EXPRESS: Revisiting representativeness heuristic classic paradigms: Replication and extensions of nine experiments in Kahneman and Tversky (1972).

Kahneman and Tversky (1972) showed that when people make probability judgments, they tend to ignore relevant statistical information (e.g., sample size) and instead rely on a representativeness heuristic, whereby subjective probabilities are influenced by the degree to which a target is perceived as similar to (representative of) a typical example of the relevant population, class or category. Their paper has become a cornerstone in many lines of research and has been used to account for various biases in judgment and decision-making. Despite the impact this article has had on theory and practice, there have been no direct replications. In a pre-registered experiment (N = 623; Amazon MTurk on CloudResearch), we conducted a replication and extensions of nine problems from Kahneman and Tversky (1972). We successfully replicated eight out of the nine problems. We extended the replication by examining the consistency of heuristic responses across problems and by examining decision style as a predictor of participants' use of the representativeness heuristic. Materials, data, and code are available on: https://osf.io/nhqc4/.

Outcomes after deep brain stimulation for elderly versus non-elderly patients with Parkinson's disease.

INTRODUCTION: The decision to offer deep brain stimulation (DBS) to elderly patients with Parkinson's disease (PD) presents challenges due to higher perceived risks and uncertain long-term benefits. Here, we aimed to compare the outcomes after DBS for elderly versus non-elderly patients with PD. METHODS: We analyzed data from our institutional cohort and retrieved publicly available data through a systematic review. The exposure was age at DBS electrode insertion, which was defined as elderly (≥70 years old) and non-elderly (<70 years old). The outcomes examined were changes in the Movement Disorders Society-Parkinson's Disease Rating Scale (MDS-UPDRS) or UPDRS part III total score, levodopa-equivalent daily dose (LEDD), and adverse events. RESULTS: The included studies and our cohort comprised a total of 527 patients, with 111 (21.1 %) classified as elderly. There was no statistically significant difference in the change in MDS-UPDRS or UPDRS part III total score and generally no statistically significant difference in the change in LEDD between the elderly and non-elderly patients. Elderly patients had a higher incidence of wound infection (elderly 5.4 % vs non-elderly 1.9 %; p = 0.087) and inadequate wound healing (elderly 3.6 % vs non-elderly 1.4 %; p = 0.230), but this difference was not statistically significant. There was no significant difference in the incidence of mortality (elderly 0 % vs non-elderly 0 %; p = 1.000), stroke (elderly 0 % vs non-elderly 0.2 %; p = 1.000), and cognitive decline between the age groups. CONCLUSIONS: Notwithstanding the trend towards a higher risk of wound infection and inadequate wound healing, elderly patients have similar motor outcomes and levels of PD medication reduction as non-elderly patients after DBS for PD. Hence, age should not be used as the sole criterion for determining eligibility for DBS, and the decision to offer DBS to elderly patients should be personalized and made in a multidisciplinary setting, taking into consideration patient- and disease-related factors.

Accounting for adaptation when projecting climate change impacts on health: A review of temperature-related health impacts.

Exposure to high and low ambient temperatures can cause harm to human health. Due to global warming, heat-related health effects are likely to increase substantially in future unless populations adapt to living in a warmer world. Adaptation to temperature may occur through physiological acclimatisation, behavioural mechanisms, and planned adaptation. A fundamental step in informing responses to climate change is understanding how adaptation can be appropriately accounted for when estimating future health burdens. Previous studies modelling adaptation have used a variety of methods, and it is often unclear how underlying assumptions of adaptation are made and if they are based on evidence. Consequently, the most appropriate way to quantitatively model adaptation in projections of health impacts is currently unknown. With increasing interest from decisionmakers around implementation of adaptation strategies, it is important to consider the role of adaptation in anticipating future health burdens of climate change. To address this, a literature review using systematic scoping methods was conducted to document the quantitative methods employed by studies projecting future temperature-related health impacts under climate change that also consider adaptation. Approaches employed in studies were coded into methodological categories. Categories were discussed and refined between reviewers during synthesis. Fifty-nine studies were included and grouped into eight methodological categories. Methods of including adaptation in projections have changed over time with more recent studies using a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most common approaches to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were identified as using an intervention-based empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence.

