Recycling the Spent LiNi1- x - yMnxCoyO2 Cathodes for High-Performance Electrocatalysts toward Both the Oxygen Catalytic and Methanol Oxidation Reactions.

The traditional recycling methods of the spent lithium ion batteries (LIBs) involve the intricate and cumbersome steps. This work proposes a facile method of acid leaching followed by the sulfurization treatment to achieve the high Li leaching efficiency, and obtain high-performance multi-function electrocatalysts for oxygen reduction (ORR), oxygen evolution (OER), and methanol oxidation reactions (MOR) from the spent LIB ternary cathodes. By this method, the Li leaching efficiency from the spent LIB ternary cathode can reach 98.3%, and the transition metal sulfide heterostructures (LNMCO-H-450S) consisting MnS, NiS2, and NiCo2S4 phases can be obtained. LNMCO-H-450S shows the superior bifunctional oxygen catalytic activities with ORR half-wave potential of 0.763 V and OER potential at 10 mA cm-2 of 1.561 V, surpassing most of the state-of-the-art electrocatalysts. LNMCO-H-450S also demonstrates the superior MOR catalytic activity with the potential at 100 mA cm-2 being 1.37 V. Using LNMCO-H-450S as the oxygen catalyst, this work can construct the aqueous and solid-state zinc-air batteries with high power density of 309 and 257 mW cm-2, respectively. This work provides a promising strategy for the efficient recovery of Li, and reutilization of Ni, Co, and Mn from the spent LIB ternary cathodes.

Additive-assisted synthesis of α-Kdo glycosides with peracetylated glycosyl ynenoate as a donor.

A DMF-modulated glycosylation approach for the stereoselective synthesis of α-Kdo glycosides with readily accessible peracetylated Kdo ynenoate as a donor was described. By utilizing this approach, we completed the synthesis of various linkage types of Kdo-Kdo disaccharides and the α-Kdo-containing protected trisaccharide variant relevant to the lipopolysaccharide of Coxiella burnetii strain Nine Mile.

Suppressing the Surface Amorphization of Ba0.5Sr0.5Co0.8Fe0.2O3-δ Perovskite toward Oxygen Catalytic Reactions by Introducing the Compressive Stress.

Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF) perovskite has been recognized as a promising oxygen evolution reaction (OER) catalyst due to its superior intrinsic catalytic activity. However, BSCF suffers from serious degradation during the OER process due to its surface amorphization caused by the segregation of A-site ions (Ba2+ and Sr2+). Herein, we construct a novel BSCF composite catalyst (BSCF-GDC-NR) by anchoring the gadolinium-doped ceria oxide (GDC) nanoparticles on the surface of a BSCF nanorod by a concentration-difference electrospinning method. Our BSCF-GDC-NR has greatly improved bifunctional oxygen catalytic activity and stability toward both oxygen reduction reaction (ORR) and OER compared with the pristine BSCF. The improvement of the stability can be related to that anchoring GDC on BSCF effectively suppresses the segregation and dissolution of A-site elements in BSCF during the preparation and catalytic processes. The suppression effects are ascribed to the introduction of compressive stress between BSCF and GDC, which greatly inhibits the diffusions of Ba and Sr ions. This work can give a guidance for developing the perovskite oxygen catalysts with high activity and stability.

Clinical characteristics and prognosis of paroxysmal sympathetic hyperactivity in patients with severe nontraumatic brain injury.

OBJECTIVE: This prospective study investigated and analyzed the clinical characteristics and prognosis of paroxysmal sympathetic hyperactivity (PSH) in patients with severe nontraumatic brain injury. METHODS: Patients presenting with severe nontraumatic brain injury with PSH from July 2018 to June 2019 were enrolled. A PSH assessment measure ≥ 8 points was used as the criterion for PSH. Clinical data, indicators related to PSH, treatment effects and the prognosis were prospectively collected and analyzed. RESULTS: A total of 220 patients with severe nontraumatic brain injury were analyzed, and PSH occurred in 8 patients (3.6%).     The primary neurological diseases included acute cerebral infarction, anti-N-methyl-D-aspartate receptor encephalitis, hypoxic encephalopathy and acute disseminated encephalitis. The Glasgow Coma Scale score was lower than 8 in the 8 patients with PSH. Seven of these eight patients had a Glasgow outcome scale (GOS) score of 3 or less than 3, and one patient had a GOS of 5 after 6 months. The medicines that effectively controlled PSH included dexmedetomidine, clonazepam, midazolam and diazepam. CONCLUSIONS: Although the incidence was lower for nontraumatic brain injury complicated with PSH than for traumatic brain injury, patients with PSH had a more severe disease state and poorer prognoses. Dexmedetomidine might effectively control PSH.

