Effects of different doses of remimazolam on hemodynamics during general anesthesia in patients with septic shock

OBJECTIVE

The stability of hemodynamics plays a vital role in the process of anesthesia induction for patients with septic shock. As a new-type benzodiazepine, remimazolam has numerous advantages, including rapid induction, rapid recovery, stable hemodynamics, and mild respiratory depression. Nevertheless, reports about the effects of remimazolam on hemodynamics in patients with septic shock are still limited. The study aimed to evaluate the effects that different doses of remimazolam have on hemodynamics in inducing general anesthesia in patients with septic shock.

PATIENTS AND METHODS

Admitted to the intensive care unit of our hospital from January 2023 to June 2023, 75 patients with septic shock caused by acute appendicitis-induced sepsis were selected as observation subjects. They were randomly assigned to receive low-dose [0.2 mg/(kg·h)], medium-dose [0.3 mg/(kg·h)], and high-dose [0.4 mg/(kg·h)] remimazolam by using a random number table, with 25 patients in each group. Their intraoperative conditions were recorded, including operation duration, intraoperative hemorrhage volume, intraoperative transfusion volume, and decannulation time. Hemodynamic parameters, including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and stoke volume index (SVI) were collected at seven-time points (T0: before induction; T1: before intubation; T2: after intubation; T3: the start of operation; T4: 15 min after operation; T5: 30 min after operation; T6: the end of operation). We also compared hepatic and renal function indexes, including blood urea nitrogen (BUN), serum creatinine (sCr), procalcitonin (PCT), white blood cells (WBC), tumor necrosis factor-α2 (TNF-α2), and Interleukin-6 (IL-6), of the three groups of patients before operation and 1, 3, 5, 7 days after operation. In addition, the incidence of adverse reactions in the three groups was recorded and compared.

RESULTS

During remimazolam induction, the number of patients with intraoperative need for rescue remimazolam in the medium-dose and high-dose groups was significantly lower than in the low-dose group (p < 0.05). In terms of hemodynamic indexes, MAP in the high-dose group at T2 was lower than that at T0 (p < 0.05), and MAP at T2 was significantly lower in the high-dose group than that in the medium-dose group (p < 0.05). Furthermore, MAP at T4 in the medium-dose and high-dose groups declined compared with the low-dose group (p < 0.05). There were no significant differences in HR, CI, and SVI at different time points among the three groups (p > 0.05), but levels of HR and SVI decreased and CI increased after anesthesia compared with those before operation. Additionally, in comparison with the levels before operation, levels of sCR, BUN, PCT, WBC, TNF-α, and IL-6 were higher on postoperative days 1, 3 (p < 0.05) and lower on postoperative day 7 (p < 0.05). After the operation, both levels of BUN and sCR in the medium-dose and high-dose groups were lower than those in the low-dose group (p < 0.05).

CONCLUSIONS

Remimazolam is safe and effective for inducing general anesthesia in patients with septic shock. Low, medium, and high doses of remimazolam can maintain a stable hemodynamic state, and the recovery of hepatic and renal function is certain to depend on the dose.

Gradiently Foaming Ultrasoft Hydrogel with Stop Holes for Highly Deformable, Crack-Resistant and Sensitive Conformal Human-Machine Interfaces

Hydrogels are considered as promising materials for human-machine interfaces (HMIs) owing to their merits of tailorable mechanical and electrical properties; nevertheless, it remains challenging to simultaneously achieve ultrasoftness, good mechanical robustness and high sensitivity, which are the pre-requisite requirements for wearable sensing applications. Herein, for the first time, this work proposes a universal phase-transition-induced bubbling strategy to fabricate ultrasoft gradient foam-shaped hydrogels (FSHs) with stop holes for high deformability, crack-resistance and sensitive conformal HMIs. As a typical system, the FSH based on polyacrylamide/sodium alginate system shows an ultralow Young's modulus (1.68 kPa), increased sustainable strain (1411%), enhanced fracture toughness (915.6 J m-2 ), improved tensile sensitivity (21.77), and compressive sensitivity (65.23 kPa-1 ). The FSHs are used for precisely acquiring and identifying gesture commands of the operator to remotely control a surgical robot for endoscopy and an electric ship in a first-person perspective for cruising, feeding crabs and monitoring the environmental change in real-time.

