Coaching doctors to improve ethical decision-making in adult hospitalized patients potentially receiving excessive treatment. The CODE stepped-wedge cluster randomized controlled trial.

PURPOSE: The aim of this study was to assess whether coaching doctors to enhance ethical decision-making in teams improves (1) goal-oriented care operationalized via written do-not-intubate and do-not attempt cardiopulmonary resuscitation (DNI-DNACPR) orders in adult patients potentially receiving excessive treatment (PET) during their first hospital stay and (2) the quality of the ethical climate. METHODS: We carried out a stepped-wedge cluster randomized controlled trial in the medical intensive care unit (ICU) climate questionnaire (ethical decision-making climate questionnaire, EDMCQ) before and after the study, and anonymously identified PET via an electronic alert during the entire study period. All departments were randomly assigned to a 4-month coaching. At least one month of coaching was compared to less than one month coaching and usual care. The first primary endpoint was the incidence of written DNI-DNACPR decisions. The second primary endpoint was the EDMCQ before and after the study period. Because clinicians identified less PET than required to detect a difference in written DNI-DNACPR decisions, a post-hoc analysis on the overall population was performed. To reduce type I errors, we further restricted the analysis to one of our predefined secondary endpoints (mortality up to 1 year). RESULTS: Of the 442 and 423 clinicians working before and after the study period, respectively 270 (61%) and 261 (61.7%) filled out the EDMCQ. Fifty of the 93 (53.7%) doctors participated in the coaching for a mean (standard deviation [SD]) of 4.36 (2.55) sessions. Of the 7254 patients, 125 (1.7%) were identified as PET, with 16 missing outcome data. Twenty-six of the PET and 624 of the overall population already had a written DNI-DNACPR decision at study entry, resulting in 83 and 6614 patients who were included in the main and post hoc analysis, respectively. The estimated incidence of written DNI-DNACPR decisions in the intervention vs. control arm was, respectively, 29.7% vs. 19.6% (odds ratio 4.24, 95% confidence interval 4.21-4.27; P < 0.001) in PET and 3.4% vs. 1.9% (1.65, 1.12-2.43; P = 0.011) in the overall study population. The estimated mortality at one year was respectively 85% vs. 83.7% (hazard ratio 2.76, 1.26-6.04; P = 0.011) and 14.5% vs. 15.1% (0.89, 0.72-1.09; P = 0.251). The mean difference in EDMCQ before and after the study period was 0.02 points (- 0.18 to 0.23; P = 0.815). CONCLUSION: This study suggests that coaching doctors regarding ethical decision-making in teams safely improves goal-oriented care operationalized via written DNI-DNACPR decisions in hospitalized patients, however without concomitantly improving the quality of the ethical climate.

A Comprehensive Analysis of LYAR in Colorectal Cancer: Prognostic Marker and Therapeutic Target.

Background: Colorectal cancer (CRC) is a major global health challenge with a need for new biomarkers and therapeutic targets. This work aimed to investigate the biological mechanisms and clinical value of Ly1 antibody reactive (LYAR) in CRC. Methods: We analyzed LYAR mRNA expression across multiple public databases, including genotype-tissue expression, gene expression omnibus, Oncomine, and the cancer genome atlas, alongside in-house immunohistochemical data to evaluate LYAR protein expression in CRC and non-CRC colorectal tissues. Gene set enrichment analysis (GSEA) was used to elucidate LYAR's biological functions, and its impact on the tumor immune microenvironment was assessed using CIBERSORT, ESTIMATE, and single-cell RNA sequencing techniques. In addition, LYAR's association with clinicopathological features and patient prognosis was explored, and its influence on drug sensitivity was investigated using the Connectivity Map database. Results: LYAR was significantly upregulated in CRC tissues compared with non-CRC colorectal counterparts, associated with altered immune cell composition and enhanced RNA processing, splicing, and cell cycle regulation. High LYAR expression correlated with poor disease-free and overall survival, underscoring its prognostic value. GSEA revealed LYAR's involvement in critical cellular processes and pathways, including DNA repair, cell cycle, and mTORC1 signaling. Correlation analysis identified genes positively and negatively associated with LYAR, leading to the discovery of temsirolimus and WYE-354, mTOR inhibitors, as potential therapeutic agents for CRC. Furthermore, LYAR expression predicted increased sensitivity to cetuximab in RAS wild-type metastatic CRC, indicating its utility as a biomarker for treatment responsiveness. Conclusions: LYAR's upregulation in CRC highlights its potential as a biomarker for prognosis and therapeutic targeting, offering insights into CRC pathology and suggesting new avenues for treatment optimization.

