Clinical analysis of C5 palsy after cervical decompression surgery: relationship between recovery duration and clinical and radiological factors.

BACKGROUND: Postoperative C5 palsy is a widely known complication of cervical decompression surgery. Many studies have focused on its etiology and factors affecting it. However, no study to date has evaluated the association between the clinical outcome and recovery duration of post-operative C5 palsy. We evaluated this in our current report. METHODS: A retrospective analysis was conducted for 710 consecutive degenerative cervical spine decompression surgeries performed in a single institution. We included all patients who underwent any type of surgical procedure for cervical spinal stenosis, ossification of posterior longitudinal ligament (OPLL), or cervical spondylotic myelopathy (CSM). Demographic, radiologic, clinical information was recorded. Finally, correlation analysis was conducted to identify demographic, radiologic, or clinical factors related with recovery duration (within or after 6 months). RESULTS: The incident rate of postoperative C5 palsy was 5.1 % (36/710 cases). Analysis of recovery duration revealed that 18 patients had recovered within 6 months and 33 (91.7 %) within 2 years, whilst 3 individuals (8.3 %) had not fully recovered within the follow-up period. Factors related to longer recovery (>6 months) included motor grade ≤2 (p < 0.001), presence of multi-segment paresis involving more than the C5 root (p = 0.002), loss of somatic sensation with pain (p = 0.008), and the degree of posterior spinal cord shifting (p = 0.040). Furthermore, multivariate analysis revealed that motor grade ≤2 (p = 0.010) had a significant effect on a recovery duration beyond 6 months. CONCLUSIONS: A motor grade ≤2, the presence of multi-segment paresis involving more than the C5 root, the loss of somatic sensation with pain, and the degree of posterior spinal cord shifting significantly influence whether the duration of recovery from postoperative C5 palsy will take longer than 6 months.

Simultaneous feature engineering and interpretation: Forecasting harmful algal blooms using a deep learning approach.

Routine monitoring for harmful algal blooms (HABs) is generally undertaken at low temporal frequency (e.g., weekly to monthly) that is unsuitable for capturing highly dynamic variations in cyanobacteria abundance. Therefore, we developed a model incorporating reverse time attention with a decay mechanism (RETAIN-D) to forecast HABs with simultaneous improvements in temporal resolution, forecasting performance, and interpretability. The usefulness of RETAIN-D in forecasting HABs was illustrated by its application to two sites located in the lower sections of the Nakdong and Yeongsan rivers, South Korea, where HABs pose a critical water quality issue. Three variations of recurrent neural network models, i.e., long short-term memory (LSTM), gated recurrent unit (GRU), and reverse time attention (RETAIN), were adopted for comparisons of performance with RETAIN-D. Input features encompassing meteorological, hydrological, environmental, and biological factors were used to forecast cyanobacteria abundance (total cyanobacteria cell counts and cell counts of dominant cyanobacteria taxa). Incorporation of a decay mechanism into the deep learning structure in RETAIN-D allowed forecasts of HABs on a high temporal resolution (daily) without manual feature engineering, increasing the usefulness of resulting forecasts for water quality and resources management. RETAIN-D yielded a high degree of accuracy (RMSE = 0.29-1.67, R2 = 0.76-0.98, MAE = 0.18-1.14, SMAPE = 9.77-87.94% for test sets; on natural log scales) across model outputs and sites, successfully capturing high variability and irregularities in the time series. RETAIN-D showed higher accuracy than RETAIN (except for comparable accuracy in forecasting Microcystis abundance at the Nakdong River site) and outperformed LSTM and GRU across all model outputs and sites. Ambient temperature had high importance in forecasting cyanobacteria abundance across all model outputs and sites, whereas the relative importance of other input features varied by the output and site. Increases in contributions with increasing irradiance, decreasing flow rates, and increasing residence time were more pronounced in summer than other seasons. Differences in the contributions of input features among different time steps (1 to 7 days prior to forecasting) were larger in the Yeongsan River site. RETAIN-D is applicable to a wide range of forecasting models that can benefit from improved temporal resolution, performance, and interpretability.

Adaptive Self-Organization of Nanomaterials Enables Strain-Insensitive Resistance of Stretchable Metallic Nanocomposites.

