On approximating a new generalization of traveling salesman problem.

The current best-known performance guarantees for the extensively studied Traveling Salesman Problem (TSP) of determinate approximation algorithms is 32, achieved by Christofides' algorithm 47 years ago. This paper investigates a new generalization problem of the TSP, termed the Minimum-Cost Bounded Degree Connected Subgraph (MBDCS) problem. In the MBDCS problem, the goal is to identify a minimum-cost connected subgraph containing n=|V| edges from an input graph G=(V,E) with degree upper bounds for particular vertices. We show that for certain special cases of MBDCS, the aim is equivalent to finding a minimum-cost Hamiltonian cycle for the input graph, same as the TSP. To appropriately solve MBDCS, we initially present an integer programming formulation for the problem. Subsequently, we propose an algorithm to approximate the optimal solution by applying the iterative rounding technique to solution of the integer programming relaxation. We demonstrate that the returned subgraph of our proposed algorithm is one of the best guarantees for the MBDCS problem in polynomial time, assuming P≠NP. This study views the optimization of TSP as finding a minimum-cost connected subgraph containing n edges with degree upper bounds for certain vertices, and it may provide new insights into optimizing the TSP in future research.

Phenotypic and genetic characterization of hypervirulent Klebsiella pneumoniae in patients with liver abscess and ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) and pyogenic liver abscess (PLA) due to Klebsiella pneumoniae infection can trigger life-threatening malignant consequences, however, there are few studies on the strain-associated clinical pathogenic mechanisms between VAP and PLA. A total of 266 patients consist of 129 VAP and 137 PLA were included for analysis in this study. We conducted a comprehensive survey for the two groups of K. pneumoniae isolates, including phenotypic experiments, clinical epidemiology, genomic analysis, and instrumental analysis, i.e., to obtain the genomic differential profile of K. pneumoniae strains responsible for two distinct infection outcomes. We found that PLA group had a propensity for specific underlying diseases, especially diabetes and cholelithiasis. The resistance level of VAP was significantly higher than that of PLA (78.57% vs. 36%, P < 0.001), while the virulence results were opposite. There were also some differences in key signaling pathways of biochemical processes between the two groups. The combination of iucA, rmpA, hypermucoviscous phenotype, and ST23 presented in K. pneumoniae infection is more important and highly prudent for timely treatment. The present study may contribute a benchmark for the K. pneumoniae clinical screening, epidemiological surveillance, and effective therapeutic strategies.

Mapping the research trends and hot topics of ventricular arrhythmia: A bibliometric analysis from 2001 to 2020.

Background: Studies of ventricular arrhythmia (VA) have drawn much scholarly attention over the past two decades. Our study aimed to assess the current situation and detect the changing research trends of VA quantitatively and qualitatively. Materials and methods: All the information used in our statistical and bibliometric analysis were collected and summarized from papers retrieved from the Web of Science Core Collection (WoSCC) database on December 22, 2021 using certain criteria. Visual analytics were realized using CiteSpace, VOSviewer, the bibliometrix R package, and the bibliometric online analysis platform. Results: A total of 6,897 papers (6,711 original articles, 182 proceedings papers, three book chapters, and one data paper) were published in 796 journals that concentrated on the research areas of cardiovascular and critical care medicine. The most productive country and influential institution was the USA and the Mayo Clinic, respectively. Heart Rhythm (551 articles and 8,342 local citations) published the most manuscripts. The keyword co-occurrence and co-citation network of references analyses revealed that the most popular terms were ventricular tachycardia, ventricular fibrillation, catheter ablation, implantable cardioverter defibrillator (ICD), and sudden cardiac death (SCD). Further, the burst detection analysis demonstrated that topics strongly associated with clinical prognosis, such as meta-analysis, long-term outcomes, and impact, were new concerns. Conclusion: Our study offers a comprehensive picture of VA research and provides profound insights into the current research status. Moreover, we show that new topics within the VA research field have focused more on prognosis and evidence-based clinical guidelines.

Thromboelastography Parameters in Urosepsis: A Retrospective Study.

