Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients

BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.

Reduced emergence agitation with proparacaine hydrochloride eye drops after general anaesthesia for paediatric strabismus surgery

Purpose:To investigate the effect of proparacaine hydrochloride eye drops on emergence agitation after general anaesthesia for paediatric strabismus surgery.Methods:Paediatric patients(3-12 years-old)receiving strabismus surgery were randomly assigned to receive 1-2 drops of isotonic saline(n=129)or proparacaine hydrochloride(n=129)after surgery.The incidence and degree of emergence agitation were recorded and compared between groups.Results:A significantly lower occurrence of emergence agitation was observed with proparacaine hydrochloride drops compared to isotonic saline(12.4% vs.31.8%;p<0.05).Conclusion:Proparacaine hydrochloride eye drops reduce the incidence of emergence agitation after general anaesthesia for paediatric strabismus surgery.

Dexmedetomidine versus Ketamine for the Prevention of Emergence Agitation in Pediatric: A Prospective, Randomized, and Controlled Clinical Trial

Background: This study compares the effect of dexmedetomidine versus Ketamine for the prevention of emergence agitation in children undergoing general anaesthesia. Method: 75 Children are randomly allocated into three groups. Group C: Were assigned to receive normal saline. Group K: Were assigned to receive Ketamine 0.25 mg/kg. Group D: assigned to receive 0.25 ug /kg of dexmedetomidine, before the end of surgery. Results: There was no statistically significant difference in demographic data and intraoperative parameters between the three groups. But as regards to time to discharge, there was a significant difference between group C, group K and group D (group C = 39.96 ± 2.84, group K = 37.28 ± 3.80, group D = 35.08 ± 3.36 and P value = 0.0002). FLACC scale was low after extubation, before leaving the operating room and on arrival to PACU (small FLACC scale in group K, D than group C). PAED scoreless in Group K and Group D than Group C (postoperative, at 10 minutes, 20 min, 30 min). Conclusion: Ketamine and dexmedetomidine reduced the incidence and severity of emergence delirium effectively when compared to normal saline, and the effects of dexmedetomidine being much superior to Ketamine.

Effect of dezocine pretreatment on emergence agitation and relatedinternal environment changes in children with general anesthesia surgery

Objective:To study the effect of dezocine pretreatment on the emergence agitation and related internal environment changes in children with general anesthesia surgery.Methods: A total of 200 children who underwent general anesthesia surgery in the Central Hospital of Xiaogan between January 2015 and December 2017 were enrolled in the study and divided into two groups by random number table method, dezocine group received routine general anesthesia and intravenous injection of dezocine 30 min before the end of surgery, and control group received routine general anesthesia and intravenous injection of saline 30 min before the end of surgery. The CHEPOS score of emergence agitation was performed during anesthesia recovery;the levels of inflammatory stress mediators in serum as well as the expression of stress signal molecules and inflammatory signal molecules in peripheral blood were measured before anesthesia induction and during anesthesia recovery.Results: The CHEPOS score of emergence agitation of dezocine group was lower than that of control group;compared with those of same group before anesthesia induction, serum ACTH, Cor, INS, ICAM1 and TNF-α levels as well as peripheral blood CHOP, GRP78, JNK, c-jun, CD14 and SR expression intensity of both groups of patients were significantly higher whereas IRS-1, IRS-2 and PKB expression intensity were significantly lower during anesthesia recovery, and serum ACTH, Cor, INS, ICAM1 and TNF-α levels as well as peripheral blood CHOP, GRP78, JNK, c-jun, CD14 and SR expression intensity of dezocine group during anesthesia recovery were significantly lower than those of control group whereas IRS-1, IRS-2 and PKB expression intensity were significantly higher than those of control group.Conclusions: Dezocine pretreatment has improving effect on the emergence agitation and related internal environment changes in children with general anesthesia surgery.

The Association between Preoperative Parental Anxiety and Emergence Agitation in Preschoolers

Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.

