High power self-Q-switched Tm:YAP laser.

To the best of our knowledge, the output performance of a self-Q-switched Tm:YAP laser has been controlled by adjusting the cavity length for the first time. By using a concise concave-flat cavity, a pulsed laser emitting at 1993 nm is produced without any additional modulation device. Under a stable self-Q-switched mode, the maximum average output power of 9.76 W is achieved from the laser when the incident pump power is 28.78 W, corresponding to a slope efficiency of 36.9% and an optical-to-optical conversion efficacy of 33.9%. Also, the narrowest pulse width of 485 ns at 48.97 kHz is obtained from the laser with a single pulse energy of 199.3 µJ. As far as we know, this laser has the highest average power and narrowest pulse width compared to other self-Q-switched Tm:YAP lasers.

Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial.

Background: Studies have shown that oral oxycontin tablets can be used for opioid titration. The European Society for Medical Oncology (ESMO) guidelines for adult cancer pain recommend opioid titration through the parenteral route, usually the intravenous or subcutaneous route. Patient-controlled subcutaneous analgesia (PCSA) with hydromorphone needs further evaluation for opioid titration. This prospective multicenter study was designed to compare the efficacy and safety of hydromorphone PCSA with oral oxycontin tablets for opioid titration of cancer pain. Patients and Methods: Eligible patients with cancer pain were randomly assigned in a 1:1 ratio to the PCSA group or the oxycontin group for dose titration. Different titration methods were given in both groups depending on whether the patient had an opioid tolerance. The primary endpoint of this study was time to successful titration (TST). Results: A total of 256 patients completed this study. The PCSA group had a significantly lower TST compared with the oxycontin group (median [95% confidence interval (CI)], 5.5[95% CI:2.5-11.5] hours vs.16.0 [95% CI:11.5-22.5] hours; p<0.001). The frequency (median; interquartile) of breakthrough pain (Btp) over 24 hours was significantly lower in the PCSA group (2.5;2.0-3.5) than in the oxycontin group.(3.0; 2.5-4.5) (p=0.04). The pain was evaluated by numeric rating scale (NRS) score at 12 hours after the start of titration. The pain score (median; interquartile) was significantly lower in the PCSA versus the oxycontin group (2.5;1.5-3.0) vs 4.5;3.0-6.0) (p=0.02). The equivalent dose of oral morphine (EDOM) for a successful titration was similar in both groups (p=0.29), but there was a significant improvement in quality of life (QoL) in both groups (p=0.03). No between-group difference in the incidence of opioid-related adverse effects was observed (p=0.32). Conclusion: Compared with oral oxycontin tablet, the use of PCSA with hydromorphone achieved a shorter titration duration for patients with cancer pain (p<0.001), without significantly increasing adverse events (p=0.32).

Ferrielectricity controlled widely-tunable magnetoelectric coupling in van der Waals multiferroics.

The discovery of various primary ferroic phases in atomically-thin van der Waals crystals have created a new two-dimensional wonderland for exploring and manipulating exotic quantum phases. It may also bring technical breakthroughs in device applications, as evident by prototypical functionalities of giant tunneling magnetoresistance, gate-tunable ferromagnetism and non-volatile ferroelectric memory etc. However, two-dimensional multiferroics with effective magnetoelectric coupling, which ultimately decides the future of multiferroic-based information technology, has not been realized yet. Here, we show that an unconventional magnetoelectric coupling mechanism interlocked with heterogeneous ferrielectric transitions emerges at the two-dimensional limit in van der Waals multiferroic CuCrP2S6 with inherent antiferromagnetism and antiferroelectricity. Distinct from the homogeneous antiferroelectric bulk, thin-layer CuCrP2S6 under external electric field makes layer-dependent heterogeneous ferrielectric transitions, minimizing the depolarization effect introduced by the rearrangements of Cu+ ions within the ferromagnetic van der Waals cages of CrS6 and P2S6 octahedrons. The resulting ferrielectric phases are characterized by substantially reduced interlayer magnetic coupling energy of nearly 50% with a moderate electric field of 0.3 V nm-1, producing widely-tunable magnetoelectric coupling which can be further engineered by asymmetrical electrode work functions.

