Pulmonary thromboembolism associated with hereditary antithrombin III deficiency: A case report.

BACKGROUND: Thrombophilia is a coagulation disorder closely associated with venous thromboembolism. Hereditary antithrombin III (AT III) deficiency is a type of genetic thrombophilia. In China, genetic thrombophilia patients mainly suffer from deficiencies in AT III, protein S, and protein C. Multiple mutations in the serpin family C member 1 (SERPINC1) can affect AT III activity, resulting in thrombosis. CASE PRESENTATION: This case presented a 17-year-old adolescent female who developed lower extremity venous thrombosis and subsequently pulmonary embolism (PE) following a right leg injury. A missense mutation in gene SERPINC1 of c.331 T > C, p.S111P was detected on the patient, resulting in a decreased AT III activity and an elevated risk of thrombosis. The patient received anticoagulation treatment for approximately 5 months. During follow-up, the blood clot gradually dissolved, and there have been no recurrent thrombotic events reported thus far. DISCUSSION: Hereditary AT deficiency can be classified into two types based on the plasma levels of the enzymatic activity and antigen. Type I is a quantitative defect, while Type II is a qualitive defect. Until 2021, 486 SERPINC1 gene mutations have been registered, more than 18% of which are point mutations. The SERPINC1 mutation c.331 T > C in was firstly reported in 2017, which was classified into type I AT III deficiency. CONCLUSION: Hereditary thrombophilia is a coagulation disorder with a high omission diagnostic rate. Minor mutations in the SERPINC1 gene can also lead to hereditary AT III deficiency, which in turn can cause PE. We emphasized the importance of etiological screening for hereditary thrombophilia in venous thromboembolism patients without obvious high-risk factors. Long-term anticoagulation treatment and avoidance of potential thrombosis risk factors are critical for such patients.

Self-assembly of an amino acid derivative as an anode interface layer for advanced alkaline Al-air batteries.

Alkaline Al-air batteries (AABs) are gaining increasing attention for large-scale energy storage systems due to their attractive intrinsic safety and cost-effectiveness. Nonetheless, the future development of AABs is substantially hampered by water-induced self-corrosion processes on the Al anode. In this work, we introduce an amino acid derivative, namely Nα-Boc-N1-formyl-L-tryptophan (NBLT), into a 4 M NaOH electrolyte to construct a unique layer that can effectively regulate the surface microstructure of the Al anode. The findings of the experiments show that NBLT can be used as a reliable corrosion inhibitor. The effectiveness of such inhibitors increases with NBLT concentration, reaching a maximum of 73.9% at 1.5 mM. In comparison to the pristine condition, there is a significant increase in anode utilization from 31.8% to 82.9%, capacity density from 947.9 to 2469.1 mA h g-1, and energy density from 1261.6 to 3384.6 W h kg-1. Theoretical calculations indicate that the carboxyl moieties present in the NBLT molecule establish coordination bonds with the Al atoms, thereby exerting a dominant role in the formation of the self-assembled barrier. The present investigation paves an effective strategy to inhibit reactions between anodes and electrolytes for advanced AABs.

Exacerbation of Pre-Existing Chronic Pain in Older Adults After SARS-CoV-2 Infection: A Single-Center, Cross-Sectional, Observational Study.

