Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study

BACKGROUND

Endoscopy plays an important role in the management of acute variceal bleeding (AVB) in patients with cirrhosis. This study aimed at determining the optimal endoscopy timing for cirrhotic AVB.

METHODS

Patients with cirrhosis with AVB across 34 university hospitals in 30 cities from February 2013 to May 2020 who underwent endoscopy within 24 hours were included in this study. Patients were divided into an urgent endoscopy group (endoscopy <6 h after admission) and an early endoscopy group (endoscopy 6-24 h after admission). Multivariable analysis was performed to identify risk factors for treatment failure. Primary outcome was the incidence of 5-day treatment failure. Secondary outcomes included in-hospital mortality, need for intensive care unit, and length of hospital stay. A propensity score matching analysis was performed. In addition, we performed an analysis, in which we compared the 5-day treatment failure incidence and the in-hospital mortality among patients with endoscopy performed at <12 hours and 12-24 hours.

RESULTS

A total of 3319 patients were enrolled: 2383 in the urgent endoscopy group and 936 in the early endoscopy group. After propensity score matching, on multivariable analysis, Child-Pugh class was identified as an independent risk factor for 5-day treatment failure (HR, 1.61; 95% CI: 1.09-2.37). The incidence of 5-day treatment failure was 3.0% in the urgent endoscopy group and 2.9% in the early group ( p = 0.90). The in-hospital mortality was 1.9% in the urgent endoscopy group and 1.2% in the early endoscopy group ( p = 0.26). The incidence of need for intensive care unit was 18.2% in the urgent endoscopy group and 21.4% in the early endoscopy group ( p = 0.11). The mean length of hospital stay was 17.9 days in the urgent endoscopy group and 12.9 days in the early endoscopy group ( p < 0.05). The incidence of 5-day treatment failure in the <12-hour group was 2.3% and 2.2% in the 12-24 hours group ( p = 0.85). The in-hospital mortality was 2.2% in the <12-hour group and 0.5% in the 12-24 hours group ( p < 0.05).

CONCLUSIONS

The data suggest that performance of endoscopy within 6-12 or within 24 hours of presentation among patients with cirrhosis with AVB led to similar treatment failure outcomes.

Integrating molybdenum into zinc vanadate enables Zn3V2MoO8 as a high-capacity Zn-supplied cathode for Zn-metal free aqueous batteries

The commercialization of aqueous zinc-ion batteries (AZIBs) has been hindered by the obsession with Zn-metal anode, just like the early days of lithium-ion batteries. Developing Zn-metal free aqueous batteries (ZFABs) with superior Zn-supplied cathodes is a promising way to escape this predicament. Herein, a novel mixed transition-metal spinel, Zn₃V₂MoO₈, has been synthesized via a sol-gel technique and proposed as a Zn-supplied cathode material. Utilizing the synergistic effect of vanadium and molybdenum, Zn₃V₂MoO₈ can provide a high capacity of 360.3 mA h g^-1 at 100 mA g^-1, which is the state-of-the-art in existing Zn-supplied cathodes, and the capacity retention is 82% over 700-4500 cycles at 10 A g^-1. The mechanism is that Zn₃V₂MoO₈ undergoes a phase transition to Zn_y(V,Mo)₂O_5-x·nH₂O in the initial charge, and then protons and zinc ions intercalate/deintercalate concurrently into/from the new host. To construct ZFABs with a Zn₃V₂MoO₈ cathode, two non-zinc materials (brass and 9,10-anthraquinone) are used as anodes. Thereby, the Zn₃V₂MoO₈||9,10AQ battery reveals a more satisfactory electrochemical performance, with a stable capacity of 100.4 mA h g^-1 lasting for 200 cycles, which provides a feasible scheme for the practical application of AZIBs.

