早期肺康复联合ESCAPE集束化护理对ICU有创机械通气患者呼吸机相关膈肌功能障碍的影响

目的:探讨早期肺康复联合ESCAPE集束化护理对ICU有创机械通气患者呼吸机相关膈肌功能障碍(VIDD)的影响。方法:将2023年2月1日~12月31日综合ICU收治的41例成人有创机械通气患者随机分为实验组20例和对照组21例,其中实验组3例、对照组4例因转出ICU而脱落,最终纳入实验组和对照组各17例。实验组给予早期肺康复训练联合ESCAPE集束化护理,对照组给予ESCAPE集束化护理。比较两组膈肌移动度及增厚率、临床肺部感染评分(CPIS)、急性生理学与慢性健康状况评分(APACHEⅡ)。结果:实验组治疗后膈肌移动度高于治疗前(P<0.05),膈肌增厚率比较差异无统计学意义(P>0.05);实验组治疗后CPIS、APACHEⅡ评分均低于治疗前(P<0.05)。结论:早期肺康复联合ESCAPE集束化护理可改善ICU有创机械通气患者的膈肌移动度,降低肺部感染发生风险、改善健康状况,减轻膈肌萎缩,控制ICU呼吸机相关性肺炎。

Escape room游戏宣教对阴道分娩初产妇分娩恐惧及产程进展的影响

目的探究Escape room游戏宣教对阴道分娩初产妇分娩恐惧及产程进展的影响。方法采用便利抽样法,选取本院2021年1月—2022年6月收治的140例阴道分娩初产妇为研究对象,按随机数字表法将其分为对照组和观察组,每组各70例。对照组采取常规教育模式,观察组在常规护理基础上应用Escape room游戏宣教,比较两组初产妇分娩恐惧水平、产程进展。结果观察组分娩恐惧中高水平初产妇占比为57.14%小于对照组的80.00%,差异有统计学意义(P<0.05);观察组初产妇第一产程时间、第二产程时间均短于对照组,差异有统计学意义(P<0.05),两组第三产程时间比较差异无统计学意义(P>0.05)。结论Escape room游戏宣教在阴道分娩初产妇中的应用,能缓解产妇分娩恐惧情绪,可一定程度上加快产程进展。

优化ESCAPE集束化策略对ICU亚临床谵妄患者的效果评价

目的 分析优化ESCAPE集束化策略对ICU亚临床谵妄患者的效果。方法 选取本院入住ICU超过24h的亚临床谵妄患者,对照组予常规护理,观察组在常规护理上给优化ESCAPE集束化策略。比较2组睡眠质量、认知水平、谵妄发生率及48h内亚临床谵妄持续时间。结果 观察组睡眠质量、认知水平、谵妄发生率、亚临床谵妄持续时间低于对照组,差异有统计学意义(P<0.05)。结论 优化ESCAPE集束化策略可提高患者睡眠质量,改善亚临床谵妄患者认知水平,缩短亚临床谵妄持续时间,降低谵妄发生率。

When Fleeing Matters:Differences in Escape Behaviours of Three Northeast Asian Anurans

Prey species may have their own optimal escape strategy to balance predation risks and the energetic cost of fleeing.Some species have an advantage when maintaining a short fleeing distance,while others may favour an earlier escape based on microhabitat,size,or body condition.Here,we examined the escape behaviour of the three syntopic Northeast Asian anuran species:Mongolian toads(Strauchbufo raddei),Amur brown frogs(Rana amurensis),and Japanese treefrogs(Dryophytes japonicus)in Mongolia,Russia,China and DPR Korea.We examined flight initiation distance(FID;the distance from a potential predator to the point when the individual starts to flee)and distance fled(DF;distance between flight initiation and flight termination points)of each species and the effects of microhabitat,sex,and body size.Strauchbufo raddei and R.amurensis had a longer FID than D.japonicus,and S.raddei also had a longer DF than D.japonicus.These trends remained similar when dividing FID and DF by a size proxy(snout-vent length)for all individuals.This suggests that the treefrog D.japonicus used a strategy to stay immobile even when they were detected,and the toad S.raddei reacted quicker and more sensitively to predators despite the presence of toxin.Female S.raddei had a significantly longer FID than males suggesting that females are more sensitive to predation risk in this species,but body size was not significant for any of the three species.Our results indicate that the three sympatric species have different escaping strategies,likely related to differences in physiology and crypticity.

Correction:The escape mechanisms of the proto-atmosphere on terrestrial planets:“boil-off”escape,hydrodynamic escape and impact erosion

In the original publication of the article,the affiliation“College of Earth and Planetary Sciences,University of Chinese Academy of Sciences,Beijing,People’s Republic of China”for author Ziqi Wang was missing and included in this correction article.

