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Research into organic light emitters employing multiple resonance-induced thermally activated delayed fluorescence (MR-TADF) materials is presently attracting a great deal of attention due to the potential for efficient deep-blue emission. However, the origins and mechanisms of successful TADF are unclear, as many MR-TADF materials do not show TADF behaviour in solution, but only as particular pure solids. Here, an investigation into a well-known MR-TADF material, DABNA-1, together with other new MR materials (9H-quinolino[3,2,1-kl]phenothiazin-9-one (QPO) and 9H-quinolino-[3,2,1-kl]-phenothiazin-9-one 5,5-dioxide (QP3O)), yields new insights regarding the origin of TADF. Although a material system may support the concept of MR, inefficiency in both forward and reverse intersystem crossings forbids TADF unless a suitable host material allows an exciplex-like host–emitter interaction that boosts TADF. This boosted-TADF mechanism can be generalized to any fluorescence dye that lacks TADF in the photoluminescence measurement but has a thermally accessible S1–T1 energy gap, opening the way to high-performance organic light-emitting diodes.This study reveals the importance of host–guest interactions for effective multiple-resonance thermally activated delayed fluorescence in organic light emitters.

The correlation between molecular packing structure and its room-temperature phosphorescence (RTP), hence rational promotion of the intensity, remains unclear. We herein present racemism enhanced RTP chiral chromophores by 2,2-bis-(diphenylphosphino)-1,1-napthalene (rac- BINAP ) in comparison to its chiral counterparts. The result shows that rac- BINAP in crystal with denser density, consistent with a long standing Wallach’s rule, exhibits deeper red RTP at 680 nm than that of the chiral counterparts. The cross packing between alternative R- and S- forms in rac- BINAP crystal significantly retards the bimolecular quenching pathway, triplet-triplet annihilation (TTA), and hence suppresses the non-radiative pathway, boosting the RTP intensity. The result extends the Wallach’s rule to the fundamental difference in chiral-photophysics. In electroluminescence, rac- BINAP exhibits more balanced fluorescence versus phosphorescence intensity by comparison with that of photoluminescence, rendering a white-light emission. The result paves an avenue en route for white-light organic light emitting diodes via full exploitation of intrinsic fluorescence and phosphorescence. Room temperature phosphorescence (RTP) is a topic which is currently widely studied, but a study on the correlation between types of molecular solid and RTP properties is lacking. Here the authors show that RTP is enhanced in the racemic form of axial chiral molecules due to its denser R- and S- cross packing arrangement.

Extracellular vesicles (EVs) are involved in the progression of various diseases. Tumor cell-derived EVs (TEVs) are a particular concern, as they can induce fatty liver by promoting liver macrophages to secrete tumor necrosis factor (TNF), thus enhancing the toxicity of chemotherapy. Therefore, reducing pathogenic EV production is a potential strategy for treating EV-related diseases. However, there are currently no effective clinical reagents to obtain this purpose. In addition, EVs are also natural and ideal drug-delivery vehicles. Improving the delivery efficiency of EVs remains a challenge. Proton pump inhibitors (PPIs) have been demonstrated to promote cell uptake of EVs by inducing micropinocytosis. Here, we show that PPIs can accelerate TEV clearance, reduce TEV uptake by liver macrophages and decrease the mRNA expression of TNF in liver macrophages of tumor-bearing mice. Correspondingly, the fatty liver phenotypes are alleviated, and the tolerance to chemotherapy is improved in these mice. Furthermore, our findings indicate that PPIs facilitate the uptake of red blood cell-derived EVs (RBC-EVs) loaded with antisense oligonucleotides of Trim21 ( Trim21 -ASOs) by the liver macrophages of obesity. Consequently, the inhibition of macrophage inflammatory responses in obese mice mediated by RBC-EVs/ Trim21 -ASOs was further enhanced by PPIs, resulting in a more profound improvement in obesity and related metabolic disorders. In conclusion, our findings demonstrated that PPIs can effectively clear pathogenic EVs and enhance the delivery efficacy of EV vehicles, making them a highly promising clinical prospect.

