Impact of Regional Collaborative Network on the Rescue of Patients with ST-Elevation Myocardial Infarction First Visit to non-PCI Hospitals.

Objective: To assess the effect of a regional collaborative network on the treatment of ST-elevation myocardial infarction (STEMI) patients first admitted to non- percutaneous coronary intervention (PCI) hospitals. Methods: Using data from Kunshan Hospital of Traditional Chinese Medicine's chest pain center database, patients were grouped based on the establishment of the regional collaborative rescue network. Key timepoints and in-hospital complications were analyzed. Results: A total of 152 ST-elevation myocardial infarction patients were included in the study. Compared to control group, symptom-to-balloon time (S-B), time of first medical contact to balloon and inter-hospital referral time in observation group were significantly shorter [(314.03 ± 209.26) min vs (451.27 ± 290.44) min, P = .001], [(115.32 ± 54.73) min vs (191.67 ± 130.30) min, P = .001], [(55.09 ± 37.23) min vs (112.67 ± 95.90) min, P = .001], but time of symptom to first medical contact were not statistically significant[(210.27±217.07) min vs (239.61 ± 200.92) min, P = .136].The incidence of heart failure and total complications during hospitalization decreased [7 (8.14%) vs 13 (19.70%), P = .037] and [14 (16.28%) vs 24 (36.36%), P = .004]. However no statistically significant difference were observed in rate of death during hospitalization [2 (2.33%) vs 3 (4.55%), P = .450], ventricular fibrillation [2 (2.33%) vs 3 (4.55%), P = .450], left ventricular thrombosis [2 (2.33%) vs 4 (6.06%), P = .244] and recurrent myocardial infarction[1 (1.16%) vs 1 (1.52%), P = .851]. Conclusions: The regional cooperative rescue network notably reduces ischemic and referral times for STEMI patients, lowering the incidence of heart failure during their hospital stay.

Folic Acid Protects Against Kidney Damage in Mice with Diabetic Nephropathy by Inhibiting M1 Macrophage Polarization via Nuclear Factor-k-gene Binding Pathway.

Kidney damage is one of the most common complications of diabetes, and inflammation caused by macrophage infiltration plays an important role. Folic acid (FA), a water-soluble vitamin, was previously found to affect inflammation by regulating macrophage polarization. In our study, we aimed to investigate the effect of FA on renal injury in mice with diabetic nephropathy (DN). We found that FA treatment ameliorated diabetic metabolic parameters in mice with DN, including reducing 24-hour food consumption, 24-hour urine volume and 24-hour water intake and increasing body weight and serum insulin. Of note, FA treatment improved renal functional and structural damage in mice with DN. In addition, FA treatment significantly reduced the number of renal infiltrating M1 macrophages, inflammatory cytokine FA stimulation significantly reduced the increase in F4/80+CD86+ cell ratio, inflammatory factor content and p-p65/p65 protein expression induced by high glucose exposure in RAW264.7 cells. All in all, our results indicated that FA protects against kidney damage in mice with DN by inhibiting M1 macrophage polarization, and its mechanism may be related to the inhibition of nuclear factor-k-gene binding (NF-kB) signaling pathway.

Robotic versus Open Pancreatoduodenectomy for Pancreatic and Periampullary Tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial.

