Radiomics-based distinction of small (≤2 cm) hepatocellular carcinoma and precancerous lesions based on unenhanced MRI

AIM

To assess the feasibility of a radiomics model based on unenhanced magnetic resonance imaging (MRI) to differentiate small hepatocellular carcinoma (S-HCC) (≤2 cm) and pre-hepatocellular carcinoma (Pre-HCC).

MATERIALS AND METHODS

One hundred and fourteen histopathologically confirmed 114 hepatic nodules were analysed retrospectively. All patients had undergone MRI before surgery using a 3 T MRI system. Each nodule was segmented on unenhanced MRI sequences (T1-weighted imaging [T1] and T2WI with fat-suppression [FS-T2]). Radiomics features were extracted and the optimal features were selected using the least absolute shrinkage and selection operator (LASSO). The support vector machine (SVM) was used to establish the radiomics model. One abdominal radiologist performed the conventional qualitative analysis for classification of S-HCC and Pre-HCC. The diagnostic performances of the radiomics and radiologist models were evaluated using receiver operating characteristic (ROC) analysis.

RESULT

Radiomics features (n=1,223) were extracted from each sequence and the optimal features were selected from T1, FS-T2, and T1+FS-T2 to construct the radiomics models. The radiomics model based on T1+FS-T2 showed the best performance among the three models, with areas under the ROC curves (AUCs) of 0.95 (95 % confidence interval [CI], 0.875-0.986) and 0.942 (95 % CI, 0.775-0.985), accuracies of 86 % and 88.5 %, sensitivities of 94.12 % and 100 %, and specificities of 85.48 % and 85.19 %, respectively. The radiomics model on FS-T2 showed better performance on a single sequence than that of the T1-based model. The diagnostic performance for the radiomic model was significantly higher than that for the radiologist (AUC = 0.518, p<0.05).

CONCLUSION

This study suggested that a radiomics model based on unenhanced MRI may serve as a feasible and non-invasive tool to classify S-HCC and Pre-HCC.

Dehydration-induced corrugated folding in Rhapis excelsa plant leaves

Plant leaves, whose remarkable ability for morphogenesis results in a wide range of petal and leaf shapes in response to environmental cues, have inspired scientific studies as well as the development of engineering structures and devices. Although some typical shape changes in plants and the driving force for such shape evolution have been extensively studied, there remain many poorly understood mechanisms, characteristics, and principles associated with the vast array of shape formation of plant leaves in nature. Here, we present a comprehensive study that combines experiment, theory, and numerical simulations of one such topic-the mechanics and mechanisms of corrugated leaf folding induced by differential shrinking in Rhapis excelsa. Through systematic measurements of the dehydration process in sectioned leaves, we identify a linear correlation between change in the leaf-folding angle and water loss. Building on experimental findings, we develop a generalized model that provides a scaling relationship for water loss in sectioned leaves. Furthermore, our study reveals that corrugated folding induced by dehydration in R. excelsa leaves is achieved by the deformation of a structural architecture-the "hinge" cells. Utilizing such connections among structure, morphology, environmental stimuli, and mechanics, we fabricate several biomimetic machines, including a humidity sensor and morphing devices capable of folding in response to dehydration. The mechanisms of corrugated folding in R. excelsa identified in this work provide a general understanding of the interactions between plant leaves and water. The actuation mechanisms identified in this study also provide insights into the rational design of soft machines.

Effects of wollastonite and phosphate treatments on cadmium bioaccessibility in pak choi (Brassica rapa L. ssp. chinensis) grown in contaminated soils

Cadmium (Cd) contamination of soil can strongly impact human health through the food chain due to uptake by crop plants. Inorganic immobilizing agents such as silicates and phosphates have been shown to effectively reduce Cd transfer from the soil to cereal crops. However, the effects of such agents on total Cd and its bioaccessibility in leafy vegetables are not yet known. Pak choi (Brassica rapa L. ssp. chinensis) was here selected as a representative leafy vegetable to be tested in pots to reveal the effects of silicate-phosphate amendments on soil Cd chemical fractions, total plant Cd levels, and plant bioaccessibility. The collected Cd contaminated soil was mixed with control soil at 1:0, 1:1, 1:4, 0:1 with a view to Cd high/moderate/mild/control soil samples. Three heavy metal-immobilizing agents: wollastonite (W), potassium tripolyphosphate (KTPP), and sodium hexametaphosphate (SHMP) were added to the soil in order to get four different treatment groups, i.e., control (CK), application of wollastonite alone (W), wollastonite co-applied with KTPP (WKTPP), application of wollastonite co-applied with SHMP (WSHMP) for remediation of soils with different levels of Cd contamination. All three treatments increased the effective bio-Cd concentration in the soils with varying levels of contamination, except for W under moderate and heavy Cd contamination. The total Cd concentration in pak choi plants grown in mildly Cd-contaminated soil was elevated by 86.2% after WKTPP treatment compared to the control treatment could function as a phytoremediation aid for mildly Cd-contaminated soil. Using an in vitro digestion method (physiologically based extraction test) combined with transmission electron microscopy, silicate and phosphorus agents were found to reduce the bioaccessibility of Cd in pak choi by up to 66.13% with WSHMP treatment. Application of silicate alone reduced soil bio-Cd concentration through the formation of insoluble complexes and silanol groups with Cd, but the addition of phosphate may have facilitated Cd translocation into pak choi by first co-precipitating with Ca in wollastonite while simultaneously altering soil pH. Meanwhile, wollastonite and phosphate treatments may cause Cd to be firmly enclosed in the cell wall in an insoluble form, reducing its translocation to edible parts and decreasing the bioaccessibility of Cd in pak choi. This study contributes to the mitigation of Cd bioaccessibility in pak choi by reducing soil Cd concentration through in situ remediation and will help us to extend the effects of wollastonite and phosphate on Cd bioaccessibility to other common vegetables. Therefore, this study thus reveals effective strategies for the remediation of soil Cd and the reduction of Cd bioaccessibility in crops based on two indicators: total Cd and Cd bioaccessibility. Our findings contribute to the development of methods for safer cultivation of commonly consumed leafy vegetables and for soil remediation.

