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Highlights Organic spacers in Ruddlesden–Popper (RP) perovskites play a vital role in tuning crystallization, charge transport and photovoltaic performance for RP perovskite solar cells (PSCs). Fundamental understanding of the functions of molecular structure of organic spacers is the prerequisite to design high-performance PSCs. This review proposes practical design strategies in seeking RP molecular structure to maximize its photovoltaic performance for PSCs.

Background: Leadless cardiac pacemakers (LCPs) are emerging as viable alternatives to conventional transvenous pacemakers (TVPs). This study aimed to systematically compare the postoperative outcomes of LCPs and TVPs based on available published studies. Methods: We conducted a systematic review and meta-analysis of literature comparing outcomes from LCP and TVP implantations. Data analysis was performed using Stata/MP 17.0. The evaluated endpoints included pericardial effusion or perforation, puncture site events, infective endocarditis, lead or device dislodgement, pocket-related complications, tricuspid regurgitation or dysfunction, any infection, increased right ventricle (RV) pacing threshold, embolism, and thrombosis. Aggregated odds ratios (OR) and 95% confidence intervals (CI) were determined. Sensitivity analyses were conducted for heterogeneity if I2 was >50% or p < 0.01, otherwise, the random-effects model was chosen. Publication bias was analyzed if the number studies exceeded ten. Results: The meta-analysis included 24 observational studies with 78,938 patients, comprising 24,191 with LCP implantation and 54,747 with TVP implantation. The results indicated a significantly lower incidence of lead or device dislodgment (OR = 3.32, 95% CI: 1.91–5.77, p < 0.01), infective endocarditis (OR = 3.62, 95% CI: 3.10–4.24, p < 0.01), and infection (OR = 3.93, 95% CI: 1.67–9.24, p < 0.01) in the LCP group compared to the TVP group. In contrast, incidences of puncture site complications (OR = 0.24, 95% CI: 0.19–0.32, p < 0.01) and pericardial effusion or perforation (OR = 0.33, 95% CI: 0.28–0.39, p < 0.01) were significantly higher in the LCP group. Conclusions: Compared with TVP, LCP implantation is associated with a lower risk of infective endocarditis, lead or device dislodgment, infections, and pocket-related complications. However, LCP implantation carries a higher risk of puncture site complications and pericardial effusion or perforation. These findings underscore the need for careful consideration of patient-specific factors when choosing between LCP and TVP implantation. The PROSPERO Registration: https://www.crd.york.ac.uk/prospero/ (CRD42023453145).

Abstract Lipid metabolism disorders are considerably involved in the pathology of atherosclerosis; nevertheless, the fundamental mechanism is still largely unclear. This research sought to examine the function of lipophagy in lipid metabolism disorder-induced atherosclerosis and its fundamental mechanisms. Previously, Sirt6 has been reported to stimulate plaque stability by promoting macrophage autophagy. However, its role in macrophage lipophagy and its relationship with Wnt1 remains to be established. In this study, ApoE−/−: Sirt6−/− and ApoE−/−: Sirt6Tg mice were used and lipid droplets were analysed via transmission electron microscopy and Bodipy 493/503 staining in vitro. Atherosclerotic plaques in ApoE−/−: Sirt6−/− mice showed greater necrotic cores and lower stability score. Reconstitution of Sirt6 in atherosclerotic mice improved lipid metabolism disorder and prevented the progression of atherosclerosis. Furthermore, macrophages with Ac-LDL intervention showed more lipid droplets and increased expression of adipophilin and PLIN2. Reconstitution of Sirt6 recruited using SNF2H suppressed Wnt1 expression and improved lipid metabolism disorder by promoting lipophagy. In addition, downregulation of Sirt6 expression in Ac-LDL-treated macrophages inhibited lipid droplet degradation and stimulated foam cell formation. Innovative discoveries in the research revealed that atherosclerosis is caused by lipid metabolism disorders due to downregulated Sirt6 expression. Thus, modulating Sirt6’s function in lipid metabolism might be a useful therapeutic approach for treating atherosclerosis.

