Neuroendocrine,epigenetic,and intergenerational effects of general anesthetics

The progress of modern medicine would be impossible without the use of general anesthetics(GAs).Despite advancements in refining anesthesia approaches,the effects of GAs are not fully reversible upon GA withdrawal.Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly.Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research,but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects.The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents,which are far more extensively studied than any other species.Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated.Specifically,we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities(somatic effects),but also epigenetic reprogramming of germ cells(germ cell effects).The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring,who may be affected even at levels of anesthesia that are not harmful to the exposed parents.The large number of patients who require general anesthesia,the even larger number of their future unexposed offspring whose health may be affected,and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs.In this mini review,we discuss emerging experimental findings on neuroendocrine,epigenetic,and intergenerational effects of GAs.

Designing General Anesthetics That Have a Better Safety Profile

General anesthetics constitute some of the most important and widely-used therapeutic drugs in the pharmacotherapeutic armamentarium. They are routinely used effectively and with adequate precaution-safety throughout the world for a multitude of clinical applications, predominantly as adjunctive agents for surgical procedures. Nevertheless, they have potential adverse effects (such as a drop in blood pressure and the inhibition of steroid production), particularly in vulnerable populations such as the very young and the frail elderly. It would be desirable therefore to have alternative agents that are just as efficacious, but have a better safety profile in a broader spectrum of patients. Toward this end, an anesthetic based on a unique chemical core (viz., an N-arylpyrrole derivative) has been reported in preclinical models to produce anesthetic effects without hemodynamic suppression. This lead could pave the way for new general anesthetics that are safer and easier to use.

Anesthesia,Anesthetics,and Postoperative Cognitive Dysfunction in Elderly Patients

Postoperative cognitive dysfunction(POCD)remains a major issue that worsens the prognosis of elderly surgery patients.This article reviews the current research on the effect of different anesthesia methods and commonly utilized anesthetics on the incidence of POCD in elderly patients,aiming to provide an understanding of the underlying mechanisms contributing to this condition and facilitate the development of more reasonable anesthesia protocols,ultimately reducing the incidence of POCD in elderly surgery patients.

Higher-order expansions of powered extremes of logarithmic general error distribution

In this paper,Let M_(n)denote the maximum of logarithmic general error distribution with parameter v≥1.Higher-order expansions for distributions of powered extremes M_(n)^(p)are derived under an optimal choice of normalizing constants.It is shown that M_(n)^(p),when v=1,converges to the Frechet extreme value distribution at the rate of 1/n,and if v>1 then M_(n)^(p)converges to the Gumbel extreme value distribution at the rate of(loglogn)^(2)=(log n)^(1-1/v).

Inhaled volatile anesthetics in the intensive care unit

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century.Recently,a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres,finding diverse applications in intensive care settings.In the dynamic landscape of intensive care,volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements,managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus,conditions of high sedative requirements including burns,high opioid or alcohol use and neurological conditions such as status epilepticus.Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry,providing intensivists with multiple options to tailor therapy.Furthermore,their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy,mitigating risks associated with conventional sedation modalities.Despite the amounting enthusiasm for the use of these therapies,barriers to widespread utilization include expanding equipment availability,staff familiarity and training of safe use.This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology,administration considerations in intensive care settings,complication considerations,and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

Pathological and Etiological Aspects of Nephrotic Syndrome at the Niamey General Reference Hospital

Introduction: Studies have been conducted on nephrotic syndrome in Niger. The study aimed to determine the histological and etiological aspects of nephrotic syndrome. Patients and Method: This was a retrospective study from February 1st, 2018 to January 31st, 2024. All patients with nephrotic syndrome who underwent renal biopsy were included. Samples were analyzed at the anatomy-cytology pathology laboratory of the Faculty of Medicine in Dakar (Senegal). The variables studied included clinical, biological, histological and etiological characteristics. Data were analyzed using Excel 2013 and Epi-info 7.2.0 software. Results: The study included 119 patients with nephrotic syndrome. Prevalence of nephrotic syndrome was 11.24%. The male-to-female ratio was 2.25:1. The mean age at diagnosis was between 34.5 ± 18.84 years. Edema was the reason for admission in 40.34% of cases. The nephrotic syndrome was impure in 63.86% of cases. Nine histological lesions were identified. Focal and segmental glomerulosclerosis (40.09%), minimal change disease (23.53%), membranous nephropathy (13.45%), diabetic nephropathy (10.92%), membranous proliferative glomerulonephritis (3.36%), acute glomerulonephritis (3.36%), glomerular thrombotic microangiopathy (2.52%), non-IgA mesengial proliferative glomerulonephritis (1.68%) and amyloidosis (0.84%). Nephrotic syndrome was primary in 57.98% of cases. Secondary etiologies were dominated by diabetes (11.76%), followed by hepatitis B virus (9.24%), lupus, lymphoma, malaria, syphilis, cryoglobulinemia, sickle cell disease and HIV. Conclusion: Future studies should investigate the causes of glomerulopathy secondary to chronic tubulointerstitial lesions.