BACKGROUND: Pancreatoduodenectomy is a complex and challenging procedure that requires meticulous tissue dissection and proficient suturing skills. Minimally invasive surgery with the utilization of robotic platforms has demonstrated advantages in perioperative patient outcomes in retrospective studies. The development of robotic pancreatoduodenectomy (RPD) in specific has progressed significantly, since first reported in 2003, and high-volume centers in pancreatic surgery are reporting large patient series with improved pain management and reduced length of stay. However, prospective studies to assess objectively the feasibility and safety of RPD compared to open pancreatoduodenectomy (OPD) are currently lacking. METHODS/DESIGN: The PORTAL trial is a multicenter randomized controlled, patient-blinded, parallel-group, phase III non-inferiority trial performed in seven high-volume centers for pancreatic and robotic surgery in China (> 20 RPD and > 100 OPD annually in each participating center). The trial is designed to enroll and randomly assign 244 patients with an indication for elective pancreatoduodenectomy for malignant periampullary and pancreatic lesions, as well as premalignant and symptomatic benign periampullary and pancreatic disease. The primary outcome is time to functional recovery postoperatively, measured in days. Secondary outcomes include postoperative morbidity and mortality, as well as perioperative costs. A sub-cohort of 128 patients with pancreatic adenocarcinoma (PDAC) will also be compared to assess the percentage of patients who undergo postoperative adjuvant chemotherapy within 8 weeks, in each arm. Secondary outcomes in this cohort will include patterns of disease recurrence, recurrence-free survival, and overall survival. DISCUSSION: The PORTAL trial is designed to assess the feasibility and safety of RPD compared to OPD, in terms of functional recovery as described previously. Additionally, this trial will explore whether RPD allows increased access to postoperative adjuvant chemotherapy, in a sub-cohort of patients with PDAC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04400357 . Registered on May 22, 2020.

Dyadic Coping in Couples With Breast Cancer in China.

BACKGROUND: Dyadic coping may play an important role in promoting marital adjustment in couples with breast cancer. However, few studies have explored dyadic coping and its predictors in couples with breast cancer. OBJECTIVE: To assess the dyadic coping level of Chinese couples with breast cancer and identify its predictors and explore the actor and partner effects of marital adjustment on dyadic coping. METHODS: Chinese couples (n = 114) with breast cancer participated in a cross-sectional study and completed the general information questionnaire, the Dyadic Coping Inventory, the Locke-Wallace Marital Adjustment Test, and the Body Image Scale. RESULTS: Total scores of the Dyadic Coping Inventory were 114.09 (SD, 18.49) and 114.62 (SD, 17.42) for the patients and partners, respectively. Relationship duration, monthly family income, postoperative time, adjuvant treatments, marital adjustment, body image, and dyadic coping style of the partners predicted dyadic coping among patients with breast cancer. In addition, marital adjustment exhibited both actor and partner effects on dyadic coping in the couples. CONCLUSIONS: Dyadic coping in couples with breast cancer in China was in the reference range. Psychosocial characteristics, marital adjustment, and body image should be considered and evaluated when conducting interventions for couples with breast cancer. IMPLICATIONS FOR PRACTICE: When conducting interventions for couples with breast cancer, nurses should identify couples who are likely to adopt negative dyadic coping styles and then conduct targeted interventions that consider psychosocial characteristics, marital adjustment, and body image in couples with breast cancer.

Distinct dyadic coping profiles in Chinese couples with breast cancer.

PURPOSE: Conceptualizing cancer as a dyadic stress provides new insight into how stress impacts couples with breast cancer. The present study aimed to identify subgroups with distinct dyadic coping profiles in a sample of Chinese couples with breast cancer and to determine how these subgroups differed in terms of demographic and clinical characteristics in addition to marital adjustment outcomes. METHODS: Using convenience sampling, a cross-sectional survey was conducted. Couples with breast cancer completed the general information questionnaire, the Dyadic Coping Inventory, and the Locke-Wollance Marital Adjustment Test. The modeling was performed using a latent profile analysis to identify the dyadic coping subgroups. Parametric and nonparametric tests were applied to examine between-group differences across the identified classes. RESULTS: The analytical results supported a three-class solution of dyadic coping groups: high (27.4%), medium (32.2%), and low (40.4%). Between-group differences were found in educational background, number of children, postoperative time, and type of surgery. CONCLUSION: Most couples reported low levels of dyadic coping. The couples with an educational level of primary school or below, with one child or who were childless, and who had undergone breast preservation surgery within the past year were more likely to belong to the low dyadic coping group. When supporting couples with breast cancer, it is essential to assess several demographic and clinical risk factors in addition to the marital adjustment level to identify high-risk subgroups that warrant intervention.

An All-Scale Hierarchical Architecture Induces Colossal Room-Temperature Electrocaloric Effect at Ultralow Electric Field in Polymer Nanocomposites.

