Controlling the nutritional status score: a new tool for predicting postoperative mortality in patients with infrarenal abdominal aortic aneurysm treated with endovascular aneurysm repair.

Background: AAA is a fatal condition that commonly occurs during vascular surgery. Nutritional status exerts a significant influence on the prognosis of various pathological conditions Scores from the CONUT screening tool have been shown to predict outcomes of certain malignancies and chronic diseases. However, the ramifications of nutritional status on AAA patients undergoing EVAR have not been elucidated in prior studies. In this study, we aimed to elucidate the correlation between CONUT scores and postoperative prognostic outcomes in patients with AAA undergoing EVAR. Methods: This was a retrospective review of 177 AAA patients treated with EVAR from June 2018 to November 2019 in a single center. Patient characteristics, CONUT scores, and postoperative status were collected. These patients were stratified into groups A and B according to CONUT scores. Subsequently, a comparative analysis of the baseline characteristics between the two cohorts was conducted. Cox proportional hazards and logistic regression analyses were employed to identify the autonomous predictors of mid-term mortality and complications, respectively. Results: Compared with group A, patients in group B had higher midterm mortality (p < 0.001). Univariate analysis showed that CONUT scores; respiratory diseases; stent types; preoperative Hb, CRP, PT, and Fb levels were risk factors for death. Multivariate analysis confirmed that CONUT score [HR, 1.276; 95% CI, 1.029-1.584; p = 0.027] was an independent risk factor for mortality. Logistic regression analysis showed that prior arterial disease, smoking, and D-dimer levels were risk factors, although multivariate analysis showed smoking (OR, 3.492; 95% CI, 1.426-8.553; p = 0.006) was an independent risk factor. Kaplan-Meier curves showed that patients in group B had shorter mid-term survival than those in group A (log-rank p < 0.001). Conclusion: Malnutrition was strongly associated with mid-term mortality in patients with infrarenal AAA treated with EVAR.

Analysis of the intestinal microbiota and profiles of blood amino acids and acylcarnitines in neonates with hyperbilirubinemia.

OBJECTIVE: This study aimed to discuss the distinctive features of the intestinal microbiota in neonates with hyperbilirubinemia and to comprehensively analyse the composition of the intestinal microbiota as well as the levels of free amino acids and acylcarnitines in the peripheral blood of neonates experiencing hyperbilirubinemia. RESULTS: At the phylum level, Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Chloroflexi were the five predominant microbial groups identified in both the hyperbilirubinemia and control groups. Alpha diversity analysis, encompassing seven indices, showed no statistically significant differences between the two groups. However, Beta diversity analysis revealed a significant difference in intestinal microbiota structure between the groups. Linear discriminant analysis effect size (LEfSe) indicated a significant reduction in the abundance of Gammaproteobacteria and Enterobacteriaceae within the hyperbilirubinemia group compared to that in the control group. The heatmap revealed that the control group exhibited increased abundances of Escherichia and Bifidobacterium, while the hyperbilirubinemia group exhibited increased levels of Enterococcus and Streptococcus. Regarding blood amino acids and acylcarnitines, there were greater concentrations of citrulline (Cit), arginine (Arg), ornithine (Orn), and valine (Val) in the hyperbilirubinemia group than in the control group. The hyperbilirubinemia group also exhibited significant increases in medium-chain fatty acids (C6, C8), long-chain fatty acids (C18), and free carnitine (C0). CONCLUSION: By comparing neonates with hyperbilirubinemia to those without, a significant disparity in the community structure of the intestinal microbiota was observed. The intestinal microbiota plays a crucial role in the bilirubin metabolism process. The intestinal microbiota of neonates with hyperbilirubinemia exhibited a certain degree of dysbiosis. The abundances of Bacteroides and Bifidobacterium were negatively correlated with the bilirubin concentration. Therefore, the fact that neonates with hyperbilirubinemia exhibit some variations in blood amino acid and acylcarnitine levels may provide, to a certain degree, a theoretical basis for clinical treatment and diagnosis.

