Protection of Si Nanowires against Aß Toxicity by the Inhibition of Aß Aggregation.

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by the accumulation of amyloid beta (Aß) plaques in the brain. Aß1-42 is the main component of Aß plaque, which is toxic to neuronal cells. Si nanowires (Si NWs) have the advantages of small particle size, high specific surface area, and good biocompatibility, and have potential application prospects in suppressing Aß aggregation. In this study, we employed the vapor-liquid-solid (VLS) growth mechanism to grow Si NWs using Au nanoparticles as catalysts in a plasma-enhanced chemical vapor deposition (PECVD) system. Subsequently, these Si NWs were transferred to a phosphoric acid buffer solution (PBS). We found that Si NWs significantly reduced cell death in PC12 cells (rat adrenal pheochromocytoma cells) induced by Aß1-42 oligomers via double staining with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and fluorescein diacetate/propyl iodide (FDA/PI). Most importantly, pre-incubated Si NWs largely prevented Aß1-42 oligomer-induced PC12 cell death, suggesting that Si NWs exerts an anti-Aß neuroprotective effect by inhibiting Aß aggregation. The analysis of Fourier Transform Infrared (FTIR) results demonstrates that Si NWs reduce the toxicity of fibrils and oligomers by intervening in the formation of ß-sheet structures, thereby protecting the viability of nerve cells. Our findings suggest that Si NWs may be a potential therapeutic agent for AD by protecting neuronal cells from the toxicity of Aß1-42.

Grifolin Induces Cell Death of Human Lung Cancer A549 Cell Line via Inhibiting KRAS-Mediated Multiple Signaling Pathways.

In the current work, grifolin was obtained from the twigs and leaves of Daphne genkwa for the first time and displayed significant growth inhibition against human lung carcinoma A549 cells. Subsequent in vitro antitumor evaluation revealed that grifolin could induce remarkable cell apoptosis and G0/G1 phase arrest, as well as block cell migration and invasion. In addition, grifolin also disrupted cellular energy metabolism by inducing reactive oxygen species, reducing adenosine triphosphate and mitochondrial membrane potential, and damaging DNA synthesis. Further RNA-seq analysis demonstrated that treatment of grifolin on A549 cells led to gene enrichment in MAPK, PI3K/Akt and NF-κB signaling pathways, all of which were inhibited by grifolin according to immunoblotting experiments. Further mechanistical studies disclosed that the expression of a key upstream protein KRAS was also blocked, and the cell death triggered by grifolin could be rescued by a RAS activator ML-099. Moreover, pretreatment of ML-099 on A549 cells could reverse the grifolin-induced downregulation of key proteins in the three aforementioned pathways. These findings indicate that grifolin could induce cell death in A549 cell line by inhibiting KRAS-mediated multiple signaling pathways.

Triterpenoids with α-glucosidase inhibitory and cytotoxic activities from the fruits of Schisandra chinensis.

An intensive phytochemical investigation into the fruits of Schisandra chinensis afforded 28 triterpenoids incorporating diverse backbones with methyl-migration, ring-expansion and ring-opening features. Among them, ten compounds (1-10) including three likely extracting artefacts (8-10) were described for the first time. Their structures were fully characterized by comprehensive spectroscopic analyses, with the absolute configurations established via electronic circular dichroism and Mosher's NMR techniques. Preliminary biological evaluations revealed that nine isolates showed inhibitory activity against the hyperglycemic target α-glycosidase and 12 compounds exerted cytotoxicity toward three female tumor cell lines (Hela (cervical), MDA-MB231 and MCF-7 (breast)). Compound 6 exhibited the most promising potency on all the three tested cancer cells, and further assessment demonstrated that it could induce significant cell apoptosis and cycle arrest, as well as suppress cell migration, by regulating relevant proteins in MDA-MB231 cells.

Population Structures and Dynamics of Rhododendron Communities with Different Stages of Succession in Northwest Guizhou, China.

