Characteristics of Postoperative Heart Failure in Older Hip Fractures Patients Combined with Coronary Heart Disease and Construction of a Prediction Model of Nomogram, a Retrospective Cohort Study.

Introduction: Older patients combined with coronary heart disease (CHD) develop acute heart failure (AHF) after hip fracture surgery is common, and this study aimed to investigate the risk factors of postoperative AHF in older hip fracture patients and to construct a nomogram prediction model. Methods: We retrospectively collected older hip fracture patients with CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2017 to December 2021. We divided them into a training set and a validation set. We collected the demographic data, laboratory indicators and imaging examination results. We identified risk factors for postoperative AHF and used R language software to establish a nomogram prediction model, plot ROC curves, calibration curves and DCA decision curves. Results: We retrospectively collected 1288 older hip fractures patients with CHD. After excluding 214 patients who did not meet the criteria, 1074 patients were included in our research and we divided them into the training set and the validation set. In the training set, a total of 346 (42.8%) patients developing postoperative AHF. Through univariate and multivariate logistic regression analysis, we identified the risk factors for postoperative AHF and constructed a nomogram prediction model. The AUC of the prediction model is 0.778. The correction curve shows that the model has good consistency. The decision curve analysis shows that the model has good clinical practicality. Conclusion: There were 42.8% older patients combined with CHD develop postoperative AHF. Among them, fracture type, age, anemia at admission, combined with COPD, ASA ≥ 3, and preoperative waiting time >3 days are risk factors for postoperative AHF. We constructed a nomogram prediction model that can effectively predict the risk of postoperative AHF in older hip fracture patients combined with CHD.

Occurrence, distribution, and ecological risk assessment of pharmaceuticals and personal care products in the surface water of Lipu River, China.

Pharmaceuticals and Personal Care Products (PPCPs) are inadvertently released into the aquatic environment, causing detrimental effects on aquatic ecosystem. There is an urgent need of an in-deep investigation on contamination information of PPCPs in aquatic environment as well as the ecological risks to the aquatic ecosystem. This study was carried out in Lipu River basin, China, to investigate the distribution pattern and ecological risks of PPCPs. Results showed that PPCPs pollution is ubiquitous, 29 out of 30 targeted PPCPs were detected in Lipu River. Fourteen PPCPs were detected with a frequency of 100% in all water samples, and ten PPCPs were detected with a frequency of more than 80%. The cumulated PPCPs concentrations ranged from 33.30 ng/L to 99.60 ng/L, with a median value of 47.20 ng/L in Lipu River. CAF, FQ, NF, and LMLX were the predominant PPCPs in study area. CAF showed high ecological risk, five and seven individual PPCP showed medium and low ecological risk to algae.

Predictive characteristics and model development for acute heart failure preceding hip fracture surgery in elderly hypertensive patients: a retrospective machine learning approach.

BACKGROUND: Hip fractures are a serious health concern among the elderly, particularly in patients with hypertension, where the incidence of acute heart failure preoperatively is high, significantly affecting surgical outcomes and prognosis. This study aims to assess the risk of preoperative acute heart failure in elderly patients with hypertension and hip fractures by constructing a predictive model using machine learning on potential risk factors. METHODS: A retrospective study design was employed, collecting preoperative data from January 2018 to December 2019 of elderly hypertensive patients with hip fractures at the Third Hospital of Hebei Medical University. Using SPSS 24.0 and R software, predictive models were established through LASSO regression and multivariable logistic regression analysis. The models' predictive performance was evaluated using metrics such as the concordance index (C-index), receiver operating characteristic curve (ROC curve), and decision curve analysis (DCA), providing insights into the nomogram's predictive accuracy and clinical utility. RESULTS: Out of 1038 patients screened, factors such as gender, age, history of stroke, arrhythmias, anemia, and complications were identified as independent risk factors for preoperative acute heart failure in the study population. Notable predictors included Sex (OR 0.463, 95% CI 0.299-0.7184, P = 0.001), Age (OR 1.737, 95% CI 1.213-2.488, P = 0.003), Stroke (OR 1.627, 95% CI 1.137-2.327, P = 0.008), Arrhythmia (OR 2.727, 95% CI 1.490-4.990, P = 0.001), Complications (OR 2.733, 95% CI 1.850-4.036, P < 0.001), and Anemia (OR 3.258, 95% CI 2.180-4.867, P < 0.001). The prediction model of acute heart failure was Logit(P) = -2.091-0.770 × Sex + 0.552 × Age + 0.487 × Stroke + 1.003 × Arrhythmia + 1.005 × Complications + 1.181 × Anemia, and the prediction model nomogram was established. The model's AUC was 0.785 (95% CI, 0.754-0.815), Decision curve analysis (DCA) further validated the nomogram's excellent performance, identifying an optimal cutoff value probability range of 3% to 58% for predicting preoperative acute heart failure in elderly patients with hypertension and hip fractures. CONCLUSION: The predictive model developed in this study is highly accurate and serves as a powerful tool for the clinical assessment of the risk of preoperative acute heart failure in elderly hypertensive patients with hip fractures, aiding in the optimization of preoperative risk assessment and patient management.

