Enhanced Memristive Performance of Double Perovskite Cs2 AgBiBr6-x Clx Devices by Chloride Doping

Mixed halide perovskites are promising memristive materials because of their excellent electronic-ionic properties. In this work, lead-free Cs₂ AgBiBr_6-x Cl_x (x=0, 0.2, 0.4, 0.6, 0.8, 1.0) double perovskite films were fabricated using a one-step solution spin-coating method in air. Moreover, the ITO/Cs₂ AgBiBr_6-x Cl_x /Al sandwich-like devices are fabricated to investigate the memristive behaviors. The present memristors exhibit nonvolatile and bipolar resistive switching behaviors without electroforming process. Interestingly, as the chloride content increases, the ON/OFF ratio of the device increases from 10³ to 10⁴ , the average SET voltage and the RESET voltage decrease from -0.40 V to -0.21 V and from 1.55 V to 1.34 V, respectively. In addition, resistance states of devices can be maintained after 100 switching cycles and 10⁴  s of reading. This study provides new possibility for the development of low-power and environmentally friendly memristors.

Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial

Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear.

Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance.

Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test.

Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P < 0.05). The between-group comparison showed no significant differences in all outcome measures (P > 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P < 0.05), but significant improvements were found in the control group only with eyes open (P < 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P < 0.05).

Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function.

Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.

Toward Clinically Applicable 3-Dimensional Tooth Segmentation via Deep Learning

Digital dentistry plays a pivotal role in dental health care. A critical step in many digital dental systems is to accurately delineate individual teeth and the gingiva in the 3-dimension intraoral scanned mesh data. However, previous state-of-the-art methods are either time-consuming or error prone, hence hindering their clinical applicability. This article presents an accurate, efficient, and fully automated deep learning model trained on a data set of 4,000 intraoral scanned data annotated by experienced human experts. On a holdout data set of 200 scans, our model achieves a per-face accuracy, average-area accuracy, and area under the receiver operating characteristic curve of 96.94%, 98.26%, and 0.9991, respectively, significantly outperforming the state-of-the-art baselines. In addition, our model takes only about 24 s to generate segmentation outputs, as opposed to >5 min by the baseline and 15 min by human experts. A clinical performance test of 500 patients with malocclusion and/or abnormal teeth shows that 96.9% of the segmentations are satisfactory for clinical applications, 2.9% automatically trigger alarms for human improvement, and only 0.2% of them need rework. Our research demonstrates the potential for deep learning to improve the efficacy and efficiency of dental treatment and digital dentistry.

[Establishment of a fluorescent recombinase-aided isothermal amplification assay for nucleic acid detection of Paraginiumus skrjabini and preliminary evaluation of its detection efficiency]

OBJECTIVE

To establish a nucleic acid assay for detection of Paragonimus skrjabini based on the recombinase-aided isothermal amplification (RAA) technique, and to preliminarily evaluate its detection efficiency.

METHODS

The metacercariae of P. skrjabini, P. westermani and Euparagonimus cenocopiosus were isolated from crabs, and genomic DNA was extracted for molecular characterization. The cytochrome coxidase 1 (cox1) gene sequence of P. skrjabini was selected as the target gene fragment, and the primers and probes were designed, screened and synthesized for RAA assay. The genomic DNA of P. skrjabini metacercariae from Jiyuan City and Yiyang County of Luoyang City, Henan Province were used as templates for verification of the fluorescent RAA assay. The fluorescent RAA assay was performed to detect different concentrations of plasmids containing target gene fragment and P. skrjabini metacercariae genomic DNA to determine the sensitivity. Fluorescent RAA assay was performed with recombinant plasmids containing P. skrjabini cox1 gene sequences at different concentrations and P. skrjabini genomic DNA as templates to evaluate its sensitivity, and the genomic DNA of P. westermani, E. cenocopiosus, Clonorchis sinensis and Schistosoma japonicum was detected with fluorescent RAA assay to evaluate its specificity.

