Revisiting the Asian Buffalo Leech (Hirudinaria manillensis) Genome: Focus on Antithrombotic Genes and Their Corresponding Proteins.

Leeches are well-known annelids due to their obligate blood-feeding habits. Some leech species secrete various biologically active substances which have important medical and pharmaceutical value in antithrombotic treatments. In this study, we provided a high-quality genome of the Asian buffalo leech (Hirudinaria manillensis), based on which we performed a systematic identification of potential antithrombotic genes and their corresponding proteins. Combining automatic and manual prediction, we identified 21 antithrombotic gene families including fourteen coagulation inhibitors, three platelet aggregation inhibitors, three fibrinolysis enhancers, and one tissue penetration enhancer. A total of 72 antithrombotic genes, including two pseudogenes, were identified, including most of their corresponding proteins forming three or more disulfide bonds. Three protein families (LDTI, antistasin, and granulin) had internal tandem repeats containing 6, 10, and 12 conserved cysteines, respectively. We also measured the anticoagulant activities of the five identified hirudins (hirudin_Hman1 ~ hirudin_Hman5). The results showed that three (hirudin_Hman1, hirudin_Hman2, and hirudin_Hman5), but not the remaining two, exhibited anticoagulant activities. Our study provides the most comprehensive collection of antithrombotic biomacromolecules from a leech to date. These results will greatly facilitate the research and application of leech derivatives for medical and pharmaceutical purposes in the treatment of thrombotic diseases.

Enhancing the Output Performance of a Triboelectric Nanogenerator Based on Modified Polyimide and Sandwich-Structured Nanocomposite Film.

Recently, scientists have been facing major obstacles in terms of improving the performances of dielectric materials for triboelectric nanogenerators. The triboelectric nanogenerator (TENG) is one of the first green energy technologies that can convert random mechanical kinetic energy into electricity. The surface charge density of TENGs is a critical factor speeding up their commercialization, so it is important to explore unique methods to increase the surface charge density. The key to obtaining a high-performance TENG is the preparation of dielectric materials with good mechanical properties, thermal stability and output performance. To solve the problem of the low output performance of PI-based triboelectric nanogenerators, we modified PI films by introducing nanomaterials and designed a new type of sandwich-shaped nanocomposite film. Herein, we used polyimide (PI) with ideal mechanical properties, excellent heat resistance and flexibility as the dielectric material, prepared an A-B-A sandwich structure with PI in the outer layer and modified a copper calcium titanate/polyimide (CCTO/PI) storage layer in the middle to improve the output of a TENG electrode. The doping amount of the CCTO was tailored. The results showed that at 8 wt% CCTO content, the electrical output performance was the highest, and the open-circuit voltage of CCTO/PI was 42 V. In the TENG, the open-circuit voltage, short-circuit current and transfer charge of the prepared sandwich-structured film were increased by 607%, 629% and 672% compared to the TENG with the PI thin film, respectively. This study presents a novel strategy of optimizing dielectric materials for triboelectric nano-generators and has great potential for the future development of high output-performance TENGs.

The efficiency of quick response code versus telephone contact for post-discharge follow-up after ophthalmic day surgery: a randomized controlled trial.

PURPOSE: To assess and compare the efficiency of quick response (QR) code versus telephone contact for post-discharge follow-up in patients receiving low-risk ophthalmic day surgery. METHODS: One hundred and sixty patients undergoing strabismus day-care surgery with general anesthesia were randomly allocated to either the intervention group using QR code (QR group) or the control group receiving telephone call (TEL group) for post-discharge follow-up. The primary outcome was the follow-up overall attendance rate on the second postoperative day. Secondary outcomes included attendance rate at the first scheduled follow-up, number of text message reminders, elapsed time and estimated cost for follow-up, omission rate of follow-up responses, and patient satisfaction. RESULTS: The overall attendance rate of follow-up was significantly higher in the QR group than that in the TEL group (97.5% vs. 87.5%, p = 0.016). As compared with the TEL group, the QR group significantly reduced the number of text message reminders with higher attendances at the first scheduled follow-up (p < 0.001, p = 0.001). Besides, the TEL group cost a median time of 258 s and a median cost of RMB 5.8 yuan to complete a follow-up consultant, but was associated with a significantly high omission rate of follow-up responses comparing to the QR group (p = 0.002). Patient satisfaction was comparable between two groups. CONCLUSION: QR code follow-up can be more efficient than traditional telephone contact in assessing the post-discharge recovery after strabismus day surgery, which provides a safe and intuitively alternative follow-up pathway for identifying issues that may necessitate further clinical care for more low-risk ophthalmic day surgeries.

