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Study design: Retrospective study. Objectives: To investigate the risk factors of tracheostomy and decannulation after cervical spinal cord injury (CSCI) and their epidemiological changes over the past 8 years in Beijing Bo’ai Hospital, China Rehabilitation Research Center (CRRC), China. Setting: Beijing Bo’ai Hospital, CRRC. Methods: We reviewed 8 years of patient data (2013.1.1 to 2020.12.31) at CRRC, focusing on those hospitalized and diagnosed with CSCI. We analyzed changes in demographic and clinical data’s trends. Logistic regression analysis was used to determine factors impacting tracheostomy and decannulation. Results: Finally, 1641 CSCI patients met the inclusion criteria. Over the past 8 years, the proportion of tracheostomized patients with CSCI was 16.3%, and the proportion of successfully decannulated of tracheostomized patients with TCSCI was 77.9%. We found that Traumatic (OR = 1.8, 95% CI = 1.06, 3.22; p= 0.046), Motor level of injury (C5–C8) (OR = 0.32, 95% CI = −1.91,−0.34; p= 0.005), AIS = A/B/C (OR = 22.7/11.1/4.2, 95% CI = 12.16,42.26/5.74,21.56/2.23,7.89; p< 0.001/p< 0.001/p< 0.001), age > 56 (OR = 1.6, 95% CI = 1.04, 2.32; p= 0.031) were the risk factors for tracheostomy. By analyzing the risk factors of decannulation failure in tracheostomized patients with TCSCI through multivariable logistic regression, statistically significant differences were found in age > 45 (OR = 4.1, 95% CI = 1.44, 11.81; p= 0.008), complete injury (OR = 2.7, 95% CI = 1.26, 5.95; p= 0.011), facet dislocation (OR = 2.8, 95% CI = 1.13,7.07; p= 0.027). Conclusions: Recent years have witnessed shifts in the epidemiological characteristics of CSCI. Identifying the factors influencing tracheostomy and decannulation in CSCI can aid in improving patient prognosis.

It is relatively rare to achieve a median progression-free survival (PFS) of 40 months with pemetrexed monotherapy maintenance, especially in patients with advanced and severe lung cancer. Here, we reported a case of advanced severe lung adenocarcinoma treated with pemetrexed monotherapy maintenance achieving long survival with a median PFS of 46 months. A 52-year-old female diagnosed with stage IV lung adenocarcinoma was tested for no targeted drug benefit in the driver gene. The patient was financially disadvantaged and could not afford and refused immune checkpoint inhibitor drugs but was in the favor of platinum-based double-drug chemotherapy. After six cycles of effective administration of cisplatin in combination with pemetrexed, pemetrexed monotherapy was given for long-term maintenance treatment to date, with a median PFS of 46 months, with a treatment effect close to complete response and tolerable side effects.

Study objectives: Pentoxifylline (POF) has been shown to suppress the cytokine production from lipopolysaccharide (LPS)-stimulated monocytes/alveolar macrophages (AMs). Sarcoidosis is a granulomatous disease that is driven by the action of [...]

To determine whether higher positive end- expiratory pressure (PEEP) could provide a survival advantage for patients without acute respiratory distress syndrome (ARDS) compared with lower PEEP.

Studies about the clinical significance of high eosinophil levels in chronic obstructive pulmonary disease (COPD) are conflicting, and it has been less studied in hospitalized patients with acute exacerbation of COPD (AECOPD).This study was to examine blood eosinophil levels in relation to the prognosis of hospitalized patients with AECOPD.

Large amounts of food are wasted during the food supply chain. This loss is in part due to consumer confusion over dates on food packages that can indicate a variety of quality indicators in the product (e.g., expiration date, “best by” date, “sell by” dates, etc.). To reduce this food loss, much research has been focused on the films that offer simple and easily manipulated indication systems to detect food spoilage. However, these materials are usually hydrophilic biopolymers that can detect the food spoilage in a wide pH range but do not provide highly sensitive real-time measurements. In this work, a glycerol-based nanocomposite core–shell latex film was synthesized to create a responsive packaging material that can provide real-time pH detection of food with high sensitivity. First, the pH-responsive dendrimer comonomer was synthesized from glycerol and diamine. Then, the nanoencapsulation polymerization process via miniemulsion was conducted to form a core–shell structure with tunable nanoshell thickness for a sensible pH-responsive release (<0.5 pH change). Next, the flexible film encapsulated a color-indicative dye that provided highly sensitive and visible color changes as both the pH dropped and the time elapsed in the food. This film also provided a barrier to water and heat and resisted deformation. Ultimately, this nanocomposite flexible film pending a pH sensor has the potential as an intelligent food packaging material for a universal, accurate, easy-to-use, and real-time food spoilage monitoring system to reduce food waste.

