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To compare non-pharmacological interventions in their ability to prevent delirium in critically ill patients, and find the optimal regimen for treatment. Literature searches were conducted using PubMed, Embase, CINAHL, and Cochrane Library databases until the end of June 2019. We estimated the risk ratios (RRs) for the incidence of delirium and in-hospital mortality and found the mean difference (MD) for delirium duration and the length of ICU stay. The probabilities of interventions were ranked based on clinical outcomes. The study was registered on PROSPERO (CRD42020160757). Twenty-six eligible studies were included in the network meta-analysis. Studies were grouped into seven intervention types: physical environment intervention (PEI), sedation reducing (SR), family participation (FP), exercise program (EP), cerebral hemodynamics improving (CHI), multi-component studies (MLT) and usual care (UC). In term of reducing the incidence of delirium, the two most effective interventions were FP (risk ratio (RR) 0.19, 95% confidence interval (CI) 0.08 to 0.44; surface under the cumulative ranking curve (SUCRA) = 94%) and MLT (RR 0.43, 95% CI 0.30 to 0.57; SUCRA = 68%) compared with observation. Although all interventions demonstrated nonsignificant efficacy in regards to delirium duration and the length of the patient's stay in the ICU, MLT (SUCRA = 78.6% and 71.2%, respectively) was found to be the most effective intervention strategy. In addition, EP (SUCRA = 97.2%) facilitated a significant reduction in hospital mortality, followed in efficacy by MLT (SUCRA = 73.2%), CHI (SUCRA = 35.8%), PEI (SUCRA = 34.8%), and SR (SUCRA = 31.8%). Multi-component strategies are overall the optimal intervention techniques for preventing delirium and reducing ICU length of stay in critically ill patients by way of utilizing several interventions simultaneously. Additionally, family participation as a method of patient-centered care resulted in better outcomes for reducing the incidence of delirium. •Systematic review of different preventive nonpharmacological interventions for ICU delirium.•Multi-component strategies are overall the optimal intervention for preventing delirium and reducing ICU length of stay.•Exercise program is recommended as the preferable intervention when considering feasibility and cost-effectiveness.•Family participation proved to be a promising intervention for reducing delirium incidence, but requires further research.

Retinopathy ofprematurity （ROP） is a proliferative disease that affects infants of young gestational age （GA） and low birth weight （BW）. Aggressive posterior ROP （AP-ROP） is a rapidly progressing and severe presentation of ROP. It is characterized as posterior location （zone 1 or posterior zone I1）, Stage 3, and with plus disease （arterial tortuosity and venous dilation）. It can quickly lead to retinal detachment and blindness if not treated in time.

Aim： To investigate the effect and underlying mechanisms of immune-tolerance induced by the adoptive transfer of bone marrow （BM）-derived dendritic cells （DC） in insulin-dependent diabetes mellitus （IDDM） mice. Methods： The IDDM model was established by a low dose of streptozotocin （STZ） in Balb/c mice. Two DC subpopulations were generated from the BM cells with granulocyte-macrophage colony-stimulating factor with or without interleukin-4. The purity and the T cell stimulatory capability of DC were identified. These cells were used to modulate autoimmune response in pre-diabetic mice. Blood glucose was examined weekly; pancreas tissues were taken for histopathological analysis, and CD4^＋ T cells were isolated to detect lymphocyte proliferation by Mq-T assay and the ratio of CD4^＋CD25^＋ T cells by fluorescence-activated cell sorting （FACS）. The cytokine secretion was determined by ELISA analysis. Results： Two DC subsets were generated from BM, which have phenotypes of mature DC （mDC） and immature DC （iDC）, respectively. The level of blood glucose decreased significantly by transferring iDC （P〈0.01） rather than mDC. Less lymphocyte infiltration was observed in the islets, and pancreatic structure was intact. In vitro, proliferation of lymphocytes decreased and the proportion of CD4^＋CD25^＋ T cells increased remarkably, compared with the mDC-treated groups （P〈0.05）, which were associated with increased level of the Th2 cytokine and reduced level of the Thl cytokine after iDC transfer. Conclusion： Our data showed that iDC transfer was able to confer protection to mice from STZ-induced IDDM. The immune-tolerance to IDDM may be associated with promoting the production of CD4^＋CD25^＋ T cells and inducing regulatory Th2 responses in vivo.

