Effectiveness and safety of knotless barbed sutures in cosmetic surgery: A systematic review and meta-analysis.

BACKGROUND: The barbed suture, which can eliminate knot tying and accelerate the placement of sutures, is an innovative type of suture, whereas the benefits of cosmetic surgeries (CS) are controversial. This study aimed to comprehensively evaluate the effectiveness and safety of barbed sutures in CS. METHOD: PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for English studies comparing the use of barbed with conventional sutures in CS up to October 2020. The updated Cochrane risk-of-bias tool (ROB2.0) and Newcastle-Ottawa Scale (NOS) were utilized to evaluate the risk of bias. Subgroup analysis was performed according to study designs and barbed suture types. RESULTS: A total of 14 studies, including 5 randomized controlled trials and 9 cohort studies, were included (risk of bias: moderate to low), representing 2259 patients. The barbed suture was identified to reduce suture time (mean difference [MD]=-6.18, 95% confidence interval [CI]: -8.75 to -3.60, P < 0.00001) and operative time (MD=-10.80, 95% CI: -20.83 to -0.76, P = 0.03) without increasing the hospital stays and total postoperative complications (most were Clavien I and IIIa). No significant difference was detected for incisional infection, delayed wound healing, and hematoma; however, increasing incidence of wound dehiscence (odds ratio [OR]=1.60, 95% CI: 1.09-2.34, P = 0.02) and suture extrusion (OR=3.97, 95%CI: 1.96-8.04, P = 0.0001) were found, particularly in the unidirectional barbed suture subgroup. Barbed sutures might also help CS advance and reduce seroma formation. CONCLUSION: The barbed suture was effective in CS; however, its safety needs to be cautiously interpreted as it might be related to more wound dehiscence and suture extrusion despite similar total postoperative complications with conventional sutures. This study might provide important references for decision-makers and clinicians, though further evidence of randomized design, larger sample size, longer follow-up, and standardized rating approaches are warranted.

[Design and Research of Wearable Fall Protection Device for the Elderly].

A protective device was designed that can be worn on the elderly, which consists of protective airbag, control box and protective mechanism. The combined acceleration, combined angular velocity and human posture angle are selected as the parameters to determine the fall, and the threshold algorithm and SVM algorithm are used to detect the fall. The protective mechanism is an inflatable device based on CO2 compressed air cylinder, and the equal-width cam structure is applied to its transmission part to improve the puncture efficiency of the compressed gas cylinder. A fall experiment was designed to obtain the combined acceleration and angular velocity eigenvalues of fall actions (forward fall, backward fall and lateral fall) and daily activities (sitting-standing, walking, jogging and walking up and down stairs), showing that the specificity and sensitivity of the protection module reached 92.1% and 84.4% respectively, which verified the feasibility of the fall protection device.

Linking trait network to growth performance of submerged macrophytes in response to ammonium pulse.

Extreme precipitation events caused by climate change leads to large variation of nitrogen input to aquatic ecosystems. Our previous study demonstrated the significant effect of different ammonium pulse patterns (differing in magnitude and frequency) on submersed macrophyte growth based on six plant morphological traits. However, how connectivity among plant traits responds to nitrogen pulse changes, which in turn affects plant performance, has not yet been fully elucidated. The response of three common submersed macrophytes (Myriophyllum spicatum, Vallisneria natans and Potamogeton maackianus) to three ammonium pulse patterns was tested using plant trait network (PTN) analysis based on 18 measured physiological and morphological traits. We found that ammonium pulses enhanced trait connectivity in PTN, which may enable plants to assimilate ammonium and/or mitigate ammonium toxicity. Large input pulses with low frequency had stronger effects on PTNs compared to low input pulses with high frequency. Due to the cumulative and time-lagged effect of the plant response to the ammonium pulse, there was a profound and prolonged effect on plant performance after the release of the pulse. The highly connected traits in PTN were those related to biomass allocation (e.g., plant biomass, stem ratio, leaf ratio and ramet number) rather than physiological traits, while phenotype-related traits (e.g., plant height, root length and AB ratio) and energy storage-related traits (e.g., stem starch) were least connected. V. natans showed clear functional divergence among traits, making it more flexible to cope with unfavorable habitats (i.e., high input pulses with low frequencies). M. spicatum with high RGR revealed strong correlations among traits and thus supported nitrogen accumulation from favourable environments (i.e., low input pulses with high frequencies). Our study highlights the responses of PTN for submerged macrophytes to ammonium pulses depends on their intrinsic metabolic rates, the magnitude, frequency and duration of the pulses, and our results contribute to the understanding of the impact of resource pulses on the population dynamics of submersed macrophytes within the context of global climate change.

