bluuebunny/crossref_metadata_2025 huggingface dataset:
Hookworm infection in stomach: A case report found by physical examination
Authors: Zhao Di , He Ronghua , Wang Yiqin , Jiang Hongyu
Published: May 2021

BackgroundHookworm disease is one of the most widely distributed parasitic diseases in the world. It is endemic in Europe, America, Africa and Asia[1]. The main clinical manifestations of hookworm disease are anemia, malnutrition, gastrointestinal dysfunction, and labor decline. It is caused by the parasites of Ancylostoma duodenale Dubini and (or) Necator americanus Stiles. The larvae can invade human capillaries through the skin or mucous membranes, enter the bloodstream, reach the lungs through the right heart, destroy the capillaries of the lungs, enter the alveoli, travel along the bronchi to the pharynx, enter the digestive tract and reach the small intestine after swallowing, and develop into adults in the upper part of the small intestine Attached to the intestinal mucosa[2]. MethodsWe described one case of a businesswomen who sufferd from persistent symptoms of anemia, weight loss, and fatigue for years. Anemia was not significantly improved after routine antianemia treatment. In order to further evaluate the cause of anemia, a gastroscopy was performed, and the microscope showed a single hookworm in the lower stomach. Diagnosis was confirmed by the successful funding of Hookworm eggs in the lining of excrement. Conclusions Hookworm is a human parasite transmitted through the faecal-oral route which reside the duodenal bulb normally[3]. Adult worms are not usually seen in the stomach. There are only few cases reporting hookworm infestation of the stomach. In this case report we present an endoscopic demonstration of hookworm infestation in the stomach found by physical examination of a woman who presented with chronic anaemia. For anaemia patients, especially chronic anaemia patients and those suspected of hookworm disease, gastroscopy should pay attention to the observation of duodenal globules and fecal search for eggs, which are conducive to the early diagnosis of hookworm disease.
WITHDRAWN: Treatability of Pharmaceutical Wastewater by Using Combined Ultrasound Cavitation and Persulfate Process
Authors: Pandya Karan , S Anantha Singh T , Kodgire Pravin
Published: May 2021

In recent years industrialization caused, magnificent leaps to high profitable growth of pharmaceutical industries, however, simultaneously it has given rise to environmental pollution. Pharmaceutical processes like extraction, purification, formulation etc. generates huge volume of wastewater with high COD, biological oxygen demand, auxiliary chemicals, and different pharmaceuticals substance or their metabolites in the active or inactive form imparting intensive color, which necessitates its proper treatment before being discharged. This study focuses on the feasibility analysis of utilization of ultrasound cavitation assisted with persulfate oxidation approach for the treatment of such complex effluent. Process parameters like pH, amplitude intensity, oxidant dosage was optimized for COD removal applying response surface methodology-based Box Behnken design. The optimum value observed for pH, amplitude intensity, oxidant dosage is 5, 20%, 100 mg/L respectively with 39.5% removal of COD and 6.5% removal of TOC in 60 min of fixed processing time. Study confirms that acombination of ultrasound cavitation and persulfate is a viable option for the treatment of pharmaceutical wastewater than individual treatment and it can be used as an intensification technique in existing treatment plants for achieving maximum COD removal.
A Ten-Year Retrospective Study of Invasive Candidiasis in a Tertiary Hospital
Authors: Yang Zhihui , Song Yinggai , Li Ruoyu
Published: May 2021

Background: Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality worldwide. Delay in diagnosis and antifungal therapy significantly increases the risk of death. Thus, comprehensive knowledge of IC is required to recognize the IC onset timely. Objectives: This study aimed to evaluate the epidemiological, clinical and mycological characteristics of IC in China.Methods: A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing, China.Results: The overall incidence rate during 2010-2019 was 0.261 episodes per 1,000 discharges. Candidemia (71.0%) was the major infective pattern. 70.3% of the patients tested positive for Candida spp. colonization before IC and the median time to develop an invasive infection after colonization was 13.5 days (interquartile range: 4.5-37.0 days). Candida albicans (45.8%) was the most prevalent species, followed by Candida parapsilosis (19.5%), Candida glabrata (14.2%) and Candida tropicalis (13.7%). C. non-albicans IC was more common in patients with severe anemia (p=0.018), long-term hospitalization (p=0.015), hematologic malignancies (p=0.002), continuous administration of broad-spectrum antibiotics (p<0.001) and mechanical ventilation (p=0.012). In vitro resistance testing showed that 14.4% of the Candida isolates were resistant/ non-wild type (non-WT) to fluconazole, followed by voriconazole (9.6%), micafungin (3.8%) and caspofungin (2.9%). Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis (52.6% and 54.6%, respectively). 30-day and 90-day all-cause mortality was 24.5% and 32.7%, respectively. Conclusions: The incidence of IC was lower in recent years. C. non-albicans contributed to more than half of the IC cases. Fluconazole could still be used as first-line therapy if its resistance/ non-WT was not prevalent. The mortality of IC was still high. A prospective, multi-center surveillance to clinical and mycological characteristics of IC is required.
Generation of knock-in lampreys by CRISPR-Cas9-mediated genome engineering
Authors: Suzuki Daichi G. , Wada Hiroshi , Higashijima Shin-ichi
Published: May 2021

