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Flexible electronic devices are developing rapidly, especially in medical applications. This paper reports an arrayed flexible piezoelectric micromachined ultrasonic transducer (FPMUT) with a sandwich structure for adjuvant treatment of bone injury. To make the device conformable and stretchable for attaching to the skin surface, the flexible substrate of polydimethylsiloxane (PDMS) was combined with the flexible metal line interconnection between the bulk lead zirconate titanate (PZT) arrays. Simulations and experiments were carried out to verify the resonant frequency and tensile property of the reported FPMUT device. The device had a resonant frequency of 321.15 KHz and a maximum sound pressure level (SPL) of 180.19 dB at the distance of 5 cm in water. In addition, detailed experiments were carried out to test its acoustic performance with different pork tissues, and the results indicated good ultrasound penetration. These findings confirm that the FPMUT shows unique advantages for adjuvant treatment of bone injury.

Few-layer black phosphorus (FLBP) is a highly promising material for high sensitivity label-free surface plasmon resonance (SPR) sensors due to its exceptional electrical, optical, and mechanical properties. FLBP exhibits inherent anisotropy with different refractive indices along its two main crystal orientations, the zigzag and armchair axes. However, this anisotropic property is often overlooked in FLBP-based sensors. In this study, we conducted a comprehensive investigation of the SPR reflectivity and phase in a BK7-Ag-FLBP structure to understand the influence of the stacking sequence and the number of FLBP layers on the sensing performance. Clear resonant angle shifts caused by different stacking sequences of FLBP could be observed both theoretically and experimentally. In the theoretical study, the highest reflective and phase sensitivities were achieved with a 12-layer black phosphorus (BP) structure. The reflectivity sensitivity reached 287.9°/refractive index units (RIU) with the zz stacking 12-layer BP film exhibiting a sensitivity 76°/RIU higher than the ac stacking structure. Similarly, the phase sensitivity reached 1162°/RIU with the zz stacking 12-layer BP structure showing a sensitivity 276.9°/RIU higher than the ac stacking structure. The electric field distribution of the 12-layer BP structure with four different stacking sequences has also been analyzed. In the experiment study, the well-known Attenuated Total Reflection (ATR) θ−2θ SPR setup is utilized to detect the reflectivity and phase of BK7-Ag-FLBP structures. The FLBP samples with the same thickness but different stacking sequences show significant resonant angle shift (0.275°) and maximum phase difference variation (34.6°). The FLBP sample thickness and crystal orientations have been demonstrated using the angular-resolved polarized Raman spectroscopy (ARPRS). These theoretical and experimental results provide strong evidence that the stacking sequences of FLBP have a significant impact on the sensing performance of SPR sensors. By harnessing the anisotropic properties of materials like FLBP, novel structures of anisotropic-2D material-based SPR sensors could open up exciting possibilities for innovative applications.

We sought to explore the risk factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism through logistic regression analysis. A retrospective analysis was conducted on 168 patients with coronary heart disease and subclinical hypothyroidism admitted to the Department of Cardiology of our hospital from February 2020 to November 2022. Patients were categorized into the control group, anxiety group, and depression group based on the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores. All participants were informed about the protocol and provided signed informed consent upon inclusion. The study examined influencing factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. Collect patients’ gender, age, presence or absence of chronic diseases (including Diabetes, hypertension and hyperthyroidism), sleep quality, dietary habits, psychosocial stress, living environment, social support, education level, and blood TSH levels. The linear relationship between anxiety, depression, and each influencing factor was quantified using the Pearson correlation coefficient. Blood level of TSH and free T4 were detected by chemiluminescence immunoassay. Multiple logistic regression was applied to analyze the factors influencing anxiety and depression in these patients. Various factors were identified as significant influencers of anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. For anxiety, presence or absence of chronic diseases, sleep quality, dietary habits, psychosocial pressure, living environment, and blood TSH levels were found to be influential ( P  < 0.05). Similarly, for depression, presence or absence of chronic diseases, sleep quality, social support, quality of life, social support, education level, and blood TSH levels were identified as significant factors ( P  < 0.05). The study revealed positive correlations between presence or absence of chronic diseases, psychosocial stress, and TSH levels with anxiety symptoms in patients with coronary heart disease and subclinical hypothyroidism ( P  < 0.05). Conversely, sleep quality, dietary patterns, and living environment showed negative correlations with anxiety symptoms ( P  < 0.05).Gender and age had no correlation with anxiety levels ( P  > 0.05). Presence or absence of chronic diseases and TSH levels were positively correlated with depressive symptoms in patients with coronary heart diseaseand subclinical hypothyroidism ( P  < 0.05). On the other hand, sleep quality, social support, quality of life, and educational level were negatively correlated with anxiety symptoms ( P  < 0.05). Gender and age had no correlation with depression ( P  > 0.05). Notably, TSH levels in both the anxiety and depression groups were higher than those in the control group ( P  < 0.05), with no significant difference in free T4 levels among the groups ( P  > 0.05). The combination of chronic illness types, living habits (sleep quality, dietary habits), psychosocial pressure, living environment, and TSH levels emerged as risk factors for anxiety in patients with coronary heart disease and subclinical hypothyroidism ( P  < 0.05). Similarly, the combination of chronic illness types, sleep quality, social support, quality of life, education level, and TSH levels were identified as risk factors for depression in these patients ( P  < 0.05). This logistic regression analysis underscores the significant impact of factors such as types of chronic illness, sleep quality, social support, living environment, education level, and TSH levels on anxiety and depression symptoms in patients with coronary heart disease and subclinical hypothyroidism. These findings highlight the importance of considering these multiple risk factors collectively when devising treatment and management strategies to reduce the risk of mental health issues in this patient population.

