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The “Fast track” protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD.
We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled “Fast track” protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays.
The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0–169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031).
Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
This study investigated the effect of the flavonoid-based compound isorhamnetin (ISO) on maturation and developmental competence in oxidative stress-exposed porcine oocytes in vitro. Treatment with 2 μM ISO (2 ISO) increases the developmental rate of oxidative stress-exposed porcine oocytes during in vitro maturation (IVM). The glutathione level and mRNA expression of antioxidant-related genes (NFE2L2 and SOD2) were increased in the 2 ISO-treated group, whereas the reactive oxygen species level was decreased. Treatment with 2 ISO increased mRNA expression of a cumulus cell expansion-related gene (SHAS2) and improved chromosomal alignment. mRNA expression of maternal genes (CCNB1, MOS, BMP15 and GDF9) and mitogen activated protein kinase (MAPK) activity were increased in the 2 ISO-treated group. The total cell number per blastocyst and percentage of apoptotic cells were increased and decreased in the 2 ISO-treated group, respectively. Treatment with 2 ISO increased mRNA expression of development-related genes (SOX2, NANOG, and POU5F1) and anti-apoptotic genes (BCL2L1 and BIRC5) and decreased that of pro-apoptotic genes (CASP3 and FAS). These results demonstrate that 2 ISO improves the quality of porcine oocytes by protecting them against oxidative stress during IVM and enhances subsequent embryo development in vitro. Therefore, we propose that ISO is a useful supplement for IVM of porcine oocytes.
Our previous studies have already revealed that β-cryptoxanthin (BCX), hesperetin (HES), and icariin (ICA) antioxidants are effective for in vitro maturation (IVM) of porcine oocytes. In this study, we investigated which of BCX, HES, or ICA was more effective for IVM of porcine oocytes. The antioxidant properties were assessed with aged porcine oocytes and embryos by comparing 2,2-diphenyl-1-(2,4,6-trinitrophenyl)hydrazyl (DPPH), reducing power, and H2O2 scavenging activity assays. The chemical assay results demonstrated that BCX had a greater DPPH scavenging activity and reducing power than HES and ICA, compared with controls. However, the H2O2 scavenging activity of the antioxidants was similar when tested at the optimal concentrations of 1 μM BCX (BCX-1), 100 μM HES (HES-100), and 5 μM ICA (ICA-5). The biological assay results showed that BCX-1 treatment was more effective in inducing a significant reduction in reactive oxygen species (ROS), improving glutathione levels, and increasing the expression of antioxidant genes. In addition, BCX-1 inhibited apoptosis by increasing the expression of anti-apoptotic genes and decreasing pro-apoptotic genes in porcine parthenogenetic blastocysts. BCX-1 also significantly increased the blastocyst formation rate compared with the ageing control group, HES-100 and ICA-5. This study demonstrates that damage from ROS produced during oocyte ageing can be prevented by supplementing antioxidants into the IVM medium, and BCX may be a potential candidate to improve assisted reproductive technologies.
This study was performed to improve production efficiency at the level of recipient pig and donor nuclei of transgenic cloned pigs used for xenotransplantation. To generate transgenic pigs, human endothelial protein C receptor (hEPCR) and human thrombomodulin (hTM) genes were introduced using the F2A expression vector into GalT–/–/hCD55+ porcine neonatal ear fibroblasts used as donor cells and cloned embryos were transferred to the sows and gilts. Cloned fetal kidney cells were also used as donor cells for recloning to increase production efficiency. Pregnancy and parturition rates after embryo transfer and preimplantation developmental competence were compared between cloned embryos derived from adult and fetal cells. Significantly higher parturition rates were shown in the group of sows (50.0 vs. 4.1%), natural oestrus (20.8 vs. 0%), and ovulated ovary (16.7 vs. 5.6%) compared with gilt, induced and non-ovulated, respectively (P < 0.05). When using gilts as recipients, final parturitions occurred in only the fetal cell groups and significantly higher blastocyst rates (15.1% vs. 21.3%) were seen (P < 0.05). Additionally, gene expression levels related to pluripotency were significantly higher in the fetal cell group (P < 0.05). In conclusion, sows can be recommended as recipients due to their higher efficiency in the generation of transgenic cloned pigs and cloned fetal cells also can be recommended as donor cells through correct nuclear reprogramming.
