In order to determine the role of the adrenergic system in bupivacaine-induced cardiotoxicity, a series of experiments were performed. In an animal experiment, male Sprague-Dawley (SD) rats under chloral hydrate anesthesia received intravenous bupivacaine, followed by an intravenous injection of adrenalin or isoprenalin, and the electrocardiogram (ECG), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), the maximum rate of rise of left ventricular pressure (+dP/dtmax) and the maximum rate of pressure decrease (-dP/dtmax) were continually monitored. In a cellular experiment, freshly isolated adult SD rat ventricular myocytes were perfused with bupivacaine at different concentrations in the presence or absence of isoprenalin, with or without esmolol. The percentage of the sarcomere shortening (bl% peak h), departure velocity (dep v) of sarcomere shortening and time to 50% of the peak speed of myocyte contraction (Tp50) was assessed by a video-based edge-detection system. In an additional experiment, Swiss mice pretreated with saline, isoprenalin, esmolol or dexmedetomidine received bupivacaine to determine the 50% lethal dose (LD50) of bupivacaine. Electron microscopy of myocardial mitochondria was performed to assess damage of these structures. To test mitochondrial reactive oxygen species (ROS) production, freshly isolated SD rat ventricular myocytes were incubated with bupivacaine in the presence of isoprenalin, with or without esmolol. First, our results showed that bupivacaine significantly reduced the LVSP and +dP/dtmax, as well as enhanced the LVEDP and -dP/dtmax (P < 0.05, vs. control, and vs. baseline). Adrenalin and isoprenalin induced a further reduction of LVSP and +dP/dtmax (P < 0.05, vs. before adrenalin or isoprenalin delivery, and vs. control). Second, bupivacaine induced a dose-dependent cardiomyocyte contractile depression. While 5.9 μmol/L or 8.9 μmol/L of bupivacaine resulted in no change, 30.0 μmol/L of bupivacaine prolonged the Tp50 and reduced the bl% peak h and dep v (P < 0.05, vs. control and vs. baseline). Isoprenalin aggravated the bupivacaine-induced cardiomyocyte contractile depression, significantly prolonging the Tp50 (P < 0.05, vs. bupivacaine alone) and reducing the dep v (P < 0.05, vs. bupivacaine alone). Third, esmolol and dexmedetomidine significantly enhanced, while isoprenalin significantly reduced, the LD50 of bupivacaine in mice. Fourth, bupivacaine led to significant mitochondrial swelling, and the extent of myocardial mitochondrial swelling in isoprenalin-pretreated mice was significantly higher than that compared with mice pretreated with saline, as reflected by the higher mitochondrial damage score (P < 0.01). Meanwhile, esmolol pretreatment significantly reduced the mitochondrial damage score (P < 0.01). Fifth, bupivacaine significantly increased the ROS in freshly isolated cardiomyocytes, and added isoprenalin induced a further enhancement of ROS production (P < 0.05, vs. bupivacaine alone). Added esmolol significantly decreased ...

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Patellar resurfacing (PR) and peripheral patellar denervation (PD) are common surgical treatments for knee osteoarthritis (KOA) in total knee arthroplasty (TKA). The aim of study was to compare preventive effect on postoperative anterior knee pain (AKP) between PR and peripheral PD in TKA. A total of 202 patients who underwent unilateral TKA were randomized into 3 groups: T, TPD, and TPR. Patients in T group received simple TKA, patients in TPD group received TKA combined PD while patients in TPR group received TKA combined PR. Incidence, intensity, and presentation time of AKP and clinical outcomes were evaluated at 3, 6, 9, 12, 18, and 24 months postoperatively. The incidence of AKP was significantly lower and the intensity of AKP and patients’ satisfaction score were significantly better at 3 months after surgery in group TPD and TPR compared with group T. Compared with group TPR, the intensity of AKP was significantly better at 3 months after surgery in group TPD. There were no significant difference in Oxford knee score, range of motion (ROM), patellar score, knee society score (KSS) and activities of daily living (ADL) score among 3 groups in the follow-up period. Both PD and PR can effectively reduce the intensity and incidence of AKP after TKA and improve patients’ satisfaction at 3 months after TKA. Additionally, PD is more effective on alleviating AKP than PR.