Composed of electrocaloric (EC) ceramics and polymers, polymer composites with high EC performances are considered as promising candidates for next-generation all-solid-state cooling devices. Their mass application is limited by the low EC strength, which requires very high operational voltage to induce appreciable temperature change. Here, an all-scale hierarchical architecture is proposed and demonstrated to achieve high EC strength in poly(vinylidene fluoride-trifluoroethylene-chlorofluoroethylene)-based nanocomposites. On the atomic scale, highly polarizable hierarchical interfaces are induced by incorporating BiFeO3 (BFO) nanoparticles in Ba(Zr0.21 Ti0.79 )O3 (BZT) nanofibers (BFO@BZT_nfs); on the microscopic scale, percolation of the interfaces further raises the polarization of the composite nanofibers; on the mesoscopic scale, orthotropic orientation of BFO@BZT_nfs leads to much enhanced breakdown strength of the nanocomposites. As a result, an ultrahigh EC strength of ≈0.22 K m MV-1 is obtained at an ultralow electric field of 75 MV m-1 in nanocomposites filled with the orthotropic composite nanofibers, which is by far the highest value achieved in polymer nanocomposites at a moderate electric field. Results of high-angle annular dark-field scanning transmission electron microscopy, in situ scanning Kelvin probe microscopy characterization, and phase-field simulations all indicate that the much enhanced EC performances can be attributed to the all-scale hierarchical structures of the nanocomposite.

MicroRNA­21 contributes to the puerarin­induced cardioprotection via suppression of apoptosis and oxidative stress in a cell model of ischemia/reperfusion injury.

Puerarin, a major bioactive constituent of the Radix puerariae, can ameliorate myocardial ischemia/reperfusion (I/R) injury. Emerging evidence supports that microRNA (miR)­21 functions as a protective factor against I/R and/or hypoxia­reperfusion (H/R)­induced myocardial injury. However, the role of miR­21 in the cardioprotective effect of puerarin remains unclear. Therefore, the purpose of the present study was to demonstrate the involvement of miR­21 in the cardioprotective mechanisms of puerarin using a cell model of I/R injury, generated by culturing rat H9c2 cardiomyocytes under H/R conditions. The results demonstrated that pre­treatment with puerarin significantly increased cell viability, decreased lactate dehydrogenase activity and upregulated miR­21 expression in H/R­treated H9c2 cells. Transfection of an miR­21 inhibitor led to an increase in H/R­induced cytotoxicity and reversed the protective effects of puerarin. Additionally, miR­21 inhibition attenuated the puerarin­induced decrease in the rate of apoptosis, caspase­3 activity and the expression of apoptosis regulator Bax, and increased apoptosis regulator Bcl­2 expression, under H/R conditions. Furthermore, puerarin mitigated H/R­induced oxidative stress as evidenced by the decrease in endogenous reactive oxygen species production, malondialdehyde content and NADPH oxidase 2 expression, and enhanced the antioxidative defense system as illustrated by the increase in superoxide dismutase activity, catalase and glutathione peroxidase levels. These effects were all eliminated by miR­21 inhibitor transfection. Furthermore, the miR­21 inhibitor exacerbated the H/R­induced oxidative stress and attenuated the antioxidative defense system in H/R­treated H9c2 cells. Taken together, the results suggested that miR­21 mediated the cardioprotective effects of puerarin against myocardial H/R injury by inhibiting apoptosis and oxidative stress.

Flexible Robust and High-Density FeRAM from Array of Organic Ferroelectric Nano-Lamellae by Self-Assembly.

Ferroelectric memories are endowed with high data storage density by nanostructure designing, while the robustness is also impaired. For organic ferroelectrics favored by flexible memories, low Curie transition temperature limits their thermal stability. Herein, a ferroelectric random access memory (FeRAM) is demonstrated based on an array of P(VDF-TrFE) lamellae by self-assembly. Written data shows enhanced thermal endurance up to 90 °C and undergoes 12 thermal cycles between 30 and 80 °C with little volatilization. The promoted thermal stability is attributed to pinning effect at interfaces between grain boundaries and lamellae, where charged domain walls and charged defects are coupled. These results provide a strategy for improving robustness of organic flexible FeRAMs, and reveal an attracting coupling effect between different phases of ferroelectric polymer.

