The association between admission mean corpuscular volume and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study.

OBJECTIVE: This study evaluated the association between admission MCV and preoperative deep vein thrombosis (DVT) in geriatric hip fractures. METHODS: Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected at the largest trauma center in northwest China. MCV was measured at admission and converted into a categorical variable according to the quartile. Multivariate binary logistic regression and generalized additive model were used to identify the linear and nonlinear association between MCV and preoperative DVT. Analyses were performed using EmpowerStats and the R software. RESULTS: A total of 1840 patients who met the criteria were finally enrolled and divided into four groups according to their MCV levels. The mean MCV was 93.82 ± 6.49 (80.96 to 105.91 fL), and 587 patients (31.9%) were diagnosed with preoperative DVT. When MCV was a continuous variable, the incidence of preoperative DVT increased with mean corpuscular volume. In the fully adjusted model, admission MCV was positively correlated with the incidence of preoperative DVT (OR: 1.03; 95% CI: 1.01-1.05; P = 0.0013). After excluding the effect of other factors, each additional 1fL of MCV increased the prevalence of preoperative DVT by 1.03 times as a continuous variable. CONCLUSION: MCV was linearly associated with preoperative DVT in geriatric patients with hip fractures and could be considered a predictor of DVT risk. The MCV may contribute to risk assessment and preventing adverse outcomes in the elderly. STUDY REGISTRATION: This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323).

The Predictive Value of Serum NT-proBNP on One-Year All-Cause Mortality in Geriatrics Hip Fracture: A Cohort Study.

Objective This study evaluated the association between N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and one-year mortality in geriatric patients with intertrochanteric and femoral neck fractures receiving the operative treatment. Methods Consecutive age ≥65 years patients with hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics of the patients were collected. The multivariate logistic regression models were used to identify the association between preoperative NT-proBNP concentrations and mortality. All analyses were performed using EmpowerStats and the R software. Result One thousand two hundred nineteen patients were included in the study. The average age was 79.73±6.65 years (range 66-99 years). The mean NT-proBNP concentration was 616.09±1086.85 ng/L (median 313.40 ng/L, range 16.09-20123.00 ng/L). The follow-up was 35.39±15.09 months (median 35.78 months, range 0.10-80.14 months). One hundred and eleven (9.1%) patients died within one year. After adjusting for confounding factors, multivariate logistic regression models showed a curved association between preoperative NT-proBNP concentration and one-year mortality. When the NT-proBNP concentration was below 1099 ng/L, the mortality increased by 10% (OR=1.10, 95%CI: 1.03-1.17, P=0.0025) when NT-proBNP increased by 100 ng/L. When the NT-proBNP concentration was above 1099 ng/L, the mortality did not increase anymore when NT-proBNP increased (OR=1.00, 95%CI: 0.99-1.02, P=0. 7786). Thus, NT-proBNP was a valuable indicator to predict high one-year mortality in practice. Conclusion The NT-proBNP concentrations were nonlinearly associated with mortality in elderly hip fractures with a saturation effect, and NT-proBNP was a risk indicator of all-cause mortality. A well-designed controlled trial to show the role of mortality by decreasing the concentration of NT-proBNP is needed in the future.

Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training. METHODS: A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants' confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software. RESULTS: Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18-0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21-1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20-0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants' satisfaction and confidence demonstrated no significant benefit for HF simulation. CONCLUSIONS: Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient's outcomes.

Efficient nitrogen removal and robustness enhancement of a two-stage partial nitrification-anammox (PN/A) process with low sludge concentration for mature landfill leachate.

The biological treatment system for high-strength wastewater, particularly landfill leachate, typically requires high sludge concentration to maintain nitrogen removal performance. However, it frequently causes an excessive accumulation of toxins in microbial metabolism, resulting in unstable performance during long-term operation. An efficient two-stage partial nitrification/anammox (PN/A) mature landfill leachate process with low sludge concentration was constructed by settling time reduction and Ca2+ addition. The ammonia removal rate reached 46.7 mg N/(L·h) in PN-SBR. Nitrosomonas (2.0%) was the sole genus responsible for partial nitrification. The influent NO2--N/NH4+-N of A-SBR was kept at 1.39, leading to a dynamic equilibrium of anammox and denitrification. Ca. Brocadia recovered fastest (0.32% â†’ 1.8%) among the detected AnAOB genera. The process achieved NRE of 95.0% with effluent TIN of 37.6 mg/L (<40 mg/L). This research offered recommendations for the favorable operation of the two-stage PN/A mature landfill leachate treatment system with low sludge concentration.

