Modified traditional TNM staging of pyriform sinus and hypopharyngeal and laryngeal cancer based on lymph node ratio and its clinical significance: a population-based study combined with external validation.

BACKGROUND: To evaluate the application value of a new TLNRM staging prediction model based on lymph node ratio (LNR) in patients with Pyriform Sinus and Hypopharyngeal and Laryngeal cancer (PHLC). METHODS: A total of 2,257 patients with pathologically diagnosed PHLC from 2004 through 2019 were collected from the SEE database for analysis. The N staging of AJCC was replaced by LNR, and we compared the differences in patient prognosis and judgment ability between the new TLNRM staging and the 8th edition TNM staging. At the same time, data from 1,094 people in our hospital were included for external verification and validation. RESULTS: We selected four cutoff points based on LNR and reclassified N staging into five groups (LNR1-5). Compared to the traditional TNM staging (8th edition), the new TLNRM staging showed a statistically significant 5-year OS difference. The decision curve showed that the new TLNRM staging had a higher net benefit for different decision thresholds than the traditional TNM staging system's prediction line. The smaller AIC and BIC suggested that the new staging system had a higher sensitivity to prognosis evaluation compared to the traditional staging system. TLNRM stage III patients can benefit from radiotherapy, while TLNRM IVA and IVB patients can benefit from chemoradiotherapy. The same conclusion has been drawn from external validation data from our center. CONCLUSIONS: Compared with the traditional 8th edition AJCC staging system, the new TLNRM staging system has advantages in predicting the staging and prognosis of PHLC patients, and can independently guide postoperative chemoradiotherapy in patients.

A Predefined-Time Adaptive Zeroing Neural Network for Solving Time-Varying Linear Equations and Its Application to UR 5 Robot.

Time-varying linear equations (TVLEs) play a fundamental role in the engineering field and are of great practical value. Existing methods for the TVLE still have issues with long computation time and insufficient noise resistance. Zeroing neural network (ZNN) with parallel distribution and interference tolerance traits can mitigate these deficiencies and thus are good candidates for the TVLE. Therefore, a new predefined-time adaptive ZNN (PTAZNN) model is proposed for addressing the TVLE in this article. Unlike previous ZNN models with time-varying parameters, the PTAZNN model adopts a novel error-based adaptive parameter, which makes the convergence process more rapid and avoids unnecessary waste of computational resources caused by large parameters. Moreover, the stability, convergence, and robustness of the PTAZNN model are rigorously analyzed. Two numerical examples reflect that the PTAZNN model possesses shorter convergence time and better robustness compared with several variable-parameter ZNN models. In addition, the PTAZNN model is applied to solve the inverse kinematic solution of UR 5 robot on the simulation platform CoppeliaSim, and the results further indicate the feasibility of this model intuitively.

Hydrogels Containing Chitosan-Modified Gold Nanoparticles Show Significant Efficacy in Healing Diabetic Wounds Infected with Antibiotic-Resistant Bacteria.

