Evaluation of the Flexibility for Catalytic Ozonation of Dichloromethane over Urchin-Like CuMnOx in Flue Gas with Complicated Components

The evaluation of the poisoning effect of complex components in practical gas on DCM (dichloromethane) catalytic ozonation is of great significance for enhancing the technique's environmental flexibility. Herein, Ca, Pb, As, and NO/SO₂ were selected as a typical alkaline-earth metal, heavy metal, metalloid, and acid gas, respectively, to evaluate their interferences on catalytic behaviors and surface properties of an optimized urchin-like CuMn catalyst. Ca/Pb loading weakens the formation of oxygen vacancies, oxygen mobility, and acidity due to the fusion of Mn-Ca/Pb-O, leading to their inferior catalytic performance with poor CO₂ selectivity and mineralization rate. Noticeably, the presence of As induces excessively strong acidity, facilitating the inevitable formation of byproducts. Catalytic co-ozonation of NO/DCM is achieved with stoichiometric ozone addition. Unfortunately, SO₂ introduction brings irreversible deactivation due to strong competition adsorption and the loss of active sites. Unexpectedly, Ca loading protects active sites from an attack by SO₂. The formation of unstable sulfites and the released Mn-O structure offset the negative effect from SO₂. Overall, the catalytic ozonation of DCM exhibits a distinctive priority in the antipoisoning of metals with the maintenance of DCM conversion. The construction of more stable acid sites should be the future direction of catalyst design; otherwise, catalytic ozonation should be arranged together with post heavy metal capture and a deacidification system.

Mechanisms and inhibitors of ferroptosis in psoriasis

Psoriasis is a chronic inflammatory skin disease that features localized or widespread erythema, papules, and scaling. It is common worldwide and may be distributed throughout the whole body. The pathogenesis of psoriasis is quite complex and the result of the interplay of genetic, environmental and immune factors. Ferroptosis is an iron-dependent programmed death that is different from cell senescence, apoptosis, pyroptosis and other forms of cell death. Ferroptosis involves three core metabolites, iron, lipids, and reactive oxygen species (ROS), and it is primarily driven by lipid peroxidation. Ferrostatin-1 (Fer-1) is an effective inhibitor of lipid peroxidation that inhibited the changes related to ferroptosis in erastin-treated keratinocytes and blocked inflammatory responses. Therefore, it has a certain effect on the treatment of psoriatic lesions. Although ferroptosis is closely associated with a variety of human diseases, such as inflammatory diseases, no review has focused on ferroptosis in psoriasis. This mini review primarily focused on the pathogenesis of psoriasis, the mechanisms of ferroptosis, the connection between ferroptosis and psoriasis and ferroptosis inhibitors in psoriasis treatment. We discussed recent research advances and perspectives on the relationship between ferroptosis and psoriasis.

Synthesis of Silver Nanoparticles-Modified Graphitic Carbon Nitride Nanosheets for Highly Efficient Photocatalytic Hydrogen Peroxide Evolution

As a promising metal-free photocatalyst, graphitic carbon nitride (g-C3N4) is still limited by insufficient visible light absorption and rapid recombination of photogenerated carriers, resulting in low photocatalytic activity. Here, we adjusted the microstructure of the pristine bulk-g-C3N4 (PCN) and further loaded silver (Ag) nanoparticles. Abundant Ag nanoparticles were grown on the thin-layer g-C3N4 nanosheets (CNNS), and the Ag nanoparticles decorated g-C3N4 nanosheets (Ag@CNNS) were successfully synthesized. The thin-layer nanosheet-like structure was not only beneficial for the loading of Ag nanoparticles but also for the adsorption and activation of reactants via exposing more active sites. Moreover, the surface plasmon resonance (SPR) effect induced by Ag nanoparticles enhanced the absorption of visible light by narrowing the band gap of the substrate. Meanwhile, the composite band structure effectively promoted the separation and transfer of carriers. Benefiting from these merits, the Ag@CNNS reached a superior hydrogen peroxide (H2O2) yield of 120.53 μmol/g/h under visible light irradiation in pure water (about 8.0 times higher than that of PCN), significantly surpassing most previous reports. The design method of manipulating the microstructure of the catalyst combined with the modification of metal nanoparticles provides a new idea for the rational development and application of efficient photocatalysts.

