New retinal findings in NLRP3-associated autoinflammatory disease.

PURPOSE: To determine whether the rare NLRP3-Associated Autoinflammatory Disease (NLRP3-AID) is associated with retinal changes and to assess the ocular involvement. METHODS: A retrospective cohort study of 20 patients(40 eyes) diagnosed with rare NLRP3-AID at Peking Union Medical College Hospital, from April 2015 to August 2022. Patients underwent a comprehensive ophthalmological examination, including visual acuity, intraocular pressure examination, slit-lamp examination, fundus photography, optical coherence tomography(OCT), and fluorescence angiography (FA). Some patients also underwent optical coherence tomography angiography (OCTA). RESULTS: This study analyzed 40 eyes of 20 patients (11 [55.0%] male; median age, 25.0 years [range, 12-52 years]) and 13 patients (26 eyes, 65%) demonstrated ocular involvement. The most common ophthalmologic manifestation was conjunctivitis (22 eyes, 84.6%), followed by papilledema (14 eyes, 53.8%), retinopathy (10 eyes, 38.5%), optic atrophy (6 eyes, 23.1%), uveitis (4 eyes, 15.4%), reduced pupil light reflex (3 eyes, 11.5%) and cataracts (2 eyes, 7.7%). Ocular involvement was bilateral in 11 patients (55.0%). Five kinds of retinal lesions were seen in 5 patients (10 eyes, 25%) with NLRP3-AID, including peripheral retinal vascular leakage, microaneurysms, macular ischemia, macular epiretinal membrane formation and drusen. CONCLUSIONS: Peripheral retinal vascular leakage, macular ischemia, microaneurysms and drusen are newly identified retinal findings in patients with NLRP3-AID, which suggests the importance of detailed retinal examination in these patients.

Large-scale emergency medical services scheduling during the outbreak of epidemics.

This paper studies a new large-scale emergency medical services scheduling (EMSS) problem during the outbreak of epidemics like COVID-19, which aims to determine an optimal scheduling scheme of emergency medical services to minimize the completion time of nucleic acid testing to achieve rapid epidemic interruption. We first analyze the impact of the epidemic spread and assign different priorities to different emergency medical services demand points according to the degree of urgency. Then, we formulate the EMSS as a mixed-integer linear program (MILP) model and analyze its complexity. Given the NP-hardness of the problem, we develop two fast and effective improved discrete artificial bee colony algorithms (IDABC) based on problem properties. Experimental results for a real case and practical-sized instances with up to 100 demand points demonstrate that the IDABC significantly outperforms MILP solver CPLEX and two state-of-the-art metaheuristic algorithms in both solution quality and computational efficiency. In addition, we also propose some managerial implications to support emergency management decision-making.

Early onset drusen and RPE dysfunction in a patient with NLRP3-AID.

Retinal pigment epithelium (RPE) dysfunction, manifested as drusen formation and RPE mottling, is a characteristic lesion of aging. The mechanism of RPE dysfunction remains unknown. Previous animal studies have proven that the activation of NLRP3 inflammasome in RPE leads to apoptosis and pyroptosis, which may play a very important role in the development of age-related macular degeneration (AMD). However, there is a lack of clinical evidence to support the above hypothesis. Herein, we report a 38-year-old Chinese Han woman who had NLRP3-associated autoinflammatory disease (NLRP3-AID) with widely scattered drusen at the posterior pole in both eyes. NLRP3-AID is a rare disease caused by mutations of the NLRP3 gene, leading to NLRP3 inflammasome activation. This report of early-onset drusen provides clinical evidence that the NLRP3 inflammasome might contribute to the occurrence of RPE dysfunction and is a potential cause of age-related macular degeneration (AMD).

The Gut Microbiota and Inflammatory Factors in Pediatric Appendicitis.