改良ESCAPE集束化策略在急性呼吸衰竭有创机械通气脱机患者中的应用价值

目的:探讨改良ESCAPE集束化策略在急性呼吸衰竭有创机械通气脱机患者中的应用价值。方法:接受有创机械通气治疗的急性呼吸衰竭患者116例,随机分为观察组60例和对照组56例。对照组由主管医师制定整体治疗方案,采用常规治疗护理。观察组在常规治疗护理基础上,实施改良ESCAPE集束化策略。结果:观察组脱机后1 h、12 h、24 h时SaO_(2)分别为(96.7±3.7)%、(97.3±3.8)%和(97.4±3.3)%,高于对照组的(92.1±4.3)%、(92.5±2.1)%和(93.3±3.9)%,观察组脱机后1 h、12 h、24 h时PaO_(2)/FiO_(2)分别为255.5±33.5 mmHg、257.5±28.7 mmHg和271.3±32.6 mmHg,高于对照组的213.4±30.7 mmHg、218.1±30.4 mmHg和225.5±30.3 mmHg,差异均有统计学意义(P<0.05);观察组患者脱机后1 h RR 20.5±3.7次/min,低于对照组的25.6±4.1次/min,差异有统计学意义(P<0.05)。观察组机械通时间5.9±2.7 d,短于对照组的8.6±3.1 d,差异有统计学意义(P<0.05);观察组48 h内再插管5例(8.3%),对照组48 h内再插管6例(10.7%),两组再插管率的差异无统计学意义(P>0.05)。观察组谵妄发生率18.3%,低于对照组的35.7%,观察组ICU-AW发生率16.7%,低于对照组的25.0%,差异均有统计学意义(P<0.05);观察组ICU住院时间8.3±3.7 d,短于对照组的11.2±4.1 d,差异有统计学意义(P<0.05)。结论:改良ESCAPE策略可改善急性呼吸衰竭患者呼吸机撤机后的氧合指标,降低谵妄及ICU获得性衰弱的发生率,缩短机械通气时间和ICU住院时间。

Escape of Brownian Particles in the System Driven by Correlated White Noises:Comparison of Three Models

The relative escape rate (RER) in the bistable sawtooth system driven by correlated white noises was studied in the case of linear multiplicative noise coefficient.And we compare the RER of linear multiplicative noise coefficient with the RER of the piecewise constant multiplicative noise coefficient in the bistable sawtooth system,finally compare the RER of the bistable sawtooth potential with the RER of the quartic potential in the case of linear multiplicative noise coefficient.It can be seen that the form of the multiplicative noise coefficient and the nonlinearity of potential have an important influence on the resonant activation and the suppression of the RER.The resonant activation of the RER vanishes in the negative correlation when the multiplicative noise coefficient was shifted from piecewise constant to linear function in the bistable sawtooth potential.The suppression of the RER disappears in the negative correlation when thelinear potential is converted into nonlinear one.

Possible mechanisms associated with immune escape and apoptosis on anti-hepatocellular carcinoma effect of Mu Ji Fang granules

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common digestive system cancers with high mortality rates worldwide.The main ingredients in Mu Ji Fang Granules(MJF)are alkaloids,flavonoids,and polysaccharides.MJF has been used in the clinical treatment of hepatitis,cirrhosis and HCC for more than 30 years.Few previous studies have focused on the mechanism of MJF on tumor immunology in the treatment of HCC.AIM To explore the mechanism of action of MJF on tumor immunology in the treatment of HCC.METHODS The absorbable ingredients of MJF were identified using Molecule Network related to High Performance Liquid Chromatography-Electron Spray Ionization-Time of Flight-Mass Spectrometry,and hub potential anti-HCC targets were screened using network pharmacology and pathway enrichment analysis.Forty male mice were randomly divided into the Blank,Model,and MJF groups(1.8,5.4,and 10.8 g/kg/d)following 7 d of oral administration.Average body weight gain,spleen and thymus indices were calculated,tumor tissues were stained with hematoxylin and eosin,and Interferon gamma(IFN-γ),Tumor necrosis factorα(TNF-α),Interleukin-2,aspartate aminotransferase,alanine aminotransferase,alpha-fetoprotein(AFP),Fas,and FasL were measured by Enzyme-linked Immunosorbent Assay.Relevant mRNA expression of Bax and Bcl2 was evaluated by Real Time Quantitative PCR(RTqPCR)and protein expression of Transforming growth factorβ1(TGF-β1)and Mothers against decapentaplegic homolog(SMAD)4 was assessed by Western blotting.The HepG2 cell line was treated with 10 mg/mL,20 mg/mL,30 mg/mL,40 mg/mL of MJF,and another 3 groups were treated with TGF-β1 inhibitor(LY364947)and different doses of MJF.Relevant mRNA expression of TNF-α,IFN-γ,Bax and Bcl2 was evaluated by RT-qPCR and protein expression of TGF-β1,SMAD2,p-SMAD2,SMAD4,and SMAD7 was assessed by Western blotting.RESULTS It was shown that MJF improved body weight gain and tumor inhibition rate in H22 tumorbearing mice,protected immune organs and liver function,reduced the HCC indicator AFP,affected immunity and apoptosis,and up-regulated the TGF-β1/SMAD signaling pathway,by increasing the relative expression of TGF-β1,SMAD2,p-SMAD2 and SMAD4 and decreasing SMAD7,reducing immune factors TNF-αand IFN-γ,decreasing apoptosis cytokines Fas,FasL and Bcl2/Bax,and inhibiting the effect of LY364947 in HepG2 cells.CONCLUSION MJF inhibits HCC by activating the TGF-β1/SMAD signaling pathway,and affecting immune and apoptotic cytokines,which may be due to MJF adjusting immune escape and apoptosis.

