck resting and movement VAS score within 24 h after surgery, intraoperative remifentanil consumption, postoperative analgesia rate and analgesic requirements and patient satisfaction score for pain management at discharge. Results: Compared with the control group, the block group at rest showed consistently lower VAS scores in the chest area at 6 and 12 h after operation; the block group at rest showed lower VAS scores in the neck at 6, 12 and 24 h after operation. Regarding movement, the VAS scores of the chest and neck area at 2, 6, 12 and 24 h after the operation were lower in the block group than in the control group. The consumption of remifentanil, rate of postoperative analgesic requirements, and consumption of postoperative rescue analgesia in the block group were lower than those in the control group. Satisfaction with pain treatment at discharge was higher in the block group than in the control group. Conclusion: Ultrasound-guided TTPB combined with ICPB provides good analgesic effect in the early postoperative period after trans-areola endoscopic thyroidectomy.

Pyrolytic preparation and modification of carbon black recovered from waste tyres.

The medium temperature pyrolysis process using a fixed-bed reactor at atmospheric pressure was utilised to recover carbon black from motorcycle and automobile tyres. Experimental results have shown that the ash and volatile contents of several recovered carbon blacks are high, the elongation at break of the vulcanised natural rubber filled with recovered carbon blacks from motorcycle tyres is better than that from motorcycle tyres and standard carbon black 7#, while the other mechanical properties are worse. In order to improve the reinforcing effect of recovered carbon blacks, the modification of recovered carbon black was performed by high-energy electron bombardment and non-oxidising acid. The specific surface area of the pyrolytic carbon blacks increased after high-energy electron bombardment. The ash content of the pyrolytic carbon black was reduced from 22.5% to 8.4% after rinsing with hydrochloric acid, and the tensile stress at 300% was increased by about 2.2 MPa.

Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials.

The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] -6.20; 95% CI -10.39 to -2.01), hospital stay (MD -0.59; 95% CI -0.74 to -0.45), visual analgesic score on the first and third postoperative day (MD -2.62, 95% CI -3.04 to -2.19 and MD -0.38; 95% CI -0.58 to -0.18) , analgesic requirements (MD -36.84; 95% CI -55.23 to -18.45), and nausea and/or vomiting (relative risk [RR] 0.28; 95% CI 0.13-0.61). There were no significant differences between RA and GA groups in terms of stone-free rate, blood transfusion, and postoperative fever rate. The results of subgroup analysis were basically consistent with the overall findings. Current evidence suggests that RA is an available and safe option in carefully evaluated and selected patients.