Effect of opioid-free anesthesia on the incidence of postoperative nausea and vomiting: A meta-analysis of randomized controlled studies.

BACKGROUND: Research on opioid-free anesthesia has increased in recent years; however, it has never been determined whether it is more beneficial than opioid anesthesia. This meta-analysis was primarily used to assess the effect of opioid-free anesthesia compared with opioid anesthesia on the incidence of postoperative nausea and vomiting. METHODS: We searched the electronic databases of PubMed, the Cochrane Library, Web of Science and Embase from 2014 to 2022 to identify relevant articles and extract relevant data. The incidence of postoperative nausea and vomiting, time to extubation, pain score at 24 hours postoperatively, and time to first postoperative rescue analgesia were compared between patients receiving opioid-free anesthesia and those receiving standard opioid anesthesia. Differences in the incidence of postoperative nausea and vomiting were evaluated using risk ratios (95% confidence interval [CI]). The significance of the differences was assessed using mean differences and 95% CI. The heterogeneity of the subject trials was evaluated using the I2 test. Statistical analysis was performed using the RevMan 5.4 software. RESULTS: Fourteen randomized controlled trials, including 1354 participants, were evaluated in the meta-analysis. As seen in the forest plot, the OFA group had a lower risk of postoperative nausea and vomiting than the control group (risk ratios = 0.41, 95% CI: 0.33-0.51, P < .00001; n = 1354), and the meta-analysis also found that the OFA group had lower postoperative analgesia scores at 24 hours (P < .000001), but time to extubation (P = .14) and first postoperative resuscitation analgesia time (P < .54) were not significantly different. CONCLUSIONS: Opioid-free anesthesia reduces the incidence of postoperative nausea and vomiting while providing adequate analgesia without interfering with postoperative awakening.

Correlation between burst suppression and postoperative delirium in elderly patients: a prospective study.

OBJECTIVE: To explore the correlation between intraoperative burst suppression (BS) and postoperative delirium (POD) in elderly patients, and provide more ideas for reducing POD in clinical. METHODS: Ninety patients, aged over 60 years, who underwent lumbar internal fixation surgery in our hospital were selected. General information of patients was obtained and informed consent was signed during preoperative visits. Patients were divided into burst suppression (BS) group and non-burst suppression (NBS) group by intraoperative electroencephalogram monitoring. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded, and the variation and minimum value were obtained by calculating. Hemoglobin (HGB), C-reactive protein (CRP), system immune inflammatory index (SII) at 24 and 72 h after surgery, the incidence of postoperative adverse reactions, postoperative hospital stay, and total cost were recorded after operation. POD assessment was performed using CAM within 7 days after surgery or until discharge. SPSS25.0 was used for statistical analysis. RESULTS: Compared with the NBS group, the number of elderly patients with high frailty level in BS group was more (P = 0.048). There is correlation between BS and POD (OR: 4.954, 95%CI 1.034-23.736, P = 0.045), and most of the POD patients in BS group behave as hyperactive type. CONCLUSION: The occurrence of intraoperative BS is associated with POD, and elderly patients with frailty are more likely to have intraoperative BS. BS can be used as a predictor of POD.

Clinical application of intubation-free anesthesia in radical resection of lung cancer.