RESULTS

P. skrjabini, P. westermani and E. cenocopiosus metacercariae were isolated from crabs, respectively. Molecular characterization and phylogenetic analysis confirmed their homology with the genes sequences of standard Paragonimus strains in GenBank. A fluorescent RAA assay was successfully established for nucleic acid detection of P. skrjabini, and the genomic DNA of P. skrjabini metacercariae from Jiyuan City and Yiyang County of Luoyang City, Henan Province was amplified using the fluorescent RAA assay within 5 min, while the negative control was not amplified. If the recombinant plasmid containing P. skrjabini cox1 gene sequences was used as templates, the fluorescent RAA assay showed the lowest detection limit of 10 copies/μL, and positive amplification was observed within 5 min. If genomic DNA was used as templates, the fluorescent RAA assay showed the lowest detection limit of 10 pg/μL, and all positive amplifications were found within 5 to 10 min. In addition, the fluorescent RAA assay was tested negative for P. westermani, E. cenocopiosus, C. sinensis and S. japonicum.

CONCLUSIONS

A rapid, sensitive and specific fluorescent RAA assay is successfully established for nucleic acid detection of P. skrjabini, which has potential values in rapid field detection and species identification in freshwater crabs in areas endemic for P. skrjabini.

Bioaugmentation of acetamiprid-contaminated soil with Pigmentiphaga sp. strain D-2 and its effect on the soil microbial community

Bioaugmentation, a strategy based on microbiome engineering, has been proposed for bioremediation of pollutant-contaminated environments. However, the complex microbiome engineering processes for soil bioaugmentation, involving interactions among the exogenous inoculum, soil environment, and indigenous microbial microbiome, remain largely unknown. Acetamiprid is a widely used neonicotinoid insecticide which has caused environmental contaminations. Here, we used an acetamiprid-degrading strain, Pigmentiphaga sp. D-2, as inoculum to investigate the effects of bioaugmentation on the soil microbial community and the process of microbiome reassembly. The bioaugmentation treatment removed 94.8 and 92.5% of acetamiprid within 40 days from soils contaminated with 50 and 200 mg/kg acetamiprid, respectively. A decrease in bacterial richness and diversity was detected in bioaugmentation treatments, which later recovered with the removal of acetamiprid from soil. Moreover, the bioaugmentation treatment significantly influenced the bacterial community structure, whereas application of acetamiprid alone had little influence on the soil microbial community. Furthermore, the bioaugmentation treatment improved the growth of bacteria associated with acetamiprid degradation, and the inoculated and recruited taxa significantly influenced the keystone taxa of the indigenous microbiome, resulting in reassembly of the bacterial community yielding higher acetamiprid-degrading efficiency than that of the indigenous and acetamiprid-treated communities. Our results provide valuable insights into the mechanisms of microbiome engineering for bioaugmentation of acetamiprid-contaminated soils.

Making Digital Innovation Happen: A Chief Information Officer Issue Selling Perspective

We encourage chief information officers (CIOs) to play more active roles in organizational level strategy making in the digital era and examine how CIOs could lead their organizations’ digital innovation initiatives. We propose that it is the CIO’s effectiveness in issue selling (i.e., the acts that are directed toward affecting top management teams’ (TMT) attention to and understanding of strategic issues), rather than his or her structural position, that directly influences the level of organizational digital innovation success. Nevertheless, CIO structural power should not be overlooked because it could amplify (i.e., positively moderate) the impact of CIO issue selling to digital innovation outcomes. In addition, we identify four enabling forces of CIO issue selling effectiveness: (1) CIO strategic decision-making authority, (2) CIO/TMT partnership, (3) CIO information technologies (IT)–related strategic knowledge, and (4) CIO political savvy. Matched-pair survey data collected from senior business and IT executives of 179 organizations largely support the research hypotheses.

[Prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County of Henan Province in 2019]

OBJECTIVE

To investigate the prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County, Henan Province in 2019, so as to provide insights into the management of enterobiasis.

METHODS

Five kindergartens were selected in urban and rural areas of Fanxian County, Henan Province using the stratified sampling method in 2019, and a census of E. vermicularis infections was performed among all children in the kindergartens. E. vermicularis eggs were detected using adhesive and scotch cellophane-tape anal swab methods, and the basic characteristics of children and their families, health habits and the kindergartens' information were investigated with questionnaires. Logistic regression analysis was used to investigate the risk factors and protective factors of pinworm infection in children.

