Prediction of carbapenem-resistant gram-negative bacterial bloodstream infection in intensive care unit based on machine learning.

BACKGROUND: Predicting whether Carbapenem-Resistant Gram-Negative Bacterial (CRGNB) cause bloodstream infection when giving advice may guide the use of antibiotics because it takes 2-5 days conventionally to return the results from doctor's order. METHODS: It is a regional multi-center retrospective study in which patients with suspected bloodstream infections were divided into a positive and negative culture group. According to the positive results, patients were divided into the CRGNB group and other groups. We used the machine learning algorithm to predict whether the blood culture was positive and whether the pathogen was CRGNB once giving the order of blood culture. RESULTS: There were 952 patients with positive blood cultures, 418 patients in the CRGNB group, 534 in the non-CRGNB group, and 1422 with negative blood cultures. Mechanical ventilation, invasive catheterization, and carbapenem use history were the main high-risk factors for CRGNB bloodstream infection. The random forest model has the best prediction ability, with AUROC being 0.86, followed by the XGBoost prediction model in bloodstream infection prediction. In the CRGNB prediction model analysis, the SVM and random forest model have higher area under the receiver operating characteristic curves, which are 0.88 and 0.87, respectively. CONCLUSIONS: The machine learning algorithm can accurately predict the occurrence of ICU-acquired bloodstream infection and identify whether CRGNB causes it once giving the order of blood culture.

Scalable integration of hybrid high-κ dielectric materials on two-dimensional semiconductors.

Two-dimensional (2D) semiconductors are promising channel materials for next-generation field-effect transistors (FETs). However, it remains challenging to integrate ultrathin and uniform high-κ dielectrics on 2D semiconductors to fabricate FETs with large gate capacitance. We report a versatile two-step approach to integrating high-quality dielectric film with sub-1 nm equivalent oxide thickness (EOT) on 2D semiconductors. Inorganic molecular crystal Sb2O3 is homogeneously deposited on 2D semiconductors as a buffer layer, which forms a high-quality oxide-to-semiconductor interface and offers a highly hydrophilic surface, enabling the integration of high-κ dielectrics via atomic layer deposition. Using this approach, we can fabricate monolayer molybdenum disulfide-based FETs with the thinnest EOT (0.67 nm). The transistors exhibit an on/off ratio of over 106 using an ultra-low operating voltage of 0.4 V, achieving unprecedently high gating efficiency. Our results may pave the way for the application of 2D materials in low-power ultrascaling electronics.

Single Crystals of a Highly Conductive Three-Dimensional Conjugated Coordination Polymer.

Conjugated coordination polymers (CCPs), which possess long-range planar π-d conjugation, are fascinating for various applications because they inherit the merits of both metal-organic frameworks (MOFs) and conducting polymers. However, only one-dimensional (1D) and two-dimensional (2D) CCPs have been reported so far. The synthesis of three-dimensional (3D) CCPs is challenging and even seems theoretically infeasible because conjugation implies 1D or 2D structure. Besides, the redox activity of the conjugated ligands and the π-d conjugation makes the synthesis of CCPs very complicated, and hence, single crystals of CCPs are rarely achieved. Herein, we reported the first 3D CCP and its single crystals with atomically precise structures. The synthesis process involves complicated in situ dimerization, deprotonation of ligands, oxidation/reduction of both ligands and metal ions, and precise coordination between them. The crystals contain in-plane 1D π-d conjugated chains and close π-π interactions between the adjacent chains that are bridged by another column of stacked chains, thus forming 3D CCP with high conductivity (400 S m-1 at room temperature and 3100 S m-1 at 423 K) and potential applications as cathodes in sodium-ion batteries with high capacity, rate capability, and cyclability.

Ceftazidime/Avibactam for the Treatment of Carbapenem-Resistant Pseudomonas aeruginosa Infection in Lung Transplant Recipients.

Background: Experience of ceftazidime-avibactam (CAZ/AVI) for carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection in recipients after lung transplantation (LT) is relatively limited. Methods: A retrospective observational study was conducted on lung transplant recipients receiving CAZ/AVI therapy for CRPA infection. The primary outcomes were the 14-day and 30-day mortality. The secondary outcomes were clinical cure and microbiological cure. Results: Among 183 LT recipients, a total of 15 recipients with CRPA infection who received CAZ/AVI therapy were enrolled in this study. The mean age of recipients was 54 years and 73.3% of recipients were male. The median time from infection onset to initiation of CAZ/AVI treatment was 4 days (IQR, 3-7) and the mean duration of CAZ/AVI therapy was 10 days. CAZ/AVI was mainly administered as monotherapy in LT recipients (80%). Among these eligible recipients, 14-day and 30-day mortality were 6.7% and 13.3%, respectively. The clinical cure and microbiological cure rates of CAZ/AVI therapy were 53.3% and 60%, respectively. Three recipients (20%) experienced recurrent infection. In addition, the mean lengths of ICU stay and hospital stay were 24 days and 35 days, respectively, among LT recipients. Conclusion: CAZ/AVI may be an alternative and promising regimen for CRPA eradiation in lung transplant recipients.

