Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation

Purpose

Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults.

Patients and Methods

Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a "non-re-positive" group and a "re-positive" group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model's goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively.

Results

We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ2 =5.916, P =0.657; the AUC was 0.881; when the threshold probability was >8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was >80%, the positive estimated value was closer to the actual number of cases.

Conclusion

This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies to further validate, refine, and update this model.

Biotin-new indocyanine green conjugate: Synthesis, in vitro photocytotoxicity and in vivo biodistribution

New indocyanine green (ICG) (IR820) is one of the ICG derivatives and attracts increasing attention for cancer management. However, the unsatisfactory tumor targeting ability of IR820 significantly limits its applications for cancer theranostics. Biotin receptor is overexpressed on the membrane of various tumor cells and biotin modified nanocarriers have been reported to enhance the tumor targeting ability on several tumor types. In this work, biotin-new ICG conjugate (Biotin-SS-IR820) was prepared for tumor-targeted IR820 delivery. Biotin and IR820 were coupled through cystamine. The synthesized Biotin-SS-IR820 was characterized by 1 H NMR, FT-IR and HRMS. The in vitro singlet oxygen generation study shows that Biotin-SS-IR820 exhibits similar singlet oxygen generation as compared to IR820 upon 660 nm laser irradiation (0.8 W/cm2 ). The cellular uptake study shows that Biotin-SS-IR820 shows enhanced cellular uptake amount as compared to IR820 on 4T1 cells. As a result, Biotin-SS-IR820 displays enhanced in vitro photodynamic therapeutic effect against 4T1 cells as compared to IR820. In in vivo biodistribution study, Biotin-SS-IR820 shows enhanced tumor accumulation as compared to IR820. Biotin-SS-IR820 developed in this work shows promising prospects for targeted delivery of IR820 to biotin receptor overexpressed tumors.

Altered brain iron deposition in patients with minimal hepatic encephalopathy: an MRI quantitative susceptibility mapping study

AIM

To explore the use of quantitative susceptibility mapping (QSM) in assessing changes in brain iron deposits and their association with cognitive function in patients with minimal hepatic encephalopathy (MHE).

MATERIALS AND METHODS

The study cohort comprised 27 cases with hepatitis B-associated cirrhosis with MHE (MHE group), 25 with hepatitis B-associated cirrhosis without MHE (NMHE group), and 25 healthy controls (HC group). Iron deposits in the bilateral frontal white matter, caudate nucleus (CN), putamen, globus pallidus, thalamus, red nucleus, substantia nigra (SN), hippocampus, and dentate nucleus were measured by QSM. The associations between iron deposition with the time taken to complete number connection tests A (NCT-A) and the score on digital-symbol test (DST) were analysed.

RESULTS

Susceptibility values differed significantly in the bilateral CN, left thalamus, right SN, and left hippocampus in the MHE group compared with the other groups and were positively associated with the times taken to complete the NCT-A in the bilateral CN, left thalamus, and right SN and negatively associated with DST scores in the bilateral CN, left TH, and left HP.

CONCLUSION

Reduced cognitive function in MHE patients was significantly associated with abnormally increased iron deposition in certain brain areas. The quantification of brain iron deposition by QSM may thus be an objective and accurate means of evaluating MHE.

Discovering Cathodic Biocompatibility for Aqueous Zn-MnO2 Battery: An Integrating Biomass Carbon Strategy

Developing high-performance aqueous Zn-ion batteries from sustainable biomass becomes increasingly vital for large-scale energy storage in the foreseeable future. Therefore, γ-MnO2 uniformly loaded on N-doped carbon derived from grapefruit peel is successfully fabricated in this work, and particularly the composite cathode with carbon carrier quality percentage of 20 wt% delivers the specific capacity of 391.2 mAh g-1 at 0.1 A g-1, outstanding cyclic stability of 92.17% after 3000 cycles at 5 A g-1, and remarkable energy density of 553.12 Wh kg-1 together with superior coulombic efficiency of ~ 100%. Additionally, the cathodic biosafety is further explored specifically through in vitro cell toxicity experiments, which verifies its tremendous potential in the application of clinical medicine. Besides, Zinc ion energy storage mechanism of the cathode is mainly discussed from the aspects of Jahn-Teller effect and Mn domains distribution combined with theoretical analysis and experimental data. Thus, a novel perspective of the conversion from biomass waste to biocompatible Mn-based cathode is successfully developed.

[Immunogenicity, safety and immune persistence of the sequential booster with the recombinant protein-based COVID-19 vaccine (CHO cell) in healthy people aged 18-84 years]

Objective: To evaluate the immunogenicity, safety, and immune persistence of the sequential booster with the recombinant protein-based COVID-19 vaccine (CHO cell) in healthy people aged 18-84 years. Methods: An open-label, multi-center trial was conducted in October 2021. The eligible healthy individuals, aged 18-84 years who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, were recruited from Shangyu district of Shaoxing and Kaihua county of Quzhou, Zhejiang province. All participants were divided into three groups based on the differences in prime-boost intervals: Group A (3-4 months), Group B (5-6 months) and Group C (7-9 months), with 320 persons per group. All participants received the recombinant COVID-19 vaccine (CHO cell). Blood samples were collected before the vaccination and after receiving the booster at 14 days, 30 days, and 180 days for analysis of GMTs, antibody positivity rates, and seroconversion rates. All adverse events were collected within one month and serious adverse events were collected within six months. The incidences of adverse reactions were analyzed after the booster. Results: The age of 960 participants was (52.3±11.5) years old, and 47.4% were males (455). The GMTs of Groups B and C were 65.26 (54.51-78.12) and 60.97 (50.61-73.45) at 14 days after the booster, both higher than Group A's 44.79 (36.94-54.30) (P value<0.05). The GMTs of Groups B and C were 23.95 (20.18-28.42) and 27.98 (23.45-33.39) at 30 days after the booster, both higher than Group A's 15.71 (13.24-18.63) (P value <0.05). At 14 days after the booster, the antibody positivity rates in Groups A, B, and C were 91.69% (276/301), 94.38% (302/320), and 93.95% (295/314), respectively. The seroconversion rates in the three groups were 90.37% (272/301), 93.75% (300/320), and 93.31% (293/314), respectively. There was no significant difference among these rates in the three groups (all P values >0.05). At 30 days after the booster, antibody positivity rates in Groups A, B, and C were 79.60% (238/299), 87.74% (279/318), and 90.48% (285/315), respectively. The seroconversion rates in the three groups were 76.92% (230/299), 85.85% (273/318), and 88.25% (278/315), respectively. There was a significant difference among these rates in the three groups (all P values <0.001). During the sequential booster immunization, the incidence of adverse events in 960 participants was 15.31% (147/960), with rates of about 14.38% (46/320), 17.50% (56/320), and 14.06% (45/320) in Groups A, B, and C, respectively. The incidence of adverse reactions was 8.02% (77/960), with rates of about 7.50% (24/320), 6.88% (22/320), and 9.69% (31/320) in Groups A, B, and C, respectively. No serious adverse events related to the booster were reported. Conclusion: Healthy individuals aged 18-84 years, who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, have good immunogenicity and safety profiles following the sequential booster with the recombinant COVID-19 vaccine (CHO cell).

