Analysis of Chemical Oxygen Demand in Barrel Finishing Based on Reusing Water Resource of Grinding Fluid.

To explore the sustainable development of grinding fluid in barrel finishing, the idea of water resource reuse in grinding fluid has been proposed. The influence of the graphene oxide (GO) and the sodium dodecyl benzene sulfonate (SDBS) as main components in the grinding fluid on the chemical oxygen demand (COD) was analyzed. Repreparing new grinding fluids by utilizing the water resources in grinding fluid after finishing will not cause a sharp increase in COD value. GO which absorbs SDBS can be taken away from grinding fluid by physical separation. It will decrease the COD value of grinding fluid. However, SDBS exists in the form of colloids in the grinding fluid and cannot be removed through physical separation, which also affects the COD value. Based on water quality indicators (the COD, pH, total hardness, metal aluminum, anionic surfactants, and total dissolved solids), the water quality index (WQI) of the reusing grinding fluid after finishing by the physical separation is significantly reduced. It indicates that reusing water resources in grinding fluid is a feasible way to reuse grinding fluid.

Comparison of life cycle assessment between hydrogen production from silicon waste and alkaline water electrolysis.

With global warming becoming increasingly severe, environmental issues are receiving international attention. Crystalline silicon is an indispensable and important raw material for photovoltaic and semiconductor fields, but the cutting of crystalline silicon materials generates a large amount of silicon wastes. This article evaluates the environmental impact of a hydrogen production process using diamond-wire sawing silicon waste (DSSW) using the life cycle assessment (LCA) methodology. For comparison, it was also analyzed the environmental impact of the alkaline water electrolysis (AEL) hydrogen production route. In the DSSW alkaline catalyzed hydrolysis (DACH) hydrogen production route, the hydrogen production stage accounts for the main contribution of nine environmental impact indexes, including GWP, PED, ADP, AP, EP, ODP, ET, HT-cancer, and HT-non cancer, exceeding 56 %. Whereas for the AEL route, the environmental impacts of the electrolytic cell manufacturing stage can be neglected, and the operating stage contributes almost all the environmental impacts, contributing more than 92 % to the twelve environmental impact indexes. Compared to the AEL route, the DACH route has higher environmental impacts, with GWP index reaching 87.78 kg CO2 -eq/kg H2, PED index reaching 1772.90 MJ/kg H2, and IWU index reaching 622.37 kg/kg H2 which are 2.85, 4.07 and 7.56 times higher than the former, respectively. Although the environmental impact of the DACH route is significant, most of its indirect impacts were caused by the use of raw materials, and the energy consumption and direct environmental impact are both low. The environmental impact of the AEL route is mainly indirect effects generated due to the use of electricity. If clean renewable energy sources (e.g., solar PV, hydropower, geothermal or biofuels), were used for the AEL route, all twelve environmental impact indexes would be significantly reduced.

Drug target genes and molecular mechanism investigation in isoflurane-induced anesthesia based on WGCNA and machine learning methods.

PURPOSE: This study sought to identify drug target genes and their associated molecular mechanisms during isoflurane-induced anesthesia in clinical applications. METHODS: Microarray data (ID: GSE64617; isoflurane-treated vs. normal samples) were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were screened and hub genes were investigated using weighted correlation network analysis (WGCNA). Protein-protein interactions (PPIs) were constructed among the co-DEGs (common genes between DEGs and hub genes), followed by functional enrichment analyses. Then, three machine learning methods were used to reveal drug targets, followed by validation, nomogram analysis, and gene set enrichment analysis. Finally, an miRNA-target network was constructed. RESULTS: A total of 686 DEGs were identified between the two groups-of which, 183 DEGs integrated with genes revealed by WCGNA were identified as co-genes. These genes, including contactin-associated protein 1 (CNTNAP1), are mainly involved in functions such as action potentials. PPI network analysis revealed three models, with the machine learning analysis exploring four drug target genes: A2H, FAM155B, SCARF2, and SDR16C5. ROC and nomogram analyses demonstrated the ideal diagnostic value of these target genes. Finally, miRNA-mRNA pairs were constructed based on the four mRNAs and associated 174 miRNAs. CONCLUSION: FA2H, FAM155B, SCARF2, and SDR16C5 may be novel drug target genes for isoflurane-induced anesthesia. CNTNAP1 may participate in the progression of isoflurane-induced anesthesia via its action potential function.

