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Patients undergoing head and neck skeletal reconstruction (HNR) often require free tissue transfer from the extremities to ensure proper restoration of form and function. This requires a team-based, highly reliable medical system centered around the patient needs. Surgical intervention across multiple sites and harvesting of donor tissue results in short- and long-term physical impairments. There is a paucity of research objectively measuring impairments resulting from the graft donor site. There is a lack of research that objectively measures impairments and protocols for the management of these patients postoperatively. Patients undergo little, if any, formal approach to dealing with the vast impairments, which are sequelae to this surgery. This leads to large discrepancies in proposed functional progressions, return to duty timelines, and utilization of rehabilitative resources. At a major military medical center, an innovative clinical care pathway for patients undergoing HNR using free tissue transfer was implemented using a multidisciplinary model that focuses on early engagement with rehabilitation. This model, paired with a single surgery, will attempt to return service members to duty months earlier than the traditional approach. This report describes the conceptual framework and implementation of a new criteria-based, multidisciplinary clinical care pathway for HNR patients. The collaboration amongst the multidisciplinary care team has optimized the holistic health of the patient and communication with their support network, yielding faster return to normalization of daily life activities. The long-term goal is to further develop and formalize this pathway to best serve this patient population.
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Objective: To evaluate the effects of obesity on the incidence of postoperative pulmonary complications (PPCs) following laparoscopic colorectal surgery. Methods: A total of 150 patients with pathological diagnosis of colorectal cancer who accepted laparoscopic colorectal excision from January to May 2023 were retrospectively recruited. All the patients scored 26 points or more in the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) model, making them all in intermediate to high risks of PPCs. Patients were divided into obesity group and non-obesity group depending on whether they were obese or not. Propensity score matching (1â¶1) was performed to achieve the balance of clinicopathological characteristics with the matching factors of age, sex, respiratory complications and ARISCAT score. A total of 96 patients were eventually enrolled, with 48 patients in obesity group and 48 patients in non-obesity group. Besides, the patients were divided into 25°-30° Trendelenburg subgroup and ±10°-15° Trendelenburg subgroup according to surgical sites for further analysis. The incidence of PPCs, the intraoperative airway pressure and blood biomarker expression of lung injury, including soluble receptor for advanced glycation end products (sRAGE) and angiopoietin-2 (ANG2) at postoperative day (POD) 1 and POD3 between the two groups were compared. The relationship between obesity and incidence of PPCs within 30 postoperative days were analyzed with unifactorial Cox proportional hazard model. Results: The obesity group was comprised of 35 males and 13 females with a median age of 60 (49, 69) years, and the non-obesity group was comprised of 35 males and 13 females with a median age of 60 (52, 67) years. The incidence of PPCs was 50.0% (24/48) in the obesity group, which was higher than 20.8% (10/48) in the non-obesity group and the incidence of grade â PPCs and microatelectasis were 31.3% (15/48) and 33.3% (16/48), higher than the 12.5% (6/48) and 12.5% (6/48) of the non-obesity group (all P<0.05). The peak airway pressure (Ppeak) and plateau airway pressure (Pplat) of patients in obesity group were 34.0(31.5, 36.5) and 30.0(27.0, 32.0) cmH2O(1 cmH2O=0.098 kPa), which were significantly higher than the 26.0 (24.0, 29.5) and 22.0 (21.0, 26.5) cmH2O of the non-obesity group (all P<0.001). The ANG2 level of the obesity group at POD3 was 11.9 (8.4, 16.5) µg/L, which was higher than 9.2 (6.0, 12.3) µg/L of the non-obesity group (P=0.045). In 25°-30°Trendelenburg subgroup, the incidence of PPCs in obese patients were significantly higher than that of non-obese patients [41.4% (12/29) vs 11.4% (4/35), P=0.005]. In ±10°-15°Trendelenburg subgroup, no significant difference was found in PPCs incidence between obese and non-obese patients [63.2% (12/19) vs 46.2% (6/13), P=0.215]. The unifactorial Cox proportional hazard model analysis showed that obesity was a risk factor of PPCs in 30 postoperative days (HR=3.015, 95%CI: 1.438-6.321, P=0.001). Conclusion: In patients undergoing laparoscopic colorectal surgery with intermediate to high risk of PPCs, obesity raises intraoperative airway pressure and aggravates intraoperative lung endothelial injury. Obesity is a risk factor of PPCs in 30 postoperative days.
