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BACKGROUND: Insulin efsitora alfa (efsitora) is a new basal insulin designed for once-weekly administration. Data on safety and efficacy have been limited to small, phase 1 or phase 2 trials. METHODS: We conducted a 52-week, phase 3, parallel-design, open-label, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned in a 1:1 ratio to receive efsitora or degludec. The primary end point was the change in the glycated hemoglobin level from baseline to week 52; we hypothesized that efsitora would be noninferior to degludec (noninferiority margin, 0.4 percentage points). Secondary and safety end points included the change in the glycated hemoglobin level in subgroups of participants using and not using glucagon-like peptide-1 (GLP-1) receptor agonists, the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter in weeks 48 through 52, and hypoglycemic episodes. RESULTS: A total of 928 participants underwent randomization (466 to the efsitora group and 462 to the degludec group). The mean glycated hemoglobin level decreased from 8.21% at baseline to 6.97% at week 52 with efsitora (least-squares mean change, -1.26 percentage points) and from 8.24% to 7.05% with degludec (least-squares mean change, -1.17 percentage points) (estimated treatment difference, -0.09 percentage points; 95% confidence interval [CI], -0.22 to 0.04), findings that showed noninferiority. Efsitora was noninferior to degludec with respect to the change in the glycated hemoglobin level in participants using and not using GLP-1 receptor agonists. The percentage of time that the glucose level was within the target range was 64.3% with efsitora and 61.2% with degludec (estimated treatment difference, 3.1 percentage points; 95% CI, 0.1 to 6.1). The rate of combined clinically significant or severe hypoglycemia was 0.58 events per participant-year of exposure with efsitora and 0.45 events per participant-year of exposure with degludec (estimated rate ratio, 1.30; 95% CI, 0.94 to 1.78). No severe hypoglycemia was reported with efsitora; six episodes were reported with degludec. The incidence of adverse events was similar in the two groups. CONCLUSIONS: In adults with type 2 diabetes who had not previously received insulin, once-weekly efsitora was noninferior to once-daily degludec in reducing glycated hemoglobin levels. (Funded by Eli Lilly; QWINT-2 ClinicalTrials.gov number, NCT05362058.).

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Microscale swimmers are attractive for targeted drug delivery, noninvasive microsurgery and environmental remediation at different length scales, among which, Marangoni-based swimmers have garnered considerable attention due to their independence of external energy supply. However, applications of most existing chemical swimmers are limited by complex fabrication, high cost, utilization of organic (or even toxic) solvents, poor motility performance, and lack of controllability. To address these challenges, we propose an approach for all-aqueous soft milli-swimmers that utilizes biodegradable hydrogels and biocompatible fuels. This innovative method achieves swimmer body generation and fuel loading in one step by simply dripping one aqueous solution into another, saving fabrication time and minimizing fuel loss during transfer. These all-aqueous soft milli-swimmers have rove beetle-like self-propulsion, which stores low-surface-energy compounds within their body for propulsion on liquid surfaces. Isotropic and anisotropic all-aqueous soft milli-swimmers are formed with precise control over their dimension, morphology, and movement velocity. Through their motion within engineered channels, intricate labyrinths, dynamic air-liquid interfaces, and collective self-assemblies, their remarkable adaptability in complex aqueous environments is demonstrated. Furthermore, the integration of functional nanoparticles endows these all-aqueous milli-swimmers with multifunctionality, expanding their applications in cargo transportation, sensing, and environmental remediation.

