The Trend of Radiographic Healing after Root Canal Treatment in Teeth with Apical Periodontitis Based on Cone-Beam Computed Tomography: A 4-Year Longitudinal Study.

OBJECTIVES: The aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. METHODS: In total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20% or more. RESULTS: During the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6%), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7%) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. CONCLUSIONS: The efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20% or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. CLINICAL SIGNIFICANCE: The volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

A transthyretin-like protein acts downstream of miR397 and LACCASE to regulate grain yield in rice.

Increasing grain yield is a major goal of breeders due to the rising global demand for food. We previously reported that the miR397-LACCASE (OsLAC) module regulates brassinosteroid (BR) signaling and grain yield in rice (Oryza sativa). However, the precise roles of laccase enzymes in the BR pathway remain unclear. Here, we report that OsLAC controls grain yield by preventing the turnover of TRANSTHYRETIN-LIKE (OsTTL), a negative regulator of BR signaling. Overexpressing OsTTL decreased BR sensitivity in rice, while loss-of-function of OsTTL led to enhanced BR signaling and increased grain yield. OsLAC directly binds to OsTTL and regulates its phosphorylation-mediated turnover. The phosphorylation site Ser226 of OsTTL is essential for its ubiquitination and degradation. Overexpressing the dephosphorylation-mimic form of OsTTL (OsTTLS226A) resulted in more severe defects than did overexpressing OsTTL. These findings provide insight into the role of an ancient laccase in BR signaling and suggest that the OsLAC-OsTTL module could serve as a target for improving grain yield.

Computer aided diagnosis of diabetic retinopathy based on multi-view joint learning.

Diabetic retinopathy (DR) is a kind of ocular complication of diabetes, and its degree grade is an essential basis for early diagnosis of patients. Manual diagnosis is a long and expensive process with a specific risk of misdiagnosis. Computer-aided diagnosis can provide more accurate and practical treatment recommendations. In this paper, we propose a multi-view joint learning DR diagnostic model called RT2Net, which integrates the global features of fundus images and the local detailed features of vascular images to reduce the limitations of single fundus image learning. Firstly, the original image is preprocessed using operations such as contrast-limited adaptive histogram equalization, and the vascular structure of the extracted DR image is segmented. Then, the vascular image and fundus image are input into two branch networks of RT2Net for feature extraction, respectively, and the feature fusion module adaptively fuses the feature vectors' output from the branch networks. Finally, the optimized classification model is used to identify the five categories of DR. This paper conducts extensive experiments on the public datasets EyePACS and APTOS 2019 to demonstrate the method's effectiveness. The accuracy of RT2Net on the two datasets reaches 88.2% and 85.4%, and the area under the receiver operating characteristic curve (AUC) is 0.98 and 0.96, respectively. The excellent classification ability of RT2Net for DR can significantly help patients detect and treat lesions early and provide doctors with a more reliable diagnosis basis, which has significant clinical value for diagnosing DR.

Synergistic effects of photodynamic therapy and chemotherapy: Activating the intrinsic/extrinsic apoptotic pathway of anoikis for triple-negative breast cancer treatment.

Triple-negative breast cancer (TNBC) is a highly invasive and metastatic subtype of breast cancer that often recurs after surgery. Herein, we developed a cyclodextrin-based tumor-targeted nano delivery system that incorporated the photosensitizer chlorin e6 (Ce6) and the chemotherapeutic agent lonidamine (LND) to form the R6RGD-CMßCD-se-se-Ce6/LND nanoparticles (RCC/LND NPS). This nanosystem could target cancer cells, avoid lysosomal degradation and further localize within the mitochondria. The RCC/LND NPS had pH and redox-responsive to control the release of Ce6 and LND. Consequently, the nanosystem had a synergistic effect by effectively alleviating hypoxia, enhancing the production of cytotoxic reactive oxygen species (ROS) and amplifying the efficacy of photodynamic therapy (PDT). Furthermore, the RCC/LND NPS + light weakened anoikis resistance, disrupted extracellular matrix (ECM), activated both the intrinsic apoptotic pathway (mitochondrial pathway) and extrinsic apoptotic pathway (receptor death pathway) of anoikis. In addition, the nanosystem showed significant anti-TNBC efficacy in vivo. These findings collectively demonstrated that RCC/LND NPS + light enhanced the anticancer effects, induced anoikis and inhibited tumor cell migration and invasion through a synergistic effect of chemotherapy and PDT. Overall, this study highlighted the promising potential of the RCC/LND NPS + light for the treatment of TNBC.

