Journal PLOS ONE-
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231378
Protocols for “Enhanced recovery after surgery (ERAS)” are on the rise in different surgical disciplines and represent one of the most important recent advancements in perioperative medical care. In cardiac surgery, only few ERAS protocols have been described in the past. At University Heart Center Hamburg, Germany, we invented an ERAS protocol for patients undergoing minimally invasive cardiac valve surgery. In this retrospective single center study, we aimed to describe the implementation of our ERAS program and to evaluate the results of the first 50 consecutive patients. Our ERAS protocol was developed according to a modified Kern cycle by an expert group, literature search, protocol creation and pilot implementation in the clinical practice. Data of the first 50 consecutive patients undergoing minimally invasive cardiac valve surgery were analysed retrospectively. The key features of our multidisciplinary ERAS protocol are physiotherapeutic prehabilitation, minimally invasive valve surgery techniques, modified cardiopulmonary bypass management, fast-track anaesthesia with on- table extubation and early mobilisation. A total of 50 consecutive patients (mean age of 51.9±11.9 years, mean STS score of 0.6±0.3) underwent minimally-invasive mitral or aortic valve surgery. The adherence to the ERAS protocol was high and neither protocol related complications nor in-hospital mortality occurred. 12% of the patients developed postoperative atrial fibrillation, postoperative delirium emerged in two patients and reintubation was required in one patient. Intensive care unit stay was 14.0±7.4 hours and total hospital stay 6.2±2.9 days. Our ERAS protocol is feasible and safe in minimally-invasive cardiac surgery setting and has a clear potential to improve patients outcome.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0230853
Variation of information in the firing rate of neural population, as reflected in different frequency bands of electroencephalographic (EEG) time series, provides direct evidence for change in neural responses of the brain to hypnotic suggestibility. However, realization of an effective biomarker for spiking behaviour of neural population proves to be an elusive subject matter with its impact evident in highly contrasting results in the literature. In this article, we took an information-theoretic stance on analysis of the EEG time series of the brain activity during hypnotic suggestions, thereby capturing the variability in pattern of brain neural activity in terms of its information content. For this purpose, we utilized differential entropy (DE, i.e., the average information content in a continuous time series) of theta, alpha, and beta frequency bands of fourteen-channel EEG time series recordings that pertain to the brain neural responses of twelve carefully selected high and low hypnotically suggestible individuals. Our results show that the higher hypnotic suggestibility is associated with a significantly lower variability in information content of theta, alpha, and beta frequencies. Moreover, they indicate that such a lower variability is accompanied by a significantly higher functional connectivity (FC, a measure of spatiotemporal synchronization) in the parietal and the parieto-occipital regions in the case of theta and alpha frequency bands and a non-significantly lower FC in the central region’s beta frequency band. Our results contribute to the field in two ways. First, they identify the applicability of DE as a unifying measure to reproduce the similar observations that are separately reported through adaptation of different hypnotic biomarkers in the literature. Second, they extend these previous findings that were based on neutral hypnosis (i.e., a hypnotic procedure that involves no specific suggestions other than those for becoming hypnotized) to the case of hypnotic suggestions, thereby identifying their presence as a potential signature of hypnotic experience.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231220
To investigate the longitudinal findings of spectral-domain optical coherence tomography (SD-OCT) in relation to the morphologic features in Rdh5 knockout (Rdh5-/-) mice. The mouse retina was segmented into four layers; the inner retinal (A), outer plexiform and outer nuclear (B), rod/cone (C), and retinal pigment epithelium (RPE)/choroid (D) layers. The thickness of each retinal layer of Rdh5-/- mice was longitudinally and quantitatively measured at six time points from postnatal months (PM) 1 to PM6 using SD-OCT. Age-matched C57BL/6J mice were employed as wild-type controls. The data were statistically compared using Student’s t-test. The fundus appearance was assessed, histologic and ultrastructural examinations were performed in both groups. Layers A and B were significantly thinner in the Rdh5-/- mice than in the wild-type C57BL/6J mice during the observation periods. Layers C and D became thinner in the Rdh5-/- mice than in the wild-type mice after PM6. Although no abnormalities corresponding to whitish fundus dots were detected by SD-OCT or histologic examinations, the intracellular accumulation of low-density vacuoles was noted in the RPE of the Rdh5-/- mice by electron microscopy. The photoreceptor nuclei appeared less dense in the Rdh5-/- mice than in the wild-type mice. The results from the present study suggest that although it is difficult to detect qualitative abnormalities, SD-OCT can detect quantitative changes in photoreceptors even in the early stage of retinal degeneration induced by the Rdh5 gene mutation in mice.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0230425
