Associations between perioperative fluid management and patient outcomes: a multicentre retrospective study

BACKGROUND: Postoperative complications increase hospital length of stay and patient mortality. Optimal perioperative fluid management should decrease patient complications. This study examined associations between fluid volume and noncardiac surgery patient outcomes within a large multicentre US surgical cohort. METHODS: Adults undergoing noncardiac procedures from January 1, 2012 to December 31, 2017, with a postoperative length of stay ≥24 h, were extracted from a large US electronic health record database. Patients were segmented into quintiles based on recorded perioperative fluid volumes with Quintile 3 (Q3) serving as the reference. The primary outcome was defined as a composite of any complications during the surgical admission and a postoperative length of stay ≥7 days. Secondary outcomes included in-hospital mortality, respiratory complications, and acute kidney injury. RESULTS: A total of 35 736 patients met the study criteria. There was a U-shaped pattern with highest (Q5) and lowest (Q1) quintiles of fluid volumes having increased odds of complications and a postoperative length of stay ≥7 days (Q5: odds ratio [OR] 1.51 [95% confidence interval {CI}: 1.30-1.74], P<0.001; Q1: OR 1.20 [95% CI: 1.04-1.38], P=0.011) compared with Q3. Patients in Q5 had greater odds of more severe acute kidney injury compared with Q3 (OR 1.52 [95% CI: 1.22-1.90]; P<0.001) and respiratory complications (OR 1.44 [95% CI: 1.17-1.77]; P<0.001). CONCLUSIONS: Both very high and very low perioperative fluid volumes were associated with an increase in complications after noncardiac surgery

Stripe Fluctuations, Carriers, Spectroscopies, Transport, and BCS-BEC Crossover in the High-T_c Cuprates

The quasiparticles of the high-T_c cuprates are found to consist of: polaron-like "stripons" carrying charge, and associated primarily with large-U orbitals in stripe-like inhomogeneities; "quasielectrons" carrying charge and spin, and associated with hybridized small-U and large-U orbitals; and "svivons" carrying spin and lattice distortion. It is shown that this electronic structure leads to the systematic behavior of spectroscopic and transport properties of the cuprates. High-T_c pairing results from transitions between pair states of stripons and quasielectrons through the exchange of svivons. The cuprates fall in the regime of crossover between BCS and preformed-pairs Bose-Einstein condensation behaviors.Comment: Latex file, 8 pages (new version including a figure

Thick calcification from a GIST of the stomach penetrating into pericolic soft tissue - report of a case

Thick calcification is a rare presentation of gastrointestinal stromal tumor (GIST). Penetration into gastric mucosa and pericolic soft tissue has never been reported. We report a case of gastric GIST with cystic degeneration and thick calcification in an 81-year old female, who presented with hematemesis and severe abdominal pain. Thick calcification of this tumor penetrating into pericolic soft tissue was noted and successfully treated by distal gastrectomy and partial colectomy. For gastrointestinal tumors with thick calcification, even with benign behavior, surgical intervention should be considered for both oncological considerations and prevention of catastrophes like perforation or penetration into surrounding soft tissue

Direct imaging of the coexistence of ferromagnetism and superconductivity at the LaAlO3/SrTiO3 interface

LaAlO3 and SrTiO3 are insulating, nonmagnetic oxides, yet the interface between them exhibits a two-dimensional electron system with high electron mobility,1 superconductivity at low temperatures,2-6 and electric-field-tuned metal-insulator and superconductorinsulator phase transitions.3,6-8 Bulk magnetization and magnetoresistance measurements also suggest some form of magnetism depending on preparation conditions5,9-11 and suggest a tendency towards nanoscale electronic phase separation.10 Here we use local imaging of the magnetization and magnetic susceptibility to directly observe a landscape of ferromagnetism, paramagnetism, and superconductivity. We find submicron patches of ferromagnetism in a uniform background of paramagnetism, with a nonuniform, weak diamagnetic superconducting susceptibility at low temperature. These results demonstrate the existence of nanoscale phase separation as suggested by theoretical predictions based on nearly degenerate interface sub-bands associated with the Ti orbitals.12,13 The magnitude and temperature dependence of the paramagnetic response suggests that the vast majority of the electrons at the interface are localized, and do not contribute to transport measurements.3,6,7 In addition to the implications for magnetism, the existence of a 2D superconductor at an interface with highly broken inversion symmetry and a ferromagnetic landscape in the background suggests the potential for exotic superconducting phenomena.Comment: Edited version to appear in Nature Physic