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Laparoscopía , Obesidad , Complicaciones Posoperatorias , Humanos , Obesidad/complicaciones , Masculino , Femenino , Laparoscopía/efectos adversos , Estudios Retrospectivos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Incidencia , Factores de Riesgo , Neoplasias Colorrectales/cirugía , Cirugía Colorrectal/efectos adversos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/epidemiología , Puntaje de Propensión , Persona de Mediana EdadRESUMEN
Objective: To evaluate the quality and item characteristics of the Brief Job Stress Questionnaire (BJSQ) among employees in manufacturing and service industries. Methods: From December 2021 to December 2022, a total of 2077 employees from 4 manufacturing and service enterprises in Beijing were selected by the method of combining purpose sampling and convenience sampling. The Chinese version of BJSQ was used to carry out a survey on occupational stress from 57 items in 4 dimensions including job stress factors, stress response, social support factors and satisfaction. Classical test theory (CTT) was used to analyze the validity and reliability of the questionnaire. The Semejima hierarchical response model in item response theory (IRT) was used to analyze the differentiation a, difficulty coefficient b and information content of each item. Results: Among the 2077 subjects, the age M (Q(1), Q(3)) was 33 (28, 37) years old, and the working age M (Q(1), Q(3)) was 4 (2, 8) years. There were 723 (34.8%) people in manufacturing industry and 1354 (65.2%) people in service industry. Eleven common factors were extracted by exploratory factor analysis, with a cumulative variance contribution rate of 62.823%, the variance of the common factors of each entry ranging from 0.451 to 0.865, and the range of factor loading values from 0.413 to 0.825, with 5 items having cross-loadings. The results of the validation factor analysis showed that the model fit indexes of root means square error of approximation was 0.055, comparative fit index was 0.950, Tucker Lewis index was 0.948, and standardized root mean square was 0.066. Content validity results showed that the total scores of the Chinese version of the BJSQ were positively correlated with the scores of the 4 dimensions (r(s)=0.487-0.936, P<0.05) . The results of the reliability analysis showed that the Cronbach's alpha coefficient for the total questionnaire was 0.945, and the Cronbach's alpha coefficients of job stress factors, stress response and social support factors were 0.775, 0.957, and 0.830, respectively. The Spearman-Brown coefficient for the total questionnaire was 0.866, and for the 3 dimensions, it was 0.572, 0.882 and 0.772. The results of IRT analysis showed that only 1 of the 57 items had a differentiation a-value<0.30, the difficulty coefficient b-value of each item ranged from -12.02 to 11.09, of which 8 items had a difficulty coefficient that was too high, 3 items had a difficulty coefficient that was too low, and 3 items did not meet the requirements, and the average amount of information in each item ranged from 0.022 to 2.566, and there were 47 items with average amount of information>0.088 (5/57) . Conclusion: The Chinese version of BJSQ has good reliability and validity in the typical occupational groups of manufacturing and service industries in China, and most of the items have good performance, but some items still need to be further improved and optimized or deleted.
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Estrés Laboral , Humanos , Encuestas y Cuestionarios , Estrés Laboral/psicología , Adulto , Reproducibilidad de los Resultados , Masculino , Femenino , Psicometría , Satisfacción en el Trabajo , Persona de Mediana Edad , Apoyo SocialRESUMEN
Objective: To investigate the effect of deep neuromuscular blockade (DNMB) combined with low pneumoperitoneum pressure anesthesia strategy on postoperative pain in patients undergoing laparoscopic colorectal surgery. Methods: This study was a randomized controlled trial. One hundred and twenty patients who underwent laparoscopic colorectal surgery at Cancer Hospital of Chinese Academy of Medical Sciences from December 1, 2022 to May 31, 2023 were selected and randomly divided into two groups by random number table method. Moderate neuromuscular blockade [train of four stimulations count (TOFC)=1-2] was maintained in patients of the control group (group C, n=60) and pneumoperitoneum pressure level was set at 15 mmHg(1 mmHg=0.133 kPa). DNMB [post-tonic stimulation count (PTC)=1-2] was maintained in patients of the DNMB combined with low pneumoperitoneum pressuregroup (group D, n=60) and pneumoperitoneum pressure level was set at 10 mmHg. The primary measurement was incidence of moderate to severe pain at 1 h after surgery. The secondary measurements the included incidence of moderate to severe pain at 1, 2, 3, 5 d and 3 months after surgery, the incidence of rescue analgesic drug use, the doses of sufentanil in analgesic pumps, surgical rating scale (SRS) score, the incidence of postoperative residual neuromuscular block, postoperative recovery [evaluated with length of post anesthesia care unit (PACU) stay, time of first exhaust and defecation after surgery and length of hospital stay] and postoperative inflammation conditions [evaluated with serum concentration of interleukin (IL)-1ß and IL-6 at 1 d and 3 d after surgery]. Results: The incidence of moderate to severe pain in group D 1 h after surgery was 13.3% (8/60), lower than 30.0% (18/60) of group C (P<0.05). The incidence of rescue analgesia in group D at 1 h and 1 d after surgery were 13.3% (8/60) and 4.2% (5/120), respectively, lower than 30.0% (18/60) and 12.5% (15/120) of group C (both P<0.05). The IL-1ß level in group D was (4.1±1.8)ng/L at 1 d after surgery, which was lower than (4.9±2.6) ng/L of group C (P=0.048). The IL-6 level in group D was (2.0±0.7)ng/L at 3 d after surgery, which was lower than (2.4±1.1) ng/L of group C (P=0.018). There was no significant difference in the doses of sufentanil in analgesic pumps, intraoperative SRS score, incidence of neuromuscular block residue, time spent in PACU, time of first exhaust and defecation after surgery, incidence of nausea and vomiting, and length of hospitalization between the two groups (all P>0.05). Conclusion: DNMB combined with low pneumoperitoneum pressure anesthesia strategy alleviates the early-stage pain in patients after laparoscopic colorectal surgery.