Frequency Splitting of Chiral Phonons from Broken Time-Reversal Symmetry in CrI_{3}.

Conventional approaches for lattice dynamics based on static interatomic forces do not fully account for the effects of time-reversal-symmetry breaking in magnetic systems. Recent approaches to rectify this involve incorporating the first-order change in forces with atomic velocities under the assumption of adiabatic separation of electronic and nuclear degrees of freedom. In this Letter, we develop a first-principles method to calculate this velocity-force coupling in extended solids and show via the example of ferromagnetic CrI_{3} that, due to the slow dynamics of the spins in the system, the assumption of adiabatic separation can result in large errors for splittings of zone-center chiral modes. We demonstrate that an accurate description of the lattice dynamics requires treating magnons and phonons on the same footing.

Continuous plug-flow anammox system for mature landfill leachate treatment: Key zone for anammox pathway.

This study established the one-stage partial nitrification coupled anammox and partial denitrification coupled anammox process in an anoxic/oxic continuous plug-flow system and operated for 465 days to treat mature landfill leachate. 97.9 %-98.1 % of inorganic nitrogen was removed when the nitrogen loading rate was maintained at 0.33-0.36 kg N/m3/d, and a high anammox contribution to nitrogen removal (89.8 %-92.4 %) was achieved. The long-term in-situ free ammonia (FA) anoxic treatment contributed to the stable performances of partial nitrification and in-situ fermentation. The employed integrated fixed-film activated sludge technology favored the enrichment of hzsA, hzsB, hdh, amoA, hao, narG, and napA functional genes. The oxic zone, particularly oxic biofilm, was the key zone for anammox pathway, where Candidatus_Kuenenia (from 1.6 % to 8.3 %) with high tolerance to FA and salinity stress outcompeted Candidatus_Brocadia (from 18.3 % to 0.1 %) as the dominant anammox bacteria. This study could provide guidance for anammox-mediated landfill leachate treatment in practical projects.

Advanced nitrogen removal from mature landfill leachate based on novel step-draining partial nitrification-denitrification and Anammox process: Significance of low volume exchange ratio.

To save external carbon source dosage and simplify NH4+ to NO2- ratio control strategy, this study established a novel step-draining based partial nitrification-denitrification and Anammox (PND-AMX) system for advanced nitrogen removal from mature landfill leachate. Separation of partial nitrification and denitrification was realized based on step-draining, achieving 74.8 % nitrogen removal. 25 % was the optimal volume exchange ratio for synergistic removal of organics and nitrogen, allowing full use of carbon source. NH4+ to NO2- ratio was easily controlled by varying the volume ratio of the first and second effluent of PND reactor. Brocadia, Kuenenia and Jettenia collectively accounted for 13.61 % in AMX reactor, contributing 21.0 % of nitrogen removal. Nitrogen removal efficiency and nitrogen removal rate reached 98.3 ± 1.2 % and 3.07 ± 0.09 kgN/(m3∙d), respectively. Partial Anammox process based on step-draining was easier to realize and of practical significance for application in treatment of landfill leachate.

Case report: Cardiac metastatic leiomyoma in an Asian female.

Background: Uterine leiomyomas are the most common gynecological tumors in women of child-bearing age and premenopausal women, while benign metastasizing leiomyomas of the heart are rare. Case presentation: We report a rare case of metastasizing leiomyoma in the heart of a 54-year-old woman 10 years after a uterine leiomyoma was discovered during hysterectomy. Echocardiography, cardiac plain scan and enhanced MRI at presentation showed a soft tissue signal mass in the right ventricle. A large cardiac mass attached to the chordae of the tricuspid valve and later shown to be histopathologically consistent with uterine leiomyoma was successfully resected through a right atriotomy. Conclusions: Our case report highlights a rare type of tumor of the heart and suggests that metastasizing leiomyoma should be considered in the differential diagnosis of right-sided cardiac tumors. The complete surgical resection of the tumor was considered to be the best treatment.

Anammox-mediated municipal solid waste leachate treatment: A critical review.