A near-complete genome assembly of Catharanthus roseus and insights into its vinblastine biosynthesis and high susceptibility to the Huanglongbing pathogen

This study reports the assembly of a near-complete genome of Catharanthus roseus, consisting of 561.7 Mb scaffolded into 8 pseudochromosomes with a contig N50 of 24.7 Mb and a scaffold N50 of 71.1 Mb. The assembly enables the construction of a gene regulatory network of the vinblastine biosynthetic pathway and provides insights into the high susceptibility of C. roseus to the Huanglongbing pathogen.

Fabrication of metal-organic salts with heterogeneous conformations of a ligand as dual-functional urease and nitrification inhibitors

Urease inhibitors (UIs) and nitrification inhibitors (NIs) can greatly reduce nitrogen loss in agriculture soil. However, design and synthesis of an efficient and environmentally friendly dual-functional inhibitor is still a great challenge. Herein, four metal-organic salts (MOSs) based on heterogeneous conformations of the ligand N1,N1,N2,N2-tetrakis(2-fluorobenzyl)ethane-1,2-diamine (L), namely, [2HL]2+·[MCl4]2- (M = Cu, Zn, Cd, and Co), have been synthesized by the "second sphere" coordination method and structurally characterized in detail. Single crystal X-ray diffraction (SCXRD) analyses reveal that the four MOSs are 0D supramolecular structures containing [2HL]2+ and [MCl4]2-, which are connected through non-covalent bonds. Furthermore, the urease and nitrification inhibitory activities of MOSs are evaluated, showing excellent nitrification inhibitory activity with the nitrification inhibitory rate as high as 70.57% on the 28th day in soil cultivation experiment. In particular, MOS 1 shows significant urease inhibitory activity with half maximal inhibitory concentration (IC50) values of 0.89 ± 0.01 μM (0.5 h) and 1.87 ± 0.01 μM (3 h), which can serve as a dual-functional inhibitor.

[Pulmonary nuclear protein of the testis midline carcinoma:a case report]

Nuclear protein of the testis (NUT) midline carcinoma (NMC) is a rare malignant epithelial tumor that typically occurs in the midline regions such as the head, neck, and mediastinum. This tumor is characterized by rapid development, aggressive growth, and strong invasiveness. Due to its short duration, most patients are diagnosed at advanced stages, often leading to rapid mortality. Although reports on pulmonary NUT carcinoma are uncommon, this article presents a case of pulmonary NUT carcinoma in which the patient repeatedly expectorated bronchial casts and tumor tissue. Additionally, a comprehensive review of relevant literature from recent years is provided to enhance understanding of this disease.

CCL2 Promotes Novel Coronavirus-Mediated Inflammatory Responses in Macrophages

PURPOSE

The hyperinflammatory response is one of the main complications associated with novel coronavirus disease 2019 (COVID-19), and there is no effective treatment for cytokine storm. Therefore, it is important to investigate the key genes associated with severity of the disease.

METHODS

In this study, we used a microarray data set to analyze the key genes associated with severe illness in patients with COVID-19. The proportion of immune cells was determined using the CIBERSORT algorithm. The key genes were further verified by detecting the levels of cytokines and chemokines in the serum of patients. Additionally, macrophages were stimulated with SARS-CoV-2 spike protein and chemokine ligand (CCL) 2. The expression of cytokines, ERK1/2, and NF-κB in macrophages was detected.

RESULTS

Four hub genes were identified. Among them, C-C motif chemokine receptor 2 (CCR2) was an upregulated hub gene, while killer cell lectin-like receptor subfamily K member 1 (KLRK1), macrophage colony-stimulating factor receptor (CSF1R), and CD3D human recombinant protein (CD3D) were downregulated genes. Immune cell type identification found that the proportion of monocytes was higher in patients with severe COVID-19 than that in controls. Moreover, levels of CCL2 were significantly higher in patients with COVID-19. When stimulated with SARS-CoV-2 S protein and CCL2, macrophages secreted more inflammatory cytokines. The expression level of ERK1/2 was elevated.

CONCLUSIONS

These results suggested that S protein and CCL2 may mediate macrophage inflammatory responses through the ERK1/2 signaling pathway. This study provides a basis for clinical treatment and improves the prognosis of critically ill patients with COVID-19.

The chromosome-scale reference genome of mirid bugs (Adelphocoris suturalis) genome provides insights into omnivory, insecticide resistance, and survival adaptation

BACKGROUND

Adelphocoris suturalis (Hemiptera: Miridae) is a notorious agricultural pest, which causes serious economic losses to a diverse range of agricultural crops around the world. The poor understanding of its genomic characteristics has seriously hindered the establishment of sustainable and environment-friendly agricultural pest management through biotechnology and biological insecticides.

RESULTS

Here, we report a chromosome-level assembled genome of A. suturalis by integrating Illumina short reads, PacBio, 10x Chromium, and Hi-C mapping technologies. The resulting 1.29 Gb assembly contains twelve chromosomal pseudomolecules with an N50 of 1.4 and 120.6 Mb for the contigs and scaffolds, respectively, and carries 20,010 protein-coding genes. The considerable size of the A. suturalis genome is predominantly attributed to a high amount of retrotransposons, especially long interspersed nuclear elements (LINEs). Transcriptomic and phylogenetic analyses suggest that A. suturalis-specific candidate effectors, and expansion and expression of gene families associated with omnivory, insecticide resistance and reproductive characteristics, such as digestion, detoxification, chemosensory receptors and long-distance migration likely contribute to its strong environmental adaptability and ability to damage crops. Additionally, 19 highly credible effector candidates were identified and transiently overexpressed in Nicotiana benthamiana for functional assays and potential targeting for insect resistance genetic engineering.

CONCLUSIONS

The high-quality genome of A. suturalis provides an important genomic landscape for further investigations into the mechanisms of omnivory, insecticide resistance and survival adaptation, and for the development of integrated management strategies.

