Health care-associated infections after surgical treatment of ruptured intracranial aneurysms.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is catastrophic, and microsurgery for ruptured intracranial aneurysms is one of the preventive modalities for rebleeding. However, patients remain at high risk of medical morbidities after surgery, one of the most important of which is health care-associated infections (HAIs). We analyzed the incidence and risk factors of HAIs, as well as their association with the outcomes after surgical treatment of ruptured aneurysms. METHODS: We retrospectively enrolled 607 patients with SAH who had undergone surgery for intracranial aneurysms. Information was retrieved from the database using codes of the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: Of the 607 patients, 203 were male and 404 were female. HAIs occurred in 113 patients, accounting for 18.6 % of the population. The independent risk factors for HAIs included age ((p = 0.035), hypertension ((p = 0.042), convulsion ((p = 0.023), external ventricular drain ((p = 0.035), ventricular shunt ((p = 0.033), and blood transfusion ((p = 0.001). The mean length of hospital stay was 25.3 ± 18.2 and 18.8 ± 15.3 days for patients with and without HAIs, respectively ((p = 0.001). The in-hospital mortality rates were 11.5 % in the HAIs group, and 14.0 % in the non-HAIs group ((p = 0.490). CONCLUSION: HAIs are a frequent complication in patients with SAH who underwent surgery for ruptured intracranial aneurysms. The length of hospital stay is remarkably longer for patients with HAIs, and to recognize and reduce the modifiable risks should be implemented to improve the quality of patient care.

Utilizing the International Normalized Ratio-Platelet Index for Predicting Hospital Outcomes After Spontaneous Supratentorial Intracerebral Hemorrhage.

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) poses a public health issue due to its elevated mortality rates. The International Normalized Ratio-platelet index (INR-Plt index) has recently been recognized as a predictive factor for liver disease progression. The potential of applying the INR-Plt index in forecasting ICH prognosis presents an intriguing subject. This study endeavors to examine the correlation between the INR-Plt index and hospital outcomes in patients with spontaneous supratentorial ICH. METHODS: A retrospective examination of 283 adult ICH patients was undertaken. The INR-Plt index was computed using the formula: [INR/platelet counts (1000/µL)] × 100. The clinical outcomes evaluated consisted of mortality rates and the Modified Rankin Scale (mRS) at discharge. An unfavorable outcome was defined as an mRS score from 4 to 6. RESULTS: The study found a significant correlation between the INR-Plt index and hospital mortality (odds ratio: 4.31, 95% CI: 1.07-17.31, P = 0.04). There was a 43% rise in mortality risk for every 0.1 unit increase in the INR-Plt index. Kaplan-Meier survival curves illustrated a considerably lower survival rate at discharge for patients with an INR-Plt index >0.8 (log-rank test: P = 0.047). Regarding unfavorable outcomes, the INR-Plt index was not a significant factor according to logistic regression analyses. CONCLUSIONS: The INR-Plt index is a predictor of hospital mortality in patients with spontaneous supratentorial ICH. A higher INR-Plt index value is associated with an increased risk of mortality, underlining the potential usefulness of this composite index in guiding clinical decision-making and enabling risk stratification.

Deep learning-based bronchial tree-guided semi-automatic segmentation of pulmonary segments in computed tomography images.