Large area single crystal gold of single nanometer thickness for nanophotonics.

Two-dimensional single crystal metals, in which the behavior of highly confined optical modes is intertwined with quantum phenomena, are highly sought after for next-generation technologies. Here, we report large area (>104 µm2), single crystal two-dimensional gold flakes (2DGFs) with thicknesses down to a single nanometer level, employing an atomic-level precision chemical etching approach. The decrease of the thickness down to such scales leads to the quantization of the electronic states, endowing 2DGFs with quantum-confinement-augmented optical nonlinearity, particularly leading to more than two orders of magnitude enhancement in harmonic generation compared with their thick polycrystalline counterparts. The nanometer-scale thickness and single crystal quality makes 2DGFs a promising platform for realizing plasmonic nanostructures with nanoscale optical confinement. This is demonstrated by patterning 2DGFs into nanoribbon arrays, exhibiting strongly confined near infrared plasmonic resonances with high quality factors. The developed 2DGFs provide an emerging platform for nanophotonic research and open up opportunities for applications in ultrathin plasmonic, optoelectronic and quantum devices.

High performance artificial visual perception and recognition with a plasmon-enhanced 2D material neural network.

The development of neuromorphic visual systems has recently gained momentum due to their potential in areas such as autonomous vehicles and robotics. However, current machine visual systems based on silicon technology usually contain photosensor arrays, format conversion, memory and processing modules. As a result, the redundant data shuttling between each unit, resulting in large latency and high-power consumption, seriously limits the performance of neuromorphic vision chips. Here, we demonstrate an artificial neural network (ANN) architecture based on an integrated 2D MoS2/Ag nanograting phototransistor array, which can simultaneously sense, pre-process and recognize optical images without latency. The pre-processing function of the device under photoelectric synergy ensures considerable improvement of efficiency and accuracy of subsequent image recognition. The comprehensive performance of the proof-of-concept device demonstrates great potential for machine vision applications in terms of large dynamic range (180 dB), high speed (500 ns) and low energy consumption per spike (2.4 × 10-17 J).

Mogroside V alleviates inflammation response by modulating miR-21-5P/SPRY1 axis.

Mogroside V (MV) is a natural sweetener extracted from the edible plant Siraitia grosvenorii that possesses anti-inflammatory bioactivity. It has been reported that microRNAs (miRNAs) play an important role in the inflammation response suppression by natural agents. However, whether the anti-inflammation effect of mogroside V is related to miRNAs and the underlying mechanism remains unclear. Our study aimed to identify the key miRNAs important for the anti-inflammation effect of MV and reveal its underlying mechanisms. Our results showed that MV effectively alleviated lung inflammation in ovalbumin-induced (OVA-induced) asthmatic mice. miRNA-seq and mRNA-seq combined analysis identified miR-21-5p as an important miRNA for the inflammation inhibition effect of MV and it predicted SPRY1 to be a target gene of miR-21-5p. We found that MV significantly inhibited the production of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-2 (IL-2), interleukin-6 (IL-6), and nitric oxide (NO), as well as the protein expression of p-P65/P65, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS) in OVA-induced asthmatic mice and LPS-treated RAW 264.7 cells. Moreover, the release of ROS increased in LPS-stimulated RAW 264.7 cells but was mitigated by MV pretreatment. In the meantime, the expression of miR-21-5p was decreased by MV, leading to an increase in the expression of SPRY1 in RAW 264.7 cells. Furthermore, miR-21-5p overexpression or SPRY1 knockdown reversed MV's protective effect on inflammatory responses. Conversely, miR-21-5p inhibition or SPRY1 overexpression enhanced MV's effect on inflammatory responses in LPS-exposed RAW 264.7 cells. Therefore, the significant protective effect of mogroside V on inflammation response is related to the downregulation of miR-21-5p and upregulation of SPRY1 in vitro and in vivo, MiR-21-5p/SPRY1 may be novel therapeutic targets of MV for anti-inflammation treatment.

