Deep Learning Based Automatic Left Ventricle Segmentation from the Transgastric Short-Axis View on Transesophageal Echocardiography: A Feasibility Study.

Segmenting the left ventricle from the transgastric short-axis views (TSVs) on transesophageal echocardiography (TEE) is the cornerstone for cardiovascular assessment during perioperative management. Even for seasoned professionals, the procedure remains time-consuming and experience-dependent. The current study aims to evaluate the feasibility of deep learning for automatic segmentation by assessing the validity of different U-Net algorithms. A large dataset containing 1388 TSV acquisitions was retrospectively collected from 451 patients (32% women, average age 53.42 years) who underwent perioperative TEE between July 2015 and October 2023. With image preprocessing and data augmentation, 3336 images were included in the training set, 138 images in the validation set, and 138 images in the test set. Four deep neural networks (U-Net, Attention U-Net, UNet++, and UNeXt) were employed for left ventricle segmentation and compared in terms of the Jaccard similarity coefficient (JSC) and Dice similarity coefficient (DSC) on the test set, as well as the number of network parameters, training time, and inference time. The Attention U-Net and U-Net++ models performed better in terms of JSC (the highest average JSC: 86.02%) and DSC (the highest average DSC: 92.00%), the UNeXt model had the smallest network parameters (1.47 million), and the U-Net model had the least training time (6428.65 s) and inference time for a single image (101.75 ms). The Attention U-Net model outperformed the other three models in challenging cases, including the impaired boundary of left ventricle and the artifact of the papillary muscle. This pioneering exploration demonstrated the feasibility of deep learning for the segmentation of the left ventricle from TSV on TEE, which will facilitate an accelerated and objective alternative of cardiovascular assessment for perioperative management.

Low estimated glomerular filtration rate and high body mass index are risk factors for acute kidney injury in systemic lupus erythematosus patients after cardiac surgery.

Objective: The occurrence of acute kidney injury (AKI) is common following cardiac surgery, especially among patients characterized with systemic lupus erythematosus (SLE), but studies on this clinical scenario have been limited by the rarity of SLE. We aimed to explore the risk predictors and outcomes with regards to postoperative AKI among cardiac-surgical patients concomitant with SLE. Methods: This was a single-center retrospective study performed in a tertiary hospital. Adult patients diagnosed with SLE who underwent cardiac surgery within the last 22 years were enrolled. Essential variables, including patient-, surgery- and anesthesia-related information, were collected from the medical record system. The definition of AKI was derived from the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk predictors suspected to be linked with post-surgical AKI were calculated using the univariable and multivariable analyses. Results: Of all 59 SLE patients undergoing cardiac surgery, 57 were ultimately enrolled into the analysis. AKI occurred in 29 patients (50.9%), who had significantly longer extubation time (median difference 1.0 day, P < 0.001), ICU length of stay (median difference 2.0 days, P = 0.001), postoperative length of stay (median difference 5.0 days, P = 0.026), and more postoperative major complications (odds ratio 10.29, P = 0.025) than the others. Preoperative estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 (odds ratio 5.31, P = 0.021) and body mass index (BMI) ≥ 24 kg/m2 (odds ratio 4.32, P = 0.043) were the only two factors in the multivariable analysis that were significantly correlated with the development of postoperative AKI in patients with SLE after cardiac surgery. Conclusion: AKI in SLE patients after cardiac surgery is common and requires scrutiny, especially in overweight patients with moderate to severe preoperative renal dysfunction.

Statistical inference for Gompertz distribution under adaptive type-II progressive hybrid censoring.

