Impact of paravertebral block on perioperative neurocognitive disorder: a systematic review and meta-analysis of randomized controlled trials.

Objective: To investigate whether paravertebral block reduces postoperative delirium (POD)/delayed neurocognitive recovery (DNR) in adults after major surgery with general anesthesia. Methods: For this systematic review and meta-analysis, we searched online databases PubMed, EMBASE, CENTRAL, and Web of Science till March 19th, 2023 to examine studies which use paravertebral block (PVB) for perioperative neurocognitive disorder. Primary and secondary outcomes were identified for the incidence of perioperative neurocognitive disorder. We did not restrict the follow-up duration of the included studies. Statistical analysis was performed to calculate mean difference (MD), Odd ratios (OR) and CI between RCTs. The quality of the evidence was assessed with the Cochrane risk of bias tool. The registration number of the study in PROSPERO is CRD42023409502. PROSPERO is an international database of prospectively registered systematic reviews. Registration provides transparency in the review process and it helps counter publication bias. Results: Total 1,225 patients from 9 RCTs were analyzed. The incidence of POD [Odds Ratio (OR) = 0.48, 95% CI 0.32, 0.72; p = 0.0004; I2 = 0%] and DNR [OR = 0.32, 95% CI 0.13, 0.80; p = 0.01; I2 = 0%] were significantly reduced in PVB group. The analysis showed no significant differences in postoperative MMSE scores [MD = 0.50, 95% CI -2.14, 3.15; p = 0.71; I2 = 98%]. Paravertebral block analgesia reduces pain scores and/or opioid use after surgery. Additionally, blood pressure was significantly lower in the PVB group, intraoperatively [MD = -15.50, 95% CI -20.71, -10.28; p < 0.001; I2 = 12%] and postoperatively [MD = -5.34, 95% CI -10.65, -0.03 p = 0.05; I2 = 36%]. Finally, PVB group had significantly shorter hospital stays [MD = -0.86, 95% CI -1.13, -0.59; p < 0.001; I2 = 0%]. Conclusion: Paravertebral block analgesia may prevent perioperative POD/DNR in patients undergoing major surgery. Further research with large sample sizes is required to confirm its effectiveness.

Effect of dexmedetomidine on the Montreal Cognitive Assessment in older patients undergoing pulmonary surgery.

OBJECTIVE: We investigated the effect of dexmedetomidine anesthesia on postoperative cognitive function after pulmonary surgery. METHODS: A blinded, prospective, randomized, placebo-controlled study was performed on 60 patients (age range 65-74 years) undergoing lobectomy by video-assisted thoracoscopic surgery (29 in the dexmedetomidine group; 31 in the placebo group). Dexmedetomidine group patients received dexmedetomidine, and placebo group patients received an equal volume of physiological saline 20 minutes before anesthesia induction. Cognitive function was evaluated using the Montreal Cognitive Assessment 1 day before surgery and on postoperative day (POD)1, POD3, and POD7. The regional cerebral oxygen saturation (rSO2) was monitored continuously by near-infrared spectroscopy before anesthesia. RESULTS: The Montreal Cognitive Assessment score was significantly different between the two groups on POD1 (dexmedetomidine 26.4 ± 0.73 vs. placebo 25.5 ± 0.96) and POD3 (dexmedetomidine 27.1 ± 0.79 vs. placebo 26.6 ± 0.80). Specifically, attention and orientation scores were increased in the dexmedetomidine group on POD1 and POD3. The rSO2 was not significantly different between the dexmedetomidine and placebo groups. CONCLUSION: Dexmedetomidine given before induction of anesthesia could reduce the risk of postoperative cognitive dysfunction and might not decrease rSO2. Hence, dexmedetomidine could be employed in pulmonary surgical procedures, especially for older patients with a high risk of cognitive dysfunction.

The Effects of Programmed Intermittent Paravertebral Bolus Infusion on Postoperative Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized, Controlled Study.

