Effects of ciprofol for the induction of general anesthesia in patients scheduled for elective surgery compared to propofol: a phase 3, multicenter, randomized, double-blind, comparative study

OBJECTIVE

Ciprofol is a newly developed intravenous sedative-hypnotic drug. The objective of the study was to prove whether ciprofol was non-inferior to propofol for the successful induction of general anesthesia. The ideal post-induction sedation level was assessed by comparing patients' clinical symptoms and their hemodynamic effects in responding to noxious stimuli, mostly tracheal intubation and bispectral index (BIS) alterations following ciprofol/propofol administration.

PATIENTS AND METHODS

In this multi-center, randomized, double-blind phase 3 trial, selective surgery patients were randomly assigned in a 1:1 ratio to either ciprofol 0.4 mg/kg (n = 88) or propofol 2.0 mg/kg (n = 88) groups. The primary endpoint was the percentage of patients with successful anesthesia inductions. Secondary endpoints included the times to successful induction of general anesthesia and loss of the eyelash reflex, changes in BIS, as well as safety indicators.

RESULTS

The anesthesia induction success rates for both ciprofol 0.4 mg/kg and propofol 2 mg/kg groups were 100.0%, with a 95% CI lower success limit of -4.18% difference between the two groups, indicating that ciprofol was non-inferior to propofol. For secondary outcomes, the average time to successful anesthesia and loss of the eyelash reflex were 0.91 min and 0.80 min for ciprofol and 0.80 min and 0.71 min for propofol, respectively. The pattern of BIS changes with ciprofol was similar to propofol and stable during the anesthesia maintenance period. Safety was comparable with 88.6% TEAEs in the ciprofol group compared to 95.5% in the propofol group. The incidence of injection pain was significantly lower in the ciprofol group compared to the propofol group (6.8% vs. 20.5%, p < 0.05). In addition, the patients treated with ciprofol had a lesser increase in blood pressure and heart rate, and fewer cases with BIS > 60 within 15 min of intravenous administration, which indicated that ciprofol may provide a better ideal sedation level during the post-induction period under an equivalent dosing regimen to propofol.

CONCLUSIONS

Ciprofol for patients undergoing selective surgery is a new option for the induction of general anesthesia.

[Advances in pathogen diagnosis of respiratory infection diseases in 2021]

Respiratory tract infections (RTI) are a common and highly prevalent disease in the population, which can develop into acute respiratory distress syndrome (ARDS) in severe cases.A large variety of microorganisms can cause RTI, including bacteria, respiratory viruses, and fungi. The timely and accurate detection of these pathogens is the prerequisites of effective treatment of RTI. However, more than 50% of RTI patients failed to diagnosis of causative agents due to unavailability of qualified samples, antimicrobial treatment prior to sample collection, high variety of respiratory pathogens, and influence of the normal flora in respiratory tract. In recent years, progress on molecular diagnosis, especially the novel approaches such as clinical metagenomics and CRSIPR (Clustered regularly interspaced short palindromic repeats), has not only improved our capacity for RTI pathogen detection but also brought new challenges. In this review, we summed up the advances in RTI pathogen diagnosis in 2021 and discussed the clinical benefits and challenges from novel approaches, which provided a clinical perspective on the development and application of these diagnostic tools in the real world.

[Significance of bacteria detection with filter paper method on diagnosis of diabetic foot wound infection]

