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Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article.

Seed priming with a composite of iron oxide (Fe 3 O 4 ) and silicon dioxide (SiO 2 ) nanoparticles (NPs) is an innovative technique to mitigate cadmium (Cd) and chromium (Cr) uptake in plants from rooting media. The current study explored the impact of seed priming with varying levels of Fe 3 O 4 NPs, SiO 2 NPs, and Fe 3 O 4 -SiO 2 nanocomposites on Cd and Cr absorption and phytotoxicity, metal-induced oxidative stress mitigation, growth and biomass yield of spinach (Spinacia oleracea L.). The results showed that seed priming with the optimum level of 100 mg L -1 of Fe 3 O 4 -SiO 2 nanocomposites significantly (p ≤ 0.05) increased root dry weight (144 %), shoot dry weight (243 %) and leaf area (34.4 %) compared to the control, primarily by safeguarding plant's photosynthetic machinery, oxidative stress and phytotoxicity of metals. Plants treated with this highest level of Fe 3 O 4 -SiO 2 nanocomposites exhibited a substantial increase in photosynthetic and gas exchange indices of spinach plants and enhanced activities of superoxide dismutase (SOD), catalase (CAT), and ascorbate peroxidase (APX) antioxidant enzymes by 45 %, 48 %, and 60 %, respectively. Correspondingly, the relative gene expression levels of SOD, CAT, and APX also rose by 109 %, 181 %, and 137 %, respectively, compared to non-primed plants. This nanocomposite application also boosted the levels of phenolics (28 %), ascorbic acid (68 %), total sugars (129 %), flavonoids (39 %), and anthocyanin (29 %) in spinach leaves, while significantly reducing Cd (34.7 %, 53.4 %) and Cr (20.2 %, 28.8 %) contents in plant roots and shoots, respectively. These findings suggest that seed priming with Fe 3 O 4 -SiO 2 nanocomposites effectively mitigated the toxic effects of Cd and Cr, enhancing the growth and biomass yield of spinach in Cd and Cr co-contaminated environments, offering a promising sustainable approach for producing metal-free crops., 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.)

Background: Few studies have assessed the dose ratio of calcium gluconate to calcium chloride or defined the time course of change in serum ionized calcium concentration after intravenous injection., Methods: In a bioequivalence (dose ratio) trial, parturients undergoing cesarean delivery were randomly assigned to receive calcium chloride 0.5 grams or calcium gluconate 1.5 or 2 grams by 10-minute intravenous infusion. Venous serum ionized calcium concentration was measured prior to calcium infusion and approximately 5, 10, 15, 30, and 60 minutes after infusion start. We combined these data with serum ionized calcium concentration measurements in parturients who received 1 gram calcium chloride or saline placebo in two recent clinical trials to define the pharmacokinetics of intravenous calcium over the first hour during and after drug administration., Results: The bioequivalence study enrolled 34 participants, from whom we collected 181 serum ionized calcium concentration measurements. The dose ratio of calcium gluconate to calcium chloride was 3.11 (95% CI: 2.77-3.48). Population pharmacokinetics of calcium were determined using 311 serum ionized calcium concentration measurements from 70 parturients. The pharmacokinetics of intravenous calcium were described by a two-compartment model with systemic clearance of 0.18 (95% CI: 0.07-0.27) L/min, distributional clearance of 1.25 (95%CI: 1.03-1.56) L/min, central volume of 10.9 (95% CI: 9.3-12.6) L, and peripheral volume of 16.5 (95% CI: 12.5-24.7) L. After adjusting for the dose ratio, calcium gluconate and calcium chloride had identical time courses. A one-gram infusion of calcium chloride results in a peak increase in serum ionized calcium concentration of 0.39 (0.38-0.42 mmol/L), which decreases by half 29 (23-40) minutes after initiation of the 10-minute infusion., Conclusions: We confirmed a 3:1 dose ratio of calcium gluconate to calcium chloride and estimated the pharmacokinetics over the first hour following intravenous delivery. These data inform clinical care and may guide future trials assessing calcium efficacy to reduce bleeding in obstetric patients., Clinicaltrials.gov Registration: NCT05973747 (bioequivalence), NCT05027048, and NCT03867383 (trials included in pharmacokinetic assessment)., Competing Interests: Conflicts of Interest: Dr. Shafer is a consultant to Concentric Analgesics and ResQ Pharma. Dr. Shafer has equity interest in Concentric Analgesics and ResQ Pharma. Dr. Cole receives royalties from UpToDate for her work on post dural puncture headache., (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)

