Synergistic effect on simultaneous treatment of Cr(VI) and chloramphenicol using a non-thermal plasma technology.

Toxic organic and heavy metal contaminants commonly exist in industrial waste stream(s) and treatment is of great challenge. In this study, a dielectric barrier discharge (DBD) non-thermal plasma technology was employed for the simultaneous treatment of two important contaminants, chloramphenicol (CAP) and Cr(VI) in an aqueous solution through redox transformations. More than 70% of CAP and 20% of TOC were degraded in 60 min, while Cr(VI) was completely removed in 10 min. The hydroxyl radicals were the main active species for the degradation. Meanwhile, the consumption of hydroxyl radicals was beneficial to the reduction of Cr(VI). The synergistic effect was investigated between CAP degradation and Cr(VI) reduction. The reduction of Cr(VI) would be enhanced in the presence of CAP with a low concentration and could be inhibited under a high concentration, because part of hydroxyl radicals could be consumed by the low-concentration CAP and the obtained intermediates with a higher kinetic rate. However, CAP with a high concentration could react with such reductive species as eaq- and •H, which could compete with Cr(VI) and inhibit the reduction. In addition, the presence of Cr(VI) enhanced the degradation and mineralization of CAP; the study of obtained intermediates indicated that the presence of Cr(VI) changed the degradation path of CAP as Cr(VI) would react with reductive species, enhance the generation of hydroxyl radicals, and cause more hydroxylation reactions. Moreover, the mechanism for the simultaneous redox transformations of CAP and Cr(VI) was illustrated. This study indicates that the DBD non-thermal plasma technology can be one of better solutions for simultaneous elimination of heavy metal and organic contaminants in aquatic environments.

Newly graphene/polypyrrole (rGO/PPy) modified carbon felt as bio-cathode in bio-electrochemical systems (BESs) achieving complete denitrification.

Nitrate reduction in bio-electrochemical systems (BESs) has attracted wide attention due to its low sludge yields and cost-efficiency advantages. However, the high resistance of traditional electrodes is considered to limit the denitrification performance of BESs. Herein, a new graphene/polypyrrole (rGO/PPy) modified electrode is fabricated via one-step electrodeposition and used as cathode in BES for improving nitrate removal from wastewater. The formation and morphological results support the successful formation of rGO/PPy nanohybrids and confirm the part covalent bonding of Py into GO honeycomb lattices to form a three-dimensional cross-linked spatial structure. The electrochemical tests indicate that the rGO/PPy electrode outperforms the unmodified electrode due to the 3.9-fold increase in electrochemical active surface area and 6.9-fold decrease in the charge transfer resistance (Rct). Batch denitrification activity tests demonstrate that the BES equipped with modified rGO/PPy biocathode could not only achieve the full denitrification efficiency of 100% with energy recovery (15.9 × 10-2 ± 0.14 A/m2), but also favor microbial attach and growth with improved biocompatible surface. This work provides a feasible electrochemical route to fabricate and design a high-performance bioelectrode to enhance denitrification in BESs.

Unraveling the Activity and Mechanism of TM@g-C4N3 Electrocatalysts in the Oxygen Reduction Reaction.

In this work, a high-throughput screening strategy and density functional theory (DFT) are jointly employed to identify high-performance TM@g-C4N3 (TM = 3d, 4d, 5d transition metals) single-atom catalysts (SACs) for the oxygen reduction reaction (ORR). Comprehensive studies demonstrated that Cu@, Zn@, and Ag@g-C4N3 show high ORR catalytic activities under both acidic and alkaline conditions with favorable overpotentials (ηORR) of 0.70, 0.89, and 0.89 V, respectively; among them, Cu@g-C4N3 is the best candidate. The ORR follows a four-electron mechanism with the final product H2O/OH-. Cu@, Zn@, and Ag@g-C4N3 catalysts also exhibit good thermal (500 K) and electrochemical (0.93-3.14 V) stabilities. Cu@, Zn@, and Ag@g-C4N3 demonstrate superior activities with low ηORR due to its moderate adsorption strength of *OH. The ηORR and the Gibbs free energy changes of *OH (ΔG4(acidic)/ΔG4(alkaline)) resemble a volcano-type relationship under acidic/alkaline conditions, respectively. Additionally, the O-O bond length in *OOH emerged as an effective structural descriptor for rapidly identifying the promising electrocatalysts. This research provides valuable insights into the origin of the ORR activity on TM@g-C4N3 and offers useful guidance for the efficient exploration of high-performance catalyst candidates.

