0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period.

BACKGROUND: 3% chloroprocaine (CP) has been reported as the common local anesthetic used in pregnant women undergoing urgent cesarean delivery during labor analgesia period. However, 0.75% ropivacaine is considered a promising and effective alternative. Therefore, we conducted a randomized controlled trial to compare the effectiveness and safety of 0.75% ropivacaine with 3% chloroprocaine for extended epidural anesthesia in pregnant women. METHODS: We conducted a double-blind, randomized, controlled, single-center study from November 1, 2022, to April 30, 2023. We selected forty-five pregnant women undergoing urgent cesarean delivery during labor analgesia period and randomized them to receive either 0.75% ropivacaine or 3% chloroprocaine in a 1:1 ratio. The primary outcome was the time to loss of cold sensation at the T4 level. RESULTS: There was a significant difference between the two groups in the time to achieve loss of cold sensation (303, 95%CI 255 to 402 S vs. 372, 95%CI 297 to 630 S, p = 0.024). There was no significant difference the degree of motor block (p = 0.185) at the Th4 level. Fewer pregnant women required additional local anesthetics in the ropivacaine group compared to the chloroprocaine group (4.5% VS. 34.8%, p = 0.011). The ropivacaine group had lower intraoperative VAS scores (p = 0.023) and higher patient satisfaction scores (p = 0.040) than the chloroprocaine group. The incidence of intraoperative complications was similar between the two groups, and no serious complications were observed. CONCLUSIONS: Our study found that 0.75% ropivacaine was associated with less intraoperative pain treatment, higher patient satisfaction and reduced the onset time compared to 3% chloroprocaine in pregnant women undergoing urgent cesarean delivery during labor analgesia period. Therefore, 0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period. CLINICAL TRIAL NUMBER AND REGISTRY URL: The registration number: ChiCTR2200065201; http://www.chictr.org.cn , Principal investigator: MEN, Date of registration: 31/10/2022.

Inositol Inclusion Affects Growth, Body Composition, Antioxidant Performance, and Lipid Metabolism of Largemouth Bass (Micropterus salmoides).

The present study explored the effects of inositol on growth performance, body composition, antioxidant performance, and lipid metabolism of largemouth bass (Micropterus salmoides). Six isonitrogenous and isolipidic diets containing 0 mg/kg (G1, control), 125 mg/kg (G2), 250 mg/kg (G3), 375 mg/kg (G4), 500 mg/kg (G5), and 625 mg/kg (G6) inositol were prepared and fed to cultured fish (initial weight: 110 ± 1 g) for 8 weeks in recirculating the aquaculture systems. The results indicated that compared with G1 group, the weight gain rate (WGR), specific growth rate (SGR), and feed efficiency rate (FER) in the G3 group were significantly higher. The crude lipid content of the whole fish and the liver of cultured fish was significantly reduced with increasing dietary inositol inclusion. However, no significant effects on moisture, crude protein, and ash contents of fish were observed among the different groups. Dietary inositol supplementation significantly increased muscular crude protein. However, muscular total lipid contents were decreased when the inclusion level was higher than 250 mg/kg (G3-G6 groups). As dietary inositol supplemental level increased, serum triglyceride (TG), and cholesterol (TC) contents showed an increasing trend and reached the maximum value in the G3 group. Additionally, serum low-density lipoprotein cholesterol (LDL-C) in G2, G3, G4, and G5 groups was significantly upregulated by increasing inositol. While, there was no significant change in serum high-density lipoprotein cholesterol (HDL-C) among the treatments. Inositol inclusion also significantly reduced the serum alkaline phosphatase (AKP), glutamic-pyruvic transaminase (ALT), and glutamic-oxaloacetic transaminase (AST) activities as well as serum malondialdehyde (MDA) content but significantly increased serum catalase (CAT), superoxide dismutase (SOD) activities, and total antioxidant capacity (T-AOC). Compared with the control group, the activities of hepatic total lipase (TL) and lipoprotein lipase (LPL) were significantly elevated in the G3, G4, and G5 groups. Above all, dietary inositol supplementation could improve growth performance and antioxidant capacity, and reduce the liver fat content of largemouth bass, and the optimal supplementation level of inositol in feed is estimated to be 250.31-267.27 mg/kg.

Independently switchable dual-passband frequency-selective surface design based on characteristic mode analysis.