Guiding the Formation of Metal-Organic Structures of 1,4-Diaminoanthraquinone through Surface-Based Cu Atoms.

The gradual guidance of the formation of metal-organic structures through surface-based Cu atoms for 1,4-diaminoanthraquinones (DAQs) has been studied by scanning tunneling microscopy (STM) at room temperature. On the Ag(110) surface, the transition from a hydrogen-bond network structure to metal-organic coordination structures of DAQs can be induced by introducing foreign copper atoms. Due to the weak interaction between DAQs and Ag(110), thermal treatment easily leads to the desorption of DAQs from the surface. To address this challenge, Cu(111) is selected as the substrate. Under thermal driving and in the presence of copper adatoms, the hydrogen-bond network structure of DAQs on the surface gradually undergoes a transition into a metal-coordinated structure, eventually leading to the formation of metal-organic complexes through amino dehydrogenation. It is demonstrated that the construction of a metal-organic coordination structure on metal surfaces is a result of the competition among factors such as metal atoms, functional groups of molecules, surface chemical activity, and temperature.

Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study.

BACKGROUND: Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF. METHODS: A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis. RESULTS: We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection. CONCLUSION: Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.

Clinical characteristics of elderly hip fracture patients with chronic cerebrovascular disease and construction of a clinical predictive model for perioperative pneumonia.

INTRODUCTION: The recovery of cerebrovascular disease (CVD) will increase the incidence of perioperative pneumonia (POP). However, there is limited research on POP in elderly patients with hip fractures complicated by CVD. Therefore, our research focuses on the following two issues: (1) What are the clinical features of elderly patients with hip fractures combined with CVD? (2) What are the predictive factors for the occurrence of POP in such patients? HYPOTHESIS: Male, femoral neck fracture and hypoalbuminemia can be predictive factors for the development of POP after hip fracture in CVD patients. MATERIAL AND METHODS: This is a nested case-control study that included patients aged 65 to 105 years with CVD who had a hip fracture between January 2021 and January 2023. According to the occurrence of POP, they were divided into case group and control group. Collecting data includes demographic information, clinical data, and surgical information. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to select variables. The constructed predictive model was transformed into a nomogram. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). RESULTS: We ultimately included 714 patients, 69.3% female, with a median age of 80 years. Asymptomatic cerebral infarction (ACI) is the most common CVD (55.7%). More patients developed intertrochanteric fractures than femoral neck fractures (57.1 vs. 42.9%). In total, 606 patients (84.9%) underwent surgery. The most common perioperative complications were anemia (76.9%) and hypoalbuminemia (71.8%). POP (20.0%) was more common preoperatively (89.5%). Factors such as fracture type, surgical wait time, implant used for surgery, and anesthesia type did not differ between the presence or absence of postoperative pneumonia. 143 patients with POP served as the case group. Five hundred and seventy one patients did not develop POP and served as the control group. The predictors of POP were male (OR 1.699,95%CI 1.150-2.511, p<0.05), femoral neck fracture (OR 2.182,95%CI 1.491-3.192, p<0.05), and hypoalbuminemia (OR 3.062, 95%CI 1.833-5.116, p<0.05). This model has good discrimination, calibration, and clinical practicality. DISCUSSION: In this study, we constructed a clinical prediction model for the occurrence of POP in CVD combined with hip fracture in the elderly, with risk factors including gender, fracture type and perioperative hypoproteinemia. Therefore, we can take effective preventive measures against the occurrence of POP in patients with these factors in our clinical work. LEVEL OF PROOF: IV; nested case-control study.

