Multi-Functional and Flexible Nano-Silver@MXene Heterostructure-Decorated Graphite Felt for Wearable Thermal Therapy.

Wearable heaters with multifunctional performances are urgently required for the future personal health management. However, it is still challengeable to fabricate multifunctional wearable heaters simultaneously with flexibility, air-permeability, Joule heating performance, electromagnetic shielding property, and anti-bacterial ability. Herein, silver nanoparticles (AgNPs)@MXene heterostructure-decorated graphite felts are fabricated by introducing MXene nanosheets onto the graphite felts via a simple dip-coating method and followed by a facile in situ growth approach to grow AgNPs on MXene layers. The obtained AgNPs@MXene heterostructure decorated graphite felts not only maintain the intrinsic flexibility, air-permeability and comfort characteristics of the matrixes, but also present excellent Joule heating performance including wide temperature range (30-128 °C), safe operating conditions (0.9-2.7 V), and rapid thermal response (reaching 128 °C within 100 s at 2.7 V). Besides, the multifunctional graphite felts exhibit excellent electromagnetic shielding effectiveness (53 dB) and outstanding anti-bacterial performances (>95% anti-bacterial rate toward Bacillus subtilis, Escherichia coli and Staphy-lococcus aureus). This work sheds light on a novel avenue to fabricate multifunctional wearable heaters for personal healthcare and personal thermal management.

Organic Electrolyte Additive: Dual Functions Toward Fast Sulfur Conversion and Stable Li Deposition for Advanced Li-S Batteries.

Lithium-sulfur (Li-S) battery is of great potential for the next generation energy storage device due to the high specific capacity energy density. However, the sluggish kinetics of S redox and the dendrite Li growth are the main challenges to hinder its commercial application. Herein, an organic electrolyte additive, i.e., benzyl chloride (BzCl), is applied as the remedy to address the two issues. In detail, BzCl can split into Bz· radical to react with the polysulfides, forming a Bz-S-Bz intermediate, which changes the conversion path of S and improves the kinetics by accelerating the S splitting. Meanwhile, a tight and robust solid electrolyte interphase (SEI) rich in inorganic ingredients namely LiCl, LiF, and Li2O, is formed on the surface of Li metal, accelerating the ion conductivity and blocking the decomposition of the solvent and lithium polysulfides. Therefore, the Li-S battery with BzCl as the additive remains high capacity of 693.2 mAh g-1 after 220 cycles at 0.5 C with a low decay rate of 0.11%. This work provides a novel strategy to boost the electrochemical performances in both cathode and anode and gives a guide on the electrolyte design toward high-performance Li-S batteries.

Multifunctional Liquid Metal-Bridged Graphite Nanoplatelets/Aramid Nanofiber Film for Thermal Management.

Miniaturization of modern micro-electronic devices urges the development of multi-functional thermal management materials. Traditional polymer composite-based thermal management materials are promising candidates, but they suffer from single functionality, high cost, and low fire-resistance. Herein, a multifunctional liquid metal (LM)-bridged graphite nanoplatelets (GNPs)/ aramid nanofibers (ANFs) film is fabricated via a facile vacuum-assisted self-assembly approach followed by compression. ANFs serve as interfacial binders to link LM and GNPs together via hydrogen bondings and π-π interactions, while LM bridges the adjacent layer of GNPs to endow a fast thermal transport by phonons and electrons. The resultant composite films exhibit a high bidirectional thermal conductivity (In-plane: 29.5 W m-1 K-1 and through-plane: 5.3 W m-1 K-1 ), offering a reliable and effective cooling. Moreover, the as-fabricated composite films exhibit superior flame-retardance (peak of heat release rate of 4000J g-1 ), outstanding Joule heating performance (200 °C at supplied voltage of 3.5 V), and excellent electromagnetic interference shielding effectiveness (EMI SE of 62 dB). This work provides an efficient avenue to fabricate multifuntional thermal management materials for micro-electronic devices, battery thermal management, and artificial intelligence.

Multifunctional MoSe2 @MXene Heterostructure-Decorated Cellulose Fabric for Wearable Thermal Therapy.