Polyvinyl alcohol (PVA) is a popular material used in the packaging industry. However, it is vulnerable to moisture, which can affect its performance and durability. Introducing hydrophobic substances, such as tetraethyl orthosilicate (TEOS) and hexadecyltrimethoxysilane (HDTMS), on the top layer of PVA can help maintain the excellent properties of PVA under high-humidity conditions. The low compatibility of hydrophobic materials with the hydrophilic layers allows them to aggregate more easily. To overcome these issues, we focused on the effects of particle size when increasing the coating suspension's dispersibility. A carbon quantum dot (CQD) suspension is an appropriate novel solvent for hydrophobic TEOS/HDTMS coating suspensions because its particles are small and light and exhibit good dispersibility. The CQD suspension formed a smooth hydrophobic coating on the TEOS/HDTMS materials. Furthermore, the uniformly coated PVA with the CQD suspension exhibited a water contact angle of 110°. The water droplets remained intact without being absorbed, confirming the effectiveness of the surface coating facilitated by CQDs. These results suggested that CQDs improved the dispersibility and enhanced the coating quality of TEOS/HDTMS on PVA. Enhancing the hydrophobicity of PVA is ideal for applications in packaging and other fields.

Incorporating starch, which is a potential biodegradable substitute for petroleum-based polymers, into conventional polymers is challenging owing to limitations in processability and weak-performing resulting materials. Herein, corn starch/polyvinyl alcohol (PVA) blend films (starch: PVA ratio of 50:50) were prepared via the solvent casting method using glycerol as a plasticizer and with varying concentrations of maleic acid as the crosslinking agent. Fourier transform infrared spectroscopy revealed the molecular interactions of the maleic acid crosslinker with the polymeric network of starch and PVA through an ester linkage. The properties of the films were strongly dependent on the maleic acid concentration. An increasing maleic acid concentration imparted hydrophobicity to the film; therefore, water swelling was significantly reduced, and water resistance was enhanced. The film containing 20 wt% maleic acid exhibited excellent barrier properties, with the lowest oxygen and water vapor transmission rates of 0.5 ± 0.2 cc/m 2 ⋅day and 232.3 ± 5.4 g/m 2 ⋅day, respectively. Moreover, the mechanical properties of the film improved with increasing crosslinking. This study demonstrates that the addition of maleic acid leads to an improvement in the overall performance of starch/PVA blend films. Therefore, maleic acid-crosslinked films can be used as barrier materials in food packaging applications., 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 Elsevier B.V. All rights reserved.)