Rheology Engineering for Dry-Spinning Robust N-Doped MXene Sediment Fibers toward Efficient Charge Storage

MXene nanosheets are believed to be an ideal candidate for fabricating fiber supercapacitors (FSCs) due to their metallic conductivity and superior volumetric capacitance, while challenges remain in continuously collecting bare MXene fibers (MFs) via the commonly used wet-spinning technique due to the intercalation of water molecules and a weak interaction between Ti3 C2 TX nanosheets in aqueous coagulation bath that ultimately leads to a loosely packed structure. To address this issue, for the first time, a dry-spinning strategy is proposed by engineering the rheological behavior of Ti3 C2 TX sediment and extruding the highly viscose stock directly through a spinneret followed by a solvent evaperation induced solidification. The dry-spun Ti3 C2 TX fibers show an optimal conductivity of 2295 S cm-1 , a tensile strength of 64 MPa and a specific capacitance of 948 F cm-3 . Nitrogen (N) doping further improves the capacitance of MFs to 1302 F cm-3 without compromising their mechanical and electrical properties. Moreover, the FSC based on N-doped MFs exhibits a high volumetric capacitance of 293 F cm-3 , good stability over 10 000 cycles, excellent flexibility upon bending-unbending, superior energy/power densities and anti-self-discharging property. The excellent electrochemical and mechanical properties endow the dry-spun MFs great potential for future applications in wearable electronics.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Detection of Circulating Tumor DNA Correlates with Recurrence and Survival in Localized Non-Small-Cell Lung Cancer: A Meta-Analysis

PURPOSE/OBJECTIVE(S)

Circulating tumor DNA (ctDNA) is approved recently to use in clinical practice of solid tumor. Several large-scale prospective studies also revealed that minimal residual disease based on ctDNA (ctDNA-MRD) is a potential predictive and prognostic biomarker of localized non-small-cell lung cancer (NSCLC) receiving curative treatment (surgery or radiotherapy). However, there are still barriers to clinical management of ctDNA/ctDNA-MRD in localized NSCLC, and the most significant is effectiveness and detection times of ctDNA/ctDNA-MRD. This meta-analysis aims to clarify the prognostic value of the ctDNA and ctDNA-MRD in predicting the disease recurrence and survival of localized NSCLC.

MATERIALS/METHODS

Electronic databases (Pubmed/MEDLINE, Web of Science, Cochrane Library, meeting abstracts) were comprehensively searched for eligible studies from January 2001 to January 2023. The Hazard ratio (HR) from relevant reports was extracted to better evaluate the correlation of ctDNA and ctDNA-MRD detected in plasma with clinical outcomes among patients with localized NSCLC. Pooled results including ctDNA detection rate, disease-/relapse-/progression- free survival (DFS/RFS/PFS) and overall survival (OS) were obtained and analyzed by Review Manager 5.4.1.

RESULTS

A total of 18 eligible studies with 2692 patients were enrolled in the final analysis. The pooled analysis revealed that ctDNA detection in pretreatment plasma indicated poor prognosis for DFS/RFS/PFS (HR 3.82, 95% CI 2.85 - 5.12, p < .00001; Figure 1) with a long-term effect on OS (HR 4.88, 95% CI 3.29 - 7.24, p < .00001; Figure 2). The same result was also observed in patients with positive posttreatment ctDNA-MRD who have shorter DFS/RFS/PFS (HR 7.15, 95% CI 5.50 - 9.31, p < .00001; Figure 3) and OS (HR 4.34, 95% CI: 2.51-7.51, p < .00001; Figure 4) compared to negative groups.

CONCLUSION

Based on the results from our meta-analysis, the presence of pretreatment ctDNA or posttreatment ctDNA-MRD in radically treated localized NSCLC is associated with higher risk of recurrence and poorer survival. This finding is supportive of ctDNA/ctDNA-MRD becoming a widespread prognostic biomarker in localized NSCLC.

The Impact of a High Radiation Dose to the Immune Cells on Tumor Control and Survival in Patients with Non-Small Cell Lung Cancer Undergoing Postoperative Radiotherapy

PURPOSE/OBJECTIVE(S)

Previous studies showed that the estimated dose of radiation to immune cells (EDRIC) was correlated with the overall survival (OS) of patients who received definitive thoracic radiotherapy. However, planning target volume (PTV) may be a confounding factor. The PTV is relatively uniform for patients undergoing postoperative radiotherapy (PORT). We further assessed the prognostic value of EDRIC on survival in patients with non-small cell lung cancer (NSCLC) undergoing PORT.

