Do race and gender influence the use of invasive procedures?

OBJECTIVE: To assess the influence of race and gender influence on the use of invasive procedures in patients with acute myocardial infarction (AMI) in community hospitals. DESIGN: Prospective, observational. SETTING: Five mid-Michigan community hospitals. PATIENTS: All patients (838) identified with AMI between January 1994 and April 1995 in 1 of these hospitals. MEASUREMENTS AND MAIN RESULTS: After adjusting for age, hospital of admission, insurance type, severity of AMI, and comorbidity, using white men as the reference group, the rate of being offered cardiac catheterization (CC) was 0.88 (95% confidence interval [95% CI], 0.60 to 1.29) for white women; 0.79 (95% CI, 0.41 to 1.50) for black men; and 1.14 (95% CI, 0.53 to 2.45)for black women. Among patients who underwent CC, after also adjusting for coronary artery anatomy, the rate of being offered angioplasty, using white men as the reference group, was 1.22 (95% CI, 0.75 to 1.98) for white women; 0.61 (5% CI, 0.29 to 1.28, P =.192) for black men; and 0.40 (95% CI, 0.14 to 1.13) for black women The adjusted rate of being offered bypass surgery was 0.47 (95% CI, 0.24 to 0.89) for white women; 0.36 (95% CI, 0.12 to 1.06) for black men; and 0.37 (95% CI, 0.11 to 1.28)for black women. CONCLUSIONS: Our study shows that white women are less likely than white men to be offered bypass surgery after AMI. Although black men and women with AMI are less likely than white men to be offered percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in both unadjusted and adjusted analyses, these findings did not reach statistical significance. Our study is limited in power due to the small number of blacks in the sample.     

Near universal detection of alterations in CTNNB1 and Wnt pathway regulators in desmoid‐type fibromatosis by whole‐exome sequencing and genomic analysis

CTNNB1 mutations or APC abnormalities have been observed in ～85% of desmoids examined by Sanger sequencing and are associated with Wnt/β‐catenin activation. We sought to identify molecular aberrations in “wild‐type” tumors (those without CTNNB1 or APC alteration) and to determine their prognostic relevance. CTNNB1 was examined by Sanger sequencing in 117 desmoids; a mutation was observed in 101 (86%) and 16 were wild type. Wild‐type status did not associate with tumor recurrence. Moreover, in unsupervised clustering based on U133A‐derived gene expression profiles, wild‐type and mutated tumors clustered together. Whole‐exome sequencing of eight of the wild‐type desmoids revealed that three had a CTNNB1 mutation that had been undetected by Sanger sequencing. The mutation was found in a mean 16% of reads (vs. 37% for mutations identified by Sanger). Of the other five wild‐type tumors sequenced, two had APC loss, two had chromosome 6 loss, and one had mutation of BMI1. The finding of low‐frequency CTNNB1 mutation or APC loss in wild‐type desmoids was validated in the remaining eight wild‐type desmoids; directed miSeq identified low‐frequency CTNNB1 mutation in four and comparative genomic hybridization identified APC loss in one. These results demonstrate that mutations affecting CTNNB1 or APC occur more frequently in desmoids than previously recognized (111 of 117; 95%), and designation of wild‐type genotype is largely determined by sensitivity of detection methods. Even true CTNNB1 wild‐type tumors (determined by next‐generation sequencing) may have genomic alterations associated with Wnt activation (chromosome 6 loss/BMI1 mutation), supporting Wnt/β‐catenin activation as the common pathway governing desmoid initiation. © 2015 Wiley Periodicals, Inc.     

