Prospective Evaluation of the Peripheral Perfusion Index in Assessing the Organ Dysfunction and Prognosis of Adult Patients With Sepsis in the ICU.

Background: The peripheral perfusion index (PI) reflects microcirculatory blood flow perfusion and indicates the severity and prognosis of sepsis. Method: The cohort comprised 208 patients admitted to the intensive care unit (ICU) with infection, among which 117 had sepsis. Demographics, medication history, ICU variables, and laboratory indexes were collected. Primary endpoints were in-hospital mortality and 28-day mortality. Secondary endpoints included organ function variables (coagulation function, liver function, renal function, and myocardial injury), lactate concentration, mechanical ventilation time, and length of ICU stay. Univariate and multivariate analyses were conducted to assess the associations between the PI and clinical outcomes. Sensitivity analyses were performed to explore the associations between the PI and organ functions in the sepsis and nonsepsis groups. Result: The PI was negatively associated with in-hospital mortality (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.15 to 0.55), but was not associated with 28-day mortality. The PI was negatively associated with the coagulation markers prothrombin time (PT) (ß -0.36, 95% CI -0.59 to 0.13) and activated partial thromboplastin time (APTT) (ß -1.08, 95% CI -1.86 to 0.31), and the myocardial injury marker cardiac troponin I (cTnI) (ß -2085.48, 95% CI -3892.35 to 278.61) in univariate analysis, and with the PT (ß -0.36, 95% CI -0.60 to 0.13) in multivariate analysis. The PI was negatively associated with the lactate concentration (ß -0.57, 95% CI -0.95 to 0.19), mechanical ventilation time (ß -23.11, 95% CI -36.54 to 9.69), and length of ICU stay (ß -1.28, 95% CI -2.01 to 0.55). Sensitivity analyses showed that the PI was significantly associated with coagulation markers (PT and APTT) and a myocardial injury marker (cTnI) in patients with sepsis, suggesting that the associations between the PI and organ function were stronger in the sepsis group than the nonsepsis group. Conclusion: The PI provides new insights for assessing the disease severity, short-term prognosis, and organ function damage in ICU patients with sepsis, laying a theoretical foundation for future research.

Experimental study on the impact of signal bandwidth on the transverse mode instability threshold of fiber amplifiers.

In this work, we conduct a detailed experimental study on the impact of signal bandwidth on the TMI threshold of fiber amplifiers. Both the filtered superfluorescent fiber sources and the phase-modulated single-frequency lasers are employed to construct seed lasers with different 3 dB spectral linewidths ranging from 0.19 nm to 7.97 nm. The TMI threshold of the fiber amplifier employing those seed lasers are estimated through the intensity evolution of the signal laser, and different criteria have been utilized to characterize the spectral linewidth of the seed lasers. Notably, the experimental results reveal that the TMI threshold of fiber amplifiers grows, keeps constant, and further grows as a function of spectral linewidth of seed lasers. Our experimental results could provide a well reference to understand the mechanism of the TMI effect and optimize the TMI effect in high-power fiber amplifiers.

Bidirectional tandem-pumped high-brightness 6†kW level narrow-linewidth confined-doped fiber amplifier exploiting the side-coupled technique.

In this work, a bidirectional tandem-pumped high-power narrow-linewidth confined-doped ytterbium fiber amplifier is demonstrated based on side-coupled combiners. Benefiting from the large-mode-area design of the confined-doped fiber, the nonlinear effects, including stimulated Raman (SRS) and stimulated Brillouin scattering (SBS), are effectively suppressed. While the transverse mode instability (TMI) effect is also mitigated through the combination of confined-doped fiber design and the bidirectional tandem pumping scheme. As a result, narrow-linewidth fiber laser with 5.96 kW output power is obtained, the slope efficiency and the 3-dB linewidth of which are ∼81.7% and 0.42 nm, respectively. The beam quality is well maintained during the power scaling process, being around M2 = 1.6 before the TMI occurs, and is well kept (M2 = 2.0 at 5.96 kW) even after the onset of TMI. No SRS or SBS is observed at the maximum output power, and the signal-to-noise ratio reaches as high as ∼61.4 dB. To the best of our knowledge, this is the record power ever reported in narrow-linewidth fiber lasers. This work could provide a good reference for realizing high-power high-brightness narrow-linewidth fiber lasers.