DNA Methylation Architecture Provides Insight into the Pathogenesis of Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis.

PURPOSE: Numerous studies suggested methylation modifications play an important role in upper tract urothelial carcinoma (UTUC), but few have depicted DNA methylation architecture on the pathological process of UTUC. We aimed to better understand the pathogenesis of UTUC and provide precision medicine references when managing UTUC patients. METHODS: PubMed, Cochrane Library, EMBASE, and Scopus were searched for UTUC until December 31, 2020. Methodological quality assessment was conducted according to NIH recommendations. Meta-analysis was conducted to assess the prognostic effect of methylated genes. Kaplan-Meier survival analyses were performed to validate methylated genes and cytosine-phosphate-guanine (CpG) sites. RESULTS: Eleven studies (3619 patients) were eligible to investigate 12 methylated genes and 10 CpGs. The quality of all the studies was fair to good. Meta-analysis found the pooled effect of eligible methylated genes had a low risk of tumor recurrence (HR = 0·67; 95% CI: 0·51-0·87; P = ·003), but a high risk of tumor progression (HR = 1·60; 95% CI: 1·17-2·18; P = ·003) and cancer-specific mortality (HR = 1·35; 95% CI: 1·06-1·72; P = ·01). For individual methylation status of GDF15, HSPA2, RASSF1A, TMEFF2, and VIM, the pooled effect of each gene was found pleiotropic on both diagnosis and prognosis. Survival analysis suggested higher methylation of SPARCL1 had a better disease-specific survival (P = ·048). CONCLUSION: We combined meta-analysis and Kaplan-Meier survival analysis using the most updated evidence on the methylation of UTUC. Candidate biomarkers with essential diagnosis and prognosis function might provide precision medicine references for personalized therapies.

Impairment of kidney function and kidney cancer: A bidirectional Mendelian randomization study.

BACKGROUND: Many observational epidemiology studies discovered that kidney cancer and impaired kidney function have a bidirectional relationship. However, it remains unclear whether these two kinds of traits are causally linked. In this study, we aimed to investigate the bidirectional causal relation between kidney cancer and kidney function biomarkers (creatinine-based estimated glomerular filtration rate (eGFRcrea), cystatin C-based estimated glomerular filtration rate (eGFRcys), blood urea nitrogen (BUN), serum urate, and urinary albumin-to-creatinine ratio (UACR)). METHODS: For both directions, single-nucleotide polymorphisms (SNPs), as genetic instruments, for the five kidney function traits were selected from up to 1,004,040 individuals, and SNPs for kidney cancer were from 408,786 participants(1338 cases). In the main analysis, we applied two state-of-the-art MR methods, namely, contamination mixture and Robust Adjusted Profile Score to downweight the effect of weak instrument bias, pleiotropy, and extreme outliers. We additionally conducted traditional MR analyses as sensitivity analyses. Summary-level data of European ancestry were extracted from UK Biobank, Chronic Kidney Disease Genetics Consortium, and Kaiser Permanente. RESULTS: Based on 99 SNPs, we found that the eGFRcrea had a significant negative causal effect on the risk of kidney cancer (OR = 0.007, 95% CI:2.6 × 10-4 -0.569, p = 0.041). After adjusting for body composition or diabetes, urate had a significant negative causal effect on kidney cancer (OR <1, p < 0.05). For UACR, it showed a strong causal effect on kidney cancer, after adjusting for body composition (OR = 14.503, 95% CI: 2.546-96.001, p = 0.032). Due to lacking significant signals and effect power for the reverse MR, further investigations are warranted. CONCLUSIONS: Our study suggested a potential causal effect of damaged kidney function on kidney cancer. EGFRcrea and UACR might be causally associated with kidney cancer, especially when patients were comorbid with obesity or diabetes. We called for larger sample-size studies to further unravel the underlying causal relationship and the exact mechanism.

