Impact of simulation-based training on bougie-assisted cricothyrotomy technique: a quasi-experimental study.

BACKGROUND: Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness. METHODS: Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants' confidence in performing cricothyrotomy was conducted during the training session. RESULTS: The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5-103.0 s) to the posttest (median = 59.0 s, IQR = 49.0-69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5-39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0-25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants' confidence levels in performing cricothyrotomy also improved after the curriculum. CONCLUSION: The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy.

Assessment of the risk factors of duodenogastric reflux in relation to different dietary habits in a Chinese population of the Zhangjiakou area.

Objective: To explore the risk factors of duodenogastric reflux (DGR) in relation to different dietary habits. Methods: A total of 106 patients with symptoms of DGR who underwent electronic gastroscopy from June 2019 to June 2020 were selected and divided into the DGR group (n = 33) and the non-DGR group (n = 73) according to the diagnosis of bile reflux. Questionnaires were used to collect the basic information and dietary habits of the patients, including age, gender, body mass index, place of residence, comorbidities, dietary composition, salt intake, smoking and drinking consumption. The total bile acid (TBA) and cholesterol (CHO) of the gastric juice were measured using a fully automated biochemical analyser, with an enzyme-linked immunosorbent assay used for the serum cholecystokinin, gastrin and gastrin levels. Univariate analysis and multivariate logistic regression analysis were used to predict the attendant DGR risk factors. Results: There was no significant difference in age or gender between the DGR and the non-DGR groups (P > 0.05). The proportion of patients living in the Bashang region was significantly higher in the DGR group (78.79%) than in the non-DGR group (38.36%) (P < 0.05). The levels of TBA and CHO in the gastric juice and the cholecystokinin and gastrin levels in the serum of the DGR group were higher than those in the non-DGR group, while the serum motilin levels were significantly lower in the DGR group than in the non-DGR group (P < 0.05). The univariate analysis indicated that the proportion of patients with daily consumption of dairy products and fried foods, a high salt intake and smoking and drinking consumption were significantly higher in the DGR than in the non-DGR group (P < 0.05). Conclusion: The daily consumption of dairy products and a preference for fried food are independent risk factors for the occurrence of DGR (odds ratio ≥ 1, P < 0.05).

Molecular identification of Bambusa changningensis is the natural bamboo hybrid of B. rigida × Dendrocalamus farinosus.

Bamboo is one of the fastest-growing plants commonly used in food, fibre, paper, biofuel, ornamental and medicinal industries. Natural hybridization in bamboo is rare due to its long vegetative period followed by gregarious flowering and death of the entire population. In the current study, a new bamboo species, Bambusa changningensis, shows intermediate characteristics of Dendrocalamus farinosus and B. rigida morphologically, but it is unknown whether B. changningensis is a natural hybrid. Moreover, B. changningensis has been identified as a superior variety of Sichuan Province with high pulping yield, fibre length and width. Therefore, we analyzed the morphological characteristics, DNA markers, DNA barcoding and chloroplast genomes to identify the hybrid origin of B. changningensis and possible maternal parent. We have developed the transcriptomic data for B. changningensis and mined the SSR loci. The putative parental lines and hybrid were screened for 64 SSR makers and identified that SSR14, SSR28, SSR31 and SSR34 markers showed both alleles of the parental species in B. changningensis, proving heterozygosity. Sequencing nuclear gene GBSSI partial regions and phylogenetic analysis also confirm the hybrid nature of B. changningensis. Further, we have generated the complete chloroplast genome sequence (139505 bp) of B. changningensis. By analyzing the cp genomes of both parents and B. changningensis, we identified that B. rigida might be the female parent. In conclusion, our study identified that B. changningensis is a natural hybrid, providing evidence for bamboo's natural hybridization. This is the first report on confirming a natural bamboo hybrid and its parents through SSR and chloroplast genome sequence.

Scalpel cricothyrotomy versus punctured cricothyrotomy in the context of the CICO crisis. A systematic review and Meta-analysis.

