Safety and Efficacy of 4 mg·kg⁻¹ Sugammadex for Simultaneous Pancreas-Kidney Transplantation Recipients: A Prospective Randomized Trial.

BACKGROUND Simultaneous pancreas-kidney transplantation (SPK) is a time-consuming and important surgical procedure, which can provide a physiological mean of achieving normoglycemia and render patients free of dialysis. The potential clinical benefits of sugammadex include fast and predictable reverse deep neuromuscular blockade (NMB), but whether sugammadex affects the function of SPK grafts is uncertain. MATERIAL AND METHODS Forty-eight patients were studied and reversed deep NMB with either sugammadex (n=24) or neostigmine (n=24). The safety variables included serum creatinine (Scr), creatinine clearance rate (CCr), serum amylase (AMS), blood glucose (Glu), mean arterial pressure (MAP), and heart rate (HR). Secondary outcomes were time from administration of sugammadex/neostigmine at the scheduled time to recovery of a TOF ratio to 0.7 and 0.9, and post-acute pulmonary complications. RESULTS Scr at T2-6 was significantly lower than that at T0-1 (P<0.01), while CCr was higher (P<0.05). Between the 2 groups, Scr, CCr, and AMS were similar at the same timepoints (P>0.05). MAP, HR, and Glu were higher in group S than in group N at T1 (P<0.05). The recovery time of TOF=0.7 was 3 (2.4-4.2) min for group S and 12.1 (10.2-15.9) min for group N (P<0.001), and recovery time to TOFr ≥0.9 was 4.8 (3.6-7.1) min for group S and 23.5 (19.8-30.8) in group S. Compared to group N, group S had lower risk for post-acute pulmonary complications: supplemental oxygen requirements 0 vs 4 (16.7%), pulmonary atelectasis 0 vs 2 (0.83%), pneumonia 1 (4.2%) vs 3 (12.5%), and hypoxemia 1 (4.2%) vs 4 (16.7%). CONCLUSIONS Sugammadex administration is safe and effective for SPK transplantation recipients.

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy.

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when there are tumors adjacent to the cystic bed, surgeons cannot palpate the surgical margins through the laparoscopic approach, which leads to uncertainty about R0 resection. Conventionally, the gallbladder is resected first, and the hepatic lobes or segments are resected second. However, tumor tissues can be disseminated in the above cases. To address this issue, based on the recognition of the porta hepatis and intrahepatic anatomy, we propose a unique approach to hepatectomy combined with gallbladder resection by en bloc anatomic resection in situ. Firstly, after dissecting the cystic duct, without cutting the gallbladder primarily, the porta hepatis is pre-occluded by the single lumen ureter; secondly, the left hepatic pedicle is made free by the gap of the Laennec membrane and Hilar plate; thirdly, the assistant is asked to drag the fundus of the gallbladder, and the liver parenchyma tissue is resected using a harmonic scalpel along the ischemia line on the liver surface and intraoperative ultrasound. The whole middle hepatic vein (MHV) and its tributaries appear completely; lastly, the left hepatic vein (LHV) is disconnected, and the specimen is taken out from the abdominal cavity. The tumor, gallbladder, and other surrounding tissues are resected en bloc, which meets the tumor-free criterion, and a wide incisal margin and R0 resection are achieved. Therefore, the laparoscopic hepatectomy with the combination of the en bloc concept and anatomic resection is a safe, effective, and radical method with low postoperative recurrence and metastasis.

Nb2CTx MXene Cathode for High-Capacity Rechargeable Aluminum Batteries with Prolonged Cycle Lifetime.

Aluminum-ion batteries have garnered significant interest as a potentially safer and cheaper replacement for conventional lithium-ion batteries, offering a shorter charging time and denser storage capacity. Nonetheless, the progress in this field is considerably hampered by the limited availability of suitable cathode materials that can sustain the reversible intercalation of Al3+/[AlCl4]- ions, particularly after long cycles. Herein, we demonstrate that rechargeable Al batteries embedded with two-dimensional (2D) Nb2CTx MXene as a cathode material exhibit excellent capacity and exceptional long cyclic performance. We have successfully improved the initial electrochemical performance of Nb2CTx MXene after being properly delaminated to a single-layered microstructure and subjected to a post-synthesis calcining treatment. Compared to pristine Nb2CTx MXene, the Al battery embedded with the calcined Nb2CTx MXene cathode has, respectively, retained high capacities of 108 and 80 mAh g-1 after 500 cycles at current densities of 0.2 and 0.5 A g-1 in a wide voltage window (0.1-2.4 V). Noteworthily, the cyclic lifetime of Nb2CTx MXene was extended from ∼300 to >500 times after calcination. We reveal that attaining Nb2CTx nanosheets with a controllable d-spacing has promoted the migration of the [AlCl4]- and Al3+ ions in the MXene interlayers, leading to enhanced charge storage. Furthermore, we found out that the formation of niobium oxides and amorphous carbon after calcination probably benefits the electrochemical performance of Nb2CTx MXene electrode in Al batteries.

