Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery.

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery. Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 µg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day (POD) 1. Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups. Conclusions: OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

Synergistic Integration of Machine Learning with Microstructure/Composition-Designed SnO2 and WO3 Breath Sensors.

A high-performance semiconductor metal oxide gas sensing strategy is proposed for efficient sensor-based disease prediction by integrating a machine learning methodology with complementary sensor arrays composed of SnO2- and WO3-based sensors. The six sensors, including SnO2- and WO3-based sensors and neural network algorithms, were used to measure gas mixtures. The six constituent sensors were subjected to acetone and hydrogen environments to monitor the effect of diet and/or irritable bowel syndrome (IBS) under the interference of ethanol. The SnO2- and WO3-based sensors suffer from poor discrimination ability if sensors (a single sensor or multiple sensors) within the same group (SnO2- or WO3-based) are separately applied, even when deep learning is applied to enhance the sensing operation. However, hybrid integration is proven to be effective in discerning acetone from hydrogen even in a two-sensor configuration through the synergistic contribution of supervised learning, i.e., neural network approaches involving deep neural networks (DNNs) and convolutional neural networks (CNNs). DNN-based numeric data and CNN-based image data can be exploited for discriminating acetone and hydrogen, with the aim of predicting the status of an exercise-driven diet and IBS. The ramifications of the proposed hybrid sensor combinations and machine learning for the high-performance breath sensor domain are discussed.

Long-term benzodiazepine usage and mortality in patients with chronic non-cancer musculoskeletal pain: A Nationwide cohort study.

OBJECTIVES: The impact of benzodiazepine use on mortality in patients with chronic non-cancer pain (CNCP) has not been identified. We aimed to examine the factors associated with benzodiazepine use among patients with CNCP and examine whether long-term benzodiazepine usage is associated with mortality in patients with CNCP. METHODS: This study was conducted using data from the National Health Insurance Service database of South Korea. We selected 2.5% of all adult patients diagnosed with musculoskeletal diseases (MSD) in South Korea from 2010 to 2019 using a stratified random sampling technique and included them in the analysis as patients with CNCP. The risk of 10-year all-cause mortality in patients with CNCP was investigated using the 2010 cohort of patients with CNCP. RESULTS: The proportion of the study population that used benzodiazepine during the 10-year study period was 2.1% (390,683/18,770,234). Multivariable logistic regression showed that old age; increased Charlson comorbidity index (CCI); opioid, gabapentin or pregabalin, paracetamol, non-steroidal anti-inflammatory drugs, and Z-drugs usage; and underlying psychiatric comorbidities were associated with increased benzodiazepine use. In addition, benzodiazepine use was associated with increased 10-year all-cause mortality (adjusted hazard ratio: 1.03, 95% confidence interval: 1.01, 1.06; p < 0.001). CONCLUSIONS: Benzodiazepine was prescribed to 2.1% of the patients with CNCP in South Korea from 2010 to 2019. Old age, increased CCI, underlying psychiatric comorbidities, and use of certain drugs are associated with increased use of benzodiazepines. In addition, benzodiazepine use is associated with 10-year all-cause mortality in patients with CNCP.

Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis.

BACKGROUND: The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques. METHODS: We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. RESULTS: We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters. CONCLUSIONS: Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.

Risks and outcome of fatal respiratory events after lung cancer surgery: cohort study in South Korea.

Background: Severe complications such as acute respiratory distress syndrome or respiratory failure can occur after lung cancer surgery. However, the prevalence and risk factors have not been well identified. The aim of this study was to investigate the prevalence of and risk factors for fatal respiratory events after lung cancer surgery in South Korea. Methods: The National Health Insurance Service database in South Korea was used to extract data of all adult patients who were diagnosed with lung cancer and underwent lung cancer surgery from January 1, 2011, to December 31, 2018, for a population-based cohort study. Diagnosis of acute respiratory distress syndrome or respiratory failure after surgery was defined as postoperative fatal respiratory event. Results: A total of 60,031 adult patients who received lung cancer surgery were included in the analysis. Among them, 0.5% (285/60,031) experienced fatal respiratory events after the lung cancer surgery. In multivariable logistic regression, some risk factors (older age, male sex, higher Charlson comorbidity index score, underlying severe disability, bilobectomy, pneumonectomy, redo-case, lower case volume, and open thoracotomy) for developing postoperative fatal respiratory events were identified. Moreover, the development of postoperative fatal respiratory events was associated with high in-hospital mortality, 1-year mortality, longer length of hospital stays, and higher total hospitalization costs. Conclusions: Postoperative fatal respiratory events might worsen the clinical outcomes of lung cancer surgery. The knowledge of potential risk factors related to postoperative fatal respiratory events could enable earlier intervention to reduce the occurrence of these events and improve the postoperative clinical outcome.

