Effects of glycopyrrolate and atropine for oral secretions and perioperative hemodynamics in children undergoing tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled trial.

Introduction: Glycopyrrolate is commonly researched as a preoperative medication or in conjunction with cholinesterase inhibitors to counteract the lingering muscarinic effects of non-depolarizing muscarinic agents. However, studies have yielded inconsistent results regarding the superiority of glycopyrrolate over other anti-cholinergic drugs, such as atropine, particularly its effect on heart rate, blood pressure (BP), and glandular secretions. This study aimed to evaluate the differences in perioperative oral secretions, hemodynamics, and recovery quality with glycopyrrolate versus those with atropine before anesthesia induction in children undergoing tonsillectomy and adenoidectomy. Methods: In this prospective, single-center, randomized, double-blind, controlled trial, a total of 103 children were randomly assigned to group A (n = 51, glycopyrrolate 0.005 mg/kg) or B (n = 52, atropine 0.01 mg/kg). The follow-up anesthetic induction and maintenance protocols were the same in both groups. Vital signs, duration of surgery, extubation time, degree of wetness around the vocal cords during tracheal intubation, weight of oral secretions, and perioperative complications were recorded. Results: No significant differences were observed in the degree of wetness around the vocal cords during tracheal intubation, as well as in the weight of oral secretions, duration of surgery, or extubation time, between the two groups. The intraoperative and postoperative heart rates were lower in group A than in group B (110.18 ± 10.58 vs. 114.94 ± 11.14, p = 0.028; 96.96 ± 10.81 vs. 103.38 ± 10.09, p = 0.002). The differences observed in the intraoperative and preoperative heart rates were lower in group A than in group B (23.84 ± 9.62 vs. 29.65 ± 8.75, p = 0.002). The differences observed in the postoperative and preoperative heart rates were lower in group A than in group B (10.63 ± 9.97 vs. 18.09 ± 9.39, p = 0.000). Conclusion: Glycopyrrolate showed a smoother change in heart rate than atropine during and after tonsillectomy and adenoidectomy, with no effect on BP or recovery quality, and did not increase oral secretions. The findings indicate that glycopyrrolate can serve as an alternative to atropine to prevent secretions in anesthesia induction for tonsillectomy and adenoidectomy in children. Trial registration: This study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200063578; Date of Registration: 12/09/2022).

Carnosine ameliorates postoperative cognitive dysfunction of aged rats by limiting astrocytes pyroptosis.

Postoperative cognitive dysfunction (POCD) is a common postoperative complication in elderly patients, and neuroinflammation is a key hallmark. Recent studies suggest that the NOD-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome-mediated astrocytes pyroptosis is involved in the regulation of neuroinflammation in many neurocognitive diseases, while its role in POCD remains obscure. Carnosine is a natural endogenous dipeptide with anti-inflammatory and neuroprotective effects. To explore the effect of carnosine on POCD and its mechanism, we established a POCD model by exploratory laparotomy in 24-month-old male Sprague-Dawley rats. We found that the administrated of carnosine notably attenuated surgery-induced NLRP3 inflammasome activation and pyroptosis in astrocytes, central inflammation, and neuronal damage in the hippocampus of aged rats. In addition, carnosine dramatically ameliorated the learning and memory deficits of surgery-induced aged rats. Then in the in vitro experiments, we stimulated primary astrocytes with lipopolysaccharide (LPS) after carnosine pretreatment. The results also showed that the application of carnosine alleviated the activation of the NLRP3 inflammasome, pyroptosis, and inflammatory response in astrocytes stimulated by LPS. Taken together, these findings suggest that carnosine improves POCD in aged rats via inhibiting NLRP3-mediated astrocytes pyroptosis and neuroinflammation.

The Simulation Analysis and Experimental Study on the Temperature Field of Four Row Rolling Bearings of Rolling Mill under Non-Uniform Load Conditions.

