High intraoperative fluid load associated with prolonged length of hospital stay and complications after non-cardiac surgery in neonates.

Inappropriate perioperative fluid load can lead to postoperative complications and death. This retrospective study was designed to investigate the association between intraoperative fluid load and outcomes in neonates undergoing non-cardiac surgery. From April 2020 to September 2022, 940 neonates who underwent non-cardiac surgery were retrospectively enrolled and their perioperative data were harvested for further analysis. According to recorded intraoperative fluid volumes defined as ml.kg-1 h-1, patients were mandatorily divided into quintile with fluid load as restrictive (quintile 1, Q1), moderately restrictive (Q2), moderate (Q3), moderately liberal (Q4), and liberal (Q5). The primary outcomes were defined as prolonged length of hospital stay (LOS) (postoperative LOS ≥ 14 days), complications beyond prolonged LOS, and 30-day mortality. Secondary outcomes included postoperative complications within 14 days of hospital stay. The intraoperative fluid load was in Q1 of 6.5 (5.3-7.3) (median and IQR); Q2: 9.2 (8.7-9.9); Q3: 12.2 (11.4-13.2); Q4: 16.5 (15.4-18.0); and Q5: 26.5 (22.3-32.2) ml.kg-1 h-1. The odd of prolonged LOS was positively correlated with an increase fluid volume (Q5 quintile: OR 2.602 [95% CI 1.444-4.690], P = 0.001), as well as complications beyond prolonged LOS (Q5: OR 3.322 [95% CI 1.656-6.275], P = 0.001). The overall 30-day mortality rate was increased with high intraoperative fluid load but did not reach to a statistical significance after adjusted with confounders. Furthermore, the highest quintile of fluid load (26.5 ml.kg-1 h-1, IQR [22.3-32.2]) (Q5 quintile) was significantly associated with longer postoperative mechanical ventilation time compared with Q1 (Q5: OR 2.212 [95% CI 1.101-4.445], P = 0.026).    Conclusion: Restrictive intraoperative fluid load had overall better outcomes, whilst high fluid load was significantly associated with prolonged LOS and complications after non-cardiac surgery in neonates.    Trial registration:  Chictr.org.cn Identifier: ChiCTR2200066823 (December 19, 2022). What is Known: • Inappropriate perioperative fluid load can lead to postoperative complications and even death. What is New: • High perioperative fluid load was significantly associated with an increased length of stay after non-cardiac surgery in neonates, whilst low fluid load was consistently related to better postoperative outcomes.

Study of the ageing and the sorption of polyaromatic hydrocarbons as influencing factors on the effects of microplastics on blue mussel.

The mussels are species with high socio-economic weights and are often used as bioindicators of biological and chemical contamination. In the field and aquaculture, they can intake microplastics during filter-feeding, and the microplastics can have a negative impact on their health, even at low concentrations. The effects of microplastics have yet to be fully examined on the blue mussel (Mytilus edulis), considering the factors of ageing and sorption of some polyaromatic hydrocarbons (PAHs), ubiquitous environmental contaminants. In this work, 5 different exposure conditions were studied: pristine microplastics, microplastics aged for 1000 days under UV radiation, microplastics sorbing PAHs, as well as microplastics both aged and sorbing PAHs, in parallel to controls. The microplastic changes after ageing were studied with spectroscopic and chromatographic methods. Then, 8-day laboratory exposures of mussels at 10 µg/L of microplastics were performed. The oxidative stress, as well as neurotoxic and immunological responses of M. edulis, were measured using a battery of biomarkers (catalase/CAT, superoxide dismutase/SOD, glutathione S-transferases/GST, acetylcholinesterase/AChE) in 3 different organs (digestive gland, gills and mantle), and acid phosphatase in hemolymph. Then, a study of lipid impairments on the digestive gland was performed through the use of lipidomic tools. No significant difference of oxidative stress activity was observed for all the tissues of mussels exposed to pristine microplastics at 10 µg/L, compared to controls. The ageing and the PAH soption onto microplastics were influencing factors of the oxydative stress in mussels with increased CAT activities in the digestive glands and decreased SOD activities in the mantles. The neurotoxicity was highlighted by higher AChE activities measured in the mantle of mussels exposed to all the microplastic treatments, compared to controls. Concerning lipidomics, no compound was determined as a biomarker of microplastic exposure. The study demonstrated a low toxicity of microplastics at environmental relevant concentration with a 8-day exposure and using the chosen biomarkers. However, some microplastic changes seemed to lead to specific effects on mussels.

