Intravenous Bolus of Dexmedetomidine for Treatment of Severe Shivering After Caesarean Delivery Under Combined Spinal-Epidural Anaesthesia: A Randomized Dose-Response Study.

Purpose: Shivering occurs frequently after caesarean delivery. The present study aimed to investigate the ED50 and ED95 of an intravenous (i.v.) bolus of dexmedetomidine for treating severe shivering after caesarean delivery under combined spinal-epidural anaesthesia. Patients and methods: Seventy-five parturients with severe shivering after caesarean delivery were randomized into one of the five groups to receive an i.v. bolus of 0.2 (Group D1), 0.25 (Group D2), 0.3 (Group D3), 0.35 (Group D4) or 0.4 (Group D5) µg/kg of dexmedetomidine. Effectiveness of shivering treatment was defined as a standardized shivering score decreasing to ≤1 within 10 min of dexmedetomidine injection. The ED50 and ED95 were determined by probit regression. Adverse effects were also compared among the groups. Results: The ED50 and ED95 of i.v. dexmedetomidine to treat severe shivering were 0.23 (95% CI, 0.16-0.26) µg/kg and 0.39 (95% CI, 0.34-0.52) µg/kg, respectively. No difference in the incidence of adverse effects was found between groups. Conclusion: An i.v. bolus of 0.39 µg/kg of dexmedetomidine will treat 95% of parturients experiencing severe shivering after caesarean delivery.

Peptidoglycan biosynthesis-associated enzymatic kinetic characteristics and ß-lactam antibiotic inhibitory effects of different Streptococcus pneumoniae penicillin-binding proteins.

Penicillin-binding proteins (PBPs) include transpeptidases, carboxypeptidases, and endopeptidases for biosynthesis of peptidoglycans in the cell wall to maintain bacterial morphology and survival in the environment. Streptococcus pneumoniae expresses six PBPs, but their enzymatic kinetic characteristics and inhibitory effects on different ß-lactam antibiotics remain poorly understood. In this study, all the six recombinant PBPs of S. pneumoniae displayed transpeptidase activity with different substrate affinities (Km = 1.56-9.11 mM) in a concentration-dependent manner, and rPBP3 showed a greater catalytic efficiency (Kcat = 2.38 s-1) than the other rPBPs (Kcat = 3.20-7.49 × 10-2 s-1). However, only rPBP3 was identified as a carboxypeptidase (Km = 8.57 mM and Kcat = 2.57 s-1). None of the rPBPs exhibited endopeptidase activity. Penicillin and cefotaxime inhibited the transpeptidase and carboxypeptidase activity of all the rPBPs but imipenem did not inhibited the enzymatic activities of rPBP3. Except for the lack of binding of imipenem to rPBP3, penicillin, cefotaxime, and imipenem bound to all the other rPBPs (KD = 3.71-9.35 × 10-4 M). Sublethal concentrations of penicillin, cefotaxime, and imipenem induced a decrease of pneumococcal pbps-mRNA levels (p < 0.05). These results indicated that all six PBPs of S. pneumoniae are transpeptidases, while only PBP3 is a carboxypeptidase. Imipenem has no inhibitory effect on pneumococcal PBP3. The pneumococcal genes for encoding endopeptidases remain to be determined.

EADD-YOLO: An efficient and accurate disease detector for apple leaf using improved lightweight YOLOv5.