Promoter-Controlled Synthesis and Conformational Analysis of Cyclic Mannosides up to a 32-mer.

Cyclodextrins are widely used as carriers of small molecules for drug delivery owing to their remarkable host properties and excellent biocompatibility. However, cyclic oligosaccharides with different sizes and shapes are limited. Cycloglycosylation of ultra-large bifunctional saccharide precursors is challenging due to the constrained conformational spaces. Herein we report a promoter-controlled cycloglycosylation approach for the synthesis of cyclic α-(1→6)-linked mannosides up to a 32-mer. Cycloglycosylation of the bifunctional thioglycosides and (Z)-ynenoates was found to be highly dependent on the promoters. In particular, a sufficient amount of a gold(I) complex played a key role in the proper preorganization of the ultra-large cyclic transition state, providing a cyclic 32-mer polymannoside, which represents the largest synthetic cyclic polysaccharide to date. NMR experiments and a computational study revealed that the cyclic 2-mer, 4-mer, 8-mer, 16-mer, and 32-mer mannosides adopted different conformational states and shapes.

Prophylactic effects of Periplaneta americana L. extract on anxiety-like and depression-like behaviors in rats exposed to chronic stress.

The effect of P. americana L. on anxiety and depression-behavior after chronic stress (CS) is still unknown. Here, CS were induced by a combined stimulation of chronic restraint stress, excess failure and improper diet in SD rats. At 15 days after CS, except for normal group and model group, all the groups were continuously administrated P. americana L. (i.g., 400, 200, 100 mg/kg) treatment for 14 days. Anxiety and depression-behavior was determined by sucrose preference test, forced swimming and open field. The contents of cortisol (CORT), adrenocorticotropic hormone (ACTH), adrenocorticotropic hormone-releasing hormone (CRH), interleukin (IL)-4, IL-6, IL-17 and interferon (IFN) -γ were detected by ELISA. 16S rRNA analysis was performed to examine the composition of gut microbiota. Our results indicated that P. americana L. improved the anxiety and depression-behavior. P. americana L. reduced the release of IL-6, IL-17 and IFN-γ and increased the release of IL-4. Comparably, remarkably decreased CRH, ACTH and CORT were observed by the treatment of P. americana L. 16S rRNA analysis suggested that Bifidobacterium and sulfate-reducing bacteria may be responsible for improving CS in P. americana L. -treated rats. Collectively, P. americana L. could relieve CS are associated with regulation of intestinal flora.

Acute iron oxide nanoparticles exposure induced murine eosinophilic airway inflammation via TLR2 and TLR4 signaling.

Iron oxide nanoparticles (Fe2 O3 NPs) is the main component of air pollution particles in urban rail transit environment. People are more exposed to Fe2 O3 NPs, however, the studies on relationship between Fe2 O3 NPs and respiratory health are limited. In the present study, acute airway inflammation caused by Fe2 O3 NPs and its possible mechanism were investigated. BALB/c mice were intratracheally challenged with different concentrations of Fe2 O3 NPs. Fe2 O3 NPs induced bronchial epithelial barrier function damage, infiltration of neutrophils and lymphocytes into the airway submucosa, secretion of mucus in the airway epithelium and elevated expression of eosinophil major basic protein (EMBP) in lungs. Compared with the control group, Fe2 O3 NPs increased eosinophils by 20 times in bronchoalveolar lavage fluid (BALF), and markedly increased eosinophils related cytokines and chemokines, including interleukin (IL) -5, IL-33, thymic stromal lymphopoietin (TSLP), monocyte chemotactic protein (MCP)-3, eotaxin, tumor necrosis factor (TNF)-α, keratinocyte chemoattractant (KC). Furthermore, Fe2 O3 NPs up-regulated levels of IL-5, MCP-3, eotaxin, and KC in serum. In vitro studies showed that Fe2 O3 NPs increased the genes and proteins expression of Toll-like receptors (TLR)-2, TLR4, TNF receptor associated factor 6 (TRAF6), myeloid differentiation factor 88 (MyD88), nuclear factor (NF)-κB, and TNF-α in RAW267.4 cells. The downstream inflammatory cytokine protein expression and release such as TNF-α was significantly decreased after using TLR2/TLR4 inhibitor OxPAPC, but not MyD88 inhibitor ST2825. These results suggest that TLR2 and TLR4 played important role in Fe2 O3 NPs inducing acute eosinophilic airway inflammation in the murine lung.

