Comprehensive strategies for controlling Listeria monocytogenes biofilms on food-contact surfaces.

Listeria monocytogenes biofilms formed on food-contact surfaces within food-processing facilities pose a significant challenge, serving as persistent sources of cross-contamination. In this review, we examined documented cases of foodborne outbreaks and recalls linked to L. monocytogenes contamination on equipment surfaces and in the food production environment, provided an overview of the prevalence and persistence of L. monocytogenes in different food-processing facilities, and discussed environmental factors influencing its biofilm formation. We further delved into antimicrobial interventions, such as chemical sanitizers, thermal treatments, biological control, physical treatment, and other approaches for controlling L. monocytogenes biofilms on food-contact surfaces. This review provides valuable insights into the persistent challenge of L. monocytogenes biofilms in food processing, offering a foundation for future research and practical strategies to enhance food safety.

M6[Cd2(CO3)2(B12O18)(OH)6] (M = K, Rb): Borate-Carbonates with Two CdCO3 Embedded in a Cyclic Oxoboron Anion.

Two metal borate-carbonates, M6[Cd2(CO3)2(B12O18)(OH)6] [M = K (1), Rb (2)], were obtained under surfactant-thermal conditions. In 1 and 2, each cyclic [(B12O18)(OH)6]6- anion captures two CdCO3 in two sides of the rings and finally forms the unusual (CdCO3)2@[(B12O18)(OH)6] cluster. Both 1 and 2 show moderate birefringence. Density functional theory calculations indicate that carbonate groups have a major contribution to electron-related optical transition.

Failure mechanisms of the Li(Ni0.6Co0.2Mn0.2)O2-Li4Ti5O12 lithium-ion batteries in long-time high-rate cycle.

With the ever-growing widespread use of lithium-ion batteries in heavy machinery and daily life, the demand for improved longevity and high-rate performance is escalating. While Li4Ti5O12 (LTO) batteries excel in safety and cycling performance, their full potential for long-term, high-rate cycling still yet remains unrealized. In this paper, we present an analysis of a pouch battery with an LTO anode system that was cycled for an extended period at high rates. We compared the performance changes and internal component properties between fresh and cycled batteries. Our results reveal that, after tens of thousands of high-rate cycles, microcracks emerged on the cathode electrode material (NCM622) particles of the battery, whereas the LTO remained largely unchanged. Additionally, we observed significant electrolyte reduction, characterized the separator surface, and measured its properties. Our findings indicate that the electrolyte reactions are the primary cause of battery failure, leading to capacity fading and impedance increase. This research provides valuable insights into the failure mechanisms of lithium-ion batteries at high rates, thus contributing to the improvement of high-rate lithium-ion batteries.

Comparison of psoas major activation during standing hip flexion between chronic low back pain and healthy populations.

BACKGROUND: The psoas major (PM) has been identified as a potential contributor to chronic low back pain (LBP). However, few studies have investigated the effects of upright functional movement on PM activation in cLBP individuals. OBJECTIVE: This cross-sectional study aims to compare PM muscle activation characteristics in chronic LBP (cLBP) and healthy subjects during the transition from quiet double-leg standing to standing hip flexion. METHODS: Ultrasound Imaging was used to assess PM thickness at the lumbar vertebral level of L4-5 in 12 healthy and 12 cLBP participants. The changes in thickness between the test positions were utilized as a proxy for PM activation. RESULTS: The cLBP group exhibited greater thickness changes on the non-dominant side PM during contralateral hip flexion but not ipsilateral hip flexion (p= 0.369) compared to their healthy counterparts (p= 0.011; cLBP: resting 27.85 mm, activated 34.63 mm; healthy: resting 29.51 mm, activated 29.00 mm). There were no significant differences in dominant side PM thickness changes between the two groups during either contralateral or ipsilateral hip flexion (p= 0.306 and p= 0.077). CONCLUSION: Our findings suggest a potential overactivation of the PM in the cLBP population. This insight may aid in the development of tailored rehabilitation programs.

Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore.

