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This study aimed to assess the prevalence of anti-hepatitis E virus (HEV) immunoglobulin (Ig) M and elevated serum alanine aminotransferase (ALT) levels among employees in catering and public place industries. Blood samples were collected between January and December 2020 from 26,790 employees working in the Qinhuai district of Nanjing, China. Anti-HEV IgM in the serum samples was tested by the capture ELISA method and ALT was tested by the IFCC method. Samples positive for anti-HEV IgM or with ALT levels over 200 U/L were subjected to PCR screening of HEV RNA. The overall seroprevalence of anti-HEV IgM was 0.41%, and the seroprevalence was slightly higher in males (0.47%) than in females (0.37%); however, the difference was not substantial (p = 0.177). Seroprevalence of anti-HEV IgM increased with age, reaching its peak level after 48 years of age. The prevalence of elevated ALT levels was 4.24%, and males exhibited a higher prevalence than females (6.78% vs 2.65%, p < 0.001). Prevalence of elevated ALT levels differed in age groups and the 26–36-year-old group had the highest rate of elevated ALT levels. Employees with elevated ALT levels had a higher prevalence of positive anti-HEV IgM than those with normal ALT (0.57% vs 0.31%, p < 0.001). Positive HEV RNA was detected in one anti-HEV IgM-negative employee with ALT higher than 200 U/L. In our study, all the HEV RNA-positive and IgM-positive individuals are asymptomatic, and a combination of ALT tests, serological methods, and molecular methods is recommended to screen asymptomatic HEV carriers and reduce the risk of transmission.
A regional block, also known as a localized block, is a type of anesthetic that blocks nerve transmission to prevent or alleviate pain. Regional anesthesia is the process of injecting an anesthetic substance into a peripheral nerve and inhibiting transmission to avoid or treat pain. It is distinct from general anesthesia in that it does not alter the patient’s level of awareness to alleviate pain. There are numerous advantages of regional anesthesia over general anesthesia, including avoidance of airway manipulation, lower dosages, fewer systemic medication adverse effects, shorter recovery period, and considerably less discomfort following surgery.
Shoulder surgery can be accomplished arthroscopically or open, and is usually performed in either a lateral decubitus (LDP) or beach-chair (BCP) position. The LDP involves placing the patient on their side on a padded table on top of a bean bag to support the pelvis and lower torso. For the BCP, the patient is placed on a table with a headrest and the bed is positioned in Trendelenburg, with the feet elevated to 15 degrees and the knees flexed to 30 degrees. Some potential advantages of the BCP over the LDP include shorter surgical times, less difficult conversion to an open procedure, and a lower incidence of neuropathies. The BCP can present a unique challenge for the anesthesia provider in accessing the airway and has been associated with rare, but catastrophic, neurologic complications, including transient visual loss, spinal cord ischemia, and strokes. These complications have been suggested to be from the gravitational effects of the sitting position and the blunting of cerebral autoregulation under general anesthesia (GA). There is some evidence that patients in the BCP have diminished cerebral autoregulation and lower regional cerebral oxygenation, when compared to the LDP. This, however, do not relate to cognitive outcomes.
The intercostal nerves are the continuations of the ventral ramus of the thoracic spinal nerves. To perform an effective ICB, the block should be performed proximal to the mid-axillary line, where the lateral cutaneous branch takes off. ICBs can be performed using landmarks, a nerve stimulator, or under ultrasound guidance. Evidence supports the effectiveness of ICBs for chest tube placement, rib fractures, and procedures of the breast and chest wall. Limitations of ICBs include the need to perform blocks at multiple levels (each level of fractured rib) and their association with a shorter duration of action, compared to other chest wall fascial plane blocks such as pectoralis (PECS) II block and serratus anterior plane block (SAP). This is mainly related to a high rate of absorption of local anesthetic within the intercostal space. These considerations make ICBs a less favorable option, as with each injection, there is a potential risk of complications, such as neurovascular injury and pneumothorax. The risk of local anesthetic systemic toxicity (LAST) may also be increased with multiple intercostal injections related to the highly vascularized bundle located underneath each rib, resulting in a high rate of absorption.
Lithospheric thinning occurred in the North China Craton (NCC) that resulted in extensive Mesozoic magmatism, which has provided the opportunity to explore the mechanism of the destruction of the NCC. In this study, new zircon U–Pb ages, geochemical and Lu–Hf isotopic data are presented for Early Cretaceous adakitic rocks in the Liaodong Peninsula, with the aim of establishing their origin as well as the thinning mechanism of the NCC. The zircon U–Pb data show that crystallization occurred during 127–120 Ma (i.e. Early Cretaceous). These rocks are characterized by high Sr (294–711 ppm) content and Sr/Y ratio (38.5–108), low Yb (0.54–1.24 ppm) and Y (4.9–16.4 ppm) contents, and with no obvious Eu anomalies, implying that they are adakitic rocks. They are enriched in large-ion lithophile elements (e.g. Ba, K, Pb and Sr) and depleted in high-field-strength elements (e.g. Nb, Ta, P and Ti). These adakitic rocks have negative zircon ϵHf(t) contents (−28.9 to −15.0) with two-stage Hf model ages (TDM2) of 3004–2131 Ma. Based on the geochemical features, such as low TiO2 and MgO contents, and high La/Yb and K2O/Na2O ratios, these adakites originated from the partial melting of thickened eclogitic lower crust. They were in an extensional setting associated with the slab rollback of the Palaeo-Pacific Ocean. In combination with previous studies, as a result of the rapid retracting of the Palaeo-Pacific Ocean during 130–120 Ma, the asthenosphere upwelled and modified the thickened lithospheric mantle, which lost its stability, resulting in the lithospheric delamination and thinning of the NCC.