A booming demand for wearable electronic devices urges the development of multifunctional smart fabrics. However, it is still facing a challenge to fabricate multifunctional smart fabrics with satisfactory mechanical property, excellent Joule heating performance, highly efficient photothermal conversion, outstanding electromagnetic shielding effectiveness, and superior anti-bacterial capability. Here, a MoSe2 @MXene heterostructure-based multifunctional cellulose fabric is fabricated by depositing MXene nanosheets onto cellulose fabric followed by a facile hydrothermal method to grow MoSe2 nanoflakes on MXene layers. A low-voltage Joule heating therapy platform with rapid Joule heating response (up to 230 °C in 25 s at a supplied voltage of 4 V) and stable performance under repeated bending cycles (up to 1000 cycles) is realized. Besides, the multifunctional fabric also exhibits excellent photothermal performance (up to 130 °C upon irradiation for 25 s with a light intensity of 400 mW cm-2 ), outstanding electromagnetic interference shielding effectiveness (37 dB), and excellent antibacterial performances (>90% anti-bacterial rate toward Escherichia coli, Bacillus subtilis, and Staphylococcus aureus). This work offers an efficient avenue to fabricate multifunctional wearable thermal therapy devices for mobile healthcare and personal thermal management.

Microbiome-metabolomics analysis reveals abatement effects of itaconic acid on odorous compound production in Arbor Acre broilers.

BACKGROUND: Public complaints concerning odor emissions from intensive livestock and poultry farms continue to grow, as nauseous odorous compounds have adverse impacts on the environment and human health. Itaconic acid is a metabolite from the citric acid cycle of the host and shows volatile odor-reducing effects during animal production operations. However, the specific role of itaconic acid in decreasing intestinal odorous compound production remains unclear. A total of 360 one-day-old chicks were randomly divided into 6 treatment groups: control group (basal diet) and itaconic acid groups (basal diet + 2, 4, 6, 8 and 10 g/kg itaconic acid). The feeding experiment lasted for 42 d. RESULTS: Dietary itaconic acid supplementation linearly and quadratically decreased (P < 0.05) the cecal concentrations of indole and skatole but did not affect (P > 0.05) those of lactic, acetic, propionic and butyric acids. The cecal microbial shift was significant in response to 6 g/kg itaconic acid supplementation, in that the abundances of Firmicutes, Ruminococcus and Clostridium were increased (P < 0.05), while those of Bacteroidetes, Escherichia-Shigella and Bacteroides were decreased (P < 0.05), indicative of increased microbial richness and diversity. Furthermore, a total of 35 significantly (P < 0.05) modified metabolites were obtained by metabolomic analysis. Itaconic acid decreased (P < 0.05) the levels of nicotinic acid, nicotinamide, glucose-6-phosphate, fumatic acid and malic acid and increased (P < 0.05) 5-methoxytroptomine, dodecanoic acid and stearic acid, which are connected with the glycolytic pathway, citrate acid cycle and tryptophan metabolism. Correlation analysis indicated significant correlations between the altered cecal microbiota and metabolites; Firmicutes, Ruminococcus and Clostridium were shown to be negatively correlated with indole and skatole production, while Bacteroidetes, Escherichia-Shigella and Bacteroides were positively correlated with indole and skatole production. CONCLUSIONS: Itaconic acid decreased cecal indole and skatole levels and altered the microbiome and metabolome in favor of odorous compound reduction. These findings provide new insight into the role of itaconic acid and expand its application potential in broilers.

Soft Organic Thermoelectric Materials: Principles, Current State of the Art and Applications.

The enormous demand for waste heat utilization and burgeoning eco-friendly wearable materials has triggered huge interest in the development of thermoelectric materials that can harvest low-cost energy resources by converting waste heat to electricity efficiently. In particular, due to their high flexibility, nontoxicity, cost-effectivity, and promising applicability in various fields, organic thermoelectric materials are drawing more attention compared with their toxic, expensive, heavy, and brittle inorganic counterparts. Organic thermoelectric materials are approaching the figure of merit of the inorganic ones via the construction and optimization of unique transport pathways and device geometries. This review presents the recent development of the interdependence and decoupling principles of the thermoelectric efficiency parameters as well as the new achievements of high performance organic thermoelectric materials. Moreover, this review also discusses the advances in the thermoelectric devices with emphasis on their energy-related applications. It is believed that organic thermoelectric materials are emerging as green energy alternatives rivaling their conventional inorganic counterparts in the efficient and pure electricity harvesting from waste heat and solar thermal energy.