Manipulations of Electronic and Spin States in Co-Quantum Dot/WS2 Heterostructure on a Metal-Dielectric Composite Substrate by Controlling Interfacial Carriers.

Charge and spin are two intrinsic attributes of carriers governing almost all of the physical processes and operation principles in materials. Here, we demonstrate the manipulation of electronic and spin states in designed Co-quantum dot/WS2 (Co-QDs/WS2) heterostructures by employing a metal-dielectric composite substrate and via scanning tunneling microscope. By repeatedly scanning under a unipolar bias, switching the bias polarity, or applying a pulse through nonmagnetic or magnetic tips, the Co-QDs morphologies exhibit a regular and reproducible transformation between bright and dark dots. First-principles calculations reveal that these tunable characters are attributed to the variation of density of states and the transition of magnetic anisotropy energy induced by carrier accumulation. It also suggests that the metal-dielectric composite substrate is successful in creating the interfacial potential for carrier accumulation and realizes the electrically controllable modulations. These results will promote the exploration of electron-matter interactions in quantum systems and provide an innovative way to facilitate the development of spintronics.

Phase Transitions of Naphthalene-2,3-carbonitride Steered by Solvent Effects and Metal Ion Concentration Variation.

The delicate regulation of structural phase transition can provide advanced approaches for fabricating desired and well-organized nanoarchitectures on surfaces. Introduction of metal ions into pure organic systems can facilitate the phase transition from hydrogen-bonded structures to metal-organic structures by coordinating with organic molecules. However, it remains a challenge to attain a phase transition dominated by variable metal coordination configurations through adjustment of the metal ion concentration. Herein, we report the phase transitions of naphthalene-2,3-carbonitride (2,3-DCN) molecules on highly oriented pyrolytic graphite (HOPG) under varying solvents and Cu2+ ion concentrations. By integrating data from scanning tunneling microscopy imaging and density functional theory calculations, it is demonstrated that phase transitions of 2,3-DCN occur through forming diverse coordination configurations where Cu2+ ions can coordinate with 2,3-DCN and 1-nonanoic acid or Cl- ions to form different ligand components with a coordination number of 4 when varying the molar ratios of 2,3-DCN to Cu2+ ion in the 1-nonanoic acid solvent. However, in the case of 1-heptanoic acid as a solvent, the self-assembly structure of 2,3-DCN only changes via the alteration of hydrogen bonding sites and Cu2+ ions do not coordinate with 2,3-DCN molecules. These findings provide valuable insights into the coordination behavior of metal ions in different solvents.

Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study.

Background: The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model. Methods: We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation. Results: There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility. Conclusion: This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.

Reactive wetting enabled anchoring of non-wettable iron oxide in liquid metal for miniature soft robot.

Magnetic liquid metal (LM) soft robots attract considerable attentions because of distinctive immiscibility, deformability and maneuverability. However, conventional LM composites relying on alloying between LM and metallic magnetic powders suffer from diminished magnetism over time and potential safety risk upon leakage of metallic components. Herein, we report a strategy to composite inert and biocompatible iron oxide (Fe3O4) magnetic nanoparticles into eutectic gallium indium LM via reactive wetting mechanism. To address the intrinsic interfacial non-wettability between Fe3O4 and LM, a silver intermediate layer was introduced to fuse with indium component into AgxIny intermetallic compounds, facilitating the anchoring of Fe3O4 nanoparticles inside LM with improved magnetic stability. Subsequently, a miniature soft robot was constructed to perform various controllable deformation and locomotion behaviors under actuation of external magnetic field. Finally, practical feasibility of applying LM soft robot in an ex vivo porcine stomach was validated under in-situ monitoring by endoscope and X-ray imaging.

