Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns. DATA SOURCES: We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024. METHODS: We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity. RESULTS: The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55-0.77; I2, 0%; P < .00001); 0.62 for endometritis (95% CI, 0.52-0.74; I2, 2%; P < .00001); and 0.43 for maternal wound or surgical site infection (95% CI, 0.24-0.78; P < .005); however, there was great heterogeneity among the studies (I2, 75%). The pooled OR for pyelonephritis and urinary tract infections was 0.3 (95% CI, 0.17-0.52; I2, 0%; P < .0001), and that for neonatal skin infections was 0.48 (95% CI, 0.35-0.65; I2, 0%, P < .00001). There was no significant difference in maternal all-cause mortality or incidence of chorioamnionitis between the two groups. No significant differences were observed in the incidence of neonatal sepsis or suspected sepsis, all-cause mortality, or infections of the eyes or ears. CONCLUSION: In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections. These findings indicate that azithromycin may be potentially beneficial for maternal postpartum infections, but its effect on neonatal prognosis remains unclear. Azithromycin should be used antenatally only if the clinical indication is clear and the potential benefits outweigh the harms.

Opioid infusions at different times of the day produce varying degrees of opioid-induced hyperalgesia.

BACKGROUND: Opioids are metabolised by enzymes the activities of which vary with the circadian rhythm. We examined whether opioid infusions administered at different times of the day produce varying degrees of opioid-induced hyperalgesia (OIH) in animal experiments and clinical studies. METHODS: Male Sprague-Dawley rats received remifentanil infusions (1 µg kg-1·min-1 for 1 h) at Zeitgeber times (ZT) 0, 4, 8, 12, 16, or 20 h. Rhythmicity of mechanical hypersensitivity was assayed after the infusion. Mechanical hypersensitivity, drug concentration, and metabolic enzyme activity of Wistar rats that received sufentanil (10 µg kg-1; four consecutive i.p. injections at 15-min intervals) or remifentanil infusion at ZT0 or ZT8 were assayed. Sixty patients who underwent abdominal laparoscopic surgery under general anaesthesia received remifentanil infusion (0.15 µg kg-1 min-1) and sufentanil injection (0.2 µg kg-1) at induction and skin incision, respectively. Postoperative pressure pain sensitivity, pain Numeric Rating Scale (NRS), drug concentrations, and nonspecific esterase activity were assessed. RESULTS: Sprague-Dawley rats that received remifentanil infusion exhibited a robust rhythmic paw withdrawal threshold (JTK_CYCLE: P=0.001, Q=0.001, Phase=26). Wistar rats infused with remifentanil or sufentanil at ZT8 exhibited greater OIH (P<0.001) than those infused at ZT0, with higher blood concentrations (P<0.001) and lower metabolic enzyme activities (P=0.026 and P=0.028, respectively). Patients in the afternoon group exhibited higher pressure pain sensitivity at forearm (P=0.002), higher NRS (P<0.05), higher drug concentrations (sufentanil: P=0.037, remifentanil: P=0.005), and lower nonspecific esterase activity (P=0.024) than the morning group. CONCLUSIONS: Opioid infusions administered at different times of day produced varying degrees of OIH, possibly related to circadian rhythms of metabolic enzyme activities. CLINICAL TRIAL REGISTRATION: NCT05234697.

Moraxella occupied the largest proportion in the nasal microbiome in healthy children, which potential protect them from COVID-19.

BACKGROUND: In the prevalence of COVID-19, infection symptoms are different in children and adults. In this study to investigate the differences in the upper respiratory tract microbiome profile between healthy children and adults and to explore which microbiome protect them from COVID-19. METHODS: Thirty healthy children and 24 healthy adults were enrolled between October 2020 and January 2021. Nasal and throat swabs were obtained at enrollment, and DNA was extracted. We performed 16S rDNA sequencing to compare the alpha and beta diversity of the nasal and throat microbiomes between children and adults and assessed potential microbiome biomarkers. RESULTS: In the nasal microbiome, there were significant differences between healthy children and adults, and Moraxella occupied the largest proportion in healthy children. Notably, there was no significant difference between healthy children and adults in the throat microbiome, and it was predominated by Firmicutes. In the function analysis, compared with adults, there was increased enrichment in pathways related to amino acid metabolism and lipid metabolism, in children. CONCLUSIONS: In the upper respiratory tract microbiome profiles, Moraxella may be involved in protecting children from COVID-19 infections and may be involved the amino acid metabolism and lipid metabolism.

