Abstract There remains no optimal anticoagulation protocol for continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in pediatric patients with elevated D-dimer ...levels. We aimed to assess the effects of different anticoagulation strategies on the risk of CRRT filter clotting in these patients. Pediatric patients undergoing CRRT were retrospectively grouped based on pre-CRRT D-dimer levels and anticoagulant: D-RCA group (normal D-dimer, RCA only, n = 22), D+ RCA group (elevated D-dimer, RCA only, n = 50), and D+ RCA+ systemic heparin anticoagulation (SHA) group (elevated D-dimer, RCA combined with SHA, n = 55). The risk of filter clotting and incidence of bleeding were compared among the groups. Among the groups, the D+ RCA+ SHA group had the longest filter lifespan; further, the incidence of bleeding was not increased by concurrent use of low-dose heparin for anticoagulation. Moreover, concurrent heparin anticoagulation was associated with a decreased risk of filter clotting. Contrastingly, high pre-CRRT hemoglobin and D-dimer levels and post-filter ionized calcium level > 0.4 mmol/L were associated with an increased risk of filter clotting. RCA combined with low-dose heparin anticoagulation could reduce the risk of filter clotting and prolong filter lifespan without increasing the risk of bleeding in patients with elevated D-dimer levels undergoing CRRT.
Accomplishing optical activity in achiral materials has long been a challenge. Achiral nanomaterials that crystallize in achiral point groups are generally optically inactive. Herein we report the ...surprising observation of optical activity in several achiral point groups for supercrystals assembled from anisotropic metal nanoclusters with atomic precision. By analyzing multiple achiral nanoclusters with different molecular structures and symmetry space groups, we have identified that the molecular anisotropy of nanocluster entities and their asymmetric arrangement in point groups of supercrystals are the two key factors for the realization of optical activity in such supercrystals. We have further exploited the polarization effect of the nanocluster supercrystals as a polarization switch that can alter the polarized state of the linearly polarized light. Our findings have broadened the fundamental principles for producing nanomaterial-based optical activity and devices with polarization effects.
With low mature Triassic Chang 7 Member shale samples from the Ordos Basin as study object, the 3-D porosity evolution with temperature increase and its main controlling factors are analyzed based on ...the physical modeling under high temperature & pressure and nano-CT scanning data. More and more nano-pores were developed in Chang 7 Member organic-rich shale with the increase of maturity. The porosity calculated from the nano-CT scanning model increased from 0.56% to 2.06%, more than 250% times larger, when temperature increased from 20 °C to 550 °C. The process of porosity evolution can be divided into three phases. Firstly, porosity decreased rapidly from immature to low mature stage because of weak hydrocarbon generation and strong compaction; Secondly, porosity increased rapidly when the maturity increased from low mature stage to mature and post-mature stage, organic matter cracked into hydrocarbon (HC) massively, and clay minerals transformed intensively; Thirdly, porosity system kept stable when the shale entered into post-mature stage and the intensity of both HC generation and clay mineral transformation decreased. Organic matter thermal evolution, clay mineral transformation and brittle mineral transformation make different contribution to the porosity of shale, and the ratio is 6:3:1 respectively. It is inferred abundant organic matter pores occur when Ro is over 1.2%.
Bisphenol A (BPA) is used in the production of plastic but has oestrogenic activity. Therefore, BPA substitutes, such as fluorene-9-bisphenol (BHPF), have been introduced for the production of ...so-called 'BPA-free' plastics. Here we show that BHPF is released from commercial 'BPA-free' plastic bottles into drinking water and has anti-oestrogenic effects in mice. We demonstrate that BHPF has anti-oestrogenic activity in vitro and, in an uterotrophic assay in mice, induces low uterine weight, atrophic endometria and causes adverse pregnancy outcomes, even at doses lower than those of BPA for which no observed adverse effect have been reported. Female mice given water containing BHPF released from plastic bottles, have detectable levels of BHPF in serum, low uterine weights and show decreased expressions of oestrogen-responsive genes. We also detect BHPF in the plasma of 7/100 individuals, who regularly drink water from plastic bottles. Our data suggest that BPA substitutes should be tested for anti-oestrogenic activity and call for further study of the toxicological effects of BHPF on human health.
