Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients.

Introduction: The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown. Methods: In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision. Results: There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 µg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 µg·kg-1·min-1) and Group A (0.06 ± 0.02 µg·kg-1·min-1) (p = 0.004). Conclusion: Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.

Efficacy of pretreatment with remimazolam on prevention of propofol-induced injection pain in patients undergoing gastroscopy.

To evaluate the efficacy of remimazolam pretreatment in preventing propofol-induced injection pain (PIP) in patients undergoing gastroscopy. One hundred and forty patients (ASA I-II, aged 18-65 years, BMI 18-28 kg/m2) who were to undergo gastroscopy were randomized into either a saline group (group S) or a remimazolam group (group R) (n = 70 for each) on a computer-generated random number basis. The patients in group S received normal saline (0.1 ml/kg) and those in group R were administered remimazolam (0.1 mg/kg) via intravenous infusion for 60 s. 30 s after the injection of normal saline or remimazolam, patients received intravenously propofol (0.5 ml/s) until loss of consciousness. A different anesthesiologist who was unaware of the pretreatment was responsible for maintaining the outcome. The primary endpoint of our study was the incidence of PIP, which was measured using a 4-point scale. Secondary endpoints include the intensity of PIP, vital signs, characteristics of surgery and recovery, and adverse events. The incidence of PIP was significantly lower in group R than in group S (13 vs 51%, p < 0.001), and a lower percentage of patients presented with moderate PIP (3 vs 20%, p < 0.001). Moreover, lower consumption of propofol, shorter recovery time, and greater patient satisfaction were observed in group R than in group S. Pretreatment with remimazolam can effectively reduce the incidence and intensity of PIP in gastroscopy and shorten the recovery time without severe adverse effects.Clinical Trials Registration: Trial Registration: Chinese Clinical Trial Registry (identifier: ChiCTR2200063793). Registry time: 16/09/2022. Registry name: Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Gastroscopy. The date of patient enrollment began from 2022-9-17 to 2022-10-10. The link to the registration: https://www.chictr.org.cn/showproj.html?proj=176004 .

Hierarchical self-supporting sugar gourd-shape MOF-derived NiCo2O4 hollow nanocages@SiC nanowires for high-performance flexible hybrid supercapacitors.

Rational construction of hierarchical electrode materials has been a research hotspot in the field of energy storage. In this work, metal-organic framework (MOF) derived hollow NiCo2O4 nanocages (NCs) were strung by interwoven SiC nanowires (NWs) network on carbon cloth (CC), forming a unique sugar gourd-like core-shell architecture, which were fabricated via a multi-step process containing of chemical vapor deposition, solution reaction of MOF templates, ion exchanging/etching and subsequent heat treatment. Benefiting from the unique structural advantages, such as hierarchical porous structure with abundant active sites for electrochemical reactions and interwoven conductive networks for electron transport, the formed core-shelled CC/SiCNWs@NiCo2O4NCs as a binder supercapacitor electrode exhibits excellent electrochemical performance with a large specific capacitance (1377.6F g-1 at a current density of 1 A g-1), good rate capability (68.8% capacitance retention at 20 A g-1) and excellent cycling stability (88.3% capacitance retention after 6000 cycles). Furthermore, the hybrid supercapacitor based on CC/SiCNWs@NiCo2O4NCs and activated carbon, not only delivers a high energy density of 46.58 Wh kg-1 at the power density of 800 W kg-1, but also possesses good flexibility with high capacitance retention, exhibiting the application potential in the field of flexible energy storage. More importantly, our work gives a new thinking for structural design of SiCNWs-based and MOF-based electrode materials for high-performance flexible energy storage.

NiCo2O4 nanosheets sheathed SiC@CNTs core-shell nanowires for high-performance flexible hybrid supercapacitors.

