In vitro long-term antibacterial performance and mechanism of Zn-doped micro-arc oxidation coatings

Micro-arc oxidation (MAO) coatings containing 2.86 wt%, 5.83 wt% and 8.81 wt% Zn (Zn-2.86 wt%, Zn-5.83 wt% and Zn-8.81 wt%) were separately fabricated on Ti6Al4V alloys using EDTA-ZnNa2 electrolytes. In vitro antibacterial examination exhibits that the antibacterial rates of Zn-2.86 wt%, Zn-5.83 wt% and Zn-8.81 wt% against Staphylococcus aureus (S. aureus) are 76.0 %, 100.0 % and 99.2 %, respectively. Reactive oxygen species (ROS) level of MAO samples is significantly higher than that of the untreated Ti6Al4V. Zn-containing coatings especially Zn-5.83 wt% induces the strongest oxidative stress on S. aureus due to relatively high released Zn2+ concentration. Moreover, qPCR analysis shows that MAO samples inhibit the icaADBC transcription and result in the down-regulation of PIA production, thereby mitigating biofilm formation. After immersion in simulated body fluid (SBF) for 3, 8 and 14 d, the antibacterial rate of Zn-5.83 wt% is 84.7 %, 63.2 % and 12.5 % respectively, and ROS level of MAO samples is also significantly higher than that of the untreated Ti6Al4V even after 14 d of immersion, suggesting that the antibacterial performance of MAO samples can last a relatively long immersion period and exhibit large application potential in orthopedic clinic.

[Clinical analysis of 10 cases of multi-center tumor necrosis factor receptor-associated periodic syndrome]

Objective: To summarize the clinical characteristics of tumour necrosis factor receptor-associated periodic syndrome (TRAPS) in children. Methods: The clinical manifestations, laboratory tests, genetic testing and follow-up of 10 children with TRAPS from May 2011 to May 2021 in 6 hospitals in China were retrospectively analyzed. Results: Among the 10 patients with TRAPS, including 8 boys and 2 girls. The age of onset was 2 (1, 5) years, the age of diagnosis was (8±4) years, and the time from onset to diagnosis was 3 (1, 7) years. A total of 7 types of TNFRSF1A gene variants were detected, including 5 paternal variations, 1 maternal variation and 4 de novo variations. Six children had a family history of related diseases. Clinical manifestations included recurrent fever in 10 cases, rash in 4 cases, abdominal pain in 6 cases, joint involvement in 6 cases, periorbital edema in 1 case, and myalgia in 4 cases. Two patients had hematological system involvement. The erythrocyte sedimentation rate and C-reactive protein were significantly increased in 10 cases. All patients were negative for autoantibodies. In the course of treatment, 5 cases were treated with glucocorticoids, 7 cases with immunosuppressants, and 7 cases with biological agents. Conclusions: TRAPS is clinically characterized by recurrent fever accompanied by joint, gastrointestinal, skin, and muscle involvement. Inflammatory markers are elevated, and autoantibodies are mostly negative. Treatment mainly involves glucocorticoids, immunosuppressants, and biological agents.

Penpulimab combined with anlotinib in patients with R/M HNSCC after failure of platinum-based chemotherapy: a single-arm, multicenter, phase Ⅱ study

BACKGROUND

Treatment regimens for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) after failure of platinum-based chemotherapy have been illustrated with limited efficacy.

PATIENTS AND METHODS

Here, we report a single-arm, multicenter, phase Ⅱ study of R/M HNSCC patients treated with a programmed cell death-1 antibody penpulimab (200 mg) and anlotinib (12 mg) after failing at least one line of platinum-based chemotherapy.

RESULTS

Of 38 patients in total, 13 (34.21%) patients achieved partial response and 16 (42.11%) patients achieved stable disease. After a median follow-up of 7.06 months (range: 4.14-15.70 months), the independent review committee-assessed objective response rate was 34.21%, the disease control rate was 76.32%. The median progression-free survival was 8.35 months (95% confidence interval 5.95-13.11 months). Twelve patients died and the median overall survival (OS) was not reached. The 12-month OS rate was 59.76%. Grade 3/4 treatment-related adverse events occurred in 47.37% of the patients.

