A high linearity and multilevel polymer-based conductive-bridging memristor for artificial synapses.

Conductive-bridging memristors based on a metal ion redox mechanism have good application potential in future neuromorphic computing nanodevices owing to their high resistance switch ratio, fast operating speed, low power consumption and small size. Conductive-bridging memristor devices rely on the redox reaction of metal ions in the dielectric layer to form metal conductive filaments to control the conductance state. However, the migration of metal ions is uncontrollable by the applied bias, resulting in the random generation of conductive filaments, and the conductance state is difficult to accurately control. Herein, we report an organic polymer carboxylated chitosan-based memristor doped with a small amount of the conductive polymer PEDOT:PSS to improve the polymer ionic conductivity and regulate the redox of metal ions. The resulting device exhibits uniform conductive filaments during device operation, more than 100 and non-volatile conductance states with a ∼1 V range, and linear conductance regulation. Moreover, simulation using handwritten digital datasets shows that the recognition accuracy of the carboxylated chitosan-doped PEDOT:PSS memristor array can reach 93%. This work provides a path to facilitate the performance of metal ion-based memristors in artificial synapses.

Changes in fractional exhaled nitric oxide, exhaled carbon monoxide and pulmonary function during the acute attack, treatment and remission phases of pediatric asthma.

BACKGROUND: The current study aimed to explore the value of fractional exhaled nitric oxide (FeNO), exhaled carbon monoxide (eCO), and pulmonary function in the management of asthmatic children. METHODS: One hundred children diagnosed with asthma were selected as research subjects. Patients were divided into a 3-5-year-old group and a group with children 6 years and older. They were also grouped depending on whether they had asthma alone (A0 group) or whether their asthma was complicated with allergic rhinitis (A+AR group). The FeNO, eCO levels, and pulmonary function in the acute attack period were analyzed 1 month after treatment and clinical remission period. RESULTS: Asthmatic children demonstrated greater pulmonary dysfunction and significantly higher FeNO and eCO during the acute attack phase compared to both one month after treatment and clinical remission. The remission phase was characterized by decreased levels of FeNO and eCO and improvement of pulmonary function. The eCO levels in children aged 3-5 years old, and both FeNO and eCO levels in children 6 years and older were statistically lower during remission regardless of whether the patients had asthma alone or asthma complicated with rhinitis. However, 10% of the 100 children in the clinical remission period still demonstrated mid to high levels of FeNO. The critical value of FeNO levels during the acute period in children 6 years and older with asthma and rhinitis was 34.5 ppb (AUROC 0.814, 95% CI: 0.684-0.944) with a sensitivity of 69.2% and specificity of 93.7%. CONCLUSIONS: Dynamic monitoring of FeNO and eCO is an effective indicator of airway inflammation and thus represents an important clinical tool in assessing the severity of asthma in children.

Feasibility Study on Temperature Distribution Measurement Method of Thrust Sliding Bearing Bush Based on FBG Quasi-Distributed Sensing.

According to the characteristics of the temperature distribution of the thrust sliding bearing bush, the principle and method of quasi-distributed fiber Bragg grating (FBG) sensing is used to measure it. The key problems such as calibration, arrangement and lying of optical FBG sensors are studied by using the simulated thrust sliding bearing bush, which was customized in the laboratory. Combined with the thrust sliding bearing bush, the measurement experiments were carried out, which were divided into two groups: Steady-state experiments and transient experiment. The steady-state experiments obtain the temperature data measured by the FBG temperature sensors at each setting temperature, and the transient experiment obtains the relationship between the measured temperature by each temperature sensor and time in the heating and cooling process. The experimental results showed that the FBG temperature sensors had good accuracy, stability and consistency when measuring the temperature distribution of bearing bush.

[Predictors of Long-term Mortality and Health Related Quality of Life for Elderly Patients with Sepsis].

