Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication that results in increased morbidity and mortality after cardiac surgery. Most established prediction models are ...limited to the analysis of nonlinear relationships and fail to fully consider intraoperative variables, which represent the acute response to surgery. Therefore, this study utilized an artificial intelligence-based machine learning approach thorough perioperative data-driven learning to predict CSA-AKI.
A total of 671 patients undergoing cardiac surgery from August 2016 to August 2018 were enrolled. AKI following cardiac surgery was defined according to criteria from Kidney Disease: Improving Global Outcomes (KDIGO). The variables used for analysis included demographic characteristics, clinical condition, preoperative biochemistry data, preoperative medication, and intraoperative variables such as time-series hemodynamic changes. The machine learning methods used included logistic regression, support vector machine (SVM), random forest (RF), extreme gradient boosting (XGboost), and ensemble (RF + XGboost). The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). We also utilized SHapley Additive exPlanation (SHAP) values to explain the prediction model.
Development of CSA-AKI was noted in 163 patients (24.3%) during the first postoperative week. Regarding the efficacy of the single model that most accurately predicted the outcome, RF exhibited the greatest AUC (0.839, 95% confidence interval CI 0.772-0.898), whereas the AUC (0.843, 95% CI 0.778-0.899) of ensemble model (RF + XGboost) was even greater than that of the RF model alone. The top 3 most influential features in the RF importance matrix plot were intraoperative urine output, units of packed red blood cells (pRBCs) transfused during surgery, and preoperative hemoglobin level. The SHAP summary plot was used to illustrate the positive or negative effects of the top 20 features attributed to the RF. We also used the SHAP dependence plot to explain how a single feature affects the output of the RF prediction model.
In this study, machine learning methods were successfully established to predict CSA-AKI, which determines risks following cardiac surgery, enabling the optimization of postoperative treatment strategies to minimize the postoperative complications following cardiac surgeries.
Sn‐based materials are identified as promising catalysts for the CO2 electroreduction (CO2RR) to formate (HCOO−). However, their insufficient selectivity and activity remain grand challenges. A new ...type of SnO2 nanosheet with simultaneous N dopants and oxygen vacancies (VO‐rich N‐SnO2 NS) for promoting CO2 conversion to HCOO− is reported. Due to the likely synergistic effect of N dopant and VO, the VO‐rich N‐SnO2 NS exhibits high catalytic selectivity featured by an HCOO− Faradaic efficiency (FE) of 83% at −0.9 V and an FE of > 90% for all C1 products (HCOO− and CO) at a wide potential range from −0.9 to −1.2 V. Low coordination Sn–N moieties are the active sites with optimal electronic and geometric structures regulated by VO and N dopants. Theoretical calculations elucidate that the reaction free energy of HCOO* protonation is decreased on the VO‐rich N‐SnO2 NS, thus enhancing HCOO− selectivity. The weakened H* adsorption energy also inhibits the hydrogen evolution reaction, a dominant side reaction during the CO2RR. Furthermore, using the catalyst as the cathode, a spontaneous Galvanic Zn‐CO2 cell and a solar‐powered electrolysis process successfully demonstrated the efficient HCOO− generation through CO2 conversion and storage.
A novel SnO2 nanosheet catalyst presents a possible synergistic effect of N dopants and oxygen vacancies on the activity and selectivity for CO2 electroreduction to formate. Low‐coordination Sn–N moieties with optimal N dopants and O vacancies are identified as active sites with intrinsically enhanced activity.
In practice, there are various types of eco-innovation. While each type of innovation has its own attributes, determinants, and contribution to business performance, it is not effective to implement ...eco-innovation programs without a holistic view. This study draws from the resource-based view theory to investigate inter-relationships among three types of eco-innovation (process, product, organizational) and their relative impact on business performance. Using structural equation modeling with 121 samples collected from Taiwan Environmental Management Association, we find that eco-organizational innovation has the strongest effect on business performance. Additionally, eco-process and eco-product innovations partially mediate the effects of eco-organizational innovation, and eco-product innovation mediates eco-process innovations' effects on business performance. Business performance is directly and indirectly affected by eco-organizational, eco-process, and eco-product innovations. The findings suggest that, in order to develop effective eco-innovation programs, managers must understand the interdependence and co-evolutionary relationships between different types of eco-innovation. Overall, this study extends the discussion of innovation to the area of environmental innovation or eco-innovation.
