Conventional and contrast-enhanced ultrasound in the differential diagnosis of recurrent dermatofibrosarcoma protuberans and postoperative scar

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) has a high recurrence rate after resection. Because of the lack of specific manifestations, recurrent DFSP is easily misdiagnosed as post-resection scar. A few series have reported ultrasound findings of recurrent DFSP; moreover, the usefulness of contrast-enhanced ultrasound in differentiating recurrent DFSP has not been studied.

OBJECTIVE

We investigated conventional and contrast-enhanced ultrasound in the differential diagnosis of recurrent DFSP and post-resection scar.

METHODS

We retrospectively evaluated the findings of conventional and contrast-enhanced ultrasound in 34 cases of recurrent DFSP and 38 postoperative scars examined between January 2018 and December 2022.

RESULTS

The depth and vascular density of recurrent DFSP were greater than those of postoperative scars (P < 0.05). On gray-scale ultrasound, recurrent DFSP lesions were more commonly irregular, heterogeneous, and hypoechoic, with finger-like projections and ill-defined borders. Postoperative scar was more likely to appear as hypoechoic and homogeneous with well-defined borders (P < 0.05). On color Doppler ultrasound, recurrent DFSP was more likely to feature rich arterial and venous blood flow, and postoperative scar was more likely to display poor blood flow (P < 0.05). On contrast-enhanced ultrasound, recurrent DFSP was more likely to feature heterogeneous hyper-enhancement, and postoperative scar was more likely to display homogeneous iso-enhancement (P < 0.05). Recurrent DFSP presented a higher peak and sharpness than postoperative scar (P < 0.05).

CONCLUSION

Conventional and contrast-enhanced ultrasound produced distinct features of recurrent DFSP and post-resection scar, which could improve the accuracy of differential diagnosis.

Development and validation of a nomogram for identifying venous thromboembolism following oral and maxillofacial oncological surgery with simultaneous reconstruction

OBJECTIVES

This study aimed to establish and validate a novel predictive model for venous thromboembolism (VTE) in patients undergoing oral and maxillofacial oncological surgery with simultaneous reconstruction.

MATERIAL AND METHODS

A total of 372 patients were selected, and their demographic data, comorbidities, medical history, laboratory variables, postoperative Caprini scores, perioperative indicators, and procedures were recorded and analyzed to build the model. The predictive model is displayed as a nomogram.

RESULTS

The incidence of VTE was 20.7% (77/372). Several factors were found to be significantly associated with VTE, including age (67 vs. 56 years, P < 0.001), preoperative level of D-dimer (0.56 vs. 0.36 mg/L, P < 0.001), proportion of female patients (46.8% vs. 33.6%, P = 0.032), hypertension (33.8% vs. 21%, P = 0.019). The predictive model was composed of age, gender, and preoperative D-dimer level, with good discriminative ability, as reflected by an area under the curve (AUC) of 0.756, the 95% confidence interval (CI) was 0.696-0.816. Moreover, it showed favorable diagnostic performance compared with both the 2005 (AUC 0.646, 95% CI = 0.578-0.714) and 2010 (AUC 0.627, 95% CI = 0.559-0.694) versions of the Caprini risk assessment model. For patients with malignant tumor, neoadjuvant chemotherapy was also an independent risk factor.

CONCLUSIONS

This novel predictive model consists of three readily available clinical variables that show good diagnostic performance in predicting postoperative VTE.

Immunogenicity and safety of a live attenuated varicella vaccine co-administered with inactive hepatitis A vaccine: A phase 4, single-center, randomized, controlled trial

Co-administration of vaccines can facilitate the introduction of new vaccines in immunization schedules. This study aimed to evaluate the immunogenicity and safety of co-administration with live attenuated varicella vaccine (VarV) and inactivated hepatitis A vaccine (HepA) among children aged 12 ~ 15 months. In this phase 4 clinical trial, 450 children were randomized with a ratio of 1:1 to receive VarV and Hep A simultaneously (Group A) or separately (Group B). The primary endpoints were the seroconversion rate of anti-varicella-zoster virus (VZV) antibodies 42 days after vaccination of VarV and the seroconversion rate of anti-Hepatitis A virus (HAV) antibodies 30 days after two-dose vaccination of HepA. After full immunization, the seroconversion rates of anti-VZV antibodies were 91.79% in Group A and 92.15% in Group B; the geometric mean titers (GMTs) were 11.80 and 12.19, respectively. The seroconversion rates of anti-HAV antibodies were 99.48% in Group A and 100.0% in Group B; the geometric mean concentrations (GMCs) reached 9499.11 and 9528.36 mIU/ml, respectively. The lower limits of the 95% CI for the seroconversion difference of anti-VZV antibodies and anti-HAV antibodies were -5.86% and -2.90%, which greater than the predefined non-inferiority margin (-10%). The incidence rate of adverse reactions in Group A was lower than Group B (9.33% vs 16.22%), and only one serious adverse event was reported in Group B, which was unrelated to the study vaccine. In conclusion, the co-administration of VarV with HepA has non-inferior immunogenicity and safety profiles were quite comparable with the separate administration of both vaccines.Trial registration number: NCT05526820 (ClinicalTrials.gov).

Microneedling radiofrequency enhances poly-L-lactic acid penetration that effectively improves facial skin laxity without lipolysis

BACKGROUND

Microneedle fractional radiofrequency (MFR) is commonly used for skin laxity treatment, and poly-L-lactic acid (PLLA) can stimulate collagen synthesis in the body. However, the synergy of their combination for skin rejuvenation has not been proven. We aimed to evaluate the combined efficacy of PLLA and MRF and the potential mechanism underlying skin laxity.

METHODS

This prospective, randomized study included C57BL/6 mice treated with MFR, MFR+PLLA, and CO2 laser+PLLA and 32 patients who underwent split-face treatments with MFR or MFR+PLLA twice every 2 months. The global aesthetic improvement scale, Facial Laxity Rating scale of the whole face, ECCA grading scale of acne scars, and VISIA parameters on both treated sides were evaluated. Dermatological changes were measured by ultrasonography in the submental space, and adverse events were documented.

RESULTS

PLLA was delivered by channels produced by MFR but not CO2 laser in the mice model. Thirty patients were treated with split-face MFRF+PLLA or MFRF, revealing an improvement in VISIA wrinkle percentile (0.020) compared with the age-matched controls (0.000). The thickness of the dermis increased, while the fat layer did not change significantly. No adverse effects were observed.

CONCLUSIONS

PLLA can be delivered via microchannels produced by MFR. PLLA enhances the efficacy of MFR for skin laxity without lipolysis.

