Effectiveness of Low-frequency Pulse Electrical Stimulation Combined with Dexamethasone in Treating Facial Nerve Paralysis and Its Impact on Facial Nerve Function and Electromyography.

Objective: This study aimed to evaluate the efficacy of adjunct low-frequency pulse electrical stimulation alongside dexamethasone in the treatment of facial nerve paralysis and its subsequent effects on facial nerve function and electromyographic parameters. With the aim of addressing a knowledge gap in the field, this research provides valuable insights into the potential benefits of combining these treatments and their impact on clinical outcomes, facial nerve functionality, and electromyographic dynamics. Methods: A cohort of 66 patients with facial nerve paralysis treated at our institution between April 2018 and November 2021 were randomly assigned to either an observation (n=33) or an experimental group (n=33). The observation group received standard pharmacotherapy, including Western medications and Daqinjiao decoction, along with dexamethasone. The experimental group was administered low-frequency pulse electrical stimulation in addition to the observation group's regimen. Outcomes assessed were clinical efficacy, facial nerve paralysis scoring, facial nerve functional scoring and indices, electromyographic latency, amplitude ratios between affected and unaffected sides, as well as any adverse events. Results: The experimental group demonstrated a significant improvement over the observation group in clinical treatment outcomes, facial nerve paralysis scores, and facial nerve function scores (P < .05 for all). Furthermore, electromyographic analysis revealed shorter latency periods and greater amplitude ratios in the experimental group's facial muscles post-treatment (P < .05). No significant difference was observed in the incidence of adverse reactions between the two groups (P > .05). Conclusion: The integration of low-frequency pulse electrical stimulation with dexamethasone therapy significantly ameliorates the severity of facial nerve paralysis, enhances facial nerve function, and improves electromyographic signals in facial muscles without increasing adverse effects. These findings support the clinical value and safety of this combined treatment approach for facial nerve paralysis, suggesting its suitability for broader clinical application. These results suggest that this combined treatment approach holds promise for broader clinical application, potentially providing a more effective and safer therapeutic option for patients with facial nerve paralysis. Implementing this approach in clinical practice may lead to improved treatment outcomes, better functional recovery, and enhanced quality of life for affected individuals.

Effect of statins combined with PCSK9 inhibitors on the prognosis of patients with acute coronary syndromes after interventional therapy.

Acute coronary syndromes (ACS) are a leading cause of morbidity and mortality worldwide. It has been clinically confirmed percutaneous coronary intervention (PCI) can alleviate the symptoms of ACS, but there are still some patients with slow blood flow or no-reflow after surgery, which has adverse effects on the prognosis of patients. This study aimed to investigate the effect of statins combined with PCSK9 inhibitors on the prognosis of patients with ACS after interventional therapy. A total of 208 ACS patients treated in our hospital from January 2021 to December 2022 were separated into observation and control groups. Patients in the control group received oral rosuvastatin 20 mg/ day. Patients in the observation group received PCSK9 inhibitor elozumab (Repatha) 140 mg, subcutaneously injected twice a week. The levels of inflammatory factors, cardiac function indexes, clinical effectiveness rate, adverse events, and complications were compared before and after treatment. After 1 week of treatment and 4 weeks of follow-up, the levels of inflammatory indicators in the observation group declined relative to the control group (P < 0.05 and P < 0.01). After 4 weeks, LVEF in the observation group was elevated in comparison to the control group, while LVEDD in the observation group declined compared to the control group (P < 0.05). The incidence of adverse events after treatment in the observation group declined relative to the control group (P < 0.05). The incidence of complications in the observation group declined in contrast to the control group (P < 0.05). Statins combined with PCSK9 inhibitors significantly reduce LDL-C levels in ACS patients undergoing PCI without increasing cardiovascular events or major adverse clinical effects.

Clinical effects of Special Pressure Ulcer Intervention Combined with Gel Positioning Pad Intervention on Preventing Acute Stress Injury in Patients Undergoing Long-Term Lateral Position Spinal Surgery.

