Phosphonium Iodide Featuring Blue Thermally Activated Delayed Fluorescence for Highly Efficient X-ray Scintillator.

Organic scintillators are praised for their abundant element reserves, facile preparation procedures, and rich structures. Herein, a new family of highly efficient organic phosphonium halide salts with thermally activated delayed fluorescence (TADF) are designed by innovatively adopting quaternary phosphonium as the electron acceptor, while dimethylamine group and halide anions (I-) serve as the electron donor. The prepared butyl(2-[2-(dimethylamino)phenyl]phenyl)diphenylphosphonium iodide (C4-I) exhibits bright blue emission and an ultra-high photoluminescence quantum yield (PLQY) of 100%. Efficient charge transfer is realized through the unique n-π and anion-π stacking in solid-state C4-I. Photophysical studies of C4-I suggest that the incorporation of I accounts for high intersystem crossing rate (kISC) and reverse intersystem crossing rate (kRISC), suppressing the intrinsic prompt fluorescence and enabling near-pure TADF emission at room temperature. Benefitting from the large Stokes shift, high PLQY, efficient exciton utilization, and remarkable X-ray attenuation ability endowed by I, C4-I delivers an outstanding light yield of 80721 photons/MeV and a low limit of detection (LoD) of 22.79 nGy·s-1. This work would provide a rational design concept and open up an appealing road for developing efficient organic scintillators with tunable emission, strong X-ray attenuation ability, and excellent scintillator performance.

An adult with hemorrhagic varicella co-infects with cytomegalovirus: a case report.

BACKGROUND: Hemorrhagic varicella (HV) is a particular form of chicken pox.,with high mortality in adults. This form of the disease is rare, to date, approximately 4 cases have been reported. Occasional cases of HV have been documented in adults with hematologic disorders or other diseases. While there is one reported case of simultaneous reactivation of cytomegalovirus in an adult with chickenpox, there is a lack of information regarding changes in liver function indicators for such patients. This is unfortunate, as CMV reactivation can further exacerbate liver failure and increase mortality. In this report, we present a case of hemorrhagic varicella reactivation with cytomegalovirus and provide some relevant discussions. CASE PRESENTATION: We present the case of a 25-year-old male with HV, who had a history of nephrotic syndrome generally controlled with orally administered prednisone at a dosage of 50 mg per day for two months. The patient arrived at the emergency room with complaints of abdominal pain and the presence of hemorrhagic vesicles on his body for the past 3 days. Despite medical evaluation, a clear diagnosis was not immediately determined. Upon admission, the leukocyte count was recorded as 20.96 × 109/L on the first day, leading to the initiation of broad-spectrum antibiotic treatment. Despite the general interpretation that a positive IgG and a negative IgM indicate a previous infection, the patient's extraordinarily elevated IgG levels, coupled with a markedly increased CMV DNA quantification, prompted us to suspect a reactivation of the CMV virus. In light of these findings, we opted for the intravenous administration of ganciclovir as part of the treatment strategy. Unfortunately,,the patient succumbed to rapidly worsening symptoms and passed away. Within one week of the patient's demise, chickenpox gradually developed in the medical staff who had been in contact with him. In such instances, we speculate that the patient's diagnosis should be classified as a rare case of hemorrhagic varicella. CONCLUSION: Swift identification and timely administration of suitable treatment for adult HV are imperative to enhance prognosis.

Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning: A case report.

BACKGROUND: This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome (MODS). Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning, the intricate path to diagnosis, and the exploration of potential underlying mechanisms. CASE SUMMARY: A patient taking 10 g of cantharidin powder orally subsequently developed MODS. The patient was treated with supportive care, fluid hydration and antibiotics, and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission. Cantharidin poisoning can cause life-threatening MODS and is rare clinically. This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention. CONCLUSION: This article has reported and analyzed the clinical data, diagnosis, treatment, and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Population dynamics and seasonal migration patterns of Spodoptera exigua in northern China based on 11 years of monitoring data.