As a key component of the rolling mill, the four-row cylindrical roller bearing (FCRB) operates under complex working conditions of high speed, high temperature, and heavy load. Due to the lack of an effective temperature test scheme for rolling mill bearings, a too high temperature can easily lead to bearing failure or damage under unsteady conditions. To reveal the internal temperature distribution law of four-row roller bearings of rolling mills and solve the common problem of difficult temperature monitoring of rolling mill bearings, in this paper, a four-row cylindrical roller bearing of 1140 mm cold rolling six-high mill is taken as the research object, and the temperature field calculation model for four-row cylindrical roller bearings is established. Firstly, the mechanical analysis model of FCRB is established on the basis of single row bearing by slice method. Secondly, the mechanical calculation model of FCRB is established by the Newton-Raphson method (NRM) and the finite element method (FEM). Thirdly, based on the mechanical calculation model, the finite element method is used to establish the temperature field model of FCRB under uniform load distribution and non-uniform load distribution. Finally, the temperature test experiment is carried out with the FCRB in the rolling mill fault diagnosis test bench. The results show that the error between the FCRB temperature calculation model and the experimental results is less than 10%. It can be seen that the uneven temperature distribution of FCRB is mainly caused by the uneven load distribution. The temperature distribution along the axial direction of the bearing is related to the load distribution of each column, while the circumferential temperature distribution is related to the azimuth angle.

In-situ reactivation and reuse of micronsized sulfidated zero-valent iron using SRB-enriched culture: A sustainable PRB technology.

Sulfidated zero-valent iron (S-ZVI) is an attractive material of permeable reactive barriers (PRBs) for the remediation of contaminated groundwater. However, S-ZVI is prone to be passivated due to the oxidation of reactive and conductive iron sulfide (FeSx) shell and the formation of inactive and non-conductive ferric (hydr)oxides, which serve as electron transfer barriers to hinder the electron flow from Fe° core to contaminants. This study thus proposed a novel approach for in-situ reactivation and reuse of micronsized S-ZVI (S-mZVI) in PRB using sulfate-reducing bacteria (SRB) enriched culture to realize long-lasting remediation of Cr(VI)-contaminated groundwater. S-mZVI were passivated after reactions with Cr(VI) due to the formation of electron transfer barriers (mainly inactive and non-conductive Fe(III) (hyd)oxides, which increased the polarization resistance from 16.38 to 27.38 kΩ cm2 and hindered the electron transfer from the Fe° core. Interestingly, the passivated S-mZVI was efficiently reactivated by providing the SRB-enriched culture and organic carbon within 12 h, and the Cr(VI) removal capacity of S-mZVI in the three use cycles increased to 37.4 mg Cr/g, which was 2.1 times higher than that of the virgin S-mZVI. After biological reactivation, the Rp of reactivated S-mZVI decreased to 12.30 kΩ cm2. SRB-mediated reactivation removed the electron transfer barriers via biotic and abiotic reduction of Fe(III) (hyd)oxides. Especially, the microbial Fe(III) reduction mediated by FmnA-dmkA-fmnB-pplA-ndh2-eetAB-dmkB protein family enhanced the Fe2+ release from the surface and the subsequent re-formation of reactive and conductive FeSx shell. A long-term PRB column test further demonstrated the feasibility of in-situ biological reactivation and reuse of S-mZVI for enhanced Cr(VI)-contaminated groundwater remediation. Within 64 days, the Cr(VI) removal capacity of S-mZVI in the four use cycles increased by 3.2 times, compared to the virgin one. The bio-reactivation using the SRB-enriched culture and sulfate locally-available in groundwater will reduce the chemical and maintenance costs associated with the frequent replacement of reactive ZVI-based materials. The PRB technology based on the bio-renewable S-mZVI can be a sustainable alternative to the conventional PRBs for the long-lasting and low-cost remediation of groundwater contaminated by oxidative pollutants.

Optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique: A prospective randomized controlled study.

BACKGROUND: The dynamic needle tip positioning technique represents an advanced version of the short-axis out-of-plane ultrasound-guided approach employed for radial artery catheterization. The study aimed to explore the most effective insertion site capable of expeditiously and accurately executing the procedure in a clinical setting. METHODS: A prospective randomized controlled study encompassed 246 elective surgery patients necessitating invasive arterial monitoring. Participants were randomly assigned to three distinct groups: Site 1 (targeting the radial styloid process), Site 2 (midway between Sites 1 and 3), and Site 3 (distal one-third of the forearm). The dynamic needle tip positioning technique was implemented across all groups. Crucial parameters, such as first-attempt success rate, time to success, overall success rate, total catheterization time, number of attempts, and complications, were meticulously documented and compared. RESULTS: The Site 2 cohort presented a significantly heightened first-attempt success rate compared to Site 1 (97.5% vs 80%, p = 0.003) and Site 3 (97.5% vs 81.25%, p = 0.006). Moreover, Site 2 displayed a reduced time to success in contrast to Site 1 (31.5 vs 38, p = 0.003) and Site 3 (31.5 vs 40, p = 0.006). Total catheterization time was significantly shorter in Site 2 compared to Site 1 (32 vs 42.5, p < 0.001) and Site 3 (32 vs 43.5, p < 0.001). Site 2 necessitated fewer attempts than Site 1 (p = 0.02) and Site 3 (p = 0.03). Male gender and puncture at Site 2 were associated with expedited time to success. Adverse events manifested more frequently in the Site 3 group compared to the Site 1 group (15% vs 3.75%, p = 0.03) and the Site 2 group (15% vs 2.5%, p = 0.01). CONCLUSIONS: The optimal insertion site for ultrasound-guided radial artery catheterization utilizing the dynamic needle tip positioning technique in adult patients is situated midway between the radial styloid process and the distal one-third of the forearm.