•This study takes a holistic approach to investigating inter-relationships of different types of eco-innovation.•We find that eco-organizational innovation has the strongest effect on business performance.•Eco-product and eco-process mediate eco-organizational innovation and business performance.
Abstract
Two-dimensional metal-organic frameworks (MOFs) have been explored as effective electrocatalysts for hydrogen evolution reaction (HER). However, the sluggish water activation kinetics and ...structural instability under ultrahigh-current density hinder their large-scale industrial applications. Herein, we develop a universal ligand regulation strategy to build well-aligned Ni-benzenedicarboxylic acid (BDC)-based MOF nanosheet arrays with S introducing (S-NiBDC). Benefiting from the closer
p
-band center to the Fermi level with strong electron transferability, S-NiBDC array exhibits a low overpotential of 310 mV to attain 1.0 A cm
−2
with high stability in alkaline electrolyte. We speculate the newly-constructed triangular “Ni
2
-S
1
” motif as the improved HER active region based on detailed mechanism analysis and structural characterization, and the enhanced covalency of Ni-O bonds by S introducing stabilizes S-NiBDC structure. Experimental observations and theoretical calculations elucidate that such Ni sites in “Ni
2
-S
1
” center distinctly accelerate the water activation kinetics, while the S site readily captures the H atom as the optimal HER active site, boosting the whole HER activity.
The network of stemness genes and oncogenes in human patient‐specific reprogrammed cancer stem cells (CSCs) remains elusive, especially in liver cancer. HepG2‐derived induced pluripotent stem ...cell‐like cells (HepG2‐iPS‐like cells) were generated by introducing Yamanaka factors and the knockdown vector shTP53. They exhibited features of stemness and a higher tumorigenesis after xenograft transplantation compared with HepG2 cells. The cancerous mass of severe combined immunodeficiency (SCID) mice derived from one colony was dissected and cultured to establish reprogrammed HepG2‐derived CSC‐like cells (designated rG2‐DC‐1C). A single colony exhibited 42% occurrence of tumors with higher proliferation capacities. rG2‐DC‐1C showed continuous expression of the OCT4 stemness gene and of representative tumor markers, potentiated chemoresistance characteristics, and invasion activities. The sphere‐colony formation ability and the invasion activity of rG2‐DC‐1C were also higher than those of HepG2 cells. Moreover, the expression of the OCT4 gene and the c‐JUN oncogene, but not of c‐MYC, was significantly elevated in rG2‐DC‐1C, whereas no c‐JUN expression was observed in HepG2 cells. The positive‐feedback regulation via OCT4‐mediated transactivation of the c‐JUN promoter and the c‐JUN‐mediated transactivation of the OCT4 promoter were crucial for promoting cancer development and maintaining cancer stemness in rG2‐DC‐1C. Increased expression of OCT4 and c‐JUN was detected in the early stage of human liver cancer. Therefore, the positive feedback regulation of OCT4 and c‐JUN, resulting in the continuous expression of oncogenes such as c‐JUN, seems to play a critical role in the determination of the cell fate decision from iPS cells to CSCs in liver cancer. Stem Cells 2016;34:2613–2624
The OCT4/c‐JUN positive feedback loop found in reprogrammed HepG2‐derived cancer stem cell‐like cells (rG2‐DC‐1C) sheds light on the tumorigenesis of liver cancer. 4F, Yamanaka 4 factors; iPS‐like cells, induced pluripotent stem‐like cells.