Tough, Transparent, and Slippery PVA Hydrogel Led by Syneresis

Slippery and transparent polyvinyl alcohol (PVA) hydrogels with mechanical robustness exhibit broad applications in artificial biological soft tissues, flexible wearable electronics, and implantable biomedical devices. Most of the current PVA hydrogels, however, are unable to integrate these features, which compromises its performance in biological and engineering applications. To achieve such purpose, herein, a novel tactic is proposed, salting-out-after-syneresis of PVA, to realize a mechanically robust and highly transparent slippery PVA hydrogel. The syneresis of PVA sol is first conducted to form highly dense and transparent PVA polymer networks, then the salting-out effect tunes the aggregation of the polymer chains to rapidly induce the phase separation and crystallization. The resultant hydrogels show the transparency up to 98% in the visible region, the tribological coefficient down to 0.0081, and the excellent mechanical properties with strength, modulus, and toughness of 26.72 ± 1.05, 6.66 ± 0.29 MPa, and 55.21 ± 1.62 MJ m^-3 , respectively. To reveal the potentials, PVA contact lens that combine remarkable lubrication, anti-protein adhesion, biocompatibility, and drug-loading functions are demonstrated. This strategy provides a simple and new avenue for developing the mechanically robust, transparent, and hydrated hydrogels, showing the potential in biomedicine and wearable devices.

Threshold Effect of Environmental Regulation and Green Innovation Efficiency: From the Perspective of Chinese Fiscal Decentralization and Environmental Protection Inputs

In the context of China's 14th Five-Year Plan and 2035 visionary goals of national economic and social development, to achieve the national dual carbon goals, an innovation-driven green development strategy must be implemented, and the relationship between environmental regulation and green innovation efficiency must be clarified. Based on the DEA-SBM model, in this study, we measured the green innovation efficiency of 30 provinces and cities in China from 2011 to 2020 by introducing environmental regulation as the core explanatory variable, and two threshold variables, environmental protection input and fiscal decentralization, to empirically analyze the threshold effect of environmental regulation on green innovation efficiency. We found that: (1) The green innovation efficiency of 30 provinces and municipalities in China is spatially distributed as strong in the east and weak in the west. (2) A double-threshold effect exists with environmental protection input as the threshold variable. Environmental regulation showed an inverted N-shaped relationship of first inhibiting, then promoting, and finally inhibiting green innovation efficiency. (3) A double-threshold effect exists with fiscal decentralization as the threshold variable. Environmental regulation showed an inverted N-shaped relationship of inhibiting, promoting, and then inhibiting green innovation efficiency. The study results provide theoretical guidance and practical reference for China to achieve the dual carbon goal.

Metabolomics strategy of Pikang oral liquid in the treatment of psoriasis

OBJECTIVE

This study aimed to investigate the effect of Pikang oral liquid (PK) on psoriasis and analyze its possible mechanism from the perspective of metabolism.

METHODS

A psoriasis-form mouse model established using imiquimod (IMQ) was used to evaluate the anti-psoriatic effects of PK. The serum samples were analyzed by high-resolution nuclear magnetic resonance (¹ H NMR) based metabonomics. Nine amino acids were furthere quantitatively analyzed by ultraperformance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF MS).

RESULTS

This study suggested that PK treatment markedly attenuated IMQ-induced psoriasis in a dose-dependent manner. ¹ HNMR based multivariate trajectory analysis revealed that PK had a certain regression effect on eight differential metabolites. The quantitative results showed that PK could regulate significantly the serum levels of alanine, histidine and arginine to the healthy control levels.

CONCLUSIONS

The mechanism of PK on anti-psoriasis may be associated with the restoration of the disturbance in the amino acid metabolism, energy metabolism, and lipid metabolism and so on. Quantitative results further confirmed that amino acid metabolism play an key role in the pathogenesis of psoriasis. Our investigation provided a holistic view of PK for intervention psoriasis and provided the scientific information in vivo about a clinical value of PK for psoriasis.

