Pre-incisional Preventive Precise Multimodal Analgesia May Enhance the Rehabilitation Process of Acute Postoperative Pain Following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

BACKGROUND: There has been limited research regarding the effect of preventive precise multimodal analgesia (PPMA) on the duration of acute postoperative pain after total laparoscopic hysterectomy (TLH). This randomized controlled trial aimed to evaluate how PPMA affects pain rehabilitation. OBJECTIVES: Our primary objective was to reduce the duration of acute postoperative pain after TLH, including incisional and visceral pain. STUDY DESIGN: A double blind randomized controlled clinical trial. SETTING: Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China. METHODS: Seventy patients undergoing TLH were randomized to Group PPMA or Group Control (Group C) in a 1:1 ratio. Patients in Group PPMA were given PPMA through the pre-incisional administration of parecoxib sodium 40 mg (parecoxib is not approved for use in the US) and oxycodone 0.1 mg/kg as well as local anesthetic infiltration at the incision sites. In Group C, similar doses of parecoxib sodium and oxycodone were injected during uterine removal, and a local anesthetic infiltration procedure was performed immediately before skin closure. The index of consciousness 2 was utilized to titrate the remifentanil dosage in all patients to ensure sufficient analgesia. RESULTS: Compared with the Control, PPMA shortened the durations of incisional and visceral pain at rest (median, interquartile range [IQR]: 0, 0.0- 2.5) vs 2.0, 0.0-48.0 hours, P = 0.045; 24.0, 6.0-24.0 vs 48.0, 24.0-48.0 hours, P < 0.001; and during coughing 1.0, 0.0-3.0 vs 24.0, 0.3-48.0 hours, P = 0.001; 24.0, 24.0-48.0] vs 48.0, 48.0-72.0] hours, P < 0.001). The Visual Analog Scale (VAS) scores for incisional pain within 24 hours and visceral pain within 48 hours in Group PPMA were lower than those in Group C (P < 0.05). PPMA evidently decreased the VAS scores for incisional pain during coughing at 48 hours (P < 0.05). Pre-incisional PPMA significantly reduced postoperative opioid consumption (median, IQR: 3.0 [0.0-3.0] vs 3.0 [0.8-6.0] mg, P = 0.041) and the incidence of postoperative nausea and vomiting (25.0% vs 50.0%, P = 0.039). Postoperative recovery and hospital stay were similar between the 2 groups. LIMITATIONS: This research had some limitations, including that it was a single-center research with a limited sample size. Our study cohort did not represent the overall patient population in the People's Republic of China; therefore, the external validity of our findings remains limited. Furthermore, the prevalence of chronic pain was not tracked. CONCLUSION: Pre-incisional PPMA may enhance the rehabilitation process of acute postoperative pain after TLH.

Co-finance for energy project under the Belt and Road Initiative: an application of evidential reasoning-group decision-making method.

Cooperation among consortium countries for energy projects under the Belt and Road Initiative (BRI) faces various uncertainties, and urges institutional investors to choose the co-finance mode to diversify the investment risk of energy projects. Recently, responsible investing in energy finance has been raised as a path to make the BRI greener. However, few studies focused on the issue on how to make the optimal decision in the process of collaboration. Therefore, this study constructed the financial-environment, social, and governance (F-ESG) evaluation indicator system from the perspective of responsible investors and proposed an integrated evidential reasoning group decision-making (ER-GDM) model. Then, programmed algorithms were designed to analyze and visualize the selection of the desired alternative. Finally, we applied the evaluation framework to the co-finance for four energy projects under the BRI. The results showed that after multiple rounds of discussion and negotiation (DAN), the consensus level reached 95.1%. It depicts that the optimized collective opinion has been obtained despite heterogeneous preferences. The analysis framework and proposed model in this study not only help international investors to co-finance energy project efficiently but also provide a solution for policy-makers to realize sustainable and high-quality cooperation in investment and financing under the BRI.

Research on identification of key brittleness factors in emergency medical resources support system based on complex network.

To address the problem of difficulty in identifying the key brittleness factors in the emergency medical resources support system (EMRSS), the principle of Interpretive Structural Modeling is utilized to construct a hierarchical recursive structural model for probing the influencing factors of the brittleness risk formation in the system. Further, by incorporating with the complex network theory, the network of the emergency medical resources support system has been built. The integrated value reflecting the importance of the network nodes is calculated by integrating the local nodes and the whole network to identify the critical factors that lead to the collapse of the emergency medical system. The validity of the method was verified by Advanced Research Project Agency network. The results showed that the key brittleness factors in EMRSS mainly include the professional competence of staff, the amount of government funding and the passing rate of quality sampling medical supplies in storage. It is hoped that this study provides useful information for reducing the brittleness risk and ensuring the safe operation of the system.

Does the green credit policy affect the scale of corporate debt financing? Evidence from listed companies in heavy pollution industries in China.

