Remifentanil is Superior to Propofol for Treating Emergence Agitation in Adults After General Anesthesia.

Background: Emergence agitation (EA) is one of the most common complications in clinical general anesthesia during recovery in adults. Remifentanil and propofol can reduce the incidence of EA, but with no randomized controlled trial to evaluate their effectiveness for treating EA. This study aims to compare the effectiveness of remifentanil and propofol for treating EA following general anesthesia. Patients and methods: Among 152 randomized patients with a mean of 49.5 years, and 99 (65.1%) of them being male, 149 were divided into two groups for subsequent analysis. The remifentanil group (Group R, n = 74) received a 0.5µg kg-1 remifentanil infusion followed by a 0.05µg kg-1 min-1 infusion until 15 minutes, after the onset of agitation. The propofol group (Group P, n = 75) received a 1mg kg-1 propofol infusion once agitation occurred. Emergence agitation was assessed using the Riker Sedation Agitation Score, with a score of ≥5 defining emergence agitation. During the post-anesthesia care unit (PACU), the recurrence of emergence agitation, time to extubation, and discharge from PACU were evaluated. Results: The incidence of reoccurring emergence agitation was lower in Group R (29.7%) compared with Group P (49.3%), with an odds ratio of 0.44 (95% CI 0.22-0.85; P=0.014). The time to extubation was shorter in Group R (mean 12min, range 8-15 min) compared with Group P (mean 17min, range 13-21 min) (P<0.001), as was the time discharge from the PACU (mean 30.5 min, range 25-40 min) vs Group P (mean 37.5 min, range 31-50 min) (P=0.001). Conclusion: Treatment of emergence agitation in adults with remifentanil infusion is more effective than propofol, with a shorter time to extubation and discharge from PACU.

Comparing Continuous and Intermittent Infusion Effects on Serratus Anterior Plane Blocks in Video-Assisted Thoracoscopic Surgery: A Randomized Clinical Trial.

Objective: The programmed intermittent bolus infusion (PIBI) of local anesthetic produces wider sensory blockade and better analgesia than continuous infusion (CI). We designed this trial to compare the effects of these two different infusion methods combined with Serratus Anterior Plane Blocks (cSAPBs) on postoperative pain relief in patients undergoing video-assisted thoracoscopic surgery. Methods: We randomly allocated 66 patients under going elective video-assisted thoracoscopic unilateral lung resection surgery to two groups (PIBI group and CI group, n=33 per group). After the surgical operation, the patients received ultrasound-guided ipsilateral SAPB, we randomized them to receive either automated intermittent boluses or continuous infusion of 0.3% ropivacaine. Tramadol consumption during the 48 hours following surgery was the primary outcome. Secondary outcomes included cumulative tramadol consumption during the first 24-h and the second 24-h periods after surgery, pain scores, patient satisfaction, blocked dermatomes, and adverse events. Results: During 48h, tramadol consumption in the PIBI group was significantly lower than in the CI group (190 mg [125, 305] vs 220 mg [170, 480], p= 0.034). As compared to the CI group, the PIBI group consumed less tramadol during the first 24 hours (145 mg [87.5, 210] vs 190 mg [140, 400], p=0.012). The dermatomes anesthetized to the pinprick and cold test were significantly more abundant in the PIBI group than in the CI group (3 [3,4] vs. 5 [4,5], p<0.001). Both groups had similar VAS scores at rest and when moving (p>0.05). Additionally, the PIBI group showed greater patient satisfaction. Both groups experienced similar adverse events (p>0.05). Conclusion: Compared with CI, PIBI administration regimen (0.3% ropivacaine 5 mL/h) for cSAPBs resulted in lower tramadol consumption, superior analgesia during the initial 12 h after the operation, and higher patient satisfaction. PIBI combined with cSAPBs was a better choice for postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery.

Alginate-Xylan Biopolymer as a Multifunctional Binder for 5 V High-Voltage LNMO Electrodes.