Enhanced evanescent field via integration of a graphene oxide/poly(methyl methacrylate) hybrid film on coreless D-shaped fibers.

This study presents the implementation of an evanescent field (EF)-based sensing platform employing a hybrid film composed of graphene oxide (GO) and poly(methyl methacrylate) (PMMA), integrated onto coreless D-shaped fibers (cDsFs). The operational framework of the hybrid film-coated cDsFs (GoP-cDsFs) was comprehensively elucidated through theoretical and experimental analyses. To establish a baseline for comparison, the performance of the cDsFs with the sole inclusion of the PMMA film was investigated. Our investigations underscore the substantive role of graphene oxide in augmenting the evanescent field, thereby generating a synergistic effect that contributes to the overall enhancement of the evanescent field in the device. Consequently, the fabricated GoP-cDsF sensor manifests an outstanding sensitivity of -4.936 nm/°C, rendering it particularly well-suited for applications demanding high-sensitivity temperature sensing. Moreover, the unique attributes of the GoP-cDsF position it as a promising candidate for the measurement of both magnetic and electric fields, presenting an effective strategy for multifunctional sensing applications.

Awake versus Asleep Anesthesia in Deep Brain Stimulation Surgery for Parkinson's Disease: A Systematic Review and Meta-Analysis.

INTRODUCTION: Deep brain stimulation (DBS) is a well-established surgical therapy for patients with Parkinsons' Disease (PD). Traditionally, DBS surgery for PD is performed under local anesthesia, whereby the patient is awake to facilitate intraoperative neurophysiological confirmation of the intended target using microelectrode recordings. General anesthesia allows for improved patient comfort without sacrificing anatomic precision and clinical outcomes. METHODS: We performed a systemic review and meta-analysis on patients undergoing DBS for PD. Published randomized controlled trials, prospective and retrospective studies, and case series which compared asleep and awake techniques for patients undergoing DBS for PD were included. A total of 19 studies and 1,900 patients were included in the analysis. RESULTS: We analyzed the (i) clinical effectiveness - postoperative UPDRS III score, levodopa equivalent daily doses and DBS stimulation requirements. (ii) Surgical and anesthesia related complications, number of lead insertions and operative time (iii) patient's quality of life, mood and cognitive measures using PDQ-39, MDRS, and MMSE scores. There was no significant difference in results between the awake and asleep groups, other than for operative time, for which there was significant heterogeneity. CONCLUSION: With the advent of newer technology, there is likely to have narrowing differences in outcomes between awake or asleep DBS. What would therefore be more important would be to consider the patient's comfort and clinical status as well as the operative team's familiarity with the procedure to ensure seamless transition and care.

Application of deep learning in predicting suspended sediment concentration: A case study in Jiaozhou Bay, China.

Previous research methodologies for quantifying Suspended Sediment Concentration (SSC) have encompassed in-situ observations, numerical simulations, and analyses of remote sensing datasets, each with inherent constraints. In this study, we have harnessed Convolutional Neural Networks (CNNs) to create a deep learning model, which has been applied to the remote sensing data procured from the Geostationary Ocean Color Imager (GOCI) spanning April 2011 to March 2021. Our research indicates that on a small time scale, wind and hydrodynamic forces both have a significant impact on the prediction results of CNNs model. Considering both wind and hydrodynamic forces can effectively improve the model's prediction efficiency for SSC. Moreover, we have employed CNNs to interpolate absent values within the remote sensing datasets, yielding enhancements superior to those attained via linear or multivariate regression techniques. Finally, the correlation coefficient between CNN-derived SSC estimates for Jiaozhou Bay (JZB) and its corresponding remote sensing data is 0.72. Correlation coefficient and root mean square error differ in different regions. In the shallow water of JZB, due to water level changes, there is limited data, and the correlation coefficient in this area is about 0.5-0.6. In the central region of JZB with sufficient data, the correlation coefficient is generally higher than 0.75. Therefore, we believe that this CNNs model can be used to predict the hourly variation of SSC. When juxtaposed with alternative methodologies, the CNN approach is found to economize computational resources and enhance processing efficiency.