Network architecture of non-coding RNAs provides insights into the pathogenesis of upper tract urothelial carcinoma.

Numerous studies suggested that non-coding RNA modifications play an important role in upper tract urothelial carcinoma (UTUC), but few have depicted the architecture of non-coding RNA on the pathological process of UTUC. We aimed to better understand the pathogenesis of UTUC and provide precision medicine references of non-coding RNA when managing UTUC patients. PubMed, Cochrane Library, Embase, and Scopus were searched for UTUC until December 31, 2020. Methodological quality assessment was conducted according to NIH recommendations. Enrichment analyses and network analyses were conducted to explore the interactions of miRNA with genes and other non-coding RNAs. Survival analyses were performed to validate the novel genes. A total of 12 pairs of UTUC tumors and adjacent normal tissues were also included to validate the gene expressions regulated by miRNAs from the miRNA-gene network. Thirteen studies with 945 patients were eligible, investigating 106 miRNAs mutations. The quality of all the studies was fair to good. Most miRNAs were enriched in tissue/organs, diseases, and specific anti-cancer drugs (false discovery rate <0.05). Other non-coding RNAs, i.e.,: miR-34a, DLGAP1-AS1, USP39, and RNA5SP479, were highlighted by network analyses to have potential in the pathogenesis of UTUC. Top hub genes in the miRNA-gene network, namely ZNF460, NUFIP2, and E2F3, were all validated by survival analysis(P < 0.05). Using own cohort data, the differential expression analyses identified 368 overlapped significant genes, including above 3 hub genes (false discovery rate <0.05). Novel biomarkers identified in our studies might play essential roles in UTUC, from the perspectives of the molecule, tissue/organ, diagnosis, treatment, and prognosis. Candidate biomarkers could be significant references for personalized and target therapies.

Potential effect of pulmonary fluid viscosity on positive end-expiratory pressure and regional distribution of lung ventilation in acute respiratory distress syndrome.

BACKGROUND: Computational fluid dynamic simulations have showed that the elevated viscosity of pulmonary fluids may increase the likelihood of airway closure, thus exacerbating inhomogeneity of regional lung ventilation. Unfortunately, there have been few studies directed toward measurements of viscosity of pulmonary fluids and its effect on airway opening pressure and regional distribution of lung ventilation in acute respiratory distress syndrome. METHODS: In this study, pulmonary fluids from 8 ARDS patients were measured using a cone and plate rheometer on days 1, 3, 7 and 14 in the treatment of the disorder. Ventilator settings were simultaneously recorded, including tidal volume, positive end-expiratory pressure, fraction of inspired oxygen (FiO2), and so on. The regional distribution of lung ventilation was monitored by a bedside electrical impedance tomography system. FINDINGS: The results showed that rheological properties of pulmonary fluids behaved as either Newtonian or non-Newtonian across all patients studied. Significant intersubject and intrasubject variations in measured viscosities were observed, spanning ranges from approximately 1 cP to 7 × 104 cP at shear rates between 0.075-750 s-1. The product of the positive end-expiratory airway pressure and fraction of inspired oxygen was well correlated with fluid viscosity in patients with high viscosity pulmonary fluids. Furthermore, lung ventilation in these patients was highly inhomogeneous and influenced by rheology of pulmonary fluids. INTERPRETATION: The current findings provided the direct clinical data for theoretical models of airway reopening and may have important clinical implications in explaining inhomogeneity of lung ventilation and selecting initial levels of positive end-expiratory pressure in mechanically ventilated patients.

Effects of the Lower Airway Secretions on Airway Opening Pressures and Suction Pressures in Critically Ill COVID-19 Patients: A Computational Simulation.

