Kidney disease in trials of perioperative tranexamic acid

STUDY OBJECTIVE

To assess how kidney disease is handled in randomized trials evaluating the safety and efficacy of perioperative tranexamic acid, and to evaluate its effects across levels of kidney function.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

SETTING

We screened studies from a previous comprehensive systematic review, and updated its search of PubMed, Embase, and Cochrane CENTRAL to July 31, 2023.

PATIENTS

Patients undergoing non-obstetric surgery.

INTERVENTIONS

Intravenous tranexamic acid compared to placebo or usual care without tranexamic acid.

MEASUREMENT

We summarized the handling of kidney disease in eligibility criteria, dose adjustments for kidney function, and effects of tranexamic acid on thrombotic events, seizures, and bleeding by subgroups of kidney function.

MAIN RESULTS

We evaluated 300 trials with 53,085 participants; 45,958 participants (86.6%) were enrolled in 228 trials (76.0%) that explicitly excluded patients with kidney disease. Definitions of kidney diseased used for exclusion varied widely. Most were non-specific and some corresponded to mild disease. Only 5 trials adjusted dosing for kidney function. Meta-analysis of two large trials found tranexamic acid unlikely to substantially increase or decrease the occurrence of thrombotic events in patients with eGFR <60 mL/min/1.73m2 (RR, 0.95; 95% CI: 0.83 to 1.07) or ≥ 60 mL/min/1.73m2 (RR, 1.00; 95% CI, 0.91 to 1.11; P for subgroup difference = 0.47), but both trials excluded patients with severe kidney disease. No analysis could be performed regarding seizure risk. One large trial in noncardiac surgery reported similar reduction in bleeding across subgroups of kidney function but excluded patients with creatinine clearance <30 mL/min.

CONCLUSIONS

The large evidence base supporting perioperative tranexamic acid suffers from broad and unjustified exclusion of patients with kidney disease. Typical perioperative dosing of tranexamic acid is likely safe and effective in patients with creatinine clearance >30 mL/min, but effects in more severe kidney disease are unknown.

Sex identification of birds in Taipei Zoo

As a conservation and breeding institution for birds, Taipei Zoo plays an important role in restoring endangered species. As approximately half of all bird species are monomorphic, precisely confirming the sex of individuals is critical for the management of ex-situ conservation breeding populations, as well as for understanding the sex ratio of those in the wild. Generally, PCR is used more reliably for sex determination versus traditional methods such as plumage, behavior or hormone levels. Nevertheless, the various primer sets and annealing temperatures vary between species, and so inaccurate sexing can occasionally happen due to inadequate PCR conditions. To reduce the probability of misidentification, and to establish a PCR condition database for sex determination across the diverse range of avian taxa, we tested multiple primer sets and annealing temperatures for amplification of the bird sex-specific gene fragments (CHD1) for each captive or rescued avian species held at Taipei Zoo since 2014. A total of 162 species across 22 orders were tested using one or two primer sets. One hundred and fifty-five species were successfully sexed by the primer set 2550F/2718R and the success rate of sex typing reached over 90% of species tested in each order. Most species have suitable PCR annealing temperatures between 45°C and 55°C, and the species in the same avian taxa showed similar results in temperature. This indicates that it is possible to select the annealing temperature of other species in the same family when the species had not been tested before. We expect this study will improve the success rate of identifying sex by using applicable PCR conditions and reduce the time for searching references every time before attempts to PCR sex birds.

An alleviative effect of Lonicerae japonicae flos water extract against liver fibrogenesis in vitro and in vivo

Lonicerae japonicae (L. japonicae) flos is a medical and food homology herb. This study investigated the phenolic acid and flavonoid contents in L. japonicae flos water extract solution (LJWES) and the preventive effects of LJWES against liver fibrogenesis via FL83B cells and rats. LJWES contains many polyphenols, such as chlorogenic acid, morin, and epicatechin. LJWES increased cell viability and decreased cytotoxicity in thioacetamide (TAA)-treated FL83B cells (75 mM) (p < .05). LJWES decreased (p < .05) gene expressions of Tnf-α, Tnfr1, Bax, and cytochrome c but upregulated Bcl-2 and Bcl-xl in TAA-treated cells; meanwhile, increased protein levels of P53, cleaved caspase 3, and cleaved caspase 9 in TAA treated cells were downregulated (p < .05) by LJWES supplementation. In vivo, results indicated that TAA treatment increased serum liver damage indices (alanine aminotransferase [ALT] and alkaline phosphatase [ALP]) and cytokines (interleukin-6 and transforming growth factor-β1) levels and impaired liver antioxidant capacities (increased thiobarbituric acid reactive substance value but decreased catalase/glutathione peroxidase activities) in rats (p < .05) while LJWES supplementation amended (p < .05) them. Liver fibrosis scores, collagen deposition, and alpha-smooth muscle actin deposition in TAA-treated rats were also decreased by LJWES supplementation (p < .05). To sum up, LJWES could be a potential hepatoprotective agent against liver fibrogenesis by enhancing antioxidant ability, downregulating inflammation in livers, and reducing apoptosis in hepatocytes.

Hydride-doped coinage metal superatoms and their catalytic applications

Superatomic constructs have been identified as a critical component of future technologies. The isolation of coinage metal superatoms relies on partially reducing metallic frameworks to accommodate the mixed valent state required to generate a superatom. Controlling this reduction requires careful consideration in reducing the agent, temperature, and the ligand that directs the self-assembly process. Hydride-based reducing agents dominate the synthetic wet chemical routes to coinage metal clusters. However, within this category, a unique subset of superatoms that retain a hydride/s within the nanocluster post-reduction have emerged. These stable constructs have only recently been characterized in the solid state and have highly unique structural features and properties. The difficulty in identifying the position of hydrides in electron-rich metallic constructs requires the combination and correlation of several analytical methods, including ESI-MS, NMR, SCXRD, and DFT. This text highlights the importance of NMR in detecting hydride environments in these superatomic systems. Added to the complexity of these systems is the dual nature of the hydride, which can act as metallic hydrogen in some cases, resulting in entirely different physical properties. This review includes all hydride-doped superatomic nanoclusters emphasizing synthesis, structure, and catalytic potential.

Doping effect on a two-electron silver nanocluster

This study investigates the effects of metal addition and doping of a 2-electron silver superatom, [Ag10{S2P(OiPr)2}8] (Ag10). When Ag+ is added to Ag10 in THF solution, [Ag11{S2P(OiPr)2}8(OTf)] (Ag11) is rapidly formed almost quantitatively. When the same method is used with Cu+, a mixture of alloys, [CuxAg11-x{S2P(OiPr)2}8]+ (x = 1-3, CuxAg11-x), is obtained. In contrast, introducing Au+ to Ag10 leads to decomposition. The structural and compositional analysis of Ag11 was characterized by single-crystal X-ray diffraction (SCXRD), ESI-MS, NMR spectroscopy, and DFT calculations. While no crystal structure was obtained for CuxAg11-x, DFT calculations provide insights into potential sites for copper location. The absorption spectrum exhibits a notable blue shift in the low-energy band after copper doping, contrasting with that of the slight shift observed in 8-electron Cu-doped Ag nanoclusters. Ag11 and CuxAg11-x are strongly emissive at room temperature, and solvatochromism across different organic solvents is highlighted. This study underscores the profound influence of metal addition and doping on the structural and optical properties of silver nanoclusters, providing important contributions to understanding the nanoclusters and their photophysical behaviors.

[Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery]

Objective: To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications (MC) following long-segment spinal correction surgery in female patients with degenerative scoliosis (DS). Methods: The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed. According to whether restoring the ideal Roussouly classification after surgery, the patients were divided into R group(recovery group) (n=51) and N group(non-recovery group) (n=21). According to whether mechanical complications occurred after operation within two years, the patients were divided into MC (mechanical complications)group (n=24) and NMC(non-mechanical complications) group (n=48). The RM group (n=14) experienced mechanical complications in the R group, while the RN group (n=37) did not. The NM group (n=10) experienced mechanical complications in the N group, while the NN group (n=11) did not.Radiographic assessment included Sagittal parameters of spine and pelvis, standardized cross-sectional area (SCSA) and fat infiltration rate (FI%) of paraspinal muscle at each lumbar disc level. Results: The age of DS patients in this study was (61.4±6.2) years.The incidence of MC was 33.33%(n=24)in all patients. The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10) in group N. The correction amount of pelvic tilt angle (PT) (-11.62°±10.06° vs -7.04°±8.45°, P=0.046) and T1 pelvic angle(TPA)(-12.88°±11.23° vs -7.31°±9.55°, P=0.031)during surgery were significantly higher in MC group compared to the NMC group. In group R, the FI% of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC (P<0.05). In the R and N groups, there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level (all P>0.05). Multivariate logistic regression analysis showed that the average FI% of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI% of lumbar PSM≥22.63% was a risk factors for MC after spinal fusion (P=0.010,OR=1.088, 95%CI:1.020-1.160). Conclusions: Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications. For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.

A Silver Nanocluster Assembled by a Superatomic Building Unit

A unique assembly of a two-electron superatom, [Ag10{S2P(OiPr)2}8], as a primary building unit in the construction of a supramolecule [Ag10{S2P(OiPr)2}8]2(μ-4,4'-bpy) through a 4,4'-bipyridine (4,4'-bpy) linker is reported. This approach is facilitated by an open site in the structure that allows for effective pairing. The assembled structure demonstrates a minimal solvatochromic shift across organic solvents with variable polarities, highlighting the influence of self-assembly on the photophysical properties of silver nanoclusters.

[Effect of different observations on evaluation of cosmetic shoulder balance in adolescent idiopathic scoliosis patients with thoracic curve]

Objective: To investigate the correlations between cosmetic and radiographic parameters of shoulder balance, as well as the variations in cosmetic shoulder balance observed from different perspectives, among patients with adolescent idiopathic scoliosis (AIS) characterized by thoracic curves. Methods: A total of 43 patients with thoracic curves treated from July to October in 2022 in Nanjing Drum Tower Hospital were recruited in this study. There were 9 males and 34 females with a mean age of (14.3±1.5) years. All participants underwent comprehensive radiographic assessments and were photographed both from posterior and anterior views, focusing on the shoulder region as well as a higher level (maintaining a consistent vertical distance of 180 cm from the ground). Six cosmetic parameters were measured on the photographs: shoulder angle(α1), axilla angle(α2), shoulder area index 1(SAI1), shoulder area index 2 (SAI2), inner shoulder height (SHi) and outer shoulder height (SHo). Eight radiographic parameters were measured on the radiographs: radiographic shoulder height difference (RSHD), first rib angle (FRA), clavicle-rib cage intersection (CRCI), coracoid process height (CPH), T1 tilt, clavicle angle(CA), clavicle chest cage angle difference (CCAD) and Cobb angle. Differences among bilateral cosmetic indicators from different perspectives were analyzed and compared, and their correlation with bilateral radiographic indicators was studied. Results: There was no significant differences between anterior cosmetic parameters and posterior cosmetic parameters at the same level of observation(all P>0.05). However, when observing SHi, SHo, α1, and α2 at the shoulder level, it became evident that they exhibited significantly higher values compared to the corresponding higher level on the same side of the patients' bodies. This contrast was observed in both the dorsal [SHo: (0.11±1.20) cm vs (-0.44±1.39) cm, P=0.005; SHi: (0.64±0.86) cm vs (0.32±0.56) cm, P=0.003; α1:-0.47°±2.27° vs -0.77°±2.49°, P=0.014; α2:-3.06°±3.23° vs -2.21°±3.03°, P=0.034] and ventral [SHo: (0.12±1.29) cm vs (-0.48±1.35) cm, P=0.007; SHi: (0.61±0.88) cm vs (0.30±0.59) cm, P=0.006; α1:-0.46°±2.18° vs -0.69°±2.35°, P=0.018; α2:-3.26°±3.12° vs -2.05°±2.97°, P=0.029] aspects of the patients. SHi and SHo were more sensitive to this difference of height. The correlation coefficients between radiographic parameters and cosmetic aspects at the shoulder level varied from 0.374 to 0.767. Similarly, the correlation coefficients between radiographic parameters and cosmetic factors at the higher level ranged from 0.273 to 0.579 (all P<0.05). Conclusions: The cosmetic parameters had significant difference between different perspective of observation, the cosmetic parameters are needed to be observed at the shoulder level in the evaluation of patients' shoulder balance.

Hydride-Containing Pt-doped Cu-rich Nanoclusters: Synthesis, Structure, and Electrocatalytic Hydrogen Evolution

A structurally precise hydride-containing Pt-doped Cu-rich nanocluster [PtH2 Cu14 {S2 P(Oi Pr)2 }6 (CCPh)6 ] (1) has been synthesized. It consists of a bicapped icosahedral Cu14 cage that encapsulates a linear PtH2 unit. Upon the addition of two equivalents of CF3 COOH to 1, two hydrido clusters are isolated. These clusters are [PtHCu11 {S2 P(Oi Pr)2 }6 (CCPh)4 ] (2), which is a vertex-missing Cu11 cuboctahedron encaging a PtH moiety, and [PtH2 Cu11 {S2 P(Oi Pr)2 }6 (CCPh)3 ] (3), a distorted 3,3,4,4,4-pentacapped trigonal prismatic Cu11 cage enclosing a PtH2 unit. The electronic structure of 2, analyzed by Density Functional Theory, is a 2e superatom. The electrocatalytic activities of 1-3 for hydrogen evolution reaction (HER) were compared. Notably, Cluster 2 exhibited an exceptionally excellent HER activity within metal nanoclusters, with an onset potential of -0.03 V (at 10 mA cm-2 ), a Tafel slope of 39 mV dec-1 , and consistent HER activity throughout 3000 cycles in 0.5 M H2 SO4 . Our study suggests that the accessible central Pt site plays a crucial role in the remarkable HER activity and may provide valuable insights for establishing correlations between catalyst structure and HER activity.

Nanotribological Characteristics of the Al Content of AlxGa1-xN Epitaxial Films

The nanotribological properties of aluminum gallium nitride (AlxGa1-xN) epitaxial films grown on low-temperature-grown GaN/AlN/Si substrates were investigated using a nanoscratch system. It was confirmed that the Al compositions played an important role, which was directly influencing the strength of the bonding forces and the shear resistance. It was verified that the measured friction coefficient (μ) values of the AlxGa1-xN films from the Al compositions (where x = 0.065, 0.085, and 0.137) were in the range of 0.8, 0.5, and 0.3, respectively, for Fn = 2000 μN and 0.12, 0.9, and 0.7, respectively, for Fn = 4000 μN. The values of μ were found to decrease with the increases in the Al compositions. We concluded that the Al composition played an important role in the reconstruction of the crystallites, which induced the transition phenomenon of brittleness to ductility in the AlxGa1-xN system.

Reduced-Dose Rivaroxaban Is Associated with Lower All-Cause Mortality in Older Patients with Nonvalvular Atrial Fibrillation

BACKGROUND

Reduced-dose rivaroxaban (10 mg) was used in the J-ROCKET AF trial, demonstrating safety in the Asian population. It remains unclear whether treatment with reduced-dose versus full-dose rivaroxaban (20 mg/15 mg) is associated with all-cause mortality in older patients with nonvalvular atrial fibrillation. Proposed: To evaluate the effects of reduced-dose rivaroxaban on all-cause mortality in patients over 85.