Thromboelastography (TEG) is usually used to monitor coagulation disorder clinically. It is unclear whether TEG has association with urosepsis and sepsis-induced coagulopathy (SIC). The purpose of this study was to investigate the clinical significance of TEG parameters in urosepsis. 90 patients who were admitted to the Emergency Ward and Emergency Intensive Care Unit (EICU) of Ren Ji Hospital affiliated to Shanghai Jiao Tong University School of Medicine due to urinary infection from February 2014 to February 2022 were retrospectively studied. Urosepsis patients and non-sepsis patients were separately investigated according to the final discharge diagnosis and Sepsis 3.0. At the same time, patients with urosepsis were further divided into groups of SIC and non-SIC based on the definition of SIC. The data of clinical features, laboratory biomarkers, and TEG parameters were collected and analyzed. There were significant differences in white blood cell count, C-reactive protein (CRP), platelet count, procalcitonin (PCT), fibrinogen (FIB), international normalized ratio (INR), prothrombin time (PT), D-dimer, and incidence of urinary tract obstruction between the urosepsis group and non-sepsis group (P < 0.05). In the comparison with non-sepsis group, K value was significantly lower (P = 0.006), while α-angle (P = 0.003) and clot index (CI) (P = 0.048) were significantly higher in urosepsis group. The area under the K value curve excluding urosepsis was 0.667. The areas under CI and α-angle curves for diagnosing urosepsis were 0.682 and 0.621, respectively. The patients in SIC group had significantly higher K value, lower α-angle, and maximum amplitude (MA) than those in non-SIC group (P < 0.05). Coagulopathy is prone to occur in patients with urosepsis. TEG is helpful for assessment of hypercoagulable state in urosepsis and prediction of hypocoagulability in SIC patients implying the dynamic process of DIC.

Protection Against Post-resuscitation Acute Kidney Injury by N-Acetylcysteine via Activation of the Nrf2/HO-1 Pathway.

Background and Objective: Acute kidney injury (AKI), the common complication after cardiopulmonary resuscitation (CPR), seriously affects the prognosis of cardiac arrest (CA) patients. However, there are limited studies on post-resuscitation AKI. In addition, it has been demonstrated that N-acetylcysteine (N-AC) as an ROS scavenger, has multiorgan-protective effects on systemic and regional ischaemia-reperfusion injuries. However, no studies have reported its protective effects against post-resuscitation AKI and potential mechanisms. This study aimed to clarify the protective effects of N-AC on post-resuscitation AKI and investigate whether its potential mechanism was mediated by activating Nrf-2/HO-1 pathway in the kidney. Methods: We established cardiac arrest models in rats. All animals were divided into four groups: the sham, control, N-AC, and ZnPP groups. Animals in each group except for the ZnPP group were assigned into two subgroups based on the survival time: 6 and 48 h. The rats in the control, N-AC, and ZnPP groups underwent induction of ventricular fibrillation (VF), 8 min untreated VF and cardiopulmonary resuscitation. Renal function indicators, were detected using commercial kits. Renal pathologic changes were assessed by haematoxylin-eosin (HE) staining. Oxidative stress and inflammatory responses were measured using the corresponding indicators. Apoptosis was evaluated using terminal uridine nick-end labeling (TUNEL) staining, and expression of proteins associated with apoptosis and the Nrf-2/HO-1 pathway was measured by western blotting. Results: N-AC inhibited post-resuscitation AKI. We observed that N-AC reduced the levels of biomarkers of renal function derangement; improved renal pathological changes; and suppressed apoptosis, oxidative stress, and inflammatory response. Additionally, the production of ROS in the kidneys markedly decreased by N-AC. More importantly, compared with the control group, N-AC further upregulated the expression of nuclear Nrf2 and endogenous HO-1 in N-AC group. However, N-AC-determined protective effects on post-resuscitation AKI were markedly reversed after pretreatment of the HO-1 inhibitor zinc protoporphyrin (ZnPP). Conclusions: N-AC alleviated renal dysfunction and prolonged survival in animal models of CA. N-AC partially exerts beneficial renal protection via activation of the Nrf-2/HO-1 pathway. Altogether, all these findings indicated that N-AC as a common clinical agent, may have the potentially clinical utility to improve patients the outcomes in cardiac arrest.

[Acupuncture mediated miR-34c-5p regulates the autophagy of hippocampal neurons in rats with cerebral ischemia/reperfusion injury].