Background: The beet armyworm, Spodoptera exigua (Hübner), is an important agricultural pest worldwide that has caused serious economic losses in the main crop-producing areas of China. To effectively monitor and control this pest, it is crucial to investigate its population dynamics and seasonal migration patterns in northern China. Methods: In this study, we monitored the population dynamics of S. exigua using sex pheromone traps in Shenyang, Liaoning Province from 2012 to 2022, combining these data with amigration trajectory simulation approach and synoptic weather analysis. Results: There were significant interannual and seasonal variations in the capture number of S. exigua, and the total number of S. exigua exceeded 2,000 individuals in 2018 and 2020. The highest and lowest numbers of S. exigua were trapped in September and May, accounting for 34.65% ± 6.81% and 0.11% ± 0.04% of the annual totals, respectively. The average occurrence period was 140.9 ± 9.34 days during 2012-2022. In addition, the biomass of S. exigua also increased significantly during these years. The simulated seasonal migration trajectories also revealed varying source regions in different months, primarily originated from Northeast China and East China. These unique insights into the migration patterns of S. exigua will contribute to a deeper understanding of its occurrence in northern China and provide a theoretical basis for regional monitoring, early warning, and the development of effective management strategies for long-range migratory pests.

Unraveling the origins of the coexisting localized-interfacial mechanism in oxide-based memristors in CMOS-integrated synaptic device implementations.

The forefront of neuromorphic research strives to develop devices with specific properties, i.e., linear and symmetrical conductance changes under external stimuli. This is paramount for neural network accuracy when emulating a biological synapse. A parallel exploration of resistive memory as a replacement for conventional computing memory ensues. In search of a holistic solution, the proposed memristive device in this work is uniquely poised to address this elusive gap as a unified memory solution. Opposite biasing operations are leveraged to achieve stable abrupt and gradual switching characteristics within a single device, addressing the demands for lower latency and energy consumption for binary switching applications, and graduality for neuromorphic computing applications. We evaluated the underlying principles of both switching modes, attributing the anomalous gradual switching to the modulation of oxygen-deficient layers formed between the active electrode and oxide switching layer. The memristive cell (1R) was integrated with 40 nm transistor technology (1T) to form a 1T-1R memory cell, demonstrating a switching speed of 50 ns with a pulse amplitude of ±2.5 V in its forward-biased mode. Applying pulse trains of 20 ns to 490 ns in the reverse-biased mode exhibited synaptic weight properties, obtaining a nonlinearity (NL) factor of <0.5 for both potentiation and depression. The devices in both modes also demonstrated an endurance of >106 cycles, and their conductance states were also stable under temperature stress at 85 °C for 104 s. With the duality of the two switching modes, our device can be used for both memory and synaptic weight-storing applications.

Biochemical and Transcriptome Analysis Reveals Pigment Biosynthesis Influenced Chlorina Leaf Formation in Anoectochilus roxburghii (Wall.) Lindl.

Anoectochilus roxburghii (Wall.) Lindl is a perennial herb of the Orchidaceae family; a yellow-green mutant and a yellow mutant were obtained from the wild type, thereby providing good material for the study of leaf color variation. Pigment content analysis revealed that chlorophyll, carotenoids, and anthocyanin were lower in the yellow-green and yellow mutants than in the wild type. Transcriptome analysis of the yellow mutant and wild type revealed that 78,712 unigenes were obtained, and 599 differentially expressed genes (120 upregulated and 479 downregulated) were identified. Using the Kyoto Encyclopedia of Genes and Genomes pathway analysis, candidate genes involved in the anthocyanin biosynthetic pathway (five unigenes) and the chlorophyll metabolic pathway (two unigenes) were identified. Meanwhile, the low expression of the chlorophyll and anthocyanin biosynthetic genes resulted in the absence of chlorophylls and anthocyanins in the yellow mutant. This study provides a basis for similar research in other closely related species.

Selection and validation of optimal reference genes for RT-qPCR analyses in Aphidoletes aphidimyza Rondani (Diptera: Cecidomyiidae).

Aphidoletes aphidimyza is a predator that is an important biological agent used to control agricultural and forestry aphids. Although many studies have investigated its biological and ecological characteristics, few molecular studies have been reported. The current study was performed to identify suitable reference genes to facilitate future gene expression and function analyses via quantitative reverse transcription PCR. Eight reference genes glyceraldehyde-3-phosphate dehydrogenase (GAPDH), RPS13, RPL8, RPS3, α-Tub, ß-actin, RPL32, and elongation factor 1 alpha (EF1-α) were selected. Their expression levels were determined under four different experimental conditions (developmental stages, adult tissues, sugar treatment, and starvation treatment) using qRT-PCR technology. The stability was evaluated with five methods (Ct value, geNorm, NormFinder, BestKeeper, and RefFinder). The results showed that GAPDH, RPL32, and EF1-α were ranked as the best reference gene combinations for measuring gene expression levels among different developing stages and in various starvation treatments. RPL8 and RPS3 were recommended to normalize the gene expression levels among different adult tissues. RPL32, ß-actin, and EF1-α were recommended sugar-feeding conditions. To validate the utility of the selected reference pair, RPL8, and RPS3, we estimated the tissue-biased expression level of a chemosensory protein gene (AaphCSP1). As expected, AaphCSP1 is highly expressed in the antennae and lowly expressed in the abdomen. These findings will lay the foundation for future research on the molecular physiology and biochemistry of A. aphidimyza.

