Apnea Testing Practice to Increase Baseline PaCO2 and Frequency of Blood Gas Analyses.

OBJECTIVE: To study the influence of the initial partial pressure of carbon dioxide (PaCO2) and frequency of blood gas analyses on the positivity rate and safety of apnea testing (AT). DESIGN: A prospective multicenter cohort study. SETTING: Seven teaching hospitals. PARTICIPANTS: A total of 55 patients who underwent AT. INTERVENTIONS: Patients were divided into 2 groups according to their initial PaCO2-the experimental group (≥40 mmHg, 27 patients) and the control group (<40 mmHg, 28 patients). Blood gas analysis was performed at 3, 5, and 8 minutes, and vital signs were taken. AT results and complications were compared between the groups. RESULTS: The initial PaCO2 of the experimental group was 42.8 ± 2.2 mmHg v 36.4 ± 2.9 mmHg in the controls. The AT positivity rate was 100%. The experimental group needed less time to reach the target PaCO2 than the control group (4.07 ± 1.27 minutes v 5.68 ± 2.06 minutes; p = 0.001). Twenty-six patients (96.3%) in the experimental group reached the target PaCO2 in 5 minutes v 17 in the control group (60.7%) (p = 0.001). Seven patients (12.7%) were unable to complete 8-minute disconnection due to hypotension. The experimental group had a slightly lower incidence of hypotension than the control group, but there was no statistical difference (7.4% v 17.9%, p = 0.245). CONCLUSION: Increasing the baseline PaCO2 and doing more blood gas analyses can significantly shorten the time needed for AT and improve the AT positivity rate.

Effects of Residential Environment and Lifestyle on Atopic Eczema Among Preschool Children in Shenzhen, China.

Eczema, one of the most prevalent inflammatory skin diseases among children, is potentially influenced by genetic, environmental and social factors. However, few studies have investigated the effect of residential environment and lifestyle on childhood eczema. Therefore, this study conducted a cross-sectional study based on 2,781 preschool children in Shenzhen, China, during 2015-2016. Logistic regression models were employed to analyze the associations between residential/household environment, lifestyle, dietary habits and eczema in children. The prevalence of eczema among children in Shenzhen was 24.6%. Significant associations (increased odds >50%, P < 0.05) were found between childhood eczema and the factors of using composite wood floors (adjusted OR = 1.777 for doctor-diagnosed eczema, 1.911 for eczema-like symptoms), living in a villa/townhouse (aOR = 3.102, 2.156), the presence of mold or damp stains in the child's room (aOR = 1.807, 2.279), and rarely cleaning the child's room (aOR = 1.513, 1.540). In addition, watching TV/playing computer games for more than one hour per day was significantly associated with eczema (aOR = 1.172, 1.174). Notably, we found that eating rice/pasta one to three times per week may elevate the risk of eczema-like symptoms (aOR = 1.343), which warrants further investigation. In addition, ambient air pollution, in the covariates, may also affect childhood eczema. Therefore, avoiding these adverse factors and creating a low-risk environment are crucial to prevent childhood eczema.

Traumatic Brain Injury Is Associated With Both Hemorrhagic Stroke and Ischemic Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: Traumatic brain injury (TBI) is considered a risk factor for the development of stroke (Hemorrhagic Stroke and Ischemic Stroke). We performed this systemic review and meta-analysis to determine the association of prior TBI with the subsequent diagnosis of stroke. METHODS: We systematically searched PubMed, EMBASE, and the Cochrane Library for cohort studies involving TBI patients who subsequently developed stroke. Study selection, data extraction, and quality assessment were performed by two separate researchers. Data were analyzed with random-effects models, and a secondary analysis stratified by the type of stroke was performed. RESULTS: Of the 741 identified studies, 6 studies were eligible for inclusion, with more than 2,200,000 participants. TBI predicted the occurrence of stroke in the random-effect model, with a relative risk of 2.14 (95% CI 1.97-2.32, P < 0.001). Furthermore, in the analysis of each type of stroke, TBI was associated with the incidence of ischemic stroke (RR 1.351 95% CI 1.212-1.506, P < 0.001), and TBI was associated with an even greater increase in the incidence of hemorrhagic stroke (RR 6.118 95% CI 5.265-7.108, P < 0.001). CONCLUSION: Our meta-analysis showed that TBI was associated with a more than two-fold increase in the risk of stroke. However, owing to the high degree of heterogeneity, decisions should be made on a patient-by-patient basis. The occurrence of TBI is associated with the development of both hemorrhagic and ischemic stroke, and the risk of hemorrhagic stroke is much higher than that of ischemic stroke in TBI patients.

