Skin-attachable Tb-MOF ratio fluorescent sensor for real-time detection of human sweat pH.

The pH of human sweat is highly related with a variety of diseases, whereas the monitoring of sweat pH still remains challenging for ordinary families. In this study, we developed a novel dual-emission Tb-MOF using DPA as the ligand and further designed and constructed a skin-attachable Tb-MOF ratio fluorescent sensor for real-time detection of human sweat pH. With the increased concentration of H+, the interaction of H+ with carbonyl organic ligand leads to the collapse of the Tb-MOF crystal structure, resulting in the interruption of antenna effect, and correspondingly increasing the emission of the ligand at 380 nm and decreasing the emission of the central ion Tb3+ at 544 nm. This Tb-MOF nanoprobe has a good linear response in the pH range of 4.12-7.05 (R2 = 0.9914) with excellent anti-interference ability. Based on the merits of fast pH response and high sensitivity, the nanoprobe was further used to prepare flexible wearable sensor. The wearable sensor can detect pH in the linear range of 3.50-6.70, which covers the pH range of normal human sweat (4.50-6.50). Subsequently, the storage stability and detection accuracy of the sensors were evaluated. Finally, the sensor has been successfully applied for the detection of pH in actual sweat samples from 21 volunteer and the real-time monitoring of pH variation during movement processing. This skin-attachable Tb-MOF sensor, with the advantages of low cost, visible color change and long shelf-life, is appealing for sweat pH monitoring especially for ordinary families.

Facile Light-Driven Synthesis of Highly Luminous Sulfur Quantum Dots for Fluorescence Sensing and Cell Imaging.

Sulfur quantum dots (SQDs) are emerging fluorescent nanomaterials, whereas most of the methods for synthesizing SQDs are limited to thermal synthesis. In this study, we report the first case of a light-driven strategy for facile synthesis of SQDs and further applied the SQDs for fluorescence cell imaging. The light-driven synthesis strategy only utilized Na2S as the sulfur source and nano-TiO2 as the photosensitizer. Under ultraviolet illumination, the nano-TiO2 photosensitizer generated a large number of •O2- and •OH to oxidize S2- to Sx2- and further to elemental sulfur, which could be obtained as monodispersed SQDs after etching by H2O2. The prepared SQDs exhibit excellent tunable photoluminescence properties, superior stability, and a uniform small size, with particle diameters in the range of 0.5-4 nm, and the fluorescence absolute quantum yield is as high as 27.8%. Meanwhile, the prepared SQDs also exhibited extreme biocompatibility and stability, and we further applied it for intracellular imaging and Hg2+ sensing with satisfactory results. In comparison to the widely reported thermal synthesis, the light-driven synthesis method is greener and simpler, opening a new way for the preparation of biocompatible SQDs.

Plants attacked above-ground by leaf-mining flies change below-ground microbiota to enhance plant defense.

Root-associated microbiomes play a crucial role in plant responses to biotic and abiotic stresses. Plants can enrich beneficial microbes to increase their stress-relieving ability. Above-ground insect herbivory is among the most detrimental stresses for plants, especially to crop production. However, few studies have explored how root-associated microbiomes respond to herbivores and influence plant-defense functions under herbivory stress. We investigate the changes and functional role of root-associated microbial communities under herbivory stress using leafminer (Liriomyza trifolii) and cowpea (Vigna unguiculata) as a focal system. We did this by using a combination of 16S ribosomal RNA gene profiling and metagenomic sequencing to test for differences in co-occurrence networks and functions between cowpea plants infested and noninfested with leafminers. The results demonstrated that leafminer infestation caused a shift in the rhizosphere microbiome, which was characterized by a significant variation in microbiome community structure and composition, the selection of hub microbes involved in nitrogen (N) metabolism, and functional enrichment related to N metabolism. Notably, nitrogen-fixing bacteria Bradyrhizobium species were actively enriched and selected to be hubs in the rhizosphere. Inoculation with Bradyrhizobium enhanced cowpea performance under leafminer stress and increased protease inhibitor levels to decrease leafminer fitness. Overall, our study characterized the changes of root-associated microbiota between leafminer-infested and noninfested cowpea plants and revealed the mechanisms underlying the rhizosphere microbiome shift that enhance plant performance and defense against herbivory. Our findings provide further support for the notion that plants enrich rhizosphere microbes to counteract aboveground insect herbivores.

Megalurothrips usitatus Directly Causes the Black-Heads and Black-Tail Symptoms of Cowpea along with the Production of Insect-Resistance Flavonoids.