Analysis of the outcome of bi-vertebral transpedicular wedge osteotomy for correcting severe kyphotic deformity in ankylosing spondylitis.

To study the outcomes of bi-vertebral transpedicular wedge osteotomy in correcting severe kyphotic deformity in ankylosing spondylitis (AS). This retrospective study focused on all the patients who underwent thoracic and lumbar bi-vertebra transpedicular wedge osteotomy with pedicle screw internal fixation to treat their severe thoracolumbar kyphotic deformity of AS in our hospital from January 2014 to January 2020. The perioperative and operative data of each patient were collected and analyzed. A total of 21 male AS patients with severe kyphotic deformity were studied with a mean age of 42.2 ± 9.2 years. Intraoperatively, the mean operating time is 5.8 ± 1.6 hour with a mean blood loss of 725.5 ± 140.6 mL. The average postoperative correction of kyphosis reached 60.8o at 1 week after the surgery, which is significantly improved from preoperative presentation (P < .05), and stayed no significant change over the time during longer period of follow-ups (12-24 months) with the overall correction rate of 72.2%. Moreover, the postoperative changes in thoracic kyphosis (TK) angle, thoracolumbar kyphosis (TLK) angle, lumbar lordosis (LL) angle, maxilla-brow angle, as well as C2SVA and C7SVA sagittal balance were also significant, all of which enabled the patients to walk in upright position and sleep in the supine position with the improvements in other clinical symptoms. Bi-vertebral transpedicular wedge osteotomy of thoracic and lumbar vertebrae is a safe and effective method to restore the physiological curvature of the sagittal position of the spine and correct severe ankylosing deformity.

The Interplay Between Financial Literacy, Financial Risk Tolerance, and Financial Behaviour: The Moderator Effect of Emotional Intelligence.

Aim: This study aims to examine financial literacy's impact on individual investors' financial behaviour while also investigating the mediating role of financial risk tolerance and the moderator effect of emotional intelligence. Methods: The study collects time-lagged data from 389 financially independent individual investors from leading educational institutes in Pakistan. Data are analysed using SmartPLS (v 3.3.3) to test the measurement and structural models. Results: The findings reveal that financial literacy significantly impacts the financial behaviour of individual investors. In addition, financial risk tolerance partially mediates the relationship between financial literacy and financial behaviour. Besides, the study found a significant moderating role of emotional intelligence in the direct relationship between financial literacy and financial risk tolerance and an indirect relationship between financial literacy and financial behaviour. Discussion: The study examined a hitherto unexplored relationship between financial literacy and financial behaviour, mediated by financial risk tolerance and moderated by emotional intelligence.

Teachers' Adoption of Emotions-Based Learning Outcomes: Significance of Teachers' Competence, Creative Performance, and University Performance.

Studies have revealed that emotion-based learning outcomes are scarce when teachers' competence and creative performance are neglected, further university performance in relation to teachers' emotion-based learning outcomes is disregarded in literature so far. Based on the Attributional theory of achievement motivation and emotion, the purpose of this empirical study is to investigate the effects of Emotional Intelligence (EI) on learning outcomes (social, cognitive, self-growth outcomes, and satisfaction with university experience) of academicians in Pakistan's higher education institutions (HEIs). This study also examines the mediating role of teacher competence (personal assessment) and creative performance (Creative self-efficacy and leadership/supervisor support) in a relationship between EI and learning outcomes. Furthermore, this study ascertained the relationship between learning outcomes and organizational performance (OP) of HEIs. This study used a sample frame of 237 academic professionals from Pakistani HEIs, the hypothesized associations were ascertained using the partial least squares structural equation modeling method (PLS-SEM). The findings disclose that EI has a positive and significant influence on learning outcomes. Furthermore, an indirect relation between EI and learning outcomes is established through teacher competence and creative performance while the relationship between learning outcomes and OP is established also. Results of the considered study reinforce the academic understanding of EI and propose how academicians of HEIs can value their competence and creative performance which in turn enhances learning outcomes and OP. There is a lack of studies in HEIs that investigate the relationship between EI, teacher competence, creative performance, learning outcomes, and OP. This is one of the initial researches that not only empirically examine the interface of EI, learning outcomes, and OP of HEIs' academicians but also enlightens comprehensions into the prevailing literature by immediate investigation of the mediating role of teacher competence and creative performance in fundamental association.