Adsorption in Reversed Order of C2 Hydrocarbons on an Ultramicroporous Fluorinated Metal-Organic Framework.

Metal-organic frameworks have been widely studied in the separation of C2 hydrocarbons, which usually preferentially bind unsaturated hydrocarbons with the order of acetylene (C2 H2 )>ethylene (C2 H4 )>ethane (C2 H6 ). Herein, we report an ultramicroporous fluorinated metal-organic framework Zn-FBA (H2 FBA=4,4'-(hexafluoroisopropylidene)bis(benzoic acid)), shows a reversed adsorption order characteristic for C2 hydrocarbons, that the uptake for C2 hydrocarbons of the framework and the binding affinity between the guest molecule and the framework follows the order C2 H6 >C2 H4 >C2 H2 . Density-functional theory calculations confirm that the completely reversed adsorption order behavior is attributed to the close van der Waals interactions and multiple cooperative C-H⋅⋅⋅F hydrogen bonds between the framework and C2 H6 . Moreover, Zn-FBA exhibits a high selectivity of about 2.9 for C2 H6 over C2 H4 at 298 K and 1 bar. The experimental breakthrough studies show that the high-purity C2 H4 can be obtained from C2 H6 and C2 H4 mixtures in one step.

Influence of first-pass effect on recanalization outcomes in the era of mechanical thrombectomy: a systemic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis summarized the current literature to compare the safety and efficacy between first-pass effect (FPE) and multiple-pass effect (MPE) for thrombectomy in treatment of acute ischemic stroke (AIS). METHODS: Major databases were searched for studies which reported clinical outcomes regarding successful or complete recanalization after first pass of mechanical thrombectomy in AIS. The assessment of bias was performed using different scales. I2 statistic was used to evaluate heterogeneity between reviewers. Subgroup, meta-regression, and sensitivity analyses were conducted to explore the source of heterogeneity. Visualization of funnel plots was used to evaluate publication bias. RESULTS: A total of 9 studies were eligible for final analysis. For successful recanalization (mTICI 2b-3), favorable outcomes were seen in 49.7% (95% confidence interval (CI): 40.5-58.9%) and 34.7% (95% CI: 26.8-42.7%) of FPE and MPE patients, respectively. Mortality at 3 months was 13.8% (95% CI: 10.8-16.9%) and 26.0% (95% CI: 17.7-34.2%), respectively. For complete recanalization (mTICI 2c-3), proportion of favorable outcomes were 62.7% (95% CI: 51.2-74.2%) and 47.7% (95% CI: 37.4-58.0%) in FPE and MPE; mortality was seen in 11.5% (95% CI: 4.9-18.2%) and 17.0% (95% CI: 5.2-28.7%), respectively. For AIS with successful recanalization, FPE had more favorable outcome (odds ratio (OR): 1.85, 95% CI: 1.48-2.30; p < 0.01; I2 = 0%) and lower mortality than MPE (OR: 0.58, 95% CI: 0.42-0.79; p = 0.001; I2 = 61.9%). Similar results were seen in a subgroup analysis of patients with complete recanalization, with FPE having better outcome (OR: 1.79, 95% CI: 1.40-2.28; p < 0.01; I2 = 0%) and lower mortality risk (OR: 0.61, 95% CI: 0.44-0.86; p = 0.005; I2 = 0%) compared to MPE. CONCLUSION: FPE is associated with better outcomes than MPE after achieving successful or complete recanalization.

Deciphering the Degradation Mechanism Induced by the Air-Exposure in Li2NiO2 and the Recovery Strategy.

