Search

Abstract Background Low-dose IL-2 (Ld-IL2) has shown favorable therapeutic effects in systemic lupus erythematosus (SLE) therapy. However, previous clinical trials reported an SLE Responder Index-4 (SRI-4) response rate of 65.52%-68%, with approximately half failing to achieve the primary endpoint by week 24. Our study aims to determine the real-world use of Ld-IL2 and to identify determinants of its effectiveness in SLE. Methods We pooled data from 342 SLE patients undergoing sequential Ld-IL2 treatment, with 314 persisting for over 3 months were included in effectiveness and prediction analyses. All patients were categorized into responder (n = 136) and non-responder group (n = 178) according to SRI-4. Lupus Low Disease Activity State (LLDAS) was also analyzed to validate our results. Results Rash, lower complement 3 (C3), and renal involvement including urine protein, urine occult blood and urine casts emerged as prominent predictors of achieving SRI-4. Adjusting for baseline values using the ratio of change to baseline revealed significant differences in CD4 + T cell immune profiles between responders and non-responders. ROC analysis confirmed a satisfactory performance of rash, renal involvement, percentage change of CD4 + T cells, and C3 in predicting SRI-4, yielding an AUC of 0.933. LLDAS analysis showed that hematological involvements and lower CLA + Treg were potent predictive markers in LLDAS attainment. Conversely, renal involvement failed to have significant association in achieving LLDAS. The analysis of background therapy in SLE patients showed that MMF was more likely to reach the SRI-4 response with the combination of Ld-IL2. Conclusions These findings uncovered the predictors of Ld-IL2 treatment efficacy in SLE patients and provided guidance to physicians for rational utilization.

Abstract Depersonalization/derealization disorder (DPD) is a prevalent yet inadequately understood clinical condition characterized by a recurrent or persistent sense of unreality. This study aims to provide insight into DPD through descriptive and comparative analyses involving a large group of Chinese participants. The socio-demographic details (age, gender proportion, education, occupational status, marital status), depersonalized and dissociative symptom characteristics (symptomatic factors or subscales of the Cambridge Depersonalization Scale and the Dissociative Experiences Scale), development trajectory (age of onset, potential precipitating factors, course characteristics), treatment history (duration of delayed healthcare attendance, duration of delayed diagnosis, previous diagnoses), and adverse childhood experiences of the DPD patients are presented. Comparisons of anxiety and depressive symptoms, alongside psychosocial functioning, between DPD participants and those diagnosed with generalized anxiety disorder, bipolar disorders, and major depressive disorder were conducted. The analysis highlights a higher male preponderance and early onset of DPD, symptomatology marked by derealization, notable impairment in psychosocial functioning, and prolonged periods of delayed healthcare attendance and diagnosis associated with symptom severity. Furthermore, noteworthy relationships between adverse childhood experiences and symptom levels were identified. The findings substantiate the view that DPD is a serious but neglected mental disorder, urging initiatives to improve the current condition of DPD patients.

Abstract Background The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient’s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA). Methods We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event. Results A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group. Conclusion We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.

Introduction Congenital heart disease is a common birth defect, but advancements in diagnosis and treatment have improved survival rates. Enhanced recovery after surgery (ERAS) programmes have emerged in paediatric cardiac surgery. Multimodal pain management, as a vital part of ERAS programmes, has been found to be effective in reducing pain and improving outcomes in cardiac surgery patients. Traditional methods of pain control using high-dose opioids can lead to complications, so nonopioid analgesics and regional anaesthesia techniques are being used to reduce the consumption. However, there is a significant variability in pain management practices in paediatric cardiac surgery. A network meta-analysis (NMA) is needed to comprehensively compare the effects of different analgesic interventions in this population.Methods and analysis A comprehensive electronic literature database search will be performed using electronic databases, mainly including PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials. All randomised controlled trials associated with perioperative pain management for paediatric cardiac surgery will be included. The primary outcome will be visual analogue score or numeric rating scale of pain and total opioid consumption (or equivalent) 24 hours after postoperative tracheal extubation. The Revised Cochrane Risk of Bias Tool will be employed to assess the quality of included articles. A random-effects pairwise meta-analysis will be performed to report the head-to-head comparison. Following the assessment of individual articles, an NMA will be conducted using a Bayesian framework with random-effects’ models.Ethics and dissemination Ethics approval is not necessary because this study will be based on publications. The results of this study will be published in a peer-reviewed journal.PROSPERO registration number CRD42023477520.

Abstract With the expansion of the global population, the energy shortage is becoming increasingly acute. Phase change materials (PCMs) are considered green and efficient mediums for thermal energy storage, but the leakage problem caused by volume instability during phase change limits their application. Encapsulating PCMs with supporting materials can effectively avoid leakage, but most supporting materials are expensive and consume huge of natural resources. Carbon materials, which are rich and renewable resources, can be used as economical and environmentally friendly supporting skeletons to prepare form‐stable PCMs. Although many researchers have begun to use recyclable materials especially various derivatives of carbon as supporting skeletons to prepare form‐stable PCMs, the preparation methods, thermophysical properties and applications of form‐stable PCMs with recyclable skeletons have rarely been systematically summarized yet. Form‐stable PCMs with a recyclable skeleton can be used as green and efficient thermal storage materials due to their high heat storage capacity and good thermophysical stability after 2000 thermal cycles. This review investigates the effects of recyclable skeletons on the thermophysical properties including phase change temperature, latent heat, thermal conductivity, supercooling, and thermal cycling reliability. Four major kinds of recyclable skeletons are focused on: biomass, biochar, industrial by‐products as well as waste incineration ash. Additionally, the application scales of form‐stable PCMs with recyclable skeletons are explicated in depth. Moreover, the main challenges confronted by form‐stable PCMs with recyclable skeletons are discussed, and future research trends are proposed. This article provides a systematic review of the form‐stable PCMs with recyclable skeletons, giving significant guidance for further reducing carbon emissions and promoting the development of sustainable energy.

Abstract Objective Preoperative chronic stress (CS) is associated with postoperative brain injury in patients undergoing open heart cardiac surgery. This research is to explore the potential molecular biological mechanisms of brain damage following cardiac surgery in preoperative CS rats by the analyses combining proteomics and metabolomics. Methods We constructed the chronic unpredictable stress (CUS) and cardiac surgery models in adult rats. We proved the brain injury in CUS cardiac surgery rats by Hematoxylin–Eosin (H&E) staining, followed by separating the hippocampal tissue and investigating the potential mechanisms of brain injury by the methods of data-independent acquisition proteomics and untargeted metabolomics. Results The signaling pathways of glycoproteins and metabolism of amino acids were the main possible mechanisms of brain injury in CUS rats following cardiac surgery according to the proteomics and metabolomics. In addition, the pathways of animo acids metabolism such as the pathways of lysine degradation and β-alanine metabolism may be the main mechanism of cardiac surgery related brain injury in preoperative CUS rats. Conclusions The pathways of animo acids metabolism such as lysine degradation and β-alanine metabolism may be the potential mechanisms of brain injury in CUS rats following cardiac surgery. We should focus on the varieties of bioproteins and metabolites in these pathways, and related changes in other signaling pathways induced by the two pathways.