Drastic Gas Sensing Selectivity in 2-Dimensional MoS2 Nanoflakes by Noble Metal Decoration.

Noble metal nanoparticle decoration is a representative strategy to enhance selectivity for fabricating chemical sensor arrays based on the 2-dimensional (2D) semiconductor material, represented by molybdenum disulfide (MoS2). However, the mechanism of selectivity tuning by noble metal decoration on 2D materials has not been fully elucidated. Here, we successfully decorated noble metal nanoparticles on MoS2 flakes by the solution process without using reducing agents. The MoS2 flakes showed drastic selectivity changes after surface decoration and distinguished ammonia, hydrogen, and ethanol gases clearly, which were not observed in general 3D metal oxide nanostructures. The role of noble metal nanoparticle decoration on the selectivity change is investigated by first-principles density functional theory (DFT) calculations. While the H2 sensitivity shows a similar tendency with the calculated binding energy, that of NH3 is strongly related to the binding site deactivation due to preferred noble metal particle decoration at the MoS2 edge. This finding is a specific phenomenon which originates from the distinguished structure of the 2D material, with highly active edge sites. We believe that our study will provide the fundamental comprehension for the strategy to devise the highly efficient sensor array based on 2D materials.

MOF-Based Chemiresistive Gas Sensors: Toward New Functionalities.

The sensing performances of gas sensors must be improved and diversified to enhance quality of life by ensuring health, safety, and convenience. Metal-organic frameworks (MOFs), which exhibit an extremely high surface area, abundant porosity, and unique surface chemistry, provide a promising framework for facilitating gas-sensor innovations. Enhanced understanding of conduction mechanisms of MOFs has facilitated their use as gas-sensing materials, and various types of MOFs have been developed by examining the compositional and morphological dependences and implementing catalyst incorporation and light activation. Owing to their inherent separation and absorption properties and catalytic activity, MOFs are applied as molecular sieves, absorptive filtering layers, and heterogeneous catalysts. In addition, oxide- or carbon-based sensing materials with complex structures or catalytic composites can be derived by the appropriate post-treatment of MOFs. This review discusses the effective techniques to design optimal MOFs, in terms of computational screening and synthesis methods. Moreover, the mechanisms through which the distinctive functionalities of MOFs as sensing materials, heterostructures, and derivatives can be incorporated in gas-sensor applications are presented.

Quality of Recovery after Laparoscopic Cholecystectomy Following Neuromuscular Blockade Reversal with Neostigmine or Sugammadex: A Prospective, Randomized, Controlled Trial.

The risk of neuromuscular blockade is certainly minimized by sugammadex in combination with monitoring. However, the effect of sugammadex-aided recovery on patients' satisfaction is unclear. This study compared the Quality of Recovery (QoR)-15 score, which is a patient-reported outcome, in patients undergoing laparoscopic cholecystectomy. Eighty patients were randomly assigned to the neostigmine or sugammadex groups. At the end of surgery, neostigmine or sugammadex was administered, and tracheal extubation was performed after confirmation of a train of four ratio ≥ 0.9. The QoR-15 questionnaire was administered at 1 day before surgery and on post-operative days (POD) 1 and 2. The primary outcome was the QoR-15 score on POD 1. The secondary outcomes were the QoR-15 score on POD 2, modified Aldrete score, length of post-anesthetic care unit stay, post-operative pain, administration of anti-emetics, urinary retention, and length of hospital stay. No significant differences were found in QoR-15 scores on POD 1 (94.4 vs. 95.5, p = 0.87) or 2 (116.3 vs. 122, p = 0.33). Secondary outcomes were also comparable, with the exception of urinary retention (15.8% neostigmine vs. 2.6% sugammadex, p = 0.04). This study demonstrated that the quality of recovery was comparable between the neostigmine and sugammadex groups when reversal and tracheal extubation were performed in accordance with the current guidelines.

Real-Time Weld Quality Prediction Using a Laser Vision Sensor in a Lap Fillet Joint during Gas Metal Arc Welding.

Nondestructive test (NDT) technology is required in the gas metal arc (GMA) welding process to secure weld robustness and to monitor the welding quality in real-time. In this study, a laser vision sensor (LVS) is designed and fabricated, and an image processing algorithm is developed and implemented to extract precise laser lines on tested welds. A camera calibration method based on a gyro sensor is used to cope with the complex motion of the welding robot. Data are obtained based on GMA welding experiments at various welding conditions for the estimation of quality prediction models. Deep neural network (DNN) models are developed based on external bead shapes and welding conditions to predict the internal bead shapes and the tensile strengths of welded joints.

