Selective omission of sentinel lymph node biopsy in mastectomy for ductal carcinoma in situ: identifying eligible candidates.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is recommended for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy, given the concerns regarding upstaging and technical difficulties of post-mastectomy SLNB. However, this may lead to potential overtreatment, considering favorable prognosis and de-escalation trends in DCIS. Data regarding upstaging and axillary lymph node metastasis among these patients remain limited. METHODS: We retrospectively reviewed patients with DCIS who underwent mastectomy with SLNB or axillary lymph node dissection at Gangnam Severance Hospital between January 2010 and December 2021. To explore the feasibility of omitting SLNB, we assessed the rates of DCIS upgraded to invasive carcinoma and axillary lymph node metastasis. Binary Cox regression analysis was performed to identify clinicopathologic factors associated with upstaging and axillary lymph node metastasis. RESULTS: Among 385 patients, 164 (42.6%) experienced an invasive carcinoma upgrade: microinvasion, pT1, and pT2 were confirmed in 53 (13.8%), 97 (25.2%), and 14 (3.6%) patients, respectively. Seventeen (4.4%) patients had axillary lymph node metastasis. Multivariable analysis identified age ≤ 50 years (adjusted odds ratio [OR], 12.73; 95% confidence interval [CI], 1.18-137.51; p = 0.036) and suspicious axillary lymph nodes on radiologic evaluation (adjusted OR, 9.31; 95% CI, 2.06-41.99; p = 0.004) as independent factors associated with axillary lymph node metastasis. Among patients aged > 50 years and/or no suspicious axillary lymph nodes, only 1.7-2.3%) experienced axillary lymph node metastasis. CONCLUSIONS: Although underestimation of the invasive component was relatively high among patients with DCIS undergoing mastectomy, axillary lymph node metastasis was rare. Our findings suggest that omitting SLNB may be feasible for patients over 50 and/or without suspicious axillary lymph nodes on radiologic evaluation.

Resolution of Nonmass Enhancement Extension to the Nipple at Breast MRI after Neoadjuvant Chemotherapy: Pathologic Response and Feasibility for Nipple-sparing Mastectomy.

Background Nipple-sparing mastectomy (NSM) is usually contraindicated in patients with nonmass enhancement (NME) extension to the nipple at breast MRI. However, little is known about the feasibility of NSM when NME extension to the nipple resolves after neoadjuvant chemotherapy (NAC). Purpose To evaluate whether NSM is an appropriate surgical procedure for patients in whom NME extension to the nipple resolves after NAC. Materials and Methods This retrospective study included 383 women with NME at baseline MRI who underwent NAC followed by mastectomy between January 2007 and March 2022 at a single institution. NME extension to the nipple was assessed using breast MRI before NAC (hereafter, pre-NAC) and after NAC (hereafter, post-NAC). In 326 women who underwent mastectomy with removal of the nipple-areolar complex, the rate of pathologic analysis-confirmed tumor invasion of the nipple compared with NME extension to the nipple at post-NAC breast MRI was evaluated. Tumor involvement of the nipple was also assessed in those with complete pathologic response at posttreatment MRI. Furthermore, the outcomes in 57 women undergoing NSM were investigated, particularly in patients with NME extension to the nipple at initial diagnosis. Results Of the 326 women who underwent mastectomy with removal of the nipple-areolar complex (mean age, 49 years ± 9.4 [SD]), 217 patients (67%) showed NME extension to the nipple on pre-NAC MRI scans. Among the 153 women (70%) in whom the NME extension to the nipple resolved after NAC, the rate of pathologic analysis-confirmed tumor invasion of the nipple was 2.6% (four of 153 women; 95% CI: 0, 6.5). No pathologic analysis-confirmed tumor invasion of the nipple was detected in 31 women with complete response at MRI. Of the 57 women who underwent NSM, 12 (21%) with resolution of NME extension to the nipple after NAC had no relapse during the median follow-up of 31 months (range, 11-80 months). Conclusion Pathologic analysis-confirmed tumor invasion of the nipple was rare in women with resolution of nonmass enhancement extension to the nipple after neoadjuvant chemotherapy (NAC). Therefore, nipple-sparing mastectomy could be feasible in this population, especially in those with complete MRI response to NAC. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee in this issue.

Pore-Size-Tuned Graphene Oxide Membrane as a Selective Molecular Sieving Layer: Toward Ultraselective Chemiresistors.

