Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial.

BACKGROUND: Based on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC1 (depth of sedation) and IoC2 (depth of analgesia). The potential for concurrent monitoring of IoC1 and IoC2 to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC1 and IoC2 can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia. METHODS: In this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T1 (before anesthesia induction) and T2 (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T0 (1 day before surgery) and T4 (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T1, T2, and T3 (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation. RESULTS: The incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T2 (CRP: P = 0.000; GFAP: P = 0.000) and T3 (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control. CONCLUSION: The employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019).

A synthetic health risk assessment based on geochemical equilibrium simulation and grid spatial interpolation for zinc (II) species.

Soil heavy metal pollution has become a global issue involving environmental safety and human health risks. This paper quantified the sources of heavy metals by positive matrix factorization (PMF) model and explored the spatial distribution of heavy metals by means of grid scales, with an industrial site as the study area in Suzhou. The PMF identified four pollution sources of heavy metal in soil, and the quantitative results revealed that industrial activities (33.5%) contributed the most to heavy metals, followed by soil parent materials (30.8%) and agricultural activities (19.7%). Zinc (Zn) was screened out as the targeted metal (TM) through the potential ecological risk assessment, the metal species of which was simulated by the geochemical software PHREEQC. This research aimed to determine the dominant metal species of TM with high-risk levels to realize the transformation of toxic metal species. Herein, according to the morphological evolution of metal species, the activity and concentration of the Zn ion species were obtained for both carcinogenic and non-carcinogenic risk assessment. The evaluation of the optimized human health risk demonstrated that the associated health risk of Zn (II) ions depended predominantly on its metal speciation. Overall, the optimized carcinogenic and non-carcinogenic risk value of Zn2S32- for adults was 2.01E-04 and for children was 1.31, resulting in corresponding hazardous risk to humans, which accounted for high-risk levels of 61.5% and 58.5% for adults and children, respectively. The OHRA method can provide a reference for the decision-making of soil heavy metal pollution and remediation for specific heavy metals in polluted areas.

Comparative transcriptome combined with morpho-physiological analyses revealed key factors for differential cadmium accumulation in two contrasting sweet sorghum genotypes.

Cadmium (Cd) is a widespread soil contaminant threatening human health. As an ideal energy plant, sweet sorghum (Sorghum bicolor (L.) Moench) has great potential in phytoremediation of Cd-polluted soils, although the molecular mechanisms are largely unknown. In this study, key factors responsible for differential Cd accumulation between two contrasting sweet sorghum genotypes (high-Cd accumulation one H18, and low-Cd accumulation one L69) were investigated. H18 exhibited a much higher ability of Cd uptake and translocation than L69. Furthermore, Cd uptake through symplasmic pathway and Cd concentrations in xylem sap were both higher in H18 than those in L69. Root anatomy observation found the endodermal apoplasmic barriers were much stronger in L69, which may restrict the Cd loading into xylem. The molecular mechanisms underlying these morpho-physiological traits were further dissected by comparative transcriptome analysis. Many genes involved in cell wall modification and heavy metal transport were found to be Cd-responsive DEGs and/or DEGs between these two genotypes. KEGG pathway analysis found phenylpropanoid biosynthesis pathway was over-represented, indicating this pathway may play important roles in differential Cd accumulation between two genotypes. Based on these results, a schematic representation of main processes involved in differential Cd uptake and translocation in H18 and L69 is proposed, which suggests that higher Cd accumulation in H18 depends on a multilevel coordination of efficient Cd uptake and transport, including efficient root uptake and xylem loading, less root cell wall binding, and weaker endodermal apoplasmic barriers.

Identification for the capability of Cd-tolerance, accumulation and translocation of 96 sorghum genotypes.

Cadmium (Cd) pollution is a worldwide environmental problem which heavily threatens human health and food security. Sorghum, as one of the most promising energy crop, has been considered to be the source of high-quality feedstock for ethanol fuel. Ninety-six sorghum genotypes were investigated under hydroponic conditions to compare their capabilities of Cd-tolerance, accumulation and translocation for their potential in remediation of Cd contamination. Different genotypes varied largely in the tolerance to Cd stress with tolerance indexes ranked from 0.107 to 0.933. Great difference was also found in Cd uptake and accumulation with concentrations ranging from 19.0 to 202.4mg/kg in shoots and 277.0-898.3mg/kg in roots. The total amounts of Cd ranked from 6.1 to 25.8µg per plant and the highest translocation factor was over 4 times higher than the lowest one. The correlation analysis demonstrated that Cd concentration in shoot reflected the ability of Cd translocation and tolerance of sorghum, and the path coefficient analysis indicated that root biomass could be taken as a biomarker to evaluate Cd extraction ability of sorghum. The results in this study can facilitate the restoring of Cd contaminated areas by sorghum.