The lamprey represents the oldest group of living vertebrates and has been a key organism in various research fields such as evolutionary developmental biology and neuroscience. However, no knock-in technique for this animal has been established yet, preventing application of advanced genetic techniques. Here, we report efficient generation of F0 knock-in lampreys by CRISPR-Cas9-mediated genome editing. A donor plasmid containing a heat-shock promoter was co-injected with a short guide RNA (sgRNA) for genome digestion, a sgRNA for donor plasmid digestion, and Cas9 mRNA. Targeting different genetic loci, we succeeded in generating knock-in lampreys expressing photoconvertible protein Dendra2 as well as those expressing EGFP. With its simplicity, design flexibility, and high efficiency, we propose that the present method has great versatility for various experimental uses in lamprey research and that it can also be applied to other “non-model” organisms.
ZIF-67 Derived Co Nanoparticles Embedded N-Doped Mesoporous Carbon Nanocages as an Active Heterogeneous Fenton Catalyst for the Degradation of Tetracycline
Authors: Wang Qian , Wang Xiaofei , He Huairu
Published: May 2021

Herein, the novel application of ZIF-67 derived HCo@NC as a highly active and stable catalyst for Fenton treatment of organic wastewater is discussed. The carbonization of the Cobalt based Zeolitic Imidazolate Framework-67 (ZIF-67) yielded of HCo@NC~700 nm shows a hollow structure inheriting the rhombic dodecahedron shape of the precusor ZIF-67. XPS analysis reveales the coexistence of Co2+ and Co0. The treatment of Tetracycline (TC) in HCo@NC catalyzed Fenton system indicates that hydroxyl radicals generated to oxidize TC to decompose, and the optimal condition is determined to be 0.71 mmol·L-1 H2O2 and 0.03 g·L-1 HCo@NC at pH 3 for the treatment of 15 mg·L-1 TC. H2O2 is catalyzed by HCo@NC to decompose to hydroxyl radicals for the degradation of TC, and the reaction mechanism is proposed.
Information Content Carried by Brain Signals Reduces Differentially in MCS and UWS Patients
Authors: Chen Shanshan , Wang Yituo , Meng Xiangfeng , Yang Zheng , Weng Dongdong , Wu Xinhuai , Wang Lubin
Published: May 2021

Objective: Human consciousness is thought to depend on information integration in the brain. How brain injuries affect the information content carried by signals of brain imaging modalities in patients with consciousness disorders has received little attention. Here we propose a novel approach to quantify changes of regional information content in the brain by assessing the entropy delineated by the principal components of regional voxel-based functional imaging signals in clinical MCS and UWS patients.Method: Resting-state functional imaging was performed in 23 MCS patients, 31 UWS patients, and 20 age-matched healthy individuals. Results: We show that, as the symptoms of DOC deepen from MCS to UWS, regional information content also was significantly reduced in that order in the sensory and memory systems of the brain. In contrast, with few exceptions, regional information content in high-order cognitive systems remained statistically at a level similar to those in healthy individuals in MCS patients and only showed a significant reduction in UWS patients. Conclusions and Significance: These findings provide, in the theoretical context of consciousness, novel evidence for a reduction of regional information content as a potential systems-level mechanism of consciousness disorder in MCS and UWS. Further, the findings reveal, for the first time, differential patterns of the reduction of information content in the sensory and memory compared with cognitive systems in MCS and UWS patients, consistent with the manifestations of clinical symptoms in the two DOC patient populations.
Adaptability of Organic Matter and Solid Content to Fe2+/Persulfate and Skeleton Builder Conditioner for Waste Activated Sludge Dewatering
Authors: Li Xiaoran , Shi Yafei , Zhou Xi , Wang Lu , Zhang Huiqin , Pi Kewu , Gerson Andrea R , Liu Defu
Published: May 2021