Perillaldehyde: A promising antibacterial agent for the treatment of pneumonia caused by Acinetobacter baumannii infection.

Perillaldehyde is a monoterpene compound mainly from the medicinal plant Perilla frutescens (L.) Britt., which has hypolipidemic, antioxidant, antibacterial and anti-inflammatory functions. In this investigation, we discovered that Perillaldehyde had powerful antimicrobial activity against Acinetobacter baumannii 5F1, and its minimum inhibitory concentration was 287.08 µg/mL. A. baumannii is a conditionally pathogenic bacterium with a high clinical resistance rate and is a major source of hospital infections, especially in intensive care units, which is one of the main causes of pneumonia. Inflammatory immune response is characteristic of pneumonia caused by A. baumannii infection. The results of our in vitro experiments indicate that Perillaldehyde disrupts the cell membrane of A. baumannii 5F1 and inhibits its quorum sensing to inhibit biofilm formation, among other effects. With an experimental model of murine pneumonia, we investigated that Perillaldehyde decreased NLRP3 inflammasome activation and TNF-α expression in lung tissues by inhibiting the NF-κB pathway, and also impacted MAPKs protein signaling pathway through the activation of TLR4. Notably, the use of high doses of Perillaldehyde for the treatment of pneumonia caused by A. baumannii 5F1 infection resulted in a survival rate of up to 80 % in mice. In summary, we demonstrated that Perillaldehyde is promising as a new drug for the treatment of pneumonia caused by A. baumannii 5F1 infection.

Clinical effects of remimazolam alone or in combination with dexmedetomidine in patients receiving bronchoscopy and influences on postoperative cognitive function: a randomized-controlled trial.

BACKGROUND: Remimazolam and dexmedetomidine are commonly used as sedatives. However, the effects and safety of remimazolam alone or in combination with dexmedetomidine have not been investigated. AIM: We sought to investigate the clinical effects of remimazolam alone or in combination with dexmedetomidine in bronchoscopy, and their influence on cognitive function. METHOD: Ninety eligible patients who underwent bronchoscopy under intravenous anesthesia were randomly divided into three groups: propofol control, remimazolam, and remimazolam plus dexmedetomidine. The primary outcome was the incidence of perioperative hypoxemia. Secondary outcomes included induction and maintenance doses of remimazolam, hemodynamic variables, scores for modified Observer's Assessment of Alertness/Sedation (MOAA/S), coughing, limb movement, incidence of adverse events, patient satisfaction, bronchoscopist satisfaction, incidence of post-operative cognitive dysfunction (POCD), time to loss of consciousness (LoC), and time to awake. RESULTS: The incidence of hypoxemia, hypotension, and bronchoscopist satisfaction score were significantly decreased, and time to LoC and time to awake were markedly longer in the remimazolam and remimazolam plus dexmedetomidine groups than in the propofol control group (p < 0.05). The remimazolam group had significantly decreased induction and maintenance doses of remimazolam and a shorter time to LoC than the remimazolam plus dexmedetomidine group (p < 0.05). Scores for coughing, limb movement, MOAA/S, and post-operative patient satisfaction were comparable among the three groups. POCD was not induced in any of the groups. CONCLUSION: Remimazolam is safe and effective for painless bronchoscopy, with a low incidence of adverse reactions, and exhibits a good synergistic effect with dexmedetomidine. TRIAL REGISTRATION: This trial protocol had been registered on Chinese Clinical Trial Registry (ChiCTR2000041435, date: 2020 12 26.

