Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017

OBJECTIVES

Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China.

METHODS

We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression.

RESULTS

Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis.

CONCLUSIONS

The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.

Enhancing the Rapid Na+-Storage Performance via Electron/Ion Bridges through GeS2/Graphene Heterojunction

Hybridizing carbonous matrix into metal sulfide is confirmed as an effective strategy to enhance electrode conductance and structure stability. However, a comprehensive understanding of the interface reaction mechanism between active materials and carbon substrate is still urgently needed. Based on the band energy theory, a route to enhance the rate ability for electrode is exploited on regulating interfaces of substrates/active heterojunction. Herein, the highly stable Na⁺-storage performance of GeS₂/3DG is delicately designed, where the hierarchical structure is enabled by uniformly overcoating GeS₂ nanograins with graphene matrix. Different from the widespread doping route of active materials for fast ion transfer, we focus on the effects of interface regulation on the high-rate Na^- ion-storage performance of substrate/active materials. Here, a well-designed interface of the C-Ge bond at the heterointerface induced by hierarchical GeS₂/graphene heterojunction is pioneeringly explored, which can result in a fast electron transfer by reducing electron gathering polarization. More importantly, defects in graphene can alleviate the polarization aroused by ion concentration, which not only offers anchoring/doping sites for C-Ge bond but also provides extra ion channels for Na-ion transportation into GeS₂. This interface regulation of constructing metal-carbon bonds will shine light on the reaction kinetics and interface stability and contribute to the fundamental understanding of interface reaction mechanisms for metal sulfide anode materials.

Maternal Anxiety and Depression during Late Pregnancy and Newborn Brain White Matter Development

BACKGROUND AND PURPOSE

Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development.

MATERIALS AND METHODS

Pregnant women were recruited at ∼36 weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods.

RESULTS

Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P < .05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P < .05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, -0.47 to -0.67; P values, .008 to <.001), Trait-Anxiety (R, -0.37 to -0.59; P, .04 to <.001), and Beck Depression Inventory (R values, -0.36 to -0.55; P, .05 to .002) scores.

CONCLUSIONS

Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.

Brain Cortical Structure and Executive Function in Children May Be Influenced by Parental Choices of Infant Diets

BACKGROUND AND PURPOSE

While it is known that breastfeeding promotes healthy brain development in children, the potential effects of formulas substantially differing in composition (ie, milk-based versus soy-based) during infancy on brain development are unclear.

MATERIALS AND METHODS

Seventy-one 8-year-old children who were predominantly breastfed, milk formula fed, or soy formula fed during infancy were recruited for an MR imaging examination of the brain and a Behavior Rating Inventory of Executive Function assessment (completed via a questionnaire to the parents). Brain cortical features measured from MR imaging such as cortical thickness and surface area were extracted and compared among groups and correlated with Behavior Rating Inventory of Executive Function test scores.

RESULTS

Clusters in the frontal and occipital lobes showed significant differences (cluster-wise P  ≤  .05, corrected for multiple comparisons) in cortical thickness or surface area among the 3 diet groups. The effects were more prominent for boys, particularly for comparison of the milk formula fed versus soy formula fed boys. Assessments of executive function and behavior showed significantly lower Behavior Rating Inventory of Executive Function test scores in soy formula fed versus milk formula fed groups, which were mostly attributed to differences in boys. There were no differences between milk formula fed and breastfed groups for either sex. Mean cortical thickness for several of the clusters in the brain showing infant diet-associated effects significantly correlated with Behavior Rating Inventory of Executive Function scores.

CONCLUSIONS

Choices of infant diets (ie, breastfed, milk formula fed, soy formula fed) may have long-term and sex-specific effects on the cortical development and executive function and behavior of children's brains.

[Real-world efficacy and safety of lopinavir/ritonavir and arbidol in treating with COVID-19 : an observational cohort study]