Ultrabroadband High Photoresponsivity at Room Temperature Based on Quasi-1D Pseudogap System (TaSe4 )2 I.

Narrow bandgap materials have garnered significant attention within the field of broadband photodetection. However, the performance is impeded by diminished absorption near the bandgap, resulting in a rapid decline in photoresponsivity within the mid-wave infrared (MWIR) and long-wave infrared (LWIR) regions. Furthermore, they mostly worked in cryogenic temperature. Here, without the assistance of any complex structure and special environment, it is realized high responsivity covering ultra-broadband wavelength range (Ultraviolet (UV) to LWIR) in a single quasi-1D pseudogap (PG) system (TaSe4 )2 I nanoribbon, especially high responsivity (From 23.9 to 8.31 A W-1 ) within MWIR and LWIR region at room temperature (RT). Through direct probing the carrier relaxation process with broadband time-resolved transient absorption spectrum measurement, the underlying mechanism of majorly photoconductive effect is revealed, which causes an increased spectral weight extended to PG region. This work paves the way for realizing high-performance uncooled MWIR and LWIR detection by using quasi-1D PG materials.

Two-Dimensional Atomically Thin Titanium Nitride via Topochemical Conversion.

Titanium nitride as a typical transition metal nitride (TMN) has attracted increasing interest for its fascinating characteristics and widespread applications. However, the synthesis of two-dimensional (2D) atomically thin titanium nitride is still challenging which hinders its further research in electronic and optoelectronic fields. Here, 2D titanium nitride with a large area was prepared via in situ topochemical conversion of the titanate monolayer. The titanium nitride reveals a thickness-dependent metallic-to-semiconducting transition, where the atomically thin titanium nitride with a thickness of ∼1 nm exhibits an n-type semiconducting behavior and a highly sensitive photoresponse and displays photoswitchable resistance by repeated light irradiation. First-principles calculations confirm that the chemisorbed oxygen on the surface of the titanium nitride nanosheet depletes its electrons, while the light irradiation induced desorption of oxygen leads to increased electron doping and hence the conductance of titanium nitride. These results may allow the scalable synthesis of ultrathin TMNs and facilitate their fundamental physics research and next-generation optoelectronic applications.

Conservative rehabilitation therapy for respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor: A case series study.

RATIONALE: Cases of respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor have rarely been studied in detail. Diaphragmatic dysfunction in such cases can lead to potentially fatal respiratory and circulatory disturbances. Therefore, timely diagnosis and intervention are important. Conservative rehabilitation therapy is the first choice for respiratory dysfunction due to diaphragmatic dysfunction. PATIENT CONCERNS, DIAGNOSES AND INTERVENTIONS: We present 3 patients with respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor. The diagnostic methods and therapeutic procedures for diaphragmatic dysfunction for each patient are described in detail. This study highlights the role of ventilator support combined with physical therapy in the treatment of respiratory dysfunction in such cases. The diagnosis of diaphragmatic dysfunction as well as the risk assessment of phrenic nerve involvement are also discussed. The modalities of ventilator support, including modes and parameters, are listed. OUTCOMES AND LESSONS: This study provides experiences of diagnosis and treatment of respiratory dysfunction due to phrenic nerve sacrifice during resection of massive mediastinal tumor. Timely diagnosis of diaphragmatic dysfunction primarily relies on clinical manifestations and radiography. Conservative rehabilitation therapy can improve or restore diaphragmatic function in majority of patients, and avert or delay the need for surgical intervention. Preoperative assessment of the risk of phrenic nerve involvement is important in such cases.

Neoadjuvant camrelizumab plus chemotherapy in locally advanced oesophageal squamous cell carcinoma: a retrospective cohort study.

