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Background: Lymphopenia is common in respiratory viral infection. However, no studies elucidated the impact of prolonged lymphopenia on worse outcome in the way of quantitative risk. Methods: Adult patients with laboratory-confirmed respiratory virus infection (influenza, SARS-CoV-2, and other viruses) between January 1st, 2016, and February 1st, 2023 were enrolled in this retrospective cohort study. Serial data of laboratory examination during hospitalization were acquired. The primary outcome was in-hospital all-cause death, and all information was obtained from the electronic medical records system. Legendre orthogonal polynomials (LOP), restricted cubic splines, and multivariable logistic regression were performed. Results: Finally, 2388 inpatients were involved in this study, including 436 patients with influenza, 1397 with SARS-CoV-2, and 319 with other respiratory virus infections. After being adjusted for age, corticosteroids, chronic kidney disease, chronic respiratory disease, cardiovascular disease, lymphopenia on admission and length of hospital stay, prolonged lymphopenia was significantly associated with death in influenza (OR 7.20, 95 % CI 2.27-22.77, p = 0. 0008 for lasting for 3-7 days; OR 17.80, 95 % CI 5.21-60.82, p < 0.0001 for lasting for more than 7 days) and SARS-CoV-2 (OR 3.07, 95 % CI 1.89-5.01, p < 0.0001 for lasting for 3-7 days; OR 6.28, 95 % CI 3.53-11.18, p < 0.0001 for lasting for more than 7 days), compared with a transient lymphopenia of 1-2 days, while no significant association was found in other respiratory viruses. Prolonged lymphopenia was also associated with multi-organ damage in influenza and SARS-CoV-2 infections. Conclusions: Prolonged lymphopenia was significantly associated with worse clinical prognoses in influenza and SARS-CoV-2 infections, but not in other respiratory virus infections.
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Magnetic proximity interaction provides a promising route to manipulate the spin and valley degrees of freedom in van der Waals heterostructures. Here, we report a control of valley pseudospin in the WS2/MoSe2 heterostructure by utilizing the magnetic proximity effect of few-layered CrBr3 and, for the first time, observe a substantial difference in valley polarization of intra/interlayer excitons under different circularly polarized laser excitations, referred to as chirality-dependent valley polarization. Theoretical and experimental results reveal that the spin-selective charge transfer between MoSe2 and CrBr3, as well as between MoSe2 and WS2, is mostly responsible for the chiral feature of valley polarization in comparison with the proximity exchange field. This means that a long-distance manipulation of exciton behaviors in multilayer heterostructures can be achieved through spin-selective charge transfer. This work marks a significant advancement in the control of spin and valley pseudospin in multilayer structures.
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Interlayer excitons, with prolonged lifetimes and tunability, hold potential for advanced optoelectronics. Previous research on the interlayer excitons has been dominated by two-dimensional heterostructures. Here, we construct WSe2/GaN composite heterostructures, in which the doping concentration of GaN and the twist angle of bilayer WSe2 are employed as two ingredients for the manipulation of exciton behaviors and polarizations. The exciton energies in monolayer WSe2/GaN can be regulated continuously by the doping levels of the GaN substrate, and a remarkable increase in the valley polarizations is achieved. Especially in a heterostructure with 4°-twisted bilayer WSe2, a maximum polarization of 38.9% with a long lifetime is achieved for the interlayer exciton. Theoretical calculations reveal that the large polarization and long lifetime are attributed to the high exciton binding energy and large spin flipping energy during depolarization in bilayer WSe2/GaN. This work introduces a distinctive member of the interlayer exciton with a high degree of polarization and a long lifetime.