Dry and wet seasonal variations of the sediment fungal community composition in the semi-arid region of the Dali River, Northwest China

Microbial communities play an important role in water quality regulation and biogeochemical cycling in freshwater ecosystems. However, there has been a lack of research on the seasonal variation of sediment microorganisms in the sediments of small river basins in typical semi-arid region. In this study, high-throughput DNA sequencing was used to investigate the fungal community and its influencing factors in the sediment of the Dali River in the dry and wet seasons. The results showed that there were obvious seasonal differences in fungal alpha diversity. The diversity and richness of fungi in the dry season were greater than that in the wet season, but the evenness of fungi in the dry season was lower than that in the wet season. In addition, Ascomycota and Basidiomycota were the most important phyla in the Dali River fungal community, but their distributions showed clear seasonal differences. In the dry season, the relative abundance of Ascomycota and Basidiomycota were 12.34-46.42% and 17.59-27.20%, respectively. In the wet season, the relative abundances of these two phyla were 24.33-36.56% and 5.75-12.26%, respectively. PICRUSt2 was used to predict the metabolic function of fungal community in the sediment, and it was found that at the first level, the proportion of biosynthesis in the dry season was higher than that in the wet season. The ecological network structure showed that the fungal community in the wet season was more complex and stable than that in the dry season. The characteristic fungi in the dry season sediment were chytrid fungi in the family Rhizophydiaceae and the order Rhizophydiales, whereas those in the wet season sediment were in the orders Eurotiales and Saccharomycetales. Canonical correspondence analysis (CCA) showed that the physicochemical properties of water and sediment together explained a greater proportion of the dry-season fungal community changes than of the wet-season changes. In the dry season, temperature and ammonia nitrogen in the water were the main factors affecting the change of fungal community, whereas in the wet season, total nitrogen concentration of the water, electrical conductivity, total organic carbon and available phosphorus of the sediment, pH, and temperature were the main factors affecting the changes in fungal community composition. The results of this study enhanced our understanding of microbial communities in semi-arid river ecosystems, and highlight the importance of the management and protection in river ecosystems.

Usefulness of Ultrasound in Verrucous Venous Malformation: a Series of 103 Cases

BACKGROUND

Verrucous venous malformation (VVM), previously called "verrucous hemangioma," is a rare type of vascular malformation.

OBJECTIVE

Little is known about the ultrasonographic characteristics of VVM. The present study aimed to show the conventional US and elastographic features of a VVM.

MATERIALS AND METHODS

The US findings in 103 patients with VVMs were retrospectively evaluated.

RESULTS

On gray-scale ultrasound images, 98 (95.1%) lesions showed subcutaneous fat infiltration from skin across muscle to deep fascia. The other 5 (4.9%) sat in the subcutaneous layer with no skin involvement. Most (96.1%) lesions were hyperechoic. Furthermore, 71.8% of lesions were heterogeneous, 68.9% of which were with ill-defined margins. Calcifications and visible vessels were present in 5.7% and 10.7% of the VVM cases, respectively. By color Doppler ultrasound, all lesions were found with low vascular density and 4.9% showed enhanced blood flow after compression. Venous spectrum was observed in 67.0% of lesions. The elasticity score was 2.66 ± 0.48.

CONCLUSION

Diagnosis of a VVM is challenging in the clinic. However, we found that most VVM lesions present distinctive ultrasound imaging characteristics. These ultrasound findings may well contribute to the accuracy of VVM diagnosis, especially in those with the absence of epidermal changes and the lack of dermal involvement.

Effect of noninvasive embryo viability testing versus conventional IVF on the live birth rate in IVF/ICSI patients: a study protocol for a double-blind, multicenter, randomized controlled trial

BACKGROUND

Preimplantation genetic testing for aneuploidy (PGT-A) was demonstrated to be superior to conventional IVF in reducing the incidence of miscarriage and abnormal offspring after the first embryo transfer (ET). PGT-A requires several embryo trophectoderm cells, but its negative impacts on embryo development and long-term influence on the health conditions of conceived children have always been a concern. As an alternative, noninvasive PGT-A (niPGT-A) approaches using spent blastocyst culture medium (SBCM) achieved comparable accuracy with PGT-A in several pilot studies. The main objective of this study is to determine whether noninvasive embryo viability testing (niEVT) results in better clinical outcomes than conventional IVF after the first embryo transfer. Furthermore, we further investigated whether niEVT results in higher the live birth rate between women with advanced maternal age (AMA, > 35 years old) and young women or among patients for whom different fertilization protocols are adopted.

METHODS

This study will be a double-blind, multicenter, randomized controlled trial (RCT) studying patients of different ages (20-43 years) undergoing different fertilization protocols (in vitro fertilization [IVF] or intracytoplasmic sperm injection [ICSI]). We will enroll 1140 patients at eight reproductive medical centers over 24 months. Eligible patients should have at least two good-quality blastocysts (better than grade 4 CB). The primary outcome will be the live birth rate of the first embryo transfer (ET). Secondary outcomes will include the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, cumulative live birth rate, ectopic pregnancy rate, and time to pregnancy.

DISCUSSION

In this study, patients who undergo noninvasive embryo viability testing (niEVT) will be compared to women treated by conventional IVF. We will determine the effects on the pregnancy rate, miscarriage rate, and live birth rate and adverse events. We will also investigate whether there is any difference in clinical outcomes among patients with different ages and fertilization protocols (IVF/ICSI). This trial will provide clinical evidence of the effect of noninvasive embryo viability testing on the clinical outcomes of the first embryo transfer.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR) Identifier: ChiCTR2100051408. 9 September 2021.

Ultrasonography characteristics of cystic components in primary salivary gland tumors

OBJECTIVES

The present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs).

MATERIALS AND METHODS

A total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated.

RESULTS

Similarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity.

CONCLUSIONS

US features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT.

CLINICAL RELEVANCE

Cystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US.

Diagnostic value of shear wave elastography quantification combined with conventional ultrasound in salivary gland tumors

Background

The histopathological classification of salivary gland tumors is extremely complex. The imaging manifestations of some tumors are nonspecific. It is particularly important to improve the value of ultrasound in the diagnosis of salivary gland tumors. This study aimed to analyze the diagnostic value of different parameters of shear wave elastography (SWE) in the quantitative diagnosis of salivary gland tumors, and to evaluate the value of SWE combined with conventional ultrasound.

