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Objective: This study aimed to disclose the relationship between ambient air pollution and neurology clinic visits (NCVs) for vertigo. Methods: A time-series study was conducted to examine relationships between different air pollutants (SO2, NO2, PM2.5, PM10, CO, and O3) and daily NCVs for vertigo in Wuhan, China from January 1st 2017 to November 31th 2019. Stratified analyses were computed according to gender, age and season. Results: 14,749 records of NCVs for vertigo were enrolled in the study. Data demonstrated daily NCVs for vertigo significantly corresponded to per increase of 10μg/m3 for SO2, NO2 and O3. Males were more susceptible in acute SO2 and NO2 exposure, while females were more vulnerable to O3. Acute SO2, NO2, and O3 exposure correlated with daily NCVs for vertigo significantly stronger in individuals aged less than 50 years old. Acute PM2.5 exposure associated with daily NCVs for vertigo more obviously in cool seasons, whereas the correlation was conversely stronger in warm seasons between O3 exposure and daily NCVs for vertigo. Conclusion: Our study demonstrated acute exposure to ambient NO2 and O3 positively associated with daily NCVs for vertigo. Acute effects of air pollution on daily NCVs for vertigo varied according to gender, age and season.

Background: Essential tremor (ET) patients present with both motor and non-motor symptoms including depression. Although deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) is used to treat motor symptoms of ET, there is no consensus as to how VIM DBS influences non-motor symptoms, specifically depression. Objective: The objective of this study was to conduct a meta-analysis of available studies investigating change in pre- to postoperative depression scores as measured by Beck Depression Inventory (BDI) in ET patients receiving VIM DBS. Methods: Inclusion criteria were randomized control trials or observational studies of patients undergoing unilateral/bilateral VIM DBS. Non-ET patients, case reports, patients Results: Seven studies divided into eight cohorts for a total of 281 ET patients met inclusion criteria. Pooled preoperative BDI score was 12.44 (95% CI [6.63–18.25]). A statistically significant decrease in depression scores was observed postoperatively (SMD = −0.29, 95% CI [−0.46 to −0.13], p = 0.0006). Pooled postoperative BDI score was 9.18 (95% CI [4.98–13.38]). A supplementary analysis which included an additional study with an estimated standard deviation at last follow-up was conducted. There was also a statistically significant decrease in depression postoperatively (9 cohorts, n = 352, SMD = −0.31, 95% CI [−0.46 to −0.16], p < 0.0001). Conclusions: Both quantitative and qualitative analyses of the existing literature suggest that VIM DBS improves depression postoperatively among ET patients. These results may guide surgical risk-benefit analysis and counseling for ET patients undergoing VIM DBS.

To explore a new magnetic resonance imaging (MRI)-based bone quality assessment method for predicting pedicle screw loosening in the lumbar spine.We reviewed 174 patients aged ≥50 years who were treated for lumbar degenerative diseases using posterior lumbar interbody fusion. All patients were followed-up for ≥12 months. Based on the presence of radiolucent areas on follow-up MRI images, the patients were divided into loosening and non-loosening groups. The vertebral bone quality (VBQ) score was calculated using T1-weighted MRI images. Demographic data, health history, and radiological parameters were also recorded and compared between the two groups. Logistic regression analysis was used to predict the independent risk factors affecting screw loosening.Screw loosening occurred in 29.88% (52/174) of patients. A total of 83 screws (9.18%, 83/904) were loosened. There were differences in the age, fixation length, fixation at S1, preoperative and postoperative PI-LL, PT, preoperative LL, lowest bone mineral density (BMD), and VBQ scores (P0.05) between the non-loosening and loosening groups. In the logistic regression, the VBQ score (OR=1.02 per point; 95% CI: 1.01-1.03; p0.001) was identified as an independent factor influencing screw loosening.As an independent risk factor for screw loosening after lumbar spine fusion, the VBQ score provides a new noninvasive protocol for assessing bone quality during surgical planning.

