[Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm]

Objective: To evaluate the safety and efficacy of dental floss traction-assisted endoscopic submucosal dissection (DFS-ESD) for rectal neuroendocrine neoplasm (NEN). Methods: A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital, Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled, including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1, and the mean size was 0.8±0.2(0.5-1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS-ESD treatment (DFS-ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS-ESD group, after the mucosa was partly incised along the marker dots, the endoscopy was extracted, and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted, the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time, modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS-ESD group), en bloc resection rate, R0 resection rate, morbidity of operative complication, recurrence and metastasis were compared between two groups. Results: The average tumor size was (0.8±0.2) cm in DFS-ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425, P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm, 13 were G1 and 4 were G2 in DFS-ESD group, while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative, the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS-ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS-ESD group (t=1.776, P=0.084). The modified operation time of DFS-ESD group was (11.9±2.8) minutes, which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3±0.6) days and (2.0±0.5) days in conventional ESD group and DFS-ESD group, respectively, without significant difference (t=1.436, P=0.160). No patient was transferred to surgery, and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor-related death, and all the patients recovered well during a follow-up period of 14(1-24) months. Conclusion: Dental floss traction-assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin.

Self-Powered and Self-Functional Cotton Sock Using Piezoelectric and Triboelectric Hybrid Mechanism for Healthcare and Sports Monitoring

Wearable devices rely on hybrid mechanisms that possess the advantages of establishing a smarter system for healthcare, sports monitoring, and smart home applications. Socks with sensing capabilities can reveal more direct sensory information on the body for longer duration in daily life. However, the limitation of suitable materials for smart textile makes the development of multifunctional socks a major challenge. In this paper, we have developed a self-powered and self-functional sock (S²-sock) to realize diversified functions including energy harvesting and sensing various physiological signals, i.e., gait, contact force, sweat level, etc., by hybrid integrating poly(3,4-ethylenedioxythiophene) polystyrenesulfonate (PEDOT:PSS)-coated fabric triboelectric nanogenerator (TENG) and lead zirconate titanate (PZT) piezoelectric chips. An output power of 1.71 mW is collected from a PEDOT:PSS-coated sock with mild jumping at 2 Hz and load resistance of 59.7 MΩ. The study shows that cotton socks worn daily can potentially be a power source for enabling self-sustained socks comprising wireless transmission modules and integrated circuits in the future. We also investigate the influences of environmental humidity, temperature, and weight variations and verify that our S²-sock can successfully achieve walking pattern recognition and motion tracking for smart home applications. On the basis of the sensor fusion concept, the outputs from TENG and PZT sensors under exercise activities are effectively merged together for quick detection of the sweat level. By leveraging the hybrid S²-sock, we can achieve more functionality in the applications of foot-based energy harvesting and monitoring the diversified physiological signals for healthcare, smart homes, etc.

[Efficacy of RCDOP regimen in the treatment of patients with diffuse large B-cell lymphoma]

Objective: To investigate the efficacy of RCDOP (Rituximab, cyclophosphamide, liposome doxorubicin, vincristine and prednisone) regimen in patients with de novo diffuse large B-cell lymphoma (DLBCL), especially in those patients with multiple extra-nodal involvement or Bulky diseases. Methods: A total of 87 newly diagnosed DLBCL patients who received RCDOP regimen from October 2012 to October 2017 were enrolled into this study. Survival functions were estimated using the Kaplan-Meier method and compared by the log-rank test, and χ(2) tests were used for categorical data. Results: Among the 87 DLBCL patients treated with RCDOP regimen, 81 patients achieved complete remission (CR) or partial remission (PR), with ORR as 93.1%. Patients were further classified into groups, according to the risk factors, such as IPI scores, multiple extra-nodal involvement, bulky disease, age>60, tumor Ki-67>80%, elevated serum LDH level and advanced Ann Arbor stage. The progression-free survival (PFS, P=0.084) and overall survival (OS, P=0.515) had no statistical difference among the IPI low risk (0-1 score) group, intermediate risk (2-3 scores) group and high risk (4-5 scores) group. Similarly, no statistical difference were fou nd in PFS and OS of patients with extra-nodal involvements ≥2 (P=0.303 and P=0.624), with bulky disease (P=0.518 and P=0.466), with age>60 (P=0.600 and P=0.183), with elevated serum LDH level (P=0.054 and P=0.880), with advanced Ann Arbor stage (P=0.075 and P=0.286), and with tumor Ki-67 over 80% (P=0.190 and P=0.109), when compared with those of patients without these risk factors. Conclusion: RCDOP can improve the therapeutic effect and prognosis of DLBCL patients with certain high risk factors, such as intermediate and high IPI risks, multiple extra-nodal involvements, bulky disease, age over 60, elevated LDH level, advanced Ann Arbor stage and tumor Ki-67 over 80%.