Highly conductive and stretchable nanocomposites are promising material candidates for skin electronics. However, the resistance of stretchable metallic nanocomposites highly depends on external strains, often deteriorating the performance of fabricated electronic devices. Here, a material strategy for the highly conductive and stretchable nanocomposites comprising metal nanomaterials of various dimensions and a viscoelastic block-copolymer matrix is presented. The resistance of the nanocomposites can be well retained under skin deformations (<50% strain). It is demonstrated that silver nanomaterials can self-organize inside the viscoelastic media in response to external strain when their surface is conjugated with 1-decanethiol. Distinct self-organization behaviors associated with nanomaterial dimensions and strain conditions are found. Adopting the optimum composition of 0D/1D/2D silver nanomaterials can render the resistance of the nanocomposites insensitive to uniaxial or biaxial strains. As a result, the resistance can be maintained with a variance of < 1% during 1000 stretching cycles under uniaxial and biaxial strains of <50% while a high conductivity of ≈31 000 S cm-1 is achieved.

Facile and Scalable Synthesis of Whiskered Gold Nanosheets for Stretchable, Conductive, and Biocompatible Nanocomposites.

Noble metal nanomaterials have been studied as conductive fillers for stretchable, conductive, and biocompatible nanocomposites. However, their performance as conductive filler materials is far from ideal because of their high percolation threshold and low intrinsic conductivity. Moreover, the difficulty in large-scale production is another critical hurdle in their practical applications. Here we report a method for the facile and scalable synthesis of whiskered gold nanosheets (W-AuNSs) for stretchable, conductive, and biocompatible nanocomposites and their application to stretchable bioelectrodes. W-AuNSs show a lower percolation threshold (1.56 vol %) than those of gold nanoparticles (5.02 vol %) and gold nanosheets (2.74 vol %), which enables the fabrication of W-AuNS-based stretchable nanocomposites with superior conductivity and high stretchability. Addition of platinum-coated W-AuNSs (W-AuNSs@Pt) to the prepared nanocomposite significantly reduces the impedance and improved charge storage capacity. Such enhanced performance of the stretchable nanocomposite enables us to fabricate stretchable bioelectrodes whose performance is demonstrated through animal experiments including electrophysiological recording and electrical stimulation in vivo.

Enhanced Chemodynamic Therapy by Cu-Fe Peroxide Nanoparticles: Tumor Microenvironment-Mediated Synergistic Fenton Reaction.

An urgent need in chemodynamic therapy (CDT) is to achieve high Fenton catalytic efficiency at small doses of CDT agents. However, simple general promotion of the Fenton reaction increases the risk of damaging normal cells along with the cancer cells. Therefore, a tailored strategy to selectively enhance the Fenton reactivity in tumors, for example, by taking advantage of the characteristics of the tumor microenvironment (TME), is in high demand. Herein, a heterogeneous CDT system based on copper-iron peroxide nanoparticles (CFp NPs) is designed for TME-mediated synergistic therapy. CFp NPs degrade under the mildly acidic conditions of TME, self-supply H2O2, and the released Cu and Fe ions, with their larger portions at lower oxidation states, cooperatively facilitate hydroxyl radical production through a highly efficient catalytic loop to achieve an excellent tumor therapeutic efficacy. This is distinct from previous heterogeneous CDT systems in that the synergism is closely coupled with the Cu+-assisted conversion of Fe3+ to Fe2+ rather than their independent actions. As a result, almost complete ablation of tumors at a minimal treatment dose is demonstrated without the aid of any other therapeutic modality. Furthermore, CFp NPs generate O2 during the catalysis and exhibit a TME-responsive T1 magnetic resonance imaging contrast enhancement, which are useful for alleviating hypoxia and in vivo monitoring of tumors, respectively.

Highly conductive and elastic nanomembrane for skin electronics.

Skin electronics require stretchable conductors that satisfy metallike conductivity, high stretchability, ultrathin thickness, and facile patternability, but achieving these characteristics simultaneously is challenging. We present a float assembly method to fabricate a nanomembrane that meets all these requirements. The method enables a compact assembly of nanomaterials at the water-oil interface and their partial embedment in an ultrathin elastomer membrane, which can distribute the applied strain in the elastomer membrane and thus lead to a high elasticity even with the high loading of the nanomaterials. Furthermore, the structure allows cold welding and bilayer stacking, resulting in high conductivity. These properties are preserved even after high-resolution patterning by using photolithography. A multifunctional epidermal sensor array can be fabricated with the patterned nanomembranes.