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Alquenos , Cirugía Colorrectal , Laparoscopía , Bloqueo Neuromuscular , Nitrocompuestos , Neumoperitoneo , Humanos , Bloqueo Neuromuscular/métodos , Sufentanilo , Cirugía Colorrectal/métodos , Interleucina-6 , Laparoscopía/métodos , Dolor Postoperatorio , AnalgésicosRESUMEN
Objective: To explore the relationship between gut microbiota and its metabolite dysregulation and postoperative cognitive dysfunction in elderly male C57BL/6J mice after laparotomy exploration. Methods: A total of 48 specific pathogen-free (SPF) male C57BL/6J mice, aged 16-17 months, were divided into two groups by random number table method: control group (n=24) and operation group (n=24). Mice in the operation group were induced with 1.4% isoflurane for 15 minutes, followed by a 10 minutes exploratory laparotomy anesthetized with 1.4% isoflurane and 100% oxygen, and anesthesia continued for 2 hours after surgery. Mice in control group were put in 100% oxygen for 2 hours. Feces and venous blood samples of both groups were collected 48 hours after surgery. Changes in the abundance and diversity of intestinal bacteria in the feces were detected by 16S rDNA gene sequencing. Functional changes of fecal metabolic profiles were detected by liquid chromatography tandem mass spectrometry (LC/MS) metabolomics and differential metabolite functions were analyzed. The serum level of interleukin (IL)-6, IL-1ß and tumor necrosis factor-α (TNF-α) were detected by Enzyme-linked immunosorbent assay (ELISA). The cognitive function of the mice was detected by Morris water maze test 3 days after operation. Results: The postoperative escape latency of mice in control group and operation group was (22.0±4.9) and (35.0±5.1) s, and the target quadrant residence time was (26.0±3.7) and (16.0±2.9) s, respectively. Compared with the control group, the postoperative escape latency of mice in the operation group was prolonged (P=0.035), and the residence time in the target quadrant was reduced (P=0.006). The difference of intestinal flora between the two groups was comparable. The expression levels of Escherichia coli, shigella and clostridium in the operation group were up-regulated, while the expression levels of rumen bacteria and butyricobacteria were down-regulated. Fecal metabolic profiles of mice in control group and operation group were obtained by LC/MS, and 14 and 21 different metabolites were screened in positive and negative ion modes, respectively. The different metabolites in positive ion mode were glutamic acid, 2-indoleic acid, kynuuric acid and glyceraldehyde. The negative ion pattern differential metabolites are methionine, aspartic acid, L-threonine, tyrosyl-threonine and 5-hydroxyindole-3-acetic acid. The identified differential metabolite pathways are mainly involved in amino acid, fatty acid and tryptophan metabolism and nucleotide synthesis. There were no significant differences in serum levels of IL-1ß, IL-6 and TNF-α between the two groups (all P>0.05). Conclusion: The dysregulated changes of gut microbiota and its metabolites are correlated with the occurrence of postoperative cognitive dysfunction in elderly male C57BL/6J mice. Anesthesia and surgery alter the structure of mice intestinal bacteria on the level of abundance, and change the metabolic balance and feces metabolomic phenotype.
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Microbioma Gastrointestinal , Isoflurano , Complicaciones Cognitivas Postoperatorias , Humanos , Masculino , Ratones , Animales , Anciano , Factor de Necrosis Tumoral alfa , Ratones Endogámicos C57BL , Laparotomía/efectos adversos , Interleucina-6 , Oxígeno , ARN Ribosómico 16SRESUMEN
Objective: To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF). Methods: 220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ(2) test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results: There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group (Pâ <â 0.05). Among the 220 ACLF cases, 158 (71.82%) were infected with the hepatitis B virus (HBV). The incidence rate of infection during hospitalization was 69.09% (152/220). The common sites of infection were intraabdominal (57.07%) and pulmonary infection (29.29%). Pearson correlation analysis showed that PNI and MELD-Na were negatively correlated (râ =â -0.150, Pâ <â 0.05). Multivariate logistic analysis results showed that low PNI score (OR=0.916, 95%CI: 0.865~0.970), ascites (OR=4.243, 95%CI: 2.237~8.047), and hepatorenal syndrome (OR=4.082, 95%CI : 1.106~15.067) were risk factors for ACLF co-infection (Pâ <â 0.05). The ROC results showed that the PNI curve area (0.648) was higher than the MELD-Na score curve area (0.610, Pâ <â 0.05). The effectiveness of predicting infection risk when PNI was combined with ascites and hepatorenal syndrome complications was raised. Patients with co-infections had a good predictive effect when PNI ≤ 40.625. The sensitivity and specificity were 84.2% and 41.2%, respectively. Conclusion: Low PNI score and ACLF co-infection have a close correlation. Therefore, PNI has a certain appraisal value for ACLF co-infection.