To explore the population structures and dynamics of Rhododendron shrub communities at different stages of succession in northwest Guizhou, China, this study examined the populations of Rhododendron annae and Rhododendron irroratum shrub with two different stages. A space-for-time substitution was employed to establish the diameter class/height structures, static life tables, and survival/mortality rate/disappearance rate curves of both Rhododendron populations with different orders of succession. Their structural and quantitative dynamics were analyzed, and their development trends were predicted. The results showed that, quantitatively, the populations of R. annae and R. irroratum in the two Rhododendron communities with different orders of succession were dominated by age classes one, two, and three as well as height classes i, ii, and iii. The number of Rhododendron plants at the three age classes and the three height classes accounted for 97.61-100% of the total. The quantitative dynamic indices of R. annae and R. irroratum were both greater than 0, with and without considering external interference. In terms of age class and height structures, both Rhododendron populations were expanding populations, presenting "inverted-J-shaped" and irregular pyramid patterns. There was a sufficient number of young individuals, but few or no old individuals. Both survival curves of the populations of R. annae and R. irroratum in the two Rhododendron communities with different orders of succession belonged to the Deevy-II type. In the late stage of succession, the mortality curves and disappearance curves of both Rhododendron populations in these communities presented a trend of increasing first and then decreasing with increasing age class. This result indicates that at each age class, R. annae and R. irroratum showed a trend of gradual increase after two, four, and six years. In brief, the populations of R. annae and R. irroratum have rich reserves of seedlings and saplings, but high mortality and disappearance rates. In this context, it is necessary to reduce human interference and implement targeted conservation measures to promote the natural renewal of Rhododendron populations.

Rare flavanone-diarylheptanoid hybrids from Typha angustifolia shows anti breast cancer activity via activating TGF-ß1/Smad signaling pathway.

Four new flavanone-diarylheptanoid hetero dimers, typhatifolins A-D (1-4), were separated from the pollen of a widely distributed medicinal plant Typha angustifolia. Structures of these rare hybrids were elucidated by detailed interpretation of spectroscopic data, and their absolute configurations were determined on the basis of Mosher's method and ECD analyses. All the four compounds showed moderate to significant cytotoxicities against a panel of tumor cell lines with IC50 values ranging from 0.67 to 12.48 µM. Further in vitro antitumor evaluation for typhatifolin B (TTB, 2) on two breast cancer cells (4T1 and MDA-MB231) revealed that it could remarkably induce cell apoptosis and G0/G1 cycle arrest, as well as block cell migration and invasion. Mechanistically, TTB could exert its antitumor effect via activating the TGF-ß1 (transforming growth factor beta 1) signaling pathway as evidenced by RNA-seq analysis and immunoblotting experiments, which was further corroborated by treating cancer cells with a TGF-ß signaling inhibitor. Lastly, the in vivo anti breast cancer activity was demonstrated by applying the mixture of typhatifolins A-D to a preclinical animal model.

Polarized Tunneling Transistor for Ultralow-Energy-Consumption Artificial Synapse toward Neuromorphic Computing.

Neural networks based on low-power artificial synapses can significantly reduce energy consumption, which is of great importance in today's era of artificial intelligence. Two-dimensional (2D) material-based floating-gate transistors (FGTs) have emerged as compelling candidates for simulating artificial synapses owing to their multilevel and nonvolatile data storage capabilities. However, the low erasing/programming speed of FGTs renders them unsuitable for low-energy-consumption artificial synapses, thereby limiting their potential in high-energy-efficient neuromorphic computing. Here, we introduce a FGT-inspired MoS2/Trap/PZT heterostructure-based polarized tunneling transistor (PTT) with a simple fabrication process and significantly enhanced erasing/programming speed. Distinct from the FGT, the PTT lacks a tunnel layer, leading to a marked improvement in its erasing/programming speed. The PTT's highest erasing/programming (operation) speed can reach ∼20 ns, which outperforms the performance of most FGTs based on 2D heterostructures. Furthermore, the PTT has been utilized as an artificial synapse, and its weight-update energy consumption can be as low as 0.0002 femtojoule (fJ), which benefits from the PTT's ultrahigh operation speed. Additionally, PTT-based artificial synapses have been employed in constructing artificial neural network simulations, achieving facial-recognition accuracy (95%). This groundbreaking work makes it possible for fabricating future high-energy-efficient neuromorphic transistors utilizing 2D materials.

PZT-Enabled MoS2 Floating Gate Transistors: Overcoming Boltzmann Tyranny and Achieving Ultralow Energy Consumption for High-Accuracy Neuromorphic Computing.