Methods

The study was conducted retrospectively. Patients who underwent salivary gland tumor resection from April 2021 to November 2022 in the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were randomly recruited to the study. A total of 305 masses were divided into an elastography group (150 cases) and a control group (155 cases). The control group underwent conventional ultrasonography, whereas the elastography group underwent conventional ultrasonography and elastography. The Young's modulus E of the mass was quantitatively measured in the elastography group, including maximum cross-sectional area (S), maximum Young's modulus (Emax), mean Young's modulus (Emean), and Young's modulus standard deviation (SD). Pathologic diagnosis was used as the reference standard to determine the cut-off of shear wave elastography of salivary gland tumors, and the diagnostic performance of the 2 groups was compared.

Results

In the elastography group, the diagnostic value of Emax·S (the product of the maximum Young's modulus of the mass and the maximum cross-sectional area of the mass) in the differential diagnosis of malignant tumors (MT) and non-malignant tumors (NMT) was the highest, with a sensitivity and specificity of 72.0% and 80.0%, respectively. The diagnostic value of Emax/D (the quotient of the maximum Young's modulus of the mass and the maximum diameter of the mass) in the differential diagnosis of pleomorphic adenoma (PA) and adenolymphoma (AL) was the highest, with a sensitivity and specificity of 62.3% and 82.4%, respectively. The receiver operating characteristic (ROC) curves for the diagnosis of salivary gland tumors were compared between the elastography group and the control group. The area under the curve (AUC) of the elastography group was 0.915, the sensitivity, specificity, and Youden index were 84.0%, 88.0%, and 0.720, respectively. The AUC of the control group was 0.906, the sensitivity, specificity, and Youden index were 76.0%, 90.0%, and 0.660, respectively, which is the main finding of the study.

Conclusions

SWE can be used as a complementary method for the diagnosis of salivary gland tumors, which has certain value in improving the diagnostic performance. As a result, the sensitivity is improved but the specificity is worsened by addition of SWE to B-mode ultrasound and color Doppler flow imaging (CDFI).

Interactive effect between sleep and exercise on depressive symptoms in Chinese adolescents

Objectives

The study aimed to investigate the effects of sleep and exercise, individually and jointly, on depressive symptoms in Chinese adolescents.

Methods

Cluster sampling was used to conduct a cross-sectional, electronic survey among 11,563 students from five primary and high schools in Sichuan Province in Western China. The questionnaire contained custom-designed items concerning sleep and exercise, while it used the Center for Epidemiologic Studies Depression Scale to assess depressive symptoms and the Core Self-Evaluations Scale to assess core self-evaluation. Data were analyzed using descriptive statistics and multivariate linear regression.

Results

A total of 10,185 valid questionnaires were collected, corresponding to an effective response rate of 88.1%. Among the respondents in the final analysis, 5,555 (54.5%) were boys and 4,630 (45.5%) were girls, and the average age was 15.20 ± 1.72 years (range, 11-18 years). Only less than half of the respondents (4,914, 48.2%) reported insufficient sleep, while the remainder (5,271, 51.8%) had adequate sleep. Nearly one-quarter (2,250, 22.1%) reported insufficient exercise, while the remainder (7,935, 77.9%) reported adequate exercise. More than half of the respondents (5,681, 55.7%) were from vocational high school, 3,368 (33.1%) were from junior high school, 945 (9.3%) were from senior high school, and 191 (1.9%) were from primary school. The prevalence of depressive symptoms among all respondents was 29.5% (95% CI 28.7%-30.4%). When other variables were controlled, the depression score did not vary significantly with gender (B = -0.244, SE = 0.127, P = 0.054), but it decreased by 0.194 points per 1-year increase in age (B = -0.194, SE = 0.037, P < 0.001). Students getting adequate sleep had depression scores 2.614 points lower than those getting insufficient sleep (B = -2.614, SE = 0.577, P < 0.001), while students who engaged in adequate exercise had depression scores 1.779 points lower than those not exercising enough (B = -1.779, SE = 0.461, P < 0.001). The depression score decreased by 0.919 points per 1-point increase in the core self-evaluation score (B = -0.919, SE = 0.008, P < 0.001). In regression controlling for gender, age, and core self-evaluation, sleep and exercise were found to be related significantly to influence depressive symptoms (B = 0.821, SE = 0.315, P = 0.009).

Conclusion

Adequate sleep and adequate exercise are individually associated with milder depressive symptoms in Chinese adolescents. Our results further highlight the need for researchers and clinicians to take into account not only the individual but also the joint effects of sleep and exercise on depression in adolescents when conducting research and designing interventions. If sleep or physical exercise has substantially reduced the risk of depressive symptoms, further reductions by improving sleep and exercise become difficult and may even have opposite effects.

T Cell Subsets are Associated with Clinical Activity and Efficacy of 4.5g Intravenous Glucocorticoid for Moderate-To-Severe Thyroid-Associated Ophthalmopathy

BACKGROUND

Intravenous glucocorticoid (IVGC) remains the main treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). However, a substantial number (20-30%) of active moderate-to-severe TAO patients may not respond to IVGC. Some patients may have disease progression despite IVGC treatment or relapse after steroid withdrawal.

OBJECTIVES

To analyze risk factors for clinical activity and predictive factors for clinical outcomes of 4.5 g IVGC therapy in patients with moderate-to-severe TAO.

DESIGN AND METHODS

Our study was performed in two steps: step 1 involved 110 moderate-to-severe TAO patients and analyzed risk factors for TAO activity; step 2 involved 53 active moderate-to-severe TAO patients from step 1 who were treated with 4.5 g IVGC therapy and analyzed predictive factors for clinical outcomes of IVGC therapy. Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model.

RESULTS

Abnormal TRAb (OR = 4.717; P = 0.019) and the percentage of CD3+CD4+ T cell (OR = 1.092; P = 0.028) were independently associated with the activity of moderate-to-severe TAO patients. The pretreatment CAS-max in both eyes (OR = 7.221; P = 0.013) and the percentage of pretreatment CD3+T cell (OR = 0.718; P = 0.037) were independently associated with therapeutic efficacy. The pretreatment CAS-max in both eyes (OR = 156.53; P = 0.028) and the percentage of post-treatment CD3+T cell (OR = 0.554; P = 0.043) were independently associated with therapeutic efficacy. Besides, multivariable prediction models were established, which were better in the forecasting aspect than single-variable prediction models.

CONCLUSIONS

Based on the findings of this study, we should monitor the peripheral blood T cell subsets for TAO, which could be helpful to timely judge the condition of clinical manifestation and effect of treatment for TAO patients. Multivariable prediction models have been established, which have great significance for clinical work.

Effect of an inactivated coronavirus disease 2019 vaccine, CoronaVac, on blood coagulation and glucose: a randomized, controlled, open-label phase IV clinical trial

Background

Billions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered and several cases of thrombocytopenia with thrombosis syndrome (TTS) have been reported after the administration of adenoviral vector vaccines. However, the effects of an inactivated COVID-19 vaccine, CoronaVac, on coagulation are not well understood.

