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Background Methods Results Conclusion To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD.This randomized controlled trial conducted in a single‐institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty‐five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund–Kennedy score, Eustachian Tube Dysfunction Questionnaire‐7 (ETDQ‐7), and serial Eustachian tube function test results were analyzed 3 months postoperatively.The improvement (12.60 ± 6.50) in the ETDQ‐7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ‐7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02–28.79, p = 0.048) and a low post‐modified Lund–Kennedy score (OR: 0.15, 95% CI: 0.04–0.54, p = 0.004) were significantly associated with ETDQ‐7 score improvement.Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD. [ABSTRACT FROM AUTHOR]

Pendelluft, the shift of air from non-dependent to dependent lung regions, is known to occur during active breathing in ventilated patients. However, information about pendelluft in ARDS patients under assisted mechanical ventilation is limited. In this prospectively collected and retrospectively analyzed study, we combined electrical impedance tomography and respiratory mechanics monitoring to quantitatively examine pendelluft in trigger and reverse triggering breaths in 20 mechanically ventilated patients with ARDS during the transition from controlled to active breaths under volume-cycled ventilation. Besides the 10 resting breaths in each patient, 20% of the counted active breaths were selected based on three levels of esophageal pressure swing (∆Pes): low (< 5 cm H2O, breaths = 471), moderate (≥ 5, < 10 cm H2O, breaths = 906), and high effort (≥ 10 cm H2O, breaths = 565). The pendelluft response to breathing efforts was significantly greater in trigger breaths than in reverse triggering breaths (p < 0.0001). Based on the pendelluft-∆Pes slope (ml/cmH2O), there were two distinct patterns of effort-related pendelluft (high vs. low pendelluft group). For trigger breaths, the high pendelluft group (n = 9, slope 0.7–2.4 ml/cmH2O) was significantly associated with lower peak airway/plateau pressure and lower respiratory system/lung elastance than the low pendelluft group (n = 11, slope − 0.1 to 0.3 ml/cmH2O). However, there was no difference in respiratory mechanics between high and low pendelluft groups for reverse triggering breathes. The use of ∆Pes to predict pendelluft was found to have a low positive predictive value. [ABSTRACT FROM AUTHOR]

Background: Eustachian tube dysfunction (ETD) is a common disorder causing ear pressure, pain, and hearing loss. Balloon Eustachian tuboplasty (BET) is an emerging technique for dilating the Eustachian tube and treating ETD. Whether adding myringotomy improves BET efficacy is controversial. Methods: This retrospective study included 95 ETD patients undergoing BET alone (n = 44) or BET with myringotomy (BET + M; n = 51) between June 2020 and August 2021 at a single medical center. The primary outcome was the change in ETDQ-7 symptom scores from baseline to 6 months after treatment. Secondary outcomes included audiometry, endoscopy, Valsalva maneuver, and complications. Results: The ETDQ-7 scores improved significantly after treatment in both groups (p < 0.001), without significant between-group differences (p = 0.417). No significant differences occurred in the audiometry, endoscopy, and Valsalva results or in most complications between groups. One BET + M patient had a persistent tympanic membrane perforation. Conclusions: Both BET alone and BET + M effectively and safely improved the subjective and objective ETD outcomes. However, adding myringotomy did not further improve the outcomes over BET alone, while it incurred risks such as persistent perforation. BET alone may sufficiently treat ETD without requiring myringotomy in this cohort. Further randomized controlled trials should identify optimal candidates for BET alone versus combined approaches. [ABSTRACT FROM AUTHOR]

Kallistatin, an endogenous serine proteinase inhibitor, is protective against sepsis in animal models. The aim of this study was to determine the plasma concentration of kallistatin in intensive care unit (ICU) patients with severe sepsis and septic shock and to determine their potential correlation with disease severity and outcomes. We enrolled 86 ICU patients with severe sepsis and septic shock. Their plasma concentrations of kallistatin, kallikrein, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 were measured by enzyme-linked immunosorbent assay. The association of kallistatin levels with disease severity and patient outcomes was evaluated. The relationship between kallistatin and other biomarkers was also analyzed. Plasma kallistatin levels on day 1 of ICU admission were lower in patients with septic shock compared with patients with severe sepsis (p = 0.004). Twenty-nine patients who died in the hospital had significantly lower day 1 kallistatin levels than patients who survived (p = 0.031). Using the optimal cutoff value (4 μg/ml) of day 1 plasma kallistatin determined by receiver operating characteristic curves for 60-day mortality, we found that high kallistatin levels were associated with a preferable 60-day survival (p = 0.012) by Kaplan-Meier analysis and lower Sequential Organ Failure Assessment (SOFA) scores over the first 5 days in the ICU (p = 0.001). High kallistatin levels were also independently associated with a decreased risk of septic shock, the development of acute respiratory distress syndrome, and positive blood cultures. In addition, there were inverse correlations between day 1 kallistatin levels and the levels of TNF-α, IL-1β, IL-6, and C-reactive protein, and SOFA scores on day 1. Our results indicate that during severe sepsis and septic shock, a decrease in plasma concentrations of kallistatin reflects increased severity and poorer outcome of disease. [ABSTRACT FROM AUTHOR]