Objective: Prevention of acute pressure injuries (PS) is critical in patients undergoing certain surgeries. This type of pressure injury can develop during and after surgery, causing unnecessary pain and complications for the patient. However, preventing PS in these high-risk patients may present some challenges and require specific nursing measures. To explore the clinical effects of special pressure ulcer intervention combined with gel positioning pad intervention on the prevention of acute stress injury in patients undergoing long-term lateral position spinal surgery. Methods: The simple randomization method was used in this study; 100 patients with lateral position spinal surgery from March 2022 to March 2023 were selected as research subjects and were divided into an observation group and control group with 50 cases in each group by the random number table method. The control group was given routine intervention, and the observation group carried out special pressure ulcer intervention and gel positioning pad intervention. Special pressure ulcer intervention was performed, using appropriate surface support to relieve pressure, keeping the patient's skin clean and dry, and turning regularly to relieve pressure. In addition, we use a gel positioning pad intervention to disperse pressure, improve local blood circulation, and reduce the risk of pressure injuries. The occurrence of acute stress injury, VAS scores at different time points after surgery, local skin infrared thermography analysis results at 72 hours after surgery, incidence rates of complications and nursing satisfaction were compared between the two groups of patients. Results: The incidence rates of acute stress injury during surgery, within 2 hours after surgery and within 72 hours after surgery in the observation group were lower than those in the control group (P < .0046). The number and area of injury in the observation group were smaller than those in the control group (P < .0037). The National Pressure Ulcer Advisory Panel (NPUAP) grading of acute stress injury in the observation group was lower compared with that in the control group (P < .0021). The pain VAS scores in the observation group at 2 hours, 24 hours and 72 hours after surgery were lower than those in the control group (P < .001). The local skin infrared thermography analysis temperature values of the neck, shoulder, hip, knee and ankle were lower in the observation group than those in the control group at 72 hours after surgery (P < .001). The incidence rates of postoperative lumbago and shoulder-neck pain in the observation group were lower than those in the control group (P < .001). The scores of three aspects of nursing technology and nursing operation satisfaction, service attitude and humanistic care satisfaction, and nursing environment satisfaction were higher in the observation group than compared to the control group (P < .001). The findings of this study highlight the importance of specific pressure ulcer interventions that can be widely used in clinical practice and have the potential to reduce the incidence of pressure injuries and improve patient satisfaction with care. Conclusion: Special pressure ulcer intervention combined with gel positioning pad intervention has a good preventive effect on acute stress injury in patients undergoing long-term lateral position spinal surgery. Limitations of this study include the small sample size and single study institution, which may affect the external validity of the study. In addition, data collection in this study was limited to a specific time period and does not reflect long-term outcomes. Future studies could consider multi-center, broader samples, and longer follow-up to confirm the benefits of these interventions and to investigate in depth the long-term rehabilitation and quality of life of patients.

Eukaryotic Extension Factor 2 Kinase may Affect the Occurrence and Development of Glioblastoma Through Immune Cell Infiltration.

Glioblastoma (GBM) is one of the most common malignancies among primary brain tumors in adults, featuring a poor prognosis and a high recurrence rate. Eukaryotic elongation factor 2 kinase (eEF2K) is a calcium/calmodulin-dependent protein kinase that is involved in promoting tumor cell proliferation, migration, invasion, and survival. However, its expression level in GBM, its prognostic impact and correlation with immune infiltration are not yet known. In this study, we used The Cancer Genome Atlas (TCGA) database to explore the potential molecular mechanisms of eEF2K in GBM development and clinical prognosis in terms of gene expression, survival status, immune infiltration, and associated cellular pathways. We found that eEF2K expression levels were elevated in GBM, but eEF2K was not associated with the prognosis of GBM patients; eEF2K expression in GBM was associated with multiple immune cell infiltrations. These results show a statistical correlation between eEF2K expression and the development of GBM and immune cell infiltration, which helps us to understand the roles of eEF2K in GBM from different perspectives.

High specific surface CeO2-NPs doped loose porous C3N4for enhanced photocatalytic oxidation ability.

Porous C3N4(PCN) is favored by researchers because it has more surface active sites, higher specific surface area and stronger light absorption ability than traditional g-C3N4. In this study, cerium dioxide nanoparticles (CeO2-NPs) with mixed valence state of Ce3+and Ce4+were doped into the PCN framework by a two-step method. The results indicate that CeO2-NPs are highly dispersed in the PCN framework, which leads to a narrower band gap, a wider range of the light response and an improved the separation efficiency of photogenerated charge in PCN. Moreover, the specific surface area (145.69 m2g-1) of CeO2-NPs doped PCN is a 25.5% enhancement than that of PCN (116.13 m2g-1). In the experiment of photocatalytic selective oxidation of benzyl alcohol, CeO2-NPs doped porous C3N4exhibits excellent photocatalytic activity, especially Ce-PCN-30. The conversion rate of benzyl alcohol reaches 74.9% using Ce-PCN-30 as photocatalyst by 8 h of illumination, which is 25.7% higher than that of pure porous C3N4. Additionally, CeO2-NPs doped porous C3N4also exhibits better photocatalytic efficiency for other aromatic alcohols.