Application of Sophora alopecuroides organic fertilizer changes the rhizosphere microbial community structure of melon plants and increases the fruit sugar content.

BACKGROUND: Sophora alopecuroides L. is a leguminous plant commonly found in northwest China. In Xinjiang, the fresh herb of S. alopecuroides is often applied as a green fertilizer to the rhizosphere of melon (Cucumis melo) plants at the end of their flowering period, to improve the taste of the fruits. However, the effects of S. alopecuroides-based fertilizers on the microbial community structure of soil and crop-root systems are unclear. In order to study the sweetening mechanism of the S. alopecuroides organic fertilizer, three different varieties of melon were selected. The untreated plants were used as the control (CK) group, and the plants treated with S. alopecuroides-based organic fertilizer were selected as the treatment (T) group. The physical and chemical properties, enzyme activities and microbial community structure of the rhizosphere samples were also determined, and a correlation analysis with the fruit sweetness index was conducted. RESULTS: Sugar content of group T was at least 40% higher than that of group CK. The increase in fruit sugar content positively correlated with the increase in the abundance of beneficial microorganisms, including Pseudomonas, Bacillus, Mycobacterium, Burkholderia, Streptomyces, Acinetobacter, Proteobacteria, Lysobacter, Actinomycetes, Penicillium and Aspergillus. CONCLUSION: Sophora alopecuroides organic fertilizer could alter the composition and function of bacterial and fungal communities and promote the growth of beneficial bacteria in the melon plant rhizosphere. Further, it could increase the content of soluble solids and sugar in the fruits to achieve a sweetening effect. This fertilizer can be applied as a fruit sweetener in melon cultivation, improving the sugar content of the fruit and consequently the sweetness. © 2022 Society of Chemical Industry.

[Effect of respiratory mechanics-guided sedation strategy on diaphragm function in mechanical ventilated patients with chronic obstructive pulmonary disease].

OBJECTIVE: To investigate the effects of respiratory mechanics-guided sedation strategy on diaphragm function in chronic obstructive pulmonary disease (COPD) patients treated with mechanical ventilation (MV). METHODS: A prospective study was conducted. Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) received invasive MV who were admitted to the Affiliated Huxi Hospital of Jining Medical University from May 2020 to May 2021 were enrolled. The patients were divided into observational group and control group by random number table method. All patients were intubated for MV, and received bronchodilators, glucocorticoid, anti-infectives, expectorant, nutritional support, analgesia and sedation. The sedatives were dexmedetomidine combined with propofol, and the analgesics were sufentanil in both groups. Respiratory mechanics monitoring was performed every 6 hours in the observational group, and the depth of sedation was adjusted according to the parameters of respiratory mechanics: when airway resistance (Raw) > 20 cmH2O×L-1×s-1, deep sedation was given to maintain Richmond agitation-sedation scale (RASS) ≤ -3; when the Raw was 10-20 cmH2O×L-1×s-1, the initial depth of sedation maintained to reach the RASS score of -2-0; when Raw < 10 cmH2O×L-1×s-1, withdrawn the sedation, or given light sedation, and maintained the RASS score of -2-0. While the control group received light sedation. The patients' diaphragmatic excursions (DE) was measured by bedside ultrasound, tidal volume (VT) and respiratory rate (RR) were recorded, and the diaphragmatic rapid shallow breathing index (D-RSBI, D-RSBI = RR/DE) and diaphragmatic excursion efficiency (DEE, DEE = VT/DE) were calculated. The differences in DE, D-RSBI, and DEE before and 3 days and 5 days of treatment between the two groups were compared. The difference in the RASS score within 3 days of sedation between the two groups was compared. The differences in the duration of MV and 28-day mortality between the two groups were compared. RESULTS: A total of 96 patients were selected. Six patients were excluded due to delirium or the duration of MV shorter than 3 days. Finally, 90 patients were enrolled, with 46 in the observational group, and 44 in the control group. There were no statistically significant differences in DE, D-RSBI or DEE before treatment between the two groups. After treatment, D-RSBI in both groups was gradually decreased, and DEE was gradually increased with time. The D-RSBI at 3 days and 5 days of treatment in the observational group were significantly lower than those in the control group (times×min-1×mm-1: 1.73±0.48 vs. 1.96±0.35 at 3 days, 1.45±0.64 vs. 1.72±0.40 at 5 days, both P < 0.05), and DEE were significantly higher than those in the control group (mL/mm: 19.7±4.3 vs. 17.1±3.9 at 3 days, 25.8±5.6 vs. 22.9±5.4 at 5 days, both P < 0.05). There was no significant difference in DE at all time points between the two groups. The RASS scores within 2 hours of sedation in the observational group were significantly lower than those in the control group (1 day: -3.78±0.92 vs. -2.34±0.68, 2 days: -2.87±1.04 vs. -2.43±0.79, both P < 0.05), while no statistical difference at 3 days was found between the two groups. The duration of MV in the observational group was significantly shorter than that in the control group (days: 5.78±2.01 vs. 6.84±2.27, P < 0.05). One patient died in each of the control group and the observational group, and there was no significant difference in the 28-day mortality between the two groups (2.3% vs. 2.2%, P > 0.05). CONCLUSIONS: For AECOPD patients undergoing MV, respiratory mechanics-guided sedation strategy can reduce D-RSBI, increase DEE, shorten the duration of MV, and have a certain protective effect on the diaphragm.