To determine parental awareness of influenza vaccination recommendations for children and explore associations with awareness. Cross-sectional survey. South Australian parents with a telephone listing in the Electronic White Pages were randomly selected. Participants were interviewed using Computer Assisted Telephone Interviewing (CATI) during May–July 2016. Univariable and multivariable analyses explored characteristics associated with awareness; with the survey data weighted to reflect the population of SA and the probability of selection within a household. Of 539 parents, 33% were aware of the recommendation that all children (<5 years) should receive the influenza vaccine annually with 51.9% aware that children with special risk medical conditions (SRMC) should also receive the vaccine annually. Characteristics strongly associated with parental awareness of the recommendation for children aged < 5 years were knowledge of recommendation for children with a SRMC (adjusted Odds Ratio [aOR] 10.46, CI 4.44–24.63) or living in a metropolitan area (aOR 2.91, CI 1.19–7.09). There was lack of awareness in those not working (aOR 0.13, CI 0.04–0.47), with trade level education (compared with high school) (aOR 0.25 CI, 0.09–0.71) and in those born in the UK or Ireland (aOR 0.19, CI 0.04–0.85). Awareness of the recommendation for children with SRMC to receive the vaccine was strongly associated with knowledge of the influenza recommendation for children <5 years (aOR 10.22, CI 4.39–23.77) or not being born in Australia [UK/ Ireland (aOR 7.63, CI 1.86–31.31); other (aOR 3.93, CI 0.94–16.42)]. The most influential cues to future receipt were a general practitioner (GP) recommendation (63.8%) and providing influenza vaccine free for all children (37.6%). More parents who delayed or excluded vaccines believed that their children’s vaccinations (in general) were unnecessary, as other children were vaccinated (42.8%) compared to those with no or minor concerns (11.1%) (p<0.0001). Parental awareness of children’s influenza vaccine recommendations is low. Targeted communication strategies and resources are required to establish broader community awareness of recommendations. Healthcare provider endorsement of the vaccine remains key and health care professionals, particularly GPs and paediatric specialists should be encouraged to discuss influenza vaccine with parents at every opportunity. Many parents have vaccine concerns and addressing concerns across the spectrum of hesitancy is crucial.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0230867
Economic, environmental, and social effects are the most dominating issues in cold chain logistics. The goal of this paper is to propose a cost-saving, energy-saving, and emission-reducing bi-objective model for the cold chain-based low-carbon location-routing problem. In the proposed model, the first objective (economic and environmental effects) is to minimize the total logistics costs consisting of costs of depots to open, renting vehicles, fuel consumption, and carbon emission, and the second one (social effect) is to reduce the damage of cargos, which could improve the client satisfaction. In the proposed model, a strategy is developed to meet the requirements of clients as to the demands on the types of cargos, that is, general cargos, refrigerated cargos, and frozen cargos. Since the proposed problem is NP-hard, we proposed a simple and efficient framework combining seven well-known multiobjective evolutionary algorithms (MOEAs). Furthermore, in the experiments, we first examined the effectiveness of the proposed framework by assessing the performance of seven MOEAs, and also verified the efficiency of the proposed model. Extensive experiments were carried out to investigate the effects of the proposed strategy and variants on depot capacity, hard time windows, and fleet composition on the performance indicators of Pareto fronts and cold chain logistics networks, such as fuel consumption, carbon emission, travel distance, travel time, and the total waiting time of vehicles.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231403
A flavone luteolin has various health-promoting activities. Several studies reported that high dose of luteolin activates the Nrf2/ARE pathway in the liver. However, the effect of the low dose of luteolin that can be taken from a dietary meal on the Nrf2 activation remain unclear. It is expected that the flavonoid metabolism possesses a circadian rhythm, since nutritional metabolism processes daily cycle. In this study we investigated whether an administration affects the Nrf2 activation. ICR mice were orally administered 0.01–10 mg/kg body weight of luteolin once a day for 7 days at two time-points: at the start of active phase (ZT12) or at that of inactive phase (ZT0). Luteolin increased the nuclear translocation of Nrf2, resulting in the increases in its target gene products HO-1 and NQO1 at ZT12 but not at ZT0. The expression level of Nrf2 was lower at ZT12 than at ZT0 in the liver. We also found that the level of luteolin aglycon in the plasma is higher at ZT12 than at ZT0. These results suggest that the low dose of luteolin can activate Nrf2 pathway and the aglycon form of luteolin may mainly contribute to activate the Nrf2 pathway at ZT12 in the liver.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231194
