Effects of different phosphorus and potassium supply on the root architecture, phosphorus and potassium uptake, and utilization efficiency of hydroponic rice.

Phosphorus (P) and potassium (K) affect seedling growth, root configuration, and nutrient uptake in hydroponic rice, but there are few studies on all growth stages of rice. The purpose of this experiment was to determine the response characteristics of root morphology, plant physiology, and P and K uptake and utilization efficiency to different supplies of P and K. Two local conventional rice varieties (Shennong 265 and Liaojing 294) were used as experimental materials across four treatments, including HPHK (sufficient P and K supply), HPLK (sufficient P supply under low K levels), LPHK (sufficient K supply under low P levels) and LPLK (low P and K levels) in a hydroponic setting. The results showed that HPHK and HPLK significantly decreased the acid phosphatase activity of leaves and roots from full heading to filling stages when compared to LPHK and LPLK. Sufficient supply of P or K significantly increased the accumulation of P and K (aboveground, leaves, stem sheath, and whole plant) and root morphological parameters (root length, root surface area, total root volume, and tips) during major growth stages when compared to LP or LK levels. HPHK was significantly higher than other treatments in terms of dry weight and the root activity at the main growth stage, P and K uptake rates in nutrient solutions at various stages, related P and K efficiency at the maturity stage, yield, effective panicle number, and grain number per panicle. In addition, the effect of HPHK on the above indexes were significantly greater than those of single sufficient supply of P or K. In conclusion, HPHK can improve plant configuration, increase plant P and K absorption and root activity, and increase rice yield and related P and K utilization efficiency.

Sigmoid colon cancer presenting as a large abdominal mass accompanied by abscess and rupture: a case report and literature review.

Introduction and Importance: Colon cancer presenting as a large abdominal mass accompanied by abscess and rupture is rare and prone to be misdiagnosed and delayed. In addition, the treatment plan is not clear when combined with abdominal wall metastasis. Case Presentation: A 79-year-old woman presented with a large abdominal mass accompanied by abscess and rupture. It was misdiagnosed as a soft tissue infection in a local hospital, and after a comprehensive examination, it was diagnosed as sigmoid colon cancer with abdominal wall metastasis and abscess formation. The patient underwent a one-stage surgery, including en bloc resection of the tumor and invaded abdominal wall, as well as autologous tissue abdominal wall reconstruction, with a good clinical prognosis. Clinical Discussion: For the diagnosis of large abdominal masses, abdominal CT, and pus culture are more valuable than ultrasound. For colon cancer with abdominal wall metastasis, one-stage surgery to completely remove the tumor and full-thickness of the abdominal wall, and the use of autologous tissue abdominal wall reconstruction technology to repair defects is feasible. Conclusion: This case highlights the importance of using colon cancer as one of the differential diagnoses for the diagnosis for large abdominal mass accompanied by abscess and rupture in elderly patients, as well as the possibility of one-stage surgical resection of the tumor and invasion of the abdominal wall and reconstruction of the abdominal wall with autologous tissue when there is abdominal wall metastasis.

Construction and validation of a risk prediction model for 3- and 5-year new-onset atrial fibrillation in HFpEF patients.

Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) are more prone to atrial fibrillation (AF) compared to those with heart failure with reduced ejection fraction (HFrEF). Nevertheless, a risk prediction model for new-onset atrial fibrillation (NOAF) in HFpEF patients remains a notable gap, especially with respect to imaging indicators. Methods: We retrospectively analyzed 402 HFpEF subjects reviewed at the Affiliated Hospital of Qingdao University from 2017 to 2023. Cox regression analysis was performed to screen predictors of NOAF. A nomogram was constructed based on these factors and internally validated through the bootstrap resampling method. A performance comparison between the nomogram and the mC2HEST score was performed. Results: Out of the 402 participants, 62 (15%) developed atrial fibrillation. The risk factors for NOAF were finally screened out to include age, chronic obstructive pulmonary disease (COPD), hyperthyroidism, renal dysfunction, left atrial anterior-posterior diameter (LAD), and pulmonary artery systolic pressure (PASP), all of which were identified to create the nomogram. We calculated the bootstrap-corrected C-index (0.819, 95% CI: 0.762-0.870) and drew receiver operator characteristic (ROC) curves [3-year areas under curves (AUC) = 0.827, 5-year AUC = 0.825], calibration curves, and clinical decision curves to evaluate the discrimination, calibration, and clinical adaptability of the six-factor nomogram. Based on two cutoff values calculated by X-tile software, the moderate- and high-risk groups had more NOAF cases than the low-risk group (P < 0.0001). Our nomogram showed better 3- and 5-year NOAF predictive performance than the mC2HEST score estimated by the Integrated Discriminant Improvement Index (IDI) and the Net Reclassification Index (NRI) (P < 0.05). Conclusions: The nomogram combining clinical features with echocardiographic indices helps predict NOAF among HFpEF patients.

Knowledge, Attitudes, and Practices of Patients with Knee Osteoarthritis Regarding Osteoporosis and Its Prevention: A Cross-Sectional Study in China.

Background: Older age and female sex are risk factors for osteoarthritis and osteoporosis (OP). This study evaluated the knowledge, attitudes, and practices of patients with knee osteoarthritis (KOA) in China regarding OP and its prevention. This cross-sectional, questionnaire-based study enrolled patients with KOA at four grade-A tertiary hospitals in Shandong Province between 1st September and 20th November 2022. Methods: The administered questionnaire contained 55 items across four dimensions (demographic information, knowledge, attitude, and practice). Logistic regression analyses were performed to identify factors associated with an overall questionnaire score ≥70% of the maximum possible score. SPSS 26.0 was used for the analyses; P<0.05 was considered significant. Results: The analysis included 434 participants (261 females). The median knowledge, attitude, and practice scores were 7 (interquartile range: 5-10) (possible range, 0-17 points), 44 (interquartile range: 42-49) (possible range, 11-55 points), and 43 (interquartile range: 38-47) (possible range, 13-65 points), respectively. Multivariable logistic regression indicated that female sex (odds ratio [OR], 2.421; 95% confidence interval [95% CI] 1.558-3.762; P<0.001), age 56-65 years-old (OR, 4.222; 95% CI, 1.763-10.109; P=0.001 vs ≤55 years-old), age >65 years-old (OR, 4.358; 95% CI, 1.863-10.195; P=0.001 vs ≤55 years-old), middle/high/technical secondary school education (OR, 1.853; 95% CI, 1.002-3.428; P=0.049 vs primary school or below), and having KOA for 4-5 years (OR, 2.682; 95% CI, 1.412-5.094; P=0.003 vs ≤3 years) were independently associated with a high KAP score. Conclusion: There is room for improvement in the knowledge and practices of patients with osteoarthritis in China regarding OP. The findings of this study may facilitate the design and implementation of education programs to increase awareness about OP prevention among patients with KOA.

Applications of nanotechnology in orthodontics: a comprehensive review of tooth movement, antibacterial properties, friction reduction, and corrosion resistance.

Nanotechnology has contributed important innovations to medicine and dentistry, and has also offered various applications to the field of orthodontics. Intraoral appliances must function in a complex environment that includes digestive enzymes, a diverse microbiome, mechanical stress, and fluctuations of pH and temperature. Nanotechnology can improve the performance of orthodontic brackets and archwires by reducing friction, inhibiting bacterial growth and biofilm formation, optimizing tooth remineralization, improving corrosion resistance and biocompatibility of metal substrates, and accelerating or decelerating orthodontic tooth movement through the application of novel nanocoatings, nanoelectromechanical systems, and nanorobots. This comprehensive review systematically explores the orthodontic applications of nanotechnology, particularly its impacts on tooth movement, antibacterial activity, friction reduction, and corrosion resistance. A search across PubMed, the Web of Science Core Collection, and Google Scholar yielded 261 papers, of which 28 met our inclusion criteria. These selected studies highlight the significant benefits of nanotechnology in orthodontic devices. Recent clinical trials demonstrate that advancements brought by nanotechnology may facilitate the future delivery of more effective and comfortable orthodontic care.

