[Analysis of the whole genome traceability and transmission path simulation experiment of the local cluster COVID-19 epidemic]

Objective: To trace and characterize the whole genome of SARS-CoV-2 of confirmed cases in the outbreak of COVID-19 on July 31, 2021 in Henan Province. Method: Genome-wide sequencing and comparative analysis were performed on positive nucleic acid samples of SARS-CoV-2 from 167 local cases related to the epidemic on July 31, 2021, to analyze the consistency and evolution of the whole genome sequence of virus. Results: Through high-throughput sequencing, a total of 106 cases of SARS-CoV-2 whole genome sequences were obtained. The results of genome analysis showed that the whole genome sequences of 106 cases belonged to the VOC/Delta variant strain (B.1.617.2 clade), and the whole genome sequences of 106 cases were shared with the genomes of 3 imported cases from Myanmar admitted to a hospital in Zhengzhou. On the basis of 45 nucleotide sites, 1-5 nucleotide variation sites were added, and the genome sequence was highly homologous. Conclusion: Combined with the comprehensive analysis of viral genomics, transmission path simulation experiments and epidemiology, it is determined that the local new epidemic in Henan Province is caused by imported cases in the nosocomial area, and the spillover has caused localized infection in the community. At the same time, it spills over to some provincial cities and results in localized clustered epidemics.

Venc Design and Velocity Estimation for Phase Contrast MRI

In phase-contrast magnetic resonance imaging (PC-MRI), spin velocity contributes to the phase measured at each voxel. Therefore, estimating velocity from potentially wrapped phase measurements is the task of solving a system of noisy congruence equations. We propose Phase Recovery from Multiple Wrapped Measurements (PRoM) as a fast, approximate maximum likelihood estimator of velocity from multi-coil data with possible amplitude attenuation due to dephasing. The estimator can recover the fullest possible extent of unambiguous velocities, which can greatly exceed twice the highest venc. The estimator uses all pairwise phase differences and the inherent correlations among them to minimize the estimation error. Correlations are directly estimated from multi-coil data without requiring knowledge of coil sensitivity maps, dephasing factors, or the actual per-voxel signal-to-noise ratio. Derivation of the estimator yields explicit probabilities of unwrapping errors and the probability distribution for the velocity estimate; this, in turn, allows for optimized design of the phase-encoded acquisition. These probabilities are also incorporated into spatial post-processing to further mitigate wrapping errors. Simulation, phantom, and in vivo results for three-point PC-MRI acquisitions validate the benefits of reduced estimation error, increased recovered velocity range, optimized acquisition, and fast computation. A phantom study at 1.5T demonstrates 48.5% decrease in root mean squared error using PRoM with post-processing versus a conventional "dual-venc" technique. Simulation and 3T in vivo results likewise demonstrate the proposed benefits.

Ultrasonographic pathological grading of prostate cancer using automatic region-based Gleason grading network

The Gleason scoring system is a reliable method for quantifying the aggressiveness of prostate cancer, which provides an important reference value for clinical assessment on therapeutic strategies. However, to the best of our knowledge, no study has been done on the pathological grading of prostate cancer from single ultrasound images. In this work, a novel Automatic Region-based Gleason Grading (ARGG) network for prostate cancer based on deep learning is proposed. ARGG consists of two stages: (1) a region labeling object detection (RLOD) network is designed to label the prostate cancer lesion region; (2) a Gleason grading network (GNet) is proposed for pathological grading of prostate ultrasound images. In RLOD, a new feature fusion structure Skip-connected Feature Pyramid Network (CFPN) is proposed as an auxiliary branch for extracting features and enhancing the fusion of high-level features and low-level features, which helps to detect the small lesion and extract the image detail information. In GNet, we designed a synchronized pulse enhancement module (SPEM) based on pulse-coupled neural networks for enhancing the results of RLOD detection and used as training samples, and then fed the enhanced results and the original ones into the channel attention classification network (CACN), which introduces an attention mechanism to benefit the prediction of cancer grading. Experimental performance on the dataset of prostate ultrasound images collected from hospitals shows that the proposed Gleason grading model outperforms the manual diagnosis by physicians with a precision of 0.830. In addition, we have evaluated the lesions detection performance of RLOD, which achieves a mean Dice metric of 0.815.