Low-power electronic devices play a pivotal role in the burgeoning artificial intelligence era. The study of such devices encompasses low-subthreshold swing (SS) transistors and neuromorphic devices. However, conventional field-effect transistors (FETs) face the inherent limitation of the "Boltzmann tyranny", which restricts SS to 60 mV decade-1 at room temperature. Additionally, FET-based neuromorphic devices lack sufficient conductance states for highly accurate neuromorphic computing due to a narrow memory window. In this study, we propose a pioneering PZT-enabled MoS2 floating gate transistor (PFGT) configuration, demonstrating a low SS of 46 mV decade-1 and a wide memory window of 7.2 V in the dual-sweeping gate voltage range from -7 to 7 V. The wide memory window provides 112 distinct conductance states for PFGT. Moreover, the PFGT-based artificial neural network achieves an outstanding facial-recognition accuracy of 97.3%. This study lays the groundwork for the development of low-SS transistors and highly energy efficient artificial synapses utilizing two-dimensional materials.

Meroterpenoids from Daphne genkwa shows promising in vitro antitumor activity via inhibiting PI3K/Akt/mTOR signaling pathway in A549 cells.

Phytochemical investigation into the leaves and branches of Daphne genkwa afforded 25 meroterpenoids (1-16) including nine pairs of enantiomers (1a/1b-8a/8b and 12a/12b), among which 20 compounds have been reported in the present work for the first time. The structures with absolute configurations of the new molecules (excluding 10-13) were established via comprehensive spectroscopic analyses especially electronic circular dichroism (ECD) and Mosher's methods. A preliminary in vitro cell viability assay revealed remarkable cytotoxicities of selective compounds against A549 (lung), Hela (cervical), MDA-MB231 (breast) and MCF-7 (breast) cancer cells, and compound 8a showed the best inhibitory activity with IC50 values in the range of 3.12-4.67 µM toward the four cell lines. Subsequent in vitro antitumor evaluation of 8a disclosed that it could inhibit the proliferation and metastasis, as well as induce significant apoptosis and cycle arrest, of A549 cells. Further mechanistic investigations revealed that 8a could exert its antitumor activity via inhibiting the PI3K/Akt/mTOR signaling pathway.

Structurally Diverse Sesquiterpenoids with NO Production and α-Glucosidase Inhibitory Activities from the Fruits of Schisandra chinensis.

Chemical fractionation of the AcOEt partition, generated from the EtOH extract of the fruits of Schisandra chinensis, afforded a series of sesquiterpenyl constituents including two new cadinanes, a new eudesmane, two new widdranes (a handling artefact and a new natural product), a new bisabolane and two new natural cuparane enantiomers, along with 15 known structurally related analogs. Structures of the new compounds were unambiguously characterized by interpretation of detailed spectroscopic data including ESI-MS and 1D/2D NMR, with their absolute configurations being established by electronic circular dichroism (ECD) calculation and induced ECD experiment. The inhibitory effects of all the isolates against α-glucosidase and lipopolysaccharide (LPS) induced nitric oxide (NO) production in murine RAW264.7 macrophages, as well as their antibacterial and cytotoxic potential, were evaluated, with selective compounds showing moderate α-glucosidase and NO inhibitory activity. Notably, canangaterpene III exhibited the most significant NO inhibitory effect with an IC50 value of 31.50±1.49 µM.

Effects of fertilization gradient on the production performance and nutritional quality of cultivated grasslands in karst areas.

Optimal fertilization is an important measure for managing cultivated grasslands, and a necessary means for maintaining the nutrient balance, yield, and quality of grassland ecosystems. This study aimed to explore the effects of organic fertilizers on the production performance and nutritional quality of cultivated grasslands in karst areas. Two types of monocultured cultivated grasslands (i.e., Medicago sativa and Dactylis glomerata) were employed as the research objects, and a randomized block design was adopted to investigate the effects of five fertilization gradients on the forage height, coverage, yield, and nutritional quality of the cultivated grasslands. According to the results, the plant height, coverage, and yield of M. sativa first presented an increasing trend, then decreased with increasing fertilization gradient, with a peak at 20-30 t/hm2 fertilization gradient. The height, coverage, and yield of D. glomerata increased gradually with increase in fertilization gradient, and peaked at 40 t/hm2. Meanwhile, the crude protein (CP) and ether extract (EE) contents of both grassland types displayed first presented an increasing trend, then decreased with increasing fertilization gradient, and peaked at 10-30 t/hm2 fertilization gradient. The neutral detergent fiber (NDF) and acidic detergent fiber (ADF) contents of M. sativa presented "N-shaped" and "M-shaped" change trends with increasing fertilization gradient, while those of D. glomerata showed "V-shaped" and "M-shaped" change trends, reaching minimum values under fertilization gradients of 30 and 20 t/hm2, respectively. Year, fertilization, and year × fertilization (Y×F) significantly affected the plant heights, coverages, dry/fresh weight ratios, and yields of M. sativa and D. glomerata. The contribution of coverage to the subordinate function of M. sativa was greatest at a fertilization gradient of 20 t/hm2. Meanwhile, the subordinate function values of the height and coverage of D. glomerata increased gradually with increasing fertilization gradient, but the difference in the subordinate function value of height was only 0.09%-0.18% under the fertilization gradient of 20-40 t/hm2. Evaluation of forage nutrition revealed 10-30 t/hm2 and 20-30 t/hm2 as the optimal organic fertilizer application rates for M. sativa and D. glomerata, respectively.

