Factors influencing willingness to participate in ophthalmic clinical trials and strategies for effective recruitment

AIM:To explore the factors influencing individuals’willingness to participate in ophthalmic clinical trials.METHODS:A questionnaire survey was conducted from January to April 2021 among patients and their family members at Zhongshan Ophthalmic Center,Sun Yat-sen University,in Guangzhou,China.The survey gathered data on respondents’willingness,demographic and socioeconomic profiles,as well as their reasons and concerns regarding engagement in clinical trials.RESULTS:Of the 1078 residents surveyed(mean age 31.2±13.1y;65.8%females)in Guangzhou,749(69.5%)expressed a willingness to participate in future ophthalmic clinical trials.Specific characteristics associated with greater willingness included a younger age,lower annual income,higher education,prior participation experience,previous ophthalmic treatment,and a better understanding of clinical trials.With the exception of age,these characteristics were significantly linked to a higher willingness.The primary barrier to participation,expressed by 64.8%of those willing and 54.4%of those unwilling,was“Uncertain efficacy”.In terms of motivations,the willing group ranked“Better therapeutic benefits”(35.0%),“Professional monitoring”(34.3%),and“Trust in healthcare professionals”(33.1%)as their top three reasons,whereas the unwilling participants indicated“Full comprehension of the protocol”(46.2%)as the key facilitator.CONCLUSION:This study reveals a substantial willingness to participate in ophthalmic clinical trials and demonstrates the predictive role of demographic and socioeconomic factors.Variations in motivators and concerns between willing and unwilling participants highlight the significance of tailored recruitment strategies.Importantly,the need for and trust in healthcare professionals stand out as powerful motivations,underscoring the importance of enhancing physician-patient relationships,adopting patient-centered communication approaches,and addressing individualized needs to improve accrual rates.

Effects of positive psychological control intervention on sleep and psychology of officers and soldiers working at sea

BACKGROUND The working environment of submarine crews is also very special.They are in a closed,high-temperature,high-noise,high-vibration and narrow working and living space for a long time,and they suffer from physical discomfort caused by seasickness,which will affect the mental health of officers and soldiers.American psychologists have achieved positive results in psychological resilience training for officers and soldiers from the perspective of positive psychology.At present,there are few reports on the correlation between psychological resilience in the field of domestic research on submarine crew psychology,and it is necessary to conduct further research.METHODS A total of 121 soldiers working in a confined space of a large ship were randomly divided into an experimental group and a control group.The 50 soldiers in the experimental group were given a training course intervention,while the 71 soldiers in the control group did not receive any intervention measures.The Pittsburgh Sleep Quality Index,Psychological Resilience Scale,military Psycho-logical Stress Self-Assessment Questionnaire,and General Self-Efficacy Scale scores were compared before and 6 months after the intervention.RESULTS Under the positive psychological control intervention,except for sleep efficiency(P=0.05),the difference between the remaining dimensions of the Pittsburgh Sleep Quality Index scores and the total scores of the experimental group compared with the control group was statistically significant(P<0.05);the assessment of the psychological condition showed that,in addition to the Psychological Stress Self-assessment Questionnaire for Military Personnel scores(P=0.05),the scores of the Mental Toughness Scale(Dispositional Resilience Scale Resilience II)in the experimental group,General Self-Efficacy Scale scores were statistically significant(P<0.05)compared to pre-intervention.CONCLUSION Positive psychological intervention and control can improve the sleep state and psychological state of officers and soldiers working in confined space at sea.

Patient Recruitment in Clinical Trials: Areas of Challenges and Success, a Practical Aspect at the Private Research Site

Enrolling in clinical trials could be time-sensitive and time-demanding tasks for the research site, especially if it is a private research organization compared to the research conducted at an academic or medical center. Every study differs in various aspects, such as phases, study indication, eligibility criteria, etc. In terms of meeting the enrollment deadline, typically, the study indication and availability of the patient’s population at the geographical area of the research site would decide if the trial could be time-consuming. Patient recruitment and retention are critical for the success of every clinical trial;however, worldwide, this area is facing tremendous pressure and challenges. Globally 55% of clinical trials terminated due to low recruitment, with an average enrollment success rate of 40% for Phase III and IV trials. Over 80% of clinical trial attempts fail to enroll, extending the study and adding new study sites. In the United States, more than 80% of clinical trials fail to achieve targeted patient enrollment, and 30% of study participants discontinue participation. This article reviewed various factors hindering clinical trial recruitment and retention and suggested strategies to make the research site successful.

