Effect of esketamine on hypotension in women with preoperative anxiety undergoing elective cesarean section: a randomized, double-blind, controlled trial.

To investigate the effect of low-doses esketamine on spinal anesthesia-induced hypotension in women with preoperative anxiety undergoing elective cesarean section, the randomized controlled trial enrolled 120 women aged 18-35 years who preoperative State-Trait Anxiety Inventory State scores > 40, conducted from September 2022 to August 2023 in Xuzhou Central Hospital, China. Women in the esketamine group received a single intravenous injection of 0.2 mg/kg esketamine after sensory block level achieved. The incidence of hypotension in the esketamine group was significantly lower than the control group at T2 (10% [6 of 60]; P < 0.001), T3 (5.0% [3 of 60]; P = 0.007) and T4(5.0% [3 of 60]; P = 0.004). Despite being higher in the esketamine group, the overall rates of hypertension (11.7% [7 of 60]; P = 0.186), tachycardia (23.3% [14 of 60]; P = 0.246), and bradycardia (0.0% [0 of 60]; P = 0.079) were no significantly difference between the two groups. STAI-S scores was significantly lower in the esketamine group (mean [SD] 37.52[7.14]) than in the control group (mean [SD] 41.03[9.66], P = 0.39) in postoperative day 1. Spinal anesthesia combined with intravenous low-doses esketamine infusion can significantly reduce the incidence of hypotension in women with preoperative anxiety undergoing elective cesarean section.

Optimizing percutaneous vertebroplasty: extra-facet puncture for osteoporotic vertebral compression fractures.

PURPOSE: To assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures. METHODS: Demographics (age, gender, body mass index and underlying diseases) were recorded for analyzing. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores as well as their corresponding minimal clinically important difference (MCID) were used to evaluate clinical outcomes. The segmental kyphotic angle, the vertebral compression ratio and bone cement distribution pattern were evaluated by the plain radiographs. The facet joint violation (FJV) was defined by the postoperative computed tomography scan. Binary logistic regression analysis was performed to investigate relationships between multiple risk factors and residual back pain. RESULTS: VAS and ODI scores in both traditional puncture group and extra-facet puncture group were significantly decreased after PVP surgery (p < 0.05). However, no significant difference was observed between the two groups according to VAS and ODI scores. The proportion of patients achieving MCID of VAS and ODI scores was higher in extra-facet puncture group as compared to traditional puncture group within a month (p < 0.05). Finally, multivariate logistic regression analysis showed that FJV (odds ratio 16.38, p < 0.001) and unilateral bone cement distribution (OR 5.576, p = 0.020) were significant predictors of residual back pain after PVP surgery. CONCLUSIONS: Extra-facet puncture percutaneous vertebroplasty can decrease the risk of FJV and it also has the advantage of more satisfied bone cement distribution.

Mass Customization of Polylactic Acid (PLA) Parts via a Hybrid Manufacturing Process.

Mass customization is the development of items tailored to specific customers, but produced at low unit cost in high-volume. In this context, hybrid manufacturing (HM) combines fused deposition modeling (FDM) and injection molding (IM) to fabricate a single personalized part with minimum manufacturing cost. In this technique, inserts with different physical features are first FDM-fabricated and then IM-overmolded. This study investigated the effect of hybrid FDM-IM production technology, FDM insert geometry on mechanical properties, and micro-structural evolution of Polylactic Acid (PLA) samples. The findings indicated a comparable tensile properties of FDM-IM samples (68.38 MPa) to IM batch (68.95 MPa), emphasizing the potential of HM in the manufacturing industry. Maximum tensile stress of FDM-IM specimens shows an upward trend due to the increased infill density of preforms. In addition, overmolding interface direction results in a big gap for the maximum tensile strengths between half-length series specimens (12.99 MPa to 19.09 MPa) and half-thickness series specimens (53.83 MPa to 59.92 MPa). Furthermore, four joint configurations resulted in different mechanical performances of finished specimens, in which the female cube sample exhibits the highest tensile stress (68.38 MPa), while the batch with male T joint shows a lower value in maximum tensile strength (59.51 MPa), exhibiting a similar tensile performance with the half-thickness 75% batch without joint configuration. This study lays the groundwork for using HM to produce bespoke and mechanically improved parts over FDM alone.

Estimating metal loading into the sea from tidal rivers using total suspended solids and water quality models.

Metals are mainly transported with suspended sediments in tidal rivers, and it is difficult to describe the transformation process of metals. Freely dissolved metals and suspended metals (including acid-soluble, reducible, oxidizable, and residual metals) were separately analyzed according to a sequential extraction scheme. The regression of the observed suspended metals and total suspended solids (TSS) concentrations allowed us to couple the two pollutant types. TSS is a highly dynamic parameter, and a model can be developed to simulate TSS transport. Thus, a method including the following five steps was proposed to estimate the loadings of metals entering the sea using TSS concentrations and water quality models: (1) collecting and observing basic information on the hydrological conditions, pollution sources, and water quality of the studied river; (2) obtaining a regression model between the suspended metals and TSS and analyzing the potential of establishing a suspended metal flux model; (3) introducing a model describing the fluxes of water-soluble metals into the sea; (4) establishing a calculation model to determine the fluxes of suspended metals into the sea; and (5) characterizing the fluxes of metals into the sea. The method was programmed, and metal concentrations and fluxes could be characterized quickly when the basic river data were sufficient. In addition, if regional development scenarios could be set, metal loadings in all scenarios could be predicted through the procedure developed herein, and some effective suggestions on regional sustainable development might be proposed for decision makers. Integr Environ Assess Manag 2022;18:198-208. © 2021 SETAC.

Observations on the particle pollution of the cities in China in the Coronavirus 2019 closure: Characteristics and lessons for environmental management.

Particulate matter in the air seriously affects human health and has been a hot topic of discussion. Because of the coronavirus disease 2019 (COVID-19) lockdown in cities in China, sources of particulate matter, including gasoline-burning vehicles, dust-producing building sites, and coal-fired factories, almost all ceased at the end of January 2020. It was not until early April that outdoor activities recovered. Ten cities were selected as observation sites during the period from 19 December 2019 to 30 April 2020, covering the periods of preclosure, closure, and gradual resumption. A total of 11 720 groups of data were obtained, and 4 indicators were used to assess the characteristics of the particle pollution in the period. The quality of the atmospheric environment was visibly influenced by human activities in those 5 mo. The concentrations of particulate matter with particle sizes below 10 µm (PM10) decreased slightly in February and March and then began to increase slowly after April with the gradual recovery of production. The concentrations of particulate matter with particle sizes below 2.5 µm (PM2.5) decreased greatly in most regions, especially in northern cities, during closure and maintained a relatively stable level in the following 3 mo. The trends of PM10 and PM2.5 indicated that the reduced human activities during the COVID-19 lockdown decreased the concentrations of particulate matter in the air, and the difference between the PM10 and PM2.5 trends might be due to the different sources of the 2 particles and their different aerodynamics. However, during closure, the particulate matter pollution in the cities remained at a high level, which indicated that some ignored factors other than outdoor production activities, automobile exhaust, and construction site dust might have contributed greatly to the PM10 and PM2.5 concentrations, and the tracing of the particulate matter should be given further attention in environmental management. Integr Environ Assess Manag 2021;17:1014-1024. © 2021 SETAC.