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Background Nivolumab, an anti-programmed cell death protein 1 antibody, is commonly used as an immune checkpoint inhibitor in various cancers. Various adverse events are associated with these therapies, including hepatitis, dermatitis, and myocarditis. Myocarditis is a relatively rare but potentially fatal immune-mediated adverse reaction. Case presentation We report a case of colon cancer in a 56-year-old Chinese patient with lung and liver metastasis who developed fulminant myocarditis by nivolumab and survived with the support of extracorporeal membrane oxygenation. After six cycles (within 3 months) of nivolumab treatment, the patient developed chest tightness and was hospitalized. A diagnosis of fulminant myocarditis associated with immunotherapy was confirmed based on the clinical manifestations and laboratory examinations. He recovered well and was discharged on day 45 after management with extracorporeal membrane oxygenation, intravenous methylprednisolone, and immunoglobulin. Conclusions This case illustrates a severe cardiovascular complication of immunotherapy, strongly suggesting the necessity of close monitoring for outpatient usage of nivolumab. Additionally, our experience provided an efficient management strategy of extracorporeal membrane oxygenation in terms of life-threatening conditions.

π-Stacked dendrimers consisting of cofacially aligned donors and acceptors are developed by introducing three dendritic teracridan donors with orthogonal configuration and three triazine acceptors in periphery of hexaphenylbenzene skeleton. The dendritic structure and orthogonal configuration of teracridan not only make their outer acridan segments approaching to acceptor in close distance, but also fix donor and acceptor in face-to-face alignment, leading to through-space charge transfer emission with thermally activated delayed fluorescence (TADF) effect. By regulating charge transfer strength via substituent effect of acceptor, emission color of the dendrimers can be tuned from blue to yellow/red region. Solution-processed two-color white organic light-emitting diodes (OLEDs) based on blue and yellow π-stacked donor-acceptor dendrimers exhibit the maximum external quantum efficiency of 20.6 % and maximum power efficiency of 58.9 lm W-1 , representing the state-of-the-art efficiency for all-TADF white OLEDs by solution process.

The bit error rate (BER) formula of the M-QAM system is derived under nonequally likely condition of the constellation points, from which improving the BER performance of the M-QAM system by optimizing the probability distribution of constellation points is identified. Based on the analysis, the bit-level XOR method is employed to encrypt the image data and modify the probability distribution of the constellation points. The simulation results show that bit-level XOR is helpful to obtain a better probability distribution of the 16-QAM system compared to that without bit XOR and hence can improve the BER performance of the proposed OFDM transmission system. Simulation results based on test images over the AWGN channel further confirm that the reliability of the OFDM transmission system and the reconstructed quality of the compressed image are both significantly enhanced using bit-level XOR operation.

Polymer light-emitting diodes (PLEDs) based on thermally activated delayed fluorescence (TADF) emitters show great potential in developing high-efficiency solution-processed light-emitting devices ...

AIMS AND OBJECTIVES To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU). BACKGROUND Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. DESIGN A qualitative action research study combined with a quantitative cross-sectional method. METHODS According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. RESULTS The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p

