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Author(s): Yuanqiang Li [sup.1], Cheng Lin [sup.1], Jingchen Liu [sup.1] Author Affiliations: (1) grid.412594.f, 0000 0004 1757 2961, Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, , [...], Background Quadratus lumborum block (QLB) guided by ultrasound is a novel local block anesthesia technique, which can be used in various surgeries for multimodal analgesia. Its analgesic effectiveness for renal surgery is still uncertain. The aim of this meta-analysis was to assess the postoperative analgesic efficacy of QLB in adult patients undergoing renal surgery. Methods We systematically searched randomized controlled trials (RCTs) through the databases of Cochrane Library, Embase, and PubMed until June 21, 2021. Postoperative consumption of opioid in the first 24-h was set as the primary outcome. The risk of bias was evaluated by Cochrane methodology. Results Ten RCTs involving 577 patients were eligible for our inclusion criteria. Ultrasound-guided QLB significantly reduced postoperative consumption of opioid in the first 24 h after surgery (mean differences [MD] - 17.58, 95% confidence interval [CI] - 23.14 to - 12.02, P < 0.00001, I.sup.2 = 98%). Similarly, the results were consistent in subgroups analysis of both different types of renal surgeries and different QLB approaches. The QLB also significantly decreased postoperative static pain scores at different time points, and reduced the incidence of postoperative nausea and vomiting (PONV) (risk ratio [RR] = 0.48, 95% CI 0.33 to 0.70, P = 0.0002, I.sup.2 = 0%) and the number of rescue analgesia patients (RR = 0.34, 95% CI 0.20 to 0.58, P < 0.0001, I.sup.2 = 0%). No major complications related to QLB were reported in the included studies. Conclusions Ultrasound-guided QLB improves postoperative analgesic efficacy and reduces PONV in adult patients undergoing renal surgery. There is currently limited evidence concerning the analgesic effects of different QLB approaches after renal surgery, and further research is required in this area. PROSPERO registration PROSPERO Registration CRD42021260821.

Objectives: The molecular mechanism underlying the protective effects of DEX against sepsis-induced acute kidney injury (SAKI) remains to be elucidated. Methods: We established S-AKI models in vivo via CLP and in vitro with LPS-induced HK-2 cells. Results: The Nrf2/SLC7A11/FSP1/CoQ10 pathway was inhibited in S-AKI both in vitro and in vivo. The overexpression of Nrf2 inhibited LPS-induced ferroptosis by activating the SLC7A11/FSP1/CoQ10 pathway. DEX ameliorated kidney tissue damage, as determined by a decrease in BUN, Cr, and inflammatory factor levels, along with renal tubule vacuolation and inflammatory cell infiltration in S-AKI mice. Additionally, DEX treatment significantly ameliorated ferroptosis in S-AKI in vitro and in vivo, as indicated by an improvement in mitochondrial shrinkage and disruption of cristae, a decrease in iron, ROS, MDA, and 4-HNE levels, and an increase in GSH and GPX4 levels. Mechanistically, DEX treatment restored the reduction of Nrf2 expression and nuclear translocation in S-AKI, as well as, the levels of downstream SLC7A11, FSP1, and CoQ10. Knocking down Nrf2 in vitro and administering brusatol in vivo eliminated the protective effect of DEX against S-AKI. Conclusions: DEX mitigated ferroptosis and attenuated S-AKI by activating the Nrf2/SLC7A11/FSP1/CoQ10 pathway. Abbreviation: CLP: Cecal ligation puncture; LPS: Lipopolysaccharide; Nrf2: Nuclear factor-erythroid- 2-related factor 2; SLC7A11: Solute carrier family 7 member 11; FSP1: Ferroptosis suppressor protein 1; CoQ10: Coenzyme Q10; BUN: Blood urea nitrogen; Cr: Serum creatinine; ROS: Reactive oxygen species; MDA: Malondialdehyde; 4-HNE: 4-hydroxynonenal; GSH: Hlutathione; GPX4: Glutathione peroxidase 4. [ABSTRACT FROM AUTHOR]

Background: Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1‐year CKD and mortality. Methods: This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021. Postoperative AKI and CKD after 1 year were assessed according to KDIGO criteria. AKI was classified as mild, moderate, or severe based on severity as well as transient (≤2 days) and persistent (>2 days) based on duration. CKD occurrence was the primary outcome, whereas all‐cause mortality was the secondary outcome. Results: AKI developed in 45.4% of children, with 40.7% mild, 37.1% moderate, and 22.2% severe. Half of the children with AKI subsequently developed CKD within 1 year, compared to 23.1% without AKI. Multivariate analysis indicated that moderate AKI, severe AKI, and persistent AKI were risk factors for CKD development (moderate AKI, OR = 3.8, 95% CI = 1.2–12.3; severe AKI, OR = 7.4, 95% CI = 1.4–38.3; persistent AKI, OR = 9.7, 95% CI = 2.3–36.4). The overall mortality rate within 1 year after surgery was 9.8%. Children with severe AKI and AKI lasting longer than 2 days exhibited a higher mortality rate than those without AKI. Conclusions: The development of postoperative AKI is relatively common after PLT, and the severity and duration of AKI are associated with CKD and mortality within 1 year. [ABSTRACT FROM AUTHOR]

