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Hesperetin (HES), one of the major flavonoids that has various biological activities, such as anti-inflammatory and antioxidant activities, may preserve the intestinal barrier during sepsis.

Working memory (WM) is considered the mental workplace that retains and manipulates information. This study investigates the internal mechanism in WM states from an electroencephalography (EEG) network perspective. Firstly, we devised a novel letter-sequence version of the n -back experiment to collect EEG data, analyzed the neural oscillations in the theta and gamma bands, and then constructed Phase Lock Value (PLV) grounded brain networks to examine the synchronizations among dissimilar brain regions. The complex topology properties (e.g., global efficiency, local efficiency, and small-worldness) were scrutinized as well. Additionally, we presented an original algorithm, the Weighted K -Order Propagation Number (WKPN) algorithm, to extract the important brain regions associated with WM processes. The simulation revealed that the frontal and posterior regions were activated in two WM states, i.e., update and readout states. Throughout the readout, brain networks performed better in efficiency and resistance to interference. Furthermore, the right prefrontal and parietooccipital regions became more prominent in the completion of extra difficult WM tasks. In summary, these EEG-based results can be taken as promising evidence to understand and improve WM.

BackgroundThe objective of this study was to explore whether longitudinal changes in skeletal muscle mass, from hospital admission to 3 weeks post-trauma, are associated with poor prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma.MethodsA single-center retrospective observational review was conducted on 103 patients with abdominal trauma admitted to the Affiliated Jinling Hospital, Medical School of Nanjing University between January 2010 and April 2020. Skeletal muscle mass was assessed by abdominal computed tomography (CT) performed within 14 days before surgery and on post-trauma days 1–3 (week 0), 7–10 (week 1), 14–17 (week 2), and 21–24 (week 3). The skeletal muscle index (SMI) at L3, change in SMI per day (ΔSMI/day), and percent change in SMI per day (ΔSMI/day [%]) were calculated. The receiver-operating characteristic (ROC) curve was used to evaluate the discriminatory performance of ΔSMI/day (%) for mortality. Linear correlation analysis was used to evaluate the associations between ΔSMI/day (%) and daily caloric or protein intake.ResultsAmong the included patients, there were 91 males and 12 females (mean age ± standard deviation 43.74 ± 15.53 years). ΔSMI4-1/d (%) had a ROC-area under the curve of 0.747 (p = 0.048) and a cut-off value of −0.032 for overall mortality. There were significant positive correlations between ΔSMI4-1/d (%) and daily caloric intake and protein intake (Y = 0.0007501*X – 1.397, R2 = 0.282, R = 0.531, p R2 = 0.194, R = 0.440, p 1.2 g/kg/d in weeks 3 and 1–3 post-trauma.ConclusionLoss of skeletal muscle mass is associated with poor prognosis and nutritional intake in patients admitted to hospital with abdominal trauma.