The thrip (Megalurothrips usitatus) damages the flowers and pods of the cowpea, causing "black-heads and black-tails" (BHBT) symptoms and negatively affecting its economic value. However, the mechanism by which BHBT symptoms develop is still unknown. Our results showed that the microstructure of the pod epidermis was altered and the content of the plant's resistance-related compounds increased after a thrip infestation. However, the contents of protein and free amino acids did not change significantly, suggesting that the nutritional value was not altered. Pathogens were found not to be involved in the formation of BHBT symptoms, as fungi and pathogenic bacteria were not enriched in damaged pods. Two herbivory-induced flavonoids-7,4'-dihydroxyflavone and coumestrol-were found to exert insecticidal activity. Our study clarified that BHBT symptoms are directly caused by the thrip. Thresholds for pest control need to be reconsidered as thrip herbivory did not degrade cowpea nutrition.

Formation of 8-hydroxylinalool in tea plant Camellia sinensis var. Assamica 'Hainan dayezhong'.

Linalool and its derivatives contribute greatly to tea aroma. Here, 8-hydroxylinalool was found to be one of the major linalool-derived aroma compounds in Camellia sinensis var. assamica 'Hainan dayezhong', a tea plant grown in Hainan Province, China. Both (Z)-8-hydroxylinalool and (E)-8-hydroxylinalool were detected, and the E type was the main compound. Its content fluctuated in different months and was the highest in the buds compared with other tissues. CsCYP76B1 and CsCYP76T1, located in the endoplasmic reticulum, were identified to catalyze the formation of 8-hydroxylinalool from linalool in the tea plant. During withering of black tea manufacturing, the content of both (Z)-8-hydroxylinalool and (E)-8-hydroxylinalool significantly increased. Further study suggested that jasmonate induced gene expression of CsCYP76B1 and CsCYP76T1, and the accumulated precursor linalool may also contribute to 8-hydroxylinalool accumulation. Thus, this study not only reveals 8-hydroxylinalool biosynthesis in tea plants but also sheds light on aroma formation in black tea.

Bone marrow free immune checkpoints as a potential biomarker for differential diagnosis of acquired bone marrow failures.

OBJECTIVE: Clinically, to make a definite diagnosis of aplastic anemia (AA), idiopathic cytopenia of undetermined significance (ICUS) or myelodysplastic syndrome (MDS), they should be distinguished from each other. AA and ICUS have some incidence to transform into MDS. Immunosuppressive therapy (IST) is effective in AA and partial ICUS patients, while other ICUSs are more likely to progress to MDS without response to IST. To date, we neither found a technical method that could easily identify AA from hypoproliferative MDS, nor a simple parameter that could indicate ICUS with a response to IST. Here, we detected the concentration of free immune checkpoints in bone marrow supernatant of AA, ICUS, and MDS patients, analyzed the differences of immune status among these three diseases, to try to find a way to predict the response to IST in ICUSs. METHODS: Seventy-four novel patients were enrolled with newly diagnosed acquired bone marrow failure (including 29 AA patients, 11 ICUS patients, and 34 MDS patients), bone marrow supernatants were collected. Luminex liquid suspension array technology was used to measure the concentrations of 17 immune checkpoints to analyze the differences of immune status among these three diseases. RESULTS: The levels of 17 free immune checkpoints were elevated in MDS and showed a strong correlation with each other, followed by ICUS, and with the weakest in AA. By drawing the ROC curve, we found eight immune checkpoints, including sCD40, sCD86/B7-2, sCTLA-4, sGITR, sHVEM, sPD-1, sTIM-3, and sTLR-2, could easily distinguish AA from hypoproliferative MDS. ICUSs with lower concentrations of these eight free immune checkpoints predicted a better IST response. CONCLUSION: In conclusion, we found that there were notable differences in the immune status of AA, ICUS, and MDS. The concentrations of sCD40, sCD86/B7-2, sCTLA-4, sGITR, sHVEM, sPD-1, sTIM-3, and sTLR-2 could be used to identify AA and hypoproliferative MDS patients, as well as to distinguish ICUS patients who could benefit from IST.

Retrospective Analysis of the Risk Factors and Drug Resistance of Pathogenic Bacteria in Systemic Inflammatory Response Syndrome After Ureteroscopic Holmium Laser Lithotripsy for Impacted Ureteral Calculi.