Background Systemic sclerosis (SSc) often overlaps with other autoimmune diseases. More complex autoantibody profiles may be observed in SSc overlap syndrome (SSc OS). To determine the clinical significance of autoantibodies in SSc OS and classify the patients more accurately for better disease assessments, we analysed the correlation between serological profiles, organ involvements and outcomes.Methods A retrospective cohort study was conducted in Peking University People’s Hospital. Chi-square tests and analysis of variance were used to analyse univariate comparisons of clinical symptoms, organ involvement and laboratory indicators. Survival was evaluated using Cox proportional hazards model.Results Among 141 cases, anti-Ro-52 was the most common antibody, followed by anti-centromere antibody and anti-Scl-70 antibody. We analysed the correlation between autoantibodies and vital organ damage in SSc OS patients, and compared the differences across four SSc OS subgroups (SSc SLE, SSc RA, SSc PM/DM and SSc SS) to demonstrate the correlation between autoantibodies and clinical characteristics and organ damage. Cox regression analysis showed that scleroderma renal crisis (SRC) (p = .004) and pulmonary arterial hypertension (PH) (p = .010) were independent risk factors for survival.Conclusions Autoantibodies are associated with clinical features, organ involvement and prognosis in SSc OS patients. Anti-Scl-70 antibody is associated with interstitial lung disease (ILD) and SRC, while ACA is a protective factor of ILD. SRC and PH are risk factors associated with death.

AbstractObjective Accumulating evidence suggests that differentially expressed circular RNAs (circRNAs) play critical roles in immune cells of systemic lupus erythematosus (SLE) patients. Hsa_circ_0000479 has been studied in the field of cancer and infection, whereas seldom studied in autoimmune diseases. The aim of this study was to investigate the role and clinical value of neutrophil hsa_circ_0000479 in SLE.Methods The expression levels of hsa_circ_0000479 in both healthy individuals and SLE patients’ neutrophils were detected by qPCR and compared with those in peripheral blood mononuclear cells (PBMCs) . In addition, the correlation of hsa_circ_0000479 levels in neutrophils with the clinical and immunological features of SLE patients was also analysed.Results The expression levels of hsa_circ_0000479 in the patients with SLE were significantly higher in neutrophils than that of PBMCs, and also significantly higher than that in healthy controls (HCs). Moreover, the expression levels of hsa_circ_0000479 in neutrophils were negatively associated with absolute neutrophil count and complement 3 (C3), whereas positively correlated with anti-dsDNA and anti-nucleosome antibodies in SLE. In addition, SLE patients with higher levels of hsa_circ_0000479 demonstrated more several clinical manifestations, including Raynaud’s phenomenon, alopecia and leucopenia.Conclusions Hsa_circ_0000479 is up-regulated in neutrophils of SLE patients, and is also associated with several important laboratory indicators and clinical manifestations, suggesting that hsa_circ_0000479 in neutrophils was one of probable factors involved in the pathogenesis of SLE with potential clinical value.

Background: Machine learning has shown to be an effective method for early prediction and intervention of Gestational diabetes mellitus (GDM), which greatly decreases GDM incidence, reduces maternal and infant complications and improves the prognosis. However, there is still much room for improvement in data quality, feature dimension, and accuracy. The contributions and mechanism explanations of clinical data at different pregnancy stages to the prediction accuracy are still lacking. More importantly, current models still face notable obstacles in practical applications due to the complex and diverse input features and difficulties in redeployment. As a result, a simple, practical but accurate enough model is urgently needed. Design and methods: In this study, 2309 samples from two public hospitals in Shenzhen, China were collected for analysis. Different algorithms were systematically compared to build a robust and stepwise prediction system (level A to C) based on advanced machine learning, and models under different levels were interpreted. Results: XGBoost reported the best performance with ACC of 0.922, 0.859 and 0.850, AUC of 0.974, 0.924 and 0.913 for the selected level A to C models in the test set, respectively. Tree-based feature importance and SHAP method successfully identified the commonly recognized risk factors, while indicated new inconsistent impact trends for GDM in different stages of pregnancy. Conclusion: A stepwise prediction system was successfully established. A practical tool that enables a quick prediction of GDM was released at https://github.com/ifyoungnet/MedGDM.This study is expected to provide a more detailed profiling of GDM risk and lay the foundation for the application of the model in practice.

The MgO-activated SiO2 system demonstrates potential for a low carbon footprint throughout its lifecycle and is characterized by favorable mechanical properties, low alkalinity, and a high specific surface area, which shows promise in replacing traditional silicate cement in certain applications. The current system faces challenges such as slow early hydration rate, low early strength, and inadequate volume stability, which impede its further development and application. The MgO-activated SiO2 system was improved and optimized through multiple tests using carbonation (CO2 gas/NaHCO3 solution), nanomaterials (whiskers), and fiber (organic/inorganic fiber) composite reinforcement. This paper provides an overview of the hydration mechanism of the MgO-activated SiO2 system, explores modifications and control measures based on this mechanism, and discusses the potential applications and future development of the MgO-activated SiO2 system.

Abstract Background The Enhanced Recovery After Cardiac Surgery (ERACS) programs are comprehensive multidisciplinary interventions to improve patients’ recovery. The application of the ERAS principle in pediatric patients has not been identified completely. Methods This study is a multicenter, stepwise design, cluster randomized controlled trial. 3030 patients presenting during control and intervention periods are eligible if they are aged from 28 days to 6 years old and awaiting elective correction surgery of congenital heart disease with cardiopulmonary bypass. 5 centers are randomly assigned to staggered start dates for one-way crossover from the control phase to the intervention phase. In the intervention periods, patients will receive a bundle strategy including preoperative, intraoperative, and postoperative approaches. During the control phase, patients receive the usual care. The primary outcome consists of major adverse cardiac and cerebrovascular events (MACCEs), postoperative pulmonary complications (PPCs), and acute kidney injury (AKI). Discussion This study aims to explore whether the bundle of ERAS measurements could improve patients’ recovery in congenital heart surgery. Trial registration http://www.clinicaltrials.gov . (NCT05914103).

The enhanced recovery after surgery (ERAS) program is less implemented in gastric cancer patients. The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastric cancer.

Abstract. Background:. Human neutrophil lipocalin (HNL) has been used extensively to differentiate acute bacterial infection from febrile diseases as a biomarker to reflect the activation of the neutrophil. The serum HNL levels in the adult-onset Still's disease (AOSD) patients with and without infection, as well as the healthy controls (HCs), were analyzed statistically in this study to evaluate the value of HNL for the diagnosis of AOSD. Methods:. A total of 129 AOSD patients were enrolled, from whom blood samples were drawn and the AOSD diagnosis was confirmed through the review of the medical records, where the systemic score, demographic characteristics, clinical manifestations, and laboratory parameters were also collected for the patients; in addition, a total of 40 HCs were recruited among the blood donors from the healthcare center with the relevant information collected. The HNL test was done for the blood samples with the enzyme-linked immunosorbent assay and the analyses were done for the correlations of HNL with clinical manifestations and diagnostic effectiveness. Results:. The serum HNL increased significantly in the patients with only AOSD as compared with that in the HCs (139.76 ± 8.99 ng/mL vs. 55.92 ± 6.12 ng/mL; P

PM2.5 poses a serious threat to human life and health, so the accurate prediction of PM2.5 concentration is essential for controlling air pollution. However, previous studies lacked the generalization ability to predict high-dimensional PM2.5 concentration time series. Therefore, a new model for predicting PM2.5 concentration was proposed to address this in this paper. Firstly, the linear rectification function with leakage (LeakyRelu) was used to replace the activation function in the Temporal Convolutional Network (TCN) to better capture the dependence of feature data over long distances. Next, the residual structure, dilated rate, and feature-matching convolution position of the TCN were adjusted to improve the performance of the improved TCN (LR-TCN) and reduce the amount of computation. Finally, a new prediction model (GRU-LR-TCN) was established, which adaptively integrated the prediction of the fused Gated Recurrent Unit (GRU) and LR-TCN based on the inverse ratio of root mean square error (RMSE) weighting. The experimental results show that, for monitoring station #1001, LR-TCN increased the RMSE, mean absolute error (MAE), and determination coefficient (R2) by 12.9%, 11.3%, and 3.8%, respectively, compared with baselines. Compared with LR-TCN, GRU-LR-TCN improved the index symmetric mean absolute percentage error (SMAPE) by 7.1%. In addition, by comparing the estimation results with other models on other air quality datasets, all the indicators have advantages, and it is further demonstrated that the GRU-LR-TCN model exhibits superior generalization across various datasets, proving to be more efficient and applicable in predicting urban PM2.5 concentration. This can contribute to enhancing air quality and safeguarding public health.

