RESUMO
Background: The increasing incidence and high mortality rate of Candida glabrata infection in ICU patients is an important issue. Therefore, it is imperative to investigate the antifungal susceptibility profiles and epidemiological characteristics in local regions. Methods: Herein, antifungal susceptibility testing was conducted to determine the minimum inhibitory concentrations (MICs) of eight antifungal drugs. Multilocus sequence typing (MLST) was used to study the strain genotype, geographical distribution, and susceptibility to antifungal agents among C. glabrata isolates. The mechanism of echinocandin resistance was explored by sequencing the FKS1 and FKS2 genes (encoding 1,3-ß-D-glucan synthases) of echinocandin-resistant C. glabrata strains. Moreover, we further investigated the clinical manifestations and the various risk factors of patients infected with C. glabrata in the ICU. Results: We selected 234 C. glabrata isolates from 234 patients in the ICU randomly for the follow-up study. Cross-resistance was found among the ICU C. glabrata isolates. Analysis using MLST showed that the genetic diversity among the C. glabrata isolates was low. Furthermore, sequence type showed no correlation with the antifungal resistance profiles, but was associated with geographical distribution. We also revealed novel mutations in FKS1 (S629P) and FKS2 (W1497stop) that mediated high-level echinocandin resistance (MIC >8 µg/mL). More than 14 days' stay in ICU (P=0.007), Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (P=0.024), prior antifungal exposure (P=0.039) and lung disease (P=0.036) were significantly associated with antifungal resistant/non-wild-type C. glabrata infection. Conclusion: Our study shed light on the antifungal susceptibility, molecular epidemiology, and clinical risk factors of C. glabrata in the ICU of a Chinese Tertiary Hospital. Importantly, we revealed the molecular mechanism of echinocandin resistance. These results highlight the significance of continued surveillance in ICUs and provide data support for the treatment of C. glabrata in clinics.
Assuntos
Antifúngicos , Candida glabrata , Candidíase , Farmacorresistência Fúngica , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Centros de Atenção Terciária , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antifúngicos/farmacologia , Candida glabrata/genética , Candida glabrata/efeitos dos fármacos , Candidíase/microbiologia , Candidíase/epidemiologia , China/epidemiologia , Farmacorresistência Fúngica/genética , Equinocandinas/farmacologia , Proteínas Fúngicas/genética , Variação Genética , Genótipo , Glucosiltransferases/genética , Mutação , Fatores de RiscoRESUMO
The growing global interest in preventing and controlling fires in high-rise buildings reflects the increasing significance of this issue today. This research aims to establish an early warning framework for fire risk in high-rise buildings. Firstly, considering the importance of a scientific indicator system for the application of the model, this study combines the event analysis method with the building design fire code to identify 11 key risk factors that have a far-reaching impact on the prevention of fires in high-rise buildings. Based on identifying the risk factors, a high-rise building fire risk warning tree is also established, which scientifically solves the problem of the indicator system of the warning object. Subsequently, in response to the various complex issues arising from the uncertainty of fire occurrence in high-rise buildings, this study adopts the unascertained method to model the fire risk of high-rise buildings for early warning. In addition, the developed methodology was empirically validated through case studies and analyses of empirical data on fire risks in nine representative high-rise buildings. The results of the unascertained method were also compared with the results of the K-means method, from which it was concluded that the unascertained method can predict building fires more accurately. The research results provide a reliable decision support system for fire disaster prevention and control in high-rise buildings.