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Patients with venous thromboembolism (VTE) comorbid renal insufficiency (RI) are at higher risk of bleeding and thrombosis. Recommendations in guidelines on anticoagulation therapy for those patients remain ambiguous. The goal of this study is to compare the efficacy and safety between different anticoagulant regimens in VTE patients comorbid RI at different stages of treatment and prophylaxis. We performed English-language searches of Pubmed, EMBASE, and Web of Science (inception to Nov 2022). RCTs evaluated anticoagulants for VTE treatment at the acute phase, extension phase, and prophylaxis in patients with RI and reported efficacy and safety outcomes were selected. The methodological quality of the studies was assessed at the outcome level using the risk-of-bias assessment tool developed by the Cochrane Bias Methods Group. A meta-analysis of twenty-five RCTs was conducted, comprising data from twenty-three articles, encompassing a total of 9,680 participants with RI. In the acute phase, the risk of bleeding was increased with novel oral anticoagulants (NOACs) compared to LMWH (RR 1.29, 95% CI 1.04-1.60). For the prophylaxis of VTE, NOACs were associated with an elevated risk of bleeding compared with placebo (RR 1.31, 95%CI 1.02-1.68). In comparison to non-RI patients, both NOACs and vitamin K antagonists (VKA) could increase the risk of bleeding among RI patients (RR 1.45, 95%CI 1.14-1.84 and RR 1.53, 95%CI 1.25-1.88, respectively) during acute phase, while NOACs may increase the incidence of VTE in RI population (RR 1.74, 95%CI 1.29-2.34). RI patients who are under routine anticoagulation have a significantly higher risk of adverse outcomes. LMWH is the most effective and safe option for VTE treatment or prophylaxis in patients with RI.
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Background: Risk stratification for patients with acute pulmonary embolism (APE) is significantly important for treatment and prognosis evaluation. We aimed to develop a novel clot burden score on computed tomography pulmonary angiography (CTPA) based on deep learning (DL) algorithm for risk stratification of APE. Methods: The study retrospectively enrolled patients newly diagnosed with APE in China-Japan Friendship Hospital consecutively. We collected baseline data and CTPA parameters, and calculated four different clot burden scores, including Qanadli score, Mastora score, clot volume and clot ratio. The former two were calculated by two radiologists separately, while clot volume and clot ratio were based on the DL algorithm. The area under the curve (AUC) of four clot burden scores were analyzed. Results: Seventy patients were enrolled, including 17 in high-/intermediate-high risk and 53 in low-/intermediate-low risk. Clot burden was related to the risk stratification of APE. Among four clot burden scores, clot ratio had the highest AUC (0.719, 95% CI: 0.569-0.868) to predict patients with higher risk. In the patients with hemodynamically stable APE, only clot ratio presented statistical difference (P=0.046). Conclusions: Clot ratio is a new imaging marker of clot burden which correlates with the risk stratification of patients with APE. Higher clot ratio may indicate higher risk and acute right ventricular dysfunction in patients with hemodynamically stable status.
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BACKGROUND: Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models. METHODS: This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Naïve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis. RESULTS: The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. CONCLUSIONS: Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.
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Hominidae , Embolia Pulmonar , Humanos , Animais , Estudos Retrospectivos , Teorema de Bayes , Embolia Pulmonar/diagnóstico , Algoritmos , Doença AgudaRESUMO
Developing a rational and cost-effective approach for designing highly-efficient and sustainable electrocatalysts is essential for clean and renewable hydrogen energy. Herein, we report nitrogen-doped CoP on two-dimensional ammoniated black phosphorus (BP) nanosheets (N-CoP/NH2-BP) as novel and highly-active heterostructure electrocatalysts for the hydrogen evolution reaction (HER). Using the reactive defects on the BP nanosheets as the original sites under NH3 gas, N-doped CoP nanocrystals were grown on the surface of the BP nanosheets that were functionalized with NH2 groups at their edge. The N-CoP/NH2-BP heterostructure exhibits low overpotentials of 90 and 246 mV at 10 and 200 mA cm-2, respectively, in an alkaline electrolyte. The excellent HER activity should be attributed to the synergistic effect between N-doped CoP and NH2-functionalized BP, in which NH2-BP, with its high electron mobility and hydrophilicity, accelerates the charge transfer and offers more active sites, moreover, N-doped CoP modulates the electronic structure of CoP for enhanced HER activity. This work not only provides a novel and effective electrocatalyst, but also opens up a straightforward strategy for the design of phosphorene-based electrocatalysts for highly efficient hydrogen evolution and beyond.
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Memristors with nonvolatile storage performance and simulated synaptic functions are regarded as one of the critical devices to overcome the bottleneck in traditional von Neumann computer architecture. 2D van der Waals heterostructures have paved a new way for the development of advanced memristors by integrating the intriguing features of different materials and offering additional controllability over their optoelectronic properties. Herein, planar memristors with both electrical and optical tunability based on ReS2 /WS2 van der Waals heterostructure are demonstrated. The devices show unique unipolar nonvolatile behavior with high Roff /Ron ratio of up to 106 , desirable endurance, and retention, which are superior to pure ReS2 and WS2 devices. When decreasing the channel length, the set voltage can be notably reduced while the high Roff /Ron ratios are retained. By introducing electrostatic doping through the gate control, the set voltage can be tailored in a wide range from 4.50 to 0.40 V. Furthermore, biological synaptic functions and plasticity, including spike rate-dependent plasticity and paired-pulse facilitation, are successfully realized. By employing optical illumination, resistive switching can also be modulated, which is dependent on the illumination energy and power. A mechanism related to the interlayer charge transfer controlled by optical excitation is revealed.