CONCLUSION

Penpulimab combined with anlotinib demonstrated promising efficacy and manageable safety in R/M HNSCC patients after failure of platinum-based chemotherapy.

[A case of left pulmonary artery sling combined with congenital tracheal stenosis in an adult]

Pulmonary artery sling in adults is a rare congenital vascular malformation usually accompanied by tracheal and bronchial stenosis. Due to its high mortality risk and relatively poor prognosis, it has rarely been reported in adults. We reported a middle-aged patient who presented with shortness of breath, predominantly after activity, since childhood. He was diagnosed with "tracheal stenosis" in another hospital and received symptomatic treatment. The diagnosis of left pulmonary artery sling with congenital tracheal stenosis was confirmed by multi-slice spiral CT (MSCT), airway examination with flexible bronchoscope and 3D image post-processing system. Data from this case and the related literatures have been summarized and analyzed. This will help clinicians to improve their level of diagnosis and treatment.

Predictive value of DEEPVESSEL-fractional flow reserve and quantitative plaque analysis based on coronary CT angiography for major adverse cardiac events

AIM

To investigate the predictive value of the combination of DEEPVESSEL-fractional flow reserve (DVFFR) and quantitative plaque analysis using coronary computed tomographic angiography (CCTA) for major adverse cardiac events (MACE).

METHOD

In this retrospective study, data from 69 vessels from 58 consecutive patients were collected. These patients who underwent coronary angiography (CAG) with DVFFR were divided into MACE-positive and MACE-negative groups. DVFFR measurements were obtained from CCTA images acquired before CAG, and an FFR or DVFFR value ≤ 0.80 was considered haemodynamically significant. CCTA images were analysed quantitatively using automated software to obtain the following indices: total plaque volume (TPV) and burden (TPB), calcified plaque volume (CPV) and burden (CPB), non-calcified plaque volume (NCPV) and burden (NCPB), low-attenuation plaque (LAP), minimum lumen area (MLA), stenosis grade (SG) and lesion length (LL). Univariate and multivariate logistic regression, correlation, and receiver operating characteristic (ROC) analyses were used for statistical analysis.

RESULTS

DVFFR was highly correlated with invasive FFR (R=0.728), and the Bland-Altman plot showed good agreement between DVFFR and FFR (95% CI: -0.109-0.087) on a per-vessel level. DVFFR showed a high diagnostic performance in identifying abnormal haemodynamic vessels, with an area under the ROC curve (AUC) of 0.984. In multivariate analysis, the following biomarkers were predictors of MACE: DVFFR ≤ 0.8, SG, TPB, NCPB, and LL values. The combination of the above independent risk factors yielded the most valuable prediction for MACE (AUC:0.888).

CONCLUSIONS

DVFFR was highly correlated with FFR with satisfactory diagnostic accuracy. DVFFR, together with plaque analysis indices, yielded valuable predictions for MACE.

The contingency effects of dependence relationship on supply chain information sharing and agility

Purpose

Supply chain agility (SCA) is the primary strategy for reducing impacts and quick recovery when supply chains experience a disruption risk, such as the COVID-19 pandemic. This study will investigate how SCA can be achieved through supply chain information sharing (SCIS) under the different dependence relationships (DR) with suppliers or customers. The purpose of this paper is to investigate this issue.

Design/methodology/approach

Based on information process and resource dependency theories, this study constructs and empirically tests a proposed model of the relationships amongst the three dimensions of SCIS and the two areas of SCA and the contingency effects of two types of DR on those relationships. Using a dataset collected from 400 manufacturers in China, the authors tested this theoretical model using multi-group and structural path analysis.

Findings

The results of the structural path and multi-group analyses show that (1) all dimensions of SCIS are positively correlated with both areas of SCA and (2) dependence on the supplier and dependence on the customer have completely different impacts on the relationship between SCIS and SCA.

Originality/value

This study can improve the understanding of the multidimensional concepts of SCIS and SCA and relationships between them under two different DR conditions in the Chinese manufacturing setting. It contributes to IS and the SCA literature and provides theoretically driven and empirical explanations for the diverse dynamics between the dependence on the supplier and customer.