Background: The study analyzed gut microflora's composition and investigated the associations between the associations between gut dysbiosis and inflammatory indicators in pediatric patients with acute appendicitis. Methods: High-throughput sequencing and bioinformatics analysis were used to investigate the composition and diversity of gut microflora in 20 pediatric patients with acute appendicitis and 11 healthy children. Endpoints measured were operational taxonomic units (OTU) of gut microflora. The OTU and its abundance analysis, sample diversity analysis, principal component analysis of samples, differential analysis, and analysis of biomarkers were performed. Results: Overall fecal microbial richness and diversity were similar in patients and controls. Yet richness within the group of Bilophila, Eggerthella, Clostridium, Parvimonas, Megasphaera, Atopobium, Phascolarctobacterium, Adlercreutzia, Barnesiella, Klebsiella, Enterococcus, and Prevotella genera was higher in patients. Adlercreutzia was significantly positively correlated with IL-10, while the three other genera, comprising Klebsiella, Adlercreutzia, and Prevotella, were positively correlated with B cells level. Conclusion: Gut microbiome components are significantly different in pediatric patients with acute appendicitis and healthy children. The differential abundance of some genera is correlated with the production of inflammatory markers in appendicitis.

ZIF-8@MXene-reinforced flame-retardant and highly conductive polymer composite electrolyte for dendrite-free lithium metal batteries.

Though polymer electrolytes have been regarded as promising separators for solid-state lithium metal batteries, their low ionic conductivity, poor thermostability and inflammability limit their practical applications. Herein, a polymer composite electrolyte consisting of metal-organic frameworks modified Ti3C2-MXene nanosheets (ZIF-8@MXene) and polymer mixture (PE-ZIF-8@MXene) was fabricated. The fabricated nonflammable ZIF-8@MXene nanosheets have abundant functional groups and Lewis acid sites as well as high specific surface area. In the composite electrolyte, ZIF-8@MXene nanosheets increased the dissociation of lithium salts and provided channels for transporting ions, accelerating the Li ion transportation. They also enhanced the tensile strength, thermostability and flame resistance of PE-ZIF-8@MXene. Consequently, the fabricated flame-retardant PE-ZIF-8@MXene presented high ionic conductivity (4.4 mS cm-1), impressive Li+ transference number (0.76) and enhanced tensile strength (3.77 MPa). In addition, the assembled Li|PE-ZIF-8@MXene|Li had a long cycle life of 2000 h, and Li|PE-ZIF-8@MXene|LiFePO4 batteries displayed a capacity retention of 89.6% after 500 cycles.

Furoxan Incorporation into C-H Bonds Enabling Nitrogen-Containing Functional Group Installation into the Same.

A C-C bond forming method was developed, whereby a furoxan ring is incorporated into various types of C-H bonds. The protocol not only offers a concise synthetic route to a variety of alkylated furoxan derivatives but also provides an efficient strategy for the insertion of various nitrogen-containing functional groups into C-H bonds via transformation of the resultant furoxan ring.

Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis.

PURPOSE: Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction. METHODS: From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction. RESULTS: Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9. CONCLUSION: Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.

The Efficacy and Safety of Topical ß-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials.