RESULTS

A total of 671 children were tested, and the mean prevalence of E. vermicularis infections was 15.50% (104/671). The prevalence of E. vermicularis infections was higher among children in rural kindergartens (28.13%, 72/256) than in urban kindergartens (7.71%, 32/415) (χ² = 50.380, P < 0.01), and greater in private kindergartens (32.26%, 60/186) than in public kindergartens (9.07%, 44/485) (χ² = 55.183, P < 0.01). There was no gender-specific prevalence of E. vermicularis infections among children (χ² = 1.442, P > 0.05), and the prevalence of E. vermicularis infections presented a tendency towards a rise with age (χ²_trend = 8.373, P < 0.05) and school grade (χ²_trend = 30.274, P < 0.05). Logistic regression analysis identified rural kindergartens and high grades as risk factors, and separate washing of children's and adults' cloths, frequent bathing and frequent dinnerware disinfection in kindergartens as protective factors for E. vermicularis infections among children. In addition, there was no significant difference in the detection of E. vermicularis infections among children by using adhesive (73.08%, 76/104) and scotch cellophane-tape anal swab methods (56.73%, 59/104) (χ² = 3.959, P > 0.05).

CONCLUSIONS

The prevalence of E. vermicularis infection is high among children in Fanxian Country, Henan Province. Health education and surveillance of enterobiasis are required to be intensified among children in rural kindergartens and senior grades and their parents and teachers.

[Analysis of families with fetal congenital abnormalities but negative prenatal diagnosis by whole exome sequencing]

Objective: To evaluate the value of whole exome sequencing (WES) in prenatal clinical application. Methods: A total of 1 152 cases of congenital abnormal [including structural malformation, nuchal translucency (NT) thickening and intrauterine growth restriction] with traditional prenatal diagnosis [including G-band karyotype analysis and chromosome microarray analysis (CMA)] negative were analyzed. The congenital abnormal fetuses were divided into retrospective group and prospective group according to the time of WES detection, that is whether the pregnancy termination or not. According to the specific location of fetal malformation and their family history, the cohort was divided into subgroups. The clinical prognosis of all fetuses were followed up, and the effect of WES test results on pregnancy decision-making and clinical intervention were analyzed. According to the follow-up results, the data of fetuses with new phenotypes in the third trimester or after birth were re-analyzed. Results: Among 1 152 families who received WES, 5 families were excluded because of nonbiological parents. Among the remaining 1 147 families, 152 fetuses obtained positive diagnosis (13.3%,152/1 147), including 74 fetuses in the retrospective group (16.1%,74/460) and 78 fetuses in the prospective group (11.4%,78/687). In fetuses with negative CMA and G-band karyotype analysis results but new phenotypes in the third trimester or after birth, the positive rate by WES data re-analysis was 4.9% (8/163). A total of 34 (21.3%, 34/160) fetuses were directly affected by the corresponding positive molecular diagnosis. Among 68 cases of live births with diagnostic variation grade 4, 29 cases (42.7%, 29/68) received appropriate medical intervention through rapid review of WES results. Conclusions: WES could increase the detection rate of abnormal fetuses with negative G-banding karyotype analysis and CMA by 13.3%. Prenatal WES could guide pregnancy decision-making and early clinical intervention. It might be an effective strategy to pay attention to the special follow-up of the third trimester and postnatal fetus and to re-analyze the WES data.

[Prevalence of intestinal protozoan infections among rural children in Henan Province from 2014 to 2015]

OBJECTIVE

To investigate the prevalence and influencing factors of intestinal protozoan infections among rural children in Henan Province.

METHODS

A total of 104 survey sites were sampled from 35 counties (cities) in Henan Province using the stratified cluster sampling method to investigate the prevalence of intestinal protozoan infections among rural children from 2014 to 2015. The trophozoites and cysts of intestinal protozoa were identified using the iodine staining method and the physiological saline direct smear method (one detection for one stool sample). The prevalence of intestinal protozoan infections was compared among rural children with different characteristics, and the factors affecting intestinal protozoan infections among rural children were identified.

RESULTS

The overall prevalence of intestinal protozoan infections was 0.60% (40/6 771) among rural children in Henan Province from 2014 to 2015. There were 7 species of intestinal protozoa identified, and there was no species-specific prevalence (χ² = 37.732, P = 0.000). No significant differences were found in prevalence of intestinal protozoan infections among rural children in terms of gender (χ² = 1.793, P = 0.181), age (χ² = 1.443, P = 0.486), occupation (χ² = 0.219, P = 0.896) or ecological region (χ² = 1.700, P = 0.637). In addition, terrain (χ² = 2.311, P = 0.510), economic level (χ² = 4.322, P = 0.229), source of drinking water (χ² = 0.731, P = 0.393), eating raw vegetables (χ² = 1.134, P = 0.287) and deworming (χ² = 1.089, P = 0.297) had no remarkable effects on the prevalence of intestinal protozoan infections among rural children in Henan Province; however, the prevalence of intestinal protozoan infections varied significantly among rural children living in regions with different coverage of non-harmless toilets (χ² = 10.050, P = 0.018).