Exercise capacity-hemodynamics mismatch in elderly patients with pulmonary hypertension: A nationwide multicenter study from Taiwan Society of Cardiology Pulmonary Hypertension Registry (TAIPANS).

Background: Demographics of pulmonary hypertension (PH) has changed a lot over the past forty years. Several recent registries noted an increase in mean age of PH but only a few of them investigated the characteristics of elderly patients. Thus, we aimed to analyze the characteristics of PH in such a population in this study. Methods: This multicenter study enrolled patients diagnosed with PH in group 1, 3, 4, and 5 consecutively from January 1, 2019 to December 31, 2020. A total of 490 patients was included, and patients were divided into three groups by age (≤45 years, 45-65 years, and >65 years). Results: The mean age of PH patients diagnosed with PH was 55.3 ± 16.3 years of age. There was higher proportion of elderly patients classified as group 3 PH (≤45: 1.3, 45-65: 4.5, >65: 8.1 %; p = 0.0206) and group 4 PH (≤45: 8.4, 45-65: 14.5, >65: 31.6 %; p < 0.0001) than young patients. Elderly patients had shorter 6-min walking distance (6 MWD) (≤45 vs. >65, mean difference, 77.8 m [95% confidence interval (CI), 2.1-153.6 m]), lower mean pulmonary arterial pressure (mPAP) (≤45 vs. >65, mean difference, 10.8 mmHg [95% CI, 6.37-15.2 mmHg]), and higher pulmonary arterial wedge pressure (PAWP) (≤45 vs. 45-65, mean difference, -2.1 mmHg [95% CI, -3.9 to -0.3 mmHg]) compared to young patients. Elderly patients had a poorer exercise capacity despite lower mPAP level compared to young population, but they received combination therapy less frequently compared to young patients (triple therapy in group 1 PH, ≤45: 16.7, 45-65: 11.3, >65: 3.8 %; p = 0.0005). Age older than 65 years was an independent predictor of high mortality for PH patients. Conclusions: Elderly PH patients possess unique hemodynamic profiles and epidemiologic patterns. They had higher PAWP, lower mPAP, and received combination therapy less frequently. Moreover, ageing is a predictor of high mortality for PH patients. Exercise capacity-hemodynamics mismatch and inadequate treatment are noteworthy in the approach of elderly population with PH.

Enhancing moisture detection in coal gravels: A deep learning-based adaptive microwave spectra fusion method.

The accurate and effective detection of moisture in coal gravels is crucial. Conventional air oven-drying method suffers from prolonged processing times and their disruptive nature. This paper proposes a deep learning-based adaptive fusion method for multiple microwave spectra to non-destructively detect the moisture content of coal gravels. First, a purpose-built free-space measurement platform is employed to acquire microwave spectra of coal samples, encompassing the magnitude and phase spectra of reflection coefficients (S11) and transmission coefficients (S21). Subsequently, a Monte-Carlo cross-validation-based method is adopted to detect and eliminate outliers in the spectra. Furthermore, a novel feature extraction module is proposed, enhancing the traditional U-shaped network using residual learning (ResNet) and the convolutional block attention module (CBAM) to extract and reconstruct subtle spectral features. Inspired by the high-level data fusion, an adaptive spectra fusion method is then introduced that can autonomously balance the contributions between different spectra. The experimental results underscore the advantages of the proposed method, with narrow frequency intervals between 2.50-3.25 GHz, 3.75-4.00 GHz, and 4.75-5.00 GHz exhibiting superior detection accuracy compared to the entire frequency band, achieving R2 = 0.9034, MAE = 1.0254, RMSE = 1.2948 and RPIQ = 6.0630.

Comparison of continuous 24-hour and 14-day ECG monitoring for the detection of cardiac arrhythmias in patients with ischemic stroke or syncope.

