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Abstract Background Congenital diaphragmatic defects are rare, with most cases presenting in childhood. Diagnosis in adulthood is usually incidental or when symptoms develop. We present a case of a strangulated Bochdalek hernia complicated by possible tension pneumothorax and iatrogenic bowel injury in a healthy young male. Case presentation A 23-year-old Chinese man initially presented with complaints of mild back pain and was discharged with symptomatic treatment. He presented again 3 days later, with dyspnea and left upper back pain and was haemodynamically unstable and hypoxic. A chest x-ray was reported as a moderately large left-sided pneumothorax with herniation of bowel into the left hemithorax. Needle decompression resulted in feculent fluid being aspirated with no resolution of symptoms. The patient required an immediate transfer to the operating theatre for surgical intervention of his left diaphragmatic rupture, complicated by visceral herniation and left tension pneumothorax, with accidental puncture of the herniated bowel. He underwent an emergent laparotomy with requirements for rapid lung isolation and continued aggressive resuscitation. Conclusions Patients with congenital diaphragmatic hernias may present in adulthood, either incidentally or emergently. In the well adult patient with good reserves, these initial symptoms may be mild, and may be symptomatically treated with no further workup. However, patients may deteriorate rapidly once their compensatory mechanisms are exhausted. This is the first reported case of a patient with diaphragmatic rupture and bowel herniation, complicated by iatrogenic tension pneumothorax. This rare case illustrates the speed at which a diaphragmatic rupture may progress, possible pitfalls and offers insights on how a misdiagnosis may be avoided.

Abstract Background As the interest in manned spaceflight increases, so does the requirement to understand the transcriptomic mechanisms that underlay the detrimental physiological adaptations of skeletal muscle to microgravity. While microgravity-induced differential gene expression (DGE) has been extensively investigated, the contribution of differential alternative splicing (DAS) to the plasticity and functional status of the skeletal muscle transcriptome has not been studied in an animal model. Therefore, by evaluating both DGE and DAS across spaceflight, we set out to provide the first comprehensive characterization of the transcriptomic landscape of skeletal muscle during exposure to microgravity. Methods RNA-sequencing, immunohistochemistry, and morphological analyses were conducted utilizing total RNA and tissue sections isolated from the gastrocnemius and quadriceps muscles of 30-week-old female BALB/c mice exposed to microgravity or ground control conditions for 9 weeks. Results In response to microgravity, the skeletal muscle transcriptome was remodeled via both DGE and DAS. Importantly, while DGE showed variable gene network enrichment, DAS was enriched in structural and functional gene networks of skeletal muscle, resulting in the expression of alternatively spliced transcript isoforms that have been associated with the physiological changes to skeletal muscle in microgravity, including muscle atrophy and altered fiber type function. Finally, RNA-binding proteins, which are required for regulation of pre-mRNA splicing, were themselves differentially spliced but not differentially expressed, an upstream event that is speculated to account for the downstream splicing changes identified in target skeletal muscle genes. Conclusions Our work serves as the first investigation of coordinate changes in DGE and DAS in large limb muscles across spaceflight. It opens up a new opportunity to understand (i) the molecular mechanisms by which splice variants of skeletal muscle genes regulate the physiological adaptations of skeletal muscle to microgravity and (ii) how small molecule splicing regulator therapies might thwart muscle atrophy and alterations to fiber type function during prolonged spaceflight.

Polycyclic aromatic hydrocarbons (PAHs) are produced during combustion of organic matter, such as during cigarette smoking, and they exist widely in the environment. Exposure to 3,4-benzo[a]pyrene (BaP), as the most widely studied PAHs, relates to many cardiovascular diseases. However, the underlying mechanism of its involvement remains largely unclear. In this study, we developed a myocardial ischemia–reperfusion (I/R) injury mouse model and an oxygen and glucose deprivation–reoxygenation H9C2 cell model to evaluate the effect of BaP in I/R injury. After BaP exposure, the expression of autophagy-related proteins, the abundance of NLRP3 inflammasomes, and the degree of pyroptosis were measured. Our results show that BaP aggravates myocardial pyroptosis in a autophagy-dependent manner. In addition, we found that BaP activates the p53–BNIP3 pathway via the aryl hydrocarbon receptor to decrease autophagosome clearance. Our findings present new insights into the mechanisms underlying cardiotoxicity and reveal that the p53–BNIP3 pathway, which is involved in autophagy regulation, is a potential therapeutic target for BaP-induced myocardial I/R injury. Because PAHs are omnipresent in daily life, the toxic effects of these harmful substances should not be underestimated.