Introduction: Current detection methods for apple leaf diseases still suffer some challenges, such as the high number of parameters, low detection speed and poor detection performance for small dense spots, which limit the practical applications in agriculture. Therefore, an efficient and accurate model for apple leaf disease detection based on YOLOv5 is proposed and named EADD-YOLO. Methods: In the EADD-YOLO, the lightweight shufflenet inverted residual module is utilized to reconstruct the backbone network, and an efficient feature learning module designed through depthwise convolution is proposed and introduced to the neck network. The aim is to reduce the number of parameters and floating point of operations (FLOPs) during feature extraction and feature fusion, thus increasing the operational efficiency of the network with less impact on detection performance. In addition, the coordinate attention module is embedded into the critical locations of the network to select the critical spot information and suppress useless information, which is to enhance the detection accuracy of diseases with various sizes from different scenes. Furthermore, the SIoU loss replaces CIoU loss as the bounding box regression loss function to improve the accuracy of prediction box localization. Results: The experimental results indicate that the proposed method can achieve the detection performance of 95.5% on the mean average precision and a speed of 625 frames per second (FPS) on the apple leaf disease dataset (ALDD). Compared to the latest research method on the ALDD, the detection accuracy and speed of the proposed method were improved by 12.3% and 596 FPS, respectively. In addition, the parameter quantity and FLOPs of the proposed method were much less than other relevant popular algorithms. Discussion: In summary, the proposed method not only has a satisfactory detection effect, but also has fewer parameters and high calculation efficiency compared with the existing approaches. Therefore, the proposed method provides a high-performance solution for the early diagnosis of apple leaf disease and can be applied in agricultural robots. The code repository is open-sourced at https://github.com/AWANWY/EADD-YOLO.

Coarse-to-Fine Contrastive Self-Supervised Feature Learning for Land-Cover Classification in SAR Images With Limited Labeled Data.

Contrastive self-supervised learning (CSSL) has achieved promising results in extracting visual features from unlabeled data. Most of the current CSSL methods are used to learn global image features with low-resolution that are not suitable or efficient for pixel-level tasks. In this paper, we propose a coarse-to-fine CSSL framework based on a novel contrasting strategy to address this problem. It consists of two stages, one for encoder pre-training to learn global features and the other for decoder pre-training to derive local features. Firstly, the novel contrasting strategy takes advantage of the spatial structure and semantic meaning of different regions and provides more cues to learn than that relying only on data augmentation. Specifically, a positive pair is built from two nearby patches sampled along the direction of the texture if they fall into the same cluster. A negative pair is generated from different clusters. When the novel contrasting strategy is applied to the coarse-to-fine CSSL framework, global and local features are learned successively by forcing the positive pair close to each other and the negative pair apart in an embedding space. Secondly, a discriminant constraint is incorporated into the per-pixel classification model to maximize the inter-class distance. It makes the classification model more competent at distinguishing between different categories that have similar appearance. Finally, the proposed method is validated on four SAR images for land-cover classification with limited labeled data and substantially improves the experimental results. The effectiveness of the proposed method is demonstrated in pixel-level tasks after comparison with the state-of-the-art methods.

Role and Mechanism of Keap1/Nrf2 Signaling Pathway in the Regulation of Autophagy in Alleviating Pulmonary Fibrosis.

A variety of internal and external lung diseases may eventually lead to pulmonary fibrosis, and insufficient autophagy is closely related to pulmonary fibrosis. This research is aimed to explore the mechanism of autophagy to alleviate pulmonary fibrosis. Then, a mouse model of pulmonary fibrosis induced by boromycin and histopathological lesions of the lungs of mice were observed by HE staining, which Masson staining assessed the degree of fibrosis in the lung tissue by detecting the expression of hydroxyproline in the tissue. RT-qPCR and western blotting were used to detect the levels of autophagy and Keap1/Nrf2 signaling pathway-related proteins. It was proved that autophagy-related proteins MAP1LC3(LC3) and Beclin 1 were decreased in mice with pulmonary fibrosis, while the expression of p62 was increased. Mice with pulmonary fibrosis worsened after injection of a 3-MA autophagy inhibitor, while injection of autophagy activation of rapamycin agent promoted Nrf2 nuclear mobilization. In a word, autophagy relieves pulmonary fibrosis through the activation of the Keap1/Nrf2 signaling pathway.

Evidence-Based Nursing Model in Interventional Thrombolysis for Acute Lower Extremity Arterial Embolism.

