Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer

To explore the effect of early enteral nutrition （EN） on postoperative nutritional status, intestinal permeability, and immune 6anction in elderly patients with esophageal cancer or cardiac cancer. Methods： A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group （n=50） and parenteral nutrition （PN） group （n=46） based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase （DAO） activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme- linked immunosorbent assay （ELISA）. Results： After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group （P〈0.05）, whereas the EN group had significantly higher albumin levels than the PN group （P〈0.05）. On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group （all P〈0.05）. In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group （P〈0.05） but significantly lower IL-2, IL-6, and TNF-a levels （P〈0.05）. Conclusions： In elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier （by reducing plasma endoxins）, and enhance the immune function

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer

Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.

Nonintubated thoracoscopic lobectomy plus lymph node dissection following segmentectomy for central type pulmonary masses

Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,

A flexible design strategy to modify Ti3C2Tx MXene surface terminations via nucleophilic substitution for long-life Li-S batteries

MXene-based materials have gained considerable attention for lithium-sulfur(Li-S)batteries cathode materials due to their superior electric conductivity and high affinitive to polysulfides.However,there are still challenges in modifying the surface functional groups of MXene to further improve the electrochemical performance and increase the structure variety for MXene-based sulfur host.Herein,we report an efficient and flexible nucleophilic substitution(S_(N))strategy to modify the Ti_(3)C_(2)T_(x) surface terminations and purposefully designed Magnolol-modified Ti_(3)C_(2)T_(x)(M-Ti_(3)C_(2)T_(x))as powerful cathode host materials.Benefiting from more C-Ti-O bonds forming and diallyl groups terminations reducing after the dehalogenation and nucleophilic addition reactions,the given M-Ti_(3)C_(2)T_(x) electrode could effectively suppress the lithium polysulfides shuttling via chemisorption and C—S covalent bond formation.Besides,the Magnolol-modified Ti_(3)C_(2)T_(x) significantly accelerates polysulfide redox reaction and reduces the activation energy of Li_(2) S decomposition.As a result,the as-prepared M-Ti_(3)C_(2)T_(x) electrode displays an excellent rate capability and a high reversible capacity of 7.68 mAh cm^(-2)even under 7.2 mg cm^(-2)S-loaded with a low decay rate of 0.07%(from 2 nd cycle).This flexible surface-modified strategy for MXene terminations is expected to be extended to other diverse MXene applications.

A Novel Strategy of In Situ Trimerization of Cyano Groups Between the Ti3C2Tx(MXene) Interlayers for High-Energy and High-Power Sodium-Ion Capacitors

2D MXenes are attractive for energy storage applications because of their high electronic conductivity.However,it is still highly challenging for improving the sluggish sodium(Na)-ion transport kinetics within the MXenes interlayers.Herein,a novel nitrogen-doped Ti3C2Tx MXene was synthesized by introducing the in situ polymeric sodium dicyanamide(Na-dca)to tune the complex terminations and then utilized as intercalation-type pseudocapacitive anode of Na-ion capacitors(NICs).The Na-dca can intercalate into the interlayers of Ti3C2 Tx nanosheets and simultaneously form sodium tricyanomelaminate(Na3TCM)by the catalyst-free trimerization.The as-prepared Ti3C2Tx/Na3TCM exhibits a high N-doping of 5.6 at.%in the form of strong Ti-N bonding and stabilized triazine ring structure.Consequently,coupling Ti3C2Tx/Na3 TCM anode with different mass of activated carbon cathodes,the asymmetric MXene//carbon NICs are assembled.It is able to deliver high energy density(97.6 Wh kg-1),high power output(16.5 kW kg-1),and excellent cycling stability(≈82.6%capacitance retention after 8000 cycles).

