Effectiveness of general anaesthesia with remimazolam tosilate on intraoperative haemodynamics and postoperative recovery: study protocol for a randomised, positive-controlled, pragmatic clinical trial (GARTH trial).

INTRODUCTION: It is encouraged to estimate the effectiveness of components within the enhanced recovery after surgery (ERAS) protocol through patient-reported outcomes, alongside doctor-reported outcomes and length of hospital stay. At present, studies on the contributions of optimal anaesthetic drugs within the ERAS protocol to patient-reported and doctor-reported outcomes are limited. Therefore, this study aims to pragmatically evaluate the effectiveness and safety of general anaesthesia (GA) with remimazolam tosilate within the ERAS protocol on intraoperative haemodynamics and postoperative recovery in adults undergoing elective surgeries, compared with propofol. METHODS AND ANALYSIS: This study is a single-centre, randomised, blinded, positive-controlled, pragmatic clinical trial. A total of 900 patients, aged ≥18 years old, scheduled for an elective surgical procedure under GA will be included. Patients will be randomised in a 1:1 ratio to the remimazolam group (the GA with remimazolam tosilate within the ERAS protocol group) or propofol group (the GA with propofol within the ERAS protocol group), stratified by general surgery, thoracic surgery and other surgeries (including urological surgery and otolaryngology surgery). The primary outcomes include the 24-hour postoperative quality of recovery-40 score and the rate of intraoperative hypotension. Secondary endpoints include the rate of sedative hypotension requiring treatment, the haemodynamic profiles, the 72-hour postoperative quality of recovery-40 score, the functional anaesthetic capability, adverse events and complications, quality of life within 3 months as well as economic health outcomes. ETHICS AND DISSEMINATION: This study protocol has been approved by the ethics committee of Guangdong Provincial People's Hospital (KY-H-2022-005-03-08). Dissemination plans will be presented at scientific meetings and in scientific publications. TRIAL REGISTRATION NUMBER: ChiCTR2200062520.

[Effect of electroacupuncture at different time points on postoperative urination function in patients with mixed hemorrhoids surgery].

OBJECTIVE: To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery. METHODS: A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group. RESULTS: In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05). CONCLUSION: EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.

Resection of an anal fistula with endoscopic submucosal dissection.

A 34-year-old man presented with paroxysmal hypogastralgia during defecation for 2 weeks. Physical and laboratory examination findings were unremarkable, other than a depression located 1 cm above the dentate line, accompanied by mild tenderness and a clubbed induration extending to the rectum. Colonoscopy showed a 2.0×0.8 cm longitudinal, protruding mass in the posterior wall of the lower rectum. Endosonography revealed a mixed echogenic mass originating from the rectal submucosa, with no sign of muscular wall disruption. There was no evidence of Crohn's or other diseases. Following anorectal consultation, we suspected a submucosal or internal blind fistula since the patient was symptomatic with a superficial mass which communicated to the rectum. The location and depth of the mass indicated that endoscopic resection might allow for removal of the lesion without impairment of the anorectal anatomy and function. After obtaining the patient's consent, endoscopic submucosal dissection (ESD) was performed. En bloc resection was achieved using a disposable, high-frequency knife (Micro-Tech, China). No adverse events occurred. Histopathological examination revealed a benign fistula composed of local submucous granulomatous tissue proliferation and a focal mucous epithelial defect. The patient's symptoms were relieved postoperatively, and no recurrence was evident after 6 months.

Risk Factors for Sepsis Based on Sepsis-3 Criteria after Orthotopic Liver Transplantation.

