Neural correlates of appetite in adolescents

Appetitive characteristics are associated with child adiposity, but their biological underpinnings are unclear. We sought to investigate the neural correlates of psychometric and behavioral measures of appetitive characteristics in youth. Adolescents (14-18y; 39F, 37M) varying in familial obesity risk and body weight (20% with overweight, 24% with obesity) viewed pictures of high energy-density (ED) foods, low-ED foods and non-foods during fMRI scanning on two separate days. On one day participants consumed a 474 ml preload of water (0 kcal, fasted) and on another (counter-balanced) 474 ml milkshake (480 kcal, fed), before scanning. A multi-item ad libitum meal (ALM) followed scanning. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing food approach and food self-regulation. Caloric compensation was calculated as the percentage of preload intake compensated for by down-regulation of ALM intake in the fed vs. fasted condition. Analyses correcting for multiple comparisons demonstrated that, for the fasted condition, higher CEBQ Food Responsiveness scores were associated with greater activation to high-ED (vs. low-ED) foods in regions implicated in food reward (insula, rolandic operculum, putamen). In addition, higher caloric compensation was associated with greater fed vs. fasted activations in response to foods (vs. non-foods) in thalamus and supramarginal gyrus. Uncorrected analyses provided further support for associations of different measures of appetitive characteristics with brain responses to food cues in each condition. Measures of appetitive characteristics demonstrated overlapping and distinct associations with patterns of brain activation elicited by food cues in fasted and fed states. Understanding the neural basis of appetitive characteristics could aid development of biobehaviorally-informed obesity interventions.

Histogram analysis of diffusion kurtosis imaging of deep brain nuclei in Parkinson's disease with different motor subtypes

AIM

To evaluate the diagnostic and differential efficacy of diffusion kurtosis imaging (DKI) histogram analysis for different motor subtypes of Parkinson's disease (PD).

MATERIALS AND METHODS

Seventy PD patients including 40 with postural instability and gait disorder (PIGD) and 30 with tremor-dominant (TD) and 36 healthy controls (HC) were enrolled prospectively and underwent MRI examinations. The regions of interest (ROI) in the deep brain nuclei were delineated and features were extracted on the map of mean kurtosis (MK), axial kurtosis (Ka), and radial kurtosis (Kr), respectively. The differences in histogram features between PD patients and HC and between patients with PIGD and TD were compared. The areas under the curve (AUCs) were calculated to evaluate the diagnostic efficacy of all histogram features. The correlations between histogram features and clinical indicators were evaluated.

RESULTS

Some DKI histogram features were significantly different between PD patients and HC, and also different between patients with PIGD and TD (all p<0.05). MK of the substantia nigra pars reticulate (SNprkurtosis), Ka of the substantia nigra pars compacta (SNpc) 50 percentile (SNpcP50), and Kr of SNpc 90th percentile showed the highest AUC for distinguishing patients with PIGD from HC. MK-SNpc 10th percentile, Ka-SNpc 25th percentile, and Kr of the head of the caudate nucleus (CN) 90th percentile had the highest AUC for distinguishing patients with TD from HC. MK of the putamen 10th percentile combined with Ka of the bilateral red nucleus RNkurtosis yielded the highest diagnostic performance with an AUC of 0.762 for distinguishing patients with PIGD from TD. Certain DKI histogram features were correlated with Hoehn-Yahr (H&Y) stage, Mini Mental State Examination (MMSE) score, tremor score, and PIGD score (all p<0.05).

CONCLUSION

DKI histogram analysis was useful to diagnose and discriminate different motor subtypes of PD. Certain DKI histogram features correlated with clinical indicators.

Confinement-enhanced microalgal individuals biosensing for digital atrazine assay

Microalgal sensors are widely recognized for their high sensitivity, accessibility, and low cost. However, the current dilemma of motion-induced spatial phase changes and concentration-related multiple scattering interferes with induced test instability and limited sensitivity, which has hindered their practical applications. Here, a differentiated strategy, named confinement-enhanced microalgal biosensing (C-EMB), is developed and proposed to pave the way. The in-situ printed microgel trap is designed to confine Chlamydomonas reinhardtii individuals, stabilizing their spatial phase. The microgel trap arrays are introduced to eliminate the multiple scattering of microalgae, breaking the existing effective concentration in traditional microalgal sensing and enabling sensitive assays. The integration with lab-on-a-chip technology and a developed digital imaging algorithm empower portable and automated detection. With this system, a microalgae analyzer is developed for atrazine detection, featuring a linear range of 0.04-100 μg/L. We assess the system's performance through practical atrazine assays on commercial food, using a double-blind test against a standard instrument. Our results demonstrate the good accuracy and test stability of this system with the mean bias atrazine detection in corn and sugarcane juice samples (SD) were 1.661 μg/L (3.122 μg/L) and 3.144 μg/L (4.125 μg/L), respectively. This method provides a new paradigm of microalgal sensors and should advance the further applications of microalgal sensors in commercial and practical settings.