Objective: To evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) and arbidol in the treatment of COVID-19 in the real world. Methods: The clinical data of 178 patients diagnosed with COVID-19 admitted to Guangzhou Eighth People's Hospital were retrospectively analyzed from January 21 to February 9, 2020. According to the patient's antiviral treatment regimen, 178 patients were divided into 4 groups including LPV/r group (59 patients), arbidol group (36 patients), combination therapy with LPV/r plus arbidol group (25 patients) and the conventional treatment group without any antiviral drugs (58 patients). The main observation end points of the study was the negative conversion time of nucleic acid of the novel coronavirus (2019-nCoV) in pharyngeal swab. Results: The baseline of 4 groups before treatment was consistent and comparable. The negative conversion time of nucleic acid of the 2019-nCoV in pharyngeal swab was (10.20 ± 3.49), (10.11 ± 4.68), (10.86 ± 4.74), (8.44 ± 3.51) days separately in the LPV/r group, the arbidol group, the combination therapy group, and the conventional treatment group without significant difference (F = 2.556, P = 0.058). There was also no significant difference in the rate of negative conversion rate of 2019-nCoV nucleic acid, the improvement ration in clinical symptoms, and the improvement ration of pulmonary infection in the lung CT imaging (P> 0.05). However, a statistically significant difference was found in the proportion of deterioration changing from mild/moderate to severe/critical type at day 7 (χ(2) = 9.311, P = 0.017) as follows: the combination therapy group (24.0%, 6/25), the arbidol group ( 16.7%, 6/36), LPV/r group (5.4%, 3/56) and conventional treatment group (5.2%, 3/58). Moreover, the frequency of adverse reactions in the three groups receiving antiviral drugs was significantly higher than that in the conventional treatment group (χ(2) = 14.875, P = 0.002). Conclusions: No evidences could prove that LPV/r and arbidol could shorten the negative conversion time of novel coronavirus nucleic acid in pharyngeal swab nor improve the symptoms of patients. Furthermore, the combination usage of LPV/r and arbidol may not benefit for improving the disease. Noteworthy, the adverse reactions of the antiviral drugs should be paid careful attention during the treatment.

Composition and Architecture Design of Double-Shelled Co0.85 Se1- x Sx @Carbon/Graphene Hollow Polyhedron with Superior Alkali (Li, Na, K)-Ion Storage

The exploration of materials with reversible and stable electrochemical performance is crucial in energy storage, which can (de) intercalate all the alkali-metal ions (Li⁺ , Na⁺ , and K⁺ ). Although transition-metal chalcogenides are investigated continually, the design and controllable preparation of hierarchical nanostructure and subtle composite withstable properties are still great challenges. Herein, component-optimal Co_0.85 Se_{1- x} S_x nanoparticles are fabricated by in situ sulfidization of metal organic framework, which are wrapped by the S-doped graphene, constructing a hollow polyhedron framework with double carbon shells (CoSSe@C/G). Benefiting from the synergistic effect of composition regulation and architecture design by S-substitution, the electrochemical kinetic is enhanced by the boosted electrochemistry-active sites, and the volume variation is mitigated by the designed structure, resulting in the advanced alkali-ion storage performance. Thus, it delivers an outstanding reversible capacity of 636.2 mAh g^-1 at 2 A g^-1 after 1400 cycles for Li-ion batteries. Remarkably, satisfactory initial charge capacities of 548.1 and 532.9 mAh g^-1 at 0.1 A g^-1 can be obtained for Na-ion and K-ion batteries, respectively. The prominent performance combined with the theory calculation confirms that the synergistic strategy can improve the alkali-ion transportation and structure stability, providing an instructive guide for designing high-performance anode materials for universal alkali-ion storage.

Bimetallic Sulfide Sb2S3@FeS2 Hollow Nanorods as High-Performance Anode Materials for Sodium-Ion Batteries

Constructing a heterojunction and introducing an interfacial interaction by designing ideal structures have the inherent advantages of optimizing electronic structures and macroscopic mechanical properties. An exquisite hierarchical heterogeneous structure of bimetal sulfide Sb₂S₃@FeS₂ hollow nanorods embedded into a nitrogen-doped carbon matrix is fabricated by a concise two-step solvothermal method. The FeS₂ interlayer expands in situ grow on the interface of hollow Sb₂S₃ nanorods within the nitrogen-doped graphene matrix, forming a delicate heterostructure. Such a well-designed architecture affords rapid Na⁺ diffusion and improves charge transfer at the heterointerfaces. Meanwhile, the strongly synergistic coupling interaction among the interior Sb₂S₃, interlayer FeS₂, and external nitrogen-doped carbon matrix creates a stable nanostructure, which extremely accelerates the electronic/ion transport and effectively alleviates the volume expansion upon long cyclic performance. As a result, the composite, as an anode material for sodium-ion batteries, exhibits a superior rate capability of 537.9 mAh g^-1 at 10 A g^-1 and excellent cyclic stability with 85.7% capacity retention after 1000 cycles at 5 A g^-1. Based on the DFT calculation, the existing constructing heterojunction in this composite can not only optimize the electronic structure to enhance the conductivity but also favor the Na₂S adsorption energy to accelerate the reaction kinetics. The outstanding electrochemical performance sheds light on the strategy by the rational design of hierarchical heterogeneous nanostructures for energy storage applications.

