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BACKGROUND Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce. OBJECTIVE To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA). DESIGN A randomised, double-blind, placebo-controlled trial. SETTING Single-centre, tertiary care hospital, November 2016 to September 2018. PATIENTS Eligible patients (n = 177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n = 87) or dexmedetomidine with TIVA (DEX-TIVA, n = 90). INTERVENTIONS Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4 μg kg−1), over 15 min, followed by a continuous infusion at a rate of 0.1 μg kg−1 h−1 until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol. OUTCOME MEASURES The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile. RESULTS All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine, and in 32 (36.8%) of 87 cases given saline (P = 0.0036). The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%, P = 0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA group (P < 0.0001). CONCLUSION Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the pro-inflammatory cytokine IL-6 and stabilisation of the haemodynamic profile. TRIAL REGISTRATION Chinese Clinical Trials Register Identifier: ChiCTR-IPR-17010881.

Transverse mode instability (TMI) is one of the main limiting factors in kW-level fiber lasers. Unlike fiber amplifiers, TMI in fiber laser oscillators attracts less attention from researchers. In this work, we construct an all-fiber ytterbium-doped laser oscillator and investigate the performance in co-pumping and bidirectional-pumping configurations, respectively. In the co-pumping scheme, TMI occurs at ~1.6kW and restricts further output power scaling. Different from the characteristic of dynamic TMI in fiber amplifiers, quasi-static TMI is observed in the laser oscillator. Details of the temporal characteristic around the TMI threshold are provided. In the bidirectional-pumping scheme, experimental results validate that the TMI is mitigated notably by employing bidirectional-pumping instead of co-pumping. The output laser power is further scaled to 2.5kW with a slope efficiency of 74.5% and good beam quality (M²~1.3). At the maximum power, the FWHM bandwidth of optical spectra is 5.2nm, and the Raman stokes light is ~20dB below the signal.

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Thyroid hormones play an important role in regulating the metabolism and can affect the homeostasis of fat deposition. The gene encoding thyroglobulin (TG), producing the precursor for thyroid hormones, has been proposed as a positional and functional candidate gene for a QTL with an effect on fat deposition. In the present study, we identified 6 novel SNPs at the 3' flanking region of the TG gene. The SNP marker association analysis indicated that the SNP markers G133C, G156A, C220T and A506C were significantly associated with marbling score (P<0.05, N=271). Animals with the new homozygote genotype had higher marbling scores than those with the other genotypes. Besides, the linkage disequilibrium analysis indicated that these 4 SNPs were completely linked (r2 = 1). Results of this study suggest that the TG-gene-specific SNP may be a useful marker for meat quality traits in future marker-assisted selection programmes in beef cattle.

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With an increasing output power, the power scaling of monolithic fiber laser oscillators faces the severe limitations of stimulated Raman scattering (SRS) and the transverse mode instability (TMI) effect. In this work, we report a high power monolithic fiber laser oscillator with a maximum output power of 5.2 kW, which is realized with a trade-off design between the SRS and TMI. The monolithic fiber laser oscillator is constructed with ytterbium-doped fiber with a core/inner cladding diameter of 25/400 µm and corresponding home-made FBG. High-power 915 nm laser diodes are employed as a pump source and are distributed in a bidirectional-pump configuration. By optimizing the bidirectional pump proportion, the monolithic fiber laser oscillator is scaled up to 5.2 kW with a slope efficiency of ~63%. Operating at 5.2 kW, the intensity of the Raman stokes light is ~22 dB below the signal laser and the beam quality (M2-factor) is ~2.2. To the best of our knowledge, this is a record high power for monolithic fiber laser oscillators.