Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Patients frequently experience postoperative pain after a total knee arthroplasty; such pain is always challenging to treat and may delay the patient’s recovery. It is unclear whether local infiltration or a femoral nerve block offers a better analgesic effect after total knee arthroplasty.We performed a systematic review and meta-analysis of randomized controlled trials to compare local infiltration with a femoral nerve block in patients who underwent a primary unilateral total knee arthroplasty. We searched Pubmed, EMBASE, and the Cochrane Library through December 2014. Two reviewers scanned abstracts and extracted data. The data collected included numeric rating scale values for pain at rest and pain upon movement and opioid consumption in the first 24 hours. Mean differences with 95% confidence intervals were calculated for each end point. A sensitivity analysis was conducted to evaluate potential sources of heterogeneity.While the numeric rating scale values for pain upon movement (MD-0.62; 95%CI: -1.13 to -0.12; p=0.02) in the first 24 hours differed significantly between the patients who received local infiltration and those who received a femoral nerve block, there were no differences in the numeric rating scale results for pain at rest (MD-0.42; 95%CI:-1.32 to 0.47; p=0.35) or opioid consumption (MD 2.92; 95%CI:-1.32 to 7.16; p=0.18) in the first 24 hours.Local infiltration and femoral nerve block showed no significant differences in pain intensity at rest or opioid consumption after total knee arthroplasty, but the femoral nerve block was associated with reduced pain upon movement

Characteristic Quality Evaluation of Nang from the Yili Region in Xinjiang Based on Principal Component and Cluster Analysis

This study determined 13 quality indexes (weight, transverse diameter, height, moisture content, water activity, L*, a*, b*, hardness, cohesion, elasticity, adhesiveness, and chewability) in 55 different Nang samples from the Yili region in Xinjiang to examine their quality characteristics. The main indexes were selected for the Nang quality evaluation via principal component analysis, cluster analysis, and sensory quality assessment. The results showed an association between the 13 quality indexes of the 55 Nang samples. The height was highly significantly correlated with moisture content, water activity, elasticity, and chewiness (P<0.01), while the L* value and adhesiveness were substantially related (P<0.05). Three principal components were extracted via principal component analysis, with a cumulative variance contribution rate of 76.856%. Cluster analysis showed that six quality indexes, namely elasticity, chewability, adhesiveness, hardness, L* values, and b* values, were crucial for evaluating Nang quality. Then, the 55 Nang samples were classified into three categories: Large Nang, thick Nang, and snack Nang. The sensory quality analysis revealed significant differences between the quality of the three Nang categories (P<0.05). The color, flavor, and hardness scores of the large Nang were the highest at 14.85, 13.52, and 14.37, respectively, with a golden color and rich flavor. The elasticity and chewability scores of the thick Nang were the highest at 14.82 and 14.54, respectively, while the crisp score of the snack Nang was the highest at 14.47. These results revealed the key indexes for assessing the quality characteristics of three types of Nang from the Yili region in Xinjiang, providing a scientific classification method for constructing a Xinjiang Nang quality evaluation system

Leadership Ostracism Behaviors From the Target’s Perspective: A Content and Behavioral Typology Model Derived From Interviews With Chinese Employees

Leadership ostracism denotes a severe work stressor, potentially entailing more serious negative effects than other types of workplace ostracism. However, scholars have paid relatively little attention to ostracism carried out by leaders, leaving the phenomenon insufficiently accounted for in the literature. Hence, the present study aims to explore the content and typology of leadership ostracism behavior by in-depth interviews and inductive analyses based on grounded theory, in order to give a thorough presentation and description of the leadership ostracism concept as perceived and construed by Chinese subordinates. Respondents were invited using a snowball sampling technique, and the final sample consisted of 26 individuals employed in different Chinese firms. Based on the reported experience of the interviewees, 11 concrete leadership ostracism behaviors emerged from the data. Further analyses revealed a leadership ostracism behavioral typology model reflecting five core categories, i.e., general ignoring, neglect, exclusion, differential treatment, and undermining. These findings appear to partly replicate and partly expand on previous conceptualizations of workplace ostracism, indicating that leadership ostracism may reflect a distinct variant of the phenomenon, eligible to be studied in its own right. The present study also discusses certain culture-specific aspects of leadership ostracism that can be taken into consideration in future studies

Case report: Supratherapeutic tacrolimus concentrations with nirmatrelvir/ritonavir in a lung transplant patient: a case report using Rifampin for reversal