3 kW power-level all-fiberized superfluorescent fiber source with linear polarization and near-diffraction-limited beam quality.

In this paper, we demonstrate a high-power linearly polarized all-fiberized superfluorescent fiber source (SFS) with near-diffraction-limited beam quality. The laser system is based on a master oscillator power amplifier configuration, which mainly consists of a polarization-maintained (PM) broadband SFS and multistage PM fiber amplifiers. A linearly polarized fiber laser over 3 kW is obtained at a pump power of about 4.3 kW with the corresponding slope efficiency of 71.9%. The polarization extinction ratio and the beam quality (M2 factor) of the output laser are about 12.7 dB and 1.18, respectively, at the maximum output power. To the best of our knowledge, this is the highest output power of a linearly polarized broadband SFS with near-diffraction-limited beam quality.

["Water-pathogen" theory-based Juanyin Tongluo Recipe for varicocele complicated with oligozoospermia: A clinical observation].

OBJECTIVE: To observe the clinical efficacy of the "water-pathogen" theory-based Juanyin Tongluo Recipe (JTR) in the treatment of varicocele (VC) complicated with oligozoospermia and its effects on the semen parameters, sperm morphology, sperm DNA fragmentation index (DFI) and testis volume of the patient. METHODS: Ninety-two VC patients complicated with oligozoospermia were randomly assigned to receive JTR (n = 47) and Maizhiling Tablets (the control group, n = 45), respectively, both for three months, followed by comparisons of the clinical effects, total sperm count, sperm motility, percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DNA fragmentation index (DFI) and testis volume of the patients before and after medication, and the pregnancy rate after treatment between the two groups. RESULTS: The total rate of effectiveness was significantly higher in the JTR than in the control group (87.23% vs 68.89%, P < 0.05). Compared with the baseline, the patients showed dramatic improvement after treated with JTR in the sperm count (ï¼»16.35 ± 3.52ï¼½ vs ï¼»43.82 ± 6.02ï¼½ ×106, P < 0.05), sperm motility (ï¼»17.37 ± 6.76ï¼½% vs ï¼»36.68 ± 11.32ï¼½%, P < 0.05), PMS (ï¼»13.42 ± 5.62ï¼½% vs ï¼»31.03 ± 7.47ï¼½%, P < 0.05), MNS (ï¼»1.91 ± 0.13ï¼½% vs ï¼»4.06 ± 0.11ï¼½%, P < 0.05), and sperm DFI (ï¼»43.32 ± 7.84ï¼½% vs ï¼»26.98 ± 6.87ï¼½%, P < 0.05), and even better than in the control group (sperm count ï¼»15.78 ± 3.84ï¼½ vs ï¼»31.53 ± 5.62ï¼½ ×106, P < 0.05; sperm motility ï¼»19.41 ± 6.24ï¼½% vs ï¼»31.32 ± 9.73ï¼½%, P < 0.05; PMS ï¼»14.01 ± 4.98ï¼½% vs ï¼»20.71 ± 6.49ï¼½%, P < 0.05; MNS ï¼»1.88 ± 0.14ï¼½% vs ï¼»3.12 ± 0.09ï¼½%, P < 0.05; sperm DFI ï¼»41.42 ± 9.62ï¼½% vs ï¼»34.13 ± 5.73ï¼½%, P < 0.05; sperm DFI, P < 0.05). And the rate of natural pregnancy was significantly higher in the JTR group than in the control (40.43% vs 20%, P < 0.05). No statistically significant difference, however, was observed in the testis volume before and after treatment between the JTR group (ï¼»11.53 ± 1.24ï¼½ vs ï¼»10.89 ± 1.17ï¼½ ml, P > 0.05) and the control (ï¼»10.94 ± 1.34ï¼½ vs ï¼»10.65 ± 1.52ï¼½ ml, P > 0.05). CONCLUSION: Juanyin Tongluo Recipe can increase the total sperm count, sperm motility, percentages of PMS and MNS and sperm DFI, and improve the rate of natural pregnancy in VC patients complicated with oligozoospermia.