An aquaporin and an aquaglyceroporin have roles in low temperature adaptation of mosquitoes (Anopheles sinensis).

Mosquitoes (Anopheles sinensis), widely geographically distributed in Asia including China, are the primary vector of the malaria parasite Plasmodium vivax and other parasitic diseases such as Malayan filariasis. An. sinensis can survive through low winter temperatures. Aquaporin channels are found in all life forms, where they facilitate environmental adaptation by allowing rapid trans-cellular movement of water (classical aquaporins) or water and solutes such as glycerol (aquaglyceroporins). Here, we identified and characterized 2 aquaporin (AQP) homologs in An. sinensis: AsAQP2 (An. sinensis aquaglyceroporin) and AsAQP4 (An. sinensis aquaporin). When expressed in frog (Xenopus laevis) oocytes, AsAQP2 transported water, glycerol, and urea; AsAQP4 transported only water. Water permeation through AsAQP2 and AsAQP4 was inhibited by mercuric chloride. AsAQP2 expression was slightly higher in adult female mosquitoes than in males, and AsAQP4 expression was significantly higher in adult males. The 2 AsAQPs were highly expressed in Malpighian tubules and midgut. AsAQP2 and AsAQP4 expression was up-regulated by blood feeding compared with sugar feeding. At freezing point (0 °C), the AsAQP4 expression level increased and An. sinensis survival time reduced compared with those at normal temperature (26 °C). At low temperature (8 °C), the AsAQP2 and AsAQP4 expression levels decreased and survival time was significantly longer compared with those at 26 °C. These results suggest that AsAQP2 and AsAQP4 have roles in water homeostasis during blood digestion and in low temperature adaptation of A. sinensis. Together, our results show that the 2 AQPs are important for mosquito diuresis after blood feeding and when exposed to low temperatures.

Integrating Shared Socioeconomic Pathway-informed adaptation into temperature-related mortality projections under climate change.

The extent to which populations will successfully adapt to continued warming temperatures will be a crucial factor in determining future health burdens. Previous health impact assessments of future temperature-related mortality burdens mostly disregard adaptation or make simplistic assumptions. We apply a novel evidence-based approach to model adaptation that takes into account the fact that adaptation potential is likely to vary at different temperatures. Temporal changes in age-specific mortality risk associated with low and high temperatures were characterised for Scotland between 1974 and 2018 using temperature-specific RR ratios to reflect past changes in adaptive capacity. Three scenarios of future adaption were constructed consistent with the SSPs. These adaptation projections were combined with climate and population projections to estimate the mortality burdens attributable to high (above the 90th percentile of the historical temperature distribution) and low (below the 10th percentile) temperatures up to 2080 under five RCP-SSP scenarios. A decomposition analysis was conducted to attribute the change in the mortality burden into adaptation, climate and population. In 1980-2000, the heat burden (21 deaths/year) was smaller than the colder burden (312 deaths/year). In the 2060-2080 period, the heat burden was projected to be the highest under RCP8.5-SSP5 (1285 deaths/year), and the cold burden was the highest under RCP4.5-SSP4 (320 deaths/year). The net burden was lowest under RCP2.6-SSP1 and highest under RCP8.5-SSP5. Improvements in adaptation was the largest factor reducing the cold burden under RCP2.6-SSP1 whilst temperature increase was the biggest factor contributing to the high heat burdens under RCP8.5-SSP5. Ambient heat will become a more important health determinant than cold in Scotland under all climate change and socio-economic scenarios. Adaptive capacity will not fully counter projected increases in heat deaths, underscoring the need for more ambitious climate mitigation measures for Scotland and elsewhere.