Co-Salient Object Detection Based on Deep Saliency Networks and Seed Propagation Over an Integrated Graph.

This paper presents a co-salient object detection method to find common salient regions in a set of images. We utilize deep saliency networks to transfer co-saliency prior knowledge and better capture high-level semantic information. The resulting initial co-saliency maps are enhanced by seed propagation steps over an integrated graph. The deep saliency networks are trained in a supervised manner to avoid weakly supervised online learning and exploit them not only to extract high-level features but also to produce both intra- and inter-image saliency maps. Through a refinement step, the initial co-saliency maps can uniformly highlight co-salient regions and locate accurate object boundaries. To handle input image groups inconsistent in size, we propose to pool multi-regional descriptors including both within-segment and within-group information. In addition, the integrated multilayer graph is constructed to find the regions that the previous steps may not detect by seed propagation with low-level descriptors. In this paper, we utilize the useful complementary components of high- and low-level information and several learning-based steps. Our experiments have demonstrated that the proposed approach outperforms comparable co-saliency detection methods on widely used public databases and can also be directly applied to co-segmentation tasks.

Novel CdS Hole-Blocking Layer for Photostable Perovskite Solar Cells.

Currently, the stability issue of the perovskite solar cells (PSCs) is one of the most critical obstacles in the commercialization of PSCs. Although incredible advances in the photovoltaic efficiencies of PSCs have been achieved in the past few years, research on the stability of PSCs has been relatively less explored. In this study, a new kind of CdS hole-blocking layer replacing the traditional compact TiO2 layer is developed to improve the photostability of PSCs because the intrinsic oxygen vacancies of the TiO2 surface are suspected to be the main cause for the photoinduced degradation of PSCs. As a result, PSCs with the CdS layer exhibit considerably improved photostability, maintaining over 90% of the initial efficiency after continuous sunlight illumination for 12 h, while the TiO2 PSC retains only 18% of the initial efficiency under the same conditions. Charge-transfer characteristics related to photodegradation are investigated by various analyses including electrochemical impedance spectroscopy and open-circuit voltage decay and time-resolved photoluminescence decay measurements. the CdS PSC exhibits negligible degradation in the charge-carrier dynamics, while the TiO2 PSC suffers from severely damaged characteristics like increased charge recombination rate, charge-transfer resistance, and reduced charge extraction rate.

Core/Shell Structured TiO2/CdS Electrode to Enhance the Light Stability of Perovskite Solar Cells.

In this work, enhanced light stability of perovskite solar cell (PSC) achieved by the introduction of a core/shell-structured CdS/TiO2 electrode and the related mechanism are reported. By a simple solution-based process (SILAR), a uniform CdS shell was coated onto the surface of a TiO2 layer, suppressing the activation of intrinsic trap sites originating from the oxygen vacancies of the TiO2 layer. As a result, the proposed CdS-PSC exhibited highly improved light stability, maintaining nearly 80% of the initial efficiency after 12 h of full sunlight illumination. From the X-ray diffraction analyses, it is suggested that the degradation of the efficiency of PSC during illumination occurs regardless of the decomposition of the perovskite absorber. Considering the light-soaking profiles of the encapsulated cells and the OCVD characteristics, it is likely that the CdS shell had efficiently suppressed the undesirable electron kinetics, such as trapping at the surface defects of the TiO2 and preventing the resultant charge losses by recombination. This study suggests that further complementary research on various effective methods for passivation of the TiO2 layer would be highly meaningful, leading to insight into the fabrication of PSCs stable to UV-light for a long time.

Enhancing Stability of Perovskite Solar Cells to Moisture by the Facile Hydrophobic Passivation.

In this study, a novel and facile passivation process for a perovskite solar cell is reported. Poor stability in ambient atmosphere, which is the most critical demerit of a perovskite solar cell, is overcome by a simple passivation process using a hydrophobic polymer layer. Teflon, the hydrophobic polymer, is deposited on the top of a perovskite solar cell by a spin-coating method. With the hydrophobic passivation, the perovskite solar cell shows negligible degradation after a 30 day storage in ambient atmosphere. Suppressed degradation of the perovskite film is proved in various ways: X-ray diffraction, light absorption spectrum, and quartz crystal microbalance. This simple but effective passivation process suggests new kind of approach to enhance stability of perovskite solar cells to moisture.