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC

High and ultra-stable energy storage from all-carbon sodium-ion capacitor with 3D framework carbon as cathode and carbon nanosheet as anode

Sodium-ion capacitors(SICs)are extremely promising due to the combined merits of high energy-power characteristics and considerable price advantage.However,it is still difficult to achieve high energypower outputs and cycle stability in a typical configuration of the metal-based battery-type anode and activated carbon capacitor-type cathode due to the kinetic mismatching.In this work,a carbon nanosheet(PSCS-600)with large interlayer spacing of 0.41 nm derived from the bio-waste pine cone shell was prepared.Besides,the covalent triazine framework derived carbon(OPDN-CTF-A)was obtained through ionothermal synthesis strategy,exhibiting beneficial hierarchical pores(0.5-6 nm)and high heteroatoms(5.6 at%N,6.6 at%O).On this basis,the all-carbon SICs were fabricated by the integration of PSCS-600 anode and OPDN-CTF-A cathode.The device delivered high energy density 111 Wh kg^(-1),high power output of 14,200 W kg^(-1) and ultra-stable cycling life(~90.7%capacitance retention after 10,000 cycles).This work provides new ideas in fabricating carbon-carbon architectural SICs with high energy storage for practical application.

Carbon spheres with rational designed surface and secondary particle-piled structures for fast and stable sodium storage

The electrochemical performance of hard carbon in sodium storage is still limited by its poor cycling stability and rate capability because of the sluggish kinetics process.In this study,we use a simple and effective method to accelerate the kinetics process by engineering the structure of the electrode to promote its surface and near-surface reactions.This goal is realized by the use of slightly aggregated ultra-small carbon spheres.The large specific surface area formed by the small spheres can provide abundant active sites for electrochemical reactions.The abundant mesopores and macropores derived from the secondary particle piled structure of the carbon spheres could facilitate the transport of electrolytes,shorten the diffusion distance of Na^(+)and accommodate the volume expansion during cycling.Benefiting from these unique structure features,PG700-3(carbon spheres with the diameters of 40-60 nm carbonized at 700℃)exhibits high performance for sodium storage.A high reversible capacity of 163 mAh g^(-1) could be delivered at a current density of 1.0 A g^(-1) after 100 cycles.Interestingly,at a current density of 10.0 A g^(-1),the specific capacity of PG700-3 gradually increases to 140 mAh g^(-1) after 10000 cycles,corresponding to a capacity retention of 112%.Given the enhanced kinetics of SIBs reactions,PG700-3 exhibits an excellent rate capability,i.e.,230 and 138 mAh g^(-1) at 0.1 and 5.0 A g^(-1),respectively.This study provides a facile method to attain high performance anode materials for SIBs.The design strategy and improvement mechanism could be extended to other materials for high rate applications.

A lightweight nitrogen/oxygen dual-doping carbon nanofiber interlayer with meso-/micropores for high-performance lithium-sulfur batteries

Lithium-sulfur(Li-S) batteries are promising energy-storage devices for future generations of portable electronics and electric vehicles because of the outstanding energy density,low cost,and nontoxic nature of S.In the past decades,various novel electrodes and electrolytes have been studied to improve the performance of Li-S batteries.However,the very limited lifespan and rate performance of Li-S batteries originating from the dissolution and diffusion of long-chain polysulfides in liquid electrolytes,and the intrinsic poor conductivity of S severely hinder their practical application.Herein,an electrospinning method was developed to fabricate a thin conductive interlayer consisting of meso-/microporous N/O dual-doping carbon nanofiber(CNF).The freestanding 3 D interwoven structure with conductive pathways for electrons and ions can enhance the contact between polysulfides and N/O atoms to realize the highly robust trapping of polysulfides via the extremely polar interaction.Consequently,combining the meso-microporous N/O dual-doping CNF interlayer with a monodispersed S nanoparticle cathode results in a superior electrochemical performance of 862.5 mAh/g after 200 cycles at 0.2 C and a cycle decay as low as 0.08% per cycle.An area specific capacity of 5.22 mAh/cm^(2) can be obtained after 100 cycles at 0.1 C with a high S loading of 7.5 mg/cm^(2).

