Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study.

Objectives: The cuff pressures > 30 cmH2O may create a seal in the trachea. The objective of this study was to identify risk factors associated with lack of tracheal sealing by an endotracheal cuff inflated to > 30 cmH2O in patients undergoing mechanical ventilation. Methods: This prospective cross-sectional study was conducted from 2019 to 2020 in the cardiothoracic intensive care unit and respiratory medical care unit of a Hospital in Nantong, China. Patients aged >16 years undergoing cardiothoracic surgery with mechanical ventilation using endotracheal intubation were included. Patient characteristics and ventilator parameters were analyzed. Cuff pressure was maintained with the minimum leak technique (MLT) and measured with a cuff pressure gauge. Cuff pressure was measured for 30 seconds when ventilation was accompanied by no leak, simultaneously detected by the ventilator or auscultation with a stethoscope. Result: Of 352 patients undergoing mechanical ventilation, 51 patients (14.5%) had a cuff pressure of >30 cmH2O. Multivariable analysis showed that cuff manufacturer (Guangzhou Weili) and nasal endotracheal intubation significantly increased the risk of an unsealed trachea. Peak inspiratory pressure, cuff diameter and male sex had a strong inverse association with an unsealed trachea. Conclusions: These findings suggest that an endotracheal cuff pressure of 20 to 30 cmH2O is adequate for most patients, but lack of a tracheal seal still occurs in a small number of people. An unsealed trachea is most likely because cuff and tracheal diameters do not match. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx Unique identifier: ChiCTR-COC-15006459.

Photodynamic therapy synergizes with PD-L1 checkpoint blockade for immunotherapy of CRC by multifunctional nanoparticles.

Checkpoint inhibitors, such as anti-PD-1/PD-L1 antibodies, have been shown to be extraordinarily effective, but their durable response rate remains low, especially in colorectal cancer (CRC). Recent studies have shown that photodynamic therapy (PDT) could effectively enhance PD-L1 blockade therapeutic effects, although the reason is still unclear. Here, we report the use of multifunctional nanoparticles (NPs) loaded with photosensitized mTHPC (mTHPC@VeC/T-RGD NPs)-mediated PDT treatment to potentiate the anti-tumor efficacy of PD-L1 blockade for CRC treatment and investigate the underlying mechanisms of PDT enhancing PD-L1 blockade therapeutic effect in this combination therapy. In this study, the mTHPC@VeC/T-RGD NPs under the 660-nm near infrared (NIR) laser could kill tumor cells by inducing apoptosis and/or necrosis and stimulating systemic immune response, which could be further promoted by the PD-L1 blockade to inhibit primary and distant tumor growth, as well as building long-term host immunological memory to prevent tumor recurrence. Furthermore, we detected that mTHPC@VeC/T-RGD NP-mediated PDT sensitizes tumors to PD-L1 blockade therapy mainly because PDT-mediated hypoxia could induce the hypoxia-inducible factor 1α (HIF-1α) signaling pathway that upregulates PD-L1 expression in CRC. Taken together, our work demonstrates that mTHPC@VeC/T-RGD NP-mediated PDT is a promising strategy that may potentiate the response rate of anti-PD-L1 checkpoint blockade immunotherapies in CRC.

Percutaneous Transhepatic Papillary Balloon Dilation versus Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: A Multicenter Prospective Study.

