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BackgroundAcute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.MethodsPubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.ResultsTwenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% vs. 13.2%; risk ratio = 0.57, 95% CI = 0.40 to 0.83, P =  0.003, I2 = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.ConclusionDexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.RegistrationInternational Prospective Register of Systematic Reviews; Registration number: CRD42022299252.

BackgroundPostoperative delirium (POD) is common among older surgical patients and may be affected by dexmedetomidine and depth of anesthesia. We designed this pilot study to assess the feasibility of comparing dexmedetomidine with normal saline during light versus deep anesthesia on POD in older patients undergoing major noncardiac surgery.MethodsIn this pilot randomized factorial study, 80 patients aged 60 years or older undergoing major noncardiac surgery were randomized (1:1:1:1) to receive dexmedetomidine infusion 0.5 μg/kg/h or normal saline placebo during light (bispectral index [BIS] target 55) or deep (BIS target 40) anesthesia. Feasibility end points included consent rate and dropout rate, timely enrollment, blinded study drug administration throughout surgery, no inadvertent unmasking, achieving BIS target throughout >70% of surgery duration, and the process of twice-daily POD screening. In addition, we estimated the POD incidences in the 2 control groups (placebo and deep anesthesia) and treatment effects of dexmedetomidine and light anesthesia.ResultsBetween November 1, 2021, and June 30, 2022, 78 patients completed the trial (mean [standard deviation, SD] age, 69.6 [4.6] years; 48 male patients [62%]; dexmedetomidine-deep, n = 19; dexmedetomidine-light, n = 20; placebo-deep, n = 19; placebo-light, n = 20). This study had a high consent rate (86%) and a low dropout rate (2.5%). Average recruitment was 5 patients at each center per month. Dexmedetomidine and normal saline were administered in a blinded fashion in all patients. Unmasking did not occur in either group. Approximately 99% of patients received the scheduled study drug infusion throughout the surgery. Approximately 81% of patients achieved the BIS targets throughout >70% of the surgery duration. The scheduled twice-daily POD screening was completed without exception. Overall, 10 of the 78 patients (13%; 95% confidence interval [CI], 7%-22%) developed POD. For the 2 reference groups, POD was observed in 7 of the 39 patients (17.9%; 95% CI, 9%-32.7%) in the placebo group and 7 of the 38 patients (18.4%; 95% CI, 9.2%-33.4%) in the deep anesthesia group. Regarding the treatment effects on POD, the estimated between-group difference was -10% (95% CI, -28% to 7%) for dexmedetomidine versus placebo, and -11% (95% CI, -28% to 6%) for light versus deep anesthesia.ConclusionsThe findings of this pilot study demonstrate the feasibility of assessing dexmedetomidine versus placebo during light versus deep anesthesia on POD among older patients undergoing major noncardiac surgery, and justify a multicenter randomized factorial trial.

Objective To investigate the application value of combining the Demirjian’s method with machine learning algorithms for dental age estimation in northern Chinese Han children and adolescents. Methods Oral panoramic images of 10 256 Han individuals aged 5 to 24 years in northern China were collected. The development of eight permanent teeth in the left mandibular was classified into different stages using the Demirjian’s method. Various machine learning algorithms, including support vector regression （SVR）, gradient boosting regression （GBR）, linear regression （LR）, random forest regression （RFR）, and decision tree regression （DTR） were employed. Age estimation models were constructed based on total, female, and male samples respectively using these algorithms. The fitting performance of different machine learning algorithms in these three groups was evaluated. Results SVR demonstrated superior estimation efficiency among all machine learning models in both total and female samples, while GBR showed the best performance in male samples. The mean absolute error （MAE） of the optimal age estimation model was 1.246 3, 1.281 8 and 1.153 8 years in the total, female and male samples, respectively. The optimal age estimation model exhibited varying levels of accuracy across different age ranges, which provided relatively accurate age estimations in individuals under 18 years old. Conclusion The machine learning model developed in this study exhibits good age estimation efficiency in northern Chinese Han children and adolescents. However, its performance is not ideal when applied to adult population. To improve the accuracy in age estimation, the other variables can be considered.

This study presents new detrital zircon laser ablation inductively coupled plasma mass spectrometry (LA‐ICP‐MS) U–Pb ages and in situ Hf–O isotopic data in order to constrain the depositional age and provenance of the Benxi Formation in the Sanmenxia area of the southern North China Craton (NCC). Detrital zircons in quartz sandstone drillcore from the Benxi Formation are euhedral–subhedral, oscillatory zoned, and have high Th/U ratios (0.03–1.60, generally greater than 0.3) that are indicative of a magmatic origin. Detrital zircons from samples 13H16A and 13H16B yield seven (2544, 1788, 1123, 955, 737, 441, and 344 Ma) and six main age populations (2440, 1583, 951, 759, 434, and 348 Ma), respectively. The εHf(t) values of the Neoarchean–Paleoproterozoic zircons range from −11.3 to +13.9, and these zircons have δ18O values that range from 5.68‰ to 8.83‰. The Neoproterozoic zircons have variable εHf(t) (−9.2 to +12.5) and δ18O (5.58‰ to 9.85‰) values, whereas the Palaeozoic zircons have εHf(t) values between −19.9 and +13.4 and δ18O values of 5.23‰–9.43‰. The Benxi Formation was deposited during the late Carboniferous and contains sediments derived from igneous rocks of the North Qinling Orogen combined with a small amount of material derived from Precambrian basement of the NCC. The northward subduction of the South Qinling Orogen caused the uplift and erosion of the North Qinling Orogen during the late Carboniferous. [ABSTRACT FROM AUTHOR]

To study the mechanical characteristics and the damage evolution process of coal under direct tensile loads, the direct tensile tests and real-time acoustic emission (AE) tests on raw coal specimens were conducted using MTS815 rock mechanics testing system and PCI-1I AE testing system. In addition, the direct tensile mechanical characteristics and the AE property of coal were analyzed and a damage model of coal based on AE was built. The test results show that the tensile strengths of specimens, whose average tensile strength is 0.66 MPa, are obviously discrete because of the variations of defect distribution in coal specimens. Under direct tensile loading conditions, the post-peak bearing capacity of specimen decreases due to the damage accumulation, but does not directly reach zero. The AE events increase and converge dramatically along the failure surface, which indicates the formation of macroscopic crack surface and the occurrence of coal destruction at the peak stress zoon. As the specimen destruction process gradually advances, the AE count rate and the AE energy rate increase and decrease repeatedly at the post-peak region. The AE tests can demonstrate the complete evolution process of coal damage under direct tensile loading conditions: occurrence, development and destruction. [ABSTRACT FROM AUTHOR]

To discuss the effects of coal-rock combination mode on its mechanical and damaging characteristics, the uniaxial and triaxial compressive tests for three combination modes, such as Rock-Coal-Rock ( YMY), Rock-Coal (YM) and Coal-Rock (MY) ,were carried out on MTS815 Rock Mechanics Testing System. The results show that the failure mainly concentrates on the coal part of combination specimen, and do not be affected by the combining mode and the loading condition. The development of damage and increase of failure extent in coal part can result in the emergence of damage and failure in rock part to some extent. The failure states are mainly tensile failure and happens in coal part for uniaxial compressive test. The uniaxiaI compressive strength of YMY is 40.03 MPa, which is 1.80 and 1.53 times of YM and MY, respectively. Under triaxial compressive condition, the failure are all mainly shear failure in coal part, and the average triaxial strength for three, combination modes gradually approaches with the confining pressure increasing. [ABSTRACT FROM AUTHOR]