Association Between Nadir Hematocrit and Severe Acute Kidney Injury After Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study Based on the MIMIC-IV Database.

BACKGROUND We aimed to evaluate the association between postoperative nadir hematocrit (Hct) and severe acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass graft (OPCABG) surgery. MATERIAL AND METHODS Data of patients who received OPCABG were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A generalized additive model was applied to explore the relationship between nadir Hct and severe AKI. Patients were divided into 4 groups by quartiles of postoperative nadir Hct, with the lowest group (Hct <25%) as reference. We conducted multivariate logistic regression models to calculate adjusted odds ratios (OR) and 95% CI and evaluate trend among the 4 groups. RESULTS In total, 1783 OPCABG patients were included. A nonlinear association between nadir Hct and severe AKI was identified. After adjusting for potential confounders, nadir Hct was negatively associated with risk of severe AKI when Hct was less than 31%; there was no statistical significance between highest Hct group (Hct ≥31%) and control group (Hct <25%; P>0.05). Tests for trend were significant (P<0.05). Subgroup analyses showed each 1% increase in postoperative nadir Hct was associated with a 23% decrease in risk of severe AKI (OR, 0.77; P=0.002) in lower BMI group (<30 kg/m²). CONCLUSIONS The association between postoperative nadir Hct and severe AKI in patients after OPCABG was nonlinear. Lower nadir Hct may be associated with increased risk of severe AKI when Hct values are less than 31%. However, no statistical significance was found between the highest Hct group and control group.

Preoperative pulmonary vascular resistance and neutrophil-to-lymphocyte ratio predict the demand of extracorporeal membrane oxygenation after pulmonary endarterectomy.

BACKGROUND: Acute respiratory and circulatory collapse might occasionally happen after pulmonary endarterectomy (PEA). We aimed to investigate the utilization of extracorporeal membrane oxygenation (ECMO) after PEA and potential risk factors. METHODS: Demographic characteristics, clinical and surgical data were collected for all patients who underwent PEA from December 2016 to June 2022. All factors were compared between patients in the ECMO group and those in the other group. The most characteristic risk factors were obtained by least absolute shrinkage and selection operator regression and support vector machine machine learning, and receiver operating characteristics (ROC) Curve analysis was performed to verify the diagnostic value of the obtained risk factors. RESULTS: A total of 117 patients underwent PEA, and 8 (6.8%) of them received ECMO treatment intraoperatively or postoperatively. There were significant differences between the two groups in terms of cardiac function, pulmonary vascular resistance (PVR), preoperative inflammation and cardiopulmonary bypass time. The PVR and neutrophil-to-lymphocyte ratio (N/L ratio) were the most characteristic risk factors with an area under the ROC curve of 0.847 (95% confidence interval [CI] = 0.7517-0.9420, p = .005) and 0.896 (95% CI = 0.803-0.989, p = .001), respectively. The ECMO group had higher PVR (1549.4 ± 600.7 vs. 952.9 ± 466.9 dyn.s.cm-5 , p = .004) and N/L ratio (6.3 ± 5.6 vs. 2.4 ± 1.7, p = .001). CONCLUSIONS: PVR and N/L ratio can correctly predict who is likely to receive ECMO treatment after PEA. Therefore, addressing the preoperative inflammatory status might be beneficial but further research is needed.

Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study.

BACKGROUND: Deep hypothermic circulatory arrest (DHCA) is nowadays commonly used in pulmonary thromboendarterectomy (PTE). Neurological injury related to DHCA severely impairs the prognosis of patients. However, the risk factors and predictors of neurological injury are still unclear. METHODS: We conducted a prospective observational study, including 82 patients diagnosed as chronic thromboembolic pulmonary hypertension and underwent PTE alone in our center from December 2016 to May 2021. Demographic characteristics, clinical and surgical data, and neurological adverse events were recorded prospectively. Univariate and multivariate analyses were conducted to identify the predictors of neurological injury. RESULTS: Eleven (13.4%) patients exhibited neurological injuries after surgery. Univariate analysis showed that the duration of regional cerebral oxygen saturation (rSO2 ) under 40% (p < .001), the minimum rSO2 (p = .006), and the percentage of decrease in rSO2 (p = .011) were significantly associated with neurological injury. Multivariate analysis showed that the duration of rSO2 under 40% was an independent predictor for postoperative neurological injury (odds ratio = 3.896, 95% confidence interval: 1.812-8.377, p < .001). The receiver operating characteristic curve showed that when the cut-off value was 1.25 min, its sensitivity for predicting neurological injury was 63.6% with a specificity of 88.7%. CONCLUSIONS: The duration of rSO2 under 40% is an independent predictor for neurological injury following PTE. For complicated lesions, more times of circulatory arrest were much safer and more reliable than a prolonged time of a single circulatory arrest. The circulation should be restored as soon as possible, when the rSO2 under 40% is detected, rather than waiting for 5 min.