Purpose: To identify the prevalence of exacerbation of pre-existing chronic pain after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and investigate the impact of exacerbated previous chronic pain on quality of life, sleep quality, anxiety and depression levels and risk factors associated with exacerbated chronic pain among elderly coronavirus disease of 2019 (COVID-19) survivors. Patients and Methods: In this cross-sectional study, elderly COVID-19 survivors with chronic pain residing in Continuing Care Retirement Community (CCRC) were recruited from April 2023 to June 2023. Eligible individuals were divided into exacerbation and non-exacerbation groups based on the patient-reported worsening symptoms of previous chronic pain after SARS-CoV-2 infection. Baseline information, COVID-19 symptoms, laboratory parameters, characteristics of exacerbated chronic pain, quality of life, anxiety and depression levels were systematically collected. Results: Ninety-five (95/441, 21.5%) older adults suffered from exacerbated chronic pain with a median numerical rating scale (NRS) score of 6 (4-7) on a median duration of 4.9 (4.3-5.6) months after SARS-CoV-2 infection. More participants were not vaccinated against COVID-19 (46.5%, 40/86 vs 26.1%, 86/330, P < 0.001) in exacerbation group. Exacerbation group exhibited poor quality of life (EQ5D index: 0.734 [0.536-0.862] vs 0.837 [0.716-0.942], P < 0.001), more severe anxiety (GAD-7: 2 [0-5] vs 0 [0-3], P < 0.001) and depression (PHQ-9: 4 [2-7] vs 2.5 [0-5], P < 0.001) than non-exacerbation group. Risk factors significantly associated with exacerbation of pre-existing chronic pain were neuropathic pain (aOR 4.81, 95% CI 1.73-13.32, P = 0.003), lymphocyte count (aOR 0.31, 95% CI 0.12-0.78, P = 0.013) and D-dimer levels (aOR 6.46, 95% CI 1.92-21.74, P = 0.003). Conclusion: Our study observed a prevalence of 21.5% exacerbation of pre-existing chronic pain after SARS-CoV-2 infection, with a consequence of poor quality of life, more severe anxiety and depression. Previous chronic neuropathic pain, lower lymphocyte count and higher D-dimer levels were risk factors associated with the development of exacerbated previous chronic pain.

Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study.

Background: Postoperative delirium (POD) is prevalent in craniotomy patients and is associated with high mortality. Sleep disturbances are receiving increasing attention from clinicians as associated risk factors for postoperative complications. This study aimed to determine the impact of preoperative sleep disturbances on POD in craniotomy patients. Methods: We recruited 130 patients undergoing elective craniotomy for intracranial tumors between May 1st and December 30th, 2022. Preoperative subjective sleep disturbances were assessed using the Pittsburgh Sleep Quality Index on the day of admission. We also measured objective perioperative sleep patterns using a dedicated sleep monitoring device 3 days before and 3 days after the surgery. POD was assessed twice daily using the Confusion Assessment Model for the Intensive Care Unit within the first week after craniotomy. Results: Preoperative sleep disturbances were diagnosed in 49% of the study patients, and POD was diagnosed in 22% of all the study patients. Sleep disturbances were an independent risk factor for POD (OR: 2.709, 95% CI: 1.020-7.192, P = 0.045). Other risk factors for POD were age (OR: 3.038, 95% CI: 1.195-7.719, P = 0.020) and the duration of urinary catheterization (OR: 1.246, 95% CI: 1.025-1.513, P = 0.027). Perioperative sleep patterns (including sleep latency, deep sleep duration, frequency of awakenings, apnea-hypopnea index, and sleep efficiency) were significantly associated with POD. Conclusion: This study demonstrated that preoperative sleep disturbances predispose patients undergoing craniotomy to POD, also inferred a correlation between perioperative sleep patterns and POD. The targeted screening and intervention specifically for sleep disturbances during the perioperative period are immensely required.

Investigation of the decomposition mechanism of MTNP melt-cast explosive at different temperatures and pressures through ReaxFF/lg molecular dynamics simulations.

