Theoretical Calculation of Different Side-Chain Lengths [Cnmim]FeCl4 and Factors Influencing Coal Pyrolysis Swelling Modification

With the increasing requirements for clean and effective utilization, coal swelling pretreatment provides a good theoretical basis for coal molecular structure, application in coal pyrolysis, and liquefaction. Ionic liquids containing magnetic anionic groups were designed, synthesized, and used as solvents to study the effect on swelling pyrolysis performance. Studies have shown magnetism enhancement with the growth of alkyl chains. The growth of the MIL alkyl side chain made the modification effect of coal more obvious, and the swelling degree showed a trend of first increasing and then decreasing with the increase of temperature and time, and at the temperature of 35 °C, the swelling degree is the largest when the modification time is 8 h. Pyrolysis experiments show that magnetic ionic liquid (MIL) pretreatment can significantly reduce the temperature at the maximum weight loss of coal and increase the tar content of pyrolysis, indicating that MIL plays a catalytic cracking role in coal pyrolysis.

Heralded Three-Photon Entanglement from a Single-Photon Source on a Photonic Chip

In the quest to build general-purpose photonic quantum computers, fusion-based quantum computation has risen to prominence as a promising strategy. This model allows a ballistic construction of large cluster states which are universal for quantum computation, in a scalable and loss-tolerant way without feed forward, by fusing many small n-photon entangled resource states. However, a key obstacle to this architecture lies in efficiently generating the required essential resource states on photonic chips. One such critical seed state that has not yet been achieved is the heralded three-photon Greenberger-Horne-Zeilinger (3-GHZ) state. Here, we address this elementary resource gap, by reporting the first experimental realization of a heralded 3-GHZ state. Our implementation employs a low-loss and fully programmable photonic chip that manipulates six indistinguishable single photons of wavelengths in the telecommunication regime. Conditional on the heralding detection, we obtain the desired 3-GHZ state with a fidelity 0.573±0.024. Our Letter marks an important step for the future fault-tolerant photonic quantum computing, leading to the acceleration of building a large-scale optical quantum computer.

A215 EVALUATING THE COMPARABILITY OF CARE FOR PERSONS ADMITTED TO TORONTO AREA HOSPITALS WITH ACUTE SEVERE ULCERATIVE COLITIS

Background

Approximately 20% of patients with ulcerative colitis will experience an acute severe exacerbation requiring hospitalization. Acute severe ulcerative colitis (ASUC) is a medical emergency associated with significant morbidity and a mortality rate of 1%. Timely initiation of treatment and assessment of clinical response is critical in the management of ASUC. With an aim to reduce treatment variability and improve outcomes, multiple gastrointestinal societies have published guidelines highlighting recommendations for optimal care in ASUC. It remains unclear how closely these guidelines are implemented in clinical practice. Measuring adherence to these recommended processes of care may act as a surrogate measure for quality of care and a way to indirectly evaluate outcomes in the management of patients with ASUC. Studies have shown that even amongst experienced providers practice pattern variability exists. Identifying significant variations in the management of patients with ASUC will highlight where improvement in guideline dissemination and greater adherence is required.

Purpose

We sought to evaluate how quality of care indicators varied across 7 hospital sites for patients admitted ASUC in the Greater Toronto Area.

Method

Using GEMINI, a research collaborative that collects and analyses data from inpatient admissions at 7 Toronto area hospitals, we identified patients admitted to hospital with ASUC from June 2016-December 2019. Hospital sites were further categorized into 3 hospital types; 1 IBD specialty centre (ISC), 3 other academic centres (AC) and 3 community centres (CC). Process measures assessed included proportion tested for C-reactive protein at baseline and following treatment initiation, duration of corticosteroid use, timing and initiation of biologic agents, rates of venous thromboembolism prophylaxis and opioid use. Outcome measures included hospital length of stay, rates of colectomy and mortality.

Result(s)

765 hospitalizations were included in the study; 320 occurring at ISC, 308 at AC and 137 at CC. Corticosteroid use on admission were highest at the ISC at 78% compared to 64% at AC and 63% at CC (p <0.001). Among those who received steroids on admission, 47% of patients remained on intravenous corticosteroids for at least 5 days in the ISC compared to 39% in AC and 75% in CC (p< 0.001). Initiation of biologic rescue therapy was highest at the ISC occurring in 37% of hospitalizations compared to 22% in AC and 23% in CC (p<0.001). In addition, VTE prophylaxis rates were highest at the ISC at 83% followed by 60% in AC and 45% in CC (p<0.001). Rates of colectomy were highest at ISC (12% of hospitalizations vs. 7% in AC).