[Primary testicular mucinous cystadenoma: A case report and literature review].

Objective: To investigate the tissue source, clinical diagnosis, treatment and prognosis of primary testicular mucinous cystadenoma (PTMC). METHODS: We retrospectively analyzed the clinical data on a case of PTMC and reviewed relevant literature. RESULTS: The patient underwent radical resection of the right testis after relevant preoperative examinations. Postoperative pathology indicated mucinous cystadenoma with low-grade intraepithelial neoplasia of the glandular epithelium. No recurrence was observed during an 11-month follow-up. CONCLUSIONS: PTMC is an extremely rare testicular and ovarian surface epithelial tumor, usually benign, rarely malignant. For the treatment of localized PTMC, radical orchiectomy is mostly recommended, while for the cases with invasion, metastasis or recurrence tendency, chemotherapy protocols for ovarian tumors can be considered.

One-Pot Synthesis of Co3 O4 /Ag Nanoparticles Supported on N-Doped Graphene as Efficient Bifunctional Oxygen Catalysts for Flexible Rechargeable Zinc-Air Batteries.

Flexible rechargeable zinc-air batteries are considered as one of the most promising power supplies for the emerging flexible and wearable electronic devices. However, the development of flexible zinc-air batteries is stagnant due to the lack of efficient bifunctional catalysts with high oxygen catalytic activity and flexible solid-state electrolytes with high mechanical stability and ionic conductivity. In this work, Co3 O4 /Ag@NrGO composite was synthesized by a facile one-pot method, and the catalyst shows remarkable oxygen reduction reaction (ORR)/oxygen evolution reaction (OER) bifunctional catalytic activity and good long-term stability. In particular, the OER overpotential of Co3 O4 /Ag@NrGO reaches 437 mV, outperforming that of the commercial IrO2 catalyst. This can be attributed to the combined effects of Co3 O4 , Ag, and N-rGO. Furthermore, PAA (polyacrylic acid) and PVA (polyvinyl alcohol) based gel-electrolytes have been developed as flexible solid-state electrolytes for zinc-air batteries. The results show that PAA-based electrolyte is more favorable to the flexible zinc-air battery with a high power density due to its relatively high ionic conductivity. The maximum power density of flexible zinc-air batteries with Co3 O4 /Ag@NrGO catalyst and PAA-based electrolyte can reach 108 mW cm-2 , which is almost the highest value reached in recent reports. This work will provide valuable guidance for the development of flexible rechargeable zinc-air batteries with high power density and stability.

Human papillomavirus genotype distribution among HPV-positive women in Sichuan province, Southwest China.