Esketamine Prevents Postoperative Emotional and Cognitive Dysfunction by Suppressing Microglial M1 Polarization and Regulating the BDNF-TrkB Pathway in Ageing Rats with Preoperative Sleep Disturbance.

Postoperative depression (POD) and postoperative cognitive dysfunction (POCD) have placed heavy burden on patients' physical and mental health in recent years. Sleep disturbance before surgery is a common phenomenon that has been increasingly believed to affect patients' recovery, especially in aged patients, while little attention has been paid to sleep disruption before surgery and the potential mechanism remains ambiguous. Ketamine has been reported to attenuate POCD after cardiac surgery and elicit rapid-acting and sustained antidepressant actions. The present study aimed to clarify the effect of esketamine's (the S-enantiomer of ketamine) protective effects and possible mechanisms of action in POCD and POD. Our results showed that sleep disturbance before surgery exacerbated microglial M1 polarization and microglial BDNF-TrkB signalling dysfunction induced by surgery, resulting in postoperative emotional changes and cognitive impairments. Notably, treatment with esketamine reversed the behavioural abnormalities through inhibiting the M1 polarization of microglia and the inflammatory response thus improving BDNF-TrkB signalling in vivo and vitro. In addition, esketamine administration also reversed the impaired hippocampal synaptic plasticity which has been perturbed by sleep disturbance and surgery. These findings warrant further investigations into the interplay of esketamine and may provide novel ideas for the implication of preoperative preparations and the prevention of postoperative brain-related complications.

Long-term stable and efficient degradation of ornidazole with minimized by-product formation by a biological sulfidogenic process based on elemental sulfur.

Conventional biological treatment processes cannot efficiently and completely degrade nitroimidazole antibiotics, due to the formation of highly antibacterial and carcinogenic nitroreduction by-products. This study investigated the removal of a typical nitroimidazole antibiotic (ornidazole) during wastewater treatment by a biological sulfidogenic process based on elemental sulfur (S0-BSP). Efficient and stable ornidazole degradation and organic carbon mineralization were simultaneously achieved by the S0-BSP in a 798-day bench-scale trial. Over 99.8 % of ornidazole (200‒500 µg/L) was removed with the removal rates of up to 0.59 g/(m3·d). Meanwhile, the efficiencies of organic carbon mineralization and sulfide production were hardly impacted by the dosed ornidazole, and their rates were maintained at 0.15 kg C/(m3·d) and 0.49 kg S/(m3·d), respectively. The genera associated with ornidazole degradation were identified (e.g., Sedimentibacter, Trichococcus, and Longilinea), and their abundances increased significantly. Microbial degradation of ornidazole proceeded by several functional genes, such as dehalogenases, cysteine synthase, and dioxygenases, mainly through dechlorination, denitration, N-heterocyclic ring cleavage, and oxidation. More importantly, the nucleophilic substitution of nitro group mediated by in-situ formed reducing sulfur species (e.g., sulfide, polysulfides, and cysteine hydropolysulfides), instead of nitroreduction, enhanced the complete ornidazole degradation and minimized the formation of carcinogenic and antibacterial nitroreduction by-products. The findings suggest that S0-BSP can be a promising approach to treat wastewater containing multiple contaminants, such as emerging organic pollutants, organic carbon, nitrate, and heavy metals.

Recycling of waste aluminum scraps to fabricate sulfidated zero-valent iron-aluminum particles for enhanced chromate removal.