Objective: To evaluate whether prophylactic administration of 1 g of intravenous calcium chloride after cord clamping reduces blood loss from uterine atony during intrapartum cesarean delivery., Methods: This single-center, block-randomized, placebo-controlled, double-blind superiority trial compared the effects of 1 g intravenous calcium chloride with those of saline placebo control on blood loss at cesarean delivery. Parturients at 34 or more weeks of gestation requiring intrapartum cesarean delivery after oxytocin exposure in labor were enrolled. Calcium or saline placebo was infused over 10 minutes beginning 1 minute after umbilical cord clamping in addition to standard care with oxytocin. The primary outcome was quantitative blood loss, analyzed by inverse Gaussian regression. Planned subgroup analysis excluded nonatonic bleeding, such as hysterotomy extension, arterial bleeding, and occult placenta accreta. We planned to enroll 120 patients to show a 200-mL reduction in quantitative blood loss in planned subgroup analysis, assuming up to 40% incidence of nonatonic bleeding (80% power, α<0.05)., Results: From April 2022 through March 2023, 828 laboring parturients provided consent and 120 participants were enrolled. Median blood loss was 840 mL in patients allocated to calcium chloride (n=60) and 1,051 mL in patients allocated to placebo (n=60), which was not statistically different (mean reduction 211 mL, 95% CI -33 to 410). In the planned subgroup analysis (n=39 calcium and n=40 placebo), excluding cases of surgeon-documented nonatonic bleeding, calcium reduced quantitative blood loss by 356 mL (95% CI 159-515). Rates of reported side effects were similar between the two groups (38% calcium vs 42% placebo)., Conclusion: Prophylactic intravenous calcium chloride administered during intrapartum cesarean delivery after umbilical cord clamping did not significantly reduce blood loss in the primary analysis. However, in the planned subgroup analysis, calcium infusion significantly reduced blood loss by approximately 350 mL. These data suggest that this inexpensive and shelf-stable medication warrants future study as a novel treatment strategy to decrease postpartum hemorrhage, the leading global cause of maternal morbidity and mortality., Clinical Trial Registration: ClinicalTrials.gov , NCT05027048., Competing Interests: Financial Disclosure Deirdre Lyell reports financial relationships with National Institutes of Health (NIH), the Society for Maternal-Fetal Medicine (SMFM), and UC San Francisco. Lyell is a stock owner in ZenFlow, unrelated to this work, and a consultant for stock options for Bloomlife, also unrelated to this work. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Nanotechnology has advanced significantly in recent years and is currently used in a wide range of sectors. Only a handful of the many diverse issues covered by nanotechnology include nanoscale gadgets, nanomaterials, nanoparticles, and nanomedicines. Its performance in treating a range of grave conditions, such as cancer, early detection of infections, analysis, bio-imaging, and bio sensing, suggests that it is highly advanced. Nanoscale materials have been employed for medicine delivery, pharmaceutics, and a range of diagnostic techniques due to their various biochemical and physical features. The use of nanoparticles that are based on nanotechnology can significantly improve the drug delivery mechanism. It is believed that nanoparticles capacity to improve the stability and solubility of drugs and shield them from impulsive inactivation during drug transfer makes it possible for them to capture, encapsulate, or bond with the molecules. The use of nanomedicine or nanoparticle-based tactics to combat viruses has emerged as a potentially life-saving tactic. These approaches have the power to protect both humans and animals against viruses. In order to inactivate a virus, nanoparticles have the unique capacity to connect with the virus epitope. Many nanocarriers have the potential to replace current drug delivery methods with focused drug delivery. Small dosages, low toxicity, and targeted flow of drug release at the infected location are all characteristics of nanocarriers or nanomedicine. Due to their distinct physicochemical and biological features, nanomaterial-based drug delivery systems (NBDDS) are frequently employed to enhance the safety and therapeutic efficacy of encapsulated pharmaceuticals. The program's objective can be supported by the applications that have so far been developed. This idea is therefore essential and sophisticated for the development of civilization. Our research will therefore concentrate on how human use of nanomedicines has changed through time in many domains., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Most of the 1.1 million women who deliver by cesarean in the United States each year have an uncomplicated recovery. However, severe pain resistant to standard multimodal therapy within the first days after surgery is associated with an increased risk for prolonged pain and opioid use. The best outpatient management for parturients with severe resistant early onset pain is not known., Methods: We performed a prospective, double-blind, placebo-controlled, randomized trial of up to 12 weeks of outpatient treatment with gabapentin to evaluate its effectiveness to facilitate opioid cessation in women with at least 2 reports of severe pain during the immediate postpartum period resistant to standard multimodal pain management. Time to opioid cessation was the primary outcome. Time to pain resolution; time to discontinuation of gabapentin, acetaminophen, and ibuprofen; time to self-reported recovery; and National Institute of Health Patient-Reported Outcomes System (PROMIS) surveys for anxiety, depression, fatigue, and physical function were assessed as secondary outcomes., Results: There was no difference in time to opioid cessation between patients who were randomly assigned to be treated with gabapentin (Kaplan-Meier estimated median of 2 [25th-75th percentiles of 1-3] weeks, n = 35) versus those who were treated with placebo (2 [1-3] weeks, n = 35). The hazard ratio was 1.1 (95% confidence interval [CI], 0.67-1.8), P = .65. There were no differences in any secondary end points between the study groups., Conclusions: Outpatient supplementation with gabapentin did not reduce time to opioid cessation, pain, anxiety, depression, fatigue, or improve physical function in women with severe pain after cesarean delivery. Gabapentin should not be routinely added to the standard outpatient multimodal regimen of ibuprofen, acetaminophen, and opioids., (Copyright © 2023 International Anesthesia Research Society.)