In this hospital-based descriptive study, the genotype distribution of human papillomavirus (HPV) among HPV-infected women were investigated in 4,305 gynecological patients in Sichuan province. Females attending gynecology clinics between March 2014 and March 2015 were subjected to HPV screening after giving informed consent. Cervical scrapings were examined by cytopathology and colposcopy-directed biopsies. HPV genotyping was performed on a Luminex 200 system. Seventeen high-risk (HR) genotypes (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -53, -56, -58, -59, -66, -68, -73, and -82) and seven low-risk (LR) genotypes (HPV-6, -11, -42, -43, -61, -81, and -83) were detected. Among all HPV-positive women, 34.1% (1,467/4,305) of the cases showed abnormal cytology and biopsy, including high-grade squamous lesions (HSIL), cervical intraepithelial neoplasias of grades 2 and 3 (CIN2/CIN3), and cervical cancer (CC). HPV-16, -52, and -58 were the predominant genotypes, followed by HPV-56, -18, -59, -39, -53, -33, and -81. A total of 3,785 (87.9%) HPV positive women were found to have HR HPV infection, while 859 (20.0%) were found to have LR HPV infection. Among all patients, 79% (3,401/4,305) were infected with a single strain of HPV, 85.5% (2,907/3,401) cases of which were of the HR HPV genotype. In cervical precancerous lesions (CPLs) and CC patients, HR HPV-16, -58, -52, -33, and -18 were the predominant genotypes. Interestingly, 33 CPL patients had a single LR HPV infection with HPV-61, -11, -81, -6, -43, or -42. Furthermore, one CC patient was infected only with LR HPV-11. According to the abundant genotype diversity of HPV in Sichuan, we suggest that a large-scale epidemiological investigation should be launched, not only to understand the distribution of HPV genotype, but also to provide information needed for HPV vaccination programs and to predict the effectiveness of current vaccines in Southwest China.

Evaluation of the genetic parameters and mutation analysis of 22 STR loci in the central Chinese Han population.

At present, the Han nationality is China's main ethnic group and also the most populous nation in the world. This is a great resource to study microsatellite mutations and for the study of ethnogeny. The aim of this study is to investigate the genetic polymorphisms and mutations of 22 autosomal STR loci in 2475 individuals from Henan province, China. DNA is amplified and genotyped using PowerPlex™24 system. The gene frequencies, forensic parameters, and the mutation rate of the 22 STR loci are analyzed. A total of 295 alleles are observed in this Henan Han population, and the allelic frequencies ranged from 0.0003 to 0.5036. In order to investigate the genetic relationships between the Henan Han and the other 14 different populations, our present data were compared with previously published data for the same 15 STR loci. The results indicated that the Henan Han had closer genetic relationships the groups including Minnan Han, Maonan, Yi and Guangdong Han groups while the South morocco population, the Moroccan population, the Malay group, and the Uigur stand away from Henan Han. Except of D2S441, D13S317, PentaE, D2S1338, D5S818, TPOX and D19S433, the mutation events are found in the other 15 STR loci. A total of 40 mutation events are observed in the 15 STR loci. The mutation rates are ranged from 0 to 4.85 × 10-3. In this study, 39 mutations are single-step mutations, and only one at FGA comprised two steps. STR mutation is commonly existed in paternity testing, while there are no STR mutation studies of the 22 STR loci in the Henan Han population. It is of great importance in forensic individual discrimination and paternal testing.

A simple approach to assess N load capacity of rice paddy fields in the southern Taihu Lake watershed.

High nitrogen (N) leaching from irrigated agricultural soils is the result of N input exceeding soil N load capacity (NLC). A simple approach was developed in this research to assess the NLC of paddy soils in the southern Taihu Lake watershed. Paddy soils were classified into four types (Submergenic, Illuvium, Gleyed, and Percogenic) and 28 soil samples representing all four types were collected from across the region. The NLC values of the paddy soils were assessed using a split-line model and the spatial variability of the NLC among various rice paddy soils in the region was also evaluated with Kriging analysis. Results showed the NLC of paddy soils were both soil type and background N content related. The critical N sorption values (NLC plus soil N background) of the Gleyed, Illuvium, Submergenic, and Percogenic paddy soil samples varied from 283.1 to 315.6 mg kg(-1), 203.0 to 270.2 mg kg(-1), 240.6 to 254.4 mg kg(-1), and 177.4 to 186.2 mg kg(-1), respectively. However, on average the NLC of paddy soils in the region was 80.3 mg kg(-1), and the corresponding environmental N load threshold was around 110 kg N ha(-1). Geo-statistic results showed that the NLCs were unevenly distributed throughout the rice paddy dominated areas of the southern Taihu Lake watershed. The NLC assessment approach and spatial distribution information provided helpful guidance to set an environmental N threshold for best N management and hence reduce degradation of water for the whole rice ecosystem.

A novel variant in the FLCN gene in a Chinese family with Birt-Hogg-Dubé syndrome.