High-order bandpass filtering responses are highly desirable for frequency-selective surfaces (FSSs) in narrowband antenna/radar systems. In this paper, the design process of a reconfigurable dual-band FSS with second-order response is presented. Initially, the basic dumbbell-shaped resonator used in this design is theoretically investigated using the characteristic mode analysis (CMA) method to study the relation between geometric design parameters and the excited orthogonal resonance modes in different frequency bands. Then, an additional CMA process was performed on a unit cell with four such patch resonators arranged with 90-degree rotation between adjacent ones. This detailed analysis leads to a polarization-independent FSS design with a high-order dual-band response. Two of these composite resonators are combined back-to-back through coupling apertures on the middle layer. Finally, PIN diodes are loaded on separate layers to realize independent pass-band switching. The loading place of the PIN diodes is carefully chosen based on electromagnetic field analysis. A prototype was also fabricated and experimentally tested. Experimental results show that this FSS has two independently switchable passbands centered at 3 GHz and 4.8 GHz.

Practical security analysis of a continuous-variable source-independent quantum random number generator based on heterodyne detection.

Heterodyne-based continuous-variable source-independent quantum random number generator (CV-SI-QRNG) can produce true random numbers without any assumptions on source. However, practical implementations always contain imperfections, which will greatly influence the extractable randomness and even open loopholes for eavesdroppers to steal information about the final output. In this work, based on the theoretical model, we systematically analyzed the effects of imperfect implementations on the practical security of heterodyne-based CV-SI-QRNG. The influences of local oscillator (LO) fluctuation under imbalanced heterodyne detection are first analyzed. The simulation results show that the lower bound of extractable randomness will be overestimated without considering the influence of LO fluctuation, which will threaten the practical security of CV-SI-QRNG system. Moreover, we analyze the effects of the degree of imbalance and the magnitude of LO fluctuation on evaluating the extractable randomness. Finally, we investigate the impact of an imperfect phase modulator on the practical security of CV-SI-QRNG and find it will reduce the extractable randomness. Our analysis reveals that one should carefully consider the imperfections in the actual implementations of CV-SI-QRNGs.

Mechanism of the Anti-Influenza Functions of Guizhi Granules Based on Network Pharmacology, Molecular Docking, and in Vitro Experiments.

Guizhi granules mainly treat colds and improve overall health. They are widely used in clinical practice, but their protective effect and anti-inflammatory mechanism against influenza are unclear. In this study, the therapeutic effect of Guizhi granules on influenza was verified in vitro. The active compounds, targets, and cellular pathways of Guizhi granules against influenza were predicted using network pharmacology. The protein-protein interaction and component-target networks identified 5 core targets (JUN, TNF-α, RELA, AKT1, and MAPK1) and components (dihydrocapsaicin, kumatakenin, calycosin, licochalcone A, and berberine). GO and KEGG enrichment analyses revealed the anti-influenza pathways of Guizhi granules as antiviral and anti-inflammatory pathways. Molecular docking further verified that the core targets and components have good or strong binding activity. Therefore, the active ingredients, targets, and molecular mechanisms of Guizhi granules involved in influenza treatment were elucidated.

Correlation between clinical characteristics and tinnitus severity in tinnitus patients of different sexes: an analytic retrospective study.

PURPOSE: This study aimed to explore whether sex is influences tinnitus severity and whether the risk factors for tinnitus severity are the same in tinnitus patients of different sexes. METHODS: This was a retrospective study of data from 1427 patients complaining of tinnitus in a local hospital otolaryngology clinic from November 2019 to January 2022. All patients were interviewed and assessed by otoscopy, pure-tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and tinnitus refinement test. RESULTS: THI values were higher in females than in males (P = 0.00). Types of tinnitus sounds (OR 0.667, P = 0.000) and degree of hearing loss (OR 1.318, P = 0.000) were risk factors for tinnitus severity in males. Types of tinnitus sounds (OR 0.789, P = 0.005), sensation level (OR 1.023, P = 0.037), tinnitus types (OR 1.163, P = 0.041), tinnitus location (OR 1.198, P = 0.026), and the degree of hearing loss (OR 1.303, P = 0.000) were risk factors for tinnitus severity in females. Sex was an influencing factor for tinnitus severity. There were different risk factors for the tinnitus severity in different sexes. CONCLUSION: The risk factors for tinnitus severity differed according to sex in tinnitus patients, and the risk factors for tinnitus severity were greater in women than in men. These findings add to the literature on sex differences in tinnitus and suggest that medical and psychological screening of affected individuals and customized tinnitus treatment for each individual with tinnitus are needed. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION: ChiCTR2200057958, 2022/3/24 (retrospectively registered trials).

