Search

Jin-Jin Yang,1,2 Lei Lei,1,2 Di Qiu,1 Sai Chen,1 Li-Ka Xing,1 Jing-Wei Zhao,1 Yuan-Yuan Mao,1,2 Jian-Jun Yang1,2 1Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, People’s Republic of ChinaCorrespondence: Jian-Jun Yang, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, People’s Republic of China, Tel +8613783537619, Email yjyangjj@126.comBackground: Postoperative delirium is common in older adult patients and associated with a poor prognosis. The use of benzodiazepine was identified as an independent risk factor for delirium, but there is no randomized controlled trial regarding the relationship between remimazolam, a new ultra-short acting benzodiazepine, and postoperative delirium. We designed a randomized controlled trial to evaluate if remimazolam increases the incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery with general anesthesia.Patients and Methods: We enrolled 320 patients aged more than 60 with American Society of Anesthesiologists physical status I–III who underwent orthopedic surgery. Patients were randomized to two groups to receive intraoperative remimazolam or propofol, respectively. Our primary outcome was the incidence of delirium within 3 days after surgery. Secondary outcome was emergence quality including the incidence of emergence agitation, extubation time, and length of post-anesthesia care unit (PACU) stay. Adverse events were also recorded.Results: The incidence of postoperative delirium was 15.6% in the remimazolam group and 12.4% in the propofol group (Risk ratio, 1.26; 95% CI, 0.72 to 2.21; Risk difference, 3.2%; 95% CI, − 4.7% to 11.2%; P = 0.42). No significant differences were observed for time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in remimazolam group had a lower incidence of hypotension after induction and consumed less vasoactive drugs intraoperatively, but had a longer postoperative extubation time and PACU stay.Conclusion: General anesthesia with remimazolam was not associated with an increased incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery.Keywords: benzodiazepines, delirium, older adults, orthopedic surgery, propofol, remimazolam

Weiya Li,1,&ast; Di Qiu,2,&ast; Han Yin,1 Yu Wang,1 Yilin Chen,3 Quanjun Liu,3 Huan Ma,1 Qingshan Geng1,3 1Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 2Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 3School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qingshan Geng, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China, Tel +86 20 83827812, Email gengqingshan@gdph.org.cnPurpose: Patients with the comorbidity of coronary artery disease (CAD) and depression are very common and always have poor prognosis. The relationship between thyroid-stimulating hormone (TSH) levels and major cardiovascular event (MACE) in these patients is still unknown. We aimed to explore this association.Patients and Methods: We enrolled 203 CAD patients proven by coronary angiography (CAG). In the meanwhile, they were all assessed to have depression symptom by professional psycho-cardiologists. After an average follow-up of 23.7 months, patients were divided into two groups (high TSH group with TSH ≥ 1.395μIU/mL and low TSH group with TSH < 1.395μIU/mL) according to the cut-off value of baseline TSH. The impact of two different TSH groups for adverse events in CAD patients with depression was evaluated.Results: The average age of these patients was 64.9 years old. The two TSH groups had no significant difference in the comparison of other baseline data. Area under the receiver operating characteristic (ROC) curves (AUC) analysis indicated the well-discriminatory power of TSH levels for the occurrence of MACE (AUC = 0.61, 95% CI: 0.52– 0.70, P = 0.03). In the KM survival analysis, high TSH group had a higher risk of MACE (P = 0.029). After multi-factor adjustment, there still existed a higher risk of MACE in high TSH group (HR = 2.05, 95% CI: 1.08– 3.88, P = 0.028).Conclusion: In patients with the comorbidity of CAD and depression, higher TSH levels are associated with the occurrence of MACE. More researches need to be conducted to prove this association and explore whether the drug-related TSH reduction can decrease the occurrence of adverse events in the future.Keywords: thyroid-stimulating hormone, TSH, coronary artery disease, CAD, depression, MACE