[Clincopathological analysis of 171 patients with osteochondroma and malignant transformation in maxillofacial bone].

PURPOSE: To investigate the clinical and pathological features of osteochondroma in maxillofacial region, and to summarize the clinicopathological features of rare osteochondroma malignant transformation in order to provide clinical guidance. METHODS: From January 2018 to September 2023, a total of 171 patients with osteochondroma were retrospectively collected in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Their preoperative CT and clinicopathological features were analyzed. RESULTS: Of the 171 patients with osteochondroma in maxillofacial bone, 66%（113/171） were females and 34% were male. Their age ranged from 11-76 with an average age was 44 years old. Of the 171 cases, 95.3%（163/171）in mandible condyle, 4%(7/171) in mandible processus coronoideus, and 0.5%（1/171） in zygomatic arch. The imaging findings showed that the thickness of cartilaginous cap was less than 1 cm in 98%（159/161） cases with condyle lesions. Only 2 cases(2/171, 1.1%) had malignant transformation. One was diagnosed with secondary chondrosarcoma, another developed low-grade osteosarcoma. CONCLUSIONS: Osteochondroma in maxillofacial region mostly occurs in females, and most commonly located in condylar process, with a malignant change rate of 1.1%, which is similar to that of other parts of the body. Imaging findings have important guiding significance for the diagnosis of osteochondroma malignant change.

First-line treatment of severe aplastic anemia: immunosuppressive therapy plus eltrombopag versus haploidentical hematopoietic stem cell transplantation, a multicenter prospective study.

Matched-related donor hematopoietic stem cell transplantation (HSCT) remains the preferred first-line option for severe aplastic anemia (SAA) patients aged <40 years even in the era of eltrombopag (EPAG). However, there has not been any direct comparison between immunosuppressive therapy (IST) plus EPAG (IST + EPAG) and haploidentical HSCT (Haplo-HSCT) as first-line therapy. This study prospectively compared the efficacy, safety and health-related quality of life (HRQoL) of Haplo-HSCT (n = 147) and IST + EPAG (n = 121) as first-line treatment for patients with SAA. The results showed that 86.3% of patients in the Haplo-HSCT group and 24.1% of patients in the IST + EPAG group achieved normal complete blood count (CBC) (P < 0.001) after 6 months of treatment. The time to achieve transfusion independence and absolute neutrophil count ≥ 1.0 × 109/L were shorter in the Haplo-HSCT group than in the IST + EPAG group (P < 0.05). In the IST + EPAG and Haplo-HSCT, 3-year overall survival (OS) was 92.4 ± 2.4% and 82.8 ± 3.1% (P = 0.017), whereas 3-year failure-free survival (FFS) was 69.4 ± 4.2% and 81.6 ± 3.2% (P = 0.002), respectively. Similar results were observed in patients with <40 years of age. Among patients with ≥40 years of age, there was no difference in 3-year OS (88.6 ± 4.8% vs. 82.4 ± 8.1%, P = 0.517) between the IST + EPAG and Haplo-HSCT groups, whereas 3-year FFS was lower in the IST + EPAG (58.7 ± 7.5% vs. 82.4 ± 8.1%, P = 0.043). Subgroup analysis for populations aged <40 years indicated that SAA benefited more from IST + EPAG, and very SAA (vSAA) benefited more from Haplo-HSCT. Patients treated with haplo-HSCT scored significantly better in the HRQoL than treated with IST + EPAG (P < 0.0001). Multivariate analysis showed that first-line Haplo-HSCT was associated with normal CBC at 6 months, better FFS and led to a better HRQoL (P < 0.001). In summary, the IST + EPAG achieved better OS for <40 years SAA patients, while the Haplo-HSCT accelerated hematopoietic recovery and HRQoL, achieved better FFS even for those <40 years vSAA and ≥40 years patients.