Conclusion(s)

Greater adherence to indicators of quality of care were seen at the ISC compared to ACs and CCs, although patient outcomes assessed were not clearly different between sites. Further strategies are required to improve adherence to markers of quality care for patients admitted with ASUC.

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Disclosure of Interest

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Influence and mechanism of alkali-modified sludge on coal water slurry properties

Municipal sludge (MS) is used to prepare coal water slurry (CWS). This practice is beneficial for resource utilization and reduces treatment costs and environmental pollution. In this study, alkali-modified municipal sludge (AMS) was prepared with Ca(OH)₂ as modifier and mixed with coal to produce AMS-CWS. The effect and mechanism of MS and AMS on slurry ability, stability, and combustion characteristics of the CWS were explored. The results of the pulping experiments showed that the slurry concentration of the AMS-CWS was approximately 10% greater than that of MS-CWS. The water separation rates of MS-CWS and AMS-CWS were 5% and 5.26%, respectively, which were 13.62% and 13.36% less than that of CWS (18.62%). The zeta potential experiments verified these results. Combustion performance research shows that both MS and AMS have positive effects on combustion performance. The results of the contact angle experiments showed that the hydrophobicity of AMS was enhanced, which was beneficial for improving the pulping capacity of MS-CWS.

Effect of bio-based surfactant on wettability of low-rank coal surface and its mechanism

In this study, the effect of a bio-based environment-friendly surfactant, cardanol polyoxyethylene ether (BGF), on the wettability of the surface of low-rank coal (LRC) and its mechanism were studied. The adsorption experiment showed that the adsorption of the surfactant conformed to the Langmuir adsorption model and the pseudo-second-order kinetic model. The adsorption was mainly affected by hydrogen bonding, and the adsorption rate was affected by intraparticle diffusion and liquid film diffusion. The wettability experiment showed that the influence of BGF on the wettability of the surface of LRC followed the given order: BGF-7 > BGF-10 > BGF-15. The investigation of adhesion work showed that the adhesion work and the stability of the coal-water system decreased after adsorption. Fourier transform infrared and X-ray photoelectron spectroscopy analyses showed that after adsorption, the peak strength of vinyl ether, the content of elemental carbon, and the content of C-C/C-H groups increased.

A radiomics model combined with XGBoost may improve the accuracy of distinguishing between mediastinal cysts and tumors: a multicenter validation analysis

Background

Mediastinal cysts (MCs) can be misdiagnosed as mediastinal tumors (MTs) such as thymomas on the basis of radiological examinations, including computerized tomography (CT) and magnetic resonance imaging (MRI). Our study aimed to determine the utility of a radiomics model combined with eXtreme Gradient Boosting (XGBoost) for diagnosing anterior mediastinal masses.

Methods

Patients with anterior mediastinal lesions admitted to Shanghai Pulmonary Hospital between October 2014 and January 2018 were enrolled in the study. Mediastinal lesions were sketched on each CT image frame using OsiriX workstation. The study involved a total of 592 patients (289 male/303 female; age range, 18–83 years) with anterior mediastinal lesions (322 MCs and 270 MTs). Previously collected training data was used to build an XGBoost model to classify MCs and MTs, and a prospectively collected training dataset and external data from Huashan Hospital were used for validation. The SHapley Additive exPlanations (SHAP) method was used to help understand the complex model.

Results

The XGBoost model was established using 107 selected radiomic features, and an accuracy of 0.972 [95% confidence interval (CI): 0.948–0.995] was achieved compared to 0.820 for radiologists. For lesions smaller than 2 cm, XGBoost model accuracy reduced slightly to 0.835, while the accuracy of radiologists was only 0.667. The model accuracy also achieved 0.910 when validated using an independent external dataset containing 87 cases. SHAP analysis suggested the 90% percentile Hounsfield unit value as a promising diagnostic parameter.

