Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial.

BACKGROUND: Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation. METHODS: Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation. RESULTS: A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups. CONCLUSIONS: Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) "retrospectively registered".

Numerical simulations of fluid flow in trabecular-lacunar cavities under cyclic loading.

BACKGROUND: Under external loading, the fluid shear stress (FSS) in the porous structures of bones, such as trabecular or lacunar-canalicular cavity, can influence the biological response of bone cells. However, few studies have considered both cavities. The present study investigated the characteristics of fluid flow at different scales in cancellous bone in rat femurs, as well as the effects of osteoporosis and loading frequency. METHODS: Sprague Dawley rats (3 months old) were divided into normal and osteoporotic groups. A multiscale 3D fluid-solid coupling finite element model considering trabecular system and lacunar-canalicular system was established. Cyclic displacement loadings with frequencies of 1, 2, and 4 Hz were applied. FINDINGS: Results showed that the wall FSS around the adhesion complexes of osteocyte on the canaliculi was higher than that on the osteocyte body. Under the same loading conditions, the wall FSS of the osteoporotic group was smaller than that of the normal group. The fluid velocity and FSS in trabecular pores exhibited a linear relationship with loading frequency. Similarly, the FSS around osteocytes also showed the loading frequency-dependent phenomenon. INTERPRETATION: The high cadence in movement can effectively increase the FSS level on osteocytes for osteoporotic bone, i.e., expand the space within the bone with physiological load. This study might help in understanding the process of bone remodeling under cyclic loading and provide the fundamental data for the development of strategies for osteoporosis treatment.

Finite element analysis on mechanical state on the osteoclasts under gradient fluid shear stress.

Mechanical loading, such as fluid shear stress (FSS), is regarded as the main factor that regulates the biological responses of bone cells. Our previous studies have demonstrated that the RAW264.7 osteoclast precursors migrate toward the low-FSS region under the gradient FSS field by a cone-and-plate flow chamber, in which the FSS in the outer region is larger than that in the inner region along the radial direction. Whether the FSS distribution on a cell depends on the gradient direction of FSS field should be clarified to explain this experimental observation. In this study, the finite element models of the discretely distributed or closely packed cells adherent on the bottom plate in a cone-and-plate flow chamber were constructed, and cells were regarded as compressible isotropic Hookean solid. Results showed that the average FSS of each discretely distributed cell at the quarter sector far from the center (SFC) was about 0.1% greater than that at the quarter sector near the center (SNC). In the bands with different orientations for a cell, the relative difference between the average FSS in the SFC and the SNC becomes smaller with increased band height. For the hexagonal closely packed cells, the relative value of SFC and SNC increases with increasing cell spacing. The difference between the local wall FSS in the SFC and the SNC may activate mechanosensitive ion channels and further regulate the migration of osteoclast precursors toward the low-FSS region under the gradient FSS field.

Effect of trachea stiffness on tumor distribution in papillary thyroid microcarcinoma.

Biomechanical factors play an important role in tumor distribution, epithelial-mesenchymal transition (EMT), invasion and other important processes. Despite fewer reports investigating biomechanical function in papillary thyroid carcinoma (PTC), a large number of PTC cases are located close to the trachea and the majority of advanced cases of PTC have been associated with invasion of the trachea. However, the effect of trachea stiffness on PTC distribution and growth remains unknown. To clarify this issue, two types of PTC cells (TPC-1 and KTC-1) were seeded on a substrate with different stiffness to observe cell proliferation and movement. To identify the effect of trachea stiffness on the thyroid, two thyroid lobes (left and right) were evenly divided into interior (close to the trachea) and lateral (away from the trachea) parts, based on the vertical line between the trachea and thyroid lateral margin with different von Mises stress values. As PTC originates from papillary thyroid microcarcinoma (PTMC) with a maximum diameter of <1 cm, the present study selected PTMC as the study subject to reflect initial PTC distribution in the thyroid. The association between the percentage of PTMC distribution in different parts of the thyroid and von Mises stress values was analyzed. Both PTC cells exhibited stronger proliferation and mobility on the stiff substrate compared with that on the soft substrate. Furthermore, the results of finite element analysis revealed that the von Mises stress values of the interior parts of the trachea were notably higher compared with that in the lateral parts. PTMC distribution in the interior trachea was notably greater compared with that in the lateral section. There was also an observed association between von Mises stress values and PTMC distribution. In addition, the results of RNA-sequencing and reverse transcription-quantitative PCR demonstrated that three biomechanical genes were overexpressed in PTMC located in the interior section compared with that in adjacent normal tissue, and the related signaling pathways were also activated in these tissues. On the whole, these results indicated that trachea stiffness may supply a suitable biomechanical environment for PTMC growth, and the related biomechanical genes may serve as novel targets for PTMC diagnosis and prognostic estimation.