Gate Dielectrics Integration for 2D Electronics: Challenges, Advances, and Outlook.

2D semiconductors have emerged both as an ideal platform for fundamental studies and as promising channel materials in beyond-silicon field-effect-transistors due to their outstanding electrical properties and exceptional tunability via external field. However, the lack of proper dielectrics for 2D semiconductors has become a major roadblock for their further development toward practical applications. The prominent issues between conventional 3D dielectrics and 2D semiconductors arise from the integration and interface quality, where defect states and imperfections lead to dramatic deterioration of device performance. In this review article, the root causes of such issues are briefly analyzed and recent advances on some possible solutions, including various approaches of adapting conventional dielectrics to 2D semiconductors, and the development of novel dielectrics with van der Waals surface toward high-performance 2D electronics are summarized. Then, in the perspective, the requirements of ideal dielectrics for state-of-the-art 2D devices are outlined and an outlook for their future development is provided.

Giant Tunability of Charge Transport in 2D Inorganic Molecular Crystals by Pressure Engineering.

The unique intermolecular van der Waals force in emerging two-dimensional inorganic molecular crystals (2DIMCs) endows them with highly tunable structures and properties upon applying external stimuli. Using high pressure to modulate the intermolecular bonding, here we reveal the highly tunable charge transport behavior in 2DIMCs for the first time, from an insulator to a semiconductor. As pressure increases, 2D α-Sb2 O3 molecular crystal undergoes three isostructural transitions, and the intermolecular bonding enhances gradually, which results in a considerably decreased band gap by 25 % and a greatly enhanced charge transport. Impressively, the in situ resistivity measurement of the α-Sb2 O3 flake shows a sharp drop by 5 orders of magnitude in 0-3.2 GPa. This work sheds new light on the manipulation of charge transport in 2DIMCs and is of great significance for promoting the fundamental understanding and potential applications of 2DIMCs in advanced modern technologies.

Case report: AngioJet thrombectomy with extracorporeal membrane oxygenation support for acute massive pulmonary embolism in a severe multiple trauma patient.

Acute massive pulmonary embolism (PE) is one of the main leading causes of high cardiovascular mortality, and the prognosis strongly varies, depending on the severity of pulmonary arterial obstruction and its impact on the RV function. Alternative therapy approaches comprise systemic thrombolysis, catheter-directed thrombolysis, catheter embolectomy, catheter-assisted fragmentation techniques, and surgical thrombectomy. The following case study explores a 72-year-old man with severe multiple trauma who suffered from a sudden massive pulmonary embolism and presented with an unstable hemodynamic status. Extracorporeal membrane oxygenation (ECMO) has amply proven its efficacy in supplying cardiopulmonary assistance for this patient shocked by a massive PE with contraindication for thrombolysis. AngioJet catheter embolectomy and ECMO were performed, which finally cleared the massive pulmonary embolism away and improved the patient's hemodynamic status. The use of ECMO was continued during the weaning program, on the fifth day after ECMO decannulation, the patient was extubated and transferred to a local hospital for further recuperation. This case highlights that the AngioJet thrombectomy with the combination use of ECMO may be a potential choice of treatment for unstable PE patients.

Case report: Total percutaneous post-closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) which is a form of circulatory and gas exchange support. Following VA-ECMO, total percutaneous closure of the site of femoral arterial puncture with perclose Proglide (PP) has become widespread, enhancing patient comfort and lessening the incidence of wound infections and lymphatic fistulas in a short closure time. The preclose technique with perclose Proglide provides numerous benefits, however, it prolongs extra time during the VA-ECMO procedure, adds additional post-operative care to workloads, and increases the potential for Proglide stitch infection. The modified technique-percutaneous post-closure, described here by a case of a 65-year-old man with heart attack who underwent VA-ECMO, is a simple, rapidly applied technique to wean VA-ECMO also suitable for emergency cannulation. The patient was administered mechanically ventilated and sedated and the femoral artery access site and evaluated by ultrasound for precise positioning, then the VA-ECMO arterial cannula was withdrawn, and a 0.035-in guidewire was left in the artery. The first set of sutures was deployed after the Proglide device was inserted over the guidewire. The second sutures were then replaced in the same way but at a different angle. After hemostasis was achieved, the guidewire was removed, and additional manual compression was used to control any residual blood seeping. No hematoma, pseudoaneurysm, major bleeding, minor bleeding, acute arterial thrombosis, arteriovenous fistula, groin infection, lymphocele, or arterial dissection and stenosis occurred during the periprocedural period or during the 30-day post-procedural follow-up. In conclusion, the standardized algorithm we established, total percutaneous post-closure of femoral arteriotomies utilizing Perclose ProGlide device is feasible and safe with a low incidence of access site complications.