Alleviating OH Blockage on the Catalyst Surface by the Puncture Effect of Single-Atom Sites to Boost Alkaline Water Electrolysis.

Nonprecious transition metal catalysts have emerged as the preferred choice for industrial alkaline water electrolysis due to their cost-effectiveness. However, their overstrong binding energy to adsorbed OH often results in the blockage of active sites, particularly in the cathodic hydrogen evolution reaction. Herein, we found that single-atom sites exhibit a puncture effect to effectively alleviate OH blockades, thereby significantly enhancing the alkaline hydrogen evolution reaction (HER) performance. Typically, after anchoring single Ru atoms onto tungsten carbides, the overpotential at 10 mA·cm-2 is reduced by more than 130 mV (159 vs 21 mV). Also, the mass activity is increased 16-fold over commercial Pt/C (MA100 = 17.3 A·mgRu-1 vs 1.1 A·mgPt-1, Pt/C). More importantly, such electrocatalyst-based alkaline anion-exchange membrane water electrolyzers can exhibit an ultralow potential (1.79 Vcell) and high stability at an industrial current density of 1.0 A·cm-2. Density functional theory (DFT) calculations reveal that the isolated Ru sites could weaken the surrounding local OH binding energy, thus puncturing OH blockage and constructing bifunctional interfaces between Ru atoms and the support to accelerate water dissociation. Our findings exhibit generality to other transition metal catalysts (such as Mo) and contribute to the advancement of industrial-scale alkaline water electrolysis.

Amorphization Activated Multimetallic Pd Alloys for Boosting Oxygen Reduction Catalysis.

Amorphous nanomaterials have drawn extensive attention owing to their unique features, while amorphization on noble metal nanomaterials still remains formidably challenging. Herein, we demonstrate a universal strategy to synthesize amorphous Pd-based nanomaterials from unary to quinary metals through the introduction of phosphorus (P). The amorphous Pd-based nanoparticles (NPs) exhibit generally promoted oxygen reduction reaction (ORR) activity and durability compared with their crystalline counterparts. Significantly, the quinary P-PdCuNiInSn NPs, benefiting from the amorphous structure and multimetallic component effect, exhibit mass activities as high as 1.04 A mgPd-1 and negligible activity decays of 1.8% among the stability tests, which are much better than values for original Pd NPs (0.134 A mgPd-1 and 28.4%). Experimental and theoretical analyses collectively reveal that the synergy of P-induced amorphization and the expansion of metallic components can considerably lower the free energy changes in the rate-determined step, thereby explaining the positive correlation with the catalytic activity.

Rapid discrimination of urine specific gravity using spectroscopy and a modified combination method based on SPA and spectral index.

To achieve high-accuracy urine specific gravity discrimination and guide the design of four-waveband multispectral sensors. A modified combination strategy was attempted to be proposed based on the successive projections algorithm (SPA) and the spectral index (SI) in the present study. First, the SPA was used to select four spectral variables in the full spectra. Second, the four spectral variables were mathematically transformed by SI to obtain SI values. Then, SPA gradually fusions the SI values and establishes models to identify USG. The results showed that the SPA can screen out the four characteristic wavelengths related to the measured sample attributes. SIs can be used to improve the performance of constructed prediction models. The best model only involves four spectral variables and 1 SI value, with high accuracy (91.62%), sensitivity (0.9051), and specificity (0.9667). The results reveal that m-SPA-SI can effectively distinguish USG and provide design guidance for 4-wavelength multispectral sensors.