Genome-wide association study identifies variants associated with semen volume in white-feathered broilers

Semen is a measure of the reproductive efficiency of roosters, which affects the economic benefits of white-feathered broilers. Over the years, research in this field has mainly focused on hens, while there have been fewer studies on the reproductive traits of roosters. To identify the genes related to the semen traits of roosters, we used a chicken 55 K SNP chip to genetically type the white-feathered population (220) and performed imputation with resequencing data from 97 roosters. In total, 1 048 576 SNPs were obtained and used for genome-wide association analysis of semen volume, from which 197 genome-wide significant markers were identified, all within the interval of 13.82-16.12 Mb on chromosome 7. By combining our results with the biological functions of genes in the interval, four candidate genes were identified that potentially relate to semen volume: FAPP1, OSBPL6, SESTD1 and SSFA2. Our findings may provide a basis for further research on the genetic mechanism and marker-assisted selection of semen volume in white-feathered broilers.

Absolute and relative iodine concentrations in the spot sign and haematoma for prediction of haematoma expansion in spontaneous intracerebral haemorrhage

AIM

To explore the predictive value of absolute and relative iodine concentrations in the spot sign (SS) and haematoma on gemstone spectral imaging (GSI) for haematoma expansion (HE).

MATERIALS AND METHODS

Patients with spontaneous intracerebral haemorrhage (ICH) who underwent computed tomography (CT) angiography using GSI were divided into an SS-positive group and an SS-negative group. In the SS-positive group, absolute and relative iodine concentrations in the SS (aICIS and rICIS, respectively) were measured. In the SS-negative group, absolute and relative iodine concentrations in haematoma (aICIH and rICIH, respectively) were measured. The area under the receiver operating characteristic curve (AUC-ROC) was used to investigate the HE predictive performance of aICIS, rICIS, and their combination in the SS-positive group, as well as the HE predictive performance of aICIH, rICIH, and their combination in the SS-negative group. The risk variables for HE in the two groups were investigated separately using logistic regression.

RESULTS

A total of 123 spontaneous ICH patients were enrolled. In the SS-positive group, the AUC of aICIS, rICIS, and their combination for predicting HE were 0.853, 0.893, and 0.922, respectively. rICIS was demonstrated to be a standalone predictor of HE via logistic regression. In the SS-negative group, aICIH, rICIH, and their combination had AUC-ROC values of 0.552, 0.783, and 0.851, respectively, to predict HE. According to multivariate analysis, rICIH was a reliable predictor of HE.

CONCLUSION

Absolute and relative iodine concentrations in the SS and haematoma can predict HE.

[New technology and research progress in neurosurgery diagnosis and treatment]

Neurosurgery is a vital branch of medicine that deals with the surgical management of brain disorders. The increasing demand for clinical solutions drives technological innovation, and the rapid progress in science and technology enables new discoveries, knowledge, techniques, and instruments in neurosurgery, expanding the scope and accuracy of diagnosis and treatment, and enhancing therapeutic outcomes. The author team combines domestic and international literature and previous clinical and scientific research experience, focusing on practical clinical problems in several subspecialties, including neuroimaging, neuronavigation and surgical robot assistance, central nervous system tumors, surgical treatment of cerebrovascular disease, functional neurosurgery, neuroinjury and neural repair, and digital neurosurgery. The paper summarizes in detail the research hotspots and puts forward the research direction prospects, including the innovative application of imaging technology, the development of fine surgery, the innovation of neuro-oncology diagnosis and treatment, the surgical standardization of cerebrovascular disease, the progress of neuromodulation, the individualized neurological alternative treatment and the digitalization of multi-dimensional information in neurosurgery.

Factors associated with early failure of the femoral neck system (FNS) in patients with femoral neck fractures

BACKGROUND

Femoral neck system (FNS) is a new type of internal fixation system which has been widely used for treating femoral neck fractures (FNFs).Compared with other internal fixation methods, FNS is minimally invasive and stable, and often achieves satisfactory short-term efficacy.Early failure of FNS (EFFNS) is not uncommon, however, there are few literatures and reports on factors associated with EFFNS.This study aimed to survey the prevalence and risk factors of EFFNS.

METHODS

We retrospectively analysed 62 patients with FNFs and underwent FNS fixation between 2019 and 2021. Demographic data, clinical characteristics, radiographic features and treatment process were described. Multifactor logistic regression analysis was used to analyse the different influencing factors.

RESULTS

Out of the 62 FNFs patients, 10 patients (16.1%) developed EFFNS, including 6 cases of severe femoral neck shortening, 2 cases of screw-out, 1 case of avascular necrosis of the femoral head and 1 case of nonunion. In the failure group, all patients were younger than 65 years old, which was significantly higher than 59.6% in the healing group (P = 0.012). There were no significant differences in sex(P = 0.490), BMI (P = 0.709), injured side (P = 0.312), injury mechanism (P = 0.617), reduction method(P = 0.570),femoral neck-shaft angle(P = 0.545), Pauwels classification (P = 0.564) and Garden classification (P = 0.195). Moreover, we not found that Garden classification (P = 0.464) and age (P = 0.128) were statistically significant risk factors for EFFNS at multivariate analysis.