In patients with critically ill COVID-19 pneumonia, lower airways are filled with plenty of highly viscous exudates or mucus, leading to airway occlusion. The estimation of airway opening pressures and effective mucus clearance are therefore two issues that clinicians are most concerned about during mechanical ventilation. In this study we retrospectively analyzed respiratory data from 24 critically ill patients with COVID-19 who received invasive mechanical ventilation and recruitment maneuver at Jinyintan Hospital in Wuhan, China. Among 24 patients, the mean inspiratory plateau pressure was 52.4 ± 4.4 cmH2O (mean ± [SD]). Particularly, the capnograms presented an upward slope during the expiratory plateau, indicting the existence of airway obstruction. A computational model of airway opening was subsequently introduced to investigate possible fluid dynamic mechanisms for the extraordinarily high inspiratory plateau pressures among these patients. Our simulation results showed that the predicted airway opening pressures could be as high as 40-50 cmH2O and the suction pressure could exceed 20 kPa as the surface tension and viscosity of secretion simulants markedly increased, likely causing the closures of the distal airways. We concluded that, in some critically ill patients with COVID-19, limiting plateau pressure to 30 cmH2O may not guarantee the opening of airways due to the presence of highly viscous lower airway secretions, not to mention spontaneous inspiratory efforts. Active airway humidification and effective expectorant drugs are therefore strongly recommended during airway management.

Determination of rheology and surface tension of airway surface liquid: a review of clinical relevance and measurement techniques.

By airway surface liquid, we mean a thin fluid continuum consisting of the airway lining layer and the alveolar lining layer, which not only serves as a protective barrier against foreign particles but also contributes to maintaining normal respiratory mechanics. In recent years, measurements of the rheological properties of airway surface liquid have attracted considerable clinical attention due to new advances in microrheology instruments and methods. This article reviews the clinical relevance of measurements of airway surface liquid viscoelasticity and surface tension from four main aspects: maintaining the stability of the airways and alveoli, preventing ventilator-induced lung injury, optimizing surfactant replacement therapy for respiratory syndrome distress, and characterizing the barrier properties of airway mucus to improve drug and gene delivery. Primary measuring techniques and methods suitable for determining the viscoelasticity and surface tension of airway surface liquid are then introduced with respect to principles, advantages and limitations. Cone and plate viscometers and particle tracking microrheometers are the most commonly used instruments for measuring the bulk viscosity and microviscosity of airway surface liquid, respectively, and pendant drop methods are particularly suitable for the measurement of airway surface liquid surface tension in vitro. Currently, in vivo and in situ measurements of the viscoelasticity and surface tension of the airway surface liquid in humans still presents many challenges.

M2 macrophages promote pulmonary endothelial cells regeneration in sepsis-induced acute lung injury.

BACKGROUND: Macrophages can polarize to M2 phenotype to decrease inflammation and encourage tissue repair. Nonetheless, its role in sepsis-induced acute lung injury and its effect on endothelial cells (ECs) regeneration remains unknown. The aim of the current study was to explore the impact of M2 macrophages on pulmonary ECs proliferation in sepsis-induced acute lung injury. METHODS: We co-cultured mouse lung microvascular endothelial cells (MLMVECs) with M2 macrophages following LPS challenge. M2 macrophages were intratracheally transplanted into mice subjected to cecal ligation and puncture (CLP). We further performed cytokine array for the supernatant from M2 macrophages and serum from mice subjected with CLP. RESULTS: We found both co-culture with M2 macrophages and treating with supernatant from M2 macrophages increased ECs viability following LPS challenge. Intratracheal transplantation of M2 macrophages markedly promoted pulmonary ECs proliferation, manifesting as attenuation of lung microvascular permeability and lung tissue edema, as well as improvement of survival rate. We further found that CXCL12, IL-1ra, TIMP-1, IL-4, and CXCL1 were increased in the supernatant of M2 macrophages in vitro. G-CSF and Complement Component 5a (C5/C5a) were increased in the serum of the M2-transplanted mice. CONCLUSIONS: The present study suggested M2 macrophages could promote ECs proliferation in sepsis-induced ALI through secretion of anti-inflammatory cytokines and growth factors.