CONCLUSIONS

The prevalence of intestinal protozoan infections is low among rural children in Henan Province.

[Value of ATP synthase C subunit in predicting cardiac function and outcomes of sepsis]

Objective: To investigate the value of serum mitochondrial ATP synthase C subunit level in the evaluation of cardiac functional status and prognosis in patients with sepsis. Methods: A total of 165 sepsis patients admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2017 to December 31, 2018 were included, there were 103 males (62.4%) and 62 females (37.6%) with an age of (63±14) years. Human ATP synthase lipid binding protein (ATP5G1) ELISA kit was used to detect the level of serum ATP synthase C subunit within 24 h after admission to EICU, and compared with that in 45 healthy subjects. Clinical data of patients were collected and divided into groups according to different left ventricular ejection fraction (LVEF) and clinical outcomes. The differences in clinical indicators among each group were compared to evaluate the value of serum ATP synthase C subunit level in the evaluation of cardiac functional state and prognosis of patients with sepsis, and the independent risk factors for cardiac functional state and prognosis of patients with sepsis were analyzed. Results: Compared with the control group, the level of serum ATP synthase C subunit in the sepsis group was higher ((116±62) μg/L vs (77±34) μg/L, P<0.001). Compared with normal cardiac function group, the level of serum ATP synthase C subunit in septic cardiac dysfunction group was higher (P<0.001). Compared with the survival group, the level of serum ATP synthase C subunit in the death group was higher (P<0.05). The receiver operating curve (ROC) was drawn to analyze the value of ATP synthase C subunit, creatine kinase isoenzyme (CK-MB), B-type natriuretic peptide (BNP), troponin I (cTnI), left atrial end diastolic diameter, left ventricular end systolic diameter, left ventricular end diastolic volume, left ventricular end systolic volume in evaluating the cardiac function in patients with sepsis, and the area under the curve (AUC) was 0.928, 0.661, 0.837, 0.814, 0.703, 0.831, 0.794 and 0.765, respectively. The cut-off value, sensitivity and specificity of ATP synthase C subunit in it was 139.44 ng/L, 100% and 75.2%, respectively. ROC was drawn to analyze the prognostic value of age, urea nitrogen (BUN), ATP synthase C subunit, APACHEⅡ score and SAPSⅡ score in patients with sepsis, and the AUC was 0.719, 0.772, 0.656, 0.868 and 0.884, respectively. The cut-off value, sensitivity and specificity of ATP synthase C subunit in it was 131.24 ng/L, 61.9% and 68.7%, respectively. Logistic regression analysis showed that age, BUN, ATP synthase C subunit, cardiac dysfunction, APACHEⅡ score and SAPS Ⅱ score were independent risk factors for the prognosis of patients with sepsis. Conclusion: The level of serum ATP synthase C subunit is closely related to cardiac dysfunction in patients with sepsis, and can effectively predict the prognosis of patients with sepsis.

[Treatment status of tyrosine kinase inhibitors in Chinese patients with chronic myeloid leukemia in 2020]

目的

调查中国慢性髓性白血病（CML）患者的治疗现状。

方法

横断面研究，2020年4月末至5月中旬，以填写调研问卷的形式在全国范围内调研CML患者，分析酪氨酸激酶抑制剂（TKI）一线选择、目前用药、药物转换和获得主要分子学反应（MMR）的比例及其影响因素。

