The microstructures and phase formations of Ti20Zr15Hf15Ni35Cu15 high entropy shape memory alloy (HESMA) under different aging conditions were investigated in this study. At aging temperatures below ...500 °C, a large amount of the H-phase formed, and the martensitic transformation temperatures were suppressed due to the strain field around the H-phase. Aging treatment at 600 °C caused a eutectoid reaction, which yielded a lamellar structure composed of (Zr,Hf)7Cu10 and Ti2Cu phases. When the aging treatment was increased to 700 °C, the lamellar structure was no longer observed, but (Zr,Hf)7Cu10 and newly-formed Ti2Ni phases formed around the original Ti2Ni phase. Experimental results demonstrated that the H-phase precipitation, eutectoid decomposition, and (Zr,Hf)7Cu10 formation occurred at different aging temperatures. These results could be utilized to adjust the martensitic transformation temperatures and design microstructures, providing a new strategy for developing TiZrHfNiCu HESMAs.
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•The complex phase formations of Ti20Zr15Hf15Ni35Cu15 alloy was studied.•Aging at 400 °C and 500 °C resulted in the formation of H-phase precipitates.•Eutectoid orthorhombic (Zr,Hf)7Cu10 and tetragonal Ti2Cu phases formed at 600 °C.•Orthorhombic (Zr,Hf)7Cu10 and cubic Ti2Ni formed when the alloy was aged at 700 °C.•Addition of Cu induced the formation of (Zr,Hf)7Cu10 and the eutectoid reaction.
Abstract Effective therapeutic strategies for radiation-induced lung injury (RILI) are lacking. Mesenchymal stem cells (MSCs), as gene therapy delivery vehicles, possess the ability to repair injured ...lung. In this study, we conducted MSC-based hepatocyte growth factor (HGF) gene therapy for RILI. Mice received single-dose radiation with 20 Gy of γ rays locally to the lung, and then were administered normal sodium, Ad-HGF-modified MSCs, or Ad-Null-modified MSCs. Ad-HGF-modified MSCs (MSCs-HGF) improved histopathological and biochemical markers of lung injury. MSCs-HGF could reduce secretion and expression of proinflammatory cytokines, including tumor necrosis factor-α, interferon-γ, interleukin (IL)-6, and intercellular adhesion molecule-1, and increase the expression of antiinflammatory cytokine IL-10. It could also decrease expression levels of profibrosis factors transforming growth factor-β, Col1a1 (collagen type 1, α1), and Col3a1, and inhibit fibrosis progress. MSCs-HGF could promote proliferation of lung epithelial cells and protect them from apoptosis, and improve the expression of endogenous HGF and its receptor c-Met significantly. We also found that sphingosine-1-phosphate receptor-1 expression was increased in injured lung. These results suggest MSC-based HGF gene therapy not only reduces inflammation but also inhibits lung fibrosis.
With innovative modern material-growth methods, a broad spectrum of fascinating materials with reduced dimensionsranging from single-atom catalysts, nanoplasmonic and nanophotonic materials to ...two-dimensional heterostructural interfacesis continually emerging and extending the new frontiers of materials research. A persistent central challenge in this grand scientific context has been the detailed characterization of the individual objects in these materials with the highest spatial resolution, a problem prompting the need for experimental techniques that integrate both microscopic and spectroscopic capabilities. To date, several representative microscopy–spectroscopy combinations have become available, such as scanning tunneling microscopy, tip-enhanced scanning optical microscopy, atom probe tomography, scanning transmission X-ray microscopy, and scanning transmission electron microscopy (STEM). Among these tools, STEM boasts unique chemical and electronic sensitivity at unparalleled resolution. In this Perspective, we elucidate the advances in STEM and chemical mapping applications at the atomic scale by energy-dispersive X-ray spectroscopy and electron energy loss spectroscopy with a focus on the ultimate challenge of chemical quantification with atomic accuracy.
