The effects of prophylactic use of esketamine on postoperative depression and quality of life: a meta-analysis.

INTRODUCTION: The aim of this systemic review and meta-analysis was to assess the impact of prophylactic use of esketamine on postoperative depression and quality of life in patients. EVIDENCE ACQUISITION: We searched for all articles on esketamine in patients after surgury in electronic data bases, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, up to the June 2023.The included studies compared the impact of using esketamine and placebo on postoperative depression and quality of life in patients through randomized controlled trials. The outcome measurements consist of postoperative depression and indicators that can reflect the impact on patients' post Cochrane Risk of Bias tool in Review Manager 5.4 tool was adopted to assess the risk of bias. EVIDENCE SYNTHESIS: The study included a total of 11 randomized controlled trials with 1447 participants. This meta-analysis demonstrated that the prophylactic use of esketamine alleviated postoperative depressive symptoms (standardized mean difference [SMD]: -0.61; 95% confidence interval [CI]: -0.96 to -0.25; P=0.0008) and incidence (relative risk [RR]:0.37;95% [CI]: 0.22 to 0.62; P=0.0001), reducing the occurrence of postoperative depression, anxiety, and chronic pain. Additionally, it improved postoperative sleep quality and enhanced the postoperative quality of life for patients. CONCLUSIONS: Prophylactic use of esketamine during the preoperative and anesthesia period has shown significant benefits in improving postoperative quality of life. It can effectively alleviate postoperative depression, anxiety, and chronic pain, as well as enhance sleep quality.

Slower intravenous tramadol administration can prevent nausea and vomiting and predict postoperative nausea and vomiting: a randomized controlled trial.

Objective: Nausea and vomiting are the most common complications in patients who use tramadol for analgesia. This study evaluated the risk of nausea and vomiting related to intravenous tramadol administration. Methods: In this study, 315 patients who received pre-analgesia before elective surgery were selected, and participants were divided into groups based on the Apfel risk assessment of nausea and vomiting, as follows: high risk (Apfel=4), medium risk (Apfel=2-3), and low-risk (Apfel=1). Tramadol (1.5 mg/kg) was administered intravenously over a duration of 1 min, 2 min, or 3 min before anaesthesia induction to observe preoperative nausea and vomiting reactions within 10 min. Results: In the low-risk group, the numeric rating scale for postoperative nausea scores and the incidence of nausea and vomiting were significantly lower in the 3-min group than those in the 1-min group, and the incidence of preoperative nausea and vomiting after intravenous administration of tramadol in the 1-min and 3-min groups were significantly related to the incidence of postoperative nausea and vomiting. The incidence of nausea and vomiting during pre-administration in the 1-min and 3-min groups was identified as an independent risk factor for postoperative nausea and vomiting. Conclusions: In the clinical treatment of pain with tramadol, the slow intravenous application of tramadol within 3 min is worthy of being adopted and promoted by clinicians in their daily work.

postGWAS: A web server for deciphering the causality post the genome-wide association studies.

While genome-wide association studies (GWAS) have unequivocally identified vast disease susceptibility variants, a majority of them are situated in non-coding regions and are in high linkage disequilibrium (LD). To pave the way of translating GWAS signals to clinical drug targets, it is essential to identify the underlying causal variants and further causal genes. To this end, a myriad of post-GWAS methods have been devised, each grounded in distinct principles including fine-mapping, co-localization, and transcriptome-wide association study (TWAS) techniques. Yet, no platform currently exists that seamlessly integrates these diverse post-GWAS methodologies. In this work, we present a user-friendly web server for post-GWAS analysis, that seamlessly integrates 9 distinct methods with 12 models, categorized by fine-mapping, colocalization, and TWAS. The server mainly helps users decipher the causality hindered by complex GWAS signals, including casual variants and casual genes, without the burden of computational skills and complex environment configuration, and provides a convenient platform for post-GWAS analysis, result visualization, facilitating the understanding and interpretation of the genome-wide association studies. The postGWAS server is available at http://g2g.biographml.com/.

Promoting healthy lifestyle considerations during pregnancy in Midwifery clinics in China: a best practice implementation project.