Background: Pulmonary segments are valuable because they can provide more precise localization and intricate details of lung cancer than lung lobes. With advances in precision therapy, there is an increasing demand for the identification and visualization of pulmonary segments in computed tomography (CT) images to aid in the precise treatment of lung cancer. This study aimed to integrate multiple deep-learning models to accurately segment pulmonary segments in CT images using a bronchial tree (BT)-based approach. Methods: The proposed segmentation method for pulmonary segments using the BT-based approach comprised the following five essential steps: (I) segmentation of the lung using a U-Net (R231) (public access) model; (II) segmentation of the lobes using a V-Net (self-developed) model; (III) segmentation of the airway using a combination of a differential geometric approach method and a BronchiNet (public access) model; (IV) labeling of the BT branches based on anatomical position; and (V) segmentation of the pulmonary segments based on the distance of each voxel to the labeled BT branches. This five-step process was applied to 14 high-resolution breath-hold CT images and compared against manual segmentations for evaluation. Results: For the lung segmentation, the lung mask had a mean dice similarity coefficient (DSC) of 0.98±0.03. For the lobe segmentation, the V-Net model had a mean DSC of 0.94±0.06. For the airway segmentation, the average total length of the segmented airway trees per image scan was 1,902.8±502.1 mm, and the average number of the maximum airway tree generations was 8.5±1.3. For the segmentation of the pulmonary segments, the proposed method had a DSC of 0.73±0.11 and a mean surface distance of 6.1±2.9 mm. Conclusions: This study demonstrated the feasibility of combining multiple deep-learning models for the auxiliary segmentation of pulmonary segments on CT images using a BT-based approach. The results highlighted the potential of the BT-based method for the semi-automatic segmentation of the pulmonary segment.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy.

ABSTRACT: This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies, namely chatting while under local anesthesia (Chat-LA), total intravenous anesthesia (TIVA), and general anesthesia with laryngeal mask airway (GA-LMA), employed in transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion prostate biopsy (TP-MUF-PB). A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University (Suzhou, China). Clinical data and outcomes, including total costs, complications, and quality-adjusted life years (QALYs), were compared. Probability sensitivity and subgroup analyses were also performed. Chat-LA was found to be the most cost-effective option, outperforming both TIVA and GA-LMA. However, subgroup analyses revealed that in younger patients (under 65 years old) and those with smaller prostate volumes (<40 ml), TIVA emerged as a more cost-effective strategy. While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB, personalization of anesthesia strategies is crucial, considering specific patient demographics such as age and prostate volume.

Effect of plasma transfusion on in-hospital mortality and morbidities in patients with spontaneous subarachnoid hemorrhage.

OBJECTIVE: Spontaneous subarachnoid hemorrhage (SAH) is a critical condition in which patients may require plasma transfusion during hospitalization. However, it remains unknown whether plasma administration has detrimental effects on the prognosis of SAH beyond the correction of coagulopathy or hypovolemia. This study aimed to analyze the association of plasma transfusion with in-hospital mortality and morbidities in patients with SAH. METHODS: We retrospectively analyzed the data of 1689 adult patients with a primary diagnosis of spontaneous SAH. Differences in the clinical parameters were evaluated between patients who received plasma transfusion and those who did not. RESULTS: Of 1689 patients, 158 (9.4%) received plasma transfusion. Statistical analysis revealed significant differences in pre-existing comorbidity prevalence between the two study groups. The post-SAH morbidities, including cerebral ischemic events (13.3% vs. 6.4%; p = 0.01), were more common in the plasma transfusion group, whereas the mortality rate was not different between the two study groups (p = 0.166). The mean duration of hospital stay was 19.3 ± 14.4 days and 15.1 ± 15.2 days for patients with and without plasma transfusion, respectively (p = 0.001). CONCLUSION: Plasma transfusion following spontaneous SAH is not uncommon. Although the in-hospital mortality rate does not increase following plasma transfusion, cerebral ischemic events as well as other morbidities are more frequent in patients receiving plasma transfusion. Therefore, the indication for plasma transfusion following SAH needs careful weighing and should be further defined by well-controlled studies.

Long-term survival after primary decompressive craniectomy for severe traumatic brain injury: an observational study from 1 to 17 years.

Primary decompressive craniectomy (DC) is carried out to prevent intracranial hypertension after removal of mass lesions resulting from traumatic brain injury (TBI). While primary DC can be a life-saving intervention, significant mortality risks persist during the follow-up period. This study was undertaken to investigate the long-term survival rate and ascertain the risk factors of mortality in TBI patients who underwent primary DC. We enrolled 162 head-injured patients undergoing primary DC in this retrospective study. The primary focus was on long-term mortality, which was monitored over a range of 12 to 209 months post-TBI. We compared the clinical parameters of survivors and non-survivors, and used a multivariate logistic regression model to adjust for independent risk factors of long-term mortality. For the TBI patients who survived the initial hospitalization period following surgery, the average duration of follow-up was 106.58 ± 65.45 months. The recorded long-term survival rate of all patients was 56.2% (91/162). Multivariate logistic regression analysis revealed that age (odds ratio, 95% confidence interval = 1.12, 1.07-1.18; p < 0.01) and the status of basal cisterns (absent versus normal; odds ratio, 95% confidence interval = 9.32, 2.05-42.40; p < 0.01) were the two independent risk factors linked to long-term mortality. In conclusion, this study indicated a survival rate of 56.2% for patients subjected to primary DC for TBI, with at least a one-year follow-up. Key risk factors associated with long-term mortality were advanced age and absent basal cisterns, critical considerations for developing effective TBI management strategies.