Conventional graphene oxide (GO)-based gas membranes, having a narrow pore-size range of less than 0.3 nm, exhibit limited gas molecular permeability because of the kinetic diameters of most volatile organic and sulfur compound (VOCs/VSCs) molecules being larger than 0.3 nm. Here, we employ GO nanosheets (NSs) with a tunable pore-size distribution as a molecular sieving layer on two-dimensional (2D) metal oxide NSs-based gas sensors, i.e., PdO-sensitized WO3 NSs to boost selectivity toward specific gas species. The pore size, surface area, and pore density of GO NSs were simply manipulated by controlling H2O2 concentration. In addition, the pore size-tuned GO NSs were coated on cellulose filtering paper as a free-standing nanoporous membrane. Holey GO membrane showed a highly selective H2S permeability characteristic, exhibiting superior cross-selectivity to CH3COCH3 (0.46 nm), C2H5OH (0.45 nm), and C7H8 (0.59 nm) with larger kinetic diameters compared with H2S (0.36 nm). Such pore-size-tuned GO nanoporous layer is scalable and robust, highlighting a great promise for designing low cost and highly efficient gas-permeable membrane for outstanding selective gas sensing platform.

Janus Graphene Liquid Crystalline Fiber with Tunable Properties Enabled by Ultrafast Flash Reduction.

Flash photothermal treatment via Xenon lamp with a broad wavelength spectrum can effectively remove oxygen functionalities and restore sp2 domains at graphitic carbon materials. The chemical composition and relevant structure formation of flash reduced graphene oxide liquid crystal (GOLC) fibers are investigated in accordance with flash irradiation conditions. Owing to the spatial controllability of reduction level via anisotropic flash irradiation, the mechanical properties and electrical conductivity of graphene fibers can be delicately counterbalanced to attain desired properties. High sensitivity humidity sensors can be fabricated from the flash reduced fibers demonstrating notably higher sensitivity over the thermally reduced counterparts. This ultrafast flash reduction holds great promise for multidimensional macroscopic GO based structures, enabling a wide range of potential applications, including textile electronics and wearable sensors.

An Impedance-Transduced Chemiresistor with a Porous Carbon Channel for Rapid, Nonenzymatic, Glucose Sensing.

A new type of chemiresistor, the impedance-transduced chemiresistor (ITCR), is described for the rapid analysis of glucose. The ITCR exploits porous, high surface area, fluorine-doped carbon nanofibers prepared by electrospinning of fluorinated polymer nanofibers followed by pyrolysis. These nanofibers are functionalized with a boronic acid receptor and stabilized by Nafion to form the ITCR channel for glucose detection. The recognition and binding of glucose by the ITCR is detected by measuring its electrical impedance at a single frequency. The analysis frequency is selected by measuring the signal-to-noise ( S/ N) for glucose detection across 5 orders of magnitude, evaluating both the imaginary and real components of the complex impedance. On the basis of this analysis, an optimal frequency of 13 kHz is selected for glucose detection, yielding an S/ N ratio of 60-100 for [glucose] = 5 mM using the change in the total impedance, Δ Z. The resulting ITCR glucose sensor shows a rapid analysis time (<8 s), low coefficient of variation for a series of sensors (<10%), an analysis range of 50 µM to 5 mM, and excellent specificity versus fructose, ascorbic acid, and uric acid. These metrics for the ITCR are obtained using a sample size as small as 5 µL.

Nitrogen-Doped Single Graphene Fiber with Platinum Water Dissociation Catalyst for Wearable Humidity Sensor.

Humidity sensors are essential components in wearable electronics for monitoring of environmental condition and physical state. In this work, a unique humidity sensing layer composed of nitrogen-doped reduced graphene oxide (nRGO) fiber on colorless polyimide film is proposed. Ultralong graphene oxide (GO) fibers are synthesized by solution assembly of large GO sheets assisted by lyotropic liquid crystal behavior. Chemical modification by nitrogen-doping is carried out under thermal annealing in H2 (4%)/N2 (96%) ambient to obtain highly conductive nRGO fiber. Very small (≈2 nm) Pt nanoparticles are tightly anchored on the surface of the nRGO fiber as water dissociation catalysts by an optical sintering process. As a result, nRGO fiber can effectively detect wide humidity levels in the range of 6.1-66.4% relative humidity (RH). Furthermore, a 1.36-fold higher sensitivity (4.51%) at 66.4% RH is achieved using a Pt functionalized nRGO fiber (i.e., Pt-nRGO fiber) compared with the sensitivity (3.53% at 66.4% RH) of pure nRGO fiber. Real-time and portable humidity sensing characteristics are successfully demonstrated toward exhaled breath using Pt-nRGO fiber integrated on a portable sensing module. The Pt-nRGO fiber with high sensitivity and wide range of humidity detection levels offers a new sensing platform for wearable humidity sensors.