LiNi0.5Mn1.5O4 (LNMO) with a spinel structure is one of the most promising cathode materials choices for Li-ion batteries (LIBs). However, at a high operating voltages, the decomposition of organic electrolytes and the dissolution of transition metals, especially Mn(II) ions, cause unsatisfactory cycle stability. The initial application of a sodium alginate (SA)-xylan biopolymer as an aqueous binder aims to address the aforementioned problems. The SX28-LNMO electrode has a sizable discharge capacity, exceptional rate capability, and long-term cyclability with a capacity retention of 99.8% after 450 cycles at 1C and a remarkable rate capability of 121 mAh g-1 even at 10C. A more thorough investigation illustrated that SX28 binder provides a substantial adhesion property and generates a uniform (CEI) layer on the LNMO surface, suppressing electrolytes' oxidative decomposition upon cycling and improving LIB performances. This work highlights the potential of hemicellulose as an aqueous binder for 5.0 V high-voltage cathodes.

Principle of relationship between seepage movement and action.

The seepage is completed under the control of the action. There is a definite relationship between the seepage and its controlling factors. The recharge flow, seepage flow and water level change are unified. In this paper, the exact and complete relationship among seepage flow, recharge flow and water level change is discussed in detail through field observation and repeated tests, and a new equation for clarifying seepage flow law and water level change law is established, it provides more accurate, more convenient and more reliable theoretical basis for solving the problem of seepage flow. At the same time, through the study of seepage movement law, it is found that the method of parameter introduction has some disadvantages, and then a new method is established to study the law of seepage movement.

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study.

Objective: The dose selection of ropivacaine for spinal anesthesia in clinical work mainly depends on the experience of the anesthesiologist. In this study, a prospective and modified up-down sequential allocation design was used to provide the optimal dose selection of ropivacaine for spinal anesthesia. Patients and methods: This study was divided into two stages, and a total of 164 elderly patients with elective hip fractures were included. In stage I, the dose of ropivacaine was selected using the up-down sequential method of height correction, and the 50% effective dose (ED50) and 95% effective dose (ED95) were obtained. A nomogram for predicting satisfactory anesthesia and a formula for predicting the optimal dose was also given in this stage. In stage II, the dose of ropivacaine was calculated by using the optimal dose prediction formula, so as to evaluate the efficacy and safety of the model. Results: The ED50 and ED95 of the stage I were 7.036 mg (95%CI 6.549-7.585 mg) and 8.709 mg (95%CI 7.902-14.275 mg), respectively. And provided a nomogram predicting satisfactory anesthesia with a C-index of 0.847 (95%CI 0.774-0.92). The optimal dose prediction formula of ropivacaine was calculated, including variables for age, gender, height, and weight. This formula was found to be 90% efficient. It is worth mentioning that the incidence of direct transfer to the ward in the two stages was as high as 86.84% and 93.33%, respectively, and no patients were transferred to the ICU in stage II. Conclusion: The ED50 and ED95 of ropivacaine were 7.036 mg and 8.709 mg, respectively, and the nomograms are sufficiently accurate to predict satisfactory anesthesia. Beyond that, the dose prediction equation provided in this study has high efficacy and safety, and can guide the dose selection of spinal anesthesia in elderly patients with hip fracture in clinical practice. Clinical trials registration: ChiCTR2100046982.

Analysis of stability law and optimization of slope angle during excavation of deep concave mine slope.

Occasional collapse failure is a typical occurrence during mine slope excavation processes. This study aimed to investigate the disaster law in the process of mining slope excavation, and further explore the optimal selection of excavation angle. Based on the systematic analysis of the residual sliding force and deformation response characteristics during slope excavation, the increment of the residual sliding force increases and the stability coefficient decreases with the increase in excavation depth. Additionally, a numerical model of the Jinchuan mining area in Jinchuan City, Gansu Province, China was created using the Midas-GTS finite element software. The influence of different excavation slope angles on slope stability was analyzed via numerical simulation under certain step slope height and width. The results show that the force and deformation of the slope were unfavorable to slope stability, and the slope stability coefficient would decrease gradually with the increase in slope angle. In addition, the optimal excavation angle combination ranges were determined as 62°~ 65°, 64°~ 67°, 67°~ 69°, 70°~ 71°, 73°, 75°~ 76°, 77°~ 80°considering the stability and maximum recovery. Therefore, the above research results verify the loading effect of mine slope excavation, and can serve as a reference for studies on the optimal range of excavation angles for the mine slope.