METHODS

We retrospectively enrolled medical records representing the period from October 2012 to November 2016. The 2 × 2 factorial design incorporated age (≥85 vs. <85) and rivaroxaban use (reduced vs. full dose). The primary study outcomes were all-cause and cardiac-related mortality.

RESULTS

The study enrolled 2386 patients with a mean age of 76.6 ± 10.4 years; 51.8% were male. In the ≥85 group (n = 593), the reduced-dose subgroup had lower all-cause (5.3% vs. 10.6%, p = 0.02) and cardiac-related mortality (1.9% vs. 5.1%, p = 0.04), whereas the younger patients receiving reduced-dose rivaroxaban had higher all-cause mortality (3.7% vs. 1.8%, p = 0.01) but no difference in cardiac-related mortality (1.2% vs. 0.7%, p = 0.33). The rate of hospitalization for heart failure was significantly lower in the elderly group with reduced-dose rivaroxaban (7.2% vs. 15.7%, p < 0.01) but not in the younger group. After adjusting for confounders in the older group, treatment with reduced-dose rivaroxaban was associated with lower risk of all-cause mortality (adjusted HR (aHR): 0.40, 95% CI: 0.21-0.74, p < 0.01) and hospitalization for heart failure (aHR: 0.54, 95% CI: 0.29-0.99, p = 0.05). No associations were found between rivaroxaban dose and cardiac-related mortality in either group, nor between younger age and any outcome.

CONCLUSIONS

Reduced-dose rivaroxaban was associated with lower risks of all-cause mortality and hospitalization for heart failure in older patients with nonvalvular atrial fibrillation. Future studies can investigate the effect of reduced-dose rivaroxaban on prognoses in elderly individuals ≥85 years in the west.

Spin independence of the strongly enhanced effective mass in ultra-clean SiGe/Si/SiGe two-dimensional electron system

The effective mass at the Fermi level is measured in the strongly interacting two-dimensional (2D) electron system in ultra-clean SiGe/Si/SiGe quantum wells in the low-temperature limit in tilted magnetic fields. At low electron densities, the effective mass is found to be strongly enhanced and independent of the degree of spin polarization, which indicates that the mass enhancement is not related to the electrons' spins. The observed effect turns out to be universal for silicon-based 2D electron systems, regardless of random potential, and cannot be explained by existing theories.

The Interplay Effect and Mitigations with Cyclotron and Linac Proton Beam Scanning for Lung SBRT

PURPOSE/OBJECTIVE(S)

To evaluate the impact of different types of pencil beam scanning proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for lung cancer patients treated with SBRT.

MATERIALS/METHODS

Twenty lung cancer patients (ten peripheral and ten central tumors) treated in our institution with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes for this retrospective study. The respiratory motion amplitude ranged from 0.1 to 1.0 cm with compression. For each patient, plans were created using: 1) cyclotron-generated proton beams (CPB) (σ: 2.7-7.0 mm); 2) linear accelerator proton beams (LPB) (σ: 2.9-5.5 mm); and 3) linear accelerator proton minibeams (LPMB) (σ: 0.9-3.9 mm). Plans were robustly optimized on the GTV using each individual 4DCT phase. Single-filed optimization (SFO) plans were the first attempt, and if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparison. For each patient, all plans were normalized to have the same dose to 99% of the GTV. Interplay effects were evaluated for ten scenarios of treatment delivery starting in ten breathing phases using machine generic time models and a constant breathing period of 4 seconds. Volumetric repainting (VR) was performed 2-6 times for each plan. To assess plan quality in the nominal scenario, we compared the conformity index (CI), R50, and the percentage of lung volume receiving 20 Gy (RBE) (V20Gy). CI is defined as the ratio of the 100% isodose volume to the GTV. R50 is defined as the 50% isodose volume divided by the GTV. Dmax and V18Gy of the proximal bronchial tree (PBT) were evaluated for central tumors.

RESULTS

Twelve of 20 plans can be optimized sufficiently with SFO. In interplay effect evaluation, the mean V100%RX values of the GTV were 99.42±0.6%, 97.52±3.9%, and 94.49±7.3%for CPB, LPB, and LPMB plans respectively. After VR 2/3/5 times, the V100%RX values were improved (on average) by 0.13%/1.84%/4.63% for CPB/LPB/LPMB plans. The delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 minute longer than CPB plans. VR showed no effect on lung V20Gy, Dmax and V18Gy of the PBT. SFO plans were more robust against the interplay effect compared with MFO plans for LPB and LPMB. Average CIs of 1.88±0.4, 1.79±0.4, and 1.75±0.4; average R50s of 7.99±4.0, 6.68±3.0, and 5.70±2.6; and average lung V20Gy values of 2.81±1.5, 2.26±1.3, and 1.85±1.1 were obtained for CPB, LPB, and LPMB plans, respectively. Dmax and V18Gy of the PBT decreased with decreasing spot sizes.

CONCLUSION

LPMB, with the smallest spot size, produced superior plan quality. In the absence of VR, proton machines with large spot sizes generated more robust plans against interplay effects. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.

Investigation of the Relationship between Aperture Use for Treating Small and Shallow Brain Lesions in Proton Therapy with Different Spot Size Variations in Three Proton Therapy Systems

PURPOSE/OBJECTIVE(S)

To compare plan quality among standard vs. aperture-based Intensity-Modulated Proton Therapy (IMPT) using cyclotron-generated proton beams (CPB), linear accelerator proton beams (LPB), and linear accelerator proton minibeams (LPMB) for multiple brain metastases.

MATERIALS/METHODS

Fifty-five brain lesions from twenty patients were planned with three different spot size ranges using CPBs (σ: 2.7-7.0 mm) and compared against LPBs (σ: 2.9-5.5 mm), and LPMBs (σ: 0.9-3.9 mm). Apertures with a diameter of 0.3 cm were applied to beams irradiating all tumors < 1 cm3 in volume and any tumor < 2.5 cm depth in the patient and compared against the same patient plans containing no apertures. All plans were optimized with the multi-field optimization (MFO) technique using the Monte Carlo algorithm. Dose coverage to each lesion for each proton plan was set to 99% of the GTV receiving the prescription (Rx) dose for all plans. Robustness with ±2 mm setup uncertainty and ±2% range uncertainty was included in robust evaluation using V100%Rx > 95% of the GTV. Conformity index (CI) and gradient index (GI) were used to analyze the effect of apertures vs. no apertures (standard) for each IMPT plan type. CI was defined as the volume of the 100% isodose line divided by the volume of the GTV + 2 mm expansion to account for robust planning. The Wilcoxon signed rank test was utilized to determine the statistical significance of dosimetric results compared between aperture-based and standard IMPT plans.

RESULTS

When apertures were implemented in the treatment planning for all shallow and small brain lesions, shallow brain tumors showed the most prominent improvement in conformity and gradient index. A 6.7% difference in average conformity was calculated for standard vs. aperture-based plans for LPMBs, followed by a 5.3% improvement for CPBs. Improvement in gradient index for standard vs. aperture-based plans was significant for both shallow and deeper tumors for CPB and LPB plan types, as shown in Table 1 below. CPB and LPB plan gradient indices were statistically significant for comparing aperture-based vs. standard IMPT plans.

CONCLUSION

We successfully quantified plan quality and evaluated results for aperture- vs. standard IMPT plans using CPBs, LPBs, and LPMBs for brain metastases. Plan quality improves the greatest with apertures applied to beams irradiating shallow tumors. Apertures may not be necessary for small, deeper tumors with IMPT.