Network approach has been applied to a wide variety of psychiatric disorders. The aim of the present study was to identify network structures of remitters and non-remitters in patients with first-episode psychosis (FEP) at baseline and the 6-month follow-up.
Participants (n = 252) from the Korean Early Psychosis Study (KEPS) were enrolled. They were classified as remitters or non-remitters using Andreasen's criteria. We estimated network structure with 10 symptoms (three symptoms from the Positive and Negative Syndrome Scale, one depressive symptom, and six symptoms related to schema and rumination) as nodes using a Gaussian graphical model. Global and local network metrics were compared within and between the networks over time.
Global network metrics did not differ between the remitters and non-remitters at baseline or 6 months. However, the network structure and nodal strengths associated with positive-self and positive-others scores changed significantly in the remitters over time. Unique central symptoms for remitters and non-remitters were cognitive brooding and negative-self, respectively. The correlation stability coefficients for nodal strength were within the acceptable range.
Our findings indicate that network structure and some nodal strengths were more flexible in remitters. Negative-self could be an important target for therapeutic intervention.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
To evaluate the bidirectional relationship between blood pressure (BP) and depressive symptoms using a large prospective cohort study.
Prospective cohort study was performed in 276 244 adults who participated in a regular health check-up and were followed annually or biennially for up to 5.9 years. BP levels were categorised according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. Depressive symptoms were assessed using Centre for Epidemiologic Studies-Depression (CESD) questionnaire and a cut-off score of ≥25 was regarded as case-level depressive symptoms.
During 672 603.3 person-years of follow-up, 5222 participants developed case-level depressive symptoms. The multivariable-adjusted hazard ratios (HRs) [95% confidence interval (CI)] for incident case-level depressive symptoms comparing hypotension, elevated BP, hypertension stage 1 and hypertension stage 2 to normal BP were 1.07 (0.99–1.16), 0.93 (0.82–1.05), 0.89 (0.81–0.97) and 0.81 (0.62–1.06), respectively (p for trend <0.001). During 583 615.3 person-years of follow-up, 27 787 participants developed hypertension. The multivariable-adjusted HRs (95% CI) for incident hypertension comparing CESD 16–24 and ⩾25 to CESD < 16 were 1.05 (1.01–1.11) and 1.12 (1.03–1.20), respectively (p for trend <0.001) and in the time-dependent models, corresponding HRs (95% CI) were 1.12 (1.02–1.24) and 1.29 (1.10–1.50), respectively (p for trend <0.001).
In this large cohort study of young and middle-aged individuals, higher BP levels were independently associated with a decreased risk for developing case-level depressive symptoms and depressive symptoms were also associated with incident hypertension. Further studies are required to elucidate the mechanisms underlying the bidirectional association between BP levels and incident depression.
The submarine channel-fill system of the Cambrian Spurs Formation exhibits unique metre-scale cycles of breccia and diamictite. The studied sections, Eureka Spurs, are located at the Mariner Glacier in the central-eastern part of northern Victoria Land, Antarctica. A facies analysis of the channel-fill deposit has led to the recognition of four main lithofacies: breccia, diamictite, thin-bedded sandstone and mudstone. The channel-fill deposit consists of two architectural elements: hollow-fill (HF) and sheet-like (SL) elements. The SL has wide convex-up geometry and consists solely of a very thick bed of diamictite, and is interpreted as a submarine channel lobe. The HF has a concave-up erosional base and flat upper surface. The HF consists of nine cyclic alternations of underlying breccia (cohesionless debris flow) and overlying diamictite (cohesive debris flow). The deposition of breccia is interpreted to have been controlled by repeated allogenic processes such as earthquakes. In contrast, the abrupt vertical transition from breccia to diamictite in each cycle is interpreted to have resulted from an autogenic, slope instability-related process. The interaction of the allogenic and autogenic factors recorded in the metre-scale unique cyclic deposits provides new criteria to interpret cycles of submarine debris flow.
The aim of this study is to develop predictive models to predict organ at risk (OAR) complication level, classification of OAR dose-volume and combination of this function with our in-house developed treatment decision support system.
Materials and methods
We analysed the support vector machine and decision tree algorithm for predicting OAR complication level and toxicity in order to integrate this function into our in-house radiation treatment planning decision support system. A total of 12 TomoTherapyTM treatment plans for prostate cancer were established, and a hundred modelled plans were generated to analyse the toxicity prediction for bladder and rectum.