Sludge conditioning is important for improved dewatering, with the sludge characteristics impacting the effect of conditioning. A composite conditioner, Fe2+ activated sodium persulfate (Fe2+/SPS) combined with phosphogypsum (PG), was used to examine its impact on sludges with different organic content or different solid content. Response surface optimization analysis shows that when the best conditioning is achieved, the reduction of the specific resistance to filtration is not sensitive to organic matter content, but the dewatering performance of the sludge is greatly affected by the solid content. The oxidation role of Fe2+/SPS and the skeleton builder role of PG, together, affect the conditioning, with oxidation playing a major role in conditioning, especially for greater organic matter content. The organic content also affects the effectiveness of the skeleton builder more than the solid content. Changes in PG significantly impacts the optimal molar ratio and dosage of Fe2+/SPS. Sludge with greater solid content requires greater Fe2+/SPS dosage to provide stronger oxidation to destroy flocs. The composite conditioning decreases the content of extracellular polymeric substances and proteins/polysaccharides with the decrease in protein content being significantly greater than that of polysaccharides, these decreases improve the sludge dewaterability.
Control of chronic obstructive pulmonary disease in urban populations: findings from a cross-sectional prevalence survey in Shenzhen, China
Authors: Ji Le-Cai , Yin Jin-Feng , Lu Chun-Rong , Guan Hong-Yun , Tan Wei-Guo , Wang Ling-Wei , Jiang Qi
Published: May 2021

Background: The prevalence of chronic obstructive pulmonary disease (COPD) among urban populations is generally Lower than rural residents, but the disease burden is still high. Limited evidence on the patients’ characteristics has been offered to guide the control of the disease in city settings. Methods: We conducted a cross-sectional prevalence survey of COPD among residents aged ≥40 years in an emerging city Shenzhen, China. The multi-stage stratified random sampling method was applied to enroll eligible participants from September, 2018 to June, 2019. Tested by spirometry, individuals were diagnosed with COPD if the post-bronchodilator FEV1/FVC ratio was less than 0.7. Patients’ demographic and clinical characteristics, as well as estimates of the exposure to air pollutants, were included in the univariable and multivariable logistic regression models to assess the risk factors for COPD. Results: A total of 4157 individuals were invited to participate in this survey and 3591 who had available spirometry results and epidemiological data were enrolled in the final analysis. The estimated standardized prevalence of COPD among residents over 40 years old in Shenzhen was 5.92% (95% confidential intervals 4.05-8.34). Risk factors for COPD included elder age (adjusted odds ratio 1.206, 95% CI 1.120-1.299 per 10-year increase), smoking over 20 pack-years (1.968, 1.367-2.832), history of chronic bronchitis (1.733, 1.036-2.900) or asthma (4.920, 2.425-9.982), and exposure to higher annual minimum concentrations of ambient SO2 (1.156, 1.053-1.270 per 1-µg/m3 increase). Among 280 spirometry-diagnosed patients, most (221, 78.93%) patients were classified as mild COPD (GOLD stage I). The COPD assessment tests showed 24.7% (58/235) patients had severe symptoms with a total score ≥ 10, and 82.6% (194/235) were clinically symptomatic with a total score ≥ 2. Conclusions: This survey found a low prevalence of COPD in Shenzhen and most patients had mild symptoms, thus recommended screening using spirometry in primary health care to detect early-stage COPD. Increased risk from the exposure to air pollutants also indicated the urgent need for environmental improvement in city settings.
Highly Sensitive Plasmonic Refractive Index Sensor using Doped Silicon: An Alternative to MIM Structures
Authors: Faruque Md. Omar , Mahmud Rabiul Al , Sagor Rakibul Hasan
Published: May 2021

Metal-Insulator-Metal (MIM) structures possess a number of shortcomings which include optical loss, tenability, nanofabrication challenges, chemical instability, incompatible manufacturing process etc. To overcome these shortcomings, plasmonic properties of heavily n-doped silicon are studied and found to be similar to those of conventional plasmonic metals like gold or silver. A plasmonic refractive index sensor using n-doped silicon instead of metal is designed and analyzed numerically using Finite Element Method (FEM). A maximum sensitivity of 4900 nm/RIU, which is higher than most of the MIM plasmonic refractive index (RI) sensors proposed to date, is obtained here. The RI sensor reported here, provides a significant improvement in the sensitivity of the device along with its compatibility with traditional nanoelectronics.
Efficacy and Safety of Antithrombotic Therapy With Non-Vitamin K Antagonist Oral Anticoagulants After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
Authors: An Qing , Su Shuwen , Tu Yan , Gao Lingfeng , Xian Gaopeng , Bai Yujia , Zhan Qiong , Xu Xingbo , Xu Dingli , Zeng Qingchun
Published: May 2021