BACKGROUND: This study aimed to identify disease-causing variants within a Chinese family affected by Birt-Hogg-Dubé syndrome (BHDS), which arises from an autosomal dominant inheritance pattern attributed to variants in the folliculin (FLCN) gene, recognized as a tumor suppressor gene. METHODS: A Chinese proband diagnosed with BHDS due to renal tumors underwent next-generation sequencing (NGS), revealing a novel variant in the FLCN gene. Sanger sequencing was subsequently performed on blood samples obtained from family members to confirm the presence of this variant. RESULTS: A novel germline frameshift variant (NM_144997.5:c.977dup) was identified in five individuals among the screened family members, marking the first report of this variant. Additionally, a somatic frameshift variant (NM_144997.5:c.1252del) was detected in the renal tumors of the proband. No variant was detected in unaffected family members. CONCLUSIONS: A novel heterozygous variant was identified in exon 9 of the FLCN gene, which broadens the spectrum of FLCN variants. We recommend that molecular analysis of the FLCN gene be performed in patients with suspected BHDS and their families.

Promoting the four electrocatalytic reactions of OER/ORR/HER/MOR using a multi-component metal sulfide heterostructure for zinc-air batteries and water-splitting.

Multi-component metal sulfide heterostructures are promising for multi-functional catalytic activities. In this work, we fabricated a multi-component metal sulfide heterostructure (Co-S-INF, composed of Co3S4 and (Fe, Ni)9S8) with nanoflower morphology clustered with numerous nanosheets by the electrodeposition of cobalt on iron-nickel foam followed by hydrothermal sulfurization treatment. Co-S-INF possesses high multi-functional electrocatalytic properties toward the oxygen evolution reaction (OER), oxygen reduction reaction (ORR), hydrogen evolution reaction (HER), and methanol oxidation reaction (MOR). In particular, the ORR potential at 10 mA cm-2 is 0.682 V, and the OER, HER, and MOR potentials at 100 mA cm-2 are 1.478 V, 0.289 V, and 1.417 V, respectively. By using Co-S-INF, the aqueous ZAB with an ultrahigh peak power density of 332.30 mW cm-2 and an overall water splitting (OWS) device with a low splitting voltage of 1.82 V at 100 mA cm-2 can be obtained. In addition, the OWS potential can be further decreased to 1.70 V at a current density of 100 mA cm-2 with the assistance of MOR at the anode accompanying the production of the high value-added formate. Our work opens the way for the application and development of multi-functional electrocatalysts.

YAP promotes the early development of temporomandibular joint bony ankylosis by regulating mesenchymal stem cell function.

To explore the role of YAP, a key effector of the Hippo pathway, in temporomandibular joint (TMJ) ankylosis. The temporal and spatial expression of YAP was detected via immunohistochemistry and multiplex immunohistochemistry on postoperative Days 1, 4, 7, 9, 11, 14 and 28 in a sheep model. Isolated mesenchymal stem cells (MSCs) from samples of the Day 14. The relative mRNA expression of YAP was examined before and after the osteogenic induction of MSCs. A YAP-silenced MSC model was constructed, and the effect of YAP knockdown on MSC function was examined. YAP is expressed in the nucleus of the key sites that determine the ankylosis formation, indicating that YAP is activated in a physiological state. The expression of YAP increased gradually over time. Moreover, the number of cells coexpressing of RUNX2 and YAP-with the osteogenic active zone labelled by RUNX2-tended to increase after Day 9. After the osteogenic induction of MSCs, the expression of YAP increased. After silencing YAP, the osteogenic, proliferative and migratory abilities of the MSCs were inhibited. YAP is involved in the early development of TMJ bony ankylosis. Inhibition of YAP using shRNA might be a promising way to prevent or treat TMJ ankylosis.

Three different bacterial detection systems for platelet concentrates under inter-laboratory conditions.