OBJECTIVES: To compare the effects of programmed intermittent bolus infusion (PIBI), continuous thoracic paravertebral infusion (CTPI), and continuous intravenous infusion (CII) on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN: Prospective, randomized, controlled. SETTING: The operating room, post-anesthesia care unit, and patient ward of a university hospital. PARTICIPANTS: Ninety patients with American Society of Anesthesiologists (ASA) physical status Ι to II, aged 35-70 years, and scheduled for VATS. INTERVENTIONS: Postoperative analgesia was randomized to PIBI, CTPI, and CII. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the numeric rating scale (NRS) score at rest and during coughing at 1, 4, 24, and 48 hours after surgery. The secondary outcomes included the actual and effective numbers of patient-controlled analgesia (PCA), ropivacaine use, Ramsay sedation scale score, quality of recovery-15 (QoR-15) score, values of hemodynamic parameters at different periods, intraoperative consumption of anesthetic drugs, and postoperative adverse events. Postoperatively, the NRS score was reduced in the PIBI group compared with the CTPI and CII groups at rest and during coughing (p < 0.05). The number of PCAs was significantly lower in the PIBI group compared with the CTPI and CII groups (p < 0.05). The QoR-15 score noticeably increased in the PIBI group compared with the CTPI and CII groups (p = 0.001 and p = 0.000, respectively). CONCLUSIONS: PIBI outperformed CTPI and CII in inducing analgesia for postoperative pain in patients undergoing VATS.

Tandem utilization of CO2 photoreduction products for the carbonylation of aryl iodides.

Photocatalytic CO2 reduction reaction has been developed as an effective strategy to convert CO2 into reusable chemicals. However, the reduction products of this reaction are often of low utilization value. Herein, we effectively connect photocatalytic CO2 reduction and amino carbonylation reactions in series to reconvert inexpensive photoreduction product CO into value-added and easily isolated fine chemicals. In this tandem transformation system, we synthesize an efficient photocatalyst, NNU-55-Ni, which is transformed into nanosheets (NNU-55-Ni-NS) in situ to improve the photocatalytic CO2-to-CO activity significantly. After that, CO serving as reactant is further reconverted into organic molecules through the coupled carbonylation reactions. Especially in the carbonylation reaction of diethyltoluamide synthesis, CO conversion reaches up to 85%. Meanwhile, this tandem transformation also provides a simple and low-cost method for the 13C isotopically labeled organic molecules. This work represents an important and feasible pathway for the subsequent separation and application of CO2 photoreduction product.

Anthraquinone Covalent Organic Framework Hollow Tubes as Binder Microadditives in Li-S Batteries.

The exploration of new application forms of covalent organic frameworks (COFs) in Li-S batteries that can overcome drawbacks like low conductivity or high loading when typically applied as sulfur host materials (mostly ≈20 to ≈40 wt % loading in cathode) is desirable to maximize their low-density advantage to obtain lightweight, portable, or high-energy-density devices. Here, we establish that COFs could have implications as microadditives of binders (≈1 wt % in cathode), and a series of anthraquinone-COF based hollow tubes have been prepared as model microadditives. The microadditives can strengthen the basic properties of the binder and spontaneously immobilize and catalytically convert lithium polysulfides, as proved by density functional calculations, thus showing almost doubly enhanced reversible capacity compared with that of the bare electrode.

Implanting Numerous Hydrogen-Bonding Networks in a Cu-Porphyrin-Based Nanosheet to Boost CH4 Selectivity in Neutral-Media CO2 Electroreduction.

The exploration of novel systems for the electrochemical CO2 reduction reaction (CO2 RR) for the production of hydrocarbons like CH4 remains a giant challenge. Well-designed electrocatalysts with advantages like proton generation/transferring and intermediate-fixating for efficient CO2 RR are much preferred yet largely unexplored. In this work, a kind of Cu-porphyrin-based large-scale (≈1.5 µm) and ultrathin nanosheet (≈5 nm) has been successfully applied in electrochemical CO2 RR. It exhibits a superior FE CH 4 of 70 % with a high current density (-183.0 mA cm-2 ) at -1.6 V under rarely reported neutral conditions and maintains FE CH 4 >51 % over a wide potential range (-1.5 to -1.7 V) in a flow cell. The high performance can be attributed to the construction of numerous hydrogen-bonding networks through the integration of diaminotriazine with Cu-porphyrin, which is beneficial for proton migration and intermediate stabilization, as supported by DFT calculations. This work paves a new way in exploring hydrogen-bonding-based materials as efficient CO2 RR catalysts.

Research on the cooperative mechanism of government and enterprise for basin ecological compensation based on differential game.