Background Endoscopic retrograde cholangiopancreatography (ERCP) is recommended by major guidelines for the removal of common bile duct (CBD) stones but is technically challenging in patients with low cardiopulmonary reserve and anatomic abnormalities of the upper gastrointestinal (GI) tract. Purpose To compare percutaneous transhepatic papillary balloon dilation (PTPBD) with ERCP for CBD stone removal. Materials and Methods Participants with one to three CBD stones (largest stone ≤30 mm) and without intrahepatic bile duct or gallbladder stones were eligible for this prospective cohort study. PTPBD was recommended in participants with low cardiopulmonary reserve or definitive anatomic abnormalities of the upper GI tract. Otherwise, both procedures were offered without preference. Follow-up, including abdominal CT, was conducted at 1-week and 1-, 3- and 6-month follow-up, and every 6 months thereafter. US and MR cholangiopancreatography were conducted if recurrence could not be confirmed with CT. Technical success rate was the primary outcome. Results A total of 531 participants were analyzed: there were 360 undergoing PTPBD (median age, 76 years; interquartile range [IQR], 64-82 years; 163 men) and 171 undergoing ERCP (median age, 66 years; IQR, 57-74 years; 94 men). The technical success rate was 99% (355 of 360) in the PTPBD group and 98% (167 of 171) in the ERCP group (relative risk, 1.02; P = .12). The incidence of overall complications was 4% (13 of 360) for PTPBD and 8% (13 of 171) for ERCP (relative risk, 0.27; 95% CI: 0.12, 0.61; P < .001). The PTPBD group showed a longer fluoroscopy time and a higher radiation exposure, with adjusted differences of 28.7 minutes (95% CI: 22.2, 35.2) and 384.3 mGy (95% CI: 296.5, 472), respectively. A propensity score-matching analysis (n = 123 per group) indicated that PTPBD had a slightly higher technical success rate and significantly fewer complications. Conclusion When compared with endoscopic retrograde cholangiopancreatography, percutaneous transhepatic papillary balloon dilation has a similar technical success rate and fewer perioperative complications but a higher radiation exposure. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by van Sonnenberg and Mueller in this issue.

Circular RNA ATXN7 promotes the development of gastric cancer through sponging miR-4319 and regulating ENTPD4.

BACKGROUND: Circular RNAs (circRNAs) which are shown as a class of RNAs exhibit the importance in the regulation of gene expression and the development of biological process. However, the expression profile and molecular mechanism of circRNA ATXN7 (circATXN7) is still mostly uncertain in gastric cancer (GC). METHODS: qRT-PCR analysis was performed to detect the expression of circATXN7, miR-4319 and ENTPD4 in GC tissues and cells. CCK-8, colony formation, EdU, flow cytometry, TUNEL and transwell assays were conducted to assess the effect of circATXN7 or miR-4319 on cell proliferation, apoptosis and invasion. In vivo assays were utilized to further analyze the function of circATXN7 on the tumorigenesis and progression of GC. The interaction between miR-4319 and circATXN7 (or ENTPD4) was verified using luciferase reporter and RNA pull-down assays. RESULTS: The results showed an upregulated circATXN7 expression in GC tissues and cell lines. Besides, silenced circATXN7 hampered the proliferation and invasion as well as promoted the apoptosis in GC cells. Moreover, low expression of miR-4319 was found in GC. It was determined that circATXN7 acted as a sponge for miR-4319 and had a negative association with miR-4319. We also found that miR-4319 upregulation restrained GC cell proliferation and migration whereas enhanced apoptosis. Subsequently, ENTPD4, the target gene of miR-4319, was found overexpressed in GC. Additionally, it was negatively correlated with miR-4319 whereas positively associated with circATXN7. In vivo experiments, circATXN7 silence was confirmed to inhibit GC tumor growth. CONCLUSIONS: CircATXN7 promoted GC development through sponging miR-4319 and regulating ENTPD4, which identified circATXN7 as a new biomarker in GC.

An Optically Tunable THz Modulator Based on Nanostructures of Silicon Substrates.

Nanostructures can induce light multireflection, enabling strong light absorption and efficient photocarrier generation. In this work, silicon nanostructures, including nanocylinders, nanotips, and nanoholes, were proposed as all-optical broadband THz modulators. The modulation properties of these modulators were simulated and compared with finite element method calculations. It is interesting to note that the light reflectance values from all nanostructure were greatly suppressed, showing values of 26.22%, 21.04%, and 0.63% for nanocylinder, nanohole, and nanotip structures, respectively, at 2 THz. The calculated results show that under 808 nm illumination light, the best modulation performance is achieved in the nanotip modulator, which displays a modulation depth of 91.63% with a pumping power of 60 mW/mm2 at 2 THz. However, under shorter illumination wavelengths, such as 532 nm, the modulation performance for all modulators deteriorates and the best performance is found with the nanohole-based modulator rather than the nanotip-based one. To further clarify the effects of the nanostructure and wavelength on the THz modulation, a graded index layer model was established and the simulation results were explained. This work may provide a further theoretical guide for the design of optically tunable broadband THz modulators.

Simulation and Experiment for Growth of High-Quality and Large-Size AlN Seed Crystals by Spontaneous Nucleation.