CircMERTK modulates the suppressive capacity of tumor-associated macrophage via targeting IL-10 in colorectal cancer

Macrophages represent the major population in the tumor microenvironment (TME). Recent studies have demonstrated circular RNAs (circRNAs) are implicated in the development and progression of different immune responses and immune diseases. However, the role of circRNAs in the development of tumor-associated macrophages (TAM) remains unknown. Here, we used the circRNA sequencing to identify the differentially expressed circRNAs (DEcircRNAs) in TAM-like cell induced by culture medium of colorectal cancer cell lines. Of note, the expression of circMERTK was remarkably overexpressed in TAMs. The ISH assay displayed that the expressions of circMERTK were mainly overlapped with macrophages marker CD68, and the abundance of circMERTK in CRC tissues was much higher than that in matched normal tissues. Functionally, circMERTK knockdown resulted in attenuated CD8⁺ T cell apoptosis in the co-culture assay, indicating that circMERTK could have an impact on the immunosuppressive activity of TAM-like cell. Mechanically, TAM-like cell could exert immunosuppressive activity via circMERTK/miR-125a-3p/IL-10 axis. These data suggested that circMERTK could play an important role in TAM activation, and may serve as a potential therapeutic target for CRC.

Study on the measurement of industrial eco-efficiency, spatial distribution and influencing factors in Yangtze River Economic Belt

Nowadays, China insists on the strategy of ecological priority and green development, and the Yangtze River Economic Belt is a pioneering demonstration belt for the construction of ecological civilization in China. Promoting industrial ecological efficiency is of great significance to Chinese sustainable development and high-quality economic development. Based on the provincial panel data of 11 provinces and cities in the Yangtze River Economic Belt region from 2011 to 2020, we use the super-efficient slacks-based measure of efficiency SBM model to measure the industrial eco-efficiency of the Yangtze River Economic Belt, reveal the spatial differences in industrial eco-efficiency of different provincial units, and explore the industrial eco-efficiency. The results show that: (1) from the perspective of the Yangtze River Economic Belt as a whole, industrial eco-efficiency is on a stable upward trend, but the efficiency level is not high, and there is more room for improvement; (2) in terms of the spatial distribution of industrial eco-efficiency in the Yangtze River Economic Belt, there are significant differences, with industrial eco-efficiency in the downstream region being higher than that in the midstream region and the upstream region, and the lowest in the midstream region, while in terms of the spatial distribution pattern, the industrial eco-efficiency of 11 provinces and cities in the Yangtze River Economic Belt eco-efficiency has a significant positive spatial autocorrelation; (3) in terms of influencing factors, economic development level, factor endowment, and foreign investment can significantly influence industrial eco-efficiency in the Yangtze River Economic Belt. The study's result helps provide theoretical guidance and practical reference for promoting the green and ecological development of industries in the Yangtze River Economic Belt.

A novel method of hybrid plasma injection driven by the pulsed discharge of a metal-polytetrafluoroethylene-stacked capillary in high-pressure SF6

A reliable and repeatable triggering technology for a megavolt gap switch with a low working coefficient η is an urgent need and a research focus. In this study, a novel method of hybrid plasma injection (HPI) driven by pulsed discharge inside a capillary was first proposed. The HPI actuator adopted a metal-polytetrafluoroethylene (PTFE)-stacked capillary, in which severe ablation could generate a hybrid plasma containing gas and metal vapor ionized component ejected outward from the nozzle. The HPI actuator could perform repeatedly with an extremely strong plasma injection and triggering ability and, thus, provided a solution for megavolt ultrafast bypass switches (UFBPSs). The evolution and the trigger properties of the HPI actuator were investigated, and the influence of the stacked material (Al, Zn, and Sn) and its proportion (3/15, 7/15, and 10/15) was studied, followed by the performance degradation in multi-shot. It was found that stacking chemically active and low-ionization-energy aluminum in a proportion of 7/15 strongly enhanced the HPI, with an initial velocity of 1200 m/s and a maximum height of 7.5 cm in 0.5 MPa SF₆. In repeated operations, the HPI actuator performance degraded obviously due to capillary expansion and deformation, and the lifetime was tens of magnitude. Finally, the optimized HPI actuator was used to trigger a 7 cm-0.5 MPa SF₆ gap, with a breakdown voltage of ∼1.5 MV. When a 100 kV DC voltage was applied (η < 7%), the gap was successfully and continuously triggered for 27 shots with the trigger delay ranging from 301 to 670 µs, indicating that the HPI actuator could effectively and repeatedly trigger megavolt-magnitude SF₆ gaps at a very low η and was a good solution for megavolt UFBPSs.