Non-invasive respiratory strategies (NIRS) including high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) have become widely used in patients with COVID-19 who develop acute respiratory failure. However, use of these therapies, if ineffective, might delay initiation of invasive mechanical ventilation (IMV) in some patients. We aimed to determine early predictors of NIRS failure and develop a simple nomogram and online calculator that can identify patients at risk of NIRS failure.

ABSTRACTBackgroundPatients with undiagnostic pleural effusions are routinely examined by conventional medical thoracoscopy under the white light (WL). The endoscopic appearance of pleural diseases under WL could be misleading. Narrow-Band Imaging (NBI) has been applied as an interesting and effective diagnostic tool for endoscopy. However, there is also controversy about its value in the application of thoracoscopy.ObjectiveThe objective of this study was to investigate the diagnostic value of NBI technology during thoracoscopy.MethodsPatients with undiagnosed pleural effusions admitted to our hospital between September 2017 and September 2019 were enrolled. During the thoracoscopy, we performed WL mode first and then NBI. Pictures of endoscopic real-time lesions were recorded under two modes, and at least five pieces of tissue were taken, respectively, on pleura lesions. Biopsy specimens were respectively taken for pathologic analysis. Diagnostic sensitivity, specificity were calculated to compare with pathologic results.Results100 eligible patients were enrolled, including 63 with malignancy, 23 with tuberculous pleurisy, 3 with systemic disease and 11 with the negative condition. Compared with pathological results, the sensitivity of WL was 91.01%, and NBI 84.27%; while the specificity of WL was 27.27%, and NBI 81.82%. Compared NBI with WL, the former’s specificity is superior to the latter’s, which is statistically significant (P < 0.05).ConclusionsThe advantage of NBI lies in its high specificity. It’s useful to diagnose unknown pleural effusions in clinical practice. With better visualization of blood vessels, we can enhance the accuracy of biopsy and reduce the risk of unexpected bleeding arose from the biopsy.

Self-healing materials have received increased attention because of their automatic detecting and repairing damage function. In this paper, a novel self-assembly and self-healing bionanocomposite was developed as a coating material for controlled release fertilizers. This nanotechnology-enabled coating is environmentally friendly and highly efficient and possesses a tunable nutrient-releasing characteristic. In the synthesis process, bio-based polyurethane coated urea (BPCU) was prepared by the reaction of bio-polyols with isocyanate. The BPCU was then modified by the layer-by-layer technology to prepare self-assembling modified BPCU (SBPCU). Last, hollow nano-silica (HNS) particles loaded with the sodium alginate (SA) were used to modify SBPCU to fabricate of self-assembling and self-healing BPCU (SSBPCU). The results show that the self-assembled materials were synthesized through electrostatic adsorption. The self-healing was observed through scanning electron microscopy and 3D-X-ray computed tomography, revealing the mechanism was that the repair agent released from HNS reacted with the curing agent to block the pore channels and cracks of the coating. As a result, the SSBPCU exhibited the highest hydrophobicity and surface roughness and thus the slowest release rate. For the first time, this work has designed a novel strategy to solve the bottleneck problem that restricts the development of a controlled-release fertilizer.

Shiga toxin-producing Escherichia coli(STEC) are critical foodborne pathogens, which cause serious human health issues, including hemolytic uremic syndrome. Illnesses caused by STEC lack effective treatments that target the elimination of these bacteria from the gastrointestinal tract without causing an adverse effect. Reducing this pathogen from a reservoir of STEC is an effective strategy, but the challenges remain due to the lack of efficient, selective antimicrobial agents. We developed specific antibody-conjugated chitosan nanoparticles (CNs) to selectively target and treat STEC in the gastrointestinal tract. Given the great broad-spectrum antimicrobial activity of CN, we conjugated antibodies to CN. Antibodies were raised and purified from egg yolks after immunization of hens with seven different O-side-chain antigens isolated from STEC (O26, O45, O103, O111, O121, O145, and O157). We prepared CN-immunoglobulin Y (IgY) conjugates by forming amide bonds at different ratios of CN:IgY (10:1, 10:2, and 10:4). The CN-IgY conjugated at a 10:2 ratio demonstrated significantly enhanced antimicrobial activity against E. coliO157:H7. Conjugates of CN and anti-STEC IgY antibodies killed corresponding STEC serotypes specifically and selectively, while showing no significant impact on nontargeted bacteria, including Salmonella entericaand Lactobacillus plantarum. The enhanced antimicrobial activity of CN-IgY against STEC was also confirmed in synthetic intestinal fluid, as well as an in vivo animal model of Caenorhabditis elegans. These results suggest that the CN-IgY conjugates have strong and specific antimicrobial activity and that they are also great candidates to eliminate pathogens selectively in the gastrointestinal tract without inhibiting beneficial bacteria.