Tandem Electro-Thermo-Catalysis for the Oxidative Aminocarbonylation of Arylboronic Acids to Amides from CO2 and Water.

Direct CO2 electroreduction to valuable chemicals is critical for carbon neutrality, while its main products are limited to simple C1 /C2 compounds, and traditionally, the anodic O2 byproduct is not utilized. We herein report a tandem electrothermo-catalytic system that fully utilizes both cathodic (i.e., CO) and anodic (i.e., O2 ) products during overall CO2 electrolysis to produce valuable organic amides from arylboronic acids and amines in a separate chemical reactor, following the Pd(II)-catalyzed oxidative aminocarbonylation mechanism. Hexamethylenetetramine (HMT)-incorporated silver and nickel hydroxide carbonate electrocatalysts were prepared for efficient coproduction of CO and O2 with Faradaic efficiencies of 99.3 % and 100 %, respectively. Systematic experiments, operando attenuated total reflection surface-enhanced Fourier transform infrared spectroscopy characterizations and theoretical studies reveal that HMT promotes *CO2 hydrogenation/*CO desorption for accelerated CO2 -to-CO conversion, and O2 inhibits reductive deactivation of the Pd(II) catalyst for enhanced oxidative aminocarbonylation, collectively leading to efficient synthesis of 10 organic amides with high yields of above 81 %. This work demonstrates the effectiveness of a tandem electrothermo-catalytic strategy for economically attractive CO2 conversion and amide synthesis, representing a new avenue to explore the full potential of CO2 utilization.

Electrochemical ammonia synthesis under ambient conditions using TM-embedded porphine-fused sheets as single-atom catalysts.

In this research, we systematically investigated the reaction mechanism and electrocatalytic properties of transition metal anchored two-dimensional (2D) porphine-fused sheets (TM-Por) as novel single-atom catalysts (SACs) for the electrochemical nitrogen reduction reaction (eNRR) under ambient conditions. Using high-throughput screening and first-principles calculations based on the density functional theory (DFT) method, three eNRR catalyst candidates, i.e. Mo-Por, Tc-Por, and Nb-Por, were screened out, with the eNRR onset potentials on them being -0.36, -0.53, and -0.74 V, respectively. Furthermore, these catalyst candidates all have good stability and selectivity. Analyzing the band structures found that these catalyst candidates all are metallic, which is needed for good electrocatalysts. Ab initio molecular dynamics (AIMD) simulations show that these catalyst candidates have good stability at 500 K. It is hoped that our work will open up new possibilities for the experimental synthesis of electrochemical ammonia catalysts.

[Clinical Outcome and Risk Factors of Treatment Failure of Peritoneal Dialysis Associated Peritonitis Caused by Klebsiella Pneumoniae:A Multicenter Study].

Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli.Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae. Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli.The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP (P=0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP (OR=1.082,95%CI=1.011-1.158,P=0.023).Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.

Transmutation Engineering Makes a Large Class of Stable and Exfoliable A3BX2 Compounds with Exceptional High Magnetic Critical Temperatures and Exotic Electronic Properties.

We establish a robust protocol for materials innovation based on our proposed transmutation engineering strategy combined with combinatorial chemistry and hierarchical high-throughput screening to make a large class of layered 2D A3BX2 materials. After several rounds of efficient screening, 60 types of easily exfoliable and highly stable A3BX2 monolayers have been obtained. Excitingly, four representative monolayers (ferromagnetic Fe3SiS2 and Fe3GeS2, antiferromagnetic Mn3PbTe2 and Co3GeSe2) demonstrate quite high magnetic critical temperatures of 600 (TC), 630 (TC), 770 (TN), and 510 K (TN), respectively. Through electronic fingerprint identification, the magnetic exchange mechanism is fundamentally unveiled at the atomic level in combination with a local chemical topology environment and crystal/exchange field. Furthermore, two simple and effective unified descriptors are proposed to perfectly explain the origin of magnetic strain regulation. Some intriguing materials (featuring double Dirac cones, node-loops, and ultrahigh Fermi velocities) are expected to be used in high-speed and low-dissipation nanodevices. This material family forms a dataset, which establishes a platform to discover and explore unexpected physicochemcial properties and develop promising applications under different circumstances. The chemical trends of diverse properties for this class of materials are revealed, which offers guiding insights for the development of spintronics and nanoelectronics with the target of exploiting both spin and charge degrees of freedom directed functional materials design and screening.