Cisplatin plus 5-fluorouracil (PF) is used as the standard neoadjuvant chemotherapy (also called preoperative chemotherapy) in the treatment of tongue squamous cell carcinoma (TSCC). Although PF chemotherapy reduces the distant metastasis of TSCC, the five-year survival rate has not significantly improved. In recent years, components considered in traditional Chinese medicine have been researched as adjuvant drugs for radiotherapy and chemotherapy. Plumbagin (PB) is a quinone component isolated from Plumbago zeylanica L. Notably, PB demonstrates numerous anticancer properties. In order to examine the chemosensitization effect of PB on PF and its associated mechanisms, in vitro experiments using TSCC Cal27 and cisplatin (CDDP)-resistant Cal27/CDDP cells were carried out in the present study, and the results were subsequently verified using nude mice xenografts. Results of the present study demonstrated that PB enhanced the anticancer effects of PF on the proliferation, migration, and invasion of Cal27 and Cal27/CDDP cells. Cell cycle assays demonstrated that both Cal27 and Cal27/CDDP cells were arrested in the S phase following the combined treatment of PF and PB. Moreover, the PF and PB combination group induced higher levels of apoptosis in Cal27 and Cal27/CDDP cells compared with the group treated with PF alone. In addition, the results of the present study demonstrated that combined PB and PF inhibited the PI3K/AKT/mTOR/p70S6K pathway in TSCC cells. Moreover, the weight and volumes of tumors in nude mice were reduced following treatment with a combination of PF and PB. Results of the present study also demonstrated that the expression levels of Ki67 were markedly reduced in the combined treatment group compared with the group treated with PF alone. In summary, the results of the present study demonstrated that PB enhanced the PF sensitivity of TSCC through induction of S-phase arrest and apoptosis via the PI3K/AKT/mTOR/p70S6K pathway.

The deep brain stimulation (DBS) in early-stage Parkinson's disease (PD) pilot clinical trial randomized 30 patients (HoehnYahr II off; medication duration 0.5-4 years; without dyskinesia/motor fluctuations) to optimal drug therapy (ODT) (early ODT) or bilateral subthalamic nucleus (STN) DBS plus ODT (early DBS+ODT). This study aims to report the 11-year outcomes of patients who completed the DBS in early-stage PD pilot clinical trial.Attempts were made to contact all 29 subjects who completed the two-year trial to participate in an 11-year follow-up study. Mixed-effects models compared overall trend in outcomes for randomization groups (fixed-effects: assigned treatment, year, their interaction; random-effect: subject) to account for repeated measures.Twelve subjects participated in this 11-year follow-up study (n = 8 early ODT, n = 4 early DBS+ODT). Participating subjects were 70.0 ± 4.8 years old with a PD medication duration of 13.7 ± 1.7 years (early DBS duration 11.5 ± 1.3 years, n = 4). Three early ODT subjects received STN-DBS as standard of care (DBS duration 6.5 ± 2.0 years). Early ODT subjects had worse motor complications (Unified Parkinson's Disease Rating Scale [UPDRS]-IV) than early DBS+ODT subjects over the 11-year follow-up period (between-group difference = 3.5 points; pEleven years after randomization, early DBS+ODT subjects had fewer motor complications than early ODT subjects. These results should be interpreted with caution because only 40% of pilot trial subjects participated in this 11-year follow-up study. The Food and Drug Administration has approved the conduct of a pivotal clinical trial evaluating DBS in early-stage PD (IDEG050016).The Clinicaltrials.gov registration number for the study is NCT00282152.

To identify quantitative electroencephalography (EEG)-based indicators of delirium or coma in mechanically ventilated patients.We prospectively enrolled 28 mechanically ventilated intensive care unit (ICU) patients to undergo 24-hour continuous EEG, 25 of whom completed the study. We assessed patients twice daily using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). We evaluated the spectral profile, regional connectivity and complexity of 5-minute EEG segments after each assessment. We used penalized regression to select EEG metrics associated with delirium or coma, and compared mixed-effects models predicting delirium with and without the selected EEG metrics.Delta variability, high-beta variability, relative theta power, and relative alpha power contributed independently to EEG-based identification of delirium or coma. A model with these metrics achieved better prediction of delirium or coma than a model with clinical variables alone (Akaike Information Criterion: 36 vs 43, p = 0.006 by likelihood ratio test). The area under the receiver operating characteristic curve for an ad hoc hypothetical delirium score using these metrics was 0.94 (95%CI 0.83-0.99).We identified four EEG metrics that, in combination, provided excellent discrimination between delirious/comatose and non-delirious mechanically ventilated ICU patients.Our findings give insight to neurophysiologic changes underlying delirium and provide a basis for pragmatic, EEG-based delirium monitoring technology.

Drawing on social exchange theory and institutional theory, this article extends the literature on sustainable operations by examining the mediating and moderating effects of buyer–supplier relation and institutional context on the relationships among internal green practice, external green practice, and environmental performance. This article analyzes data from 440 firms in three categories of market (the institutional context): industrialized Western, emerging Western, and emerging Asian markets. Both internal green practice and external green practice have positive direct impacts on firms’ environmental performance. More specifically and interestingly, external green practice partially mediates the relationship between internal green practice and environmental performance, and this process is moderated by the quality of the buyer–supplier relation. A higher quality of buyer–supplier relation helps to achieve a better outcome. In addition, the examined relationships vary between the emerging market and developed market: that is, they depend on the institutional context. The findings have implications for both practitioners and policymakers on how to improve environmental performance through leveraging green practice and buyer–supplier relation and what policies on green supply chain management might best be used in different markets.