Dandan Qiu,1 Yan Zhu,1 Zhicheng Cong2 1Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Urology, Zhejiang Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Zhicheng CongDepartment of Urology, Zhejiang Hospital, Hangzhou 310013 Zhejiang Province, People’s Republic of ChinaEmail cz111aybzz8@126.comBackground: The transcriptional regulator YAP is frequently overexpressed in human cancers, such as breast and pancreatic cancers, plays an important role in tumorigenesis and can regulate many factors affecting cancer progression. These observations encouraged us to investigate the effect of YAP expression on bladder cancer.Methods: The changes in multiple cellular functions associated with tumor progression including cell proliferation, cell migration, cell cycle, and cell apoptosis were assessed after YAP knockdown/overexpression in bladder cancer cell lines. Additionally, Western blot was developed to verify the change of proteins caused by YAP knockdown/overexpression.Results: YAP had relatively higher expression in bladder cancer tissues than in normal tissues. The proliferation and migration of bladder cancer cells were inhibited by YAP knockdown but were promoted by its overexpression. This promoting effect was accompanied by the increased activity of MAPK/ERK pathway.Conclusion: Our data established that YAP is an oncogene involved in bladder cancer and thus can be a potential target for treatment.Keywords: bladder cancer, proliferation, migration, MAPK/ERK pathway

Yongjian Yang, Dahai Qiu, Yajun Liu, Lei Chao Department of Anesthesiology, Jinan Central Hospital Affiliated to Shandong University, Ji’nan, Shandong Province 250013, People’s Republic of ChinaCorrespondence: Lei ChaoDepartment of Anesthesiology, Jinan Central Hospital Affiliated to Shandong University, No. 105 Jiefang Road, Ji’nan, Shandong Province 250013, People’s Republic of ChinaTel +86 05 318 569 5114Email leichaojncp@outlook.comPurpose: Hyaluronic acid-poly(ethylene glycol)-distearoyl phosphoethanolamine (HA-PEG-DSPE) modified and tocopheryl polyethylene glycol 1000 succinate (TPGS) contained nanostructured lipid carriers (NLCs) were prepared loading ropivacaine and dexmedetomidine to improve the topical anesthetic analgesic anesthesia efficiency.Methods: NLCs were prepared by the solvent diffusion method. The average particle size, zeta potential, release behavior, and cytotoxicity of the NLCs were tested. Ex vivo skin permeation was studied using a Franz diffusion cell mounted with depilated rat skin. Local anesthesia antinociceptive efficiency was evaluated by rat tail flick latency study in vivo.Results: NLCs have sizes of about 100 nm, with negative zeta potentials. All the NLCs formulations were found to be significantly less cytotoxic than free drugs at equivalent concentrations. The cumulative amount of drugs penetrated through rat skin from NLCs was 2.0–4.7 folds higher than that of the drugs solution. The in vivo anesthesia antinociception study displayed that NLCs showed stronger and longer anesthesia antinociceptive effect when compared with single drugs loaded NLCs and drugs solution even at a lower dosage of drugs.Conclusion: The results demonstrated that the HA modified, TPGS contained, dual drugs loaded NLCs could perform a synergistic effect and may reduce the amount of drugs, which can lower the toxicity of the system and at the meanwhile, increase the anesthesia antinociceptive efficiency.Keywords: topical anesthetic analgesic, skin penetration, hyaluronic acid, long-acting nanostructured lipid carriers, tocopheryl polyethylene glycol 1000 succinate

Fu Jin,1 Huan-Li Luo,1 Juan Zhou,2 Ya-Nan He,1 Xian-Feng Liu,1 Ming-Song Zhong,1 Han Yang,1 Chao Li,1 Qi-Cheng Li,1 Xia Huang,1 Xiu-Mei Tian,1 Da Qiu,1 Guang-Lei He,1 Li Yin,1 Ying Wang1 1Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China; 2Forensic Identification Center, College of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, People’s Republic of China Abstract: Modern radiotherapy (RT) is being enriched by big digital data and intensive technology. Multimodality image registration, intelligence-guided planning, real-time tracking, image-guided RT (IGRT), and automatic follow-up surveys are the products of the digital era. Enormous digital data are created in the process of treatment, including benefits and risks. Generally, decision making in RT tries to balance these two aspects, which is based on the archival and retrieving of data from various platforms. However, modern risk-based analysis shows that many errors that occur in radiation oncology are due to failures in workflow. These errors can lead to imbalance between benefits and risks. In addition, the exact mechanism and dose–response relationship for radiation-induced malignancy are not well understood. The cancer risk in modern RT workflow continues to be a problem. Therefore, in this review, we develop risk assessments based on our current knowledge of IGRT and provide strategies for cancer risk reduction. Artificial intelligence (AI) such as machine learning is also discussed because big data are transforming RT via AI. Keywords: cancer risk, radiotherapy, workflow, big data