Epstein-Barr virus-based prognostic model in nodular sclerosis classic Hodgkin lymphoma.

The role of Epstein-Barr virus (EBV) in lymphoma cells of nodular sclerosis classic Hodgkin lymphoma (NScHL) is controversial. Our aim was to explore this and establish a clinically feasible model for risk stratification. We interrogated data from 542 consecutive subjects with NScHL receiving ABVD therapy and demonstrated EBV-infection in their lymphoma cells with EBV-encoded small RNAs (EBERs) in situ hybridization. Subjects were divided into training and validation datasets. As data from the training dataset suggested EBERs-positivity was the only independent prognostic factor for both progression-free survival (PFS) and overall survival (OS), we developed corresponding prognostic models based on it. Our models showed excellent performance in both training and validation cohort. These data indicate the close association of EBV infection and the outcomes of persons with NScHL receiving ABVD. Additionally, our newly developed models should help physicians estimate prognosis and select individualized therapy.

Band Structure Optimized by Electron-Acceptor Cations for Sensitive Perovskite Single Crystal Self-Powered Photodetectors.

Low-dimensional perovskites afford improved stability against moisture, heat, and ionic migration. However, the low dimensionality typically results in a wide bandgap and strong electron-phonon coupling, which is undesirable for optoelectronic applications. Herein, semiconducting A-site organic cation engineering by electron-acceptor bipyridine (bpy) cations (2,2'-bpy2+ and 4,4'-bpy2+) is employed to optimize band structure in low-dimensional perovskites. Benefiting from the merits of lower lowest unoccupied molecular orbital (LUMO) energy for 4,4'-bpy2+ cation, the corresponding (4,4'-bpy)PbI4 is endowed with a smaller bandgap (1.44 eV) than the (CH3NH3)PbI3 (1.57 eV) benchmark. Encouragingly, an intramolecular type II band alignment formation between inorganic Pb-I octahedron anions and bpy2+ cations favors photogenerated electron-hole pairs separation. In addition, a shortening distance between inorganic Pb-I octahedral chains in (4,4'-bpy)PbI4 single crystal (SC) can effectively promote carrier transfer. As a result, a self-powered photodetector based on (4,4'-bpy)PbI4 SC exhibits 131 folds higher on/off ratio (3807) than the counterpart of (2,2'-bpy)2Pb3I10 SC (29). The presented result provides an effective strategy for exporting novel organic cation-based low-dimensional perovskite SC for high-performance optoelectronic devices.

Classifying Alzheimer's disease and normal subjects using machine learning techniques and genetic-environmental features.

BACKGROUND: Alzheimer's disease (AD) is complicated by multiple environmental and polygenetic factors. The accuracy of artificial neural networks (ANNs) incorporating the common factors for identifying AD has not been evaluated. METHODS: A total of 184 probable AD patients and 3773 healthy individuals aged 65 and over were enrolled. AD-related genes (51 SNPs) and 8 environmental factors were selected as features for multilayer ANN modeling. Random Forest (RF) and Support Vector Machine with RBF kernel (SVM) were also employed for comparison. Model results were verified using traditional statistics. RESULTS: The ANN achieved high accuracy (0.98), sensitivity (0.95), and specificity (0.96) in the intrinsic test for AD classification. Excluding age and genetic data still yielded favorable results (accuracy: 0.97, sensitivity: 0.94, specificity: 0.96). The assigned weights to ANN features highlighted the importance of mental evaluation, years of education, and specific genetic variations (CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650) for AD classification. Receiver operating characteristic analysis revealed AUC values of 0.99 (intrinsic test), 0.60 (TWB-GWA), and 0.72 (CG-WGS), with slightly lower AUC values (0.96, 0.80, 0.52) when excluding age in ANN. The performance of the ANN model in AD classification was comparable to RF, SVM (linear kernel), and SVM (RBF kernel). CONCLUSIONS: The ANN model demonstrated good sensitivity, specificity, and accuracy in AD classification. The top-weighted SNPs for AD prediction were CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650. The ANN model performed similarly to RF and SVM, indicating its capability to handle the complexity of AD as a disease entity.