Broadband optical frequency comb generation based on single electro-absorption modulation driven by radio frequency coupled signals

Broadband optical frequency comb (OFC) generation based on a single electro-absorption modulator (EAM) is proposed. The EAM is driven by a radio frequency (RF) multi-frequency signal generated by a multiplication coupler composed of an electrical power splitter and an arithmetic circuit. Thus the number of comb-lines of the generated OFC can be increased. A complete theoretical model of OFC generation by an EAM driven by nth power of the RF source is established, and the performance of the OFC is analyzed by using OptiSystem software. The results show that, the number of comb-lines of the OFC is positively correlated with the number of multiplication of the RF source signal. The frequency spacing of the comb-lines is twice the frequency of the RF source signal and is tunable by adjusting the frequency of the RF source signal. Increasing chirp factor and modulation index of EAM could increase the number of comb-lines of the generated OFC. The amplitude of the RF source signal had little impact on the flatness of the OFC and the average OFC power. The scheme developed is not only simple and low-cost, but also can produce a large number of comb-lines.

Impact of Digital Economy Development on Carbon Emission Efficiency: A Spatial Econometric Analysis Based on Chinese Provinces and Cities

In the realistic context of the development of China's digital economy and carbon peaking and carbon neutrality goals, to efficiently achieve high-quality economic and green and low-carbon transformation, this paper investigates the impact of digital economy development on the carbon emission efficiency of 30 Chinese provinces and cities from 2011-2019. In this paper, firstly, the digital economy development index and carbon emission efficiency are calculated by the entropy method and the Super-SBM-Undesirable Model. Secondly, the Spatial Lag Model (SAR) and the Spatial Durbin Model (SDM) are respectively constructed under the adjacency matrix and the geographic distance matrix to empirically test the spatial impact of the digital economy on carbon emission efficiency. The results show that: the digital economy development and carbon emission efficiency of Chinese provinces and cities both show the spatial distribution characteristics of stronger in the East and weaker in the Middle and West; the digital economy development in Chinese provinces and cities has a significantly positive direct and spatial spillover effect on carbon emission efficiency; there are differences in the direct and spatial spillover effects of various dimensions of the digital economy development on the carbon emission efficiency in Chinese provinces and cities; the direct effect of the digital economy development on the carbon emission efficiency in Chinese provinces and cities has significant regional heterogeneity among eastern, central, and western regions. This paper provides new empirical evidence for developing countries such as China to proactively develop a digital economy to promote energy conservation and emission reduction to realize green and low-carbon transformation.

Influence Mechanism of Different Environmental Regulations on Carbon Emission Efficiency

The rational use of environmental regulation tools has become an important means by which to improve the efficiency of carbon emissions. Different types of environmental regulations and their combinations have different impacts on carbon emission efficiency. In order to determine the environmental regulation configurations that may achieve high carbon emission efficiency or lead to low carbon emission efficiency, we constructed an analytical framework of connections between environmental regulation configurations and carbon emission efficiency. Moreover, 30 Chinese provinces from the period covering 2016 to 2019 were selected as research cases. In addition, the super slacks-based measure of efficiency (SE-SBM) model was applied to evaluate carbon emission efficiency. Finally, the fuzzy-set qualitative comparative analysis (fsQCA) method was employed to analyze the impact of different environmental regulation configurations on carbon emission efficiency. The results showed that the carbon emission efficiency of various regions of China is generally low (with most regions not having reached an effective level) and that there are large regional differences. We found that there are four environmental regulation configurations that can achieve high carbon emission efficiency and two environmental regulation configurations that lead to low carbon emission efficiency. Based on these configurations, we draw three conclusions: (1) There are three paths to achieving high carbon emission efficiency: one that values command-and-control environmental regulation but disfavors market-incentive environmental regulation, another that combines command-and-control environmental regulation with market-incentive environmental regulation, and a third that couples command-and-control environmental regulation with voluntary environmental regulation. (2) Two paths that may lead to low carbon emission efficiency were established: excessive penalties and the lack of specific measures. (3) In some conditions, environmental governance investment and fiscal expenditure could be substituted for each other; environmental protection administrative penalties and pollution charges are synchronized; environmental governance investment in the promotion of carbon emission efficiency is indispensable. Policies and suggestions on how the government can use environmental regulation tools to improve carbon emission efficiency are proposed from a general coordinative perspective in the final section of this paper.