Streptomyces: Derived Active Extract Inhibits Candida albicans Biofilm Formation.

Candida albicans is an opportunistic pathogen that causes biofilm-associated infections. C. albicans biofilms are known to display reduced susceptibility to antimicrobials and high rates of acquired antibiotic resistance, and biofilm forming in C. albicans further hampers treatment options and highlights the need for new antibiofilm strategies. Identifying active components from desert actinomycetes strains to inhibit the formation of C. albicans biofilms represents an effective treatment strategy. In this study, actinomycetes that can inhibit C. albicans biofilm formation were isolated from the Taklimakan Desert, and the underlying mechanisms were explored. After screening the anti-C.albicans biofilm activities of culture supernatants from 170 Actinomycete strains, six strains showed significant inhibition of C. albicans biofilm formation. Microscopic examination showed a reduction in biofilm formation of C. albicans treated with supernatants from actinomycetes. Scanning electron microscopy showed that the morphological changes in biofilm cells were caused by cell membrane rupture and cell material leakage. Then, C.albicans biofilms were destroyed by changing the content of extracellular polysaccharides or degrading extracellular DNA. Finally, a preliminary study on active substances extracted from a new species (TRM43335) showed that the substances that inhibited the formation of biofilms might be peptides. This study provides preliminary evidence that desert actinomyces strains have inhibitory effects on the biofilm development of C. albicans.

The Derived Components of Gnaphalium hypoleucum DC. Reduce Quorum Sensing of Chromobacterium violaceum.

Gnaphalium hypoleucum DC. was first recorded in the Chinese National Pharmacopoeia "Yi Plant Medicine". There is no detailed report on its main components' activity in suppressing the quorum sensing activity (QS) of bacteria. Our study aimed to screen the main components in extracts of G. hypoleucum DC. in order to measure their effects on bacterial QS activity and to explore specific quorum sensing mechanisms that are affected by G. hypoleucum DC. extracts. Crude extracts of G. hypoleucum DC. contained significant amounts of two compounds shown to inhibit bacterial QS activity, namely apigenin and luteolin. Apigenin and luteolin in crude extracts of G. hypoleucum DC. showed substantial inhibition of pigment formation, biofilm production, and motility in Chromobacterium violaceum ATCC 12472 compared to the effects of other phytochemicals from G. hypoleucum DC. Apigenin and luteolin exhibited a strong QS inhibitory effect on C. violaceum, interfering with the violacein pigment biosynthesis by downregulating the vioB, vioC, and vioD genes. In the presence of signal molecules, the QS effect is prevented, and the selected compounds can still inhibit the production of the characteristic purple pigment in C. violaceum. Based on qualitative and quantitative research using genomics and bioinformatics, we concluded that apigenin and luteolin in crude extracts of G. hypoleucum DC can interfere with the generation of QS in C. violaceum by downregulating the vioB, vioC, and vioD genes. Indeed, G. hypoleucum DC. is used for the treatment of bacterial infections, and this research provides new ideas and potential alternative uses for medicinal plants.