BACKGROUND: Previous studies show that using 12-lead electrocardiogram (ECG) or 24-h ECG monitor for the detection of cardiac arrhythmia events in patients with stroke or syncope is ineffective. HYPOTHESIS: The 14-day continuous ECG patch has higher detection rates of arrhythmias compared with conventional 24-h ECG monitoring in patients with ischemic stroke or syncope. METHODS: This cross-sectional study of patients with newly diagnosed ischemic stroke or syncope received a 24-h ECG monitoring and 14-day continuous cardiac monitoring patch and the arrhythmia events were measured. RESULTS: This study enrolled 83 patients with ischemic stroke or syncope. The detection rate of composite cardiac arrhythmias was significantly higher for the 14-day ECG patch than 24-h Holter monitor (69.9% vs. 21.7%, p = .006). In patients with ischemic stroke, the detection rates of cardiac arrhythmias were 63.4% for supraventricular tachycardia (SVT), 7% for ventricular tachycardia (VT), 5.6% for atrial fibrillation (AF), 4.2% for atrioventricular block (AVB), and 1.4% for pause by 14-day ECG patch, respectively. The significant difference in arrhythmic detection rates were found for SVT (45.8%), AF (6%), pause (1.2%), AVB (2.4%), and VT (9.6%) by 14-day ECG patch but not by 24-h Holter monitor in patients with ischemic stroke or syncope. CONCLUSIONS: A 14-day ECG patch can be used on patients with ischemic stroke or syncope for the early detection of AF or other cardiac arrhythmia events. The patch can be helpful for physicians in planning medical or mechanical interventions of patients with ischemic stroke and occult AF.

Combined Photosensitive Gene Therapy Effective Against Triple-Negative Breast Cancer in Mice Model.

Introduction: Tumor hypoxia and invasion present significant challenges for the efficacy of photodynamic therapy (PDT) in triple-negative breast cancer (TNBC). This study developed a mitochondrial targeting strategy that combined PDT and gene therapy to promote each other and address the challenges. Methods: The positively charged amphiphilic material triphenylphosphine-tocopherol polyethylene glycol succinate (TPP-TPGS, TPS) and the photosensitizer chloride e6 (Ce6) formed TPS@Ce6 nanoparticles (NPs) by hydrophobic interaction. They electrostatically condensed microRNA-34a (miR-34a) to form stable TPS@Ce6/miRNA NPs. Results: Firstly, Ce6 disrupted the lysosomal membrane, followed by successful delivery of miR-34a by TPS@Ce6/miRNA NPs. Meanwhile, miR-34a reduced ROS depletion and further enhanced the effectiveness of PDT. Consequently, the mutual promotion between PDT and gene therapy led to enhanced anti-tumor effects. Furthermore, the TPS@Ce6/miRNA NPs promoted apoptosis by down-regulating Caspase-3 and inhibited tumor cell migration and invasion by down-regulating N-Cadherin. In addition, in vitro and in vivo experiments demonstrated that the TPS@Ce6/miRNA NPs achieved excellent anti-tumor effects. These findings highlighted the enhanced anticancer effects and reduced migration of tumor cells through the synergistic effects of PDT and gene therapy. Conclusion: Taken together, the targeted co-delivery of Ce6 and miR-34a will facilitate the application of photodynamic and genic nanomedicine in the treatment of aggressive tumors, particularly TNBC.

Dual strategies of mild C-F scissoring fluorination and local high-concentration electrolyte to enable reversible Li-Fe-F conversion batteries.

Batteries taking conversion-type iron fluorides as energy-dense cathodes provide the possibility for the power electrification of the transportation and aviation industries. However, a safe and low-toxicity synthesis method for fluorides and the design of a compatible electrolyte formula are still challenging. Here, we propose a dual strategy of mild C-F scissoring fluorination and a local high-concentration electrolyte (LHCE) to enable highly reversible Li-Fe-F conversion batteries. A facile and safe scissoring strategy at a low temperature (95 °C) enables the preparation of a carbon-iron fluoride composite with a porous cubic cage-like structure. CFx plays a double role as a solid fluorination agent and an in situ conductive network after defluorination. The as-prepared fluoride cathode delivers a reversible capacity as high as 300 mA h g-1 over 100 cycles. The further LHCE strategy not only enhances the oxidation stable voltage of the electrolyte (>5 V) and the transference number of Li+ (0.74), but also realizes dual protection of the fluoride cathode and Li metal anode by facilitating the construction of robust cathode- and anode-electrolyte interfaces, respectively. The LHCE-assisted fluoride battery releases a higher reversible capacity of 335 mA h g-1 after 130 cycles. This work provides a solution to high-performance carbon-fluoride conversion cathodes by a synergetic effect of tailored synthesis, electroactive particle texture and electrolyte formula.