基于案例的Teach-back在肿瘤患者预防跌倒 健康教育中的应用

目的 探讨基于案例的Teach-back法在肿瘤患者预防跌倒健康教育中的应用效果。方法 选取我科2016年6-12月120例肿瘤患者作为对照组,2017年1-6月140例肿瘤患者作为观察组。对照组实施传统预防跌倒健康教育,观察组采用基于案例的Teach-back法实施预防跌倒的健康教育。比较2组患者跌倒防范措施依从率、跌倒发生率的差异。结果 观察组患者跌倒防范措施依从率为97.63%,明显高于对照组的85.18%(χ²=2 774.640,P<0.001),患者跌倒发生率低于对照组(χ²=5.119,P=0.024)。结论 在肿瘤跌倒高风险患者中运用基于案例的Teach-back对患者进行健康教育,能有效提高患者跌倒防范措施的依从率,降低患者跌倒发生率,值得临床推广。     

Low temperature CO oxidation catalysed by flower-like Ni–Co–O: how physicochemical properties influence catalytic performance

In this work, mesoporous Ni–Co composite oxides were synthesized by a facile liquid-precipitation method without the addition of surfactant, and their ability to catalyse a low temperature CO oxidation reaction was investigated. To explore the effect of the synergetic interaction between Ni and Co on the physicochemical properties and catalytic performance of these catalysts, the as-prepared samples were characterized using XRF, XRD, LRS, N₂-physisorption (BET), SEM, TEM, XPS, H₂-TPR, O₂-TPD and in situ DRIFTS characterization techniques. The results are as follows: (1) the doping of cobalt can reduces the size of NiO, thus massive amorphous NiO have formed and highly dispersed on the catalyst surface, resulting in the formation of abundant surface Ni²⁺ ions; (2) Ni²⁺ ions partially substitute Co³⁺ ions to form a Ni–Co spinel solid solution, generating an abundance of surface oxygen vacancies, which are vital for CO oxidation; (3) the Ni_0.8Co_0.2 catalyst exhibits the highest catalytic activity and a satisfactory stability for CO oxidation, whereas a larger cobalt content results in a decrease in activity, suggesting that the amorphous NiO phase is the dominant active phase instead of Co₃O₄ for CO oxidation; (4) the introduction of Co can alter the morphology of catalyst from plate-like to flower-like and then to dense granules. This morphological variation is related to the textural properties and catalytic performance of the catalysts. Lastly, a possible mechanism for CO oxidation reaction is tentatively proposed.

The flower-like catalyst possesses highly dispersed amorphous NiO and a high concentration of surface oxygen vacancies which are the central points for CO oxidation.     

Manganese(ii) enhanced fluorescent nitrogen-doped graphene quantum dots: a facile and efficient synthesis and their applications for bioimaging and detection of Hg2+ ions

Manganese ion (Mn²⁺) bonded nitrogen-doped graphene quantum dots (Mn(ii)-NGQDs) with water solubility have been successfully synthesized by a simple, one-pot hydrothermal carbonization, using sodium citrate, glycine and manganese chloride as raw materials. The photoluminescence (PL) characteristics of Mn(ii)-NGQDs were studied in detail. The resulting Mn(ii)-NGQDs show a remarkably enhanced PL intensity and quantum yield (QY = 42.16%) compared with the product without Mn(ii)-doped (named as NG, QY = 27.06%) and the product doped with other metal ions. The Mn(ii)-NGQDs not only display low toxicity and high cellular uptake efficiency for fluorescence live cell imaging in biological evaluations but also exhibit a fast, highly selective and sensitive fluorescence quenching effect toward Hg²⁺ ions, with a detection limit of 3.4 × 10⁻⁸ mol L⁻¹.

Manganese ion (Mn²⁺) bonded nitrogen-doped graphene quantum dots (Mn(ii)-NGQDs) with water solubility have been successfully synthesized by a simple, one-pot hydrothermal carbonization, using sodium citrate, glycine and manganese chloride as raw materials.     

