A novel surgical treatment approach for the vertical root fracture of posterior teeth: a case report with 24-month review.

BACKGROUND: Up to 25% of the tooth extraction after root canal treatment could be attributed to the vertical root fracture (VRF). The treatment choice for teeth with VRF would mostly be the extraction despite some repairing methods were also reported. The repairing treatment result of VRF would mostly depend on the fixation strength and the bioactivity of the repairing materials, especially for the posterior teeth with high masticating stresses. This case report designed a novel surgical treatment approach for the VRF of posterior teeth. METHODS: a maxillary premolar with buccal-palatal complete VRF was treated with a new dual-layered repairing approach using adhesive resin + iRoot BP Plus bioceramic cement to fill the modified fracture line with retention forms through the intentional replantation. RESULTS: At the 24-month review, the tooth showed desirable periodontal healing and normal function. CONCLUSIONS: This case report indicated that the dual-layered repairing approach might be effective for saving the posterior teeth with VRF. Nevertheless, further clinical trials are needed for its long-term result.

Charge-Transfer-Induced Interfacial Ferromagnetism in Ferromagnet-Free Oxide Heterostructures.

Due to the strong interlayer coupling between multiple degrees of freedom, oxide heterostructures have demonstrated exotic properties that are not shown by their bulk counterparts. One of the most interesting properties is ferromagnetism at the interface formed between "nonferromagnetic" compounds. Here we report on the interfacial ferromagnetic phase induced in the superlattices consisting of the two paramagnetic oxides CaRuO3 (CRO) and LaNiO3 (LNO). By varying the sublayer thickness in the superlattice period, we demonstrate that the ferromagnetic order has been established in both CaRuO3 and LaNiO3 sublayers, exhibiting an identical Curie temperature of ∼75 K. The X-ray absorption spectra suggest a strong charge transfer from Ru to Ni at the interface, triggering superexchange interactions between Ru/Ni ions and giving rise to the emergent ferromagnetic phase. Moreover, the X-ray linear dichroism spectra reveal the preferential occupancy of the d3z2-r2 orbital for the Ru ions and the dx2-y2 orbital for the Ni ions in the heterostructure. This leads to different magnetic anisotropy of the superlattices when they are dominated by CRO or LNO sublayers. This work clearly demonstrates a charge-transfer-induced interfacial ferromagnetic phase in the whole ferromagnet-free oxide heterostructures, offering a feasible way to tailor oxide materials for desired functionalities.

The development of variable system-based internet of things for the solar greenhouse and its application in lettuce.

The east-west ridge orientation has recently become an important agronomic method to improve mechanization in solar greenhouses. However, these ridge orientation changes shape differences between different ridges in crop water consumption, and there is a lack of research on the regulation and adaptation of water consumption. Therefore, this study introduces a variable irrigation decision-making method based on the Internet of Things management and control system for an east-west ridge orientation. To replenish water on demand, this study seting the variable irrigation decision-making (VRI) methods and traditional average irrigation decision-making (URI) methods in the system, and lettuce cultivation experiments were conducted to verify the effectiveness of the model and system. The results show that the difference of accumulated photosynthetically active radiation is the most significant between different ridges of the east-west ridge orientation, and the coefficient of variation is 43.77 %, which can be used as an activating factor for VRI methods. The irrigation water consumption, yield, water-use efficiencies, and irrigation water utilization of lettuce at different levels of irrigation were 307.12 L/m2, 5854.07 kg·ha-1, 1391.47 kg·ha-1·mm-1, and 7.63 kg·cm-3, respectively. Compared with the URI methods, the VRI method saved 10.02 % of water, increased yield by 9 %, and enhanced water use efficiency and irrigation water use efficiency by 12 % and 21.32 %, respectively. This study provides a new approach for improving crop production efficiency under an east-west ridge orientation.

Impact of a multifaceted intervention on non-guideline-recommended prescribing of acid suppressive medications for stress ulcer prophylaxis in critically ill patients.