Ultrathin Carbon Shell Protecting Copper Sites to Boost Anodic Hydrogen Production via Low-Potential Formaldehyde Oxidation.

The oxidation of aldehydes on a copper-based electrocatalyst within a small potential window can produce hydrogen at the anode, thus offering a bipolar hydrogen production system. However, the inherent activity and stability of Cu-based electrocatalysts for aldehyde oxidation are still not satisfactory in practical application. Herein, by coating an ultrathin carbon shell on the copper sphere, an effective and stable formaldehyde oxidation reaction (FOR) can be realized to produce H2 at a very low potential. FOR needs only a potential of 0.13 V (vs RHE) to reach a current density of 100 mA cm-2. By coupling FOR with hydrogen evolution reaction (HER), hydrogen is generated simultaneously at both the cathode and the anode. The Faraday efficiency of H2 at the bipolar state is close to 100%. In a flow cell, it needs a low cell voltage of 0.1 V to reach a current density of 100 mA cm-2. Moreover, it can be operated steadily for more than 30 h at high current density. The carbon shell acts as an armor to protect the Cu(0) sites, avoid the oxidation of copper, and keep the catalyst activity for a long time in the electrolytic process. Experimental and theoretical calculation results indicate that electron transfer occurs at the interface between the copper core and ultrathin carbon shell. The ultrathin carbon-coated Cu reduces the reaction energy barrier, making the C-H bond more easily fractured and facilitating H coupling to generate H2. This study provides a basic principle for the design of copper-based electrocatalysts with long durability and activity.

A case report of right-sided heart failure secondary to JAK2-mutation Loeffler endocarditis.

Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome. We present a case of LE in a 45-year-old female, resulting in diffuse endothelial fibrosis and severe right-sided heart failure. The patient was admitted with dyspnoea and oedema, with haematology revealing an absolute eosinophil count of 20.9 × 109. Imaging showed near-complete obliteration of the right ventricular apical and formation of thromboses. Endomyocardial biopsy indicated diffuse fibrous hyperplasia of the endocardium with fibrinous thrombi rich in eosinophils. Molecular and cytogenetic analyses of bone marrow cells showed no signs of FIP1L1-PDGFRA fusion, PDGFRB mutation, abnormal myeloid maturation, or a lymphoproliferative disorder. Flow cytometry indicated no clonality, ruling out chronic eosinophilic leukaemia. Gene mutation screening discovered a p.L583_A586delinesS mutation in the JAK2 gene. Following treatment with ruxolitinib, the patient's eosinophil levels normalized, but unfortunately, the damage to the heart was irreversible. The patient was hospitalized multiple times due to right heart failure and resistance to diuretics. After thorough discussions with the medical team, it was determined that a heart transplantation would be the most effective treatment. Following the surgery, the patient successfully navigated the postoperative critical period with the support of an intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), and ventilator-assisted ventilation but subsequently developed an acquired Intensive care unit-acquired weakness (ICU-AW) and a depressive state. Fortunately, the patient gradually recovered from these complications.

Improved memory truncation scheme for quasi-adiabatic propagator path integral via influence functional renormalization.

