Positive legacies of severe droughts in the Inner Mongolia grassland

Global change-induced extreme droughts are increasing in grasslands worldwide, and drought legacies may greatly affect the responses of grassland ecosystems to these changes. However, it remains poorly understood whether and how severe droughts have a positive legacy effect on grassland productivity. By combining a 4-year precipitation manipulation experiment with a 40-year observational study in a semiarid grassland, we showed that extreme droughts could create strong positive legacies on community productivity and that such legacies could last for multiple years. The mechanism behind this was the coupled effect of the drought-induced increase in annuals and the favorable precipitation pattern that facilitated the flourishing of annuals in subsequent years. This study provides experimental and observational evidence for positive drought legacies and reveals their underlying mechanisms. Our findings suggest that positive drought legacies should be incorporated into Earth system models to better predict the impact of extreme droughts on grassland ecosystems.

Association between site of infection and mortality in patients with cancer with sepsis or septic shock: A retrospective cohort study

Infections are associated with increased mortality in patients with sepsis or septic shock. However, to the best of our knowledge, the influence of the site of infection on patients with cancer remains unclear. The present study aimed to evaluate the association between the site of infection and mortality in patients with cancer and sepsis or septic shock. The present study was conducted in a Lebanon tertiary care centre from July 2010 to April 2015. A total of 176 patients with active cancer presenting to the emergency department with sepsis or sepsis shock were included in the present analysis. Cox regression and Kaplan-Meier analysis of the effect of the site of infection on mortality were performed. The most common site of infection was the lung (37.50%), followed by the urinary tract (26.70%), unknown site (13.63%), gastrointestinal (13.07%) and others (9.10%). The overall mortality rate was 47.73%. Gastrointestinal infection (78.26%) was associated with the highest mortality, followed by pneumonia (62.12%). The urinary tract infection with the lowest mortality rate was the reference group. After adjusting for confounding variables, gastrointestinal infection was associated with the highest in-hospital mortality [hazard ratio (HR), 2.64; 95% CI, 1.25-5.55], followed by pneumonia (HR, 1.95; 95% CI, 1.03-3.68). The association between site of infection and 28-day and 60-day mortality was analysed by Cox regression, as well as by stratified analysis to investigate the association between site of infection and mortality from haematological and solid tumors. Gastrointestinal infection had a higher mortality rate. In conclusion, the site of infection had the same association with mortality in patients with solid and haematological tumours.

[Clinical characteristics of digestive system cancers metastatic to the heart]

Objective: To investigate the clinical features of patients with cardiac metastases from digestive system tumors. Methods: This retrospective study collected and analyzed the medical records of patients with cardiac metastases from digestive system tumors who received treatments in the Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and January 2021. Kaplan-Meier method was used for survival analysis. Results: A total of 19 patients were identified. The primary tumors were esophageal squamous cell carcinoma (n=7), gastric or gastroesophageal junction adenocarcinoma (n=6), hepatobiliary cancers (n=3) and colorectal cancers (n=3). 16 patients had pericardial metastases, 2 patients had right atrium metastases, and 1 patient had left ventricle metastasis. The most common symptom was dyspnea, which was present in 8 cases. 7 patients received locoregional treatment, while 11 patients underwent systemic therapies. The median overall survival from diagnosis of primary cancer was 31.4 months, and the median overall survival time from diagnosis of cardiac metastasis was 4.7 months. Conclusion: Cardiac metastasis from digestive system tumors is associated with low incidence and a poor prognosis. Systemic treatment remains the cornerstone of management, while novel anti-tumor drugs may improve therapeutic efficacy.