Prognostic value of receptor tyrosine kinases in malignant melanoma patients: A systematic review and meta-analysis of immunohistochemistry

Background

Substantial evidence suggests that receptor tyrosine kinases (RTKs) are overexpressed in tumors; however, few studies have focused on the prognostic value of RTKs in melanoma.

Objectives

The objective of this study is to evaluate the association between overexpression of RTKs and survival in melanoma patients based on immunohistochemistry (IHC) analysis.

Methods

Our review is registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42021261460. Seven databases were searched, and data were extracted. We used IHC to measure the association between overexpression of RTKs and overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and clinicopathology in melanoma patients. Pooled analysis was conducted to assess the differences between Hazard Ratios along with 95% confidence intervals.

Results

Of 5,508 publications examined following the database search, 23 publications were included in this study, which included data from a total of 2,072 patients. Vascular endothelial growth factor receptor 2 (VEGF-R2) overexpression was associated with worse OS and DFS in melanoma. Furthermore, there was an association between OS and the expression of several RTKs, including epidermal growth factor receptor (EGFR), mesenchymal-epithelial transition factor (MET), vascular endothelial growth factor receptor 1 (VEGF-R1), and insulin-like growth factor 1 receptor (IGF-1R). There were no significant correlations between EGFR overexpression and worse DFS or PFS. EGFR overexpression was associated with worse OS cutaneous and nasal melanoma, but not uveal melanoma. However, MET overexpression was related to worse OS in both cutaneous and uveal melanoma. Furthermore, EGFR overexpression was associated with a worse OS in Europe compared to other geographic areas. Moreover, EGFR and MET overexpression showed significant prognostic value in patients with the cut-off “≥10% staining”.

Conclusions

Our findings build concrete evidence that overexpression of RTKs is associated with poor prognosis and clinicopathology in melanoma, highlighting RTK expression has the potential to inform individualized combination therapies and accurate prognostic evaluation.

Inhibitory Effect of Nano-targeted Micelle Administration Combined with in Vitro Radiotherapy on Glioma Based on Nuclear Magnetic Resonance Technology

Glioma is a malignant tumor originating from the central nervous system. Glioma is the incidence rate of the central nervous system in adults. Nanotechnology has been widely used in drug delivery in vivo, achieving targeted drug delivery through surface modification. At the same time, the samples measured by NMR have no bias to all compounds, and there is no need for specific internal standards for quantification. Therefore, based on the use of nuclear magnetic resonance technology, this paper analyzed the inhibitory effect of nano-targeted micelles combined with in vitro radiotherapy on glioma. The results show that the coupling constants of β - CH3 of Ala and β - CH3 of Lac are close. It is difficult to distinguish the spectral lines of Ala and Lae by 1.5T NMR. DHA-PLys(s-s)P can efficiently deliver drugs across BBB and into brain parenchymal cells to release drugs. Due to its increased stability in the systemic circulation, DHA-PLys(s-s)P can help to improve drug delivery efficiency. The DNA damage of U87 and U251 cells was more serious than that of C6 cells. There was a positive correlation between DNA damage and Cho/Cr ratio, indicating that nano-targeted micelles combined with in vitro radiotherapy have an inhibitory effect on glioma.