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Insuficiencia Hepática Crónica Agudizada , Coinfección , Síndrome Hepatorrenal , Humanos , Insuficiencia Hepática Crónica Agudizada/diagnóstico , Evaluación Nutricional , Pronóstico , Síndrome Hepatorrenal/complicaciones , Ascitis/complicaciones , Estudios Retrospectivos , Virus de la Hepatitis B , Curva ROCRESUMEN
Methane (CH4) is a potent gas produced by ruminants, and new measurement techniques are required to generate large datasets suitable for genetic analysis. One such technique are portable accumulation chambers (PAC), a short-term sampling method. The objectives of the current study were to explore the relationship between CH4 and carbon dioxide (CO2) output measured using both PAC and respiration chambers (RC) in growing lambs, and separately investigate the relationship among CH4, CO2 and measured ad libitum DM intake (DMI). Methane, CO2 and DMI were measured on 30 Suffolk and 30 Texel ewe lambs (age 253 ± 12 days) using the RC and PAC sequentially. The experiment was conducted over a 14-day period, with DMI measured from days 1 to 14; measurements in RC were conducted from days 10 to 12, while measurements in PAC were taken twice, the day immediately prior to the lambs entering the RC (day 9; PAC Pre-RC) and on the day lambs exited the RC (day 13; PAC Post-RC). Greater CH4 and CO2 output was measured in the RC than in the PAC (P < 0.01); similarly mean CH4 yield was greater when measured in the RC (15.39 ± 0.452 g CH4/kg DMI) compared to PAC (8.01 ± 0.767 g CH4/kg DMI). A moderate correlation of 0.37 was found between CH4 output measured in PAC Pre-RC and the RC, the corresponding regression coefficient of CH4 output measured in the RC regressed on CH4 output measured in PAC Pre-RC was close to unity (0.74; SE 0.224). The variance of CH4 and CO2 output within the measurement technique did not differ from each other (P > 0.05). Moderate to strong correlations were found between CH4 and CO2 per kg of live weight and CH4 and CO2 yield. Results from this study highlight the suitability of PAC as a ranking tool to rank animals based on their gaseous output when compared to the RC. However, repeated measurements separated by several days may be beneficial if precise rankings are required. Given the close to unity regression coefficient of CH4 output measured in the RC regressed on CH4 output measured in PAC Pre-RC suggests that PAC could also be potentially used to estimate absolute CH4 output; however, further research is required to substantiate this claim. When DMI is unknown, CH4 and CO2 per kg of live weight are a suitable alternative to the measurement of CH4 and CO2 yield.
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Dióxido de Carbono , Gases de Efecto Invernadero , Metano , Animales , Dióxido de Carbono/análisis , Dióxido de Carbono/metabolismo , Metano/metabolismo , Gases de Efecto Invernadero/análisis , Femenino , Ovinos/fisiologíaRESUMEN
Resting-state functional connectivity is a promising tool for understanding and characterizing brain network architecture. However, obtaining uninterrupted long recording of resting-state data is challenging in many clinically relevant populations. Moreover, the interpretation of connectivity results may heavily depend on the data length and functional connectivity measure used. We compared the performance of three frequency-domain connectivity measures: magnitude-squared, wavelet and multitaper coherence; and the effect of data length ranging from 3 to 9 minutes. Performance was characterized by distinguishing two groups of channel pairs with known different connectivity strengths. While all methods considered improved the ability to distinguish the two groups with increasing data lengths, wavelet coherence performed best for the shortest time window of 3 minutes. Knowledge of which measure is more reliably used when shorter fNIRS recordings are available could make the utility of functional connectivity biomarkers more feasible in clinical populations of interest.
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Mapeo Encefálico , Encéfalo , Encéfalo/diagnóstico por imagen , Mapeo Encefálico/métodos , Análisis EspectralRESUMEN
Background: This study compares the arthroscopic shaver and liposuction with other established methods for treatment of adolescent gynecomastia. Methods: Surgical management was via four operative techniques: open excision, open excision/liposuction, arthroscopic shaver/liposuction, or open excision and free nipple graft. Data were collected and compared using independent t tests, linear regression models, and one-way analysis of variance. Results: Patients were stratified by Rohrich grades I -II (low) (N = 47) or III -IV (high) (N = 13). The groups were similar in age (P = 0.662) with lower BMI in the low-grade group (xÌ = 25.36 ± 2.1) vs. high-grade group (xÌ = 27.62 ± 4.0; P < 0.001). The low-grade group showed no significant difference in operative time across surgical techniques with decreased mean operative time in the high-grade group using the arthroscopic shaver technique (xÌ = 55.8 ± 7.56) compared with open excision (xÌ = 70.83 ± 11.02, P = 0.04), open excision plus liposuction (xÌ = 89.5 ± 24.93, P = 24.93), and open excision plus free nipple graft (xÌ = 81.67 ± 19.11, P = 0.05). There was no significant difference in complication (P = 0.84) or reoperation (P = 0.68) rates across surgical techniques regardless of grade. Conclusions: These findings suggest that the arthroscopic shaver is safe and effective for treatment of both low- and high-grade gynecomastia in adolescents. The results yielded a similar incidence of complications and reoperation across surgical techniques, and the arthroscopic shaver approach demonstrated a shorter operative time compared with other techniques for high-grade gynecomastia.