Gompertz distribution is a significant and commonly used lifetime distribution, which plays an important role in reliability engineering. In this paper, we study the statistical inference of Gompertz distribution based on adaptive Type-II hybrid progressive censored schemes. From the perspective of frequentist, we derive the point estimations through the method of maximum likelihood estimation (MLE) and the existence of MLE is proved. Besides MLE, we propose the stochastic EM algorithm to reduce complexity and simplify computing. We also apply the method of Bootstraps (Bootstrap-p and Bootstrap-t) to construct confidence intervals. From Bayesian aspect, the Bayes estimates of the unknown parameters are evaluated by applying the MCMC method, the average length and coverage rate of credible intervals are also carried out. The Bayes inference is based on the squared error loss function and LINEX loss function. Furthermore, a numerical simulation is conducted to assess the performance of the proposed methods. Finally, a real-life example is considered to illustrate the application and development of the inference methods. In summary, the Bayesian method seems to perform the best among all approaches, while other approaches also present different advantages.

Designing step-scheme AgI decorated Ta2O5-x heterojunctions for boosted photodegradation of organic pollutants.

Step-scheme (S-scheme) AgI decorated Ta2O5-x heterojunctions have been designed and synthesized via a combination of solvothermal and chemical deposition methods for enhanced visible-light harvesting and high-performance photocatalysis. The AgI nanoparticles showed great influences on the visible-light absorption and charge separation between AgI and Ta2O5-x microspheres. The experimental results indicated that the as-prepare AgI/Ta2O5-x composites achieved enhanced photocatalytic performance towards tetracycline degradation under visible light, and the AgI/Ta2O5-x-11 sample displayed the highest photocatalytic performance and the maximum rate constant of approximately 0.09483 min-1, which was 7.22 times that of Ta2O5-x microspheres and 2.56 times that of AgI, respectively. The highly enhanced photocatalytic performance was mainly attributed to the construction of S-scheme heterostructure and formation of oxygen vacancies in Ta2O5-x microspheres. In addition, the trapping experimental and DMPO spin-trapping ESR spectra confirmed the ⸱O2- and ⸱OH species as the main radicals during tetracycline degradation. Current work indicates an S-scheme tantalum-based composites for high-performance environmental photocatalysis.

Postoperative acute kidney injury after on-pump cardiac surgery in patients with connective tissue disease.

Objective: Patients with connective tissue disease have a poor prognosis after receiving cardiac surgery. This study described the clinical scenarios and investigated factors correlated with acute kidney injury (AKI) after on-pump cardiac surgery in patients with systemic lupus erythematosus (SLE) or vasculitis. Methods: Patients with SLE or vasculitis who underwent on-pump cardiac surgery from March 2002 to March 2022 were enrolled, while patients with preoperative renal dysfunction were excluded. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Uni- and multivariable analyses were performed to identify potential factors associated with postoperative AKI. Results: Among 123 patients enrolled, 39 (31.7%) developed AKI within seven days after receiving on-pump cardiac surgery. Four patients died in the hospital, resulting in an overall in-hospital mortality of 3.3%, and all deaths occurred in the AKI group. Patients in the AKI group also had longer ICU stays (median difference 3.0 day, 95% CI: 1.0-4.0, P < 0.001) and extubation time (median difference 1.0 days, 95% CI: 0-2.0, P < 0.001) than those in the non-AKI group. Multivariable logistic regression revealed that BMI over 24 kg/m2 (OR: 3.00, 95% CI: 1.24-7.28) and comorbid SLE (OR: 4.73, 95% CI: 1.73-12.93) were independently correlated with postoperative AKI. Conclusion: Factors potentially correlated with AKI following on-pump cardiac surgery in patients with connective tissue disease were explored. Clinicians should pay more attention to preoperative evaluation and intraoperative management in patients with risk factors.

Peptide-Based Optical/Electronic Materials: Assembly and Recent Applications in Biomedicine, Sensing, and Energy Storage.

The unique optical and electronic properties of living systems are impressive. Peptide-based supramolecular self-assembly systems attempt to mimic these properties by preparation optical/electronic function materials with specific structure through simple building blocks, rational molecular design, and specific kinetic stimulation. From the perspective of building blocks and assembly strategies, the unique optical and electronic properties of peptide-based nanostructures, including peptides self-assembly and peptides regulate the assembly of external function subunits, are systematically reviewed. Additionally, their applications in biomedicine, sensing, and energy storage are also highlighted. This bioinspired peptide-based function material is one of the hot candidates for the new generation of green intellect materials, with many advantages such as biocompatibility, environmental friendliness, and adjustable morphology.