Exploring the relationship between admission pulse pressure and clinical features in patients with spontaneous supratentorial intracerebral hemorrhage.

Elevated pulse pressure is commonly observed in cardiovascular diseases and serves as an independent risk factor and predictor of cardiac mortality. However, the role of pulse pressure in patients with spontaneous intracerebral hemorrhage (ICH) remains uncertain. This study aimed to investigate the association between admission pulse pressure and clinical characteristics, including in-hospital outcomes, in ICH patients. We retrospectively analyzed the data of 292 ICH patients, categorizing them into two groups based on admission wide pulse pressure: > 100 mmHg (n = 60) and ≤ 100 mmHg (n = 232). Clinical characteristics and in-hospital outcomes were compared between the groups, and multivariate logistic regression was performed to identify independent factors. Patients with wide pulse pressure were older, had lower Glasgow Coma Scale, larger intraparenchymal hematomas, more pronounced midline shifts, and higher rates of intraventricular hematoma extension and hydrocephalus. These patients also experienced higher frequencies of craniotomy or craniectomy and longer hospital stays. Multivariate logistic regression revealed that pulse pressure > 100 mmHg was significantly associated with increased in-hospital mortality (odds ratio 4.31, 95% confidence interval 1.12-16.62, p = 0.03), but not with a modified Rankin Scale score of 4-6. In conclusion, our investigation demonstrates a significant relationship between admission pulse pressure and severe clinical characteristics in ICH patients. Importantly, a wider pulse pressure is linked to heightened in-hospital mortality. These results underscore the necessity for customized strategies to predict patient outcomes in this population. Further research is essential to explore potential therapeutic interventions targeting pulse pressure to improve clinical outcomes for ICH patients.

Response to programmed cell death protein 1 antibody in patients with Epstein-Barr virus-associated intrahepatic cholangiocarcinoma.

AIM: Epstein-Barr virus-associated intrahepatic cholangiocarcinoma (EBVaICC) has a distinct genomic profile and increased CD3+ and CD8+ T cells infiltration. However, the efficacy of immunotherapy in EBVaICC remains largely unknown. This study aimed to assess the efficacy of programmed cell death protein 1 (PD-1) antibody therapy in EBVaICC. METHODS: Patients with metastatic biliary tract cancer (BTC) diagnosed at Sun Yat-sen University Cancer Center from January 2016 to December 2021 were identified. In situ hybridisation was performed to detect EBV. Overall survival (OS) and progression-free survival (PFS) were measured. RESULTS: A total of 698 patients with metastatic BTC were identified, of whom 39 (5.6%) had EBVaICC. Among the 136 patients who were not administered PD-1 antibody, the OS was similar between patients with EBVaICC and EBV-negative ICC (median OS 12.5 versus 9.5 months, respectively; P = 0.692). For the 205 patients who were administered PD-1 antibody, patients with EBVaICC had significantly longer OS than patients with EBV-negative ICC (median OS 24.9 versus 11.9 months, respectively; P = 0.004). Seventeen patients with EBVaICC were administered PD-1 antibody. Eight patients (47%) achieved a partial response, and 17 patients achieved disease control. The median PFS was 17.5 months. CONCLUSIONS: This study identified a clinically actionable subset of patients with EBVaICC with a promising response to the PD-1 antibody.

Intraventricular Hemorrhage Score as a Robust Predictor for Shunt-Dependent Hydrocephalus After Spontaneous Supratentorial Intracerebral Hemorrhage.