Background Diagnosing rare diseases traditionally requires patients to endure lengthy and challenging journeys to find specialists familiar with their conditions. This study advocates a paradigm shift in rare disease diagnosis, moving from patients seeking physicians to physicians actively identifying patients. Using hereditary angioedema (HAE) as an example, we demonstrate how this approach, supported by electronic medical records (EMRs), enables proactive care for patients with rare diseases. Our EMR system incorporates a free-text search engine to screen for patients with potential HAE based on clinical symptoms and laboratory tests. Search terms include recurrent skin edema, abdominal pain, laryngeal edema, and/or decreased C4 levels. Suspected cases are followed up by telephone calls from trained physicians, inviting patients to undergo confirmatory C1-INH and C4 testing and genetic testing to ensure accurate diagnosis and appropriate treatment. Results Of 2,689 patients who met the screening criteria, 3,441 records were analyzed. Ninety-five patients had already been diagnosed with HAE. After excluding those with a known etiology for edema or characteristics inconsistent with HAE, three patients with unexplained cutaneous edema, abdominal pain, and/or laryngeal edema were included in the final screening. Laboratory tests confirmed HAE in all three, highlighting the effectiveness of this proactive approach. Conclusions This study underscores the transformative potential of EMRs in diagnosing rare diseases. By shifting the responsibility of identifying rare diseases from patients to healthcare professionals, we expedite diagnosis and exemplify the spirit of service in medicine, ensuring patients with rare diseases receive timely and effective care. Highlights 1. What is already known about this topic? Traditional rare disease diagnosis is prolonged and complex, often requiring multiple consultations and leading to misdiagnoses. EMRs can improve diagnosis by identifying patterns in clinical data. 2. What does this article add to our knowledge? This article demonstrates how EMRs can be used proactively to identify and diagnose rare diseases such as HAE, reducing diagnostic time through the initiative of healthcare professionals. 3. How does this study impact current management guidelines? This study introduces a paradigm shift in diagnostic workflows for rare diseases, reducing diagnostic delays and ensuring that patients receive timely and appropriate treatment.

Identifying critically ill patients is a key challenge in emergency department (ED) triage. Mis-triage errors are still widespread in triage systems around the world. Here, we present a machine learning system (MLS) to assist ED triage officers better recognize critically ill patients and provide a text-based explanation of the MLS recommendation. To derive the MLS, an existing dataset of 22,272 patient encounters from 2012 to 2019 from our institution’s electronic emergency triage system (EETS) was used for algorithm training and validation. The area under the receiver operating characteristic curve (AUC) was 0.875 ± 0.006 (CI:95%) in retrospective dataset using fivefold cross validation, higher than that of reference model (0.843 ± 0.005 (CI:95%)). In the prospective cohort study, compared to the traditional triage system’s 1.2% mis-triage rate, the mis-triage rate in the MLS-assisted group was 0.9%. This MLS method with a real-time explanation for triage officers was able to lower the mis-triage rate of critically ill ED patients.

HighlightsAlkyl-tailored Y-SMAs named YR-SeNF series with near-infrared absorption, different molecular crystallinity and self-assembly abilities are developed.The related organic solar cells (OSCs) with an active layer processed from halogen-free solvents and spin-coating-free technologies achieve a ~ 19% efficiency.Ternary OSCs offer a robust operating stability under MPP tracking and well-keep > 80% of the initial efficiency for even over 400 h.Power-conversion-efficiencies (PCEs) of organic solar cells (OSCs) in laboratory, normally processed by spin-coating technology with toxic halogenated solvents, have reached over 19%. However, there is usually a marked PCE drop when the blade-coating and/or green-solvents toward large-scale printing are used instead, which hampers the practical development of OSCs. Here, a new series of N-alkyl-tailored small molecule acceptors named YR-SeNF with a same molecular main backbone are developed by combining selenium-fused central-core and naphthalene-fused end-group. Thanks to the N-alkyl engineering, NIR-absorbing YR-SeNF series show different crystallinity, packing patterns, and miscibility with polymeric donor. The studies exhibit that the molecular packing, crystallinity, and vertical distribution of active layer morphologies are well optimized by introducing newly designed guest acceptor associated with tailored N-alkyl chains, providing the improved charge transfer dynamics and stability for the PM6:L8-BO:YR-SeNF-based OSCs. As a result, a record-high PCE approaching 19% is achieved in the blade-coating OSCs fabricated from a green-solvent o-xylene with high-boiling point. Notably, ternary OSCs offer robust operating stability under maximum-power-point tracking and well-keep > 80% of the initial PCEs for even over 400 h. Our alkyl-tailored guest acceptor strategy provides a unique approach to develop green-solvent and blade-coating processed high-efficiency and operating stable OSCs, which paves a way for industrial development.

