Severe hypoxemia after extubation secondary to myxedema coma: a case report

Myxedema coma is a rare and life-threatening endocrine emergency characterized by abnormalities in multiple organ systems. A 32-year-old woman with prolonged undiagnosed severe hypothyroidism was referred to our hospital owing to lower abdominal pain and menopause for more than 3 months. She underwent exploratory laparotomy and induced abortion under general anesthesia, and developed severe hypoxemia after extubation. She was diagnosed with myxedema coma, and was subsequently discharged with a good prognosis following treatment. This case suggests that myxedema coma should be considered a potential etiology of peri-operative hypoxemia. The findings in this case emphasize the importance of anesthesiologists’ comprehensive understanding of myxedema coma. Prompt diagnosis followed by treatment is essential to reduce the mortality rate associated with this condition

Study on the second personalized chair ⁃ side education to change the knowledge, attitude, and practice of patients with periodontitis

Objective To explore the application effect of secondary personalized chairside education on changing the knowledge and behavior of patients with oral periodontal disease. Methods A total of 124 patients experiencing initial periodontal disease were selected. Sixty⁃two patients were observed in the observation group, and 62 patients were observed in the control group. After the doctor checked and determined the periodontal condition of the patients, the nurse conducted a targeted, personalized secondary one⁃on⁃one chairside mission for the observation group; in the control group, the nurses provided routine one⁃to⁃one health education to the patients before treatment. Statistical analysis was conducted to assess periodontal knowledge mastery, self ⁃ care behaviors, rate of return for periodontal treatment and patient satisfaction after 3 months. The plaque index and scale index were statistically analyzed before and 3 months after treatment. Results No statistical difference was found in the general data between the two groups of patients (P > 0.05); however, the degree of mastery of periodontal knowledge in the observation group was higher than that in the control group. The degrees of mastery of the clinical manifestations, hazards and treatment methods were 96.7% , 93.5% , and 91.9% in the observation group and 72.5% , 48.3% , and 69.3% in the control group, respectively; the difference was statistically significant (P < 0.05). The patients in the observation group were more likely than those in the control group to brush more than 2 times daily, use dental floss and use an interdental brush; 100%, 96.7%, and 77.4% of patients in the observation group and 80.6%, 56.4%, and 40.3% of patients in the control group participated in these oral health care behaviors, respectively. The difference was statistically significant (P < 0.05). The rate of recovery and patient satisfaction were higher in the observation group than in control group at 3 months; the rate of recovery and patient satisfaction were 80.6% and 96%, in the observation group and 41.9% and 88.7% in the control group, respectively. The difference was statistically significant (P < 0.05). After 3 months, the plaque index in the observation group was lower than that in the control group (1.71 ± 1.12, 2.35 ± 0.78), and the difference was statistically significant (P < 0.05). Conclusion Secondary personalized chairside education can significantly improve the patient s cognition of the disease, allow the formation of accurate oral health awareness, and change the patients bad oral hygiene habits and medical behavior. Thus, this method is an effective oral health education method and can change the knowledge and beliefs of patients with oral periodontitis

Preparation of High Thermo-Stability and Compactness Microencapsulated Phase Change Materials with Polyurea/Polyurethane/Polyamine Three-Composition Shells through Interfacial Polymerization

In the preparation of microencapsulated phase change materials (MicroPCMs) with a three-composition shell through interfacial polymerization, the particle size, phase change behaviors, core contents, encapsulation efficiency morphology, thermal stability and chemical structure were investigated. The compactness of the MicroPCMs was analyzed through high-temperature drying and weighing. The effect of the core/shell ratio and stirring rate of the system was studied. The results indicated that the microcapsules thus-obtained possessed a spherical shape and high thermal stability and the surfaces were intact and compact. Furthermore, in the emulsification stage, the stirring speed had a significant influence on the microcapsules&rsquo; particle size, and smaller particles could be obtained under the higher stirring speed, and the distributions were more uniform in these cases. When the core/shell ratio was lower than 4, both the core content and the encapsulation efficiency was high. Additionally, when the core/shell ratio was higher than 4, the encapsulation efficiency was decreased significantly. The three-composition shell greatly increased the compactness of microcapsules, and when the core/shell ratio was adjusted to 3, the mass loss of the MicroPCMs was lower than 6% after drying at 120 &deg;C for 1 h. After the microencapsulation, double exothermic peaks appeared on the crystallization curve of the MicroPCMs, the crystallization mechanism was changed from the heterogeneous nucleation to the homogeneous nucleation and the super cooling degree was enhanced

Whether Chinese Medicine Have Effect on Halitosis: A Systematic Review and Meta-Analysis