Background: In recent years, video-assisted thoracic surgery (VATS) has become increasingly widespread. However, the implementation of VATS requires the assistance with lung isolation techniques. Spontaneous breathing with laryngeal masks is also increasingly used in VATS. However, evidence on the characteristics of intubated anesthesia is insufficient. Objective: This study aimed to explore whether intubation-free anesthesia has more advantages than other intubation methods in the clinical setting. Methods: Patients with lung tumors who underwent VATS in our hospital between June 2022 and October 2022 were included in the study. Perioperative data of patients, including basic information, intraoperative hemodynamic changes, postoperative inflammatory indicators, and adverse reactions were obtained through the electronic medical record system. According to the protocol of airway management during anesthesia, participants were divided into the following groups: laryngeal mask with spontaneous breathing group (LMSB group), laryngeal mask combined with bronchial blocker group (LM + BB group), double-lumen tube group (DLT group), and tracheal tube combined with bronchial blocker group (TT + BB group). All data were analyzed using SPSS 25.0 software. Results: At baseline, patients in the LMSB and LM + BB groups had a lower body weight (P = 0.024). Systolic blood pressure (SBP), diastolic BP (DBP), and heart rate (HR) were significantly higher in the DLT group than in the non-intubated group during surgery (SBP: T1 P = 0.048, T4 P = 0.021, T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P = 0.004; DBP: T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P ≤ 0.001; HR: T1 P = 0.021, T6 P ≤ 0.001, T7 P = 0.007, T8 P ≤ 0.001). The input fluid (P = 0.009), urine output (P = 0.010), surgery duration (P = 0.035), and procalcitonin levels (P = 0.024) of the DLT group were also significantly higher than those of the other groups. The recovery duration of the LMSB group was significantly longer (P = 0.003) and the incidence of postoperative adverse reactions, mainly atelectasis, was higher (P = 0.012) than those of the other groups. Conclusion: Although the intubation-free anesthesia has less stimulation during operation and less postoperative inflammatory response, it has obvious adverse reactions after operation, which may be not the best anesthesia scheme for radical resection of lung cancer in VATS. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=182767, identifier ChiCTR2200066180.

Glycocholic acid supplementation improved growth performance and alleviated tissue damage in the liver and intestine in Pelteobagrus fulvidraco fed a high-pectin diet.

In a study on the anti-nutritional effect of dietary fiber, it was noticed that a high-pectin diet (PEC diet) caused growth retardation, hepatic cholestasis, steatosis, fibrosis, and enteritis accompanied by decreased glycocholic acid (GCA) in Pelteobagrus fulvidraco. This study was conducted to investigate the potential alleviating effects of supplementation with GCA. A PEC diet and a diet supplemented with 0.6 g kg-1 GCA based on the PEC diet (named the GCA diet) were formulated and randomly fed to juvenile Pelteobagrus fulvidraco. Compared to fish that were fed the PEC diet for 7 days, the GCA content in liver increased significantly in fish fed the GCA diet, the incidence of abnormal liver color, gallbladder somatic index (GBSI), total bile acid concentration in serum and liver, and the expression of arnesoid X receptor gene (fxr) upregulated and genes involved in bile acid (BA) synthesis and uptake in liver decreased significantly. After 56 days, the SGR, the expression of fxr and genes involved in BA synthesis and transportation in the liver, the serum content of total bilirubin, total protein, and globulin were significantly higher, while the hepatosomatic index, GBSI, liver lipid and collagen content, and the incidence of distal intestine tissue damage were lower in fish fed the GCA diet than in those fed the PEC diet. These results suggested that GCA improved growth performance and alleviated hepatic cholestasis and tissue damage to the liver and intestine induced by a high-pectin diet, which might occur through activating FXR.

Bolt-Loosening Detection Using 1D and 2D Input Data Based on Two-Stream Convolutional Neural Networks.

At present, the detection accuracy of bolt-loosening diagnoses is still not high. In order to improve the detection accuracy, this paper proposes a fault diagnosis model based on the TSCNN model, which can simultaneously extract fault features from vibration signals and time-frequency images and can precisely detect the bolt-loosening states. In this paper, the LeNet-5 network is improved by adjusting the size and number of the convolution kernels, introducing the dropout operation, and building a two-dimensional convolutional neural network (2DCNN) model. Combining the advantages of a one-dimensional convolutional neural network (1DCNN) with wide first-layer kernels to suppress high-frequency noise, a two-stream convolutional neural network (TSCNN) is proposed based on 1D and 2D input data. The proposed model uses raw vibration signals and time-frequency images as input and automatically extracts sensitive features and representative information. Finally, the effectiveness and superiority of the proposed approach are verified by practical experiments that are carried out on a machine tool guideway. The experimental results show that the proposed approach can effectively achieve end-to-end bolt-loosening fault diagnoses, with an average recognition accuracy of 99.58%. In addition, the method can easily achieve over 93% accuracy when the SNR is over 0 dB without any denoising preprocessing. The results show that the proposed approach not only achieves high classification accuracy but also has good noise immunity.