Incidence,characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection

BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.

Exploring the Attractiveness of Companies Branding D&I to Potential Employees in Online Recruitment

Concrete action on diversity and inclusion(D&I)is critical to companies’value creation and brand.Companies that intentionally fail to attract and retain a diverse talent pool will struggle to innovate,compete,and prosper.The advantages of a diverse and inclusive workplace include the reduction of homogenous thinking and an increase in novel ideas and perspectives due to the wealth of talent from diverse backgrounds.Previous studies have focused on the benefits of corporate D&I from a corporate perspective;however,there is scant research on the impact of corporate D&I from employees’perspectives.Resultingly,this study,through an online questionnaire,proposes to examine the impact of employer brand D&I on potential employees in online recruitment channels from the perspective of potential employees.The study results indicate that most Chinese companies still exhibit low levels of D&I during recruitment.This study also included an empirical analysis of 267 valid samples,which showed that:(1)the D&I of employer brand perceptions positively impact job search intentions,behaviour,and decision making.(2)Companies’D&I has the most significant influence on job seekers’decision making,followed by behavioural influence and cognitive influence.(3)The type of job seeker plays a moderating role in the relationship between employer brand perception and job search intention,behaviour,and decision making.(4)Online recruitment’s increasing popularity amplifies employer branding’s effect.Based on the findings,this study suggests how companies can use D&I branding strategies to attract quality talent and increase job seekers’job search intentions.

The Effectiveness of Psychotherapy on Posttraumatic Stress Disorder in Soldier:A Systematic Review

The objective of this systematic review is to examine the effectiveness of psychotherapy in treating Post-Traumatic Stress Disorder(PTSD)in military personnel.PubMed,Web of Science,The Cochrane Library,EBSCO and CNKI databases were searched from 1 January,2000 to November 2022 for Randomized Controlled Trials(RCTs)on psychotherapeutic interventions for military PTSD.The physical Therapy Evidence Database(PEDro)scale was used to evaluate the quality of the literature.Two researchers conducted literature screening,data extraction,and risk bias assessment in accordance with inclusion and exclusion criteria.Ultimately,49 RCTs were included,involving a total of 5073 veterans,retired and active military from four countries.The average score on the PEDro scale was 7.60.The primary psychotherapeutic modalities for military PTSD intervention include Cognitive-Behavioral Therapy,Exposure Therapy,Mindfulness interventions,psychotherapy based on new technological tools,and other emerging psychotherapeutic tools.The review highlights that Cognitive Processing Therapy(CPT)and Prolonged Exposure Therapy(PET)stand out as the primary psychotherapeutic modalities for treating PTSD in military personnel.In cases where CPT and PET yield limited benefits,Mindfulness interventions emerge as effective alternatives.Moreover,considering the diverse needs and high dropout rates in the military,population,the review suggests using web-based,computer,and virtual reality technology tools as supplements to first-line treatments(CPT/PET)to enhance overall intervention effectiveness.For the advancement of future psychotherapeutic initiatives,there is a pronounced emphasis on prioritizing proven first-line interventions,CPT and PET while also recognizing the potential of mindfulness-based interventions as credible alternatives.In tandem with this,the active integration of technological tools is advocated to amplify the therapeutic impact of conventional psychological treatment modalities.

Trauma in The Lonely Soldier

Benedict is an award-winning novelist and non-fiction writer specializing in social injustice.Her non-fiction book The Lonely Soldier reflects the impact of war on violence against women.Female soldiers are always the victims of violence,before,during,and after serving in the Iraq War.This thesis aims to explore their trauma and illuminate the book’s meaning.