Assuntos
Incêndios , Incêndios/prevenção & controle , Medição de Risco , Fatores de Risco , Modelos TeóricosRESUMO
As an important potential dust suppression method, the slow onset time is one of the key factors that restrict the effect of microbial dust suppressant. In the early stage, we have confirmed that extracellular polymeric substances (EPS) can improve the dust suppression effect by wetting coal dust and increasing Ca2+ nucleation sites. Therefore, in this study, chitosan (CTS) and bovine serum albumin (BSA) in different ratios (CTS: BSA = 1:1, 1:2, 2:1) as model molecules of EPS were combined with Bacillus subtilis to prepare efficient and fast microbial dust suppressants. Furthermore, the interaction forces were analyzed through molecular dynamics simulation. Results showed that adding CTS and BSA would improve the dust suppression effect, and the dust suppression effect was the best when the ratio of CTS: BSA was 1:2. In addition, the contact angle decreased as the BSA content increased. The Fourier transform infrared spectroscopy (FTIR) results showed that when the ratio of CTS to BSA was 1:2, the dust suppressants were easier to interact with coal dust by the key functional groups and form calcite type CaCO3. The molecular dynamics simulation results showed that the main interaction was Van der Waals force. In addition, the interaction force was strongest when CTS: BSA was 1:2, increasing by 137% compared with the microbial dust suppressants without CTS or BSA. This study provides theoretical support for the development of efficient and rapid microbial dust suppressants.
RESUMO
Hypertension is prevalent in e-waste recycling areas, and elevated blood pressure in children significantly increases the risk of hypertension in adulthood. However, the associations and toxic pathways between chronic exposure to metal(loids) and elevated blood pressure are rarely investigated. In this study, we measured the levels of 29 hair metal(loids) (chronic exposure biomarkers) and blood pressure in 667 susceptible children from an e-waste recycling area to explore their relationships. Paired urine metabolomics analysis was also performed to interpret potential mechanistic pathways. Results showed that the hypertension prevalence in our recruited children (13.0 %) exceeded the average rate (9.5 %) for Chinese children aged 6-17 years. The top five abundant metal(loids), including lead, strontium, barium, and zinc, demonstrated the most profound associations with elevated systolic blood pressure. Quantile g-computation, weighted quantile sum, and Bayesian kernel machine regression analysis jointly demonstrated a significant association between chronic exposure to metal(loids) mixture and systolic blood pressure. Interestingly, selenium showed significant antagonistic interactions with these four metals, suggesting that supplementing selenium may help children resist the elevated blood pressure induced by metal(loids) exposure. Increased metal(loids) and blood pressure levels were significantly linked to changes in urine metabolomics. Structural equation model indicated that androsterone glucuronide and N-Acetyl-1-aspartylglutamic acid were the significant mediators of the associations between metal(loids) and blood pressure, with mediation effects of 77.4 % and 29.0 %, respectively, suggesting that androsterone glucuronide and N-Acetyl-1-aspartylglutamic acid may be involved in the development of metal-induced blood pressure elevating effect. Girls were more vulnerable to metal(loids)-induced hormonal imbalance, especially androsterone glucuronide, than boys. Chronic exposure to metal(loids) at e-waste recycling sites may contribute to elevated blood pressure in children through disrupting various metabolism pathways, particularly hormonal balance. Our study provides new insights into potential mechanistic pathways of metal(loids)-induced changes in children's blood pressure.
RESUMO
PURPOSE: To investigate the differences in survival after venous thromboembolism (VTE) and anticoagulation efficacy and safety between catheter (CRVTE) and non-catheter-related VTE (NCRVTE) in cancer patients. METHODS: A retrospective research was conducted, and consecutive cancer (digestive, respiratory, genitourinary, blood and lymphatic, and the other cancers) patients with VTE were enrolled. The anticoagulation therapies included low-molecular-weight heparin (LMWH), warfarin, new type of direct oral anticoagulants (NDOACs), LMWH combined with warfarin, and LMWH combined with NDOACs. Data were collected from the electronic medical record database of our hospital and were analyzed accordingly by Kruskal-Wallis H Test, Chi-square test, Fisher's exact test, Logistic regressions, Kaplan-Meier analysis, and Cox regressions. RESULTS: 263 patients were included, median age in years (interquartile range) was 64(56-71) and 60.5% were male. VTE recurrence rate was 16.7% in CRVTE group which was significantly lower than 34.8% in NCRVTE group (P = .032). Heart diseases were independently associated with VTE recurrence (P = .025). Kaplan-Meier survival estimates at 1, 2, and 3 years for CRVTE group were 62.5%, 60.0%, and 47.5%, respectively, compared with 47.9% (P = .130), 38.7% (P = .028), and 30.1% (P = .046), respectively, for NCRVTE group. Cox regression showed surgery (P = .003), anticoagulation therapy types (P = .009), VTE types (P = .006) and cancer types (P = .039) were independent prognostic factors for 3-year survival after VTE. Nonmajor and major bleeding were not significantly different (P = .417). Anticoagulation therapy types were independently associated with the bleeding events (P = .030). CONCLUSIONS: Cancer patients with CRVTE potentially have a better anticoagulation efficacy and survival compared to NCRVTE, and the anticoagulation safety seems no significant difference.