Strigolactones alleviate AlCl3 stress by vacuolar compartmentalization and cell wall blocking in apple

Poor management and excess fertilization of apple (Malus domestica Borkh.) orchards are causing increasingly serious soil acidification, resulting in Al toxicity and direct poisoning of roots. Strigolactones (SLs) are reported to be involved in plant responses to abiotic stress, but their role and mechanism under AlCl3 stress remain unknown. Here, we found that applying 1 μm GR24 (an SL analoge) significantly alleviated AlCl3 stress of M26 apple rootstock, mainly by blocking the movement of Al through cell wall and by vacuolar compartmentalization of Al. RNA-seq analysis identified the core transcription factor gene MdWRKY53, and overexpressing MdWRKY53 enhanced AlCl3 tolerance in transgenic apple plants through the same mechanism as GR24. Subsequently, we identified MdPMEI45 (encoding pectin methylesterase inhibitor) and MdALS3 (encoding an Al transporter) as downstream target genes of MdWRKY53 using chromatin immunoprecipitation followed by sequencing (ChIP-seq). GR24 enhanced the interaction between MdWRKY53 and the transcription factor MdTCP15, further increasing the binding of MdWRKY53 to the MdPMEI45 promoter and inducing MdPMEI45 expression to prevent Al from crossing cell wall. MdWRKY53 also bound to the promoter of MdALS3 and enhanced its transcription to compartmentalize Al in vacuoles under AlCl3 stress. We therefore identified two modules involved in alleviating AlCl3 stress in woody plant apple: the SL-WRKY+TCP-PMEI module required for excluding external Al by blocking the entry of Al3+ into cells and the SL-WRKY-ALS module allowing internal detoxification of Al through vacuolar compartmentalization. These findings lay a foundation for the practical application of SLs in agriculture.

Presentation, anagement, and outcomes of norovirus in adult and pediatric solid organ and hematopoietic stem cell transplant recipients: A multicenter, retrospective study

BACKGROUND

Norovirus (NoV) can cause chronic relapsing and remitting diarrhea in immunocompromised patients.  Few multicenter studies have described the clinical course, outcomes, and complications of chronic NoV in transplant recipients.

METHODS

A multicenter retrospective study of adult and pediatric SOT and HSCT recipients diagnosed with NoV between November 1, 2017, and February 28, 2021. Data were obtained from electronic medical records (EMR) and entered into a central REDCap database. Descriptive statistics were calculated.

RESULTS

A total of 280 NoV+ patients were identified across eight sites. The majority were adults (74.1%) and SOT recipients (91.4%). Initial diagnosis of NoV occurred a median of 36 months post-Tx (IQR [15.0, 90.0]). Most NoV cases had >3 diarrheal episodes daily (66.0%), nausea and vomiting (60.1%). Duration of diarrhea varied greatly (median = 10 days, mean = 85.9 days, range (1, 2100)). 71.3% were hospitalized. Adjustment of immunosuppression, including reduction and discontinuation of mToR inhibitor, CNI, and/or MMF, was the most common management intervention for NoV. Other therapies resulted only in temporary improvement. Four patients died within 30 days and three others died by 180 days postdiagnosis. Clinically significant renal dysfunction was observed in 12.5% by 30 days and 21.4% by 180 days post-NoV diagnosis.

CONCLUSION

In HSCT and SOT patients, NoV frequently resulted in severe symptoms, prolonged diarrhea (30% persistent with diarrhea for >30 days), and clinically significant renal dysfunction (up to 21% of patients). Utilized therapies did not reliably result in the resolution of infection demonstrating the need for more effective treatment.

Self-regulated reversal deformation and locomotion of structurally homogenous hydrogels subjected to constant light illumination

Environmentally adaptive hydrogels that are capable of reconfiguration in response to external stimuli have shown great potential toward bioinspired actuation and soft robotics. Previous efforts have focused mainly on either the sophisticated design of heterogeneously structured hydrogels or the complex manipulation of external stimuli, and achieving self-regulated reversal shape deformation in homogenous hydrogels under a constant stimulus has been challenging. Here, we report the molecular design of structurally homogenous hydrogels containing simultaneously two spiropyrans that exhibit self-regulated transient deformation reversal when subjected to constant illumination. The deformation reversal mechanism originates from the molecular sequential descending-ascending charge variation of two coexisting spiropyrans upon irradiation, resulting in a macroscale volumetric contraction-expansion of the hydrogels. Hydrogel film actuators were developed to display complex temporary bidirectional shape transformations and self-regulated reversal rolling under constant illumination. Our work represents an innovative strategy for programming complex shape transformations of homogeneous hydrogels using a single constant stimulus.

The distribution characteristics of strabismus surgery types in a tertiary hospital in the Central Plains region during the COVID-19 epidemic

OBJECTIVE

This study aimed to analyze the distribution of different types of strabismus surgery in a tertiary hospital in Central China during the three-year period of the COVID-19 pandemic.

METHODS

A retrospective analysis was conducted on the clinical data of strabismus patients who underwent surgery and were admitted to the Department of Strabismus and Pediatric Ophthalmology at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022.

RESULTS

A total of 3939 strabismus surgery patients were collected, including 1357 in 2020, 1451 in 2021, and 1131 in 2022. The number of surgeries decreased significantly in February 2020, August 2021, and November and December 2022. Patients aged 0-6 years accounted for 37% of the total number of strabismus surgery patientsr. The majority (60%) of all strabismus surgery patients were diagnosed with exotropia, with intermittent exotropia accounting for the highest proportion (53%). There was no statistically significant difference in the proportion of intermittent exotropia and constant exotropia during the three-year period (χ2 = 2.642, P = 0.267 and χ2 = 3.012, P = 0.221, respectively). Among patients with intermittent exotropia, insufficient convergence type was the most common form of strabismus (accounting for over 70%). Non-accommodative esotropia accounted for more than 50% of all internal strabismus cases.

CONCLUSION

During the period from 2020 to 2022, the total number of strabismus surgeries in our hospital did not show significant fluctuations, but there was a noticeable decrease in the number of surgeries during months affected by the pandemic. Exotropia accounted for the highest proportion among strabismus surgery patients. Intermittent exotropia was the most common type among patients undergoing surgery for exotropia, and the most prevalent subtype was the insufficient convergence type. The age distribution of patients varied in different months, with a concentration of surgeries for strabismus patients in the 7-12 years old age group during the months of July and August each year.

Brief PROMIS Assessment Screens for Frailty and Predicts Hospitalizations in Liver Transplant Candidates

BACKGROUND

Frailty is prevalent in patients with end-stage liver disease and predicts waitlist mortality, posttransplant mortality, and frequency of hospitalizations. The Liver Frailty Index (LFI) is a validated measure of frailty in liver transplant (LT) candidates but requires an in-person assessment.

METHODS

We studied the association between patient-reported physical function and LFI in a single-center prospective study of adult patients with cirrhosis undergoing LT evaluation from October 2020 to December 2021. Frailty was assessed with the LFI and 4-m gait speed. Patient-reported physical function was evaluated using a brief Patient-Reported Outcomes Measurement Information System (PROMIS) survey.

