The Second Hip Fracture is not an Independent Predictor of Poor Outcomes in Elderly Patients - A Case-Control Study.

Introduction: Hip fracture is particularly seen in elderly patients with frailty and osteoporosis and leads to diminished functional independence and quality of life. Despite the susceptibility of these patients to a second hip fracture (SHF), the literature insufficiently discussed its impact leading to poor outcomes. This study aims to directly assess the outcomes of elderly patients with initial hip fractures (IHF) vs those experiencing an SHF within a well-matched group with similar characteristics. Materials and Methods: This case-control study gathered data from the clinical hip fracture registry at a medical center from 2019 to 2022. Patients with SHF were matched with those with IHF in a 1:2 ratio according to the similarity of age, sex, and Charlson Comorbidity Index classification. Demographics at admission, baseline characteristics, and 1-year postoperative outcome were compared between the SHF and IHF groups. Results: Thirty-two SHF patients were matched with 64 IHF patients (81.25% of women, median age of 86 years). Anthropometric measurements and socioeconomic factors were not significantly different between the two groups. No differences in baseline characteristics were observed, except IHF patients had a significantly lower T-score than SHF patients (-3.98 vs. -3.31, P = 0.016). At one-year follow-up, despite a notable decrease in Barthel Index scores and an uptick in EQ-5D measures among the patients, the IHF and SHF groups demonstrated similar quality of life and a high level of activities of daily living. Discussions: In this case-control study, after matching for age, sex, and comorbidities, an SHF did not indicate poorer outcomes than an IHF, providing a more optimistic outlook for the patients and healthcare providers. Conclusion: Despite the significant challenges presented by hip fracture, the one-year postoperative outcomes did not differ between IHF and SHF patients, suggesting that SHF is not an independent predictor of poor outcomes following hip fracture in the elderly population.

Reevaluation of prognostic and severity indicators for COVID-19 patients in the emergency department.

AIMS: This study aimed to re-evaluate whether the scoring systems, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were effective in predicting prognosis and severity of COVID-19 patients in the emergency department (ED). METHODS: COVID-19 patients enrolled in this retrospective study divided into the death (DEA) and survival (SUR) groups, the severe/critical (SC) and non-severe/critical (non-SC) groups. The Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS) and CCEDRRN COVID-19 Mortality Score were calculated. The neutrophil, lymphocyte and platelet counts were extracted from the first routine blood examination, and NLR and PLR were calculated accordingly. Receiver Operating Characteristic (ROC) curve and logistic regression were performed. RESULTS: All the scoring systems, as well as NLR and PLR, significantly increased in both the DEA and SC groups. The ROC curve showed that the CCEDRRN COVID-19 Mortality Score had the highest predictive value for mortality and severity (AUC 0.779, 0.850, respectively), which outperformed the APACHE II, SOFA and NEWS. NLR presented better predictive ability for severity (AUC 0.741) than death (AUC 0.702). The APACHE II, NEWS and CCEDRRN COVID-19 Mortality Score were positively correlated with both prognosis and severity, whereas NLR only with severity. CONCLUSION: The NEWS and CCEDRRN COVID-19 Mortality Score were reconfirmed for early and rapid predicting the poor prognosis and severity of COVID-19 patients in ED, especially the CCEDRRN COVID-19 Mortality Score with the highest discrimination capacity, and NLR was more appropriate for predicting the severity.

Influence of COVID-19 pandemic on prevalence and genotype distribution of HPV in cervical cancer screening population.