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Genome-wide association studies (GWAS) have identified numerous risk loci for venous thromboembolism (VTE), but it is challenging to decipher the underlying mechanisms. We employed an integrative analytical pipeline to transform genetic associations to identify novel plasma proteins for VTE. Proteome-wide association studies (PWAS) were determined by functional summary-based imputation leveraging data from a genome-wide association analysis (14,429 VTE patients, 267,037 controls), blood proteomes (1348 cases), followed by Mendelian randomization, Bayesian colocalization, protein-protein interaction, and pathway enrichment analysis. Twenty genetically regulated circulating protein abundances (F2, F11, ABO, PLCG2, LRP4, PLEK, KLKB1, PROC, KNG1, THBS2, SERPINA1, RARRES2, CEL, GP6, SERPINE2, SERPINA10, OBP2B, EFEMP1, F5, and MSR1) were associated with VTE. Of these 13 proteins demonstrated Mendelian randomized correlations. Six proteins (F2, F11, PLEK, SERPINA1, RARRES2, and SERPINE2) had strong support in colocalization analysis. Utilizing multidimensional data, this study suggests PLEK, SERPINA1, and SERPINE2 as compelling proteins that may provide key hints for future research and possible diagnostic and therapeutic targets for VTE.
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Tromboembolia Venosa , Humanos , Tromboembolia Venosa/genética , Proteoma/genética , Estudo de Associação Genômica Ampla/métodos , Análise da Randomização Mendeliana , Teorema de Bayes , Serpina E2/genética , Proteínas Sanguíneas/genética , Polimorfismo de Nucleotídeo Único , Proteínas da Matriz Extracelular/genéticaRESUMO
Background: Elevated risk of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) pneumonia has been recognized, while the risk factors associated with VTE in patients with non-COVID-19 pneumonia remain to be defined. This study aimed to conduct a meta-analysis and systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify potential risk factors for VTE in patients with pneumonia from the pre-COVID-19 era. Methods: PubMed, EMBASE, and Cochrane Library were searched. Two reviewers performed screening, full-text review, and extraction. Risk factors and odds ratio (OR) were estimated. Results: Of 595 articles identified, six studies were included. Pooled analysis suggested that age ≥60 years [OR =2.75, 95% confidence interval (CI): 2.55-2.97, P<0.001], mechanical ventilation (MV) (OR =9.48, 95% CI: 8.24-10.91, P<0.001), hypertension (OR =1.41, 95% CI: 1.09-1.83, P=0.010), diabetes (OR =1.49, 95% CI: 1.36-1.64, P<0.001), heart failure (OR =3.15, 95% CI: 1.05-9.41, P=0.040) and cancer (OR =2.86, 95% CI: 2.07-3.95, P<0.001) were associated with higher risk for deep vein thrombosis in patients with pneumonia. While age ≥60 years (OR =2.46, 95% CI: 2.21-2.73, P<0.001), bacterial pneumonia (OR =3.80, 95% CI: 1.65-8.73, P=0.002), hyperlipidemia (OR =1.55, 95% CI: 1.00-2.41, P=0.049), heart failure (OR =2.70, 95% CI: 2.05-3.56, P<0.001), chronic obstructive pulmonary disease (OR =4.73, 95% CI: 3.11-7.17, P<0.001) and cancer (OR =2.90, 95% CI: 2.39-3.53, P<0.001) were risk factors for pulmonary embolism in patients with pneumonia. Conclusions: Patients with non-COVID-19 pneumonia, particularly those with advanced age, MV, cardiovascular comorbidities or cancer, warrant individualized management during hospitalization. Our findings could contribute to refining risk prediction models and further risk stratification for VTE in patients with pneumonia in clinical practice.