Hydrogel Nanoarchitectonics of a Flexible and Self-Adhesive Electrode for Long-Term Wireless Electroencephalogram Recording and High-Accuracy Sustained Attention Evaluation.

Hydrogels are ideal building blocks to fabricate the next generation of electrodes for acquiring high-quality physiological electrical signals, for example, electroencephalography (EEG). However, collection of EEG signals still suffers from electrode deformation, sweating, extensive body motion and vibration, and environmental interference. Herein, polyvinyl alcohol and polyvinylpyrrolidone are selected to prepare a hydrogel network with tissue-like modulus and excellent flexibility. Additionally, polydopamine nanoparticles, obtained by polydopamine peroxidation, are integrated into the hydrogel to endow them with higher transparency, higher self-adhesion, and lower impedance. Consequently, a multichannel and wirelessly operated hydrogel electrode can establish a conformal and stable interface with tissue and illustrate high channel uniformity, low interfacial contact impedance, low power noise, long-term stability, and a tolerance to sweat and motion. Furthermore, the hydrogel electrode shows the unprecedented ability to classify the recorded high-quality prefrontal EEG signals into seven-category sustained attention with high accuracy (91.5%), having great potential applications in the assessment of human consciousness and in multifunctional diagnoses.

High-yield production of single-cell protein from starch processing wastewater using co-cultivation of yeasts.

Single-cell protein (SCP) from potato starch processing wastewater (PSPW) shows great potential against protein scarcity and unsustainable production of plant and animal proteins. In this study, five yeasts were selected to conduct a series of PSPW fermentation for obtaining high-value SCP by optimizing fermentation conditions. The yeast combination was optimized as Candida utilis, Geotrichum candidum and Candida tropicalis with the volume proportion of 9:5:1. The inoculum size, temperature, rotation speed and initial pH were optimized at 12 %, 24℃, 200 r·min-1 and âˆ¼ 4.13 (natural pH), respectively. At the optimal conditions, SCP yield of 3.06 g·L-1 and water-soluble protein of 17.32 % were obtained with the chemical oxygen demand removal of 56.9 %. A resource-recycling process of PSPW was proposed by coupling yeast fermentation and up-flow anaerobic sludge blanket (UASB) treatment to achieve simultaneous high-level organic removal and SCP production, which could be a promising alternative technology for PSPW treatment.

Factors correlated with neuropathic pain in patients with neuromyelitis optica spectrum disorder.

BACKGROUND: Neuropathic pain in neuromyelitis optica spectrum disorder (NMOSD) is common but has always been overlooked. This study was conducted to explore factors correlated with neuropathic pain in NMOSD and to evaluate associations between pain and quality of life. METHODS: In this cross-sectional study, NMOSD patients were interviewed face-to-face. The Brief Pain Inventory, Douleur Neuropathique 4, and Neuropathic Pain Symptom Inventory scales were used to evaluate pain. Patients completed the Beck Depression Inventory-II and Social Functioning-36 tests to evaluate depression and quality of life. RESULTS: A total of 122 NMOSD patients were enrolled. Eighty-one (66.4%; 95% CI, 39.9% to 92.9%) had current pain, of which 35 (28.7%; 95% CI, 20.7% to 36.7%) had neuropathic pain. Forty-nine (40.2%; 95% CI, 31.5% to 48.9%) patients experienced depression, which was moderate to severe in 22 patients. Multinomial logistic regression showed that significantly more patients with neuropathic pain had depression than those with other pain (OR, 4.15; 95% CI, 1.40 to 12.35; P=0.010) or no pain (OR, 5.65; 95% CI, 1.74 to 18.18; P=0.004). Significantly more patients with neuropathic pain had initial spinal cord involvement than those in the no-pain group (OR, 15.78; 95% CI, 1.37 to 182.15; P=0.027). Quality of life was severely affected in NMOSD patients with neuropathic pain. Only 29.6% were treated with analgesics, and none were prescribed antidepressants. CONCLUSION: Depression was correlated with neuropathic pain and was often overlooked. Initial spinal cord involvement might indicate a higher risk for neuropathic pain. Neuropathic pain in NMOSD patients requires scrutiny.