CONTEXT: Thermal decomposition of 1-methyl-3,4,5-trinitropyrazole (MTNP), a melt-cast explosive, was investigated at different temperatures (2500, 2750, 3000, 3250, and 3500 K) and pressures (3000 K/0.5 GPa, 3000 K/1 GPa) using the ReaxFF/lg force field. The study aimed to analyze the changes in reactant quantities, initial reaction pathways, and final product yields. The results demonstrated that complete decomposition of MTNP molecules occurred within a timeframe of 200 ps, with shorter decomposition times observed as the temperature increased. The high-temperature thermal decomposition of MTNP was found to follow two primary reaction pathways. Reaction 1 involved denitration, while reaction 2 proceeded with nitro group isomerization. DFT calculations indicated that nitro group isomerization was the most favorable reaction. During the initial stages, higher quantities of NO2, NO, and N2 were observed compared to other species. This can be attributed to the relatively higher nitrogen and oxygen content in the MTNP structure. Among the five reaction temperatures, it was observed that the quantities of small molecules followed the order of NO2 > NO > N2 > CO. Moreover, with increasing temperature, the quantities of all four small molecules increased, indicating that higher temperatures promoted the progression of the reactions. However, as the pressure increased, there was a trend of initially increasing and then decreasing to zero for the quantities of NO2 and NO. This suggests that high temperature accelerated the high-temperature thermal decomposition of NO2 and NO, leading to a significant increase in the content of N2. METHODS: A 3 × 5 × 5 supercell model of MTNP was constructed in Materials Studio, consisting of 75 unit cells and 300 MTNP molecules. The model was then subjected to a 20 ps geometric optimization using the Polak-Ribiere version of the conjugate gradient (CG) algorithm in the large-scale atomic/molecular massively parallel simulator (LAMMPS) under the isothermal-isobaric (NPT) ensemble at 1 atm pressure and 300 K temperature. Following the optimization, molecular dynamics simulations were performed on the model at five temperatures (2500, 2750, 3000, 3200, and 3500 K) under 1 atm using the NPT ensemble for a total duration of 1 ns. During the simulations, atomic trajectories, as well as information on atomic and molecular species, were output every 500 steps. Subsequently, a custom script was utilized to analyze the thermal decomposition pathways and products. A time step of 0.1 fs was employed for the calculations, and periodic boundary conditions were applied to eliminate boundary effects.

Associations between perioperative sleep patterns and clinical outcomes in patients with intracranial tumors: a correlation study.

Objective: Although the quality of perioperative sleep is gaining increasing attention in clinical recovery, its impact role remains unknown and may deserve further exploration. This study aimed to investigate the associations between perioperative sleep patterns and clinical outcomes among patients with intracranial tumors. Methods: A correlation study was conducted in patients with intracranial tumors. Perioperative sleep patterns were assessed using a dedicated sleep monitor for 6 consecutive days. Clinical outcomes were gained through medical records and follow-up. Spearman's correlation coefficient and multiple linear regression analysis were applied to evaluate the associations between perioperative sleep patterns and clinical outcomes. Results: Of 110 patients, 48 (43.6%) were men, with a median age of 57 years. A total of 618 days of data on perioperative sleep patterns were collected and analyzed. Multiple linear regression models revealed that the preoperative blood glucose was positively related to the preoperative frequency of awakenings (ß = 0.125; 95% CI = 0.029-0.221; P = 0.011). The level of post-operative nausea and vomiting was negatively related to perioperative deep sleep time (ß = -0.015; 95% CI = -0.027--0.003; P = 0.015). The level of anxiety and depression was negatively related to perioperative deep sleep time, respectively (ß = -0.048; 95% CI = -0.089-0.008; P = 0.020, ß = -0.041; 95% CI = -0.076-0.006; P = 0.021). The comprehensive complication index was positively related to the perioperative frequency of awakenings (ß = 3.075; 95% CI = 1.080-5.070; P = 0.003). The post-operative length of stay was negatively related to perioperative deep sleep time (ß = -0.067; 95% CI = -0.113-0.021; P = 0.005). The Pittsburgh Sleep Quality Index was positively related to perioperative sleep onset latency (ß = 0.097; 95% CI = 0.044-0.150; P < 0.001) and negatively related to perioperative deep sleep time (ß = -0.079; 95% CI = -0.122-0.035; P < 0.001). Conclusion: Perioperative sleep patterns are associated with different clinical outcomes. Poor perioperative sleep quality, especially reduced deep sleep time, has a negative impact on clinical outcomes. Clinicians should, therefore, pay more attention to sleep quality and improve it during the perioperative period. Clinical trial registration: http://www.chictr.org.cn, identifier: ChiCTR2200059425.

