Search

Competing Interests: Declaration of competing interest None.

Introduction: Gabapentin has been used in enhanced recovery after surgery (ERAS) pathways for pain control for patients undergoing ambulatory uro-oncologic surgery; however, it may cause undesirable side effects. We studied the causal association between gabapentin and rapidity of recovery and perioperative pain management after minimally invasive uro-oncologic surgery., Methods: We identified 2397 patients ≤ 65 years undergoing prostatectomies or nephrectomies between 2018 and 2022; 131 (5.5%) did not receive gabapentin. We tested the effect of gabapentin use on time of discharge and perioperative opioid consumption, respectively, using multivariable linear regression adjusting for potential confounders including age, gender, BMI, American Society of Anesthesiologists score, and surgery type., Results: On adjusted analysis, we found no evidence of a difference in discharge time among those who did vs did not receive gabapentin (adjusted difference 0.07 hours shorter on gabapentin; 95% CI -0.17, 0.31; P = .6). There was no evidence of a difference in intraoperative opioid consumption by gabapentin receipt (adjusted difference -1.5 morphine milligram equivalents; 95% CI -4.2, 1.1; P = .3) or probability of being in the top quartile of postoperative opioid consumption within 24 hours (adjusted difference 4.2%; 95% CI -4.8%, 13%; P = .4). We saw no important differences in confounders by gabapentin receipt suggesting causal conclusions are justified., Conclusions: Our confidence intervals did not include clinically meaningful benefits from gabapentin, when used with an ERAS protocol, in terms of length of stay or perioperative opioid use. These results support the omission of gabapentin from ERAS protocols for minimally invasive uro-oncologic surgeries.

Background: Performing large randomized trials in anesthesiology is often challenging and costly. The clinically integrated randomized trial is characterized by simplified logistics embedded into routine clinical practice, enabling ease and efficiency of recruitment, offering an opportunity for clinicians to conduct large, high-quality randomized trials under low cost. Our aims were to (1) demonstrate the feasibility of the clinically integrated trial design in a high-volume anesthesiology practice and (2) assess whether trial quality improvement interventions led to more balanced accrual among study arms and improved trial compliance over time., Methods: This is an interim analysis of recruitment to a cluster-randomized trial investigating three nerve block approaches for mastectomy with immediate implant-based reconstruction: paravertebral block (arm 1), paravertebral plus interpectoral plane blocks (arm 2), and serratus anterior plane plus interpectoral plane blocks (arm 3). We monitored accrual and consent rates, clinician compliance with the randomized treatment, and availability of outcome data. Assessment after the initial year of implementation showed a slight imbalance in study arms suggesting areas for improvement in trial compliance. Specific improvement interventions included increasing the frequency of communication with the consenting staff and providing direct feedback to clinician investigators about their individual recruitment patterns. We assessed overall accrual rates and tested for differences in accrual, consent, and compliance rates pre- and post-improvement interventions., Results: Overall recruitment was extremely high, accruing close to 90% of the eligible population. In the pre-intervention period, there was evidence of bias in the proportion of patients being accrued and receiving the monthly block, with higher rates in arm 3 (90%) compared to arms 1 (81%) and 2 (79%, p = 0.021). In contrast, in the post-intervention period, there was no statistically significant difference between groups (p = 0.8). Eligible for randomization rate increased from 89% in the pre-intervention period to 95% in the post-intervention period (difference 5.7%; 95% confidence interval = 2.2%-9.4%, p = 0.002). Consent rate increased from 95% to 98% (difference of 3.7%; 95% confidence interval = 1.1%-6.3%; p = 0.004). Compliance with the randomized nerve block approach was maintained at close to 100% and availability of primary outcome data was 100%., Conclusion: The clinically integrated randomized trial design enables rapid trial accrual with a high participant compliance rate in a high-volume anesthesiology practice. Continuous monitoring of accrual, consent, and compliance rates is necessary to maintain and improve trial conduct and reduce potential biases. This trial methodology serves as a template for the implementation of other large, low-cost randomized trials in anesthesiology., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study explores the conversion of recovered carbon black (rCB) from end-of-life tires (ELTs) into activated carbons (ACs) using potassium-based activators, targeting enhanced textural properties development. The research focuses on the interaction between potassium and rCB, with the aim of understanding the underlying mechanisms of rCB activation. The study investigates several parameters of KOH activation, including the KOH/rCB mass ratio (1:3 to 1:6), activation temperatures (700-900 °C), activation time (1-4 h), and heating rate (5-13 °C/min). It also assesses the effects of different potassium salts (KCl, K 2 CO 3 , CH 3 COOK, and K 2 C 2 O 4 ) on porosity and surface characteristics of the rCB/ACs. Furthermore, the role of the physical state of KOH as an activator (solid and gas-solid) was examined, alongside a comparative analysis with NaOH to evaluate the distinct effects of potassium and sodium ions. Optimal conditions were identified at an 800 °C activation temperature, a 7 °C/min heating rate, a 1:5 KOH/rCB ratio, and a 4 h activation period. X-ray diffraction analysis showed the formation of several K-phases, such as K 2 CO 3 , K 2 CO 3 ·1.5H 2 O, K 4 (CO 3 ) 2 ·(H 2 O) 3 , KHCO 3 , and K 2 O. The effectiveness of the potassium salts was ranked as follows: KOH > K 2 C 2 O 4 > CH 3 COOK > K 2 CO 3 > KCl, with KOH emerging as the most effective. Notably, the gas-solid reaction of KOH/rCB was indicated as a contributor to the activation process. Additionally, it was concluded that the role of KOH in enhancing the textural properties of rCB was primarily due to the interaction of K + ions with the graphite-like structure of rCB, compared to the effects observed with NaOH. This research introduces novel insights into the specific roles of different potassium salts and KOH activation conditions in optimizing the textural characteristics of rCB/ACs., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

