IntroductionThis study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality.MethodsWe conducted a retrospective cohort study using data from 213 adult septic shock patients treated at two general surgical intensive care units of a tertiary care hospital over a two year period. The primary outcome was 28-day mortality.ResultsThe 28-day mortality was 37.6% overall. Among the 213 patients, a strong relationship between delayed initial norepinephrine administration and 28-day mortality was noted. The average time to initial norepinephrine administration was 3.1 ± 2.5 hours. Every 1-hour delay in norepinephrine initiation during the first 6 hours after septic shock onset was associated with a 5.3% increase in mortality. Twenty-eight day mortality rates were significantly higher when norepinephrine administration was started more than or equal to 2 hours after septic shock onset (Late-NE) compared to less than 2 hours (Early-NE). Mean arterial pressures at 1, 2, 4, and 6 hours after septic shock onset were significantly higher and serum lactate levels at 2, 4, 6, and 8 hours were significantly lower in the Early-NE than the Late-NE group. The duration of hypotension and norepinephrine administration was significantly shorter and the quantity of norepinephrine administered in a 24-hour period was significantly less for the Early-NE group compared to the Late-NE group. The time to initial antimicrobial treatment was not significantly different between the Early-NE and Late-NE groups.ConclusionOur results show that early administration of norepinephrine in septic shock patients is associated with an increased survival rate.

We demonstrate an all-fiber passively Q-switched erbium-doped fiber laser (EDFL) using a gold-nanosphere (GNS) based saturable absorber (SA) with evanescent field interaction. Using the interaction of evanescent field for fabricating SAs, long nonlinear interaction length of evanescent wave and GNSs can be achieved. The GNSs are synthesized from mixing solution of chloroauricacid (HAuCl4) and sodium citrate by the heating effects of the microfiber's evanescent field radiation. The proposed passively Q-switched EDFL could give output pulses at 1562 nm with pulse width of 1.78 μs, a repetition rate of 58.1 kHz, a pulse energy of 133 nJ and a output power of 7.7 mW when pumped by a 980 nm laser diode of 237 mW.

Received Month X, XXXX; revised Month X, XXXX; accepted Month X, XXXX; posted Month X, XXXX (Doc. ID XXXXX); published Month X, XXXX We experimentally demonstrate a passively Q-switched erbium-doped fiber laser (EDFL) operation by using a saturable absorber based on Fe 3 O 4 nanoparticles (FONP) in magnetic fluid (MF). As a kind of transition metal oxide, the FONP has a large nonlinear optical response with a fast response time for saturable absorber. By depositing MF at the end of optical fiber ferrule, we fabricated a FONP-based saturable absorber, which enables a strong light-matter interaction owing to the confined transmitted optical field within the single mode fiber. Because of large third-order optical nonlinearities of FONP-based saturable absorber, large modulation depth of 8.2% and non saturable absorption of 56.6% are demonstrated. As a result, stable passively Q-switched EDFL pulses with maximum output pulse energy of 23.76 nJ, repetition rate of 33.3 kHz, and pulse width of 3.2 μs are achieved when the input pump power is 110 mW at the wavelength of 980 nm. The laser features a low threshold pump power of ~15 mW.

ObjectiveCigarette smoking is a major risk factor for colorectal cancer (CRC). We aimed to investigate whether cigarette smoke promotes CRC by altering the gut microbiota and related metabolites.DesignAzoxymethane-treated C57BL/6 mice were exposed to cigarette smoke or clean air 2 hours per day for 28 weeks. Shotgun metagenomic sequencing and liquid chromatography mass spectrometry were parallelly performed on mice stools to investigate alterations in microbiota and metabolites. Germ-free mice were transplanted with stools from smoke-exposed and smoke-free control mice.ResultsMice exposed to cigarette smoke had significantly increased tumour incidence and cellular proliferation compared with smoke-free control mice. Gut microbial dysbiosis was observed in smoke-exposed mice with significant differential abundance of bacterial species including the enrichment of Eggerthella lenta and depletion of Parabacteroides distasonis and Lactobacillus spp. Metabolomic analysis showed increased bile acid metabolites, especially taurodeoxycholic acid (TDCA) in the colon of smoke-exposed mice. We found that E. lenta had the most positive correlation with TDCA in smoke-exposed mice. Moreover, smoke-exposed mice manifested enhanced oncogenic MAPK/ERK (mitogen-activated protein kinase/extracellular signal‑regulated protein kinase 1/2) signalling (a downstream target of TDCA) and impaired gut barrier function. Furthermore, germ-free mice transplanted with stools from smoke-exposed mice (GF-AOMS) had increased colonocyte proliferation. Similarly, GF-AOMS showed increased abundances of gut E. lenta and TDCA, activated MAPK/ERK pathway and impaired gut barrier in colonic epithelium.ConclusionThe gut microbiota dysbiosis induced by cigarette smoke plays a protumourigenic role in CRC. The smoke-induced gut microbiota dysbiosis altered gut metabolites and impaired gut barrier function, which could activate oncogenic MAPK/ERK signalling in colonic epithelium.