Objective: To investigate the risk factors, pathogen distribution, and drug resistance of systemic inflammatory response syndrome (SIRS) after holmium laser ureteroscopic lithotripsy for impacted ureteral calculi (HLULIUC). Patients and Methods: The clinical data of 293 patients with HLULIUC in our hospital from October 2017 to February 2021 were retrospectively collected, including age, BMI, stone size, operation time, urine routine, urine culture, basic illness, complete blood count, liver and kidney function, etc. Patients were divided into SIRS and non-SIRS groups according to whether they had SIRS or not. Then the differences in clinical data, blood and urine bacterial culture results, and drug resistance between the two groups were analyzed. Results: The incidence of SIRS after HLULIUC was 17.75%. Logistic regression analysis showed that the risk factors of SIRS after HLULIUC include ureteral calculi≥1cm (OR=2.839, 95% CI=1.341-5.647, P=0.021), long operation time (OR=4.534, 95% CI=2.597-12.751, P=0.017), diabetes mellitus (OR=3.137, 95% CI=1.142-7.319, P=0.012), increased preoperative C-reactive protein (OR=1.864, 95% CI=1.05-4.347, P=0.032), and positive urine leukocytes (OR=3.514, 95% CI=1.7237-9.734, P=0.007) and culture (OR=6.034, 95% CI=3.097-15.751, P<0.001) before operation. The main pathogens causing SIRS after HLULIUC were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa. The pathogenic bacteria are sensitive to drugs including piperacillin/tazobactam, meropenem, tigecycline, teicoplanin, vancomycin, and imipenem. The resistance rates to quinolones (such as levofloxacin) and to the second- and third-generations of cephalosporins were as high as 52.94%-90.19%. Conclusion: Ureteral calculi≥1cm, long operation time, diabetes, increased C-reactive protein, and preoperative positive urine leukocytes and culture are independent risk factors of SIRS after HLULIUC. Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa are the main pathogenic bacteria for SIRS after HLULIUC. The pathogenic bacteria are sensitive to drugs, including piperacillin/tazobactam, meropenem, tigecycline, teicoplanin, vancomycin, and imipenem.

Smartphone-based molecularly imprinted sensors for rapid detection of thiamethoxam residues and applications.

In order to achieve rapid detection of thiamethoxam residues in mango, cowpea and water, this study modified the screen printed carbon electrode (SPCE) to make a specific molecular imprinting sensor (Thiamethoxam-MIP/Au/rGO/SPCE) for thiamethoxam. An integrated smartphone platform was also built for thiamethoxam residue analysis. The performance of the complete system was analyzed by cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The system was then applied for the rapid determination of thiamethoxam residues in water, mango and cowpea samples. The results showed that the molecular sensor showed good linearity in the range 0.5-3.0 µmol/L of thiamethoxam. The detection limit of thiamethoxam was 0.5 µmol/L. Moreover, the sensor had good reproducibility and anti-interference performance. The average recovery rates of the pesticide residues in water, mango and cowpea samples were in the range of 90-110% with relative standard deviations < 5%. The rapid detection system for thiamethoxam residue constructed in this study was simple, reliable, reproducible and had strong anti-interference. It has broad application prospects in the field detection of thiamethoxam residue, and serves as a valuable reference for the further development of rapid detection technology of pesticide residues in the field of environment and food safety.

Analysis of imidacloprid residues in mango, cowpea and water samples based on portable molecular imprinting sensors.

Imidacloprid is a neonicotinoid insecticide widely used in the production and cultivation of crops. In recent years, the extensive use of imidacloprid in agricultural production has resulted in large amounts of pesticide residues in agricultural products and the environment. Therefore, it is necessary to establish a rapid, accurate, sensitive and convenient method for detecting imidacloprid pesticide residues to ensure the safety of agricultural products and the environment. To clarify how to use the molecular imprinting method for the electrochemical rapid residue detection of imidacloprid. This paper selected reduced graphene oxide and gold nanoparticles as modifiers modified on screen-printed carbon electrodes (SPCE) chitosan as a functional monomer, and imidacloprid as template molecule to prepare molecularly imprinted polymer, and applied this sensor to the residue detection of imidacloprid. The results showed that the concentration of imidacloprid showed a good linear relationship with the peak response current, and the detection limit of imidacloprid was 0.5 µM, while the sensor had good repeatability and interference resistance. The recoveries of imidacloprid spiked on three samples, mango, cowpea and water, were in the range of 90-110% (relative standard deviation, RSD<5%), which proved the practicality and feasibility of the assay established in this paper. The results of this paper can be used as a basis for the research on the detection of imidacloprid pesticide residues in food or environment.