Glass-Fabric Reinforced Ag Nanowire/Siloxane Composite Heater Substrate: Sub-10 nm Metal@Metal Oxide Nanosheet for Sensitive Flexible Sensing Platform.

The development of flexible chemiresistors is imperative for real-time monitoring of air quality and/or human physical conditions without space constraints. However, critical challenges such as poor sensing characteristics, vulnerability under toxic chemicals, and weak reliability hinder their practical use. In this work, for the first time, an ultrasensitive flexible sensing platform is reported by assembling Pt loaded thin-layered (≈10 nm) SnO2 nanosheets (Pt-SnO2 NSs) based 2D sensing layers on Ag nanowires embedded glass-fabric reinforced vinyl-phenyl siloxane hybrid composite substrate (AgNW-GFRVPH film) as a heater. The thermally stable AgNW-GFRVPH film based heater is fabricated by free radical polymerization of vinyl groups in vinyl-phenyl oligosiloxane and phenyltris(dimethylvinylsiloxy)silane with Ag NW and glass-fabric, showing outstanding heat generation (≈200 °C), high dimensional stability (13 ppm °C-1), and good thermal stability (≈350 °C). The Pt-SnO2 NSs, which are synthesized by calcination of Sn precursor coated graphene oxide (GO) sheets and subsequent Pt functionalization, exhibit high mechanical flexibility and superior response (Rair/Rgas = 4.84) to 1 ppm level dimethyl sulfide. Taking these advantages, GO-templated oxide NSs combined with a highly stable AgNW-GFRVPH film heater exhibits the best dimethyl sulfide sensing performance compared to state-of-the-art flexible chemiresistors, enabling them as a superior flexible gas sensing platform.

Innovative Nanosensor for Disease Diagnosis.

As a futuristic diagnosis platform, breath analysis is gaining much attention because it is a noninvasive, simple, and low cost diagnostic method. Very promising clinical applications have been demonstrated for diagnostic purposes by correlation analysis between exhaled breath components and specific diseases. In addition, diverse breath molecules, which serve as biomarkers for specific diseases, are precisely identified by statistical pattern recognition studies. To further improve the accuracy of breath analysis as a diagnostic tool, breath sampling, biomarker sensing, and data analysis should be optimized. In particular, development of high performance breath sensors, which can detect biomarkers at the ppb-level in exhaled breath, is one of the most critical challenges. Due to the presence of numerous interfering gas species in exhaled breath, selective detection of specific biomarkers is also important. This Account focuses on chemiresistive type breath sensors with exceptionally high sensitivity and selectivity that were developed by combining hollow protein templated nanocatalysts with electrospun metal oxide nanostructures. Nanostructures with high surface areas are advantageous in achieving high sensitivity because the sensing signal is dominated by the surface reaction between the sensing layers and the target biomarkers. Furthermore, macroscale pores between one-dimensional (1D) nanostructures can facilitate fast gas diffusion into the sensing layers. To further enhance the selectivity, catalytic functionalization of the 1D metal oxide nanostructure is essential. However, the majority of conventional techniques for catalytic functionalization have failed to achieve a high degree of dispersion of nanoscale catalysts due to aggregation on the surface of the metal oxide, which severely deteriorates the sensing properties by lowering catalytic activity. This issue has led to extensive studies on monolithically dispersed nanoscale particles on metal oxides to maximize the catalytic performances. As a pioneering technique, a bioinspired templating route using apoferritin, that is, a hollow protein cage, has been proposed to obtain nanoscale (∼2 nm) catalyst particles with high dispersity. Nanocatalysts encapsulated by a protein shell were first used in chemiresistive type breath sensors for catalyst functionalization on 1D metal oxide structures. We discuss the robustness and versatility of the apoferrtin templating route for creating highly dispersive catalytic NPs including single components (Au, Pt, Pd, Rh, Ag, Ru, Cu, and La) and bimetallic catalysts (PtY and PtCo), as well as the core-shell structure of Au-Pd (Au-core@Pd-shell). The use of these catalysts is essential to establish high performance sensors arrays for the pattern recognition of biomarkers. In addition, novel multicomponent catalysts provide unprecedented sensitivity and selectivity. With this in mind, we discuss diverse synthetic routes for nanocatalysts using apoferritin and the formation of various catalyst-1D metal oxide composite nanostructures. Furthermore, we discuss detection capability of a simulated biomarker gas using the breath sensor arrays and principal component analysis. Finally, future prospects with the portable breath analysis platform are presented by demonstrating the potential feasibility of real-time and on-site breath analysis using chemiresistive sensors.