Current status of xenotransplantation research and the strategies for preventing xenograft rejection

Transplantation is often the last resort for end-stage organ failures, e.g., kidney, liver, heart, lung, and pancreas. The shortage of donor organs is the main limiting factor for successful transplantation in humans. Except living donations, other alternatives are needed, e.g., xenotransplantation of pig organs. However, immune rejection remains the major challenge to overcome in xenotransplantation. There are three different xenogeneic types of rejections, based on the responses and mechanisms involved. It includes hyperacute rejection (HAR), delayed xenograft rejection (DXR) and chronic rejection. DXR, sometimes involves acute humoral xenograft rejection (AHR) and cellular xenograft rejection (CXR), which cannot be strictly distinguished from each other in pathological process. In this review, we comprehensively discussed the mechanism of these immunological rejections and summarized the strategies for preventing them, such as generation of gene knock out donors by different genome editing tools and the use of immunosuppressive regimens. We also addressed organ-specific barriers and challenges needed to pave the way for clinical xenotransplantation. Taken together, this information will benefit the current immunological research in the field of xenotransplantation.

Behavior Classification and Analysis of Grazing Sheep on Pasture with Different Sward Surface Heights Using Machine Learning

Behavior classification and recognition of sheep are useful for monitoring their health and productivity. The automatic behavior classification of sheep by using wearable devices based on IMU sensors is becoming more prevalent, but there is little consensus on data processing and classification methods. Most classification accuracy tests are conducted on extracted behavior segments, with only a few trained models applied to continuous behavior segments classification. The aim of this study was to evaluate the performance of multiple combinations of algorithms (extreme learning machine (ELM), AdaBoost, stacking), time windows (3, 5 and 11 s) and sensor data (three-axis accelerometer (T-acc), three-axis gyroscope (T-gyr), and T-acc and T-gyr) for grazing sheep behavior classification on continuous behavior segments. The optimal combination was a stacking model at the 3 s time window using T-acc and T-gyr data, which had an accuracy of 87.8% and a Kappa value of 0.836. It was applied to the behavior classification of three grazing sheep continuously for a total of 67.5 h on pasture with three different sward surface heights (SSH). The results revealed that the three sheep had the longest walking, grazing and resting times on the short, medium and tall SHH, respectively. These findings can be used to support grazing sheep management and the evaluation of production performance.

Development, validation, and clinical application of a rapid UPLC-MS/MS method for detection of colchicine in human whole blood and urine

A rapid, simple, and economical method has been developed to determine colchicine in both human whole blood and urine using UPLC-MS/MS. Colchicine and isotope-labeled internal standard were extracted from the matrix by liquid-liquid extraction with saturated borax and ethyl acetate, and separated by a reversed-phase chromatography C18 column. Gradient elution was carried out using acetonitrile and water spiked with 0.01% formic acid. Multiple reaction monitoring was performed at positive ion mode. The quantitative transitions were m/z 400.27 → 310.28 for colchicine and m/z 406.16 → 313.18 for colchicine-D6. The method has good linearity in the range of 0.5-200 ng/mL for blood and 2-2000 ng/mL for urine. The sensitivity, accuracy, and matrix effect were all in line with the guidelines of Food and Drug Administration and European Medicines Agency. The extraction recovery was above 63.94%. The samples were stable under various storage conditions. Six deuterium-substituted isotopic internal standard was used to demonstrate a different mode of colchicine cleavage from the existing literature. This method has been successfully used in the diagnosis of patients with colchicine poisoning. Blood is recommended as the optimal sample compared with urine.

Unveiling the relationship between the multilayer structure of metallic MoS2 and the cycling performance for lithium ion batteries

Molybdenum disulfide (MoS₂) with a layered structure is a desirable substitute for the graphite anode in lithium ion storage. Compared with the semiconducting phase (2H-MoS₂), the metallic polymorph (1T-MoS₂) usually shows much better cycling stability. Nevertheless, the origin of this remarkable cycling stability is still ambiguous, hindering further development of MoS₂-based anodes. Herein, we assembled multilayered 1T-MoS₂ nanosheets directly on Ti foil to investigate the Li⁺ storage mechanism. Based on experimental observation and computational simulation, we found that the cycling stability correlates with the layer number of MoS₂. Multilayered 1T-MoS₂ can accommodate inserted Li⁺ in a ternary compound Li-Mo-S through a reversible reaction, which is favorable for retaining a substantial number of MoS₂ nanodomains upon Li intercalation. These residual MoS₂ nanodomains can serve as an anchor to adhere Li_xS species, thereby suppressing the "shuttle effect" of polysulfides and enhancing cycling stability. This work sheds light on the development of high-performance anodes based on metallic MoS₂ for LIBs.