Defects exist in almost all materials and defect engineering at the atomic level is part of modern semiconductor technology. Defects and their long-range strain fields can have a negative impact on ...the host materials. In materials with confined dimensions, the influence of defects can be even more pronounced due to the enhanced relative volume of the 'defective' regions. Here we report the dislocation-induced polarization instability of (001)-oriented Pb(Zr(0.52)Ti(0.48))O(3) (PZT) nanoislands, with an average height of approximately 9 nm, grown on compressive perovskite substrates. Using quantitative high-resolution electron microscopy, we visualize the strain fields of edge-type misfit dislocations, extending predominantly into a PZT region with a height of approximately 4 nm and width of approximately 8 nm. The lattice within this region deviates from the regular crystal structure. Piezoresponse force microscopy indicates that such PZT nanoislands do not show ferroelectricity. Our results suggest that misfit engineering is indispensable for obtaining nanostructured ferroelectrics with stable polarization.
Background
The use of proteasome inhibitors (PIs), new immune modulators (IMiDs), and other new drugs, as well as high‐dose chemotherapy combined with autologous stem cell transplantation has ...considerably improved the survival of young patients with multiple myeloma (MM). However, the improvement in survival among elderly patients remains insufficient. Optimal treatment recommendation models for elderly patients with MM have not been developed especially there are quite few study in the real world.
Methods
We retrospectively analyzed the treatment patterns and outcomes of 328 Chinese patients (≥65 years) with MM in a real‐world setting. Patients were divided into three groups according to induction regimens.
Results
The median age of the cohort was 70 (65–86) years. The patients were divided into group 1 (PIs based regimens, n = 218), group 2 (IMiDs based regimens, n = 48) and group 3 (PIs + IMiDs, n = 62). Induction regimens in group 3 produced higher overall response rate than group 1 and 2 (85.42% vs. 71.08% vs. 66.67%, p = 0.016). The median follow‐up of the cohort was 30 (interquartile range IQR 18–36) months. For the entire cohort median progression‐free survival (PFS) was 26 (IQR 12.00–42.89) months and overall survival (OS) was 60 (IQR 40.00–67.20) months. The PFS were not significantly different among the three groups (28 months vs. 18 months vs. 26 months, p = 0.182). So were the OS (60 months vs. 59 months vs. not reached, p = 0.067). Multivariate analysis revealed that age >70 year, frailty status (Geriatric vulnerability score), induction efficacy < partial remission, and no maintenance treatment were independent poor prognostic factors for OS.
Conclusion
Front‐line induction regimens combining PIs and IMiDs developed more deep response than single PI or IMiD based regimens. Maintenance treatment can further improve the clinical outcome in elderly MM patients in real‐world setting.
Front‐line treatment for elderly MM patients.
The rich structure of bright and dark surface-plasmon modes localized in individual and coupled gold nanoparticles is unveiled by electron-energy-loss spectroscopy performed in a scanning ...transmission electron microscope. Spatially resolved maps of surface-plasmon modes in the ∼1.5−2.5 eV range (wavelengths ∼500−800 nm), collected for individual nanorods, coupled nanorod dimers, and touching nanosphere dimers, are in excellent agreement with theory. Surface-plasmon maps constructed from the spatially and spectrally resolved energy-loss signals are shown to mimic rather well the near fields calculated for external illumination in the case of bright surface-plasmon modes (i.e., those coupling to external light). Dark surface-plasmon modes that cannot be excited by optical means are also found, and our electron probing technique provides further insight into their corresponding spatial distribution and symmetry, which are not accessible to any other existing techniques. Our results initiate the study of a whole set of new dark surface-plasmon modes that should become a source of new applications in sensing and microscopy but have escaped experimental scrutiny so far.
Whether the cardiovascular (CV) outcomes of second-generation limus-eluting stents (LESs) differ from those of paclitaxel-eluting stents (PESs) in patients with acute myocardial infarction (AMI) ...complicated by cardiogenic shock (CS) is still unclear.
We used the Taiwan National Health Insurance Research Database to analyse data of 516 patients with AMI and CS diagnosed from January 2007 to December 2011. We used propensity score matching to adjust for the imbalance in covariate baseline values between these two groups. We evaluated clinical outcomes by comparing 197 subjects who used second-generation LESs to 319 matched subjects who used PESs.
The risk of the primary composite outcomes (i.e., myocardial infarction, coronary revascularisation or CV death) was significantly lower in the second-generation LES group than in the PES group 37.3% vs. 51.8%; hazard ratio (HR), 0.73; 95% CI: 0.56-0.95 at the 12-month follow-up. The patients who received second-generation LESs had a lower risk of coronary revascularisation (HR 0.62; 95% CI: 0.41-0.93) than those who used PESs. However, the risks of myocardial infarction (HR 0.56; 95% CI: 0.26-1.24), ischemic stroke (HR 0.73; 95% CI: 0.23-2.35), or CV death (HR 0.90; 95% CI: 0.63-1.28) were not significantly different between the two groups.