Classification and characterisation of extracellular vesicles-related tuberculosis subgroups and immune cell profiles

Around the world, tuberculosis (TB) remains one of the most common causes of morbidity and mortality. The molecular mechanism of Mycobacterium tuberculosis (Mtb) infection is still unclear. Extracellular vesicles (EVs) play a key role in the onset and progression of many disease states and can serve as effective biomarkers or therapeutic targets for the identification and treatment of TB patients. We analysed the expression profile to better clarify the EVs characteristics of TB and explored potential diagnostic markers to distinguish TB from healthy control (HC). Twenty EVs-related differentially expressed genes (DEGs) were identified, and 17 EVs-related DEGs were up-regulated and three DEGs were down-regulated in TB samples, which were related to immune cells. Using machine learning, a nine EVs-related gene signature was identified and two EVs-related subclusters were defined. The single-cell RNA sequence (scRNA-seq) analysis further confirmed that these hub genes might play important roles in TB pathogenesis. The nine EVs-related hub genes had excellent diagnostic values and accurately estimated TB progression. TB's high-risk group had significantly enriched immune-related pathways, and there were substantial variations in immunity across different groups. Furthermore, five potential drugs were predicted for TB using CMap database. Based on the EVs-related gene signature, the TB risk model was established through a comprehensive analysis of different EV patterns, which can accurately predict TB. These genes could be used as novel biomarkers to distinguish TB from HC. These findings lay the foundation for further research and design of new therapeutic interventions aimed at treating this deadly infectious disease.

[Preliminary exploration of modified side overlap with fundoplication by Yamashita (mSOFY) anastomosis technique in laparoscopic proximal gastrectomy]

Objective: To discuss the feasibility and safety of modified side overlap with fundoplication by Yamashita (mSOFY) in laparoscopic proximal gastrectomy. Methods: Using the method of descriptive case series study, the clinical data of 9 patients with upper gastric cancer who successfully performed mSOFY anastomosis from March 2022 to October 2022 in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University were retrospectively analyzed.The reconstruction steps of mSOFY anastomosis are as follows: (1) Make a small incision on the right side of the esophageal stump and in front of the anterior wall of the gastric stump; (2) The 45mm linear cutting stapler is placed into the preset anastomosis of the esophagus and the remnant stomach, and the esophagus is rotated 90° counterclockwise along the axis, so that the right wall of the esophagus is anastomosed with the remnant stomach, and the stomach wall is sutured to the left side of the esophagus; (3) The common opening of esophagus and remnant stomach was sutured with inverted suture; (4)Suture the left and lower sides of the esophagus with the remnant stomach to make the esophagus flat against the stomach wall; (5) Open the sutured common opening: due to the pressure of the false dome, the posterior wall of the lower esophageal segment was compressed into a valve-like structure. We mainly observing the postoperative reflux and nutritional improvement of the patients, and recording the intraoperative situation and postoperative complications. Results: Nine patients with upper gastric cancer who completed laparoscopic proximal gastrectomy (mSOFY anastomosis) did not have conversion to laparotomy or intraoperative / postoperative complications. The operation time was (169.4±10.4) minutes, the anastomotic reconstruction time was (51.7±7.1) minutes, the intraoperative bleeding volume was (98.9±43.4) ml, and the number of lymph nodes dissected was (27.2±6.7). The patient recovered well after operation, without any complaints related to reflux esophagitis. Postoperative gastrointestinal radiography showed that the anastomosis was smooth, without stenosis and leakage. The serum albumin [(41.6±3.4) L vs. (39.9±2.6) L], prealbumin [(211.3±38.6) mg/L vs. (205.3±36.0) mg/L], and hemoglobin levels [(126.7±13.2) g/L vs. (121.0±9.7) g/L] of patients before and one month after surgery have no statistically significant differences (all P>0.05). Conclusion: mSOFY anastomosis can be used as one of the safe and feasible reconstruction methods in laparoscopic proximal gastrectomy.

A novel mitovirus isolated from the filamentous fungus Hypoxylon fendleri

Members of the fungal genus Hypoxylon of the family Xylariaceae are known to produce secondary metabolites with significant chemical diversity. There are more than 200 species in the genus, including the filamentous fungus Hypoxylon fendleri. To the best of our knowledge, there have been no reports of mycoviruses in H. fendleri. In this study, a novel mycovirus, designated "Hypoxylon fendleri mitovirus 1" (HfMV1), was isolated from this fungus. The genome of HfMV1 is 2850 nt in length with a G + C content of 36% and contains a large open reading frame (ORF) encoding an RNA-dependent RNA polymerase (RdRp). BLASTp analysis revealed that the RdRp domain of HfMV1 had 28.30-50.90% sequence identity to those of members of the genus Duamitovirus and had the highest identity (50.90%) to Fusarium graminearum mitovirus 2-2 (FgMV2-2). Phylogenetic analysis further indicated that HfMV1 is a member of the genus Duamitovirus of the family Mitoviridae. This is the first report of a mycovirus in H. fendleri.

Effect of Si on Microstructure and Mechanical Properties of FeCrNi Medium Entropy Alloys

FeCrNi medium entropy alloy (MEA) has been widely regarded for its excellent mechanical properties and corrosion resistance. However, insufficient strength limits its industrial application. Intermetallic particle dispersion strengthening is considered to be an effective method to improve strength, which is expected to solve this problem. In this work, microstructural evolution and mechanical behavior of FeCrNi MEA with different Si content were investigated. We found that the precipitation of fine σ particles can be formed in situ by thermomechanical treatment of Si doping FeCrNi MEAs. The FeCrNiSi_0.15 MEA exhibits a good combination of strength and ductility, with yield strength and tensile elongation of 1050 MPa and 7.84%, respectively. The yield strength is almost five times that of the as-cast FeCrNi MEA. The strength enhancement is mainly attributed to the grain-boundary strengthening and precipitation strengthening caused by fine σ particles.

Bacteria-induced amino acid metabolism involved in appearance characteristics of high-temperature Daqu

BACKGROUND

Significant changes occurd in Daqu bricks on the 15th day of incubation, and brick color (yellow, brown, or dark) is generally used as a standard for quality evaluation by experienced workers. This study aimed to explore the basis behind the phenomenon through multi-omics studies. The physicochemical properties of different high-temperature Daqu were compared. Furthermore, PacBio sequencing and the ultra-high-performance liquid chromatographic-Q-exactive-mass spectrometric approach were employed to analyze the differences in the microbiome and metabolome among different Daqu samples.

