Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection.

OBJECTIVE: To investigate the independent risk factors for postoperative prolonged ICU stay in patients with Stanford type A aortic dissection (TAAD) and assess the clinical outcomes of prolonged ICU stay. METHOD: The clinical data of 100 patients with TAAD admitted to the Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were retrospectively collected and analyzed. Patients were divided into two groups, based on the postoperative ICU stay (7 days as the threshold), regular ICU stay group (< 7 days) and prolonged ICU stay group (≥ 7 days). First, preoperative and intraoperative materials were collected for univariate analysis. Then, the significant variables after univariate analysis were analyzed using logistic regression, and the final independent risk factors for prolonged ICU stay were determined. Meanwhile, the postoperative clinical outcomes were analyzed with the aim of assessing the clinical outcomes due to prolonged ICU stay. RESULTS: There were 65 and 35 patients in the regular ICU stay group and the prolonged ICU stay group, respectively. In accordance with the result of univariate analysis in the two groups, emergency surgery (χ2 = 13.598; P < 0.001), preoperative urea nitrogen (t = 3.006; P = 0.004), cardiopulmonary bypass (CPB) time (t = 2.671; P = 0.001) and surgery time (t = 2.630; P = 0.010) were significant. All significant variates were analyzed through logistic regression, and it was found that emergency surgery (OR = 0.192; 95% CI: 0.065-0.561), preoperative urea nitrogen (OR = 0.775; 95% CI: 0.634-0.947) and cardiopulmonary time (OR = 0.988; 95% CI: 0.979-0.998) were independent risk factors for prolonged postoperative ICU stay. The Receiver Operating Characteristic (ROC) curves of these three factors were also effective in predicting postoperative prolonged ICU stay (Emergency surgery, AUC = 0.308, 95% CI: 0.201-0.415; Preoperative urea nitrogen, AUC = 0.288, 95% CI: 0.185-0.392; cardiopulmonary time, AUC = 0.340, 95% CI: 0.223-0.457). Moreover, compared with a single factor, the predictive value of combined factors was more significant (AUC = 0.810, 95% CI: 0.722-0.897). For the comparison of postoperative data in the two groups,, compared with the regular ICU stay group, the incidence of adverse events in the prolonged ICU stay group increased significantly, including limb disability of limbs (χ2 = 22.182; P < 0.001), severe organ injury (χ2 = 23.077; P < 0.001), tracheotomy (χ2 = 17.582; P < 0.001), reintubation (χ2 = 28.020; P < 0.001), 72 h tracheal extubation after surgery (χ2 = 29.335; P < 0.001), 12 h consciousness recovery after surgery (χ2 = 18.445; P < 0.001), ICU re-entering (χ2 = 9.496; P = 0.002) and irregular discharging (χ2 = 24.969; P < 0.001). CONCLUSION: Emergency surgery, preoperative urea nitrogen, and CPB time are risk factors for postoperative prolonged ICU stay after TAAD surgery. Furthermore, prolonged ICU stay is associated with worse clinical outcomes. Hence, a reasonable strategy should be adopted proactively focusing on the risk factors to shorten ICU stays and improve clinical outcomes.

The postmortem diagnosis of an Armillifer infection case in a cynomolgus macaque (Macaca fascicularis).

Armillifer moniliformis belongs to the order Porocephalida and family Porocephalidae, and it can cause zoonotic pentastomiasis. A suspected parasitic infection was incidentally discovered in the abdominal cavity of a cynomolgus macaque that died of persistent diarrhea. 18S rDNA amplification and sequencing revealed a high similarity (99.83%) to the Armillifer moniliformis Guangxi isolate. The isolated parasite was named the Armillifer moniliformis Yunnan isolate (GenBank accession no. HM048870). Our report presents a case of Armillifer moniliformis infection in macaques. The results indicated that early quarantine and diagnosis should be employed for animal health.

Postoperative hypoxemia for patients undergoing Stanford type A aortic dissection.