[Baihe Yuzi Prescription improves asthenospermia by up-regulating the expression of CFTR in the sperm].

OBJECTIVE: To observe the therapeutic efficacy of Baihe Yuzi Prescription (BYP) in the treatment of clinical syndrome-free asthenospermia and its effects on semen parameters, sperm DNA fragmentation index (DFI) and the expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in the sperm. METHODS: We randomly divided 112 patients with clinical syndrome-free asthenospermia into a control group (n = 55) and an experimental group (n = 57), the former treated orally with L-carnitine liquid combined with vitamin E capsules and the latter with BYP in addition, both for 3 months. After treatment, we obtained the total sperm count, sperm motility, percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DFI and expression of CFTR in the sperm, and compared the above parameters between the two groups of patients before and after medication. RESULTS: The total effectiveness rate was significantly higher in the experimental group (82.46%) than in the control (65.45%) (P < 0.05). Compared with the baseline, the patients in the experimental group showed significant improvement after treatment in the total sperm count (��53.5��3.5�� vs ��86.5��3.9�� ��106, P < 0.05), sperm motility (��23.5��3.5��% vs ��38.8��3.7��%, P < 0.05), PMS (��20.1��3.2��% vs ��30.3��3.3��%, P < 0.05), MNS (��2.3��0.3��% vs ��3.9��0.4��%, P < 0.05), sperm DFI (��37.3��3.1��% vs ��25.2��3.4��%, P < 0.05) and the expression of CFTR (P < 0.05), and even better improvement than the controls in sperm motility (��23.8��3.7��% vs ��30.2��3.4��%, P < 0.05), PMS (��19.6��3.1��% vs ��25.3��2.9��%, P < 0.05), MNS (��2.4��0.4��% vs ��3.1��0.3��%, P < 0.05), and sperm DFI (��36.6��3.3��% vs ��30.3��3.1��%, P < 0.05). The total sperm count and the expression of CFTR, however, were not significantly improved in the control group after treatment (P > 0.05). CONCLUSION: Baihe Yuzi Prescription can increase sperm count and motility, improve sperm morphology and DFI in patients with clinical syndrome-free asthenospermia, which may be related to the up-regulated expression of CFTR in the sperm.

Template-Free Synthesis of Hierarchical SSZ-13 Microspheres with High MTO Catalytic Activity.

Hierarchical SSZ-13 microspheres, with abundant mesoporous channels, have been successfully synthesized by addition of calcined SSZ-13 crystals in the starting gel in the absence of any organic templates. This strategy not only remarkably reduces the production cost and environmental pollution, but also significantly decreases the crystallization time as well as evidently reducing the zeolite crystal sizes in many cases. The synthesized sample was characterized by XRD, BET, ICP, SEM, TEM, TG, and NH3 -TPD, which indicates that the organic template free synthesized SSZ-13 exhibits high crystallinity, textural properties, and acidity. Moreover, the synthesized hierarchical SSZ-13 catalyst shows outstanding performance in the methanol-to-olefin (MTO) reaction, with slightly higher ethylene plus propylene selectivity and prolonged catalyst lifetime as compared to the templated SSZ-13 catalyst.

MMP3 -1171 5A/6A Promoter Genotype Influences Serum MMP3 Levels and Is Associated with Deep Venous Thrombosis.