Metal Organic Framework-Templated Chemiresistor: Sensing Type Transition from P-to-N Using Hollow Metal Oxide Polyhedron via Galvanic Replacement.

Facile synthesis of porous nanobuilding blocks with high surface area and uniform catalyst functionalization has always been regarded as an essential requirement for the development of highly sensitive and selective chemical sensors. Metal-organic frameworks (MOFs) are considered as one of the most ideal templates due to their ability to encapsulate ultrasmall catalytic nanoparticles (NPs) in microporous MOF structures in addition to easy removal of the sacrificial MOF scaffold by calcination. Here, we introduce a MOFs derived n-type SnO2 (n-SnO2) sensing layer with hollow polyhedron structures, obtained from p-n transition of MOF-templated p-type Co3O4 (p-Co3O4) hollow cubes during galvanic replacement reaction (GRR). In addition, the Pd NPs encapsulated in MOF and residual Co3O4 clusters partially remained after GRR led to uniform functionalization of efficient cocatalysts (PdO NPs and p-Co3O4 islands) on the porous and hollow polyhedron SnO2 structures. Due to high gas accessibility through the meso- and macrosized pores in MOF-templated oxides and effective modulation of electron depletion layer assisted by the creation of numerous p-n junctions, the GRR-treated SnO2 structures exhibited 21.9-fold higher acetone response (Rair/Rgas = 22.8 @ 5 ppm acetone, 90%RH) compared to MOF-templated p-Co3O4 hollow structures. To the best of our knowledge, the selectivity and response amplitudes reported here for the detection of acetone are superior to those MOF derived metal oxide sensing layers reported so far. Our results demonstrate that highly active MOF-derived sensing layers can be achieved via p-n semiconducting phase transition, driven by a simple and versatile GRR process combined with MOF templating route.

Supercharging a MnO2 Nanowire: An Amine-Altered Morphology Retains Capacity at High Rates and Mass Loadings.

The influence of hexamethylenetetraamine (HMTA) on the morphology of δ-MnO2 and its properties for electrical energy storage are investigated-specifically for ultrathick δ-MnO2 layers in the micron scale. Planar arrays of gold@δ-MnO2, core@shell nanowires, were prepared by electrodeposition with and without the HMTA and their electrochemical properties were evaluated. HMTA alters the MnO2 in three ways: First, it creates a more open morphology for the MnO2 coating, characterized by "petals" with a thickness of 6 to 9 nm, rather than much thinner δ-MnO2 sheets seen in the absence of HMTA. Second, the electronic conductivity of the δ-MnO2 is increased by an order of magnitude. Third, δ-MnO2 prepared in HMTA shows a (001) interlayer spacing that is expanded by ≈30% possibly accelerating Li transport. The net effect of "HTMA doping" is to dramatically improve high rate performance, culminating in an increase in the specific capacity for the thickest MnO2 shells examined here by a factor of 15 at 100 mV/s.

Heterogeneous Sensitization of Metal-Organic Framework Driven Metal@Metal Oxide Complex Catalysts on an Oxide Nanofiber Scaffold Toward Superior Gas Sensors.