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) is a common stroke subtype, and patients often develop intraventricular hemorrhage (IVH) and hydrocephalus (H). It is essential to promptly recognize factors that can predict the need for permanent cerebrospinal fluid shunt. This study aims to assess the potential of the IVH score as a predictor for shunt-dependent H in ICH patients. METHODS: We retrospectively reviewed data from 296 patients with spontaneous supratentorial ICH. Clinical and radiographic data were analyzed. IVH scores were calculated based on initial brain computed tomography scans. A multivariable logistic regression analysis was performed to identify independent predictors of shunt-dependent H, and a receiver operating characteristic curve was generated for the IVH score. RESULTS: Among the 296 ICH patients, 25 (8.4%) required permanent cerebrospinal fluid shunt placement. The IVH score was identified as the sole significant independent predictor of shunt-dependent H (P < 0.01), with an odds ratio of 1.13 and a 95% confidence interval between 1.04 and 1.22. With each unit increase in the IVH score, the likelihood of shunt dependence rises by 13%. The area under the curve for the IVH score as a predictor of shunt-dependent H was 0.818. With an IVH score threshold of 6.5, the sensitivity was 80.0%, and the specificity was 26.6%. CONCLUSIONS: The IVH score is a valuable predictor of shunt-dependent H in patients with spontaneous supratentorial ICH. Its simplicity allows for easy integration into routine clinical practice, aiding in better patient risk stratification and informed decision-making regarding permanent CSF shunt placement.

Admission serum creatinine in non-hemodialysis-dependent patients with spontaneous supratentorial intracerebral hemorrhage: Is it a prognosticator?

INTRODUCTION: Spontaneous intracerebral hemorrhage (ICH) carries a high mortality rate, with end-stage renal disease (ESRD) and hemodialysis being risk factors for early mortality. However, the role of admission serum creatinine in ICH prognosis remains unclear. This study aimed to analyze the correlation between admission serum creatinine levels and short-term ICH prognosis in non-hemodialysis-dependent patients. METHODS: This retrospective study analyzed 296 adult patients admitted with spontaneous supratentorial ICH. Demographic, clinical, and radiographic data were collected, including admission serum creatinine levels. The primary outcomes were mortality and unfavorable outcomes, defined as Modified Rankin Scale scores of 4-6. Univariate or multivariate analysis was performed to examine the association between admission serum creatinine levels and ICH prognosis, with and without the inclusion of maintenance hemodialysis patients. RESULTS: Among all patients, elevated admission serum creatinine levels were significantly associated with increased mortality (OR = 1.39, 95% CI: 1.21-1.59, P < 0.01). However, this association disappeared when excluding patients undergoing maintenance hemodialysis (OR = 0.95, 95% CI: 0.53-1.69, P = 0.86). No significant association was found between admission serum creatinine levels and unfavorable outcomes. Other well-established prognostic factors, such as age and admission GCS, demonstrated significant associations with both mortality and unfavorable outcomes in multivariate analysis. CONCLUSION: Admission serum creatinine appears to have limited prognostic value in non-hemodialysis-dependent patients with spontaneous supratentorial ICH. Our findings suggest that the relationship between renal function and ICH prognosis is complex and may be influenced by factors such as comorbidities and maintenance hemodialysis.

Respiratory Invariant Textures From Static Computed Tomography Scans for Explainable Lung Function Characterization.