Environmental risk factors of pregnancy outcomes: A summary of recent meta-analyses of epidemiological studies.

Background Various epidemiological studies have suggested associations between environmental exposures and pregnancy outcomes. Some studies have tempted to combine information from various epidemiological studies using meta-analysis. We aimed to describe the methodologies used in these recent meta-analyses of environmental exposures and pregnancy outcomes. Furthermore, we aimed to report their main findings. Methods We conducted a bibliographic search with relevant search terms. We obtained and evaluated 16 recent meta-analyses. Results The number of studies included in each reported meta-analysis varied greatly, with the largest number of studies available for environmental tobacco smoke. Only a small number of the studies reported having followed meta-analysis guidelines or having used a quality rating system. Generally they tested for heterogeneity and publication bias. Publication bias did not occur frequently. The meta-analyses found statistically significant negative associations between environmental tobacco smoke and stillbirth, birth weight and any congenital anomalies; PM2.5 and preterm birth; outdoor air pollution and some congenital anomalies; indoor air pollution from solid fuel use and stillbirth and birth weight; polychlorinated biphenyls (PCB) exposure and birth weight; disinfection by-products in water and stillbirth, small for gestational age and some congenital anomalies; occupational exposure to pesticides and solvents and some congenital anomalies; and agent orange and some congenital anomalies. Conclusions The number of meta-analyses of environmental exposures and pregnancy outcomes is small and they vary in methodology. They reported statistically significant associations between environmental exposures such as environmental tobacco smoke, air pollution and chemicals and pregnancy outcomes

f(R) theories

Over the past decade, f(R) theories have been extensively studied as one of the simplest modifications to General Relativity. In this article we review various applications of f(R) theories to cosmology and gravity - such as inflation, dark energy, local gravity constraints, cosmological perturbations, and spherically symmetric solutions in weak and strong gravitational backgrounds. We present a number of ways to distinguish those theories from General Relativity observationally and experimentally. We also discuss the extension to other modified gravity theories such as Brans-Dicke theory and Gauss-Bonnet gravity, and address models that can satisfy both cosmological and local gravity constraints.Comment: 156 pages, 14 figures, Invited review article in Living Reviews in Relativity, Published version, Comments are welcom

Gate-tunable giant nonreciprocal charge transport in noncentrosymmetric oxide interfaces

A polar conductor, where inversion symmetry is broken, may exhibit directional propagation of itinerant electrons, i.e., the rightward and leftward currents differ from each other, when time-reversal symmetry is also broken. This potential rectification effect was shown to be very weak due to the fact that the kinetic energy is much higher than the energies associated with symmetry breaking, producing weak perturbations. Here we demonstrate the appearance of giant nonreciprocal charge transport in the conductive oxide interface, LaAlO3/SrTiO3, where the electrons are confined to two-dimensions with low Fermi energy. In addition, the Rashba spin???orbit interaction correlated with the sub-band hierarchy of this system enables a strongly tunable nonreciprocal response by applying a gate voltage. The observed behavior of directional response in LaAlO3/SrTiO3 is associated with comparable energy scales among kinetic energy, spin???orbit interaction, and magnetic field, which inspires a promising route to enhance nonreciprocal response and its functionalities in spin orbitronics