IMPORTANCE: The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic. OBJECTIVE: We performed a systematic review and meta-analysis comparing puncture cricothyrotomy with scalpel cricothyrotomy using overall success rate, first-time success rate, and time taken to perform the procedure as the primary outcome together with complications as a secondary outcome. EVIDENCE REVIEW: Pubmed databases, EMBASE databases, MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, from 1980 to October 2022. FINDINGS: A total of 32 studies were included in the systematic review and meta-analysis. It also showed that PCT was close to SCT in terms of overall success rate (82.2% vs. 82.6%, Odd Ratios OR = 0.91, [95%CI: 0.52-1.58], p = 0.74) as well as first-performance success rate (62.9% vs. 65.3%, OR = 0.52, [0.22-1.25], p = 0.15). PCT does not compare favorably with SCT in terms of required time for the procedure (the mean time required for PCT versus SCT incision in the intervention groups was 0.34 standard deviations higher (Mean Difference MD = 17.12, [3.37-30.87], p = 0.01) as well as complications (21.4% vs. 15.1%, Relative Risk RR = 1.49, [0.80-2.77], p = 0.21). CONCLUSIONS AND RELEVANCE: The results show that SCT has an advantage over PCT in terms of time required for the procedure, while there is no difference in overall success rate, first-time success rate after training, and complications. The superiority of SCT may be the result of fewer and more reliable procedural steps. However, the level of evidence is low (GRADE).

Dexmedetomidine Protects against Airway Inflammation and Airway Remodeling in a Murine Model of Chronic Asthma through TLR4/NF-κB Signaling Pathway.

Asthma is a common respiratory disease characterized by chronic airway inflammation. Dexmedetomidine (DEX), a highly selective α2 adrenergic receptor agonist, has been shown to participate in regulating inflammatory states and thus exert organ protective actions. However, the potential of DEX in asthma is still unknown. This study is aimed at investigating the role of DEX in a mouse model of house dust mite- (HDM-) induced asthma and exploring its underlying mechanism. Here, we found that DEX treatment significantly ameliorated airway hyperresponsiveness, airway inflammation, and airway remodeling in the asthmatic mice, which were similar to the efficacy of the reference anti-inflammatory drug dexamethasone. In addition, DEX reversed the increased expression of toll-like receptor 4 (TLR4) and its downstream signaling adaptor molecule nuclear factor-κB (NF-κB) in the lung tissue of asthmatic mice. Furthermore, these protective effects of DEX were abolished by yohimbine, an α2 adrenergic receptor antagonist. These results indicate that DEX is capable of ameliorating airway inflammation and remodeling in asthmatic mice, and this protective effect is associated with the inhibition of the TLR4/NF-κB signaling pathway.

The Short-Term Efficacy of Bifidobacterium Quadruple Viable Tablet in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: Potentially Mediated by Metabolism Rather Than Diversity Regulation.

INTRODUCTION: The therapeutic effect of probiotics for irritable bowel syndrome (IBS) was controversial. This study aims to evaluate the short-term efficacy of Bifidobacterium quadruple viable tablet in patients with diarrhea-predominant IBS and explore factors associated with response to probiotics. METHODS: A randomized, double-blind, placebo-controlled, multicenter trial was performed in 15 hospitals. A total of 290 patients who fulfilled the eligibility criteria were assigned to the probiotics or placebo group randomly with a ratio of 1:1 for a 4-week treatment and a 2-week follow-up. The primary outcome was the response rate. It was regarded as the proportion of patients with composite responses of improvement in both abdominal pain and diarrhea simultaneously. RESULTS: After 4-week continuous administration, the response rates of the probiotics and the placebo were 67.59% and 36.55%, respectively ( P < 0.001). In the probiotics, those with higher abdominal pain scores (2.674 [1.139-6.279]) were more likely to respond, but responders in placebo had lower Hamilton Depression Scale score (0.162 [0.060-0.439]), lower Hamilton Anxiety Scale score (0.335 [0.148-0.755]), and higher degree of bloating (2.718 [1.217-6.074]). Although the diversity of the microbiota was not significantly changed by probiotics, the abundance of bacteria producing short-chain fatty acids (SCFAs), including Butyricimonas ( P = 0.048), Pseudobutyrivibrio ( P = 0.005), Barnesiella ( P = 0.020), and Sutterella ( P = 0.020), and the concentration of SCFAs including butyric acid ( P = 0.010), valeric acid ( P = 0.019), and caproic acid ( P = 0.046) in feces increased. DISCUSSION: A Bifidobacterium quadruple viable tablet had a significant short-term efficacy for the treatment of diarrhea-predominant IBS and was more effective in patients with higher abdominal pain scores. This kind of probiotics could improve the abundance of several bacteria producing SCFAs and the concentration of fecal SCFAs compared with placebos.

Dexmedetomidine attenuates airway inflammation and oxidative stress in asthma via the Nrf2 signaling pathway.

