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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.
This paper focuses on the wave inverse cascade instability analysis with self-regulating feedback control for a fixed external potential field and a highly localized finite-amplitude initial pulse. The wave inverse cascade instability analysis is carried out by solving the corresponding two-dimensional generalized nonlinear Schrödinger equation. The wave field firstly suffers from the modulation instability, followed by collapse into turbulence containing the shortest-wavelength modes in the system. This is followed by inverse cascade of the shortest wavelength modes back to the longer-wavelength ones, until a statistical stationary turbulent state is reached. It is found that the inverse cascade is limited to the shorter-wavelength modes with the wavenumber $\left |k\right |\geq 100$. This shows that the viscous damping $p_i$ acts like a control switch to the inverse cascade, and the feedback control can also regulate the intensity of the inverse cascade mode.
Iodine is a vital trace element in the human body and is associated with several important coronary artery disease (CAD) risk factors. We aimed to explore the correlation between urinary iodine concentration (UIC) and CAD. Data from 15 793 US adults in the National Health and Nutrition Examination Survey (2003–2018) were analysed. We conducted multivariable logistic regression models and fitted smoothing curves to study the correlation between UIC and CAD. Furthermore, we performed subgroup analysis to investigate possible effect modifiers between them. We found a J-shaped association between UIC and CAD, with an inflection point at Lg UIC = 2·65 μg/l. This result indicated a neutral association (OR 0·89; 95 % CI 0·68, 1·16) between UIC and CAD as Lg UIC < 2·65 μg/l, but the per natural Lg [UIC] increment was OR 2·29; 95 % CI 1·53, 3·43 as Lg UIC ≥ 2·65 μg/l. An interaction between diabetes and UIC might exist. The increase in UIC results in an increase in CAD prevalence (OR 1·84, 95 % CI 1·32, 2·58) in diabetes but results in little to no difference in non-diabetes (OR 0·98, 95 % CI 0·77, 1·25). The J-shaped correlation between UIC and CAD and the interaction between diabetes and UIC should be confirmed in a prospective study with a series of UIC measurements. If excessive iodine precedes CAD, then this new finding could guide clinical practice and prevent iodine deficiency from being overcorrected.
Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care.
Methods
This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother–infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap.
Results
Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = −4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93–4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03–5.04). Participants reported improvements in mother–infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone.
Conclusions
One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother–infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.
Water fountains (WFs) are thought to represent an early stage in the morphological evolution of circumstellar envelopes surrounding low- and intermediate-mass evolved stars. These objects are considered to transition from spherical to asymmetric shapes. Despite their potential importance in this transformation process of evolved stars, there are only a few known examples. To identify new WF candidates, we used databases of circumstellar OH (1612 MHz) and H2O (22.235 GHz) maser sources, and compared the velocity ranges of the two maser lines. Finally, 41 sources were found to have a velocity range for the H2O maser line that exceeded that of the OH maser line. Excluding known planetary nebulae and after reviewing the maser spectra in the original literature, we found for 11 sources the exceedance as significant, qualifying them as new WF candidates.