The article discusses as study which compared the positive end-expiratory pressure (PEEP) electrical impedance tomography (EIT) or PEEP selection based on best respiratory system compliance during decremental PEEP titration in acute respiratory distress syndrome (ARDS) patients. Data on the patients included in the study are presented. It was found that PEEP selection based on PEEP EIT is justified.

Efficient solution-processed color-stable and color-tunable white organic light emitting diodes (OLEDs) have been realized by judicious selection of the host materials for the emission layers. The color-tunable OLED demonstrates the unique characteristic of modulating the electroluminescence by using the applied voltage of the device and displays color temperatures ranging from 1600 K to 4600 K around the daylight locus, with a peak external quantum efficiency of 13.6% and a peak current efficiency of 22.5 cd A −1 . On the other hand, the chromaticity-stable device shows a negligible color change, from 300 to 2000 nits. The manipulation of chromaticity is attributed to the energy transfer dynamics of the hosts and dopants under different electric fields. [ABSTRACT FROM AUTHOR]

Electromagnetic simulation and multiple light extraction concepts for solution-processed organic light-emitting diodes were explored in this report. Based on the optical simulation results, the device architecture was optimized for maximization of the light out-coupling efficiency. By utilizing a high refractive index substrate, a high light scattering electrode, and an external light extraction structure, trapped photons in the wave-guided and substrate modes were extracted effectively. The best solution-processed device exhibited a maximum external quantum efficiency of 42.9%, a current efficiency as high as 150.1 cd/A, and a power efficacy up to 125.1 lm/W. [ABSTRACT FROM AUTHOR]

Four carbazole-based bipolar host materials are utilized for solution-processed phosphorescent organic light-emitting diodes (PhOLEDs). These bipolar materials consist of an electron-donor unit (carbazole) linking to a fluorene unit bearing various electron-acceptor units (oxadiazole, cyano, and benzimidazole) via a saturated carbon, giving sufficiently high triplet energies due to the lack of direct electronic coupling between the donor and acceptor(s). The resulting physical properties and bipolar characteristics render the realization of efficient solution-processed green and white OLEDs feasible. The best green light-emitting device based on bipolar host CzFCBI incorporating a stepwise hole-injection/transporting system exhibit a low drive voltage, a maximum external quantum efficiency of 14.0%, a current efficiency of 49.0 cd/A, and a power efficacy of 55.0 lm/W. Moreover, the CzFOXa -based two-component (blue–orange) white light-emitting device shows a warmish-white emission with a maximum external quantum efficiency of 6.9% and stable chromaticity coordinates at different luminance levels and yield a high color rendering index (CRI) reaching 76 at a luminance of 1000 cd/m 2 . [ABSTRACT FROM AUTHOR]

Highlights: [•] Electrochemical photocatalytic degradation (ECPD) was effective in the practice of dye wastewater. [•] P25-TiO2/SS photo-anode was prepared by electrophoretic deposition. [•] The photocatalytic reaction and electrochemical reaction are synergistic in the degradation of orange G. [Copyright &y& Elsevier]

Abstract: The use of 1,4,5,8,9,11-hexaazatriphenylene hexacarbonitrile (HAT-CN) thin layers, particularly the solution-processed type, as an efficient hole-injection layer (HIL) for organic optoelectronic devices is demonstrated herein. Among the solvents commonly used for solution processing, 2-propanone was found to selectively dissolve HAT-CN, allowing the fabrication of a rigid film. The alignment of the electronic energy levels of the solution-processed HAT-CN and thermally polymerized 2,7-disubstituted fluorene-based triaryldiamine (VB-FNPD) species was evaluated using ultraviolet photoelectron spectroscopy. The results revealed that the lowest unoccupied molecular orbital of HAT-CN and the highest occupied molecular orbital of VB-FNPD were very close to the Fermi level, which facilitated charge transfer at the interface and improved hole injection. The utilization of HAT-CN as HIL resulted in a dramatic enhancement of the performance of solution-processed red, green, and blue organic light-emitting diodes. The external quantum efficiency, current efficiency, and power efficiency of the HAT-CN-based devices were higher than or almost similar to those of optimized poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS)-based devices. Because of the efficient carrier-injection capability and the capacity to prevent interfacial mixing and erosion during fabrication, solution-processed HAT-CN is promising as a novel alternative to conventional PEDOT:PSS HILs. [Copyright &y& Elsevier]

