Epidural dexmedetomidine or esketamine versus fentanyl to decrease ropivacaine use for labor analgesia: A randomized non-inferiority study.

Background: Epidural nonopioid adjuvants also reduce local anesthetic use. We aimed to test the hypothesis that, compared with the present standard fentanyl, the hourly consumption of local anesthetic was at least as good when dexmedetomidine or esketamine was combined with local anesthetic for patient-controlled epidural analgesia (PCEA). Methods: A total of 120 laboring nulliparous subjects requiring labor analgesia were recruited for the final statistical analysis. Subjects were randomized to receive 0.075 % ropivacaine added with one of three equivalent adjuvants: 0.4 µg/mL fentanyl, 0.4 µg/mL dexmedetomidine, or 1.0 mg/mL esketamine. The primary outcome was hourly ropivacaine consumption. Compared with the fentanyl group, a 20 % difference in hourly local anesthetic consumption between the dexmedetomidine and esketamine groups was considered a clinical difference (non-inferiority margin). Results: The hourly ropivacaine consumption of the fentanyl group was 12.4 (95 % confidence interval CI 11.2 to 13.6) ml/h, so the prespecified non-inferiority limit was 2.5 ml/h. The hourly ropivacaine consumption of the fentanyl group was not inferior to that of the dexmedetomidine group (12.4 ml/h vs. 11.9 ml/h, risk difference, 0.5; 95 % confidence interval CI, -1.0 to 2.0, meeting criteria for non-inferiority). However, the hourly ropivacaine consumption of the esketamine group was 14.3 ml/h, and that of the fentanyl group was 12.4 ml/h (risk difference, 1.9, 95 % CI, 0.2 to 3.6), failing to confirm non-inferiority with a non-inferiority margin of 20 %. The incidence of pruritus was highest in the fentanyl group, whereas the occurrence of mild dizziness was highest in the esketamine group. Conclusions: In setting of the conditions of this study, epidural dexmedetomidine was non-inferior compared with epidural fentanyl in combination with ropivacaine for PCEA during labor. Meanwhile, we failed to establish the non-inferiority of epidural esketamine compared with epidural fentanyl in combination with ropivacaine for labor analgesia.

Enhancing Water Resistance in Foam Cement through MTES-Based Aerogel Impregnation.

The propensity of foamed concrete to absorb water results in a consequential degradation of its performance attributes. Addressing this issue, the integration of aerogels presents a viable solution; however, their direct incorporation has been observed to compromise mechanical properties, attributable to the effects of the interface transition zone. This study explores the incorporation of MTES-based aerogels into foamed cement via an impregnation technique, examining variations in water-cement ratios. A comprehensive analysis was conducted, evaluating the influences of MTES-based aerogels on the thermal conductivity, compressive strength, density, chemical composition, and microstructure of the resultant composites across different water-cement ratios. Our findings elucidate that an increment in the water-cement ratio engenders a gradual regularization of the pore structure in foamed concrete, culminating in augmented porosity and diminished density. Notably, aerogel-enhanced foamed concrete (AEFC) exhibited a significant reduction in water absorption, quantified at 86% lower than its conventional foamed concrete (FC) counterpart. Furthermore, the softening coefficient of AEFC was observed to surpass 0.75, with peak values reaching approximately 0.9. These results substantiate that the impregnation of MTES-based aerogels into cementitious materials not only circumvents the decline in strength but also bolsters their hydrophobicity and water resistance, indirectly enhancing the serviceability and longevity of foamed concrete. In light of these findings, the impregnation method manifests promising potential for broadening the applications of aerogels in cement-based materials.

Fabrication and Experimental Validation of a Sensitive and Robust Tactile Sensing Array with a Micro-Structured Porous Dielectric Layer.

The development of pressure sensors of high sensitivity and stable robustness over a broad range is indispensable for the future progress of electronic skin applicable to the detection of normal and shear pressures of various dynamic human motions. Herein, we present a flexible capacitive tactile sensing array that incorporates a porous dielectric layer with micro-patterned structures on the surface to enable the sensitive detection of normal and shear pressures. The proposed sensing array showed great pressure-sensing performance in the experiments, with a broad sensing range from several kPa to 150 kPa of normal pressure and 20 kPa of shear pressure. Sensitivities of 0.54%/kPa at 10 kPa and below, 0.45%/kPa between 10 kPa and 80 kPa, and 0.12%/kPa at 80 kPa and above were achieved for normal pressures. Meanwhile, for shear pressures, sensitivities up to 1.14%/kPa and 1.08%/kPa in x and y directions, respectively, and below 10 kPa, 0.73%/kPa, and 0.75%/kPa under shear pressure over 10 kPa were also validated. The performance of the finger-attached sensing array was also demonstrated, demonstrating which was a potential electronic skin to use in all kinds of wearable devices, including prosthetic hands, surgical robots, and other pressure monitoring systems.

