Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system.

BACKGROUND: Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health. Therefore, this study examined patients who underwent breast cancer surgery, analyzed hospitalization costs and structure, and explored the impact of China Healthcare Security Diagnosis Related Groups (CHS-DRG) management on patient costs. It aimed to provide medical institutions with ways to reduce costs, optimize cost structures, reduce patient burden, and improve service efficiency. AIM: To study the CHS-DRG payment system's impact on breast cancer surgery costs. METHODS: Using the CHS-DRG (version 1.1) grouping criteria, 4073 patients, who underwent the radical resection of breast malignant tumors from January to December 2023, were included in the JA29 group; 1028 patients were part of the CHS-DRG payment system, unlike the rest. Through an independent sample t-test, the length of hospital stay as well as total hospitalization, medicine and consumables, medical, nursing, medical technology, and management expenses were compared. Pearson's correlation coefficient was used to test the cost correlation. RESULTS: In terms of hospitalization expenses, patients in the CHS-DRG payment group had lower medical, nursing, and management expenses than those in the diagnosis-related group (DRG) non-payment group. For patients in the DRG payment group, the factors affecting the total hospitalization cost, in descending order of relevance, were medicine and consumable costs, consumable costs, medicine costs, medical costs, medical technology costs, management costs, nursing costs, and length of hospital stay. For patients in the DRG non-payment group, the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses, consumable expenses, medical technology expenses, the cost of medicines, medical expenses, nursing expenses, length of hospital stay, and management expenses. CONCLUSION: The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs, medical consumable costs, and the length of hospital stay while ensuring medical safety.

Reinforcement Effects on Tensile Behavior of Ultra-High-Performance Concrete (UHPC) with Low Steel Fiber Volume Fractions.

Ultra-high-performance concrete (UHPC) with a low steel fiber volume fraction offers lower material costs than UHPC with typical steel fiber volume fractions, and has the potential to mitigate the ductility degradation of rebar-reinforced UHPC (R-UHPC). This study explores the reinforcement effect on the tensile behavior of UHPC with a low fiber volume fraction with the aim of facilitating more cost-efficient UHPC applications. The axial tensile behavior of 30 UHPC specimens with low fiber volume fractions at different reinforcement ratios was tested through direct tensile tests. The findings indicate that adopting UHPC with a low fiber volume fraction can significantly mitigate the ductility deterioration of rebar-reinforced UHPC (R-UHPC), and both increasing the reinforcement ratio and decreasing the fiber volume fraction contribute to the improvement in ductility. The failure modes of R-UHPC are determined by the ratio of reinforcement ratio and fiber volume fraction, rather than a single parameter, which also means that R-UHPC with different parameters may correspond to different methods to predict tensile load-bearing capacity. For UHPC with a fiber volume fraction low to 0.5%, incorporating steel rebars gives superior multi-crack cracking behavior and excellent capacity to restrict the maximum crack width. Increasing the fiber volume fraction from 0.5% to 1.0% at the same reinforcement ratio will yield little benefit other than an increase in tensile load-bearing capacity.

Unraveling the connection between gut microbiota and Alzheimer's disease: a two-sample Mendelian randomization analysis.

Purpose: Studies have shown a close relationship between gut microbiota (GM) and Alzheimer's disease (AD). However, the causal relationship between them remains unclear. Methods: We conducted a genome-wide association study (GWAS) using publicly available summary statistics data for GM and AD. We extracted independent genetic loci significantly associated with GM relative abundances as instrumental variables based on predefined thresholds (p < 1*e-5). The inverse variance-weighted (IVW) method was primarily used for causal relationship assessment. Additional analyses, including MR-Egger, weighted median, simple mode, and weighted mode, were performed as supplementary analyses. Results: IVW analysis revealed significant correlations between certain microbial taxa and the risk of AD. Higher abundances of Actinobacteria at the class level, phylum. Actinobacteria, class. Deltaproteobacteria, order. Desulfovibrionales, genus. Oscillospira, and genus. Ruminococcaceae UCG004 (p < 0.048) was found to be positively associated with an elevated risk of AD. However, within the genus-level taxa, Ruminococcus1 (p = 0.030) demonstrated a protective effect on lowering the risk of AD. In addition, to ensure the robustness of the findings, we employed Cochrane's Q test and leave-one-out analysis for quality assessment, while the stability and reliability of the results were validated through MR-Egger intercept test, MR-PRESSO global test, and sensitivity analysis. Conclusion: This study provided a comprehensive analysis of the causal relationship between 211 GM taxa and AD. It discerned distinct GM taxa linked to the susceptibility of AD, thereby providing novel perspectives on the genetic mechanisms governing AD via the GM. Additionally, these discoveries held promise as valuable biomarkers, enabling the identification of potential therapeutic targets and guiding forthcoming AD investigations.