Retrospective analysis of risk factors of postoperative nausea and vomiting in patients undergoing ambulatory strabismus surgery via general anaesthesia.

BACKGROUND AND AIMS: Postoperative nausea and vomiting (PONV), one of the common complications following strabismus surgery, would delay the ambulatory discharge time. The aim of this retrospective study was to determine the risk factors of PONV in patients undergoing ambulatory strabismus surgery under general anaesthesia, with the treatments of dexamethasone and 5-HT3 antagonist combination. METHODS: We reviewed 721 consecutive patients (12-60 years old) undergoing ambulatory strabismus surgery under general anaesthesia at an academic eye centre between December 2016 and January 2019. Patients received prophylactic treatment of dexamethasone and 5-HT3 antagonist combination during anaesthesia induction, and PONV was evaluated during the early recovery period before discharge. RESULTS: The dexamethasone and 5-HT3 antagonist combination effectively reduced the incidence of PONV (3.05%, 22/721), and the patients who experienced PONV had statistically prolonged phase II recovery time as compared those who did not (P = 0.006). The sum of the extraocular muscles manipulated and the use of nalbuphine (vs flurbiprofen axetil) were the independent risk factors for PONV (P < 0.05). CONCLUSION: The sum of the extraocular muscles manipulated and the use of nalbuphine are potentially modifiable risk factors for PONV after strabismus surgery with the treatments of dexamethasone and 5-HT3 antagonist combination.

Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials.

STUDY OBJECTIVE: Procedural sedation for non-painful pediatric examinations outside the operating room remains a challenge, this study was designed to compare the safety and effectiveness of sedation provided by dexmedetomidine versus other sedatives including chloral hydrate, midazolam, and pentobarbital for pediatric patients to complete diagnostic examinations. DESIGN: Systematic review and meta-analysis of RCTs. SETTING: Pediatric procedural sedation. INTERVENTIONS: Comparison of sedation by dexmedetomidine and chloral hydrate, or pentobarbital, or midazolam for pediatric non-painful sedation. PATIENTS: The PubMed, Embase, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched and limited the studies to those published in English through July 30, 2018. MEASUREMENTS: Prospective randomized clinical trials (RCTs) comparing dexmedetomidine to chloral hydrate, pentobarbital, and midazolam for pediatric procedural examinations outside the operating room were included in the meta-analysis. Search terms included dexmedetomidine, precede, adrenergic alpha-2 receptor agonists, adrenergic alpha 2 agonists, adrenergic alpha-agonists, adrenergic alpha 2 receptor agonists, chloral hydrate, pentobarbital, midazolam, AND sedation. MAIN RESULTS: A total of 1486 studies were screened and nine RCTs were identified; 1076 patients were analyzed. Sedation with dexmedetomidine provided statistically higher incidences in completing examinations with fewer episodes of desaturation than the other sedatives did (OR 2.90, 95% CI: 1.39-6.07, P = 0.005, I2 = 77%; OR 0.29, 95% CI: 0.15-0.57, P = 0.0004, I2 = 0%, respectively). CONCLUSIONS: The meta-analysis shows that sedation by dexmedetomidine has lower incidence of respiratory depression and provides higher success rates in completing examinations than other traditional sedatives without compromising safety, indicating a prospective clinical use for procedural sedation.

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study.

AIM: To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects. METHODS: A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves. RESULTS: Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes. CONCLUSION: Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.

Cricoid-mental distance-based versus weight-based criteria for size selection of classic laryngeal mask airway in adults: a randomized controlled study.