Electrode materials with hierarchical self-supporting core-shell structures, with the metric of structural advantages and synergetic effect for different components, have been widely applied in supercapacitor. Besides, interface designing would improve the bonding of different components and further enhance the stability of electrochemical performance. In this work, by the introduction of CNTs layer to construct the conductive and rugged interface on SiC nanowires (NWs), the formed core-shell SiCNWs@CNTs network were served as conductive skeleton for supporting NiCo2O4 nanosheets (NSs). Benefiting from the unique hierarchical structure with designed interface, the formed SiCNWs@CNTs@NiCo2O4NSs electrode exhibits exceptional electrochemical performance with high specific capacitance of 2302F g-1 (319.7 mAh g-1) at 1 A g-1, excellent rate capability (86.3% capacitance retention at 20 A g-1) and outstanding cycling stability (95% capacitance retention after 5000 cycles). Furthermore, the hybrid supercapacitor assembled SiCNWs@CNTs@NiCo2O4NSs and activated carbon (AC), exhibits a high energy density of 64.2 Wh kg-1 at a power density of 0.79 kW kg-1, long cycle life and good flexibility. More impressively, this work provides a facile method for rationally constructing electrode materials with hierarchical structures for high-performance flexible energy storage devices.

Cu nanowires paper interlinked with cobalt oxide films for enhanced sensing and energy storage.

A Cu-NWs paper synthesized by a one-step method is first presented. Owing to its good conductivity, it is an effective framework to interlink TMOs and prevent aggregation. For a practical application, the core-shell Cu NWs@ultrathin CoOx delivers good performance for the catalytic oxidation of glucose and energy storage, with a sensitivity of 396.57 µA mM-1 cm-2 and a capacitance of 797.7 F g-1 (1 A g-1).

Self-Templating Synthesis of Cobalt Hexacyanoferrate Hollow Structures with Superior Performance for Na-Ion Hybrid Supercapacitors.

Prussian blue (PB) and its analogues (PBA), especially with hollow structures, have attracted growing attention from the researchers of energy storage field. Herein, we have developed a facile self-templating method to synthesize hollow-structured cobalt hexacyanoferrate (CoHCF) with controllable morphologies by using water-soluble precursors as templates. The method is versatile and can be extended to synthesize various PB/PBA hollow structures with tunable composition and morphology. Profiting from the unique hollow structure, the CoHCF hollow prisms manifest exceptional electrochemical performance in the Na2SO4 aqueous electrolyte, including a high specific capacitance (284 F g-1 at 1 A g-1), a high rate capability, and an excellent cycling stability (92% retention after 5000 cycles). A hybrid supercapacitor device assembled with the CoHCF hollow prisms and activated carbon shows a high specific density of 47 W h kg-1 at a specific power of 1000 W kg-1 and stable cycling performance.

3D CuO nanosheet wrapped nanofilm grown on Cu foil for high-performance non-enzymatic glucose biosensor electrode.

3D binder-free CuO nanosheets wrapped nanofilms has been in situ synthesized on Cu substrate by a simple and facile procedure, with an aim of fabricating high-performance glucose sensor. The complex morphology that the nanosheet grown on Cu subtract evolved into nanofilms and eventually converged to nanowires, is benefit for the mass transport and electro-catalysis. Compared the ECSA of the CuO modified electrode to that of the bare Cu electrode, the effective surface area during the electro-catalysis of the CuO/Cu electrode is much larger. The glucose sensor based on CuO products exhibited high sensitivity (4201µAcm-2mM-1), low detection limit (0.5µmol/L) and quick response time (0.7s). And the stability and selectivity is also fantastic. According to the serum sample analysis, it transpires that the CuO/Cu sensor displayed excellent recovery compared to the concentration values measured by medial method. So this material shows great potential applications in glucose sensors.

A single-nucleotide polymorphism in SCN9A may decrease postoperative pain sensitivity in the general population.