Methods

In this randomized, controlled, open-label phase IV clinical trial, 270 participants including 135 adults aged 18-59 years and 135 adults aged 60 years or older, were enrolled and randomized to the CoronaVac group or to the control group in a 2:1 ratio and received two doses of CoronaVac or one dose of the 23-valent pneumococcal polysaccharide vaccine and one dose of inactivated hepatitis A vaccine on days 0 and 28, respectively. Adverse events were collected for 28 days after each dose. Blood samples were taken on days 0, 4, 14, 28, 32, 42, and 56 after the first dose to evaluate neutralizing antibody titers and laboratory parameters of coagulation function and blood glucose.

Results

Fourteen days after the second dose of CoronaVac, the seroconversion rates of neutralizing antibodies against the prototype strain and beta, gamma, and delta variants of concern (VOC) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) reached peak values of 89.31%, 23.3%, 45.3%, and 53.5%, respectively. The incidence of adverse reactions was 43.6% and 52.2% in the CoronaVac group and in the control group, respectively. All were mild or moderate in severity. For the laboratory parameters, there was no difference in the means of any parameter between the two groups at any time point, except for the D-dimer on day 14. However, the D-dimer in the CoronaVac group decreased on day 14 compared to the value at baseline, while a higher D-dimer value, instead of a decreased D-dimer value, was a risk factor for TTS.

Conclusion

CoronaVac showed a good safety profile and could induce a humoral response against the prototype and VOCs of SARS-CoV-2 in adults 18 years or older, with no abnormal effects on laboratory parameters of blood glucose and coagulation function.

The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study

Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120 N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.

Cultural inclusion and corporate sustainability: evidence from food culture and corporate total factor productivity in China

This article constructed a food taste deviation index using text analysis based on food culture as a measure of cultural inclusion. Cultural inclusion was related to corporate total factor productivity, aiming to investigate whether the cultural inclusion affects corporate sustainability. The findings showed uneven distribution of cultural inclusion in various areas of China, contributing to the unbalanced sustainable development of firms in different regions, as reflected by the higher total factor productivity of firms located in regions with higher cultural inclusion. A test using mountainous undulation as an instrumental variable verified the causal relationship between cultural inclusion and firm sustainability. Besides, a regression discontinuity design was employed to mitigate the impacts of the bidirectional causality. Moreover, a high level of cultural inclusion in top managers' hometown significantly improved corporate sustainability, suggesting that executives can transmit cultural inclusion in society. In addition, firms in more inclusive regions are more motivated to increase their social responsibility to staff as a way to promote their total factor productivity, suggesting that cultural inclusion promotes firm sustainability by increasing firms' care for staff. This article also found that cultural inclusion has heterogeneous effects across firms of different levels of industry competition, and different levels of analyst attention. The research reveals the impact of cultural inclusion on the real economy and help academics dissect the informal institutional reasons behind the sustainable development of firms in different geographies from a new perspective, contributing to the promotion of economic sustainability at the regional level and related policy formulation.

Abstract 2526: The Bcl-2 family proteins in CLL: Effects by the cytogenetics, microenvironments and therapy

The balance between the pro- and anti-apoptotic members of the Bcl-2 family proteins governs the fate of CLL cells and determines their response to therapeutics. Thus, we have developed an assay to quantify the Bcl-2 family proteins at the molecular level and express them as molecules/pg total protein. This set of proteins represents the 10 major Bcl-2 members in CLL: Bcl-2, Bcl-XL, Mcl-1, BIM, BID, BMF, BAX, BAK, PUMA and Noxa. This analysis enabled us to evaluation of the interplay of these proteins and how they respond to cytogenetic aberrations, drug treatment or environmental changes. In 36 CLL samples that represent 6 districted cytogenetic features: normal cytogenetics, del17p, del11q, del13q14, 11q/13q double deletion, and trisomy 12, we found that the major anti-apoptotic proteins in CLL is Bcl-2, that averaged &gt;9,000 molecules/pg of total protein. Mcl-1 was expressed at less than one tenth of Bcl-2 and Bcl-XL was expressed less than one percent of Bcl-2 molecules. The major pro-apoptotic proteins were Bax and Puma which were expressed at similar levels to Bcl-2. Among the cytogenetic groups, there were significant increases of Bcl-2 in the 11q/13q group whereas Mcl-1 was increased in 11q and trisomy 12 groups compared to samples with normal cytogenetic characteristics. Next, we screened CLL response to different microenvironments by incubating primary CLL cells in vitro in media supplemented with either fetal bovine serum (FBS), patient autologous plasma, a layer of StromaNKtert cells representing the stroma cell support in the bone marrow, a B-cell activating media (BCA) that consisted of anti-CD40, IL-4 and anti-IgM to mimic the lymphoid microenvironment, or oligodeoxynucleotide (ODN) plus IL-15 to represent the T-cell independent stimulation in the lymph nodes. Compared to FBS, homologous patient plasma moderately promoted CLL viability. However, stroma cells, BCA media as well ODN+IL-15 greatly induced levels of Mcl-1 and Bcl-XL and were more effective in promoting CLL survival. For the pro-apoptotic proteins, BMF was induced by BCA media, and PUMA, NOXA and BID were greatly induced by ODN+IL-15. We also examined the changes in Bcl-2 family proteins in response to therapeutic agents with different mechanisms of action, such as the CDK9 inhibitor fadraciclib, the Bcl-2 antagonist venetoclax, the Mcl-1 inhibitors AZD5991 and S63845, the proteasome inhibitor carfilzomib, the BTK inhibitor ibrutinib and the splicing inhibitor herboxidiene. Fadraciclib and herboxidiene were effective in reducing Mcl-1 to induce apoptosis. While both the Mcl-1 inhibitors and carfilzomib increased the Mcl-1 level, and carfilzomib increased Noxa that counteracted its effect on Mcl-1. Puma was reduced by most of the drugs except ibrutinib. Thus, the systematic analysis of the Bcl-2 family proteins provide insights on how the interplay of members of this important family affects the destiny of the CLL cells.

Citation Format: Rong Chen, Ping Xiong, Chaomei Liu, Yuling Chen, Yingjun Jiang, Varsha Gandhi, Nitin Jain, William Wierda, William Plunkett. The Bcl-2 family proteins in CLL: Effects by the cytogenetics, microenvironments and therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2526.