Emergency department management of acute agitation in the reproductive age female and pregnancy

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

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.

Nurse anesthetists’perceptions and experiences of managing emergence delirium:A qualitative study

BACKGROUND This study employs a descriptive phenomenological approach to investigate the challenges anesthesia nurses face in managing emergence delirium(ED),a common and complex postoperative complication in the post-anesthesia care unit.The role of nurses in managing ED is critical,yet research on their understanding and management strategies for ED is lacking.AIM To investigate anesthetic nurses’cognition and management experiences of ED in hopes of developing a standardized management protocol.METHODS This study employed a descriptive phenomenological approach from qualitative research methodologies.Purposeful sampling was utilized to select 12 anesthetic nurses from a tertiary hospital in Shanghai as research subjects.Semi-structured interviews were conducted,and the data were organized and analyzed using Colaizzi’s seven-step analysis method,from which the final themes were extracted.RESULTS After analyzing the interview content,four main themes and eight subthemes were distilled:Inefficient cognition hinders the identification of ED(conceptual ambiguity,empirical identification),managing diversity and challenges(patientcentered safe care,low level of medical-nursing collaboration),work responsibilities and pressure coexist(heavy work responsibilities,occupational risks and stress),demand for high-quality management(expecting the construction of predictive assessment tools and prevention strategies,and pursuing standardized management processes to enhance management effectiveness).CONCLUSION Nursing managers should prioritize the needs and suggestions of nurses in order to enhance their nursing capabilities and provide guidance for standardized management processes.

Sufentanil reduces emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl

Background Emergence agitation is a common problem in pediatric anesthesia, especially after sevoflurane induction and maintenance anesthesia. The purpose of this study was to investigate the effect of sufentanil to reduce emergence agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy compared with fentanyl. Methods One hundred and five children, aged 3-11 years, were randomly allocated to receive normal saline （control group）, sufentanil 0.2 pg/kg （S2） or fentanyl 2 pg/kg （F2） 1 minute after loss of the eyelash reflex. Anesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anesthesia Emergence Delirium （PAED） scale, and emergence behavior were assessed. Results The incidence of severe agitation was significantly lower in $2 and F2 groups vs. the control group, 4/32 and 15/34 vs. 24/34 respectively, （P=0.002, 0.009, respectively）. PAED scales were significantly different among three groups （P=0.007）, and lower in the S2 and F2 groups than in the control group （P=0.007 and P=-0.025, respectively）. And the incidence of severe agitation and the PAED scale score was significantly different between the $2 and F2 groups （P=-0.007, P=0.019, respectively）. Time to tracheal extubation and recovery time were similar in all three groups. Conclusions Administration of sufentanil at 0.2 IJg/kg after induction of anesthesia reduced emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl. This was without delaying the recovery time or causing significant hypotension.

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

Background: After functional endoscopic nasal surgery, emergence agitation is not uncommon. The aim of this trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality and incidence of emergence agitation in patient undergoing functional endoscopic sinus surgery. Study Design: Prospective, randomized, double-blinded, placebo-controlled trial. Methods: 100 patients of ASA I and II, aged 18 - 50 years, of both sexes scheduled for FEES, were assigned into two groups. In Group L;patients received an intravenous bolus infusion of 1.5 mg/kg lidocaine just before induction of anesthesia followed by a continuous infusion of 2 mg/kg/h during the operation and until the end of the surgery. In Group C;patients received normal saline infusion with the same volume as group L according to the same protocol. The primary endpoints were incidence of emergence agitation and postoperative recovery quality (QoR-40) score on first postoperative day (POD1). Results: Incidence of emergence agitation was significantly lower in group L (P < 0.05) compared with group C. Global QoR-40 scores on POD1 were significantly lower in both groups compared with preoperative assessment, it was significantly higher in group L on POD1 (P < 0.05) than in group C. Among the five dimensions of QoR-40, the scores for physical comfort and pain were superior in group L compared to group C (P < 0.05) at POD1. Conclusion: Systemic lidocaine infusion can improve QoR-40 scores and decrease incidence of emergence agitation in patients scheduled for FEES, also it reduces the duration of stay in PACU after surgery.