BACKGROUND: Neoadjuvant therapy is recommended to improve the prognosis of oesophageal squamous cell carcinoma (ESCC). As a PD-1 inhibitor developed in China, camrelizumab is more accessible and available for Chinese ESCC patients. Camrelizumab plus neoadjuvant chemotherapy has shown promising efficacy with acceptable toxicity for resectable ESCC in the NIC-ESCC2019 trial. However, this was a single-arm trial, so we conducted a retrospective cohort study to compare neoadjuvant camrelizumab plus chemotherapy with neoadjuvant chemotherapy alone in terms of the safety and efficacy in patients with locally advanced ESCC. METHODS: Between January 2017 and December 2021, patients with stage II-IVa ESCC who received neoadjuvant therapy at the First Affiliated Hospital of Chongqing Medical University and underwent radical oesophagectomy were enrolled in our study. These included 19 patients who received neoadjuvant chemotherapy plus camrelizumab (group 1) and 40 patients who only received neoadjuvant chemotherapy (group 2). RESULTS: The baseline characteristics of the patients were comparable between the two groups. The pathological complete response (pCR) rate in group 1 was significantly higher than that in group 2 (26.3% vs. 2.5%, P = 0.018). All patients in group 1 achieved complete resection (R0), compared with 39 (97.5%) patients in group 2. Adverse events occurred in 16 (84%) patients in group 1 versus 35 (87.5%) patients in group 2. No grade ≥ 4 adverse events occurred in either group. No significant difference was found in surgical outcomes or postoperative complications. The 90-day mortality rate was comparable between the two groups (1 patient died in group 1 versus 2 patients in group 2). CONCLUSIONS: Neoadjuvant camrelizumab plus chemotherapy followed by surgery was associated with a promising pCR rate and a manageable safety profile for patients with locally advanced ESCC.

Highly sensitive fiber-optic temperature sensor with compact hybrid interferometers enhanced by the harmonic Vernier effect.

A compact fiber-optic temperature sensor with hybrid interferometers enhanced by the harmonic Vernier effect was proposed, which realized 36.9 times sensitization of the sensing Fabry-Perot interferometer (FPI). The hybrid interferometers configuration of the sensor consists of a FPI and a Michelson interferometer. The proposed sensor is fabricated by splicing the hole-assisted suspended-core fiber (HASCF) to the multi-mode fiber fused with the single-mode fiber, and filling polydimethylsiloxane (PDMS) into the air hole of HASCF. The high thermal expansion coefficient of PDMS improves the temperature sensitivity of the FPI. The harmonic Vernier effect eliminates the limitation of the free spectral range on the magnification factor by detecting the intersection response of internal envelopes, and realizes the secondary sensitization of the traditional Vernier effect. Combing the characteristics of HASCF, PDMS, and first-order harmonic Vernier effect, the sensor exhibits a high detection sensitivity of -19.22 nm/°C. The proposed sensor provides not only a design scheme for compact fiber-optic sensors, but also a new strategy to enhance the optical Vernier effect.

RNA-binding domain 2 of nucleolin is important for the autophagy induction of curcumol in nasopharyngeal carcinoma cells.

BACKGROUND & AIMS: Excessive autophagy induces cell death and is regarded as the treatment of cancer therapy. We have confirmed that the anti-cancer mechanism of curcumol is related to autophagy induction. As the main target protein of curcumol, RNA binding protein nucleolin (NCL) interacted with many tumor promoters accelerating tumor progression. However, the role of NCL in cancer autophagy and in curcumol's anti-tumor effects haven't elucidated. The purpose of the study is to identify the role of NCL in nasopharyngeal carcinoma autophagy and reveal the immanent mechanisms of NCL played in cell autophagy. METHODS & RESULTS: In the current study, we have found that NCL was markedly upregulated in nasopharyngeal carcinoma (NPC) cells. NCL overexpression effectively attenuated the level of autophagy in NPC cells, and NCL silence or curcumol treatment obviously aggravated the autophagy of NPC cells. Moreover, the attenuation of NCL by curcumol lead a significant suppression on PI3K/AKT/mTOR signaling pathway in NPC cells. Mechanistically, NCL was found to be directly interact with AKT and accelerate AKT phosphorylation, which caused the activation of the PI3K/AKT/mTOR pathway. Meanwhile, the RNA Binding Domain (RBD) 2 of NCL interacts with Akt, which was also influenced by curcumol. Notably, the RBDs of NCL delivered AKT expression was related with cell autophagy in the NPC. CONCLUSION: The results demonstrated that NCL regulated cell autophagy was related with interaction of NCL and Akt in NPC cells. The expression of NCL play an important role in autophagy induction and further found that was associated with its effect on NCL RNA-binding domain 2. This study may provide a new perspective on the target protein studies for natural medicines and confirm the effect of curcumol not only regulating the expression of its target protein, but also influencing the function domain of its target protein.