Abstract Designing Pt-based electrocatalysts with high catalytic activity and CO tolerance is challenging but extremely desirable for alkaline hydrogen oxidation reaction. Herein we report the design of a series of single-atom lanthanide (La, Ce, Pr, Nd, and Lu)-embedded ultrasmall Pt nanoclusters for efficient alkaline hydrogen electro-oxidation catalysis based on vapor filling and spatially confined reduction/growth of metal species. Mechanism studies reveal that oxophilic single-atom lanthanide species in Pt nanoclusters can serve as the Lewis acid site for selective OH- adsorption and regulate the binding strength of intermediates on Pt sites, which promotes the kinetics of hydrogen oxidation and CO oxidation by accelerating the combination of OH− and *H/*CO in kinetics and thermodynamics, endowing the electrocatalyst with up to 14.3-times higher mass activity than commercial Pt/C and enhanced CO tolerance. This work may shed light on the design of metal nanocluster-based electrocatalysts for energy conversion.

Abstract Background Acute myocardial infarction is a major health problem and is the leading cause of death worldwide. Myocardial apoptosis induced by myocardial infarction injury is involved in the pathophysiology of heart failure. Therapeutic stem cell therapy has the potential to be an effective and favorable treatment for ischemic heart disease. Exosomes derived from stem cells have been shown to effectively repair MI injury-induced cardiomyocyte damage. However, the cardioprotective benefits of adipose tissue-derived mesenchymal stem cell (ADSC)-Exos remain unknown. This study aimed to investigate the protective effects of exosomes from ADSC on the hearts of MI-treated mice and to explore the underlying mechanisms. Methods Cellular and molecular mechanisms were investigated using cultured ADSCs. On C57BL/6J mice, we performed myocardial MI or sham operations and assessed cardiac function, fibrosis, and angiogenesis 4 weeks later. Mice were intramyocardially injected with ADSC-Exos or vehicle-treated ADSCs after 25 min following the MI operation. Results Echocardiographic experiments showed that ADSC-Exos could significantly improve left ventricular ejection fraction, whereas ADSC-Exos administration could significantly alleviate MI-induced cardiac fibrosis. Additionally, ADSC-Exos treatment has been shown to reduce cardiomyocyte apoptosis while increasing angiogenesis. Molecular experiments found that exosomes extracted from ADSCs can promote the proliferation and migration of microvascular endothelial cells, facilitate angiogenesis, and inhibit cardiomyocytes apoptosis through miRNA-205. We then transferred isolated exosomes from ADSCs into MI-induced mice and observed decreased cardiac fibrosis, increased angiogenesis, and improved cardiac function. We also observed increased apoptosis and decreased expression of hypoxia-inducible factor-1α and vascular endothelial growth factor in HMEC-1 transfected with a miRNA-205 inhibitor. Conclusion In summary, these findings show that ADSC-Exos can alleviate cardiac injury and promote cardiac function recovery in MI-treated mice via the miRNA-205 signaling pathway. ADSC-Exos containing miRNA205 have a promising therapeutic potential in MI-induced cardiac injury.

Abstract Background Pancreatic cancer is one of the most lethal cancers worldwide. Aidi injection (ADI) is a representative antitumor medication based on Chinese herbal injection, but its antitumor mechanisms are still poorly understood. Materials and methods In this work, the subcutaneous xenograft model of human pancreatic cancer cell line Panc-1 was established in nude mice to investigate the anticancer effect of ADI in vivo. We then determined the components of ADI using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS) and explored the possible molecular mechanisms against pancreatic cancer using network pharmacology. Results In vivo experiments, the volume, weight, and degree of histological abnormalities of implanted tumors were significantly lower in the medium and high concentration ADI injection groups than in the control group. Network pharmacology analysis identified four active components of ADI and seven key targets, TNF, VEGFA, HSP90AA1, MAPK14, CASP3, P53 and JUN. Molecular docking also revealed high affinity between the active components and the target proteins, including Astragaloside IV to P53 and VEGFA, Ginsenoside Rb1 to CASP3 and Formononetin to JUN. Conclusion ADI could reduce the growth rate of tumor tissue and alleviate the structural abnormalities in tumor tissue. ADI is predicted to act on VEGFA, P53, CASP3, and JUN in ADI-mediated treatment of pancreatic cancer.