A highly enantioselective palladium-catalyzed hydrosilylation reaction of prochiral 1,1-disubstituted cyclopropenes to access a wide variety of silylcyclopropanes bearing a quaternary carbon-stereocenter with good diastereo- and enantioselectivities.

A highly enantioselective palladium-catalyzed hydrosilylation of 1,3-diynes with dihydrosilanes was established for the facile preparation of Si-stereogenic enynes and an enyne-linked chiral polymer (polyenyne) in good yields with excellent ees.

In recent years, China has extensively made use of underground space, and with the rapid development of metros, more than 40 cities have opened rail transit. However, a problem has also emerged in the form and function of entrances to metro stations. Unlike countries of the West, Chinese design has developed under the historical background of rapid social and economic development and transformation. The design of entrances to metro stations mostly stays at the level of satisfying functions; many spaces adopt similar designs, lack innovative ideas and fail to spread urban culture and improve city visibility. Therefore, this study aims to conduct a comprehensive analysis and research on entrances to Chinese metro stations and proposes design concepts suitable for China's national conditions to stand out as examples for many metro stations that will be built in future. This paper investigates and analyses the entrances of independent metro stations in China, explores the problems in independent metro stations and proposes the corresponding solutions. Finally, the design concept of entrances to metro stations is discussed in terms of exterior and interior spaces.

Biomasses can be used as sacrificial agents. The presence of hemicelluloses and polar groups significantly enhances the H2 production rate.

The transition-metal-catalyzed synthesis of chiral silacycles is a challenging processes in organosilicon chemistry. Herein, we report a facile and regioselective synthesis of a novel class of 2,3-dihydrosilole derivatives with good yields via the palladium-catalyzed Heck-type reaction of silacyclopentenes (SCPs) with aryl iodides. Preliminary investigations on the enantioselective version of this palladium-catalyzed Heck-type process reveal that the presence of N-Boc-l-proline allows the diastereo- and enantioselective formation of chiral 2,3-dihydrosilole derivatives bearing both carbon and silicon-stereogenic centers.

Currently, one of the main reasons for the ineffectiveness of tumor treatment is that the abnormally high tumor interstitial pressure (TIP) hinders the delivery of drugs to the tumor center and promotes intratumoral cell survival and metastasis. Herein, we designed a "nanomotor" by in situ growth of Ag

Predicting breast cancer survival and targeting patients at high-risk of mortality is of crucial importance.We built a Bayesian Dynamic Cox (BDCox) model for predicting 5-year overall survival in breast cancer patients using data of the SEER Cancer Registry with 12,840 women. Four feature selection methods were used to identify predictors and enhance parsimony: fast backward variable selection, elastic net, Bayesian Model Average (BMA), and clinical expertise. All resulting models and a baseline full model containing all features were internally validated via bootstrapping and externally validated in the Shanghai Breast Cancer Survival Study.BMA outperformed other feature selection methods in both internal and external validations. The BDCox model with 12 predictors had the best performance. Several predictors showed time-varying associations with survival that are in agreement with previous studies.The model developed using BDCox outperformed other prognostic models considered in our study. The internal validation results indicate that the BDCox model is capable of achieving high prediction accuracy (C-statistic: 0.802), and the external validation results showed excellent generalizability of the BDCox model (C-statistic: 0.739).We built a dynamic Bayesian model from the large population-based registry SEER for predicting 5-year breast cancer overall survival. The prediction performance of the BDCox model is significantly better than other survival models.

Segmental lining is subject to significant upward buoyancy forces when a grouting material (slurry), initially fluid, is adopted to fill the gap between its external profile and the wall of a tunnel excavated with a TBM machine. The analysis of the effects of these forces is important in order to correctly dimension the segmental lining and avoid damage to the lining and subsequent costly maintenance and restoration actions. Given the complexity of the behavior of a segmental lining consisting of segmental rings and circular joints that alternate in the longitudinal direction of the tunnel, a specific numerical model has been implemented, adopting the Finite Element Method (FEM). This model is able to obtain the development of the vertical displacements of the segmental lining starting from the TBM tail, together with the bending moments and the shear forces induced inside it. The developed model is able to assess the risks of breaking and damaging the concrete and steel bolts that are used to connect the segmental rings at the circular joints; therefore, it represents a useful design tool for being able to correctly dimension the segmental lining also in relation to the risks produced by the appearance of considerable buoyancy forces around it, due to the presence of the initially fluid filling material. The proposed numerical model was applied to a real case (Ningbo metro tunnel) and allowed to obtain satisfactory results from the comparison of the calculated displacements with in situ measurements. Some sensitivity analyzes developed on the studied case have made it possible to detect which are the influencing parameters that have the greatest impact on the behavior of segmental lining in the presence of the studied buoyancy forces.