The article presents a study that investigated the feasibility of using computerized algorithm in detecting ineffective triggering (IT) in the expiratory phase (ITE) in mechanically-ventilated patients. A total of 14 mechanically ventilated adult patients were evaluated at a medical intensive care unit (MICU) of a university hospital. It found that the accuracy of detecting and quantifying ITEs can be feasible with the use of a computerized algorithm.

Kallistatin, an endogenous plasma protein, exhibits pleiotropic properties in inhibiting inflammation, oxidative stress and apoptosis, as evidenced in various animal models and cultured cells. Here, we demonstrate that kallistatin levels were positively correlated with the concentration of total protein in bronchoalveolar lavage fluids (BALF) from patients with sepsis-related acute respiratory distress syndrome (ARDS), indicating a compensatory mechanism. Lower ratio of kallistatin to total protein in BALF showed a significant trend toward elevated neutrophil counts (P = 0.002) in BALF and increased mortality (P = 0.046). In lipopolysaccharide (LPS)-treated mice, expression of human kallistatin in lung by gene transfer with human kallistatin-encoding plasmid ameliorated acute lung injury (ALI) and reduced cytokine/chemokine levels in BALF. These mice exhibited attenuated lung epithelial apoptosis and decreased Fas/FasL expression compared to the control mice. Mouse survival was improved by kallistatin gene transfer or recombinant human kallistatin treatment after LPS challenge. In LPS-stimulated A549 human lung epithelial cells, kallistatin attenuated apoptosis, down-regulated Fas/FasL signaling, suppressed intracellular reactive oxygen species (ROS) and inhibited ROS-mediated NF-κB activation and inflammation. Furthermore, LPS-induced apoptosis was blocked by antioxidant N-acetylcysteine or NF-κB inhibitor via down-regulating Fas expression. These findings suggest the therapeutic potential of kallistatin for sepsis-related ALI/ARDS. [ABSTRACT FROM AUTHOR]

Apoptosis regulation is essential for neutrophil homeostasis. We previously demonstrated that a process involving glycogen synthase kinase (GSK)-3β determines neutrophil apoptosis. As for this apoptotic process, an overdose of propofol (2,6-Diisopropylphenol; 25 μg/ml or 140 μM) also causes GSK-3β-mediated macrophage apoptosis; however, the early deactivation of GSK-3β with low-dose propofol has been shown. Therefore, we hypothesize that low-dose propofol may induce neutrophil survival via GSK-3β inactivation. Following in vitro culture, the therapeutic concentration of propofol (10 μg/ml or 56 μM) treatment decreased constitutive apoptosis in isolated human primary neutrophils and in granulocyte-differentiated HL60 cells after all-trans retinoic acid (1 μM) treatment. The inactivation of phosphatidylinositol 3-kinase (PI3-kinase)/AKT and the activation of GSK-3β results in myeloid cell leukemia 1 (Mcl-1) down-regulation, the loss of the mitochondrial transmembrane potential, and caspase-3 activation in these cells, which is accompanied by apoptosis. Notably, propofol treatment attenuates these effects in a PI3-kinase-regulated manner. We found that propofol initiates PI3-kinase/AKT-mediated GSK-3β inactivation and Mcl-1 stabilization, rescuing the constitutive apoptosis in primary neutrophils and granulocyte-differentiated acute promyelocytic leukemia HL60 cells. [ABSTRACT FROM AUTHOR]

Highlights: [•] The chromaticity of single EML solution-processed white OLEDs was investigated. [•] Correlation of CCT, CRI, and spectral designs was found. [•] The solution-processed quaternary doping white OLEDs were designed and fabricated. [•] White OLED with CRI=85, Du′v′ =+0.0009, EQE=13.7%, current efficiency=24.9cd/A at 1000cd/m2 was demonstrated. [ABSTRACT FROM AUTHOR]