Long-range ordered amino acid assemblies exhibit effective optical-to-electrical transduction and stable photoluminescence.

Bio-endogenous peptide molecules are ideal components for fabrication of biocompatible and environmentally friendly semiconductors materials. However, to date, their applications have been limited due to the difficulty in obtaining stable, high-performance devices. Herein, simple amino acid derivatives fluorenylmethoxycarbonyl-leucine (Fmoc-L) and fluorenylmethoxycarbonyl-tryptophan (Fmoc-W) are utilized to form long-range ordered supramolecular nanostructures by tight aromatic stacking and extensive hydrogen bonding with mechanical, electrical and optical properties. For the first time, without addition of any photosensitizers, pure Fmoc-L microbelts and Fmoc-W microwires exhibit Young's modulus up to 28.79 and 26.96 GPa, and unprecedently high values of photocurrent responses up to 2.2 and 2.3 µA/cm2, respectively. Meanwhile, Fmoc-W microwires with stable blue fluorescent emission under continuous excitation are successfully used as LED phosphors. Mechanism analysis shows that these two amino acids derivatives firstly formed dimers to reduce the bandgap, then further assemble into bioinspired semiconductor materials using the dimers as the building blocks. In this process, aromatic residues of amino acids are more conducive to the formation of semiconducting characteristics than fluorenyl groups. STATEMENT OF SIGNIFICANCE: Long-range ordered amino acid derivative assemblies with mechanical, electrical and optical properties were fabricated by a green and facile biomimetic strategy. These amino acid assemblies have Young's modulus comparable to that of concrete and exhibit typical semiconducting characteristics. Even without the addition of any photosensitizer, pure amino acid assemblies can still produce a strong photocurrent response and an unusually stable photoluminescence. The results suggest that amino acid structures with hydrophilic C-terminal and aromatic residues are more conducive to the formation of semiconducting characteristics. This work unlocks the potential for amino acid molecules to self-assemble into high-performance bioinspired semiconductors, providing a reference for customized development of biocompatible and environmentally friendly semiconductor materials through rational molecular design.

Increasing the removal efficiency of antibiotic resistance through anaerobic digestion with free nitrous acid pretreatment.

Swine manure is a significant reservoir for antibiotic resistance. Anaerobic digestion (AD) is a common biological process used to treat swine manure but still faces low efficiencies in biogas production and antibiotic resistance removal. It is here shown that AD with free nitrous acid pretreatment (FNA) was effective in reducing antibiotic resistance genes (ARGs) in swine manure. FNA pretreatment (nitrite =250 mg N/L, pH=5.0, temperature=20 ± 1 °C) simultaneously reduced antibiotics (Tetracyclines, Quinones and Sulfonamides), inactivated antibiotics resistance bacteria (ARB) by 0.5-3 logs, and decreased ARGs tet, sul and qnr by 1-2, 1-3 and 0.5 logs, respectively. In the following AD step, the total residual ARGs was reduced to ~3.49 × 107 gene copies/g dry total solids (TS), ~1 log lower than that in the AD without pretreatment (3.55 ×108 gene copies/g dry TS). Microbial community and network analyses revealed that the ARG removal was mainly driven by the direct FNA effect on reducing ARGs and antibiotics, not related to ARB. Besides, the FNA pretreatment doubled biochemical methane production potential from swine manure. Together these results demonstrate that AD with FNA pretreatment is a useful process greatly facilitating swine manure management.

Sample pretreatment and analytical methodology for the determination of antibiotics in swine wastewater and activated sludge.