BACKGROUND: Human Papillomavirus (HPV) DNA screening was a crucial element in the fight against cervical cancer and had been adopted in many countries, including China. However, the onset of the COVID-19 pandemic in March 2020 disrupted this program significantly. METHODS: The aim of this study is to investigate the prevalence and distribution of HPV genotypes among the population undergoing cervical cancer screening during the pandemic period. From January 2017 to December 2022, Peking Union Medical College Hospital gathered 45,496 cervical swabs from individuals undergoing cervical cancer screening. These samples were analyzed to detect fifteen high-risk HPV (HR-HPV) DNA types and a combination of two low-risk HPV (LR-HPV) types. RESULTS: The study revealed an overall infection rate of 11.24% (5,114/45,496), with 11.06% (5,032/45,496) of individuals infected with HR-HPV. The number of HPV screening patients and the infection rates of HPV, HR-HPV, LR-HPV, multiple genotype HPV (M-HPV), and single genotype HPV (S-HPV) during the pandemic were lower than those observed before the pandemic. Moreover, the age group with the highest percentage of infected individuals was under 45-49 years, with HPV52, HPV58, HPV16, and HPV51 being the most prevalent genotypes. Notably, HPV66 emerged as the fifth most commonly detected genotype during the pandemic. Additionally, among the eleven age groups examined, women under 25 exhibited the highest detection rate, with HPV52 and HPV16 infection rates exceeding those observed in the pre-pandemic period. CONCLUSIONS: The findings of this study offer significant insights for shaping HPV prevention strategies and enhancing cervical cancer screening initiatives in China following the epidemic.

Association between frailty and suicidal ideation in older adults: A cross-sectional study.

OBJECTIVES: This study seeks to investigate the potential correlation between various levels of frailty and suicidal ideation (SI) in older adults from the USA. METHODS: Our cross-sectional study extracted data on adults ≥60 years from the NHANES in 2005-2018. Frailty levels were assessed by computing the Frailty Index, classifying individuals into robust, prefrail, and frail categories. SI was evaluated utilizing Item #9 of PHQ-9. Logistic regression and restricted cubic splines were employed for analysis. RESULTS: The analysis comprised 8564 participants, revealing that 3.3% reported experiencing SI. The association between frailty and SI in older adults was statistically significant in crude model (OR: 5.94, 95% CI: 3.46-11.27, P < 0.001). Upon adjusting for baseline characteristics, the association remained robust (AOR: 5.35, 95% CI: 3.09-10.19, P < 0.001). Model II did not substantially alter the association between frailty and SI after further adjustment for lifestyle factors (AOR: 5.23, 95% CI: 3.02-9.98, P < 0.001). In a sensitivity analysis controlling for depression, the association remained statistically significant (AOR:3.62, 95%CI: 1.76-8.75, P = 0.001). Furthermore, the associations between the Frailty Index and SI were pronounced in the restricted cubic spline (RCS) models (P overall < 0.001, P nonlinearity = 0.771). CONCLUSION: Frailty appears to heighten vulnerability to suicidal ideation in older adults. Training healthcare professionals to identify and address mental health issues related to frailty is crucial. Through comprehensive intervention measures, we can better safeguard the mental well-being of older adults and reduce the risk of suicide.

Deformation Control in Mesoscale Micro-Milling of Curved Thin-Walled Structures.

The micro-machining scale effect makes it challenging to forecast and control the process parameters of the micro-milling process, which makes the micro-flanking-milling of weak-rigidity micro-thin-walled parts prone to deformation. To determine the critical cutting parameters for chip formation in the micro-milling of curved thin-walled parts at the mesoscale, the strain-softening effect of titanium alloy during high-speed milling and the scale effect of mesoscale cutting were comprehensively considered and a finite element prediction model for curved micro-thin-wall micro-milling was established to determine the critical milling parameters for effective material removal. Based on the determined milling parameters, an experimental design of response surface optimization was carried out. Based on the response surface methodology, a data-driven quantitative model with milling process parameters as design variables and deformation amounts as response variables was established to reveal the influence mechanism of multiple milling process parameters on machining accuracy. Based on the process requirements for deformation control in the micro-milling of curved thin-walled structures, dynamic optimization of the milling process parameters was performed using an improved NSGA-III algorithm to obtain non-dominated solutions. A visual ranking and a determination of the unique solution were conducted using the entropy weight-TOPSIS method. Finally, micro-milling validation experiments were carried out using the optimal parameter combination. The optimal solution for the process parameters of the arc-shaped micro-thin-wall micro-milling of titanium alloy established by the institute provides a relevant reference and guidance for mesoscale arc-shaped thin-wall micro-milling.

Higher socioeconomic status is associated with higher ultra-processed food intake: a cross-sectional analysis.