Comparative Proteomic Analysis of Fucosylated Glycoproteins Produced by Bacteroides thetaiotaomicron Under Different Polysaccharide Nutrition Conditions.

Bacteroides thetaiotaomicron, one of the most eminent representative gut commensal Bacteroides species, is able to use the L-fucose in host-derived and dietary polysaccharides to modify its capsular polysaccharides and glycoproteins through a mammalian-like salvage metabolic pathway. This process is essential for the colonization of the bacteria and for symbiosis with the host. However, despite the importance of fucosylated proteins (FGPs) in B. thetaiotaomicron, their types, distribution, and functions remain unclear. In this study, the effects of different polysaccharide (corn starch, mucin, and fucoidan) nutrition conditions on newly synthesized FGPs expressions and fucosylation are investigated using a chemical biological method based on metabolic labeling and bioorthogonal reaction. According to the results of label-free quantification, 559 FGPs (205 downregulated and 354 upregulated) are affected by the dietary conditions. Of these differentially expressed proteins, 65 proteins show extremely sensitive to polysaccharide nutrition conditions (FGPs fold change/global protein fold change ≥2.0 or ≤0.5). Specifically, the fucosylation of the chondroitin sulfate ABC enzyme, Sus proteins, and cationic efflux system proteins varies significantly upon the addition of mucin, corn starch, or fucoidan. Moreover, these polysaccharides can trigger an appreciable increase in the fucosylation level of the two-component system and ammonium transport proteins. These results highlight the efficiency of the combined metabolic glycan labeling and bio-orthogonal reaction in enriching the intestinal Bacteroides glycoproteins. Moreover, it emphasizes the sensitivity of Bacteroides fucosylation to polysaccharide nutrition conditions, which allows for the regulation of bacterial growth.

Sitagliptin activates the p62-Keap1-Nrf2 signalling pathway to alleviate oxidative stress and excessive autophagy in severe acute pancreatitis-related acute lung injury.

Acute lung injury (ALI) is a complication of severe acute pancreatitis (SAP). Sitagliptin (SIT) is a DPP4 inhibitor that exerts anti-inflammatory and antioxidant effects; however, its mechanism of action in SAP-ALI remains unclear. In this study, we investigated the effects of SIT on SAP-ALI and the specific pathways involved in SAP-induced lung inflammation, including oxidative stress, autophagy, and p62-Kelch-like ECH-associated protein 1 (Keap1)-NF-E2-related factor 2 (Nrf2) signalling pathways. Nrf2 knockout (Nrf2-/-) and wild-type (WT) mice were pre-treated with SIT (100 mg/kg), followed by caerulein and lipopolysaccharide (LPS) administration to induce pancreatic and lung injury. BEAS-2B cells were transfected with siRNA-Nrf2 and treated with LPS, and the changes in inflammation, reactive oxygen species (ROS) levels, and autophagy were measured. SIT reduced histological damage, oedema, and myeloperoxidase activity in the lung, decreased the expression of pro-inflammatory cytokines, and inhibited excessive autophagy and ROS production via the activation of the p62-Keap1-Nrf2 signalling pathway and promotion of the nuclear translocation of Nrf2. In Nrf2-knockout mice, the anti-inflammatory effect of SIT was reduced, resulting in ROS accumulation and excessive autophagy. In BEAS-2B cells, LPS induced ROS production and activated autophagy, further enhanced by Nrf2 knockdown. This study demonstrates that SIT reduces SAP-ALI-associated oxidative stress and excessive autophagy through the p62-Keap1-Nrf2 signalling pathway and nuclear translocation of Nrf2, suggesting its therapeutic potential in SAP-ALI.