Object. Halitosis has great adverse impact on personal and social life. There is no strong evidence for the effect of Chinese medicine (CM) and combined Chinese and western medicine (CWM) on halitosis. The aim of the present study is to evaluate the effective rate of CM and CWM on halitosis. Materials and Methods. Literature search in English and Chinese was conducted in PubMed, Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by the Cochrane tool. Synthesis of results was done by RevMan 5.3. p<0.05 was considered significant difference. Subgroup analysis by classification of halitosis and sensitivity analysis were also conducted. Results. Seventeen studies were included. The follow-up length ranged from five days to eight weeks. CM had significantly better effect than WM on intraoral halitosis (I2 =24%; RR=1.21 (95% CI, 1.04, 1.40), P=0.01) and extraoral halitosis (I2 =0; RR=1.39 (95% CI, 1.19, 1.63), P<0.0001). CWM had significantly better effect than WM on intraoral halitosis (I2 =0; RR=1.25 (95% CI, 1.16, 1.35), P<0.00001) and extraoral halitosis (I2 =0; RR=1.19 (95% CI, 1.08, 1.31), P=0.0004). Subgroup analysis and sensitivity analysis showed insignificant results. Conclusion. With the limitation of our study, both CM and CWM have significantly better effect on halitosis than WM. More effort should be made to explore long-term effect of CM and CWM on halitosis. This study was registered with the PROSPERO (ID: CRD42018107229)

A SSVEP-Based Brain&#x2013;Computer Interface With Low-Pixel Density of Stimuli

The brain-computer interface (BCI) based on the steady-state visual evoked potential (SSVEP) has drawn widespread attention due to its high communication speed and low individual variability. However, there is still a need to enhance the comfort of SSVEP-BCI, especially considering the assurance of its effectiveness. This study aims to achieve a perfect balance between comfort and effectiveness by reducing the pixel density of SSVEP stimuli. Three experiments were conducted to determine the most suitable presentation form (flickering square vs. flickering checkerboard), pixel distribution pattern (random vs. uniform), and pixel density value (100&#x0025;, 90&#x0025;, 80&#x0025;, 70&#x0025;, 60&#x0025;, 40&#x0025;, 20&#x0025;). Subjects&#x2019; electroencephalogram (EEG) and fatigue scores were recorded, while comfort and effectiveness were measured by fatigue score and classification accuracy, respectively. The results showed that the flickering square with random pixel distribution achieved a lower fatigue score and higher accuracy. EEG responses induced by stimuli with a square-random presentation mode were then compared across various pixel densities. In both offline and online tests, the fatigue score decreased as the pixel density decreased. Strikingly, when the pixel density was above 60&#x0025;, the accuracies of low-pixel-density SSVEP were all satisfactory (&#x003E;90&#x0025;) and showed no significant difference with that of the conventional 100&#x0025;-pixel density. These results support the feasibility of using 60&#x0025;-pixel density with a square-random presentation mode to improve the comfort of SSVEP-BCI, thereby promoting its practical applications in communication and control

Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study

Abstract Background To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China. Methods This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good. Results This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were “the anesthetic drugs that tend to cause POCD” (23.3%) and “Treatment of POCD” (40.3%). Multivariable analysis showed that ≥ 40 years old, master’s degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice. Conclusions These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education. Trial registration ChiCTR2200066749

In Vitro Characterization of Polysaccharides from Fresh Tea Leaves in Simulated Gastrointestinal Digestion and Gut Microbiome Fermentation

Tea plants have a long cultivation history in the world, but there are few studies on polysaccharides from fresh tea leaves. In this study, tea polysaccharides (TPSs) were isolated from fresh tea leaves. Then, we investigated the characteristics of TPSs during in vitro simulated digestion and fermentation; moreover, the effects of TPSs on gut microbiota were explored. The results revealed that saliva did not significantly affect TPSs’ molecular weight, monosaccharide composition, and reducing sugar content, indicating that TPSs cannot be digested in the oral cavity. However, TPSs were partially decomposed in the gastrointestinal tract after gastric and intestinal digestion, resulting in the release of a small amount of free glucose monosaccharides. Our in vitro fermentation experiments demonstrated that TPSs are degraded by gut microbiota, leading to short-chain fatty acid (SCFA) production and pH reduction. Moreover, TPSs increased the abundance of Bacteroides, Lactobacillus, and Bifidobacterium but reduced that of Escherichia, Shigella, and Enterococcus, demonstrating that TPSs can regulate the gut microbiome. In conclusion, TPSs are partially decomposed by gut microbiota, resulting in the production of SCFAs and the regulation of gut microbiota composition and function. Therefore, TPSs may be used to develop a prebiotic supplement to regulate the gut microbiome and improve host health

Pharmacokinetic/Pharmacodynamic Modeling of Tulathromycin against Pasteurella multocida in a Porcine Tissue Cage Model

