SrTiO3 is one of the most widely studied perovskite oxides that exhibit quantum paraelectric behavior. Being at the border of the paraelectric-ferroelectric transition, SrTiO3 is known to become ...ferroelectric at a finite temperature by exploiting various approaches including epitaxial strain, oxygen isotope exchange, and dimensionality. In this study, owing to the state-of-the-art pulsed laser epitaxy, a selective engineering of elemental vacancies is proposed for the emergence and systematic control of the ferroelectricity in SrTiO3 thin films. Therein, Sr vacancy plays an essential role in inducing the cubic-to-tetragonal transition, resulting in the inversion symmetry breaking necessary for the switchable electric polarization. Furthermore, the tetragonality is enhanced with the increase in the Sr vacancies, eventually strengthening the ferroelectricity. Our research summarizes the tetragonality-induced ferroelectricity in SrTiO3 and provides facile growth control of the behavior.
•A strategy to systematically design the ferroelectric thin films using the selective elemental engineering is proposed.•Concrete experimental evidence of the relationship between tetragonality and the ferroelectricity is shown.•Selective vacancy engineering promotes a facile ferroelectricity control in SrTiO3 thin films.
Aims/Introduction
The cardiovascular (CV) outcomes of vildagliptin – a dipeptidyl peptidase‐4 inhibitor – in patients with type 2 diabetes mellitus after acute coronary syndrome or acute ischemic ...stroke are unclear.
Materials and Methods
We analyzed data from the Taiwan National Health Insurance Research Database on 3,750 type 2 diabetes mellitus patients with acute coronary syndrome or acute ischemic stroke within 3 months between 1 August 2011 and 31 December 2013. Clinical outcomes were evaluated by comparing 1,250 participants receiving vildagliptin with 2,500 propensity score‐matched participants. The primary composite outcome included CV death, non‐fatal myocardial infarction and non‐fatal stroke.
Results
The primary composite outcome occurred in 122 patients (9.8%) in the vildagliptin group and 263 patients (10.5%) in the control group (hazard ratio HR 0.90, 95% confidence interval CI 0.72–1.11) with a mean follow‐up period of 9.9 months. No significant between‐group differences were observed for CV death (HR 0.93, 95% CI 0.56–1.52), non‐fatal myocardial infarction (HR 0.79, 95% CI 0.46–1.36) and non‐fatal stroke (HR 0.96, 95% CI 0.74–1.24). The vildagliptin group was at similar risks of hospitalization for heart failure (HF) or coronary intervention to the control group (P = 0.312 and 0.430, respectively). For patients with HF at baseline, the risk of hospitalization for HF was similar between the vildagliptin and control groups (HR 1.04, 95% CI 0.57–1.88).
Conclusions
Among patients with type 2 diabetes mellitus after a recent acute coronary syndrome or acute ischemic stroke, treatment with vildagliptin was not associated with increased risks of CV death, non‐fatal myocardial infarction, non‐fatal stroke and hospitalization for HF.
Among patients with type 2 diabetes mellitus after a recent acute coronary syndrome or acute ischemic stroke, treatment with vildagliptin was not associated with increased risks of cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke and hospitalization for heart failure.
Background Patients with impaired liver function ( ILF ) were excluded from clinical trials that investigated non-vitamin K antagonist oral anticoagulants ( NOAC s) for stroke prevention in patients ...with atrial fibrillation. The aim of this study was to evaluate the efficacy and safety of NOAC s in atrial fibrillation patients with ILF . Methods and Results A cohort study based on electronic medical records was conducted from 2009 to 2016 at a multicenter healthcare provider in Taiwan and included 6451 anticoagulated atrial fibrillation patients (aged 76.7±7.0 years, 52.5% male). Patients were classified into 2 subgroups: patients with normal liver function (n=5818) and patients with ILF (n=633, 9.8%). Cox regression analysis was performed to investigate the risks of thromboembolism, bleeding, and death associated with use of NOAC s and warfarin in patients with normal liver function and ILF , respectively. In patients with normal liver function, compared with warfarin therapy (n=2928), NOAC therapy (n=4048) was associated with significantly lower risks of stroke or systemic embolism (adjusted hazard ratio: 0.75; 95% confidence interval, 0.65-0.88; P<0.001) and death (adjusted hazard ratio: 0.69; 95% confidence interval, 0.60-0.80; P<0.001) with no difference in major bleeding or gastrointestinal bleeding. In patients with ILF , compared with warfarin therapy (n=394), NOAC therapy (n=342) was associated with significantly lower risk of death (adjusted hazard ratio: 0.64; 95% confidence interval, 0.49-0.83; P<0.001), but no difference in stroke or systemic embolism, major bleeding, or gastrointestinal bleeding. Conclusions In atrial fibrillation patients with ILF , NOAC therapy and warfarin therapy were associated with similar risks of stroke or systemic embolism, major bleeding, and gastrointestinal bleeding.
