Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients.

BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65-90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible, <50% visual obstruction of epiglottis to vocal cords; vocal cords and posterior epiglottis visible; and vocal cords visible. We also investigated success rate and ease of insertion, insertion time, and manipulations during insertion as insertion variables, complications during maintenance and emergence periods, and postoperative pharyngolaryngeal complications including sore throat, dysphagia, and dysphonia. RESULTS: After assessing for eligibility, 48 patients were allocated to each group. Oropharyngeal leak pressures were significantly higher in the i-gel group than in the self-pressurized air-Q group (P < .001) at the 2 measurement points. The raw mean difference at initial assessment and the median difference after 10 minutes were 5.5 cm H2O (95% confidence interval, 3.3-7.6 cm H2O) and 5.0 (95% confidence interval, 2.0-7.0 cm H2O), respectively. The initial scores of fiberoptic view were similar in the 2 groups. However, the self-pressurized air-Q supraglottic airway provided a significantly improved fiberoptic view at 10 minutes after initial assessment (P = .030). We found no statistically significant differences in insertion variables and complications between the 2 groups. CONCLUSIONS: The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.

Incidence and Risk Factors of Acute Kidney Injury after Kasai Operation for Biliary Atresia: A Retrospective Study.

Background: Biliary atresia is a progressive, inflammatory, and destructive pathology of the bile ducts. Patients who undergo surgery for correction of biliary atresia (Kasai operation) are at risk of acute kidney injury (AKI) because of their young age at the time of surgery, long operation time, and liver fibrosis or failure as complication of biliary atresia. Conversely, AKI is associated with poor outcomes after surgery. This study therefore aimed to evaluate the incidence, risk factors, and outcomes of AKI after Kasai operation. Methods: All consecutive patients who underwent Kasai operation between March 2006 and December 2015 in a single tertiary-care university hospital were enrolled. AKI was defined based on the Acute Kidney Injury Network criteria. Multivariate logistic regression models were used to assess risk factors for AKI. Results: One hundred sixty-six patients received Kasai operation during study period. Of these, AKI occurred in 37 of 166 patients (22.3%). In multivariate logistic regression analysis, age older than 30 days, higher preoperative estimated glomerular filtration rate, and preoperative contrast use within 7 days were associated with the development of AKI. Perioperative packed red blood cells transfusion was related to reduced occurrence of AKI. AKI was associated with longer ICU stay (OR = 1.015, p = 0.016). More patients with AKI were also found to receive additional surgery except liver transplantation within 1 year compared to those without AKI (10.8 % vs. 2.3 %, p = 0.045). Conclusions: Increased age is strongly associated with the development of AKI after Kasai operation. These findings indicate a rational basis for early corrective surgery for biliary atresia, early screening for AKI, and intervention to improve the results of Kasai operation.

High-Performance Chemically Regenerative Redox Fuel Cells Using a NO3- /NO Regeneration Reaction.

In this study, we proposed high-performance chemically regenerative redox fuel cells (CRRFCs) using NO3- /NO with a nitrogen-doped carbon-felt electrode and a chemical regeneration reaction of NO to NO3- via O2 . The electrochemical cell using the nitrate reduction to NO at the cathode on the carbon felt and oxidation of H2 as a fuel at the anode showed a maximal power density of 730 mW cm-2 at 80 °C and twofold higher power density of 512 mW cm-2 at 0.8 V, than the target power density of 250 mW cm-2 at 0.8 V in the H2 /O2 proton exchange membrane fuel cells (PEMFCs). During the operation of the CRRFCs with the chemical regeneration reactor for 30 days, the CRRFCs maintained 60 % of the initial performance with a regeneration efficiency of about 92.9 % and immediately returned to the initial value when supplied with fresh HNO3 .

Improving Tumor-Infiltrating Lymphocytes Score Prediction in Breast Cancer with Self-Supervised Learning.

Tumor microenvironment (TME) plays a pivotal role in immuno-oncology, which investigates the intricate interactions between tumors and the human immune system. Specifically, tumor-infiltrating lymphocytes (TILs) are crucial biomarkers for evaluating the prognosis of breast cancer patients and have the potential to refine immunotherapy precision and accurately identify tumor cells in specific cancer types. In this study, we conducted tissue segmentation and lymphocyte detection tasks to predict TIL scores by employing self-supervised learning (SSL) model-based approaches capable of addressing limited labeling data issues. Our experiments showed a 1.9% improvement in tissue segmentation and a 2% improvement in lymphocyte detection over the ImageNet pre-training model. Using these SSL-based models, we achieved a TIL score of 0.718 with a 4.4% improvement. In particular, when trained with only 10% of the entire dataset, the SwAV pre-trained model exhibited a superior performance over other models. Our work highlights improved tissue segmentation and lymphocyte detection using the SSL model with less labeled data for TIL score prediction.