RESULTS

Eighty-one LT candidates were enrolled, with a mean model of end-stage liver disease-sodium of 17.6 (±6.3). The mean LFI was 3.7 (±0.77; 15% frail and 59% prefrail) and the mean PROMIS Physical Function score was 45 (±8.6). PROMIS Physical Function correlated with LFI ( r  = -0.54, P  < 0.001) and 4-m gait speed ( r  = 0.48, P  < 0.001). The mean hospitalization rate was 1.1 d admitted per month. After adjusting for age, sex, and model of end-stage liver disease-sodium, patient-reported physical function-predicted hospitalization rate ( P  = 0.001).

CONCLUSIONS

This study suggests that a brief patient-reported outcome measure can be used to screen for frailty and predict hospitalizations in patients with cirrhosis.

A Bio-Inspired Safety Control System for UAVs in Confined Environment With Disturbance

This article presents a bio-inspired safety control scheme for unmanned aerial vehicles (UAVs) in confined environments with disturbance. Although there has been some existing research on the effect of disturbance for a single UAV, multi-UAV formation under external wind disturbances remains challenging, especially in a tight and confined environment. Inspired by nature, this study concentrates on an anti-disturbance mechanism for safe multi-UAV formation in a tight environment. The presented safety control system combines disturbance observer-based control (DOBC), bionic formation switching (BFS) strategy, and safety evaluation. Two safety issues are considered in this article. For a single UAV, the estimated disturbance is compensated in the inner-loop controller. While for multi-UAV formation, the BFS strategy attenuates the effect of external wind disturbance leveraging the formation configuration. The so-called group perturbation immune factor (GPIF) is designed to analyze and evaluate the safety of the overall formation. The experimental results validate the comprehensiveness and anti-disturbance capability of the system.

[Expression of endosialin in human hypertrophic scars and its regulation on fibroblast phenotype]

Objective: To explore the expression of endosialin, i.e., CD248 in human hypertrophic scars (HSs) and its regulatory effect on the phenotype of hypertrophic scar fibroblasts (HSFs). Methods: The method of experimental research was used. From March to May, 2023, 3 pediatric patients with HS were admitted to the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University, including 2 females and 1 male, aged one year ten months to two years. The HS tissue resected during the surgery and the remaining full-thickness skin graft, i.e., normal skin tissue after full-thickness skin grafting were collected from the aforementioned pediatric patients for subsequent experiments. Using the aforementioned two types of tissue, the histological structures were observed by hematoxylin-eosin staining, collagen distribution was observed by Masson staining, and the expression of CD248 was observed and measured by immunohistochemical staining. The primary HSFs were isolated from HS tissue using explant culture technique, and the 3rd to 5th passages of HSFs were used in subsequent experiments. According to the random number table, HSFs were divided into immunoglobulin G78 (IgG78)-treated group and IgG control group, which were treated with 200 nmol/L human CD248 monoclonal antibody IgG78 and human IgG control antibody for 24 h, respectively. The mRNA expressions of collagen type Ⅰ (Col Ⅰ) and α-smooth muscle actin (α-SMA) in HSFs were measured by real-time fluorescence quantitative reverse transcription polymerase chain reaction, the protein expressions of Col Ⅰ and α-SMA in HSFs were detected by Western blotting, and the intracellular location and protein expressions of Col Ⅰ and α-SMA were detected by immunofluorescence method. The number of samples in each experiment was 3. Data were statistically analyzed with paired sample t test and independent sample t test. Results: Compared with those in normal skin tissue, the epidermis and dermis in HS tissue were significantly thicker, with massive accumulation and disordered arrangement of collagen in the dermis. The expression of CD248 in HS tissue was significantly upregulated compared with that in normal skin tissue (t=5.29, P<0.05). At post treatment hour 24, the mRNA expressions of Col Ⅰ and α-SMA of HSFs in IgG78-treated group were 0.39±0.05 and 0.56±0.09, respectively, which were significantly lower than 1.00±0.07 and 1.00±0.08 in IgG control group, respectively (with t values of 11.87 and 6.49, respectively, P values all <0.05). The protein expressions of Col Ⅰ and α-SMA of HSFs in IgG78-treated group were 0.617±0.011 and 0.67±0.14, respectively, which were significantly lower than 1.259±0.052 and 1.23±0.16 in IgG control group, respectively (with t values of 20.92 and 4.52, respectively, P values all <0.05). At post treatment hour 24, immunofluorescence staining showed that Col Ⅰ and α-SMA mainly located in the cytoplasm of HSFs in the two groups, and the protein expressions of Col Ⅰ and α-SMA of HSFs in IgG78-treated group were obviously downregulated compared with those in IgG control group. Conclusions: The expression of CD248 is significantly upregulated in human HS. Targeted blockade of CD248 can significantly inhibit the collagen synthesis by HSFs and the transdifferentiation of HSFs into myofibroblasts.

Factors Underlying Racial Disparity in Utilization of Hepatitis C-Viremic Kidneys in the United States

Utilization of hepatitis C (HCV) viremic kidneys is increasing in the United States. We examined racial disparity in this utilization using UNOS/OPTN data (2014-2020) and mixed effects models adjusting for donor/recipient/center factors. Included in the study were 58,786 adults receiving a deceased donor kidney transplant from 191 centers. Two thousand six hundred thirteen (4%) received kidneys from HCV-viremic donors. Of these, 1598 (61%) were HCV seronegative and 1015 (49%) were HCV seropositive. Among seronegative recipients, before adjusting for waiting time and education, Blacks (OR 0.69, 95%CI (0.60, 0.80)), Hispanics (OR 0.63, 95%CI (0.51, 0.79)), and Asians (OR 0.69, 95%CI (0.53, 0.90)) were less likely than Whites to receive HCV-viremic kidneys. In final models, effect of race was attenuated. Notably, shorter waiting time (OR 0.65, 95%CI (0.63, 0.67)) and increasing educational level (grade school less likely compared to high school OR 0.67, 95% CI (0.49, 0.92) and college more likely than high school (OR 1.16 95% CI (1.02, 1.31)) were associated with receipt of HCV-viremic kidneys. Among HCV-seropositive recipients, recipient race was not independently associated with receipt of HCV-viremic kidneys; however, centers with larger populations of Black waitlisted patients were more likely to utilize HCV-viremic kidneys (OR 1.71, 95%CI (1.20, 2.45)) compared to other centers. Our results suggest recipient race does not independently determine who receives HCV-viremic kidneys; however, other underlying factors including waiting time, education (among seronegative), and center racial mix (among seropositive) contribute to the current differential distribution of HCV-viremic kidneys among races.