OBJECTIVES: The aim of this project was to initiate and promote formal and individualized evidence-based education on healthy lifestyle choices during pregnancy for pregnant women. INTRODUCTION: Evidence suggests that lifestyle choices during pregnancy can have a profound influence on many pregnancy complications and chronic diseases such as preterm birth, diabetes, obesity, fetal growth restriction, breast cancer and hypertensive diseases in both pregnant women and their babies. It is widely accepted that formal, individualized, hospital-directed education about lifestyle choices during pregnancy should commence as early as the first consultation between pregnant women and maternal healthcare workers. METHODS: The methods of this project were audit and feedback. The approach to data collection used the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System and implementation planning utilized the Getting Research into Practice component. A baseline audit of 50 observations of midwife-led education on prenatal lifestyle were conducted and measured against seven best practice audit criteria. Targeted strategies were then implemented to improve compliance to best practice. A follow-up audit was conducted over a 6-month period from June 2019 to November 2019. RESULTS: The baseline audit revealed significant deficits between current prenatal education practice and recommended best practice. Zero percent compliance was observed in six out of seven audit criteria, indicating that education provided did not conform to best practice. Total compliance (100%) was observed for one audit criterion at baseline, assessing pregnant women being offered an opportunity to discuss and ask questions regarding the education session or information they had received. Three barriers that prevented midwives from achieving compliance with best practice were identified, and a bundled education strategy was implemented. A follow-up audit indicated 100% compliance of all audit criteria. CONCLUSION: Results demonstrated that formal, individualized, midwife-led prenatal education and provision of relevant evidence-based resources had an immediate positive effect. The project helped to transform care givers' attitudes toward education regarding lifestyle during pregnancy from a passive routine 'must do' task to an active process with focus on healthy lifestyle and engagement of pregnant women. Future strategies such as support from hospital management and social media are planned in conjunction with follow-up clinical audits to ensure sustainability.

Discussion on operative skills in the embolization of hydrosalpinx by hysteroscopic placement of a microcoil.

This study aims to discuss the operative skills of hysteroscopic tubal embolization and reduce the occurrence of complications.Ninety-four patients were divided into group A and group B. The main surgical technique in group A: when the inner sleeve is sent to the fallopian tube and no longer accessible (but no >3 cm), remove the guide wire and put into the microcoil. But in group B, there are four major surgical techniques. First, the depth at which the guide wire enters the tube was controlled at 2 cm. Second, the inner diameter of the fallopian tube must be explored to determine the type and shape of the coils. Third, saline should be used to separate the catheter. Fourth, it is to control the release speed of the coils. The superiority of the improved operation method was confirmed by comparing the surgical failure rate, incidence of complications, and cost of surgery before and after the procedure.The reoperation rate of group A was 10% (3/30), while that of group B was 2.68% (3/112). The ectopic microcoils rate of group A was 6.67% (2/30), while that of group B was 0.89% (1/112). The microcoil damages rate of group 23.33% (7/30), while that of group B was 8.04% (9/112). All P values were <.01, and the difference was statistically significant.Hysteroscopic tubal embolization is currently a new surgical procedure to block the fallopian tubes and prevent the reverse flow of fluid in the fallopian tubes into the uterine cavity. After we improved surgical techniques, the surgical failure rate, complication rate, and operation cost of fallopian tube embolization were significantly lower than before the improved method was applied. The improved techniques led to a higher success rate.

Long noncoding RNA BDNF-AS regulates ketamine-induced neurotoxicity in neural stem cell derived neurons.

BACKGROUND: Ketamine is an anesthetic commonly used in both humans and animals. Emerging evidence has demonstrated that ketamine may induce neurotoxicity in neural stem cell-derived neurons. In this work, we investigated whether long noncoding RNA (lncRNA) Brain derived neurotrophic factor antisense (BDNF-AS) was involved in ketamine-induced neurotoxicity in differentiation of mouse embryonic neural stem cells. METHODS: Mouse embryonic neural stem cells were differentiated in vitro, and treated with ketamine. The corresponding change in gene expression levels of BDNF and BDNF-AS were assessed by qRT-PCR. BDNF-AS was subsequently downregulated by siRNA. And its effect on protecting neuronal apoptosis, promoting neurite regrowth, and activating TrkB signaling pathways were assessed by TUNEL assay, neurite outgrowth assay, and western blot assay, respectively. RESULTS: In ketamine-injured mouse embryonic neural stem cell-derived neurons, BDNF was downregulated, whereas BDNF-AS was upregulated in dose-dependent manner. SiRNA-mediated BDNF-AS downregulation ameliorated neuronal apoptosis, induced neurite outgrowth, and phosphorylated TrkB signaling pathway after ketamine-induce neurotoxicity in mouse embryonic neural stem cell-derived neurons. CONCLUSIONS: Inhibition of BDNF-AS is a novel method to protect ketamine-induced neurotoxicity in mouse embryonic neural stem cell-derived neurons, very likely through the activation of TrkB signaling pathway.