RESULTS

Bacillus was the biomarker of yellow Daqu, Thermoactinomyces and Thermoascus were the key genera in brown Daqu, and Burkholderiales, Sphingomonas, and Ralstonia were biomarkers in dark Daqu. The physicochemical characteristics (especially the color values) of different high-temperature Daqu showed strong correlations with the bacterial alpha diversity and the relative abundance of dominant bacterial genera. Amino acid metabolism pathways including tryptophan metabolism, β-alanine metabolism, and arginine biosynthesis were the key factors resulting in the characteristic differences where Bacillus, Burkholderia, Ralstonia, and Sphingomonas were pivotal bacterial genera. The relative abundance of Bacillus had a positive correlation with the content of 3-hydroxykynurenamine, l-glutamic acid, and pantothenic acid, while it showed a negative correlation with indoleacetic acid, l-tryptophan, N-acetylserotonin, l-histidine, l-aspartic acid, phosphatidylserine, 5-methoxyindoleacetate, and L-serine. Burkholderia, Ralstonia, and Sphingomonas had the opposite effects.

CONCLUSION

Microbes play different roles in amino acid metabolism pathways, producing different metabolites, contributing to the differences in Daqu appearance and quality. © 2022 Society of Chemical Industry.

Investigation on oral nursing of elderly patients and prognosis of patients

OBJECTIVE

To understand the oral care status of elderly inpatients in various departments, analyze the existing problems, and provide a basis for further improving the oral care practices and promoting the oral health of elderly patients.

PATIENTS AND METHODS

This study intends to investigate the oral care status of patients in a tertiary hospital in Chongqing. This study was divided into two phases, the first phase was designed as a cross-sectional study. Our aim was to explore the implementation status of oral care in each department. The second phase of this study was to explore the correlation between patient oral care and patient outcomes.

RESULTS

We extracted a total of 9,164 cases of elderly discharged patients. Primary care patients were mainly distributed in various general wards, among which orthopedics was the most frequent, accounting for 30.19%. The oral care doctor order rate of the patients with premium care was 80.21%, and the rate of oral care orders of the primary care patients was only 2.10%. The study analysis found that among surgical and intensive care unit (ICU) patients, patients in high-frequency group and low-frequency group were significantly better than that of patients without oral care in terms of overall survival.

CONCLUSIONS

The oral care is still insufficient, and the frequency of use is relatively infrequent. This study also found that oral care can improve patient outcomes and reduce the incidence of ventilator-associated pneumonia (VAP).

Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China

Background

Acute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care.

Objective

This study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China.

Methods

This retrospective analysis was based on an integrated database of China’s MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score–matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes.

Results

A total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen κ=0.918, P<.001) was higher than that of the before MPDS group (Cohen κ=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: –1.67, 95% CI –2.33 to –1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: –3.81, 95% CI –4.63 to –2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes.

Conclusions

The optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis.

[Recommendations for the diagnosis and treatment of connective tissue disease associated pulmonary arterial hypertension in China]

Pulmonary arterial hypertension (PAH) is a clinicopathological syndrome caused by the increase of pulmonary artery, and it is the most serious complication of connective tissue disease (CTD). In recent years, a lot of progress has been made in the diagnosis, treatment and evaluation of PAH. Chinese Rheumatology Association formulated this recommendation on the basis of current experience and guidelines, in order to promote early screening, early diagnosis and early intervention of CTD-PAH, as well as patient follow-up and management, to improve the prognosis of CTD-PAH patients.

Guidance Value of Procalcitonin Detection in Selecting Switching Points for Sequential Therapy in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated by Respiratory Failure

Objective

To analyse the guiding value of procalcitonin (PCT) for the selection of ventilation switching points in sequential mechanical ventilation for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure, and to provide a reference for the optimisation of mechanical ventilation for patients with COPD and respiratory failure.

Methods

The study included 160 patients with an acute exacerbation of COPD complicated by respiratory failure who received sequential mechanical ventilation treatment. They were divided into two groups of 80 participants. The critical point of the pulmonary infection observation window (PIC) was used as the switching point for sequential mechanical ventilation treatment in the control group, and PCT clinical node was used as the switching point for sequential mechanical ventilation treatment in the observation group. The invasive ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, intensive care unit (ICU) treatment time, complication rate and prognosis were compared for the two groups.

Results

(1) There was no significant difference in the respiratory rate, heart rate, arterial systolic pressure, arterial oxygen partial pressure, arterial carbon dioxide partial pressure or pH value between the two groups after 1 day of treatment, and (2) invasive mechanical ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, ICU treatment time and the incidence of complications were significantly different in the two groups (P = 0.0001).

Conclusion

Detecting PCT can guide the selection of ventilation switching points in sequential mechanical ventilation therapy for patients with COPD with respiratory failure in the acute exacerbation stage, effectively reduce the misevaluation of PIC switching points so that patients can obtain stable criteria for judgement and effectively improve the efficiency and safety of mechanical ventilation treatment for patients in the acute exacerbation stage.

Amino porphyrin-peptide assemblies induce ribosome damage and cancer stem cell inhibition for an enhanced photodynamic therapy

Cancer stem cells (CSCs) are the subpopulation of tumor cells with the properties of tumorigenesis, multilineage differentiation potential and self-renewal, which is the driving force of tumor recurrence and metastasis. However, targeting CSCs is still the main challenge in cancer therapy due to their rapid growth and fast mutation rate. Herein, we developed a simple strategy of photodynamic therapy (PDT) targeting CSCs, dependent on much more abundant ribosomes in CSCs. The interactions between positively charged nanoparticles with negatively charged nucleic acids architectures in cancer cells could lead ribosomes targeting as well as CSCs targeting. The co-assembly of simple amino porphyrin (m-TAPP) with short peptide (Fmoc-L₃-OMe) formed nanoparticles (NPs) with good biocompatibility and photoactivity, became positively charged due to low pH value of tumour microenvironment, and efficiently accessed cancer cell ribosome, approached cancer cell nuclei, therefore enriched in the fast-amplifying CSCs. The inhibitive effect on CSCs by m-TAPP assemblies was verified by the significant reduction of CSCs markers CD44, CD133 and ribosome amount in cancer cells and tissues. Upon light irradiation, the NPs induced ROS generation to provoke destructive cancer cell ribosome damage and subsequent apoptosis to prevent tumor growth markedly. Based on the assemblies of small organic molecules, our study not only achieves ribosome degradation induced cancer cells apoptosis, but also indicates new possibility of performing CSCs targeting PDT.

