[Clinical application of a novel separated magnetic controlled forceps assisted single-incision laparoscopic cholecystectomy]

Objective: To explore the application value of a novel separated magnetic-controlled forceps in transumbilical single-incision laparoscopic cholecystectomy (SILC). Methods: This is a prospective case series study. Data from patients who underwent SILC at the Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University from March to August 2023 were prospectively collected, based on inclusion and exclusion criteria. All patients underwent cholecystectomy assisted by a novel separated magnetic-controlled forceps. Surgical time, intraoperative blood loss, the need for additional incisions during surgery, and the length of hospital stay were recorded to assess surgical difficulty and effectiveness. Postoperative pain scores and complications were documented to evaluate the safety of the procedure. The collaboration experience of the surgeon and assistant was evaluated using a 5-point Likert scale to assess the feasibility of this surgical approach. Informed consent was obtained from all patients in accordance with medical ethical regulations. Patients were followed up through outpatient visits or telephone calls, with follow-up at 7 days and 1 month after surgery, and evaluation of incisional scar healing and completion of satisfaction questionnaires. Follow-up was conducted until September 30, 2023. Results: A total of 45 patients were included in the study,including 19 males and 26 females,aged (42.7±4.2)years(range:32 to 61 years). The difficulty of the operation was evaluated as grade 1 or 2 in 38 cases(84.4%) and grade 3 in 7 cases(15.6%). Operation time was (37.3±5.3) minutes(range: 25 to 80 minutes),and intraoperative blood loss(M(IQR)) was 17.8(35.0) ml (range:10 to 60 ml). All surgical procedures proceeded smoothly without intraoperative incidents, and the overall satisfaction of the surgeon and assistants was high. All patients underwent successful day surgery management and were discharged within 48 hours of hospitalization. The postoperative pain scores at 1, 7, and 30 days were 3 (4), 1 (3), and 0 (2), respectively. The follow-up time was 5.0(2.2) weeks (range: 3 to 7 weeks), with no occurrence of grade 3 to 4 adverse reactions, and the patients were satisfied with the cosmetic effect of the umbilical incision. Conclusions: The novel separated magnetic-controlled forceps can be applied in transumbilical SILC. It has the advantages of convenient operation, and patients are satisfied with the surgical results.

Biomimicking TRPM8: A Conversely Temperature-Dependent Nonionic Retrorse Nanochannel for Ion Flow Control

Ion channels play a crucial role in the transmembrane transport and signal transmission of substances. In animals, transient receptor potential vanilloid 1 (TRPV1) and transient receptor potential melastatin 8 (TRPM8) serve as temperature-sensing units in sensory nerve endings. TRPV1 allows cells to sense heat, while TRPM8 enables them to detect cold, both serving to protect living organisms from harmful substances and environments. However, almost all studies on artificial nanochannels have mainly focused on TRPV1-like "forward nanochannels" thus far, which are incapable of "backward" responding to heat. So, we constructed an innovational TRPM8-inspired "retrorse nanochannel" through internal modification of poly(acrylamide-co-acrylonitrile) [P(AAm-co-AN)] with an upper critical solution temperature (UCST). Our results demonstrated that the internally modified nanochannels exhibited rapid, stable, and reversible heat-closing capability and converse temperature dependence within the typical temperature range of 25-40 °C. The biomimetic ion channel can effectively function as a facile, precise, and reversible thermal gate for controlling the transport of ions and substances. It also offers a promising microscopic technology for managing thermal effects on the substance, fluid, energy, and even signal delivery.

Gradient Quasi-Solid Electrolyte Enables Selective and Fast Ion Transport for Robust Aqueous Zinc-Ion Batteries

The quasi-solid electrolytes (QSEs) attract extensive attention due to their improved ion transport properties and high stability, which is synergistically based on tunable functional groups and confined solvent molecules among the polymetric networks. However, the trade-off effect between the polymer content and ionic conductivity exists in QSEs, limiting their rate performance. In this work, the epitaxial polymerization strategy is used to build the gradient hydrogel networks (GHNs) covalently fixed on zinc anode. Then, it is revealed that the asymmetric distribution of negative charges benefits GHNs with fast and selective ionic transport properties, realizing a higher Zn2+ transference number of 0.65 than that (0.52) for homogeneous hydrogel networks (HHNs) with the same polymer content. Meanwhile, the high-density networks formed at Zn/GHNs interface can efficiently immobilize free water molecules and homogenize the Zn2+ flux, greatly inhibiting the water-involved parasitic reactions and dendrite growth. Thus, the GHNs enable dendrite-free stripping/plating over 1000 h at 8 mA cm-2 and 1 mAh cm-2 in a Zn||Zn symmetric cell, as well as the evidently prolonged cycles in various full cells. This work will shed light on asymmetric engineering of ion transport channels in advanced quasi-solid battery systems to achieve high energy and safety.