We report on the heterogeneous sensitization of metal-organic framework (MOF)-driven metal-embedded metal oxide (M@MO) complex catalysts onto semiconductor metal oxide (SMO) nanofibers (NFs) via electrospinning for markedly enhanced chemical gas sensing. ZIF-8-derived Pd-loaded ZnO nanocubes (Pd@ZnO) were sensitized on both the interior and the exterior of WO3 NFs, resulting in the formation of multiheterojunction Pd-ZnO and ZnO-WO3 interfaces. The Pd@ZnO loaded WO3 NFs were found to exhibit unparalleled toluene sensitivity (Rair/Rgas = 4.37 to 100 ppb), fast gas response speed (∼20 s) and superior cross-selectivity against other interfering gases. These results demonstrate that MOF-derived M@MO complex catalysts can be functionalized within an electrospun nanofiber scaffold, thereby creating multiheterojunctions, essential for improving catalytic sensor sensitization.

Silver Nanowire Embedded Colorless Polyimide Heater for Wearable Chemical Sensors: Improved Reversible Reaction Kinetics of Optically Reduced Graphene Oxide.

Optically reduced graphene oxide (ORGO) sheets are successfully integrated on silver nanowire (Ag NW)-embedded transparent and flexible substrate. As a heating element, Ag NWs are embedded in a colorless polyimide (CPI) film by covering Ag NW networks using polyamic acid and subsequent imidization. Graphene oxide dispersed aqueous solution is drop-coated on the Ag NW-embedded CPI (Ag NW-CPI) film and directly irradiated by intense pulsed light to obtain ORGO sheets. The heat generation property of Ag NW-CPI film is investigated by applying DC voltage, which demonstrates unprecedentedly reliable and stable characteristics even in dynamic bending condition. To demonstrate the potential application in wearable chemical sensors, NO2 sensing characteristic of ORGO is investigated with respect to the different heating temperature (22.7-71.7 °C) of Ag NW-CPI film. The result reveals that the ORGO sheets exhibit high sensitivity of 2.69% with reversible response/recovery sensing properties and minimal deviation of baseline resistance of around 1% toward NO2 molecules when the temperature of Ag NW-CPI film is 71.7 °C. This work first demonstrates the improved reversible NO2 sensing properties of ORGO sheets on flexible and transparent Ag NW-CPI film assisted by Ag NW heating networks.

Metal Chelation Assisted In Situ Migration and Functionalization of Catalysts on Peapod-Like Hollow SnO2 toward a Superior Chemical Sensor.

Rational design of nanostructures and efficient catalyst functionalization methods are critical to the realization of highly sensitive gas sensors. In order to solve these issues, two types of strategies are reported, i.e., (i) synthesis of peapod-like hollow SnO2 nanostructures (hollow 0D-1D SnO2 ) by using fluid dynamics of liquid Sn metal and (ii) metal-protein chelate driven uniform catalyst functionalization. The hollow 0D-1D SnO2 nanostructures have advantages in enhanced gas accessibility and higher surface areas. In addition to structural benefits, protein encapsulated catalytic nanoparticles result in the uniform catalyst functionalization on both hollow SnO2 spheres and SnO2 nanotubes due to their dynamic migration properties. The migration of catalysts with liquid Sn metal is induced by selective location of catalysts around Sn. On the basis of these structural and uniform functionalization of catalyst benefits, biomarker chemical sensors are developed, which deliver highly selective detection capability toward acetone and toluene, respectively. Pt or Pd loaded multidimensional SnO2 nanostructures exhibit outstanding acetone (R air /R gas = 93.55 @ 350 °C, 5 ppm) and toluene (R air /R gas = 9.25 @ 350 °C, 5 ppm) sensing properties, respectively. These results demonstrate that unique nanostructuring and novel catalyst loading method enable sensors to selectively detect biomarkers for exhaled breath sensors.

WO3 Nanofiber-Based Biomarker Detectors Enabled by Protein-Encapsulated Catalyst Self-Assembled on Polystyrene Colloid Templates.

A novel catalyst functionalization method, based on protein-encapsulated metallic nanoparticles (NPs) and their self-assembly on polystyrene (PS) colloid templates, is used to form catalyst-loaded porous WO3 nanofibers (NFs). The metallic NPs, composed of Au, Pd, or Pt, are encapsulated within a protein cage, i.e., apoferritin, to form unagglomerated monodispersed particles with diameters of less than 5 nm. The catalytic NPs maintain their nanoscale size, even following high-temperature heat-treatment during synthesis, which is attributed to the discrete self-assembly of NPs on PS colloid templates. In addition, the PS templates generate open pores on the electrospun WO3 NFs, facilitating gas molecule transport into the sensing layers and promoting active surface reactions. As a result, the Au and Pd NP-loaded porous WO3 NFs show superior sensitivity toward hydrogen sulfide, as evidenced by responses (R(air)/R(gas)) of 11.1 and 43.5 at 350 °C, respectively. These responses represent 1.8- and 7.1-fold improvements compared to that of dense WO3 NFs (R(air)/R(gas) = 6.1). Moreover, Pt NP-loaded porous WO3 NFs exhibit high acetone sensitivity with response of 28.9. These results demonstrate a novel catalyst loading method, in which small NPs are well-dispersed within the pores of WO3 NFs, that is applicable to high sensitivity breath sensors.

