Intraoperative Dexmedetomidine Versus Midazolam in Patients Undergoing Peripheral Surgery With Mild Traumatic Brain Injuries: A Retrospective Cohort Analysis

Background:

The intra- and postoperative effects of dexmedetomidine are not completely consistent and midazolam/fentanyl is most widely used in peripheral surgeries. The objectives of the study were to evaluate the sedative, analgesic, hemodynamic, anti-inflammatory, and antioxidant effects of dexmedetomidine against midazolam in patients undergoing peripheral surgeries with mild traumatic brain injuries.

Methods:

Medical records of patients who underwent peripheral surgeries with mild traumatic brain injury were included in the analysis. Patients received intraoperative midazolam (MDZ cohort, n = 225) or dexmedetomidine (DEX cohort, n = 231). Pre-, intra-, and postoperative characteristics of patients were collected and analyzed.

Results:

After administration of anesthesia, up to 40 minutes, patients of the MDZ group had lower modified observer’s assessment of alertness/sedation score than those of the DEX group (P = .041), but after 40 minutes, patients of the MDZ group had a higher score than those of the DEX group throughout surgeries (P = 0.048). The DEX group has less requirements of postoperative morphine/equivalent doses than the MDZ group (4 ± 1 vs 5 ± 1, P < .0001, q = 18.451).

Conclusions:

Intraoperative DEX offers better sedation, postoperative analgesia, and clinical recovery for peripheral surgeries and suppresses inflammatory response.

Level of Evidence:

III.

Uncertainty Measurement for a Tolerance Knowledge Base

A knowledge base is an important notion of rough set theory. A tolerance knowledge base is its generalization. Measures of uncertainty as important evaluation tools in the fields of machine learning can measure the dependence and similarity between two targets. This paper investigates uncertainty measurement for a tolerance knowledge base by using its knowledge structure. The knowledge structure of a given tolerance knowledge base is first introduced by means of set vectors. Then, the dependence and independence between knowledge structures of tolerance knowledge bases are depicted. Next, the measurement uncertainty of tolerance knowledge bases is investigated. Finally, to obtain two tolerance knowledge bases with additional data, two information systems from the UCI Repository of machine learning databases are selected to construct two numerical experiments, and an effectiveness analysis is performed from the perspective of statistics to show the feasibility of the proposed measures.

GPER-mediated, oestrogen-dependent visceral hypersensitivity in stressed rats is associated with mast cell tryptase and histamine expression

Visceral hypersensitivity (VH) is common in irritable bowel syndrome (IBS), and female patients are more likely to seek healthcare services for IBS-related abdominal pain. Oestrogen has been reported to mediate pain modulation via its receptor, and mast cells are known to participate in the development of visceral hypersensitivity. Our previous studies showed that the G-protein-coupled oestrogen receptor (GPER, also known as GPR30) was expressed by mast cells in human colonic tissues and was associated with IBS type and severity of visceral pain. However, whether GPER is involved in oestrogen-dependent visceral hypersensitivity via mast cell degranulation is still unknown. Rats were subjected to wrap partial restraint stress to induce visceral hypersensitivity and were ovariectomized (OVX) to eliminate the effects of oestrogen on visceral hypersensitivity. OVX rats were treated with oestrogen, an oestrogen receptor α and β antagonist (ICI 182.780), a GPER antagonist (G15) or a GPER agonist (G1), to evaluate the effects of oestrogen via its receptor. The colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were performed to evaluate GPER and mast cell tryptase co-expression. Mast cell number with degranulation was detected by specific staining. Mast cell tryptase expression in rat colon was also investigated by Western blot and immunohistochemistry. Substance P and histamine expression were examined by ELISA. GPER was expressed by the majority of tryptase-positive mast cells in the colonic mucosa. Stressed rats showed increased visceral sensitivity, increased mast cell degranulation, mast cell tryptase expression, and increased colon histamine levels. Ovariectomy reduced stress-induced VH in female rats and decreased mast cell degranulation, mast cell tryptase expression, and histamine levels, whereas oestrogen replacement reversed these effects. In OVX rats, the GPER antagonist G15 counteracted the enhancing effects of oestrogen on stress-induced VH, mast cell degranulation, mast cell tryptase, and histamine expression, whereas VH was preserved after treatment with ICI 182.780. On the other hand, pretreatment with the selective GPER agonist G1 at doses between 1 and 20 μg/kg significantly increased VH, mast cell tryptase, and histamine expression in OVX-stressed rats, mimicking the effects of oestrogen. GPER plays a pivotal role in the regulation of mast cell degranulation, mast cell tryptase expression, and histamine levels and contributes to the development of colonic hypersensitivity in a female rat model of IBS.