Hydride Doping Effects on the Structure and Properties of Eight-Electron Rh/Ag Superatoms: The [RhHx@Ag21-x{S2P(OnPr)2}12] (x = 0-2) Series

Three hitherto unknown eight-electron rhodium/silver alloy nanoclusters, [RhAg₂₁{S₂P(OⁿPr)₂}₁₂] (1), [RhHAg₂₀{S₂P(OⁿPr)₂}₁₂] (2), and [RhH₂Ag₁₉{S₂P(OⁿPr)₂}₁₂] (3), have been isolated and fully characterized. Cluster 1 contains a regular Rh@Ag₁₂ icosahedral core, whereas 2 and 3 exhibit distorted RhH@Ag₁₂ and RhH₂@Ag₁₂ icosahedral cores. The single-crystal neutron structure of 2 located the encapsulated hydride at the center of an enlarged RhAg₃ tetrahedron. A similar position was found by neutron diffraction for one of the hydrides in 3, whereas the other hydride is trigonally coordinated to Rh and an elongated Ag-Ag edge. The solid-state structures of 1-3 possess C₁ symmetry due to the asymmetric arrangement of the surrounding capping Ag atoms. Our investigation shows that the insertion of one hydride dopant provokes the elimination of one capping silver atom on the cluster surface, resulting in the general formula [RhH_x@Ag_21-x{S₂P(OⁿPr)₂}₁₂] (x = 0-2), which maintains the same number of cluster electrons as well as neutral charge. Clusters 1-3 exhibit an intense emission band in the NIR region. Contrarily to their PdAg₂₁ and PdHAg₂₀ relatives, the 4d orbitals of the encapsulated heterometal are somewhat involved in the optical processes.

A heteroleptic fused bi-cuboctahedral Cu21S2 cluster

A new dicationic cluster, [Cu₂₁S₂{S₂CNⁿBu₂}₉(C₂Ph)₆]²⁺, where the Cu21S2 kernel consists of two S@Cu₁₂ cuboctahedra sharing a triangular Cu₃ face is reported. Its waist part is bridged by three dithiocarbamate ligands, each in a hexaconnective, hexametallic (μ₃, μ₃) coordination pattern, an unprecedented feature in Cu nanocluster chemistry.

Recent progress in dichalcophosphate coinage metal clusters and superatoms

Atomically precise clusters of group 11 metals (Cu, Ag, and Au) attract considerable attention owing to their remarkable structure and fascinating properties. One of the unique subclasses of these clusters is based on dichalcophosphate ligands of [(RO)₂PE₂]^- type (E = S or Se, and R = alkyl). These ligands successfully stabilise the most diverse Cu, Ag, and Au clusters and superatoms, spanning from simple ones to amazing assemblies featuring unusual structural and bonding patterns. It is noteworthy that such complicated clusters are assembled directly from cheap and simple reagents, metal(I) salts and dichalcophosphate anions. This reaction, when performed in the presence of a hydride or other anion sources, or foreign metal ions, results in hydrido- or anion-templated homo- or heteronuclear structures. In this feature article, we survey the recent advances in this exciting field, highlighting the powerful synthetic capabilities of the system "a metal(I) salt - [(RO)₂PX₂]^- ligands - a templating anion or borohydride" as an inexhaustible platform for the creation of new atomically precise clusters, superatoms, and nanoalloys.

Galvanic replacement-induced introduction of a heteroligand into bimetallic and trimetallic nanoclusters

Heteroleptic 8-electron silver-rich alloy nanoclusters, [Au@Au₄Ag₁₂(dtp)₇(PPh₃)₄]²⁺ (1) and [Pt@Au₄Ag₁₁(dtp)₇(PPh₃)₄] (2), were successfully synthesized via a galvanic replacement reaction of 1,1-dithiolate-protected M@Ag₂₀ (M = Au and Pt) nanoclusters with Au(I)-phosphine salts, leading to the alteration of the cluster nuclearity and geometry of shell skeletons but retaining the same 8-electron count.

Superatom Pruning by Diphosphine Ligands as a Chemical Scissor

A two-electron silver superatom, [Ag₆{S₂P(OⁱPr)₂}₄(dppm)₂] (1), was synthesized by adding dppm (bis(diphenylphosphino)methane) into [Ag₂₀{S₂P(OⁱPr)₂}₁₂] (8e). It was characterized by single-crystal crystallography, multinuclear NMR spectroscopy, electrospray ionization-mass spectrometry, density functional theory (DFT), and time-dependent DFT calculations. The added dppm ligands, which carry out the nanocluster-to-nanocluster transformation, act as a chemical scissor to prune the nanocluster geometrically from an icosahedron-based Ag₂₀ nanocluster (NC) to an octahedral Ag₆ NC and electronically from eight-electron to two-electron. Eventually, dppm was involved in the protective shell to form a new heteroleptic NC. The temperature-dependent NMR spectroscopy confirms its fluxional behavior, showing the fast atomic movement at ambient temperature. Compound 1 exhibits a bright yellow emission under UV irradiation at ambient temperature with a quantum yield of 16.3%. This work demonstrates a new methodology to achieve nanocluster-to-nanocluster transformation via stepwise synthesis.

Hydride-containing 2-Electron Pd/Cu Superatoms as Catalysts for Efficient Electrochemical Hydrogen Evolution

The first hydride-containing 2-electron palladium/copper alloys, [PdHCu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₄ ] (PdHCu₁₁ ) and [PdHCu₁₂ {S₂ P(Oⁱ Pr)₂ }₅ {S₂ PO(Oⁱ Pr)} (C≡CPh)₄ ] (PdHCu₁₂ ), are synthesized from the reaction of [PdH₂ Cu₁₄ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₆ ] (PdH₂ Cu₁₄ ) with trifluoroacetic acid (TFA). X-ray diffraction reveals that the PdHCu₁₁ and PdHCu₁₂ kernels consist of a central PdH unit encapsulated within a vertex-missing Cu₁₁ cuboctahedron and complete Cu₁₂ cuboctahedron, respectively. DFT calculations indicate that both PdHCu₁₁ and PdHCu₁₂ can be considered as axially-distorted 2-electron superatoms. PdHCu₁₁ shows excellent HER activity, unprecedented within metal nanoclusters, with an onset potential of -0.05 V (at 10 mA cm^-2 ), a Tafel slope of 40 mV dec^-1 , and consistent HER activity during 1000 cycles in 0.5 M H₂ SO₄ . Our study suggests that the accessible central Pd site is the key to HER activity and may provide guidelines for correlating catalyst structures and HER activity.

Unusual core engineering on a copper hydride nanoball

A neutral polyhydrido copper cluster, [Cu₂₇H₁₅{S₂CNⁿBu₂}₁₂] (abbreviated as [Cu₂₇H₁₅]), was prepared by the reaction of dithiocarbamates (dtc), Cu(I) salts and NaBH₄. The isolated cluster provides insights into core engineering, demonstrating its novel ability to reversibly add or remove one copper atom from the cluster core. Single-crystal X-ray analysis reveals that the new core-shell structure exhibits a Cu₂₄ rhombicuboctahedral outer cage and an inner Cu₃ triangular kernel. The two core-shell clusters, [Cu₂₇H₁₅{S₂CNⁿBu₂}₁₂] and previously published [Cu₂₈H₁₅(S₂CNⁿBu₂)₁₂]⁺ (abbreviated as [Cu₂₈H₁₅]⁺), are only differentiated by one copper atom in their inner core. Importantly, we demonstrate core engineering with the controllable reversible transition between an irregular Cu₄ tetrahedron and a Cu₃ triangle, whilst maintaining their outer Cu₂₄ shell intact. The 15 hydride atoms in [Cu₂₇H₁₅], coordinated in three different modes, are co-incident with the hydride positions in [Cu₂₈H₁₅]⁺. The degradation of [Cu₂₇H₁₅] in solution or the addition of one eq. of Cu(I) ions leads to the conversion of [Cu₂₇H₁₅] into [Cu₂₈H₁₅]⁺, while the reverse transformation can be achieved by the addition of either formic acid or a reducing agent to [Cu₂₈H₁₅]⁺. A dicationic species was observed in the ESI mass spectrum, and the composition is formulated as [Cu₅₆H₃₀(S₂CNⁿBu₂)₂₄]²⁺, a dimer of [Cu₂₇H₁₅(S₂CNⁿBu₂)₁₂ + Cu⁺]₂²⁺. The dimeric species was further explored by DFT calculations, suggesting that the lowest energy structure consists of a [Cu₂₈H₁₅]⁺ and a [Cu₂₇H₁₅] cluster connected through one Cu⁺ atom bridge. As a result, [Cu₂₇H₁₅] is considered an intermediate species in the formation of the more stable [Cu₂₈H₁₅]⁺ nanoball.