Interfacial Coupling Boosts Giant Electrocaloric Effects in Relaxor Polymer Nanocomposites: In Situ Characterization and Phase-Field Simulation.

The electrocaloric effect (ECE) refers to reversible thermal changes of a polarizable material upon the application or removal of electric fields. Without a compressor or cooling agents, all-solid-state electrocaloric (EC) refrigeration systems are environmentally benign, highly compact, and of very high energy efficiency. Relaxor ferroelectric ceramics and polymers are promising candidates as EC materials. Here, synergistic efforts are made by composing relaxor Ba(Zr0.21 Ti0.79 )O3 nanofibers with P(VDF-TrFE-CFE) to make relaxor-relaxor-type polymer nanocomposites. The ECEs of the nanocomposites are directly measured and these relaxor nanocomposites exhibit, so far, the highest EC temperature change at a modest electric field, along with high thermal stability within a broad temperature range span to room temperature. The superior EC performance is attributed to the interfacial coupling between dipoles across the filler/polymer interfaces. The thermodynamics and kinetics of interfacial coupling are investigated in situ by piezoresponse force microscopy while the real-time evolution of interfacial coupling is simulated and visualized by phase-field modeling.

High electrocaloric cooling power of relaxor ferroelectric BaZrxTi1-xO3 ceramics within broad temperature range.

Electrocaloric effect (ECE) is much promising to realize high efficiency and environment friendly solution in solid cooling devices. Relaxor ferroelectrics are good candidates for the materials with high electrocaloric cooling power. In this paper, relaxor ferroelectric Ba(ZrxTi1-x)O3 (BZT, x = 0.2, 0.21, 0.22, 0.23) ceramics were prepared with their temperature change (ΔT) induced by the ECE and electrocaloric strength (ΔT/E) measured within broad temperature range. It is found that the BZT21 (x = 0.21) exhibits the largest ΔT of ∼4.67 K and a high ΔT/E value of ∼0.46 km/MV at 9.9 MV/m and 25 °C. BZT21 also exhibits apparent relaxor ferroelectric response, showing a very broad EC peak in the temperature interval between 15 °C and 50 °C. Moreover, the relationship between EC properties and relaxor features was analyzed by piezoresponse force microscopy test. The results reveal that more dispersed phase structures induce additional configurational entropy, which is in favor for the enhanced EC performance. The interplay and compromise between the kinetic and thermodynamic mechanisms of domain switching determines the optimal composition for the EC performances of the BZT ceramics.

Li(+)-conductive polymer-embedded nano-Si particles as anode material for advanced Li-ion batteries.

Si has been considered as a promising alternative anode for next-generation lithium ion batteries (LIBs), but the commercial application of Si anodes is still limited due to their poor cyclability. In this paper, we propose a new strategy to enhance the long-term cyclability of Si anode by embedding nano-Si particles into a Li(+)-conductive polymer to form a Si/polymer composite with core-shell structure, in which nano-Si cores act as active Li-storage phase and the polymeric matrix serves not only as a strong buffer to accommodate the volume change, but also as a protection barrier to prevent the direct contact of Si surface with electrolyte, so as to maintain the mechanical integrity of Si anode and suppress the repeated destruction and construction of solid electrolyte interphase (SEI) on the Si surface. To realize this strategy, we synthesize a Si/PPP (polyparaphenylene) composite simply by ball-milling the Si nanoparticles with PPP polymer that has n-doping activity. Our experimental results demonstrate that the thus-prepared Si/PPP composite exhibits a high capacity of 3184 mA h g(-1) with an initial coulombic efficiency of 78%, an excellent rate capability with a considerably high capacity of 1670 mA h g(-1) even at a very high rate of 16 A g(-1), and a long-term cyclability with 60% capacity retention over 400 cycles, showing a great prospect for battery application. In addition, this structural design could be adopted to other Li-storable metals or alloys for developing cycle-stable anode materials for Li-ion batteries.