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Postoperative cognitive dysfunction increases mortality and morbidity in perioperative patients and has become a major concern for patients and caregivers. Previous studies demonstrated that synaptic plasticity is closely related to cognitive function, anesthesia and surgery inhibit synaptic function. In central nervous system, autophagy is vital to synaptic plasticity, homeostasis of synapticproteins, synapse elimination, spine pruning, proper axon guidance, and when dysregulated, is associated with behavioral and memory functions disorders. The mammalian target of rapamycin (mTOR) negatively regulates the process of autophagy. This study aimed to explore whether rapamycin can ameliorate anesthesia/surgery-induced cognitive deficits by inhibiting mTOR, activating autophagy and rising synaptic plasticity-related proteins in the hippocampus. Aged C57BL/6J mice were used to establish POCD models with exploratory laparotomy under isoflurane anesthesia. The Morris Water Maze (MWM) was used to measure reference memory after anesthesia and surgery. The levels of mTOR phosphorylation (p-mTOR), Beclin-1 and LC3-II were examined on postoperative days 1, 3 and 7 by western blotting. The levels of synaptophysin (SYN) and postsynaptic density protein 95 (PSD-95) in the hippocampus were also examined by western blotting. Here we showed that anesthesia/surgery impaired reference memory and induced the activation of mTOR, decreased the expression of autophagy-related proteins such as Beclin-1 and LC3-II. A corresponding decline in the expression of neuronal/synaptic, plasticity-related proteins such as SYN and PSD-95 was also observed. Pretreating mice with rapamycin inhibited the activation of mTOR and restored autophagy function, also increased the expression of SYN and PSD-95. Furthermore, anesthesia/surgery-induced learning and memory deficits were also reversed by rapamycin pretreatment. In conclusion, anesthesia/surgery induced mTOR hyperactivation and autophagy impairments, and then reduced the levels of SYN and PSD-95 in the hippocampus. An mTOR inhibitor, rapamycin, ameliorated anesthesia/surgery-related cognitive impairments by inhibiting the mTOR activity, inducing activation of autophagy, enhancing SYN and PSD-95 expression.

This study was carried out to evaluate the effectiveness of general versus intraspinal anesthesia in lower limb fracture surgery. Between January 2018 and August 2022, the researchers' hospital recruited and randomized 433 patients who underwent surgery for lower limb fractures. The study population was divided into 2 groups. Group A (n=220) received general anesthesia during surgery; group B (n=213) received intraspinal anesthesia. Factors were recorded and analyzed, including anesthesia duration, operative time, length of hospital stay, and laboratory indices such as hemoglobin (Hb), serum glutamate pyruvate transaminase (SGPT), blood urea nitrogen (BUN), creatinine (Cr). All adverse events were monitored as well. There were no significant differences in anesthesia duration, surgery time, and length of hospital stay between the two patient groups (P > .05). After receiving different anesthesia approaches, both groups had similar laboratory results (P > .05). The absence of significant differences in adverse events between the two groups indicates that both methods of anesthesia have comparable surgical safety (P > .05). Both general anesthesia and intraspinal anesthesia provided effective anesthetic effects for lower limb fracture surgery with a similar safety profile. Patients also showed similar laboratory indices and experienced comparable anesthesia duration, operative time, and length of hospital stay.