Wenyong Tan,1,* Liying Xu,2,* Xiaohong Wang,1 Dasheng Qiu,3 Guang Han,1 Desheng Hu1 1Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, People’s Republic of China; 2Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China; 3PET-CT Center, Hubei Cancer Hospital, Wuhan, People’s Republic of China *These authors have contributed equally to this paper Purpose: The aim of this study was to quantify the displacement of cardiac substructures, including the anterior myocardial territory (AMT), left ventricle, and coronary arteries during a normal cardiac cycle. Materials and methods: Computed tomography (CT) images with retrospective electrocardiographic gating of 17 eligible patients were obtained. All images were reconstructed automatically for the end-diastolic and end-systolic phases. CT scanning without contrast at a random phase and a selected vertebral body were used as references to measure three-dimensionaldisplacements of the cardiac substructures. Results: The displacement between the end-diastolic and end-systolic phases (Dd-s) was greater than that between the end-systolic and random phases and between the end-diastolic and random cardiac phases. The largest displacements for the heart were in the left, posterior, and inferior directions with an average Dd-s of approximately 4–6 mm. The average Dd-s for the AMT and left ventricle was 1.2–2.7 mm in the anterior and right directions, 4.3–7.8 mm in left and posterior directions, and 4.9–6.3 mm in superior and inferior directions. For the coronary arteries, the average Dd-s was 2.8–5.9 mm in the anterior-posterior direction, 3.5–6.6 mm in left-right direction, and 3.8–5.3 mm in the superior-inferior direction. Inter-observer agreement was excellent for the heart, AMT, and left ventricle (kappa coefficient, >0.75 for all) and good for most coronary arteries in three dimensions (kappa coefficient, 0.511–0.687). The Dd-s did not differ significantly between men and women. Conclusion: Most average displacements of the cardiac substructures and coronary arteries were 3–8 mm in three dimensions. These findings will be useful to accurately estimate the radiation dose to cardiac substructures during thoracic radiation and to evaluate the risk of radiation-related heart disease. Keywords: coronary artery, organ motion/displacement, radiotherapy, heart disease

Context. Heat stress is an increasing concern for the Australian dairy industry. Aims. This study aimed to evaluate the effect of temperature-humidity index (THI) on rumination time (RT), milk yield and quality, and milking frequency in a pasture-based voluntary-movement automatic milking system (AMS). Methods. Data were collected from the University of Melbourne Dookie College AMS farm for 3 years (June 2016 to March 2019). Daily RT was collected through the transponder collar (Qwes-HR, Lely). Climatic data (maximumambient temperature and relative humidity) were obtained fromthe Dookie Meteorological station to calculate daily maximumTHI (THImax). Key results. Daily milk yield increased with a rising THImax to 65, then declined after THImax 65. Milking frequency was highest at THImax 90, followed by a steady decline afterwards. Rumination time was maximum at mid-range THImax and declined for high and low values. Conclusions. The findings of this study clearly indicated that under pasture-based voluntary-movement AMS, high THI resulted in a drop in the milk yield, milking frequency and RT. Implications. With the provision of automation of data collection from AMS, further study with mathematical modelling describing the daily patterns and thresholds in conjunction with the different heat stress levels can be useful for assessing animal welfare and to mitigate heat stress and seek alternative management strategies. [ABSTRACT FROM AUTHOR]