A Protocol for Transverse Cardiac Slicing and Optical Mapping in Murine Heart

Thin living tissue slices have recently emerged as a new tissue model for cardiac electrophysiological research. Slices can be produced from human cardiac tissue, in addition to small and large mammalian hearts, representing a powerful in vitro model system for preclinical and translational heart research. In the present protocol, we describe a detailed mouse heart transverse slicing and optical imaging methodology. The use of this technology for high-throughput optical imaging allows study of electrophysiology of murine hearts in an organotypic pseudo two-dimensional model. The slices are cut at right angles to the long axis of the heart, permitting robust interrogation of transmembrane potential (Vm) and calcium transients (CaT) throughout the entire heart with exceptional regional precision. This approach enables the use of a series of slices prepared from the ventricles to measure Vm and CaT with high temporal and spatial resolution, allowing (i) comparison of successive slices which form a stack representing the original geometry of the heart; (ii) profiling of transmural and regional gradients in Vm and CaT in the ventricle; (iii) characterization of transmural and regional profiles of action potential and CaT alternans under stress (e.g., high frequency pacing or β-adrenergic stimulation) or pathological conditions (e.g., hypertrophy). Thus, the protocol described here provides a powerful platform for innovative research on electrical and calcium handling heterogeneity within the heart. It can be also combined with optogenetic technology to carry out optical stimulation; aiding studies of cellular Vm and CaT in a cell type specific manner.

Enhancing High-Voltage Performance of Ni-Rich Cathode by Surface Modification of Self-Assembled NASICON Fast Ionic Conductor LiZr2(PO4)3

Coating methodology is commonly employed in the enhancement of Ni-rich cathodes for Li-ion batteries as an efficient approach, while its strategy and effect are still great challenges to achieve success in surface modifications for comprehensive electrochemical properties. In this work, the surface of Ni-rich cathode LiNi_0.82Co_0.15Al_0.03O₂ (NCA) is modified by intimately coating NASICON-type solid electrolyte LiZr₂(PO₄)₃ (LZP) via a facile approach involving electrostatic attraction. With well-designed architecture and a uniform NASICON-type LZP nanolayer wrapping over the NCA microsphere, the entire electrode demonstrates exceptional Li⁺ diffusion and conductivity and suppresses the side reaction between electrolyte and electroactive NCA, stabilizing the phase interface with less Li⁺/Ni²⁺ cation mixing. As a result, the NCA@LZP can deliver a high reversible capacity of 182 mAh g^-1 at 1C in 2.7-4.3 V, maintaining the capacity retention of 84.6% after 100 cycles. More importantly, the structure stability of NCA is enhanced substantially by surface modification of LZP at high cutoff voltage. It achieves a reversible capacity of 204 mAh g^-1 and keeps 100.4 mAh g^-1 after 500 cycles at 1C in the potential range of 2.7-4.5 V. This effective strategy of using NASICON fast ionic conductor like LZP as a coating layer may provide a new insight to modify the surface of Ni-rich electrode, improving the rate capability and cyclic performance under high voltage.

Fabrication of SnS2/Mn2SnS4/Carbon Heterostructures for Sodium-Ion Batteries with High Initial Coulombic Efficiency and Cycling Stability

SnS₂ has been extensive studied as an anode material for sodium storage owing to its high theoretical specific capacity, whereas the unsatisfied initial Coulombic efficiency (ICE) caused by the partial irreversible conversion reaction during the charge/discharge process is one of the critical issues that hamper its practical applications. Hence, heterostructured SnS₂/Mn₂SnS₄/carbon nanoboxes (SMS/C NBs) have been developed by a facial wet-chemical method and utilized as the anode material of sodium ion batteries. SMS/C NBs can deliver an initial capacity of 841.2 mAh g^-1 with high ICE of 90.8%, excellent rate capability (752.3, 604.7, 570.1, 546.9, 519.7, and 488.7 mAh g^-1 at the current rate of 0.1, 0.5, 1.0, 2.0, 5.0, and 10.0 A g^-1, respectively), and long cycling stability (522.5 mAh g^-1 at 5.0 A g^-1 after 500 cycles). The existence of SnS₂/Mn₂SnS₄ heterojunctions can effectively stabilize the reaction products Sn and Na₂S, greatly prevent the coarsening of nanosized Sn⁰, and enhance reversible conversion--alloying reaction, which play a key role in improving the ICE and extending the cycling performance. Moreover, the heterostructured SMS coupled with the interacting carbon network provides efficient channels for electrons and Na⁺ diffusion, resulting in an excellent rate performance.