Purpose: Ultrasound-guided modified thoracolumbar fascial plane block (MTLIP) has been reported effective for postoperative pain control following lumbar surgery. Although trauma of the Tianji robot-assisted lumbar internal fixation is reduced, the degree of pain cannot be ignored.MTLIP may improve operation efficiency and reduce puncture complications.This study aimed to explore whether MTLIP is not inferior to thoracolumbar fascial plane block (TLIP) in the treatment of lumbar internal fixation. Methods: This prospective double-blinded, non-inferiority randomized trial enrolled patients underwent Tianji robot-assisted lumbar internal fixation between April and August 2022 to either MTLIP or TLIP. The primary outcome was an effective dermatomal block area after 30 min. Secondary outcomes included the numeric rating scale (NRS) scores, nerve block operation time, puncture times, image clarity, patient satisfaction, intraoperative opioid consumption, complications/adverse reactions, and Oswestry Disability Index (ODI). Results: Sixty participants were randomized to MTLIP (n=30) and TLIP (n=30). The effective dermatomal block area 30 min after block was non-inferior in the MTLIP group (283.6 [+ or -] 62.6 [cm.sup.2) compared with the TLIP group (261.4[+ or -]53.2 [cm.sup.2) (P=0.145; estimated mean difference: -22.17, 95% CI: -52.19, 7.85; smaller than the non-inferiority margin of 39.5). Compared with TLIP, MTLIP showed shorter operation time, smaller puncture times, and better target definition and satisfaction scores (all P<0.001). Sufentanil amount, remifentanil amount, PCIA sufentanil dosage, parecoxib amount, NRS scores (increased with time in the two groups but without inter-group differences), and complications were not significantly different between the two groups (all P>0.05). Conclusion: This non-inferiority trial supports the hypothesis that MTLIP yields a non-inferior effective dermatomal block area compared with TLIP for Tianji robot-assisted lumbar internal fixation. Clinical Trials Registration: Chinese Clinical Trial Registry (ChiCTR2200058687);. Keywords: local anesthetics, regional anesthesia, lumbosacral plexus, lumbar internal fixation, robotic surgical procedures

Ultrasound-guided modified thoracolumbar fascial plane block (MTLIP) has been reported effective for postoperative pain control following lumbar surgery. Although trauma of the Tianji robot-assisted lumbar internal fixation is reduced, the degree of pain cannot be ignored.MTLIP may improve operation efficiency and reduce puncture complications.This study aimed to explore whether MTLIP is not inferior to thoracolumbar fascial plane block (TLIP) in the treatment of lumbar internal fixation. This prospective double-blinded, non-inferiority randomized trial enrolled patients underwent Tianji robot-assisted lumbar internal fixation between April and August 2022 to either MTLIP or TLIP. The primary outcome was an effective dermatomal block area after 30 min. Secondary outcomes included the numeric rating scale (NRS) scores, nerve block operation time, puncture times, image clarity, patient satisfaction, intraoperative opioid consumption, complications/adverse reactions, and Oswestry Disability Index (ODI). Sixty participants were randomized to MTLIP (n=30) and TLIP (n=30). The effective dermatomal block area 30 min after block was non-inferior in the MTLIP group (283.6 ± 62.6 cm ) compared with the TLIP group (261.4±53.2 cm ) ( =0.145; estimated mean difference: -22.17, 95% CI: -52.19, 7.85; smaller than the non-inferiority margin of 39.5). Compared with TLIP, MTLIP showed shorter operation time, smaller puncture times, and better target definition and satisfaction scores (all <0.001). Sufentanil amount, remifentanil amount, PCIA sufentanil dosage, parecoxib amount, NRS scores (increased with time in the two groups but without inter-group differences), and complications were not significantly different between the two groups (all >0.05). This non-inferiority trial supports the hypothesis that MTLIP yields a non-inferior effective dermatomal block area compared with TLIP for Tianji robot-assisted lumbar internal fixation. Chinese Clinical Trial Registry (ChiCTR2200058687);.

