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Aims: To compare anaesthesia-related outcomes between patients monitored by newly recruited nurse anaesthetists and those monitored by newly recruited anaesthesiologists., Design: This was a retrospective study., Methods: We conducted a retrospective study that collected demographic information on newly recruited nurse anaesthetists and anaesthesiologists between 2017 and 2022 and recorded information on patients within 6 months of monitoring. Postoperative pain, emergency agitation, nausea, and vomiting were designated anaesthesia-related outcomes. Propensity score matching was used to adjust for covariates. The study adhered to the STROBE guidelines., Results: The study's statistical analysis included 4483 patients monitored by 22 newly recruited nurse anaesthetists and 4959 patients monitored by 23 newly recruited anaesthesiologists. Compared with patients monitored by newly trained anaesthesiologists, the patients monitored by nurse anaesthetists were younger (42.07 ± 20.00 vs. 47.39 ± 18.45 years, p < 0.001) and had a lower body mass index (23.56 ± 4.46 vs. 24.19 ± 4.25, p < 0.001). Patients monitored by anaesthesiologists had a greater proportion of women (61.62% vs. 59.25%, p < 0.001), a high proportion of ASA III and ASA IV (17.1% vs. 8.88%, p < 0.001), and a longer mean surgery duration (78.65 ± 59.01 vs. 70.70 ± 60.65 min, p < 0.001). After propensity score matching was used to adjust for covariates, no statistically significant differences were found in the prevalence of postoperative pain, emergency agitation, or postoperative nausea and vomiting between the two groups (p < 0.05)., Conclusion: Nurse anaesthetists monitoring alone during anaesthesia maintenance is feasible and safe. The two groups had no significant differences in the incidence of postoperative pain, emergency agitation, or postoperative nausea and vomiting., Relevance to Clinical Practice: The shortage of anaesthesiologists leads to heavy work burden and high incidence of occupational burnout among anaesthesiologists. The study found that it was safe for nurse anaesthetists to perform anaesthetic monitoring alone in the operating room under the supervision of the attending anaesthesiologist and did reduce the burden of anaesthesiologists' work. The results of the current study contribute to the expansion of occupational categories for nurse anaesthetists in countries where anaesthesiologists are in short supply. It provides new ideas for hospital administrators and policy-makers to formulate medical and nursing service policies., (© 2023 John Wiley & Sons Ltd.)

This was an observational study of patients with benign breast tumors intended to investigate and compare the predictive value of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) for hypertension in the recovery room. Logistic regression analysis was used to determine the association between these body fat anthropometric indices and hypertension. Receiver operating characteristic curve (ROC) analysis was performed to assess the comparative predictive ability. A total of 689 women were evaluated. Patients with BMI ≥28 (kg/m 2 ), WC > 85 cm, WHR ≥0.82, and WHtR ≥0.5 had a significantly higher probability of increased systolic blood pressure (SBP) and diastolic blood pressure (DBP) than patients with less than threshold values (all P < 0.05). The areas under the ROC curve (AUC) of BMI, WC, and WHtR where all modestly significant (all AUC ≥0.65) and nearly identical at 0.6592, 0.65, and 0.6724, respectively. Conclusion: body fat anthropometric indices are useful predicting hypertension during recovery from general anesthesia in patients with benign breast tumors undergoing day surgery; WHtR outperformed the other indices and nearly identical., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Unplanned transfer to intensive care unit (ICU) lead to reduced trust of patients and their families in medical staff and challenge medical staff to allocate scarce ICU resources. This study aimed to explore the incidence and risk factors of unplanned transfer to ICU during emergence from general anesthesia after cerebral surgery, and to provide guidelines for preventing unplanned transfer from post-anesthesia care unit (PACU) to ICU following cerebral surgery. Methods: This was a retrospective case-control study and included patients with unplanned transfer from PACU to ICU following cerebral surgery between January 2016 and December 2020. The control group comprised patients matched (2:1) for age (±5 years), sex, and operation date (±48 hours) as those in the case group. Stata14.0 was used for statistical analysis, and p < .05 indicated statistical significance. Results: A total of 11,807 patients following cerebral surgery operations were cared in PACU during the study period. Of the 11,807 operations, 81 unscheduled ICU transfer occurred (0.686%). Finally, 76 patients were included in the case group, and 152 in the control group. The following factors were identified as independent risk factors for unplanned ICU admission after neurosurgery: low mean blood oxygen (OR = 1.57, 95%CI: 1.20-2.04), low mean albumin (OR = 1.14, 95%CI: 1.03-1.25), slow mean heart rate (OR = 1.04, 95%CI: 1.00-1.08), blood transfusion (OR = 2.78, 95%CI: 1.02-7.58), emergency surgery (OR = 3.08, 95%CI: 1.07-8.87), lung disease (OR = 2.64, 95%CI: 1.06-6.60), and high mean blood glucose (OR = 1.71, 95%CI: 1.21-2.41). Conclusion: We identified independent risk factors for unplanned transfer from PACU to ICU after cerebral surgery based on electronic medical records. Early identification of patients who may undergo unplanned ICU transfer after cerebral surgery is important to provide guidance for accurately implementing a patient's level of care.