What is the impact of perioperative cerebral oxygen desaturation on postoperative delirium in old population: a systemic review and meta-analysis.

BACKGROUND: Perioperative cerebral oxygen saturation (ScO2) has been reported to associate with postoperative delirium (POD) which is a common postoperative complication, however, the results were inconclusive. Therefore, we aimed to conduct an up-to-date review and meta-analyze the relationship between perioperative ScO2 and POD. METHODS: We systematically searched PubMed, Embase and Web of science through January 13, 2022. The pooled results were estimated through a random-effects model meta-analysis and expressed as odds ratios (ORs) and standard mean differences (SMDs), accompanied with 95% confident intervals (CIs). RESULTS: Finally, of 467 searched articles, ten articles were included. A total of six studies reported the baseline ScO2 value and the pooled result showed that preoperative baseline ScO2 was lower in POD groups (SMD = - 0.41, 95% CI - 0.64 to - 0.18). And beyond that, the pooled OR across four literatures about preoperative low ScO2 on POD was 3.44 (95% CI 1.69, 7.02). In contrast, insignificant differences were detected in baseline/lowest ScO2 value during intraoperative and postoperative period. Additionally, there were no statistically significant associations for intraoperative and postoperative low ScO2 effect on POD risk. Meta-regress analysis has found no significant impact factors. CONCLUSIONS: Based on current evidence, POD patients have a lower ScO2, and ScO2 desaturation may increase POD incidence, indicating the role of ScO2 underlying pathological mechanisms. For generalizability of evidence, we should rely on high-quality, considering more comprehensively longitudinal, interdisciplinary studies.

Hippocampus-Based Mitochondrial Respiratory Function Decline Is Responsible for Perioperative Neurocognitive Disorders.

Perioperative neurocognitive disorders (PNDs) are a type of cognitive dysfunction occurring with a higher incidence in elderly patients. However, the pathological mechanism of PND and effective treatment remain elusive. We generated a PND mouse model by providing wild-type mice with surgical trauma; in our case, we used tibial fracture to investigate PND pathology. Mice aged 7-8 months were randomly divided into two groups: the surgery (tibial fracture) group and the control (sham) group. All mice were subjected to anesthesia. We examined the transcriptome-wide response in the hippocampus, a brain region that is tightly associated with memory formation, of control mice and mice subjected to surgical trauma at day 1 and day 3 after the surgical procedure. We observed reduced transcript levels of respiratory complex components as early as day 1 after surgery, and subsequent protein changes were found at day 3 after surgical trauma. Consequently, the activities of respiratory complexes were reduced, and adenosine triphosphate (ATP) production was decreased in the hippocampus of mice with surgical operations, supporting that respiratory chain function was impaired. In support of these conclusions, the mitochondrial membrane potential (MMP) levels were decreased, and the reactive oxygen species (ROS) levels were significantly increased. Mechanistically, we demonstrated that surgery induced a significant increase in cytokine IL-1ß levels at day 1 after surgery, which concomitantly occurred with transcript changes in respiratory complex components. We further uncovered that transcription factors PGC-1α and NRF-1 were responsible for the observed transcript changes in mitochondrial complex components. Importantly, HT22 cells treated with the cytokine IL-1ß resulted in similar reductions in PGC-1α and NRF-1, leading to a reduction of both the transcript and protein levels of respiratory complex subunits. Consequently, respiratory function was impaired in HT22 cells treated with IL-1ß. Taken together, we demonstrated that reductions in respiratory complex components and subsequent impairment in mitochondrial functions serve as a novel mechanism for PND pathology, providing a potential therapeutic target for PND treatment.