结果

2933份来自全国31个省市自治区CML受访者的问卷可供分析，男性1683例（57.4％），中位年龄38（16～87）岁。一线选择：伊马替尼2481例（84.6％），原创性新药（原研药）1803例（61.5％）。填写问卷时用药：伊马替尼1765例（60.2％），原研药1791例（61.1％）。共1185例（40.4％）受访者曾经历TKI药物转换。1944例初发慢性期受访者TKI中位治疗45（3～227）个月，1417例（72.9％）获得≥MMR的疗效。多因素分析显示，城镇户籍（OR＝0.6，95％CI 0.5～0.8，P<0.001）、≥大学学历（OR＝0.5，95％CI 0.4～0.7，P<0.001）和进展期（OR＝0.5，95％CI 0.3～0.8，P＝0.001）受访者更少首选仿制TKI，而来自中部地区受访者比东部地区更多首选国产仿制TKI（OR＝1.7，95％CI 1.4～2.0，P<0.001）。进展期受访者更多首选二代TKI（OR＝5.4，95％CI 3.6～8.2，P<0.001），≥60岁受访者更少首选二代TKI（OR＝0.4，95％CI 0.2～0.7，P＝0.002）。诊断时处于进展期（OR＝2.2，95％CI 1.6～3.2，P<0.001）、首选伊马替尼（OR＝2.0，95％CI 1.6～2.6，P<0.001）、首选国产仿制药（OR＝1.3，95％CI 1.1～1.6，P＝0.002）、诊断距开始TKI治疗的时间更长（OR＝1.2，95％CI 1.1～1.2，P<0.001）和服用TKI的时间更长（OR＝1.1，95％CI 1.0～1.1，P<0.001）与药物转换比例增高显著相关。城镇户籍（OR＝0.7，95％CI 0.6～0.8，P<0.001）、获≥MMR（OR＝0.6，95％CI 0.5～0.8，P<0.001）和疗效未知（OR＝0.7，95％CI 0.6～0.9，P＝0.003）与药物转换比例低显著相关。女性（OR＝1.4，95％CI 1.1～1.7，P＝0.003）、城镇户籍（OR＝1.6，95％CI 1.3～2.0，P<0.001）、初始服用伊马替尼（OR＝1.4，95％CI 1.1～1.9，P＝0.016）和TKI治疗时间更长（OR＝1.2，95％CI 1.2～1.3，P<0.001）与获得≥MMR显著相关，而年龄≥60岁（OR＝0.7，95％CI 0.4～1.0，P＝0.047）和药物转换（OR＝0.6，95％CI 0.5～0.7，P<0.001）与未获得MMR显著相关。

结论

截至2020年，中国CML患者中大多数首选并持续服用伊马替尼，半数以上服用原研药。社会人口学特征和疾病分期影响了患者的TKI选择、药物转换和治疗反应。

[Translocations of MYC, bcl-2 and bcl-6 genes and Epstein-Barr virus infection in primary cardiac large B-cell lymphoma]

Objective: To investigate the translocations of MYC, bcl-2 and bcl-6 genes, the Epstein-Barr virus (EBV) status and the clinicopathological features of primary cardiac large B cell lymphoma (LBCL). Methods: Seven cases of primary cardiac LBCL were collected at Beijing Friendship Hospital, Capital Medical University, China from February 2013 to May 2019. The clinical feature, pathological morphology and immunophenotype were analyzed. The detections of EBV and gene rearrangements of MYC, bcl-2 and bcl-6 were conducted. The 2017 WHO classification of tumors of haematopoietic and lymphoid tissues was used to classify the tumors. Results: Four patients with right atrial lesions showed diffuse infiltration of medium size lymphoid cells with small vascular hyperplasia, without evidence of EBV infection. Without detectable gene rearrangements of MYC and bcl-2, 2 of the patients showed bcl-6 gene break-apart. The diagnosis was revised from diffuse LBCL to high-grade B-cell lymphoma, not otherwise specified (HGBL-NOS). There was a case of CD5⁺ diffuse LBCL involving the right atrium and ventricle and 2 cases of fibrin-associated diffuse LBCL located at left atrium without gene rearrangements of MYC, bcl-2 and bcl-6. However, EBER and EBNA2 were highly expressed in fibrin-associated diffuse LBCL. The patients were followed up for 10-71 months. Four cases of HGBL-NOS and a case of CD5⁺ diffuse LBCL received R-CHOP with/without autologous stem cell transplantation. All but two patients survived. Two cases of fibrin-associated diffuse LBCL were disease free without adjuvant chemotherapy and radiotherapy. Conclusions: Primary cardiac LBCL is heterogeneous, including at least HGBL-NOS. Primary cardiac HGBL-NOS most frequently occurs in the right atrium. Tumor cells of primary cardiac LBCL have the morphological characteristics similar to Burkitt lymphoma, lacking MYC and bcl-2 gene rearrangements, but usually show bcl-6 gene disruption. Fibrin-associated diffuse LBCL has a good prognosis and postoperative chemotherapy seems unnecessary.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Sorafenib plus partial splenic embolism for treatment of hepatocellular carcinoma Barcelona stage C combined with hypersplenism: a case series

Background

Sorafenib is mainly used to treat patients with hepatocellular carcinoma (HCC) Barcelona Clinic Liver Cancer (BCLC) stage C, many of whom also have severe cirrhosis. However, hypersplenism and digestive tract hemorrhage are common complications of cirrhosis, which increase the risk and difficulty of treatment.