Synthesis of coralloid carbon nitride polymers and photocatalytic selective oxidation of benzyl alcohol.

Polymeric carbon nitride (C3N4) is currently the most potential nonmetallic photocatalyst, but it suffers from low catalytic activity due to rapid electron-hole recombination behavior and low specific surface area. The morphology control of C3N4is one of the effective methods used to achieve higher photocatalytic performance. Here, bulk, lamellar and coralloid C3N4were synthesized using different chemical methods. The as-prepared coralloid C3N4has a higher specific surface area (123.7 m2 · g-1) than bulk (5.4 m2 · g-1) and lamellar C3N4(2.8 m2 · g-1), thus exhibiting a 3.15- and 2.59-fold higher photocatalytic efficiency for the selective oxidation of benzyl alcohol than bulk and lamellar C3N4, respectively. Optical characterizations of the photocatalysts suggest that coralloid C3N4can effectively capture electrons and accelerate carrier separation, which is caused by the presence of more nitrogen vacancies. Furthermore, it is demonstrated that superoxide radicals (·O2-) and holes (h+) play major roles in the photocatalytic selective oxidation of benzyl alcohol using C3N4as a photocatalyst.

An optimal window of platelet reactivity by LTA assay for patients undergoing percutaneous coronary intervention.

OBJECTIVE: This study was aimed to determine how platelet reactivity (PR) on dual antiplatelet therapy predicts ischemic and bleeding events in patients underwent percutaneous coronary intervention (PCI). DESIGN: A total of 2768 patients who had received coronary stent implantation and had taken aspirin 100 mg in combination with clopidogrel 75 mg daily for > 5 days were consecutively screened and 1885 were enrolled. The recruited patients were followed-up for 12 months. The primary end-point was the net adverse clinical events (NACE) of cardiovascular death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST) and any bleeding. RESULT: 1709 patients completed the clinical follow-up. By using the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were found to be 37.5 and 25.5% respectively in predicting ischemic and bleeding events. Patients were classified into 2 groups according to PR: inside the window group (IW) [adenosine diphosphate (ADP) induced platelet aggregation (PLADP) 25.5-37.4%)] and outside the window group (OW) (PLADP < 25.5% or ≥ 37.5%). The incidence of NACE was 16.8 and 23.1% respectively in the IW and OW group. The hazard ratio of NACE in IW group was significantly lower [0.69 (95% CI, 0.54-0.89, P = 0.004)] than that in the OW group during 12-month follow-up. CONCLUSION: An optimal therapeutic window of 25.5-37.4% for PLADP predicts the lowest risk of NACE, which could be referred for tailored antiplatelet treatment while using LTA assay. TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov NCT01968499 . Registered 18 October 2013 - Retrospectively registered.

Surface modification of polyamide reverse osmosis membranes with small-molecule zwitterions for enhanced fouling resistance: a molecular simulation study.

Surface modification with small-molecule zwitterions is experimentally proved to be an effective solution to improve the antifouling performance of polyamide membranes. However, there is no comprehensive understanding of their microscopic mechanism. In order to address this issue, in this work we constructed two atomistic models, PA (a pure polyamide membrane) and QDAP-PA (a polyamide membrane surface-modified with QDAP), where QDAP was a zwitterion that was prepared by 2,6-daaminopyridine quaternized with 3-bromopropionic acid experimentally. Density functional theory was adopted to elucidate the variations in the electrostatic potential before and after modification. Then, equilibrium molecular dynamics (EMD) simulations were conducted to investigate the structure and hydrophobic/hydrophilic nature of the membrane surface in the two models. Finally, we introduced two typical organic foulants, sodium dodecyl sulfonate (SDS) and dodecyl trimethyl ammonium chloride (DTAC), to evaluate the antifouling performance of the membranes with the umbrella sampling method. The analyses of the membrane structure and properties show that surface modification with small-molecule zwitterions can densify the membrane surface as well as enlarge the distribution of electrostatic potential on the membrane surface. Water molecules tend to have more interactions with the membrane and more hydrogen bonds near the membrane surface are observed in QDAP-PA. The antifouling test supports that QDAP-PA shows a better antifouling performance, as the surface-modified membrane exhibits a stronger resistance to SDS and DTAC. Even if the foulant is adsorbed to the membrane surface, the denser interface region can prevent a further pollution of the foulant. Also, the free energy needed during the process for QDAP-PA to desorb a foulant is relatively small, indicating that this kind of membrane is easy to clean. The current work might provide a comprehensive understanding of the enhanced fouling resistance of polyamide membranes after surface modification with small-molecule zwitterions.