Tulathromycin, a macrolide antibiotic, is used for the treatment of respiratory disease in cattle and swine. The aim of our study was to investigate the in vitro and ex vivo activities of tulathromycin in serum, (non-inflamed) transudate, and (inflamed) exudate against Pasteurella multocida in piglets. The pharmacokinetics properties of tulathromycin were studied for serum, transudate, and exudate using a tissue cage model. In vitro antibiotic susceptibility of P. multocida and dynamic time-kill curve experiments over eight tulathromycin concentrations were determined. The ratio of 24-h area under the concentration–time curve to minimum inhibitory concentration [AUC(0-24 h)/MIC] was recognized as an important pharmacokinetic/pharmacodynamic (PK/PD) parameter of tulathromycin for antibacterial efficiency (R2 = 0.9969). In serum ex vivo, for bacteriostatic, bactericidal activity, and virtual bacterial eradication AUC(0-24 h)/MIC values for tulathromycin were 44.55, 73.19, and 92.44 h by using sigmoid Emax model WinNonlin software, respectively, and lower values were obtained for exudate and transudate. In conjunction with the data on MIC90, the dose of tulathromycin for a bacteriostatic effect and virtual elimination of P. multocida as computed using the value of the PK/PD breakpoint obtained in serum were 6.39 and 13.25 mg/kg. However, it would be preferable to calculate a dose combined with population pharmacokinetics data to optimize the dosage regimen for bacteriological and clinical cure

Development and validation of a deep learning-based framework for automated lung CT segmentation and acute respiratory distress syndrome prediction: a multicenter cohort studyResearch in context

Summary: Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition with a high incidence and mortality rate in intensive care unit (ICU) admissions. Early identification of patients at high risk for developing ARDS is crucial for timely intervention and improved clinical outcomes. However, the complex pathophysiology of ARDS makes early prediction challenging. This study aimed to develop an artificial intelligence (AI) model for automated lung lesion segmentation and early prediction of ARDS to facilitate timely intervention in the intensive care unit. Methods: A total of 928 ICU patients with chest computed tomography (CT) scans were included from November 2018 to November 2021 at three centers in China. Patients were divided into a retrospective cohort for model development and internal validation, and three independent cohorts for external validation. A deep learning-based framework using the UNet Transformer (UNETR) model was developed to perform the segmentation of lung lesions and early prediction of ARDS. We employed various data augmentation techniques using the Medical Open Network for AI (MONAI) framework, enhancing the training sample diversity and improving the model's generalization capabilities. The performance of the deep learning-based framework was compared with a Densenet-based image classification network and evaluated in external and prospective validation cohorts. The segmentation performance was assessed using the Dice coefficient (DC), and the prediction performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. The contributions of different features to ARDS prediction were visualized using Shapley Explanation Plots. This study was registered with the China Clinical Trial Registration Centre (ChiCTR2200058700). Findings: The segmentation task using the deep learning framework achieved a DC of 0.734 ± 0.137 in the validation set. For the prediction task, the deep learning-based framework achieved AUCs of 0.916 [0.858–0.961], 0.865 [0.774–0.945], 0.901 [0.835–0.955], and 0.876 [0.804–0.936] in the internal validation cohort, external validation cohort I, external validation cohort II, and prospective validation cohort, respectively. It outperformed the Densenet-based image classification network in terms of prediction accuracy. Moreover, the ARDS prediction model identified lung lesion features and clinical parameters such as C-reactive protein, albumin, bilirubin, platelet count, and age as significant contributors to ARDS prediction. Interpretation: The deep learning-based framework using the UNETR model demonstrated high accuracy and robustness in lung lesion segmentation and early ARDS prediction, and had good generalization ability and clinical applicability. Funding: This study was supported by grants from the Shanghai Renji Hospital Clinical Research Innovation and Cultivation Fund (RJPY-DZX-008) and Shanghai Science and Technology Development Funds (22YF1423300)

A Probiotic Formula for Modulation of Colorectal Cancer Risk via Reducing CRC-Associated Bacteria

Gut microbiota dysbiosis with increased pathogenic bacteria and decreased beneficial bacteria is associated with colorectal cancer (CRC) development. This study examined the effect of a newly developed probiotic formula in modulating CRC-related bacteria. We developed a probiotic formula containing three bifidobacteria (B. adolescentis, B. longum, and B. bifidum) based on the identification of bacterial species that showed significant correlations with CRC-related bacteria including Fusobacterium nucleatum (Fn), Lachnoclostridium sp. m3, Clostridium hathewayi (Ch), and Bacteroides clarus (Bc). We co-cultured Fn with each bifidobacterium or the combined formula and examined the growth of Fn by qPCR. The three individual bifidobacteria significantly inhibited the growth of Fn compared to the control treatment (24~65% inhibition; all p Fn growth (70% inhibition) than the individual bifidobacteria (all p Fn, m3, Ch, and Bc) were quantitated by qPCR before and after the intervention, and the combined CRC risk score (4Bac; Fn, m3, Ch, and Bc) was evaluated. Subjects with probiotics intervention showed significantly increased abundances of the bifidobacteria from week 2 to week 5 compared to baseline (p Fn and m3) and the CRC risk score (4Bac) from week 2 to week 12 compared to baseline levels (p B. adolescentis, B. longum, and B. bifidum was effective in inhibiting the growth of F. nucleatum in vitro and improving the gut microbial environment against CRC development