Clinically, it is widely recognized that surgical treatment is the preferred and reliable option for Stanford type A aortic dissection. Stanford type A aortic dissection is an emergent and serious cardiovascular disease characterized with an acute onset, poor prognosis, and high mortality. However, the incidences of postoperative complications are relatively higher due to the complexity of the disease and its intricate procedure. It has been considered that hypoxemia, one of the most common postoperative complications, plays an important role in having a worse clinical prognosis. Therefore, the effective intervention of postoperative hypoxemia is significant for the improved prognosis of patients with Stanford type A aortic dissection.

Acute effects of blood flow restriction with whole-body vibration on sprint, muscle activation and metabolic accumulation in male sprinters.

Purpose: The aim of this study was to explore the acute effects of Blood Flow Restriction Training (BFRT), Whole-Body Vibration (WBV), and BFRT + WBV on the 20 m sprint, muscle activation, and metabolic accumulation in male sprinters. Method: Sixteen male sprinters randomly performed BFRT, WBV, or BFRT + WBV interventions with 72 h intervals. Electromyography (EMG) signals were collected before and during interventions. Fingertip blood was taken before, immediately after, and 15 min after the intervention. 20 m sprint was performed before and 3 min after the intervention. Results: 1) 0-10m and 0-20 m sprint performance were significantly improved after WBV and BFRT + WBV interventions (p < 0.05), 0-20 m sprint performance was significantly improved after all three interventions (p < 0.05), 2) After BFRT + WBV intervention, the EMG amplitude of the vastus lateralis and soleus were significantly improved. Greater increases in EMG activity of the tibialis anterior muscle (p < 0.05)and blood lactate (p < 0.05)were observed following BFRT intervention compared to BFRT + WBV intervention. Conclusion: For sprint performance, BFRT and WBV had similar post-activation enhancement effects to BFRT + WBV, and the metabolic accumulation immediately following the BFRT were higher than that following BFRT + WBV in male sprinters.

Assisted Da Vinci robotic surgery combined with 3D printing technology applied in septal myectomy.

Generally, the standard surgical route of Morrow begins with the incision of median sternal, which leads to more trauma, pains and discomforts to patients with hypertrophic obstructive cardiomyopathy (HOCM). It is more difficult and rough to perform the competed resection of hypertrophic myocardium due to complicated anatomical morphology of left ventricular outflow tract and limited visual field of left ventricle during surgery. As the novel surgical strategy, firstly, under the guiding of 3D printing technology, the platform of effective preoperative evaluation focusing on how to resect the hypertrophic myocardium is established. Then, combined with assisted Da Vinci robotic surgery system, the outcome of patient with HOCM is positive and promised.

The optimal diagnosis and treatment of intravenous leimyomatosis.

Intravenous leiomyomatosis (IVL) is a rare form of gynaecological- uterine leiomyoma. Clinically, the diagnosis and treatment are more difficult and challenging due to occult symptoms and clinical presentations, which can be similar to other common diseases. In this report, comprehensive management of a case of IVL is reported and discussed, with the aim of sharing our academic and clinical experience to improve the medical management of IVL.

Protective Effects of Different Selenium Green Tea Polysaccharides on the Development of Type 2 Diabetes in Mice.

Selenium polysaccharides have attracted significant interest due to their superior function to that of individual polysaccharides. However, limited research has compared the protective effects of different selenium polysaccharides from different selenization methods on diabetes. This work aims to compare the preventive effects of natural selenium-enriched green tea polysaccharides (NSe-TPS), synthetic selenized green tea polysaccharides (PCSe-TPS), and a mixture of sodium selenite and green tea polysaccharides (ordinary tea polysaccharides (Ord-TPS)+Se) on the development of diabetes. While establishing a diabetes model induced by a high-sugar, high-fat diet combined with streptozotocin, different selenium polysaccharides were administered daily by gavage for nine weeks. Our findings indicate that PCSe-TPS exhibited superior preventive effects on developing type 2 diabetes compared to NSe-TPS and Ord-TPS+Se. PCSe-TPS effectively regulated glucose metabolism and insulin resistance by activating the PI3K/Akt pathway, thereby preventing elevated blood glucose levels. Additionally, PCSe-TPS mitigated oxidative damage and inflammatory responses in liver tissues. Notably, PCSe-TPS intervention reversed the decline in bacterial species richness and the abundance of unclassified_Oscillospiraceae during the development of diabetes in mice. These results provide valuable insights into the protective effects of PCSe-TPS against diabetes development, highlighting its advantages over NSe-TPS and Ord-TPS+Se.