Enhanced lysosome escape mediated by 1,2-dicarboxylic-cyclohexene anhydride-modified poly-L-lysine dendrimer as a gene delivery system

Antisense oligodeoxynucleotide(ASODN)can directly interfere a series of biological events of the target RNA derived from tumor cells through Watson-Crick base pairing,in turn,plays antitumor therapeutic roles.In the study,a novel HIF-1αASODN-loaded nanocomposite was formulated to efficiently deliver gene to the target RNA.The physicochemical properties of nanocomposite were characterized using TEM,FTIR,DLS and zeta potentials.The mean diameter of resulting GEL-DGL-FA-ASODN-DCA nanocomposite was about 170–192 nm,and according to the agarose gel retardation assay,the loading amount of ASODN accounted for 166.7 mg/g.The results of cellular uptake showed that the nanocomposite could specifically target to HepG2 and Hela cells.The cytotoxicity assay demonstrated that the toxicity of vectors was greatly reduced by using DCA to reversibly block the cationic DGL.The subcellular distribution images clearly displayed the lysosomal escape ability of the DCA-modified nanocomposite.In vitro exploration of molecular mechanism indicated that the nanocomposite could inhibit m RNA expression and HIF-1αprotein translation at different levels.In vivo optical images and quantitative assay testified that the formulation accumulated preferentially in the tumor tissue.In vivo antitumor efficacy research confirmed that this nanocomposite had significant antitumor activity and the tumor inhibitory rate was 77.99%.These results manifested that the GEL-DGL-FA-ASODNDCA nanocomposite was promising in gene therapeutics for antitumor by interacting directly with target RNA.

A Fire Escape Simulation System Based on the Dijkstra Algorithm

Despite the support of all kinds of fire prevention measures and high-tech fire prevention equipment,fires still occur frequently because of both anthro-pogenic factors and natural disasters.This issue has drawn the attention of schools,all levels of government,and other organizations.Many types of organi-zations carry out fire drills throughout the year.Because this kind of drill cannot anticipate the specific circumstances of each fire,which are generally far more complicated than drills,most people cannot correctly choose the optimal escape route from real fires.Thus,a fire-scene virtual simulation system based on the Dijkstra algorithm is here proposed to address such problems as casualties caused by frequent fires and the inability of most people to correctly choose a fire escape route.This virtual fire escape simulation system uses Maya to carry out 3D recon-struction of the fire scene,the Unity engine to conduct interactive function design,and the Dijkstra algorithm to calculate the best escape route.The results of the example indicate that the simulation system solves the problems of the traditional simulation system,such as stiffness,lack of intelligence,and poor simulation.

Secondary electron emission and photoemission from a negative electron affinity semiconductor with large mean escape depth of excited electrons

The formulae for parameters of a negative electron affinity semiconductor(NEAS)with large mean escape depth of secondary electrons A(NEASLD)are deduced.The methods for obtaining parameters such asλ,B,E_(pom)and the maximumδandδat 100.0 keV≥E_(po)≥1.0 keV of a NEASLD with the deduced formulae are presented(B is the probability that an internal secondary electron escapes into the vacuum upon reaching the emission surface of the emitter,δis the secondary electron yield,E_(po)is the incident energy of primary electrons and E_(pom)is the E_(po)corresponding to the maximumδ).The parameters obtained here are analyzed,and it can be concluded that several parameters of NEASLDs obtained by the methods presented here agree with those obtained by other authors.The relation between the secondary electron emission and photoemission from a NEAS with large mean escape depth of excited electrons is investigated,and it is concluded that the presented method of obtaining A is more accurate than that of obtaining the corresponding parameter for a NEAS with largeλ_(ph)(λ_(ph)being the mean escape depth of photoelectrons),and that the presented method of calculating B at E_(po)>10.0 keV is more widely applicable for obtaining the corresponding parameters for a NEAS with largeλ_(ph).

