Rationally Designed Cyclooctatetrathiophene-Based Porous Aromatic Frameworks (COTh-PAFs) for Efficient Photocatalytic Hydrogen Peroxide Production

Constructing stable and efficient photocatalysts for H2O2 production is of great importance and is challenging. In this study, the synthesis of three photoactive cyclooctatetrathiophene (COTh)-based porous aromatic frameworks (COTh-PAFs) in an alternating donor-acceptor (D-A) fashion is presented. In combination with a triazine-derived electron acceptor, PAF-363 exhibits high efficiency for the photosynthesis of H2O2 with production rates of 11733 μmol g-1 h-1(with sacrificial agent) and 3930 μmol g-1 h-1 (without sacrificial agent) from water and oxygen under visible light irradiation. Experimental results and theoretical calculations reveal that the charge transfer positions and the O2 adsorption sites in PAF-363 are both concentrated on COTh fragments, which facilitate the H2O2 production through the oxygen reduction reaction (ORR) pathway. This work highlights that the rational design of COTh-PAFs with consideration of D-A direction, charge transfer positions, and O2 adsorption sites provides a feasible access to efficient H2O2 production photocatalysts.

Healthcare-associated carbapenem-resistant Klebsiella pneumoniae infections are associated with higher mortality compared to carbapenem-susceptible K. pneumoniae infections in the intensive care unit: a retrospective cohort study

BACKGROUND

Klebsiella pneumoniae (KP) is an opportunistic pathogen causing severe pneumonia and sepsis. Carbapenem-resistant KP (CRKP) has become a major pathogen in many centres.

AIM

To investigate the association between carbapenem resistance and the mortality rate, length of stay, and hospital cost in patients with Klebsiella pneumoniae infection.

METHODS

The retrospective cohort study was conducted in the intensive care units of a large teaching tertiary hospital in southwest China between January 1st, 2020 and December 31st, 2022. To examine the impact of carbapenem resistance on mortality rates and economic burden, multivariate Cox regression and generalized linear models were constructed.

FINDINGS

The study included 282 adult patients with KP infection (135 CSKP; 147 CRKP). CRKP-infected patients demonstrated higher mortality risk (unadjusted hazard ratio (aHR): 1.980; 95% confidence interval (CI): 1.206-3.248; P = 0.007; aHR: 1.767; 95% CI: 1.038-3.005; P = 0.036) compared to CSKP-infected patients. Stratified analysis, according to type of KP infection, revealed that patients with healthcare-associated CRKP infection had a significantly higher mortality risk compared to those with CSKP infection (log-rank P = 0.015). Patients with CRKP infection had longer hospital stays than those infected with CSKP (adjusted mean: 38.74 vs 29.71 days; P = 0.003), and hospital-related expenses were notably higher among CRKP patients than CSKP patients (adjusted cost: £40,126.73 vs 25,713.74; P < 0.001).

CONCLUSION

CRKP infections increase mortality rates, prolong hospital stays, and raise healthcare costs. Healthcare facilities should adopt targeted strategies, including curtailing pre-infection hospitalization periods and managing medications more judiciously.

Rapidly Synthesized Single-Ion Conductive Hydrogel Electrolyte for High-Performance Quasi-Solid-State Zinc-ion Batteries

Single-ion conductive electrolytes can largely eliminate electrode polarization, reduce the proportion of anion migration and inhibit side reactions in batteries. However, they usually suffer from insufficient ion conductivity due to the strong interaction between cations and cationic receptors. Here we report an ultrafast light-responsive covalent organic frameworks (COF) with sulfonic acid groups modification as the acrylamide polymerization initiator. Benefiting from the reduced electrostatic interaction between Zn2+ and sulfonic acid groups through solvation effects, the as-prepared COF-based hydrogel electrolyte (TCOF-S-Gel) receives an ion conductivity of up to 27.2 mS/cm and Zn2+ transference number of up to 0.89. In addition, sufficient hydrogen bonds endow the single-ion conductive TCOF-S-Gel electrolyte to have good water retention and superb mechanical properties. The assembled Zn||TCOF-S-Gel||MnO2 full zinc-ion battery exhibits high discharge capacity (248 mAh/g at 1C), excellent rate capability (90 mAh/g at 10C) and superior cycling performance. These enviable results enlist the instantaneously photocured TCOF-S-Gel electrolyte to be qualified to large-scaled flexible high-performance quasi-solid-state zinc-ion batteries.

MRI Guided Adaptive Radiotherapy (MRgART) in Primary and Metastatic Liver Lesions

PURPOSE/OBJECTIVE(S)

The role of stereotactic body radiotherapy (SBRT) in the management of primary hepatic and metastatic tumors has increased significantly over the past few years. MR-Linac is rapidly gaining evidence in the delivery of ablative doses using MR guided adaptive radiotherapy (MRgART) with improved accuracy and dose coverage to the lesions. We report local control and toxicity of patients with primary and metastatic liver lesions treated with MR guided adaptive SBRT.