C16H9BrINO2, triclinic, P1̄ (no. 2), a = 7.9305(12) Å, b = 8.2051(10) Å, c = 11.3141(13) Å, α = 85.384(10)°, β = 85.619(11)°, γ = 87.745(11)°, V = 731.27(17) Å3, Z = 2, Rgt(F) = 0.0397, wRref(F2) = 0.0819, T = 293(2) K.

Abstract Background Tetralogy of Fallot (TOF) is a common cyanotic congenital heart malformation that carries a high risk of right-to-left shunting. Anemia is characterized by decreased hemoglobin (Hb) levels that can affect tissue oxygen delivery and impact postoperative recovery in patients. Chronic hypoxia caused by right-to-left shunting of TOF could lead to compensatory increases in Hb to maintain systemic oxygen balance. This study aims to investigate whether preoperative Hb and blood oxygen saturation (SpO2) can predict adverse outcomes in children undergoing corrective surgery for TOF. Methods This retrospective study included patients under 18 years of age who underwent corrective surgery for TOF at Fuwai Hospital between January 2016 and December 2018. Adverse outcomes, including in-hospital death, extracorporeal membrane oxygenation implantation, ICU stay > 30 days, and severe complications, were considered as the primary outcome. Univariable and multivariable logistic analyses were performed to identify independent risk factors for adverse outcomes. Propensity score-matched (PSM) analysis was also conducted to minimize the confounding factors. Results A total of 596 children were included in the study, of which 64 (10.7%) experienced adverse outcomes. Hb*SpO2

Abstract Background Adult-onset Still’s disease (AOSD) is a systemic autoinflammatory disorder of unknown etiology. B cells are critical participants in different rheumatic diseases, and their roles in AOSD are rarely investigated. This study aimed to unveil the B cell subset features in AOSD and provide evidence for B cell-based diagnosis and targeted therapies of AOSD. Methods B cell subsets in the peripheral blood of AOSD patients and healthy controls (HCs) were detected by flow cytometry. Firstly, the frequencies of B cell subsets were compared. Then, the correlation analysis was performed to explore the correlation between B cell subsets and clinical manifestations in AOSD. Finally, unbiased hierarchical clustering was performed to divide AOSD patients into three groups with different B cell subset features, and the clinical characteristics of the three groups were compared. Results The frequencies of B cell subsets were altered in AOSD patients. Disease-promoting subsets (such as naïve B cells, double negative B cells (DN B cells), and plasmablasts) increased, and potential regulatory subsets (such as unswitched memory B cells (UM B cells) and CD24hiCD27+ B cells (B10 cells)) decreased in the peripheral blood of AOSD patients. In addition, the altered B cell subsets in AOSD correlated with the clinical and immunological features, such as immune cells, coagulation features, and liver enzymes. Intriguingly, AOSD patients could be divided into three groups with distinct B cell immunophenotyping: group 1 (naïve B cells-dominant), group 2 (CD27+ memory B cells-dominant), and group 3 (precursors of autoantibody-producing plasma cells-dominant). Moreover, these three group patients demonstrated differential manifestations, including immune cells, liver or myocardial enzymes, coagulation features, and systemic score. Conclusions B cell subsets are significantly altered in AOSD patients, potentially contributing to the disease pathogenesis. These findings would inspire B cell-based diagnosis and targeted therapies for this refractory disease.

Introduction Postoperative delirium is a prominent and clinically important complication in older adults after coronary artery bypass grafting (CABG) surgery, resulting in prolonged hospital stay, long-term cognitive impairment and increased morbidity and mortality. Many studies have shown that cerebral desaturation is associated with increased risk of postoperative delirium during on-pump cardiac surgery. However, few studies have focused on the effect of optimising regional cerebral oxygen saturation (rSO2) on postoperative delirium during off-pump CABG. The purpose of this study is to investigate whether intraoperative anaesthetic management based on percutaneous cerebral oximetry monitoring decreases the incidence of postoperative delirium in older adults undergoing off-pump CABG.Methods This single-centre randomised controlled trial will randomly assign 200 patients to the intervention group or the control group at a ratio of 1:1. The patients in the intervention group will be observed by percutaneous cerebral oximetry monitoring that the desaturation (a drop of more than 20% from baseline value or rSO2 less than 55% for >60 consecutive seconds at either probe) during the procedure triggered the intervention strategies, while the cerebral oximetry data of the control group will be hidden from the clinical team and patients will be anaesthetised by the usual anaesthetic management. The primary outcome will be the incidence of postoperative delirium during the first 7 days after off-pump CABG. Delirium will be comprehensively evaluated by the combination of the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the intensive care unit. The secondary outcomes will include the incidence of postoperative acute kidney injury and myocardial infarction during the hospital stay, as well as the intensive care unit and hospital length of stay.Ethics and dissemination This study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences, Fuwai Hospital (No 2022–1824). Written informed consent will be obtained from each patient or their legal representatives before enrolment. The results of this trial will be published in an international peer-reviewed scientific journal.Trial registration number ChiCTR2300068537.

AbstractPurpose To provide a foundation for clinical diagnosis, epidemiological investigation and intervention trials, we examined the reliability and validity of the American College of Rheumatology (ACR) 2011 and 2016 survey diagnostic criteria among Chinese patients based on the fibromyalgia severity (FS) scale.Methods In this study, 200 fibromyalgia patients diagnosed according to the 1990 criteria (1990c) were matched with rheumatoid arthritis (RA) patients based on age and gender. The FS scale score and its subscales were examined to determine their correlations with the revised fibromyalgia impact questionnaire (FIQR). Receiver operator characteristic (ROC) analysis was performed, and test-retest reliability, internal consistency, and construct validity were examined.Results The area under the curve (AUC) for the ACR 2011c and 2016c was 0.870 and 0.845, respectively, and the sensitivity and specificity were 78.0% and 96.0% for the 2011c and 70.5% and 98.5% for the 2016c, respectively. The FS scale and its subscales were confirmed to exhibit good internal consistency, and they were significantly correlated with the FIQR, thereby indicating adequate construct validity. Using a lower cutoff value 11 points for the FS scale score based on the generalized pain requirement might be a more effective approach in the Chinese population; this approach yielded an AUC of 0.923 and a sensitivity of 87.0% and specificity of 97.5%.Conclusion The 2011c and 2016c are reliable instruments for diagnosing fibromyalgia patients in China. The FS scale could be a valid tool to assist in fibromyalgia diagnosis, and a cutoff value 11 points is more suitable in Chinese patients.Trial registration ClinicalTrials.gov ID: NCT03381131