Postoperative ecchymoma of eyelid after botulinum toxin injection for hemifacial spasm: a case report

Hemifacial spasm (HFS) is a rare movement disorder characterized by involuntary muscle contractions on one side of the face. Compared to the high therapeutic effect, adverse effects of botulinum toxin treatment for HFS occurred rarely. However, managing HFS patients who are also taking antithrombotic drugs poses a challenge. Here, we present a case of postoperative ecchymoma of the eyelid following a botulinum toxin injection in a patient receiving daily vinpocetine and aspirin antiplatelet therapy. This case highlights the importance of considering the potential risks and formulating a treatment plan that maximizes benefit while minimizing complications in HFS patients undergoing botulinum toxin injections and taking antithrombotic medications. To the best of our knowledge, this is the first reported case of postoperative ecchymoma of the eyelid following a botulinum toxin injection. Further research and additional case reports are needed to better understand the management strategies for this patient population.

E. urophylla × E. grandis high-quality genome and comparative genomics provide insights on evolution and diversification of eucalyptus

BACKGROUND

Eucalyptus urophylla × Eucalyptus grandis, an economically important forest tree, provides important raw material for energy and reduces damage to native forests. However, the absence of a high-quality E. urophylla × E. grandis reference genome has significantly hindered its evolution and genetic analysis.

RESULTS

We successfully presented a high-quality reference genome of E. urophylla × E. grandis (545.75 Mb; scaffold N50, 51.62 Mb) using a combination of the Illumina, PacBio HiFi, and Hi-C sequencing platforms. A total of 34,502 genes and 58.56% of the repetitive sequences in this genome were annotated. Using genome evolution analyses, we identified a recent whole-genome duplication (WGD) event in E. urophylla × E. grandis. We further found that gene families associated with starch and sucrose metabolism, flavonoid biosynthesis, and plant-pathogen interaction were significantly expanded in E. urophylla × E. grandis. Moreover, comparative genomic and evolutionary analyses showed large structural variations among the different chromosomes of the 34 Eucalyptus accessions, which were divided into six clades.

CONCLUSIONS

Overall, our findings provide a valuable resource for expanding our understanding of the E. urophylla × E. grandis genome evolution, genetic improvement, and its comparative biology.

Genetic and phenotypic heterogeneity of multiple lentigines and precise diagnosis in four Chinese families with multiple lentigines

Lentigines are well-defined, small, brown macules resulting from the accumulation of melanin content in the basement membrane zone with an increase in the number of melanocytes. Hereditary multiple lentigines (ML) can be associated with multiple genes and are not commonly encountered in clinical practice. Patients can solely have skin involvement or present with multisystemic deformative phenotypes. This study aimed to describe four unrelated Chinese families presenting with ML as their first visit symptom. We performed whole-exome sequencing (WES) and Sanger sequencing on all patients and immediate family members for precise molecular diagnosis. Two novel variants c.1548 T > A (p.Ser516Arg) and c.1811C > A (p.Thr604Lys) in SASH1, and two recurrent variants c.1403C > T (p.Thr468Met) and c.1493G > T (p.Arg498Leu) in PTPN11, were identified in these four families. We also summarized the genes associated with ML and differential diagnosis of pigment abnormality. We suggested that the molecular diagnosis of ML should be emphasized because it can help in the clinical differential diagnosis and further genetic counseling and prognosis.

Safety Flight Control Design of a Quadrotor UAV With Capability Analysis

This article considers the safety control problem of a quadrotor unmanned aerial vehicle (UAV) subject to actuator faults and external disturbances, based on the quantization of system capability and safety margin. First, a trajectory function is constructed online with backpropagation of system dynamics. Therefore, a degraded trajectory is gracefully regenerated, via the tradeoff between the remaining system capability and the expected derivatives (velocity, jerk, and snap) of the trajectory. Second, a control-oriented model is established into a form of strict feedback, integrating actuator malfunctions and disturbances. Therefore, a retrofit dynamic surface control (DSC) scheme based on the control-oriented model is developed to improve the tracking performance. When comparing to the existing control methods, the compensation ability is analyzed to determine whether the faults and disturbances can be handled or not. Finally, simulation and experimental studies are conducted to highlight the efficiency of the proposed safety control scheme.

Identification of Toxicity Forcing Agents from Individual Aliphatic and Aromatic Disinfection Byproducts Formed in Drinking Water: Implications and Limitations

Recently, a study found that aromatic DBP fractions dominate the overall toxicity of chlorinated drinking water. However, key toxicity drivers have not been reported via comprehensive evaluation based on the formation of aliphatic and aromatic DBPs in drinking water. In this study, the occurrence of 37 aliphatic and 19 aromatic DBPs in drinking samples with different water characteristics collected in a Chinese megacity was explored. According to the individual DBP concentrations and cytotoxicity potencies as well as the "TIC-Tox" method, haloacetonitriles and halonitrophenols were found to be the toxicity drivers among the measured aliphatic and aromatic DBPs, respectively. However, when aromatic and aliphatic DBPs are taken into consideration together, aliphatic DBPs were calculated to present higher toxicity contribution than aromatic DBPs, which is inconsistent with the previous study. TOX showed significant positive correlations with most aliphatic DBPs but no aromatic DBPs, and the overall toxicity of the water sample concentrates is significantly related to the total calculated cytotoxicity and aliphatic DBPs, suggesting that current selected aromatic DBPs are insufficient to represent the overall aromatic DBPs. UV254 and DOC rather than SUVA are better surrogates for predicting DBP formation potential for DOM with a lower humification degree as indicated by fluorescence results.

Efficacy and Safety of Probiotics in Geriatric Patients with Constipation: Systematic Review and Meta-Analysis

BACKGROUND

Probiotics may be an effective alternative to traditional drug therapy for constipation in the elderly.

OBJECTIVE

To assess the efficacy and safety of probiotics in managing constipation among the elderly.

METHODS

Eight databases were queried for randomized controlled trials (RCTs) investigating probiotics' efficacy in addressing constipation among the elderly until January 2023. The meta-analysis was conducted employing R software version 4.2.2. The Cochrane risk of bias tool was utilized to evaluate the risk of bias, and the GRADE approach was employed to assess the credibility of the evidence concerning the efficacy of probiotics in treating constipation in older individuals.

RESULTS

A total of six RCTs involving 444 patients were included. Two studies were rated as low risk of bias. The meta-analysis findings revealed that probiotics, when compared to a placebo, led to an increase in stool frequency (MD = 1.02,95% CI [0.21, 2.07], p<0.05, very low quality), the probiotic group exhibited a notable impact on ameliorating symptoms associated with constipation (OR = 11.28, 95%CI [7.21, 17.64], p < 0.05, very low quality), no significant disparities were observed in terms of efforts to evacuate, manual maneuvers, and the incidence of adverse events (p>0.05).