Distribution characteristics of organic carbon (nitrogen) content, cation exchange capacity, and specific surface area in different soil particle sizes.

Understanding the distribution of soil organic carbon and nitrogen (OC(N)) content, cation exchange capacity (CEC), and specific surface area (SSA) in different soil particle sizes is crucial for studying soil fertility and properties. In this study, we investigated the distribution characteristics of the OC(N), CECand SSA in different particles of yellow-brown soil under different methods. The result revealed that as the particle size decreased, the soil OC(N), SSA and CEC content gradually increase. The content of OC and ON different soil particles ranged from 1.50-28.16 g·kg-1 to 0.18-3.78 g·kg-1, respectively, and exhibited significant differences between different particles. We observed good linear relationships between OC and ON in different particle sizes of yellow-brown soil under different utilization methods, with correlation coefficients ranging from 0.86 to 0.98, reaching a very significant level (n = 12, p < 0.01). The ranges of SSA and CEC in different particles of the four soils were 0.30-94.70 m2·g-1 and 0.70-62.91 cmol·kg-1, respectively. Additionally, we found logarithmic relationships between SSA (CEC) and the equivalent diameter for the four soils, with correlation coefficients (r2) higher than 0.91. Furthermore, there was an extremely significant linear relationship between CEC and SSA of the four soils, with correlation coefficients (r2) of 0.92-0.97 (n = 12, p < 0.01). These results highlight the close relationship between soil particle size and soil OC(N), SSA, and CEC. The conclusions drawn from this study provide valuable data support and a theoretical basis for further understanding soil properties.

A dePEGylated Lipopeptide-Based Pan-Coronavirus Fusion Inhibitor Exhibits Potent and Broad-Spectrum Anti-HIV-1 Activity without Eliciting Anti-PEG Antibodies.

We previously identified a lipopeptide, EK1C4, by linking cholesterol to EK1, a pan-CoV fusion inhibitory peptide via a polyethylene glycol (PEG) linker, which showed potent pan-CoV fusion inhibitory activity. However, PEG can elicit antibodies to PEG in vivo, which will attenuate its antiviral activity. Therefore, we designed and synthesized a dePEGylated lipopeptide, EKL1C, by replacing the PEG linker in EK1C4 with a short peptide. Similar to EK1C4, EKL1C displayed potent inhibitory activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other coronaviruses. In this study, we found that EKL1C also exhibited broad-spectrum fusion inhibitory activity against human immunodeficiency virus type 1 (HIV-1) infection by interacting with the N-terminal heptad repeat 1 (HR1) of viral gp41 to block six-helix bundle (6-HB) formation. These results suggest that HR1 is a common target for the development of broad-spectrum viral fusion inhibitors and EKL1C has potential clinical application as a candidate therapeutic or preventive agent against infection by coronavirus, HIV-1, and possibly other class I enveloped viruses.

Measuring the route topography impact on real driving emissions based on neural network models.

Route topography is an important test boundary of real driving emission (RDE) tests. However, the RDE test boundaries, such as atmospheric environment, driver behavior, route topography, and traffic congestion, are random, uncertain, and completely coupled. It is difficult to know to what extent route topography can determine on-road emissions, especially in a region with hilly topography. In this regard, the neural network predictor importance algorithms were proposed to measure the importance of the route topography test boundary. Based on tens of thousands of data window samples from the RDE tests in Chongqing, factor analysis was performed to reduce the data dimensionality and eliminate information overlap, and neural network models were established to predict pollutant emissions and calculate the relative importance of input variables. The results show that route topography is comparable to trip dynamics for on-road emissions but the importance of the route topography test boundary is not fully appreciated in the existing RDE regulation, making mountain cities suffer from severe vehicle emissions that are not effectively controlled.