Noise color influence on escape times in nonlinear oscillators-experimental and numerical results

The interplay between noise and nonlinearites can lead to escape dynamics.Associated nonlinear phe-nomena have been observed in various applications ranging from climatology to biology and engineering.For reasons of computational ease,in most studies,Gaussian white noise is used.However,this noise model is not physical due to the associated infinite energy content.Here,the authors present extensive experimental investigations and numerical simulations conducted to examine the impact of noise color on escape times in nonlinear oscillators.With a careful parameterization of the numerical simulations,the authors are able to make quantitative comparisons with experimental results.Through the experi-ments and simulations,it is illustrated that the noise color can drastically influence escape times and escape probability.

Meta-Analysis of the Effect of the Escape Room Teaching Method on Nursing Education

Objectives:A meta-analysis was conducted to systematically evaluate the effect of the escape room teaching method on nursing education.Methods:We searched PubMed,Medline,Web of Science,CNKI,VIP,and Wanfang databases,with a search time frame from the first day of database establishment to October 2022.Two researchers evaluated the quality of the obtained literature and extracted the data.The RevMan5.4 software was used for meta-analysis.Results:A total of 7 studies involving 1487 nursing students were included.Compared with the control group,the escape room teaching method improved the professional performance of nursing students[standardized mean difference(SMD)=0.98,95%confidence interval(CI;0.38,1.59),P<0.0001].The critical thinking ability of nursing students was enhanced[mean difference(MD)=12.64,95%CI(7.91,17.37),P<0.0001],and the investment level of nursing students in learning was improved[MD=4.18,95%CI(1.74,6.62),P<0.0001].Conclusion:The escape room teaching method can improve nursing students’professional performance,critical thinking ability,and learning engagement level.There is no significant difference in the impact of nursing teaching satisfaction,and there is still a lack of data support.This paper is limited by the quality and quantity of included literature,and more high-quality studies are still needed to further demonstrate the above conclusions.

ESCAPE策略在机械通气患者谵妄管理的应用

目的评价ESCAPE策略用于机械通气患者谵妄管理的效果。方法将165例机械通气患者采用随机数字软件分为干预组(n=86)、对照组(n=79)。对照组采用ICU常规护理,包括观察患者生命体征、呼吸机及循环监测、常规镇痛镇静护理、药物不良反应及脏器功能监测。干预组采用ICU常规护理的同时应用ESCAPE策略,包括早期活动、睡眠管理、每日唤醒及自主呼吸试验、精神状态评估、情感支持、镇痛镇静管理。比较两组患者谵妄发生率、谵妄持续时间、镇痛镇静药物使用量、机械通气时间、ICU住院时间。结果干预组患者谵妄发生率、谵妄持续时间、镇痛镇静药物使用量、机械通气时间、ICU住院时间显著低于/短于对照组(P<0.05,P<0.01)。结论实施ESCAPE策略可有效降低ICU机械通气患者谵妄发生率,缩短谵妄持续时间,提高临床护理质量。

Present-day Upper-crustal Strain Rate Field in Southeastern Tibet and its Geodynamic Implications:Constraints from GPS Measurements with ABIC Method

The Earth’s surface kinematics and deformation are fundamental to understanding crustal evolution.An effective research approach is to estimate regional motion field and deformation fields based on modern geodetic networks.If the discrete observed velocity field is obtained,the velocity related fields,such as dilatation rate and maximum shear strain rate,can be estimated by applying varied mathematical approaches.This study applied Akaike's Bayesian Information Criterion(ABIC)method to calculate strain rate fields constrained by GPS observations in the southeast Tibetan Plateau.Comparison with results derived from other three methods revealed that our ABIC-derived strain rate fields were more precise.The maximum shear strain rate highlighted the Xianshuihe–Xiaojiang fault system as the main boundary for the outward migration of material in southeastern Tibet,indicating rotation of eastern Tibet material around the eastern Himalaya rather than whole extrusion along a fixed channel.Additionally,distinct dilatation rate patterns in the northeast and southwest regions of the fault system were observed.The northeast region,represented by the Longmenshan area,exhibited negative dilatational anomalies;while the southwest region,represented by the Jinsha River area north of 29°N,displayed positive dilatational anomalies.This indicates compression in the former and extension in the latter.Combined with deep geophysical observations,we believe that the upper and lower crusts of the Jinsha River area north of 29°N are in an entire expanding state,probably caused by the escape-drag effect of material.The presence of a large,low-viscosity region south of 29°N may not enable the entire escape of the crust,but instead result in a differential escape of the lower crust faster than the upper crust.