Re-emergence of schistosomiasis in regions of China where control programs have ceased requires development of molecular-genetic tools to track gene flow and assess genetic diversity of Schistosoma populations. We identified many microsatellite loci in the draft genome of Schistosoma japonicum using defined search criteria and selected a subset for further analysis. From an initial panel of 50 loci, 20 new microsatellites were selected for eventual optimization and application to a panel of worms from endemic areas. All but one of the selected microsatellites contain simple tri-nucleotide repeats. Moderate to high levels of polymorphism were detected. Numbers of alleles ranged from 6 to 14 and observed heterozygosity was always >0.6. The loci reported here will facilitate high resolution population-genetic studies on schistosomes in re-emergent foci. © 2011 Xiao et al; licensee BioMed Central Ltd.

Respiratory versatility and psychrophily are the hallmarks of Shewanella. The ability to utilize a wide range of electron acceptors for respiration is due to the large number of c-type cytochrome genes present in the genome of Shewanella strains. More recently the dissimilatory metal reduction of Shewanella species has been extensively and intensively studied for potential applications in the bioremediation of radioactive wastes of groundwater and subsurface environments. Multiple Shewanella genome sequences are now available in the public databases (Fredrickson et al., 2008). Most of the sequenced Shewanella strains were isolated from marine environments and this genus was believed to be of marine origin (Hau and Gralnick, 2007). However, the well-characterized model strain, S. oneidensis MR-1, was isolated from the freshwater lake sediment of Lake Oneida, New York (Myers and Nealson, 1988) and similar bacteria have also been isolated from other freshwater environments (Venkateswaran et al., 1999). Here we comparatively analyzed the genome sequence and physiological characteristics of S. putrefaciens W3-18-1 and S. oneidensis MR-1, isolated from the marine and freshwater lake sediments, respectively. The anaerobic respirations, carbon source utilization, and cell motility have been experimentally investigated. Large scale horizontal gene transfers have been revealed and the genetic divergence between these two strains was considered to be critical to the bacterial adaptation to specific habitats, freshwater or marine sediments.

Abstract The diagnosis of early prostate cancer depends on the accurate segmentation of prostate regions in magnetic resonance imaging (MRI). However, this segmentation task is challenging due to the particularities of prostate MR images themselves and the limitations of existing methods. To address these issues, we propose a U-shaped encoder-decoder network MM-UNet based on Mamba and CNN for prostate segmentation in MR images. Specifically, we first proposed an adaptive feature fusion module based on channel attention guidance to achieve effective fusion between adjacent hierarchical features and suppress the interference of background noise. Secondly, we propose a global context-aware module based on Mamba, which has strong long-range modeling capabilities and linear complexity, to capture global context information in images. Finally, we propose a multi-scale anisotropic convolution module based on the principle of parallel multi-scale anisotropic convolution blocks and 3D convolution decomposition. Experimental results on two public prostate MR image segmentation datasets demonstrate that the proposed method outperforms competing models in terms of prostate segmentation performance and achieves state-of-the-art performance. In future work, we intend to enhance the model's robustness and extend its applicability to additional medical image segmentation tasks.

With the large-scale integration of renewable energy， distribution networks are faced with frequent voltage limit violations. In response to this challenge， it is urgent to study whether new voltage regulation measures， represented by photovoltaic inverters， can meet the daily voltage regulation needs of distribution networks. To objectively evaluate the adaptability of voltage regulation measures in distribution systems， a method based on interval and probability power flow analysis is proposed. This method enables a comprehensive analysis of voltage regulation effectiveness and cost. Firstly， based on the results of interval and probability power flow， indicators for voltage regulation effectiveness evaluation in distribution networks are constructed. Secondly， the corresponding cost of the optimal reactive power scheme is used as the cost benchmark value to construct the evaluation index of the voltage regulation cost of the distribution network. On this basis， the analytic hierarchy process （AHP） is employed to weight the effectiveness and cost indicators and thus establish a comprehensive evaluation indicator system for voltage regulation adaptability in distribution network. Finally， based on the constructed evaluation indicators， adaptability analysis of voltage regulation measures in distribution networks is conducted. The rationality of the proposed method is validated through comparative evaluations under multiple scenarios.