Massive waste aluminum scraps produced from the spent aluminum products have high electron capacity and can be recycled as an attractive alternative to materials based on zero-valent iron (Fe0) for the removal of oxidative contaminants from wastewater. This study thus proposed an approach to fabricate micron-sized sulfidated zero-valent iron-aluminum particles (S-Al0@Fe0) with high reactivity, electron selectivity and capacity using recycled waste aluminum scraps. S-Al0@Fe0 with a three-layer structure contained zero-valent aluminum (Al0) core, Fe0 middle layer and iron sulfide (FeS) shell. The rates of chromate (Cr(VI)) removal by S-Al0@Fe0 at pH 5.0‒9.0 were 1.6‒5.9 times greater than that by sulfidated zero-valent iron (S-Fe0). The Cr(VI) removal capacity of S-Al0@Fe0 was 8.2-, 11.3- and 46.9-fold greater than those of S-Fe0, zero-valent iron-aluminum (Al0-Fe0) and Fe0, respectively. The chemical cost of S-Al0@Fe0 for the equivalent Cr(VI) removal was 78.5% lower than that of S-Fe0. Negligible release of soluble aluminum during the Cr(VI) removal was observed. The significant enhancement in the reactivity and capacity of S-Al0@Fe0 was partially ascribed to the higher reactivity and electron density of the Al0 core than Fe0. More importantly, S-Al0@Fe0 served as an electric cell to harness the persistent and selective electron transfer from the Al0-Fe0 core to Cr(VI) at the surface via coupling Fe0-Fe2+-Fe3+ redox cycles, resulting in a higher electron utilization efficiency. Therefore, S-Al0@Fe0 fabricated using recycled waste aluminum scraps can be a cost-effective and environmentally-friendly alternative to S-Fe0 for the enhanced removal of oxidative contaminants in industrial wastewater.

A comparative study of esketamine-dexmedetomidine and sufentanil-dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA): a randomized double-blind clinical trial.

OBJECTIVE: To observe and evaluate the effectiveness and safety of Esketamine or Sufentanil combined with Dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA) to provide a clinical basis for the optimization of sedation and analgesia in lung tumor PRFA protocols outside the operating room. METHODS: In this trial, 44 patients aged 37 to 84 undergoing lung tumor PRFA were enrolled and assigned to Group E (n = 22, Esketamine 0.2 mg/kg) or Group S (n = 22,Sufentanil 0.1 µg/kg ). Dexmedetomidine was infused intravenously as a sedative in both groups. The modified observer's assessment of alertness and sedation scale (MOAAS), physical movement pain scale, intraoperative vital signs, anesthesia recovery time, radiologist and patient satisfaction rates, incidence of respiratory depression, and incidence of postoperative nausea and vomiting were recorded. RESULTS: Although there was no significant difference in the physical movement pain scale, blood oxygen saturation or incidence of perioperative adverse events between the two groups during ablation, the MOAAS, mean arterial pressure (MAP) and heart rate (HR) were higher in Group E than in Group S. The anesthesia recovery time was shorter in Group E than in Group S, and radiologist satisfaction was better in Group E than in Group S, but there was no significant difference between the two groups in terms of patient satisfaction. CONCLUSION: Esketamine or Sufentanil combined with Dexmedetomidine is safe for lung tumor PRFA. However, in elderly patients with multiple underlying diseases, low-dose Esketamine combined with Dexmedetomidine has fewer hemodynamic effects on patients, milder respiratory depression, shorter recovery time, and better radiologist satisfaction because of its better controllability of sedation depth. TRIAL REGISTRATION: Chinese Clinical Trial Registry (Registration number#ChiCTR ChiCTR21000500 21); Date of Registration: 16/08/2021.

Quality-Related Process Monitoring and Diagnosis of Hot-Rolled Strip Based on Weighted Statistical Feature KPLS.

Rolling is the main process in steel production. There are some problems in the rolling process, such as insufficient ability of abnormal detection and evaluation, low accuracy of process monitoring, and fault diagnosis. To improve the accuracy of quality-related fault diagnosis, this paper proposes a quality-related process monitoring and diagnosis method for hot-rolled strip based on weighted statistical feature KPLS. Firstly, the process-monitoring and diagnosis model of strip thickness and quality based on the KPLS method is introduced. Then, considering that the KPLS diagnosis method ignores the contribution of process variables to quality, it is easy to misjudge the root cause of quality in the diagnosis process. Based on the rolling mechanism model, the influence weight of strip thickness is constructed. By weighing the statistical data features, a quality diagnosis framework of series structure data fusion is constructed. Finally, the method is applied to the 1580 mm hot-rolling process for industrial verification. The verification results show that the proposed method has higher diagnostic accuracy than PLS, KPLS, and other methods. The results show that the diagnostic model based on weighted statistical feature KPLS has a diagnostic accuracy of more than 96% for strip thickness and quality-related faults.