The formation and evolution of back-arc basins is complex controlled by subduction dynamics, lithosphere delamination, magmatism, slab roll-back and extension. In such a complex geodynamic context, it is difficult to decipher the mechanisms which controls sedimentary basin subsidence history and distinguish the contribution of lithosphere tectonics from dynamic topography.Here we focus on one of the main basins of the Western Mediterranean, the Valencia Trough, which formed in the Cenozoic in relation with the slab roll-back of the Tethyan oceanic lithosphere. More specifically, we investigate the subsidence and geodynamic context related to the formation of a regionally observed unconformity, which separates Mesozoic from latest Palaeogene to Neogene sediments, and here referred to as the Miocene Unconformity.Using a dense grid of seismic reflection data, well data and 3D flexural backstripping, we show that the Miocene Unconformity subsided by more than 1.5 km from ~17 Ma to the present day at an average rate of 90 m/Myr in the SW Valencia Trough. The absence of Cenozoic extensional faults affecting the basement shown by seismic data indicates that this rapid subsidence is not caused by Cenozoic rifting. This subsidence cannot be explained by flexural loading related to the adjacent thin-skin Betic fold and thrust belt either, which only affects subsidence observed near the deformation front. Subduction dynamic subsidence generated by the positive mass anomaly of the subducting slab in the mantle is another mechanism that can control the subsidence evolution of back-arc basins. However, since the formation of the Miocene unconformity, the subduction has propagated westwards and southwards and has slowed or ceased under the Valencia Trough, which would have resulted in the progressive diminution of subduction dynamic subsidence, generating a relative uplift rather than subsidence.We propose an alternative mechanism and interpret the 1.5 km subsidence of the Miocene Unconformity as the collapse of a back-arc transient uplift event. Erosion during the uplift, resulting in the formation of the unconformity, is estimated to exceed 4 km. This transient uplift was likely caused by heating of back-arc lithosphere and asthenosphere, combined with mantle dynamic uplift, both caused by segmentation of Tethyan subduction resulting in slab tear. Rapid subsidence subsequently resulted from the removal of mantle flow dynamic support from the Tethyan subduction slab roll-back and thermal equilibration.Our observations and interpretation of rapid back-arc kilometre-scale uplift and collapse might have global applicability to explain some of the observed vertical motions and the subsidence evolution of other back-arc regions experiencing subduction segmentation and slab tear during subduction slab roll-back.

21 pages, 10 figures, supporting information https://doi.org/10.1029/2022JB026171.-- Data Availability Statement: The raw data used for P-wave travel-time tomographic inversion in this study is available at Science Data Bank via https://www.scidb.cn/anonymous/ckVyTVpm with CC0 (Zhang J., Zhao, M., & Qiu X., 2022), A three-dimensional (3D) P-wave seismic velocity (Vp) model of the crust in the northern South China Sea margin drilled by IODP Expeditions 367/368/368X has been obtained with first-arrival travel-time tomography using wide-angle seismic data from a network of 49 OBSs and 11 air-gun shot lines. The 3D Vp distribution constrains the extent, structure and nature of the continental, continent to ocean transition (COT), and oceanic domains. Continental crust laterally ranges in thickness from ∼8 to 20 km, a ∼20 km-width COT contains no evidence of exhumed mantle, and crust with clear oceanic seismic structure ranges in thickness from ∼4.5 to 9 km. A high-velocity (7.0–7.5 km/s) lower crust (HVLC) ranges in thickness from ∼1 to 9 km across the continental and COT domains, which is interpreted as a proxy of syn-rift and syn-breakup magma associated to underplating and/or intrusions. Continental crust thinning style is abrupter in the NE segment and gradual in the SW segment. Abrupter continental thinning exhibits thicker HVLC at stretching factor (β) < ∼3, whereas gentler thinning associates to thinner HVLC at β > ∼4. Opening of the NE segment thus occurred by comparatively increased magmatism, whereas tectonic extension was more important in the SW segment. The Vp distribution shows the changes in deformation and magmatism are abrupt along the strike of the margin, with the segments possibly bounded by a transfer fault system. No conventional model explains the structure and segmentation of tectonic and magmatic processes. Local inherited lithospheric heterogeneities during rifting may have modulated the contrasting opening styles, This work was financially supported by National Natural Science Foundation of China (Grants 41730532, 91958212, and U20A20100), With the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)

Background: Pancreatic trauma results in significant morbidity and mortality. However, few studies have investigated the postoperative prognostic factors in patients with pancreatic trauma. Material and methods: A retrospective study was conducted on consecutive patients with pancreatic trauma who underwent surgery in a national referral trauma center. Clinical data were retrieved from the electronic medical system. Univariate and binary logistic regression analyses were performed to identify the perioperative clinical parameters that may predict the factors of mortality of the patients. Results: A total of 150 patients underwent laparotomy due to pancreatic trauma during the study period. 128(85.4%) patients survived and 22 (14.6%) patients died due to pancreatic injury (10 patients died of recurrent intra-abdominal active hemorrhage and 12 died of multiple organ failure). Univariate analysis showed that age, hemodynamic status, and injury severe score (ISS) as well as postoperative serum levels of C-reactive protein (CRP), procalcitonin, albumin, creatinine and the volume of intraoperative blood transfusion remained strongly predictive of mortality (P