Municipal solid waste (MSW) leachate treatment through the anaerobic ammonium oxidation (anammox) process has received increasing attention due to less oxygen consumption, carbon source demand, and sludge production. The recent advances in anammox-mediated MSW leachate treatment are systematically reviewed. During MSW leachate treatment, the anammox technology could be flexibly combined with partial nitrification, partial denitrification, fermentation, and methane oxidation. Additionally, this review comprehensively discussed the specific effects on anammox bacteria (AnAOB) of key stressors in MSW leachate such as dissolved organic matters, salinity, and antibiotics, and introduced the corresponding pretreatment methods. The key control strategies focusing on achieving effective AnAOB retention, amelioration of microenvironments, and stable nitrite source were summarized. Moreover, the potential for nitrous oxide emission mitigation in anammox-based MSW leachate treatment systems was evaluated. Finally, this review highlighted the full-scale applications of anammox-mediated MSW leachate treatment and proposed the prospects as well as research gaps in this field.

Evanescent Wave Optical-Fiber Aptasensor for Rapid Detection of Zearalenone in Corn with Unprecedented Sensitivity.

Zearalenone (ZEN) is a common mycotoxin pollutant found in agricultural products. Aptamers are attractive recognition biomolecules for the development of mycotoxin biosensors. Even though numerous aptasensors have been reported for the detection of ZEN in recent years, many of them suffer from problems including low sensitivity, low specificity, tedious experimental steps, high-cost, and difficulty of automation. We report here the first evanescent wave optical-fiber aptasensor for the detection of ZEN with unprecedented sensitivity, high specificity, low cost, and easy of automation. In our aptasensor, a 40-nt ZEN-specific aptamer (8Z31) is covalently immobilized on the fiber. The 17-nt fluorophore Cy5.5-labeled complementary DNA strand and ZEN competitively bind with the aptamer immobilized on the fiber, enabling the signal-off fluorescent detection of ZEN. The coating of Tween 80 enhanced both the sensitivity and the reproducibility of the aptasensor. The sensor was able to detect ZEN spiked-in the corn flour extract with a semilog linear detection range of 10 pM-10 nM and a limit of detection (LOD, S/N = 3) of 18.4 ± 4.0 pM (equivalent to 29.3 ± 6.4 ng/kg). The LOD is more than 1000-fold lower than the maximum ZEN residue limits set by China (60 µg/kg) and EU (20 µg/kg). The sensor also has extremely high specificity and showed negligible cross-reactivity to other common mycotoxins. In addition, the sensor was able to be regenerated for 28 times, further decreasing its cost. Our sensor holds great potential for practical applications according to its multiple compelling features.

Near-Field Modulation of Differently Oriented Single Photon Emitters with A Plasmonic Probe.

Single photon emitters (SPEs) are critical components of photon-based quantum technology. Recently, the interaction between surface plasmons and emitters has attracted increasing attention because of its potential to improve the quality of single-photon sources through stronger light-matter interactions. In this work, we use a hybrid plasmonic probe composed of a fiber taper and silver nanowire to controllably modulate the radiation properties of SPEs with differently oriented polarization. For out-of-plane oriented SPEs such as single CdSe quantum dots, the radiation lifetime could be reduced by a factor as large as seven; for in-plane oriented SPEs such as hBN defect SPEs, the average modulation amplitude varied from 0.69 to 1.23, depending on the position of the probe. The experimental results were highly consistent with the simulations and theory. This work provides an efficient approach for optimizing the properties of SPEs for quantum photonic integration.

Systematic review and meta-analysis of imaging differential diagnosis of benign and malignant ovarian tumors.

Background: With the increasing incidence of gynecological ovarian tumors, the differential diagnosis of benign and malignant ovarian tumors is of great significance for subsequent treatment. Currently, ovarian examinations commonly use computed tomography (CT) or magnetic resonance imaging (MRI). This study sought to compare the value of CT and MRI in differentiating between benign and malignant ovarian tumors. Methods: The PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and Weipu databases were searched for published articles using the following terms "CT" or "Computed Tomography" or "MRI" or "Magnetic Resonance imaging" and "ovarian cancer" or "ovarian tumor" or "ovarian neoplasm" or "adnexal mass" or "adnexal lesion". The articles were screened and the data were extracted based on the inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and the network meta-analysis was performed by Stata 15.0. Results: The results showed that the overall sensitivity and specificity of CT were 0.79 [95% confidence intervals (CI): 0.70-0.87] and 0.87 (95% CI: 0.80-0.92), respectively. The overall sensitivity and specificity of MRI were 0.94 (95% CI: 0.91-0.95) and 0.91 (95% CI: 0.90-0.93), respectively. The area under the curve of the CT and MRI summary receiver operating characteristics were 0.9016 and 0.9764, respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CT were 5.26 (95% CI: 2.78-9.93), 0.26 (95% CI: 0.13-0.50), and 22.19 (95% CI: 7.54-65.30), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of MRI were 8.69 (95% CI: 5.06-14.92), 0.07 (95% CI: 0.04-0.13), and 146.19 (95% CI: 68.88-310.24), respectively. Conclusions: Compared to CT, MRI has a stronger ability to differentiate between benign and malignant ovarian tumors. It's a promising non-radiological imaging technique and a more favorable choice for patients with ovarian tumors. However, in the future, large-sample, multi-center prospective studies need to be conducted to compare the performance of MRI and CT in distinguishing between benign and malignant ovarian tumors.

