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ObjectiveThe oxidative balance score (OBS) is important for determining the cause of obesity and its complications. We aimed to evaluate the association between OBS and obesity and other segmental body composition parameters among young and middle-aged U.S. adults.Methods9,998 participants from the National Health and Nutrition Examination Survey 2011–2018 were included. Lean mass percentage (LM%) and FM% were evaluated by dual-energy x-ray absorptiometry. Obesity was defined as body FM% ≥25% in men and ≥ 35% in women. The OBS was scored by 5 pro-oxidant and 21 antioxidant factors. Associations of quartiles of OBS with obesity risk were estimated using multivariable logistic regression models. Multivariable linear regression was conducted to estimate the association between OBS and segmental body composition measures including the arm LM%, leg LM%, torso LM%, whole LM%, arm FM%, leg FM%, torso FM% and total FM%.ResultsCompared to participants in the lowest quartile of OBS, those in the highest quartile of OBS were associated with a lower risk of BMI-defined obesity BMI-defined obesity [0.43 (0.36, 0.50)] and FM%-related obesity [0.43 (0.35, 0.52)]. Additionally, OBS was negatively associated with FM% of the limb and torso but positively associated with the percentage of lean mass (LM%) of the limb and trunk.ConclusionOBS was negatively associated with the risk of obesity and segmental FM%, but was positively associated with segmental LM% among US adults, indicating that adhering to an anti-oxidative diet and lifestyle management may be beneficial for preventing segmental obesity.

Introduction and Objectives: Accumulating evidence has supported that mild elevated total bilirubin exerts antioxidant and anti-inflammatory properties in multiple metabolic diseases. We aimed to explore the association of circulating total bilirubin concentration with non-alcoholic fatty liver disease (NAFLD) risk and all-cause mortality and examine the potential nonlinear relationships between them. Material and Methods: We used nationally representative data from the National Health and Nutrition Examination Survey (NHANES). NAFLD was assessed using the fatty liver index (FLI) and United States fatty liver index (USFLI), respectively. Results: A total of 35 912 and 17 329 participants were included in FLI-NAFLD (case with NAFLD was diagnosed by FLI) and USFLI-NAFLD (case with NAFLD was diagnosed by USFLI) groups, respectively. The mean age of total population was 46.25 years, and 48.51% were male. Compared to participants with lowest quintile of total bilirubin concentration, those with highest quintile had lower risk of NAFLD in both FLI-NAFLD (OR: 0.48, 95% CI: 0.40, 0.59) and USFLI-NAFLD (OR: 0.55, 95% CI: 0.43, 0.70) groups. Compared to participants with lowest quintile of total bilirubin concentration, the association between total bilirubin concentration and all-cause mortality was not significant among those with highest quintile of total bilirubin concentration (HR: 0.89, 95% CI: 0.66, 1.20). The restricted spline curves showed the nonlinear U-shaped association of total bilirubin concentration with NAFLD risk and all-cause mortality. The segmented linear regression analysis showed negative associations between total bilirubin concentration and risk of NAFLD in both FLI-NAFLD (OR: 0.94, 95% CI: 0.93, 0.95) and USFLI-NAFLD (OR: 0.95, 95% CI: 0.93, 0.96) groups when total bilirubin concentration was below the turning point (FLI-NAFLD: 18.81 μmol/L; USFLI-NAFLD: 15.39 μmol/L) and these associations were not significant when total bilirubin concentration was higher than the turning point. Furthermore, all-cause mortality decreased (OR: 0.97, 95%CI: 0.95, 1.00) with increased total bilirubin concentration up to the turning point (11.97 μmol/L), and then all-cause mortality increased with increasing total bilirubin concentration (OR: 1.03, 95%CI: 1.02, 1.04). Conclusions: We found that higher circulating total bilirubin concentration within the physiological range was associated with decreased risk of NAFLD and all-cause mortality among NAFLD patients.