Comparison of the innovative endoscopic oropharyngeal airway and the conventional mouthpiece in elderly outpatients undergoing esophagogastroduodenoscopy under sedation: a prospective and randomized study.

BACKGROUND: Undesirable outcomes may appear for elderly patients undergoing esophagogastroduodenoscopy (EGD) under sedation, such as hypoxia and hypotension. The aim of our study was to investigate the ability of the innovative endoscopic oropharyngeal airway to reduce the frequency of hypoxia during EGD under sedation in elderly patients. METHODS: In this trial, aged patients undergoing EGD were randomized into airway group and mouthpiece group. The primary outcome was the incidence of the minimum pulse oxygen saturation < 90% and minimum pulse oxygen saturation. In addition, sedation dose, recovery time, emergency management and adverse reactions were recorded. RESULTS: 360 patients completed the study (180 in each groups). The minimum pulse oxygen saturation during EGD was significantly higher in airway group (97.66 ± 2.96%) than in mouthpiece group (95.52 ± 3.84%, P < 0.001). The incidence of pulse oxygen saturation of 85-89% of airway group (5.0%, 9/180) was lower than mouthpiece group (10.6%, 19/180, P = 0.049). The endoscopy entry time in airway group was 3 (2, 4) seconds and in mouthpiece group was 5 (4, 6) (P < 0.001). Propofol total dose and awakening time were significantly lower in the airway group than in the mouthpiece group (P = 0.020 and P = 0.012, respectively). Furthermore, the incidence rate of hypotension was significantly higher in mouthpiece group (12.2%) than in airway group (5.0%) (P = 0.015). By comparison with the mouthpiece group, the satisfaction of endoscopists was higher in airway group (P = 0.012). CONCLUSION: Elderly patients undergoing EGD, Endoscopy Protector was associated with a significantly lower incidence of hypoxia, shortened endoscopy entry time and more stable hemodynamics. TRIAL REGISTRATION: ChiCTR, ChiCTR2000031998, 17/04/2020. http://www.chictr.org.cn/index.aspx.

The meso-fracturing mechanism of marble under unloading confining pressure paths and constant axial stress.

Failure tests on marble during unloading confining-pressure under constant axial stress and simulations with the particle flow code were performed. The influence mechanism of the unloading rate of the confining pressure, initial unloading stress, and confining pressure on the failure characteristics of, and crack propagation in, marble was studied. By using the trial-and-error method, the conversion relationship between the unloading rates of confining pressures in laboratory tests and numerical simulations was ascertained. Micro-cracks formed in the unloading process of confining pressure are dominated by tension cracks, accompanied by shear cracks. The propagation of shear cracks lags that of tension cracks. As the confining pressure is increased, more cracks occur upon failure of the samples. The proportion of shear cracks increases while that of tension cracks decreases. The failure mode of samples undergoes a transition from shear-dominated failure to conjugated shear failure.

Nuclear speckle specific hnRNP D-like prevents age- and AD-related cognitive decline by modulating RNA splicing.

