Delirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine ...administration on the incidence of delirium in elderly patients after cardiac surgery.
This randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Eligible patients were randomized into two groups. Dexmedetomidine (DEX) was administered during anesthesia and early postoperative period for patients in the DEX group, whereas normal saline was administered in the same rate for the same duration for patients in the control (CTRL) group. The primary endpoint was the incidence of delirium during the first five days after surgery. Secondary endpoints included the cognitive function assessed on postoperative days 6 and 30, the overall incidence of non-delirium complications within 30 days after surgery, and the all-cause 30-day mortality.
Two hundred eighty-five patients were enrolled and randomized. Dexmedetomidine did not decrease the incidence of delirium (4.9% 7/142 in the DEX group vs 7.7% 11/143 in the CTRL group; OR 0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar between the two groups; however, the incidence of pulmonary complications was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of early extubation was significantly increased (OR 3.32, 95% CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required treatment for intraoperative tachycardia (21.1% 30/142 in the DEX group vs 33.6% 48/143 in the CTRL group, p = 0.019), but increased the required treatment for postoperative hypotension (84.5% 120/142 in the DEX group vs 69.9% 100/143 in the CTRL group, p = 0.003).
Dexmedetomidine administered during anesthesia and early postoperative period did not decrease the incidence of postoperative delirium in elderly patients undergoing elective cardiac surgery. However, considering the low delirium incidence, the trial might have been underpowered.
ClinicalTrials.gov NCT02267538.
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Observing the structure and regeneration of the myelin sheath in peripheral nerves following injury and during repair would help in understanding the pathogenesis and treatment of neurological ...diseases caused by an abnormal myelin sheath. In the present study, transmission electron microscopy, immunofluorescence staining, and transcriptome analyses were used to investigate the structure and regeneration of the myelin sheath after end-to-end anastomosis, autologous nerve transplantation, and nerve tube transplantation in a rat model of sciatic nerve injury, with normal optic nerve, oculomotor nerve, sciatic nerve, and Schwann cells used as controls. The results suggested that the double-bilayer was the structural unit that constituted the myelin sheath. The major feature during regeneration was the compaction of themyelin sheath, wherein the distance between the 2 layers of cell membrane in the double-bilayer became shorter and the adjacent double-bilayers tightly closed together and formed the major dense line. The expression level of myelin basic protein was positively correlated with the formation of the major dense line, and the compacted myelin sheath could not be formed without the anchoring of the lipophilin particles to the myelin sheath.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Most patients with triple negative breast cancer (TNBC) do not respond to anti-PD1/PDL1 immunotherapy, indicating the necessity to explore immune checkpoint targets. B7H3 is a highly glycosylated ...protein. However, the mechanisms of B7H3 glycosylation regulation and whether the sugar moiety contributes to immunosuppression are unclear. Here, we identify aberrant B7H3 glycosylation and show that N-glycosylation of B7H3 at NXT motif sites is responsible for its protein stability and immunosuppression in TNBC tumors. The fucosyltransferase FUT8 catalyzes B7H3 core fucosylation at N-glycans to maintain its high expression. Knockdown of FUT8 rescues glycosylated B7H3-mediated immunosuppressive function in TNBC cells. Abnormal B7H3 glycosylation mediated by FUT8 overexpression can be physiologically important and clinically relevant in patients with TNBC. Notably, the combination of core fucosylation inhibitor 2F-Fuc and anti-PDL1 results in enhanced therapeutic efficacy in B7H3-positive TNBC tumors. These findings suggest that targeting the FUT8-B7H3 axis might be a promising strategy for improving anti-tumor immune responses in patients with TNBC.
This letter focuses on the metric sorting step for successive cancellation list decoders for polar codes, which play an important role in the overall comparison process. We propose three effective ...pairwise metric sorting (PMS) methods based on general pairwise sorting. We first describe a full-sorted PMS architecture with fewer comparators than state-of-the-art methods. Second, we present a half-sorted PMS architecture for notable decreases in the number of comparison stages and augmentation of the comparisons. Finally, we describe the M-bit parallel decoding architecture, which significantly reduces the comparison stages when compared with the 1-bit sorting method of M times. Evaluation results indicate that the proposed PMS method outperforms state-of-the-art metric sorting methods in terms of comparisons and comparison stages, which effectively reduces latency and hardware resource.
Improving supply chain sustainability is an essential part of achieving the UN’s sustainable goals. Digitalization, such as blockchain technology, shows the potential to reshape supply chain ...management. Using distributed ledger technology, the blockchain platform provides a digital system and database to record the transactions along the supply chain. This decentralized database of transactions brings transparency, reliability, traceability, and efficiency to the supply chain management. This paper focuses on such novel blockchain-based supply chain management and its sustainability performances in the areas of environmental protection, social equity, and governance efficiency. Using a systematic literature review and two case studies, we evaluate whether the three sustainability indicators can be improved indirectly along supply chains based on blockchain technology. Our study shows that blockchain technology has the potential to improve supply chain sustainability performance, and we expect blockchain technology to rise in popularity in supply chain management.