Abstract Background The aim of this study is to evaluate cardiovascular and respiratory effects of intrathoracic pressure overshoot (higher than insufflation pressure) in patients who underwent thoracoscopic esophagectomy procedures with carbon dioxide (CO2) pneumothorax. Methods This prospective research included 200 patients who were scheduled for esophagectomy from August 2016 to July 2020. The patients were randomly divided into the Stryker insufflator (STR) group and the Storz insufflator (STO) group. We recorded the changes of intrathoracic pressure, peak airway pressure, blood pressure, heart rate and central venous pressure (CVP) during artificial pneumothorax. The differences in blood gas analysis, the administration of vasopressors and the recovery time were compared between the two groups. Results We found that during the artificial pneumothorax, intrathoracic pressure overshoot occurred in both the STR group (8.9 mmHg, 38 times per hour) and the STO group (9.8 mmHg, 32 times per hour). The recorded maximum intrathoracic pressures were up to 58 mmHg in the STR group and 51 mmHg in the STO group. The average duration of intrathoracic pressure overshoot was significantly longer in the STR group (5.3 ± 0.86 s) vs. the STO group (1.2 ± 0.31 s, P < 0.01). During intrathoracic pressure overshoot, a greater reduction in systolic blood pressure (SBP) (5.6 mmHg vs. 1.1 mmHg, P < 0.01), a higher elevation in airway peak pressure (4.8 ± 1.17 cmH2O vs. 0.9 ± 0.41 cmH2O, P < 0.01), and a larger increase in CVP (8.2 ± 2.86 cmH2O vs. 4.9 ± 2.35 cmH2O, P < 0.01) were observed in the STR group than in the STO group. Vasopressors were also applied more frequently in the STR group than in the STO group (68% vs. 43%, P < 0.01). The reduction of SBP caused by thoracic pressure overshoot was significantly correlated with the duration of overshoot (R = 0.76). No obvious correlation was found between the SBP reduction and the maximum pressure overshoot. Conclusions Intrathoracic pressure overshoot can occur during thoracoscopic surgery with artificial CO2 pneumothorax and may lead to cardiovascular adverse effects which highly depends on the duration of the pressure overshoot. Trial registration Clinicaltrials.gov ( NCT02330536 ; December 24, 2014).

Abstract Background Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery. Methods Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™. Results Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients. Conclusions The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists. Trial registration The trial was registered at the Chinese Clinical Trial Registry ( ChiCTR1800018300 , date of registration: September 2018).

Abstract The objective of this study was to propose a new method for facilitating needle-beam alignment ultrasound-guided in-plane catheterization of the subclavian vein (SCV). Three hundred patients were recruited, and ultrasound examination of the SCV was performed. Then, the patients were divided into two groups and SCV catheterization was performed: ultrasound-guided catheterization with the aiming method (group A) and ultrasound-guided catheterization with needle guide (group NG). The success rate, insertion time, number of skin breaks, number of needle redirections, needle visibility and rate of mechanical complications were documented and compared for each procedure. To depict the optimum long-axis view of the SCV, there was a 30° ± 7.3° angle (rotation) between the long axis of the ultrasound probe and the clavicle, while there was a 39° ± 7.4° angle (tilt) between the ultrasound beam plane and the right chest wall. The aiming method was associated with fewer skin breaks [(mean (IQR): 1 (1–1) times vs 1 (1–2) times, P = 0.009], a shorter time to cannulation [(mean (IQR): 39 (32–48.5) s vs 48 (44–54.8) s, P = 0.000] and more needle redirections [(mean (IQR): 0 (0–1) vs 0 (0–0), P = 0.000]. There were no differences between group A and group NG in the overall success rate, first puncture success rate, needle visibility or mechanical complication rate. In conclusion, during ultrasound-guided in-plane catheterization of the SCV, the aiming method provides comparable needle-beam alignment with a lower cannulation time than the needle guide technique.

