To Compare the Anesthetic Effect of Remimazolam and Propofol in Painless Hysteroscopic Minimally Invasive Surgery.

OBJECTIVE: Hysteroscopic surgery will stimulate the autonomic nerves innervating the uterus, causing intense discomfort and pain in the examined person, and in severe cases, it will cause blood pressure drop, heart rate slowing, arrhythmia and even cardiac arrest, so most patients need anesthetic intervention. This study to retrospectively compare the anesthetic effect of remimazolam and propofol in minimally invasive painless hysteroscopic surgery and to explore the safety and efficacy of remimazolam. METHODS: The clinical data of 110 female patients who underwent painless hysteroscopic minimally invasive surgery in our hospital from January 2023 to June 2023 were collected. The patients were divided into the remimazolam group (group R, n = 55) and the propofol group (group P, n = 55) according to the main anesthetic drugs used during the operation. The changes in heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), and respiratory rate (RR) at the time of entry (T0), modified vigilance/sedation score (MOAA/S) 0 (T1), cervical dilation (T2), end of the operation (T3) and anesthesia recovery (T4) were compared between the two groups. Anesthesia induction time, operation time, and anesthesia recovery time were compared between the two groups, and the incidence of intraoperative and postoperative adverse reactions was compared between the two groups. RESULTS: HR, MAP, and SpO2 in group R were significantly higher than those in group P at T1, T2, T3, and T4 (p < 0.05), and there was no significant difference in RR between the two groups (p > 0.05). HR, MAP, and SpO2 at T1 and T2 were significantly lower than those at T0 in group R (p < 0.05), and RR at different time points in the group had no significant difference (p > 0.05). HR, MAP, and SpO2 at T1, T2, T3, and T4 were significantly lower than those at T0 in group P (p < 0.01), and RR at different time points in the same group had no significant difference (p > 0.05). The anesthesia induction time in group R was more prolonged than in group P, and the anesthesia recovery time in group R was shorter than in group P (p < 0.05). The incidences of hypotension, bradycardia, low oxygen saturation, respiratory depression, and injection pain in group R were significantly lower than those in group P (p < 0.05). CONCLUSION: Intravenous induction of remimazolam at 6 mg·kg-1·h-1 and maintenance of anesthesia at 1-2 mg·kg-1·h-1 have less effect on hemodynamics, faster recovery time and lower incidence of adverse reactions compared with propofol when used in minimally invasive hysteroscopic surgery. Remimazolam can be safely and effectively used in this kind of surgery.

Employee Voice: A Mechanism to Harness Employees' Potential for Sustainable Success.

Listening to employees' concerns reduces their dissatisfaction, but moreover, for an organization to achieve sustainable success, employees must raise their creative voice and give their input in decision-making without the fear of rejection in a psychologically safe environment. Ethical leaders facilitate such a participative style of management. A bureaucratic culture, as is generally encountered in Pakistan's work settings, poses real challenges to those who dare to speak up, therefore the importance of ethical leadership, leader-member exchange (LMX), and psychological safety cannot be neglected as coping mechanisms to sustain the employee voice for mutual gains. To investigate ethical leadership's mediating mechanisms and boundary conditions on voice behavior, we examined a moderated mediation model with the leader-member exchange as a moderator and psychological safety as a mediator. Grounded in social exchange theory (SET), the current study uniquely posits and tests that employees feel psychologically safe in the presence of an ethical leader with whom they have high-quality social exchanges. Data were collected from 281 employees from the public corporations and private enterprises of the petroleum sector of Karachi. Results of the analysis, through SPSS and AMOS, revealed that psychological safety mediated the relationship of ethical leadership and voice behavior, while the indirect effect of ethical leadership on voice behavior (via psychological safety) is stronger for those employees who enjoy high-quality exchanges with ethical leaders. LMX was also found to moderate the relationship between ethical leadership and voice behavior. Contributions, recommendations, and limitations of the current study and further research areas are also discussed. The study offers practical insight on the mechanism of ethical leadership on employee voice behavior and recommends leaders to develop social exchanges to improve voice behavior for sustainable success.

Probing Kinetics of Water-in-Salt Aqueous Batteries with Thick Porous Electrodes.

Aqueous electrochemical systems suffer from a low energy density due to a small voltage window of water (1.23 V). Using thicker electrodes to increase the energy density and highly concentrated "water-in-salt" (WIS) electrolytes to extend the voltage range can be a promising solution. However, thicker electrodes produce longer diffusion pathways across the electrode. The highly concentrated salts in WIS electrolytes alter the physicochemical properties which determine the transport behaviors of electrolytes. Understanding how these factors interplay to drive complex transport phenomena in WIS batteries with thick electrodes via deterministic analysis on the rate-limiting factors and kinetics is critical to enhance the rate-performance in these batteries. In this work, a multimodal approach-Raman tomography, operando X-ray diffraction refinement, and synchrotron X-ray 3D spectroscopic imaging-was used to investigate the chemical heterogeneity in LiV3O8-LiMn2O4 WIS batteries with thick porous electrodes cycled under different rates. The multimodal results indicate that the ionic diffusion in the electrolyte is the primary rate-limiting factor. This study highlights the importance of fundamentally understanding the electrochemically coupled transport phenomena in determining the rate-limiting factor of thick porous WIS batteries, thus leading to a design strategy for 3D morphology of thick electrodes for high-rate-performance aqueous batteries.

Strong adhesion of poly(vinyl alcohol)-glycerol hydrogels onto metal substrates for marine antifouling applications.

Hydrogels can be used as an alternative coating material for ships against marine biofouling. However, the adhesion of wet and soft hydrogels onto solid metals remains a challenging problem. Here we report the adhesion of a typical hydrogel material, poly(vinyl alcohol) (PVA)-glycerol hydrogel, onto stainless steel substrates and the antifouling potency of the adhered PVA-glycerol hydrogels. Poly(allylamine hydrochloride) (PAH) hydrogel and ethyl α-cyanoacrylate (ECA) are used as the binders, and they are found to be able to firmly bond the PVA-glycerol hydrogels onto the stainless steel substrates. The PAH hydrogel does not affect the mechanical properties of the PVA-glycerol hydrogel during use, but it tends to lose the adhesive ability in a dehydrating environment. In contrast, the ECA adhesive can maintain strong bonding between PVA-glycerol hydrogels and substrates upon several water losing/water absorbing cycles, despite some negative effects on the strength of the PVA-glycerol hydrogel. Biological experiments show that the PVA-glycerol hydrogel has a strong settlement-inhibiting effect on the barnacle Balanus albicostatus, suggesting that combining the PVA-glycerol hydrogel with ECA adhesive may have promising applications in marine antifouling.