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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.
Supersonic internal flows often exhibit multiple reflected shocks within a limited distance. These shocks can interact with each other in a complex manner due to the characteristics of the shock wave–turbulent boundary layer interaction (STBLI), including flow distortion and the relaxing boundary layer. This study aims to characterise this type of interaction and to clarify its fluid physics. A separated STBLI zone was established either upstream or downstream, and another weaker STBLI was established in the opposing position to serve as a perturbation. Time-resolved measurements were employed to characterise the mean separation and unsteadiness as the two regions approached each other, as well as their relationship. The experimental results indicated that the STBLI could affect the separation and reattachment of the other STBLI through either the decelerated or relaxing boundary layer. Despite a small deflection angle, the incident shock can amplify the low-frequency oscillations in the downstream STBLI region. Additionally, the interaction in the downstream region can be influenced by both low- and high-frequency oscillations associated with the upstream STBLI through a relaxing boundary layer. Despite the limited correlation observed between the low-frequency fluctuations in the downstream region and the boundary layer flow not far upstream, there still exists some degree of correlation between the low-frequency shock motions even when they are widely separated. Both the ‘upstream mechanism’ and ‘downstream mechanism’ have been observed, and the significance of low-frequency dynamics in the separated flow, relative to that of the upstream flow, is closely associated with interaction intensity.
Preoperative pneumonia in children with CHD may lead to longer stays in the ICU after surgery. However, research on the associated risk factors is limited. This study aims to evaluate the pre-, intra-, and postoperative risk factors contributing to extended ICU stays in these children.
Methods:
This retrospective cohort study collected data from 496 children with CHD complicated by preoperative pneumonia who underwent cardiac surgery following medical treatment at a single centre from 2017 to 2022. We compared the clinical outcomes of patients with varying ICU stays and utilised multivariate logistic regression analysis and multiple linear regression analyses to evaluate the risk factors for prolonged ICU stays.
Results:
The median ICU stay for the 496 children was 7 days. Bacterial infection, severe pneumonia, and Risk Adjustment for Congenital Heart Surgery-1 were independent risk factors for prolonged ICU stays following cardiac surgery (P < 0.05).
Conclusion:
CHD complicated by pneumonia presents a significant treatment challenge. Better identification of the risk factors associated with long-term postoperative ICU stays in these children, along with timely diagnosis and treatment of respiratory infections in high-risk populations, can effectively reduce ICU stays and improve resource utilisation.
The femtosecond laser filament-induced air laser plays a significant role for the remote sensing of air pollutants. The spatial distributions of air laser intensity were investigated experimentally in previous studies. However, the mechanism of the air laser propagation properties inside the filament plasma has not been quite clear yet. Moreover, few studies have been dedicated to the reproduction of the air laser profile from nitrogen molecules propagating in the filament plasma based on the numerical simulation method. In this study, the lasing action of the air laser from the transition of the first negative (0,0) band of nitrogen ions at 391 nm was simulated during the femtosecond laser filamentation. The beam profile of the air laser changes from a Gaussian or super-Gaussian shape to an outer ring structure by increasing the filament length or nitrogen ion density, which is in accord with the previous experimental result. A multiple-diffraction effect has been proposed to clarify the mechanism of the outer rings beam pattern formation, which is induced by the dynamical interaction between the lasing effect and diffraction effect of the air laser propagating inside the filament plasma. In addition, the amplified air laser power as a function of both the filament length and nitrogen ion density was investigated. Our study would pave the way to improve the energy conversion efficiency and directivity of remote air lasers, which would be significant for remote sensing applications.