Cathode prelithium agent is regarded as the most applicable approach to compensate the initial capacity loss in lithium ion batteries (LIBs). Li2NiO2 (LNO) has attracted numerous attention due to its superior environmental stability and reliable synthesis approach. To promote the commercial application of LNO, the understanding of the degradation mechanism induced by air-exposure and finding reliable strategies to improve the air stability are necessary. Herein, by preserving the LNO in different environments (relative humidity of 70% and 40%), the surface chemistry evolution of LNO is subtly investigated, which shows Li2CO3 and LiOH cover the surface of the LNO, which decline the Li+ diffusion kinetics as well as the charge capacity. What's more, the slurry turns gel when the LNO exposed to the environment of 70% relative humidity for 2 days and 40% relative humidity for 5 days. Facile approaches, including washing the deteriorative LNO with ethanol, reacting the alkali components with H3BO3, and coating the LNO with Al2O3 are conducted to recover the disabled LNO, which retains 84.2% of initial capacity. In addition, a coating approach is proposed for the fresh LNO to effectively improve the air stability. This work provides guideline to the commercial application of the LNO.

Peripheral Ganglion Cell Complex Thickness and Retinal Microvasculature in Myopia Using Wide-Field Swept-Source OCT.

Purpose: This study aims to investigate the impact of axial elongation on ganglion cell complex thickness (GCCT) and retinal capillary density (CD) using wide-field swept-source optical coherence tomography angiography. Methods: A retrospective cross-sectional analysis was conducted involving 506 eyes. Fovea-centered scans were obtained to assess the subregional GCCT and capillary density across the whole retina, the superficial capillary plexus (SCP), and deep capillary plexus (DCP) among three groups: normal control, high myopia (HM) eyes with axial length < 28 mm, and HM eyes with axial length > 28 mm. Regional variations (central vs. peripheral, quadrants difference [superior, inferior, nasal, and temporal]) were analyzed. Results: In HM eyes with axial length > 28 mm, GCCT and retinal CD exhibit a general decline in most regions (P < 0.05). In HM eyes with axial length < 28 mm, significant reductions were observed specifically in peripheral regions, as in the GCCT beyond the 3 × 3 mm2 area and CD in the 9-12 mm whole retina, 9-12 mm superior SCP, and 6-12 mm DCP (P < 0.05). Maximum GCCT and retinal CD reduction with axial elongation was observed in subregions beyond 6 × 6  mm2. Conclusions: GCCT beyond the 3 × 3 mm2 area and peripheral retinal CD beyond the 6 × 6  mm2 area were more susceptible to axial elongation and are thereby deserving of particular attention. Translational Relevance: It is necessary to evaluate different regions during the clinical assessment of the effect of myopia on the fundus and pay close attention to the peripheral retina.

Diagnostic performance of wide-field optical coherence tomography angiography in detecting open-angle glaucoma in high myopia.

PURPOSE: To compare the diagnostic performance of the capillary density (CD) of the central 1-6 mm and peripheral 6-12 mm annular regions in detecting open-angle glaucoma in high myopia (HM) using 15 × 12 mm wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). METHODS: The study enrolled 206 and 103 eyes with HM and highly myopic open-angle glaucoma (HM-OAG), respectively. WF SS-OCTA images centred on the fovea were obtained to analyse the changes in the CD in the 1-3 mm, 3-6 mm, 6-9 mm, and 9-12 mm annular regions. CD of the superficial capillary plexus (SCP) was measured with the built-in software. The area under the receiver operating characteristic curve (AUROC) of each region was compared. RESULTS: The diagnostic performance of the SCP CD in the central 1-6 mm annular region (AUROC = 0.849) was better than that in the peripheral 6-12 mm annular region (AUROC = 0.756, p = 0.001). The annular AUROCs of SCP CD peaked in the 3-6 mm annular region (AUROC = 0.858) and gradually decreased with increasing diameter and were lower than the corresponding AUROCs of the ganglion cell-inner plexiform layer thickness (p < 0.05 for all comparisons). SCP CD of the inferior quadrant in the 3-6 mm annular region had the best diagnostic performance (AUROC = 0.859). CONCLUSION: The SCP CD in the central 1-6 mm annular region exhibited better diagnostic performance for the detection of HM-OAG in HM. The assessment of more peripheral regions has no added value in detecting glaucoma in HM.