The toxicity prediction algorithm analysis showed 91·0% accuracy in the training process. A scatter plot for bladder and rectum was obtained by 100 modelled plans and classification result derived. OAR complication level was analysed and risk factor for 25% bladder and 50% rectum was detected by decision tree. Therefore, it was shown that complication prediction of patients using big data-based clinical information is possible.
We verified the accuracy of the tested algorithm using prostate cancer cases. Side effects can be minimised by applying this predictive modelling algorithm with the planning decision support system for patient-specific radiotherapy planning.
Polycyclic aromatic hydrocarbons (PAH) are common dietary exposures that cross the human placenta and are classified as a probable human carcinogen. The aim of the present study was to investigate the potential impact of exposure to PAH-containing meat consumed during pregnancy on birth outcomes.
Prospective birth cohort study. Only non-smoking women with singleton pregnancies, who were free from chronic disease such as diabetes and hypertension, were included in the study. Maternal consumption of PAH-rich meat was estimated through FFQ. Multiple linear regression was used to assess factors related to higher intake and the association between dietary PAH and birth outcomes.
Republic of Korea, 2006–2011.
Pregnant women (n 778) at 12–28 weeks of gestation enrolled in the Mothers and Children’s Environmental Health (MOCEH) study.
The multivariable regression model showed a significant reduction in birth weight associated with higher consumption level of foods rich in PAH, such as grilled or roasted meat, during pregnancy (β=−17·48 g, P<0·05 for every 1 point higher in meat score). Further adjusting for biomarkers of airborne PAH did not alter this association. There was no evidence that higher consumption level of PAH-rich meat shortens the duration of gestation (P=0·561). Regression models performed for birth length and head circumference produced negative effects that were not statistically significant.
Consumption of higher levels of barbecued, fried, roasted and smoked meats during pregnancy was associated with reduced birth weight. Dietary risk of PAH exposure in Korean women is of concern.
Zygote wishes to inform its readers that its Editor-in-Chief has decided to retract the above article after an investigation carried out in compliance with the Committee on Publication Ethics guidelines found that the authors duplicated substantial parts of the following two articles:
1. Kim H, Yamanouchi K, Nishihara M. (2006) Expression of ski in the granulosa cells of atretic follicles in the rat ovary. J. Reprod. Dev. 52, 715–721
2. Kim H, Yamanouchi K, Matsuwaki T, Nishihara M. (2012) Induction of Ski protein expression upon luteinization in rat granulosa cells without a change in its mRNA expression. J. Reprod. Dev. 58, 254–259
Sloan-Kettering virus gene, a product of a cellular proto-oncogene c-Ski is a unique nuclear pro-oncoprotein and belongs to the Ski/Sno proto-oncogene family. The aim of the present study was to locate Ski protein in rat ovaries in order to find insights into the possible involvement of Ski in follicular development. First, expression of c-Ski mRNA in the ovaries of adult female rats was confirmed by RT-PCR. Then, ovaries obtained on the day of estrus were subjected to immunohistochemical analysis for Ski and proliferating cell nuclear antigen (PCNA) in combination with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). RT-PCR and in situ hybridization revealed that c-Ski mRNA was expressed in the ovaries of the adult rat on the day of estrous and localized mainly in the granulose cells. Ski was expressed in granulosa cells that were positive for TUNEL, but negative for PCNA, regardless of the shape and size of follicles. Expression of Ski in TUNEL-positive granulosa cells, but not in PCNA-positive granulosa cells, was also verified in rats having atretic follicles with double staining. These results indicate that Ski is profoundly expressed in the granulosa cells of atretic follicles, but not in growing follicles. Based on the present findings, Ski may play a role in the apoptosis of granulosa cells during follicular atresia.
We report on the formation of highly flexible and transparent TiO2/Ag/ITO multilayer films deposited on polyethylene terephthalate substrates. The optical and electrical properties of the multilayer films were investigated as a function of oxide thickness. The transmission window gradually shifted toward lower energies with increasing oxide thickness. The TiO2 (40 nm)/Ag (18 nm)/ITO (40 nm) films gave the transmittance of 93.1% at 560 nm. The relationship between transmittance and oxide thickness was simulated using the scattering matrix method to understand high transmittance. As the oxide thickness increased from 20 to 50 nm, the carrier concentration gradually decreased from 1.08 × 1022 to 6.66 × 1021 cm−3, while the sheet resistance varied from 5.8 to 6.1 Ω/sq. Haacke's figure of merit reached a maximum at 40 nm and then decreased with increasing oxide thickness. The change in resistance for the 60 nm-thick ITO single film rapidly increased with increasing bending cycles, while that of the TiO2/Ag/ITO (40 nm/18 nm/40 nm) film remained virtually unchanged during the bending test.