Application of Hemostatic Devices in Laparoscopic Hepatectomy.

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. Despite its non-invasive aspect, bleeding and bile leakage occur in liver parenchyma tissue resection during the operation or in the post-operation period, indicating the requirement for high-grade hemostatic devices, such as ultrasonic surgical aspiration, bipolar electrocoagulation, etc. The lack of availability of these high-grade hemostatic devices prevents laparoscopic hepatectomy from becoming a generalized procedure in basic medical organizations. In view of the situation mentioned above, a suite of simple and easy hemostatic devices is developed in this protocol, which includes a harmonic scalpel, monopole electrocoagulation, and a single lumen catheter, to innovatively perform liver parenchyma tissue resection. First of all, the porta hepatis or hepatic pedicle is occluded intermittently by a single lumen catheter, followed by clamping for 15 min and releasing for 5 min. Subsequently, using the harmonic scalpel, clamping and crushing of the liver are done to cut off the hepatic parenchyma tissue and to reveal the intrahepatic arteries, veins, and bile ducts. Lastly, the bleeding spots are coagulated by using monopole electrocoagulation at each spot. Intrahepatic pipeline structures are then visible by using these methods, which could stop bleeding easily, reduce the incidence rate of bile leakage, and improve the safety and feasibility of laparoscopic hepatectomy. Therefore, the simple and easy hemostatic devices shown here are suitable for conducting procedures in primary medical institutions.

3D Porous MXene (Ti3C2Tx) Prepared by Alkaline-Induced Flocculation for Supercapacitor Electrodes.

2D layered MXene (Ti3C2Tx) with high conductivity and pseudo-capacitance properties presents great application potential with regard to electrode materials for supercapacitors. However, the self-restacking and agglomeration phenomenon between Ti3C2Tx layers retards ion transfer and limits electrochemical performance improvement. In this study, a 3D porous structure of Ti3C2Tx was obtained by adding alkali to a Ti3C2Tx colloid, which was followed by flocculation. Alkaline-induced flocculation is simple and effective, can be completed within minutes, and provides 3D porous networks. As 3D porous network structures present larger surface areas and more active sites, ions transfer accelerates, which is crucial with regard to the improvement of the superior capacitance and rate performance of electrodes. The sample processed with KOH (K-a-Ti3C2Tx) exhibited a high capacity of approximately 300.2 F g-1 at the current density of 1 A g-1. The capacitance of the samples treated with NaOH and LiOH is low. In addition, annealing is essential to further improve the capacitive performance of Ti3C2Tx. After annealing at 400 °C for 2 h in a vacuum tube furnace, the sample treated with KOH (K-A-Ti3C2Tx) exhibited an excellent specific capacitance of approximately 400.7 F g-1 at a current density of 1 A g-1, which is considerably higher than that of pristine Ti3C2Tx (228.2 F g-1). Furthermore, after 5000 charge-discharge cycles, the capacitance retention rate reached 89%. This result can be attributed to annealing, which can further remove unfavourable surface groups, such as -F or -Cl, and then improve conductivity capacitance and rate performance. This study can provide an effective approach to the preparation of high-performance supercapacitor electrode materials.

Influence of Pulse Current Forward-Reverse Duty Cycle on Structure and Performance of Electroplated W-Cu Composite Coatings.

Tungsten-copper (W-Cu) composites are widely used as electrical contact materials, resistance welding, electrical discharge machining (EDM), and plasma electrode materials due to their excellent arc erosion resistance, fusion welding resistance, high strength, and superior hardness. However, the traditional preparation methods pay little attention to the compactness and microstructural uniformity of W-Cu composites. Herein, W-Cu composite coatings are prepared by pulse electroplating using nano-W powder as raw material and the influence of forward-reverse duty cycle of pulse current on the structure and mechanical properties is systematically investigated. Moreover, the densification mechanism of the W-Cu composite coating is analyzed from the viewpoints of forward-pulse plating and reverse-pulse plating. At the current density (J) of 2 A/dm2, frequency (f) of 1500 Hz, forward duty cycle (df) of 40% and reverse duty cycle (dr) of 10%, the W-Cu composite coating rendered a uniform microstructure and compact structure, resulting in a hardness of 127 HV and electrical conductivity of 53.7 MS/m.