Efficient hemostasis during emergency trauma with massive bleeding remains a critical challenge in prehospital settings. Thus, multiple hemostatic strategies are critical for treating large bleeding wounds. In this study, inspired by bombardier beetles to eject toxic spray for defense, a shape-memory aerogel with an aligned microchannel structure was proposed, employing thrombin-carrying microparticles loaded as a built-in engine to generate pulse ejections for enhanced drug permeation. Bioinspired aerogels, after contact with blood, can rapidly expand inside the wound, offering robust physical barrier blocking, sealing the bleeding wound, and generating a spontaneous local chemical reaction causing an explosive-like generation of CO 2 microbubbles, which provide propulsion thrust to accelerate burst ejection from arrays of microchannels for deeper and faster drug diffusion. The ejection behavior, drug release kinetics, and permeation capacity were evaluated using a theoretical model and experimentally demonstrated. This novel aerogel showed remarkable hemostatic performance in severely bleeding wounds in a swine model and demonstrated good degradability and biocompatibility, displaying great potential for clinical application in humans.

A three-dimensional (3D) P-wave seismic velocity (Vp) model of the crust at the northern South China Sea margin drilled by IODP Expeditions 367/368/368X has been obtained with first-arrival travel-time tomography using wide-angle seismic data from a network of 49 OBSs and 11 air-gun shot lines. The 3D Vp distribution constrains the extent, structure and nature of the continental, continent to ocean transition (COT), and oceanic domains. Continental crust laterally ranges in thickness from ~8 to 20 km, a ~20 km-width COT contains no evidence of exhumed mantle, and crust with clear oceanic seismic structure ranges in thickness from ~4.5 to 9 km. A high-velocity (7.0-7.5 km/s) lower crust (HVLC) ranges in thickness from ~1 to 9 km across the continental and COT domains, which is interpreted as a proxy of syn-rift and syn-breakup magma associated to underplating and/or intrusions. Continental crust thinning style is abrupter in the NE segment and gradual in the SW segment. Abrupter continental thinning exhibits thicker HVLC at stretching factor (β) ~4. Opening of the NE segment thus occurred by comparatively increased magmatism, whereas tectonic extension was more important in the SW segment. The Vp distribution shows the changes in deformation and magmatism are abrupt along the strike of the margin, with the segments possibly bounded by a transfer fault system. No conventional model explains the structure and segmentation of tectonic and magmatic processes. Local inherited lithospheric heterogeneities during rifting may have modulated the contrasting opening styles.

Magnetic resonance imaging (MRI) is the most widely used imaging method in clinical lumbar spine examination. Because of its advantages of non-radiation and good tissue contrast, magnetic resonance imaging provides rich and effective diagnostic information for clinic. The most commonly used sequence is type 2 (T2) sequence, which has a longer time (usually longer than 2000 ms). It shows well in long T2 tissues such as nucleus pulposus, cerebrospinal fluid and adipose tissue, showing moderator high signal in images, while for short T2 tissues such as cartilage endplate and anterior and posterior longitudinal zone, it is often no signal and low signal because of its short attenuation time, thus forming obvious tissue contrast. But at the same time, because the time is too long, for short T2 tissue, the signal has been attenuated to zero before sequence acquisition, so the complete structure can not be displayed directly. In this paper, the normal human lumbar intervertebral disc was studied by conventional magnetic resonance type 1 (T1), T2 and double-echo-UTE imaging techniques. Each part of lumbar intervertebral disc and the semi-quantitative analysis of anatomical structure in images were compared, and the advantages and characteristics of each sequence for each anatomical structure of lumbar intervertebral disc and the advantage of MR-UTE in intervertebral disc display were discussed. It has been found that UTE, as a new sequence which can effectively image short T2 tissue, is gradually applied from experiment to clinic in bone and joint system because of its shorter time. In the gross specimens of lumbar intervertebral disc, sequence can directly display the cartilage endplate and the short T2 tissue of the anterior and posterior longitudinal ligament.