Methods

Nineteen patients with HCC BCLC stage C with hypersplenism were treated with sorafenib plus partial splenic embolism at Chongqing University Cancer Hospital, Chongqing, China, between January 2015 and June 2018. We analyzed the therapeutic effect and clinical safety of this treatment in these patients.

Result

Hypersplenism was rectified in all patients. The incidence rates of hemorrhage and myelosuppression were 0%, and the mean survival time was 11.2 months.

Conclusion

Sorafenib plus partial splenic embolism could relieve hypersplenism and prolong survival in patients with BCLC stage C HCC.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

[Logistic regression analysis of risk factors for subretinal fluid after rhegmatogenous retinal detachment repair]

Objective: To identify factors associated with persistent subretinal fluid (SRF) after scleral buckling and to evaluate surgical outcomes of patients with primary rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study and cohort study. This study included 104 patients (104 eyes) who underwent scleral buckling for repair of RRD between January 2016 and June 2017. Several statistically significant risk factors associated with SRF were screened out with univariate analysis. Then independent risk factors were determined with multivariate stepwise logistic regression analysis. Examinations were taken preoperatively, at 1, 3, 6, and 12 months postoperatively, and thereafter every six months. Patients were divided into two groups depending on the presence or absence of persistent SRF on optical coherence tomography at 1 month. Results: Persistent SRF occurred in 69.2% (72/104) of patients. In multivariate analysis, younger age (OR=32.860, 95%CI=3.636-296.986, P=0.002), high myopia (OR=7.229, 95%CI=1.217-42.94, P=0.03) and macula-involving retinal detachment (OR=357.397, 95%CI=29.761-4292.0, P=0.000) were associated with persistent SRF. Best corrected visual acuity in patients with SRF at 1 month (0.71±0.18 vs. 0.58±0.11; t=4.047, P<0.01) and 3 months (0.55±0.15 vs. 0.43±0.12; t=3.914, P<0.01) was worse than that in patients with absence of SRF. Best corrected visual acuity in patients with SRF was 0.44±0.16 at 6 months, 0.37±0.12 at 12 months and 0.36±0.10 at the last follow-up, with no significant difference from patients without SRF at the three time points (0.39±0.13, 0.38±0.12 and 0.35±0.09; t=1.643, -0.202, 0.464; P>0.05). Conclusions: RRD patients with younger age, high myopia and macular involvement were more likely to develop persistent SRF after scleral buckling. The presence of persistent SRF slowed visual recovery but did not influence the final visual outcomes. (Chin J Ophthalmol, 2021, 57: 426-432).

[Effectiveness of the "14 plus 7 day quarantine" and "nucleic acid plus total antibody testing" strategy for screening imported patients with COVID-19 in Xiamen]

Objective: To analysis effectiveness of the "14 plus 7 day quarantine" and "nucleic acid plus total antibody testing" strategy (combined screening strategy) for screenin the imported patients with COVID-19 in Xiamen. Methods: The study populations were overseas travelers arriving in Xiamen from March 17 to December 31, 2020, and overseas travelers who had quarantine outside Xiamen for less than 21 days from July 18 to December 31, 2020. Data were collected and analyzed on the timing of detection, pathways, and test results of the imported patients with COVID-19 after implementing combined screening strategy. Results: A total of 304 imported patients with COVID-19 were found from 174 628 overseas travelers and 943 overseas travelers from other cities. A total of 163 cases (53.6%) were diagnosed by multitime, multisite intensive nucleic acid testing after positive finding in total antibody testing. Among them, 27 (8.9%) were first positive for nucleic acid in 14 plus 7 day quarantine and 136 were first positive for nucleic acid in 14-day quarantine. Only 8 of these individuals were tested positive for nucleic acid after positive total antibody testing. The other 128 individuals were tested positive for nucleic acid after being negative for average 2.3 times (maximum of 6 times). Aditional 155 cases might be detected by using the combined "14 plus 7 day quarantine" and " nucleic acid plus total antibody testing" strategy compared with "14-day quarantine and nucleic acid testing" strategy, accounting for 51.0% of the total inbound infections. So the combined screening strategy doubled the detection rate for imported patients with COVID-19. No second-generation case caused by overseas travelers had been reported in Xiamen as of February 26, 2021. Conclusions: Xiamen's combined screening strategy can effectively screen the imported patients with COVID-19 who were first positive for nucleic acid after 14 day quarantine. Compared with "14 day quarantine and nucleic acid testing", the combined screening strategy improved detection rate and further reduced the risk of the secondary transmission caused by the imported patients with COVID-19.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