[Killing activity of nonequilibrium plasma against young and old Enterococcus faecalis biofilms with long-term exposure in infected root canals in vitro]

Objective: To evaluate the antimicrobial activity of nonequilibrium plasma against Enterococcus faecalis (Ef) biofilms in vitro and to obtain novel evidence of root canal disinfection with nonequilibrium plasma. Methods: Sterile cover slips and single-rooted canals were filled with Ef and incubated to form 1-week-old and 3-week-old biofilms, respectively. The infected samples were subjected to nonequilibrium plasma, 2% chlorhexidine digluconate (CHX) and saline for 3, 10 and 30 minutes, respectively. After treatment, the killing effectiveness of nonequilibrium plasma was analyzed by using laser scanning confocal microscopy (LSCM) and colony forming unit (CFU) counting. Results: The 3-dimentional reconstruction LSCM images showed that about 48.3%-79.8% of 1-week-old Ef biofilm cells and 40.0%-67.4% of 3-week-old biofilm cells were killed by nonequilibrium plasma and 2% CHX compared to saline (P<0.05). The proportion of killing activity was lower after 3 minutes (40.0%-50.9% killing) than after 10 minutes (65.3%-77.8% killing) and 30 minutes (66.4%-79.8% killing) (P<0.05). And the killing of biofilm bacteria was fastest during the first 3 minutes (13.3%-17.0% killing per minute) and slow down greatly after 10 minutes. Remarkably more bacteria were killed in 1-week-old Ef biofilms (48.3%-79.8% killing) than in 3-week-old biofilms (P<0.05). Conclusions: The nonequilibrium plasma killed more Ef biofilm cells in infected root canals showed promotional as an additional approach against bacterial biofilms during root canal disinfection.

Triboelectric Self-Powered Wearable Flexible Patch as 3D Motion Control Interface for Robotic Manipulator

Triboelectric nanogenerators and sensors can be applied as human-machine interfaces to the next generation of intelligent and interactive products, where flexible tactile sensors exhibit great advantages for diversified applications such as robotic control. In this paper, we present a self-powered, flexible, triboelectric sensor (SFTS) patch for finger trajectory sensing and further apply the collected information for robotic control. This innovative sensor consists of flexible and environmentally friendly materials, i. e., starch-based hydrogel, polydimethylsiloxane (PDMS), and silicone rubber. The sensor patch can be divided into a two-dimensional (2D) SFTS for in-plane robotic movement control and a one-dimensional (1D) SFTS for out-of-plane robotic movement control. The 2D-SFTS is designed with a grid structure on top of the sensing surface to track the continuous sliding information on the fingertip, e. g., trajectory, velocity, and acceleration, with four circumjacent starch-based hydrogel PDMS elastomer electrodes. Combining the 2D-SFTS with the 1D-SFTS, three-dimensional (3D) spatial information can be generated and applied to control the 3D motion of a robotic manipulator, and the real-time demonstration is successfully realized. With the facile design and very low-cost materials, the proposed SFTS shows great potential for applications in robotics control, touch screens, and electronic skins.