BACKGROUND: Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL). METHODS: Underpinned by Kincaid's ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed. DISCUSSION: This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial. TRIAL REGISTRATION: Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

Effect of tea polyphenol-trehalose complex coating solutions on physiological stress and flesh quality of marine-cultured Turbot Scophthalmus maximus during waterless transport.

OBJECTIVE: The waterless transport of live fish has changed the present situation of live-fish transport. However, the waterless transport environment may cause stress in fish. This research evaluated the effect of tea polyphenol-trehalose (TPT) coating solutions on Turbot Scophthalmus maximus during waterless transport. METHODS: After cold acclimation, Turbot were coated and subsequently transported in a waterless environment for 18 h. Physiological and biochemical parameters were measured, including lysozyme (LZM) and immunoglobulin M (IgM) activities, serum creatinine (Cr) and uric acid (UA) concentrations, and nutritional flavor. RESULT: The results showed that the nonspecific immunity of Turbot was inhibited during the waterless transport; the LZM activity first increased and then decreased, and the serum Cr and UA concentrations significantly increased. In addition, the waterless transport promoted the breakdown of Turbot flesh proteins, leading to changes in nucleotides and free amino acids (FAAs). After waterless transport, the LZM and IgM activities in the TPT-treated Turbot were higher than those in the control group (CK), and the changes in FAA content and nucleotides were smaller than those observed in the CK group. CONCLUSION: This study shows that the use of TPT coating solution can reduce the impact of waterless transportation stress on the immune and metabolic functions of Turbot and can maintain the meat quality and flavor of Turbot.

α-Ketoglutarate for Preventing and Managing Intestinal Epithelial Dysfunction.

The epithelium lining the intestinal tract serves a multifaceted role. It plays a crucial role in nutrient absorption and immune regulation and also acts as a protective barrier, separating underlying tissues from the gut lumen content. Disruptions in the delicate balance of the gut epithelium trigger inflammatory responses, aggravate conditions such as inflammatory bowel disease, and potentially lead to more severe complications such as colorectal cancer. Maintaining intestinal epithelial homeostasis is vital for overall health, and there is growing interest in identifying nutraceuticals that can strengthen the intestinal epithelium. α-Ketoglutarate, a metabolite of the tricarboxylic acid cycle, displays a variety of bioactive effects, including functioning as an antioxidant, a necessary cofactor for epigenetic modification, and exerting anti-inflammatory effects. This article presents a comprehensive overview of studies investigating the potential of α-ketoglutarate supplementation in preventing dysfunction of the intestinal epithelium.

AMPK Suppression Due to Obesity Drives Oocyte mtDNA Heteroplasmy via ATF5-POLG Axis.

Due to the exclusive maternal transmission, oocyte mitochondrial dysfunction reduces fertility rates, affects embryonic development, and programs offspring to metabolic diseases. However, mitochondrial DNA (mtDNA) are vulnerable to mutations during oocyte maturation, leading to mitochondrial nucleotide variations (mtSNVs) within a single oocyte, referring to mtDNA heteroplasmy. Obesity (OB) accounts for more than 40% of women at the reproductive age in the USA, but little is known about impacts of OB on mtSNVs in mature oocytes. It is found that OB reduces mtDNA content and increases mtSNVs in mature oocytes, which impairs mitochondrial energetic functions and oocyte quality. In mature oocytes, OB suppresses AMPK activity, aligned with an increased binding affinity of the ATF5-POLG protein complex to mutated mtDNA D-loop and protein-coding regions. Similarly, AMPK knockout increases the binding affinity of ATF5-POLG proteins to mutated mtDNA, leading to the replication of heteroplasmic mtDNA and impairing oocyte quality. Consistently, AMPK activation blocks the detrimental impacts of OB by preventing ATF5-POLG protein recruitment, improving oocyte maturation and mitochondrial energetics. Overall, the data uncover key features of AMPK activation in suppressing mtSNVs, and improving mitochondrial biogenesis and oocyte maturation in obese females.

Effect of magnetic nano-particles combined with multi-frequency ultrasound-assisted thawing on the quality and myofibrillar protein-related properties of salmon (Salmo salar).

