A Multielectron and High-Potential Spirobifluorene-based Posolyte for Aqueous Redox Flow Batteries.

The rising energy demand driven by human activity has posed pressing challenges in embracing renewable energy, necessitating advances in energy storage technologies to maximize their utilization efficiency. Recent studies in aqueous organic redox flow batteries focused primarily on the development of organic negative electrolytes, while the progress in organic positive electrolytes remains constrained by limitations in their redox potentials and effective electron concentrations. Herein, we report a spatially twisted chlorinated spirobifluorene ammonium salts (CSFAs), created through an unexpected green chlorination-protection pathway during the initial cycling in flow battery, utilizing chloride ions from counterions in aqueous solution. The chlorinated, nonplanar spiral structure of CFSAs possesses a one-step four-electron transfer electrochemical property and offers exceptional resistance to nucleophilic attacks, exhibiting an unprecedented redox potential as high as 1.05 V (vs. SHE). A full redox flow battery based on CFSA-Cl (chloride ions as the counter ions) with 1.4 M electron concentration achieved an average coulombic efficiency exceeding 99.4% and a capacity utilization reaching 95% of the four-electron capacity for a stable cycling over 250 cycles (~22 days). The present work exemplifies the use of side reactions to develop new redox species, which can be extended to create more structurally versatile energy storage materials.

The CBM91 module enhances the activity of ß-xylosidase/α-L-arabinofuranosidase PphXyl43B from Paenibacillus physcomitrellae XB by adopting a unique loop conformation at the top of the active pocket.

Carbohydrate-binding module (CBM) family 91 is a novel module primarily associated with glycoside hydrolase (GH) family 43 enzymes. However, our current understanding of its function remains limited. PphXyl43B is a ß-xylosidase/α-L-arabinofuranosidase bifunctional enzyme from physcomitrellae patens XB belonging to the GH43_11 subfamily and containing CBM91 at its C terminus. To fully elucidate the contributions of the CBM91 module, the truncated proteins consisting only the GH43_11 catalytic module (rPphXyl43B-dCBM91) and only the CBM91 module (rCBM91) of PphXyl43B were constructed, respectively. The result showed that rPphXyl43B-dCBM91 completely lost hydrolysis activity against both p-nitrophenyl-ß-D-xylopyranoside and p-nitrophenyl-α-L-arabinofuranoside; it also exhibited significantly reduced activity towards xylobiose, xylotriose, oat spelt xylan and corncob xylan compared to the control. Thus, the CBM91 module is crucial for the ß-xylosidase/α-L-arabinofuranosidase activities in PphXyl43B. However, rCBM91 did not exhibit any binding capability towards corncob xylan. Structural analysis indicated that CBM91 of PphXyl43B might adopt a loop conformation (residues 496-511: ILSDDYVVQSYGGFFT) to actively contribute to the catalytic pocket formation rather than substrate binding capability. This study provides important insights into understanding the function of CBM91 and can be used as a reference for analyzing the action mechanism of GH43_11 enzymes and their application in biomass energy conversion.

2D Graphene Oxide Membrane Nanoreactors for Rapid Directional Flow Ring-Opening Reactions with Dominant Same-Configuration Products.

Nanoconfinement within enzymes can increase reaction rate and improve selectivity under mild conditions. However, it remains a great challenge to achieve chemical reactions imitating enzymes with directional molecular motion, short reaction time, ≈100% conversion, and chiral conversion in artificial nanoconfined systems. Here, directional flow ring-opening reactions of styrene oxide and alcohols are demonstrated with ≈100% conversion in <120 s at 22 °C using graphene oxide membrane nanoreactors. Dominant products have the same configuration as chiral styrene oxide in confined reactions, which is dramatically opposed to bulk reactions. The unique chiral conversion mechanism is caused by spatial confinement, limiting the inversion of benzylic chiral carbon. Moreover, the enantiomeric excess of same-configuration products increased with higher alkyl charge in confined reactions. This work provides a new route to achieve rapid flow ring-opening reactions with specific chiral conversion within 2D nanoconfined channels, and insights into the impact of nanoconfinement on ring-opening reaction mechanisms.