Abstract The objective of this study was to identify the factors that complicate the needle visualization in ultrasound-guided in-plane needling procedures. Forty-nine residents were recruited and randomized to insert the simulated blood vessel with four different views including Neutral (the long axis of the probe along the visual axis and the ultrasonic beam vertical to the surface of gel phantom), 45°-rotation (45° angle between the long axis of probe and the operator’s visual axis), 45°-tilt (45° angle between the ultrasonic beam and the surface of gel phantom) and 45°-rotation plus 45°-tilt of probe. Number of needle redirections, insertion time, and needle visibility were documented and compared for each procedure. When the residents faced with 45°-tilt view, the needle redirections (2 vs 0) and insertion time increased significantly (39 vs 16) compared with that of the Neutral view. When faced with 45°-rotation plus 45°-tilt view, the residents’ performance decreased further as compared with that of the 45°-tilt view and the Neutral view. However, there was no performance difference between the Neutral view and 45°-rotation view. In conclusion, during ultrasound-guided in-plane procedures, tilting the ultrasound probe may increase the difficulty of needle-beam alignment.

Abstract Background A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. Main body The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. Conclusions The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.

Understanding the evolutionary patterns of real-world complex systems such as human interactions, biological interactions, transport networks, and computer networks is important for our daily lives. Predicting future links among the nodes in these dynamic networks has many practical implications. This research aims to enhance our understanding of the evolution of networks by formulating and solving the link-prediction problem for temporal networks using graph representation learning as an advanced machine learning approach. Learning useful representations of nodes in these networks provides greater predictive power with less computational complexity and facilitates the use of machine learning methods. Considering that existing models fail to consider the temporal dimensions of the networks, this research proposes a novel temporal network-embedding algorithm for graph representation learning. This algorithm generates low-dimensional features from large, high-dimensional networks to predict temporal patterns in dynamic networks. The proposed algorithm includes a new dynamic node-embedding algorithm that exploits the evolving nature of the networks by considering a simple three-layer graph neural network at each time step and extracting node orientation by using Given’s angle method. Our proposed temporal network-embedding algorithm, TempNodeEmb, is validated by comparing it to seven state-of-the-art benchmark network-embedding models. These models are applied to eight dynamic protein–protein interaction networks and three other real-world networks, including dynamic email networks, online college text message networks, and human real contact datasets. To improve our model, we have considered time encoding and proposed another extension to our model, TempNodeEmb++. The results show that our proposed models outperform the state-of-the-art models in most cases based on two evaluation metrics.

Background: This study aimed to explore the correlation between body mass index (BMI) and dyslipidemia and the optimal cut-off point for BMI to distinguish the risk of dyslipidemia in lactating women. Methods: A total of 2295 lactating women subjects were included in this study, all within 2 years postpartum. All samples were from “China Children and Lactating Mothers Nutritional Health Surveillance (2016–2017)”. BMI, blood lipids, demographic information, lifestyle habits, and other serum indicators were obtained in this survey. Generalized linear model, logistic regression, restricted cubic spline (RCS) and ROC curve analysis were used to evaluate the relationship among BMI, blood lipids, and dyslipidemia. Results: BMI in lactating women was positively correlated with total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), but negatively correlated with high-density lipoproteincholesterol (HDL-C) (p < 0.05). Higher BMI in lactating women was associated with higher ORs of dyslipidemia (hypercholesterolemia, hypertriglyceridemia, high-LDL-cholesterolemia, low HDL-cholesterolemia) (p < 0.05). These associations were stable across age groups, breastfeeding child age (months), parity, physical activity level, fasting plasma glucose (FPG), and hemoglobin. These factors did not interact with this relationship (p > 0.05). The optimal cut-off point for BMI was 24.85 kg/m2 determined by using ROC analysis, which can distinguish the risk of dyslipidemia. Conclusions: BMI was positively correlated with risk of dyslipidemia. Maintaining an ideal weight may prevent dyslipidemia in lactating women, and BMI is recommended to be controlled below 24.85 kg/m2.