e12602 Background: Triple negative breast cancer (TNBC) has the traits of early onset, high malignancy and no effective molecular targets to act on, neoadjuvant chemotherapy is recommended as the preferred treatment for locally advanced TNBC with highly recurrence risk. The addition of platinum-based agents to conventional taxanes regimens in locally advanced TNBC can significantly improve pathological complete response (pCR) rate. Anti-angiogenic drugs are currently one of the few targeted therapies that have achieved efficacy in TNBC. Apatinib, an inhibitor of VEGFR2, shows significant antitumor activity in the patients with breast cancer. Methods: Pathologically confirmed TNBC patients with clinical stage I-IIIC (per AJCC 8th ed) with no previous surgery or radio-chemotherapy treatment were enrolled in our center from September 2018 to June 2020. Enrolled patients received 4-8 neoadjuvant treatment cycles of apatinib 250mg per day + paclitaxel 175mg/m2 d1 + carboplatin AUC = 4 d2 q14d (Apa+TC), followed by sequential surgery. Enrolled patients who underwent surgery were matched with TNBC patients received paclitaxel and carboplatin intense regimen (TC) contemporarily in our center by propensity score matching (PSM). pCR in breast and axilla (ie. ypT0/Tis ypN0) was the primary endpoint. Objective response rate (ORR), disease control rate (DCR), event-free survival (EFS), overall survival (OS) and adverse events (AEs) are secondary endpoints. Results: 25 locally advanced TNBC patients were enrolled for neoadjuvant therapy of Apa+TC. In radiological evaluation, 2 patients achieved CR, 20 patients achieved PR, 3 patients achieved SD, which indicated an ORR of 88% and a DCR of 100%. 23 of 25 enrolled patients underwent surgery, with a pCR rate of 60.87% (95%CI: 38.54%-80.29%). 69 patients who were treated by TC before surgery were matched by PSM based on baseline stage T and stage N features. A significant higher pCR rate was achieved in Apa+TC arm compared with TC alone (60.87% vs. 30.43%, respectively, P = 0.009). Similar incidence of AEs was observed between two arms. The main AEs were hematologic toxicities fatigue, digestive canal symptoms, transaminase elevation and peripheral neurotoxicity in Apa+TC arm. Grade III-IV AEs included granulocytopia (14/25), thrombocytopenia (4/25), anaemia (3/25), fatigue (1/25), hypertension (1/25) and arrhythmia (1/25). Meanwhile, apatinib-related AEs, including hypertension, proteinuria, and hand-and-foot syndrome, were mild. Due to the limited time, the survival follow-up is still in progress. Conclusions: Apatinib combined with paclitaxel and carboplatin intensive regimen achieved a better efficacy and manageable adverse events in neoadjuvant chemotherapy for locally advanced TNBC, which might be a promising strategy in the treatment of locally advanced TNBC. Clinical trial information: NCT03735082.

Through-space charge transfer polynorbornenes with fixed and controllable spatial alignment of donor and acceptor in edge-to-face/face-to-face stacking patterns are developed for achieving high-efficiency blue thermally activated delayed fluorescence (TADF). The alignment is realized by using the cis, exo-configuration of norbornene to confine donor and acceptor in close proximity, and utilizing orthogonal and dendritic structures of donors to provide either perpendicular or parallel stacking motif relative to acceptors. Compared to edge-to-face counterparts, polynorbornenes with face-to-face aligned donor and acceptor exhibit much larger oscillator strength and higher photoluminescence quantum yield. The resulting polymers exhibit deep blue (422 nm) to sky blue (482 nm) emission and TADF effect with reverse intersystem crossing rates of 0.4-5.9×106 s-1 , giving the maximum external quantum efficiency of 18.8 % for non-doped blue organic light-emitting diodes by solution process.

Single white light-emitting polymers (SWPs) represent a high-fidelity system for generating white light emission from polymers without phase separation compared to polymer blend systems. However, their device performance so far has been limited because of the unwanted hole scattering caused by an energy-level mismatch between emitters and hosts, and the large injection barrier at the polymer/anode interface. Here, we report novel poly(arylene phosphine oxide)-based all-phosphorescent SWPs by using the combination of a high-HOMO-level blue phosphor and high-HOMO-level poly(arylene phosphine oxide) host to achieve a low turn-on voltage of 2.8 V, high external quantum efficiency of 18.0% and remarkable power efficiency of 52.1 lm W−1, which makes them the most efficient SWPs so far. This record power efficiency is realized by using the high-HOMO-level blue phosphor to eliminate the hole scattering effect and by using the high-HOMO-level polymer host to reduce the hole injection barrier. This result represents an important progress in SWPs to achieve efficiency surpassing that of the polymer blends currently used for solution-processed white organic light-emitting diodes (WOLEDs) and even comparable with that of the small molecules used for vacuum-deposited WOLEDs.

The buildup of uncaptured fly ash particles from wet flue gas desulfurization (WFGD) system in post-combustion CO 2 capture processes is an important issue in existing coal-fired power plants. A self-designed lab-scale packed column filled with θ-ring packing was used to investigate the influence of fly ash particles on the volumetric overall mass-transfer coefficient K G a v using K 2 CO 3 absorbent. The affecting laws of fly ash particles on the K G a v were discussed under different operating conditions such as the solution temperature, the liquid-gas ratio L/G and the concentration of fly ash particles. The results showed that the effect of two types of fly ash particles on the outlet CO 2 concentration mainly occurred at the early period of the experimental process, while the effect extent of the Inner Mongolia ash was larger than Nanjing ash. The solution temperature and the liquid-gas ratio had a significant role in promoting the K G a v , but the presence of fly ash particles in K 2 CO 3 solution markedly reduced the K G a v . The influence of fly ash particles on the K G a v was independent of its chemical compositions, but was related to the operating parameters. With the solution temperature increasing, the influence of fly ash particles on the K G a v was weakened but, conversely, was increased with the liquid-gas ratio increasing. Change range of the K G a v was smaller and finally reached a stable state as the fly ash particles concentration increases. The analysis results indicated that the influence of the ash particles was realized via changing the initial distribution of the absorption solution.