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OBJECTIVE: To compare the sedation profiles and the pharmacokinetic, pharmacodynamic and safety characteristics of ciprofol and propofol at 3 escalated dose levels in healthy Chinese male subjects. PATIENTS AND METHODS: Eighteen subjects were planned to be enrolled into 3 dose groups in turn: group 1 (ciprofol-0.4 mg/kg vs. propofol-2.0 mg/kg), group 2 (ciprofol-0.6 mg/kg vs. propofol-3.0 mg/kg) and group 3 (ciprofol-0.8 mg/kg vs. propofol-4.0 mg/kg). They were randomly assigned into a ciprofol or propofol group in a ratio of 1:1, with sequences of ciprofol-propofol or propofol-ciprofol, separated with a washout period of at least 48 h. RESULTS: A total of 19 subjects were enrolled and 18 completed the trial. The median time to being fully alert after induction by ciprofol was longer than for propofol. The bispectral index (BIS) recovered significantly slower with ciprofol than with propofol 5 min and 10 min after reaching its lowest points. Systolic blood pressure (group 1: p=0.041; group 2: p=0.015; group 3: p=0.004) and mean arterial pressures (group 1: p=0.026; group 2: p=0.015; group 3: p=0.004) measured by the area under the curve below the baseline during the 2 min after induction were significantly less for ciprofol compared to propofol, but a significant change in diastolic blood pressure was only observed in group 3 (p=0.002). Eighteen (100.0%) subjects experienced 47 ciprofol-related treatment emergent adverse events (TEAEs) and 17 (94.4%) subjects had 54 propofol-related TEAEs, which were mainly hypotension, involuntary movements, respiratory depression, and pain at the injection site with severity of grade 1 or 2. CONCLUSIONS: Ciprofol may be well tolerated at higher doses in the clinical practice and exhibited significantly different sedation profiles to propofol.
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Propofol , Masculino , Humanos , Propofol/efectos adversos , Estudios Cruzados , Voluntarios Sanos , Dolor , HemodinámicaRESUMEN
Objective.Blindness affects approximately 40 million people worldwide and has inspired the development of cortical visual prostheses for restoring sight. Cortical visual prostheses electrically stimulate neurons of the visual cortex to artificially evoke visual percepts. Of the 6 layers of the visual cortex, layer 4 contains neurons that are likely to evoke a visual percept. Intracortical prostheses therefore aim to target layer 4; however, this can be difficult due to cortical curvature, inter-subject cortical variability, blindness-induced anatomical changes in cortex, and electrode placement variations. We investigated the feasibility of using current steering to stimulate specific cortical layers between electrodes in the laminar column.Approach.We explored whether the multiunit neural activity peak can be manipulated between two simultaneously stimulating electrodes in different layers of the cortical column. A 64-channel, 4-shank electrode array was implanted into the visual cortex of Sprague-Dawley rats (n= 7) orthogonal to the cortical surface. A remote return electrode was positioned over the frontal cortex in the same hemisphere. Charge was supplied to two stimulating electrodes along a single shank. Differing ratios of charge (100:0, 75:25, 50:50) and separation distances (300-500µm) were tested.Results.Current steering across the cortical layers did not result in a consistent shift of the neural activity peak. Both single-electrode and dual-electrode stimulation induced activity throughout the cortical column. This contrasts observations that current steering evoked a controllable peak of neural activity between electrodes implanted at similar cortical depths. However, dual-electrode stimulation across the layers did reduce the stimulation threshold at each site compared to single-electrode stimulation.Significance.Multi-electrode stimulation is not suitable for targeted activation of layers using current steering. However, it can be used to reduce activation thresholds at adjacent electrodes within a given cortical layer. This may be applied to reduce the stimulation side effects of neural prostheses, such as seizures.
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Prótesis Visuales , Ratas , Animales , Electrodos Implantados , Estimulación Eléctrica/métodos , Ratas Sprague-Dawley , Potenciales Evocados VisualesRESUMEN
In the reach and saccade regions of the posterior parietal cortex (PPC), multiregional communication depends on the timing of neuronal activity with respect to beta-frequency (10-30 Hz) local field potential (LFP) activity, termed dual coherence. Neural coherence is believed to reflect neural excitability, whereby spiking tends to occur at a particular phase of LFP activity, but the mechanisms of multiregional dual coherence remain unknown. Here, we investigate dual coherence in the PPC of non-human primates performing eye-hand movements. We computationally model dual coherence in terms of multiregional neural excitability and show that one latent component, a multiregional mode, reflects shared excitability across distributed PPC populations. Analyzing the power in the multiregional mode with respect to different putative cell types reveals significant modulations with the spiking of putative pyramidal neurons and not inhibitory interneurons. These results suggest a specific role for pyramidal neurons in dual coherence supporting multiregional communication in PPC.