MATERIALS/METHODS

Patients with NSCLC who received PORT between 2004 and 2019 were analyzed. EDRIC was calculated as a function of the number of radiation fractions and mean doses to the lung, heart, and remaining body based on a model developed by Jin et al. The correlation between EDRIC and OS, PFS, local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) were analyzed using univariable and multivariable Cox models. Kaplan-Meier method was used to show the survival difference between patients with high and low EDRIC.

RESULTS

A total of 345 patients were eligible. The mean EDRIC was 7.6 Gy. Multivariate analysis showed that EDRIC was associated with OS (HR 1.14, P = 0.002), PFS (HR 1.08, P = 0.016), LRFS (HR 1.111, P = 0.008), and DMFS (HR 1.10, P = 0.018). Patients were divided into low and high EDRIC groups according to median EDRIC. The 3-year OS was 82.7% and 72.2% (p = 0.03). The 3-year PFS was 40.3% and 17.8% (p < 0.01). The 3-year LRFS was 71.39% and 59.18% (p = 0.05). The 3-year DMFS was 74.4% and 63.4% (p = 0.06).

CONCLUSION

EDRIC was an independent prognostic factor for survival. Higher doses of radiation to the immune system were associated with tumor progression and death after the PORT of NSCLC. The organ at risk for the immune system should be considered during radiotherapy planning.

A Machine Learning Method to Predict Pathological Complete Response of Esophageal Cancer after Neoadjuvant Chemoradiotherapy with Clinicohematological Markers and MR Radiomics: A Multi-Center Study

PURPOSE/OBJECTIVE(S)

Nearly 30% of patients with local advanced esophageal cancer achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT), who may benefit from organ-preservation strategy under accurate prediction of pCR. We aimed to develop and validate machine learning models based on clinicohematological markers and MR radiomics to accurately predict pCR of esophageal cancer after nCRT.

MATERIALS/METHODS

In this multi-center study, eligible patients with esophageal cancer who received baseline MR scan (T2-weighted image) and nCRT plus surgery were enrolled between September 2014 and September 2022 at institution 1 (training set) and between December 2017 and August 2021 at institution 2 (testing set). Pre-nCRT and post-nCRT blood test results were collected to calculate hematological markers. Models were constructed by machine learning based on clinicohematological markers and MR radiomics to predict pCR. Area under the curve (AUC) and cut-off analysis were used to evaluate model performances.

RESULTS

Totally 154 patients (81 in the training set and 73 in the testing set) were enrolled. The combined model integrating pre-nCRT monocyte-to-lymphocyte ratio and 6 radiomics features achieved AUC of 0.800 (95% CI 0.671-0.918) in the testing set, with sensitivity of 79.2% (95% CI 62.5%-95.8%), specificity of 83.7% (95% CI 73.5%-93.9%), positive predictive value of 76.0% (95% CI 62.5%-90.0%), and negative predictive value of 89.6% (95% CI 82.0%-95.8%).

CONCLUSION

A machine learning model based on clinicohematological markers and MR radiomics to predict pCR after nCRT for patients with esophageal cancer was developed and validated, providing a novel tool for personalized treatment. It is necessary to further validate in more large datasets.

Clinical Verification of a Nomogram Model for Prediction of Brain Metastases in Patients with pⅢA-N2 Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

Brain metastasis is one of the most common failure patterns of pⅢA-N2 non-small cell lung cancer (NSCLC) after complete resection. Prophylactic Cranial Irradiation (PCI) can improve intracranial control but not overall survival. Thus, it is particularly important to identify risk factors that are associated with brain metastasis and subsequently provide instructions for selecting patients who will optimally benefit from PCI. We have reported a nomogram model which was established based on the condition of histology, bronchial invasion, perineural invasion, and adjuvant chemotherapy, through which we can predict high risk brain metastases in patients with pⅢA-N2 NSCLC. The purpose of this study is to verify the accuracy of the nomogram model by using new cases information.

