Esketamine combined with dexmedetomidine and lidocaine induced inbition of tracheal intubation response

Objective To investigate the median effective dose （ED50） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine under opioid-free anesthesia （OFA）. Methods Adult patients aged 18-59 years with body mass index （BMI）<30 kg/m² and ASA grade Ⅰ or Ⅱ were selected for endotracheal intubation general anesthesia. Dixon sequential method was adopted. The initial dose of esketamine was 0.5 mg/kg， and the dose of the next patient was determined according to the tracheal intubation response. The ratio of adjacent doses was 1:1.1. The ED50 and 95% confidence interval （CI） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA were calculated. Results A total of 29 patients were included for statistical analysis. Tracheal intubation reaction was positive in 15 cases （positive group） and negative in 14 cases （negative group）. In the positive group， 3 cases had cough reaction during tracheal intubation. The ED50 of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA was 0.448 mg/kg， and the corresponding 95%CI was 0.421-0.476 mg/kg. Conclusion In the OFA of esketamine combined with dexmedetomidine and lidocaine， 0.448 mg/kg of esketamine results in 50% of the maximum response intensity for inhibiting tracheal intubation response

Brain imaging changes in patients recovered from COVID-19: a narrative review

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused several outbreaks of highly contagious respiratory diseases worldwide. The respiratory symptoms of Coronavirus Disease-19 (COVID-19) have been closely monitored and studied, while the central nervous system (CNS) and peripheral system (PNS) lesions induced by COVID-19 have not received much attention. Currently, patients with COVID-19-associated encephalopathy present with dizziness, headache, anxiety and depression, stroke, epileptic seizures, the Guillain-Barre syndrome (GBS), and demyelinating disease. The exact pathologic basis for these neurological symptoms is currently not known. Rapid mutation of the SARS-CoV-2 genome leads to the appearance of SARS-CoV-2 variants of concern (VOCs), which have higher infectivity and virulence. Therefore, this narrative review will focus on the imaging assessment of COVID-19 and its VOC. There has been an increase in technologies, such as [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and functional magnetic resonance imaging (fMRI), that have been used to observe changes in brain microstructure over time in patients with COVID-19 recovery. Medical imaging and pathological approaches aimed at exploring the associations between COVID-19 and its VOC, with cranial nerve and abnormal nerve discharge will shed light on the rehabilitation process of brain microstructural changes related to SARS-CoV-2, and aid future research in our understanding of the treatment and prognosis of COVID-19 encephalopathy

Role of inflammation and immunity in vascular calcification: a bibliometric and visual analysis, 2000–2022

BackgroundIn recent years, a great deal of research has been done on vascular calcification (VC), and inflammation and immunity have been displayed to play important roles in the mechanism of VC. However, to date, no comprehensive or systematic bibliometric analyses have been conducted on this topic.MethodsArticles and reviews on the roles of inflammation and immunity in VC were obtained from the Web of Science Core Collection on August 5, 2022. Four scientometric software packages—HistCite, CiteSpace, VOSviewer, and R-bibliometrix—were used for the bibliometric and knowledge mapping analyses.ResultsThe obtained 1,868 papers were published in 627 academic journals by 9,595 authors of 2,217 institutions from 69 countries. The annual number of publications showed a clear growth trend. The USA and China were the most productive countries. Karolinska Institutet, Harvard University, and the University of Washington were the most active institutions. Stenvinkel P published the most articles, whereas Demer LL received the most citations. Atherosclerosis published the most papers, while Circulation was the most highly cited journal. The largest cluster among the 22 clusters, based on the analysis of co-citations, was osteo-/chondrogenic transdifferentiation. “Vascular calcification,” “inflammation,” “chronic kidney disease,” and “expression” were the main keywords in the field. The keyword “extracellular vesicle” attracted great attention in recent years with the strongest citation burst.ConclusionsOsteo-/chondrogenic transdifferentiation is the primary research topic in this field. Extracellular vesicles are expected to become a new research focus for exploring the inflammatory and immune mechanisms of VC

Global disease burden linked to diet high in red meat and colorectal cancer from 1990 to 2019 and its prediction up to 2030

Abstract Numerous studies have already identified an association between excessive consumption of red meat and colorectal cancer (CRC). However, there has been a lack of detailed understanding regarding the disease burden linked to diet high in red meat and CRC. Our objective was to evaluate global, regional, and national mortality rates and disability-adjusted Life years (DALYs) related to this diet. We also considered factors such as sex, age, the socio-demographic index (SDI), and evaluated the cross-national inequalities. Furthermore, we utilized DALYs data from 204 countries and regions to gauge cross-country inequalities of CRC by calculating the slope index of inequality and concentration index as standard indicators of absolute and relative inequalities. Our data was derived from the Global Burden of Disease (GBD) Study 2019. The results show that globally, the ASMR and ASDR related to CRC due to diet high in red meat have decreased, with EAPCs of -0.32% (95% CI -0.37 to -0.28) and -0.18% (95% CI -0.25 to -0.11). Notably, the burden was higher among males and the elderly. The slope index of inequality rose from 22.0 (95% CI 18.1 to 25.9) in 1990 to 32.9 (95% CI 28.3 to 37.5) in 2019 and the concentration index fell from 59.5 (95% CI 46.4 to 72.6) in 1990 to 48.9 (95% CI 34.6 to 63.1) in 2019. We aim to offer evidence-based guidance for developing effective strategies that can mitigate the elevated CRC burden in certain countries. Keywords: colorectal cancer, red meat, Global Burden of Disease, mortality, disability-adjusted life years, health inequality, epidemiolog