We numerically investigate the influence of high-order dispersion (HOD) on temporal and spectral characteristics of microresonator-based optical frequency combs. Theoretical analysis based on the moment method associated with numerical simulations are utilized to study the comb evolution dynamics, showing that temporal shifts of steady-state intracavity solitons are induced by high-odd-order dispersion rather than high-even-order dispersion. The role of HOD on comb spectral envelopes is also elucidated through analyzing the intracavity dispersive wave generations. We further demonstrate that the spectral envelope of a broadband optical frequency comb can be engineered by using a cavity dispersion profile with multiple zero dispersion wavelengths.

Background. The pathogenesis of postoperative ileus (POI) is complex. The present study was designed to investigate the effects of peritoneal air exposure on the POI intestinal inflammation and the underlying mechanism. Methods. Sprague-Dawley rats were randomized into five groups (6/group): the control group, the sham group, and three exposure groups with peritoneal air exposure for 1, 2, or 3 h. At 24 h after surgery, we analyzed the gastrointestinal transit, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10, the myeloperoxidase activity, and the levels of TNF-α, IL-1β, IL-6, and IL-10 in the ileum and colon. The oxidant and antioxidant levels in the ileum and colon were analyzed by measuring malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC). Results. Peritoneal air exposure caused an air-exposure-time-dependent decrease in the gastrointestinal transit. The length of peritoneal air exposure is correlated with the severity of both systemic and intestinal inflammations and the increases in the levels of MDA, SOD, GSH-Px, and T-AOC. Conclusions. The length of peritoneal air exposure is proportional to the degree of intestinal paralysis and the severity of intestinal inflammation, which is linked to the oxidative stress response.

Acute traumatic coagulopathy (ATC) may trigger sympathoadrenal activation associated with endothelial damage and coagulation disturbances. Overexcitation of sympathetic nerve in this state would disrupt sympathetic-vagal balance, leading to autonomic nervous system dysfunction. The aim of this study was to evaluate the autonomic function in ATC and its influence on inflammation, endothelial and coagulation activation. Male Sprague-Dawley rats were randomly assigned to sham, ATC control (ATCC) and ATC with sympathectomy by 6-hydroxydopamine (ATCS) group. Sham animals underwent the same procedure without trauma and bleeding. Following trauma and hemorrhage, rats underwent heart rate variability (HRV) test, which predicts autonomic dysfunction through the analysis of variation in individual R-R intervals. Then, rats were euthanized at baseline, and at 0, 1 and 2 h after shock and blood gas, conventional coagulation test and markers of inflammation, coagulation, fibrinolysis, endothelial damage and catecholamine were measured. HRV showed an attenuation of total power and high frequency, along with a rise of low frequency and low frequency : high frequency ratio in the ATC rats, which both were reversed by sympathectomy in the ATCS group. Additionally, sympathetic denervation significantly suppressed the increase of proinflammatory cytokines, tumor necrosis factor-α and the fibrinolysis markers including tissue-type plasminogen activator and plasmin-antiplasmin complex. Serum catecholamine, soluble thrombomodulin and syndecan-1 were also effectively inhibited by sympathectomy. These data indicated that autonomic dysfunction in ATC involves both sympathetic activation and parasympathetic inhibition. Moreover, sympathectomy yielded anti-inflammatory, antifibrinolysis and endothelial protective effects in rats with ATC. The role of autonomic neuropathy in ATC should be explored further.

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