Patient Self-Management Scale After Total Knee Arthroplasty (PSMS-TKA): Instrument Development and Cross-Sectional Validation Study.

BACKGROUND: Effective self-management after total knee arthroplasty (TKA) not only improves patients' knee pain and physical function but also improves quality of life. However, there is no assessment tool that can be targeted to evaluate the self-management level of patients after TKA. This study aimed to develop and validate a scale to specifically assess the level of self-management in patients after TKA. METHODS: The study was conducted in 2 steps: (1) instrument development and (2) psychological tests (n = 428). For the instrument development portion, scale items were generated through a literature review and semi-structured interviews, then reviewed and revised by a panel of experts, and assessed for content validity and pilot testing. For the psychometric tests component, items were analyzed using corrected item-total scale correlations, the critical ratio method, and Cronbach's α. Construct validity was evaluated using exploratory factor analysis and validation factor analysis. Criterion correlation validity was checked by calculating Pearson's correlation coefficient using the Arthritis Self-Efficacy Scale-8 and the scale developed in this study. Internal consistency reliability was evaluated using Cronbach's α and fold-half reliability, and retest reliability was assessed using intragroup correlation coefficients. RESULTS: The Patient Self-Management Scale after Total Knee Arthroplasty (PSMS-TKA) comprises 4 factors and 23 items that assess daily behavior management, disease information management, psychosocial management, and exercise rehabilitation management. Exploratory factor analysis and validation factor analysis yielded a stable 4-factor model for the 23 items. The PSMS-TKA demonstrated good criterion-related validity when using the Arthritis Self-Efficacy-8 as a criterion. The Cronbach's α of the PSMS-TKA was 0.903, the split-half reliability was 0.934, and the test-retest reliability correlation coefficient was 0.887 (P < .01); thus, the reliability of the scale is good. CONCLUSIONS: The PSMS-TKA developed in this study has good validity and reliability and can be used to assess the level of self-management in patients after TKA. The scale helps healthcare professionals understand the level of self-management of patients undergoing TKA.

Towards sustainable development in resource-based cities: Assessing the effects of extraregional technology and investment on the low-carbon transition.

Resource-based cities (RBCs) worldwide with a single industrial structure face the double pressures of sustainable development to promote development (i.e., industrial upgrading) and mitigating carbon emissions. Although building extraregional linkages is a potential path to advance this goal, the action of these linkages still requires study since there are many contradictory conclusions in the literature. To fill this gap, the study addresses the relationship between extraregional linkages, industrial upgrading, and the low-carbon transition in RBCs from 2012 to 2019 with the help of econometric panel models with proposed variables (e.g., the coupling coordination degree of extraregional technology and investment, CCD) built from multiple new data sources. The results are as follows. First, the diversification and specialization of the local industrial structure in RBCs both reduce carbon efficiency (CE). Second, extraregional technology, on its own, does not directly enhance CE as investments do. Third, the CCD not only serves to augment CE but also acts as a mitigating factor against CE reduction during industrial diversification. Based on the above findings, distinct low-carbon transition pathways are suggested for various types of RBCs, considering their positions within the extraregional linkage network.

Patients' needs and experiences of telerehabilitation after total hip and knee arthroplasty: A qualitative systematic review and meta-synthesis.