Waveguide-Integrated Light-Emitting Metal-Insulator-Graphene Tunnel Junctions.

Ultrafast interfacing of electrical and optical signals at the nanoscale is highly desired for on-chip applications including optical interconnects and data processing devices. Here, we report electrically driven nanoscale optical sources based on metal-insulator-graphene tunnel junctions (MIG-TJs), featuring waveguided output with broadband spectral characteristics. Electrically driven inelastic tunneling in a MIG-TJ, realized by integrating a silver nanowire with graphene, provides broadband excitation of plasmonic modes in the junction with propagation lengths of several micrometers (∼10 times larger than that for metal-insulator-metal junctions), which therefore propagate toward the junction edge with low loss and couple to the nanowire waveguide with an efficiency of ∼70% (∼1000 times higher than that for metal-insulator-metal junctions). Alternatively, lateral coupling of the MIG-TJ to a semiconductor nanowire provides a platform for efficient outcoupling of electrically driven plasmonic signals to low-loss photonic waveguides, showing potential for applications at various integration levels.

Fast Fabrication of WS2/Bi2Se3 Heterostructures for High-Performance Photodetection.

Two-dimensional (2D) material heterostructures have attracted considerable attention owing to their interesting and novel physical properties, which expand the possibilities for future optoelectronic, photovoltaic, and nanoelectronic applications. A portable, fast, and deterministic transfer technique is highly needed for the fabrication of heterostructures. Herein, we report a fast half-wet poly(dimethylsiloxane) (PDMS) transfer process utilizing the change of adhesion energy with the help of micron-sized water droplets. Using this method, a vertical stacking of the WS2/Bi2Se3 heterostructure with a straddling band configuration is successfully assembled on a fluorophlogopite substrate. Thanks to the complementary band gaps and high efficiency of interfacial charge transfer, the photodetector based on the heterostructure exhibits a superior responsivity of 109.9 A W-1 for a visible incident light at 473 nm and 26.7 A W-1 for a 1064 nm near-infrared illumination. Such high photoresponsivity of the heterostructure demonstrates that our transfer method not only owns time efficiency but also ensures high quality of the heterointerface. Our study may open new pathways to the fast and massive fabrication of various vertical 2D heterostructures for applications in twistronics/valleytronics and other band engineering devices.

Highly Tunable Lateral Homojunction Formed in Two-Dimensional Layered CuInP2S6 via In-Plane Ionic Migration.

As basic building blocks for next-generation information technologies devices, high-quality p-n junctions based on van der Waals (vdW) materials have attracted widespread interest. Compared to traditional two-dimensional (2D) heterojunction diodes, the emerging homojunctions are more attractive owing to their intrinsic advantages, such as continuous band alignments and smaller carrier trapping. Here, utilizing the long-range migration of Cu+ ions under an in-plane electric field, a lateral p-n homojunction was constructed in the 2D layered copper indium thiophosphate (CIPS). The symmetric Au/CIPS/Au devices demonstrate an electric-field-driven resistance switching (RS) accompanied by a rectification behavior without any gate control. Moreover, such rectification behavior can be continuously modulated by poling voltage. We deduce that the reversable rectifying RS behavior is governed by the effective lateral build-in potential and the change of the interfacial barrier during the poling process. Furthermore, the CIPS p-n homojuction is evidenced by the photovoltaic effect, with the spectral response extending up to the visible region due to the better photogenerated carrier separation efficiency. Therefore, this work provides a facile route to fabricate homojunctions through electric-field-driven ionic migration.