Transesophageal echocardiography-guided implantation of totally implantable venous access devices via the internal jugular vein: retrospective analysis of 297 cases in pediatric patients

BACKGROUND

Accurately positioning totally implantable venous access device (TIVAD) catheters and reducing complications in pediatric patients are important and challenging. A number of studies have shown methods for locating the tip of the TIVAD catheter. We assessed the success and complications of TIVAD implantation guided by transesophageal echocardiography (TEE) via the internal jugular vein (IJV) for 294 patients in this retrospective study.

METHODS

From May 2019 to March 2021, 297 cases of TIVADs in our hospital were analyzed in this observational, non-randomized, single-center study. The position of the catheter tip under TEE and chest radiography and rates of periprocedural, early, and late complications were evaluated.

RESULTS

The implantation was successful in 242 (82.3%) cases which was in a proper position, and the results were consistent with those of postoperative chest radiography. A total of 72 complications were recorded. Of these, 1 case had a perioperative complication, 66 had early complications, and 5 had late complications after port implantation. The most common complications were local infection and catheter malposition, namely 10 (13.9%) cases of incision infection and 58 (80.6%) cases of catheter malposition. In total, 6 (8.3%) cases of port explantation were required.

CONCLUSION

Confirmation of proper TIVAD catheter positioning by TEE through an internal jugular approach in children was accurate and safe.

VALUE OF CORRECTED FLOW TIME IN COMMON CAROTID ARTERY IN PREDICTING VOLUME RESPONSIVENESS UNDER MECHANICAL VENTILATION

ABSTRACT

Objective: The present study aimed to investigate whether corrected flow time (FTc) in common carotid artery could predict volume responsiveness under mechanical ventilation and to further explore whether the sensitivity and specificity would be influenced by positive end-expiratory pressure (PEEP). Methods: The first stage of this study included 80 patients from the general surgery department undergoing laparotomy. After induction of general anesthesia, FTc in the common carotid artery was measured when hemodynamic indicators, such as blood pressure, heart rate, and cardiac output (CO), were stabilized. Then, 7 mg/kg (ideal body weight) of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused from the peripheral venous system. The infusion was completed within 15 minutes, and hemodynamic indicators were measured again immediately to evaluate volume responsiveness. The patients with change rate of CO (ΔCO ≥15%) were categorized into the responsive (R) group, whereas those with ΔCO <15% were categorized into the nonresponsive group (NR) group. In the second stage, 29 patients undergoing laparotomy were included. After induction of general anesthesia, PEEP of 0, 5, and 10 cmH 2 O was applied sequentially. Corrected flow time and hemodynamic indicators were recorded. Then, 7 mg/g of hydroxyethyl starch 130/0.4 sodium chloride was rapidly infused for 15 minutes, after which PEEP of 0, 5, and 10 cmH 2 O was applied sequentially, and the indicators were measured again. The patients with FTc equal to or less than the threshold in the first stage were categorized into the R group, otherwise into the NR group. Results: In the first stage of the study, CO and FTc differed significantly between the 2 groups, before and after volume load ( P < 0.05). Mean arterial pressure in the R group was significantly different, whereas heart rate did not differ before and after fluid infusion. Also, heart rate and mean arterial pressure were not significantly different before and after fluid infusion in the NR group. The area under the receiver operating characteristic curve was 0.786 ± 0.056 (95% confidence interval, 0.676-0.896; P = 0.00) for FTc before infusing volume load for predicting volume responsiveness. In the second stage of the study, PEEP did not have significant effects on FTc ( F2, 56 = 1.930, P = 0.155), whereas volume load had statistically significant effects on FTc ( F1, 28 ) = 9.381, P < 0.05). Moreover, FTc differed significantly different before and after fluid infusion ( P < 0.05). The area under the receiver operating characteristic curve for FTc in predicting volume responsiveness was 0.921, 0.805, and 0.719 when PEEP was 0, 5, and 10 cmH 2 O ( P < 0.05), respectively, and the cutoff value of FTc for diagnosing volume responsiveness was 323.42 milliseconds, 326.69 milliseconds, and 312.03 milliseconds, respectively. Conclusion: Corrected flow time in the common carotid artery can predict volume responsiveness under mechanical ventilation, and the predictive performance is not influenced by PEEP. Clinical Trial Registration Clinical register number: ChicTR2000029519.

Effect of spontaneous breathing trial on extubation in patients with acute exacerbation of chronic obstructive pulmonary disease under mechanical ventilation

Objective

To evaluate how spontaneous breathing trial (SBT) affects successful extubation and prognosis in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients under mechanical ventilation.

Methods

AECOPD patients under invasive mechanical ventilation were recruited into the study and divided into the SBT and non-SBT groups. SBT patients received SBT for 60 min before extubation, while non-SBT patients that met weaning criteria were immediately extubated without SBT.

Results

A total of 64 patients were enrolled in analysis, including 32 in SBT group and 32 in non-SBT group. Patients in the two groups had similar baseline demographics and clinical characteristics (all parameters: p =  > 0.05). Four (12.5%) patients in the SBT group and 5 (15.6%) in the non-SBT group were reintubated in 48 h of extubation (p = 0.821). During the 28-day follow-up after extubation, 3 patients died, 1 (3.1%) in the SBT group and 2 (6.3%) in the non-SBT group (p = 0.554).

Conclusion

Our findings indicate that SBT did not affect extubation success, in-hospital mortality, and 28-day survival in AECOPD patients under mechanical ventilation.

[Risks and preventive strategy of periodontal treatments for patients with cardiovascular and cerebrovascular diseases]

The prevalence and mortality of the patients who suffer cardiovascular and cerebrovascular diseases are rising in China, and the number of periodontitis patients with cardiovascular and cerebrovascular diseases is growing. Certain principles should be followed during periodontal treatments for these patients due to their particular health conditions. Stomatologists should cooperate with cardiovascular physicians to evaluate the risks and benefits of periodontal treatments in advance, and to select reasonable treatment timings and plans. During treatments, the heart rates, blood pressures and other vital indicators are monitored in real time to avoid acute cardiovascular and cerebrovascular events. The application, discontinuation and adjustment of specific cardiovascular drugs are determined by cardiovascular physicians.