CONCLUSION

In this study, sex, BMI, injury side, injury mechanism, reduction method, Pauwels angle, femoral neck-shift angle, Pauwels classification and Garden classification were excluded as EFFNS risk factors. Moreover, our study demonstrated that age and Garden classification were not significant risk factors at multivariate analysis.

TRIAL REGISTRATION

ChiCTR, ChiCTR2100051360. Registered on 21 September, 2021. https://www.chictr.org.cn/index.aspx .

Impact of COVID-19 infection experience on mental health status of intensive care unit patients' family members: a real-world study

PURPOSE

Family members of patients hospitalized in intensive care unit (ICU) are susceptible to adverse psychological outcomes. However, there is a paucity of studies specifically examining the mental health symptoms in ICU patients' family members with a prior history of coronavirus disease 2019 (COVID-19) infection.

AIM

This study aimed to investigate mental health status and its influencing factors of ICU patients' family members with previous COVID-19 infection experience in China.

DESIGN

Nationwide, cross-sectional cohort of consecutive participants of family members of ICU patients from 10 provinces randomly selected in mainland China conducted between October 2022 and May 2023.

METHODS

The basic information scale, Self-rating depression scale, Self-rating Anxiety Scale, Impact of Event Scale-Revised, Pittsburgh sleep quality index, Perceived Stress Scale, Connor-Davidson resilience scale, Simplified Coping Style Questionnaire were employed to explore mental health status among participants.

RESULTS

A total of 463 participants, comprising 156 individuals in Covid-19 family member cohort (infection group) and 307 individuals in control family member cohort (control group), met inclusion criteria. The infection group exhibited significantly higher incidence of composite mental health symptoms compared to control group (P = 0.017). Multivariable logistic regression analysis revealed that being female, engaging in physical/mental labor, residing in rural areas, and having children were identified as risk factors for the development of depression, anxiety, and post-traumatic stress disorder symptoms, while medical history of surgery was protective factor. A predictive model demonstrated a favorable discriminative ability and excellent calibration.

CONCLUSION

COVID-19 infection experience regarded as new traumatic stressors worsen mental health status of ICU patients' family members.

Purtscher-like retinopathy in systemic lupus erythematosus: clinical features, risk factors and prognosis

BACKGROUND

Purtscher-like retinopathy (PLR) is a rare ocular manifestation in systemic lupus erythematosus (SLE) with poor prognosis, but its clear risk factors and treatment consensus are still lacking.

AIM

To investigate the clinical features, risk factors and prognosis of PLR in SLE patients.

DESIGN AND METHODS

A retrospective analysis was conducted on SLE patients with PLR admitted at Peking Union Medical College Hospital from 2013 to 2022. Clinical data, including demographic characteristics, lupus-related features, laboratory findings and ophthalmologic examinations, were collected and analyzed. The prognosis was evaluated based on best-corrected visual acuity and ophthalmologic outcomes.

RESULTS

Seventeen SLE patients (32 eyes) diagnosed with PLR were included, along with a random selection of 100 SLE patients without retinopathy and 100 with retinal microvasculopathy as controls. Patients with PLR had a significantly younger age, a higher proportion of hemolytic anemia, a shorter duration of SLE, a higher SLE disease activity index-2000 (SLEDAI-2K) score, higher erythrocyte sedimentation rate (ESR) values and lower hemoglobin (HGB) values than the group without retinopathy (P < 0.05). They also had a significantly higher SLEDAI-2K score, higher ESR values and higher white blood cell values (P < 0.05) than the Microvasculopathy group. The majority of eyes (22/26, 84.62%) achieved stabilization at the last follow-up, with different therapeutic strategies, while a few (4/26, 15.38%) experienced complications or progression.

CONCLUSION

This is the largest reported case series of PLR in SLE, which was associated with higher disease activity and poor visual prognosis. It was also associated with younger age, shorter SLE duration, concomitant hemolytic anemia, lower HGB and higher ESR value. Early recognition and prompt treatment are crucial for improving visual outcomes.

[Preliminary application of recombinase -aided amplification in detection of Clonorchis sinensis metacercariae in freshwater fish]

OBJECTIVE

To evaluate the performance of recombinase-aided amplification (RAA) assay in detection of Clonorchis sinensis metacercariae in freshwater fish samples, so as to provide insights into standardization and field application of this assay.

METHODS

Wild freshwater fish samples were collected in the rivers of administrative villages where C. sinensis-infected residents lived in Jiangyan District, Xinghua County and Taixing County of Taizhou City, Jiangsu Province from June to September 2022. Genomic DNA was extracted from six freshwater fish specimens (5 g each) containing 0, 1, 2, 4, 8 and 16 C. sinensis metacercariae for fluorescent RAA assay, and the diagnostic sensitivity was evaluated. Fluorescent RAA assay was performed with genomic DNA from C. sinensis, Metorchis orientalis, Haplorchis pumilio and Centrocestus formosanus metacercariae as templates to evaluate its cross-reactions. In addition, the detection of fluorescent RAA assay and direct compression method for C. sinensis metacercariae was compared in field-collected freshwater fish samples.