Effects of 12-Year Nitrogen Addition and Mowing on Plant-Soil Micronutrients in a Typical Steppe

Changes in soil micronutrient availability may have adverse consequences on grassland productivity, yet it’s still largely unclear how concurrent human practices, such as fertilization and mowing, affect micronutrient cycling in the plant-soil systems. Here, we measured six essential micronutrient (Fe, Mn, Cu, Zn, Co and Mo) contents in both plant pool (separated as aboveground plant parts, litter, and belowground roots) at the community level and soil pool (0−10 cm depth) after 12-year consecutive nitrogen (N) addition (0, 2, 10, and 50 g N m−2 year−1) and mowing in a typical steppe of the Mongolian Plateau. The results show that (i) medium-N (10 g m−2 year−1) and high-N (50 g m−2 year−1) addition rates significantly increased contents of soil-available Fe (+310.0%, averaging across the two N addition rates), Mn (+149.2%), Co (+123.6%) and Mo (+73.9%) irrespective of mowing treatment, whereas these addition treatments usually decreased contents of soil total Fe (−8.9%), Mn (−21.6%), Cu (−15.9%), Zn (−19.5%), Co (−16.4%) and Mo (−34.7%). (ii) Contents of Fe in aboveground plant parts, litter, and roots significantly decreased, whereas plant Mn increased with N addition. Contents of above ground plant Cu, Zn, Co, and Mo significantly decreased at high-N addition rate, whereas contents of micronutrients in roots and litters, except for Fe, generally increased with N addition. Moreover, the total amount of micronutrients in the plant pool (contents × biomass) significantly increased at the medium-N addition rate but decreased at the high-N addition rate. All N addition rates significantly enlarged the pool of litter micronutrients, and roots could hold more micronutrients under N addition, especially combined with mowing treatment. Importantly, although mowing could regulate the effects of N addition on variables (i) and (ii), the effects were weaker overall than those of N addition. (iii) Changes in root micronutrients, except for Mn, could explain corresponding changes in plant micronutrients (R2: 0.19−0.56, all p < 0.01), and significant linear correlations were also observed between soil-available Fe and Fe in plant and roots. Aboveground plant Mn was significantly correlated with soil-available Mn, while Co and Mo in roots were also significantly correlated with soil-available Co and Mo. These results indicate that soil micronutrient supply capacity may decrease due to a decrease in total micronutrient contents after long-term N addition and mowing. They also suggest that different magnitude responses of soil micronutrients in plants (i.e., litters, roots) and soil should be considered when comprehensively examining nutrient cycling in grassland ecosystems.

Quality Improvement at the Laboratory’s Specimen Reception Station

Introduction/Objective

In our 1000-bed acute care tertiary hospital, physicians order laboratory tests via the computerized-provider-order-entry (CPOE) system and print barcode labels (patient demographics/tests ordered) at the computer-on-wheel printer. When tubes with unsuitable barcodes (misaligned, poor quality) are received at the laboratory specimen reception area a fresh barcode is re-printed by our laboratory staff. An incident involving a re- printed barcode label pasted on the wrong blood tube prompted an investigation into the quality of barcodes.

Methods/Case Report

We initiated ‘an opportunity for improvement (OFI) project’ at the laboratory specimen reception station. The OFI team involved Nursing, Information Technology (IT) and Pathology departments aimed to eliminate re-printing of barcode labels by 75% within 6 months. We collated and analyzed reasons for re-printing of barcodes on 3 separate 48-hour periods (27-28 April 2020, 24-25 June 2020, and 13-14 June 2022). A series of interventions and initiatives were implemented.

Results (if a Case Study enter NA)

Re-printed barcodes were from the Emergency Department (56%), Out-patient clinics (7%) and Wards (57%). Root cause analysis(RCA) using the “5 whys” technique categorized re-print causes into staff-related (misaligned barcodes) and printer-related (faint barcodes lines/truncated un-verifiable patient demographics). The team mass-emailed clinicians an educational “Do-You-Know” guide on proper pasting of barcodes on blood tubes and instructions on how to obtain help for printer rectification. These guide documents were placed in the hospital-wide document-sharing portal - Docupedia. Immediate close follow-up with sites that had poor barcodes was done in real-time. Barcode reprints decreased 83% within 2 months - from 174 (27-28 Apr 2020) to 30 (24-25 Jun 2020). A recent audit showed sustained elimination of barcode re-printing: 25 cases (13-14 Jun 2022).