Clinical and imaging characteristics of pulmonary cryptococcosis: a comparative analysis of 118 non-AIDS patients in China

The accurate diagnosis of pulmonary cryptococcosis (PC) is an important guarantee for the selection of reasonable treatment methods. In this paper, the clinical and imaging manifestations of PC in non-AIDS patients were retrospectively analyzed, and according to whether there was an underlying disease, a comparative analysis was carried out to deepen the understanding of PC, and improve the accuracy of its diagnosis. Both clinical and CT imaging data of 118 PC patients were analyzed retrospectively. The clinical manifestations of PC patients were not specific, and 61 patients had no apparent symptoms. A total of 49 patients (49/118) were treated with antifungal agents alone, 46 of them had follow-up records after treatment, and 91.3% (42/46) of them achieved a good outcome. The most common imaging sign was the subpleural nodule or mass. Other main imaging signs include bronchial air sign (50/118), halo sign (32/118), ring target sign (65/118), lobulation sign (72/118), and necrosis (76/118). In terms of age, halo sign, and ring target sign, there were significant differences between the group with underlying disease and the group without underlying disease (P < .05). The CT manifestations of PC have some characteristics, and using antifungal agents can achieve good outcomes.

DISC1 as a prognostic biomarker correlated with immune infiltrates in gastric cancer

Multiple mental diseases could arise in people who have the disrupted in schizophrenia 1 (DISC1) gene. However, it was unknown how DISC1 might contribute to the development of tumors and immune responses. We extracted data from the Cancer Genome Atlas (TCGA) and TISIDB databases from stomach adenocarcinoma (STAD) patients, which revealed that DISC1 overexpression was closely associated with tumor histological type (mucinous vs. tubular, OR = 2.860, CI = 1.423-5.872, p = 0.004), as well as tumor stage and grade. Furthermore, the higher the DISC1 expression, the lower the overall 10-year survival rate. Patients with low DISC1 expression had a significantly longer progression-free interval (PFI) and disease-specific survival (DSS) than patients with high DISC1 expression. However, patients with higher DISC1 expression in the T3&T4, N0&N1 and M0 subgroups had poorer prognosis in terms of OS, DSS and PFI, as could be seen in the subgroup survival analysis. Public datasets were used to predict lncRNA-miRNA-DISC1 regulation. DISC1 was significantly up-regulated in GC(gastric cancer), and its expression levels showed a moderate to strong positive correlation with infiltration levels of effector memory T cells (Tem) and central memory T cells (Tcm), and a negative correlation was observed with Th17 cells and NK CD56bright cells. In addition, concomitant with the high expression of the DISC1 gene was a decrease in MHC-I (Major Histocompatibility Complex-I)expression and an increase in MHC-II expression, and altered chemokine expression. The upregulation of CXCL12 and CXCR4 expression could be caused by an increase in DISC1 expression. The above expression variability and correlation suggest a role for DISC1 in regulating tumor immunity in GC. These findings suggest that high expression of DISC1 could be an independent prognostic factor for GC.

Precise Facial Landmark Detection by Reference Heatmap Transformer

Most facial landmark detection methods predict landmarks by mapping the input facial appearance features to landmark heatmaps and have achieved promising results. However, when the face image is suffering from large poses, heavy occlusions and complicated illuminations, they cannot learn discriminative feature representations and effective facial shape constraints, nor can they accurately predict the value of each element in the landmark heatmap, limiting their detection accuracy. To address this problem, we propose a novel Reference Heatmap Transformer (RHT) by introducing reference heatmap information for more precise facial landmark detection. The proposed RHT consists of a Soft Transformation Module (STM) and a Hard Transformation Module (HTM), which can cooperate with each other to encourage the accurate transformation of the reference heatmap information and facial shape constraints. Then, a Multi-Scale Feature Fusion Module (MSFFM) is proposed to fuse the transformed heatmap features and the semantic features learned from the original face images to enhance feature representations for producing more accurate target heatmaps. To the best of our knowledge, this is the first study to explore how to enhance facial landmark detection by transforming the reference heatmap information. The experimental results from challenging benchmark datasets demonstrate that our proposed method outperforms the state-of-the-art methods in the literature.

The self-medication behaviors of residents and the factors related to the consideration of drug efficacy and safety-A cross-sectional study in China

Background: Over-the-counter (OTC) drugs facilitates residents self-medication. However, inappropriate self-medications have become a serious problem in China and even all over the world. Objectives: To make an investigation on the current status of Chinese residents' self-medication behaviors and important considerations, and to explore the factors related to the considerations of drug efficacy and safety. Design: A quantitative, cross-sectional study. Methods: Multi-stage sampling was used to conduct a cross-sectional investigation in China 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government. State that an interviewer-administrated questionnaire, was used for data collection. The questionnaire that was used in the investigation included demographic sociological characteristics, health literacy scale-short form (HLS-SF), the 10-item Big Five Inventory (BFI-10), the EuroQol-5D visual analogue scale (EQ-5D VAS), self-medication status and important considerations when self-medicating. Descriptive statistics were performed, and the Chi-square test was used for univariate analysis. Log-binomial regression was used for multivariate analysis on whether residents regard drug efficacy or safety as an important consideration. Results: 9256 respondents were included in the data analysis. The self-medication rate of Chinese adults was as high as 99.1%. Paracetamol and other analgesics were the most common types of OTC medication that respondents purchased, followed by vitamins/minerals. Medical staff recommendations, drug safety and efficacy were the top three important considerations. The residents in the east, central and western regions who consider safety is 63.5%, 61.5%, and 66.8% respectively. The proportion of curative effect was 60.2%, 55.7%, and 61.4% respectively. Log-binomial regression showed that western respondents, retired people, those who mainly used ways including basic medical insurance for employees, commercial medical insurance, free medical treatment to cover their medical cost, respondents with high neuroticism, high health literacy were more likely to consider drug safety as an important factor (p < 0.05). Eastern respondents, employed, main way of medical expenses borne was Out-of-pocket Payment, those with chronic disease were more likely to consider drug efficacy as an important factor (p < 0.05). Female, respondents with high levels of agreeableness, conscientiousness, openness, and self-rated health status were more likely to regard both drug safety and efficacy as important considerations (p < 0.05). Conclusion: Self-medication is practiced by most Chinese adults. Whether Chinese adults take drug efficacy or safety as an important consideration is related to their demographic and sociological characteristics, Big Five personality characteristics, health literacy and self-assessed health status. There is a need to strengthen the management of OTC drugs and public education about self-medication.

Self-medication in Chinese residents and the related factors of whether or not they would take suggestions from medical staff as an important consideration during self-medication

Objective

To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs.

Study design

A cross-sectional survey.

Methods

A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs.

Results

Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider.

Conclusion

The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.

The current status and factors related to the preparation of home first-aid kits in China

Background

Home first-aid kits can play an important role when residents are injured, suddenly become seriously ill or suffer from disasters.