General Anesthesia for Patients With Chronic Obstructive Pulmonary Disease and Postoperative Respiratory Failure: A Retrospective Analysis of 120 Patients.

Background: Chronic obstructive pulmonary disease (COPD) has been considered a risk factor for postoperative respiratory failure after general anesthesia. However, the association between COPD severity and postoperative respiratory failure among COPD patients is unknown. Our aim was to compare the prevalence of postoperative respiratory failure in COPD patients according to disease severity after general anesthesia. Methods: We retrospectively reviewed COPD patients undergoing spinal surgery with general anesthesia at our clinical center between January 2016 and January 2021. These subjects were divided into four groups (group I = mild COPD, group II = moderate COPD, group III = severe COPD, and group IV = very severe COPD) according to their preoperative lung function. The primary endpoint was a respiratory failure 1 week after surgery. The diagnosis of respiratory failure was made with the presence of one or more of the following criteria: prolonged ventilator dependence, unplanned postoperative intubation, and partial pressure of arterial oxygen (PaO2) ≤ 50 mmHg while the patient was breathing ambient air in the hospital. The extubation time, perioperative PaO2 and partial pressure of arterial carbon dioxide (PaCO2), postoperative lung infection, and length of hospitalization were also compared. Results: A total of 120 patients who underwent spinal surgery with general anesthesia were included in this retrospective study. Postoperative respiratory failure occurred in 0 (0.0%) patient in group I, 1 (1.5%) patient in group II, 1 (2.5%) patient in group III, and 1 (14.5%) patient in group IV 1 week after surgery (p = 0.219). The duration of anesthesia was 243.3 ± 104.3 min in group I, 235.5 ± 78.8 min in group II, 196.0 ± 66.3 min in group III, and 173.1 ± 63.7 min in group IV (p < 0.001). Preoperative PaO2, PaCO2, intraoperative oxygenation index [a ratio of PaO2 to fraction of inspired oxygen (FiO2)], and postoperative PaO2 were significantly different among the four groups (p < 0.001, 0.001, 0.046, <0.001, respectively). No significant differences among the four groups were seen in extubation time, pulmonary infection, or hospital stay (p = 0.174, 0.843, 0.253, respectively). The univariate analysis revealed that higher preoperative PaO2 was associated with a lower rate of postoperative respiratory failure (OR 0.83; 95% CI, 0.72 to 0.95; p = 0.007). Conclusion: The severity of COPD as assessed with GOLD classification was not associated with the development of postoperative respiratory failure. However, lower preoperative PaO2 was associated with greater odds of postoperative respiratory failure in COPD patients.

[Effects of tillage with mulching on potato yield and the characteristics of soil water and temperature in arid area of southern Ningxia]. / 宁南旱区耕作覆盖对马铃薯产量及土壤水热特征的影响.

To clarify the effects of tillage with mulching on potato yield and soil water and heat characteristics, we conducted a field experiment for two consecutive years in arid region of southern Ningxia. The results showed that tillage depths and mulching materials had significant impacts on soil water storage at 0-100 cm layer during the potato sowing period. The interactive effects of tillage depths and mulching materials were not significant. In 2019, the highest soil water storage was obtained in the subsoiling 30 cm with plastic film mulching, while soil water storage under the subsoiling 40 cm with straw mulch was the highest in 2020. Subsoiling 30 cm with plastic film mul-ching and subsoiling 40 cm with straw mulch significantly increased soil water storage by 16.9% and 33.4% compared with the plowing 15 cm with no mulch (CK), respectively. Tillage depths and mulching materials significantly affected soil water storage in the key growth period of potato. Among the tillage systems, the straw mulching plots and plastic film mulching plots had the strongest effect of soil water conservation. Irrespective of the mulching materials, soil water storage was significantly improved in the subsoiling 30-40 cm plots. Mulching materials and the interaction between tillage depths and mulching materials significantly affected soil effective accumulated temperature at 0-25 cm soil layer after sowing to budding. Among the tillage systems, the plastic film mulching plots significantly increased the average soil effective accumulated temperature by 9.3%, whereas the straw mulching plots significantly reduced the temperature by 18.7%, in comparison with no mulching plots. The highest soil effective accumulated temperature during the whole growth period was obtained in the subsoiling 30 cm with plastic film mulching and subsoiling 40 cm with plastic film mulching treatments in 2019 and 2020. The highest potato tuber yield and economic benefit in 2019 were found in the subsoiling 30 cm with straw mulching treatment, respectively, being 84.6% and 107.9% higher than CK. In 2020, the improvement effect of subsoiling 40 cm with straw mulch on potato tuber yield and economic benefit was the strongest, respectively, which were significantly increased by 81.7% and 105.7%, compared with CK. Tillage depths and mulching materials had significant interactive effects on the water and heat use efficiency of crop. The higher water use efficiency was obtained in the subsoiling 30-40 cm with straw mulch treatments, whereas the accumulated temperature use efficiency was increased significantly under different tillage depths with straw mulching treatments compared with CK. Soil water and effective accumulated temperature during the tuber formation stage were the main factors affecting potato total yield, with stronger effect of soil water than that of soil effective accumulated temperature. Therefore, the treatments of subsoiling 30-40 cm with straw mulch could improve soil moisture and heat condition, and realize potato yield and income increase and efficient use of water and heat resources, which have application and popularization value in dryland potato cultivation of southern Ningxia.