On the Vacuum Hydrodynamics of Moving Bodies—The Theory of General Singularity

The Theory of General Singularity is presented, unifying quantum field theory, general relativity, and the standard model. This theory posits phonons as fundamental excitations in a quantum vacuum, modeled as a Bose-Einstein condensate. Through key equations, the role of phonons as intermediaries between matter, energy, and spacetime geometry is demonstrated. The theory expands Einsteins field equations to differentiate between visible and dark matter, and revises the standard model by incorporating phonons. It addresses dark matter, dark energy, gravity, and phase transitions, while making testable predictions. The theory proposes that singularities, the essence of particles and black holes, are quantum entities ubiquitous in nature, constituting the very essence of elementary particles, seen as micro black holes or quantum fractal structures of spacetime. As the theory is refined with increasing mathematical rigor, it builds upon the foundation of initial physical intuition, connecting the spacetime continuum of general relativity with the hydrodynamics of the quantum vacuum. Inspired by the insights of Tesla and Majorana, who believed that physical intuition justifies the infringement of mathematical rigor in the early stages of theory development, this work aims to advance the understanding of the fundamental laws of the universe and the perception of reality.

Extended wet sieving method for determination of complete particle size distribution of general soils

The traditional standard wet sieving method uses steel sieves with aperture?0.063 mm and can only determine the particle size distribution(PSD)of gravel and sand in general soil.This paper extends the traditional method and presents an extended wet sieving method.The extended method uses both the steel sieves and the nylon filter cloth sieves.The apertures of the cloth sieves are smaller than 0.063 mm and equal 0.048 mm,0.038 mm,0.014 mm,0.012 mm,0.0063 mm,0.004 mm,0.003 mm,0.002 mm,and 0.001 mm,respectively.The extended method uses five steps to separate the general soil into many material sub-groups of gravel,sand,silt and clay with known particle size ranges.The complete PSD of the general soil is then calculated from the dry masses of the individual material sub-groups.The extended method is demonstrated with a general soil of completely decomposed granite(CDG)in Hong Kong,China.The silt and clay materials with different particle size ranges are further examined,checked and verified using stereomicroscopic observation,physical and chemical property tests.The results further confirm the correctness of the extended wet sieving method.

A nonlocal dispersal and time delayed HIV infection model with general incidences

Biologically,because of the impact of reproduction period and nonlocal dispersal of HIV-infected cells,time delay and spatial heterogeneity should be considered.In this paper,we establish an HIV infection model with nonlocal dispersal and infection age.Moreover,applying the theory of Fourier transformation and von Foerster rule,we transform the model to an integrodifferential equation with nonlocal time delay and dispersal.The well-posedness,positivity,and boundedness of the solution for the model are studied.

NORMALIZED SOLUTIONS FOR THE GENERAL KIRCHHOFF TYPE EQUATIONS

In the present paper,we prove the existence,non-existence and multiplicity of positive normalized solutions(λ_(c),u_(c))∈ℝ×H^(1)(ℝ^(N))to the general Kirchhoff problem-M\left(\int_{\mathbb{R}^N}\vert\nabla u\vert^2{\rm d}x\right)\Delta u+\lambda u=g(u)~\hbox{in}~\mathbb{R}^N,u\in H^1(\mathbb{R}^N),N\geq 1,satisfying the normalization constraint\int_{\mathbb{R}^N}u^2{\rm d}x=c,where M∈C([0,∞))is a given function satisfying some suitable assumptions.Our argument is not by the classical variational method,but by a global branch approach developed by Jeanjean et al.[J Math Pures Appl,2024,183:44–75]and a direct correspondence,so we can handle in a unified way the nonlinearities g(s),which are either mass subcritical,mass critical or mass supercritical.

