Tilting homeostatic and dyshomeostatic microglial balance in health and disease:transforming growth factor-beta1 as a critical protagonist

Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS),microglia display a unique molecular homeostatic signature(i.e.,Tmem119,P2ry12,Sall1,Siglech,Gpr34,and Hexb)(Figure 1A).

Unlocking hypoglycemia–associated brain microvascular dysfunction:critical insights from proteomic analysis

Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.

Deep eutectic solvents for separation and purification applications in critical metal metallurgy:Recent advances and perspectives

Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and flammability,causing a spectrum of hazards to human health and environmental safety.Neoteric solvents have been recognized as potential alternatives to these harmful organic solvents.In the past two decades,several neoteric solvents have been proposed,including ionic liquids(ILs)and deep eutectic solvents(DESs).DESs have gradually become the focus of green solvents owing to several advantages,namely,low toxicity,degradability,and low cost.In this critical review,their classification,formation mechanisms,preparation methods,characterization technologies,and special physicochemical properties based on the most recent advancements in research have been systematically described.Subsequently,the major separation and purification applications of DESs in critical metal metallurgy were comprehensively summarized.Finally,future opportunities and challenges of DESs were explored in the current research area.In conclusion,this review provides valuable insights for improving our overall understanding of DESs,and it holds important potential for expanding separation and purification applications in critical metal metallurgy.

Transient extreme insulin resistance in a critically ill patient:A case report

BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.

Forging an easier path through graduation:Improving the patient transition from paediatric to adult critical care

Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.

Effect of dietary fibre on the gastrointestinal microbiota during critical illness:A scoping review

The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly recognised.Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promise.While changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain uncertain.Dietary fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI microbiota.The aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical illness.Randomised controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were identified.Studies show dietary fibres have an impact on faecal microbiota in health and disease.The fibre,inulin,has a marked and specific effect on increasing the abundance of faecal Bifidobacteria.Short chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient populations.Very few trials have evaluated the effect of dietary fibre on the GI microbiota during critical illness.More research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.

面向Critical MTC的无连接传输

关键机器类通信(Critical MTC)对时延和可靠性都有极高的要求。支持海量Critical MTC的终端是一个巨大挑战。提出了一种面向海量Critical MTC终端的无连接传输方案。为了降低时延,提出了基于竞争的无连接单次传输方案;为了实现高可靠性,设计了具有极低导频碰撞概率的稀疏正交多导频。进一步利用大规模多输入多输出(MIMO)的增益来提高可靠性以及在空域复用大量用户。仿真结果表明,提出的方案可以支持海量Critical MTC终端,同时满足低时延和高可靠的严格要求。

Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia:A 6-month follow-up questionnaire study

BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.

Critical Solvation Structures Arrested Active Molecules for Reversible Zn Electrochemistry

Aqueous Zn-ion batteries(AZIBs)have attracted increasing attention in next-generation energy storage systems due to their high safety and economic.Unfortunately,the side reactions,dendrites and hydrogen evolution effects at the zinc anode interface in aqueous electrolytes seriously hinder the application of aqueous zinc-ion batteries.Here,we report a critical solvation strategy to achieve reversible zinc electrochemistry by introducing a small polar molecule acetonitrile to form a“catcher”to arrest active molecules(bound water molecules).The stable solvation structure of[Zn(H_(2)O)_(6)]^(2+)is capable of maintaining and completely inhibiting free water molecules.When[Zn(H_(2)O)_(6)]^(2+)is partially desolvated in the Helmholtz outer layer,the separated active molecules will be arrested by the“catcher”formed by the strong hydrogen bond N-H bond,ensuring the stable desolvation of Zn^(2+).The Zn||Zn symmetric battery can stably cycle for 2250 h at 1 mAh cm^(-2),Zn||V_(6)O_(13) full battery achieved a capacity retention rate of 99.2%after 10,000 cycles at 10 A g^(-1).This paper proposes a novel critical solvation strategy that paves the route for the construction of high-performance AZIBs.