Editorial for focus on manipulations of atomic and molecular layers and its applications in energy, environment sciences and optoelectronic devices.

This Focus aims at showcasing the significance of manipulating atomic and molecular layers for various applications. To this end, this Focus collects 15 original research papers featuring the applications of atomic layer deposition, chemical vapor deposition, wet chemistry, and some other methods for manipulations of atomic and molecular layers in lithium-ion batteries, supercapacitors, catalysis, field-effect transistors, optoelectronics, and others.

Reaction mechanism of nickel sulfide atomic layer deposition using bis(N,N'-di-tert-butylacetamidinato)nickel(II) and hydrogen sulfide.

As a unique nanofabrication technology, atomic layer deposition (ALD) has been used in the microelectronics, catalysis, environmental and energy fields. As an energy and catalytic material, nickel sulfide has excellent electrochemical and catalytic activities and has attracted extensive attention. In this work, the reaction mechanism for nickel sulfide ALD from an amidine metal precursor was investigated using density functional theory (DFT) calculations. The results show that the first amidine ligand of bis(N,N'-di-tert-butylacetamidinato)nickel(II) [Ni(tBu-MeAMD)2] can be easily eliminated on the sulfhydrylated surface. The second amidine ligand can also react with the adjacent sulfhydryl group to generate the N,N'-di-tert-butylacetamidine (tBu-MeAMD-H) molecule, which can strongly interact with the Ni atom on the surface and be difficult to be desorbed. In the subsequent H2S reaction, the tBu-MeAMD-H molecule can be exchanged with the H2S precursor. Ultimately, the tBu-MeAMD-H molecule can be desorbed and H2S can be dissociated to form two sulfhydrylated groups on the surface. Meanwhile, the -SH of a H2S molecule can be exchanged with the second tBu-MeAMD ligand. These insights into the reaction mechanism of nickel sulfide ALD can provide theoretical guidance to design the metal amidinate precursors and improve the ALD process for metal sulfides.

Atomic/Molecular Layer-Deposited Laminated Li2O-Lithicone Interfaces Enabling High-Performance Silicon Anodes.

Silicon-based materials are of long-standing interest as the anodes for next-generation lithium-ion batteries, yet their low initial Coulombic efficiency and poor interfacial stability are lethal limitations. In this work, we used atomic layer deposition (ALD) and molecular layer deposition (MLD) techniques to fabricate a lithium-containing laminated Li2O-lithicone hybrid film (∼5 nm) on a silicon electrode. The laminated film provides an additional surface Li source around silicon cores, which can partially reimburse the Li loss during battery cycling. Characterization of interfacial components shows that such a laminated Li2O-lithicone interface undergoes gentle element changes and participates in a hybrid solid electrolyte interphase with Li2CO3, Li2O, LixPOFy, and LiF species. Finite element model analysis and morphology characterization demonstrate that the laminated structure design can help relieve the interfacial stress and thus retain the integrity and reactivity of the silicon composite anode during cycling. Moreover, the lithium-based laminated film leads to a fast Li+ migration kinetics on the surface of the electrode as revealed by the galvanostatic intermittent titration technique and density functional theory calculation. Benefiting from the above merits, a silicon anode with a 91.2% initial Coulombic efficiency, a rate performance of 1460 mA h g-1 at 2 A g-1, and a reversible capacity over 646 mA h g-1 after 850 cycles was achieved. This work exemplifies the advantages of lithium-based hybrid films precisely engineered by ALD/MLD techniques for improving performances of advanced silicon anode batteries and deepens understandings on the mechanism of interfacial stability and reaction kinetics.