In vitro fertilization-embryo transfer in patients with unexplained recurrent pregnancy loss.

BACKGROUND: Empiric therapy for patients with unexplained recurrent pregnancy loss (URPL) is not precise. Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age. The clinical outcomes of URPL patients who have undergone in vitro fertilization-embryo transfer (IVF-ET) require elucidation. The IVF outcome and influencing factors of URPL patients need further study. METHODS: A retrospective cohort study was designed, and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included. By comparing clinical outcomes between these patients and those with tubal factor infertility (TFI), the factors affecting the clinical outcomes of URPL patients were analyzed. RESULTS: The clinical pregnancy rate (35.18% vs. 34.52% in fresh ET cycles, P = 0.877; 34.48% vs. 40.27% in frozen-thawed ET cycles, P = 0.283) and live birth rate (LBR) in fresh ET cycles (27.67% vs. 26.59%, P = 0.785) were not significantly different between URPL group and TFI group. URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group (23.56% vs. 33.56%, P = 0.047), but the cumulative LBRs (34.69% vs. 38.26%, P = 0.368) were not significantly different between the two groups. The increased endometrial thickness (EMT) on the human chorionic gonadotropin day (odds ratio [OR]: 0.848, 95% confidence interval [CI]: 0.748-0.962, P = 0.010) and the increased number of eggs retrieved (OR: 0.928, 95% CI: 0.887-0.970, P = 0.001) were protective factors for clinical pregnancy in stimulated cycles. The increased number of eggs retrieved (OR: 0.875, 95% CI: 0.846-0.906, P < 0.001), the increased two-pronucleus rate (OR: 0.151, 95% CI: 0.052-0.437, P < 0.001), and increased EMT (OR: 0.876, 95% CI: 0.770-0.997, P = 0.045) in ET day were protective factors for the cumulative live birth outcome. CONCLUSION: After matching ages, no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI. A thicker endometrium and more retrieved oocytes increase the probability of pregnancy in fresh transfer cycles, but a better normal fertilization potential will increase the possibility of a live birth.

Fluid-solid coupling numerical simulation of trabecular bone under cyclic loading in different directions.

The structure of a bone tissue is capable of adapting to mechanical loading through the process of bone remodeling, which is regulated by osteoblasts and osteoclasts. Fluid flow within trabecular porosity under cyclic loading is one of the factors stimulating the biological response of osteoblasts and osteoclasts. However, the relation between loading directions and interstitial fluid flow was seldom studied. In the present study, a finite element model based on micro-computed tomographic reconstructions is built by using a mouse femur. Results from the fluid-solid coupling numerical simulation indicate that the loading in different directions generates a distinct distribution of von Mises stress in the bone matrix and a fluid shear stress (FSS) in the bone marrow. The loading along the physiological direction leads to a more uniform distribution of solid stress and produces an FSS level beneficial to the biological response of osteoblasts and osteoclasts compared with those along the non-physiological direction. There was a minimum threshold line of wall FSS with a specific solid stress at the bone surface, suggesting that the wall FSS is mainly induced by the solid strain. These results may offer fundamental data in understanding the mechanical environment around osteoblasts and osteoclasts and the cellular and molecular mechanisms of mechanical loading-induced bone remodeling.

Gradient fluid shear stress regulates migration of osteoclast precursors.

Cell migration is highly sensitive to fluid shear stress (FSS) in blood flow or interstitial fluid flow. However, whether the FSS gradient can regulate the migration of cells remains unclear. In this work, we constructed a parallel-plate flow chamber with different FSS gradients and verified the gradient flow field by particle image velocimetry measurements and finite element analyses. We then investigated the effect of FSS magnitudes and gradients on the migration of osteoclast precursor RAW264.7 cells. Results showed that the cells sensed the FSS gradient and migrated toward the low-FSS region. This FSS gradient-induced migration tended to occur in low-FSS magnitudes and high gradients, e.g., the migration angle relative to flow direction was approximately 90° for 0.1 Pa FSS and 0.2 Pa mm-1 FSS gradient. When chemically inhibiting the calcium signaling pathways of the mechanosensitive cation channel, endoplasmic reticulum, phospholipase C, and extracellular calcium, the cell migration toward the low-FSS region was significantly reduced. This study may provide insights into the mechanism of the recruitment of osteoclast precursors at the site of bone resorption and of mechanical stimulation-induced bone remodeling.