To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.
A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.
A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).
Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.
The dehydrogenated microstructure of the lithium borohydride-yttrium hydride (LiBH4-YH3) composite obtained at 350°C under 0.3 MPa of hydrogen and static vacuum was investigated by transmission electron microscopy combined with a focused ion beam technique. The dehydrogenation reaction between LiBH4 and YH3 into LiH and YB4 takes place under 0.3 MPa of hydrogen, which produces YB4 nano-crystallites that are uniformly distributed in the LiH matrix. This microstructural feature seems to be beneficial for rehydrogenation of the dehydrogenation products. On the other hand, the dehydrogenation process is incomplete under static vacuum, leading to the unreacted microstructure, where YH3 and YH2 crystallites are embedded in LiBH4 matrix. High resolution imaging confirmed the presence of crystalline B resulting from the self-decomposition of LiBH4. However, Li2B12H12, which is assumed to be present in the LiBH4 matrix, was not clearly observed.
In this study, the transcriptome of Vitis flexuosa leaves inoculated with Elsinoe ampelina was analysed to identify useful genes and elucidate their function and differential expression patterns through assembly and annotation gene ontology of data from sequencing short reads on the Illumina platform. We assembled ~121 million high-quality trimmed reads using Velvet and Oases with optimal parameters into a non-redundant set of 70,899 transcripts ( ≥ 200 bp in length). The transcripts exhibited an average length of 1138 bp and a N50 length of 1695 bp, with the largest contig length being 9623 bp. Functional categorization revealed the conservation of genes involved in various molecular functions, including protein binding (21.1%) and oxidoreductase activity (11.7%), in V. flexuosa. The V. flexuosa transcript set generated in this study will serve as a resource for gene discovery and development of functional molecular markers.
The neurobiological mechanism of auditory hallucination (AH) in schizophrenia remains elusive, but AH can be caused by the abnormality in the speech perception system based on the speech perception neural network model.
The purpose of this study was to investigate whether schizophrenic patients with AH have the speech processing impairment as compared with schizophrenic patients without AH, and whether the speech perception ability could be improved after AH had subsided.
Twenty-four schizophrenic patients with AH were compared with 25 schizophrenic patients without AH. Narrative speech perception was assessed using a masked speech tracking (MST) task with three levels of superimposed phonetic noise. Sentence repetition task (SRT) and auditory continuous performance task (CPT) were used to assess grammar-dependent verbal working memory and non-language attention, respectively. These tests were measured before and after treatment in both groups.
Before treatment, schizophrenic patients with AH showed significant impairments in MST compared with those without AH. There were no significant differences in SRT and CPT correct (CPT-C) rates between both groups, but CPT incorrect (CPT-I) rate showed a significant difference. The low-score CPI-I group showed a significant difference in MST performance between the two groups, while the high-score CPI-I group did not. After treatment (after AH subsided), the hallucinating schizophrenic patients still had significant impairment in MST performance compared with non-hallucinating schizophrenic patients.
Our results support the claim that schizophrenic patients with AH are likely to have a disturbance of the speech perception system. Moreover, our data suggest that non-language attention might be a key factor influencing speech perception ability and that speech perception dysfunction might be a trait marker in schizophrenia with AH.
Dense thin β/β’’-alumina electrolyte films of less than 50 μm thickness were fabricated using vacuum dip-coating on porous substrate tubes. The porous substrate tubes were fabricated using a slip casting method. Fine Na-β/β’’-alumina powder was obtained via traditional solid state reaction processing. It was found that vacuum dip-coating is an effective method for fabricating thin dense layers coated on the porous tube. The mechanical properties of the porous tube, with and without the dense layer, were tested using a C-ring method. The optimized sintering process was also studied.
Background: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education.
Methods: A total of 249 aMCI patients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (−1.5 to −1.0 standard deviation (SD)) and late-stage aMCI (below −1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated.
Results: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCI participants, and late-stage aMCI participants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCI participants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCI participants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores.
Conclusions: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.