RESULTS

Positive amplification was found in fresh-water fish specimens containing different numbers of C. sinensis metacercariae, and fluorescent RAA assay was effective to detect one C. sinensis metacercaria in 5 g freshwater fish specimens within 20 min. Fluorescent RAA assay tested negative for DNA from M. orientalis, H. pumilio and C. formosanus metacercariae. Fluorescent RAA assay and direct compression method showed 5.36% (93/1 735) and 2.88% (50/1 735) detection rates for C. sinensis metacercariae in 1 735 field-collected freshwater fish samples, with a statistically significant difference seen (χ2 = 478.150, P < 0.001). There was a significant difference in the detection of C. sinensis metacercariae in different species of freshwater fish by both the direct compression method (χ2 = 11.20, P < 0.05) and fluorescent RAA assay (χ2 = 20.26, P < 0.001), and the detection of C. sinensis metacercariae was higher in Pseudorasbora parva than in other fish species by both the direct compression method and fluorescent RAA assay (both P values < 0.05).

CONCLUSIONS

Fluorescent RAA assay has a high sensitivity for detection of C. sinensis metacercariae in freshwater fish samples, and has no cross-reactions with M. orientalis, H. pumilio or C. formosanus metacercariae. Fluorescent RAA assay shows a higher accuracy for detection of C. sinensis infections in field-collected freshwater fish than the direct compression method.

A microfluidic hemostatic diagnostics platform: Harnessing coagulation-induced adaptive-bubble behavioral perception

Clinical viscoelastic hemostatic assays, which have been used for decades, rely on measuring biomechanical responses to physical stimuli but face challenges related to high device and test cost, limited portability, and limited scalability.. Here, we report a differential pattern using self-induced adaptive-bubble behavioral perception to refresh it. The adaptive behaviors of bubble deformation during coagulation precisely describe the transformation of viscoelastic hemostatic properties, being free of the precise and complex physical devices. And the integrated bubble array chip allows microassays and enables multi-bubble tests with good reproducibility. Recognition of the developed bubble behaviors empowers automated and user-friendly diagnosis. In a prospective clinical study (clinical model development [n = 273]; clinical assay [n = 44]), we show that the diagnostic accuracies were 99.1% for key viscoelastic hemostatic assay indicators (reaction time [R], kinetics time [K], alpha angle [Angle], maximum amplitude [MA], lysis at 30 min [LY30]; n = 220) and 100% (n = 44) for hypercoagulation, healthy, and hypocoagulation diagnoses. This should provide fresh insight into existing paradigms and help more clinical needs.

Higher oxidative balance score decreases risk of stroke in US adults: evidence from a cross-sectional study

Background

The oxidative balance score (OBS) can be used to represent the overall burden of oxidative stress in an individual. This study aimed to explore the association between the risk of stroke and OBS.

Methods and materials

The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 was used to extract a series of variables for participants who took the stroke questionnaire. The construction of OBS relied on diet and lifestyle components, which included 16 nutrients and 4 lifestyle factors. Weighted multivariable-adjusted logistic regression was performed to investigate the association between stroke risk and OBS. A stratified analysis was also conducted. The dose-response relationship between stroke risk and OBS was elucidated by performing a restricted cubic spline function.

Results

A total of 20,680 participants were included for analysis, 768 of whom suffered from stroke. Based on weighted multivariable logistic regression analysis, we discovered that the stroke prevalence decreased by 2% for each OBS unit added [OR: 0.98 (0.97-1.00), P < 0.01]. For the OBS subgroup, we also discovered that higher OBS was related to a reduction in the risk of stroke [Q4 vs. Q1: OR:0.65 (0.46-0.90), P < 0.01]. The prevalence of stroke declined by 3% with every OBS unit added to the diet component [OR: 0.97 (0.96-0.99), P < 0.01]. For the dietary OBS subgroup, higher OBS in diet components was associated with a decrease in the prevalence of stroke [Q4 vs. Q1: OR: 0.65, (0.47-0.91), P < 0.05]. Further stratified analysis showed that every OBS unit raised was associated with a decline in stroke prevalence, which was statistically significant in participants in subgroups of ≥60 years, female, no-diabetes mellitus and no-hypertension. OBS and stroke prevalence were correlated in a linear manner.

Conclusion

The study found that a higher OBS was associated with a decrease in stroke prevalence, which could be a significant indicator for evaluating stroke risk.

[Interaction of SENP6 with PINK1 Promotes Temozolomide Resistance in Neuroglioma Cells via Inducing the Mitophagy]

Temozolomide resistance is a major cause of recurrence and poor prognosis in neuroglioma. Recently, growing evidence has suggested that mitophagy is involved in drug resistance in various tumor types. However, the role and molecular mechanisms of mitophagy in temozolomide resistance in glioma remain unclear. In this study, mitophagy levels in temozolomide-resistant and -sensitive cell lines were evaluated. The mechanisms underlying the regulation of mitophagy were explored through RNA sequencing, and the roles of differentially expressed genes in mitophagy and temozolomide resistance were investigated. We found that mitophagy promotes temozolomide resistance in glioma. Specifically, small ubiquitin-like modifier specific protease 6 (SENP6) promoted temozolomide resistance in glioma by inducing mitophagy. Protein-protein interactions between SENP6 and the mitophagy executive protein PTEN-induced kinase 1 (PINK1) resulted in a reduction in small ubiquitin-like modifier 2 (SUMO2)ylation of PINK1, thereby enhancing mitophagy. Our study demonstrates that by inducing mitophagy, the interaction of SENP6 with PINK1 promotes temozolomide resistance in glioblastoma. Therefore, targeting SENP6 or directly regulating mitophagy could be a potential and novel therapeutic target for reversing temozolomide resistance in glioma.