Advancing Breathability of Respiratory Nanofilter by Optimizing Pore Structure and Alignment in Nanofiber Networks.

Respiratory masks are the primary and most effective means of protecting individuals from airborne hazards such as droplets and particulate matter during public engagements. However, conventional electrostatically charged melt-blown microfiber masks typically require thick and dense membranes to achieve high filtration efficiency, which in turn cause a significant pressure drop and reduce breathability. In this study, we have developed a multielectrospinning system to address this issue by manipulating the pore structure of nanofiber networks, including the use of uniaxially aligned nanofibers created via an electric-field-guided electrospinning apparatus. In contrast to the common randomly collected microfiber membranes, partially aligned dual-nanofiber membranes, which are fabricated via electrospinning of a random 150 nm nanofiber base layer and a uniaxially aligned 450 nm nanofiber spacer layer on a roll-to-roll collector, offer an efficient way to modulate nanofiber membrane pore structures. Notably, the dual-nanofiber configuration with submicron pore structure exhibits increased fiber density and decreased volume density, resulting in an enhanced filtration efficiency of over 97% and a 50% reduction in pressure drop. This leads to the highest quality factor of 0.0781. Moreover, the submicron pore structure within the nanofiber networks introduces an additional sieving filtration mechanism, ensuring superior filtration efficiency under highly humid conditions and even after washing with a 70% ethanol solution. The nanofiber mask provides a sustainable solution for safeguarding the human respiratory system, as it effectively filters and inactivates human coronaviruses while utilizing 130 times fewer polymeric materials than melt-blown filters. This reusability of our filters and their minimum usage of polymeric materials would significantly reduce plastic waste for a sustainable global society.

Bidirectional Water-Stream Behavior on a Multifunctional Membrane for Simultaneous Energy Generation and Water Purification.

Hydroelectric nanogenerators have been previously proposed to recycle various water resources and polluted water. However, as conventional hydroelectric nanogenerators only utilize water resources, they cannot provide a fundamental solution for water recycling. In this study, a water purification membrane is proposed that can simultaneously generate electricity during the purification process (electricity generation and purification membrane (EPM)) for water recycling. As polluted water passes through the EPM, the water is purified in the perpendicular direction, while electricity is simultaneously produced in the horizontal direction by the movement of ions. Notably, the EPM exhibits high energy generation performance (maximum power 16.44 µW and energy 15.16 mJ) by the streaming effect of water-streaming carbon nanotubes (CNTs). Moreover, by using a poly(acrylic acid)/carboxymethyl cellulose (PAA/CMC) binder to EPM, the energy-generation performance and long-term stability are substantially improved and outstanding mechanical stability is provided, regardless of the acidity of the water source (pH 1-10). More importantly, the EPM exhibits the water purification characteristics of >90% rejection of sub-10 nm pollutants and potentiality of ångstrom level cation rejection, with simultaneous and continuous energy generation. Overall, this study proposes an efficient EPM model, which can be potentially used as a next-generation renewable energy generation approach, thus laying the foundation for effective utilization of polluted water resources.

Optimal treatment strategy for hormone receptor-positive human epidermal growth factor receptor 2-negative breast cancer patients with 1-2 suspicious axillary lymph node metastases on breast magnetic resonance imaging: upfront surgery vs. neoadjuvant chemotherapy.