Heterotopic lung transplant: a feasible approach to compensate for organ shortages.

Lung transplants are still limited by the shortage of suitable donor lungs, especially during the coronavirus disease 2019 pandemic. A heterotopic lung transplant (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its widespread use is hindered by difficulties in anastomosis and paucity of outcome data. We performed a retrospective review of 4 patients, each of whom received an HLTxs over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs and 1 lobar HLTx (right upper lobe-to-left). The median recipient age was 58.5 years (46-68); 3 patients were male. The postoperative hospital stay was 33 days (30-42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome; the others were alive with no major morbidity at 12 to 31 months after the operation with a 1-year survival of 100%. The follow-up chest images showed that transplanted lungs could be inflated well and adapted morphologically to fill the thoracic cavity in the short and long term. This study demonstrates that an HLTx is a feasible alternative to a conventional lung transplant in emergency cases and could be considered in selected patients at advanced medical centres.

Active surveillance of carbapenem-resistant gram-negative bacteria to guide antibiotic therapy: a single-center prospective observational study.

BACKGROUND: Carbapenem-resistant gram-negative bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. METHODS: A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. RESULTS: 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). CONCLUSIONS: CRGNB colonized patients who are prone to infection have some high-risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, early use of effective antibiotics may be associated with reduced mortality, but more studies are needed.

Extracorporeal Membrane Oxygenation-First Strategy for Acute Life-Threatening Pulmonary Embolism.

Background: Both venoarterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous mechanical thrombectomy (PMT) are increasingly used to treat acute life-threatening pulmonary embolism (PE). However, there are little data regarding their effectiveness. This study aimed to present the short-term outcomes after managing nine patients with acute life-threatening massive or submassive PE by VA-ECMO with or without complemented PMT and propose a preliminary treatment algorithm. Methods: This study was a single-center retrospective review of a prospectively maintained registry. It included nine consecutive patients with massive or submassive pulmonary embolism who underwent VA-ECMO for initial hemodynamic stabilization, with or without PMT, from August 2018 to November 2021. Results: Mean patient age was 54.7 years. Four of nine patients (44.4%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All cannulations (100%) were successfully performed percutaneously. Overall survival was 88.9% (8 of 9 patients). One patient died from a hemorrhagic stroke. Of the survivors, the median ECMO duration was 8 days in patients treated with ECMO alone and 4 days in those treated with EMCO and PMT. Five of nine patients (55.6%) required concomitant PMT to address persistent right heart dysfunction, with the remaining survivors (44.4%) receiving VA-ECMO and anticoagulation alone. For survivors receiving VA-ECMO plus PMT, median hospital lengths of stay were 7 and 13 days, respectively. Conclusions: An ECMO-first strategy complemented with PMT can be performed effectively and safely for acute life-threatening massive or submassive PE. VA-ECMO is feasible for initial stabilization, serving as a bridge to therapy primarily in inoperable patients with massive PE. Further evaluation in a larger cohort of patients is warranted to assess whether VA-ECMO plus PMT may offer an alternative or complementary therapy to thrombolysis or surgical thrombectomy. Type of Research: Single-center retrospective review of a prospectively maintained registry.

Scalable Van der Waals Encapsulation by Inorganic Molecular Crystals.

Encapsulation is critical for devices to guarantee their stability and reliability. It becomes an even more essential requirement for devices based on 2D materials with atomic thinness and far inferior stability compared to their bulk counterparts. Here a general van der Waals (vdW) encapsulation method for 2D materials using Sb2 O3 layer of inorganic molecular crystal fabricated via thermal evaporation deposition is reported. It is demonstrated that such a scalable encapsulation method not only maintains the intrinsic properties of typical air-susceptible 2D materials due to their vdW interactions but also remarkably improves their environmental stability. Specifically, the encapsulated black phosphorus (BP) exhibits greatly enhanced structural stability of over 80 days and more sustaining-electrical properties of 19 days, while the bare BP undergoes degradation within hours. Moreover, the encapsulation layer can be facilely removed by sublimation in vacuum without damaging the underlying materials. This scalable encapsulation method shows a promising pathway to effectively enhance the environmental stability of 2D materials, which may further boost their practical application in novel (opto)electronic devices.