Structure-evolution-designed amorphous oxides for dielectric energy storage.

Recently, rapidly increased demands of integration and miniaturization continuously challenge energy densities of dielectric capacitors. New materials with high recoverable energy storage densities become highly desirable. Here, by structure evolution between fluorite HfO2 and perovskite hafnate, we create an amorphous hafnium-based oxide that exhibits the energy density of ~155 J/cm3 with an efficiency of 87%, which is state-of-the-art in emergingly capacitive energy-storage materials. The amorphous structure is owing to oxygen instability in between the two energetically-favorable crystalline forms, in which not only the long-range periodicities of fluorite and perovskite are collapsed but also more than one symmetry, i.e., the monoclinic and orthorhombic, coexist in short range, giving rise to a strong structure disordering. As a result, the carrier avalanche is impeded and an ultrahigh breakdown strength up to 12 MV/cm is achieved, which, accompanying with a large permittivity, remarkably enhances the energy storage density. Our study provides a new and widely applicable platform for designing high-performance dielectric energy storage with the strategy exploring the boundary among different categories of materials.

Atomic layer deposition assisted non-destructive strategy for cleaning Ag dendrites based SERS substrates.

Ag dendrites have recently been widely reported due to their excellent surface-enhanced Raman scattering (SERS) properties. However, prepared pristine Ag dendrites are usually contaminated by organic impurities, which has a huge negative impact on their Raman detection and greatly limits their practical applications. In this paper, we reported a facile strategy to obtain clean Ag dendrites by high temperature decomposition of organic impurities. With the assistance of ultra-thin coating via atomic layer deposition (ALD), the nanostructure of Ag dendrites can be retained at high temperature. SERS activity can be recovered after etching ALD coating. Chemical composition tests indicate that the organic impurities can be effectively removed. As a result, the clean Ag dendrites can obtain more clearly discernible Raman peaks and lower limits of detection than the pristine Ag dendrites. Furthermore, it was demonstrated that this strategy is also applicable to clean other substrates, such as gold nanoparticles. Therefore, high temperature annealing with the help of ALD sacrifice coating is a promising and non-destructive strategy to clean the SERS substrates.

Atomic layer deposition assisted fabrication of large-scale metal nanogaps for surface enhanced Raman scattering.

Metal nanogaps can confine electromagnetic field into extremely small volumes, exhibiting strong surface plasmon resonance effect. Therefore, metal nanogaps show great prospects in enhancing light-matter interaction. However, it is still challenging to fabricate large-scale (centimeter scale) nanogaps with precise control of gap size at nanoscale, limiting the practical applications of metal nanogaps. In this work, we proposed a facile and economic strategy to fabricate large-scale sub-10 nm Ag nanogaps by the combination of atomic layer deposition (ALD) and mechanical rolling. The plasmonic nanogaps can be formed in the compacted Ag film by the sacrificial Al2O3deposited via ALD. The size of nanogaps are determined by the twice thickness of Al2O3with nanometric control. Raman results show that SERS activity depends closely on the nanogap size, and 4 nm Ag nanogaps exhibit the best SERS activity. By combining with other porous metal substrates, various sub-10 nm metal nanogaps can be fabricated over large scale. Therefore, this strategy will have significant implications for the preparation of nanogaps and enhanced spectroscopy.

Electrochemical Resistive Switching in Nanoporous Hybrid Films by One-Step Molecular Layer Deposition.