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses.

BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurological disease, and the surgical evacuation of subdural collection remains the primary treatment approach for symptomatic patients. Postoperative recurrence is a serious complication, and several factors are correlated with postoperative recurrence. METHODS: We searched Embase, Web of Science, PubMed, and Cochrane Library from their establishment to September 2020. Reports on randomized, prospective, retrospective, and overall observational studies on the management of surgical patients with CSDH were searched, and an independent reviewer performed research quality assessment. Factors that affect the postoperative recurrence of CSDH were extracted: social demographics, drugs (as the main or auxiliary treatment), surgical management, imaging, and other risk factors. We evaluated the recurrence rate of each risk factor. A random effect model was used to perform a meta-analysis, and each risk factor affecting the postoperative recurrence of CSDH was then evaluated and graded. FINDINGS: In total, 402 studies were included in this analysis and 32 potential risk factors were evaluated. Among these, 21 were significantly associated with the postoperative recurrence of CSDH. Three risk factors (male, bilateral hematoma, and no drainage) had convincing evidence. The classification of evidence can help clinicians identify significant risk factors for the postoperative recurrence of CSDH. INTERPRETATION: Only few associations were supported by high-quality evidence. Factors with high-quality evidence may be important for treating and preventing CSDH recurrence. Our results can be used as a basis for improving clinical treatment strategies and designing preventive methods. FUNDING: No funding was received.

A new expansion material used for roof-contacted filling based on smelting slag.

The improper handling of smelting slag will seriously pollute the environment, and the unfilled roof of the goaf of the mine will threaten the safety of the mine. Expansion materials have attracted more and more attention because of their excellent properties. In this paper, copper-nickel smelting slag that has some active ingredients of gelling is used instead of traditional aggregate and some part of cement in order to reduce its pollution to the environment and its costs. For safety reasons, hydrogen peroxide was chosen as the foaming agent. Sodium silicate and hexadecyl trimethyl ammonium bromide (CTAB) are used as additives. Our results showed that after 28 days of curing, the material has better mechanical properties and the early compressive strength of the material was enhanced by sodium silicate. The efficiency of foaming was improved by CTAB. It also proves that copper-nickel smelting slag can be used in expansion material. At the same time, the utilization rate of the copper-nickel smelting slag of this formula can reach 70%, reduce its pollution to the environment.

Alkali Activation of Copper and Nickel Slag Composite Cementitious Materials.

Alkali-activated copper and nickel slag cementitious materials (ACNCMs) are composite cementitious materials with CNS (copper and nickel slag) as the main materials and GGBFS (ground-granulated blast-furnace slag) as a mineral admixture. In this paper, the activity indexes of CNS with different grinding times were studied using CNS to replace a portion of cement. NaOH, Na2SO4, and Na2SiO3 activators were used to study the alkaline solution of the CNS glass phase. The effects of the fineness of CNS and the type of activator on the hydration of ACNCMs were investigated via physical/mechanical grinding and chemical activation. The hydration products of ACNCMs were analyzed via XRD, SEM, FT-IR, TG, and MIP. The results of the study revealed that the activity indexes of CNS ground with different grinding times (10, 30 and 50 min) were 0.662, 0.689, and 0.703, respectively. When Na2SiO3 was used as the activator, the glass phase dissolved the most Si4+, Al3+, and Ca2+, and the respective concentrations in the solution were found to be 2419, 39.55, and 3.38 mg/L. Additionally, the hydration products of ACNCMs were found to have a 28-day compressive strength of up to 84 MPa.