An analytical method for the simultaneous extraction and determination of eight veterinary antibiotics in swine wastewater and activated sludge was developed and validated based on the instrumental determination by liquid chromatography tandem quadrupole mass spectrometry. Ultrasound-assisted extraction and solid-phase extraction were introduced into the pretreatment procedure of the two complex environmental matrices. The critical steps involved in the sample pretreatment procedure and the instrumental analysis conditions were optimized progressively. Recoveries of the optimized method were good with 75.3-118.2% in wastewater and 82.8-130.1% in sludge. The absolute deviations of methods were lower than 11.7%, presenting a high reproducibility and precision. The limits of quantification for the eight pharmaceuticals in wastewater and sludge were 5-15 ng·L-1 and 2-6 ng·g-1, showing high sensitivity of the methods. The developed method has been successfully applied to evaluate the actual concentration levels of tetracyclines, quinolones, and sulfonamides in actual swine wastewater (maximum detected concentration of 87.377 µg·L-1) and activated sludge (maximum detected concentration of 51242.3 ng·g-1).

[Effects of Straw Returning on Soil Ammonia Volatilization Under Different Production Conditions Based on Meta-analysis].

In order to explore the response of Chinese farmland soil ammonia volatilization to straw returning to the field under different production conditions, this study used no straw returning as a control. Through the collection of published literature test data, the Meta-analysis method was used to quantitatively study the effects of different natural factors and, under the conditions of farmland management measures, the effect of returning straw to the field on the emission reduction of soil ammonia volatilization. At the same time, through partial correlation analysis, the main influencing factors of ammonia volatilization under the condition of returning straw to the field were found, and the ammonia volatilization was quantified. The results showed that the effect of straw returning on soil ammonia volatilization decreased with the increase in accumulated rainfall during the growth period and increased with the increase in average temperature during the growth period. When the soil pH was less than 6, straw returning to the field significantly promoted soil ammonia volatilization, and when the pH was ≥ 6, returning straw to the field significantly inhibited ammonia volatilization in the soil. The reduction effect of returning straw to the field on soil ammonia volatilization increased with the increase in soil clay content. When the total soil nitrogen content was <0.1% and >0.2%, returning the straw to the field significantly inhibited the volatilization of soil ammonia, and when the total soil nitrogen content was between 0.1% and 0.2%, returning the straw to the field significantly promoted the volatilization of ammonia from the soil. When the nitrogen application rate was 60-180 kg·hm-2 and the nitrogen application rate was >240 kg·hm-2, returning straw to the field significantly reduced soil ammonia volatilization (P<0.05), and when nitrogen application rate was 180-240 kg·hm-2, returning straw to the field significantly promoted ammonia volatilization in the soil. Returning straw to the field by plowing or rotary tillage significantly inhibited ammonia volatilization in the soil, whereas returning straw to the field in a mulching mode had no significant effect on ammonia volatilization. When the straw C/N>45, it significantly inhibited ammonia volatilization from the soil, and when the straw C/N ≤ 45, the straw returning to the field significantly promoted the ammonia volatilization of the soil. The reduction effect of straw returning on ammonia volatilization increased with the increase in straw-returning amount. In non-paddy fields, returning straw to the field had a significant inhibitory effect on soil ammonia volatilization, and in paddy fields, returning straw to the field had a significant effect on soil ammonia volatilization. The results of partial correlation analysis showed that in paddy fields, the average growth period and soil pH were the main factors affecting soil ammonia volatilization under the condition of returning straw to the field, and in non-paddy fields, nitrogen application rate and straw C/N were the main factors affecting the conditions. This study can provide reference for the scientific and rational use of straw to achieve ammonia volatilization emission reduction in farmland.

Performance and nitrogen removal mechanism in a novel aerobic-microaerobic combined process treating manure-free piggery wastewater.