Skeleton engineering of rigid covalent organic frameworks to alter the number of binding sites for improved radionuclide extraction

Crystalline porous covalent frameworks (COFs) have been considered as a platform for uranium extraction from seawater and nuclear waste. However, the role of rigid skeleton and atomically precise structures of COFs is often ignored in the design of defined binding configuration. Here, a COF with an optimized relative position of two bidentate ligands realizes full potential in uranium extraction. Compared with the para-chelating groups, the optimized ortho-chelating groups with oriented adjacent phenolic hydroxyl groups on the rigid skeleton endow an additional uranyl binding site, thereby increasing the total number of binding sites up to 150%. Experimental and theoretical results indicate that the uranyl capture is greatly improved via the energetically favored multi-site configuration and the adsorption capacity reaches up to 640 mg g-1, which exceeds that of most reported COF-based adsorbents with chemical coordination mechanism in uranium aqueous solution. This ligand engineering strategy can efficiently advance the fundamental understanding of designing the sorbent systems for extraction and remediation technology.

Construction of a hierarchical membrane with angstrom-scale ion channels for enhanced Li+/Mg2+ separation

A biomimetic hierarchical membrane consisting of ZIF-8 and MXene with controllable morphology could be fabricated by the facile electrochemical deposition method, well-realizing Li⁺/Mg²⁺ sieving. This membrane could work stably in real brine with perm-selectivity of Li⁺/Mg²⁺ up to 47.4.

Engineering Multi-field-coupled Synergistic Ion Transport System Based on the Heterogeneous Nanofluidic Membrane for High-Efficient Lithium Extraction

The global carbon neutrality strategy brings a wave of rechargeable lithium-ion batteries technique development and induces an ever-growing consumption and demand for lithium (Li). Among all the Li exploitation, extracting Li from spent LIBs would be a strategic and perspective approach, especially with the low energy consumption and eco-friendly membrane separation method. However, current membrane separation systems mainly focus on monotonous membrane design and structure optimization, and rarely further consider the coordination of inherent structure and applied external field, resulting in limited ion transport. Here, we propose a heterogeneous nanofluidic membrane as a platform for coupling multi-external fields (i.e., light-induced heat, electrical, and concentration gradient fields) to construct the multi-field-coupled synergistic ion transport system (MSITS) for Li-ion extraction from spent LIBs. The Li flux of the MSITS reaches 367.4 mmol m-2 h-1, even higher than the sum flux of those applied individual fields, reflecting synergistic enhancement for ion transport of the multi-field-coupled effect. Benefiting from the adaptation of membrane structure and multi-external fields, the proposed system exhibits ultrahigh selectivity with a Li+/Co2+ factor of 216,412, outperforming previous reports. MSITS based on nanofluidic membrane proves to be a promising ion transport strategy, as it could accelerate ion transmembrane transport and alleviate the ion concentration polarization effect. This work demonstrated a collaborative system equipped with an optimized membrane for high-efficient Li extraction, providing an expanded strategy to investigate the other membrane-based applications of their common similarities in core concepts.

Surfactant-Assisted Sulfonated Covalent Organic Nanosheets: Extrinsic Charge for Improved Ion Transport and Salinity-Gradient Energy Harvesting

Charge-governed ion transport is the vital property of nanofluidic channels for salinity-gradient energy harvesting and other electrochemical energy conversion technologies. 2D nanofluidic channels constructed by nanosheets exhibit great superiority in ion selectivity, but a high ion transport rate remains challenging due to the insufficiency of intrinsic surface charge density in nanoconfinement. Herein, extrinsic surface charge into nanofluidic channels composed of surfactant-assisted sulfonated covalent organic nanosheets (SCONs), which enable tunable ion transport behaviors, is demonstrated. The polar moiety of surfactant is embedded in SCONs to adjust in-plane surface charges, and the aggregation of nonpolar moiety results in the sol-to-gel transformation of SCON solution for membrane fabrication. The combination endows SCON/surfactant membranes with considerable water-resistance, and the designable extrinsic charges promise fast ion transport and high ion selectivity. Additionally, the SCON/surfactant membrane, serving as a power generator, exhibits huge potential in harvesting salinity-gradient energy where corresponding output power density can reach up to 9.08 W m^-2 under a 50-fold salinity gradient (0.5 m NaCl|0.01 m NaCl). The approach to extrinsic surface charge provides new and promising insight into regulating ion transport behaviors.