The current study constructs a quasi-natural experiment based on China's 2012 Green Credit Guidelines and develops a difference-in-difference model using the financial data of listed companies from 2006 to 2018 to conduct empirical testing. The results reveal that the green credit policy has significantly reduced the short-term and long-term debt financing of heavily polluting enterprises; however, the restrictions on short-term debt financing are insufficient. At the same time, the decline in operating performance brings financial penalty effects, among which state-owned, large-scale, and heavily polluting enterprises in high-emission areas have strong financial penalty effects. The green credit policy encourages heavy-polluting companies to increase R&D investment and increase fixed assets investments to obtain long-term credit support with short-term investment. Furthermore, it is found that the green credit policies have significantly restrained the scale of debt financing of heavily polluting companies. The Chinese government should formulate green financial policies based on local conditions and provide credit resources to favor environmentally friendly companies. Financial institutions should strictly implement green credit standards and modify financial products and services. Companies should take the initiative to eliminate outdated production capacity to obtain green credit support.

Can corporate environmental responsibility improve environmental performance? An inter-temporal analysis of Chinese chemical companies.

The empirical research on the relationship between corporate environmental responsibility and environmental performance remains in the one-way positive impact and lacks the research on nonlinear relationship between them. Based on the stakeholder theory, this paper selects A-share chemical-listed companies in China from 2006 to 2017 as the research samples and uses generalized method of moments (GMM) model to investigate the impact mechanism between corporate environmental responsibility and environmental performance. The results showed that corporate environmental responsibility positively impacted on environmental performance; however, the impact was not significant. The corporate environmental performance positively and significantly impacted on environmental responsibility. Moreover, results reported that industry competition played a positive regulatory role in corporate environmental responsibility affecting environmental performance and has played a positive role in corporate environmental impact on environmental responsibility. A nonlinear relationship (inverted "U" shape) between environmental responsibility and environmental performance was found. The study results stress to establish a fair and perfect market competition mechanism to improve the environmental performance of chemical industries in China.

Evolution and Driving Mechanism of Ecological Security Pattern: A Case Study of Yangtze River Urban Agglomeration.

Urbanization adversely affects the ecological environment and reduces the quality of life in China. In view of the current situation, this study aims to determine the dynamics of the ecological security pattern of urban agglomerations using the Yangtze River urban agglomeration (YRUA) as a case study. We used the pressure-state-response (PSR) framework to establish an ecological security assessment system, combined with the technique for order of preference by similarity to an ideal solution (TOPSIS) method and gray correlation method, to estimate a comprehensive ecological security index, and we analyzed its evolution trends and driving mechanisms. The results indicated that the distribution of the regional ecological security level had a linked effect and that industrial pollutants posed the greatest threat to ecological security. Moreover, the main factors affecting the YRUA were urbanization, ecopathology, economic development, population pressure, land pressure, and water resource pressure. For the protection of ecological security, it is necessary to establish an ecological security governance mechanism. Moreover, the study stresses changing the traditional sewage discharge model and establishing an ecologically safe market system. Integr Environ Assess Manag 2021;17:573-583. © 2020 SETAC.

Parecoxib Shortens the Duration of Acute Postoperative Pain After Laparoscopic-Assisted Vaginal Hysterectomy.

The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups [parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S)]. The duration of pain during coughing [median (interquartile range)] was significantly lower in Group P than in Group M or Group S [26.0 (5.8-48.0) vs. 48.0 (30.0-55.5) vs. 48.0 (36.0-58.5) h; p = 0.025]. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S [5.5 (3.8-21.0) vs. 24.0 (6.0-28.0) vs. 22.0 (5.8-36.0) h; p = 0.009]. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (p = 0.050) and 24 h (p = 0.009) as well as at rest at 12 h (p = 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.

Role of Liquid-based Cytology and Cell Block in the Diagnosis of Endometrial Lesions.

BACKGROUND: Liquid-based cytology (LBC) offers an alternative method to biopsy in screening endometrial cancer. Cell block (CB), prepared by collecting residual cytological specimen, represents a novel method to supplement the diagnosis of endometrial cytology. This study aimed to compare the specimen adequacy and diagnostic accuracy of LBC and CB in the diagnosis of endometrial lesions. METHODS: A total of 198 women with high risks of endometrial carcinoma (EC) from May 2014 to April 2015 were enrolled in this study. The cytological specimens were collected by the endometrial sampler (SAP-1) followed by histopathologic evaluation of dilatation and curettage or biopsy guided by hysteroscopy. The residual cytological specimens were processed into paraffin-embedded CB after LBC preparation. Diagnostic accuracies of LBC and CB for detecting endometrial lesions were correlated with histological diagnoses. Chi-square test was used to compare the specimen adequacies of LBC and CB. RESULTS: The specimen inadequate rate of CB was significantly higher than that of LBC (22.2% versus 7.1%, P < 0.01). There were 144 cases with adequate specimens for LBC and CB preparation. Among them, 29 cases were atypical endometrial hyperplasia (11 cases) or carcinoma (18 cases) confirmed by histology evaluation. Taking atypical hyperplasia and carcinoma as positive, the diagnostic accuracy of CB was 95.1% while it was 93.8% in LBC. When combined LBC with CB, the diagnostic accuracy was improved to 95.8%, with a sensitivity of 89.7% and specificity of 97.4%. CONCLUSIONS: CB is a feasible and reproducible adjuvant method for screening endometrial lesions. A combination of CB and LBC can improve the diagnostic accuracy of endometrial lesions.