This study compared survival outcomes between intensive care unit (ICU) patients receiving enteral nutrition (EN) and parenteral nutrition (PN) with vasopressor support, explored risk factors affecting clinical outcomes and established an evaluation model. Data from 1046 ICU patients receiving vasopressor therapy within 24 h from 2008 to 2019 were collected. Patients receiving nutritional therapy within 3 d of ICU admission were divided into EN or PN (including PN+EN) groups. Cox analysis and regression were used to determine relevant factors and establish a nomogram for predicting survival. The 28-d survival rate was significantly better in the EN group compared with the PN/PN+EN group. Risk factors included age, peripheral capillary oxygen saturation, red cell distribution width, international normalised ratio, potassium level, mean corpuscular Hg, myocardial infarction, liver disease, cancer status and nutritional status. The nomogram showed good predictive performance. In ICU patients receiving vasopressor drugs, patients receiving EN had a better survival rate than PN. Our nomogram had favourable predictive value for 28-d survival in patients. However, it needs further validation in prospective trials.
In large-scale galaxy surveys, particularly deep ground-based photometric studies, galaxy blending was inevitable. Such blending posed a potential primary systematic uncertainty for upcoming surveys. Current deblenders predominantly depended on analytical modelling of galaxy profiles, facing limitations due to inflexible and imprecise models. We presented a novel approach, using a U-net structured transformer-based network for deblending astronomical images, which we term the CAT-deblender. It was trained using both RGB and the grz-band images, spanning two distinct data formats present in the Dark Energy Camera Legacy Survey (DECaLS) database, including galaxies with diverse morphologies in the training dataset. Our method necessitated only the approximate central coordinates of each target galaxy, sourced from galaxy detection, bypassing assumptions on neighbouring source counts. Post-deblending, our RGB images retained a high signal-to-noise peak, consistently showing superior structural similarity against ground truth. For multi-band images, the ellipticity of central galaxies and median reconstruction error for r-band consistently lie within $\pm$0.025 to $\pm$0.25, revealing minimal pixel residuals. In our comparison of deblending capabilities focused on flux recovery, our model showed a mere 1% error in magnitude recovery for quadruply blended galaxies, significantly outperforming SExtractor’s higher error rate of 4.8%. Furthermore, by cross-matching with the publicly accessible overlapping galaxy catalogs from the DECaLS database, we successfully deblended 433 overlapping galaxies. Moreover, we have demonstrated effective deblending of 63 733 blended galaxy images, randomly chosen from the DECaLS database.
Depression is a common mental health problem, especially in the student group. Paroxetine hydrochloride is a commonly used antidepressant drug, and artistic psychodrama and ideological education can help students understand and deal with emotional problems.
Subjects and Methods
The study selected 100 college students with depression and randomly divided them into intervention group and control group. The intervention group received a 12-week art psychodrama and ideological and political education course, supplemented with paroxetine hydrochloride. While the control group only received paroxetine hydrochloride treatment. It took a normal course of three weeks. Efficacy was assessed using the Hamilton Depression Scale (HAMD) and the Self-rating Scale (SDS) after the treatment sessions.
Results
After the end of the treatment course, the depressive symptoms in the intervention group were significantly reduced, and the HAMD score and SDS score were significantly lower than those in the control group (P <0.05). The cure rate and overall response rate in the intervention group were also significantly higher than those in the control group (P <0.05). In addition, the mental health level and self-awareness were also significantly improved in the intervention group.
Conclusions
The combined application of artistic psychodrama and political education combined with paroxetine hydrochloride on depression treatment is significantly better than drug treatment, and the proposed treatment program can improve students’ mental health and self-cognition ability.
To identify the optimal weight gain at the end of the second trimester.
Design:
This was a population-based cohort study from the antenatal care system in Tianjin, China. We calculated gestational weight gain (GWG) based on the weight measured in the first trimester and the end of the second trimester. Restricted cubic spline analysis was performed to model the possible non-linear relationships between GWG and adverse outcomes. The optimal GWG was defined as the value of the lowest risk. Non-inferiority margins and the shape of the spline curves identified the recommended ranges in Chinese-specific BMI categories.
Setting:
Tianjin Maternal and Child Health Cohort.
Participants:
Singleton pregnant women aged 18–45 years.