Abstract Ischemic heart disease is a leading cause of death in human population and protection of myocardial infarction (MI) associated with ischemia–reperfusion (I/R) remains a challenge. MG53 is an ...essential component of the cell membrane repair machinery that protects injury to the myocardium. We investigated the therapeutic value of using the recombinant human MG53 (rhMG53) protein for treatment of MI. Using Langendorff perfusion of isolated mouse heart, we found that I/R caused injury to cardiomyocytes and release of endogenous MG53 into the extracellular solution. rhMG53 protein was applied to the perfusion solution concentrated at injury sites on cardiomyocytes to facilitate cardioprotection. With rodent models of I/R-induced MI, we established the in vivo dosing range for rhMG53 in cardioprotection. Using a porcine model of angioplasty-induced MI, the cardioprotective effect of rhMG53 was evaluated. Intravenous administration of rhMG53, either prior to or post-ischemia, reduced infarct size and troponin I release in the porcine model when examined at 24 h post-reperfusion. Echocardiogram and histological analyses revealed that the protective effects of rhMG53 observed following acute MI led to long-term improvement in cardiac structure and function in the porcine model when examined at 4 weeks post-operation. Our study supports the concept that rhMG53 could have potential therapeutic value for treatment of MI in human patients with ischemic heart diseases.
The traditional approaches for evaluating the stability of slopes or earth dams subjected to water drawdown are performed under plane-strain two-dimensional (2D) condition. Three-dimensional (3D) ...effect is neglected in assessment of the safety of a slope limited by rigid structures or a dam constrained by a narrow valley. Based on the kinematic approach of limit analysis, a 3D rotational failure mechanism is adopted here to investigate the influence of water drawdown on stability of 3D slopes. Several stability charts are presented to conveniently estimate the safety factor of 3D slopes under four different types of drawdown processes. An example is given to demonstrate the difference in the safety factors obtained from 2D and 3D analyses. When a slope is constrained to a large width (the ratio of the width to the height B/H ≥ 10.0), the 3D effect can be neglected and the plane-strain analysis is appropriate to assess its safety.
Abstract
Objective
This study aims to investigate the efficacy and safety of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the ...treatment of parapelvic cysts, and to review recently published relevant literature.
Method
This is a retrospective study in which the clinical data of 47 patients who underwent flexible ureteroscopic holmium laser incision and internal drainage of parapelvic cysts in our center from March 2017 to March 2021 were retrospectively analyzed. A literature search was conducted to review and summarize relevant reports on endoscopic treatment of parapelvic cysts published in the past 10 years.
Results
Among 47 patients with parapelvic cysts who underwent flexible ureteroscopic holmium laser incision and internal drainage, 12 (25.53%) cases had a typical cyst wall bulging into the collecting system under flexible ureteroscope. As the cyst wall was thin and translucent in these cases, ultrasound was not used during the operation. The cysts of the remaining 35 patients were located with the aid of intraoperative real time ultrasound, and all underwent successful operation. No serious surgical complications occurred after surgery. The patients were followed up for 12–24 months after operation. The cyst in one case was observed larger than its original size before operation, so recurrence was considered. In another two cases, the diameters of the cysts were more than half of their original diameters before operation. Thus, the efficacy was poor in the three cases. For the remaining 44 cases, there was no obvious cyst observed or the diameter of the cysts was less than half their preoperative level.
Conclusion
The approach of ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts is safe and effective, which helps to solve the problem of localization of atypical parapelvic cysts on endoscopic findings.
