Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study.

INTRODUCTION: Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs. METHODS AND ANALYSIS: A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively. ETHICS AND DISSEMINATION: The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals. TRIAL REGISTRATION NUMBER: The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).

Aerobic Exercise in Male Mice Prevents Ventilator-Induced Lung Injury by Inhibiting Mitochondrial Damage from sirt1 Dysregulation.

BACKGROUND: Ventilator-induced lung injury (VILI) is a common complication of mechanical ventilation under general anesthesia. Regular aerobic exercise before surgery improves postoperative recovery and reduces postoperative pulmonary complications, but the mechanism driving this protective effect is unclear. METHODS: To determine how aerobic exercise prevents VILI, we investigated the effects of exercise and mechanical ventilation on the lungs of male mice and the effects of AMPK stimulation (simulating exercise) and cyclic stretching on human lung microvascular endothelial cells (HLMVEC). Sirtuin 1 (Sirt1) knockdown male mice were generated to explore the regulating mechanisms of sirt1 on mitochondrial function in male mice after mechanical ventilation was explored. Western blot, flow cytometry, live cell imaging, and mitochondrial function evaluations were used to determine the protective effects of aerobic exercise in preventing mitochondrial damage in VILI. RESULTS: Mitochondrial function and cell junctions were destroyed by mechanical ventilation in male mice or cyclic stretching in HLMVEC, a model of VILI. However, mitochondrial function and cell junction dysfunction were improved by exercise before mechanical ventilation (male mice) or treatment with AMPK before cyclic stretching (HLMVEC). p66shc, a marker of oxidative stress, was increased, and PINK1, a marker of mitochondrial autophagy, was decreased by mechanical ventilation or cyclic stretching. Sirt1 knockdown increased p66shc and decreased PINK1. Increased sirt1 expression was observed in the exercise and exercise + ventilation groups, suggesting that sirt1 inhibits mitochondrial damage in VILI. CONCLUSIONS: Mechanical ventilation induces mitochondrial damage in lung cells and leads to VILI. Regular aerobic exercise before ventilation may prevent VILI by improving mitochondrial function.

Gradient Variation Oxygen-Content Vanadium-Oxygen Composite Films with Enhanced Crystallinity and Excellent Durability for Smart Windows.

Vanadium dioxide (VO2)-based smart windows show excellent promise for energy-saving and have been extensively researched. However, for the glass industry-compatible magnetron sputtering process, VO2 films are difficult to obtain and have homogeneous crystalline state, leaving them lacking the ideal solar modulation (ΔTsol) and sensitivity (narrow hysteresis loop). More importantly, the instability of VO2 hinders its commercialization. Multilayer structures have been repeatedly investigated to solve these problems. Unfortunately, the mediocre thermochromic properties as well as the complex and expensive manufacturing steps still hinder its commercialization. In this work, we prepared gradient variation oxygen-content vanadium-oxygen composite films (V2O3/VO2/V2O5, VOgv) with enhanced crystallinity and excellent durability by one-step continuous sputtering. According to optical measurements, the ΔTsol of the VOgv films was significantly increased by 145% (from 6.85 to 16.80%) compared to VO2 films, and the width of the hysteresis loop was reduced by 67% (from 19.34 to 6.36 °C), while the VOgv films exhibited a wider preparation window. The accelerated tests have shown that the film has an equivalent service life of approximately 20 years. We exploited the intrinsic similarity in properties of homologous compounds of vanadium oxide and simplified the preparation process, which is supposed to break the existing application bottlenecks and increase the commercializing possibility of VO2-based thermochromic smart windows.

Determinants of the digital outcome divide in E-learning between rural and urban students: Empirical evidence from the COVID-19 pandemic based on capital theory.