Study Objective: To assess the feasibility, patient tolerance, pharmacokinetics, and potential effectiveness of a randomized controlled trial protocol investigating intravenous calcium chloride for the prevention of uterine atony during cesarean delivery., Design: Double-blind, randomized controlled pilot trial with nested population pharmacokinetic analysis., Setting: This study was performed at Lucile Packard Children's Hospital, from August 2018 to September 2019., Patients: Forty patients with at least two risk factors for uterine atony at the time of cesarean delivery., Interventions: One gram of intravenous calcium chloride (n = 20 patients) or a saline placebo control (n = 20 patients), in addition to standard care with oxytocin, upon umbilical cord clamping., Measurements: The primary efficacy-related outcome was the presence of uterine atony defined as the use of a second-line uterotonic medication, surgical interventions for atony, or hemorrhage with blood loss >1000 mL. Blood loss, uterine tone numerical rating scores, serial venous blood calcium levels, hemodynamics, and potential side effects were also assessed., Main Results: The study protocol proved feasible. The incidence of atony was 20% in parturients who received calcium compared to 50% in the placebo group (relative risk 0.38, P = 0.07, 95% CI 0.15-1.07, NNT 3.3). Calcium recipients tolerated the drug infusion well, with no adverse events and an equal incidence of potential side effects in the calcium and placebo groups. Ionized calcium concentration rose significantly in all patients who received calcium infusion, from baseline 1.18 mmol/L to peak levels 1.50-1.60 mmol/L. One-compartment population pharmacokinetics established clearance of 0.93 (95% CI 0.63-1.52) L/min and volume of distribution 76 (95% CI 49-94) L., Conclusions: In this pilot study, investigators found that intravenous calcium chloride was well-tolerated by the 20 patients assigned to receive the study drug and may be effective in prevention of uterine atony. A 1-g dose was sufficient to substantially increase calcium levels without any critically elevated lab values or concern for adverse side effects. These encouraging findings warrant further investigation of calcium as a novel agent to prevent uterine atony with an adequately powered clinical trial. Clinical trial registry NCT03867383 https://clinicaltrials.gov/ct2/show/NCT03867383., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose of Review: Postpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony., Recent Findings: Rates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0-10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony., Summary: There is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies., Methods: This retrospective cohort study included pregnant patients with congenital and/or acquired cardiac disease who delivered at a single institution between 2014 and 2020. The primary outcome was a positive postpartum depression screen, defined as Edinburgh Postpartum Depression Score (EPDS) ≥10. Potential exposures were selected a priori and compared between patients with and without a positive postpartum depression screen using Wilcoxon rank-sum and Fisher's exact tests. Secondary outcomes were responses to a longitudinal follow-up survey sent to English-speaking patients evaluating cardiac status, mental health, and infant development., Results: Of 126 eligible cardiac patients, 23 (18.3%) had a positive postpartum depression screen. Patients with a positive postpartum depression screen were more likely to have had antepartum anticoagulation with heparin or enoxaparin (56.5% versus 26.2%, p=0.007), blood transfusion during delivery (8.7% versus 0%, p=0.032), and maternal-infant separation postpartum (52.2% versus 28.2%, p=0.047) compared to patients with a negative screen. Among 29 patients with a positive screen who responded to the follow up survey, 50% reported being formally diagnosed with anxiety or depression and 33.3% reported child development problems., Conclusions: Our results highlight the importance of screening for postpartum depression in patients with cardiac disease, especially those requiring antepartum anticoagulation or maternal-infant separation postpartum., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest.