Metagenomic analysis revealed the evolution of microbial communities, metabolic pathways, and functional genes in the heterotrophic nitrification-aerobic denitrification process under La3+ stress.

Trivalent lanthanum (La3+) exists widely in ammonia nitrogen (NH4+-N) tailing water from ionic rare earth mines; however, its effect on heterotrophic nitrification-aerobic denitrification (HN-AD) is unknown, thereby limiting the application of the HN-AD process in this field. In this study, we conducted an HN-AD process using a sequencing batch reactor (5 L) that was continuously operated to directly treat acidic (NH4)2SO4 wastewater (influent NH4+-N concentration of approximately 110 mg/L and influent pH of 5) containing different La3+ concentrations (0-100 mg/L). The NH4+-N removal efficiency of the reactor reached 98.25 % at a La3+ concentration of 100 mg/L. The reactor was in a neutral-to-alkaline environment, which favored La3+ precipitation and complexation. Metagenomic analysis revealed that the relative abundance of Thauera in the reactor remained high (88.62-92.27 %) under La3+ stress. The relative abundances of Pannonobacter and Hyphomonas significantly increased, whereas that of Azoarcus significantly decreased. Metabolic functions in the reactor were mainly contributed by Thauera, and the abundance of metabolic functions under low La3+ stress (≤5 mg/L) significantly differed from that under high La3+ stress (≥10 mg/L). The relative abundance of ammonia assimilation-related genes in the reactor was high and significantly correlated with ammonia removal. However, traditional ammonia oxidation genes were not annotated, and unknown ammonia oxidation pathways may have been present in the reactor. Moreover, La3+ stimulated amino acid biosynthesis and translocation, the citrate cycle, sulfur metabolism, and oxidative phosphorylation and promoted the overproduction of extracellular polymeric substances, which underwent complexation and adsorbed La3+ to reduce its toxicity. Our results showed that the HN-AD process had a strong tolerance to La3+, stable NH4+-N removal efficiency, the potential to recover La3+, and considerable application prospects in treating NH4+-N tailing water from ionic rare earth mines.

Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial-A Preliminary Study.

Spinal cord injury (SCI) is damage to any part of the spinal cord resulting in paralysis, bowel and/or bladder incontinence, and loss of sensation and other bodily functions. Current treatments for chronic SCI are focused on managing symptoms and preventing further damage to the spinal cord with limited neuro-restorative interventions. Recent research and independent clinical trials of spinal cord stimulation (SCS) or intensive neuro-rehabilitation including neuro-robotics in participants with SCI have suggested potential malleability of the neuronal networks for neurological recovery. We hypothesize that epidural electrical stimulation (EES) delivered via SCS in conjunction with mental imagery practice and robotic neuro-rehabilitation can synergistically improve volitional motor function below the level of injury in participants with chronic clinically motor-complete SCI. In our pilot clinical RESTORES trial (RESToration Of Rehabilitative function with Epidural spinal Stimulation), we investigate the feasibility of this combined multi-modal approach in restoring volitional motor control and achieving independent overground locomotion in participants with chronic motor complete thoracic SCI. Secondary aims are to assess the safety of this combination therapy including the off-label SCS usage as well as improving functional outcome measures. To our knowledge, this is the first clinical trial that investigates the combined impact of this multi-modal EES and rehabilitation strategy in participants with chronic motor complete SCI. Two participants with chronic motor-complete thoracic SCI were recruited for this pilot trial. Both participants have successfully regained volitional motor control below their level of SCI injury and achieved independent overground walking within a month of post-operative stimulation and rehabilitation. There were no adverse events noted in our trial and there was an improvement in post-operative truncal stability score. Results from this pilot study demonstrates the feasibility of combining EES, mental imagery practice and robotic rehabilitation in improving volitional motor control below level of SCI injury and restoring independent overground walking for participants with chronic motor-complete SCI. Our team believes that this provides very exciting promise in a field currently devoid of disease-modifying therapies.