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OBJECTIVE: This study investigated the efficacy of different concentrations of cholesterolloaded cyclodextrin (CLC) on cryopreservation in boar sperm quality. METHODS: In this study, we treated boar sperm with different concentrations of CLC before freezing and analyzed the sperm cholesterol concentration, plasma membrane, acrosome integrity rate and total motility rate before and after freeze-thawing. We also investigated the levels of reactive oxygen species (ROS), malondialdehyde (MDA), adenosine triphosphate (ATP), and structural- and oxidative-damage related proteins in all groups after thawing. RESULTS: The results revealed that the cholesterol concentration of the CLC-treated groups was higher than that of the control group, both before freezing and after thawing (p<0.05). The plasma membrane integrity rate, acrosome integrity rate, and total motility rate of sperm were also enhanced after thawing in the CLC-treated group (all p<0.05). Moreover, ROS and MDA production and ATP loss were reduced in CLC-treated sperm during freezing and thawing (p<0.05). Finally, CLC pretreatment partially prevented the consumption of various proteins involved in metabolism including capping actin protein of muscle Z-line subunit beta (CAPZB), heat shock protein 90 alpha family class A member 1 (HSP90AA1) and phosphoglycerate mutase 2 (PGAM2) (p<0.05). CONCLUSION: The CLC treatment increased cholesterol concentration and decreased structural injury and oxidative damage during boar sperm freezing and thawing, improving the efficacy of sperm cryopreservation in boar.

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Background: As a culture-independent method, metagenomic next-generation sequencing (mNGS) is widely used in microbiological diagnosis with advantages in identifying potential pathogens, guiding antibiotic therapy, and improving clinical prognosis, especially in culture-negative cases. Mycoplasma hominis (M. hominis) mediastinitis is a rare and severe disease for which etiological diagnosis is important but challenging. The application of mNGS in the etiological diagnosis of mediastinitis has seldom been studied. Methods: By searching the electronic medical history retrieval system with "Mycoplasma hominis" and "mediastinitis", seven patients diagnosed with M. hominis mediastinitis were reviewed in Zhongshan Hospital, Fudan University, Shanghai from 9 December 2020 to 14 February 2023. Microbiological cultures and mNGS were conducted for blood, abscess, and/or mediastinal fluid. Adjustment of the antibiotic therapy due to mNGS was assessed. A literature review was conducted in the PubMed database beginning in 1970 for M. hominis infection and mediastinitis. Results: For the seven patients, cultures of blood, abscess, and mediastinal fluid were negative whereas mNGS identified M. hominis in serum, abscess, and/or mediastinal fluid and was used to guide specific antibiotic therapy. The stringent mapped reads number of genera (SMRNG), stringent mapped reads number of species (SMRN), and coverage rate of M. hominis detection by mNGS were significantly higher in body fluid (abscess or mediastinal fluid) than in serum. All seven patients had underlying heart diseases and underwent previous cardiac surgery. The most common symptoms were fever and sternal pain. After detection of M. hominis, antibiotics were adjusted to quinolones or doxycycline except for one patient, whose diagnosis was clarified after death. Two patients died. Literature review since 1970 identified 30 cases of extra-genital infection caused by M. hominis. Including our seven new cases, 2 (5.4%) were neonates and 35 (94.6%) were adults. Thirty (81.1%) cases were postoperative infection and 15 (40.5%) had implanted devices. Five patients (13.5%) died. Conclusions: mNGS might be a promising technology in the detection of fastidious pathogens such as M. hominis. Accurate etiological diagnosis by mNGS could guide antibiotic therapy and facilitate clinical management.

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Transarterial chemoembolisation (TACE) is a standard therapy for hepatocellular carcinoma (HCC). However, adverse events, including abdominal pain, are common. This study aimed to investigate and verify the feasibility of a nomogram model to predict severe abdominal pain after first conventional TACE (cTACE) among patients with HCC. Patients with HCC treated with cTACE between October 28, 2019, and August 5, 2022, at a single centre were enrolled (n = 216). Patients were divided into training and validation cohorts (ratio, 7:3). A visual analogue scale score between 7 and 10 was considered severe abdominal pain. A total of 127 (58.8%) patients complained of severe abdominal pain after first cTACE treatment. The nomogram considered age and tumour number and size. The nomogram demonstrated good discrimination, with a C-index of 0.749 (95% confidence interval [CI], 0.617, 0.881). Further, the C-index in the validation cohort reached 0.728 (95% CI 0.592, 0.864). The calibration curves showed ideal agreement between the prediction and real observations, and the nomogram decision curve analysis performed well. The nomogram model can provide an accurate prediction of severe abdominal pain in patients with HCC after first cTACE, aiding in the personalization of pain management and providing novel insights into hospital nursing.

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Pseudomonas aeruginosa is one of the top-listed pathogens in nosocomial infection. It is notorious for its complicated virulence system and rapid adaptability to drugs or antimicrobials. In this study, we aimed to evaluate the prevalence of sixteen virulence genes in four groups including type III secretion system, biofilm formation, extracellular toxin biosynthesis and enzymes amongst 209 clinical Pseudomonas aeruginosa strains. We investigated the different distribution patterns of virulence genotypes based on carbapenem-resistant phenotype or the carriage of carbapenemase genes. The detection rate of each virulence gene varied greatly. phzM and plcN were detected in all collected strains, while pilB and exoU were only carried by a small portion of isolates (6.7% and 16.3%). Additionally, the number of genotypes observed in each group of examined virulence genes ranged from 4 to 8. Only the distribution of genotypes of type III secretion system showed statistical difference between carbapenem-mediated or carbapenem-resistant and carbapenem-sensitive strains. The virulence genotype of Pseudomonas aeruginosa was possibly interrelated to its resistance mechanism. Further research suggested that one particular TTSS genotype exhibited higher ratio in carbapenemase-producing strains and exoS was less frequently detected in CRPA strains carrying carbapenemase gene. Generally, the significant genetic diversity of virulence genes amongst Pseudomonas aeruginosa strains was highlighted in this study. Specific TTSS genotypes were associated with carbapenem-resistance. In particular, certain incompatibility might exist between exoS and carbapenemase genes, which provided valuable information for further understanding the relationship between carbapenem resistance and virulence.

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Background: Aspergillus species are becoming a major public health concern worldwide due to the increase in the incidence of aspergillosis and emergence of antifungal resistance. In this study, we surveyed all Aspergillus species isolated from aspergillosis patients in Zhongshan Hospital Fudan University, Shanghai, China, from 2019 to 2021. Methods: We characterized the susceptibility profiles of these Aspergillus species to medical azoles (voriconazole, itraconazole and posaconazole) using YeastOneTM broth microdilution system. To determine the underlying antifungal resistance mechanisms in azole-resistant A. fumigatus (ARAf) isolates, we characterized mutations in the cyp51A gene. Genotypic diversity of sampled A. fumigatus was investigated using CSP-typing. Results: A total of 112 Aspergillus isolates (81 A. fumigatus, 17 A. flavus, 5 A. niger, 2 A. terreus, 2 A. lentulus, 2 A. oryzae, 1 A. nidulans, 1 A. versicolor and 1 A. sydowii) from 105 patients diagnosed with aspergillosis (including proven or probable invasive aspergillosis, chronic pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and cutaneous aspergillosis) were obtained. Eight isolates (7 A. fumigatus and 1 A. niger) from seven patients were either azole non-susceptible or non-wild type. Azole non-susceptible or non-wild type rate was 7.1%/isolate and 6.7%/patient analysed. Four ARAf harbored TR34/L98H mutation, whereas one carried TR46/Y121F/T289A allele. The 81 A. fumigatus isolates were spread across 8 CSP types with t01 to be the predominant type (53.1%). ARAf isolates were distributed over CSP types t01, t02, t04A and t11. Conclusion: Results from this study provided us with an understanding of the antifungal resistance and related characteristics of Aspergillus species in Eastern China. Further comparisons of our results with those in other countries reflect potential clonal expansion of A. fumigatus in our region. Further surveillance study is warranted to guide antifungal therapy and for epidemiological purposes.

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Chrysolina aeruginosa is a major pest of Artemisia ordosica, and knowledge of the spatial distribution pattern of its larvae in their natural habitat is crucial for the implementation of effective control measures. This study employed geostatistical methods to investigate the damage caused by larvae of different age groups and their spatial distribution pattern. The distribution of C. aeruginosa larvae, which cause damage to A. ordosica, differed significantly according to their age. Younger larvae were predominantly found in the middle and upper parts of the plant, whereas older larvae were mainly distributed in the middle and lower parts, with significant differences in distribution location. A generalized linear model analysis revealed that the height of the plant, and plant morphological characteristics such as height, crown width, and ground diameter were significantly correlated with the number of larvae present. Furthermore, the interaction of age with other variables had an impact on the number of larvae. Kriging interpolation showed that C. aeruginosa larvae were distributed in aggregated patches with strong spatial heterogeneity. The younger larvae were more abundant in the center of the sample site, while the older larvae tended to be distributed toward the edges. These findings provide valuable information for designing effective control programs.