Fabrication of modified electrode by reduced graphene oxide (rGO) and polyaniline (PANI) for enhancing azo dye decolorization in bio-electrochemical systems (BESs).

Bio-electrochemical systems (BESs) have attracted wide attention in the field of wastewater treatment owing to their fast electron transfer rate and high performance. Unfortunately, the low electro-chemical activity of carbonaceous materials commonly used in BESs remains a bottleneck for their practical applications. Especially, for refractory pollutants remediation, the efficiency is largely limited by the cathode property in term of (bio)-electrochemical reduction of highly oxidized functional groups. Herein, a reduced graphene oxide (rGO) and polyaniline (PANI) modified electrode was fabricated via two-step electro-deposition using carbon brush as raw material. Benefiting from the modified graphene sheets and PANI nanoparticles, the rGO/PANI electrode shows highly conductive network with the electro-active surface area increased by 12 times (0.013 mF cm-2) and the charge transfer resistance decreased by 92% (0.23Ω) comparing with the unmodified one. Most importantly, the rGO/PANI electrode used as abiotic cathode achieves highly efficient azo dye removal from wastewater. The highest decolorization efficiency reaches 96 ± 0.03% within 24 h and the maximum decolorization rate is as high as 20.9 ± 1.45 g h-1·m-3. The features of improved electro-chemical activity and enhanced pollutant removal efficiency provide a new insight toward development of high performance BESs via electrode modification for practical application.

Effective modulation of the exotic properties of two-dimensional multifunctional TM2@g-C4N3 monolayers via transition metal permutation and biaxial strain.

The exotic physicochemical properties of TM atom (3d, 4d, and 5d) embedded g-C4N3 as a novel class of 2D monolayers were systematically investigated through hierarchical high-throughput screening combined with spin-polarized first-principles calculations. After several rounds of efficient screening, 18 types of TM2@g-C4N3 monolayers with a TM atom embedded g-C4N3 substrate in large cavities on both sides in asymmetrical mode have been obtained. The effects of transition metal permutation and biaxial strain on the magnetic, electronic, and optical properties of TM2@g-C4N3 monolayers were comprehensively and deeply analyzed. By anchoring different TM atoms, various magnetic states including ferromagnetism (FM), antiferromagnetism (AFM), and nonmagnetism (NM) can be obtained. The Curie temperatures of Co2@ and Zr2@g-C4N3 are substantially improved up to 305 K and 245 K by applying -8% and -12% compression strains, respectively. This makes them promising candidates for low-dimensional spintronic device applications at or close to room temperature. Additionally, rich electronic states (metal, semiconductor, and half-metal) can be realized through biaxial strains or diverse metal permutations. Interestingly, the Zr2@g-C4N3 monolayer undergoes a transition of FM semiconductor → FM half-metal → AFM metal under biaxial strains from -12% to 10%. Notably, the embedding of TM atoms dramatically enhances visible light absorption compared to bare g-C4N3. Excitingly, the power conversion efficiency of the Pt2@g-C4N3/BN heterojunction can be as high as 20.20%, which has great potential in solar cell applications. This large class of 2D multifunctional materials provides a candidate platform to develop promising applications under different circumstances and is expected to be prepared in the future.