BackgroundThe high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage.MethodsThe research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30).ResultsThe literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index (I-CVI) was 0.53–1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation.ConclusionThe research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.

Objective. This study intended to explore the nursing outcome-oriented intervention’s effect on airway management in elderly long-term bedridden patients. Methods. A total of 120 cases of elderly long-term bedridden patients admitted to our hospital from May 2018 to June 2020 were enrolled and randomly divided into the observation group ( n = 60 ) and control group ( n = 60 ). The control group received the routine nursing intervention, while the observation group received the nursing outcome-oriented intervention. Forced expiratory volume (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in the first second were compared between the two groups before and after the intervention. The pulmonary infection of the two groups was observed. Total protein, hemoglobin, albumin, and cholesterol levels were compared between the two groups. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the two groups’ psychological status before and after the intervention. The Generic Quality of Life Inventory-74 (GQOLI-74) assessed the two groups’ quality of life. Results. After the intervention, the levels of FEV1, FVC, and MVV; total protein, hemoglobin, albumin, and cholesterol; and scores of physical function, psychological function, social function, and material life function in the observation group were higher than those in the control group. Pulmonary infection, secondary infection, the infection rate is more than 3%, HAMA, and HAMD scores, and the incidence of pressure ulcers, aspiration, constipation, and the falling bed was lower than those in the control group, with statistical significance (all P < 0.05 ). Conclusion. Nursing outcome-oriented intervention can effectively improve lung function, pulmonary infection, nutritional status, negative mood, and quality of life of long-term bedridden elderly patients.

We consider the equation u t = u x x + f ( t , u ) u_t=u_{xx} +f(t,u) , x ∈ R x\in \mathbb {R} , t > 0 t>0 , where f ( t , x ) f(t,x) periodically depends on t t and is of bistable type. Classical results showed that for a large class of initial functions, the solutions converge to a periodic traveling wave if it connects two linearly stable time-periodic states. Under some conditions on the initial functions, we prove this convergence result by a new approach which allows the time-periodic states to be degenerate.

Aim To identify the symptom clusters of early‐stage poststroke depression (PSD) and provide an in‐depth understanding of the symptoms. Design A mixed‐methods study with a convenient sampling method was used. Methods A cross‐sectional questionnaire survey in 231 stroke patients and semi‐structured interviews in 14 stroke patients were conducted in the neurological department of a comprehensive hospital in Southeast China. Data from the questionnaire survey were analysed through descriptive and exploratory factor analyses; data from the semi‐structured interview were transcribed verbatim and analysed through inductive content analysis. This study adheres to the GRAMMS checklist. Results Exploratory factor analysis revealed six symptom clusters of early‐stage PSD that accounted for an ideal variance in PSD: nervous, wakefulness, emotional, dull, guilt and low mood. Further, inductive content analysis revealed five themes that were like the above symptom clusters, except for the dull symptom cluster.

Embedding heteroatoms in buckybowls is an effective approach to alter their electronic structures and physicochemical properties. However, buckybowls with heteroatoms situated at both the peripheral rim and the central core to modulate the properties are quite rare. Herein, we report buckybowls containing sulfur atoms at the rim and nitrogen atoms in the center with tunable properties according to the state of the sulfur atoms. When the sulfur atoms are in the form of electron-donating sulfide, the buckybowl demonstrates weak fluorescence. It shows a low oxidative potential and elevated frontier molecular orbital energy levels due to the increased electron density. The electron-rich heterobuckybowl can be chemically oxidized to generate monocations and dications with gradually planarized structures according to the oxidation state. Moreover, it can assemble with electron-deficient fullerene C60 to form a 1 : 1 complex in toluene solution and a 2 : 1 complex in the crystalline state with strong intermolecular attractive interactions. After the oxidation of the sulfur atom to an electron-withdrawing sulfonyl group, the buckybowl shows the strongest photoluminescence in both solution and solid states in the regime of heterobuckybowls thus far. A decline in frontier molecular orbital energy levels and weak association behavior with fullerene C60 to generate a 1 : 1 complex in toluene solution are also observed due to the reduced electron density.