An organic-inorganic hybrid resistive random-access memory based on a nanoporous zinc-based hydroquinone (Zn-HQ) thin film has been constructed with a Pt/Zn-HQ/Ag sandwich structure. The porous Zn-HQ functional layer was directly fabricated by a one-step molecular layer deposition. These Pt/Zn-HQ/Ag devices show a typical electroforming-free bipolar resistive switching characteristic with lower operation voltages and higher on/off ratio above 102. Our nanoporous hybrid devices can also realize multilevel storage capability and exhibit excellent endurance/retention properties. The connection and disconnection of Ag conductive filaments in nanoporous Zn-HQ thin film follow the electrochemical metallization mechanism. Our computational simulations confirm that the existence of nanopores in Zn-HQ thin films facilitates the Ag filament formation, contributing to the high performance of our hybrid devices.

First-Principles Molecular Dynamics Simulations on Water-Solid Interface Behavior of H2O-Based Atomic Layer Deposition of Zirconium Dioxide.

As an important inorganic material, zirconium dioxide (ZrO2) has a wide range of applications in the fields of microelectronics, coating, catalysis and energy. Due to its high dielectric constant and thermodynamic stability, ZrO2 can be used as dielectric material to replace traditional silicon dioxide. Currently, ZrO2 dielectric films can be prepared by atomic layer deposition (ALD) using water and zirconium precursors, namely H2O-based ALD. Through density functional theory (DFT) calculations and first-principles molecular dynamics (FPMD) simulations, the adsorption and dissociation of water molecule on the ZrO2 surface and the water-solid interface reaction were investigated. The results showed that the ZrO2 (111) surface has four Lewis acid active sites with different coordination environments for the adsorption and dissociation of water. The Zr atom on the surface can interacted with the O atom of the water molecule via the p orbital of the O atom and the d orbital of the Zr atom. The water molecules could be dissociated via the water-solid interface reaction of the first or second layer of water molecules with the ZrO2 (111) surface. These insights into the adsorption and dissociation of water and the water-solid interface reaction on the ZrO2 surface could also provide a reference for the water-solid interface behavior of metal oxides, such as H2O-based ALD.

Reaction mechanism of atomic layer deposition of zirconium oxide using zirconium precursors bearing amino ligands and water.

As a unique nanofabrication technology, atomic layer deposition (ALD) has been widely used for the preparation of various materials in the fields of microelectronics, energy and catalysis. As a high-κ gate dielectric to replace SiO2, zirconium oxide (ZrO2) has been prepared through the ALD method for microelectronic devices. In this work, through density functional theory calculations, the possible reaction pathways of ZrO2 ALD using tetrakis(dimethylamino)zirconium (TDMAZ) and water as the precursors were explored. The whole ZrO2 ALD reaction could be divided into two sequential reactions, TDMAZ and H2O reactions. In the TDMAZ reaction on the hydroxylated surface, the dimethylamino group of TDMAZ could be directly eliminated by substitution and ligand exchange reactions with the hydroxyl group on the surface to form dimethylamine (HN(CH3)2). In the H2O reaction with the aminated surface, the reaction process is much more complex than the TDMAZ reaction. These reactions mainly include ligand exchange reactions between the dimethylamino group of TDMAZ and H2O and coupling reactions for the formation of the bridged products and the by-product of H2O or HN(CH3)2. These insights into surface reaction mechanism of ZrO2 ALD can provide theoretical guidance for the precursor design and improving ALD preparation of other oxides and zirconium compounds, which are based ALD reaction mechanism.

Advances in stromal cell therapy for management of Alzheimer's disease.

Deposition of misfolded proteins and synaptic failure affects the brain in Alzheimer's disease (AD). Its progression results in amnesia and cognitive impairment. Absence of treatment is due to excessive loss of neurons in the patients and the delayed effects of drugs. The enhanced pluripotency, proliferation, differentiation, and recombination characteristics of stromal cells into nerve cells and glial cells present them as a potential treatment for AD. Successful evidence of action in animal models along with positive results in preclinical studies further encourage its utilization for AD treatment. With regard to humans, cell replacement therapy involving mesenchymal stromal cells, induced-pluripotent stromal cells, human embryonic stromal cells, and neural stems show promising results in clinical trials. However, further research is required prior to its use as stromal cell therapy in AD related disorders. The current review deals with the mechanism of development of anomalies such as Alzheimer's and the prospective applications of stromal cells for treatment.