Conclusions

Our combined radiomics and XGBoost model significantly increased the accuracy of distinguishing between MCs and MTs compared to the level of accuracy obtained by radiologists.

Cloning, genome structure and expression analysis of MHC class I gene in Korean quail

1. The major histocompatibility complex (MHC) is a highly polymorphic region of the genome essential to immune responses and animal health. However, avian MHC genetic structure is different from that of mammals. In this study, the structure and expression of Korean quail MHC class I gene was analysed.2. The quail MHC gene consisted of eight exons and seven introns. The open reading frame of the cDNA was 353 amino acids, and the molecular weight was about 38.91 kDa. Exons 1 and 2 coded for leading peptides and alpha 1 regions, respectively. Exons 3 and 4 encoded alpha 2 and alpha 3 regions. Exons 5 to 8 coded for connecting peptides and transmembrane regions/cytoplasmic regions (TM/CY). The Korean quail MHC class I amino acid sequence shared 87% to 99% homology with Japanese quail and 71% to 75% with chicken. The amino acid shared 40% and 43% homology with humans and mice, respectively.3. Real-time quantitative PCR showed that MHC-I was highly expressed in immune tissues such as the bursa of Fabricius. Moreover, the constructed evolutionary tree was consistent with accepted evolutionary pathways.4. MHC-I is closely related to the host's immune system, and these findings may help to better understand the role of Korean quail MHC-I in the immune system.

Catheterization of PICC through a superficial femoral vein for patients with superior vena cava syndrome using ECG positioning and ultrasound-guided technologies

OBJECTIVE

We herein demonstrate the efficacy of PICC placement through a superficial femoral vein in patients with superior vena cava syndrome using ultrasound guidance and electrocardiographic localization. The treatment of PICC disconnection was also discussed.

METHODS

The study enrolled 51 patients with superior vena cava syndrome. Ultrasound-guided technology and ECG positioning technology are employed to help these patients in catheterization. The puncture time, the number of punctures, and catheter tip position were recorded. The patient was followed up for at least 2 years. The complications and treatment during follow-up were recorded.

RESULT

The average puncture time was 32.13 ± 3.91 min. A total of 49 patients were successfully punctured once, while 2 patients failed in the first puncture. The main reason for puncture failure is that the inability of a guide wire to pass through. After the nurse removed the needle and pressed the puncture point until no rebleeding occurred, the puncture above the original puncture point was successful. X-ray examination revealed that the catheter tip was located in the inferior vena cava, above the diaphragm, near the right atrium. The success rate of catheterization was 100%. The visual analog scale (VAS) score was (2.44 ± 0.73) at the time of puncture, which was tolerable during the operation, and the patient did not complain of obvious pain following the operation. One patient developed complications of broken tube half a year after the puncture. Interventional physicians utilized angiography to locate the broken catheter.

CONCLUSION

It is safe and feasible to place PICC through a superficial femoral vein under ultrasound combined with ECG positioning technology in patients with superior vena cava syndrome.

A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery

BACKGROUND

Prolonged hospitalization and immobility of critical care patients elevate the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. We conducted a meta-analysis to assess the effects of early mobilization therapy on cardiac surgery patients in the intensive care unit (ICU).

METHODS

PubMed, Excerpta Medica database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were comprehensively searched from their inception to September 2018. Randomized controlled trials were included if patients were adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who were treated with experimental physiotherapy initiated in the ICU (pre, post, or peri-operative). Data were extracted by 2 reviewers independently using a pre-constructed data extraction form. Length of ICU and hospital stay was evaluated as the primary outcomes. Physical function and adverse events were assessed as the secondary outcomes. Review Manager 5.3 (RevMan 5.3) was used for statistical analysis. For all dichotomous variables, relative risks or odds ratios with 95% confidence intervals (CI) were presented. For all continuous variables, mean differences (MDs) or standard MDs with 95% CIs were calculated.

RESULTS

The 5 studies with a total of 652 patients were included in the data synthesis final meta-analysis. While a slight favorable effect was detected in 3 out of the 5 studies, the overall effects were not significant, even after adjusting for heterogeneity.

CONCLUSIONS

This population-specific evaluation of the efficacy of early mobilization to reduce hospitalization duration suggests that intervention may not universally justify the labor barriers and resource costs in patients undergoing non-emergency cardiac surgery.

