Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.

Long interspersed nuclear element ORF-1 protein promotes proliferation and resistance to chemotherapy in hepatocellular carcinoma

AIM:To clarify the specific roles and mechanisms of long interspersed nuclear element-1 ORF-1 protein [human long interspersed nuclear element-1(LINE-1),ORF-1p] in chemotherapeutic drug resistance and cell proliferation regulation in hepatocellular carcinoma(HCC) cells.METHODS:MTT assays were performed to identify the effect of the chemotherapeutic drug toxicity on HepG2 cells.Cell proliferation inhibition and the IC 50 were calculated by the Origin 8.0 software.Western blotting assays were performed to investigate whether LINE-1 ORF-1p modulates the expression of some important genes,including p53,p27,p15,Bcl-2,mdr,and p-gp.To corroborate the proliferation and anchor-independent growth results,the HepG2 cells were analyzed by flow cytometry to investigate the effect of LINE-1 ORF1p on the apoptosis regulation.RESULTS:LINE-1 ORF-1p contributed to the resistance to several chemotherapeutic drugs(cisplatin and epirubicin) in HepG2 cells.The IC 50 of the epirubicin and cisplatin increased from 36.04 nmol/L to 59.11 nmol/L or from 37.94 nmol/L to 119.32 nmol/L.Repression of LINE-1 ORF-1p expression by the siRNA could markedly enhance the response of HepG2 cells to the epirubicin and cisplatin.The IC 50 correspondingly decreased from 28.06 nmol/L to 3.83 nmol/L or from 32.04 nmol/L to 2.89 nmol/L.Interestingly,down-regulation of LINE-1 ORF-1p level by siRNA could promote the response of HepG2 cells to the paclitaxel.The IC 50 decreased from 35.90 nmol/L to 7.36 nmol/L.However,overexpression of LINE-1 ORF-1p did not modulate the paclitaxel toxicity in HepG2 cells.Further Western blotting revealed that LINE-1 ORF-1p enhanced mdr and p-gp gene expression.As a protein arrested in the nucleus,LINE-1 ORF-1p may function through modulating transcriptional activity of some important transcription factors.Indeed,LINE-1 ORF-1p promoted HepG2 cell proliferation,anchor-independent growth and protected the cells against apoptosis through modulating the expression of p15,p21,p53,and Bcl-2 genes.CONCLUSION:LINE-1 ORF-1p promotes HepG2 cell proliferation and plays an important role in the resistance of chemotherapeutic drugs.By establishing novel roles and defining the mechanisms of LINE-1 ORF1p in HCC chemotherapeutic drug resistance and cell proliferation regulation,this study indicates that LINE-1 ORF-1p is a potential target for overcoming HCC chemotherapeutic resistance.

Influence of chloride salts on hydrogen generation via hydrolysis of MgH_2 prepared by hydriding combustion synthesis and mechanical milling

The effects of chloride salts(NaCl,MgCl2and NH4Cl)on the hydrolysis kinetics of MgH2prepared by hydridingcombustion synthesis and mechanical milling(HCS+MM)were discussed.X-ray diffraction(XRD)analyses show that high-purityMgH2was successfully prepared by HCS.Hydrolysis performance test results indicate that the chloride salt added during the millingprocess is favorable to the initial reaction rate and hydrogen generation yield within60min.A MgH2?10%NH4Cl composite exhibitsthe best performance with the hydrogen generation yield of1311mL/g and a conversion rate of85.69%in60min at roomtemperature.It is suggested that the chloride salts not only play as grinding aids in the milling process,but also create fresh surface ofreactive materials,favoring the hydrolysis reaction.

Synthesis of highly stable Ni nanoparticles via electrostatic self-assembly for enhanced hydrogen storage of MgH_(2)

Magnesium-based hydrides have been widely recognized as an appropriate choice for solid-state hydrogen storage.However,its undesirable thermodynamics and sluggish hydrogenation/dehydrogenation kinetics are major bottlenecks for its application.Herein,a highly stable and highly dispersed Ni-based catalyst(Ni/Al_(2)O_(3)/GN)was fabricated to promote the hydrogen storage performance of MgH_(2)via the electrostatic effect of NiAl-LDH/GN precursor with a co-calcination reduction process.MgH_(2)-5wt%Ni/Al_(2)O_(3)/GN exhibits excellent hydrogen storage performance,releasing about 5.7 wt%hydrogen in 3500 s at 250℃,and can reach a saturation hydrogen absorption of about 6.15 wt%in 3000 s at 100℃.Furthermore,it also shows low dehydrogenation apparent activation energy of 89.1 and 118.2 kJ·mol^(-1).Impressively,the catalyst ensures the stability of both the physical phase and structure during ball milling and cycling process.The role of each phase in Ni/Al_(2)O_(3)/GN on the hydrogen storage performance of MgH_(2)was also discussed through experiments and theoretical calculation,and the synergistic catalytic mechanism of Ni/Al_(2)O_(3)/GN was clearly elaborated.This work provides a unique perspective for the preparation of highly stable and highly dispersible catalysts.

Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device： An Exploratory Feasibility Study in vitro

Background：A single drilled tunnel from the lateral mastoid cortex to the cochlea via the facial recess is essential for minimally invasive cochlear implant surgery.This study aimed to explore the safety profile of this kind of new image-guided and bi-planar device-assisted surgery procedure in vitro.Methods：Image-guided minimally invasive cochlear implantations were performed on eight cadaveric temporal bone specimens.The main procedures were：（1） temporal bone specimens were prepared for surgery and fiducial markers were registered.（2） computed tomography （CT） scans were performed for future reference.（3） CT scan images were processed and drill path was planned to minimize cochlear damage.（4） bi-planar device-assisted drilling was performed on the specimens using the registration.（5） surgical safety was evaluated by calculating the deviation between the drill and the planned paths,and by measuring the closest distance between the drilled path and critical anatomic structures.Results：Eight cases were operated successfully to the basal turn of the cochlear with intact facial nerves （FNs）.The deviations from target points and entrance points were 0.86 mm （0.68-1.00 mm） and 0.44 mm （0.30-0.96 mm）,respectively.The angular error between the planned and the drilled trajectory was 1.74° （1.26-2.41°）.The mean distance from the edge of the drilled path to the FN and to the external canal was 0.60 mm （0.35-0.83 mm） and 1.60 mm （1.30-2.05 mm）,respectively.In five specimens,the chorda tympani nerves were well preserved.In all cases,no injury happened to auditory ossicles.Conclusions：This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures.Further,more in vitro experiments are needed to improve the system operation and its safety.

Phase transformation and thermal analysis during combustion synthesis of Mg_(17)Al_(12) alloy

The Mg-A1 hydrogen storage alloy was suc- cessfully prepared by combustion synthesis （CS） method. The formation of alloy phases during the CS process was studied using X-ray diffraction （XRD）, scanning electron microscope （SEM）, and differential scanning calorimetry （DSC）. When the time increases from 0, 0.5, 1.0 to 2.0 h at 733 K, the products are Mg and A1; Mg2A13, Mg and A1; Mgl7All2, Mg2A13; and Mg; and eventually only MgI7A112, respectively. Combined with three peaks in the DSC traces, it is concluded that the formation of MglyAll2 during the CS includes three processes, namely, the formation of MgzA13 first; then the unsaturated solid solution, MglvAla2; and finally the complete MglvA112 alloy. The formation of MgzA13 prior to MglvA112 in this work is different from those prepared by mechanical alloying. This is thought to be related to the instant high temperature during the ther- mal explosion of CS.