Assuntos
Anticoagulantes , Neoplasias , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade , Neoplasias/complicações , Neoplasias/mortalidade , Neoplasias/tratamento farmacológico , Masculino , Feminino , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Objective: To analyze the effectiveness of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humerus fracture. Methods: A clinical data of 28 patients with fresh proximal humerus fractures, who met the selection criteria and admitted between June 2014 and April 2022, was retrospectively analyzed. There were 7 males and 21 females. Age ranged from 65 to 81 years, with an average of 73.8 years. The causes of injury were 21 cases of fall, 6 cases of traffic accident, and 1 case of falling from height. The time from injury to operation ranged from 5 to 20 days with an average of 9.2 days. There were 8 cases of Neer three-part fracture and 20 cases of four-part fracture. The reverse total shoulder arthroplasty was performed, and the greater and lesser tuberosities were sutered and reconstructed with autogenous bone grafting. After operation, the Constant score, American Society for Shoulder Surgery (ASES) score, and visual analogue scale (VAS) score were used to evaluate shoulder function and pain; and the active range of motion of the shoulder joint was recorded, including flexion, external rotation, and internal rotation. X-ray films were taken to observe the position of prosthesis. According to the evaluation criteria proposed by Boileau, the healing of greater tuberosity was evaluated, and the effectiveness was compared between the patients with healed and non-healed (displacement and absorption) greater tuberosity. Results: All incisions healed by first intention after operation. All patients were followed up 24-106 months, with an average of 60.9 months. At last follow-up, the VAS score of shoulder joint ranged from 0 to 6 (mean, 1.1). The Constant score ranged from 45 to 100 (mean, 80.1). The ASES score ranged from 57 to 100 (mean, 84.7). The active range of motions of shoulder joint were 60°-160° (mean, 118°) in flexion, 0°-50° (mean, 30°) in external rotation, and corresponding to reaching the S 5-T 8 vertebral body level in internal rotation. During follow-up, no shoulder joint re-dislocation or severe shoulder instability occurred, and no revision surgery was performed. X-ray film reexamination showed that there was no loosening of the prosthesis. According to the evaluation criteria proposed by Boileau, the greater tuberosity fused in 22 cases (78.6%), displaced in 3 cases (10.7%), and absorbed in 3 cases (10.7%). The shoulder joint function and pain related evaluation indicators in the healed group were significantly better than those in the non-healed group ( P<0.05). Conclusion: Tuberosity suture combined with autogenous bone grafting is a relatively simple procedure that provides a reliable fixation for the anatomic recovery of greater and lesser tuberosities and is beneficial for the recovery of shoulder function in elderly patients with proximal humeral fractures.