BACKGROUND: This study had aimed to describe long-term decision regret, bowel dysfunction, and the overall quality of life in patients with diverticulitis, and to determine if elective colectomy was associated with these patient-reported outcome measures. METHODS: This mixed-methods, survey-based study was administered to a national cohort of patients in the United States with diverticulitis. We measured decision regret (Brehaut Decision Regret), bowel dysfunction (Low Anterior Resection Syndrome score), and the overall quality of life (EuroQol 5 Dimension) in this population. We asked open-ended questions to elucidate factors that influenced patients’ choices between elective colectomy and observation. RESULTS: Among the 614 respondents, 294 (48%) chose between colectomy and observational management, 94 (15%) had surgery, and 157 (26%) had major Low Anterior Resection Syndrome. Of the 294 that chose between colectomy and observational management, 51 (17%) experienced decision regret. Colectomy was associated with an average decrease in the Brehaut Decision Regret score by 6 points but was not associated with a categorical measure of decision regret (Brehaut Score ≥50). Bowel dysfunction and overall quality of life were not significantly associated with colectomy. Disease-related factors, psychosocial factors, and interactions with physicians were commonly cited as reasons for pursuing colectomy or observational management. CONCLUSION: Patients with self-reported diverticulitis describe high levels of decision regret and bowel dysfunction regardless of chosen management strategy. Physicians should be aware that psychosocial factors can strongly influence a patient’s choice between colectomy and observational management. We advocated for future prospective studies using patient reported outcome metrics to improve outcomes in diverticulitis.

As a popular weight management intervention, intermittent fasting (IF) has been widely applied to the treatment of overweight and obesity in adults. This review describes the different forms and implementation protocols of IF and their effects on body weight, body composition, cardiometabolic risk factors and other diseases. The existing evidence suggests that IF is as effective as continuous energy restriction and may be a feasible and effective approach to weight loss.

Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications. Therefore, reducing the incidence of postoperative hypoxemia is a clinical concern.To investigate the clinical efficacy of high-flow nasal cannula oxygen (HFNCO) in the resuscitation period of older orthopedic patients.In this prospective randomized controlled trial, 60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups: those who used conventional face mask and those who used HFNCO. All patients were treated with 60% oxygen for 1 h after extubation. Patients in the conventional face mask group were treated with a combination of air (2 L) and oxygen (2 L) using a traditional mask, whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34 °C and flow rate of 40 L/min. We assessed the effectiveness of oxygen therapy by monitoring the patients' arterial blood gas, peripheral oxygen saturation, and postoperative complications.The characteristics of the patients were comparable between the groups. One hour after extubation, patients in HFNCO group had a significantly higher arterial partial pressure of oxygen (paOHFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia. Thus, HFNCO can be used to prevent postoperative hypoxemia.

To study the inorganic nitrogen in the process of interaction of river and groundwater and the changes in the microbial community, a vertical simulation device was used to simulate groundwater recharge to river water (upwelling) and river water recharge to groundwater (downwelling). The inorganic nitrogen concentrations in the soil and water solution as well as the characteristics of the microbial community were assessed to determine the inorganic nitrogen transformation and microbial community response in the heterogeneous interaction zone under hydrodynamic action, and the interaction mechanism between nitrogen transformation and the microbial community in the interaction zone was revealed. The removal rates of NO

Detection of serum embryonic miRNAs miR-371a-3p and miR-372-3p has been proposed to aid in diagnosis, prognosis, and management of patients with testicular germ cell tumors (GCTs). This study describes the analytical validation and performance of a laboratory-developed test to detect these miRNA targets by stem loop real-time quantitative RT-PCR (RT-qPCR) in serum from patients with GCTs. The assay was standardized using an exogenous spike-in control of nonhuman miRNA from Caenorhabditis elegans (cel-miR-39-3p) to assess extraction efficiency, and an endogenous housekeeping miRNA, miR-30b-5p, to control for miRNA normalization. miRNA results were expressed as relative expression level, using the comparative threshold cycle method (2