Early detection of rockslides at high-elevation and well-vegetated slopes remains challenging. This study used satellite and unmanned aerial vehicle (UAV) optical remote-sensing (ORS) images to track evidence of slope deformation and examine potential geomorphological precursors of five large rockslides in China. The multi-temporal image interpretation results were combined with available pre-sliding slope displacement data derived from synthetic aperture radar (SAR) or field monitoring to study the temporal changes in geomorphological precursors accompanying slope deformation. All the surveyed landslides had cracks or scarps and rockfalls within the landslide source area before the onset of rapid sliding. These precursors can be identified in ORS images taken several years or decades before the rapid slope failure, which provides sufficient time for the landslide early detection in practice. Local topography affects the spatial locations of cracks or scarps. Rockfalls within the landslide source area tend to locate at “key blocks” where slope mass provides forces resisting sliding. The rockfall area ratio, defined as the accumulated area of rockfalls over the landslide source area, ranged from 0.33 to 0.92 before rapid slope failure. The landslides developed on anti-dip and igneous rock slopes show a more significant rise of rockfall area ratio before the slope failure than the landslides on dip slopes. Given the broad availability of ORS data, this study could shed light on the ORS-based landslide early detection and landslide kinematics study.

The highly dynamic nature of the real-world environment poses significant challenges for electric bus system operations (EBSOs), which are prone to serious accidents due to their complexity and a wide variety of risk factors. The accidents are often the result of ignoring the most serious risk sources because of a lack of comprehensive risk assessments. Therefore, this paper proposes an improved failure mode and effects analysis (FMEA) multicriteria group decision-making model to ensure the reliability and safety of EBSOs. First, an expert group is invited to evaluate the risk failure modes (FMs) of the EBSOs and transform them into a normal wiggly hesitant fuzzy set (NWHFS) form. Because the risk assessment process involves a large number of team members with different backgrounds, the experts are grouped based on scoring function values using the K-medoids clustering technique. Then, the evaluation values of the expert group are integrated using the normal hesitant fuzzy weighted geometric (NWHFWG) aggregation operator to obtain the final aggregation matrix, and the weights of the three criteria of occurrence (O), severity (S) and detection (D) are determined for each FM via the CCSD method. Finally, considering the cross-correlation between factors within the system, the relationships between FMs are analyzed, and their impact and importance are quantified using the gray correlation-based DEMATEL method, followed by the final ranking of the FMs using regret theory and the PROMETHEE II methodology to achieve a rational allocation of resources. The results are analyzed with sensitivity and comparative analyses to illustrate the superiority of the model.

A growing number of developing countries have experienced worsening air pollution, which has been shown to cause significant health problems. However, few studies have explored the impact of air pollution on the mental health of university students, particularly in the Chinese context. In order to address this gap, through a large-scale cross-sectional survey, this study aims to examine the effects of air pollution on final-year Chinese university undergraduates’ (due to graduate in 2020) mental health by employing multivariable logistic regression. Our findings show that, first, although normal air quality is not strongly associated with lower levels of negative mental health, there is a strong link between poor air quality and higher levels of negative mental health. More specifically, life satisfaction hedonic unhappiness and depression measured by the Centre for Epidemiological Studies’ Depression scale (CES-D) are statistically associated with air pollution. In addition, we also found that gender is a significant factor, as males had more than 1.6 times greater odds of increased mental health problems compared to their female counterparts. Place of birth also plays a significant role in participants’ mental health. Moreover, undergraduates with urban household registration experienced significant levels of hedonic unhappiness and depression on the CES-D scale. Finally, we found that there is an association between respondents’ economic situation and their mental health too. Overall, this study contributes to the research on air pollution management and mental health intervention, particularly in relation to student groups. The undergraduate curriculum should provide more guidance and suggestions on promoting mental health and establishing positive attitudes to life and academic study of the final year students, under the context of air pollution in China.