Acute pulmonary embolism with arrhythmia associated with minimal change disease in adults: a case report.

Background: Minimal change disease (MCD) is a common pathological type of nephrotic syndrome (NS), and is one of the most common causes of NS in children, but is not common in adults. MCD is sensitive to corticosteroid therapy and has a good prognosis, but is prone to relapse. Venous thromboembolism (VTE) is less common in MCD. Case presentation: We report a case of acute pulmonary embolism (PE) with arrhythmia associated with MCD in adults. The hypercoagulable state caused by MCD through multiple systems may be one of the important causes of thrombosis in this patient. In addition to the conventional corticosteroid therapy, he was started on anticoagulation for VTE and PE. His hospital course was complicated by atrial tachyarrhythmias initially controlled by amiodarone but he required readmission due to recurrent atrial flutter. His clinical condition became more stable after radiofrequency ablation. Conclusion: VTE associated with MCD in adults is rare. Treatment of MCD with corticosteroids may be associated with a higher risk of developing blood clots. This type of case is relatively rare and should be paid attention to. The mechanism of VTE in MCD is still a direction worthy of further research.

Acupressure in the treatment of patients with mild infection of COVID-19 omicron variant: A prospectively observational study.

During the coronavirus disease 2019 epidemic, acupressure has been widely used as a complementary treatment for coronavirus disease 2019 in China, but its safety and effectiveness have not been determined until now. This was a prospectively observational study containing 400 cases of mild infection of Omicron who were admitted to Chongming Flower Expo Makeshift Hospital from April 1, 2022 to May 1, 2022. Patients were assigned to receive basic treatment or a combination with acupressure treatment (5 minutes per acupoint, at least twice daily), from admission to discharge. The conversion time of viral RNA assay, the recovery time of symptoms and the clinical cure rate at day 7 were compared in 2 groups. All cases were included in the final analysis. The time to conversion of viral RNA assay (6 vs 7 days, P < .001) and time to symptom recovery (2 vs 4 days, P < .001) were markedly shortened in the acupressure treatment group compared to controls. The time to recovery from individual symptoms of coughing, a sore throat, a fever, fatigue, poor appetite, and insomnia were shorter in the treatment group compared to the control (all P < .05), but there was no statistical difference in reducing the recovery time from headache, muscle ache, anxiety, loss of taste between 2 groups (all P > .05). In addition, acupressure therapy also revealed a higher clinical cure rate at day 7 than basic treatment alone (91% vs 65%, P < .001) and reported no serious adverse events. This study provided evidence for acupressure therapy in treatment of Omicron infection concerning the viral load disappearance and the clinical symptoms improvements. Findings were expected to help guide efforts to position acupressure therapy as a therapeutic option for patients with Omicron variant.

Treatment of Persistent Idiopathic Dentoalveolar Pain with Venlafaxine: A Multicentric Retrospective Study on Its Effectiveness and Safety.

Purpose: To determine the effectiveness and safety of venlafaxine in treating persistent idiopathic dentoalveolar pain (PIDP). Patients and Methods: A retrospective analysis was conducted on a cohort comprising 129 patients with a definite diagnosis of PIDP, who were treated with venlafaxine between May 2020 and December 2022 at three different institutions. Baseline characteristics were statistically described, and visual analog scale (VAS) scores before and during treatment were collected. The percentage of pain relief was calculated. Differences in baseline characteristics between responsive and unresponsive patients were evaluated. Additionally, side effects experienced during treatment were also summarized. Results: Among the included patients, 4 suffered immediate side effects following the initial dose of venlafaxine and the treatment was discontinued. 104 (80.6%) patients achieved pain relief. VAS scores of responsive patients at weeks 2, and months 1, 2, and 3 were significantly lower than baseline (p<0.001). Duration of pain was the only factor related to responsiveness (Wilcoxon rank sum test p<0.001, logistic regression p=0.001). 64 patients (49.6%) suffered from mild side effects. No serious side effects were observed during the study. Conclusion: Venlafaxine is potentially effective and safe in the management of PIDP. Early application of venlafaxine following the diagnoses of PIDP can result in a higher possibility of pain relief.