A potential source of recruitment of Acartia pacifica nauplii: viable benthic resting eggs

Many estuarine and coastal planktonic copepods depend on the hatching of benthic resting eggs for recruitment of nauplii to the water column population. The distribution and abundance of viable resting eggs of Acartia pacifica in the Xiamen Bay were determined by the presence of nauplii in the laboratory. The number of viable eggs var/ed temporally and spatially. The maximum number (9.2×10^4m^-2) of viable eggs was in summer. In spring the average abundance of viable eggs was 5.6×10^4 m^-2. The abundances of viable eggs in fall and winter were similar, respectively 2.7×10^4 and 3.3×10^4m^-2, which were the lowest in the year. The numbers of viable eggs inside the stations of the Xiamen Bay were higher than those outside the stations. The viable eggs were found at all depths (0-10 cm),although not in every station. The maximum number did not necessarily occur in the uppermost centimeter of the sediments but often occurred several centimeters below the water-sediment interface. The accumulation of viable eggs in the seabed of a subtropical bay constitutes a potential source of recruitment of nauplii into the pelagic population.

Reduction of recruitment of Acartia pacifica nauplii from benthic resting eggs due to organochlorine pesticides

Many estuarine and coastal planktonic copepods depend on the hatching of benthic resting eggs for recruitment ofnauplii to the water column population. The potential effects of two organochlorine pesticides, hexchloriobinzene （HCH） and dichlorodiphenyltrichloroethane （DDT）, on the recruitment of A ccu＇tla pacifica nauplii from benthic resting eggs in the seabed of Xiamen Bay were experimentally investigated. The abundance of A. pacifica nauplii hatched from the sediment significantly decreased with the increase of pesticide concentration. Trimmed Spearman-Karber analysis gave sediment 96-h LC50 values were 84.81 ng/g for HCH, and 157.94 ng/g for DDT. The median AI （Al50） was -0.77, which suggested that the combined effect of riCH and DDT showed a weak effect than individual effects. There was a positive relationship between mortality and exposure time in DDT treatment, while the relationship was not significant in HCH treatment. The results suggest that organochlorine pesticides can reduce recruitment of A. pacifica nauplii from benthic resting eggs to planktonic population.

Recruitment maneuvers in acute respiratory distress syndrome: The safe way is the best way

Acute respiratory distress syndrome(ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers(RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange(functional recruitment). However, the reopening process could lead to vascular compression, which can be associated with overinflation, and gas exchange may not improve as expected(anatomical recruitment). The purpose of this review was to discuss the effects of different RM strategies- sustained inflation, intermittent sighs, and stepwise increases of positive end-expiratory pressure(PEEP) and/or airway inspiratory pressure- on the following parameters: hemodynamics, oxygenation, barotrauma episodes, and lung recruitability through physiological variables and imaging techniques. RMs and PEEP titration are interdependent events for the success of ventilatory management. PEEP should be adjusted on the basis of respiratory system mechanics and oxygenation. Recent systematic reviews and meta-analyses suggest that RMs are associated with lower mortality in patients with ARDS. However, the optimal RM method(i.e., that providing the best balance of benefit and harm) and the effects of RMs on clinical outcome are still under discussion, and further evidence is needed.

Ichthyoplankton recruitment from mainstream of the Changjiang River into the Dongting Lake, the second largest freshwater lake in China

Floodplains are important and distinctive ecosystems around the world,and the recruitment of ichthyoplankton from river to floodplain lakes is crucial to maintain this unique ecosystem.However,this process has not been well documented.In this study,ichthyoplankton were sampled to investigate the details of ichthyoplankton recruitment from the Changjiang(Yangtze)River to the Dongting Lake via a floodway channel,the Songzi River,from May to July in 2013 and 2014.During the study period,41 species of eggs and larvae were sampled.Among the samples,16 were river-lake migratory species(RL),representing 23.5%of the species in the Dongting Lake.In 2013,an estimated 130 million eggs and 3180 million larvae drifted through the sampling section,and in 2014,an estimated 1 060 million eggs and 1040 million larvae drifted through the sampling section.The amount of eggs and larvae of RL reached 3 210 million in 2013 and 1 850 million in 2014,respectively.These results demonstrated the importance of ichthyoplankton recruitment from the river to the lake,as species diversity will decrease sharply without this recruitment.Canonical correspondence analysis(CCA)showed that water temperature and water flow are the two most important factors influencing the spawning activities of fish.To maintain the high fish diversity in the Changjiang floodplain,we suggest to irrigate the channel to increase water discharge and increase the transport of ichthyoplankton from the Changjiang mainstream into the Dongting Lake.