Based on the M 4 -square-containing M 4 Li 2 (M = Al, Ga, In, Tl, Ge, Sn, Pb, Sb, Bi, Cu, Ag, Au, and Hg) clusters, we computationally designed two-dimensional (2D) M 2 Li sheets consisting of M 4 -square motifs. The four M 2 Li-I (M = Sb, Bi, Ag, and Au) monolayers with Li square sublayer sandwiched between two M square sublayers ( P 4/ mmm space group) were confirmed to be stable (high cohesive energies, positive vibrational frequencies, moderate Young's moduli, and structural integrity during first-principles molecular dynamics simulations at 500 K), and the particle swarm optimization (PSO) method identified these constructed monolayers as the global minima in the 2D space. The three M 2 Li-I (M = Sb, Bi, and Ag) monolayers demonstrated a half-auxetic behavior. Ag 2 Li-I could well activate CO 2 and convert it into HCOOH by following the path * → *CO 2 → *OCHO → *HCOOH → *+HCOOH. Particularly, Ag 2 Li-I shows great promise as an electrocatalyst for CO 2 reduction as its limiting potential is as low as 0.40 (0.27) V without (with) considering the solvent effect. Our theoretical explorations reveal that lithium can stabilize the square metal monolayers, and the stable square binary metal sheets exhibit diverse mechanical and electrochemical properties, which can be used in the fields of mechanics and electrochemical catalysis.

Inspired by the advantages of bi-atom catalysts and recent exciting progresses of nanozymes, by means of density functional theory (DFT) computations, we explored the potential of metal dimers embedded in phthalocyanine monolayers (M 2 -Pc), which mimics the binuclear centers of methane monooxygenase, as catalysts for methane conversion using H 2 O 2 as an oxidant. In total, 26 transition metal (from group IB to VIIIB) and four main group metal (M = Al, Ga, Sn and Bi) dimers were considered, and two methane conversion routes, namely *O-assisted and *OH-assisted mechanisms were systematically studied. The results show that methane conversion proceeds via an *OH-assisted mechanism on the Ti 2 -Pc, Zr 2 -Pc and Ta 2 -Pc, a combination of *O- and *OH-assisted mechanism on the surface of Sc 2 -Pc, respectively. Our theoretical work may provide impetus to developing new catalysts for methane conversion and help stimulate further studies on metal dimer catalysts for other catalytic reactions.