The primary endpoint was 1-year mortality, while secondary outcomes included (1) 30-day mortality and (2) in-hospital events, comprising device failure, major vascular complications, life-threatening or major bleeding, postprocedural moderate/severe perivalvular aortic regurgitation (AR), permanent pacemakers, atrial fibrillation, stroke, and myocardial infarction (MI). Restricted cubic spline (RCS) analysis showed a non-linear dose-response relationship between BMI and 1-year mortality. According to both the univariate and the multivariate Cox regression models, the risk of 1-year mortality was higher for underweight patients compared with normal-weight patients, but not for overweight or obese individuals. Inverse probability weighting analysis of in-hospital adverse outcomes comparing different BMI groups is shown in Supplementary Table 4, http://links.lww.com/CM9/C197.

Few centers routinely report aortic arch calcification (AAC) due to the lack of an easy and effective evaluation method. The association between AAC and the clinical prognosis of patients who undergo transcatheter aortic valve replacement (TAVR) is unclear. We aimed to develop a rapid method to evaluate AAC in patients who underwent TAVR and to further assess their prognosis. We enrolled 464 consecutive patients with aortic stenosis who underwent TAVR. Patients with severe (11.2%), moderate (18.5%), mild (58.2%), and no (12.1%) AAC had an estimated 3-year all-cause mortality incidence of 39.6%, 20.8%, 13.4%, and 6.7% (log rank p  < 0.001), respectively. Patients with severe AAC had a significantly higher incidence of both cardiovascular (log rank p  = 0.002) and non-cardiovascular mortality (log rank p  = 0.009), whereas patients with moderate AAC had a higher incidence of only non-cardiovascular mortality ( p  = 0.003) compared with patients with no/mild AAC. Moderate/severe AAC was an independent predictor of 3-year all-cause mortality in univariate (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.41–4.03; p  = 0.001) and multivariate COX regression analyses (HR: 1.78, 95%CI: 1.04–3.06; p  = 0.037). Our rapid semi-quantitative method to evaluate AAC is highly reproducible and can be used to assess AAC in patients who undergo TAVR.

The CRB600H reinforcement is a new type of cold-rolled ribbed steel bar, which has the advantages of green and low carbon, stable quality, saving precious metal resources and so on. In order to study the axial compression performance of short concrete columns with CRB600H stirrups, the finite element analysis model of high-strength reinforced concrete stub columns was established by using ABAQUS, and the accuracy of the finite element model was verified by literature experiments. The effects of stirrup construction (Type A, B and C), stirrup spacing and concrete strength on the axial compressive bearing capacity and ductility of concrete columns with CRB600H stirrups were analyzed and compared with HRB400 stirrups columns. The results showed that the peak bearing capacity of the specimens with CRB600H stirrups was similar to that with HRB400 stirrups, and the ductility of the specimens was improved with CRB600H stirrup. Compared with the type A stirrup and type C stirrup, the type B stirrup had the best concrete restraining effect, and the ductility and peak bearing capacity of the specimens were higher. With a decrease in the stirrup spacing, the ductility and peak bearing capacity of the specimens increased. With an increase in concrete strength, the peak bearing capacity increases, but the ductility decreases. Through parameter analysis, a formula for calculating the axial bearing capacity of 600 MPa high-strength stirrup concrete stub columns based on the effective confinement index (keλt) was proposed. It is suggested that the equivalent volume of a HRB400 stirrup can be replaced by a CRB600H stirrup in the actual project. At the same time, when the high-strength stirrup was used, the restraining effect of the stirrup on concrete should be considered in the calculation of the axial compression bearing capacity.

Lossy mode resonance (LMR) sensors offer a promising avenue to surpass the constraints of conventional surface plasmon resonance (SPR) sensors by delivering enhanced label-free detection capabilities. A notable edge of LMR over SPR is its excitation potential by both transverse electric (TE) and transverse magnetic (TM) polarized light. Yet this merit remains underexplored due to challenges to achieving high sensing performance under both TM and TE polarization within a singular LMR model. This study introduces a theoretical model for an LMR prism refractive index sensor based on a MgF2-few layer black phosphorus-MgF2 configuration, which can achieve angular sensitivity nearing 90° refractive index unit−1 (RIU−1) for both polarizations. Leveraging the distinct anisotropic nature of black phosphorus, the figure of merit (FOM) values along its two principal crystal axes (zigzag and armchair) show great difference, achieving an impressive FOM of 1.178 × 106 RIU−1 along the zigzag direction under TE polarized light and 1.231 × 104 RIU−1 along the armchair direction under TM polarized light. We also provide an analysis of the electric field distribution for each configuration at its respective resonant conditions. The proposed structure paves the way for innovative applications of anisotropic-material-based LMR sensors in various applications.