Effect of cavitation bubble on the dispersion of magnetorheological polishing fluid under ultrasonic preparation.

In the ultrasonic dispersion process, the ultrasonic cavitation effect can seriously affect the dispersion efficiency of magnetorheological polishing fluid (MRPF), but the mechanism remains unclear now. Through considering the continuity equation and Vand viscosity equation of the suspension, a revised cavitation bubble dynamic model in the MRPF was developed and calculated. The effects of presence or absence of solid particles, the volume fraction of solid particles, and viscosity on the cavitation bubble motion characteristics in the MRPF were discussed. Settlement experiments of the MRPF under ultrasonic and mechanical dispersion were observed. Analysis of particle dispersion is made by trinocular biomicroscope and image processing of the microscopic morphology of the MRPF. The results show that the high volume fraction of carbonyl iron particle (CIP) will significantly weaken the cavitation effect, and the low volume fraction of green silicon carbide (GSC) has a negligible effect on the cavitation effect in the MRPF. When the liquid viscosity is greater than or equal to 0.1 Pa·s, it is inconvenient to produce micro-jets in the MRPF. The sedimentation rate of the MRPF prepared by ultrasonic dispersion is lower than mechanical dispersion when the volume fraction of CIP is between 1% and 25%. The dispersion ratio under ultrasonic dispersion is lower than that under mechanical dispersion. The experimental results fit the simulation well. It offers a theoretical basis for exploring the ultrasonic cavitation effect in the industrial application of the MRPF.

Expression of miR-9a-5p in cirrhosis patients with recurrent portal hypertension after treatment.

BACKGROUND: MicroRNA (miR) influences the biological activities of cirrhotic patients with recurrent portal hypertension. OBJECTIVES: The current study was designed to investigate risk factors related to the survival of cirrhosis patients and assessed the possibility of using miR-9a-5p predictability to prevent post-treatment portal hypertension. MATERIAL AND METHODS: Patients with portal hypertension due to liver cirrhosis treated from January 2015 to September 2016 were included in this study. Patients without relapse after treatment were selected as the success group while patients with relapse after treatment were selected as the recurrence group. Serum samples from healthy people were also collected. The blood indexes of the 2 groups of patients before and after treatment were compared and the miR-9a-5p serum level in each group was determined. The Kaplan-Meier method was applied to analyze three-year survival, Cox univariate regression was used to analyze the risk factors for recurrence of cirrhotic portal hypertension, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of serum miR-9a-5p, total bilirubin (TBIL) and platelet (PLT) levels in patients with recurrence. RESULTS: The miR-9a-5p level in the recurrence group was higher than that in the success group after treatment. In patients with recurrence, the miR-9a-5p level was negatively correlated with red blood cell count, TBIL, white blood cell count, and PLT count, and positively correlated with albumin. The miR-9a-5p, TBIL and PLT are potential markers of recurrent portal hypertension in liver cirrhosis. The miR-9a-5p had the highest area under the curve (AUC) value in patients with relapse. CONCLUSIONS: The miR-9a-5p is a risk factor for the recurrence of cirrhotic portal hypertension after treatment. It may be used as a marker of recurrence, and so has potential clinical value for the diagnosis and treatment of recurrent portal hypertension.

A tool path optimization approach based on blend feature simplification for multi-cavity machining of complex parts.