CRISPR-Cas9-mediated deletion of carbonic anhydrase 2 in the ciliary body to treat glaucoma.

The carbonic anhydrase 2 (Car2) gene encodes the primary isoenzyme responsible for aqueous humor (AH) production and plays a major role in the regulation of intraocular pressure (IOP). The CRISPR-Cas9 system, based on the ShH10 adenovirus-associated virus, can efficiently disrupt the Car2 gene in the ciliary body. With a single intravitreal injection, Car2 knockout can significantly and sustainably reduce IOP in both normal mice and glaucoma models by inhibiting AH production. Furthermore, it effectively delays and even halts glaucomatous damage induced by prolonged high IOP in a chronic ocular hypertension model, surpassing the efficacy of clinically available carbonic anhydrase inhibitors such as brinzolamide. The clinical application of CRISPR-Cas9 based disruption of Car2 is an attractive therapeutic strategy that could bring additional benefits to patients with glaucoma.

Understanding natural language: Potential application of large language models to ophthalmology.

Large language models (LLMs), a natural language processing technology based on deep learning, are currently in the spotlight. These models closely mimic natural language comprehension and generation. Their evolution has undergone several waves of innovation similar to convolutional neural networks. The transformer architecture advancement in generative artificial intelligence marks a monumental leap beyond early-stage pattern recognition via supervised learning. With the expansion of parameters and training data (terabytes), LLMs unveil remarkable human interactivity, encompassing capabilities such as memory retention and comprehension. These advances make LLMs particularly well-suited for roles in healthcare communication between medical practitioners and patients. In this comprehensive review, we discuss the trajectory of LLMs and their potential implications for clinicians and patients. For clinicians, LLMs can be used for automated medical documentation, and given better inputs and extensive validation, LLMs may be able to autonomously diagnose and treat in the future. For patient care, LLMs can be used for triage suggestions, summarization of medical documents, explanation of a patient's condition, and customizing patient education materials tailored to their comprehension level. The limitations of LLMs and possible solutions for real-world use are also presented. Given the rapid advancements in this area, this review attempts to briefly cover many roles that LLMs may play in the ophthalmic space, with a focus on improving the quality of healthcare delivery.

The AI revolution in glaucoma: Bridging challenges with opportunities.

Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms' widespread applicability. Additionally, the "black box" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.

Synthesis and Corrosion Inhibition Performance of Mannich Bases on Mild Steel in Lactic Acid Media.

Heterocyclic Mannich bases, N-(3-oxo-3-phenylpro-pyl)thiazol-2-aminium chloride (DTZA) and N-(3-oxo-3-phenylpropyl)-1H-pyrazol-3-aminium chloride (DPZA), were developed for the corrosion inhibition of N80 steel in a 15 wt % lactic acid solution. Weight loss measurements, electrochemical techniques, surface characterization, and theoretical calculations were combined to investigate their anticorrosion performance and mechanism. The results showed that DTZA exhibited a satisfactory inhibitor efficiency of 97.56% with a dosage of 0.15% at 363 K, while DPZA achieved only 58.3% under the same conditions. Adsorptions of both inhibitors on the metal surface followed the Langmuir model with physical and chemical adsorptions. Based on X-ray photoelectronic spectroscopy (XPS) analysis, DFT calculations, and molecular dynamics (MD) simulations, stronger interactions between DTZA and iron than those in the case of DPZA were revealed, leading to the formation of a compact protective film on the metal surface, which is attributed to the presence of a thiazole ring in the DTZA chemical structure.

Analysis of gas-solid two-phase flow and structure optimization of mobile shot blasting machine recovery device.

