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This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
A comprehensive direct numerical simulation of electroconvection (EC) turbulence caused by strong unipolar charge injection in a two-dimensional cavity is performed. The EC turbulence has strong fluctuations and intermittency in the closed cavity. Several dominant large-scale structures are found, including two vertical main rolls and a single primary roll. The flow mode significantly influences the charge transport efficiency. A nearly $Ne \sim T^{1/2}$ scaling stage is observed, and the optimal $Ne$ increment is related to the mode with two vertical rolls, while the single roll mode decreases the charge transport efficiency. As the flow strength increases, EC turbulence transitions from an electric force-dominated mode to an inertia-dominated mode. The former utilizes the Coulomb force more effectively and allocates more energy to convection. The vertical mean profiles of charge, electric field and energy budget provide intuitive information on the spatial energy distribution. With the aid of the energy-box technique, a detailed energy transport evolution is illustrated with changing electric Rayleigh numbers. This exploration of EC turbulence can help explain more complicated electrokinetic turbulence mechanisms and the successful utilization of Fourier mode decomposition and energy-box techniques is expected to benefit future EC studies.
Our research question was to evaluate the chromosome concordance of trophectoderm (TE) biopsy with noninvasive chromosome screening (NICS) using embryo culture medium renewed twice on Day 3 (D3) and Day 4 (D4). In this study, we evaluated 64 cycles with 223 biopsied blastocysts. These were categorized into two groups based on replacing embryo culture medium on D3 (control group) or on D3 and D4 (experimental group). The fundamental characteristics and main outcomes were compared. The concordance rates of NICS results with TE biopsy were determined according to next generation sequencing results. In total, 103 experimental and 120 control embryo cultures were collected, and the euploid status was analyzed using NICS technology. The overall concordance rates with TE biopsy of the experimental and control groups were 0.86 and 0.75, respectively. Statistically significant difference was found between the two groups. An additional medium renewal of the D4 embryo culture can improve the concordance of NICS with TE biopsy.
We demonstrate an efficient ultrafast source with 195 fs pulse duration, 54 W average power at 200 kHz repetition rate and near diffraction-limited beam quality. The compact setup incorporates a thin-disk Yb:YAG regenerative amplifier (RA) and a subsequent nonlinear pulse compression stage with periodic-layered Kerr media (PLKM), which is one of the multiple-thin-solid-plate schemes based on nonlinear resonator theory. In virtue of the formation of quasi-stationary spatial soliton in PLKM, the near diffraction-limited beam quality of the RA remained almost undisturbed after post-compression. The nonlinear pulse compression module is simple and efficient with a transmission of 96%. To the best our knowledge, for pulse energy over 200 μJ, this is the highest output power reported for the multiple-thin-solid-plate scheme. This source manifests an economical combination to mitigate the bandwidth limitations of Yb-based high-power chirped pulse amplifiers.
Geopolymers can be transformed into zeolites under certain synthesis conditions. However, zeolite formation is not frequently reported in KOH-activated geopolymers. This study attempted to explore zeolite synthesis through geopolymerization for a curing time of 24 h using mixed NaOH/KOH alkaline solution as an activator, and then applying the geopolymer-supported zeolites to immobilize Cd(II) in paddy soil. The K2O/M2O–H2O/SiO2 and K2O/M2O–OH–/SiO2 binary zeolite crystallization phase diagrams were obtained. Zeolite A, faujasite and sodalite formed at lower K2O/M2O molar ratios (0–0.2), ferrierite formation was favoured at a K2O/M2O molar ratio of 0.2–0.4 and zeolite K-I and zeolite F-K (both K-zeolites) were observed at a K2O/M2O molar ratio of 0.6. The geopolymer-supported zeolites had micropores and mesopores and specific surface area values of 44.2–74.8 m2 g–1. The material displayed a considerable Cd(II) immobilization efficiency (55.6–58.7% at 4–6 wt.% addition of zeolite).
Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been discovered in Wuhan and spread rapidly across China and worldwide. Characteristics of infected patients are needed to get insight into the full spectrum of the disease.
Methods:
Epidemiological and clinical information of 1738 diagnosed patients during February 7-26, 2020 in Wuhan Dongxihu Fangcang Hospital were analyzed. A total of 709 patients were followed up on symptom, mental health, isolation site, and medication after discharge.
Results:
There were 852 males and 886 females in the cohort. The average age of the patients was 48.8 y. A total of 79.98% of the patients were from Wuhan, Hubei Province. The most common initial symptoms were fever, cough, and shortness of breath. Among all the patients, 1463 had complications, with respiratory distress as the most common complication. The average duration of hospitalization was 15.95 ± 14.69 d. The most common postdischarge symptom is cough. After discharge, most patients were full of energy and chose hotel as their self-isolation site. Coronavirus disease 2019 (COVID-19) Chinese medicine No.2 prescription is the medication used most commonly by the patients after discharge.