Controlling Surface Charge Generated by Contact Electrification: Strategies and Applications

Contact electrification is the phenomenon in which charge is generated on the surfaces of materials after they come into contact. The surface charge generated has traditionally been known to cause a vast range of undesirable consequences in our lives and in industry; on the other hand, it can also give rise to many types of useful applications. In addition, there has been a lot of interest in recent years for fabricating devices and materials based on regulating a desired amount of surface charge. It is thus important to understand the general strategies for increasing, decreasing, or controlling the surface charge generated by contact electrification. Herein, the fundamental mechanisms for influencing the amount of charge generated, the methods used for implementing these mechanisms, and some of the recent interesting applications that require regulating the amount of surface charge generated by contact electrification, are briefly summarized.

Longitudinal evaluation of markers of inflammation in HIV-positive and HIV-negative Rwandan women

OBJECTIVES

African women are disproportionately affected by HIV infection and may experience non-AIDS-related complications associated with inflammation. High-sensitivity C-reactive protein (hsCRP), d-dimer and transthyretin have been examined as inflammatory markers elsewhere, but it is unclear how they change over time in HIV-negative or HIV-positive African women with or without antiretroviral therapy (ART) initiation.

METHODS

We examined hsCRP, d-dimer and transthyretin levels at baseline and at follow-up of ≥2 years in 185 HIV-negative and 510 HIV-positive Rwandan women who were ART naïve at study entry. Generalized estimating equations for each marker were used to investigate the association with HIV infection/CD4 count, ART and follow-up time.

RESULTS

Compared with HIV-negative women, HIV-positive women had higher hsCRP and d-dimer and lower transthyretin concentrations, with greater differences at lower CD4 counts. After adjusting for CD4 count and other factors, ART was not significantly associated with log hsCRP (P = 0.36) at follow-up, but was independently associated with lower log d-dimer (P = 0.03) and higher transthyretin (P = 0.0008) concentrations. At ≥ 2 years of follow-up, hsCRP had not significantly changed in any group but log d-dimer had decreased significantly in all groups. Transthyretin declined significantly over time in HIV-negative women and HIV-positive non-ART initiators, but increased significantly in HIV-positive ART initiators.

CONCLUSIONS

HIV infection and advanced immune suppression were associated with higher hsCRP and d-dimer and lower transthyretin concentrations. ART (independently of CD4 changes) was significantly associated with decreases in d-dimer and increases in transthyretin, but, in contrast to other studies, was not associated with decreases in hsCRP. We found no change in hsCRP over time in any group.

Investigation of Position Sensing and Energy Harvesting of a Flexible Triboelectric Touch Pad

Triboelectric nanogenerator (TENG) is a promising technology because it can harvest energy from the environment to enable self-sustainable mobile and wearable electronic devices. In this work, we present a flexible touch pad capable of detecting the contact location of an object and generating substantial energy simultaneously based on the coupling of triboelectric effects and electrostatic induction. The touch pad consists of Polytetrafluoroethylene (PTFE) thin film, multiple Aluminum (Al) electrodes and Polyethylene terephthalate (PET) layers, which can be achieved through low cost, simplified and scalable fabrication process. Different from the conventional multi-pixel-based positioning sensor (i.e., large array of sensing elements and electrodes), the analogue method proposed here is used to implement the positioning function with only four electrodes. Position location can achieve a detecting resolution of as small as 1.3 mm (the size of locating layer is 7.5 cm × 7.5 cm). For the energy harvesting part, a multilayer structure is designed to provide higher current output. The open circuit voltage of the device is around 420 V and the short circuit current can reach up to 6.26 µA with current density of 0.25 µA/cm². The maximum output power obtained is approximately 10 mW, which is 0.4 mW/cm². The flexibility and significantly reduced number of electrodes enable the proposed touch pad to be readily integrated into portable electronic devices, such as intelligent robots, laptops, healthcare devices, and environmental surveys, etc.