Lodging is a severe problem for rice (Oryza sativaL.) because it interferes with mechanical harvesting, and potentially results total crop loss. This study investigated whether a controlled‐release urea (CRU) could reduce lodging, improve the uptake of K and Si, and yields of direct‐seeded rice. The 2‐yr field experiment included four rates of CRU (120, 180, 240, and 360 kg N ha−1), each provided in one application; a conventional urea fertilizer provided in four applications (360 kg N ha−1total); and a control with no N fertilizer. Results indicated that the N release rates from the CRUs were matched well to N uptakes by rice plants; hence, N use efficiencies were improved. Concentrations of K and Si in rice tissues were much higher for treatments with the full and reduced rates of CRU than for the full rate urea treatment. Lodging of rice only appeared to occur in the urea treatment. Microscopic examination revealed that cells of rice stems provided with CRU treatments were more resistant to lodging than stem cells from plants in the urea treatment.

Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013–17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year.

To determine if recruitment manoeuvres (RMs) would decrease 28-day mortality of patients with acute respiratory distress syndrome (ARDS) compared with standard care.

Nemonoxacin is a novel nonfluorinated quinolone with excellent in vitroactivity against most pathogens in community-acquired pneumonia (CAP), especially Gram-positive isolates. The purpose of this study was to assess the efficacy and safety of nemonoxacin compared with levofloxacin in patients with CAP.

Application of biochar to agricultural soils is effective to sequester atmospheric carbon and improve soil quality, but current pyrolysis and transportation costs are high, making biochar too costly to be used at the field scale. This study developed a new in-situtechnique, burning and soil covering (B-SC), which can be used by farmers for production of biochar with crop residue. In this study, the air-dried feedstocks, elephant grass and corn residue, were burnt in situfor biochar production in the field. After approximately 90% of the leaves were combusted, the burning process was dramatically slowed down by covering the feedstock with soil. The biochar yield averaged 18.0 ± 1.3 (n =15) and 13.7 ± 1.3 (n= 10) kg per 100 kg air-dried feedstock for the elephant grass and corn residue, respectively. The biochar properties were suitable for soil improvement. The inputs for biochar production of the B-SC process only included low labor force, open field, feedstock (e.g.,grass and crop residue), and simple tools. The operation time for processing 10 kg of the corn residue by an individual farmer was 24.4 ± 4.1 min (n= 10). As compared with the conventional field burning process, the B-SC process drastically shortened the time for biomass burning and generated a significantly lower emission of smoke and thermal energy. This simple technique can be particularly practical and effective for farmers to improve the soils of poor quality in China.

Conventional medical thoracoscopy (MT), routinely performed in patients with pleural disease, does not always lead to a conclusive diagnosis. The endoscopic appearance of pleural diseases under white light could be misleading. Autofluorescence has been shown to be an interesting and effective diagnostic tool. The objective of this study was to evaluate the diagnostic value of autofluorescence imaging during MT.

The impacts of nanoclays on the miniemulsion polymerization kinetics of styrene were studied. It was found that both RPand the fractional conversion decreased upon increasing the organoclay content in the miniemulsion system. In the presence of nanoclay the molecular weight of polystyrene nanoclay composite is lower and the particle size polydispersity of the final composite latex is greater than that of pure styrene miniemulsion polymerization. The effect of the nanoclays is mainly caused by the destabilization of the miniemulsion by the organoclay particles. The increase in the monomer viscosity and the decrease in the diffusion rate of the monomer and the living polymer inside the monomer droplet also accounts for the reduction in the polymerization rate.

A stable water-based polystyrene nano-saponite composite suspension was synthesized via miniemulsion polymerization. The stability of the suspension and the intercalation degree of clay were strongly affected by the pretreatment of saponite-Ca with cationic surfactant OTAB (octadecyltrimethylammonium bromide). This pretreatment process not only intercalated the clay layers but also converted the nanoclay particles from hydrophilic (waterlike) to hydrophobic (monomerlike). The organophilic clay obtained by the above treatment could be well dispersed in the monomer phase by sonication at low saponite concentration (<5%), but formed a high-viscosity solution or a gel in the organic monomer at higher concentration of saponite. The effects of saponite modification conditions on the stability of the miniemulsion were studied, and the optimum conditions for preparing stable emulsions are reported. The final products resulting from the subsequent polymerization were characterized using light scattering, transmission electronic microscopy (TEM), and X-ray diffraction (XRD). It was found that the particle size of the prepared suspensions is in the range of 90−120 nm, and the final latex of nano-saponite composite is stable for months. It was also found that the addition of clay slightly reduced both the reaction rate and the conversion.

