The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation

ObjectiveTo analyze the incidence, timing, risk factors and prognosis of delirium after liver transplantation (LT).MethodsThe clinical data of 321 patients undergoing LT in the Third Xiangya Hospital of Central South University from January 2018 to December 2022 were collected to investigate the incidence, onset, and risk factors for post-LT delirium and the impact of delirium on LT recipients’ prognosis by statistical analysis.ResultsThe incidence of post-LT delirium was 19.3% (62/321), and the median interval between LT and onset of delirium was 20.1 h. Univariate analysis showed that pre-LT variables (Model for End Stage Liver Disease (MELD) score, hospital stay, hepatic encephalopathy, infection, white blood cell (WBC) count, lymphocyte count, abnormal potassium, lactulose use), intraoperative variables (red blood cell transfusion, remimazolam use, dexmedetomidine use) and post-LT variables (hypernatraemia, acute rejection, reoperation, basiliximab use, tacrolimus concentration) were associated with post-LT delirium. Multivariate logistic regression analysis revealed that MELD score at LT ≥22 [OR = 3.400, 95% CI:1.468–7.876, p = 0.004], pre-LT hepatic encephalopathy [OR = 3.224, 95% CI:1.664–6.244, p = 0.001], infection within 2 months prior to LT [OR = 2.238, 95% CI:1.151–4.351, p = 0.018], acute rejection [OR = 2.974, 95% CI:1.322–6.690, p = 0.008], and reoperation [OR = 11.919, 95% CI:2.938–48.350, p = 0.001] were independent risk factors for post-LT delirium. Post-LT delirium was reduced in LT recipients exposing to intraoperative remimazolam [OR = 0.287, 95% CI: 0.113–0.733, p = 0.009] or ≥ 25 μg of intraoperative dexmedetomidine [OR = 0.441, 95% CI 0.225–0.867, p = 0.018]. As for clinical outcomes, patients with delirium had a higher percentage of staying at the (ICU) ≥7 d after LT than those without delirium [OR = 2.559, 95% CI 1.418–4.617, p = 0.002].ConclusionThe incidence of delirium was high and the onset of delirium was early after LT. Risk factors for post-LT delirium included high MELD score at LT, pre-LT hepatic encephalopathy and infections, acute rejection and reoperation. Intraoperative use of remimazolam or dexmedetomidine reduced post-LT delirium. Delirium had a negative impact on the length of ICU stay

Effects of crown-to-implant ratio on marginal bone level and bone density in non-splinted single implants: a cross-sectional study

Abstract Background Few studies have evaluated the effects of the crown-to-implant (C/I) ratio on the marginal bone level (MBL) and bone density in non-splinted single implants. The aim of this study was to assess the effect of C/I ratio on MBL and density of peri-implant bone in non-splinted posterior implants. Methods The C/I ratio, MBL, and grayscale values (GSVs) for bone density were measured from X-rays. Four areas of interest (two at the apical area and two at the middle of the peri-implant area) and two control areas were selected for evaluation. Follow-up radiographs were calibrated according to the control areas. Results In all, 117 non-splinted posterior implants in 73 patients followed up for a mean duration of 36.23 ± 10.40 (range 24–72) months were considered. The mean anatomical C/I ratio was 1.78 ± 0.43 (range 0.93 to 3.06). The mean change in MBL was 0.28 ± 0.97 mm. There were no significant associations between the C/I ratio and MBL changes (r = -0.028, p = 0.766). Pearson correlation showed a significant correlation between changes in GSV and the C/I ratio in the middle peri-implant area (r = 0.301, p = 0.001) and apical area (r = 0.247, p = 0.009). Conclusions A higher C/I ratio of single non-splinted posterior implants is associated with increased peri-implant bone density, but not correlated with changes in MBL

Detailed amount of particle breakage in nonuniformly graded sands under one-dimensional compression

The coexistence of broken and unbroken grains in each size range can disturb the assessment of actual amount of particle breakage. In this study, a series of one-dimensional compression tests were carried out on three kinds of coral sands and a silica sand to clarify the detailed amount of particle breakage for nonuniformly graded sands. Before the compression tests, both coral and silica sand assemblies were divided into different grain-size groups and dyed in different colors, then mixed as nonuniformly graded packings. After the compression, grains of different color in each size range were discerned quantitatively by implementing particle images segmentation on images of grains. Results show that the extent of particle breakage was found to be larger than the change in relative mass percentage in most size ranges, and the new “absolute particle breakage” wd for each size range satisfied linear relationships with the logarithmic value of compression pressure. Compared with silica sand, coral sand has weaker abrasion under high pressure due to the strong interlock among grains. New breakage indexes of sand samples, based on detailed particle breakage, are proposed. The detailed particle breakage could be useful for proposing a breakage-dependent constitutive model of crushable granular soils.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Optimal Operation for Economic and Exergetic Objectives of a Multiple Energy Carrier System Considering Demand Response Program