MATERIALS/METHODS

All patients were treated with MRgART on the Unity 1.5T MR Linacs at two institutions and consented to the ADAPT-MRL study (1). A 4DCT and MRI with abdominal compression were obtained at simulation and the primary MRI sequence used for online treatment included a T2 3D navigated scan. A balanced turbo field echo (btFFE) 2D cine motion scan was also acquired at every fraction to determine movement of the tumor to aid in internal target volume margin. All plans were treated with SBRT prescribed to 3-5 alternate daily fractions. Acute toxicity was reported according to Common Terminology Criteria for Adverse Events version 5 (CTCAE) v.5. Patient demographics, prescribed dose fractionation, acute toxicity and clinical response at 6 months were analyzed. Clinical response to treatment was measured according to RECIST criteria 1.1.

RESULTS

Between February 2021 to January 2023 a total of 30 patients were treated with 149 fractions to the liver. Patients were majority male (70%) with a median age of 66 (range 36-83). 16 patients were treated for primary hepatocellular carcinoma (HCC) of the liver and 14 patients for metastatic liver lesions. The median prescribed dose was 48 Gy (range 30-50Gy) in median 5 fractions (range (3-5 fractions). All patients completed treatment with no interruptions. The mean time from 'patient setup' to 'beam-off' was 52.6 minutes (range 37-73 minutes). Data on acute toxicity at 3 month follow up was available for 28 patients. Of these patients 7/28 (25%) had grade 1 or 2 toxicity and no >/ = grade 3 toxicity was reported. Clinical response at 6 months was available for 18 patients and showed complete response in 44% (8/18), partial response in 22% (4/18), stable disease in 22% (4/18) and progressive disease in 11.1% (2/18).

CONCLUSION

Our experience on MRgART to the liver has shown good local control and minimal acute toxicity in the treatment of primary and metastatic liver lesions. We continue to collect data on patient reported outcomes, clinical response and toxicity to determine the feasibility and safety of this system.

Safety and Efficacy of Stereotactic Body Radiotherapy for Ultra-Central Thoracic Tumors

PURPOSE/OBJECTIVE(S)

Stereotactic body radiotherapy (SBRT) is increasingly utilized in the management of ultra-central thoracic tumors, although concerns regarding significant toxicity remain. We sought to evaluate the toxicity and efficacy of SBRT to these tumors at our institution.

MATERIALS/METHODS

Patients with ultra-central lung tumors or nodes treated at our institution with SBRT between 2009 and 2019 were retrospectively reviewed. Ultra-central was defined as having the planning target volume (PTV) overlapping or abutting the central bronchial tree and/or esophagus. All SBRT plans were generated with homogenous dose distributions using target coverage objectives of ITV V100% >99%, PTV V95% >99%, and an ideal PTV Dmax <105% (strict <120%). All plans were reviewed in quality assurance rounds by a team of dosimetrists, physicists, and radiation oncologists. The primary endpoint was incidence of severe toxicity (ST), defined as SBRT-related grade ≥3 toxicities, graded using the Common Terminology Criteria for Adverse Events V5.0. Secondary endpoints included local failure (LF), progression-free survival (PFS) and overall survival (OS). Competing risk analysis was used to estimate incidence and predictors of ST and LF, with death as a competing risk. Kaplan-Meier method was used to estimate PFS and OS.

RESULTS

A total of 154 patients who received 162 ultra-central courses of SBRT were included, with a median follow-up of 21.5 months. Treatment intent was most commonly for oligoprogression (46%), oligometastasis (30%), followed by curative (20%). The most frequent tumor histologies were NSCLC (41%) and RCC (26%). SBRT prescription doses ranged from 30-55 Gy in 5 fractions (BED10 range 48-115 Gy). The most common prescription was 50 Gy in 5 fractions (42%). The cumulative incidence of ST was 8.9% at 3-years. The most common ST was pneumonitis (n = 4). Notable toxicities included bronchopleural fistula (n = 2, grade 3 and 4), bronchial stricture (n = 1, grade 3), and esophagitis leading to bleeding (n = 1, grade 4). There were no esophageal strictures or perforations, and no bronchial bleeds. There was 1 possible treatment related death from pneumonitis/pneumonia. Predictors of any ST included increased lung V5 Gy, decreased PTV V95%, and not having prior radiation therapy to the chest. The cumulative incidence of LF was 4.8%, 11% and 14% at 1-, 2-, and 3-years respectively. Predictors of LF included younger age, and greater volume of overlap between the PTV and esophagus. Median PFS was 8.4 months, while median OS was 3.7 years.

CONCLUSION

In one of the largest case series of ultra-central thoracic SBRT reported to date, homogenously prescribed SBRT plans were associated with relatively low rates of ST and LF across a variety of treatment indications. Predictors of ST should be interpreted recognizing the heterogeneity in toxicities observed. Identified predictors of both ST and LF can contribute to future work to optimize the therapeutic ratio in treatment of ultra-central thoracic tumors.

[Landmark vessel in membrane anatomy-based colorectal surgery]

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.

Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion

BACKGROUND

In order to identify individuals with chronic internal carotid artery occlusion (CICAO), it is essential to understand the integrity of the circle of Willis (CoW). This understanding is important as it may determine the potential benefits of active medical and endovascular treatments.

PURPOSE

The objective of this study is to assess whether diminished integrity of the CoW can serve as a useful marker for identifying individuals with more severe impairment in cerebral blood perfusion and a higher incidence of cerebral infarction among asymptomatic or mildly affected patients with CICAO.

MATERIALS AND METHODS

We conducted a retrospective review of asymptomatic or mildly affected patients with newly diagnosed CICAO who did not receive reperfusion therapies. The categorization of patients into good or poor integrity groups was based on the assessment of CoW integrity using CTA. We evaluated the volume and value of prolonged time to peak (TTP) in both groups, as well as the occurrence of new cerebral infarctions. Our analysis involved multivariate regression and receiver operating characteristic (ROC) analysis.

RESULTS

Hemodynamic abnormalities characterized by prolonged TTP were observed in the affected side's blood supply region in all 38 patients. There was a notable difference in the volume and value of prolonged TTP between the two groups (P < 0.001). Correlation analyses based on CTP and CTA parameters revealed a negative relationship between CoW scores and both the abnormal volume (r = -0.624, P = 0.000) and value (r = -0.589, P = 0.000) of prolonged TTP. Upon multivariable adjustment, the independent predictors for new cerebral infarction and higher volume of prolonged TTP were solely the CoW status, with respective estimates of (b = 6.05; 95% confidence interval [CI]: 1.619, 22.619; P = 0.007) and (b = 35.486; 95% CI: 4.697, 268.088; P = 0.001).

CONCLUSION

Assessing the integrity of the CoW is crucial in evaluating abnormal perfusion in asymptomatic or mildly affected individuals who are newly diagnosed with CICAO and have not undergone reperfusion therapy.

Efficient Conversion of Biomass to Formic Acid Coupled with Low Energy Consumption Hydrogen Production from Water Electrolysis

The development of a new electrolytic water hydrogen production coupling system is the key to realize efficient and low-cost hydrogen production and promote its practical application. Herein, a green and efficient electrocatalytic biomass to formic acid (FA) coupled hydrogen production system has been developed. In such system, carbohydrates such as glucose are oxidized to FA using polyoxometalates (POMs) as the redox anolyte, while H2 is evolved continuously at the cathode. Among them, the yield of glucose to FA is as high as 62.5%, and FA is the only liquid-product. Furthermore, the system requires only 1.22 V to drive a current density of 50 mA·cm-2, and the Faraday efficiency of hydrogen production is close to 100%. Its electrical consumption is only 2.9 kWh·Nm-3(H2), which is only 69% of that of traditional electrolytic water. This work opens up a promising direction for the low-cost hydrogen production coupled with efficient biomass conversion.

Dispersing small Ru nanoparticles into boron nitride remodified by reduced graphene oxide for high-efficient electrocatalytic hydrogen evolution reaction

Ruthenium (Ru) electrocatalysts suffer from excessive aggregation during the hydrogen evolution reaction (HER), which hinders their practical application for hydrogen production. Hexagonal boron nitride (h-BN) is a potential carrier that could solve the above problem, but its wide band gap and low conductivity become obstacles. Herein, we provide a new, facile, low-cost, and effective strategy (killing two birds with one stone) to overcome the above issues. After modifying h-BN with reduced graphene oxide (rGO), a small amount of Ru nanoparticles (NPs) (2.2 %) are dispersed into BN with approximately uniform distribution and size control of Ru nanoparticles (∼3.85 nm). The strong synergy between Ru NPs and BN@C in the optimal Ru/BN@C (Ru wt.% = 2.22 %) electrocatalyst endows it an outstanding HER activity, with small HER overpotentials (η₁₀ = 32 mV, 35 mV) and low Tafel slopes (33.89 mV dec^-1, 37.66 mV dec^-1) in both 1 M KOH and 0.5 M H₂SO₄ media, respectively, along with good long-term stability for 50 h. Based on density functional theory (DFT) calculations, the addition of Ru to BN has been successful in creating fresh active sites for H*, with good possible adsorption/desorption ability (ΔG_H* = -0.24 eV) while preserving low water dissociation (ΔG_b = 0.46 eV) in an alkaline environment. As a result, the Ru/BN composite exhibits outstanding HER activity in both acidic and alkaline conditions. Furthermore, this study provides, for the first time, a template-free strategy to develop a good and low-cost supporter (BN) for dispersing other noble metals and the formation of highly efficient HER/OER electrocatalysts.

Heteropoly Blue/Carbon Nanotubes Nanocomposites as High-Performance Photothermal Conversion Materials

To realize the direct and full use of the widely distributed solar energy, developing novel materials with superb photothermal conversion capability is essential. Although heteropoly blue has intrinsic outstanding solar absorption and photothermal conversion properties, its spectral absorption in the infrared region is weak. Here, composites of heteropoly blue and carbon nanotubes (HPB/CNTs) are synthesized depending on electrostatic interactions by facile microwave sonication and freeze-drying. The doped CNTs can dramatically improve the spectral absorption performance of HPB ontology in the infrared region. As a result, the light absorption of the optimized HPB/CNTs (20 %) reaches more than 95 % in the range of 200-2400 nm, showing promising prospects as high-performance photothermal conversion material in the applications of solar desalination and wastewater treatment.

Defect engineering in conjugated polyimide for promoting visible-light-driven photocatalytic benzylamine oxidation

The defect engineering has become a promising strategy to tailor the specific surface area, energy band structure and photocatalytic properties of catalysts. Thus, a series of oxygen defect modified polyimide...

[Cognition and reflection on the "lateral ligament of rectum"]

As total mesorectal excision (TME) for rectal cancer is widely carried out in China, lateral ligament of rectum, as an important anatomical structure of the lateral rectum with certain anatomical value and clinical significance, has been the focus of attention. In this paper, by comparing and analyzing the characteristics about ligaments of the abdomen and pelvis, reviewing the membrane anatomy and the theory of primitive gut rotation, and combining clinical observations and histological studies, the author came to a conclusion that lateral ligament of rectum does not exist, but is only a relatively dense space on the rectal side accompanied by numerous tiny nerve plexuses and small blood vessels penetrating through it.

Two-Dimensional Covalent Heptazine-Based Framework Enables Highly Photocatalytic Performance for Overall Water Splitting

Screening high-efficiency 2D conjugated polymers toward visible-light-driven overall water splitting (OWS) is one of the most promising but challenging research directions to realize solar-to-hydrogen (STH) energy conversion and storage. "Mystery molecule" heptazine is an intriguing hydrogen evolution reaction (HER) building block. By covalently linking with the electron-rich alkynyl and phenyl oxygen evolution reaction (OER) active units, 10 experimentally feasible 2D covalent heptazine-based frameworks (CHFs) are constructed and screened four promising visible-light-driven OWS photocatalysts, which are linked by p-phenyl (CHF-4), p-phenylenediynyl (CHF-7), m-phenylenediynyl (CHF-8), and phenyltriynyl (CHF-9), respectively. Their HER and OER active sites achieve completely spatially separated, where HER active sites focus on heptazine units and OER active sites located on alkynyl or phenyl units. Their lower overpotentials allow them to spontaneously trigger the surface OWS reaction under their own light-induced bias without using any sacrificial agents and cocatalysts. Among them, CHF-7 shows the best photocatalytic performance with an ideal STH energy conversion efficiency estimated at 12.04%, indicating that it is a promising photocatalyst for industrial OWS. This work not only provides an innovative idea for the exploration of novel polymer photocatalysts for OWS but also supplies a direction for the development of heptazine derivatives.

Use of covered stents to treat complex cerebrovascular diseases: Expert consensus

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

Copper-Bridged Tetrakis(4-ethynylphenyl)ethene Aggregates with Photo-Regulated 1 O2 and O2 .- Generation for Selective Photocatalytic Aerobic Oxidation

Active species regulation is a key scientific issue that essentially determines the selectivity and activity of a photocatalyst. Herein, Cu^I -bridged tetrakis(4-ethynylphenyl)ethene aggregates (T₄ EPE-Cu) with photo-regulated ¹ O₂ and O₂ ^.- generation were demonstrated for selective photocatalytic aerobic oxidation. In this system, transient photovoltage combined with the density functional theory calculations confirmed that Cu-alkynyl was the main oxygen activation site. The adsorbed O₂ tends to produce O₂ ^.- because of the potential well effect of Cu-alkynyl under high-energy light excitation. But under low-energy light, O₂ tends to produce ¹ O₂ via resonance energy transfer with Cu-alkynyl. For α-terpinene oxidation, the ratios of ¹ O₂ products to O₂ ^.- products can be controlled from 1.3 (380 nm) to 10.7 (600 nm). Furthermore, T₄ EPE-Cu exhibited ultrahigh photocatalytic performance for Glaser coupling and benzylamine oxidation, with a conversion and selectivity of over 99 %.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Visible-Light-Driven Oxidation of Amines to Imines in Air Catalyzed by Polyoxometalate-Tris(bipyridine)ruthenium Hybrid Compounds

The development of visible-light photocatalysts for the selective oxidative coupling of amines to imines is an area of great interest. Herein, four hybrid compounds based on polyoxometalate anions and tris(bipyridine)ruthenium cations, Ru(bpy)₃[M₆O₁₉] (M = Mo, W) 1-2, [Ru(bpy)₃]₂[Mo₈O₂₆] 3, [Ru(bpy)₃]₂[W₁₀O₃₂] 4, are prepared and characterized by X-ray diffraction (single-crystal and powder), elemental analysis, energy-dispersive X-ray spectroscopy (EDS) analysis, infrared (IR) spectroscopy, and solid diffuse reflective spectroscopy. Single-crystal structural analysis indicates that polyoxometalate anions and tris(bipyridine)ruthenium cations interact with each other through extensive hydrogen bonds in these compounds. These hybrid species with strong visible-light-harvesting abilities and suitable photocatalytic energy potentials show excellent photocatalytic activity and selectivity for the oxidation of amines to imines at room temperature in air as an oxidant. Among them, compound 1 with the [Mo₆O₁₉]^2- anion has the highest catalytic activity, which can swiftly convert >99.0% of benzylamine into N-benzylidenebenzylamine with a selectivity of 98.0% in 25 min illumination by a 10 W 445 nm light-emitting diode (LED). Its turnover frequency reaches 392 h^-1, which is not only better than the homogeneous catalyst [Ru(bpy)₃]Cl₂ but also much superior to those achieved over most of reported heterogeneous catalysts. Moreover, it shows a wide generality for various aromatic amines, accompanied by the advantages of good recyclability and stability. The photocatalytic oxidation mechanism of amines to the corresponding imines over polyoxometalate-based hybrid compounds was fully investigated.

Cost-effectiveness analyses of denosumab for osteoporosis: a systematic review

This paper systematically reviewed and assessed all retrievable pharmacoeconomic studies on denosumab for the treatment of osteoporosis. Denosumab was more cost-effective in patients with older age, prior fracture experience, lower BMD T-scores, and more risk factors. ESCEO-IOF guidelines were more applicable to improve the quality of pharmacoeconomic studies in osteoporosis.

INTRODUCTION

There are many pharmacoeconomic studies on denosumab for osteoporosis. However, the corresponding reviews are outdated or incomplete and need to be updated and refined. This article aims to systematically review and evaluate all retrievable pharmacoeconomic studies of denosumab for osteoporosis.

METHODS

A systematic literature search was performed utilizing PubMed, EMBASE(Ovid), Proquest(EconLit), Chongqing VIP, WanFang Database, and Chinese National Knowledge Infrastructure to identify full-text articles published before September 2021. The quality of full-text articles was evaluated by the Consolidated Health Economic Evaluation Reporting Standards(CHEERS) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases International Osteoporosis Foundation guideline(ESCEO-IOF).

RESULTS

In total, 21 full-text articles were eligible for inclusion. Denosumab for postmenopausal osteoporosis was not dominant compared to zoledronate and teriparatide. However, denosumab was dominant compared with strontium ranelate, raloxifene, and ibandronate in patients over 65 years. The probabilities of denosumab being cost-effective or dominant were more than 85% compared with no treatment and risedronate in patients aged over 70 years. Compared to alendronate, the highest rate of denosumab dominance occurred in patients aged 65 to 75 years, at about 65%. Most of the articles had higher CHEERS scores than ESCEO-IOF scores (converted into percentages).

CONCLUSIONS

The cost-effectiveness of denosumab for the treatment of osteoporosis was influenced by multiple factors. Generally, denosumab was more cost-effective in patients with older age, prior fracture experience, lower BMD T-scores, and more risk factors. ESCEO-IOF guidelines were more applicable to improve the transparency, generalization, and quality of pharmacoeconomic studies in osteoporosis.

Finely-tuned gamma oscillations: Spectral characteristics and links to dyskinesia

Gamma oscillations comprise a loosely defined, heterogeneous group of functionally different activities between 30 and 100 Hz in the cortical and subcortical local field potential (LFP) of the motor network. Two distinct patterns seem to emerge which are easily conflated: Finely-tuned gamma (FTG) oscillations - a narrowband activity with peaks between 60 and 90 Hz - have been observed in multiple movement disorders and are induced by dopaminergic medication or deep brain stimulation (DBS). FTG has been linked with levodopa or DBS-induced dyskinesias, which makes it a putative biomarker for adaptive DBS. On the other hand, gamma activity can also present as a broad phenomenon (30-100 Hz) in the context of motor activation and dynamic processing. Here, we contrast FTG, either levodopa-induced or DBS-induced, from movement-related broadband gamma synchronisation and further elaborate on the functional role of FTG and its potential implications for adaptive DBS. Given the unclear distinction of FTG and broad gamma in literature, we appeal for more careful separation of the two. To better characterise cortical and subcortical FTG as biomarkers for dyskinesia, their sensitivity and specificity need to be investigated in a large clinical trial.

Integrative bioinformatics analysis identifies LINC01614 as a potential prognostic signature in esophageal cancer

Background

Esophageal cancer (EC) is one of the most common gastrointestinal cancers and the incidence is on the increase in recent years. The aim of the present study was to assess novel long non-coding RNA (lncRNA) biomarkers for the prognosis of EC through the analysis of gene expression microarrays.

Methods

Three datasets (GSE53622, GSE53624, and GSE53625) were downloaded from the Gene Expression Omnibus (GEO) database and EC patients’ clinical information were from The Cancer Genome Atlas (TCGA) databases. Differentially expressed genes (DEGs) were screened by comparing tumor tissues with normal tissues using limma R package. The Gene Expression Profiling Interactive Analysis 2 (GEPIA2) database was used to obtain the novel lncRNAs and their co-expression genes in EC and these were visualized with the Cytoscape software. The Kyoto Encyclopedia of Genes and Genomes (KEGG) Orthology Based Annotation System (KOBAS) database was used to analyze the functions enrichment of selected DEGs. Cell Counting Kit-8 (CCK8) and Transwell assays were used to further confirm the function of target lncRNAs.

Results

We identified 24 differentially expressed (DE) lncRNAs and 659 DE mRNAs from the intersection of GEO and TCGA databases. And we found that only LINC01614 was concerned with a candidate prognostic signature in EC. “Extracellular matrix (ECM)-receptor interaction” and “PI3K-Akt signaling pathway” were observed, and we constructed a lncRNA-mRNA co-expression network for EC that includes LINC01614 and 64 mRNAs. The results of CCK8 and Transwell assays showed that suppression of LINC01614 inhibited EC cell proliferation and migration.

Conclusions

Our study might provide LINC01614 as a novel lncRNA biomarker for diagnosis and prognosis in EC.

Defect engineering and spilt-over hydrogen in Pt/(WO3–TH2) for selective hydrogenation of CO bonds

The effect of defects in pre-treatment WOx on the catalytic performance of selective hydrogenation of cinnamaldehyde to cinnamyl alcohol has been revealed.

Repurposing Ivermectin to augment chemotherapy's efficacy in osteosarcoma

BACKGROUND

Osteosarcoma is the most frequent malignant bone malignancy and the current treatments are ineffective. Ivermectin, an anti-protozoal drug, has been shown to have anti-cancer activity. This work investigated the potential of repurposing ivermectin to augment chemotherapy's efficacy in osteosarcoma.

METHODS

Proliferation, migration and apoptosis assays were performed in ivermectin-treated osteosarcoma cells. Combination studies were performed. Osteosarcoma xenograft mouse model was established to investigate the in vivo efficacy of ivermectin. Intracellular reactive oxygen species (ROS) and mitochondrial superoxide, membrane potential, ATP, 8-OHdG level, protein carbonylation and lipid peroxidation were determined after ivermectin treatment.

RESULTS

Ivermectin was effective and acted synergistically with doxorubicin in osteosarcoma cells regardless of cellular origin and genetic profiling. This was achieved through suppressing inhibiting growth and migration, and inducing caspase-dependent apoptosis. Ivermectin also significantly inhibited osteosarcoma growth in vivo and its combination with doxorubicin resulted in much greater efficacy than doxorubicin alone. Importantly, the effective dose of ivermectin was clinically feasible and did not cause significant toxicity in mice. Mechanistical analysis showed that ivermectin induced oxidative stress and damage, and mitochondrial dysfunction.

CONCLUSIONS

Our findings indicate that ivermectin has utility in treating patients with osteosarcoma, especially those resistant to chemotherapy.

Assessment of automated craving across substances and across cultures: stability-analysis of the Craving Automated Scale (CAS)

BACKGROUND

The transition from hedonic to compulsive use in Substance Use Disorders (SUD) is a critical point in SUD progression and hence relevant for assessment and treatment. To measure the habitual patterns of substance consumption, the Craving Automated Scales (CAS) for alcohol (CAS-A), substances (CAS-S) and cigarette smoking (CAS-CS) were developed and introduced to different countries. In this study, we aimed to investigate the structural stability of CAS across substances and cultures.

METHODS

This study analyzed the CAS-scores of a sample of 370 participants in Germany, China and the UK, including 262 opioid-users, 65 smokers and 43 alcohol-users. We performed stability analyses to check the stability (i. e. factorial invariance) of factor solutions. Based on confirmed stability of the general factor (gfactor) solution and the calculations rule obtained in the previous validation of CAS-alcohol (CAS-A), the factor structures of CAS-A, CAS-S and CAS-CS were compared.

RESULTS

The gfactor solutions based on calculations rule shows good stability, with the mean stability coefficients of 0.990 and 0.977 for CAS-S and CAS-CS respectively. The gfactor patterns were similar for CAS-A, CAS-S and CAS-CS, as well as across samples (Germany, China and the UK), with most factor-loadings larger than 0.7. Based on these findings, CAS-S and CAS-CS were also associated with established clinical measures of SUD.

CONCLUSIONS

Our findings suggest the two-gfactor solution based on a proposed calculation rule has a high stability across substances and cultures. This could be in line with common neurobiological mechanisms underlying habitual substance use. Moreover, comparing CAS with established clinical tools suggests that CAS might assess the automated behavior in substance consumption in a more sophisticated way.

New carbon nitride close to C6N7 with superior visible light absorption for highly efficient photocatalysis

The rational design and construction of novel two-dimensional (2D) carbon nitrides (CNs) beyond g-C₃N₄ is a hot topic in the fields of chemistry and materials. Inspired by the polymerisation of urea, we have prepared a series of novel C-C bridged heptazine CNs UO_x (where x is the ratio of urea to oxamide, x = 1, 1.5, 2, 2.5, and 3), which are similar to (C₆N₇)_n, upon the introduction of oxamide. As predicted using density functional theory (DFT) calculations, the conjugated structure of UO_x was effectively extended from an individual heptazine to the entire material. Consequently, its bandgap was reduced to 2.05 eV, and its absorption band edge was significantly extended to 600 nm. Furthermore, its carrier transfer and separation were significantly enhanced, establishing its superior photocatalytic activity. The optimised UO₂ exhibits a superior photocatalytic hydrogen production rate about 108.59 μmol h^-1 (using 10 mg of catalyst) with an apparent quantum efficiency (AQE) of 36.12% and 0.33% at 420 and 600 nm, respectively, which is one of the most active novel CNs reported to date. Moreover, UO₂ exhibits excellent photocatalytic activity toward the oxidation of diphenylhydrazine to azobenzene with conversion and selectivity reaching ~100%, which represents a promising highly efficient 2D CN material. Regarding phenols degradation, UO₂ also displayed significantly higher activity and durability during the degradation of phenol when compared to traditional g-C₃N₄, highlighting its significant potential for application in energy, environment and photocatalytic organic reactions.

Cannabis and orofacial pain: a systematic review

The naturally occurring cannabis plant has played an established role in pain management throughout recorded history. However, in recent years, both natural and synthetic cannabis-based products for medicinal use (CBPM) have gained increasing worldwide attention due to growing evidence supporting their use in alleviating chronic inflammatory and neuropathic pain associated with an array of conditions. In view of these products' growing popularity in both the medical and commercial fields, we carried out a systematic review to ascertain the effects of cannabis and its synthetically derived products on orofacial pain and inflammation. The application of topical dermal cannabidiol formulation has shown positive findings such as reducing pain and improving muscle function in patients suffering from myofascial pain. Conversely, two orally-administered synthetic cannabinoid receptor agonists (AZD1940 and GW842166) failed to demonstrate significant analgesic effects following surgical third molar removal. There is a paucity of literature pertaining to the effects of cannabis-based products in the orofacial region; however, there is a wealth of high-quality evidence supporting their use for treating chronic nociceptive and neuropathic pain conditions in other areas. Further research is warranted to explore and substantiate the therapeutic role of CBPMs in the context of orofacial pain and inflammation. As evidence supporting their use expands, healthcare professionals should pay close attention to outcomes and changes to legislation that may impact and potentially benefit their patients.

Foamer-Derived Bulk Nitrogen Defects and Oxygen-Doped Porous Carbon Nitride with Greatly Extended Visible-Light Response and Efficient Photocatalytic Activity

Constructing bulk defects and doping are feasible ways to essentially narrow the band gap and improve the light absorption of photocatalysts. Herein, inspired by bread foaming, the foaming agent azoformamide or azodicarbonamide (AC) was introduced during the thermal polymerization of urea. In the polymerization process, a large number of bubbles produced by AC decomposition seriously interfered with the polymerization of urea, resulting in the breaking of the hydrogen bonds and van der Waals interaction in carbon nitride, distortion of its structure, and partial oxidation, thus forming a series of porous carbon nitrides U/AC_x (x is the ratio of AC to urea; where x = 0.25, 0.5, and 1) with bulk N defects and O doping. Its band gap was reduced to 1.91 eV and the absorption band edge was greatly extended to 650 nm. The optimal U/AC_0.5 exhibits the highest visible light photocatalytic hydrogen production rate of about 44.7 μmol·h^-1 (10 mg catalysts) and shows superior photocatalytic performance for the oxidation of diphenylhydrazine to azobenzene, with conversion and selectivity of almost 100%, and is one of the most active defective carbon nitrides, especially under long-wavelength (λ ≥ 550 nm) light irradiation. It paves the way for the design of highly efficient and wide-spectral-response photocatalysts.

Bakkenolide‑IIIa ameliorates lipopolysaccharide‑induced inflammatory injury in human umbilical vein endothelial cells by upregulating LINC00294

Inflammation, which causes injury to vascular endothelial cells, is one of the major factors associated with atherosclerosis (AS); therefore, inhibition of endothelial inflammation is a key step toward preventing AS. The present study aimed to investigate the effects of bakkenolide-IIIa (Bak-IIIa), an important active component of bakkenolides, on endothelial inflammation, as well as the mechanisms underlying such effects. Lipopolysaccharide (LPS)-damaged human umbilical vein endothelial cells (HUVECs) were treated with Bak-IIIa. The results of the MTT assay and enzyme-linked immunosorbent assay indicated that Bak-IIIa significantly alleviated survival inhibition, and decreased the levels of LPS-induced TNF-α, interleukin (IL)-1β, IL-8, and IL-6. Furthermore, long noncoding RNA (lncRNA) microarray analyses revealed 70 differentially expressed lncRNAs (DELs) in LPS-damaged HUVECs treated with Bak-IIIa. lncRNA target prediction results revealed that 44 DELs had 52 cis-targets, whereas 12 DELs covered 386 trans-targets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses of the trans-targets indicated that three GO terms were associated with inflammation. Therefore, 17 targets involved in these GO terms and six relevant DELs were screened out. Validation via reverse transcription-quantitative PCR indicated that the fold change of NR_015451 (LINC00294) was the highest among the six candidates and that overexpression of LINC00294 significantly alleviated LPS-induced survival inhibition and inflammatory damage in HUVECs. In conclusion, Bak-IIIa ameliorated LPS-induced inflammatory damage in HUVECs by upregulating LINC00294. Thus, Bak-IIIa exhibited potential for preventing vascular inflammation.

Long non-coding RNA BCAR4 aggravated proliferation and migration in esophageal squamous cell carcinoma by negatively regulating p53/p21 signaling pathway

Long non-coding RNA breast cancer antiestrogen resistance 4 (lncRNA BCAR4) is an independent factor on the survival prognosis of patients with multiple cancers. However, the role of lncRNA BCAR4 in esophageal squamous cell cancer (ESCC) remains unknown. Here, we unraveled that lncRNA BCAR4 was upregulated in ESCC and predicted poor prognosis. Functionally, lncRNA BCAR4 knockdown induced cell apoptosis and G1/S arrest, while inhibited cell proliferation and migration in vitro; conversely, overexpressing lncRNA BCAR4 promoted proliferation and metastasis. Mechanistically, lncRNA BCAR4 sponged miR-139-3p to upregulate ELAVL1, thereby inhibiting p53/p21 pathway in ESCC cells. In conclusion, lncRNA BCAR4 promotes ESCC tumorigenesis via regulating p53/p21 signaling pathway and develops a brand-new biomarker and medicine target for ESCC.

Precise Molecular-Level Modification of Nafion with Bismuth Oxide Clusters for High-performance Proton-Exchange Membranes

Fabricating proton exchange membranes (PEMs) with high ionic conductivity and ideal mechanical robustness through regulation of the membrane microstructures achieved by molecular-level hybridization remains essential but challenging for the further development of high-performance PEM fuel cells. In this work, by precisely hybridizing nano-scaled bismuth oxide clusters into Nafion, we have fabricated the high-performance hybrid membrane, Nafion-Bi₁₂ -3 %, which showed a proton conductivity of 386 mS cm^-1 at 80 °C in aqueous solution with low methanol permeability, and conserved the ideal mechanical and chemical stabilities as PEMs. Moreover, molecular dynamics (MD) simulation was employed to clarify the structural properties and the assembly mechanisms of the hybrid membrane on the molecular level. The maximum current density and power density of Nafion-Bi₁₂ -3 % for direct methanol fuel cells reached to 432.7 mA cm^-2 and 110.2 mW cm^-2 , respectively. This work provides new insights into the design of versatile functional polymer electrolyte membranes through polyoxometalate hybridization.

Copolymerization of urea and murexide for efficient photocatalytic hydrogen evolution and tetracycline degradation

A g-C₃N₄ based material modified with murexide has been prepared and used for photocatalytic hydrogen production and degradation of tetracycline.

A branch-leaf-like hierarchical self-supporting electrode as a highly efficient catalyst for hydrogen evolution

A composite electrocatalyst with a branch-leaf-like structure (MoNi₄/MoO_3−x/NiCo@NF) was prepared, and hydrogen evolution reaction activity was studied.

Letter to the Editor: COVID-19 and Persons with Dementia in Acute Care Settings: How to "EVADE" Challenging Behaviors

The double whammy of dementia and coronavirus disease 2019 (COVID-19) has raised huge concerns for healthcare systems which are already struggling to cope with care demands of persons with dementia (PWD) in non-pandemic times (1). PWD who are admitted to acute care services are particularly vulnerable to behavioural changes and adverse outcomes from delirium (2, 3). During the COVID-19 period, ward relocation is frequently encountered due to COVID-19 screening and segregation; this constant changing of environment and care teams puts PWD at risk of behavioural exacerbations. This is aggravated by restrictive visitor policies in hospitals, depriving PWD of the reassuring presence of family members. Not surprisingly, caring for persons with dementia (PWD) with behavioral issues in acute care settings has become extremely challenging.