PROSPERO RESEARCH REGISTRATION IDENTIFYING NUMBER

CRD42019135338.

Extended Sleeve Lobectomy is an Alternative for Centrally Located Lung Cancer With Superior Short- and Long-term Outcomes

INTRODUCTION

Extended sleeve lobectomy (ESL) is a feasible alternative to pneumonectomy; however, the survival benefit is unclear, and preoperative selection of potential candidates for ESL remains a problem.

MATIERALS AND METHODS

ESL was performed on selected candidates with double sleeve lobectomy for more than 1 lobe (eg, left upper lobe and S6 segment resection). Three-dimensional (3-D) reconstruction was routinely validated. Patients were candidates for ESL if the predicted distal stump length was > 6 mm and the pulmonary vein of the remaining segments was not invaded.

RESULTS

Of the 1809 patients with centrally located lung cancer for surgical resection, 86 patients with tumors invading more than 1 lobe were enrolled in the study. After evaluation by 3-D reconstruction, 22 (95.7%) of 23 selected candidates underwent ESL, and 63 patients were deemed unsuitable for ESL and underwent pneumonectomy (43 cases) or thoracic exploration (20 cases). Surgical outcomes between the ESL and pneumonectomy groups were similar in terms of complications, blood loss and surgical duration, but the 6-minute walking distance was significantly improved in the ESL group (371 ± 111 m vs. 191 ± 55 m, respectively; P < .001). The mean forced expiratory volume in 1 second was 1.6 ± 0.3 L at the 1-year follow up examination in the ESL group. In the survival analysis, no difference was observed between the ESL and pneumonectomy groups in terms of 3-year overall survival (85% vs. 89%, respectively; P = .626) and 3-year disease-free survival (75% vs. 76%, respectively; P = .625).

CONCLUSIONS

ESL is a feasible and superior surgical procedure in terms of its short-term and long-term outcomes, and we suggest 3-D reconstruction to identify candidates for ESL.

Knockdown of LINC00461 inhibits cell proliferation and induces apoptosis in gastric cancer by targeting LSD1

OBJECTIVE

To uncover the function of LINC00461 in regulating cellular behaviors of gastric cancer (GC) via targeting LSD1.

PATIENTS AND METHODS

LINC00461 level in GC tissues with different tumor node metastasis (TNM) staging and lymphatic metastasis statues was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). In vitro influences of LINC00461 on proliferative and apoptotic rates were evaluated in AGS and SGC-7901 cells. The interaction between LINC00461 and LSD1 was explored by RNA immunoprecipitation (RIP) assay and qRT-PCR. Finally, the potential role of LSD1 in the proliferative ability of GC cells mediated by LINC00461 was assessed.

RESULTS

LINC00461 level was higher in GC tissues relative to matched control ones. It was positively correlated to TNM staging and lymphatic metastasis of GC. Knockdown of LINC00461 markedly attenuated viability and the proliferative ability of AGS and SGC-7901 cells, but induced apoptosis. RIP assay demonstrated the interaction between LINC00461 and LSD1. Moreover, LSD1 could reverse the regulatory effect of LINC00461 on the proliferative ability of GC cells.

CONCLUSIONS

LINC00461 is upregulated in GC, which is positively related to TNM staging and lymphatic metastasis. LINC00461 mediates proliferation and apoptosis of GC cells, thereafter aggravating the progression of GC.

LncRNA PAPAS aggravates the progression of gastric cancer through regulating miRNA-188-5p

OBJECTIVE

To uncover the biological effect of long non-coding RNA (lncRNA) PAPAS on the progression of gastric cancer (GC) by mediating microRNA-188-5p (miRNA-188-5p) level.

PATIENTS AND METHODS

The relative level of PAPAS was determined in GC tissues and cell lines by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The Kaplan-Meier method was introduced to assess the prognostic potential of PAPAS in the overall survival of GC patients. Regulatory effects of PAPAS on proliferative, migratory, and invasive abilities of HGC-27 and AGS cells were detected by cell counting kit-8 (CCK-8), transwell, and wound closure assay, respectively. Subsequently, the binding relation between PAPAS and miRNA-188-5p was verified by the Dual-luciferase reporter gene assay. Correlation between expression levels of PAPAS and miRNA-188-5p in GC tissues was explored. Finally, rescue experiments were conducted to uncover the role of PAPAS/miRNA-188-5p axis in the progression of GC.