Results:
In total, 69 859 pregnant women were included. Adverse outcome (including stillbirth, preterm birth, hypertensive disorders of pregnancy, gestational diabetes mellitus, small and large for gestational age) was significantly associated with GWG at the end of the second trimester. The risk score was non-linearly correlated with GWG in the underweight, normal weight and overweight groups. GWG at the end of the second trimester should not be < 7 kg in underweight group. For most normal-weight women, a GWG of about 8 kg is optimal. Pregnant women who are overweight should not have a GWG of more than 9 kg. We advised women with overweight and obesity to keep positive growth of GWG (> 0 kg) in the first and second trimesters.
Conclusions:
According to the comprehensive adverse maternal and infant outcomes, we recommend the optimal GWG at the end of the second trimester. This study may provide a considerable reference for weight management.
A 198.8 m deep borehole was drilled through ice to subglacial bedrock in the northwestern marginal part of Princess Elizabeth Land, ~12 km south of Zhongshan Station, in January–February 2019. Three years later, in February 2022, the borehole temperature profile was measured, and the geothermal heat flow (GHF) was estimated using a 1-D time-dependent energy-balance equation. For a depth corresponding to the base of the ice sheet, the GHF was calculated as 72.6 ± 2.3 mW m−2 and temperature −4.53 ± 0.27°C. The regional averages estimated for this area based, generally, on tectonic setting vary from 55 to 66 mW m−2. A higher GHF is interpreted to originate mostly from the occurrence of metamorphic complexes intruded by heat-producing elements in the subglacial bedrock below the drill site.
This study aims at establishing a model for close-contact melting (CCM) of shear-thinning fluids. We presented a theoretical framework for predicting the variation of liquid melt film thickness and motion of unmelted solid for both Carreau and power-law fluids. We identified the appropriate energy equation considering the convective effect and derived an analytical temperature profile across the liquid film. Using the lubrication approximation, force equilibrium relationships and the corresponding numerical approaches were built. By using laser interferometry and photographic recording methods, we found excellent agreement between numerical solutions and experimental results for Carreau liquids, revealing that the convective effect weakens heat transfer and melting rate. We identified the critical liquid film thickness that determines three situations of CCM in the theoretical model for Carreau fluids. Numerical prediction demonstrated that the CCM of Carreau fluids can be almost equivalent to that of power-law fluids if the initial film thickness is greater than the critical value. Finally, approximate analytical models were developed for both Carreau and power-law models. For the applicability of the approximate analytical solutions, we derived two- and three-dimensional dimensionless phase diagrams of validity range and identified a key dimensionless group $(\varLambda Re)^{4/3}{Re}\left [3\ln (Ste+1)\right ]^{1/3}{Pe}^{-1/3}$, where $\varLambda$ is dimensionless characteristic time, Re is Reynolds number, Ste is Stefan number and Pe is Peclect number. The reliability of the approximate solutions was verified by comparing with the numerical results. These approximate solutions enable convenient and low-cost computational prediction of the dynamic CCM process of shear-thinning fluids.
Mammalian oocytes not fertilized immediately after ovulation can undergo ageing and a rapid decline in quality. The addition of antioxidants can be an efficient approach to delaying the oocyte ageing process. Onion peel extract (OPE) contains quercetin and other flavonoids with natural antioxidant activities. In this study, we investigated the effect of OPE on mouse oocyte ageing and its mechanism of action. The oocytes were aged in vitro in M16 medium for 16 h after adding OPE at different concentrations (0, 50, 100, 200, and 500 μg/ml). The addition of 100 μg/ml OPE reduced the oocyte fragmentation rate, decreased the reactive oxygen species (ROS) level, increased the glutathione (GSH) level, and improved the mitochondrial membrane potential compared with the control group. The addition of OPE also increased the expression of SOD1, CAT, and GPX3 genes, and the caspase-3 activity in OPE-treated aged oocytes was significantly lower than that in untreated aged oocytes and similar to that in fresh oocytes. These results indicated that OPE delayed mouse oocyte ageing by reducing oxidative stress and apoptosis and enhancing mitochondrial function.