In the era of ecology and careful care for the environment, it becomes important to use renewable raw materials of plant origin, which are often more easily available and cheaper. One of the important and rapidly developing directions of research are works related to the use of waste plant biomass; an example of this trend is the production of activated carbons from food industry waste. One of the examples of the application of derived from biomass activated carbons can be using them as catalysts for the isomerization of terpene compounds. Carbons based on waste biomass are characterized by the minimal amount of waste formation during their manufacture, and their use in the isomerization reaction allows to obtain high conversion of organic raw material and high selectivities of transformation to the desired products, making these carbons environmentally friendly substitutes for the catalysts used usually in this process. In this work, obtained carbonaceous catalysts were tested in the process of isomerization of α-pinene to high value chemicals (mainly camphene and limonene). Under the most favorable conditions (activated carbon from sunflower husks content in reaction mixture 5 wt%, temperature 180 °C, and reaction time 100 min), α-pinene was completely converted (conversion 100 mol%) with high selectivity towards camphene (54 mol%). To prepare activated carbons, biomass precursors (orange peels, sunflower husks, spent coffee grounds) were activated with 85% H 3 PO 4 through the chemical activation. The obtained materials were characterized by such methods as sorption N 2 at - 196 °C, X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), scanning electron microscope (SEM), and X-ray fluorescence (XRF) to determine the relationship between their textural-chemical properties and catalysts activity in isomerization process. The synthesized materials were characterized by a specific surface area in the range of 930-1764 m 2 , total pore volume in the range of 0.551-1.02 cm 3 /g, and total acid-site concentrations in the range of 1.47-2.33 mmol/g. These results showed that textural parameters of the obtained activated carbons have the important role in the isomerization of α-pinene., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Recent data suggest disparities in receipt of regional anesthesia prior to breast reconstruction. We aimed to understand factors associated with block receipt for mastectomy with immediate tissue expander (TE) reconstruction in a high-volume ambulatory surgery practice with standardized regional anesthesia pathways., Patients and Methods: Patients who underwent mastectomy with immediate TE reconstruction from 2017 to 2022 were included. All patients were considered eligible for and were offered preoperative nerve blocks as part of routine anesthesia care. Interpreters were used for non-English speaking patients. Patients who declined a block were compared with those who opted for the procedure., Results: Of 4213 patients who underwent mastectomy with immediate TE reconstruction, 91% accepted and 9% declined a nerve block. On univariate analyses, patients with the lowest rate of block refusal were white, non-Hispanic, English speakers, patients with commercial insurance, and patients undergoing bilateral reconstruction. The rate of block refusal went down from 12 in 2017 to 6% in 2022. Multivariable logistic regression demonstrated that older age (p = 0.011), Hispanic ethnicity (versus non-Hispanic; p = 0.049), Medicaid status (versus commercial insurance; p < 0.001), unilateral surgery (versus bilateral; p = 0.045), and reconstruction in earlier study years (versus 2022; 2017, p < 0.001; 2018, p < 0.001; 2019, p = 0.001; 2020, p = 0.006) were associated with block refusal., Conclusions: An established preoperative regional anesthesia program with blocks offered to all patients undergoing mastectomy with TE reconstruction can result in decreased racial disparities. However, continued differences in age, ethnicity, and insurance status justify future efforts to enhance preoperative educational efforts that address patient hesitancies in these subpopulations., (© 2024. Society of Surgical Oncology.)