Pharmacodynamic effects of indobufen compared with aspirin in patients with coronary atherosclerosis.

PURPOSE: This study aimed to investigate the pharmacodynamic effects of indobufen and low-dose aspirin in patients with coronary atherosclerosis. METHODS: In the first phase, 218 patients with coronary atherosclerosis were randomly assigned to receive aspirin 100 mg once daily (standard dose); 100 mg once every 2 days; 100 mg once every 3 days; 50 mg twice daily; 75 mg once daily; 50 mg once daily; or indobufen 100 mg twice daily for 1 month. In the second phase, 20 healthy subjects were treated with indobufen 100 mg twice daily for 1 week followed after a 2-week washout by aspirin 100 mg once daily for 1 week. The primary outcome was arachidonic acid-induced platelet aggregation (PLAA), and the secondary outcomes included plasma thromboxane B2 (TXB2) and urinary 11-dehydro-TXB2 (11-dh-TXB2) levels at the end of each treatment.  RESULTS: In the first phase, compared with aspirin 100 mg once daily: all aspirin groups had similar suppression of PLAA whereas indobufen group had significantly less suppressed PLAA. Aspirin given every second or third day, and indobufen produced less suppression of plasma TXB2. All treatment regimens produced similar inhibition of 11-dh-TXB2. In the second phase, compared with aspirin, indobufen produced less suppression of plasma TXB2 at 8 h and 12 h after the last dose. CONCLUSIONS: Aspirin 50 mg twice daily, 75 mg once daily, and aspirin 50 mg once daily produce antiplatelet effects that are similar to aspirin 100 mg once daily. Aspirin given less often than once daily and indobufen 100 mg twice daily do not suppress platelets as effectively as aspirin 100 mg once daily.

Identification of Gliotoxin isolated from marine fungus as a new pyruvate kinase M2 inhibitor.

Pyruvate kinase M2 (PKM2) functions as an important rate-limiting enzyme of aerobic glycolysis that is involved in tumor initiation and progression. However, there are few studies on effective PKM2 inhibitors. Gliotoxin is a marine-derived fungal secondary metabolite with multiple biological activities, including immunosuppression, cytotoxicity, and et al. In this study, we found that Gliotoxin directly bound to PKM2 and inhibited its glycolytic activity in a dose-dependent manner accompanied by the decreases in glucose consumption and lactate production in the human glioma cell line U87. Moreover, Gliotoxin suppressed tyrosine kinase activity of PKM2, leading to a dramatic reduction in Stat3 phosphorylation in U87 cells. Furthermore, Gliotoxin suppressed cell viability in U87 cells, and cytotoxicity of Gliotoxin on U87 cells was obviously augmented under hypoxia condition compared to normal condition. Finally, Gliotoxin was demonstrated to induce cell apoptosis of U87 cells and synergize with temozolomide. Our findings identify Gliotoxin as a new PKM2 inhibitor with anti-tumor activity, which lays the foundation for the development of Gliotoxin as a promising anti-tumor drug in the future.

In silico study of structure and water dynamics in CNT/polyamide nanocomposite reverse osmosis membranes.