A blunted hypothalamic–pituitary–adrenal (HPA) axis response to acute stress is associated with psychiatric symptoms. Although the prefrontal cortex and limbic areas are important regulators of the HPA axis, whether the neural habituation of these regions during stress signals both blunted HPA axis responses and psychiatric symptoms remains unclear. In this study, neural habituation during acute stress and its associations with the stress cortisol response, resilience, and depression were evaluated.
Methods
Seventy-seven participants (17–22 years old, 37 women) were recruited for a ScanSTRESS brain imaging study, and the activation changes between the first and last stress blocks were used as the neural habituation index. Meanwhile, participants' salivary cortisol during test was collected. Individual-level resilience and depression were measured using questionnaires. Correlation and moderation analyses were conducted to investigate the association between neural habituation and endocrine data and mental symptoms. Validated analyses were conducted using a Montreal Image Stress Test dataset in another independent sample (48 participants; 17–22 years old, 24 women).
Results
Neural habituation of the prefrontal cortex and limbic area was negatively correlated with cortisol responses in both datasets. In the ScanSTRESS paradigm, neural habituation was both positively correlated with depression and negatively correlated with resilience. Moreover, resilience moderated the relationship between neural habituation in the ventromedial prefrontal cortex and cortisol response.
Conclusions
This study suggested that neural habituation of the prefrontal cortex and limbic area could reflect motivation dysregulation during repeated failures and negative feedback, which might further lead to maladaptive mental states.
Paresis of muscle groups in patients with amyotrophic lateral sclerosis (ALS) tends to present split phenomena. We explored the split phenomenon of fasciculation in multiple antagonistic muscle groups in ALS patients.
Methods:
One hundred and forty ALS patients and 66 non-ALS patients were included from a single ALS center. Muscle ultrasonography (MUS) was performed to detect fasciculation in elbow flexor-extensor, wrist flexor-extensor, knee flexor-extensor, and ankle flexor-extensor. Split phenomena of fasciculation between different antagonistic muscle groups were summarized, and the possible influence factors were analyzed through stratified analysis.
Results:
The frequency of split phenomenon of fasciculation intensity was significantly higher than those of muscle strength (26.1% vs. 7.1% for elbow flexor-extensor, 38.3% vs. 5.7% for wrist flexor-extensor, 37.9% vs. 3.0% for knee extensor-flexor, and 33.6% vs. 14.4% for ankle flexor-extensor) (P < 0.01). For muscles with 0–1 level of muscle strength (the Medical Research Council, MRC, score), significance difference in mean fasciculation intensity was observed only in ankle flexor-extensor. For muscles with 2–5 level of muscle strength, significant dissociation of fasciculation grade was common, especially among patients with slow rapid progression rate and both upper and lower motor neuron (UMN and LMN) involvement. As for non-ALS patients, no significant difference was observed in fasciculation intensity between antagonistic muscles.
Conclusion:
Split phenomenon of fasciculation between antagonistic muscles was common and relatively specific in ALS patients. Muscle strength, progression rate, and UMN involvement were influence factors of the split phenomenon of fasciculation intensity.
We report high-precision K isotopes, apatite U–Pb ages, whole-rock elements and Sr–Nd isotopes for the Saima nephelite syenite in the North China Craton. Trace-element and Sr–Nd–Hf–O isotope data indicate the presence of subducting sediments in the source region, while K isotopic compositions show a narrow range between –0.54 ‰ and –0.28 ‰, with an average of –0.41 ± 0.06 ‰, identical to the value of the asthenosphere. The nearly identical K isotopic compositions are low probability events compared with the K isotopic compositions of island arc lavas reported previously (–1.55 ‰ to +0.2 ‰). Although crustal contamination is consistent with the Sr–Nd–K isotopic data, alternatively we propose that the isotopic data also reconcile with the interaction between cratonic roots and the underlying convective asthenosphere, if this interaction is over prolonged periods of time. Numerical simulations successfully reproduced the observed data, if the metasomatism of the lithospheric mantle root, the source of the Saima alkaline rocks, occurred 500 Ma ago. Our study reveals that the isotopic compositions of fast-diffusion components in a lithospheric mantle metasomatized by ancient subducting melts can be effectively homogenized by convective asthenosphere through diffusion over a long time interval.
