Effects of laryngeal mask ventilation on postoperative atelectasis in children undergoing day surgery: a randomized controlled trial.

BACKGROUND: To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. METHODS: Children aged 3-7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators. RESULTS: The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05). CONCLUSION: Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management. TRIAL REGISTRATION: The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).

AGAMOUS-LIKE67 Cooperates with the Histone Mark Reader EBS to Modulate Seed Germination under High Temperature.

Seed germination is a vital developmental process that is tightly controlled by environmental signals, ensuring germination under favorable conditions. High temperature (HT) suppresses seed germination. This process, known as thermoinhibition, is achieved by activating abscisic acid and inhibiting gibberellic acid biosynthesis. The zinc-finger protein SOMNUS (SOM) participates in thermoinhibition of seed germination by altering gibberellic acid/abscisic acid metabolism, but the underlying regulatory mechanism is poorly understood. In this study, we report that SOM binds to its own promoter and activates its own expression in Arabidopsis (Arabidopsis thaliana) and identify the MADS-box transcription factor AGAMOUS-LIKE67 (AGL67) as a critical player in SOM function, based on its ability to recognize CArG-boxes within the SOM promoter and mediate the trans-activation of SOM under HTs. In addition, AGL67 recruits the histone mark reader EARLY BOLTING IN SHORT DAY (EBS), which recognizes H3K4me3 at SOM chromatin. In response to HTs, AGL67 and EBS are highly enriched around the SOM promoter. The AGL67-EBS complex is also necessary for histone H4K5 acetylation, which activates SOM expression, ultimately inhibiting seed germination. Taken together, our results reveal an essential mechanism in which AGL67 cooperates with the histone mark reader EBS, which bridges the process of H3K4me3 recognition with H4K5 acetylation, thereby epigenetically activating SOM expression to suppress seed germination under HT stress.

[Effects of different intraoperative lithotomy positions on the absorption of irrigation fluid during bipolar plasmakinetic resection of the prostate].

OBJECTIVE: To investigate the effect of intraoperative lithotomy position (LP) with a head-down tilt (HDT) on the absorption of intraoperative irrigation fluid in patients undergoing bipolar plasmakinetic resection of the prostate (PKRP). METHODS: Eighty BPH patients underwent PKRP, 40 in a conventional 0-degree position (0° LP) and the other 40 in a －10-degree HDT position (－10° LP), with 0.9% saline containing 1% ethanol as intraoperative irrigation fluid. We determined the alcohol concentration in the exhaled breath of the patients with a digital alcohol detector at the start of the operation and every 10 minutes afterwards. Meanwhile we recorded the operation time, the volume of intraoperative intravenous crystalloid infusion and the weight of the resected prostatic tissue, monitored the mean arterial pressure (MAP) and heart rate (HR) at 5 minutes before surgery, 30 minutes after the start of surgery and the end of surgery, and measured the concentrations of Na+, K+, Cl－ and Ca2+ with an arterial blood gas analyzer at 5 minutes before surgery and 1 hour after the start of surgery. RESULTS: There were no statistically significant differences in age, height, body weight and prostate volume, or in intraoperative MAP and HR between the 0° LP and －10° LP groups. Compared with the baseline, at 1 hour after the start of PKRP, the patients in the 0° LP group showed significantly decreased concentrations of K+ (ï¼»3.64 ± 0.29ï¼½ vs ï¼»3.49 ± 0.22ï¼½ mmol/L, P = 0.002) and Ca2+ (ï¼»1.16 ± 0.03ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.001), increased concentration of Cl－ (ï¼»106.9 ± 2.2ï¼½ vs ï¼»108.7 ± 2.3ï¼½ mmol/L, P = 0.006), but no significant difference in the concentration of Na+ (ï¼»139.7 ± 1.5ï¼½ vs ï¼»139.4 ± 1.6ï¼½ mmol/L, P = 0.231), while those in the －10° LP group exhibited remarkably decreased concentration of Ca2+ (ï¼»1.14 ± 0.04ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.016) but no statistically significant differences in the concentrations of Na+ (ï¼»140.3 ± 1.8ï¼½ vs ï¼»140.0 ± 2.0ï¼½ mmol/L, P = 0.156), K+ (ï¼»3.49 ± 0.36ï¼½ vs ï¼»3.47 ± 0.34ï¼½ mmol/L, P = 0.506) and Cl－ (ï¼»108.2 ± 2.6ï¼½ vs ï¼»109.1 ± 2.5ï¼½ mmol/L, P = 0.071). Over 1 500 ml of intraoperative irrigation fluid absorption was observed in 6 cases (15%) in the 0° LP group as compared with 4 cases (10%) in the －10°LP group, with no significant difference between the two groups. CONCLUSIONS: Lithotomy position with a 10-degree head-down tilt can reduce PKRP-induced decrease in the concentration of K+ and increase in that of Cl－ without affecting the levels of the other electrolytes.