The integration of pyrolysis and prepositive anaerobic digestion could be a solution to improve energy recovery from sewage sludge. However, it is not clear whether this integrated pathway always ...outperforms the two single technologies when dealing with different types of sludge. In this study, the integrated pathway is compared with anaerobic digestion and pyrolysis from the points of view of life cycle environmental impacts and energy efficiency. In addition, the effect of the organic content in the feed sludge on the performance of the three pathways is investigated. The results indicated that the environmental impacts of the three pathways are heavily dependent on their energy inputs and outputs. The single pyrolysis pathway exhibited the lowest energy efficiency and the heaviest environmental burden, and only the sludge with volatile solids in total solids (VS/TS) higher than 63% allowed the system generate a net energy output. The integrated pathway had better environmental performance and energy efficiency than single pyrolysis because prepositive anaerobic digestion enhanced the conversion of sludge organic matter to energy. When sludge VS/TS exceeded 61%, the integrated system exported surplus heat. Anaerobic digestion performed the best among the three pathways because it required no energy and material expenditure for thermal drying and pyrolysis. Also, a VS/TS of 52% in the feed sludge corresponded to the balance point for equal energy input and output. Therefore, anaerobic digestion should be the first choice when designing a sewage sludge disposal system. The integrated pathway is an alternative for high organic content sludge because of its high conversion rate of sludge to energy.
•Anaerobic digestion, pyrolysis and their integration are compared from two aspects.•Energy flow is the major factor determining their environmental impact.•The integrated system has the highest conversion rate from sludge to energy.•The integrated system is only suitable for high-organic-content sludge.•Sludge organic contents required for net energy output are concluded for the systems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract
Most triple-negative breast cancer (TNBC) patients fail to respond to T cell-mediated immunotherapies. Unfortunately, the molecular determinants are still poorly understood. Breast cancer is ...the disease genetically linked to a deficiency in autophagy. Here, we show that autophagy defects in TNBC cells inhibit T cell-mediated tumour killing in vitro and in vivo. Mechanistically, we identify Tenascin-C as a candidate for autophagy deficiency-mediated immunosuppression, in which Tenascin-C is Lys63-ubiquitinated by Skp2, particularly at Lys942 and Lys1882, thus promoting its recognition by p62 and leading to its selective autophagic degradation. High Tenascin-C expression is associated with poor prognosis and inversely correlated with LC3B expression and CD8
+
T cells in TNBC patients. More importantly, inhibition of Tenascin-C in autophagy-impaired TNBC cells sensitizes T cell-mediated tumour killing and improves antitumour effects of single anti-PD1/PDL1 therapy. Our results provide a potential strategy for targeting TNBC with the combination of Tenascin-C blockade and immune checkpoint inhibitors.
Learning-Based Compressive MRI Gozcu, Baran; Mahabadi, Rabeeh Karimi; Yen-Huan Li ...
IEEE transactions on medical imaging,
06/2018, Volume:
37, Issue:
6
Journal Article
Open access
In the area of magnetic resonance imaging (MRI), an extensive range of non-linear reconstruction algorithms has been proposed which can be used with general Fourier subsampling patterns. However, the ...design of these subsampling patterns has typically been considered in isolation from the reconstruction rule and the anatomy under consideration. In this paper, we propose a learning-based framework for optimizing MRI subsampling patterns for a specific reconstruction rule and anatomy, considering both the noiseless and noisy settings. Our learning algorithm has access to a representative set of training signals, and searches for a sampling pattern that performs well on average for the signals in this set. We present a novel parameter-free greedy mask selection method and show it to be effective for a variety of reconstruction rules and performance metrics. Moreover, we also support our numerical findings by providing a rigorous justification of our framework via statistical learning theory.
•Various leaching methods are summarised and compared.•Purification and separation are reviewed separately.•Metals with less economic interests should be recovered.•Greener lixiviants, potentially ...glycine, are required for a sustainable process.•Hybrid leaching and recovery technologies would be the future trend.
Printed circuit boards (PCBs) represent one of the most complicated and valuable components in electric and electronic equipment (EEE). Waste PCBs (WPCBs) contain more than 40 kinds of metals with a wide and variable range of concentrations, such as environmentally harmful metals (e.g. Pb, Cr, As, Cd and Hg) and others of economic value (e.g. Cu, Sn, Au, Ag and Pd). Recovery of metals from WPCBs is of great importance for both environmental protection and resource re-utilization. In contrast to metal recovery from natural resources, these secondary resources have to be essentially stripped completely of its harmful metallic content before the remaining plastic substrate can be disposed, charred or incinerated. Hydrometallurgy has been successfully used for metals recovery from primary and secondary resources around the world, owing to its easily controlled process and high recovery rates at relatively low costs, and a number of researches using various hydrometallurgical methods for metals recovery from WPCBs has been published each year since 2002. This study provides an up-to-date review of the hydrometallurgical recovery of metals from WPCBs and gives perspectives of this particular area, which is expected to provide an insight for the selection of suitable hydrometallurgical leaching and purification methods and to point out the novel and potential technologies that would be the future focuses of this area.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
MicroRNA (miR)-155 is a critical player in both innate and adaptive immune responses. It can influence CD4(+) T cell lineage choice. To clarify the role of miR-155 in CD4(+) CD25(+) regulatory T ...(Treg)/T helper (Th)17 cell differentiation and function, as well as the mechanism involved, we performed gain-and loss-of-function analysis by transfection pre-miR-155 and anti-miR-155 into purified CD4(+) T cells. The results showed that miR-155 positively regulated both Treg and Th17 cell differentiation. It also induced the release of interleukin (IL)-17A by Th17 cells, but not the release of IL-10 and transforming growth factor (TGF)-β1 by Treg cells. Furthermore, we found that miR-155 reacted through regulating Janus kinase/signal transducer and activator of transcription (JAK/STAT) rather than TGF-β/mothers against decapentaplegic homolog (SMAD) signaling pathway in the process of Treg and Th17 cells differentiation. This may because suppressors of cytokine signaling (SOCS)1, the important negative regulator of JAK/STAT signaling pathway, was the direct target of miR-155 in this process, but SMAD2 and SMAD5 were not. Therefore, we demonstrated that miR-155 enhanced Treg and Th17 cells differentiation and IL-17A production by targeting SOCS1.
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