Left ventricular hypertrophy detection using electrocardiographic signal

Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.

Estimating the burden of foodborne gastroenteritis due to nontyphoidal Salmonella enterica, Shigella and Vibrio parahaemolyticus in China

To estimate the incidence of foodborne gastroenteritis caused by nontyphoidal Salmonella enterica, Shigella, and Vibrio parahaemolyticus in China, population surveys and sentinel hospital surveillance were implemented in six provinces from July 2010 to July 2011, and a multiplier calculation model for the burden of disease was constructed. The multiplier for salmonellosis and V. parahaemolyticus gastroenteritis was estimated at 4,137 [95% confidence interval (CI) 2,320–5,663], and for shigellosis at 4,356 (95% CI 2,443–5,963). Annual incidence per 100,000 population was estimated as 245 (95% CI 138–336), 67 (95% CI 38–92), and 806 (95% CI 452–1,103) for foodborne salmonellosis, shigellosis, and V. parahaemolyticus gastroenteritis, respectively, indicating that foodborne infection caused by these three pathogens constitutes an important burden to the Chinese healthcare system. Continuous implementation of active surveillance of foodborne diseases, combined with multiplier models to estimate disease burden, makes it possible for us to better understand food safety status in China.

A cluster of mesopontine GABAergic neurons suppresses REM sleep and curbs cataplexy

Physiological rapid eye movement (REM) sleep termination is vital for initiating non-REM (NREM) sleep or arousal, whereas the suppression of excessive REM sleep is promising in treating narcolepsy. However, the neuronal mechanisms controlling REM sleep termination and keeping sleep continuation remain largely unknown. Here, we reveal a key brainstem region of GABAergic neurons in the control of both physiological REM sleep and cataplexy. Using fiber photometry and optic tetrode recording, we characterized the dorsal part of the deep mesencephalic nucleus (dDpMe) GABAergic neurons as REM relatively inactive and two different firing patterns under spontaneous sleep–wake cycles. Next, we investigated the roles of dDpMe GABAergic neuronal circuits in brain state regulation using optogenetics, RNA interference technology, and celltype-specific lesion. Physiologically, dDpMe GABAergic neurons causally suppressed REM sleep and promoted NREM sleep through the sublaterodorsal nucleus and lateral hypothalamus. In-depth studies of neural circuits revealed that sublaterodorsal nucleus glutamatergic neurons were essential for REM sleep termination by dDpMe GABAergic neurons. In addition, dDpMe GABAergic neurons efficiently suppressed cataplexy in a rodent model. Our results demonstrated that dDpMe GABAergic neurons controlled REM sleep termination along with REM/NREM transitions and represented a novel potential target to treat narcolepsy.

Oxocarbon Anions Templated in Silver Clusters

Three types of oxocarbon anions as templates were used to synthesize high-nuclear silver clusters, [Ag₁₆(C₂O₄){S₂P(OEt)₂}₁₂]₂(PF₆)₄ (1), [Ag₁₆(C₄O₄){S₂P(OEt)₂}₁₂]₂(PF₆)₄ (2), and [Ag₃₂(S)₂(C₅O₅)₂{S₂P(OEt)₂}₂₂](PF₆)₂ (3), and characterized by multi-NMR spectroscopy and X-ray crystallography. As the template size increases, the shape and size of the clusters change accordingly. The template effect in high-nuclear silver clusters has been investigated in this work.

SARS-CoV-2 testing, infection and outcomes among Ontario physicians: a descriptive population-based cohort study

BACKGROUND

Health care workers have a higher risk of acquiring SARS-CoV-2 infection than the general population. Our study reports on SARS-CoV-2 testing, infection and associated outcomes in Ontario physicians before SARS-CoV-2 vaccination became available on Dec. 14, 2020.

METHODS

We conducted a descriptive, population-based cohort study of physicians in Ontario, Canada, from Jan. 25 to Dec. 31, 2020. We included physicians and postgraduate medical trainees who were residents of Ontario and registrants with the College of Physicians and Surgeons of Ontario during the study period. We examined the proportion of physicians tested for SARS-CoV-2 infection, the proportion who tested positive, and how testing and infections varied by certain physician characteristics. We reported on clinical outcomes associated with infection, including hospital admission and death.

RESULTS

Of 41 208 physicians (mean age 47 yr; 56.1% male), 19 116 (46.4%) were tested at least once for SARS-CoV-2 infection; 358 tested positive (0.9%). No physicians died within 30 days of testing positive; however, 20/358 (5.6%) were admitted to hospital. By specialty, the proportion tested was highest among postgraduate medical trainees (2531/4125 [61.4%]), emergency physicians (281/478 [58.8%]), infectious disease physicians (33/67 [49.3%]) and family physicians (8857/18 553 [47.7%]). The proportion who tested positive was highest among internal medicine physicians (44/3499 [1.3%]), postgraduate medical trainees (47/4125 [1.1%]) and family physicians (171/18 553 [0.9%]). Of 2290 physicians who worked in long-term care, 1636 (71.4%) were tested and 25 (1.1%) tested positive.

INTERPRETATION

During the prevaccination period of the COVID-19 pandemic in Ontario, nearly half of all physicians in the province were tested at least once for SARS-CoV-2 infection, 0.9% tested positive and none died. These findings may reflect the public health measures that were implemented in the province during this period.

Heart rate variability in patients with anxiety disorders: A systematic review and meta-analysis

AIMS

Patients with anxiety disorders (AD) have been found to have lower heart rate variability (HRV) than healthy individuals in some studies, but this was inconsistent. Furthermore, the influence of distinct diagnoses, study design, and demographic factors on the results was not comprehensively examined.

METHODS

We gathered studies comparing HRV in patients with AD and in healthy controls. The parasympathetic activity in the hierarchical order principle was adopted in the main analysis. We adopted the random effects model to calculate the standardized mean difference.

RESULTS

Of the 7805 screened studies, 99 were included in the quantitative analysis, with a total of 4897 AD patients and 5559 controls finally entered the meta-analysis. AD patients had a significantly lower resting-state HRV for parasympathetic activity compared to control (Hedges' g = -0.3897). For the diagnostic subgroup analysis relative to the controls, resting-state HRV was significantly lower in post-traumatic stress disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder patients. HRV reactivity (all reactivity data, data on physiological challenge, and psychological challenge) did not show significant inter-group differences between AD patients and healthy subjects.

CONCLUSIONS

The results supported that patients with AD had significantly lower resting-state HRV than the healthy population, but no alterations were found for HRV reactivity.