Seed crystals are the prerequisite for the growth of high quality and large size aluminum nitride (AlN) single crystal boules. The physical vapor transport (PVT) method is adopted to grow AlN seed crystal. However, this method is not available in nature. Herein, the temperature field distribution in the PVT furnace was simulated using the numerical analysis method to obtain free-standing and large-size seeds. The theoretical studies indicate that the temperature distribution in the crucible is related to the crucible height. According to the theory of growth dynamics and growth surface dynamics, the optimal thermal distribution was achieved through the design of a specific crucible structure, which is determined by the ratio of top-heater power to main-heater power. Moreover, in our experiment, a sole AlN single crystal seed with a length of 12 mm was obtained on the tungsten (W) substrate. The low axial temperature gradient between material source and substrate can decrease the nucleation rate and growth rate, and the high radial temperature gradient of the substrate can promote the expansion of crystal size. Additionally, the crystallinity of the crystals grown under different thermal field conditions are analyzed and compared. The Raman results manifest the superiority of the thermal inversion method in the growth of high quality AlN single crystal.

A Method by Disposable Medical Hydrogel to Reduce Water Vapor in Goggles.

In this letter, we describe a method about disposable medical hydrogel recommended inside surgical masks to reduce the water vapor in the goggles. The introduction is as follows.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Letter to the Editor.

LINC00511 accelerated the process of gastric cancer by targeting miR-625-5p/NFIX axis.

BACKGROUND: Gastric cancer (GC) is a common-sighted cancer which is hard to cure over the world. Substantial researches revealed that long non-coding RNAs (lncRNAs) were fundamental regulators in the process of cancers. Nevertheless, the biological function of LINC00511 and how LINC00511 was involved in the regulatory system in GC remained unclear. METHODS: RIP assays and luciferase reporter assays were performed to illustrate combination between LINC00511 and miR-625-5p. Loss-of-function assays were applied for identifying LINC00511 function in GC. RESULTS: In our study, LINC00511 was discovered significantly high in expression in GC tissues and cell lines. Moreover, LINC00511 showed a strong expression in I/II and III/IV stage. Knockdown of LINC00511 could inhibit the cell proliferation while enhanced cell apoptosis rate in GC. We used nuclear-cytoplasmic fractionation to judge the subcellular localization of LINC00511. Furthermore, miR-625-5p was found to have binding sites for LINC00511 and negatively regulated by LINC00511. Overexpression of miR-625-5p repressed the course of GC. And knockdown of miR-625-5p could recover the effects of LINC00511 silence. Besides, NFIX was discovered as a downstream target of miR-625-5p and overexpression of NFIX could offset the influence of LINC00511 silence. The results of vivo studies manifested that down-regulation of LINC00511 could reduce the Ki67 expression and NFIX while lifted the expression of miR-625-5p. CONCLUSION: Overall, the results from our study demonstrated that LINC00511 could function as a tumor promoter by targeting miR-625-5p NFIX axis, suggesting LINC00511 could be considered as a target for GC treatment.

The Physical Vapor Transport Method for Bulk AlN Crystal Growth.

In this report, the development of physical vapor transport (PVT) methods for bulk aluminum nitride (AlN) crystal growth is reviewed. Three modified PVT methods with different features including selected growth at a conical zone, freestanding growth on a perforated sheet, and nucleation control with an inverse temperature gradient are discussed and compared in terms of the size and quality of the bulk AlN crystals they can produce as well as the process complexity. The PVT method with an inverse temperature gradient is able to significantly reduce the nucleation rate and realize the dominant growth of only one bulk AlN single crystal, and thus grow centimeter-sized bulk AlN single crystals. X-ray rocking curve (XRC) and Raman spectroscopy measurements showed a high crystalline quality of the prepared AlN crystals. The inverse temperature gradient provides an efficient and relatively low-cost method for the preparation of large-sized and high-quality AlN seed crystals used for seeded growth, devoted to the diameter enlargement and quality improvement of bulk AlN single crystals.

Case report: A rare case of very well-differentiated gastric adenocarcinoma of gastric type with a lymphovascular invasion.