Trace elements (TEs) emitted from coal-fired power plants have caused widespread concern. The onsite investigation of TEs emission from a Chinese 660 MW pulverized coal (PC) boiler equipped with selective catalytic reduction (SCR), electric submersible pump (ESP), wet flue gas desulfurization (WFGD), and wet electrostatic precipitator (WESP) was conducted by using U.S. Environmental Protection Agency Method 29. Simultaneous sampling of the coal, bottom ash, ESP ash, flue gas, and by-products from WFGD and WESP processes was performed. Results show that TEs mass balance rates for the entire system, furnace and each air pollution control device (APCD), are in the acceptable range of 70–130%, which confirms the validity and reliability of the field test data. The studied TEs are mainly distributed in bottom and ESP ash with the ratios of 2.11–12.15% and 87.83–97.83%, respectively, while little amounts of them exist in WFGD, WESP, and the stack. Coal combustion by-products such as bottom ash and gypsum have l...

Through-space charge transfer hexaarylbenzene dendrimers containing circularly-arrayed electron donors and acceptors exhibit thermally activated delayed fluorescence and aggregation-induced emission effects, giving EQE of 14.2% for solution-processed OLEDs., Through-space electron interaction plays a critical role in determining the optical and charge transport properties of functional materials featuring π-stacked architectures. However, developing efficient organic luminescent materials with such interactions has been a challenge because of the lack of well-established prototypical molecules. Here we report the design of through-space charge transfer hexaarylbenzenes (TSCT-HABs) containing circularly-arrayed electron donors (acridan/dendritic triacridan) and acceptors (triazine), which exhibit both thermally activated delayed fluorescence (TADF) and aggregation-induced emission (AIE) effects for high-efficiency solution-processed organic light-emitting diodes (OLEDs). Spatial separation of donors and acceptors in the TSCT-HABs induces a small singlet–triplet energy splitting of 0.04–0.08 eV, leading to delayed fluorescence with microsecond-scale lifetimes. Meanwhile, the TSCT-HABs display the AIE effect with emission intensity enhanced by 6–17 fold from solution to the aggregation state owing to their propeller-shaped configuration. Solution-processed OLEDs based on the TSCT-HABs show maximum external quantum efficiency up to 14.2%, making them among the most efficient emitters for solution-processed TADF OLEDs.

An organic photovoltaic (OPV) device based on a carbazole-derived copolymer poly[N-9'-heptadecany1-2,7-carbazole-alt-5,5-(4',7'-di-2-thienyl-2',1', 3 -benzothiadiazole)] (PCDTBT) and N,N'bis(1-ethylpropyl)-perylene-3,4,9,10-tetracarboxylic diimide (EP-PDI) was fabricated by incorporating alcohol-soluble phosphate group-containing perylene diimide derivative (PDIP) as a cathode interfacial layer. The final performance of PDI-based OPV device modified by PDIP layer enhanced due to both optimized interfacial contact and the formation of interfacial dipole. Firstly, the film roughness of active layer was reduced from 8.8 nm to less than 4.0 nm by the introduction of the relatively amorphous PDIP layer. Meanwhile, the surface of active layer became more hydrophilic with significantly decreasing the contact angle from 90 degrees to 78 degrees. Secondly, an interfacial dipole between active layer and metal electrode was formed as indicated by the surface potential measurement, which not only enhanced built-in potential but also improved charge transport and extraction. Thus, the final improved device performance of PDI-based OPV device with simultaneous enhancement of open-circuit voltage (V-oc) and short-circuit current density (J(sc)) was achieved. (C) 2015 Elsevier B.V. All rights reserved.

With the changing of power supply pattern, almost all the large capacity thermal power units are used to depth peak load cycling, which causes reheated steam temperature fluctuated big and frequently. And in such a situation, the thermal power units can't work very safely and efficiently. In this paper the γ incremental SGPC-PID cascade control scheme is proposed, which solved the fluctuating problem of reheated steam temperature. The GPC is firstly introduced to overcome the reheated steam temperature's fluctuating problem, and then the stair like control scheme and γ factor are introduced to avoid the matrix inversion and simplify the parameter adjustment of GPC. The γ incremental SGPC-PID cascade control algorithm fully develops the PID's anti-interference ability and the SGPC's strong adaptability to large inertia and large time delay. Simulation results show that with better robustness and anti-disturbance performance, this control scheme not only improves the dynamic and static performance of reheated steam temperature, but also it has the advantage of computation simple and parameter adjust easily.