Purpose: We performed a meta-analysis to compare the efficacy and safety of antithrombotic therapy with non-vitamin K antagonist oral anticoagulants (NOACs) versus standard care in patients after successful transcatheter aortic valve replacement (TAVR).Methods: A systematic search of PubMed, Cochrane Central Register of Controlled Trials, EMBASE databases and ClinicalTrials.gov Website (through Oct 21, 2020) was performed. Risk ratio (RR) with 95% confidence intervals (CI) for all outcomes were calculated using random-effects models.Results: Twelve studies comprising 6,943 patients were included (5,299 had indications for OAC while 1,644 didn’t). No significant differences were found between NOACs and the standard care in all stroke, a composite endpoint and major/life-threatening bleeding. NOACs were associated lower all-cause mortality than VKAs for post-TAVR patients with indications for OAC after more than 1-year follow-up (RR = 0.64, 95% CI: [0.42, 0.96], p = 0.03) while NOACs were poorer than APT for patients without indications for OAC (RR = 1.66, 95% CI: [1.12, 2.45], p = 0.01). As for the impact to prevent valve thrombosis, NOACs and VKAs were not significantly different for patients with indications for OAC (RR = 0.66, 95% CI: [0.24, 1.84], p = 0.43) while NOACs were better than APT for patients without indications for OAC (RR = 0.19, 95% CI: [0.04, 0.83], p = 0.03).Conclusions: For patients with indications for OAC, post-TAVR antithrombotic therapy with NOACs were more favorable due to its lower all-cause mortality after more than 1-year follow-up. For those without indications for OAC, NOACs were poorer due to its higher all-cause mortality.
The Influence of Early Thoracic Fusion on the Pulmonary Function of Patients with Idiopathic Scoliosis in the Early Period of the Second Growth Peak with Different Risser Signs
Authors: Xu Xiaolin , Wang Shengru , Yang Yang , Du You , Lin Guanfeng , Zhang Jianguo
Published: May 2021

Background: Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs. Methods: Thirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 2<Risser sign≤4, 14 patients) groups. Patient age, Risser sign, main Cobb angle, thoracic kyphosis, and fusion levels were recorded. Perioperative and follow-up pulmonary function and thoracic diameters were compared between both groups. Results: There were no differences in patients’ general characteristics between two groups. The preoperative FEV1 and FVC were 2.06±0.43 L and 2.50±0.49 L, respectively, in the LR group, and 2.31±0.49 L (p=0.067) and 2.74±0.56 L (p=0.122), respectively, in the HR group. While these values significantly increased postoperatively, to 2.62±0.46 L (p<0.000) and 3.09±0.69 L (p<0.000), in the LR group, they remained unchanged in the HR group [2.53±0.56 L (p=0.093) and 2.70±0.98 L (p=0.386), respectively]. The FEV1/FVC in both groups was >80% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups. Conclusion: For patients with IS, early fusion didn’t deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2.
Process Evaluation of an Implementation Study in Dementia Care (EIT-4-BPSD): Stakeholder Perspectives
Authors: Behrens Liza , Boltz Marie , Riley Kiernan , Eshraghi Karen , Resnick Barbara , Galik Elizabeth , Ellis Jeanette , Kolanowski Ann , Haitsma Kimberly Van
Published: May 2021

Background: Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods: EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results: The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion: Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration: The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017
Spotting Areas Critical to Storm Waves and Surge Impacts on Coasts with Data Scarcity: A Case Study in Santa Catarina, Brazil
Authors: Pazini Karen Cristina , Bonetti Jarbas , Silva Paula Gomes da , Klein Antonio Henrique da Fontoura
Published: May 2021

The impacts of severe storms on the coastal zone, combined with rapid population growth in this area, has made coastal risk management an urgent need. However, integrated risk assessment can be a challenging task for many locations worldwide, as it normally requires the use of a large amount of data. The Coastal Risk Assessment Framework phase one (CRAF1), is a recently proposed analytical scheme based on empirical models and spatial analysis that combines different indicators to identify storm-induced hotspots. The methodology, however, requires accurate data at the regional scale and was conceived and validated for the European region. In this study, we show that this approach can be applied, with some simplifications, on data-poor areas, allowing the identification of hotspots considering one or multiple hazards. Here, the coastal risk was assessed for erosion and coastal flooding events with return periods of 10 and 50 years on the Santa Catarina Central Coast. The study area is characterized by the occurrence of storm-induced impacts that historically cause disruption and damage to local communities. Although the components of risk have been assessed using various methods along this sector, to date, no integrated risk analysis has been presented in probabilistic terms. Predicted scenarios for the Santa Catarina Central Coast suggest that extreme episodes may cause several impacts, exposing urban settlements as well local road systems, especially in the municipalities of Tijucas and Florianópolis. The results show that the CRAF1 is an appropriate approach for a first-level risk analysis, even when implemented with poor data resolution, as it effectively points to some of the most vulnerable stretches detected in the study area.
The Modulation of Interdecadal Pacific Oscillation and Atlantic Multidecadal Oscillation on winter Eurasian Cold Anomaly via the Ural Blocking Change
Authors: Luo Binhe , Luo Dehai , Dai Aiguo , Ian Simmonds , Wu Lixin
Published: May 2021