Magnetic Moment Is an Effective Descriptor for Electrocatalytic Nitrogen Reduction Reaction on Two-Dimensional Organometallic Nanosheets.

Electrocatalytic reduction of nitrogen to ammonia (eNRR) under ambient condition is a potential sustainable and promising alternative to the traditional Haber-Bosch process. However, this electrochemical transformation is limited by the high overpotential, poor selectivity, low efficiency, and low yield. Herein, a new class of two-dimensional (2D) organometallic nanosheets c-TM-TCNE (c = cross motif, TM = 3d/4d/5d transition metals, TCNE = tetracyanoethylene) were comprehensively investigated as potential electrocatalysts for eNRR through high-throughput screening combined with spin-polarized density functional theory computations. After a multistep screening and follow-up systematic evaluation, c-Mo-TCNE and c-Nb-TCNE were selected as eligible catalysts, and c-Mo-TCNE showed the lowest limiting potential of -0.35 V via a distal pathway, displaying high catalytic performance. In addition, the desorption of NH3 from the surface of c-Mo-TCNE catalyst is also easy, with the free energy being 0.34 eV. Furthermore, the stability, metallicity, and eNRR selectivity are preeminent, making c-Mo-TCNE a promising catalyst. Unexpectedly, the magnetic moment of the transition metal shows a strong correlation with the catalytic activity (limiting potential), i.e., the larger the magnetic moment of the transition metal, the smaller the limiting potential of the electrocatalyst. The Mo atom has the largest magnetic moment and the c-Mo-TCNE catalyst features the smallest magnitude of limiting potential. Thus, the magnetic moment can be used as an effective descriptor for eNRR on c-TM-TCNE catalysts. The present study opens a way toward the rational design of highly efficient electrocatalysts for eNRR with novel two-dimensional functional materials. This work will promote further experimental efforts in this field.

Low-Coordinated Pd Site within Amorphous Palladium Selenide for Active, Selective, and Stable H2 O2 Electrosynthesis.

The development of high-performance catalysts with high activity, selectivity, and stability are essential for the practical applications of H2 O2 electrosynthesis technology, but it is still formidably challenging. It is reported that the low-coordinated structure of Pd sites in amorphous PdSe2 nanoparticles (a-PdSe2 NPs) can significantly boost the electrocatalytic synthesis of H2 O2 . Detailed investigations and theoretical calculations reveal that the disordered arrangement of Pd atoms in a-PdSe2 NPs can promote the activity, while the Pd sites with low-coordinated environment can optimize the adsorption toward oxygenated intermediate and suppress the cleavage of O-O bond, leading to a significant enhancement in both the H2 O2 selectivity and productivity. Impressively, a-PdSe2 NPs/C exhibits high H2 O2 selectivity over 90% in different pH electrolytes. H2 O2 productivities with ≈3245.7, 1725.5, and 2242.1 mmol gPd -1  h-1 in 0.1 m KOH, 0.1 m HClO4 , and 0.1 m Na2 SO4 can be achieved, respectively, in an H-cell electrolyzer, being a pH-universal catalyst for H2 O2 electrochemical synthesis. Furthermore, the produced H2 O2 can reach 1081.8 ppm in a three-phase flow cell reactor after 2 h enrichment in 0.1 m Na2 SO4 , showing the great potential of a-PdSe2 NPs/C for practical H2 O2 electrosynthesis.

Transoral Endoscopic Thyroidectomy by Vestibular Approach for Papillary Thyroid Carcinoma with Tumor Size ≥2 cm.