AbstractIntroduction Dysmagnesemia has been demonstrated to be involved in the pathophysiology of kidney diseases and is common in cardiac surgical patients. It remains unknown whether changes of serum magnesium after cardiac surgery affect AKI. We aimed to investigate the association of early postoperative magnesium with cardiac surgery-associated AKI in adults.Methods We conducted a multicenter retrospective cohort study involving patients who underwent cardiac surgery in the eICU Collaborative Research Database between 2014 and 2015. AKI within 7 days after surgery was defined using both serum creatinine and urine output criteria of Kidney Disease Improving Global Outcomes definition. Postoperative AKI was analyzed using multivariable logistic regression with early postoperative serum magnesium measured within the first 24 h after surgery as a continuous variable and categorically by quartiles.Results Postoperative AKI was identified in 3498 of 6124 (57.1%) patients receiving cardiac surgery. The median (25th–75th percentiles) early postoperative serum magnesium level of the study population was 2.3 (2.0–2.7) mg/dL. Higher serum magnesium level was associated with a higher risk of developing postoperative AKI (adjusted odds ratio (OR), 1.46 per 1 mg/dL increase; 95% confidence interval (CI), 1.31–1.62; p

The most critical aspect of panorama generation is maintaining local semantic consistency. Objects may be projected from different depths in the captured image. When warping the image to a unified canvas, pixels at the semantic boundaries of the different views are significantly misaligned. We propose two lightweight strategies to address this challenge efficiently. First, the original image is segmented as superpixels rather than regular grids to preserve the structure of each cell. We propose effective cost functions to generate the warp matrix for each superpixel. The warp matrix varies progressively for smooth projection, which contributes to a more faithful reconstruction of object structures. Second, to deal with artifacts introduced by stitching, we use a seam line method tailored to superpixels. The algorithm takes into account the feature similarity of neighborhood superpixels, including color difference, structure and entropy. We also consider the semantic information to avoid semantic misalignment. The optimal solution constrained by the cost functions is obtained under a graph model. The resulting stitched images exhibit improved naturalness. Extensive testing on common panorama stitching datasets is performed on the algorithm. Experimental results show that the proposed algorithm effectively mitigates artifacts, preserves the completeness of semantics and produces panoramic images with a subjective quality that is superior to that of alternative methods.

In this paper, the reliability analysis of the YRY-4 borehole component strain observation data at Dongping seismic station is carried out through the four-component self-check and the relative calibration internal accuracy analysis. The data of the two instruments are compared by combining the sliding correlation calculation and the internal accuracy of the tidal factor. It is proved that the two surface strain correlation of the YRY-4 borehole component strain is high, and the correlation coefficient is close to 1. The relative calibration internal accuracy is high, which is consistent with the overall trend of the volume strain data. The observation environment of the two instruments is consistent, and the operation is stable, the data are normal and reliable. However, there are also inconsistencies in the curves of rainfall and site interference in special periods. For the two special cases, compared by correlation calculation and S transform, the results show that, due to the large difference in drilling conditions, the correlation between the two instrument data during rainfall period is poor, close to 0. During the site interference period, the two observation systems were affected, and the interference signals appeared synchronously in the frequency domain, which affected the data curve shape and the accuracy of the tidal factor, but the strain correlation between the two instruments reached 0.91 during the interference period. Comprehensive analysis shows that the two sets of instrument observation systems of component strain and volume strain at Dongping seismic station are reliable and stable.

Abstract Background Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children. Methods The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve. Results Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05. Conclusions We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery.

With the gradual miniaturization of electronic devices, the thermal conductivity of electronic components is increasingly required. Epoxy (EP) resins are easy to process, exhibit excellent electrical insulation properties, and are light in weight and low in cost, making them the preferred material for thermal management applications. In order to endow EPs with better dielectric and thermal conductivity properties, bromo-oxygen-bismuth (BiOBr) prepared using the hydrothermal method was used as a filler to obtain BiOBr/EP composites, and the effect of BiOBr addition on the properties of the BiOBr/EP composites was also studied. The results showed that the addition of a small amount of BiOBr could greatly optimize the dielectric properties and thermal conductivity of EP resin, and when the content of BiOBr was 0.75 wt% and 1.00 wt%, the dielectric properties and thermal conductivity of the composite could reach the optimum, respectively. The high dielectric constant and excellent thermal conductivity of BiOBr/EP composites are mainly due to the good layered structure of BiOBr, which can provide good interfacial polarization and thermal conductivity.

A growing body of research suggests that short-chain fatty acids (SCFAs), metabolites produced by intestinal symbiotic bacteria that ferment dietary fibers (DFs), play a crucial role in the health status of symbiotes. SCFAs act on a variety of cell types to regulate important biological processes, including host metabolism, intestinal function, and immune function. SCFAs also affect the function and fate of immune cells. This finding provides a new concept in immune metabolism and a better understanding of the regulatory role of SCFAs in the immune system, which impacts the prevention and treatment of disease. The mechanism by which SCFAs induce or regulate the immune response is becoming increasingly clear. This review summarizes the different mechanisms through which SCFAs act in cells. According to the latest research, the regulatory role of SCFAs in the innate immune system, including in NLRP3 inflammasomes, receptors of TLR family members, neutrophils, macrophages, natural killer cells, eosinophils, basophils and innate lymphocyte subsets, is emphasized. The regulatory role of SCFAs in the adaptive immune system, including in T-cell subsets, B cells, and plasma cells, is also highlighted. In addition, we discuss the role that SCFAs play in regulating allergic airway inflammation, colitis, and osteoporosis by influencing the immune system. These findings provide evidence for determining treatment options based on metabolic regulation.

Previous studies suggest a close relationship between self-disorders and schizophrenia or unipolar depression. However, few studies have explored the characteristics of self-processing in bipolar disorder (BD) during different clinical states. This study compared the differences in self-face recognition (SFR) among patients with bipolar mania (BPM), bipolar depression (BPD), bipolar remission (RM), and healthy controls (HC). Images of subject's own face, a familiar face, and an unfamiliar face were combined in pairs at a certain proportion to obtain three types of blended images. We then compared the tendency between BD and HC while judging two kinds of blended faces emerging from presentation software. The results showed that the BPM and BPD groups seemed to lack an advantage in self-recognition. Self-processing and familiarity processing were significantly enhanced in BPM patients, while only familiarity processing was enhanced in BPD. The severity of clinical symptoms was not significantly correlated with self-bias or familiarity bias in BD.