A meta-analysis of the comparison of phlebitis between midline catheters and peripherally inserted central catheters in infusion therapy.

AIMS: To compare the risk of phlebitis between midline catheters and peripherally inserted central catheters in infusion therapy with a meta-analysis. DESIGN: This was a systematic literature review and meta-analysis. DATA SOURCES: Web of Science, PubMed, Scopus, Embase, Cochrane Library, ProQuest, CNKI, WanFang, VIP and SinoMed were searched from inception to May 2020. REVIEW METHODS: All studies comparing the risk of phlebitis between midline catheters and peripherally inserted central catheters were included. According to the inclusion and exclusion criteria, two authors independently assessed the literature and extracted the data. Meta-analyses were conducted to generate estimates of phlebitis risk in patients with midline catheters verse peripherally inserted central catheters, and publication bias was evaluated with RevMan 5.3. RESULTS: A total of seven studies were collected, involving 1377 participants. The incidence of phlebitis with midline catheters and peripherally inserted central catheters was 1.52% and 3.41%. Meta-analysis showed that the incidence of phlebitis has no significant difference between midline catheters and peripherally inserted central catheters. The sensitivity analysis shows that the results from this meta-analysis are fair in overall studies. All studies have no significant publication bias. CONCLUSION: This study provides the first systematic assessment of the risk of phlebitis between midline catheters and peripherally inserted central catheters. The incidence of phlebitis has no significant difference between them. There are many factors to consider when choosing vascular access devices.

Impacts of market segmentation on the over-capacity of the thermal electricity generation industry in China.

China's thermal electricity generation industry, the world's largest emitter of carbon dioxide, is experiencing a severe over-capacity problem. An effective solution to this problem is urgently needed to achieve the energy conservation and emission reduction goals, as well as a sustainable growth of China's economy. However, under China's existing political promotion system, there exists a market segmentation that hinders cooperation between regions. In the short term, market segmentation is conducive to the utilization of installed capacity in each place; however, in the long run, can market segmentation alleviate the over-capacity problem in the thermal electricity generation industry across China? Using the China Industrial Enterprise Database (CIED) from 2002 to 2013, this paper estimates the capacity utilization rate, an indicator of over-capacity, of China's thermal electricity generation firms through stochastic frontier analysis. Then, by applying the fuel and electricity price index, this paper measures the degree of market segmentation at three levels, (i) among all provinces, (ii) between neighboring provinces and (iii) among provinces covered by the same grid company. Based on these, this paper empirically estimates the impacts of market segmentation on the utilization rate of China's thermal electricity generation firms. The results indicate that market segmentation has significantly negative impacts on the capacity utilization rates. Heterogeneity analysis suggests that private firms, firms in regions with abundant coal resources and those in the western regions are affected to a larger degree. The results remain robust in the robustness check that replaces the data with the China Stock Market & Accounting Research (CSMAR) Database, the counterfactual test and the test that concerns endogeneity. These findings provide important policy implications for the solution of the over-capacity problem in China's electricity generation industry.

Long noncoding RNA LINC00958 regulates cell sensitivity to radiotherapy through RRM2 by binding to microRNA-5095 in cervical cancer.