Assuntos
Artroplastia do Ombro , Transplante Ósseo , Amplitude de Movimento Articular , Fraturas do Ombro , Articulação do Ombro , Humanos , Masculino , Feminino , Idoso , Artroplastia do Ombro/métodos , Fraturas do Ombro/cirurgia , Transplante Ósseo/métodos , Articulação do Ombro/cirurgia , Idoso de 80 Anos ou mais , Transplante Autólogo , Resultado do Tratamento , Suturas , Úmero/cirurgia , Técnicas de SuturaRESUMO
BACKGROUND: Oxidative Balance Scores (OBS) is composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle. Evidence on OBS and cardiovascular disease (CVD) in diabetic patients is scarce. This study investigates the potential association between OBS and CVD-prevalence and all-cause and CVD-related mortality in adult diabetic patients. METHODS: Participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. OBS-related data collection was initiated by linking the National Death Index to determine mortality due to all-cause and cardiovascular disease until December 31, 2019. Weighted logistic regression analyses explored the relationship between OBS and CVD. In addition, multivariable Cox proportional risk regression models and Kaplan-Meier curves were used to determine the correlation between OBS and mortality, with time to event as the time variable, as well as to estimate hazard ratios (HR) and 95% confidence interval (CI). RESULTS: A total of 3491 participants were included in the final analysis. Weighted logistic regression analysis of the relationship between OBS and CVD prevalence found that higher OBS was not associated with CVD prevalence compared with lower levels after fully adjustment in model 3 (OR: 0.82, 95% CI: 0.51-1.31, P = 0.39). During 3,491 person-years of follow-up, 408 deaths were recorded, of which 105 deaths were attributed to CVD. In fully adjusted model 3, participants in the highest quartile of OBS had significant reductions in all-cause mortality of 53% [HR: 0.47, 95% CI: 0.29-0.77), Ptrend= 0.002] and in cardiovascular disease mortality of 78% [HR: 0.22, 95% CI: 0.08-0.56), Ptrend= 0.004], compared with the lowest quartile groups of OBS. The Kaplan-Meier analysis results showed that participants in the highest quartile of OBS had the lowest risk of all-cause and CVD-related mortality and were statistically different (P < 0.05). Subgroup analysis confirmed that P for interaction was significant only concerning the educational level attained and in individuals with a history of CKD (P < 0.05). CONCLUSIONS: Although OBS wasn't very useful for assessing CVD prevalence outcomes, higher OBS was significantly associated with lower all-cause and CVD-related mortality, suggesting that maintaining adequate OBS may reduce mortality in patients with DM.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Inquéritos Nutricionais , Humanos , Doenças Cardiovasculares/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/mortalidade , Adulto , Idoso , Causas de Morte , Estresse Oxidativo , Estados Unidos/epidemiologia , PrevalênciaRESUMO
While a large body of work in sentence comprehension has explored how different types of linguistic information are used to guide syntactic parsing, less is known about the effect of discourse structure. This study investigates this question, focusing on the main and subordinate discourse contrast manifested in the distinction between restrictive relative clauses (RRCs) and appositive relative clauses (ARCs) in American English. In three self-paced reading experiments, we examined whether both RRCs and ARCs interfere with the matrix clause content and give rise to the agreement attraction effect. While the standard attraction effect was consistently observed in the baseline RRC structures, the effect varied in the ARC structures. These results collectively suggest that discourse structure indeed constrains syntactic dependency resolution. Most importantly, we argue that what is at stake is not the static discourse structure properties at the global sentence level. Instead, attention should be given to the incremental update of the discourse structure in terms of which discourse questions are active at any given moment of a discourse. The current findings have implications for understanding the way discourse structure, specifically the active state of discourse questions, constrains memory retrieval.