Radio emission from Supernova Remnants

The explosion of a supernova releases almost instantaneously about 10^51 ergs of mechanic energy, changing irreversibly the physical and chemical properties of large regions in the galaxies. The stellar ejecta, the nebula resulting from the powerful shock waves, and sometimes a compact stellar remnant, constitute a supernova remnant (SNR). They can radiate their energy across the whole electromagnetic spectrum, but the great majority are radio sources. Almost 70 years after the first detection of radio emission coming from a SNR, great progress has been achieved in the comprehension of their physical characteristics and evolution. We review the present knowledge of different aspects of radio remnants, focusing on sources of the Milky Way and the Magellanic Clouds, where the SNRs can be spatially resolved. We present a brief overview of theoretical background, analyze morphology and polarization properties, and review and critical discuss different methods applied to determine the radio spectrum and distances. The consequences of the interaction between the SNR shocks and the surrounding medium are examined, including the question of whether SNRs can trigger the formation of new stars. Cases of multispectral comparison are presented. A section is devoted to reviewing recent results of radio SNRs in the Magellanic Clouds, with particular emphasis on the radio properties of SN 1987A, an ideal laboratory to investigate dynamical evolution of an SNR in near real time. The review concludes with a summary of issues on radio SNRs that deserve further study, and analyzing the prospects for future research with the latest generation radio telescopes.Comment: Revised version. 48 pages, 15 figure

Metabolic role of pyrophosphate-linked phosphofructokinasepfkfor C1 assimilation inMethylotuvimicrobium alcaliphilum20Z

Background Methanotrophs is a promising biocatalyst in biotechnological applications with their ability to utilize single carbon (C1) feedstock to produce high-value compounds. Understanding the behavior of biological networks of methanotrophic bacteria in different parameters is vital to systems biology and metabolic engineering. Interestingly, methanotrophic bacteria possess the pyrophosphate-dependent 6-phosphofructokinase (PPi-PFK) instead of the ATP-dependent 6-phosphofructokinase, indicating their potentials to serve as promising model for investigation the role of inorganic pyrophosphate (PPi) and PPi-dependent glycolysis in bacteria. Gene knockout experiments along with global-omics approaches can be used for studying gene functions as well as unraveling regulatory networks that rely on the gene product. Results In this study, we performed gene knockout and RNA-seq experiments inMethylotuvimicrobium alcaliphilum20Z to investigate the functional roles of PPi-PFK in C1 metabolism when cells were grown on methane and methanol, highlighting its metabolic importance in C1 assimilation inM. alcaliphilum20Z. We further conducted adaptive laboratory evolution (ALE) to investigate regulatory architecture inpfkknockout strain. Whole-genome resequencing and RNA-seq approaches were performed to characterize the genetic and metabolic responses of adaptation topfkknockout. A number of mutations, as well as gene expression profiles, were identified inpfkALE strain to overcome insufficient C1 assimilation pathway which limits the growth in the unevolved strain. Conclusions This study first revealed the regulatory roles of PPi-PFK on C1 metabolism and then provided novel insights into mechanism of adaptation to the loss of this major metabolic enzyme as well as an improved basis for future strain design in type I methanotrophs

Control of electronic conduction at an oxide heterointerface using surface polar adsorbates

The transfer of electrons between a solid surface and adsorbed atomic or molecular species is fundamental in natural and synthetic processes, being at the heart of most catalytic reactions and many sensors. In special cases, metallic conduction can be induced at the surface of, for example, Si-terminated SiC1, or mixed-terminated ZnO2, in the presence of a hydrogen adlayer. Generally, only the surface atoms are significantly affected by adsorbates. However, remotely changing electronic states far from the adsorbed layer is possible if these states are electrostatically coupled to the surface. Here we show that the surface adsorption of common solvents such as acetone, ethanol, and water can induce a large change (factor of three) in the conductivity at the buried interface between SrTiO3 substrates and LaAlO3 thin films3-8. This phenomenon is observed only for polar solvents. Our result provides experimental evidence that adsorbates at the LaAlO3 surface induce accumulation of electrons at the LaAlO3/SrTiO3 interface, suggesting a general polarization-facilitated electronic transfer mechanism, which can be used for sensor applications.Comment: 14 pages, 4 figure