[Efficacy of selective bronchial occlusion in the treatment of biliary bronchial fistula]

Objective: To analyze the effect of selective bronchial occlusion (SBO) in the treatment of biliary bronchial fistula (BBF). Methods: Eight patients with BBF that without biliary obstruction admitted to the Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Naval Medical University from January 1, 2015 to December 31, 2021 were included in this study. Bronchial silicone plug (6 cases) and autologous blood+thrombin (2 cases) were used as sealing materials for SBO treatment for the first time. Among the 7 patients who underwent subsequent closure treatment, 5 cases were blocked by bronchial silicone plug, 1 case was blocked by "bronchial silicone plug+bullet-covered stent" and 1 case was blocked by "bronchial silicone plug+bronchial one-way valve". The clinical data related to SBO treatment were collected and patients were followed up, and the therapeutic effect of SBO on BBF was analyzed. Results: The age of BBF onset was (58±9) years old, including 6 males. Among the 6 patients who used bronchial silicone plug as plugging material in the first SBO treatment, 1 case was successfully plugged, 2 cases did not achieve symptoms relief after plugging, 2 cases coughed up the plugging device immediately after surgery, and 1 case developed a new fistula. Autologous blood and thrombin were used as sealing materials in 2 patients, and both failed. Among the 7 patients who received subsequent closure treatment, bronchial silicone plug+bullet-covered stent (1 case) and bronchial silicone plug+bronchial unidirectional valve (1 case) were successful. After 2-6 times of bronchial silicone plug (5 cases), fistula were successfully blocked in 3 cases, and the frequency and volume of bile-like sputum decreased by 50% or more in 2 cases. The main postoperative complications were fever and cough (expectoration) in 7 and 6 cases, respectively. During the follow-up period, 2 patients were lost to follow-up, and the remaining 6 patients were followed up for 2-31 months. During the follow-up period, the effect of closure treatment was basically stable, and there was no death case. Conclusion: SBO therapy provides a safe and feasible palliative treatment for BBF.

Ethical, legal and social issues raised by human brain banks

Based on the research methods of literature review and philosophical reflection, this article points out the deficiencies and problems in the current research of brain banks: lack of nature analysis of brain banks and human brains; insufficient discussion of ethical, legal and social issues (ELSI) in the process of brain bank implementation - which has become the main research goal of this article. The article firstly clarifies the formation process of modern brain banks and briefly introduces the current development status of brain banks in the UK, the US and China, as well as the different types of modern brain banks. Next, the nature of brain banks and human brain samples are analyzed through an analogical model. Then, the ELSI issues at different stages are analyzed according to three stages: recruitment of donors, acquisition and storage of human brain tissue samples, and release and use of human brain tissue samples. Last, in the conclusion section, the main ideas of this paper are reiterated and questions for further reflection are presented.

[Technology update and field expansion of bronchoscopy interventional diagnosis in 2021]

In recent years, with the rapid development of interventional pulmonary diseases, new instruments and new concepts are constantly updated. The increased detection rate of pulmonary nodules increases the demand of patients. These factors jointly promote the continuous progress of bronchoscopy diagnosis and treatment technology. The following techniques including thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (R-EBUS), and navigation bronchoscopy including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB), robotic-assisted bronchoscopy (RAB), frozen biopsy for the diagnosis of diffuse lung diseases are particularly prominent and important in clinical practice. This paper reviews the progress and application of bronchoscopy in interventional diagnosis through the review of literature published in 2021.

[A randomized controlled trial of indobufen versus aspirin in the prevention of bridging restenosis after coronary artery bypass grafting]