Background: The number of patients undergoing joint replacement procedures is continuously increasing. Tele-equipment is progressively being employed for postrehabilitation of total hip and knee replacements. Gaining a comprehensive understanding of the experiences and requirements of patients undergoing total hip and knee arthroplasty who participate in telerehabilitation can contribute to the enhancement of telerehabilitation programs and the overall rehabilitation and care provided to this specific population. Objective: To explore the needs and experiences of total hip and knee arthroplasty patients with telerehabilitation. Design: Systematic review and qualitative synthesis. Methods: Electronic databases PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, Scopus, ProQuest, CNKI, Wanfang Data, VIP, and SinoMed were systematically searched for information on the needs and experiences of telerehabilitation for patients with total hip arthroplasty and total knee arthroplasty in qualitative studies. The search period was from the creation of the database to March 2024. Literature quality was assessed using the 2016 edition of the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research. A pooled integration approach was used to integrate the findings inductively. Results: A total of 11 studies were included and 4 themes were identified: the desire to communicate and the need to acquire knowledge; accessible, high-quality rehabilitation services; positive psychological experiences; the dilemmas of participating in telerehabilitation. Conclusions: This study's findings emphasize that the practical needs and challenges of total hip and knee arthroplasty patients' participation in telerehabilitation should be continuously focused on, and the advantages of telerehabilitation should be continuously strengthened to guarantee the continuity of patients' postoperative rehabilitation and to promote their postoperative recovery.

Clinicopathological features of two cases of ETV6-NTRK3 rearranged papillary thyroid carcinoma: a case report.

Rearrangements involving the neurotrophic-tropomyosin receptor kinase (NTRK) gene family (NTRK1, NTRK2, and NTRK3) have been identified as drivers in a wide variety of human cancers. However, the association between NTRK rearranged thyroid carcinoma and clinicopathological characteristics has not yet been established. In our study, we retrospectively reviewed medical records of thyroid cancer patients and identified 2 cases with NTRK rearrangement, no additional molecular alterations were observed in either of these cases. The fusion of the rearrangement in both cases was ETV6(E4)::NTRK3(E14). By analyzing the clinicopathological features of these two cases, we found that both were characterized by multiple tumor nodules, invasive growth, and central lymph node metastases, indicating the follicular subtype of papillary thyroid carcinoma. Immunohistochemical staining profiles showed CD56-, CK19+, Galectin-3+, HBME1+. These clinicopathological features suggest the possibility of ETV6-NTRK3 rearranged thyroid carcinoma and highlight the importance of performing gene fusion testing by FISH or NGS for these patients.

Coal mining environment causes adverse effects on workers.

Background: The objective of this study is to study the adverse effects of coal mining environment on workers to discover early effective biomarkers. Methods: The molecular epidemiological study was conducted with 502 in-service workers, who were divided into miner and auxiliary. We measured the individual levels of dust exposure for participants. Clinical examinations were conducted by qualified doctors. Peripheral blood was collected to measure biochemistry, hemogram, and karyocyte apoptosis. Results: All workers were healthy who have not found with any diseases that can be diagnosed medically in the physical examination and showed no difference in dust exposure level, age, height, weight, and body mass index between groups. The working years of miners were lower than that of auxiliaries (p < 0.001). Compared with auxiliaries, the concentration and percentage of lymphocytes (p = 0.040, p = 0.012), basophils (p = 0.027, p = 0.034), and red blood cells (p < 0.001) and the concentration of hemoglobin of miners were lower (p < 0.001). The percentage of neutrophils (p = 0.003), the concentration of mean corpuscular hemoglobin concentration (p = 0.002), and the proportion of karyocyte apoptosis in miners were higher (p < 0.001). Miners presented higher blood urea nitrogen (p < 0.001), ratio of blood urea nitrogen to creatinine (p < 0.001), the high density lipoprotein cholesterol (p < 0.001), lower creatinine (p < 0.05), and cholesterol (p < 0.001). Conclusion: The coal mining environment impacted mining workers' immune function, renal function, and the hematopoietic system, including BUN/CRE, HGB, RBC, and LYMPH, which could be used as early biomarkers to screen the health of coal miners.

Gut microbiome-mediated monocytes promote liver metastasis.