Background: It is unclear whether upfront surgery or neoadjuvant chemotherapy is appropriate for first treatment in hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients with 1-2 suspicious axillary lymph node (ALN) metastases on preoperative breast magnetic resonance imaging (MRI). Method: We identified 282 patients with HR+HER2- breast cancer and 1-2 suspicious ALN metastases on baseline breast MRI (147 received upfront surgery; 135 received neoadjuvant chemotherapy). We evaluated the predictive clinicopathological factors for pN2-3 in the adjuvant setting and axillary pathologic complete response (pCR) in the neoadjuvant setting. Results: Lymphovascular invasion (LVI)-positive and clinical tumors >3 cm were significantly associated with pN2-3 in patients who received upfront surgery. The pN2-3 rate was 9.3% in patients with a clinical tumor ≤ 3 cm and LVI-negative versus 34.7% in the others (p < 0.001). The pN2-3 rate in patients with a clinical tumor ≤ 3 cm and LVI-negative and in the others were 9.3% versus 34.7% in all patients (p < 0.001), 10.7% versus 40.0% (p = 0.033) in patients aged < 50 years, and 8.5% versus 31.0% in patients aged ≥ 50 years (p < 0.001), respectively. In the neoadjuvant setting, patients with tumor-infiltrating lymphocytes (TILs) ≥ 20% had a higher axillary pCR than those with TILs < 20% (46.7% vs. 15.3%, p < 0.001). A similar significant finding was also observed in patients < 50 years. Conclusions: Upfront surgery may be preferable for patients aged ≥ 50 years with a clinical tumor < 3 cm and LVI-negative, while neoadjuvant chemotherapy may be preferable for those aged < 50 years with TILs ≥ 20%.

Breathable MOFs Layer on Atomically Grown 2D SnS2 for Stable and Selective Surface Activation.

2D transition metal dichalcogenides (TMDs) have significant research interests in various novel applications due to their intriguing physicochemical properties. Notably, one of the 2D TMDs, SnS2 , has superior chemiresistive sensing properties, including a planar crystal structure, a large surface-to-volume ratio, and a low electronic noise. However, the long-term stability of SnS2 in humid conditions remains a critical shortcoming towards a significant degradation of sensitivity. Herein, it is demonstrated that the subsequent self-assembly of zeolite imidazolate framework (ZIF-8) can be achieved in situ growing on SnS2 nanoflakes as the homogeneous porous materials. ZIF-8 layer on SnS2 allows the selective diffusion of target gas species, while effectively preventing the SnS2 from severe oxidative degradation. Molecular modeling such as molecular dynamic simulation and DFT calculation, further supports the mechanism of sensing stability and selectivity. From the results, the in situ grown ZIF-8 porous membrane on 2D materials corroborates the generalizable strategy for durable and reliable high-performance electronic applications of 2D materials.

Autonomous Resonance-Tuning Mechanism for Environmental Adaptive Energy Harvesting.

An innovative autonomous resonance-tuning (ART) energy harvester is reported that utilizes adaptive clamping systems driven by intrinsic mechanical mechanisms without outsourcing additional energy. The adaptive clamping system modulates the natural frequency of the harvester's main beam (MB) by adjusting the clamping position of the MB. The pulling force induced by the resonance vibration of the tuning beam (TB) provides the driving force for operating the adaptive clamp. The ART mechanism is possible by matching the natural frequencies of the TB and clamped MB. Detailed evaluations are conducted on the optimization of the adaptive clamp tolerance and TB design to increase the pulling force. The energy harvester exhibits an ultrawide resonance bandwidth of over 30 Hz in the commonly accessible low vibration frequency range (<100 Hz) owing to the ART function. The practical feasibility is demonstrated by evaluating the ART performance under both frequency and acceleration-variant conditions and powering a location tracking sensor.

Ultrahigh dielectric permittivity in oxide ceramics by hydrogenation.

Boosting dielectric permittivity representing electrical polarizability of dielectric materials has been considered a keystone for achieving scientific breakthroughs as well as technological advances in various multifunctional devices. Here, we demonstrate sizable enhancements of low-frequency dielectric responses in oxygen-deficient oxide ceramics through specific treatments under humid environments. Ultrahigh dielectric permittivity (~5.2 × 106 at 1 Hz) is achieved by hydrogenation, when Ni-substituted BaTiO3 ceramics are exposed to high humidity. Intriguingly, thermal annealing can restore the dielectric on-state (exhibiting huge polarizability in the treated ceramics) to the initial dielectric off-state (displaying low polarizability of ~103 in the pristine ceramics after sintering). The conversion between these two dielectric states via the ambient environment-mediated treatments and the successive application of external stimuli allows us to realize reversible control of dielectric relaxation characteristics in oxide ceramics. Conceptually, our findings are of practical interest for applications to highly efficient dielectric-based humidity sensors.