The synthetic aperture radar (SAR) oriented ship detection is a more complex and finer task than the horizontal, and it provides ship orientation for military and civilian applications, such as trajectory prediction. However, many oriented target detection methods discarded high-resolution (low-level) feature map, which provides morphological features for predicting accurate bounding box for small ships, due to computational cost and lack of semantic information. In addition, most methods follow the samples assignment in horizontal detection after padding oriented bounding box. The inaccurate geometric relationship causes that some low-quality positive samples without contributing accuracy improvement are introduced. To improve the precision of small oriented ship detection, we proposed the feature pyramid network contained high-resolution feature to fuse high-level semantics and highlight contours and textures of ships in the low-level feature map. To select high-quality positive rotated samples, dynamic rotated positive samples mining (DRPSM) is designed to mine hard positive samples for oriented ship detection specially. In one word, a two-stage and anchor-free detector trained by DRPSM and utilized high-resolution feature map is proposed for detecting oriented ships in SAR imagery. Subsequently, extensive experiments have been conducted on two oriented SAR datasets: the SSDD and the HRSID. As a result, our method attains recall of 96.2% and 90.1%, and AP50 of 90.7% and 86.5% on SSDD and HRSID, respectively. It shows that our detector achieves state-of-the-art results applied in capturing ships, when compared with other popular remote sensing oriented detectors.

Antibiotics (ABX) residues frequently occurred in water and cow milk. This work aims to understand the kinetics and mechanisms of sonolytic degradation of four ABX, i.e. ceftiofur hydrochloride (CEF), sulfamonomethoxine sodium (SMM), marbofloxacin (MAR), and oxytetracycline (OTC) in water and milk. In both water and milk, the sonolytic degradation of ABX follows pseudo-first order (PFO) kinetics well (R2: 0.951–0.999), with significantly faster ABX degradation in water (PFO kinetics constants (k1): 1.5 × 10−3-1.2 × 10−1 min−1) than in milk (k1: 3.5 × 10−4-5.6 × 10−2 min−1). The k1 values for SMM degradation in water increased by 118% with ultrasonic frequency (40–120 kHz), 174% with ultrasonic frequency (80–500 kHz), 649% with ultrasonic power (73–259 W), 22% with bulk temperature (12–40℃), and by 68% with reaction volume (50–250 mL), respectively, in other things being equal. The relevant k1 values in milk increased by 326%, 231%, 122%, 10% as well as 82% with the above same effective factors, respectively. The oxidation by free radicals generated in situ dominates ABX degradation, and the hydrophobic CEF (54.0–971.7 nM min−1) and SMM (39.2–798.4 nM min−1) underwent faster degradation than the hydrophilic MAR (33.9–751.9 nM min−1) and OTC (33.8–545.3 nM min−1) in both water and milk. Adding an extra 0.5 mM H2O2 accelerated SMM degradation by 19% in water and 33% in milk. After 130–150 min sonication of 100 mL of 2.0 mg L−1 (6.62 μM) SMM in various milk with 500 kHz and 259 W, the residue concentrations (52.9–96.3 μg L−1) can meet the relevant maximum residue limit (100 μg L−1).