Observations revealed distinct interdecadal winter Eurasian cold anomaly (ECA) centered over central Eurasia (40o-60oN,60o-120oE), with a more southwestward extension during 1965-1976 than during 2002-2013. In this paper, Ural blockings (UB) in association with the Interdecadal Pacific Oscillation (IPO) and Atlantic Multi-decadal Oscillation (AMO) are analyzed to explain the ECA’s interdecadal change using reanalysis data. It is found that the 1965-1976 winter ECA is associated with the negative-phase IPO (IPO-) together with negative-phase AMO (AMO-), while the 2002-2013 ECA is related to positive-phase AMO (AMO+) concurring with IPO-.
The UB mainly related to positive North Atlantic Oscillation is long-lived during IPO- and AMO+ and shows different longitudinal position and movement, but short-lived and retrograde during both IPO+ and AMO-. During IPO-, the UB grows rapidly and decays slowly due to weak westerly winds and small meridional potential vorticity gradient (PVy) over North Atlantic mid-high latitudes, and moves westward mainly during its decay stage, causing strong cold anomalies over central Eurasia and its upstream region (30o-50oN, 30o-70oE). Such a slow blocking decay is also seen during AMO-. However, during AMO+ the UB grows slowly, decays rapidly and shows eastward movement due to strong westerly winds and large PVy over North Atlantic high latitudes, causing strong cold anomalies over central Eurasia and its downstream region (30o-50oN, 90o-130oE). Through these UB-induced sub-seasonal changes, the interdecadal IPO-, AMO- and AMO+ help explain the variation of the winter-mean ECA from 1965-1976 to 2002-2013.
Morphomolecular identification, metabolic profile, anticancer, and antioxidant capacities of Penicillium sp. NRC F1 and Penicillium sp. NRC F16 isolated from Egyptian remote cave
Authors: Elkhateeb Waill A. , Mettwally Walaa S. A. , Saleh Shireen A. A. , Fayad Walid , Nafady Ibrahim M. , Daba Ghoson
Published: May 2021

The authors have requested that this preprint be removed from Research Square.
The Effect of Anesthesia Depth Monitoring on Postoperative Delirium and Postoperative Cognitive Dysfunction in Non-cardiac Surgery Patients---- A Systematic Review and Meta-Analysis
Authors: Huang Ping , Sun Shufang , Liu Hongliang
Published: May 2021

Objective: To systematically evaluate the influence of intraoperative anesthesia depth monitoring on the prognosis of non-cardiac surgery to guide clinical work.Methods: Search literature in the database The Cochrane Library, Ovid MEDLINE, EMBASE, Google search ，National Knowledge Infrastructure (CNKI), Wanfangdata library and VIP network. We conducted meta-analysis by searching the literature of randomized controlled studies on the effects of different depth of anesthesia monitoring on patients with postoperative delirium and postoperative cognitive dysfunction. The depth of anesthesia monitoring methods include: Bispectral index of EEG, Auditory evoked potential, Primitive EEG monitoring, narcotrend, index of consciousness monitor, entropy, neuroSENSE monitor, SEDline monitor. Two authors independently completed literature retrieval and inclusion, and two authors independently completed literature data collection and bias analysis. The registration number of this study on PROSPERO is CRD42021232899Results: A total of 7 randomized controlled English literatures with full texts were finally included, with a sample size of 3845 cases. In 5 trials, the depth of anesthesia was monitored by bispectral index (BIS) monitoring, 2 was monitoring of auditory evoked potentials, and 1 was monitoring of raw EEG. They were grouped into monitoring group and control group. Analysis suggests that the depth of anesthesia monitoring, especially the anesthesia guided by BIS monitoring, can reduce the incidence of postoperative delirium. Intraoperative anesthesia depth monitoring reduced the impact of cognitive dysfunction at 1 and 12 weeks after surgery and was statistically significant.Conclusion: Depth of anesthesia monitoring, especially intraoperative bispectral index monitoring can reduce the occurrence of postoperative delirium in patients undergoing non-cardiac surgery. More clinical trials are needed to evaluate the role of primitive EEG monitoring. Monitoring of the depth of anesthesia is meaningful for reducing postoperative cognitive dysfunction at 1 and 12 weeks after surgery.
Universal origin of heavy elements
Authors: Orce Jose , Dey Balaram , Ngwetsheni Cebo , Lesch Brenden , Zulu Andile , Bhattacharya Srijit , Pandit Deepak , Gopal Sumeera , Khumalo Siphamandla , Mngonyama Sifiso , Mthethwa Gift , Ndala Yandisa , Ndingi Asive , Wakudyanaye Ignasio
Published: May 2021