OBJECTIVE: To observe the effect of acupuncture on the expression of miR-34c-5p, autophagy-related proteins and apoptosis rate in hippocampus of rats with cerebral ischemia/reperfusion injury (CI/RI), so as to explore its mechanism in regulating autophagy in hippocampal neurons in CI/RI rats. METHODS: SD rats were randomly divided into sham operation, model, medication and acupuncture groups, with 20 rats in each group. The rat model of CI/RI was established by occlusion of the middle cerebral artery. In the acupuncture group, "Dazhui" (GV14), "Baihui" (GV20) and "Shuigou" (GV26) were punctured with filiform needles and stimulated manually once every 15 min, for 30 min. The rats of the medication group were intraperito-neally injected with edaravone (5 mg/kg). The treatment was conducted once every 12 h for a total of 7 times. The neurological de-ficit score of all the rats were evaluated according to Garcia's methods, and TTC staining was employed to assess the cerebral ischemic area (percentage of cerebral infarct area, CIA). Transmission electron microscopy (TEM) was used to observe the ultrastructural changes of hippocampal neurons. The expression of hippocampal miR-34c-5p was measured by real-time PCR, and the protein expressions of hippocampal LC3B, Beclin1 and p62 were measured by Western blot. The apoptosis rate of ischemic brain tissue was observed by TUNEL staining. RESULTS: Compared with the sham operation group, the neurological deficit score, the expressions of miR-34c-5p, Beclin1, p62 and LC3B-Ⅱ/LC3B-Ⅰ were significantly decreased (P<0.01, P<0.05), and the CIA and the apoptosis rate significantly increased (P<0.01) in the model group. Compared with the model group, the neurological deficit scores, the expressions of miR-34c-5p, Beclin1, p62 and LC3B-Ⅱ/LC3B-Ⅰ were significantly increased (P<0.01, P<0.05), and the CIA and the apoptosis rate significantly decreased (P<0.01) in the medication and acupuncture groups. Compared with the medication group, the expression of miR-34c-5p was significantly increased (P<0.01). The results of electron microscope showed that the neurons in the acupuncture and medication groups were less damaged than those in the model group, the cells showed mild edema, and the structures were relatively complete. Some normal organelles could be seen, and autophagy bodies, autophagy lysosomes and their encapsulated organelles could still be observed. CONCLUSION: Acupuncture can improve the neurological deficit and reduce the area of cerebral infarction in CI/RI rats, which is closely with its effect in promoting hippocampal neuronal autophagy and anti-apoptosis via up-regulating the expression of miR-34c-5p.

AQMDRL: Automatic Quality of Service Architecture Based on Multistep Deep Reinforcement Learning in Software-Defined Networking.

Software-defined networking (SDN) has become one of the critical technologies for data center networks, as it can improve network performance from a global perspective using artificial intelligence algorithms. Due to the strong decision-making and generalization ability, deep reinforcement learning (DRL) has been used in SDN intelligent routing and scheduling mechanisms. However, traditional deep reinforcement learning algorithms present the problems of slow convergence rate and instability, resulting in poor network quality of service (QoS) for an extended period before convergence. Aiming at the above problems, we propose an automatic QoS architecture based on multistep DRL (AQMDRL) to optimize the QoS performance of SDN. AQMDRL uses a multistep approach to solve the overestimation and underestimation problems of the deep deterministic policy gradient (DDPG) algorithm. The multistep approach uses the maximum value of the n-step action currently estimated by the neural network instead of the one-step Q-value function, as it reduces the possibility of positive error generated by the Q-value function and can effectively improve convergence stability. In addition, we adapt a prioritized experience sampling based on SumTree binary trees to improve the convergence rate of the multistep DDPG algorithm. Our experiments show that the AQMDRL we proposed significantly improves the convergence performance and effectively reduces the network transmission delay of SDN over existing DRL algorithms.

Efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke: a systematic review and network meta-analysis.

