Safety and efficacy of esketamine for postoperative analgesia in pediatric patients with hypospadias

ObjectiveTo explore the safety and efficacy of the combination of continuous intravenous infusion of esketamine with sacral block for postoperative analgesia in pediatric patients undergoing surgery for hypospadiasMethodsPediatric patients (n = 77) undergoing surgery for hypospadias were randomized into two groups: a hydromorphone group (H group, initial dose, 0.02 mg/kg; maintenance dose, 0.01 mg/kg/h) or an esketamine group (E group, initial dose, 0.3 mg/kg; maintenance dose 0.15 mg/kg/h). Caudal epidural block involved injection of 0.2% ropivacaine 1 ml/kg through the sacral hiatus. Age, weight, grade of hypospadias, intraoperative blood loss, operative time, and awaking time of patients were recorded. The Face, Legs, Activity, Cry and Consolability (FLACC) scale and Ramsay sedation scores were recorded when leaving the PACU (0 h) and at postoperative 2, 6, 12, 24, 36, and 48 h. The Pediatric Anesthesia Emergence Delirium Scale (PAED), incidence of hypotension, respiratory depression, nausea and vomiting and pruritus, and the time to first bowel movement after surgery were recorded.ResultsThere were no significant differences in demographic and clinical characteristics between the H group and the E group. There were no significant differences in FLACC scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in intra-group and inter-group comparisons. There were no significant differences in Ramsay sedation scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in the intra-group comparisons. Ramsay sedation scores were significantly lower at postoperative 2, 12, and 36 h in the H group compared to the E group. There were no significant differences in the PAED scale or incidence of nausea and vomiting or pruritus between the H group and the E group. The incidence of hypotension and respiratory depression was significantly lower, and the time to first bowel movement was significantly shorter in the E group compared to the H group. Urinary tryptophan, 5-hydroxytryptamine and substance P levels were significantly lower but arginine was significantly higher in the E group compared to the H group.ConclusionsThe combination of continuous intravenous infusion of esketamine with sacral block provided safe and effective postoperative analgesia for pediatric patients undergoing surgery for hypospadias.Trial registrationChinese Clinical Trial Register ChiCTR2200066967. Clinical trial registry URL: http://www.chictr.org.cn/edit.aspx?pid=185042&htm=

Flame-Retardant and Thermal Degradation Mechanism of Caged Phosphate Charring Agent with Melamine Pyrophosphate for Polypropylene

An efficient caged phosphate charring agent named PEPA was synthesized and combined with melamine pyrophosphate (MPP) to flame-retard polypropylene (PP). The effects of MPP/PEPA on the flame retardancy and thermal degradation of PP were investigated by limiting oxygen index (LOI), vertical burning test (UL-94), cone calorimetric test (CCT), and thermogravimetric analysis (TGA). It was found that PEPA showed an outstanding synergistic effect with MPP in flame retardant PP. When the content of PEPA was 13.3 wt% and MPP was 6.7 wt%, the LOI value of the flame retardant PP was 33.0% and the UL-94 test was classed as a V-0 rating. Meanwhile, the peak heat release rate (PHRR), average heat release rate (AV-HRR), and average mass loss rate (AV-MLR) of the mixture were significantly reduced. The flame-retardant and thermal degradation mechanism of MPP/PEPA was investigated by TGA, Fourier transform infrared spectroscopy (FTIR), TG-FTIR, and scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDXS). It revealed that MPP/PEPA could generate the triazine oligomer and phosphorus-containing compound radicals which changed the thermal degradation behavior of PP. Meanwhile, a compact and thermostable intumescent char was formed and covered on the matrix surface to prevent PP from degrading and burning

A comprehensive two-sample Mendelian randomization analysis of trigeminal neuralgia and modifiable risk factors

ObjectiveTo conduct a comprehensive search and causality study of potential modifiable risk factors for trigeminal neuralgia. To provide new ideas for subsequent treatment and management of patients with trigeminal neuralgia.MethodsData were obtained from large GWAS databases and then analyzed by Mendelian randomization analysis. The causal relationship between 36 potentially modifiable risk factors and trigeminal neuralgia was explored based on the results of the inverse variance weighting method(IVW). p < 0.05 was considered statistically significant.ResultsYears of schooling [OR (95%CI), 0.59(0.42–0.84), p = 0.003] to be a significant protective factor. Anxiety disorders [OR (95%CI), 1.62(1.05–2.48), p = 0.028], Depression [OR (95%CI), 1.53(1.03–2.28), p = 0.035] and Autoimmune [OR (95%CI), 1.16(1.01–1.32), p = 0.033] were significant risk factors. Sleep duration [OR (95%CI), 0.43(0.18–1.01), p = 0.051] was a close protective factor. Body mass index [OR (95%CI), 1.24(0.98–1.57), p = 0.077] was a close risk factor.ConclusionMendelian randomization analysis shows Years of schooling and Sleep duration as protective factors. Anxiety disorders, Depression, Autoimmune, and Body mass index are risk factors. This will help in the research of diagnosis, treatment, and mechanism of trigeminal neuralgia. And reduce the prevalence of trigeminal neuralgia through positive psychological and lifestyle interventions