Cardioprotective effect of novel sulphonamides-1,3,5-triazine conjugates against ischaemic-reperfusion injury via selective inhibition of MMP-9.

Diseases affecting cardiovascular system are ranked as a top most cause of morbidity and mortality. Herein, a novel class sulphonamides-1,3,5-triazine conjugates have been synthesized and tested for inhibitory activity against MMP-2 and MMP-9. The results of the study showed that these molecules efficiently inhibit MMP-9 than MMP-2, revealing compound 8e as the most potent inhibitor (IC50  = 2.34 ± 0.56 nm). Due to involvement of MMP-9 in many cardiovascular diseases, particularly in myocardial ischaemia (MI), compound 8e was further subjected for the determination of the protective effect on isoproterenol (ISO)-induced myocardial injury in rats.

The role of TNF-α in regulating ketamine-induced hippocampal neurotoxicity.

INTRODUCTION: Ketamine is commonly used in pediatric anesthesia but recent studies have shown that it could induce neurotoxicity in the developing brain. The inflammatory cytokine, tumor necrosis factor α (TNF-α) is involved in the pathogenesis of various types of neurodegenerations. In the present study, we examined whether TNF-α may regulate ketamine-induced neurotoxicity in the hippocampus of neonatal mouse. MATERIAL AND METHODS: The in vitro organotypic culture of hippocampal slices was used to investigate the gain-of-function and loss-of-function effect of TNF-α modulation on ketamine-induced hippocampal neurotoxicity. Also, western blotting analysis was used to examine the relative pathways associated with TNF-α modulation. In the in vivo Morris water maze test, TNF-α was genetically silenced to see if memory function was improved after anesthesia-induced memory impairment. RESULTS: In in vitro experiments, adding TNF-α enhanced (112.99 ±5.4%, p = 0.015), whereas knocking down TNF-α ameliorated (46.8 ±11.6%, p = 0.003) ketamine-induced apoptosis in hippocampal CA1 neurons in the organotypic culture. Western blotting showed that addition of TNF-α reduced (67.1 ±3.7%, p = 0.022), whereas downregulation of TNF-α increased (126.87 ±8.5%, p = 0.004) the phosphorylation of PKC-ERK pathway in ketamine-treated hippocampus. In in vivo experiments, genetically silencing TNF-α markedly improved the ketamine-induced memory impairment through Morris water maze test. CONCLUSIONS: Our results clearly demonstrated a protective mechanism of down-regulating TNF in ketamine-induced hippocampal neurotoxicity. This study may present a new target for pharmacological intervention to prevent anesthesia-related neurodegeneration in brain.

Low doses of esmolol and phenylephrine act as diuretics during intravenous anesthesia.

INTRODUCTION: The renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but experiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the adrenergic balance is modified. METHODS: Sixty females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to control group and received only the conventional anesthetic drugs and 20 ml/kg of lactated Ringer's over 30 mins. The others were also given an infusion of 50 µg/kg/min of esmolol (beta1-receptor blocker) or 0.01 µg/kg/min of phenylephrine (alpha1-adrenergic agonist) over 3 hours. The distribution and elimination of infused fluid were studied by volume kinetic analysis based on urinary excretion and blood hemoglobin level. RESULTS: Both drugs significantly increased urinary excretion while heart rate and arterial pressure remained largely unaffected. The urine flows during non-surgery were 43, 147, and 176 ml in the control, esmolol, and phenylephrine groups, respectively (medians, P<0.03). When surgery had started the corresponding values were 34, 65 and 61 ml (P<0.04). At 3 hours, averages of 9%, 20%, and 25% of the infused volume had been excreted in the three groups (P<0.01). The kinetic analyses indicated that both treatments slowed down the distribution of fluid from the plasma to the interstitial fluid space, thereby preventing hypovolemia. CONCLUSIONS: Esmolol doubled and phenylephrine almost tripled urinary excretion during anesthesia-induced depression of renal fluid clearance.