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Objective: Two phase 3 galcanezumab trials were conducted in Europe and North America to analyze the reduction of weekly cluster headache (CH) attack frequency in populations with episodic and chronic CH. The current study aims to illustrate prospectively recorded baseline clinical data from these trials and to identify possible predictors of response. Methods: Patients (aged 18-65 years) met The International Classification of Headache Disorders 3rd edition-beta criteria for CH. Attacks were evaluated using an electronic headache diary for 7-day (episodic) or 14-day (chronic) eligibility assessments before patients were randomized 1:1 to monthly subcutaneous galcanezumab 300 mg or placebo. Results: Data were collected from 106 patients with episodic and 237 with chronic CH. Overall, the mean age [standard deviation] was 45.4 [11.0] years; patients were predominantly White (84.5%), male (75.8%), and European (77.6%). Patients with episodic CH reported 17.5 [10.0] attacks/week; patients with chronic CH reported 18.8 [10.2] attacks/week. The average pain severity score (range 0-4) was 2.5 [0.7] for episodic CH and 2.7 [0.7] for chronic CH. Higher attack frequency was a possible predictor of response to galcanezumab; potential negative predictors of response were greater attack severity and duration. Conclusion: This large dataset of patients with CH provides reliable systematically and prospectively collected information on disease characteristics. The analysis in episodic CH underscores potential predictors of response worth considering for future CH trial design. Clinical Trial Registration: ClinicalTrials.gov, identifiers: NCT02397473 and NCT02438826.

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BACKGROUND: The application of clinical mNGS for diagnosing respiratory infections improves etiology diagnosis, however at the same time, it brings new challenges as an unbiased sequencing method informing all identified microbiomes in the specimen. METHODS: Strategy evaluation and metagenomic analysis were performed for the mNGS data generated between March 2017 and October 2019. Diagnostic strengths of four specimen types were assessed to pinpoint the more appropriate type for mNGS diagnosis of respiratory infections. Microbiome complexity was revealed between patient cohorts and infection types. A bioinformatic pipeline resembling diagnosis results was built based upon multiple bioinformatic parameters. RESULTS: The positive predictive values (PPVs) for mNGS diagnosing of non-mycobacterium, Nontuberculous Mycobacteria (NTM), and Aspergillus were obviously higher in bronchoalveolar lavage fluid (BALF) demonstrating the potency of BALF in mNGS diagnosis. Lung tissues and sputum were acceptable for diagnosis of the Mycobacterium tuberculosis (MTB) infections. Interestingly, significant taxonomy differences were identified in sufficient BALF specimens, and unique bacteriome and virome compositions were found in the BALF specimens of tumor patients. Our pipeline showed comparative diagnostic strength with the clinical microbiological diagnosis. CONCLUSIONS: To achieve reliable mNGS diagnosis result, BALF specimens for suspicious common infections, and lung tissues and sputum for doubtful MTB infections are recommended to avoid the false results given by the complexed respiratory microbiomes. Our developed bioinformatic pipeline successful helps mNGS data interpretation and reduces manual corrections for etiology diagnosis.

