Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneou...Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention （PCI）. However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission （bleeding requiring transfusion, access site hematoma 〉 5 cm, pseudoaneurysm, and retroperitoneal bleed） and in-hospital mortality were reported for four age groups （〈 65 years, 65-74 years, 75-84 years, and ≥ 85 years）. The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age 〈 85 years and age ≥85 years. Results Of 17,378 patients studied, 1019 （5.9%） experienced bleeding and 369 （2.1%） died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age （mortality： 0.94%, 2.27%, 4.24% and 4.58%; bleeding： 3.96%, 6.62%, 10.68% and 13.99% for ages 〈 65, 65-4, 75-84 and ≥ 85 years, respectively）. On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥85 years [odds ratio （95% CI）： age 〈 65 years, 3.65 （1.99-6.74）; age 65-74 years, 2.83 （1.62-4.94）; age 75-84 years, 3.86 （2.56-5.82）, age ≥ 85 years 1.39 （0.49-3.95）]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.展开更多
Liquid-phase exfoliation （LPE） is an attractive method for the scaling-up of exfoliated MoS2 sheets compared to chemical vapor deposition and mechanical cleavage. However, the MoS2 nanosheet yield from LPE is too sm...Liquid-phase exfoliation （LPE） is an attractive method for the scaling-up of exfoliated MoS2 sheets compared to chemical vapor deposition and mechanical cleavage. However, the MoS2 nanosheet yield from LPE is too small for practical applications. We report a facile method for the scaling-up of exfoliated MoS2 nanosheets using freeze-dried silk fibroin powders. Compared to MoS2 dispersion in the absence of silk fibroin powder, sonicated MoS2 dispersions with silk fibroin powder （MoSJSilk dispersion） show noticeably higher exfoliated MoS2 nanosheet yields, with suspended MoS2 concentrations in MoS2/Silk dispersions sonicated for 2 and 5 h of 1.03 and 1.39 mg.mL-1, respectively. The MoS2 concentration in the MoS2/Silk dispersion after centrifugation above 10,000 rpm is more than four times that without the silk fibroin. The size of the dispersed silk fibroin is controlled by the change of centrifugation rate, showing the removal of silk fibroin above tens of micrometers in size after centrifugation at 2,000 rpm. Size-controlled silk fibroin biomolecules combined with MoS2 nanosheets are expected to increase the practical use of such materials in fields related to tissue engineering, biosensors and electrochemical electrodes. Atomic force microscopy and Raman spectroscopy provide the height of the MoS2 nanosheets spin-cast from MoS2/Silk dispersions, showing thicknesses of 3--6 nm. X-ray photoelectron spectroscopy and X-ray diffraction indicate that the outermost surface layer of the hydrophobic MoS2 crystals interact with oxygen-containing functional groups that exist in the hydrophobic part of silk fibroins. The amphiphilic properties of silk fibroin combined with the MoS2 nanosheets stabilize dispersions by enhancing solvent-material interactions. The large quantities of exfoliated MoS2 nanosheets suspended in the as-synthesized dispersions can be utilized for the fabrication of vapor and electrochemical devices requiring high MoS2 nanosheets contents.展开更多
文摘Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention （PCI）. However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission （bleeding requiring transfusion, access site hematoma 〉 5 cm, pseudoaneurysm, and retroperitoneal bleed） and in-hospital mortality were reported for four age groups （〈 65 years, 65-74 years, 75-84 years, and ≥ 85 years）. The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age 〈 85 years and age ≥85 years. Results Of 17,378 patients studied, 1019 （5.9%） experienced bleeding and 369 （2.1%） died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age （mortality： 0.94%, 2.27%, 4.24% and 4.58%; bleeding： 3.96%, 6.62%, 10.68% and 13.99% for ages 〈 65, 65-4, 75-84 and ≥ 85 years, respectively）. On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥85 years [odds ratio （95% CI）： age 〈 65 years, 3.65 （1.99-6.74）; age 65-74 years, 2.83 （1.62-4.94）; age 75-84 years, 3.86 （2.56-5.82）, age ≥ 85 years 1.39 （0.49-3.95）]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.
文摘Liquid-phase exfoliation （LPE） is an attractive method for the scaling-up of exfoliated MoS2 sheets compared to chemical vapor deposition and mechanical cleavage. However, the MoS2 nanosheet yield from LPE is too small for practical applications. We report a facile method for the scaling-up of exfoliated MoS2 nanosheets using freeze-dried silk fibroin powders. Compared to MoS2 dispersion in the absence of silk fibroin powder, sonicated MoS2 dispersions with silk fibroin powder （MoSJSilk dispersion） show noticeably higher exfoliated MoS2 nanosheet yields, with suspended MoS2 concentrations in MoS2/Silk dispersions sonicated for 2 and 5 h of 1.03 and 1.39 mg.mL-1, respectively. The MoS2 concentration in the MoS2/Silk dispersion after centrifugation above 10,000 rpm is more than four times that without the silk fibroin. The size of the dispersed silk fibroin is controlled by the change of centrifugation rate, showing the removal of silk fibroin above tens of micrometers in size after centrifugation at 2,000 rpm. Size-controlled silk fibroin biomolecules combined with MoS2 nanosheets are expected to increase the practical use of such materials in fields related to tissue engineering, biosensors and electrochemical electrodes. Atomic force microscopy and Raman spectroscopy provide the height of the MoS2 nanosheets spin-cast from MoS2/Silk dispersions, showing thicknesses of 3--6 nm. X-ray photoelectron spectroscopy and X-ray diffraction indicate that the outermost surface layer of the hydrophobic MoS2 crystals interact with oxygen-containing functional groups that exist in the hydrophobic part of silk fibroins. The amphiphilic properties of silk fibroin combined with the MoS2 nanosheets stabilize dispersions by enhancing solvent-material interactions. The large quantities of exfoliated MoS2 nanosheets suspended in the as-synthesized dispersions can be utilized for the fabrication of vapor and electrochemical devices requiring high MoS2 nanosheets contents.