CONCLUSION

The available evidence indicates a degree of uncertainty, ranging from low-to-very low, suggesting the efficacy of probiotics in augmenting bowel frequency and ameliorating constipation-related symptoms among elderly patients with constipation. Nevertheless, given the quality of the studies included, it is advisable to conduct further well-designed investigations with substantial sample sizes to substantiate the findings of this study.

Programmed Death of Microglia in Alzheimer's Disease: Autophagy, Ferroptosis, and Pyroptosis

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline, amyloid-β (Aβ) plaques and the formation of neurofibrillary tangles (NFTs) composed of hyperphosphorylated tau. Increasing evidence has demonstrated that the damage of cell plays an important role in AD. Cell death is a critical phenomenon for physiological functions, which promotes AD pathogenesis. Programmed cell death, including necroptosis, pyroptosis, autophagy, and ferroptosis, have been discovered that have unique biological functions and pathophysiological characteristics. Here, we review the available evidence detailing the mechanisms of programmed microglial death, including pyroptosis, autophagy, and ferroptosis. We also highlight the role of programmed death of microglia during the process of AD and focus on the connection between the disease and cell death.

Risk Assessment of China Rapeseed Supply Chain and Policy Suggestions

Rapeseed, as the most important oil crop in the world, not only affects national food security but also affects energy security and environmental security. It is very important to conduct a risk assessment of China's rapeseed supply chain and put forward suggestions to construct a safe, effective, and accessible supply chain. In order to accurately evaluate the safety of the rapeseed supply chain from 2010 to 2020, we applied fuzzy multiconnection theory and analytic hierarchy process model (AHP). A comprehensive risk assessment model for the rapeseed supply chain with two primary indicators and 10 secondary indicators was constructed. By establishing the rapeseed risk evaluation model, we quantitatively analyzed the risk of China's rapeseed supply chain. The domestic risk of production is still high, and the international risk under the high import dependence is alarming. We put forward risk prevention and countermeasures for China's rapeseed supply chain. The results show that China has a large demand for rapeseed products, but the increase in China production is limited and the import from other countries is unstable. The proposed suggestions are designed to optimize and enhance the stability of the rapeseed product's supply chain. It is recommended to continue to consolidate and deepen the cooperation with traditional trading partners such as Germany, Spain, the United States, and Brazil; expand other import sources to build a more diversified and efficient rapeseed product import network and extend the supply chain of rapeseed products. This research can be a basis for making decisions for promoting the sustainable and efficient development of the rapeseed supply chain.

Solvent-Free Synthesis of Magnetic Sewage Sludge-Derived Biochar for Heavy Metal Removal from Wastewater

The commonly used two-step and one-pot synthesis methods for producing biochar require the use of iron salt solutions, resulting in the undesirable consequences of energy consumption for dewatering and potential pollution risks. To address this drawback, a magnetic sewage sludge-derived biochar (MSBC-2) was synthesized by a solvent-free method in this study. The pseudo-second-order kinetic model and Langmuir model provided the best fit to the experimental data, implying a monolayered chemisorption process of Pb2+, Cd2+and Cu2+ onto MSBC-2. As the reaction temperature increased from 25 °C to 45 °C, the maximum adsorption capacities increased from 113.64 mg·g−1 to 151.52 mg·g−1 for Pb2+, from 101.01 mg·g−1 to 109.89 mg·g−1 for Cd2+ and from 57.80 mg·g−1 to 74.07 mg·g−1 for Cu2+, respectively. Thermodynamic parameters (ΔG0 < 0, ΔS0 > 0, ΔH0 > 0) revealed that the adsorption processes of all three metals by MSBC-2 were favourable, spontaneous and endothermic. Surface complexation, cation-π interaction, ion exchange and electrostatic attraction mechanisms were involved in the adsorption of Pb2+, Cd2+ and Cu2+ onto MSBC-2. Overall, this study will provide a new perspective for the synthesis of magnetic biochar and MSBC-2 shows great potential as an adsorbent for heavy metal removal.

Spatial-Temporal Evolution and Improvement Measures of Embodied Carbon Emissions in Interprovincial Trade for Coal Energy Supply Bases: Case Study of Anhui, China

On account of the long-term dependence on energy trade and the phenomenon of embodied carbon emissions in interprovincial trade (ECEs-IPT), energy supply bases (ESBs) in the economic integration regions (EIRs) are under unprecedented dual pressure of achieving carbon emissions (CEs) reduction targets and ensuring security and stability of the energy supply. This problem has attracted more and more attention and research by experts and scholars. This paper took Anhui, the coal ESB of the Yangtze River Economic Belt (YREB), as an example and took the key stage of rapid development of regional economic integration (REI) and accelerated the realization of CEs reduction targets in YREB from 2007 to 2017 as the study period. From the perspectives of regions and industry sectors, we calculated the transfer amount of ECEs-IPT in Anhui among the YREB, analyzed the spatial-temporal evolution pattern of ECEs-IPT, and revealed the industrial characteristics of ECEs-IPT. Then, we classified the industry sectors and proposed the direction of industrial improvement measures. The results showed that, during the decade, the amount of provinces undertaking the net ECEs-IPT outflow from Anhui increased significantly and spatially expanded from only Jiangxi Province to almost all of the YREB. In addition, 39.77% of the net ECEs-IPT outflow of Anhui was concentrated in petroleum processing, coking, and nuclear fuel processing (RefPetraol), metal smelting and rolling processing (MetalSmelt), and electricity and heat production and supply (ElectpowerProd) that trade with Shanghai, Jiangsu, Zhejiang, and Jiangxi. The analytical model and results will provide a useful reference for the global similar coal ESBs, especially the coal ESBs within the EIRs, to formulate improvement measures for regions or even the world to ensure stability of the energy supply and achieve regional CEs reduction targets.

215a. Use of Viracor Cytomegalovirus T-Cell Immunity Panel (TCIP) to Predict the Risk of Recurrent Cytomegalovirus Infection in Solid Transplant Patients and Guide Appropriate Management

Background

Cytomegalovirus infection (CMV) is the most common opportunistic infection in solid organ transplant recipients (SOTR). Predicting recurrent disease and appropriate use of secondary antiviral prophylaxis is currently poorly defined. CMV-specific T-cell assays have been shown to be promising tools in determining presence of CMV immunity and helping guide primary and secondary antiviral prophylaxis. The goal of this study was to evaluate the ability of commercially available CMV-TCIP in predicting the risk of CMV relapse.