A bi-functional three-terminal memristor applicable as an artificial synapse and neuron.

Due to their significant resemblance to the biological brain, spiking neural networks (SNNs) show promise in handling spatiotemporal information with high time and energy efficiency. Two-terminal memristors have the capability to achieve both synaptic and neuronal functions; however, such memristors face asynchronous programming/reading operation issues. Here, a three-terminal memristor (3TM) based on oxygen ion migration is developed to function as both a synapse and a neuron. We demonstrate short-term plasticity such as pair-pulse facilitation and high-pass dynamic filtering in our devices. Additionally, a 'learning-forgetting-relearning' behavior is successfully mimicked, with lower power required for the relearning process than the first learning. Furthermore, by leveraging the short-term dynamics, the leaky-integrate-and-fire neuronal model is emulated by the 3TM without adopting an external capacitor to obtain the leakage property. The proposed bi-functional 3TM offers more process compatibility for integrating synaptic and neuronal components in the hardware implementation of an SNN.

Proton-Assisted Redox-Based Three-Terminal Memristor for Synaptic Device Applications.

Emerging technologies, i.e., spintronics, 2D materials, and memristive devices, have been widely investigated as the building block of neuromorphic computing systems. Three-terminal memristor (3TM) is specifically designed to mitigate the challenges encountered by its two-terminal counterpart as it can concurrently execute signal transmission and memory operations. In this work, we present a complementary metal-oxide-semiconductor-compatible 3TM with highly linear weight update characteristics and a dynamic range of ∼15. The switching mechanism is governed by the migration of oxygen ions and protons in and out of the channel under an external gate electric field. The involvement of the protonic defects in the electrochemical reactions is proposed based on the bipolar pulse trains required to initiate the oxidation process and the device electrical characteristics under different humidity levels. For the synaptic operation, an excellent endurance performance with over 256k synaptic weight updates was demonstrated while maintaining a stable dynamic range. Additionally, the synaptic performance of the 3TM is simulated and implemented into a four-layer neural network (NN) model, achieving an accuracy of ∼92% in MNIST handwritten digit recognition. With such desirable conductance modulation characteristics, our proposed 3T-memristor is a promising synaptic device candidate to realize the hardware implementation of the artificial NN.

The impact of oxygen vacancy defect density on the nonlinearity and short-term plasticity of TiO2-based exponential selector.

The readout margin of the one selector-one RRAM crossbar array architecture is strongly dependent on the nonlinearity of the selector device. In this work, we demonstrated that the nonlinearity of Pt/TiO2/Pt exponential selectors increases with decreasing oxygen vacancy defect density. The defect density is controlled by modulating the sputtering pressure in the oxide deposition process. Our results reveal that the dominant conduction mechanisms of the Pt/TiO2/Pt structure transit from Schottky emission to Poole-Frenkel emission with the increase of sputtering pressure. Such transition is attributed to the rise of oxygen vacancy concentration. In addition, the short-term plasticity feature of the Pt/TiO2/Pt selector is shown to be enhanced with a lower defect density. These results suggest that low defect density is necessary for improved exponential selector performances.

Examining the effects of second-and third-trimester gestational weight gain rates on the perinatal outcomes among Chinese twin pregnancies: a retrospective cohort study.

BACKGROUND: This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. METHODS: A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups. RESULTS: A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 ~ 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 ~ 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 ~ 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 ~ 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups. CONCLUSIONS: While this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Suv39h1 regulates memory stability by inhibiting the expression of Shank1 in hippocampal newborn neurons.

Adult newborn neurons are involved in memory encoding and extinction, but the neural mechanism is unclear. We found the adult newborn neurons at 4 weeks are recruited by learning and subjected to epigenetic regulations, consequently reducing their ability to be re-recruited later. After removal of the epigenetic blockage, Suv39h1 KO mice showed an increased recruiting number of aged newborn neurons and enhanced flexibility in learning tasks. Besides NRXN1, we found SHANK1, the synaptic scaffold protein, is one of the major targets of Suv39h1, regulating memory stability. Expression of Shank1 is transiently engaged to enhance synaptogenesis during learning and is strongly suppressed by Suv39h1 from 5 h after learning. Exogenously overexpression of Shank1 in dentate gyrus increased the density of mushroom spines and decreased the persistency of old memories. Our study indicated the activity-regulated epigenetic modification in newly matured newborn neurons in hippocampus insulates temporally distinct experiences and stabilizes old memories.