Efficient Flow Synthesis of Aspirin within 2D Sub-Nanoconfined Laminar Annealed Graphene Oxide Membranes.

The aim of this work is to develop an environmentally friendly, safe, and simple route for realizing efficient preparation of aspirin. Here, inspired by enzyme synthesis in vivo, the aspirin synthesis has been realized by sub-nanoconfined esterification with directional flow and ≈100% conversion in an unprecedented reaction time of <6.36 s at 23 °C. Such flow esterification reaction is catalyzed by thermally transformed graphene oxide (GO) membranes with tailored physicochemical properties, which can be obtained simply through a mild annealing method. A possible mechanism is revealed by density functional theory calculation, indicating that the synergistic effect of spatial confinement and surface electronic structure can significantly improve the catalytic performance. By restricting reactants within 2D sub-nano space created by GO-based laminar flow-reactors, the present strategy provides a new route to achieve rapid flow synthesis of aspirin with nearly complete conversion.

Development and validation of a prognostic model based on RNA binding proteins in patients with esophageal cancer.

Background: RNA-binding proteins (RBPs) play a crucial role in regulating RNA turnover and are associated with cancer development. However, little is known about the role of RBPs in esophageal cancer (ESCA). The present study focuses on the association between RBP gene expression and survival in ESCA, addressing the clinical relevance of an RBPs-based prediction model for prognosis. Methods: RNA-sequencing data and clinical information of patients with ESCA were obtained from The Cancer Genome Atlas (TCGA) database. We identified differentially expressed genes in ESCA and intersected them with RBP-encoding genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed with the identified differentially expressed RBPs. Then, a protein-protein interaction (PPI) network was constructed through the STRING database to determine the hub RBPs. Univariate Cox regression analysis and multivariate Cox regression analysis were applied to construct a novel prognostic model based on RBPs. Based on the R package "Caret", we divided patients into the training set and validation set. The efficacy of the prognostic model was evaluated by the area under the receiver operating characteristic (ROC) curve. A nomogram was developed for the prediction of patient survival outcomes. Results: A total of 158 ESCA patients from the TCGA database were included in our analysis. We screened out five prognostic RBPs (CLK1, CIRBP, MRPL13, TNRC6A, and TYW3) through univariate and multivariate Cox regression analysis. CLK1, CIRBP, TNRC6A and TYW3 were downregulated in tumor samples, while MRPL13 was upregulated. A prognostic model constructed with these five RBPs in the training data set accurately stratified ESCA patients into high- and low-risk groups. When the same prognostic model was applied to the test data set and entire cohort, the 5-RBP signature remained an independent prognostic factor in multivariate analysis. The areas under the time-dependent ROC curve of the prognostic model for predicting one-year survival in the training data set, test data set, and entire cohort were 0.789, 0.753, and 0.764, respectively, confirming that this model is a good prognostic model. The nomogram based on the five RBPs and clinical variables could improve individualized outcome predictions and highlight the importance of RBPs in the outcomes of patients with ESCA. Conclusions: Our study provides a potential prognostic model for predicting the prognosis of ESCA patients. The prognostic nomogram could improve individualized outcome predictions for patients with ESCA, therefore providing novel insights into future diagnosis and treatment.

Maternal dominance contributes to subgenome differentiation in allopolyploid fishes.

Teleost fishes, which are the largest and most diverse group of living vertebrates, have a rich history of ancient and recent polyploidy. Previous studies of allotetraploid common carp and goldfish (cyprinids) reported a dominant subgenome, which is more expressed and exhibits biased gene retention. However, the underlying mechanisms contributing to observed 'subgenome dominance' remains poorly understood. Here we report high-quality genomes of twenty-one cyprinids to investigate the origin and subsequent subgenome evolution patterns following three independent allopolyploidy events. We identify the closest extant relatives of the diploid progenitor species, investigate genetic and epigenetic differences among subgenomes, and conclude that observed subgenome dominance patterns are likely due to a combination of maternal dominance and transposable element densities in each polyploid. These findings provide an important foundation to understanding subgenome dominance patterns observed in teleost fishes, and ultimately the role of polyploidy in contributing to evolutionary innovations.