Efficient nitrogen removal from mature landfill leachate in a step feed continuous plug-flow system based on one-stage anammox process.

A continuous plug-flow multistage anoxic/oxic (A/O) system based on one-stage partial nitrification coupled anammox (PNA) process with integrated fixed-film activated sludge (IFAS) was established and operated over 400 days. A step feed strategy effectively controlled free ammonia concentration and alleviated impacts on ammonia oxidizing bacteria (AOB) and anammox bacteria (AnAOB). During day 301-405, 98.1% of total inorganic nitrogen was removed from mature landfill leachate, whereas chemical oxygen demand (COD) removal efficiency was 52.9%. With the enrichment of AnAOB in oxic biofilm, nitrogen removal via the anammox pathway reached 94.3%-95.0%. During system operation, the dominant anammox genus shifted from Candidatus_Brocadia to Candidatus_Kuenenia. Fluorescent in situ hybridization (FISH) indicated AnAOB encapsulated by AOB colonies were mainly distributed inside of the biofilm, which promoted nitrite utilization by the anammox process. This innovative system and the results are of great value to practical applications.

An Innovative Process for Mature Landfill Leachate and Waste Activated Sludge Simultaneous Treatment Based on Partial Nitrification, In Situ Fermentation, and Anammox (PNFA).

An innovative partial nitrification, in situ fermentation, and Anammox (PNFA) system was developed to achieve mature landfill leachate and waste activated sludge simultaneous treatment. Three separate sequencing batch reactors (SBRs) were used for partial nitrification (PN-SBR), integrated fermentation-denitrification (IFD-SBR), and partial nitrification-Anammox (PNA-SBR). After 200 days of continuous operation, a satisfactory nitrogen removal efficiency (NRE) of 99.2 ± 0.1% was obtained, with an effluent total nitrogen (TN) of 15.2 ± 3.2 mg/L. In IFD-SBR, the volatile fatty acids generated from fermentation drove efficient denitrification, obtaining sludge and nitrogen reduction rates of 4.2 ± 0.7 and 0.61 ± 0.04 kg/m3·day, respectively. Furthermore, unwanted fermentation metabolites (134.1 mg/L NH4+-N) were further treated by PNA-SBR using a combination of step-feed and intermittent aeration strategies. In PNA-SBR, Anammox significantly contributed to 82.1% nitrogen removal, and Anammox bacteria (Candidatus Brocadia, 2.3%) mutually benefited with partially denitrifying microorganisms (Thauera, 4.2%), with 66.3% of generated nitrate reduced to nitrite and then reutilized in situ by Anammox. Compared with the conventional nitrification-denitrification process, PNFA reduced oxygen energy consumption, external carbon source dosage, and CO2 emission by 21.3, 100, and 38.9%, respectively, and obtained 50.1% external WAS reduction efficiency.

Shortened and multivalent aptamers for ultrasensitive and rapid detection of alternariol in wheat using optical waveguide sensors.