The oxidative demethylation of ortho-dimethoxyacridone with ceric ammonium nitrate (CAN) regioselectively furnished an ortho-quinone leaving a methoxyl group unreacted, which further condensed with aromatic ortho-diamines to afford angularly fused π-extended acridone derivatives. Crystallographic analysis reveals the distinct manner of molecular packing in the crystals according to the dimension of π-extension. The benzene at the turning point possesses a shorter outer bond and a longer inner bond, which affects molecular conjugation and results in weakened aromaticity.

Background Some biotics, like β-Lactams, have shown immunomodulation effects during sepsis, but the detailed mechanism was still unclear. Here we postulated that neutrophils play an essential role and β-Lactams exert immunomodulation effects through modulating neutrophil extracellular traps (NETs) formation. Methods NETs formation induced by two β-Lactams, Meropenem (MEM) and ceftazidime/tazobactam (CAZ/TB) in neutrophils from healthy donors and HL-60 cells was performed. Reactive oxygen species (ROS) generation and the activity of nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase were examined. Additionally, the upstream signal pathway of NETs formation, including protein kinase C (PKC), protein kinase B (Akt) and mammalian target of rapamycin (mTOR), were detected. Results MEM and CAZ/TB modulate NETs formation in activated PMNs, not resting PMNs. Both reduced ROS generation in resting PMNs and increased in activated PMNs. To test the activity of NADPH oxidase, we detected NADPH in MEM and CAZ/TB pre-cultivated activated PMNs, which showed that MEM and CAZ/TB modulates NETs formation through activation of NADHP oxidase by affecting the subunits of key enzymes. However, MEM reduced levels of phosho-PKC-Akt-mTOR, with no changes in CAZ/TB. Conclusions We firstly demonstrate that β-Lactams showed the definitive immunomodulation effects through modulating NETs formation, which is depended on PKC-Akt-mTOR signal pathway.

The Cenozoic geodynamic evolution of the Western Mediterranean is complex comprising subduction, slab roll-back, back-arc extension, collision, and lithosphere delamination. We investigate the subsidence of a regionally observed unconformity in the Valencia Trough of the Western Mediterranean, here referred to as the Miocene Unconformity, which separates Mesozoic from latest Palaeogene to Neogene sediments. The mechanisms controlling its subsidence are poorly understood. We show, using a dense grid of seismic reflection data, well data and 3D flexural backstripping, that the Miocene Unconformity in the SW Valencia Trough subsided by more than 1.5 km to the present day at an average rate of 90 m/Myr. The absence of Cenozoic extensional faults affecting the basement shown by seismic data indicates that this rapid subsidence is not caused by Cenozoic rifting or remaining Mesozoic post-rift thermal subsidence. Neither can this subsidence be explained by subduction dynamic subsidence or flexural loading related to the thin-skin Betic fold and thrust belt which only affects subsidence observed near the deformation front. We interpret the 1.5 km subsidence of the Miocene Unconformity as the collapse of a back-arc transient uplift event. Erosion during this uplift, resulting in the formation of the Miocene Unconformity, is estimated to exceed 4 km. Transient uplift was likely caused by heating of back-arc lithosphere and asthenosphere, combined with mantle dynamic uplift, both caused by segmentation of Tethyan subduction resulting in slab tear. Subsidence resulted from thermal equilibration and the removal of mantle flow dynamic support Tethyan subduction slab roll-back. We propose that our observations and interpretation of rapid back-arc km-scale uplift and collapse have global applicability for other back-arc regions experiencing subduction segmentation and slab tear during subduction slab roll-back.