Epitaxially Strained CeO2 /Mn3 O4 Nanocrystals as an Enhanced Antioxidant for Radioprotection.

Nanomaterials with antioxidant properties are promising for treating reactive oxygen species (ROS)-related diseases. However, maintaining efficacy at low doses to minimize toxicity is a critical for clinical applications. Tuning the surface strain of metallic nanoparticles can enhance catalytic reactivity, which has rarely been demonstrated in metal oxide nanomaterials. Here, it is shown that inducing surface strains of CeO2 /Mn3 O4 nanocrystals produces highly catalytic antioxidants that can protect tissue-resident stem cells from irradiation-induced ROS damage. Manganese ions deposited on the surface of cerium oxide (CeO2 ) nanocrystals form strained layers of manganese oxide (Mn3 O4 ) islands, increasing the number of oxygen vacancies. CeO2 /Mn3 O4 nanocrystals show better catalytic activity than CeO2 or Mn3 O4 alone and can protect the regenerative capabilities of intestinal stem cells in an organoid model after a lethal dose of irradiation. A small amount of the nanocrystals prevents acute radiation syndrome and increases the survival rate of mice treated with a lethal dose of total body irradiation.

A risk model for relapsed/refractory aggressive NHL integrating clinical risk factors and pretransplant Deauville score.

There are limited data regarding the combined value of the pretransplant Deauville score (DS) from a positron emission tomography scan and clinical risk factors in patients with relapsed/refractory aggressive non-Hodgkin lymphoma (NHL). We performed a retrospective analysis to assess the prognostic role of pretransplant DS in patients with relapsed/refractory aggressive NHL who underwent salvage chemotherapy and autologous stem cell transplantation (ASCT). We identified 174 eligible patients between January 2013 and March 2019. In multivariable analysis, pretransplant DS, B symptoms, and secondary International Prognostic Index (sIPI) were independent risk factors for event-free survival (EFS). These variables were used to derive an integrated risk score that categorized 166 patients with available information for all risk factors into 3 groups: low (n = 92; 55.4%), intermediate (n = 48; 28.9%), and high (n = 26; 15.7%). The new prognostic index showed a strong association with EFS (low-risk vs intermediate-risk hazard ratio [HR], 3.94; 95% confidence interval [CI], 2.16-7.17; P < .001; low-risk vs high-risk HR, 10.83; 95% CI, 5.81-20.19; P < .001) and outperformed models based on clinical risk factors or DS alone. These results were validated in 60 patients from an independent external cohort (low-risk vs intermediate-risk HR, 4.04; 95% CI, 1.51-10.82; P = .005; low-risk vs high-risk HR, 10.49; 95% CI, 4.11-26.73; P < .001). We propose and validate a new prognostic index that risk-stratifies patients undergoing salvage chemotherapy followed by ASCT, thereby identifying patients at high risk for posttransplant treatment failure.

Highly conductive, stretchable and biocompatible Ag-Au core-sheath nanowire composite for wearable and implantable bioelectronics.

Wearable and implantable devices require conductive, stretchable and biocompatible materials. However, obtaining composites that simultaneously fulfil these requirements is challenging due to a trade-off between conductivity and stretchability. Here, we report on Ag-Au nanocomposites composed of ultralong gold-coated silver nanowires in an elastomeric block-copolymer matrix. Owing to the high aspect ratio and percolation network of the Ag-Au nanowires, the nanocomposites exhibit an optimized conductivity of 41,850 S cm-1 (maximum of 72,600 S cm-1). Phase separation in the Ag-Au nanocomposite during the solvent-drying process generates a microstructure that yields an optimized stretchability of 266% (maximum of 840%). The thick gold sheath deposited on the silver nanowire surface prevents oxidation and silver ion leaching, making the composite biocompatible and highly conductive. Using the nanocomposite, we successfully fabricate wearable and implantable soft bioelectronic devices that can be conformally integrated with human skin and swine heart for continuous electrophysiological recording, and electrical and thermal stimulation.