The gut microbiome plays an important role in tumor growth by regulating immune cell function. However, the role of the gut microbiome-mediated monocytes in liver metastasis remains unclear. In this study, we found that fecal microbiome transplantation (FMT) from the stool of patients with liver metastasis (LM) significantly promoted liver metastasis compared with healthy donors (HD). Monocytes were upregulated in liver tissues by the CCL2/CCR2 axis in LM patients' stool transplanted mouse model. CCL2/CCR2 inhibition and monocyte depletion significantly suppress liver metastasis. FMT using LM patients' stool enhanced the plasma lipopolysaccharides (LPS) concentration. The LPS/TLR4 signaling pathway is crucial for gut microbiome-mediated liver metastasis. These results indicated that monocytes contribute to liver metastasis via the CCL2/CCR2 axis.

Genome-Wide Association Analysis of Effective Tillers in Rice under Different Nitrogen Gradients.

Nitrogen is a crucial element that impacts rice yields, and effective tillering is a significant agronomic characteristic that can influence rice yields. The way that reduced nitrogen affects effective tillering is a complex quantitative trait that is controlled by multiple genes, and its genetic basis requires further exploration. In this study, 469 germplasm varieties were used for a genome-wide association analysis aiming to detect quantitative trait loci (QTL) associated with effective tillering at low (60 kg/hm2) and high (180 kg/hm2) nitrogen levels. QTLs detected over multiple years or under different treatments were scrutinized in this study, and candidate genes were identified through haplotype analysis and spatio-temporal expression patterns. A total of seven genes (NAL1, OsCKX9, Os01g0690800, Os02g0550300, Os02g0550700, Os04g0615700, and Os04g06163000) were pinpointed in these QTL regions, and were considered the most likely candidate genes. These results provide favorable information for the use of auxiliary marker selection in controlling effective tillering in rice for improved yields.

The Needs and Experiences of Patients Returning to Work After Total Knee Arthroplasty and Total Hip Arthroplasty: A Systematic Review and Meta-Synthesis.

OBJECTIVE: The objective of this study was to conduct a systematic and comprehensive review of qualitative research to examine the physical and psychological needs, as well as work experiences, of patients undergoing total knee replacement and total hip replacement surgeries during their process of returning to work. METHODS: A systematic review and meta-synthesis of qualitative literature was conducted. A systematic search was conducted across 8 databases to identify qualitative or mixed-methods research on the needs and experiences of individuals with total knee replacement and total hip replacement who have returned to work. The search period extended from the inception of each database to March 2023. Two researchers independently utilized a predetermined search strategy to retrieve relevant English-language studies published in any year. The included studies were assessed for quality using the Critical Appraisal Skills Program appraisal tool. Findings from the studies were then summarized and integrated using the pooled integration method. RESULTS: There were 10 studies in total. Three key themes were identified from the original research: needs during the return to work process and rehabilitation training, faith and support to return to work, and constraints and challenges at work. CONCLUSION: Health care professionals and employers should conscientiously consider the physical and psychological requirements of patients who have undergone total knee replacement and total hip replacement when they are resuming work, taking into account the specific constraints and challenges that may arise in the workplace. To ensure a seamless transition back to work, it is essential to develop tailored occupational interventions, implement comprehensive return to work programs, and offer patients sufficient understanding and support. IMPACT: The findings of this study offer valuable insights into the physical and psychological needs, as well as the work experiences, of patients who have undergone total knee replacement and total hip replacement during their reintegration into the workforce. These findings have the potential to assist health care professionals and employers in providing enhanced support to facilitate successful return-to-work outcomes for patients.

Effects of biochar application methods on greenhouse gas emission and nitrogen use efficiency in paddy fields.