Background Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear. Aim To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT. Methods The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require. Results Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively. Conclusion Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.

The broad zone between old oceanic lithosphere of the NW Pacific and Eastern Eurasian continental lithosphere is home to a chain of marginal basins. Different from oceans, marginal basins are more ...

This paper is concerned with the Cauchy problem $u_{t}=u_{xx}+f(t,u),x\in \mathbb{R} ,t>0$ with initial function $u(0,\cdot)=u_0 (\cdot)\in L^{\infty} (\mathbb{R})$, where $f$ is a rather general n...

Extensional systems of back-arc basins have been widely recognized and studied in SE Asia, however the interactions between extensional tectonics and spatial-temporal distributions of tectonic subsidence in an active back-arc basin are poorly known. Using a backstripping technique, we analysed 33 multichannel seismic profiles to calculate the Neogene tectonic subsidence across the entire Okinawa Trough (OT) for the first time. Reconstruction of the tectonic subsidence shows that the OT can be roughly divided into four subsidence stages with variable rate. By comparing the temporal-spatial distribution of the intensive subsidence area, we confirmed that rifting events first occurred in the northern segment (NOT) and middle segment (MOT) from the Miocene to Late Pliocene, and then propagated to the southern segment (SOT) after the Late Pliocene. The factors controlling the rapid tectonic subsidence over the entire OT can be classified into two categories: 1) NE-to NNE-trending normal faulting, related to extension of the OT, and NW- to NWW-trending strike-slip faulting; i.e., the Tokara Fault and the Miyako Fault, related to subduction of the Philippine Sea Plate under the Eurasian Plate; 2) The anomalous rapid subsidence occurred in the southernmost part of the SOT is likely related to the subducted Gagua Ridge which caused magma intrusion resulting from partial melting. We suggest that magmatic bodies produced by partial melting of subducted materials intruded into the crust and created a dense lithosphere, causing this rapid tectonic subsidence.

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe 3 O 4 on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO 3 clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

Background: The management strategy associated with the optimal clinical outcomes for patients with pancreatic trauma remains ambiguous. We sought to determine whether transitioning from initial laparotomy (LAP) to the nonoperative management strategy based on initial percutaneous drainage (PCD) without opening the retroperitoneum would improve clinical outcomes in patients with blunt high-grade pancreatic trauma.Methods: We conducted a retrospective cohort study of pancreatic trauma at a single tertiary referral center. Blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis were enrolled consecutively in the study. The primary outcome measure was the incidence of severe complications (Clavien-Dindo classification ≥ Ⅲb) for patients who underwent initial LAP vs PCD. To study effect modification by different initial strategies and to adjust for confounding, modified Poisson regression and sensitivity analysis based on propensity score matching and weighting were performed to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs).Results: Among 119 patients with blunt grade Ⅲ/Ⅳ pancreatic trauma (107 male [89.9%] and 12 female [10.1%]; mean age, 35.7 [SD, 12.7] years), 29 underwent initial PCD and 90 underwent initial LAP (January 2009 through October 2021). Compared with initial LAP, patients underwent initial PCD were significantly lower risk of severe complicates (9/29 [31.0%] vs 65/90 [72.2%]; aRR, 0.52 [95% CI, 0.30-0.90]). Consistent results are also observed in sensitivity analysis models. The relative risk of severe complications for the PCD group in propensity score matching model was 0.53 (95% CI, 0.28-0.99; P = 0.035), 0.37 (95% CI, 0.18-0.75; P = 0.006) in inverse probability of treatment weighting model, and 0.55 (95% CI, 0.31-0.99; P = 0.046) in overlap weighting model. In addition, the mean number of reinterventions per patient was 1.8 in the PCD group and 2.6 in the LAP group (P = 0.067). Conclusions: For blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis, initial PCD strategy without open the retroperitoneum has a significantly lower rate of severe complications and does not increase reinterventions compared with initial LAP. Further randomized controlled trials are warranted to validate these results.Trial Registration: ClinicalTrials.gov Identifier: NCT03681041(Sept. 21 2018).