Growth behavior of Ir metal formed by atomic layer deposition in the nanopores of anodic aluminum oxide.

The conformal coating or surface modification in high aspect ratio nanostructures is a tough challenge using traditional physical/chemical vapor deposition, especially for metal deposition. In this work, the growth behavior of iridium (Ir) metal formed by atomic layer deposition (ALD) in anodic aluminum oxide (AAO) templates was explored deeply. It is found that the surface hydrophilicity is crucial for the nucleation of ALD Ir. An in situ ALD Al2O3 layer with an ultra-hydrophilic surface can greatly promote the nucleation of ALD Ir in AAO nanopores. The effect of the Ir precursor pulse time, diameter, and length of AAO nanopores on the infiltration depth of ALD Ir was investigated systematically. The results show that the infiltration depth of ALD Ir in AAO nanopores is in proportion to the pore diameter and the square root of the Ir precursor pulse time, which follows a diffusion-limited model. Furthermore, the Ir precursor pulse time to obtain conformal Ir coating throughout all the AAO channels is in proportion to the square of the aspect ratio of AAO templates. In addition, the conformal Ir deposition in AAO nanopores is also related to the Ir precursor purge time and the O2 partial pressure. Insufficient Ir purge time could cause a CVD-like reaction, leading to the reduction of the infiltration depth in AAO. Higher O2 partial pressure can facilitate Ir nucleation with more Ir precursor consumption at the entrance of nanopores, decreasing the infiltration depth in AAO nanopores, so appropriate O2 partial pressure should be chosen for ALD Ir in high aspect ratio materials. Above all, our research is valuable for surface modification or coating of metal by ALD in high aspect ratio nanostructures for 3D microelectronics, nano-fabrication, catalysis and energy fields.

In Situ Formation of Polycyclic Aromatic Hydrocarbons as an Artificial Hybrid Layer for Lithium Metal Anodes.

Nonuniform Li deposition causes dendrites and low Coulombic efficiency (CE), seriously hindering the practical applications of Li metal. Herein, we developed an artificial solid-state interphase (SEI) with planar polycyclic aromatic hydrocarbons (PAHs) on the surface of Li metal anodes by a facile in situ formation technology. The resultant dihydroxyviolanthron (DHV) layers serve as the protective layer to stabilize the SEI. In addition, the oxygen-containing functional groups in the soft and conformal SEI film can regulate the diffusion and transport of Li ions to homogenize the deposition of Li metal. The artificial SEI significantly improves the CEs and shows superior cyclability of over 1000 h at 4 mAh cm-2. The LiFePO4/Li cell (2.8 mAh cm-2) enables a long cyclability for 300 cycles and high CEs of 99.8%. This work offers a new strategy to inhibit Li dendrite growth and enlightens the design on stable SEI for metal anodes.

Corrigendum: Reaction mechanism of atomic layer deposition of zirconium oxide using zirconium precursors bearing amino ligands and water.

[This corrects the article DOI: 10.3389/fchem.2022.1035902.].

Tailoring Stress and Ion-Transport Kinetics via a Molecular Layer Deposition-Induced Artificial Solid Electrolyte Interphase for Durable Silicon Composite Anodes.

Silicon is considered as a blooming candidate material for next-generation lithium-ion batteries due to its low electrochemical potential and high theoretical capacity. However, its commercialization has been impeded by the poor cycling issue associated with severe volume changes (∼380%) upon (de)lithiation. Herein, an organic-inorganic hybrid film of titanicone via molecular layer deposition (MLD) is proposed as an artificial solid electrolyte interphase (SEI) layer for Si anodes. This rigid-soft titanicone coating with Young's modulus of 21 GPa can effectively relieve stress concentration during the lithiation process, guaranteeing the stability of the mechanical structure of a Si nanoparticles (NPs)@titanicone electrode. Benefiting from the long-strand (Ti-O-benzene-O-Ti-) unit design, the optimized Si NPs@70 cycle titanicone anode delivers a high Li+ diffusion coefficient and a low Li+ diffusion barrier, as revealed by galvanostatic intermittent titration (GITT) investigations and density functional theory (DFT) simulations, respectively. Ultimately, the Si NPs@70 cycle titanicone electrode shows high initial Coulombic efficiency (84%), long cycling stability (957 mAh g-1 after 450 cycles at 1 A g-1), a stable SEI layer, and good rate performances. The molecular-scale design of the titanicone-protected Si anodes may bring in new opportunities to realize the next-generation lithium-ion batteries as well as other rechargeable batteries.