Purpose

To explore the home first-aid kit preparedness of Chinese residents and the relationship between demographic sociological characteristics, self-efficacy, Big Five personality, health literacy and home first-aid kit preparation behavior.

Methods

A cross-sectional study was conducted. Information was collected through a self-designed questionnaire consisting of sociological characteristics, the New General Self-Efficacy Scale (NGSES), the Health Literacy Scale Short-Form (HLS-SF12), and the 10-item short version of Big Five Inventory (BFI-10). Rank sum test, Chi-square test, and logistic regression were used to explore the relationship between independent variables and home first-aid kit preparation behavior.

Results

A total of 9,344 respondents were included, and 2,156 (23.07%) prepared home first-aid kits. Among the respondents who had prepared their home first-aid kits, disinfection supplies (85.20%), medical masks (84.51%), commonly used drugs (82.79%) were the most frequently available. The respondents whose geographic area was Central and Western China, permanent residence in the urban area, secondary education or above, monthly income of 3,000 RMB or above, health care cost-bearing method mainly resident health insurance, high subgroup of self-efficacy, high subgroup of health care dimension in health literacy, and whose openness and conscientiousness was high subgroup were more likely to prepare home first-aid kits (P < 0.05).

Conclusion

The preparation rate for home first-aid kits in China is less than a quarter. The public's home first-aid kit preparation behavior is related to demographic characteristics, self-efficacy, health literacy, and the openness of the Big Five personality. A multi-level linked national emergency literacy education system should be established to enhance the residents' attention to home first-aid kits and improve the residents' ability to prevent emergencies.

Multimodal ultrasound for preoperative evaluation of dermatofibrosarcoma protuberans: a series of 40 cases

Background

Dermatofibrosarcoma protuberans (DFSP) is a rare, low to intermediate-grade sarcoma, which needs imaging examination. Small series of ultrasound findings in DFSP have been published; however, the usefulness of elastography and contrast-enhanced ultrasound (CEUS) in DFSP has not been studied. We aim to study multimodal ultrasound findings and report the correlation between imagings and tiny extension in DFSP for preoperative evaluation.

Methods

Two-D ultrasound, 3-D color ultrasound, elastography, and CEUS findings were retrospectively evaluated. Forty histopathologically confirmed DFSPs were studied.

Results

On 2-D ultrasound, 26(65%) appeared as mostly hypoechoic lesions with occasional hyperechoic dots within the tumor matrix and lobulated lateral borders. Eight (20%) lesions were multilayered. Ninety-five percent of lesions showed increased vascularity. On 3-D ultrasound, DFSPs showed branch-shaped, striped, and wrapped color patterns. Power Doppler showed mainly artery of a moderate arterial peak systolic blood flow and low resistance index. DFSP is hard on elastography. On CEUS, DFSPs showed a long peak time, low peak and a small amount of perfusion around the tumor, 73.7% (14/19) of lesions showed a heterogeneous contrast enhancement and 89.5% (17/19) of lesions showed hyper-enhancement. CEUS showed better concordance than US with histology on the maximum diameter and depth (P < 0.05).

Conclusions

Multimodal ultrasound showed significant characteristics in DFSP, which would improve diagnostic accuracy. CEUS could be an effective tool to determine tiny tumor extension.

Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study

BACKGROUND

Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication.

METHODS

A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price.

RESULTS

In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05).

CONCLUSION

Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.

A novel variant in the HX repeat motif of ATN1 in a Chinese patient with CHEDDA syndrome and literature review

BACKGROUND

CHEDDA syndrome is a rare neurodevelopmental syndrome caused by heterozygous missense or indel variants in the HX repeat motif of ATN1 gene. To date, CHEDDA has been identified in a few ethnic groups, and only 17 patients have been reported in literature, and no case has been reported in any country or region in Asia.

METHODS

Trio-exome sequencing (Trio-ES) examination was conducted in a Chinese girl with global developmental delay and in her parents. Sanger sequencing was performed to confirm the candidate variant.

RESULTS

This patient presented with mental and motor developmental delay, speech delay, and mild dysmorphic facial features, and had no epilepsy and visual impairment. Brain MRI did not show obvious structural abnormality. Through ES we identified a novel and de novo variant, c.3176_c.3177insGCACCT (p.Ser1059_His1060insHisLeu), within the HX motif of ATN1. No other pathogenic variant in another gene was found to support an alternative clinical and molecular diagnosis.

CONCLUSIONS

This is the first described case of CHEDDA from China. Together with the available literature data, we found that either disruption of HX motif or alteration of the HX repeat number would lead to ATN1-associated CHEDDA. We also noted that CHEDDA is a clinical heterogenous syndrome, and patients carrying the same or similar variant might have different clinical manifestations and prognosis.

Stable magnetic CoZn/N-doped polyhedron with self-generating carbon nanotubes for highly efficient removal of bisphenols from complex wastewaters

Bisphenols have extensively been found in various environmental matrices and caused public concerns due to their endocrine-disrupting potential. Herein, we developed a ZIF-67@ZIF-8-derived CoZn/nitrogen-doped carbon (CoZn/NC) as a robust adsorbent for bisphenols in wastewaters. The self-generating carbon nanotubes and the open metal sites provided sufficient adsorption sites. The Co component endowed the derivative with strong magnetism facilitating its separation from water. CoZn/NC exhibited exceeding water stability in pH 3 - 12 solution and withstood water up to 15 days. The great applicability of CoZn/NC was validated with 16 real wastewaters from different sources (recoveries exceeding 97.9%). Fast adsorption kinetics were observed with removal efficiencies above 96.5% within 1 min. The adsorption isotherms were well fitted with the Langmuir model, with adsorption capacities of 222, 200, 193, and 321 mg g^-1 for bisphenol A, bisphenol F, bisphenol S, and bisphenol AF, respectively. Variations in external conditions, including pH 3 - 9, humic acid (50 mg L^-1), and NaCl (0.1 mol L^-1), had negligible impacts on the adsorption process. The characterizations and density functional theory computation demonstrated that electrostatic, hydrophobic, π - π, and cation- π interactions are the driving forces in this system. The as-prepared CoZn/NC exhibits great promise in real wastewater treatment.