Acute lower extremity arterial embolism (AE) is a serious clinical emergency, and, if not treated in time, it can easily lead to limb ischemia and necrosis and eventually facing amputation, which seriously damages patients' physical and mental health. In the past, the conventional drug thrombolytic therapy had slow and limited efficacy, and the best time for treatment is easily delayed, while arterial dissection and thrombectomy treatment, although fast, is traumatic and has many complications, which is not easily accepted by patients. The aim of this study was to investigate the value of evidence-based care model in the application of interventional thrombolysis for acute lower limb arterial embolism. Seventy-two patients with acute lower limb arterial embolism who underwent interventional thrombolysis treatment received by the Department of Vascular Surgery of our hospital from July 2016 to December 2021 were randomly divided into a control group (given conventional nursing services) and a quality group (given full quality nursing services) to compare the effect of nursing services in the two groups. The results showed that the postoperative psychological status of patients in the quality group was significantly better than that of patients in the control group (P < 0.05). The total incidence of postoperative adverse events and the total treatment efficiency of the quality group were better than those of the control group (P < 0.05). The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than conventional nursing care and is recommended. The site of vascular occlusion after bypass surgery can be clarified when angiography is performed after thrombolytic therapy, which can help secondary surgical intervention to prolong the time to patency. The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than that of conventional nursing care and is recommended.

Molecular Characterization of Predominant Serotypes, Drug Resistance, and Virulence Genes of Streptococcus pneumoniae Isolates From East China.

Streptococcus pneumoniae is a common diplococcus pathogen found worldwide. The characterization of predominant serotypes, drug resistance, and virulence genes of S. pneumoniae isolates prevailing in different areas and countries is clinically important for choice of antibiotics and improvement of vaccines. In this study, pneumonia (78.7%) and meningitis (37.0%) were the predominant diseases observed in the 282 (children) and 27 (adults) S. pneumoniae-infected patients (p < 0.05) from seven hospitals in different areas of East China. Of the 309 pneumococcal isolates, 90.3% were classified by PCR into 15 serotypes, with serotypes 19F (27.2%) and the 6A/B (19.1%) being most predominant (p < 0.05). Importantly, serotypes 15A and 15B/C combined for a total of 10.4% of the isolates, but these serotypes are not included in the 13-valent pneumococcal capsule conjugate vaccine used in China. Antimicrobial susceptibility analysis by the E-test showed that >95% of the 309 pneumococcal isolates were susceptible to moxifloxacin and levofloxacin, as well as 18.4, 85.8, and 81.6% of the isolates displayed susceptibility to penicillin, cefotaxime, and imipenem, respectively. A significant correlation between the prevalence of predominant serotypes and their penicillin resistance was observed (p < 0.05). In particular, >95% of all the pneumococcal isolates showed resistance to erythromycin and azithromycin. Of the nine detected virulence genes, the lytA, ply, hysA, and nanA were the most common with 95-100% positive rates in the 309 pneumococcal isolates, while the pavA and psaA genes displayed a significant correlation with pneumococcal bacteremia and meningitis (p < 0.05). Overall, our data suggested that the predominant serotypes, drug resistance, and virulence genes of the S. pneumoniae isolates prevailing in East China are distinct from those observed in other areas of China and adjacent countries.

Effect of continuous positive airway pressure on albuminuria in patients with obstructive sleep apnea: a meta-analysis.

PURPOSE: A relationship between albuminuria and obstructive sleep apnea (OSA) has been documented in previous studies. Nevertheless, the impact of continuous positive airway pressure (CPAP) treatment on albuminuria in subjects with OSA is debated. This meta-analysis was carried out to investigate whether or not CPAP treatment affected urinary albumin-to-creatinine ratio (UACR) in subjects with OSA. METHODS: A comprehensive literature search was conducted on Web of Science, Embase, and PubMed from January 1990 to December 2020. Information on patients' characteristics, features of the studies, and UACR of pre- and post-CPAP treatment was collected. For estimation of the pooled effects, standardized mean difference (SMD) was applied. RESULTS: This meta-analysis included 6 articles and 211 subjects. The pooled analysis suggested that CPAP therapy exerted a favorable effect on the decrease of UACR in subjects with OSA (SMD = 0.415, 95% CI = 0.026 to 0.804, z = 2.09, p = 0.037). Subgroup analyses revealed that the CPAP treatment effect was not influenced by sample size, BMI, age, or AHI. CONCLUSION: The present meta-analysis indicated that UACR was significantly reduced by CPAP therapy in subjects with OSA. Further well-designed randomized controlled trials with large sample size are required to confirm the benefits.

