Application of Phenylephrine Combined with Goal-Directed Fluid Therapy in Elderly Patients Undergoing Hip Arthroplasty: A Randomized Controlled Trial.

Objective: To investigate the therapeutic effect of phenylephrine combined with goal-directed fluid therapy (GDFT) in elderly patients undergoing total hip arthroplasty. Methods: From June 2018 to May 2019, a total of 80 patients, age > 70 years, scheduled for total hip arthroplasty at Guangzhou Red Cross Hospital in China were consecutively included in this prospective randomized controlled trial. The patients were divided into 2 groups of 40 patients each by the random number table method. Patients in the control group were given GDFT alone, and patients in the experimental group were given phenylephrine combined with GDFT. The duration of surgery, blood loss, intraoperative urine output, and fluid input were analyzed. Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI) and stroke volume variation (SVV) were compared in the 2 groups at different times: before surgery (T0), after induction (T1), before bone cement placement (T2), after bone cement placement (T3) and after surgery (T4). Lactate, oxygenation index and cerebral oxygen uptake rate were compared perioperatively. Meanwhile, the incidence of abdominal distension, nausea and vomiting, pulmonary infection and cognitive dysfunction within 7 days after surgery were compared. Results: The intraoperative fluid input in the experimental group was significantly lower than in the control group (P < .05). In T1 and T3, heart rate (HR) and stroke volume variability (SVV) in the control group were significantly higher than in the experimental group (P < .05), but mean arterial pressure (MAP) and cardiac index (CI) were significantly lower than in the experimental group (P < .05). The intraoperative lactic acid in the control group was significantly higher than in the experimental group (P < .05). In addition, we found that the intraoperative oxygenation index and the postsurgical oxygenation index in the control group decreased by 86.86% and 87.49%, respectively, compared with the preoperative values (P < .05). In addition, at T1 and T3, HR and SVV in the control group were significantly higher than T0 (P < .05), while MAP and CI were significantly lower than T0 (P < .05). In the experimental group, there was no significant difference in HR, SVV, MAP or CI at any time points compared with those of T0 (P < .05). The oxygenation index in the control group was lower than before surgery (P < .05). There was no significant difference in urine volume or brain oxygen uptake between the 2 groups (P < .05). Conclusion: Phenylephrine combined with GDFT can be used in elderly patients undergoing hip arthroplasty to reduce fluid input and improve intraoperative hemodynamic stability, to reduce the occurrence of postoperative related complications.

Air Pollution, Environmental Violation Risk, and the Cost of Debt: Evidence from China.

Although a firm's exposure to air pollution-related risk has become an important factor that creditors cannot ignore in the procedure of lending decision making with the aggravation of air pollution, empirical evidence on whether and how air pollution affects the cost of debt has been relatively scarce. Employing a series of Chinese listed firms from the main board of the Shanghai and Shenzhen Stock Exchanges covering 2014 to 2018, our research responds to this research gap by exploring how air pollution-induced environmental violation risk affects the cost of debt by constructing an assessment system of firms' environmental violation risk. The results shed light on an issue that firms exposed to higher concentrations of air pollution may suffer a higher environmental violation risk, resulting in a higher debt cost. In addition, a further analysis shows that environmental regulatory pressure and heavily polluting firms enhance the influence of air pollution on the cost of debt, while state-owned firms and firms' economic contributions weaken the influence of air pollution on the cost of debt. Our research is conducive to highlighting not only the importance of environmental governance for mitigating the cost of debt to the firms exposed to air pollution, but also its importance to creditors exposed to their clients' environmental violation risk and default risk.

TANK-binding kinase 1 (TBK1): An emerging therapeutic target for drug discovery.

Dysregulation of TANK-binding kinase 1 (TBK1) homeostasis leads to the occurrence and progression of many diseases, such as inflammation, autoimmune diseases, metabolic diseases, and cancer. Therefore, there is a need to develop TBK1 inhibitors as therapeutic agents. In this review, we highlight the diverse biological functions of TBK1 and summarize the promising small-molecule inhibitors of TBK1 that have the potential to be developed as therapeutic candidates.

Signal identification system for developing rehabilitative device using deep learning algorithms.

Paralyzed patients were increasing day by day. Some of the neurodegenerative diseases like amyotrophic lateral sclerosis, Brainstem Leison, Stupor and Muscular dystrophy affect the muscle movements in the body. The affected persons were unable to migrate. To overcome from their problem they need some assistive technology with the help of bio signals. Electrooculogram (EOG) based Human Computer Interaction (HCI) is one of the technique used in recent days to overcome such problem. In this paper we clearly check the possibilities of creating nine states HCI by our proposed method. Signals were captured through five electrodes placed on the subjects face around the eyes. These signals were amplified with ADT26 bio amplifier, filtered with notch filter, and processed with reference power and band power techniques to extract features to detect the eye movements and mapped with Time Delay Neural Network to classify the eye movements to generate control signal to control external hardware devices. Our experimental study reports that maximum average classification of 91.09% for reference power feature and 91.55%-for band power feature respectively. The obtained result confirms that band power features with TDNN network models shows better performance than reference features for all subjects. From this outcome we conclude that band power features with TDNN network models was more suitable for classifying the eleven difference eye movements for individual subjects. To validate the result obtained from this method we categorize the subjects in age wise to check the accuracy of the system. Single trail analysis was conducted in offline to identify the recognizing accuracy of the proposed system. The result summarize that band power features with TDNN network models exceed the reference power with TDNN network model used in this study. Through the outcome we conclude that that band power features with TDNN network was more suitable for designing EOG based HCI in offline mode.