Prediction of Base-Catalyzed Hydrolysis Kinetics of Polychlorinated Dibenzo-p-Dioxins by Density Functional Theory Calculations.

Polychlorinated dibenzo-p-dioxins (PCDDs), comprising 75 congeners, have gained considerable attention from the general public and the scientific community owing to their high toxic potential. The base-catalyzed hydrolysis of PCDDs is crucial for the assessment of their environmental persistence. Nonetheless, owing to the substantial number of congeners and low hydrolysis rates of PCDDs, conducting hydrolysis experiments proves to be exceedingly time-consuming and financially burdensome. Herein, density functional theory and transition state theory were employed to predict the base-catalyzed hydrolysis of PCDDs in aquatic environments. Findings reveal that PCDDs undergo base-catalyzed hydrolysis in aquatic environments with two competing pathways: prevailing dioxin ring-opening and reduced reactivity in the hydrolytic dechlorination pathway. The resultant minor products include hydroxylated PCDDs, which exhibit thermodynamic stability surpassing that of the principal product, chlorinated hydroxydiphenyl ethers. The half-lives (ranging from 17.10 to 1.33 × 1010 h at pH = 8) associated with the base-catalyzed hydrolysis of PCDDs dissolved in water were shorter compared to those within the water-sediment environmental system. This observation implies that hydroxide ions can protect aquatic environments from PCDD contamination. Notably, this study represents the first attempt to predict the base-catalyzed hydrolysis of PCDDs by using quantum chemical methods.

Fermented Corn-Soybean Meal Improved Growth Performance and Reduced Diarrhea Incidence by Modulating Intestinal Barrier Function and Gut Microbiota in Weaned Piglets.

This study aimed to investigate the effects of fermented corn-soybean meal mixed feed (FMF) on growth performance, intestinal barrier function, gut microbiota and short-chain fatty acids in weaned piglets. A total of 128 weaned piglets [Duroc×(Landrace×Yorkshire), male, 21-day-old] were randomly allocated to four groups. Piglets were fed a control diet (CON) or the control diet supplemented with 10%, 50% or 100% FMF (FMF-10, FMF-50 or FMF-100, respectively) for 14 d. The results showed that the FMF-100 group had higher average daily gain and average daily feed intake and lower diarrhea incidence than the CON group (p < 0.05). The FMF-50 and FMF-100 groups had greater villus height in the duodenum and jejunum, and the FMF-10 and FMF-100 groups had higher villus height-to-crypt depth ratio in the duodenum and jejunum than the CON group. Additionally, the FMF-100 group had higher protein expression of duodenal, jejunal and ileal ZO-1 and jejunal claudin-1; higher mRNA expression of duodenal and ileal TJP1 and jejunal CLDN1 and IL10; and lower jejunal IL1B mRNA expression (p < 0.05). The FMF-50 group showed higher jejunal ZO-1 and claudin-1 protein levels, higher mRNA expression levels of IL10 and TJP1 and lower levels of TNF in the jejunum; the FMF-10 group had higher mRNA expression levels of IL10 and lower levels of TNF in the jejunum than the CON group (p < 0.05). Furthermore, the FMF-10 and FMF-50 groups had higher colonic Lactobacillus abundance and butyrate levels; the FMF-100 group had higher abundance of colonic butyrate, Lactobacillus and Faecalibacterium than the CON group (p < 0.05). Collectively, our results suggest that FMF could improve intestinal mucosal barrier function, gut microbiota and their metabolites, thereby enhancing average daily gain and reducing diarrhea incidence in weaned piglets.

Using sEMG Signal Frequency to Evaluate Post-Stroke Elbow Spasticity.

Spasticity is a motor disorder with high prevalence and critical consequences following a stroke. Reliable and sensitive measurements are important to guide the selection and evaluation of treatment strategies. Technology-assisted methods, such as the surface electromyography (sEMG) technique, have been developed to measure spasticity as sensitive and accurate alternatives to commonly used clinical scales. However, sEMG amplitude based measures may confound spasticity-induced muscle activities with other types of muscle contractions. This study thus introduces the idea of using sEMG frequency information to detect spasticity as a potential solution to overcome the limitations of existing sEMG based measures. The preliminary results of three patients demonstrate the possibility and future research directions for this approach.

Modified combined short and long axis method versus oblique axis method in adult patients undergoing right internal jugular vein cannulation: A randomized controlled non-inferiority study.