1T-MoS2 Nanosheets Coupled with CoS2 Nanoparticles: Electronic Modulation for Efficient Electrochemical Nitrogen Fixation

Electrocatalytic nitrogen reduction reaction (eNRR), a substitute process for the conventional Haber-Bosch for NH₃ production, has drawn tremendous attention due to its merits in mild conditions, abundant reactant sources, low energy consumption, and environmental protection. However, electrocatalysts for eNRR are still subjected to low catalytic activity and selectivity. Herein, we constructed a CoS₂/1T-MoS₂ heterostructure with CoS₂ nanoparticles uniformly loaded on 1T-MoS₂ nanosheets and applied it as an eNRR electrocatalyst for the first time. Theoretical calculation suggests that electron transfer from CoS₂ to 1T-MoS₂ across their contact interface optimizes the local electronic structure of 1T-MoS₂, where the electron-depletion region near CoS₂ is in favor of accepting lone-pair electrons from N₂ to enable N₂ absorption, and the electron-accumulation region near 1T-MoS₂ is conductive to break inert N≡N triple bonds. Unlike pure 1T-MoS₂, the potential-determining step (PDS) demonstrates a significantly lower energy barrier. In addition, the weak interaction between CoS₂/1T-MoS₂ and hydrogen discourages competitive hydrogen evolution reaction. As a result, CoS₂/1T-MoS₂ exhibited noticeably improved eNRR activity and selectivity, with an NH₃ yield of 59.3 μg h^-1 mg^-1 and a high Faradaic efficiency of 26.6%.

Ultrahigh Photocatalytic CO2 Reduction Efficiency and Selectivity Manipulation by Single-Tungsten-Atom Oxide at the Atomic Step of TiO2

The photocatalytic CO₂ reduction reaction is a sustainable route to the direct conversion of greenhouse gases into chemicals without additional energy consumption. Given the vast amount of greenhouse gas, numerous efforts have been devoted to developing inorganic photocatalysts, e.g., titanium dioxide (TiO₂ ), due to their stability, low cost, and environmentally friendly properties. However, a more efficient TiO₂ photocatalyst without noble metals is highly desirable for CO₂ reduction, and it is both difficult and urgent to produce selectively valuable compounds. Here, a novel "single-atom site at the atomic step" strategy is developed by anchoring a single tungsten (W) atom site with oxygen-coordination at the intrinsic steps of classic TiO₂ nanoparticles. The composition of active sites for CO₂ reduction can be controlled by tuning the additional W⁵⁺ to form W⁵⁺ -O-Ti³⁺ sites, resulting in both significant CO₂ reduction efficiency with 60.6 μmol g^{- 1} h^{- 1} and selectivity for methane (CH₄ ) over carbon monoxide (CO), which exceeds those of pristine TiO₂ by more than one order of magnitude. The mechanism relies on the accurate control of the single-atom sites at step with 22.8% coverage of surface sites and the subsequent excellent electron-hole separation along with the favorable adsorption-desorption of intermediates at the sites.

Isotype Heterojunction-Boosted CO2 Photoreduction to CO

Photocatalytic conversion of CO₂ to high-value products plays a crucial role in the global pursuit of carbon-neutral economy. Junction photocatalysts, such as the isotype heterojunctions, offer an ideal paradigm to navigate the photocatalytic CO₂ reduction reaction (CRR). Herein, we elucidate the behaviors of isotype heterojunctions toward photocatalytic CRR over a representative photocatalyst, g-C₃N₄. Impressively, the isotype heterojunctions possess a significantly higher efficiency for the spatial separation and transfer of photogenerated carriers than the single components. Along with the intrinsically outstanding stability, the isotype heterojunctions exhibit an exceptional and stable activity toward the CO₂ photoreduction to CO. More importantly, by combining quantitative in situ technique with the first-principles modeling, we elucidate that the enhanced photoinduced charge dynamics promotes the production of key intermediates and thus the whole reaction kinetics.

