Intravenous Bolus of Dexmedetomidine for Treatment of Severe Shivering After Caesarean Delivery Under Combined Spinal-Epidural Anaesthesia: A Randomized Dose-Response Study.

Purpose: Shivering occurs frequently after caesarean delivery. The present study aimed to investigate the ED50 and ED95 of an intravenous (i.v.) bolus of dexmedetomidine for treating severe shivering after caesarean delivery under combined spinal-epidural anaesthesia. Patients and methods: Seventy-five parturients with severe shivering after caesarean delivery were randomized into one of the five groups to receive an i.v. bolus of 0.2 (Group D1), 0.25 (Group D2), 0.3 (Group D3), 0.35 (Group D4) or 0.4 (Group D5) µg/kg of dexmedetomidine. Effectiveness of shivering treatment was defined as a standardized shivering score decreasing to ≤1 within 10 min of dexmedetomidine injection. The ED50 and ED95 were determined by probit regression. Adverse effects were also compared among the groups. Results: The ED50 and ED95 of i.v. dexmedetomidine to treat severe shivering were 0.23 (95% CI, 0.16-0.26) µg/kg and 0.39 (95% CI, 0.34-0.52) µg/kg, respectively. No difference in the incidence of adverse effects was found between groups. Conclusion: An i.v. bolus of 0.39 µg/kg of dexmedetomidine will treat 95% of parturients experiencing severe shivering after caesarean delivery.

Effect of Remimazolam Supplementation on Propofol Requirements During Hysteroscopy: A Double-Blind, Dose-Response Study.

BACKGROUND: Propofol is commonly used for procedural sedation but may increase side effects in a dose-dependent manner. Remimazolam, an ultrashort-acting benzodiazepine, has been approved for procedural sedation but may delay awakening. This study tested the hypothesis that remimazolam as a supplement reduces effect-site propofol concentration (Ceprop) required to suppress response to cervical dilation in patients undergoing hysteroscopy. METHODS: One hundred and fifty patients who were scheduled for hysteroscopy were randomized to receive 0, 0.05, 0.1, 0.15, or 0.2 mg·kg-1 intravenous remimazolam, followed by a bolus of sufentanil 0.15 µg⋅kg-1, and a target-controlled propofol infusion. The initial target Ceprop was 3.5 µg·mL-1 and was increased or decreased in subsequent patients by steps of 0.5 µg·mL-1 according to whether there was loss of response to cervical dilation in the previous patient. We used up-down sequential analysis to determine values of Ceprop that suppressed response to cervical dilation in 50% of patients (EC50). RESULTS: The EC50 of propofol for suppressing response to cervical dilation was lower in patients given 0.1 mg·kg-1 (2.08 [95% confidence interval, CI, 1.88-2.28] µg·mL-1), 0.15 mg⋅kg-1 (1.83 [1.56-2.10] µg·mL-1), and 0.2 mg⋅kg-1 (1.43 [1.27-1.58] µg·mL-1) remimazolam than those given 0 mg⋅kg-1 (3.67 [3.49-3.86] µg·mL-1) or 0.05 mg⋅kg-1 (3.47 [3.28-3.67] µg·mL-1) remimazolam (all were P < .005). Remimazolam at doses of 0.1, 0.15, and 0.2 mg·kg-1 decreased EC50 of propofol by 43.3% (95% CI, 41.3%-45.5%), 50.3% (48.0%-52.8%), and 61.2% (58.7%-63.8%), respectively, from baseline (remimazolam 0 mg⋅kg-1). Propofol consumption was lower in patients given 0.1 mg⋅kg-1 (4.15 [3.51-5.44] mg·kg-1), 0.15 mg⋅kg-1 (3.54 [3.16-4.46] mg·kg-1), and 0.2 mg⋅kg-1 (2.74 [1.73-4.01] mg·kg-1) remimazolam than those given 0 mg⋅kg-1 (6.09 [4.99-7.35] mg·kg-1) remimazolam (all were P < .005). Time to anesthesia emergence did not differ significantly among the 5 groups. CONCLUSIONS: For women undergoing hysteroscopic procedures, remimazolam at doses from 0.1 to 0.2 mg·kg-1 reduced the EC50 of propofol inhibiting response to cervical dilation and the total propofol requirement. Whether the combination could improve perioperative outcomes deserves further investigation.

A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia.

BACKGROUND: Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients. METHODS: One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded. RESULTS: The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ±â€Š16 bolus, 129 ±â€Š25 mL) than those in group MN (15 ±â€Š10 bolus, 120 ±â€Š16 mL) (both P < 0.05) and group HN (13 ±â€Š9 bolus, 117 ±â€Š13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05). CONCLUSIONS: Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS. TRIAL REGISTRATION NUMBER: ChiCTR1800015014, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.

Biocompatible polydopamine fluorescent organic nanoparticles: facile preparation and cell imaging.

Biocompatible fluorescent organic nanoparticles with tunable photoluminescence were prepared via the one-pot oxidation of polydopamine and subsequently utilized for cell imaging.

A magnetic self-healing hydrogel.

A straightforward method to prepare a novel magnetic self-healing hydrogel has been successfully developed.

Combining chemoenzymatic monomer transformation with ATRP: a facile "one-pot" approach to functional polymers.