A recruitment forecasting model for the Pacific stock of the Japanese sardine (<i>Sardinops melanostictus</i>) that does not assume density-dependent effects

This study developed a recruitment forecasting model based on a new concept of the stock recruitment relationship. No density-dependent effect in the relationship was assumed in the model, which showed that fluctuations in recruitment and spawning stock biomass of Japanese sardine in the northwestern Pacific can be explained mainly by environmental factors and the effects of fishing. The February Arctic Oscillation (AO) and sea surface temperature over the southern area of the Kuroshio Extension (30 - 35°N and 145 - 180°E;KEST) were used as the environmental factors. The recruitment forecasting model is proposed: The values for recruitment (), spawning stock biomass, (), in year t, forecast by this model accurately reproduced those estimated by tuning virtual population analysis (VPA), and the pattern of variability in the stock recruitment relationship was also reproduced well. In conclusion, a density-dependent effect does not necessarily have to be included to explain the large variations in recruitment and the spawning stock biomass of the Japanese sardine.

Limitations on the recruitment of the rare sand shrubby legume Eremosparton songoricum(Fabaceae) in Gurbantunggut Desert,China

Eremosparton songoricum,a rare and endemic sand dune plant,appears to be experiencing recruitment failure.The structure of five populations from the Gurbantunggut Desert,China,was investigated for recruitment patterns,and two of them were examined for flowering,pollination and seed germination limits on regeneration.The results showed that total 150 seedlings only occurred on line transects in riverside Dure population,but they all died half a month later;no seedlings occurred in other four hinterland desert populations indicating recruitment was a failure at all populations although flowers were plentiful.Reproductive success depends on pollinators.Nectar is ＇reward＇ for pollinators,with 0.06 μL-0.12 μL and 0.15 μL-0.35 μL per flower in Dure and Kabu populations,respectively,in continuously two secreting days.Spontaneous self pollination is rare with nearly zero fruit production.Geitonogamous self pollination is predominant with 14.47% fruit set.Seed mass in the riverside Dure population was significantly greater than that in other hinterland desert populations.Consequently,the Dure population exhibited a significantly higher germination rate（about 90%） than those in other populations（about 30%）.Results suggested that recruitment failure of E.songoricum is not due to flower shortage,pollination limitation,or poor seed germination but environmental pressure and/or human disturbance.

Syncope as a health risk for soldiers: Influence of medical history and clinical findings on the sensitivity of head-up tilt table testing

Background: Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography(ECG) abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.Methods: Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation. Results: Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the ECG patterns of patients showing syncope during tilt table testing.Conclusions: Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.

Recruitment of older adults into randomized controlled trials:Issues and lessons learned from two community-based exercise interventions in Shanghai

Background: With the increasing need for high-quality exercise interventions in China, relatively little is known about issues and challenges related to recruitment of older Chinese adults into exercise-based disease prevention interventions. This study aims to describe the recruitment process and outcomes of 2 exercise interventions conducted in Shanghai, China.Methods: Recruitment information was ascertained from 2 community-based randomized controlled trials for 2 exercise interventions, the first designed to improve health outcomes for older women with knee osteoarthritis and the second to study changes in cognitive function in adults with mild cognitive impairment. Results were summarized in terms of recruitment sources, number screened, screening-to-enrollment ratios, and costs.Results: Recruitment was primarily achieved through working with local residential divisions(i.e., neighborhood associations and residential committees). Both studies achieved their planned target number of older adults(45 and 46, respectively) within a 1-year time frame, with a screening-to-randomized ratio of 5:1 and demonstrated excellent retention rates(range 87%–93%) at 6 months. The recruitment cost for the 2studies averaged RMB 189(about USD 30) per initial recruit and RMB 738(about USD 119) per participant randomized. Some major issues encountered during the recruitment process included(1) the use of community neighborhoods to support the conduct of the projects,(2) access to participants, and(3) feasibility.Conclusion: Analysis of the 2 randomized controlled trials has provided valuable insights into the recruitment process and identified resources that can help better planning and recruitment for future interventions. Recommendations aimed at increasing the success of future recruitment efforts are provided.

Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome

BACKGROUND：Animal experiments showed that recruitment maneuver （RM） and protective ventilation strategy of the lung could improve oxygenation and reduce extravascular lung water. This study was to investigate the effects of RM on respiratory mechanics and extravascular lung water index （EVLWI） in patients with acute respiratory distress syndrome （ARDS）. METHODS：Thirty patients with ARDS were randomized into a RM group and a non-RM group. In the RM group, after basic mechanical ventilation stabilized for 30 minutes, RM was performed and repeated once every 12 hours for 3 days. In the non-RM group, lung protective strategy was conducted without RM. Oxygenation index （PaO2/FiO2）, peak inspiratory pressure （PIP）, Plateau pressure （Pplat）, static pulmonary compliance （Cst） and EVLWI of patients before treatment and at 12, 24, 48, 72 hours after the treatment were measured and compared between the groups. Hemodynamic changes were observed before and after RM. One-way ANOVA, Student＇s t test and Fisher＇s exact test were used to process the data. RESULTS：The levels of PaO2/FiO2 and Cst increased after treatment in the two groups, but they were higher in the RM group than in the non-RM group （P〈0.05）. The PIP and Pplat decreased after treatment in the two groups, but they were lower in the RM group than in the non-RM group （P〈0.05）. The EVLWI in the two groups showed downward trend after treatment （P〈0.05）, and the differences were signifcant at all time points （P〈0.01）; the EVLWI in the RM group was lower than that in the non-RM group at 12, 24, 48 and 72 hours （P〈0.05 or P〈0.01）. Compared with pre-RM, hemodynamics changes during RM were significantly different （P〈0.01）; compared with pre-RM, the changes were not significantly different at 120 seconds after the end of RM （P〉0.05）. CONCLUSIONS： RM could reduce EVLWI, increase oxygenation and lung compliance. The effect of RM on hemodynamics was transient.

An Intelligent Model for Online Recruitment Fraud Detection

This study research attempts to prohibit privacy and loss of money for individuals and organization by creating a reliable model which can detect the fraud exposure in the online recruitment environments. This research presents a major contribution represented in a reliable detection model using ensemble approach based on Random forest classifier to detect Online Recruitment Fraud (ORF). The detection of Online Recruitment Fraud is characterized by other types of electronic fraud detection by its modern and the scarcity of studies on this concept. The researcher proposed the detection model to achieve the objectives of this study. For feature selection, support vector machine method is used and for classification and detection, ensemble classifier using Random Forest is employed. A freely available dataset called Employment Scam Aegean Dataset (EMSCAD) is used to apply the model. Pre-processing step had been applied before the selection and classification adoptions. The results showed an obtained accuracy of 97.41%. Further, the findings presented the main features and important factors in detection purpose include having a company profile feature, having a company logo feature and an industry feature.

Model for stock-recruitment dynamics of the Peruvian anchoveta (<i>Eugraulis ringens</i>) off Peru

This paper was aimed at re-examining the validity of the results from Cahuin et al. (Estuar. Coast. Shelf Sci. 84, 2009) and identifying a model to describe the stock-recruitment relationship of the Peruvian anchoveta (Eugraulis ringens). Regression analysis was used to determine if density-dependent effects were present. The analysis did not show the existence of any densitydependent effects. It is important to use environmental factors and take observational and process errors into account when attempting to identify density-dependent effects in fish populations. Sea surface temperature (SST) and Southern Oscillation Index (SOI) were used as independent variables to fit the recruitment dynamics of the anchoveta. Both SST and SOI were found to be significantly important parameters in structuring anchoveta dynamics according to Akaike Information Criterion (AIC) and R2 values. The results of this study do not correlate with the findings of Cahuin et al., (2009), where density-dependent effects and the presence of regimes were detected. In conclusion, the recruitment Rt is essentially determined in proportion to spawning stock biomass St, and then environmental factors in year t further change the recruitments. This mechanism is completely same with that for Japanese sardine proposed by Sakuramoto (The Open Fish. Sci. 5, 2012).