Development of an audiological assessment and diagnostic model for high occupational noise exposure.

PURPOSE: To explore the diagnostic auditory indicators of high noise exposure and combine them into a diagnostic model of high noise exposure and possible development of hidden hearing loss (HHL). METHODS: We recruited 101 young adult subjects and divided them according to noise exposure history into high-risk and low-risk groups. All subjects completed demographic characteristic collection (including age, noise exposure, self-reported hearing status, and headset use) and related hearing examination. RESULTS: The 8 kHz (P = 0.039) and 10 kHz (P = 0.005) distortion product otoacoustic emission amplitudes (DPOAE) (DPs) in the high-risk group were lower than those in the low-risk group. The amplitudes of the summating potential (SP) (P = 0.017) and action potential (AP) (P = 0.012) of the electrocochleography (ECochG) in the high-risk group were smaller than those in the low-risk group. The auditory brainstem response (ABR) wave III amplitude in the high-risk group was higher than that in the low-risk group. When SNR = - 7.5 dB (P = 0.030) and - 5 dB (P = 0.000), the high-risk group had a lower speech discrimination score than that of the low-risk group. The 10 kHz DPOAE DP, ABR wave III amplitude and speech discrimination score under noise with SNR = - 5 dB were combined to construct a combination diagnostic indicator. The area under the ROC curve was 0.804 (95% CI 0.713-0.876), the sensitivity was 80.39%, and the specificity was 68.00%. CONCLUSIONS: We expect that high noise exposure can be detected early with this combined diagnostic indicator to prevent HHL or sensorineural hearing loss (SNHL). TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION: ChiCTR2200057989, 2022/3/25.

Oxygen Vacancy and Core-Shell Heterojunction Engineering of Anemone-Like CoP@CoOOH Bifunctional Electrocatalyst for Efficient Overall Water Splitting.

Constructing cost-efficient and robust bifunctional electrocatalysts for both neutral and alkaline water splitting is highly desired, but still affords a great challenge, due to sluggish hydrogen/oxygen evolution reaction (HER/OER) kinetics. Herein, an in situ integration engineering strategy of oxygen-vacancy and core-shell heterojunction to fabricate an anemone-like CoP@CoOOH core-shell heterojunction with rich oxygen-vacancies supported on carbon paper (CoP@CoOOH/CP), is described. Benefiting from the synergy of CoP core and oxygen-vacancy-rich CoOOH shell, the as-obtained CoP@CoOOH/CP catalyst displays low overpotentials at 10 mA cm-2 for HER (89.6 mV/81.7 mV) and OER (318 mV/200 mV) in neutral and alkaline media, respectively. Notably, a two-electrode electrolyzer, using CoP@CoOOH/CP as bifunctional catalyst to achieve 10 mA cm-2 , only needs low-cell voltages in neutral (1.65 V) and alkaline (1.52 V) electrolyte. Besides, systematically experimental and theoretical results reveal that the core-shell heterojunction efficiently accelerates the catalytic kinetics and strengthens the structural stability, while rich oxygen-vacancies efficiently decrease the kinetic barrier and activation energy, and reduce the energy barrier of the rate-determining-step for OER intermediates, thus intrinsically boosting OER performance. This work clearly demonstrates that oxygen-vacancy and core-shell heterojunction engineering provide an effective strategy to design highly-efficient non-precious, bi-functional electrocatalysts for pH-universal water splitting.

An Evaluation of Replacing Soybean Meal with Proteolytic Soybean Meal in Low-Fish-Meal Diet on Growth Performance, Expression of Immune-Related Genes, and Resistance against Vibrio alginolyticus in White Shrimp (Litopenaeus vannamei).