We show how prospect theory uncovers critical decision-making insights in the design of sequential experiences by formulating a general framework and applying it to three experience design settings. First, we study the problem of releasing a piece of good news versus bad news, where a firm may incrementally reveal the news over a preemptive period. We characterize the optimal release strategy for both types of news and show that when the ultimate news is good (resp., bad) and the audience is sufficiently gain-seeking, it is optimal first to release information of a negative (resp., positive) sentiment. Second, we consider the problem of organizing an event such as a concert with performances of known valuations, where an event organizer needs to arrange the sequence of all performances. We show that for both loss-averse and gain-seeking audiences, interior peaks can be optimal, where pleasant and aversive performances are arranged to alternate throughout the event. Lastly, we investigate the problem of simultaneous versus sequential release of a series, such as songs or TV episodes, where a content provider does not know a priori the audience's exact valuation of each item. We show that if the audience's sensitivity to losses is sufficiently small (resp., large), the optimal strategy is to release all items in the series sequentially (resp., simultaneously). Across all of the settings, we show that the audience's sensitivity to losses relative to a reference point is a critical factor that governs how to design and manage the audience's evolving experience dynamics. [ABSTRACT FROM AUTHOR]

Companies that are investing in blockchain technology to enhance supply chain transparency face challenges in fostering collaborations with others and deciding what information to share. Transparency over the actions of supply chain partners can improve operational decisions, but sharing own data on the blockchain can put firms at a competitive disadvantage. In this paper, we investigate the resulting questions of when blockchain should be adopted in a supply chain and how it should be designed by analyzing two ways that it can enhance supply chain transparency: making the manufacturer's sourcing cost transparent to the buyers (i.e., vertical cost transparency) and making the ordering status of buyers transparent to each other (i.e., horizontal order transparency). Given such transparency, firms can design a smart contract that automates transactions contingent on the revealed information and enables them to realize better equilibrium outcomes. We find that blockchain increases supply chain profit only when the manufacturer's capacity is large and decreases supply chain profit otherwise. If the capacity is sufficiently large to eliminate the buyers' competition, blockchain leads to a win–win–win and the incentives of all participants are naturally aligned. If the capacity is only moderately large, the manufacturer needs to compensate the buyers to facilitate a blockchain implementation. However, if the capacity is small, horizontal order transparency enabled by the blockchain mitigates the buyers' overorder incentive to compete for the manufacturer's capacity and increases double marginalization. For such cases, we show that a blockchain that only enables vertical cost transparency should (and can) still be adopted in a range of small capacity cases, and we propose an access control layer for the logistics data to implement such a blockchain. This paper was accepted by David Simchi-Levi, operations management. Funding: J. Liu was supported by the National Natural Science Foundation of China [Grant 72101110] and The MOE (Ministry of Education in China) Project of Humanities and Social Sciences [Grant 20YJC630084]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2023.4851. [ABSTRACT FROM AUTHOR]

Response process data collected from human–computer interactive items contain detailed information about respondents' behavioural patterns and cognitive processes. Such data are valuable sources for analysing respondents' problem‐solving strategies. However, the irregular data format and the complex structure make standard statistical tools difficult to apply. This article develops a computationally efficient method for exploratory analysis of such process data. The new approach segments a lengthy individual process into a sequence of short subprocesses to achieve complexity reduction, easy clustering and meaningful interpretation. Each subprocess is considered a subtask. The segmentation is based on sequential action predictability using a parsimonious predictive model combined with the Shannon entropy. Simulation studies are conducted to assess the performance of the new method. We use a case study of PIAAC 2012 to demonstrate how exploratory analysis for process data can be carried out with the new approach. [ABSTRACT FROM AUTHOR]

To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. (1) Thirty-four children who had underwent 38 bronchoscopy procedures were included. (2) General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, combination use of propofol and remifentanil intravenously infusion were given in 31 procedures (81.6%) and propofol intravenously infusion alone was given in the rest 7 procedures (18.4%). An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. (3) Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%), and bronchospasm was found in 17 procedures (44.7%). Intraoperative hypoxemia occurred in 16 procedures (42.1%). The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P < .05). Intraoperative hypercapnia also occurred in 16 procedures (42.1%). Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The full extent of intravenous lidocaine's effectiveness in alleviating postoperative pain and enhancing gastrointestinal function recovery remains uncertain., Evidence Acquisition: We conducted an exhaustive search of databases to identify randomized controlled trials that compared intravenous lidocaine infusion's efficacy to that of a placebo or routine care in patients undergoing gastrointestinal surgery. The primary outcome measure was resting pain scores 24 h postoperatively. We utilized a random-effects model based on the intention-to-treat principle for the overall results., Evidence Synthesis: This study included twenty-four trials with 1533 patients. Intravenous lidocaine significantly reduced resting pain scores 24 h after gastrointestinal surgery (twenty trials, SMD -0.67, 95% CI -1.09 to -0.24, P=0.002, I 2 = 90%). This finding was consistent in subgroup analyses and sensitivity analyses. The benefit was also observed at other resting and moving time points (1, 2, 4, and 12 h) postoperatively. Intravenous lidocaine significantly decreased opioid consumption within 24 h after surgery (eleven trials, SMD: -1.19; 95% CI: -1.99 to -0.39; P=0.003). Intravenous lidocaine also shortened the time to bowel sound (MD: -8.51; 95% CI: -14.59 to -2.44; P=0.006), time to first flatus (MD: -6.00; 95% CI: -9.87 to -2.13; P=0.002), and time to first defecation (MD: -9.77; 95% CI: -17.19 to -2.36; P=0.01)., Conclusions: Perioperative intravenous lidocaine can alleviate acute pain and expedite gastrointestinal function recovery in patients undergoing gastrointestinal surgery. However, the results should be interpreted with caution due to substantial heterogeneity. Further large-scale studies are necessary to validate these findings.