Impact of delayed veno-venous extracorporeal membrane oxygenation weaning on postoperative rehabilitation of lung transplantation: a single-center comparative study.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a reliable and effective extracorporeal life support during lung transplantation (LTx). However, the clinical benefit of delayed VV-ECMO weaning remains unclear. The current study aims to investigate whether delayed weaning of VV-ECMO is more beneficial to the rehabilitation for lung transplant patients. Patients who underwent LTx with VV-ECMO between January 2017 and January 2019 were included. Enrollment of patients was suitable for weaning off ECMO immediately after surgery. Randomization was performed in the operating room. Postoperative outcomes were compared between the two groups. Besides, univariate and multivariable logistic regressions were performed to estimate risk of postoperative complications. Compared to VV-ECMO weaning immediately after LTx, delayed weaning was associated with shorter hospital length of stay (days, 31 vs. 46; P < 0.05), lower incidence of noninvasive ventilation (4.3% vs. 24.4%; P < 0.05), primary graft dysfunction (PGD) (6.4% vs. 29.3%; P < 0.05), atrial fibrillation (AF) (4.3% vs. 22%, P < 0.05), and respiratory failure (4.3% vs. 19.5%; P < 0.05). Multivariable logistic regressions revealed that VV-ECMO weaning after LTx was independently correlated with increased risk of developing PGD [odds ratio (OR), 5.97, 95% CI 1.16-30.74], AF (OR, 6.87, 95% CI 1.66-28.47) and respiratory failure (OR, 6.02, 95% CI 1.12-32.49) by comparison of delayed VV-ECMO weaning. Patients with delayed VV-ECMO weaning are associated with lower complications and short hospital length of stay, while it relates to longer mechanical ventilation. These findings suggest that delayed VV-ECMO after LTx can facilitate rehabilitation.

New insight into scale inhibition during tea brewing: Ca2+/Mg2+ complexing and alkalinity consumption.

Scale not only affects the taste and color of water, but also increases the risks of osteoporosis and cardiovascular diseases associated with drinking it. As a popular beverage, tea is rich many substances that have considerable potential for scale inhibition, including protein, tea polyphenols and organic acids. In this study, the effect of tea brewing on scale formation was explored. It was found that the proteins, catechins and organic acids in tea leaves could be released when the green tea was brewed in water with sufficient hardness and alkalinity. The tea-released protein was able to provide carboxyl groups to chelate with calcium ions (Ca2+), preventing the Ca2+ from reacting with the carbonate ions (CO32-). The B rings of catechins were another important structure in the complexation of Ca2+ and magnesium ions (Mg2+). The carboxyl and hydroxyl groups on the organic acids was able to form five-membered chelating rings with Ca2+ and Mg2+, resulting in a significant decrease in Ca2+ from 100.0 to 60.0 mg/L. Additionally, the hydrogen ions (H+) provided by the organic acids consumed and decreased the alkalinity of the water from 250.0 to 131.4 mg/L, leading to a remarkable reduction in pH from 8.93 to 7.73. It further prevented the bicarbonate (HCO3-) from producing CO32- when the water was heated. The reaction of the tea constituents with the hardness and alkalinity inhibited the formation of scale, leading to a significant decrease in turbidity from 10.6 to 1.4 NTU. Overall, this study provides information to help build towards an understanding of the scale inhibition properties of tea and the prospects of tea for anti-scaling in industrial applications.

Uniportal video-assisted thoracic S9+10 segmentectomy using a single-direction approach is good for pulmonary function.