Multi-model fusion short-term power load forecasting based on improved WOA optimization

The high accuracy of short-term power load forecasting has a pivotal role in helping power companies to construct reasonable production scheduling plans and avoid resource waste. In this paper, a multi-model short-term power load prediction method based on Variational mode decomposition (VMD)-improved whale optimization algorithm (IWOA)-wavelet temporal convolutional network (WTCN)-bidirectional gated recurrent unit (BiGRU)-attention and CatBoost model fusion is proposed. First, VMD was employed to decompose the load data into different intrinsic mode functions. Second, a WTCN was utilized to extract the load data features, and multi-dimensional feature factors were integrated into the BiGRU network for model training. Moreover, an attention mechanism was added to enhance the influence degree of important information. The WTCN-BiGRU-attention model is improved by the WOA algorithm to optimize the hyperparameters of the network. Finally, the model was fused with the predicted data of the CatBoost network by the mean absolute percentage error-reciprocal weight (MAPE-RW) algorithm to construct the best fusion model. Compared with other forecasting models, the proposed multi-model fusion method has higher accuracy in short-term power load forecasting using the public data set for an Australian region.

[Genetic characteristics of varicella zoster virus in Shandong province from 2020 to 2021]

Objective: To investigate the genetic characteristics of varicella zoster virus (VZV) in Shandong province from 2020 to 2021. Methods: From April 2020 to December 2021, 85 herpes fluid samples from suspected varicella patients in Shandong province were collected. The qPCR was used to detect viral DNA and screen suspected samples. Six single nucleotide polymorphisms (SNPs) of ORF22 fragment and ORF38 fragment in positive samples were examined via PCR and Sanger sequencing to identify the viral genotypes. Four SNPs of ORF38 and ORF62 were examined to identify the vaccine and wild-type strains. The sequences were analyzed with Sequencher and MEGA7 software, using the VZV reference strain sequences from GenBank. Results: In the 85 samples suspected of varicella, 80 were VZV positive and wild-type strains belonging to Clade 2. Compared with clade 2 representative strains, the nucleotide and amino acid similarities of ORF22 fragment were 99.5%-100% and 98.5%-100%, respectively. SD20-1, SD20-5, SD20-6, SD20-8, SD20-9, SD20-10, SD20-11, SD20-12, SD20-13, SD20-30 and SD20-31 had a A➝G nucleotide mutation at 37990, causing amino acid change from glutamine to arginine. SD21-1 had a C➝A nucleotide mutation at 38059, causing threonine to asparagine during coding. Conclusions: From 2020 to 2021, all VZV strains in Shandong province are the wild-type strains belonging to Clade 2.

[Analysis of multimodal ultrasound in differential diagnosis of salivary gland tumors]

PURPOSE

To explore the differential diagnosis of salivary gland tumors by multimodal ultrasound and to establish a preliminary scoring system by assigning meaningful parameters.

METHODS

Seventy-seven tumors from 69 patients with salivary gland tumors were examined by two-dimensional gray-scale ultrasound, color Doppler flow imaging (CDFI), superb microvascular imaging(SMI), real time tissue elastography(RTE) and acoustic radiation force impulse (ARFI). Different scoring schemes were obtained for the assignment and combination of meaningful parameters. The ROC curve of each scheme was drawn, and the one with the largest area under the curve was taken as the best scoring scheme. SPSS 25.0 software package was used for statistical analysis of the data.

RESULTS

There were significant differences in tumor shape, boundary, posterior echo, blood flow resistance index, RTE grade and ARFI average value between benign and malignant salivary gland tumors(P<0.05). The scoring scheme 7, which was composed of the above 6 parameters, was the best scoring scheme. When each parameter was assigned a score of 1, the total score was 6, and the area under the curve was 0.944. The sensitivity, specificity and accuracy of distinguishing benign and malignant salivary gland tumors with ≥4 points were 80.0%, 98.4% and 94.8%, respectively.

CONCLUSIONS

Application of multimodal ultrasound and establishment of a scoring system can effectively improve the ability of ultrasound in the differential diagnosis of benign and malignant salivary gland tumors.

[Analysis of multimodal ultrasound in differential diagnosis of salivary gland tumors]

PURPOSE

To explore the differential diagnosis of salivary gland tumors by multimodal ultrasound and to establish a preliminary scoring system by assigning meaningful parameters.

METHODS

Seventy-seven tumors from 69 patients with salivary gland tumors were examined by two-dimensional gray-scale ultrasound, color Doppler flow imaging (CDFI), superb microvascular imaging(SMI), real time tissue elastography(RTE) and acoustic radiation force impulse (ARFI). Different scoring schemes were obtained for the assignment and combination of meaningful parameters. The ROC curve of each scheme was drawn, and the one with the largest area under the curve was taken as the best scoring scheme. SPSS 25.0 software package was used for statistical analysis of the data.

RESULTS

There were significant differences in tumor shape, boundary, posterior echo, blood flow resistance index, RTE grade and ARFI average value between benign and malignant salivary gland tumors(P<0.05). The scoring scheme 7, which was composed of the above 6 parameters, was the best scoring scheme. When each parameter was assigned a score of 1, the total score was 6, and the area under the curve was 0.944. The sensitivity, specificity and accuracy of distinguishing benign and malignant salivary gland tumors with ≥4 points were 80.0%, 98.4% and 94.8%, respectively.

CONCLUSIONS

Application of multimodal ultrasound and establishment of a scoring system can effectively improve the ability of ultrasound in the differential diagnosis of benign and malignant salivary gland tumors.

Retinoid Drugs Improve Autophagy of Medulloblastoma Cells via Hedgehog-Gli Signaling Pathway

Our study aims to discuss the effect of retinoid drug on autophagy of medulloblastoma cells. Targeted ferrocenoretinoic acid was prepared and identified. The MB cells were assigned into blank group, control group and transfection group followed by analysis of cell survival rate and expression of Rack1, Hedgehog-Gli, Beclin1 and LC3. The size and form of prepared ferrocenoretinoic acid was uniform. There was positive charge which can bind target. Ferrocenoretinoic acid treatment declined cell survival rate and increased cell apoptotic rate. The level of Rack1 and Hedgehog-Gli in transfection group was lower than other two group. The tendency in expression of Beclin1 and LC3 was reversed. In conclusion, the expression of Rack1 is restrained by nano-retinoid drug so as to restrain the Hedgehog-Gli signal activity. Therefore, the survival rate of medulloblastoma cells could be restrained and apoptotic rate could be prompted.