BACKGROUND: Modified combined short and long axis method (MCSL) can replace oblique axis in-plane method (OA-IP) for internal jugular vein cannulation (IJVC). This randomized, non-inferiority study estimated the efficacy of MCSL compared with OA-IP in right IJVC. METHODS: Patients (18-75 yr. old) undergoing right IJVC under local anesthesia were randomly assigned to MCSL or OA-IP group. The primary outcome is the event of first needle pass without posterior vessel wall puncture (PVWP). Secondary outcomes included needle attempts, success rate, puncture and cannulation time, needle visualization, probe placement difficulty and complications. RESULTS: Among 190 randomized patients, 187 were involved in the analysis. The first needle pass without PVWP was 85(89.47%) in the MCSL and 81 (85.26%) in the OA-IP (p = 0.382), with a mean rate difference of 4.2% (95% confidence interval: -5.2-13.6), which confirmed the non-inferiority with the margin of -8%. MCSL group exhibited shorter procedure time and lower complications than OA-IP group. No significant differences were discovered between groups in needle attempts, success rate, incidence of probe placement difficulty and needle visualization. CONCLUSIONS: MCSL is non-inferior to OA-IP in first needle pass without PVWP in adults who underwent elective right IJVC and associate with less complications and shorter operating time. CLINICAL TRIAL REGISTRATION: ChiCTR, ChiCTR2100046899.

Virtual high-throughput screening: Potential inhibitors targeting aminopeptidase N (CD13) and PIKfyve for SARS-CoV-2.

Since the outbreak of the novel coronavirus nearly 3 years ago, the world's public health has been under constant threat. At the same time, people's travel and social interaction have also been greatly affected. The study focused on the potential host targets of SARS-CoV-2, CD13, and PIKfyve, which may be involved in viral infection and the viral/cell membrane fusion stage of SARS-CoV-2 in humans. In this study, electronic virtual high-throughput screening for CD13 and PIKfyve was conducted using Food and Drug Administration-approved compounds in ZINC database. The results showed that dihydroergotamine, Saquinavir, Olysio, Raltegravir, and Ecteinascidin had inhibitory effects on CD13. Dihydroergotamine, Sitagliptin, Olysio, Grazoprevir, and Saquinavir could inhibit PIKfyve. After 50 ns of molecular dynamics simulation, seven compounds showed stability at the active site of the target protein. Hydrogen bonds and van der Waals forces were formed with target proteins. At the same time, the seven compounds showed good binding free energy after binding to the target proteins, providing potential drug candidates for the treatment and prevention of SARS-CoV-2 and SARS-CoV-2 variants.

Generation, evolution, interfering factors, applications, and challenges of patient-derived xenograft models in immunodeficient mice.

Establishing appropriate preclinical models is essential for cancer research. Evidence suggests that cancer is a highly heterogeneous disease. This follows the growing use of cancer models in cancer research to avoid these differences between xenograft tumor models and patient tumors. In recent years, a patient-derived xenograft (PDX) tumor model has been actively generated and applied, which preserves both cell-cell interactions and the microenvironment of tumors by directly transplanting cancer tissue from tumors into immunodeficient mice. In addition to this, the advent of alternative hosts, such as zebrafish hosts, or in vitro models (organoids and microfluidics), has also facilitated the advancement of cancer research. However, they still have a long way to go before they become reliable models. The development of immunodeficient mice has enabled PDX to become more mature and radiate new vitality. As one of the most reliable and standard preclinical models, the PDX model in immunodeficient mice (PDX-IM) exerts important effects in drug screening, biomarker development, personalized medicine, co-clinical trials, and immunotherapy. Here, we focus on the development procedures and application of PDX-IM in detail, summarize the implications that the evolution of immunodeficient mice has brought to PDX-IM, and cover the key issues in developing PDX-IM in preclinical studies.

Trunk control in and out of an episode of recurrent low back pain in young adults during the Balance-Dexterity Task.

We investigated motor control strategies utilized by individuals with recurrent low back pain (rLBP) during active pain and remission periods as well as by back-healthy controls using the Balance-Dexterity Task. Nineteen young adults with rLBP were tested first when they were in pain and then again in symptom remission, and 19 matched controls were also tested. Trunk kinematic coupling and muscle co-activation were examined while participants performed the task by standing on one leg while compressing a spring with a maximum consistent force with the other leg. We found a decreased bilateral external oblique co-activation during the spring condition of the task compared to the stable block condition in people with rLBP compared to back healthy individuals. There was also reduced trunk coupling during the spring condition of the task compared to the stable block condition in both the rLBP active and remission groups, but no group difference between rLBP and back-healthy individuals. When individuals were in active pain, they exhibited more co-activation than when they were in remission, but the co-activation during active pain was not greater than in back-healthy individuals.