Objective To investigate the clinical characteristics of event‐related potential P300 in elderly schizophrenics with different levels of violence and the risk factors of severe violence. Methods A total of 138 elderly schizophrenic patients from January 2020 to December 2021 in the First Hospital of Hebei Medical University were enrolled in this retrospective analysis. Based on the violence risk assessment, 61, 102, and 145 patients were divided into high‐risk, medium‐risk, and low‐risk groups, respectively. Clinical characteristics, P300 latency, and P300 amplitude were compared among the three groups followed by a logistic regression analysis of elderly schizophrenics with severe violence. Results The latency of P300 in the high‐risk group was higher than that in the low‐risk group (p < .05). The P300 amplitude of patients in the high‐risk group was significantly lower than that in the low‐risk group (p < .05). Univariate logistic regression analysis showed that previous history of violence, delusion of persecution, P300 latency, and amplitude were independent influencing factors of severe violence in elderly schizophrenics (odds ratio [OR]: 0.022, 95% confidence interval [CI]: 0.007–0.067, p < .001; OR: 0.118, 95% CI: 0.043–1.763, p = .037; OR: 1.289, 95% CI: 1.142–1.673, p < .001; and OR: 0.049, 95% CI: 0.021–0.067, p < 0.001, respectively). After adjusting gender, age, and other confounding factors, multivariate logistic regression analysis showed that delusion of persecution, P300 latency, and P300 amplitude were associated with severe violence in elderly schizophrenics (OR: 2.211, 95% CI: 0.061–4.067, p < .001; OR: 2.006, 95% CI: 1.421–2.721, p = .017; and OR: 0.067, 95% CI: 0.037–0.276; p < .001; respectively). Conclusion The latency and amplitude of P300 can be used as effective neuroelectrophysiological indicators to evaluate the violence level of elderly schizophrenics. Delusion of persecution, P300 latency, and P300 amplitude were independent influencing factors of severe violence in elderly schizophrenics.

Far less attention has been paid to the prognostic effect of right‐side heart disease on outcomes after transcatheter aortic valve replacement (TAVR) when compared with the left side. Therefore, we performed a systematic review and meta‐analysis on the impact of tricuspid regurgitation (TR) and right ventricular (RV) dysfunction on outcomes after TAVR. We hypothesized that TR and RV dysfunction may have a deleterious effect on outcomes after TAVR. Article revealing the prognostic effect of TR and RV dysfunction on outcomes after TAVR were being integrated. Random or fixed effect model was adopted in accordance with the heterogeneity. There were nine studies with a total of 6466 patients enrolled after a comprehensive literature search of the MEDLINE/PubMed, EMBASE, ISI Web of Science, and Cochrane databases. The overall analysis revealed that moderate or severe TR at baseline increased all‐cause mortality after TAVR (HR = 1.79, CI 95% 1.52‐2.11, P < 0.001). Both baseline RV dysfunction (HR = 1.53, CI 95% 1.27‐1.83, P < 0.001) and presence of RV dilation (HR = 1.83, CI 95% 1.47‐2.27, P < 0.001) were associated with all‐cause mortality. Both baseline moderate or severe TR and RV dysfunction worsen prognosis after TAVR and careful assessment of right heart function should be done for clinical decision by the heart team before the TAVR procedure.

Pulmonary hypertension (PH) is a common entity in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI), but its role on clinical outcomes remains undetermined. We evaluated the impact of baseline and postprocedural PH on clinical outcomes and changes in pulmonary artery systolic pressure after TAVI by performing a meta-analysis of 16 studies enrolling 9,204 patients with AS who underwent TAVI. In patients with baseline PH, all-cause mortality was significantly increased, as shown by pooled odds ratio (ORs) for overall 30-day (OR 1.52, 95% confidence interval [CI] 1.28 to 1.80), 1-year (OR 1.39, 95% CI 1.27 to 1.51), and 2-year all-cause mortality (OR 2.00, 95% CI 1.49 to 2.69), compared with those without PH, independent of different methods of PH assessment. The presence of post-TAVI PH was associated with a significant increase in 2-year all-cause mortality (OR 2.32, 95% CI 1.43 to 3.74). Nevertheless, pulmonary artery systolic pressure decreased at 3-month to 1-year follow-up (standardized mean difference −1.12, 95% CI −1.46 to −0.78). Baseline PH was associated with higher 30-day and 1-year cardiovascular mortality. Patients with baseline PH had higher risk of stroke at 1 year and acute kidney injury at 30 days. But the risk of major vascular complications was significantly lower in patients with baseline PH. In conclusion, the presence of PH is associated with increased short- and long-term mortality, also higher risk of stroke and acute kidney injury after TAVI. A significant decrease in PSAP is detected in patients with AS in midterm follow-up after TAVI.