Method matters: Development of characterization techniques for branched and glucose-poly(lactide-co-glycolide) polymers

Defining the qualitative sameness of parenteral formulations comprised of poly(lactide-co-glycolide) (PLGA) requires assays of the relevant properties of polymer from each formulation. Gel-permeation chromatography with quaternary detection (GPC-4D) has been previously applied to other polymers, and the relevant mathematical parameters for their characterization are available; however, such parameters have not been described for branched PLGA polymers. Little information is available for the determination of glucose within glucose-PLGA (Glu-PLGA) branched polymers. This study describes the experimental methods of defining the mathematical parameters for characterization of branched PLGA polymers and the validation of these parameters using known branched-PLGA standards. The glucose, used as an initiator, was tracked through the synthesis of Glu-PLGA by both ¹³C NMR and enzymatic analysis. The analytical determination of the relevant parameters defining Glu-PLGA, such as the branching number, and the presence of glucose, requires the use of appropriate procedures experimentally validated in a systematic manner. The procedures described in this study were developed for characterization of Glu-PLGA with the lactide:glycolide (L:G) ratio of 55:45 used in Sandostatin® LAR. The procedures can also be used for characterization of Glu-PLGAs made of different L:G ratios.

First principles investigation of dissociative adsorption of H2 during CO2 hydrogenation over cubic and hexagonal In2O3 catalysts

Dissociative adsorption of H₂ and migration of the adsorbed H adatom over cubic and hexagonal In₂O₃ catalysts were investigated.

Exogenous melatonin reduces the inhibitory effect of osmotic stress on photosynthesis in soybean

Understanding the relationship between exogenous melatonin and water deficit stress is crucial for achieving high yields and alleviating the effects of water deficit stress on soybean (Glycine max (L.) Merrill) plants in agriculture. This study investigated the effects of exogenous melatonin on soybean photosynthetic capacity under water deficit stress induced by polyethylene glycol (PEG) 6000. We conducted a potting experiment in 2018 using the soybean (Glycine max L. Merrill) cultivar Suinong 26. We identified the impacts of a concentration of PEG 6000 simulating drought (15%, w/v) and an appropriate melatonin concentration (100 μmol/L) on the growth of soybean seedlings and flowering stages in a preliminary test. We applied exogenous melatonin by foliar spraying and root application to determine the effects on leaf photosynthesis during water deficit stress. Our results indicated that 15% PEG 6000 had an obvious inhibitory effect on the growth of soybean seedlings and flowering stages, causing oxidative stress and damage due to reactive oxygen species (ROS) (H2O2 and O2·-) accumulation and potentially reducing air exchange parameters and photosystem II (PSII) efficiency. The application of exogenous melatonin significantly relieved the inhibitory effects of PEG 6000 stress on seedlings and flowering growth, and gas exchange parameters, potentially improved PSII efficiency, improved the leaf area index (LAI) and the accumulation of dry matter, slowed down oxidative stress and damage to leaves by increasing the activity of antioxidant enzymes (SOD, POD, and CAT), reduced the content of malondialdehyde (MDA), and ultimately improved soybean yield. Overall, the results of this study demonstrated that application of exogenous melatonin at the seedlings and flowering stages of soybean is effective in alleviating plant damage caused by water deficit stress and improving the drought resistance of soybean plants. In addition, the results showed that application of exogenous melatonin by root is superior to foliar spraying.

Vortioxetine treatment for generalised anxiety disorder: a meta-analysis of anxiety, quality of life and safety outcomes

OBJECTIVES

The aim of this study was to investigate the efficacy, tolerability, safety, and impact on quality of life (QoL) and functional status of vortioxetine treatment for patients with generalised anxiety disorder (GAD) by performing a meta-analysis of randomised controlled trials (RCTs).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Data mining was conducted in January 2019 across PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials Cochrane Library, Web of science and ClinicalTrials.gov.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

All published RCTs, which assessed the effect of vortioxetine treatment for patients with GAD when compared with a placebo group, were included.

DATA EXTRACTION AND SYNTHESIS

Relevant data were extracted and synthesised narratively. Results were expressed as standardised mean differences or ORs with 95% CIs.