Conclusions:
The population is generally susceptible to SARS-CoV-2. After receiving aggressive treatment of combined Chinese and Western medicine, most patients had a good prognosis and mental health after discharge.
We report an experimental study of the Prandtl-number effects in quasi-two-dimensional (quasi-2-D) Rayleigh–Bénard convection. The experiments were conducted in four rectangular convection cells over the Prandtl-number range of $11.7 \leqslant Pr \leqslant 650.7$ and over the Rayleigh-number range of $6.0\times 10^8 \leqslant Ra \leqslant 3.0\times 10^{10}$. Flow visualization reveals that, as $Pr$ increases from 11.7 to 145.7, thermal plumes pass through the central region much less frequently and their self-organized large-scale motion is more confined along the periphery of the convection cell. The large-scale flow is found to break down for higher $Pr$, resulting in a regime transition in the Reynolds number $Re$. For the $Pr$ range with a large-scale flow of system size, the $Re$ number, Nusselt number $Nu$ and local temperature fluctuations were investigated systematically. It is found that $Re$ scales as $Re \sim Ra^{0.58}Pr^{-0.82}$ in the present geometry, which suggests that it is in line with the behaviour in the 2-D configuration. On the other hand, the measured $Nu(Ra, Pr)$ relation $Nu \sim Ra^{0.289}Pr^{-0.02}$ tends to be compatible with the finding in a three-dimensional (3-D) system. For the temperature fluctuations in the cell centre and near the sidewall, they exhibit distinct $Ra$-dependent scalings that could not be accounted for with existing theories, but their $Pr$ dependences for $Pr \lesssim 50$ are in agreement with the predictions by Grossmann & Lohse (Phys. Fluids, vol. 16, 2004, pp. 4462–4472). These results enrich our understanding of quasi-2-D thermal convection, and its similarities and differences compared to 2-D and 3-D systems.
We investigated the effects of botulinum toxin on gait in Parkinson’s disease (PD) patients with foot dystonia. Six patients underwent onabotulinum toxin A injection and were assessed by Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), visual analog scale (VAS) of pain, Timed Up and Go (TUG), Berg Balance Test (BBT), and 3D gait analysis at baseline, 1 month, and 3 months. BFMDRS (p = 0.002), VAS (p = 0.024), TUG (p = 0.028), and BBT (p = 0.034) were improved. Foot pressures at Toe 1 (p = 0.028) and Midfoot (p = 0.018) were reduced, indicating botulinum toxin’s effects in alleviating the dystonia severity and pain and improving foot pressures during walking in PD.
Disaster literacy, which is a concept involved in moral quality, knowledge, and ability, impacts the disaster response. This study aimed to evaluate disaster education needs and to determine the affecting factors of disaster literacy among college students.
Methods:
A cross-sectional study was conducted through questionnaires. A total of 7200 college students from 10 colleges and universities in 5 provinces and cities in China were investigated.
Results:
Disaster education needs were urgently. For the participants, 79.43% stated that their families were not prepared for disaster prevention items, 96.36% suggested a campus emergency rescue team, and 88.64% obtained disaster knowledge through TV or Internet, and only 12.89% had offered relevant courses in their disciplines. The total scores of college students’ disaster literacy were 87.85 ± 19.86, which was at a low level. Multiple linear regression analysis showed that age, major, grade, place of residence, parental education, mother’s occupation, disaster experience, disaster training experience, and family disaster preparedness significantly affected college students’ disaster literacy, especially grade, family disaster preparedness, and place of residence.
Conclusions:
College students’ disaster literacy education is urgently needed. Families, communities, colleges and the government should attach importance to disaster literacy education for college students.
A simple, compact, double-pass pumped Nd:YVO4 thin disk laser is demonstrated. Its continuous-wave performance with different Nd doping concentrations and thicknesses is investigated experimentally. The maximum output power of 17.7 W is achieved by employing a 0.5 at.% doped sample, corresponding to an optical-to-optical efficiency of 46% with respect to the absorbed pump power. In addition, a numerical analysis and an experimental study of the temperature distribution, and thermal lens effect of the Nd:YVO4 thin disk, are presented considering the influence of the energy transfer upconversion effect and the temperature dependence of the thermal conductivity tensor. The simulated results are in good agreement with the experimental results.