Various injuries to the neural tissues can cause irreversible damage to multiple functions of the nervous system ranging from motor control to cognitive function. The limited treatment options available for patients have led to extensive interest in studying the mechanisms of neuronal regeneration and recovery from injury. Since many neurons are terminally differentiated, by increasing cell survival following injury it may be possible to minimize the impact of these injuries and provide translational potential for treatment of neuronal diseases. While several cell types are known to survive injury through plasma membrane repair mechanisms, there has been little investigation of membrane repair in neurons and even fewer efforts to target membrane repair as a therapy in neurons. Studies from our laboratory group and others demonstrated that mitsugumin 53 (MG53), a muscle-enriched tripartite motif (TRIM) family protein also known as TRIM72, is an essential component of the cell membrane repair machinery in skeletal muscle. Interestingly, recombinant human MG53 (rhMG53) can be applied exogenously to increase membrane repair capacity both in vitro and in vivo. Increasing the membrane repair capacity of neurons could potentially minimize the death of these cells and affect the progression of various neuronal diseases. In this study we assess the therapeutic potential of rhMG53 to increase membrane repair in cultured neurons and in an in vivo mouse model of neurotrauma. We found that a robust repair response exists in various neuronal cells and that rhMG53 can increase neuronal membrane repair both in vitro and in vivo. These findings provide direct evidence of conserved membrane repair responses in neurons and that these repair mechanisms can be targeted as a potential therapeutic approach for neuronal injury.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231374
Because the sex difference in outcomes of fracture was incompletely understood, we evaluated the post-fracture complications and mortality of female and male patients. We conducted a nationwide study of 498,586 fracture patients who received inpatient care using Taiwan’s National Health Insurance Research Database 2008–2013 claims data. Female and male fracture patients were selected for comparison by using a propensity-score matching procedure. Age, low income, types of fracture, fracture with surgery, several medical conditions, number of hospitalization and emergency visits were considered as potential confounding factors. Multivariate logistic regressions were used to calculate the adjusted odds ratios (OR), the 95% CI of post-fracture complications and 30-day in-hospital mortality differences between women and men. Male patients had a higher risk of post-fracture pneumonia (OR 1.96, 95% CI 1.83–2.11), acute renal failure (OR 1.85, 95% CI 1.60–2.15), deep wound infection (OR 1.63, 95% CI 1.51–1.77), stroke (OR 1.58, 95% CI 1.49–1.67), septicemia (OR 1.51, 95% CI 1.42–1.61), acute myocardial infarction (OR 1.38, 95% CI 1.09–1.75) and 30-day in-hospital mortality (OR 1.69, 95% CI 1.48–1.93) compared with female patients. However, a lower risk of post-fracture urinary tract infection (OR 0.69, 95% CI 0.65–0.72) was found in men than in women. Male patients also had longer hospital stays and higher medical expenditures due to fracture admission than did the female patients. Higher rates of post-fracture adverse events in male patients were noted in all age groups and all types of fractures. We raised the possibility that male patients showed more complications and higher mortality rates after fracture admission compared with female patients, with the exception of urinary tract infections.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0230802
The recent emergence of bat-borne zoonotic viruses warrants vigilant surveillance in their natural hosts. Of particular concern is the family of coronaviruses, which includes the causative agents of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and most recently, Coronavirus Disease 2019 (COVID-19), an epidemic of acute respiratory illness originating from Wuhan, China in December 2019. Viral detection, discovery, and surveillance activities were undertaken in Myanmar to identify viruses in animals at high risk contact interfaces with people. Free-ranging bats were captured, and rectal and oral swabs and guano samples collected for coronaviral screening using broadly reactive consensus conventional polymerase chain reaction. Sequences from positives were compared to known coronaviruses. Three novel alphacoronaviruses, three novel betacoronaviruses, and one known alphacoronavirus previously identified in other southeast Asian countries were detected for the first time in bats in Myanmar. Ongoing land use change remains a prominent driver of zoonotic disease emergence in Myanmar, bringing humans into ever closer contact with wildlife, and justifying continued surveillance and vigilance at broad scales.
PLOS ONE, Volume 15; doi:10.1371/journal.pone.0231347
Mineral building materials are porous materials. The volume of pores connected is the active volume of pores or the effective volume. The volume of all pores is the total volume of the pores. The properties of the individual pores are different. Their dimensions and shape can influence the properties of materials. Materials are modified with different admixtures to improve their properties. However, additives or admixtures can cause corrosion. Although building materials do not provide food for microorganisms, they are very often inhabited by them. As a result of their presence and the action of metabolic products, biodeterioration occurs. One of the products of metabolism is water. In this paper we investigated how the modified structure of biodeterioration caused by mould fungi affects the moisture content of cement-polymer mortar with the admixture of polysiloxane latex.