Background Online information on mpox (monkeypox) is not well studied. We have analysed the video content, information quality, and audience engagement of mpox-related videos on TikTok.Methods Using a hashtag-based searching strategy, we identified 2462 mpox-related videos on TikTok from 1 January to 11 August 2022; 85 were included after exclusion criteria screening. Videos were evaluated for content on features and treatment of mpox. Video and information quality was assessed using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria. We recorded video source, evaluation scores, and viewer engagement metrics. The Kruskal-Wallis test was used for statistical analysis and multiple linear regression for factor-association studies.Results Of the 85 videos, two assessed all content topics and highlighted 33% of all content items in clinical guidelines. The overall average score for the videos was 39.56 of 80 on the DISCERN instrument and 1.93 of 4 on the JAMA criteria. No video met all JAMA criteria. Subgroup analysis based on author identity suggested the variance in video scores by source (p

Global pandemics such as COVID-19 have resulted in significant global social and economic disruption. Although polymerase chain reaction (PCR) is recommended as the standard test for identifying the SARS-CoV-2, conventional assays are time-consuming. In parallel, although artificial intelligence (AI) has been employed to contain the disease, the implementation of AI in PCR analytics, which may enhance the cognition of diagnostics, is quite rare. The information that the amplification curve reveals can reflect the dynamics of reactions. Here, we present a novel AI-aided on-chip approach by integrating deep learning with microfluidic paper-based analytical devices (µPADs) to detect synthetic RNA templates of the SARS-CoV-2 ORF1ab gene. The µPADs feature a multilayer structure by which the devices are compatible with conventional PCR instruments. During analysis, real-time PCR data were synchronously fed to three unsupervised learning models with deep neural networks, including RNN, LSTM, and GRU. Of these, the GRU is found to be most effective and accurate. Based on the experimentally obtained datasets, qualitative forecasting can be made as early as 13 cycles, which significantly enhances the efficiency of the PCR tests by 67.5% (∼40 min). Also, an accurate prediction of the end-point value of PCR curves can be obtained by GRU around 20 cycles. To further improve PCR testing efficiency, we also propose AI-aided dynamic evaluation criteria for determining critical cycle numbers, which enables real-time quantitative analysis of PCR tests. The presented approach is the first to integrate AI for on-chip PCR data analysis. It is capable of forecasting the final output and the trend of qPCR in addition to the conventional end-point Cq calculation. It is also capable of fully exploring the dynamics and intrinsic features of each reaction. This work leverages methodologies from diverse disciplines to provide perspectives and insights beyond the scope of a single scientific field. It is universally applicable and can be extended to multiple areas of fundamental research.

Considering the large number of individuals who have already been infected and may have reinfection, the post-infection effects of COVID-19 are of great importance for clinical practice and predicting disease trends. However, our understanding of the potential long-term effects, particularly on immunity, after recovering from COVID-19 remains limited. The aim of this study was to investigate the abnormal immunological factors that contribute to the prolonged immunological effects of COVID-19. Two groups of patients were enrolled in the study, including 11 individuals with various autoimmune diseases (AIDs) and 16 patients diagnosed with systemic lupus erythematosus (SLE). Detailed clinical symptoms were closely monitored, and peripheral mononuclear cells were analyzed using flow cytometry. The clinical status was evaluated using the SLE Disease Activity Index (SLEDAI) and the Clinical Global Impressions (CGI) index. The proportions of follicular T helper cells (Tfh) exhibited significant increases in both cohorts (AID: p = 0.03; SLE: p = 0.0008). Conversely, the percentages of Foxp3+ and CD4+ regulatory T cells (Treg) were reduced in patients following COVID-19 infection (AID: p = 0.009, 0.05, resp.; SLE: p = 0.02, 0.0009, resp.). The percentages of Th2 and Th17 cells were significantly increased in SLE patients (p < 0.05). Exacerbated conditions were observed in SLE patients two months after infection (SLEDAI, p < 0.05). Our findings show that COVID-19 infection increases Tfh cells and decreases Treg cells in patients of AIDs, worsening pathogenetic immune status in post-recovery populations.

Etimicin is a fourth-generation aminoglycoside antibiotic. It has potent activity and low toxicity when employed for the treatment of Gram-negative and Gram-positive bacterial infections. The pharmacokinetics of etimicin in humans have not been elucidated completely. Two liquid chromatography-tandem mass spectrometry (LC-MS/MS) bioanalytical methods, without the use of any ion-pairing reagents, were developed and validated for the quantification of etimicin in human samples of serum and urine. Using a deuterated reagent as the internal standard, analytes in serum and urine samples were extracted by protein precipitation and dilution before LC-MS/MS analysis, respectively. For the two methods, chromatographic separations were undertaken under isocratic elution of water–ammonia solution–acetic acid (96:3.6:0.2, v/v/v) and methanol at 50%:50% and a flow rate of 0.35 ml/min within 5 min. A Waters XTerra MS C18 column (2.1 × 150 mm, 3.5 μm) and a column temperature of 40°C were chosen. A Sciex Qtrap 5500 mass spectrometer equipped with an electrospray ion source was used in both methods under multiple-reaction monitoring in positive-ion mode. The two methods showed good linearity, accuracy, and precision with high recovery and a minimal matrix effect in the range of 50.0–20000 ng/ml for serum samples and 50.0–10000 ng/ml for urine samples, respectively. Carry-over effects were not observed. Etimicin remained stable in human samples of serum or urine under the storage, preparation, and analytical conditions of the two methods. These two simple and reliable methods were applied successfully to a dose-escalation, phase I clinical trial of etimicin in Chinese healthy volunteers after intravenous administration of single and multiple doses. Based on these two methods we ascertained, for the first time, the comprehensive pharmacokinetics of etimicin in humans, which will be used for the exploration of the breakpoint research further.

BackgroundChronic hypoxia induces pulmonary microvascular endothelial dysfunction. The left atrial pressure (LAP) represents the hydrostatic pressure of pulmonary microcirculation. The conjunction of the LAP and any abnormal pulmonary microvascular endothelial barrier function will have an impact on pulmonary exudation, resulting in prolonged mechanical ventilation. This study aimed to investigate the tolerance threshold of the pulmonary microcirculation to LAP in children with tetralogy of Fallot (TOF) to avoid prolonged mechanical ventilation after surgery.MethodsThis retrospective study included 297 Chinese patients who underwent TOF correction at Fuwai Hospital. Patients were categorized according to their preoperative oxygen saturation (SpO2) level. One-to-one propensity score matching (PSM) revealed a total of 126 participants in the SpO2

The Gleeble-3500 thermal simulation tester was used to perform hot deformation behavior on the extruded AZ40 Mg alloy to analyze the trend of the true stress-strain curve after compression and to obtain the influence of the flow stress on the deformation temperature and strain rate. Subsequently, the constitutive equation was constructed for extruded AZ40 alloy based on the hyperbolic-sine relationship, and the thermal processing map of extruded AZ40 alloy was established based on the dynamic material model (DMM), thereby estimating the processing range of extruded AZ40 alloy. The results show that the rheological curve of extruded AZ40 alloy is characterized by obvious dynamic recrystallization. Furthermore, during the compression process, the peak stress of extruded AZ40 alloy decreases with the increase of deformation temperature, while increases with the increase of strain rate. Moreover, the proportion of dynamic recrystallized grains (DRGs) decreases with the increase of the strain rate under the same deformation temperature condition; while the DRGs size increases with the increase of the deformation temperature under the same strain rate condition. The coarse uncrystallized grains show obvious crystallographic orientations of 〈1010〉‖ND and 〈2110〉‖ND, while crystallographic orientation of DRGs is random distributed. Finally, through thermal processing map and tissue analysis, the optimal processing window was identified as T=573 K, $\dot \varepsilon $=0.1 s-1.