Seismic Fragility of Chinese Light-Gauge Steel Keel Gypsum Board Partition Walls

A quasi-static experimental program of light-gauge steel keel gypsum board partition walls (LSKGBPW) was carried out to evaluate the seismic damage phenomena, failure mechanisms, and fragility. The 15 specimens in five groups were designed per current Chinese codes and engineering practice. Then, three damage states were defined based on the damage and repair measures, and the fragility data of each group were presented, providing basic data for the estimation of seismic damage and consequential loss of nonstructural components

Opioid-free anesthesia with ultrasound-guided quadratus lumborum block in the supine position for lower abdominal or pelvic surgery: a randomized controlled trial

Abstract In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People’s Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a “human eye” and “baby in a cradle” under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SPO2, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia

Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19

BACKGROUND: Patients with Coronavirus Disease 2019(COVID-19) will experience high levels of anxiety and low sleep quality due to isolation treatment. Some sleep-improving drugs may inhibit the respiratory system and worsen the condition. Prolonged bedside instruction may increase the risk of medical infections. OBJECTIVE: To investigate the effect of progressive muscle relaxation on anxiety and sleep quality of COVID-19. METHODS: In this randomized controlled clinical trial, a total of 51 patients who entered the isolation ward were included in the study and randomly divided into experimental and control groups. The experimental group used progressive muscle relaxation (PMR) technology for 30 min per day for 5 consecutive days. During this period, the control group received only routine care and treatment. Before and after the intervention, the Spielberger State-Trait Anxiety Scale (STAI) and Sleep State Self-Rating Scale (SRSS) were used to measure and record patient anxiety and sleep quality. Finally, data analysis was performed using SPSS 25.0 software. RESULTS: The average anxiety score (STAI) before intervention was not statistically significant (P = 0.730), and the average anxiety score after intervention was statistically significant (P &lt; 0.001). The average sleep quality score (SRSS) of the two groups before intervention was not statistically significant (P = 0.838), and it was statistically significant after intervention (P &lt; 0.001). CONCLUSION: Progressive muscle relaxation as an auxiliary method can reduce anxiety and improve sleep quality in patients with COVID-19

Failure modes for reticulated domes under diverse impact

p. 1813-1822FE models of both the single-layer Kiewitt-8 reticulated domes with a span of 60m and the cylindrical impactor were developed incorporating ANSYS/LS-DYNA. Afterward, fourteen groups impact are simulated by changing the impact position or impacted angle on reticulated dome, and impact velocity and mass of impactor are changed for each group impact. On the basis of large numbers of numerical simulations, characteristics of dynamic response for reticulated dome under impact are shown. And four failure modes (Members slightly damaged, Local collapse of dome, Global collapse of dome, Members shear failed) are presented for single-layer Kiewitt-8 reticulated dome under diverse impact. The distributing of failure modes for the fourteen types impact are different from each other, and the adverse position and angle are summrized.Fan, F.; Wang, D.; Zhi, X.; Tan, S.; Shen, S. (2009). Failure modes for reticulated domes under diverse impact. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/681

Adaptive pseudospectral successive convex optimization for six-degree-of-freedom powered descent guidance

Guidance for six-degrees-of-freedom powered descent is more challenging due to its stronger nonlinearity compared to three-degrees-of-freedom. The standard convex programming algorithm has been difficult to effectively address this problem. To enhance the performance of successive convex programming in terms of both optimality and accuracy, an adaptive pseudospectral successive convex optimization algorithm is proposed in this paper. First, it transforms the nonlinear optimal control problem into a convex subproblem by integrating global pseudospectral discretization with local linearization. Second, a parameter-adaptive successive convexification algorithm is proposed, which adaptively adjusts the trust region size based on the update rate of the optimal trajectory. Last, the global error and local error are accurately calculated based on the pseudospectral method. To tackle the issue of excessively large local errors caused by nonlinearity, an adaptive grid method is proposed to refine the mesh grid. Simulation results demonstrate the efficacy of the proposed pseudospectral convex optimization method and adaptive mesh grid method in reducing local errors and improving solution accuracy. Furthermore, the proposed parameter-adaptive successive convex optimization algorithm exhibits adaptability and optimality across different initial conditions, while also improving solution accuracy