Exosomes derived from BMSCs enhance diabetic wound healing through circ-Snhg11 delivery.

BACKGROUND: Exosomes (Exos) generated from bone mesenchymal stem cells (BMSCs) are elucidated to enhance cutaneous wound healing in mice models of diabetes mellitus (DM). While underlying mechanisms remain unknown. METHODS: Next-generation sequencing (NGS) was used to examine changes in circRNA expression levels following Exo treatment. Luciferase assays were used to determine the interactions between RNAs. Immunofluorescence staining was used to examine reactive oxygen species (ROS) in endothelial progenitor cells (EPCs) cultured in high glucose (HG) conditions. Therapeutic effects regarding Exos were also examined by immunofluorescence. RESULTS: We found that Exo treatment enhanced cutaneous wound healing significantly. NGS indicated that circ-Snhg11 was involved in Exo-mediated tissue repairing. Downregulation of circ-Snhg11 decreased Exo-mediated therapy responses during wound healing in diabetic mouse. Our luciferase reporter data confirmed that SLC7A11 and miR-144-3p were circ-Snhg11 downstream targets. miR-144-3p overexpression or SLC7A11 knockdown altered the protective effects of circ-Snhg11 upon EPCs exposed to HG conditions. Upregulation of circ-Snhg11 incremented therapy effects of Exo treatment during wound healing in DM mice through enhanced angiogenesis along with a reduction in GPX4-mediated ferroptosis. CONCLUSIONS: circ-Snhg11 in BMSC-Exos enhanced SLC7A11/GPX4-mediated anti-ferroptosis signals via miR-144-3p sponging resulting in enhanced diabetic wound healing and improved angiopoiesis.

Comparison between canine and porcine models of chronic deep venous thrombosis.

OBJECTIVE: To first induce chronic deep venous thrombosis in the left iliac veins of canines and porcines and then compare these two models to validate endovascular treatment devices. METHODS: Thrombin and fibrinogen were used to produce a solid thrombus in the left iliac veins of a stenosis model. The researchers used venous angiography and histological staining to investigate the progression of thrombosis. RESULTS: A left iliac vein thrombus was successfully formed in all experimental animals, including six Labrador dogs and three Bama miniature pigs, and there was minimal surgical bleeding. All dogs survived until 90 days, and three pigs died on Days 29, 33, and 58. CONCLUSION: The researchers first established the models and then observed the progression of chronic deep venous thrombosis of the iliac vein in large animals for up to 90 days. Dogs are better suited for chronic deep venous thrombosis models due to their uncomplicated anatomy, excellent obedience, and proneness to physical activity compared with pigs.

Imaging guidance for cholesteatoma surgery using tissue autofluorescence.

Significance: Cholesteatoma is an expansile destructive lesion of the middle ear and mastoid, which can result in significant complications by eroding adjacent bony structures. Currently, there is an inability to accurately distinguish cholesteatoma tissue margins from middle ear mucosa tissue, causing a high recidivism rate. Accurately differentiating cholesteatoma and mucosa will enable a more complete removal of the tissue. Aim: Develop an imaging system to enhance the visibility of cholesteatoma tissue and margins during surgery. Approach: Cholesteatoma and mucosa tissue samples were excised from the inner ear of patients and illuminated with 405, 450, and 520 nm narrowband lights. Measurements were made with a spectroradiometer equipped with a series of different longpass filters. Images were obtained using a red-green-blue (RGB) digital camera equipped with a long pass filter to block reflected light. Results: Cholesteatoma tissue fluoresced under 405 and 450 nm illumination. Middle ear mucosa tissue did not fluoresce under the same illumination and measurement conditions. All measurements were negligible under 520 nm illumination conditions. All spectroradiometric measurements of cholesteatoma tissue fluorescence can be predicted by a linear combination of emissions from keratin and flavin adenine dinucleotide. We built a prototype of a fluorescence imaging system using a 495 nm longpass filter in combination with an RGB camera. The system was used to capture calibrated digital camera images of cholesteatoma and mucosa tissue samples. The results confirm that cholesteatoma emits light when it is illuminated with 405 and 450 nm, whereas mucosa tissue does not. Conclusions: We prototyped an imaging system that is capable of measuring cholesteatoma tissue autofluorescence.

The controlling nutritional status score predicts postoperative mortality in patients with ruptured abdominal aortic aneurysm: a retrospective study.

Background: Ruptured abdominal aortic aneurysms (rAAAs) are challenging for vascular surgeons because they have a high mortality rate. In many diseases, nutritional status is closely associated with prognosis. The Controlling Nutritional Status (CONUT) screening tool score is a prognostic factor in some malignant and chronic diseases; however, the impact of nutritional status on rAAA has not yet been reported. In this study, we explored the relationship between the CONUT score and the postoperative prognosis of patients with rAAA. Methods: This was a retrospective review of 39 patients with rAAA who underwent surgical treatment from March 2018 to September 2021 at one center. Patient characteristics, nutritional status (CONUT score), and postoperative status were recorded. The patients were divided into groups A and B based on the CONUT score. The baseline characteristics of the two groups were compared, and Cox proportional hazards and logistic regression analyses were used to determine independent predictors of mid-term mortality and complications, respectively. Results: The overall mid-term mortality rate was 28.21% (11/39). Compared with group A, group B had higher intraoperative (P = 0.047) and mid-term mortality (P = 0.033) rates. The univariate analysis showed that age [hazard ratio (HR), 1.098; 95% confidence interval (CI), 1.019-1.182; P = 0.014], CONUT score (HR, 1.316; 95% CI, 1.027-1.686; P = 0.03), and surgical procedure (HR, 0.127; 95% CI, 0.016-0.992; P = 0.049) were associated with mid-term mortality, whereas the multivariate analysis showed that the CONUT score (HR, 1.313; 95% CI, 1.009-1.710; P = 0.043) was an independent predictor of mid-term mortality. The multivariate logistic regression analysis did not reveal any associations with complications. The Kaplan-Meier curves showed that group B had a lower mid-term survival rate (log-rank P = 0.024). Conclusion: Malnutrition is closely associated with the prognosis of patients with rAAA, and the CONUT score can be used to predict mid-term mortality.

Clinical implications of hemodynamic analysis for the three-dimension iliac vein model with different stenosis.

Background: The aim of this study was to perform hemodynamic simulations of a three-dimension ideal inferior vena cava-iliac vein model with artificial stenosis to determine the degree of stenosis that requires clinical intervention. Methods: Four three-dimension stenosis models (30%, 50%, 70%, and 90% stenosis) were constructed using commercial software (Solidworks). The inlet flow rates were acquired from previous literatures to perform the hemodynamic simulations. Changes in the old blood volume fraction, as well conventional hemodynamic parameters including pressure, differential pressure, wall shear stress, and flow patterns, over time were recorded. The pressure at the telecentric region of the stenosis increased with increasing degree of stenosis. Results: For the 70% stenosis model, the pressure at the telecentric region of the stenosis reached 341 Pa, and the differential pressure between the two ends of the stenosis was 363 Pa (approximately 2.7 mmHg). Moreover, in the 70% and 90% stenosis models, there was a marked change in wall shear stress in the stenosis and the proximal end region, and the flow patterns began to show the phenomenon of flow separation. Blood stasis analysis showed that the 70% stenosis model had the slowest decrease in old blood volume fraction, while the proximal end region had the largest blood residue (15%). Conclusion: Iliac vein stenosis of approximately 70% is associated with clinically relevant hemodynamic changes, and is more closely related to DVT than other degrees of stenosis.

The regulatory role of exosomes in venous thromboembolism.

Exosomes are nanoscale endocytic vesicles, 30-150 nm in diameter, secreted by most cells. They mainly originate from multivesicular bodies formed by intracellular invagination of lysosomal microparticles, and released into the extracellular matrix after fusion of multivesicular bodies with cell membrane. Studies have shown that exosomes contain a variety of active molecules, such as proteins, lipids and RNAs (such as mRNA, miRNA, lncRNA, circRNA, etc.), which regulate the behavior of recipient cells and serve as circulating biomarkers of diseases, including thrombosis. Therefore, exosome research is important for the diagnosis, treatment, therapeutic monitoring, and prognosis of thrombosis in that it can reveal the counts, surface marker expression, protein, and miRNA cargo involved. Recent studies have shown that exosomes can be used as therapeutic vectors for tissue regeneration and as alternative vectors for drug delivery. In this review, we summarize the physiological and biochemical characteristics, isolation, and identification of exosomes. Moreover, we focus on the role of exosomes in thrombosis, specifically venous thromboembolism, and their potential clinical applications, including as biomarkers and therapeutic vectors for thrombosis.

Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials.

Carotid and vertebral artery dissections are estimated to account for ∼20% of strokes in patients under 45-years-old. This meta-analysis compared the efficacy and safety of treatment with anticoagulants versus antiplatelet agents to determine the optimal therapy. We searched 4 electronic databases for clinical trials published from January 1, 1980 to August 25, 2021 that included patients who received anticoagulant or antiplatelet therapy for carotid and/or vertebral artery dissections. The curative effect was judged by recanalization evaluated by imaging. The primary outcomes were all cause death and ischemic stroke; secondary outcomes included hemorrhage and transient ischemic attack (TIA). Patients who received only a single drug treatment were divided into antiplatelet or anticoagulant groups; all received conservative treatment without surgical intervention. For this investigation, we pooled the available studies to conduct a meta-analysis, which included 7 articles with 1126 patients. The curative effect of vascular recanalization was not significantly different between the 2 treatment groups (odds ratio [OR] = 0.913, 95% confidence interval [CI]: 0.611-1.365, P = .657); similarly, no significant differences were found regarding the primary outcomes all cause death (OR = 1.747, 95%CI: 0.202-15.079, P = .612) and ischemic stroke (OR = 2.289, 95%CI: 0.997-5.254, P = .051). Patients treated with anticoagulants were more likely to experience TIA (OR = 0.517, 95%CI: 0.252-1.060, P = .072) and hemorrhage (OR = 0.468, 95%CI: 0.210-1.042, P = .063), but the differences were not statistically significant. Overall, there were no statistically significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections.

Highly Robust Silver Nanowire Network for Transparent Electrode.

Solution-processed silver nanowire networks are one of the promising candidates to replace a traditional indium tin oxide as next-generation transparent and flexible electrodes due to their ease of processing, moderate flexibility, high transparency, and low sheet resistance. To date, however, high stability of the nanowire networks remains a major challenge because the long-term usages of these electrodes are limited by their poor thermal and chemical stabilities. Existing methods for addressing this challenge mainly focus on protecting the nanowire network with additional layers that require vacuum processes, which can lead to an increment in manufacturing cost. Here, we report a straightforward strategy of a sol-gel processing as a fast and robust way to improve the stabilities of silver nanowires. Compared with reported nanoparticles embedded in nanowire networks, better thermal and chemical stabilities are achieved via sol-gel coating of TiO2 over the silver nanowire networks. The conformal surface coverage suppressed surface diffusion of silver atoms and prevented chemical corrosion from the environment. These results highlight the important role of the functional layer in providing better thermal and chemical stabilities along with improved electrical properties and mechanical robustness. The silver nanowire/TiO2 composite electrodes were applied as the source and drain electrodes for In2O3 thin-film transistors (TFTs) and the devices exhibited improved electrical performance annealed at 300 °C without the degradation of the electrodes. These key findings not only demonstrated a general and effective method to improve the thermal and chemical stabilities of metal nanowire networks but also provided a basic guideline toward rational design of highly efficient and robust composite electrodes.

Spatial element distribution control in a fully solution-processed nanocrystals-based 8.6% Cu2ZnSn(S,Se)4 device.