To obtain a kind of superhydrophobic sponge with high oil and water selectivity, the MS/TiO2/PDMS sponge was prepared via a two-step hydrophobic fabrication based on the melamine sponge (MS), tetrabutyl titanate (TBOT), and polydimethylsiloxane (PDMS). The effects of modification time, the concentrations of TBOT and PDMS on the properties of the MS/TiO2/PDMS sponge were studied, and the separation mechanism was also discussed based on the interaction between the oil and the surface of the MS/TiO2/PDMS sponge. The results suggest that under optimal conditions, the MS/TiO2/PDMS sponge show superhydrophobicity. The contact angle and adsorption capacity for oil of the MS/TiO2/PDMS sponge are 149.2° and 98.5 g·g−1, respectively, and they can be recycled for about 25 cycles after oil–water separation test. This study prepares a new composite material with high oil–water selectivity, which is a good foundation for the development and research of new oil adsorbents. HIGHLIGHTS The MS/TiO2/PDMS sponge was prepared via a two-step hydrophobic fabrication.; The contact angle of the MS/TiO2/PDMS sponge was 149.2°.; The adsorption capacity for oil of the MS/TiO2/PDMS sponge are 98.5 gg−1.; The MS/TiO2/PDMS sponge can be recycled about 25 cycles after oil-water separation test.;

ObjectiveNon-criteria antiphospholipid antibodies (aPLs) increase the diagnostic value for antiphospholipid syndrome (APS) and contribute to better recognition of seronegative APS (SNAPS). However, the clinical utility and the diagnostic value of non-criteria aPLs are inconsistent. This study aimed to investigate the prevalence and clinical significance of 7 non-criteria aPLs in a large APS cohort.MethodsSeven non-criteria aPLs, including anti-phosphatidylserine/prothrombin (aPS/PT) antibodies IgG/IgA/IgM, anti-phosphatidylethanolamine antibodies (aPE) IgG/IgA/IgM, anti-Annexin V antibodies (aAnnexinV) IgG/IgA/IgM, anti-phosphatidylserine antibodies (aPS) IgM, aPS IgG, antibodies directed against a mixture of phospholipids (APhL) IgG, and APhL IgM were tested among 175 patients with APS, 122 patients with other autoimmune diseases (as disease controls), and 50 healthy controls.ResultsIn the present study, the highest prevalence of non-criteria aPLs was seen in aAnnexinV (58.86%). APhL IgG and aPS IgM showed the highest specificity (95.35%) and aPS/PT showed the highest Youden index (0.3991) for the diagnostic value of APS. The aAnnexinV also showed the highest prevalence in SNAPS (43.3%), followed by APhL IgM (21.7%), aPE (16.7%) and aPS/PT (16.7%). APhL IgG, aPS/PT, and aPS IgG showed positive association with thrombotic events in APS patients [APhL IgG: odds ratio (OR) = 2.26, 95% confidence interval (CI) 1.18-4.34, p = 0.013; aPS/PT: OR = 2.48, 95% CI: 1.32-4.69, p = 0.004; aPS IgG: OR = 1.90, 95% CI 1.01-3.60, p = 0.046; respectively). The inclusion of the non-criteria aPLs increased the accuracy of APS diagnosis from 65.7% to 87.4%.ConclusionOur data provide evidence that adding the non-criteria aPLs can improve the diagnostic accuracy in APS. APhL IgG, aPS/PT, and aPS IgG may be potential biomarkers to predict the risk of thrombosis in APS.

BackgroundAlthough right ventricular pacing (RVP) is recommended by most of the guidelines for atrioventricular block, it can cause electrical and mechanical desynchrony, impair left ventricular function, and increase the risk of atrial fibrillation. Recently, the His–Purkinje system pacing, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), has emerged as a physiological pacing modality. However, few studies have compared their efficacy and safety in atrioventricular block (AVB).Methods and results:The PubMed, Web of Science, Cochrane Library, and ScienceDirect databases were searched for observational studies and randomized trials of patients with atrioventricular block requiring permanent pacing, from database inception until 10 January 2022. The primary outcomes were complications and heart failure hospitalization. The secondary outcomes included changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD), pacing parameters, procedure duration, and success rate. After extracting the data at baseline and the longest follow-up duration available, a pairwise meta-analysis and a Bayesian random-effects network meta-analysis were performed. Odds ratios (ORs) with 95% confidence intervals (CIs) or 95% credible intervals (CrIs) were calculated for dichotomous outcomes, whereas mean differences (MDs) with 95% CIs or 95% CrIs were calculated for continuous outcomes. Seven studies and 1,069 patients were included. Overall, 43.4% underwent LBBP, 33.5% HBP, and 23.1% RVP. Compared with RVP, LBBP and HBP were associated with a shorter paced QRS duration and a more preserved LVEF. HBP significantly increased the pacing threshold and reduced the R-wave amplitude. There was no difference in the risk of complications or the implant success rate. The pacing threshold remained stable during follow-up for the three pacing modalities. The pacing impedance was significantly reduced in HBP, while a numerical but non-significant pacing impedance decrease was observed in both LBBP and RVP. LBBP was associated with an increased R-wave amplitude during follow-up.ConclusionIn this systematic review and network meta-analysis, HBP and LBBP were superior to RVP in paced QRS duration and preservation of LVEF for patients with atrioventricular block. LBBP was associated with a lower pacing threshold and a greater R-wave amplitude than HBP. However, the stability of the pacing output of LBBP may be a concern. Further investigation of the long-term efficacy in left ventricular function and the risk of heart failure hospitalization is needed.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=315046], identifier [CRD42022315046].

Urban traffic prediction is essential for intelligent transportation systems. However, traffic data often exhibit highly complex spatio-temporal correlations, posing challenges for accurate forecasting. Graph neural networks have demonstrated an outstanding ability in capturing spatial correlations and are now extensively applied to traffic prediction. However, many graph-based methods neglect the dynamic spatial features between road segments and the continuity of spatial features across adjacent time steps, leading to subpar predictive performance. This paper proposes a Dynamic Spatio-Temporal Graph Fusion Convolutional Network (DSTGFCN) to enhance the accuracy of traffic prediction. Specifically, we designed a dynamic graph fusion module without prior road spatial information, which extracts dynamic spatial information among roads from observed data. Subsequently, we fused the dynamic spatial features of the current time step and adjacent time steps to generate a dynamic graph for each time step. The graph convolutional gated recurrent network was employed to model the spatio-temporal correlations jointly. Additionally, residual connections were added to the model to enhance the ability to extract long-term temporal relationships. Finally, we conducted experiments on six publicly available traffic datasets, and the results demonstrated that DSTGFCN outperforms the baseline models with state-of-the-art predictive performance.

BackgroundAcute kidney injury (AKI) is a common postoperative complication in pediatric patients undergoing cardiac surgery and associated with poor outcomes. Dexmedetomidine has the pharmacological features of organ protection in cardiac surgery patients. The aim of this meta-analysis is to investigate the effect of dexmedetomidine infusion on the incidence of AKI after cardiac surgery in pediatric patients.MethodsThe databases of Pubmed, Embase, and Cochrane Library were searched until April 24, 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RevMan 5.3 was used to perform statistical analyses.ResultsFive relevant trials with a total of 630 patients were included. The pooled result using fixed-effects model with OR demonstrated significant difference in the incidence of AKI between patients with dexmedetomidine and placebo (OR = 0.49, 95% CI: [0.33, 0.73], I2 = 0%, p for effect = 0.0004). Subgroup analyses were performed based on congenital heart disease (CHD) types and dexmedetomidine intervention time. Pooled results did not demonstrate considerable difference in the incidence of AKI in pediatric patients receiving intraoperative (OR = 0.53, 95% CI: [0.29, 0.99], I2 = 0%, p for effect = 0.05) or postoperative dexmedetomidine infusion (OR = 0.56, 95% CI: [0.31, 1.04], p for effect = 0.07), but a significant difference in patients receiving combination of intra- and postoperative dexmedetomidine infusion (OR = 0.27, 95% CI: [0.09, 0.77], p for effect = 0.01). Besides, there was no significant difference in duration of mechanical ventilation (SMD: –0.19, 95% CI: –0.46 to 0.08, p for effect = 0.16; SMD: –0.16, 95% CI: –0.37 to 0.06, p for effect = 0.15), length of ICU (SMD: 0.02, 95% CI: –0.41 to 0.44, p for effect = 0.93) and hospital stay (SMD: 0.2, 95% CI: –0.13 to 0.54, p for effect = 0.23), and in-hospital mortality (OR = 1.26, 95% CI: 0.33–4.84, p for effect = 0.73) after surgery according to the pooled results of the secondary outcomes.ConclusionCompared to placebo, dexmedetomidine could significantly reduce the postoperative incidence of AKI in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), but the considerable difference was reflected in the pediatric patients receiving combination of intra- and postoperative dexmedetomidine infusion. Besides, there was no significant difference in duration of mechanical ventilation, length of ICU and hospital stay, or in-hospital mortality after surgery.