The optimal size selection of laryngeal mask airway (LMA) based on body weight is not always applicable. This study was prospectively conducted to evaluate the efficacy of cricoid-mental distance-based method versus weight-based method in optimal size selection of LMA in adults. Seventy-four patients (aged from 18 to 65) undergoing ophthalmic surgery were randomly assigned into cricoid-mental (CM) distance-based group or weight-based group to select appropriate size of LMA. The primary outcome was oropharyngeal leak pressure (OLP). Secondary outcomes included overall insertion success rate, number of insertion attempts, time to successful insertion, ease of insertion, score of fiber-optic view, peak inspiratory pressure during mechanical ventilation and postoperative pharyngolaryngeal morbidity. The OLP was significantly higher in CM distance-based group than that in weight-based group (19.38 ± 3.52 vs. 17.50 ± 3.18, P = 0.022). The successful placement at the first attempt in CM distance-based group was dramatically increased as compared with weight-based group (89.2% vs. 62.2%, P = 0.005). The overall success rate of LMA insertion in CM distance-based group was slightly increased in comparison with the weight-based group (100% vs. 91.9%, P = 0.240). There were no significant differences in score of fiber-optic view and postoperative pharyngolaryngeal morbidity between both groups (all P > 0.05). CM distance-based criteria is an alternative choice for optimizing size selection of classic LMA in adults.

Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examination.

BACKGROUND AND AIM: Pediatric ophthalmic examinations can be conducted under sedation either by chloral hydrate or by dexmedetomidine. The objective was to compare the success rates and quality of ophthalmic examination of children sedated by intranasal dexmedetomidine vs oral chloral hydrate. METHODS: One hundred and forty-one children aged from 3 to 36 months (5-15 kg) scheduled to ophthalmic examinations were randomly sedated by either intranasal dexmedetomidine (2 µg·kg-1 , n = 71) or oral chloral hydrate (80 mg·kg-1 , n = 70). The primary endpoint was successful sedation to complete the examinations including slit-lamp photography, tonometry, anterior segment analysis, and refractive error inspection. The secondary endpoints included quality of eye position, intraocular pressure, onset time, duration of examination, recovery time, discharge time, any side effects during examination, and within 48 h after discharge. RESULTS: Sixty-one children were sedated by dexmedetomidine with a success rate of 85.9%, which is significantly higher than that by chloral hydrate (64.3%) [OR 3.39, 95% CI: 1.48-7.76, P = 0.003]. Furthermore, children in the dexmedetomidine group displayed better eye position in anterior segment analysis than in chloral hydrate group median difference. All children displayed stable hemodynamics and none suffered hypoxemia in both groups. Oral chloral hydrate induced higher percentages of vomiting and altered bowel habit after discharge than dexmedetomidine. CONCLUSIONS: Intranasal dexmedetomidine provides more successful sedation and better quality of ophthalmic examinations than oral chloral hydrate for small children.

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane.

STUDY OBJECTIVES: This study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia. DESIGN: Single-blinded, randomized, placebo-controlled clinical comparison study. SETTING: Academic medical center. PATIENTS: Ninety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery. INTERVENTIONS: Patients were randomized into 3 groups: group D1, group D2, and saline group (group C), in which the children received 1 or 2 µg/kg of intranasal DEX or saline, respectively, and each group comprises 30 patients. MEASUREMENTS: The mask induction score and the incidences of postoperative emergence agitation evaluated by the Pediatric Anesthesia Emergence Delirium scale were assessed. The emergence time, postanesthesia care unit (PACU) stay time, and any adverse events were recorded. MAIN RESULTS: The mask induction scores were significantly higher in the saline group than those in the D1 and D2 groups (P<.001). The incidences of emergence agitation in the D1 and D2 groups were significantly lower than that in the saline group (7/30 in group D1 and 3/30 in group D2 vs 24/30 in group C, P<.001). The emergence time and PACU stay time were comparable among the 3 groups (P>.05). The emergence time and PACU stay time did not differ significantly in DEX-treated groups as compared with the saline group; there were no differences between 1- and 2-µg/kg groups. None of the patients exhibited significant clinical complications. CONCLUSION: Intranasal DEX (1 or 2 µg/kg) dose independently improves the incidences of mask acceptance and prevents the incidences of postoperative emergency agitation mainly from sevoflurane without delaying the emergency time or inducing severe adverse events.

Rescue Sedation With Intranasal Dexmedetomidine for Pediatric Ophthalmic Examination After Chloral Hydrate Failure: A Randomized, Controlled Trial.