Pentoxifylline is a well-established drug with hemorheologic properties. Various evidence suggests an additional therapeutic potential in regard to inflammation and immunomodulation. Extrinsic allergic alveolitis (EAA) is a granulomatous disease that is driven by T-cell and alveolar macrophage (AM)-derived cytokines.

Polymeric membrane design is a multidimensional process involving selection of membrane materials and optimization of fabrication conditions from an infinite candidate space. It is impossible to explore the entire space by trial-and-error experimentation. Here, we present a membrane design strategy utilizing machine learning-based Bayesian optimization to precisely identify the optimal combinations of unexplored monomers and their fabrication conditions from an infinite space. We developed ML models to accurately predict water permeability and salt rejection from membrane monomer types (represented by the Morgan fingerprint) and fabrication conditions. We applied Bayesian optimization on the built ML model to inversely identify sets of monomer/fabrication condition combinations with the potential to break the upper bound for water/salt selectivity and permeability. We fabricated eight membranes under the identified combinations and found that they exceeded the present upper bound. Our findings demonstrate that ML-based Bayesian optimization represents a paradigm shift for next-generation separation membrane design.

ABSTRACTMost patients with advanced or metastatic urothelial carcinoma do not benefit significantly from Immune checkpoint inhibitors (ICIs) use. A systematic review and meta-analysis of randomized controlled trials to assess the efficacy and activity of ICIs, in terms of Overall Survival (OS), Progression-free survival (PFS), and Objective Response Rate (ORR). We systematically searched for articles from PubMed, Cochrane Library, Embase, and Web of science from their inception to December 1, 2020 with no language restrictions. The search was performed to identify all clinical trials (phase I, phase II, phase III) of ICIs for treating urothelial carcinoma. The endpoints of the meta-analysis were OS, PFS, and ORR, compared unselected patients and in the subgroup of patients characterized by high expression of PD-L1 (PD-L1 selected patients). Sixteen studies comprising 5559 patients were identified, of which data for OS comparison were available from 4 RCTs (2342 patients), two studies for PFS (649 patients), and four RCTs were eligible for ORR analysis (2921 patients). Both pembrolizumab and atezolizumab have showed to improve OS compared to chemotherapy in unselected patients (HR 0.86, 95% CI 0.80–0.93, P= .0001, I2 = 60%), while the difference was not significant in PD-L1 selected patients (HR 0.91, 95% CI 0.77–1.07, P= .23, I2 = 0%). PFS difference was not observed in neither unselected population nor PD-L1 selected patients, the pooled HR of PFS for immunotherapy compared to control treatment was 1.05 (95% CI 0.74–1.49, P= .79, I2 = 85%) and 0.84 (95% CI 0.68–1.03, P= .09, I2 = 0%, respectively. Similar result was observed in ORR, the pooled HR of ORR for immunotherapy compared to control treatment was 1.45 (95% CI 0.53–3.98, P= .47, I2 = 95%) and 2.19 (95% CI 0.79–6.08, P= .13, I2 = 83%), respectively. Immunotherapy could significantly improve survival advantage in unselected patients but not in PD-L1 selected population, indicating that PD-L1 expression may not be a reliable marker in previously platinum-treated patients.

Objective This study aimed to evaluate the relationship between obstructive sleep apnea (OSA) and the fraction of exhaled nitric oxide (FENO), and to assess the effect of risk factors of airway inflammation on OSA.Methods Medical records of patients in the Respiratory Sleep Center at Chao-Yang Hospital in Beijing between January 2015 and June 2017 were analyzed. All patients were diagnosed with OSA. Data of the medical history, clinical examinations, FENO, and upper airway computed tomographic findings were collected. Logistic regression was used to evaluate risk factors of OSA.Results A total of 181 patients were admitted to the Respiratory Sleep Center during the study and 170 had a diagnosis of OSA and were included in the study. Single factor analysis showed that male sex, age, body mass index, smoking index, alcohol consumption, FENO, soft palate thickness, soft palate length, the narrowest transverse diameter of the upper airway, tonsil size, and nasal sinusitis were risk factors for sleep-disordered breathing and disease severity.Conclusions Male sex, age, body mass index, FENO, the narrowest transverse diameter of the upper airway, and normal tonsil size are associated with OSA and disease severity. The severity of OSA is associated with FENOlevels.

Exacerbations of chronic obstructive pulmonary disease (COPD) are sporadic, acute worsening of symptoms. Identifying predictors of exacerbation frequency may facilitate medical interventions that reduce exacerbation frequency and severity. The objective of this study was to determine predictors of exacerbation frequency and mortality.