DPFL-Nets: Deep Pyramid Feature Learning Networks for Multiscale Change Detection.

Due to the complementary properties of different types of sensors, change detection between heterogeneous images receives increasing attention from researchers. However, change detection cannot be handled by directly comparing two heterogeneous images since they demonstrate different image appearances and statistics. In this article, we propose a deep pyramid feature learning network (DPFL-Net) for change detection, especially between heterogeneous images. DPFL-Net can learn a series of hierarchical features in an unsupervised fashion, containing both spatial details and multiscale contextual information. The learned pyramid features from two input images make unchanged pixels matched exactly and changed ones dissimilar and after transformed into the same space for each scale successively. We further propose fusion blocks to aggregate multiscale difference images (DIs), generating an enhanced DI with strong separability. Based on the enhanced DI, unchanged areas are predicted and used to train DPFL-Net in the next iteration. In this article, pyramid features and unchanged areas are updated alternately, leading to an unsupervised change detection method. In the feature transformation process, local consistency is introduced to constrain the learned pyramid features, modeling the correlations between the neighboring pixels and reducing the false alarms. Experimental results demonstrate that the proposed approach achieves superior or at least comparable results to the existing state-of-the-art change detection methods in both homogeneous and heterogeneous cases.

Systematic review and meta-analysis of the safety and effectiveness of low molecular heparin for severe acute pancreatitis.

BACKGROUND: Because the effect of low molecular heparin (LMH) on acute ulcer and bleeding complications in patients with severe acute pancreatitis (SAP) is unclear, we investigated the safety and efficacy of early intervention with LMH in patients with SAP. METHODS: Using the keywords "heparin", "low molecular weight heparin", "pancreatitis", and "severe acute pancreatitis", we searched PubMed, Medline, CNKI, etc. And select the reference documents of the comparative study of traditional treatment and low molecular weight heparin intervention. RevMan was used for the meta-analysis. RESULTS: A total of 8 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis shows that, The MHS between the two groups is statistically heterogeneous. (Chi2=19.59, I2=95%, P<0.00001), Fixed-effects model (FEM) analysis showed that the MHS of experimental subjects was obviously shorter than that of controls (Z=3.24, P=0.001); The acute physiology and chronic health score (APACHE II) of the two groups were heterogeneous (Chi2=7.24, I2=72%, P=0.03); No heterogeneity was found in the amount of bleeding (Chi2=5.83, I2=31%, P=0.21), FEM analysis showed the number of complications in the experimental group was significantly less than that in the control group (Z=2.70, P=0.007). DISCUSSION: LMH intervention can dramatically reduce the average hospital stay and complications of patients with SAP, improve treatment efficacy, and has high safety.

Insight into the benefits of anammox bacteria living as aggregates.

This work tried understanding aggregation preference of anammox bacteria from benefit-driven perspective. Aggregated anammox sludge (AGS) gained benefits in specific anammox activity (SAA) (increased by 40.47 ± 12.64%) and in toxicity resistance (enhanced by 65.41%) than scattered anammox sludge (SCS), which were verified by kinetics. The increased heme c content by 35.67 ± 5.77% and enhanced relative abundance of anammox bacteria by 9.29% supported the benefits in biological activity and improved EPS content by 1097.59 ± 43.06% (622.16 ± 61.73% for protein (PN), 2403.47 ± 162.75% for humic acid (HA) and 1145.34 ± 97.33% for polysaccharide (PS)) justified the benefits in toxicity resistance. The diverse microbial communities and organized spatial structures owned by AGS promoted interactions between species, as the intrinsic justification for obtaining the benefits. We expect our findings to provide theoretical guidance for promotions and applications of the anammox process with excellent nitrogen removal capacity and stability.

Preoperative nursing visit reduces preoperative anxiety and postoperative complications in patients with laparoscopic cholecystectomy: A randomized clinical trial protocol.