Excessive accumulation of carbon dioxide in the atmosphere has become a serious environmental problem due to the increasing consumption of fossil fuels in modern society. Reasonably reducing CO 2 in the atmosphere has become a new research hotspot. Electrocatalytic CO 2 reduction reaction (CO 2 RR) offers an appealing strategy to reduce the atmospheric CO 2 concentration and to produce value-added chemicals simultaneously. In this paper, two-dimensional (2D) N-decorated graphene (NG)-supported bimetallic trimers (Fe 2 M@NG) were designed as triple-atom catalysts (TACs). Theoretical calculations showed that Fe 2 M@NG can effectively activate CO 2 , and among the 23 TACs examined, Fe 2 Ir@NG not only has a good catalytic activity for CO 2 RR (limiting potential is 0.49 V for CH 4 formation) but also limits the competing side reaction of the hydrogen evolution reaction (HER). Our theoretical study not only further extends the triple-atom catalysts, but also opens a new door to boost the sustainable CO 2 conversion., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Background: Acetaminophen is a widely clinically used analgesic. However, the clinical effect of the route of administration on postoperative analgesia as well as on postoperative nausea and vomiting in patients undergoing general anesthesia remains unclear. This study aimed to explore whether the route of administration of acetaminophen affects postoperative analgesia, nausea, and vomiting in patients undergoing general anesthesia., Methods: We included all randomized controlled trials investigating the effects of the route of administration of acetaminophen on postoperative pain, nausea, and vomiting in patients undergoing general anesthesia. Independent examiners reviewed the literature and extracted data, with disagreements resolved through negotiation or the involvement of a third party. The Cochrane risk assessment tool was used to evaluate the quality of the included randomized controlled trials. A narrative synthesis was conducted to summarize the qualitative information from the included studies. A meta-integration of quantitative data was performed using RevMan 5.4., Results: Ten studies met the inclusion criteria. Eight studies assessed postoperative pain, whereas two assessed postoperative nausea and vomiting. Data from the eight studies assessing postoperative pain confirmed that there was no difference between intravenously and orally administered acetaminophen in adults (OR = -0.13; 95% CI, -0.36 to 0.11; p = 0.3). Data from the two studies assessing postoperative nausea and vomiting revealed no difference between intravenously and orally administered acetaminophen in adults (OR = 0.89; 95% CI, 0.64-1.25; p = 0.51). The included studies were of poor quality, with a heterogeneity of 68%., Conclusions: No differences in postoperative analgesia or postoperative nausea and vomiting were observed between the routes of administration (intravenous vs. oral) of acetaminophen in adult patients undergoing general anesthesia. There is a need for future large sample studies to increase the reliability of the results., (© 2021 World Institute of Pain.)

Background: In China, there is no unified standard for the responsibilities and authority of nurse anesthetists, resulting in different professional expectations from anesthesiologists and nursing managers, which may result in high levels of role stress and burnout in nurse anesthetists. Additional factors such as high occupational risk and heavy work may also contribute to role stress and burnout., Methods: In this multicenter cross-sectional study, an online questionnaire survey was conducted among 198 nurses from six tertiary hospitals in Shandong Province. The t test, analysis of variance, linear regression, and logistic regression were used to analyze the risk factors for role stress and professional burnout., Results: The scores of role conflict and role ambiguity in role stress were 30.61 ± 9.53 and 31.89 ± 9.56, respectively; satisfaction with income and the working environment, the hospital's attention, years of experience as a nurse, clarity concerning the nurse anesthetist's occupational scope, and attitude to career prospects were independent risk factors for role stress. The burnout data were non-normally distributed and were expressed as medians and quartiles. The scores of emotional exhaustion, depersonalization, and personal achievement in professional burnout were 30 (26-34), 11 (8-14), and 23 (20-26) respectively. The number of working hours per week, attitude to career prospects, satisfaction with the working environment and income, physical health, gender, and education were independent risk factors for burnout., Conclusions: Chinese nurse anesthetists were found to be in danger of high role stress and professional burnout, a situation requiring the attention of managers., (© 2021 Japan Academy of Nursing Science.)