Measurement of the Cosmic Ray Helium Energy Spectrum from 70 GeV to 80 TeV with the DAMPE Space Mission

The measurement of the energy spectrum of cosmic ray helium nuclei from 70 GeV to 80 TeV using 4.5 years of data recorded by the Dark Matter Particle Explorer (DAMPE) is reported in this work. A hardening of the spectrum is observed at an energy of about 1.3 TeV, similar to previous observations. In addition, a spectral softening at about 34 TeV is revealed for the first time with large statistics and well controlled systematic uncertainties, with an overall significance of 4.3σ. The DAMPE spectral measurements of both cosmic protons and helium nuclei suggest a particle charge dependent softening energy, although with current uncertainties a dependence on the number of nucleons cannot be ruled out.

[Genetics Analysis of patients with Dravet syndrome due to mosaicism variation of paternal SCN1A gene]

Genetic analysis was performed on a family of fraternal twins affected with Dravet syndrome by genetic tests whose parents were normal. To further analyze the cause of the disease, the fraternal twins were subjected to whole exome sequencing (WES), and the family was verified by Sanger sequencing, with the father semen and peripheral blood DNA were further analysed by target sequencing. The WES test identified a heterozygous c.5348C>T (p.Ala1783Val) variant of the SCN1A gene in the fraternal twins, which was predicted to be pathogenic and was detected in the father peripheral blood and semen, but not in the mother. So the mosaicism mutation of paternal SCN1A gene might be the genetic cause of Dravet syndrome in offspring.

cGAS-STING cytosolic DNA sensing pathway is suppressed by JAK2-STAT3 in tumor cells

Deficiencies in DNA repair and DNA degrading nucleases lead to accumulation of cytosolic DNA. cGAS is a critical DNA sensor for the detection of cytosolic DNA and subsequent activation of the STING signaling pathway. Here, we show that the cGAS-STING pathway was unresponsive to STING agonists and failed to induce type I interferon (IFN) expression in many tested human tumor cells including DU145 prostate cancer cells. Inhibition of IL-6 or the downstream JAK2/STAT3 signaling restored responsiveness to STING agonists in DU145 cells. STING activity in murine TRAMP-C2 prostate cancer cells was critical for tumor rejection and immune cell infiltration. Endogenous STING agonists including double-stranded DNA and RNA:DNA hybrids present in TRAMP-C2 cells contribute to tumor rejection, but tumor growth was further suppressed by administration of cGAMP. Intratumoral co-injections of IL-6 significantly reduced the anti-tumor effects of cGAMP. In summary, STING in tumor cells contributes to tumor rejection in prostate cancer cells, but its functions are frequently suppressed in tumor cells in part via JAK2 and STAT3 pathways.

[Analysis of the level of T lymphocyte subsets and the relationship with the prognosis of pulmonary fibrosis in patients with paraquat poisoning]

Objective: To analyze the levels of T lymphocyte subsets (CD3, CD4, CD8 and CD4/CD8) in patients with paraquat poisoning, and to explore the relationship between the changes of T lymphocyte subsets and the prognosis of pulmonary fibrosis. Methods: In October 2019, a total of 47 patients with oral 20% paraquat low water solvent poisoning in Guangzhou 12th people's Hospital from June 2018 to June 2019 were selected as the research objects. Patients were divided into early death group (16 cases died within 2 weeks) and non early death group (31 cases survived more than 2 weeks) . The non early death group was divided into pulmonary fibrosis group (23 cases) and normal lung group (8 cases) . 20 healthy people in the same period were randomly selected as the control group. The neutrophils (N) , C reaction protein (CRP) , alanine aminotransferase (ALT) , creatinine (Cr) , amylase (aAMY) , creatine kinase isoenzyme (CKMB) , pH, HCO(3)(-), blood oxygen saturation (SO(2)) and lactic acid (Lac) of patients poisoned within 3 d were examined every day. Independent sample t-test was used for inter group comparison, and paired sample t-test was used for intra group comparison. Results: Compared with non early death group, the levels of N, CRP, ALT, Cr, aAMY, CKMB and Lac in early death group increased (P<0.05) , while pH and HCO(3)(-) decreased (P<0.05) . Compared with the control group, the levels of CD3, CD4 and CD4/CD8 were decreased on the first day in the early death group and non early death group (P<0.05) , and the levels of CD3, CD4 and CD4/CD8 were decreased on the 15th day in the pulmonary fibrosis group (P<0.05) . Compared with the normal lung group, the levels of CD3, CD4 and CD4/CD8 in the pulmonary fibrosis group decreased on the 15th day (P<0.05) . Conclusion: The persistent low cellular immune function in patients with paraquat poisoning is related to the progress of pulmonary fibrosis, which is an important factor affecting the prognosis of patients with pulmonary fibrosis.