Synergistical Coupling Interconnected ZnS/SnS2 Nanoboxes with Polypyrrole-Derived N/S Dual-Doped Carbon for Boosting High-Performance Sodium Storage

Metal sulfides possess tremendous potentials owing to their high specific capacity for sodium storage. However, the huge volume expansion, accompanied with structural collapse and unsatisfied electric conductivity upon continuous cycling, always lead to inferior rate capability and severe cycling fading. In this work, binary metal sulfide (ZnS/SnS₂ ) nanoboxes confined in N/S dual-doped carbon shell (ZSS@NSC) are fabricated through a facile co-precipitation method involving the wrapping of polypyrrole, and subsequent in situ sulfidation process. Such a well-designed heterogeneity between ZnS and SnS₂ provides rapid Na⁺ insertion and enhanced charge transport by creating an electric field at the heterointerface. More significantly, the formation of polypyrrole-derived N/S dual-doped carbon is synergistically coupled with the ZnS/SnS₂ to create a unique and robust architecture, further strengthening the interconnect function at the heterointerface, which improves electric/ion transfer and mitigates the volume variation during the long-term cycling process. Herein, this as-prepared ZSS@NSC exhibits satisfied specific capacity, excellent rate property, and superior cyclic stability (a reversible capacity of 456.2 mAh g^-1 with excellent capacity retention of 97.2% after 700 stable cycles at ultrahigh rate of 5 A g^-1 ). The boosted Na-storage properties demonstrate that the optimized strategy of structure-engineering has a broad prospect to promote energy storage applications.

Rational Design of TiO-TiO2 Heterostructure/Polypyrrole as a Multifunctional Sulfur Host for Advanced Lithium-Sulfur Batteries

Despite outstanding theoretical energy density (2600 Wh kg^-1) and low cost of lithium-sulfur (Li-S) batteries, their practical application is seriously hindered by inferior cycle performance and low Coulombic efficiency due to the "shuttle effect" of lithium polysulfides (LiPSs). Herein, we proposed a strategy that combines TiO-TiO₂ heterostructure materials (H-TiO _x, x = 1, 2) and conductive polypyrrole (PPy) to form a multifunctional sulfur host. Initially, the TiO-TiO₂ heterostructure can enhance the redox reaction kinetics of sulfur species and improve the conductivity of sulfur cathode together with the PPy coating layer. Moreover, the defect-abundant H-TiO _x matrices can trap LiPSs by the formation of Ti-S bond via the Lewis acid-base interaction. Furthermore, the PPy coating can physically hinder the diffusion of LiPSs, as well as chemically adsorb LiPSs by the polar-polar mechanism. Benefiting from the synergistic effect of H-TiO _x and PPy layer, the novel cathode delivered high specific capacities at different current rates (1130, 990, 932, 862, and 726 mAh g^-1 at 0.1, 0.2, 0.3, 0.5, and 1C, respectively) and an ultralow capacity decay of 0.0406% per cycle after 1000 cycles at 1C. This work can not only indicate effectiveness of employing H-TiO _x materials to realize the LiPSs immobilization but also shed light on the feasibility of combining different materials to achieve the multifunctional sulfur hosts for advanced Li-S batteries.

Cesarean Delivery Impacts Infant Brain Development

BACKGROUND AND PURPOSE

The cesarean delivery rate has increased globally in the past few decades. Neurodevelopmental outcomes associated with cesarean delivery are still unclear. This study investigated whether cesarean delivery has any effect on the brain development of offspring.

MATERIALS AND METHODS

A total of 306 healthy children were studied retrospectively. We included 3 cohorts: 2-week-old neonates (cohort 1, n = 32/11 for vaginal delivery/cesarean delivery) and 8-year-old children (cohort 2, n = 37/23 for vaginal delivery/cesarean delivery) studied at Arkansas Children's Hospital, and a longitudinal cohort of 3-month to 5-year-old children (cohort 3, n = 164/39 for vaginal delivery/cesarean delivery) studied independently at Brown University. Diffusion tensor imaging, myelin water fraction imaging, voxel-based morphometry, and/or resting-state fMRI data were analyzed to evaluate white matter integrity, myelination, gray matter volume, and/or functional connectivity, respectively.

RESULTS

While not all MR imaging techniques were shared across the institutions/cohorts, post hoc analyses showed similar results of potential effects of cesarean delivery. The cesarean delivery group in cohort 1 showed significantly lower white matter development in widespread brain regions and significantly lower functional connectivity in the brain default mode network, controlled for a number of potential confounders. No group differences were found in cohort 2 in white matter integrity or gray matter volume. Cohort 3 had significantly different trajectories of white matter myelination between groups, with those born by cesarean delivery having reduced myelin in infancy but normalizing with age.

CONCLUSIONS

Cesarean delivery may influence infant brain development. The impact may be transient because similar effects were not observed in older children. Further prospective and longitudinal studies may be needed to confirm these novel findings.

Facile synthesis of a molybdenum phosphide@carbon nanocomposite as an advanced anode material for sodium-ion batteries

The MoP@C nanocomposite was successfully fabricated via a facile sol–gel approach, which demonstrated excellent electrochemical properties as a sodium-ion battery anode.