Designing a material to realize the simultaneous improvement in strength and ductility is very meaningful to its industrial application. Here, the first-principles calculations based on density functional theory (DFT) were adopted to investigate the stability, elastic properties and Debye temperature of binary Cu–Cr alloys; and the effect of micro-alloying elements on their mechanical properties, including the bulk modulus B, shear modulus G, Yong’s modulus E and Poisson’s ratio σ, was discussed. The elastic constants show that all the studied binary Cu–Cr alloys are mechanically stable, and the Cu–0.7Cr alloy has a combination of good strength and ductility. Moreover, the addition of Ag, Sn, Nb, Ti and Zr can improve the basic properties of Cu–0.7Cr alloy, and the Cu–0.7Cr–1.1Sn possess a large strength combined with improved ductility and strong covalent bonds due to the large Debye temperature. Additionally, the introduction of Y and In further improves the mechanical properties (strength and ductility) of the excellent Cu–0.7Cr–1.1Sn alloy. Our studied results can provide guidance for the theoretical design and experimental improvement of Cu-based alloys.

Background Chronic alcohol intake is associated with an increased risk of alcoholic cardiomyopathy, which may present with pathological changes such as myocardial insulin resistance, leading to ventricular dilation and cardiac dysfunction. Although a correlation between microRNA-155 (miR-155) and insulin signaling has been identified, the underlying mechanism has not been elucidated to date. The purpose of the study was to determine whether overexpression of miR-155-5p in vivo could ameliorate chronic alcohol-induced myocardial insulin resistance and cardiac dysfunction. Material and Methods Wistar rats were fed with either alcohol or water for 20 weeks to establish chronic alcohol intakes model. Then the alcohol group were divided into three groups: model group, miRNA-155 group and AAV-NC group. Rats undergoing alcohol treatment were injected with AAV-miRNA-155 (adeno-associated virus 9) or its negative control AAV-NC, respectively. Gene expression was determined by real-time PCR, and protein expression was determined by western blot. Echocardiography was performed to assess terminal cardiac function. Insulin responsiveness was determined through the quantification of phosphorylated insulin receptor substrate 1 (ser 307) and phosphorylated insulin receptor (Tyr 1185) levels. Results We found that cardiac function was attenuated in chronic alcohol intake rats, with an activated mammalian target of rapamycin (mTOR) signaling pathway, accompanied by an increase in p-IRS1(ser 307) and a decrease in p-IR (Tyr 1185) level in myocardial tissue. Also, alcohol drinking significantly up-regulated miR-155-5p level and its overexpression decreased p-IRS1 (ser 307) and increased p-IR (Tyr 1185) levels, and meanwhile inhibited the mTOR signaling pathway. Conclusion miR-155-5p upregulation ameliorates myocardial insulin resistance via the mTOR signaling in chronic alcohol drinking rats. We propose that miR-155 may serve as a novel potential therapeutic target for alcoholic heart disease.

Twin T-graphene (TTG) is a new two-dimensional carbon allotrope of graphene. Heteroatom co-doping is an effective method for the modulation of the physical and chemical properties of two-dimensional materials. This study explored the structural stability, electronic structures, and optical properties of boron and phosphorus co-doped TTG using first-principles calculations. TTG was doped with B and P atoms (BP) at different positions considering 13 different configurations. Pristine TTG has a band gap of 1.89 eV, and all BP co-doped TTG (TTG/BP) systems remain semiconducting with band gaps that gradually decrease with increasing doping concentration. For a given doping concentration, the TTG/BP-ortho systems had a narrower band gap than the corresponding TTG/BP-para systems. The TTG and TTG/BP systems exhibited significant optical anisotropy. In the infrared region, BP co-doping increased the absorption coefficient, and the reflectance and refractive index increased with increasing doping concentration, except for the vertical component of the TTG/BP-ortho system. In the visible region, the absorption coefficient, reflectance, and refractive index decreased with increasing doping concentration for the vertical component, and the peaks were red-shifted from the near-ultraviolet region to the visible region. In the near-ultraviolet region, the reflectance also decreased with increasing doping concentration. The BP co-doping concentration can regulate the electronic structures and optical properties of the TTG, showing that the BP co-doped TTG has potential for application in nanoelectronics and optoelectronics.