Background: The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for papillary thyroid carcinoma (PTC) treatment with satisfactory results. However, there were few malignant thyroid nodules ≥2 cm in previous studies of TOETVA. Therefore, we conducted this study to evaluate the results of treatment by TOETVA for PTC with tumor size ≥2 cm. Materials and Methods: The clinical characteristics and surgical outcomes of 10 PTC patients with tumor size ≥2 cm who underwent TOETVA in our center from June 2018 to August 2021 were, respectively, reviewed. Results: All 10 included PTC patients successfully underwent TOETVA and the mean tumor size was 2.5 ± 0.5 cm. The mean number lymph nodes dissected was 9.6 ± 2.9, and 3.1 ± 3.3 positive lymph nodes were discovered. Postoperatively, transient hypoparathyroidism was recorded in 2 patients (20%), transient recurrent laryngeal nerve injury was noted in 1 patient (10%), transient superior laryngeal nerve injury was noted in 1 patient (10%), and numb chin was identified in 1 patient (10%). The postoperative complications aforementioned recovered within 6 months. During a median follow-up of 23.8 ± 13.1 months, no other complications or tumor recurrence were found. Conclusions: TOETVA is feasible for PTC patients with tumor size ≥2 cm and satisfactory short-term surgical outcomes have achieved in this study. We suggested that experienced surgeons can gradually expand the indications for TOETVA.

Advancing single-cell RNA-seq data analysis through the fusion of multi-layer perceptron and graph neural network.

The advancement of single-cell sequencing technology has smoothed the ability to do biological studies at the cellular level. Nevertheless, single-cell RNA sequencing (scRNA-seq) data presents several obstacles due to the considerable heterogeneity, sparsity and complexity. Although many machine-learning models have been devised to tackle these difficulties, there is still a need to enhance their efficiency and accuracy. Current deep learning methods often fail to fully exploit the intrinsic interconnections within cells, resulting in unsatisfactory results. Given these obstacles, we propose a unique approach for analyzing scRNA-seq data called scMPN. This methodology integrates multi-layer perceptron and graph neural network, including attention network, to execute gene imputation and cell clustering tasks. In order to evaluate the gene imputation performance of scMPN, several metrics like cosine similarity, median L1 distance and root mean square error are used. These metrics are utilized to compare the efficacy of scMPN with other existing approaches. This research utilizes criteria such as adjusted mutual information, normalized mutual information and integrity score to assess the efficacy of cell clustering across different approaches. The superiority of scMPN over current single-cell data processing techniques in cell clustering and gene imputation investigations is shown by the experimental findings obtained from four datasets with gold-standard cell labels. This observation demonstrates the efficacy of our suggested methodology in using deep learning methodologies to enhance the interpretation of scRNA-seq data.

Safety and feasibility of the transoral endoscopic thyroidectomy vestibular approach with neuroprotection techniques for papillary thyroid carcinoma.

BACKGROUND: This study aimed to evaluate the feasibility and safety of the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) with neuroprotection techniques for the surgical management of papillary thyroid carcinoma (PTC). METHODS: Patients with PTC who underwent TOETVA between December 2016 and July 2020 were included in this study, and their relevant clinical characteristics, operational details, and surgical outcomes were reviewed and extracted from their medical records for further analysis. RESULTS: A total of 75 patients successfully underwent TOETVA with zero conversions. Unilateral lobectomy with isthmectomy and total thyroidectomy were completed for 58 and 17 patients, respectively, all using our unique neuroprotective procedure and ipsilateral central neck dissection (CND). The mean number of retrieved lymph nodes versus positive lymph nodes was 6.8 ± 3.7 vs. 1.5 ± 2.3. Postoperative complications included three cases of transient superior laryngeal nerve (SLN) palsy (4.0%), five cases of transient recurrent laryngeal nerve (RLN) palsy (6.7%), 14 cases of transient hypoparathyroidism (18.7%), two cases of numb chin (2.7%) and two cases of flap perforation (2.7%). The follow-up period for patients with PTC lasted for 15.6 ± 10.9 months, during which no other complications or tumor recurrence were observed. CONCLUSION: TOETVA can be safely performed for patients with PTC with satisfactory results during the short-term follow-up period. Our neuroprotection techniques can be integrated into TOETVA, which is worth recommending for PTC patients who desire better cosmetic surgical outcomes.

Endoscopic thyroidectomy via the combined trans-oral and chest approach for cT1-2N1bM0 papillary thyroid carcinoma.