Quantification of Particle Filtration Using a Quartz Crystal Microbalance Embedded in a Microfluidic Channel.

To quantify colloidal filtration, a quartz crystal microbalance (QCM) with a silicon dioxide surface is embedded on the inner surface of a microfluidic channel to monitor the real-time particle deposition. Potassium chloride solution with micrometer-size polystyrene particles simulating bacterial strains flows down the channel. In the presence of intrinsic Derjaguin-Landau-Verwey-Overbeek (DLVO) intersurface forces, particles are trapped by the quartz surfaces, and the increased mass shifts the QCM resonance frequency. The method provides an alternative way to measure filtration efficiency in an optically opaque channel and its dependence on the ionic concentration.

MOF Material-Derived Bimetallic Sulfide CoxNiyS for Electrocatalytic Oxidation of 5-Hydroxymethylfurfural.

The electrocatalytic conversion of biomass into high-value-added chemicals is one of the effective methods of green chemistry. Conventional metal catalysts have disadvantages, such as low atomic utilization and small surface areas. Catalyst materials derived from metal-organic frameworks (MOFs) have received much attention due to their unique physicochemical properties. Here, an MOF-derived non-precious metal CoxNiyS electrocatalyst was applied to the oxidation of biomass-derivative 5-hydroxymethylfurfural (HMF). The HMF oxidation reaction activities were modulated by regulating the content of Co and Ni bimetals, showing a volcano curve with an increasing proportion of Co. When the Co:Ni ratio was 2:1, the HMF conversion rate reached 84.5%, and the yield of the main product, 2,5-furandicarboxylic acid (FDCA), was 54%. The XPS results showed that the presence of high-valent nickel species after electrolysis, which further proved the existence and reactivity of NiOOH, as well as the synergistic effect of Co and Ni promoted the conversion of HMF. Increasing the content of Ni could increase the activity of HMF electrochemical oxidation, and increasing the content of Co could reduce the increase in the anodic current. This study has important significance for designing better HMF electrochemical catalysts in the future.

Lobectomy versus gross total resection for glioblastoma multiforme: A systematic review and individual-participant data meta-analysis.

Overall survival (OS)for glioblastoma multiforme (GBM) has a known association with the extent of tumor resection with gross total resection (GTR) typically considered as the upper limit. In certain regions such as the anterior temporal lobe, more extensive resection by means of a lobectomy may be feasible. In our systematic review and meta-analysis, we aimed to compare the outcomes of lobectomy and GTR for GBM. PubMed and Embase were queriedfor studies that compared the outcomes after lobectomy or GTR for GBM. The primary outcomes were OS, progression-free survival (PFS), and Karnofksy Performance Status (KPS) score at the latest follow-up. The secondary outcomes were seizure control at the latest follow-up and complication rates. Meta-analysis for OS and PFS was performed using individual-participant data reconstructed from published Kaplan-Meier curves. Random-effect meta-analysis was performed for KPS. The secondary outcomes were pooled using descriptive statistics. Of the 795 records screened, 6 were included in our study. Meta-analysis revealed that anterior temporal, frontal, or occipital lobectomy was associated with significantly better OS (p < 0.001) and PFS (p < 0.001) than GTR, but not KPS (MD = 6.37; 95% CI=(-13.80, 26.54); p = 0.536). Anterior temporal lobectomy was associated with significantly better seizure control rates than GTR for temporal GBM (OR = 27; 95% CI=(1.4, 515.9); p = 0.002). There was no statistically significant difference in complication rates between anterior temporal, frontal, or occipital lobectomy and GTR. In conclusion, lobectomy was associated with significantly better OS, PFS, and seizure control than GTR for GBM.

Neurostimulation for Chronic Pain: A Systematic Review of High-Quality Randomized Controlled Trials With Long-Term Follow-Up.