A novel combined sequencing batch reactor (SBR) - up-flow microaerobic sludge reactor (UMSR) process was developed to treat manure-free piggery wastewater characterized by low COD/TN ratio and high NH4+-N. The front-end SBR was designed to get an effluent with COD/TN ≤ 1 by removing COD, allowing the back-end UMSR to practice anammox for the simultaneous removal of TN and NH4+-N. Fed with the raw piggery wastewater, the combined SBR-UMSR process was started up at 27℃ with a reflux ratio of 15:1 in the UMSR. After 230-days running, the removal of COD, TN, and NH4+-N in the combined SBR-UMSR process reached 78.41%,85.05%, and 92.21%, respectively. 50.22% of COD in the wastewater was removed in the SBR, while 87.11% of NH4+-N and 79.69% of TN were removed in the UMSR. Stoichiometry and bacterial function analysis revealed that the partial nitrification - anammox process was the dominant nitrogen removal approach in the UMSR.

[Influence of Pain-depression Comorbidity on Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder].

Objective To investigate the incidence,treatment,therapeutic effect,and impact on quality of life of pain-depression comorbidity in the patients with neuromyelitis optica spectrum disorder(NMOSD).Methods The NMOSD patients comorbid with pain visiting the out-patient clinic of Peking Union Medical College Hospital were interviewed in a face-to-face manner by neurologists for evaluating the neurologic disease.Pain,depression,and quality of life were evaluated by anesthesiologists based on the brief pain inventory,the Beck depression inventory-Ⅱ,and the MOS 36-item short form health survey scales,respectively.Results Totally 81 patients were included in this study,among which 38(46.9%)patients comorbid with depression were enrolled in the comorbidity group.The pain severity showed no significant difference between the two groups(3.3±3.1 vs. 2.3±2.2,P=0.087).The daily life activities and health-related quality of life were more severely influenced in the patients with comorbidity than in the patients without comorbidity as illustrated by the breif pain inventory[general activity and normal work(P=0.001);mood,relationship with other people,and enjoyment of life(all P<0.001);walking ability(P=0.004);sleep(P=0.016)]and the MOS 36-item short form health survey scales[physical functioning(P=0.001);role-physical,bodily pain,general health,vitality,social functioning,role-emotional,mental health(all P<0.001)].Only 30.9% of pain sufferers received analgesic medications,with the mean pain reduction percentage of(53.6±28.9)%.None of the patients in this study took antidepressants.Conclusions Pain-depression comorbidity was common in NMOSD patients and severely influenced the quality of life of the patients.However,only a few patients received analgesic or antidepressant medications.Pain-depression comorbidity in NMOSD patients should be scrutinized.

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022.

Objective Airway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists. Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis. Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1%) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P= 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 d vs. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27,P = 0.024). Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022 / 中国医学科学杂志(英文版)

Objective Airway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists. Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis. Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1%) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P= 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 d vs. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27,P = 0.024). Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.

[Comparative study on pros and cons of sequential high-flow nasal cannula and non-invasive positive pressure ventilation immediately following early extubated patients with severe respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease].