Integration of amorphous structures and anion defects into ultrathin 2D materials has been identified as an effective strategy for boosting the electrocatalytic performance. However, the in-depth understanding of the relationship among the amorphous structure, vacancy defect, and catalytic activity is still obscure. Herein, a facile strategy was proposed to prepare ultrathin and amorphous Mo-FeS nanosheets (NSs) with abundant sulfur defects. Benefited from the ultrathin, amorphous nanostructure, and synergy effect of Mo-doping and sulfur defect, the Mo-FeS NSs manifested excellent electrocatalytic activity toward oxygen evolution reaction (OER) in alkaline medium, as shown by an ultralow overpotential of 210 mV at 10 mA cm -2 , a Tafel slope of 50 mV dec -1 , and retaining such good catalytic stability over 30 h. The efficient catalytic performance for Mo-FeS NSs is superior to the commercial IrO 2 and most reported top-performing electrocatalysts. Density functional theory calculations revealed that the accelerated electron/mass transfer over the oxygen-containing intermediates can be attributed to the amorphous structure and sulfur-rich defects caused by structural reconfiguration. Furthermore, the S vacancies could enhance the activity of its neighboring Fe-active sites, which was also beneficial to their OER kinetics. This work integrated both amorphous structures and sulfur vacancies into ultrathin 2D NSs and further systematically evaluated the OER performance, providing new insights for the design of amorphous-layered electrocatalysts.

Published data on the association between CYP17 rs743572 polymorphism and risk of PC showed inconclusive results. The aim of this study was to further estimate the pooled effect size of rs743572 polymorphism and PC progression via large-scale meta-analysis. We searched the case-control studies of rs743572 polymorphism and PC risk in PubMed, Embase, and Web of Science databases up to February 2014. Odds ratios (ORs) along with 95 % confidence intervals (CIs) were pooled by means of both fixed effects model and random effects model. A total of 38 publications consisting of 42 studies with 15,735 cases and 17,825 controls were included in this meta-analysis. Overall, no significant association was found between rs743572 polymorphism and PC risk. Stratified analyses by control source and sample size did not provide significant results. However, there was a borderline association in African population under A2A2 versus A1A2 + A1A1 genetic model (OR = 1.39, 95 % CI: 1.01-1.92, P = 0.975, I (2) = 0.0 %). Results from the current meta-analysis suggested that CYP17 rs743572 polymorphism might modify the risk of PC in the subjects of African decent.