Effects of different doses of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy in children.

Background: This study aimed to investigate the effect of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia in developmental hip dislocation in children after Salter osteotomy. Methods: The clinical data of 98 children with developmental hip dislocation, who underwent Salter osteotomy in our center between January 2020 and February 2023, were selected. The children were randomly divided into four groups based on the application of patient-controlled intravenous analgesia (sufentanil + granisetron ± dexmedetomidine). All children received 1 µg/kg/day of sufentanil and 3 mg of granisetron. Group A did not receive dexmedetomidine, and Groups B, C, and D received 0.5, 0.75, and 1.0 µg/kg/day of dexmedetomidine, respectively. The pain indicators and immune factor levels of children in each group were compared. Results: The heart rate (HR) and respiratory rate (RR) 2 h after operation in Groups C and D were significantly lower than those in Groups A and B (P < 0.05). The pain scores decreased over time after treatment in all groups. When compared at the same time point, children in Group D had the lowest pain scores, which were significantly lower than the other three groups (P < 0.05). The total consumption of sufentanil in Groups C and D was significantly lower than that in Group A (P < 0.05). On the first day after surgery, the children in Group D had lower levels of serum adrenocorticotropic hormone, interleukin-6, and corticosterone than those in Group A (P < 0.05). Conclusion: Administration of 1.0 µg/kg/day of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy for developmental hip dislocation in children has a better analgesic effect, less consumption of sufentanil, and low incidence of opioid adverse reactions.

Effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia.

OBJECTIVE: To determine the effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia. METHODS: The data of 98 children who received painless gastroscopy in the Children's Hospital of Nanjing Medical University from May 2022 and November 2022 were analyzed retrospectively. Patients anesthetized with propofol (1.5-2 mg/kg) combined with sufentanil (0.03-0.05 µg/kg) were assigned to a study group (n=52), and patients anesthetized with propofol (1.5-2 mg/kg) combined with fentanyl (0.3-0.5 µg/kg) were included in a control group (n=46). The changes in hemodynamic levels (mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) at T0 (before anesthesia), T1 (1 min after anesthesia induction), T2 (start of examination), T3 (2 min after the start of examination), and T4 (end of examination) in the two groups were analyzed and compared. The Ramsay sedation score was adopted to evaluate the sedation of the two groups at the anesthesia recovery and at 1 h and 2 h after the anesthesia recovery. The anesthetic effects (time to loss of consciousness, eye opening, and recovery of orientations) of the two groups were analyzed and compared. The excellent and good anesthesia outcomes, hospitalization time and dosage of propofol were compared between the two groups, and the adverse reactions in the two groups during and after the examination were analyzed. RESULTS: At T0, the two groups were not significantly different in the levels of MAP, HR and SpO2 (P>0.05), but at T1, T2, T3, and T4, the study group showed a significantly higher MAP level than the control group (P<0.05). At T1 and T3, the study group exhibited a significantly higher HR level than the control group (P<0.05), and at T2 and T4, the HR level of the two groups was not greatly different (P>0.05). The SpO2 levels at T0, T1, T2, T3, and T4 were not greatly different between the two groups (P>0.05). There was no significant difference in Ramsay score between the two groups at anesthesia recovery and at 1 h and 2 h after the anesthesia recovery (P>0.05). Additionally, the study group experienced significantly earlier time to loss of consciousness, eye opening, and recovery of orientations than the control group (P<0.05). The number of patients with excellent anesthetic outcome in the study group was notably higher than that in the control group (P<0.05). Compared with the control group, the study group consumed less propofol, experienced shorter hospitalization time, and showed a notably lower incidence of adverse reactions (P<0.05). CONCLUSION: For children undergoing painless gastroscopy under general anesthesia, sufentanil combined with propofol can deliver better anesthetic effect than propofol combined with fentanyl, with less effect on hemodynamics and fewer gastroscopy-related adverse reactions.

Assessing pediatric anesthesia outcomes and prognostic factors: a comparative study of ketamine vs. ketamine + propofol.