MATERIALS/METHODS

Between January 1, 2015 and December 31, 2019, patients of pⅢA-N2 NSCLC were retrospectively analyzed, to verify the consistency between actual and predictive brain metastases. The verification group was divided into two groups according to the years when genetic testing has been widely used in clinic (group1:2015-2016, group2:2017-2019). ROC curves and calibration curves were chosen for validation.

RESULTS

A total of 770 patients were enrolled in our retrospective study (group1:294 patients, group2: 476patients). The 1-, 3- and 5-year survival rates were 97.2%, 76.5%, 63.2% in group1, and 95.8%, 84.5%, 76.9% in group2, respectively. The 1-, 3- and 5-year brain metastasis rates were 7.9%, 19.7%, 25.8%, and 5.4%, 14.5%, 26.3% in group2, respectively. The AUC were 0.74 (95% CI:0.72 - 0.76) in group1, and 0.71(95% CI:0.70 - 0.73) in group 2.The 1.3.5-year calibration curves of the two groups show that the prediction is in good agreement with the actual observation.

CONCLUSION

The nomogram model can predict brain metastases high risk patients with pⅢA-N2 NSCLC. Whether gene test or not, it can be used as a basis to screening out patients of high-risk brain metastases in future clinical trials for PCI.

Overall Survival Following Salvage Thoracic Radiotherapy for Locoregional Recurrence in Patients with Completely Resected PIIIA-N2 NSCLC

PURPOSE/OBJECTIVE(S)

Locoregional recurrence is a common failure pattern for patients with completely resected pIIIA-N2 NSCLC. The salvage thoracic radiotherapy is administered in some pIIIA-N2 NSCLC patients despite postoperative radiotherapy (PORT). Salvage thoracic radiotherapy could be well tolerated and might improve survival from several small sample retrospective studies, while the high-level clinical evidence is presently lacking. We conducted this retrospective case control study to demonstrate the efficacy of salvage thoracic radiotherapy for completely resected pIIIA-N2 NSCLC patients with locoregional recurrence.

MATERIALS/METHODS

Between January 2003 and June 2019, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were retrospectively reviewed. Those with pⅢA-N2 NSCLC that did not receive PORT and suffered locoregional recurrence being the first treatment failure were enrolled. The log-rank test was used to analyze differences between the groups, and the Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate potential prognostic factors for survival. Statistically significant difference was set as p<0.05.

RESULTS

Of all the patients with pⅢA-N2 NSCLC reviewed, 105 suffered locoregional recurrence as the first treatment failure and didn't receive PORT. Among these patients, 51 (48.6%) received salvage thoracic radiotherapy and 54 (51.4%) did not. The median OS was 47.7 months of all patients. Survival analysis showed that the median OS in salvage thoracic radiotherapy group (69.0 months) was significantly longer than that in non-salvage thoracic radiotherapy group (37.7 months) (p = 0.029). For patients of EGFR wild type, salvage thoracic radiotherapy group had significantly longer median OS of 69.0 months compared with non-salvage thoracic radiotherapy group of 31.3 months (p = 0.004). When assessed by histological types, salvage thoracic radiotherapy significantly improved the survival of patients with lung squamous cell carcinoma with median OS not reached compared with non-salvage thoracic radiotherapy group of 31.3 months (p<0.001), while in patients with non-squamous cell carcinoma, this survival benefit was not observed (p = 0.829).

CONCLUSION

Salvage thoracic radiotherapy is an effective treatment for completely resected pIIIA-N2 NSCLC patients that have not received PORT and suffered post-operative locoregional recurrence.

Ti3 C2 TX MXene Ink Direct Writing Flexible Sensors for Disposable Paper Toys

Flexible electronics have gained great attention in recent years owing to their promising applications in biomedicine, sustainable energy, human-machine interaction, and toys for children. Paper mainly produced from cellulose fibers is attractive substrate for flexible electronics because it is biodegradable, foldable, tailorable, and light-weight. Inspired by daily handwriting, the rapid prototyping of sensing devices with arbitrary patterns can be achieved by directly drawing conductive inks on flat or curved paper surfaces; this provides huge freedom for children to design and integrate "do-it-yourself (DIY)" electronic toys. Herein, viscous and additive-free ink made from Ti3 C2 TX MXene sediment is employed to prepare disposable paper electronics through a simple ball pen drawing. The as-drawn paper sensors possess hierarchical microstructures with interweaving nanosheets, nanoflakes, and nanoparticles, therefore exhibiting superior mechanosensing performances to those based on single/fewer-layer MXene nanosheets. As proof-of-concept applications, several popular children's games are implemented by the MXene-based paper sensors, including "You say, I guess," "Emotional expression," "Rock-Paper-Scissors," "Arm wrestling," "Throwing game," "Carrot squat," and "Grab the cup," as well as a DIY smart whisker for a cartoon mouse. Moreover, MXene-based paper sensors are safe and disposable, free from producing any e-waste and hazard to the environment.