A 56-day feeding trial was conducted to investigate the effects of dietary proteolytic soybean meal (PSM) on growth performance, immune-related genes, and resistance against Vibrio alginolyticus in Litopenaeus vannamei. Six dietary levels of PSM (0, 35, 45, 55, and 65 g/kg) were added to a basal diet. The results showed that juveniles fed more than 45 g/kg PSM exhibited significantly (P < 0.05) promoted growth performance compared to the control. Furthermore, all PSM supplemented treatments showed significantly better performances in terms of feed conversion ratio (FCR), the protein efficiency ratio (PER), and the protein deposition ratio (PDR). Corresponding to the performances on growth and nutrient utilization, a significantly higher protease activity in hepatopancreas was also obtained in all PSM incorporations. Also, the activities of immune-related enzymes such as superoxide dismutase (SOD) and lysozyme in serum were significantly (P < 0.05) elevated in shrimp fed with PSM. Notably, shrimp fed with the 65 g/kg PSM supplemented diet showed significantly (P < 0.05) lower cumulative mortality compared to the control after challenging with Vibrio alginolyticus injection at 72 h. PSM supplementation significantly (P < 0.05) upregulated expression levels of immune deficiency (IMD) and Toll-like receptor 2 mRNA in shrimp gill tissues directly or indirectly reflected their activation effect in shrimp innate immune response. In conclusion, the current study proved that partial replacement of soybean meal with PSM could result in better growth and immune status of L. vannamei.

Comparison of Lumped Oscillator Model and Energy Participation Ratio Methods in Designing Two-Dimensional Superconducting Quantum Chips.

Over the past two decades, superconducting quantum circuits have become one of the essential platforms for realizing quantum computers. The Hamiltonian of a superconducting quantum circuit system is the key to describing the dynamic evolution of the system. For this reason, various methods for analyzing the Hamiltonian of a superconducting quantum circuit system have been proposed, among which the LOM (Lumped Oscillator Model) and the EPR (Energy Participation Ratio) methods are the most popular ones. To analyze and improve the design methods of superconducting quantum chips, this paper compares the similarities and differences of the LOM and the EPR quantification methods. We verify the applicability of these two theoretical approaches to the design of 2D transmon quantum chips. By comparing the theoretically simulated results and the experimentally measured data at extremely low temperature, the errors between the theoretical calculation and observed measurement values of the two methods were summarized. Results show that the LOM method has more parameter outputs in data diversity and the qubit frequency calculation in LOM is more accurate. The reason is that in LOM more coupling between different systems are taken into consideration. These analyses would have reference significance for the design of superconducting quantum chips.

Suppressing the Dielectric Loss in Superconducting Qubits through Useful Geometry Design.

Dielectric loss from different interfacial layers in the superconducting circuit and from external environment may cause superconducting qubit decoherence. Compared to modeling the entire device at once with a numerical solver, quantitatively formulating the dielectric loss can both describe all loss mechanisms and make the optimization more transparent. In this paper, we first analyze the expression formula of dielectric loss, and obtain a design scheme that can reduce the dielectric loss of qubits. That is, we replace the straight junction wires with the tapered junction wires. Based on this scheme, we perform a simulation to optimize the design of junction wires. Finally, a real experiment is conducted to verify our design. The results show that both the T1 time and T2 time of qubits are significantly improved.

RACO-1 modulates Hippo signalling in oesophageal squamous cell carcinoma.

Oesophageal cancer is one of the most lethal malignancies worldwide, whereas the 5-year survival is less than 20%. Although the detailed carcinogenic mechanisms are not totally clear, recent genomic sequencing data showed dysregulation of Hippo signalling could be a critical factor for oesophageal squamous cell carcinoma (ESCC) progression. Therefore, understanding of the molecular mechanisms that control Hippo signalling activity is of great importance to improve ESCC diagnostics and therapeutics. Our current study revealed RACO-1 as an inhibitory protein for YAP/TEAD axis. Depletion of RACO-1 increases the protein level of YAP and expression of YAP/TEAD target gene. Besides, RACO-1 silencing could promote ESCC cell invasion and migration, which effect could be rescued by YAP depletion in ESCC cells. Immunoprecipitation showed that RACO-1 associated with YAP and promote ubiquitination and degradation of YAP at k48 poly-ubiquitination site. Our research discovered a new regulator of Hippo signalling via modulating YAP stability. RACO-1 could be a promising factor, which serves cancer diagnostics and therapeutics in ESCC patients.

Upper Security Bounds for Coherent-One-Way Quantum Key Distribution.

