Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the ...convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO
) < 90% during bronchoscopy.
In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO
< 90% during bronchoscopy.
Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO
< 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO
during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083-0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002-1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group.
A modified HFNC could decrease the proportion of patients with a single moment of SpO
< 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.
Summary
Citrate is a common primary metabolite which often characterizes fruit flavour. The key regulators of citrate accumulation in fruit and vegetables are poorly understood. We systematically ...analysed the dynamic profiles of organic acid components during the development of kiwifruit (Actinidia spp.). Citrate continuously accumulated so that it became the predominate contributor to total acidity at harvest. Based on a co‐expression network analysis using different kiwifruit cultivars, an Al‐ACTIVATED MALATE TRANSPORTER gene (AcALMT1) was identified as a candidate responsible for citrate accumulation. Electrophysiological assays using expression of this gene in Xenopus oocytes revealed that AcALMT1 functions as a citrate transporter. Additionally, transient overexpression of AcALMT1 in kiwifruit significantly increased citrate content, while tissues showing higher AcALMT1 expression accumulated more citrate. The expression of AcALMT1 was highly correlated with 17 transcription factor candidates. However, dual‐luciferase and EMSA assays indicated that only the NAC transcription factor, AcNAC1, activated AcALMT1 expression via direct binding to its promoter. Targeted CRISPR‐Cas9‐induced mutagenesis of AcNAC1 in kiwifruit resulted in dramatic declines in citrate levels while malate and quinate levels were not substantially affected. Our findings show that transcriptional regulation of a major citrate transporter, by a NAC transcription factor, is responsible for citrate accumulation in kiwifruit, which has broad implications for other fruits and vegetables.
We have developed a new distributed boosted multi-effect distillation (DBMED) process to effectively harness low-grade “waste heat” in the temperature range 65°C–90°C to address the problem of ...freshwater scarcity. Comparisons are made with multi-effect distillation (MED) and recently proposed advanced MED schemes, namely boosted MED (BMED) and flash boosted MED (FBMED) on the basis of waste heat performance ratio, normalised pumping power consumption (NPPC) and specific capital cost. The main advantage of DBMED compared to FBMED, is a 30.9% decrease in the average NPPC. Compared to FBMED, which has the highest waste heat performance ratio of systems described in the literature to date, DBMED has a similar average waste heat performance ratio and specific capital cost over the temperature range 65°C–90°C. For driving temperatures lower than 75°C, DBMED has a better waste heat performance ratio by up to 7.3% while also reducing NPPC by at least 22%. At temperatures above 75°C, the waste heat performance ratio of DBMED is greater than those of MED and BMED but less than that of FBMED by ≤4.5%, while having the advantage of up to 38% reduction in NPPC at 90°C.
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•A new MED based desalination process, entitled DBMED, has been developed.•Compared to an optimised conventional MED, it produces up to 45% more freshwater.•The Jensen number is used to calculate NPPC and improve the capital cost function.•Compared with the FBMED, it decreases the NPPC by up to 38%.•The DBMED enjoys up to 2.6% decrease in the specific capital cost as compared to MED.
Nitrites commonly found in food, especially in fermented vegetables, are potential carcinogens. Therefore, limiting nitrites in food is critically important for food safety. A Lactobacillus strain ...(Lactobacillus sp. DMDL 9010) was previously isolated from fermented vegetables by our group, and is not yet fully characterized. A number of phenotypical and genotypical approaches were employed to characterize Lactobacillus sp. DMDL 9010. Its nitrite degradation capacity was compared with four other Lactobacillus strains, including Lactobacillus casei subsp. rhamnosus 719, Lactobacillus delbrueckii subsp. bulgaricu 1.83, Streptococcus thermophilus 1.204, and lactobacillus plantarum 8140, on MRS medium. Compared to these four Lactobacillus strains, Lactobacillus sp. DMDL 9010 had a significantly higher nitrite degradation capacity (P<0.001). Based on 16S rDNA sequencing and sequence comparison, Lactobacillus sp. DMDL 9010 was identified as either Lactobacillus plantarum or Lactobacillus pentosus. To further identify this strain, the flanking regions (922 bp and 806 bp upstream and downstream, respectively) of the L-lactate dehydrogenase 1 (L-ldh1) gene were amplified and sequenced. Lactobacillus sp. DMDL 9010 had 98.92 and 76.98% sequence identity in the upstream region with L. plantarum WCFS1 and L. pentosus IG1, respectively, suggesting that Lactobacillu sp. DMDL 9010 is an L. plantarum strain. It was therefore named L. plantarum DMDL 9010. Our study provides a platform for genetic engineering of L. plantarum DMDL 9010, in order to further improve its nitrite degradation capacity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
Ganoderic acids produced by Ganoderma exhibit anticancer and antimetastatic activities. A novel approach by combining Vitreoscilla haemoglobin (VHb) expression and calcium ion induction was ...developed to enhance ganoderic acid (GA) production in liquid static cultures of G. lingzhi. The maximum contents of GA‐O, GA‐S and GA‐Me were 1451.33 ± 67.50, 1431.23 ± 79.74 and 1283.81 ± 85.13 μg per 100 mg cell weight, respectively under the integrated approach, which are the highest contents as ever reported in Ganoderma. The contents of squalene and lanosterol were increased by 2.0‐ and 3.0‐fold in this case compared with those in the control. The transcription levels of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase, farnesyl‐diphosphate synthase, squalene synthase and cytochrome P450 CYP5150L8 were upregulated by 2.56‐, 3.31‐, 2.59‐ and 6.12‐fold respectively. Additionally, the expression of VHb improved the ratio of type I to type II GA in liquid static cultivation of G. lingzhi. The transcription levels of cyp512a2, cyp512v2 and cyp512a13, candidate cytochrome P450 genes involved in oxidative modification of the lanostane skeleton in GA biosynthesis, were also increased by 2.28‐, 2.65‐ and 3.54‐fold in the VHb‐expressing strain respectively. Our results illustrated that the approach described here efficiently improved GA production in G. lingzhi fermentation.