Allergic asthma is a chronic inflammatory disease in which oxidative stress serves a pivotal role. In clinical practice, dexmedetomidine (DEX), an α­2­adrenergic receptor agonist, is used as a sedative. DEX exhibits antioxidative and organ­protective properties. In a murine model of asthma, DEX has a therapeutic effect via the toll like receptor 4/NF­ÐºB signaling pathway; however, whether DEX can exert an antioxidative effect on asthma has yet to be elucidated. In the present study, a T helper (Th)2­dominant murine asthma model was established. DEX treatment significantly reduced eosinophilic airway inflammation, mucus overproduction and airway hyperresponsiveness, as well as the concentrations of Th2 cytokines. The lung tissues of mice with asthma were characterized by redox imbalance (increased oxidative stress and impaired antioxidant capacity). DEX treatment alleviated this imbalance by decreasing the levels of malondialdehyde and reactive oxygen species, and increasing the levels of glutathione. Furthermore, the nuclear factor erythroid 2­related factor 2 (Nrf2) signaling pathway was inhibited in the lung tissues of asthmatic mice; these effects were noted in its downstream genes, heme oxygenase 1 and glutathione peroxidase 4. In mice with asthma, DEX treatment induced the expression of these antioxidant genes and the activation of Nrf2, whereas ML385 (an inhibitor of Nrf2) partially abrogated the antioxidative and therapeutic effects of DEX. To the best of our knowledge, the present study is the first to demonstrate the protective effect of DEX on Th2­dominant asthma through the activation of the Nrf2 signaling pathway. The results suggested that the antioxidative properties of DEX could be beneficial in clinical application of DEX for the relief of asthmatic symptoms.

Complete Chloroplast Genome Features of Dendrocalamusfarinosus and Its Comparison and Evolutionary Analysis with Other Bambusoideae Species.

Dendrocalamus farinosus is one of the essential bamboo species mainly used for food and timber in the southwestern region of China. In this study, the complete chloroplast (cp) genome of D. farinosus is sequenced, assembled, and the phylogenetic relationship analyzed. The cp genome has a circular and quadripartite structure, has a total length of 139,499 bp and contains 132 genes: 89 protein-coding genes, eight rRNAs and 35 tRNAs. The repeat analyses showed that three types of repeats (palindromic, forward and reverse) are present in the genome. A total of 51 simple sequence repeats are identified in the cp genome. The comparative analysis between different species belonging to Dendrocalamus revealed that although the cp genomes are conserved, many differences exist between the genomes. The analysis shows that the non-coding regions were more divergent than the coding regions, and the inverted repeat regions are more conserved than the single-copy regions. Moreover, these results also indicate that rpoC2 may be used to distinguish between different bamboo species. Phylogenetic analysis results supported that D. farinosus was closely related to D. latiflorus. Furthermore, these bamboo species' geographical distribution and rhizome types indicate two evolutionary pathways: one is from the tropics to the alpine zone, and the other is from the tropics to the warm temperate zone. Our study will be helpful in the determination of the cp genome sequences of D. farinosus, and provides new molecular data to understand the Bambusoideae evolution.

Clinical Comparison of Endoscopic Ultrasonography and CT in Preoperative TN Staging of Esophagogastric Junction Cancer.

In recent years, the incidence of esophagogastric junction cancer has increased year by year. It is a special type of gastric cancer, with 80% of patients being clinically in the middle and late stages. The traditional treatment methods are extremely ineffective, and the accuracy of preoperative staging is not good enough. At present, the medical treatment for esophagogastric junction cancer mainly adopts surgery and postoperative adjuvant therapy. The current mainstream clinical diagnostic methods of esophagogastric junction cancer before concurrent neoadjuvant chemoradiotherapy are X-ray, CT examination, and gastroscopic diagnosis. However, these clinical diagnostic methods have many limitations. Endoscopic ultrasonography (EUS) can accurately locate malignant tumors in the digestive tract, surrounding microstructures. It can diagnose lymphatic metastasis so as to provide a clear imaging basis for neoadjuvant chemoradiotherapy. This method can also effectively improve the prognosis of the esophagus and stomach according to the characteristics of the patient. In this experiment, we conducted a controlled trial on patients with stage III esophagogastric junction cancer, divided into an experimental group (neoadjuvant chemotherapy + surgery) and a control group (conventional surgery). The preoperative EUS staging in the control group, the preoperative EUS staging in the neoadjuvant chemoradiotherapy group, and the postoperative pathological staging were compared. The experiment showed that in the control group, the preoperative and postoperative accuracy of EUS was 89.2%, while the preoperative and postoperative accuracy of CT examination was only 62.5%. In the experimental group, the preoperative and postoperative accuracies of EUS and CT were 79.6% and 56.7%, respectively. EUS has both specificity and accuracy due to CT examination. Through studying EUS technology in the staging and diagnosis of esophagogastric junction cancer, the therapeutic effect of esophagogastric junction cancer can be improved. The prognosis of esophagogastric junction cancer can also be improved.