High-Performance and Flexible Co-Planar Integrated Microsystem of Carbon-Based All-Solid-State Micro-Supercapacitor and Real-Time Temperature Sensor

With the rapid development of flexible and portable microelectronics,the extreme demand for miniaturized,mechanically flexible,and integrated microsystems are strongly stimulated.Here,biomass-derived carbons(BDCs)are prepared by KOH activation using Qamgur precursor,exhibiting three-dimensional(3D)hierarchical porous structure.Benefiting from unobstructed 3D hierarchical porous structure,BDCs provide an excellent specific capacitance of 433 F g^(-1)and prominent cyclability without capacitance degradation after 50000 cycles at 50 A g^(-1).Furthermore,BDC-based planar micro-supercapacitors(MSCs)without metal collector,prepared by mask-assisted coating,exhibit outstanding areal-specific capacitance of 84 mF cm^(-2)and areal energy density of 10.6μWh cm^(-2),exceeding most of the previous carbon-based MSCs.Impressively,the MSCs disclose extraordinary flexibility with capacitance retention of almost 100%under extreme bending state.More importantly,a flexible planar integrated system composed of the MSC and temperature sensor is assembled to efficiently monitor the temperature variation,providing a feasible route for flexible MSC-based functional micro-devices.

Manipulating the morphology of CdS/Sb_(2)S_(3) heterojunction using a Mg-doped tin oxide buffer layer for highly efficient solar cells

Antimony sulfide(Sb_(2)S_(3))is an appealing semiconductor as light absorber for solar cells due to its high absorption coefficient,appropriate band gap(~1.7 e V)and abundance of constituent elements.However,power conversion efficiency(PCE)of Sb_(2)S_(3)-based solar cells still lags much behind the theoretically predicted due to the imperfect energy level alignment at the charge transporting layer/Sb_(2)S_(3)interfaces and hence severe charge recombination.Herein,we insert a high-temperature sintered magnesium(Mg)-doped tin oxide(SnO_(2))layer between cadmium sulfide(Cd S)and fuorine doped tin oxide to form a cascaded energy level alignment and thus mitigate interfacial charge recombination.Simultaneously,the inserted Mg-doped Sn O_(2)buffer layer facilitates the growth of the neibouring Cd S film with orientation followed by Sb_(2)S_(3)film with larger grains and fewer pinholes.Consequently,the resultant Sb_(2)S_(3)solar cells with Mg-doped SnO_(2)deliver a champion PCE of 6.31%,22.8%higher than those without a buffer layer.Our work demonstrates that deliberate absorber growth as well as efficient hole blocking upon an appropriate buffer layer is viable in obtaining solution-processed Sb_(2)S_(3)solar cells with high performance.

The activity and immune dynamics of PD-1 inhibition on high-risk pulmonary ground glass opacity lesions:insights from a single-arm,phase II trial

Immune checkpoint inhibitors targeting the programmed cell death-1(PD-1)protein significantly improve survival in patients with advanced non-small-cell lung cancer(NSCLC),but its impact on early-stage ground-glass opacity(GGO)lesions remains unclear.This is a single-arm,phase II trial(NCT04026841)using Simon’s optimal two-stage design,of which 4 doses of sintilimab(200 mg per 3 weeks)were administrated in 36 enrolled multiple primary lung cancer(MPLC)patients with persistent high-risk(Lung-RADS category 4 or had progressed within 6 months)GGOs.The primary endpoint was objective response rate(ORR).T/B/NK-cell subpopulations,TCR-seq,cytokines,exosomal RNA,and multiplexed immunohistochemistry(mIHC)were monitored and compared between responders and non-responders.Finally,two intent-to-treat(ITT)lesions(pure-GGO or GGO-predominant)showed responses(ORR:5.6%,2/36),and no patients had progressive disease(PD).No grade 3-5 TRAEs occurred.The total response rate considering two ITT lesions and three non-intent-to-treat(NITT)lesions(pure-solid or solid-predominant)was 13.9%(5/36).The proportion of CD8^(+)T cells,the ratio of CD8^(+)/CD4^(+),and the TCR clonality value were significantly higher in the peripheral blood of responders before treatment and decreased over time.Correspondingly,the mIHC analysis showed more CD8^(+)T cells infiltrated in responders.Besides,responders’cytokine concentrations of EGF and CTLA-4 increased during treatment.The exosomal expression of fatty acid metabolism and oxidative phosphorylation gene signatures were down-regulated among responders.Collectively,PD-1 inhibitor showed certain activity on high-risk pulmonary GGO lesions without safety concerns.Such effects were associated with specific T-cell re-distribution,EGF/CTLA-4 cytokine compensation,and regulation of metabolism pathways.