Binder-Free Sodium Zinc Phosphate Protection Layer Enabled Dendrite-Free Zn Metal Anode.

Aqueous Zn battery has been a promising alternative battery in large-scale energy storage systems due to its cost-effectiveness, sustainability, and intrinsic safety. However, its cycle life is impeded by the dendrite formation, severe corrosion, and side reactions on the zinc metal anode. Most ex situ coatings on the zinc surface extend the life span of zinc anodes but have drawbacks in Zn2+ ion conductivity. Herein, a robust sodium zinc phosphate layer was in situ built on zinc metal foil anode (Zn@NZP) via facile electrodeposition. The Zn2+ ion conducting protection layer alleviates corrosion, suppresses zinc dendrites, and lowers the energy barrier of Zn2+ plating and stripping. As a result, the Zn@NZP anode renders dendrite-free plating/stripping with a small overpotential of about 44 mV and a 12-fold enhancement long-life span compared to the bare zinc. Furthermore, a full cell using the Zn@NZP anode shows much improved capacity and cycling stability. This work provides a promising anode candidate for dendrite-free aqueous zinc ion batteries.

The surgical strategy of hormonally active primary cardiac paraganglioma sarcoma: A case report.

Cardiac paraganglioma is a kind of rare neuroendocrine tumor characterized by the persistent secretion of catecholamines. Under excessive exposure of catecholamines, some atypical symptoms are presented, including hypertension, arrhythmias, and headache. The case of surgical treatment of a 28-year-old woman with primary cardiac paraganglioma is presented for experience sharing and surgical skill improvements.

Relationships between Functional Movement Quality and Sprint and Jump Performance in Female Youth Soccer Athletes of Team China.

This study aimed to determine the optimal functional movement screen (FMS) cut score for assessing the risk of sport injury, and to investigate the correlations between functional movement quality and sprint and jump performance. Twenty-four (N = 24) athletes performed all tests in one day at 10−30 min intervals, and the FMS test was performed first, without a warm-up session. After a standard warm-up, athletes then completed the Y-balance Test (YBT), sprint, counter-movement jump (CMJ), and standing long jump (SLJ), in turn. For each test, the best of three attempts was recorded for further analysis. A receiver operating characteristic (ROC) curve and area-under-the-curve (AUC) were used to determine the optimal FMS cut score for assessing the risk of sport injuries, and Spearman's rank correlation analysis was used to quantify associations between functional movement scores and athletic performance. The average FMS score was 16.2 and the optimal FMS cut score for assessing the risk of sport injuries was 14.5. There were moderate relationships between total FMS score and 10−20 m sprint time (r = −0.46, p < 0.05), between In-line Lunge and 0−20 m sprint time (r = −0.47, p < 0.05), between Shoulder Mobility and 0−10 m sprint time (r = −0.48, p < 0.05), and between Trunk-stability Push-up and 10−20 m sprint time (r = −0.47, p < 0.05). Moreover, Hurdle Step score was largely correlated with 0−10 m time (r = −0.51, p < 0.05). For Y-balance, moderate correlations were observed between CMJ height and anterior asymmetry score (r = −0.47, p < 0.05) and posteromedial asymmetry score (r = −0.44, p < 0.05). However, there were no significant associations between YBT performance (asymmetric in three directions and composite score) and sprint performance (p > 0.05). Taken together, the results indicate that a FMS score of 14 is not a gold standard for assessing the risk of injury in all populations; we recommend that the FMS cut score of 14.5 should be the optimal score for assessing risk of injury in young female elite soccer players. Moreover, the FMS and YBT were introduced to assess the quality of functional movements, and they cannot be used to assess sprint and jump performance. Practitioners can use components of the FMS that have similar characteristics to specific sports to assess athletic performance.

Facile and Rapid Synthesis of Porous Hydrated V2O5 Nanoflakes for High-Performance Zinc Ion Battery Applications.