Conclusion

The OFI project has successfully raised the quality of CPOE labels on specimen tubes contributing to process efficiency and safer patient care. Close communication with all care sites and their representatives on the OFI team are critical success factors.

Expert consensus on the diagnosis and treatment of NTRK gene fusion solid tumors in China

Gene fusions can drive tumor development for multiple types of cancer. Currently, many drugs targeting gene fusions are being approved for clinical application. At present, tyrosine receptor kinase (TRK) inhibitors targeting neurotrophic tyrosine receptor kinase (NTRK) gene fusions are among the first "tumor agnostic" drugs approved for pan-cancer use. Representative TRK inhibitors, including larotrectinib and entrectinib, have shown high efficacy for many types of cancer. At the same time, several second-generation drugs designed to overcome first-generation drug resistance are undergoing clinical development. Due to the rarity of NTRK gene fusions in common cancer types and technical issues regarding the complexity of fusion patterns, effectively screening patients for TRK inhibitor treatment in routine clinical practice is challenging. Different detection methods including immunohistochemistry, fluorescence in situ hybridization, reverse transcription-polymerase chain reaction, and (DNA and/or RNA-based) next-generation sequencing have pros and cons. As such, recommending suitable tests for individual patients and ensuring the quality of tests is essential. Moreover, at present, there is a lack of systematic review for the clinical efficacy and development status of first- and second-generation TRK inhibitors. To resolve the above issues, our expert group has reached a consensus regarding the diagnosis and treatment of NTRK gene fusion solid tumors, aiming to standardize clinical practice with the goal of benefiting patients with NTRK gene fusions treated with TRK inhibitors.

Evaluation of 2 Novel Ratio-Based Metrics for Lumbar Spinal Stenosis

BACKGROUND AND PURPOSE

Quantitative metrics of the dural sac such as the cross-sectional area are commonly used to evaluate central canal stenosis. The aim of this study was to analyze 2 new metrics to measure spinal stenosis on the basis of the ratio between the dural sac and disc cross-sectional areas (DDRCA) and the dural sac and disc anterior-posterior diameters (DDRDIA) and compare them with established quantitative metrics of the dural sac.

MATERIALS AND METHODS

T2-weighted axial MR images (n = 260 patients) were retrospectively evaluated, graded for central canal stenosis as normal (no stenosis), mild, moderate, or severe from L1/L2 through L5/S1 with 1 grade per spinal level and annotated to measure the DDRCA and DDRDIA. Thresholds were obtained using a decision tree classifier on a subset of patients (n = 130) and evaluated on the remaining patients (n = 130) for accuracy and consistency across demographics, anatomic variation, and clinical outcomes.

RESULTS

DDRCA and DDRDIA had areas under the receiver operating characteristic curve of 98.6 (97.4-99.3) and 98.0 (96.7-98.9) compared with dural sac cross-sectional area at 96.5 (95.0-97.7) for binary classification. DDRDIA and DDRCA had κ scores of 0.75 (0.71-0.79) and 0.80 (0.75-0.83) compared with dural sac cross-sectional area at 0.62 (0.57-0.66) for multigrade classification. No significant differences (P > .1) in the area under the receiver operating characteristic curve were observed for the DDRDIA across variations in the body mass index. The DDRDIA also had the highest area under the receiver operating characteristic curve among symptomatic patients (visual analog scale ≥ 7) or patients who underwent surgery.

CONCLUSIONS

Ratio-based metrics (DDRDIA and DDRCA) are accurate and robust to anatomic and demographic variability compared with quantitative metrics of the dural sac and better correlated with symptomatology and surgical outcomes.