Sewage sludge is bio-solid with high moisture content generated from wastewater treatment plants. Due to the avoidance of energy-intensive dewatering, hydrothermal conversion of sewage sludge becomes ...a promising technology to simultaneously achieve energy recovery and solid waste management. In order to obtain an entire understanding of applicability of hydrothermal gasification for hydrogen rich gas production from sewage sludge, this review article discussed hydrothermal conversion and gasification processes in terms of fundamental principles, operating conditions, partial oxidative gasification, and detrimental effects of intermediates. Furthermore, since organic compounds in sewage sludge are mainly composed of carbohydrates, proteins, lipids, and lignin, this article comprehensively reviewed hydrogen production from these biomass model compounds and their hydrolysis products under sub- and supercritical water. Additionally, introduction of alkali salts and heterogeneous catalysts to enhance hydrogen yield under mild temperatures and pressures in hydrothermal gasification process was also discussed. Based on bench and pilot scale studies, supercritical water gasification of sewage sludge for hydrogen production is feasible in terms of technical and economic evaluation. Given issues concerning corrosion, plugging and high operating cost, a combined supercritical water gasification and catalytic hydrothermal gasification concept is proposed as a practical strategy to directly harness hydrogen from sewage sludge in future applications.
The oral absorption of a therapeutic peptide (such as exenatide; EXT) that can improve glycemic control in the treatment of type 2 diabetes is limited by multiple barriers of the intestinal ...epithelium. This work presents an oil‐structured nanoemulsion system that consists of a phase‐changeable fatty acid that allows EXT (EXT@PC/NEMs) to be delivered orally and absorbed efficiently in the small intestine. To construct an appropriate vehicle to encapsulate EXT, an oil‐in‐water single emulsion is generated at 37 °C, which is well above the melting point of the fatty acid but below the denaturation temperature of the peptide drug. The as‐prepared EXT@PC/NEMs are physically stable when stored at 4 °C, as they form a solid core, which prevents drug leakage. Upon their oral delivery at body temperature, the deformable liquid EXT@PC/NEMs may undergo effective cellular uptake, enhancing their permeability across the intestinal epithelium. The orally administered PC/NEMs significantly improve the bioavailability of EXT via intestinal lymphatic transport, ultimately accumulating in the pancreas, suggesting the possibility of orally delivering labile peptide drugs. The delivered EXT may act on pancreatic β‐ and α‐cells to stimulate insulin release and suppress glucagon secretion, respectively, reducing the blood glucose level, eventually having antidiabetic effects.
Phase‐changeable nanoemulsions are used to encapsulate a peptide drug during emulsification at 37 °C and are physically stable when stored at 4 °C. Upon oral ingestion at body temperature, the deformable liquid nanoemulsions undergo effective cellular uptake, enhancing their permeability across the intestinal epithelium, ultimately accumulating in the pancreas via lymphatic transport to exert their beneficial antidiabetic effects.
ObjectivesThe majority of female immigrants who are married in Taiwan often face a variety of stresses, which may lead to physical or mental illness. Yet few studies have validated the impact of ...length of residency on physical and mental health using large-scale data. This study combined five nationwide databases and explored the impact of length of residency in Taiwan on the physical and mental health of female marriage immigrants.DesignThis is a retrospective cohort study.SettingTaiwan.ParticipantsA total of 168 202 female immigrants, who were registered in the national health insurance database from 2001 to 2017, were enrolled for analysis.MeasureThe length of residency was taken as the period from their first appearance in the national health insurance database to the end of 2017. Hypertension and diabetes were chosen as indices of physical health and depression as an index of mental health. Diagnosis standards were based on the International Classification of Disease, ninth or 10th Revision.ResultsThe physical and mental health of the immigrants deteriorated with increasing time of residence in Taiwan. Immigrants who had resided in Taiwan for 5–10 years or ≥10 years, respectively, had a 5.8-fold (95% CI: 3.46 to 9.74) or 6.29-fold (95% CI: 4.61 to 8.59) higher adjusted risk of developing hypertension; a 3.97-fold (95% CI: 2.54 to 6.21) or 9.18-fold (95% CI: 5.48 to 15.38) higher adjusted risk of developing diabetes; and a 5.01-fold (95% CI: 3.14 to 8.01) or 12.19-fold (95% CI: 8.65 to 17.18) higher adjusted risk of developing depression than their counterparts who had lived in Taiwan for ≤5 years.ConclusionThese findings suggest the time elapsed since migration can be a factor in the deterioration of both physical and mental health among female marriage immigrants in Taiwan.