The performance of quantum key distribution (QKD) is severely limited by multiphoton pulses emitted by laser sources due to the photon-number splitting attack. Coherent-one-way (COW) QKD has been introduced as a promising solution to overcome this limitation, and thus extend the achievable distance of practical QKD. Indeed, thanks to its experimental simplicity, the COW protocol is already used in commercial applications. Here, we derive simple upper security bounds on its secret key rate, which demonstrate that it scales at most quadratically with the system's transmittance, thus solving a long-standing problem. That is, in contrast to what has been claimed, this approach is inappropriate for long-distance QKD transmission. Remarkably, our findings imply that all implementations of the COW protocol performed so far are insecure.

The effect of dietary supplementation of Astragalus membranaceus and Bupleurum chinense on the growth performance, immune-related enzyme activities and genes expression in white shrimp, Litopenaeus vannamei.

A 56-day feeding trial was conducted to investigate the effects of dietary supplementation of Astragalus membranaceus or/and Bupleurum chinense on the growth performance, immune enzymes, and related gene expression of Pacific white shrimp (Litopenaeus vanammei). Six experimental diets were formulated and supplemented with two levels (0.25% and 0.5%) of each herb and their combination. At the end of the trial, the specific growth rate and feed conversion ratio of shrimp were significantly (P < 0.05) improved by herbal diets. Besides, the activities of immune-related enzymes such as superoxide dismutase (SOD), alkaline phosphatase (AKP), and lysozyme in serum and hepatopancreas were significantly (P < 0.05) elevated in shrimp fed A. membranaceus or/and B. chinense. The high expression levels of immune deficiency (IMD), lysozyme, and Toll-like receptor mRNA directly or indirectly reflected the activation effect of innate immune in shrimp by dietary A. membranaceus or/and B. chinense. However, no significant difference (P > 0.05) among the herbal incorporated treatments was detected on the growth performance and immune response. In conclusion, the results suggest that A. membranaceus and B. chinense could be used as a beneficial feed additives and alternatives to antibiotics for white shrimp aquaculture.

Interactive effects of dietary cholesterol and phospholipids on the growth performance, expression of immune-related genes and resistance against Vibrio alginolyticus in white shrimp (Litopenaeus vannamei).

A 56-day feeding trial was done to investigate the interactive effects of cholesterol (CHO) and phospholipids (PL) on the growth performance, immune response, expression of immune-related genes, and resistance against Vibrio alginolyticus of freshwater cultured white shrimp (Litopenaeus vannamei). A 3 × 3 experimental design was conducted with nine experimental diets containing three levels of CHO (0, 0.2%, and 0.4%) and three levels of PL (0, 2%, and 4%). The results indicated that the growth performance significantly (P < 0.05) increased with the increase in dietary CHO levels. Interactive effects between dietary CHO and PL on the growth parameters were not observed. Superoxide dismutase (SOD) and lysozyme activities were also significantly affected by dietary CHO levels. Furthermore, the interaction between these two additives was only detected in SOD activity. Shrimp fed experimental diet with CHO and PL supplementation showed better tolerance against Vibrio alginolyticus compared to the control, interactive effects (P < 0.05) were also detected on these two factors. The expression of immune deficiency (IMD) and lysozyme mRNA was up-regulated in shrimp fed diets with CHO and PL. The expression level of Toll-like receptor mRNA directly reflected the dietary CHO levels, which was not affected by dietary PL. The interaction between dietary CHO and PL was shown as the significant factor (P < 0.05) both in the expression of IMD and lysozyme mRNA, which indicated that different dietary levels of CHO and PL could strongly affect expression levels of some immune-relevant genes of the juvenile freshwater cultured L. vannamei.

RNF168 facilitates proliferation and invasion of esophageal carcinoma, possibly via stabilizing STAT1.

Oesophageal cancer ranks as one of the most common malignancy in China and worldwide. Although genome-wide association studies and molecular biology studies aim to elucidate the driver molecules in oesophageal cancer progression, the detailed mechanisms remain to be identified. Interestingly, RNF168 (RING finger protein 168) shows a high frequency of gene amplification in oesophageal cancer from TCGA database. Here, we report an important function for RNF168 protein in supporting oesophageal cancer growth and invasion by stabilizing STAT1 protein. RNF168 gene is amplified in oesophageal cancer samples, which tends to correlate with poor prognosis. Depletion RNF168 causes decreased cell proliferation and invasion in oesophageal cancer cells. Through unbiased RNA sequencing in RNF168 depleted oesophageal cancer cell, we identifies JAK-STAT pathway is dramatically decreased. Depletion RNF168 reduced JAK-STAT target genes, such as IRF1, IRF9 and IFITM1. Immuno-precipitation reveals that RNF168 associates with STAT1 in the nucleus, stabilizing STAT1 protein and inhibiting its poly-ubiquitination and degradation. Our study provides a novel mechanism that RNF168 promoting JAK-STAT signalling in supporting oesophageal cancer progression. It could be a promising strategy to target RNF168 for oesophageal cancer treatment.