Blend features usually exist in the machining of complex multi-cavity parts; however, the ideal linear boundary of the cavity is shown as an arc curve at actual corner machining, which affects the accuracy of a robot's tool feed position. Focused on this problem, this article presents an automatic tool path planning approach based on blend feature simplification. By analyzing the geometric elements of blend feature, a line segment is constructed to obtain the machining boundary, while the robot tool feed position is accurately measured. On this basis, the coordinates of a robot tool feed position are assigned to the machining element, which can be used to calculate the spatial distance between different cavities. Then, an improved genetic algorithm is applied to improve the optimization of the tool path. The automatic decision of the corresponding work steps is realized by merging and sorting the machining elements. Finally, a corresponding prototype system is presented, with the correctness and validity of the proposed approach being examined, using aircraft structural part machining as an illustrative example.

Investigation on Wear Behavior of Cryogenically Treated Ti-6Al-4V Titanium Alloy under Dry and Wet Conditions.

Titanium alloys are widely used in many fields because of their excellent comprehensive properties. However, its poor friction and wear properties limit its many potential applications. In general, the surface roughness of important parts manufactured by titanium alloy should meet certain requirements. As a low-cost and high-efficiency processing method, barrel finishing has been used for the surface finishing of titanium alloys. The main material removal mechanism of barrel finishing is micro-cutting/grinding, which is similar to the material wear mechanism under some conditions. In addition, titanium alloys are subjected to a low force in common surface finishing processes. Cryogenic treatment is a method that can improve the comprehensive properties of titanium alloys. Therefore, the friction and wear behavior of cryogenically treated Ti-6Al-4V titanium alloy (CT Ti alloy) and non-cryogenically treated Ti-6Al-4V titanium alloy (NT Ti alloy) at a low load and scratch speed was studied comparatively in this paper. The results show that the CT Ti alloy exhibits a lower friction coefficient and wear rate under both dry and wet wear conditions. Under wet conditions, the stabilized friction coefficient is lower than that under dry conditions. The stabilized friction coefficient of CT Ti alloy is 0.18 after reaching a stable wear stage under wet conditions. Under dry wear conditions, the NT Ti alloy mainly showed typical abrasive wear, heavy adhesion wear and oxidation wear characters. The wear mechanisms of CT Ti alloy are mainly abrasive wear, slight adhesion wear and oxidation wear. Under wet wear conditions, the wear mechanism of NT Ti alloy is abrasive wear and slight adhesion wear. After cryogenic treatment, the mechanism for CT Ti alloy is slight abrasive wear.

De-alloying Behavior of Mg-Al alloy in Sulphuric Acid and Acetic Acid Aqueous Solutions.

The fabricated Mg-Al alloy consists of α-Mg phase and Mg-Mg17Al12 eutectic phase. The corrosion behavior of cast Mg-Al alloy in sulphuric acid (H2SO4) and acetic acid (HAc) aqueous solutions was investigated. The Mg-Al alloy shows general corrosion in H2SO4 solution, and the α-Mg dendrites revealed a slightly faster corrosion rate than that of the eutectics. In HAc solution, the alloy shows an obvious selective corrosion characteristic, with the α-Mg dendrites being corroded preferentially. Grain orientation plays an important role in corrosion behavior of the alloy in the HAc solutions.

[Effect of high-flow nasal cannula oxygen therapy on diaphragmatic function in patients with acute exacerbation of chronic obstructive pulmonary disease: a prospective randomized controlled trial].

OBJECTIVE: To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: The patients with mild to moderate AECOPD (clinical classification I-II) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluation II (APACHE II) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. RESULTS: Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPD II grade or APACHE II score between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times×min-1×mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. CONCLUSIONS: HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.

Comparison of the postoperative effect between epidural anesthesia and continuous wound infiltration on patients with open surgeries: A meta-analysis.