Knockdown of Bcl-xL enhances growth-inhibiting and apoptosis-inducing effects of resveratrol and clofarabine in malignant mesothelioma H-2452 cells.

Mcl-1 and Bcl-xL, key anti-apoptotic proteins of the Bcl-2 family, have attracted attention as important molecules in the cell survival and drug resistance. In this study, we investigated whether inhibition of Bcl-xL influences cell growth and apoptosis against simultaneous treatment of resveratrol and clofarabine in the human malignant mesothelioma H-2452 cells. Resveratrol and clofarabine decreased Mcl-1 protein levels but had little effect on Bcl-xL levels. In the presence of two compounds, any detectable change in the Mcl-1 mRNA levels was not observed in RT-PCR analysis, whereas pretreatment with the proteasome inhibitor MG132 led to its accumulation to levels far above basal levels. The knockdown of Bcl-xL inhibited cell proliferation with cell accumulation at G2/M phase and the appearance of sub-G0/G1 peak in DNA flow cytometric assay. The suppression of cell growth was accompanied by an increase in the caspase-3/7 activity with the resultant cleavages of procaspase-3 and its substrate poly (ADP-ribose) polymerase, and increased percentage of apoptotic propensities in annexin V binding assay. Collectively, our data represent that the efficacy of resveratrol and clofarabine for apoptosis induction was substantially enhanced by Bcl-xL-lowering strategy in which the simultaneous targeting of Mcl-1 and Bcl-xL could be a more effective strategy for treating malignant mesothelioma.

Highly durable and efficient quantum dot-sensitized solar cells based on oligomer gel electrolytes.

For stable quantum dot-sensitized solar cells, an oligomer-contained gel electrolyte was employed with a carbon-based counter electrode and a hierarchically shelled ZnO photoelectrode. Poly(ethylene glycol) dimethyl-ether (PEGDME) was added to the polysulfide electrolyte to enhance the stability of the methanol-based electrolyte. In addition, the nanocomposite gel electrolyte with fumed silica was used, which provided a solid three-dimensional network. A quantum-dot-modified ZnO nanowire photoanode enhanced the visible light harvesting, and a Pt/CNT-RGO counter electrode increased the catalytic activity. The oligomer gel electrolyte prevented the liquid electrolyte from leaking, and the carbon-based counter electrode retarded chemical poisoning at the counter electrode. The optimized cell exhibited 5.45% photoelectric conversion efficiency with long-term stability demonstrated over 5000 s operation time.

Influence of somatic cell donor breed on reproductive performance and comparison of prenatal growth in cloned canines.

Using in vivo-flushed oocytes from a homogenous dog population and subsequent embryo transfer after nuclear transfer, we studied the effects of donor cells collected from 10 different breeds on cloning efficiency and perinatal development of resulted cloned puppies. The breeds were categorized into four groups according to their body weight: small (≤9 kg), medium (>9-20 kg), large (>20-40 kg), and ultra large (>40 kg). A total of 1611 cloned embryos were transferred into 454 surrogate bitches for production of cloned puppies. No statistically significant differences were observed for initial pregnancy rates at Day 30 of embryo transfer for the donor cells originated from different breeds. However, full-term pregnancy rates were 16.5%, 11.0%, 10.0%, and 7.1% for the donor cells originated from ultra-large breed, large, medium, and small breeds, respectively, where pregnancy rate in the ultra-large group was significantly higher compared with the small breeds (P < 0.01). Perinatal mortality until weaning was significantly higher in small breeds (33.3%) compared with medium, large, or ultra-large breeds where no mortality was observed. The mean birth weight of cloned pups significantly increased proportional to breed size. The highest litter size was examined in ultra-large breeds. There was no correlation between the number of embryo transferred and litter size. Taken together, the efficiency of somatic cell cloning and fetal survival after embryo transfer may be affected significantly by selecting the appropriate genotype.

Production of multiple transgenic Yucatan miniature pigs expressing human complement regulatory factors, human CD55, CD59, and H-transferase genes.