Efficient and Highly Continuous Chromosome-Level Genome Assembly of the First Chameleon Genome.

Most amniote genomes are diploid and moderate in size (∼1-6 Gbp) and contain a large proportion of repetitive sequences. The development of next-generation sequencing technology, especially the emergence of high-fidelity (HiFi) long-read data, has made it feasible to resolve high-quality genome assembly for nonmodel species efficiently. However, reference genomes for squamate reptiles have lagged behind other amniote lineages. Here, we de novo assembled the first genome from the Chameleonidae family, the panther chameleon (Furcifer pardalis). We obtained telomere-to-telomere contigs using only HiFi data, reaching a contig N50 of 158.72 Mbp. The final chromosome-level assembly is 1.61 Gbp in size, and 100% of primary contigs were placed to pseudochromosomes using Hi-C interaction data. We also found that sequencing depth > 30 folds can ensure both the integrity and accuracy of the genome, whereas insufficient depth led to false increase in genome size and proportion of duplicated genes. We provide a high-quality reference genome valuable for evolutionary and ecological studies in chameleons as well as provide comparative genomic resources for squamate reptiles.

Dual-wavelength passively Q-switched Ho:GdVO4 self-Raman laser operating at 2473†nm and 2520†nm.

A dual-wavelength passively Q-switched Ho:GdVO4 self-Raman laser in the 2.5 µm wave band was demonstrated with Cr:ZnS as a saturable absorber. Synchronized dual-wavelength pulsed laser outputs at 2473 nm and 2520 nm were acquired, corresponding to Raman frequency shifts of 808 cm-1 and 883 cm-1, respectively. The maximum total average output power of 114.9 mW was obtained at an incident pump power of 12.8 W with a pulse repetition rate of 3.57 kHz and a pulse width of 16.36 ns. The maximum total single pulse energy was 32.18 µJ, corresponding to a total peak power of 1.97 kW. The power ratios of the two Raman lasers can be controlled by varying the incident pump power. To the best of our knowledge, this is the first time a dual-wavelength passively Q-switched self-Raman laser in the 2.5 µm wave band has been reported.

Study on Mechanical Properties and Micro Characterization of Fibre Reinforced Ecological Cementitious Coal Gangue Materials.

Eco-gelled coal gangue materials (EGCGMs) are usually produced using coal gangue, slag, and fly ash in a highly alkaline environment. Herein, to improve the mechanical properties of such materials, polypropylene fibers were uniformly mixed with them. An unconfined compressive strength test and a three-point bending test of the fiber-reinforced EGCGMs under different conditions were conducted. Based on the performance degradation control technology of the fiber structure, the interface mechanism of the composite materials was analyzed from the micro level using scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and X-ray diffraction (XRD). In the mechanical test, the 28 d UCS and flexural properties of the fiber-reinforced EGCGMs were analyzed using the Box-Behnken design response surface design method and orthogonal design method, respectively. The order of significance was as follows: sodium hydroxide, fiber length, and fiber content. Within the scope of the experimental study, when the NaOH content is 3, the fiber content is 5 ‱, and the fiber length is 9 mm, the mechanical properties are the best. Based on the microscopic equipment, it was discovered that the amorphous ecological glue condensation product formed by the reaction of slag and fly ash in the alkaline environment was filled between the coal gangue particles and the fibers, and several polymerization products accumulated to form a honeycomb network topology. The distribution of fibers in the EGCGM matrix could be primarily divided into single embedded and network occurrences. The fiber inhibits the crack initiation and development of the matrix through the crack resistance effect, and improves the brittleness characteristics through the bridging effect during the failure process, which promotes the ductility of the ecological cementitious coal gangue matrix.The results presented herein can provide a theoretical basis for improving the mechanical properties of alkali-activated geopolymers.