Alias-Free Arrays

Nonuniform array geometries provide freedom for increased aperture and reduced mutual coupling. A necessary and sufficient condition is given for an array of isotropic sensor elements to be unambiguous for any specified set of directions of arrival. The set of unambiguous spatial frequencies is shown to be a parallelepiped, admitting simple geometrical interpretation. Results are used in design of linear, planar, and 3D arrays.

[Predictive models and prophylactic strategies for anastomotic leakage in colorectal surgery]

Anastomotic leakage (AL) has always been a persistent issue for colorectal surgeons. It is still difficult to reduce the incidence of AL despite the advances in technology and equipment. With the development of evidence-based medicine, increasing high-risk factors for AL have been identified. How to efficiently and systematically combine and quantify these isolated risk factors to provide a scientific early warning of AL in clinical practices and help surgeons in choosing the optimal prophylactic strategies, is of great significance for reducing the incidence of AL. There are generally two types of AL prediction models in colorectal surgery, including prognostic models (for preoperative and intraoperative AL prediction) and diagnostic models (for early warning and improving the early diagnosis rate of AL). Prophylactic strategies for AL include stabilizing the underlying diseases, improving anemia and hypoalbuminemia, choosing an appropriate operative time window, and emphasizing and improving anastomotic techniques (including choosing an appropriate size of stapler). However, a prophylactic ostomy is still the most common method for surgeons. However, how to reduce the morbidity of complications following prophylactic ostomy and how to avoid the conversion of the prophylactic stoma to permanent stoma need further study.

Prevalence of USP and hlyA Genes and Association with Drug Resistance in Uropathogenic Escherichia coli Isolated from Patients in a Tertiary Hospital from Southeast China

E. coli was cultured from the urine of patients from the tertiary hospital located in Southeast China from 2017 to 2019. The species were identified, drug sensitivity test was performed, and the presence of the virulence genes USP and hlyA was determined. A total of 483 strains of E. coli were isolated, including 132 from patients with urinary tract infection (UTI). The resistance to ciprofloxacin was more common in non-UTI patients, while resistance to gentamycin was significantly higher in the UTI group. In the UTI group, the proportions of isolated bacteria with the virulence USP (40.15%) and hlyA (8.33%) genes were significantly higher than in the non-UTI group (19.60 and 2.56%, respectively). The rate of resistance of E. coli toward levofloxacin in the USP⁺ group was significantly (p<0.05) higher than in the USP- group. Thus, we revealed the differences in the rate of drug resistance and prevalence of USP and hlyA between the UTI and non-UTI groups. Furthermore, the presence of the USP gene was found to be associated with greater resistance to levofloxacin.

Isolated hand weakness due to brain lesion

When hand weakness is linked to a brain lesion, there is risk of misdiagnosis. A case of hand weakness related to stroke is presented. The electromyography report indicated a segmental lesion of the median nerve at the wrist. Thus, the patient was initially diagnosed with carpal tunnel syndrome, and was referred to the orthopedic department for release surgery. Because the symptom was immediate and did not include hand numbness, the orthopedic surgeon ruled out the previous diagnosis and ordered a head CT scan, which revealed stroke. Aspirin and other medications were given. Percutaneous carotid balloon angioplasty with stent implantation and percutaneous vertebral artery balloon angioplasty were performed. The weakness of the left hand was greatly improved. So far, only a few cases suggest that hand weakness may be linked to stroke. Therefore, physicians should pay attention to physical examination.

Phase 2 randomized controlled trial of intravenous or intraperitoneal paclitaxel plus mFOLFOX6 vs. mFOLFOX6 as first-line treatment of advanced gastric cancer

Objective

We conducted a phase 2 trial to compare the safety and efficacy of intravenous paclitaxel or intraperitoneal paclitaxel plus mFOLFOX6 vs. mFOLFOX6 in untreated advanced gastric cancer.

