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This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.
Methods
In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.
Results
Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.
Conclusions
Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.
Femtosecond oscillators with gigahertz (GHz) repetition rate are appealing sources for spectroscopic applications benefiting from the individually accessible and high-power comb line. The mode mismatch between the potent pump laser diode (LD) and the incredibly small laser cavity, however, limits the average output power of existing GHz Kerr-lens mode-locked (KLM) oscillators to tens of milliwatts. Here, we present a novel method that solves the difficulty and permits high average power LD-pumped KLM oscillators at GHz repetition rate. We propose a numerical simulation method to guide the realization of Kerr-lens mode-locking and comprehend the dynamics of the Kerr-lens mode-locking process. As a proof-of-principle demonstration, an LD-pumped Yb:KGW oscillator with up to 6.17-W average power and 184-fs pulse duration at 1.6-GHz repetition rate is conducted. The simulation had a good agreement with the experimental results. The cost-effective, compact and powerful laser source opens up new possibilities for research and industrial applications.
Revealing the impact of forest succession processes on changes in plant diversity is crucial for understanding the mechanisms that maintain plant diversity across various succession stages. While previous research has predominantly focused on the influence of environmental factors or management strategies on plant diversity within rubber plantation understories, there is a scarcity of studies examining the effects of forest succession processes on plant diversity. This study focuses on the plant diversity of the understory herbaceous layer within the rubber forest of the Yinggeling area, located in National Park of Hainan Tropical Rainforest. It employs a spatial analysis approach, rather than a temporal one, to examine the characteristics of the understory herbaceous community. The findings revealed that (1) The understory of Yinggeling rubber plantations harbors 175 plant species from 149 genera and 75 families, with Gramineae and Rubiaceae representing 46.45% of total species. And the dominant families are Rubiaceae, Gramineae, and Moraceae, with Ficus and Pteris being the dominant genera. (2) The dominant species vary with succession duration, with Tetrastigma pachyphyllum dominating in 0-year succession, Paspalum conjugatum in 3-year succession, and Microstegium fasciculatum in 7-year succession. (3) Diversity indices such as the Shannon–Wiener index, Simpson index, and Pielou index peak at 7 years of natural succession, while the species richness is highest at 3 years. (4) The similarity coefficient between understory herbaceous plant communities in rubber plantations undergoing 0 and 3 years of natural succession is highest 0.56, indicating a significant similarity, while similarity is lowest between 0 and 7 years of succession. This research shows that natural restoration helps increase species diversity in the understory herb layer of rubber forests. Succession leads to changes in the dominant families, genera, and species of the herbaceous layer. This change can be attributed to the intraspecific competition and ecological competition that occur during the succession process, leading to changes in biological and resource allocation.
Decimetre-scale carbonaceous macrofossils from the Mesoproterozoic Gaoyuzhuang Formation in the Yanshan Range are known as the current oldest unambiguous evidence of macroscopic multicellular eukaryotes. Here, we reported a new SIMS zircon age of 1588.8 ± 6.5 Ma from a volcanic tuff in the Qianxi County of Hebei Province, about 11 m above the macrofossil’s horizon. This new age provides a direct age constraint on the macroscopic eukaryotic fossils from the Gaoyuzhuang Formation. It indicates that macroscopic life with the moderate diversity and certain morphological complexity had already evolved at the beginning of the Mesoproterozoic, and implies a possibility of discovering macroscopic eukaryotes in earlier rocks. This study also calls for a stratigraphic framework to integrate biological and environmental studies in different regions for a better understanding of the evolution of multicellular organisms and environmental change during this important period.
Based on 30 high-resolution U-Th dating controls, we reconstruct stalagmite δ18O records from 45 to 15 thousand years ago (ka B.P., before AD 1950) from the Shizhu Cave, which is located in southwestern China under the influence of both the Indian Summer Monsoon (ISM) and the East Asian Summer Monsoon (EASM). By integrating with the other stalagmite δ18O records in Asia during the middle to late last glacial, our results reveal two main moisture trajectories: one from the Indian Ocean, through the Shizhu Cave towards central China, and the other from the Pacific Ocean to central and northern China. The systematic decrease of the average values of stalagmite δ18O records from oceans to inland China reveals a spatial pattern of water vapour fractionation and moisture trajectory during the middle to late last glacial. In contrast, the variation amplitude, which is defined as the departures apart from the background δ18O records during Heinrich stadials 1 to 4 (HS1–HS4), show an increasing trend from the coastal oceans to mid-latitude inland China, presenting a ‘coastal-inland’ pattern, which can be interpreted by the enhanced East Asian Winter Monsoon (EAWM) and the weakened EASM. More specifically, the enriched stalagmite δ18O records in the EASM region during HS1 to HS4 are caused by the decreased summer rainfall amount or/and the increased proportion of summer moisture resources from the Pacific Ocean. These new observations deepen our understanding of the complicated stalagmite δ18O records in the EASM region.