Assuntos
Compreensão , Idioma , Leitura , Humanos , Linguística , Psicolinguística , Feminino , Masculino , AdultoRESUMO
PURPOSE: Arthroscopic Bankart repair combined with remplissage and autologous scapular spine bone grafting have been described as a treatment for off-track Hill-Sachs lesions with subcritical glenoid bone defects in the anterior shoulder instability. However, whether these two techniques can achieve satisfactory postoperative outcomes is unclear, and there are few comparative studies between them. Therefore, this study compared the postoperative efficacy of the two techniques for off-track Hill-Sachs lesions with subcritical glenoid bone loss. METHOD: Between June 2017 and December 2020, 62 patients with shoulder instability due to Off-Track Hill-Sachs lesions with subcritical glenoid bone loss underwent surgical treatment and were included in this regression study. Thirty-two patients underwent arthroscopic Bankart repair combined with remplissage (B + R group), and 30 patients underwent additional autologous scapular glenoid bone grafting (additional bone grafting group). The general information of the patients was recorded. The patient's activity before and after surgery was recorded. The DASH score and Constant-Murley (CM) score were used to assess the patient's functional status; the Rowe score was used to evaluate the patient's shoulder stability. The shoulder function and stability before and after surgery were analyzed and compared between the two groups. RESULTS: The final DASH scores of the B + R group and the additional bone grafting group were significantly lower than those before surgery, with a statistically significant difference (9.76 ± 4.32 vs. 27.89 ± 6.63, 8.50 ± 3.32 vs. 28.0 ± 4.27, p = 0.000); the final CM scores of the two groups were significantly higher than those before surgery (88.71 ± 3.74 vs. 73.68 ± 3.74, 87.16 ± 2.29 vs. 71.37 ± 2.68, p = 0.000). There was no statistical difference in the final DASH score and final CM score between the two groups (p > 0.05). In terms of postoperative stability, the final Rowe scores of the two groups were significantly higher than those before surgery, with a statistically significant difference (89.06 ± 9.19 vs. 41.71 ± 4.13; 93.16 ± 4.99 vs. 42.33 ± 2.53, p = 0.000). Compared with the control group, the additional bone graft group achieved higher final Rowe scores (93.16 ± 4.99 vs. 89.06 ± 9.19, p = 0.032). CONCLUSION: For patients with anterior shoulder instability due to off-track Hill-Sachs lesions with subcritical glenoid bone loss, although Bankart and remplissage can achieve satisfactory clinical results, additional autogenous scapular spine bone grafting can provide better stability of the shoulder, especially for patients with high sports demands.
Assuntos
Artroscopia , Lesões de Bankart , Transplante Ósseo , Instabilidade Articular , Escápula , Humanos , Transplante Ósseo/métodos , Masculino , Feminino , Escápula/cirurgia , Lesões de Bankart/cirurgia , Adulto , Instabilidade Articular/cirurgia , Artroscopia/métodos , Adulto Jovem , Adolescente , Articulação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Pessoa de Meia-Idade , Cavidade Glenoide/cirurgiaRESUMO
Li-rich layered oxides are promising candidates for high-capacity Li-ion battery cathode materials. In this study, we employ first-principles calculations to investigate the effect of F doping on Li-rich Li2MnO3 layered cathode materials. Our findings reveal that both Li2MnO3 and Li2MnO2.75F0.25 exhibit significant volume changes (greater than 10%) during deep delithiation, which could hinder the cycling of more Li ions from these two materials. For Li2MnO3, it is observed that oxygen ions lose electrons to compensate for charge during the delithiation process, leading to a relatively high voltage plateau. After F doping, oxidation occurs in both the cationic (Mn) and anionic (O) components, resulting in a lower voltage plateau at the beginning of the charge, which can be attributed to the oxidation of Mn3+ to Mn4+. Additionally, F doping can somewhat suppress the release of oxygen in Li2MnO3, improving the stability of anionic oxidation. However, the increase of the activation barriers for Li diffusion can be observed after F doping, due to stronger electrostatic interactions between F- and Li+, which adversely affects the cycling kinetics of Li2MnO2.75F0.25. This study enhances our understanding of the impact of F doping in Li2MnO3 based on theoretical calculations.
RESUMO
BACKGROUND: We aimed to explore the differences and relationships in body composition, social function, and comorbidities between children with attention-deficit/hyperactivity disorder (ADHD) and subthreshold ADHD. METHODS: A case-control study was conducted to analyze the differences between children with ADHD and subthreshold ADHD. Logistic regression models were used to analyze the factors influencing social functional impairments and comorbidities. RESULTS: Children with ADHD and subthreshold ADHD had a higher fat mass index than healthy children (p < 0.05). The scores of all six social functional domains were higher in the subthreshold ADHD and ADHD groups than in the control group (p < 0.05). The prevalence of comorbidity was higher in children with subthreshold ADHD and ADHD compared to the control group (p < 0.05). Inattention and comorbid anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), whereas a higher fat-free mass index reduced the risk. The severity of hyperactivity was associated with a higher risk of comorbidity in children with ADHD (full syndrome/subthreshold). CONCLUSION: Children with subthreshold ADHD and ADHD had more fat mass and higher rates of social functional impairments and comorbidities than healthy children. There were clinical correlations between body composition, social functional impairments, and comorbidities in ADHD. IMPACT: 1. Children with subthreshold ADHD and ADHD had higher fat mass levels than normal children. 2. The social function impairments and comorbidities of children with subthreshold ADHD were similar to those with ADHD. 3. Inattentiveness and anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), while a higher fat-free mass index and skeletal muscle-to-body fat ratio reduced the risk.