Image Steganography by Pixel-Value Differencing Using General Quantization Ranges

A new steganographic method by pixel-value differencing(PVD)using general quantization ranges of pixel pairs’difference values is proposed.The objective of this method is to provide a data embedding technique with a range table with range widths not limited to powers of 2,extending PVD-based methods to enhance their flexibility and data-embedding rates without changing their capabilities to resist security attacks.Specifically,the conventional PVD technique partitions a grayscale image into 1×2 non-overlapping blocks.The entire range[0,255]of all possible absolute values of the pixel pairs’grayscale differences in the blocks is divided into multiple quantization ranges.The width of each quantization range is a power of two to facilitate the direct embedding of the bit information with high embedding rates.Without using power-of-two range widths,the embedding rates can drop using conventional embedding techniques.In contrast,the proposed method uses general quantization range widths,and a multiple-based number conversion mechanism is employed skillfully to implement the use of nonpower-of-two range widths,with each pixel pair being employed to embed a digit in the multiple-based number.All the message bits are converted into a big multiple-based number whose digits can be embedded into the pixel pairs with a higher embedding rate.Good experimental results showed the feasibility of the proposed method and its resistance to security attacks.In addition,implementation examples are provided,where the proposed method adopts non-power-of-two range widths and employsmultiple-based number conversion to expand the data-hiding and steganalysis-resisting capabilities of other PVD methods.

Intelligent Transformation: General Intelligence Theory

This paper aims to formalize a general definition of intelligence beyond human intelligence. We accomplish this by re-imagining the concept of equality as a fundamental abstraction for relation. We discover that the concept of equality = limits the sensitivity of our mathematics to abstract relationships. We propose a new relation principle that does not rely on the concept of equality but is consistent with existing mathematical abstractions. In essence, this paper proposes a conceptual framework for general interaction and argues that this framework is also an abstraction that satisfies the definition of Intelligence. Hence, we define intelligence as a formalization of generality, represented by the abstraction ∆∞Ο, where each symbol represents the concepts infinitesimal, infinite, and finite respectively. In essence, this paper proposes a General Language Model (GLM), where the abstraction ∆∞Ο represents the foundational relationship of the model. This relation is colloquially termed “The theory of everything”.

A NOTE ON THE GENERAL STABILIZATION OF DISCRETE FEEDBACK CONTROL FOR NON-AUTONOMOUS HYBRID NEUTRAL STOCHASTIC SYSTEMS WITH A DELAY

Discrete feedback control was designed to stabilize an unstable hybrid neutral stochastic differential delay system(HNSDDS) under a highly nonlinear constraint in the H_∞ and exponential forms.Nevertheless,the existing work just adapted to autonomous cases,and the obtained results were mainly on exponential stabilization.In comparison with autonomous cases,non-autonomous systems are of great interest and represent an important challenge.Accordingly,discrete feedback control has here been adjusted with a time factor to stabilize an unstable non-autonomous HNSDDS,in which new Lyapunov-Krasovskii functionals and some novel technologies are adopted.It should be noted,in particular,that the stabilization can be achieved not only in the routine H_∞ and exponential forms,but also the polynomial form and even a general form.

Cost Control Strategies for Hubei General Highway Greening Project

In order to respond to the national policy of focusing on the service of building a new development pattern and promoting high-quality development,and to reduce the cost of greening projects while ensuring the effect of highway landscape,a process and cost control points of highway greening design,construction,and maintenance are summarized through a review of the literature.Additionally,this paper examines the attributes of highway greening and proposes cost control strategies that are aligned with these attributes.It is proposed that the implementation of cost control strategies for highway greening should commence at the project establishment phase,with the objective of establishing a comprehensive and effective cost management control system.While guaranteeing the greening landscape effect and the duration of the project,it is essential to regulate the crucial nodes in each phase of the design,construction,and maintenance process.Furthermore,it is vital to facilitate close collaboration between all parties involved,thereby reducing costs,conserving resources,and lowering energy consumption.This approach can also lead to enhanced economic and social benefits for highway greening projects.

Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.