[Efficacy of in-situ full-left/full-right split liver transplantation for adult recipients using the living donor liver transplantation technique:a single-center report of 25 cases]

Objective: To evaluate the efficacy of in-situ full size split liver transplantation(fSLT) for adult recipients using the living donor liver transplantation(LDLT) technique and to compare the characteristics of the left hemiliver graft (LHG) and the right hemiliver graft(RHG)transplantation. Methods: Deceased donor and recipient data of 25 consecutive cases of fSLT at Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital from March to December 2021 was retrieved and the patients divided into two groups:LHG group and RHG group. Among the 13 donors,11 were male and 2 were female,aged (M(IQR))38(19) years(range: 25 to 56 years),with height of 168(5) cm(range:160 to 175 cm) and weight of 65(9) kg(range: 50 to 75 kg). The median age of the 25 recipients was 52(14) years(range:35 to 71 years),17 were male and 8 were female,15 had primary liver cancer and 10 had benign end-stage liver disease,model for end-stage liver disease score was 10(9) points(range:7 to 23 points). Of the 25 recipients,10 recipients had previously undergone hepatobiliary surgery. The follow-up period was to January 2022. Demographic,clinicopathological,surgical outcomes and postoperative complications were evaluated and compared between the two groups. Continuous quantitative data were compared using Mann-Whitney U test. Classification data were expressed as frequencies,and were compared between groups using χ² test or Fisher exact probability method. Results: Using LDLT technique,in-situ full-left/full-right liver splitting was performed and 13 viable pairs of hemiliver grafts were harvested with acquisition time of 230(53) minutes(range:125 to 352 minutes) and blood loss of 250(100) ml(range:150 to 1 000 ml). A total of 25 hemiliver grafts(13 LHG and 12 RHG) were allocated to patients listed for liver transplantation in our center by China Organ Transplant Response System. In the LHG group(13 cases),there were more females and more patients with benign end-stage liver disease than in the RHG group(12 cases)(P<0.05). The body weight and graft weight of recipients in the LHG group were lower than that in RHG group(both P<0.05). There were no significant differences in other baseline data between the two groups(all P>0.05). The graft to recipient weight ratio(GRWR) was 1.2(0.4)%(range:0.7% to 1.9%) for 25 recipients,1.1(0.5)%(range:0.7% to 1.6%)for the LHG group and 1.3(0.5)%(range:0.9% to 1.9%)for the RHG group. There was no significant difference between the two groups (P>0.05). Sharing patterns of hepatic vessels and the common bile duct are as follows:all the trunk of middle hepatic vein were allocated to the LHG group. The proportion of celiac trunk,main portal vein and common bile duct assigned to LHG and RHG was 10∶3 (P=0.009), 9∶4 (P>0.05) and 4∶9 (P=0.027),respectively. The vena cava of 12 donors in early stage retained in LHG and that of last one was shared between LHG and RHG (P<0.01). The median cold ischemia time of 25 hemiliver grafts was 240(90) minutes(range:138 to 420 minutes). For the total of 25 fSLT,the median anhepatic phase was 50(16) minutes(range:31 to 98 minutes) and the operation time was 474(138)minutes(range:294 to 680 minutes) with blood loss of 800(640) ml(range:200 to 5 000 ml). There were no significant differences in all of operation data between two groups. In the LHG group,3 patients with GRWR≤0.8% had postoperative small-for-size syndrome which improved after treatment. Postoperative Clavien-Dindo grade≥Ⅲ complications were observed in 6 cases(24.0%),4 cases(4/13) in the LHG group and 2 cases(2/12) in the RHG group,respectively. The difference was not statistically significant. Among them,5 cases improved after re-operation and intervention,1 case in LHG group died of secondary infection 2 weeks after operation,and the mortality was 4.0%. Analysis of serious postoperative complications and death has suggested that conventional caval interposition should not be used for LHG transplantation. Conclusion: Relying on accurate donor-recipient evaluation and the apply of LDLT technique,the morbidity and mortality of in-situ fSLT in adults is acceptable.