BACKGROUND: Impairment of motor function and activities of daily living is very common in post-stroke patients. Acupuncture has been used in stroke for a long time. Although growing evidence supports the beneficial effects of acupuncture, there is still no clear conclusion on the optimal intervention time-point for acupuncture in stroke. Thus, we tried to assess the efficacy and safety of dissimilar acupuncture intervention time-points by network meta-analysis (NMA). METHODS: A retrieval was performed in several databases from beginning to October 2020. We only enrolled randomized controlled trials (RCTs) testing acupuncture for stroke, and the outcome indicators measured were Fugl-Meyer assessment (FMA) score, Barthel Index (BI), and adverse events. RESULTS: Thirty-eight trials involving 3,836 participants were included in this NMA, the vast majority of which had a low or unclear risk of selection bias, detection bias, reporting bias, attrition bias, but had a high risk of performance bias. The results showed as following: (I) acupuncture treatment (Acu) is significantly more effective than non-acupuncture treatment (Non-Acu) with a good safety. (II) In terms of FMA, acupuncture within 48 h post-stroke (Acu I) was superior to acupuncture within 2-15 d post-stroke (Acu II) [standard mean difference (SMD): 7.17; 95% confidence interval (CI), 1.11 to 13.22], acupuncture within 16-30 d post-stroke (Acu III) (SMD: 20.73; 95% CI, 13.68 to 27.78), acupuncture within 1 month to half a year post-stroke (Acu IV) (SMD: 26.95; 95% CI, 14.88 to 39.02). As for BI, Acu I was the optimal time-point, comparing with Acu III (SMD: 15.18; 95% CI, 8.97 to 21.39) and Acu IV (SMD: 22.88; 95% CI, 11.07 to 34.69). (III) Results of ranking indicated that Acu was better than Non-Acu at a similar stage in improving FMA and BI, while Acu I was the optimal intervention time-point, followed by Acu II. CONCLUSIONS: Although the credibility of our conclusions is low, our NMA indicates that acupuncture can be beneficial for stroke survivors with good safety. In terms of improvement in FMA score and BI, the soon use of acupuncture the better the efficacy. The optimal acupuncture intervention time-point for stroke is within 48 h post-stroke, and the significant validity period lasts until 15 days after onset.

Levosimendan in rats decreases acute kidney injury after cardiopulmonary resuscitation by improving mitochondrial dysfunction.

BACKGROUND: Acute kidney injury (AKI), the most common complication after cardiac resuscitation, is highly prevalent and harmful. There is increasing evidence that levosimendan can improve cardiac output, increase renal blood flow, and prevent AKI. As a novel calcium sensitizer, levosimendan may exert its protective effect via mitochondria. METHODS: Rat models of asphyxia-induced cardiac arrest and cardiopulmonary resuscitation (CPR) were set up. Thirty healthy adult male SD rats were randomly divided into CPR group (CPR group, n=10), levosimendan-treated group (levo group, n=10), and sham-operated group (sham group, n=10). Twelve hours after CPR, serum renal function indicators were measured, the kidney injury and mitochondrial morphological changes were observed. Oxygen uptake of the mitochondria, mitochondrial adenosine triphosphate (ATP) and mitochondrial free Ca2+ concentration were measured. Oxidative stress-related indicator levels in rat kidney tissues were further detected to analyze the differences in apoptosis rates among these three groups. Mitochondrial optic atrophy 1 (Opa1), dynamin-related protein 1 (Drp1), and apoptosis-related proteins were detected using Western blotting. RESULTS: Compared with the sham group, the CPR group had a significant increase in renal tissue damage. PAS staining and HE stains confirmed that CPR led to renal histopathological damage and destruction of the mitochondrial structure. Levosimendan improved the histopathological and ultrastructural damages of kidneys. Further analysis revealed that mitochondrial ATP content, NADH dehydrogenase, succinate dehydrogenase/cytochrome C oxidase, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (CSH-Px) decreased. Free Ca2+ concentration and malondialdehyde (MDA) significantly increased (all P<0.05) in the kidney tissues of rats in the CPR group. However, mitochondrial ATP content, NADH dehydrogenase, succinate dehydrogenase/cytochrome C oxidase, SOD, CAT, and CSH-Px increased, whereas free Ca2+ concentration and MDA decreased (all P<0.05) in the levo group. The apoptosis rate increased in the CPR group. There were significantly increased levels of Drp1 protein levels, and significantly decreased Opa1 expression (all P<0.05). However, the levo group showed the opposite effects (all P<0.05). CONCLUSIONS: Levosimendan can alleviate AKI following CPR, which may be achieved by improving mitochondrial dysfunction and suppressing the mitochondrial apoptosis pathway.

Renoprotective effects of levosimendan on acute kidney injury following cardiac arrest via anti-inflammation, anti-apoptosis, and ERK activation.