Epidemiological, Clinical Aspects and Factors Associated with Typical Gastroesophageal Reflux Disease in the General Population of Parakou, Republic of Benin

Introduction: Gastroesophageal reflux disease (GERD) is a benign and chronic disease that can impair the quality of life. Objective: To study the epidemiological, clinical aspects and factors associated with typical GERD in the general population of Parakou in the Republic of Benin. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection which took place from May 1, 2019 to June 30, 2019. The study population consisted of any subject aged at least 15 years and living in Parakou. Subjects aged at least 15 years, present on the day of the survey and having given their free and informed verbal consent were included. The Short form of QRS®(Reflux-Qual Short form) questionnaire and the “Hospital Anxiety and Depression” score were used to assess the quality of life and anxiety/depression, respectively. The sampling was probabilistic through a 2-stage cluster sampling. The variable of interest was the presence of GERD. Results: Out of 390 subjects surveyed, 28 had symptoms of typical GERD, representing a prevalence of 7.18%. The average age of these subjects was 27.11 ± 7.88 years. Fifteen subjects (53.57%) were male, giving a sex ratio of 1.15. Fourteen (50%) had a secondary level of education, 12 (42.86%) were pupils/students, 18 (64.29%) were single. The monthly income of 22 subjects (78.57%) was lower than the guaranteed interprofessional minimum wage (40,000 FCFA). The average duration of progression of symptoms was 15.89 ± 4.97 months. Symptoms occurred less than twice a week in 22 subjects (78.57%). The clinical manifestations were both diurnal and nocturnal in 12 subjects (42.86%). None of the 28 subjects with GERD had clinical warning signs. Asthma, diabetes, consumption of high fat or spice foods, carbonated drinks, non-steroidal anti-inflammatory drugs, alcoholic beverages and tobacco were statistically associated with the occurrence of GERD. Each of the 28 subjects had at least one associated factor. A significant impair in quality of life was observed in 27 patients (96.43%). Conclusion: Typical GERD is relatively common in the general population of Parakou in the Republic of Benin. It often affects young males. Among the risk factors identified, the most common are carbonated drinks, spicy meals and diabetes. GERD significantly impairs quality of life. Raising awareness about the disease and its associated factors is necessary among the general population.

“Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Primary Healthcare General Practice—An Open-Label Cohort Study Measuring Montgomery-Åsberg Depression Rating Scale (MADRS-S) Outcomes

Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

New Approach to Synchronize General Relativity and Quantum Mechanics with Constant “K”-Resulting Dark Matter as a New Fundamental Force Particle

Planck scale plays a vital role in describing fundamental forces. Space time describes strength of fundamental force. In this paper, Einstein’s general relativity equation has been described in terms of contraction and expansion forces of space time. According to this, the space time with Planck diameter is a flat space time. This is the only diameter of space time that can be used as signal transformation in special relativity. This space time diameter defines the fundamental force which belongs to that space time. In quantum mechanics, this space time diameter is only the quantum of space which belongs to that particular fundamental force. Einstein’s general relativity equation and Planck parameters of quantum mechanics have been written in terms of equations containing a constant “K”, thus found a new equation for transformation of general relativity space time in to quantum space time. In this process of synchronization, there is a possibility of a new fundamental force between electromagnetic and gravitational forces with Planck length as its space time diameter. It is proposed that dark matter is that fundamental force carrying particle. By grand unification equation with space-time diameter, we found a coupling constant as per standard model “αs” for that fundamental force is 1.08 × 10-23. Its energy calculated as 113 MeV. A group of experimental scientists reported the energy of dark matter particle as 17 MeV. Thorough review may advance science further.

Exploration of the Integration of Curriculum Ideology and Politics into the Educational Pathway of Standardized Training for General Practice Residents

In recent years,the national higher education reform has proposed the concept of curriculum ideological and political education as a major element.This integration into the standardized training of general practice residents(commonly referred to as general resident training)is an unavoidable trend in the teaching field.Based on the actual situation of our unit at The First Affiliated Hospital of Xi’an Medical University,this paper emphasizes the necessity of incorporating ideological and political education into the general resident training curriculum,despite the absence of pertinent practical experience in how to effectively incorporate such courses into comprehensive residential training.In our hospital,we must assess the ideological and political education in the curriculum of general resident training,proposing a scientific,reasonable ideological and political education concept system for general practice courses,integrating ideological and political education with general practice resident training,and strengthening the team of ideological and political education physicians to teach them to carry out such education,this would foster enthusiasm and initiative.Strengthening admission education and training for general practice resident training,as well as regularly hosting symposiums to share ideas and understand the mission of doctors can provide effective experience for ideological and political education in general resident training courses.