Role of polyvinylpyrrolidone in the electrochemical performance of Li2MnO3 cathode for lithium-ion batteries.

While Li2MnO3 as an over-lithiated layered oxide (OLO) shows a significantly high reversible capacity of 250 mA h g-1 in lithium-ion batteries (LIBs), it has critical issues of poor cycling performance and deteriorated high rate performance. In this study, modified OLO cathode materials for improved LIB performance were obtained by heating the as-prepared OLO at different temperatures (400, 500, and 600 °C) in the presence of polyvinylpyrrolidone (PVP) under an N2 atmosphere. Compared to the as-prepared OLO, the OLO sample heated at 500 °C with PVP exhibited a high initial discharge capacity of 206 mA h g-1 and high rate capability of 111 mA h g-1 at 100 mA g-1. The superior performance of the OLO sample heated at 500 °C with PVP is attributed to an improved electronic conductivity and Li+ ionic motion, resulting from the formation of the graphitic carbon structure and increased Mn3+ ratio during the decomposition of PVP.

Effects of chronic statin use on 30-day major adverse cardiac and cerebrovascular events after thoracic endovascular aortic repair.

BACKGROUND: Cardiac and cerebrovascular complications are major causes of adverse outcomes following thoracic endovascular aortic repair (TEVAR). The benefits of statins have been established, but little is known about their impact on patients undergoing TEVAR. We investigated whether chronic statin use protected against early postoperative major adverse cardiac and cerebrovascular events (MACCEs) after TEVAR. METHODS: We retrospectively reviewed 211 patients who underwent TEVAR between February 2013 and March 2017 classified into two groups, those with acute aortic syndrome (AAS, N.=79) and those without (non-AAS, N.=132). Patients were subdivided according to preoperative statin therapy for ≥3 months or not. The primary endpoint was 30-day MACCE, defined as myocardial infarction, stroke, arrhythmia, cardiovascular death, or cerebrovascular death. Acute kidney injury (AKI) occurrence within 48 hours was also evaluated. Multivariate logistic regression analysis was performed to identify independent risk factors for MACCEs and AKI. RESULTS: Incidence of MACCEs (1% vs. 11%, P=0.019) was significantly lower in the statin group than in the no-statin group in non-AAS patients. Multivariate logistic regression analysis revealed statin use (odds ratio 0.85, 95% confidence interval 0.01-0.95, P=0.046) as an independent predictor for MACCE in non-AAS patients. The AKI incidence was significantly higher in the statin group than in the no-statin group in AAS patients (44% vs. 15%, P=0.018). CONCLUSIONS: In patients undergoing TEVAR, chronic statin use was associated with reduced 30-day MACCEs in non-AAS patients, but not in AAS patients. It might rather be associated with increased risk of AKI in AAS patients.

In Situ Synthesis and Characterization of Ge Embedded Electrospun Carbon Nanostructures as High Performance Anode Material for Lithium-Ion Batteries.

While active materials based on germanium (Ge) are considered as a promising alternative anodic electrode due to their relatively high reversible capacity and excellent lithium-ion diffusivity, the quite unstable structural/electrochemical stability and severe volume expansion or pulverization problems of Ge electrodes remain a considerable challenge in lithium ion batteries (LIBs). Here, we present the development of Ge embedded in one-dimensional carbon nanostructures (Ge/CNs) synthesized by the modified in situ electrospinning technique using a mixed electrospun solution consisting of a Ge precursor as an active material source and polyacrylonitrile (PAN) as a carbon source. The as-prepared Ge/CNs exhibit superior lithium ion behavior properties, i.e., highly reversible specific capacity, rate performance, Li ion diffusion coefficient, and superior cyclic stability (capacity retention: 85% at 200 mA g(-1)) during Li alloying/dealloying processes. These properties are due to the high electrical conductivity and unique structures containing well-embedded Ge nanoparticles (NPs) and a one-dimensional carbon nanostructure as a buffer medium, which is related to the volume expansion of Ge NPs. Thus, it is expected that the Ge/CNs can be utilized as a promising alternative anodic material in LIBs.

Cuboctahedral Pd nanoparticles on WC for enhanced methanol electrooxidation in alkaline solution.

We report cuboctahedral Pd nanoparticles on WC synthesized by the polyol process using ethylene glycol with NO(3)(-) and Fe(3+)/Fe(2+) ions. The cuboctahedral Pd/WC shows much improved electrocatalytic activity for methanol electrooxidation in alkaline solution.