Purpose: Persistent Infections and inflammation are associated with impaired wound healing in diabetic patients. There is a pressing demand for innovative antimicrobial strategies to address infections arising from antibiotic-resistant bacteria. Polymer-modified gold nanoparticles (AuNPs) show broad-spectrum antibacterial properties and significant biocompatibility. This study investigated the antibacterial and wound healing efficacy of hydrogel dressings conjugated with chitosan-AuNPs in diabetic model rats. Methods: Chitosan (CS)-functionalized gold nanoparticles (CS-AuNPs) were incorporated into hydrogel dressings (Gel/CS-AuNPs), which were formulated through the chemical cross-linking of gelatin with sodium alginate (SA). The basic characteristics of Gel/CS-AuNPs were analyzed by TEM, SEM, XRD, and UV-visible spectra. Rheological, swelling, degradation, and adhesive properties of Gel/CS-AuNPs were also determined. In vitro anti-bactericidal effects of the Gel/CS-AuNPs were analyzed with E. coli, S. aureus, and MRSA. In vitro biocompatibility of the Gel/CS-AuNPs was evaluated using NIH3T3 cells. The in vivo antibacterial and wound healing efficacy of the Gel/CS-AuNPs was analyzed in the diabetic wound model rats. Histological and immunofluorescence staining were performed to determine the status of angiogenesis, epithelization, inflammation response, and collagen deposition. Results: Gel/CS-AuNPs demonstrated significant high biodegradability, water absorption bactericidal, and biocompatibility, and slight adhesiveness. Gel/CS-AuNPs exhibited pronounced antibacterial efficacy against gram-negative, gram-positive, and MRSA in a CS-AuNPs-dose-dependent manner. In the diabetic wound model rats, Gel/CS-AuNPs effectively killed MRSA, reduced inflammation, and promoted angiogenesis and collagen deposition and remodeling at the wound site. As a result, Gel/CS-AuNPs expedited the recovery process for infected diabetic wounds. Among the hydrogels with different CS-AuNPs concentrations, Gel/CS-Au25 with 25% CS-AuNPs showed the best bactericidal and wound healing performance. Conclusion: Gel/CS-AuNPs significantly improve the healing of MRSA-infected diabetic wounds in the rat model. Therefore, Gel/CS-AuNPs show great promise for the treatment of diabetic infection wound healing.

Functional hemostatic hydrogels: design based on procoagulant principles.

Uncontrolled hemorrhage results in various complications and is currently the leading cause of death in the general population. Traditional hemostatic methods have drawbacks that may lead to ineffective hemostasis and even the risk of secondary injury. Therefore, there is an urgent need for more effective hemostatic techniques. Polymeric hemostatic materials, particularly hydrogels, are ideal due to their biocompatibility, flexibility, absorption, and versatility. Functional hemostatic hydrogels can enhance hemostasis by creating physical circumstances conducive to hemostasis or by directly interfering with the physiological processes of hemostasis. The procoagulant principles include increasing the concentration of localized hemostatic substances or establishing a physical barrier at the physical level and intervention in blood cells or the coagulation cascade at the physiological level. Moreover, synergistic hemostasis can combine these functions. However, some hydrogels are ineffective in promoting hemostasis or have a limited application scope. These defects have impeded the advancement of hemostatic hydrogels. To provide inspiration and resources for new designs, this review provides an overview of the procoagulant principles of hemostatic hydrogels. We also discuss the challenges in developing effective hemostatic hydrogels and provide viewpoints.

GeSe-evoked synchronous strategy for electrodeposited CZGSe solar cells.

Sn-free Cu2ZnGeSe4 (CZGSe) is emerging as a promising non-toxic and earth-abundant photovoltaic absorber material due to its attractive electrical and optical properties as well as its high theoretical conversion efficiency. Nevertheless, no photovoltaic device fabricated through the green electrodeposition process has yet been reported, likely due to the poor solubility of Ge-based salts and harsh electrodeposition conditions. Herein, we propose a GeSe-evoked synchronous strategy involving a Ge incorporation and selenization-regulated co-heating process of GeSe and Se, following electrodeposition of a Cu-Zn preformed layer. We experimentally found that the low-melting-point GeSe could promote the crystal growth and induce a high-quality bulk absorber layer and good back interface. In the GeSe-promoted sample, it was found that MoSe2 could ensure a good back quasi-Ohmic contact, and the band bending at the grain boundaries (GBs) was favorably inverted. Moreover, the depletion region width was also prolonged, and the deleterious CuZn near EF was passivated, leading to an increased carrier separation. In turn, a surprising progress in device performance was found, achieving a ground-breaking efficiency of 3.69%, and it could fill the bank of green electrodeposited CZGSe-based solar cells.

Experimental Investigation of Solar-Driven Hollow Fiber Membrane Liquid Dehumidification System.