Tunable Ion Transport in Two-Dimensional Nanofluidic Channels

Layered two-dimensional (2D) materials with interlayer channels at the nanometer scale offer an ideal platform to control ion transport behaviors, including high-precision separation, ultrafast diffusion, and tunable permeation flux, which show great potential for energy conversion and storage, water treatment, catalysis, biosynthesis, and sensing. Recent advances in controlling the structure and functionality of 2D nanofluidic channels sustainably open doors for more revolutionary applications. In this Perspective, we first present a brief introduction to the fundamental mechanisms for ion transport in 2D nanofluidic channels and an overview of state-of-the-art assembly technologies of nanochannel membranes. We then point out new avenues for developing advanced nanofluidics, combining molecular-level cross-linking, and surface modification in nanoconfinement. Finally, we outline the potential applications of these 2D nanofluidic channel membranes and their technical challenges that need to be addressed to afford for practical applications.

Heterogeneous Electrospinning Nanofiber Membranes with pH-regulated Ion Gating for Tunable Osmotic Power Harvesting

Biological ion channels existing in organisms are critical for many biological processes. Inspired by biological ion channels, the heterogeneous electrospinning nanofiber membranes (HENM) with functional ion channels are constructed by electrospinning technology. The HENM successfully realizes ion-gating effects, which can be used for tunable energy conversions. Introduction of pyridine and carboxylic acid groups into the HENM plays an important role in generating unique and stable ion transport behaviors, in which gates become alternative states of open and close, responding to symmetric/asymmetric pH stimulations. Then we used the HENM to convert osmotic energy into electric energy which reach a maximum value up to 12.34 W m^-2 and the output power density of HENM-based system could be regulated by ion-gating effects. The properties of the HENM provide widespread potentials in application of smart nanofluidic devices, energy conversion, and water treatment.

[A multicenter, double-blind, randomized controlled clinical trial comparing ergometrine with oxytocin and oxytocin alone for prevention of postpartum hemorrhage at cesarean section]

Objective: To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS). Methods: This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration. Results: (1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant (P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups (P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant (P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion: The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

Covalent organic frameworks embedded in polystyrene membranes for ion sieving

A mixed matrix membrane composed of COF-300 and polystyrene (PS) with controllable thickness and porosity achieves ion sieving performance, which is dependent on the regular pore size and surface functional groups of COF-300. Hence, the selectivity of the COF-300/PS membrane for K⁺/Li⁺ and Mg²⁺/Li⁺ reached 31.5 and 14.7, respectively.

Ionic Crosslinking-Induced Nanochannels: Nanophase Separation for Ion Transport Promotion

Charge-governed ion transport is crucial to numerous industries, and the advanced membrane is the essential component. In nature, the efficient and selective ion transport is mainly governed by the charged ion channels located in cell membrane, indicating the architecture with functional differentiation. Inspired by this architecture, a membrane by ionic crosslinking sulfonated poly(arylene ether ketone) and imidazolium-functionalized poly(arylene ether sulfone) is designed and fabricated to make full use of the charges. This ionic crosslinking is designed to realize nanophase separation to aggregate the ion pathways in the membrane, which results in excellent ion selectivity and high ion conductivity. With the excellent ion transport behavior, ionic crosslinking membrane shows great potential in osmotic energy conversion, which maximum power density can be up to 16.72 W m^-2 . This design of ionic crosslinking-induced nanophase separation offers a roadmap for ion transport promotion.

Two-Dimensional Nanofluidic Membranes toward Harvesting Salinity Gradient Power

The salinity gradient between seawater and river water has been identified as a promising, clean, renewable, and sustainable energy source that can be converted into electricity using ion-selective membranes in a reverse electrodialysis (RED) configuration. However, the major hindrance to current salinity gradient power (SGP) conversion is its poor energy efficiency due to the use of low-performance membrane processes, which affords power for neither miniaturized devices nor industrial-level applications. Nanofluidics, which combines strong confinement and surface charge effects at the nanoscale, contributes to novel transport properties, including excellent ion selectivity and high ion throughput; thus, nanofluidics may lead to technological breakthroughs and act as an emerging platform for harnessing SGP. Recently, two-dimensional (2D) materials have provided impressive energy extraction performance and further insight into fundamental transport mechanisms and theoretical feasibility. To reach the commercialization benchmark and real-world applications, an array of nanopores and channels that can be scaled up to industrial sizes is in high demand; additionally, it remains challenging to develop macroscale nanofluidic membranes that meet the "selectivity versus throughput" dual requirement. In the first section, we start with our understanding of the underlying mechanism of ion-channel interactions and transport characteristics in nanofluidic channel systems from the microscale to the macroscale. We review our recent efforts in this field by constructing a heterojunction with asymmetric ion transport behavior that generates rectification of the ion flux and creates an osmotic diode, which is composed of two nanofluidic layers with opposite polar charges and different chemical compositions. Another efficient way to improve the performance of the system is introducing charged functional materials intercalated into laminar 2D nanosheets. The intercalated nanofluidic material can be explained by two classical models to account for the synergistic effects that (i) improve the stability and mechanical properties of 2D materials with a fixed interlayer spacing and (ii) provide space charge for modulating ion diffusion; both of these effects contribute to its considerable energy conversion performance. Further, layer-by-layer membranes are superior to traditional membranes consisting of a simple stack because they retain their repulsion effect toward co-ions, largely strengthening the efficiency of ion separation and conversion. In particular, we highlight our views on the role of the 2D phase structure (e.g., semiconductor 2H phase and metallic 1T phase) in which the two phases differ from each other in physical and chemical properties, including ionic conductance, surface charge, and wetting, thereby presenting a state-of-the-art avenue for controlling ion transport. In view of the nature of 2D materials, we also report improved osmotic energy harvesting by exploiting the photoinduced heat gradient and electrons that increase ion mobility and surface charge, respectively. Finally, we point out specific research topics in which a combined project can certainly come into the limelight. For example, we discuss the combination of SGP with desalination systems and water splitting. We expect that this Account will stimulate further efforts toward functionalized 2D nanoporous materials and facilitate interdisciplinary efforts in chemistry, material engineering, environmental science, and nanotechnology.