Determination of the Dose-Response Relationship of Epidural Dexmedetomidine Combined with Ropivacaine for Labor Analgesia.

Background: The safety and efficacy of dexmedetomidine for epidural labor analgesia have been reported in numerous literatures, but the optimal dose has not been fully determined. The objective of this study was to determine the dose-response relationship of epidural dexmedetomidine (combined with ropivacaine) for labor analgesia. Methods: A total of 120 full-term laboring parturients requesting epidural labor analgesia were enrolled in the study from July 5, 2020 to September 22, 2021. The parturients were randomly assigned to receive 0, 0.1, 0.2, 0.3, 0.4 or 0.5 µg/mL dexmedetomidine combined with 0.075% ropivacaine epidurally. An effective dose was defined as numerical rating scale (NRS) pain score ≤3 at 30-minutes of epidural drug injection. The dose-response relationship of dexmedetomidine (with ropivacaine) for epidural labor analgesia was performed using probit regression. The median effective dose (ED50) and the 95% effective dose (ED95) values for epidural dexmedetomidine combined with 0.075% ropivacaine with 95% confidence intervals (CIs) were derived by interpolation. Results: The estimated values of ED50 and ED95 with 95% CIs for epidural dexmedetomidine (combined with 0.075% ropivacaine) were 0.085 (0.015 to 0.133) µg/mL and 0.357 (0.287 to 0.493) µg/mL, respectively. No differences were found among groups for sensory block level, number of parturients with Bromage score >0, total dosage of analgesics, cesarean delivery rate, fetal birth weight, Apgar score at 1-minute, Apgar score at 5-minutes and adverse effects. Compared with other groups, group dexmedetomidine 0.5 µg/mL had a longer duration of the first stage of labor. Conclusion: The ED50 and ED95 values of dexmedetomidine for epidural labor analgesia was 0.085 and 0.357 µg/mL under the conditions of this study. Dexmedetomidine is a suitable adjuvant for epidural labor analgesia.

Iso-suillin-induced DNA damage leading to cell cycle arrest and apoptosis arised from p53 phosphorylation in A549 cells.

Extensive investigations have revealed that iso-suillin, a secondary metabolite isolated from Suillus flavus, could induce cell cycle arrest and apoptosis in human chronic myeloid leukemia K562 cells, human hepatocellular carcinoma SMMC-7721 cell line, and human small cell lung cancer H446 cell line in vitro. In the present study, human lung cancer A549 cells were used to reveal the mechanism of iso-suillin's effects on lung adenocarcinoma, which were detected both in vitro and in vivo. Results showed that iso-suillin potently inhibited A549 cell proliferation through an early G1 arrest. Iso-suillin also induced A549 cell apoptosis in vitro. Phosphorylation of p53 at serines 15 and 20 may be one of the pivotal factors for cell cycle arrest and apoptosis after treatment of iso-suillin in A549 cells. Moreover, in an A549 xenograft model, tumor growth and progression could be inhibited by iso-suillin. Body weight change and some vital organs toxicity was also roughly examined, no significant toxic effects of iso-suillin were shown (at a dose of 5 mg/kg for each administration). The in vitro and in vivo anti-tumor effects implied that iso-suillin may act as a tumor growth inhibitor, and its induction of p53 phosphorylation is pivotal for cell cycle arrest and apoptosis in A549 cells.

Microstructure Characterization of Reversed Transformation in Cryogenically Rolled 22MnB5.

Hot stamping is a well-known process to produce structural automotive parts with an excellent strength-to-weight ratio. However, this process is more expensive due to the lower energy efficiency and operating cost of the traditional roller-hearth furnace. Additionally, lower ductility and toughness are commonly recognized as the main disadvantages of the current hot stamped ultra-high-strength parts. Refinement of austenite grains could be a profitable way to improve the strength of hot stamped parts. In this work, the evolution of reversed transformation in asymmetrically cryogenically rolled samples was studied in order to control the austenite. Thermomechanical simulation and heat treatment in the salt bath were used to investigate the reversed transformation process, and the typical microstructures were characterized by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Compared with symmetric prerolling, ferrite recrystallization could be remarkably inhibited by asymmetric rolling at the liquid nitrogen temperature (LNT) during the reheating process. Additionally, the nucleation of the austenite inner grains can also be promoted and the dynamics of the reversed transformation accelerated by asymmetric prerolling. Such phenomena might be very useful to refine the parent austenite grains before press hardening and enhance the new hot stamping strategy by partial fast reheating.