Replacing“Alkyl”with“Aryl”for inducing accessible channels to closed pores as plateau-dominated sodium-ion battery anode

Hard carbons are promising anodes for sodium-ion batteries.However,there is still considerable controversy regarding the sodium storage behaviors in hard carbons,which are mainly attributed to the varied precursors,confused pyrolysis mechanism,and different characterization methods.Herein,benefiting from the flexible molecular structure of polymers,a series of hard carbons with carefully tunedmicrostructures are fabricated by adjusting the ratio of aryl and alkyl groups in the epoxy resins.The results of dynamic mechanical analysis,insitu Fourier transform infrared spectra,and synchronous thermal gravimetricinfrared spectrum-gas chromatography/mass spectrometry reveal that replacing the alkyl with aryl groups in the resin can enhance the crosslink density,inhibit the degradation and rearrangement process,and further lead to a more disordered microstructure.In addition,it is suggested that accessible channels provided by sufficiently wide interlayer spacing are necessary for closed pore filling.The optimized anode delivers a high capacity of 375 mAh/g in half cell with an initial Coulombic efficiency of 80.61%,and an energy density of 252 Wh/kg is attained in full cell.Finally,a reliable relationship among precursor-pyrolysis mechanism-structure-performance is established,and the sodium storagemechanism of“adsorption-insertion-pore filling”iswell proved.

Sulfur polymerization strategy based on the intrinsic properties of polymers for advanced binder-free and high-sulfur-content Li–S batteries

Lithium-sulfur(Li-S)batteries are the promising next-generation secondary energy storage systems,because of their advantages of high energy density and environmental friendliness.Among numerous cathode materials,organosulfur polymer materials have received extensive attentions because of their controllable structure and uniform sulfur distribution.However,the sulfur content of most organosulfur polymer cathodes is limited(S content<60%)due to the addition of large amounts of conductive agents and binders,which adversely affects the energy density of Li-S batteries.Herein,a hyperbranched sulfur-rich polymer based on modified polyethyleneimine(Ath-PEI)named carbon nanotubeentangled poly(allyl-terminated hyperbranched ethyleneimine-random-sulfur)(CNT/Ath-PEI@S)was prepared by sulfur polymerization and used as a Li-S battery cathode.The high intrinsic viscosity of Ath-PEI provided considerable adhesion and avoided the addition of PVDF binder,thereby increasing the sulfur content of cathodes to 75%.Moreover,considering the uniform distribution of elemental sulfur by the polymer,the utilization of sulfur was successfully improved,thus improving the rate capability and discharge capacity of the battery.The binder-free,sulfur-rich polymer cathode exhibited ultra-high initial discharge capacity(1520.7 mAh g^(−1) at 0.1 C),and high rate capability(804 mAh g^(−1) at 2.0 C).And cell-level calculations show that the electrode exhibits an initial capacity of 942.3 mAh g^(−1) electrode,which is much higher than those of conventional sulfur-polymer electrodes reported in the literature.