Among patients with CS-complicating AMI, second-generation LES implantation significantly reduced the risk of coronary revascularisation and composite CV events compared to PES implantation at the 12-month follow-up.
Patients with thrombocytopenia were excluded from major clinical trials that investigated non-vitamin-K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF). The ...aim of this study was to evaluate the effectiveness and safety of NOAC versus warfarin in AF patients with thrombocytopenia. From 2010 to 2017, a cohort study based on electronic medical records of a multi-center healthcare provider in Taiwan and included 8239 anticoagulated AF patients (age 77.0 ± 7.3 years, 48.0% female). Patients were divided into two subgroups: 7872 patients with a normal platelet count and 367 patients (4.4%) with thrombocytopenia, which was defined as a platelet count less than 100 × 10
3
/µL. We performed Cox proportional hazard analyses to compare the risks of ischemic stroke or systemic embolism (IS/SE), major bleeding, and death between NOAC and warfarin therapies in patients with a normal platelet count and those with thrombocytopenia, respectively. In patients with a normal platelet count, NOAC therapy (n = 4904) was associated with a significantly lower risk of major bleeding, with no difference in the risk of IS/SE or death when compared with warfarin therapy (n = 2968). In patients with thrombocytopenia, NOAC therapy (n = 181) was associated with a lower tendency for major bleeding (aHR 0.45, 95% CI 0.16–1.14) with no significant difference in IS/SE (aHR 0.94, 95% CI 0.29–2.91) or death (aHR 0.95, 95% CI 0.46–1.95) when compared with warfarin therapy (n = 186). NOAC therapy is a reasonable choice for stroke prevention in AF patients with thrombocytopenia.
Colonoscopy is considered a safe and effective tool for detecting colorectal cancer. Nevertheless, the proportion of patients are hesitating to receive colonoscopy. Smartphone education may decrease ...the barrier of colonoscopy. The aim of this study is to examine the effectiveness of smartphone education in colonoscopy.
We conducted a prospective, double-blinded, randomized, controlled study to examine the effectiveness of smartphone education on embarrassment, bowel preparation, and satisfaction in colonoscopy. The patients' embarrassment was measured by the colonoscopy embarrassment scale. The quality of the bowel preparation was evaluated by gastroenterologists according to the Aronchik Scale. The satisfaction of colonoscopy care was assessed by a satisfaction scale developed by the authors.
A total of 150 patients were analyzed in the smartphone education and control groups (n = 75 in each group). The smartphone education group reported fewer embarrassment (B = -2.78, P = .02) than those of the control group, the patients who were older (B = .15, P = .001) and who were male (B = 2.91, P = .003) showed higher embarrassment. Additionally, smartphone education group were likely to have better colon preparation (odds ratio = 2.46, 95% confidence interval: 1.20-5.02) than that of the control group. Smartphone education also improved the satisfaction with care (β = 4.60, P < .001), and above normal body mass index decreased the satisfaction with care (β = -0.19, P < .05).
Smartphone education improves embarrassment, bowel preparation, and satisfaction with care in patients receiving colonoscopy.
Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical ...management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF.
The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed.
A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean age of 64 years (72% were male). Ischemic cardiomyopathy and dilated cardiomyopathy were diagnosed in 44% and 33% of patients, respectively. Coronary artery disease, hypertension, diabetes, and chronic renal insufficiency were the common comorbid conditions. Acute coronary syndrome, non-compliant to treatment, and concurrent infection were the major precipitating factors for acute decompensation. The median length of hospital stay was 8 days, and the in-hospital mortality rate was 2.4%. At discharge, 62% of patients were prescribed either angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, 60% were prescribed beta-blockers, and 49% were prescribed mineralocorticoid receptor antagonists.
The TSOC-HFrEF registry provided important insights into the current clinical characteristics and management of hospitalized decompensated systolic HF patients in Taiwan. One important observation was that adherence to guideline-directed medical therapy was suboptimal.
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