Background: Very well-differentiated gastric adenocarcinoma (VWDA) is a rare variant of gastric cancer, for which the diagnostic criteria and clinical behavior are not fully established. We reported a case of an intramucosal VWDA of gastric type with a lymphovascular invasion (LVI). Case presentation: A 67-year-old female was diagnosed as intramucosal gastric adenocarcinoma after a biopsy at the local hospital 3 weeks ago and then visited our hospital for further treatment. The endoscopic examination in our hospital showed a rough, slightly faded, 30-mm, flat, and elevated lesion on the lesser curvature of the middle gastric body. Histopathologically, the lesion consisted of superficial foveolar-type papillary adenocarcinoma and deep pyloric gland-type tubular adenocarcinoma. The immunostaining results showed that the foveolar-type papillary adenocarcinoma was positive for MUC5AC and had a high index of Ki-67, but the pyloric gland-type tubular adenocarcinoma was positive for MUC6 and had a low index of Ki-67. Both components were negative for MSH2 and MSH6, which suggested the high microsatellite instability phenotype. Moreover, a LVI was detected in the lesion. The pathological diagnosis was VWDA of gastric type. Conclusion: The case has unique histological and immunophenotypic characteristics, which not only indicates the importance of architectural features in the diagnosis of VWDA but also further proves that the aggressive behavior of VWDA is correlated with tumor histological type and immunophenotype.

Risk factor evaluation of cuff pressure of >30 cmH2O to stop air leakage during mechanical ventilation: A prospective observational study.

AIM: The commonly recommended endotracheal tube cuff pressure is 20-30 cmH2O. However, some patients require a cuff pressure of >30 cmH2O to prevent air leakage. The study aims to determine the risk factors that contribute to the endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. DESIGN: A multi-centre prospective observational study. METHODS: Eligible patients undergoing mechanical ventilation in the intensive care unit of three hospitals between March 2020 and July 2022 were included. The endotracheal tube cuff pressure to prevent air leakage was determined using the minimal occlusive volume technique. The patient demographics and clinical information were collected. RESULTS: A total of 284 patients were included. Among these patients, 55 (19.37%) patients required a cuff pressure of >30 cmH2O to prevent air leakage. The multivariate logistic regression results revealed that the surgical operation (odds ratio [OR]: 8.485, 95% confidence interval [CI]: 1.066-67.525, p = 0.043) was inversely associated with the endotracheal tube cuff pressure of >30 cmH2O, while the oral intubation route (OR: 0.127, 95% CI: 0.022-0.750, p = 0.023) and cuff inner diameter minus tracheal area (OR: 0.949, 95% CI: 0.933-0.966, p < 0.001) were negatively associated with the endotracheal tube cuff pressure of >30 cmH2O. Therefore, a significant number of patients require an endotracheal tube cuff pressure of ＞30 cmH2O to prevent air leakage. Several factors, including the surgical operation, intubation route, and difference between the cuff inner diameter and tracheal area at the T3 vertebra, should be considered when determining the appropriate cuff pressure during mechanical ventilation.

Effect of varying cuff sizes with identical inner diameter on endotracheal intubation in critically ill adults: A sealed tracheal controlled trial.

BACKGROUND: The present study aims to determine the impact of different cuff diameters on the cuff pressure of endotracheal tubes (ETTs) when the trachea is adequately sealed. METHODS: In the present single-center clinical trial, adult patients who underwent cardiothoracic surgery were assigned to use ETTs from 2 brands (GME and GZW). The primary endpoint comprised of the following: cuff diameter, inner diameter of the ETT, manufacturer, and the number of subjects with tracheal leakage when the cuff pressure was 30 cm H2O. RESULTS: A total of 298 patients were assigned into 2 groups, based on the 2 distinct brands of ETTs: experimental group (n = 122, GME brand) and control group (n = 176, GZW brand). There were no significant differences in baseline characteristics. However, the cuff diameter was significantly smaller in the control group, when compared to the experimental group (P = .001), and the incidence of tracheal leakage was significantly higher in the control group (P = .001). Furthermore, the GME brand ETT had a significantly larger cuff diameter, when compared to the GZW brand ETT. CONCLUSION: The cuff size would mismatch the tracheal area in clinical practice. Therefore, chest computed tomography is recommended to routinely evaluate the tracheal cross-sectional area during anesthesia, in order to ensure the appropriate cuff size selection.

2D Semi-Metallic Hafnium Ditelluride: A Novel Nonlinear Optical Material for Ultrafast and Ultranarrow Photonics Applications.