A facile "one-pot" chemoenzymatic-ATRP has been successfully developed through the combination of copper-catalytic ATRP and enzyme-catalytic monomer transformation reactions.

One-Pot Cascade Synthetic Strategy: A Smart Combination of Chemoenzymatic Transesterification and Raft Polymerization.

Enzymatic transesterification was combined with RAFT polymerization to develop a new one-pot synthetic method for new polymer synthesis. This method contained in situ monomer transformation reaction between acyl donor monomer and primary alcohols such as hexanol and so on, followed by subsequent RAFT polymerization to get target polymers. The enzymatic reaction and RAFT polymerization tolerated each other and cooperated well to get new polymers with a completely transformed new monomer, high polymer yields, excellent control over the polymerization process, and good enzyme activity maintenance, providing a general and straightforward methodology for new polymer synthesis and modification.

Synthesis of multiresponsive and dynamic chitosan-based hydrogels for controlled release of bioactive molecules.

An inexpensive, facile, and environmentally benign method has been developed for the preparation of multiresponsive, dynamic, and self-healing chitosan-based hydrogels. A dibenzaldehyde-terminated telechelic poly(ethylene glycol) (PEG) was synthesized and was allowed to form Schiff base linkages between the aldehyde groups and the amino groups in chitosan. Upon mixing the telechelic PEG with chitosan at 20 °C, hydrogels with solid content of 4-8% by mass were generated rapidly in <60 s. Because of the dynamic equilibrium between the Schiff base linkage and the aldehyde and amine reactants, the hydrogels were found to be self-healable and sensitive to many biochemical-stimuli, such as pH, amino acids, and vitamin B6 derivatives. In addition, chitosan could be digested by enzymes such as papain, leading to the decomposition of the hydrogels. Encapsulation and controlled release of small molecules such as rhodamine B and proteins such as lysozyme have been successfully carried out, demonstrating the potential biomedical applications of these chitosan-based dynamic hydrogels.

Mechanical properties of experimental dental composites containing a combination of mesoporous and nonporous spherical silica as fillers.

OBJECTIVES: Mesoporous fillers have been investigated for use in dental composites because of their potential for creating micromechanical filler/resin matrix interphase bonding. Such a micromechanical bonding could eliminate the need for the silane treatment of fillers for interfacial chemical bonding that is prone to hydrolysis in the oral environment. In the case of micromechanical bonding, dental polymer chains are threaded mechanically (like a "necklace") through nanosized channels in the fillers. METHODS: A combination of mesoporous silica, which was synthesized using the non-surfactant templating method, and nonporous spherical silica (500nm) was used to prepare experimental dental composites. The porous silica used in this study contained interconnected pores and channels as opposed to porous fillers containing surface pores. The compressive strength, compressive modulus, flexural modulus, and flexural strength of these composites were evaluated. RESULTS: The results showed that composites containing a combination of mesoporous and nonporous fillers have better mechanical properties than the composites having either of these fillers alone. SIGNIFICANCE: The results showed that a combination of mesoporous and nonporous materials can be used to prepare stronger dental materials that may resist hydrolysis and wear.

In situ encapsulation of horseradish peroxidase in electrospun porous silica fibers for potential biosensor applications.

Nanoporous silica nanofibers have been employed as a matrix to encapsulate horseradish peroxide enzymes via a simple electrospinning method. A viscous solution of prehydrolyzed tetramethyl orthosilicate, beta-d-glucose, poly(vinyl alcohol), and enzymes were employed as spinning solution to generate porous fibers in the form of nonwoven mats. The silica fiber mats thus produced have a high surface area because of the small diameter (100 to 200 nm) of the fibers as well as the extreme porosity (2 to 4 nm) of individual fibers caused by the glucose template present in them. The high surface area, mechanical flexibility, thermal stability, reusability, and freedom of encapsulating various enzymes make porous silica nanofibers excellent biosensors.

Polyaniline, an electroactive polymer, supports adhesion and proliferation of cardiac myoblasts.

Conductive polymers, such as polypyrrole, have recently been studied as potential surfaces/matrices for cell- and tissue-culture applications. We have investigated the adhesion and proliferation properties of H9c2 cardiac myoblasts on a conductive polyaniline substrate. Both the non-conductive emeraldine base (PANi) and its conductive salt (E-PANi) forms of polyaniline were found to be biocompatible, viz., allowing for cell attachment and proliferation and, in the case of E-PANi, maintaining electrical conductivity. By comparison to tissue-culture-treated polystyrene (TCP), the initial adhesion of H9c2 cells to both PANi and E-PANi was slightly reduced by 7% (P < 0.05, n = 18). By contrast, the overall rate of cell proliferation on the conductive surfaces, although initially decreased, was similar to control TCP surfaces. After 6 days in culture on the different surfaces, the cells formed confluent monolayers which were morphologically indistinguishable. Furthermore, we observed that E-PANi, when maintained in an aqueous physiologic environment, retained a significant level of electrical conductivity for at least 100 h, even though this conductivity gradually decreased by about 3 orders of magnitude over time. These results demonstrate the potential for using polyaniline as an electroactive polymer in the culture of excitable cells and open the possibility of using this material as an electroactive scaffold for cardiac and/or neuronal tissue engineering applications that require biocompatibility of conductive polymers.