OBJECTIVE: To explore the differences in ultra-processed food (UPF) consumption across different socioeconomic status (SES) levels. METHODS: Data on UPF consumption (grams/day) were derived from the 2017-2018 National Health and Nutrition Examination Survey. The analysis controlled for age, marital status, race, and sex. A restricted cubic spline (RCS) model was applied to examine the nonlinear response curve. RESULTS: UPF consumption increased with higher poverty income ratio (PIR), the ratio of household income to the established poverty line. Compared to the low PIR group, the medium group showed a non-significant increase (ß = 34.23[95%CI: -28.81, 97.28], p = 0.287), while the high group exhibited a significant increase (ß = 115.15[95%CI: 43.53, 186.76], p = 0.002). A linear positive correlation was observed in RCS analysis (p-nonlinear = 0.166, p-overall < 0.001). CONCLUSIONS: The study highlights that higher SES is associated with greater consumption of UPF in the US. The findings suggest that policy interventions should take SES into consideration.

Current Status of Nursing Home Distribution in China: A National Cross-Sectional Study.

AIMS: Population aging is a challenge that the whole world is facing, especially in China. This study aims to investigate the current distribution status of nursing homes in China using spatial epidemiology methods. DESIGN: Cross-sectional study in China. METHODS: The data were obtained from the Integrated Civil Affairs Government Service Platform 'China County Statistical Yearbook' for 2020 and the 'China City Statistical Yearbook' for 2020. Using global Moran's index to test the clustering of nursing homes, inter-group and intra-group Theil index was utilised to differentiate the sources of differences. The coupling coordination analysis was conducted to explore the coordination. Geographically weighted regression was utilised to investigate the impact of economic development and aging on nursing home resources. All analyses were conducted by Arcgis 10.8 and R Studio 4.3.2. RESULTS: Global Moran's index indicated that the distribution of nursing homes in China exhibited clustering. The Theil index values for institutions and beds at the national county were 0.32450 and 0.30675. However, upon comparing provinces and regions, it was found that the differences across the country mainly stem from within provinces (contribution rate: institutions 65.0%; beds 73.0%) and within regions (contribution rate: institutions 99.0%; beds 91.0%). The majority of districts and counties had a coupling coordination index of institutions and bed numbers, both of which were < 0.5. CONCLUSION: The development of nursing home resources in China has been rapid, generally presenting a balanced state, but further optimisation is needed. This study established a foundation for the targeted distribution of essential public services, focusing on nursing home healthcare resources tailored to the needs of older persons. IMPLICATIONS: The study underscored the urgent need for targeted elderly care policies, emphasising the optimisation of resource distribution to enhance the overall quality of care provided to the aging population. NO PATIENTS OR PUBLIC CONTRIBUTION: The study did not involve humans.

Influences and mechanisms of iron input for methane productions in peatlands.

Atmospheric deposition provides a stable iron source for peatlands. The influences of Fe input on methane (CH4) productions and the underlying mechanisms remain unclear. We conducted a microcosm experiment with peat sediments collected from the Qinghai-Tibet Plateau of China to explore the effects of ferrihydrite reductionfor CH4 productions in peatlands by using geochemical analyses including 57Fe Mössbauer spectroscopy and three-dimensional fluorescence spectroscopy (3D-EEM) in combination with high-throughput sequencing of 16S rRNA and real-time fluorescence quantitative PCR (qPCR). Results showed that ferrihydrite reduction significantly increased CH4 production, being 30 times of that under the control. Selective extractions for iron oxides and 57Fe Mössbauer spectroscopy measurements revealed that no crystalline secondary iron minerals were formed during the ferrihydrite reduction process. The addition of ferrihydrite enhanced the degradation of dissolved organic matter (DOM) in peat soil, resulting in a reduction in the concentration of dissolved organic carbon (DOC). Furthermore, the relative abundance of typical fermentative microorganisms in peat sediments, including Acidobacteriota and Bacteroidota, significantly increased. Such a result indicated that reduction of ferrihydrite accelerated organic matter decomposition and increased substrate concentration required for methanogenesis. Furthermore, a co-increase in relative abundance of Geobacter, Geothrix, and Methanobacterium in the ferrihydrite-amended group suggested a potential synergistic interaction that may promote the CH4 production. Our results demonstrated that ferrihydrite reduction could significantly enhance CH4 production and play a vital role in regulating CH4 emissions in peatlands.