ATP-sensitive potassium channels (KATPs) have protective effects in ischemia-reperfusion-induced injuries and can be activated by levosimendan. This study investigated the effects of levosimendan on renal injury, inflammation, apoptosis, and survival in a rat model of acute kidney injury (AKI) following cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Rats underwent a 5-min asphyxia-based CA and resuscitation. The rats were treated with levosimendan after successful resuscitation. Renal functions, histological changes, inflammatory responses, and apoptosis were examined. NRK-52E cells treated by hypoxia/reoxygenation (H/R) were used to establish an in vitro CA-CPR model. Rats in the CA-induced AKI group had a low survival rate and increased levels of creatinine, blood urea nitrogen, and proinflammatory cytokines, as well as increased tubular injury. These results were significantly reversed after treatment with levosimendan. Levosimendan downregulated the expression of the apoptosis-related proteins Bax, cleaved caspase-3, and cleaved caspase-9, as well as upregulated Bcl-2 and p-ERK expression in vivo and in vitro. Thus, our data suggest that levosimendan reduces mortality and AKI following CA and CPR via suppression of inflammation and apoptosis, and activation of ERK signaling.

Levosimendan Ameliorates Post-resuscitation Acute Intestinal Microcirculation Dysfunction Partly Independent of its Effects on Systemic Circulation: A Pilot Study on Cardiac Arrest in a Rat Model.

BACKGROUND: Cardiac arrest (CA) is recognized as a life-threatening disease; however, the initial resuscitation success rate has increased due to advances in clinical treatment. Levosimendan has shown potential benefits in CA patients. However, its exact function on intestinal and systemic circulation in CA or post-cardiac arrest syndrome (PCAS) remained unclear. This study preliminarily investigated the link between dynamic changes in intestine and systemic hemodynamics post-resuscitation after levosimendan administration. METHODS: Twenty-five rats were randomized into three groups: sham control group (n = 5), levosimendan group (n = 10), and vehicle group (n = 10). Intestinal microcirculation was observed using a sidestream dark-field imaging device at baseline and each hour of the return of spontaneous circulation (≤6 h). Systemic hemodynamics, serum indicators of cardiac injury, and tissue perfusion/metabolism were measured by echo-cardiography, a biological signal acquisition system, and an enzyme-linked immunosorbent assay, respectively. RESULTS: Myocardial injury and global and intestinal perfusion/metabolism were significantly improved by levosimendan treatment. There was no statistically significant difference in the mean arterial pressure values between the vehicle and levosimendan groups (P > 0.05). The intestinal and systemic circulation measurements showed poor correlation (Pearson r-value of variable combinations in the levosimendan group was much less than 0.75; P < 0.01, levosimendan vs. vehicle group). CONCLUSIONS: Levosimendan significantly reduced the cardiac injury and corrected the metabolic status in an experimental rat model of ventricular fibrillation induced CA and cardiopulmonary resuscitation. Levosimendan may ameliorate PCAS-induced intestinal microcirculation dysfunction, partly independent of its effects on macrocirculation.

Different acupuncture intervention time-points for improving capacity in motor function and activities of daily living after stroke: A protocol for systematic review and network meta-analysis.

BACKGROUND: The incidence of stroke has been found in an increasing trend worldwide, resulting in significant negative effects and severe impairments to survivors in terms of motor function and activities of daily living. Acupuncture therapy has been widely used in the clinical treatment of stroke for a long time, meanwhile, the efficacy has been confirmed by many studies. However, the optimal intervention time-point of acupuncture in stroke is controversial. Therefore, the purpose of our study is to provide scientific evidence and reasonable suggestions for this issue. METHODS: A computer-based retrieval will be employed in 7 electronic databases: EMBASE Database, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang databases, Chinese Scientific Journals Database (VIP) and China Biological Medicine Database (CBM), from the establishment date of each database throughout October 2020. Only randomized controlled trials of acupuncture for stroke will be recruited and language is limited to English or Chinese. The outcomes we focus on include the Fugl-Meyer Assessment score and the Barthel Index. Additionally, safety assessments such as adverse events and drop-out cases may also be taken into consideration. The network meta-analysis will be performed based on the Bayesian framework and literature selection will be conducted by 2 trained reviewers. All data analysis will be calculated by Revman5.3, WinBUGS 1.4.3, Stata13.0, and R software 3.6.1. The Assessment of heterogeneity, inconsistency, subgroup, sensitivity, and publication bias will also be done under the guidelines of Cochrane Collaboration's tool. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This network meta-analysis will provide evidence-based references to evaluate the efficacy of different acupuncture intervention time-points during the treatment of stroke. Furthermore, it will help the clinicians to formulate appropriate medical plans and improve clinical efficacy. TRIALS REGISTRATION NUMBER: INPLASY2020120060.