Objective: To investigate the anesthesia outcomes of ketamine and propofol in pediatric anesthesia and analyze associated prognostic factors. Methods: A retrospective study was conducted on 160 children who underwent anesthesia and operation in Children's Hospital of Nanjing Medical University from 2020 to 2022. The anesthesia outcomes was analyzed by comparing the blood oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP) at before (T1), during (T2) and after (T3) operations, recovery time after anesthesia, post-anesthesia care unit (PACU) stay, adverse reactions, as well as the Steward and FLACC scores between the control and research groups. Univariate analysis and logistic regression analysis were used to identify the prognostic factors in pediatric anesthesia. Results: The changes in SpO2, HR, and MAP were different between the two groups at different time points (P < 0.05). There were significant differences in anesthesia recovery time, PACU stay, Steward and FLACC scores, and incidence of adverse reactions between the two groups (P < 0.05). Logistic regression analysis revealed that operation time ≥ 49.5 minutes (P = 0.001, OR = 3.828, 95% CI: 1.715-8.544) and single use of ketamine for anesthesia (P = 0.048, OR = 2.257, 95% CI: 1.006-5.063) were independent risk factors for postoperative delirium. Conclusion: Combining propofol with ketamine for pediatric anesthesia yields superior clinical outcome compared to using ketamine alone. This combined approach can effectively maintain stable circulation during operation, lead to shorter anesthesia recovery time, ensure high recovery quality, reduce postoperative pain, adverse reaction rate, and risk of post-anesthesia delirium in children, thereby improving the prognosis.

Plasmonic Cu2-xSe Mediated Colorimetric/Photothermal Dual-Readout Detection of Glutathione.

Plasmonic nanomaterials have attracted great attention in the field of catalysis and sensing for their outstanding electrical and optical properties. Here, a representative type of nonstoichiometric Cu2-xSe nanoparticles with typical near-infrared (NIR) localized surface plasma resonance (LSPR) properties originating from their copper deficiency was applied to catalyze the oxidation of colorless TMB into their blue product in the presence of H2O2, indicating they had good peroxidase-like activity. However, glutathione (GSH) inhibited the catalytic oxidation of TMB, as it can consume the reactive oxygen species. Meanwhile, it can induce the reduction of Cu(II) in Cu2-xSe, resulting in a decrease in the degree of copper deficiency, which can lead to a reduction in the LSPR. Therefore, the catalytic ability and photothermal responses of Cu2-xSe were decreased. Thus, in our work, a colorimetric/photothermal dual-readout array was developed for the detection of GSH. The linear calibration for GSH concentration was in the range of 1-50 µM with the LOD as 0.13 µM and 50-800 µM with the LOD as 39.27 µM. To evaluate the practicability of the assay, tomatoes and cucumbers were selected as real samples, and good recoveries indicated that the developed assay had great potential in real applications.

Plasmonic scattering imaging of single Cu2-xSe nanoparticle for Hg2+ detection.

The development of new efficient contrast nanoprobe has been greatly concerned in the field of scattering imaging for sensitive and accurate detection of trace analytes. In this work, the non-stoichiometric Cu2-xSe nanoparticle with typical localized surface plasmon resonance (LSPR) properties originating from their copper deficiency as a plasmonic scattering imaging probe was developed for sensitive and selective detection of Hg2+ under dark-field microscopy. Hg2+ can compete with Cu(I)/Cu(II) which were sources of optically active holes coexisting in these Cu2-xSe nanoparticles for its higher affinity with Se2-. The plasmonic properties of Cu2-xSe were adjusted effectively. Thus, the color scattering images of Cu2-xSe nanoparticles was changed from blue to cyan, and the scattering intensity was obviously enhanced with the dark-field microscopy. There was a linear relationship between the scattering intensity enhancement and the Hg2+ concentration in the range of 10-300 nM with a low detection limit of 1.07 nM. The proposed method has good potential for Hg2+ detection in the actual water samples. This work provides a new perspective on applying new plasmonic imaging probe for the reliable determination of trace heavy metal substances in the environment at a single particle level.

Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials.