Chinese Anesthesiology Milestones in Resident Evaluation: Reliability, Validity, and Correlation with Objective Examination Scores: a Cross-sectional Study.

BACKGROUND: Evaluating competency acquisition during residency training is crucial. The Anesthesiology Milestones have been implemented in the United States. The China Consortium of Elite Teaching Hospitals for Residency Education has also developed the Chinese Resident Core Competency Milestone Evaluation System. Despite this, Milestones tailored for anesthesiology have yet to be implemented in China. To address this gap, we have developed Chinese Anesthesiology Milestones. This study aims to assess the reliability and validity of the Chinese Anesthesiology Milestones and their correlation with objective examinations. METHODS: In this single-center cross-sectional study, we included anesthesia residents enrolled in the standardized residency training program at our hospital during the academic year 2021 to 2022. The Chinese Anesthesiology Milestones were developed based on the American version of Anesthesiology Milestones 2.0 and the Chinese Resident Core Competency Milestone Evaluation System using the Delphi method. The Delphi panel comprised a diverse group, including education administrators, faculty from teaching hospitals, and anesthesia residents. Five attending anesthesiologists independently assessed the levels achieved by each anesthesia resident based on the Chinese Anesthesiology Milestones. Subsequently, they collaboratively discussed the ratings for each resident until a consensus was reached. The interrater reliability, internal consistency, and construct validity were assessed using Kendall's coefficient, Cronbach's α coefficient/ composite reliability, and average variance extracted, respectively. Higher values indicated better reliability or validity. The correlation between Milestone ratings and objective examination scores, including written examinations and Objective Structured Clinical Examinations, were analyzed using Pearson correlation. RESULTS: The Chinese Anesthesiology Milestones encompassed 6 competencies, including professionalism, medical knowledge and technical skills, patient care, interpersonal and communication skills, teaching ability, and life-long learning. Milestone evaluation data were available and analyzed from 66 residents. The Kendall's coefficient of concordance among raters ranged from 0.799 (95% confidence interval [CI], 0.793-0.918) to 0.942 (95% CI, 0.934-0.982). The average variance extracted, composite reliability, and Cronbach's α coefficient ranged from 0.782 to 0.920, 0.935 to 0.980, and 0.916 to 0.978, respectively. Correlations between objective examination scores and related Milestone subcompetencies were as follows: written examinations: r = 0.52 (95% CI, 0.22-0.71), technical skills stations: r = 0.51 (95% CI, 0.21-0.71), the oral test station: r = 0.66 (95% CI, 0.45-0.79), and the standardized patient station: r = 0.61 (95% CI, 0.36-0.76). CONCLUSIONS: The Chinese Anesthesiology Milestones demonstrated satisfactory interrater reliability, internal consistency, construct validity, and correlation with objective examination scores within our hospital.

Modified furosemide responsiveness index and biomarkers for AKI progression and prognosis: a prospective observational study.