BACKGROUND: Anxiety is a kind of emotional disorder caused by acute conditions or trigger. It is manifested in the components of the autonomic nervous system, for instance, stress, anxiety, nervosity, and discomfort. Most patients with anxiety are more active, nervous, and alert to various stimuli. Inappropriate management of early postoperative anxiety will not only prolong recovery but also increase the risk of other complications. We conduct a randomized clinical trial to investigate the influences of nursing visits against the preoperative anxiety and postoperative complications in patients undergoing laparoscopic cholecystectomy (LC). METHODS: This is a single center, placebo-controlled randomized trial, which will be performed from August 2020 to December 2020. The trial is performed in accordance with the SPIRIT Checklist for randomized studies. It is authorized by the Ethics Committee of Taizhou Hospital of Zhejiang Province (D20211-34). Two hundred patients undergoing LC will be included in this study. Patients are randomly divided into 2 groups: experiential group (n = 100) or control group (n = 100). The experimental group is given preoperative nursing visit to each patient 1 day before the operation, whereas the control group did not receive the preoperative nursing intervention. The patients in experience group also received education on the surgery team and the environment of operating room, the process of anesthesia, advantages of laparoscopic surgery, and the postoperative care from recovery room to discharge. The primary outcomes include State-Trait anxiety level and postoperative visual analogue scale. Secondary outcomes include total consumption of analgesics and postoperative complications. RESULTS: Figure (a) will show the comparison of outcomes between 2 groups. CONCLUSION: The preoperative nursing visit may decrease the anxiety and the complications after operation in patients receiving LC. TRIAL REGISTRATION: This study protocol is registered in Research Registry (researchregistry5924).

Integrating floc, aggregate and carrier to reap high-quality anammox biofilm.

This work investigated the effects of integration of floc, aggregate and carrier (IFAC) on anammox biofilm quality and development mechanisms. The IFAC system harvested high-quality anammox biofilm with a reduction of 60% in the formation period, an increment of 282.14%~397.26% in mechanical stability, an enhancement of 10.18 ~ 21.56% in ecological stability and an improvement of 9.44%~46.18% in abundance of the phylum Planctomycetes. Aggregates enabled carriers to accumulate initial biomass efficiently and equipped biofilm with additional joint forces. Floc promoted accumulation of terminal biomass, enhanced ecological stability by improving community diversity and raised abundance of the phylum Planctomycetes by assisting anammox consortium settlement. A model of the development procedure of high-quality anammox biofilm was established and a strategy for pre-designing the IFAC system to reap high-quality biofilm was proposed. We expect our findings to provide theoretical guidance for designs and applications of anammox process with excellent stability.

A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia.

BACKGROUND: Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients. METHODS: One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded. RESULTS: The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ±â€Š16 bolus, 129 ±â€Š25 mL) than those in group MN (15 ±â€Š10 bolus, 120 ±â€Š16 mL) (both P < 0.05) and group HN (13 ±â€Š9 bolus, 117 ±â€Š13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05). CONCLUSIONS: Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS. TRIAL REGISTRATION NUMBER: ChiCTR1800015014, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.

Comparison of the ED50 of intrathecal hyperbaric ropivacaine co-administered with or without intrathecal dexmedetomidine for cesarean section: A prospective, double-blinded, randomized dose-response trial using up-down sequential allocation method.