Background: In China, the transportation sector is the main energy consumer and the main source of carbon emissions. Reducing carbon emissions in the transportation sector is an important goal for China, especially during the current period of economic development. Due to the impact of pandemic shocks, the rapid development of green finance is conducive to supporting the transportation sector in achieving a carbon peak. Thus, we examined whether the development of green finance is still effective under the impact of a pandemic and the actual effect of green finance on the reduction of carbon emissions.Methods: In this study, we searched the internet for consumption structure data of vehicles and green finance indices of 30 Chinese provinces and cities from 2016 to 2021. A regression discontinuity model was constructed to test the effect of pandemic shock and green finance development on the reduction of transportation energy carbon emissions.Results: The results show that the impact of the COVID-19 pandemic has helped people change their preference toward more energy-efficient vehicles and reduce carbon emissions in the transportation sector. Green finance can effectively contribute to the reduction of transportation energy carbon emissions; however, the overall mitigation effect is limited.Conclusion: The empirical evidence is not only helpful in assessing the long-term impact of the COVID-19 pandemic but also conducive to the appropriate establishment of policy tools for supporting green finance development, which is further conducive to reducing carbon emissions in the transportation sector.

Re: Stav K, Taleb E, Sabler IM, Siegel YI, Beberashvili I, Zisman A. Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men:A pilot study. Neurourol Urodyn. 2014;34:450-3.Dear Editor in Chief, With great interest we read the article by Stav K on the effectiveness of lubricant and topical anesthetics in reducing urethral pain during urodynamic study. 1 We want to ask whether we should give up topical anesthetics or try to make it more effective?Topical anesthetics have been used in urology since 1884, when Pease described using ''cocaine in a sensitive urethrawith charming results.'' In 1949, Haines and Grabstald applied topical 2% lidocaine intraurethrally in 250 patients undergoing cystoscopy ''without untoward results and with good, rapid anesthesia.'' Similarly, in 1953, Persky and Davis reported 2% lidocaine to be a ''safe, rapid, and adequate anesthetic'' in a case series of 622 cystoscopies. 2There are also controversial issues regarding the need for local anesthesia during urethral instrumentation. Birch tested 2% lidocaine against plain lubricating gel for cystoscopy in a placebo-controlled trial of 138 patients, and concluded that the topical anesthetic is no more effective than ''good lubrication.'' Ho tested 2% lidocaine gel against plain aqueous gel in a placebo-controlled trial of 100 male patients undergoing flexible cystoscopy, and concluded that lidocaine gel causes urethral pain rather than preventing it, and now Stav et al. suggest that lidocaine gel is no better than plain lubricants. 1 Is intraurethral topical anesthesia not necessary or it is not effective enough? It is clear that the superficial layer of the uroepithelium is not tolerant against friction and is sensitive to various injuries, thus intraurethral instrumentation is a potentially painful procedure. Lubricant reduces friction by creating a slippery barrier between the urethra and instruments to attenuate the mechanical injury, whereas lidocaine acts on these suburothelial nerves by inhibiting neuronal impulse propagation and/or generation. Lidocaine gel emerged based on its simultaneous role as both lubricant and local anesthetic Pharmacologically, lidocaine enters the hydrophobic component of the neural membrane and prevents the transmembrane flow of sodium ions necessary for initiation and propagation of action potential. In local block anesthesia, anesthetics must first traverse both the perineural sheath and nerve membrane, whereas in topical application, the anesthetic has to remain on the mucosal surface for a substantial period of time, before it penetrates through the mucosa to reach pain receptors. Therefore, the onset of action of topical anesthetic needs a relatively long time. Pharmacokinetically, the absorption of topical lidocaine is slow, with a peak level reached at 15-60 min and better pain control established 25 min later than normal 2% lidocaine gel instillation. If one starts the catheterization too early, for example, after only 4 min, lidocaine gel cannot sho...