Influence of dietary inosine and vitamin C supplementation on growth, blood chemistry, oxidative stress, innate and adaptive immune responses of red sea bream, Pagrus major juvenile.

Both inosine (INO) and vitamin C (l-ascorbic acid, AsA) play important roles in growth performance, feed utilization and health status of fish. Therefore, a 56 days feeding trial was conducted to determine the interactive effects of dietary INO and AsA on growth performance, oxidative status, innate and adaptive immune responses of red sea bream. Fish growth performance and fed utilization parameters were significantly affected by dietary INO supplementation but not by AsA. Fish fed diets with INO at 4 g kg-1 diet in combination of high and low levels of AsA (3.1 g kg-1 and 9.3 g kg-1) produced the highest growth and feed utilization performances. In terms of growth and feed utilization performances no significant interaction effects were observed between INO and AsA. Dietary INO significantly influenced hematocrit, glucose and glutamyl oxaloacetic transaminase (GOT) content of red sea bream meanwhile AsA also significantly influenced hematocrit, glucose, total cholesterol, blood urea nitrogen (BUN) and glutamic-pyruvate transaminase (GPT) content of the test fish. No significant interaction effects was also observed between INO and AsA on measured hematological parameters. Reactive oxygen metabolites (d-ROMs) significantly influenced by both INO and AsA. Fish fed diet groups D1, D4 and D6 showed best oxidative stress resistance. Only INO was a significant factor on nitro-blue-tetrazolium activity (NBT) and bactericidal activity (BA). Neither INO nor AsA was a significant factor on serum catalase activity (CAT), total serum protein (TSP), peroxidase activity (PA) and lysozyme activity (LA). No significant interaction effects was observed between INO and AsA on measured innate immune parameters. Agglutination antibody titer was significantly influenced by dietary supplementation, after 15 days of vaccination but not in 21 days. In the day 15th fish and diet group D3 and D5 showed significantly higher values compared to diet groups control and D1. INO was the only significant factor of increasing agglutination antibody titer in 15 t h day. While AsA was not a significant factor on agglutination antibody titer values in day 15 t h, there was an interaction between dietary INO and AsA levels. Finally under the experimental conditions, fish fed high INO and low AsA levels (4 g kg-1 and 0.31 g kg-1 diet, respectively) showed best growth and feed utilization performance. Simultaneously, low level of INO and high level of AsA (2 g kg-1 and 0.93 g kg-1 diet, respectively) improved blood chemistry and immunological parameters. Furthermore, combined use of INO and AsA is possible to improve hemato-immunological responses of red sea bream.

Bacillus subtilis as probiotic candidate for red sea bream: Growth performance, oxidative status, and immune response traits.

The effects of dietary administration of Bacillus subtilis on the growth, digestive enzyme activity, blood chemistry, oxidative status and immune response of red sea bream (Pagrus major) were evaluated in the current study. Fish fed five different levels of B. subtilis at 0 (BS0), 1 × 104 (BS1), 1 × 106 (BS2), 1 × 108 (BS3) and 1 × 1010 (BS4) CFU kg-1 diet for 60 days. The obtained results showed that B. subtilis supplementation significantly improved growth performance (FBW, WG and SGR), feed utilization (FI, FCE, PER and PG) and whole-body protein content when compared to the control group (P < 0.05). Furthermore, the specific activities of amylase, protease and lipase enzymes up regulated significantly upon B. subtilis incorporation in red sea bream diets (P < 0.05). No changes have been reported on blood biochemical variables except for the plasma total protein, which increased significantly in fish fed BS3 diet when compared with the control diet (P < 0.05). Hematocrit, hemoglobin and the nitro blue tetrazolium values also reported the highest values significantly in fish fed B. subtilis, especially in case of BS3 and BS4 diets (P < 0.05). Serum bactericidal activity enhanced significantly in BS2, BS3 and BS4 groups (P < 0.05), while mucus bactericidal activity showed no significant activity among tested groups (P > 0.05). Serum lysozyme activity exhibited higher values in case of BS3 and BS4 groups than BS0 group (P < 0.05), while mucus lysozyme activity increased only in BS3 group. Also, serum peroxidase activity enhanced significantly in fish fed BS2 and BS3 diets (P < 0.05), however, no activities were observed in the collected mucus. All groups reflexed high tolerance ability against oxidative stress except for BS0 and BS1 groups. Additionally, catalase activity increased significantly in all B. subtilis fed groups when compared to BS0 group (P < 0.05). Considering the obtained results, the supplementation of B. subtilis in the diet of red sea bream at 1 × 108 and 1 × 1010 CFU kg-1 diet could improve the growth, feed utilization, health condition and immune response.

