RESUMEN
BACKGROUND: Video-assisted thoracoscopic (VATS) lobectomy can affect patients' pulmonary function and quality of life significantly. No optimal protocol combining patient-reported outcome-based symptom management and post-discharge rehabilitation programme has yet been established. This study aimed to assess the efficacy of a novel smartphone app designed for home-based symptom management and rehabilitation. METHODS: The app was developed based on three modules: a symptom reporting system with alerts, aerobic and respiratory training exercises, and educational material. Four core symptoms were selected based on a questionnaire survey of 201 patients and three rounds of Delphi voting by 30 experts. We screened 265 patients and randomly assigned 136 equally to the app group and usual care group. The primary outcome was pulmonary function recovery at 30 days postoperatively. Secondary outcomes included symptom burden and interference with daily living (both rated using the MD Anderson Symptom Inventory for Lung Cancer), aerobic exercise intensity, emergency department visits, app-related safety, and satisfaction with the app. FINDINGS: Of the 136 participants, 56.6% were women and their mean age was 61 years. The pulmonary function recovery ratio 1 month after surgery in the app group was significantly higher than that in the usual care group (79.32% vs. 75.73%; P=0.040). The app group also recorded significantly lower symptom burden and interference with daily living scores and higher aerobic exercise intensity after surgery than the usual care group. Thirty-two alerts were triggered in the app group. The highest pulmonary function recovery ratio and aerobic exercise intensity were recorded in those patients who triggered alerts in both groups. INTERPRETATION: Using a smartphone app is an effective approach to accelerate home-based rehabilitation after VATS lobectomy. The symptom alert mechanism of this app could optimise recovery outcomes, possibly driven by patients' increased self-awareness.
RESUMEN
Graphene-based flexible electronic devices are widely used in photoelectric components and photodetectors. However, it remains a huge challenge to fabricate graphene-based flexible devices efficiently and economically. Compared with the flexible electronic devices made by combining the flexible film with metal and semiconductor materials, the graphene-based flexible substrate (GFS) can be efficiently and conveniently induced by laser direct writing on the flexible film. In this paper, the GFS with a resistance of as low as 15 Ω was successfully induced by CO2 laser on a polyimide (PI) film in one step, and the GFS surface covered with carbon nanoparticles (GFSC) with a resistance of 25 Ω was further induced by femtosecond (fs) laser reprocessing. Benefiting from the laser-induced porous graphene structure, the absorptivity of GFS is up to 90% in the wavelength range of 200-2000 nm. The formation of carbon nanoparticles on the GFSC surface further improves the absorptivity to 97.5% in a wide spectral range. Under white light irradiation of 1 sun, the surface temperature of GFS reaches 65.7 °C and that of GFSC is up to 70.8 °C within 2 min. Under the irradiation of a light-emitting diode (LED) with a central wavelength of 365 nm, the highest photoresponsivity of GFS and GFSC was 8.8 and 1.3 mA/W, respectively. The response time and recovery time of GFS are 8 and 7.3 s, and those of GFSC are 8.3 and 6.7 s, respectively. Importantly, GFSC has a more stable photoresponse performance due to the better electron capture and transfer capability of carbon nanoparticles. It is believed that GFS and GFSC have great application potential in flexible photodetectors and sensors.
RESUMEN
Reverse vaccinology (RV) has been widely used for screening of surface-exposed proteins (PSEs) of important pathogens, including outer membrane proteins (OMPs), and extracellular proteins (ECPs) as potential vaccine candidates. In this study, we applied a novel RV negative strategy and a pan-genome analysis for screening of PSEs from 17 L. interrogans strains covering 11 predominately epidemic serovars and 17 multilocus typing (MLST) sequence types (STs) worldwide. Our results showed, for instance, out of a total of 633 predicted PSEs in strain 56601, 92.8% were OMPs or ECPs (588/633). Among the 17 strains, 190 core PSEs, 913 dispensable PSEs and 861 unique PSEs were identified. Of the 190 PSEs, 121 were further predicted to be highly antigenic and thus may serve as potential vaccine candidates against leptospirosis. With the exception of LipL45, OmpL1, and LigB, the majority of the 121 PSEs were newly identified antigens. For example, hypothetical proteins BatC, LipL71, and the OmpA family proteins sharing many common features, such as surface-exposed localization, universal conservation, and eliciting strong antibody responses in patients, are regarded as the most promising vaccine antigens. Additionally, a wide array of potential virulence factors among the predicted PSEs including TonB-dependent receptor, sphingomyelinase 2, leucine-rich repeat protein, and 4 neighboring hypothetical proteins were identified as potential antigenicity, and deserve further investigation. Our results can contribute to the prediction of suitable antigens as potential vaccine candidates against leptospirosis and also provide further insights into mechanisms of leptospiral pathogenicity. In addition, our novel negative-screening strategy combined with pan-genome analysis can be a routine RV method applied to numerous other pathogens.