To address the problem of low efficiency of recycling process waste by gas-solid two-phase flow of the shot blasting machine recycling device, a method and structure by increasing the negative pressure value and optimizing the outlet pipe position are proposed. Computational fluid dynamics (CFD), discrete element method (DEM) and discrete phase model (DPM) were used to study the waste recovery efficiency at different pressure outlet conditions and outlet pipe locations. The validity of the model was verified by velocity tests at the outlet and inlet compared with simulations. The effect of particle size and particle generation rate on solid particle recovery efficiency was further investigated by analyzing the flow field distribution of the recovery unit. The results show that the maximum velocity of the gas phase in the recovery device increases with the increase of the absolute value of the outlet pressure, when the outlet pressure is -6500 Pa, the maximum velocity is 67.59 m/s. When the absolute value of the outlet pressure is greater than 6000 Pa, a small amount of steel shot particles is discharged from the recovery bin under the action of the outlet pressure, resulting in the loss of steel shot particles. After the outlet pipe position optimization, the steel shot particle recovery efficiency increased by 10% and the waste particle recovery efficiency increased by 18.9%.

Effects of dietary supplementation with itaconic acid on the growth performance, nutrient digestibility, slaughter variables, blood biochemical parameters, and intestinal morphology of broiler chickens.

Itaconic acid (IA) is a biologically based unsaturated dicarboxylic acid secreted by mammalian cells. While IA has potential for use in multiple applications, information regarding the influence of IA on animal production remains scarce. This study investigated the effects of dietary IA supplementation on the growth performance, nutrient digestibility, slaughter variables, blood parameters, and intestinal morphology of broiler chickens. A total of 360 one-day-old Arbor Acre broiler chicks were allotted to 6 groups, with 10 chicks per cage and 6 replicates per group in a randomized complete block design. Broiler chicks were fed a basal diet with 0 (control), 0.2, 0.4, 0.6, 0.8, or 1.0% IA. The experimental period lasted from 1 to 42 d of age. Dietary IA supplementation did not affect average daily gain (ADG) and feed/gain ratio (F/G) but quadratically increased average daily feed intake (ADFI) and linearly increased crude protein (CP) digestibility during the grower period (d 22-42). A higher breast and thigh muscle yield and a lower abdominal fat yield were observed in a linear and quadratic manner with the IA supplementation. Adding IA to the diet had significant effects on superoxide dismutase (SOD), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and catalase (CAT) levels in serum at d 21 and on total antioxidation capacity (T-AOC) at d 42. There were linear and quadratic increases in villus height and the villus height/crypt depth ratio (V/C) of the duodenum and villus height of the jejunum with the supplementation of IA. Regression analyses for ADFI, dressed yield, breast and thigh muscle yield, abdominal fat yield, serum ALT, CAT, and SOD levels, villus length of the duodenum and jejunum, and V/C of the duodenum indicated that the optimal dietary IA supplementation would be from 0.4 to 0.7%. From an economic perspective, a level of 0.4% IA in the broiler diet is recommended for improving the nutrient digestibility, slaughter performance, antioxidant ability, and intestinal morphology of broiler chickens.

Modified Eversion Carotid Endarterectomy: A Novel Surgical Technique for Carotid Artery Stenosis Treatment.

Background: Carotid endarterectomy (CEA) has been the standard therapy for carotid artery stenosis (CAS). Modified eversion carotid endarterectomy (mECEA) was recently introduced to treat CAS. However, the short-term safety and long-term efficacy of mECEA are still controversial among studies. This systematic review aims to summarize the current literatures about safety and efficacy of mECEA in treating CAS. Methods: A systematic review of mECEA was conducted in the main bibliographic databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Clinical studies on the safety and efficacy of mECEA in treating CAS with clinical results of transient ischemic attack (TIA), stroke, death, and restenosis were included. Results: The initial search and screening found 15 references from the main databases, and 7 studies were finally included after full-text article assessment, which consisted of 3 single-arm studies and 4 comparative studies. The risks of postoperative complications including TIA, stroke, myocardial infarction (MI), and death ranged from 1.1% to 2%, 0% to 2.5%, 0% to 4.4%, and 0% to 2.32%, respectively. The mECEA was significantly related to lower risk of carotid artery occlusion, incision numbness, and shorter lengths of stay in hospital and average scar when separately compared with conventional CEA (cCEA), CEA with patch closure (pCEA), and eversion CEA (eCEA). Conclusions: The mECEA is a promising surgical option for CAS with acceptable clinical outcomes. In order to prove its safety and efficacy, future practices need to be conducted by more medical workers in more large-scale trials.