PURPOSE: The inherent characteristics of lung tissue independent of breathing maneuvers may provide fundamental information for function assessment. This paper attempted to correlate textural signatures from computed tomography (CT) with pulmonary function measurements. MATERIALS AND METHODS: Twenty-one lung cancer patients with thoracic 4-dimensional CT, DTPA-single-photon emission CT ventilation ( VNM ) scans, and available spirometry measurements (forced expiratory volume in 1 s, FEV 1 ; forced vital capacity, FVC; and FEV 1 /FVC) were collected. In subregional feature discovery, function-correlated candidates were identified from 79 radiomic features based on the statistical strength to differentiate defected/nondefected lung regions. Feature maps (FMs) of selected candidates were generated on 4-dimensional CT phases for a voxel-wise feature distribution study. Quantitative metrics were applied for validations, including the Spearman correlation coefficient (SCC) and the Dice similarity coefficient for FM- VNM spatial agreement assessments, intraclass correlation coefficient for FM interphase robustness evaluations, and FM-spirometry comparisons. RESULTS: At the subregion level, 8 function-correlated features were identified (effect size>0.330). The FMs of candidates yielded moderate-to-strong voxel-wise correlations with the reference VNM . The FMs of gray level dependence matrix dependence nonuniformity showed the highest robust (intraclass correlation coefficient=0.96 and P <0.0001) spatial correlation, with median SCCs ranging from 0.54 to 0.59 throughout the 10 breathing phases. Its phase-averaged FM achieved a median SCC of 0.60, a median Dice similarity coefficient of 0.60 (0.65) for high (low) functional lung volumes, and a correlation of 0.565 (0.646) between the spatially averaged feature values and FEV 1 (FEV 1 /FVC). CONCLUSIONS: The results provide further insight into the underlying association of specific pulmonary textures with both local ( VNM ) and global (FEV 1 /FVC, FEV 1 ) functions. Further validations of the FM generalizability and the standardization of implementation protocols are warranted before clinically relevant investigations.

Noninvasive imaging signatures of HER2 and HR using ADC in invasive breast cancer: repeatability, reproducibility, and association with pathological complete response to neoadjuvant chemotherapy.

BACKGROUND: The immunohistochemical test (IHC) of HER2 and HR can provide prognostic information and treatment guidance for invasive breast cancer patients. We aimed to develop noninvasive image signatures ISHER2 and ISHR of HER2 and HR, respectively. We independently evaluate their repeatability, reproducibility, and association with pathological complete response (pCR) to neoadjuvant chemotherapy. METHODS: Pre-treatment DWI, IHC receptor status HER2/HR, and pCR to neoadjuvant chemotherapy of 222 patients from the multi-institutional ACRIN 6698 trial were retrospectively collected. They were pre-separated for development, independent validation, and test-retest. 1316 image features were extracted from DWI-derived ADC maps within manual tumor segmentations. ISHER2 and ISHR were developed by RIDGE logistic regression using non-redundant and test-retest reproducible features relevant to IHC receptor status. We evaluated their association with pCR using area under receiver operating curve (AUC) and odds ratio (OR) after binarization. Their reproducibility was further evaluated using the test-retest set with intra-class coefficient of correlation (ICC). RESULTS: A 5-feature ISHER2 targeting HER2 was developed (AUC = 0.70, 95% CI 0.59 to 0.82) and validated (AUC = 0.72, 95% CI 0.58 to 0.86) with high perturbation repeatability (ICC = 0.92) and test-retest reproducibility (ICC = 0.83). ISHR was developed using 5 features with higher association with HR during development (AUC = 0.75, 95% CI 0.66 to 0.84) and validation (AUC = 0.74, 95% CI 0.61 to 0.86) and similar repeatability (ICC = 0.91) and reproducibility (ICC = 0.82). Both image signatures showed significant associations with pCR with AUC of 0.65 (95% CI 0.50 to 0.80) for ISHER2 and 0.64 (95% CI 0.50 to 0.78) for ISHER2 in the validation cohort. Patients with high ISHER2 were more likely to achieve pCR to neoadjuvant chemotherapy with validation OR of 4.73 (95% CI 1.64 to 13.65, P value = 0.006). Low ISHR patients had higher pCR with OR = 0.29 (95% CI 0.10 to 0.81, P value = 0.021). Molecular subtypes derived from the image signatures showed comparable pCR prediction values to IHC-based molecular subtypes (P value > 0.05). CONCLUSION: Robust ADC-based image signatures were developed and validated for noninvasive evaluation of IHC receptors HER2 and HR. We also confirmed their value in predicting treatment response to neoadjuvant chemotherapy. Further evaluations in treatment guidance are warranted to fully validate their potential as IHC surrogates.

The association between Gabapentin or Pregabalin use and the risk of dementia: an analysis of the National Health Insurance Research Database in Taiwan.