CNT-based reverse osmosis membranes have long been regarded as one of the most promising candidates for water desalination. However, it is a pity that there is no complete understanding of the exact role of CNTs in those nanocomposite membranes. To address this issue, three atomistic models of PA (pure polyamide membrane), PA-CNT1 (polyamide nanocomposite membrane with an embedded carbon nanotube oriented vertical to the membrane surface) and PA-CNT2 (polyamide nanocomposite with an embedded carbon nanotube oriented parallel to the membrane surface) were constructed respectively in this work. Then, equilibrium molecular dynamics (EMD) and non-equilibrium molecular dynamics (NEMD) simulations were conducted to investigate the structure and water dynamics in these three models. The EMD simulations revealed a better stacking of the PA matrix due to the addition of the CNT and this impact was more significant in PA-CNT1 than in PA-CNT2. Meanwhile, PA matrix near the mouth of the CNT was found to behave as an obstruction that hindered the exchange of water molecules inside and outside the CNT. In NEMD simulations, we found that water molecules were guided away from the CNT because of the better stacked surrounding PA matrix. The partially covered CNT might not help to increase water flux in PA-CNT1 while guided water molecules and the smaller polymer region afftected by the CNT contributed to a relatively high flux in PA-CNT2. The current work might serve as a comprehensive understanding of the role of CNTs in the reverse osmosis process.

Serum uric acid level negatively correlated with the prevalence of clopidogrel low response in patients undergoing antiplatelet treatment with aspirin and clopidogrel.

BACKGROUND AND AIMS: It has been reported that elevated serum uric acid (SUA) is related to inflammation and potentially to platelet hyper-reactivity. However, the relationship between elevated SUA and residual platelet reactivity is uncertain in patients on dual antiplatelet treatment (DAPT) with aspirin and clopidogrel. METHODS AND RESULTS: A cross-sectional cohort study was conducted on 2569 patients undergoing DAPT with aspirin and clopidogrel. Patients' SUA levels, residual platelet aggregation, routine blood tests and clinical characteristics were recorded. The relationship between SUA level and residual platelet aggregation was assessed by correlation analysis, and the relationship between SUA level and the prevalence of clopidogrel low response (CLR) was assessed by multivariate logistic regression analysis. Adenosine diphosphate (ADP) induced platelet aggregation (PLADP) was higher in normal-SUA group than that in hyperuricemia group [30(21, 40) % vs. 27(19, 39) %, p = 0.032]. No significant difference was found for arachidonic acid (AA) induced platelet aggregation (PLAA) between the two groups [4(2, 5) % vs. 3(2, 5) %, p = 0.557]. The correlation between SUA and PLADP was statistically significant(r = -0.115, p < 0.001), while that between SUA and PLAA was non-significant (r = -0.012, p = 0.643). Using the multivariate logistic regression analysis, higher SUA concentration was associated with a decreased risk of clopidogrel low response (CLR) (OR [95%CI] = 0.997 [0.995-0.999], p = 0.001). CONCLUSION: This is the largest study to date showing that in patients receiving DAPT with aspirin and clopidogrel, SUA is independently and negatively associated with the prevalence of clopidogrel low response. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov Unique Identifier: NCT01955200.

New metabolites from a Mariana Trench-derived actinomycete Nocardiopsis sp. HDN 17-237.

One new ß,γ-butenoate derivative phenylbutenote (1), and one new α-pyrone nocapyrone T (2) were isolated from the deep-sea derived actinomycete Nocardiopsis sp. HDN 17-237. Their structures were elucidated by extensive HRMS, IR and NMR analyses. Among them, compound 1 is the first microbial natural products bearing a rare ß,γ-butenoate moiety, and compound 2 is the first α-pyrone isolated from strain of Mariana Trench. Compounds 1 and 2 were tested for antioxidant and antibacterial activities, while none of them showed significant activity.

Trichothecin Inhibits Cancer-Related Features in Colorectal Cancer Development by Targeting STAT3.

Signal transducer and activator of transcription 3 (STAT3) is a transcription factor that contributes to cancer progression through multiple processes of cancer development, which makes it an attractive target for cancer therapy. The IL-6/STAT3 pathway is associated with an advanced stage in colorectal cancer patients. In this study, we identified trichothecin (TCN) as a novel STAT3 inhibitor. TCN was found to bind to the SH2 domain of STAT3 and inhibit STAT3 activation and dimerization, thereby blocking STAT3 nuclear translocation and transcriptional activity. TCN did not affect phosphorylation levels of STAT1. TCN significantly inhibited cell growth, arrested cell cycle at the G0/G1 phase, and induced apoptosis in HCT 116 cells. In addition, the capacities of colony formation, migration, and invasion of HCT 116 cells were impaired upon exposure to TCN with or without IL-6 stimulation. In addition, TCN treatment abolished the tube formation of HUVEC cells in vitro. Taken together, these results highlight that TCN inhibits various cancer-related features in colorectal cancer development in vitro by targeting STAT3, indicating that TCN is a promising STAT3 inhibitor that deserves further exploration in the future.