OBJECTIVE: To promote an effective strategy to improve the non-guideline-recommended prescribing (NGRP) of acid suppressive medications for stress ulcer prophylaxis (SUP) in critically ill patients and to evaluate the impact and barriers of a multifaceted intervention on NGRP in critically ill patients. RESEARCH DESIGN AND METHODS: A retrospective, pre- post-intervention study was performed in the medical-surgical ICU. This study included pre-intervention and post-intervention period. There was no SUP guideline and intervention in the pre-intervention period. In the post-intervention period, the multifaceted intervention included five features: a practice guideline, an education campaign, medication review and recommendations, medication reconciliation, and pharmacist rounding with the ICU team. RESULTS: A total of 557 patients were studied (305 in the pre-intervention group and 252 in the post-intervention group). Patients who underwent surgery, stayed in ICU more than 7 days, or used corticosteroids experienced significantly higher rate of NGRP in the pre-intervention group. The average percentage of patient days of NGRP was significantly reduced from 44.2% to 23.5% (p < .001) by implementing the multifaceted intervention. The percentage of patients with NGRP decreased from 86.7% to 45.5% in terms of all 5 criteria (indication, dosage, IV to PO, duration, and ICU discharge; p = .003). Per-patient NGRP cost decreased from $45.1 (22.6, 93.0) to $11.3 (11.3, 45.1; p = .004). The main barrier influencing NGRP was the factors of the patient, including the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), the number of comorbidities, and undergoing surgery. CONCLUSION: The multifaceted intervention was effective in improving NGRP. Further studies are needed to confirm whether our strategy is cost-effective.

Direct Observation of Magnetic Skyrmions and Their Current-Induced Dynamics in Epitaxial Single-Crystal Oxide Films.

Magnetic skyrmions are scarcely investigated for single-crystal quality films, for which skyrmions may have a remarkable performance. Even in the limited studies in this aspect, the skyrmions are usually probed by the topological Hall effect, missing important information on dynamic properties. Here, we present a comprehensive investigation on the generation/manipulation of magnetic skyrmions in La0.67Ba0.33MnO3 single-crystal films. Using the technique of magnetic force microscopy, the current-driven skyrmion dynamics are directly observed. Unlike isolated skyrmions produced by magnetic field alone, closely packed skyrmions can be generated by electric pulses in a magnetic background, with a high density (∼60/µm2) and a small size (dozens of nanometers). The threshold current moving skyrmions is ∼2.3 × 104 A/cm2, 2-3 orders of magnitude lower than that required by metallic multilayers or van der Waals ferromagnetic heterostructures. Our work demonstrates the great potential of single-crystal oxide films in developing skyrmion-based devices.

Effect of appropriate empirical antimicrobial therapy on mortality of patients with Gram-negative bloodstream infections: a retrospective cohort study.

BACKGROUND: Little evidence exists regarding the prevalence of pathogens in bloodstream infections (BSIs), the mortality risk, and the benefit of combination therapy over monotherapy. This study aims to describe patterns of empiric antimicrobial therapy, and the epidemiology of Gram-negative pathogens, and to investigate the effect of appropriate therapy and appropriate combination therapy on the mortality of patients with BSIs. METHODS: This was a retrospective cohort study including all patients with BSIs of Gram-negative pathogens from January 2017 to December 2022 in a Chinese general hospital. The in-hospital mortality was compared between appropriate and inappropriate therapy, and between monotherapy and combination therapy for patients receiving appropriate therapy. We used Cox regression analysis to identify factors independently associated with in-hospital mortality. RESULTS: We included 205 patients in the study, of whom 147 (71.71%) patients received appropriate therapy compared with 58 (28.29%) who received inappropriate therapy. The most common Gram-negative pathogen was Escherichia coli (37.56%). 131 (63.90%) patients received monotherapy and 74 (36.10%) patients received combination therapy. The in-hospital mortality was significantly lower in patients administered appropriate therapy than inappropriate therapy (16.33% vs. 48.28%, p = 0.004); adjusted hazard ratio [HR] 0.55 [95% CI 0.35-0.84], p = 0.006). In-hospital mortality was also not different in combination therapy and monotherapy in the multivariate Cox regression analyses (adjusted HR 0.42 [95% CI 0.15-1.17], p = 0.096). However, combination therapy was associated with lower mortality than monotherapy in patients with sepsis or septic shock (adjusted HR 0.94 [95% CI 0.86-1.02], p = 0.047). CONCLUSIONS: Appropriate therapy was associated with a protective effect on mortality among patients with BSIs due to Gram-negative pathogens. Combination therapy was associated with improved survival in patients with sepsis or septic shock. Clinicians need to choose optical empirical antimicrobials to improve survival outcomes in patients with BSIs.