Low-strength and highly compressible excavated clayey soils are common in geotechnical engineering, which cannot serve as a bearing stratum and typically end up being disposed of in landfills. Autoclaved aerated concrete powder (AACP) is a lightweight and porous waste material, with its stockpiles rapidly accumulating worldwide. To promote sustainable development in geotechnical engineering, a type of composite admixture consisting of cement and AACP was developed to modify clayey soils in this study. The physical and mechanical properties of untreated and the composite admixture-treated soil samples were investigated via Atterberg limits, compaction, bender element, constraint compression, free swell, and unconfined compressive strength (UCS) tests. The physicochemical and microstructural observations, including soil pH, scanning electron microscopy, and mercury intrusion porosimetry analyses, were conducted to interpret the macroscopic mechanical behaviors. Test results showed that the incorporation of AACP improved the workability of clayey soils, while cement further enhanced their mechanical properties. Hydration compounds primarily filled the voids with a diameter ranging from 0.1 to 1 µm. From the perspective of volume change behavior, 8% cement content was recommended. Shear wave velocity showed a strong correlation with the UCS, demonstrating that the bender element technique was an effective non-destructive tool for assessing the strength of compacted samples. [ABSTRACT FROM AUTHOR]

Purpose: The home-based medical integrated program (HMIP) is a novel model for home healthcare (HHC) in Taiwan, initiated in 2016 to enhance care quality. However, the outcomes of this program on health outcomes and medical resource utilization in HHC patients remain unclear. Thus, we conducted this study to clarify it. Patients and Methods: The authors utilized the Taiwan National Health Insurance Research Database to identify HHC patients who received HMIP and those who did not between January 2015 and December 2017. A retrospective cohort study design was used. Convenience sampling was employed to select patients who met the inclusion criteria: being part of the HHC program and having complete data for analysis. Results: A total of 4982 HHC patients in the HMIP group and 10,447 patients in the non-HMIP group were identified for this study. The mean age in the HMIP group and non-HMIP group was 77.6 years and 76.1 years, respectively. Compared with the non-HMIP group, the HMIP group had lower total medical costs for HHC, fewer outpatient department visits and lower medical costs, lower medical costs for emergency department visits, fewer hospitalizations, and a lower mortality rate (34.6% vs 41.2%, p< 0.001). Conclusion: The HMIP is a promising model for improving care quality and reducing medical resource utilization in HHC patients. While this suggests that the non-HMIP model should be replaced, it's important to note that both non-HMIP and HMIP models currently coexist. The HMIP may serve as an important reference for other nations seeking to improve care quality and reduce medical resource utilization in their own HHC systems. [ABSTRACT FROM AUTHOR]