Coherence singularity and evolution of partially coherent Bessel-Gaussian vortex beams.

For a partially coherent Bessel-Gaussian (PCBG) vortex beam, information regarding the topological charge (TC) is hidden in the phase of the cross-spectral density (CSD) function. We theoretically and experimentally confirmed that during free-space propagation, the number of coherence singularities is equal to the magnitude of the TC. In contrast to the Laguerre-Gaussian vortex beam, this quantitative relationship only holds for the case with an off-axis reference point for the PCBG vortex beam. The phase winding direction is determined by the sign of the TC. We developed a scheme for CSD phase measurement of PCBG vortex beams and verified the aforementioned quantitative relationship at different propagation distances and coherence widths. The findings of this study may be useful for optical communications.

Karst grassland forage quality and its determinants in Guizhou Province of Southwest China.

Forage quality is a key property of grassland ecosystems. In this study, grassland forage qualities were measured at 373 sampling sites throughout Guizhou Province in the karst mountain region of Southwest China, and the factors affecting it were explored. The forage quality level of most plant species was categorized into four levels: (1) preferred forage species; (2) desirable forage species; (3) consumed but undesirable forage species; and (4) non-consumable or toxic forage species. High temperature and precipitation appeared to facilitate the growth of preferred forage species, but limited the growth of other plants. Increasing soil pH had a positive impact on the number and biomass of preferred forage plants, but a negative influence on other plants, especially non-consumable or toxic plants. Both GDP and population density had a positive correlation with the number and biomass of preferred forage species, while such correlations for other levels of forage species tended to be negative. Grazing could lead to a decrease in the preferred forage species. Therefore, it is suggested that by focusing on soil improvement in grassland and maintaining an appropriate grazing intensity, global warming and rapid economic growth in Guizhou Province will likely contribute to increase the forage quality of karst grasslands in Southwest China.

PPh3-Mediated Cascade Reaction of 2-Alkynylnitrobenzenes and Thioureas for the Construction of Imidazo[4,5-b]indole-2-thiones.

A simple method for the preparation of imidazo[4,5-b]indole-2-thiones from 2-alkynylnitrobenzenes and thioureas is described. In the reaction, a Wittig-like process was triggered by PPh3 and followed by a cyclization step. The products were afforded in yields of 70-98% under mild conditions. Additionally, the 2-alkynylnitrobenzenes were stable and could be prepared via a simple coupling step.

Effect of dermatopontin on osteogenic differentiation of periodontal ligament stem cells.

Human periodontal ligament stem cells (hPDLSCs) are promising seed cells for oral bone tissue engineering. Dermatopontin (DPT) is a small-molecule protein recognized as a non-collagenous component of the extracellular matrix and is associated with a variety of biological processes. In this study, we first determined that DPT was elevated during the osteogenic differentiation of hPDLSCs. HPDLSCs interfering with DPT expression were established by lentiviral infection. It was found that the proliferation and osteogenic differentiation ability of hPDLSCs were inhibited after interfering DPT with lentivirus. Exogenous recombinant DPT treatment could not alter the proliferation of hPDLSCs. Coincidentally, exogenous DPT can only enhance the osteogenic differentiation of hPDLSCs in the control lentivirus group, but had no significant effect on the DPT interference group. This study expands the understanding of DPT function and implicates DPT as an important target for enhancing osteogenic differentiation of hPDLSCs.

Impacts of intrathecal fentanyl on the incidence of postoperative nausea/vomiting: Systematic review and meta-analysis of randomized studies.