Accurately simulating non-Markovian quantum dynamics in system-bath coupled problems remains challenging. In this work, we present a novel memory truncation scheme for the iterative quasi-adiabatic propagator path integral (iQuAPI) method to improve accuracy. Conventional memory truncation in iQuAPI discards all influence functional beyond a certain time interval, which is not effective for problems with a long memory time. Our proposed scheme selectively retains the most significant parts of the influence functional using the density matrix renormalization group algorithm. We validate the effectiveness of our scheme through simulations of the spin-boson model across various parameter sets, demonstrating faster convergence and improved accuracy compared to the conventional scheme. Our findings suggest that the new memory truncation scheme significantly advances the capabilities of iQuAPI for problems with a long memory time.

Comparison of efficacy of eltrombopag combined with immunosuppression in the treatment of severe aplastic anemia and very severe aplastic anemia: real-world data and evidence.

Eltrombopag combined with immunosuppressive therapy (IST) was superior to IST alone for severe aplastic anemia (SAA) in the previous studies. But in China, horse antithymocyte globulin (hATG) is not available, instead, we use rabbit ATG (rATG). Here, we compared the efficacy and safety of IST (rATG combined with cyclosporine) combined with or without eltrombopag for the first-line treatment of SAA and very severe aplastic anemia (VSAA). A total of 371 patients in ten institutions in China from April 1, 2017 to December 1, 2022 were enrolled. The overall response (OR) rate at 3 months (54.2% vs. 41%; P = 0.046), the complete response (CR) (31.3% vs. 19.4%; P = 0.041) and OR (78.3% vs. 51.1%; P < 0.0001) rates at 6 months were significantly higher with IST combined with eltrombopag than with IST alone in SAA patients. While in VSAA patients, the addition of eltrombopag to IST only increased the CR rate at 6 months (29.8% vs. 9.43%; P = 0.010). Liver injury increased significantly in groups treated with IST combined with eltrombopag (P < 0.05). Serious treatment-related toxicities were similar (P > 0.05). In patients with SAA, 3-year failure-free survival (FFS) of eltrombopag combined with IST group was significantly higher than that of IST group (70.7 ± 5.3% vs. 50.3 ± 3.9%; P = 0.007). In patients with VSAA, the addition of eltrombopag significantly improved 3-year overall survival (OS) (82.2 ± 5.7% vs. 57.3 ± 7.2%; P = 0.020). Our findings suggested that IST combined with eltrombopag could improve the hematological recovery of newly diagnosed SAA without increasing severe toxicities. But in VSAA, the addition of eltrombopag seemed to show no other improvement to efficacy except the CR rate at 6 months.

The effect of brace treatment history on bone density in preoperative patients with adolescent idiopathic scoliosis (AIS) assessed by vertebral bone quality (VBQ) score: a retrospective propensity score-matched analysis.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS), a prevalent condition among teenagers, is often accompanied by osteopenia. However, the impact of brace treatment on bone density in AIS patients remains a matter of debate. The Vertebral bone quality (VBQ) score, derived from MRI signal intensity, has been shown to correlate with bone mineral density (BMD). Yet, no studies to date have drawn comparisons between VBQ scores in preoperative AIS patients who had brace treatment history and those who have not received brace treatment. OBJECTIVE: This study aims to elucidate the influence of brace treatment on bone density in AIS patients using VBQ score. METHODS: A retrospective analysis was conducted on 243 AIS patients, each with Cobb angles ranging from 50-70°, who had undergone preoperative MRI scans. The patients were segregated into two cohorts: those who received brace treatment (n = 174) and those who did not (n = 69). Through propensity score matching, a total of 53 matched pairs were selected for further analysis. VBQ scores were extracted from T1-weighted MRI scans. RESULTS: Post-matching, no significant baseline discrepancies were observed between the two groups. Interestingly, brace-treated patients exhibited lower average VBQ scores than their non-brace-treated counterparts (2.43 ± 0.11 vs. 2.55 ± 0.12, p < 0.01), suggesting a higher bone density. Furthermore, a negative correlation was observed between VBQ scores and the duration of brace usage (R2 = 0.3853, p < 0.01). CONCLUSION: Brace treatment may potentially enhance bone density in AIS patients by mitigating vertebral fat infiltration. The utilization of VBQ scores presents an alternative, potentially robust approach to assessing bone quality.