Room-temperature reversible F-ion batteries based on sulfone electrolytes with a mild anion acceptor additive.

Rechargeable fluoride ion batteries (FIBs) as an emerging anion shuttle system are attracting much attention due to their potential advantages in terms of energy density, cost and safety. A liquid electrolyte system enables the FIB operation at low or room temperature due to its higher ionic conductivity than that of a solid F-ion electrolyte. However, the insolubility of fluoride salts in aprotic solvents limits the development of liquid F-ion electrolytes. Although the boron-based anion acceptors (AAs) can facilitate the dissolution of F-ion salts, they are prone to lead to a tough desolvation process for F- due to strong Lewis acidity and therefore an inferior electrochemical performance. Here, a new non-boron AA (6-thioguanine) with moderate Lewis acidity is proposed to dissolve F- in the sulfone solvent. The ionic conductivity of the corresponding electrolytes reaches a level of mS cm-1 at room temperature. A model FIB coin cell is successfully operated with high conversion reaction reversibility based on the coupled defluorination/fluorination mechanism of electrodes, enabling a low overpotential of 0.36 V and a reversible capacity of 126 mA h g-1 after 40 cycles.

Building Organic-Inorganic Robust Interphases from Deep Eutectic Solution for Highly Stable Mg Metal Anode in Conventional Electrolyte.

Magnesium metal batteries (MMBs) currently face challenges suffering from severe Mg metal passivation and extremely high overpotential in conventional electrolytes. Herein, a strategy of using a low-cost deep eutectic solution (DES) is proposed to modify Mg anode with the monolithic and compact coating of a MgCl2 -Al-MgCl2 sandwich structure, enabling the stable and reversible Mg plating-stripping behavior. An organic/nanocrystal hybrid interphase is in-situ built through a facile Mg-Al displacement reaction between aluminum-chloro clusters and Mg in AlCl3 /Et3 NHCl solution, and it can effectively minimize the adverse interfacial passivation reaction and surface diffusion barrier, affording the high ion-conduction and electronic insulation. This DES-assisted method guarantees a highly reversible cycling of Mg metal anode (over 5000 h at 0.1 mA cm-2 and 400 h at 2.0 mAh cm-2 ) in Mg(TFSI)2 /DME electrolyte with the improved interfacial kinetics and low overpotential. Even at a much higher current density of 1 mA cm-2 , the overpotential only undergoes a slight increase from 0.2 V (at 0.1 mA cm-2 ) to 0.23 V. The corresponding full cells with CuS and phenanthraquinone cathodes deliver satisfactory cyclic performance. The DES modification strategy provides a new solution to the design of robust and conductive solid electrolyte interphase for achieving high-voltage and durable MMBs.

Hydrogels with tunable mechanical plasticity regulate endothelial cell outgrowth in vasculogenesis and angiogenesis.

The endothelial cell (EC) outgrowth in both vasculogenesis and angiogenesis starts with remodeling surrounding matrix and proceeds with the crosstalk between cells for the multicellular vasculature formation. The mechanical plasticity of matrix, defined as the ability to permanently deform by external traction, is pivotal in modulating cell behaviors. Nevertheless, the implications of matrix plasticity on cell-to-cell interactions during EC outgrowth, along with the molecular pathways involved, remain elusive. Here we develop a collagen-hyaluronic acid based hydrogel platform with tunable plasticity by using compositing strategy of dynamic and covalent networks. We show that although the increasing plasticity of the hydrogel facilitates the matrix remodeling by ECs, the largest tubular lumens and the longest invading distance unexpectedly appear in hydrogels with medium plasticity instead of the highest ones. We unravel that the high plasticity of the hydrogels promotes stable integrin cluster of ECs and recruitment of focal adhesion kinase with an overenhanced contractility which downregulates the vascular endothelial cadherin expression and destabilizes the adherens junctions between individual ECs. Our results, further validated with mathematical simulations and in vivo angiogenic tests, demonstrate that a balance of matrix plasticity facilitates both cell-matrix binding and cell-to-cell adherens, for promoting vascular assembly and invasion.