The abundance of heavy elements above iron through the rapid neutron capture process or r-process is intimately related to the competition between neutron capture and $\beta$ decay rates, which ultimately depends on the binding energy of atomic nuclei. The well-known Bethe-Weizsacker semi-empirical mass formula describes the binding energy of ground states in nuclei with temperatures of T~0 MeV, where the nuclear symmetry energy saturates between 23-26 MeV. Here we find a larger saturation energy of ~30 MeV for nuclei at T~0.7-1.3 MeV, which corresponds to the typical temperatures where seed elements are created during the cooling down of the ejecta following neutron-star mergers and collapsars. This large symmetry energy yields a reduction of the binding energy per nucleon for neutron-rich nuclei; hence, the close in of the neutron dripline, where nuclei become unbound. This finding constrains exotic paths in the nucleosynthesis of heavy elements -- as supported by microscopic calculations of radiative neutron-capture rates -- and further supports the universal origin of heavy elements, as inferred from the abundances in extremely metal-poor stars and meteorites.
Moist convection drives an upscale energy transfer at Jovian high latitudes
Authors: Siegelman Lia , Klein Patrice , Ingersoll Andrew , Ewald Shawn , Young William , Bracco Annalisa , Mura Alessandro , Adriani Alberto , Grassi Davide , Plainaki Christina , Sindoni Giuseppe
Published: May 2021

Jupiter’s atmosphere is one of the most turbulent places in the solar system. While lightning and thunderstorm observations point to moist convection as a small-scale energy source for Jupiter’s large-scale vortices and zonal jets, it has never been demonstrated due to the coarse resolution of pre-Juno measurements. Since 2017, the Juno spacecraft discovered that Jovian high-latitudes host a cluster of large cyclones (diameter of ~ 5,000 km each) associated with intermediate (~ 1,600--500 km) and smaller-scale vortices and filaments (~ 100 km). Here, we analyze Juno-infrared images with an unprecedented high-resolution of 10 km. We unveil a new dynamical regime associated with a significant energy source of convective origin that peaks at 100 km-scales and in which energy gets subsequently transferred upscale to the large circumpolar and polar cyclones. While this energy route has never been observed on another planet, it is surprisingly consistent with idealized studies of rapidly rotating Rayleigh-Bénard convection, lending robust theoretical support to our analyses. This energy route is expected to enhance the heat transfer from Jupiter’s hot interior to its troposphere and may also be relevant to the Earth’s atmosphere, helping us better understand the dynamics of our own planet.
Emergency Care of Sepsis in Sub-Saharan Africa: Incidence, Mortality and Non-Physician Clinician Management of Sepsis in rural Uganda from 2010 to 2019
Authors: Rice Brian , Calo Sal , Kamugisha John Bosco , Kamara Nicholas , Chamberlain Stacey , n/a Global Emergency Care Investigator Study Group
Published: May 2021

Introduction:Little data exists from sub-Saharan Africa describing incidence and outcomes of sepsis in emergency units and uncertainty exists surrounding optimal management of sepsis in low-income settings. There exists limited data regarding quality care metrics for non-physician clinicians trained in emergency care.Methods:Data were obtained for patients seen from 2010-2019 in a rural Ugandan emergency unit staffed by non-physician clinicians. Sepsis was defined as suspected infection with a qSOFA score ≥ 2. Descriptive analysis was performed and a multi-variable logistic regression mortality model was created. Analysis included Wilcoxon rank-sum test, t-test, one-way ANOVA, and Fisher’s exact test.Results:Overall, 48,653 patient visits from 2010-2019 yielded 17,490 encounters for patients age≥18 who had suspected infection, including 3,323 with sepsis. Overall sepsis incidence from 2010 to 2019 decreased from 16.4% to 4.7%, and malarial sepsis incidence decreased from 4.3% to 0.1%. From 2012 to 2019, the proportion of septic patients receiving quality care (both fluids and anti-infectives) increased from 36.2% to 44.7% but observed mortality rates for non-malarial sepsis increased from 6.3% to 14.9% and predicted mortality rates increased from 8.8% to 12.0%. Higher qSOFA scores were significantly associated with higher rates of both interventions and mortality. All interventions for non-malarial sepsis were independently associated with increased relative risks for death: “fluids alone” RR=1.22 [95%CI 0.57 – 1.87]; “antibiotics alone” RR=1.25 [95%CI 0.60 – 1.91]; “both fluids and antibiotics”: RR=1.85 [95%CI 1.02 – 2.69]. Conclusion: The largest study of sepsis management and outcomes ever published in both Uganda and sub-Saharan Africa showed decreasing incidence, increasing quality of non-physician clinician care and increasing predicted and observed mortality from 2010 to 2019. With causal associations between antibiotics and mortality deemed implausible, associations between sepsis mortality and interventions likely represent confounding by indication. Defining optimal sepsis care regionally will likely require randomized controlled trials.
WITHDRAWN: Reduction in Microbial Manifestation on In Vitro Culture of Eucalyptus Microcorys
Authors: Atala Laura Ribeiro , Faria Júlio Cézar Tannure , Molinari Letícia V , Avelar Maria Lopes Martins , Brondani Gilvano Ebling
Published: May 2021