Iso-suillin from Suillus flavus Induces Apoptosis in Human Small Cell Lung Cancer H446 Cell Line.

BACKGROUND: The suillin isoform iso-suillin is a natural substance isolated from a petroleum ether extract of the fruiting bodies of the mushroom Suillus flavus. Previous studies have found its inhibition effect on some cancer cells, and we aimed to study its effects on human small cell lung cancer H446 cell line. METHODS: Cell viability was measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay. Cellular morphological changes (apoptosis and necrosis) were evaluated using an electron microscope and Hoechst 33258 staining detected by the inverted microscope. Flow cytometry was used to detect cell apoptosis, cell cycle distribution, and mitochondrial membrane potential. Protein expression was determined by Western blotting analysis. RESULTS: Here, we describe the ability of iso-suillin to inhibit the growth of H446 cells in time- and dose-dependent way. Iso-suillin had no obvious impact on normal human lymphocyte proliferation at low concentrations (9.09, 18.17, or 36.35 µmol/L) but promoted lymphocyte proliferation at a high concentration (72.70 µmol/L). After treatment of different concentrations of iso-suillin (6.82, 13.63, or 20.45 µmol/L), the apoptosis rate of H446 cells increased with increasing concentrations of iso-suillin (16.70%, 35.54%, and 49.20%, respectively, all P < 0.05 compared with the control), and the expression of related apoptotic proteins in the mitochondrial pathway including cytochrome c and caspase-9 were up-regulated compared with the control (all P < 0.05). On the contrary, Bcl-2/Bax ratio was down-regulated compared with the control. Besides, the expression of pro-apoptotic proteins in the death receptor apoptosis pathway, including Fas-associating protein with a novel death domain and caspase-8, and the expression of caspase-3, a downstream regulatory protein of apoptosis, were also increased compared with the control (all P < 0.05). Inhibitors of caspase-9 and caspase-8 reversed the apoptosis process in H446 cells to varying degrees. CONCLUSIONS: These results suggest that iso-suillin could induce H446 cell apoptosis through the mitochondrial pathway and the death-receptor pathway. Therefore, iso-suillin might have a potential application as a novel drug for lung cancer treatment.

Tetramethylpyrazine induces SH-SY5Y cell differentiation toward the neuronal phenotype through activation of the PI3K/Akt/Sp1/TopoIIß pathway.

Tetramethylpyrazine (TMP) is an active compound extracted from the traditional Chinese medicinal herb Chuanxiong. Previously, we have shown that TMP induces human SH-SY5Y neuroblastoma cell differentiation toward the neuronal phenotype by targeting topoisomeraseIIß (TopoIIß), a protein implicated in neural development. In the present study, we aimed to elucidate whether the transcriptional factors specificity protein 1 (Sp1) and nuclear factor Y (NF-Y), in addition to the upstream signaling pathways ERK1/2 and PI3K/Akt, are involved in modulating TopoIIß expression in the neuronal differentiation process. We demonstrated that SH-SY5Y cells treated with TMP (80µM) terminally differentiated into neurons, characterized by increased neuronal markers, tubulin ßIII and microtubule associated protein 2 (MAP2), and increased neurite outgrowth, with no negative effect on cell survival. TMP also increased the expression of TopoIIß, which was accompanied by increased expression of Sp1 in the differentiated neuron-like cells, whereas NF-Y protein levels remained unchanged following the differentiation progression. We also found that the phosphorylation level of Akt, but not ERK1/2, was significantly increased as a result of TMP stimulation. Furthermore, as established by chromatin immunoprecipitation (ChIP) assay, activation of the PI3K/Akt pathway increased Sp1 binding to the promoter of the TopoIIß gene. Blockage of PI3K/Akt was shown to lead to subsequent inhibition of TopoIIß expression and neuronal differentiation. Collectively, the results indicate that the PI3K/Akt/Sp1/TopoIIß signaling pathway is necessary for TMP-induced neuronal differentiation. Our findings offer mechanistic insights into understanding the upstream regulation of TopoIIß in neuronal differentiation, and suggest potential applications of TMP both in neuroscience research and clinical practice to treat relevant diseases of the nervous system.