Biomimetic Nanocomposite Membranes with Ultrahigh Ion Selectivity for Osmotic Power Conversion

Ion transport in nanoconfinement exhibits significant features such as ionic rectification, ionic selectivity, and ionic gating properties, leading to the potential applications in desalination, water treatment, and energy conversion. Two-dimensional nanofluidics provide platforms to utilize this phenomenon for capturing osmotic energy. However, it is challenging to further improve the power output with inadequate charge density. Here we demonstrate a feasible strategy by employing Kevlar nanofiber as space charge donor and cross-linker to fabricate graphene oxide composite membranes. The coupling of space charge and surface charge, enabled by the stabilization of interlayer spacing, plays a key role in realizing high ion selectivity and the derived high-performance osmotic power conversion up to 5.06 W/m2. Furthermore, the output voltage of an ensemble of the membranes in series could reach 1.61 V, which can power electronic devices. The system contributes a further step toward the application of energy conversion.

Ultra-Sensitive and Selective Electrochemical Bio-Fluid Biopsy for Oral Cancer Screening

The early diagnosis of recurrence and metastasis is critically important for decreasing the morbidity and mortality associated with oral cancers. Although liquid biopsy methods hold great promise that provide a successive "time-slice" profile of primary and metastatic oral cancer, the development of non-invasive, rapid, simple, and cost-effective liquid biopsy techniques remains challenging. In this study, an ultrasensitive and selective electrochemical liquid biopsy is developed for oral cancer screening based on tracking trace amounts of cancer biomarker by functionalized asymmetric nano-channels. Detection via antigen-antibody reactions is assayed by evaluating changes in ionic current. Upon the recognition of cancer biomarker antigens in bio-fluids, the inner wall of nano-channel immobilized with the corresponding antibodies undergoes molecular conformation transformation and surface physicochemical changes, which significantly regulate the ion transport through the nano-channel and help achieve sensitivity with a detection limit of 10^-12 g mL^-1 . Furthermore, owing to the specificity of the monoclonal antibody for the antigen, the nano-channel exhibits high selectivity for the biomarker than for structurally similar biological molecules present in bio-fluids. The effectiveness of this technique is confirmed through the diagnosis of clinical cases of oral squamous cell carcinoma. This study presents a novel diagnostic tool for oral cancer detection in bio-fluids.

Improved Ion Transport in Hydrogel-Based Nanofluidics for Osmotic Energy Conversion

In nature, ultrafast signal transfer based on ion transport, which is the foundation of biological processes, commonly works in a hydrogel-water mixed mechanism. Inspired by organisms' hydrogel-based system, we introduce hydrogel into nanofluidics to prepare a hydrogel hybrid membrane. The introduction of a space charged hydrogel improves the ion selectivity evidently. Also, a power generator based on the hydrogel hybrid membrane shows an excellent energy conversion property; a maximum power density up to 11.72 W/m² is achieved at a 500-fold salinity gradient. Furthermore, the membrane shows excellent mechanical properties. These values are achievable, which indicates our membrane's huge potential applications in osmotic energy conversion.