Migration and differentiation of osteoclast precursors under gradient fluid shear stress.

The skeleton can adapt to mechanical loading through bone remodeling, and osteoclasts close to microdamages are believed to initiate bone resorption. However, whether local mechanical loading, such as fluid flow, regulates recruitment and differentiation of osteoclast precursors at the site of bone resorption has yet to be investigated. In the present study, finite element analysis first revealed the existence of a low-fluid shear stress (FSS) field inside microdamage. Based on a custom-made device of cone-and-plate fluid chamber, finite element analysis and particle image velocimetry measurement were performed to verify the formation of gradient FSS flow field. Furthermore, the effects of gradient FSS on the migration, aggregation, and fusion of osteoclast precursors were observed. Osteoclast precursor RAW264.7 cells migrated along a radial direction toward the region with decreased FSS during exposure to gradient FSS stimulation for 40 min, thereby deviating from the direction of actual fluid flow indicated by fluorescent particles. When calcium signaling pathway was inhibited by gadolinium and thapsigargin, cell migration toward a low-FSS region was significantly reduced. For the other cell lines MC3T3-E1, PDLF, rat mesenchymal stem cells, and Madin-Darby canine kidney epithelial cells, gradient FSS stimulation did not lead to low-FSS inclined migration. After being cultured under gradient FSS stimulation for 6 days, RAW264.7 cells showed significantly higher density and ratio of TRAP-positive multinucleated osteoclasts in the low-FSS region to those in the high-FSS region. Therefore, osteoclast precursor cells may exhibit the special ability to sense FSS gradient and tend to actively migrate toward low-FSS regions, which are regulated by calcium signaling pathway.

Coordination templated [2+2+2] cyclotrimerization in a porous coordination framework.

Controlling chemical reactions by the supramolecular confinement effects of nanopores has attracted great attention. Here we show that open metal sites in porous coordination frameworks can constitute more powerful and strict templates for precision syntheses. A Fe(III) dicarboxylate framework functionalized with triangularly arranged metal sites is used to accomplish [2+2+2] cyclotrimerization reactions for organonitrile, alkyne and alkene monomers bearing a geometrically suitable pyridyl group. In situ single-crystal X-ray diffraction facilitates the direct observation of such a coordination templated reaction, before cylcotrimerization, the monomer coordinates at the Fe(III) centre by its pyridyl donor, which forces three unsaturated groups to gather around a position very similar with that of the desired covalent cyclic trimer. After the reaction, the trimers serve as tripodal ligands to perfectly fix the Fe(III) ions and the whole crystal to generate an exceptionally rigid and porous material with large surface area coupled with guest-proof zero thermal expansion.

Tuning fluorocarbon adsorption in new isoreticular porous coordination frameworks for heat transformation applications.

Adsorption heat transformation is one of the most energy-efficient technologies, which relies much on the type and performance of the adsorbent-adsorbate pair. Here, we report adsorption behaviors of a typical fluorocarbon R22 (CHClF2) in a new series of isoreticular porous coordination polymers [Zn4O(bpz)2(ldc)], in which the typical Zn4O clusters are connected by hydrophobic 3,3',5,5'-tetramethyl-4,4'-bipyrazolate (bpz2-) and different linear dicarboxylates (ldc2-) to form non-interpenetrated pcu networks with variable pore sizes, shapes, and volumes. Fluorocarbon sorption measurements of these materials revealed high R22 uptakes of 0.73-0.97 g g-1 (0.62-0.65 g cm-3) at 298 K and 1 bar and working capacities of 0.41-0.72 g g-1 (0.35-0.47 g cm-3) between 273 and 313 K at about 0.13, 0.11 and 0.52 bar, respectively, as well as very large diffusion coefficients of 5.1-7.3 × 10-7 cm2 s-1. Noteworthily, the R22 sorption performance can be dramatically improved by subtle modification of the pore size and shape, demonstrating porous coordination polymer-fluorocarbon as a promising adsorbent-adsorbate pair for heat transformation applications.