Insight into selective breeding for robustness based on field survival records: New genetic evaluation of survival traits in pacific white shrimp (Penaeus vannamei) breeding line.

Survival can be considered a relatively 'old' trait in animal breeding, yet commonly neglected in aquaculture breeding because of the simple binary records and generally low heritability estimates. Developing routine genetic evaluation systems for survival traits however, will be important for breeding robust strains based on valuable field survival data. In the current study, linear multivariate animal model (LMA) was used for the genetic analysis of survival records from 2-year classes (BL2019 and BL2020) of pacific white shrimp (Penaeus vannamei) breeding lines with data collection of 52, 248 individuals from 481 fullsib families. During grow-out test period, 10 days intervals of survival data were considered as separate traits. Two survival definitions, binary survivability (S) and continuous survival in days (SL), were used for the genetic analysis of survival records to investigate; 1) whether adding more survival time information could improve estimation of genetic parameters; 2) the trajectory of survival heritability across time, and 3) patterns of genetic correlations of survival traits across time. Levels of heritability estimates for both S and SL were low (0.005-0.076), while heritability for survival day number was found to be similar with that of binary records at each observation time and were highly genetically correlated (r g > 0.8). Heritability estimates of body weight (BW) for BL2019 and BL2020 were 0.486 and 0.373, respectively. Trajectories of survival heritability showed a gradual increase across the grow-out test period but slowed or reached a plateau during the later grow-out test period. Genetic correlations among survival traits in the grow-out tests were moderate to high, and the closer the times were between estimates, the higher were their genetic correlations. In contrast, genetic correlations between both survival traits and body weight were low but positive. Here we provide the first report on the trajectory of heritability estimates for survival traits across grow-out stage in aquaculture. Results will be useful for developing robust improved pacific white shrimp culture strains in selective breeding programs based on field survival data.

Effects of different levels of controlled hypotension on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing total knee arthroplasty.

Background: Controlled hypotension technique was usually used to reduce intraoperative bleeding, and it could improve visualization of the surgical field during total knee arthroplasty (TKA). However, inappropriate controlled hypotension, through reducing cerebral blood flow or cerebral perfusion pressure, may cause postoperative cognitive dysfunction (POCD), so it is important to identify the appropriate level of controlled hypotension. Objective: To investigate the effects of different levels of controlled hypotension on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing TKA. Methods: Patients meeting inclusion criteria were enrolled through preoperative visits and basic information was obtained. The patients were randomly divided into three groups: Group A, MAP was maintained at 90-100% of the baseline; Group B, MAP was maintained at 80-90% of the baseline; Group C, MAP was maintained at 70-80% of the baseline. The MAP, HR, and rSO2 were observed and recorded during the operation. The C-reactive protein (CRP), hemoglobin (Hb) and MMSE score at 1, 3, and 7 days after operation were recorded. SPSS25.0 was used for data analysis. Result: When the MAP had a decrease among the three groups, rSO2 did not decrease significantly, and none of the patients experienced POCD which was measured by MMSE. And there was no correlation between the decline in rSO2 and that in MAP. Conclusion: No POCD was experienced in the three groups, and we recommend that the controlled hypotensive target indicated by MAP was maintained at 70-80% of the baseline which not only decreases intraoperative bleeding and improve the quality of the surgical field, but also is still within safe levels.

Effects of dietary carbohydrate/lipid ratios on non-specific immune responses, antioxidant capacity, hepatopancreas and intestines histology, and expression of TLR-MAPK/NF-κB signaling pathway-related genes of Procambarus clarkii.