Realizing the enhanced cyclability of a cactus-like NiCo2O4 nanocrystal anode fabricated by molecular layer deposition.

Lithium-ion batteries with conversion-type anode electrodes have attracted increasing interest in providing higher energy storage density than those with commercial intercalation-type electrodes. However, conversion-type materials exhibit severe structural instability and capacity fade during cycling. In this work, a molecular layer deposition (MLD)-derived conductive Al2O3/carbon layer was employed to stabilize the structure of the cactus-like NiCo2O4 nanocrystal (NC) anode. The conductive Al2O3/carbon network and cactus-like NiCo2O4 NCs are beneficial for fast Li+/e- transport. Moreover, the Al2O3/carbon buffer-layer can prevent the NiCo2O4 NCs from agglomeration and form a steady solid electrolyte interphase (SEI), thus hampering the penetration of the electrolyte. Owing to these advantages, the assembled NiCo2O4@Al2O3/carbon half battery shows a high reversible capacity (931.2 mA h g-1 at 2 A g-1) and long-term stability of 290 mA h g-1 at 5 A g-1 over 500 cycles. Quantitative analyses further reveal the fast kinetics and the capacitance-battery dual model mechanism in the 3D core-shell structures. The design and introduction of MLD-derived hybrid coating may open a new way to conversion-type and alloy-type anode materials beyond NiCo2O4 to achieve high cyclability.

Enhanced visible light photocatalytic activity of Fe2O3 modified TiO2 prepared by atomic layer deposition.

In this work, commercial anatase TiO2 powders were modified using ultrathin Fe2O3 layer by atomic layer deposition (ALD). The ultrathin Fe2O3 coating having small bandgap of 2.20 eV can increase the visible light absorption of TiO2 supports, at the meantime, Fe2O3/TiO2 heterojunction can effectively improve the lifetime of photogenerated electron-hole pairs. Results of ALD Fe2O3 modified TiO2 catalyst, therefore, showed great visible light driven catalytic degradation of methyl orange compared to pristine TiO2. A 400 cycles of ALD Fe2O3 (~ 2.6 nm) coated TiO2 powders exhibit the highest degradation efficiency of 97.4% in 90 min, much higher than pristine TiO2 powders of only 12.5%. Moreover, an ultrathin ALD Al2O3 (~ 2 nm) was able to improve the stability of Fe2O3-TiO2 catalyst. These results demonstrate that ALD surface modification with ultrathin coating is an extremely powerful route for the applications in constructing efficient and stable photocatalysts.

Titanicone-derived TiO2 quantum dot@carbon encapsulated ZnO nanorod anodes for stable lithium storage.

To address the issues of large volume expansion and low electrical conductivity of ZnO anode nanomaterials during lithium ion battery operation, herein we engineered a rod-like ZnO anode with robust and conductive TiO2 quantum dot (QD)@carbon coating derived from molecular layer deposited titanicone, in which the TiO2 QDs are well confined inside the carbon layer. Transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS) confirm the formation of TiO2 QDs and carbonization of fumaric acid in hybrid films after annealing in H2 atmosphere at 700 °C. Benefiting from a unique protective layer design, the prepared TiO2 QD@carbon@ZnO nanorod (NR) anodes display outstanding cycling performance with a discharge capacity of 1154 mA h g-1 after 100 cycles and 70% capacity retention, along with a high rate capacity of 470 mA h g-1 for 500 cycles at 2 A g-1. Moreover, our work demonstrates an innovative and promising approach toward a robust and conductive metal oxide QD@carbon nanocomposite layer for electrode materials in the future.