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Background: Rapid pathogen identification is critical for optimizing diagnosis and treatment of infectious diseases. Multiplex polymerase chain reaction (PCR) is a sensitive, broad-spectrum molecular detection technique that is simple and rapid to perform. It is capable of simultaneously screening for multiple pathogens within a short time range. Here, we designed and evaluated a multiplex PCR kit for the identification of 17 common respiratory pathogens in clinical samples from hospitalized patients. Methods: A total of 452 samples from hospitalized patients, including 242 respiratory and 210 non-respiratory samples, were analyzed for 13 bacteria and 4 fungi by a multiplex fluorescent PCR kit. The diagnostic performance of the kit was assessed by considering routine microbiology as the reference standard. Results: The overall positivity rate of the multiplex PCR kit was 86.9%, much higher than that noted on routine microbiology (56.9%). Furthermore, the co-infection detection rate was also significantly higher than that noted on routine microbiology (69.5% vs. 15.0%). Compared with routine microbiology, kit sensitivity was >90% for detection of most target bacteria, with a negative predictive value (NPV) of >99%, especially for detection of Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Stenotrophomonas maltophilia, Enterococcus faecium, Enterococcus faecalis and Escherichia coli. The kit was noted to be particularly superior in identifying Stenotrophomonas maltophilia and Streptococcus pneumoniae as compared to routine microbiology. The multiplex PCR kit was noted to be less sensitive (33.3-59.6%) and more specific (93.9-100.0%) for detection of mycobacteria and fungi. Conclusions: Our multiplex PCR kit offers a rapid and sensitive diagnosis of common bacterial pneumonia, although sensitivity for mycobacteria and fungi warrants enhancement. Further optimization includes minimizing false positivity and increasing relevance to clinical application.

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The electrochemical carbon dioxide reduction reaction (CO2RR) is a promising method to realize carbon recycling and sustainable development because of its mild reaction conditions and capability to utilize the electric power generated by renewable energy such as solar, wind, or tidal energy to produce high-value-added liquid fuels and chemicals. However, it is still a great challenge to deeply understand the reaction mechanism of CO2RRs involving multiple chemical processes and multiple products due to the complexity of the traditional catalyst's surface. Organic ligand-protected metal nanoclusters (NCs) with accurate compositions and definite atom packing structures show advantages for revealing the reaction mechanism of CO2RRs. This Review focuses on the recent progress in CO2RRs catalyzed by atomically precise metal NCs, including gold, copper, and silver NCs. Particularly, the influences of charge, ligand, surface structure, doping of Au NCs, and binders on the CO2RR are discussed in detail. Meanwhile the reaction mechanisms of CO2RRs including the active sites and the key reaction intermediates are also discussed. It is expected that progress in this research area could promote the development of metal NCs and CO2RRs.

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Background: Conventional ultrasound and contrast-enhanced ultrasound (CEUS) are commonly used in the diagnosis of benign and malignant thyroid nodules. However, the value of the two methods in the diagnosis of benign and malignant thyroid nodules remains controversial. Methods: PubMed, Medline, EBSCO, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI) database and manual journal retrieval were searched from January 2000 to January 2022, to include research on conventional ultrasound or CEUS in the diagnosis of benign and malignant thyroid nodule related clinical studies. Meta-analysis was conducted using RevMan5.3 and Stata Corp to analyze the sensitivity and specificity of conventional ultrasound and CEUS in the diagnosis of benign and malignant thyroid nodules with 95% confidence interval (CI) as indicators. Heterogeneity of the results was evaluated by Q test and I2 in RevMan5.3. Deek's method was used to evaluate publication bias. Results: A total of 1,378 nodules were included in 11 literatures, including 535 malignant thyroid nodules and 843 benign thyroid nodules. Heterogeneity tests conducted for CEUS diagnostic sensitivity of the 6 included literatures indicated that there was no heterogeneity among the study groups [Q=2.05, degree of freedom (df) =5.00, I2=0.00%, P=0.84]. The combined sensitivity was 0.87, with 95% confidence interval (CI): 0.82 to 0.90. Heterogeneity tests on the diagnostic specificity of CEUS of the six included literatures suggested that there was heterogeneity among the different study groups (Q=14.27, df =5.00, I2=64.96%, P=0.01). The combined specificity was 0.84 (95% CI: 0.78 to 0.89). Heterogeneity tests performed on the sensitivity of five conventional ultrasound diagnosis articles revealed that there was heterogeneity among different study groups (Q=13.62, df =4.00, I2=70.64%, P=0.01). The combined sensitivity was 0.86 (95% CI: 0.78 to 0.92). Heterogeneity tests on the specificity of conventional ultrasound diagnosis in five included literatures indicated that there was heterogeneity among different study groups (Q=16.94, df =4.00, I2=76.39%, P=0.00). The combined specificity was 0.84 (95% CI: 0.75 to 0.90). There was no bias in the included literature. Discussion: The sensitivity of CEUS in the diagnosis of benign and malignant thyroid nodules was slightly higher than that of conventional ultrasound, which provides a reference for the clinical diagnosis of benign and malignant thyroid nodules.

