Search

To identify and compare the rates of cannula-associated deep vein thrombosis (CaDVT) in patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) who receive systemic anticoagulation (AC) and those who do not receive AC. Retrospective observational study. Tertiary academic medical center. Consecutive patients who successfully have been decannulated from VV-ECMO for treatment of refractory acute respiratory distress syndrome between 2017 and 2022. None. After decannulation of ECMO, a duplex sonograph was performed on the cannulation sites to determine the incidence and characteristics of cannula-related thrombosis. Thrombosis was classified as occlusive or nearly occlusive. Ninety-four of 161 patients were weaned from VV-ECMO. Nineteen patients who were placed on VV-ECMO due to COVID-19 were excluded. Twenty-seven of 52 patients (52%) who did not receive AC were identified to have thrombus. Twelve of 23 patients (52%) who received AC were identified to have thrombus. Patients who received AC required more blood products during the ECMO run and required longer support on VV-ECMO. This study showed a high incidence of cannula-related venous thrombosis after VV-ECMO decannulation. Surprisingly, the incidence of CaDVT in anticoagulation-free patients was the same as in patients requiring anticoagulation. Anticoagulated patients required longer support on VV-ECMO and required more transfusions. Routine post-decannulation screening for DVT is recommended due to the high incidence of CaDVT. [ABSTRACT FROM AUTHOR]

The number of electrophysiology (EP) procedures being performed has dramatically increased in recent years. This escalation necessitates a full understanding by the general anesthesiologist as to the risks, specific considerations, and comorbidities that accompany these now common procedures. Procedures reviewed in this article include atrial fibrillation and flutter ablation, supraventricular tachycardia ablation, ventricular tachycardia ablation, electrical cardioversion, pacemaker insertion, implantable cardioverter-defibrillator (ICD) insertion, and ICD lead extraction. General anesthetic considerations as well as procedure-specific concerns are discussed. Knowledge of these procedures will add to the anesthesiologist's armamentarium in safely caring for patients in the EP laboratory. [ABSTRACT FROM AUTHOR]

Remotely located offshore wind farms (OWFs) are usually in unmanned operation, and are severely at risk from accidental or deliberate man-made damages, such as cable faults caused by vessel anchoring. In this work, a proactive alarming and interception method utilising unmanned surface vehicles (USV) is proposed to prevent suspect vessels from intruding OWF areas and damaging the assets. More specifically, the vessel intrusion interception system keeps monitoring the motion of surrounding vessels and assessing their potential intrusive risks. When a suspect intruder is identified, USV will be automatically deployed to proactively intercept the target vessel with an alarming and expelling system. In particular, a risk assessment model based on the analytic hierarchy process (AHP) and entropy weight method (EWM) is established to predict the potential intrusive risk, and an improved fast marching square (FMS) algorithm is designed for USV path planning to guarantee dynamic and reliable vessel interception. In order to verify the effectiveness of the proposed method, case studies have been conducted for the Zhejiang Jiaxing 2 OWF with authentic vessel traffic data. Results indicate that the proposed risk assessment model based on AHP-EMW is able to correctly predict the potential intrusion risk in various scenarios, and the improved FMS path planning algorithm with multi-objective optimisation is capable of providing both efficient and safe trajectories for USV interception. • An intrusive vessel interception system for offshore wind farm asset protection. • An intrusive risk assessment model is established for different types of vessels. • A multi-objective optimisation path planning framework is developed for interception. • Effectiveness of the proposed approach is verified with authentic AIS data. [ABSTRACT FROM AUTHOR]

