Ultrasound-guided lesser occipital nerve combined with great auricular nerve block for vestibular schwannoma craniotomy via a suboccipital retrosigmoid approach: a prospective, double-blind randomized controlled trial.

PURPOSE: This aim of this study was to investigate the analgesic efficacy and safety of lesser occipital nerve combined with great auricular nerve block (LOGAB) for craniotomy via a suboccipital retrosigmoid approach. METHODS: Patients underwent vestibular schwannoma resection via a suboccipital retrosigmoid approach were randomly assigned to receive ultrasound-guided unilateral LOGAB with 5 ml of 0.5% ropivacaine (LOGAB group) or normal saline (NSB group). Numeric rating scale (NRS) scores at rest and motion were recorded within 48 h after surgery. Mean arterial pressure (MAP), heart rate (HR), opioid consumption and other variables were measured secondly. RESULTS: Among 59 patients who were randomized, 30 patients received ropivacaine, and 29 patients received saline. NRS scores at rest (1.8 ± 0.5 vs. 3.2 ± 0.8, P = 0.002) and at motion (2.2 ± 0.7 vs. 3.2 ± 0.6, P = 0.013) of LOGAB group were lower than those of NSB group within 48 h after surgery. NRS scores of motion were comparable except for 6th and 12th hour (P < 0.05) in the LOGAB group. In LOGAB group, MAP decreased significantly during incision of skin and dura (P < 0.05) and intraoperative opoid consumption was remarkably reduced (P < 0.01). Postoperative remedial analgesia was earlier in the NSB group (P < 0.001). No patients reported any adverse events. CONCLUSION: Among patients undergoing craniotomy for vestibular schwannoma via a suboccipital retrosigmoid approach, LOGAB may be a promising treatment for perioperative analgesia and has the potential to maintain intraoperative hemodynamic stability. CLINICAL TRIAL REGISTRATION NUMBER: Chictr.org.cn ChiCTR2000038798.

Association between preoperative hypokalemia and postoperative complications in elderly patients: a retrospective study.

BACKGROUND: Hypokalemia is a common form of electrolyte disorder, which has a higher incidence in hospitalized patients and is closely related to perioperative complications and prognosis. Due to decreased skeletal muscle mass which causes total body potassium reduction, and increased comorbidities, the elderly are more susceptible to hypokalemia. OBJECTIVE: To investigate preoperative hypokalemia in elderly patients and its effect on postoperative complications. METHODS: Data were retrospectively collected from the elderly patients who underwent elective surgery from April 2018 to March 2019 and had preoperative blood gas data available. Patients, with age 60 to 100 years, were divided into hypokalemia group (potassium level < 3.5 mmol/L) and normokalemia group (potassium level between 3.5 and 5.5 mmol/L) according to preoperative blood gas analysis. Hypokalemia can be divided into mild (potassium level 3.0 to 3.5 mmol/L), moderate (potassium level 2.5 to 3.0 mmol/L) and severe (potassium level < 2.5 mmol/L), respectively. The risk factors of preoperative hypokalemia and its impact on postoperative complications and prognosis were primary outcomes. Secondary outcomes included postanesthesia care unit (PACU) stay time and hospital length of stay (LOS). RESULTS: Of 987 participants, 436 (44.17%) developed preoperative hypokalemia, among them 357 (81.88%) mild, 87 (16.74%) moderate and 6 (1.38%) severe. Multivariate logistic regression showed that female gender (OR, 1.851; 95% CI, 1.415-2.421), pre-existing hypokalemia at admission (OR, 4.498; 95% CI, 2.506-8.071), and oral laxative twice or more (OR, 1.823; 95% CI, 1.266-2.624) are risk factors of preoperative hypokalemia. Gynecological and biliopancreatic surgery were more common in hypokalemia group than normokalemia group (P <  0.001, P <  0.05). There was no significant difference in postoperative complications, PACU stay time, LOS, and 30-day mortality between the two groups (all P >  0.05). CONCLUSIONS: Female gender, pre-existing hypokalemia at admission, and oral laxative twice or more are independent risk factors for preoperative hypokalemia in elderly patients. However, postoperative complications and 30-day mortality were not increased, which may be related to monitoring blood gas analysis and prompt correction of potassium levels during surgery.