Infinite-layer/perovskite oxide heterostructure-induced high-spin states in SrCuO2/SrRuO3 bilayer films.

Heterostructures composed of dissimilar oxides with different properties offer opportunities to develop emergent devices with desired functionalities. A key feature of oxide heterostructures is interface electronics and orbital reconstructions. Here, we combined infinite-layered SrCuO2 and perovskite SrRuO3 into heterostructures. A rare high spin state as large as 3.0 µB f.u-1 and an increase in Curie temperature by 12 K are achieved in an ultrathin SrRuO3 film capped by a SrCuO2 layer. Atomic-scale lattice imaging shows the uniform CuO2-plane-to-RuO5-pyramid connection at the interface, where the regularly arranged RuO5 pyramids were elongated along the out-of-plane direction. As revealed by theoretical calculations and spectral analysis, these features finally result in an abnormally high spin state of the interfacial Ru ions with highly polarized eg orbitals. The present work demonstrates that oxygen coordination engineering at the infinite-layer/perovskite oxide interface is a promising approach towards advanced oxide electronics.

Impact and barriers of a pharmacist-led practice with computerized reminders on intravenous to oral antibiotic conversion for community-acquired pneumonia inpatients.

WHAT IS KNOWN AND OBJECTIVE: Intravenous to oral (IV-PO) antibiotic conversion, one of the critical elements in antimicrobial stewardship (AMS), is not well implemented in China. Studies on the strategy to apply the IV-PO conversion are needed. Our objective was to evaluate the impact and its barriers of a pharmacist-led practice with computerized reminders on IV-PO antibiotic conversion for community-acquired pneumonia (CAP) inpatients. METHOD: This was a retrospective, observational pre- and post-intervention study. Interventions were introduced in 2 sequential 12-month phases: Phase 1: pharmacists implemented the conventional practice of reviewing patient charts and medication records every 24 h and verbally informed the prescribers on eligible IV-PO conversions; Phase 2: pharmacists implemented a new intervention practice to inform the prescribers with a computerized reminder in electronic medical record system on eligible IV-PO conversions. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients who converted to oral therapy on the day patients were eligible for the conversion. The secondary outcomes were length of IV antibiotic therapy days, total length of antibiotic therapy days and length of hospital stay. RESULTS: A total of 524 patients were studied (256 in phase 1 and 268 in phase 2). The proportion of patients who converted to oral therapy on the day patients were eligible for the conversion was significantly increased from 34.77% (89/256) in phase 1 to 62.69% (168/268) in phase 2 (p < 0.05). Length of IV antibiotic therapy days in phase 2 was shortened by 1.23 days, which was 5.52 days compared to 6.75 days in phase 1 (p < 0.05). Total length of antibiotic therapy days was 12.05 days in Phase 1, compared to 10.75 days in phase 2 (p > 0.05). Length of hospital stay for patients in phase 2 was significantly shorter, with a difference of 1.38 days (6.02 days vs. 7.40 days, p < 0.05). The most common barrier of not converting IV-PO was the presence of co-morbidity. CONCLUSION: The pharmacist-led IV-PO antibiotic conversion practice with computerized reminders was successful and feasible in Chinese hospitals. More IV-PO intervention studies in patients with other infections are needed in the future.

sgRNA-shRNA Structure Mediated SNP Site Editing on Porcine IGF2 Gene by CRISPR/StCas9.