Objective: To compare the efficacy and safety between indobufen and aspirin in the prevention of restenosis of bridge vessels at 1 year after off-pump coronary artery bypass grafting. Methods: This study was a prospective cohort study. We selected 152 patients who received coronary artery bypass grafting in Beijing Anzhen Hospital from December 2016 to December 2018. Patients were divided into the indobufen group and the aspirin group. Patients in the aspirin group were treated with aspirin and clopidogrel, and patients in the indobufen group were treated with indobufen and clopidogrel. During the 1-year follow-up, the rate of restenosis of saphenous vein bridge and internal mammary artery bridge, the rate of adverse cardiac events and adverse reactions were compared between the two groups. The levels of fibrinogen (FIB), D-dimer (D-D), thrombomodulin (TM) and thrombin-activatable fibrinolysis inhibitor (TAFI) were compared before and after antiplatelet therapy. Results: There were 76 cases in the indobufen group, including 57 males (75.0%), aged (60.3±6.6) years. There were 76 cases in the aspirin group, including 62 males (81.6%), aged (59.7±7.2) years. Baseline data were comparable between the two groups (P>0.05). During the follow-up, 3 cases were lost to follow up. Follow-up was completed in 74 patients in the indobufen group and 75 in the aspirin group. A total of 268 bridging vessels were grafted in the indobufen group and 272 in the aspirin group. One year after surgery, the patency rates of great saphenous vein bridge and internal mammary artery bridge were 94.5% (189/200) and 97.1% (66/68) in the indobuphen group, and 91.3% (189/207) and 96.9% (63/65) in the aspirin group, respectively. There was no significant difference in patency rate of great saphenous vein bridge and internal mammary artery bridge between the two groups (χ²=0.282, 0.345, P>0.05). The total incidence of adverse cardiac events was 5.4% (4/74) in the indobufen group and 6.7% (5/75) in the aspirin group (χ²=0.126, P>0.05). The overall incidence of gastrointestinal adverse reactions was significantly lower in the indobufen group than in the aspirin group (4.1% (3/74) vs. 13.3% (10/75), χ²=4.547, P<0.05). The levels of FIB, D-D, TM and TAFI in the two groups were lower than those before surgery (P<0.05), and there was no statistical significance between the two groups at baseline and post-operation (P>0.05). Conclusion: The efficacy of indobufen combined with clopidogrel in the prevention of 1-year restenosis after coronary artery bypass graft is similar to that of aspirin combined with clopidogrel, but the incidence of adverse reactions is lower, and the safety is higher in patients treated with indobufen combined with clopidogrel compared to aspirin combined with clopidogrel strategy.

Microstructure Evolution and Deformation Mechanisms of As-Cast Antibacterial Ti6Al4V-5Cu Alloy for Isothermal Forging Process

The hot workability behavior of antibacterial Ti6Al4V-5Cu alloy was investigated using a hot compression experiment in the temperature range of 790-1040 °C and strain rate of 10^-3-10 s^-1 with a strain of 0.4. The deformation behavior of the alloy was characterized by Gleeble 3800 compression experiment, and the relationship among deformed microstructures and deformation parameters was established. The deformations of Ti6Al4V-5Cu alloy were temperature and strain rate-dependent. Higher temperature and lower strain rate made power dissipation efficiency (η) increase and reach 89%. The activation energies (Q) in the dual-phase (α + β) and single β phase regions were calculated as 175.43 and 159.03 kJ mol^-1, respectively. In the dual (α + β) phase region, with an increase in strain rate, flow-softening behavior was dominated, however in the single β phase region such as processing at 940 °C. Flow stress increased slightly in which work-hardening behavior was dominated (especially between strain rates of 10^-3-1 s^-1). The deformation at various conditions exhibited different stress-strain profiles, providing an insight that work hardening and flow softening coexisted in Ti6Al4V-5Cu alloy. The relative intensity of oscillatory change in flow stress profile decreased as the strain rate decreased. The hot workability of Ti6Al4V-5Cu alloy was also accessed from the viewpoint of the sub-grain structure.

Treatment-related adverse events as predictive biomarkers of efficacy in patients with advanced neuroendocrine tumors treated with surufatinib: results from two phase III studies

Background

No validated biomarkers currently exist for predicting the efficacy outcomes in patients with neuroendocrine tumors (NETs) treated with antiangiogenic therapy. We aimed to evaluate the association between treatment-related adverse events (TRAEs) and efficacy outcomes of surufatinib in patients with advanced NET.

Patients and methods

We included patients with NET treated with surufatinib in two multicenter, randomized, double-blind, placebo-controlled, phase III trials (SANET-p and SANET-ep) in this study. The main exposure was the presence of any of the TRAEs including hypertension, proteinuria, and hemorrhage in the first 4 weeks of surufatinib treatment. The primary outcome of the study was investigator-assessed progression-free survival (PFS). PFS outcomes were estimated using the Kaplan–Meier method with the log-rank test. Hazard ratios (HRs) were calculated by using univariable and multivariable Cox proportional hazard regression models. Blinded independent image review committee (BIIRC) assessments and 4-week landmark analysis were also performed as supportive evaluations.