The stability of slopes might be influenced by numerous uncertainty factors. In this study, three uncertainty factors are considered in the slope stability analysis, which are locations of weak ...structural surfaces, structures of soil-rock mixtures, saptial variability of shear strength parameters. One new uncertainty analysis method considering these three uncertainty factors is proposed. And three geostatistical simulation algorithms are used to simulate three uncertainty factors, which are single normal equation simulation, sequential indicator simulation, sequential Gaussian simulation, respectively. When the uncertainty geology model is established, the finite element shear strength reduction method is carried out to calculate the factor of safety. This method is used to the stability analysis of Dahua landslide. The results of the Mont Carlo simulations showed that this method can effectively evaluate the influence of these three uncertainty factors on the slope stability. And the deformation pattern of Dahua landslide has been obtained by this method, which is retrogressive landslide. Then, the influence of the weak structural surfaces’ dip angle to the stability of slopes is discussed. Results show that when there are more vertical weak surfaces the more unstable of the slope.
Abstract
Background
Hemophagocytic lymphohistiocytosis (HLH) is a relatively rare and life-threatening disorder. Early mortality remains significantly high among patients with HLH. Our aim was to ...investigate clinical features and risk factors associated with 7-day and 30-day mortality among pediatric HLH patients. We retrospectively collected medical records of patients with discharge diagnosis of HLH between August 2014 and October 2018 from a tertiary children’s hospital in China. The main outcome measures were the 7-day and 30-day outcome after hospital admission. The associations between symptoms, concomitant diagnoses, laboratory test results, and the risk of 7-day and 30-day mortality were examined.
Results
Among 160 pediatric HLH patients, 18 (11.3%) patients were deceased within 7 days after admission, and 46 (28.8%) patients were deceased within 30 days. The identified strong risk factors (OR > 10 and
p
< 0.05) for 30-day mortality were myocardial damage, severe pneumonia, respiratory failure, coagulopathy, gastrointestinal disorder, and multiple organ dysfunction syndrome (MODS). Factors strongly associated with 7-day mortality were sepsis, myocardial damage, shock, and respiratory failure. All patients deceased within 7 days developed hepatic dysfunction, coagulopathy, and MODS.
Conclusions
The identified risk factors could help to stratify patients with high risk of early death, and need to be considered in the development of treatment protocols. As early mortality of HLH remains high, studies are needed to investigate how to initiate adequate HLH-directed treatment strategies for patients at higher risk of early death.
Introduction
Neurofascin (NF) is critical for the formation and maintenance of Ranvier nodes. NF186, the neuronal form of NF, localizes in the initial segment of axon and Ranvier node. NF186 antibody ...has been detected in demyelinating diseases of both central nervous system (CNS) and peripheral nervous system (PNS).
Aims
To evaluate the clinical features of patients with anti-NF186 IgG neuropathy.
Methods
Sixteen patients (16/138) with serum-positive anti-NF186 IgG were included and divided into groups of either CNS or PNS-involved according to their clinical manifestations. Anti-NF186 IgG was detected by cell-based assays.
Results
In 7 patients who were confirmed to have CNS involvement, the most frequent symptoms were dizziness (57%) and vision impairment (43%); lesions in centrum semiovale, cerebellum, and meninges were shown by magnetic resonance imaging (MRI). In comparison, limb weakness (78%) and numbness (78%) were the most common symptoms in PNS-involved patients; axonal loss and demyelination were confirmed by nerve conduction examinations. Elevated level of cerebrospinal fluid (CSF) protein was found in 12 cases without statistically significant difference between the CNS and PNS groups. Meanwhile, CSF white blood cell counts were found significantly elevated in CNS-involved patients compared with patients of PNS group. Thirteen patients received immunomodulating treatments, and patients with chronic onset and progressive course showed poor response to the therapies.
Conclusions
Patients with anti-NF186 IgG neuropathy showed no specific symptoms or signs. It is worth noting that quite a few patients show CNS-impaired signs only, and cranial MRI is essential for the screening of CNS involvement.
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