Semi-analytical solution for drained expansion analysis of a hollow cylinder of critical state soils

The expansion of a thick-walled hollow cylinder in soil is of non-self-similar nature that the stress/deformation paths are not the same for different soil material points.As a result,this problem cannot be solved by the common self-similar-based similarity techniques.This paper proposes a novel,exact solution for rigorous drained expansion analysis of a hollow cylinder of critical state soils.Considering stress-dependent elastic moduli of soils,new analytical stress and displacement solutions for the nonself-similar problem are developed taking the small strain assumption in the elastic zone.In the plastic zone,the cavity expansion response is formulated into a set of first-order partial differential equations(PDEs)with the combination use of Eulerian and Lagrangian descriptions,and a novel solution algorithm is developed to efficiently solve this complex boundary value problem.The solution is presented in a general form and thus can be useful for a wide range of soils.With the new solution,the non-self-similar nature induced by the finite outer boundary is clearly demonstrated and highlighted,which is found to be greatly different to the behaviour of cavity expansion in infinite soil mass.The present solution may serve as a benchmark for verifying the performance of advanced numerical techniques with critical state soil models and be used to capture the finite boundary effect for pressuremeter tests in small-sized calibration chambers.

Dosage and utilization of dexamethasone in the management of COVID-19: A critical review

BACKGROUND The severe respiratory manifestations observed in severe coronavirus disease 2019(COVID-19)cases are often associated with an excessive inflammatory response.Dexamethasone,a synthetic glucocorticoid,exerts its anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes and suppressing the activity of various immune cells.This mechanism has implications for mitigating the cytokine storm observed in severe COVID-19 cases.Early on in the pandemic,the Recovery Collaborative working group showed a mortality benefit of using dexamethasone in decreasing mortality in patients with COVID-19 requiring respiratory support.However,the optimal dosage of corticosteroids remains debatable.Several studies that compare different doses of dexamethasone in COVID-19 exist,but the results are conflicting.AIM To review the latest evidence regarding dosage,safety,and efficacy of dexamethasone in severe COVID-19.METHODS We followed preferred reporting items for systematic reviews and meta-analysis guidelines.A detailed literature search was conducted across PubMed,Google Scholar,and Medline to include publications up to March 2024.Our keywords included“COVID-19”“SARS-CoV-2”“dexamethasone”“corticosteroid”“steroid”and“glucocorticoid”-along with their combinations.We employed the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale to evaluate the integrity and potential of bias in the included studies.A meta-analysis was conducted using a random-effects model,assessing pooled odds ratios and mean differences,with heterogeneity gauged by the I2 statistic and theχ^(2) tests.RESULTS No statistical differences were found in 28-day all-cause mortality[pooled odds ratio(OR)=1.109,95%CI:0.918-1.340],60-day all-cause mortality(OR=0.873,95%CI:0.744-1.024;I2=47.29%),mean length of hospital stay(mean difference=-0.08 days,95%CI:-0.001 to 0.161)and adverse events(OR=0.877,95%CI:0.707-1.087).CONCLUSION Differing doses of corticosteroids have no clinical implications on mortality,mean length of hospital stay,and adverse events in COVID-19 patients.Additional research is required in patients requiring invasive or noninvasive ventilation.

Enhancing Critical Path Problem in Neutrosophic Environment Using Python

In the real world,one of the most common problems in project management is the unpredictability of resources and timelines.An efficient way to resolve uncertainty problems and overcome such obstacles is through an extended fuzzy approach,often known as neutrosophic logic.Our rigorous proposed model has led to the creation of an advanced technique for computing the triangular single-valued neutrosophic number.This innovative approach evaluates the inherent uncertainty in project durations of the planning phase,which enhances the potential significance of the decision-making process in the project.Our proposed method,for the first time in the neutrosophic set literature,not only solves existing problems but also introduces a new set of problems not yet explored in previous research.A comparative study using Python programming was conducted to examine the effectiveness of responsive and adaptive planning,as well as their differences from other existing models such as the classical critical path problem and the fuzzy critical path problem.The study highlights the use of neutrosophic logic in handling complex projects by illustrating an innovative dynamic programming framework that is robust and flexible,according to the derived results,and sets the stage for future discussions on its scalability and application across different industries.