In this paper, we provide a comprehensive review of the latest research trends in terms of the preparation, and characteristics of activated carbons regarding CO 2 adsorption applications, with a special focus on future investigation paths. The reported current research trends are primarily closely related to the synthesis conditions (carbonization and physical or chemical activation process), to develop the microporosity and surface area, which are the most important factors affecting the effectiveness of adsorption. Furthermore, we emphasized the importance of regeneration techniques as a factor determining the actual technological and economic suitability of a given material for CO 2 capture application. Consequently, this work provides a summary and potential directions for the development of activated carbons (AC). We attempt to create a thorough theoretical foundation for activated carbons while also focusing on identifying and specific statements of the most relevant ongoing research scope that might be advantageous to progress and pursue in the coming years., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objectives: Expanding outpatient surgery to the increasing number of procedures and patient populations warrants continuous evaluation of postoperative outcomes to ensure the best care and safety. We describe adverse postoperative outcomes and transfer rates related to anesthesia in a large sample of patients who underwent same-day cancer surgery at a freestanding ambulatory surgery center., Methods: Between January 2017 and June 2021, 3361 cancer surgeries, including breast and plastic, head and neck, gynecology, and urology, were performed. The surgeries were indicated for diagnosis, staging, and/or treatment. We report the incidence of transfers and adverse postoperative outcomes related to anesthesia., Results: Breast and plastic surgeries were the most common (1771, 53%), followed by urology (1052, 31%), gynecology (410, 12%), and head and neck surgeries (128, 4%). Based on patients' first procedure, comorbidity levels were highest for urology (75% American Society of Anesthesiologists physical status score 3, 1.7% score 4) and lowest for breast surgeries (31% score 3, 0.2% score 4). Most gynecology surgeries used general anesthesia (97.6%), whereas breast surgeries used the least (38%). A total of seven patients (0.2%; 95% CI: 0.08%-0.4%) were immediately transferred to an outside hospital; four due to anesthesia-related reasons. Only 7 (0.2%) patients needed additional postoperative care related to anesthesia-related adverse events, specifically cardiac events (4), difficult intubations (2), desaturation (1), and agitation, nausea, and headache (1)., Conclusions: The incidence of anesthesia-related adverse postoperative outcomes is low in cancer patients undergoing outpatient surgeries at our freestanding ambulatory surgery center. This suggests that carefully selected cancer patients, including patients with metastatic cancer, can undergo anesthesia for same-day surgery, making cancer care accessible locally and reducing stress associated with travel for treatment. More research investigating complication rates related to surgery and to cancer disease trajectory are needed to establish a complete evaluation of safety for outpatient cancer surgery., (© 2024 Wiley Periodicals LLC.)