This paper is concerned with pulsating waves for multi-dimensional reaction-diffusion equations in spatially periodic media. First, assuming the existence of pulsating waves connecting two linearly stable steady states, we study the continuity of wave speeds with respect to the direction of propagation. The continuity was proved in [15] under the extra condition that the speeds are nonzero in all directions. Here, we revisit this continuity result without the extra condition. Secondly, we provide some sufficient conditions ensuring the existence of pulsating waves in rapidly oscillating media, which allow the equations to have multiple stable steady states.

Empiric broad-spectrum antimicrobials therapy is suggested to be started immediately for sepsis patients. Empiric antimicrobial therapy should be narrowed once pathogen identification and sensitivities are established. However, the detailed mechanisms of de-escalation strategy are still unclear. Here we hypothesized neutrophil extracellular traps (NETs) played an essential role and de-escalation strategy might alleviate organs injury through regulation of NETs formation in sepsis. We evaluated the effect of imipenem and ceftriaxone on NETs formation in vitro and examined the role of reactive oxygen species (ROS). Next, we designed de-escalation and escalation strategy in cecum ligation and puncture (CLP) models. Organ injury, inflammatory cytokines, NETs levels were compared and evaluated. In CLP models, de-escalation therapy resulted in an increased serum MPO-DNA level during the early stage and decreased MPO-DNA level during late stage, which exerted the reverse effects in escalation therapy. Inflammatory response and organ injury exacerbated when eliminated NETs with DNAse I during the early stage of sepsis (p p p p = 0.051). The in vitro study showed that the imipenem could promote, while the ceftriaxone could inhibit the formation of NETs in PMA-activated PMNs through a ROS-dependent manner. We firstly demonstrate that de-escalation, not escalation, therapy reduces organ injury, decreases inflammatory response by promoting NETs formation in the early stage, and inhibiting NETs formation in the late stage of sepsis.

Background Due to the lack of health education adherence assessment tools for stroke patients, the assessment of health education adherence in this population is insufficient, which hinders the prevention and rehabilitation of stroke. This study aims to develop and validate a Health Education Adherence Scale for Stroke Patients (HEAS-SP). Methods A cross-sectional design with a purposive sampling method was used for this study. Six hundred and fifty-four eligible participants completed the demographic questionnaire and the HEAS-SP. The data collection lasted for 7 months, from March 1stto September 30th in 2019. Item analysis and exploratory and confirmatory factor analysis were employed to develop and validate the HEAS-SP. Results The item analysis, exploratory and confirmatory factor analysis resulted in a 20-item HEAS-SP with 4 domains: medication adherence, diet adherence, rehabilitation exercise adherence, and healthy lifestyle adherence. The four-domain model demonstrated acceptable model fit indexes and the 20-item HEAS-SP demonstrated acceptable reliability and validity. Conclusion The 20-item HEAS-SP was shown to have acceptable reliability and validity for assessing health education adherence with respect to diet, medication, rehabilitation exercise and healthy lifestyle in stroke patients, making it a potential basis for developing targeted interventions for stroke patients.

Seamounts are submarine volcanoes postulated to be formed either by hot mantle plumes rising from the deep mantle or by shallow, plate-related processes. However, the relative importance of these two mechanisms has not hitherto been quantified. In this study, applying Gaussian Process regression to reconstruct irregular seamount topography above and under the sedimentary layer, we calculate an accurate map of volcanism distribution within the Pacific plate. We find that previous erupted volumes have been underestimated by 75% on average. Our results show that (1) the total erupted volume postulated to be plume-related makes up only 18% of total Pacific intraplate volcanism, and (2) the volume statistics for plume-related seamounts and those along the Large Low-Shear-Velocity Province margins are nearly indistinguishable from the rest of the intraplate seamounts. We conclude that proposed plumes account for only a minority of the volume of intraplate volcanism in the Pacific plate, implying that shallow rather than deep processes are dominant.