Research Updates on the Mechanism and Influencing Factors of the Photocatalytic Degradation of Perfluorooctanoic Acid (PFOA) in Water Environments.

Perfluorooctanoic acid is ubiquitous in water bodies and is detrimental to the health of organisms. Effectively removing perfluorooctanoic acid (PFOA), a persistent organic pollutant, has been a hot topic around the world. With traditional physical, chemical, and biological methods, it is difficult to effectively and completely remove PFOA, the costs are high, and it is easy to cause secondary pollution. There are difficulties in applying some technologies. Therefore, more efficient and green degradation technologies have been sought. Photochemical degradation has been shown to be a low-cost, efficient, and sustainable technique for PFOA removal from water. Photocatalytic degradation technology offers great potential and prospects for the efficient degradation of PFOA. Most studies on PFOA have been conducted under ideal laboratory conditions at concentrations that are higher than those detected in real wastewater. This paper summarizes the research status of the photo-oxidative degradation of PFOA, and it summarizes the mechanism and kinetics of PFOA degradation in different systems, as well as the influence of key factors on the photo-oxidative degradation and defluoridation process, such as system pH, photocatalyst concentration, etc. PFOA photodegradation technology's existing problems and future work directions are also presented. This review provides a useful reference for future research on PFOA pollution control technology.

Preparation of aluminium-hydroxide-modified diatomite and its fluoride adsorption mechanism.

As the current excessive accumulation of fluoride (F-) in the environment can be hazardous to human health, it is essential to remove fluoride from wastewater. In this study, diatomite (DA) was used as a raw material and modified using aluminum hydroxide (Al-DA) for use in the adsorption of F- from water bodies. SEM, EDS, XRD, FTIR, and Zeta potential characterization analyses were carried out; adsorption tests and kinetic fitting were performed, and the effects of pH, dosing quantity, and presence of interfering ions on the adsorption of F- by the materials were investigated. The results show that the Freundlich model effectively describes the adsorption process of F- on DA, which therefore involves adsorption-complexation interactions; however, the Langmuir model effectively describes the adsorption process of F- on Al-DA, corresponding to unimolecular layer adsorption mainly via ion-exchange interactions, that is, adsorption is dominated by chemisorption. Aluminum hydroxide was shown to be the main species involved in F- adsorption. The efficiency of F- removal by DA and Al-DA was over 91% and 97% for 2 h, and the adsorption kinetics were effectively fit by the quasi-secondary model, suggesting that chemical interactions between the absorbents and F- control the adsorption process. The adsorption of F- was highly dependent on the pH of the system, and the maximum adsorption performance was obtained at pH 6 and 4. The optimal dosage of DA and Al-DA was 4 g/L. Even in the presence of interfering ions, the removal of F- on Al-DA reached 89%, showing good selectivity. XRD and FTIR studies showed that the mechanism of F- adsorption on Al-DA involved ion exchange and the formation of F-Al bonds.

A Practical Post-Stroke Elbow Spasticity Assessment Using an Upper Limb Rehabilitation Robot: A Validation Study.

Spasticity is a motor disorder characterised by a velocity-dependent increase in muscle tone, which is critical in neurorehabilitation given its high prevalence and potential negative influence among the post-stroke population. Accurate measurement of spasticity is important as it guides the strategy of spasticity treatment and evaluates the effectiveness of spasticity management. However, spasticity is commonly measured using clinical scales which may lack objectivity and reliability. Although many technology-assisted measures have been developed, showing their potential as accurate and reliable alternatives to standard clinical scales, they have not been widely adopted in clinical practice due to their low usability and feasibility. This paper thus introduces an easy-to-use robotic based measure of elbow spasticity and its evaluation protocol. Preliminary results collected with one post-stroke patient and one healthy control subject are presented and demonstrate the feasibility of the approach.

Contour-Based Wild Animal Instance Segmentation Using a Few-Shot Detector.