In “Risky choice framing: Task versions and a comparison of prospect theory and fuzzy-trace theory”, Kühberger and Tanner (2010) examined the impacts of removing stated zero/non-zero complements of risky options on the gain/loss framing effect. They also tested two rival theoretical explanations for this effect: prospect theory and fuzzy-trace theory. The present study aimed to examine the reliability and robustness of the evidence provided by Kühberger and Tanner by precise replication in Study 1. The original findings were reported for conditions in which the probability of the risky option was fixed, and the expected value of the two alternatives was approximately equivalent. The present study also aimed to examine the generality of their findings under additional conditions in which large, medium and small probabilities of the risky option were assigned, and the expected value of the certain or risky options differed. The main findings of Kühberger and Tanner (2010) were successfully replicated and confirmed under the original and additional conditions. The implications of these findings are discussed.
Understanding predator–prey interactions is essential for successful pest management by using predators, especially for the suppression of novel invasive pest. The green lacewing Chrysopa formosa is a promising polyphagous predator that is widely used in the biocontrol of various pests in China, but information on the control efficiency of this predator against the seriously invasive pest Spodoptera frugiperda and native Spodoptera litura is limited. Here we evaluated the predation efficiency of C. formosa adults on eggs and first- to third-instar larvae of S. frugiperda and S. litura through functional response experiments and determined the consumption capacity and prey preference of this chrysopid. Adults of C. formosa had a high consumption of eggs and earlier instar larvae of both prey species, and displayed a type II functional response on all prey stages. Attack rates of the chrysopid on different prey stages were statistically similar, but the handling time increased notably as the prey developed. The highest predation efficiency and shortest-handling time were observed for C. formosa feeding on Spodoptera eggs, followed by the first-instar larvae. C. formosa exhibited a significant preference for S. litura over S. frugiperda in a two-prey system. In addition, we summarized the functional response and predation efficiency of several chrysopids against noctuid pests and made a comparison with the results obtained from C. formosa. These results indicate that C. formosa has potential as an agent for biological control of noctuid pests, particularly for the newly invasive pest S. frugiperda in China.
The subduction model of the Neo-Tethys during the Early Cretaceous has always been a controversial topic, and the scarcity of Early Cretaceous magmatic rocks in the southern part of the Gangdese batholith is the main cause of this debate. To address this issue, this article presents new zircon U–Pb chronology, zircon Hf isotope, whole-rock geochemistry and Sr–Nd isotope data for the Early Cretaceous quartz diorite dykes with adakite affinity in Liuqiong, Gongga. Zircon U–Pb dating of three samples yielded ages of c. 141–137 Ma, indicating that the Liuqiong quartz diorite was emplaced in the Early Cretaceous. The whole-rock geochemical analysis shows that the Liuqiong quartz diorite is enriched in large-ion lithophile elements (LILEs) and light rare-earth elements (LREEs) and is depleted in high-field-strength elements (HFSEs), which are related to slab subduction. Additionally, the Liuqiong quartz diorite has high SiO2, Al2O3 and Sr contents, high Sr/Y ratios and low heavy rare-earth element (HREE) and Y contents, which are compatible with typical adakite signatures. The initial 87Sr/86Sr values of the Liuqiong adakite range from 0.705617 to 0.705853, and the whole-rock ϵNd(t) values vary between +5.78 and +6.24. The zircon ϵHf(t) values vary from +11.5 to +16.4. Our results show that the Liuqiong adakite magma was derived from partial melting of the Neo-Tethyan oceanic plate (mid-ocean ridge basalt (MORB) + sediment + fluid), with some degree of subsequent peridotite interaction within the overlying mantle wedge. Combining regional data, we favour the interpretation that the Neo-Tethyan oceanic crust was subducted at a low angle beneath the Gangdese during the Early Cretaceous.