An integrated approach that combines Vitreoscilla haemoglobin expression and calcium ion induction can effectively improve the production of individual ganoderic acids in liquid static cultivation of Ganoderma lingzhi. *Significantly difference from value for the wild‐type G. lingzhi in the liquid static culture mode (P < 0.05).
A novel cathode material, carbon nanotube (CNT)-decorated Na3V2(PO4)3 (NVP) microspheres, was designed and synthesized via spray-drying and carbothermal reduction methods. The microspheres were ...covered and embedded by CNTs, the surfaces of which were also covered by amorphous carbon layers. Thus, a carbon network composed of CNTs and amorphous carbon layers formed in the materials. The polarization of a 10 wt % CNT-decorated NVP (NVP/C10) electrode was much less compared with that of the electrode with pristine NVP without CNTs. The capacity of the NVP/C10 electrode only decreased from 103.2 to 76.2 mAh g–1 when the current rates increased from 0.2 to 60 C. Even when cycled at a rate of 20 C, the initial discharge capacity of the NVP/C10 electrode was as high as 91.2 mAh g–1, and the discharge capacity was 76.9 mAh g–1 after 150 cycles. The charge-transfer resistance and ohmic resistance became smaller because of CNT decorating. Meanwhile, the addition of CNTs can tune the size of the NVP particles and increase the contact area between NVP and the electrolyte. Consequently, the resulted NVP had a larger sodium ion diffusion coefficient than that of the pristine NVP.
The doctor-patient relationship has been a major focus of society. Hospitals' efforts to improve the quality of their medical services have been to reduce the probability of doctor-patient conflicts. ...In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality.
Twenty-seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics.
There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients' perceptions of service quality are lower than their expectations.
According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Neural networks (NNs) have emerged as a powerful illustrative diagram for the brain. Unveiling the mechanism of neural-dynamic evolution is one of the crucial steps toward understanding how the brain ...works and evolves. Inspired by the universal existence of impulses in many real systems, this paper formulates a type of hybrid NNs (HNNs) with impulses, time delays, and interval uncertainties, and studies its global dynamic evolution by a robust interval analysis. The HNNs incorporate both continuous-time implementation and impulsive jump in mutual activations, where time delays and interval uncertainties are represented simultaneously. By constructing a Banach contraction mapping, the existence and uniqueness of the equilibrium of the HNN model are proved and analyzed in detail. Based on nonsmooth Lyapunov functions and delayed impulsive differential equations, new criteria are derived for ensuring the global robust exponential stability of the HNNs. Convergence analysis together with illustrative examples show the effectiveness of the theoretical results.
Developing robust non-platinum electrocatalysts with multifunctional active sites for pH-universal hydrogen evolution reaction (HER) is crucial for scalable hydrogen production through ...electrochemical water splitting. Here ultra-small ruthenium-nickel alloy nanoparticles steadily anchored on reduced graphene oxide papers (Ru-Ni/rGOPs) as versatile electrocatalytic materials for acidic and alkaline HER are reported. These Ru-Ni alloy nanoparticles serve as pH self-adaptive electroactive species by making use of in situ surface reconstruction, where surface Ni atoms are hydroxylated to produce bifunctional active sites of Ru-Ni(OH)
for alkaline HER, and selectively etched to form monometallic Ru active sites for acidic HER, respectively. Owing to the presence of Ru-Ni(OH)
multi-site surface, which not only accelerates water dissociation to generate reactive hydrogen intermediates but also facilitates their recombination into hydrogen molecules, the self-supported Ru
Ni
/rGOP hybrid electrode only takes overpotential of as low as ≈106 mV to deliver current density of 1000 mA cm
, and maintains exceptional stability for over 1000 h in 1 m KOH. While in 0.5 m H
SO
, the Ru
Ni
/rGOP hybrid electrode exhibits acidic HER catalytic behavior comparable to commercially available Pt/C catalyst due to the formation of monometallic Ru shell. These electrochemical behaviors outperform some of the best Ru-based catalysts and make it attractive alternative to Pt-based catalysts toward highly efficient HER.
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