The subduction model of the Neo-Tethys during the Early Cretaceous has always been a controversial topic, and the scarcity of Early Cretaceous magmatic rocks in the southern part of the Gangdese batholith is the main cause of this debate. To address this issue, this article presents new zircon U–Pb chronology, zircon Hf isotope, whole-rock geochemistry and Sr–Nd isotope data for the Early Cretaceous quartz diorite dykes with adakite affinity in Liuqiong, Gongga. Zircon U–Pb dating of three samples yielded ages of c. 141–137 Ma, indicating that the Liuqiong quartz diorite was emplaced in the Early Cretaceous. The whole-rock geochemical analysis shows that the Liuqiong quartz diorite is enriched in large-ion lithophile elements (LILEs) and light rare-earth elements (LREEs) and is depleted in high-field-strength elements (HFSEs), which are related to slab subduction. Additionally, the Liuqiong quartz diorite has high SiO2, Al2O3 and Sr contents, high Sr/Y ratios and low heavy rare-earth element (HREE) and Y contents, which are compatible with typical adakite signatures. The initial 87Sr/86Sr values of the Liuqiong adakite range from 0.705617 to 0.705853, and the whole-rock ϵNd(t) values vary between +5.78 and +6.24. The zircon ϵHf(t) values vary from +11.5 to +16.4. Our results show that the Liuqiong adakite magma was derived from partial melting of the Neo-Tethyan oceanic plate (mid-ocean ridge basalt (MORB) + sediment + fluid), with some degree of subsequent peridotite interaction within the overlying mantle wedge. Combining regional data, we favour the interpretation that the Neo-Tethyan oceanic crust was subducted at a low angle beneath the Gangdese during the Early Cretaceous.
A turbulent drag-reduction method employing synthetic jet sheets in a turbulent channel flow is investigated by direct numerical simulations. The jet sheets are wall-parallel and produced by periodic blowing and suction from pairs of thin slots aligned with the main streamwise flow. By varying the slot height and the jet-sheet angle with respect to the spanwise direction, drag-reduction margins between $10\,\%$ and $30\,\%$ are obtained for jet-sheet angles between $45 ^{\circ }$ and $75 ^{\circ }$, while a drag increase of almost 100 % is computed when the jet sheets are spanwise-oriented. When global skin-friction drag reduction occurs, the wall-shear stress near the jet-sheet exits increases during suction and decreases during blowing, while the velocity fluctuations weaken during suction and intensify during blowing. The global drag-reduction effect is produced by a finite counter flow induced by the nonlinear interaction between the jet-sheet flow and the main flow, although the turbulent intensity and Reynolds shear stresses increase. The power spent to generate the jet sheets is computed by modelling numerically the actuator underneath the channel flow as a piston oscillating sinusoidally along the spanwise direction in a round-shaped cavity from which the fluid is released into the channel through the cavity exits. A power balance leads to the computation of the efficiency of the actuator system, quantifying the portion of the piston power that is lost as internal power fluxes and heat transfer through the cavity walls. For the tested configurations, the power consumed by the piston to generate the jet sheets is larger than the power saved thanks to the drag reduction.
Frequent freezing injury greatly influences winter wheat production; thus, effective prevention and a command of agricultural production are vital. The freezing injury monitoring method integrated with ‘3S’ (geographic information systems (GIS), global positioning system (GPS) and remote sensing (RS)) technology has an unparalleled advantage. Using HuanJing (HJ)-1A/1B satellite images of a winter wheat field in Shanxi Province, China plus a field survey, crop types and winter wheat planting area were identified through repeated visual interpretations of image information and spatial analyses conducted in GIS. Six vegetation indices were extracted from processed HJ-1A/1B satellite images to determine whether the winter wheat suffered from freezing injury and its degree of severity and recovery, using change vector analysis (CVA), the freeze injury representative vegetation index and the combination of the two methods, respectively. Accuracy of the freezing damage classification results was verified by determining the impact of freezing damage on yield and quantitative analysis. The CVA and the change of normalized difference vegetation index (ΔNDVI) monitoring results were different so a comprehensive analysis of the combination of CVA and ΔNDVI was performed. The area with serious freezing injury covered 0.9% of the total study area, followed by the area of no freezing injury (3.5%), moderate freezing injury (10.2%) and light freezing injury (85.4%). Of the moderate and serious freezing injury areas, 0.2% did not recover; 1.2% of the no freezing injury and light freezing injury areas showed optimal recovery, 15.6% of the light freezing injury and moderate freezing injury areas showed poor recovery, and the remaining areas exhibited general recovery.
Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favourably associated with obesity and MHO phenotype in a Chinese multi-ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11·2 % were with obesity. MHO phenotype was present in 5·7 % of total population and 52·7 % of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23 % decreased odds of obesity (OR = 0·77, 95 % CI 0·71, 0·83, Ptrend < 0·001) and 27 % increased odds of MHO (OR = 1·27, 95 % CI 1·10, 1·48, Ptrend = 0·001) in population with obesity. However, aMED diet showed no obvious favourable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.
This study explored the effects of condition notification based on virtual reality technology on the anxiety levels of parents of children with simple CHD.
Methods:
The subjects of the study were the parents of 60 children with simple CHD who were treated in our centre. The state anxiety scale was used to assess the anxiety status of the parents of the children before and after the condition notification in different ways (based on virtual reality explanations and written explanations).
Results:
In this study, a total of 55 parents of children with CHD successfully completed the survey. At the time of admission, there was no significant difference in the state anxiety scale scores of the parents between the two groups. The anxiety status of the virtual reality group was relieved after the condition notification assisted by virtual reality technology, and there was a significant difference compared with the control group.
Conclusion:
Condition notification based on virtual reality technology can effectively alleviate the anxiety of parents of children with simple CHD, which is worthy of clinical application.
The joint effects of stimulus quality and semantic context in visual word recognition were examined with event-related potential (ERP) recordings. In one-character Chinese word recognition, we manipulated stimulus quality at two degradation levels (highly vs. slightly degraded) and semantic context at two priming levels (semantically related vs. unrelated). In a prime–target–probe trial flow, ERPs were recorded to the target character which was presented in either high or slight degradation and which was preceded by either a semantically related or unrelated prime character. The target character was then followed by a probe character which was either identical to or different from the target character. Subjects were instructed to make target–probe matching judgments. The ERP results demonstrated a degradation by priming interaction, with larger N400 semantic priming effects for slightly degraded targets. Moreover, the degradation effects were observed on the P200, N250, and N400. These findings provided evidence for the cascaded model of visual word recognition such that the visual processing cascaded into the semantic stage and thus interacted on the N400 amplitude. The results were compared to an earlier study with a null ERP degradation by priming interaction. The ramifications of these results for models of visual word recognition are discussed.
This study aimed to explore the effects of eye masks on the sleep quality and pain of school-age children with CHD after surgery.
Methods:
Forty school-age children with CHD who underwent open-heart surgery in the Cardiac Surgery Department of a provincial hospital in China from January 2020 to December 2020 were selected. The children were randomly divided into the experimental group (n = 20) and the control group (n = 20). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights following the removal of tracheal intubation. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children’s Pain Behaviour Scale was used to evaluate the pain of the children.
Results:
After three nights of receiving the eye masks intervention, the sleep quality scores of the children in the experimental group were significantly lower than those of the control group, the difference was statistically significant (p < 0.05) and the sleep quality of the children in the experimental group was higher. The pain scores of the children in the experimental group were significantly lower than those of the children in the control group, the difference was statistically significant (p < 0.05), and the children in the experimental group suffered less post-operative pain.
Conclusion:
Eye masks are a simple, safe and economical intervention, that is beneficial for improving the post-operative sleep quality and relieving post-operative pain in school-age children with congenital heart disease.
To evaluate the relationship between religious beliefs and mental state, care burden, and quality of life in parents of infantile patients with CHD.
Methods:
A cross-sectional study was conducted at a provincial hospital in Fujian, China. In this study, 114 parents of infant patients with CHD were successfully enrolled. Data were collected using the Duke University Religion Index, Hospital Anxiety and Depression Scale, Zarit Caregiver Burden Interview, and 36-Item Short-Form Health Survey.