OBJECTIVE: To explore the pros and cons of sequential high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) immediately following early extubated patients with severe respiratory failure (SRF) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), so as to provide evidence for clinical selection of optimal scheme. METHODS: Consecutive AECOPD patients admitted to the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to September 2020 were screened for enrollment. Patients were between 40 years old and 85 years old with acute exacerbation of bronchial-pulmonary infection, who received endotracheal intubation mechanical ventilation (ETI-MV) as the initial respiratory support method. The pattern of synchronous intermittent mandatory ventilation (SIMV) was used in the study. The parameters were set as follows: tidal volume (VT) 8 mL/kg, support pressure 10-15 cmH2O (1 cmH2O = 0.098 kPa), positive end-expiratory pressure (PEEP) 4-6 cmH2O and the ratio of inspiratory to expiratory time 1.5-2.5:1. Under these conditions, the plateau pressure (Pplat) was maintained less than 30 cmH2O. The minimum fraction of inspired oxygen was adjusted to keep the pulse oxygen saturation no less than 0.92. When the pulmonary infection control window (PIC window) occurred, the subjects were extubated immediately and randomly divided into two groups, with one group receiving HFNC (called HFNC group), the other group receiving NIPPV (called NIPPV group). Patients with failed sequential HFNC or NIPPV underwent tracheal re-intubation. The rate of tracheal re-intubation within 7 days of extubation, complications (such as nose and face crush injury and gastric distension), in-hospital mortality, duration of ETI before PIC window, length of RICU stay and length of hospital stay were compared, respectively. RESULTS: Forty-four patients were enrolled in the study, 20 in the HFNC group and 24 in the NIPPV group. There was no significant difference in the duration of ETI before PIC window between HFNC and NIPPV groups (hours: 95.9±13.1 vs. 91.8±20.4, P > 0.05). The rate of tracheal re-intubation within 7 days in the HFNC group was significantly higher than that in the NIPPV group [35.0% (7/20) vs. 4.2 % (1/24), P < 0.05]. However, the incidence of complication in the HFNC group was significantly lower than that in the NIPPV group [0% (0/20) vs. 25.0% (6/24), P < 0.05]. Compared with the NIPPV group, the in-hospital mortality in the HFNC group was slightly higher [5.0% (1/20) vs. 4.2% (1/24)], the length of RICU stay (days: 19.5±10.8 vs. 15.5±7.2) and the length of hospital stay (days: 27.4±12.2 vs. 23.3±10.9) were slightly longer, without statistical differences (all P > 0.05). CONCLUSIONS: For early extubated patients with SRF due to AECOPD, the compliance of sequential HFNC increased and the complications decreased significantly, but the final effect may be worse than sequential NIPPV.

Association between the ABCA1 (R219K) polymorphism and lipid profiles: a meta-analysis.

Conflicting evidence was found about the relationship between lipid profiles and R219K polymorphism in adenosine triphosphate-binding cassette exporter A1 (ABCA1) gene. In this study, four meta-analyses were conducted to assess the effect of R219K on lipid levels, including high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol, total cholesterol, and triglycerides (TG). A total of 125 samples of 87 studies (about 60,262 subjects) were included. The effect of each study was expressed using the standard mean difference (SMD) and 95% confidence interval (95% CI) and pooled by meta-analysis in the random-effects model. Subgroup and meta-regression analyses were conducted to explore potential heterogeneity sources. The overall pooled effect showed the following results. (1) The R219K was significantly associated with HDLC level (SMD = - 0.25 mmol/L, 95%CI - 0.32 to - 0.18, z = - 6.96, P < 0.01, recessive genetic model). People with different genotypes had significantly different HDLC levels under the recessive, codominant and dominant genetic models (all Ps < 0.01). (2) A weak and indeterminate relationship between R219K and TG level was observed (SMD = 0.18 mmol/L, 95%CI 0.06-0.30, z = 3.01, P < 0.01, recessive genetic model). These findings suggested that R219K was associated with HDLC and TG levels, which might implicate a promising clinical application for lipid-related disorders, though the influences of race, health status, BMI, and other heterogeneity sources should be considered when interpreting current findings. The protocol was registered at PROSPERO (registration number: CRD42021231178).

Template Guiding for the Encapsulation of Uniformly Subnanometric Platinum Clusters in Beta-Zeolites Enabling High Catalytic Activity and Stability.

Subnanometric metal clusters have attracted extensive attention because of their unique properties as heterogeneous catalysts. However, it is challenging to obtain uniformly distributed metal clusters under synthesis and reaction conditions. Herein, we report a template-guidance protocol to synthesize subnanometric metal clusters uniformly encapsulated in beta-zeolite, with the metal ions anchored to the internal channels of the zeolite template via electrostatic interactions. Pt metal clusters with a narrow size range of 0.89 to 1.22 nm have been obtained on the intersectional sites of beta-zeolite (Pt@beta) with a broad range of Si/Al molar ratios (15-200). The uniformly distributed Pt clusters in Pt@H-beta are subject to strong electron withdrawal by the zeolite, which promotes transfer of active hydrogen, providing excellent activity and stability in hydrodeoxygenation reactions. A general strategy is thus proposed for the encapsulation of subnanometric metal clusters in zeolites with high thermal stability.