Development of a Thermoelectric and Electromagnetic Hybrid Energy Harvester from Water Flow in an Irrigation System

A hybrid energy harvester is presented in this paper to harvest energy from water flow motion and temperature difference in an irrigating pipe at the same time. The harvester is based on the integration of thermoelectric and electromagnetic mechanisms. To harvest the water flow motion, a turbine fan with magnets that are attached on the blades is placed inside of the water pipe. Multiple coils turn the water flow energy into electricity with the rotation of the turbine. The thermoelectric generators (TEGs) are attached around the pipe, so as to harvest energy due to temperature difference. For a maximum temperature difference of 55 °C (hot side 80 °C and room temperature 25 °C), twelve serial-connected TEGs can generate voltage up to 0.346 V. Under a load resistance of 20 Ώ, the power output of 1.264 mW can be achieved. For a maximum water flow rate of 49.9 L/min, the electromagnetic generator (EMG) can produce an open circuit voltage of 0.911 V. The EMG can be potentially used as a water flow meter due to the linear relationship between water flow rate and output voltage. Under the joint action of TEG and EMG, the maximum terminal voltage for TEG is 66 mV and for EMG is 241 mV at load resistances of 10 and 100 Ώ, respectively, resulting in a corresponding power output of 0.435 and 0.584 mW.

Labour patterns in Chinese women in Chongqing

OBJECTIVE

To obtain data on the characteristics of labour from a regional sample of Chinese parturients and to assess the pattern of progress of labour among nulliparous women.

DESIGN

A prospective observational study.

SETTING

The study was conducted in the First Affiliated Hospital of Chongqing Medical University.

POPULATION

The final sample involved 1200 Chinese parturients with singleton, vertex and term gestation; spontaneous onset of labour; vaginal delivery; and without adverse perinatal outcomes.

METHODS

A repeated-measures analysis was used to depict labour curves while an interval-censored regression was used to estimate the duration of labour centimetre by centimetre.

MAIN OUTCOME MEASURES

Labour curves and the duration of labour at the 50th and 95th percentiles.

RESULTS

Among 1091 nulliparous women, 57.7% had cervical dilation of 3 cm or less at the time of admission, and the mean duration of the first stage of labour was 9.1 ± 3.3 hours. From 5 to 9 cm of cervical dilation it sometimes took more than 2 hours for dilation to advance 1 cm. No obvious inflection points appeared in the labour curve of Chinese nulliparae, and no deceleration was observed.

CONCLUSION

Progress of labour in Chinese parturients was more gradual than in their Western counterparts. Obstetric practice standards based on data generated from Western countries may not be appropriate for Chinese women.

TWEETABLE ABSTRACT

A prospective study has evaluated labour patterns in Chinese women using regional data from nulliparae.

A Self-Powered Six-Axis Tactile Sensor by Using Triboelectric Mechanism

Triboelectric nanogenerators (TENGs) are highly promising because they can scavenge energy from their working environment to sustainably power wearable/mobile electronics. In this work, we propose a novel and straightforward strategy for six-axis force detection and object controlling by using a self-powered sensor based on TENG. The self-powered sensor can be used in diversified tactile sensing and energy saving applications, which has been demonstrated to be able to detect normal force in the range of 0⁻18 N. Using the vector properties of external force, six-axis directions in three-dimensional (3D) space is detected. Additionally, it is fabricated with environmental friendly materials, i.e., galinstan and polydimethylsiloxane (PDMS), promoting its applications in more diversified situations. Because of the available and high output voltage as well as the low internal impedance, the self-powered sensor is readily compatible with commercial signal processing and management circuits. The device presented in this work shows robust structure and stable output performance, enabling itself as an ideal human machine interface in self-powered, batteryless, and electric energy saving applications.