CS2164 and Venetoclax Show Synergistic Antitumoral Activities in High Grade B-Cell Lymphomas With MYC and BCL2 Rearrangements.

High-grade B-cell lymphoma with concurrent MYC and BCL2 rearrangements (HGBL-DHL) is a rare, aggressive mature B-cell malignancy with a high likelihood of treatment failure following front-line immunochemotherapies. Patients with HGBL-DHL who develop a relapsed or refractory disease have little effective therapeutic strategies and show very poor clinical outcomes, thus calling for development of novel therapies for this specific patient population. In this study, we investigated the preclinical anti-lymphoma efficacies and potential mechanism of action of a novel treatment approach, combining the BCL2 inhibitor venetoclax with CS2164, a new orally active multitarget inhibitor, in HGBL-DHL models. This combination therapy exhibited a robust synergistic cytotoxicity against HGBL-DHL cells, evidenced by cooperatively inducing loss of cell viability and promoting cell apoptosis. Moreover, coadministration of CS2164 and venetoclax resulted in significant superior suppression of HGBL-DHL cell growth and remarkably abrogated tumor burden in a HGBL-DHL-xenografted mouse model. The synergistic lethality of CS2164 and venetoclax in HGBL-DHL cells was associated with induction of DNA damage and impairment of DNA repair ability. Of importance, the combined treatment almost abolished the expression of both BCL2 and MYC, two hallmark proteins of HGBL-DHL, and substantially blunted the activity of PI3K/AKT/mTOR signaling cascade. In addition, MCL1 and BCL-XL, two well-characterized contributors for venetoclax resistance, were significantly lessened in the presence of CS2164 and venetoclax, thus leading to the accumulation of proapoptotic proteins BAX and PUMA and then initiating the intrinsic apoptosis pathway. Taken together, these findings suggest that the regimen of CS2164 and venetoclax is highly effective to eliminate HGBL-DHL cells in the preclinical setting, warranting further clinical investigations of this regimen for the treatment of unfavorable HGBL-DHL patients.

Li-Zn Overlayer to Facilitate Uniform Lithium Deposition for Lithium Metal Batteries.

The highly reactive nature and rough surface of Li foil can lead to the uncontrollable formation of Li dendrites when employed as an anode in a lithium metal battery. Thus, it could be of great practical utility to create uniform, electrochemically stable, and "lithiophilic" surfaces to realize homogeneous deposition of Li. Herein, a LiZn alloy layer is deposited on the surface of Li foil by e-beam evaporation. The idea is to introduce a uniform alloy surface to increase the active area and make use of the Zn sites to induce homogeneous nucleation of Li. The results show that the alloy film protected the Li metal anode, allowing for a longer cycling life with a lower deposition overpotential over a pure-Li metal anode in symmetric Li cells. Furthermore, full cells pairing the modified lithium anode with a LiFePO4 cathode showed an incremental increase in Coulombic efficiency compared with pure-Li. The concept of using only an alloy modifying layer by an in-situ e-beam deposition synthesis method offers a potential method for enabling lithium metal anodes for next-generation lithium batteries.

Function and Application of Defect Chemistry in High-Capacity Electrode Materials for Li-Based Batteries.

Current commercial Li-based batteries are approaching their energy density limitation, yet still cannot satisfy the energy density demand of the high-end devices. Hence, it is critical to developing advanced electrode materials with high specific capacity. However, these electrode materials are facing challenges of severe structural degradation and fast capacity fading. Among various strategies, constructing defects in electrode materials holds great promise in addressing these issues. Herein, we summarize a series of significant defect engineering in the high-capacity electrode materials for Li-based batteries. The detailed retrospective on defects specification, function mechanism, and corresponding application achievements on these electrodes are discussed from the view of point, line, planar, volume defects. Defect engineering can not only stabilize the structure and enhance electric/ionic conductivity, but also act as active sites to improve the ionic storage and bonding ability of electrode materials to Li metal. We hope this review can spark more perspectives on evaluating high-energy-density Li-based batteries.

Tanshinone IIA Promotes M2 Microglia by ERß/IL-10 Pathway and Attenuates Neuronal Loss in Mouse TBI Model.