Multi-frequency ultrasound-assisted thawing (MUAT) has been proven to be an effective method of maintaining the quality of frozen food. The effects of magnetic nano-particles (MNPs) combined with MUAT and multi-frequency ultrasound-assisted sequential thawing (MUST) on water retention, myofibrillar protein (MP) structural characteristics, function characteristics, and MP aggregation and degradation of salmon (Salmo salar) were studied. The results showed that MNPs combined with multi-frequency ultrasound-assisted sequential thawing (MNPs-MUST) significantly improved the thawing rate and the retention of water and had better emulsifying and foaming properties. MNPs-MUST treatment reduced the oxidation and degradation of MP, increased sulfhydryl content, and protected the structure of MP. Confocal laser scanning microscopy (CLSM) indicated that the MP transformed into a filamentous polymer into more evenly distributed units, resulting in higher protein solubility, lower surface hydrophobicity, and lower protein turbidity. Therefore, MNPs combined with MUST has a potential application value in the thawing research of frozen salmon.

Evaluation of Enterococcus faecium NRRL B-2354 as a surrogate for Listeria monocytogenes during chlorine and peroxyacetic acid interventions in simulated apple dump tank water.

Sanitizers are widely incorporated in commercial apple dump tank systems to mitigate the cross-contamination of foodborne pathogens. This study validated the suitability of Enterococcus faecium NRRL B-2354 as a surrogate for Listeria monocytogenes during sanitizer interventions in dump tank water systems. E. faecium NRRL B-2354 inoculated on apples exhibited statistically equivalent susceptibility to L. monocytogenes when exposed to chlorine-based sanitizers (25-100 ppm free chlorine (FC)) and peroxyacetic acid (PAA, 20-80 ppm) in simulated dump tank water (SDTW) with 1000 ppm chemical oxygen demand (COD), resulting in 0.2-0.9 and 1.1-1.7 log CFU/apple reduction, respectively. Increasing the contact time did not affect sanitizer efficacies against E. faecium NRRL B-2354 and L. monocytogenes on apples. Chlorine and PAA interventions demonstrated statistically similar efficacies against both bacteria inoculated in SDTW. Chlorine at 25 and 100 ppm FC for 0.5-5 min contact yielded ~37.68-78.25 % and > 99.85 % inactivation, respectively, in water with 1000-4000 ppm COD, while ~51.55-99.86 % and > 99.97 % inactivation was observed for PAA at 20 and 80 ppm, respectively. No statistically significant difference was observed between the transference of E. faecium NRRL B-2354 and L. monocytogenes from inoculated apples to uninoculated apples and water, and from water to uninoculated apples during chlorine- or PAA-treated SDTW exposure. The data suggest E. faecium NRRL B-2354 is a viable surrogate for L. monocytogenes in dump tank washing systems, which could be used to predict the anti-Listeria efficacy of chlorine and PAA interventions during commercial apple processing. Further investigations are recommended to assess the suitability of E. faecium NRRL B-2354 as a surrogate for L. monocytogenes, when using different sanitizers and different types of produce to ensure reliable and comprehensive results.

Output information-based intermittent optimal control for continuous-time nonlinear systems with unmatched uncertainties via adaptive dynamic programming.

Intermittent control stands as a valuable strategy for resource conservation and cost reduction across diverse systems. Nonetheless, prevailing research is intractable to address the challenges posed by robust optimal intermittent control of nonlinear input-affine systems with unmatched uncertainties. This paper aims to fill this gap. Initially, we introduce an enhanced finite-time intermittent control approach to ensure stability within nonlinear dynamic systems harboring bounded errors. A neural networks (NNs) state observer is constructed to estimate system information. Subsequently, an optimal intermittent controller that operates within a finite time span, guaranteeing system stability by employing the Hamilton-Jacobi-Bellman (HJB) methodology. Furthermore, we devise an output information-based event-triggered intermittent (ETI) approach rooted in the robust adaptive dynamic programming (ADP) algorithm, furnishing an optimal intermittent control law. In this process, a critic NNs is introduced to estimate the cost function and optimal intermittent controller. Simulation results show that our proposed method is superior to existing intermittent control strategies.