A Novel Coagulation Classification and Postoperative Bleeding in Severe Spontaneous Intracerebral Hemorrhage Patients on Antiplatelet Therapy

Background and Purpose

For patients with severe spontaneous intracerebral hemorrhage on antiplatelet therapy (patients with APT-SICH), postoperative rebleeding (PR) is an important cause of poor outcomes after surgery. As impacted by coagulation disorder caused by APT, patients with APT-SICH are likely to suffer from PR. This study aimed to assess the risk of PR in patients with APT-SICH receiving emergency surgery using a novel coagulation classification.

Methods

This prospective, multicenter cohort study consecutively selected patients with APT-SICH between September 2019 and March 2021. The preoperative coagulation factor function was recorded, and the platelet function was assessed using thrombelastography. Based on platelet and coagulation factor function, a novel four-type coagulation classification, i.e., Type I (severe coagulation disorder), Type IIa (low platelet reserve capacity), Type IIb (normal coagulation), and Type III (hypercoagulation), was presented. The primary outcome was PR, defined as the rebleeding in the operative region or new intracerebral hemorrhage correlated with the operation.

Results

Of the included 197 patients with APT-SICH, PR occurred in 40 patients (20.3%). The novel coagulation classification categorized 28, 32, 122, and 15 patients into Type I, Type IIa, Type IIb, and Type III, respectively. The Type I patients had the highest incident rate of PR (39.3 per 100 persons), followed by the Type IIa patients (31.3 per 100 persons). In the PR-related analysis, the large hematoma volume (hazard ratio (HR): 1.02; 95% CI: 1.02–1.03; p < 0.001), Type I (HR: 9.72; 95% CI: 1.19–79.67; p = 0.034), and Type IIa (HR: 8.70; 95% CI: 1.09–69.61; p = 0.041) were correlated with the highest risk of PR. The coagulation classification could discriminate the PR patients from no PR (NPR) patients (p < 0.001), and it outperformed the conventional coagulation assessment (only considering platelet count and coagulation factor function) (c-statistic, 0.72 vs. 0.55).

Conclusion

The novel coagulation classification could discriminate the patients with APT-SICH with the highest risk of PR preoperatively. For the Type I and Type IIa patients, emergency surgery should be performed carefully.

Atomic-Scale Observation of Unusual Dislocations in GaAs-GaAsSb Heterostructured Nanowires

Cognizing the structural characteristics of a heterointerface is significant to understand the growth mechanism of heterostructured nanowires. Here, the structural characteristics of a heterointerface in GaAs-GaAsSb heterostructured nanowires were investigated by employing spherical aberration (C_S)-corrected transmission electron microscopy (TEM). It is found that some unusual dislocations are formed at the heterointerface, leading to the bending of nanowires. Further, the atomically inhomogeneous distribution of Sb content near the heterointerface is revealed, which is responsible for the formation of dislocations. By applying a thermal electric system equipped in the Cs-corrected TEM, a direct observation of structural evolution at the heterointerface was enabled and the stability of GaAs-GaAsSb heterostructured nanowires was evaluated. In situ high-resolution TEM imaging indicates that the destabilization of the heterointerface occurs during nanowire annealing. This study builds a direct correlation between the nanowire heterointerfacial structure with nanowire growth behavior and its stability, which is of importance for heterostructured nanowire design for practical use.

Ablative therapies versus partial nephrectomy for small renal masses - A systematic review and meta-analysis

BACKGROUND

High quality studies and reviews on the management of small renal masses (SRM) are lacking. This review aims to compare oncological outcomes in patients undergoing ablative therapies (AT) or partial nephrectomy (PN) for T1a or T1b SRM.

MATERIAL AND METHODS

Medline, EMBASE, Cochrane CENTRAL and conference proceedings were searched on the 15th July 2020 for comparative studies respective to our research question. The ROBINS-I tool and the GRADE approach were used to assess any risk of biases and certainty of evidence in the included studies. The review is registered on PROSPERO.

RESULTS

1,748 records were retrieved. 32 observational studies and 1 RCT integrating 74,946 patients were included. Patients undergoing AT patients are significantly older than PN patients (MD 5.70, 95%CI 3.83-7.58). In T1a patients, AT patients have significantly worse overall survival (HR 1.64, 95%CI 1.39-1.95). Local recurrence-free survival is similar with PN in patients with longer than five-years follow up (HR 1.54, 95%CI 0.88-2.71). AT patients also have similar cancer-specific survival (CSS), metastasis-free survival, disease-free survival, significantly fewer post-operative complications (RR 0.72, 95%CI 0.55-0.94), and a smaller decline in estimated glomerular filtration rate post-operatively (MD: -7.42, 95%CI -13.1 to -1.70) compared to those undergoing PN. Evidence contradicts in T1b patients for oncological outcomes.