PURPOSE: The study aimed to compare the effect of epidural anesthesia (EA) and continuous wound infiltration (CWI) on surgical patients. METHODS: The literature retrieval was conducted in relevant databases from their inception to June 2018 with the predefined searching strategy and selection criteria. Then, the Cochrane Collaboration's tool was used to assess the quality of included studies. In addition, odds ratio (OR) and standardized mean difference (SMD) with its corresponding 95% confidence interval (CI) were used as a measure of effect size for evaluating outcomes indicators. RESULTS: Totally, sixteen RCTs were included. The incidence of hypotension in EA group was significantly higher than CWI group (OR = 3.7398; 95% CI: 1.0632 to 13.1555). In addition, EA provided better pain relief than CWI on rest at 72 h (SMD = -0.6037; 95% CI: -1.0767 to -0.1308) after surgery. Additionally, there were no significant differences in pain score on rest and mobilization at 2 h, 12 h, 24 h and 48 h. Moreover, the subgroup analysis showed that pain scores in EA group was significantly reduced at 2 h on rest and 12 h on mobilization than CWI group after liver resection surgery, as well as at 72 h on rest after colorectal surgery. CONCLUSION: CWI is superior to EA with a lower incidence of complications for use in surgery, and EA may provide better pain control than CWI on pain relief after surgery.

[Effect of early mobilization on diaphragmatic function in patients with mechanical ventilation: a prospective randomized controlled study].

OBJECTIVE: To investigate the effect of early mobilization on diaphragmatic function in patients with mechanical ventilation (MV). METHODS: Sixty chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with respiratory failure (RF) and underwent MV admitted to intensive care unit (ICU) of Huxi Affiliated Hospital of Jining Medical College from January 2016 to January 2017 were enrolled. The patients were divided into treatment group (n = 30) and control group (n = 30) by randomly number table method. The two groups were given analgesia, sedation, MV, antibiotics, nutritional support and other treatments. An implementation plan was developed based on the clinical practice of pain, irritability and delirium in adult patients (PAD) with ICU, while the treatment group was given early mobilization (such as joint activity, stand to the bed, 3 times a day). The diaphragmatic thickness at the end of expiration (DTee), diaphragmatic thickness at the end of inspiration (DTei) and diaphragmatic thickening fraction (DTF) were measured by bedside ultrasonography before and 24 hours, 48 hours, 3 days and 5 days after treatment respectively. RESULTS: There were no significant differences in the parameters of the diaphragm before treatment between the two groups. In the control group, DTee was gradually decreased at 5 days after treatment and was significantly lower than that before treatment (cm: 0.26±0.06 vs. 0.28±0.08, t = 3.045, P = 0.005). While there was no significant change in DTee in the treatment group. There was no significant difference in DTee between the two groups at different time points after treatment. DTei and DTF were significantly increased in the two groups after treatment, and reached the peak value at 48 hours; with the prolonged of MV time, DTei and DTF in the control group at 3 days and 5 days were significantly lower than those at 48 hours [DTei (cm): 0.35±0.07, 0.34±0.07 vs. 0.36±0.08; DTF: (29.29±11.01)%, (28.62±11.97)% vs. (32.48±15.63)%, all P < 0.01]; there were no significant changes in the treatment group. DTF in the treatment group at 3 days and 5 days was significantly higher than that in the control groups [(38.53±11.39)% vs. (29.29±11.01)%, (37.27±11.26)% vs. (28.62±11.97)%, both P < 0.01]. CONCLUSIONS: MV can lead to diaphragmatic dysfunction, while early mobilization can delay diaphragmatic atrophy and systolic dysfunction in MV patients.

Impact of Dexmedetomidine on Pediatric Agitation in the Postanesthesia Care Unit.