The hollow fiber membrane modules act as dehumidifiers and regenerators to avoid gas-liquid entrainment problems in direct-contact dehumidification systems. A solar-driven hollow fiber membrane dehumidification experimental rig was designed to investigate its performance from July to September in Guilin, China. The dehumidification, regeneration, and cooling performance of the system between 8:30 and 17:30 are analyzed. The energy utilization of the solar collector and system is investigated. The results show that solar radiation has a significant influence on the system. The hourly regeneration of the system has the same trend as the temperature of solar hot water, which ranges from 0.13 g/s to 0.36 g/s. The regeneration capacity of the dehumidification system is always larger than the dehumidification capacity after 10:30, which increases the solution concentration and the dehumidification performance. Further, it ensures stable system operation when the solar radiation is lower (15:30-17:50). In addition, the hourly dehumidification capacity and efficiency of the system ranges from 0.15 g/s to 0.23 g/s and 52.4 to 71.3%, respectively, with good dehumidification performance. The COP of the system and solar collector have the same trend, in which their maximum values are 0.874 and 0.634, respectively, with high energy utilization efficiency. The solar-driven hollow fiber membrane liquid dehumidification system performs better in regions with larger solar radiation.

Recent advances in biomimetic hemostatic materials.

Although the past decade has witnessed unprecedented medical advances, achieving rapid and effective hemostasis remains challenging. Uncontrolled bleeding and wound infections continue to plague healthcare providers, increasing the risk of death. Various types of hemostatic materials are nowadays used during clinical practice but have many limitations, including poor biocompatibility, toxicity and biodegradability. Recently, there has been a burgeoning interest in organisms that stick to objects or produce sticky substances. Indeed, applying biological adhesion properties to hemostatic materials remains an interesting approach. This paper reviews the biological behavior, bionics, and mechanisms related to hemostasis. Furthermore, this paper covers the benefits, challenges and prospects of biomimetic hemostatic materials.

Covalently Interlayer-Confined Organic-Inorganic Heterostructures for Aqueous Potassium Ion Supercapacitors.

Artificial assembly of organic-inorganic heterostructures for electrochemical energy storage at the molecular level is promising, but remains a great challenge. Here, a covalently interlayer-confined organic (polyaniline [PANI])-inorganic (MoS2 ) hybrid with a dual charge-storage mechanism is developed for boosting the reaction kinetics of supercapacitors. Systematic characterizations reveal that PANI induces a partial phase transition from the 2H to 1T phases of MoS2 , expands the interlayer spacing of MoS2 , and increases the hydrophilicity. More in-depth insights from the synchrotron radiation-based X-ray technique illustrate that the covalent grafting of PANI to MoS2  induces the formation of MoN bonds and unsaturated Mo sites, leading to increased active sites. Theoretical analysis reveals that the covalent assembly facilitates cross-layer electron transfer and decreases the diffusion barrier of K+ ions, which favors reaction kinetics. The resultant hybrid material exhibits high specific capacitance and good rate capability. This design provides an effective strategy to develop organic-inorganic heterostructures for superior K-ion storage. The K-ion storage mechanism concerning the reversible insertion/extraction upon charge/discharge is revealed through ex situ X-ray photoelectron spectroscopy.

Ultralight, Superelastic, and Washable Nanofibrous Sponges with Rigid-Flexible Coupling Architecture Enable Reusable Warmth Retention.

Nanofibrous sponges enable promising potentials in warmth retention but are impeded by short service life and nonwashability, owing to their inadequate mechanical properties. Herein, a scalable strategy is reported to develop ultralight, superelastic, and washable micro/nanofibrous sponges (MNFSs) with a rigid-flexible coupling architecture created by bridging high-modulus polyethylene terephthalate microfibers with flexible polyacrylonitrile nanofibers via robust bonding structures. Meanwhile, the in situ doping of fluoropolymer endows micro/nanofibers with desirable amphiphobicity. The resultant MNFSs present high resilience, superior compressive fatigue resistance (5.7% residual strain at 1000th), low-temperature-resistant superelasticity (up to -196 °C), and unique washing-invariant superelasticity. Moreover, the fascinating structures of high porosity, high tortuosity, and small pores enable MNFSs both ultralight property (7.5 mg cm-3) and effective warmth retention (28.51 mW m-1 K-1). Additionally, the MNFSs possess remarkable antifouling, robust stability, and long service life. The work might provide an avenue to develop mechanically robust nanofibrous sponges for various applications.