Purpose This study aimed to evaluate the cervical sagittal profile after the spontaneous compensation of global sagittal imbalance and analyze the associations between the changes in cervical sagittal alignment and spinopelvic parameters. Methods In this retrospective radiographic study, we analyzed 90 patients with degenerative lumbar stenosis (DLS) and sagittal imbalance who underwent short lumbar fusion (imbalance group). We used 60 patients with DLS and sagittal balance as the control group (balance group). Patients in the imbalance group were also divided into two groups according to the preoperative PI: low PI group (≤ 50°), high PI group (PI > 50°). We measured the spinal sagittal alignment parameters on the long-cassette standing lateral radiographs of the whole spine. We compared the changes of spinal sagittal parameters between pre-operation and post-operation. We observed the relationships between the changes in cervical profile and spinopelvic parameters. Results Sagittal vertical axis (SVA) occurred spontaneous compensation ( p  = 0.000) and significant changes were observed in cervical lordosis (CL) ( p  = 0.000) and cervical sagittal vertical axis (cSVA) ( p  = 0.023) after surgery in the imbalance group. However, there were no significant differences in the radiographic parameters from pre-operation to post-operation in the balance group. The variations in CL were correlated with the variations in SVA ( R  = 0.307, p  = 0.041). The variations in cSVA were correlated with the variations in SVA ( R =-0.470, p  = 0.001). Conclusion Cervical sagittal profile would have compensatory changes after short lumbar fusion. The spontaneous decrease in CL would occur in patients with DLS after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. The changes of cervical sagittal profile were related to the extent of the spontaneous compensation of SVA.

Background To explore the predictors for the restoration of the sagittal spinal malalignment in the elderly patients with lumbar spinal stenosis (LSS) after short-segment decompression and fusion surgery. Methods We retrospectively reviewed 82 LSS patients with sagittal malalignment (SVA ≥ 50 mm or PT ≥ 20° or PI-LL ≥ 20°) who underwent short-segment decompression and fusion surgery between January 2019 and March 2021. Patients’ characteristic, radiographic and paravertebral muscle parameters were assessed. The patients were divided into group A (postoperative malalignment) and B (postoperative alignment) according to whether the postoperative restoration of the sagittal alignment was achieved. Results There existed more males in group B than in group A ( p  = 0.002). The age of group A (73.36 ± 8.02) was greater than that of group B (69.08 ± 6.07, p  = 0.009). Preoperative PT in group A (27.40 ± 5.82) was greater than that in group B (19.30 ± 7.32, p  < 0.001). The functional cross-sectional area (fCSA) in group A (28.73 ± 4.23) was lower than that in group B (36.94 ± 7.81, p  < 0.001). And the fatty infiltration rate (FI) of group A (27.16% ± 5.58%) was higher than that of group B (22.61% ± 5.81%, p  = 0.001). The fCSA was negatively correlated with the postoperative PT and PTr ( p  < 0.05). Conclusion Stronger lumbar paravertebral muscles, smaller preoperative PI, PT or PI-LL, male and younger age are the predictors for the restoration of the sagittal spinal malalignment in the elderly LSS patients after short-segment decompression and fusion surgery.