miR-1297 inhibits osteosarcoma cell proliferation and growth by targeting CCND2

Cyclin D2 (CCND2) is abnormally overexpressed in many tumor types and has been associated with tumor cell proliferation. Although the important role of miR-1297 is well established, the molecular mechanism between CCND2 and miR-1297 in osteosarcoma (OS) has not been determined. In the present study, we found CCND2 was highly expressed in OS cells, and its downregulation suppressed cell proliferation, resulting in G1 phase cell cycle arrest. In contrast, miR-1297 was lowly expressed in OS compared to normal tissue. Several data platforms predicted that CCND2 was a target of miR-1297, which was validated by a dual-luciferase reporter assay that revealed miR-1297 could bind with CCND2-3'UTR. miR-1297 overexpression greatly inhibited CCND2 protein expression and exerted the same phenotypic effect as CCND2 downregulation in OS cells. Furthermore, miR-1297 inhibition could also be rescued by CCND2. Nude mice injected cells stable overexpressing miR-1297 OS cells showed lower size and tumor weight. Moreover, lower fluorescence activity recorded by in vivo imaging system and bone erosion revealed by microCT in the miR-1297 group demonstrated miR-1297 inhibited OS tumor growth via CCND2. Our findings demonstrated that miR-1297 can inhibit proliferation and tumor growth in OS by directly targeting CCND2, which indicates that miR-1297 may represent a novel therapeutic target for OS.

[Research progress on physiological changes caused by wearing N95 mask in patients with chronic obstruction pulmonary disease]

N95 mask has been shown to reduce lower airway infections requiring hospitalization, mortality and exacerbation frequency in patients with chronic obstructive pulmonary disease(COPD), and therefore is recommended for all COPD patients by guidelines. However, the coverage of influenza vaccination in Chinese COPD patients is far from satisfactory. The large-scale COVID-19 vaccination may have a positive impact on the attitude towards influenza vaccines, and healthcare professionals should take active measures to improve the physical activation in patients with COPD.

Effect of chronic intermittent hypoxia-induced HIF-1α/ATAD2 expression on lung cancer stemness

Background

Obstructive sleep apnea is associated with increased lung cancer incidence and mortality. Cancer stem cells (CSCs) are characterized by their self-renewing ability, which contributes to metastasis, recurrence, and drug resistance. ATPase family AAA domain-containing protein 2 (ATAD2) induces malignancy in different types of tumors. However, a correlation between ATAD2 expression and CSCs in lung cancer has not yet been reported.

Methods

The relative messenger RNA (mRNA) levels of ATAD2, CD44, CD133, and hypoxia-inducible factor (HIF)-1α were determined using reverse-transcription quantitative polymerase chain reaction. ATAD2 protein levels were determined using Western blotting. Cell counting kit-8, 5-ethynyl-2′-deoxyuridine (EdU), and colony formation assays were performed to analyze the proliferation of lung cancer cells. Transwell migration and invasion assays were performed to evaluate cell migration and invasion, respectively. Tumor sphere formation analysis was used to determine tumor spheroid capacity. The link between ATAD2 and HIF-1α was verified using a dual-luciferase reporter assay. Immunofluorescence staining was performed to assess mitochondrial reactive oxygen species (mtROS) production. Flow cytometry analysis was conducted to determine the CD133 and CD44 positive cell ratio.

Results

We evaluated the relative expression of ATAD2 in four lung cancer cell lines (A549, SPC-A1, H460, and H1299 cells) and found increased mRNA and protein levels of ATAD2 in lung cancer samples. ATAD2 overexpression was a poor prognostic factor for lung cancer patients. Loss of ATAD2 reduced lung cancer cell viability and proliferation. Additionally, ATAD2 knockdown repressed lung cancer cell migration, invasion, stem-cell-like properties, and mtROS production. Chronic intermittent hypoxia (CIH)-induced HIF-1α expression significantly activated ATAD2 during lung cancer progression.