The SNP within intron 3 of the porcine IGF2 gene (G3072A) plays an important role for muscle growth and fat deposition in pigs. In this study, the StCas9 derived from Streptococcus thermophilus together with the Drosha-mediated sgRNA-shRNA structure were combined to boost the G to A base editing on the IGF2 SNP site, which we called "SNP editing." The codon-humanized StCas9 as we previously reported was firstly compared with the prevalently used SpCas9 derived from Streptococcus pyogenes using our idiomatic surrogate report assay, and the StCas9 demonstrated a comparable targeting activity. On the other hand, by combining shRNA with sgRNA, simultaneous gene silencing and genome targeting can be achieved. Thus, the novel IGF2.sgRNA-LIG4.shRNA-IGF2.sgRNA structure was constructed to enhance the sgRNA/Cas9-mediated HDR-based IGF2 SNP editing by silencing the LIG4 gene, which is a key molecule of the HDR's competitive NHEJ pathway. The sgRNA-shRNA/StCas9 all-in-one expression vector and the IGF2.sgRNA/StCas9 as control were separately used to transfect porcine PK15 cells together with an ssODNs donor for the IGF2 SNP editing. The editing events were detected by the RFLP assay, Sanger sequencing as well as Deep-sequencing, and the Deep-sequencing results finally demonstrated a significant higher HDR-based editing efficiency (16.38%) for our sgRNA-shRNA/StCas9 strategy. In short, we achieved effective IGF2 SNP editing by using the combined sgRNA-shRNA/StCas9 strategy, which will facilitate the further production of base-edited animals and perhaps extend for the gene therapy for the base correction of some genetic diseases.

Unusual Electric and Optical Tuning of KTaO3-Based Two-Dimensional Electron Gases with 5d Orbitals.

Controlling electronic processes in low-dimension electron systems is centrally important for both fundamental and applied researches. While most of the previous works focused on SrTiO3-based two-dimensional electron gases (2DEGs), here we report on a comprehensive investigation in this regard for amorphous-LaAlO3/KTaO3 2DEGs with the Fermi energy ranging from ∼13 meV to ∼488 meV. The most important observation is the dramatic variation of the Rashba spin-orbit coupling (SOC) as Fermi energy sweeps through 313 meV: The SOC effective field first jumps and then drops, leading to a cusp of ∼2.6 T. Above 313 meV, an additional species of mobile electrons emerges, with a 50-fold enhanced Hall mobility. A relationship between spin relaxation distance and the degree of band filling has been established in a wide range. It indicates that the maximal spin precession length is ∼70.1 nm and the maximal Rashba spin splitting energy is ∼30 meV. Both values are much larger than the previously reported ones. As evidenced by density functional theory calculation, these unusual phenomena are closely related to the distinct band structure of the 2DEGs composed of 5d electrons. The present work further deepens our understanding of perovskite conducting interfaces, particularly those composed of 5d transition-metal oxides.

Magnetic Anisotropy Controlled by Distinct Interfacial Lattice Distortions at the La1- xSr xCoO3/La2/3Sr1/3MnO3 Interfaces.

Interface engineering is an important approach leading to multifunctional artificial materials. Although most of the previous works focused on the effects of the rotation/tilting of interfacial oxygen octahedron on perovskite multilayers, here, we report on a new kind of lattice distortion characterized by an off-center shift of the Mn ions within the MnO6 oxygen octahedra at the interfaces of La1- xSr xCoO3/La2/3Sr1/3MnO3/La1- xSr xCoO3/LaAlO3 trilayers ( x = 0-1/3), which drives the initially perpendicularly aligned magnetic axis of the La2/3Sr1/3MnO3 (LSMO) film toward the in-plane direction, though the film is in a strongly compressive state. It is further found that the magnetic anisotropy considerably depends on the content of Sr in La1- xSr xCoO3, enhancing as x decreases. The maximal anisotropy constant at 10 K is +2.5 × 106 erg/cm3 for the trilayers with x = 0, whereas it is -1.5 × 105 erg/cm3 for a bare LSMO film on LaAlO3. On the basis of the analysis of X-ray absorption spectroscopy and the results of density functional theory calculations, we found that the off-center displacement of the Mn ions has caused a strong orbital reconstruction at interfaces, resulting in the anomalous spin orientation against magnetoelastic coupling.