Ecological compensation is an important means of basin pollution control, the existing researches mainly focus on the government level ignoring the important role of enterprises. Therefore, this paper introduces enterprises into the process of ecological compensation. Firstly, suppose the ecological compensation system composed of government and enterprises, the government is in the dominant position. The ecological compensation input of the government and enterprise will produce social reputation, and the ecological compensation of enterprise will also produce advertising effect. Consumer demand will be affected by social reputation and advertising effect. Then, the compensation strategies of the government and enterprise are analyzed by constructing the differential game model. The research shows that under certain conditions, the cost-sharing mechanism can realize the Pareto improvement of the benefits of government, enterprise and the whole system. Under the cooperative mechanism, the benefit of the government, enterprise and the whole system is optimal. Finally, the validity of the conclusion is verified by case analysis, and the sensitivity analysis of the relevant parameters is carried out. The conclusion can provide reference for government to establish sustainable watershed ecological compensation mechanism.

Single Metal Site and Versatile Transfer Channel Merged into Covalent Organic Frameworks Facilitate High-Performance Li-CO2 Batteries.

The sluggish kinetics and unclear mechanism have significantly hindered the development of Li-CO2 batteries. Here, a Li-CO2 battery cathode catalyst based on a porphyrin-based covalent organic framework (TTCOF-Mn) with single metal sites is reported to reveal intrinsic catalytic sites of aprotic CO2 conversion from the molecular level. The battery with TTCOF-Mn exhibits a low overpotential of 1.07 V at 100 mA/g as well as excellent stability at 300 mA/g, which is one of the best Li-CO2 battery cathode catalysts to date. The unique features of TTCOF-Mn including uniform single-Mn(II)-sites, fast Li+ transfer pathways, and high electron transfer efficiency contribute to effective CO2 reduction and Li2CO3 decomposition in the Li-CO2 system. Density functional theory calculations reveal that different metalloporphyrin sites lead to different reaction pathways. The single-Mn(II) sites in TTCOF-Mn can activate CO2 and achieve an efficient four-electron CO2 conversion pathway. It is the first example to reveal the catalytic active sites and clear reaction pathways in aprotic Li-CO2 batteries.

Stepped Channels Integrated Lithium-Sulfur Separator via Photoinduced Multidimensional Fabrication of Metal-Organic Frameworks.

Multidimensional fabrication of metal-organic frameworks (MOFs) into multilevel channel integrated devices are in high demanded for Li-S separators. Such separators have advantages in pore-engineering that might fulfill requirements such as intercepting the diffusing polysulfides and improving the Li+ /electrolyte transfer in Li-S batteries. However, most reported works focus on the roles of MOFs as ionic sieves for polysulfides while offering limited investigation on the tuning of Li+ transfer across the separators. A photoinduced heat-assisted processing strategy is proposed to fabricate MOFs into multidimensional devices (e.g., hollow/Janus fibers, double-or triple-layer membranes). For the first time, a triple-layer separator with stepped-channels has been designed and demonstrated as a powerful separator with outstanding specific capacity (1365.0 mAh g-1 ) and cycling performance (0.03 % fading per cycle from 100th to 700th cycle), which is superior to single/double-layer and commercial separators. The findings may expedite the development of MOF-based membranes and extend the scope of MOFs in energy-storage technologies.

Self-assembly of anthraquinone covalent organic frameworks as 1D superstructures for highly efficient CO2 electroreduction to CH4.

The design of selective and efficient covalent organic frameworks (COFs) based electrocatalysts with tunable morphology for efficient CO2 reduction reaction (CO2RR) to CH4 is highly desirable. Here, two kinds of anthraquinone-based COFs (i.e., AAn-COF and OH-AAn-COF) with tunable 1D superstructures (e.g., nanofibers (NF) and hollow tubes (HT)) have been produced via Schiff-base condensation reaction. Interestingly, a rarely reported nanosheet-based self-template mechanism and a nanosheet-crimping mechanism have been demonstrated for the production of COF-based nanofibers and hollow tubes, respectively. Besides, the obtained COF-based superstructures can be post-modified with transition metals for efficient CO2RR. Specifically, AAn-COF-Cu (NF) and OH-AAn-COF-Cu (HT) exhibit superior faradaic-efficiency with CH4 (FECH4) of 77% (-128.1 mA cm-2, -0.9 V) and 61% (-99.5 mA cm-2, -1.0 V) in a flow-cell, respectively. Noteworthy, the achieved FECH4 of AAn-COF-Cu (NF) (77%) the is highest one among reported crystalline COFs. This work provides a general methodology in exploring morphology-controlled COFs for electrocatalytic CO2RR.

Rapid Production of Metal-Organic Frameworks Based Separators in Industrial-Level Efficiency.