Conclusions

This study found that CIH induced HIF-1α expression, which acts as a transcriptional activator of ATAD2. The present study also suggests a novel mechanism by which the integrity of CIH-triggered HIF-1α/ATAD2 may determine lung cancer aggressiveness via the interplay of mtROS and stemness in lung cancer cells.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11658-022-00345-5.

Potential distribution of Blumea balsamifera in China using MaxEnt and the ex situ conservation based on its effective components and fresh leaf yield

Blumea balsamifera is a famous Chinese Minority Medicine, which has a long history in Miao, Li, Zhuang, and other minority areas. In recent years, due to the influence of natural and human factors, the distribution area of B. balsamifera resources has a decreasing trend. Therefore, it is very important to analyze the suitability of B. balsamifera in China. Following three climate change scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5) under 2050s and 2070s, geographic information technology (GIS) and maximum entropy model (MaxEnt) were used to simulate the ecological suitability of B. balsamifera. The contents of L-borneol and total flavonoids of B. balsamifera in different populations were determined by gas chromatography (GC) and ultraviolet spectrophotometry (UV). The results showed that the key environmental variables affecting the distribution of B. balsamifera were mean temperature of coldest quarter (6.18-26.57 ℃), precipitation of driest quarter (22.46-169.7 mm), annual precipitation (518.36-1845.29 mm), and temperature seasonality (291.31-878.87). Under current climate situation, the highly suitable habitat was mainly located western Guangxi, southern Yunnan, most of Hainan, southwestern Guizhou, southwestern Guangdong, southeastern Fujian, and western Taiwan, with a total area of 24.1 × 10⁴ km². The areas of the moderately and poorly suitable habitats were 27.57 × 10⁴ km² and 42.43 × 10⁴ km², respectively. Under the future climate change scenarios, the areas of the highly, moderately, and poorly suitable habitats of B. balsamifera showed a significant increasing trend, the geometric center of the total suitable habitats of B. balsamifera would move to the northeast. In recent years, the planting area of B. balsamifera has been reduced on a large scale in Guizhou, and its ex situ protection is imperative. By comparison, the content of L-borneol, total flavonoids and fresh leaf yield had no significant difference between Guizhou and Hainan (P > 0.05), which indicated that Hainan is one of the best choice for ex situ protection of B. balsamifera.

Treatment Strategies in Emergency Endoscopy for Acute Esophageal Variceal Bleeding (CHESS1905): A Nationwide Cohort Study

Background and Aims

Emergency endoscopy is recommended for patients with acute esophageal variceal bleeding (EVB) and their prognosis has improved markedly over past decades due to the increased specialization of endoscopic practice. The study aimed to compare outcomes following emergency endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) in cirrhotic patients with acute EVB.

Methods

Cirrhotic patients with acute EVB who underwent emergency endoscopy were retrospectively enrolled from 2013 to 2020 across 34 university hospitals from 30 cities. The primary outcome was the incidence of 5-day rebleeding after emergency endoscopy. Subgroup analysis was stratified by Child-Pugh class and bleeding history. A 1:1 propensity score matching (PSM) analysis was performed.

Results

A total of 1,017 and 382 patients were included in EIS group and EVL group, respectively. The 5-day rebleeding incidence was similar between EIS group and EVL group (4% vs. 5%, P = 0.45). The result remained the same after PSM (P = 1.00). Among Child-Pugh class A, B and C patients, there were no differences in the 5-day rebleeding incidence between the two groups after PSM (P = 0.25, 0.82, and 0.21, respectively). As for the patients with or without bleeding history, the differences between EIS group and EVL group were not significant after PSM (P = 1.00 and 0.26, respectively).

Conclusion

The nationwide cohort study indicates that EIS and EVL are both efficient emergency endoscopic treatment strategies for acute EVB. EIS should not be dismissed as an economical and effective emergency endoscopic treatment strategy of acute EVB. ClincialTrials.gov number NCT04307264.