O3-type layered oxide cathodes are primarily limited by complex phase transitions and sluggish kinetics resulting in rapid capacity drop and poor rate capability. Even worse, its inherent air sensitivity leads to spontaneous extraction of lattice Na-ions and the deactivation of the cathode. Simultaneous modification of both the bulk phase and the surface structure is promising to offset the above deficiencies. A spinel@O3 type layered composite structure Na 0.9 Mn 0.5 Ni 0.5 Cu 0.1 O 2+x (NMNCO-SL) was constructed for the design of cathodes with higher cycling, rate and air stability. The atomic-level Cu-rich spinel structure on the surface was identified by scanning transmission electron microscopy, elemental linear scanning analysis and Raman spectra. In situ charge-discharge X-ray diffraction results show that the phase transition of NMNCO-SL is significantly suppressed. Finally, the material maintains good electrochemical properties after exposure to stringent humidity environments. The results indicate that the spinel structure at the surface plays a significant role in improving ion-diffusion dynamics, enhancing structural integrity, and increasing air stability. 1 Ah pouch cell based on NMNCO-SL showed 92% capacity retention after 500 cycles of charge/discharge cycling at 1 C, demonstrating the potential prospects of customizing the surface phase structure for materials engineering applications. [Display omitted] • The Cu-rich spinel structure on the surface plays a role in enhancing structural integrity and increasing air stability. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs), known for their health risks, are prevalent in the environment, with the coking industry being a major source of their emissions. To bridge the knowledge gap concerning the relationship between environmental and dietary PAH exposure, we explore this complex interplay by investigating the dietary exposure characteristics of 24 PAHs within a typical Chinese coking plant and their association with environmental pollution. Our research revealed Nap and Fle as primary dietary contaminants, emphasizing the significant influence of soil and atmospheric pollution on PAH exposure. We subjected our data to non-metric multidimensional scaling (NMDS), Spearman correlation analysis, Lasso regression, and Weighted Quantile Sum (WQS) regression to delve into this multifaceted phenomenon. NMDS reveals that dietary PAH exposure, especially within the high molecular weight (HMW) group, is common both within and around the coking plant. This suggests that meals prepared within the plant may be contaminated, posing health risks to coking plant workers. Furthermore, our assessment of dietary exposure risk highlights Nap and Fle as the primary dietary contaminants, with BaP and DahA raising concerns due to their higher carcinogenic potential. Our findings indicate that dietary exposure often exceeds acceptable limits, particularly for coking plant workers. Correlation analyses uncover the dominant roles of soil and atmospheric pollution in shaping dietary PAH exposure. Soil contamination significantly impacts specific PAHs, while atmospheric pollution contributes to others. Additionally, WQS regression emphasizes the substantial influence of soil and drinking water on dietary PAHs. In summary, our study sheds light on the dietary exposure characteristics of PAHs in a typical Chinese coking plant and their intricate interplay with environmental factors. These findings underscore the need for comprehensive strategies to mitigate PAH exposure so as to safeguard both human health and the environment in affected regions. [Display omitted] • Soil pollution is the main source of dietary PAH (particularly anthracene) exposure. • Urgent soil pollution mitigation is needed to safeguard local population's health. • Atmospheric and drinking water pollution significantly affect specific dietary PAHs. • Our findings are instrumental in shaping vital public health policies and interventions. [ABSTRACT FROM AUTHOR]