BACKGROUND: Recent years there have been witnessed considerable advances in endoscopic selective lateral neck dissection (LND). However, dissection of lymph nodes at level IV and level VI via the chest approach is inherently challenging. In this study, we used combined trans-oral and chest approach for endoscopic thyroidectomy in patients with cT1-2N1bM0 papillary thyroid carcinoma (PTC). METHODS: Clinical characteristics and surgical outcomes of ten patients with cT1-2N1bM0 PTC who underwent endoscopic thyroidectomy via combination of trans-oral and chest approach between September 2020 and September 2021 were retrospectively reviewed. RESULTS: All 10 patients successfully underwent total thyroidectomy and selective LND via chest approach, while central neck dissection (CND) and supplementary dissection of lymph nodes at level IV were performed via the trans-oral approach. The mean number of positive/retrieved level II, III-IV, and VI lymph nodes were 0.6 ± 1.0/9.8 ± 5.0, 4.6 ± 2.8/23.1 ± 4.7, and 4.9 ± 3.4/10.3 ± 4.6, respectively. Four patients developed transient hypoparathyroidism which spontaneously resolved within 1 month. Five patients developed numbness of lateral neck and ear and one patient experienced limb lift restriction. No other complications or tumor recurrence occurred during follow-up. CONCLUSION: It is feasible to perform total thyroidectomy, CND, and selective LND via combined trans-oral and chest approach, and satisfactory short-term outcomes were observed in this cohort. This approach may offer one more option for cT1-2N1bM0 PTC patients, especially those in whom metastatic lymph nodes at level IV or level VI are detected by preoperative examination.

Transition Metals Embedded Two-Dimensional Square Tetrafluorotetracyanoquinodimethane Monolayers as a Class of Novel Electrocatalysts for Nitrogen Reduction Reaction.

The combination of transition metal (TM) atoms and high electron affinity organic framework tetrafluorotetracyanoquinodimethanes (F4TCNQs) makes the TM-embedded two-dimensional (2D) square F4TCNQ monolayers (TM-sF4TCNQ) possible to have excellent characteristics of single-atom catalysts and 2D materials. For the first time, the TM-sF4TCNQ monolayers have been considered for application in the electrocatalytic nitrogen reduction reaction (eNRR) field. Through high-throughput screening, the catalytic performance of 30 TM-sF4TCNQ (TM = 3d∼5d TMs) monolayers for eNRR was comprehensively evaluated. The Mo-, Nb-, and Tc-sF4TCNQ catalysts stand out with the onset potentials of -0.18, -0.44, and -0.54 V, respectively, through the optimal reaction paths. Our work will provide guidance for the green and sustainable development of electrocatalytic nitrogen fixation.

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study.

BACKGROUND: The risk of early mortality of patients who start dialysis urgently is high; however, in patients with diabetes undergoing urgent-start peritoneal dialysis (USPD), the risk of, and risk factors for, early mortality are unknown. AIM: To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD. METHODS: This retrospective cohort study enrolled 568 patients with diabetes, aged ≥ 18 years, who underwent USPD at one of five Chinese centers between 2013 and 2019. We divided the follow-up period into two survival phases: The first 6 mo of USPD therapy and the months thereafter. We compared demographic and baseline clinical data of living and deceased patients during each period. Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association (NYHA) classification. A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD. RESULTS: Forty-one patients died within the first 6 mo, accounting for the highest proportion of mortalities (26.62%) during the entire follow-up period. Cardiovascular disease was the leading cause of mortality within 6 mo (26.83%) and after 6 mo (31.86%). The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms. Independent risk factors for mortality within the first 6 mo were advanced age [hazard ratio (HR: 1.908; 95%CI: 1.400-2.600; P < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; P < 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; P < 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; P = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; P = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; P = 0.002). CONCLUSION: To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes, controlling the serum phosphorus level and improving cardiac function are recommended.