Results

During the study period, a total of 242 patients treated with surufatinib were included in the analysis, and 164 (68%) patients had at least one of hypertension, proteinuria, and hemorrhage in the first 4 weeks of treatment. The presence of TRAEs in the first 4 weeks was associated with prolonged median PFS [11.1 versus 9.2 months; HR 0.67, 95% confidence interval (CI) 0.47-0.97; P = 0.036]. In multivariable Cox regression analysis, the presence of TRAEs was also significantly associated with longer PFS (HR 0.65, 95% CI 0.44-0.97; P = 0.035). Similar results were obtained in the BIIRC assessments and 4-week landmark analysis.

Conclusions

Treatment-related hypertension, proteinuria, and hemorrhage could be potential biomarkers to predict antitumor efficacy of surufatinib in patients with advanced NET. Future prospective studies are needed to validate the findings.

Trial registration

ClinicalTrials.govNCT02589821; https://clinicaltrials.gov/ct2/show/NCT02589821 and ClinicalTrials.gov NCT02588170; https://clinicaltrials.gov/ct2/show/NCT02588170

•

Treatment-related hypertension, proteinuria, or hemorrhage is associated with longer survival in NETs.

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The association is confirmed by the BIIRC assessments and 4-week landmark analysis.

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TRAEs can be biomarkers to predict antitumor efficacy in patients with NET.

Pembrolizumab versus chemotherapy for patients with esophageal squamous cell carcinoma enrolled in the randomized KEYNOTE-181 trial in Asia

BACKGROUND

In the randomized phase III KEYNOTE-181 study, pembrolizumab prolonged overall survival (OS) compared with chemotherapy as second-line therapy in patients with advanced esophageal cancer and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥10. We report a post hoc subgroup analysis of patients with esophageal squamous cell carcinoma (ESCC) enrolled in KEYNOTE-181 in Asia, including patients from the KEYNOTE-181 China extension study.

PATIENTS AND METHODS

Three hundred and forty Asian patients with advanced/metastatic ESCC were enrolled in KEYNOTE-181, including the China cohort. Patients were randomly assigned 1 : 1 to receive pembrolizumab 200 mg every 3 weeks for ≤2 years or investigator's choice of paclitaxel, docetaxel, or irinotecan. OS, progression-free survival, response, and safety were analyzed without formal comparisons. OS was evaluated based on PD-L1 CPS expression level.

RESULTS

In Asian patients with ESCC, median OS was 10.0 months with pembrolizumab and 6.5 months with chemotherapy [hazard ratio (HR), 0.63; 95% CI 0.50-0.80; nominal P < 0.0001]. Median progression-free survival was 2.3 months with pembrolizumab and 3.1 months with chemotherapy (HR, 0.79; 95% CI 0.63-0.99; nominal P = 0.020). Objective response rate was 17.1% with pembrolizumab and 7.1% with chemotherapy; median duration of response was 10.5 months and 7.7 months, respectively. In patients with PD-L1 CPS <1 tumors (pembrolizumab versus chemotherapy), the HR was 0.99 (95% CI 0.56-1.72); the HR (95% CI) for death was better for patients with PD-L1 CPS cut-offs >1 [CPS ≥1, 0.57 (0.44-0.75); CPS ≥5, 0.56 (0.41-0.76); CPS ≥10, 0.53 (0.37-0.75)]. Treatment-related adverse events were reported in 71.8% of patients in the pembrolizumab group and 89.8% in the chemotherapy group; grade 3-5 events were reported in 20.0% and 44.6%, respectively.

CONCLUSIONS

Pembrolizumab monotherapy demonstrated promising efficacy in Asian patients with ESCC, with fewer treatment-related adverse events than chemotherapy. PD-L1 CPS ≥1 is an appropriate cut-off and a predictive marker of pembrolizumab efficacy in Asian patients with ESCC.