BACKGROUND: Modified furosemide responsiveness index (mFRI) is a novel biomarker for assessing diuretic response and AKI progression in patients with early AKI. However, the comparative predictive performance of mFRI and novel renal biomarkers for adverse renal outcomes remains unclear. In a single-center prospective study, we aimed to evaluate the discriminatory abilities of mFRI and other novel renal biomarkers in predicting AKI progression and prognosis in patients with initial mild and moderate AKI (KDIGO stage 1 to 2). RESULTS: Patients with initial mild and moderate AKI within 48 h following cardiac surgery were included in this study. The mFRI, renal biomarkers (including serum or urinary neutrophil gelatinase-associated lipocalin [sNGAL or uNGAL], serum cystatin C, urinary N-acetyl-beta-D-glycosaminidase [uNAG], urinary albumin-to-creatinine ratio) and cytokines (TNF, IL-1ß, IL-2R, IL-6, IL-8, and IL-10) were measured at AKI diagnosis. The mFRI was calculated for each patient, which was defined as 2-hour urine output divided by furosemide dose and body weight. Of 1013 included patients, 154 (15.2%) experienced AKI progression, with 59 (5.8%) progressing to stage 3 and 33 (3.3%) meeting the composite outcome of hospital mortality or receipt of renal replacement therapy (RRT). The mFRI showed non-inferiority or potential superiority to renal biomarkers and cytokines in predicting AKI progression (area under the curve [AUC] 0.80, 95% confidence interval [CI] 0.77-0.82), progression to stage 3 (AUC 0.87, 95% CI 0.85-0.89), and composite outcome of death and receipt of RRT (AUC 0.85, 95% CI 0.82-0.87). Furthermore, the combination of a functional biomarker (mFRI) and a urinary injury biomarker (uNAG or uNGAL) resulted in a significant improvement in the prediction of adverse renal outcomes than either individual biomarker (all P < 0.05). Moreover, incorporating these panels into clinical model significantly enhanced its predictive capacity for adverse renal outcomes, as demonstrated by the C index, integrated discrimination improvement, and net reclassification improvement (all P < 0.05). CONCLUSIONS: As a rapid, cost-effective and easily accessible biomarker, mFRI, exhibited superior or comparable predictive capabilities for AKI progression and prognosis compared to renal biomarkers in cardiac surgical patients with mild to moderate AKI. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04962412. Registered July 15, 2021, https://clinicaltrials.gov/ct2/show/NCT04962412?cond=NCT04962412&draw=2&rank=1 .

Molecular Pairing in Twisted Bilayer Graphene Superconductivity.

We propose a theory for how the weak phonon-mediated interaction (J_{A}=1-4 meV) wins over the prohibitive Coulomb repulsion (U=30-60 meV) and leads to a superconductor in magic-angle twisted bilayer graphene (MATBG). We find the pairing mechanism akin to that in the A_{3}C_{60} family of molecular superconductors: Each AA stacking region of MATBG resembles a C_{60} molecule, in that optical phonons can dynamically lift the degeneracy of the moiré orbitals, in analogy to the dynamical Jahn-Teller effect. Such induced J_{A} has the form of an intervalley anti-Hund's coupling and is less suppressed than U by the Kondo screening near a Mott insulator. Additionally, we also considered an intraorbital Hund's coupling J_{H} that originates from the on-site repulsion of a carbon atom. Under a reasonable approximation of the realistic model, we prove that the renormalized local interaction between quasiparticles has a pairing (negative) channel in a doped correlated insulator at ν=±(2+δν), albeit the bare interaction is positive definite. The proof is nonperturbative and based on exact asymptotic behaviors of the vertex function imposed by Ward identities. Existence of an optimal U for superconductivity is predicted. In a large area of the parameter space of J_{A}, J_{H}, the ground state is found to have a nematic d-wave singlet pairing, which, however, can lead to a p-wave-like nodal structure due to the Berry's phase on Fermi surfaces (or Euler obstruction).

Acute ingestion of caffeinated chewing gum reduces fatigue index and improves 400-meter performance in trained sprinters: a double-blind crossover trial.

BACKGROUND: This study investigated the effects of caffeinated chewing gum on fatigue index and 400-meter performance in trained sprinters. METHODS: Nineteen participants (age: 20.9 ± 1.0 years; height: 175.6 ± 4.9 cm; mass: 66.5 ± 5.6 kg; training age: 7.9 ± 1.0 years) were randomly assigned to either a caffeine trial (CAF) or a placebo trial (PL) using a double-blind, randomized crossover design. The participants in the CAF trial chewed a gum containing 3 mg/kg of caffeine for a period of 10 minutes, while those in the PL trial chewed a gum containing a placebo with no caffeine. Following a 15-minute period of rest, the fatigue index was tested by six maximal 35-meter sprints with a 10-second rest between efforts. After this, at least 30 minutes of rest was permitted, during which time the participants engaged in brief warm-up activities prior to the commencement of the 400-meter sprint test. Saliva samples were collected before chewing gum, before the fatigue test and before 400-meters sprinting. RESULTS: The fatigue index was significantly lower in the CAF trial compared to the PL trial (CAF: 8.1 ± 2.5%; PL: 9.6 ± 4.8%; p = 0.046, Cohen's d = 039). The CAF trial demonstrated significantly lower sprint time for the 300-400 meter segment (CAF: 14.73 ± 1.35 seconds; PL: 15.23 ± 1.30 seconds; p = 0.019, Cohen's d = 0.37) and total sprint time compared to the PL trial (CAF: 53.87 ± 2.88 seconds; PL: 54.68 ± 3.37 seconds; p = 0.003, Cohen's d = 0.27). Saliva caffeine and α-amylase concentration were significantly higher in the CAF trial compared to the PL trial (p < 0.05). CONCLUSION: The present study demonstrated that caffeine gum supplementation prior to exercise significantly reduced the fatigue index and increased the capacity to maintain speed, particularly in the final 300 to 400 meters, as well as enhancing 400-meter sprint performance.