Post-operative nausea and vomiting (PONV) is an event of multifactorial origin with an incidence of 30% in the general population. Opioids such as fentanyl are being used as adjuvant to local anesthetic for its antiemetic effect. In this context, with this study we aimed to evaluate the impact of spinal fentanyl as an adjuvant on the incidence of PONV compared with a placebo, and shivering. A systematic search of randomized controlled trials that evaluated the use of spinal fentanyl in the prevention of PONV and shivering was conducted in different databases, of which 32 studies met the inclusion criteria. A total of 2116 patients scheduled for various surgeries, including cesarean section, orthopedic surgery in the lower limb, hysterectomy, and transurethral resection of the prostate, were included in the final analysis. The meta-analysis estimated the relative risk of incidence of PONV in the first 24 hours after surgery and secondary outcomes included the shivering symptom. The use of intrathecal fentanyl was associated with lower incidence of PONV, but not statistically significant when compared to the placebo (RR: 0.74 CI95%: 0.55-1.01 P = 0.06). Subgroup analysis showed a statistically significant reduction in PONV incidences with lower doses between 10 and 15 µg (RR: 0.44 CI95%: 0.35-0.55 P < 0.00001, I2 = 0%) but not with higher doses 20-25 µg. Secondary outcomes showed a decrease in incidence with the use of fentanyl vs the placebo (RR: 0.49, CI95% 0.33-0.72 P = 0.0003). Current evidence shows that the use of spinal fentanyl decreases the incidence of PONV, an effect favored using low doses.

Statistical properties of a partially coherent vector beam with controllable spatial coherence, vortex phase, and polarization.

We report on a partially coherent radially polarized power-exponent-phase vortex (PC-RP-PEPV) beam with various distributions of intensity, controllable coherence width, vortex phase, and polarization. The statistical properties of the PC-RP-PEPV beam depend on topological charge, power order, polarization states, and coherence width, which differ from those of conventional radially polarized beams. Here, the initial radial polarization state will transform to complex ellipse polarization state during propagation. By modulating the topological charge of the PC-RP-PEPV beam, the intensity structure of the beam can be adjusted from circular to polygonal. Finally, PC-RP-PEPV beams were experimentally generated, and were consistent with numerical simulation results. This work has applications in optical manipulation, optical measurements, and optical information processing.

Contribution of Fine Roots to Soil Organic Carbon Accumulation in Different Desert Communities in the Sangong River Basin.

This study explored the relationship between soil organic carbon (SOC) and root distribution, with the aim of evaluating the carbon stocks and sequestration potential under five plant communities (Alhagi sparsifolia, Tamarix ramosissima, Reaumuria soongorica, Haloxylon ammodendron, and Phragmites communis) in an arid region, the Sangong River watershed desert ecosystem. Root biomass, ecological factors, and SOC in different layers of a 0-100 cm soil profile were investigated. The results demonstrated that almost all living fine root biomass (11.78-34.41 g/m2) and dead fine root biomass (5.64-15.45 g/m2) levels were highest in the 10-20 cm layer, except for the P. communis community, which showed the highest living and dead fine root biomass at a depth of 60-70 cm. Fine root biomass showed strong seasonal dynamics in the five communities from June to October. The biomass levels of the A. sparsifolia (138.31 g/m2) and H. ammodendron (229.73 g/m2) communities were highest in August, whereas those of the T. ramosissima (87.76 g/m2), R. soongorica (66.29 g/m2), and P. communis (148.31 g/m2) communities were highest in September. The SOC of the five communities displayed strong changes with increasing soil depth. The mean SOC value across all five communities was 77.36% at 0-30 cm. The highest SOC values of the A. sparsifolia (3.08 g/kg), T. ramosissima (2.35 g/kg), and R. soongorica (2.34 g/kg) communities were found in June, and the highest value of the H. ammodendron (2.25 and 2.31 g/kg, p > 0.05) community was found in June and September. The highest SOC values of the P. communis (1.88 g/kg) community were found in July. Fine root production and turnover rate were 50.67-486.92 g/m2/year and 1.25-1.98 times per year. The relationships among SOC, fine root biomass, and ecological factors (soil water content and soil bulk density) were significant for all five communities. Based on the results, higher soil water content and soil conductivity favored the decomposition of root litter and increased fine root turnover, thereby facilitating SOC formation. Higher pH and bulk density levels are not conducive to soil biological activity and SOC mineralization, leading to increased SOC levels in desert regions.