Micropropagation is one of the main applications of tissue culture of plants. It allows rejuvenation and, consequently, improves explant rooting of woody species. However, one of its main problems is the risk of microbial manifestation. Here, we aimed to evaluate the survival and the reduction in microbial manifestations on in vitro cultures of Eucalyptus microcorys with the addition of chemical agents (sodium hypochlorite or streptomycin) to WPM culture medium. We used in vitro cultivated explants from adventitious shoots from two E. microcorys mother plants, over at 44 years-old. We drew from the multiplication phase explants with clumps of 8 to 12 shoots that displayed bacterial manifestation and submitted them to microbe control, adding different chemical agents at different concentrations to the culture medium: sodium hypochlorite (NaClO) and the antibiotic streptomycin. The results indicated that the best concentrations to reduce the manifestation of microorganisms on in vitro cultivation were 100 mg L− 1 of streptomycin and sodium hypochlorite with 0.003% of active chlorine, since these concentrations maintained 100% of the explants alive and reduced microbial manifestation more efficiently.
Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study
Authors: Shah Ashka , Knecht Lauren , Jacobson Cameron , Runnels Sean , Presson Angela , Zhang Chong , Durnford Kathryn
Published: May 2021

Difficult intubations can require advanced intubation techniques. Studies point to potential advantages of combined techniques using video laryngoscopes (VL) and dynamic stylets for anticipated difficult intubations. This study is designed to compare combined techniques to awake and asleep fiberoptic (FOB) techniques.Methods: 138,387 consecutive anaesthesia cases were reviewed for use of: FOB awake, FOB asleep, or combined technique (VL for visualization and either a FOB or a novel TCITM articulating introducer ((TCITM; Through The Cords, LLC; Salt Lake City, UT)) as dynamic stylets as a primary approach for anticipated difficult intubations. Primary end points measured: first attempt success rate, failure to intubate with the primary technique, “in-room to intubation’ time, reported traumatic intubation rate, and reported ease of intubation.Results: Significant differences were found between techniques. First pass success rate was highest in combined techniques (either VL + FOB or VL + TCITM) (88.7%) followed by FOB awake (74.2%, P<0.001) and FOB asleep (80.7%, P=0.06). “Failure to intubate with the primary technique” was lowest in combined techniques (1.8%) followed by FOB asleep (4.6%, P=0.11) and FOB awake (9.2%, P=0.002). “In room to intubated” time was fastest in combined techniques (13.0 minutes) followed by FOB asleep (15.1 minutes, P=0.002) and FOB awake (21.2 minutes, P<0.001). Combined techniques were rated as ‘easy’ more often (72%) followed by FOB asleep (62.9%, P=0.12) and FOB awake (38.2%, P<0.001). Combined techniques were rated as “atraumatic” more often (91.1%) followed by FOB asleep (89.4%, P=0.91) and FOB awake (75.8%, P<0.001). In subgroup analysis of combined techniques, VL + TCITM had the highest first attempt success rate (90.2%), lowest failure rate (1%, P=0.56), and shortest “in room to intubated time” (12.1 minutes, P=0.12). It was also rated as "easy” (83.3%, P<0.001), and “atraumatic“ (96.1%, P=0.009) more often than VL + FOB, FOB awake or FOB asleep.Conclusions: Combined techniques outperformed FOB techniques in terms of effectiveness, speed, ease of use, and patient injury in patients with risk factors for difficult intubation. As a sub-group of combined technique, VL + TCITM outperformed all other techniques. Combined techniques should be considered when managing difficult intubations.
Analysis of Three-Dimensional Flow Field Inside the Pilot Stage of the Deflector Jet Servo Valve
Authors: Li Shuanglu , Yin YaoBao , Yuan JiaYang , Guo ShengRong
Published: May 2021

Current two-dimensional flow field model has some defects in describing the pilot stage’s flow field and static characteristics of the deflector jet servo valve(DJSV) because the three-dimensional(3D) jet of the flow field is ignored. In order to overcome the shortcomings, a new flow field model is proposed and the energy transfer process of the pilot stage is obtained. In this model, the flow field is divided into five regions: pressure jet region, free jet region, mixed collision region, secondary jet region and pressure recovery region. Especially, three-dimensional turbulent jet is adopted in the free jet region for the first time to describe the structure of the flow field, and the jet entrainment model is proposed in pressure recovery region to describe the coupling relationship between the pressure in the receiving chamber and the jet flow which has never been considered before. The static characteristics of the pilot stage, such as pressure-flow characteristics, pressure characteristics and flow characteristics are obtained, and the relationship between zero-position valve coefficients and the key structural parameters of the pilot stage is analyzed. The results show that main structural parameters that affect the pressure gain include the length of receiving chamber, the width of guide groove outlet and the width of the wedge; The thickness of jet-pan has the most significant influence on flow gain. The flow field structure and the static characteristics are verified respectively by finite element analysis(FEA) and experimental results, and the results show that the pilot stage mathematical model has good reliability which is beneficial to understand the working mechanism of the pilot stage provide theoretical basis for parameter optimization.
In-depth Insights into Alzheimer's Disease by using Explainable Machine Learning Approach - Existing Hypothesis Confronted
Authors: Bogdanovic Bojan , Eftimov Tome , Simjanoska Monika
Published: May 2021