Promising bactericidal approach of dihydrazone analogues against bio-film forming Gram-negative bacteria and molecular mechanistic studies

Gram-negative members of the ESCAPE family are more difficult to treat, due to the presence of an additional barrier in the form of a lipopolysaccharide layer and the efficiency of efflux pumps to pump out the drugs from the cytoplasm. The development of alternative therapeutic strategies to tackle ESCAPE Gram-negative members is of extreme necessity to provide a solution to the cause of life-threatening infections. The present investigations demonstrated that compounds 17, 20, 25 and 26 possessing the presence of electron donating (OH and OCH₃) groups on the phenyl rings are highly potent; whereas compounds 9, 10, 15, 16, 18, 33 and 36 showed moderate activity against Gram-negative bacteria. An excellent dose-dependent antibacterial activity was established compared to that of the standard antibiotic ampicillin. Significant anti-biofilm properties were measured quantitatively, showing optical density (O.D) values of 0.51 ± 015, 0.63 ± 0.20, 0.38 ± 0.07 and 0.62 ± 0.11 at 492 nm and the leakage of cellular components by the compounds, such as 17, 20, 25 and 26, increased the O.D. of respective treated samples compared to the control. In addition, the implication of experimental results is discussed in the light of the lack of survivability of planktonic bacteria and biofilm destruction in vitro. These results revealed the great significance of the development of a new generation of synthetic materials with greater efficacy in anti-biofilm properties by targeting to lock the bio-film associated protein Bap in Gram-negative bacteria.

Gram-negative members of the ESCAPE family are more difficult to treat, due to the presence of an additional barrier in the form of a lipopolysaccharide layer and the efficiency of efflux pumps to pump out the drugs from the cytoplasm.     

Improved performance of optical phased arrays assisted by transparent graphene nanoheaters and air trenches

In this paper, high-performance optical phased arrays (OPAs) assisted by transparent graphene nanoheaters and air trenches have been designed and simulated. By directly locating graphene nanoheaters on silicon waveguides, heating efficiency is enhanced by 62.96% compared to conventional structures with 1 μm SiO₂ overlays, and is further enhanced by a factor of 200% by the presence of air trenches. Thanks to the high thermal conductivity of graphene, a record-high operation speed on the order of 200 kHz is realized. Power consumption for π phase shift is 4.65 mW, approximately half of that of the state-of-the-art OPAs. By introducing air trenches, thermal crosstalk is significantly reduced, resulting in an enlarged fill factor. In addition, a novel beam steering scheme in the θ direction is proposed. By applying a 30 mW heating power, a temperature gradient along antennas is generated and beam steering of 2.3° is achieved, satisfying applications such as long-range collision avoidance for autonomous driving.

Improved performances of optical phased arrays have been achieved assisted by graphene nanoheaters and air trenches.     

3D Pd/Co core–shell nanoneedle arrays as a high-performance cathode catalyst layer for AAEMFCs

A novel cathode architecture using vertically aligned Co nanoneedle arrays as an ordered support for application in alkaline anion-exchange membrane fuel cells (AAEMFCs) has been developed. The Co nanoneedle arrays were directly grown on a stainless steel sheet via a hydrothermal reaction and then a Pd layer was deposited on the surface of the Co nanoneedle arrays using a vacuum sputter-deposition method to form Pd/Co nanoneedle arrays. After transferring the Pd/Co nanoneedle arrays to an AAEM, a cathode catalyst layer was formed. Without the use of an alkaline ionomer, the AAEMFC with the prepared cathode catalyst layer showed an enhanced performance with ultra-low Pd loading of down to 33.5 μg cm⁻², which is much higher than the conventionally used cathode electrode with a Pt loading of 100 μg cm⁻². This is the first report where three-dimensional Co nanoneedle arrays have been used as the cathode support in an AAEMFC, which is able to deliver a higher power density without an alkaline ionomer than that of conventional membrane electrode assembly (MEA).

A novel ordered Pd/Co nanoneedle array was used as a cathode in an AAEMFC and delivered a higher power density than that of conventional MEA.