BackgroundAs an easily accessible and intervened clinical indicator, preoperative pulse oximeter oxygen saturation (SpO2) is an important factor affecting the prognosis of patients with tetralogy of Fallot (TOF). However, whether SpO2 is associated with postoperative mechanical ventilation (MV) time remains unknown. Therefore, this study aimed to investigate the impact of preoperative SpO2 on postoperative prolonged mechanical ventilation (PMV) in children with TOF.Materials and methodsThe study included children younger than 18 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. Univariate and multivariate logistic regression analyses were used to evaluate the influence of preoperative SpO2 on postoperative PMV. After identifying SpO2 as an independent risk factor for PMV, patients were further divided into two groups according to the cutoff value of SpO2, and propensity score matching (PSM) analysis was used to eliminate the effect of confounding factors. The logistic regression was used to compare the outcomes between the two groups after PSM.ResultsA total of 617 patients were finally enrolled in this study. By the univariable and multivariate logistic analysis, four independent risk factors for PMV were determined, namely, SpO2, surgical technique, aortic cross-clamp time, and intraoperative minimum temperature. According to the outcomes of 219 paired patients after PSM, the incidence of PMV was significantly higher in patients with lower preoperative SpO2 (P = 0.022). Also, there was significant increase in mechanical ventilation time (P = 0.019), length of intensive care unit stay (P = 0.044), postoperative hospital stay (P = 0.006), hospital stay (P = 0.039), and hospitalization cost (P = 0.019) at the lower preoperative SpO2 level.ConclusionLow preoperative SpO2 represents an independent risk factor of postoperative PMV in children with TOF.

BackgroundIschemic stroke (IS) is the most common and life-threatening arterial manifestation of antiphospholipid syndrome (APS). It is related to high mortality and severe permanent disability in survivors. Thus, it is essential to identify patients with APS at high risk of IS and adopt individual-level preventive measures. This study was conducted to identify risk factors for IS in patients with APS and to develop a nomogram specifically for IS prediction in these patients by combining the adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS) with additional clinical and laboratory data.MethodsA total of 478 consecutive patients with APS were enrolled retrospectively. All patients were randomly assigned to the training and validation cohorts. Univariate and multivariate binary logistic analyses were conducted to identify predictors of IS in the training cohort. Then, a nomogram was developed based on these predictors. The predictive performance of the nomogram for the training and validation cohorts was evaluated by determining areas under the receiver operating characteristic curve (AUROC) and creating calibration plots. A decision curve analysis (DCA) was conducted to compare the potential net benefits of the nomogram with those of the aGAPSS.ResultsDuring a mean follow-up period of 2.7 years, 26.9% (129/478) of the patients were diagnosed with IS. Binary logistic regression analysis revealed that five risk factors were independent clinical predictors of IS: age (P < 0.001), diabetes (P = 0.030), hyperuricemia (P < 0.001), the platelet count (P = 0.001), and the aGAPSS (P = 0.001). These predictors were incorporated into the nomogram, named the aGAPSS-IS. The nomogram showed satisfactory performance in the training [AUROC = 0.853 (95% CI, 0.802–0.896] and validation [AUROC = 0.793 (95% CI, 0.737–0.843)] cohorts. Calibration curves showed good concordance between observed and nomogram-predicted probability in the training and validation cohorts. The DCA confirmed that the aGAPSS-IS provided more net benefits than the aGAPSS in both cohorts.ConclusionAge, diabetes, hyperuricemia, the platelet count, and the aGAPSS were risk factors for IS in patients with APS. The aGAPSS-IS may be a good tool for IS risk stratification for patients with APS based on routinely available data.

Wound healing is a complex and long-term process consisting of hemostasis, inflammation, proliferation, and maturation/remodeling. These four stages overlap and influence each other; they affect wound healing in different ways, and if they do not function perfectly, they may cause scarring, proliferative scarring and keloid formation. A therapeutic target affecting wound healing in multiple ways will help the healing process proceed more effectively. DPP-4/CD26 is a multifunctional dimorphic glycoprotein widely distributed on the surface of a variety of cells, including fibroblasts and keratin-forming cells. It has been found to affect periwound inflammation, re-epithelialization, extracellular matrix secretion and skin fibrosis and is a potential target for promoting wound healing and inhibiting scar formation. After presenting a brief introduction of the wound healing process and DPP-4/CD26, this paper summarizes the effects of DPP-4/CD26 on cells involved in different stages of wound healing and discusses the feasibility of DPP-4/CD26 as a multifunctional target for the treatment of wound healing and inhibition of scar formation.

Bone morphogenetic protein (BMP) pathway is essential for M2 macrophage polarization and hair-follicle neogenesis. Icariin, a flavonoid derived from Epimedium, is a mediator of the BMP pathway. Here, we develop a hydrogel formulation functionalized with icariin for regulation of macrophage polarization to accelerate wound healing and hair-follicle neogenesis. Compared to skin defects without icariin treatment, those treated with icariin+PEG hydrogel healed faster and had new hair follicles. Results in vivo showed that icariin+PEG hydrogel induced a higher level of M2 phenotypic transformation of macrophages. Moreover, icariin+PEG hydrogel significantly accelerated wound-repair process by reducing the invasion of inflammation, excessive deposition of collagen, immoderate activation of myofibroblasts, and increasing the regeneration of hair follicles. Furthermore, studies in vitro demonstrated that the icariin+PEG hydrogel induced macrophages to polarize to the M2 phenotype and dermal papilla cell to hair follicles. Finally, molecular analysis demonstrated that the icariin+PEG hydrogel increased the expression of BMP4 and Smad1/5 phosphorylation in skin wounds. These results demonstrate the therapeutic potential of icariin-containing thermosensitive hydrogels for inducing M2 macrophage polarization to accelerate wound healing and promote hair-follicle neogenesis by regulating the BMP pathway.