BACKGROUND: Aberrant alternative splicing plays critical role in aging and age-related diseases. Heterogeneous nuclear ribonucleoproteins (hnRNPs) reportedly regulate RNA splicing process. Whether and how hnRNPs contribute to age-related neurodegenerative diseases, especially Alzheimer's disease (AD), remain elusive. METHODS: Immunoblotting and immunostaining were performed to determine expression patterns and cellular/subcellular localization of the long isoform of hnRNP D-like (L-DL), which is a hnRNP family member, in mouse hippocampus. Downregulation of L-DL in WT mice was achieved by AAV-mediated shRNA delivery, followed by memory-related behavioural tests. L-DL interactome was analysed by affinity-precipitation and mass spectrometry. Alternative RNA splicing was measured by RNA-seq and analyzed by bioinformatics-based approaches. Downregulation and upregulation of L-DL in APP/PS1 mice were performed using AAV-mediated transduction. RESULTS: We show that L-DL is specifically localized to nuclear speckles. L-DL levels are decreased in the hippocampus of aged mouse brains and downregulation of L-DL impairs cognition in mice. L-DL serves as a structural component to recruit other speckle proteins, and regulates cytoskeleton- and synapse-related gene expression by altering RNA splicing. Mechanistically, these splicing changes are modulated via L-DL-mediated interaction of SF3B3, a core component of U2 snRNP, and U2AF65, a U2 spliceosome protein that guides U2 snRNP's binding to RNA. In addition, L-DL levels are decreased in APP/PS1 mouse brains. While downregulation of L-DL deteriorates memory deficits and overexpression of L-DL improves cognitive function in AD mice, by regulating the alternative splicing and expression of synaptic gene CAMKV. CONCLUSIONS: Our findings define a molecular mechanism by which hnRNP L-DL regulates alternative RNA splicing, and establish a direct role for L-DL in AD-related synaptic dysfunction and memory decline.

Effects of sliding liquefaction on homogeneous loess landslides in western China.

Sliding liquefaction is considered to be the cause of high-speed and long-distance sliding of some homogeneous loess landslides in western China. However, there is still a lack of necessary experimental research and analysis on the effects of sliding liquefaction on these landslides. In this work, the effects of sliding liquefaction on irrigation-induced, high-speed and long-distance loess landslides on the South Jingyang Tableland area in China are studied by performing large-scale ring shear tests and using the sled mode. The results are as follows. (1) There are two kinds of long-runout sliding modes of loess landslides on the South Jingyang Tableland: sliding along the terrace surface and sliding within the saturated terrace alluvium, which is associated with sliding liquefaction. Both sliding modes can lead to long-runout sliding. (2) There are some differences in the inclination of the sliding surface between the two sliding modes. Based on the inclination of the sliding surface, the corresponding sliding mode can be distinguished. (3) Under the two sliding modes, the large shear mechanical properties of the two-layer soil composed of loess and alluvial sandy silt show significant differences. The friction between the loess and dry terrace alluvium increases with increasing normal stress and shear rate, while the friction between the loess and saturated terrace alluvium presents the opposite trend. The results show that the sliding distances under different sliding modes present opposite trends with the change in sliding speed. (4) Based on the test results from the ring shear tests and the morphological characteristics of the sliding surface, the sliding mode and sliding distance of a loess landslide can be identified and predicted.

A Wide Bandgap Polymer Donor Composed of Benzodithiophene and Oxime-Substituted Thiophene for High-Performance Organic Solar Cells.

Oxime-substituted thiophene (TO) is used as an acceptor (A) unit to copolymerize with the benzodithiophene (BDT) donor (D) unit to form a novel D-A polymer donor, PBDTTO, which has a low-lying highest occupied molecular orbital energy level (EHOMO) of -5.60 eV and a wide bandgap of 2.03 eV, forming complementary absorption and matching energy levels with the narrow bandgap nonfullerene acceptors. Organic solar cells using PBDTTO and Y6 as the donor and acceptor, respectively, exhibited a JSC of 27.03 mA cm-2, a VOC of 0.83 V, and a fill factor of 0.59, reaching a high power conversion efficiency of 13.29%. The unencapsulated devices show good long-term stability in ambient air. Compared with the acceptor monomers used in other high-performance BDT-based D-A polymer donors, which are synthesized tediously in low yields, the TO acceptor monomer can be conveniently synthesized in only two steps with a high overall yield of 70%. These results demonstrate that TO unit can be used as a promising acceptor unit for developing BDT-based D-A polymer donors at low cost while maintaining high photovoltaic performance.

Astrocytic ApoE reprograms neuronal cholesterol metabolism and histone-acetylation-mediated memory.