Biomimetic Nacre-Like Silk-Crosslinked Membranes for Osmotic Energy Harvesting

As an approach to harvesting sustainable energy from ambient conditions, the osmotic energy between river water and seawater contributes to solving global issues such as the energy shortage and environmental pollution. Current attempts based on a reverse electrodialysis technique are limited mainly due to the economically unviable power density and inadequate mass transportation of membrane materials. Here, we demonstrate a benign strategy for designing a multilayer graphene oxide-silk nanofiber-graphene oxide biomimetic nacre-like sandwich as an osmotic power generator. Enhanced interfacial bonding endows the composite membranes with long-term stability in saline, and meanwhile, the two-dimensional nanofluidic channel configuration also reduces the ion transport resistance and provides large storage spaces for ions. Thus, the output power density of the proposed membrane-based generator achieves a value of up to 5.07 W m^-2 by mixing seawater and river water. Furthermore, we experimentally and theoretically demonstrate that the thermal-field drives the increased output power density due to the advances in ionic movement range and activity of electrode reaction, showing the promise of strengthened thermo-osmotic energy conversion.

Robust sulfonated poly (ether ether ketone) nanochannels for high-performance osmotic energy conversion

The membrane-based reverse electrodialysis (RED) technique has a fundamental role in harvesting clean and sustainable osmotic energy existing in the salinity gradient. However, the current designs of membranes cannot cope with the high output power density and robustness. Here, we construct a sulfonated poly (ether ether ketone) (SPEEK) nanochannel membrane with numerous nanochannels for a membrane-based osmotic power generator. The parallel nanochannels with high space charges show excellent cation-selectivity, which could further be improved by adjusting the length and charge density of nanochannels. Based on numerical simulation, the system with space charge shows better conductivity and selectivity than those of a surface-charged nanochannel. The output power density of our proposed membrane-based device reaches up to 5.8 W/m2 by mixing artificial seawater and river water. Additionally, the SPEEK membranes exhibit good mechanical properties, endowing the possibility of creating a high-endurance scale-up membrane-based generator system. We believe that this work provides useful insights into material design and fluid transport for the power generator in osmotic energy conversion.

Assessment of Apparent Internal Carotid Tandem Occlusion on High-Resolution Vessel Wall Imaging: Comparison with Digital Subtraction Angiography

BACKGROUND AND PURPOSE

Not all tandem occlusions diagnosed on traditional vascular imaging modalities, such as MRA, represent actual complete ICA occlusion. This study aimed to explore the utility of high-resolution vessel wall imaging in identifying true ICA tandem occlusions and screening patients for their suitability for endovascular recanalization.

MATERIALS AND METHODS

Patients with no signal in the ICA on MRA were retrospectively reviewed. Two neuroradiologists independently reviewed their high-resolution vessel wall images to assess whether there were true tandem occlusions and categorized all cases into intracranial ICA occlusion, extracranial ICA occlusion, tandem occlusion, or near-occlusion. DSA classified patient images into the same 4 categories, which were used as the comparison with high-resolution vessel wall imaging. The suitability for recanalization of occluded vessels was evaluated on high-resolution vessel wall imaging compared with DSA.

RESULTS

Forty-five patients with no ICA signal on MRA who had available high-resolution vessel wall imaging and DSA images were included. Among the 34 patients (34/45, 75.6%) with tandem occlusions on DSA, 18 cases also showed tandem occlusions on high-resolution vessel wall imaging. The remaining 16 patients, intracranial ICA, extracranial ICA occlusions and near-occlusions were found in 2, 6, and 8 patients, respectively, on the basis of high-resolution vessel wall imaging. A total of 20 cases (20/45, 44.4%) were considered suitable for recanalization on the basis of both DSA and high-resolution vessel wall imaging. Among the 25 patients deemed unsuitable for recanalization by DSA, 11 were deemed suitable for recanalization by high-resolution vessel wall imaging.

CONCLUSIONS

High-resolution vessel wall imaging could allow identification of true ICA tandem occlusion in patients with an absence of signal on MRA. Findings on high-resolution vessel wall imaging can be used to screen more suitable candidates for recanalization therapy.

High-performance silk-based hybrid membranes employed for osmotic energy conversion

The salinity gradient between seawater and river water is a clean energy source and an alternative solution for the increasing energy demands. A membrane-based reverse electrodialysis technique is a promising strategy to convert osmotic energy to electricity. To overcome the limits of traditional membranes with low efficiency and high resistance, nanofluidic is an emerging technique to promote osmotic energy harvesting. Here, we engineer a high-performance nanofluidic device with a hybrid membrane composed of a silk nanofibril membrane and an anodic aluminum oxide membrane. The silk nanofibril membrane, as a screening layer with condensed negative surface and nanochannels, dominates the ion transport; the anodic aluminum oxide membrane, as a supporting substrate, offers tunable channels and amphoteric groups. Thus, a nanofluidic membrane with asymmetric geometry and charge polarity is established, showing low resistance, high-performance energy conversion, and long-term stability. The system paves avenues for sustainable power generation, water purification, and desalination.