Isolation and Characterization of Endomycorrhizal Fungi Associated with Growth Promotion of Blueberry Plants.

Despite their notable root mutualism with blueberries (Vaccinium spp.), studies related to Ericoid mycorrhizal (ERM) are relatively limited. In this study, we report the isolation of 14 endomycorrhizal fungi and their identification by fungal colony morphology characterization combined with PCR-amplified fungal internal transcribed spacer (ITS) sequence analyses. Six of the isolated strains were confirmed as beneficial mycorrhizal fungi for blueberry plants following inoculation. We observed the formation of typical ERM hyphae coil structures-which promote and nutritionally support growth-in blueberry seedlings and significant nitrogen and phosphorous content increases in diverse tissues. QRT-PCRs confirmed changes in VcPHT1s expression patterns. After the formation of ERM, PHT1-1 transcription in roots was upregulated by 1.4- to threefold, whilst expression of PHT1-3 and PHT1-4 in roots were downregulated 72% and 60%, respectively. Amino acid sequence analysis of all four VcPHT1s genes from the blueberry variety "Sharpblue" revealed an overall structural similarity of 67% and predicted transmembrane domains. Cloning and overexpression of PHT1-1 and PHT1-3 genes in transgenic Arabidopsis thaliana plants significantly enriched total phosphorus and chlorophyll content, confirming that PHT1-1 and PHT1-3 gene functions are associated with the transport and absorption of phosphorus.

Development and validation of a risk score for predicting mortality after resection of primary hepatocellular carcinoma.

BACKGROUND: Primary hepatocellular carcinoma (PHCC) has a poor prognosis and high short-term mortality rate, even after resection. Thus, early diagnosis in PHCC cases can help improve quality of life via personalized management strategies. RESULTS: The risk score system (RSS) were classified as low risk (<5 points), medium risk (5-10 points), or high risk (>10 points). The areas under the receiver operating characteristic curves were 0.80 in the training cohort and 0.69 in the validation cohort, which indicated satisfactory prognostic performance. The Hosmer-Lemeshow goodness of fit test (P>0.05) revealed consistent performance in both groups. The concordance index (C-index: 0.663, 95% CI: 0.618-0.708) revealed excellent discrimination and good calibration in the validation cohort. CONCLUSIONS: This simple RSS, which is based on clinical and laboratory data from patients undergoing resection of PHCC, might allow clinicians and medical staff to better manage PHCC. MATERIALS AND METHODS: A total of 672 PHCC cases were retrospectively obtained from the First Affiliated Hospital of Wenzhou Medical University between January 2007 and February 2015. Cox proportional hazard models were used to identify independent predictors of mortality. Kaplan-Meier curves and the log-rank test were used to examine the relationships between the prognostic factors and overall mortality.

Use of a novel index, the A-index, and its associated nomogram to predict overall survival rates after resection of primary hepatocellular carcinoma.

BACKGROUND: Several international staging or scoring systems don't accurately predict overall survival (OS) after resection of primary hepatocellular carcinoma (PHCC). Therefore, we attempted to overcome this limitation by constructing the A-index and its associated nomogram. METHODS: We selected 672 patients who underwent curative resection of PHCC between January 2007 and February 2015 at the first affiliated hospital of the Wenzhou medical university. These subjects were randomly divided into the training (n = 470) and the validation group (n = 202) according to the ratio of 7:3. RESULTS: We prepared the nomogram using eight independent risk factors including the A-index (calculated by 100 × aspartate transaminase /albumin /albumin) in the training cohort. The concordance index (C-index) of the nomogram for both training and validation set was similar in indicating the OS rate. The nomogram showed the strongest predictive power for the 1-year, 3-year, and 5-year OS, with the area under the ROC curve being 0.8182, 0.7892, and 0.7669, respectively. Correction curves showed consistent performance for both groups, stratification of the Kaplan-Meier curve was significant (P < 0.001), and decision curve analysis (DCA) showed the superiority of nomograms considering clinical effects. CONCLUSIONS: The predictive power of the nomogram integrating the A-index for OS was optimal.

DPP4 Inhibitor Attenuates Severe Acute Pancreatitis-Associated Intestinal Inflammation via Nrf2 Signaling.