RESUMO
The mechanism by which aging induces aortic aneurysm and dissection (AAD) remains unclear. A total of 430 participants were recruited for the screening of differentially expressed plasma microRNAs (miRNAs). We found that miR-1204 is significantly increased in both the plasma and aorta of elder patients with AAD and is positively correlated with age. Cell senescence induces the expression of miR-1204 through p53 interaction with plasmacytoma variant translocation 1, and miR-1204 induces vascular smooth muscle cell (VSMC) senescence to form a positive feedback loop. Furthermore, miR-1204 aggravates angiotensin II-induced AAD formation, and inhibition of miR-1204 attenuates ß-aminopropionitrile monofumarate-induced AAD development in mice. Mechanistically, miR-1204 directly targets myosin light chain kinase (MYLK), leading to the acquisition of a senescence-associated secretory phenotype (SASP) by VSMCs and loss of their contractile phenotype. MYLK overexpression reverses miR-1204-induced VSMC senescence, SASP and contractile phenotypic changes, and the decrease of transforming growth factor-ß signaling pathway. Our findings suggest that aging aggravates AAD via the miR-1204-MYLK signaling axis.
Assuntos
Envelhecimento , Aneurisma Aórtico , Dissecção Aórtica , Senescência Celular , MicroRNAs , Músculo Liso Vascular , Quinase de Cadeia Leve de Miosina , Transdução de Sinais , Animais , Feminino , Humanos , Masculino , Camundongos , Envelhecimento/genética , Envelhecimento/metabolismo , Angiotensina II/metabolismo , Aneurisma Aórtico/metabolismo , Aneurisma Aórtico/genética , Aneurisma Aórtico/patologia , Dissecção Aórtica/metabolismo , Dissecção Aórtica/genética , Dissecção Aórtica/patologia , Proteínas de Ligação ao Cálcio , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , MicroRNAs/genética , MicroRNAs/metabolismo , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/metabolismo , Quinase de Cadeia Leve de Miosina/metabolismo , Quinase de Cadeia Leve de Miosina/genética , Fator de Crescimento Transformador beta/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Proteína Supressora de Tumor p53/genéticaRESUMO
BACKGROUND: The incidence and mortality of lung cancer have increased annually. Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis. Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer. Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years. AIM: To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions. METHODS: We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People's Hospital. The patients were randomly divided into two groups: The CEUS-guided before lesion puncture group (contrast group) and conventional ultrasound-guided group (control group). Analyze the diagnostic efficacy of the puncture biopsy, impact of tumor size, and number of puncture needles and complications were analyzed and compared between the two groups. RESULTS: Accurate pathological results were obtained for 92.83% (220/237) of peripheral lung lesions during the first biopsy, with an accuracy rate of 95.8% (113/118) in the contrast group and 89.9% (107/119) in the control group. The difference in the area under the curve (AUC) between the contrast and the control groups was not statistically significant (0.952 vs 0.902, respectively; P > 0.05). However, when the lesion diameter ≥ 5 cm, the diagnostic AUC of the contrast group was higher than that of the control group (0.952 vs 0.902, respectively; P < 0.05). In addition, the average number of puncture needles in the contrast group was lower than that in the control group (2.58 ± 0.53 vs 2.90 ± 0.56, respectively; P < 0.05). CONCLUSION: CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions, especially for lesions with a diameter ≥ 5 cm. Therefore, CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.