A Novel Deformity Correction Manipulation System for Better Correction of Large Thoracic Scoliosis.

OBJECTIVE: Treating patients with large thoracic scoliosis (between 70° and 100°) poses technical challenges, particularly with traditional correction techniques (TCT). To address this, we developed a novel deformity correction manipulation system (DCMS) aimed at reducing surgical complexity and trauma. This study aims to assess the safety and effectiveness of DCMS in treating large thoracic scoliosis. METHODS: From January 2016 to June 2021, 76 patients with large thoracic scoliosis were included in this retrospective study. The patients were divided into two groups: DCMS (n = 34) and TCT (n = 42). Basic patient data including age at surgery, sex, etiology, Risser sign, flexibility of the main thoracic curve, instrumented levels, number of screws, duration of hospital stay, and follow-up time were collected and analyzed. Radiographic and clinical outcomes, as measured by various radiographic parameters and Scoliosis Research Society-30 (SRS-30) scores, were retrospectively analyzed and compared between the two groups. Adverse events were also documented. Statistical analyses were performed using two-tailed independent t-tests, chi-square tests, and Fisher's exact test. RESULTS: The DCMS group exhibited significantly shorter operative times, reduced blood loss, and shorter hospital stays compared to the TCT group. However, there were no significant differences between the two groups in terms of age at surgery, sex, etiology, Risser sign, flexibility of the main curve, instrumented levels, number of screws, and follow-up time. While preoperative major curves were statistically similar between the two groups, the DCMS group achieved a superior correction rate compared to the TCT group (74.2% ± 8.8% vs 68.1% ± 10.5%). No significant differences were observed in other radiographic parameters, SRS-30 scores, or the incidence of adverse events. CONCLUSION: The application of DCMS resulted in shorter operative times, reduced blood loss, shorter hospital stays, and greater curve correction compared to TCT. DCMS proves to be a safe and effective technique for treating large thoracic curves.

Highthroughput Screening of CuBi Bimetallic Catalyst Array for Electrocatalytic CO2 Reduction Reaction by Scanning Electrochemical Microscope.

The testing and evaluation of catalysts in CO2 electroreduction is a very tedious process. To study the catalytic system of CO2 reduction more quickly and efficiently, it is necessary to establish a method that can detect multiple catalysts at the same time. Herein, a series of CuBi bimetallic catalysts have been successfully prepared on a single glass carbon electrode by a scanning micropieptte contact method. The application of scanning electrochemical microscopy (SECM) enabled the visualization of the CO2 reduction activity in diverse catalyst micro-points. The SECM imaging with Substrate generation/tip collection (SG/TC) mode was conducted on CuBi bimetallic micro-points, revealing that HER reaction emerged as the prevailing reaction when a low overpotential was employed. While the applied potential was lower than -1.5 V (vs Ag/AgCl), the reduction of CO2 to formic acid became dominant. Increasing the bismuth proportion in the bimetallic catalyst can inhibit the hydrogen evolution reaction at low potential and enhances the selectivity of the CO product at high cathode overpotential.This research offers a novel approach to examining arrays of catalysts for CO2 reduction.

Machine learning for the prediction of 1-year mortality in patients with sepsis-associated acute kidney injury.