Here, we report functionalized graphene quantum dots (GQDs) for the optical detection of arsenic at room temperature. GQDs with the fluorescence of three fundamental colors (red, green, and blue) were synthesized and functionally capped with L-cysteine (L-cys) to impart selectively towards As (III) by exploiting the affinity of L-cys towards arsenite. The optical characterization of GQDs was carried out using UV-vis absorption spectroscopy, Fourier transform infrared spectroscopy, and fluorescence spectrometry, and the structural characterizations were performed using transmission electron microscopy. The fluorescence results showed instantaneous quenching in intensity when the GQDs came in contact with As (III) for all test concentrations over a range from 0.025 to 25 ppb, which covers the permissible limit of arsenic in drinking water. The experimental results suggested excellent sensitivity and selectivity towards As (III)., (© 2021 IOP Publishing Ltd.)

Background: Unintentional dural puncture with an epidural needle complicates approximately 1% of epidural anaesthetics and causes an acute headache in 60-80% of these patients. Several retrospective studies suggest an increased risk of chronic headache. We assessed the relationship between unintentional dural puncture and chronic disabling headache, defined as one or more functionally limiting headaches within a 2-week interval ending 2, 6, and 12 months postpartum., Methods: In this prospective observational study, parturients who experienced unintentional dural puncture were matched 1:4 with control patients. Patients completed questionnaires regarding characteristics of headache and back pain pre-pregnancy, during pregnancy, immediately postpartum, and at 2, 6, and 12 months postpartum. The primary outcome was prevalence of disabling headache in the past 2 weeks, assessed at 2 months postpartum. Secondary outcomes included prevalence and characteristics of headache and back pain at these time points., Results: We enrolled 99 patients. At 2 and 6 months postpartum, the prevalence of disabling headache was greater among patients with unintentional dural puncture than matched controls (2 months, 74% vs 38%, relative risk 1.9, 95% confidence interval 1.2-2.9, P=0.009; 6 months, 56% vs 25%, relative risk 2.1, 95% confidence interval 1.1-4.0, P=0.033). There was no difference in the prevalence of back pain at any time point., Conclusions: Our prospective trial confirms retrospective studies that chronic headache is more prevalent among women who experienced unintentional dural puncture compared with controls who received uncomplicated neuraxial anaesthesia. This finding has implications for the. patient consent process and recommendations for long-term follow-up of patients who experience unintentional dural puncture., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

We report the solvothermal synthesis of MoS 2 based quantum dots (QDs) and the performance evaluation of bare QDs for the detection of aqueous As (III) oxidative state at room temperature and neutral pH over a vast range (0.1-1000 ppb). Concentration-dependent photoluminescence (PL) of the QDs enhances up to 50 ppb and then suppresses till 1000 ppb. It shows two distinctive slopes for enhancement and suppression. The enhancement is possibly due to the passivation of trap states or defects. The formation of tiny glassy As 2 S 3 particles on the QD surface may be the possible reason for suppression. The pattern of optical absorption of QDs follows the similar patterns of PL. Still, it shows an enhanced absorbance in the near UV range below ≤300 nm, which increases with As (III) concentration up to 50 ppb and then decreases following the PL pattern. The MoS 2 QDs were characterized by using transmission electron microscopy, x-ray diffraction, UV-Vis, and PL spectroscopy. The enhancement and suppression results were excellently fitted with the modified Stern-Volmer equation. The detection of arsenic is possible using these linear fit equations as calibration curves., (© 2021 IOP Publishing Ltd.)

Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team., (Copyright © 2020 Elsevier Inc. All rights reserved.)

During a cesarean hysterectomy for placenta percreta, transesophageal echocardiography was used to monitor volume status and guide resuscitation. After delivery of the neonate but before massive surgical hemorrhage, a thrombus appeared in the inferior vena cava. Roughly 3 hours later, the patient had hemodynamic changes consistent with an intraoperative pulmonary embolism. Boluses of epinephrine stabilized the patient. An inferior vena cava filter was placed via an in situ internal jugular central venous cannula to prevent further embolic events. We believe transesophageal echocardiography is a useful monitor during surgery for placenta percreta.