[Application of patient-reported outcome measures in the diagnosis and treatment of male urethral stricture: An update].

Urethral stricture is a common and recurrent male disease, and its treatment has been shifted from endoscopic management to urethroplasty, which has greatly improved the success rate of treatment. However, patients and doctors often have different evaluations of the sexual function and lower urinary tract symptoms after urethroplasty, which has attracted the attention of researchers. In recent years, specific questionnaires or scales have been used to evaluate the effects of preoperative and postoperative treatment, laying more stress on the subjective feelings of the patients. Such questionnaires or scales are called patient-reported outcome measures (PROM). This article reviews the application of PROM in recent studies of urethral stricture, focusing on sexual function and lower urinary tract symptoms, aiming to provide some reference for the development and application of PROM in the diagnosis and treatment of male urethral stricture.

Immunomodulatory effects of flazin from Crassostrea sikamea on splenic lymphocytes of Sprague-Dawley rats.

Crassostrea sikamea (C.sikamea) is an important edible and medicinal seafood in China. In the present study, a compound named flazin was separated and identified from the ethyl acetate extract of C.sikamea (EAECs) for the first time. In addition, the 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetra zolium (MTS) assay revealed that EAECs and flazin inhibited the transformation of splenic lymphocytes in vitro. Moreover, flazin (20 µg·mL-1) altered the populations of splenic lymphocyte subtypes. Real-time quantitative PCR (RT-qPCR) analysis and enzyme-linked immunosorbent assay (ELISA) showed that flazin suppressed the mRNA expression and secretion of TNF-α and IL-2, and reversed Concanavalin A (ConA)-induced mRNA up-regulation and protein secretion of TNF-α and IL-2. Western blot results showed that flazin reversed ConA-induced increases in p-ERK1/2 and p-p38 in splenocytes. In conclusion, flazin exhibits effective immunomodulatory function and may be useful for treating immune-related disorders, which indicates the application potential of C.sikamea as a functional food or immunomodulator.

Multiarchitecture-Based Plasmonic-Coupled Emission Employing Gold Nanoparticles: An Efficient Fluorescence Modulation and Biosensing Platform.

Surface plasmon-coupled emission (SPCE) is an efficient surface-enhanced fluorescence method based on the near-field coupling process of surface plasmons and fluorophores. Based on this, we developed multiple coupling structures for an SPCE system by introducing gold nanoparticles (AuNPs) with different architectures by adjusting different modification methods and configurations. By assembling AuNPs on a gold substrate through electrostatic adsorption and spin-coating, 40- and 55-fold enhancements were obtained compared to free space (FS) emission, respectively. After theoretical simulations and the optimization of experimental conditions, a novel "hot-spot" plasmonic structure, an intense electromagnetic field within the system, plasmonic properties, and the coupled process were found to be mainly responsible for the diverse enhancement effects observed. For the spin-coating deposition method, new enhancing systems with high efficiency can be easily built without complex modification. Additionally, the subsequent detection system based on the uniform modification of AuNPs through electrostatic adsorption is convenient to establish with high sensitivity and stability, which can broaden the application of SPCE in both fluorescence-based sensing and imaging. This AuNP-enhanced SPCE using an electrostatic adsorption method was designed as an immunosensor to prove feasibility.

Lrp6 Genotype affects Individual Susceptibility to Nonalcoholic Fatty Liver Disease and Silibinin Therapeutic Response via Wnt/ß-catenin-Cyp2e1 Signaling.

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious threat to human health worldwide, with a high genetic susceptibility. Rs2302685, a functional germline variant of LRP6, has been recently found to associate with NAFLD risk. This study was aimed to clarify the underlying mechanism associated with rs2302685 risk and its impact on pharmacotherapy in treatment of NAFLD. Methods: Venous blood samples were collected from NAFLD and non-NAFLD patients for SNP genotyping by using mass spectrometry. The Lrp6-floxdel mouse (Lrp6(+/-)) was generated to model the partial function associated with human rs2302685. The liver injury and therapeutic effects of silibinin were compared between Lrp6(+/-) and Lrp6(+/+) mice received a methionine-choline deficient (MCD) diet or normal diet. The effect of Lrp6 functional alteration on Wnt/ß-catenin-Cyp2e1 signaling activities was evaluated by a series of cellular and molecular assays. Results: The T allele of LRP6 rs2302685 was confirmed to associate with a higher risk of NAFLD in human subjects. The carriers of rs2302685 had reduced level of AST and ALT as compared with the noncarriers. The Lrp6(+/-) mice exhibited a less severe liver injury induced by MCD but a reduced response to the treatment of silibinin in comparison to the Lrp6(+/+) mice, suggesting Lrp6 as a target of silibinin. Wnt/ß-catenin-Cyp2e1 signaling together with ROS generation could be exacerbated by the overexpression of Lrp6, while decreased in response to Lrp6 siRNA or silibinin treatment under NAFLD modeling. Conclusions: The Lrp6 function affects individual susceptibility to NAFLD and the therapeutic effect of silibinin through the Wnt/ß-catenin-Cyp2e1 signaling pathway. The present work has provided an underlying mechanism for human individual susceptibility to NAFLD associated with Lrp6 polymorphisms as well as a rationale for the effective use of silibinin in NAFLD patients.