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A young adult woman presented with exertional dyspnea and she had had recurrent epistaxis for more than 10 years. On physical examination, cyanosis was noted on the lips, and telangiectasias were seen on the oral mucosa and fingertips. Routine investigations revealed iron deficiency anemia and slightly elevated bilirubin. The result of right heart catheterization was indicative of pulmonary arterial hypertension (PAH). Pulmonary angiography showed arteriovenous malformations of the left upper pulmonary artery, and anterior cerebral artery malformation was seen in cranial computed tomographic angiogram. Genetic testing revealed that she and her three daughters carried heterozygous variant of ENG c.1195-1196del p.Arg399GlyfsTer2, which is characterized by pulmonary and cerebral arteriovenous malformations. In addition, our patient had pulmonary hypertension (PH) that is commonly associated with ACVRL1 mutations, revealing her phenotype was not consistent with isolated ENG genetic mutations. Here, we report a case with hereditary hemorrhagic telangiectasia (HHT) combined with PAH, which is associated with interesting differential diagnosis and etiological analysis. We have discussed the relationship between PH and HHT and the characteristics of PAH in HHT patients.
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Valleytronics in transition metal dichalcogenides has been intensively investigated for potential applications in next-generation information storage, data processing, and signal transmission devices. Here a ferroelectric gating approach is engaged in achieving nonvolatile electrical tuning of the valley-excitonic properties of monolayer and bilayer WS2. The gating effects include carrier doping and ferroelectric coupling, which are further distinguished by comparing two geometries where the gate electrodes are in direct contact with or insulated from the WS2 crystal. The results show that the carrier doping from gate electrodes acts on WS2 through carrier screening, which only moderately alters the valley polarization. In contrast, the ferroelectric gating promotes electron-phonon interaction, introduces a strong surface polarization field, and controls the interfacial charge trapping/detrapping, causing a Stark shift in exciton energy and strongly enhancing room-temperature valley polarization. In bilayer WS2, the intralayer-interlayer exciton transition is further induced, contributing to even higher valley polarization. The ferroelectric coupling effect can still be maintained after the removal of gate voltage, showing its nonvolatile nature. The role of ferroelectricity is further verified by the anomalous temperature dependence in valley polarization. This work has revealed effective electrical control over valley excitons in semiconductors through interaction with ferroelectric materials. The reported high room-temperature valley polarization in WS2 will boost the development of valleytronics devices.
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Electronic textiles have been regarded as the basic building blocks for constructing a new generation of wearable electronics. However, the electronization of textiles often changes their original properties such as color, softness, glossiness, or flexibility. Here a rapid room-temperature fabrication method toward conductive colorful threads and fabrics with Ag-coated Cu (Cu-Ag) nanonets is demonstrated. Cu-Ag core-shell nanowires are produced through a one-pot synthesis followed by electroless deposition. According to the balance of draining and entraining forces, a fast dip-withdraw process in a volatile solution is developed to tightly wrap Cu-Ag nanonets onto the fibers of thread. The modified threads are not only conductive, but they also retain their original features with enhanced mechanical stability and dry-wash durability. Furthermore, various e-textile devices are fabricated such as a fabric heater, touch screen gloves, a wearable real-time temperature sensor, and warm fabrics against infrared thermal dissipation. These high quality and colorful conductive textiles will provide powerful materials for promoting next-generation applications in wearable electronics.
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Nanofios , Dispositivos Eletrônicos Vestíveis , Condutividade Elétrica , Eletrônica , TêxteisRESUMO
Asymmetric transport characteristic in n- and p-type conductivity has long been a fundamental difficulty in wide bandgap semiconductors. Hexagonal boron nitride (h-BN) can achieve p-type conduction, however, the n-type conductivity still remains unavailable. Here, we demonstrate a concept of orbital split induced level engineering through sacrificial impurity coupling and the realization of efficient n-type transport in 2D h-BN monolayer. We find that the O 2pz orbital has both symmetry and energy matching to the Ge 4pz orbital, which promises a strong coupling. The introduction of side-by-side O to Ge donor can effectively push up the donor level by the formation of another sacrificial deep level. We discover that a Ge-O2 trimer brings the extremely shallow donor level and very low ionization energy. By low-pressure chemical vapor deposition method, we obtain the in-situ Ge-O doping in h-BN monolayer and successfully achieve both through-plane (~100 nA) and in-plane (~20 nA) n-type conduction. We fabricate a vertically-stacked n-hBN/p-GaN heterojunction and show distinct rectification characteristics. The sacrificial impurity coupling method provides a highly viable route to overcome the n-type limitation of h-BN and paves the way for the future 2D optoelectronic devices.