Exploring the Role of Land Transfer and Social Capital in Improving Agricultural Income under the Background of Rural Revitalization.

Under the background of rural revitalization in China, with the process of urbanization and the implementation of China's land system reform, rural workers gradually gain multiple income streams. However, increasing agricultural income remains the final guarantee for professional farmers to shake off poverty, and land is still their last security. We applied the OLS model and mediation model to a dataset of 3789 households in 25 provinces obtained from China Family Panel Studies (CFPS) to investigate the influence of farmland transfer and social capital on farmers' agricultural incomes. The results show that farmland "transfer in" and social capital significantly help to increase agricultural income directly, and farmland "transfer in" behavior plays a vital mediating role, influencing the positive effect of social capital on agricultural income. The study examined the logical social capital-agricultural land transfer-agricultural income correlation in the progression of rural society, from "hollow" to "reflux", under the continuous expansion of rural revitalization strategies, which is of great practical significance for re-recognizing the positive role of rural social capital and agricultural land transfer in improving the income of professional farmers and realizing the overall goal of rural revitalization. The results also provide a theoretical basis for guiding and leveraging the effective use of social capital to promote agricultural land transfer.

Short-Term Results on Leaflet Mobility in Patients Undergoing Rheumatic Mitral Valve Repair With an Efficient 4-Step Commissuroplasty Technique.

BACKGROUND: Mitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to examine the efficacy of the 4-step commisuroplasty "SCORe" procedure by assessing changes in the mobility of mitral valve leaflets and its clinical effects. METHODS: From September 1, 2018, to January 13, 2019, patients with MS who underwent mitral valve repair with the SCORe procedure in the study center were analyzed in this prospective study. Mitral valve structure was assessed by transthoracic echocardiography pre- and postoperatively as well as during follow-up. RESULTS: In total, 60 consecutive patients were examined. In 56 patients (93.3%), mitral valve orifice area (MVOA) was less than 1.5 cm2, and mean (SD) MVOA for the whole cohort was 1.20 (0.34) cm2. The mobility of the anterior leaflet was improved (P < .001) during the cardiac cycle postsurgery, but that of the posterior leaflet was not (P = .591). The mean (SD) coaptation length was increased significantly from 6.69 (1.32) mm to 7.92 (1.24) mm (P < .001) postoperatively. Mean (SD) MVOAs increased to 2.24 (0.38) cm2 postoperatively (P < .001). During the 1-year follow-up, there were no deaths or reoperations. Follow-up echocardiography revealed minor or mild regurgitation in 98.3% of patients. CONCLUSION: These findings demonstrated that the SCORe procedure can effectively improve the mobility of mitral leaflets and enlarge the valve orifice area in patients with rheumatic MS in China, with minimal complications and promising results.

The prognostic value of an immune-related gene signature and infiltrating tumor immune cells based on bioinformatics analysis in primary esophageal cancer.