Multi-channel photodissociation dynamics of 14N2 in its b' 1Σ+u(ν = 20) state

b' ¹Σ+u(ν = 20) is the first vibronic state above the dissociation limit N(²D_3/2,5/2) + N(²D_3/2,5/2) of ¹⁴N₂ that has been observed in the absorption spectrum. It provides a unique opportunity for studying the multi-channel photodissociation dynamics of ¹⁴N₂, particularly the competition between the spin-forbidden and spin-allowed photodissociation channels. Here, photofragment excitation (PHOFEX) and (1VUV + 1'UV) photoionization spectra of ¹⁴N₂ in the b' ¹Σ+u(ν = 20) state and the time-slice velocity-map ion (TS-VMI) images at each individual rotational levels are collected by using a vacuum ultraviolet (VUV) pump-VUV probe scheme. It is found that the spin-forbidden channels N(⁴S) + N(²D_3/2,5/2) and N(⁴S) + N(²P_1/2,3/2) are competitive with the spin-allowed channel N(²D_3/2,5/2) + N(²D_3/2,5/2) at low rotational levels, while quickly become undetectable as the rotational quantum number J increases. At high rotational levels, only the spin-allowed channel N(²D_3/2,5/2) + N(²D_3/2,5/2) can be observed, supporting previous theoretical modeling. Channel-resolved partial predissociation rate constants (PPRCs) are calculated by combining branching ratios in this study and total predissociation rate constants (TPRCs) from previous absorption spectroscopic measurements. PPRCs for dissociation into channels N(⁴S) + N(²D_3/2,5/2) and N(⁴S) + N(²P_1/2,3/2) are almost independent of J, while those of N(²D_3/2,5/2) + N(²D_3/2,5/2) show complicated rotational dependence. Possible coupling schemes between b' ¹Σ+u(ν = 20) and the high lying ¹Π_u and ³Π_u states are analyzed, which provides deep insight into the multi-channel photodissociation dynamics of ¹⁴N₂ in a high energy range.

Morphological, Functional, and Tissue Characterization of Silent Myocardial Involvement in Patients With Primary Biliary Cholangitis

BACKGROUND & AIMS

Cirrhotic cardiomyopathy is a major complication and cause of morbidity in end-stage primary biliary cholangitis (PBC). However, it is unclear whether there is clinically silent myocardial involvement at the early stage of PBC before cirrhosis and cardiac manifestations. This prospective, three-center, multi-modality cardiac imaging study on the early identification of myocardial impairment in PBC (EARLY-MYO-PBC) was designed to identify silent myocardial impairment in PBC patients without cardiac manifestations.

METHODS

A total of 112 subjects (56 with PBC and 56 age- and sex-matched controls) undergoing cardiovascular magnetic resonance (CMR) were enrolled. Demographic, serologic, and cardiac imaging data were prospectively collected. All participants had no cardiac discomfort or previous heart disease and had normal electrocardiographic findings.

RESULTS

Subclinical myocardial involvement, as evidenced by cardiac morphologic, functional, and tissue characterization changes on CMR, including hyperdynamic left ventricular (LV) ejection fraction (median, 75% in PBC patients vs 69% in controls, P = .029), subclinical myocardial edema by T2-short tau inversion recovery (21% vs 2% in controls, P = .001), elevated extracellular matrix indices (30% vs 26% in controls, P < .001), and impaired myocardial viability by positive late gadolinium enhancement (LGE) (36%), was detected in PBC patients. Importantly, a mid-wall "stripe" at the LV septum was identified as a PBC-specific LGE pattern that differs from other known cardiomyopathies. In multivariate analysis, gp210 positivity (odds ratio [OR] = 9.909, P = .010), lower hemoglobin (OR = 0.919, P = .004), and body mass index (OR = 0.638, P = .005) were independent predictors of cardiac abnormalities in PBC.

CONCLUSIONS

This study demonstrates clinically silent cardiac impairment with specific CMR patterns in PBC, allowing optimal screening for early myocardial impairment and potentially timely therapies. (Trial registration no.: NCT03545672).