[Differences in anterior segment structure between Chinese Han people and American Caucasians]

Objective: To compare the difference of anterior segment structure between Chinese Han people and American Caucasians, and to explore the confounding factors of anterior chamber angle. Methods: Cross-sectional study. The study was designed to include two healthy groups of Chinese Han people (enrolled from Department of Ophthalmology, Peking University Third Hospital) and American Caucasians (enrolled from Department of Ophthalmology, University of California, San Francisco) from May 2008 to December 2010, each with approximately 120 participants, including 15 persons of each gender in each decade between 40 and 80 years of age. The parameters of the anterior segment were measured by the automatic refractive test, A-ultrasound and ultrasound biomicroscopy. Differences between the two groups were compared with the independent-sample t test or Wilcoxon two-sample test for continuous variable data and the χ(2) test for classified variable data. Multiple linear regression models were performed to analyze the associated factors of anterior chamber angle. Results: There were 118 subjects (118 eyes) and 117 subjects (117 eyes) enrolled in the Chinese and American Caucasians groups, respectively. Compared to Caucasians, Chinese had smaller A-ultrasound measured anterior chamber depth [(3.03±0.34) mm vs. (3.38±0.36) mm, t=-5.791, P<0.001], smaller relative lens position [0.227 (0.198, 0.256) vs. 0.235 (0.191, 0.262), Z=-3.063, P=0.002], smaller axial length [23.3 (20.9,28.3) mm vs. 24.2 (20.8,28.5) mm, Z=-5.510, P<0.001], smaller iris root distance [0.111 (0.000, 0.401) mm vs. 0.142 (0.000, 0.451) mm, Z=-3.188, P=0.001], smaller ciliary body thickness at 1 mm posterior to the scleral spur [0.661 (0.424, 0.892) mm vs. 0.716 (0.467, 0.942) mm, Z=-3.456, P=0.001], smaller trabecular ciliary process distance [0.780 (0.410, 1.400) mm vs. 0.930 (0.420, 1.470) mm, Z=-3.191, P=0.001], smaller trabecular ciliary process angle [73.4° (36.3°, 115.3°) vs. 81.1° (47.9°, 147.9°), Z=-3.407, P=0.001], smaller angle opening distance at 500 μm (AOD500) [0.181 (0.000, 0.703) mm vs. 0.264 (0.000, 0.806) mm, Z=-3.444, P=0.001], smaller angle recess area (ARA) [0.118 (0.011, 0.457) mm(2) vs. 0.179 (0.000, 0.626) mm(2), Z=-3.814, P<0.001], larger spherical equivalent [0.40 (-5.80, 4.00) D vs. -0.70 (-8.00, 4.00) D, Z=-5.454, P<0.001], larger lens thickness [(4.62±0.40) mm vs. (4.52±0.40) mm, t=2.077, P=0.039] and larger iris thickness [0.430 (0.280, 0.600) mm vs. 0.410 (0.240, 0.580) mm, Z=-2.263, P=0.024]. On average, with each decade of the increased age, Chinese had a greater decrease in the AOD500 than Caucasians (0.040 mm in Chinese vs. 0.030 mm in Caucasians), while the angle recess area decreased at the same rate (0.020 mm(2) in both groups). After adjusted for age, gender, spherical equivalent, axial length and other parameters of the anterior segment, the trabecular ciliary process angle [for AOD500, standardized regression coefficient (SRC)=0.487, R(2)=0.549, P<0.001; for ARA, SRC=0.372, R(2)=0.502, P<0.001] and anterior chamber depth (for AOD500, SRC=0.413, R(2)=0.476, P<0.001; for ARA, SRC=0.331, R(2)=0.403, P<0.001) were the main factors of anterior chamber angle parameters for Chinese and Caucasians, respectively. Conclusions: Compared with age and gender matched American Caucasians, Chinese Han people have more crowded anterior chambers and narrower anterior chamber angles. The more anteriorly positioned ciliary processes and shallower anterior chambers are the main factors that contributed to more crowded anterior chambers in Chinese Han people and American Caucasians, respectively. (Chin J Ophthalmol, 2018, 54: 820-826).