IntroductionWhile tranexamic acid (TXA) is widely used in patients with acute type A aortic dissection (ATAAD) who undergo surgical repair to reduce blood loss and transfusion requirement, the optimal dosage of TXA is unknown in these patients.Materials and MethodsThis was a retrospective cohort study that compared high-dose (>50 mg/kg) and low-dose TXA (≤50 mg/kg) in patients with ATAAD who underwent surgical repair. Propensity score matching (PSM) was performed between the two groups and results were analyzed in matched cases. The primary outcome was postoperative blood loss within 3 days after surgery. The secondary outcomes were total blood loss after surgery and perioperative blood transfusion, and safety outcomes were also assessed.ResultsThrough medical record screening, 529 patients were identified. After PSM, 196 patients in the high-dose group and 196 patients in the low-dose group were matched and included in the final analysis. Postoperative blood loss in 3 days after surgery was 940 mL (710–1,010 mL) in the low-dose group and 695 mL (620–860 mL) in the high-dose group. The difference was statistically significant (P

Abstract Background The aim of this study was to investigate the impact of an early extubation strategy on outcomes following complete repair of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery. Methods One hundred thirteen patients undergoing complete repair surgery of pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary artery between 2016 and 2018 were included in our retrospective propensity-score matched study. Propensity score matching was conducted in 1 to 2 ratio to balance the covariables impacting on clinical outcomes between groups. The primary outcomes were defined as length of intensive care unit stay, postoperative length of hospital stay and in-hospital medical cost. The secondary outcomes included postoperative complications such as re-intubation, re-exploration, in-hospital mortality, arrhythmia and etc.. In addition, blood product consumption were also abstracted. Results Compared with matched controls, patients in the early extubation group were demonstrated with a significant reduced length of intensive care unit stay (Median: 1.9 d νs. 4.1 d, p = 0.039), postoperative length of hospital stay (Median: 9.0 d νs. 17.0 d, p = 0.007) and in-hospital medical cost (Median: 69.5 × 1000CNY νs. 113.6× 1000CNY, p = 0.041). As for the postoperative complications, the occurrence of re-intubation, re-exploration, in-hospital mortality, arrhythmia and renal replacement therapy was similar between groups. However, pulmonary complications (p = 0.049) were with a significantly lower rate in the early extubation group. In addition, fresh frozen plasma (p = 0.041) transfusion volume were significantly reduced in the early extubation group rather than packed red blood cells and platelets. Conclusions Early extubation following complete repair of pulmonary atresia improved clinical outcomes and reduced in-hospital medical cost without increasing any postoperative complications.

The current investigation focuses on the stability of the magnesium oxide-based cementitious system under the action of sulfate attack and the dry-wet cycle. The phase change in the magnesium oxide-based cementitious system was quantitatively analyzed by X-ray diffraction, combined with thermogravimetry/derivative thermogravimetry and scanning electron microscope, to explore its erosion behavior under an erosion environment. The results revealed that, in the fully reactive magnesium oxide-based cementitious system under the environment of high concentration sulfate erosion, there was only magnesium silicate hydrate gel formation and no other phase; however, the reaction process of the incomplete magnesium oxide-based cementitious system was delayed, but not inhibited, by the environment of high-concentration sulfate, and it tended to turn completely into a magnesium silicate hydrate gel. The magnesium silicate hydrate sample outperformed the cement sample, in terms of stability in a high-concentration sulfate erosion environment, but it tended to degrade considerably more rapidly, and to a greater extent, than Portland cement, in both dry and wet sulfate cycle environments.

ObjectiveAlthough gastrointestinal (GI) symptoms are very common in patients with bipolar disorder (BD), Few studies have researched the pathomechanism behind these symptoms. In the present study, we aim at elucidate the pathomechanism of GI symptoms in BD through metabolomic analysis.MethodBD patients were recruited from Shanxi Bethune Hospital that divided into two groups, each group assessed with the 24-item Hamilton Depression Rating Scale (HAMD-24) according to the presence or absence of GI symptoms. Healthy controls were recruited from the medical examination center of the same hospital. Differential metabolites were identified and further analyzed using Metabo Analyst 3.0 to identify associated metabolic pathways.ResultsThere were significantly higher HAMD-24 scores in the GI symptoms group than that of non-GI symptoms group (p = 0.007). Based on metabolomic analysis results, we found that the common disturbances metabolic pathway of both two patients groups was ketone body metabolism, and the unique disturbances metabolic pathways of BD with GI symptoms were fatty acid biosynthesis and tyrosine metabolism, and these changes were independent of dietary habits.ConclusionBD patients with GI symptoms exhibited disturbances in fatty acid and tyrosine metabolism, perhaps suggesting that the GI symptoms in BD patients are related to disturbances of the gut microbiome. Both groups of patients jointly exhibit disturbances of ketone body metabolism, which may serve as a biomarker for the pathogenesis of BD patients.

BackgroundStudies have reported early liver dysfunction (LD) after cardiac surgery is associated with short and long-term mortality. In this study, we aimed to investigate risk factors for persistent LD after total cavopulmonary connection (TCPC) surgery.MethodsThis is a retrospective case-control study. We defined persistent LD as LDs occurring between postoperative day 1 (POD1) and POD7 and sustaining at least on POD7, while transient LD as LDs occurring between POD1 and POD7 and recovering at least on POD7. Multivariable logistic regression analysis was applied and central venous pressure (CVP) was considered continuously or in quantiles.ResultsPostoperative LD occurred in 111 (27.1%) patients. Transient and persistent LD occurred in 65 (15.9%) and 46 (11.2%) patients, respectively. Aortic cross-clamping (ACC) (odds ratio [OR] 2.55, 95% CI 1.26–5.14) and postoperative CVP (OR 1.34, 95% CI 1.18–1.51) were risk factors for persistent LD, also identified for postoperative any LD and transient LD. Adding postoperative CVP to the model only including ACC significantly improved persistent LD prediction (△AUC 0.15, p = 0.002). Compared with CVP ≤ 14 mmHg, adjusted ORs and 95% CI of persistent LD for CVP of 14–16 and >16 mmHg were 3.11 (1.24, 7.81) and 10.55 (3.72, 29.93), respectively. Patients with persistent LD might have a longer length of mechanical ventilation (mean difference, 13.5 h) and postoperative hospital stay (mean difference, 7 days), and higher postoperative costs (mean difference, 6.7 thousand dollars) compared to those with transient LD.ConclusionsIntra-operative application of ACC and postoperative elevated CVP were independent risk factors for persistent LD in pediatric patients following TCPC surgery. Compared to patients with transient LD, patients with persistent LD might have a longer length of mechanical ventilation and postoperative hospital stay, and higher postoperative costs. We should pay more attention to patients with high postoperative CVP to prevent their persistent LD occurrence.

Skin fibrosis is a common pathological feature of various diseases, and few treatment strategies are available because of the molecular pathogenesis is poorly understood. The urokinase-type plasminogen activator (uPA) system is the major serine protease system, and its components uPA, urokinase plasminogen activator receptor (uPAR) and plasminogen activator inhibitor-1(PAI-1) are widely upregulated in fibrotic diseases, including hypertrophic scars, keloids, and scleroderma. Here, we found that the successful binding of uPA and uPAR activates the downstream peroxisome proliferator-activated receptor (PPAR) signalling pathway to reduce the proliferation, migration, and contraction of disease-derived fibroblasts, contributing to the alleviation of skin fibrosis. However, increased or robust upregulation of the inhibitor PAI-1 inhibits these effects, suggesting of the involvement of PAI-1 in skin fibrosis. Subsequent in vivo studies showed that uPAR inhibitors increased skin fibrosis in mouse models, while uPA agonists and PAI-1 inhibitors reversed these effects. Our findings demonstrate a novel role for the uPA system and highlights its relationships with skin fibrosis, thereby suggesting new therapeutic approaches targeting the uPA system.