The present study was conducted to generate transgenic pigs coexpressing human CD55, CD59, and H-transferase (HT) using an IRES-mediated polycistronic vector. The study focused on hyperacute rejection (HAR) when considering clinical xenotransplantation as an alternative source for human organ transplants. In total, 35 transgenic cloned piglets were produced by somatic cell nuclear transfer (SCNT) and were confirmed for genomic integration of the transgenes from umbilical cord samples by PCR analysis. Eighteen swine umbilical vein endothelial cells (SUVEC) were isolated from umbilical cord veins freshly obtained from the piglets. We observed a higher expression of transgenes in the transgenic SUVEC (Tg SUVEC) compared with the human umbilical vein endothelial cells (HUVEC). Among these genes, HT and hCD59 were expressed at a higher level in the tested Tg organs compared with non-Tg control organs, but there was no difference in hCD55 expression between them. The transgenes in various organs of the Tg clones revealed organ-specific and spatial expression patterns. Using from 0 to 50% human serum solutions, we performed human complement-mediated cytolysis assays. The results showed that, overall, the Tg SUVEC tested had greater survival rates than did the non-Tg SUVEC, and the Tg SUVEC with higher HT expression levels tended to have more down-regulated α-Gal epitope expression, resulting in greater protection against cytotoxicity. By contrast, several Tg SUVEC with low CD55 expression exhibited a decreased resistance response to cytolysis. These results indicated that the levels of HT expression were inversely correlated with the levels of α-Gal epitope expression and that the combined expression of hCD55, hCD59, and HT proteins in SUVECs markedly enhances a protective response to human serum-mediated cytolysis. Taken together, these results suggest that combining a polycistronic vector system with SCNT methods provides a fast and efficient alternative for the generation of transgenic large animals with multiple genetic modifications.

Successful cloning of coyotes through interspecies somatic cell nuclear transfer using domestic dog oocytes.

Interspecies somatic cell nuclear transfer (iSCNT) is an emerging assisted reproductive technology (ART) for preserving Nature's diversity. The scarcity of oocytes from some species makes utilisation of readily available oocytes inevitable. In the present study, we describe the successful cloning of coyotes (Canis latrans) through iSCNT using oocytes from domestic dogs (Canis lupus familiaris or dingo). Transfer of 320 interspecies-reconstructed embryos into 22 domestic dog recipients resulted in six pregnancies, from which eight viable offspring were delivered. Fusion rate and cloning efficiency during iSCNT cloning of coyotes were not significantly different from those observed during intraspecies cloning of domestic dogs. Using neonatal fibroblasts as donor cells significantly improved the cloning efficiency compared with cloning using adult fibroblast donor cells (P<0.05). The use of domestic dog oocytes in the cloning of coyotes in the present study holds promise for cloning other endangered species in the Canidae family using similar techniques. However, there are still limitations of the iSCNT technology, as demonstrated by births of morphologically abnormal coyotes and the clones' inheritance of maternal domestic dog mitochondrial DNA.

Environmentally benign and efficient Ag2S-ZnO nanowires as photoanodes for solar cells: comparison with CdS-ZnO nanowires.

In this work, we develop a low-temperature, facile solution reaction route for the fabrication of quantum-dot-sensitized solar cells (QDSSCs) containing Ag(2)S-ZnO nanowires (NWs), simultaneously ensuring low manufacturing costs and environmental safety. For comparison, a CdS-ZnO NW photoanode was also prepared using the layer-by-layer growth method. Ultraviolet photoelectron spectroscopy analysis revealed type-II band alignments for the band structures of both photoanodes which facilitate electron transfer/collection. Compared to CdS-ZnO QDSSCs, Ag(2)S-ZnO QDSSCs exhibit a considerably higher short-circuit current density (J(sc)) and a strongly enhanced light-harvesting efficiency, but lower open-circuit voltages (V(oc)), resulting in almost the same power-conversion efficiency of 1.2 %. Through this work, we demonstrate Ag(2)S as an efficient quantum-dot-sensitizing material that has the potential to replace Cd-based sensitizers for eco-friendly applications.

Superior long-term cycling stability of SnO2 nanoparticle/multiwalled carbon nanotube heterostructured electrodes for Li-ion rechargeable batteries.

We demonstrate the fabrication of hybrid nanocomposite electrodes with a combination of SnO(2) nanoparticles (NPs) and conducting multiwalled carbon nanotube (MWCNT) anodes (SnO(2)@CNT) through the direct anchoring of SnO(2) NPs on the surface of electrophoretically pre-deposited MWCNT (EPD-CNT) networks via a metal-organic chemical vapor deposition process. This SnO(2)@CNT nanocomposite displays large reversible capacities of over 780, 510, and 470 mA h g(-1) at 1 C after 100, 500, and 1000 cycles, respectively. This outstanding long-term cycling stability is a result of the uniform distribution of SnO(2) NPs (~8.5 nm), a nanoscale EPD-CNT network with good electrical conductivity, and the creation of open spaces that buffer a large volume change during the Li-alloying/dealloying reaction of SnO(2).