BACKGROUND: A variety of screening methods are currently used worldwide in order to decrease the risk of transfusion-transmitted sepsis and improve the safety of PCs. METHODS/MATERIALS: PCs inoculated with five different transfusion-relevant species of bacteria at concentrations of 1, 10, and 100 colony-forming units (CFU)ml(-1) were stored at 22°C for 7 days. Flow cytometry (FACS), BacT/Alert automated culturing, and a quantitative real-time PCR (Q-PCR) were then used to detect the presence of bacteria in samples prepared from these PCs. RESULTS: At the initial spiking concentrations of 1, 10, and 100 CFU ml(-1), Q-PCR detected all five bacterial species tested. Screening with the BacT/Alert culture-based system allowed bacterial detection (inoculated on day 0) within a mean time of 15.13 h for all three spiking concentrations. Using FACS, positive signals were obtained for all three concentrations of Escherichia coli and Bacillus cereus on day 1 and for initial spiking concentrations of Pseudomonas aeruginosa and Staphylococcus aureus of 1 CFU ml(-1) on day 2. For Staphylococcus epidermidis, detection of an initial inoculum of 1 CFU ml(-1) was possible only beginning on day 6. CONCLUSION: This study shows that under standard laboratory conditions the sensitivity of FACS in the detection of bacterial contamination of PCs was lower than that of either the BacT/Alert automated culturing method or Q-PCR.

Mechanisms of conservation tillage on nitrogen-fertilizer reduction and maize grain improvement in Mollisols of Northeast China: Insights from a 15N tracing study.

Conservation tillage is an important management practice to guarantee soil fertility in degraded Mollisols. It is still unclear, however, whether the improvement and stability of crop yield under conservation tillage can be sustainable with increasing soil fertility and reducing fertilizer-N application. Based on a long-term tillage experiment initiated in Lishu Conservation Tillage Research and Development Station by Chinese Academy of Sciences, we conducted a 15N tracing field micro-plot experiment to investigate the effects of reducing nitrogen application on maize yield and fertilizer-N transformation under long-term conservation tillage agroecosystem. There were four treatments, including conventional ridge tillage (RT), no-tillage with 0% (NT0), 100% (NTS) maize straw mul-ching, and 20% reduced fertilizer-N plus 100% maize stover mulching (RNTS). The results showed that after a complete cultivation round, the average percentages of fertilizer N recovery in soil residues, crop usage, and gaseous loss were 34%, 50%, and 16%, respectively. Compared with conventional ridge tillage, no-tillage with maize straw mulching (NTS and RNTS) significantly increased the use efficiency of fertilizer N in current season by 10% to 14%. From the perspective of N sourcing analysis, the average percentage of fertilizer N absorbed by crop parts (including seeds, straws, roots, and cobs) to the total N uptake reached nearly 40%, indicating that soil N pool was the main source of N for crop uptakes. In comparison with conventional ridge tillage, conservation tillage significantly increased total N storage in 0-40 cm by reducing soil disturbance and increasing organic inputs, and thus ensured the expansion and efficiency increment of soil N pool in degraded Mollisols. Compared with conventional ridge tillage, NTS and RNTS treatments significantly increased the maize yield from 2016 to 2018. In all, by improving fertilizer nitrogen utilization efficiency and maintaining the continuous supply of soil nitrogen, long-term management of no-tillage with maize straw mulching could achieve a stable and increasing maize yield in three consecutive growing seasons and simultaneously reduce environmental risks derived by fertilizer-N losses, even under the condition of 20% reduction of fertilizer-N application, and thus actualize the sustainable development of agriculture in Mollisols of Northeast China.

IDENTIFICATION OF SUBPHENOTYPES OF SEPSIS-ASSOCIATED LIVER DYSFUNCTION USING CLUSTER ANALYSIS.

ABSTRACT: Objectives: We attempted to identify and validate the subphenotypes of sepsis-associated liver dysfunction (SALD) using routine clinical information. Design: This article is a retrospective observational cohort study. Setting: We used the Medical Information Mart for Intensive Care IV database and the eICU Collaborative Research Database. Patients: We included adult patients (age ≥18 years) who developed SALD within the first 48 hours of intensive care unit (ICU) admission. We excluded patients who died or were discharged from the ICU within the first 48 hours of admission. Patients with abnormal liver function before ICU admission were also excluded. Measurements and Main Results: Patients in the MIMIC-IV 1.0 database served as a derivation cohort. Patients in the eICU database were used as validation cohort. We identified four subphenotypes of SALD (subphenotype α, ß, γ, δ) using K-means cluster analysis in 5234 patients in derivation cohort. The baseline characteristics and clinical outcomes were compared between the phenotypes using one-way analysis of variance/Kruskal-Wallis test and the χ 2 test. Moreover, we used line charts to illustrate the trend of liver function parameters over 14 days after ICU admission. Subphenotype α (n = 1,055) was the most severe cluster, characterized by shock with multiple organ dysfunction (MODS) group. Subphenotype ß (n = 1,179) had the highest median bilirubin level and the highest proportion of patients with underlying liver disease and coexisting coagulopathy (increased bilirubin group). Subphenotype γ (n = 1,661) was the cluster with the highest mean age and had the highest proportion of patients with chronic kidney disease (aged group). Subphenotype δ (n = 1,683) had the lowest 28-day and in-hospital mortality (mild group). The characteristics of clusters in the validation cohort were similar to those in the derivation cohort. In addition, we were surprised to find that GGT levels in subphenotype δ were significantly higher than in other subphenotypes, showing a different pattern from bilirubin. Conclusions: We identified four subphenotypes of SALD that presented with different clinical features and outcomes. These results can provide a valuable reference for understanding the clinical characteristics and associated outcomes to improve the management of patients with SALD in the ICU.