Methods

Participants with untreated advanced gastric cancer were randomly assigned (1:1:1) to: intravenous paclitaxel 135 mg/m² or intraperitoneal paclitaxel 80 mg/m² plus mFOLFOX6 omitting bolus fluorouracil; or mFOLFOX6 (oxaliplatin 85 mg/m², leucovorin 400 mg/m², fluorouracil 400 mg/m² bolus, fluorouracil 2,400 mg/m² 46-h continuous infusion). Treatment was every 14 days for up to 9 cycles followed by S-1 maintenance. The primary outcome was progression-free survival.

Results

Of 90 enrolled participants, 30 in the intravenous paclitaxel group, 29 in the intraperitoneal paclitaxel group, and 30 in the mFOLFOX6 group were included in the analyses. The median progression-free survival was 6.52, 5.83, and 4.55 months, respectively, for the intravenous paclitaxel group, intraperitoneal paclitaxel group, and mFOLFOX6 group. The hazard ratios were 0.56 (95% CI: 0.33–0.94; p = 0.026) and 0.56 (95% CI: 0.33–0.96; p = 0.037), respectively, for the intravenous paclitaxel group and the intraperitoneal paclitaxel group vs. the mFOLFOX6 group. The most common grade 3/4 adverse events for the intravenous paclitaxel group, intraperitoneal paclitaxel group, and mFOLFOX6 group, respectively, were neutropenia (30.0%, 34.5%, 33.3%), diarrhea (13.3%, 20.7%, 13.3%), and leukopenia (10.0%, 13.8%, 10.0%). No treatment-related death occurred.

Conclusion

The findings of this phase 2 trial suggest that adding intravenous paclitaxel or intraperitoneal paclitaxel to mFOLFOX6 for untreated advanced gastric cancer improved progression-free survival with manageable adverse events.

Intravenous Patient-Controlled Analgesia Versus Oral Opioid to Maintain Analgesia for Severe Cancer Pain: A Randomized Phase II Trial

BACKGROUND

Optimal analgesic maintenance for severe cancer pain is unknown. This study evaluated the efficacy and safety of intravenous patient-controlled analgesia (IPCA) with continuous infusion plus rescue dose or bolus-only dose versus conventional oral extended-release morphine as a background dose with normal-release morphine as a rescue dose to maintain analgesia in patients with severe cancer pain after successful opioid titration.

METHODS

Patients with persistent severe cancer pain (≥7 at rest on the 11-point numeric rating scale [NRS]) were randomly assigned to 1 of 3 treatment arms: (A1) IPCA hydromorphone with bolus-only dose where dosage was 10% to 20% of the total equianalgesic over the previous 24 hours (TEOP24H) administered as needed, (A2) IPCA hydromorphone with continuous infusion where dose per hour was the TEOP24H divided by 24 and bolus dosage for breakthrough pain was 10% to 20% of the TEOP24H, and (B) oral extended-release morphine based on TEOP24H/2 × 75% (because of incomplete cross-tolerance) every 12 hours plus normal-release morphine based on TEOP24H × 10% to 20% for breakthrough pain. After randomization, patients underwent IPCA hydromorphone titration for 24 hours to achieve pain control before beginning their assigned treatment. The primary endpoint was NRS over days 1 to 3.

RESULTS

A total of 95 patients from 9 oncology study sites underwent randomization: 30 into arm A1, 32 into arm A2, and 33 into arm B. Arm B produced a significantly higher NRS over days 1 to 3 compared with arm A1 or A2 (P<.001). Daily NRS from day 1 to day 6 and patient satisfaction scores on day 3 and day 6 were worse in arm B. Median equivalent-morphine consumption increase was significantly lower in A1 (P=.024) among the 3 arms. No severe adverse event occurred in any arm.

CONCLUSIONS

Compared with oral morphine maintenance, IPCA hydromorphone for analgesia maintenance improves control of severe cancer pain after successful titration. Furthermore, IPCA hydromorphone without continuous infusion may consume less opioid.