[Effect of simplified and traditional Chinese character on accommodative microfluctuation in young adult myopes and emmetropes]

Objective: This study investigates the effect of simplified and traditional Chinese character on accommodative microfluctuation in young adult myopes and emmetropes. Methods: Prospective cohort study. Based on refractive errors, Young adult candidates (18-28 years) were classified into two groups based on their spherical equivalent degrees: emmetropes (n=18), myopes (n=18). Four different reading targets (12pt size simplified and traditional Chinese characters, and 8pt size simplified and traditional Chinese characters) were displayed on computer screen collectively for 135s. The accommodative microfluctuation of the candidates were measured using the free space Grand-Seiko WAM-5500 autorefractor. Results: The results indicated that the type of character (simplified and traditional) had significant influence on accommodative microfluctuation. For myopic candidates, the accommodative microfluctuation for traditional Chinese character was greater than that for simplified Chinese character [traditional Chinese character: (0.35±0.17) D, vs. simplified Chinese character: (0.29±0.11) D, t=2.556, P=0.017], however as for emmetropic candidates, the difference between the accommodative microflucuation for the two types of characters was of no statistical significance [traditional Chinese character: (0.24±0.11) D, vs. simplified Chinese character: (0.24±0.12) D, t=0.004, P=0.996]. There was a difference between emmetropic and myopic candidates in terms of accommodative microfluctuation for traditional Chinese character, myopes had greater accommodative microfluctuation than emmetropes (t=3.140, P=0.02). However the difference between emmetropic and myopic candidates in terms of accommodative microfluctuation for simplified Chinese character was of no statistical significance (t=1.866, P=0.066). Conclusions: The results of the study indicated that myopes were more susceptible than emmetropic in accommodative microfluctuation when reading traditional Chinese character of high spatial frequency. (Chin J Ophthalmol, 2018, 54: 288-293).

Cost-effectiveness analysis of fulvestrant versus anastrozole as first-line treatment for hormone receptor-positive advanced breast cancer

Although recent studies demonstrated that fulvestrant is superior to anastrozole as first-line treatment for hormone receptor (HR)-positive advanced breast cancer, the cost-effectiveness of fulvestrant versus anastrozole remained uncertain. Thus, the current study aimed to evaluate the cost-effectiveness of fulvestrant compared with anastrozole in the first-line setting. A Markov model consisting of three health states (stable, progressive and dead) was constructed to simulate a hypothetical cohort of patients with HR-positive advanced breast cancer. Costs were calculated from a Chinese societal perspective. Health outcomes were measured in quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio (ICER) was expressed as incremental cost per QALY gained. Model results suggested that fulvestrant provides an additional effectiveness gain of 0.11 QALYs at an incremental cost of $32,654 compared with anastrozole, resulting in an ICER of $296,855/QALY exceeding the willingness-to-pay threshold of $23,700/QALY. Hence, fulvestrant is not a cost-effective strategy compared with anastrozole as first-line treatment for HR-positive advanced breast cancer.

[Epidemiological study on the relationship between the siesta and blood pressure]

OBJECTIVE

Use epidemiological approaches to investigate the correlation between the siesta and blood pressure.

METHOD

From March 1(st,) 2011 to June 30(th) 2013, a total of 950 people were collected from East Jiaozhou Qingdao region using variable sampling methods including stratified method, the entire group method, random and proportional methods. Medical professionals conducted a person-to-person survey, collecting the data and inputting it into computers, after which a database was established using STATA 12.0. We analyzed the correlation between the siesta time and blood pressure/hypertension by using rank correlation method (Spearman). Logistic regression method was used to analyze the relationship between high blood pressure and different time and habit of the siesta after adjusting age, sex and BMI.

RESULTS

There was a negative correlation between the time of siesta and the systolic pressure with r=-0.18, P<0.001; there was no relationship between the time of siesta and the diastolic pressure with r=-0.07, P=0.02; also, there is a negative correlation between the time of siesta and the hypertension morbidity, with r=-0.22, P<0.001. In the Logistic regression analysis about the period of time to take a nap and the risk of hypertension, it was found that the relative risk factors for hypertension were more than 60-year-old, BMI >25 kg/m(2) and no siesta habits.

CONCLUSIONS

The time of siesta is negatively correlated to the systolic pressure, rather than the diastolic pressure, and it can generally reduce the incidence of hypertension. The relative risk factors of hypertension are more than 60-year-old, BMI >25 kg/m(2) and no siesta habits in all four seasons. We recommend that take a nap a day, or it might be even better for systolic blood pressure to take longer siesta.

Changes of peripheral-type benzodiazepine receptors in the penumbra area after cerebral ischemia-reperfusion injury and effects of astragaloside IV on rats