[Expression of iron-regulating erythroid factors in different types of erythropoiesis disorders]

目的

研究Erythroferrone（ERFE）等铁代谢红系调节因子（iron-regulatory erythroid factor）在不同类型红系造血异常疾病中的表达情况。

方法

采用ELISA方法检测2016年1月至2019年11月共47例真性红细胞增多症（PV）、纯红细胞再生障碍（PRCA）、自身免疫性溶血性贫血（AIHA）和骨髓增生异常综合征（MDS）患者血浆ERFE、生长分化因子15（GDF15）、生长分化因子11（GDF11）和扭转原肠胚形成同系物（TWSG1）的表达，分析铁代谢调节因子与红系造血异常类型及旺盛程度（以骨髓有核红细胞比例反映）的适配性。

结果

血浆GDF15表达水平在PV、PRCA、AIHA、MDS各组依次为266.01（112.40,452.37）、110.63（81.41,220.42）、52.11（32.61,171.66）、276.53（132.16,525.70）ng/L，均显著高于正常对照组的37.45（19.65,57.72）ng/L（P值均<0.01）。不同类型红系造血异常患者血浆TWSG1表达水平与正常对照组比较差异均无统计学意义（P值均>0.05）。血浆GDF11表达水平仅在PV组患者中明显高于正常对照组[74.75（10.95,121.32）ng/L对36.90（3.38,98.34）ng/L，P<0.01]，而PRCA、AIHA、MDS 3组患者与正常对照组比较差异无统计学意义（P>0.05）。PV组血浆ERFE水平为129.63（47.02, 170.03）ng/L，AIHA组血浆ERFE水平最高为121.76（68.12,343.11）ng/L，二者均明显高于正常对照组的43.23（35.18,65.41）ng/L（P值均<0.01）；PRCA组、MDS组血浆ERFE水平分别为48.92（44.59，84.83）、40.47（26.97,72.87）ng/L，与正常对照组比较差异无统计学意义（P值均>0.05）。骨髓有核红细胞比例与ERFE（r＝0.458，P＝0.001）呈正相关，而与GDF15（r＝−0.163，P＝0.274）、GDF11（r＝0.120，P＝0.421）、TWSG1（r＝−0.166，P＝0.269）无明显相关性。

结论

铁代谢红系调节因子在不同红系造血异常疾病的表达谱不尽一致，ERFE与红系造血旺盛程度相关度最高。

Solar photocatalytic abatement of tetracycline over phosphate oxoanion decorated Bi2WO6/polyimide composites

Environmental-friendly solar photocatalytic technology is attracting great attention in the field of pollution control. In this work, novel PO₄^3--Bi₂WO₆/PI photocatalyst achieved high degradation efficiency for tetracycline degradation in simulated solar light (1.6 times kinetic constants of Bi₂WO₆). The photocatalyst could produce more oxygen vacancies as well as more active species O₂^- and OH, and exhibited high mineralization ability, good stability and recyclability simultaneously. After 4 cycles of degradation experiments, its degradation efficiency was only reduced by 8.6 %. Tetracycline molecules gradually became small molecules under the attack of active species. The tetracycline degradation was highly pH-dependent and enhanced with the increase of solution pH. The water quality parameters humic acid and Cl^- presented the inhibitory effect, while HCO₃^- can accelerate the tetracycline degradation. The degradation of tetracycline by PO₄^3--Bi₂WO₆/PI conformed to the Z-scheme photocatalysis mechanism, which could effectively broaden the absorption of solar light, improve the separation and transfer of photogenerated electron-hole pairs and extend the lifespan of the photocatalyst.