BACKGROUND: The aim of this study was to investigate the roles of MMP3 (matrix metalloproteinase-3) gene polymorphism and protein expression in deep venous thrombosis (DVT) among Chinese Han population. METHODS: A total of 280 subjects were included in this study and categorized as case group (144 DVT patients) and control group (136 healthy individuals). Polymerase chain reaction-restriction fragment length polymorphism was used to detect MMP3 promoter -1171 5A>6A genotype and allele frequencies. MMP3 serum levels were measured by enzyme-linked immunosorbent assay. SPSS version 18.0 statistical software was used for data analysis. RESULTS: There was significant difference in genotype frequencies of MMP3 gene -1171 5A>6A between the case group and the control group (all P < 0.05). Furthermore, the 6A allele on MMP3 -1171 5A>6A may be associated with increased risk of DVT (odds ratio 1.961, 95% confidence interval 1.309-2.939, P < 0.01). The MMP3 serum level in DVT patients was markedly higher than the control group (case group: 28.45 ± 10.97 vs. CONTROL GROUP: 18.18 ± 9.03, P < 0.05). Serum MMP3 level in DVT patients carrying 5A/6A and 6A/6A genotypes was higher than the control group (P < 0.05). The bilateral calf circumference difference was significantly higher in DVT patients than the control group among all the genotypes at MMP3 gene -1171 5A>6A (all P < 0.05). CONCLUSION: MMP3 gene -1171 5A>6A polymorphism and upregulated protein expression may be associated with DVT risk in Chinese Han population.

Biomechanical comparison of femoral neck anti-rotation and support system versus femoral neck system for unstable pauwels III femoral neck fractures.

BACKGROUND: The optimal treatment method for managing unstable Pauwels III femoral neck fractures remains undetermined. The aim of this study was to compare the biomechanical properties of two types of Femoral Neck Anti-rotation and Support System (FNAS) and a Femoral Neck System (FNS) in unstable Pauwels III femoral neck fractures. METHODS: Eighteen synthetic femoral models were implanted with one of three fixation devices: FNS, FNAS I, or FNAS II. An unstable Pauwels III (OTA/AO 31-B2.3) femoral neck fracture was simulated using a custom-made needle and osteotomy guide. Torsion and axial compression loading tests were conducted, and the torque, torsion angle, load to failure, displacement, and stiffness values were recorded. RESULTS: FNAS II exhibited significantly higher torsional stiffness (0.67 ± 0.10 Nm/°) compared to FNAS I (0.52 ± 0.07 Nm/°, P = 0.01) and FNS (0.54 ± 0.07 Nm/°, P = 0.005). FNS demonstrated significantly greater mean axial stiffness (239.24 ± 11.38 N/mm) than both FNAS I (179.33 ± 31.11 N/mm, P = 0.005) and FNAS II (190.07 ± 34.11 N/mm, P = 0.022). FNAS I (302.37 ± 33.88 N/mm, P = 0.001) and FNAS II (319.59 ± 50.10 N/mm, P < 0.001) showed significantly higher initial axial stiffness compared to FNS (197.08 ± 33.68 N/mm). Both FNAS I and II improved resistance to deforming forces at a load level before approximately 1000 N, which is sufficient to withstand the load from most daily life activities. No significant differences were observed in compression failure load among the groups. The failure patterns at the point of failure included the pull-out of the distal locking screw and reverse oblique intertrochanteric femur fracture for FNS, while for FNAS I and II, the failures were characterized by a cleft on the calcar femorale and a decrease in the load-displacement curve. CONCLUSIONS: In unstable Pauwels III femoral neck fractures, the FNAS II enhances stability and is easier to manage for reoperation. The results of the current study support the potential of FNAS II as an alternative option for treating unstable Pauwels III femoral neck fractures in young individuals.

The Exosome-Mediated Bone Regeneration: An Advanced Horizon Toward the Isolation, Engineering, Carrying Modalities, and Mechanisms.