INTRODUCTION: Sepsis-associated acute kidney injury (SA-AKI) is strongly associated with poor prognosis. We aimed to build a machine learning (ML)-based clinical model to predict 1-year mortality in patients with SA-AKI. METHODS: Six ML algorithms were included to perform model fitting. Feature selection was based on the feature importance evaluated by the SHapley Additive exPlanations (SHAP) values. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminatory ability of the prediction model. Calibration curve and Brier score were employed to assess the calibrated ability. Our ML-based prediction models were validated both internally and externally. RESULTS: A total of 12,750 patients with SA-AKI and 55 features were included to build the prediction models. We identified the top 10 predictors including age, ICU stay and GCS score based on the feature importance. Among the six ML algorithms, the CatBoost showed the best prediction performance with an AUROC of 0.813 and Brier score of 0.119. In the external validation set, the predictive value remained favorable (AUROC = 0.784). CONCLUSION: In this study, we developed and validated a ML-based prediction model based on 10 commonly used clinical features which could accurately and early identify the individuals at high-risk of long-term mortality in patients with SA-AKI.

Platinum Cluster Decoration on Hollow Carbon Spheres for High-Efficiency Hydrogen Evolution Reaction.

Currently, platinum (Pt)/carbon support composite materials have tremendous application prospects in the hydrogen evolution reaction (HER). However, one of the primary challenges for boosting their performance is designing a substrate with the desired microstructure. Herein, the intact hollow carbon spheres (HCSs) were prepared via template method. Based on the morphology variation of the as-prepared HCSs-x, we conjectured that the polydopamine (PDA) core was generated first and then slowly grew into a complete overburden (SiO2@PDA). Afterward, Pt atomic clusters were anchored on the outer shells of HCSs-4 to construct composite electrocatalysts (Pty/HCSs-4) by a chemical reduction method. Due to the low charge-transfer resistance, the HCSs have a large electrochemical surface area and provide a continuous electron transport pathway, boosting the atom utilization efficiency during hydrogen production and release. The synthesized Pt2.5/HCSs-4 electrocatalysts exhibit excellent HER activity in acidic media, which can be ascribed to the compositional modulation and delicate structural design. Specifically, when the overpotential is 10 A g-1, the overpotential can achieve 92 mV. This work opens a new route to fabricate Pt-based electrocatalysts and brings a new understanding of the formation mechanism of HCSs.

Online rumors during the COVID-19 pandemic: co-evolution of themes and emotions.

Introduction: During public health emergencies, online rumors spread widely on social media, causing public information anxiety and emotional fluctuations. Analyzing the co-evolution patterns of online rumor themes and emotions is essential for implementing proactive and precise governance of online rumors during such events. Methods: Rumor texts from mainstream fact-checking platforms during the COVID-19 pandemic were collected and analyzed in phases based on the crisis lifecycle theory. The LDA topic model was applied to analyze the distribution of rumor themes at different stages. The Baidu AI Sentiment Analysis API was used to study the emotional tendencies of rumors at different stages. Line graphs were utilized to analyze the co-evolution characteristics of rumor themes and emotions. Results: During the COVID-19 pandemic, the themes of online rumors can be categorized into five types: epidemic prevention and control, panic-inducing, production and livelihood, virus dissemination, and social figures. These themes exhibited repetition and fluctuation at different stages of the pandemic. The emotions embedded in pandemic-related online rumors evolved with the progression of the pandemic. Panic-inducing rumors co-evolved with negative emotions, while epidemic prevention and control rumors co-evolved with positive emotions. Conclusion: The study results help to understand the public's focus and emotional tendencies at different stages of the COVID-19 pandemic, thereby enabling targeted public opinion guidance and crisis management.

High-Valence Cu Induced by Photoelectric Reconstruction for Dynamically Stable Oxygen Evolution Sites.