Pre-emergence herbicides affect seedling emergence of tropical forest tree species

Testing techniques to reduce weed infestation is a crucial step in developing direct tree seeding systems. The use of pre-emergence herbicides may be an alternative to manual weeding techniques, but so far, information on how they affect the seeds of native tree species is scarce. We established a greenhouse experiment to evaluate the effects of four pre-emergence herbicides (atrazine, diuron, isoxaflutole and oxyfluorfen) on weed suppression and seedling emergence and early growth of seven tropical forest tree species (Annona coriacea Mart., Citharexylum myrianthum Cham., Cordia ecalyculata Vell., Peltophorum dubium (Spreng.) Taub., Psidium guajava L., Pterogyne nitens Tul. and Schinus terebinthifolia Raddi). The experimental design was a randomized complete block design with five treatments and five replicates. The treatments consisted of a single dose of each pre-emergence herbicide and a control. Throughout the 60 days after sowing we evaluated weed cover and seedling emergence and early growth of tree species. Overall, our results suggest that all tested herbicides reduced weed cover; however, they also negatively affected tree species seedling emergence. Of the four herbicides tested, atrazine and diuron showed the greatest effects on tree seedling emergence, oxyfluorfen was least aggressive towards native species and isoxaflutole was most effective in weed control. Native tree species varied in their responses to herbicides, indicating that future experiments should increase the number of species tested as well as investigate how seed traits can affect the species responses to different herbicides.

Postanesthetic Emergence Delirium in Children: Qualitative Differences between Sevoflurane vs Desflurane: A Randomized Clinical Trial

Background: Emergence Delirium (ED) is considered a usual complication in pediatric anesthesia. Aim: Analyze the quantitative and qualitative differences in ED in children receiving general anesthesia with sevoflurane or desflurane in day case surgery. Materials and Methods: Two hundred and two children, ASA I-II, who required outpatient elective day case surgery, were assigned to receive anesthesia with sevoflurane or desflurane. ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 and 15 minutes (min). Results: Mean time to wake up was shorter with desflurane compared with sevoflurane (6.0 versus 8.3 min, p = 0.0001). The overall incidence of ED was 21.3% and Postoperative Maladaptive Behavior Changes (POMBC) incidence was 22%;however, these were not related. Main factors found to be associated with ED were younger age, postoperative pain and preoperative anxiety. Although there were not statistically significant differences in ED incidence between sevoflurane (26.4%, 95% CI 17.3% - 35.4%) and desflurane anesthesia (16.3%, 95% CI 8.8% - 23.8%) (p = 0.18), scores of items 1 and 2 from PAED scale (eye contact and purposeful actions, items related to the patients’ connection with their surroundings) were significantly higher in sevoflurane than in desflurane group (p = 0.034 and p = 0.021 respectively). Conclusion: Recovery after anesthetic maintenance with desflurane is faster and as safe as sevoflurane, including postoperative behavioral disorders. Although desflurane did not statistically decrease ED incidence as compared with sevoflurane, patients who were agitated with desflurane were qualitatively less disoriented and disconnected from their surroundings.

Control of Glyphosate-Resistant Giant Ragweed (<i>Ambrosia trifida</i>L.) with 2,4-D Followed by Pre-Emergence or Post-Emergence Herbicides in Glyphosate-Resistant Soybean (<i>Glycine max</i>L.)

