Comprehensively evaluate the short outcome of small bowel obstruction:A novel medical-economic score system

BACKGROUND Small bowel obstruction(SBO)still imposes a substantial burden on the health care system.Traditional evaluation systems for SBO outcomes only focus on a single element.The comprehensive evaluation of outcomes for patients with SBO remains poorly studied.Early intensive clinical care would effectively improve the short-term outcomes for SBO,however,the full spectrum of the potential risk status regarding the high complication-cost burden is undetermined.AIM We aim to construct a novel system for the evaluation of SBO outcomes and the identification of potential risk status.METHODS Patients who were diagnosed with SBO were enrolled and stratified into the simple SBO(SiBO)group and the strangulated SBO(StBO)group.A principal component(PC)analysis was applied for data simplification and the extraction of patient characteristics,followed by separation of the high PC score group and the low PC score group.We identified independent risk status on admission via a binary logistic regression and then constructed predictive models for worsened management outcomes.Receiver operating characteristic curves were drawn,and the areas under the curve(AUCs)were calculated to assess the effectiveness of the predictive models.RESULTS Of the 281 patients,45 patients(16.0%)were found to have StBO,whereas 236 patients(84.0%)had SiBO.Regarding standardized length of stay(LOS),total hospital cost and the presence of severe adverse events(SAEs),a novel principal component was extracted(PC score=0.429×LOS+0.444×total hospital cost+0.291×SAE).In the multivariate analysis,risk statuses related to poor results for SiBO patients,including a low lymphocyte to monocyte ratio(OR=0.656),radiological features of a lack of small bowel feces signs(OR=0.316)and mural thickening(OR=1.338),were identified as risk factors.For the StBO group,higher BUN levels(OR=1.478)and lower lymphocytes levels(OR=0.071)were observed.The AUCs of the predictive models for poor outcomes were 0.715(95%CI:0.635-0.795)and 0.874(95%CI:0.762-0.986)for SiBO and StBO stratification,respectively.CONCLUSION The novel PC indicator provided a comprehensive scoring system for evaluating SBO outcomes on the foundation of complication-cost burden.According to the relative risk factors,early tailored intervention would improve the short-term outcomes.

Lymphocyte-to-monocyte ratio effectively predicts survival outcome of patients with obstructive colorectal cancer

BACKGROUND Obstructive colorectal cancer(OCC)is always accompanied by severe complications,and the optimal strategy for patients with OCC remains undetermined.Different from emergency surgery(ES),self-expandable metal stents(SEMS)as a bridge to surgery(BTS),could increase the likelihood of primary anastomosis.However,the stent failure and related complications might give rise to a high recurrence rate.Few studies have focused on the indications for either method,and the relationship between preoperative inflammation indexes and the prognosis of OCC is still underestimated.AIM To explore the indications for ES and BTS in OCCs based on preoperative inflammation indexes.METHODS One hundred and twenty-eight patients who underwent ES or BTS from 2008 to 2015 were enrolled.Receiver operating characteristic(ROC)curve analysis was used to define the optimal preoperative inflammation index and its cutoff point.Kaplan–Meier analyses and Cox proportional hazards models were applied to assess the association between the preoperative inflammation indexes and the survival outcomes[overall survival(OS)and disease-free survival(DFS)].Stratification analysis was performed to identify the subgroups that would benefit from ES or BTS.RESULTS OS and DFS were comparable between the ES and BTS groups(P>0.05).ROC curve analysis showed derived neutrophil-to-lymphocyte ratio(dNLR)as the optimal biomarker for the prediction of DFS in ES(P<0.05).Lymphocyte-tomonocyte ratio(LMR)was recommended for BTS with regard to OS and DFS(P<0.05).dNLR was related to stoma construction(P=0.001),pneumonia(P=0.054),and DFS(P=0.009)in ES.LMR was closely related to lymph node invasion(LVI)(P=0.009),OS(P=0.020),and DFS(P=0.046)in the BTS group.dNLR was an independent risk factor for ES in both OS(P=0.032)and DFS(P=0.016).LMR affected OS(P=0.053)and DFS(P=0.052)in the BTS group.LMR could differentiate the OS between the ES and BTS groups(P<0.05).CONCLUSION Preoperative dNLR and LMR could predict OS and DFS in patients undergoing ES and BTS,respectively.For OCC,as the potential benefit group,patients with a low LMR might be preferred for BTS via SEMS insertion.