The value of serum lipoprotein-associated phospholipase A2, ischemia-modified albumin, and cystatin C in predicting coronary heart disease risk: a single center retrospective cohort study

OBJECTIVE

This study aims to explore the value of serum lipoprotein-associated phospholipase A2 (Lp-PLA2), ischemia-modified albumin (IMA), and cystatin C (Cys-C) in predicting the risk of coronary heart disease (CHD).

PATIENTS AND METHODS

Clinical data from 104 CHD patients admitted to our hospital from January 2020 to December 2022 were analyzed. Of them, 31 patients had stable angina (Group-S), 36 patients were diagnosed with unstable angina (Group-U), and 37 patients had acute myocardial infarction (Group-A). Additionally, clinical data from 35 healthy individuals undergoing physical examination during the same time period were selected as the control group. Levels of blood lipid indicators and serum Lp-PLA2, IMA, and Cys-C levels were compared between the groups.

RESULTS

The rates of diabetes, hypertension, and smoking in Group-S, Group-U, and Group-A were significantly higher than those in the control group (p<0.05). Levels of Lp-PLA2, IMA, and Cys-C in Group-S, Group-U, and Group-A were significantly higher than those in the control group (p<0.05). Levels of Lp-PLA2, IMA, and Cys-C in Group-U and Group-A were significantly higher than those in Group-S, and Group-A had the highest value of these indexes (p<0.05). Multivariate logistic regression analysis showed that Lp-PLA2, Cys-C, and IMA were important risk factors for the onset of CHD (p<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of Lp-PLA2, IMA, and Cys-C predicting the occurrence of CHD was 0.775, 0.835, and 0.735, respectively. The combined prediction of the three factors has an AUC of 0.920, which is higher than the individual prediction.

CONCLUSIONS

Lp-PLA2, IMA, and Cys-C are closely related to the onset and progression of CHD. These indicators, therefore, can be used in clinical practice to predict and evaluate CHD.

[Construction of a prediction model for predicting rebleeding in patients with obscure gastrointestinal bleeding after capsule endoscopy]

Objective: To explore the risk factors of rebleeding in patients with obscure gastrointestinal bleeding (OGIB) after capsule endoscopy (CE), and construct a model to predict rebleeding. Methods: The data of patients with OGIB who underwent CE in Zhongda Hospital Affiliated to Southeast University from July 2018 to September 2021 were retrospectively analyzed. Follow-up data were obtained via electronic medical records or telephone interviews. Univariate and multivariate Cox regression models were performed to figure out the risk factors of rebleeding in OGIB patients. Then the optimal prediction model was determined and presented as a nomogram. The model was evaluated by C statistic, calibration curve and decision curve analysis. Results: One hundred and thirty patients with OGIB were included, including 64 females and 66 males, aged (55.8±17.2) years (18-87 years), and 39 (30.0%) cases developed rebleeding during follow-up. Univariate and multivariate Cox regression model analysis showed the duration of more than 2 weeks OGIB (HR=3.70, 95%CI: 1.85-7.42, P<0.001), a history of previous gastrointestinal bleeding (HR=5.25, 95%CI: 2.00-13.81, P<0.001), positive CE findings (HR=3.72, 95%CI: 1.66-8.33, P=0.001), and the lowest hemoglobin level before CE<80 g/L (HR=2.00, 95%CI: 1.02-3.84, P=0.044) were risk factors for rebleeding, while specific treatment (HR=0.25, 95%CI: 0.11-0.54, P<0.001) was a protective factor. The corresponding scores of the above five predictive factors were: OGIB duration>2 weeks: 79 points; Previous history of gastrointestinal bleeding: 100 points; The result of CE was positive: 79 points; Specific treatment:-85 points; Minimum hemoglobin before CE<80 g/L: 41 points. The prediction model constructed from the above five variables had good discriminative capability (concordance index=0.798, 95%CI: 0.732-0.865). The calibration curves showed high consistency between nomogram-predicted probabilities and actual observations. The decision curves showed that when the threshold probability was above 0.04, the use of the nomogram to predict rebleeding provided a greater net benefit than the assumption of "all patients rebleeding or no patients rebleeding". Conclusion: The prediction model established in this study has a good ability to predic rebleeding in patients with OGIB after CE examination.