RESULTS

Our meta-analysis showed that multiple doses (2.5, 5 and 10 mg/day) of vortioxetine did not significantly improve the response rates, compared with placebo (OR 1.16, 95% CI 0.84 to 1.60, p=0.38; OR 1.41, 95% CI 0.82 to 2.41, p=0.21; and OR 1.05, 95% CI 0.76 to 1.46, p=0.75). Moreover, there was no statistically significant difference regarding the remission rates, discontinuation for any reason rates, discontinuation due to adverse events rates, Short-Form 36 Health Survey scores or Sheehan Disability Scale scores between administration of multiple doses (2.5, 5 and 10 mg/day) of vortioxetine and placebo.

CONCLUSIONS

Although our results suggest that vortioxetine did not improve the GAD symptoms, QoL and functional status impairment of patients with GAD, it was safe and well tolerated. Clinicians should interpret and translate our data with caution, as the meta-analysis was based on a limited number of RCTs.

Increased substantia nigra echogenicity correlated with visual hallucinations in Parkinson's disease: a Chinese population-based study

As a noninvasive technique, transcranial sonography (TCS) of substantia nigra (SN) has gradually showed its effectiveness not only in diagnosis but also in understanding clinical features of Parkinson’s Disease (PD). This study aimed to further evaluate TCS for clinical diagnosis of PD, and to explore the association between sonographic manifestations and visual hallucinations (VH). A total of 226 subjects including 141 PD patients and 85 controls were recruited. All participants received TCS. A series of rating scales to evaluate motor and non-motor symptoms were performed in PD patients. Results showed that 172 subjects were successfully assessed by TCS. The area of SN was greater in PD patients than that in controls (P < 0.001). As receiver-operating characteristic (ROC) curve analysis showed, the best cutoff value for the larger SN echogenicity size was 23.5 mm² (sensitivity 70.3%, specificity 77.0%). Patients with VH had larger SN area (P = 0.019), as well as higher Non-Motor Symptoms Scale (NMSS) scores (P = 0.018). Moreover, binary logistic regression analysis indicated that SN hyperechogenicity (odds ratio = 4.227, P = 0.012) and NMSS scores (odds ratio = 0.027, P = 0.042) could be the independent predictors for VH. In conclusion, TCS can be used as an auxiliary diagnostic tool for Parkinson’s disease. Increased SN echogenicity is correlated with VH in Parkinson’s disease, possibly because the brain stem is involved in the mechanism in the onset of VH. Further studies are needed to confirm these findings.

Overexpression of miR-638 attenuated the effects of hypoxia/reoxygenation treatment on cell viability, cell apoptosis and autophagy by targeting ATG5 in the human cardiomyocytes

OBJECTIVE

Myocardial ischemia/reperfusion (I/R) injury largely contributed to the damage of myocardial tissues in patients with coronary disease, which may subsequently lead to heart failure. MicroRNAs (miRNAs) are considered to be involved in the process of myocardial I/R injury. The present study aimed to investigate the in vitro functional role of miR-638 in the myocardial I/R injury in the human cardiomyocytes (HCMs).

PATIENTS AND METHODS

MTT assay and flow cytometry assay were performed to determine cell viability and apoptosis of HCMs. Real Time-quantitative Polymerase Chain Reaction was used to determine miRNA and mRNA expression levels. The protein levels were determined by Western blot assay.

RESULTS

Hypoxia/reoxygenation (H/R) treatment suppressed cell viability, increased cell apoptotic rate and suppressed miR-638 expression in the HCMs. The downregulation of miR-638 suppressed cell viability and induced cell apoptosis in the HCMs. The overexpression of miR-638 attenuated the effects of H/R treatment on the cell viability and cell apoptosis in the HCMs. In addition, miR-638 suppressed the expression of autophagy-related 5 (ATG5) by targeting the 3'untranslated region of ATG5. Enforced expression of ATG5 reversed the effects of miR-638 overexpression on cell viability and cell apoptosis in H/R-treated HCMs. More importantly, H/R treatment promoted autophagy in the HCMs, and this effect was significantly reversed by miR-638 mimic transfection.

CONCLUSIONS

Our results suggested that the overexpression of miR-638 attenuated the effects of H/R treatment on cell viability, cell apoptosis and autophagy, at least partly by regulating the ATG5 expression in the HCMs.