Zintl Phase BaAgSb: Low Thermal Conductivity and High Performance Thermoelectric Material in Ab Initio Calculation

Thermoelectric materials are critical parts in thermal electric devices.Here,Zintl phase BaAgSb in space group of P63/mmc is reported as a promising thermoelectric material in density function theory.The anisotropic lattice thermal conductivity and phonon transport properties are investigated in theory.The strong phonon-phonon scattering in BaAgSb exhibits ultra-low lattice thermal conductivity of 0.59 W·m^(-1)·K^(-1) along c-axis at 800 K,and high thermoelectric performance ZT=0.94 at 400 K.The mix of covalent and ionic bond supports high carrier mobility and low thermal conductivity.The unusual features make BaAgSb a potential thermoelectric material.

Rapid Conversion of Perhydropolysilazane into Thin Silica Coating at Low Temperature

The conversion of perhydropolysilazane(PHPS)to silica at low temperature is beneficial for its application on thermally vulnerable substrates.In this work,it is demonstrated that(3-aminopropyl)triethoxysilane(APTES)has high catalytic efficiency for the low temperature conversion of PHPS and the catalytic mechanism of APTES was suggested.The influence of temperatu re and humidity on the catalytic conversion process was investigated,and it was found that PHPS can be rapidly converted to silica in 10 min at 80℃with relative humidity of 90%.The achieved silica is mainly composed of SiNO_(3)/SiO_(3)OH and SiO_(4)structure with O/Si of 1.74 and N content of 1%.As an approach to prepare inorganic coating,the low-temperature conversion method achieves a silica coating with low volume shrinkage of 0.86%,low roughness of R_(a)=0.293 nm,high nanoindentation hardness of 3.62 GPa and modulus of 30.06 GPa,which exhibits high potentials as protective coating for va rious materials even those vulnerable to high temperature.

Application of neutron scattering in organic photovoltaic materials

Over last decades,the development of new organic materials has contributed to the rapid increase of high-power conversion efficiency of photovoltaic cells.At this stage,to understand the structure and the dynamic of materials is of significant importance for designing novel low-cost photovoltaic cells with superior performance.Neutron scattering is a powerful tool to provide unique and non-destructive information for the organic photovoltaic materials with particular advantages of addressing different parts of organic system by deuterium or tritium substitution.In addition,by employing several neutron scattering methods together,it is possible to further access the static structure and dynamic relaxation of the materials.With this perspective review,we introduce three neutron scattering techniques,including neutron reflectivity,small angle neutron scattering,grazing incidence small angle neutron scattering and quasi-elastic neutron scattering,and their applications on the organic photovoltaic materials.

Development of 3He-filled linear position-sensitive detector for neutron scattering instruments at CSNS

