To investigate the clinical and coagulation characteristics of the critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the intensive care unit (ICU).
The retrospective study ...included 7 critical COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed.
The median age of 7 patients was 59 years and 4 of them were men. 3 of them were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time (PT) were prolonged in 4 patients. D-dimer and FDP levels increased progressively when COVID-2019 exacerbated, and 4 patients were diagnosed with definite disseminated intravascular coagulation (DIC). 6 patients received low molecular weight heparin (LMWH) treatment, after which their D-dimer and FDP decreased, but there was no significant improvement in clinical symptoms. 5 patients died finally and the median time from acro-ischemia to death was 12 days.
The existence of hypercoagulation status in critical COVID-2019 patients should be monitored closely, and anticoagulation therapy can be considered in selected patients. More clinical data is needed to investigate the role of anticoagulation in COVID-2019 treatment.
We aimed to conduct a meta-analysis to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with post-stroke depression (PSD). Six relevant electronic databases ...(PubMed, CENTRAL, Embase, Web of Science, CINAHL, and PsycINFO) were searched. Randomized controlled trials (RCTs) that compared rTMS with control condition for PSD were included. The mean change in depression symptom scores was defined as the primary efficacy outcome. Secondary outcomes included the remission rate of depression, stroke recovery, and cognitive function recovery. In total, 7 RCTs with 351 participants were included. At post-treatment, rTMS was significantly more effective than the control condition, with a standardized mean difference (SMD) of -1.15 (95%CI: -1.62 to -0.69; P<0.001, I2=71%) and remission with an odds ratio (OR) of 3.46 (95%CI: 1.68 to 7.12; P<0.001; I2=11%). As for stroke recovery, rTMS was also better than the control condition (SMD=-0.67, 95%CI: -1.02 to -0.32; P<0.001). However, no significant difference was found for cognitive function recovery between the two groups (SMD=4.07, 95%CI: -1.41 to 9.55; P=0.15). To explore the potential moderators for the primary outcome, a series of subgroup and sensitivity analyses were performed. The results implied that rTMS may be more effective in Asian samples than in North American samples (P=0.03). In conclusion, from the current evidence in this study, rTMS could be an effective treatment for patients with PSD. Further clinical studies with larger sample sizes and clearer subgroup definitions are needed to confirm these outcomes.
Low temperature is one of the important factors limiting wheat yield in cold regions. Expansins are nonenzymatic proteins that loosen cell walls and play important roles in diverse biological ...processes related to cell wall modification, including development and stress tolerance. Many studies have shown that expansins are involved in resistance to various abiotic stresses, such as heat and drought. However, the role of expansins in response to low‐temperature stress remains unclear.
Based on our previous transcriptome data of a winter wheat cultivar Dongnongdongmai 2 (DN2), we found that one of the expansin genes, TaEXPA8, was significantly induced by low temperature, indicating a role for TaEXPA8 in cold resistance. In this study, the paralogous TaEXPA8 genes TaEXPA8‐A, TaEXPA8‐B and TaEXPA8‐D were cloned by RT‐PCR. These three genes were then transformed into Arabidopsis by the floral dip method. Expression patterns of TaEXPA8 genes in different tissues and in response to several abiotic stresses and hormones were detected by quantitative real‐time PCR (qRT‐PCR).
The results showed that TaEXPA8‐A and TaEXPA8‐B were expressed mainly in roots, while TaEXPA8‐D was expressed predominantly in flowers. TaEXPA8 genes were induced by low‐temperature and drought. The overexpression of TaEXPA8‐B and TaEXPA8‐D enhanced low‐temperature resistance and had increased superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activity and soluble protein, MDA and proline content.
In summary, our study suggested that the expansins TaEXPA8‐B and TaEXPA8‐D are involved in the response to low temperature and possibly play a role in cold resistance by activating the protective enzyme system.
The adsorption characteristics of phosphate adsorption on the dewatered alum sludge were identified as a function of pH and ion strengths in solution. In addition, adsorption mechanisms were ...investigated by conducting batch tests on both the hydrolysis and P-adsorption process of the alum sludge, and making a comparative analysis to gain newer insights into understanding the adsorption process. Results show that the adsorption capacity decreased from 3.5 to 0.7
mg
P/g
sludge when the solution pH was increased from 4.3 to 9.0, indicating that adsorption capacity is largely dependent upon the pH of the system. The results of the competitive adsorption between phosphate and typical anions found in wastewater, such as SO
4
2− and Cl
−, onto alum sludge reveal that alum sludge can selectively adsorb phosphate ions. The insignificant effect of SO
4
2− and Cl
− on P-adsorption capacity indicates that phosphate adsorption is through a kind of inner-sphere complex reaction. During the adsorption process, the decrease of phosphate concentration in solution accompanied with an increase in pH values and concentrations of SO
4
2−, Cl
− and TOC (total organic carbon) suggests that phosphate replaced the functional groups from the surface of alum sludge which infers that ligand exchange is the dominating mechanism for phosphate removal. At the same time, the simultaneous decreases in PO
4
3− and total aluminium concentration in solution indicate that chemical reaction and precipitation are other mechanisms of phosphate removal.