Despite a decade of extensive research and clinical insights, percutaneous coronary intervention strategies for coronary bifurcation lesions have remained a challenging and highly debated area. This article presents a review of the latest findings and advances in defining and classifying coronary bifurcation lesions, in vitro studies, intracoronary imaging, stenting strategies, and the deployment of drug-coated balloons. Based on current evidence, this review provides recommendations for interventional cardiologists to develop individualized interventional strategies and enhance the efficiency of stenting procedures.

Synthetic aperture radar (SAR) ship detection especially for small ships has issues, such as dense distribution of ships, interference from land and small islands. To address these issues, many deep learning methods, including anchor-based and anchor-free methods, have been successfully migrated from optical scenes to SAR images. However, when the preset scale of anchors does not match well with the ships, it will seriously reduce the detection precision. Due to the lack of anchor-based refinement process, anchor-free methods may generate missing or false alarms in complex scenarios. In this article, a two-stage ship detection network which can generate anchors is proposed. First, our method generates high-quality anchors by network, which is more beneficial for the network to capture small ships. In addition, the generated anchors are centrally set in the region of ships, which reduces the number of anchors unrelated to ships. Second, the receptive field enhancement module is inserted into the feature pyramid network. It sets different dilation ratios of atrous convolution according to the scale of the feature map, which further enriches the semantic information of the elements in the feature map. Therefore, the network can use the information of a wider region effectively to detect ships. Finally, to verify the effectiveness of our method, extensive experiments are carried out on SAR ship detection dataset and high-resolution SAR images dataset. The results show that our method has more strong ability of detecting small ships, and achieves better detection performance than some state-of-the-art methods.

Background: Provisional stenting is the preferred strategy for non-left main bifurcation lesions. However, its superiority over planned double stenting for unprotected left main distal bifurcation (UPLMB) lesions remains unclear. Previous studies have reported conflicting results. Methods: Randomised controlled trials (RCTs) and observational studies comparing the outcomes of provisional stenting to planned double stenting for UPLMB lesions were identified. The primary endpoint was major adverse cardiac events (MACE). The secondary endpoints were myocardial infarction (MI), target vessel revascularisation (TVR), target lesion revascularisation (TLR), all-cause death, cardiac death and stent thrombosis (ST). Aggregated odds ratios (OR) and 95% confidence intervals were calculated. A sensitivity analysis was conducted if I2 was >50% or p < 0.01. Publication bias analysis was considered if more than 10 studies were enrolled. Results: Two RCTs and 19 observational studies comprising 11,672 patients were enrolled. Provisional stenting had a significantly lower incidence of MACE, mainly driven by TLR and TVR. Double stenting had a significantly lower incidence of cardiac death. In addition, patients undergoing provisional stenting had a lower tendency towards the occurrence of MI, while patients undergoing double stenting had a lower tendency towards all-cause death and ST. Conclusions: A provisional stenting strategy was associated with lower MACE, TVR and TLR but higher cardiac death. Further investigation is needed through RCTs to assess which strategy performs better.

Introduction: Systematic evaluation of the clinical efficacy and safety of Brucea javanica oil emulsion injection (BJOEI) in combination with chemotherapy in the treatment of malignant pleural effusion (MPE).Methods: The study searched CNKI, Wanfang database, VIP database, SinoMed, PubMed, Embase, the Cochrane Library, and the Web of Science database and retrieved randomized controlled trials (RCTs) on the treatment of MPE with BJOEI in combination with chemotherapy from seven electronic databases from inception to 31 March 2022. Meta-analysis and sensitivity analysis were performed using Revman 5.4 and Stata 13.0 software.Results: Ultimately, 30 RCTs with 2035 patients were included, including 1002 cases in the control group and 1033 cases in the treatment group. The results of the meta-analysis showed that the overall efficacy rate of BJOEI combined with chemotherapy was higher in the treatment of MPE compared with chemotherapy alone (RR = 1.45, 95%CI: 1.36–1.54, p < 0.00001). And it could improve the Karnofsky (KPS) score (RR = 1.54, 95%CI: 1.41–1.68, p < 0.00001), reduce adverse reactions such as fever (RR = 0.82, 95%CI:0.60–1.12), chest pain (RR = 0.90, 95%CI: 0.67–1.21), gastrointestinal reactions (RR = 0.70, 95%CI: 0.57–0.87, p < 0.005), and leukopenia (RR = 0.51, 95%CI: 0.43–0.61, p < 0.00001).Conclusion: BJOEI combined with chemotherapy has better clinical efficacy than chemotherapy alone in the treatment of MPE. It can further improve KPS score, improve patients’ quality of life, and reduce the occurrence of adverse reactions. However, the conclusions of this study need to be confirmed by further randomized, double-blind, controlled trials with large sample size, reasonable design, and strict implementation.