Elucidating Surface Structure with Action Spectroscopy.

Surface Action Spectroscopy, a vibrational spectroscopy method developed in recent years at the Fritz Haber Institute is employed for structure determination of clean and H2O-dosed (111) magnetite surfaces. Surface structural information is revealed by using the microscopic surface vibrations as a fingerprint of the surface structure. Such vibrations involve just the topmost atomic layers, and therefore the structural information is truly surface related. Our results strongly support the view that regular Fe3O4(111)/Pt(111) is terminated by the so-called Fetet1 termination, that the biphase termination of Fe3O4(111)/Pt(111) consists of FeO and Fe3O4(111) terminated areas, and we show that the method can differentiate between different water structures in H2O-derived adsorbate layers on Fe3O4(111)/Pt(111). With this, we conclude that the method is a capable new member in the set of techniques providing crucial information to elucidate surface structures. The method does not rely on translational symmetry and can therefore also be applied to systems which are not well ordered. Even an application to rough surfaces is possible.

Cerebral oxygen desaturation occurs frequently in patients with hypertension undergoing major abdominal surgery.

Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO2) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO2 in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO2. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO2 and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO2 of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUCrSO2 <90% of baseline and AUCrSO2 <80% of baseline) was lower in patients of group N (2752.4 ± 1453.3 min% and 0.0 min%) than in patients of group D (6264.9 ± 1832.3 min% and 4486.5 ± 1664.9 min%, P < 0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P = 0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO2 (r2 = 0.495, P < 0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P = 0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov ).

Vibrational Action Spectroscopy of Solids: New Surface-Sensitive Technique.

Vibrational action spectroscopy employing infrared radiation from a free-electron laser has been successfully used for many years to study the vibrational and structural properties of gas phase aggregates. Despite the high sensitivity of this method no relevant studies have yet been conducted for solid sample surfaces. We have set up an experiment for the application of this method to such targets, using infrared light from the free-electron laser of the Fritz Haber Institute. In this Letter, we present first results of this technique with adsorbed argon and neon atoms as messengers. We were able to detect surface-located vibrations of a thin V_{2}O_{3}(0001) film on Au(111) as well as adsorbate vibrations, demonstrating that this method is highly surface sensitive. We consider that the dominant channel for desorption of the messenger atoms is direct inharmonic vibrational coupling, which is essentially insensitive to subsurface or bulk vibrations. Another channel is thermal desorption due to sample heating by absorption of infrared light. The high surface sensitivity of the nonthermal channel and its insensitivity to subsurface modes makes this technique an ideal tool for the study of surface-located vibrations.

Self-Anticoking of a Cobalt Surface by Subsurface Oxygen in the Fischer-Tropsch Synthesis.

Understanding the fundamental processes taking place on Co surfaces during the Fischer-Tropsch (FT) synthesis is of great interest and importance. We herein report a self-anticoking mechanism of a cobalt surface by subsurface oxygen. The active carbidic carbon species for FT synthesis tends to transform into the inactive graphitic carbon species on clean Co(0001) and poisons the Co surface. Subsurface atomic oxygen on Co(0001) can stabilize the active carbidic carbon species and quench the transformation process. These results reveal, to the best of our knowledge, for the first time the reactivity of various surface species on Co surfaces that dynamically maintain a delicate balance to enhance the long-term stability of Co catalysts during FT synthesis.

Methanol Conversion into Dimethyl Ether on the Anatase TiO2(001) Surface.