Symmetry mismatch-driven perpendicular magnetic anisotropy for perovskite/brownmillerite heterostructures.

Grouping different transition metal oxides together by interface engineering is an important route toward emergent phenomenon. While most of the previous works focused on the interface effects in perovskite/perovskite heterostructures, here we reported on a symmetry mismatch-driven spin reorientation toward perpendicular magnetic anisotropy in perovskite/brownmillerite heterostructures, which is scarcely seen in tensile perovskite/perovskite heterostructures. We show that alternately stacking perovskite La2/3Sr1/3MnO3 and brownmillerite LaCoO2.5 causes a strong interface reconstruction due to symmetry discontinuity at interface: neighboring MnO6 octahedra and CoO4 tetrahedra at the perovskite/brownmillerite interface cooperatively relax in a manner that is unavailable for perovskite/perovskite interface, leading to distinct orbital reconstructions and thus the perpendicular magnetic anisotropy. Moreover, the perpendicular magnetic anisotropy is robust, with an anisotropy constant two orders of magnitude greater than the in-plane anisotropy of the perovskite/perovskite interface. The present work demonstrates the great potential of symmetry engineering in designing artificial materials on demand.

Highly Mobile Two-Dimensional Electron Gases with a Strong Gating Effect at the Amorphous LaAlO3/KTaO3 Interface.

Two-dimensional electron gas (2DEG) at the perovskite oxide interface exhibits a lot of exotic properties, presenting a promising platform for the exploration of emergent phenomena. While most of the previous works focused on SrTiO3-based 2DEG, here we report on the fabrication of high-quality 2DEGs by growing an amorphous LaAlO3 layer on a (001)-orientated KTaO3 substrate, which is a 5d metal oxide with a polar surface, at a high temperature that is usually adopted for crystalline LaAlO3. Metallic 2DEGs with a Hall mobility as high as ∼2150 cm2/(V s) and a sheet carrier density as low as 2 × 1012 cm-2 are obtained. For the first time, the gating effect on the transport process is studied, and its influence on spin relaxation and inelastic and elastic scattering is determined. Remarkably, the spin relaxation time can be strongly tuned by a back gate. It is reduced by a factor of ∼69 while the gate voltage is swept from -25 to +100 V. The mechanism that dominates the spin relaxation is elucidated.

High mobility 2-dimensional electron gas at LaAlO3/SrTiO3 interface prepared by spin coating chemical methods.

Highly mobile 2-dimensional electron gases (2DEGs) at the (001), (011) and (111)-oriented LaAlO3/SrTiO3 (LAO/STO) interfaces are obtained using spin coating chemical method, which is a gentle technique without plasma bombardment of the pulsed laser deposition. As revealed by x-ray diffraction spectrum and x-ray reflectivity analysis, the LAO over layer is epitaxially grown, and has a uniform thickness of ∼15 nm, ∼20 nm and ∼26 nm for (001), (011) and (111) orientations, respectively. The interfaces are well metallic down to 2 K. The carrier mobilities are ∼28 000 cm2 V-1 s-1, ∼22 000 cm2 V-1 s-1 and ∼8300 cm2 V-1 s-1 at 2 K for the (001), (011) and (111) LAO/STO interfaces, respectively, and ∼8 cm2 V-1 s-1, ∼4 cm2 V-1 s-1 and ∼4 cm2 V-1 s-1 at room temperature. The present work shows that the spin coating chemical method is a feasible approach to get high quality 2DEG at both the polar/non-polar and polar/polar interfaces.