OBJECTIVE: To explore the predictors of long-term mortality and healthy related quality of life (HR-QoL) for elderly patients with sepsis. METHODS: Two hundred and thirty-eight septic patients older than 60 years old admitted to intensive care unit (ICU) were enrolled in the study,and were followed up by telephone interview one year after ICU discharge. The hospital mortality and cumulative one-year mortality were analyzed,single and multiple factors analysis were used to for the risk factors of 1-year mortality. Quality of life (QoL) was evaluated by the Euro QoL-5 Dimensions (EQ5D) questionnaire,and the influential factors of long-term QoL were also analyzed. RESULTS: A total of 238 patients were enrolled,58 patients of them(24.4%) died during hospitalization and one-year accumulative mortality was 59.7% (142 cases). Single factor analysis showed that acute physiology and chronic health evaluation (APACHE Ⅱ),continuous renal replacement therapy (CRRT),fungal infection,sepsis,tracheal extubation and use of vasopressor within 24 h,the length of mechanical ventilation were correlated with one-year mortality. Multivariate regression analysis showed that APACHE Ⅱscore,CRRT and fungal infection were independent risk factors for one-year mortality,while tracheal extubation within 24 h and shorter length of ICU stay were related to better quality of life. CONCLUSION: One-year mortality of elderly patients with sepsis was high. Tracheal extubation in 24 h and length of hospital stay were predictor of long-term QoL.

Mismatch between GLUTs and glucose levels causes neuronal damage during glucose fluctuations.

Abnormal glucose levels damage the central nervous system, especially in case of rapid fluctuations. Even a single episode of glucose reperfusion can result in overt impairment of neurons. Oxidative stress plays an important role in this process, sharing properties with the pathophysiologic changes of glucose neurotoxicity. Glucose transporters (GLUTs) located in the brain are involved in direct glucose uptake by neurons. Instead of being insulin-sensitive, these transporters are regulated by glucose levels in the extracellular fluid, increasing their expression while glucose levels fall, to absorb more glucose. Therefore, we hypothesized that mismatch between altered GLUTs and sudden glucose level changes is responsible for neuronal damage during glucose fluctuations. Modulating hypoglycemia by increasing blood glucose slowly may improve the neurological outcomes of hypoglycemia.

Relationship Between Short-Term Blood Pressure Variability and Incidence of Acute Kidney Injury in Critically Ill Patients.

BACKGROUND/AIMS: Blood pressure (BP) variability is associated with cardiovascular events, and cerebral and renal damage. The aim of this study was to investigate any potential relationship between short-term BP variability and incidence of acute onset conditions, such as acute kidney injury (AKI), in critically ill patients. METHODS: BP was monitored to analyze its variability in critically ill patients in present study. Short-term BP variability was assessed as average real variability (ARV), standard deviation (SD) and coefficient of variation (CV) of 24-hour BP. RESULTS: A total of 565 patients were included, 41.2% (n=233) of which presented with AKI after admission (AKI stage I, n = 94; stage II, n = 37; stage III, n = 102). The mean APACHE II score was 21.5 for all patients. ARV of 24 h systolic BP was significantly higher in patients with AKI (p<0.001). This association remained (p=0.006) after adjustment for potential confounders. The incidence of AKI increased with the ARV from 14.0% (ARV ≤6 mmHg) to 73.9% (ARV >14 mmHg). A weak association was also found between BP variability and hospital mortality in critically ill patients. CONCLUSION: BP variability is correlated with the incidence of AKI in critically ill patients.

[Albumin corrected anion gap is an independent risk factor for long-term mortality of patients with sepsis].