Objective: Previous studies have shown that gabapentin or pregabalin use is associated with cognitive decline. Herein, we aimed to evaluate the association between gabapentin or pregabalin use and the risk of dementia. Methods: In this retrospective, population-based matched cohort study, all research data were collected from the 2005 Longitudinal Health Insurance Database, which contains data of 2 million people randomly selected from the National Health Insurance Research Database of Taiwan in 2005. The study extracted data from 1 January 2000, to 31 December 2017. Adult patients taking gabapentin or pregabalin were included in the exposure group, and patients not using gabapentin or pregabalin matched to exposure subjects in a 1:5 ratio by propensity scores composed of age, sex and index date were included in the non-exposure group. Results: A total of 206,802 patients were enrolled in the study. Of them, 34,467 gabapentin- or pregabalin-exposure and 172,335 non-exposure patients were used for analysis. The mean follow-up day (±standard deviation) after the index date was 1724.76 (±1282.32) and 1881.45 (±1303.69) in the exposure and non-exposure groups, respectively; the incidence rates of dementia were 980.60 and 605.48 per 100,000 person-years, respectively. The multivariate-adjusted hazard ratio of risk of dementia for gabapentin or pregabalin exposure versus the matched non-exposed group was 1.45 (95% confidence interval [CI], 1.36-1.55). The risk of dementia increased with higher cumulative defined daily doses during the follow-up period. Moreover, the stratification analysis revealed that the risk of dementia associated with gabapentin or pregabalin exposure was significant in all age subgroups; however, it was higher in younger patients (age <50) than in the older patients (hazard ratio, 3.16; 95% CI, 2.23-4.47). Conclusion: Patients treated with gabapentin or pregabalin had an increased risk of dementia. Therefore, these drugs should be used with caution, particularly in susceptible individuals.

Direct Arylation of Silicon Nanocrystals with Hexadehydro-Diels-Alder-Derived Benzynes.

Colloidal silicon nanocrystals (SiNCs) have garnered significant interest in optoelectronics and biomedical applications. Direct arylation provides pathways to enhance the solution processability of particles and manipulate the photophysical and electronic properties of SiNCs. Unfortunately, existing methods employed to prepare aryl-functionalized SiNCs are based on organometallic coupling or transition-metal-catalyzed strategies, which require metal-based reagents for preactivation or the precursors and complicated post-treatment processes for product purification. Herein, we demonstrate a metal-free method that directly functionalizes SiNCs with aryl-based ligands. We design a series of benzyne derivatives formed from the thermal cyclization of predesigned alkynes, allowing efficient arylation on hydride-terminated silicon surfaces under mild conditions. These aryl-functionalized SiNCs exhibit strong blue emissions with nanosecond-scaled decay, suggesting the formation of a new radiative recombination channel on SiNC surfaces.

Ultrasound-Assisted Crystallization Enables Large-Area Perovskite Quasi-Monocrystalline Film for High-Sensitive X-ray Detection and Imaging.

In recent years, halide perovskites have shown great application potential in X-ray detection due to their superior optoelectronic properties and high X-ray attenuation coefficient. However, large-area perovskite fabrication for high performance X-ray detectors remains extremely challenging. Herein, ultrasound-assisted crystallization combined with the hot-pressing method is proposed to prepare large-area (10 cm × 10 cm) and high-quality quasi-monocrystalline thick film of a mixed-cation perovskite MA0.42 FA0.58 PbI3 . The rapid ultrasound-assisted crystallization provides more homogeneous nucleation, which is essential to the fabrication of large-area and uniform perovskite microcrystalline film. Furthermore, the post hot-pressing treatment is implemented to fuse the crystal boundaries, rearrange the crystal grains, and eliminate the voids between crystals, resulting in a quasi-monocrystalline film. After the hot-pressing treatment, the carrier mobility and the carrier mobility-lifetime product increased about 13-fold (from 1.8 to 23.5 cm2 s-1 V-1 ) and 18 times (from 8.4 × 10-6 to 1.5 × 10-4 cm2 V-1 ), respectively. As a result, a high-performance MA0.42 FA0.58 PbI3 quasi-monocrystalline X-ray detector is achieved with an impressively high sensitivity (1.16 × 106 µC Gyair -1 cm-2 ) and low detection limit (37.4 nGyair s-1 ), demonstrating the potential of the ultrasound-assisted crystallization and hot-pressing strategy from an industrial perspective.