STUDY OBJECTIVE: Studies have showed that intrathecal dexmedetomidine as supplements to local anesthetics can improve the quality of the spinal anesthesia and reduce the local anesthetic requirement of spinal anesthesia for cesarean section. However, the magnitude of this effect has not been fully quantified. Therefore, we conducted the present study to investigate the ED50 of intrathecal hyperbaric ropivacaine with or without dexmedetomidine for cesarean section in healthy parturients. ED50 values obtained were compared to estimate the effect of intrathecal dexmedetomidine versus placebo on ropivacaine requirement. DESIGN: Single-blinded, prospective, randomized study. SETTING: Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine. PATIENTS: Sixty healthy parturients under elective cesarean section with combined spinal-epidural anesthesia were randomized into Group C (intrathecal ropivacaine alone) and Group D (intrathecal ropivacaine + 5 µg dexmedetomidine). INTERVENTIONS: The dose of intrathecal ropivacaine for the first parturient in both groups was 11 mg. An increment or decrement of 0.5 mg intrathecal ropivacaine was made for the subsequent parturient based on the effective or ineffective response of the previous parturient. Effective dose was defined as a bilateral T6 or above sensory block level was achieved within 15 min after induce of spinal anesthesia and no additional epidural anesthetics was required during surgery. The Dixon and Massay sequential method and Probit regression were applied to calculate the ED50 of intrathecal ropivacaine in both groups. MEASUREMENTS: Characteristics of spinal anesthesia and side effects were recorded. MAIN RESULTS: The ED50 of hyperbaric ropivacaine calculated by Dixon and Massay formula was 11.4 mg (95% CI, 11.1-11.7 mg) in Group C, and 9.4 mg (95% CI, 9.0-9.7 mg) in Group D (P < 0.05). While using the Probit regression, the ED50 of intrathecal hyperbaric ropivacaine was 11.1 mg (95% CI, 10.7-11.6 mg) in Group C, and 9.1 mg (95% CI, 8.6-9.5 mg) in Group D. Shivering was less observed in Group D than in Group C (P < 0.05). There was no significant difference in the onset time of sensory block or motor block, the incidence of hypotension, bradycardia, nausea and vomiting, sedation and pruritus between the two groups. CONCLUSION: Under the conditions of the present study, intrathecal dexmedetomidine (5 µg) reduced the ED50 of intrathecal hyperbaric ropivacaine by approximately 18% for cesarean section in healthy parturients under combined spinal-epidural anesthesia.

A randomised double-blind dose-response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal-epidural anaesthesia for Caesarean delivery.

BACKGROUND: Norepinephrine infusion has been suggested as an effective method for preventing hypotension during spinal anaesthesia for Caesarean delivery. However, optimal dosing regimens for norepinephrine have not been well established. This study aimed to determine the dose-response characteristics of a weight-adjusted fixed-rate infusion of norepinephrine to prevent hypotension during neuraxial anaesthesia for Caesarean delivery. METHODS: In a double-blind, randomised controlled trial, 80 parturients having elective Caesarean delivery received a prophylactic norepinephrine infusion at 0.025 µg kg-1 min-1 (Group N1), 0.05 µg kg-1 min-1 (Group N2), 0.075 µg kg-1 min-1 (Group N3), or 0.10 µg kg-1 min-1 (Group N4), starting immediately after induction of combined spinal-epidural anaesthesia. The primary outcome was non-occurrence of hypotension, defined as a decrease in systolic arterial pressure ≥20% below baseline value or to ≤90 mm Hg, before delivery. Values for 50% effective dose (ED50) and ED90 were calculated using probit regression. RESULTS: The incidence of hypotension was 11/20 (55%), 6/20 (30%), 2/20 (10%), and 1/20 (5%) in Groups N1, N2, N3, and N4, respectively (P<0.0001). The ED50 and ED90 (95% confidence interval) of norepinephrine infusions for preventing hypotension were 0.029 (-0.002 to 0.043) and 0.080 (0.065-0.116) µg kg-1 min-1, respectively. The incidence of reactive hypertension increased with increasing norepinephrine dose (P=0.002). Other adverse effects were similar among groups. CONCLUSIONS: Under the conditions of this study, an infusion of norepinephrine 0.08 µg kg-1 min-1 was effective for preventing hypotension in 90% of patients. This information should provide a guide for initiating norepinephrine infusions. CLINICAL TRIAL REGISTRATION: ChiCTR1900022322 at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enindex.aspx).

Family caregivers of advanced cancer patients: self-perceived competency and meaning-making.