Digital outcome divide, the inequality of the outcomes of exploiting and benefitting from the ICT access and usage, has been raised as a severe concern of the e-learning practices during the COVID-19 pandemic. This study drew on capital theory and related literature and conducted a survey of 492 Chinese middle school students to explore: (1) whether a digital outcome divide exists between rural and urban students under the e-learning condition during the COVID-19 pandemic; (2) if it does, how does students' every form of capital impact the digital outcome divide. Our results revealed several important findings. First, we confirmed the existence of the digital outcome divide between rural and urban students, as rural students reported lower levels of behavioral engagement in e-learning courses compared to their urban peers. Second, we found that differences exist between rural and urban students in habitus (i.e., intrinsic motivation) and forms of capital, including cultural (i.e., e-learning self-efficacy) and social capital (i.e., parental support and teacher support), which are the main causes of the digital outcome divide. Third, a Blinder-Oaxaca decomposition analysis further confirmed that those factors could explain the major parts of the digital outcome divide between urban and rural students and that e-learning self-efficacy, intrinsic motivation, and parental support were the most dominant factors contributing to the rural-urban digital outcome divide in the e-learning context. Our study provides several important theoretical and managerial implications for researchers and educators.

Self-rolling of vanadium dioxide nanomembranes for enhanced multi-level solar modulation.

Thermochromic window develops as a competitive solution for carbon emissions due to comprehensive advantages of its passivity and effective utilization of energy. How to further enhance the solar modulation ([Formula: see text]) of thermochromic windows while ensuring high luminous transmittance ([Formula: see text]) becomes the latest challenge to touch the limit of energy efficiency. Here, we show a smart window combining mechanochromism with thermochromism by self-rolling of vanadium dioxide (VO2) nanomembranes to enhance multi-level solar modulation. The mechanochromism is introduced by the temperature-controlled regulation of curvature of rolled-up smart window, which benefits from effective strain adjustment in VO2 nanomembranes upon the phase transition. Under geometry design and optimization, the rolled-up smart window with high [Formula: see text] and [Formula: see text] is achieved for the modulation of indoor temperature self-adapted to seasons and climate. Furthermore, such rolled-up smart window enables high infrared reflectance after triggered phase transition and acts as a smart lens protective cover for strong radiation. This work supports the feasibility of self-rolling technology in smart windows and lens protection, which promises broad interest and practical applications of self-adapting devices and systems for smart building, intelligent sensors and actuators with the perspective of energy efficiency.

Sputtering Flexible VO2 Films for Effective Thermal Modulation.

Flexible vanadium dioxide (VO2) thermochromic films show great potential for large-scale fabrication and possess broader applications compared with VO2 coatings on rigid substrates. However, the fabrication of flexible VO2 films remains a challenge so far, leading to the scarcity of research on flexible VO2 films for smart windows. With the aim to obtain a flexible VO2-based films with excellent optical properties and a long service life, we designed and successfully fabricated a flexible ITO/VO2/ITO (IVI) film on the colorless transparent polyimide substrate, which could be directly attached to glasses for indoor temperature modulation. This flexible IVI film effectively enhances the luminous transmittance (Tlum) and solar modulation ability (ΔTsol) (15 and 68% increase relative to a VO2 single layer), reduces the thermal emissivity (εT) (50.7% decrease relative to a VO2 single layer), and exhibits better durability than previously reported structures. Such excellent comprehensive performance offers it great potential in practical applications on smart windows. This work is supposed to provide a new strategy for facile direct fabrication of flexible VO2 films and broaden the applications of flexible VO2 in more coatings and devices.

A Mind in Intelligent Personal Assistants: An Empirical Study of Mind-Based Anthropomorphism, Fulfilled Motivations, and Exploratory Usage of Intelligent Personal Assistants.

Intelligent personal assistants (IPAs) own anthropomorphic features which enable users' perception of anthropomorphism. Adopting the perspective of mind-based anthropomorphism, the purpose of this paper is to investigate how mind-based anthropomorphism influences users' exploratory usage of IPAs. Based on the notion that anthropomorphism can satisfy people's sociality and effectance motivation, we hypothesize that mind-based anthropomorphism can enhance people's social connection with IPAs and IPA self-efficacy, which can in turn influence their exploratory usage of IPAs. Questionnaires were developed and distributed to users who had experience in smart speaker-based IPAs on Wenjuanxing and 551 valid questionnaires were collected to test the research model. The results revealed that cognitive and affective anthropomorphism exerted common and differential impacts on IPA self-efficacy and social connection. Cognitive anthropomorphism versus affective anthropomorphism had stronger influences on IPA self-efficacy, while affective anthropomorphism had stronger impacts on social connection. Both IPA self-efficacy and social connection enhanced users' intentions to explore IPAs. This study enriches previous studies on IPA adoption or post-adoption by investigating exploratory usage which captures how users are deeply engaged with IPAs.