Deep Multi-View Feature Learning for EEG-Based Epileptic Seizure Detection

Epilepsy is a neurological illness caused by abnormal discharge of brain neurons, where epileptic seizure can lead to life-threatening emergencies. By analyzing the encephalogram (EEG) signals of patients with epilepsy, their conditions can be monitored and seizure can be detected and intervened in time. As the identification of effective features in EEG signals is important for accurate seizure detection, this paper proposes a multi-view deep feature extraction method in attempt to achieve this goal. The method first uses fast Fourier transform (FFT) and wavelet packet decomposition (WPD) to construct the initial multi-view features. Convolutional neural network (CNN) is then used to automatically learn deep features from the initial multi-view features, which reduces the dimensionality and obtain the features with better seizure identification ability. Furthermore, the multi-view Takagi-Sugeno-Kang fuzzy system (MV-TSK-FS), an interpretable rule-based classifier, is used to construct a classification model with strong generalizability based on the deep multi-view features obtained. Experimental studies show that the classification accuracy of the proposed multi-view deep feature extraction method is at least 1% higher than that of common feature extraction methods such as principal component analysis (PCA), FFT and WPD. The classification accuracy is also at least 4% higher than the average accuracy achieved with single-view deep features.

Study of an energy degrader made of B4C/graphite composites

The HUST-PTF (proton therapy facility in Huazhong University of Science and Technology) is now under construction based on an isochronous superconducting cyclotron at Huazhong University of Science and Technology. Because the energy extracted by the cyclotron is fixed, an energy degrader is necessary to modulate the beam energy after the cyclotron for clinical requirements. However, the multiple Coulomb scattering that occurs in the degrader increases the beam emittance. Therefore, collimators are designed after the degrader to decrease the beam emittance. Because of the severe beam losses in the aforementioned energy degradation and emittance restriction, the main design consideration is improving the beam transmission efficiency. In this note, a novel energy degrader made of B₄C/graphite composite (BGC) is studied regarding its material fabrication, improved beam transmission efficiency, energy degradation, emittance growth, and secondary-neutron yield using the Geant4 Monte Carlo software. Moreover, the thermal properties of the BGC degrader are analyzed. Finally, for a degrader with 40% boron content, the emittance after the degrader decreases by 5.5% and the transmission efficiency after the final collimator increases by 15.9% at 70 MeV compared with a pure-graphite degrader.

Experimental impacts of less lethal rubber spheres on a skin-fat-muscle model

INTRODUCTION

Effectiveness and safety assessment for kinetic energy (KE) bullets is of importance, considering numerous reports about excessive damage cases of KE bullets in recent years. Early study of KE impacting targets mainly focused on threshold penetration issue, but did not involve cavity evolution of target and energy transfer. The paper aimed at analyzing cavity evolution and energy transfer during rubber bullet impacting skin-fat-muscle model.

METHOD

In the ballistic experiment, skin-fat-muscle model was built including cowhide, paraffin gel and gelatin, respectively simulating skin, fat and muscle. 16 mm spherical rubber bullets were fired at a range of velocities (71 m/s-134 m/s) to skin-fat-muscle model. There were totally 7 valid impacts. Cavity evolution and cowhide deformation were captured by a high-speed camera.

RESULT AND DISCUSSION

Experiment result indicates that cavity shape evolution can be divided into 3 stages: parabola stage, arc stage, and bowl stage. The cavity shape evolution at different velocities follows a similar changing rule. Cavity depth firstly increases and then decreases with time. Cavity width gradually increases with time and the rate at which the cavity width grows decreases with time. The maximum cavity depth and cavity width at the same moment increase linearly with impacting velocity. When bullet impacts on the model, deformation occurs on the cowhide, paraffin gel and gelatin. Kinetic energy of bullet gradually transfers into kinetic energy of cowhide, strain energy of cowhide, absorbing energy of soft tissue (paraffin gel and gelatin). Energy transfer analysis result of 134 m/s demonstrates rubber bullet kinetic energy mainly transfers into cowhide strain energy and absorbing energy of paraffin gel and gelatin. Moreover, cowhide strain energy firstly increases and then decreases with time.