Back Shallow Ge Gradient Enhanced Carrier Separation for CZTSe Solar Cells through a Coselenization Process.

Given the prominent success of the Ga gradient in CuIn1-xGaxSe2 (CIGSe) solar cells, Ge gradient implementation is a promising way to boost Cu2ZnSn(S,Se)4 (CZTSSe) solar cells. However, Ge-graded CZTSSe solar cells only possess a low efficiency of 9.2%, far from that of Ge-incorporated CZTSSe without a gradient (12.3%). Herein, we demonstrated a shallow Ge gradient CZTSe solar cell with an improved efficiency over 10%. The Ge gradient was achieved through a GeSe2-Se coselenization process, where GeSe2 acts as a low-temperature fluxing agent to assist crystallization and induce Ge transport toward the back interface. The relieved band tails and improved junction quality, leading to a better carrier separation, were found to take a primary responsibility for device improvement. These results highlight a remarkable breakthrough for Ge-graded CZTSe solar cells and offer a promising way to develop Ge-involved solar cells.

Dihydropyridine Enhances the Antioxidant Capacities of Lactating Dairy Cows under Heat Stress Condition.

Heat stress (HS), a nonspecific response to environmental heat, can seriously affect dairy cow health. Feed additives may alleviate HS in dairy cows by improving rumen fermentation efficacy, stimulating feed consumption, enhancing vasodilation, and/or improving antioxidant capacity. The temperature-humidity index (THI) indicates that spring is a non-HS season, and summer is an HS season. HS results in the decrease in dairy cow antioxidant capacities. Our results indicated the decrease in superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), and total antioxidation (T-AOC) levels and the increase in malondialdehyde (MDA) level during HS season. Meanwhile, antioxidant indexes (SOD, GSH-Px, and T-AOC) were positively correlated with milk yield (p < 0.01), whereas MDA exhibited a significant negative correlation with milk yield (p < 0.05). In addition, the effects of dihydropyridine (DHP) on antioxidant capacity and ruminal microbial communities in dairy cows under HS were investigated. During summer, dairy cows were randomly assigned into two groups under HS, including a standard diet (S-ND) group and standard diet with 3 g/day/cow DHP (S-D) group. DHP treatment significantly restored SOD and GSH-Px levels under HS. Denaturing gradient gel electrophoresis results indicated that the DHP altered ruminal bacterial community mainly composed Proteobacteria and Firmicutes in dairy cows under HS. Our results suggest that DHP can enhance the antioxidant abilities of dairy cows with favorable effects on ruminal microbial communities under HS, further alleviating HS on dairy cows.

Wearable Sensors in Huntington Disease: A Pilot Study.

BACKGROUND: The Unified Huntington's Disease Rating Scale (UHDRS) is the principal means of assessing motor impairment in Huntington disease but is subjective and generally limited to in-clinic assessments. OBJECTIVE: To evaluate the feasibility and ability of wearable sensors to measure motor impairment in individuals with Huntington disease in the clinic and at home. METHODS: Participants with Huntington disease and controls were asked to wear five accelerometer-based sensors attached to the chest and each limb for standardized, in-clinic assessments and for one day at home. A second chest sensor was worn for six additional days at home. Gait measures were compared between controls, participants with Huntington disease, and participants with Huntington disease grouped by UHDRS total motor score using Cohen's d values. RESULTS: Fifteen individuals with Huntington disease and five controls completed the study. Sensor data were successfully captured from 18 of the 20 participants at home. In the clinic, the standard deviation of step time (time between consecutive steps) was increased in Huntington disease (p < 0.0001; Cohen's d = 2.61) compared to controls. At home with additional observations, significant differences were observed in seven additional gait measures. The gait of individuals with higher total motor scores (50 or more) differed significantly from those with lower total motor scores (below 50) on multiple measures at home. CONCLUSIONS: In this pilot study, the use of wearable sensors in clinic and at home was feasible and demonstrated gait differences between controls, participants with Huntington disease, and participants with Huntington disease grouped by motor impairment.