Causality assessment of circulating Vitamin D level on venous thromboembolism: A Mendelian randomization study.

BACKGROUND AND AIMS: The associations of vitamin D level with venous thromboembolism (VTE) reported in observational studies, whereas these causal associations were uncertain in European population. Therefore, we used Mendelian randomization (MR) method to explore the causal associations between 25-hydroxyvitamin D (25(OH)D) concentrations and the risk of VTE and its subtypes [including deep vein thrombosis (DVT) and pulmonary embolism (PE)]. METHODS AND RESULTS: We used three kinds of genetic instruments to proxy the exposure of 25(OH)D, including genetic variants significantly associated with 25(OH)D, expression quantitative trait loci of 25(OH)D target genes, and genetic variants within or nearby 25(OH)D target genes. MR analyses did not provide any evidence for the associations of 25(OH)D levels with VTE and its subtypes (p > 0.05). The summary-data-based MR (SMR) analyses indicated that elevated expression of VDR was associated with decreased risk of VTE (OR = 0.81; 95% CI, 0.65-0.998; p = 0.047) and PE (OR = 0.67; 95% CI, 0.50-0.91; p = 0.011), and expression of AMDHD1 was associated with PE (OR = 0.93; 95% CI, 0.88-0.99; p = 0.027). MR analysis provided a significant causal effect of 25(OH)D level mediated by gene AMDHD1 on PE risk (OR = 0.09; 95% CI, 0.01-0.60; p = 0.012). CONCLUSION: Our MR analysis did not support causal association of 25(OH)D level with the risk of VTE and its subtypes. In addition, the expression of VDR and AMDHD1 involved in vitamin D metabolism showed a strong association with VTE or PE and might represent targets for these conditions.

Molecular dynamics simulation of CL20/DNDAP cocrystal-based PBXs.

CONTEXT: CL-20/DNDAP cocrystal is a promising new type of explosive with exceptional energy density and detonation parameters. However, compared to TATB, FOX-7 and other insensitive explosives, it still has higher sensitivity. In order to decrease the sensitivity of CL20/DNDAP cocrystal explosive, in this article, a CL20/DNDAP cocrystal model was established, and six different types of polymers, including butadiene rubber (BR), ethylene-vinyl acetate copolymer (EVA), polyethylene glycol (PEG), hydroxyl-terminated polybutadiene (HTPB), fluoropolymer (F2603), and polyvinylidene difluoride (PVDF), were added to the three cleaved surfaces of (1 0 0), (0 1 0) and (0 0 1) to obtain polymer-bonded explosives (PBXs). Predict the effects of different polymers on the stability, trigger bond length, mechanical properties, and detonation performance of PBXs. Among the six PBX models, CL-20/DNDAP/PEG model exhibited the highest binding energy and the lowest trigger bond length, indicating that CL-20/DNDAP/PEG model had the best stability, compatibility, and the least sensitivity. Furthermore, although the CL-20/DNDAP/F2603 model demonstrated superior detonation capabilities, it should be noted that this model displayed low levels of compatibility. Overall, CL-20/DNDAP/PEG model exhibited the superior comprehensive properties, thereby demonstrating that PEG is a more suitable binder option for PBXs based on the CL20/DNDAP cocrystal. METHODS: The properties of CL-20/DNDAP cocrystal-based PBXs were predicted by molecular dynamics (MD) method under Materials Studio software. The MD simulation time step was set at 1fs and the total MD simulation time was 2ns. The Isothermal-isobaric (NPT) ensemble was used for the 2ns of MD simulation. The COMPASS force field was used, and the temperature was set at 295K.