Biochar application in rice production reduces nitrogen loss and greenhouse gases. We conducted in situ experiments for 3 years, with N210B0 (210 kg N ha-1) as the control. Two biochar application methods (B1:15 t ha-1 biochar applied once and B2: biochar applied three times at 5 t ha-1 yr-1) combined with two nitrogen levels (N210: 210 kg N ha-1 and N168: 168 kg N ha-1) were used. Soil physicochemical properties, CH4 and N2O emissions, functional gene abundance, rice yield, and nitrogen use efficiency were analyzed. Both methods improved the physicochemical properties of the soil, however, B1 was less effective than B2 in increasing soil pH, bulk density, organic carbon, total nitrogen, and microbial biomass nitrogen in year 3. B1 had a higher CH4 emission mitigation effect than B2 in 3 consecutive years, mainly due to the higher pmoA gene abundance. B1 showed a higher reduction effect of N2O emissions compared to B2 in year 1, but the opposite was observed in years 2 and 3. B2 had a higher abundance of AOB, nirK, and nosZ genes compared to B1 in year 3. Compared with N210B0, rice yields were increased by 9.1 %, 9.6 %, and 3.6 % with N210B1, N210B2, and N168B2, respectively, over 3 years, while N168B1 improved yields in the previous 2 years. Biochar improved nitrogen use efficiency over 3 consecutive years directly due to increased use efficiency of panicle fertilizer; the effect of B1 was greater than that of B2 during years 1 and 2, while the opposite was observed in year 3. Both Biochar applied once and three times appeared to be promising practices to increase yield and mitigate GHGs. From the GHGI perspective, the biochar applied once combined with 168 kg N ha-1 can further improve nitrogen use efficiency, and reduce GHGs without hindering improvements in rice yield.

LncRNA RP11-10E18.7 cooperates with lncRNA RP11-481C4.2 to affect the overall survival of breast cancer patients: a TCGA-based retrospective study.

Background: As either oncogenes or tumor suppressor genes, long non-coding RNAs (lncRNAs) have a major role in both tumorigenesis and progression of human cancers, including breast cancer (BC). However, the statistical correlation between the lncRNA-lncRNA interaction and prognosis of BC remains unclear. Methods: We analyzed the fragments per kilobase per million (FPKM) lncRNA expression data in tumor tissue samples from 890 female patients with BC in The Cancer Genome Atlas (TCGA) between May 2021 and October 2022. The Cox proportional hazards model adjusted for age, race, clinical stage, neoadjuvant therapy, estrogen receptor (ER), and progesterone receptor (PR) was adopted to evaluate the lncRNA-lncRNA interaction regarding overall survival (OS) of BC. The multiple comparison was corrected by Bonferroni method. Results: RP11-10E18.7×RP11-481C4.2 was significantly associated with OS of BC patients [hazard ratio (HR)interaction =1.04, 95% confidence interval (CI): 1.03-1.06, P=3.35×10-9]. Then, gene-gene interaction analysis was performed for genes co-expressed with lncRNAs. FOXA1×U2SURP (HRinteraction =1.49, 95% CI: 1.28-1.73, P=2.16×10-7) was found to have a similar interactive pattern to RP11-10E18.7×RP11-481C4.2. after classifying the patients by intersection (3.47), we observed that the effect of FOXA1 opposite in patients with different U2SURP expression level (HRhigh vs. low =0.58, 95% CI: 0.34-0.99, P=0.046 in low expression of U2SURP; HRhigh vs. low =1.56, 95% CI: 1.18-2.87, P=0.029 in high expression of U2SURP). Conclusions: Our comprehensive study identified RP11-10E18.7×RP11-481C4.2 as a potential biomarker of BC prognosis. The results play an essential role in the impact of lncRNA-lncRNA interaction on BC survival. Our findings elucidated potential molecular mechanisms of BC progression under complex association patterns and provided potential dynamic and reversible therapeutic targets for BC patients.

Ionic Liquid Crystal Thin Film as Switching Layer in Nonvolatile Resistive Memory.