Background: Immunotherapy is a promising novel treatment for esophageal cancer (ESCA). However, previous studies provide limited direct information about the prognostic significance of immune-related genes (IRGs) in primary ESCA development. This study explored the prognostic value of IRGs and infiltrating tumor immune cells in primary ESCA. Methods: The ribonucleic acid (RNA)-sequencing data and clinical information of primary ESCA were downloaded from The Cancer Genome Atlas (TCGA) database. Which included the clinical factors and prognosis outcomes of the ESCA patients. The IRGs were downloaded from the ImmPORT database. Results: We established the robust IRG prognostic signature of 4 IRGs (i.e., heat shock protein family A member 6, Oncostatin M, androgen receptor, and nuclear receptor subfamily 2 group F member 2) in primary ESCA, and divided the ESCA patients into high- and low-risk groups based on overall survival (OS). The Kaplan-Meier curves showed the high predictive ability of the prognostic signature in the training, testing, and full data sets (P=2.407e-03, P=1.044e-02, and P=2.535e-04, respectively). Multivariate Cox regression analyses were performed with age, grade, tumor stage, tumor type and the risk score as covariables. The risk score supports the use of a prognostic signature as an independent prognostic factor [training data set: hazard ratio (HR) =1.185, 95% confidence interval (95% CI): 1.013-1.388, P=0.034; testing data set: HR =2.056, 95% CI: 1.015-4.166, P=0.045; full data set: HR =1.197, 95% CI: 1.059-1.354, P=0.004]. The area under the curve (AUC) of the receiver operating characteristic curve validated the high predictive accuracy of the IRG signature in the training, testing, and full data set (AUCs =0.808, 0.657, and 0.751, respectively). The infiltration level of the activated mast cells was significantly higher in the high-risk group than the low-risk group; thus, infiltrating mast cells are associated with worse OS in ESCA patients. Conclusions: Our IRG prognostic signature provides a new direction to predict the survival of primary ESCA patients and has the potential ability to establish, promote, and improve personalized treatment procedures based on each patient's risk.

Interface Mechanism and Splitting Characteristics of Fiber-Reinforced Cement-Solidified Aeolian Sand.

Experimental studies on reinforcing aeolian sand with cement and fiber are lacking, and the interface mechanism and splitting characteristics thus remain unclear. Herein, the interface mechanism and splitting characteristics of fiber-reinforced, cement-solidified, aeolian sand were experimentally assessed to investigate whether glass fiber exhibits better properties as a reinforcing agent than traditional fiber-free cement-solidified aeolian sand, and whether aeolian sand is applicable as a base material in geotechnical engineering. The splitting experiments involved the use of fiber-reinforced, cement-solidified aeolian sand samples that were differentiated based on the mixing schemes used to formulate them. Based on the strengthening control technology effects on the structural performance of the fiber-reinforced, cement aeolian, sand-mixed matrix material, the internal physical and chemical mechanisms of structural performance evolution were revealed and analyzed using scanning electron microscopy images. The experimental results show that the splitting strength of the sample reaches its maximum value at a combination of 6 mm glass fiber, 3‱ fiber, and 10% cement contents. In fiber-reinforced cement-solidified aeolian sand, cement hydrate forms more needle-shaped crystal products. The crystals adhere to the fiber surfaces that interweave with each other to form a porous and dense network. Although this improves the bonding force between the fiber and aeolian sand particles, the fibers are prone to fracture and slippage during the splitting process. The three-dimensional network structure formed by overlapping fibers is critical for the improvement of the splitting strength. The study's findings will serve as benchmarks to achieve additional improvements in glass fiber-reinforced cement-solidified aeolian sand.

Lentinan Combined with (125)I Brachytherapy for Recurrent Ovarian Cancer.

OBJECTIVE: To investigate the clinical value of lentinan combined with (125)I brachytherapy in the treatment of recurrent ovarian cancer. METHODS: A total of 160 patients with recurrent ovarian cancer admitted at Jiaozhou Central Hospital from June 2009 to October 2015 were enrolled in this study and randomly divided into observation group (80 cases) and control group (80 cases). The control group received chemotherapy. Observation group (80 cases) was treated with lentinan combined with (125)I brachytherapy on the basis of control group, and the efficacy, adverse reactions, and Karnofsky Performance Scale (KPS) and quality of life scale (QOL) scores of the two groups were analyzed and compared. RESULTS: After treatment, the levels of CA125, CA199, and CA724 in the 2 groups were markedly lower than those before treatment, and the observation group was lower than the control group (P < 0.05). After treatment, the proportion of CD4+/CD8+ cells and helper T cells and NK cells in the control group remarkably depleted, while the proportion of CD4+/CD8+ cells, NK cells, and B cells in the observation group increased significantly compared to that before treatment, and the level of IgA, IgG, and IgM in the control group decreased, while that in the observation group showed no conspicuous difference compared with that before chemotherapy (P > 0.05). The effective rate of observation group (85%) was higher than that of control group (75%) (P < 0.05). The overall survival of patients in the control group was (16.2 ± 2.04) months and that of the observation group was (24.8 ± 1.8) months. KPS and QOL scores in both groups were enormously higher than those before treatment, and the observation group was higher than the control group (P < 0.05). The incidence of hemoglobin reduction, leukopenia, aglobulia, granulocytopenia, nausea and vomiting, hepatorenal toxicity, and neurovirulence in the observation group was significantly lower than that in the control group. CONCLUSION: Lentinan combined with (125)I brachytherapy is effective in treating recurrent ovarian cancer, with mild adverse reactions and good tolerance.