Living electrochemical biosensing: Engineered electroactive bacteria for biosensor development and the emerging trends.

Bioelectrical interfaces made of living electroactive bacteria (EAB) provide a unique opportunity to bridge biotic and abiotic systems, enabling the reprogramming of electrochemical biosensing. To develop these biosensors, principles from synthetic biology and electrode materials are being combined to engineer EAB as dynamic and responsive transducers with emerging, programmable functionalities. This review discusses the bioengineering of EAB to design active sensing parts and electrically connective interfaces on electrodes, which can be applied to construct smart electrochemical biosensors. In detail, by revisiting the electron transfer mechanism of electroactive microorganisms, engineering strategies of EAB cells for biotargets recognition, sensing circuit construction, and electrical signal routing, engineered EAB have demonstrated impressive capabilities in designing active sensing elements and developing electrically conductive interfaces on electrodes. Thus, integration of engineered EAB into electrochemical biosensors presents a promising avenue for advancing bioelectronics research. These hybridized systems equipped with engineered EAB can promote the field of electrochemical biosensing, with applications in environmental monitoring, health monitoring, green manufacturing, and other analytical fields. Finally, this review considers the prospects and challenges of the development of EAB-based electrochemical biosensors, identifying potential future applications.

The Effects of Perioperative Probiotics on Postoperative Gastrointestinal Function in Patients with Brain Tumors: A Randomized, Placebo-Controlled Study.

The incidence of postoperative gastrointestinal dysfunction among neurosurgical patients is as high as 80%. Probiotics help to maintain gastrointestinal barrier defense, provide competitive adherence to mucus and epithelial cells, and regulate gastrointestinal motility. Therefore, the purpose of this study was to investigate whether probiotics enhance gastrointestinal health after craniotomy in patients with brain tumors. This study was a 15-day, prospective, randomized, double-blind, placebo-controlled trial for patients being treated with elective craniotomy for brain tumors. Participants were randomly divided into the probiotics group (4 g probiotics, twice daily) and placebo group. The primary outcome was the time of first stool after surgery. The secondary outcomes included assessments of the gastrointestinal function, changes in gastrointestinal permeability and clinical outcomes. We enrolled a total of 200 participants (probiotics: 100; placebo: 100) and followed the principles of intention-to-treat analysis. The time of first stool and flatus were significantly shorter in the probiotics group compared to the placebo group (P < 0.001, respectively). No significant trends were observed for any other of the secondary outcome variables. Our findings suggest that probiotics can improve the gastrointestinal mobility of patients received craniotomy, and this improvement cannot be explained by changes in gastrointestinal permeability.

Association of NAD+ levels with metabolic disease in a community-based study.

Background: Nicotinamide adenine dinucleotide (NAD+) is a coenzyme and plays a crucial role in several metabolic processes. This study explored the association of nicotinamide adenine dinucleotide (NAD+) levels with metabolic disease (MD) in adults. Methods: In this cross-sectional study, all data were collected from the Jidong community. MD was defined as the presence of one or more of the following disease components: hypertension, dyslipidemia, diabetes, hyperuricemia, obesity, and non-alcoholic fatty liver disease (NAFLD). The MD components were categorized into three groups: those with one component, those with two components, and those with three to six components. The whole blood NAD+ level was measured using a cycling assay and LC-MS/MS analysis. The participants were divided into four groups based on their NAD+ level quartiles. Multivariable logistic regression was used to evaluate the association of the whole blood NAD+ levels with MD. Results: Of the 1,394 eligible participants, the average age was 43.2 years, and 74.3% had MD. In the top quartile of NAD+, the prevalence of MD and each of its components (hypertension, hyperlipidemia, diabetes, hyperuricemia, obesity, and NAFLD) were 87.9% 35.2%, 62.3%, 8.7%, 36.9%, 21.0%, and 60.5%, respectively. As compared with the lowest NAD+ quartile (≤29.4 µmol/L), the adjusted odds ratios and 95% confidence interval of the highest quartile were 3.01 (1.87-4.87) for MD, 2.48 (1.44-4.29) for 1 MD component, 2.74 (1.45-5.17) for 2 MD components, and 4.30 (2.32-7.98) for 3-6 MD components. The risk of MD began to increase at NAD+ levels of 31.0 µmol/L, as revealed by the gradient associations of NAD+ levels with MD. There was no significant interaction between age, sex, drinking, smoking, and NAD+ for MD (p for interaction ≥0.10). Conclusions: Increased NAD+ was significantly associated with MD, as well as its individual components. Our findings provide new evidence for the relationship between blood NAD+ levels and MD.