Improving the production traits and resistance against mastitis in dairy cattle is a challenge for animal scientists across the globe. The present study was designed to investigate the genetic effects of single nucleotide polymorphisms (SNPs) in Janus kinase 2 (JAK2) and diacylglycerol acyltransferase (DGAT1) genes with production and mastitis-related traits. Four SNPs in JAK2 and one in DGAT1 were analyzed through Chinese Cow's SNPs Chip-I (CCSC-I) and genotyped in a population of 312 Chinese Holsteins. Our findings demonstrated that milk fat percentage, somatic cell count (SCC), somatic cell score (SCS), serum cytokines interleukin 6 (IL-6) and interferon gamma (IFN-γ) showed significant associations (P < 0.05) with at least one or more identified SNPs. Consequently, the analysis based on haplotypes amongst the SNPs in JAK2 revealed noteworthy (P < 0.05) association with SCC and IL-6. Collectively, our results verified the pleiotropic ability of detected SNPs in bovine JAK2 and DGAT1 for milk fat percentage as well as mastitis-related traits. The significant SNPs in both the genes could serve as powerful genetic markers to minimize mastitis risk. In addition, besides SCC and SCS, the IFN-γ and IL-6 could also be used as indicators of improved genetic resistance against mastitis.
The present paper presents a novel method to cope with the difficulty that an N-order filter can introduce a maximum number of transmission zeros (TZs) – no more than N. The method is described by a coupling topology and realized by a regular fully canonical filter structure to increase one more TZ for an N-order filter without any filter size increase. Besides, the TZ shift property, as another advantage of the proposed topology, is investigated. The coupling topology consists of a group of fully canonical coupling nodes with the harmonic node (non-resonating node (NRN)) excited by a λ/4 resonator. Owing to the unique coupling topology and coupling node distribution as well as the inclusion of an NRN, N + 1 TZs are generated by an N-order bandpass filter, while all the TZs are close to the passband and far away from the harmonic passband resulting the highly selective passbands. For demonstration, two-, three-, and four-order filters are designed and measured with the experimental results that confirm the proposed technique.
Disclosing the diagnosis of Alzheimer's disease (AD) to a patient is controversial. There is significant stigma associated with a diagnosis of AD or dementia in China, but the attitude of the society toward disclosure of such a diagnosis had not been formally evaluated prior to our study. Therefore, we aimed to evaluate the attitude toward disclosing an AD diagnosis to patients in China with cognitive impairment from their caregivers, and the factors that may affect their attitude.
Methods:
We designed a 17-item questionnaire and administered this questionnaire to caregivers, who accompanied patients with cognitive impairment or dementia in three major hospitals in Shanghai, China. The caregiver's attitude toward disclosing the diagnosis of AD as evaluated by the questionnaire was compared to that of disclosing the diagnosis of terminal cancer.
Results:
A majority (95.7%) of the 175 interviewed participants (mean 14.2 years of education received) wished to know their own diagnosis if they were diagnosed with AD, and 97.6% preferred the doctor to tell their family members if they were diagnosed with AD. If a family member of the participants suffered from AD, 82.9% preferred to have the diagnosis disclosed to the patient. “Cognitive impairment” was the most accepted term by caregivers to disclose AD diagnosis in Chinese.
Conclusion:
This study suggests most of the well-educated individuals in a Chinese urban area favored disclosing the diagnosis when they or their family members were diagnosed with AD.
In this paper, a compact dual-band bandpass filter (DB-BPF) using new dual-mode resonator-loaded resonators (DM-RLRs) is presented and investigated to simultaneously achieve controllable return loss (RL), bandwidth (BW) and transmission zeros (TZs), and the simple strategy for this type of filter design is proposed. The DB-BPF consists of two high-flexibility DM-RLRs with separated electric and magnetic coupling (SEMC). Specifically, the proposed DM-RLR provides the DB-BPF with center frequency control as well as RL control, and SEMC is utilized for the BW and TZ control. To facilitate the design, a simple optimization-based design strategy is proposed and employed, resulting in an example layout. Finally, the example filter, with center frequencies of 1.57 GHz (channel 1 for GPS) and 3.5 GHz (channel 2 for WiMAX), is fabricated and measured. The measurement insertion loss and RL are 0.9/0.9 and 17/20 dB. The fabricated DB-BPF also exhibits a compact size of 0.12λg × 0.08λg at 1.57 GHz.
In this letter, a passive high-selectivity dual-band filter with two controllable transmission zero (TZ) pairs is proposed, while synthesis method and control mechanism of the two TZ pairs are investigated. Specifically, by employing the magnetic/electric mixed coupling (MEMC), source–load coupling (S–L coupling) and stepped-impedance resonators, a dual-band bandpass filter with two pairs of controllable TZs is constructed. Two controllable TZ pairs can be independently adjusted by re-modifying the associated coupling structures. To validate the synthesizability and controllability of the TZ pairs, mathematical synthesis, and EM simulations are carried out. Two demonstrative filters with identical passband performance and different central TZ distributions for GSM (0.9/1.8 GHz) are designed and measured. The analysis and experimental results show that the synthesis-controllable TZ pair (fz2, fz3) introduced by MEMC can be synthesized and controlled using inline mixed coupling synthesis, and the optimization-controllable TZ pair (fz1, fz4) because of S–L coupling is controlled by S–L coupling strength optimization procedure.