BACKGROUND: This study aimed to explore the role of a nonsynonymous single-nucleotide polymorphism, 3312G>T, in SCN9A, which was identified in probands with congenital indifference to pain, but which is also present in normal controls, in the prediction of individual baseline pain perception, and postoperative pain sensitivity in the general population. METHODS: Preoperative pressure pain thresholds and tolerance were measured in 200 patients undergoing pancreatectomy, and the postoperative pain sensitivity and analgesic demand were recorded. These variables were compared according to the SCN9A 3312G>T alleles. Logistic regression analysis was used to test the role of preoperative variables in the prediction of postoperative inadequate analgesia. RESULTS: The 3312Tallele was present in 22 individuals, and the 3312Tallele frequency was 5.5% (22/200). The average patient-controlled analgesia pressing frequency and opioid consumption in 3312G patients was significantly higher than those in 3312T patients (2.70 [SD: 0.84] vs. 2.05 [SD: 0.43], P < 0.001; 100.8 [SD: 40.7] vs. 74.8 [SD: 20.8] ml, P = 0.006). The incidence of inadequate analgesia in 3312G patients was significantly higher than that of patients carrying the 3312Tallele (29.2% vs. 4.5%; P = 0.013). Carrying the 3312Tallele and having a higher pressure pain threshold predicted a lower risk of postoperative inadequate analgesia, with an odds ratio of 0.10 (95% CI: 0.01 to 0.76, P = 0.026) and 0.32 (95% CI: 0.13 to 0.82, P = 0.018), respectively. CONCLUSION: Patients carrying the SCN9A 3312Tallele presented with lower postoperative pain sensitivity in the presence of a similar surgical pain stimulus, and had a lower likelihood of developing inadequate analgesia than those carrying the 3312Gallele.

Two novel SCN9A gene heterozygous mutations may cause partial deletion of pain perception.

OBJECTIVE: The physiological sensation of pain and rapid response to stimuli serve as an adaptive way to avoid harmful situations. Our purpose was to investigate why this protection disappears or almost disappears for patients with congenital indifference to pain (CIP). DESIGN: The study was designed as a case report by scanning the candidate genes within CIP patients. SETTING: The study was set at the Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. PATIENTS: We reported patients from two Chinese families that showed insensitivity to pain and were diagnosed with CIP by a neurologist. Different from recently reported studies, our patients were not entirely painless, but demonstrated little pain sensation from injuries. MEASURES: The measures made were novel mutations within SCN9A. RESULTS: Sequence analysis of candidate genes of two affected individuals identified two novel heterozygous mutations (M899I and M932L) in the SCN9A gene. Furthermore, a novel nonsynonymous single-nucleotide polymorphism (SNP) within the SCN9A gene was revealed in affected proband and several unaffected family members. This polymorphism (c. 3312G&T, which produces the amino acid substitution V1104L in human Nav1.7), is present in 6.5% of healthy Chinese. CONCLUSIONS: We speculate that the mutations may be the cause of partial deletion of pain perceptionin in our probands, and the novel polymorphism V1104L may have a predictive role in the pain sensation of healthy individuals.

Impact of CYP3A4*1G polymorphism on metabolism of fentanyl in Chinese patients undergoing lower abdominal surgery.

PURPOSE: This study aimed to investigate the impact of CYP3A4*1G genetic polymorphism on metabolism of fentanyl in Chinese patients undergoing lower abdominal surgery. METHODS: 176 patients receiving elective lower abdominal surgery under general anesthesia were recruited into this study. Genotyping of CYP3A4*1G was carried out by direct sequencing. The plasma fentanyl concentration was detected 30 min after anesthesia induction by high performance liquid chromatography-ultraviolet ray (HPLC-UV). The visual analog scale (VAS) was used for pain evaluation at rest during patient-controlled analgesia (PCA) treatment 0 h, 12 h and 24 h after operation. PCA fentanyl consumption and adverse effects were recorded during the first 24 h after surgery. RESULTS: The frequency of CYP3A4*1G variant allele was 0.227 (80/352, 95% CI 0.165, 0.289) in these patients. After grouping according to the genotype of CYP3A4*1G, plasma fentanyl concentration in the *1/*1 variant (wild-type) group (12.8±6.5 ng/ml) was significantly lower than that in the *1/*1G group (16.8±9.0 ng/ml, P<0.01) and the *1G/*1G group (28.1±9.5 ng/ml, P<0.01). Patients in the *1G/*1G group (247.1±73.2 µg) consumed significantly less fentanyl than that in either the wild-type group (395.0±138.5 µg) or the *1/*1G group (359.8±120.2 µg) (P<0.01). There was a significant correlation between plasma fentanyl concentration and PCA fentanyl consumption (r=-0.552, P<0.001). CONCLUSIONS: CYP3A4*1G polymorphism is related to the pharmacokinetics of fentanyl, and patients with CYP3A4*1G variant A allele have a lower metabolic rate of fentanyl. The specific CYP3A4*1G polymorphism may predict the individual requirement of fentanyl.