RESULTS

PAPAS was upregulated in GC tissues and cell lines compared to controls. GC patients expressing a high level of PAPAS suffered worse prognosis relative to those with low level. The silence of PAPAS remarkably attenuated proliferative, migratory, and invasive abilities of HGC-27 cells. Overexpression of PAPAS in AGS cells obtained the opposite trends. MiRNA-188-5p was the direct target of PAPAS, which was negatively regulated by PAPAS. MiRNA-188-5p was able to reverse the regulatory effects of PA-PAS on proliferative, migratory, and invasive abilities of GC cells.

CONCLUSIONS

LncRNA PAPAS is upregulated in GC and closely related to lymphatic metastasis, distant metastasis, and poor prognosis of GC patients. PAPAS aggravate the malignant progression of GC by negatively regulating the miRNA-188-5p level.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review

Background

This study aimed to report the experience of diagnosis and treatment of one rare case of mediastinal lymph node tuberculous abscess (MLNTA) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Case presentation

An 18-year-old female patient was hospitalized in the Affiliated Hospital of Xuzhou Medical University in November 2017, due to intermittent left chest pain. She was suspected of infecting tuberculosis (TB) and thus received anti-TB treatment. Since April 1, 2018, she began to exhibit symptoms of chest distress. The patient was then admitted to Shanghai Pulmonary Hospital and continued receiving systemic anti-TB treatment during the whole course. On April 11, 2018, she received EBUS-TBNA to puncture pus and inject isoniazid. Simultaneously, the pus was sent for cytopathological and bacteriological examination, both supporting the diagnosis of TB in the patient. On April 24 and May 10, she received two times of EBUS-TBNA treatment. The symptoms of chest distress were relieved, but granulomatous neoplasm occurred at the EBUS-TBNA site on the trachea wall. The patient then received local clamp removal and cryotherapy on May 29 and Jul 19, respectively. Chest computed tomography (CT) reexamination on September 28 revealed that the MLNTA lesion had been completely absorbed, and electronic bronchoscopic reexamination on September 30 demonstrated that the granulomatous neoplasm on the trachea wall was entirely invisible.

Conclusions

Using EBUS-TBNA to puncture and aspirate pus and inject drugs can be effectively used to diagnose and treat MLNTA, which provides a new, less invasive, safe and reliable method for diagnosis and treatment of MLNTA.

Mycoplasma pneumoniae lipids license TLR-4 for activation of NLRP3 inflammasome and autophagy to evoke a proinflammatory response

Mycoplasma pneumoniae is an obligate pathogen that causes pneumonia, tracheobronchitis, pharyngitis and asthma in humans. It is well recognized that membrane lipoproteins are immunostimulants exerting as lipopolysaccharides (LPS) and play a crucial role in the pathogenesis of inflammatory responses upon M. pneumoniae infection. Here, we report that the M. pneumoniae-derived lipids are another proinflammatory agents. Using an antibody-neutralizing assay, RNA interference or specific inhibitors, we found that Toll-like receptor 4 (TLR-4) is essential for M. pneumoniae lipid-induced tumour necrosis factor (TNF)-α and interleukin (IL)-1β production. We also demonstrate that NLR family pyrin domain containing 3 inflammasome (NLRP3) inflammasome, autophagy and nuclear factor kappa B (NF-κB)-dependent pathways are critical for the secretion of proinflammatory cytokines, while inhibition of TLR-4 significantly abrogates these events. Further characterization revealed that autophagy-mediated inflammatory responses involved the activation of NF-κB. In addition, the activation of NF-κB promoted lipid-induced autophagosome formation, as revealed by assays using pharmacological inhibitors, 3-methyladenine (3-MA) and Bay 11-7082, or silencing of atg5 and beclin-1. These findings suggest that, unlike the response to lipoprotein stimulation, the inflammation in response to M. pneumoniae lipids is mediated by the TLR-4 pathway, which subsequently initiates the activation of NLRP3 inflammasome and formation of a positive feedback loop between autophagy and NF-κB signalling cascade, ultimately promoting TNF-α and Il-1β production in macrophages.