Super Light-Sensitive Photosensitizer Nanoparticles for Improved Photodynamic Therapy against Solid Tumors.

Photodynamic therapy (PDT) is an effective method for superficial cancer treatment. However, the limited light intensity in tissues, tumor hypoxia, and the low accumulation efficiency of photosensitizers (PSs) in tumors are still major challenges. Herein, we introduce super light-sensitive PS nanoparticles (designated HR NPs) that can increase singlet oxygen (1 O2 ) production and improve PS accumulation in tumors. HR NPs have the ability to produce a large amount of 1 O2 under ultralow power density light (0.05 mW cm-2 ) irradiation. More significantly, HR NPs have a long circulating time in tumor-bearing mice and can accumulate in tumors with high efficiency. When irradiated by light with a suitable wavelength, the nanoparticles exhibit excellent antitumor efficacy. This work will make it possible to cure solid tumors by PDT by enhancing the therapeutic effects.

Monitoring Shear Behavior of Prestressed Concrete Bridge Girders Using Acoustic Emission and Digital Image Correlation.

In the Netherlands, many prestressed concrete bridge girders are found to have insufficient shear-tension capacity. We tested four girders taken from a demolished bridge and instrumented these with traditional displacement sensors and acoustic emission (AE) sensors, and used cameras for digital image correlation (DIC). The results show that AE can detect cracking before the traditional displacement sensors, and DIC can identify the cracks with detailed crack kinematics. Both AE and DIC methods provide additional information for the structural analysis, as compared to the conventional measurements: more accurate cracking load, the contribution of aggregate interlock, and the angle of the compression field. These results suggest that both AE and DIC are suitable options that warrant further research on their use in lab tests and field testing of prestressed bridges.

Collective oscillation in dense suspension of self-propelled chiral rods.

Active particles capable of self-propulsion commonly exhibit rich collective dynamics and have attracted increasing attention due to their applications in biology, robotics, social transport, and biomedicine. However, it remains unclear how the geometric features of active particles affect their collective behaviors. In this paper, we explore the collective dynamics of L-shaped active rods. We show that a dense suspension of self-propelled L-shaped rods exhibits fascinating non-equilibrium oscillatory dynamic clustering. A new oscillation phase can form due to distinct collisions and aggregation mechanisms arising from the L-shaped chirality of elements. A generic diagram of emerging states is provided over a wide range of geometric parameters. Our findings show that the comparative strength between the periodic separation and proximity effect from chirality and the alignment effect from elongated geometry drive the formation and transition of dynamic patterns. This chirality-triggered oscillation phase suggests a new route to understand active matter and paves a way for emerging applications.

A simulation algorithm for Brownian dynamics on complex curved surfaces.

Brownian dynamics of colloidal particles on complex curved surfaces has found important applications in diverse physical, chemical, and biological processes. However, most Brownian dynamics simulation algorithms focus on relatively simple curved surfaces that can be analytically parameterized. In this work, we develop an algorithm to enable Brownian dynamics simulation on extremely complex curved surfaces. We approximate complex curved surfaces with triangle mesh surfaces and employ a novel scheme to perform particle simulation on these triangle mesh surfaces. Our algorithm computes forces and velocities of particles in global coordinates but updates their positions in local coordinates, which combines the strengths from both global and local simulation schemes. We benchmark the proposed algorithm with theory and then simulate Brownian dynamics of both single and multiple particles on torus and knot surfaces. The results show that our method captures well diffusion, transport, and crystallization of colloidal particles on complex surfaces with nontrivial topology. This study offers an efficient strategy for elucidating the impact of curvature, geometry, and topology on particle dynamics and microstructure formation in complex environments.

High-sensitivity measurement of angular velocity based on an optoelectronic oscillator with an intra-loop Sagnac interferometer.