Camera traps are widely used in wildlife research, conservation, and management, and abundant images are acquired every day. Efficient real-time instance segmentation networks can help ecologists label and study wild animals. However, existing deep convolutional neural networks require a large number of annotations and labels, which makes them unsuitable for small datasets. In this paper, we propose a two-stage method for the instance segmentation of wildlife, including object detection and contour approximation. In the object detection stage, we use FSOD (few-shot object detection) to recognize animal species and detect the initial bounding boxes of animals. In the case of a small wildlife dataset, this method may improve the generalization ability of the wild animal species recognition and even identify new species that only have a small number of training samples. In the second stage, deep snake is used as the contour approximation model for the instance segmentation of wild mammals. The initial bounding boxes generated in the first stage are input to deep snake to approximate the contours of the animal bodies. The model fuses the advantages of detecting new species and real-time instance segmentation. The experimental results show that the proposed method is more suitable for wild animal instance segmentation, in comparison with pixel-wise segmentation methods. In particular, the proposed method shows a better performance when facing challenging images.

Adsorption Characteristics and Charge Transfer Kinetics of Fluoride in Water by Different Adsorbents.

Water containing high concentrations of fluoride is widely distributed and seriously harmful, largely because long-term exposure to fluoride exceeding the recommended level will lead to fluorosis of teeth and bones. Therefore, it is imperative to develop cost-effective and environmentally friendly adsorbents to remove fluoride from polluted water sources. In this study, diatomite (DA), calcium bentonite (CB), bamboo charcoal (BC), and rice husk biochar (RHB) were tested as adsorbents to adsorb fluoride (F-) from water, and this process was characterized by scanning electron microscopy (FEI-SEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FT-IR). The effects of pH, dosage, and the initial mass concentration of each treatment solution upon adsorption of F- were determined. Kinetic and thermodynamic models were applied to reveal the mechanism of defluoridation, and an orthogonal experiment was designed to obtain the optimal combination of conditions. The results show that the surfaces of CB, BC, and RHB have an irregular pore structure and rough surface, whereas DA has a rich pore structure, clear pores, large specific surface area, and high silica content. With regard to the adsorption process for F-, DA has an adsorption complex electron interaction; that of CB, BC, and RHB occur mainly via ion exchange with positive and negative charges; and CB on F- relies on chemical electron bonding adsorption. The maximum adsorption capacity of DA can reach 32.20 mg/g. When the mass concentration of fluoride is 100 mg/L, the pH value is 6.0 and the dosage is 4.0 g/L; the adsorption rate of F- by DA can reach 91.8%. Therefore, we conclude that DA soil could be used as an efficient, inexpensive, and environmentally friendly adsorbent for fluoride removal, perhaps providing an empirical basis for improving the treatment of fluorine-containing water in the future.

Therapy of genomic unstable solid tumours (WHO grade 3/4）in clinical stage III/IV using individualised neoantigen tumour peptides-INP trial (individualised neoantigen tumour peptides immunotherapy): study protocol for an open-label, non-randomised, prospective, single-arm trial.

INTRODUCTION: Neoantigens derived from tumour somatic mutations are recognised as ideal vaccine targets. Tumour neoantigens have been studied in a wide range of tumours. Most of research on neoantigens has focused just on a unique tumour and a single mutated gene. Currently, a few studies have reported using a mixture of neoantigen peptides derived from multiple genetic mutation sites in the treatment of genomic unstable advanced solid malignancies. The trial aims to evaluate the safety and efficacy of individualised tumour neoantigen peptide mixtures in the treatment of genomic unstable advanced solid malignant tumours. METHODS AND ANALYSIS: This is a prospective, non-randomised, open, single-centre, single-arm, phase I trial. Patients with genomic unstable advanced solid malignancies are eligible for study participations. 20 patients will be included in the trial. Through the whole exome and transcriptome sequencing analysis of the fresh blood and tumour tissues of the enrolled patients, the 20 25-33aa antigen peptides with the highest mutation scores of the patients will be screened out, and the corresponding new antigen peptides will be synthesised and prepared. Patients will be treated with their own individualised neoantigen polypeptide combined with a polypeptide adjuvant (human granulocyte-macrophage colony-stimulating factor). The primary endpoint is safety indicators, including general and specific adverse events which will be monitored continuously. Secondary endpoints are progression-free survival, objective response rate, objective duration of remission, 1-year survival rate and overall survival. ETHICS AND DISSEMINATION: This study has received approval from the Ethics Committee of Chongqing University Cancer Hospital on 21 November 2019 (207/2019). The findings of this trial will be disseminated through national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: ChiCTR1900025364.