PURPOSE: It is a challenge to rescue ophthalmology examinations performed in children in the sedation room after initial chloral hydrate failure. Intranasal dexmedetomidine can be used in rescue sedation in children undergoing computed tomography. The present study aimed to assess the efficacy and tolerability of intranasal dexmedetomidine use in children undergoing ophthalmic examination after chloral hydrate failure. METHODS: Sixty uncooperative pediatric patients with cataract (aged 5-36 months; weight, 7-15 kg) presented for follow-up ophthalmic examination. Patients who experienced chloral hydrate failure were randomized to 1 of 2 groups to receive intranasal dexmedetomidine 1 or 2 µg/kg for rescue sedation. Each group contained 30 patients. The primary outcome was the rate of a successful ophthalmic examination. Secondary outcomes included sedation onset time, recovery time, duration of examination, discharge time, and adverse events, including percentage of heart rate reduction, respiratory depression, vomiting, and postsedative agitation. FINDINGS: A successful ophthalmic examination was achieved in 93.3% (28/30) of patients in the 2-µg/kg dose group and in 66.7% (20/30) of patients in the 1-µg/kg dose group (P = 0.021). The onset time, recovery time, and discharge time did not significantly differ between the 2 groups. None of the patients required clinical intervention due to heart rate reduction, and none of the patients in either group experienced vomiting, respiratory depression, or agitation after the administration of dexmedetomidine. IMPLICATIONS: In children undergoing ophthalmic examination, intranasal dexmedetomidine can be administered in the sedation room for rescue sedation after chloral hydrate failure, with the 2-µg/kg dose being more efficacious than the 1-µg/kg dose, as measured by success rate. ClinicalTrials.gov identifier: NCT02077712.

Intestinal mucosal injury induced by tryptase-activated protease-activated receptor 2 requires ß-arrestin-2 in vitro.

Tryptase exacerbates intestinal ischemia-reperfusion injury, however, the direct role of tryptase in intestinal mucosal injury and the underlying mechanism remains largely unknown. Protease-activated receptor 2 (PAR­2), commonly activated by tryptase, interacts with various adaptor proteins, including ß­arrestin­2. The present study aimed to determine whether tryptase is capable of inducing intestinal mucosal cell injury via PAR­2 activation and to define the role of ß­arrestin­2 in the process of injury. The IEC­6 rat intestinal epithelial cell line was challenged by tryptase stimulation. Cell viability, lactate dehydrogenase (LDH) activity and apoptosis were analyzed to determine the severity of cell injury. Injury was also evaluated following treatments with specific PAR­2 and extracellular signal­related kinases (ERK) inhibitors, and knockdown of ß­arrestin­2. PAR­2, ERK and ß­arrestin­2 protein expression levels were evaluated. Tryptase treatment (100 and 1,000 ng/ml) resulted in IEC­6 cell injury, as demonstrated by significant reductions in cell viability, accompanied by concomitant increases in LDH activity and levels of cleaved caspase­3 protein expression. Furthermore, tryptase treatment led to a marked increase in PAR­2 and phosphorylated­ERK expression, and exposure to specific PAR­2 and ERK inhibitors eliminated the changes induced by tryptase. Knockdown of ß­arrestin­2 blocked tryptase­mediated cell injury, whereas tryptase exerted no influence on ß­arrestin­2 expression in IEC­6 cells. These data indicate that tryptase may directly damage IEC­6 cells via PAR-2 and the downstream activation of ERK, and demonstrate that the signaling pathway requires ß-arrestin-2.

[A simple method for evaluation of the stability of magnetic resonance scanner during brain function imaging].

OBJECTIVE: To develop a simple method for evaluating the stability of magnetic resonance (MR) scanner during brain function imaging. METHOD: A symmetrical water phantom was scanned using the same sequence and parameters as for brain function imaging. The stability of MR scanner was evaluated in view of the signal levels of phantom images. RESULT: The quality control chart of the mean value, standard deviation and the range of the signal level in the region of interest (ROI) within the same region on 128 phantom images were obtained, demonstrating the state of stability of the MR scanner. CONCLUSION: The quality control chart of ROI can be used to evaluate the stability of the MR scanner.