Background: Previous studies have shown that an awake prone position may be beneficial for the treatment of acute respiratory distress syndrome (ARDS) or acute hypoxic respiratory failure (AHRF) in patients with COVID-19, but the results are not consistent, especially in terms of oxygenation outcomes and intubation rate. This systematic review and meta-analysis assessed the effects of the awake prone position on AHRF in patients with COVID-19 with all randomized controlled trials (RCTs). Methods: An extensive search of online databases, including MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials from 1 December 2019 to 30 October 2022, with no language restrictions was performed. This systematic review and meta-analysis are based on the PRISMA statement. We only included RCTs and used the Cochrane risk assessment tool for quality assessment. Results: Fourteen RCTs fulfilled the selection criteria, and 3,290 patients were included. A meta-analysis found that patients in the awake prone position group had more significant improvement in the SpO2/FiO2 ratio [mean difference (MD): 29.76; 95% confidence interval (CI): 1.39-48.13; P = 0.001] compared with the usual care. The prone position also reduced the need for intubation [odd ratio (OR): 0.72; 95% CI: 0.61 to 0.84; P < 0.0001; I 2 = 0%]. There was no significant difference in mortality, hospital length of stay, incidence of intensive care unit (ICU) admission, and adverse events between the two groups. Conclusion: The awake prone position was a promising intervention method, which is beneficial to improve the oxygenation of patients with ARDS or AHRF caused by COVID-19 and reduce the need for intubation. However, the awake prone position showed no obvious advantage in mortality, hospital length of stay, incidence of ICU admission, and adverse events. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42022367885.

Comparison of a Small Dose of Oxycodone and Sufentanil for the Prevention of Sufentanil-Induced Cough during General Anesthesia Induction: A Prospective Randomized Controlled Trial.

Background: Sufentanil is widely used during anesthesia induction. However, it can cause coughing via different mechanisms. This study is aimed at evaluating the effectiveness of a small dose of oxycodone and sufentanil in suppressing sufentanil-induced cough (SIC) during general anesthesia induction. Methods: Of the 174 patients scheduled for elective surgery, 144 were eligible and randomly divided into 3 groups (n = 48). Five minutes before sufentanil bolus (0.4 µg/kg), patients in group O received 0.02  mg/kg oxycodone intravenously within 5 s, those in group S received 0.02 µg/kg sufentanil within 5 s, and those in group N received an equal volume of 0.9% normal saline within 5 s. Sufentanil was diluted to 5 µg/ml and administered within 5  s after pretreatment. The incidence and severity of cough in the three groups were evaluated within 1 minute after sufentanil injection during the anesthesia induction. Their mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (after entering the operation), T1 (3 minutes after pretreatment), T2 (before intubation), and T3 (1 minute after intubation). Results: The incidences of cough in group N, group O, and group S were 20 (41.6%), 7 (14.5%), and 6 (12.5%), respectively. Compared with group N, patients from group O and group S exhibited significantly reduced incidence and severity of cough, and the severity of cough in group O and group S was significantly reduced compared with group N (P < 0.05). No significant differences in the rangeability of MAP and HR were noted at the four time points in the three groups (P > 0.05). Conclusion. Preconditioning using intravenous oxycodone (0.02 mg/kg) or sufentanil (0.02 µg/kg) could represent an effective approach to reducing SIC in anesthesia induction and was associated with relatively stable hemodynamic state during general anesthesia. This trial is registered at Chinese Clinical Trial Registry with registration number ChiCTR1900021087.

Fluorescence turn-on Cu2-xSe@HA-rhodamine 6G FRET nanoprobe for hyaluronidase detection and imaging.

The application of nanostructures to design fluorescence resonance energy transfer (FRET) based sensing platforms has been greatly concerned with the demand for sensitive and selective detection of biomolecules. Here, a novel sensitive turn-on fluorescence strategy based on the FRET mechanism has been designed for hyaluronidase (HAase) detection through the modulation of Cu2-xSe@HA-Rh6G nanoprobe fabricated by self-assembly of rhodamine 6G (Rh6G) together with Cu2-xSe@HA nanoparticles through electrostatic adsorption. The Cu2-xSe@HA had extensive localized surface plasma resonance (LSPR) absorption in the wide range of ultraviolet (UV) to near-infrared (NIR) wavelengths and showed good light capture characteristics, which can be acted as good acceptors in the FRET interactions with Rh6G, inducing its efficient fluorescence quenching. In the presence of HAase, the FRET process was disrupted and the fluorescence signal was recovered. In the range of 0.1-10.0 U/mL, the fluorescence recovery of Rh6G showed a good linear relationship with the concentration of HAase, and the detection limit was 0.06 U/mL. The sensing platform has been used for HAase detection in real urine samples and cancer cells imaging.

[Interactive dynamic scalp acupuncture combined with occupational therapy for upper limb motor impairment in stroke: a randomized controlled trial].