Efficient Solar-Driven Water Harvesting from Arid Air with Metal-Organic Frameworks Modified by Hygroscopic Salt.

Freshwater scarcity is a global challenge threatening human survival, especially for people living in arid regions. Sorption-based atmospheric water harvesting (AWH) is an appealing way to solve this problem. However, the state-of-the-art AWH technologies have poor water harvesting performance in arid climates owing to the low water sorption capacity of common sorbents under low humidity conditions. We report a high-performance composite sorbent for efficient water harvesting from arid air by confining hygroscopic salt in a metal-organic framework matrix (LiCl@MIL-101(Cr)). The composite sorbent shows 0.77 g g-1 water sorption capacity at 1.2 kPa vapor pressure (30 % relative humidity at 30 °C) by integrating the multi-step sorption processes of salt chemisorption, deliquescence, and solution absorption. A highly efficient AWH prototype is demonstrated with LiCl@MIL-101(Cr) that can enable the harvesting of 0.45-0.7 kg water per kilogram of material under laboratory and outdoor ambient conditions powered by natural sunlight without optical concentration and additional energy input.

Developing mechanically robust, triazole-zwitterionic hydrogels to mitigate foreign body response (FBR) for islet encapsulation.

Zwitterionic hydrogels such as those based on polycarboxybetaine (PCB) or polysulfobetaine (PSB) have potential for various biomedical applications, due to their biocompatibility and low biofouling properties. However, the poor mechanical properties of zwitterionic hydrogels developed to date remain a challenge, severely limiting their practical uses. To improve the mechanical properties without compromising their zwitterionic feature or biocompatibility, we designed a new class of zwitterionic hydrogels by introducing triazole moieties into the hydrogel monomers that could form energy-dissipating π-π stacking. Compared to conventional zwitterionic hydrogels, the triazole-zwitterionic (TR-ZW) ones exhibited similarly excellent antifouling properties, but were much more mechanically robust with higher stretchability (250% tensile strain), better compression-resistance (89% compressive strain and 65% compression for at least 10 cycles without any crack) and better folding-resistance. In addition, upon subcutaneous implantation in mice, the TR-ZW hydrogels induced significantly lower foreign body responses (FBR) (i.e. less fibrosis and more blood vessel formation relative to a poly(2-hydroxyethyl methacrylate) hydrogel control). As an example of their potential applications, we showed the use of the TR-ZW hydrogels for islet encapsulation and transplantation and demonstrated diabetes correction up to ~1 month in mice in the convenient subcutaneous site.

Anti-N-methyl-D-aspartate receptor encephalitis induced by bilateral ovarian teratomas with distinct histopathologic types: A case report and brief literature review.

RATIONALE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder that is most frequently induced by ovarian teratoma in young females. The condition can be controlled and reversed via ovarian tumor resection and immunotherapy. However, anti-NMDAR encephalitis induced by bilateral ovarian teratomas with distinct histopathologic types is rarely reported in the literature. PATIENT CONCERNS: A 23-year-old woman presented with seizures. DIAGNOSES: The diagnosis was anti-NMDAR encephalitis associated with ovarian teratomas based on positive anti-NMDAR antibody tests in both the cerebrospinal fluid and serum, and the detection of bilateral ovarian lesions on pelvic computed tomography. The postoperative histopathologic examination confirmed that the left lesion was an immature teratoma, and the right lesion was a mature teratoma. INTERVENTIONS: We performed surgical resection of the ovarian teratomas and administered immunotherapy for the control of anti-NMDAR encephalitis. Chemotherapy was administered for the immature teratoma. OUTCOMES: The patient recovered without any postoperative complications. She has been confirmed to be in complete clinical remission, and has not had a recurrence during 18 months of follow-up. LESSONS: Anti-NMDAR encephalitis induced by bilateral ovarian teratomas of differing histopathologic types (1 immature and 1 mature) is rare. Early diagnosis and treatment with tumor resection, immunotherapy, and chemotherapy are critical for a good prognosis.