A nano-crystalline In2O3 was synthesized using calcinations methods and was used as a photocatalyst to degrade sulfan blue (SB) dye. In addition, this study addresses the conditions of the degradation and the factors that influenced the catalysis. In2O3 was prepared by calcining In(OH)3 at heat ranges of 100-700 °C for 24 h. The In2O3 was characterized using field emission scanning electron microscopy (FE-SEM), an X-ray diffractometer (XRD), thermogravimetric analysis (TGA), and high-resolution X-ray photoelectron spectroscopy (HR-XPS). The activities of these samples were tested for the photocatalytic degradation of SB dye. The results indicated that the In(OH)3 that was calcined at 300 °C for 24 h had the best performance. [ABSTRACT FROM AUTHOR]

Neutrophilia, defined as a large number of neutrophils in the circulating blood, is caused by increased differentiation and survival from activation-induced apoptosis. Regulation of apoptosis is essential for neutrophil homeostasis; however, the molecular signaling that regulates this process needs further investigation. Unlike TLR4 wild-type C3H/HeN mice, TLR4 mutated C3H/HeJ mice were insusceptible to LPS-induced blood neutrophilia. LPS prevented constitutive apoptosis in neutrophils and partly involved a blockade of the mitochondrial pathway including mitochondria transmembrane potential loss, myeloid cell leukemia sequence (Mcl) 1 degradation, and caspase-3 activation. In apoptotic neutrophils, glycogen synthase kinase (GSK)-3β was activated, and inhibiting GSK-3β decreased Mcl-1 degradation and apoptosis. LPS caused p38 MAPK-, JNK-, and PI3K/AKT-mediated Mcl-1 stabilization and prevented apoptosis, and LPS induced GSK-3β inactivation mainly through p38 MAPK and PI3K/AKT. Neutrophils in the neutrophilia showed increased GSK-3β inactivation and Mcl-1 stabilization accompanied by activation of p38 MAPK, JNK, and AKT. Notably, LPS-induced ROS generation can partly facilitate p38 MAPK/JNK/AKT activation to regulate GSK-3β-mediated Mcl-1 stability, apoptosis, and neutrophilia. These results demonstrate that the molecular basis of endotoxemic neutrophilia is through a direct action on neutrophils involving GSK-3β inactivation to prevent constitutive apoptosis. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the shear behaviour of prestressed beams made with high-workability concrete and normal concrete under static load. A total of 18 prestressed beam specimens were made in this study; nine were prestressed high-workability concrete beams, and the rest were normal concrete beams. The specimens were all 400 mm deep T-sections, tested with two concentrated loads. The test parameters included concrete strength, amount of prestress, shear span-to-depth ratio and spacing of transverse reinforcement. The results show that prestressed high-workability concrete beams have better structural behaviour than prestressed normal concrete beams. The diagonal cracking strengths and ultimate strengths of high-workability concrete beams were 1·20 and 1·17 times those of normal concrete beams respectively. Prestressed high-workability concrete beams have better crack control ability than prestressed normal concrete beams. With the same crack width, high-workability concrete beams can reach greater loads which are approximately 1·21 times those of normal concrete beams. In addition, prestressed high-workability concrete beams have greater stiffness than prestressed normal concrete beams. [ABSTRACT FROM AUTHOR]

Human rationality–the ability to behave in order to maximize the achievement of their presumed goals (i.e., their optimal choices)–is the foundation for democracy. Research evidence has suggested that voters may not make decisions after exhaustively processing relevant information; instead, our decision-making capacity may be restricted by our own biases and the environment. In this paper, we investigate the extent to which humans in a democratic society can be rational when making decisions in a serious, complex situation–voting in a local political election. We believe examining human rationality in a political election is important, because a well-functioning democracy rests largely upon the rational choices of individual voters. Previous research has shown that explicit political attitudes predict voting intention and choices (i.e., actual votes) in democratic societies, indicating that people are able to reason comprehensively when making voting decisions. Other work, though, has demonstrated that the attitudes of which we may not be aware, such as our implicit (e.g., subconscious) preferences, can predict voting choices, which may question the well-functioning democracy. In this study, we systematically examined predictors on voting intention and choices in the 2014 mayoral election in Taipei, Taiwan. Results indicate that explicit political party preferences had the largest impact on voting intention and choices. Moreover, implicit political party preferences interacted with explicit political party preferences in accounting for voting intention, and in turn predicted voting choices. Ethnic identity and perceived voting intention of significant others were found to predict voting choices, but not voting intention. In sum, to the comfort of democracy, voters appeared to engage mainly explicit, controlled processes in making their decisions; but findings on ethnic identity and perceived voting intention of significant others may suggest otherwise. [ABSTRACT FROM AUTHOR]