BACKGROUND: Family caregivers of patients with advanced cancer have been reported to provide long hours of care and be at risk for poor psychological outcomes. Although research has focused on the nature of caregiving burden, little attention has been paid to identifying protective factors that improve caregiver psychological outcomes. AIM: We examined the relationship between caregivers' time spent caregiving and the following psychological outcomes: anxiety, depression and caregiving esteem. Subsequently, we explored the main and moderating effects of caregiver-perceived self-competency and sense of meaning on caregiver psychological outcomes. DESIGN/PARTICIPANTS: Cross-sectional analysis was conducted using the baseline data from an ongoing cohort study. Family caregivers of advanced cancer patients (n=287) were recruited from two tertiary hospitals in Singapore. RESULTS: Time spent caregiving was not significantly associated with caregiver anxiety, depression or caregiving esteem. However, significant main effects of self-competency on anxiety and caregiving esteem; and sense of meaning on anxiety, depression and caregiving esteem were observed. Moderator analyses further indicated that self-competency attenuated the positive relationship between time spent caregiving and anxiety, while sense of meaning attenuated the negative relationship between time spent caregiving and caregiving esteem. CONCLUSION: Greater perceived self-competency and sense of meaning are related to better caregiver psychological outcomes, and protect caregivers from worsening outcomes as caregiving hours increase. Our findings suggest that screening caregivers for distress is an important part of care, and that supportive interventions for caregivers should aim to enhance their perceived caregiving competencies and the ability to make meaning of their caregiving role.

Effects of ghrelin on pGSK-3ß and ß-catenin expression when protects against neuropathic pain behavior in rats challenged with chronic constriction injury.

Ghrelin has been shown to alleviate neuropathic pain by inhibiting the release of proinflammatory cytokines. The purpose of this study was to investigate the role of GSK-3ß/ß-catenin signaling in mediating the effect of ghrelin on neuropathic pain and to understand the associated mechanisms. Chronic constriction injury (CCI) of the sciatic nerve was used to establish a rat model of neuropathic pain. Hyperalgesia and allodynia were evaluated by observing the mechanical withdrawal threshold and the thermal withdrawal latency. Wnt3a and ß-catenin protein expression and GSK-3ß phosphorylation were detected by western blotting analysis. The levels of tumor necrosis factor-α and IL-1ß were determined using an enzyme-linked immunosorbent assay. In addition, we used immunohistochemical analysis to determine the levels of GSK-3ß phosphorylation in the dorsal horn of the spinal cord. Intrathecal delivery of ghrelin effectively ameliorated CCI-induced mechanical allodynia and thermal hyperalgesia at 7 and 14 days and reduced the levels of tumor necrosis factor-α. Ghrelin inhibited CCI-induced GSK-3ß activation and ß-catenin overexpression in the spinal dorsal horn. Moreover, intrathecal injection of ghrelin suppressed the activation of GSK-3ß in the spinal dorsal horn of CCI rats, as assessed by immunohistochemical analysis. Our data indicated that ghrelin could markedly alleviate neuropathic pain by inhibiting the expression of ß-catenin, via the suppression of GSK-3ß activation, in the spinal cord of CCI rats.

Adsorption of DNA by using polydopamine modified magnetic nanoparticles based on solid-phase extraction.

A polydopamine magnetic composite (PDA@Fe3O4) was prepared for the extraction of human genomic DNA and characterized by transmission electron microscopy, X-ray diffraction, FT-IR spectrometer, zeta potential and vibrating sample magnetometry. PDA@Fe3O4 based on magnetic solid phase extraction (MSPE) method have highly efficient capture of genomic deoxyribonucleic acid (DNA)and gene fragments ranging from about 100 bp to 200 bp. Compared with commercial beads (Shenggong, China) and spin column nucleic acid extraction kit (Tiangen, China), the PDA coated magnetic nanoparticles display superior genomic DNA extraction capacity (116 mg/g) and yield (90.2%). The isolation protocol used the solutions (composed of PEG and NaCl) with a specific pH for the binding and release of DNA. The procedure can be attributed to the charge switch of amino and hydroxyl groups on surface of the magnetic particle. The extracted DNA with high quality (A260/A280 = 1.82 ±â€¯0.04) can be directly used as template for polymerase chain reaction (PCR) followed by agarose gel electrophoresis. The results showed the new composite to be an ideal adsorbent for separation of DNA which had the advantage of its low cost, high extraction capacity and yield.