[Analysis of differences and influencing factors of liver injury associated with different strains of 2019-nCoV infection]

Objective: To analyze whether there are differences and related influencing factors in liver injury associated with different strains of 2019-nCoV/SARS-CoV-2 infection. Methods: Data of epidemiology, clinical symptoms, laboratory tests, and treatment outcomes of patients with COVID-19 infection confirmed with Alpha and Delta virus strain in Zhejiang Province were retrospectively collected. Statistical analysis was performed using independent samples t-test or Mann-Whitney U test, χ² test or Fisher's exact test, and logistic regression analysis. Results: A total of 788 and 381 cases with Alpha and Delta virus strain were included. Vaccination ratio was 0% in Alpha and 85.30% in Delta group (P<0.001), The proportion of patients with fever (80.71% vs. 40.94%, P<0.001) was significantly higher in Alpha than Delta strain group. The proportion of critical ill patients was significantly higher in Delta group (9.90% vs. 1.57%, respectively, P<0.001). The virus negative conversion time was significantly longer in Delta than Alpha group (22 d vs. 11 d, P<0.001), but the incidence of liver injury was significantly higher in Alpha than Delta group (20.05% vs. 13.91%, P=0.011). Univariate analysis showed that Alpha virus strain infection, male sex, body mass index, chronic liver disease, fever, diarrhea, shortness of breath, severe/critical illness, elevated creatine kinase (CK), elevated international normalized ratio (INR) and an elevated neutrophil/lymphocyte ratio was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced. Multivariate analysis showed that shortness of breath [OR, 2.667 (CI: 1.389-5.122); P=0.003], increased CK [OR, 2.544 (CI: 1.414-4.576); P=0.002] and increased INR [OR, 1.721] (CI: 1.074-2.758); P=0.024] was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced [OR, 0.424 (CI: 0.254-0.709); P=0.001]. Conclusion: Although the virulence of the Delta is stronger than Alpha strain, most patients infected with Delta strain vaccinated against COVID-19 in Zhejiang province had milder clinical symptoms and a lower incidence and degree of liver injury. Notably, the infection risk even remains after vaccination; however, symptoms and the incidence of severe and critical illness can be significantly reduced.

[Diffuse midline gliomas with H3K27 alteration in children: a clinicopathological analysis of forty-one cases]

Objective: To investigate the clinicopathological features of pediatric diffuse midline glioma with H3K27 alteration and to analyze their relationship with prognosis. Methods: Forty-one cases of childhood diffuse midline glioma with H3K27 alteration were collected at Children's Hospital of Fudan University (39 cases) and Xi'an Children's Hospital (2 cases), from July 2016 to July 2020. The clinical manifestations, imaging data, histopathology, immunohistochemical phenotype and molecular genetics features, tumor size, site and histological grading were evaluated. Results: Among the 41 cases, 21 were males and 20 females, the age of onset was 3-14 years, the average and median age was 7.6 years and 7.0 years, respectively. The tumor sites were brain stem (n=36) and other locations (n=5). The clinical manifestations were dizziness, gait disturbance, and limb weakness, etc. The MRI features were variable. The histology varied from low-grade to high-grade glioma with neuron differentiation. Immunohistochemistry showed that the tumor cells expressed H3K27M, GFAP, and Olig2. Genetic study showed that 76% (16/21) of tumors had H3F3A gene mutation, mostly accompanied by TP53 (62%, 13/21) missense mutation; five tumors (24%, 5/21) had HIST1H3B gene mutation, accompanied by missense mutations in ACVR1 and PI3K pathway-related gene PIK3CA (4/5) and PIK3R1 (1/5) mutations. The prognosis was dismal with only one alive and others died. The average and median overall survival time was 7 months and 4 months, respectively. Cox multivariate regression analysis showed that age, tumor location, radiologically maximum tumor diameter, histologic grading, and surgical methods were not significantly associated with overall survival rate (P>0.05). Conclusions: Pediatric diffuse midline gliomas with H3K27 alteration have unique clinicopathological and genetic characteristics. The prognosis is poor. The tumor location and histopathologic grading are not related to prognosis. New specific drugs and comprehensive treatment are needed to improve the prognosis.

Silencing of FANCI Promotes DNA Damage and Sensitizes Ovarian Cancer Cells to Carboplatin

BACKGROUND

Ovarian cancer (OVCA) has unique epigenetic alterations and defects in homologous recombination (HR). Despite initial sensitivity to platinum-based chemotherapy, HR dysfunctional tumors eventually acquire drug resistance. Fanconi anemia (FA) is characterized by bone marrow failure (BMF) and a reduced ability to eradicate DNA interstrand cross-links (ICL). However, the mechanism of chemoresistance mediated by FANCI was unclear in OVCA.

OBJECTIVE

We explore to identify whether FANCI was involved in chemoresistance in OVCA.

METHODS

FANCI expression and epigenetic alterations were analyzed, respectively, using TIMER and cBioPortal. The correlation between FANCI expression and the survival of OVCA patients was analyzed using Kaplan-Meier Plotter, GSE63885 and TCGA-OVCA database. FANCI expression in OVCA was detected by immunohistochemistry. Cell proliferation, migration, and invasion in FANCI inhibiting cells were assessed by CCK8 and Transwell. Apoptosis and DNA damage were examined by flow cytometry and immunofluorescence. Meanwhile, the activity of caspase 3/7 was detected by Caspase-Glo® 3/7 kit. In addition, the expression of FANCI, γH2AX, and apoptosis effectors was examined by western blot.

RESULTS

FANCI has copy number variations (CNVs) in OVCA. The high expression of FANCI in OVCA patients was associated with poor survival. Moreover, FANCI expression was correlated with the response to chemotherapy in OVCA. FANCI expression in OVCA cells was induced by carboplatin in a time-dependent manner. Silencing of FANCI had no effect on cell proliferation, but it hindered OVCA cell migration and invasion. Mechanically, knockdown of FANCI enhanced DNA damage induced apoptosis through CHK1/2-P53-P21 pathway.

CONCLUSION

FANCI may be a potential therapeutic target for OVCA patients.