CONCLUSIONS

AT have similar long-term oncological durability; lower rates of complications and superior kidney function preservation compared to PN. Given the low quality of evidence, AT is a reasonable alternative to PN in frail and co-morbid patients. Long-term high-quality studies are needed to confirm the potential benefits of AT, especially in T1b patients.

PROSPERO REGISTRATION

CRD42020199099.

[A single-center retrospective analysis of 77 traumatic arterial injuries of lower extremities]

Objective: To analyze the treatment and clinical prognosis of lower extremity arterial injury caused by trauma. Methods: The clinical data of 77 patients with traumatic lower extremity arterial injury admitted to Department of Vascular Surgery,Yichang Central People's Hospital from January 2013 to June 2021 were collected. There were 65 males and 12 females, with an average age of 47.4 years (range: 7 to 75 years). Among the 77 patients, 56 (72.7%) had open injury and 21 (27.3%) had closed injury. Iliac artery was injured in 9 cases (11.7%), common femoral artery in 7 cases (9.1%), superficial femoral artery in 1 case (1.3%), popliteal artery in 11 cases (14.3%) and inferior knee artery in 49 cases (63.6%). The treatment methods and clinical effects were analyzed. Results: One patient with pelvic fracture combined the internal iliac artery injury and 1 patient with multiple injuries involving the common femoral artery died of circulatory failure before surgery. Seventy-five patients received vascular-related operations, including arterial ligation in 24 cases, arterial reconstruction in 40 cases, stent graft implantation in 1 case, primary amputation in 2 cases, and arterial embolization in 8 cases. The overall mortality rate was 6.5% (5/77), all of which were closed injuries. Except for 2 patients who died before surgery, 3 patients with pelvic fracture combined the internal iliac artery injury died of multiple organ failure after internal iliac artery embolization. There were 8 patients received amputation (10.4%, 8/77), 5 patients with closed injury and 3 patients with open injury. In addition to 2 patients with primary amputation, 6 patients underwent secondary amputation due to ischemia-reperfusion injury after revascularization (4 cases with popliteal artery injury and 2 cases with subpatellar artery injury). The average followed-up time was 17 months (range: 2 months to 8 years). One patient with femoral artery injury underwent autologous great saphenous vein bypass, and lower limb artery CT angiography was re-examined 6 months after the operation, and 30% distal anastomotic stenosis was found. Ankle brachial index<0.8 was found in two patients 1 year after popliteal artery repair, but none of the patients had intermittent claudication symptoms, and no further intervention was performed. Five patients suffered delayed healing due to severe lower limb injury, fracture and skin injury. Among them, 2 patients had poor wound healing at the stump of amputation, which gradually healed 3 to 5 months after several debridements. The other 3 vascular injury combined with tibial fracture patients had delayed tibial healing after surgery, but no symptoms of vascular ischemia occurred. All the other patients recovered well and no other serious complications occurred. Conclusions: The proportion of death and disability in patients with lower limb artery injury caused by trauma is high. Active and orderly surgical repair according to the site and type of injury can reduce the mortality, save the function of the affected limb, and promote the healing of injury.

A Computed Tomography Radiomics-Based Prediction Model on Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis

Objectives: Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5⁺ DM-ILD) is a life-threatening disease. The current study aimed to quantitatively assess the pulmonary high-resolution computed tomography (HRCT) images of MDA5⁺ DM-ILD by applying the radiomics approach and establish a multidimensional risk prediction model for the 6-month mortality.

Methods: This retrospective study was conducted in 228 patients from two centers, namely, a derivation cohort and a longitudinal internal validation cohort in Renji Hospital, as well as an external validation cohort in Guangzhou. The derivation cohort was randomly divided into training and testing sets. The primary outcome was 6-month all-cause mortality since the time of admission. Baseline pulmonary HRCT images were quantitatively analyzed by radiomics approach, and a radiomic score (Rad-score) was generated. Clinical predictors selected by univariable Cox regression were further incorporated with the Rad-score, to enhance the prediction performance of the final model (Rad-score plus model). In parallel, an idiopathic pulmonary fibrosis (IPF)-based visual CT score and ILD-GAP score were calculated as comparators.