Astrocytes metabolically interact with neighboring neurons by providing multiple substances to neurons. How astrocytes regulate neural functions via altering the neuronal metabolic state remains elusive. Here, we demonstrate that astrocytic ApoE vectors a variety of microRNAs (miRNAs), and these miRNAs specifically silence genes involved in neuronal cholesterol biosynthesis, ultimately accounting for accumulation of the pathway-initiating substrate acetyl-CoA. Consequently, histone acetylation is promoted, and transcription is activated in neurons. Functionally, we demonstrate that ApoE-mediated neuronal histone acetylation leads to increased H3K27ac enrichment in the promoters of multiple neuronal immediate early genes and subsequently to enhanced memory consolidation in mice. Importantly, human ApoE4 vectors lower levels of miRNAs than ApoE3 and therefore is less capable of metabolic and epigenetic regulation in neurons. Collectively, our findings define an astrocytic ApoE-mediated neuronal epigenetic mechanism as a novel means through which astrocytes modulate brain connectivity and function.

Synthesis of Poly(bisisoindigo) Using a Metal-Free Aldol Polymerization for Thin-Film Transistor Applications.

Typical syntheses of conjugated polymers rely heavily on organometallic reagents and metal-catalyzed cross-coupling reactions. Here, we show that an environmentally benign aldol polymerization can be used to synthesize poly(bisisoindigo), an analog of polyisoindigo with a ring-fused structural repeat unit. Owing to its extended conjugation length, poly(bisisoindigo) absorbs across the UV/vis/NIR spectrum, with an absorption tail that reaches 1000 nm. Due to the four electron-deficient lactam units on each repeat unit, poly(bisoindigo) possesses a low-lying LUMO, which lies at -3.94 eV relative to vacuum. Incorporation of the ring-fused monomer unit also lowered the overall torsional strain in the polymer backbone (relative to polyisoindigo), and the polymer was successfully used in prototype unipolar n-channel organic thin-film transistors.

Astragaloside IV prevents kidney injury caused by iatrogenic hyperinsulinemia in a streptozotocin­induced diabetic rat model.

Diabetic patients are able to manage their blood glucose with exogenous insulin but, ultimately, remain at risk of diabetic nephropathy (DN). Long­term use of insulin may lead to iatrogenic hyperinsulinemia, which has been suggested to cause kidney injury. However, there are no effective interventions for iatrogenic hyperinsulinemia leading to kidney damage. In the present paper, the hypothesis that astragaloside IV (AS­IV), a novel saponin purified from Astragalus membranaceus (Fisch) Bunge, may prevent DN in iatrogenic hyperinsulinemic diabetic rats through antioxidative and anti­inflammatory mechanisms was investigated. Diabetes was induced with streptozotocin (STZ) (55 mg/kg) by intraperitoneal injection in rats. At 1 week following STZ injection, the diabetic rats were treated with Levemir subcutaneously for 4 weeks. Diabetic rat insulin levels >30 µU/ml were considered as iatrogenic hyperinsulinemia. Rats were divided into six groups (n=8 per group): Iatrogenic hyperinsulinemic rats, and iatrogenic hyperinsulinemic rats treated with Tempol and AS­IV at 2.5, 5 and 10 mg/kg/day, intragastric infusion, for 12 weeks. The normal rats were used as a non­diabetic control group. AS­IV ameliorated albuminuria, mesangial cell proliferation, basement membrane thickening and podocyte foot process effacement in iatrogenic hyperinsulinemic rats. In iatrogenic hyperinsulinemic rat renal tissues, malondialdehyde, interleukin­1ß (IL­1ß), tumor necrosis factor­α (TNF­α), type IV collagen and laminin levels were increased, whereas glutathione peroxidase and superoxide dismutase activity levels were decreased. Nicotinamide adenine dinucleotide phosphate oxidase 4 expression and extracellular signal­regulated kinase 1/2 (ERK1/2) activation were upregulated, and canonical transient receptor potential cation channel 6 (TRPC6) protein expression was downregulated. However, all these abnormalities were attenuated by AS­IV. These findings suggested that AS­IV prevented rat kidney injury caused by iatrogenic hyperinsulinemia by inhibiting oxidative stress, IL­1ß and TNF­α overproduction, downregulating ERK1/2 activation, and upregulating TRPC6 expression.