[Evidence-based practice of self-made tracheal catheter fixation band in prevention of unplanned extubation]

With the development of medical technology, the fixation method of the oral duct is constantly updated, and the selection of a relatively safe, effective, simple and fast fixation method of the oral duct has been widely concerned. However, the use of traditional 3M I-shaped tape fixation needs to be cut, which wastes time and easily leads to the outward displacement of the tracheal tube, and is easy to be soaked by oral secretions, resulting in facial skin damage. Therefore, the medical staffs of the department of critical care medicine of Hengshui People's Hospital designed a self-made tracheal catheter fixing band (composed of the main structure, the fixed band, the internal adjusting structure and the internal structure of the fixed block), and obtained the national utility model patent (ZL 2018 2 0508681.6). The inner side of the fixing band is fixed with a spongy body, which can absorb the secretions around the mouth to avoid the moist condition around the mouth and cheek skin. Meanwhile, the endotracheal catheter is fixed with the help of the card slot, hinge and other structures, which can fully ensure the fixation effect. A total of 80 patients undergoing airway intubation were admitted to the department of critical care medicine of our hospital from October 2020 to September 2021. They were divided into observation group and control group according to intubation time (single number and double number), with 40 patients in each group. The observation group was fixed with self-made tracheal catheter fixation band. Through evidence-based practice path, relevant literatures at home and abroad were searched for clinical practice basis, and the practice plan was formulated and implemented. The control group was fixed with 3M tape + inch tape according to the traditional method. The fixation of tracheal tube and the degree of facial skin injury were compared between the two groups. All patients were included in the final analysis without shedding cases. Severe catheter displacement occurred in 3 patients (7.5%) in the control group, and no severe catheter displacement occurred in the observation group. The incidence of facial skin injury in the observation group was significantly lower than that in the control group [25.0% (10/40) vs. 55.0% (22/40), P < 0.05]. Moreover, the fixation time of the observation group was significantly shorter than that of the control group (minute: 12.11±1.69 vs 17.59±1.27, P < 0.05). The application of self-made tracheal catheter fixation band can shorten the fixation time of tracheal catheter and reduce the incidence of unplanned endotracheal extubation (UEE) and facial skin injury, which is worthy of clinical promotion and application.

Nanocatalyst doped bacterial cellulose-based thermosensitive nanogel with biocatalytic function for antibacterial application

Reactive oxygen species (ROS) for treating bacterial infection is an alternative strategy to overcome the drawbacks such as bacterial resistance of commonly used antibiotics. Nanocatalysts have been proved highly effective in regulating intracellular ROS level due to their intrinsic enzymes-mimicking ability. Herein, we prepared a carbon-based nanozyme doped with copper atoms with peroxidase mimetic activity to catalyze the decomposition of bio-safety dosage of H₂O₂ to highly reactive OH radicals for antibacterial treatment. Furthermore, we designed the thermo-responsive nanogels consisting of bacterial cellulose nanowhiskers as the carrier of the nanozyme. The obtained nanogels displayed remarkable intelligent response to temperature change with sol-gel transition temperature of ~33 °C and in situ gel forming ability. Moreover, the nanogels exhibited excellent biocompatibility in vitro, along with remarkable antibacterial efficacy which could inactivate 6.36 log of S. aureus and 6.01 log of E. coli in 3 h, respectively. The findings provide a novel strategy for advancing the development of nanocatalysts-based responsive biomaterials for treating bacterial infections.

MRI-Negative Occipital Lobe Epilepsy Presenting as Gelastic Seizures

Although gelastic seizures (GSs) with extrahypothalamic epileptogenic zones such as the frontal, temporal, or parietal lobes have been previously reported, reports of GSs arising from the occipital region are rare. Herein, we describe the seizure propagation pattern of mirthless GSs confirmed by intracranial EEG in a case of MRI-negative occipital lobe epilepsy. In this patient, EEG onset was localized to the right occipital lobe while the onset of laughter coincided with seizure propagation to the right basal temporal region. This finding suggested that the symptomatogenic area for GSs in the occipital lobe may reside in the basal temporal region, and the basal temporal region may play a role in laughing behaviors. This case demonstrated that an elaborate analysis of electroclinical features combined with imaging findings may lead to successful seizure localization.

Analysis of Kefir Grains from Different Regions of the Planet Using High-Throughput Sequencing

The taxonomic composition and spatial localization of yeast and bacteria in kefir grains (KG) obtained for study from different regions of the planet were investigated. The diversity of their microbiome has been demonstrated by high-throughput sequencing of bacterial 16S rRNA genes and the ITS1 region of the 18S-ITS1-5.8S-ITS2-28S complex of yeast rRNA. It has been established that the main representatives of the complex community of KG from different regions are lactic acid bacteria (LAB; lactobacilli, lactococci, and Leuconostoc spp. in different ratios) and different types of yeast of the genus Kazachstania (family Saccharomycetaceae). Acetic acid bacteria and a small percentage of yeast Kluyveromyces marxianus were detected in the KG from Tibet, and yeast Pichia kluyveri was detected in the KG from Ossetia.

Development of PET Fabrics Containing N-halamine Compounds with Durable Antibacterial Property

Antibacterial textile materials are widely used in daily life, but most are disposable products with poor antibacterial durability. N-halamine can rapidly inactivate microorganisms, has good stability, and shows great potential applications in antibacterial fabrics. In this study, an N-halamine monomer precursor was synthesized and treated onto PET fabrics. The treated PET fabrics were rendered antibacterial functionality after chlorination, and exhibited good antibacterial properties with inactivation rate of 100.0 % for both E. coli O157:H7 and S. aureus. After 50 wash cycles, the chlorinated treated PET fabrics could maintain 80.0 % antibacterial efficacy, demonstrating durable antibacterial properties. Storage stability and UV irradiation tests showed that the treated PET fabrics had remarkable regenerable properties. The reduction of the breaking strength was within 12 % after treatment, which is in a satisfying range in antimicrobial finishing.

Dynamic functional connectivity in modular organization of the hippocampal network marks memory phenotypes in temporal lobe epilepsy

Temporal lobe epilepsy (TLE) is a network disorder with a high incidence of memory impairment. Memory processing ability highly depends on the dynamic coordination between distinct modules within the hippocampal network. Here, we investigate the relationship between memory phenotypes and modular alterations of dynamic functional connectivity (FC) in the hippocampal network in TLE patients. Then, 31 healthy controls and 66 TLE patients with hippocampal sclerosis were recruited. The patients were classified into memory‐intact (MI, 35 cases) group and memory‐deficit (MD, 31 cases) group, each based on individual's Wechsler Memory Scale‐Revised score. The sliding‐windows approach and graph theory analysis were used to analyze the hippocampal network based on resting state functional magnetic resonance imaging. Temporal properties and modular metrics were calculated. Two discrete and switchable states were revealed: a high modularized state (State I) and a low modularized state (State II), which corresponded to either anterior or posterior hippocampal network dominated pattern. TLE was prone to drive less State I but more State II, and the tendency was more obvious in TLE‐MD. Additionally, TLE‐MD showed more widespread alterations of modular properties compared with TLE‐MI across two states. Furthermore, the dynamic modularity features had unique superiority in discriminating TLE‐MD from TLE‐MI. These findings demonstrated that state transitions and modular function of dissociable hippocampal networks were altered in TLE and more importantly, they could reflect different memory phenotypes. The trend revealed potential values of dynamic FC in elucidating the mechanism underlying memory impairments in TLE.