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Scientific identification of the factors that underpin the success of construction program can effectively promote the success of construction program. Based on literature statistics, this paper developed the measurement items of key success factors of construction program in Chinese context. Based on exploratory factor analysis, seven key success factors of construction program were extracted. Then, the excellence model of construction program was constructed by referring to the ideas, concepts, and theoretical mechanisms of EFQM model. The research conclusions of this paper provide a systematic and holistic guidance for the successful implementation of the program by the construction program organization and promote the success of the program.

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Bloodstream infection (BSI) is defined by the presence of microbes in the bloodstream and has high mortality. Early antimicrobial therapy is key to treating BSI patients. Because of potential antimicrobial resistance, rapid evaluation for the most suitable antimicrobial therapy is important for appropriate treatment. In China, the current workflow of microbiological diagnosis in BSI involves blood culture, species identification, and antimicrobial susceptibility testing, which takes around 3 days. However, this delay could lead to worse symptoms. To rapidly and accurately assess antimicrobial susceptibility, in this study, we applied EUCAST rapid antimicrobial susceptibility testing (RAST) to determine the antimicrobial susceptibilities of the most frequently detected Enterobacterales sampled in China, including Escherichia coli and Klebsiella pneumoniae. Based on EUCAST guidelines, we evaluated its efficiencies with six commercially available antimicrobials, including imipenem (10 µg), meropenem (10 µg), ciprofloxacin (5 µg), levofloxacin (5 µg), amikacin (30 µg), and trimethoprim-sulfamethoxazole (1.25/23.75 µg), with bacterium-spiked blood cultures. In addition, we developed potential breakpoints for a recently introduced antimicrobial, 30/20 µg ceftazidime-avibactam, which has high potential for treating multidrug-resistant Enterobacterales. Our results showed that EUCAST RAST is a reliable method for rapidly determining the antimicrobial susceptibilities of BSI-causing bacteria in China, with an overall categorical agreement rate at 8 h of ≥90%. The breakpoints developed in this study can categorize the isolates sampled in this study with an accuracy of 93%. Results from our experiments can be applied to clinically determine the microbial susceptibility of BSI-causing bacteria within 8 h and benefit clinical diagnostics for BSI patients.

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All-aqueous systems have attracted intensive attention as a promising platform for applications in cell separation, protein partitioning, and DNA extraction, due to their selective separation capability, rapid mass transfer, and good biocompatibility. Reliable generation of all-aqueous droplets with accurate control over their size and size distribution is vital to meet the increasingly growing demands in emulsion-based applications. However, the ultra-low interfacial tension and large effective interfacial thickness of the water-water interface pose challenges for the generation and stabilization of uniform all-aqueous droplets, respectively. Microfluidics technology has emerged as a versatile platform for the precision generation of all-aqueous droplets with improved stability. This review aims to systematize the controllable generation of all-aqueous droplets and summarize various strategies to improve their stability with microfluidics. We first provide a comprehensive review on the recent progress of all-aqueous droplets generation with microfluidics by detailing the properties of all-aqueous systems, mechanisms of droplet formation, active and passive methods for droplet generation, and the property of droplets. We then review the various strategies used to improve the stability of all-aqueous droplets and discuss the fabrication of biomaterials using all-aqueous droplets as liquid templates. We envision that this review will benefit the future development of all-aqueous droplet generation and its applications in developing biomaterials, which will be useful for researchers working in the field of all-aqueous systems and those who are new and interested in the field.