RESUMO
BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).
Assuntos
Anestésicos Inalatórios , Anestésicos Intravenosos , Procedimentos Cirúrgicos Cardíacos , Desflurano , Complicações Pós-Operatórias , Propofol , Humanos , Propofol/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Anestésicos Intravenosos/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Idoso , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Adulto , Sevoflurano/efeitos adversos , Anestesia Intravenosa/métodos , China/epidemiologia , Tempo de Internação/estatística & dados numéricos , Anestesia por Inalação/métodos , Anestesia por Inalação/efeitos adversos , Resultado do TratamentoRESUMO
The microscopic stress field inhomogeneity in the interfacial region adjacent to the liquid surface is the fundamental origin of the liquid surface tension, but because of broadening due to capillary fluctuations, a detailed molecular level understanding of the stress field remains elusive. In this work, we deconvolute the capillary fluctuations to reveal the intrinsic stress field and show that the atomic-level contributions to the surface tension are similar in functional form across a variety of monatomic systems. These contributions are confined to an interfacial region approximately 1.5±0.1 times the particle diameter for all systems studied. In addition, the intrinsic density and stress profiles show a strong spatial correlation that should be useful in the development of a statistical mechanical theory for the prediction of surface stress and surface tension.
RESUMO
To address the epidemic, such as COVID-19, the government may implement the home quarantine policy for the infected residents. The logistics company is required to control the risk of epidemic spreading while delivering goods to residents. In this case, the logistics company often uses vehicles and unmanned aerial vehicles (UAVs) for delivery. This paper studies the distribution issue of cold chain logistics by integrating UAV logistics with epidemic risk management innovatively. At first, a "vehicle-UAV" joint distribution mode including vehicles, small UAVs and large UAVs, is proposed. The green cost for vehicles and UAVs is calculated, respectively. The formula for infection risk due to large numbers of residents gathering at distribution centers to pick up goods is then derived. Furthermore, based on the control of infection risk, an optimization model is developed to minimize the total logistics cost. A modified ant colony algorithm is designed to solve the model. The numerical results show that the maximum acceptable risk and the crowd management level of distribution centers both have significant effects on the distribution network, logistics cost and number of new infections. Our study provides a new management method and technical idea for ensuring the needs of residents during the epidemic.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/economia , COVID-19/transmissão , Algoritmos , Quarentena/economia , Dispositivos Aéreos não Tripulados , SARS-CoV-2 , Epidemias/prevenção & controle , Epidemias/economia , Gestão de Riscos/métodosRESUMO
Ganoderic acids (GAs) are major functional components of Ganoderma lucidum. The study aimed to breed a new G. lucidum strain with increased contents of individual GAs. Two mating-compatible monokaryotic strains, G. 260125 and G. 260124, were successfully isolated from the dikaryotic G. lucidum CGMCC 5.0026 via protoplast formation and regeneration. The Vitreoscilla hemoglobin gene (vgb) and squalene synthase gene (sqs) were overexpressed in the monokaryotic G. 260124 and G. 260125 strain, respectively. Mating between the G. 260124 strain overexpressing vgb and the G. 260125 strain overexpressing sqs resulted in the formation of the new hybrid dikaryotic G. lucidum strain sqs-vgb. The maximum contents of ganoderic acid (GA)-T, GA-Me, and GA-P in the fruiting body of the mated sqs-vgb strain were 23.1, 15.3, and 39.8 µg/g dry weight (DW), respectively, 2.23-, 1.75-, and 2.69-fold greater than those in G. lucidum 5.0026. The squalene and lanosterol contents increased 2.35- and 1.75-fold, respectively, in the fruiting body of the mated sqs-vgb strain compared with those in the G. lucidum 5.0026. In addition, the maximum expression levels of the sqs and lanosterol synthase gene (ls) were increased 3.23- and 2.13-fold, respectively, in the mated sqs-vgb strain. In summary, we developed a new G. lucidum strain with higher contents of individual GAs in the fruiting body by integrating genetic engineering and mono-mono crossing.