A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy.

INTRODUCTION: Perioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH). METHODS: We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. RESULTS: PUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium). CONCLUSIONS: The findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs. THE MANUSCRIPT ADDS TO CURRENT KNOWLEDGE: In medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI's. CLINICAL TOPICS: Urogynecology.

Bistable response and quasi-periodicity excitation of the internal dynamics of soliton molecules.

Soliton molecules, a frequently observed phenomenon in most mode-locked lasers, have intriguing characteristics comparable to their matter molecule counterparts. However, there are rare explorations of the deterministic control of the underlying physics within soliton molecules. Here, we demonstrate the bistable response of intramolecular motion to external stimuli and identify a general approach to excite their quasi-periodic oscillations. By introducing frequency-swept gain modulation, the intrinsic resonance frequency of the soliton molecule is observed in the simulation model. Applying stronger modulation, the soliton molecule exhibits divergent response susceptibility to up- and down-sweeping, accompanied by a jump phenomenon. Quasi-periodic intramolecular oscillations appear at the redshifted resonance frequency. Given the leading role of bistability and quasi-periodic dynamics in nonlinear physics, our research provides insights into the complex nonlinear dynamics within dissipative soliton molecules. It may pave the way to related experimental studies on synchronization and chaos at an ultrafast time scale.

Spatially Modulated Fiber Speckle for High-Sensitivity Refractive Index Sensing.

A fiber speckle sensor (FSS) based on a tapered multimode fiber (TMMF) has been developed to measure liquid analyte refractive index (RI) in this work. By the lateral and axial offset of input light into TMMF, several high-order modes are excited in TMMF, and the speckle pattern is spatially modulated, which affects an asymmetrical speckle pattern with a random intensity distribution at the output of TMMF. When the TMMF is immersed in the liquid analyte with RI variation, it influences the guided modes, as well as the mode interference, in TMMF. A digital image correlations method with zero-mean normalized cross-correlation coefficient is explored to digitize the speckle image differences, analyzing the RI variation. It is found that the lateral- and axial-offsets-induced speckle sensor can enhance the RI sensitivity from 6.41 to 19.52 RIU-1 compared to the one without offset. The developed TMMF speckle sensor shows an RI resolution of 5.84 × 10-5 over a linear response range of 1.3164 to 1.3588 at 1550 nm. The experimental results indicate the FSS provides a simple, efficient, and economic approach to RI sensing, which exhibits an enormous potential in the image-based ocean-sensing application.

Terahertz topological photonic crystals with dual edge states for efficient routing.

Topological photonic crystals with robust pseudo-spin and valley edge states have shown promising and wide applications in topological waveguides, lasers, and antennas. However, the limited bandwidth and intrinsic coupling properties of a single pseudo-spin or valley edge state have imposed restrictions on their multifunctional applications in integrated photonic circuits. Here, we propose a topological photonic crystal that can support pseudo-spin and valley edge states simultaneously in a single waveguiding channel, which effectively broadens the bandwidth and enables a multipath routing solution for terahertz information processing and broadcasting. We show that distorted Kekulé lattices can open two types of bandgaps with different topological properties simultaneously by molding the inter- and intra-unit cell coupling of the tight-binding model. The distinct topological origins of the edge states provide versatile signal routing paths toward free space radiation or on-chip self-localized edge modes by virtue of their intrinsic coupling properties. Such a powerful platform could function as an integrated photonic chip with capabilities of broadband on-chip signal processing and distributions that will especially benefit terahertz wireless communications.

Effectiveness of fractional carbon dioxide laser combined with botulinum toxin type A in a rabbit ear model with the underlying mechanism.

BACKGROUND: Hypertrophic scar (HS) is a common disease in plastic and cosmetic surgery, with limited treatment options, and is a challenge for clinicians. OBJECTIVES: This study aimed to evaluate the efficacy of fractional carbon dioxide (CO2 ) laser combined with botulinum toxin type A (BTXA) in treating HSs in rabbit ears and to provide new strategies for treating HS. METHODS: Twenty-four New Zealand white rabbits with induced HSs were randomly divided into one control and three treatment groups. After 4 weeks of modeling, BTXA (2.0 U) was injected into the HS of the BTXA and combination groups, whereas a fractional CO2 laser (combo mode, deep energy: 12.5 mJ; super energy: 90 mJ) was used in the fractional CO2 laser and combination groups. The laser treatments were repeated after 2 weeks. The HSs in the rabbit ears were observed and photographed 5 weeks after the first treatment. The scar thickness in each group was measured and compared, and the scar elevation index (SEI) was determined using hematoxylin and eosin staining. Collagen content and alignment were observed using Masson's trichrome staining. Western blotting and immunohistochemistry were performed to analyze scar-related protein levels. RESULTS: Hypertrophic scars were reduced in all treatment groups compared with the control group. The combination group had lower scar thickness, SEI, and expression of scar-related proteins in HSs, with an appearance similar to that of normal rabbit ear skin. Furthermore, the fibroblast content and collagen deposition decreased significantly in the combination group (p < 0.001). CONCLUSIONS: Fractional CO2 laser combined with BTXA more effectively reduced HSs by inhibiting fibroblast proliferation, decreasing transforming growth factor-ß1 and α- smooth muscle actin expression, and causing collagen remodeling.