Nacre-Inspired Strong MXene/Cellulose Fiber with Superior Supercapacitive Performance via Synergizing the Interfacial Bonding and Interlayer Spacing

MXene fibers are promising candidates for weaveable and wearable energy storage devices because of their good electrical conductivity and high theoretical capacitance. Herein, we propose a nacre-inspired strategy for simultaneously improving the mechanical strength, volumetric capacitance, and rate performance of MXene-based fibers through synergizing the interfacial interaction and interlayer spacing between Ti₃C₂T_X nanosheets. The optimized hybrid fibers (M-CMC-1.0%) with 99 wt % MXene loading exhibit an improved tensile strength of ∼81 MPa and a high specific capacitance of 885.0 F cm^-3 at 1 A cm^-3 together with an outstanding rate performance of 83.6% retention at 10 A cm^-3 (740.0 F cm^-3). As a consequence, the fiber supercapacitor (FSC) based on the M-CMC-1.0% hybrid delivers an output capacitance of 199.5 F cm^-3, a power density of 1186.9 mW cm^-3, and an energy density of 17.7 mWh cm^-3, respectively, implying its promising applications as portable energy storage devices for future wearable electronics.

Green Flexible Electronics: Natural Materials, Fabrication, and Applications

The emergence of plastic electronics satisfies the increasing demand for flexible electronics. However, it has caused severe ecological problems. Flexible electronics based on natural materials are increasing to hopefully realize the "green" and eco-friendly concept. Herein, recent advances in the design and fabrication of green flexible electronics are reviewed. First, this review comprehensively introduces various natural materials and derivatives, focusing particularly on fibroin and silk, wood and paper, plants, and biomass. Second, fabrication techniques for modifying natural materials, including physical and chemical methods, are presented, after which their merits and demerits are thoroughly discussed. Green flexible electronics based on natural materials, comprising electrical wires/electrodes, antennas, thermal management devices, transistors, memristors, sensors, energy-harvesting devices, energy-storage devices, displays, actuators, electromagnetic shielding, and integration systems, are described in detail. Finally, perspectives on the existing challenges and opportunities to employ natural materials in green flexible electronics are presented.

Mechanisms for self-templating design of micro/nanostructures toward efficient energy storage

The ever-growing demand in modern power systems calls for the innovation in electrochemical energy storage devices so as to achieve both supercapacitor-like high power density and battery-like high energy density. Rational design of the micro/nanostructures of energy storage materials offers a pathway to finely tailor their electrochemical properties thereby enabling significant improvements in device performances and enormous strategies have been developed for synthesizing hierarchically structured active materials. Among all strategies, the direct conversion of precursor templates into target micro/nanostructures through physical and/or chemical processes is facile, controllable, and scalable. Yet the mechanistic understanding of the self-templating method is lacking and the synthetic versatility for constructing complex architectures is inadequately demonstrated. This review starts with the introduction of five main self-templating synthetic mechanisms and the corresponding constructed hierarchical micro/nanostructures. Subsequently, the structural merits provided by the well-defined architectures for energy storage are elaborately discussed. At last, a summary of current challenges and future development of the self-templating method for synthesizing high-performance electrode materials is also presented.

Universal Strategy for Preparing Highly Stable PBA/Ti3C2Tx MXene toward Lithium-Ion Batteries via Chemical Transformation

Prussian blue analogues (PBAs) are believed to be intriguing anode materials for Li⁺ storage because of their tunable composition, designable topologies, and tailorable porous structures, yet they suffer from severe capacity decay and inferior cycling stability due to the volume variation upon lithiation and high electrical resistance. Herein, we develop a universal strategy for synthesizing small PBA nanoparticles hosted on two-dimensional (2D) MXene or rGO (PBA/MX or PBA/rGO) via an in situ transformation from ultrathin layered double hydroxides (LDH) nanosheets. 2D conductive nanosheets allow for fast electron transport and guarantee the full utilization of PBA even at high rates; at the meantime, PBA nanoparticles effectively prevent 2D materials from restacking and facilitate rapid ion diffusion. The optimized Ni_0.8Mn_0.2-PBA/MX as an anode for lithium-ion batteries (LIBs) delivers a capacity of 442 mAh g^-1 at 0.1 A g^-1 and an excellent cycling robustness in comparison with bare PBA bulk crystals. We believe that this study offers an alternative choice for rationally designing PBA-based electrode materials for energy storage.