Exploring the therapeutic role of early heparin administration in ARDS management: a MIMIC-IV database analysis.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammatory properties, offers a new therapeutic opportunity for the treatment of ARDS. METHODS: In this retrospective cohort study, we examined the MIMIC-IV database for ARDS patients who received prophylactic heparin within the first 72 h of ICU admission. Employing propensity score matching and inverse probability weighting (IPW) analysis, we evaluated the impact of early heparin use on patient outcomes, focusing on mortality rates. RESULTS: Patients who received prophylactic heparin had a significantly lower in-hospital mortality rate compared to those who did not (13.55% vs 17.93%, HR = 0.71, 95% CI: 0.54-0.93, P = 0.012). This result remained significant after propensity score matching (12.75% vs 17.93%, HR = 0.65, 95% CI 0.47-0.90, P = 0.010). Analysis using five different statistical models indicated that early use of heparin significantly reduced the in-hospital mortality rate, with HR = 0.669 (95% CI 0.487-0.919, P = 0.013) in the doubly robust model without balanced covariates; HR = 0.705 (95% CI 0.515-0.965, P = 0.029) with all covariates considered; HR = 0.660 (95% CI 0.491-0.888, P = 0.006) in the propensity score (IPW) model; HR = 0.650 (95% CI 0.470-0.900, P = 0.010) in the propensity score matching model; and HR = 0.706 (95% CI 0.536-0.930, P = 0.013) in the multivariate Cox regression model. Secondary outcomes indicated that heparin use was also associated with reduced mortality rates at 60 days, and 90 days. CONCLUSION: This research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment.

Combined effects of hypoxia and ammonia-N exposure on the oxygen consumption, glucose metabolism and amino acid metabolism in hybrid grouper (Epinephelus fuscoguttatus♀ × E. lanceolatus♂).

This study evaluated the influence of hypoxia and ammonia-N co-exposure on oxygen consumption, glucose metabolism and amino acid metabolism in hybrid grouper. The results showed that elevated expression of GLUT1, MCT1, PFK, HK and LDH were induced by co-exposure to hypoxia and ammonia. In addition, co-exposure to hypoxia and ammonia reduced the tolerance of hybrid grouper to ammonia-N. Furthermore, ammonia-N exposure caused an increase in oxygen consumption in hybrid grouper. After ammonia-N exposure for 96 h, 10 amino acids contents and activities of AST and ALT elevated in hybrid grouper muscle. The study revealed that combined exposure to hypoxia and ammonia-N significantly increased glucose metabolism, oxygen consumption and amino acid metabolism in hybrid grouper, and presented significant synergistic effects.

Impacts of water activity on survival of Listeria innocua and Enterococcus faecium NRRL B-2354 in almonds during steam treatments.

Raw almonds have been associated with Salmonella outbreaks and multiple recalls related to Listeria monocytogenes contamination. While steam treatment has been approved for pasteurizing both conventional and organic whole almonds, there is limited understanding of how water activity (aw) influences the effectiveness of steam treatments in decontaminating almonds. Hence, this study aimed to assess and compare the efficacy of steam treatments against Listeria innocua and Enterococcus faecium NRRL B-2354, the known non-pathogenic surrogates, on almonds. It also sought to investigate the impact of almond's aw on bacterial resistance during steam treatments. Almond kernels were inoculated with ~8 log10 CFU/g of either E. faecium or L. innocua and equilibrated to aw 0.25 or 0.45 before being subjected to steam treatments at temperatures of 100-135 °C. Our results revealed that L. innocua exhibited lower resistance to steam compared to E. faecium, with 1.2-2.6 log10 CFU/g reductions for L. innocua and 1.0-2.0 log10 CFU/g reductions for E. faecium when the surface temperature of almonds reached 100-130 °C, depending on the aw of the almonds. The obtained DL. innocua, 100-130°C-values were 2.0-16.6 s, and DE. faecium, 100-130°C-values were 4.0-21.8 s, depending on the aw of almonds. In general, elevating steam temperatures and almond aw decreased the tolerance of L. innocua and E. faecium during steam inactivation. In addition, the z-values indicated that E. faecium on almonds was less sensitive to change in steam temperature compared to L. innocua, especially at lower aw. The zL. innocua-values were 36.6 °C and 35.7 °C, while zE. faecium-values were 48.9 °C and 42.7 °C in almonds with aw 0.25 and 0.45, respectively. Results from this study suggest that steam treatments serve as effective interventions for controlling pathogen contaminations in raw almonds.