Effect of protective lung ventilation strategy combined with lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS)

Objective:To evaluate the efficacy and safety of protective lung ventilation strategy combined with lung recruitment maneuver (RM) in the treatment patients with acute respiratory distress syndrome (ARDS).Methods:Totally 74 patients with ARDS admitted to the Department of Intensive Care Unit, Changshu Second People's Hospital in Jiangsu Province between September 2010 and June 2013 were selected and randomly divided into lung recruitment group and non-lung recruitment group, and the initial ventilation solution for both groups was synchronized intermittent mandatory ventilation (SIMV). For RM, SIMV mode (pressure control and pressure support) was adopted. Positive end expiratory pressure (PEEP) was increased by 5 cm H2O every time and maintained for 40-50 s before entering the next increasing period, and the peak airway pressure was kept below 45 cm H2O. After PEEP reached the maximum value, it was gradually reduced by 5 cm H2O every time and finally maintained at 15 cm H2O for 10 min.Results:A total of 74 patients with mean age of (49.0±18.6) years old were enrolled, 36 patients were enrolled in lung recruitment maneuver (RM) group and 38 patients were enrolled into non-lung recruitment maneuver (non-RM) group. 44 were male and accounted for 59.5% of all the patients. For the indicators such as PEEP, pressure support (PS), plateau airway pressure (Pplat), peak airway pressure (Ppeak), vital capacity (VC) and fraction of inspired oxygen (FiO2), no statistical differences in the indicators were found between the RM group and non-RM group on D1, D3 and D7 (P>0.05), except that only FiO2 of RM group on D7 was significantly lower than that of non-RM group (47.2±10.0) vs. (52.2±10.5),P<0.05]. For the indicators of blood gas analysis, including pH, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2) and oxygenation index (PaO2/FiO2), PaO2 and PaO2/FiO2 of RM group were significantly higher than those of non-RM group on D7, and the values were [(90.2±16.1) mmHg vs. (76.4±11.3) mmHg,P<0.05] and [(196.5±40.7) mmHg vs. (151.7±37.3) mmHg,P<0.05] respectively. There was no statistical difference in heart rate (HR), cardiac index (CI), central venous pressure (CVP) or mean arterial pressure (MAP) between RM group and non-RM group on D1, D3 and D7 (P>0.05). 28-day mortality, ICU mortality and in-hospital mortality were 25% vs. 28.9%, 25% vs. 26.3% and 36.1% vs. 39.5% respectively between RM group and non-RM group (allP>0.05).Conclusion:Protective lung ventilation strategy combined with lung recruitment maneuver can improve the indicators such as PaO2, FiO2 and PaO2/FiO2 on D7, but failed to improve the final outcomes such as 28-day mortality, ICU mortality and in-hospital mortality.

Controls of seed quantity and quality on seedling recruitment of smith fir along altitudinal gradient in southeastern Tibetan Plateau

Alpine treeline ecotones are harsh environment for tree establishment due to low temperature. Tree establishment at treelines requires favorable climate, suitable microsites, and viable seeds. But most researches have been addressed treeline microclimate and its effects on tree regeneration, the knowledge of seed quantity and quality and its controls on seedling recruitment were limited. We measured seed rain, soil seed bank, seed germination rate and seedling recruitment in natural forests in combination with seed transplanting manipulation to evaluate the controls of seed quantity and quality on seedling recruitment of Abies georgei var. smithii （smith fir） along altitudinal gradient, with focus on treeline ecotone in the Sygera Mountains, southeastern Tibetan Plateau. Both seed quantity and seed quality of smith fir decreased with increasing altitude and was thereby associated with decline in seed germination rate. Seed quantity and seedling recruitment were better in north-facing slope than in south slope. The treeline ecotone above 42oo m appeared as the threshold altitude to sharply decrease seed quality and seedling recruitment. The emergence and overwintering rates of transplanting seeds from 3600-38oo m also went down remarkably above 4200 m at north-facing slope. It also underpins the fact that treeline ecotone is the bottleneck of seedling recruitment. Our results suggest that seed quantity and quality are the principal limitation of treeline upward advance. This study also provides evidence to support stable treeline position in southeastern Tibetan Plateau.