Results:
The organisational religious activity, non-organisational religious activity, and intrinsic religiosity of parents were significantly related to the care burden and quality of life, and the two dimensions of non-organisational religious activity and intrinsic religiosity of parents were significantly related to their anxiety symptoms. No association was found between parents’ religious beliefs and their depressive symptoms. Among Buddhist parents, non-organisational religious activity and intrinsic religiosity reduced the care burden and improved quality of life. Among Christian parents, organisational religious activity and non-organisational religious activity were found to reduce the care burden, while organisational religious activity and intrinsic religiosity were found to improve quality of life. There was no correlation between the sub-dimensions of religious beliefs and a negative impact on the care process in Muslim parents.
Conclusion:
Religious beliefs have a protective effect on the parents of infant patients with CHD. They help relieve parents’ anxiety, reduce their care burden, and improve their quality of life. In addition, different religious beliefs have different dimensions of influence on caregivers.
We present a theoretical study of mode evolution in high-power distributed side-coupled cladding-pumped (DSCCP) fiber amplifiers. A semi-analytical model taking the side-pumping schemes, transverse mode competition, and stimulated thermal Rayleigh scattering into consideration has been built, which can model the static and dynamic mode evolution in high-power DSCCP fiber amplifiers. The mode evolution behavior has been investigated with variation of the fiber amplifier parameters, such as the pump power distribution, the length of the DSCCP fiber, the averaged coupling coefficient, the number of the pump cores and the arrangement of the pump cores. Interestingly, it revealed that static mode evolution induced by transverse mode competition is different from the dynamic evolution induced by stimulated thermal Rayleigh scattering. This shows that the high-order mode experiences a slightly higher gain in DSCCP fiber amplifiers, but the mode instability thresholds for DSCCP fiber amplifiers are higher than those for their end-coupled counterparts. By increasing the pump core number and reducing the averaged coupling coefficient, the mode instability threshold can be increased, which indicates that DSCCP fibers can provide additional mitigation strategies of dynamic mode instability.
To explore the feasibility and superiority of applying the WeChat platform in a midterm follow-up of surgical repair for ventricular septal defects in infants.
Methods:
Eighty-six infants with VSD who underwent surgical repair were divided into an outpatient follow-up group and a WeChat follow-up group. The clinical data, including complications, economic cost, time spent, loss to follow-up rate, and parents’ satisfaction at the 3-month and 1-year follow-ups, were recorded and analysed.
Results:
There was no significant difference in the incidence of post-operative complications between the two groups. Although the loss to follow-up rate in the WFU group was lower than that of the OFU group, the difference was not statistically significant. The economic cost and time spent in the 3 months and 1 year after discharge in the WFU group were significantly lower than those in the OFU group. One year after discharge, the PSQ-18 score of the WFU group was significantly higher than that of the OFU group.
Conclusion:
Compared with outpatient follow-up, the WeChat platform at the midterm follow-up after surgical repair of VSDs in infants has the advantages of saving time and economic costs and improves parents’ satisfaction.
A 1178 J near diffraction limited 527 nm laser is realized in a complete closed-loop adaptive optics (AO) controlled off-axis multi-pass amplification laser system. Generated from a fiber laser and amplified by the pre-amplifier and the main amplifier, a 1053 nm laser beam with the energy of 1900 J is obtained and converted into a 527 nm laser beam by a KDP crystal with 62% conversion efficiency, 1178 J and beam quality of 7.93 times the diffraction limit (DL). By using a complete closed-loop AO configuration, the static and dynamic wavefront distortions of the laser system are measured and compensated. After correction, the diameter of the circle enclosing 80% energy is improved remarkably from 7.93DL to 1.29DL. The focal spot is highly concentrated and the 1178 J, 527 nm near diffraction limited laser is achieved.
A 71-year-old man was admitted for gradually difficult walking for 3 years along with memory impairment and urinary incontinence for 1 year. At first, this patient just complained of weakness while walking and dizziness. He was treated for arterial hypertension; however, no relief was obtained. He experienced more difficulties in walking and initiating steps. Besides these symptoms, his memory and thinking ability declined. His wife found that he responded slowly with personality change from a talkative and considerative gentleman to a silent man with apathy. The patient often felt urinary urgency, sometimes with incontinence. It was considered as symptoms of prostate hypertrophy. He was referred to a neurologist and MRI reported some lacunar infarctions and brain atrophy (retrospectively, lateral ventricles enlargement already existed). His Mini-Mental State Examination (MMSE) score was 18 points. Lumbar puncture (LP) was performed and cerebrospinal fluid (CSF) results were normal. The patient was diagnosed as having vascular dementia, hypertension and treated with neuroprotective agents and antihypertensives. After hospitalization, his symptoms were temporarily and partially relieved. His MMSE score was improved to 24 points when he was discharged.
Over recent decades, Chinese giant salamanders Andrias spp. have declined dramatically across much of their range. Overexploitation and habitat degradation have been widely cited as the cause of these declines. To investigate the relative contribution of each of these factors in driving the declines, we carried out standardized ecological and questionnaire surveys at 98 sites across the range of giant salamanders in China. We did not find any statistically significant differences between water parameters (temperature, dissolved oxygen, ammonia, nitrite, nitrate, salinity, alkalinity, hardness and flow rate) recorded at sites where giant salamanders were detected by survey teams and/or had been recently seen by local respondents, and sites where they were not detected and/or from which they had recently been extirpated. Additionally, we found direct and indirect evidence that the extraction of giant salamanders from the wild is ongoing, including within protected areas. Our results support the hypothesis that the decline of giant salamanders across China has been primarily driven by overexploitation. Data on water parameters may be informative for the establishment of conservation breeding programmes, an initiative recommended for the conservation of these species.
Major depressive disorder (MDD) is a common debilitating disorder characterized by impaired spontaneous brain activity, yet little is known about its alterations in dynamic properties and the molecular mechanisms associated with these changes.
Methods
Based on the resting-state functional MRI data of 65 first-episode, treatment-naïve patients with MDD and 66 healthy controls, we compared dynamic regional homogeneity (dReHo) of spontaneous brain activity between the two groups, and we investigated gene expression profiles associated with dReHo alterations in MDD by leveraging transcriptional data from the Allen Human Brain Atlas and weighted gene co-expression network analysis.
Results
Compared with healthy controls, patients with MDD consistently showed reduced dReHo in both fusiform gyri and in the right temporal pole and hippocampus. The expression profiles of 16 gene modules were correlated with dReHo alterations in MDD. These gene modules were enriched for various biological process terms, including immune, synaptic signalling, ion channels, mitochondrial function and protein metabolism, and were preferentially expressed in different cell types.
Conclusions
Patients with MDD have reduced dReHo in brain areas associated with emotional and cognitive regulation, and these changes may be related to complex polygenetic and polypathway mechanisms.
Preoperative nutritional status plays an important role in predicting postoperative outcomes. Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) are good tools to assess patients’ nutritional status. They have been used in predicting outcomes in various malignancies, but few studies have focused on pancreatic adenocarcinoma (PDAC) patients. Totally, 306 PDAC patients were enrolled. The propensity score matching (PSM) method was introduced to eliminate the baseline inequivalence. Patients with different PNI (or CONUT) scores showed inequivalence baseline characteristics, and patients with compromised nutritional status were related with a more advanced tumour stage. After PSM, the baseline characteristics were well balanced. Both low PNI (≤45) and high CONUT (≥3) were independent risk factors for poor overall survival (P < 0·05), and the result remained the same after PSM. Survival analysis demonstrated both patients with low PNI and high CONUT score were associated with poorer survival, and the result remained the same after PSM. The results of AUC indicated that CONUT might have a higher sensitivity and specificity in predicting complications and survival. Preoperative low PNI (≤45) and high CONUT (≥3) scores might be reliable predictors of prognosis and surgical complications in PDAC patients. Compared with PNI, CONUT might be more effective.