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Reconfigurable metamaterials require constituent nanostructures to demonstrate switching of shapes with external stimuli. Yet, a longstanding challenge is in overcoming stiction caused by van der Waals forces in the deformed configuration, which impedes shape recovery. Here, we introduce stiff shape memory polymers. This designer material has a storage modulus of ∼5.2 GPa at room temperature and ∼90 MPa in the rubbery state at 150 °C, 1 order of magnitude higher than those in previous reports. Nanopillars with diameters of ∼400 nm and an aspect ratio as high as ∼10 were printed by two-photon lithography. Experimentally, we observe shape recovery as collapsed and touching structures overcome stiction to stand back up. We develop a theoretical model to explain the recoverability of these sub-micrometer structures. Reconfigurable structural color prints with a resolution of 21150 dots per inch and holograms are demonstrated, indicating potential applications of the stiff shape memory polymers in high-resolution reconfigurable nanophotonics.

Objective: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Design: Prospective cohort study. Setting: The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Participants: Patients aged >18 years admitted to ICUs. Results: In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line–associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). Conclusions: Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.

C34H30O7, monoclinic, C2/c (no. 15), a = 29.4446(6) Å, b = 12.4393(3) Å, c = 14.9807(3) Å, β = 90.390(1)°, V = 5486.9(2) Å3, Z = 8, R gt (F) = 0.0408, wR ref (F 2) = 0.1023, T = 100 K.

The Iso-Seq method of full-length cDNA sequencing is suitable to quantify differentially expressed genes (DEGs), transcripts (DETs) and transcript usage (DTU). However, the higher cost of Iso-Seq relative to RNA-seq has limited the comparison of both methods. Transcript abundance estimated by RNA-seq and deep Iso-Seq data for fetal liver from two cattle subspecies were compared to evaluate concordance. Inter-sample correlation of gene- and transcript-level abundance was higher within technology than between technologies. Identification of DEGs between the cattle subspecies depended on sequencing method with only 44 genes identified by both that included 6 novel genes annotated by Iso-Seq. There was a pronounced difference between Iso-Seq and RNA-seq results at transcript-level wherein Iso-Seq revealed several magnitudes more transcript abundance and usage differences between subspecies. Factors influencing DEG identification included size selection during Iso-Seq library preparation, average transcript abundance, multi-mapping of RNA-seq reads to the reference genome, and overlapping coordinates of genes. Some DEGs called by RNA-seq alone appear to be sequence duplication artifacts. Among the 44 DEGs identified by both technologies some play a role in immune system, thyroid function and cell growth. Iso-Seq revealed hidden transcriptional complexity in DEGs, DETs and DTU genes between cattle subspecies previously missed by RNA-seq.

Optimizing Resistance spot welding, often used as a time and cost-effective process in many industrial sectors, is very time-consuming due to the obscurity inherent within process with numerous interconnected welding parameters. Small changes in values will give effect to the quality of welds which actually can be easily analysed using application tool. Unfortunately, existing software to optimize the parameters are expensive, licensed and inflexible which makes small industries and research centres refused to acquire. In this study, application tool using open-sourced and customized algorithm based on artificial neural networks (ANN) was developed to enable better, fast, cheap and practical predictions of major parameters such as welding time, current and electrode force on tensile shear load bearing capacity (TSLBC) and weld quality classifications (WQC). A supervised learning algorithm implemented in standard backpropagation neural network gradient descent (GD), stochastic gradient descent (SGD) and Levenberg–Marquardt (LM) was constructed using TensorFlow with Spyder IDE in python language. All the display and calculation processes are developed and compiled in the form of application tool of graphical user interface (GUI). Results showed that this low-cost application tool Q-Check based on ANN models can predict with 80% training and 20% test set on TSLBC with an accuracy of 87.220%, 92.865% and 93.670% for GD, SGD and LM algorithms respectively while on WQC 62.5% for GD and 75% for both SGD and LM. It is also expected that tool with flexible GUI can be widely used and enhanced by practitioner with minimum knowledge in the domain.

Decompressive craniectomy (DC) in children with traumatic brain injury (TBI) and refractory raised intracranial pressure (ICP) remains controversial. We aimed to describe the clinical and operative characteristics of children with moderate to severe TBI who underwent DC, and compare outcomes with those who had medical therapy. We performed a retrospective observational cohort study on children

Background This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes. Methods A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken. Results From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values Conclusions Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.

Two pairs of enantiomeric diarylheptanoid-phenylpropanoid adducts bearing a cyclohexenone core, (±)-saccardianones A and B (1 and 2), an alkaloidal diarylheptanoid-phenylpropanoid adduct bearing a 4-piperidone core, (±)-saccardianine A (3), a pair of enantiomeric dimeric diarylheptanoid alkaloids bearing a tetrahydropyridine core, (±)-saccardianine B (4), and a suspected degradation product, saccardianine C (5), in addition to a known diarylheptanoid, platyphyllenone (6), were isolated from the leaves of Pellacalyx saccardianus. Their chemical structures were elucidated based on detailed analyses of the NMR and MS data. The structure of (±)-(1) was also confirmed by X-ray diffraction analysis. Compounds (±)-2 and 6 exhibited selective cytotoxicity towards the AsPC-1 and PANC-1 pancreatic cancer cell lines, respectively.