Influence of the Electron Beam and the Choice of Heating Membrane on the Evolution of Si Nanowires' Morphology in In Situ TEM.

We used in situ transmission electron microscopy (TEM) to observe the dynamic changes of Si nanowires under electron beam irradiation. We found evidence of structural evolutions under TEM observation due to a combination of electron beam and thermal effects. Two types of heating holders were used: a carbon membrane, and a silicon nitride membrane. Different evolution of Si nanowires on these membranes was observed. Regarding the heating of Si nanowires on a C membrane at 800 °C and above, a serious degradation dependent on the diameter of the Si nanowire was observed under the electron beam, with the formation of Si carbide. When the membrane was changed to Si nitride, a reversible sectioning and welding of the Si nanowire was observed.

Glucocorticoid minimizes local anesthetic infusion requirement through adductor canal block and improves perioperative prosthetic joint range of motion in total knee arthroplasty.

INTRODUCTION: The use of glucocorticoid as local anesthetic adjuvant in single-injection adductor canal block (ACB) is well-documented but its effects in the presence of an indwelling catheter is unclear. The purpose of this study was to determine the impacts of one-time perineural glucocorticoid injection on continuous adductor canal block in patients undergoing total knee arthroplasty. METHODS: A single center retrospective study of 95 patients undergoing unilateral total knee arthroplasty (TKA) was performed. Patients were divided into three groups based on adjuvant received through ACB before continuous catheter placement: a control group with no adjuvant (N = 41), a treatment group with dexamethasone (DEX) as adjuvant (N = 33) and another treatment group with DEX/ Methylprednisolone acetate (MPA) as adjuvant (N = 21). The primary outcome was the amount of ropivacaine administered via patient controlled ACB catheter. Secondary outcomes included numeric pain score, perioperative opioid usage, immediately postoperative prosthetic knee joint active range of motion (AROM), opioid usage at 6 weeks and 3 months, length of stay and discharge disposition. RESULTS: Patients in both treatment groups demonstrated a statistically significant decrease in the requirement of self-administered ropivacaine than the control group on postoperative day (POD) 1 (p<0.001) and POD 2 (p<0.001). There was no significant difference in opioid consumption and pain scores between either treatment group vs. control. Compared to control (66%), more home disposition was observed in the DEX (88%, p = 0.028) and DEX/MPA group (95%, p = 0.011). CONCLUSION: This study suggested that single dose perineural glucocorticoid injection with DEX or DEX/MPA significantly decreased the dose of local anesthetic ropivacaine infusion required through continuous ACB for TKA while maintaining comparable level of pain score and opioid consumption, and significantly more patients were discharged home.

Corrected and Republished: Impacts of intrathecal fentanyl on the incidence of postoperative nausea/vomiting: Systematic review and meta-analysis of randomized studies.

Post-operative nausea and vomiting (PONV) is an event of multifactorial origin with an incidence of 30% in the general population. Opioids such as fentanyl are being used as adjuvant to local anesthetic for its antiemetic effect. In this context, with this study we aimed to evaluate the impact of spinal fentanyl as an adjuvant on the incidence of PONV compared with a placebo, and shivering. A systematic search of randomized controlled trials that evaluated the use of spinal fentanyl in the prevention of PONV and shivering was conducted in different databases, of which 32 studies met the inclusion criteria. A total of 2116 patients scheduled for various surgeries, including cesarean section, orthopedic surgery in the lower limb, hysterectomy, and transurethral resection of the prostate, were included in the final analysis. The meta-analysis estimated the relative risk of incidence of PONV in the first 24 hours after surgery and secondary outcomes included the shivering symptom. The use of intrathecal fentanyl was associated with lower incidence of PONV, but not statistically significant when compared to the placebo (RR: 0.74 CI95%: 0.55-1.01 P = 0.06). Subgroup analysis showed a statistically significant reduction in PONV incidences with lower doses between 10 and 15 µg (RR: 0.44 CI95%: 0.35-0.55 P < 0.00001, I2 = 0%) but not with higher doses 20-25 µg. Secondary outcomes showed a decrease in incidence with the use of fentanyl vs the placebo (RR: 0.49, CI95% 0.33-0.72 P = 0.0003). Current evidence shows that the use of spinal fentanyl decreases the incidence of PONV, an effect favored using low doses.