Results: The Rad-score was significantly associated with the 6-month mortality, outperformed the traditional visual score and ILD-GAP score. The Rad-score plus model was successfully developed to predict the 6-month mortality, with C-index values of 0.88 [95% confidence interval (CI), 0.79–0.96] in the training set (n = 121), 0.88 (95%CI, 0.71–1.0) in the testing set (n = 31), 0.83 (95%CI, 0.68–0.98) in the internal validation cohort (n = 44), and 0.84 (95%CI, 0.64–1.0) in the external validation cohort (n = 32).

Conclusions: The radiomic feature was an independent and reliable prognostic predictor for MDA5⁺ DM-ILD.

The role of monitoring platelet function perioperatively and platelet transfusion for operated spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy: A case report

Introduction and importance

Spontaneous intracerebral hemorrhage (SICH) with long-term oral antiplatelet therapy (LOAPT) is known as a dilemma in balancing the risk of postoperative rebleeding and ischemic events because of confused coagulation function. We herein describe a report of perioperative management of spontaneous intracerebral hemorrhage patient on long-term oral antiplatelet therapy.

Case presentation

A 42-year-old male patient on long-term oral antiplatelet therapy presented with coma, and he was diagnosed with spontaneous intracerebral hemorrhage. Considering the patient's clinical condition, despite the thromboelastography suggested that the inhibition of platelet function was high preoperatively, an emergency craniectomy were underwent. After platelet transfusion during surgery and taking control of the clotting and platelet function postoperatively, the patient was stable without rebleeding and new ischemic events in perioperative period and recovered satisfactorily.

Clinical discussion

Rare studies have provided evidence for managing operated spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy, and whether platelet transfusion is recommended was controversial. In this case, we presented monitoring and taking control of clotting and platelet function postoperatively would help in preventing rebleeding and ischemic events in such patients; moreover, platelet transfusion may quickly and safely reverse platelet dysfunction for emergency surgery. This case was the first to report platelet function and coagulation function management in spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy.

Conclusion

Monitoring and maintaining coagulation and platelet function perioperatively are essential to balance the risk of postoperative rebleeding and ischemic events.

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Spontaneous intracerebral hemorrhage with antiplatelet therapy is known as a dilemma in postoperative management.

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Antiplatelet therapy may not be the absolute contraindication for surgery in the severe spontaneous intracerebral hemorrhage.

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It is essential to monitor and take control of platelet function in postoperative patients with antiplatelet therapy.

Enabling High-Performance Surfaces of Biodegradable Magnesium Alloys via Femtosecond Laser Shock Peening with Ultralow Pulse Energy

The fast degradation rate and poor wear resistance of magnesium (Mg) alloys in physiological environments have limited their potential usage as next-generation biodegradable orthopedic implant materials. In this work, femtosecond laser shock peening (fs-LSP) was successfully applied to simultaneously improve the surface mechanical, corrosion, and tribocorrosion properties of WE43 Mg alloys in blood bank buffered saline solution at body temperature. Specifically, the treated surfaces of WE43 Mg alloys via fs-LSP with ultralow pulse energy were investigated under different power densities, confining mediums, and absorbent materials. It was found that the combination of a black tape and a quartz layer gave the optimum peening effect under a power density of 28 GW/cm², which simultaneously strengthened the surface and reduced the corrosion kinetics. In addition, a rapid self-repassivation was observed in fs-LSP-treated WE43 surfaces during tribocorrosion, promising sustained corrosion resistance under mechanical loading, critical to the reliability of load-bearing implants. Finally, the subsurface microstructural evolution and residual stress development in WE43 after fs-LSP were discussed based on the results from transmission electron microscopy analysis and finite element simulations.

RNA-Containing Immune Complexes Formed by Anti-Melanoma Differentiation Associated Gene 5 Autoantibody Are Potent Inducers of IFN-α

Objective

Anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody is a distinctive serology hallmark of dermatomyositis (DM). As an autoantigen, MDA5 is a cytoplasmic RNA recognition receptor. The aim of this study was to address the question of whether the RNA-containing immune complex (IC) formed by MDA5 and anti-MDA5 could activate type I interferon (IFN) response.