A novel scheme for angular velocity measurement is proposed and demonstrated by using an optoelectronic oscillator (OEO) incorporating a Sagnac interferometer. In the OEO resonant cavity, the optical carrier (OC) and the first-order sidebands propagate in opposite directions in the Sagnac loop. Thus, the rotation-induced Sagnac phase difference between the OC and first-order sidebands will produce an oscillating frequency shift of the OEO which is proportional to the rotation angular velocity. Then a high-sensitivity angular velocity measurement is realized by monitoring the oscillating microwave frequency. The system is free from the lock-in problem, and the sensitivity scale is measured to be 51.8 kHz/(rad/s) which is equivalent to a minimally detectable angular velocity of 3.98°/h with a frequency shift of 1 Hz.

Energy landscapes for ellipsoids in non-uniform AC electric fields.

We report a closed-form analytical model for energy landscapes of ellipsoidal particles in non-uniform high-frequency AC electric fields to identify all possible particle positions and orientations. Three-dimensional equilibrium positions and orientations of prolate (rx = ry < rz), oblate (rx = rz > ry), and scalene (rx≠ry≠rz) ellipsoids are reported vs. field frequency and amplitude, which are determined from energy landscape minima. For ellipsoids within non-uniform electric fields between co-planar parallel electrodes, the number of configurations of position and orientation is 6 for prolate, 5 for oblate, and 9 for scalene ellipsoids. In addition, for coplanar electrodes, conditions are identified when particles can be treated using a quasi-2D analysis in the plane of their most probable elevation near an underlying surface. The reported expressions are valid for time-averaged interactions of ellipsoid particles in arbitrary AC electric field configurations, such that our results are applicable to electromagnetic tweezers interacting with particles having an appropriate material property contrast with the medium in the frequency range of interest.

Interfacial and Confined Colloidal Rod Diffusion.

Optical microscopy is used to measure translational and rotational diffusion of colloidal rods near a single wall, confined between parallel walls, and within quasi-2D porous media as a function of rod aspect ratio and aqueous solution ionic strength. Translational and rotational diffusivities are obtained as rod particles experience positions closer to boundaries and for larger aspect ratios. Models based on position dependent hydrodynamic interactions quantitatively capture diffusivities in all geometries and indicate particle-wall separations in agreement with independent estimates based on electrostatic interactions. Short-time translational diffusion in quasi-2D porous media is insensitive to porous media area fraction, which appears to arise from a balance of hydrodynamic hindrance and enhanced translation due to parallel alignment along surfaces. Findings in this work provide a basis to interpret and predict interfacial and confined colloidal rod transport relevant to biological, environmental, and synthetic material systems.

Interfacial colloidal rod dynamics: Coefficients, simulations, and analysis.

Colloidal rod diffusion near a wall is modeled and simulated based on a constrained Stokesian dynamic model of chains-of-spheres. By modeling colloidal rods as chains-of-spheres, complete diffusion tensors are computed for colloidal rods in bulk media and near interfaces, including hydrodynamic interactions, translation-rotation coupling, and all diffusion modes in the particle and lab frames. Simulated trajectories based on the chain-of-spheres diffusion tensor are quantified in terms of typical experimental quantities such as mean squared positional and angular displacements as well as autocorrelation functions. Theoretical expressions are reported to predict measured average diffusivities as well as the crossover from short-time anisotropic translational diffusion along the rod's major axis to isotropic diffusion. Diffusion modes are quantified in terms of closed form empirical fits to model results to aid their use in interpretation and prediction of experiments involving colloidal rod diffusion in interfacial and confined systems.

An M-estimator for reduced-rank system identification.

High-dimensional time-series data from a wide variety of domains, such as neuroscience, are being generated every day. Fitting statistical models to such data, to enable parameter estimation and time-series prediction, is an important computational primitive. Existing methods, however, are unable to cope with the high-dimensional nature of these data, due to both computational and statistical reasons. We mitigate both kinds of issues by proposing an M-estimator for Reduced-rank System IDentification ( MR. SID). A combination of low-rank approximations, ℓ1 and ℓ2 penalties, and some numerical linear algebra tricks, yields an estimator that is computationally efficient and numerically stable. Simulations and real data examples demonstrate the usefulness of this approach in a variety of problems. In particular, we demonstrate that MR. SID can accurately estimate spatial filters, connectivity graphs, and time-courses from native resolution functional magnetic resonance imaging data. MR. SID therefore enables big time-series data to be analyzed using standard methods, readying the field for further generalizations including non-linear and non-Gaussian state-space models.