To investigate the effects of dietary carbohydrate/lipid (CHO: L) ratios on non-specific immune responses, antioxidant capacity, and expression of TLR-MAPK/NF-κB signaling pathway-related genes of red swamp crayfish (Procambarus clarkii). Four isonitrogenous and isoenergetic diets containing different CHO: L ratios were formulated. The results showed that the group with a CHO: L ratio of 5.94 had better growth performance (P < 0.05). The highest T-AOC, CAT, and SOD activities and the lowest MDA content in hemolymph and hepatopancreas were observed in the group with a CHO: L ratio of 5.94 (P < 0.05). The lowest activities of ALT, AST, ACP, AKP, and ALB in the hemolymph were observed in CHO: L ratio 5.94 group (P < 0.05), while the highest LZM activity, TP, and GLB content were observed in CHO: L 5.94 group (P < 0.05). The highest mRNA expression levels of tlr3, myd88, and mapk3, and the lowest mRNA expression levels of nf-kb α, nf-kb ß, nf-kb p105, and traf6 were observed in the CHO: L of 5.94 group (P < 0.05). The highest mRNA expression levels of immune-related genes were observed in the CHO: L of 5.94 group (P < 0.05). Overall, these results indicated that the optimum dietary CHO: L ratio is vital in promoting growth and enhancing antioxidants and immunity to maintain red swamp crayfish's intestinal and hepatopancreas health status. In conclusion, the diets with a CHO:L ratio of 5.94 (approximately 36.23% carbohydrate and 6.10% lipid) is optimal for juvenile red swamp crayfish's physiological condition and health status.

Early Cognitive Dysfunction in Elderly Patients after Total Knee Arthroplasty: An Analysis of Risk Factors and Cognitive Functional Levels.

BACKGROUND: Cognitive dysfunction after total knee arthroplasty (TKA) is very common in elderly patients. Postoperative cognitive dysfunction (POCD), as a form of cognitive dysfunction, may affect patients' short- and long-term recoveries. The identification of meaningful risk factors may help reduce the occurrence of POCD in the future. OBJECTIVE: Our goal was to retrospectively investigate the risk factors for early POCD in elderly patients undergoing TKA and to further analyze the relationship between the intensity of risk factors and the level of cognitive function. METHODS: The related indicators and the Montreal Cognitive Function Assessment Scale (MOCA) scores of 105 elderly patients were collected by searching the electronic case system. According to the postoperative MOCA score, patients were divided into three groups: normal group (group N), mild POCD group (group M), and severe POCD group (group S). SPSS 25.0 software was used for statistical analyses. RESULTS: At baseline, the preoperative MOCA score was significantly different in patients with POCD (P ≤ 0.001), while other baseline indicators were not significantly different. In terms of changes in hemoglobin levels, statistically significant differences were observed between group M, group S, and group N (P = 0.039). Among inflammatory indicators, only postoperative CRP levels showed a statistically significant difference in patients with POCD (P = 0.041). Postoperative pain was also significantly different among the three groups (P = 0.009). The multivariate regression analysis revealed that a low preoperative MOCA score and severe postoperative pain were independent risk factors for mild and severe cognitive impairment, while a high postoperative CRP level was only an independent risk factor for mild cognitive impairment. CONCLUSIONS: Our study found that the level of preoperative cognitive function, postoperative CRP level, and postoperative pain were independent risk factors for POCD. Moreover, the levels of preoperative cognitive function and postoperative pain were more strongly correlated with severe POCD than postoperative CRP levels.

c-Jun N-terminal kinase (JNK) in Procambarus clarkii: Molecular characterization and involvement in oxidative stress-induced apoptosis during molting cycle.

The present study was conducted to characterize the full-length cDNA of c-Jun N-terminal kinase (JNK) in Procambarus clarkii (Pcjnk) and evaluate its potential function under different molt cycle. The full-length cDNA of Pcjnk covered 2937 bp with an open reading frame of 1320 bp, encoding 439 amino acids. A typical conserved TPY motif (118Thr-Pro-120Tyr) was found in Pcjnk. Quantitative real-time PCR (qRT-PCR) analysis revealed a constitutive expression of Pcjnk in the tested tissue, with the highest expression occurring in the hepatopancreas. Additionally, the present study initially revealed that relative mRNA expression of Pcjnk and apoptosis level were significantly higher in the premolt stage (D1/D2 and D3/D4 stage) as compared to other molt stages. In contrast to the levels of superoxide dismutase (SOD) and malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GPX) level decreased significantly from the intermolt stage (C stage) to the premolt stage (D1/D2 and D3/D4 stage), then increased from the premolt stage to the postmolt stage (A and B stage). The results obtained in the present study indicated that molt could cause apoptosis induced by oxidative stress through the activation of JNK in Procambarus clarkii.