[Risk factors and construction of a nomogram model for cirrhotic portal vein thrombosis combined with esophagogastric variceal bleeding]

Objective: To investigate the risk factors and construct a nomogram model for predicting the occurrence of cirrhotic portal vein thrombosis in patients combined with esophagogastric variceal bleeding (EVB). Methods: Clinical data on 416 cirrhotic PVT cases was collected from the First Hospital of Lanzhou University between January 2016 and January 2022. A total of 385 cases were included after excluding 31 cases for retrospective analysis. They were divided into an esophagogastric variceal bleeding group and a non-esophagogastric variceal bleeding group based on the clinical diagnosis. The esophagogastric variceal group was then further divided into an EVB group and a non-bleeding group. All patients underwent gastroscopy, serology, and imaging examinations. The risk factors of PVT combined with EVB were identified by univariate analysis using SPSS 26. The prediction model of cirrhotic PVT in patients combined with EVB was constructed by R 4.0.4. The prediction efficiency and clinical benefits of the model were evaluated by the C-index, area under the receiver operating characteristic curve, calibration plots, and decision curve. The measurement data were examined by a t-test or Mann-Whitney U test. The counting data were tested using the χ(2) test or the Fisher exact probability method. Results: There were statistically significant differences in the etiology, Child-Pugh grade,erythrocyte count, hematocrit, globulin, and serum lipids between the esophageal and non-esophageal varices groups (P < 0.05). There were statistically significant differences in etiology, erythrocyte count, hemoglobin, hematocrit, neutrophil percentage, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and neutrophil lymphocyte ratio (NLR) between the EVB and non-bleeding groups (P < 0.05). Multivariate logistic regression analysis showed that etiology (OR = 3.287, 95% CI: 1.497 ~ 7.214), hematocrit (OR = 0.897, 95% CI: 0.853 ~ 0.943), and high-density lipoprotein cholesterol (OR = 0.229, 95% CI: 0.071 ~ 0.737) were independent risk factors for cirrhotic PVT patients combined with EVB. The constructed normogram model predicted the probability of bleeding in patients. The nomogram model had shown good consistency and differentiation (AUC = 0.820, 95% CI: 0.707 ~ 0.843), as verified by 10-fold cross-validation (C-index = 0.799) and the Hosmer-Lemeshow goodness of fit test (P = 0.915). The calibration plot and the decision curve suggested that the prediction model had good stability and clinical practicability. Conclusion: The risk factors for EVB occurrence include etiology, erythrocyte, hemoglobin, hematocrit, percentage of neutrophils, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and NLR in patients with cirrhotic liver. The constructed prediction model has good predictive value, and it can provide a reference for medical personnel to screen patients with high bleeding risk for targeted treatment.

[Effects of miniature free groin perforator flaps in repairing small wounds on hands]

Objective: To investigate the effects of miniature free groin perforator flaps in repairing small wounds on hands. Methods: The retrospective observational study was conducted. Fifteen patients with 16 small wounds on hands were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital from July 2020 to October 2022, including 12 males and 3 females, aged 19 to 56 years. The size of skin and soft tissue defect was 2.0 cm×1.5 cm to 6.0 cm×3.0 cm after debridement. According to size and shape of the wounds, 13 single-lobe perforator flaps and 2 bilobed perforator flaps were designed in the groin region, with the flap size of 4.5 cm×2.5 cm to 7.5 cm×3.5 cm. According to the condition of the recipient area, the arteries and veins at the pedicle of the flap were anastomosed to the arteries and veins of the recipient area respectively. The wounds in the donor area of the flap was closed by layered and tension-reducing suture. The thickness of the flap was measured during operation. The survival of the flap was observed, and the complications in the donor and recipient areas were recorded after operation. The appearance and texture of the flap were observed during follow-up. At the last follow-up, the sensory recovery of the affected hand was evaluated, the function of the affected hand was evaluated according to the trial standard of the upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association, the scar in the donor and recipient areas were observed, and the satisfaction of patients for the curative effects was inquired. Results: The thickness of the flap was ranged from 0.3 to 1.0 cm, with an average thickness of 0.6 cm. After operation, 11 single-lobe flaps and 2 bilobed flaps survived well; in the left 2 single-lobe flaps, one flap had venous crisis but returned to normal after removing stitches to reduce tension and bloodletting of flaps, while the other one flap had a little necrosis on tip but healed after dressing change. No complications occurred in donor and recipient areas. During follow-up of 8 to 35 months after operation, the flaps had good elasticity and soft texture; 8 flaps were slightly bloated and were trimmed 3 to 8 months after operation, while the appearances of the other flaps were good. At the last follow-up, all flaps recovered protective feeling; the function of the affected hand was evaluated as excellent in 10 cases, good in 4 cases, and fair in 1 case; only linear scar remained in the donor and recipient areas; the patients were satisfied with the appearance and function recovery of the affected hand. Conclusions: The miniature free groin perforator flaps in repairing small wounds on hands have the advantages of high survival rate of flaps, hidden flap donor area, little damage, few complications, good repair effect, etc., showing clinical application value. It is recommended for repairing non-functional wounds on hands.