2D semi-metallic hafnium ditelluride material is used in several applications such as solar steam generation, gas sensing, and catalysis owing to its strong near-infrared absorbance, high sensitivity, and distinctive electronic structure. The zero-bandgap characteristics, along with the thermal and dynamic stability of 2D-HfTe2, make it a desirable choice for developing long-wavelength-range photonics devices. Herein, the HfTe2 -nanosheets are prepared using the liquid-phase exfoliation method, and their superior nonlinear optical properties are demonstrated by the obtained modulation depth of 11.9% (800 nm) and 6.35% (1560 nm), respectively. In addition, the observed transition from saturable to reverse saturable absorption indicates adaptability of the prepared material in nonlinear optics. By utilizing a side polished fiber-based HfTe2 -saturable absorber (SA) inside an Er-doped fiber laser cavity, a mode-locked laser with 724 fs pulse width and 56.63 dB signal-to-noise ratio (SNR) is realized for the first time. The generated laser with this SA has the second lowest mode-locking pump threshold (18.35 mW), among the other 2D material based-SAs, thus paving the way for future laser development with improved efficiency and reduced thermal impact. Finally, employing this HfTe2 -SA, a highly stable single-frequency fiber laser (SNR ≈ 74.56 dB; linewidth ≈ 1.268 kHz) is generated for the first time, indicating its promising ultranarrow photonic application.

LncRNA PTOV1-AS2 Promotes Colon Cancer Progression through the miR-145-5p/FSCN1 Axis.

Objective: The long noncoding RNA (lncRNA) gene PTOV1-AS2 is a potentially oncogenic lncRNA gene. However, its role and regulatory mechanism in the occurrence and development of colon cancer are still unclear. In this study, the lncRNA PTOV1-AS2 was used as a starting point to investigate the role of competing endogenous RNA (ceRNA) regulatory mechanisms in colon cancer. Methods: The expression of lncRNA PTOV1-AS2 mRNA in colon cancer tissues and cell lines was measured by quantitative real-time polymerase chain reaction (qRT-PCR) and screened for differential expression in cells. We examined the effects of lncRNA PTOV1-AS2 overexpression or downregulation of its expression on various cellular processes in HCT116 and SW620 cells after the transfection with an overexpression construct or PTOV1-AS2p-specific shRNA, respectively. In particular, we examined the effects on cell proliferation, migration, and invasion using the cell counting kit-8 CCK-8 assay and Transwell migration and invasion assays, respectively. In addition, the binding targets of lncRNA PTOV1-AS2/miR-145-5p and miR-145-5p/FSCN1 were predicted using various bioinformatics tools and validated by a dual luciferase assay. We also examined the effect of the lncRNA PTOV1-AS2/miR-145-5p axis on FSCN1 expression by qRT-PCR analysis. Furthermore, we investigated the effect of the PTOV1-AS2/miR-145-5p/FSCN1 axis on the biological function of colon cancer cells using an in vitro colon cancer cell model with reduced expression of PTOV1-AS2 and simultaneous transfection of a miR-145-5p inhibitor or FSCN1 vector. Additionally, we established a colon cancer xenograft tumor nude mouse model and used it to investigate the effect of locally injected lncRNA PTOV1-AS2 vector on the tumor growth and survival status of tumor-bearing mice. Results: We found that PTOV1-AS2 was highly expressed in colon cancer, which was associated with worse survival. High expression of PTOV1-AS2 promoted cell proliferation, migration, and invasion, while low expression of PTOV1-AS2 inhibited these processes in HCT116 and SW620 cells. The microRNA miR-145-5p was found to bind to the 3'-UTR region of both PTOV1-AS2 and FSCN1. In addition, miR-145-5p decreased the protein expression of its target gene FSCN1 and reduced the PTOV1-AS2-induced expression of FSCN1 in colon cancer cell lines. Also, silencing miR-145-5p or enhancing FSCN1 expression could partially restore the inhibition of cell proliferation, migration, invasion, and the tumorigenic capacity caused by silencing the expression of PTOV1-AS2 in vitro and in vivo. Conclusion: PTOV1-AS2 promotes colon cancer progression by "sponging" miR-145-5p to upregulate FSCN1.

Establishment of a nomogram for predicting prolonged mechanical ventilation in cardiovascular surgery patients.