Comparison of invasive intubation and noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease and obstructive sleep apnoea syndrome

Objective

The concurrence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea syndrome (OSAS) is defined as overlap syndrome (OS), but investigations into predictors of OS in patients with COPD remain limited. Here, potential markers of OS in patients with COPD were investigated, and results of intubation were compared between patients with COPD only or OS.

Methods

This retrospective study included patients with COPD who were divided according to OS diagnosis: COPD only (COPD group) or OS (OS group).

Results

Among 206 patients with COPD, 120 were diagnosed with OS. Mean body mass index (BMI) was significantly higher in the OS versus COPD group (28.95 ± 2.96 versus 23.84 ± 4.06, respectively). Receiver operating characteristic curve analyses revealed that BMI was associated with OS (area under the curve, 0.835). The rate of invasive intubation within 48 h was lower in the OS versus COPD group (9.2% versus 20.9%, respectively), and the duration of noninvasive ventilation was longer in the OS versus COPD group.

Conclusions

BMI may be a predictor of OS in patients with COPD. The duration of noninvasive ventilation was longer in patients with OS than in patients with COPD alone.

Exploration of the Polarization Curve for Proton-Exchange Membrane Fuel Cells

The polarization curve is the most important profile to evaluate the performance of proton-exchange membrane fuel cells (PEMFCs). To explore the important thermodynamic parameters and their correlation with the composition, fabrication, and operational settings, a comprehensive data set consisting of 446 polarization curves from 191 perfluorosulfonate and 255 sulfonated hydrocarbon-based PEMs is collected. Then, a Markov chain Monte Carlo simulation within the Bayesian frame provides higher than 93% confidence to extract six important thermodynamic parameters including open-circuit potential, the transfer coefficient, the current loss, the reference exchange current density, the internal resistance, and the limiting current density. An extreme gradient boosting algorithm affords a mean determinative coefficient of 0.89 to predict the whole polarization curve and a confidence of 94% to predict the peak power density (PPD). Both approaches to explore the polarization curve for PEMFCs show good robustness in the blind test. Overall, the PPD is positively correlated with the ion-exchange capacity of the polymer, operational temperature, and humidity and is negatively affected by internal resistance, membrane thickness, and the loading of the catalyst. The flow rate of fuels can effectively enhance them, while the increase of catalyst loading or fuel concentration shows deleterious impacts.

Investigating the demands for mobile internet-based home nursing services for the elderly

The great value of home nursing services in the treatment of ailments in elderly patients has attracted increasing attention. This study describes a new mobile internet-based home nursing service system and investigates the reasons for its use among elderly patients. 520 cases of mobile internet-based home nursing services were investigated. The proportion of major reasons to use mobile internet-based home nursing services among the elderly was analyzed and the satisfaction rate was investigated. The constituent ratios of nursing care for pressure ulcers, peripherally inserted central catheter (PICC), subcutaneous injection, general stoma care, psychological care, and intramuscular injection were 61.35%, 28.85%, 6.15%, 1.92%, 1.35%, and 0.38%, respectively. The satisfaction rate with mobile internet-based home nursing services among elderly patients was 100%. Considering the demand for home nursing services for elderly patients, this is the first time that a new mobile internet-based home nursing service has been applied to provide home nursing services to elderly patients and meet their home nursing service needs. Treatment for pressure ulcers, PICC, subcutaneous injection, general stoma care, psychological care, and intramuscular injection were found to be the main reasons to use mobile internet-based home nursing services among the elderly. The new mobile internet-based home nursing service system provides convenient home nursing services to elderly patients and ensures that they get equal rights in home nursing. The results provide basis for healthcare policy makers to formulate new home nursing policies for elderly patients.

Molecular signatures between citrus and Candidatus Liberibacter asiaticus

Citrus Huanglongbing (HLB), also known as citrus greening, is one of the most devastating citrus diseases worldwide. Candidatus Liberibacter asiaticus (CLas) is the most prevalent strain associated with HLB, which is yet to be cultured in vitro. None of the commercial citrus cultivars are resistant to HLB. The pathosystem of Ca. Liberibacter is complex and remains a mystery. In this review, we focus on the recent progress in genomic research on the pathogen, the interaction of host and CLas, and the influence of CLas infection on the transcripts, proteins, and metabolism of the host. We have also focused on the identification of candidate genes for CLas pathogenicity or the improvements of HLB tolerance in citrus. In the end, we propose potentially promising areas for mechanistic studies of CLas pathogenicity, defense regulators, and genetic improvement for HLB tolerance/resistance in the future.

Response to antiseizure medications in epileptic patients with malformation of cortical development

Background

Malformation of cortical development (MCD) is one of the most common causes of pharmacoresistant epilepsy. Improving the knowledge of antiseizure medications (ASMs) treatment response in epileptic patients with MCD is crucial for optimal treatment options, either pharmacological therapy or non-pharmacological intervention.

Aim

To investigate the patterns of medical treatment outcome and the predictors for seizure freedom (SF) with ASM regimens in epilepsy caused by MCD.

Methods

The epileptic patients with MCD were consecutively enrolled from March 2013 to June 2019. SF was defined as no seizures for at least 12 months or three times the longest pretreatment inter-seizure interval, whichever was longer. Outcomes were classified into three patterns: pattern A: patients achieved SF at one point and remained so throughout follow-up; pattern B: patients' seizures fluctuated between periods of SF and relapse; pattern C: SF never attained. The terminal SF was defined if the patients remained SF at the last follow-up visit.

Results

A total of 164 epileptic patients with MCD were included. Pattern A was observed in 22, pattern B in 42, and pattern C in 100 patients. SF was ever achieved in 64 (pattern A and B) patients. Twenty-nine patients had terminal SF after a median follow-up time of 4.3 years. With continuing ASM treatment, seizure relapse risk was very low after a 5-year seizure-free period. The pretreatment seizure frequency was the only independent predictor for pattern A and seizure relapse. Sodium channel blockers monotherapy (33.8%) was more effective than levetiracetam (4.5%) in rendering SF in the initial ASM regimen.

Conclusion

Medical treatment can be successful in a minority of epileptic patients with MCD, and pretreatment seizure frequency helps to predict the treatment outcome. An unequal efficacy of ASMs in epilepsy caused by MCD suggests etiological evaluation is vital in the management of focal epilepsy.