OBJECTIVE: This study aimed to review the best evidence on the long-term efficacy of neurostimulation for chronic pain. MATERIALS AND METHODS: We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the data bases and July 21, 2022. Randomized controlled trials (RCTs) with a minimum of one-year follow-up that were of high methodologic quality as ascertained using the Delphi list criteria were included in the evidence synthesis. The primary outcome was long-term reduction in pain intensity, and the secondary outcomes were all other reported outcomes. Level of recommendation was graded from I to III, with level I being the highest level of recommendation. RESULTS: Of the 7119 records screened, 24 RCTs were included in the evidence synthesis. Therapies with recommendations for their usage include pulsed radiofrequency (PRF) for postherpetic neuralgia, transcutaneous electrical nerve stimulation for trigeminal neuralgia, motor cortex stimulation for neuropathic pain and poststroke pain, deep brain stimulation for cluster headache, sphenopalatine ganglion stimulation for cluster headache, occipital nerve stimulation for migraine, peripheral nerve field stimulation for back pain, and spinal cord stimulation (SCS) for back and leg pain, nonsurgical back pain, persistent spinal pain syndrome, and painful diabetic neuropathy. Closed-loop SCS is recommended over open-loop SCS for back and leg pain. SCS is recommended over PRF for postherpetic neuralgia. Dorsal root ganglion stimulation is recommended over SCS for complex regional pain syndrome. CONCLUSIONS: Neurostimulation is generally effective in the long term as an adjunctive treatment for chronic pain. Future studies should evaluate whether the multidisciplinary management of the physical perception of pain, affect, and social stressors is superior to their management alone.

[Active components and mechanism of Jinwugutong Capsules in treatment of osteoporosis: a study based on UPLC-Q-Exactive-MS/MS combined with network pharmacology].

UPLC-Q-Exactive-MS/MS and network pharmacology were employed to preliminarily study the active components and mechanism of Jinwugutong Capsules in the treatment of osteoporosis. Firstly, UPLC-Q-Exactive-MS/MS was employed to characterize the chemical components of Jinwugutong Capsules, and network pharmacology was employed to establish the "drug-component-target-pathway-disease" network. The key targets and main active components were thus obtained. Secondly, AutoDock was used for the molecular docking between the main active components and key targets. Finally, the animal model of osteoporosis was established, and the effect of Jinwugutong Capsules on the expression of key targets including RAC-alpha serine/threonine-protein kinase(AKT1), albumin(ALB), and tumor necrosis factor-alpha(TNF-α) was determined by enzyme-linked immunosorbent assay(ELISA). A total of 59 chemical components were identified from Jinwugutong Capsules, among which coryfolin, 8-prenylnaringenin, demethoxycurcumin, isobavachin, and genistein may be the main active components of Jinwugutong Capsules in treating osteoporosis. The topological analysis of the protein-protein interaction(PPI) network revealed 10 core targets such as AKT1, ALB, catenin beta 1(CTNNB1), TNF, and epidermal growth factor receptor(EGFR). The Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment showed that Jinwugutong Capsules mainly exerted the therapeutic effect by regulating the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT) signaling pathway, neuroactive ligand-receptor interaction, mitogen-activated protein kinase(MAPK) signaling pathway, Rap1 signaling pathway and so on. Molecular docking showed that the main active components of Jinwugutong Capsules well bound to the key targets. ELISA results showed that Jinwugutong Capsules down-regulated the protein levels of AKT1 and TNF-α and up-regulated the protein level of ALB, which preliminarily verified the reliability of network pharmacology. This study indicates that Jinwugutong Capsules may play a role in the treatment of osteoporosis through multiple components, targets, and pathways, which can provide reference for the further research.

Degradation of the Novel Heterocyclic Insecticide Pyraquinil in Water: Kinetics, Degradation Pathways, Transformation Products Identification, and Toxicity Assessment.