Cyst-Peritoneal Shunt for the Treatment of a Progressive Intracerebral Cyst Associated with ASNS Mutation: Case Report and Literature Review.

BACKGROUND: Congenital microcephaly could result from a gene mutation. Asparagine synthetase deficiency, which is caused by the asparagine synthetase (ASNS) mutation, is a rare autosomal-recessive neurometabolic disorder. It is characterized by severe developmental delay, congenital microcephaly, and seizures. CASE DESCRIPTION: Here we present the first report on a progressive intracerebral cyst associated with ASNS mutation, which caused neurodevelopmental dysplasia. ASNS mutation was confirmed by whole-exome sequencing and is the most likely reason for the neurodevelopmental dysplasia, which results in microcephaly, refractory seizures, and congenital visual impairment. Antiepileptic drugs have limited therapeutic effect on these epileptic seizures. CONCLUSIONS: Although there is no cure for this disorder so far, the huge progressive intracerebral cyst can be cured by a cyst-peritoneal shunt.

Nanoscavenger provides long-term prophylactic protection against nerve agents in rodents.

Nerve agents are a class of organophosphorus compounds (OPs) that blocks communication between nerves and organs. Because of their acute neurotoxicity, it is extremely difficult to rescue the victims after exposure. Numerous efforts have been devoted to search for an effective prophylactic nerve agent bioscavenger to prevent the deleterious effects of these compounds. However, low scavenging efficiency, unfavorable pharmacokinetics, and immunological problems have hampered the development of effective drugs. Here, we report the development and testing of a nanoparticle-based nerve agent bioscavenger (nanoscavenger) that showed long-term protection against OP intoxication in rodents. The nanoscavenger, which catalytically breaks down toxic OP compounds, showed a good pharmacokinetic profile and negligible immune response in a rat model of OP intoxication. In vivo administration of the nanoscavenger before or after OP exposure in animal models demonstrated protective and therapeutic efficacy. In a guinea pig model, a single prophylactic administration of the nanoscavenger effectively prevented lethality after multiple sarin exposures over a 1-week period. Our results suggest that the prophylactic administration of the nanoscavenger might be effective in preventing the toxic effects of OP exposure in humans.

Clinical Outcomes of Valvular versus Nonvalvular Atrial Fibrillation in Acute Anterior Circulation Occlusive Stroke Undergoing Endovascular Treatment.

BACKGROUND: Thrombectomy is the first choice for cardioembolism due to atrial fibrillation (AF), however, whether valvular AF and nonvalvular AF had different safety and functional outcomes has not been reported yet. We aimed to investigate the differences between patients with valvular AF and patients with nonvalvular AF on safety and functional outcomes in acute large artery occlusion undergoing thrombectomy. METHODS: Valvular AF refers to patients with mitral stenosis or artificial heart valves and valve repair. Rate of symptomatic intracerebral hemorrhage [sICH], modified Rankin Scale Score (mRS), and death at 90 days were compared between valvular AF and nonvalvular AF groups. Univariate and multivariable logistic regression was performed to identify the predictors for unfavorable functional outcome (mRS 3-6). RESULTS: 18.8% (51/271) of AF were valvular AF. The valvular AF group had significantly higher proportion of mRS 0-2 (49% [25/51] versus 33.3% [73/219], P = .04) and less death (21.6% [11/51] versus 38.4% [84/219], P = .02) comparing with nonvalvular AF group. The rates of sICH between both groups were nonsignificantly different (21.5% [47/219] for nonvalvular AF versus 13.7% [7/51] for valvular AF, P = .46). Valvular AF was not an independent predictor for unfavorable functional outcome (odds ratio .67, 95% confidence interval: .24-1.84) with age, collateral flow, chronic heart failure, NIHSS at admission, recanalization status, glucose at admission, occlusion site, ASPECTS, and ICH as covariates. CONCLUSIONS: Valvular AF and nonvalvular AF have similar safety and functional outcomes in patients with acute anterior circulation large artery occlusion undergoing thrombectomy.

Zwitterionic Gel Coating Endows Gold Nanoparticles with Ultrastability.