Individualized treatment rules recommend treatments on the basis of individual patient characteristics. A high-quality treatment rule can produce better patient outcomes, lower costs and less ...treatment burden. If a treatment rule learned from data is to be used to inform clinical practice or provide scientific insight, it is crucial that it be interpretable; clinicians may be unwilling to implement models they do not understand, and black-box models may not be useful for guiding future research. The canonical example of an interpretable prediction model is a decision tree. We propose a method for estimating an optimal individualized treatment rule within the class of rules that are representable as decision trees. The class of rules we consider is interpretable but expressive. A novel feature of this problem is that the learning task is unsupervised, as the optimal treatment for each patient is unknown and must be estimated. The proposed method applies to both categorical and continuous treatments and produces favourable marginal mean outcomes in simulation experiments. We illustrate it using data from a study of major depressive disorder.
This experiment was conducted to assess the comparative effects of dietary antibiotics and oregano essential oil (OEO) addition on growth performance, antioxidant status and intestinal health of ...broilers. A total of 384 one-day-old broilers were randomly allocated to 4 treatments with 6 replicates of 16 broilers each. The 4 treatments were: an antibiotic-free control diet (control), control + 20 mg/kg colistin sulfate and 20 mg/kg virginiamycin (antibiotics), control + 200 mg/kg natural oregano essential oil (NOEO), and control + 200 mg/kg synthetic oregano essential oil (SOEO). The experiment lasted for 42 d. Results showed that birds fed with OEO had greater (P < 0.05) average daily gain (ADG) and lower (P < 0.05) feed conversion ratio (FCR) than those fed with control diet during d 1 to 21. Besides, birds fed with NOEO had the greatest (P < 0.05) ADG in the four groups during d 22 to 42. The serum oxidative stress parameters showed that OEO improved (P < 0.05) the activities of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and glutathione reductase (GR) of birds on day 21 and the activity of total antioxidant capacity (T-AOC) of birds on d 42. Relative to control, NOEO increased (P < 0.05) the activity of T-AOC in jejunum and decreased (P < 0.05) the level of malondialdehyde (MDA) in serum and jejunum. Moreover, OEO supplementation increased (P < 0.05) the concentrations of sIgA in duodenum and jejunum, Lactobacillus and total anaerobes in cecum, as well as activities of trypsin, chymotrypsin, lipase and amylase in duodenum, but restrained (P < 0.05) the amount of Escherichia coli. The NOEO supplementation increased (P < 0.05) total anaerobes of broilers on d 42 and the villus height to crypt depth ratio (VH/CD) of ileum. These results suggest that OEO improved antioxidant status and intestinal health of broilers which contributed to the growth performance improvement of broilers. Dietary OEO supplementation can be a promising alternative to antibiotic growth promoters for improving poultry production.
High-energy photons from the Crab Nebula
The Crab Nebula contains a pulsar that excites the surrounding gas to emit high-energy radiation. The combination of the pulsar's youth and nearby location ...makes the nebula the brightest gamma-ray source in the sky. The LHAASO Collaboration report observations of this source at energies of tera– to peta–electron volts, extending the spectrum of this prototypical object. They combine these data with observations at lower energies to model the physics of the emission process. The multiwave-length data can be explained by a combination of synchrotron radiation and inverse Compton scattering.
Science
, abg5137, this issue p.
425
Detection of the Crab Nebula at peta–electron volt energies constrains the gamma-ray emission mechanism.
The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar’s rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10
−4
to 1.1 peta–electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta–electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron’s size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta–electron volt electrons, 2.5 × 10
36
ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta–electron volt protons to the production of the highest-energy gamma rays.
Virtually all known drinking water processing systems generate an enormous amount of residual sludge, and what to do with this rapidly increasing "waste" stream in an economic and environmentally ...sustainable manner remains a significant environmental issue. Perhaps the realization of this fact has led to a series of concerted efforts aimed at beneficial reuses in an effort to close the loop between efficient water treatment and sustainable sludge management. This article therefore presents a comprehensive review of available literature on attempts at beneficial reuses of water treatment plant sludge, in an effort to provide a compendium of recent and past developments, and to update our current state of knowledge. Four broad categories of uses, which included more than 11 possible ways in which waterworks sludges can be reused, are identified and examined. Obvious advantages of such reuse options are highlighted and knowledge gaps are identified. Future issues that will assist in the development of sustainable waterworks sludge management options with a multiprong approach are discussed.
The concept, design and performance analysis of a four-stage novel constructed wetland system (CWs) capable of enhanced and simultaneous removal of phosphorus (P) and organic matter (OM) from ...wastewaters is described. Alum sludge, a largely available by-product of drinking water facilities using aluminium salts as coagulant was used as the media. Under a hydraulic loading rate of 1.27
m
3/m
2
d and a range of organic loading rate of 279.4–774.7
g-BOD
5/m
2
d and 361.1–1028.7
g-COD/m
2
d, average removal efficiencies (mean
±
SD) of 90.6
±
7.5% for BOD
5 and 71.8
±
10.2% for COD were achieved, respectively. P removal was exceptional with average removal efficiency of 97.6
±
1.9% achieved for soluble reactive P at a mean influent concentration of 21.0
±
2.9
mg/l. Overall, the system holds great promise as a novel CWs for simultaneous removal of P and OM, and at the same time, it transforms alum sludge from a waste into a useful material.
PDF