CpG-ODN stimulates dendritic cells (DCs) to produce cytokines, which are important for pathogenesis of autoimmune disorders and vaccine strategy for cancer. CpG-ODN activates the TLR9/MyD88/TRAF6 ...cascade leading to activation of IKK-NF-κB and JNK, which are critical for production of pro-inflammatory cytokines. However, whether other molecules are involved in activation of CpG-ODN signaling is still not clear. Here we report that the catalytic subunit of DNA-dependent protein kinase (DNA-PKcs) is involved in this activation process. DNA-PKcs-deficient DCs exhibited a defect in the IL-6 and IL-12 response to CpG-ODN in a dose- and time-dependent manner. Loss of DNA-PKcs impaired phosphorylation of IKK, IκBα, NF-κB and JNK in response to CpG-ODN. Interestingly, CpG-ODN was able to bind DNA-PKcs and induce its association and co-localization with TRAF6 in the absence of TLR9. Our data suggest that DNA-PKcs is a player in CpG-ODN signaling and may explain why DNA-PKcs is implicated in the pathogenic process of autoimmune disease.
Abstract A global heart failure (HF) registry suggested that the inverse association between body mass index (BMI) and all-cause mortality differed by race, particularly stronger in Japanese patients ...at 1-year follow-up. Whether this finding was consistent across all East Asian populations was unknown. In a multicenter prospective study in Taiwan, we enrolled 1,301 patients hospitalized for systolic HF from 2013 to 2014, and followed up the mortality after their discharge for a median of 1-year period. Cox proportional hazard regression analyses were used to assess the association of BMI with all-cause mortality. The results showed that BMI was inversely associated with all-cause mortality (hazard ratio (HR) and 95% confidence interval per 5-kg/m2 increase: 0.75 (0.62-0.91)) after adjusting for demographics, traditional risk factors, HF severity, and medications at discharge. Subsequently, we sought previous studies regarding the BMI association with mortality for East Asian patients with HF from Medline, and a random effect meta-analysis was performed by the inverse variance method. The meta-analysis including 7 previous eligible studies (3 for the Chinese and 4 for the Japanese cohorts) and the present one showed similar results that BMI was inversely associated with all-cause mortality (HR: 0.65 (0.58-0.73), I2 =37%). In conclusion, our study in Taiwan and a collaborative meta-analysis confirmed a strong inverse BMI-mortality association consistently among East Asian patients with HF.
The properties of van der Waals heterostructures are drastically altered by a tunable moiré superlattice arising from periodically varying atomic alignment between the layers. Exciton diffusion ...represents an important channel of energy transport in transition metal dichalcogenides (TMDs). While early studies performed on TMD heterobilayers suggested that carriers and excitons exhibit long diffusion, a rich variety of scenarios can exist. In a moiré crystal with a large supercell and deep potential, interlayer excitons may be completely localized. As the moiré period reduces at a larger twist angle, excitons can tunnel between supercells and diffuse over a longer lifetime. The diffusion should be the longest in commensurate heterostructures where the moiré superlattice is completely absent. Here, we experimentally demonstrate the rich phenomena of interlayer exciton diffusion in WSe
/MoSe
heterostructures by comparing several samples prepared with chemical vapor deposition and mechanical stacking with accurately controlled twist angles.
Although a patient care system may help nurses handle patients' requests or provide timely assistance to those in need, there are a number of barriers faced by nurses in handling alarms.