Association of baseline peripheral-blood eosinophil count with immune checkpoint inhibitor-related pneumonitis and clinical outcomes in patients with non-small cell lung cancer receiving immune checkpoint inhibitors

OBJECTIVES

Immune checkpoint inhibitors (ICIs) have revolutionized the oncologic treatment landscape, but have been accompanied by immune-related adverse events (irAEs). ICI-related pneumonitis (ICI-pneumonitis) is a potentially fatal irAE. However, the risk factors associated with ICI-pneumonitis remain unclear. There is an urgent need to identify risk factors for ICI-pneumonitis using reliable and accessible parameters. Here, we aimed to identify baseline peripheral-blood biomarkers correlated with ICI-pneumonitis and clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) who were treated with ICIs.

MATERIALS AND METHODS

We conducted a retrospective analysis of eligible patients with advanced NSCLC who were treated with ICIs at our center. Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for analyzing risk of ICI-pneumonitis. Multivariate logistic analysis was performed to identify risk factors of ICI-pneumonitis. Clinical characteristics and treatment outcomes were collected and compared according to the optimal cutoff value.

RESULTS

A total of 300 patients were included, in which 54 patients (18 %) experienced ICI-pneumonitis. Patients with ICI-pneumonitis had a high level of baseline peripheral-blood absolute eosinophil count (AEC) than those without ICI-pneumonitis (P = 0.013). The optimal threshold of baseline peripheral-blood AEC to predict ICI-pneumonitis was 0.125 × 10⁹ cells/L. The incidence of ICI-pneumonitis was higher in the high-AEC group (AEC ≥ 0.125 × 10⁹ cells/L; 27.7 %) than in the low-AEC group (AEC < 0.125 × 10⁹ cells/L; 9.8 %, P < 0.001). Moreover, patients with high AEC (compared with those with low AEC) had a higher objective response rate (ORR) (40.9 % versus 28.8 %, P = 0.029) and longer median progression-free survival (PFS) (8.93 months versus 5.87 months, P = 0.038).

CONCLUSIONS

Among patients treated with ICIs, a baseline feature of high AEC (≥0.125 × 10⁹ cells/L) was associated with an increasing risk of ICI-pneumonitis, and with a better clinical outcome.

A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery: A protocol for systematic review

BACKGROUND

Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU).

METHODS

The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model.

RESULTS

This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU.

CONCLUSION

This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.PROSPERO Research registration identifying number: CRD42019135338.

Proteomic and Transcriptomic Changes in Hibernating Grizzly Bears Reveal Metabolic and Signaling Pathways that Protect against Muscle Atrophy

Muscle atrophy is a physiological response to disuse and malnutrition, but hibernating bears are largely resistant to this phenomenon. Unlike other mammals, they efficiently reabsorb amino acids from urine, periodically activate muscle contraction, and their adipocytes differentially responds to insulin. The contribution of myocytes to the reduced atrophy remains largely unknown. Here we show how metabolism and atrophy signaling are regulated in skeletal muscle of hibernating grizzly bear. Metabolic modeling of proteomic changes suggests an autonomous increase of non-essential amino acids (NEAA) in muscle and treatment of differentiated myoblasts with NEAA is sufficient to induce hypertrophy. Our comparison of gene expression in hibernation versus muscle atrophy identified several genes differentially regulated during hibernation, including Pdk4 and Serpinf1. Their trophic effects extend to myoblasts from non-hibernating species (including C. elegans), as documented by a knockdown approach. Together, these changes reflect evolutionary favored adaptations that, once translated to the clinics, could help improve atrophy treatment.

Stroke in pregnancy

Stroke is uncommon among young adults. However, the incidence of stroke among young women increases with pregnancy during peripartum and postpartum periods. The relative risk of suffering from haemorrhagic stroke was three times higher than ischemic stroke during these periods when compared with antenatal period. Neuroimaging should be prioritized in order to establish diagnosis and to facilitate treatment in a patient with suspected acute stroke. Prophylaxic anticoagulants should be used in high risk patients. Treatments of acute stroke in pregnant women include anti-platelet and thrombolytic agents. Further studies should be carried as there is lack of high level of evidences to formulate clear guideline for the management of stroke during pregnancy.