Objective: To evaluate the significance of bacteria detection with filter paper method on diagnosis of diabetic foot wound infection. Methods: Eighteen patients with diabetic foot ulcer conforming to the study criteria were hospitalized in Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from July 2014 to July 2015. Diabetic foot ulcer wounds were classified according to the University of Texas diabetic foot classification (hereinafter referred to as Texas grade) system, and general condition of patients with wounds in different Texas grade was compared. Exudate and tissue of wounds were obtained, and filter paper method and biopsy method were adopted to detect the bacteria of wounds of patients respectively. Filter paper method was regarded as the evaluation method, and biopsy method was regarded as the control method. The relevance, difference, and consistency of the detection results of two methods were tested. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of filter paper method in bacteria detection were calculated. Receiver operating characteristic (ROC) curve was drawn based on the specificity and sensitivity of filter paper method in bacteria detection of 18 patients to predict the detection effect of the method. Data were processed with one-way analysis of variance and Fisher's exact test. In patients tested positive for bacteria by biopsy method, the correlation between bacteria number detected by biopsy method and that by filter paper method was analyzed with Pearson correlation analysis. Results: (1) There were no statistically significant differences among patients with wounds in Texas grade 1, 2, and 3 in age, duration of diabetes, duration of wound, wound area, ankle brachial index, glycosylated hemoglobin, fasting blood sugar, blood platelet count, erythrocyte sedimentation rate, C-reactive protein, aspartate aminotransferase, serum creatinine, and urea nitrogen (with F values from 0.029 to 2.916, P values above 0.05), while there were statistically significant differences among patients with wounds in Texas grade 1, 2, and 3 in white blood cell count and alanine aminotransferase (with F values 4.688 and 6.833 respectively, P<0.05 or P<0.01). (2) According to the results of biopsy method, 6 patients were tested negative for bacteria, and 12 patients were tested positive for bacteria, among which 10 patients were with bacterial number above 1×10(5)/g, and 2 patients with bacterial number below 1×10(5)/g. According to the results of filter paper method, 8 patients were tested negative for bacteria, and 10 patients were tested positive for bacteria, among which 7 patients were with bacterial number above 1×10(5)/g, and 3 patients with bacterial number below 1×10(5)/g. There were 7 patients tested positive for bacteria both by biopsy method and filter paper method, 8 patients tested negative for bacteria both by biopsy method and filter paper method, and 3 patients tested positive for bacteria by biopsy method but negative by filter paper method. Patients tested negative for bacteria by biopsy method did not tested positive for bacteria by filter paper method. There was directional association between the detection results of two methods (P=0.004), i. e. if result of biopsy method was positive, result of filter paper method could also be positive. There was no obvious difference in the detection results of two methods (P=0.250). The consistency between the detection results of two methods was ordinary (Kappa=0.68, P=0.002). (3) The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of filter paper method in bacteria detection were 70%, 100%, 1.00, 0.73, and 83.3%, respectively. Total area under ROC curve of bacteria detection by filter paper method in 18 patients was 0.919 (with 95% confidence interval 0-1.000, P=0.030). (4) There were 13 strains of bacteria detected by biopsy method, with 5 strains of Acinetobacter baumannii, 5 strains of Staphylococcus aureus, 1 strain of Pseudomonas aeruginosa, 1 strain of Streptococcus bovis, and 1 strain of bird Enterococcus. There were 11 strains of bacteria detected by filter paper method, with 5 strains of Acinetobacter baumannii, 3 strains of Staphylococcus aureus, 1 strain of Pseudomonas aeruginosa, 1 strain of Streptococcus bovis, and 1 strain of bird Enterococcus. Except for Staphylococcus aureus, the sensitivity and specificity of filter paper method in the detection of the other 4 bacteria were all 100%. The consistency between filter paper method and biopsy method in detecting Acinetobacter baumannii was good (Kappa=1.00, P<0.01), while that in detecting Staphylococcus aureus was ordinary (Kappa=0.68, P<0.05). (5) There was no obvious correlation between the bacteria number of wounds detected by filter paper method and that by biopsy method (r=0.257, P=0.419). There was obvious correlation between the bacteria numbers detected by two methods in wounds with Texas grade 1 and 2 (with r values as 0.999, P values as 0.001). There was no obvious correlation between the bacteria numbers detected by two methods in wounds with Texas grade 3 (r=-0.053, P=0.947). Conclusions: The detection result of filter paper method is in accordance with that of biopsy method in the determination of bacterial infection, and it is of great importance in the diagnosis of local infection of diabetic foot wound.

Background removal in soil analysis using laser- induced breakdown spectroscopy combined with standard addition method

The matrix effect of powder samples, especially for soil samples, is significant in laser-induced breakdown spectroscopy (LIBS), which affects the prediction accuracy of the element concentration. In order to reduce this effect of the soil samples in LIBS, the standard addition method (SAM) based on background removal by wavelet transform algorithm was investigated in this work. Five different kinds of certified reference soil samples (lead (Pb) concentrations were 110, 283, 552, 675, and 1141 ppm, respectively) were used to examine the accuracy of this method. The root mean square error of prediction (RMSEP) was more than 303 ppm by using the conventional calibration method. After adoption of SAM with background removal by wavelet transform algorithm, the RMSEP was reduced to 25.7 ppm. Therefore, the accuracy of the Pb element was improved significantly. The mechanism of background removal by wavelet transform algorithm based on SAM is discussed. Further study demonstrated that this method can also improve the predicted accuracy of the Cd element.