Pan-genome of Raphanus highlights genetic variation and introgression among domesticated, wild, and weedy radishes.

Post-polyploid diploidization associated with descending dysploidy and interspecific introgression drives plant genome evolution by unclear mechanisms. Raphanus is an economically and ecologically important Brassiceae genus and model system for studying post-polyploidization genome evolution and introgression. Here, we report the de novo sequence assemblies for 11 genomes covering most of the typical sub-species and varieties of domesticated, wild and weedy radishes from East Asia, South Asia, Europe, and America. Divergence among the species, sub-species, and South/East Asian types coincided with Quaternary glaciations. A genus-level pan-genome was constructed with family-based, locus-based, and graph-based methods, and whole-genome comparisons revealed genetic variations ranging from single-nucleotide polymorphisms (SNPs) to inversions and translocations of whole ancestral karyotype (AK) blocks. Extensive gene flow occurred between wild, weedy, and domesticated radishes. High frequencies of genome reshuffling, biased retention, and large-fragment translocation have shaped the genomic diversity. Most variety-specific gene-rich blocks showed large structural variations. Extensive translocation and tandem duplication of dispensable genes were revealed in two large rearrangement-rich islands. Disease resistance genes mostly resided on specific and dispensable loci. Variations causing the loss of function of enzymes modulating gibberellin deactivation were identified and could play an important role in phenotype divergence and adaptive evolution. This study provides new insights into the genomic evolution underlying post-polyploid diploidization and lays the foundation for genetic improvement of radish crops, biological control of weeds, and protection of wild species' germplasms.

De Novo Sequencing and High-Contiguity Genome Assembly of Moniezia expansa Reveals Its Specific Fatty Acid Metabolism and Reproductive Stem Cell Regulatory Network.

Moniezia expansa (M. expansa) parasitizes the small intestine of sheep and causes inhibited growth and development or even death. Being globally distributed, it causes considerable economic losses to the animal husbandry industry. Here, using Illumina, PacBio and BioNano techniques, we obtain a high-quality genome assembly of M. expansa, which has a total length of 142 Mb, a scaffold N50 length of 7.27 Mb and 8,104 coding genes. M. expansa has a very high body fat content and a specific type of fatty acid metabolism. It cannot synthesize any lipids due to the loss of some key genes involved in fatty acid synthesis, and it may can metabolize most lipids via the relatively complete fatty acid ß-oxidation pathway. The M. expansa genome encodes multiple lipid transporters and lipid binding proteins that enable the utilization of lipids in the host intestinal fluid. Although many of its systems are degraded (with the loss of homeobox genes), its reproductive system is well developed. PL10, AGO, Nanos and Pumilio compose a reproductive stem cell regulatory network. The results suggest that the high body lipid content of M. expansa provides an energy source supporting the high fecundity of this parasite. Our study provides insight into host interaction, adaptation, nutrient acquisition, strobilization, and reproduction in this parasite and this is also the first genome published in Anoplocephalidae.

Biomimetic Amino Acid Functionalized Phenazine Flow Batteries with Long Lifetime at Near-Neutral pH.