BACKGROUND: Uniportal video-assisted thoracic surgery is still a technical challenge, especially anatomical segmentectomy for the lateral basal segment (S9), posterior basal segment (S10), or both (S9+10). Different surgical procedures determine a variable pulmonary functional reduction depending on the extent of the resection. This study aimed to compare the efficiency of uniportal video-assisted thoracic surgery S9+10 segmentectomy with video-assisted thoracic surgery basal segmentectomy in preserving pulmonary function. METHODS: The patients who had undergone single-port video-assisted thoracic surgery S9+10 segmentectomy using a single-direction approach were age, sex, and pulmonary function matched with those undergoing video-assisted thoracic surgery basal segmentectomy. The pulmonary function tests were performed preoperatively, and at 3 and 6 months postoperatively. The operative details, postoperative complications, and pulmonary function were statistically analyzed. RESULTS: After matching, a total of 46 patients undergoing video-assisted thoracic surgery S9+10 segmentectomy and 58 patients undergoing video-assisted thoracic surgery basal segmentectomy were eligible for analysis. There was no significant difference in the average blood loss, the duration of chest tube, intensive care unit stay, or hospital stay between these 2 groups. There were no major postoperative complications and surgical mortality was found in the 2 groups. The uniportal video-assisted thoracic surgery S9+10 segmentectomy group had a greater preserved pulmonary function (concerning the values of the forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second %, and diffusion capacity of carbon monoxide %) than video-assisted thoracic surgery basal segmentectomy group at 1 and 3 months postoperatively. CONCLUSION: Uniportal video-assisted thoracic surgery anatomic S9+10 segmentectomy using a single-direction approach was safe and feasible for early stages of nonsmall cell lung cancer, and it offered significantly better functional preservation compared with basal segmentectomy.

Refractory post-thymectomy myasthenia gravis with onset at MGFA stage V: a case report.

BACKGROUND: Post-thymectomy myasthenia gravis (PTMG) is defined as thymoma patients without signs of myasthenia gravis (MG) pre-operation, but develop MG after radical surgical resection. PTMG might be misdiagnosed not only because of its rare incidence, but also the uncertain interval between the removal of thymoma and the new onset MG. Additionally, some surgeons and anesthesiologists pay less attention to those asymptomatic thymoma patients in perioperative management, leading to the neglect of new onset PTMG, and miss the best time to treat it. CASE PRESENTATION: Majority of cases of PTMG with onset at stage I-II on the basis of Myasthenia Gravis Foundation of America (MGFA) classification have been reported, but rarely at stage V, which requiring intubation or non-invasive ventilation to avoid intubation. Herein, we presented a 70-year-old male with PTMG onset at MGFA stage V, meanwhile, he had severe pulmonary infection interfering with the diagnosis of PTMG, and eventually progressed to refractory PTMG, which requiring much more expensive treatments and longer hospital stays. CONCLUSION: In the perioperative management of asymptomatic thymoma patients, careful preoperative evaluation including physical examination, electrophysiological test and acetylcholine receptor antibodies (AChR-Ab) level should be done to identify subclinical MG. Complete resection should be performed during thymectomy, if not, additional postoperative adjuvant therapy is neccessary to avoid recurrence. It's important to identify PTMG at a early stage, especially when being interfered with by postoperative complications, such as lung infection, so that treatments could be initiated as soon as possible to avoid developing to refractory PTMG.

Hot Carrier Transport and Carrier Multiplication Induced High Performance Vertical Graphene/Silicon Dynamic Diode Generator.

Dynamic semiconductor diode generators (DDGs) offer a potential portable and miniaturized energy source, with the advantages of high current density, low internal impedance, and independence of the rectification circuit. However, the output voltage of DDGs is generally as low as 0.1-1 V, owing to energy loss during carrier transport and inefficient carrier collection, which requires further optimization and a deeper understanding of semiconductor physical properties. Therefore, this study proposes a vertical graphene/silicon DDG to regulate the performance by realizing hot carrier transport and collection. With instant contact and separation of the graphene and silicon, hot carriers are generated by the rebounding process of built-in electric fields in dynamic graphene/silicon diodes, which can be collected within the ultralong hot electron lifetime of graphene. In particular, monolayer graphene/silicon DDG outputs a high voltage of 6.1 V as result of ultrafast carrier transport between the monolayer graphene and silicon. Furthermore, a high current of 235.6 nA is generated due to the carrier multiplication in graphene. A voltage of 17.5 V is achieved under series connection, indicating the potential to supply electronic systems through integration design. The graphene/silicon DDG has applications as an in situ energy source for harvesting mechanical energy from the environment.