[Design and Implementation of a Medical Nitric Oxide Flow Control Device].

Medical nitric oxide(NO)flow control system plays an important role in lowering pulmonary hypertension.The design requirements,overall scheme,delivery system and hardware circuits of a medical NO flow control system were introduced in this paper.Particularly,we proposed the design of NO delivery system and hardware circuits in detail.To deliver nitric oxide of a variable concentration,the designed system needs to work with a ventilator.The system can adjust and monitor the inhaled nitric oxide concentrations and send out sound and light alarms when the inhaled nitric oxide concentrations are out of the set range.To validate reliability and efficacy,we measured specifications such as linearity,stability and response time of the proposed NO flow control system by continuously administering nitric oxide into inspiratory circuit to deliver nitric oxide of variable concentrations to a test lung.The experiments showed that these specifications can meet the desired requirements.

An estimation of mechanical stress on alveolar walls during repetitive alveolar reopening and closure.

Alveolar overdistension and mechanical stresses generated by repetitive opening and closing of small airways and alveoli have been widely recognized as two primary mechanistic factors that may contribute to the development of ventilator-induced lung injury. A long-duration exposure of alveolar epithelial cells to even small, shear stresses could lead to the changes in cytoskeleton and the production of inflammatory mediators. In this paper, we have made an attempt to estimate in situ the magnitudes of mechanical stresses exerted on the alveolar walls during repetitive alveolar reopening by using a tape-peeling model of McEwan and Taylor (35). To this end, we first speculate the possible ranges of capillary number (Ca) ≡ µU/γ (a dimensionless combination of surface tension γ, fluid viscosity µ, and alveolar opening velocity U) during in vivo alveolar opening. Subsequent calculations show that increasing respiratory rate or inflation rate serves to increase the values of mechanical stresses. For a normal lung, the predicted maximum shear stresses are <15 dyn/cm(2) at all respiratory rates, whereas for a lung with elevated surface tension or viscosity, the maximum shear stress will notably increase, even at a slow respiratory rate. Similarly, the increased pressure gradients in the case of elevated surface or viscosity may lead to a pressure drop >300 dyn/cm(2) across a cell, possibly inducing epithelial hydraulic cracks. In addition, we have conceived of a geometrical model of alveolar opening to make a prediction of the positive end-expiratory pressure (PEEP) required to splint open a collapsed alveolus, which as shown by our results, covers a wide range of pressures, from several centimeters to dozens of centimeters of water, strongly depending on the underlying pulmonary conditions. The establishment of adequate regional ventilation-to-perfusion ratios may prevent recruited alveoli from reabsorption atelectasis and accordingly, reduce the required levels of PEEP. The present study and several recent animal experiments likewise suggest that a lung-protective ventilation strategy should not only include small tidal volume and plateau pressure limitations but also consider such cofactors as ventilation frequency and inflation rate.

A micromechanical model for estimating alveolar wall strain in mechanically ventilated edematous lungs.

To elucidate the micromechanics of pulmonary edema has been a significant medical concern, which is beneficial to better guide ventilator settings in clinical practice. In this paper, we present an adjoining two-alveoli model to quantitatively estimate strain and stress of alveolar walls in mechanically ventilated edematous lungs. The model takes into account the geometry of the alveolus, the effect of surface tension, the length-tension properties of parenchyma tissue, and the change in thickness of the alveolar wall. On the one hand, our model supports experimental findings (Perlman CE, Lederer DJ, Bhattacharya J. Am J Respir Cell Mol Biol 44: 34-39, 2011) that the presence of a liquid-filled alveolus protrudes into the neighboring air-filled alveolus with the shared septal strain amounting to a maximum value of 1.374 (corresponding to the maximum stress of 5.12 kPa) even at functional residual capacity; on the other hand, it further shows that the pattern of alveolar expansion appears heterogeneous or homogeneous, strongly depending on differences in air-liquid interface tension on alveolar segments. The proposed model is a preliminary step toward picturing a global topographical distribution of stress and strain on the scale of the lung as a whole to prevent ventilator-induced lung injury.