The traditional deep deterministic policy gradient (DDPG) algorithm has the disadvantages of slow convergence velocity and ease of falling into the local optimum. From these two perspectives, a DDPG algorithm based on the double network prioritized experience replay mechanism (DNPER-DDPG) is proposed in this paper. Firstly, the value function is approximated by introducing the idea of two neural networks, and the minimum of the action value functions generated by the two networks is selected as the updated value of the actor policy network, which reduces the incidence of local optimal policy. Then, the Q values obtained by the two networks and the immediate reward obtained by the environment are used as the criteria for prioritization, and the importance of the samples in the experience replay mechanism is divided to improve the convergence speed of the algorithm. Finally, the improved method is demonstrated in the classic control environment of OpenAI Gym, and the results show that the proposed method has increased convergence speed and cumulative reward compared with the comparison algorithm.

BackgroundAlthough provisional stenting strategy based on jailed balloon side branch (SB) protection could be useful for high-risk bifurcation lesion in certain clinical scenarios, its complexity still gives rise to procedure complications. We proposed a novel strategy, the jailed balloon proximal optimization technique (JB-POT), to simplify the procedures in treating complex coronary bifurcation lesions (CBLs). The present study was designed to verify the safety and efficacy of JB-POT under bench testing and clinical circumstances.MethodsAfter a stent was deployed in main vessel (MV) with a balloon jailed in SB, POT and post-dilation of the stent were performed without retrieving the jailed balloon. A re-POT was performed 2 mm away from SB branching point to minimize proximal stent malapposition. The JB-POT procedure was performed on 10 samples of a silicone bifurcation bench model, and optical coherence tomography (OCT) was utilized to evaluate stent deployment. From December 2018 to July 2021, a total of 28 consecutive patients with true CBLs treated with JB-POT were enrolled. Immediate procedure results were observed, and clinical follow-ups were performed.ResultsThe bench test showed that JB-POT did not induce significant stent malapposition, underexpansion or distortion, as indexed by the malapposition rate, minimum stent area (MSA), eccentricity index and symmetry index determined through OCT. Under clinical circumstances, JB-POT did not induce significant malapposition, underexpansion or distortion. Among the 30 lesions, there was no primary endpoint event defined as SB occlusion, need to rewire the SB with a polymer-covered guide wire, or failure to retrieve a jailed wire or balloon. One rewiring event and 0 double stenting events occurred as secondary endpoint events. One patient died of heart failure in the 8th month after discharge.ConclusionsThe JB-POT protocol, which tremendously simplifies the current standard provisional stenting procedure in complicated bifurcation lesions, shows acceptability in safety and efficacy. Hence, it might become an applicable strategy for treating high-risk bifurcation lesions, especially those with multiple risked SBs.