Virgin coconut oil attenuates lipopolysaccharide-induced depression-like behaviors: Integrating network pharmacology analysis and molecular mechanism evaluation.

Depression is a mental disease that seriously affects the quality of life. Its pathophysiology is complex and includes neuroinflammation and apoptosis. Virgin coconut oil (VCO) is a natural food that has been found to have remarkable anti-inflammatory and antiapoptotic properties. We assessed the effects of VCO on depression and the related mechanisms by performing network pharmacology analysis and evaluating depressive-like behaviors in rat model and found that VCO-treatment alleviated the depressive-like behaviors, inhibited microglial and astrocytic activation and reduced neuronal loss in the hippocampus, possibly by decreasing neuronal apoptosis. In addition, network pharmacology analysis and western blotting showed that VCO might exert neuroprotective effects by activating Protein Kinase B (AKT)-related pathway. Taken together, our results revealed the previously unrecognized effects of VCO on depression, and further explored the underlying mechanism of depression.

Hydrogen sulfide control in sewer systems: A critical review of recent progress.

In sewer systems where anaerobic conditions are present, sulfate-reducing bacteria reduce sulfate to hydrogen sulfide (H2S), leading to sewer corrosion and odor emission. Various sulfide/corrosion control strategies have been proposed, demonstrated, and optimized in the past decades. These included (1) chemical addition to sewage to reduce sulfide formation, to remove dissolved sulfide after its formation, or to reduce H2S emission from sewage to sewer air, (2) ventilation to reduce the H2S and humidity levels in sewer air, and (3) amendments of pipe materials/surfaces to retard corrosion. This work aims to comprehensively review both the commonly used sulfide control measures and the emerging technologies, and to shed light on their underlying mechanisms. The optimal use of the above-stated strategies is also analyzed and discussed in depth. The key knowledge gaps and major challenges associated with these control strategies are identified and strategies dealing with these gaps and challenges are recommended. Finally, we emphasize a holistic approach to sulfide control by managing sewer networks as an integral part of an urban water system.

Effect of different head-high lateral extubation on adverse reactions in the peri-extubation period of pediatric OSAS surgery under general anesthesia.

BACKGROUND: Children with OSAS are prone to various airway complications during tracheal extubation after tonsillectomy and adenoidectomy due to oropharyngeal secretions and oozing blood. However, few studies have examined the effect of position on airway complications after tracheal extubation in children with OSAS. The aim of this study was to investigate the appropriate position for extubation in children with OASA. METHODS: A total of 459 children aged 3-14 years with OSAS who underwent tonsillectomy and adenoidectomy were recruited for this study. All children were treated with the same surgical approach and standard anesthesia methods of induction of anesthesia, tracheal intubation and maintenance of anesthesia. At the end of surgery, the children were delivered to the post anesthesia care unit and randomly divided into three groups: Group A: Head-high 0° in lateral position; Group B: Head-high 15° in lateral position; Group C: Head-high 30° in lateral position. The main outcomes of this study were the pulse oxygen saturation (SpO2) and the Sedation-Agitation Scale (SAS) scores of the children after extubation, the outflow of oral-nasal secretions and the respiratory complications. Secondary outcomes were blood pressure, heart rate, end-respiratory carbon dioxide, respiratory rate, and post-operative awakening time of the children in three groups. RESULTS: Data from a total of 423 children were statistically analyzed, 141 in Group A, 142 in Group B, and 140 in Group C. The main results showed a significant decrease in choking response after extubation in Group B (46.5%) and Group C (40.7%) compared to Group A (60.3%) (P < 0.05). The SAS score for postoperative agitation was higher in Group A (4.6 [Formula: see text] 0.9) than in Group B (4.4 [Formula: see text] 0.7) and Group C (4.3 [Formula: see text] 0.6) (P < 0.05). Also the SpO2 after extubation was higher in Group B (97.2%) and Group C (97.1%) than in Group A (95.8%) (P < 0.05). In contrast, there was no difference in the occurrence of respiratory complication and postoperative agitation in children between Group B and Group C (all P > 0.05). In addition, there was no difference in the amount of oral-nasal secretions among the children in the three groups (all P > 0.05). CONCLUSION: The head-high 15° lateral position and head-high 30° lateral position can reduce the incidence of airway complications and agitation and provide safe and comfortable extubation conditions for children during the peri-extubation period after tonsillectomy and adenoidectomy, which has certain clinical guidance value. TRIAL REGISTRATION: Registration Number: NO.ChiCTR2200055835(20,01,2022) https://www.chictr.org.cn.