Severe acute pancreatitis (SAP) is a challenging disease with high morbidity and mortality, often complicated by multiple organ dysfunction syndrome (MODS). The intestine, a major organ involved in MODS, correlates strongly with the evolution of the disease. In this study, we demonstrated that the DPP4 inhibitor, sitagliptin, protects SAP-associated intestinal injury both in vitro and in vivo. These beneficial effects were achieved by suppressing oxidative stress and inflammatory responses. Moreover, in sitagliptin-treated SAP mice, expression of Nrf2 was induced and that of NF-κB was reduced, compared to the control SAP mice. In addition, we used Nrf2-/- mice to test the protective effect of Nrf2 during sitagliptin treatment of SAP; our results indicated that Nrf2-/- mice had greater pancreatic and intestinal injury than wild-type mice. Taken together, high levels of ROS induced by SAP may be inhibited by sitagliptin, possibly by inactivating the Nrf2-NF-κB pathway.

A sample model established by S-index predicting overall survival after curative resection of primary hepatocellular carcinoma.

PURPOSE: Prognostic prediction after curative resection of primary hepatocellular carcinoma (PHCC) remains an arduous task. The S-index calculated from γ-glutamyl transpeptidase, albumin, and platelets is reported to predict the severity of liver fibrosis. We constructed a nomogram for predicting the survival probability of PHCC based on a new indicator, the S-index, combined with other routine clinical parameters. PATIENTS AND METHODS: We selected 490 patients with PHCC postradical surgery at the First Affiliated Hospital of Wenzhou Medical University between January 2007 and January 2014. The subjects were randomly allocated into the training cohort and the validation cohort in the ratio 7:3 by the digital method. Important variables screened by univariate analysis were included in multivariate analysis to obtain independent risk factors for predicting the prognosis of PHCC. The construction of the nomogram was based on Cox proportional hazard regression models. The concordance index (C-index) was used in the nomogram for evaluating the model performance for prognosis. We drew time-dependent receiver operating characteristic curves to compare our model with other staging systems. RESULTS: The nomogram based on six independent risk factors after multivariate analyses had good predictive power after radical surgery of PHCC. In the training and validation groups, the C-index of the nomogram was highly consistent for evaluating survival from PHCC. Compared with the traditional scoring system, the areas under time-dependent receiver operating characteristic curves were 0.7382, 0.7293, and 0.7520 for 1-, 3-, and 5-year overall survival, respectively. In summary, the nomogram showed excellent results in terms of prognosis of PHCC. CONCLUSION: Based on the S-index and the other clinical indicators, we developed a precise nomogram that predicts the survival probability of patients with PHCC after radical surgery. This tool can provide effective information for surgeons and patients.

A nomogram integrating hepatic reserve and tumor characteristics for hepatocellular carcinoma following curative liver resection.

BACKGROUND: Because of the mutual influence of liver dysfunction and malignancy, overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC). We developed a nomogram integrating albumin-bilirubin (ALBI) grade, a new index of hepatic reserve, and tumor characteristics of HCC for predicting OS following curative liver resection. METHODS: The nomogram was built to estimate the probabilities of 1, 3, and 5-y OS based on training cohort of 709 HCC, which was validated in an international independent dataset. The prognostic value of the nomogram was determined by concordance index (C-index), time-dependent receiver operating characteristics (tdROC), and decision curves, comparing with ALBI grade alone, the Cancer of the Liver Italian Program (CLIP), the Barcelona Clinic Liver Cancer (BCLC), and Okuda staging systems. RESULTS: Independent factors derived from multivariable Cox analysis of the training cohort to predict OS were tumor grade, microvascular invasion, tumor size and ALBI grade which were assembled into nomogram. The calibration curves for probability of OS showed optimal agreement between nomogram-prediction and actual observation, which was tested in validation cohort. The C-index, tdROC and decision curves showed the nomogram was superior to CLIP, ALBI grade, BCLC and Okuda. The patients could also be stratified into low, intermediate risk, and high risk of the mortality by the normogram in both development and validation cohorts. CONCLUSIONS: The nomogram integrating hepatic reserve and tumor characteristics provided a highly accurate estimation of OS in patients with HCC after curative liver resection, contributing to assess patient prognosis.