BACKGROUND: To evaluate the efficacy and safety of topical ß-blockers in the treatment of superficial infantile hemangiomas (SIH) and mixed infantile hemangiomas (MIH), respectively, and compare the efficacy and safety of topical ß-blockers with other interventions. METHODS: The PRISMA guidelines were adhered to. We searched for randomized controlled trials in databases from 2010 to 2018 comparing topical ß-blockers with other interventions for infantile hemangiomas. The outcomes evaluated were efficacy and adverse effects. Data analyses were performed using RevMan 5.3. Publication bias was assessed to account for bias in patient selection. RESULTS: Eleven studies, involving 1,235 patients, were subjected to this meta-analysis. Six studies compared topical ß-blockers with other interventions (propranolol, placebo, corticosteroids or pulsed dye laser) in treating SIH, and 5 studies evaluated the efficacy and safety of a topical ß-blocker when it was combined with another intervention in treating MIH. A topical ß-blocker was discovered to be as effective as oral propranolol in treating SIH (risk ratio, RR, 0.96, 95% confidence interval, CI, 0.91-1.02, p = 0.20, I2 = 0%), and topical ß-blockers were more beneficial than placebo, corticosteroids or pulsed dye laser in treating SIH (RR 2.25, 95% CI 1.66-3.05, p < 0.00001, I2 = 0%). Topical ß-blockers combined with another intervention gave rise to a better clinical response in the treatment of MIH than intervention alone (RR 1.99, 95% CI 1.10-3.60, p = 0.02, I2 = 55%) (standard mean difference 0.80, 95% CI 0.28-1.31, p = 0.002, I2 = 0%). Compared with oral propranolol, topical ß-blockers were associated with fewer incidences of adverse effects (RR 0.05, 95% CI 0.01-0.39, p = 0.004, I2 = 0%). No significant difference in adverse effects was found when a topical ß-blocker was combined with another intervention in treating MIH (RR 1.01, 95% CI 0.58-1.74, p = 0.98, I2 = 0%). CONCLUSIONS: This meta-analysis provided evidence that topical ß-blockers may replace oral propranolol as first-line therapy for SIH and that they are of additive value in treating MIH.

Preventive replacement policies with time of operations, mission durations, minimal repairs and maintenance triggering approaches.

When a mission arrives at a random time and lasts for a duration, it becomes an interesting problem to plan replacement policies according to the health condition and repair history of the operating unit, as the reliability is required at mission time and no replacement can be done preventively during the mission duration. From this viewpoint, this paper proposes that effective replacement policies should be collaborative ones gathering data from time of operations, mission durations, minimal repairs and maintenance triggering approaches. We firstly discuss replacement policies with time of operations and random arrival times of mission durations, model the policies and find optimum replacement times and mission durations to minimize the expected replacement cost rates analytically. Secondly, replacement policies with minimal repairs and mission durations are discussed in a similar analytical way. Furthermore, the maintenance triggering approaches, i.e., replacement first and last, are also considered into respective replacement policies. Numerical examples are illustrated when the arrival time of the mission has a gamma distribution and the failure time of the unit has a Weibull distribution. In addition, simple case illustrations of maintaining the production system in glass factories are given based on the assumed data.

A clinical prediction model for complicated appendicitis in children younger than five years of age.

BACKGROUND: No reliably specific method for complicated appendicitis has been identified in children younger than five years of age. This study aimed to analyze the independent factors for complicated appendicitis in children younger than five years of age, develop and validate a prediction model for the differentiation of simple and complicated appendicitis. METHODS: A retrospective study of 382 children younger than five years of age with acute appendicitis from January 2007 to December 2016 was conducted with assessments of demographic data, clinical symptoms and signs, and pre-operative laboratory results. According to intraoperative findings and postoperative pathological results, acute appendicitis was divided into simple and complicated appendicitis. Univariate and multivariate analyses were used to screen out the independent factors of complicated appendicitis, and develop a prediction model for complicated appendicitis. Then 156 such patients from January 2017 to December 2019 were collected as validation sample to validate the prediction model. Test performance of the prediction model was compared with the ALVARADO score and Pediatric Appendicitis Score (PAS). RESULTS: Of the 382 patients, 244 (63.9%) had complicated appendicitis. Age, white blood cell count, and duration of symptoms were the independent factors for complicated appendicitis in children younger than five years of age. The final predication model for complicated appendicitis included factors above. In validation sample, the prediction model exhibited a high degree of discrimination (area under the curve [AUC]: 0.830; 95% confidence interval [CI]: 0.762-0.885) corresponding to a optimal cutoff value of 0.62, and outperformed the PAS (AUC: 0.735; 95% CI: 0.658-0.802), ALVARADO score (AUC: 0.733; 95% CI: 0.657-0.801). CONCLUSION: Age, white blood cell count, and duration of symptoms could be used to predict complicated appendicitis in children younger than five years of age with acute appendicitis. The prediction model is a novel but promising method that aids in the differentiation of acute simple and complicated appendicitis.