Case report: Ioversol induced Kounis syndrome and cardiogenic shock.

A 50-year-old male patient was admitted to the Cardiology Department of our hospital for intermittent chest pain for 9 days. Coronary angiography showed approximately 70% stenosis in the middle part of the left anterior descending branch. When the procedure was about to end, the patient experienced dyspnea, facial flushing and fall of blood pressure suddenly. At this time, the angiography showed severe spasm and stenosis of the left coronary artery. With antianaphylaxis, pressor therapy, fluid resuscitation and intracoronary administration of nitroglycerin, the left coronary spasm was relieved. A diagnosis of type II kounis syndrome induced by ioversol with cardiogenic shock was made.

Pre-emptive coinfiltration of dexamethasone palmitate emulsion with ropivacaine for postoperative pain in patients undergoing major spine surgery: a study protocol for a prospective, randomised controlled, multicentre trial.

INTRODUCTION: Patients undergoing major spine surgery usually experience moderate-to-severe postoperative pain. It has been shown that dexamethasone as an adjunct to local anaesthesia (LA) infiltration presented a superior analgesic benefit compared with LA alone in various types of surgeries. However, a recent meta-analysis reported that the overall benefits of dexamethasone infiltration were marginal. Dexamethasone palmitate (DXP) emulsion is a targeted liposteroid. Compared with dexamethasone, DXP has a stronger anti-inflammatory effect, longer duration of action and fewer adverse effects. We hypothesised that the additive analgesic effects of DXP on local incisional infiltration in major spine surgery may have better postoperative analgesic effect, compared with local anaesthetic alone. However, no study has evaluated this so far. The purpose of this trial is to determine whether pre-emptive coinfiltration of DXP emulsion and ropivacaine at surgical site incision will further reduce postoperative opioid requirements and pain scores after spine surgery than that with ropivacaine alone. METHODS AND ANALYSIS: This is a prospective, randomised, open-label, blinded endpoint, multicentre study. 124 patients scheduled for elective laminoplasty or laminectomy with no more than three levels will be randomly allocated in a 1:1 ratio into two groups: the intervention group will receive local incision site infiltration with ropivacaine plus DXP; the control group will receive infiltration with ropivacaine alone. All participants will complete a 3 months follow-up. The primary outcome will be the cumulative sufentanil consumption within 24 hours after surgery. The secondary outcomes will include further analgesia outcome assessments, steroid-related side effects and other complications, within the 3 months follow-up period. ETHICS AND DISSEMINATION: This study protocol has been approved by the Institutional Review Board of Beijing Tiantan Hospital (KY-2019-112-02-3). All participants will provide a written informed consent. The results will be submitted for publication in a peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05693467.

Continuous ammonia electrosynthesis using physically interlocked bipolar membrane at 1000 mA cm-2.