Oxygen vacancies are generally considered to play a crucial role in the oxygen evolution reaction (OER). However, the generation of active sites created by oxygen vacancies is inevitably restricted by their condensation and elimination reactions. To overcome this limitation, here, we demonstrate a novel photoelectric reconstruction strategy to incorporate atomically dispersed Cu into ultrathin (about 2-3 molecular) amorphous oxyhydroxide (a-CuM, M = Co, Ni, Fe, or Zn), facilitating deprotonation of the reconstructed oxyhydroxide to generate high-valence Cu. The in situ XAFS results and first-principles calculations reveal that Cu atoms are stabilized at high valence during the OER process due to Jahn-Teller distortion, resulting in para-type double oxygen vacancies as dynamically stable catalytic sites. The optimal a-CuCo catalyst exhibits a record-high mass activity of 3404.7 A g-1 at an overpotential of 300 mV, superior to the benchmarking hydroxide and oxide catalysts. The developed photoelectric reconstruction strategy opens up a new pathway to construct in situ stable oxygen vacancies by high-valence Cu single sites, which extends the design rules for creating dynamically stable active sites.

Synergy of Photogenerated Electrons and Holes toward Efficient Photocatalytic Urea Synthesis from CO2 and N2.

Directly coupling N2 and CO2 to synthesize urea by photocatalysis paves a sustainable route for urea synthesis, but its performance is limited by the competition of photogenerated electrons between N2 and CO2, as well as the underutilized photogenerated holes. Herein, we report an efficient urea synthesis process involving photogenerated electrons and holes in respectively converting CO2 and N2 over a redox heterojunction consisting of WO3 and Ni single-atom-decorated CdS (Ni1-CdS/WO3). For the photocatalytic urea synthesis from N2 and CO2 in pure water, Ni1-CdS/WO3 attained a urea yield rate of 78 µM h-1 and an apparent quantum yield of 0.15 % at 385 nm, which ranked among the best photocatalytic urea synthesis performance reported. Mechanistic studies reveal that the N2 was converted into NO species by ⋅OH radicals generated from photogenerated holes over the WO3 component, meanwhile, the CO2 was transformed into *CO species over the Ni site by photogenerated electrons. The generated NO and *CO species were further coupled to form *OCNO intermediate, then gradually transformed into urea. This work emphasizes the importance of reasonably utilizing photogenerated holes in photocatalytic reduction reactions.

A gradient-distributed binder with high energy dissipation for stable silicon anode.

Silicon is considered as a promising alternative to traditional graphite anode for lithium-ion batteries. Due to the dramatic volume expansion of silicon anode generated from the insertion of Li+ ions, the binder which can suppress the severe volume change and repeated massive stress impact during cycling is required greatly. Herein, we design a gradient-distributed two-component binder (GE-PAA) to achieve excellent cyclic stability, and reveal the mechanism of high energy dissipative binder stabilized silicon electrodes. The inner layer of the electrode is the polyacrylic acid polymer (PAA) with high Young's modulus, which is used as the skeleton binder to stabilize the silicon particle interface and the electrode structure. The outer layer is the gel electrolyte polymer (GE) with lower Young's modulus, which releases the stress generated during the lithiation and de-lithiation process effectively, achieving the high structural stability at the molecular level and silicon particles. Due to the synergistic effect of the gradient binder design, the silicon electrode retains a reversible capacity of 1557.4 mAh g-1 after 200 cycles at the current density of 0.5 C and 1539.2 mAh g-1 at a high rate of 1.8 C. This work provides a novel binder design strategy for Si anode with long cycle stability.

NiS ultrafine nanorod with translational and rotational symmetry.

Anisotropy is a significant and prevalent characteristic of materials, conferring orientation-dependent properties, meaning that the creation of original symmetry enables key functionality that is not found in nature. Even with the advancements in atomic machining, synthesis of separated symmetry in different directions within a single structure remains an extraordinary challenge. Here, we successfully fabricate NiS ultrafine nanorods with separated symmetry along two directions. The atomic structure of the nanorod exhibits rotational symmetry in the radial direction, while its axial direction is characterized by divergent translational symmetry, surpassing the conventional crystalline structures known to date. It does not fit the traditional description of the space group and the point group in three dimensions, so we define it as a new structure in which translational symmetry and rotational symmetry are separated. Further corroborating the atomic symmetric separation in the electronic structure, we observed the combination of stripe and vortex magnetic domains in a single nanorod with different directions, in accordance with the atomic structure. The manipulation of nanostructure at the atomic level introduces a novel approach to regulate new properties finely, leading to the proposal of new nanotechnology mechanisms.