Modular Synthesis of Carbon-Substituted Furoxans via Radical Addition Pathway. Useful Tool for Transformation of Aliphatic Carboxylic Acids Based on "Build-and-Scrap" Strategy.

Utilizing radical chemistry, a new general C-C bond formation on the furoxan ring was developed. By taking advantage of the lability of furoxans, a wide variety of transformation of the synthesized furoxans have been demonstrated. Thus, this developed methodology enabled not only the modular synthesis of furoxans but also short-step transformations of carboxylic acids to a broad range of functional groups.

Public access of automated external defibrillators in a metropolitan city of China.

BACKGROUND: Public access of automated external defibrillator (AED) is an important public health strategy for improving survival of cardiac arrest. Major metropolitan cities in China are increasingly investing and implementing public access defibrillator programs, but the effectiveness of these programs remains unclear. This study aims to evaluate the public accessibility of AED in Shanghai, a major metropolitan city in China. METHODS: From July 1 to September 30, 2018, all AED locations indicated by AED Access Map Apps were visited and investigated in three most densely distributing areas of AED (Huangpu District, Xuhui District, and Central Area of the Pudong New District) in Shanghai. Two AED Access Map APPs were used to identify the location of AEDs. Characteristics of and the barriers to access, the AED sites were recorded. Awareness and skills of first aid and AED among on-site staff of the AED installation sites were evaluated. RESULTS: A total of 283 sites were marked on two AED Apps. One hundred and seventy (60%) locations were accessible, and 142 (50%) were actually with AEDs installed. Among those AED installed sites, 112 (79%) were completely identifiable to the information on the maps, 20 (14%) were inconsistent and 10 (7%) were inaccurate on the maps. Ninety-four (66%) AEDs had visible signs and information around the location, 7 (5%) AEDs had signs outside of the location, and 107 (75%) sites had educational instructions. In addition, 230 individuals who were around the AED site were interviewed. Among them, 79 (34%) had good knowledge of AED. After shown the picture of AED, 112 (49%) knew whether there was AED in the site, and 108 (47%) knew the AED's location. Eighty-seven (38%) staff have received first aid training, and among them 26 (30%) reported that they had skills in operating the AED. CONCLUSIONS: Public placement and accessibility of AEDs, related public signs and information on AED, and staff's awareness about AED were not optimal in Shanghai. Continuing efforts should be made to improve public accessibility and public awareness, knowledge, and user skills of AED.

Emission characteristics of volatile sulfur compounds (VSCs) from a municipal sewage sludge aerobic composting plant.

The emission of volatile sulfur compounds (VSCs) causing strong odors is a major problem in municipal sewage sludge composting plants (MSSACPs). Improving the knowledge on characteristics of VSCs emission in MSAACPs is of particular significance to elimate odors, but the studies conducted on-site to identify them are scarce. To this purpose, characteristics of VSCs emission were studied on-site from a MSSACP during different ambient temperatures corresponding with seasonal variations. Results reveal that (1) the total emission of VSCs which included methyl disulfide (DMDS), methyl sulfide (DMS), carbon disulfide, methyl mercaptan, and hydrogen sulfide (H2S) was 561.89 mg/dry kg in summer, 358.45 mg/dry kg in spring, and 215.52 mg/dry kg in winter, and the greatest amounts of VSCs were emitted during the mesophilic and pre-thermophilic phases; (2) although DMDS and DMS contributed the most towards total VSCs emissions during winter (81.93%), spring (82.55%), and summer (83.90%), their odor contributions were less than that of H2S; (3) in summer, the odor nuisance of total VSCs was higher than that in winter and spring; (4) sulfur loss in the form of VSCs emissions and total sulfur loss both increased with rising ambient temperatures during the sewage sludge aerobic composting. Results obtained in this study will be beneficial towards the elimation of odors released from MSSACPs.