Metal-organic framework (MOF) based mixed matrix membranes (MMMs) have received significant attention in applications such as gas separation, sensing, and energy storage. However, the mass production of MOF-based MMMs with retained porosity remains a longstanding challenge. Herein, an in situ heat-assisted solvent-evaporation method is described to facilely produce MOF-based MMMs. This method can be extended into various MOFs and polymers with minimum reaction time of 5 min. Thus-obtained MMMs with high uniformity, excellent robustness, well-tuned loading, and thickness can be massively produced in industrial-level efficiency (≈4 m in a batch experiment). Furthermore, they can be readily applied as powerful separators for Li-S cell with high specific capacity (1163.7 mAh g-1) and a capacity retention of 500.7 mAh g-1 after 700 cycles at 0.5 C (0.08% fading per cycle). This work may overcome the longstanding challenge of processing MOFs into MMMs and largely facilitate the industrialization process of MOFs.

Chloroplast-like porous bismuth-based core-shell structure for high energy efficiency CO2 electroreduction.

Electrochemical CO2 reduction reaction (CO2RR) to formate is economically viable considering the energy input and market value. Through learning nature, a series of chloroplast-like porous bismuth-based core-shell (CPBC) materials have been designed. In these materials, the porous carbon can enrich and transfer CO2 to the core-shell Bi@Bi2O3 in CO2 reduction process, during which Bi2O3 layer can be transformed into activated metastable layer to efficiently convert CO2 into formate and Bi can provide abundant electrons. Based on this, superior performances for most of important parameters in CO2RR can be achieved and best of them, CPBC-1 presents remarkable Faradaic efficiency (FEformate > 94%) over a wide potential range (-0.65 to -1.0 V) with high catalysis durability (>72 h). Noteworthy, its maximum energy efficiency is as high as 76.7% at -0.7 V, the highest one in reported bismuth-based materials. This work opens novel perspectives in designing nature-inspired CO2RR electrocatalysts.

Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients.

BACKGROUND: The present study aims to evaluate the influence of alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) combined with autoflow on respiratory mechanics, the oxygen index (OI), pulmonary shut [Qs/Qt(%)], and the concentrations of IL-6 and TNF-α in venous blood after surgery in obese patients who experienced thoracic surgery with one-lung ventilation (OLV). METHODS: A total of 36 obese patients with ASAII-III degree, who experienced selective pulmonary lobectomy, were within 36-74 years old, and had a BMI of 30-40 kg/m2, were randomly divided into two groups: control group (C group) and protective ventilation group (P group). In the P group, ARS was given once when OLV began. Then, ventilation at 7 mmHg of PEEP and autoflow were given. The Ppeak before OLV (T1), at 30 minutes after OLV (T2), and at the 5 minutes after two-lung ventilation (TLV) (T3), and the changes of Pplat and Cdyn were recorded. Then, arteriovenous blood was drawn at T1, T2, T3 and T4 (6 hours after the operation), blood-gas indicators, including SPO2, PaCO2 and PaO2, were measured, and the value of Qs/Qt(%) was calculated. Afterwards, venous blood was collected at T1 and T5 (18 hours after surgery), and the concentrations of IL-6 and TNF-α were detected. The clinical pulmonary infection score (CPIS) was determined at the first day and seventh day after the operation. RESULTS: In both groups, Cdyn and OI decreased, while Pplat, Ppeak and Qs/Qt(%) increased (P<0.05) at T2, when compared with those at T1. At T2 and T3, Pplat and Ppeak decreased (P<0.05) in the P group, when compared with the C group. At T2, T3 and T4, OI increased (P<0.05) in the P group, when compared with the C group. At T2, T3 and T4, PaCO2 and Qs/Qt(%) decreased in the P group, when compared with the C group. The concentrations of IL-6 and TNF-α decreased in the P group, when compared with the C group. CONCLUSIONS: The ventilation model of ARS and PEEP combined with autoflow can better reduce airway pressure and the production of injurious inflammatory cytokines in blood in obese patients. Furthermore, it can reduce Qs/Qt during and at 6 hours after thoracotomy, improve OI and maintain the acid-base balance of the internal environment, which may be applied in clinical work. This brings new enlightenment and needs to be clarified through further studies.

Basic fibroblast growth factor shows prognostic impact on survival in operable non-small cell lung cancer patients.