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To boost the photocatalytic activity of NH2-UiO-66 toward CO2 under visible light, CdTe quantum dots and g-C3N4 nanocrystals were introduced to form NH2-UiO-66/g-C3N4/CdTe composites via a two-step synthetic strategy. g-C3N4 and CdTe in different visible light ranges possessed a strong absorption ability, and, thereby, greatly extended the range of photoresponsive wavelength of the composites. Mott-Schottky analysis revealed that the energy level of the conduction band of g-C3N4 and CdTe was higher than the LUMO level of NH2-UiO-66, benefiting for the photogenerated carriers separation and electron injection from g-C3N4 and CdTe to NH2-UiO-66, leading to a high concentrated Zr (iii) formation. Finally, the NH2-UiO-66/g-C3N4/CdTe composites exhibited the superior photocatalytic performance for CO2 conversion in the acetonitrile/ethanol system upon visible light irradiation (≥400 nm) with a HCOOH generation rate of 24.6 µmol g−1 h−1 that was ∼7.5 times higher than that of NH2-UiO-66 alone.

This work reports the results of our investigation of the structure and mechanical properties of physical vapor deposition (PVD) and chemical vapor deposition (CVD) TiAlSiN coatings deposited on cemented carbide substrates. For the first time, a novel nanocomposite of Ti0.13Al0.85Si0.02N coating deposited from TiCl4-AlCl3-SiCl4-NH3-H2 gas precursors was prepared by low pressure chemical vapor deposition (LPCVD) at 780 °C and a pressure of 60 mbar, while PVD Ti0.31Al0.60Si0.09N coating was prepared using the arc ion plating method. The investigation results including morphology, microstructure, chemical composition, phase component, and hardness were carried out by scanning electron microscopy (SEM) equipped with energy dispersive spectrometer (EDS), transmission electron microscopy (TEM), X-ray diffraction (XRD), and nano-indentator. TEM results revealed that both PVD and CVD TiAlSiN coatings consisted of nanocrystalline embedded in SiNx amorphous. The nanohardness of CVD Ti0.13Al0.85Si0.02N coating obtained in this work was 31.7 ± 1.4 GPa, which was 35% higher than that of the PVD Ti0.31Al0.60Si0.09N coating.

It is unknown whether autophagy activity is altered in insulin resistant podocytes and whether autophagy could be a therapeutic target for diabetic nephropathy (DN). Here we used shRNA transfection to knockdown the insulin receptor (IR) gene in cultured human immortalized podocytes as an in vitro insulin resistant model. Autophagy related proteins LC3, Beclin, and p62 as well as nephrin, a podocyte injury marker, were assessed using western blot and immunofluorescence staining. Our results show that autophagy is suppressed when podocytes lose insulin sensitivity and that treatment of rapamycin, an mTOR specific inhibitor, could attenuate insulin resistance induced podocytes injury via autophagy activation. The present study deepens our understanding of the role of autophagy in the pathogenesis of DN.

BACKGROUND:Antiplatelet agents are commonly used for cardiovascular diseases, but their pleiotropic effects in critically ill patients are controversial. We therefore performed a meta-analysis of cohort studies to investigate the effect of antiplatelet therapy in the critically ill. METHODS:Nine cohort studies, retrieved from PubMed and Embase before November 2015, involving 14,612 critically ill patients and 4765 cases of antiplatelet users, were meta-analysed. The main outcome was hospital or 30-day mortality. Secondary outcome was acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). Random- or fixed-effect models were taken for quantitative synthesis of the data. RESULTS:Antiplatelet therapy was associated with decreased mortality (odds ratio (OR) 0.61; 95% confidence interval (CI), 0.52-0.71; I2 = 0%; P

This article discusses the development of a new electrocatalyst, Cu/N-pg-C, for the reduction of CO2 to syngas. The Cu nanoclusters loaded on N-doped porous graphitic carbon showed high selectivity for CO generation. The electrocatalyst demonstrated tunable molar ratios of H2 to CO and exhibited high performance in generating syngas. The study explored different synthetic strategies and Cu loading percentages, and found that Cu/N-pg-C had higher electrocatalytic activity compared to N-pg-C. The article proposes a mechanism for the generation of syngas and highlights the potential of Cu/N-pg-C as an efficient electrocatalyst for sustainable production of syngas from CO2. [Extracted from the article]