Aqueous organic redox flow batteries (AORFBs) are a promising electrochemical technology for large-scale energy storage. We report a biomimetic, ultra-stable AORFB utilizing an amino acid functionalized phenazine (AFP). A series of AFPs with various commercial amino acids at different substituted positions were synthesized and studied. 1,6-AFPs display much higher stability during cycling when compared to 2,7- and 1,8-AFPs. Mechanism investigations reveal that the reduced 2,7- and 1,8-AFPs tend to tautomerize and lose their reversible redox activities, while 1,6-AFPs possess ultra-high stability both in their oxidized and reduced states. By pairing 3,3'-(phenazine-1,6-diylbis(azanediyl))dipropionic acid (1,6-DPAP) with ferrocyanide at pH 8 with 1.0 M electron concentration, this flow battery exhibits an OCV of 1.15 V and an extremely low capacity fade rate of 0.5 % per year. These results show the importance of molecular engineering of redox-active organics for robust redox-flow batteries.

Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study.

BACKGROUND: Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS. METHODS: Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences. RESULTS: A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP. Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm2, P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively. Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent re-intervention in rMVP, but one patient died of pneumonia. CONCLUSIONS: For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

Medication adherence among patients with chronic obstructive pulmonary disease treated in a primary general hospital during the COVID-19 pandemic.

BACKGROUND: The objective of this study was to investigate medication adherence and the associated influencing factors in patients with chronic obstructive pulmonary disease (COPD) who were treated in a primary general hospital in Shanghai China during the 2019 novel coronavirus (COVID-19) pandemic. METHODS: From March to April 2020, all of the COPD patients treated in our department in the last 7 years were interviewed by telephone. The basic patient data and each questionnaire item were collected, and influencing factors were analyzed by the Chi-square test, U test, and univariate and multivariate logistic regression analyses. RESULTS: A total of 191 patients with COPD were queried, and 84 (44.0%) valid questionnaires were obtained. Among them, individuals with group B symptoms were most represented (45.2%); 53.6% had Medical Research Council (MRC) dyspnea levels of 2 or above. Chronic obstructive pulmonary disease assessment test (CAT) had an average of 9 [3, 13], and 52.4% of patients used two-drug combination therapy. Medication adherence was both good in ordinary times and over the past 2 months of the pandemic, and 88.8% of patients had no acute exacerbation during the pandemic. The CAT scores of male patients <70 years old, and patients with general outpatient follow-up and regular gargling were reduced (P<0.05). Drug combination and doctor's supervision were favorable factors affecting medication adherence during the 2 months of the pandemic, while possible depression was an unfavorable factor (P<0.05). CONCLUSIONS: During the pandemic, medication adherence in patients with COPD was similar to that in regular times, and was significantly related to drug combination, doctor's supervision, and accompanying mood disorders. An effective way to improve patient adherence and disease control could be strengthening follow-up education and diagnosing and treating depression and other complications.

Quantum-confined superfluid reactions.

A helium atom superfluid was originally discovered by Kapitsa and Allen. Biological channels in such a fluid allow ultrafast molecule and ion transport, defined as a quantum-confined superfluid (QSF). In the process of enzymatic biosynthesis, unique performances can be achieved with high flux, 100% selectivity and low reaction activation energy at room temperature, under atmospheric pressure in an aqueous environment. Such reactions are considered as QSF reactions. In this perspective, we introduce the concept of QSF reactions in artificial systems. Through designing the channel size at the van der Waals equilibrium distance (r 0) for molecules or the Debye length (λ D) for ions, and arranging the reactants orderly in the channel to satisfy symmetry-matching principles, QSF reactions in artificial systems can be realized with high flux, 100% selectivity and low reaction activation energy. Several types of QSF-like molecular reactions are summarized, including quantum-confined polymerizations, quasi-superfluid-based reactions and superfluid-based molecular reactions, followed by the discussion of QSF ion redox reactions. We envision in the future that chemical engineering, based on multi-step QSF reactions, and a tubular reactor with continuous nanochannel membranes taking advantage of high flux, high selectivity and low energy consumption, will replace the traditional tower reactor, and bring revolutionary technology to both chemistry and chemical engineering.