Schistosomiasis, a parasite infectious disease caused by Schistosoma japonicum, often leads to egg granuloma and fibrosis due to the inflammatory reaction triggered by egg antigens released in the host liver. This study focuses on the role of the egg antigens CP1412 protein of S. japonicum (SjCP1412) with RNase activity in promoting liver fibrosis. In this study, the recombinant egg ribonuclease SjCP1412, which had RNase activity, was successfully prepared. By analysing the serum of the population, it has been proven that the anti-SjCP1412 IgG in the serum of patients with advanced schistosomiasis was moderately correlated with liver fibrosis, and SjCP1412 may be an important antigen associated with liver fibrosis in schistosomiasis. In vitro, the rSjCP1412 protein induced the human liver cancer cell line Hep G2 and liver sinusoidal endothelial cells apoptosis and necrosis and the release of proinflammatory damage-associated molecular patterns (DAMPs). In mice infected with schistosomes, rSjCP1412 immunization or antibody neutralization of SjCP1412 activity significantly reduced cell apoptosis and necroptosis in liver tissue, thereby reducing inflammation and liver fibrosis. In summary, the SjCP1412 protein plays a crucial role in promoting liver fibrosis during schistosomiasis through mediating the liver cells apoptosis and necroptosis to release DAMPs inducing an inflammatory reaction. Blocking SjCP1412 activity could inhibit its proapoptotic and necrotic effects and alleviate hepatic fibrosis. These findings suggest that SjCP1412 may be served as a promising drug target for managing liver fibrosis in schistosomiasis japonica.
A steady granular flow experiment was performed in a confined annular shear cell to examine how the wall friction coefficient $\mu _w$ degrades from the intrinsic sliding friction coefficient $f$ between the grains and the container wall. Two existing models are invoked to examine the decay trend of $\mu _w/f$ in view of the ratio of shear velocity to the square root of granular temperature $\chi$ (Artoni & Richard, Phys. Rev. Lett., vol. 115, 2015, 158001) and the ratio of grain angular and slip velocities $\varOmega$ (Yang & Huang, Granul. Matt., vol. 18, issue 4, 2016, p. 77), respectively. As both models correlate $\mu _w/f$ to different flow properties, a hidden relation is speculated between $\chi$ and $\varOmega$, or equivalently, between the granular temperature and the grain rotation speed. We used experiment data to confirm and reveal this hidden relation. From there, a unified $\mu _w/f-\chi$ model is proposed with physical meanings for the model coefficients and to show general agreement with the measured trend. Hence we may conclude that both the fluctuations in grain translations and their mean rotation are the crucial yet equivalent mechanisms to degrade $\mu _w/f$.
The development of high-brightness X-ray free electron lasers (XFELs), such as hard X-ray self-seeding free electron lasers and XFEL oscillators (XFELOs), brings a severe challenge to the crystal monochromator due to a strong non-uniform thermal load. The distortion caused by spatial temperature gradients can severely affect the optical performance of crystals. Therefore, this paper presents a model to estimate the performance of non-uniform thermally distorted crystals. The model not only takes into account thermal strain, slope error and incident angle deviation, but also considers temperature-dependent factors such as the Debye–Waller factor and electric susceptibility. Our investigation indicates that the Debye–Waller factor reduces the height and bandwidth of rocking curves, and the impact of the electric susceptibility is tiny. The proposed model can describe the distortion of the reflectivity and transmissivity curves of non-uniform thermally loaded crystals and can be applied in the design of crystal monochromators, crystal splitters, crystal compressors and XFELOs.
The transport phenomena of dust particles have been widely observed in fusion plasmas. In this article, we report the observations of dust fragmentations in the Experimental Advanced Superconducting Tokamak (EAST). A dust particle splits into two daughter particles and their motions are recorded before and after the breakup with a fast video camera. The trajectories of the daughter particles in the experiment are consistent with equation-of-motion simulations. The stability of a rotating charged particle in the plasma is briefly discussed.
Lower-crust-derived adakitic rocks in the Gangdese belt provide important constraints on the timing of Tibetan crustal thickening and on the relative contributions of magmatic and tectonic processes. Here we present geochronological and geochemical data for the Wangdui porphyritic monzogranites in the western Gangdese belt. Zircon U–Pb dating yields emplacement ages of 46–44 Ma. All samples have high Sr (321–599 ppm), low Yb (0.76–1.33 ppm) and Y (10.6–18.3 ppm) contents, with high La/Yb (51.1–72.3) and Sr/Y (21.0–51.4) ratios, indicating adakitic affinities. The low MgO (0.97–1.76 wt %), Cr (7.49–53.6 ppm) and Ni (4.75–29.1 ppm) contents, as well as high 87Sr/86Sr(i) (0.7143–0.7145), low ϵNd(t) (−10.4 to −9.8) and zircon ϵHf(t) (−17.7 to 0.4) values, suggest that the Wangdui pluton most likely originated from partial melting of the thickened ancient lower crust. In combination with previously published data, despite the east–west-trending heterogeneity of crustal composition in the Gangdese belt, the La/Yb ratios of magmatic rocks reveal that both western and eastern segments experienced remarkable crustal thickening in the Eocene. However, in contrast to the thickened juvenile lower crust in the eastern segment formed by the underplating of mantle-derived magmas, tectonic shortening plays a more crucial role in thickening of the ancient basement in western Gangdese. In fact, such Eocene-thickened ancient lower-crust-derived adakitic rocks are widely distributed in the central Himalayan–Tibetan orogen. This, together with the extensive development of fold–thrust belts, suggests that tectonic shortening might be the main mechanism accounting for the crustal thickening associated with the India–Asia collision.
We consider inverse nodal problems for the Sturm–Liouville operators on the tree graphs. Can only dense nodes distinguish the tree graphs? In this paper it is shown that the data of dense-nodes uniquely determines the potential (up to a constant) on the tree graphs. This provides interesting results for an open question implied in the paper.
The risk of antipsychotic-associated cardiovascular and metabolic events may differ among countries, and limited real-world evidence has been available comparing the corresponding risks among children and young adults. We, therefore, evaluated the risks of cardiovascular and metabolic events in children and young adults receiving antipsychotics.
Methods
We conducted a multinational self-controlled case series (SCCS) study and included patients aged 6–30 years old who had both exposure to antipsychotics and study outcomes from four nationwide databases of Taiwan (2004–2012), Korea (2010–2016), Hong Kong (2001–2014) and the UK (1997–2016) that covers a total of approximately 100 million individuals. We investigated three antipsychotics exposure windows (i.e., 90 days pre-exposure, 1–30 days, 30–90 days and 90 + days of exposure). The outcomes were cardiovascular events (stroke, ischaemic heart disease and acute myocardial infarction), or metabolic events (hypertension, type 2 diabetes mellitus and dyslipidaemia).
Results
We included a total of 48 515 individuals in the SCCS analysis. We found an increased risk of metabolic events only in the risk window with more than 90-day exposure, with a pooled IRR of 1.29 (95% CI 1.20–1.38). The pooled IRR was 0.98 (0.90–1.06) for 1–30 days and 0.88 (0.76–1.02) for 31–90 days. We found no association in any exposure window for cardiovascular events. The pooled IRR was 1.86 (0.74–4.64) for 1–30 days, 1.35 (0.74–2.47) for 31–90 days and 1.29 (0.98–1.70) for 90 + days.
Conclusions
Long-term exposure to antipsychotics was associated with an increased risk of metabolic events but did not trigger cardiovascular events in children and young adults.
To analyse the changes of different ventilation on regional cerebral oxygen saturation and cerebral blood flow in infants during ventricular septal defect repair.
Methods:
Ninety-two infants younger than 1 year were enrolled in the study. End-expiratory tidal pressure of carbon dioxide was maintained at 40–45 and 35–39 mmHg in relative low and high ventilation groups. Regional cerebral oxygen saturation and flow velocity of the middle cerebral artery were recorded after anaesthesia (T0), cut pericardium (T1), separation from cardiopulmonary bypass (T2), the end of modified ultrafiltration, (T3) and at the end of operation (T4).
Results:
The relative low ventilation group exhibited a significantly high regional cerebral oxygen saturation at each time point except for T2 (T0:77 ± 4, T1:76 ± 5, T3:76 ± 8, T4:76 ± 8, respectively, p < 0.001). Flow velocity of the middle cerebral artery in the relative low ventilation group was higher compared to the relative high ventilation group at each time point except for T2 (T0:53 ± 14, T1:54 ± 15, T3:53 ± 17, T4:52 ± 16, respectively, p < 0.001). Between the two groups, T2 showed the lowest middle cerebral artery flow velocity (relative low ventilation: 39 ± 15, relative high ventilation: 39 ± 11, p < 0.001).
Conclusion:
The infants’ regional cerebral oxygen saturation and middle cerebral artery flow velocity performed better in the range of 40–45 mmHg end-expiratory tidal pressure of carbon dioxide during CHD surgery. Modified ultrafiltration increased cerebral oxygen saturation. It was important to regulate ventilation in order to balance cerebral oxygen in infants.