A SPECT/NIR Fluorescence Dual-Modality Imaging Agent Composed of Drugs and Hospital Available Isotope for Preoperative Sentinel Lymph Node Mapping and Intraoperative Biopsy.

Background: Sentinel lymph node (SLN) mapping-guided biopsy is crucial for cancer staging and treatment. Optical/nuclide dual-modality imaging agents for mapping SLN are ideal for preoperative planning and intraoperative biopsy, which are enabled by penetration-depth unlimited nuclide imaging and dynamic real-time optical imaging, respectively. However, commonly reported dual-modality imaging agents are composed of novel but safety-unproven materials, making their quick clinical translation challenging. Herein, we report a novel nanoparticle composed of facile hospital-available drugs and isotope for single-photon emission computed tomography (SPECT)/near-infrared (NIR) fluorescence imaging to detect SLNs. Methods: Indocyanine green-human serum albumin (ICG-HSA) nanoparticles (NPs) were synthesized by ICG-induced HSA self-assembly and further 99mTc-labeling via a one-step, facile hospital-available method. After injecting 99mTc-ICG-HSA into the rats' forepaw pads, the rats' draining axillary lymph nodes were visualized by preoperative mapping with SPECT/CT and intraoperative biopsy with NIR fluorescence. The axillary lymph nodes of rats were identified by pathology and fluorescent staining after execution. Additionally, its toxicity testing and comparison with 99mTc-sulfur colloid imaging were also explored. Results: The study reported a self-assembled 99mTc-ICG-HSA with a high radiochemical yield (85.6 ± 3.8%). Compared with conventional 99mTc-sulfur colloid, 99mTc-ICG-HSA NPs showed faster SLN identification, higher renal clearance, and lower hepatic retention. Furthermore, NIRF imaging allowed for the accurate visualization of the SLN and guided SLN biopsy intraoperatively. Notably, the 99mTc-ICG-HSA NPs were composed of hospital-available drugs and isotope, which are safe for acute toxicity evaluation by a certified institute. Conclusion: The proposed 99mTc-ICG-HSA NPs are safe and capable of noninvasive SLN identification and biopsy guidance with multi-modal imaging strategies and could be a promising tool for clinically assisted SLN biopsy.

Fiber Microarchitecture in Interpenetrating Collagen-Alginate Hydrogel with Tunable Mechanical Plasticity Regulates Tumor Cell Migration.

The fiber structures of tumor microenvironment (TME) are well-known in regulating tumor cell behaviors, and the plastic remolding of TME has recently been suggested to enhance tumor metastasis as well. However, the interrelationship between the fiber microarchitecture and matrix plasticity is inextricable by existing in vitro models. The individual roles of fiber microarchitecture and matrix plasticity in tuning tumor cell behaviors remain elusive. This study develops an interpenetrating collagen-alginate hydrogel platform with independently tunable matrix plasticity and fiber microarchitecture through an interpenetrating strategy of alginate networks and collagen I networks. With this hydrogel platform, it is demonstrated that tumor cells in high plasticity hydrogels are more extensive and aggressive than in low plasticity hydrogels and fiber structures only have influence in high plasticity hydrogels. The study further elucidates the underlying mechanisms through analyzing the distribution of forces within the matrix and tracking the focal adhesions (FAs) and finds that highly plastic hydrogels can activate the FAs formation, whereas the maturation and stability of FAs are dominated by fiber dispersion. This study not only establishes new ideas on how cells interact with TME cues but also would help to further finely tailor engineered hydrogel platforms for studying tumor behaviors in vitro.

An aminocaproic acid-grafted chitosan derivative with superior antibacterial and hemostatic properties for the prevention of secondary bleeding.