Abstract: All-trans retionic acid (ATRA) treatment confers disease remission in acute promyelocytic leukemia (APL) patients by inducing granulocytic differentiation, which is followed by cell apoptosis. Although glycogen synthase kinase (GSK)-3? is known to be required for spontaneous cell death in neutrophils, the requirement of GSK-3? activation for the apoptotic effects remains unknown. This question is addressed in the present study using a model of ATRA-induced granulocytic differentiation and apoptosis in APL HL60 cells. ATRA at a therapeutic concentration (1?M) induced granulocytic differentiation, followed by apoptosis. ATRA treatment caused decreased Mcl-1, caspase-3 activation, and PARP cleavage following the inactivation of phosphatidylinositol 3-kinase/AKT and the activation of GSK-3?. Pharmacologically and genetically inhibiting GSK-3? effectively retarded ATRA-induced Mcl-1 degradation and apoptosis. Additional differentiation inducers, phorbol 12-myristate 13-acetate and dimethyl sulfoxide, also triggered GSK-3?-dependent apoptosis. Mechanistically, ATRA caused the generation of reactive oxygen species (ROS) through increased expression of NADPH oxidase subunits (p47phox and p67phox) to facilitate ATRA-induced GSK-3? activation and cell apoptosis. This study indicates that ROS initiate GSK-3?-dependent apoptosis in granulocyte-differentiated cells after long-term ATRA treatment. [Copyright &y& Elsevier]

Background and objective Previous studies have demonstrated that positive blood culture could contribute to poorer outcomes in patients with pneumonia. However, the impact of positive blood culture on the outcomes of patients with sepsis-induced acute respiratory distress syndrome ( ARDS) has not been evaluated. Methods An observational study that prospectively screened 4861 patients admitted to medical or surgical intensive care units ( ICUs) of a tertiary referral centre was performed. Results Among 4861 admitted patients, 146 diagnosed with sepsis-induced ARDS were enrolled (mean age: 66.1 years). Lower PaO2/ FiO2, decreased respiratory system compliance, and higher lung injury scores ( LIS) on the day of ARDS diagnosis were associated with positive blood cultures ( n = 68) rather than negative blood cultures ( n = 78). There was no relationship between positive blood culture and in-hospital mortality. Kaplan-Meier estimates also revealed that positive blood culture was not associated with 60-day mortality but with an increased length of stay in the hospital and in the ICU ( P = 0.007 and P = 0.016, respectively). Using multivariate logistic regression, higher LIS was independently associated with positive blood culture. In addition, chronic pulmonary disease, lower platelet count, higher LIS, and the development of shock on the diagnosis of ARDS, were independent risk factors for in-hospital mortality. Conclusions This study suggests that the presence of positive blood culture is not associated with increased mortality; however, the mean durations of hospital and ICU stays in patients with sepsis-induced ARDS are increased. [ABSTRACT FROM AUTHOR]

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup. [ABSTRACT FROM AUTHOR]

Abstract: Blue phosphorescent organic light-emitting devices (PhOLEDs) with quantum efficiency close to the theoretical maximum were achieved by utilizing a double-layer architecture. Two wide-triplet-gap materials, 1,3-bis(9-carbazolyl)benzene and 1,3,5-tri[(3-pyridyl)-phen-3-yl]benzene, were employed in the emitting and electron-transport layers respectively. The opposite carrier-transport characteristics of these two materials were leveraged to define the exciton formation zone and thus increase the probability of recombination. The efficiency at practical luminance (100cd/m2) was as high as 20.8%, 47.7cd/A and 31.2lm/W, respectively. Furthermore, based on the design concept of this simplified architecture, efficient warmish-white PhOLEDs were developed. Such two-component white organic light-emitting devices exhibited rather stable colors over a wide brightness range and yielded electroluminescence efficiencies of 15.3%, 33.3cd/A, and 22.7lm/W in the forward directions. [Copyright &y& Elsevier]

Electrical impedance tomography (EIT), a noninvasive and radiation-free medical imaging technique, has been used for continuous real-time regional lung aeration. However, adhesive electrodes could cause discomfort and increase the risk of skin injury during prolonged measurement. Additionally, the conductive gel between the electrodes and skin could evaporate in long-term usage and deteriorate the signal quality. To address these issues, in this work, textile electrodes integrated with a clothing belt are proposed to achieve EIT lung imaging along with a custom portable EIT system. The simulation and experimental results have verified the validity of the proposed portable EIT system. Furthermore, the imaging results of using the proposed textile electrodes were compared with commercial electrocardiogram electrodes to evaluate their performance. [ABSTRACT FROM AUTHOR]