Mortality in patients with congenital heart disease (CHD) is significantly increased even with successful surgeries. The main causes are late cardiac complications, such as heart failure and arrhythmia, probably due to genetic defects. To date, genetic causes for CHD remain largely unknown. NKX2-5 gene encodes a highly conserved homeobox transcription factor, which is essential to the heart development in embryos and cardiac function in adults. Mutations in NKX2-5 gene have been implicated in diverse types of CHD, including ventricular septal defect (VSD). As NKX2-5 is a dosage-sensitive regulator, we have speculated that changed NKX2-5 levels may mediate CHD development by influencing cardiac gene regulatory network. In previous studies, we have analyzed the NKX2-5 gene promoter and a proximal enhancer in VSD patients. In the present study, we further genetically and functionally analyzed an upstream enhancer of the NKX2-5 gene in large cohorts of VSD patients (n=340) and controls (n=347). Two novel heterozygous DNA sequence variants (DSVs), g.17483576C>G and g.17483564C>T, were identified in three VSD patients, but none in controls. Functionally, these two DSVs significantly decreased the activity of the enhancer (P<0.01). Another novel heterozygous DSV, g.17483557Ins, was found in both VSD patients and controls with similar frequencies (P>0.05). Taken together, our data suggested that the DSVs within the upstream enhancer of the NKX2-5 gene may contribute to a small number of VSD. Therefore, genetic studies of CHD may provide insight into designing novel therapies for adult CHD patients., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Congenital heart disease (CHD) is the most common birth defect in humans. Genetic causes and underlying molecular mechanisms for CHD remain largely unknown. T-box transcription factor 3 (TBX3) plays a critical role in the developing heart in a dose-dependent manner. TBX3 represses chamber myocardial gene expression. Mutations in TBX3 gene have been associated to ulnar-mammary syndrome with multiple developmental defects, including cardiac defects. We hypothesized that the sequence variants within TBX3 gene promoter that change TBX3 levels may mediate CHD development. In this study, TBX3 gene promoter was genetically analyzed in large cohorts of patients with ventricular septal defect (VSD) (n=325) and ethnic-matched healthy controls (n=359). Seven sequence variants, including two single-nucleotide polymorphisms (g.3863 C>T and g.4095G>T), three novel deletions (g.4433&#95;4435del, g.4672&#95;4675del and g.4820&#95;4821del) and two novel insertions (g.3913&#95;3914ins and g.4735&#95;4736ins), were identified. Five of the seven variants were identified in VSD patients and controls with similar frequencies. Two other variants were found only in controls. These variants, which were observed in high frequencies, did not modify or interrupt the critical binding site for basic transcription factors. Taken together, these results suggested that the sequence variants within the TBX3 gene promoter did not contribute to VSD etiology., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Congenital heart disease (CHD) is the most common birth defects in humans. The genetic causes for CHD remain largely unknown. T-box transcription factor 1 (TBX1), a dosage-sensitive regulator, plays a critical role in the heart development. Mutations in the coding regions of TBX1 gene have been associated to 22q11 deletion syndrome with cardiac defects and isolated CHD cases, including ventricular septal defect (VSD). To date, TBX1 gene promoter region has not been analyzed and reported in CHD patients. We hypothesized that the sequence variants within TBX1 gene promoter region may change TBX1 levels and mediate CHD development. In this study, the promoter regions of TBX1 gene were genetically and functionally analyzed in 280 VSD patients and 267 healthy controls. Two novel heterozygous variants, g.4353C>T and g.4510A>C, were found in two VSD patients, but in none of controls. The single-nucleotide polymorphism-rs41260844, g.4199T>C, was found more frequent in VSD patients than controls (P < 0.01). Functional analyses revealed that these sequence variants significantly enhanced transcriptional activities of TBX1 gene promoter. Therefore, the sequence variants within TBX1 gene promoter may contribute to the VSD etiology by altering the expression levels of TBX1 gene. Pharmaceutical or genetic manipulation of TBX1 gene expression may provide a novel personalized therapy to prevent and treat late cardiac complications for the adult CHD patients carrying these variants.

Congenital heart disease (CHD) is one of the most common birth defects in humans. Mutations in cardiac transcription factor genes, such as GATA4, NKX2-5 and TBX5 genes, have been associated to a small portion of familial and isolated CHD cases. NKX2-5, a highly conserved homeobox gene, is expressed in the developing heart. During embryonic development, NKX2-5 plays pivotal roles in specifying cardiac progenitors, cardiac morphogenesis, cardiomyocyte differentiation and conduction system development. Numerous mutations in NKX2-5 gene have been reported in CHD patients, including atrial septal defect, ventricular septal defect (VSD) and tetrology of Fallot. We have previously identified the sequence variants within the NKX2-5 gene promoter in VSD patients. As several studies have revealed that the NKX2-5 gene is regulated by a complex module involving promoter and multiple independent cardiac enhancers, one of which is located between -3500 bp and -2500 bp upstream to the transcription start site, we hypothesized that the variants within the cardiac enhancer may contribute to CHD. In this study, we genetically analyzed the enhancer of NKX2-5 gene in large cohorts of VSD patients (n=322) and controls (n=336). The results showed that three novel variants, g.1467G>A, g.1487 Ins with a 13 bp insertion and g.1515 Ins with a 6 bp insertion, were identified within the enhancer element in both VSD patients and controls with similar frequencies (P>0.05). Therefore, our data suggested that the enhancer of NKX2-5 gene may not be a contributor to the VSD etiology. Other regulatory elements of the NKX2-5 gene will be further analyzed in CHD patients., (Copyright © 2012 Elsevier B.V. All rights reserved.)