Colloidal stability of gold nanoparticles (GNPs) is of great importance for their applications. Although a number of ligands have been developed to protect GNPs, irreversible aggregation still happens under some particular conditions. Herein, we report a zwitterionic encapsulation strategy to endow GNPs with ultrastability. Each single GNP is coated with a cross-linked zwitterionic poly(ornithine methacrylamide) hydrogel thin-layer, which prevents particle aggregation under extremely harsh conditions, including lyophilization, strong acid solution, saturated salt solution, and concentrated alkali solution. In addition, the zwitterionic gel layer resists protein adsorption in the biological milieu, keeping the nanoparticles stable in full human blood serum. Furthermore, the amino-acid-derived polymer gel provides numerous conjugation sites for on-demand biomolecular functionalization. With all these merits, the zwitterionic gel coated GNPs hold great potential in many applications such as sensing and theragnostics.

Cerebrospinal fluid rhinorrhea in a bilateral frontal decompressive craniectomy patient caused by strenuous activity: A case report.

RATIONALE: Iatrogenic cerebrospinal fluid (CSF) rhinorrhea in a bilateral frontal decompressive craniectomy patient triggered by strenuous sport is rare. To the best of our knowledge, no similar case has yet been reported. PATIENT CONCERNS: Herein, we report a case of CSF rhinorrhea in a 37-year-old man. He had previously suffered a traumatic brain injury in a traffic accident, and a subsequent bilateral frontal decompressive craniectomy operation was performed. Based on the frontal skull defect peculiarity, strenuous exercise may have caused drastic CSF pressure waves to tear the dura mater of the anterior skull base, resulting in CSF rhinorrhea. DIAGNOSES: The thin-slice computerized tomography (CT) images revealed a frontal skull defect and the open frontal sinus. In addition, in the opened frontal sinus, low-density liquid-filled areas were visible. INTERVENTIONS: During surgery, the torn dura was carefully repaired, and the frontal sinus was filled with temporal muscle, fascia, and fibrin glue. A simultaneous cranioplasty was performed. OUTCOMES: The patient was followed-up postoperatively for 12 months to date without rhinorrhea recurrence. Recovery was uneventful. LESSONS: Patients with skull defects should avoid strenuous sports, and cranioplasty should be performed as early as possible in order to decrease the likelihood of a dural tear and prevent the occurrence of CSF leakage. After cranioplasty, the skull should be restored to a closed state to reduce the damaging effects of CSF waves during movement. It is important to maintain normal intracranial pressure to reduce the recurrence rate of CSF rhinorrhea.

Glycerophosphatidylcholine PC(36:1) absence and 3'-phosphoadenylate (pAp) accumulation are hallmarks of the human glioma metabolome.

Glioma is the most prevalent malignant brain tumor. A comprehensive analysis of the glioma metabolome is still lacking. This study aims to explore new special metabolites in glioma tissues. A non-targeted human glioma metabolomics was performed by UPLC-Q-TOF/MS. The gene expressions of 18 enzymes associated with 3'-phosphoadenylate (pAp) metabolism was examined by qRT-PCR. Those enzymes cover the primary metabolic pathway of pAp. We identified 15 new metabolites (13 lipids and 2 nucleotides) that were significantly different between the glioma and control tissues. Glycerophosphatidylcholine [PC(36:1)] content was high and pAp content was significantly low in the control brain (p < 0.01). In glioma tissues, PC(36:1) was not detected and pAp content was significantly increased. The gene expressions of 3'-nucleotidases (Inositol monophosphatase (IMPAD-1) and 3'(2'),5'-bisphosphate nucleotidase 1(BPNT-1)) were dramatically down-regulated. Meanwhile, the gene expression of 8 sulfotransferases (SULT), 2 phosphoadenosine phosphosulfate synthases (PAPSS-1 and PAPSS-2) and L-aminoadipate-semialdehyde dehydrogenase-phosphopante-theinyl transferase (AASDHPPT) were up-regulated. PC(36:1) absence and pAp accumulation are the most noticeable metabolic aberration in glioma. The dramatic down-regulation of IMPAD-1 and BPNT-1 are the primary cause for pAp dramatic accumulation. Our findings suggest that differential metabolites discovered in glioma could be used as potentially novel therapeutic targets or diagnostic biomarkers and that abnormal metabolism of lipids and nucleotides play roles in the pathogenesis of glioma.