BackgroundIn our clinical work, we found that cancer patients were susceptible to coronary atherosclerotic heart disease (CAD). However, less is known about the relationship between CAD and cancer. The present study aimed to identify the risk factors for CAD and cancer, as well as the relationship between CAD and cancer.MethodsIn this retrospective study, 1600 patients between January 2012 and June 2019 were enrolled and divided into groups according to whether they had CAD or cancer. Single-factor and multivariate analysis methods were applied to examine the risk factors for CAD and cancer.Results(1) Cancer prevalence was significantly higher in patients with CAD than in patients without CAD (47.2 vs. 20.9%). The prevalence of CAD in cancer and non-cancer patients was 78.9 and 52.4%, respectively. (2) Multivariable logistic regression showed that patients with cancer had a higher risk of developing CAD than non-cancer patients (OR: 2.024, 95% CI: 1.475 to 2.778, p < 0.001). Respiratory (OR: 1.981, 95% CI: 1.236–3.175, p = 0.005), digestive (OR: 1.899, 95% CI: 1.177–3.064, p = 0.009) and urogenital (OR: 3.595, 95% CI: 1.696–7.620, p = 0.001) cancers were significantly associated with a higher risk of CAD compared with no cancer. (3) Patients with CAD also had a higher risk of developing cancer than non-CAD patients (OR = 2.157, 95% CI: 1.603 to 2.902, p < 0.001). Patients in the Alanine aminotransferase (ALT) level ≥ 40 U/L group had a lower risk of cancer than patients in the ALT level < 20 U/L group (OR: 0.490, 95% CI: 0.333–0.722, p < 0.001). (4) An integrated variable (Y = 0.205 × 10–1 age − 0.595 × 10–2 HGB − 0.116 × 10–1 ALT + 0.135 FIB) was identified for monitoring the occurrence of cancer among CAD patients, with an AUC of 0.720 and clinical sensitivity/specificity of 0.617/0.711.Conclusion(1) We discovered that CAD was an independent risk factor for cancer and vice versa. (2) Digestive, respiratory and urogenital cancers were independent risk factors for CAD. (3) We created a formula for the prediction of cancer among CAD patients. (4) ALT, usually considered a risk factor, was proven to be a protective factor for cancer in this study.

Antibiotic residues in water are general health and environmental risks due to the antibiotic-resistance phenomenon. Sonication has been included among the advanced oxidation processes (AOPs) used to remove recalcitrant contaminants in aquatic environments. Sonochemical processes have shown substantial advantages, including cleanliness, safety, energy savings and either negligible or no secondary pollution. This review provides a wide overview of the different protocols and degradation mechanisms for antibiotics that either use sonication alone or in hybrid processes, such as sonication with catalysts, Fenton and Fenton-like processes, photolysis, ozonation, etc.

Over the past few decades, antibiotics have been considered emerging pollutants due to their persistence in aquatic ecosystems. Even at low concentrations, these pollutants contribute to the phenomenon of antibiotic resistance, while their degradation is still a longstanding challenge for wastewater treatment. In the present literature survey, we review the recent advances in synergistic techniques for antibiotic degradation in wastewater that combine either ultrasound (US) or hydrodynamic cavitation (HC) and oxidative, photo-catalytic, and enzymatic strategies. The degradation of sulfadiazine by HC/persulfate (PS)/H2O2/α-Fe2O3, US/PS/Fe0, and sono-photocatalysis with MgO@CNT nanocomposites processes; the degradation of tetracycline by US/H2O2/Fe3O4, US/O3/goethite, and HC/photocatalysis with TiO2 (P25) sono-photocatalysis with rGO/CdWO4 protocols; and the degradation of amoxicillin by US/Oxone®/Co2+ are discussed. In general, a higher efficiency of antibiotics removal and a faster structure degradation rate are reported under US or HC conditions as compared with the corresponding silent conditions. However, the removal of ciprofloxacin hydrochloride reached only 51% with US-assisted laccase-catalysis, though it was higher than those using US or enzymatic treatment alone. Moreover, a COD removal higher than 85% in several effluents of the pharmaceutical industry (500–7500 mg/L COD) was achieved by the US/O3/CuO process.