Hydrated V2O5 with unique physical and chemical characteristics has been widely used in various function devices, including solar cells, catalysts, electrochromic windows, supercapacitors, and batteries. Recently, it has attracted extensive attention because of the enormous potential for the high-performance aqueous zinc ion battery cathode. Although great progress has been made in developing applications of hydrated V2O5, little research focuses on improving current synthesis methods, which have disadvantages of massive energy consumption, tedious reaction time, and/or low efficiency. Herein, an improved synthesis method is developed for hydrated V2O5 nanoflakes according to the phenomenon that the reactions between V2O5 and peroxide can be dramatically accelerated with low-temperature heating. Porous hydrated V2O5 nanoflake gel was obtained from cheap raw materials at 40 °C in 30 min. It shows a high specific capacity, of 346.6 mAh/g, at 0.1 A/g; retains 55.2% of that at 20 A/g; and retains a specific capacity of 221.0 mAh/g after 1800 charging/discharging cycles at 1 A/g as an aqueous zinc ion battery cathode material. This work provides a highly facile and rapid synthesis method for hydrated V2O5, which may favor its applications in energy storage and other functional devices.

The Surgical Strategy for Progressive Dilatation of Aortic Root and Aortic Regurgitation After Repaired Tetralogy of Fallot: A Case Report.

It has been found that postoperative progressive dilatation of aortic root is not rare for adult patients with repaired Tetralogy of Fallot (TOF), which leads to severe aortic regurgitation or even fatal dissection. Therefore, clinically, surgical treatment for both regurgitated aortic valve and dilated root is needed based on preoperative assessments and individual treatment strategies.

Red blood cell distribution width-to-albumin ratio is associated with all-cause mortality in cancer patients.

BACKGROUND: Cancer causes a serious health burden on patients worldwide. Chronic low-level inflammation plays a key role in tumorigenesis and prognosis. However, the role of the red blood cell distribution width (RDW)-to-albumin (RA) ratio in cancer mortality remains unclear. METHODS: In this retrospective cohort study, we collected clinical information from cancer patients from the Medical Information Mart for Intensive Care III (MIMIC-III) version 1.4 database and then calculated RA by dividing RDW by albumin concentration. The primary outcome was 30 days mortality, while secondary outcomes were 90 days and 1 year mortality. Next, we adopted Cox regression models to calculate hazard ratios (HR) together with 95% confidence intervals (CI) for all-cause mortalities associated with the RA ratio. RESULTS: For 30 days mortality, the HR (95% CI) for the high RA ratio (≥5.51) was 2.17 [95CI% (1.87-2.51); p = <0.0001], compared with the low RA ratio (<5.51). In Model 2, we adjusted sex and age and obtained HR (95% CI) of 2.17 [95CI% (1.87-2.52); p = <0.0001] for the high RA ratio (≥5.51) group, compared to that in the low RA ratio (<5.51). In Model 3, adjusting for age, sex, anion gap, hematocrit, white blood cell count, congestive heart failure, SOFA, liver disease, and renal failure resulted in HR (95% CI) of 1.74 [95CI% (1.48-2.04); p = <0.0001] for the high RA ratio (≥5.51) relative to the low RA ratio (<5.51). We also analyzed common diseases in cancer patients but found no significant association. CONCLUSION: To the best of our knowledge, this is the first study demonstrating that increased RA ratio is independently associated with increased all-cause mortality in cancer patients.

Gait Phase Subdivision and Leg Stiffness Estimation During Stair Climbing.

Leg stiffness is considered a prevalent parameter used in data analysis of leg locomotion during different gaits, such as walking, running, and hopping. Quantification of the change in support leg stiffness during stair ascent and descent will enhance our understanding of complex stair climbing gait dynamics. The purpose of this study is to investigate a methodology to estimate leg stiffness during stair climbing and subdivide the stair climbing gait cycle. Leg stiffness was determined as the ratio of changes in ground reaction force in the direction of the support leg Fl (leg force) to the respective changes in length Ll during the entire stance phase. Eight subjects ascended and descended an instrumented staircase at different cadences. In this study, the changes of leg force and length (force-length curve) are described as the leg stiffness curve, the slope of which represents the normalized stiffness during stair climbing. The stair ascent and descent gait cycles were subdivided based on the negative and positive work fluctuations of the center-of-mass (CoM) work rate curve and the characteristics of leg stiffness. We found that the leg stiffness curve consists of several segments in which the force-length relationship was similarly linear and the stiffness value was relatively constant; the phase divided by the leg stiffness curve corresponds to the phase divided by the CoM work rate curve. The results of this study may guide biomimetic control strategies for a wearable lower-extremity robot for the entire stance phase during stair climbing.

Circular RNA, hsa_circRNA_102049, promotes colorectal cancer cell migration and invasion via binding and suppressing miRNA-455-3p.

Colorectal cancer (CRC) is the second most prevalent malignant gastrointestinal tumor type worldwide, displaying poor prognosis. Accumulating studies have reported the significance of circular RNAs (circRNAs) and microRNAs (miRNAs) in CRC carcinogenesis and development. At present, the functions and mechanisms of action underlying the circular RNA, hsa_circRNA_102049, in CRC are not completely understood. The present study aimed to establish the involvement of hsa_circRNA_102049 in CRC, as well as the associated mechanisms. The expression levels of hsa_circRNA_102049 and miRNA-455-3p were measured in CRC cell lines and tissues via reverse transcription-quantitative PCR. CRC progression was evaluated by performing Cell Counting Kit-8, flow cytometry, wound healing and Transwell invasion assays. The results demonstrated that hsa_circRNA_102049 was highly expressed in both CRC tissues and cell lines, which was associated with enhanced CRC cell proliferation, migration and invasion. Furthermore, miR-455-3p expression was downregulated in CRC cells and served as a target of has_circRNA_102049, which was validated by performing the dual luciferase reporter assay. hsa_circRNA_102049 knockdown significantly increased miR-455-3p expression, which was significantly reversed by co-transfection with the miR-455-3p inhibitor. Notably, miRNA-455-3p overexpression alleviated hsa_circRNA_102049-mediated induction of CRC cell proliferation, migration and invasion. The present study clearly demonstrated that miRNA-455-3p was a target of hsa_circRNA_102049. Moreover, the results indicated that the circular RNA, hsa_circRNA_102049, may function as a tumor promoter in CRC via directly sponging miRNA-455-3p.

Case Report: Two Cases of Abdominal Aggressive Fibromatosis That Mimicked Abdominal Wall Endometriosis and Review of Literature.

Background: Abdominal aggressive fibromatosis (AF) can be confounded with abdominal wall endomentriosis (AWE) because they share considerable similarity. Because of the different patient prognoses and treatment strategies available, accurate pre-operative diagnosis is important. Case Presentation: We here report two cases of abdominal masses presenting as periodic changes in tumor sizes, which occurred in correlation with the menstrual cycle. The clinical findings were highly suggestive of AWE. However, the final pathological findings revealed AF. The estrogen receptor and progesterone receptor expressions were negative in the two cases. The differences between the two diseases have been discussed in detail. Conclusion: A diagnosis of AWE should be scrutinized closely if the patient does not complain of cyclic pain. Fine-needle aspiration cytology is a suitable tool for pre-operative evaluation.

A Probability Distribution Model-Based Approach for Foot Placement Prediction in the Early Swing Phase With a Wearable IMU Sensor.

Predicting the next foot placement of humans during walking can help improve compliant interactions between humans and walking aid robots. Previous studies have focused on foot placement estimation with wearable inertial sensors after heel-strike, but few have predicted foot placements in advance during the early swing phase. In this study, a Bayesian inference-based foot placement prediction approach was proposed. Possible foot placements were modeled as a probability distribution grid map. With selected foot motion feature events detected sequentially in the early swing phase, the foot placement probability map could be updated iteratively using the feature models we built. The weighted center of the probability distribution was regarded as the predicted foot placement. Prediction errors were evaluated with collected walking data sets. When testing with the data from inertial measurement units, the prediction errors were (5.46 cm ± 10.89 cm, -0.83 cm ± 10.56 cm) for cross-velocity walking data and (-4.99 cm ± 12.31 cm, -11.27 cm ± 7.74 cm) for cross-subject-cross-velocity walking data. The results were comparable to previous works yet the prediction could be made earlier. For the subject who walked with more stable gaits, the prediction error can be further decreased. The proposed foot placement prediction approach can be utilized to help walking aid robots adjust their pose before each heel-strike event during walking, which will make human-robot interactions more compliant. This study is also expected to inspire additional probabilistic gait analysis works.

Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution.

Objectives: To investigate the clinical characteristics, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD) following laparoscopic surgery with uncontained morcellation and to summarize clinical features of iatrogenic LPD based on published literature together with our own experience. Methods: A cohort of 13 cases with iatrogenic LPD diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2020 was reported focusing on clinical characteristics, treatment and prognosis. Results: All the patients had a history of laparoscopic myomectomy with uncontained morcellation. The average age was 35.6 (range 25-47) years. The interval between initial laparoscopic surgery and first diagnosis of LPD was 6.08 years on average (range 1-12). Most of the patients had no obvious symptoms. The accuracy of pre-operative diagnosis was low. Two patients had been treated with gonadotropin-releasing hormone agonist (GnRH-a) before surgery without obvious effect. The nodules of LPD are usually located in the lower half of the peritoneal cavity. The most commonly involved site was the pouch of Douglas. The number of nodules ranged from 3 to over 10, and they ranged in size ranged from 0.3 to 22 cm. All patients underwent surgical treatment: six patients underwent laparoscopy and seven underwent laparotomy. Pathology results confirmed LPD. The immunohistochemical profile indicated LPD tends to be positive strongly for desmin, caldesmon, ER, PR and SMA. Only one patient underwent post-operative treatment with GnRH-a. All patients were followed for an average period of 49 months without recurrence. Conclusion: Iatrogenic LPD is a relatively rare condition. Patients usually exhibit no hormonal stimulation factors. Surgery is the main method of treatment, and hormone suppressive therapy is only rarely used. The nodules are usually large and less numerous, and most involve the pelvis. The prognosis of iatrogenic LPD seems good.

A Full Enhanced Recovery after Surgery Program in Gynecologic Laparoscopic Procedures: A Randomized Controlled Trial.

STUDY OBJECTIVE: To assess whether a full enhanced recovery after surgery (ERAS) program can further improve perioperative outcomes among patients undergoing gynecologic laparoscopic procedures relative to those receiving limited ERAS management. DESIGN: Randomized controlled trial. SETTING: Tertiary hospital, China: December 2018 to October 2019. PATIENTS: Total of 144 women scheduled for simple elective gynecologic laparoscopic surgery. INTERVENTIONS: The participants were randomized into 2 groups: full ERAS intervention or limited ERAS management (without preoperative carbohydrate loading or total intravenous anesthesia or opiate-sparing multimodal analgesia). MEASUREMENTS AND MAIN RESULTS: The primary outcome was postoperative length of stay (LOS), and the secondary outcomes included postoperative pain, time to postoperative milestones, morbidity, and in-hospital cost. Postoperative LOS for the full ERAS program showed a 1-day reduction in comparison with the limited ERAS group (median of 1.0 day vs 2.0 days, respectively; p = .001). Multivariate regression analysis identified preoperative carbohydrate loading and opioid-sparing analgesia as the independent factors for discharging on postoperative day 1. Patients in the full ERAS program reported less pain within 72 hours after surgery and had a lower narcotic consumption rate compared with those in the limited ERAS management. They also enjoyed better and faster recovery as demonstrated by the Quality of Recovery-15 scale on postoperative day 3: 137.0 (interquartile range, 126.3-141.0) for full ERAS program vs 130.0 (23.5-139.0) for limited ERAS management, respectively (p = .030). There were no significant differences between the groups regarding postoperative 30-day morbidity, readmission rate, or in-hospital cost. CONCLUSION: The addition of full ERAS management can further reduce postoperative LOS and improve patients' quality of life after laparoscopic surgery for gynecologic diseases.