Uncontrolled bleeding is one of the leading causes of human mortality. Existing hemostatic materials or techniques cannot meet the clinical requirements for safe and effective hemostasis. The development of novel hemostatic materials has always been of great interest. Chitosan hydrochloride (CSH), a derivative of chitin, is extensively used on wounds as an antibacterial and hemostatic agent. However, the formation of intra- or intermolecular hydrogen bonds between hydroxyl and amino groups limits its water solubility and dissolution rate and affects its effectiveness in promoting coagulation. Herein, we covalently grafted aminocaproic acid (AA) to the hydroxyl and amino groups of CSH via ester and amide bonds, respectively. The solubility of CSH in water (25 °C) was 11.39 ± 0.98 % (w/v), whereas the AA-grafted CSH (CSH-AA) reached 32.34 ± 1.23 % (w/v). Moreover, the dissolution rate of CSH-AA in water was 6.46 times higher than that of CSH. Subsequent studies proved that CSH-AA is non-toxic, biodegradable, and has superior antibacterial and hemostatic properties to CSH. Additionally, anti-plasmin activity can be exerted by the dissociated AA from the CSH-AA backbone, which can help to lessen secondary bleeding.

Hyaluronate- and gelatin-based hydrogels encapsulating doxycycline as a wound dressing for burn injury therapy.

Infection is a critical challenge in burn wound therapy. Wound dressings with antibacterial and multifunctional abilities associated with rapid burn wound healing are urgently needed. Here, we developed a bioadhesive and injectable ECM-mimicking hydrogel dressing with antibacterial capacity for burn injury therapy, which is crosslinked by dynamic boronate ester bonds between modified hyaluronate and gelatin (HG). The antibiotic doxycycline (Doxy) was encapsulated in HG networks for drug delivery around the wound sites. The HG/Doxy hydrogel dressing shows biocompatibility and antibacterial activity against Gram-positive and Gram-negative bacteria. Applying to a rat model of burn wound, the HG/Doxy hydrogel significantly speeds up wound closure by reducing the inflammatory reaction. Furthermore, the HG/Doxy hydrogel accelerates the regeneration of the skin structure by promoting collagen deposition, blood vessel regeneration, and hair follicle formation, eventually shortening the healing periods of burn wounds. These findings demonstrated the clinical potential of the HG/Doxy hydrogels as a promising burn wound dressing. STATEMENT OF SIGNIFICANCE: A bioadhesive and injectable hydrogel dressing has been developed for burn injury therapy. The ECM-mimicking hyaluronate-gelatin (HG) hydrogel with antibacterial ability is crosslinked by dynamic boronate ester bonds for delivering antibiotic doxycycline (Doxy). The HG/Doxy hydrogels exhibit bioadhesive, shape-adaptive, and water retention abilities in closing the irregular-shaped wound and providing a moist environment. The HG/Doxy hydrogels significantly shorten the healing periods of burn wounds in rat models within 10~14 days and promote the regeneration of skin structure, which have high potential for clinical applications.

[Treatment and factors associated with prognosis of hyperkalemia in the emergency department].