Trigeminal neuralgia associated with dural arteriovenous fistula: a case report and literature reviews

Trigeminal neuralgia is a paroxysmal, intense electric shock-like, or knife-like, recurrent pain that affects one or more sense areas of the unilateral facial trigeminal nerve. It can be classified into two groups from an etiological standpoint: primary and secondary. The pain episodes brought on by such vascular compression are still categorized as primary trigeminal neuralgia, despite the fact that microvascular compression of the trigeminal nerve root has now been demonstrated to be the primary cause. A rare and complicated condition known as a dural arteriovenous fistula (DAVF) can irritate the Gasserian ganglion or compress the trigeminal nerve’s root entry zone (REZ), leading to secondary trigeminal neuralgia (TN). At present, the treatment of DAVF-induced trigeminal neuralgia is not conclusive. This article reports a case of DAVF-induced trigeminal neuralgia cured by MVD and reviews the relevant literature

Transcriptome and digital gene expression analysis reveal immune responses of mantle and visceral mass pearl culturing in Hyriopsis cumingii

Biomineralization is a widespread phenomenon in marine mollusks and is responsible for the production of shells and pearls. However, the regulatory mechanisms governing the adaptive immune responses in the mollusk mantle and visceral mass during mineralization remain unclear. In this work, we examined the mantle and visceral mass immune responses of Hyriopsis cumingii during pearl culture using high-throughput sequencing techniques. A mantle transcriptome database was established using transcriptome sequencing technology and reference to the major databases. Digital gene expression profiling was used to identify the differentially expressed genes of mantle and visceral mass at different insertion periods. Moreover, quantitative real-time PCR was used to verify the expression of five immune-related genes. Transcriptome sequencing results showed 257,457 unigenes were identified. Digital gene expression profiles showed 1389, 3572, 1888, and 2613 differentially expressed genes (DEGs) in the mantle and visceral mass at 5, 20, 50, and 90 d after insertion, respectively, with the highest number at 20 d and the lowest at 5 d after insertion (q < 0.05). A cluster analysis of the DEGs showed similar clustering and expression features in the mantle to the control group, and at 5, 50 and 90 d, after mantle insertion. The DEGs in the visceral mass showed similar clustering and expression features to the control group and at 5, 20 and 50 d after insertion. We also screened 22 immune-related DEGs in the mantle and visceral mass during the same pearl culture period, including serine/threonine-protein kinase NLK, C-type lectin, and galectin. The greatest number of DEGs was found 90 d after insertion. Compared with the mantle, more immune-related DEGs were down-regulated than up-regulated in the visceral mass during pearl culture, indicating that the immune regulatory mechanisms in the visceral mass and the mantle differ during pearl culture, and that the visceral mass is liable to higher infection and mortality rates. Quantitative real-time PCR results showed that the expression of five immune-related genes was consistent with DGE results. Our findings will further knowledge of the immune systems that are present in the mantle and visceral mass during pearl culture

Anaerobic Wastewater Treatment from Finnish Forest Industry : VFA Analysis - The acidic wastewater effect on vola-tile fatty acids concentration

METVI, the efficient waste water pre-treatment project for forest industry wastewater is to strengthen the wastewater treatment process of paper mills. It is to reduce organic load in wastewater by more cost-effectively and significantly and improve the energy efficiency of the process. Influent is the wastewater from Finnish forest industry. Recycled plant wastewater and part of debarking plant wastewater (very acidic one) is operated and added in the influent. These two types of wastewater are rich in COD. The measurement of volatile fatty acids is the key to the experiment. In this study, the samples from influent, reactor 1, reactor 2, and effluent was done monitoring analyses by the anaerobic wastewater treatment: VFA analysis method. The ultimate aim of it is to reduce sludge management and recover energy in the form of biogas. The direct purpose is not only to investigate how different ratios of recycled plant wastewater and debarking plant wastewater influences the activity of biogas process, but also to evaluate the methanogenic bacteria from point the view of how the acidic wastewater effect of water volatile fatty acids concen-tration. As a result of this, experiments show that with the increasing of debarking plant wastewater, acetic acid propionic acid, ethanol, butanediol and other organic matter also increased. The energy and carbon sources of methanogenic bacteria increased, the production of methane increased. This is an advantage of increasing the proportion of de-barking plant wastewater. At the same time, if the ratios of debarking plant wastewater is increased too much, the pH of the influent would reduced too much. The balance of the original bacteria would be destroyed. If an imbal-ance occurs, the amount of volatile fatty acids produced by acid bacteria would increased. Increasing VFA would cause pH decreases to a harmfully low level. This may weaken the activity of methanogens and may completely stop the production process. Because the optimum pH range for methanogens is between 6.8 and 7.2 (Cioabla, Ionel, Dumitrel and Popescu, 2012)