As new pesticides are continuously introduced into agricultural systems, it is essential to investigate their environmental behavior and toxicity effects to better evaluate their potential risks. In this study, the degradation kinetics, pathways, and aquatic toxicity of the new fused heterocyclic insecticide pyraquinil in water under different conditions were investigated for the first time. Pyraquinil was classified as an easily degradable pesticide in natural water, and hydrolyzes faster in alkaline conditions and at higher temperatures. The formation trends of the main transformation products (TPs) of pyraquinil were also quantified. Fifteen TPs were identified in water using ultrahigh-performance liquid chromatography coupled to quadrupole Orbitrap high-resolution mass spectrometry (UHPLC-Orbitrap-HRMS) and Compound Discoverer software, which adopted suspect and nontarget screening strategies. Among them, twelve TPs were reported for the first time and 11 TPs were confirmed by synthesis of their standards. The proposed degradation pathways have demonstrated that the 4,5-dihydropyrazolo[1,5-a]quinazoline skeleton of pyraquinil is stable enough to retain in its TPs. ECOSAR prediction and laboratory tests showed that pyraquinil was "very toxic" or "toxic" to aquatic organisms, while the toxicities of all of the TPs are substantially lower than that of pyraquinil except for TP484, which was predicted to pose a higher toxicity. The results are important for elucidating the fate and assessing the environmental risks of pyraquinil, and provide guidance for scientific and reasonable use.

Adverse Events and Complications Associated With Vagal Nerve Stimulation: An Analysis of the Manufacturer And User Facility Device Experience Database.

OBJECTIVE: Drug-resistant epilepsy (DRE) can have devastating consequences for patients and families. Vagal nerve stimulation (VNS) is used as a surgical adjunct for treating DRE not amenable to surgical resection. Although VNS is generally safe, it has its inherent complications. With the increasing number of implantations, adequate patient education with discussion of possible complications forms a critical aspect of informed consent and patient counseling. There is a lack of large-scale reviews of device malfunction, patient complaints, and surgically related complications available to date. MATERIALS AND METHODS: Complications associated with VNS implants performed between 2011 and 2021 were identified through a search of the United States Food and Drug Administration Manufacturer And User Facility Device Experience (MAUDE) data base. We found three models on the data base, CYBERONICS, INC pulse gen Demipulse 103, AspireSR 106, and SenTiva 1000. The reports were classified into three main groups, "Device malfunction," "Patient complaints," and "Surgically managed complications." RESULTS: A total of 5888 complications were reported over the ten-year period, of which 501 reports were inconclusive, 610 were unrelated, and 449 were deaths. In summary, there were 2272 reports for VNS 103, 1526 reports for VNS 106, and 530 reports for VNS 1000. Within VNS 103, 33% of reports were related to device malfunction, 33% to patient complaints, and 34% to surgically managed complications. For VNS 106, 35% were related to device malfunction, 24% to patient complaints, and 41% to surgically managed complications. Lastly, for VNS 1000, 8% were device malfunction, 45% patient complaints, and 47% surgically managed complications. CONCLUSION: We present an analysis of the MAUDE data base for adverse events and complications related to VNS. It is hoped that this description of complications and literature review will help promote further improvement in its safety profile, patient education, and management of both patient and clinician expectations.

Performance changes in the anammox process under the stress of rare-earth element Ce(III) and the evolution of microbial community and functional genes.

The high Ce(III) content in ionic rare-earth tailings wastewater has hindered the application of anammox process in this field. Here, the effect of Ce(III) on the performance of anammox processes was investigated, and the evolution of microbial communities and functional genes was explored using metagenomic sequencing. The results showed that the reactor nitrogen removal rate decreased when the Ce(III) concentration reached 25 mg/L, although ammonia nitrogen removal (92.31%) and nitrogen removal efficiency (81.33%) remained at a high level; however, both showed a significant decreasing trend. The relative abundance of anammox bacteria increased continuously from P1-P5, reaching 48.81%, whereas the relative abundance of Candidatus jettenia reached 33.71% at P5, which surpassed that of Candidatus brocadia as the most abundant anammox bacteria, and further analysis of functional genes and metabolic pathways revealed that Candidatus brocadia was richer in biochemical metabolic genes, whereas Candidatus jettenia had richer efflux genes.