To investigate the value of lung protective ventilation strategy (LPVS) guided by driving pressure for preventing postoperative pulmonary complications (PPCs) in patients recovered from COVID-19 and optimize intraoperative respiratory management.From December, 2022 to February, 2023, a total of 118 patients recovered from COVID-19 within a month (ASA Ⅰ~Ⅲ, aged ≥18 years) undergoing elective non-cardiac surgeries under general anesthesia in our hospital were randomized equally into LPVS group and control group.The patients in LPVS group received a tidal volume of 6 mL/kg with an individualized PEEP guided by minimum driving pressure and lung re-expansion every 30 min, and those in the control group received conventional mechanical ventilation.The incidence of PPCs and hypoxemia and pulmonary ultrasound score of the patients were compared between the two groups.There was no significant difference in the baseline data between LPVS group and the control group (P>0.05).Compared with the control group, LPVS group showed significantly lower incidences of PPCs (16.95%vs 35.59%, χ2=5.294, P=0.021) and hypoxemia (15.25%vs 30.51%, χ2=3.890, P=0.049) with also lower pulmonary ultrasound scores (5.31±1.07 vs 8.32±2.34, t=8.986, P<0.001).The PEEP value, airway pressure and plateau pressure in LPVS group were significantly higher, but the driving pressure and the tidal volume were lower than those in the control group (P<0.05).LPVS guided by driving pressure can improve oxygenation and reduce the risk of PPCs in patients recently recovered from COVID-19.
In-home unintentional injuries (IUIs) seriously threatened children's safety. Three factors, including risky behaviors, parental supervision, and home environmental risks, have been identified as major causes for IUIs. Studies considering the interrelations between the three were limited and no relative studies has been carried out among Chinese children. The purpose of this study is to fully explore the influences of behavioral, supervisory and environmental risk factors on IUIs and their associations among Chinese children on the bases of our self-developed scales.Through stratified cluster sampling, a cross-sectional survey was conducted with 798 parents of children aged 0 ~ 6 years in Changsha, China. Social demographics and IUIs history in the past year were collected by self-administered questionnaires. Three IUI-related scales, which had been developed and validated by our team, aimed to measure risks from children behavior, parental supervision and in-home environment. Structural equation models were constructed to analyze the relationship of these factors and their influences on IUIs using SPSS 26.0 and AMOS 22.0.Seven hundred ninety-eight parents were surveyed in total, and 33.58% of them reported with IUIs history of their children. X2/df, goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI) and the root-mean-square error of approximation (RMSEA) for the model of the whole children were 4.832, 0.879, 0.856 and 0.069 respectively, indicating an acceptable level of model fit. Direct influences were discovered between risky behaviors and children's IUIs. Home environmental risks indirectly exerted impacts on IUIs by the mediating effect of risky behaviors, while the significant effect of parental supervision only existed in children aged 4-6 and girls.Risky behaviors played a mediating role in IUIs among children. Supervision and environmental risks affected IUIs indirectly by the exposure to risky behaviors. Parental supervision may not be able to offset the risks posed by the environmental and behavioral factors, so effective IUIs prevention strategies should focus on behavioral and environmental interventions, with appropriate supervision strategies based on the age and sex characteristics of the child.
Sweet whey permeate was hydrogenated under high pressure and temperature with Raney Ni as a catalyst. Different reaction conditions, such as reaction time, amount of catalyst, and initial hydrogen pressure and temperature, were studied. The reaction mixtures were analyzed by HPLC and NMR. The major whey component, lactose (4-O-β-d-galactopyranosyl-d-glucose), was converted under these conditions to lactitol (4-O-β-d-galactopyranosyl-d-glucitol) to different degrees. Hydrolysis of lactose to galactose and glucose and further reduction was also observed over a wide temperature range, whereas isomerization of lactose to lactulose (4-O-β-d-galactopyranosyl-d-fructose) and subsequent reduction only occurred above 110 °C. With reaction time of 4 h, an initial hydrogen pressure of 1500 psi, 40.5 g of Raney Ni, and a temperature = 120 °C, sweet whey permeate (42%, 340 g) gives lactitol (85.2 %), lactulitol (1.7%), and sorbitol and dulcitol (0.8%) together with unreacted fat, protein, and salts (12.3%). Keywords: Sweet whey permeate; lactose; lactitol; isomerization; hydrolysis; lactulose; glucose; galactose; sorbitol; dulcitol; lactulitol; catalytic hydrogenation; HPLC; NMR
Contrastive Language-Image Pre-training (CLIP) model, as an effective pre-trained multimodal neural network, has been widely used in distributed machine learning tasks, especially Federated Learning (FL). Typically, CLIP-based FL adopts Parameter-Efficient Fine-Tuning (PEFT) for model training, which only fine-tunes adapter parameters or soft prompts rather than the full parameters. Although PEFT is different from the traditional training mode, in this paper, we theoretically analyze that the gradients of adapters or soft prompts can still be used to perform image reconstruction attacks. Based on our theoretical analysis, we propose Multm-In-Parvo (MIP), a proprietary reconstruction attack method targeting CLIP-based distributed machine learning architecture. Specifically, MIP can reconstruct CLIP training images according to the gradients of soft prompts or an adapter. In addition, MIP includes a label prediction strategy to accelerate convergence and an inverse gradient estimation mechanism to avoid the vanishing gradient problem on the text encoder. Experimental results show that MIP can effectively reconstruct training images according to the gradients of soft prompts or adapters of CLIP models.
The Government of China has promoting the free trade zones of the country to captivate the largest overseas investment. The association between development of tourism and foreign trade is widely recognised. This study discussed the impact of Hainan free trade zone on medical tourism in Hainan province. The Hainan free trade zone plan is not only to promote the growth in South China, but it also contributes to the growth of economy in the Pacific Asia region and the rest of the World. Under the free visa entry policy, the government can attract tourists from all over the world, and can increase the industry of tourism by fulfilling the requirements of international tourists.
The Government of China has promoting the free trade zones of the country to captivate the largest overseas investment. The association between development of tourism and foreign trade is widely recognised. This study discussed the impact of Hainan free trade zone on medical tourism in Hainan province. The Hainan free trade zone plan is not only to promote the growth in South China, but it also contributes to the growth of economy in the Pacific Asia region and the rest of the World. Under the free visa entry policy, the government can attract tourists from all over the world, and can increase the industry of tourism by fulfilling the requirements of international tourists.
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