[Operative treatment of terrible triad of the elbow joint].

OBJECTIVE: To explore the operation procedure and effectiveness of terrible triad of the joint. METHODS: Between October 2006 and June 2010, 11 cases of closed terrible triad of the elbow joint were treated operation. There were 8 males and 3 females with an average age of 32 years (range, 21-53 years). The mechanism of was falling from height in 4 cases and traffic accident in 7 cases. The time from injury to admission was 30 minutes to According to Regan-Morrey classification for fractures of the ulnar coronoid, there were 5 cases of type I, 5 cases of type case of type III; and according to Mason classification for fractures of the radial head, there were 4 cases of type I, 5 cases II, and 2 cases of type III. The elbow joint range of motion (ROM) was (63 +/- 9) degrees at flexion and extension, and the forearm was (71 +/- 8) degrees at pronation and supination. All cases underwent reduction and fixation by lateral approach combined with approach according to McKeeps operation process. After operation, the affected limb was immobilized with plaster at joint flexion of 90 degrees and in forearm neutral position, then passive physical exercises were carried out, and finally active exercises were done after removing plaster at 4 weeks. RESULTS: All incisions healed by first intention. Eleven cases followed up 7-27 months (14.5 months on average). The X-ray films showed good reduction, the clinical healing time was weeks with an average of 11 weeks. Mild ectopic ossification of the elbow joint occurred in 3 cases at 6 months after operation, mild degenerative change in 1 case at 18 months after operation. At last follow-up, the elbow joint ROM was (103 +/- flexion and extension, and the forearm ROM was (122 +/- 13) degrees at pronation and supination, showing no significant difference when compared with the values of normal elbow joint (P > 0.05) and significant difference when compared with the preoperative values of affected elbow joint (P < 0.05). According to Mayo elbow performance score, the results were excellent in 5 cases, in 5 cases, and fair in 1 case with an excellent and good rate of 90.9%. CONCLUSION: The surgical treatment of terrible the elbow joint can restore sufficiently elbow stability, allow early motion postoperatively, and enhance the functional outcome.

[Treatment of ulnar coronoid process fracture with mini-plate].

OBJECTIVE: To investigate the treatment of ulnar coronoid process fracture with mini-plate and to evaluate the clinical results. METHODS: Between September 2006 and March 2009, 14 patients with ulnar coronoid process fracture were treated with open reduction and internal fixation of mini-plate. There were 10 males and 4 females with an average age of 29 years (range, 14-51 years). Fracture was caused by falling from height in 4 cases and traffic accident in 10 cases. The locations were left side in 6 cases and right side in 8 cases. According to Regan-Morrey classification, there were 2 cases of type I, 6 of type II, and 6 of type III. The flexion-extension are of the elbow was (60 +/- 10)0 and the forearm rotation was (70 +/- 10) degrees. The disease duration was 30 minutes to 11 days, and CT scan was used for definite diagnosis. Patients received early functional exercise 1 week postoperatively. RESULTS: All incisions healed by first intention. Fourteen cases were followed up 12-25 months (17 months on average). All fractures healed well, and the average union time was 10 weeks with a range of 7-12 weeks. No loosening or breakage of the internal fixation occurred except for 2 patients who had heterotopic ossification. The flexion-extension arc of the elbow was (110 +/- 10) degrees and the forearm rotation was (130 +/- 15) degrees, showing significant difference when compared with that before operation (P < 0.05). The clinical results were evaluated according to Morrey's scale, 8 cases were rated as excellent, 4 as good, and 2 as fair; the excellent and good rate was 85.7%. CONCLUSION: Fixation of ulnar coronoid process fracture with mini-plate provides sufficient stability to do early functional exercise and it can enhance functional outcome.