The aim of ...the study was to describe the implementation and experience of an innovative smart patient care system (SPCS). This study applied a cross-sectional descriptive design. We recruited 82 nurses from a medical center in Taiwan, with 25 nurses from a ward that had introduced an SPCS and 57 nurses from wards that used the traditional patient care system (TPCS). The major advantages of the SPCS compared to the TPCS include the specification of alarm purposes, the routing of alarms directly to the mobile phone; the capability of immediate communication via phone; and three-stage bed-exit alerts with low false alarm rate.
Approximately 56% of nurses in the TPCS wards perceived that the bed-exit alert was easily ignorable, while this rate was reduced to 32% in the SPCS ward. The immediate communication via phone was considered as the most helpful function of the SPCS, with a weighted average score of 3.92/5, and 52% of nurses strongly agreed (5/5) that this function was helpful. The second-highest ranked function was the three-stage bed-exit alert, with an average score of 3.68/5, with approximately 24% of nurses strongly agreeing (5/5) that this function was helpful. The average response time using TPCS was 145.66 s while it was 59.02 s using the SPCS (P < .001). Among the 110 observed alarms in the SPCS ward, none of them were false bed-exit alarms. In comparison, among 120 observed alarms in the TPCS wards, 42 (35%) of them were false bed-exit alarms (P < .001). In this study, we found that 30.91% of alarms using SPCS were processed because nurses received and responded to the alert via mobile phone.
A smart patient care system is needed to help nurses make more informed prioritization decisions between responding to alarms and ongoing tasks and finally assist them in adjusting their work in various situations to improve work efficiency and care quality.
CpG-ODNs activate dendritic cells (DCs) to produce interferon alpha (IFNα) and beta (IFNβ). Previous studies demonstrated that Toll-like receptor 9 (TLR9) deficient DCs exhibited a residual IFNα ...response to CpG-A, indicating that yet-unidentified molecules are also involved in induction of IFNα by CpG-A. Here, we report that the catalytic subunit of DNA-dependent protein kinase (DNA-PKcs) but not Ku70 deficient BMDCs showed defective IFNα and IFNβ responses to CpG-A or CpG-B. Loss of both DNA-PKcs and TLR9 further reduced the IFNα response to CpG-A. These DNA-PKcs and TLR9 effects were mediated by their downstream Akt/mTORC1 pathway and downstream events IRAK1 and IKKα. Loss of DNA-PKcs, TLR9, MyD88 or IRAK4 impaired phosphorylation of Akt(S473), S6K, S6, IRAK1, or IKKα in BMDCs in response to CpG-ODNs. The residual IFNα and IFNβ in DNA-PKcs-deficient BMDCs were partially responsible for the induction of IL-6 and IL-12 by CpG-ODNs and their stimulatory effect was blocked by IFNAR1 neutralizing antibodies. Further analysis indicated that CpG-ODN associated with DNA-PKcs and Ku70, and induced DNA-PKcs's interaction with TRAF3. Intriguingly, DNA-PKcs but not Ku70 expression level was reduced in TLR9-deficient BMDCs. Taken together, our data suggest that DNA-PKcs is an important mediator in the type I IFN response to CpG-ODNs in TLR9-dependent or -independent fashions.
Clusteroluminescence (CL) materials, as an emerging class of luminescent materials with unique photophysical properties, have received increasing attention owing to their great theoretical ...significance and potential for biological applications. Although much progress has been made in the design, synthesis and application of CL materials, there is still a big challenge in the emission mechanism. So far, through-space interaction has been proposed as the preliminary mechanism of the corresponding clusterization-triggered emission (CTE) effect, but a systematic theory is still needed. This review summarizes the current mechanistic understanding of CL materials including organic/inorganic small molecules, and polymers with/without isolated aromatic structures. In addition, some strategies to achieve high quantum yield, adjustable emission color, and persistent room temperature phosphorescence in CL materials are also summarized. At last, a perspective of the mechanism and application of CL materials are demonstrated, which inspire the researchers working on the development of new kinds of functional materials.
The CTE process is achieved by the aggregation of atoms or groups under the action of external forces (e.g., crystallization, hydrogen bonding and polymerization) to generate TSI, thereby causing orbital splitting and further luminescence emission. Display omitted
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