Asymmetric Conjugated Molecules Based on [1]Benzothieno[3,2-b][1]benzothiophene for High-Mobility Organic Thin-Film Transistors: Influence of Alkyl Chain Length.

Herein, we report the synthesis and characterization of a series of [1]benzothieno[3,2-b][1]benzothiophene (BTBT)-based asymmetric conjugated molecules, that is, 2-(5-alkylthiophen-2-yl)[1]benzothieno[3,2-b][1]benzothiophene (BTBT-Tn, in which T and n represent thiophene and the number of carbons in the alkyl group, respectively). All of the molecules with n ≥ 4 show mesomorphism and display smectic A, smectic B (n = 4), or smectic E (n > 4) phases and then crystalline phases in succession upon cooling from the isotropic state. Alkyl chain length has a noticeable influence on the microstructures of vacuum-deposited films and therefore on the performance of the organic thin-film transistors (OTFTs). All molecules except for 2-(thiophen-2-yl)[1]benzothieno[3,2-b][1]benzothiophene and 2-(5-ethylthiophen-2-yl)[1]benzothieno[3,2-b][1]benzothiophene showed OTFT mobilities above 5 cm2 V-1 s-1. 2-(5-Hexylthiophen-2-yl)[1]benzothieno[3,2-b][1]benzothiophene and 2-(5-heptylthiophen-2-yl)[1]benzothieno[3,2-b][1]benzothiophene showed the greatest OTFT performance with reliable hole mobilities (µ) up to 10.5 cm2 V-1 s-1 because they formed highly ordered and homogeneous films with diminished grain boundaries.

Propofol in combination with remifentanil for cesarean section: Placental transfer and effect on mothers and newborns at different induction to delivery intervals.

OBJECTIVE: This study aims to describe the administration of propofol in combination with remifentanil for the induction of general anesthesia during cesarean section (CS). Our aim was to evaluate its impact on the drug concentrations of the maternal and neonatal blood at different induction of anesthesia to delivery (I-D) intervals as well as its effect on newborns. MATERIALS AND METHODS: In this double-blind randomized controlled study, patients undergoing elective CS were administered anesthesia at short (n = 20) or long (n = 20) I-D intervals. Anesthesia was induced with 1 mg/kg propofol and 1 µg/kg remifentanil and maintained by continuous infusion of 3 mg/kg/h propofol and 7 µg/kg/h remifentanil. RESULTS: The mean plasma propofol concentrations at delivery in the maternal arterial (MA) blood and the fetal umbilical arterial (UA) and venous (UV) blood in the short I-D interval group were 1.91, 1.17, and 0.51 µg/mL, respectively, while those in the long I-D interval group were 1.57, 1.07, and 0.61 µg/mL, respectively. The mean plasma remifentanil concentrations at delivery in the MA, UA, and UV in the short I-D interval group were 2.25, 1.43, and 0.65 ng/mL, respectively, and those in the long I-D interval group were 1.96, 1.25, and 0.75 ng/mL, respectively. There were no statistically significant differences in the neonatal Apgar scores and neurological adaptive capacity scores between the two groups. CONCLUSIONS: It is safe to administer propofol in combination with remifentanil by continuous infusion after the bolus dose for the induction of anesthesia during cesarean section. Prolonging the I-D interval within a certain limit will not have any significant influence on the fetus.

Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine.

OBJECTIVE: To observe the therapeutic effect of blood-letting cupping plus herbal medicine for acute gouty arthritis. METHODS: The 34 cases of acute gouty arthritis were treated by blood-letting cupping plus herbal medicine. RESULTS: 21 cases were cured and 13 cases improved. CONCLUSION: The therapeutic effect of this therapy was satisfactory for gouty arthritis.