Characteristics of preoperative atrial fibrillation in geriatric patients with hip fracture and construction of a clinical prediction model: a retrospective cohort study.

INTRODUCTION: Atrial fibrillation is the most common atrial arrhythmia in the perioperative period and is associated with prolonged hospital stay, increased costs, and increased mortality. However, there are few data on the predictors and incidence of preoperative atrial fibrillation in hip fracture patients. Our aim was to identify predictors of preoperative atrial fibrillation and to propose a valid clinical prediction model. METHODS: Predictor variables included demographic and clinical variables. LASSO regression analyzes were performed to identify predictors of preoperative atrial fibrillation, and models were constructed and presented as nomograms. Area under the curve, calibration curve, and decision curve analysis (DCA) were used to examine the discriminative power, calibration, and clinical efficacy of the predictive models. Bootstrapping was used for validation. RESULTS: A total of 1415 elderly patients with hip fractures were analyzed. Overall, 7.1% of patients had preoperative atrial fibrillation, and they were at significant risk for thromboembolic events. Patients with preoperative AF had a significantly longer delay in surgery than those without preoperative atrial fibrillation (p < 0.05). Predictors for preoperative atrial fibrillation were hypertension (OR 1.784, 95% CI 1.136-2.802, p < 0.05), C-reactive protein at admission (OR 1.329, 95% CI 1.048-1.662, p < 0.05), systemic inflammatory response index at admission (OR 2.137, 95% CI, 1.678-2.721 p < 0.05), Age-Adjusted Charlson Comorbidity Index (OR 1.542, 95% CI 1.326-1.794, p < 0.05), low potassium(OR 2.538, 95% CI 1.623-3.968, p < 0.05), anemia(OR 1.542, 95% CI 1.326-1.794, p < 0.05). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.799. DCA demonstrated this nomogram has good clinical utility. CONCLUSION: This model has a good predictive effect on preoperative atrial fibrillation in elderly patients with hip fractures, which can help to better plan clinical evaluation.

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study.

BACKGROUND: Due to concomitant factors like frailty and comorbidity, super elderly (≥90 years) patients with hip fracture differ from patients aged 65-89 years in perioperative complications and mortality. The integrated management bundle referred to bundled application of multiple clinical measures. The aim of this study was to analyze effect of integrated management bundle on 1-year overall survival and perioperative outcomes in super elderly patients with hip fracture, with multidisciplinary management group serving as the control group. METHODS: In this retrospective cohort study, super elderly patients with hip fracture were included from Jan 2017 to Nov 2020. Patients were retrospectively divided to multidisciplinary management group and integrated management bundle group. The primary outcome was 1- year overall survival, and the secondary outcome was perioperative outcomes. Kaplan-Meier methods was used to compare survival probability. Multivariable Cox's modeling was used to explain the effect of integrated bundle on 1-year overall survival adjusted for confounders. The perioperative outcomes including complications and in-hospital data of two groups were compared. The multivariable logistic regression was used to explain the effect of integrated bundle on the occurrence of perioperative complications adjusted for confounders. Prognostic factors related to survival was identified by multivariable Cox's regression analysis. RESULTS: Ninety-seven patients comprised multidisciplinary management group, and 83 comprised integrated management bundle group. The Kaplan-Meier plots showed that the survival probability of integrated management bundle group was significantly better than multidisciplinary management group (HR:0.435, 95%CI:0.207-0.914, P = 0.039). Multivariable analysis after adjustment for confounders showed a 42.8% lower incidence of mortality integrated management bundle group than multidisciplinary management group (HR:0.428, 95%CI:0.186-0.986, P = 0.046). Incidence of hypoproteinemia, and electrolyte disturbance in integrated management bundle group was significantly lower than multidisciplinary management group (all P < 0.05). In addition, significant reduction was observed in length of stay (P < 0.05) in integrated management bundle group. Multivariable logistic regression showed integrated management bundle was independent protective factor of hypoproteinemia, and electrolyte disturbance. mECM score ≥ 6 and ASA score > 2 were independent risk factors of overall survival (HR: 1.940, 95%CI: 1.067-3.525,P = 0.030; HR: 2.281, 95%CI: 1.113-4.678,P = 0.024). CONCLUSIONS: The integrated management bundle improved 1-year overall survival and played positive effects in improving perioperative outcomes. It might be a more suitable management modality for super elderly patients with hip fracture.