Dexmedetomidine alleviates airway hyperresponsiveness and allergic airway inflammation through the TLR4/NF­κB signaling pathway in mice.

Dexmedetomidine (DEX) suppresses inflammatory responses and protects against organ injury. The aim of the present study was to investigate the effect of DEX on airway hyperresponsiveness (AHR) and allergic airway inflammation, as well as its underlying mechanism of action in a murine model of ovalbumin (OVA)­induced asthma. A total of 30 female BALB/c mice were divided into 6 groups (n=5 mice/group): Control, OVA, OVA + DEX (20, 30 or 50 µg/kg) and OVA + TAK­242 [a toll­like receptor 4 (TLR4) inhibitor]. The mice were intraperitoneally injected with 20, 30 or 50 µg/kg DEX 1 h before OVA challenge. AHR to inhaled methacholine (Mch) was measured, and the mice were sacrificed 24 h after the last challenge. AHR following Mch inhalation was measured using the FlexiVent apparatus. Hematoxylin and eosin, periodic acid­Schiff and Wright­Giemsa staining was performed to evaluate inflammatory cell infiltration in the lung tissue. The levels of IL­4, IL­5 and IL­13 in the bronchoalveolar lavage fluid were analyzed using ELISA, and their mRNA expression levels in the lung tissue were examined using reverse transcription­quantitative PCR. The protein expression of TLR4, NF­κB and phosphorylated (p)NF­κB in the lung tissue was also detected using immunohistochemistry. In the murine OVA­induced asthma model, DEX decreased AHR following Mch inhalation and reduced the infiltration of inflammatory cells. IL­4, IL­5 and IL­13 levels in the bronchoalveolar lavage fluid were significantly lower following DEX treatment. Furthermore, DEX treatment inhibited the expression of TLR4, NF­κB and p­NF­κB in the lung tissue and exhibited a similar effect to TAK­242 treatment. In conclusion, DEX may attenuate AHR and allergic airway inflammation by inhibiting the TLR4/NF­κB pathway. These results suggested that DEX may represent a potential anti­inflammatory agent for the treatment and management of patients with asthma.

A POCS super resolution restoration algorithm based on BM3D.

The inherent shortcoming of POCS (Projection Onto Convex Sets) is its sensitiveness to noise. The restoration quality of POCS based super resolution will severely decline when the noise is larger. In practical applications, the low resolution images generally include some kinds of noise, such as camera internal noise, transmission system noise and coherent noise. Therefore POCS cannot be used directly in super-resolution restoration for observed low resolution images. In order to solve the noise sensitive problem of the traditional POCS restoration algorithm, we firstly propose to optimize the BM3D (Block-Matching 3D) filtering by mean pre-screening of image blocks and limiting the number of image blocks. Then we combine the optimized BM3D filtering with POCS restoration in this paper. Experimental results show that the proposed POCS super resolution restoration algorithm based on BM3D can achieve better restoration effect when the low resolution images contain noise. Furthermore no noise can be perceived in the restored high resolution image basically.

[Compression of interference hyperspectral image based on FHALS-NTD].

A hyperspectral interference image compression algorithm based on fast hierarchical alternating least squares nonnegative tensor Tucker decomposition (FHALS-NTD) is proposed. Firstly, the interference hyperspectral image is decomposed by 3-D OPD lifting-based discrete wavelet transform (3D OPT-LDWT) in the OPD direction. Then, the 3D DWT sub-bands decomposed are used as a three order nonnegative tensor, which is decomposed by the proposed FHALS-NTD algorithm to obtain 8 core tensors and 24 unknown component matrices. Finally, to obtain the final compressed bit-stream, each unknown component matrices element is quantized, and each core tensor is encoded by the proposed bit-plane coding of significant coefficients. The experimental results showed that the proposed compression algorithm could be used for reliable and stable work and has good compressive property. In the compression ratio range from 32 : 1 to 4 : 1, the average peak signal to noise ratio of proposed compression algorithm is higher than 40 dB. Compared with traditional approaches, the proposed method could improve the average PSNR by 1.23 dB. This effectively improves the compression performance of hyperspectral interference image.