Predicted Critical State Based on Invariance of the Lyapunov Exponent in Dual Spaces

Critical states in disordered systems,fascinating and subtle eigenstates,have attracted a lot of research interests.However,the nature of critical states is difficult to describe quantitatively,and in general,it cannot predict a system that hosts the critical state.We propose an explicit criterion whereby the Lyapunov exponent of the critical state should be 0 simultaneously in dual spaces,namely the Lyapunov exponent remains invariant under the Fourier transform.With this criterion,we can exactly predict a one-dimensional quasiperiodic model which is not of self-duality,but hosts a large number of critical states.Then,we perform numerical verification of the theoretical prediction and display the self-similarity of the critical state.Due to computational complexity,calculations are not performed for higher dimensional models.However,since the description of extended and localized states by the Lyapunov exponent is universal and dimensionless,utilizing the Lyapunov exponent of dual spaces to describe critical states should also be universal.Finally,we conjecture that some kind of connection exists between the invariance of the Lyapunov exponent and conformal invariance,which can promote the research of critical phenomena.

Fermionic Critical Fluctuations: Potential Driver of Strange Metallicity and Violation of the Wiedemann-Franz Law in YbRh_(2)Si_(2)

Results of combined thermal and electrical transport measurements through the magnetic field-induced quantum critical point(QCP)in the heavy-fermion compound YbRh_(2)Si_(2) were revisited to explore the relationship between the strange-metal behavior observed in electrical and electronic thermal resistivities and the violation of the Wiedemann-Franz(WF)law in the zero-temperature limit.A new type of inelastic scattering center for the charge and heat carriers was detected,attributed to small-to-large Fermi surface fluctuations operating near the Kondo-destroying QCP.These fermionic quantum critical fluctuations are considered the primary driver of the strange-metal behavior and the violation of the WF law.

Anisotropic s-Wave Gap in the Vicinity of a Quantum Critical Point in Superconducting BaFe_(2)(As_(1-x)P_(x))_(2) Single Crystals:A Study of Point-Contact Spectroscopy

We report on soft c-axis point-contact Andreev reflection(PCAR)spectroscopy combining with resistivity measurements on BaFe_(2)(As_(0.7)P_(0.3))_(2),to elucidate the superconducting gap structure in the vicinity of the quantum critical point.A double peak at the gap edge plus a dip feature at zero-bias has been observed on the PCAR spectra,indicative of the presence of a nodeless gap in BaFe_(2)(As_(0.7)P_(0.3))_(2).Detailed analysis within a sophisticated theoretical model reveals an anisotropic gap with deep gap minima.The PCARs also feature additional structures related to the electron-bosonic coupling mode.Using the extracted superconducting energy gap value,a characteristic bosonic energy Ω_(b) and its temperature dependence are obtained,comparable with the spin-resonance energy observed in neutron scattering experiment.These results indicate a magnetism-driven quantum critical point in the BaFe_(2)(As_(1-x)P_(x))_(2) system.

Engineering Quantum Criticality for Quantum Dot Power Harvesting

Coupling of quantum-dot circuits to microwave photons enables us to investigate photon-assisted quantum transport.Here,we revisit this typical circuit quantum electrodynamical setup by introducing the Kerr nonlinearity of photons.By exploiting quantum critical behavior,we propose a powerful scheme to control the power-harvesting efficiency in the microwave regime,where the driven-dissipative optical system acts as an energy pump.It drives electron transport against a load in the quantum-dot circuit.The energy transfer and,consequently,the harvesting efficiency are enhanced near the critical point.As the critical point moves towards to low input power,high efficiency within experimental parameters is achieved.Our results complement fundamental studies of photon-to-electron conversion at the nanoscale and provide practical guidance for designs of integrated photoelectric devices through quantum criticality.

Characterization of bright betatron radiation generated by direct laser acceleration of electrons in plasma of near critical density

Directed x-rays produced in the interaction of sub-picosecond laser pulses of moderate relativistic intensity with plasma of near-critical density are investigated. Synchrotron-like (betatron) radiation occurs in the process of direct laser acceleration (DLA) of electrons in a relativisticlaser channel when the electrons undergo transverse betatron oscillations in self-generated quasi-static electric and magnetic fields. In anexperiment at the PHELIX laser system, high-current directed beams of DLA electrons with a mean energy ten times higher than the ponderomotive potential and maximum energy up to 100 MeV were measured at 10^(19) W/cm^(2)laser intensity. The spectrum of directed x-raysin the range of 5–60 keV was evaluated using two sets of Ross filters placed at 0°and 10°to the laser pulse propagation axis. The differential x-ray absorption method allowed for absolute measurements of the angular-dependent photon fluence. We report 10^(13) photons/sr withenergies >5 keV measured at 0°to the laser axis and a brilliance of 10^(21) photons s^(−1) mm^(−2) mrad−2(0.1%BW)−1. The angular distributionof the emission has an FWHM of 14°–16°. Thanks to the ultra-high photon fluence, point-like radiation source, and ultra-short emissiontime, DLA-based keV backlighters are promising for various applications in high-energy-density research with kilojoule petawatt-class laserfacilities.

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Exploring Critical Thinking Dispositions among Fourth Year BSc Nursing Students of Various Colleges of Nursing, Pakistan

Background: Critical Thinking (CT) dispositions in nursing are prominent predictors of competence in delivering high-quality care, and of professionalism, in newly graduated nurses. CT skills, in isolation of CT dispositions, do not guarantee success in the workplace, because Critical Thinking Dispositions (CTD) are important elements of intellectual reasoning that simulate a person towards using the CT skills. Therefore, nursing educational programs should promote lifelong learning rather than focusing on transferring the content of nursing knowledge only. And for this purpose, quality education is the key. Education should focus on teaching from diverse perspectives, incorporating various teaching learning strategies that are congruent with the modern era. Purpose: The purpose of this study is to explore critical thinking dispositions among final year Baccalaureate Nursing students of various military colleges of nursing, in Pakistan. Methodology: A descriptive qualitative exploratory study design was used to investigate the CTD of BSc final year nursing students. The study population included twelve willing nursing students, from six military colleges across the country. Demographic information and consent was taken from the participants of the study. In-depth interviews, through a semi structured interview guide, and probes were used to obtain data related to personal experiences of CTD amongst the nursing students. Results: Data analysis showed two broad themes: 1) Perceptions of CT, and 2) Experiences of CT dispositions. In theme one, the emerging category was: Clarity of CT;whereas in theme two, the categories that emerged were: a) Truth Seeking, b) Open Mindedness, c) Inquisitiveness, and d) Self Organization. Conclusion: The findings of the study revealed positive dispositions towards truth seeking, open mindedness, and self-organization, whereas disposition towards inquisitiveness was weak. Self-confidence and maturity also emerged as positive factors that the students possessed. This study recommends that faculty and learners should extend their concept of CTD, and emphasizes its application in daily routine. Additionally, faculty should modify their instructional strategies and focus on the cultivation of dispositions of inquisitiveness, curiosity, and allow questioning by students in the class.

BILL Strategy:Points to Consider During the Performance and Interpretation of Critical Care Echocardiography

The growing utilization of critical care echocardiography(CCE) by clinicians necessitates a meticulous review of clinical conditions in critically ill patients, both before and during the examination. The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings. This article proposes a comprehensive strategy, namely BILL strategy, to integrate into the CCE protocol, where "B" represents baseline respiratory and hemodynamic support, "I" signifies information gleaned from invasive monitoring, including central venous pressure and thermodilution-derived cardiac output, the first "L" denotes laboratory results such as central venous oxygen saturation, troponin, and brain natriuretic peptide, and the second "L" refers to lung ultrasound data. Combining the BILL strategy with CCE can enhance comprehensive understanding of critical conditions, potentially leading to improved diagnostic accuracy and patient outcomes.