OBJECTIVE: To survey treatment and prognosis of hyperkalemia patients in the emergency department and to analyze factors associated with all-cause in-hospital mortality. METHODS: We implemented electronic hospital information system, extracted demographic characteristics, underlying diseases, laboratory findings, potassium lowering therapy and prognosis of hyperkalemia patients [age ≥ 18 years, serum potassium (K+) concentration ≥ 5.5 mmol/L] in the emergency department of Peking Union hospital in Beijing between June 1st 2019 to May 31st 2020. The enrolled subjects were divided into the non-survival group and the survival group according to their prognosis. Univariate analysis and Cox regression model were adopted to analyze factors affecting all-cause in-hospital mortality of hyperkalemia patients. RESULTS: A total of 579 patients [median age 64 (22) years; 310 men (53.5%) and 269 women (46.5%)] with hyperkalemia were enrolled, among which, 317 (54.7%), 143 (24.7%) and 119 (20.6%) were mild, moderate, and severe hyperkalemia, respectively. 499 (86.20%) patients received potassium-lowering therapy, forty-four treatment regimens were administered. Insulin and glucose (I+G, 61.3%), diuretics (Diu, 57.2%), sodium bicarbonate (SB, 41.9%) and calcium gluconate/chloride (CA, 44.4%) were commonly used for the treatment of hyperkalemiain the emergency department. The combination of insulin and glucose, calcium gluconate/chloride, diuretics and sodium bicarbonate (I+G+CA+Diu+SB) was the most favored combined treatment regimen of hyperkalemia in the emergency department. The higher serum potassium concentration, the higher proportion of administrating combined treatment regimen and/or hemodialysis (HD) (the proportion of administrating combined treatment regimen in mild, moderate, and severe hyperkalemia patients were 58.4%, 82.5% and 94.8%; the proportion of administrating HD in mild, moderate, and severe hyperkalemia patients were 9.7%, 13.3% and 16.0%, respectively). The proportion of achievement of normokalaemia elevated as the kinds of potassium lowering treatment included in the combined treatment regimen increased. The proportion of achievement of normokalaemia was 100% in the combined treatment regimen including 6 kinds of potassium lowering therapy. Among various potassium lowering treatments, HD contributed to the highest rate of achievement of normokalaemia (93.8%). 111 of 579 (19.20%) hyperkalemia patients died in hospital. Cox regression model revealed that complicated with cardiac dysfunction predicted higher mortality [hazard ratio (HR) = 1.757, 95% confidence interval (95%CI) was 1.155-2.672, P = 0.009]. Achievement of normokalaemia and administration of diuretics attributed to lower mortality (HR = 0.248, 95%CI was 0.155-0.398, P = 0.000; HR = 0.335, 95%CI was 0.211-0.531, P = 0.000, respectively). CONCLUSIONS: Treatment of hyperkalemia in the emergency department were various. Complicated with cardiac dysfunction were associated with higher mortality. Achieving normokalaemia was associated with decreased mortality.

Effects of non-fasting molting on performance, oxidative stress, intestinal morphology, and liver health of laying hens.

Animal welfare concerns in laying-hen production facilities have necessitated research on alternative strategies for improving egg production and hen health. At present, most laying-hen facilities in China use the fasting method, but with international emphasis on animal welfare, scholars have begun to find ways to improve production efficiency while ensuring animal welfare standards are adhered to. Therefore, this study investigated the effects of non-fasting molting on production performance, oxidative stress, intestinal morphology, and liver health of laying hens. A total of 180 healthy 90-week-old Dawu Jinfeng laying hens with similar body weights and laying rates (76 ± 2%) were randomly divided into three groups, with five replicates per group and 12 hens per replicate. The hens in the experimental group (NF) were molted using the non-fasting method, the negative control group (C) was not treated with centralized molting, and the positive control group (F) was molted using the fasting method. The results showed that: (1) During the molting period, the laying rate in the NF group (10.58%) decreased and was significantly lower than that in the other two groups (P < 0.05). During the secondary laying peak period, the laying rate in the NF group was highest (89.71%); significantly higher than that in the C group (P < 0.05). (2) During the molting period, compared to the C group, the NF group showed a significant decrease and increase in the total antioxidant capacity (T-AOC) and superoxide dismutase (T-SOD) activity, respectively (P < 0.05). During the secondary laying peak period, the T-SOD activity of the NF group was significantly lower than that of the C group (P < 0.05). (3) During the molting period, the villus height (VH) and the ratios of VH to crypt depth (V/C) of the duodenum, jejunum, and ileum in the NF group were significantly lower than those in the C group (P < 0.05). At the secondary laying peak period, the jejunum V/C was significantly higher than that in the C group (P < 0.05), whereas in the duodenum and ileum it increased but not significantly (P > 0.05). (4) During the molting period, serum glutathione transaminase (AST) and glutathione alanine transaminase (ALT) activities were significantly higher (P < 0.05), and very low-density lipoprotein (VLDL) content and liver weight were significantly lower (P < 0.05) in the non-fasted and fasted groups. However, there was a low degree of liver injury (cell boundary still visible) in the NF group. At the secondary laying peak period, there was no significant difference (P > 0.05) in the indices among the three groups and the liver returned to normal. In summary, non-fasting molting can improve the production performance of laying hens in the later stages, ensure the welfare and health of animals, and provide a theoretical basis for the efficient production of laying hens.