Mesoporous metal-organic framework NH2-MIL-101(Cr) as an efficient photocatalyst for the epoxidation of styrene.

Oxidation of styrene is a key reaction in the synthesis of pharmaceuticals and fine chemicals, and therefore oxidizing styrene with selective, efficient, and recyclable heterogeneous catalysts is significant from an environmental and economic standpoint. In this study, we report the transition Cr-based metal-organic framework [NH2-MIL-101(Cr)] as a heterogeneous photocatalyst, which efficiently promotes styrene epoxidation using H2O2 as a green oxidant, achieving high conversion efficiency (98%) and excellent selectivity (82%) under ambient conditions. Radical detection and quenching experiments reveal that the superoxide radical anion (O2˙-) acts as an active oxygen species, selectively promoting the oxidation of styrene to its oxidized form. This work provides insight into the development of a sustainable and cost-effective method for producing styrene oxide.

Etelcalcetide ameliorates bone loss in chronic kidney disease-mineral and bone disorder by activation of IRF7 and necroptosis pathways.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a multifaceted clinical syndrome characterized by mineral imbalances, abnormalities in bone metabolism, chronic inflammation and vascular calcification. Etelcalcetide, a second-generation intravenous calcimimetic agent, has been approved for treating high-turnover renal osteodystrophy, effectively targeting the pathophysiological mechanisms underlying this condition. We investigate the impacts of etelcalcetide on osteoclast (OC) differentiation and functionality in CKD-MBD via three critical mechanisms: inflammation initiated by interferon regulatory factor 7 (IRF7), receptor-interacting protein (RIP)-mediated necroptosis and apoptosis-induced cell death. The low-dose (CKD + L) or high-dose (CKD + H) of etelcalcetide groups significantly improved biochemical markers compared to the CKD control mice. Additionally, etelcalcetide-treated CKD mice significantly improved cortical and trabecular bone parameters. In an in vitro study, etelcalcetide was observed to bolster the IRF7-mediated IFNß response in OC differentiation. Furthermore, it stimulated RIP-mediated necroptosis via RIP and MLKL activation, inhibiting bone resorption. Moreover, the drug increased levels of caspases 3 and 9, inducing cell death in OCs. These findings suggest that etelcalcetide regulates bone metabolism and reduces skeletal issues in CKD-MBD. Etelcalcetide likely enhances bone parameters in CKD-MBD mice by regulating IRF7 pathways and inhibiting OC differentiation. It also improves bone health and promotes RIP-mediated necroptosis and apoptosis pathways within OCs.

Effects of Caffeinated Chewing Gum on Ice Hockey Performance after Jet Lag Intervention: Double-Blind Crossover Trial.

The purpose of this study was to examine the impact of caffeinated chewing gum on the physical performance of elite ice hockey players after a jet lag intervention. Fourteen national-level (age: 25.2 ± 5.4; height: 176.5 ± 5.3; weight: 78.1 ± 13.4) ice hockey players were tested late at night after a full day awake schedule with jet lag. A randomised, double-blind experimental design was employed in which participants either chewed caffeinated gum (CAF) containing 3 mg/kg caffeine or a caffeine-free placebo gum (PLA) for 10 min prior to undertaking a series of on-ice and off-ice tests. The off-ice tests included grip force, the counter-movement jump (CMJ), and the squat jump (SJ). The on-ice tests included a 35 m sprint, the S-Shape agility test, and the Yo-Yo intermittent recovery test (Yo-Yo IR1 test). The CMJ height (CAF: 47.2 ± 4.4; PL: 45.9 ± 3.5; p = 0.035; Cohen's d = 0.32) and SJ height (CAF: 46.7 ± 4.1; PL: 44.9 ± 3.8; p = 0.047; Cohen's d = 0.44) were found to be significantly higher in the CAF than in the PL trial. However, there were no significant differences (p > 0.05) in grip force, as well as in the 35 m sprint, the S-Shape agility test, and the Yo-Yo IR1 test. The present study found that, following a jet lag intervention, although the consumption of caffeinated gum resulted in an increase in vertical jump height, it had no impact on performance in the ice tests. The results of this study may help coaches and athletes consider the need for caffeine supplementation when experiencing jet lag.

Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: a multicenter randomized controlled trial.

BACKGROUND: The optimal sedative regime for noninvasive ventilation (NIV) intolerance remains uncertain. The present study aimed to assess the efficacy and safety of remifentanil (REM) compared to dexmedetomidine (DEX) in cardiac surgery patients with moderate-to-severe intolerance to NIV. METHODS: In this multicenter, prospective, single-blind, randomized controlled study, adult cardiac surgery patients with moderate-to-severe intolerance to NIV were enrolled and randomly assigned to be treated with either REM or DEX for sedation. The status of NIV intolerance was evaluated using a four-point NIV intolerance score at different timepoints within a 72-h period. The primary outcome was the mitigation rate of NIV intolerance following sedation. RESULTS: A total of 179 patients were enrolled, with 89 assigned to the REM group and 90 to the DEX group. Baseline characteristics were comparable between the two groups, including NIV intolerance score [3, interquartile range (IQR) 3-3 vs. 3, IQR 3-4, p = 0.180]. The chi-squared test showed that mitigation rate, defined as the proportion of patients who were relieved from their initial intolerance status, was not significant at most timepoints, except for the 15-min timepoint (42% vs. 20%, p = 0.002). However, after considering the time factor, generalized estimating equations showed that the difference was statistically significant, and REM outperformed DEX (odds ratio = 3.31, 95% confidence interval: 1.35-8.12, p = 0.009). Adverse effects, which were not reported in the REM group, were encountered by nine patients in the DEX group, with three instances of bradycardia and six cases of severe hypotension. Secondary outcomes, including NIV failure (5.6% vs. 7.8%, p = 0.564), tracheostomy (1.12% vs. 0%, p = 0.313), ICU LOS (7.7 days, IQR 5.8-12 days vs. 7.0 days, IQR 5-10.6 days, p = 0.219), and in-hospital mortality (1.12% vs. 2.22%, p = 0.567), demonstrated comparability between the two groups. CONCLUSIONS: In summary, our study demonstrated no significant difference between REM and DEX in the percentage of patients who achieved mitigation among cardiac surgery patients with moderate-to-severe NIV intolerance. However, after considering the time factor, REM was significantly superior to DEX. Trial registration ClinicalTrials.gov (NCT04734418), registered on January 22, 2021. URL of the trial registry record: https://register. CLINICALTRIALS: gov/prs/app/action/SelectProtocol?sid=S000AM4S&selectaction=Edit&uid=U00038YX&ts=3&cx=eqn1z0 .

Characterization, expression and functional analysis of Hsp40 during LPS challenge in blood parrot Amphilophus citrinellus ×Vieja melanura.

Heat shock protein 40 belonging to heat shock protein family plays an important role in the immune responses of organisms. In this study, the full length cDNA of Hsp40 was 2426 bp including a 1368 bp open reading frame (ORF) encoding 455 amino acids with a molecular weight of 49.16 kDa and a theoretical isoelectric point of 9.34 in blood parrot Vieja synspila ♀ × Amphilophus citrinellus ♂, an important ornamental fish in China. It had three conserved domains DnaJ, CRR and DnaJ_C. Phylogenetic analysis showed that the sequence of Hsp40 among species was conserved, and the blood parrot Hsp40 was closely related to Neolamprologus brichardi. Blood parrot Hsp40 mRNA could be detected in all of the tissues examined and mainly distributed in the cytoplasm. The expression of Hsp40 was upregulated during lipopolysaccharide (LPS) challenge. Upregulated Hsp40 inhibited the activity of nuclear factor κB (NF-κB) and activated protein 1 (AP-1) and reduced the ratio of Bax/Bcl-2 mRNA expression. This study provides a theoretical basis for further exploring the role of Hsp40 gene in the anti-bacterial immunity of blood parrot.