Microwave photonic comb filter with ultra-fast tunability

A microwave comb filter with ultra-fast tunability is proposed based on the fundamental delay-line microwave photonic filter. The central frequency of the passband or stopband in such a filter can be rapidly adjusted, along with the independent tunability of the free spectral range (FSR). Experimental results show that the central frequency of the transfer function is electronically tuned with a frequency difference of half of the FSR at a speed of <100  ps. Such high-speed tunability is vital for high-speed microwave switching, frequency hopping, cognitive radio, and next-generation radar systems.

Polarization-diversified photonic comb filter with independently tunable free spectrum range

A polarization-diversified photonic comb filter with tunable free spectrum range (FSR) is proposed using two variable differential group delay (DGD) elements in a loop configuration. Two different cosine transfer functions could be simultaneously realized on orthogonal polarization states. Experimental demonstrations also verify feasibilities in various reconfigurable transfer functions.

Accuracy improvement of quantitative analysis in laser-induced breakdown spectroscopy using modified wavelet transform

A modified algorithm of background removal based on wavelet transform was developed for spectrum correction in laser-induced breakdown spectroscopy (LIBS). The optimal type of wavelet function, decomposition level and scaling factor γ were determined by the root-mean-square error of calibration (RMSEC) of the univariate regression model of the analysis element, which is considered as the optimization criteria. After background removal by this modified algorithm with RMSEC, the root-mean-square error of cross-validation (RMSECV) and the average relative error (ARE) criteria, the accuracy of quantitative analysis on chromium (Cr), vanadium (V), cuprum (Cu), and manganese (Mn) in the low alloy steel was all improved significantly. The results demonstrated that the algorithm developed is an effective pretreatment method in LIBS to significantly improve the accuracy in the quantitative analysis.

Photonic arbitrary waveform generation based on crossed frequency to time mapping

Microwave photonic arbitrary waveform generation based on incoherent frequency-to-time-mapping (FTTM) accompanied by intersymbol interference, so called crossed FTTM (CFTTM). The pulse shape can be defined and tuned by properly adjusting the spectrum shaper (symbol shape) and the degree of intersymbol interference. UWB-, triangular-, rectangle-, comb- and user-defined pulse shapes are experimentally obtained.

Bandwidth improvement for slow light using amplification characteristics of cascaded vertical-cavity surface-emitting lasers

A scheme to improve the bandwidth of slow light using cascaded vertical-cavity surface-emitting lasers (VCSELs) is proposed and experimentally demonstrated. In the scheme, a proper adjustment on the gain peaks of two cascaded VCSELs enables the generation of the desired composite gain spectrum, which has flat-top gain and delay profiles with enhanced peak values. By employing the improved gain and delay profiles in a slow light system, a large delay can be achieved within a wider bandwidth. In the experiment, by using two cascaded VCSELs, a tunable slow light up to 135 ps for a 5 Gbits/s pseudorandom binary sequence is demonstrated with relatively low signal distortion.

Photonic generation of impulse ultrawideband signals with switchable shapes and polarities based on frequency-to-time mapping

A photonic approach to generate impulse ultrawideband (UWB) signals with switchable shapes and polarities based on the frequency-to-time mapping technique is proposed and demonstrated. UWB monocycle, doublet, and triplet signals with two polarities can be obtained by adjusting the switchable spectrum shaper.

Chondroitin sulfate in palatal wound healing

Chondroitin sulfate is up-regulated in granulation tissue during wound healing. To investigate the role of chondroitin sulfate in the wound-healing process after surgical repair of cleft palate, we isolated and cultured rabbit palatal fibroblasts. Treatment with chondroitin-6-sulfate resulted in a dose-dependent increase in cell adhesion and cell proliferation, whereas the reverse effects were seen after chondroitinase degradation of chondroitin sulfate. The biological actions of chondroitin sulfate appeared to be dependent on the presence and position of sulfate groups. Inhibition of glycosaminoglycan sulfation by chlorate treatment led to reduced cell adhesion and cell proliferation and a slower rate of wound closure in vitro. Furthermore, exposure to chondroitin-4-sulfate resulted in a dose-dependent reduction in cell adhesion. Together, these results show that chondroitin sulfate is involved in palatal wound healing.