Sepsis is a common complication of solid organ transplant procedures and, in particular, can affect the prognosis of orthotopic liver transplantation (OLT). This retrospective study determined the pre-, peri-, and postoperative risk factors for sepsis after OLT, using as reference the 2016 Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Pre-, peri-, and postoperative clinical data of the sepsis-positive (n = 85) and sepsis-negative (n = 41) groups were analyzed for potential risk factors of OLT-related sepsis. The sepsis-positive patients had a significantly higher rate of dialysis (49.4%), longer time under mechanical ventilation (1.5 d), higher hospitalization costs (0.41 million RMB), and worse survival rate (68.5%), compared with the sepsis-negative patients (4.8%, 1 d, 0.30 million RMB, and 73.1%, resp.). The multivariate logistic analysis identified the following as risk factors for OLT-related sepsis: preoperative Child-Pugh grade C (OR 10.43; 95% CI 2.081-52.292; P = 0.004), preoperative hypercalcemia (OR 6.372; 95% CI 1.693-23.98; P = 0.006), and perioperative acidosis (OR 6.364; 95% CI 1.196-33.869; P = 0.030). Patients with preoperative Child-Pugh grade C, preoperative hypercalcemia, or perioperative acidosis are at higher risk for developing sepsis after OLT. When any of these problems occur, timely sepsis management should be planned.

Resonance light scattering method for the determination of anionic surfactant with acridine orange.

The resonance Rayleigh scattering (RRS), second-order scattering (SOS) and frequency-double scattering (FDS) spectra of sodium dodecylbenzene sulfonate (SDBS) (anionic surfactant (AS)) with acridine orange (AO) system were studied. Experimental results showed that when lambda(em) = lambda(ex) = 537 nm, the RRS peak of AO was greatly enhanced with the increase of SDBS concentration at a pH range of 1.8-4.0. The linear range of the calibration curve for SDBS was 0.028-8.71 mg L(-1) with a detection limit of 8.36 microg L(-1) when the AO concentration was 2.5 x 10(-5)mol L(-1). The method has been applied to the determination of trace amount of AS in environmental water samples with satisfactory results. In addition, when lambda(em) = 321 nm and lambda(ex) = 642 nm, the intensity of FDS was proportional to the SDBS concentration ranging from 0.014 to 8.71 mg L(-1) and the correlation coefficient was 0.993 with a detection limit of 4.31 microg L(-1); when lambda(em) = 642 nm and lambda(ex) = 321 nm, the intensity of SOS was proportional to the SDBS concentration ranging from 0.050 to 8.71 mg L(-1), and the correlation coefficient was 0.993 with a detection limit of 14.9 microg L(-1).

[Determination of deoxyribonucleic acids at nanograms levels with toluidine blue by a resonance light-scattering method].

Resonance light scattering (RLS) spectra of toluidine blue (TB) with DNA was studied. The RLS of TB was greatly enhanced by DNA in the range of pH 10-11. A RLS peak at 350 nm was found, and the enhanced intensity of RLS at this wavelength was proportional to the concentration of DNA. The linear range of the calibration curve was 0-900 ng x mL(-1) with the detection limit of 6.75 ng x mL(-1) for the ctDNA, and for fsDNA the linear range was 0-900 ng x mL(-1) with the detection limit of 2.99 ng x mL(-1). Precision at 500 ng x mL(-1) for the two nucleic acids was 3.7% and 5.6%, respectively. Four synthetic samples were determined satisfactorily.

[Study on the defluoridation of drinking water with model-La cation exchange resin].

Model-La cation exchange resin was transformed from strong acid cation exchange resin, which was used for the defluoridation of drinking water. The 001 x 7 strong acid cation exchange resin was transformed into model-La cation exchange by soaking in the La(NO3)3 solution. The F- in the water was removed by model-La cation exchange resin under the optimum condition because it was combined into fluoride with the La3+ in the model-La cation exchange resin. The used resin was regenerated with the La(NO3)3 solution and was used to defluoridate many times. The optimum conditions of transform and defluoridation and regeneration were d(rasin) = 0.315-0.600 mm, V(rasin):V(regeneration) = 1:6, t(transform) = 48 h, T = 298.16 K(25 degrees C). The defluoridation capacity was 5.60 mg/g in column test, and 4.08 mg/g in batch test. The model-La cation exchange resin could be used for defluoridation for 8 times. The results suggest that the model-La cation exchange resin is a novel material of defluoridation. This method is easy to master and the pH value of the solution doesn't need to be regenerated that the cost of defluoridation can be reduced significantly and it can be used for a long time.