Exploring human health risk assessment based on the screening of primary targeted metal and chemical balance simulation of ionic speciation in an industrial area, China.

A comprehensive human health risk assessment methodology based on major hazard element screening and morphological evolution simulation is proposed. The primary targeted metal (PTM) screened by classical health risk assessment was introduced into chemical balance simulation to obtain speciation distribution and corresponding risk. According to the results of risk assessment of morphological evolution of primary targeted metal (PTM), a potential methodology for the remediation is proposed, which could reduce the risk level efficiently and quickly by changing the pH of soil environment with additional acid and alkali substances. A case study was performed in a dye factory in Suzhou city, Jiangsu Province, China. The results of classical health risk assessment showed that the regional health risk index for children exceeded tolerance value of 1, in which Cr accounted for high risk level of 61%. Chemical balance simulation results showed that CrO42- and CaCrO4 had the highest risk index, and the change of pH value would affect the proportion of CrO42- and CaCrO4 in Cr6+ ionic speciation, which may indirectly change the risk level. It is recommended to adjust the pH of the soil environment to quickly reduce regional human health risk. This study will provide a theoretical basis for public health protection and site restoration management.

The Analgesic Effect of Different Concentrations of Epidural Ropivacaine Alone or Combined With Sufentanil in Patients After Cesarean Section.

Background: Patients experience moderate-high intensity postoperative pain after cesarean section (CS). The aim of this study was to investigate the optimal concentrations of ropivacaine and sufentanil for use in controlling pain after CS. Methods: One hundred and seventy-four women undergoing elective CS were randomly allocated to four groups. Epidural analgesia was administered with 0.1% ropivacaine in the R1 group, 0.15% ropivacaine in the R2 group, a combination of 0.1% ropivacaine and 0.5 µg/ml of sufentanil in the R1S group, and a combination of 0.15% ropivacaine and 0.5 µg/ml of sufentanil in the R2S group (at a basal rate of 4 ml/h, bolus dose of 4 ml/20 min as needed). Pain scores (numerical rating scale [NRS]: 0-10 cm) at rest (NRS-R), during movement (NRS-M), and when massaging the uterus (NRS-U) were documented at 6 and 24 h. We also recorded patient satisfaction scores, time to first flatus, motor deficits, and adverse drug reactions. Results: NRS (NRS-R, NRS-M, NRS-U) scores in the R2S group (2 [1-3], 4 [3-5], 6 [5-6], respectively) were lower than in the R1 group (3 [3-4], 5 [4-6], 7 [6-8], respectively) (p < 0.001, p < 0.05, p < 0.01, respectively) at 6 h; and patient satisfaction (9 [8-10]) was improved compared to the R1 group (8 [6-8]) (p < 0.01). The time to first flatus (18.7 ± 11.8 h) was reduced relative to the R1 group (25.9 ± 12.0 h) (p < 0.05). The time to first ambulation was not delayed (p > 0.05). However, the incidence of pruritus (4 [9.3%]) was increased compared to the R2 group (0 [0]) (p < 0.05) at 6 h, and the incidence of numbness (23 [53.5%], 23 [53.5%]) was increased compared to the R1 group (10 [23.3%], 10 [23.3%]) (all p < 0.01) at both 6 and 24 h. Conclusions: Although we observed a higher incidence of pruritus and numbness, co-administration of 0.15% ropivacaine and 0.5 µg/ml of sufentanil administered epidurally optimized pain relief after CS, with treated subjects exhibiting lower NRS scores, shorter time to first flatus, and higher patient-satisfaction scores.