Mitochondria-engine with self-regulation to restore degenerated intervertebral disc cells via bioenergetic robust hydrogel design.

Previous studies have confirmed that intervertebral disc degeneration (IDD) is closely associated with inflammation-induced reactive oxygen species (ROS) and resultant cell mitochondrial membrane potential (MMP) decline. Clearance of ROS in an inflammatory environment is essential for breaking the vicious cycle of MMP decline. Additionally, re-energizing the mitochondria damaged in the inflammatory milieu to restore their function, is equally important. Herein, we proposed an interesting concept of mitochondrion-engine equipped with coolant, which enables first to "cool-down" the inflammatory environment, next to restore the MMP, finally to allow cells to regain normal energy metabolism through materials design. As such, we developed a multi-functional composite composed of a reactive oxygen species (ROS)-responsive sodium alginate/gelatin hydrogel infused into a rigid 3D-printed thermoplastic polyurethane (TPU) scaffold. The TPU scaffold was coated with conductive polypyrrole (PPy) to electrophoretically deposit l-arginine, which could upregulate the Mammalian target of rapamycin (mTOR) pathway, thus increasing MMP and energy metabolism to stimulate extracellular matrix synthesis for IVD repair. While the ROS-responsive hydrogel acting as the "mito-engine coolant" could scavenge the excessive ROS to create a favorable environment for IVD cells recovery. Demonstrated by in vitro and in vivo evaluations, the mito-engine system markedly promoted the proliferation and collagen synthesis of nucleus pulposus cells while enhancing the mitochondrial respiration and MMP under oxidative stress. Radiological and histological assessments in vivo revealed the efficacy of this system in IVD repair. This unique bioinspired design integrated biomaterial science with mitochondrial biology, presents a promising paradigm for IDD treatment.

HLA-mismatched allogeneic adoptive immune therapy in patients with severely immunosuppressed AIDS: a multicenter, open-label, controlled, phase 2a study.

Recurrent opportunistic infections (OIs) in patients with severely immunosuppressed AIDS remain an unresolved medical challenge despite advancements in antiretroviral therapy (ART). To address this gap, we developed an HLA-mismatched allogeneic adoptive immune therapy (AAIT) specifically targeting this patient population. The safety and efficacy of this novel therapeutic approach were preliminarily confirmed in our phase 1 trial. Subsequently, a multicenter, open-label, controlled, phase 2a trial was conducted to evaluate the efficacy of AAIT in combination with ART compared with the conventional ART-only regimen. No difference in the incidence of adverse events (AEs) was observed between the two groups at the 96-week follow-up. AAIT treatment improved CD4+ T cell recovery at weeks 72 (P = 0.048) and 96 (P = 0.024) compared to the Control Group. Additionally, stratified analysis of patients in the AAIT Group showed that donor/recipient sex mismatch was significantly associated with the likelihood of patients achieving an immunological response (OR = 8.667; 95% CI, 2.010-37.377; P = 0.004). These findings suggest that AAIT serves as a promising adjunct therapy for improving the outcomes of patients with severely immunosuppressed AIDS. Further studies are needed to elucidate the immunological mechanisms underlying AAIT and identify the subpopulations that respond optimally to this therapeutic approach. This trial is registered at www.clinicaltrials.gov (NCT04098770).Trial registration: ClinicalTrials.gov identifier: NCT04098770.Trial registration: ClinicalTrials.gov identifier: NCT02651376.