Comparison of anticoagulation monitoring strategies for adults supported on extracorporeal membrane oxygenation: A systematic review.

BACKGROUND: Anticoagulation is critical in patients supported on extracorporeal membrane oxygenation (ECMO). The appropriate monitoring strategies for heparin remain unclear. OBJECTIVES: This systematic review aimed to compare the accuracy and safety of various monitoring strategies for patients supported on ECMO. METHODS: The PubMed and Web of Science databases were searched for articles in March 2023 without restrictions on publication date. Anticoagulation monitoring strategies for adults supported on ECMO were compared across all included studies. The incidence of bleeding, thrombosis, mortality, blood transfusion, correlation between tests and heparin dose, and the discordance between different tests were discussed in the included studies. The risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. RESULTS: Twenty-six studies, including a total of 1,684 patients, met the inclusion criteria. The monitoring of anticoagulation by activated partial thromboplastin time (aPTT) resulted in less blood product transfusion than that by activated clotting time (ACT). Moreover, the monitoring of anticoagulation by anti-factor Xa (Anti-Xa) resulted in a more stable anticoagulation than that by aPTT. Anti-Xa and aPTT correlated with heparin dose better than ACT, and the discordance between different monitoring tests was common. Finally, combined monitoring showed some advantages in reducing mortality and blood product transfusion. CONCLUSION: Anti-Xa and aPTT are more suitable for anticoagulation monitoring for patients supported on ECMO than ACT. Thromboelastography and combination strategies are less applied. Most of the studies were retrospective, and their sample sizes were relatively small; thus, more appropriate monitoring strategies and higher quality research are needed.

Oncologic safety of the pedicled submental island flap for reconstruction in oral tongue squamous cell carcinoma: An analysis of 101 cases.

OBJECTIVE: To evaluate whether the pedicle submental island flap (SIF) can be safely used in the oral tongue squamous cell carcinoma (OTSCC) patients with pathologically node-positive (pN+) neck, especially pN+ at level I. METHODS: Retrospectively, 101 OTSCC patients with SIF reconstruction were enrolled. Oncological outcomes included the total locoregional recurrence, the SIF related locoregional recurrence (SRLR) which referred to the local recurrence at flap and ipsilateral neck recurrence at level I, recurrence free survival (RFS), overall survival (OS), and disease specific survival (DSS). RESULTS: Sixty-one patients were pathologically node-negative (pN0) and 40 were pN+. Thirteen patients experienced locoregional recurrence, of which 5 had a SRLR. The pN+ group had a significantly higher locoregional recurrence rate, lower 5-year RFS, OS and DSS than pN0 group (P < 0.05). Patients with pN0 had a significantly higher neck RFS when compared to those with pN+ either at level I (P = 0.005) or at other levels (P < 0.001). However, the neck RFS was similar between the two subgroups of pN+ (P = 0.550). Especially, patients with pN+ at level I had a significantly higher SRLR rate (P = 0.006) compared to those with pN0 at level I. Multivariate analysis showed that pN+ was an unfavorable factor for tumor recurrence and OS. CONCLUSION: Our data did not support the use of SIF in OTSCC patients with pN+ neck at level I due to an significantly increased SRLR rate compared to those with pN0 neck at level I.