[Research on the association between unhealthy lifestyle and psychological distress among Chinese children and adolescents aged 9-18 years]

Objective: To evaluate the level of psychological distress among Chinese children and adolescents and analyze its lifestyle influencing factors. Methods: Data were obtained from the 2019 Chinese National Survey on Students' Constitution and Health. A lotal of 120 285 Han Chinese children and adolescents aged 9-18 years with complete information on the psychological distress scale and lifestyle factors were selected, including 58 432 boys and 61 853 girls. The Kessler Psychological Distress Scale (K10) measured psychological distress, and lifestyles such as physical activity, sedentary behavior, diet, and sleep were also investigated. K10 scores of different genders were compared using the t-test, and the levels of psychological distress were compared using the χ2 test. Logistic regression was used to analyze lifestyle risk factors associated with high psychological distress, and multiple linear regression was used to find the relationship between K10 scores and lifestyle scores. Results: The average K10 score for Han Chinese children and adolescents aged 9-18 years was 21.25±7.35, with girls (21.43±7.35) scoring higher than boys (21.06±7.36), the difference was statistically significant (t=8.72, P<0.001). The rate of high psychological distress was 29.81%, with girls (31.08%) reporting higher rates than boys (28.46%), the difference was statistically significant (χ2=98.54,P<0.001). 56.10% of children and adolescents have unhealthy lifestyles, with girls (58.77%) reporting higher rates than boys (53.27%), the difference was statistically significant (χ2=368.53,P<0.001). Except for insufficient outdoor activities for girls (P=0.128), lifestyles such as insufficient physical activity, insufficient muscle-and-bone exercises, long screen time, not eating breakfast, eggs and dairy products every day, drinking sugary beverages once or more per day, and not having enough sleep are all risk factors for high psychological distress (all P<0.001). For every additional healthy lifestyle score, the K10 score decreased by 0.98 [β=-0.98 (95%CI: -1.01- -0.95)] points (P<0.001). K10 scores in each region negatively correlate with lifestyle scores (all P<0.001). Among them, the K10 score in the eastern region showed the slightest decrease as the lifestyle score increased, while the western region showed the most decrease. Conclusions: The prevalence of psychological distress and unhealthy lifestyle in Chinese children and adolescents are high and interrelated. Compared those with healthy lifestyles, children and adolescents with unhealthy lifestyles are at greater risk of high psychological distress. Therefore, promoting healthy lifestyles for children and adolescents may be one of the important ways to improve their mental health.

[Research on the association between ambient PM2.5 and its components and psychological distress among Chinese children and adolescents aged 9-18 years]

Objective: To analyze the association between exposure to ambient PM2.5 and its components [sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC)] and psychological distress among school children and adolescents aged 9 to 18 years in China. Methods: Based on data from the 2019 Chinese National Survey on Students' Constitution and Health, 130 808 children and adolescents aged 9 to 18 years were included. Scoring and determination of higher psychological distress were based on the Kessler Psychological Distress Scale (K10), and annual average exposure data for air pollution were matched by survey location and time. We used a restricted cubic spline approach based on logistic regression to fit the associations between PM2.5, SO42-, NO3-, NH4+, organic matter, black carbon concentrations, and psychological distress. Logistic regression models were used to analyse different age, gender, BMI and physical activity subgroups to estimate the association between exposure to high levels of pollution and high levels of psychological distress in different subgroups. Results: The proportion of children and adolescents with high levels of psychological distress in China was 30.4%, with girls being higher than boys at 31.6% and 29.1%, respectively (P<0.05). A non-linear positive association existed between exposure to PM2.5, SO42-, NO3- and organic matter concentrations and higher psychological distress. As PM2.5, NO3-, NH4+, organic matter, and black carbon concentrations continued to rise, the increase in the risk of higher psychological distress slowed, while SO42- showed little change in the OR of psychological distress at lower concentrations but continued to rise at higher concentrations. PM2.5 and its components were statistically associated with psychological distress in the physically inactive group but not in the physically active group. The association between high levels of pollutants and high psychological distress was stronger among students aged 9 to 12 years compared with students aged 13 to 15 years and 16 to 18 years. Conclusions: The ambient pollutant PM2.5 and its components are associated with psychological distress in children and adolescents aged 9 to 18 years in China. High pollutant exposure is a risk factor for high psychological distress among physically inactive children and adolescents, and there are age differences in the association between PM2.5 and components and psychological distress.

[Research on the association between overweight and obesity mediated by Chinese children and adolescent aged 13-18 years physical exercise and psychological distress]