BACKGROUND: The important role of angiogenesis displaying in tumor development and metastasis has been generally realized. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and endostatin (ES) are critical members of angiogenesis modulating the balance between pro-angiogenenic and anti-angiogenenic factors. The aim of this study was to evaluate the circulating level of these factors in serum and explore their prognostic significance in 96 operable non-small cell lung cancer (NSCLC) patients. METHODS: Pre-operational serum VEGF, bFGF, and ES were determined by commercially available enzyme-link immunosorbent assay for 96 NSCLC patients and compared to a cohort of healthy controls (n = 51). Values were correlated with clinicopathological features and overall survival (OS). RESULTS: The pretreatment serum levels of VEGF, bFGF and ES in NSCLC were significantly higher than in the healthy control (P < 0.001, P = 0.009 and P = 0.016, respectively). Univariate survival analysis showed that a high bFGF level correlated with shorter OS and remained an independent factor in multivariate analysis (hazard ratio [HR] = 1.918, 95% confidence interval [CI], 1.061-3.464). In the squamous subtype, a high bFGF indicated a particularly poor prognosis (HR = 2.609, 95% CI, 1.188-5.729). CONCLUSIONS: bFGF is an independent predictor of poor survival in patients with NSCLC. For patients with high serum bFGF, aggressive antitumor treatments should be given after surgery. Approaches targeting the bFGF signaling pathway should be considered as potentially promising therapeutic strategies in NSCLC, especially for the squamous subtype.

[A comparison of double-lumen endotracheal tube with univent blocker and bronchial blocker during thoracic surgical anesthesia].

OBJECTIVE: To compare the effectiveness of lung isolation among double-lumen endotracheal tube, Univent blocker and bronchial blocker during thoracic surgical anesthesia. METHODS: A total of 120 patients undergoing elective thoracic surgery were enrolled. They were intubated with Mallinckrodt DLT (DLT group, n = 40), Univent blocker (UNI group, n = 40) and Coopdech bronchial blocker (BB group, n = 40) after intravenous anesthesia induction. The following parameters were recorded:(1) time to initially position the assigned tube; (2) changes of mean arterial pressure (MAP) and heart rate (HR) at 5 min post-intubation; (3) lung collapse scores; (4) frequency of malpositions; (5) airway press and blood gas change during one lung ventilation (OLV); (6)postoperative sore throat at 24 h postoperation. RESULTS: No statistical difference existed in positioning three types of endotracheal tubes. But MAP and HR were higher at post-intubation in DLT group compared with the other 2 groups. No difference existed among the lung isolation devices in lung collapse scores at 5/10 min after pleural opening. As compared with the UNI and BB groups, Ppeak and Pplat increased while compliance decreased in DLT group during OLV. Statistical differences existed in tube malpositions among three groups (n = 4, DLT; n = 5, UNI; n = 8, BB). The incidence of postoperative sore throat was significantly higher in DLT group (70%) than the other two groups (37.5%, UNI; 22.5%, BB). CONCLUSION: As compared with DLT, Univent and Coopdech bronchial blocker may reduce the airway injury and improve the compliance during OLV. But there is a higher intraoperative incidence of tube malposition.

[Correlation of postoperative serum VEGF levels with platelet counts in non-small cell lung cancer].

BACKGROUND AND OBJECTIVE: It ha been proven that serum vascular endothelial growth factor (VEGF) concentration was elevated significantly after surgery in patients of non-small cell lung cancer (NSCLC). Platelet may be the main resource of serum VEGF. The aim of this study is to investigate the correlation between postoperative dynamic changes of serum VEGF levels and platelet counts in patients of NSCLC who underwent surgery. METHODS: Serum VEGF levels were determined in 76 patients of NSCLC who were treated with surgery by ELISA (enzyme linked immunosorbent assay) method before operation and on postoperative day 1, 7. At the same day the concentrations of platelet were determined. RESULTS (1) Serum VEGF in patients of NSCLC on preoperative day, postoperative 1 day and 7 day were (842.06 +/- 527.24) pg/mL, (1 119.28 +/- 609.62) pg/mL, (1 574.09 +/- 873.38) pg/mL, respectively (P < 0.001); (2) Platelet counts in patients of NSCLC on preoperative day, postoperative 1 day and 7 day were (230.42 +/- 82.56 x 10(9)/L, (196.47 +/- 81.48) x 10(9)/L, (237.90 +/- 86.94) x 10(9)/L; the value on postoperative 1 day was the lowest (P < 0.001); (3) On postoperative 7 day, serum VEGF in the group of lower than the mean and higher than the mean were respectively (1 398.81 +/- 734.00) pg/mL and (1 842.86 +/- 1 006.63) pg/mL (P = 0.043). CONCLUSION: Serum VEGF in patients of NSCLC after surgery were elevated. In the group of higher platelet counts, serum VEGF increased more significantly.