As an emerging form of pollution, microplastic contamination of the coastal ecosystems is one of the world's most pressing environmental concerns. Coastal sediments have been polluted to varying degrees by microplastics, and their ubiquitous presence in sediments poses a threat to marine organisms. However, there is currently no ecological risk assessment of microplastics on aquatic biota in sediments. This study, for the first time, established a new procedure to evaluate the toxicity of microplastics on aquatic biota in sediments, based on the probabilistic risk assessment (PRA) concept. The choice of Zhelin Bay as the case study site was based on its severe pollution status. The average content of microplastics in the sediments of Zhelin Bay was 2054.17 items kg−1 dry weight, and these microplastics consisted of 46 different species. Microplastics in sediments exist in five different forms, with the film form being the main composition, and the majority of microplastics have particle sizes ranging from 100 to 500 μm. Correlation analysis (CA) reveals significant negative correlations between microplastic abundance, and Al 2 O 3 and SiO 2. The toxicity of microplastics, based on the PRA concept, suggests that Zhelin Bay surface sediments had a low probability (3.43%) of toxic effects on aquatic biota. [Display omitted] • A new procedure has been established to assess the ecological risks of microplastics. • The new procedure can effectively assess the probability risk and toxicity of sediment microplastics. • The surface sediments of Zhelin Bay had a 3.44% probability of toxic effects on aquatic biota. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The sonographic appearance of benign and malignant breast nodules overlaps to some extent, and we aimed to assess the performance of the Gail model as an adjunctive tool to ultrasound (US) Breast Imaging Reporting and Data System (BI-RADS) for predicting the malignancy of nodules.Materials and Methods: From 2018 to 2019, 2607 patients were prospectively enrolled by 35 health care facilities. An individual breast cancer risk was assessed by the Gail model. Based on B-mode US, color Doppler, and elastography, all nodules were evaluated according to the fifth edition of BI-RADS, and these nodules were all confirmed later by pathology.Results: We demonstrated that the Gail model, age, tumor size, tumor shape, growth orientation, margin, contour, acoustic shadowing, microcalcification, presence of duct ectasia, presence of architectural distortion, color Doppler flow, BI-RADS, and elastography score were significantly related to breast cancer (all p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve (AUC) for combining the Gail model with the BI-RADS category were 95.6%, 91.3%, 85.0%, 97.6%, 92.8%, and 0.98, respectively. Combining the Gail model with the BI-RADS showed better diagnostic efficiency than the BI-RADS and Gail model alone (AUC 0.98 vs 0.80, p < 0.001; AUC 0.98 vs 0.55, p < 0.001) and demonstrated a higher specificity than the BI-RADS (91.3% vs 59.4%, p < 0.001).Conclusion: The Gail model could be used to differentiate malignant and benign breast lesions. Combined with the BI-RADS category, the Gail model was adjunctive to US for predicting breast lesions for malignancy. For the diagnosis of malignancy, more attention should be paid to high-risk patients with breast lesions. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The objective of this study was to evaluate the utility of the fifth edition of the Breast Imaging-Reporting and Data System (BI-RADS) in clinical breast radiology by using prospective multicenter real-time analyses of ultrasound (US) images.Materials and Methods: We prospectively studied 2049 female patients (age range, 19-86 years; mean age 46.88 years) with BI-RADS category 4 breast masses in 32 tertiary hospitals. All the patients underwent B-mode, color Doppler US, and US elastography examination. US features of the mass and associated features were described and categorized according to the fifth edition of the BI-RADS US lexicon. The pathological results were used as the reference standard. The positive predictive values (PPVs) of subcategories 4a-4c were calculated.Results: A total of 2094 masses were obtained, including 1124 benign masses (54.9%) and 925 malignant masses (45.1%). For BI-RADS US features of mass shape, orientation, margin, posterior features, calcifications, architectural distortion, edema, skin changes, vascularity, and elasticity assessment were significantly different for benign and malignant masses (p< 0.05). Typical signs of malignancy were irregular shape (PPV, 57.2%), spiculated margin (PPV, 83.7%), nonparallel orientation (PPV, 63.9%), and combined pattern of posterior features (PPV, 60.6%). For the changed or newly added US features, the PPVs for intraductal calcifications were 80%, 56.4% for internal vascularity, and 80% for a hard pattern on elastography. The associated features such as architectural distortion (PPV, 89.3%), edema (PPV, 69.2%), and skin changes (PPV, 76.2%) displayed high predictive value for malignancy. The rate of malignant was 7.4% (72/975) in category 4a, 61.4% (283/461) in category 4b, and 93.0% (570/613) in category 4c. The PPV for category 4b was higher than the likelihood ranges specified in BI-RADS and the PPVs for categories 4a and 4c were within the acceptable performance ranges specified in the fifth edition of BI-RADS in our study.Conclusion: Not only the US features of the breast mass, but also associated features, including vascularity and elasticity assessment, have become an indispensable part of the fifth edition of BI-RADS US lexicon to distinguish benign and malignant breast lesions. The subdivision of category 4 lesions into categories 4a, 4b, and 4c for US findings is helpful for further assessment of the likelihood of malignancy of breast lesions. [ABSTRACT FROM AUTHOR]

Zinc tin oxide (ZTO) thin films can be deposited by atomic layer deposition (ALD) with adjustable electrical, optical and structural properties. However, the ternary ALD processes usually suffer from low growth rate and difficulty in controlling film thickness and elemental composition, due to the interaction of ZnO and SnO 2 processes. In this work, ZTO thin films with different Sn levels are prepared by ALD super cycles using diethylzinc, tetrakis(dimethylamido)tin, and water. It is observed that both the film growth rate and atom composition show nonlinear variation versus [Sn]/([Sn]+[Zn]) cycle ratio. The experimental thickness measured by spectroscopic ellipsometry and X-ray reflectivity are much lower than the expected thickness linearly interpolated from pure ZnO and SnO x films. The [Sn]/([Sn]+[Zn]) atom ratios estimated by X-ray photoelectron spectroscopy have higher values than that expected from the cycle ratios. Hence, to characterize the film growth behavior versus cycle ratio, a numerical method is proposed by simulating the effect of reduced density and reactivity of surface hydroxyls and surface etching reactions. The structure, electrical and optical properties of ZTO with different Sn levels are also examined by X-ray diffraction, atomic force microscope, Hall measurements and ultraviolet–visible–infrared transmittance spectroscopy. The ZTO turns out to be transparent nanocrystalline or amorphous films with smooth surface. With more Sn contents, the film resistivity gets higher (>1 Ω cm) and the optical bandgap rises from 3.47 to 3.83 eV. [ABSTRACT FROM AUTHOR]