Experimental and modeling investigations on the unexpected hydrogen sulfide rebound in a sewer receiving nitrate addition: Mechanism and solution.

Biogenic hydrogen sulfide is an odorous, toxic and corrosive gas released from sewage in sewers. To control sulfide generation and emission, nitrate is extensively applied in sewer systems for decades. However, the unexpected sulfide rebound after nitrate addition is being questioned in recent studies. Possible reasons for the sulfide rebounds have been studied, but the mechanism is still unclear, so the countermeasure is not yet proposed. In this study, a lab-scale sewer system was developed for investigating the unexpected sulfide rebounds via the traditional strategy of nitrate addition during 195-days of operation. It was observed that the sulfide pollution was even severe in a sewer receiving nitrate addition. The mechanism for the sulfide rebound can be differentiated into short-term and long-term effects based on the dominant contribution. The accumulation of intermediate elemental sulfur in biofilm resulted in a rapid sulfide rebound via the high-rate sulfur reduction after the depletion of nitrate in a short period. The presence of nitrate in sewer promoted the microorganism proliferation in biofilm, increased the biofilm thickness, re-shaped the microbial community and enhanced biological denitrification and sulfur production, which further weakened the effect of nitrate on sulfide control during the long-term operation. An optimized biofilm-initiated sewer process model demonstrated that neither the intermittent nitrate addition nor the continuous nitrate addition was a sustainable strategy for the sulfide control. To minimize the negative impact from sulfide rebounds, a (bi)monthly routine maintenance (e.g., hydraulic flushing with nitrate spike) to remove the proliferative microorganism in biofilm is necessary.

Patient Preferences for Rescue Medications in the Treatment of Breakthrough Cancer Pain.

OBJECTIVE: The discrete choice experiment (DCE) is conducted in this study to discuss Chinese cancer patients' risk-benefit preferences for rescue medications (RD) and their willingness to pay (WTP) in the treatment of breakthrough cancer pain (BTcP). METHOD: Through literature reviews, specialist consultation, and patient surveys, this work finally included five attributes in the DCE questionnaire, i.e., the remission time of breakthrough pain, adverse reactions of the digestive system, adverse reactions of the neuropsychiatric system, administration routes, and drug costs (estimating patients' WTP). The alternative-specific conditional logit model is used to analyze patients' preferences and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics. RESULTS: A total of 134 effective questionnaires were collected from January, 1 to April, 5 in 2022. Results show that the five attributes all have a significant impact on cancer patients' choice of "rescue medications" (P<0.05). Among these attributes, the remission time after drug administration (10.0; 95%CI 8.5-11.5) is the most important concern for patients, followed by adverse reactions of the digestive system (8.5; 95%CI 7.0-10.0), adverse reactions of the neuropsychiatric system (2.9; 95%CI 1.4-4.3), and administration routes (0.9; 95%CI 0-1.8). The respondents are willing to spend 1182 yuan (95%CI 605-1720 yuan) per month for "rescue medications" to take effect within 15 minutes and spend 1002 yuan (95%CI 605-1760 yuan) per month on reducing the incidence of drug-induced adverse reactions in the digestive system to 5%. CONCLUSION: For Chinese cancer patients, especially those with moderate/severe cancer pain, the priority is to relieve the BTcP more rapidly and reduce adverse drug reactions more effectively. This study indicates these patients' expectations for the quick control of breakthrough pain and their emphasis on the reduction of adverse reactions. These findings are useful for doctors, who are encouraged to communicate with cancer patients about how to better alleviate the BTcP.

Research on Dynamic Characteristics of the RBBH System Based on Dynamics Model and Vibration Data Fusion.

The roll-bearing-bearing housing (RBBH) system is one of the most common kernel structures used to determine strip mill stability and product surface quality in modern metallurgical machinery. To better understand dynamic characteristics of the RBBH system, this paper provides a nonlinear dynamic model and designs an engineering test platform on the RBBH system in the whole rolling process. First, a nonlinear dynamic model of the RBBH system supported by four-row rolling bearings under high speed and heavy load is established. Then, the method of combining Riccati transfer matrix and Newmark-ß numerical integration is employed to solve nonlinear dynamic equations. After that, the engineering test platform is designed and assembled to capture and analyze the vibration signals of weathering steel (SPA-H) with finished thicknesses of 1.6 and 3.2 mm. Finally, the dynamic characteristics of the RBBH system are studied with the method of the dynamic model and vibration data fusion. The results show that the SPA-H with a finished thickness of 1.6 mm is rolled, the RBBH system fluctuates violently in both horizontal and vertical directions, and numerical results are highly consistent with experimental results in acceleration response, velocity response, and displacement response. In addition, the dynamic performance parameters of the four-row rolling bearing will also fluctuate greatly. Finally, there is significant interest to gain the benefits for the RBBH system design and mill stable rolling purposes.