The aim of the study was to evaluate the risk and threshold doses of lens opacity among residents exposed to low-dose radiation. Residents aged ≥45 years were recruited from a high natural background radiation (HNBR) area in Yangjiang City and a control area selected from nearby Enping City. Lens opacities (LOPs) were classified according to the Lens Opacities Classification System (LOCS) III system. Face-to-face interviews were conducted to collect information on lifestyles, migration and medical history. Life-time cumulative doses were estimated using gender, age, occupancy factors and environmental radiation doses received indoors and outdoors. Logistic regression analyses were conducted to estimate the dose response and determine thresholds. In the HNBR area, among 479 study participants, 101 (21.1%), 245(51.1%) and 23 cases (4.8%), respectively, of cortical, nuclear and posterior subcapsular (PSC) LOPs were found. In the control area, those types of LOPs were identified among 58 cases (12.6%), 206 cases (51.2%) and 6 cases (1.3%) of 462 examinees, respectively. Cumulative eye lens dose was estimated to be 189.5 ± 36.5 mGy in the HNBR area. Logistic analyses gave odds ratios at 100 mGy of 1.26 [95% confidence interval (CI) 1.00–1.60], 0.81 (95% CI 0.64–1.01) and 1.73 (95% CI 1.05–2.85) for cortical, nuclear and PSC LOPs, respectively. For cortical LOPs, a logistic analysis with a threshold dose gave a threshold estimate of 140 mGy (90% CI 110–160 mGy). The results indicated that population exposed to life-time, low-dose-rate environmental radiation was at an elevated risk of cortical and PSC LOPs. A statistically significant threshold dose was obtained for cortical LOPs and no threshold dose for PSC LOPs.

Purpose To investigate the perioperative outcomes, clinical manifestations, and radiographic indicators in patients who underwent oblique lateral lumbar fusion (OLIF) and posterior instrumentation, compared with those who underwent posterior transforaminal lumbar interbody fusion (TLIF) and instrumentation. Methods In this retrospective cohort analysis, elderly patients diagnosed with L4-5 lumbar spinal stenosis between July 2022 and July 2023 at our institution who underwent OLIF and posterior instrumentation (OLIF group), compared with those who underwent posterior TLIF and instrumentation (TLIF group). Enhanced Recovery After Surgery (ERAS) protocol was implemented for all patients. The perioperative data, patient-reported outcomes (PROs), radiographic assessments, and complications were gathered immediately after surgery and again at the 1-year follow-up. The perioperative outcomes and immediately postoperative and follow-up radiographic outcomes were compared between the two groups. Results A total of 120 patients participated in this study, with 60 patients assigned to the OLIF group and 60 to the TLIF group. With respect to outcomes, the length of stay was notably shorter in the OLIF group compared to the TLIF group ( P  < 0.001). Patients in the OLIF group exhibited significantly reduced postoperative drainage volume ( P  < 0.001), first ambulation on the postoperative day (POD) ( P  < 0.001), drain placement duration ( P  < 0.001), and urinary catheter retention ( P  = 0.037) compared to those in the TLIF group. Furthermore, there were statistically significant differences between the two groups in the incidence of postoperative deep venous thrombosis (DVT) (1 vs. 8, P  = 0.015), urinary tract infection (2 vs. 11, P  = 0.008), pulmonary infection (2 vs. 10, P  = 0.015), and nausea and vomiting (3 vs. 11, P  = 0.023). With respect to radiographic measurements, At the 1-year follow-up, the posterior disc height (PDH) and intervertebral disc angle (IDA) demonstrated statistically increase in the OLIF group. The sagittal vertical axis (SVA) was statistically decrease and Lumbosacral lordosis (LL) was statistically increase in the OLIF group. Conclusion OLIF was demonstrated to have significant advantages in terms of perioperative, clinical outcomes and radiographic parameters for L4-5 lumbar spinal stenosis for elderly patients, comapred with TLIF.