Uncertainty exists about whether lowering systolic blood pressure to less than 120 mm Hg is superior to that of less than 140 mm Hg, particularly in patients with diabetes and patients with previous stroke. In this open-label, blinded-outcome, randomised controlled trial, participants with high cardiovascular risk were enrolled from 116 hospitals or communities in China. We used minimised randomisation to assign participants to intensive treatment targeting standard office systolic blood pressure of less than 120 mm Hg or standard treatment targeting less than 140 mm Hg. The primary outcome was a composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes, assessed by the intention-to-treat principle. This trial was registered with ClinicalTrials.gov, NCT04030234. Between Sept 17, 2019, and July 13, 2020, 11 255 participants (4359 with diabetes and 3022 with previous stroke) were assigned to intensive treatment (n=5624) or standard treatment (n=5631). Their mean age was 64·6 years (SD 7·1). The mean systolic blood pressure throughout the follow-up (except the first 3 months of titration) was 119·1 mm Hg (SD 11·1) in the intensive treatment group and 134·8 mm Hg (10·5) in the standard treatment group. During a median of 3·4 years of follow-up, the primary outcome event occurred in 547 (9·7%) participants in the intensive treatment group and 623 (11·1%) in the standard treatment group (hazard ratio [HR] 0·88, 95% CI 0·78–0·99; p=0·028). There was no heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke. Serious adverse events of syncope occurred more frequently in the intensive treatment group (24 [0·4%] of 5624) than in standard treatment group (eight [0·1%] of 5631; HR 3·00, 95% CI 1·35–6·68). There was no significant between-group difference in the serious adverse events of hypotension, electrolyte abnormality, injurious fall, or acute kidney injury. For hypertensive patients at high cardiovascular risk, regardless of the status of diabetes or history of stroke, the treatment strategy of targeting systolic blood pressure of less than 120 mm Hg, as compared with that of less than 140 mm Hg, prevents major vascular events, with minor excess risk. The Ministry of Science and Technology of China and Fuwai Hospital. For the Mandarin translation of the abstract see Supplementary Materials section.

The Chinese government has long been preoccupied with solving the problem of overloaded trucking in intercity freight systems (IFSs). The enforcement of prohibiting overloaded trucking, which enhances environmental and social performance of sustainability, has not progressed well, as it raises transport costs and lowers economic performance, and cannot improve the overall performance of sustainability. It is, thus, necessary to find a way to eliminate overloaded trucking without undermining the overall performance of sustainability. A modal shift is a potential way to achieve freight sustainability, by encouraging greater use of more efficient transport modes. This paper develops a system dynamics model to perform a long-term evaluation of alternative modal shift policies with trucks meeting the statutory limit, and then identified effective policies, whereby the increasing sustainability of IFSs could be achieved. The proposed model was applied to a specific case in China. The results show that the effective modal shift policy is to construct a Class I railway to shift freight away from highways. A discussion is then proposed, based on an analysis of different parameter setting scenarios regarding more general situations.

Beta-defensin-1 (BD-1) is among the class of antibacterial peptides that are rich in disulfide bonds, have direct antibacterial activity and showed enhanced expression following external stimulation. However, existing research studies only treated BD-1 to cell models without stimulation from pathogen-associated molecular patterns (PAMPs), which will further influence our understanding of the role of BD-1. In this study, we map the tissue distribution of Equus BD-1 (i.e., eBD-1, ass BD-1, and mule BD-1) and compare their expression levels in various tissues. We further characterize the three kinds of Equus BD-1 by analyzing their full-length cDNA. We showed that eBD-1, ass BD-1, and mule BD-1 have an identical (100%) open reading frame (ORF). The ORF encoding OEBD-1 expressed the ORF in the E. coli Top10 expression system. This expression system was combined with an S. aureus-infected J774A.1 macrophage cell line to determine the influence on innate immune mediator expression. Using this expression model system, it was determined that the OEBD-1 protein enhanced IL-6 and TNF-α secretion. It can also promote TLR2, IL-1β, CCL2, CCL7, CXCL10 and NF-κB p65 mRNA expression. Moreover, OEBD-1 upregulates phosphorylation of ATK, Syk and IκB-α. In addition, OEBD-1 enhances the macrophage’s ability to phagocytose S. aureus. In conclusion, Equus BD-1 was shown to play an essential role in macrophage-involved innate immune responses in an in vitro system.