Alternariol (AOH) is one of the common mycotoxins existing in a variety of foods at low level. Aptamers hold great promise for the development of sensitive and rapid aptasensors, but suffer from the excessive length and the difficulty in identification of critical binding domains (CBDs). In this study, the 5 nt CBD of the original 59-nt AOH aptamer (AOH-59, KD = 423 nM) was identified to be a 'C' bulge in between two A-T base pairs. AOH-59 was successfully shortened to a 23 nt aptamer (AOH 6C, KD = 701 nM). A 30 nt bivalent aptamer B-2-3 (KD = 445 nM) and a 39 nt trivalent aptamer T-2-3 (KD = 274 nM) were obtained by simply incorporating one or two CBDs into AOH 6C. The AOH 6C-, B-2-3-, and T-2-3-based optical waveguide aptasensors possessed the unprecedented detection of limits (LODs, S/N = 3) of 42 ± 3, 6 ± 1 and 2 ± 1 fM, respectively. Using the AOH 6C-based sensor as an example, we further demonstrated the detection of AOH spiked in wheat powder with a LOD of 37 pg/g, 20-230-fold lower than those achieved by ELISAs. The sensor was capable for 35 times 2-min regeneration and the assay time including the extraction of AOH from wheat was only about 1 h. We not only devised the first aptasensors for AOH detection, but also provided a simple strategy to design multivalent aptamers for small molecule targets.

[Extraperitoneal robot-assisted laparoscopic radical prostatectomy through single incision: Establishment and application of a modified channel].

Objective: To assess the feasibility and validity of the establishment of a modified channel for extraperitoneal robot-assisted laparoscopic radical prostatectomy (RARP) through single incision. METHODS: From November 2020 to January 2021, 35 cases of localized PCa were treated by extraperitoneal RARP through single incision in our center. All the operations were performed by the same surgeon, none via the multichannel port for the establishment of the channel. We recorded and analyzed the intra- and postoperative parameters, operation cost, complications, pathological findings and follow-up data. RESULTS: All the operations were successfully completed, without conversion to open surgery or additional channels, or serious postoperative complications, the time for establishing the extraperitoneal space averaging 25.4 (20.0－45.0) min, the operation time 67.3 (35.0－125.0) min, intraoperative blood loss 75.5 (60.0－150.0) ml, time to first postoperative anal exhaust 26 (8－48) h, and postoperative hospital stay 7.89 (7－10) d. Postoperative pathology showed adenocarcinoma in all the cases, with Gleason score (GS) 3+3 in 9 (25.7%), GS 3+4 in 9 (25.7%), GS 4+3 in 8 (22.9%), and GS ≥ 8 in 9 (25.7%) of the cases, 23 (65.7%) in the

Stable nitritation of mature landfill leachate via in-situ selective inhibition by free nitrous acid.

In-situ free nitrous acid (FNA) and free ammonia (FA) treatments are more feasible than side-stream methods to achieve nitritation. To assess the optimum conditions and long-term performance of in-situ inhibition by FNA, batch tests and a sequencing batch reactor (SBR) treating mature landfill leachate were conducted and established. As a result, the selective inhibition characteristic by FNA was more conspicuous than FA, and FNA (0.175 mg N/L, 6 h) treatment are more biocidal to nitrite oxidizing bacteria (NOB). Moreover, ammonia oxidizing bacteria (AOB) were more sensitive to the FA environment but its activity recovered preferentially compared to NOB. The SBR achieved a sustained nitrite accumulation rate above 90% for 200 days, with a significant decrease of NOB activity and microbial abundance according to qPCR and 16S rRNA gene sequencing results. In-situ selective inhibition by FNA (0.175 mg N/L, 6 h) has been proved to be effective to maintain stable nitritation.

Achieving synergetic treatment of sludge supernatant, waste activated sludge and secondary effluent for wastewater treatment plants (WWTPs) sustainable development.

A novel process that combines partial nitrification, fermentation and Anammox-partial denitrification (NFAD) was proposed to co-treat ammonia rich sludge supernatant (NH4+-N = 1194.1 mg/L), external WAS (MLSS = 22092.6 mg/L) and WWTP secondary effluent (NO3--N = 58.6 mg/L). Three separated reactors were used for partial nitrification (PN-SBR), integrated fermentation and denitrification (IFD-SBR) and combined Anammox-partial denitrification (AD-UASB), respectively. The process resulted in excellent nitrogen removal efficiency (NRE) of 98.7%, external sludge reduction efficiency (SRE) of 44.6% and external sludge reduction rate of 4.1 kg/m3 after 200 days of continuous operation. IFD-SBR and AD-UASB contributed towards 89.4% and 9.2% nitrogen removal, respectively. In AD-UASB, cooperation between Anammox bacteria (4.1% Candidatus Brocadia) and partial denitrifying bacteria (3.2% Thauera) resulted in significant stability of Anammox pathway, which contributed up to 84.1% nitrogen removal in the combined Anammox-partial denitrification process. NFAD saved up to 100% organic resource demand and 25% of aeration consumption compared with the traditional nitrification-denitrification process.