Method

Patients with anti-MDA5⁺ DM (n = 217), anti-MDA5⁻ DM (n = 68), anti-synthase syndrome (ASyS, n = 57), systemic lupus erythematosus (SLE, n = 245), rheumatoid arthritis (RA, n = 89), and systemic sclerosis (SSc, n = 30) and healthy donors (HD, n = 94) were enrolled in our studies. Anti-MDA5 antibody was detected by line blotting, enzyme-linked immunosorbent assay (ELISA), immunoprecipitation, and Western blotting. Cytokine profiling was determined by multiplex flow cytometry, and IFN-α was further measured by ELISA. Type I IFN-inducible genes were detected by quantitative PCR (qPCR). RNA–IC binding was analyzed by RNA immunoprecipitation. Plasmacytoid dendritic cells (pDCs) derived from healthy donors were cultivated and stimulated with MDA5 ICs with or without RNase and Toll-like receptor 7 (TLR-7) agonist. The interaction between MDA5 ICs and TLR7 was evaluated by immunoprecipitation and confocal microscopy.

Results

According to our in-house ELISA, the presence of anti-MDA5 antibody in 76.1% of DM patients, along with 14.3% of SLE patients who had a lower titer yet positive anti-MDA5 antibody, was related to the high level of peripheral IFN-α. ICs formed by MDA5 and anti-MDA5 were potent inducers of IFN-α via TLR-7 in an RNA-dependent manner in vitro.

Conclusion

Our data provided evidence of the mechanistic relevance between the anti-MDA5 antibody and type I IFN pathway.

A nomogram to predict the risk of postoperative intracranial rebleeding in patients with spontaneous intracranial hematoma

The 30-day mortality rate of spontaneous cerebral hemorrhage (ICH) is approximately 30-50%. Surgery may improve the prognosis of patients with severe ICH. However, ICH survivors after surgery still face the risks of postoperative intracranial rebleeding (PIB), and clinical tools that accurately predict the risk of PIB occurrence are not available. Therefore, a retrospective study was performed. The population was divided into two groups according to the occurrence of PIB. Univariate and multivariate logistic regression analyses were performed to screen risk factors for PIB. Next, an early PIB risk nomogram prediction model was constructed. In addition, the impact of PIB on the prognosis of ICH was evaluated. In total, 150 ICH patients were continuously enrolled in this study; 21 patients suffered from PIB, and the overall incidence of PIB was 14.0% (21/150). Coronary heart disease history, a lower GCS score, and subarachnoid hemorrhage absence were screened as risk factors for early PIB. The early PIB risk nomogram showed good calibration and discrimination with a concordance index of 0.807 (95% confidence interval (CI), 0.715-0.899), which was confirmed to be 0.788 through bootstrapping validation. In addition, a significant difference in discharged GOS scores (P = 0.043) was observed between the PIB group and the n-PIB group. These results showed that a history of coronary heart disease, a lower GCS score, and absence of subarachnoid hemorrhage were risk factors for early PIB. In addition, the early PIB risk nomogram prediction model exhibits good discrimination and calibration. The occurrence of PIB could reduce the prognosis of ICH patients.

Treatment patterns and outcomes of palliative systemic therapy in patients with salivary duct carcinoma and adenocarcinoma, not otherwise specified

BACKGROUND

Salivary duct carcinoma (SDC) and adenocarcinoma, not otherwise specified (adeno-NOS), are rare salivary gland cancers. Data on the efficacy of systemic therapy for these diseases are limited.

METHODS

Data were retrospectively collected from patients seen at The University of Texas MD Anderson Cancer Center during 1990 to 2020. Objective response rate (ORR) was assessed per RECIST v1.1. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were assessed by Kaplan-Meier method. Cox regression model was performed to identify predictors of survival.

RESULTS

The analysis included 200 patients (110 with SDC and 90 with adeno-NOS); 77% had androgen-receptor-positive tumors and 47% had HER2-positive (2+-3+) tumors. Most patients without metastasis at diagnosis underwent surgery (98%) and postoperative radiotherapy (87%). Recurrence rate was 55%, and the median RFS was 2 years. Nodal involvement and positive surgical margins were associated with recurrence (P < .005). Among patients with stage IVA-B disease, addition of systemic therapy to local therapy increased OS (P = .049). The most-used palliative-systemic-therapy regimen was platinum doublet ± trastuzumab. For first-line therapy, the ORR and median PFS were 33% and 5.76 months, respectively, and for second-line therapy the ORR and median PFS were 25% and 5.3 months, respectively. ORR and PFS were higher with HER2-targeting agents. Median OS was 5 years overall and 2 years for metastatic disease. Older age and higher stage were associated with worse OS.