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BACKGROUND: Metagenomic next-generation sequencing (mNGS) is widely applied in the etiological diagnosis of infectious diseases. However, the clinical practice of mNGS in infective endocarditis (IE) is relatively less studied. This research aimed to assess the etiological diagnostic value of valve mNGS in IE. METHODS: We retrospectively analyzed 49 IE patients who underwent cardiac valve surgery in Zhongshan Hospital, Fudan University, Shanghai from 1 June 2018 to 30 November 2020. Among these IE patients, 28 were culture positive and 21 were culture negative. The culture results of the culture-positive IE patients were set as gold standard to assess the sensitivity and specificity of valve mNGS in the etiological diagnosis of IE. We studied the positive detection rate of pathogens by valve mNGS among the culture-negative IE patients. During the same period, we also collected the resected valves of 8 patients with non-infective valvular diseases for mNGS as negative controls. RESULTS: The valve mNGS results of the culture-positive IE patients were the exact same as their culture results. Both the sensitivity and specificity of valve mNGS were 100%. The positive detection rate of pathogens by valve mNGS was 100% among the culture-negative IE patients. The stringent mapped reads number of genera (SMRNG), relative abundance of genera, stringent mapped reads number of species (SMRN), relative abundance of species, and coverage rate of valve mNGS results were significantly higher in culture-positive IE participants than in culture-negative IE participants. The valve mNGS results of the 8 participants with non-infective valvular diseases were all negative. CONCLUSIONS: Valve mNGS is a promising technology for the etiological diagnosis of IE, especially culture-negative IE, and it may be used to guide precise antibiotic treatment after surgery.

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An aqueous two-phase system (ATPS) is considered as a promising candidate for biological applications due to its excellent permeability, selective separation, rapid mass transfer and all-biocompatible nature. However, it remains difficult to generate ATPS emulsions with controllable and prolonged stability due to ultra-low interfacial tension. Here, we present a transient double emulsion (TDE) technique to address this challenge. The method involves two steps: (i) water-in-oil-in-water (W1/O/W2) transient double emulsion droplets are first produced with droplet microfluidics by introducing an additional middle oil phase, and (ii) the W1/O/W2 droplets dewet into oil-in-water and ATPS droplets in a controllable manner. Using the TDE method, both dextran-in-polyethylene glycol (PEG) and PEG-in-dextran ATPS droplets can be generated with high uniformity (coefficient of variation (CV) ranging from 0.66% to 2.55%), a wide range of droplet sizes (∼100 to 250 µm in radius), and tunability in the generation frequency (∼4 to 170 Hz). Tuning the oil viscosity controls the destabilization time for on-demand dewetting and releasing of aqueous core droplets. The stability of ATPS droplets is significantly improved by storing aqueous droplets in double emulsion vessels, which would benefit various applications, such as small molecule encapsulation.

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Soft actuators have the potential of revolutionizing the field of robotics. However, it has been a long-standing challenge to achieve simultaneously: i) miniaturization of soft actuators, ii) high contrast between materials properties at their "on" and "off" states, iii) significant actuation for high-payload mechanical work, and iv) ability to perform diverse shape transformations. This challenge is addressed by synergistically utilizing structural concepts found in the dermis of sea cucumbers and the tendrils of climbing plants, together with microfluidic fabrication to create diatomite-laden hygroscopically responsive fibers with a discontinuous ribbon of stiff, asymmetrically shaped, and hygroscopically inactive microparticles embedded inside. The microactuators can undergo various deformations and have very high property contrast ratios (20-850 for various mechanical characteristics of interest) between hydrated and dehydrated states. The resulting energy density, actuation strain, and actuation stress are shown to exceed those of natural muscle by ≈4, >2, and >30 times, respectively, and their weight-lifting ratio is 2-3 orders of magnitude higher than the value of recent hygroscopic actuators. This work offers a new and general way to design and fabricate next-generation soft microactuators, and thus advances the field of soft robotics by tailoring the structure and properties of deformable elements to suit a desired application.

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Catalytic non-oxidative direct dehydrogenation of light alkanes serves as an effective reinforcement to selectively produce the corresponding olefins, and the heterogeneous metals and metal oxides, not limited to the commercially used Pt- and Cr-based catalysts, are widely investigated to enhance the efficiency. In this review, we outline the progress of these dehydrogenation catalysts that have been mainly developed in the past five years. For different classes of the most-promising catalysts in the selective dehydrogenation of ethane-to-ethylene and propane-to-propylene, their syntheses, structural information, catalytic properties and mechanisms are comparatively summarized.