Design of an arbitrary ratio optical power splitter based on a discrete differential multiobjective evolutionary algorithm.

Traditional photonic integrated devices are designed to predict their optical response by transforming the structure and parameters, and it is often difficult to obtain devices with excellent performance in all aspects. The nanophotonic computing design method based on the optimization algorithm has revolutionized the traditional photonic integrated device design technology. Here, we report a discrete differential evolution algorithm that simulates a natural selection process to achieve an ultracompact arbitrary power ratio splitter. The footprint of the designed splitter is only ${2.5}\;\unicode{x00B5} {\rm m} \times {2}.{5}\;\unicode{x00B5} {\rm m}$2.5µm×2.5µm, the simulated total transmission efficiency is above 90%, the power ratio error is less than 3%, and it can work normally over the C-band. Our algorithm can provide new ideas for the application of genetic algorithms to the automatic optimization of photonic integrated devices.

Theoretical study of bicharacteristic waveguide for fundamental-mode phase-matched SHG from MIR to NIR.

In this paper, a bicharacteristic waveguide (BW) is proposed for fundamental-mode phase-matched second harmonic generation (SHG) from mid-infrared (MIR) to near-infrared (NIR). The required phase matching condition (PMC) is satisfied between the fundamental plasmonic mode at 3100 nm and the photonic mode at 1550 nm. With 1 W pump power, the SHG conversion efficiency of 4.173% can be obtained in 90.3 µm length waveguide. Moreover, the SHG conversion can be enhanced by using a microring resonator (MRR). By optimizing the MRR, the SHG conversion efficiency is increased to 8.30%. The proposed waveguide can also provide a promising platform for upconversion detection. By using an on-chip cascaded configuration, a gas sensor with the capability of MIR absorption and NIR detection is proposed. It is found that the detection limit (DL) can reach 1.04 nmol/L with 100 mW pump power, which shows significant enhancement compared with direct MIR absorption and detection.

Serological diagnosis of Mycoplasma pneumoniae infection by using the mimic epitopes.

Nowadays, there is lack of effective serological detection method for Mycoplasma pneumoniae (M. pneumoniae) infection in clinic. In this study, the mimic epitopes of M. pneumoniae were screened to evaluate the role in the serodiagnosis of M. pneumoniae infection. The M. pneumoniae-positive serum was used as the target for biopanning to phage display random 7-peptide library. The positive phage clones were selected and the DNA were sequenced and analyzed by BLAST. The representative phages were identified using dot immunoblotting and ELISA. The exogenous heptapeptides were synthesized and their reactions with M. pneumonia-positive serum were tested by indirect ELISA. Two heptapeptides, namely heptapeptide 1: TVNFKLY and heptapeptide 2: LPQRLRT, were screened out from the randomly selected 40 phages after the four bio-panning rounds. They had high homologies to some M. pneumoniae antigens. Besides, the representative bacteriophage containing heptapeptide 1 or 2 could react with the M. pneumonia- positive serum. The sensitivities of heptapeptide 1 and heptapeptide 2 for the diagnosis of M. pneumoniae infection were 90.1 and 80.0%, respectively, and the specificities were 94.3 and 97.1%, respectively. Therefore the two heptapeptides were the mimic epitopes of M. pneumoniae and might have potential serological diagnosis value for M. pneumoniae infection.

[Clinical efficacy analysis of myocutaneous flap in blepharoplasty].

Objective: To introduce the myocutaneous flap in blepharoplasty and summarize its clinical efficacy. Methods: Between January 2013 and March 2016, 1 560 patients underwent blepharoplasty with myocutaneous flap. Of them, 158 patients were followed up over 6 months and included in the study. There were 18 males and 140 females with the average age of 23.4 years (range, 18-35 years). The unilateral side was involved in 13 cases and bilateral sides in 145 cases. The patients had narrow double eyelid, shallow double eyelid, single eyelid, bloated upper eyelid, and upper eyelid skin relaxation. During operation, the tissue between the orbicular muscle of eye and the tarsus was trimmed layer by layer; the orbicularis oculi muscle, capillary network, and the front fascia of tarsus were retained, and the full-thickness skin, muscle, and the front fascia of tarsus were sutured by anatomical apposition. Results: Incision healed at stage I. All patients were followed up 6 months to 2 years (mean, 8.3 months). During follow-up period, shallow or extinctive double-eyelid line was observed in 9 cases (12 eyes), and satisfactory results were achieved after trimming front fascia of tarsus and suturing. Good clinical results were obtained in the other patients, who had natural and coherent double eyelid without obvious scar or depression at resection margin. Conclusion: Myocutaneous flap for blepharoplasty has many advantages of fast recovery, little wound, light swelling, permanent effects, and good appearance.

[CLINICAL STUDY ON ZYGOMATIC SPINDLE-SHAPED OSTEOTOMY AND INTERNAL PUSH OF TITANIUM SCREW ANCHOR IN TREATMENT OF PROMINENT MALAR].

OBJECTIVE: To explore the effectiveness of the zygomatic spindle-shaped osteotomy and internal push of titanium screw anchor for prominent malar. METHODS: Between July 2011 and January 2015, 58 patients with prominent malar underwent zygomatic spindle-shaped osteotomy and internal push of titanium screw anchor. There were 3 males and 55 females, aged 18-33 years (mean, 23 years). They had congenital bilateral prominent malar. Preoperative anteroposterior, lateral, supine position, 45" oblique photographs of the face were taken, three-dimensional CT reconstruction of face was performed. Simple prominent malar was observed in 30 cases, and prominent malar and zygomatic arch in 28 cases; zygomatic bone and zygomatic arch were symmetrical in 51 cases, and asymmetrical in 7 cases. RESULTS: All patients obtained stage I incision healing after operation, without infection or hematoma. Numbness of the upper lip occurred in 2 cases, limitation of mouth opening in 1 case, and nasolabial fold deepening in 1 case, which recovered spontaneously after 3 months. Fifty-eight cases were followed up 6-12 months (mean, 10 months). Zygomatic narrow spacing was 10.6-13.9 mm (mean, 11.2 mm). No ptosis of facial soft tissue, zygomatic step, facial nerve injury, raising eyebrow, dysfunction of eyes closure, or temporomandibular joint disorder syndrome occurred. Good bone healing was obtained, zygomatic facial sensation had no obvious abnormality, all patients were satisfied with the improvement of appearance. CONCLUSION: Zygomatic spindle-shaped osteotomy and internal push titanium screw anchor can effectively reduce the cheekbones, and maintain the natural curve of zygomatic body and zygomatic arch. Because of simple operation, less complications, and excellent results, it is an ideal plasty.

Prognostic value of cancer stem cell marker CD133 expression in esophageal carcinoma: A meta-analysis.

CD133 has been identified as a putative neoplastic stem cell marker in esophageal carcinoma. However, the prognostic value of CD133 overexpression in patients with esophageal carcinoma remains controversial. A meta-analysis of previous studies was performed, in order to assess the association of CD133 overexpression with the clinicopathological characteristics of esophageal carcinoma patients. A total of 7 studies, including 538 patients, were subjected to the final analysis. Our results indicated that a positive CD133 expression was significantly associated with lymph node metastasis [odds ratio (OR)=3.09, 95% confidence interval (CI): 1.93-4.95; P<0.00001], clinical stage (OR=4.26, 95% CI: 1.55-11.73; P=0.005) and histopathological grade (OR=2.40, 95% CI: 1.16-4.94; P=0.02). There was no statistically significant association of CD133 with depth of invasion (OR=1.89, 95% CI: 0.42-8.43; P=0.41). Based on the results of this study, we concluded that CD133 is an efficient prognostic factor in esophageal carcinoma. Higher CD133 expression is significantly associated with lymph node metastasis, clinical stage and histopathological grade.

Cell-assisted lipotransfer in the clinical treatment of facial soft tissue deformity.

Cosmetic surgeons have experimented with a variety of substances to improve soft tissue deformities of the face. Autologous fat grafting provides significant advantages over other modalities because it leaves no scar, is easy to use and is well tolerated by most patients. Autologous fat grafting has become one of the most popular techniques in the field of facial plastic surgery. Unfortunately, there are still two major problems affecting survival rate and development: revascularization after transplantion; and cell reservation proliferation and survival. Since Zuk and Yosra developed a technology based on adipose-derived stem cells and cell-assisted lipotrophy, researchers have hoped that this technology would promote the survival and reduce the absorption of grafted fat cells. Autologous adipose-derived stem cells may have great potential in skin repair applications, aged skin rejuvenation and other aging-related skin lesion treatments. Recently, the study of adipose-derived stem cells has gained increased attention. More researchers have started to adopt this technology in the clinical treatment of facial soft tissue deformity. The present article reviews the history of facial soft tissue augmentation and the advent of adipose-derived stem cells in the area of the clinical treatment of facial soft tissue deformity.