Physiological response, blood chemistry profile and mucus secretion of red sea bream (Pagrus major) fed diets supplemented with Lactobacillus rhamnosus under low salinity stress.

Environmental stressors caused by inadequate aquaculture management strategies suppress the immune response of fish and make them more susceptible to diseases. Therefore, efforts have been made to relieve stress in fish by using various functional feed additives in the diet, including probiotics. The present work evaluates the effects of Lactobacillus rhamnosus (LR) on physiological stress response, blood chemistry and mucus secretion of red sea bream (Pagrus major) under low salinity stress. Fish were fed four diets supplemented with LR at [0 (LR0), 1 × 102 (LR1), 1 × 104 (LR2) and 1 × 106 (LR3) cells g-1] for 56 days. Before stress, blood cortisol, urea nitrogen (BUN) and total bilirubin (T-BIL) showed no significant difference (P > 0.05), whereas plasma glucose and triglyceride (TG) of fish-fed LR2 and LR3 diets were significantly lower (P < 0.05) than those of the other groups. Plasma total cholesterol (T-CHO) of fish-fed LR3 diet was significantly (P < 0.05) lower than that of the other groups. Furthermore, total plasma protein, mucus myeloperoxidase activity and the amount of mucus secretion were significantly enhanced in LR-supplemented groups when compared with the control group (P < 0.05). After the application of the low salinity stress test, plasma cortisol, glucose, T-CHO and TG contents in all groups showed an increased trend significantly (P < 0.01) compared to the fish before the stress challenge. However, plasma total protein and the amount of secreted mucus showed a decreased trend in all groups. On the other hand, BUN, T-BIL and mucus myeloperoxidase activity showed no significant difference after exposure to the low salinity stress (P > 0.05). In addition, the fish that received LR-supplemented diets showed significantly higher tolerance against low salinity stress than the fish-fed LR-free diet (P < 0.05). The physiological status and the detected immune responses, including total plasma protein and mucus myeloperoxidase activity in red sea bream, will provide a more comprehensive outlook of the effects of probiotics to relieve stress in fish.

Counting the Cost of Pins and Needles: A Case Study of Paresthesias and the Cost of Healthcare in the United States.

Healthcare costs in the United States (US) exceed those of comparable nations without yielding better outcomes. Factors contributing to this include lack of cost transparency, limited outpatient resources due to primary care provider shortages, and high patient volumes, where patients are not educated on differentials and the stepwise process of workup. Addressing these issues could curb unnecessary hospitalizations and expenses. A 31-year-old woman with hypertension, alcohol use, anemia, and obesity experienced paresthesias in September 2022. At her first visit, the exam was consistent with decreased bilateral plantar sensation; however, there was no weakness or gait abnormality. This was not consistent with a focal neurologic distribution. Despite multiple ER visits, her condition persisted. Initial evaluations included potassium replacement ($80 for labs, $13 for tablet), nonacute head CT ($1500), and benign CT L-spine ($2500). Subsequent hospitalization led to brain MRI/MRA head/neck ($6700) and serum workup ($240), revealing deficiencies in vitamin D, folate, and B12. Treatment involved prednisone taper ($30) and supplemental vitamins ($35), with lifestyle recommendations ($0). After evaluating CompuNet lab costs and equivalent market imaging prices, potential savings exceeding $15,000 were identified through more focused and cost-conscious initial testing including vitamin studies and outpatient management, reducing hospitalizations and imaging expenses. Rising healthcare costs in the US are driven by various factors, yet fail to correlate with improved outcomes. Our case argues that enhancing access to primary care, promoting cost transparency, and educating patients on healthcare decisions are crucial for mitigating excessive spending.