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Neuronas , Lóbulo Parietal , Animales , Potenciales de Acción/fisiología , Lóbulo Parietal/fisiología , Neuronas/fisiología , Células Piramidales/fisiologíaRESUMEN
Objective: To investigate the effects of human umbilical cord mesenchymal stem cells (hUCMSCs) combined with autologous Meek microskin transplantation on patients with extensive burns. Methods: The prospective self-controlled study was conducted. From May 2019 to June 2022, 16 patients with extensive burns admitted to the 990th Hospital of PLA Joint Logistics Support Force met the inclusion criteria, while 3 patients were excluded according to the exclusion criteria, and 13 patients were finally selected, including 10 males and 3 females, aged 24-61 (42±13) years. A total of 20 trial areas (40 wounds, with area of 10 cm×10 cm in each wound) were selected. Two adjacent wounds in each trial area were divided into hUCMSC+gel group applied with hyaluronic acid gel containing hUCMSCs and gel only group applied with hyaluronic acid gel only according to the random number table, with 20 wounds in each group. Afterwards the wounds in two groups were transplanted with autologous Meek microskin grafts with an extension ratio of 1â¶6. In 2, 3, and 4 weeks post operation, the wound healing was observed, the wound healing rate was calculated, and the wound healing time was recorded. The specimen of wound secretion was collected for microorganism culture if there was purulent secretion on the wound post operation. In 3, 6, and 12 months post operation, the scar hyperplasia in wound was assessed using the Vancouver scar scale (VSS). In 3 months post operation, the wound tissue was collected for hematoxylin-eosin (HE) staining to observe the morphological changes and for immunohistochemical staining to observe the positive expressions of Ki67 and vimentin and to count the number of positive cells. Data were statistically analyzed with paired samples t test and Bonferronni correction. Results: In 2, 3, and 4 weeks post operation, the wound healing rates in hUCMSC+gel group were (80±11)%, (84±12)%, and (92±9)%, respectively, which were significantly higher than (67±18)%, (74±21)%, and (84±16)% in gel only group (with t values of 4.01, 3.52, and 3.66, respectively, P<0.05). The wound healing time in hUCMSC+gel group was (31±11) d, which was significantly shorter than (36±13) d in gel only group (t=-3.68, P<0.05). The microbiological culture of the postoperative wound secretion specimens from the adjacent wounds in 2 groups was identical, with negative results in 4 trial areas and positive results in 16 trial areas. In 3, 6, and 12 months post operation, the VSS scores of wounds in gel only group were 7.8±1.9, 6.7±2.1, and 5.4±1.6, which were significantly higher than 6.8±1.8, 5.6±1.6, and 4.0±1.4 in hUCMSC+gel group, respectively (with t values of -4.79, -4.37, and -5.47, respectively, P<0.05). In 3 months post operation, HE staining showed an increase in epidermal layer thickness and epidermal crest in wound in hUCMSC+gel group compared with those in gel only group, and immunohistochemical staining showed a significant increase in the number of Ki67 positive cells in wound in hUCMSC+gel group compared with those in gel only group (t=4.39, P<0.05), with no statistically significant difference in the number of vimentin positive cells in wound between the 2 groups (P>0.05). Conclusions: The application of hyaluronic acid gel containing hUCMSCs to the wound is simple to perform and is therefore a preferable route. Topical application of hUCMSCs can promote healing of the autologous Meek microskin grafted area in patients with extensive burns, shorten wound healing time, and alleviate scar hyperplasia. The above effects may be related to the increased epidermal thickness and epidermal crest, and active cell proliferation.
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Quemaduras , Cicatriz , Femenino , Humanos , Masculino , Quemaduras/cirugía , Eosina Amarillenta-(YS) , Ácido Hialurónico/uso terapéutico , Hiperplasia , Antígeno Ki-67 , Estudios Prospectivos , Cordón Umbilical , Vimentina , Adulto Joven , Adulto , Persona de Mediana EdadRESUMEN
Objective.Hearing is an important sensory function that plays a key role in how children learn to speak and develop language skills. Although previous neuroimaging studies have established that much of brain network maturation happens in early childhood, our understanding of the developmental trajectory of language areas is still very limited. We hypothesized that typical development trajectory of language areas in early childhood could be established by analyzing the changes of functional connectivity in normal hearing infants at different ages using functional near-infrared spectroscopy.Approach.Resting-state data were recorded from two bilateral temporal and prefrontal regions associated with language processing by measuring the relative changes of oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) concentrations. Connectivity was calculated using magnitude-squared coherence of channel pairs located in (a) inter-hemispheric homologous and (b) intra-hemispheric brain regions to assess connectivity between homologous regions across hemispheres and two regions of interest in the same hemisphere, respectively.Main results.A linear regression model fitted to the age vs coherence of inter-hemispheric homologous test group revealed a significant coefficient of determination for both HbO (R2= 0.216,p= 0.0169) and HbR (R2= 0.206,p= 0.0198). A significant coefficient of determination was also found for intra-hemispheric test group for HbO (R2= 0.237,p= 0.0117) but not for HbR (R2= 0.111,p= 0.0956).Significance.The findings from HbO data suggest that both inter-hemispheric homologous and intra-hemispheric connectivity between primary language regions significantly strengthen with age in the first year of life. Mapping out the developmental trajectory of primary language areas of normal hearing infants as measured by functional connectivity could potentially allow us to better understand the altered connectivity and its effects on language delays in infants with hearing impairments.