The effect of low-dose esketamine on pain and post-partum depression after cesarean section: A prospective, randomized, double-blind clinical trial.

Objective: To observe and evaluate the effect of a single intravenous injection of low-dose esketamine on post-operative pain and post-partum depression (PPD) in cesarean delivery patients. Methods: A total of 210 patients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were divided into an esketamine group (Group S, n = 105) and a normal saline group (Group L, n = 105) by a random number table. At 5 min after childbirth, patients in the S group were given 0.25 mg/kg esketamine, whereas patients in the L group received an equal volume of saline. The primary outcomes included post-operative pain control according to the Numerical Rating Scale (NRS) and the incidence of PPD according to the Edinburgh Post-partum Depression Scale (EPDS). The secondary outcomes included analgesia-related adverse events and Ramsay sedation scores. Results: This clinical study was a prospective, randomized, double-blind trial. A total of 210 patients were enrolled in this study. The NRS pain (cough pain) score was lower in the S group than in the L group at 24 h after surgery (P = 0.016), and there was no significant difference in resting pain and mobilization pain at 4, 8, and 48 h after surgery or resting pain at 24 h after surgery between the two groups. There was no significant difference in the prevalence of PPD between the two groups on the day before delivery, or at the first week, the second week, or the fourth week after childbirth. At 5 min after dosing, the incidence of hallucinations (P < 0.001) and dizziness (P < 0.001) was higher in the S group than in the L group. At 15 min after dosing, the incidence of dizziness (P < 0.001) and nausea (P = 0.011) was higher in the S group than in the L group. The incidence of dizziness (P < 0.001) was higher in the S group than in the L group when leaving the operating room. The Ramsay scores in Group S were lower than in Group L at 5 min (p < 0.001), 15 min (p < 0.001) after dosing and at the time of leaving the operating room (p < 0.001). Conclusion: In this study, a single intravenous injection of 0.25 mg/kg esketamine did not reduce the incidence of depression at 1, 2, or 4 w post-partum but improved pain during exercise at 24 h post-operatively under the conditions of this clinical trial. Clinical trial registration: [www.chictr.org.cn], identifier [ChiCTR2100054332].

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial.

Background: Deliberate hypotension can reduce bleeding and improve visualization of the surgical field during functional endoscopic sinus surgery (FESS). However, hypotension may cause brain hypoperfusion and subsequent ischemic injuries, such as delayed awakening, stroke, postoperative delirium, and postoperative cognitive dysfunction. Near-infrared spectroscopy (NIRS) can be used to monitor real-time regional cerebral oxygen saturation (rSO2) levels to estimate brain perfusion. The present study aimed to evaluate the change in rSO2 induced by deliberate hypotension during FESS, and assess the impact of deliberate hypotension on the surgical process. Material and Methods: A randomized controlled trial was registered with the Chinese clinical trial registry (ChiCTR2000039846). A total of 40 patients were enrolled and randomly divided into the control and intervention groups, and finally, 39 patients were analyzed. Deliberate hypotension was induced in the intervention group using nicardipine and esmolol, whereas the control group received general anesthesia without deliberate hypotension. We recorded mean arterial pressure (MAP), saturation of pulse oximetry (SpO2), rSO2, and heart rate (HR) before induction of anesthesia (T0), immediately after induction of anesthesia (T1), at the beginning of the operation (corresponding with the establishment of deliberate hypotension) (T2), 10 min (T3) and 20 min (T4) after the operation began, at the end of the operation (corresponding with the end of deliberate hypotension) (T5), and 5 min (T6) and 15 min (T7) after the operation. The partial pressure of end-tidal carbon dioxide (PetCO2) was recorded at T1, T2, T3, T4, T5, and T6. The duration of surgery, intraoperative blood loss, tracheal extubation time, and the number of patients that experienced cerebral desaturation events (CDEs) were recorded. The surgical field was estimated postoperation based on the Fromme score. Results: A 30% decrease from the baseline MAP resulted in a decrease of intraoperative bleeding, improvement in the quality of the surgical field, and the shortening of the duration of surgery during FESS in the intervention group compared with the control group. In addition, rSO2 was reduced and no CDEs were experienced in the intervention group. Linear regression analysis demonstrated a correlation between the decline in rSO2 and that in MAP. Conclusions: A decrease in MAP to a certain level will cause a decrease of rSO2 in patients undergoing FESS under general anesthesia. Based on our findings, we recommend that the deliberate hypotensive target indicated by MAP be reduced by 30%, while PetCO2 is maintained at 35-40 mmHg and HR is maintained at about 60 beats per minute during FESS.

