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.

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.

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 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.

MolMiner: You Only Look Once for Chemical Structure Recognition.

Molecular structures are commonly depicted in 2D printed forms in scientific documents such as journal papers and patents. However, these 2D depictions are not machine readable. Due to a backlog of decades and an increasing amount of printed literatures, there is a high demand for translating printed depictions into machine-readable formats, which is known as Optical Chemical Structure Recognition (OCSR). Most OCSR systems developed over the last three decades use a rule-based approach, which vectorizes the depiction based on the interpretation of vectors and nodes as bonds and atoms. Here, we present a practical software called MolMiner, which is primarily built using deep neural networks originally developed for semantic segmentation and object detection to recognize atom and bond elements from documents. These recognized elements can be easily connected as a molecular graph with a distance-based construction algorithm. MolMiner gave state-of-the-art performance on four benchmark data sets and a self-collected external data set from scientific papers. As MolMiner performed similarly well in real-world OCSR tasks with a user-friendly interface, it is a useful and valuable tool for daily applications. The free download links of Mac and Windows versions are available at https://github.com/iipharma/pharmamind-molminer.

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.

Full size microplastics in crab and fish collected from the mangrove wetland of Beibu Gulf: Evidences from Raman Tweezers (1-20 µm) and spectroscopy (20-5000 µm).

Microplastic pollution in organisms is a growing environmental concern worldwide. Current methods to identify microplastics (MPs) are subject to the limitations of analytical techniques, and there is no full-scale method to measure MPs in organisms. In this study, Raman Tweezers and spectroscopy methods were combined and applied to identify MPs in organisms within the size range of 1-5000 µm. The abundance of small MPs (1-20 µm) was measured in crab (0.39-2.83 items/individual) and fish (0.35-3.22 items/individual). Most MPs were transparent in color and pellet shape. The proportion of small MPs (1-20 µm) was 35.77%, and analysis revealed the non-inclusion of this fraction will induce large deviations in the overall measurement. The large MPs (20-5000 µm) were identified in crab and fish with abundances ranging from 0.74-4.96 items/individual and 0.72-5.39 items/individual, respectively. Mainly fiber shape items were detected, the dominant particle size ranged from 20 to 100 µm, and most MPs were white. Polyethylene (PE) and polyethylene terephthalate (PET) were the main types of MPs polymers detected. Our study fills the gap to provide a new method to detect MPs in organisms below 20 µm, facilitating study of the migration and transformation of small MPs in the environment.

Dynamic distribution of microplastics in mangrove sediments in Beibu Gulf, South China: Implications of tidal current velocity and tidal range.

Hydrodynamic factors have always been considered as the predominant factors determining the transportation of suspended particulate matter in tidal flats. However, whether such factors also affect the transportation of microplastics (MPs) in mangrove forests remains largely unknown. In our study, the extent to which the two most critical hydrodynamic factors (tidal range and current velocity) impact the distribution of MPs in mangrove sediments was evaluated. In the different zones of the mangrove forest, strong linear relationships were observed between the tidal current velocity and MPs content during both the flood and ebb tide periods (p = 0.002, R2 > 0.837). Similarly, in the same mangrove forest, the MPs content significantly differed, and a general increasing trend was found from the seaward boundary (ranging from 80 ± 16 item/kg to 1020 ± 89 item/kg) to the landward boundary (ranging from 520 ± 32 to 6040 ± 114 item/kg). The MPs growth rates showed obvious linear relationships with the tidal current velocity (p < 0.005, R2 > 0.905), but there were no relationships with the tidal range (p = 0.717). The results of this work highlight that tidal current velocity and tidal range should be taken into account when exploring the mechanisms of MPs distributions in mangrove ecosystems.

Field study of the microplastic pollution in sea snails (Ellobium chinense) from mangrove forest and their relationships with microplastics in water/sediment located on the north of Beibu Gulf.

Laboratory studies demonstrated that the mussels were good model organisms in revealing microplastics (MPs) uptake and toxicity. However, only limited field study data on the MPs in benthic marine mesoherbivores collected from mangrove forests are currently available. In this study, the MPs in the snails (Ellobium chinense) organs, rather than the shell, from a mangrove forest were dominant fraction (maximum reaching to 60%). Unexpectedly, no significant linear relationships were found between the levels of MPs in the organs of the snails and the levels in the sediment/tidal water. Further studies were done to explore the sources of the MPs in snail organs. MPs in snail organs at both the landward (interior) and seaward (exterior) zones mainly origin from the pore water. Moreover, the MPs found in the snails showed no relevance to the particulate matter (PM) collected from pore water. The findings reported here imply that both the MPs and PM in pore water affect the extent of MPs enter into the organs of benthic marine mesoherbivores collected from mangrove forest.

The spatial distribution of microplastic in the sands of a coral reef island in the South China Sea: Comparisons of the fringing reef and atoll.

Microplastic pollution of coral reef ecosystems has received increasing attention since the discovery that several typical coral types have the ability to ingest (micro-) plastics. However, data on the distribution of microplastics in coral reef ecosystems are still very limited. The study reported here selected sands/sediments from coral reef islands located in the South China Sea as a representative study site. The abundance of microplastics was found to reach 90 ±â€¯5 items/kg and 530 ±â€¯7 items/kg at the Weizhou Island and Sanya Lu Hui Tou (LHT) sites (fringing reef), respectively. Each of these qualities are lower than the quantity of microplastics collected from the Xisha Islands (atoll) (60 ±â€¯3 to 610 ±â€¯11 items/kg), which experiences less human activity and pollution. Moreover, further investigation demonstrated that the differences in the microplastics in the sands of these atolls and fringing reefs were determined not only by their sources, but were also dependent on their water exchange rates. The primary type and color of the microplastics found in these four sampling zones was red polypropylene and there was a greater proportion of smaller size particles (<1 mm) in the remote atolls of the Nansha and Xisha islands than in the other fringing reef sites. Additionally, there were no obvious differences found in the abundance of microplastics and the compositions/structures of coral sand in the Weizhou Island and Sanya LHT sites.

Using a Three-Dimensional Reduction Method in the High-Efficiency Grain Selector and Corresponding Grain Selection Mechanism.

In the development of a high-efficiency grain selector, the spiral selectors are widely used in Ni-based single crystal (SX) superalloys casting to produce single crystal turbine blades. For the complex three-dimensional structure of the spiral, a 2D grain selector was designed to investigate in this paper. As a result, the parameters of two-dimensional grain selection bond and the corresponding grain selection mechanism were established, and the three-dimensional grain selection bond was designed again by means of two-dimensional coupling optimization parameters.

Investigation of Start Block and Corresponding Influence for Grain Selection during Casting of Single-Crystal Superalloys.

To figure out the impact of the parameters of a starter block (the diameter D and height H) on grain selection and the selecting mechanism, a spiral selector was measured with optical microscopy (OM) and electron backscatter diffraction (EBSD) during the solidification of Ni-based single crystal (SX) superalloys. In this experiment, starter blocks with diameters of 8 mm, 10 mm, 15 mm, and 30 mm and a height of 30 mm were designed to find the best parameters. Recommendations for optimizing starter block geometry are provided.