Context Coronavirus disease 2019 (COVID-19) could induce the "cytokine storm" due to overactivation of immune system and accompanied by acute respiratory distress syndrome as a serious complication. Vitamin C has been effective in improving lung function of patients by reducing inflammation. Objective The aim was to explore the therapeutic effects of high-dose vitamin C supplementation for patients with COVID-19 using meta-analysis. Data Sources Published studies were searched from PubMed, Cochrane Library, Web of Science, EMBASE, and China National Knowledge Infrastructure databases up to August 2022 using the terms "vitamin C" and "COVID-19". Data analyses were performed independently by 2 researchers using the PRISMA guidelines. Data Extraction Heterogeneity between the included studies was assessed using I2 statistics. When I2 ≥50%, the random-effects model was used; otherwise, a fixed-effects model was applied. Stata 14.0 software was used to pool data by standardized mean differences (SMDs) with 95% CIs or odds ratios (ORs) with 95% CIs. Data Analysis The 14 studies had a total of 751 patients and 1583 control participants in 7 randomized controlled trials and 7 retrospective studies. The vitamin C supplement significantly increased ferritin (SMD = 0.272; 95% CI: 0.059 to 0.485; P = 0.012) and lymphocyte count levels (SMD = 0.376; 95% CI: 0.153 to 0.599; P = 0.001) in patients with COVID‐19. Patients administered vitamin C in the length of intensive care unit staying (SMD = 0.226; 95% CI: 0.073 to 0.379; P = 0.004). Intake of vitamin C prominently alleviate disease aggravation (OR = 0.344, 95%CI: 0.135 to 0.873, P = 0.025). Conclusions High-dose vitamin C supplementation can alleviate inflammatory response and hinder the aggravation of COVID-19. [ABSTRACT FROM AUTHOR]

A class of time-varying delay impulsive reaction–diffusion tree–grass–water–nitrogen system driven by Lévy jump process is considered. First, we prove the existence and uniqueness of the global positive solution of the model by constructing the Lyapunov function. Secondly, several sufficient conditions for finite-time stability are given by using comparison theorem and mean impulse interval method. Finally, numerical simulations are carried out to verify the effectiveness of the theoretical analysis. [ABSTRACT FROM AUTHOR]

The Geriatric Influenza Death (GID) score was developed to help decision making in older patients with influenza in the emergency department (ED), but external validation is unavailable. Thus, we conducted a study was to fill the data gap. We recruited all older patients (≥65 years) who visited the ED of three hospitals between 2009 and 2018. Demographic data and clinical characteristics were retrospectively collected. Discrimination, goodness of fit, and performance of the GID score were evaluated. Of the 5,508 patients (121 died) with influenza, the mean age was 76.6±7.4 (standard deviation) years, and 49.3% were males. The GID score was higher in the mortality group (1.7±1.1 vs. 0.8±0.8, p

Abstract A crucial component of the musculoskeletal system, the tendon is one of the most commonly injured tissues in the body. In severe cases, the ruptured tendon leads to permanent dysfunction. Although many efforts have been devoted to seeking a safe and efficient treatment for enhancing tendon healing, currently existing treatments have not yet achieved a major clinical improvement. Here, an injectable granular hyaluronic acid (gHA)‐hydrogel is engineered to deliver fibromodulin (FMOD)—a bioactive extracellular matrix (ECM) that enhances tenocyte mobility and optimizes the surrounding ECM assembly for tendon healing. The FMOD‐releasing granular HA (FMOD/gHA)‐hydrogel exhibits unique characteristics that are desired for both patients and health providers, such as permitting a microinvasive application and displaying a burst‐to‐sustained two‐phase release of FMOD, which leads to a prompt FMOD delivery followed by a constant dose‐maintaining period. Importantly, the generated FMOD‐releasing granular HA hydrogel significantly augmented tendon‐healing in a fully‐ruptured rat's Achilles tendon model histologically, mechanically, and functionally. Particularly, the breaking strength of the wounded tendon and the gait performance of treated rats returns to the same normal level as the healthy controls. In summary, a novel effective FMOD/gHA‐hydrogel is developed in response to the urgent demand for promoting tendon healing.

Two dimensional inorganic–organic hybrid perovskites (2D perovskites) suffer from not only quantum confinement, but also dielectric confinement, hindering their application perspective in devices involving the conversion of an optical input into current. In this report, we theoretically predict that an extremely low exciton binding energy can be achieved in 2D perovskites by using high dielectric-constant organic components. We demonstrate that in (HOCH2CH2NH3)2PbI4, whose organic material has a high dielectric constant of 37, the dielectric confinement is largely reduced, and the exciton binding energy is 20-times smaller than that in conventional 2D perovskites. As a result, the photo-induced excitons can be thermally dissociated efficiently at room temperature, as clearly indicated from femtosecond transient absorption measurements. In addition, the mobility is largely improved due to the strong screening effect on charge impurities. Such low dielectric-confined 2D perovskites show excellent carrier extraction efficiency, and outstanding humidity resistance compared to conventional 2D perovskites.