Empathy as a Mediator of the Relation between Peer Influence and Prosocial Behavior in Adolescence: A Meta-Analysis.

During adolescence, empathy and prosocial behavior contribute to the establishment of positive interpersonal relationships and social connections, promoting holistic development in youth. A substantial amount of research has provided compelling evidence that there is a relationship between peer relationships and empathy and prosocial behavior. Empathy, as a key mediating factor, links the influence of peers with prosocial behavior in adolescents, yet there is currently a lack of robust meta-analytic evidence regarding this mediating role. This study employed a two-stage structural equation modeling approach to synthesize existing research on peer influence, empathy, and prosocial behavior during adolescence. Systematic searches were conducted across three databases (PubMed, Web of Science, and PsycINFO), identifying a total of 49 studies, with a systematic assessment of study quality. The results indicated that empathy plays a mediating role between peer influence and prosocial behavior. Positive peer influence is positively correlated with empathy and prosocial behavior, while negative peer influence is negatively correlated with empathy and prosocial behavior, and empathy is positively correlated with prosocial behavior. This meta-analysis demonstrates that during adolescence, empathy mediates the connection between peer influence and prosocial behavior, representing a potential process that can explain the relationship between peer influence and prosocial behavior.

Projections from the ventral tegmental area to zona incerta regulate fear generalization in a mouse model of PTSD.

Generalized fear is a maladaptive behavior in which non-threatening stimuli elicit a fearful response. The ventral tegmental area (VTA) has been demonstrated to play important roles in fear response and fear memory generalization, but the precious neural circuit mechanism is still unclear. Here, we demonstrated that VTA-zona incerta (ZI) glutamatergic projection is involved in regulating high-intensity threatening training induced generalization and anxiety. Combining calcium signal recording and chemogentics, our work reveals that VTA glutamatergic neurons respond to closed arm entering in the model of PTSD. Inhibition of VTA glutamatergic neurons or the glutamatergic projection to ZI could both relieve fear generalization and anxiety. Together, our study proves the VTA - ZI glutamatergic circuit is involved in mediating fear generalization and anxiety, and provides a potential target for treating post-traumatic stress disorder.

Structural Allograft versus Polyetheretherketone Cage in Anterior Cervical Discectomy and Fusion: A Meta-Analysis.

BACKGROUND: Polyetheretherketone (PEEK) cages and structural allografts (SAs) are commonly used in anterior cervical discectomy and fusion (ACDF), yet their postoperative results remain uncertain. This meta-analysis was conducted to determine whether there were any differences in outcomes between patients who received these two grafts in ACDF. METHODS: We comprehensively searched electronic databases up to August 2023. Observational studies or randomized controlled trials reported postoperative outcomes, including fusion, subsidence, reoperation rates, and patient-reported outcomes through the Neck Disability Index, the visual analog scale for neck and arm pain, and the Japanese Orthopaedic Association (JOA)/modified JOA score following primary ACDF using SA or PEEK cage. The results are presented in odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). RESULTS: Eleven studies were included, with 1213 patients (788 receiving SAs and 425 receiving PEEK cages). Patients having SA had significantly higher fusion (OR: 1.84; 95% CI: 1.27-2.67; P = 0.001) and lower subsidence (OR: 0.50; 95% CI: 0.30-0.86; P = 0.01) rates when compared with the PEEK cage. There was no difference in revision rate between SA or PEEK cage (P = 0.88). Two grafts demonstrated similar clinical improvements in Neck Disability Index (P = 0.31), visual analog scale for the neck (P = 0.77) and arm pain (P = 0.22), and JOA/modified JOA score (P = 0.99). CONCLUSIONS: SA demonstrates better fusion and lower subsidence rates than the PEEK cage in ACDF. Nevertheless, SAs and PEEK cages resulted in equally successful postoperative clinical performances.