Paxlovid (nirmatrelvir/ritonavir) is an antiviral drug used to treat COVID-19, nirmatrelvir, a SARS-CoV-2 main protease inhibitor, works by inhibiting viral replication in the early stages, and ritonavir is a strong cytochrome P450 (CYP) 3A inhibitor that helps the nirmatrelvir reach and maintain the therapeutic concentrations. Paxlovid has a potential risk of drug interaction by elevating the plasma concentration of other drugs metabolized by CYP3A, like tacrolimus. This report examines the case of a 57-year-old female lung transplant patient self-administered Paxlovid for 5 days without discontinuing tacrolimus. She presented to the hospital with symptoms of headache, dizziness, palpitations, abdominal distension, nausea, vomiting, and diarrhea. The patient presented with tacrolimus toxicity and the blood concentration of tacrolimus was measured at 106 ng/mL. Urgent medical intervention was initiated, and Rifampin was administered to induce enzyme activity and rapidly decrease the concentration of tacrolimus. By adjusting the tacrolimus dosage, the final concentration was brought within the appropriate range. Clinical pharmacists should prioritize medication education for transplant patients to prevent severe drug interactions and minimize the impact on the patient’s overall well-being

Comparing sputum microbiota characteristics between severe and critically ill influenza patients

BackgroundCurrently, limited attention has been directed toward utilizing clinical cohorts as a starting point to elucidate alterations in the lower respiratory tract (LRT) microbiota following influenza A virus (IAV) infection.ObjectivesOur objective was to undertake a comparative analysis of the diversity and composition of sputum microbiota in individuals afflicted by severe and critically ill influenza patients.MethodsSputum specimens were procured from patients diagnosed with IAV infection for the purpose of profiling the microbiota using 16S-rDNA sequencing. To ascertain taxonomic differences between the severe and critically ill influenza cohorts, we leveraged Linear Discriminant Analysis Effect Size (LEfSe). Additionally, Spearman correlation analysis was employed to illuminate associations between sputum microbiota and influenza Ct values alongside laboratory indicators.ResultsOur study encompassed a total cohort of 64 patients, comprising 48 within the severe group and 16 within the critically ill group. Intriguingly, Bacteroidetes exhibited significant depletion in the critically ill cohort (p=0.031). The sputum microbiomes of the severe influenza group were hallmarked by an overrepresentation of Neisseria, Porphyromonas, Actinobacillus, Alloprevotella, TM7x, and Clostridia_UCG-014, yielding ROC-plot AUC values of 0.71, 0.68, 0.60, 0.70, 0.70, and 0.68, respectively. Notably, Alloprevotella exhibited an inverse correlation with influenza Ct values. Moreover, C-reactive protein (CRP) manifested a positive correlation with Haemophilus and Porphyromonas.ConclusionThe outcomes of this investigation lay the groundwork for future studies delving into the connection between the LRT microbiome and respiratory disorders. Further exploration is warranted to elucidate the intricate mechanisms underlying the interaction between IAV and Alloprevotella, particularly in disease progression

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effect of Tempering Time on Carbide Evolution and Mechanical Properties of a Nb-V-Ti Micro-Alloyed Steel

The evolution of the microstructure, the precipitation behavior, and the mechanical performances of Nb-V-Ti micro-alloyed steel prepared under different tempering time were studied using transmission electron microscopy (TEM), X-ray diffraction (XRD), and mechanical tests. It was found that the width of the martensite laths increases with the increasing tempering time. Several kinds of carbides, including M3C, M2C, M23C6, M7C3, and MC particles, were identified after tempering. The MC carbides remain stable during tempering, but the transformation behavior of other carbides was identified. The transformation sequence can be summarized as: M3C → M2C → M7C3 → M23C6. The strength decreases and the Charpy impact toughness increases gradually with the increase in the tempering time. The ultimate strength (UTS) decreases from 1231 to 896 MPa, and the yield strength (YS) decreases from 1138 to 835 MPa. The −40 °C Charpy impact toughness increases from 20 to 61 J as the tempering time increases from 10 min to 100 h. The evolution of carbides plays an important role in their mechanical performances

i4mC-EL: Identifying DNA N4-Methylcytosine Sites in the Mouse Genome Using Ensemble Learning

As one of important epigenetic modifications, DNA N4-methylcytosine (4mC) plays a crucial role in controlling gene replication, expression, cell cycle, DNA replication, and differentiation. The accurate identification of 4mC sites is necessary to understand biological functions. In the paper, we use ensemble learning to develop a model named i4mC-EL to identify 4mC sites in the mouse genome. Firstly, a multifeature encoding scheme consisting of Kmer and EIIP was adopted to describe the DNA sequences. Secondly, on the basis of the multifeature encoding scheme, we developed a stacked ensemble model, in which four machine learning algorithms, namely, BayesNet, NaiveBayes, LibSVM, and Voted Perceptron, were utilized to implement an ensemble of base classifiers that produce intermediate results as input of the metaclassifier, Logistic. The experimental results on the independent test dataset demonstrate that the overall rate of predictive accurate of i4mC-EL is 82.19%, which is better than the existing methods. The user-friendly website implementing i4mC-EL can be accessed freely at the following