Under the background of seeking high efficiency and low nitrogen oxides (NOx) emissions for the boiler of power plants, this paper used least squares support vector machine (LSSVM) to model the boiler efficiency and NOx emissions of a power plant according to the experimental data acquired from a combustion adjustment test. A pruning algorithm based on active learning was applied to the combustion model built earlier to obtain a sparse LSSVM model. Compared to Suykens standard pruning algorithm for LSSVM, AL-LSSVM (active learning LSSVM) can significantly reduce the complexity of combustion models without degrading much, which provides an effective method for incremental or adaptive learning of combustion models.

Up to now, the research on artificial neural network modeling NOx emissions is based on simple neural networks, not taking full advantage of the characteristics between NOx generation mechanism and neural network. In this paper, an improved fuzzy artificial neural network based on NOx generation mechanism is presented. The formation mechanism layer of this model is based on generation mechanism of NOx in order to decompose the input parameters. An improved RBF sequential algorithm and a particle swarm algorithm based on optimal stopping method are used in structure identification and parameter optimization. The results show that: in comparison to the traditional model, this model reduces the number of fuzzy rules and the complexity of the network, thus to improve the stability and the generalization ability of the model. Consequently, the model presented can provide reference for huge power station boiler to reduce NOx emissions by autoadjustment or reconstruction.

Previous field studies show that surgery residents and medical students have difficulty recognizing appropriate anatomic cues during laparoscopic surgery, causing delays in procedures and errors. Such observations led to the development of an anatomy recognition training intervention, specifically the use of an ordered set of video clips that show the main steps of a laparoscopic procedure. Each procedural step is shown several times in succession, with each repetition coming from a different surgery, thus exposing the learner to varied anatomy and crucial maneuvers. A factorial experiment with 30 medical students showed that the group using these ordered, perceptual learning modules had a significant increase in scores on questions assessing perceptual knowledge and procedural knowledge, with no corresponding increase for the control group who watched the videos from the same cases but in an unstructured format for the same amount of time (p< 0.05). Neither group showed improvement on strategic or declarative knowledge tests. The study suggests that ordered perceptual learning modules are a potential means for training perceptual and procedural knowledge in an effective, safe, and efficient manner, serving as a complement to other types of training methods that teach physical dexterity, strategic and declarative knowledge.

We investigate numerically the negative refraction of a simultaneous normal and parallel incidence planar left-handed metamaterial (LHM) in this paper. This LHM is comprised of fourfold C-shaped rings, which are printed on both sides of the substrates symmetrically, and it can exhibit left-handed properties with electromagnetic wave incident in three different directions. The retrieved result and the simulated result verify the left-handed properties of the fourfold C-shaped metamaterial very well. Then the different electric responses of the normal and parallel incidence cases to the incident electromagnetic wave are discussed, and it is due to the different distribution of the induced currents in the metallic wires.

A single-sided structure left-handed metamaterial (LHM), of which the symmetric paired split-ring resonators are connected directly through cut wires, is discussed in this paper. This connected single-sided LHM can exhibit a low loss and broad negative refraction passband. Good agreement of the retrieved result and the simulated result verify the above conclusion by comparison with the in-plane case and the off-plane case [T. Koschny, M. Kafesaki, E. N. Economou, and C. M. Soukoulis, Phys. Rev. Lett. 93, 107402 (2004)].

This paper proposes a method for fuzzy gain scheduling state-space model predictive controller to deal with the nonlinearity of the boiler-turbine system. Simulation results over wide range show the good load-tracking property and robust control performance of the proposed controller under amplitude and slew-rate constraints on the manipulated variables.

The present study presents a plasma source, capable of generating overdense plasma below the whole quartz plate while exciting surface plasmon polaritons (SPPs) by means of a subwavelength diffraction grating. The wavelength of surface wave, calculated on either the discharge image or the simulated electric field distribution graph, is about 5.7 cm, which approximates the theoretical value by a calculation of the SPP dispersion equation in overdense plasma. The operation mechanism of plasma heating is attributed to the resonant excitation of SPPs and its dissipation in plasma.