Polypeptides with High Zwitterion Density for Safe and Effective Therapeutics.

The commonly used "stealth material" poly(ethylene glycol) (PEG) effectively promotes the pharmacokinetics of therapeutic cargos while reducing their immune response. However, recent studies have suggested that PEG could induce adverse reactions, including the emergence of anti-PEG antibodies and tissue histologic changes. An alternative stealth material with no or less immunogenicity and organ toxicity is thus urgently needed. We designed a polypeptide with high zwitterion density (PepCB) as a stealth material for therapeutics. Neither tissue histological changes in liver, kidney, or spleen, nor abnormal behavior, sickness or death was induced by the synthesized polymer after high-dosage administration for three months in rats. When conjugated to a therapeutic protein uricase, the uricase-PepCB bioconjugate showed significantly improved pharmacokinetics and immunological properties compared with uricase-PEG conjugates.

Malignant Cerebral Swelling After Cranioplasty due to Ipsilateral Intracranial Vasculopathy: Case Report and Literature Review.

BACKGROUND: Cranioplasty is a well-established surgical operation that is used worldwide for patients with skull defects following decompressive craniectomy (DC). However, in some cases, potentially fatal complications may occur, such as malignant cerebral swelling after uneventful cranioplasty. CASE DESCRIPTION: We present a rare case of massive malignant ipsilateral cerebral swelling following uneventful titanium mesh cranioplasty due to rare ipsilateral intracranial vasculopathy confirmed by magnetic resonance angiography (MRA) and magnetic resonance venography (MRV). Fortunately, we performed titanium mesh explantation and extended DC in time, and the patient survived. Malignant cerebral swelling after uneventful cranioplasty is an unpredictable but fatal complication. Most reported cases have had an unfavorable prognosis. To the best of our knowledge, the mechanism was first confirmed by MRA and MRV, which demonstrated that the cerebral swelling was due to unilateral intracranial vasculopathy, including a rare ipsilateral intracranial internal carotid artery occlusion, as well as extremely thin lateral and sigmoid sinuses. CONCLUSIONS: Our case demonstrates for the first time that ipsilateral intracranial vasculopathy is a risk factor for malignant cerebral swelling after cranioplasty. Patients with traumatic brain injury with suspected intracranial vasculopathy should undergo a comprehensive vascular evaluation before cranioplasty to help prevent malignant cerebral swelling.

Partial titanium mesh explantation cured post-cranioplasty implant-associated scalp infection.

Titanium mesh cranioplasty is routinely used worldwide for skull defect patients given its advantages, such as stability and biocompatibility. However, there are very few reports concerning the treatment of implant-associated scalp infection, which is one of the most common complications. The aim of the study is to retrospectively evaluate a novel operation technique for the treatment of titanium mesh-associated scalp infection post-cranioplasty, namely partial titanium mesh explantation (PTME). A retrospective study was conducted in all patients who underwent surgical treatment for implant-associated scalp infection from January 2012 to September 2016 in our hospital. In total, 17 patients were selected for study analysis among 231 patients who underwent cranioplasty. The treatment success rate of PTME was 85.7%. There was no statistically significant difference in demographics and characteristics except for follow-up length of time between the PTME group and TTME (total titanium mesh explantation) group (Non-paired Student's t-test, P=0.037). While, The PTME group exhibited a significantly reduced skull defect area post-operation compared with the TTME group (Non-paired Student's t-test, P=0.002). Moreover, post-PTME skull area also exhibited a significantly reduced skull defect area compared with the pre-cranioplasty area in the same patient (Non-paired Student's t-test, P=0.006). Compared with traditional surgical treatment of implant-associated scalp infection, PTME combined with strict debridement and antibiotic therapy can cure implant-associated scalp infection. Moreover, PTME could preserve sufficient titanium mesh for brain protection and cosmesis.