Dietary Cannabidiol Activates PKA/AMPK Signaling and Attenuates Chronic Inflammation and Leaky Gut in DSS-Induced Colitis Mice.

SCOPE: Inflammatory bowel disease (IBD) is characterized by chronic inflammation in the gut, accompanied by impaired epithelial integrity, increased macrophage infiltration, and enhanced colon cancer risk. METHODS AND RESULTS: Cannabidiol (CBD), a phytocannabinoid isolated from cannabis plants, is supplemented into mice diet, and its beneficial effects against dextran sulfate sodium (DSS)-induced experimental colitis is evaluated. Eight-week-old mice were fed a standard diet supplemented with or without CBD (200 mg kg-1 ) for 5 weeks. In the 4th week of dietary treatment, mice were subjected to 2.5% DSS induction for 7 days, followed by 7 days of recovery, to induce colitis. CBD supplementation reduced body weight loss, gross bleeding, fecal consistency, and disease activity index. In addition, CBD supplementation protected the colonic structure, promoted tissue recovery, and ameliorated macrophage infiltration in the colonic tissue, which was associated with the activation of cyclic AMP-protein kinase A, extracellular signal-regulated kinase ½, and AMP-activated protein kinase signaling pathways. CBD supplementation also suppressed NLRP3 inflammasome activation and related pro-inflammatory marker secretion. Consistently, CBD feeding reduced tight junction protein claudin2 and myosin light chain kinase in DSS-treated mice. CONCLUSION: Dietary CBD protects against inflammation and colitis symptoms induced by DSS, providing an alternative approach to IBD management.

Unlocking the Hidden Threat: Impacts of Surface Defects on the Efficacy of Sanitizers Against Listeria monocytogenes Biofilms on Food-contact Surfaces in Tree Fruit Packing Facilities.

Food-contact surfaces showing signs of wear pose a substantial risk of Listeria monocytogenes contamination and may serve as persistent sources of cross-contamination in fresh produce packinghouses. This study offers a comprehensive exploration into the influence of surface defects on the efficacies of commonly used sanitizers against L. monocytogenes biofilms on major food-contact surfaces. The 7-day-old L. monocytogenes biofilms were cultivated on food-contact surfaces, including stainless steel, polyvinyl chloride, polyester, low-density polyethylene, and rubber, with and without defects and organic matter. Biofilms on those surfaces were subjected to treatments of 200 ppm chlorine, 400 ppm quaternary ammonium compound (QAC), or 160 ppm peroxyacetic acid (PAA). Results showed that surface defects significantly (P < 0.05) increased the population of L. monocytogenes in biofilms on non-stainless steel surfaces and compromised the efficacies of sanitizers against L. monocytogenes biofilms across various surface types. A 5-min treatment of 200 ppm chlorine caused 1.84-3.39 log10 CFU/coupon reductions of L. monocytogenes on worn surfaces, compared to 2.79-3.93 log10 CFU/coupon reduction observed on new surfaces. Similarly, a 5-min treatment with 400 ppm QAC caused 2.05-2.88 log10 CFU/coupon reductions on worn surfaces, compared to 2.51-3.66 log10 CFU/coupon reductions on new surfaces. Interestingly, PAA sanitization (160 ppm, 1 min) exhibited less susceptibility to surface defects, leading to 3.41-4.35 log10 CFU/coupon reductions on worn surfaces, in contrast to 3.68-4.64 log10 CFU/coupon reductions on new surfaces. Furthermore, apple juice soiling diminished the efficacy of sanitizers against L. monocytogenes biofilms on worn surfaces (P < 0.05). These findings underscore the critical importance of diligent equipment maintenance and thorough cleaning processes to effectively eliminate L. monocytogenes contamination on food-contact surfaces.