Oxycodone suppresses the lipopolysaccharide-induced neuroinflammation by downregulating nuclear factor-κB in hippocampal astrocytes of Sprague-Dawley rats.

Neuroinflammation is a common pathogenic mechanism in several neurodegenerative diseases, and glial cells are the primary inflammatory mediators of the central nervous system (CNS). Acute neuronal injury, infection, and chronic neurodegeneration may induce astrocyte activation, which is a response characterized by hyperproliferation and release of multiple inflammatory signaling factors. The opioid analgesic oxycodone has demonstrated anti-inflammatory efficacy in peripheral tissue, but its effects on the CNS have not been studied. We evaluated the inhibitory effects of oxycodone on astrocyte activation and proinflammatory mediator production in response to lipopolysaccharide (LPS). Our results showed that oxycodone (5-20 µg/ml) dose-dependently inhibited the LPS-induced astrocytosis, as measured by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide and bromodeoxyuridine assays, as well as the overexpression of glial fibrillary acidic protein, which are two hallmarks of reactive astrogliosis in neurodegenerative diseases. Oxycodone also decreased both the mRNA and protein expression levels of proinflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1ß. Besides, oxycodone increased the expression of the nuclear factor kappa-B (NF-κB) endogenous inhibitor IκB-α, and blocked NF-κB translocation to the nucleus. The anti-inflammatory efficacy of oxycodone on rat astrocytes increased with pretreatment duration. These results suggest that oxycodone can suppress neuroinflammation by inhibiting NF-κB signaling in astrocytes. Targeting the astrocytic NF-κB-mediated inflammatory response may be an effective therapeutic strategy against diseases involving neuroinflammatory damage.

Oxycodone suppresses the apoptosis of hippocampal neurons induced by oxygen-glucose deprivation/recovery through caspase-dependent and caspase-independent pathways via κ- and δ-opioid receptors in rats.

Cerebral ischemia/reperfusion injury (CIRI) can lead to perioperative neurocognitive disorders (PND) during clinical recanalization procedures in cerebral vessels, principally due to neuronal apoptosis in the hippocampus. Oxycodone appears to be a multiple opioid receptor agonist and exerts intrinsic antinociception activity via κ-opioid receptor (KOR). Recent evidence has revealed that activation of both δ-opioid receptor (DOR) and KOR can provide neuroprotection against CIRI in vivo and in vitro. In our study, we established an oxygen-glucose deprivation/recovery (OGD/R) model with fetal hippocampal neurons and found that oxycodone could induce CIRI tolerance in these neurons, primarily through KOR and DOR. Possible mechanisms might involve the regulatory effect of oxycodone on the MAPK-Bcl2/Bax-caspase-9-caspase-3 pathway, as well as its inhibitory effect on cellular reactive oxygen species (ROS) production and mitochondrial membrane potential activation. Taken together, our findings may indicate a potential method for the prevention and treatment of PND associated with CIRI.

Golgi fragmentation induced by overactivated cyclin-dependent kinase 5 is associated with isoflurane-induced neurotoxicity.

Overactivated cyclin-dependent kinase 5 (Cdk5) induces Golgi fragmentation, which interrupts the processing and trafficking of secretory cargo and subsequently synaptic plasticity and synaptogenesis, and even leads to neuronal cell death. Cdk5 overactivation and subsequent Golgi fragmentation are involved in many neurodegenerative diseases. However, whether isoflurane-induced neurotoxicity is relevant to aberrant Cdk5 activation and subsequent Golgi fragmentation remains unknown. In the present study, we explored the underlying molecular mechanisms of isoflurane-induced neurotoxicity in primary cultured hippocampal neurons. After treatment with 2% isoflurane for 6 h, immunofluorescence staining and transmission electron microscopy were used to examine the Golgi structure. Neuronal viability was evaluated using the 3-(4,5-dimethyithiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and TUNEL staining. Cdk5 activity was assessed using histone H1 as a substrate. Our results showed that Cdk5 activity and the number of fragmented Golgi increased significantly after isoflurane exposure. This was accompanied by an increase in neuronal death. Meanwhile, pharmacological inhibition of Cdk5 activity by 8 µM roscovitine alleviated isoflurane-induced Golgi fragmentation and neurotoxicity. Cumulatively, this study shows that aberrant Cdk5 activation-induced Golgi fragmentation is relevant to isoflurane neurotoxicity and indicates that a Cdk5 inhibitor may be a potential therapeutic candidate for the prevention of isoflurane-induced neurotoxicity. Video abstract: http://links.lww.com/WNR/A445.