Dual-source powered nanomotor with integrated functions for cancer photo-theranostics.

While the miniaturization and motility of artificial nanomotors made them popular tools for exploring novel and innovative biomedical cancer treatment strategies, the integration of multiple functions on the small motor bodies is key to achieve further progress but remains unresolved. Here, we propose a dual-source powered Janus nanomotor whose composition integrates multiple photo-theranostic functions such as surface-enhanced Raman scattering (SERS) sensing, fluorescence imaging/photoacoustic imaging (PAI), photodynamic therapy (PDT), and photothermal therapy (PTT). This nanomotor can be fabricated by sputtering a thin gold layer onto one side of mesoporous silica (mSiO2) combined with surface modification by photo-sensitizer, Raman reporter, and catalase. Upon illumination with 808 nm near-infrared light, the half-coated gold nanoshell serves as PAI/PTT agent, and by upconverting NIR to visible light, the pre-loaded photosensitizer can be excited by the upconverted light of UCNPs to convert the dissolved oxygen (O2) into reactive oxygen species for efficient PDT. Furthermore, ratiometric SERS signal can be captured to quantitatively detect the tumor marker, H2O2, in cellular microenvironments. The immobilized catalase as a nano-engine can catalyze endogenous H2O2 to O2. This function not only improves the hypoxic tumor microenvironment and therefore enhances PDT efficiency, but also provides a thrust force for deep penetration. As a proof of concept for the in vivo trial we performed cancer photo-theranostics where our nanomotors successfully treated a mouse breast tumor in a subcutaneous tumor model. The results are promising and encourage the use of an integrated nanomotor platform that could be further developed into a photo-theranostic agent for superficial cancer treatment.

Characteristics and complications of fracture in older adults with chronic kidney disease: a cross-sectional study.

BACKGROUND: The aim of this study was to analyze the clinical characteristics of older fracture patients with chronic kidney disease (CKD) and to determine the risk factors of perioperative cardiovascular complications. METHODS: We retrospectively reviewed clinical data of older fracture patients with CKD admitted to the Third Hospital of Hebei Medical University from January 2016 to October 2021. The data we collected included baseline characteristics and complications. We finally determined the risk factors of perioperative cardiovascular complications by using logistic regression. RESULTS: We ended up enrolling 224 patients, and there were 91 (40.6%) males and 133 (59.4%) females, with a median age of 79 years. 80-84 years old was the age group with high incidence of fracture. The majority of fracture occurred indoors (130 cases, 58.0%) and morning (98 cases, 43.8%). Hip fracture was most common (183 cases, 81.7%), of which femoral neck fracture (101 cases, 45.0%) was the most prevalent. The most common comorbid condition was hypertension (171 cases, 76.3%), and anemia was the most common complication (148 cases, 66.1%). Age ≥ 80 years (OR = 2.023, 95% CI 1.110-3.688), previously combined with cardiovascular calcification (OR = 1.901, 95% CI 1.047-3.451) and admission hemoglobin level < 100 g/L (OR = 3.191, 95% CI 1.744-5.838) were independent risk factors of perioperative cardiovascular disease (CVD). CONCLUSION: It was especially necessary to enhance fracture prevention for CKD. Patients whose age older than 80, hemoglobin less than 100 g/L on admission and have previous cardiovascular calcification are more likely to develop perioperative CVD. Such patients require reasonable decisions during the perioperative period to avoid the occurrence of CVD.

Characteristics and perioperative complications of hip fracture in the elderly with acute ischemic stroke: a cross-sectional study.