Synergistic adsorption-photocatalytic degradation of different antibiotics in seawater by a porous g-C3N4/calcined-LDH and its application in synthetic mariculture wastewater.

In this work, a modified g-C3N4/MgZnAl-calcined layered double hydroxide composite (M-CN/cLDH) was successfully fabricated via a template method. The composite material is a hierarchical porous flower-like nanostructure self-assembled from stacked hybrid flakes. The 3D M-CN/cLDH architectures exhibit a synergistic effect of adsorption and photocatalysis for eliminating typical tetracycline antibiotics in seawater, i.e., oxytetracycline (OTC), tetracycline (TC), chlortetracycline (CTC), and doxycycline (DXC). The synergistic removal rate of OTC in seawater of M-CN/cLDH is 2.73 times higher than that of g-C3N4 after 120 min of visible-light illumination, and M-CN/cLDH also performs better adsorption-photocatalytic degradation on OTC in the continuous flow reaction process. The superior adsorption capability of the M-CN/cLDH is attributed to the open porous structures of cLDH, and its excellent photocatalytic degradation activity is ascribed to the closely bonded heterojunctions between g-C3N4 (CN) and cLDH double layers. The mass spectra reveals the degradation pathways of OTC, and its byproducts are less toxic after degradation for 120 min. The exploration of the M-CN/cLDH in synthetic mariculture wastewater suggested a huge potential for its practical application. With the assistance of magnesium ammonium phosphate (MAP) precipitation pretreatment, the material can effectively retain the high OTC removal rate in the synthetic mariculture wastewater circumstance.

pH-dependent biological sulfidogenic processes for metal-laden wastewater treatment: Sulfate reduction or sulfur reduction?

Both biological sulfate reduction process and sulfur reduction process are attractive technologies for metal-laden wastewater treatment. However, the acidity stress of metal-laden wastewater could affect the sulfidogenic performance and the microbial community, weaken the stability, efficiency and cost-effectiveness of the biological sulfidogenic processes (BSP). In this study, long-term lab-scale trials were conducted with a sulfate-reducing bioreactor and a sulfur-reducing bioreactor to evaluate the effects of acidity on sulfidogenic activities and the microbial community of the BSP. In the 300-day trial, the sulfate-reducing bacteria (SRB)-driven BSP was stable in terms of sulfidogenic performance and microbial community with the decline of pH, while the sulfur-reducing bacteria (S0RB)-driven BSP achieved high-rate and low-cost sulfide production under neutral conditions but unstable under acidic conditions. With the decline of pH, the sulfide production rate (SPR) of the SRB-driven BSP stably increased from 30 to 83 mg S/L-h; while it decreased from 56 to 37 mg S/L-h in the S0RB-driven BSP with high fluctuation. The results of estimation were consistent with the thermodynamical calculations, in which the sulfur reduction process showed a better performance at pH 5-7, while the sulfate reduction process might gain more energy when pH<5. The stable sulfidogenic performance and microbial community diversity of the SRB-driven BSP could be attributed to the alkalinity produced in sulfate reduction to buffer the acidic stress. In comparison, the microbial community in the S0RB-driven BSP was significantly re-shaped by acidity stress, and the predominant sulfidogenic bacterium changed from Desulfovibrio at neutral condition, to Desulfurella at pH≤5.4. The stability of the microbial community significantly affected the SPR and the operational cost. Nevertheless, the organic consumption for sulfide production of the S0RB-driven BSP was still less than the SRB-driven BSP even in acidic conditions. Collectively, the S0RB-driven BSP was recommended under neutral or mild acid conditions, while the SRB-driven BSP was more suitable under fluctuating pH conditions, especially at low pH. Overall, this study presented the long-term performance of SRB- and S0RB-driven BSP under varying pH conditions, and provided guidance to determine the suitable BSP and operational cost for different metal-laden wastewater.