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Solar-blind photodetectors (PDs) are widely applicable in special, military, medical, environmental, and commercial fields. However, high performance and flexible PD for deep ultraviolet (UV) range is still a challenge. Here, it is demonstrated that an upconversion of photon absorption beyond the energy bandgap is achieved in the ZnO nanoarray/h-BN heterostructure, which enables the ultrahigh responsivity of a solar-blind photodetecting paper. The direct growth of ultralong ZnO nanoarray on polycrystalline copper paper induced by h-BN 2D interlayer is obtained. Meanwhile, strong photon trapping takes place within the ZnO nanoarray forest through the cyclic state transition of surface oxygen ions, resulting in an extremely high absorption efficiency (> 99.5%). A flexible photodetecting paper is fabricated for switchable detections between near UV and deep UV signals by critical external bias. The device shows robust reliability, ultrahigh responsivity up to 700 A W-1 @ 265-276 nm, and high photoconductive gain of ≈2 × 103 . A negative differential resistance effect is revealed for driving the rapid transfer of up-converted electrons between adjacent energy valleys (Γ to A) above the critical bias (3.9 V). The discovered rationale and device structure are expected to bring high-efficiency deep UV detecting and future wearable applications.
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Óxido de Zinco , Fótons , Reprodutibilidade dos Testes , Luz Solar , Raios Ultravioleta , Óxido de Zinco/químicaRESUMO
The presence and accumulation of dyestuff in the environment is posing great harm to human beings. In this study, a novel poly(pyrrole methane) (PPm) adsorbent with abundant OH was greenly synthesized via a facile polymerization method. Its physicochemical properties were characterized in detail. Furthermore, the adsorption performance of PPm for anionic dye (acid red G, ARG) and cationic dye (methylene blue, MB) was comparatively studied with a typical dye adsorbent (polyprrrole, PPy). The results revealed that the adsorption of ARG or MB onto PPm followed pseudo-second-order model and Langmuir mode. The adsorption processes were endothermic and spontaneous. The maximum capacities of PPm to adsorb ARG and MB were 555.56 mg/g and 99.11 mg/g, which were about 10 and 2 times higher than that of PPy, respectively. PPm could be reused for 5 cycles without a significant decrease of its adsorption rate. The adsorption of ARG and MB is mainly attributed to electrostatic interaction and hydrogen bonding between ARG or MB and OH in PPm. Additionally, ARG could be adsorbed by ion exchange with the doped Cl- in PPm. Therefore, this study provides a new strategy to synthesis efficient adsorbent for the removal of both anionic and cationic dyes.
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We report a novel lanthanide-doped core-shell nanostructure NaYF4:Yb,Er@NaGdF4:Nd@SiO2-RB with a unique design feature that integrates luminescence imaging in biological window II, magnetic resonance imaging, and NIR-excited photodynamic antimicrobial chemotherapy, in a single nanoscale entity.
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The worldwide increase in bacterial antibiotic resistance has led to a search for alternative antibacterial therapies. The present study reports the development of yolk-structured multifunctional up-conversion nanoparticles (UCNPs) that combine photodynamic and sonodynamic therapy for effective killing of antibiotic-resistant bacteria. The multifunctional nanoparticles (NPs) were achieved by enclosing hematoporphyrin monomethyl ether (HMME) into its yolk-structured up-conversion core and covalently linked rose bengal (RB) on its silica (SiO2) shell. Excitation of UCNPs with near-infrared (NIR) light that has improved penetration depth for photodynamic therapy (PDT) enabled the activation of HMME and RB and thus the generation of singlet oxygen (1O2). The SiO2 layer, which improved the biocompatibility of the UCNPs, surrounded the yolk structure, with a cavity space which had a high efficiency of loading photosensitizers. Synergistic PDT and sonodynamic therapy (SDT) improved the photosensitizer utilization rate. As a result, a greater inhibition rate was observed when antibiotic-resistant bacteria were treated with a combined therapy (100%) compared with either the PDT (74.2%) or SDT (70%) alone. Our data indicate that the multifunctional NPs developed in this study have the potential for use in the clinical synergistic PDT-SDT treatment of infectious diseases caused by antibiotic-resistant bacteria.