BACKGROUND: Patients with acute ischemic stroke (AIS) after hip fracture in the elderly have worse prognosis. We aimed to describe the characteristics and complications of hip fracture with AIS in the elderly. METHODS: This cross-sectional study selected patients with hip fracture (age ≥65 years) from January 2018 to September 2020. The collected data included age, sex, fracture types, comorbidities. In above screened patients, we further collected cerebral infarction related information of AIS patients. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to identify the strongest predictors of AIS after hip fracture. Multivariate logistic regression analysis was conducted to find independent risk factors for AIS after hip fracture. RESULTS: Sixty patients (mean age 79.7 years;female 56.7%) occurred AIS after hip fracture in 1577 cases. The most common infarction type was partial anterior circulation infarction (PACI) (70.0%). The majority of these infarction lesions were single (76.7%) and most infarction lesions(65.0%) were located in the left side. 81.7% of AIS patients had mild (Health stroke scale NIHSS <4) AIS. Older patients with AIS after hip fracture were more frequently complicated by hypertension(73.3%), prior stroke (46.7%), diabetes(35.0%) and were more likely to have hypoproteinemia(68.3%), electrolyte disorders ( 66.7%), anemia (65.0%), deep vein thrombosis (51.6%), pneumonia (46.6%),cardiac complications (45.0%). Combined with hypertension (OR 2.827, 95%CI 1.557-5.131) and male sex(OR 1.865, 95%CI 1.095-3.177) were associated with the increased risk of AIS after hip fracture. CONCLUSIONS: Older patients combined with hypertension are more likely to have AIS after hip fracture. For these patients, early preventions should be administered. AIS patients after hip fracture are prone to have multiple complications under traumatic stress, and we should enhance the management of these patients to reduce the stress and avoid occurrence of complications.

Active nanomotors surpass passive nanomedicines: current progress and challenges.

Artificial nanomotors show advantages over traditional nanomedicines in biomedical applications due to their active locomotion by converting various energy sources into mechanical force in situ. Currently, nanomotors are attracting wide attention in diagnosis and therapy towards clinical applications. In this perspective, we summarize recent developments of nanomotors in biomedical applications, including targeted drug delivery, biological barrier penetration, and diagnostics and cancer treatment. The development of nanomotors in biomedicine still faces considerable challenges and practical difficulties towards clinical use, which are discussed in detail. Finally, we propose potential solutions that may help the development of nanomotors towards advanced diagnostics and therapy.

Effects of Recombinant Human Brain Natriuretic Peptide in Patients with Acute Pulmonary Embolism Complicated with Right Ventricular Dysfunction Who Underwent Catheter-Directed Therapy.

Acute pulmonary embolism (PE) remains a significant cause of cardiovascular morbidity and mortality worldwide. Brain natriuretic peptide (BNP) combined with catheter-directed therapy (CDT) may improve right ventricular (RV) dysfunction and stabilize hemodynamics in acute PE.We retrospectively studied 159 patients with confirmed acute PE who were treated with CDT and admitted to the intensive care unit of our department between September 2016 and May 2020. The patients were divided into the control group and the rhBNP group based on whether to receive recombinant human BNP treatment (rhBNP) or not. The basic characteristics of the patients between the control group and the rhBNP group was systematically compared during admission and follow-up. Risk factors for all-cause mortality within 30 days were determined using multivariate logistic regression analysis.Respiratory rate was found to be significantly lower in the rhBNP group than in the control group. Patients in the rhBNP group had significantly lower levels of white blood cell, C-reactive protein (CRP), D-dimers, troponin I, creatinine, and N-terminal (NT) -proBNP compared with those in the control group. Levels of tricuspid annular plane systolic excursion were significantly higher in the rhBNP group than in the control group. The percentage of patients with rehospitalization readmission due to PE differed significantly between the control group and the rhBNP group. On the basis of the multivariate regression analysis, CRP, creatinine, troponin I, and NT-proBNP were independent factors of all-cause mortality in 30 days.rhBNP is effective in the treatment of patients with RV dysfunction caused by acute PE who underwent CDT, which may be an alternative treatment option for improving clinical prognosis.