Phylogeography of Bellamya (Mollusca: Gastropoda: Viviparidae) snails on different continents: contrasting patterns of diversification in China and East Africa.

BACKGROUND: Species diversity is determined by both local environmental conditions that control differentiation and extinction and the outcome of large-scale processes that affect migration. The latter primarily comprises climatic change and dynamic landscape alteration. In the past few million years, both Southeast Asia and Eastern Africa experienced drastic climatic and geological oscillations: in Southeast Asia, especially in China, the Tibetan Plateau significantly rose up, and the flow of the Yangtze River was reversed. In East Africa, lakes and rivers experienced frequent range expansions and regressions due to the African mega-droughts. To test how such climatic and geological histories of both regions relate to their respective regional species and genetic diversity, a large scale comparative phylogeographic study is essential. Bellamya, a species rich freshwater snail genus that is widely distributed across China and East Africa, represents a suitable model system to address this question. We sequenced mitochondrial and nuclear DNA for members of the genus from China and used published sequences from Africa and some other locations in Asia to investigate their phylogeny and distribution of genetic diversity. RESULTS: Our phylogenetic analysis revealed two monophyletic groups, one in China and one in East Africa. Within the Chinese group, Bellamya species show little genetic differentiation. In contrast, we observe fairly deep divergence among the East African lakes with almost every lake possessing its unique clade. Our results show that strong divergence does not necessarily depend on intrinsic characteristics of a species, but rather is related to the landscape dynamics of a region. CONCLUSION: Our phylogenetic results suggest that the Bellamya in China and East Africa are independent phylogenetic clades with different evolutionary trajectories. The different climate and geological histories likely contributed to the diverging evolutionary patterns. Repeated range expansions and regressions of lakes likely contributed to the great divergence of Bellamya in East Africa, while reversal of the river courses and intermingling of different lineages had an opposite effect on Bellamya diversification in China.

Methane emissions from the trunks of living trees on upland soils.

Upland forests are traditionally thought to be net sinks for atmospheric methane (CH4 ). In such forests, in situ CH4 fluxes on tree trunks have been neglected relative to soil and canopy fluxes. We measured in situ CH4 fluxes from the trunks of living trees and other surfaces, such as twigs and soils, using a static closed-chamber method, and estimated the CH4 budget in a temperate upland forest in Beijing. We found that the trunks of Populus davidiana emitted large quantities of CH4 during July 2014-July 2015, amounting to mean annual emissions of 85.3 and 103.1 µg m(-2)  h(-1) on a trunk surface area basis on two replicate plots. The emission rates were similar in magnitude to those from tree trunks in wetland forests. The emitted CH4 was derived from the heartwood of trunks. On a plot or ecosystem scale, trunk CH4 emissions were equivalent to c. 30-90% of the amount of CH4 consumed by soils throughout the year, with an annual average of 63%. Our findings suggest that wet heartwoods, regardless of rot or not, occur widely in living trees on various habitats, where CH4 can be produced.

Exopisiod B and farylhydrazone C, two new alkaloids from the Antarctic-derived fungus Penicillium sp. HDN14-431.

Two new compounds, exopisiod B (1) and farylhydrazone C (2), together with two known compounds (3-4), were isolated from the Antarctic-derived fungus Penicillium sp. HDN14-431. Their structures including absolute configurations were elucidated by spectroscopic methods and TDDFT ECD calculations. The cytotoxicity and antimicrobial activities of all compounds were tested.

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes.