AIMS: This study aimed to develop a nomogram model for predicting prolonged mechanical ventilation (PMV) in patients undergoing cardiovascular surgery. METHODS AND RESULTS: In total, 693 patients undergoing cardiovascular surgery at an Affiliated Hospital of Nantong University between January 2018 and June 2020 were studied. Postoperative PMV was required in 147 patients (21.2%). Logistic regression analysis showed that delirium [odds ratio (OR), 3.063; 95% confidence interval (CI), 1.991-4.713; P < 0.001], intraoperative blood transfusion (OR, 2.489; 95% CI, 1.565-3.960; P < 0.001), obesity (OR, 2.789; 95% CI, 1.543-5.040; P = 0.001), postoperative serum creatinine level (mmol/L; OR, 1.012; 95% CI, 1.007-1.017; P < 0.001), postoperative serum albumin level (g/L; OR, 0.937; 95% CI, 0.902-0.973; P = 0.001), and postoperative total bilirubin level (µmol/L; OR, 1.020; 95% CI, 1.005-1.034; P = 0.008) were independent risk factors for PMV. The area under the receiver operating characteristic curve for our nomogram was found to be 0.770 (95% CI, 0.727-0.813). The goodness-of-fit test indicated that the model fitted the data well (χ2 = 12.480, P = 0.131). After the model was internally validated, the calibration plot demonstrated good performance of the nomogram, as supported by the Harrell concordance index of 0.760. Decision curve analysis demonstrated that the nomogram was clinically useful in identifying patients at risk for PMV. CONCLUSION: We established a new nomogram model that may provide an individual prediction of PMV. This model may provide nurses, social workers, physicians, and administrators with an accurate and objective assessment tool to identify patients at high risk for PMV after cardiovascular surgery.

Iron-Based Shape Memory Alloys in Construction: Research, Applications and Opportunities.

As a promising candidate in the construction industry, iron-based shape memory alloy (Fe-SMA) has attracted lots of attention in the engineering and metallography communities because of its foreseeable benefits including corrosion resistance, shape recovery capability, excellent plastic deformability, and outstanding fatigue resistance. Pilot applications have proved the feasibility of Fe-SMA as a highly efficient functional material in the construction sector. This paper provides a review of recent developments in research and design practice related to Fe-SMA. The basic mechanical properties are presented and compared with conventional structural steel, and some necessary explanations are given on the metallographic transformation mechanism. Newly emerged applications, such as Fe-SMA-based prestressing/strengthening techniques and seismic-resistant components/devices, are discussed. It is believed that Fe-SMA offers a wide range of applications in the construction industry but there still remains problems to be addressed and areas to be further explored. Some research needs at material-level, component-level, and system-level are highlighted in this paper. With the systematic information provided, this paper not only benefits professionals and researchers who have been working in this area for a long time and wanting to gain an in-depth understanding of the state-of-the-art, but also helps enlighten a wider audience intending to get acquainted with this exciting topic.

Prediction model for delirium in patients with cardiovascular surgery: development and validation.

BACKGROUND: The aim of this study was to construct a nomogram model for discriminating the risk of delirium in patients undergoing cardiovascular surgery. METHODS: From January 2017 to June 2020, we collected data from 838 patients who underwent cardiovascular surgery at the Affiliated Hospital of Nantong University. Patients were randomly divided into a training set and a validation set at a 5:5 ratio. A nomogram model was established based on logistic regression. Discrimination and calibration were used to evaluate the predictive performance of the model. RESULTS: The incidence of delirium was 48.3%. A total of 389 patients were in the modelling group, and 449 patients were in the verification group. Logistic regression analysis showed that CPB duration (OR [Formula: see text] 1.004, 95% CI: 1.001-1.008, [Formula: see text] 0.018), postoperative serum sodium (OR [Formula: see text] 1.112, 95% CI: 1.049-1.178, [Formula: see text] 0.001), age (OR [Formula: see text] 1.027, 95% CI: 1.006-1.048, [Formula: see text] 0.011), and postoperative MV (OR [Formula: see text] 1.019, 95% CI: 1.008-1.030, [Formula: see text] 0.001) were independent risk factors. The results showed that AUC[Formula: see text] was 0.712 and that the 95% CI was 0.661-0.762. The Hosmer-Lemeshow goodness of fit test showed that the predicted results of the model were in good agreement with the actual situation ([Formula: see text] 6.200, [Formula: see text] 0.625). The results of verification showed that the AUC[Formula: see text] was 0.705, and the 95% CI was 0.657-0.752. The Hosmer-Lemeshow goodness of fit test results were [Formula: see text] 8.653 and [Formula: see text] 0.372, indicating that the predictive effect of the model is good. CONCLUSIONS: The establishment of the model provides accurate and objective assessment tools for medical staff to start preventing postoperative delirium in a purposeful and focused manner when a patient enters the CSICU after surgery.