Long noncoding RNAs (lncRNAs) have been implicated in the regulation of resistance to radiotherapy in cervical cancer, which is a type of gynecological disease with high mortality in women around the world. Hence, our purpose is to delineate the involvement of LINC00958 in regulating cell sensitivity to radiotherapy in cervical cancer. LINC00958 expression in cervical cancer was assayed, followed by verification of the relationship among LINC00958, microRNA-5095 (miR-5095) and ribonucleotide reductase subunit M2 (RRM2). Hela cells were transduced with up-/downregulation of miR-5095 or RRM2, or LINC00958 silencing, respectively, and then treated with or without a 6 Gy dose of X-ray irradiation. Then the cell proliferation, apoptosis, survival fraction rate, as well as sensitivity to radiotherapy, were assessed. Finally, xenograft tumor in nude mice was established by transplanting Hela cells transfected with sh-LINC00958 and irradiated with 6 Gy of X-ray. High expression of LINC00958 was revealed in The Cancer Genome Atlas and Gene Expression Profiling Interactive Analysis, as well as in radiation-resistant patients, which was associated with lower sensitivity to radiotherapy in cervical cancer. Moreover, cervical cancer patients with higher LINC00958 expression exhibited a shorter overall survival according to Kaplan-Meier analysis. In addition, LINC00958 could regulate the expression of RRM2 by competing for miR-5095. A combination of radiotherapy with LINC00958 silencing, RRM2 downregulation or miR-5095 overexpression was found to inhibit cervical cancer cell proliferation and tumor growth, while promoting cell apoptosis both in vitro and in vivo. Collectively, our results suggest that LINC00958 could regulate RRM2 by competing to miR-5095, which regulates cell sensitivity to radiotherapy in cervical cancer.

Reactive oxygen and nitrogen species induce cell apoptosis via a mitochondria-dependent pathway in hyperoxia lung injury.

Hyperoxia-induced lung injury limits the application of mechanical ventilation on rescuing the lives of premature infants and seriously ill and respiratory failure patients, and its mechanisms are not completely understood. In this article, we focused on the relationship between hyperoxia-induced lung injury and reactive oxygen species (ROS), reactive nitrogen species (RNS), mitochondria damage, as well as apoptosis in the pulmonary epithelial II cell line RLE-6TN. After exposure to hyperoxia, the cell viability was significantly decreased, accompanied by the increase in ROS, nitric oxide (NO), inflammatory cytokines, and cell death. Furthermore, hyperoxia triggered the loss of mitochondrial membrane potential (▵Ψm), thereby promoting cytochrome c to release from mitochondria to cytoplasm. Further studies conclusively showed that the Bax/Bcl-2 ratio was enlarged to activate the mitochondria-dependent apoptotic pathway after hyperoxia treatment. Intriguingly, the effects of hyperoxia on the level of ROS, NO and inflammation, mitochondrial damage, as well as cell death were reversed by free radical scavengers N-acetylcysteine and hemoglobin. In addition, a hyperoxia model of neonatal Sprague-Dawley (SD) rats presented the obvious characteristics of lung injury, such as a decrease in alveolar numbers, alveolar mass edema, and disorganized pulmonary structure. The effects of hyperoxia on ROS, RNS, inflammatory cytokines, and apoptosis-related proteins in lung injury tissues of neonatal SD rats were similar to that in RLE-6TN cells. In conclusion, mitochondria are a primary target of hyperoxia-induced free radical, whereas ROS and RNS are the key mediators of hyperoxia-induced cell apoptosis via the mitochondria-dependent pathway in RLE-6TN cells.

Efficacy of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in abdominal surgery: A meta-analysis of randomised controlled trials.

To assess the efficacy and safety of dexmedetomidine (DEX) as an adjuvant to local wound infiltration anaesthesia in abdominal surgery, we conducted this meta-analysis. First, the systematic search strategy was performed on PubMed, Embase, and Cochrane Library and five randomised controlled trials (RCTs) involving 294 patients were included. Then, the outcome data were extracted from the studies and their effect sizes were calculated using Review Manager 5. As a result, the addition of DEX significantly reduced visual analogy scores at 6 hours after surgery (mean difference = -0.53[-0.82, -0.25], P < .001), 12 hours after surgery (mean difference = -0.39 [-0.73, -0.05]; P = .03), and 24 hours after surgery (mean difference = -0.20 [-0.29, -0.11], P < .001) and reduced total analgesic consumption within 24 hours after surgery (mean difference = -4.92 [-9.00, -0.84]; P = .02) compared with placebo groups. However, there was no difference in the incidence of postoperative nausea and vomiting (risk ratio = 0.68 [0.41, 1.14]; P = .14). In summary, DEX as a local anaesthetic adjuvant added for local wound infiltration anaesthesia in abdominal surgery could reduce visual analogy scores and postoperative analgesic consumption without changing incidence of postoperative nausea and vomiting.