[The study of simulation system for cardiopulmonary bypass cardiac surgery].

According to the clinical requirements of cardiopulmonary bypass surgery, this paper established a simulation system for cardiac surgery which consists of venous reservoir, variable balance chamber, blood suction bag, ventricle suction bag, resistance valves, pressure gauges and tubings. Using the proposed system, perfusionists can mimic the implementation of pre-established surgery strategy, predict various abnormal conditions in the operation, and accordingly take the urgent actions so as to improve the success rate of surgery and to ensure the safety of patients.

[Control and testing methods for blood bump in heart assistant and replacement devices].

Using extracorporeal circulation for cardiopulmonary bypass is the first step for the successful cardiac surgery, and the blood pump is the key component in extracorporeal circulation devices, the control and measurement of mechanical-fluid parameters such as flow rate and pressure are very important to guarantee the successful cardiac surgery. This paper reviews several control methods of the blood pump based on the flow rate/pressure, heart rate, ventricular work and blood assist index, and also discusses the direct and indirect measurements of the flow rate and pressure. This review concludes with the main possible trends for the further development of the blood pump control and testing methods.

[Magnetic field numerical calculation and analysis for magnetic coupling of centrifugal blood pump for extracorporeal circulation].

This paper mainly studies the driving system of centrifugal blood pump for extracorporeal circulation, with the core being disc magnetic coupling. Structure parameters of disc magnetic coupling are related to the ability of transferring magnetic torque. Therefore, it is necessary to carry out disc magnetic coupling permanent magnet pole number (n), air gap length (L(g)), permanent magnet thickness (L(m)), permanent magnet body inside diameter (R(i)) and outside diameter (R(o)), etc. thoroughly. This paper adopts the three-dimensional static magnetic field edge element method of Ansys for numerical calculation, and analyses the relations of magnetic coupling each parameter to transmission magnetic torque. It provides a good theory basis and calculation method for further optimization of the disc magnetic coupling.

Control system design for a Continuous Positive Airway Pressure ventilator.

Continuous Positive Airway Pressure (CPAP) ventilation remains a mainstay treatment for obstructive sleep apnea syndrome (OSAS). Good pressure stability and pressure reduction during exhalation are of major importance to ensure clinical efficacy and comfort of CPAP therapy. In this study an experimental CPAP ventilator was constructed using an application-specific CPAP blower/motor assembly and a microprocessor. To minimize pressure variations caused by spontaneous breathing as well as the uncomfortable feeling of exhaling against positive pressure, we developed a composite control approach including the feed forward compensator and feedback proportional-integral-derivative (PID) compensator to regulate the pressure delivered to OSAS patients. The Ziegler and Nichols method was used to tune PID controller parameters. And then we used a gas flow analyzer (VT PLUS HF) to test pressure curves, flow curves and pressure-volume loops for the proposed CPAP ventilator. The results showed that it met technical criteria for sleep apnea breathing therapy equipment. Finally, the study made a quantitative comparison of pressure stability between the experimental CPAP ventilator and commercially available CPAP devices.

[Study on optimal selection of structure of vaneless centrifugal blood pump with constraints on blood perfusion and on blood damage indexes].

This paper is aimed to study the optimal selection of structure of vaneless centrifugal blood pump. The optimal objective is determined according to requirements of clinical use. Possible schemes are generally worked out based on structural feature of vaneless centrifugal blood pump. The optimal structure is selected from possible schemes with constraints on blood perfusion and blood damage indexes. Using an optimal selection method one can find the optimum structure scheme from possible schemes effectively. The results of numerical simulation of optimal blood pump showed that the method of constraints of blood perfusion and blood damage is competent for the requirements of selection of the optimal blood pumps.

A haemodynamic model for heart-mural coronary artery-myocardial bridge.

An experimental model for heart-mural coronary artery-myocardial bridge was established based on the theory of haemodynamics. The application of the model demonstrated that it can repeat to great extent the phenomenon of the myocardial bridge compressing the mural coronary artery, which results in abnormal haemodynamic characteristics. The results of simulation experiments are mostly consistent with clinical research.