Aim of the study: The research group proposed that the mechanism of “Feature Identification based Quality Assessment” (FIQA) of Traditional Chinese Medicine (TCM) can be explained according to the relationship between the “Feature” of TCM and the Pharmacodynamic Components representing the holistic effect of TCM. Gastrodiae Rhizoma (GR) was selected as the research object to reveal the close relationship between “Feature” and the quality of TCM. Materials and methods: In this study, the “Feature” such as “Shape”, “Color”, “Odour” and “Taste” of GR are quantified by the electronic nose, electronic tongue, and other instruments. Then, the Pharmacodynamic Components Group (PCG) of GR was determined which could reflect the holistic effect of GR by spectrum effect relationship analysis. By analyzing the correlation between the “Feature” and the content of PCG, the mechanism of FIQA of GR was determined. Results: The quantitative results of “Shape”, “Color”, “Odour” and “Taste” of GR from different sources were significantly different. Six components were selected as the PCG, which can represent the holistic effect of GR in the aspect of the neuroprotective effect. There was a good correlation between the components in the PCG and “Feature”. Conclusions: The quality of GR can be determined quantitatively according to its “Shape”, “Color”, “Odour” and “Taste”. The mechanism of FIQA of TCM can be explained according to the relationship between the Shape of TCM and the Pharmacodynamic Components representing the quality of TCM. The revelation of this mechanism reflects the holistic characteristics of the multi-component synergistic effect of TCM. This study provides a reference research method for revealing the mechanism of FIQA of TCM.

To explore the association between fluoride exposure and depression / anxiety in adults, the 1,169 participants were recruited. The demographic information of participants was obtained through questionnaire survey and physical measurements. Morning urine samples were collected, and urinary fluoride (UF) level was determined. Changes in depression and anxiety levels were evaluated using the Patient Health Questionnaire-2 and General Anxiety Disorder-2 scales. The association between psychiatric disorders and UF levels was analyzed. In the total population, the prevalence of depression and anxiety were 3.17% and 4.19%, respectively. These results showed no significant association between depression / anxiety scale scores and UF levels. Logistic regression suggested no significant association between depression / anxiety levels, and UF levels, but there was an interaction between UF and income on depression. Our findings highlighted the interaction between fluoride exposure and monthly income, which may affect depression in adults. [ABSTRACT FROM AUTHOR]

Background: While the impact of telephone follow-up (TFU) for older emergency department (ED) patients is controversial, its effects on the Asian population remain uncertain. In this study, we evaluated the effectiveness of a novel computer assisted TFU model specifically for this demographic. Methods: At a Taiwanese tertiary medical center, we developed a TFU protocol that included a referral and case management system within the ED hospital information system. We provided TFU to older discharged patients between April 1, 2021, and May 31, 2021. We compared this cohort with a non-TFU cohort of older ED patients and analyzed demographic characteristics and post-ED discharge outcomes. Results: The TFU model was successfully implemented, with 395 patients receiving TFU and 191 without TFU. TFU patients (median age: 76 years, male proportion: 48.9%) differed from non-TFU patients (median age: 74 years, male proportion: 43.5%). Compared with the non-TFU cohort, the multivariate logistic regression analysis revealed that the TFU cohort had a lower total medical expenditure < 1 month (adjusted odds ratio [AOR]: 0.32; 95% CI: 0.21 − 0.47 for amounts exceeding 5,000 New Taiwan Dollars), and higher satisfaction (AOR: 2.80; 95% CI: 1.46 − 5.36 for scores > 3 on a five-point Likert Scale). However, the TFU cohort also had a higher risk of hospitalization < 1 month (AOR: 2.50; 95% CI: 1.31 − 4.77) compared to the non-TFU cohort. Conclusion: Computer-assisted TFU appears promising. Further research involving a larger number of patients and validation in other hospitals is necessary to bolster the evidence and extend the findings to a broader context. [ABSTRACT FROM AUTHOR]