Klebsiella pneumoniae infection associated septic pulmonary embolism in an emergency department from east China.

BACKGROUND: Septic pulmonary embolism (SPE) is attracting more attention as a special pulmonary sign in severe infection. We aimed to describe the clinical and imaging features of Klebsiella pneumoniae (K. pneumonia)-associated SPE in the emergency department. METHODS: Records of patients with primarily extrapulmonary infection of K. pneumoniae who were admitted to the emergency department between 2014 and 2019 were retrieved. The identifications of K. pneumoniaeassociated SPE were mainly dependent on the clinical manifestations, typical imaging findings, and presence of a primary source of K. pneumoniae infection. RESULTS: A total of 33 cases were identified as SPE with extrapulmonary K. pneumoniae infection. The main clinical manifestations were a febrile/fragile state (100%), respiratory symptoms (18.2%), and digestive symptoms (33.3%). Eight patients (24.2%) developed septic shock, 2 (6.0%) experienced respiratory failure, and 2 (6.0%) complicated endophthalmitis. The major source of infection was liver abscess (n=26, 78.8%), followed by septicemia (n=8, 24.2%), intestinal infection (n=3, 9.1%), and ascites (n=1, 3.0%). The computed tomography (CT) features included the following: peripheral wedge-shaped opacity (n=12, 36.4%), a feeding vessel sign (n=3, 9.1%), multiple nodular lesions (n=5, 15.2%), multifocal lung ill-infiltrations (n=15, 45.5%), patchy ground-glass opacities (n=6, 18.2%), focal consolidations (n=9, 27.3%), lung abscesses (n=4, 12.1%), and pleural effusion (n=21, 63.6%). Re-examination of lung HRCT conducted in 7 patients demonstrated imaging improvement after treatment. CONCLUSIONS: K. pneumonia-SPE presented special clinical and imaging characteristics, which bear similarities to the signs of pneumonia, but was potentially catastrophic. Identifying SPE in septic conditions is crucial to improving clinical outcomes.

Emerging Trends and Hot Topics in Cardiopulmonary Resuscitation Research: A Bibliometric Analysis from 2010 to 2019.

BACKGROUND Cardiopulmonary resuscitation (CPR) is a topic of great scientific and clinical interest that has received much attention in the past decade. Our study aimed to predict the trends in CPR research activities and evaluate hot topics via bibliometric means, quantitatively and qualitatively. MATERIAL AND METHODS All data were collected from a search of the Web of Science Core Collection on May 12, 2020. Retrieved information was investigated with bibliometric analysis by CiteSpace and VOSviewer software and the Online Analysis Platform of Literature Metrology to analyze and predict the trends and hotspots in this field. RESULTS Our search returned a total of 9563 articles and reviews on CPR published from 2010 through 2019. The number of original research studies on CPR has been increasing annually. The journal Resuscitation published the greatest number of manuscripts involved CPR, and the leading country and institution with regard to contributions on CPR were the United States and the University of Pennsylvania. Keyword co-occurrence/co-citation-cluster analysis showed that the most popular terms associated with CPR occurred in the manner of cluster labels, such as therapeutic hypothermia and treatment recommendation, among others. In addition, palliative care, sepsis, extracorporeal membrane oxygenation, and brain injury were identified as new foci through burst detection analysis. CONCLUSIONS Our study showed that the scientific research focus on CPR is switching from traditional therapeutic treatments to a public health practice, with in-depth understanding and development of CPR-related techniques expanding over the past decade. These results demonstrate trends in the CPR research and detected the possible neo-foci for ensuing research.

Enhancement of hydrogen peroxide production by electrochemical reduction of oxygen on carbon nanotubes modified with fluorine.