Objective: To analyze the association between overweight and obesity, psychological distress, and the influence of physical exercise among Chinese children and adolescents. Methods: The study used data from the 2019 Chinese National Survey on Students' Constitution and Health. A total of 95 280 Han Chinese children and adolescents aged 13 to 18 years were included in the study based on complete information on overweight and obesity, psychological distress assessment, and physical exercise variables. The Kessler Psychological Distress Scale was used to measure their psychological distress, with scores above 25 indicating high psychological distress. The BMI group of the adolescents was evaluated according to the Chinese standard "WS/T 586-2018 Screening for Overweight and Obesity in School-age Children and Adolescents", including underweight, normal weight, overweight, and obesity. The individual's BMI Z-score (BMIZ) was evaluated using the WHO standard and divided into ten groups based on the population percentile distribution. The survey collected the subjects' average daily physical exercise time and divided them into two groups: less than 1 hour and greater than or equal to 1 hour. Logistic regression analysis was used to analyze the relationship between overweight and obesity and high psychological distress among children and adolescents and the differences in association between different physical exercise groups. Results: The detection rates of overweight and obesity among Han Chinese children and adolescents aged 13 to 18 years in 2019 were 14.5%, and 7.6%, respectively. The rate of high psychological distress was 37.6%, and the rate of average daily physical exercise time exceeding 1 hour was 17.1%. Using the population with a BMIZ P10 below as a reference, the association strength between high psychological distress and the population gradually increased, with an OR (95%CI) value of 1.08 (1.02-1.14), 1.09 (1.02-1.14), 1.10 (1.03-1.16), and 1.16 (1.09-1.23) for BMIZ in the P60-, P70-, P80-, >P90 groups. Compared to normal weight, both overweight and obesity were positively associated with high psychological distress in children and adolescents, with obesity showing a more significant correlation, while underweight was negatively associated with high psychological distress. The detection rates of high psychological distress in normal weight, underweight, overweight, and obese groups were 37.6%, 37.0%, 38.2%, and 38.7%, respectively, with an OR (95%CI) value of 0.93 (0.88-0.98) for the underweight group and 1.05 (1.01-1.10) and 1.13 (1.07-1.19) for the overweight and obese groups, respectively. The positive correlation between BMIZ, overweight, and obesity with high psychological distress was significant only in adolescents who exercised less than 1 hour per day on average. Conclusions: Chinese children and adolescents face the problem of obesity and high psychological distress, with a positive correlation between these two problems. Physical activity may moderate the association between obesity and psychological distress in children and adolescents. Adequate physical exercise may offset the potential high psychological distress caused by obesity in children and adolescents. Thus, strengthening physical exercise among children and adolescents reduces the risks of both obesity and psychological health problems effectively.

An inverse Jiles-Atherton model of nanocrystalline magnetic core for nanoseconds square pulsed magnetization

The magnetic core is a key component of a linear transformer driver (LTD), and the accuracy of the core model affects the calculation of the LTD power flow and the prediction of the output waveform. In this paper, a magnetization model based on the inverse Jiles-Atherton (inverse J-A) model is developed and a particle swarm algorithm is used to identify the parameters and to obtain the variation of the parameters with the excitation characteristic. A nanoseconds square wave LTD magnetic core test platform was built to obtain the magnetization characteristics of nanocrystalline magnetic cores under different excitation characteristic parameters. Under square wave pulses, due to the presence of harmonic components, core loss is more complex. In view of the fitting deviation caused by the traditional J-A model not considering harmonic factors and anisotropy, a dynamic loss correction factor is proposed. Through a comparison of experimental and simulation results, this model can well reflect the magnetization process and has high accuracy in fitting dynamic hysteresis loops and predicting losses, which is important for guiding the design of a square pulse LTD.

Dosimetric Analysis of CBCT-Based Weekly Online Adaptive Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

Anatomic and geometric changes are common during a radiotherapy course amongst patients receiving conventional fractionated radiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). These changes may cause significant deviation from initial reference plan resulting in over-treatment of normal tissue or under-coverage of the target. Cone-beam computed tomography (CBCT)-based online adaptive radiotherapy (ART) platforms allow for response to these changes and is being increasingly used in the clinic though less so for intrathoracic disease. We hypothesized weekly CBCT-ART would improve target coverage and decrease dose to organs at risk (OAR) in patients with LA-NSCLC.

MATERIALS/METHODS

Data was collected from a prospective registry of 23 LA-NSCLC patients treated to 60 Gy in 30 fractions with CBCT-ART between June 2021 and December 2022. For weekly ART (Wk-ART), online plan adaptation started on week two. The adapted plan was then used to treat patients with image guidance until the next ART. For comparison, doses were recalculated with the initial reference plan on the SCT with updated contours to derive non-adapted (non-ART) dosimetry for each week. The final dosimetric parameters were obtained by averaging weekly coverage (ITV, PTV) and critical OAR (Lung, esophagus, heart, spinal cord) doses for non-ART and weekly ART treatments respectively for each patient. Paired student t-test was performed to compare the dosimetric parameters between non-ART and Wk-ART.

RESULTS

We observed an average 29% ± 19% (median: 26%) reduction in ITV volume through the radiotherapy course, with 48% (11/23) of patients showing >30% reduction. Most significant volume reductions (16%) were observed between the third and fourth adaptation. Weekly ART showed significant (p<1×10-3) improvements in ITV and PTV coverage, and showed improved clinically relevant lung, esophageal, cardiac, and lung dosimetry (Table 1), especially in the later stages of treatment when the tumor showed significant shrinkage. The average time from contour review to quality assurance completed is 8.5±1.2 min.

CONCLUSION

CBCT-ART provides robust ART plan quality and efficient workflow. There are significant improvements in target coverage and OAR sparing in LA-NSCLC treated with weekly CBCT-ART and these are driven by the significant volume reduction of the ITV throughout treatment course.