Dietary pectin caused great changes in bile acid profiles of Pelteobagrus fulvidraco.

To reveal the impact of dietary fiber (DF) on the bile acid (BA) profiles of fish, yellow catfish (Pelteobagrus fulvidraco) were fed a diet containing 300 g kg-1 dextrin (CON diet, control) or pectin (a type of soluble DF, PEC diet) for 7 days, and then the BA profiles were analyzed by UHPLC-MS/MS. A total of 26 individuals of BAs were detected in the fish body, with 8, 10, 14, and 22 individuals of BAs detected in the liver, serum, bile, and hindgut digesta, respectively. The conjugated BAs (CBAs) of fish were dominated by taurine CBAs (TCBAs). The concentrations of free BAs (FBAs) and the value of FBAs/CBAs in the bile of fish fed the PEC diet were nearly 5 and 7 times higher, respectively than those in fish fed the CON diet. The value of glycine CBAs/TCBAs in the liver, serum and bile of fish fed the PEC diet was significantly lower, and in the hindgut digesta was higher than that of fish fed the CON diet (P < 0.05). These results suggested that dietary pectin greatly changed the BA profiles of Pelteobagrus fulvidraco, attributed to inhibition of reabsorption of BAs. Therefore, attention should be paid to the impact on BA homeostasis when replacing fishmeal with DF-rich plant ingredients in the fish diet.

Quantitative Genetic Assessment of Female Reproductive Traits in a Domesticated Pacific White Shrimp (Penaeus vannamei) Line in China.

Seed production can be improved if genetic selection is applied to key reproductive traits when a substantial amount additive genetic variation is present that can be exploited in a selective breeding program. Despite the commercial importance of reproductive traits to the seed production sector currently, few quantitative genetic studies have been conducted to address these traits in farmed penaeid shrimp culture lines. Here, we investigated genetic parameters for a number of key reproductive traits that directly impact nauplii production in Pacific white shrimp (P. vannamei) hatcheries in China. Our objectives were to determine the additive genetic variance associated with reproductive traits, and to anticipate any potential impacts on reproductive performance when selecting for increased body weight by assessing genetic correlations between post-spawning body weight and specific female reproductive traits. Data were collected on 595 females from 78 full-sib families over 30 days, with a total of 1,113 spawning events recorded. Traits studied included: body weight after spawning (WAS), number of eggs per spawn (NE), number of nauplii per spawn (NN), egg hatching rate per spawn (HR), number of eggs produced relative to female weight (g) (FE), and spawn frequency over 30 days (SF). Estimated heritability was high  for WAS (h2 = 0.64 ± 0.10) and moderate for NE (0.26 ± 0.07), NN (0.18 ± 0.06), and SF (0.15 ± 0.06), respectively. In contrast, h2 for HR (0.04 ± 0.03) and FE (0.05 ± 0.04) were low. The genetic correlations between growth trait (WAS) with NE, NN and SF were 0.93 ± 0.10, 0.84 ± 0.10, and 0.57 ± 0.18, respectively. While the genetic correlation between WAS and HR was low (0.02 ± 0.33), a negative genetic correlation was found between WAS and FE (-0.50 ± 0.27). Overall, we concluded that it is possible to improve the key female reproductive traits (i.e. NE, NN, and SF) in cultured white shrimp lines via genetic selection, but not for HR or FE. The genetic relationship between the growth trait and reproductive traits predicts that selection on fast growth would increase the production in the seed sector, with little or no compromise on the eggs quality.