Methods

After IRB approval, clinical and laboratory data was retrospectively collected from our Enterprise Data Warehouse and primary chart review on 74 SOTR. As part of routine clinical care, the CMV T-Cell Immunity Panel (CMV-TCIP, Viracor Eurofins, Lenexa, KS) were collected by the TID provider managing the infection; generally this was done around the time of first negative test to inform choice of 2° prophylaxis. Analysis was completed for the total patient population and a subgroup of patients with CMV-TCIP tests completed ± 21 days of the first negative CMV VL. Descriptive statistics and Cohen’s Kappa statistics were used to assess association of relapse with assay results.

Results

Patient demographics are shown in Table 1. 2° prophylaxis was given to 60 (81.1%) of total patients for a mean of 86 days (0-614 days) after the first negative CMV VL. 26 (35.1%) SOTRs had relapse – 9 with positive CD4 and 20 with positive CD8 CMV-TCIP values. There was no association between specific test results and risk of relapse in the overall study population (see table 2). Similarly, no significance was found in the subgroup analysis of patients with CMV-TCIP results ± 21 days after first negative CMV VL.

Conclusion

In this study, CMV-TCIP did not predict CMV relapse after initial infection and treatment. While prior studies have shown a potential role for assessment of CMV-specific immunity to guide need for secondary prophylaxis, more studies of the CMV-TCIP are needed to assess the utility of this assay for this indication.

Disclosures

Michael P. Angarone, DO, Abbvie: Advisor/Consultant Valentina Stosor, MD, DiaSorin: Advisor/Consultant|Eli Lilly and Company: Grant/Research Support|Med Learning Group: Honoraria Michael G. Ison, MD MS, GlaxoSmithKlein: Grant/Research Support|Pulmocide: Grant/Research Support|Viracor Eurfins: Advisor/Consultant.

Leaf morphogenesis: The multifaceted roles of mechanics

Plants produce a rich diversity of biological forms, and the diversity of leaves is especially notable. Mechanisms of leaf morphogenesis have been studied in the past two decades, with a growing focus on the interactive roles of mechanics in recent years. Growth of plant organs involves feedback by mechanical stress: growth induces stress, and stress affects growth and morphogenesis. Although much attention has been given to potential stress-sensing mechanisms and cellular responses, the mechanical principles guiding morphogenesis have not been well understood. Here we synthesize the overarching roles of mechanics and mechanical stress in multilevel and multiple stages of leaf morphogenesis, encompassing leaf primordium initiation, phyllotaxis and venation patterning, and the establishment of complex mature leaf shapes. Moreover, the roles of mechanics at multiscale levels, from subcellular cytoskeletal molecules to single cells to tissues at the organ scale, are articulated. By highlighting the role of mechanical buckling in the formation of three-dimensional leaf shapes, this review integrates the perspectives of mechanics and biology to provide broader insights into the mechanobiology of leaf morphogenesis.

Single Center Experience with Incidence, Impact and Predictors of Biliary Complications in Donation After Circulatory Death Liver Transplantation

Introduction: Utilizing allografts from donors after cardiac death (DCD) has improved organ availability, and DCD livers comprise a growing proportion of transplantations. However, it has been suggested that DCD transplantations have worse outcomes. Research Questions: We aimed to characterize outcomes in a large cohort of DCD transplantations, identify trends in outcomes over time, and identify factors associated with the development of biliary complications. Design: We conducted an observational retrospective cohort study of patients receiving DCD liver allografts within a large academic teaching hospital with a high transplantation volume. Consecutive patients who underwent Type III DCD liver transplantation from 2006-2016 were included in our cohort. Re-transplantations and multi-organ transplant recipients were excluded. Results: Ninety-six type III DCD transplantations occurred between 2006-2016. We report a 1one-year patient survival of 90.6% (87) and a 5five-year patient survival of 69.8% (67). Twenty-nine (30.2%) patients experienced any biliary complication in the first year following discharge, with 17 (17.7%) experiencing ischemic cholangiopathy. Five-year patient (P = 0.04) and graft (P = 0.005) survival improved over time. Post-operative biliary complications experienced during index admission and prior to discharge were found to be associated with the development of biliary complications (P = 0.005) and ischemic cholangiopathy (P = 0.01) following discharge. Conclusion: Our data suggested that outcomes using DCD allografts have improved, however biliary complications remain a significant issue in DCD transplantation. Patients who experienced post-operative biliary complications during index admission may require more frequent screening to allow the initiation of earlier treatment for biliary complications.

Prediction of Liver Transplant Rejection With a Biologically Relevant Gene Expression Signature

BACKGROUND

Noninvasive biomarkers distinguishing early immune activation before acute rejection (AR) could more objectively inform immunosuppression management in liver transplant recipients (LTRs). We previously reported a genomic profile distinguishing LTR with AR versus stable graft function. This current study includes key phenotypes with other causes of graft dysfunction and uses a novel random forest approach to augment the specificity of predicting and diagnosing AR.

METHODS

Gene expression results in LTRs with AR versus non-AR (combination of other causes of graft dysfunction and normal function) were analyzed from single and multicenter cohorts. A 70:30 approach (61 ARs; 162 non-ARs) was used for training and testing sets. Microarray data were normalized using a LT-specific vector.

RESULTS

Random forest modeling on the training set generated a 59-probe classifier distinguishing AR versus non-AR (area under the curve 0.83; accuracy 0.78, sensitivity 0.70, specificity 0.81, positive predictive value 0.54, negative predictive value [NPV] 0.89; F-score 0.61). Using a locked threshold, the classifier performed well on the testing set (accuracy 0.72, sensitivity 0.67, specificity 0.73, positive predictive value 0.48, NPV 0.86; F-score 0.56). Probability scores increased in samples preceding AR versus non-AR, when liver function tests were normal, and decreased following AR treatment (P < 0.001). Ingenuity pathway analysis of the genes revealed a high percentage related to immune responses and liver injury.

CONCLUSIONS

We have developed a blood-based biologically relevant biomarker that can be detected before AR-associated graft injury distinct from LTR never developing AR. Given its high NPV ("rule out AR"), the biomarker has the potential to inform precision-guided immunosuppression minimization in LTRs.