Enhanced CRISPR/Cas9-mediated biallelic genome targeting with dual surrogate reporter-integrated donors.

The clustered regularly interspaced short palindromic repeat (CRISPR)/CRISPR-associated protein 9 (Cas9) system has recently emerged as a simple, yet powerful genome engineering tool, which has been widely used for genome modification in various organisms and cell types. However, screening biallelic genome-modified cells is often time-consuming and technically challenging. In this study, we incorporated two different surrogate reporter cassettes into paired donor plasmids, which were used as both the surrogate reporters and the knock-in donors. By applying our dual surrogate reporter-integrated donor system, we demonstrate high frequency of CRISPR/Cas9-mediated biallelic genome integration in both human HEK293T and porcine PK15 cells (34.09% and 18.18%, respectively). Our work provides a powerful genetic tool for assisting the selection and enrichment of cells with targeted biallelic genome modification.

Development and application of dual-fluorescence reporter systems for measuring specific nuclease activity based on SSA repair mechanism.

Reporter vector system has become an important method for measuring activity of specific nucleases because of its fast construction, simple modification, easy operation, economic effectiveness as well as its role in enriching positive cells with genomic modification through mediating screen of specific nucleases positive cells. After introducing double strand breaks (DSBs), a reporter system based on non-homologous end joining (NHEJ)-mediated repair can only repair maximally two thirds of reporter genes after optimization, while single strand annealing (SSA)-mediated repair can repair all reporter genes theoretically which has higher sensitivity and facilitates the detection of specific nuclease with low activity and provides an effective way to detect specific nuclease activity in genome modification studies. In this study, we designed and constructed three sets of dual-fluorescence reporter systems based on SSA repair mechanism and applied the mRFP-eGFP system in measuring the effective activity of three pairs of ZFNs, which was 8.9%, 9.3% and 5.0%, respectively. Our study provides an effective way to detect the activity of nucleases.

Dual-reporter surrogate systems for efficient enrichment of genetically modified cells.

Isolation of genetically modified cells generated by designed nucleases are challenging, since they are often phenotypically indistinguishable from their parental cells. To efficiently enrich genetically modified cells, we developed two dual-reporter surrogate systems, namely NHEJ-RPG and SSA-RPG based on NHEJ and SSA repair mechanisms, respectively. Repair and enrichment efficiencies of these two systems were compared using different nucleases. In both CRISPR-Cas9- and ZFNs-induced DSB repair studies, we found that the efficiency and sensitivity of the SSA-RPG reporter with direct repeat length more than 200 bp were much higher than the NHEJ-RPG reporter. By utilizing the SSA-RPG reporter, we achieved the enrichment for indels in several endogenous loci with 6.3- to 34.8-fold of non-selected cells. Thus, the highly sensitive SSA-RPG reporter can be used for activity validation of designed nucleases and efficient enrichment of genetically modified cells. Besides, our systems offer alternative enrichment choices either by puromycin selection or FACS.

Asymmetric epoxidation of unfunctionalized alkenes catalyzed by sugar moiety-modified chiral salen-Mn(III) complexes.

Several chiral Schiff-base ligands with sugar moieties at C-3 (3') or C-5 (5') of salicylaldehyde were synthesized from reaction of salicylaldehyde derivatives with diamine. These ligands coordinated with Mn(III) to afford the corresponding chiral salen-Mn(III) complexes characterized by FT-IR, MS, and elementary analysis. These complexes were used as catalysts for the asymmetric epoxidation of unfunctionalized alkenes. Only weak enantioselectivity is induced by the chiral sugar moieties at C-3 (3') or C-5 (5') in the case of absence of chirality in the diimine bridge moiety. It was also shown that the sugars at C-5 (5') having the same rotation direction of polarized light as the diimine bridge in the catalyst could enhance the chiral induction in the asymmetric epoxidation, but the sugars with the opposite rotation direction would reduce the chiral induction.