Dynamic colloidal assembly pathways via low dimensional models.

Here we construct a low-dimensional Smoluchowski model for electric field mediated colloidal crystallization using Brownian dynamic simulations, which were previously matched to experiments. Diffusion mapping is used to infer dimensionality and confirm the use of two order parameters, one for degree of condensation and one for global crystallinity. Free energy and diffusivity landscapes are obtained as the coefficients of a low-dimensional Smoluchowski equation to capture the thermodynamics and kinetics of microstructure evolution. The resulting low-dimensional model quantitatively captures the dynamics of different assembly pathways between fluid, polycrystal, and single crystals states, in agreement with the full N-dimensional data as characterized by first passage time distributions. Numerical solution of the low-dimensional Smoluchowski equation reveals statistical properties of the dynamic evolution of states vs. applied field amplitude and system size. The low-dimensional Smoluchowski equation and associated landscapes calculated here can serve as models for predictive control of electric field mediated assembly of colloidal ensembles into two-dimensional crystalline objects.

Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial.

BACKGROUND: Propofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents. MATERIAL/METHODS: Eighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes. RESULTS: The demographic data were similarly distributed among the TCI and MCI patients. Endoscopist's satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients' satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group. CONCLUSIONS: TCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.

Target-controlled infusion of remifentanil with or without flurbiprofen axetil in sedation for extracorporeal shock wave lithotripsy of pancreatic stones: a prospective, open-label, randomized controlled trial.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is an effective therapeutic method used to treat patients with pancreatic stones. However, the anesthesia for this procedure has been underappreciated, with minimal reports of these procedures in certain case series with general or epidural anesthesia. METHODS: A cohort of 60 patients who elected to undergo ESWL in order to treat pancreatic stones for the first time were randomly selected and divided into two groups. One group of patients received target controlled infusion (TCI) of remifentanil, while the other group of patients received TCI of remifentanil plus a bolus of flurbiprofen axetil (a cyclooxygenase inhibitor) (Rem group and Rem + Flu group, n = 30 for each group). The Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC50) of remifentanil. Visual analogue scales of pain, Ramsay sedation scale, hemodynamic changes, and adverse events were also recorded. RESULTS: The EC50 of remifentanil was calculated to be 4.0 ng/ml (95 % confidential interval: 3.84 ng/ml, 4.16 ng/ml) and 2.76 ng/ml (95 % confidential interval: 2.63 ng/ml, 2.89 ng/ml) in the Rem group and Rem + Flu group respectively (p < 0.001). Pain score was comparable between the two groups, while the Ramsay sedation scale was higher in the Rem group. Hemodynamic data showed that patients in the Rem group experienced higher mean arterial pressures and higher heart rates across the procedures. Patients in Rem group demonstrated a lower respiratory rate (p < 0.001) and a lower SpO2 (p = 0.001). Less adverse events occurred in Rem + Flu group, including a reduced respiratory depression requiring wake-up as well as reduced postoperative nausea and vomiting. CONCLUSION: Remifentanil plus flurbiprofen axetil provided satisfactory analgesia and sedation for ESWL of pancreatic stones with less adverse events. (Clinicaltrial.gov: NCT01998217 ; registered on November 19, 2013).

[Clinical outcomes of synchronous revascularization on patients concomitant carotid and coronary artery severe stenosis].