Comparison of Success Rate and Complications of Totally Percutaneous Decannulation in Patients With Veno-Arterial Extracorporeal Membrane Oxygenation and Endovascular Aneurysm Repair.

Background: Total percutaneous closure for the site of femoral arterial puncture using Perclose ProGlide (PP) has become prevalent post-percutaneous endovascular aortic repair (EVAR) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Objective: To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site post-EVAR compared with VA-ECMO. Methods: This was a retrospective observational study conducted over 4 years, including 88 patients who underwent EVAR (64 patients) and VA-ECMO (24 patients). Perclose ProGlide devices were used in the femoral artery puncture sites closed percutaneously. In this study, technical success was defined as successful arterial closure of the common femoral artery (CFA) without additional surgical or endovascular procedures to prevent vessel leaking. Access site complications, including overt bleeding requiring transfusion or surgical intervention, minor bleeding, tinea cruris, pseudoaneurysm, and lymphocele, were recorded 24 h and 30 days after arterial closure. Results: Each group's technical success rates were 95.8% (VA-ECMO) and 92.2% EVAR, respectively. There were no differences in the periprocedural complications of major bleeding, pseudoaneurysm, minor bleeding, acute limb ischemia, and groin infection. Furthermore, we did not observe any complications such as arterial thrombosis, dissection, stenosis, arteriovenous fistula, hematoma, groin infection, or lymphocele at the access site by following-up an ultrasound examination. There was no significant difference in the technical success rate of percutaneous closure by the PP device in the EVAR and VA-ECMO oxygenation groups. Also, no periprocedural or 30-day complications were observed at the access site of the EVAR and VA-ECMO patients.

Edge-enriched WS2 nanosheets on carbon nanofibers boosts NO2 detection at room temperature.

Two-dimensional (2D) transition metal dichalcogenides (TMDs) hold great promise for room temperature (RT) NO2 sensors. However, the exposure of the edges of TMDs with high adsorption capability and electronic activity remains a great obstacle to achieve high sensor sensitivity. Herein, we demonstrate a high-performance RT NO2 gas sensor based on WS2 nanosheets/carbon nanofibers (CNFs) composite with abundant intentionally exposed WS2 edges. Few-layer WS2 nanosheets are anchored on CNFs through a hydrothermal process. The approach permits to achieve a coating presenting an optimized active surface area and accessibility of the sensing layers. The exposure of WS2 edges remarkably improves the sensing properties. Consequently, the WS2@CNFs composite exhibits excellent selectivity to NO2 at RT with improved response and much lower detection limit in comparison to the WS2 and CNFs counterparts. Density functional theory (DFT) calculations verify a surprisingly strong NO2 adsorption on WS2 edge sites (adsorption energy 3.40 eV) with a partial charge transfer of 0.394e, while a week adsorption on the basal surface of WS2 (adsorption energy 0.25 eV) with a partial charge transfer of 0.171e. The strategy proposed herein will be instructive to the design of efficient material structures for low-power NO2 sensors with optimized performances.

Oxygen Vacancies Enabled Porous SnO2 Thin Films for Highly Sensitive Detection of Triethylamine at Room Temperature.

Detection of volatile organic compounds (VOCs) at room temperature (RT) currently remains a challenge for metal oxide semiconductor (MOS) gas sensors. Herein, for the first time, we report on the utilization of porous SnO2 thin films for RT detection of VOCs by defect engineering of oxygen vacancies. The oxygen vacancies in the three-dimensional-ordered SnO2 thin films, prepared by a colloidal template method, can be readily manipulated by thermal annealing at different temperatures. It is found that oxygen vacancies play an important role in the RT sensing performances, which successfully enables the sensor to respond to triethylamine (TEA) with an ultrahigh response, for example, 150.5-10 ppm TEA in a highly selective manner. In addition, the sensor based on oxygen vacancy-rich SnO2 thin films delivers a fast response and recovery speed (53 and 120 s), which can be further shortened to 10 and 36 s by elevating the working temperature to 120 °C. Notably, a low detection limit of 110 ppb has been obtained at RT. The overall performances surpass most previous reports on TEA detection at RT. The outstanding sensing properties can be attributed to the porous structure with abundant oxygen vacancies, which can improve the adsorption of molecules. The oxygen vacancy engineering strategy and the on-chip fabrication of porous MOS thin film sensing layers deliver great potential for creating high-performance RT sensors.