Potential Mechanism and Effects of Different Selenium Sources and Different Effective Microorganism Supplementation Levels on Growth Performance, Meat Quality, and Muscle Fiber Characteristics of Three-Yellow Chickens.

A trial was conducted to investigate the effects of different Se sources, including sodium selenite (S-Se) and selenium yeast (Y-Se) and different effective microorganism (EM) addition levels on growth performance, meat quality, and muscle fiber characteristics of three-yellow chickens and its potential mechanism. A total of 400 birds were randomly distributed into 4 groups (S-Se, S-Se + EM, Y-Se, and Y-Se + EM groups) consisting of a 2 × 2 factorial arrangement. The main factors were the source of Se (ISe = inorganic Se: 0.2 mg/kg S-Se; OSe = organic Se: 0.2 mg/kg Y-Se) and the level of EM (HEMB = high EM: 0.5% EM; ZEMB = low EM: 0% EM). Each treatment had 5 replicates and each replicate consisted of 20 broiler chickens. The trial lasted for 70 days. The results showed that, in breast muscle, the broiler chickens fed OSe source decreased the pH24h, drip loss, shear force, perimeter, cross-sectional area, and diameter, but increased the a 24 h * and density compared with the broiler chickens fed ISe source (p < 0.05); broiler chickens supplied with HEMB level decreased the cross-sectional area and diameter, but increased the pH24h, a 24 h , * and density compared with the broiler chickens supplied with ZEMB level (p < 0.05). In thigh muscle, OSe source and HEMB level also could improve the meat quality and change muscle fiber characteristics of broiler chickens (p < 0.05). Meat quality was correlated with the muscle fiber characteristics (p < 0.05). OSe source and HEMB level could regulate the expression levels of muscle fiber-relative genes in the breast and thigh muscles (p < 0.05). In conclusion, OSe source and HEMB level could improve the meat quality of the breast and thigh muscles of three-yellow chickens by changing the muscle fiber characteristics, and they changed the muscle fiber characteristics by regulating the expression levels of muscle fiber-relative genes.

Contributions of Intrinsic and Extrinsic Foot Muscles during Functional Standing Postures.

Purpose: Maintaining balance during static standing postures requires the coordination of many neuromuscular mechanisms. The role of the intrinsic and extrinsic foot muscles in this paradigm has yet to be clearly defined. The purpose of this study was to explore foot muscle activation during static phases on common weight-bearing tasks of varying loads and balance demands. Methods: Twenty healthy young adults performed 6 standing postures (single-limb and double-limb stand, squat, and heel raise) with one foot on a force plate. Muscle activity was recorded from the abductor hallucis, flexor hallucis longus and brevis, and tibialis posterior using intramuscular electrodes; surface electrodes were used to record activity from the peroneus longus and tibialis anterior. Two-way repeated measures ANOVA (2 loading conditions × 3 postures) were run to compare muscle activation and center of pressure velocity. Results: Intrinsic foot muscle activity increased as loading and postural demand increased; however, the specific effects varied for each of the extrinsic foot muscles. Conclusions: These results suggest that the intrinsic foot muscles play an important role in maintaining static balance. Strengthening intrinsic and extrinsic foot muscles may help increase stability in people who have weak toe flexors or who suffer from a variety of foot pathologies.

Compare the Efficacy and Safety of Modified Combined Short and Long Axis Method versus Oblique Axis Method for Right Internal Jugular Vein Catheterization in Adult Patients (The MCSLOA Trial): Study Protocol of a Randomized Controlled Trial.

Background: Ultrasound-guided internal jugular vein (IJV) catheterization has become a standard procedure as it yields a higher success rate and fewer mechanical complications compared with an anatomical landmark technique. There are several common methods for ultrasound guidance IJV catheterization, such as short-axis out-of-plane, long-axis in-plane and oblique axis in-plane, but these technologies are still developing. It is important to further study the application of different ultrasound-guided IJV puncture techniques and find an effective and safe ultrasound-guided puncture technique. Methods: A China randomized, open-label, parallel, single center, positive-controlled, non-inferiority clinical trial will evaluate 190 adult patients undergoing elective surgery and need right jugular vein catheterization. Study participants randomized in a 1:1 ratio into control and experimental groups. The control group will take the oblique axis in-plane method for IJV catheterization. The experimental group will take the Modified combined short and long axis method. The primary endpoint of the trial is the rate of one-time successful guidewire insertion without posterior wall puncture (PWP). Secondary endpoints are the number of needle insertion attempts, the total success rate, the procedure time, and mechanical complications. Conclusion: This randomized controlled trial will evaluate the effectiveness and safety of Modified combined short and long axis method and oblique axis in-plane method for right IJV catheterization in adult patients.