This study investigated the changes in peripheral benzodiazepine receptors (PBRs) in the penumbra after cerebral ischemia-reperfusion injury, and examined the effects of astragaloside IV (AST) on PBRs in rats. Sixty Sprague-Dawley rats were divided into a sham operation group, a model group, and three AST treatment groups. Cerebral ischemic models were induced by the clue-blocked method. Neurological deficits were examined. The animals were sacrificed after 2 h of ischemia and 24 h of reperfusion, and mitochondria from the penumbra were purified. PBR density (Bmax) and affinity were measured by radioligand assays. Mitochondrial [(3)H]PK11195 binding was correlated with neurological deficits in rats. Compared to the model group, the 10 mg/kg AST group, 40 mg/kg AST group, and 100 mg/kg AST group had fewer neurological deficits. The effects in the 40 mg/ kg group did not significantly differ from the effects in the 100 mg/ kg group. Compared to the model group, the 10 mg/kg AST group, 40 mg/kg group, and 100 mg/kg group had a decreased Bmax in the penumbra. The Bmax decreased in the 40 mg/kg AST group and in the 100 mg/kg AST group compared with the 10 mg/kg group. The Bmax and neurological deficits in the 40 mg/kg did not significantly differ from those in the 100 mg/kg group. By contrast, the AST-treated rats showed no significant changes in the binding parameter equilibrium dissociation constant compared with those in the sham operation group and the model group. AST protects ischemic brain tissue by inhibiting PBR expression after cerebral ischemia.

Dynamic CT for parathyroid disease: are multiple phases necessary?

BACKGROUND AND PURPOSE

A 4D CT protocol for detection of parathyroid lesions involves obtaining unenhanced, arterial, early, and delayed venous phase images. The aim of the study was to determine the ideal combination of phases that would minimize radiation dose without sacrificing diagnostic accuracy.

MATERIALS AND METHODS

With institutional review board approval, the records of 29 patients with primary hyperparathyroidism who had undergone surgical exploration were reviewed. Four neuroradiologists who were blinded to the surgical outcome reviewed the imaging studies in 5 combinations (unenhanced and arterial phase; unenhanced, arterial, and early venous; all 4 phases; arterial alone; arterial and early venous phases) with an interval of at least 7 days between each review. The accuracy of interpretation in lateralizing an abnormality to the side of the neck (right, left, ectopic) and localizing it to a quadrant in the neck (right or left upper, right or left lower) was evaluated.

RESULTS

The lateralization and localization accuracy (90.5% and 91.5%, respectively) of the arterial phase alone was comparable with the other combinations of phases. There was no statistically significant difference among the different combinations of phases in their ability to lateralize or localize adenomas to a quadrant (P = .976 and .996, respectively).

CONCLUSIONS

Assessment of a small group of patients shows that adequate diagnostic accuracy for parathyroid adenoma localization may be achievable by obtaining arterial phase images alone. If this outcome can be validated prospectively in a larger group of patients, then the radiation dose can potentially be reduced to one-fourth of what would otherwise be administered.

Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is common in children; however, persistence of AD with or without asthma is less common. Longitudinal studies remain limited in their ability to characterize how IgE antibody responses evolve in AD, and their relationship with asthma.

OBJECTIVE

To use a cross-sectional study design of children with active AD to analyse age-related differences in IgE antibodies and relation to wheeze.

METHODS

IgE antibodies to food and inhalant allergens were measured in children with active AD (5 months to 15 years of age, n = 66), with and without history of wheeze.

RESULTS

Whereas IgE antibodies to foods persisted at a similar prevalence and titre throughout childhood, IgE antibodies to all aeroallergens rose sharply into adolescence. From birth, the chance of sensitization for any aeroallergen increased for each 12-month increment in age (OR ≥ 1.21, P < 0.01), with the largest effect observed for dust mite (OR = 1.56, P < 0.001). A steeper age-related rise in IgE antibody titre to dust mite, but no other allergen was associated with more severe disease. Despite this, sensitization to cat was more strongly associated with wheeze (OR = 4.5, P < 0.01), and linked to Fel d 1 and Fel d 4, but not Fel d 2. Comparison of cat allergic children with AD to those without, revealed higher IgE levels to Fel d 2 and Fel d 4 (P < 0.05), but not Fel d 1.

CONCLUSIONS AND CLINICAL RELEVANCE

Differences in sensitization to cat and dust mite among young children with AD may aid in identifying those at increased risk for disease progression and development of asthma. Early sensitization to cat and risk for wheeze among children with AD may be linked to an increased risk for sensitization to a broader spectrum of allergen components from early life. Collectively, our findings argue for early intervention strategies designed to mitigate skin inflammation in children with AD.

Prediction of Optimum Process Conditions for Rotomolded Products

This paper describes analytical and experimental work which has been carried out to identify optimum process conditions for rotomolded products. The mechanical performance of the moldings has been assessed using tensile impact tests. It has been found that changes in the oven temperature or oven time cause a very significant shift in the ductile-brittle transition for the SCLAIR 8504 grade of polyethylene used in the work. Optimum combinations of process variables can be clearly defined and used to establish a processing window for the material.

The ROTOSIM computer simulation for the rotomolding process has been used to establish the best (most economic) combinations of process conditions to obtain the optimum mechanical properties. A single equation is presented to relate pool depletion time to some of the process variables.