Exosomes, nanoparticles secreted by various cells, composed of a bilayer lipid membrane, and containing bioactive substances such as proteins, nucleic acids, metabolites, etc., have been intensively investigated in tissue engineering owing to their high biocompatibility and versatile biofunction. However, there is still a lack of a high-quality review on bone defect regeneration potentiated by exosomes. In this review, the biogenesis and isolation methods of exosomes are first introduced. More importantly, the engineered exosomes of the current state of knowledge are discussed intensively in this review. Afterward, the biomaterial carriers of exosomes and the mechanisms of bone repair elucidated by compelling evidence are presented. Thus, future perspectives and concerns are revealed to help devise advanced modalities based on exosomes to overcome the challenges of bone regeneration. It is totally believed this review will attract special attention from clinicians and provide promising ideas for their future works.

A Prospective Study of the Association of IL6 with the Critical Unit and Their Effect on in-Hospital Mortality in Critically Ill Patients.

Purpose: We previously proposed a new concept, the "critical unit", which covers the structural integrity and function of mitochondria and endothelium. Injury of the critical unit plays a key role in the development of critical illnesses. High levels of inflammation may lead to abnormalities of the critical unit, which is an important mechanism for critical illnesses, and both inflammation and critical unit dysfunction may affect patient prognosis. Here we evaluated the correlation between interleukin-6 (IL6) and the critical unit biomarkers in critically ill patients and the impact of both on prognosis. Patients and Methods: This study included adult patients admitted to the intensive care unit for various reasons from January 1st to May 31st, 2023. Baseline characteristics, intensive care unit parameters, and laboratory test and outcome data were obtained from the electronic medical records system. Critical unit parameters were measured using polymerase chain reaction and enzyme-linked immunosorbent assay methods. Correlations were examined between IL6, critical unit parameters, and various outcomes. Results: In critically ill patients, IL6 was closely associated with all the critical unit biomarkers (activated partial thromboplastin time, sphingosine 1-phosphate, mitochondrial DNA, mitochondrial fission 1, and Parkin) and the prognoses of patients. A nomogram was constructed using the critical unit biomarkers to predict the in-hospital mortality of critically ill patients. The area under the curve for the mortality prediction model was 0.708. In sensitivity analyses, the predictive effect was better in the non-surgery and tumor groups compared with the surgery and non-tumor groups, with area under the curve values of 0.885 and 0.891, respectively. Conclusion: Our study innovatively integrated mitochondrial and endothelial markers in the critical unit to comprehensively evaluate patient prognosis, which may be a trend in the future assessment of critically ill patients. There are few such studies, and ours may promote the progress of related research.

Microcirculation and Mitochondria: The Critical Unit.

Critical illness is often accompanied by a hemodynamic imbalance between macrocirculation and microcirculation, as well as mitochondrial dysfunction. Microcirculatory disorders lead to abnormalities in the supply of oxygen to tissue cells, while mitochondrial dysfunction leads to abnormal energy metabolism and impaired tissue oxygen utilization, making these conditions important pathogenic factors of critical illness. At the same time, there is a close relationship between the microcirculation and mitochondria. We introduce here the concept of a "critical unit", with two core components: microcirculation, which mainly comprises the microvascular network and endothelial cells, especially the endothelial glycocalyx; and mitochondria, which are mainly involved in energy metabolism but perform other non-negligible functions. This review also introduces several techniques and devices that can be utilized for the real-time synchronous monitoring of the microcirculation and mitochondria, and thus critical unit monitoring. Finally, we put forward the concepts and strategies of critical unit-guided treatment.

Hypoxia-inducible factor-1α is a biomarker for predicting patients with sepsis.

OBJECTIVE: This study aimed to investigate the potential value of serum hypoxia-inducible factor-1α (HIF-1α) concentrations as a biomarker in patients with sepsis. METHODS: The enrolled patients were divided into the following four groups: the intensive care unit (ICU) control group (n = 33), infection group (n = 29), septic nonshock group (n = 40), and septic shock group (n = 94). An enzyme-linked immunosorbent assay was used to measure serum HIF-1α concentrations on ICU admission. Clinical parameters and laboratory test results were also collected. RESULTS: Serum HIF-1α concentrations were significantly higher in the infection group, septic nonshock group, and septic shock group than in the ICU control group. Moreover, HIF-1α concentrations were associated with a better predictive ability for diagnosing sepsis than the Acute Physiology and Chronic Health Evaluation II score, procalcitonin concentrations, and lactate concentrations. Patients with sepsis and HIF-1α concentrations >161.14 pg/mL had a poor prognosis. CONCLUSIONS: Serum HIF-1α concentrations are a useful biomarker for the diagnosis of sepsis and predicting the prognosis of patients.