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Encéfalo , Espectroscopía Infrarroja Corta , Niño , Humanos , Lactante , Preescolar , Espectroscopía Infrarroja Corta/métodos , Encéfalo/metabolismo , Mapeo Encefálico/métodos , Lenguaje , Hemoglobinas , Imagen por Resonancia MagnéticaRESUMEN
Objective: To explore the long-term efficacy of low-dose rituximab (RTX) treatment in patients with primary membranous nephropathy (PMN). Methods: Patients with biopsy-proven PMN who received low-dose RTX as initial or second-line regimen from August 2018 to May 2020 in the Department of Nephrology, Tianjin Medical University General Hospital were respectively enrolled. The clinical parameters of patients were urinary protein>3.5 g/24 h, serum albumin<30 g/L and estimated glomerular filtration rate (eGFR)>20 ml·min-1·(1.73 m2)-1. The treatment response of patients with PMN was observed during follow-up, and the remission rate of patients with urinary protein<8 g/24 h or ≥8 g/24 h, anti-PLA2R antibody<150 RU/ml or ≥150 RU/ml, eGFR≥ 60 ml·min-1·(1.73 m2)-1 or<60 ml·min-1·(1.73 m2)-1 were analyzed, respectively. Results: A total of 40 patients were enrolled, including 26 males and 14 females, aged (53±15) years. There were 14 patients received RTX as initial treatment and 26 patients as second-line therapy. The total median dose of RTX in the first course was 800 (425, 1 075) mg. The overall remission rate at the 1st, 3rd, 6th, 12th and 24th months were 12.5% (5/40), 17.5% (7/40), 47.5% (19/40), 57.5% (23/40), 60% (24/40), respectively. The median overall response time was 6.0 (3.0, 7.5) months. Two cases relapsed. Patients with remission (n=24) had a higher level of baseline eGFR [(93.9±28.0) vs (62.4±28.1) ml·min-1·(1.73 m2)-1, P=0.001), and a lower level of both urinary protein [5.9 (5.0, 6.5) vs 11.7 (8.6, 15.5) g/24 h, P<0.001] and anti-PLA2R antibody level [73 (29, 132) vs 453 (182, 950) RU/ml, P=0.004] than those without remission (n=16) 24 month after treatment. There was no statistically significant difference in the remission rate between initial and second-line treatment (P=0.101). Moreover, patients had a higher remission rate in urinary protein<8 g/24 h group (21/26 vs 3/14, P<0.001), anti-PLA2R antibody<150 RU/ml group (16/19 vs 5/16, P=0.002) and eGFR ≥ 60 ml·min-1·(1.73 m2)-1 group (22/29 vs 2/11, P=0.003). Conclusions: Low-dose RTX treatment in PMN is effective during long-term follow-up, and has a lower recurrence rate. The results also suggest that it is more suitable for patients with baseline urinary protein<8 g/24 h, anti-PLA2R antibody<150 RU/ml and eGFR≥ 60 ml·min-1·(1.73 m2)-1.
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Glomerulonefritis Membranosa , Femenino , Humanos , Masculino , Autoanticuerpos , Tasa de Filtración Glomerular , Glomerulonefritis Membranosa/tratamiento farmacológico , Glomerulonefritis Membranosa/metabolismo , Inmunosupresores/uso terapéutico , Receptores de Fosfolipasa A2 , Rituximab/uso terapéutico , Albúmina Sérica/uso terapéutico , Adulto , Persona de Mediana Edad , AncianoRESUMEN
Hyperalgesia is an occult complication during the treatment of cancer pain, not only related to opioids, but also pertaining to the tumor itself and cancer therapeutic drugs. Yet it is often ignored by clinicians. Patients with cancer pain who were treated with opioids often have sensory abnormalities presented with reduced pain threshold and increased sensitivity to nociceptive stimuli. This phenomenon is clinically called opioid-induced hyperalgesia (OIH). However, due to the complexity of pathogenesis and the lack of clinical diagnostic criteria, the pain management of cancer patients is still facing great challenges. Therefore, this article focuses on the clinical diagnosis, pathogenesis, prevention and treatment of hyperalgesia related to cancer pain treatment, in order to provide a basis for optimal use of opioids in the future.
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Dolor en Cáncer , Neoplasias , Humanos , Hiperalgesia/tratamiento farmacológico , Analgésicos Opioides/efectos adversos , Dolor en Cáncer/tratamiento farmacológico , Dolor , Manejo del Dolor , Neoplasias/complicacionesRESUMEN
Meningitis is a life-threatening disease. In order to reduce its threat to public health, the World Health Assembly indorsed a resolution in 2020 for urgent global action to prevent and control meningitis. Defeating Meningitis by 2030: a Global Roadmap was officially launched by the World Health Organization in 2021. We interpreted some key information of the roadmap from the aspects of coverage, objectives and pillar strategies, providing ideas for further strengthening the prevention and control of bacterial meningitis in China.