Background: Alzheimer's disease is still a field of research with lots of open questions. The complexity of the disease prevents the early diagnosis before visible symptoms regarding the individual's cognitive capabilities occur. This research presents an in-depth analysis of a huge data set encompassing medical, cognitive and lifestyle's measurements from more than 12,000 individuals. Several hypothesis were established whose validity has been questioned considering the obtained results.Methods: The importance of appropriate experimental design is highly stressed in the research. Thus, a sequence of methods for handling missing data, redundancy, data imbalance, and correlation analysis have been applied for appropriate preprocessing of the data set, and consequently Random Forest and XGBoost models have been trained and evaluated with special attention to the hyperparameters tuning. Both of the models were explained by using the Shapley values produced by the SHAP method.Results: XGBoost produced the best f1-score of 0.84 and as such is considered to be highly competitive among those published in the literature. This achievement, however, was not the main contribution of this paper. This research's goal was to perform global and local interpretability of both the intelligent models and derive valuable conclusions over the established hypothesis. Those methods led to a single scheme which presents either positive, or, negative influence of the values of each of the features whose importance has been confirmed by means of Shapley values. This scheme might be considered as additional source of knowledge for the physicians and other experts whose concern is the exact diagnosis of early stage of Alzheimer's disease.Conclusion: The conclusions derived from the intelligent models interpretability rejected all the established hypothesis. This research clearly showed the importance of Machine learning explainability approach that opens the black box and clearly unveils the relationships among the features and the diagnoses.
Vesicle shape transformations driven by confined active filaments
Authors: Peterson Matthew , Baskaran Aparna , Hagan Michael
Published: May 2021

In active matter systems, deformable boundaries provide a mechanism to organize internal active stresses and perform work on the external environment. To study a minimal model of such a system, we perform particle-based simulations of an elastic vesicle containing a collection of polar active filaments. The interplay between the active stress organization due to interparticle interactions and that due to the deformability of the confinement leads to a variety of filament spatiotemporal organizations that have not been observed in bulk systems or under rigid confinement, including highly-aligned rings and caps. In turn, these filament assemblies drive dramatic and tunable transformations of the vesicle shape and its dynamics. We present simple scaling models that reveal the mechanisms underlying these emergent behaviors and yield design principles for engineering active materials with targeted shape dynamics.
The Influence of Direct Radiative Forcing Versus Indirect Sea Surface Temperature Warming on Southern Hemisphere Subtropical Anticyclones Under Global Warming
Authors: Fahad Abdullah A. , Burls Natalie J.
Published: May 2021

Southern hemisphere subtropical anticyclones are projected to change in a warmer climate during both austral summer and winter. A recent study of CMIP 5 & 6 projections found a combination of local diabatic heating changes and static-stability-induced changes in baroclinic eddy growth as the dominant drivers. Yet the underlying mechanisms forcing these changes still remain uninvestigated. This study aims to enhance our mechanistic understanding of what drives these Southern Hemisphere anticyclones changes during both seasons. Using an AGCM, we decompose the response to CO2-induced warming into two components: (1) the fast atmospheric response to direct CO2 radiative forcing, and (2) the slow atmospheric response due to indirect sea surface temperature warming. Additionally, we isolate the influence of tropical diabatic heating with AGCM added heating experiments. As a complement to our numerical AGCM experiments, we analyze the Atmospheric and Cloud Feedback Model Intercomparison Project experiments. Results from sensitivity experiments show that slow subtropical sea surface temperature warming primarily forces the projected changes in subtropical anticyclones through baroclinicity change. Fast CO2 atmospheric radiative forcing on the other hand plays a secondary role, with the exception of the South Atlantic subtropical anticyclone in austral winter, where it opposes the forcing by sea surface temperature changes resulting in a muted net response. Lastly, we find that tropical diabatic heating changes only significantly influence Southern Hemisphere subtropical anticyclone changes through tropospheric wind shear changes during austral winter.
Phrenic nerve stimulation prevents diaphragm atrophy in patients with respiratory failure on mechanical ventilation
Authors: Soták Michal , Roubík Karel , Henlín Tomáš , Tyll Tomáš
Published: May 2021

Background: Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness.Methods: A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared.Results: The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001). Conclusions: Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness – the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning.