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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 retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.
Trauma is a significant health issue that not only leads to immediate death in many cases but also causes severe complications, such as sepsis, thrombosis, haemorrhage, acute respiratory distress syndrome and traumatic brain injury, among trauma patients. Target protein identification technology is a vital technique in the field of biomedical research, enabling the study of biomolecular interactions, drug discovery and disease treatment. It plays a crucial role in identifying key protein targets associated with specific diseases or biological processes, facilitating further research, drug design and the development of treatment strategies. The application of target protein technology in biomarker detection enables the timely identification of newly emerging infections and complications in trauma patients, facilitating expeditious medical interventions and leading to reduced post-trauma mortality rates and improved patient prognoses. This review provides an overview of the current applications of target protein identification technology in trauma-related complications and provides a brief overview of the current target protein identification technology, with the aim of reducing post-trauma mortality, improving diagnostic efficiency and prognostic outcomes for patients.
Due to swelling, smectite minerals are capable of intercalating many organic molecules in their interlayer space. Tetracycline (TC) is a group of antibiotics used extensively in human and veterinary medicine. The great aqueous solubility and long environmental half life of TC mean that the study of interactions between swelling clay minerals and TC are of great importance in TC transport and retention in subsurface soils. In the present study, the intercalation of TC molecules at different levels into smectites was investigated using Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The shift of the FTIR bands of amide I and II in comparison to crystalline TC suggested a strong interaction between the amide groups and the clay surfaces. The band at 1455 cm−1 remained the same after TC intercalation into SAz-1, SWy-2, and SYn-1, suggesting that complexation was not a dominant mechanism of TC uptake by these minerals. With cation exchange as the major mechanism of TC intercalation into these minerals, simultaneous removal of H+ from solution protonated the TC molecules and provided a positive charge to interact with negatively charged mineral surfaces even in neutral to slightly alkaline conditions. The increase in interlayer distance after intercalation by TC, as revealed by XRD, suggested a tilted orientation of the intercalated TC molecules in both twisted conformation in acidic condition and extended conformation in alkaline condition.
Integrating the literature on talent management and teams, and drawing upon the signaling theory as the overarching framework, we investigated the moderated indirect effects of talent inducements on employee creativity via employee work engagement in teams. Empirical data from matched leader-members indicated that team talent inducement was positively related to member work engagement, which was then positively associated with team and member creativity. In addition, individual learning and performance-approach goal orientation positively moderated this indirect relationship, whereas individual performance-avoidance goal orientation negatively moderated this indirect relationship. Together, these results illuminate a cross-level influence process of team talent inducements on creativity and individual goal orientations as boundary conditions.
Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma.
Methods
An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study.
Results
The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications.
Conclusion
The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.
Rodents and shrews are major reservoirs of various pathogens that are related to zoonotic infectious diseases. The purpose of this study was to investigate co-infections of zoonotic pathogens in rodents and shrews trapped in four provinces of China. We sampled different rodent and shrew communities within and around human settlements in four provinces of China and characterised several important zoonotic viral, bacterial, and parasitic pathogens by PCR methods and phylogenetic analysis. A total of 864 rodents and shrews belonging to 24 and 13 species from RODENTIA and EULIPOTYPHLA orders were captured, respectively. For viral pathogens, two species of hantavirus (Hantaan orthohantavirus and Caobang orthohantavirus) were identified in 3.47% of rodents and shrews. The overall prevalence of Bartonella spp., Anaplasmataceae, Babesia spp., Leptospira spp., Spotted fever group Rickettsiae, Borrelia spp., and Coxiella burnetii were 31.25%, 8.91%, 4.17%, 3.94%, 3.59%, 3.47%, and 0.58%, respectively. Furthermore, the highest co-infection status of three pathogens was observed among Bartonella spp., Leptospira spp., and Anaplasmataceae with a co-infection rate of 0.46%. Our results suggested that species distribution and co-infections of zoonotic pathogens were prevalent in rodents and shrews, highlighting the necessity of active surveillance for zoonotic pathogens in wild mammals in wider regions.
We numerically investigated the global linear instability and bifurcations in electro-thermo-convection (ETC) of a dielectric liquid confined in a two-dimensional (2-D) concentric annulus subjected to a strong unipolar injection. Seven kinds of solutions exist in this ETC system due to the complex bifurcations, i.e. saddle-node, subcritical and supercritical Hopf bifurcations. These bifurcation routes constitute at most four solution branches. Global linear instability analysis and energy analysis were conducted to explain the instability mechanism and transition of different solutions and to predict the local instability regions. The linearized lattice Boltzmann method (LLBM) for global linear instability analysis, first proposed by Pérez et al. (Theor. Comput. Fluid Dyn., vol. 31, 2017, pp. 643–664) to analyse incompressible flows, was extended here to solve the whole set of coupled linear equations, including the linear Navier–Stokes equations, the linear energy equation, Poisson's equation and the linear charge conservation equation. A multiscale analysis was also performed to recover the macroscopic linearized Navier–Stokes equations from the four different discrete lattice Boltzmann equations (LBEs). The LLBM was validated by calculating the linear critical value of 2-D natural convection; it has an error of 1.39% compared with the spectral method. Instability with global travelling wave behaviour is a unique behaviour in the annulus configuration electrothermohydrodynamic system, which may be caused by the baroclinity. Finally, the chaotic behaviour was quantitatively analysed through calculation of the fractal dimension and Lyapunov exponent.
Very small but cumulated decreases in food intake may be sufficient to erase obesity over a period of years. We examine the effect of slight changes in the accessibility of different foods in a pay-by-weight-of-food salad bar in a cafeteria serving adults for the lunch period. Making a food slightly more difficult to reach (by varying its proximity by about 10 inches) or changing the serving utensil (spoon or tongs) modestly but reliably reduces intake, in the range of 8–16%. Given this effect, it is possible that making calorie-dense foods less accessible and low-calorie foods more accessible over an extended period of time would result in significant weight loss.
Everyone faces uncertainty on a daily basis. Two kinds of probability expressions, verbal and numerical, have been used to characterize the uncertainty that we face. Because our cognitive concept of living things differs from that of non-living things, and distinguishing cognitive concepts might have linguistic markers, we designed four studies to test whether people use different probability expressions when faced with animate or inanimate uncertainty. We found that verbal probability is the preferred way to express animate uncertainty, whereas numerical probability is the preferred way to express inanimate uncertainty. The “verbal-animate” and “numerical-inanimate” associations were robust enough to persist when tested with forced-choice response patterns regardless of the information (e.g., equally likely outcomes, frequencies, or personal beliefs) used to construct probabilities of events. When the response pattern was changed to free-responses, the associations were evident unless the subjects were asked to write their own probability predictions for vague uncertainty. Given that the world around us consists of both animate (i.e., living) and inanimate (i.e., non-living) things, “verbal-animate” and “numerical-inanimate” associations may play a major role in risk communication and may otherwise be useful for practitioners and consultants.
According to the positive time-discounting assumption of intertemporal decision-making, people prefer to undergo negative events in the future rather than in the present. However, negative discounting has been identified in the intertemporal choice and loss domains, which refers to people’s preference to experience negative events earlier rather than later. Studies have validated and supported the "anticipated dread" as an explanation for negative discounting. This study again explored the effect of anticipated dread on intertemporal choice using content analysis; that is, having participants identify anticipated dread among reasons for negative discounting. This study also validated the effect of anticipated dread on negative discounting by manipulating anticipated dread. This study adds empirical and direct evidence for the role of anticipated dread in negative discounting.
Intertemporal choices involve tradeoffs between outcomes that occur at different times. Most of the research has used pure gains tasks and the discount rates yielding from those tasks to explain and predict real-world behaviors and consequences. However, real decisions are often more complex and involve mixed outcomes (e.g., sooner-gain and later-loss or sooner-loss and later-gain). No study has used mixed gain-loss intertemporal tradeoff tasks to explain and predict real-world behaviors and consequences, and studies involving such tasks are also scarce. Considering that tasks involving a combination of gains and losses may yield different discount rates and that existing pure gains tasks do not explain or predict real-world outcomes well, this study conducted two experiments to compare the discount rates of mixed gain-loss intertemporal tradeoffs with those of pure gains or pure losses (Experiment 1) and to examine whether these tasks predicted different real-world behaviors and consequences (Experiment 2). Experiment 1 suggests that the discount rate ordering of the four tasks was, from highest to lowest, pure gains, sooner-loss and later-gain, pure losses, and sooner-gain and later-loss. Experiment 2 indicates that the evidence supporting the claim that the discount rates of the four tasks were related to different real-world behaviors and consequences was insufficient.
Recently, Scholten and Read (2014) found new violations of dominance in intertemporal choice. Although adding a small receipt before a delayed payment or adding a small delayed receipt after an immediate receipt makes the prospect objectively better, it decreases the preference for that prospect (better is worse). Conversely, although adding a small payment before a delayed receipt or adding a small delayed payment after an immediate payment makes the prospect objectively worse, it increases the preference for that prospect (worse is better). Scholten and Read explained these violations in terms of a preference for improvement. However, to produce violations such as these, we find that the temporal sequences need not be constructed as Scholten and Read suggested. In this study, adding a small receipt before a dated receipt (thus constructed as improving) or adding a receipt after a dated payment (thus constructed as improving) decreases preferences for those prospects. Conversely, adding a small payment after a dated receipt (thus constructed as deteriorating) or adding a small payment before a delayed payment (thus constructed as deteriorating) increases preferences for those prospects.
To study intertemporal choices, researchers typically instruct subjects to choose between smaller and sooner (SS) and larger and later (LL) rewards (e.g., gaining CNY 210 in a week vs. gaining CNY 250 in five weeks). People generally tend to discount steeply and prefer SS to LL rewards in such situations. Jiang, Hu and Zhu (2014) recently showed that adding upfront losses or gains to both SS and LL rewards can reduce people’s discounting, and they provided several possible accounts for this effect, including the salience account and the time scale hypothesis. In the current paper, based on the upfront money effect found in Jiang et al. (2014), we further showed that the effect of discounting decreasing could be extended to adding dated-money between SS and LL rewards and after LL rewards. The results helped us exclude both the time scale hypothesis and another possible explanation: preference for improvement. We hypothesized that all the current findings (recorded in this paper and in Jiang et al.) could be accommodated well using the salience account.
This is a follow-up discussion about the Chinese electric vehicle (EV) sector, in particular the relative prospects of traditional automotive manufacturers and new ‘species’, four years after our last conversation on this topic (Jiang & Lu, 2018). It is also a response to Murmann and Vogt's (2022) latest article, which goes beyond Teece's (2019) focus on dynamic capabilities and constructs a systematic framework of firm capabilities to understand the competitive dynamics during a transformational shift of products.
In the treatment of infertile patients with non-obstructive azoospermia (NOA) caused by the deletion of the azoospermia factor c region (AZFc) on the Y chromosome, synchronous and asynchronous surgical strategies are discussed. Clinical data from NOA patients with the AZFc deletion who underwent micro-TESE were analyzed retrospectively. The sperm retrieval rate (SRR) and sperm utilization rate of synchronous and asynchronous operation groups were followed up and compared. The fertilization rate, high-quality embryo rate, clinical pregnancy rate, abortion rate, and cumulative live birth rate of ICSI in patients with successful sperm retrieval were compared between the two groups. The two groups had sperm utilization rates of 98.9% (93/94) and 50.0% (14/28), respectively. The asynchronous group’s sperm consumption rates were much lower than those of the synchronous operation group. Fertilization rate, high-quality embryo rate, clinical pregnancy rate of fresh transfer cycle, abortion rate, and cumulative live birth rate of patients in the synchronous operation group with fresh sperm, and the asynchronous operation group with thawed sperm, respectively, were 30.6% vs 33.8%, 33.8% vs 40.7%, 40.0% vs 12.5%, 30.4% vs 7.1%. Between the two groups, there was no significant difference. This suggests that individuals with NOA caused by the AZFc deletion have a high possibility of successfully acquiring sperm using micro-TESE and ICSI to conceive their own offspring. Synchronous micro-TESE is recommended to improve sperm utilization rate and the cumulative live birth rate.
Despite increasing knowledge on the neuroimaging patterns of eating disorder (ED) symptoms in non-clinical populations, studies using whole-brain machine learning to identify connectome-based neuromarkers of ED symptomatology are absent. This study examined the association of connectivity within and between large-scale functional networks with specific symptomatic behaviors and cognitions using connectome-based predictive modeling (CPM).
Methods
CPM with ten-fold cross-validation was carried out to probe functional networks that were predictive of ED-associated symptomatology, including body image concerns, binge eating, and compensatory behaviors, within the discovery sample of 660 participants. The predictive ability of the identified networks was validated using an independent sample of 821 participants.
Results
The connectivity predictive of body image concerns was identified within and between networks implicated in cognitive control (frontoparietal and medial frontal), reward sensitivity (subcortical), and visual perception (visual). Crucially, the set of connections in the positive network related to body image concerns identified in one sample was generalized to predict body image concerns in an independent sample, suggesting the replicability of this effect.
Conclusions
These findings point to the feasibility of using the functional connectome to predict ED symptomatology in the general population and provide the first evidence that functional interplay among distributed networks predicts body shape/weight concerns.
To stimulate a debate about the rise of China's digital economy, this essay compares China and the US in one key area of the digital economy – e-commerce and internet-based services. China still lags behind the US in internet penetration, but it distinguishes itself by building a mobile-first, fiber-intensive, and inclusive digital infrastructure. A favorable infrastructure, innovations tailored to the large Chinese market, and local firms’ rapid commercialization of products and services turned the world's largest domestic population into active online consumers, helping China overtake the US by a large margin in retail e-commerce and digital payment. While China translated digital technologies into leading business-to-customer and customer-to-customer businesses, it has not been so successful in business-to-business services. The US is still ahead in the general-purpose technologies underlying the digital economy.