Scalable Preparation of Ultrathin Graphene-Reinforced Copper Composite Foils with High Mechanical Properties and Excellent Heat Dissipation.

As an important basic material of electronic equipment, copper (Cu) foils should have a small thickness, good mechanical properties, and excellent thermal conductivity. However, preparing an ultrathin Cu foil with good properties remains challenging. Herein, we report an electroless deposition (ELD) strategy for the facile and scalable preparation of an ultrathin freestanding nickel-coated graphene (NCG)/Cu composite foil in a short time of 25 min. The NCG can significantly improve the mechanical and physical properties of composite foils. Experimental results reveal that the NCG/Cu composite foil manifests the best performance when the NCG concentration in an ELD bath was 30 mg/L. The composite foil evidenced a thickness of 1.1 µm, a high tensile strength of 338.7 MPa, and a high thermal conductivity of 431.2 W/mK. Compared with the pure Cu foil, both bending times and elastic modulus are increased by 298.1 and 737.3%, respectively. Remarkably, the composite foil has excellent heat dissipation performance, showing enormous potential as a heat sink material. This work proposes a new method for manufacturing the ultrathin graphene-reinforced Cu composite foil with high performance for numerous applications.

Interleukin-33 Promotes Cell Survival via p38 MAPK-Mediated Interleukin-6 Gene Expression and Release in Pediatric AML.

Acute myeloid leukemia (AML) is a fatal disease characterized by the accumulation of immature myeloid blasts in the bone marrow (BM). Cytokine provide signals for leukemia cells to improve their survival in the BM microenvironment. Previously, we identified interleukin-33 (IL-33) as a promoter of cell survival in a human AML cell line and primary mouse leukemia cells. In this study, we report that the cell surface expression of IL-33-specific receptor, Interleukin 1 Receptor Like 1 (IL1RL1), is elevated in BM cells from AML patients at diagnosis, and the serum level of IL-33 in AML patients is higher than that of healthy donor controls. Moreover, IL-33 levels are found to be positively associated with IL-6 levels in pediatric patients with AML. In vitro, IL-33 treatment increased IL-6 mRNA expression and protein level in BM and peripheral blood (PB) cells from AML patients. Evidence was also provided that IL-33 inhibits cell apoptosis by activating p38 mitogen-activated protein kinase (MAPK) pathway using human AML cell line and AML patient samples. Finally, we confirmed that IL-33 activated IL-6 expression in a manner that required p38 MAPK pathway using clinical AML samples. Taken together, we identified a potential mechanism of IL-33-mediated survival involving p38 MAPK in pediatric AML patients that would facilitate future drug development.

Formation Mechanism of High-Purity Ti2AlN Powders under Microwave Sintering.

In the present study, high-purity ternary-phase nitride (Ti2AlN) powders were synthesized through microwave sintering using TiH2, Al, and TiN powders as raw materials. X-ray diffraction (XRD), differential scanning calorimetry (DSC), transmission electron microscopy (TEM), and scanning electron microscopy (SEM) were adopted to characterize the as-prepared powders. It was found that the Ti2AlN powder prepared by the microwave sintering of the 1TiH2/1.15Al/1TiN mixture at 1250 °C for 30 min manifested great purity (96.68%) with uniform grain size distribution. The formation mechanism of Ti2AlN occurred in four stages. The solid-phase reaction of Ti/Al and Ti/TiN took place below the melting point of aluminum and formed Ti2Al and TiN0.5 phases, which were the main intermediates in Ti2AlN formation. Therefore, the present work puts forward a favorable method for the preparation of high-purity Ti2AlN powders.

Electroless Deposition of Automatically Shedded Thin Copper Foils.

Electroless deposition (ELD) is a process widely used for the production of thin metal films, but stripping the films from the substrate remains challenging. Here, we report a low-cost ELD method for the large-scale production of freestanding copper (Cu) foils in a short time of 25-55 min. By atomizing a thin (<100 nm) sacrificial layer of chitosan with weak glycosyl bonds and a high degree of deacetylation on the glass substrate, the chitosan is completely decomposed in the process of Cu-deposition, producing automatically shedded Cu foils with varied thicknesses from 746 nm to 8.33 µm and high elastic modulus. When used as battery current collectors, the thin Cu foils with enhanced adhesive fastness and contact areas greatly enhance the capacity and rate capability of graphite anodes. Compared with the commercial Cu current collectors, both the battery capacity and energy density are increased by 429.6 and 484.1%, respectively. The reported approach can be extended for fabricating other metal foils such as nickel with properties appealing for applications.