A super-voxel-based method for generating surrogate lung ventilation images from CT.

Purpose: This study aimed to develop and evaluate CTVISVD , a super-voxel-based method for surrogate computed tomography ventilation imaging (CTVI). Methods and Materials: The study used four-dimensional CT (4DCT) and single-photon emission computed tomography (SPECT) images and corresponding lung masks from 21 patients with lung cancer obtained from the Ventilation And Medical Pulmonary Image Registration Evaluation dataset. The lung volume of the exhale CT for each patient was segmented into hundreds of super-voxels using the Simple Linear Iterative Clustering (SLIC) method. These super-voxel segments were applied to the CT and SPECT images to calculate the mean density values (D mean) and mean ventilation values (Vent mean), respectively. The final CT-derived ventilation images were generated by interpolation from the D mean values to yield CTVISVD. For the performance evaluation, the voxel- and region-wise differences between CTVISVD and SPECT were compared using Spearman's correlation and the Dice similarity coefficient index. Additionally, images were generated using two deformable image registration (DIR)-based methods, CTVIHU and CTVIJac, and compared with the SPECT images. Results: The correlation between the D mean and Vent mean of the super-voxel was 0.59 ± 0.09, representing a moderate-to-high correlation at the super-voxel level. In the voxel-wise evaluation, the CTVISVD method achieved a stronger average correlation (0.62 ± 0.10) with SPECT, which was significantly better than the correlations achieved with the CTVIHU (0.33 ± 0.14, p < 0.05) and CTVIJac (0.23 ± 0.11, p < 0.05) methods. For the region-wise evaluation, the Dice similarity coefficient of the high functional region for CTVISVD (0.63 ± 0.07) was significantly higher than the corresponding values for the CTVIHU (0.43 ± 0.08, p < 0.05) and CTVIJac (0.42 ± 0.05, p < 0.05) methods. Conclusion: The strong correlation between CTVISVD and SPECT demonstrates the potential usefulness of this novel method of ventilation estimation for surrogate ventilation imaging.

Gene signature and prediction model of the mitophagy-associated immune microenvironment in renal ischemia-reperfusion injury.

Background: Renal ischemia-reperfusion injury (IRI) is an inevitable occurrence during kidney transplantation. Mitophagy, ferroptosis, and the associated immune microenvironment (IME) have been shown to play important roles in renal IRI. However, the role of mitophagy-associated IME genes in IRI remains unclear. In this study, we aimed to construct a prediction model of IRI prognosis based on mitophagy-associated IME genes. Method: The specific biological characteristics of the mitophagy-associated IME gene signature were comprehensively analyzed using public databases such as GEO, Pathway Unification, and FerrDb. Correlations between the expression of prognostic genes and immune-related genes and IRI prognosis were determined by Cox regression, LASSO analysis, and Pearson's correlation. Molecular validation was performed using human kidney 2 (HK2) cells and culture supernatant as well as the serum and kidney tissues of mice after renal IRI. Gene expression was measured by PCR, and inflammatory cell infiltration was examined by ELISA and mass cytometry. Renal tissue damage was characterized using renal tissue homogenate and tissue sections. Results: The expression of the mitophagy-associated IME gene signature was significantly correlated with IRI prognosis. Excessive mitophagy and extensive immune infiltration were the primary factors affecting IRI. In particular, FUNDC1, SQSTM1, UBB, UBC, KLF2, CDKN1A, and GDF15 were the key influencing factors. In addition, B cells, neutrophils, T cells, and M1 macrophages were the key immune cells present in the IME after IRI. A prediction model for IRI prognosis was constructed based on the key factors associated with the mitophagy IME. Validation experiments in cells and mice indicated that the prediction model was reliable and applicable. Conclusion: We clarified the relationship between the mitophagy-related IME and IRI. The IRI prognostic prediction model based on the mitophagy-associated IME gene signature provides novel insights on the prognosis and treatment of renal IRI.