PURPOSE: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Increasing evidence indicates that activated microglia play an important role in the inflammatory response in TBI. Inhibiting M1 and stimulating M2 activated microglia have protective effects in several animal models of central nervous system (CNS) disorders. In the present study, we investigated whether tanshinone IIA (TNA) protects neurons by shifting microglia polarization in a mouse TBI model and further investigated the mechanism in vitro. MATERIALS AND METHODS: Forty C57BL/6 mice were used to investigate the effect of TNA on microglia polarization in TBI. BV-2 cells were used to examine the mechanism of TNA in regulating microglia polarization. RESULTS: Normal saline (NS), TNA and the combination of TNA with ICI 182,780 (ICI, an estrogen receptor antagonist) were used to treat the TBI mice. After TBI, mice from each group demonstrated functional improvement. The improvement rate in mice treated with TNA was faster than other groups. ICI partially reversed the benefits from TNA treatment. TNA treatment significantly reduced TBI-induced neuronal loss. The number of microglia after TBI was not significantly changed by TNA treatment. However, TNA treatment significantly decreased M1 macrophage markers (iNOS, TNFα and IL-1ß) and increased M2 macrophage markers (CD206, arginase 1 and Ym1). This effect was partially abolished by ICI. TNA treatment downregulated M1 macrophage markers and upregulated M2 macrophage markers in BV-2 cells under LPS stimulation. IL-10 was significantly increased by TNA treatment without a significantly change of IL-4 and IL-13 expression. IL-10 knockdown completely abolished the effect of TNA on microglial M2 polarization. CONCLUSION: Taken together, our data demonstrated that TNA attenuates neuronal loss in mouse TBI model and promotes M2 microglia by ERß/IL-10 pathway. Thus, TNA could be a potential drug for TBI and/or the disorders that caused by microglial over-activation in CNS.

10 years of health-care reform in China: progress and gaps in Universal Health Coverage.

In 2009, China launched a major health-care reform and pledged to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. The government has since quadrupled its funding for health. The reform's first phase (2009-11) emphasised expanding social health insurance coverage for all and strengthening infrastructure. The second phase (2012 onwards) prioritised reforming its health-care delivery system through: (1) systemic reform of public hospitals by removing mark-up for drug sales, adjusting fee schedules, and reforming provider payment and governance structures; and (2) overhaul of its hospital-centric and treatment-based delivery system. In the past 10 years, China has made substantial progress in improving equal access to care and enhancing financial protection, especially for people of a lower socioeconomic status. However, gaps remain in quality of care, control of non-communicable diseases (NCDs), efficiency in delivery, control of health expenditures, and public satisfaction. To meet the needs of China's ageing population that is facing an increased NCD burden, we recommend leveraging strategic purchasing, information technology, and local pilots to build a primary health-care (PHC)-based integrated delivery system by aligning the incentives and governance of hospitals and PHC systems, improving the quality of PHC providers, and educating the public on the value of prevention and health maintenance.

Ion- and Electron-Conductive Buffering Layer-Modified Si Film for Use as a High-Rate Long-Term Lithium-Ion Battery Anode.

The rational design of electrochemically and mechanically stable Si anodes is of great importance for the development of high energy density lithium-ion batteries. In this study, patterned Si-based (Si/ZnO/C) trilayer composite films were synthesized by magnetron sputtering with the assistance of a patterned mask. The electron-conductive C layer at the top of the composite film is deposited to enhance the interfacial stability between active film and electrolyte. The ion- and electron-conductive Li2 O-Zn middle layer can be ingeniously introduced by means of the poor reversed conversion reaction between ZnO and Li+ ions after the first cycle. The resultant Si/Li2 O-Zn/C trilayer composite film delivers a high reversible capacity of 1536 mAh g-1 after 800 cycles at a current density of 1.0 A g-1 and a long high-rate cycling stability (1400 mAh g-1 after 6000 cycles even at a high current density of 10.0 A g-1 ). Excellent rate capability and improved Coulombic efficiency are also achieved. The influences of the patterned structure and each modified layer on the electrochemical properties are analyzed systematically. This work offers a new and promising direction to enhance the lithium-storage properties of Si-based thin-film anodes.

A specific subtype of chronic obstructive pulmonary disease classified by forced vital capacity.