ObjectiveTo analyze the impacts of self-confidence cultivation combined with family collaborative nursing on the hope level, stigma and exercise tolerance in patients undergoing radical resection of pulmonary carcinoma.MethodsIn this expeirment, 79 patients who underwent radical resection of pulmonary carcinoma in our hospital from January 2018 to December 2021, were selected as research objects, and they were divided into two groups according to the date of admission. The control group (n = 39) was given routine care, while the study group (n = 40) was given self-confidence cultivation combined with family collaborative nursing on the basis of the control group. The hope level, stigma, exercise tolerance, and cancer-related fatigue of the two groups were comparatively analyzed.ResultsThe scores of T, P, I dimensions in Herth Hope Inventory (HHI) as well as the total score in the two groups were higher after intervention than before intervention (all P P P P P P ConclusionSelf-confidence cultivation combined with family collaborative nursing can promote the hope level of patients undergoing radical resection of pulmonary carcinoma, reduce stigma, enhance exercise endurance, and relieve cancer-related fatigue.

RationaleSynovial sarcoma is a subtype of soft tissue sarcoma. Synovial sarcoma in the head and neck region is relatively unusual. Primary synovial sarcoma of the thyroid gland (PSST) is first reported in 2003 by Inako Kikuchi. PSST is extremely rare with only 15 cases documented globally. PSST shows rapid disease progression and a relatively poor prognosis. However, diagnosis and therapy are challenging for clinical surgeons. In this article, we reported the 16th PSST case and reviewed the PSST cases globally for further clinical application.Patient concernsThe patient was referred to us because of gradually worsened dyspnea and dysphagia for 20 days. Physical examination showed a 5 × 4 cm mass with a clear boundary and good mobility. Contrast-enhanced ultrasonography (CEUS) and computed tomography (CT) showed a mass in the isthmus of the thyroid gland. The imageology diagnosis tends to be a benign thyroid nodule.DiagnosisAfter surgery, histopathology, immunohistochemistry, and fluorescence, in situ hybridization indicated the mass to be primary synovial sarcoma of the thyroid gland with no local and distant metastasis.InterventionsThe patient underwent total thyroidectomy and dissected the lymph nodes in the central compartment. This patient received postoperative chemotherapy (a combination of ifosfamide and epirubicin for five cycles). Patients tolerated chemotherapy well. No recurrence was found during the 9-month follow-up.LessonsAlthough PSST is an extremely rare disease, we should raise our awareness when we encounter a rapidly growing, cystic-solid mixed thyroid mass with neck compression symptoms to avoid misdiagnosis. Intraoperatively, surgeons should refine surgical procedures to avoid capsular rupture and tumor local implantation metastasis. Intraoperative frozen section pathology is necessary sometimes, especially when the diagnosis could not be established before surgery.

In the sulfotransferase (SULT) superfamily, members of the SULT1 family mainly catalyse the sulfonation reaction of phenolic compounds, which is involved in the phase II metabolic detoxification process and plays a key role in endocrine homeostasis. A coding variant rs1059491 in the SULT1A2 gene has been reported to be associated with childhood obesity. This study aimed to investigate the association of rs1059491 with the risk of obesity and cardiometabolic abnormalities in adults. This case‒control study included 226 normal weight, 168 overweight and 72 obese adults who underwent a health examination in Taizhou, China. Genotyping of rs1059491 was performed by Sanger sequencing in exon 7 of the SULT1A2 coding region. Chi-squared tests, one-way ANOVA, and logistic regression models were applied. The minor allele frequencies of rs1059491 in the overweight combined with obesity and control groups were 0.0292 and 0.0686, respectively. No differences in weight and body mass index were detected between the TT genotype and GT + GG genotype under the dominant model, but the levels of serum triglycerides were significantly lower in G-allele carriers than in non-G-allele carriers (1.02 (0.74–1.32) vs. 1.35 (0.83–2.13) mmol/L, P = 0.011). The GT + GG genotype of rs1059491 versus the TT genotype reduced the risk of overweight and obesity by 54% (OR 0.46, 95% CI 0.22–0.96, P = 0.037) after adjusting for sex and age. Similar results were observed for hypertriglyceridaemia (OR 0.25, 95% CI 0.08–0.74, P = 0.013) and dyslipidaemia (OR 0.37, 95% CI 0.17–0.83, P = 0.015). However, these associations disappeared after correction for multiple tests. This study revealed that the coding variant rs1059491 is nominally associated with a decreased risk of obesity and dyslipidaemia in southern Chinese adults. The findings will be validated in larger studies including more detailed information on genetic background, lifestyle and weight change with age.