Bismuth telluride‐based thermoelectric (TE) materials are historically recognized as the best p‐type (ZT = 1.8) TE materials at room temperature. However, the poor performance of n‐type (ZT≈1.0) ...counterparts seriously reduces the efficiency of the device. Such performance imbalance severely impedes its TE applications either in electrical generation or refrigeration. Here, a strategy to boost n‐type Bi2Te2.7Se0.3 crystals up to ZT = 1.42 near room temperature by a two‐stage process is reported, that is, step 1: stabilizing Seebeck coefficient by CuI doping; step 2: boosting power factor (PF) by synergistically optimizing phonon and carrier transport via thermal‐driven Cu intercalation in the van der Waals (vdW) gaps. Theoretical ab initio calculations disclose that these intercalated Cu atoms act as modulation doping and contribute conduction electrons of wavefunction spatially separated from the Cu atoms themselves, which simultaneously lead to large carrier concentration and high mobility. As a result, an ultra‐high PF ≈63.5 µW cm−1 K−2 at 300 K and a highest average ZT = 1.36 at 300–450 K are realized, which outperform all n‐type bismuth telluride materials ever reported. The work offers a new approach to improving n‐type layered TE materials.
The intercalated Cu atoms in the Bi2Te2.7Se0.3 structure act as modulation doping and effectively improve carrier mobility while maintaining the carrier concentration similar to that in the uniformly doped sample. A record‐high ZT of 1.42 at 375 K is successfully realized in (CuI)0.002Bi2Te2.7Se0.3 + 0.2 % Cu.
The association between selective serotonin reuptake inhibitor (SSRI) exposure and cancer incidence has been investigated; however, no epidemiological study has investigated the association between ...exposure to individual SSRIs and kidney cancer incidence. The aim of this study is to examine whether SSRI use affected the risk of kidney cancer. We conducted a population‐based retrospective cohort study using data from Taiwan's National Health Insurance Research Database. After adjusting for sex, age, urbanization level, comorbidity and medication use through propensity score matching, we identified 222 024 SSRI users and 221 361 SSRI nonusers. A robust Cox proportional hazards model was used to examine the associations between use of individual SSRIs and the risk of kidney cancer with 1‐ and 2‐year induction periods. The result showed that SSRI users tended to be associated with a lower risk of kidney cancer with a 2‐year induction period than nonusers; however, the association was not statistically significant (adjusted hazards ratio aHR = 0.88, 95% confidence interval CI = 0.77‐1.01). We further examined the effects of individual SSRIs and observed a significantly lower risk of kidney cancer associated with the use of citalopram (aHR = 0.67, 95% CI = 0.47‐0.96) and paroxetine (aHR = 0.75, 95% CI = 0.58‐0.97) with the 2‐year induction period. These findings support that SSRIs are associated with decreased kidney cancer risk and indicate that citalopram and paroxetine have protective effects in depressed patients with kidney cancer.
What's new?
Patients with kidney cancer may be at an increased risk of developing depression. In turn, depression is a risk factor for poor outcomes in kidney cancer. In addition to their antidepressant effects, serotonin reuptake inhibitor (SSRI) have been suggested to exhibit antineoplastic effects. This study is the first to demonstrate the effects of individual SSRIs on kidney cancer risk, showing that citalopram and paroxetine may play a role in reducing the risk of kidney cancer. The results suggest that citalopram and paroxetine should be preferentially considered for the management of depressed patients with a high risk of developing kidney cancer.
PDF
