This study develops and characterizes novel biodegradable soft hydrogels with dual porosity based on N-(2-hydroxypropyl)methacrylamide (HPMA) copolymers cross-linked by hydrolytically degradable linkers. The structure and properties of the hydrogels are designed as scaffolds for tissue engineering and they are tested in vitro with model mesenchymal stem cells (rMSCs). Detailed morphological characterization confirms dual porosity suitable for cell growth and nutrient transport. The dual porosity of hydrogels slightly improves rMSCs proliferation compared to the hydrogel with uniform pores. In addition, the laminin coating supports the adhesion of rMSCs to the hydrogel surface. However, hydrogels modified by heptapeptide RGDSGGY significantly stimulate cell adhesion and growth. Moreover, the RGDS-modified hydrogels also affect the topology of proliferating rMSCs, ranging from single-cell to multicellular clusters. The 3D reconstruction of the hydrogels with cells obtained by laser scanning confocal microscopy (LSCM) confirms cell penetration into the inner structure of the hydrogel and its corresponding microstructure. The prepared biodegradable oligopeptide-modified hydrogels with dual porosity are suitable candidates for further in vivo evaluation in soft tissue regeneration.
OBJECTIVE: Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DESIGN: Randomized, prospective, and double-blind. SETTING: Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PATIENTS: A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months. INTERVENTIONS: Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MEASUREMENTS: The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. MAIN RESULTS: 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). CONCLUSION: Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. CLINICAL TRIAL REGISTRATION: NCT04466579.
- MeSH
- Anesthesia, General * adverse effects MeSH
- Child MeSH
- Anesthesia, Inhalation * adverse effects MeSH
- Humans MeSH
- Emergence Delirium * epidemiology prevention & control etiology MeSH
- Child, Preschool MeSH
- Anesthesia Recovery Period MeSH
- Prospective Studies MeSH
- Sevoflurane MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- MeSH
- Drug Resistance, Microbial MeSH
- Antigens analysis MeSH
- Diagnostic Techniques, Respiratory System classification MeSH
- Molecular Diagnostic Techniques MeSH
- Respiratory Tract Infections * diagnosis etiology microbiology MeSH
- Culture Techniques methods MeSH
- Humans MeSH
- Microbiological Techniques * classification methods MeSH
- Microscopy methods MeSH
- Specimen Handling methods MeSH
- Blood Specimen Collection MeSH
- Antibodies analysis MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Bacteria classification pathogenicity MeSH
- Pulmonary Disease, Chronic Obstructive * drug therapy complications physiopathology MeSH
- Respiratory Tract Infections * etiology drug therapy complications physiopathology MeSH
- Humans MeSH
- Disease Progression MeSH
- Risk Factors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Antiviral Agents classification therapeutic use MeSH
- COVID-19 * diagnostic imaging physiopathology pathology therapy MeSH
- Humans MeSH
- Post-Acute COVID-19 Syndrome * diagnostic imaging pathology MeSH
- Risk Factors MeSH
- Vaccination methods MeSH
- COVID-19 Vaccines administration & dosage classification adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Bronchiectasis * diagnostic imaging microbiology pathology therapy MeSH
- Humans MeSH
- Prognosis MeSH
- Physical Therapy Modalities MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Child MeSH
- Humans MeSH
- Child Advocacy * MeSH
- Professional Competence MeSH
- Child Custody MeSH
- Personnel Staffing and Scheduling MeSH
- Work Performance MeSH
- Parents MeSH
- Family MeSH
- Family Relations MeSH
- Social Work * trends MeSH
- Social Workers MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Case Reports MeSH
- Geographicals
- Czech Republic MeSH
- MeSH
- COVID-19 MeSH
- Financing, Organized MeSH
- Humans MeSH
- Social Work * economics trends MeSH
- Public Expenditures MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Czech Republic MeSH