Hydride-Containing Eight-Electron Pt/Ag Superatoms: Structure, Bonding, and Multi-NMR Studies

Recent reports on hydride-doped noble metal nanoclusters strongly suggest that the encapsulated hydride is a part of the superatom core, but no accurate location of the hydride could be experimentally proved, so far. We report herein a hydride-doped eight-electron platinum/silver alloy nanocluster in which the position of four-coordinated hydride was determined by neutron diffraction for the first time. X-ray structures of [PtHAg₁₉(dtp/desp)₁₂] (dtp = S₂P(OⁿPr)₂, 1; dsep = Se₂P(OⁱPr)₂, 2) describe a central platinum hydride (PtH) unit encapsulated within a distorted Ag₁₂ icosahedron, the resulting (PtH)@Ag₁₂ core being stabilized by an outer sphere made up of 7 capping silver atoms and 12 dichalcogenolates. Solid-state structures of 1 and 2 differ somewhat in the spatial configuration of their outer spheres, resulting in overall different symmetries, C₁ and C₃, respectively. Whereas the multi-NMR spectra of 2 in solution at 173 K reveal that the structure of C₃ symmetry is the predominant one, ¹H and ¹⁹⁵Pt NMR spectra of 1 at the same temperature disclose the presence of isomers of both C₁ and C₃ symmetry. DFT calculations found both isomers to be very close in energy, supporting the fact that they co-exist in solution. They also show that the [PtH@Ag₁₂]⁵⁺ kernel can be viewed as a closed-shell superatomic core, the μ₄-hydride electron contributing to its eight-electron count. On the other hand, the 1s(H) orbital contributes only moderately to the superatomic orbitals, being mainly involved in the building of a Pt-H bonding electron pair with the 5d_z²(Pt) orbital.

Homoleptic Silver-Rich Trimetallic M20 Nanocluster

Two silver-rich M₂₀ alloy nanoclusters (NCs), [Cu_3.5Ag_16.5{S₂P(OⁿPr)₂}₁₂] (1) and [Cu_2.5AuAg_16.5{S₂P(OⁿPr)₂}₁₂] (2), were synthesized and fully characterized by electrospray ionization mass spectrometry, NMR spectroscopy, and X-ray crystallography. Cluster 2, the first structurally characterized trimetallic M₂₀ NC, was produced by doping one Au atom into a bimetallic M₂₀ NC. Structural analyses showed the preferred positions of Group 11 metals in the yielded M₂₀ NCs. Their antioxidation ability has been investigated, and the time-dependent UV-vis spectrum shows that the presence of Cu^I atoms in structures 1 and 2 can improve the antioxidant ability.

The Effect of Heavy Fe-Doping on 3D Growth Mode and Fe Diffusion in GaN for High Power HEMT Application

The high electron mobility transistor (HEMT) structures on Si (111) substrates were fabricated with heavily Fe-doped GaN buffer layers by metalorganic chemical vapor deposition (MOCVD). The heavy Fe concentrations employed for the purpose of highly insulating buffer resulted in Fe segregation and 3D island growth, which played the role of a nano-mask. The in situ reflectance measurements revealed a transition from 2D to 3D growth mode during the growth of a heavily Fe-doped GaN:Fe layer. The 3D growth mode of Fe nano-mask can effectively annihilate edge-type threading dislocations and improve transfer properties in the channel layer, and consequently decrease the vertical leakage current by one order of magnitude for the applied voltage of 1000 V. Moreover, the employment of GaN:C film on GaN:Fe buffer can further reduce the buffer leakage-current and effectively suppress Fe diffusion.

Striatal neurons expressing dopamine D1 receptor promote wakefulness in mice

Patients with Parkinson's disease (PD) suffer from severe sleep disorders. Pathophysiology of the basal ganglia (BG) underlies PD, and the dorsal striatum represents the major input pathway of the BG. However, the roles and mechanisms of the dorsal striatum in controlling sleep-wake cycles remain unknown. To demonstrate the contribution of dopamine D₁ receptor (D₁R)-positive neurons within the dorsal striatum in promoting wakefulness, we combined optogenetic manipulations and fiber photometry with electroencephalography/electromyography recording in D₁R-Cre mice. As a result, optogenetic activation of striatal D₁R neurons induced immediate transitions from non-rapid eye movement (NREM) sleep to wakefulness, whereas inhibition of striatal D₁R neurons attenuated wakefulness by chemogenetics. Multi-channel fiber photometry recordings revealed that the activity of striatal D₁R neurons synchronized with that of BG upstreams, namely the prefrontal cortex and mediodorsal thalamus, in terms of immediate increase in activity during NREM-to-wake transitions and rapid decease during wake-to-NREM transitions. Further optogenetic manipulations revealed a prominent contribution of striatal D₁R neurons in control of wakefulness by upstream, corticostriatal, thalamostriatal, and nigrostriatal projections and via downstream, striato-entopeduncular, or striatonigral pathways. Taken together, our findings revealed a circuit regulating wakefulness through striatal D₁R neurons. Striatal D₁R neurons play an important role in controlling wakefulness by integrating the corticostriatal, thalamostriatal, and nigrostriatal projections and innervation of striato-entopeduncular or striatonigral pathways.

Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada

IMPORTANCE

Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians.

OBJECTIVE

To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest.

DESIGN, SETTING, AND PARTICIPANTS

A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses.

EXPOSURES

The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic.

MAIN OUTCOMES AND MEASURES

The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use.

RESULTS

In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history.

CONCLUSIONS AND RELEVANCE

In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change.

[Emulation pulmonary nodules localization model:a novel non-invasive localization technique in resection of pulmonary nodules]

Objective: To explore the accuracy and efficiency of a novel 3D-printed emulation localization model of small pulmonary nodules in lung surgery. Methods: From April 2020 to April 2021, a total of 66 patients were selected in the study, who underwent localization and resection of pulmonary nodules with video-assisted thoracoscopic surgery (VATS) guided by the 3D-printed emulation localization model at Department of Thoracic Surgery, West China Hospital of Sichuan University. There were 13 males and 53 females, aged from 25 to 79 (52.7±11.4) years. Of all patients, 24 (36.4%) had single pulmonary nodule, and 42 (63.6%) had synchronous multiple pulmonary nodules. The chest high-resolution CT image data were utilized for digital reconstruction and 3D printing to make a tailored life-size emulation pulmonary nodules localization model, which was used to navigate real-time intraoperative localization of nodules. Clinical data including operative parameters, localization information, resection types and pathological findings of nodules were analyzed. The pulmonary nodules that doctors planned to resect were categorized into two categories:major nodules and additional nodules, according to their presence of invasion and radiological risk factors. The accuracy of localization and resection efficiency of nodules were evaluated in accordance with the categories of the nodules respectively. Results: On the basis of preoperative evaluation, there were 71 major nodules with median maximal diameter of 0.9 (0.6-1.3) cm, and 77 additional nodules with median maximal diameter of 0.5 (0.4-0.7) cm. All patients underwent VATS surgery, 52 of them (78.8%) were treated with uniportal VATS and 14 (21.2%) with triportal VATS. Among the patients with single nodule, 18 segmentectomies and 6 wedge resections were performed; whereas among the patients with multiple nodules, 5 segmentectomies, 14 wedge resections, and 23 combined pulmonary resections (including 2 cases of lobectomy+segmentectomy, 7 cases of lobectomy+wedge resections, and 14 cases of segmentectomy+wedge resections) were achieved. The median operative time was 93 (45-240) min, and the median resection time for all nodules was 51.4 (6.7-147.0) min. All major nodules were successfully resected and visibly dissected after removal, and all additional nodules were successfully resected with 85.7%(66/77) nodules visibly dissected. The accuracy rate of localization of both types of nodules was 100%. All major nodules were malignant, and the malignancy rate of additional nodules was 21.2%(14/66). Conclusion: This novel 3D-printed emulation localization model of small pulmonary nodules proved to be a non-invasive, accurate and efficient technique. Not only that, it has a unique advantage in localization of synchronous multiple pulmonary nodules.

Alloying dichalcogenolate-protected Ag21 eight-electron nanoclusters: a DFT investigation

The isoelectronic doping of dichalcogenolato nanoclusters of the type [Ag₂₁{E₂P(OR)₂}₁₂]⁺ (E = S, Se) by any heteroatom belonging to groups 9-12 was systematically investigated using DFT calculations. Although they can differ in their global structure, all of these species have the same M@M₁₂-centered icosahedral core. In any case, the different structure types are all very close in energy. In all of them, three different alloying sites can be identified (central, icosahedral, peripheral) and calculations allowed the trends in heteroatom site occupation preference across the group 9-12 family to be revealed. These trends are supported by complementary experimental results. They were rationalized on the basis of electronegativity, potential involvement in the bonding of valence d-orbitals and atom size. TD-DFT calculations showed that the effect of doping on optical properties is sizable and this should stimulate research on the modulation of luminescence properties in the dithiolato and diseleno families of complexes.

Reactivities of Interstitial Hydrides in a Cu11 Template: En Route to Bimetallic Clusters

In sharp contrast to surface hydrides, reactivities of interstitial hydrides are difficult to explore. When treated with a metal ion (Cu⁺ , Ag⁺ , and Au⁺ ), the stable Cu^I dihydride template [Cu₁₁ H₂ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ ] (H₂ Cu₁₁ ) generates surprisingly three very different compounds, namely [CuH₂ Cu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ ]⁺ (1), [AgH₂ Cu₁₄ {S₂ P(Oⁱ Pr)₂ }₆ ((C≡CPh)₆ ]⁺ (2), and [AuCu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ Cl] (3). Compounds 1 and 2 are both M^I species and maintain the same number of hydride ligands as their H₂ Cu₁₁ precursor. Neutron diffraction revealed the first time a trigonal-pyramidal hydride coordination mode in the AgCu₃ environment of 2. 3 has no hydride and exhibits a mixed-valent [AuCu₁₁ ]¹⁰⁺ metal core, making it a two-electron superatom.

Serum uric acid is associated with incident metabolic syndrome independent of body shape index and body roundness index in healthy individuals

BACKGROUND AND AIMS

Elevated serum uric acid (SUA) levels, body shape index (BSI) and body roundness index (BRI) were associated with incident metabolic syndrome (MetS). We aimed to investigate the relationship among the SUA level, BSI, and BRI on the incidence of MetS.

METHODS AND RESULTS

We retrospectively included 6221 healthy individuals from annual health exams at our hospital between 2016/1/1 and 2016/12/31. We defined hyperuricemia as SUA levels greater than 7 mg/dl in men and 6 mg/dl in women and MetS according to the contemporary definition. The study cohort included 6221 healthy individuals with an overall incidence rate of MetS of 9.8%. Compared with the normouricemic group, the hyperuricemic group had a greater incidence of MetS (17.2% vs. 9.6%, P < 0.001). After full adjustment for confounders, the SUA level was significantly associated with incident MetS in addition to body mass index (BMI) (adjusted OR [aOR]: 1.161, 95% CI: 1.071-1.259, P < 0.001), BRI (aOR: 1.196, 95% CI: 1.104-1.296, P < 0.001), and BSI (aOR: 1.297, 95% CI: 1.200-1.403, P < 0.001). Regarding the anthropometric indices, BMI and BRI were independent predictors of incident MetS, but the BSI lost its significant association in multivariate logistic regression analyses. In sensitivity analyses, various thresholds of elevated SUA levels remained associated with incident MetS.

CONCLUSION

We showed a dose-response effect of SUA on incident MetS independent of BMI, BRI and BSI in healthy individuals. Future studies can use SUA levels to stratify cardiometabolic risk in healthy individuals.

CLINICAL TRIALS

ClinicalTrials.gov with the identification number NCT03473951.

Low-dose rivaroxaban associated with lower incidence of all-cause mortality and bleeding complications in older patients with non-valvular atrial fibrillation

Background

Low-dose rivaroxaban 10mg daily was used in the J-ROCKET AF trial, and it demonstrated the safety in Asian population. It remains unclear whether low-dose rivaroxaban vs. standard dose 20mg daily is associated with efficacy, safety, and net-clinical outcomes in older Asian patients with non-valvular atrial fibrillation.

Purpose

To evaluate the effects of low-dose rivaroxaban on efficacies and safeties in the old patients age more than 85 years.

Methods

We retrospectively enrolled the patients from medical records between Oct 2012 and Nov 2016. We used 2x2 factorial design by age of 85 years and use of low-dose rivaroxaban. The study outcomes were one-year all-cause mortality and bleeding complications.

Results

The study cohort consisted of 2,386 patients with the mean age 76.6 years (SD 10.5), 51.8% male, CHA2DS2Vsc 4.4 (SD 1.7) and HASBLED 1.6 (SD 1.0). In the age ≥85 group (n=593), low vs. standard dose rivaroxaban had a lower incidence of all-cause mortality (5.3% vs. 10.6%, P=0.021), whereas the incidence of all-cause mortality was greater in the low dose rivaroxaban compared with the standard dose in the age &lt;85 group (3.7% vs. 1.8%, P=0.012). No significant differences of bleeding complication rates were found between the low- and standard-dose rivaroxaban regarding age &lt;85 or ≥85 years. After adjusting for potential confounders, low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the age ≥85 group (adjusted HR: 0.400 95% CI: 0.215–0.743, P=0.004), but the significant association was not found in the age &lt;85 group (adjusted HR: 1.101 95% CI: 0.557–2.174, P=0.782).

Conclusion

Low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the patients with non-valvular atrial fibrillation and age ≥85 years.

Funding Acknowledgement

Type of funding sources: None.

Percutaneous transluminal angioplasty associated with a comparable risk of mortality in old patients with severe lower extremities arterial disease

Background

Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients.

Purpose

We investigated the effect of age ≥85 vs &lt;85 years on prognoses in LEAD patients.

Methods

We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs).

Results

The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005).

Conclusion

Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different.

Funding Acknowledgement

Type of funding sources: None. Study outcomes in LEAD patients

[Treatment strategies and research progress of acute ilio-femoral deep vein thrombosis]

In the past,treatment of acute ilio-femoral deep vein thrombosis (IFDVT) was mainly based on anticoagulation alone,but 30%-50% of patients will develop post-thrombotic syndrome,causing a serious medical burden.Thrombus removal technology such as catheter-directed thrombolysis and percutaneous mechanical thrombectomy can effectively remove blood clots and compensate for the deficiencies of simple anticoagulation,which is expected to improve the prognosis of such disease,but the current evidence is insufficient,and other treatments such as filter implantation and compression therapy are also controversial.This article summarizes the treatment strategies and the latest progress of acute IFDVT,hoping to help the treatment of this type of disease.

Serum Uric Acid: A Murderer or Bystander for Cardiac-related Mortality?

In this issue of The Journal of Rheumatology, Colantonio, et al ¹ conducted a case-cohort study from the REGARDS study to evaluate whether the association between serum uric acid (SUA) and sudden cardiac death, and between SUA and incident coronary heart disease (CHD) events, is confounded by SLC2A9 single-nucleotide polymorphisms (SNPs). Incident CHD events were the composites of nonfatal myocardial infarction (MI) or CHD deaths.

All-selenolate-protected eight-electron platinum/silver nanoclusters

The first atomically and structurally precise platinum/silver superatoms protected by Se-donor ligands were synthesized in high yield by adopting ligand replacements on [PtAg₂₀{S₂P(OⁿPr)₂}₁₂] (3) with 12 equiv. of di-alkyl diselenophosph(in)ates. Structures of [PtAg₂₀{Se₂P(OR)₂}₁₂] (R = ⁿPr (1a), ⁱPr (1b)) and [PtAg₂₀{Se₂P(CH₂CH₂Ph)₂}₁₂] (2) were accurately determined by single-crystal X-ray diffraction to reveal an eight-electron [Pt@Ag₁₂]⁴⁺ icosahedral core embedded within a cube of eight silver(i) atoms and wrapped into a shell of 12 diselenophosph(in)ates. While the lowest energy absorption band of the Se derivatives is red-shifted to longer wavelengths in comparison with the S analogue, it is blue-shifted in the emission spectra. Density functional theory (DFT) and TD-DFT calculations rationalize the electronic structures as those of eight-electron superatoms, with their HOMO and LUMO being the 1P and 1D levels, respectively. The two UV-visible lowest bands are associated with 1P → 1D metal to metal charge transfer (MMCT) transitions. The blue shift observed for the S analogue results from a larger HOMO-LUMO gap in the case of dithiolate ligands.