OBJECTIVE: To explore whether albumin corrected anion gap (ACAG) is associated with long-term mortality of sepsis patients. METHODS: Adult patients with a diagnosis of sepsis within the first 24 hours (from December 2013 to December 2014) admitted to the intensive care unit (ICU) were included via the Sepsis database of West China Hospital Sichuan University. To record their long-term survival, patients were followed up by telephone interview one year after enrollment. ACAG was calculated according to the anion gap (AG) level within the first 24 hours admitted to ICU, and patients were divided into normal ACAG group (ACAG 12-20 mmol/L) and high ACAG group (ACAG > 20 mmol/L), and clinical characteristics and 1-year mortality were compared between groups. Patients were also divided into survivors and non-survivors according to the 1-year survival outcome, and multivariate logistic regression analysis was conducted to find independent risk factors for long-term mortality of sepsis patients. RESULTS: A total of 296 sepsis patients were enrolled in the study, with 191 (64.5%) in the high ACAG group and 105 (35.5%) in the normal ACAG group. There were no significant differences in age, gender, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Charlson cormobidity index (CCI) and other background variables between groups. Compared with the normal ACAG group, patients who suffered from multiple organ dysfunction syndrome (MODS) in the high ACAG group were more prone to develop renal and gastrointestinal injury (43.5% vs. 25.7%, 52.9% vs. 33.3%, respectively), had significantly higher serum creatinine [SCr (µmol/L): 89.0 (61.0, 148.0) vs. 67.1 (48.0, 86.0)], greater need for continuous renal replacement therapy (CRRT, 16.8% vs. 6.7%), and significantly shorter length of ICU stay and hospital stay [days: 11 (5, 22) vs. 16 (18, 31), 21 (14, 39) vs. 28 (20, 47)], with statistically significant differences (all P < 0.05). It was shown by Kaplan-Meier survival analysis that 1-year cumulative survival for the high ACAG group was significantly lower than that of the normal ACAG group (55.0% vs. 67.7%, P = 0.046). It was shown by multivariate logistic regression that ACAG [odds ratio (OR) = 1.201, 95% confidence interval (95%CI) = 1.115-1.293, P = 0.000], APACHE II (OR = 1.053, 95%CI = 1.011-1.098, P = 0.014), the incidence of septic shock (OR = 2.203, 95%CI = 1.245-3.898, P = 0.007), fungus infection (OR = 3.107, 95%CI = 1.702-5.674, P = 0.000), acute renal failure (OR = 2.729, 95%CI = 1.134-6.567, P = 0.025) and complicated with malignancy (OR = 2.929, 95%CI = 1.395-6.148, P = 0.005) were independent risk factors contributing to increased 1-year mortality among sepsis patients. CONCLUSIONS: ACAG was an independent risk factor for 1-year mortality of sepsis patients.

Phenotypic Changes and Impaired Function of Peripheral γδ T Cells in Patients With Sepsis.

INTRODUCTION: Recent studies demonstrated the significant loss of gamma delta T (γδ T) cells in patients with sepsis. Given the distinct functions of γδ T cells in human anti-infection immunity, we are interested in evaluating the phenotype and function of peripheral γδ T cells in septic patients and determining their prognostic implication. METHOD: This prospective study has been conducted in three intensive care units of a university hospital. During the period from October 2014 to June 2015, we enrolled 107 patients who were consecutively admitted and diagnosed with severe sepsis or septic shock (excluding previous immunosuppression) and 45 healthy controls. Using flow cytometry, we analyzed the in vivo percentage of γδ T cells in cluster of differentiation (CD)3 cells from peripheral blood mononuclear cells as well as their expression of surface markers (CD69, natural-killer group 2 member D [NKG2D], programmed death receptor 1 [PD-1]) and intracellular cytokines (interferon-γ [IFN-γ], interleukin [IL]-17, IL-10, transforming growth factor-ß [TGF-ß]). Then we further evaluated the different responses of γδ T cells after the antigen stimulation ex vivo by measuring CD69 and IFN-γ expression. Lastly, we conducted the multiple logistic regressions to analyze the risk factor for prognosis. RESULTS: Compared with control group, γδ T cells in septic patients displayed a decrease in percentage, increase in CD69, decrease in NKG2D, and increase in cytokine expression (pro-inflammatory IFN-γ, IL-17, anti-inflammatory IL-10, TGF-ß) in vivo. After the antigen stimulation ex vivo, both CD69 and IFN-γ expression in γδ T cells were significantly lower in septic patients than control group. Importantly, the decrease in CD69 and IFN-γ expression was more pronounced in non-survivors than survivors. Multiple logistic regression analysis revealed that lower expression of IFN-γ after stimulation is a dependent risk factor that associated with patient 28-day death in septic patients (OR: 0.908 [95% CI: 0.853-0.966]). CONCLUSION: Septic patients showed altered phenotype and function of γδ T cells. The impaired IFN-γ expression by γδ T cells after the antigen stimulation is associated with mortality in septic patients.

Radiation Exposure to Staff in Intensive Care Unit with Portable CT Scanner.