Dietary purple potato supplement attenuates DSS-induced colitis in mice: impact on mitochondrial function.

Inflammatory bowel disease (IBD) is a condition characterized by disrupted intestinal barrier function, abnormal immune response, and mucosal structure loss. This study evaluated the beneficial role of purple potato (PP) supplementation against IBD symptoms using a murine model of dextran sulfate sodium (DSS)-induced colitis, and further explored the underlying mechanisms. Six-week-old C57BL/6J male mice were randomized into two groups and fed a standard rodent diet with or without 10% PP powder for 7 weeks. At the 5th week of dietary supplements, mice in each group were further divided into two subgroups and were either induced with or without 2.5% DSS induction for 7 days, followed by 7 days of recovery. Data showed that PP supplementation ameliorated the disease activity index in DSS-treated mice and reversed the colonic structure loss, mucosal damage, macrophage infiltration, and pro-inflammatory cytokine secretion induced by DSS in the colonic tissue. PP supplementation also restored the levels of tight junction proteins and caudal type homeobox 2 in DSS-treated mice. Furthermore, dietary PP enhanced peroxisome proliferator-activated receptor-γ coactivator-1α signaling pathway, mitochondrial biogenesis, mitochondrial proteostasis, and protein-folding capacity. In summary, dietary PP ameliorated DSS-induced colitis and improved gut structures and barrier function, which was associated with improved mitochondrial function. These results support further investigation of PP as a potential dietary intervention for IBD.

A nitrous oxide/oxygen fixed mixture to reduce pain induced by the hypodermic injection: study protocol for a randomized, controlled trial.

BACKGROUND: Patients with hematological malignancies received multiple hypodermic injections of recombinant human granulocyte colony-stimulating factor. Procedural pain is one of the most common iatrogenic causes of pain in patients with hematological malignancies. It is also identified as the most commonly occurring problem in clinical care in the Department of Hematology and Oncology at Shenzhen University General Hospital. However, providing immediate relief from pain induced by hypodermic injection of recombinant human granulocyte colony-stimulating factor remains a major challenge. This trial aims to evaluate the safety and analgesic efficacy of a fixed nitrous oxide/oxygen mixture for patients with hematological malignancies and experiencing procedural pain caused by hypodermic injection of recombinant human granulocyte colony-stimulating factor in the department. METHODS: The nitrous oxide/oxygen study is a single-center, randomized, double-blind, placebo-controlled trial involving patients with hematological malignancies who require hypodermic injections of recombinant human granulocyte colony-stimulating factor for treatment. This trial was conducted in the Hematology and Oncology Department of Shenzhen University General Hospital. A total of 54 eligible patients were randomly allocated to either the fixed nitrous oxide/oxygen mixture group (n = 36) or the oxygen group (n = 18). Neither the investigators nor the patients known about the randomization list and the nature of the gas mixture in each cylinder. Outcomes were monitored at the baseline (T0), immediately after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T1), and 5 min after hypodermic injection of recombinant human granulocyte colony-stimulating factor (T2) for each group. The primary outcome measure was the score in the numerical rating scale corresponding to the highest level of pain experienced during hypodermic injection of recombinant human granulocyte colony-stimulating factor. Secondary outcomes included the fear of pain, anxiety score, four physiological parameters, adverse effects, total time of gas administration, satisfaction from both patients and nurses, and the acceptance of the patients. DISCUSSION: This study focused on the safety and analgesic efficacy during hypodermic injection of recombinant human granulocyte colony-stimulating factor procedure. Data on the feasibility and safety of nitrous oxide/oxygen therapy was provided if proven beneficial to patients with hematological malignancies during hypodermic injection of recombinant human granulocyte colony-stimulating factor and widely administered to patients with procedural pain in the department. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR2200061507. Registered on June 27, 2022. http://www.chictr.org.cn/edit.aspx?pid=170573&htm=4.