Identification of key genes for IgA nephropathy based on machine learning algorithm and correlation analysis of immune cells.

INTRODUCTION: The pathogenesis and progression mechanism of Immunoglobulin A nephropathy (IgAN) is not fully understood. There is a lack of panoramic analysis of IgAN immune cell infiltration and algorithms that are more efficient and accurate for screening key pathogenic genes. METHODS: RNA sequencing (RNA-seq) data sets on IgAN were downloaded from the Gene Expression Omnibus (GEO) database, including GSE93798, GSE35489, and GSE115857. The RNA-seq data set of kidney tissue as control samples were downloaded from the Genotype-Tissue Expression (GTEx) database. Three machine learning algorithms-weighted gene co-expression network analysis (WGCNA), least absolute shrinkage and selection operator (LASSO), and support vector machine-were used to identify the key pathogenic gene sets of the IgAN disease. The ssGSEA method was applied to calculate the immune cell infiltration (ICI) of IgAN samples, whereas the Spearman test was used for correlation analysis. The receiver operator characteristic curve (ROC) was used to evaluate the diagnostic efficacy of key genes. The correlation between the key genes and ICI was analyzed using the Spearman test. RESULTS: A total of 177 genes were screened out as differentially expressed genes (DEGs) for IgAN, including 135 up-regulated genes and 42 down-regulated genes. The DEGs were significantly enriched in the inflammatory- or immune-related pathways (gene sets). Activating transcription factor 3 (AFT3), C-X-C Motif Chemokine Ligand 6 (CXCL6), and v-fos FBJ murine osteosarcoma viral oncogene homolog B (FOSB) were identified using WGCNA, support vector machine, and LASSO algorithms. These three genes revealed good diagnostic efficacy in the training and test cohorts. The CXCL6 expression positively correlated with activated B cells and memory B cells. CONCLUSION: ATF3, FOSB, and CXCL6 genes were identified as potential biomarkers of IgAN. These three genes exhibited good diagnostic efficacy for IgAN. We described the landscape of immune cell infiltration for IgAN. Activated B cells and memory B cells were more highly expressed in the IgAN samples than in the control samples. CXCL6 seems crucial to the pathogenesis of IgAN and may induce IgAN by enriching immune cells. Our study may contribute to developing CXCL6 inhibitors that target B cells for IgAN therapy.

Comprehensive treatment of deep frostbite of multiple fingers after trauma: A case report.

BACKGROUND: Frostbite is becoming increasingly common in urban environments, and severe cases can lead to tissue loss. The treatment goal is to preserve tissue and function; the sooner appropriate treatment is administered, the more tissue can be saved. However, not every patient with deep frostbite seeks medical care promptly. CASE SUMMARY: We report the case of a 73-year-old male patient who was lost in the wilderness for 2 d due to trauma and confusion. He experienced deep frostbite on multiple fingers. Treatment should not be discontinued for patients with deep frostbite who present after the optimum treatment timing. Bullae that no longer form (bloody) blisters within 24 h of aspiration should be removed. Mucopolysaccharide polysulfate cream has clinical value in frostbite treatment. The patient was transferred to Chinese Academy of Medical Sciences and Peking Union Medical College Hospital 12 h after being rescued. The patient had contraindications for thrombolysis, the most effective treatment, due to intracranial hemorrhage and presenting past the optimum treatment timing. We devised a comprehensive treatment plan, which involved delayed use vasodilators and high-pressure oxygen therapy at day 49 post-injury. We experimented with mucopolysaccharide polysulfate cream to treat the frostbite. The aim of the treatment was to safeguard as much tissue as possible. In the end, the fingers that suffered from frostbite were able to be partially preserved. CONCLUSION: The case indicated that patients with severe frostbite who missed the optimal treatment time and had contraindications for thrombolysis could still partially preserve the affected limbs through comprehensive treatment.