It is vital to synthesis hydrogen peroxide via electrochemical reduction of oxygen since it is a green process to produce oxidant with wide applications including water/wastewater treatment. In this work, fluorine (F) was employed to modify carbon nanotube (CNT), and the obtained F doped CNT (F-CNT) catalyst was used to fabricate gas diffusion electrode (GDE). It was found that F doping could improve oxygen reduction activity and H2O2 selectivity, and then enhanced the H2O2 production. After modification, F-CNT prepared with 0.6 M HF (CNT-F-0.6) had much higher H2O2 production (47.6 mg L-1) and current efficiency (89.5%) than that of CNT (29.6 mg L-1, 70.1%) at bias voltage of -1.3 V (vs SCE) and pH 7. Moreover, the high catalytic activity of CNT-F-0.6 could maintain in 5 consecutive reaction cycles. The material characterization and electrochemical test indicated that F doping had no significant effects on the surface area of CNT, but improved the defect degree of CNT. The enhanced H2O2 production performance could be ascribed to the formation of CF2 and CF3 on the surface of F-doped CNT, which rendered the potential for practical application of novel carbon catalyst for GDE.

Efficient H2O2 generation and spontaneous OH conversion for in-situ phenol degradation on nitrogen-doped graphene: Pyrolysis temperature regulation and catalyst regeneration mechanism.

H2O2 is a green and valuable chemical that can be electrochemically synthesis from oxygen reduction, offering in-situ application for organic pollutants removal in environmental remediation. However, how to improve activity and further convert into powerful radicals is a still challenge. Herein, we show a facile and general approach to fabricate nitrogen-doped graphene (N-GE) catalyst via pyrolysis temperature regulation. The optimal N-GE at 400 °C exhibited the highest active N content (12.2 wt.%) and H2O2 selectivity (85.45 %) and spontaneous OH production (19.42 µM), achieving a high phenol degradation (93.58 %) at 180 min in neutral pH condition. Importantly, a simple catalyst regeneration method and mechanism was disclosed. It is proposed that the conversion of graphite N and pyridinic N in N-GE plays an important role in oxygen reduction reaction (ORR) and OH conversion, while the conversion of pyridinic N-oxide to pyridinic N is critical to catalyst stability and sustainability. This study provides a new insight into structure design of electro-catalyst about stability of nitrogen-doped carbon materials for efficient H2O2 generation and cost-effective pollutants removal.

Role of adsorption and oxidation in porous carbon aerogel/persulfate system for non-radical degradation of organic contaminant.

A porous carbon aerogel (CA) was prepared to activate persulfate (PS) for the removal of phenol. The adsorption of phenol on CA and its removal in CA/PS system was fitted to a second-order model and first-order kinetic model, respectively. Influencing factors of CA/PS such as pH, CA dose, PS concentration, phenol concentration and temperature were investigated. CA/PS presented good performance on phenol removal over a pH range of 3-11 with the highest removal obtained at pH 7. Four kinds of organic pollutants including tetracycline, Rhodamine B, Safranine T and malachite green were investigated in the CA/PS system, proving that the adsorption of the contaminants benefitted their subsequent oxidation removal. The removal of aromatic compounds (phenol, p-diphenol, p-chlorophenol, and p-nitrophenol) in CA/PS system followed a decreasing order of hydroxyl > chlorine > nitro. The radical scavenging experiments suggested the removal of phenol was mainly through a non-radical pathway. The study presented the preparation and application of a green catalyst to activate PS, which is very promising for the development of the technology and the treatment of phenolic wastewater.

Comparison of hematologic and biochemical reference values in specific-pathogen-free 1-month-old Yorkshire pigs and Yorkshire-Landrace crossbred pigs.

Analysis of hematologic and biochemical values in pigs is an important basis for biomedical research and veterinary clinical diagnosis. Reference values for specific-pathogen-free (SPF) 1-month-old Yorkshire (Y) pigs and Yorkshire-Landrace crossbred (YL) pigs are limited. The present research aimed to describe and compare the reference values for hematologic and biochemical parameters in such pigs. Blood samples were obtained from 90 Y pigs (52 males and 38 females) and 88 YL pigs (55 males and 33 females), all 1 month old and bred in an SPF environment. Among the 16 hematologic and 15 serum biochemical parameters tested, no significant differences between the Y and YL pigs were found except in the concentration of triglyceride (P < 0.05), and heterosis was not observed. Thus, the values determined in this study can be used as basic reference values for 1-month-old Y and YL pigs and will contribute to the use of SPF pigs in biomedical research.