Trigger-responsive surfaces with multiple surface properties have wide-ranging application potential from surfaces with trigger-responsive fluid flow to cell culture to optical effects; such surfaces can be achieved through surface morphological changes. Although multiple shape-memory effects are successful in bulk polymers, there is limited programing and recovery of multiple surface memories due to the challenges in fabricating multiple surface topographies with good controllability. Here, we report the synergy between the polymer blend formulation and the thermal nanoimprinting process to achieve multiple microtopography memories. A series of immiscible blends consisting of poly(caprolactone) (PCL) and polyethylene (PE) with distinct thermal transitions governed by distinct crystallization events were augmented with improved elasticity through preferential cross-linking in the polymer blend. The effect of preferential cross-linking by dicumyl peroxide on the elastic property of the PCL/PE has been found to be nonlinearly dependent on the blend composition. This approach enabled triple and quadruple surface pattern fixity and recovery in nanoimprinted PCL/PE blends. Specifically, we demonstrated the recovery of a micropillar structure (diameter: 20 μm and height: 10 μm) from a hierarchical micrograting topography (width: 2 μm and height: 2 μm) when exposed to a thermal stimulus at 60 °C for 180 s. Furthermore, we also demonstrated the recovery of a deformed micrograting followed by a secondary recovery of the micropillar structure.

Our study aimed to compare the clinical outcomes and cost-efficiency of antibiotic management versus laparoscopic appendectomy for acute uncomplicated appendicitis (AUA) in children during the COVID-19 pandemic when resources were limited and transmission risks uncertain.In this prospective comparative cohort study, we analyzed the data of 139 children diagnosed with AUA meeting the following inclusion criteria: 5-18 years of age, symptoms duration of ≤ 48 h, appendix diameter ≤ 11 mm and no appendicolith. Treatment outcomes between non-operative management group (78/139) and upfront laparoscopic appendectomy group (61/139) were compared. Antibiotic regimes were intravenous ceftriaxone/metronidazole or amoxicillin/clavulanic acid for 48 h, followed by oral antibiotics to complete total 10-days course.8/78 (10.3%) children had early failure (within 48 h) requiring appendectomy. 17/70 (24.3%) patients experienced late recurrence within mean follow-up time of 16.2 ± 4.7 months. There were no statistical differences in peri-operative complications, negative appendicectomy rate, and incidence of perforation and hospitalization duration between antibiotic and surgical treatment groups. Cost per patient in upfront surgical group was significantly higher ($6208.5 ± 5284.0) than antibiotic group ($3588.6 ± 3829.8; p = 0.001).Despite 24.3% risk of recurrence of appendicitis in 16.2 ± 4.7 months, antibiotic therapy for AUA appears to be a safe and cost-effective alternative to upfront appendectomy.

Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p.0001); public (OR=1.84; 95%CI=1.49-2.26, P.0001), and private (OR=1.57; 95%CI=1.29-1.91, P.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P.0001) showed the highest risk.Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.

Plants synthesize numerous alkaloids that mimic animal neurotransmitters. The diversity of alkaloid structures is achieved through the generation and tailoring of unique carbon scaffolds. However, many neuroactive alkaloids belong to a scaffold class for which no biosynthetic route or enzyme catalyst is known. By studying highly coordinated, tissue-specific gene expression in plants that produce neuroactive Lycopodium alkaloids, we identified a new enzyme class for alkaloid biosynthesis: neofunctionalized α-carbonic anhydrases (CAHs). We show that three CAH-like (CAL) enzymes are involved in a cryptic biosynthetic route to a key bicyclic precursor of the Lycopodium alkaloids, and additionally, we describe a series of oxidative tailoring steps that generate the optimized acetylcholinesterase inhibition activity of huperzine A. Our findings suggest a broader involvement of CAL enzymes in specialized metabolism and provide an example for how successive scaffold tailoring steps can drive potency against a natural protein target of interest.

To review our surgical experience and outcome of redo pull-through for various postoperative complications of Hirschsprung’s disease. A retrospective study was performed on children who underwent redo pull-through from 2016 to 2019. Operative methods and functional outcomes were compared between those with anastomotic complications (stricture and fistula, n = 12) and patients without anastomotic complications (n = 24) such as residual aganglionosis/transition zone, twisted pull-through and tight soave cuff. 36 Patients (29 male and 7 female) were included with median age 6 (0.1–54) months at primary and 36 (9–144) months at redo pull-through. A transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) pull-through with laparoscopic (n = 10, 27.8%) or laparotomy (n = 26, 72.2%) assisted techniques were performed for all patients during redo procedure. Patients with anastomotic complications had lower incidence of successful laparoscopic pull-through (0%), higher postoperative complications (25%) after redo surgery, but similar functional outcomes compared to those without anastomotic complications (41.6% underwent laparoscopic surgery, 4.2% complications). Patients with partial colectomy had significantly less soiling (36.4%) and enterocolitis (0%) compared to those with subtotal/total colectomy (79.2% soiling and 58.3% enterocolitis). TRM-PIAS with/without laparoscopic-assisted redo pull-through was effective in treating various complications after primary pull-through. The functional outcome is strongly associated with the length of residual colon after redo pull-though.

Seven new tropane alkaloids, including five monomeric (1-5), one dimeric (6), and one trimeric (7) 3α-nortropane ester, along with two known monomeric nortropane alkaloids (8 and 9), were isolated from the leaves and bark of Pellacalyx saccardianus. Their structures, including the absolute configuration of the enantiomeric pair of (±)-6, were elucidated by comprehensive spectroscopic analyses. Alkaloids 6 and 7 showed cytotoxicity toward human pancreatic cancer cell lines (AsPC-1, BxPC3, PANC-1, and SW1990). Alkaloids 1, 4, and 9 induced a smooth muscle relaxation effect comparable to that of atropine (Emax 106.1 ± 7.5%, 97.0 ± 5.2%, 100.9 ± 1.4%, 111.7 ± 1.7%, respectively) on isolated rat tracheal rings.