Control of glyphosate-resistant giant ragweed is a challenge, particularly for soybean growers, because of limited effective post-emergence (POST) herbicide options. Many soybean growers in no-till production systems use 2,4-D in burndown application for control of broadleaf weeds, including giant ragweed. Field experiments were conducted at David City, NE, in 2012 and 2013 to evaluate 2,4-D followed by PRE or POST herbicide programs for control of glyphosate-resistant giant ragweed in glyphosate-resistant soybean. Results suggested that burndown application of 2,4-D or saflufenacil plus imazethapyr resulted in 89 to 99% control of giant ragweed at 21 days after treatment. Burndown-only treatments of S-metolachlor plus metribuzin or sulfentrazone plus cloransulam resulted in poor control (≤65%) of giant ragweed and reduced soybean yield (≤ 577 kg&middotha-1). Burndown application of 2,4-D followed by saflufenacil plus imazethapyr, S-metolachlor plus metribuzin, or sulfentrazone plus cloransulam applied pre-emergence (PRE) or cloransulam, chlorimuron, fomesafen, imazethapyr, or lactofen in tank-mixtures with acetochlor applied POST resulted in 87% to 99% giant ragweed control, reduced density to ≤7 plants m-2, and resulted in soybean yield from 2519 to 3823 kg&middotha-1. There was no difference among and between 2,4-D followed by PRE or POST herbicides for giant ragweed control, density, or soybean yield, indicating all the two pass herbicide programs were effective. It is concluded that glyphosate-resistant giant ragweed can be effectively controlled in soybean by including 2,4-D in burndown program followed by PRE or POST herbicides tested in this study.

Exploration of larvicidal and adult emergence inhibition activities of Ricinus communis seed extract against three potential mosquito vectors in Kolkata,India

Objective:To determine the larvicidal and adult emergence inhibition activities of castor （Ricinus communis） seed extract against three potential mosquito vectors Anopheles stephensi（An. slephensi）,Culex quinquefasciatus（Cx.quinquefasciatus） and Aedes albopictus（Ae.albopictus） in India.Methods:The R.communis seed extract was tested,employing WHO procedure,against fourth larval instars of the three mosquito species for 24 h and larval mortalities were recorded at various concentrations（2-64μg/mL）:the 24 h LC50 values of the R.communis seed extract were determined following Probit analysis.The larval killing,antipupation and adult emergence inhibition rates of the test extract,using a single concentration of 2μLC50,were studied at different time periods（24-72 h）:the extract toxicity was tested against a fish.Oreochromis niloticus（O.niloticus）.Results:The R.communis seed extract exhibited larvicidal effects with 100%killing activities at concentrations 32-64μg/mL,and with LC50 values 7.10.11.64 and 16.84μg/mL for Cx.quinquefasciatus,An.stephensi and Ae.albopictus larvae,respectively. When the larvae were treated with the extract at a single concentration of 2×LC50,significant differences were observed,compared to control groups,in rate of pupation（P【0.001） as well as in adult formation（P【0.001）.Conclusions:The present findings suggest that the R.communis seed extract provided an excellent potential for controlling An.stephensi,Cx.quinquefasciatus and Ae. albopictus mosquito vectors.

Agitation thrombolysis combined with catheter-directed thrombolysis for the treatment of non-cirrhotic acute portal vein thrombosis

AIM To evaluate the safety and efficacy of agitation thrombolysis(AT) combined with catheter-directed thrombolysis(CDT) for the treatment of non-cirrhotic acute portal vein thrombosis(PVT). METHODS Nine patients with non-cirrhotic acute PVT who underwent AT combined with CDT were analyzed retrospectively. Portography was carried out via the transjugular intrahepatic portosystemic(commonly known as TIP) or percutaneous transhepatic(commonly known as PT) route, followed by AT combined with CDT. Complications of the procedure, and the changes in clinical symptoms, hemodynamics of the portal vein and liver function were recorded. Follow-up was scheduled at1, 3 and 6 mo after treatment, and every 6 mo thereafter, or when the patients developed clinical symptoms related to PVT. Color Doppler ultrasound and contrast-enhanced computed tomography/magnetic resonance imaging were performed during the follow-up period to determine the condition of the portal vein.RESULTS AT combined with CDT was successfully performed. The portal vein was reached via the TIP route in 6 patients, and via the PT route in 3 patients. All clinical symptoms were relieved or disappeared, with the exception of 1 patient who died of intestinal necrosis 9 d after treatment. Significant differences in the changes in portal vein hemodynamics were observed, including the maximum lumen occupancy of PVT, portal vein pressure and flow velocity between pre-and posttreatment(P < 0.05). During the follow-up period, recurrence was observed in 1 patient at 19 mo after the procedure, and the portal vein was patent in the remaining patients.CONCLUSION AT combined with CDT is a safe and effective method for the treatment of non-cirrhotic acute PVT.