Impact of conventional lipid-lowering therapy on circulating levels of PCSK9: protocol for a systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: Conventional lipid-lowering agents, including statins, ezetimibe, fibrates, bile acid sequestrants, nicotinic acid, bempedoic acid and Omega-3, are essential to the management of dyslipidaemia. However, these agents have been shown to increase the level of plasma proprotein convertase subtilisin/kexin 9 (PCSK9), a serine protease associated with increased cardiovascular risk. This review aims to investigate the impact of commonly available conventional lipid-lowering agents on circulating PCSK9 levels and lipid profiles. METHODS AND ANALYSIS: This protocol is conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A systematic search will be conducted in the following databases: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, SCOPUS and ScienceDirect. Additional information will be retrieved from clinical trial registries or from reference list searches. Published and peer-reviewed randomised controlled trials with adults receiving statin, ezetimibe, fibrate, bile acid sequestrant, nicotinic acid, bempedoic acid or Omega-3 monotherapy or in combination for at least 2 weeks, with availability of plasma PCSK9 at the beginning and end of treatment or the net changes in values, will be included. Study selection, data extraction and assessment of the risk of bias will be independently conducted by two investigators. Continuous data will be presented as a standardised mean difference with 95% confidence interval (CI) and dichotomous data as risk ratios with 95% CI. Subgroup analysis and sensitivity analysis will be performed when sufficient studies are included. Publication bias will be assessed with a funnel plot and Egger's test. ETHICS AND DISSEMINATION: Ethics approval is not required as this review will only include data from published sources. The results will be published in a peer-reviewed journal. PATIENT AND PUBLIC INVOLVEMENT: No patient or members of the general public are involved. PROSPERO REGISTRATION NUMBER: CRD42022297942.

Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Background: First-pass effect (FPE) is increasingly recognized as a predictor of good outcome in large vessel occlusion (LVO). This systematic review and meta-analysis aimed to elucidate the factors influencing recanalization after mechanical thrombectomy (MT) with FPE in treating acute ischemic stroke (AIS). Methods: Main databases were searched for relevant randomized controlled trials (RCTs) and observational studies reporting influencing factors of MT with FPE in AIS. Recanalization was assessed by the modified thrombolysis in cerebral ischemia (mTICI) score. Both successful (mTICI 2b-3) and complete recanalization (mTICI 2c-3) were observed. Risk of bias was assessed through different scales according to study design. The I 2 statistic was used to evaluate the heterogeneity, while subgroup analysis, meta-regression, and sensitivity analysis were performed to investigate the source of heterogeneity. Visual measurement of funnel plots was used to evaluate publication bias. Results: A total of 17 studies and 6,186 patients were included. Among them, 2,068 patients achieved recanalization with FPE. The results of meta-analyses showed that age [mean deviation (MD):1.21,95% confidence interval (CI): 0.26-2.16; p = 0.012], female gender [odds ratio (OR):1.12,95% CI: 1.00-1.26; p = 0.046], diabetes mellitus (DM) (OR:1.17,95% CI: 1.01-1.35; p = 0.032), occlusion of internal carotid artery (ICA) (OR:0.71,95% CI: 0.52-0.97; p = 0.033), occlusion of M2 segment of middle cerebral artery (OR:1.36,95% CI: 1.05-1.77; p = 0.019), duration of intervention (MD: -27.85, 95% CI: -42.11-13.58; p < 0.001), time of onset to recanalization (MD: -34.63, 95% CI: -58.45-10.81; p = 0.004), general anesthesia (OR: 0.63,95% CI: 0.52-0.77; p < 0.001), and use of balloon guide catheter (BGC) (OR:1.60,95% CI: 1.17-2.18; p = 0.003) were significantly associated with successful recanalization with FPE. At the same time, age, female gender, duration of intervention, general anesthesia, use of BGC, and occlusion of ICA were associated with complete reperfusion with FPE, but M2 occlusion and DM were not. Conclusion: Age, gender, occlusion site, anesthesia type, and use of BGC were influencing factors for both successful and complete recanalization after first-pass thrombectomy. Further studies with more comprehensive observations indexes are need in the future.