Highly-Responsive Broadband Photodetector Based on Graphene-PTAA-SnS2 Hybrid.

The development of wearable systems stimulate the exploration of flexible broadband photodetectors with high responsivity and stability. In this paper, we propose a facile liquid-exfoliating method to prepare SnS2 nanosheets with high-quality crystalline structure and optoelectronic properties. A flexible photodetector is fabricated using the SnS2 nanosheets with graphene-poly[bis(4-phenyl) (2,4,6-trimethylphenyl) amine (PTAA) hybrid structure. The liquid-exfoliated SnS2 nanosheets enable the photodetection from ultraviolet to near infrared with high responsivity and detectivity. The flexible broadband photodetector demonstrates a maximum responsivity of 1 × 105 A/W, 3.9 × 104 A/W, 8.6 × 102 A/W and 18.4 A/W under 360 nm, 405 nm, 532 nm, and 785 nm illuminations, with specific detectivity up to ~1012 Jones, ~1011 Jones, ~109 Jones, and ~108 Jones, respectively. Furthermore, the flexible photodetector exhibits nearly invariable performance over 3000 bending cycles, rendering great potentials for wearable applications.

An Irradiance-Adaptable Near-Infrared Vertical Heterojunction Phototransistor.

Bioinspired artificial visual perception devices with the optical environment-adaptable function have attracted significant attention for their promising potential in applications like robotics and machine vision. In this regard, a photodetector with in-sensor adaptability is longed for in terms of complexity, efficiency, and cost. Here, a near-infrared phototransistor with a benign light irradiance-adaptability is presented. The phototransistor uses a vertically stacking graphene/lead sulfide quantum dots/graphene heterojunction as the conductive channel. Compared with ordinary lead sulfide quantum dots-decorated graphene phototransistors, the present device demonstrates a faster photoresponse speed and an abnormal transfer characteristic. The latter characteristic is induced by the gate voltage-tunable Fermi level in the heterojunction and the abundant electron trap states in the quantum dot film, which jointly results in an intense dependence of the photoresponse on the gate voltage. The dynamic trapping and de-trapping processes in the quantum dot film enable the inhibition or potentiation of the photoresponse, based on which the photopic or scotopic adaptation behavior of the human retina is successfully mimicked, respectively. By providing an irradiance-adaptable photodetector with a spectral response beyond visible light, this work should inspire future research on artificial environment-adaptable perception devices.

Bufalin exacerbates Photodynamic therapy of colorectal cancer by targeting SRC-3/HIF-1α pathway.

Photodynamic therapy (PDT) induces tumour cell death by producing reactive oxygen species (ROS), and hypoxia is one of the main factors that limits its efficiency. In our previous study, bufalin (BU) enhanced photosensitizer mTHPC-mediated PDT therapy in colorectal cancer (CRC) cells, but its mechanism was not elucidated. To explore a strategy for improving the efficacy of PDT, we designed iRGD-modified nanoparticles to co-capsuled mTHPC and BU for simultaneous delivery to the tumour site and explored the underlying mechanism of the synergistic anti-CRC effect. In our study, mTHPC&BU@VES-CSO/TPGS-RGD nanoparticles (T-B@NP) had a particle size of 148.3 ± 2.5 nm and a zeta potential of 22.8 ± 2.0 mV. Specifically, these nanoparticles passively accumulated in tumour cells, and under laser irradiation, mTHPC induced cell apoptosis and death. In addition, the sustained release of BU inhibited HIF-1α and reduced VEGF-mediated angiogenesis by targeting the SRC-3/HIF-1α pathway, which induced a strong PDT effect against CRC. In vivo studies demonstrated that codelivery of the nanoparticles under laser irradiation exhibited a superior antitumour effect (84.2%) and significantly prolonged survival time of mice, with the mechanisms of alleviating hypoxia and inhibiting angiogenesis. In summary, mTHPC and BU codelivery via nanoparticles efficiently enhances the therapeutic effects of PDT by inhibiting the SRC-3/HIF-1α pathway in CRC. This work provides an effective strategy to combat hypoxia-induced tumour resistance and overcome the barriers of PDT treatment.