Mutation of a histidine-rich calcium-binding-protein gene in wheat confers resistance to Fusarium head blight

Head or ear blight, mainly caused by Fusarium species, can devastate almost all staple cereal crops (particularly wheat), resulting in great economic loss and imposing health threats on both human beings and livestock^1-3. However, achievement in breeding for highly resistant cultivars is still not satisfactory. Here, we isolated the major-effect wheat quantitative trait locus, Qfhs.njau-3B, which confers head blight resistance, and showed that it is the same as the previously designated Fhb1. Fhb1 results from a rare deletion involving the 3' exon of the histidine-rich calcium-binding-protein gene on chromosome 3BS. Both wheat and Arabidopsis transformed with the Fhb1 sequence showed enhanced resistance to Fusarium graminearum spread. The translation products of this gene's homologs among plants are well conserved and might be essential for plant growth and development. Fhb1 could be useful not only for curbing Fusarium head blight in grain crops but also for improving other plants vulnerable to Fusarium species.

The relationship between plasma homocysteine levels and MTHFR gene variation, age, and sex in Northeast China

Background

Hyperhomocysteinemia (HHcy) is the risk factor for cardiovascular disease and stroke. However, the impacts on the genetic variation of methylene tetrahydrofolate reductase (MTHFR) on plasma homocysteine levels in the Northeast Chinese population have not been studied. Therefore, this study was carried out to determine the relationship between HHcy and MTHFR gene variation, and whether it was influenced by age and sex of the population in Northeast China.

Materials and Methods

A total of 466 subjects were randomly enrolled in this study. According to the homocysteine levels (Hcy ≥ 15 μmol/L) of the subjects, they were divided into hyperhomocysteine (HHcy = 206) and normal homocysteine (Hcy = 260). Polymerase chain reaction/high-resolution dissolution curve and homocysteine determination kit methods were used for genotype testing and homocysteine detection, respectively.

Results

High plasma homocysteine levels are associated with MTHFR 677T and 1298A [P < 0.00, odds ratio (confidence interval) = 1.842 (1.418-2.394) >1], which is related to increasing age (P_range = 0.0005-0.0161), with the homocysteine levels of males higher than females (P < 0.0001).

Conclusion

High plasma homocysteine levels were linked to the MTHFR gene mutation. In addition, plasma homocysteine levels increased significantly with age with male's homocysteine levels higher than that of females.

Dissolution Chamber for Small Drug Delivery System in the Periodontal Pocket

Existing dissolution chambers have relatively large volume compared to the size of the periodontal pocket. A small volume dissolution method that simulates the physiological release environment for periodontal drug delivery is needed. The objectives were to construct a small, more physiologically relevant, dissolution chamber and investigate the properties of the new dissolution chamber for the assessment of sustained drug release systems in periodontal delivery. Flow-through dissolution chambers were constructed using three-dimensional (3D) printing. Drug release experiments were performed using the dissolution chamber and a commercially available long-acting periodontal insert product, PerioChip®. Similar experiments were performed under more traditional larger volume bulk solution conditions for comparison. Computer simulations and experimental results showed that drug clearance from the dissolution chamber was fast compared to drug release from the periodontal product. Drug clearance from the flow-through dissolution chamber and drug release from the sustained release product in the chamber were related to the dissolution medium flow rate and chamber volume. Drug release in the flow-through chamber was slower than that observed in bulk solution, but approached it when the medium flow rate increased. The presence of trypsin in the dissolution medium enhanced drug release from the product. A flow-through dissolution system was constructed that could evaluate drug release from a sustained release product in a small dimension environment by modifying the flow rate and composition of the dissolution medium.

[Analysis of correlation between serum fatty acid profile and cognitive impairment in the elderly]

Objective: To explore the relationship between cognitive impairment and serum fatty acid profile. Methods: Participants aged ≥60 years were selected from 3 communities in Shijiazhuang in 2015. The questionnaire was performed to collect basic information. And Montreal Cognitive Assessment was applied for the evaluation of cognitive impairment. Blood lipid parameters and serum fatty acid profiles were analyzed for all the subjects. A total of 529 subjects were finally included in this research. Multivariate ordinal logistic model was used to analyze the relationship between serum fatty acid profile and cognitive impairment. Results: Normal, mild and moderate cognitive impairment accounted for 41.2% (n=218), 51.4% (n=272) and 7.4% (n=39) of all the subjects respectively. With control of age, gender, education, total cholesterol (TC), total triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), the OR (95%CI) of eicosenoic acid, nervonic acid and ratio of n-3 and n-6 polyunsaturated fatty acid (n-3/n-6) was 1.06 (1.01-1.10), 0.93 (0.91-0.96), and 0.17 (0.04-0.73). Conclusion: The risk of cognitive impairment decreased with the raise of serum nervonic acid concentration and n-3/n-6, and increased with the raise of serum eicosenoic acid concentration.