OBJECTIVE: To compare the clinical efficacy on upper limb motor impairment in stroke between the interactive dynamic scalp acupuncture therapy and the traditional scalp acupuncture therapy. METHODS: The randomized controlled trial and MINIMIZE layering randomization software were adopted. Seventy patients of upper limb with III to V grade in Brunnstrom scale after stroke were randomized into an interactive dynamic scalp acupuncture group and a traditional scalp acupuncture group, 35 cases in each one. In the interactive dynamic scalp acupuncture group, the middle 2/5 of Dingnieqianxiexian (anterior oblique line of vertex-temporal), the middle 2/5 of Dingniehouxiexian (posterior oblique line of vertex-temporal) and Dingpangerxian (lateral line 2 of vertex) on the affected side were selected as the stimulation areas. Additionally, the rehabilitation training was applied during scalp acupuncture treatment. In the traditional scalp acupuncture group, the scalp stimulation areas were same as the interactive dynamic scalp acupuncture group. But the rehabilitation training was applied separately. The rehabilitation training was applied in the morning and the scalp acupuncture was done in the afternoon. The results in Fugl-Meyer for the upper limb motor function (U-FMA), the Wolf motor function measure scale (WM- FT) and the modified Barthel index in the two groups were compared between the two groups before treatment and in 1 and 2 months of treatment, respectively. RESULTS: After treatment, the U-FMA score, WMFT score and the score of the modified Barthel index were all apparently improved as compared with those before treatment (all P < 0.01). The improvement in the U-FMA score after treatment in the interactive dynamic scalp acupuncture group was better than that in the traditional scalp acupuncture group (P < 0.05). For the patients of IV to V grade in Brunnstrom scale, WMFT score in 2 months of treatment and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were improved apparently as compared with those in the traditional scalp acupuncture group (P < 0.05, P < 0.01). But, for the patients of III grade in Brunnstrom scale, WMFT score and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were not different significantly as compared with those in the traditional scalp acupuncture group (both P > 0.05). CONCLUSION: For the patients of IV to V grade in Brunnstrom scale in stroke, the interactive dynamic scalp acupuncture therapy achieves the superior improvements of the upper limb motor function and the activity of daily life as compared with the traditional scalp acupuncture therapy, and the longer the treatment lasts, the more apparent the improvements are. For the patients of III grade in Brunnstrom scale, the interactive dynamic scalp acupuncture therapy achieves the similar improvement in the upper limb motor impairment as compared with the traditional scalp acupuncture therapy.

[Observation on the clinical efficacy of shoulder pain in post-stroke shoulder-hand syndrome treated with floating acupuncture and rehabilitation training].

OBJECTIVE: To compare the efficacy difference in the treatment of shoulder pain in post-stroke shoulder-hand syndrome among floating acupuncture, oral administration of western medicine and local fumigation of Chinese herbs. METHODS: Ninety cases of post-stroke shoulder-hand syndrome (stage I) were randomized into a floating acupuncture group, a western medicine group and a local Chinese herbs fumigation group, 30 cases in each one. In the floating acupuncture group, two obvious tender points were detected on the shoulder and the site 80-100 mm inferior to each tender point was taken as the inserting point and stimulated with floating needling technique. In the western medicine group, mobic 7.5 mg was prescribed for oral administration. In the local Chinese herbs fumigation group, the formula for activating blood circulation and relaxing tendon was used for local fumigation. All the patients in three groups received rehabilitation training. The floating acupuncture, oral administration of western medicine, local Chinese herbs fumigation and rehabilitation training were given once a day respectively in corresponding group and the cases were observed for 1 month. The visual analogue scale (VAS) and Takagishi shoulder joint function assessment were adopted to evaluate the dynamic change of the patients with shoulder pain before and after treatment in three groups. The modified Barthel index was used to evaluate the dynamic change of daily life activity of the patients in three groups. RESULTS: With floating acupuncture, shoulder pain was relieved and the daily life activity was improved in the patients with post-stroke shoulder-hand syndrome, which was superior to the oral administration of western medicine and local Chinese herbs fumigation (P < 0.01). With local Chinese herbs fumigation, the improvement of shoulder pain was superior to the oral administration of western medicine. The difference in the improvement of daily life activity was not significant statistically between the local Chinese herbs fumigation and oral administration of western medicine, the efficacy was similar between these two therapies (P > 0.05). CONCLUSION: The floating acupuncture relieves shoulder pain of the patients with post-stroke shoulder-hand syndrome promptly and effectively, and the effects on shoulder pain and the improvements of daily life activity are superior to that of the oral administration of western medicine and local Chinese herbs fumigation.