PURPOSE: This study aims to investigate the impacts of dexmedetomidine (DEX) on agitation in the postanesthesia care unit (PACU) for pediatric patients undergoing tonsillectomy. DESIGN: Eighty-two pediatric patients with elective tonsillectomy were randomly divided into the DEX group (group D) and the control group (group C). All patients' surgery in the two study groups were completed under tracheal cannula-based general anesthesia. Group D was infused 0.2 mcg/kg/hour DEX. The operation time, extubation time, PACU time, number of cases with nausea and vomiting, hemodynamic changes, and doses of rescue fentanyl, as well as every 10-minute observational pain scoring, and emergence agitation score in PACU, of the two groups were recorded. METHODS: Chi-square and Fischer exact tests were applied for categorical variables. FINDINGS: The maximum observational pain scoring and emergence agitation score of group D at 0, 10, and 20 minutes in PACU were significantly lower than group C (P < .01); the rescue doses of fentanyl and incidence of severe agitation in PACU in group D were significantly reduced than group C (P < .01). Group D showed significantly less cases with nausea and vomiting than group C (P < .05). CONCLUSIONS: Low-dose DEX could significantly reduce the delirium and agitation in the PACU stage of pediatric tonsillectomy, and there were no untoward hemodynamic events in this study of 80 patients.

[Effects of the ß-blockers on cardiac protection and hemodynamics in patients with septic shock: a prospective study].

OBJECTIVE: To investigate the effects of ß-blockers on cardiac protection and hemodynamic in patients with septic shock. METHODS: A prospective randomized controlled trial was conducted. Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours, and admitted to intensive care unit (ICU) of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled. The patients were divided into treatment group (n=21) and control group (n=20) by random number table. The patients in both groups were given the standard treatment, esmolol was giving to patients in treatment group in order to control the heart rate(HR) below 100 bpm within 2 hours, and the patients in control group only received standard treatment. The changes in hemodynamic parameters [mean arterial pressure (MAP), central venous pressure (CVP), HR, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance (SVRI), global end diastolic volume index (GEDVI)], biochemistry metabolic of tissue [central venous oxygen saturation (ScvO2), lactic acid (Lac)], and cardiac markers [troponin I (cTnI)] before and 12, 24, 48, 72 hours after the treatment were recorded. RESULTS: (1) Before treatment, the hemodynamic parameters, tissue metabolism index and cTnI had no significant differences in both groups (all P>0.05). (2) The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment. HR and CI in the treatment group were gradually declined after treatment, SVRI and GEDVI were gradually increased. There were significant differences in HR, CI, SVRI, and GEDVI between treatment group and control group from 12 hours on [HR (bpm): 93 ± 4 vs. 118 ± 13, CI (L × min⁻¹ × m⁻²): 3.3 ± 0.8 vs. 4.5 ± 0.6, SVRI (kPa×s × L⁻¹ × m⁻²): 159.2 ± 27.4 vs. 130.5 ± 24.2, GEDVI (mL/m²): 668 ± 148 vs. 588 ± 103, P<0.05 or P<0.01]. MAP, CVP and SVI in the treatment group showed no significant changes. (3) Lac after treatment in both groups was decreased slowly, Lac (mmol/L) at 12 hours after treatment was significantly decreased compared with that before treatment (control group: 8.8 ± 3.2 vs. 9.8 ± 3.4, treatment group: 9.5 ± 3.1 vs. 10.5 ± 4.1, both P<0.05). The Lac of control group and treatment group were 2.5 ± 1.2 and 2.7 ± 1.1 at 72 hours after treatment, and there was no significant difference between two groups (all P>0.05). The ScvO2was not decreased in both groups. (4) Compared with before treatment, cTnI in the control group was gradually increased, peaked at 72 hours, and that in the treatment group was gradually increased, peaked at 24 hours and then gradually declined. Compared with control group, the cTnI (µg/L) in the treatment group was decreased significantly at 24, 48, 72 hours (1.15 ± 0.57 vs. 1.74 ± 0.77, 0.93 ± 0.52 vs. 2.15 ± 1.23, 0.52 ± 0.36 vs. 2.39 ± 1.17, all P<0.01). CONCLUSIONS: ß-blockers (esmolol) can improve cardiac function and myocardial compliance, reduce the myocardial injury in patients with sepsis shock. Although ß-blockers can decrease cardiac output, it has no influence on the circulation function and tissue perfusion.