An MECS (multiple energy carrier system) could meet diverse energy needs owing to the integration of different energy carriers, while the distinction of quality of different energy resources should be taken into account during the operation stage, in addition the economic principle. Hence, in this paper, the concept of exergy is adopted to evaluate each energy carrier, and an economic–exergetic optimal scheduling model is formulated into a mixed integer linear programming (MILP) problem with the implementation of a real-time pricing (RTP)-based demand response (DR) program. Moreover, a multi-objective (MO) operation strategy is applied to this scheduling model, which is divided into two parts. First, the ε-constraint method is employed to cope with the MILP problem to obtain the Pareto front by using the state-of-the-art CPLEX solver under the General Algebraic Modeling System (GAMS) environment. Then, a preferred solution selection strategy is introduced to make a trade-off between the economic and exergetic objectives. A test system is investigated on a typical summer day, and the optimal dispatch results are compared to validate the effectiveness of the proposed model and MO operation strategy with and without DR. It is concluded that the MECS operator could more rationally allocate different energy carriers and decrease energy cost and exergy input simultaneously with the consideration of the DR scheme

Comparative Study of Water-Leaching and Acid-Leaching Pretreatment on the Thermal Stability and Reactivity of Biomass Silica for Viability as a Pozzolanic Additive in Cement

The present work aims to introduce a novel and eco-friendly method, i.e., a water-leaching pretreatment for extracting highly reactive biomass silica from rice husk (RH), for viability as a pozzolanic additive in cement. For comparison, the traditional acid pretreatment method was also employed throughout the experimental study. The silica from RH was extracted using boiled deionized water and acid solution as leaching agents to remove the alkali metal impurities, and then dried and submitted to pyrolysis treatment. The results indicated that potassium was found to be the major contaminant metal inducing the formation of undesirable black carbon particles and the decrease in crystallization temperature of amorphous RHA silica. The boiling-water-leaching pretreatment and acid-leaching pretreatment on RHs significantly removed the metallic impurities and reduced the crystallization sensitivity of RHA silica to calcination temperature. A highly reactive amorphous silica with purity of 96% was obtained from RH via 1 N hydrochloric acid leaching followed by controlled calcination at 600 °C for 2 h. The acid treatments increased the crystallization temperature of silica to 1200 °C and retained the amorphous state of silica for 2.5 h. In the case of water-leaching pretreatment, leaching duration for 2.5 h could yield an amorphous silica with purity of 94% and render the silica amorphous at 900 °C for 7 h. The RHA silica yielded by water-leaching pretreatment presented a comparable enhancing effect to that of acid leaching on hydration and improved the strength of cement. Furthermore, compared with the acid-leaching method, the water-leaching pretreatment method is more environmentally friendly and easier to operate, and hence more widely available

Feasibility of Kaolin Tailing Sand to Be As an Environmentally Friendly Alternative to River Sand in Construction Applications

Kaolin tailing sand (KTS) generated as a by-product from kaolin mining sorting, is usually disposed of by delivering to landfills. Effective utilization of KTS in concrete could be an attractive solution for the waste disposal with the value-added advantage of conservation of natural resources and as an eco-friendly alternative for natural river sand (NRS). This paper explored the potential feasibility of recycling KTS, as a substitute for NRS as a fine aggregate in producing cement mortar and concrete. Material characterization tests revealed that KTS possessed a high content of quartz and comparable physical properties to NRS. The fresh and hardened properties of mortars and concretes with varying KTS replacement combinations were determined. The experimental results revealed that the introduction of KTS reduced workability of the resulting mortar, attributed to the high water absorption of KTS particles. However, the introduction of KTS led to a reduction of expansion induced by alkaline silicic acid reaction (ASR) as well as an improvement in flexural strength and compressive strength of the resulting mortar, closely relating to the rough texture and angular nature of KTS. In the case of concrete test, KTS was superior to NRS in enhancing the compressive strength and splitting tensile strength, while decreasing the chloride ion penetration of concrete regardless of whether fly ash or slag was incorporated as a mineral admixture. It is noteworthy that for both mortars and concretes, specimens with 60% of KTS replacement by mass exerted the best mechanical performance. Beyond this ratio led to a slight reduction in mechanical strength, but still acceptable, mainly due to the relatively low inherent strength and depressed packing induced by the flaky shape of KTS particles

Image_3_Bibliometric analysis of intestinal microbiota and lung diseases.tif

BackgroundIncreasing evidence suggests a close association between the intestinal microbiome and the respiratory system, drawing attention to studying the gut-lung axis. This research employs bibliometric methods to conduct a visual analysis of literature in the field of intestinal microbiota and lung diseases over the past two decades. It offers scientific foundations for research directions and critical issues in this field.MethodsWe retrieved all articles on intestinal microbiota and lung diseases from the SCI-Expanded of WoSCC on October 25, 2023. The analysis included original articles and reviews published in English from 2011 to 2023. We utilized Python, VOSviewer, and CiteSpace to analyze the retrieved data visually.ResultsA total of 794 publications were analyzed. China ranked first in the number of publications, while the United States had the highest citations and H-index. Jian Wang was the most prolific author. Zhejiang University was the institution with the highest number of publications. Frontiers in Microbiology was the journal with the most publications. Author keywords appearing more than 100 times included “intestinal microbiota/microbiome”, “microbiota/microbiome”, and “gut-lung axis”.ConclusionThe correlation and underlying mechanisms between intestinal microbiota and lung diseases, including asthma, COPD, lung cancer, and respiratory infections, remain hot topics in research. However, understanding the mechanisms involving the gut-lung axis is still in its infancy and requires further elucidation.</p