The current study presents for the first time how recovered carbon black (rCB) obtained directly from the industrial-scale end-of-life tires (ELTs) pyrolysis sector is applied as a precursor for activated carbons (ACs) with application in CO 2 capture. The rCB shows better physical characteristics, including density and carbon structure, as well as chemical properties, such as a consistent composition and low impurity concentration, in comparison to the pyrolytic char. Potassium hydroxide and air in combination with heat treatment (500-900 °C) were applied as agents for the conventional chemical and physical activation of the material. The ACs were tested for their potential to capture CO 2 . Ultimate and proximate analysis, Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS), Raman spectroscopy, thermogravimetric analysis (TGA), and N 2 /CO 2 gas adsorption/desorption isotherms were used as material characterization methods. Analysis revealed that KOH-activated carbon at 900 °C (AC-900K) exhibited the highest surface area and a pore volume that increased 6 and 3 times compared to pristine rCB. Moreover, the AC-900K possessed a well-developed dual porosity, corresponding to the 22% and 78% of micropore and mesopore volume, respectively. At 0 °C and 25 °C, AC-900K also showed a CO 2 adsorption capacity equal to 30.90 cm 3 /g and 20.53 cm 3 /g at 1 bar, along with stable cyclic regeneration after 10 cycles. The high dependence of CO 2 uptake on the micropore volume at width below 0.7-0.8 nm was identified. The selectivity towards CO 2 in relation to N 2 reached high values of 350.91 (CO 2 /N 2 binary mixture) and 59.70 (15% CO 2 /85% N 2 )., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In this work, we studied new materials free of noble metals that are active in photocatalytic H 2 generation from ethanol aqueous solutions (EtOH aq ), which can be obtained from biomass. Mo x C/g-C 3 N 4 photocatalysts containing hexagonal (hcp) Mo 2 C and/or cubic (fcc) MoC nanoparticles on g-C 3 N 4 nanosheets were prepared, characterized, and evaluated for photocatalytic hydrogen production from EtOH aq (25% v/v). Tailored Mo x C/g-C 3 N 4 nanocomposites with Mo x C crystallite sizes in the 4-37 nm range were prepared by treatment with ultrasound of dispersions containing Mo x C and g-C 3 N 4 nanosheets, formerly synthesized. The characterization of the resulting nanocomposites, Mo x C/g-C 3 N 4 , by different techniques, including photoelectrochemical measurements, allowed us to relate the photocatalytic performance of materials with the characteristics of the Mo x C phase integrated onto g-C 3 N 4 . The samples containing smaller hcp Mo 2 C crystallites showed better photocatalytic performance. The most performant nanocomposite contained nanoparticles of both hcp Mo 2 C and fcc MoC and produced 27.9 mmol H 2 g -1 Mo; this sample showed the lowest recombination of photogenerated charges, the highest photocurrent response, and the lowest electron transfer resistance, which can be related to the presence of MoC-Mo 2 C heterojunctions. Moreover, this material allows for easy reusability. This work provides new insights for future research on noble-metal-free g-C 3 N 4 -based photocatalysts., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

This article describes the synthesis and characterization of porous carbon derived from waste banana peels by chemical activation with KOH or by activation KOH and urea modification. The as-synthesized samples were carefully characterized by various techniques. The prepared carbonaceous materials possess highly developed micropore and mesopore structures and high specific surface area (up to 2795 cm 2 /g for materials synthetized with KOH and 2718 cm 2 /g for activated carbons prepared with KOH and urea). A series of KOH-activated samples showed CO 2 adsorption at 1 bar to 5.75 mmol/g at 0 °C and 3.74 mmol/g at 25 °C. The incorporation of nitrogen into the carbon sorbent structure increased the carbon uptake capacity of the resulting materials at 1 bar to 6.28 mmol/g and to 3.86 mmol/g at 0 °C and 25 °C, respectively. It was demonstrated that treatment with urea leads to a significant increase in nitrogen content and, consequently, CO 2 adsorption, except for the material carbonized at 900 °C. At such a high temperature, almost complete decomposition of urea occurs. The results presented in this work could be used in the future for utilization of biomass such as banana peels as a low-cost adsorbent for CO 2 capture, which could have a positive impact on the environment and human health protection.

Background: Autologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks for latissimus dorsi myocutaneous flap reconstruction., Methods: Patients who underwent mastectomy with latissimus flap reconstruction from 2018 to 2022 were included in three groups: local infiltration, PVB, and ESP blocks. Block effect on postoperative length of stay (LOS) and the association between block status and pain, opioid consumption, time to first analgesic, and postoperative antiemetic administration were assessed., Results: 122 patients met the inclusion criteria for this retrospective cohort study: no block (n=72), PVB (n=26), and ESP (n=24). On adjusted analysis, those who received a PVB block had a 20-hour shorter postoperative stay (95% CI 11 to 30; p<0.001); those who received ESP had a 24-hour (95% CI 15 to 34; p<0.001) shorter postoperative stay compared with the no block group, respectively. Using either block was associated with a reduction in intraoperative opioids (23 morphine milligram equivalents (MME)), 95% CI 14 to 31, p<0.001; ESP versus no block: 23 MME, 95% CI 14 to 32, p<0.001)., Conclusions: Replacing surgical infiltration with PVB and ESP blocks for autologous breast reconstruction reduces LOS. The comparable reduction in LOS suggests that ESP may be a viable alternative to PVB in patients undergoing latissimus flap breast reconstruction following mastectomy. Further research should investigate whether ESP or PVB have better patient outcomes in complex breast reconstruction., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)