Electrical stimulation of anal sphincter or pudendal nerve improves anal sphincter pressure.

OBJECTIVE: Stimulation of the pudendal nerve or the anal sphincter could provide therapeutic options for fecal incontinence with little involvement of other organs. The goal of this project was to assess the effects of pudendal nerve and anal sphincter stimulation on bladder and anal pressures. DESIGN: Ten virgin female Sprague Dawley rats were randomly allocated to control (n = 2), perianal stimulation (n = 4), and pudendal nerve stimulation (n = 4) groups. A monopolar electrode was hooked to the pudendal nerve or placed on the anal sphincter. Aballoon catheter was inserted into the anus to measure anal pressure, and a catheter was inserted into the bladder via the urethra to measure bladder pressure. Bladder and anal pressures were measured with different electrical stimulation parameters and different timing of electrical stimulation relative to spontaneous anal sphincter contractions. RESULTS: Increasing stimulation current had the most dramatic effect on both anal and bladder pressures. An immediate increase in anal pressure was observed when stimulating either the anal sphincter or the pudendal nerve at stimulation values of 1 mA or 2 mA. No increase in anal pressure was observed for lower current values. Bladder pressure increased at high current during anal sphincter stimulation, but not as much as during pudendal nerve stimulation. Increased bladder pressure during anal sphincter stimulation was due to contraction of the abdominal muscles. CONCLUSION: Electrical stimulation caused an increase in anal pressures with bladder involvement only at high current. These initial results suggest that electrical stimulation can increase anal sphincter pressure, enhancing continence control.

[Percutaneous nephroscopic 2 µm laser incision and drainage treatment of peripelvic renal cysts].

OBJECTIVE: To explore the surgical approaches, efficacy and safety of percutaneous nephroscopic 2 µm laser incision and drainage in the treatment of peripelvic renal cysts. METHODS: The peripelvic renal cysts were punctured percutaneously. A 1.5 - 4.0 cm incision was made at thin avascular area between cyst and pelvis by the 2 µm laser to connect the cyst with the renal collecting system with the help of injecting methylene blue solution into renal pelvis through ureteral catheter. The double-J tube was placed for drainage. RESULTS: The operations were successful in all cases. There were 16 males and 15 females with a mean age of 49 years old. The operative durations ranged from 25 to 120 minutes. And no severe complications occurred. The patients were followed up for an average of 12 months (range: 3 - 36). Among them, cysts disappeared in 18 cases and diminished over 1/3 in 13 cases. There was no recurrence of peripelvic renal cyst. CONCLUSION: Percutaneous nephroscopic 2 µm laser incision and drainage for peripelvic renal cyst is safe, effective and mini-invasive.

Resuscitation fluids as drugs: targeting the endothelial glycocalyx.

ABSTRACT: Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

3.96 kW All-Fiberized Linearly Polarized and Narrow Linewidth Fiber Laser with Near-Diffraction-Limited Beam Quality.

In this paper, we realize a 3.96 kW all-fiberized and polarization-maintained (PM) amplifier with narrow linewidth and near-diffraction-limited beam quality. Based on a master oscillator power amplifier (MOPA) configuration seeded with phase-modulated single-frequency laser, a 3.96 kW signal laser is achieved with a 3 dB linewidth of 0.62 nm at the pump power of 5.02 kW. At the maximum output power, the polarization extinction ratio (PER) is ~13.9 dB, and the beam quality (M2 factor) is M2x = 1.31, M2y = 1.41. As far as we know, this is the maximum output power of PM narrow linewidth fiber laser with near-diffraction-limited beam quality and all-fiber format.