L'analyse des valeurs hématologiques et biochimiques chez les porcs est une base importante pour la recherche biomédicale et le diagnostic clinique vétérinaire. Des valeurs de référence pour des porcs exempts d'agents pathogènes spécifiques (SPF) âgés de 1 mois de race Yorkshire (Y) ou Yorkshire­Landrace croisée (YL) sont limitées. La présente étude visait à décrire et comparer les valeurs de référence pour des paramètres hématologiques et biochimiques chez ces porcs. Des échantillons sanguins furent obtenus de 90 porcs Y (52 mâles et 38 femelles) et 88 porcs YL (55 mâles et 33 femelles), tous âgés de 1 mois et élevés dans un environnement SPF. Parmi les 16 paramètres hématologiques et les 15 paramètres biochimiques sériques testés, aucune différence significative ne fut trouvée entre les porcs Y et YL sauf pour la concentration de triglycérides (P < 0,05), et aucune hétérosis ne fut observée. Ainsi, les valeurs déterminées dans la présente étude peuvent être utilisées comme valeurs de référence de base pour des porcs Y et YL âgés de 1 mois et vont contribuer à l'utilisation de porcs SPF en recherche biomédicale.(Traduit par Docteur Serge Messier).

Predictive role of monocyte-to-lymphocyte ratio in patients with Klebsiella pneumonia infection: A single-center experience.

The aim of the study is to explore whether monocyte-to-lymphocyte ratio (MLR) provides predictive value of the severity in patients with Klebsiella pneumonia infection (KPI).Patients in a tertiary medical center with Klebsiella pneumonia infection from 2014 to 2017 were recruited in this study. Patients with Klebsiella pneumonia infection were stratified into two groups based on the National Early Warning Score (NEWS). MLR was calculated by dividing monocytes count by lymphocytes count obtained from routine blood examination. The area under the curve (AUC) values was determined using the receiver-operating characteristic (ROC) curve. The correlation between the variables was tested with Pearson or Spearman correlation analysis. Ordinal logistic regression analysis was used to assess the relationship between MLR and the severity of Klebsiella pneumonia infection.One hundred fifty-two patients were finally enrolled for analysis. Among those, 43 (28.29%) cases had severe KPI. MLR was found to be an independent risk factor of the serious Klebsiella pneumonia infection (OR: 23.74, 95% CI: 5.41-104.11, P < .001). Besides, MLR was positively correlated with NEWS score (r = 0.57, P < .001). In the receiver-operating characteristic (ROC) curve analysis, MLR, with an optimal cut-off value of 0.665, predicted the severe coronary lesion with a sensitivity of 79.4% and specificity of 84.4%.MLR was an independent predictor of the severe Klebsiella pneumonia infection. Compared with neutrophil-to-lymphocyte ratio (NLR), MLR has a better performance to evaluate the severity of Klebsiella pneumonia infection.

Simultaneous sulfadiazines degradation and disinfection from municipal secondary effluent by a flow-through electro-Fenton process with graphene-modified cathode.

Conventionally the deep treatment and disinfection are fulfilled by different processes for municipal wastewater treatment, this work verified a breakthrough by one process of novel flow-through electro-Fenton (EF) with graphene-modified cathode, which is usually seemed to be ineffective. This process was firstly confirmed to be cost-effective for simultaneous sulfadiazines (SDZs) degradation and disinfection from municipal secondary effluent with a very low electrical energy consumption (EEC) of 0.21 kW h/m3, attributed to the high H2O2 production of 4.41 mg/h/cm2 on the novel graphite felt cathode modified by electrochemically exfoliated graphene (EEGr) with a low EEC of 3.08 kW h/(kg H2O2). Compared with the ineffective SDZs degradation by the conventional flow EF, this process was more cost-effective and overcame the harsh requirements on electrolyte concentration. It also showed good effectiveness in the degradation of different antibiotics, and the graphene-modified cathode still kept stable performance after eight consecutive runs. Account for the combined action of OH and active chlorine, the formation of hydroxylated and chlorine containing by-products was confirmed, and a possible degradation mechanism for SDZs was proposed. This flow-through EF process provided an alternative method for the disinfection and antibiotics degradation by one process for the treatment and reuse of municipal secondary effluent.