Background. Bedside radiological procedures pose a risk of radiation exposure to ICU staff. The perception of risk may increase the degree of caution among the health care staff and raise new barriers preventing patients from obtaining prompt care. Objective. The aim of this study was to estimate the annual cumulative radiation dose to individual ICU staff. Methods. In this prospective study, forty subjects were required to wear thermoluminescent dosimeter badges during their working hours. The badges were analyzed to determine the exposure after 3 months. Results. A total of 802 radiological procedures were completed at bedside during the study period. The estimated annual dosage to doctors and nurses on average was 0.99 mSv and 0.88 mSv (p < 0.001), respectively. Residents were subjected to the highest radiation exposure (1.04 mSv per year, p = 0.002). The radiation dose was correlated with day shift working hours (r = 0.426; p = 0.006) and length of service (r = -0.403; p < 0.01). Conclusions. With standard precautions, bedside radiological procedures-including portable CT scans-do not expose ICU staff to high dose of ionizing radiation. The level of radiation exposure is related to the daytime working hours and length of service.

[New Concept for Surviving Sepsis: from Phenomenon to Essence].

Sepsis is a critical clinical syndrome which keep puzzling the medical profession for many years. Recently, the results from several large-scale trials challenged the necessity of early goal directed therapy (EGDT) in surviving sepsis bundle, These trials were not opposed to EGDT but bring new concept that it is essential to utilize therapy with multiple monitoring measures in order to minimize injury while guarantee the safety . Deeper understanding in the pathogenesis of sepsis gives rise to the update of its definition based on vital organ dysfunction. The importance of dynamic monitoring in defining sepsis also need to be emphasized. Developing more effective monitoring measures could provide better treatments, thus improve the prognosis of septic patients.

Pulmonary Infection Is an Independent Risk Factor for Long-Term Mortality and Quality of Life for Sepsis Patients.

Background. Long-term outcomes (mortality and health-related quality of life) of sepsis have risen as important indicators for health care. Pulmonary infection and abdominal infection are the leading causes of sepsis. However, few researches about long-term outcomes focused on the origin of sepsis. Here we aim to study the clinical differences between pulmonary-sepsis and abdominal-sepsis and to investigate whether different infection foci were associated with long-term outcomes. Methods. Patients who survived after hospital discharge were followed up by telephone interview. Quality of life (QoL) was assessed using the EuroQol 5-dimension (EQ5D) questionnaire. Results. Four hundred and eighty-three sepsis patients were included, 272 (56.3%) had pulmonary-sepsis, and 180 (37.3%) had abdominal-sepsis. The overall ICU and one-year mortality rates of the cohort were 17.8% and 36.1%, respectively. Compared with abdominal-sepsis, pulmonary-sepsis patients had older age, higher APACHE II, higher ICU mortality (31.7% versus 12.6%), and one-year mortality (45.4% versus 24.4%), together with worse QoL. Age, septic shock, acute renal failure, fungus infection, anion gap, and pulmonary infection were predictors for one-year mortality and pulmonary infection was a risk factor for poor QoL. Conclusions. Pulmonary-sepsis showed worse outcome than abdominal-sepsis. Pulmonary infection is a risk factor for one-year mortality and QoL after sepsis.

IL-6, IL-10 and IL-13 are associated with pathogenesis in children with Enterovirus 71 infection.

In the present study, the aim was to reveal the relationship of serum IL-6, IL-10 and IL-13 levels in patient with Enterovirus 71 (EV71) infection. To elucidate the role of immune mechanisms in the pathogenesis of Hand, foot, and mouth disease (HFMD), we analyzed the cytokine of 112 EV71-infected patients. A significant elevation of serum (interleukin) IL-6, IL-10 and IL-13 levels in patients with EV71 infection compare with Un-EV71 infection HFMD patient and Healthy individuals. The production of inflammatory cytokines was increased with disease clinical stage. In addition, the immunological consequences of these cytokine in patient with EV71 infection showed a downward trend after cure. These data suggested that EV71 infection significantly increased the release of circulating IL-6, IL-10 and IL-13. The systemic inflammatory response may play an important role in the pathogenesis of HFMD. Moreover, this study may be designed to evaluate the potential therapeutic of medicine in the treatment of patients with EV71 infection.