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Salud Global , Meningitis Bacterianas , China/epidemiología , Humanos , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/prevención & control , Organización Mundial de la SaludRESUMEN
Aim: To identify the key risk factors of intrauterine hepatitis B virus transmission (HBV) and its effect on the placenta and fetus. Methods: 425 infants born to hepatitis B surface antigen (HBsAg)-positive pregnant women who received combined immunization with hepatitis B immunoglobulin and hepatitis B vaccine between 2009 to 2015 were prospectively enrolled in this study. The intrauterine transmission situation was assessed by dynamic monitoring of infants HBV DNA load and quantitative HBsAg. Univariate and multivariate regression analysis was used to determine the high risk factors for intrauterine transmission. Stratified analysis was used to determine the relationship between maternal HBV DNA load and fetal distress. Transmission electron microscopy was used to observe HBV Effects on placental tissue. Results: HBV intrauterine infection rate was 2.6% (11/425). Multivariate analysis result showed that the maternal HBV DNA load was an independent risk factor for intrauterine infection among infants (P=0.011). Intrauterine infection and distress rate was significantly higher in infants with with maternal HBV DNA>106 IU/ml than those with HBV DNA <106 IU/ml (12.2% vs. 1.8%; χ2=11.275, P=0.006), and (24.4% vs. 16.0%, χ2=3.993, P=0.046). Transmission electron microscopy showed that mitochondrial edema, endoplasmic reticulum expansion and thicker basement membrane were apparent when the maternal HBV DNA>106 IU/ml than that of maternal HBV DNA<106 IU/ml (960 nm vs. 214 nm, Z=-2.782, P=0.005) in the placental tissue. Conclusion: Maternal HBV DNA>106 IU/ml is associated not only with intrauterine infection, but also with increased incidence of intrauterine distress and placental sub-microstructural changes, providing strong clinical and histological evidence for pregnancy avoidance and treatment in this population.
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Hepatitis B , Complicaciones Infecciosas del Embarazo , ADN Viral , Femenino , Sufrimiento Fetal/tratamiento farmacológico , Hepatitis B/prevención & control , Antígenos de Superficie de la Hepatitis B , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/genética , Humanos , Inmunoglobulinas/uso terapéutico , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Placenta , EmbarazoRESUMEN
Thirty-six ewes aged 18 months were assigned to one of three groups (n = 12) on the basis of faecal egg count (FEC) for rumen fluke; C: control (FEC = 0-5 epg), T: affected (FEC ≥ 6 epg) and treated, NT: affected (FEC ≥ 6 epg) and not treated. T ewes were treated with oxyclozanide 14 days prior to the trial commencing. Ewes were fed grass silage ad libitum. Digestibility crates and respiration chambers were used to measure feed digestibility and methane production. Dry matter intake (DMI), feed digestibility and CH4/DMI did not differ (P > 0.05) between treatments. However, CH4/live weight (LW) was significantly greater (P < 0.001) for NT ewes, while that of C and T ewes were similar. This study indicates that a high rumen fluke burden can increase methane emissions but only when expressed on a body weight basis (per kg LW). As the link between rumen fluke infection and methane production has not previously been investigated within the literature, these findings demonstrate the need for further research to better understand these relationships.
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Rumen , Trematodos , Alimentación Animal/análisis , Animales , Dieta/veterinaria , Digestión , Femenino , Fermentación , Lactancia , Metano/metabolismo , Metano/farmacología , Leche , Oxiclozanida/farmacología , OvinosRESUMEN
Nitrogen (N) excretion from livestock production systems is of significant environmental concern; however, few studies have investigated the effect of dietary CP concentration on N utilisation efficiency at different stages of lactation, and the interaction between dietary CP levels and stages of lactation on N utilisation. Holstein-Friesian dairy cows (12 primiparous and 12 multiparous) used in the present study were selected from a larger group of cows involved in a whole-lactation study designed to examine the effect of dietary CP concentration on milk production and N excretion rates at different stages of lactation. The total diet CP concentrations evaluated were 114 (low CP), 144 (medium CP) and 173 (high CP) g/kg DM, with diets containing (g/kg DM) 550 concentrates, 270 grass silage and 180 maize silage. During early (70-80â¯days), mid- (150-160â¯days) and late (230-240â¯days) lactation, the same 24 animals were transferred from the main cow house to metabolism units for measurements of feed intake, milk production and faeces and urine outputs. Diet had no effect on BW, body condition score, or milk fat, protein or lactose concentration, but DM intake, milk yield and digestibilities of DM, energy and N increased with increasing diet CP concentration. The effect of diet on milk yield was largely due to differences between the low and medium CP diets. Increasing dietary CP concentration significantly increased urine N/N intake and urine N/manure N, and decreased faecal N/N intake, milk N/N intake and manure N/N intake. Although increasing dietary CP level significantly increased urine N/milk yield and manure N/milk yield, differences in these two variables between low and medium CP diets were not significant. There was no significant interaction between CP level and stage of lactation on any N utilisation variable, indicating that the effects of CP concentration on these variables were similar between stages of lactation. These results demonstrated that a decrease in dietary CP concentration from high (173â¯g/kg DM) to medium level (144â¯g/kg DM) may be appropriate for Holstein-Friesian dairy cow to maintain milk production efficiency, whilst reducing both urine N and manure N as a proportion of N intake or milk production.