Background To evaluate the impact of follicle-flushing during oocyte collection on embryo development potential retrospectively. Methods A total of 1714 cases, including 133 who experienced retrieval difficulty (repeated follicle-flushing) on the day of oocyte retrieval (difficulty group) and the control 1581 cases (control group), were assessed in this retrospective study. The number of oocytes recovered, two pro-nuclei fertilization (2PN-fertilization), day 3 good-quality embryo and day 5/6 blastocyst utilization rates were compared between the difficulty group and control group correspondingly. Embryo implantation, clinical pregnancy and neonatal outcomes were further analyzed between the two groups in the fresh day − 3 embryo transfer cycles. Results The number of oocytes recovered in the difficulty group (9.08 ± 4.65) were significantly reduced compared with the control group (12.13 ± 5.27), P  < 0.001; The 2PN-fertilization, day 3 good-quality embryo and blastocyst utilization rates were significantly lower in the difficulty group compared with controls (71.7% vs. 75.7%; 52.7% vs. 56.5%; 31.9% vs. 37.0%, all P  < 0.05). Embryo implantation in the difficulty group was 53.2%, which was lower than the control value of 58.7%, although not reaching statistical significance. The rate of fresh embryo transfer cycles in the difficulty group was lower than normal ones (51.88% vs. 61.99%, P  = 0.026). The pregnancy and live birth rates were similar between the two groups. But the rate of spontaneous miscarriages of the difficulty group was higher than the control group, although not reaching statistical significance. The neonatal outcomes had no statistical difference between the two groups. Conclusions Oocyte retrieval difficulty, which include repeated flushing and the corresponded extending time required for oocyte recovery, significantly reduced day 3 good-quality embryo and blastocyst utilization rates of these patients. But the live birth rate had no difference between the difficulty group and the normal ones.

Introduction Retinopathy of prematurity (ROP) is a proliferative disease that affects infants of young gestational age (GA) and low birth weight (BW). Methods Subjects This study was a retrospective analysis of 32 eyes (16 patients) with AP-ROP (according to the International Classification of ROP revised in 2005) that were treated with IVR at our hospital between January 2014 and January 2015. Inclusion criteria included patients diagnosed definitely with AP-ROP, transparent, or mildly opaque refractive media that did not affect clear visualization of the fundus, and follow-up period for at least 6 months. Primary success was defined as regression of retinal neovascularization and plus disease, continued vascularization of the avascular retina, and without relapse during the whole follow-up visits. [...]we chose ranibizumab for the treatment of AP-ROP in our study. [...]we used near-confluent laser photocoagulation in patients with relapse, and our results were positive. A further study with a larger sample size and longer follow-up period or a prospective study should be performed to evaluate the long-term safety and effectiveness of IVR for the treatment of AP-ROP. Serum concentrations of bevacizumab (avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity. Zhou Y, Jiang Y, Bai Y, Wen J, Chen L. Vascular endothelial growth factor plasma levels before and after treatment of retinopathy of prematurity with ranibizumab.

Background: Neovascular glaucoma (NVG) is a refractory glaucoma. The management of NVG is very difficult, and it is more difficult when combined with vitreous hemorrhage. The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage. Methods: A total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study. The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years. The mean intraocular pressure (IOP) was 46.38 ± 5.75 mmHg (1 mmHg = 0.133 kPa) while being treated with the maximum medical therapy. The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution (logMAR BCVA) was 2.62 ± 0.43. All the patients underwent intravitreal injection of 0.5 mg (0.05 ml) ranibizumab combined with pars plana vitrectomy (PPV), pars plana lensectomy (PPL) with a preserved anterior capsule, panretinal photocoagulation (PRP), and trabeculectomy (intravitreal ranibizumab [IVR] + PPV + PPL + PRP + trabeculectomy). The IOP and logMAR BCVA were the main outcome measures in this study. Results: The follow-up period was 12 months. The mean postoperative IOPs were 26.38 ± 3.75 mmHg, 21.36 ± 3.32 mmHg, 18.57 ± 3.21 mmHg, and 16.68 ± 2.96 mmHg, respectively at 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy. At the last follow-up, the mean IOP was significantly lower than the preoperative one (t = 6.612, P = 0.001). At 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy, the mean logMAR BCVA were 1.30 ± 0.36, 1.29 ± 0.37, 1.29 ± 0.39, and 1.26 ± 0.29, respectively. At the last follow-up, the mean logMAR BCVA was significantly improved, and the difference was statistically significant compared with preoperative one (t = 6.133, P = 0.002). The logMAR BCVA improved in 22 eyes (84.62%), and remained stable in 4 eyes (15.38%). The neovascularization in the iris and the angle regressed significantly in all patients 7 days after ranibizumab injection. No serious complications occurred during 12 months of the study. Conclusions: IVR + PPV + PPL + PRP + trabeculectomy can control IOP well and improve BCVA without severe complication for NVG patients with vitreous hemorrhage.