IMPORTANCE: Bundled Payments for Care Improvement (BPCI) is a voluntary initiative of the Centers for Medicare & Medicaid Services to test the effect of holding an entity accountable for all services provided during an episode of care on episode payments and quality of care. OBJECTIVE: To evaluate whether BPCI was associated with a greater reduction in Medicare payments without loss of quality of care for lower extremity joint (primarily hip and knee) replacement episodes initiated in BPCI-participating hospitals that are accountable for total episode payments (for the hospitalization and Medicare-covered services during the 90 days after discharge). DESIGN, SETTING, AND PARTICIPANTS: A difference-in-differences approach estimated the differential change in outcomes for Medicare fee-for-service beneficiaries who had a lower extremity joint replacement at a BPCI-participating hospital between the baseline (October 2011 through September 2012) and intervention (October 2013 through June 2015) periods and beneficiaries with the same surgical procedure at matched comparison hospitals. EXPOSURE: Lower extremity joint replacement at a BPCI-participating hospital. MAIN OUTCOMES AND MEASURES: Standardized Medicare-allowed payments (Medicare payments), utilization, and quality (unplanned readmissions, emergency department visits, and mortality) during hospitalization and the 90-day postdischarge period. RESULTS: There were 29 441 lower extremity joint replacement episodes in the baseline period and 31 700 in the intervention period (mean [SD] age, 74.1 [8.89] years; 65.2% women) at 176 BPCI-participating hospitals, compared with 29 440 episodes in the baseline period (768 hospitals) and 31 696 episodes in the intervention period (841 hospitals) (mean [SD] age, 74.1 [8.92] years; 64.9% women) at matched comparison hospitals. The BPCI mean Medicare episode payments were $30 551 (95% CI, $30 201 to $30 901) in the baseline period and declined by $3286 to $27 265 (95% CI, $26 838 to $27 692) in the intervention period. The comparison mean Medicare episode payments were $30 057 (95% CI, $29 765 to $30 350) in the baseline period and declined by $2119 to $27 938 (95% CI, $27 639 to $28 237). The mean Medicare episode payments declined by an estimated $1166 more (95% CI, -$1634 to -$699; P < .001) for BPCI episodes than for comparison episodes, primarily due to reduced use of institutional postacute care. There were no statistical differences in the claims-based quality measures, which included 30-day unplanned readmissions (-0.1%; 95% CI, -0.6% to 0.4%), 90-day unplanned readmissions (-0.4%; 95% CI, -1.1% to 0.3%), 30-day emergency department visits (-0.1%; 95% CI, -0.7% to 0.5%), 90-day emergency department visits (0.2%; 95% CI, -0.6% to 1.0%), 30-day postdischarge mortality (-0.1%; 95% CI, -0.3% to 0.2%), and 90-day postdischarge mortality (-0.0%; 95% CI, -0.3% to 0.3%). CONCLUSIONS AND RELEVANCE: In the first 21 months of the BPCI initiative, Medicare payments declined more for lower extremity joint replacement episodes provided in BPCI-participating hospitals than for those provided in comparison hospitals, without a significant change in quality outcomes. Further studies are needed to assess longer-term follow-up as well as patterns for other types of clinical care.

Preparation of Fe-doped colloidal SiO(2) abrasives and their chemical mechanical polishing behavior on sapphire substrates.

Abrasives are one of key influencing factors on surface quality during chemical mechanical polishing (CMP). Silica sol, a widely used abrasive in CMP slurries for sapphire substrates, often causes lower material removal rate (MRRs). In the present paper, Fe-doped colloidal SiO2 composite abrasives were prepared by a seed-induced growth method in order to improve the MRR of sapphire substrates. The CMP performance of Fe-doped colloidal SiO2 abrasives on sapphire substrates was investigated using UNIPOL-1502 CMP equipment. Experimental results indicate that the Fe-doped colloidal SiO2 composite abrasives exhibit lower surface roughness and higher MRR than pure colloidal SiO2 abrasives for sapphire substrates under the same testing conditions. Furthermore, the acting mechanism of Fe-doped colloidal SiO2 composite abrasives in sapphire CMP was analyzed by x-ray photoelectron spectroscopy. Analytical results show that the Fe in the composite abrasives can react with the sapphire substrates to form aluminum ferrite (AlFeO3) during CMP, which promotes the chemical effect in CMP and leads to improvement of MRR.

Cladosins F and G, two new hybrid polyketides from the deep-sea-derived Cladosporium sphaerospermum 2005-01-E3.

Two new fungal hybrid polyketides, cladosins F (1) and G (2), with rare 6(3)-enamino-8,10-dihydroxy-tetraketide system were discovered from the deep-sea-derived fungus Cladosporium sphaerospermum 2005-01-E3 guided by OSMAC approach. Their structures were elucidated on the basis of comprehensive spectroscopic analyses, and cytotoxicity, antitubercular, anti-influenza A H1N1 virus, and NF-κB inhibitory activities were evaluated.