BACKGROUND: Forced expiratory volume in one second (FEV1) is widely used in grading the severity of the airflow limitation observed in chronic obstructive pulmonary disease (COPD). However, the characteristics of COPD classified by forced vital capacity (FVC) remain unknown. Hence, the characteristics of pulmonary function test (PFT) and clinical features of COPD patients classified by FVC were investigated. METHODS: COPD patients were classified into three groups by FVC: (I) large consistent FVC (LC-FVC): before bronchodilator (BBD) and after bronchodilator (ABD) FVC ≥80%pred; (II) inconsistent FVC (I-FVC): BBD FVC <80%pred, while ABD FVC ≥80%pred; (III) small consistent FVC (SC-FVC): BBD and ABD FVC <80%pred. The characteristics of pulmonary function and clinical features of 1,329 retrospective patients and 403 prospective patients were analyzed in different FVC subgroups. RESULTS: The percentages of LC-FVC, I-FVC and SC-FVC were 25.4%, 13.8% and 60.9%, respectively in the retrospective cohort, and were 34.0%, 15.6%, 50.4%, respectively in the prospective cohort. For the 1,329 retrospective patients, I-FVC showed the best responsiveness to bronchodilator when compared with those of LC-FVC and SC-FVC, no matter evaluated by FEV1 (0.21 vs. 0.14 vs. 0.10 L, P<0.001) or FVC (0.47 vs. 0.15 vs. 0.23 L, P<0.001), and similar results were found in the 403 prospective patients. Of the 405 retrospective patients who finished lung volume tests, I-FVC and SC-FVC demonstrated higher residual volume than that of LC-FVC (3.43 vs. 3.15 vs. 2.89 L, P<0.05), while I-FVC and LC-FVC showed higher total lung capacity than that of SC-FVC (5.92 vs. 6.06 vs. 5.18 L, P<0.05). In the prospective cohort, LC-FVC and I-FVC experienced more asthma comorbidity than that of SC-FVC (30.7% vs. 30.2% vs. 16.7%, P=0.005); I-FVC group tended to experience more exacerbation events than the other two groups (1.7 vs. 1.2 vs. 1.5, P=0.114). CONCLUSIONS: COPD patients classified by BBD and ABD FVC showed obviously different clinical characteristics, which could assist in distinguishing I-FVC patients who may benefit most from bronchodilators.

The Educational Gradient in Health in China.

It has been well established that better educated individuals enjoy better health and longevity. In theory, the educational gradients in health could be flattening if diminishing returns to improved average education levels and the influence of earlier population health interventions outweigh the gradient-steepening effects of new medical and health technologies. This paper documents how the gradients are evolving in China, a rapidly developing country, about which little is known on this topic. Based on recent mortality data and nationally representative health surveys, we find large and, in some cases, steepening educational gradients. We also find that the gradients vary by cohort, gender and region. Further, we find that the gradients can only partially be accounted for by economic factors. These patterns highlight the double disadvantage of those with low education, and suggest the importance of policy interventions that foster both aspects of human capital for them.

Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma.

Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

Security and cost comparison of INR self-testing and conventional hospital INR testing in patients with mechanical heart valve replacement.

BACKGROUND: International normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement. Several reviews and studies have demonstrated self-management as an option to improve patient's outcome considerably after mechanical heart valve replacement. We sought to analyze the security, economy and discuss the prospect of self-testing of anticoagulation therapy in patients following mechanical heart valve replacement in China, and evaluate the accuracy and stability of CoaguChek XS portable INR-testing device. METHODS: This was a prospective self-controlled clinical study conducted with 526 patients receiving oral warfarin anticoagulation therapy after mechanical heart valve replacement in the period of Mar.1, 2012 - Nov.1, 2012 in Cardiovascular Surgery Department of West China Hospital of Sichuan University. The same patient performed INR testing with CoaguChek XS portable coagulometer (group1) and central lab (group 2) in parallel. The follow-up time was 6 months. Meanwhile, a questionnaire was handed out to survey the expenses required for the re-examination visits to the hospital, time, and anticoagulation complications. RESULTS: No severe anticoagulation complications occurred in all the patients. No significant difference of the INR results were observed between group 1 and group 2, they showed significant relevance, r = 0.953(p < 0.05). Compared with the conventional method of INR testing in hospital, the portable coagulometer is convenient, quick and less traumatic. Self-testing of anticoagulation therapy reduced the cost and the time required for re-examination. CONCLUSIONS: Results of CoaguChek XS monitor are precise and have a good consistency and stability as compared with traditional laboratory testing. For the patients receiving anticoagulation therapy after mechanical heart valve replacement, the self-testing of anticoagulation therapy with portable coagulometer is a safe choice, and it has a promising future application in China.

Portal vein thrombosis after aortic valve replacement surgery in a patient with antithrombin III deficiency--case presentation.

We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency. PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported.