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Extracellular vesicles (EVs) are involved in the progression of various diseases. Tumor cell-derived EVs (TEVs) are a particular concern, as they can induce fatty liver by promoting liver macrophages to secrete tumor necrosis factor (TNF), thus enhancing the toxicity of chemotherapy. Therefore, reducing pathogenic EV production is a potential strategy for treating EV-related diseases. However, there are currently no effective clinical reagents to obtain this purpose. In addition, EVs are also natural and ideal drug-delivery vehicles. Improving the delivery efficiency of EVs remains a challenge. Proton pump inhibitors (PPIs) have been demonstrated to promote cell uptake of EVs by inducing micropinocytosis. Here, we show that PPIs can accelerate TEV clearance, reduce TEV uptake by liver macrophages and decrease the mRNA expression of TNF in liver macrophages of tumor-bearing mice. Correspondingly, the fatty liver phenotypes are alleviated, and the tolerance to chemotherapy is improved in these mice. Furthermore, our findings indicate that PPIs facilitate the uptake of red blood cell-derived EVs (RBC-EVs) loaded with antisense oligonucleotides of Trim21 (Trim21-ASOs) by the liver macrophages of obesity. Consequently, the inhibition of macrophage inflammatory responses in obese mice mediated by RBC-EVs/Trim21-ASOs was further enhanced by PPIs, resulting in a more profound improvement in obesity and related metabolic disorders. In conclusion, our findings demonstrated that PPIs can effectively clear pathogenic EVs and enhance the delivery efficacy of EV vehicles, making them a highly promising clinical prospect., Competing Interests: Declarations Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

A pair of circularly polarized thermally activated delayed fluorescence (CP-TADF) materials (R)-ad-PXZ/(S)-ad-PXZ were obtained, which show orange-red emission at 602 nm and clear chiroptical properties both in solution and the solid state. The solution processable circularly polarized device exhibits the maximum external quantum efficiency of 9.0% and g EL value of 10 -3 .

Background: Anticoagulant therapy for patients who underwent cardiac surgery is a challenge. Both inadequate and excessive anticoagulation can cause fatal complications. Previous studies failed to provide real-time guidance for heparin pump speed adjustment. This study intended to provide a quantitative prediction model to optimize heparin dosage for cardiac surgery patients based on machine learning method., Methods: Patients who underwent cardiac surgery and admitted to intensive care unit in Peking Union Medical College Hospital (PUMCH) from January 2013 to December 2023 were retrospectively analyzed. In order to reach target activated partial thromboplastin time (aPTT), linear regression, SVM, XGBoost, LSTM, GRU, FC (Full Connected Layer) and FC + self-attention models were used to make hourly adjustment recommendation for administrations of heparin pump speed. Mean absolute square, and absolute percentage errors were used to evaluate the reliability of the models. SHAP method and feature cumulative effect were used to interpret the features of the FC + self-attention model. Safety and economic evaluation based on clinical compliance of this real-world data-oriented model was further analyzed., Results: A total of 1080 patients including 112,554 heparin pump administrations were included in this study. Among seven candidate models, FC + self-attention model yielded the lowest mean absolute error of 0.9388 and 1.1325 in test and validation cohort. Gap to target aPTT, thrombin time, history of coronary heart disease, previous duration of arterial fibrillation and prothrombin activity were identified as important features affecting heparin adjustment. High compliance to FC + self-attention model may increase percentage of normal therapeutic time and decrease supratherapeutic therapeutic time and reducing blood draw until two consecutive normal therapeutic stabilization of aPTT., Conclusions: This FC + self-attention model is potentially applicable for giving recommendation for healthcare providers to optimize heparin dosage for cardiac surgery patients., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Study Design: A prospective case-control study., Objective: To analyze global coronal malalignment (GCM) in degenerative lumbar scoliosis (DLS) and to prospectively investigate the performance of priority-matching correction technique on preventing postoperative coronal imbalance., Methods: A total of 444 DLS inpatients and outpatients were recruited. GCMs were classified into 2 types: Type 1, GCM with thoracolumbar (TL/L) curve as the main contribution on coronal imbalance; Type 2, GCM with lumbosacral (LS) curve as the main contribution on coronal imbalance. Patients receiving priority-matching correction were assigned to Group P-M and receiving traditional correction were assigned to Group T form August 2020. The fundamental principle of priority-matching technique was to first correct the key curve contributing to coronal imbalance rather than the curve with greater magnitude., Results: Type 1 GCM accounted for 45% and Type 2 GCM accounted for 55% of patients. Type 2 GCM was detected to have greater LS Cobb angle and L4 tilt. At 1-year follow-up, 29.8% of patients with Type 2 GCM, whereas 11.7% of patients with Type 1 GCM were observed to have postoperative coronal decompensation. Patients with postoperative imbalance were revealed to have greater preoperative LS Cobb angle and L4 tilt and smaller correction extent of LS curve and L4 tilt. 6.25% of patients developed postoperative coronal imbalance in Group P-M, whereas 40.5% developed in Group T., Conclusion: Highlighting priority and aggressive correction of the key curve to coronal imbalance, priority-matching technique was proved to be able to limit the development of postoperative coronal decompensation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Overcoming the trade-off between short-circuited current (J sc ) and open-circuited voltage (V oc ) is important to achieving high-efficiency organic solar cells (OSCs). Previous works modulated the energy gap between Frenkel local exciton (LE) and charge-transfer (CT) exciton, which served as the driving force of exciton splitting. Differently, our current work focuses on the modulation of LE-CT excitonic coupling (t LE-CT ) via a simple but effective strategy that the 2-chlorothiophene (2Cl-Th) solvent utilizes in the treatment of OSC active-layer films. The results of our experimental measurements and theoretical simulations demonstrated that 2Cl-Th solvent initiates tighter intermolecular interactions with non-fullerene acceptor in comparison with that of traditional chlorobenzene solvent, thus suppressing the acceptor's over-aggregation and retarding the acceptor crystallization with reduced trap. Critically, the resulting shorter distances between donor and acceptor molecules in the 2Cl-Th treated blend efficiently strengthen t LE-CT , which not only promotes exciton splitting but also reduces non-radiative recombination. The champion efficiencies of 19.8 % (small-area) with superior operational reliability (T80: 586 hours) and 17.0 % (large-area) were yielded in 2Cl-Th treated cells. This work provided a new insight into modulating the exciton dynamics to overcome the trade-off between J sc and V oc , which can productively promote the development of the OSC field., (© 2024 Wiley-VCH GmbH.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.

Cancer-associated fibroblasts (CAFs) are abundant and heterogeneous stromal cells in the tumor microenvironment, which play important roles in regulating tumor progression and therapy resistance by transferring exosomes to cancer cells. However, how CAFs modulate esophageal squamous cell carcinoma (ESCC) progression and radioresistance remains incompletely understood. The expression of fibroblast activation protein (FAP) in CAFs was evaluated by immunohistochemistry in 174 ESCC patients who underwent surgery and 78 pretreatment biopsy specimens of ESCC patients who underwent definitive chemoradiotherapy. We sorted CAFs according to FAP expression, and the conditioned medium (CM) was collected to culture ESCC cells. The expression levels of several lncRNAs that were considered to regulate ESCC progression and/or radioresistance were measured in exosomes derived from FAP + CAFs and FAP - CAFs. Subsequently, cell counting kit-8, 5-ethynyl-2'-deoxyuridine, transwell, colony formation, and xenograft assays were performed to investigate the functional differences between FAP + CAFs and FAP - CAFs. Finally, a series of in vitro and in vivo assays were used to evaluate the effect of AFAP1-AS1 on radiosensitivity of ESCC cells. FAP expression in stromal CAFs was positively correlated with nerve invasion, vascular invasion, depth of invasion, lymph node metastasis, lack of clinical complete response and poor survival. Culture of ESCC cells with CM/FAP + CAFs significantly increased cancer proliferation, migration, invasion and radioresistance, compared with culture with CM/FAP - CAFs. Importantly, FAP + CAFs exert their roles by directly transferring the functional lncRNA AFAP1-AS1 to ESCC cells via exosomes. Functional studies showed that AFAP1-AS1 promoted radioresistance by enhancing DNA damage repair in ESCC cells. Clinically, high levels of plasma AFAP1-AS1 correlated with poor responses to dCRT in ESCC patients. Our findings demonstrated that FAP + CAFs promoted radioresistance in ESCC cells through transferring exosomal lncRNA AFAP1-AS1; and may be a potential therapeutic target for ESCC treatment., (© 2024 Wiley Periodicals LLC.)

Aim: To investigate the cost homogeneity within the Diagnosis-Related Group (DRG) "major operation of pancreas and liver, with general complications or comorbidities" (HB13), its cost-influencing factors, and to propose suggestions for better grouping efficacy., Methods: Medical and insurance settlement data of inpatients covered by the DRG payment system at the author's institution were collected from March 15, 2022 to December 31, 2023. The cost homogeneity of group HB13 was assessed using the coefficient of variation (CV). Clinical factors that may have an impact on hospitalization cost for patients undergoing pancreatic surgery were identified through a semi-structured interview administered to the pancreatic surgeons in author's department, their significance was analyzed using multiple linear regression, along with their impact on the cost of different service categories. A proposal to subdivide HB13 was made and evaluated by CV and t-test., Results: The CV of the HB13 group was 0.4. Robotic-assisted surgery and pancreaticoduodenectomy were two independent factors that significantly affected the total cost. Patients undergoing robotic-assisted surgery have an average increase of 41,873 CNY in total cost, primarily derived from operation fee. Patients undergoing pancreaticoduodenectomy have an average increase of 37,487 CNY in total cost, with significant increases across all service categories. HB13 was subdivided based on whether pancreaticoduodenectomy was performed. The newly formed groups exhibited lower CVs than the original HB13., Conclusion: The cost homogeneity of HB13 was lower than that of other DRG groups in author's department. It is recommended to introduce a supplementary payment for patients requiring robotic-assisted surgery, to guarantee their access to this advanced technology. It is recommended to establish a new group with higher payment standard for patients undergoing pancreaticoduodenectomy. A tiered CV criterion for the evaluation of grouping efficacy is recommended to increase intra-group homogeneity, facilitating a better allocation of health insurance funds, and the prevention of unintended negative outcomes such as service cuts and cherry-picking., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hou, Liu, Zhou, Zhang, Wang and Zhu.)

A novel series of excited-state intramolecular proton transfer (ESIPT) emitters, namely, DPNA , DPNA-F , and DPNA- t Bu , endowed with dual intramolecular hydrogen bonds, were designed and synthesized. In the condensed phase, DPNAs exhibit unmatched absorption and emission spectral features, where the minor 0-0 absorption peak becomes a major one in the emission. Detailed spectroscopic and dynamic approaches conclude fast ground-state equilibrium among enol-enol (EE), enol-keto (EK), and keto-keto (KK) isomers. The equilibrium ratio can be fine-tuned by varying the substitutions in DPNA s. Independent of isomers and excitation wavelength, ultrafast ESIPT takes place for all DPNAs , giving solely KK tautomer emission maximized at >650 nm. The spectral temporal evolution of ESIPT was resolved by a state-of-the-art technique, namely, the transient grating photoluminescence (TGPL), where the rate of EK* → KK* is measured to be (157 fs) -1 for DPNA- t Bu , while a stepwise process is resolved for EE* → EK* → KK*, with a rate of EE* → EK* of (72 fs) -1 . For all DPNAs , the KK tautomer emission shows a narrowband emission with high photoluminescence quantum yields (PLQY, ∼62% for DPNA in toluene) in the red, offering advantages to fabricate deep-red organic light-emitting diodes (OLED). The resulting OLEDs give high external quantum efficiency with a spectral full width at half-maximum (FWHM) as narrow as ∼40 nm centered at 666-670 nm for DPNAs , fully satisfying the BT. 2020 standard. The unique ESIPT properties and highly intense tautomer emission with a small fwhm thus establish a benchmark for reaching red narrowband organic electroluminescence.

131 I has been extensively utilized in nuclear medicine, resulting in its widespread detection in coastal algal samples due to its discharge. Therefore, it is essential to monitor 131 I in the coastal algal samples. γ-spectrometry is an expeditious method for measuring 131 I, but this method requires the pretreatment of the algal sample. The effect on 131 I in the algal sample during the oven-drying treatment is unclear. In this study, the Laminaria japonica Areschoug and Sargassum vachellianum Greville were collected at two locations and analyzed for 131 I using γ-spectrometry. Additionally, the content of iodine was measured using an Inductively Coupled Plasma-Mass Spectrometer (ICP-MS) to clarify the effect of 131 I loss during drying treatment at different temperatures. The results demonstrated that the dried Laminaria and Sargassum samples had calculated 131 I activity concentration relative standard deviations (RSDs) of 6.34 % and 16.31 %, respectively, while the fresh samples exhibited RSDs of 11.70 % and 15.57 %. Additionally, the iodine content RSDs in the dried samples were 9.19 % for Laminaria and 10.34 % for Sargassum. Significantly, discrepancies in 131 I activity concentration between the fresh and dried Laminaria and Sargassum were 5.4 % and 10.3 %. These findings indicate that the temperature factor in drying has no effect on 131 I loss in Laminaria and Sargassum in the range of 70 °C-110 °C., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Currently, much research effort has been devoted to improving the exciton utilization efficiency and narrowing the emission spectra of ultraviolet (UV) fluorophores for organic light-emitting diode (OLED) applications, while almost no attention has been paid to optimizing their light out-coupling efficiency. Here, we developed a linear donor-acceptor-donor (D-A-D) triad, namely CDFDB, which possesses high-lying reverse intersystem crossing (hRISC) property. Thanks to its integrated narrowband UV photoluminescence (PL) (λ PL : 397 nm; FWHM: 48 nm), moderate PL quantum yield (ϕ PL : 72 %, Tol), good triplet hot exciton (HE) conversion capability, and large horizontal dipole ratio (Θ // : 92 %), the OLEDs based on CDFDB not only can emit UV electroluminescence with relatively good color purity (λ EL : 398 nm; CIE x,y : 0.161, 0.040), but also show a record maximum external quantum efficiency (EQE max ) of 12.0 %. This study highlights the important role of horizontal dipole orientation engineering in the molecular design of HE UV-OLED fluorophores., (© 2024 Wiley-VCH GmbH.)

Robotic surgery has been increasingly adopted in various surgical fields, but the cost-effectiveness of this technology remains controversial due to its high cost and limited improvements in clinical outcomes. This study aims to explore the health economic implications of robotic pancreatic surgery, to investigate its impact on hospitalization costs and consumption of various medical resources. Data of patients who underwent pancreatic surgery at our institution were collected and divided into robotic and traditional groups. Statistical analyses of hospitalization costs, length of stay, costs across different service categories, and subgroup cost analyses based on age, BMI class, and procedure received were performed using t tests and linear regression. Although the total hospitalization cost for the robotic group was significantly higher than that for the traditional group, there was a notable reduction in the cost of medical consumables. The reduction was more prominent among elderly patients, obese patients, and those undergoing pancreaticoduodenectomy, which could be attributed to the technological advantages of the robotic surgery platform that largely facilitate blood control, tissue protection, and suturing. The study concluded that despite higher overall costs, robotic pancreatic surgery offers significant savings in medical consumables, particularly benefiting certain patient subgroups. The findings provide valuable insights into the economic viability of robotic surgery, supporting its adoption from a health economics perspective., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Cancer-associated thrombosis is a significant complication in cancer patients, leading to increased morbidity and mortality. The expression of coagulation/fibrinolysis genes, termed the "coagulome", plays a critical role in this process. Using the single-sample gene set enrichment analysis (ssGSEA), we identified seven cancer types with significantly activated coagulation pathways, focusing on lower-grade glioma (LGG) and stomach adenocarcinoma due to their predictive value for overall survival. Through 1000 iterations of the Least Absolute Shrinkage and Selection Operator (LASSO), we selected prognostic genes and constructed effective Cox regression models, particularly for LGG. Incorporating clinical characteristics, we constructed a nomogram for LGG, achieving an impressive area under the curve (AUCs) of 0.79, 0.82, and 0.81 at 1, 3, and 5 years in the test dataset, indicating strong potential for clinical application. Functional enrichment analysis between high-risk and low-risk LGG groups revealed significant enrichment of genes involved in the inflammatory response, interferon-gamma response, and epithelial-mesenchymal transition pathways. Combined with CIBERSORT and single-cell RNA sequencing analysis of LGG, our results demonstrated that the interplay between coagulation and the tumor microenvironment, particularly involving gliomas and myeloid cells, significantly influences tumor progression and patient outcomes., (© 2024. The Author(s).)

DNA damage plays a significant role in the tumorigenesis and progression of the disease. Abnormal DNA repair affects the therapy and prognosis of cancer. In this study, it is demonstrated that the deubiquitinase USP25 promotes non-homologous end joining (NHEJ), which in turn contributes to chemoresistance in cancer. It is shown that USP25 deubiquitinates SHLD2 at the K64 site, which enhances its binding with REV7 and promotes NHEJ. Furthermore, USP25 deficiency impairs NHEJ-mediated DNA repair and reduces class switch recombination (CSR) in USP25-deficient mice. USP25 is overexpressed in a subset of colon cancers. Depletion of USP25 sensitizes colon cancer cells to IR, 5-Fu, and cisplatin. TRIM25 is also identified, an E3 ligase, as the enzyme responsible for degrading USP25. Downregulation of TRIM25 leads to an increase in USP25 levels, which in turn induces chemoresistance in colon cancer cells. Finally, a peptide that disrupts the USP25-SHLD2 interaction is successfully identified, impairing NHEJ and increasing sensitivity to chemotherapy in PDX model. Overall, these findings reveal USP25 as a critical effector of SHLD2 in regulating the NHEJ repair pathway and suggest its potential as a therapeutic target for cancer therapy., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Background and Objectives: The Scoliosis Research Society (SRS)-Schwab system does not include a pelvic compensation (PC) subtype, potentially contributing to gaps in clinical characteristics and treatment strategy for deformity correction. It also remains uncertain as to whether PC has differing roles in sagittal balance (SB) or imbalance (SI) status. To compare radiological parameters and SRS-22r domains between patients with failed pelvic compensation (FPC) and successful pelvic compensation (SPC) based on preoperative SB and SI., Methods: A total of 145 adult spinal deformity patients who received deformity correction were analyzed. Radiographic and clinical outcomes were collected for statistical analysis. Patients were classified into 4 groups based on the median value of PT/PI ratio (PTr) and the cutoff value of SB. Patients with low PTr and high PTr were defined as FPC and SPC, respectively. Radiographic and clinical characteristics of different groups were compared., Results: Patients with SPC exhibited significantly greater improvements in lumbar lordosis, pelvic tilt, PTr, and T1 pelvic angle as compared to patients with FPC, irrespective of SB or SI. No apparent differences in any of SRS-22r domains were observed at follow-up when comparing the SB-FPC and SB-SPC patients. However, patients with SI-SPC exhibited significantly better function, self-image, satisfaction, and subtotal domains at follow-up relative to those with SI-FPC. When SI-FPC and SI-SPC patients were subdivided further based on the degree of PI-LL by adjusting for age, the postoperative function and self-image domains were significantly better in the group with overcorrection of PI-LL than undercorrection of PI-LL in SI-FPC patients. However, no differences in these SRS-22r scores were observed when comparing the subgroups in SI-SPC patients., Conclusion: Flexible pelvic rotation is associated with benefits to the correction of sagittal parameters, irrespective of preoperative SB or SI status. However, PC is only significantly associated with clinical outcomes under SI. Patients with SI-FPC exhibit poorer postoperative clinical outcomes, which should be recommended to minimize PI-LL., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.)

A chemotherapy-based mobilization regimen in patients who mobilize poorly, based on etoposide, cytarabine and pegfilgrastim (EAP), has recently been introduced. The aim of this prospective study was to investigate the efficacy and safety of the EAP regimen in patients with poorly mobilizing multiple myeloma (MM) or lymphoma. This single-arm clinical trial was performed at eight public hospitals in China and was registered as a clinical trial (NCT05510089). The inclusion criteria were; (1) diagnosis of MM or lymphoma, (2) defined as a 'poor mobilizer' and (3) aged 18-75 years. The EAP regimen consisted of etoposide 75 mg/m 2 /day on days 1-2, cytarabine 300 mg/m 2 every 12 h on days 1-2 and pegfilgrastim 6 mg on day 6. The primary endpoint of the study was the ratio of patients achieving adequate mobilization (≥2.0 × 10 6 CD34 + cells/kg). From 1 September 2022 to 15 August 2023, a total of 58 patients were enrolled, 53 (91.4%) achieved adequate mobilization, while 41 (70.7%) achieved optimal mobilization with a median number of cumulative collected CD34 + cells was 9.2 (range 2.1-92.7) × 10 6 /kg and the median number of apheresis per patient of 1.2. The median time from administration of the EAP regimen to the first apheresis was 12 days. Approximately 8.6% of patients required plerixa for rescue, which was successful. Twelve (20.7%) of the 58 patients suffered grade 2-3 infections, while 25 (43.1%) required platelet transfusions. The duration of neutrophil and platelet engraftment was 11 days. In conclusion, these results suggest that the EAP mobilization regimen might be a promising option for poorly mobilizing patients with MM or lymphoma., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Purpose: This study aimed to evaluate the cervical sagittal profile after the spontaneous compensation of global sagittal imbalance and analyze the associations between the changes in cervical sagittal alignment and spinopelvic parameters., Methods: In this retrospective radiographic study, we analyzed 90 patients with degenerative lumbar stenosis (DLS) and sagittal imbalance who underwent short lumbar fusion (imbalance group). We used 60 patients with DLS and sagittal balance as the control group (balance group). Patients in the imbalance group were also divided into two groups according to the preoperative PI: low PI group (≤ 50°), high PI group (PI > 50°). We measured the spinal sagittal alignment parameters on the long-cassette standing lateral radiographs of the whole spine. We compared the changes of spinal sagittal parameters between pre-operation and post-operation. We observed the relationships between the changes in cervical profile and spinopelvic parameters., Results: Sagittal vertical axis (SVA) occurred spontaneous compensation (p = 0.000) and significant changes were observed in cervical lordosis (CL) (p = 0.000) and cervical sagittal vertical axis (cSVA) (p = 0.023) after surgery in the imbalance group. However, there were no significant differences in the radiographic parameters from pre-operation to post-operation in the balance group. The variations in CL were correlated with the variations in SVA (R = 0.307, p = 0.041). The variations in cSVA were correlated with the variations in SVA (R=-0.470, p = 0.001)., Conclusion: Cervical sagittal profile would have compensatory changes after short lumbar fusion. The spontaneous decrease in CL would occur in patients with DLS after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. The changes of cervical sagittal profile were related to the extent of the spontaneous compensation of SVA., (© 2024. The Author(s).)

Exciplex systems are promising candidates for thermally activated delayed fluorescence (TADF) molecules because of the small energy difference between the lowest singlet and triplet excited states (ΔE ST ). However, realizing high-efficiency and low-external-quantum-efficiency (EQE) roll-off in solution-processed organic light-emitting diodes (OLEDs) using an exciplex system remains a formidable challenge. In this study, two (HLCT)-type isomers with a spiro skeleton, 2- t BuspoCz-TRZ and 10- t BuspoCz-TRZ, are designed and synthesized as acceptors of exciplexes, where tert-butylspirofluorene indole is regarded as a donor and the triazine unit as an acceptor. Green exciplex emissions are observed for the 2- t BuspoCz-TRZ:TAPC and 10- t BuspoCz-TRZ:TAPC exciplexes, indicating distinct TADF characteristics with a very small ΔE ST of 35 ± 5 meV. By using the TADF exciplex system based on the HLCT acceptor as an emitter, solution-processable OLEDs achieve a maximum external quantum efficiency (EQE max ) of 20.8%. Furthermore, a high EQE max > 25% with a very low-efficiency roll-off (≈3.5% at 1000 cd m -2 ) is obtained for solution-processable phosphorescent devices using HLCT-based exciplexes as the host matrix of phosphors. This study paves the way for a novel strategy for designing acceptor exciplex molecules for effective TADF molecules and host matrices in solution-processable OLEDs., (© 2024 Wiley‐VCH GmbH.)

Achieving both high power conversion efficiency (PCE) and device stability is a major challenge for the practical development of organic solar cells (OSCs). Herein, three non-fully conjugated dimerized giant acceptors (named 2Y-sites, including wing-site-linked 2Y-wing, core-site-linked 2Y-core, and end-site-linked 2Y-end) are developed. They share the similar monomer precursors but have different alkyl-linked sites, offering the fine-tuned molecular absorption, packing, glass transition temperature, and carrier mobility. Among their binary active layers, D18/2Y-wing has better miscibility, leading to optimized morphology and more efficient charge transfer compared to D18/2Y-core and D18/2Y-end. Therefore, the D18/2Y-wing-based OSCs achieve a superior PCE of 17.73 %, attributed to enhanced photocurrent and fill factor. Furthermore, the D18/2Y-wing-based OSCs exhibit a balance of high PCE and improved stability, distinguishing them within the 2Y-sites. Building on the success of 2Y-wing in binary systems, we extend its application to ternary OSCs by pairing it with the near-infrared absorbing D18/BS3TSe-4F host. Thanks to the complementary absorption within 300-970 nm and further optimized morphology, ternary OSCs obtain a higher PCE of 19.13 %, setting a new efficiency benchmark for the dimer-derived OSCs. This approach of alkyl-linked site engineering for constructing dimerized giant acceptors presents a promising pathway to improve both PCE and stability of OSCs., (© 2024 Wiley‐VCH GmbH.)

Achieving both high emission efficiency and exciton utilization efficiency ( η S ) in hot exciton materials is still a formidable task. Herein, a proof-of-concept design for improving η S in hot exciton materials is proposed via elaborate regulation of singlet-triplet energy difference, leading to an additional thermally activated delayed fluorescence (TADF) process. Two novel dendrimers, named D-TTT-H and D-TTT- t Bu, were prepared and characterized, in which diphenylamine derivatives were used as a donor moiety and tri(triazolo)triazine (TTT) as an acceptor fragment. Compounds D-TTT-H and D-TTT- t Bu showed an intense green color with an emission efficiency of approximately 80% in solution. Impressively, both dendrimers simultaneously exhibited a hot exciton process and TADF characteristic in the solid state, as was demonstrated via theoretical calculation, transient photoluminescence, magneto-electroluminescence and transient electroluminescence measurements, thus achieving almost unity η S . A solution processable organic light-emitting diode (OLED) employing the dendrimer as a dopant represents the best performance with the highest luminance of 15090 cd m -2 and a maximum external quantum efficiency (EQE max ) of 11.96%. Moreover, using D-TTT-H as a sensitizer, an EQE max of 30.88%, 24.08% and 14.33% were achieved for green, orange and red solution-processed OLEDs, respectively. This research paves a new avenue to construct a fluorescent molecule with high η S for efficient and stable OLEDs.

Introduction: Fluid resuscitation of patients with sepsis is crucial. This study explored the role of fluid balance in the early resuscitation of sepsis patients in the intensive care unit (ICU)., Material and Methods: A retrospective study of patients with sepsis using the Peking Union Medical College Hospital Intensive Care Medical Information System and Database from January 2014 to June 2020 was performed. Based on the survival status on day 28, the training cohort was divided into an alive group ( n = 1,803) and a deceased group ( n = 429). Univariate and multivariate analyses were used to identify risk factors, and the integrated learning XGBoost algorithm was used to construct a model for predicting outcomes. ROC and Kaplan-Meier survival curves were used to evaluate the effectiveness of the model. A verification cohort ( n = 433) was used to verify the model., Results: Univariate analysis showed that fluid balance is an important covariate. Based on the scatterplot distribution, a significant difference in mortality was determined between groups stratified with a balance of 1000 ml. There were associations in the multivariate analysis between poor outcomes and sex, PO 2 /FiO 2 , serum creatinine, FiO 2 , platelets, respiratory rate, SPO 2 , temperature, and total fluid volume (1000 ml). Among these variables, total fluid balance (1000 ml) had an OR of 1.98 (CI: 1.41-2.77, p < 0.001). Therefore, the model was built with these nine factors using XGBoost. Cross validation was used to verify generalizability. This model performed better than the SOFA and APACHE II models. The result was well verified in the verification cohort. A causal forest model suggested that patients with hypoxemia may suffer from positive fluid balance., Conclusions: Sepsis fluid resuscitation in the ICU should be a targeted and goal-oriented treatment. A new prognostic prediction model was constructed and indicated that a 6-hour positive fluid balance after ICU initial admission is a risk factor for poor outcomes in sepsis patients. A 6-hour fluid balance above 1000 ml should be performed with caution., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia & Banach.)

Chiral bipolar hosts of ( R / S )-L-2mCPCN are synthesized, which show high singlet/triplet energy levels and clear circularly polarized luminescence. Employing racemic phosphorescent and TADF materials as emitting guest molecules, solution-processable CP-OLEDs based on such chiral hosts are obtained with an EQE max of 10.7% and | g EL | values of 5.0 × 10 -3 .

It has been reported that the length of branched alkyl side chains on fused-ring electron acceptors confers different impacts on properties versus solubility of BJH blends. However, because this impact on a non-fused acceptor backbone has rarely been studied, we examined the impact of molecular optimization from alkyl chain tuning based on non-fused thiazolothiazole small-molecule acceptors. The length of the side chain on the thiophene bridge was modified from 2-butyloctyl to 2-ethylhexyl, which corresponds to small molecules TTz3(C4C6) and TTz3(C2C4), respectively. Compared with the reported TTz3(C6C8) with long alkyl side chains, TTz3(C4C6) and TTz3(C2C4) exhibited stronger molecular aggregation, higher absorption coefficients, and greater redshifted UV absorption. Unexpectedly, after the alkyl chain was slightly shortened in this type of acceptor system, devices were successfully fabricated, but it was necessary to reduce the blending concentration at low rotation speeds due to the sharp decrease in the solubility of corresponding acceptor materials. Thus, the obtained unfavorable thickness and morphology of the active layer caused a decrease in J sc and FF. As a consequence, TTz3(C4C6)- and TTz3(C2C4)-based devices showed an unsatisfactory power conversion efficiency of 6.02% and 2.71%, respectively, when donors were paired with the wide bandgap donor J71, which is inferior to that of TTz3(C6C8)-based devices (8.76%). These results indicate that it is challenging to determine the limit of the adjustable range of side chains to modify non-fused thiazolothiazole small-molecule acceptors for high-performance non-fullerene solar cells., Competing Interests: The authors declare no conflicts of interest., (This journal is © The Royal Society of Chemistry.)

Achieving a high emission efficiency and a large luminescence asymmetry factor ( g lum ) in a single molecule exhibiting circularly polarised thermally activated delayed fluorescence (CP-TADF) remains a formidable challenge. In this work, a proof-of-concept, liquid-crystalline CP-TADF molecule is proposed to realise high g lum by taking advantage of the order inherent in liquid crystals. Employing a chiral dinaphthol-based CP-TADF molecule as the emissive unit, a pair of liquid-crystalline CP-TADF molecules (R/S-4) is synthesised via the introduction of six mesogenic moieties. The enantiomers show intense emission at about 520 nm which has clear TADF and liquid-crystalline characteristics. Both enantiomers display symmetrical electronic circular dichroism (CD) and circular polarisation luminescence (CPL) signals as thin films. Impressively, relatively large g lum values of 0.11 are realised for the films. Solution-processed devices were fabricated using R/S-4 as the dopants, with the TADF molecule CzAcSF as the sensitiser. The OLEDs so prepared show a very high maximum external quantum efficiency of 21.2%, revealing a novel strategy for realising large g lum values in CP-TADF.

Chiral liquid-crystalline emitters based on 9,9-dimethyl-10-(4-(phenylsulfonyl)phenyl)-9,10-dihydroacridine and a functionalised binaphthol show smectic liquid crystal phases and circularly polarised blue fluorescence with a high luminescence dissymmetry factor | g lum | of 0.13. Solution-processable organic light-emitting diodes (OLEDs) based on the enantiomers were explored.

Objective: To retrospectively investigate the postoperative clinical and radiographic outcomes in elderly patients with degenerative lumbar spinal stenosis (DLSS) and severe global sagittal imbalance who underwent different fusion levels., Methods: A total of 214 patients with DLSS and severe global sagittal imbalance were included. Sagittal imbalance syndrome was defined as the severe decompensated radiographic global sagittal imbalance accompanied with the following symptoms: severe back pain in naturel posture that disappears or significantly relieves in support position, living disability with ODI score > 40% and dynamic sagittal imbalance. Thereinto, 54 patients were found with sagittal imbalance syndrome and were performed the lumbar decompression with a long thoracolumbar fusion (Group A) or a short lumbar fusion (Group B). Thirty patients without sagittal imbalance syndrome who underwent short lumbar decompression and fusion were selected as the control (Group C)., Results: Patients with sagittal imbalance syndrome were detected to have more paraspinal muscle degeneration and less compensatory potentials for sagittal imbalance (smaller thoracic kyphosis and larger pelvic tilt) than those without this diagnosis. Postoperative comparisons revealed significant restoration of global sagittal alignment and balance and improvement of living quality in Groups A and C at the final follow-up. Six patients in Group B and one in Group A were found to have proximal junctional complication during follow-up., Conclusion: Our results indicated that DLSS patients with sagittal imbalance syndrome had inferior surgical outcomes in terms of living quality and proximal junctional complication after lumbar decompression with a short fusion., (© 2024. The Author(s).)

The moderate charge-transporting capability together with higher-lying energetic levels of self-assembling hole-transporting materials (SAMs) constrain the productive carrier extraction dynamics. To alleviate this issue, a synergetic chlorination and extended conjugation strategy is applied to explore a novel HTL, named 2Cl-TPA-CN-COOH. Indeed, the chlorinated head backbone would deepen the energetic level and strengthen the intramolecular push-pull effect, whereas the elongated conjugation unit would boost the carrier-transporting potential. Consequently, a champion power conversion efficiency (PCE) of 18.6% with upgraded stability is obtained in a 2Cl-TPA-CN-COOH cell. These results demonstrate a new insight of the molecular configuration of SAMs, which would contribute to the enhancements of performance and reliability in the OSC field.

The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possible. Considering the need of standardization of application of big data in intensive care, Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society, Standard Committee has convened expert group, secretary group and the external audit expert group to formulate Chinese Experts' Consensus on the Application of Intensive Care Big Data (2022). This consensus makes 29 recommendations on the following five parts: Concept of intensive care big data, Important scientific issues, Standards and principles of database, Methodology in solving big data problems, Clinical application and safety consideration of intensive care big data. The consensus group believes this consensus is the starting step of application big data in the field of intensive care. More explorations and big data based retrospective research should be carried out in order to enhance safety and reliability of big data based models of critical care field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Su, Liu, Long, Chen, Chen, Chen, Chen, Cheng, Cui, Ding, Ding, Duan, Gao, Gu, He, He, Hu, Hu, Huang, Huang, Jiang, Jiang, Lan, Li, Li, Li, Li, Li, Lin, Luo, Lyu, Mao, Miao, Shang, Shang, Shang, Shen, Shi, Sun, Sun, Tang, Wang, Wang, Wang, Wang, Wang, Wang, Wang, Wang, Wei, Wu, Wu, Xing, Yang, Yang, Yu, Yu, Yu, Yuan, Zhai, Zhang, Zhang, Zhang, Zhang, Zhao, Zheng, Zhong, Zhou, Zhu, on behalf of Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society and Standard Committee and Chinese Writing Panel’s Consensus on the Application of Intensive Care Big Data.)

Patients with hematologic malignancies are often immunodeficient and therefore have a higher risk of severe symptoms from coronavirus disease 2019 (COVID-19). We retrospectively examined a cohort of 289 patients from 16 hospitals in Zhejiang Province who had hematologic malignancies and COVID-19 during a period when the Omicron variant was predominant. Univariate analysis showed that some clinical characteristics, including elder age ( P  = 0.014), multiple comorbid conditions ( P  = 0.011), and receipt of active antineoplastic therapy ( P  = 0.018) were associated with an increased risk of severe COVID-19. Patients with severe/critical COVID-19 had significantly lower levels of lymphocytes and serum albumin, and significantly higher levels of D-dimer, lactate dehydrogenase, C-reactive protein, and interleukin-6 (all P  < 0.05). Fifty-four patients (18.7%) had symptoms lasting ≥3 weeks, suggesting that persistent long-term COVID-19 infection is likely present in a significant proportion of patients. Receipt of the inactivated vaccine was unrelated to disease severity ( P  = 0.143), which indicated that many patients with hematologic malignancies may not have effective humoral immunity to inactivated vaccines.

Ternary polymer solar cells(PSCs) have been identified as an effective approach to improving power conversion efficiency (PCE) of binary PSCs. However, most of the third component, especially Y-series non-fullerene acceptors, is a fused ring acceptor which often requires a rather tedious synthesis and the use of hazardous organostannane reagents. In this work, two nonfused ring acceptors IOEH-4F and IOEH-N2F are synthesized by a green synthetic route and incorporated into PM6:Y6 blend. Encouragingly, the IOEH-4F and IOEH-N2F-based ternary PSCs exhibited more efficient charge transfer, exciton separation, and lower energy loss than PM6:Y6-based PSCs. And the IOEH-4F and IOEH-N2F-based ternary PSCs achieved an impressive PCE of 17.80% and 18.13%, respectively, which are higher than that of PM6:Y6 based PSCs (16.18%). Notably, these PCE values are also the highest PCEs for ternary PSCs including non-fused ring acceptors. Importantly, even when the IOEH-N2F:Y6 ratios increased from 0.05:1.2 to 0.50:1.2, the PCE of IOEH-N2F-based ternary PSCs (16.70%) are still higher than that of PM6:Y6 based PSCs, indicating the great potential for cost saving. It is believed that the findings will help the design of better nonfused ring acceptors and the optimization of corresponding ternary PSCs with cost-saving advantage., (© 2023 Wiley-VCH GmbH.)

Azaacenes have attracted wide research interest due to their tremendous potential in organic electronics. However, near-infrared (NIR) light-emitting iridium(III) phosphors bearing azaacene derivatives are rarely investigated. In this contribution, two solution-processable heteroleptic iridium(III) complexes, namely DBPzIr and PPzIr, are rationally designed and synthesized, and they contain a rigid phenanthrene- or pyrene-fused diazaacene core and two peripheral groups of 4- tert -butyl-phenyl attached at the 12,13-positions in the core, respectively. The effects of the diazaacene core and appending groups on the optoelectronic properties of both complexes are systematically investigated. A dramatically red-shifted NIR emission peak at 789 nm with a photoluminescence quantum yield (PLQY) of 14% is observed in PPzIr compared with the 746 nm emission with a PLQY of 40% in DBPzIr. Taking advantage of their photophysical properties, the solution-processed device doped with DBPzIr achieves a maximum external quantum efficiency (EQE max ) of 8.00% with a radiance of 54 866 mW Sr -1 m -2 at 716 nm and the device doped with PPzIr exhibits a significantly red-shifted emission at 772 nm with an EQE max of 3.53%. The achieved device performance is among the best values in the reported NIR-OLEDs based on iridium(III) complexes via a solution process at the same color gamut. Our study indicates that the reasonable collocation of the rigid diazaacene chelating core and flexible peripheral groups in the iridium(III) complex is of great significance in designing highly efficient NIR emitters.

Power-conversion-efficiencies (PCEs) of organic solar cells (OSCs) in laboratory, normally processed by spin-coating technology with toxic halogenated solvents, have reached over 19%. However, there is usually a marked PCE drop when the blade-coating and/or green-solvents toward large-scale printing are used instead, which hampers the practical development of OSCs. Here, a new series of N-alkyl-tailored small molecule acceptors named YR-SeNF with a same molecular main backbone are developed by combining selenium-fused central-core and naphthalene-fused end-group. Thanks to the N-alkyl engineering, NIR-absorbing YR-SeNF series show different crystallinity, packing patterns, and miscibility with polymeric donor. The studies exhibit that the molecular packing, crystallinity, and vertical distribution of active layer morphologies are well optimized by introducing newly designed guest acceptor associated with tailored N-alkyl chains, providing the improved charge transfer dynamics and stability for the PM6:L8-BO:YR-SeNF-based OSCs. As a result, a record-high PCE approaching 19% is achieved in the blade-coating OSCs fabricated from a green-solvent o-xylene with high-boiling point. Notably, ternary OSCs offer robust operating stability under maximum-power-point tracking and well-keep > 80% of the initial PCEs for even over 400 h. Our alkyl-tailored guest acceptor strategy provides a unique approach to develop green-solvent and blade-coating processed high-efficiency and operating stable OSCs, which paves a way for industrial development., (© 2023. The Author(s).)

Background: With the global spread of COVID-19, detecting high-risk countries/regions timely and dynamically is essential; therefore, we sought to develop automatic, quantitative and scalable analysis methods to observe and estimate COVID-19 spread worldwide and further generate reliable and timely decision-making support for public health management using a comprehensive modeling method based on multiple mathematical models., Methods: We collected global COVID-19 epidemic data reported from January 23 to September 30, 2020, to observe and estimate its possible spread trends. Countries were divided into three outbreak levels: high, middle, and low. Trends analysis was performed by calculating the growth rate, and then country grouping was implemented using group-based trajectory modeling on the three levels. Individual countries from each group were also chosen to further disclose the outbreak situations using two predicting models: the logistic growth model and the SEIR model., Results: All 187 observed countries' trajectory subgroups were identified using two grouping strategies: with and without population consideration. By measuring epidemic trends and predicting the epidemic size and peak of individual countries, our study found that the logistic growth model generally estimated a smaller epidemic size than the SEIR model. According to SEIR modeling, confirmed cases in each country would take an average of 9-12 months to reach the outbreak peak from the day the first case occurred. Additionally, the average number of cases at the peak time will reach approximately 10-20% of the countries' populations, and the countries with high trends and a high predicted size must pay special attention and implement public health interventions in a timely manner., Conclusions: We demonstrated comprehensive observations and predictions of the COVID-19 outbreak in 187 countries using a comprehensive modeling method. The methods proposed in this study can measure COVID-19 development from multiple perspectives and are generalizable to other epidemic diseases. Furthermore, the methods also provide reliable and timely decision-making support for public health management., (© 2023. The Author(s).)

Adding another constituent into a binary system, known as a ternary strategy, represents a simple and effective approach to boosting the power conversion efficiency (PCE) of organic solar cells (OSCs). Herein, we have prepared a new nonfused ring small-molecule acceptor with a medium bandgap, named DFTQA-2FIC, which possesses a high-lying lowest unoccupied molecular orbital energy level and a strong intramolecular charge-transfer effect. We elaborately utilized it as a third component in a typical PM6:Y6 blend to obtain high-performance ternary OSCs. The resulting ternary blend film exhibited superior and balanced hole/electron mobility, enhanced favorable aggregation morphology, and reduced charge carrier recombination. Consequently, an optimized ternary OSC presented a distinctly increased PCE of 17.29%, accompanied by synchronous enhancements in crucial parameters, representing a 7.46% improvement over the binary OSC based on PM6:Y6 with a PCE of 16.09%. This study highlights that incorporating DFTQA-2FIC as a third component in a binary system is suitable for optimizing photovoltaic performance.

To reducing chemotherapy-related toxicity, the chemo-free regimens become a new trend of Ph + ALL treatment. Therefore, we conducted a phase 2 trial of dasatinib plus prednisone, as induction (Course I) and early consolidation (Courses II and III) treating newly diagnosed Ph + ALL. The trial was registered at www.chictr.org.cn, ChiCTR2000038053. Forty-one patients were enrolled from 15 hospitals. The complete remission (CR) was 95% (39/41), including two elderly induction deaths. By the end of Course III, 25.6% (10/39) of patients achieved a complete molecular response. With a median follow-up of 15.4 months, 2-year disease-free survival (DFS) were 100% and 33% for patients who receiving haematopoietic stem cell transplantation (HSCT) at CR1 and receiving chemotherapy alone respectively. When censored at time of HSCT, 2-year DFS were 51% and 45% for young and elderly patients (p = 0.987). 2-year overall survival were 45%, 86% and 100% for patients without HSCT, receiving HSCT after relapse and receiving HSCT at CR1 respectively. A total of 12 patients had marrow recurrences and one had CNS relapse, with 38% occurred early (between Courses I and III). IKZF1 gene deletion was shown to be associated with relapse (p = 0.019). This chemo-free induction and early consolidation regimen was efficacious and well-tolerated in de novo Ph + ALL. Allogeneic HSCT conferred definite survival advantage after chemo-free induction., (© 2023 British Society for Haematology and John Wiley & Sons Ltd.)

Study Design: A retrospective radiologic study., Objectives: To identify age-associated changes in T1 slope (T1S) and C7 slope (C7S), as well as the difference between T1S and C7S (△, which was defined as T1S minus C7S) and to explore the cervical morphology that C7S can be the most accurate alternative for the invisible T1S., Methods: 625 asymptomatic Chinese volunteers received cervical lateral radiographs from August 2021 to May 2022. Occipito-C2 angle (O-C2), C2-7 angle (C2-7), cranial arch, caudal arch, C7S, and T1S were examined. Thereafter, the △ was established. The correlations among T1S, C7S, △ and other cervical sagittal parameters, and between age and other cervical sagittal parameters were evaluated with the Pearson correlation coefficient analysis. Then, analysis of variance (ANOVA) was conducted to compare variations in cervical sagittal parameters among volunteers aged 40 to 59 years, 60 to 64 years, 65 to 69 years, 70 to 74 years, and ≥75 years of age, and among volunteers with 1 lordotic morphology, 2 lordotic morphology, straight morphology, kyphotic morphology, 1 sigmoid morphology, and 2 sigmoid morphology. Linear regression modeling of the correlation between C7S and T1S in various cervical alignment patterns was then established., Results: △ had the strongest correlation with caudal arch ( r = .646), and weakest correlation with cranial arch ( r = -.082). Age was significantly correlated with T1S ( r = .250), C7S ( r = .244), and △ ( r = .112). Among them, △ was stable until 74 years after which it showed an elevation from 3.3° in the group 70-74 years to 4.1° in the group over 75 years. Moreover, there was marked variation between T1S and C7S at 1 lordotic, 2 lordotic, straight and 2 sigmoid alignment patterns, but no difference was seen between T1S and C7S at kyphotic and 1 sigmoid alignment patterns., Conclusions: There was a progressive increase in T1S, C7S, and △ with age. Linear regression equations for accurate prediction of T1S were developed based on the C7S in 1 lordotic, 2 lordotic, straight and 2 sigmoid alignment patterns. C7S may be a reliable proxy for T1S in kyphotic and 1 sigmoid alignment patterns., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Near-infrared (NIR) organic light-emitting diodes (OLEDs) suffer from the low external electroluminescence (EL) quantum efficiency (EQE), which is a critical obstacle for potential applications. Herein, 1-oxo-1-phenalene-2,3-dicarbonitrile (OPDC) is employed as an electron-withdrawing aromatic ring, and by incorporating with triphenylamine (TPA) and biphenylphenylamine (BBPA) donors, two novel NIR emitters with thermally activated delayed fluorescence (TADF) characteristics, namely OPDC-DTPA and OPDC-DBBPA, are first developed and compared in parallel. Intense NIR emission peaks at 962 and 1003 nm are observed in their pure films, respectively. Contributed by the local excited (LE) characteristics in the triplet (T 1 ) state in synergy with the charge transfer (CT) characteristics for the singlet (S 1 ) state to activate TADF emission, the solution processable doped NIR OLEDs based on OPDC-DTPA and OPDC-DBBPA yield EL peaks at 834 and 906 nm, accompanied with maximum EQEs of 0.457 and 0.103 %, respectively, representing the state-of-the-art EL performances in the TADF emitter-based NIR-OLEDs in the similar EL emission regions so far. This work manifests a simple and effective strategy for the development of NIR TADF emitters with long wavelength and efficiency synchronously., (© 2023 Wiley-VCH GmbH.)

Background: Immunoglobulin A nephropathy (IgAN) and idiopathic membranous nephropathy (IMN) are the most common glomerular diseases. Immunofluorescence (IF) tests of renal tissues are crucial for the diagnosis. We developed a multiple convolutional neural network (CNN)-facilitated diagnostic program to assist the IF diagnosis of IgAN and IMN., Methods: The diagnostic program consisted of four parts: a CNN trained as a glomeruli detection module, an IF intensity comparator, dual-CNN (D-CNN) trained as a deposition appearance and location classifier and a post-processing module. A total of 1573 glomerular IF images from 1009 patients with glomerular diseases were used for the training and validation of the diagnostic program. A total of 1610 images of 426 patients from different hospitals were used as test datasets. The performance of the diagnostic program was compared with nephropathologists., Results: In >90% of the tested images, the glomerulus location module achieved an intersection over union >0.8. The accuracy of the D-CNN in recognizing irregular granular mesangial deposition and fine granular deposition along the glomerular basement membrane was 96.1% and 93.3%, respectively. As for the diagnostic program, the accuracy, sensitivity and specificity of diagnosing suspected IgAN were 97.6%, 94.4% and 96.0%, respectively. The accuracy, sensitivity and specificity of diagnosing suspected IMN were 91.7%, 88.9% and 95.8%, respectively. The corresponding areas under the curve (AUCs) were 0.983 and 0.935. When tested with images from the outside hospital, the diagnostic program showed stable performance. The AUCs for diagnosing suspected IgAN and IMN were 0.972 and 0.948, respectively. Compared with inexperienced nephropathologists, the program showed better performance., Conclusion: The proposed diagnostic program could assist the IF diagnosis of IgAN and IMN., Competing Interests: The authors have declared no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

Purpose: To investigate the pelvic incidence (PI)- and age-related cervical alignment changes of Chinese healthy population., Methods: Six hundred and twenty-five asymptomatic adult subjects, who underwent the standing whole spinal radiograph, were recruited in this work. The sagittal parameters were measured, including Occipito-C2 angle (O-C2), C2-7 angle (C2-7), cranial arch, caudal arch, T1-slope (T1S), C2-7 sagittal vertical axis (C2-7 SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), PI, and sagittal vertical axis (SVA). All subjects were stratified into 5 age groups, namely 40-59 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and above, with each age group further divided into 2 subgroups based on PI (deeming PI < 50° as low PI, and PI ≥ 50° as high PI). The correlations between PI or age, and other sagittal parameters were assessed. The age-related changes of sagittal parameters in each PI subgroup were also assessed, followed by one-way analysis of variance analysis for change comparison between age groups., Results: The average cervical sagittal parameters were as below: 18.2 ± 6.8° for O-C2, 10.4 ± 10.2° for C2-7, 3.9 ± 7.5° for cranial arch, 6.5 ± 7.1° for caudal arch, 23.6 ± 7.3° for T1S, and 21.0 ± 9.7 mm for C2-7 SVA. There was no obvious difference observed between PI and cervical sagittal parameters, excepting for caudal arch. While, C2-7, cranial arch, caudal arch, T1S, and C2-7 SVA increased remarkably with the age. Thereof, C2-7 exhibited great increases at the age of 60-64 years and 70-74 years, respectively, cranial arch increased notably at 60-64 years of age, and caudal arch developed obviously at 70-74 years of age, regardless of PI., Conclusion: This study showed the PI- and age-related cervical alignment changes of Chinese healthy population. Based on the classification in our study, high or low PI apparently did not correlate with the occurrence of cervical degenerative disease., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Kimura's disease is a rare chronic inflammatory disorder characterized with subcutaneous masses, lymphadenopathy, and peripheral eosinophilia. So far, the disease pathogenesis remains hardly known. Here, we perform bulk-RNA sequencing and reveal a higher expression of transmembrane 176A (TMEM176A) with over-activated extracellular-signal-regulate kinase/mitogen-activated protein kinases (Erk/MAPK) signaling pathway in eosinophils of Kimura's disease compared with healthy controls. Flow cytometry analysis shows that the composition of lymphocytes, monocytes, and dendritic cell subsets are similar between Kimura's disease and healthy controls, which is further validated by scRNA-seq. Loss of S100 calcium binding protein P (S100P) is found in the CD24 + myeloid subset of Kimura's disease. In vitro functional assays show that S100P may participate in promoting reactive oxygen species (ROS) production in myeloid cells. Taken together, we are the first to study the immune pathogenesis systematically and demonstrate that Erk/MAPK signaling pathway might be a potential therapeutic target for Kimura's disease., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Study Design: A retrospective case-control study., Objective: To evaluate the behavior of pelvic incidence (PI) after different posterior spinal procedures in elderly patients with adult spinal deformity (ASD), to determine the potential associated factors with the variability in PI after spinal surgery and to comprehensively analyze its mechanisms., Methods: Elderly patients underwent long fusion to sacrum with and without pelvic fixation were assigned to Group L+P and Group L-P, respectively. In Group L-P, those with severe sagittal deformity were selected as Group A. 20 elderly patients with severe sagittal deformity underwent short lumbar fusion were included as Group B. The following radiographic parameters were evaluated: thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), PI-LL, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and pelvic parameters. PI changing more than 5° (△PI > 5°) was considered as substantially changed., Results: For the whole cohort and in Group L+P, PI were not substantially changed (△PI ≤ 5°) after surgery. Besides the severer sagittal malalignment in patients with △PI > 5° in Group L-P, relatively larger mean age, greater proportion of female and lower preoperative PI were found than those in patients with △PI ≤ 5°. 70.8% of patients had substantial increase of PI in Group A, while only 10% of patients had in Group B ( P < 0.001)., Conclusion: PI behaves differently under different conditions in elderly ASD patients. Besides severe sagittal deformity, aging, female and low preoperative PI are also the potential risk factors of PI increasing after long fusion to sacrum.

Two kinds of chiral hosts, named ( R / S )-BN-mCP and ( R / S )-BN-2mCP, are prepared. Solution processable circularly polarized organic light-emitting diodes (CP-OLEDs) based on the chiral hosts and achiral emitter Ir(mypp) 3 present the maximum external quantum efficiency (EQE max ) and dissymmetry factor values ( g EL ) of 12.7%/-1.7 × 10 -3 and 17.1%/-1.3 × 10 -3 , respectively. Using ( R )-BN-2mCP as the chiral host and Ir(mypp) 3 and Ir(piq) 2 (acac) as the achiral emitters, the solution-processed OLED exhibits a broad emission spectrum with the EQE max of 12.1% and g EL of -1.1 × 10 -3 .

Background: Surgical treatment of severe thoracolumbar kyphosis (TLK) secondary to late osteoporotic vertebral compression fracture (OVCF) presents several challenges to spine surgeons. Proper selection of distal fusion level is an important issue in surgical planning to decrease the likelihood of distal mechanical complications. This study was designed to compare the clinical and radiographic outcomes in elderly patients suffering from severe TLK related with late OVCF between different distal fusion strategies and to recommend a superior distal fusion level for these patients., Methods: A total of 57 consecutive subjects with a minimum follow-up of two years were retrospectively reviewed. TLK was defined as the hyperkyphosis with an apex below T10. Severe TLK was defined as the Cobb angle of kyphosis ≥60°. Patients fused to sagittal stable vertebra (SSV) were assigned to Group SSV, while those fused to the vertebra above and below SSV were assigned to Groups SSV- and SSV+, respectively. Bone cement was used to enhance pedicle screw fixation. Clinical and radiographic results were collected and compared between different groups., Results: Deformity corrections and living quality improvements at the latest follow-up were superior in Group SSV than Group SSV- with shorter fusion levels, while to the equal extent with Group SSV+ with longer fusion levels. 7 cases of distal complications were observed in Group SSV-. Negatively balanced lowest instrumented vertebra was revealed to be the independent factor predicting distal complications. Patients' satisfaction of their surgical management was greater in Group SSV than Group SSV- (83.2 ± 4.4% vs. 70.5 ± 10.9%, P = 0.024), while comparable with Groups SSV + SSV+ (84.8 ± 5.7%)., Conclusions: Fusion to SSV with cement-augmented pedicle screws could limit the development of distal junctional mechanical complications after surgical treatment for severe TLK secondary to late OVCF in elderly patients, while achieves satisfactory deformity correction with the preservation of necessary lumbar motility., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare. This study was performed under the approval from the Ethics Committee of our hospital., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Multiple causes may contribute to osteoporosis, characterized by a loss in bone mass and density as a consequence of the degradation of bone microstructure and a resultant rise in bone fragility. Recently, increasing attention has been paid to the role of necroptosis in the development of osteoporosis. Necroptosis is orchestrated by a set of proteins known as receptor-interacting protein kinase (RIPK)1, RIPK3, and mixed lineage kinase domain-like protein (MLKL). A necrosome is formed by MLKL, RIPK1, RIPK3, and RIPK3-RIPK3. A dissociated MLKL forms pores in the plasma membrane and eventually leads to necroptosis after translocating from the necrosome. In this review, we discuss a detailed understanding of necroptosis and its associated processes, a better understanding of its interactions with osteoclasts, osteoblasts, and osteocytes, and the associations between necroptosis and diabetic osteoporosis, steroid-induced osteoporosis, and postmenopausal osteoporosis. In addition, a variety of experimental medicines capable of modulating crucial necroptosis processes are highlighted. It's important to note that this is the first review paper to consolidate current data on the role of necroptosis in osteoporosis, and it offers fresh hope for the future treatment of this disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hu, Wang, Kong, Wang, Zhu, Wang, Li, Wang and Lu.)

Lower back pain (LBP) is the primary reason leading to dyskinesia in patients, which can be experienced by people of all ages. Increasing evidence have revealed that paraspinal muscle (PSM) degeneration (PSMD) is a causative contributor to LBP. Current research revealed that fatty infiltration, tissue fibrosis, and muscle atrophy are the characteristic pathological alterations of PSMD, and muscle atrophy is associated with abnormally elevated oxidative stress, reactive oxygen species (ROS) and inflammation. Interestingly, microgravity can induce PSMD and LBP. However, studies on the molecular mechanism of microgravity in the induction of PSMD are strongly limited. This study identified 23 differentially expressed genes (DEGs) in the PSM (longissimus dorsi) of mice which were flown aboard the Bion M1 biosatellite in microgravity by bioinformatics analysis. Then, we performed protein-protein interaction, Gene Ontology function, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis for the DEGs. We found that Il6ra, Tnfaip2, Myo5a, Sesn1, Lcn2, Lrg1, and Pik3r1 were inflammatory genes; Fbox32, Cdkn1a, Sesn1, and Mafb were associated with muscle atrophy; Cdkn1a, Sesn1, Lcn2, and Net1 were associated with ROS; and Sesn1 and Net1 were linked to oxidative stress. Furthermore, Lcn2, Fbxo32, Cdkn1a, Pik3r1, Sesn1, Net1, Il6ra, Myo5a, Lrg1, and Pfkfb3 were remarkably upregulated, whereas Tnfaip2 and Mafb were remarkably downregulated in PSMD, suggesting that they might play a significant role in regulating the occurrence and development of PSMD. These findings provide theoretical basis and therapeutic targets for the treatment of PSMD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Kong, Wang, Sun, Chen, Zhu, Ding and Lu.)

To detect the methylation status of the cell fate determinant (DACH1) gene in esophageal cancer tissues and to explore the predictive value of methylation of DACH1 on the sensitivity to radiotherapy for esophageal cancer. Cancer tissues, corresponding paracancerous tissues, and 30 specimens of normal esophageal mucosal tissues from 70 patients admitted to the hospital after radical esophageal cancer radiotherapy from January 2016 to April 2017 were collected. The methylation status of DACH1 was detected by a methylation-specific polymerase chain reaction (MSP). The 70 esophageal cancer patients were divided into radiotherapy-sensitive and radiotherapy-insensitive groups according to the efficacy of radiotherapy, and the methylation status of DACH1 was compared between the two groups. The χ 2 test was used to analyze the relationship between the methylation status of DACH1 and the clinicopathological characteristics of esophageal cancer patients. The Kaplan-Meier survival curve was used to analyze the relationship between the methylation status of DACH1 and radiotherapy sensitivity and survival of esophageal cancer patients, and the Cox proportional risk model was used to analyze the independent influencing factors affecting the radiotherapy sensitivity of esophageal cancer patients. The methylation rate of DACH1 in esophageal cancer tissues was higher than that in paracancerous tissues and normal tissues, and the differences were statistically significant ( P < 0.05). 70 patients with esophageal cancer completed radiotherapy, including 46 patients with radiotherapy sensitivity and 24 patients with radiotherapy insensitivity. The DACH1 methylation rate of esophageal cancer patients in the radiotherapy-sensitive group was lower than that in the radiotherapy-insensitive group, and the difference was statistically significant ( P < 0.05). The DACH1 methylation rate of esophageal cancer patients with TNM stage (III-IV), tumor differentiation degree (hypofractionation), and lymph node metastasis was higher, and the difference was statistically significant ( P < 0.05). The Kaplan-Meier curve showed that the median survival time of patients with DACH1 methylation before radiotherapy was 23 months, which was shorter than that of patients with DACH1 unmethylation before radiotherapy (36 months), and the difference between the survival curves of the two groups was statistically significant ( χ 2  = 7.425, P < 0.05); the median survival time of patients in the radiotherapy-sensitive group was 39 months, which was longer than that of patients in the radiotherapy-insensitive group (25 months), and the difference between the two groups was statistically significant ( P < 0.05). The median survival time of patients in the radiotherapy-sensitive group was 39 months, which was longer than that of patients in the radiotherapy-insensitive group (25 months), and the difference in survival curves between the two groups was statistically significant ( χ 2  = 7.011, P < 0.05). The results of the multifactorial Cox regression model showed that TNM stage (stage III-IV) (HR = 1.961, 95% CI: 1.125-2.768), tumor hypofractionation (HR = 1.453, 95% CI: 1.034-2.857), presence of lymph node metastasis (HR = 1.499, 95% CI: 1.025-2.851), and DACH1 methylation (HR = 1.718, 95% CI: 1.067-2.596) may increase the risk of insensitivity to radiotherapy in patients with esophageal cancer ( P < 0.05). The rate of DACH1 methylation in esophageal cancer tissues was increased, and the methylation status of DACH1 was related to radiotherapy sensitivity and survival of esophageal cancer patients, which is expected to be a new target for diagnosis and treatment of esophageal cancer patients., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 Jing Huang et al.)

Background: Anlotinib is a novel multitarget tyrosine kinase inhibitor for tumor angiogenesis and has antitumor activity in a variety of solid tumors. Given that, our study was designed to unearth the mechanism of anlotinib in radioresistant esophageal cancer (EC) cells., Methods: Radioresistant EC cell lines TE-1R and KYSE-150R were established by multiple fractionated irradiation. Detection of cell proliferation was governed by the MTT assay, angiogenesis by the tube formation assay, and cell migration and invasion by the transwell assay. Lastly, RT-qPCR Western blotting was employed to detect the expression of related genes. Cancerous cells showing tumor growth were then detected by tumor xenografts in mice., Results: Radioresistant EC cell lines TE-1R and KYSE-150R were successfully established. Anlotinib downregulated EphA2 inhibited proliferation, angiogenesis, migration, and invasion of radioresistant EC cells in vitro . The up-regulated expression of EphA2 in both EC cell lines and radioresistant EC cells, along with anlotinib, in turn, inhibited the expression of EphA2 in radioresistant EC cells. Inhibiting EphA2 also enhanced anlotinib-mediated effects on radioresistant EC cells, so as to restrain cell proliferation, angiogenesis, migration, and invasion. Correspondingly, overexpression of EphA2 is capable of reversing the therapeutic effect of anlotinib on radioresistant EC cells. Also, anlotinib enhances the inhibitory effect of irradiation on mice., Conclusion: It is concluded that anlotinib inhibits EphA2 expression, thereby suppressing angiogenesis and resensitizing EC cells to radiotherapy, providing another perspective to overcome radioresistance in EC., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Zhenlin Gu et al.)

Objective: We sought to investigate the risk factors of suboptimal postoperative outcomes after short-segment surgery for degenerative lumbar spinal stenosis and severe sagittal imbalance and to recommend the appropriate candidates for the short fusion., Methods: A total of 101 elderly subjects who underwent short-segment surgery were included. Preoperative sagittal vertical axis decreased to ≤50 mm was determined as sagittal compensation; otherwise, it was determined as sagittal decompensation. At the latest follow-up, 64 patients with sagittal decompensation and 14 patients with proximal junctional kyphosis (PJK) were detected. Sagittal imbalance with the related symptoms was named as symptomatic sagittal imbalance. Preoperative clinical data and spinopelvic parameters were collected and compared between different groups., Results: Symptomatic sagittal imbalance and severe degeneration of paravertebral muscle were revealed to be the risk factors for sagittal decompensation and PJK. More sagittal decompensations (100%) and PJKs (60%) were observed in patients with both of these risk factors. On the contrary, postoperative outcomes were superior with less sagittal decompensation (46.9%) and PJK (0%) in those with neither of the 2 factors., Conclusions: Symptomatic sagittal imbalance and severe degeneration of paraspinal muscle are the risk factors predisposing suboptimal surgical outcomes after lumbar short-segment decompression and fusion for degenerative lumbar spinal stenosis. We believe essential spinal function and substantial quality of paraspinal muscle are the keys to long-lasting good outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: To explore the predictors for the restoration of the sagittal spinal malalignment in the elderly patients with lumbar spinal stenosis (LSS) after short-segment decompression and fusion surgery., Methods: We retrospectively reviewed 82 LSS patients with sagittal malalignment (SVA ≥ 50 mm or PT ≥ 20° or PI-LL ≥ 20°) who underwent short-segment decompression and fusion surgery between January 2019 and March 2021. Patients' characteristic, radiographic and paravertebral muscle parameters were assessed. The patients were divided into group A (postoperative malalignment) and B (postoperative alignment) according to whether the postoperative restoration of the sagittal alignment was achieved., Results: There existed more males in group B than in group A (p = 0.002). The age of group A (73.36 ± 8.02) was greater than that of group B (69.08 ± 6.07, p = 0.009). Preoperative PT in group A (27.40 ± 5.82) was greater than that in group B (19.30 ± 7.32, p < 0.001). The functional cross-sectional area (fCSA) in group A (28.73 ± 4.23) was lower than that in group B (36.94 ± 7.81, p < 0.001). And the fatty infiltration rate (FI) of group A (27.16% ± 5.58%) was higher than that of group B (22.61% ± 5.81%, p = 0.001). The fCSA was negatively correlated with the postoperative PT and PTr (p < 0.05)., Conclusion: Stronger lumbar paravertebral muscles, smaller preoperative PI, PT or PI-LL, male and younger age are the predictors for the restoration of the sagittal spinal malalignment in the elderly LSS patients after short-segment decompression and fusion surgery., (© 2022. The Author(s).)