[Adsorption of BS-18 Amphoterically Modified Bentonite to Tetracycline and Norfloxacin Combined Pollutants].

Antibiotic pollution in the environment has become a hot topic. The amphoteric surfactant octadecyl dimethyl betaine (BS-18) was adopted to modify bentonite to investigate the effects and mechanisms of the composite adsorption of different types of antibiotics. Under the different modification ratios, temperatures, pH values, and ionic strength conditions, the adsorption of tetracycline (TC) and norfloxacin (NOR) by bentonite was studied under single and compound conditions, and the adsorption mechanism was analyzed and discussed in combination with the surface properties of amphoterically modified bentonite. The results showed that compared with those of CK, the CEC and specific surface area of the soil samples modified by BS-18 decreased, whereas the total carbon and total nitrogen contents increased. The adsorption order of BS-18 amphoterically modified bentonite to TC was CK > 100BS > 25BS > 50BS, which was in accordance with the Langmuir model; the adsorption order of NOR was 25BS > 50BS > CK > 100BS, which was consistent with the Henry model. The adsorption capacity of TC and NOR in the TC and NOR composite system was higher than that in the single system. With the increase in temperature, the adsorption of amphoterically modified bentonite to TC showed a positive warming effect, whereas the adsorption of NOR declined as the temperature increased. When the ionic strength increased from 0.001 mol·L-1 to 0.500 mol·L-1, the adsorption of TC and NOR on each soil sample was inhibited. The pH of the solution can affect the existing forms of TC and NOR, and the adsorption capacity showed different trends as the pH increased. The adsorption of TC by BS-18-modified bentonite was mainly caused by electric charge attraction, whereas the adsorption of NOR was mainly caused by the combination of electric charge attraction and the hydrophobic effect. The different values of the octanol/water partition coefficient and the difference in structure resulted in different adsorption modes. In the TC and NOR composite system, a TC+NOR mixture was formed to promote the adsorption of soil samples.

Renal supportive care programs: An observational study assessing impact on hospitalization and survival outcomes.

AIM: Renal supportive care (RSC) programs are used to manage non-dialysis end-stage kidney disease (ESKD) patients. The aim of this study was to analyse the impact of RSC programs on hospitalization and survival outcomes in these patients. METHODS: A retrospective, single-centre observational cohort study of non-dialysis ESKD patients was undertaken. Hospitalizations and survival from eGFR≤15 ml/min was compared between patients managed in an RSC program (RSC group) and patients receiving standard conservative therapy (non-RSC group). Local databases, physician letters and electronic medical records were used for data collection. Prevalent patients from 2013 to 2017 with eGFR ≤15 ml/min were included. Cox proportion hazard testing and generalized linear modelling was undertaken to adjust for confounders. RESULTS: A total of 172 patients were included (95 RSC; 75 non-RSC). The median age was 82 years [IQR 78-85], 46% were male, the median Charlson-comorbidity Index was 5 [IQR 4-7]. The RSC group had significantly lowered haemoglobin level (102 g/L vs. 111 g/L) and fewer English-speakers (34% vs. 44%). RSC was associated with the decreased number of days in hospital per year (estimated means 46.6 days [95% CI 21-67] vs. 83.2 days [95%CI 60.5-105.8]; p = .01) and decreased number of hospital admissions per year (estimated means 5.4 [95%CI 2.1-8.8] vs. 12.3 [95%CI 8.2-16.4]; p = .01) compared with non-RSC. Median overall survival from eGFR≤15 in the entire cohort was 735 days, with no significant difference between RSC and non-RSC groups (p = .9), both unadjusted and adjusted for confounders. CONCLUSION: RSC programs can significantly decrease the number and length of hospitalizations in conservatively managed ESKD patients.