Donor-derived cell-free DNA levels predict graft injury in liver transplant recipients

Donor-derived cell-free DNA (dd-cfDNA) has been evaluated as a rejection marker in organ transplantation. This study sought to assess the utility of dd-cfDNA to diagnose graft injury in liver transplant recipients (LTR) and as a predictive biomarker prior to different causes of graft dysfunction. Plasma from single and multicenter LTR cohorts was analyzed for dd-cfDNA. Phenotypes of treated biopsy-proven acute rejection (AR, N = 57), normal function (TX, N = 94), and acute dysfunction no rejection (ADNR; N = 68) were divided into training and test sets. In the training set, dd-cfDNA was significantly different between AR versus TX (AUC 0.95, 5.3% cutoff) and AR versus ADNR (AUC 0.71, 20.4% cutoff). Using these cutoffs in the test set, the accuracy and NPV were 87% and 100% (AR vs. TX) and 66.7% and 87.8% (AR vs. ADNR). Blood samples collected serially from LTR demonstrated incremental elevations in dd-cfDNA prior to the onset of graft dysfunction (AR > ADNR), but not in TX. Dd-cfDNA also decreased following treatment of rejection. In conclusion, the serial elevation of dd-cfDNA identifies pre-clinical graft injury in the context of normal liver function tests and is greatest in rejection. This biomarker may help detect early signs of graft injury and rejection to inform LTR management strategies.

A new approach for contralateral C7 nerve transfer via retrospinal route

Anterior and posterior approaches exist for the treatment of spinal pathologies. Anatomically, the 7th cervical spinal nerve(C7)crosses the C6-C7 intervertebral foramen bilaterally, allowing contralateral prevertebral or posterior C7 nerve transfer to be used. The advantage of the posterior rather than the anterior spinal approach is that it does not require retraction of important blood vessels, nerves, or other structures. In this paper, we describe transfer of the contralateral C7 nerve using a posterior approach.

Progress of uranium-contaminated soil bioremediation technology

With the extensive exploitation of nuclear energy and uranium, the problem of uranium-contaminated soil is becoming increasingly prominent. In recent years, various technologies for remediation of uranium-contaminated soil have emerged, such as bioremediation, physical remediation and chemical remediation. Bioremediation technology has the widespread attention because of its environmental friendliness, low cost and high economic benefits. This paper mainly reviews the evaluation index of uranium-contaminated soil, soil remediation technology and its advantages and disadvantages, introduces especially the research status of soil bioremediation technology in detail, and puts forward some suggestions and prospects for bioremediation of uranium-contaminated soil.

Digitally aligned ZnO nanowire array based synaptic transistors with intrinsically controlled plasticity for short-term computation and long-term memory

Digitally aligned long continuous ZnO NWs with distinct widths and microstructures are prepared and used for tuning the plasticity of synaptic transistors (STs) for the first time. Intrinsically controlled synaptic plasticity, i.e. short-term plasticity (STP) and long-term plasticity (LTP), was achieved using the same source material and post-fabrication condition for the first time, which is essential for simple and low-cost fabrication. Moreover, these versatile properties of ZnO STs enable the integration of STP and LTP as realized by multiplexed neurotransmission of different neurotransmitters: dopamine and acetylcholine, which promote learning and memory in organisms, so the device may utilize these processes in neuroelectronic devices. Devices with well-controlled synaptic plasticity can simulate the "learning-forgetting-erase" and "instant display" processes. ZnO NWs may enable the development of neuromorphic computers that can use the same material to achieve both short-term computation and long-term memory.

Application Progress of Deinococcus radiodurans in Biological Treatment of Radioactive Uranium-Containing Wastewater

Radioactive uranium wastewater contains a large amount of radionuclide uranium and other heavy metal ions. The radioactive uranium wastewater discharged into the environment will not only pollute the natural environment, but also threat human health. Therefore, the treatment of radioactive uranium wastewater is a current research focus for many researchers. The treatment in radioactive uranium wastewater mainly includes physical, chemical and biological methods. At present, the using of biological treatment to treat uranium in radioactive uranium wastewater has been gradually shown its superiority and advantages. Deinococcus radiodurans is a famous microorganism with the most radiation resistant to ionizing radiation in the world, and can also resist various other extreme pressures. D. radiodurans can be directly used for the adsorption of uranium in radioactive waste water, and it can also transform other functional genes into D. radiodurans to construct genetically engineered bacteria, and then applied to the treatment of radioactive uranium containing wastewater. Radionuclides uranium in radioactive uranium-containing wastewater treated by D. radiodurans involves a lot of mechanisms. This article reviews currently the application of D. radiodurans that directly or construct genetically engineered bacteria in the treatment of radioactive uranium wastewater and discusses the mechanism of D. radiodurans in bioremediation of uranium. The application of constructing an engineered bacteria of D. radiodurans with powerful functions in uranium-containing wastewater is prospected.

Male urethral diverticulum squamous cell carcinoma containing a calculus: a rare entity

Male urethral diverticula with calculi have a low incidence. It is extremely rare when the diverticulum accompanied with carcinoma. We report a case of diverticulum of the male urethra containing giant calculi which developed into squamous cell carcinoma. The patient initially presented with lower urinary tract symptoms and a hard, painless perineal mass. We believe that the process of diagnosis and treatment is of great significance in clinical practice.

[Efficacy and safety of paclitaxel liposomes compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma: a Meta-analysis]

Objective: To explore the efficacy and safety of paclitaxel liposomes compared to paclitaxel with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma. Methods: SinoMed, CNKI, WanFang MED ONLINE, VIP, PubMed, MEDLINE, Cochrane Library, Embase and ClinicalTrials.gov were searched to collect the papers or clinical studies of paclitaxel liposomes and paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma from the inception to January 15th 2021 in Chinese and English. Two independent reviewers screened the literatures, extracted the data and assessed the bias of the included studies. Meta-analysis was performed using RevMan 5.4 and R software. Results: Totally 9 papers involving 666 patients with unresectable cervical carcinoma were included. The results of meta-analysis indicated that compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma, paclitaxel liposomes combined with platinum exhibited superiority in near-term efficacy (complete response + partial response) [81.4%(272/334) vs 68.7%(228/332), RR=1.19; 95% CI: 1.09, 1.29, P=0.000 1]; substantially decreased the incidence rates of blood system disorders [myelosuppressio, 50.3%(168/334)vs 65.1%(216/332)], gastrointestinal disorders [34.4%(115/334) vs 55.1%(183/332)], alopecia [42.2%(94/223)vs 63.3%(140/221)], allergic reaction [11.6% (23/198)vs 27.6%(54/196), P≤0.000 1], peripheral neuritis [43.0%(52/121) vs 54.9%(67/122)], or joint and muscle pain [20.3%(16/79) vs 34.6%(28/81), P<0.050 0]. Conclusion: Compared to paclitaxel combined with platinum in concurrent chemoradiotherapy for unresectable cervical carcinoma, paclitaxel liposomes is superior in near-term efficacy, and exhibits better safety.