Electrosynthesis of ammonia from nitrate reduction receives extensive attention recently for its relatively mild conditions and clean energy requirements, while most existed electrochemical strategies can only deliver a low yield rate and short duration for the lack of stable ion exchange membranes at high current density. Here, a bipolar membrane nitrate reduction process is proposed to achieve ionic balance, and increasing water dissociation sites is delivered by constructing a three-dimensional physically interlocked interface for the bipolar membrane. This design simultaneously boosts ionic transfer and interfacial stability compared to traditional ones, successfully reducing transmembrane voltage to 1.13 V at up to current density of 1000 mA cm-2. By combining a Co three-dimensional nanoarray cathode designed for large current and low concentration utilizations, a continuous and high yield bipolar membrane reactor for NH3 electrosynthesis realized a stable electrolysis at 1000 mA cm-2 for over 100 h, Faradaic efficiency of 86.2% and maximum yield rate of 68.4 mg h-1 cm-2 with merely 2000 ppm NO3- alkaline electrolyte. These results show promising potential for artificial nitrogen cycling in the near future.

A Fluorinated Covalent Organic Framework with Accelerated Oxygen Transfer Nanochannels for High-Performance Zinc-Air Batteries.

The establishment of abundant three-phase interfaces with accelerated mass transfer in air cathodes is highly desirable for the development of high-rate and long-cycling rechargeable zinc-air batteries (ZABs). Covalent organic frameworks (COFs) exhibit tailored nanopore structures, facilitating the rational tuning of their specific properties. Here, by finely tuning the fluorinated nanopores of a COF, a novel air cathode for rechargeable ZABs is unprecedentedly designed and synthesized. COF nanosheets are decorated with fluorinated alkyl chains, which shows high affinity to oxygen (O2 ), in its nanopores (fluorinated COF). The fluorinated COF nanosheets are stacked into well-defined O2 -transport channels, which are then assembled into aerophilic "nano-islands" on the hydrophilic FeNi layered-double-hydroxide (FeNi LDH) electrocatalyst surface. Therefore, the mass-transport "highway" for O2 and water is segregated on the nanoscale, which significantly enlarges the area of three-phase boundaries and greatly promotes the mass-transfer therein. ZABs based on the COF-modified air cathode deliver a small charge/discharge voltage gap (0.64 V at 5 mA cm-2 ), a peak power density (118 mW cm-2 ), and a stable cyclability. This work provides a feasible approach for the design of the air cathodes for high-performance ZABs, and will expand the new application of COFs.

Efficacy and Safety of Pulsed Radiofrequency in Herpes Zoster Related Trigeminal Neuralgia: A Systematic Review and Meta-Analysis.

Purpose: Pulsed radiofrequency (PRF) is a neuromodulation technique for neuropathic pain. However, the effects of PRF on zoster-related trigeminal neuralgia (TN) remain unclear. The purpose of this meta-analysis is to investigate the efficacy and safety of PRF in the management of zoster-related TN. Patients and Methods: We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials from their inception to August 2022. The primary clinical outcomes included pain intensity and adverse events. Secondary clinical outcomes included pain remission rate, trigeminal postherpetic neuralgia (TPHN) incidence, rescue analgesic dose, sleep quality, and quality of life (QoL). Results: Eight studies with 788 participants were included for final analysis. PRF group exhibited lower pain scores (week 1: MD -2.10, 95% CI -3.28 to -0.93, P=0.0005; week 4: MD -1.56, 95% CI -2.60 to -0.51, P=0.003; week 12: MD -1.52, 95% CI -2.68 to -0.35, P=0.01), lower risk of TPHN incidence (RR 0.22, 95% CI 0.06 to 0.81, P=0.02) and better sleep quality (week 4: MD -2.52, 95% CI -3.28 to -1.77, P<0.01; week 12: MD -2.25, 95% CI -2.90 to -1.60, P<0.01) than control group. Besides, pain remission rate (RR 1.08, 95% CI 0.93 to 1.26, P=0.31) and adverse events (RR 0.95, 95% CI 0.71 to 1.27, P=0.74) were comparable in both groups. Conclusion: PRF is an effective and safe treatment and it yields better effects in pain relief, improvement of sleep quality, and prevention of developing TPHN. Although PRF provides a comparable pain remission rate with the control, it is still a preferred and alternative treatment for relieving zoster-related facial pain.