The design of new molecular "light switches" for DNA

Two novel ruthenium(II) complexes, [Ru(pztp)2(phen)](ClO4)2 and [Ru(pztp)2(bpy)] (ClO4)2, have been synthesized and characterized by UV/Vis and 1H NMR spectroscopies and mass spectrometry. The MeCN solutions of both complexes display fluorescence that was found to be highly sensitive to the presence and concentration of water. The complexes behave like a "light switch" for DNA in that they do not luminesce in water but were "turned on" in the presence of DNA and show emission enhancement with the increase of DNA concentration. Their DNA binding behavior was also studied by absorption spectroscopy and viscosity measurements, which suggest that the DNA-complex interaction involves intercalation of the metal-bound pztp ligand into the base pairs of duplex DNA.

Enantiomeric ruthenium(II) complexes binding to DNA: binding modes and enantioselectivity

A series of enantiomerically pure polypyridyl ruthenium(II) complexes, delta- and lambda-[Ru(bpy)2 (HPIP)](PF6)2 (delta-1 and lambda-1; bpy=2,2'-bipyridine, HPIP = 2-(2-hydroxyphenyl)imidazo[4,5-f][1,10]phenanthroline), delta and lambda-[Ru(bpy)2(HNAIP)](PF6)2 (delta-2 and lambda-2; HNAIP = 2-(2-hydroxy-1-naphthyl)imidazo[4,5-f][1,10]phenanthroline), delta- and lambda-[Ru(bpy)2 (HNOIP)](PF6)2 (delta-3 and lambda-3; HNOIP = 2-(2-hydroxy-5-nitrophenyl)imidazo[4,5-f][1,10]phenanthroline), and delta- and lambda-[Ru(bpy)2(DPPZ)](PF6)2 (delta-4 and lambda-4; DPPZ= dipyridophenazine), have been synthesized. Binding behavior of these chiral complexes to calf thymus DNA (CT-DNA) has been investigated by electronic absorption, steady-state emission, and circular dichroism spectroscopies, as well as by viscosity measurements and equilibrium dialysis binding studies. Several points came from the results. (1) The DNA-binding properties were distinctly different for the [Ru(bpy)2L]2+ (L=HPIP, HNAIP, HNOIP) series of ruthenium(II) complexes, which indicates that the photophysical behavior of the complexes on binding to DNA can be modulated through ligand design. (2) Different binding rates of individual enantiomers of complexes 1 and 4 to DNA were observed through dialysis experiments. The lambda enantiomer bound more rapidly than the lambda enantiomer and their different intercalative binding geometries were suggested to be responsible. (3) Both delta-2 and lambda-2 bound weakly to CT-DNA; delta-2 may bind through a partial intercalation mode, whereas lambda-2 may bind in the DNA groove. (4) There was no noticeable enantioselectivity for complexes 1, 3, and 4 on binding to CT-DNA. Both of their enantiomers can intercalate into DNA base pairs. It is noted that delta-3 and lambda-3 exhibited almost identical spectral changes on addition of CT-DNA, and a similar binding manner of the isomers to the double helix was proposed.

Antagonistic effect of CCK-8 on morphine-inhibited electrical and contractile activities of rat jejunum in vitro

In the present investigation, antagonistic action of cholecystokinin octapeptide (CCK-8) against morphine on the electrical and contractile activity of rat jejunum in vitro was studied. The results showed that the potentiation of acetylcholine (ACh) on both the burst of spike and the contractility were inhibited by morphine, which could be completely antagonized by CCK-8. The CCK-8 effect, again, could be suppressed by CCK-A receptor antagonist devazepide (10 nmol/L), but partially by CCK-B receptor antagonist L-365, 260 at 10 nmol/L or completely at concentration of 30 nmol/L. The above results demonstrated that the antagonism of CCK-8 on morphine was mediated by both CCK-A and CCK-B receptors.