The Jahn-Teller Effect for Amorphization of Molybdenum Trioxide towards High-Performance Fiber Supercapacitor

Amorphous pseudocapacitive nanomaterials are highly desired in energy storage applications for their disordered crystal structures, fast electrochemical dynamics, and outstanding cyclic stability, yet hardly achievable using the state-of-the-art synthetic strategies. Herein, for the first time, high capacitive fiber electrodes embedded with nanosized amorphous molybdenum trioxide (A-MoO_3-x) featuring an average particle diameter of ~20 nm and rich oxygen vacancies are obtained via a top-down method using α-MoO₃ bulk belts as the precursors. The Jahn-Teller distortion in MoO₆ octahedra due to the doubly degenerate ground state of Mo⁵⁺, which can be continuously strengthened by oxygen vacancies, triggers the phase transformation of α-MoO₃ bulk belts (up to 30 μm long and 500 nm wide). The optimized fibrous electrode exhibits among the highest volumetric performance with a specific capacitance (C_V) of 921.5 F cm⁻³ under 0.3 A cm⁻³, endowing the fiber-based weaveable supercapacitor superior C_V and E_V (energy density) of 107.0 F cm⁻³ and 9.5 mWh cm⁻³, respectively, together with excellent cyclic stability, mechanical robustness, and rate capability. This work demonstrates a promising strategy for synthesizing nanosized amorphous materials in a scalable, cost-effective, and controllable manner.

Ti3C2TX MXene for Sensing Applications: Recent Progress, Design Principles, and Future Perspectives

Sensors are becoming increasingly significant in our daily life because of the rapid development in electronic and information technologies, including Internet of Things, wearable electronics, home automation, intelligent industry, etc. There is no doubt that their performances are primarily determined by the sensing materials. Among all potential candidates, layered nanomaterials with two-dimensional (2D) planar structure have numerous superior properties to their bulk counterparts which are suitable for building various high-performance sensors. As an emerging 2D material, MXenes possess several advantageous features of adjustable surface properties, tunable bandgap, and excellent mechanical strength, making them attractive in various applications. Herein, we particularly focus on the recent research progress in MXene-based sensors, discuss the merits of MXenes and their derivatives as sensing materials for collecting various signals, and try to elucidate the design principles and working mechanisms of the corresponding MXene-based sensors, including strain/stress sensors, gas sensors, electrochemical sensors, optical sensors, and humidity sensors. In the end, we analyze the main challenges and future outlook of MXene-based materials in sensor applications.

83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

122 A Medication Self-Management Intervention to Improve Medication Adherence for Older People with Multimorbidity: A Pilot Trial

Introduction

Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity.

Method

This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations.

Results

Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up.

Conclusions

The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

Mechanistic insight in site-selective and anisotropic etching of prussian blue analogues toward designable complex architectures for efficient energy storage

Engineering coordination compounds, e.g., prussian blue (PB) and its analogues (PBAs), with designable complex nanostructures via chemical etching holds great opportunities for improving energy storage performances by adjusting topological geometry, selectively exposing active sites, tuning electronic properties and enhancing accessible surface area. Unfortunately, it remains ambiguous particularly on site-selective and anisotropic etching behaviors. Herein, for the first time, we propose that two distinct regions are formed inside NiCo PBA (NCP) cubes due to the competition between classical ion-by-ion crystallization and non-classical crystallization based on aggregation. Such a unique structure ultimately determines not only the etching position but also the anisotropic pathway by selectively exposing unprotected Ni sites. According to this principle, complex PBA architectures, including nanocages, open nanocubes (constructed by six cones sharing the same apex), nanocones, and chamfer nanocubes can be intentionally obtained. After thermal annealing, NCP nanocones are converted to morning glory-like porous architectures composed of NiO/NiCo2O4 heterostructures with a mean particle size of 5 nm, which show improved rate performance and cycling stability.