Feasibility and safety of total percutaneous closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation.

To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the Perclose ProGlide device.This retrospective observational study during an almost 2-year period included 21 patients who underwent VA-ECMO in whom the femoral artery puncture site was closed percutaneously with Perclose ProGlide devices. Technical success was defined as successful arterial closure of the common femoral artery, without the need for additional surgical or endovascular procedures. Access site complications were recorded at 24 hours and 30 days after arterial closure, such as major bleeding requiring transfusion or surgical intervention, minor bleeding, groin infection, pseudoaneurysm, and lymphocele.Technical success was achieved in 20 patients (95.2%). One patient required surgical repair for an access site pseudoaneurysm. Eighteen femoral arteries were closed with 2 devices each, while 3 patients required the use of a third device for femoral artery access site closure to achieve adequate hemostasis. No arterial thrombosis, arterial dissection, arterial stenosis, groin infection, or arteriovenous fistula occurred during the periprocedural period (within 24 hours of arterial closure) or during 30-day follow-up.Percutaneous closure with the Perclose ProGlide device is a feasible procedure for closing femoral arterial access sites after VA-ECMO, with a low incidence of access site complications.

α-Mangostin suppresses NLRP3 inflammasome activation via promoting autophagy in LPS-stimulated murine macrophages and protects against CLP-induced sepsis in mice.

BACKGROUND: The major mechanism of sepsis is immunosuppression caused by host response dysfunction. It has been found that α-Mangostin (α-M) is a potential candidate as a treatment for multiple inflammatory and immune disorders. To date, the role of α-M in host response during sepsis remains unexplored. METHODS AND RESULTS: Herein, we examined the effect of α-M on macrophages-mediated host response in the presence of lipopolysaccharide (LPS), and the vital organ function, inflammatory response, and survival rate in septic mice. In murine peritoneal macrophages, α-M induced autophagy and then inhibited LPS-stimulated NLRP3 inflammasome activation, as well as interleukin-1ß (IL-1ß) production. Moreover, α-M improved phagocytosis and killing of macrophages, and increased M2 macrophages numbers after LPS stimulation. Furthermore, in vivo experiment suggested that α-M reduced serum levels of tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-1ß, alanine transaminase (ALT), aspartate transaminase (AST), and creatinine (Cr), whilst increased that of interleukin-10 (IL-10) in caecal ligation and puncture (CLP) mice. CONCLUSION: Taken together, these findings showed that α-M-mediated macrophages autophagy contributed to NLRP3 inflammasome inactivation and α-M exerted organ protection in septic mice.

Enhancing the Lithium Storage Performance of Graphene/SnO2 Nanorods by a Carbon-Riveting Strategy.

Graphene/metal oxide (MO) nanocomposites hold great promise for application as anodes in lithium-ion batteries (LIBs). However, the restacking of graphene during subsequent processing remains a challenge to overcome for enhanced lithium storage properties. Herein, the fabrication of sandwich-architecture carbon-riveted graphene/SnO2 nanorods, in which the SnO2 nanorods are confined in the nanospaces formed by the carbon layers on graphene, by a two-step hydrothermal process followed by thermal treatment, is reported. Electrochemical tests show that the carbon-riveted nanolayers significantly improve the lithium storage performance of graphene/SnO2 . The nanocomposite displays a high reversible capacity of 815 mAh g-1 after 150 cycles at 100 mA g-1 and high cycling stability at 1000 mA g-1 . This work provides an efficient way to manipulate graphene/MO-based nanocomposites for LIBs with improved performance.

Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients.

Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection that is independently associated with mortality. Accurate diagnosis and timely treatment have been shown to improve the prognosis of VAP. Chest X-ray or computed tomography imaging are used for conventional assessment of VAP, but these methods are impractical for real-time measurement in critical patients. Therefore, lung ultrasound (LUS) has been increasingly used for the assessment of VAP in the ICU. Traditionally, LUS has seemed unsuitable for the detection of lung parenchyma owing to the high acoustic impedance of air; however, the fact that the reflection and reverberation in the detection region of the ultrasound reflect the underlying pathology of lung diseases has led to the increased use of ultrasound imaging as a standard of care supported by evidence-based and expert consensus in the ICU. Considering that any type of pneumonia causes air volume changes in the lungs, accumulating evidence has shown that LUS effectively measures the presence of VAP as well as dynamic changes in VAP. This review offers evidence for ultrasound as a noninvasive, easily repeatable, and bedside means to assess VAP; in addition, it establishes a protocol for qualitative and quantitative monitoring of VAP.