The Wnt7b/ß-catenin signaling pathway is involved in the protective action of calcitonin gene-related peptide on hyperoxia-induced lung injury in premature rats.

BACKGROUND: Calcitonin gene-related peptide (CGRP) can protect against hyperoxia-induced lung injury, making the upregulation of CGRP a potential therapeutic approach for this type of injury. However, the effects of CGRP on the Wnt7b/ß-catenin signaling pathway are unclear. In this study, we investigated the roles of CGRP and the Wnt7b/ß-catenin signaling pathway in hyperoxia-induced lung injury. METHODS: Premature Sprague Dawley (SD) rats were exposed to 21, 40, 60 and 95% oxygen for 3, 7 and 14 days. The animals' body weights, survival rates and endogenous CGRP levels were measured. Lung samples were harvested for histological analyses and measurements of malondialdehyde (MDA) concentration and total antioxidant capacity (TAOC). We also assessed the MDA concentration and TAOC in the lung tissues after administration of 200 nmol/kg CGRP8-37 (a CGRP antagonist). Finally, alveolar epithelial type II (AEC II) cells were isolated from premature rats, exposed to 21 or 95% oxygen for 3, 7 and 14 days, and treated with 10- 8 mol/l exogenous CGRP. The protein expressions of Wnt7b and ß-catenin were assessed using western blotting, and TCF and c-myc mRNA expressions were assessed using qPCR. RESULTS: Rats exposed to 60 and 95% oxygen had significantly lower body weights and survival rates than the 21 and 40% groups, and the decrease was time dependent. Endogenous CGRP was elevated in the lung tissues of premature rats exposed to 95% oxygen. CGRP8-37 induced apparent inflammation in the lung tissue and alveolar structural remodeling. In addition, the expression levels of Wnt7b and ß-catenin were markedly increased after exposure for 3 days. They peaked at 7 days, then declined at 14 days. The levels of TCF/c-myc in AEC II cells increased significantly after CGRP treatment when compared with cells that had only undergone hyperoxia. CONCLUSIONS: CGRP protected against hyperoxia-induced lung injury in premature rats. This process involves the Wnt7b/ß-catenin signaling pathway.

[Theoretical Investigation of the Electron Paramagnetic Resonance Parameters and Local Structures for Zinc Phosphate Glass Doped with VO2+].

As an important model system, 3d(1) ions (VO2+, V4+ et al) have been extensively investigated by means of electron paramagnetic resonance (EPR), and many experimental results of EPR parameters were also measured. The optical absorption and EPR parameters (g factors g||, g⊥ and hyperfine structure constants A||, A⊥) of a tetragonal V4+ center in zinc phosphate glass are theoretically investigated, using the perturbation formulas for a 3d(1) ion in tetragonally compressed octahedra. Since the spin-orbit coupling parameter r (150 cm(-1)) of ligand O2- is close to that ξp(0) (≈248 cm(-1)) of the central 3d(1) ion in zinc phosphate glass doped VO2+, the effect of the spin-orbit coupling parameter ξp(0) on the EPR spectra and optical absorption spectra should be taken into account. In this work, the relationship between the EPR parameters as well as the optical absorption spectra and the local structure of the impurity center are established based on the superposition model. By fitting the calculated EPR parameters and optical absorption spectra for V4+ center in zinc phosphate glass to the experimental data, the local structure parameters of [VO6](8-) cluster are obtained. According to the investigation, the magnitudes of the metal-ligand distances parallel and perpendicular to the C4-axis of [VO6](8-) cluster are, respectively, R|| ≈ 0.175 nm and R⊥ ≈ 0.197 nm, the local structure around the V4+ ions possesses a compressed tetragonal distortion along C4 axis. Theoretical results of EPR parameters and optical absorption spectra are in good agreement with experimental data, the validity of the calculated results has also been discussed. Thus, perturbation method is effective to the studies the EPR parameters and optical spectra of transition-metal 3d ions in crystals. In addition, based on the studies of the hyperfine structure constants (All and A1), one can found that the large value of kappa indicates a large contribution to the hyperfine constant by the unpaired selectron.

Experimental Study on the Preparation of High-Purity Iron Oxide Red by Acid Leaching Iron from Coal Gangue.

Aiming at the problems of the large storage, complex composition, low comprehensive utilization rate, and high environmental impact of coal gangue, this paper carried out experimental research on the preparation of iron oxide red from high-iron gangue by calcination activation, acid leaching, extraction, and the hydrothermal synthesis of coal gangue. The experimental results show that when the calcination temperature of coal gangue is 500 °C, the calcination time is 1.5 h, the optimal concentration of iron removal is 6 mol/L, the acid leaching temperature is 80 °C, the acid leaching time is 1 h, and the liquid--solid mass ratio is 4:1; the iron dissolution rate can reach 87.64%. A solvent extraction method (TBP-SK-hydrochloric acid system) was used to extract the leachate, and a solution with iron content up to 99.21% was obtained. By controlling the optimum hydrothermal conditions (pH = 9, temperature 170 °C, reaction time 5 h), high-purity iron oxide red product can be prepared; the yield is 80.07%. The red iron oxide was characterized by XRD, SEM-EDS, particle-size analysis, and ICP-OES. The results show that the red iron oxide peak has a cubic microstructure, an average particle size of 167.16 µm, and a purity of 99.16%. The quality of the prepared iron oxide red product meets the requirement of 98.5% of the "YHT4 Iron oxide Standard for ferrite". It can be used as a raw material to produce high-performance soft magnetic ferrite. In summary, this experimental study on the preparation of iron oxide red from coal gangue is of great significance for the comprehensive utilization of coal gangue to realize the sustainable development of the environment and economy.

Mediation effect of hope on the relationship between inner strength and self-management in patients after percutaneous coronary intervention.

Background: Effective self-management can enhance a patient's quality of life and delay disease progression. However, motivating patients to adhere to self-management behavior following percutaneous coronary intervention (PCI) remains a challenge. With the robust development of positive psychology and interdisciplinary research, the role of psychology factors in patients' health behavior has increasingly garnered attention. This study, focusing on positive psychological qualities, aims to investigate the relationship between inner strength, hope, and self-management in patients post-PCI, and to analyze the mediating role of hope between inner strength and self-management. Methods: A cross-sectional survey was conducted among 216 PCI patients from a tertiary hospital in Nanjing. Research instruments included a self-designed general information questionnaire, the Inner Strength Scale (ISS), the Herth Hope Index (HHI), and the Coronary Self-Management Scale (CSMS). T-test, analysis of variance, Pearson's correlation analysis, and mediating effect test were utilized for statistical analysis. Results: The average scores of the ISS, HHI, and CSMS were 81.46 ± 12.00, 35.94 ± 5.38, and 86.79 ± 14.84, respectively. Inner strength was positively correlated with hope and self-management (r = 0.867, r = 0.630, respectively; all P < 0.05), and hope was positively correlated with self-management (r = 0.671, P < 0.05). Moreover, hope had a complete mediating effect between inner strength and self-management (ß = 0.630, P < 0.01). Conclusion: The inner strength, hope, and self-management of patients with PCI are at a moderate level. Inner strength primarily influences patients' self-management behavior through hope, suggesting that medical staff can target hope to help patients build confidence in life after illness, form and accumulate inner strength, thereby promoting their self-management and improving prognosis.

Postoperative esketamine improves ventilation after video-assisted thoracoscopic lung resection: A double-blinded randomized controlled trial.

Background: Pain management after lung resection plays a crucial role in reducing postoperative pulmonary complications (PPCs). This study aimed to examine the effect of postoperative esketamine infusion as an adjunct to opioid analgesia on ventilation and pulmonary complications in patients underwent lung resection. Methods: Patients undergoing video-assisted thoracoscopic lung resection were randomly assigned to either the esketamine group or the control group. The esketamine group received a 24-h infusion of 1.5 mcg/ml sufentanil combined with 0.75 mcg/ml esketamine after surgery, while the control group received 1.5 mcg/ml sufentanil alone. The primary outcome measure was low minute ventilation, and the secondary outcome measures were hypoxemia, PaO2/FiO2 levels, postoperative pulmonary complications, hospital stay duration, ambulation time, Visual Analogue Scale (VAS) score, depression and anxiety levels, sleep quality, and analgesia satisfaction. Results: 80 patients were randomly divided into two groups: the esketamine group (n = 40) and the control group (n = 40). The esketamine group exhibited notably reduced incidence of low minute ventilation (P = 0.014), lower occurrence of postoperative pulmonary complications (PPCs) compared to the control group (P = 0.039), and decreased incidence of hypoxemia (P = 0.003). Furthermore, the esketamine group showed improved outcomes with lower VAS scores on the second postoperative day and enhanced sleep quality (P < 0.001) after the surgery. Conclusions: Postoperative esketamine infusion with opioids improved ventilation and reduced PPCs after lung resection, warranting further clinical studies. Trial registration: This study was registered on ClinicalTrials.gov (Trial ID: NCT05458453, https://clinicaltrials.gov/ct2/show/NCT05458453).

Tumor microenviroment-responsive self-assembly of barium titanate nanoparticles with enhanced piezoelectric catalysis capabilities for efficient tumor therapy.

Catalytic therapy based on piezoelectric nanoparticles has become one of the effective strategies to eliminate tumors. However, it is still a challenge to improve the tumor delivery efficiency of piezoelectric nanoparticles, so that they can penetrate normal tissues while specifically aggregating at tumor sites and subsequently generating large amounts of reactive oxygen species (ROS) to achieve precise and efficient tumor clearance. In the present study, we successfully fabricated tumor microenvironment-responsive assembled barium titanate nanoparticles (tma-BTO NPs): in the neutral pH environment of normal tissues, tma-BTO NPs were monodisperse and possessed the ability to cross the intercellular space; whereas, the acidic environment of the tumor triggered the self-assembly of tma-BTO NPs to form submicron-scale aggregates, and deposited in the tumor microenvironment. The self-assembled tma-BTO NPs not only caused mechanical damage to tumor cells; more interestingly, they also exhibited enhanced piezoelectric catalytic efficiency and produced more ROS than monodisperse nanoparticles under ultrasonic excitation, attributed to the mutual extrusion of neighboring particles within the confined space of the assembly. tma-BTO NPs exhibited differential cytotoxicity against tumor cells and normal cells, and the stronger piezoelectric catalysis and mechanical damage induced by the assemblies resulted in significant apoptosis of mouse breast cancer cells (4T1); while there was little damage to mouse embryo osteoblast precursor cells (MC3T3-E1) under the same treatment conditions. Animal experiments confirmed that peritumoral injection of tma-BTO NPs combined with ultrasound therapy can effectively inhibit tumor progression non-invasively. The tumor microenvironment-responsive self-assembly strategy opens up new perspectives for future precise piezoelectric-catalyzed tumor therapy.

Effects of postoperative environmental noise on surgery induced pain: Evidence based on a prospective observational study.

CONTEXT: Many patients recovering from surgery in wards are disturbed by environmental noise. However, the effects of environmental noise on postoperative pain are unclear. OBJECTIVES: This study aimed to assess the association between postoperative noise and pain. METHODS: This prospective study included 182 women who underwent cesarean sections. Postoperative noise was continuously recorded, and pain intensity at rest was assessed using a numerical rating scale (NRS) for 0-6, 6-12, 12-18, and 18-24 h after the patients were returned to the ward. Cumulative pain scores were calculated by summing the NRS scores at each time point and comprised the primary outcome. The maximum pain NRS score and analgesic consumption during the 24 h after surgery were also recorded. RESULTS: Mean environmental noise intensity during the daytime was an independent factor for cumulative pain scores, maximum pain scores, and analgesic use during the first postoperative 24 h (ß, 0.37; 95% CI, 0.21-0.53 and ß, 0.12; 95% CI, 0.07-0.17; P < 0.001 for both; ß, 0.86; 95% CI, 0.25-1.46; P = 0.006). Cumulative and maximum NRS pain scores as well as the incidence of NRS ≥ 4 were significantly higher in patients under mean daytime environmental noise of ≥58, than <58 decibels (dB) (8.0 [6.0-11.3] vs. 6.0 (5.0-7.0); 3.0 [2.0-4.0] vs. 2.0 [2.0-2.0, and 25.6% vs. 11.0%; RR, 2.32; 95% CI, 1.19-4.54, respectively; P < 0.001 for all). CONCLUSIONS: Higher-level postoperative noise exposure was associated with more severe postoperative pain and increased analgesic needs, as well as a higher incidence of moderate-to-severe pain in patients recovering from cesarean delivery. Our findings indicate that reducing environmental ward noise might benefit for postoperative pain management.

Prevalence and time course of postoperative nausea and vomiting and severe pain in patients under general anesthesia with patient-controlled intravenous analgesia.

Introduction: Postoperative nausea and vomiting (PONV) and pain are common and distressing complications in patients undergoing surgery. However, it remains uncertain whether timing of the postoperative course or the diel rhythm influences the occurrence of PONV or severe pain. Therefore, we aimed to explore the temporal distribution of PONV and severe pain. Material and methods: In this prospective observational study, we enrolled patients aged 18-65 years with American Society of Anesthesiologists classifications I-III, who were scheduled for surgery under general anesthesia. Patients were visited postoperatively at regular intervals (every 6 h over a 24-h period). Incidence of PONV was recorded and categorized based on real-time divisions: before dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59) and as sequential periods (i.e., 0-6, 6-12, 12-18, and 18-24 h). Severe pain and use of additional remedies were also recorded. Results: A total of 724 patients were included in the final analysis. Of these, 14.92 % experienced PONV within the first 6 h, and 8.29 % received antiemetic therapy. Occurrence of PONV and administration of remedies declined over the 24-h postoperative period. The lowest rate of PONV was observed during the pre-dawn hours (5.66 %). There was no statistically significant difference in the incidence of PONV 24-h postoperatively between surgeries with different end times. Patients underwent orthopedic surgeries had the highest incidence of PONV during 18:00-23:59, gynecological surgery patients had the highest incidence at 12:00-17:59, and 6:00-11:59 for other surgery patients. All patients had the lowest incidence during 0:00-5:59. During the initial 6-h postoperative period, 24.59 % of patients experienced severe pain, which declined in the remaining episodes. Patients who underwent orthopedic and gynecological surgeries exhibited similar temporal patterns and distribution characteristics of PONV and severe pain. Discussion: Both PONV and severe pain declined within the 24-h postoperative period, particularly within the first 6 h. Additionally, the onset patterns of PONV vary among patients undergoing different types of surgeries, all patients demonstrated decreased susceptibility to PONV between 00:00-05:59. Our findings enhance prevention and treatment strategies within an optimized timeframe during the postoperative course.

Key role of microRNA-15a in the KLF4 suppressions of proliferation and angiogenesis in endothelial and vascular smooth muscle cells.

While recent insights indicate that the transcription factor Krüppel-like factor 4 (KLF4) is indispensable for vascular homeostasis, its exact role in proliferation and angiogenesis and how it functions remain unresolved. Thus, the aim of the present study was to evaluate the role of KLF4 in the proliferations of endothelial and vascular smooth muscle cells, as well as the angiogenesis. The overexpression of KLF4 in endothelial cells significantly impaired tube formation. KLF4 inhibited the formation of a vascular network in implanted Matrigel plugs in nude mice. Importantly, we found that KLF4 significantly upregulated the miR-15a expression in endothelial cells and vascular smooth muscle cells, and conversely, KLF4 depletion reduced the amount of miR-15a. Furthermore, KLF4 blocked cell cycle progression and decreased cyclin D1 expression in endothelial cells and vascular smooth muscle cells through the induction of miR-15a. Intriguingly, the delivery of a miR-15a antagomir to nude mice resulted in marked attenuation of the anti-angiogenic effect of KLF4. Collectively, our present study provide the first evidence that miR-15a as a direct transcriptional target of KLF4 that mediates the anti-proliferative and anti-angiogenic actions of KLF4, which indicates that KLF4 upregulation of miR-15a may represent a therapeutic option to suppress proliferative vascular disorders.

Psychometric testing of the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey in patients with coronary heart disease in mainland China.

PURPOSE: To evaluate the psychometric properties of the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM) in patients with coronary heart disease (CHD) in mainland China. METHODS: Measurement performance of the MOS-SSS-CM was tested on a convenience sample of 200 Chinese patients with CHD in a University-affiliated hospital in Xi'an, P. R. China. To establish reliability of the instrument, 40 patients were retested 2 weeks later through telephone interview. The traditional Chinese version of the MOS-SSS was transformed into a simplified Chinese Mandarin version and administered to participants, together with Chinese Mandarin versions of the Short Form-36 item Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The MOS-SSS-CM had acceptable internal consistency with Cronbach α coefficients of 0.91 for the overall scale and 0.71-0.84 for the four subscales. The high correlation (r = 0.56-0.87) between items and the remainder of the scale provides further evidence of internal consistency. The test-retest reliability was generally acceptable with intraclass correlation coefficients of 0.89 for the overall scale and 0.74-0.88 for the four subscales. There was acceptable concurrent validity with moderate significant correlations (r ≥ 0.3, p < 0.01) between the MOS-SSS-CM and the Chinese Mandarin version of the HADS. Confirmatory factor analysis supported a four-factor structure of the MOS-SSS-CM measuring the self-perceived adequacy of functional support of Chinese patients with CHD. CONCLUSION: The MOS-SSS-CM is a valid and reliable measure for Chinese Mandarin-speaking patients with CHD.

Recovery of Zinc from Metallurgical Slag and Dust by Ammonium Acetate Using Response Surface Methodology.

Metallurgical slag and dust (MSD) are abundant Zn-containing secondary resources that can partially alleviate the shortage of zinc minerals, with hazardous characteristics and a high recycling value. In this work, the process conditions of recycling Zn from MSD materials leaching by ammonium acetate (NH3-CH3COONH4-H2O) were optimised using response surface methodology (RSM). The influences of liquid/solid ratio, stirring speed, leaching time, total ammonia concentration, and the interactions between these variables on the Zn effective extraction rate during the ammonium acetate leaching process were investigated. Additionally, the predicted regression equation between the Zn effective extraction rate and the four affecting factors was established, and the optimal process parameters were determined with a stirring speed of 345 r/min, leaching temperature of 25 °C, [NH3]/[NH4]+ of 1:1, total ammonia concentration of 4.8 mol/L, liquid/solid ratio of 4.3:1, and leaching time of 46 min. The Zn effective extraction rates predicted by the proposed model and the measured values were 85.25% and 84.67%, respectively, with a relative error of 0.58% between the two values, indicating the accuracy and reliability of the proposed model. XRD and SEM-EDS analysis results showed that Zn2SiO4, ZnS, and ZnFe2O4 were among the main factors affecting the low extraction rate of zinc from metallurgical slag dust. This work established a new technology prototype for the effective and clean extraction of zinc resources, which can provide new routes to effectively utilise Zn-containing MSD materials and lay a foundation for developing other novel techniques for recycling Zn from Zn-containing secondary resources.