Physical mechanism of secondary-electron emission in Si wafers

CMOS-compatible RF/microwave devices,such as filters and amplifiers,have been widely used in wireless communication systems.However,secondary-electron emission phenomena often occur in RF/microwave devices based on silicon(Si)wafers,especially in the high-frequency range.In this paper,we have studied the major factors that influence the secondary-electron yield(SEY)in commercial Si wafers with different doping concentrations.We show that the SEY is suppressed as the doping concentration increases,corresponding to a relatively short effective escape depthλ.Meanwhile,the reduced narrow band gap is beneficial in suppressing the SEY,in which the absence of a shallow energy band below the conduction band will easily capture electrons,as revealed by first-principles calculations.Thus,the new physical mechanism combined with the effective escape depth and band gap can provide useful guidance for the design of integrated RF/microwave devices based on Si wafers.

MAVEN observation of magnetosonic waves in the Martian magnetotail region

Magnetosonic waves are an important medium for energy transfer in collisionless space plasma.Magnetosonic waves have been widely investigated in the upstream of the bow shock at Mars.These waves are believed to originate from pickup ions or reflected particles.By utilizing MAVEN spacecraft data,we have observed the occurrence of quasi-perpendicularly propagating magnetosonic emissions near the proton gyrofrequency in the Martian magnetotail region.These plasma waves are associated with a significant enhancement of proton and oxygen flux.The excited magnetosonic waves could possibly heat the protons through resonance and facilitate the ionospheric plasma escape.Our results could be helpful to better understand the Mars’magnetospheric dynamics and offer insights into possible energy redistribution between waves and plasma in the Martian nightside magnetosphere.

Generalized Newton’s Theory of Universal Gravitation and Black Holes

The Newton’s theory of universal gravitation is generalized. Significantly strong at short distances central interaction of bodies and particles is established in comparison with Newtonian. A connection is found with Black Holes, with the horizon of events. Possibility of systematization of all Black Holes is shown. An illustration is given on the example of Black Hole SgrA*.

Escape from the Besieged Fortress——An Analysis of Alice Munro's "Runaway"

Alice Munro is one of the famous Canadian writers and is renowned above all for the astonishing subtlety of her short stories.Her theme has often been the dilemmas of the female coming to terms with family, friends in a small town. This paper attempts to make a brief introduction about the stories of Alice Munro's Runaway and explores the protagonist's choices in the dilemma situation, and then exposes the cruelty of reality is that they cannot get rid of the ineluctable reality of life. Escape is only a temporary action which cannot save them from endless triviality of life. What they should do is not to escape from life, but to adapt to the reality of life.

Single-cell RNA-seq reveals the immune escape and drug resistance mechanisms of mantle cell lymphoma

Objective:Mantle cell lymphoma(MCL)is a rare subtype of non-Hodgkin lymphoma(NHL)with high heterogeneity and a high recurrence rate.How heterogenous cell populations contribute to relapse remains to be elucidated.Methods:We performed single cell RNA sequencing(scRNA-seq)on approximately 4,000 bone marrow cells sampled from one patient with multidrug resistant MCL.We identified 10 subpopulations comprising 4 malignant B cell subtypes,3 T cell subtypes,2 dendritic cell subtypes and 1 natural killer(NK)cell subtype.Subsequently,we identified cell markers,including a series of genes associated with immune escape and drug resistance.In addition,we explored the roles of these genes in the mechanism of immune escape and drug resistance,and we verified the expression imbalance and clinical prognostic potential by using GEO datasets including 211 MCL samples.Results:The major immune escape mechanisms of MCL included anti-perforin activity,decreased immunogenicity and direct inhibition of apoptosis and cell killing,as mediated by type I and II B cells.The drug resistance mechanisms of different cell clusters included drug metabolism,DNA damage repair,apoptosis and survival promotion.Type III B cells closely communicate with other cells.The key genes involved in the resistance mechanisms showed dysregulated expression and may have significant clinical prognostic value.Conclusion:This study investigated potential immune escape and drug resistance mechanisms in MCL.The results may guide individualized treatment and promote the development of therapeutic drugs.