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Objective: To observe and evaluate the effect of a single intravenous injection of low-dose esketamine on post-operative pain and post-partum depression (PPD) in cesarean delivery patients. Methods: A total of 210 patients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were divided into an esketamine group (Group S, n = 105) and a normal saline group (Group L, n = 105) by a random number table. At 5 min after childbirth, patients in the S group were given 0.25 mg/kg esketamine, whereas patients in the L group received an equal volume of saline. The primary outcomes included post-operative pain control according to the Numerical Rating Scale (NRS) and the incidence of PPD according to the Edinburgh Post-partum Depression Scale (EPDS). The secondary outcomes included analgesia-related adverse events and Ramsay sedation scores. Results: This clinical study was a prospective, randomized, double-blind trial. A total of 210 patients were enrolled in this study. The NRS pain (cough pain) score was lower in the S group than in the L group at 24 h after surgery (P = 0.016), and there was no significant difference in resting pain and mobilization pain at 4, 8, and 48 h after surgery or resting pain at 24 h after surgery between the two groups. There was no significant difference in the prevalence of PPD between the two groups on the day before delivery, or at the first week, the second week, or the fourth week after childbirth. At 5 min after dosing, the incidence of hallucinations (P < 0.001) and dizziness (P < 0.001) was higher in the S group than in the L group. At 15 min after dosing, the incidence of dizziness (P < 0.001) and nausea (P = 0.011) was higher in the S group than in the L group. The incidence of dizziness (P < 0.001) was higher in the S group than in the L group when leaving the operating room. The Ramsay scores in Group S were lower than in Group L at 5 min (p < 0.001), 15 min (p < 0.001) after dosing and at the time of leaving the operating room (p < 0.001). Conclusion: In this study, a single intravenous injection of 0.25 mg/kg esketamine did not reduce the incidence of depression at 1, 2, or 4 w postpartum but improved pain during exercise at 24 h post-operatively under the conditions of this clinical trial. [ABSTRACT FROM AUTHOR]

In the context of metal particle catalysts, composition, shape, exposed facets, crystal structure, and atom distribution dictate activity. While techniques have been developed to control each of these parameters, there is no general method that allows one to optimize all parameters in the context of polyelemental systems. Herein, by combining a solid-state, Bi-influenced, high-index facet shape regulation strategy with thermal annealing, we achieve control over crystal structure and atom distribution on the exposed high-index facets, resulting in an unprecedentedly diverse library of chemically disordered and ordered multimetallic (Pt, Co, Ni, Cu, Fe, and Mn) tetrahexahedral (THH) nanoparticles. Density functional theory calculations show that surface Bi modification stabilizes the {210} high-index facets of the nanoparticles, regardless of their internal atomic ordering. Moreover, we find that the ordering transition temperatures for the nanoparticles are dependent on their composition, and, in the case of Pt3Fe1 THH nanoparticles, increasing Ni substitution leads to an order-to-disorder transition at 900 °C. Finally, we have discovered that ordered intermetallic THH Pt1Co1 nanocatalysts exhibit a catalytic performance superior to disordered THH Pt1Co1 nanoparticles and commercial Pt/C catalysts toward methanol electrooxidation, highlighting the importance of crystal structure and atom distribution control on high-index facets in nanoscale catalysts. [ABSTRACT FROM AUTHOR]