OBJECTIVE: To analyze the outcomes of synchronous revascularization for patients concomitant carotid and coronary artery severe stenosis. METHODS: From May 2012 to April 2014, 12 cases who received one-stage operation was retrospective analyzed, including the characteristics, methods of treatment, perioperative complications and health survey 30 days post procedure. Two subgroups were divided according to the different treatment methods on carotid artery, WIC and SF-36 scale were applied to compare the basic condition and recovery situation between 2 groups, the hospital stay time, costs, ventilation time, drainage and blood transfusion volume were also be compared. RESULTS: Totally 30 coronary vessels 8 carotid endarterectomy (CEA) and 5 carotid artery stenting (CAS) were performed on 12 patients. One patient also received coronary artery bypass grafting and bilateral carotid artery revascularization (CEA on right and CAS on left). Two (16.67%) minor stroke, 1 (8.33%) TIA, 1 wound infection occurred within 30 days post procedure, and 11 (91.67%) received blood component transfusion. No myocardial infarction and death occured. The average hospital stay time were (36.5 ± 25.3) days, ventilator application (37.5 ± 31.2) hours, postoperative drainage volume from pericardial and mediastinal was (347.92 ± 105.69) ml, infusion of concentrated red cell was 4.3 U. WIC was (5.57 ± 1.51) in CEA and (4.25 ± 1.50) in CAS subgroup, there was no significantly statistical difference (t = 1.40, P > 0.05). the results of SF-36 was (3.63 ± 1.76) and (5.44 ± 1.05) in CEA and CAS subgroup, there was no significantly statistical difference (t = -1.85, P > 0.05). In hospital stay time, ventilator application time, transfusion and drainage volume, hospitalization costs were also no significant statistical difference between two groups. CONCLUSIONS: The early outcome of synchronous revascularization on concomitant carotid and coronary severe stenosis disease is satisfactory. The clinical results are similar in the CEA and CAS subgroup.

The Axin2 rs2240308 polymorphism and susceptibility to lung cancer in a Chinese population.

Axis inhibition protein 2 (Axin2) is a negative regulator of the canonical Wnt/ß-catenin signaling pathway, and functions as a tumor suppressor in a number of human cancers. Previous pilot studies have suggested an association between Axin2 exon1 148 (rs2240308) SNP polymorphism and risk for lung cancer. In the present study, we aimed to investigate the Axin2 exon1 148 polymorphism and its association with lung cancer susceptibility in Han Chinese population. The Axin2 exon1 148 SNP was genotyped in 555 controls and 520 lung cancer patients using TaqMan SNP Genotyping Assays. Unconditional logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We observed that the genotype frequencies of TC, TT, and CC were significantly different between controls and cases (χ(2) = 6.849, P = 0.03256, df = 2). Subjects carrying T allele (TC + TT genotypes) had decreased susceptibility to lung cancer as compared to those carrying CC genotype (OR = 0.733, 95% CI = 0.5726-0.9393, P = 0.01382). No significant association was found between rs2240308 polymorphism and histological subtypes of lung cancers. Findings from this study suggest that Axin2 exon1 T148C polymorphism (rs2240308) contributes to increased susceptibility to lung cancer in Chinese population. This further implicates Axin2 as a lung cancer-related gene.

Research Progress of Photodynamic Therapy in Wound Healing: A Literature Review.

Light is an efficient technique that has a significant influence on contemporary medicine. Photodynamic therapy (PDT), which involves the combined action of photosensitizers (PSs), oxygen, and light, has emerged as a therapeutically promising method for treating a broad variety of solid tumors and infectious diseases. Photodynamic therapy is minimally invasive, has few side effects, lightens scars, and reduces tissue loss while preserving organ structure and function. In particular, PDT has a high healing potential for wounds (PDT stimulates wound healing by enhancing re-epithelialization, promoting angiogenesis as well as modulating skin homeostasis). Wound healing involves interactions between many different processes, including coagulation, inflammation, angiogenesis, cellular migration, and proliferation. Poor wound healing with diabetes or extensive burns remains a difficult challenge. This review emphasizes PDT as a potential research field and summarizes PDT's role in wound healing, including normal wounds, chronic wounds, and aging wounds.

Global Trends and Research Progress of Photodynamic Therapy in Skin Cancer: A Bibliometric Analysis and Literature Review.

Background: Based on photochemical reactions through the combined use of light and photosensitizers, photodynamic therapy (PDT) is gaining popularity for the treatment of skin cancer. Various photosensitizers and treatment regimens are continuously being developed for enhancing the efficacy of PDT on skin cancer. Reviewing the development history of PDT on skin cancer, and summarizing its development direction and research status, is conducive to the further research. Methods: To evaluate the research trends and map knowledge structure, all publications covering PDT on skin cancer were retrieved and extracted from Web of Science database. We applied VOSviewer and CiteSpace softwares to evaluate and visualize the countries, institutes, authors, keywords and research trends. Literature review was performed for the analysis of the research status of PDT on skin cancer. Results: A total of 2662 publications were identified. The elements, mechanism, pros and cons, representative molecular photosensitizers, current challenges and research progress of PDT on skin cancer were reviewed and summarized. Conclusion: This study provides a comprehensive display of the field of PDT on skin cancer, which will help researchers further explore the mechanism and application of PDT more effectively and intuitively.