Mechanism of recombinant bacteria adsorb UO22+ under culture condition

Research on the ability and mechanism of genetically recombinant E. coli DH5α containing DSR A gene to enrich uranium under culture conditions provides a theoretical basis for the application of the bacteria in the treatment of uranium pollution. By exploring the influence of factors such as the initial concentration of uranium, culture time, and inoculation amount on the characteristics of uranium enrichment in genetically recombinant E. coli, using FTIR, SEM-EDS, XPS and XRD explore the mechanism of uranium-enriched bacteria. The results showed that when initial UO₂²⁺ concentration reach 600 mg/L, E. Coli D1 could not survived, indicated that the maximum tolerance concentration is lower than 600 mg/L. While concentration between 0∼500 mg/L, strains D1 can grow normally and has the ability to enrich uranium. In the prime stage, strains D1 resist toxics through release inorganic phosphates to precipitate UO₂²⁺ on cell wall, after 96 h, most UO₂²⁺ were transferred into cytoplasm and metabolized into U(IV) which is less toxic. In the metabolize process, all groups involved in metabolizing UO₂²⁺, especially protein contain groups like hydroxyl, amine and carboxyl paly a huge role. It shows that within a certain concentration rage, strains D1 has a good enrichment effect on uranium under culture conditions.

Combining Blood Gene Expression and Cellfree DNA to Diagnose Subclinical Rejection in Kidney Transplant Recipients

BACKGROUND AND OBJECTIVES

Subclinical acute rejection is associated with poor outcomes in kidney transplant recipients. As an alternative to surveillance biopsies, noninvasive screening has been established with a blood gene expression profile. Donor-derived cellfree DNA (cfDNA) has been used to detect rejection in patients with allograft dysfunction but not tested extensively in stable patients. We hypothesized that we could complement noninvasive diagnostic performance for subclinical rejection by combining a donor-derived cfDNA and a gene expression profile assay.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We performed a post hoc analysis of simultaneous blood gene expression profile and donor-derived cfDNA assays in 428 samples paired with surveillance biopsies from 208 subjects enrolled in an observational clinical trial (Clinical Trials in Organ Transplantation-08). Assay results were analyzed as binary variables, and then, their continuous scores were combined using logistic regression. The performance of each assay alone and in combination was compared.

RESULTS

For diagnosing subclinical rejection, the gene expression profile demonstrated a negative predictive value of 82%, a positive predictive value of 47%, a balanced accuracy of 64%, and an area under the receiver operating curve of 0.75. The donor-derived cfDNA assay showed similar negative predictive value (84%), positive predictive value (56%), balanced accuracy (68%), and area under the receiver operating curve (0.72). When both assays were negative, negative predictive value increased to 88%. When both assays were positive, positive predictive value increased to 81%. Combining assays using multivariable logistic regression, area under the receiver operating curve was 0.81, significantly higher than the gene expression profile (P<0.001) or donor-derived cfDNA alone (P=0.006). Notably, when cases were separated on the basis of rejection type, the gene expression profile was significantly better at detecting cellular rejection (area under the receiver operating curve, 0.80 versus 0.62; P=0.001), whereas the donor-derived cfDNA was significantly better at detecting antibody-mediated rejection (area under the receiver operating curve, 0.84 versus 0.71; P=0.003).

CONCLUSIONS

A combination of blood-based biomarkers can improve detection and provide less invasive monitoring for subclinical rejection. In this study, the gene expression profile detected more cellular rejection, whereas donor-derived cfDNA detected more antibody-mediated rejection.

Selective Release of Different Neurotransmitters Emulated by a p-i-n Junction Synaptic Transistor for Environment-Responsive Action Control

The design of the first p-i-n junction synaptic transistor (JST) based on n-type TiO₂ film covered with poly(methyl methacrylate) (PMMA) and with a p-type P3HT/PEO nanowire (NW) on top. Except for basic synaptic functions that can be realized by a single neurotransmitter, the electronic device emulates the multiplexed neurotransmission of different neurotransmissions, i.e., glutamate and acetylcholine, for fast switching between short- and long-term plasticity (STP and LTP). This is realized by the special p-i-n junction with hole transport in the p-type P3HT NW to form STP, and electron transport in the n-type TiO₂ layer and trapped under the PMMA inversion layer to form LTP. Altering the external input induces changes of the polarity of the charge carriers in the conductive channel, promoting fast switching between STP and LTP modes. When stimulated using two parallel inputs, the response of PMMA/TiO₂ emulates the synergistic effect of taste and aroma on the control of food-intake in the brain. Because of the bipolarity, the p-i-n JST has excellent reconfigurability, which importantly is attributed to simulate the plasticity of synapses and to mimic how distinct types of gustatory receptor neurons respond to different concentrations of salt. The electronic device lays the technical foundation for the realization of the future complex artificial neural networks.

Highly regenerative and efficient adsorption of phosphate by restructuring natural palygorskite clay via alkaline activation and co-calcination

Herein, we present a new strategy to create a highly regenerative and efficient phosphate adsorbent based on activating natural palygorskite structures. Both the regeneration via alkaline activation and synthesis via co-calcination restructured the palygorskite and created adsorptive metal oxides. The phosphate adsorbent exhibits excellent regeneration performance with high removal capacity.

Treatment of multidrug-resistant gram-negative bacilli after solid organ transplant: Outcomes and complications

BACKGROUND

Infections caused by multidrug-resistant gram-negative bacilli (GNB) cause significant morbidity and mortality in solid organ transplant (SOT) recipients.

METHODS

We retrospectively collected data from all SOT recipients at a single center from 1 January 2007 to 15 April 2017 treated for infections caused by multi-drug-resistant GNB. This study examined the effects of specific antibiotics on nephrotoxicity, neurotoxicity, 30-day mortality, and length of stay in the hospital and intensive care unit.

RESULTS

A total of 225 infections were identified among 143 patients. Carbapenem-sensitive organisms were present in 112 (49.8%) infections and were associated with decreased 30-day mortality (OR 0.35, 95% CI 0.16-0.75). Neurotoxicity was associated with polymyxin use with an 8% increase in odds of neurotoxicity per day of exposure (P=.03). There was no relationship between nephrotoxicity and any individual antibiotic class. Increased hospital length-of-stay occurred among patients exposed to aminoglycosides (β-statistic = 0.48 (0.23); P = .04), while there was no relationship between antibiotic class and intensive care unit (ICU) length-of-stay. Mortality at 30 days occurred in 37 infections (16%). Carbapenem exposure was associated with decreased 30-day mortality (OR 0.93; 95% CI 0.90-0.98; P = .02). No other antibiotic class had a significant impact on 30-day mortality.

CONCLUSIONS

Carbapenems appear to be a safe and effective treatment for solid-organ transplant recipients with infections caused by carbapenem-sensitive multidrug-resistant GNB; treatment of carbapenem-resistant gram-negatives remains challenging.