Comparison of dexmedetomidine and meperidine for the prevention of shivering following coronary artery bypass graft: study protocol of a randomised controlled trial.

INTRODUCTION: Shivering is a common complication in the postoperative period. The incidence of shivering has been reported to range from 5% to 65% under general anaesthesia and as 33% during epidural anaesthesia. Shivering can increase perioperative risk in patients. Both dexmedetomidine and meperidine are effective agents for the prevention of postanaesthetic shivering. However, few studies have compared the anti-shivering effects of different agents following coronary artery bypass graft (CABG). This study aims to compare the effects of dexmedetomidine and meperidine on the incidence of shivering in patients undergoing CABG. METHODS AND ANALYSIS: A total of 180 patients aged 18-75 years, with an American Society of Anesthesiologists (ASA) grade of II-IV, undergoing elective CABG will be enrolled and randomly assigned to the dexmedetomidine, meperidine and control groups (placebo) in an intended 1:1:1 allocation ratio. The patients will be followed up for 7 days after surgery. The primary outcome is the incidence of shivering within 24 hours postoperatively. The secondary outcomes are the number of remedial drugs used after surgery, the incidence of postoperative hypotension and bradycardia, sedation scores, endotracheal extubation time, intensive care unit length of stay, incidence of postoperative delirium within 7 days after surgery, incidence of postoperative arrhythmias, incidence of postoperative nausea and vomiting, average hospital length of stay and mortality rate 30 days after surgery. ETHICS AND DISSEMINATION: The study protocol was approved by the ethics committee of The First Affiliated Hospital of Shandong First Medical University on 20 January 2021 (YXLL-KY-2021(002)) and registered at ClinicalTrials.gov. The results of this study will be presented at national and international scientific meetings and conferences. We plan to publish the data in peer-reviewed international scientific journals. TRIAL REGISTRATION NUMBER: NCT04735965.

Validation of manufacturers' laryngeal mask airway size selection standard: a large retrospective study.

BACKGROUND: Laryngeal mask airway (LMA) is a prominent supraglottic airway device, widely used especially in difficult airway management. However, the LMA sizes recommended by the manufacturers are not always well matched in clinical practice, which leads to complications. To date, there are rare models to validate whether the manufacturers' standard is suitable for use in clinical practice. METHODS: A total of 58,956 patients undergoing general anesthesia using LMA device were included in the study between January 1, 2011 and December 31, 2018, to validate the adherence rate of LMA sizes according to the manufacturers' recommendations. A logistic regression analysis was performed based on the actual LMA size used in clinical practice to establish separately size selection guidelines with gender, weight, and age as variables in adults, adolescents, and children. RESULTS: LMA insertions were analyzed in 50,776 (86.1%) adults, 3,548 (6%) adolescents, and 4,632 (7.9%) children. Suitability of manufacturers' recommendations was higher in children [male: 86.02%; female: 85.09%] than adults [male: 72.75%; female: 78.13%] or adolescents [male: 73.4%; female: 70.79%]. For adults and adolescents, LMA size was better predicted using the regression model rather than the manufacturers' recommendations [male adults: 82.4% (81.16-83.57%) vs. 73.21% (71.79-74.59%), P<0.05; female adults: 87.82% (86.65-88.9%) vs. 77.07% (75.6-78.48%), P<0.05; male adolescents: 79.45% (74.86-83.4%) vs. 72.05% (67.09-76.53%), P<0.05; female adolescents: 78.4% (71.11-84.31%) vs. 72.22% (64.54-78.82%), P<0.05]. For children, there was equal performance suitability using the regression model and the manufacturers' recommendations. CONCLUSIONS: The model-based guidelines may provide more accurate directions for LMA size selection for adolescents and adults than the manufacturers' weight-based recommendations, whereas the manufacturers' recommendation in children is consistent with clinical practice.