CONCLUSION

Adding systemic therapy to local therapy may improve outcomes of patients with locoregionally advanced SDC or adeno-NOS. Except for HER2-targeted therapy, response to palliative systemic therapy is limited. These findings may be used as a benchmark for future drug development.

Data-driven Exploration of Engagement with Workplace-based Assessment in the Clinical Skills Domain

The paper presents a multi-faceted data-driven computational approach to analyse workplace-based assessment (WBA) of clinical skills in medical education. Unlike formal university-based part of the degree, the setting of WBA can be informal and only loosely regulated, as students are encouraged to take every opportunity to learn from the clinical setting. For clinical educators and placement coordinators it is vital to follow and analyse students’ engagement with WBA while on placements, in order to understand how students are participating in the assessment, and what improvements can be made. We analyse digital data capturing the students’ WBA attempts and comments on how the assessments went, using process mining and text analytics. We compare Year 1 cohorts across three years, focusing on differences between primary vs. secondary care placements. The main contribution of the work presented in this paper is the exploration of computational approaches for multi-faceted, data-driven assessment analytics for workplace learning which includes:(i) a set of features for analysing clinical skills WBA data, (ii) analysis of the temporal aspects ofthat data using process mining, and (iii) utilising text analytics to compare student reflections on WBA. We show how assessment data captured during clinical placements can provide insights about the student engagement and inform the medical education practice. Our work is inspired by Jim Greer’s vision that intelligent methods and techniques should be adopted to address key challenges faced by educational practitioners in order to foster improvement of learning and teaching. In the broader AI in Education context, the paper shows the application of AI methods to address educational challenges in a new informal learning domain - practical healthcare placements in higher education medical training.

A novel CT scoring method predicts the prognosis of interstitial lung disease associated with anti-MDA5 positive dermatomyositis

Anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease (MDA5⁺ DM-ILD) is a life-threatening disease. This study aimed to develop a novel pulmonary CT visual scoring method for assessing the prognosis of the disease, and an artificial intelligence (AI) algorithm-based analysis and an idiopathic pulmonary fibrosis (IPF)-based scoring were conducted as comparators. A retrospective cohort of hospitalized patients with MDA5⁺ DM-ILD was analyzed. Since most fatalities occur within the first half year of the disease course, the primary outcome was the six-month all-cause mortality since the time of admission. A ground glass opacity (GGO) and consolidation-weighted CT visual scoring model for MDA5⁺ DM-ILD, namely ‘MDA5 score’, was then developed with C-index values of 0.80 (95%CI 0.75–0.86) in the derivation dataset (n = 116) and 0.84 (95%CI 0.71–0.97) in the validation dataset (n = 57), respectively. While, the AI algorithm-based analysis, namely ‘AI score’, yielded C-index 0.78 (95%CI 0.72–0.84) for the derivation dataset and 0.77 (95%CI 0.64–0.90) for the validation dataset. These findings suggest that the newly derived ‘MDA5 score’ may serve as an applicable prognostic predictor for MDA5⁺ DM-ILD and facilitate further clinical trial design. The AI based CT quantitative analysis provided a promising solution for ILD evaluation.

Constructing highly active Co sites in Prussian blue analogues for boosting electrocatalytic water oxidation

High-valence cobalt sites are considered as highly active centers for the oxygen evolution reaction (OER) and their corresponding construction is thus of primary importance in the pursuit of outstanding performance. Herein, we report the design and facile synthesis of abundant high-valence cobalt sites by introducing Zn²⁺ into CoFe Prussian blue analogues (PBAs). The modification results in the drastic morphological transformation from a pure phase (CoFe-PBA) to a three-phase composite (CoFeZn-PBA), with a significant increase not only the amount of highly oxidized Co sites but the specific surface area (by up to 4 times). Moreover, the obtained sample also exhibits outstanding electric conductivity. Consequently, an excellent OER performance with an overpotential of 343 mV@10 mA cm^-2 and a Tafel slope of 75 mV dec^-1 was achieved in CoFeZn-PBA, which outperforms the commercial IrO₂ catalyst. Further analysis reveals that CoFeZn-PBA becomes (oxyhydr)oxides after the OER.