Genome-wide re-sequencing reveals population structure and genetic diversity of Bohai Black cattle

Bohai Black (BHB) cattle, one of eight representative indigenous breeds in China, is well known for its high resistance to disease, endurance under unfavorable feeding conditions and excellent meat quality. Over recent, the number of BHB cattle has decreased sharply. To investigate the population structure and genetic diversity of this breed, the whole-genome data of 35 individuals from a conservation farm were obtained using the Illumina 150 bp paired-end platform. The results of the genetic structure and diversity analyses showed that BHB cattle had mixed Bos taurus and Bos indicus ancestry, close phylogenic relationships with Jiaxian Red and Luxi cattle and abundant genetic diversity. The bulls tested here could be divided into six families. This study presents a comprehensive evaluation of the genetic structure and diversity of the BHB cattle, and lays the theoretical basis for conservation and utilization of the valuable germplasm resource.

Assessing emission reduction effects from shifts of urban passenger transport modes by implementing targeted emission tax considering the whole fuel cycle

Controlling the emission of urban passenger transport modes has become one of the most important tasks of governing urban air pollution. Most strategies only focused on carbon emission, whereas neglecting the influences of other pollutants (CO, HC, NOx, PM_2.5), especially for upstream emissions from electricity generation caused by the electricity consumed during the operation of electrified transport modes. Based on the multinomial logit model (MNL), this study firstly calculated and evaluated the emission reduction effects brought about by the implementation of targeted emission taxes on different transport modes from the perspective of whole fuel cycle. Taking Jiangning District as an example, our research found that the policy implementing targeted emission tax for different transport modes can not only bring reduce 13.104 tons of CO, 0.327 tons of HC, 0.568 tons of NOx, and 0.140 tons of PM_2.5, but also 26,726.82 (euro) of eco-environmental benefits for the treatment of air pollution. Our study can provide useful insights for shifting the structure of urban passenger transport modes, especially promoting the transfer of private cars to the urban green transport systems, to alleviate urban air pollution by formulating effective emission reduction strategies.

COVID-19 pandemic digitization lessons for sustainable development of micro-and small- enterprises

The coronavirus (COVID-19) pandemic has undeniably influenced the global economy and environment. Major victims of the COVID-19 outbreak are Micro and Small Enterprises (MSEs), especially in developing countries, mainly because of limited use of digital technologies. This paper employs a literature review and personal insights to provide COVID-19 pandemic digitization lessons for sustainable development of MSEs from a technology for social good perspective. We develop a framework to support post COVID-19 digital transformation for sustainable development of MSEs. We find that digital payments, especially mobile money, should be a critical digital transformation priority for MSEs. Also, institutions must support MSE resources and capabilities to adopt digital transformation for business continuity, and sustainable production and consumption. Our study suggests that MSE managers and other stakeholders rethink their business strategies, incorporating crisis scenarios and business continuity plans to sustain customers virtually to enhance sustainable development. We also propose further research areas to improve the successful digital transformation of MSEs post COVID-19.

Proteomics analysis of hip articular cartilage identifies differentially expressed proteins associated with osteonecrosis of the femoral head

OBJECTIVE

The cartilage degeneration that accompanies subchondral bone necrosis plays an important role in the development of osteonecrosis of femoral head (ONFH). To better understand the molecular basis of cartilage degradation in ONFH, we compared the proteomic profiles of ONFH cartilage with that of fracture control.

DESIGN

Hip cartilage samples were collected from 16 ONFH patients and 16 matched controls with femoral neck fracture. Proteomics analysis was conducted using tandem mass tag-based quantitation technique. Gene ontology (GO) analysis, KEGG pathway and protein-protein interaction analysis were used to investigate the functions of the altered proteins and biological pathways. Differentially expressed proteins including alpha-2-HS-glycoprotein (AHSG) and Cytokine-like protein 1 (Cytl1) were validated by Western blot (WB) and immunohistochemistry (IHC).

RESULTS

303 differentially expressed proteins were identified in ONFH cartilage with 72 up-regulated and 231 down-regulated. Collagen turnover, glycosaminoglycan biosynthesis, metabolic pathways, and complement and coagulation cascades were significantly modified in ONFH cartilage. WB and IHC confirmed the increased expression of AHSG and decreased expression of Cytl1 in ONFH cartilage.