Background Helium-3-filled linear position-sensitive detectors(LPSDs)have been widely applied to neutron scattering instruments in recent decades owing to the high detection efficiency,the excellent neutron/gamma discrimination,and the ability to construct the detector with large area coverage.More than 65%of neutron instruments at the China Spallation Neutron Source(CSNS)require ^(3)He LPSDs for the building of the detector system.The detector of a neutron scattering instrument is normally an array detector composed of a large number of ^(3)He LPSDs.However,no appropriate substitute detector is available for the ^(3)He LPSD for operation over a short period,and its specifications need to be customized to satisfy the requirements of different instruments.This necessitates the development of ^(3)He LPSDs with different specifications for building and upgrading the detectors of neutron scattering instruments at CSNS.Purpose To meet the general requirements specified by the neutron instruments at CSNS,a ^(3)He LPSD was developed and its performances were investigated by using the neutron beam.Methods The neutron beam experiments for this ^(3)He LPSD,including measurements of counting rate plateau curve,position calibration,and position resolution along the tube path,were carried out at the beamline-20 of CSNS.To evaluate its performance in the instrument operation,a detector module made of this ^(3)He LPSD has been installed in the multi-physics instrument(MPI),and the comparison test with the commercial ^(3)He LPSD has been conducted at neutron scattering experiments.Results and conclusion The experimental measurements for this ^(3)He LPSD based on the neutron beam showed that it satisfies the requirements for use in neutron scattering instruments.It reaches a plateau slope of 2.6%/100 V with a plateau range from 1750 to 1950 V and attained a minimal position resolution of 5.3 mm(FWHM),superior to the one achieved by the commercial ^(3)He LPSD.In addition,this ^(3)He LPSD detector module applied to the MPI has been working steadily for half of year and is available for use in experiments.These results provide a sound basis for the subsequent construction and upgradation of the detector of neutron scattering instruments at CSNS.

Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History

Background：Preterm birth （PTB） is the leading cause of perinatal morbidity and mortality worldwide,and its prevention is an important health-care priority.The cervical incompetence is a well-known risk factor for PTB and its incidence is about 0.1-2.0%,while there is no ideal optimum treatment recommended currently.The cervical incompetence causes about 15% of habitual abortion in 16-28 weeks.This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history.Methods：We retrospectively observed the pregnancy outcome of 198 patients diagnosed with cervical incompetence from January 2010 to October 2015 in Beijing Hospital.Among the 198 women involved,women who had at least one PTB before 32 weeks （including abortion in the second trimester attributed to the cervical competence） were assigned to the PTB history cohort,and others were assigned to the non-PTB history cohort.All women underwent cerclage placement （cervical cerclage group） or administrated with vaginal progesterone （vaginal progesterone group） until delivery.The outcomes of interest were the differences in gestational age at delivery,the rate of premature delivery,neonatal outcome,complications,and route of delivery between the two treatment groups.Results：Among the 198 patients with cervical incompetence,116 patients in PTB history cohort and 80 patients in non-PTB history cohort were included in the final analysis.In the PTB history cohort,cervical cerclage group had significantly longer cervical length at 2 weeks after the start of treatment （23.1 ± 4.6 mm vs.12.4 ± 9.1 mm,P =0.002）,higher proportion of delivery ≥37 weeks＇ gestation （63.4% vs.33.3%,P =0.008）,bigger median birth weight （2860 g vs.2250 g,P =0.031）,and lower proportion of neonates whose 1-min Apgar score 〈7 （5.9% vs.33.3%,P =0.005）,compared with vaginal progesterone group.No significant differences were found in other outcome measures between the two treatment groups.In the non-PTB history cohort,there were no significant differences in the maternal outcomes between cervical cerclage and vaginal progesterone groups,such as median gestational age at delivery （37.4 weeks vs.37.3 weeks,P =0.346） and proportion of delivery ≥37 weeks＇ gestation （55.9% vs.60.9%,P =0.569）.There were also no significant differences in the neonatal outcomes between the cervical cerclage and vaginal progesterone groups including the median birth weight （2750 g vs.2810 g,P =0.145）,perinatal mortality （5.9% vs.6.5%,P =0.908）,and 1-min Apgar scores （8.8% vs.8.7%,P =0.984）.Conclusions：Cervical cerclage showed more benefits in the maternal and neonatal outcomes than vaginal progesterone therapy for women with an asymptomatic short cervix and prior PTB history,while cervical cerclage and vaginal progesterone therapies showed similar effectiveness for women with an asymptomatic short cervix but without a history of PTB.