A compact microstrip multi-stub loaded bandpass filter (BPF) with ultra-wide stopband is introduced and investigated. Lumped-equivalent circuit (LEC) method is adopted to analyze the characteristics of the in-band response based upon the low frequency LEC and even-odd mode analytical method. Besides, equivalent transmission line circuit method with even-odd mode analytical method are adopted to discuss the mechanism of the out-band rejection based upon the transmission poles and the transmission zeros analysis of the even-/odd-mode equivalent circuits. Accordingly, the design and the optimization procedures of this type of filters are summarized. To experimentally validate the proposed method, the filter is fabricated and measured. The measured results illustrate this BPF centered at f0 = 2.8 GHz, with −3 dB fractional bandwidth of 109.3%, the insert loss (IL) of less than 1 dB from 1.4 to 4 GHz, and the rejection level of 20 dB from 5.1 to 33.5 GHz(1.82f0 to 11.96f0).
We present experimental evidence that a minute amount of polymer additives can significantly enhance heat transport in the bulk region of turbulent thermal convection. The effects of polymer additives are found to be the enhancement of coherent heat fluxes and suppression of incoherent heat fluxes. The enhanced heat transport is associated with the increased coherency of thermal plumes, as a result of the suppression of small-scale turbulent fluctuations by polymers. The incoherent heat flux, arising from turbulent background fluctuations, makes no net contribution to heat transport. The fact that polymer additives can increase the coherency of thermal plumes is supported by the measurements of a number of local quantities, such as the extracted plume amplitude and width, the velocity autocorrelation functions and the velocity–temperature cross-correlation coefficient. The results from local measurements also suggest the existence of a threshold value for the polymer concentration, only above which significant modification of the plume coherent properties and enhancement of the local heat flux can be observed. Estimation of the plume emission rate suggests a stabilization of the thermal boundary layer by polymer additives.
X-ray powder diffraction data, unit-cell parameters, and space group for calcium(II)–naproxen complex, C28H26CaO6·2H2O, are reported [a = 36.918(2) Å, b = 5.655(6) Å, c = 12.505(6) Å, β = 91.263(2)°, cell volume V = 2610.47 Å3, Z = 4, and space group C2]. All measured lines were indexed and are consistent with the C2 space group. No detectable impurities were observed.
Introduction: The mortality of Parkinson’s disease (PD) and its associated risk factors among clinically definite PD patients in China has been rarely investigated. Our study aimed to identify the mortality rates and predictors of death in PD patients in China. Methods: 157 consecutive, clinically definite PD patients from the urban area of Shanghai were recruited from a central hospital based movement disorder clinic in 2006. All patients were regularly followed up at the clinic until December 31, 2011, or death. Mortality and associations with baseline demographics, health and medical factors were then determined within the cohort. Results: After 5 years, 11(7%) patients had died. The standardised mortality ratio was 0.62 (95% CI 0.32 to 1.07, P=0.104). The main causes of death were pneumonia (54.5%, 6/11) and digestive disorders (18.2%, 2/11), respectively. Age at onset, independent living, the mini mental state examination score, the Parkinson’s disease sleep scale score and the Epworth sleepiness scale score at baseline were statistically significantly different between the survival group and the deceased group (P<0.05). Across all participants, risk factors for death included low mini mental state examination score, and high Epworth sleepiness scale score according to a binary variable logistic regression analysis. Conclusions: This study confirms the similar survival of patients with PD to the control population up to a follow-up of 5 years. Interventions tailored to potential risk factors associated with death may offer further benefits.
An epigenetic mechanism has been suggested to explain the effects of the maternal diet on the development of disease in offspring. The present study aimed to observe the effects of a maternal high-lipid, high-energy (HLE) diet on the DNA methylation pattern of male offspring in mice. Female C57BL/6J mice were fed an HLE diet during gestation and lactation. The genomic DNA methylations at promoter sites of genes in the liver, mRNA and protein levels of selected genes related to lipid and glucose metabolism were measured by microarray, real-time PCR and Western blot. The results indicated that the percentage of methylated DNA in offspring from dams that were fed an HLE diet was significantly higher than that from dams that were fed a chow diet, and most of these genes were hypermethylated in promoter regions. The nuclear protein content and mRNA levels of hypermethylated genes, such as PPARγ and liver X receptor α (LXRα), were decreased significantly in offspring in the HLE group. The results suggested that the DNA methylation profile in adult offspring livers was changed by the maternal HLE diet during gestation and lactation.