Occurrence characteristics and health risk assessment of per- and polyfluoroalkyl substances from water in residential areas around fluorine chemical industrial areas, China.

Recently, identifying the contamination status and assessing the health risk of per- and polyfluoroalkyl substances (PFASs) in surface water and groundwater have been of great significance. Eighteen individual PFASs were analyzed in thirty-three surface/groundwater samples during one period in a fluorine chemical park (Park A) and during two periods in Park B. The mean total concentration of 18 PFASs (∑PFASs) in Park A (9104.63 ng·L-1) was significantly higher than that in the wet season (WS) (801.68 ng·L-1) or DS (714.64 ng·L-1) in Park B. The perfluorobutane sulfonate (PFBS) was the predominant substance in the two parks, and the maximum concentration in groundwater exceeded 10,000 ng·L-1. The contamination status in the wet season (WS) was higher than that in the dry season (DS) in Park B. The ∑PFASs in Park A presented an increasing tendency following the groundwater flow direction, whereas this rule was limited to all periods in Park B. Two relative source contributions (RSCs) of 20% or 100% allowed assessing the PFASs risk to different age groups, and the results revealed that some PFASs (4 ≤ C ≤ 7 or 9 ≤ C ≤ 12) were identified as having a low risk quotient (RQ), except for perfluorooctane sulfonate (PFOS) and PFOA (C = 8). The RQmix value mainly relies on PFOA and PFOS, with a larger contribution rate of 80-90%. All assessed cases (case 1, case 2, case 3, and case 4) in all age groups revealed that infants were vulnerable to PFASs influence, followed by children, teenagers, and adults.

Multiple pollutants in groundwater near an abandoned Chinese fluorine chemical park: concentrations, correlations and health risk assessments.

Contamination and adverse effects from various pollutants often appear in abandoned industrial regions. Thus, nine groundwater samples were collected from the vicinity of the fluorochemical industry in Fuxin City, Liaoning Province, to determine concentrations of the ten heavy metals arsenic (As), chromium (Cr), cadmium (Cd), lead (Pb), nickel (Ni), copper (Cu), manganese (Mn), zinc (Zn), iron (Fe) and mercury(Hg), as well as those of fluorine (F-) and eighteen poly- and perfluorinated substances (PFASs), analyse correlation relationships, and assess the health risks for different age groups. The results showed that the levels of fluorine (F-) (0.92-4.42 mg·L-1), Mn (0.0005-4.91 mg·L-1) and Fe (1.45-5.61 mg·L-1) exceeded the standard limits for drinking water. Short chain perfluorobutanoic acid (PFBA) (4.14-2501.42 ng·L-1), perfluorobutane sulfonate (PFBS) (17.07-51,818.61 ng·L-1) and perfluorohexanoic acid (PFHxA) (0.47-936.32 ng·L-1) were the predominant substances from the PFASs group. No individual PFASs levels had significant relationships with F- or heavy metal contents. There was a positive relationship between short chain PFASs concentrations and water depth and a negative relationship between long chain PFASs concentration and water depth. The hazard quotient (HQ) decreased in the order F- > heavy metals > PFASs and also decreased for older age groups. In addition, As, Fe, Mn and perfluorooctanoic acid (PFOA) were the main sources of risk from the heavy metal and PFASs groups, respectively.

Asymptomatic carbon dioxide embolism during transoral vestibular thyroidectomy: A case report.

BACKGROUND: Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome. Although the incidence of carbon dioxide embolism (CDE) during endoscopic thyroidectomy is very low, it is potentially fatal. The clinical manifestations of CDE vary, and more attention should be paid to this disorder. CASE SUMMARY: A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach. The patient had no other diseases or surgical history. During the operation, he developed a CDE following inadvertent injury of the anterior jugular vein. The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide, and his remaining vital signs were stable. In addition, loud coarse systolic and diastolic murmurs were heard over the precordium. The patient was discharged on day 4 after surgery without complications. CONCLUSION: A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.