Les plasticiens ont mis diverses substances à l'essai pour corriger les malformations des tissus mous de la face. La greffe de graisse autologue comporte d'importants avantages par rapport aux autres modalités, car elle ne laisse aucune cicatrice, est facile à utiliser et est bien tolérée par la plupart des patients. C'est désormais l'une des techniques les plus populaires en chirurgie plastique de la face. Malheureusement, deux grands problèmes influent encore sur le taux de survie et le développement : la revascularisation après la greffe ainsi que l'inventaire, la prolifération et la survie des cellules. Depuis que Zuk et Yosra ont mis au point une technologie qui repose sur les cellules souches adipeuses et la lipotrophie cellulaire, les chercheurs espèrent que cette technologie permettra de promouvoir la survie et de réduire l'absorption des cellules adipeuses greffées. Les cellules souches adipeuses autologues ont peut-être plus de potentiel pour les applications de réparation cutanée, le rajeunissement de la peau vieillissante et d'autres traitements des lésions cutanées liées au vieillissement. L'étude des cellules souches adipeuses a commencé à susciter l'attention. Plus de chercheurs ont commencé à adopter cette technologie pour le traitement clinique des malformations des tissus mous de la face. L'histoire de l'augmentation des tissus mous de la face et l'utilisation des cellules souches adipeuses pour le traitement clinique des malformations s'y rapportant sont analysées dans le présent article.

Modifications of surfactant distributions and surface morphologies in latex films due to moisture exposure.

Migration of surfactants in water-based, pressure-sensitive adhesive (PSA) films exposed to static and cyclic relative humidity conditions was investigated using confocal Raman microscopy (CRM) and atomic force microscopy (AFM). Studied PSA films contain monomers n-butyl acrylate, vinyl acetate, and methacrylic acid and an equal mass mixture of anionic and nonionic nonylphenol ethoxylate emulsifiers. A leveling of surfactant concentration distributions is observed via CRM after films stored at 50% relative humidity (RH) are exposed to a 100% RH for an extended time period, while relatively small increases in surface enrichment occur when films are stored at 0% RH. Use of CRM for binary mixtures containing anionic or nonionic surfactant and latex that has undergone dialysis to remove nonpolymeric components indicates that surfactant-polymer compatibility governs to a great extent surface enrichment, but not changes observed with humidity variations. AFM images show that upon drying latex coatings, surfactant and other additives collect in large aggregation regions, which protrude from film surfaces. These structures are absent at high humidity, which appears to result from lateral spreading across the polymer surface. When humidity is reduced, aggregation regions reform but appear to be smaller and more evenly dispersed, and by cycling humidity between 0 and 100% RH, interfacial enrichment can be seen to diminish. Presented results provide greater insights into the distribution behavior of surfactants in latex films and potential mechanisms for observed issues arising for these systems.

Characterizing the distribution of nonylphenol ethoxylate surfactants in water-based pressure-sensitive adhesive films using atomic-force and confocal Raman microscopy.

Surfactant distributions in model pressure-sensitive adhesive (PSA) films were investigated using atomic force microscopy (AFM) and confocal Raman microscopy (CRM). The PSAs are water-based acrylics synthesized with n-butyl acrylate, vinyl acetate, and methacrylic acid and two commercially available surfactants, disodium (nonylphenoxypolyethoxy)ethyl sulfosuccinate (anionic) and nonylphenoxypoly(ethyleneoxy) ethanol (nonionic). The ratio of these surfactants was varied, while the total surfactant content was held constant. AFM images demonstrate the tendency of anionic surfactant to accumulate at the film surfaces and retard latex particle coalescence. CRM, which was introduced here as a means of providing quantitative depth profiling of surfactant concentration in latex adhesive films, confirms that the anionic surfactant tends to migrate to the film interfaces. This is consistent with its greater water solubility, which causes it to be transported by convective flow during the film coalescence process. The behavior of the nonionic surfactant is consistent with its greater compatibility with the polymer, showing little enrichment at film interfaces and little lateral variability in concentration measurements made via CRM. Surfactant distributions near film interfaces determined via CRM are well fit by an exponential decay model, in which concentrations drop from their highs at interfaces to plateau values in the film bulk. It was observed that decay constants are larger at the film-air interface compared with those obtained at the film-substrate side indicating differences in the mechanism involved. In general, it is shown here that CRM acts as a powerful compliment to AFM in characterizing the distribution of surfactant species in PSA film formation.