Exploring reactions of methanol on TiO2 surfaces is of great importance in both C1 chemistry and photocatalysis. Reported herein is a combined experimental and theoretical calculation study of methanol adsorption and reaction on a mineral anatase TiO2(001)-(1×4) surface. The methanol-to-dimethyl ether (DME) reaction was unambiguously identified to occur by the dehydration coupling of methoxy species at the fourfold-coordinated Ti(4+) sites (Ti(4c)), and for the first time confirms the predicted higher reactivity of this facet compared to other reported TiO2 facets. Surface chemistry of methanol on the anatase TiO2(001)-(1×4) surface is seldom affected by co-chemisorbed water. These results not only greatly deepen the fundamental understanding of elementary surface reactions of methanol on TiO2 surfaces but also show that TiO2 with a high density of Ti(4c) sites is a potentially active and selective catalyst for the important methanol-to-DME reaction.

Active hydrogen species on TiO2 for photocatalytic H2 production.

Photocatalytic H2 production over TiO2 has attracted tremendous attention and achieved great progress, but the active hydrogen species is still unknown. Employing a rutile TiO2(110) surface as a model catalyst we report here for the first time the direct observation of photocatalytic H2 production under ultrahigh vacuum conditions during UV-light irradiation at 115 K and the identification of negatively-charged hydride-type H-Ti species as the corresponding photoactive surface species by means of thermal desorption spectroscopy, photon-stimulated desorption spectroscopy, X-ray photoelectron spectroscopy and DFT calculations. The formation and stability of H-Ti species are closely related to available surplus electrons on the rutile TiO2(110) surface that can be created by the formation of surface BBO vacancies or by the formation of surface hydroxyls via the adsorption of atomic H or molecular H2 on O sites. The photocatalytic H2 production from H-Ti species is hole-mediated and co-existing water exerts a negative effect on this process.

Surface Reconstruction-Induced Photocatalytic Methanol Reduction Reaction on a Rutile TiO2(001) Surface.

Photochemistry of methanol on TiO2 surfaces is of great importance both fundamentally and industrially. Methanol was previously reported only to occur photogenerated hole-participating oxidation reactions on TiO2 surfaces. Herein, we report that, upon UV light illumination, the methoxy species formed by methanol dissociation at the 5-fold coordinated Ti4+ sites (CH3O(a)Ti5c) of a reconstructed rutile TiO2(001)-(1 × 1) surface also undergoes the C-O bond cleavage into methyl fragments mediated by photogenerated electrons, in addition to the well-established photogenerated hole-participating oxidation reactions. Upon subsequent heating, the resulting methyl species undergoes hydrogenation and coupling reactions into methane and ethane, respectively. Accompanying theoretical calculations showed that the lowest unoccupied molecular orbital (LUMO) of CH3O(a)Ti5c is localized almost at the conduction band minimum of the CH3O-adsorbed reconstructed rutile TiO2(001)-(1 × 1) surface, indicating the likely TiO2 → CH3O(a)Ti5c interfacial photoexcited-electron transfer. These results greatly broaden the photochemistry of methanol on TiO2 surfaces and demonstrate a photocatalytic methanol-to-hydrocarbon reaction route.

Photocatalytic cross-coupling of methanol and formaldehyde on a rutile TiO2(110) surface.

The photocatalytic oxidation of methanol on a rutile TiO2(110) surface was studied by means of thermal desorption spectroscopy (TDS) and X-ray photoelectron spectroscopy (XPS). The combined TDS and XPS results unambiguously identify methyl formate as the product in addition to formaldehyde. By monitoring the evolution of various surface species during the photocatalytic oxidation of methanol on TiO2(110), XPS results give direct spectroscopic evidence for the formation of methyl formate as the product of photocatalytic cross-coupling of chemisorbed formaldehyde with chemisorbed methoxy species and clearly demonstrate that the photocatalytic dissociation of chemisorbed methanol to methoxy species occurs and contributes to the photocatalytic oxidation of methanol. These results not only greatly broaden and deepen the fundamental understanding of photochemistry of methanol on the TiO2 surface but also demonstrate a novel green and benign photocatalytic route for the synthesis of esters directly from alcohols or from alcohols and aldehydes.