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

BACKGROUND: Agitation occurs frequently among critically ill patients admitted to the intensive care unit(ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status.RESULTS: A total of 102 intubated patients were enrolled; of which 46(45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries(P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia(P<0.05). On multivariate analysis, use of propofol alone(OR=4.97; 95% CI=1.35–18.27), subarachnoid hemorrhage(OR=5.11; 95% CI=1.38–18.91) and ICP catheter insertion for severe head injury(OR=4.23; 95% CI=1.16–15.35) were independent predictors for agitation(P<0.01).CONCLUSION: Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

Phytotoxicity assessment of phenanthrene, pyrene and their mixtures by a soil-based seedling emergence test

Seedling emergence tests were conducted in a meadow brown soil using five plant species(i.e., Chinese cabbage, green onion, tomato, turnip and wheat) to determine the phytotoxicity of phenanthrene, pyrene and their mixtures. The soil was amended with up to 1000 mg/kg soil of phenanthrene or 600 mg/kg soil of pyrene. Seedling emergence and root growth were measured. The results indicated that root elongation was more sensitive than seedling emergence. Root length decreased with increasing phenanthrene or pyrene concentrations(p≤0 05). Phenanthrene was more phytotoxic than pyrene. The lowest observable adverse effect concentration(LOAEC) was 10 mg/kg for phenanthrene when tested with green onion, and 50 mg/kg for pyrene when tested with wheat. Among the five species, wheat was found to be the most sensitive. When amended jointly at or below their respective LOAEC, phenanthrene and pyrene produced a synergistic toxic effect.

Emergence,Mating and Oviposition Behavior of the Chinese Population in Pink Bollworm,Pectinophora gossypiella (Lepidoptera:Gelechiidae)

The pink bollworm, Pectinophora gossypiella （Lepidoptera： Gelechiidae） is one of the most serious lepidopteran pests of cotton in the world. This pest invaded China at the onset of the 20th century, possibly through repeated introductions from several different locations worldwide. In this paper, we describe different behavioral parameters of this Hubei P. gossypiella strain under laboratory and field conditions. Using an infra-red video recorder, we observed （nocturnal） emergence, flight and mating activities, and oviposition patterns. Moth emergence started from 13：00 and continued up till 23：00. Under laboratory and field conditions, 2-7-d-old moths initiated flight around sunset, peaked 50 rain later and gradually declined until 04：00. Although mating started immediately after darkness （i.e., 20：00）, mating behavior was most intense from 23：00 to 03：40. Oviposition also showed distinct time-related patterns, with approx. 70% eggs laid between 20：00 and 22：00. In the studies of the relationship between flight and oviposition, the duration of flight had an effect on oviposition. The 1-d-old moths flown for 6 and 12 h began oviposition earlier than the unflown ones, and the 6-h flight had no effect on the egg production. However, the longevity of the flown moths was shortened after flight. In addition, the peaks of oviposition for the flown moths were advanced 2-3 d. The age when the moths flied affected the oviposition of adult moths. The earlier the moths started to fly after emergence, the greater the fecundity they had. The average egg production of moths flown for 24 h was less than that of non-flown moths which were of the same age. Both flight and delay in mating could advance the oviposition peak. Our study provides detailed insights in nocturnal activities and the reproductive biology of local P. gossypiella populations, which could be employed to fine-tune current pest management programs in China.