CONCLUSIONS

Our results reveal the implication of altered protein expression in the development of ONFH, and provide novel clues for pathogenesis studies of cartilage degradation in ONFH.

The diagnosis of lung cancer in the era of interventional pulmonology

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.

[Short-term effect of sodium zirconium cyclosilicate on potassium lowering in chronic kidney disease patients with hyperkalemia]

Objective: To investigate the efficacy of sodium zirconium cyclosilicate on emergency correction of hyperkalemia in chronic kidney disease patients. Methods: Patients with chronic kidney disease who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from May to June 2020 were selected. Those who had hyperkalemia and took sodium zirconium cyclosilicate powder were finally included. The patient's clinical data and laboratory results were collected. Results: A total of 24 results were included from 21 patients. The age of patients was (48.9±13.5) years old. Fourteen patients were male, and 7 patients were female. After 2 hours of administration, the venous potassium level decreased from (5.85±0.52) mmol/L to (5.15±0.43) mmol/L (P<0.001, n=21), with an average decline of (0.71±0.43) mmol/L. Meanwhile, the arterial potassium level decreased from (5.50±0.40) mmol/L to (4.88±0.33) mmol/L (P<0.001, n=10), with an average decline of (0.62±0.29) mmol/L. Based on the initial venous potassium level, the patients were further divided into three groups. The average potassium decrease in<5.5 mmol/L group (4 patients), 5.5-<6.0 mmol/L group (11 patients) and ≥6.0 mmol/L group (6 patients) was (0.46±0.26) mmol/L, (0.62±0.38) mmol/L and (1.04±0.45) mmol/L, respectively. There was statistically significant difference of potassium reduction among the three groups (P=0.045). Moreover, the extent of potassium reduction was positively correlated with baseline venous potassium level (r=0.603, P=0.004, n=21). The study did not reveal any treatment-related adverse event. Conclusion: Sodium zirconium cyclosilicate powder can rapidly and effectively reduce the serum potassium level in chronic kidney disease patients with hyperkalemia.

Evaluating green supplier satisfaction

Purpose

There is great uncertainty and volatility in the evaluation and measurement of green supplier satisfaction. The purpose of this paper is to fill this gap based on the information entropy theory (IET) to describe the probability of green supplier satisfaction degree.

Design/methodology/approach

The authors introduce a formal model using analytic hierarchy process (AHP), IET and entropy technique for order preference by similarity to an ideal solution (TOPSIS) method to evaluate green supplier satisfaction and promote them for the better implementation of green supply chain management practices.

Findings

The first finding is developing an effective framework for green supplier satisfaction, incorporating various measures of environmental dimension. Second, a hybrid uncertainty decision method is introduced, by integrating AHP and IET and entropy-TOPSIS.

Research limitations/implications

One of the main limitations of the research is that the authors introduced a conceptual example. Real-world applications need to investigate the accuracy and effectiveness of these measures, and the operational feasibility of this method.

Originality/value

This is one of the first works to provide a comprehensive appraisal model for evaluation of green supplier satisfaction. This study and research method can form general guidelines, and organizations can increasingly benefit from using green supplier satisfaction evaluation as a management tool. Green supplier satisfaction evaluation is just the beginning.

[The 472nd case: dyspnea, pulmonary shadows, abnormalities of whole blood cells]

A 54-year-old man was admitted to respiratory department with chief complaints of recurrent cough and dyspnea. Chest imaging showed multiple patchy shadows and interstitial changes. Evidence of infectious diseases was not definite, and antibiotic treatments were not effective. In the meantime, myelodysplasia syndrome was diagnosed with pancytopenia. The pathologic findings of transbronchoscopic lung biopsyshowed chronic inflammatory interstitial changes, suggesting a clinical diagnosis of organizing pneumonia. After glucocorticoids treatment, his condition aggravated. The second percutaneous lung biopsy showed the infiltration of a large number of neutrophils. Therefore, the final diagnosis of myelodysplasia syndrome with Sweet syndrome was made. Then glucocorticoids and supportive treatment were given This case may improve physicians' understanding of myelodysplasia syndrome complicated with Sweet syndrome.