In this study, we propose the use of an ionic liquid crystal (ILC) as a new resistive switching layer in nonvolatile resistive random-access memory (ReRAM) devices. The high-quality vacuum-deposited ILC films of 1-hexadecyl-3-methylimidazolium hexafluorophosphate ([C16mim][PF6]) enabled to demonstrate the first operation of ReRAM devices with a low set voltage of ∼1 V and stable switching behavior for up to ∼44 cycles. The key to the successful operation is that the ILC layer is in the liquid crystal phase (smectic A), where the electric double layers formed at the electrode-ILC interfaces play a significant role. The results of basic electrical properties and I-V curve fittings suggested the following operation principle: the formation and rupture of charge-composed filaments within the ILC film, where the current conduction is primarily governed by the trap charge limited current (TCLC) mechanism. These achievements will pave the way for advanced studies of ILC-based electronic devices.

Emergency medical service utilization and timely treatment among acute ischemic stroke patients in Beijing from 2018 to 2021.

BACKGROUND AND IMPORTANCE: Activation of emergency medical services (EMS) is recommended for timely reperfusion therapy for acute ischemic stroke (AIS). The association of EMS utilization and time intervals from hospital arrival to a series of necessary procedures before reperfusion therapy was rarely investigated. OBJECTIVE: The objective of this study is to investigate the association of EMS utilization with the time intervals from hospital arrival to therapy in patients with AIS. DESIGN: Observational study. SETTINGS AND PARTICIPANTS: Medical records for AIS in all emergency departments in Beijing were obtained from January 2018 to December 2021. INTERVENTION OR EXPOSURE: Patients transported by ambulance were defined as the EMS group, whereas others as the non-EMS group. OUTCOME MEASURES AND ANALYSIS: Door-to-imaging time (DIT), door-to-needle time (DTN) and door-to-puncture time (DTP) were compared between the two groups. MAIN RESULTS: There were 11 190 (46%) and 13 106 (54%) AIS patients in the EMS and non-EMS groups. Compared with the non-EMS group, patients in the EMS group were more likely to receive intravenous thrombolysis or endovascular therapy (OR, 1.81; 95% CI, 1.68-1.94). For intravenous thrombolysis therapy, the DIT, ITN (time in minutes from obtaining the first brain imaging to tPA delivery) and DTN times in the EMS group were significantly shorter with time differences between the two groups of -1.1 (95% CI, -1.1 to -1.1) min, -2.6 (-2.6 to -2.6) min, and -3.7 (-3.8, -3.7) min, respectively. The proportion of DIT ≤25 min, DTN ≤45 min or DTN ≤60 min was significantly higher in the EMS group (OR, 1.03, 95% CI, 1.02-1.05; 1.11, 1.07-1.14; 1.05, 1.03-1.07). For endovascular therapy, the differences in DIT, ITP (time in minutes from obtaining the first brain imaging to groin puncture) and DTP times between the EMS and non-EMS groups were +1.1 (1.0-1.2) min, -3.8 (-4.2 to -3.5) min, -2.7 (-3.1 to -2.4) min, respectively, but no significant association was observed between EMS usage and the proportion of DIT ≤25 min or DTP ≤90 min. CONCLUSION: In this observational study, the use of EMS for patient with AIS was associated with a shorter time from hospital arrival to intravenous thrombolysis and endovascular therapy.

Airway management in out-of-hospital cardiac arrest: A systematic review and network meta-analysis.

OBJECTIVES: Airway management during cardiopulmonary resuscitation is particularly important for patients with out-of-hospital cardiac arrest (OHCA). This study was performed to compare the efficacy of the most commonly used out-of-hospital airway management methods in increasing the survival to discharge in patients with OHCA. METHODS: We screened all relevant literature from database inception to 21st January 2019 in PubMed, Web of Science, Embase, and the Cochrane Library. We included all randomized controlled trials (RCTs) of airway management for OHCA in adults (≥16 years of age) with no limitations on publication status, publication date, or language. The primary outcome was survival to discharge. The secondary outcomes were the overall airway technique success rate, return of spontaneous circulation, and survival to hospital admission. RESULTS: Overall, from 1986 to 2018, 9 RCTs involving 13,949 patients were included in the network meta-analysis, and the efficacy of six airway management methods for patients with OHCA were compared. However, none of the results were statistically significant. CONCLUSIONS: As the gold standard of airway management for patients with out-of-hospital cardiac arrest in most countries, endotracheal intubation (ETI) has been widely used for many years. However, our systematic review and network meta-analysis showed that ETI is no better than other methods in increasing the survival to discharge. This is not directly proportional to the various preparations required before ETI. Additional randomized controlled trials are needed to identify more effective methods and improve patients' outcome.