A fully solution-processed high performance Cu2ZnSn(S,Se)4 (CZTSSe, kesterite) device has been demonstrated. It is based on the rational engineering of elemental spatial distributions in the bulk and particularly near the surface of the film from nanocrystal precursors. The nanocrystals are synthesized through a modified colloidal approach, with excellent solubility over a large compositional window, followed by a selenization process to form the absorber. The X-ray photoluminescence (XPS) depth profiling indicates an undesirable Sn-rich surface of the selenized film. An excessive Zn species was quantitatively introduced through nanocrystals precursor to correct the element distribution, and accordingly a positive correlation between the spatial composition in the bulk/surface film and the resulting device parameter is established. The enhanced device performance is associated with the reduced interfacial recombination. With a Zn content 1.6 times more than the stoichiometry; the optimized device, which is fabricated by employing a full solution process from the absorber to the transparent top electrode, demonstrates a performance of 8.6%. This composition-control approach through stoichiometric adjustments of nanocrystal precursors, and the developed correlation between the spatial composition and device performance may also benefit other multielement-based photovoltaics.

Rational defect passivation of Cu2ZnSn(S,Se)4 photovoltaics with solution-processed Cu2ZnSnS4:Na nanocrystals.

An effective defect passivation route has been demonstrated in the rapidly growing Cu2ZnSn(S,Se)4 (CZTSSe) solar cell device system by using Cu2ZnSnS4:Na (CZTS:Na) nanocrystals precursors. CZTS:Na nanocrystals are obtained by sequentially preparing CZTS nanocrystals and surface decorating of Na species, while retaining the kesterite CZTS phase. The exclusive surface presence of amorphous Na species is proved by X-ray photoluminescence spectrum and transmission electron microscopy. With Na-free glasses as the substrate, CZTS:Na nanocrystal-based solar cell device shows 50% enhancement of device performance (∼6%) than that of unpassivated CZTS nanocrystal-based device (∼4%). The enhanced electrical performance is closely related to the increased carrier concentration and elongated minority carrier lifetime, induced by defect passivation. Solution incorporation of extrinsic additives into the nanocrystals and the corresponding film enables a facile, quantitative, and versatile approach to tune the defect property of materials for future optoelectronic applications.

10.2% power conversion efficiency polymer tandem solar cells consisting of two identical sub-cells.

Polymer tandem solar cells with 10.2% power conversion efficiency are demonstrated via stacking two PDTP-DFBT:PC71 BM bulk heterojunctions, connected by MoO3/PEDOT:PSS/ZnO as an interconnecting layer. The tandem solar cells increase the power conversion efficiency of the PDTP-DFBT:PC71 BM system from 8.1% to 10.2%, successfully demonstrating polymer tandem solar cells with identical sub-cells of double-digit efficiency.

Increasing surface band gap of Cu(In,Ga)Se2 thin films by post depositing an In-Ga-Se thin layer.

We have developed a simple approach to fabricate wide band gap surface layer for Cu(In,Ga)Se2 (CIGS) thin film. The Cu depleted surface layer was reconstructed by an In-Ga-Se post deposition treatment at different temperatures, which was monitored by a light controlling method. A desirable Cu concentration in surface layer has been achieved after depositing a 80 nm thick In-Ga-Se layer at 400°C and the corresponding device performance is remarkably improved compared with device without surface modification. Additionally, the excess Cu(2-x)Se phase on the surface could also be eliminated by this method in case of high Cu/(In+Ga).

Impact of different Na-incorporating methods on Cu(In,Ga)Se2 thin film solar cells with a low-Na substrate.

As a kind of Na-incorporating control method, NaF co-evaporation or soda-lime glass thin films (SLGTFs) are useful to improve the photovoltaic performance of Cu(In,Ga)Se(2) (CIGS) cells fabricated on low-Na substrates. X-ray diffraction (XRD) patterns and scanning electron microscope pictures demonstrate that the grain size of CIGS thin film is reduced with the addition of Na. In addition, a variance of the preferred orientation is found by XRD patterns in terms of SLGTF samples. By a use of 100 nm thick SLGTF as a Na source, the best CIGS solar cell with an efficiency of 13.42% has been obtained.