Doping effect on the structure and properties of eight-electron silver nanoclusters

The bimetallic M₂₀ and M₂₁ compounds, {[Cu₃Ag₁₇{S₂P(OⁱPr)₂}₁₂]_0.5 [Cu₄Ag₁₆{S₂P(OⁱPr)₂}₁₂]_0.5} ({[1a]_0.5[1b]_0.5}) and [Cu₄Ag₁₇{S₂P(OⁱPr)₂}₁₂](PF₆) (2), have been structurally characterized, in which the Cu(I) ions are randomly distributed on the eight outer positions capping the eight-electron [Ag₁₃]⁵⁺ core. DFT calculations show that the statistical disorder results from the nearly neutral preference of copper to occupy any of the eight outer positions. Surprisingly, the UV-Vis absorption spectra of the M₂₀ and M₂₁ bimetallic nanoclusters display an almost identical absorption profile as that of their homometallic [Ag₂₀{S₂P(OⁱPr)₂}₁₂] and [Ag₂₁{S₂P(OⁱPr)₂}₁₂]⁺ relatives. This is rationalized by TD-DFT calculations, which show that the frontier orbitals of such eight-electron alloys are largely independent from the nature of the capping metal ions. A blue-shifted absorption is observed upon replacing by Au the central Ag atom in 2, forming the trimetallic compound [Cu₄AuAg₁₆{S₂P(OⁱPr)₂}₁₂](PF₆) (3).

Synthesis and Luminescence Properties of Two-Electron Bimetallic Cu-Ag and Cu-Au Nanoclusters via Copper Hydride Precursors

The synthesis, structural characteristics, and photophysical properties of luminescent Cu-rich bimetallic superatomic clusters [Au@Cu₁₂(S₂CNⁿPr₂)₆(C≡CPh)₄]⁺ (1a⁺), [Au@Cu₁₂{S₂P(OR)₂}₆(C≡CPh)₄]⁺ (2⁺), (2a⁺ = ⁱPr; 2b⁺ = ⁿPr), [Au@Cu₁₂{S₂P(C₂H₄Ph)₂}₆(C≡CPh)₄]⁺ (2c⁺), and [Ag@Cu₁₂{S₂P(OⁿPr)₂}₆(C≡CPh)₄]⁺ (3⁺) were studied. Compositionally uniform clusters 1⁺-3⁺ were isolated from the reaction of dithiolato-stabilized, polyhydrido copper clusters with phenylacetylene in the presence of heterometal salts. By using X-ray diffraction, the structures of 1a⁺, 2a⁺, 2b⁺, and 3⁺ were able to be determined. ESI-mass spectrometry and elemental analysis confirmed their compositions and purity. The structural characteristics of these clusters are similar with respect to displaying gold (or silver)-centered Cu₁₂ cuboctahedra surrounded by six dithiocarbamate/dithiophosph(in)ate and four alkynyl ligands. The doping of Au and Ag atoms into the polyhydrido copper nanoclusters significantly enhances their PL quantum yields from Ag@Cu₁₂ (0.58%) to Au@Cu₁₂ (55%) at ambient temperature in solution. In addition, the electrochemical properties of the new alloys were investigated by cyclic voltammetry.

High Hole Concentration and Diffusion Suppression of Heavily Mg-Doped p-GaN for Application in Enhanced-Mode GaN HEMT

The effect of Mg doping on the electrical and optical properties of the p-GaN/AlGaN structures on a Si substrate grown by metal organic chemical vapor deposition was investigated. The Hall measurement showed that the activation efficiency of the sample with a 450 sccm Cp₂Mg flow rate reached a maximum value of 2.22%. No reversion of the hole concentration was observed due to the existence of stress in the designed sample structures. This is attributed to the higher Mg-to-Ga incorporation rate resulting from the restriction of self-compensation under compressive strain. In addition, by using an AlN interlayer (IL) at the interface of p-GaN/AlGaN, the activation rate can be further improved after the doping concentration reaches saturation, and the diffusion of Mg atoms can also be effectively suppressed. A high hole concentration of about 1.3 × 10¹⁸ cm⁻³ can be achieved in the p-GaN/AlN-IL/AlGaN structure.

Isolation and Structural Elucidation of 15-Nuclear Copper Dihydride Clusters: An Intermediate in the Formation of a Two-Electron Copper Superatom

Highly reactive copper-dihydride clusters, [Cu₁₅ (H)₂ (S₂ CNR₂ )₆ (C₂ Ph)₆ ](PF₆ ) {R = ⁿ Bu (1_H ), ⁿ Pr (2_H ), ⁱ Bu (3_H )}, are isolated during the reaction of [Cu₂₈ H₁₅ {S₂ CNⁿ Bu₂ }₁₂ ](PF₆ ) with ten equivalents of phenylacetylene. They are found to be intermediates in the formation of the earlier reported two-electron superatom [Cu₁₃ (S₂ CNR₂ )₆ (C₂ Ph)₄ ]⁺ . Better yields are obtained by reacting dithiocarbamate sodium salts, [Cu(CH₃ CN)₄ ](PF₆ ), BH₄^- and phenylacetylene. The presence of two hydrides in the isolated clusters is confirmed by the synthesis and characterization of its deuteride analogue [Cu₁₅ (D)₂ (S₂ CNR₂ )₆ (C₂ Ph)₆ ]⁺ , and a single-crystal neutron structure of 2_H . Structural characterization of 1_H reveals a new bicapped icosahedral copper(I) cage encapsulating a linear copper dihydride (CuH₂ )^- unit. Reaction of 3_H with Au(I) salts yields a highly luminescent [AuCu₁₂ (S₂ CNⁱ Bu₂ )₆ (C₂ Ph)₄ ]⁺ cluster.

[Cu{SC(O)OiPr}]96: A Giant Self-Assembled Copper(I) Supramolecular Wheel Exhibiting Photoluminescence Tuning and Correlations with Dynamic Solvation and Solventless Synthesis

The hierarchical self-organization of structurally complex high-nuclearity metal clusters with metallosupramolecular wheel architectures that are obtained from the self-assembly of smaller solvated cluster units is rare and unique. Here, we use the potentially heteroditopic monothiocarbonate ligand and demonstrate for the first time the synthesis and structure of a solvated non-cyclic hexadecanuclear cluster [Cu{SC(O)OⁱPr}]₁₆·2THF (1) that can simultaneously desolvate and self-assemble in solution and subsequently form a giant metallaring, [Cu{SC(O)OⁱPr}]₉₆ (2). We also demonstrate a luminescent precursor to cluster (2) can be achieved through a solventless and rapid mechanochemical synthesis. Cluster (2) is the highest nuclearity copper(I) wheel and the largest metal cluster containing a heterodichalcogen (O, S) ligand reported to date. Cluster (2) also exhibits solid-state luminescence with relatively long emission lifetimes at 4.1, 13.9 (μs). The synthetic strategy described here opens new research avenues by replacing solvent molecules in stable {Cu₁₆} clusters with designed building units that can form new hybrid and multifunctional finite supramolecular materials. This finding may lead to the development of novel high-nuclearity materials self-assembled in a facile manner with tunable optical properties.

Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia

Purpose

Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI.

Materials and methods

We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs).

Results

Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m², SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs.

Conclusion

CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.