Cold Stress Induced a Higher Level of Fat Oxidation in Women.

ABSTRACT: Niu, X, Han, P, Tang, Z, Huang, J, Li, L, He, H, Zhang, W, Zhao, L, and Zhao, L. Cold stress induced a higher level of fat oxidation in women. J Strength Cond Res 37(1): 114-122, 2023-To investigate women's fat oxidation under cold stress during incremental exercise testing and compare the effect of cold stress on fat oxidation between the sexes. Twenty-six healthy subjects performed 2 incremental exercise tests to determine maximal oxygen uptake (V̇ o2 max) on a treadmill in different ambient temperatures. Cardiopulmonary variables were continuously recorded during incremental exercise tests. Maximal fat oxidation (MFO) and the corresponding exercise intensity (Fat max ) were determined from the fat oxidation curve constructed by indirect calorimetry. Both men and women relied more on fat oxidation in cold environment ( p < 0.05). Compared with men, fat oxidation was significantly greater in women in the cold environment from 50 to 70% V̇ o2 max ( p < 0.05). There were no significant differences in the change of fat oxidation as exercise intensity increased between the sexes ( p > 0.05). Women had a greater MFO ( p < 0.05) and Fat max ( p < 0.05) than men in the cold environment. When MFO was the dependent variable, sex, fat-free mass, fat mass, V̇ o2 max, and temperature accounted for 48% of its variability. We conclude that cold stress enhances fat oxidation in women. Compared with men, women have significantly higher value and rely more on fat oxidation to supply energy in the cold environment, although the increasing level of fat oxidation was similar between the sexes. These factors may have important implications in the individualization of exercise prescription in cold conditions for both men and women.

Efficacy and safety profile of angiotensin receptor neprilysin inhibitors in the management of heart failure: a systematic review and meta-analysis of randomized controlled trials.

Several guidelines have recommended the use of angiotensin receptor neprilysin inhibitors (ARNIs) as replacement for angiotensin-converting enzyme inhibitors in the management of heart failure. Till date, there are no reviews done that comprehensively cover different aspects of efficacy and safety parameters. Hence, we have performed a comprehensive systematic review and meta-analysis on role of ARNIs for the management of heart failure patients. Searches were done in Embase, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, PubMed Central, Cochrane Library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov until June 2022. Risk of bias assessment was done with Cochrane's risk of bias tool. Meta-analysis was carried out using random-effects model. Pooled standardized mean difference (SMD)/mean difference (MD) and/or risk ratio (RR) with 95% confidence intervals (CIs) was reported. In total, we analysed 34 studies, with almost all of them had a high risk of bias. Pooled RR was 0.88 (95% CI: 0.82-0.95) for all-cause mortality, 0.84 (95% CI: 0.77-0.92) for cardiovascular mortality and 0.78 (95% CI: 0.70-0.87) for hospitalization. Pooled MD was 3.74 (95% CI: 1.93-5.55) for left ventricular ejection fraction, -2.16 (95% CI: -3.58 to -0.74) for left atrial volume index, -3.80 (95% CI: -6.60 to -1.00) for left ventricular end-diastolic dimension and -1.16 (95% CI: -1.98 to -0.35) for E/E' ratio. Regarding adverse events, pooled RR was 1.55 (95% CI: 1.31-1.85) for symptomatic hypotension, 0.93 (95% CI: 0.78-1.11) for worsening renal function, 1.09 (95% CI: 0.94-1.26) for hyperkalaemia and 1.29 (95% CI: 0.67-2.50) for angioedema. ARNIs had beneficial efficacy and safety profile on the management of heart failure especially patients with reduced ejection fraction.