Various induction strategies were investigated for effective porcine interferon-α (pIFN-α) production by Pichia pastoris in a 10 L fermenter. We found that pIFN-α concentration could be significantly improved with the strategies of low-temperature induction or methanol/sorbitol co-feeding. On this basis, a combinational strategy of induction at lower temperature (20 °C) with methanol/sorbitol co-feeding has been proposed for improvement of pIFN-α production. The results reveal that maximal pIFN-α concentration and antiviral activity reach the highest level of 2.7 g/L and 1.8 × 10⁷ IU/mg with the proposed induction strategy, about 1.3–2.1 folds higher than those obtained with other sub-optimal induction strategies. Metabolic analysis and online multi-variable measurement results indicate that energy metabolic enrichment is responsible for the performance enhancement of pIFN-α production, as a large amount of ATP could be simultaneously produced from both formaldehyde oxidation pathway in methanol metabolism and tricarboxylic acid (TCA) cycle in sorbitol metabolism. In addition, the proposed combinational induction strategy enables P. pastoris to be resistant to high methanol concentration (42 g/L), which conceivably occur associating with the error-prone methanol over-feeding. As a result, the proposed combinational induction strategy simultaneously increased the targeted protein concentration and operational stability leading to significant improvement of pIFN-α production.

Breast lumpectomy is usually performed under general or local anesthesia. To the best of our knowledge, whether conscious sedation with intranasal dexmedetomidine and local anesthesia is an effective anesthetic technique has not been studied. Thus, the present study aimed to investigate the effectiveness of conscious sedation with intranasal dexmedetomidine combined with local anesthesia in breast lumpectomy, and to identify its optimal dose. A prospective randomized, double-blinded, placebo-controlled, single-center study was designed, and patients undergoing breast lumpectomies were recruited based on the inclusion and exclusion criteria. All patients were randomly allocated to four groups: i) Local anesthesia with 0.9% intranasal saline (placebo); local anesthesia with ii) 1 µg.kg−1; iii) 1.5 µg.kg−1; or iv) 2 µg.kg−1 intranasal dexmedetomidine. The sedation status, pain relief, vital signs, adverse events, and satisfaction of patient and surgeon were recorded. Patients in the three dexmedetomidine groups were significantly more sedated and experienced less pain compared with the placebo group 45 min after intranasal dexmedetomidine administration and during 30 min in the post-anesthesia care unit. Patients in the 1.5 µg.kg−1 group were more sedated compared with the 1 µg.kg−1 group (without reaching statistical significance), whereas the 1.5 µg.kg−1 group exhibited a similar level of sedation 45 min after intranasal dexmedetomidine administration compared with the 2 µg.kg−1 group. In addition, patients in the 1 and 1.5 µg.kg−1 group experienced no adverse hemodynamic effects. Patient and surgeon satisfaction were greater in the 1.5 µg.kg−1 group compared with the 1 and 2 µg.kg−1 groups. Taken together, the results of the present study suggested that conscious sedation with intranasal dexmedetomidine and local anesthesia may be an effective anesthetic for breast lumpectomy surgery, and that the optimal dose for intranasal dexmedetomidine administration may be 1.5 µg.kg−1, as it resulted in good sedation and patient satisfaction without adverse effects.

(1) Background: The spontaneous combustion of coal (SCC) not only consumes huge amounts of coal resources but also causes environmental degradation. Rare earth elements (REE) can be taken as an effective indicator to evaluate the environmental effects of SCC. Coal in the Rujigou Mine has been spontaneously combusting for hundreds of years. (2) Methods: The geochemical properties of REE and major elements in the soil of the Rujigou coal mine are methodically examined to reveal the environmental effects of SCC. (3) Results: Soil REE concentration in the Rujigou mine is 216.09 mg/kg, and there is an enrichment of light rare earth elements (LREE) and a depletion of heavy rare earth elements (HREE), LREE/HREE in Rujigou mine was 5.52. The spontaneous combustion of coal could change the vertical distribution of REE, which is conducive to the enrichment of LREE. According to the Eu anomaly and δCe/δEu, the source of material in this mine may be derived from the terrigenous clastic rock controlled by weak reduction. Aluminum and titanium have similar geochemical behavior to REE, especially LREE. The concentration of sulfur is negatively correlated with REE, especially HREE. Calcium, sodium, and magnesium all had a negative correlation with LREE. (4) Conclusions: The spontaneous combustion of coal can lead to the fractionation of light and heavy rare earth elements, resulting in the enrichment of LREE and depletion of HREE.

Monolithic catalysts have great industrial application prospects compared to powdered catalysts due to their low pressure drop, the high efficiency of mass and heat transfer, and recyclability. Deposition of active phases on the monolithic carriers dramatically increases the utilization rate and has been attracting continuous attention. In this paper, we reviewed the traditional (impregnation, coating, and spraying) and novel (hydrothermal and electrodeposition) strategies of surface deposition integration, analyzed the advantages and disadvantages of both ways, and then prospected the possible directions for future development of integration technologies.