Solution-Processed Sensing Textiles with Adjustable Sensitivity and Linear Detection Range Enabled by Twisting Structure

Wearable strain sensors are emerging rapidly for their promising applications in human motion detection for diagnosis, healthcare, training instruction, and rehabilitation exercise assessment. However, it remains a bottleneck in gaining comfortable and breathable devices with the features of high sensitivity, linear response, and tunable detection range. Textiles possess fascinating advantages of good breathability, aesthetic property, tailorability, and excellent mechanical compliance to conformably attach to human body. As the meandering loops in a textile can be extended in different directions, it provides plenty of room for exploring ideal sensors by tuning a twisting structure with rationally selected yarn materials. Herein, textile sensors with twisting architecture are designed via a solution-based process by using a stable water-based conductive ink that is composed of polypyrrole/polyvinyl alcohol nanoparticles with a mean diameter of 50 nm. Depending on the predesigned twisting models, the thus-fabricated textile sensors show adjustable performances, exhibiting a high sensitivity of 38.9 with good linearity and a broad detection range of 200%. Such sensors can be integrated into fabrics and conformably attached to skin for monitoring subtle (facial expressions, breathing, and speaking) and large (stretching, jumping, running and jogging, and sign language) human motions. As a proof-of-concept application, by integrating with a wireless transmitter, the signals detected by our sensors during exercise (e.g., running) can be remotely received and displayed on a smartphone. It is believed that the integration of our textile sensors with selected twisting models into a cloth promises full-range motion detection for wearable electronics and human-machine interfaces.

Electrostatically Assembling 2D Nanosheets of MXene and MOF-Derivatives into 3D Hollow Frameworks for Enhanced Lithium Storage

As an essential member of 2D materials, MXene (e.g., Ti₃ C₂ T_x ) is highly preferred for energy storage owing to a high surface-to-volume ratio, shortened ion diffusion pathway, superior electronic conductivity, and neglectable volume change, which are beneficial for electrochemical kinetics. However, the low theoretical capacitance and restacking issues of MXene severely limit its practical application in lithium-ion batteries (LIBs). Herein, a facile and controllable method is developed to engineer 2D nanosheets of negatively charged MXene and positively charged layered double hydroxides derived from ZIF-67 polyhedrons into 3D hollow frameworks via electrostatic self-assembling. After thermal annealing, transition metal oxides (TMOs)@MXene (CoO/Co₂ Mo₃ O₈ @MXene) hollow frameworks are obtained and used as anode materials for LIBs. CoO/Co₂ Mo₃ O₈ nanosheets prevent MXene from aggregation and contribute remarkable lithium storage capacity, while MXene nanosheets provide a 3D conductive network and mechanical robustness to facilitate rapid charge transfer at the interface, and accommodate the volume expansion of the internal CoO/Co₂ Mo₃ O₈ . Such hollow frameworks present a high reversible capacity of 947.4 mAh g^-1 at 0.1 A g^-1 , an impressive rate behavior with 435.8 mAh g^-1 retained at 5 A g^-1 , and good stability over 1200 cycles (545 mAh g^-1 at 2 A g^-1 ).

Identifying the active site of ultrathin NiCo LDH as an efficient peroxidase mimic with superior substrate affinity for sensitive detection of hydrogen peroxide

Nanozymes have been extensively investigated to imitate protein enzymes in biomimetic chemistry and the identification of the active site is believed to be the pre-requisite before one can effectively regulate their activity. Herein, ultrathin NiCo LDH nanosheets are synthesized via a fast co-precipitation at room temperature and can be stably dispersed in water without any additives of surfactants or organic solvents. By tuning the ratio between Ni and Co in LDH nanosheets, the activity is tuned and their peroxidase-like activity is determined by Co sites that show higher affinity to both 3,3',5,5'-tetramethylbenzidine (TMB) and hydrogen peroxide (H2O2) due to the strong Lewis acidity of Co3+ and the low redox potential of Co3+/Co2+. Together with their small crystallite size, ultra-thin thickness and tunable composition, NiCo LDH is used as a nanozyme for highly sensitive colorimetric detection of H2O2 and the limit of detection (LOD) reaches 0.48 μM.