Histological functions of parathyroid hormone on bone formation and bone blood vessels

BACKGROUND

The intermittent administration of parathyroid hormone (PTH) has been prescribed to osteoporotic patients due to its bone anabolic effects. In addition to its actions on bone cells, PTH appears to affect bone-specific blood vessels. These blood vessels are derived from bone marrow sinusoids, which express EphB4, a hallmark of veinous vascular endothelial cells. Given the presence of osteo-vascular interactions, it is important to elucidate the effects of PTH on bone cells and blood vessels in murine models.

HIGHLIGHTS

PTH stimulates preosteoblastic proliferation and osteoblastic bone formation. The former appears to be directly affected by PTH, whereas the latter requires osteoclast-mediated coupling. The administration of PTH through high-frequency dosage schemes accelerates bone turnover featuring remodeling-based bone formation, whereas low-frequency schemes cause mainly remodeling-based and partly modeling-based bone formation. Normally, many blood vessels lack alpha smooth muscle actin (αSMA)-immunoreactive vascular muscle cells surrounding basement membranes, indicating them being capillaries. However, PTH administration increases the number of blood vessels surrounded by αSMA-positive cells. These αSMA-positive cells spread out of blood vessels and express alkaline phosphatase and c-kit, suggesting their potential to differentiate into osteogenic and vascular endothelial/perivascular cells. Unlike bone cells, αSMA-positive cells did not appear in the periphery of blood vessels in the kidney and liver, and the thickness of the tunica media did not change regardless of PTH administration.

CONCLUSION

Based on the results of the study and presence of osseous-vascular interactions, PTH appears to influence not only osteoblastic cells, but also blood vessels in bone.

POF (paclitaxel/oxaliplatin/5-fluorouracil/leucovorin) vs. SOX/CAPOX/FOLFOX as a postoperative adjuvant chemotherapy for curatively resected stage III gastric cancer: Study protocol for a randomized controlled trial, FNF-014 trial

Background

Postoperative chemotherapy is a standard treatment for stage II and III gastric cancer in Asia. With regard to single-agent or doublet, the need for improvement has consistently been pointed out because of the relatively poor outcome for patients with stage III gastric cancer. Triplet has shown significant survival benefits in the perioperative setting. We conducted a randomized, multicenter, phase III study to compare triplet to doublet regimens for patients with stage III gastric cancer.

Methods

This is currently enrolling patients (n = 230) with pathologic stage III gastric cancer after D2 lymph node dissection and achieved R0 resection. Patients are randomized 1:1 and stratified by tumor stage (IIIA, IIIB, or IIIC, AJCC 8th) into POF or SOX/CAPOX/FOLFOX. S-1 and oxaliplatin (SOX): oxaliplatin 130 mg/m² on day 1, oral S-1 80–120 mg/m² divided by two on days 1–14 every 21 days for 8 cycles. Capecitabine and oxaliplatin (CAPOX): oxaliplatin 130 mg/m² on day 1, oral capecitabine 1000 mg/m² twice daily on days 1–14 every 21 days for 8 cycles. Folinic acid (or leucovorin), 5-fluorouracil and oxaliplatin (FOLFOX): oxaliplatin 85 mg/m², levo-leucovorin 200 mg/m², and 5-fluorouracil (5-FU) 400 mg/m² bolus on day 1, then 5-FU 2400 mg/m² continuous infusion over 46 h, every 14 days for 12 cycles. Three doublets were chosen by the clinicians. Paclitaxel, oxaliplatin, 5-fluorouracil, and leucovorin (POF): paclitaxel 135 mg/m², followed by FOLFOX omitted 5-FU bolus, every 14 days for 12 cycles. The primary end point is 3-year disease-free survival (3-year-DFS). Secondary end points are overall survival (OS) and safety (any adverse event).

Discussion

The results of this study will help establish postoperative clinical evidence for patients with locally advanced gastric adenocarcinoma or gastroesophageal junction adenocarcinoma.

Clinical Trial Registration

[www.ClinicalTrials.gov], identifier [NCT0378826].