Detection of multiple human astroviruses in sewage by next generation sequencing

Human astrovirus (HAstV) composes of classic HAstV serotypes 1-8 and recently discovered novel HAstV-MLB and HAstV-VA strains. A number of studies have demonstrated that wastewater analysis is an effective approach to understand the prevalence and diversity of enteric viruses in local population. However, a comprehensive analysis of classic and novel HAstVs in sewage is still lacking. In this study, sewage samples were collected monthly from Jinan, China during 2018-2019. Quantification of HAstV genomes was performed by real-time quantitative PCR. Different from previous studies which focused on partial ORF1b or ORF2 gene, complete ORF2 region of HAstV was amplified from sewage concentrates, and amplicons were subjected to next generation sequencing (NGS) and genetic analysis. This methodology allowed detection of 18 astroviruses, of which 7 (HAstV-1, -2, -4, -5, VA1, VA2, and VA3) were detected in all sewage samples. A new strain VA6 mapped to the HMO clade was identified in 20.8% of samples, with 82.4%-83.3% nucleotide identities to the closest strain VA5. The viral load of classic, MLB and VA clades in sewage samples ranged from 3.7 × 10⁴ to 4.6 × 10⁷, 3.4 × 10⁴ to 3.9 × 10⁶, and 3.3 × 10⁴ to 4.1 × 10⁶ copies per liter, respectively. Phylogenetic analysis based on complete ORF2 region reflected local HAstVs within each genotype constituted multiple co-circulating lineages. Existence of several new lineages composed exclusively or predominantly of Chinese sequences was observed as well. These results demonstrate sewage contains astroviruses with considerable high diversities. NGS based environmental surveillance greatly improves the understanding of HAstV circulation and should be encouraged.

Cyclin-dependent kinase inhibitor fadraciclib (CYC065) depletes anti-apoptotic protein and synergizes with venetoclax in primary chronic lymphocytic leukemia cells

Fadraciclib (CYC065) is a second-generation aminopurine CDK2/9 inhibitor with increased potency and selectivity toward CDK2 and CDK9 compared to seliciclib (R-roscovitine). In chronic lymphocytic leukemia (CLL), a disease that depends on the over-expression of anti-apoptotic proteins for its survival, inhibition of CDK9 by fadraciclib reduced phosphorylation of the C-terminal domain of RNA polymerase II and blocked transcription in vitro; these actions depleted the intrinsically short-lived anti-apoptotic protein Mcl-1 and induced apoptosis. While the simulated bone marrow and lymph node microenvironments induced Mcl-1 expression and protected CLL cells from apoptosis, these conditions did not prolong the turnover rate of Mcl-1, and fadraciclib efficiently abrogated the protective effect. Further, fadraciclib was synergistic with the Bcl-2 antagonist venetoclax, inducing more profound CLL cell death, especially in samples with 17p deletion. While fadraciclib, venetoclax, and the combination each had distinct kinetics of cell death induction, their activities were reversible, as no additional cell death was induced upon removal of the drugs. The best combination effects were achieved when both drugs were maintained together. Altogether, this study provides a rationale for the clinical development of fadraciclib in CLL, either alone or in combination with a Bcl-2 antagonist.

Comparative study on molecular epidemiology of measles H1 outbreak and sporadic cases in Shandong Province, 2013–2019

Background

Measles caused by measles virus (MeV) is a highly contagious viral disease which has also been associated with complications including pneumonia, myocarditis, encephalitis, and subacute sclerosing panencephalitis. The current study isolated 33 strains belonging to 2 groups, outbreak and sporadic strains, in 13 cities of Shandong province, China from 2013 to 2019. Comparison of genetic characterization among 15 outbreak strains and 18 sporadic strains was performed by analyzing nucleotide sequences of the C-terminal region of N protein gene (N-450).

Results

All 33 stains belonged to genotype H1. The outbreak strains and sporadic strains distributed crossly in phylogenetic tree. Sequences alignment revealed some interesting G to A transversion which changed the amino acids on genomic sites 1317, 1422, and 1543. The nucleotide and amino acid similarities among outbreak isolates were 98–100% (0–10 nucleotide variations) and 97.7–100%, respectively; They were 97.3–100% and 96.6–100%, respectively for sporadic isolates. Evolutionary genetics analysis revealed that the mean evolution rates of outbreak and sporadic isolates were 1.26 N 10− 3 and 1.48 N 10− 3 substitutions per site per year separately, which were similar with corresponding data before 2012. Local transmission analysis suggested that there were three transmission chains in this study, two of them originated from Japan. Outbreak cases and sporadic cases emerged alternatively and were reciprocal causation on the transmission chains.

Conclusions

Our study investigated the phylogeny and evolutional genetics of MeV during a 7-year surveillance, and compared epidemic and genetic characteristics of outbreak strains and sporadic strains. These results underscore the importance of evolutionary study alongside with sporadic cases in discovering and tracing possible outbreaks, especially in the stage of measles elimination.

Core self-evaluation as mediator between depressive symptoms and suicidal ideation in adolescents

OBJECTIVES

To explore the role of core self-evaluation in mediating between depressive symptoms and suicidal ideation in Chinese adolescents.

METHODS

We used the cluster sampling method to analyze 11,563 students from five primary and secondary schools in China for depressive symptoms, core self-evaluation, and suicidal ideation using the following scoring scales: Core Self-Evaluation Scale (CSES), Center for Epidemiologic Survey Depression Scale (CES-D), the Second Edition of the Beck Depression Inventory (BDI- II), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Adolescent Self-Rating Life Events Checklist (ASLEC).

RESULTS

The incidence of depression was 29.7%; anxiety, 34.2%; and suicidal ideation, 28.0%. Core self-evaluation was a protective factor for suicidal ideation [OR 0.947, 95% CI 0.937-0.959, p<0.001]. Conversely, depression as measured by the CSES score was a risk factor for suicidal ideation (OR 1.084, 95% CI 1.073-1.096, p<0.001), as were anxiety as measured by the SCARED score (OR 1.011, 95% CI 1.006-1.016, p<0.001) and adolescent life events according to ASLEC score groups (OR 1.524, 95% CI 1.434-1.621, p<0.001). Core self-evaluation mediated the relationship between depression and suicidal ideation with an effect size of 13.9%.

CONCLUSIONS

Better core self-evaluation is a protective factor against suicidal ideation and mediates the relationship between depression and suicidal ideation. We may be able to reduce the risk of suicidal ideation and therefore suicide among adolescents by improving their core self-evaluation.

Deep Learning for Detecting and Locating Myocardial Infarction by Electrocardiogram: A Literature Review

Myocardial infarction is a common cardiovascular disorder caused by prolonged ischemia, and early diagnosis of myocardial infarction (MI) is critical for lifesaving. ECG is a simple and non-invasive approach in MI detection, localization, diagnosis, and prognosis. Population-based screening with ECG can detect MI early and help prevent it but this method is too labor-intensive and time-consuming to carry out in practice unless artificial intelligence (AI) would be able to reduce the workload. Recent advances in using deep learning (DL) for ECG screening might rekindle this hope. This review aims to take stock of 59 major DL studies applied to the ECG for MI detection and localization published in recent 5 years, covering convolutional neural network (CNN), long short-term memory (LSTM), convolutional recurrent neural network (CRNN), gated recurrent unit (GRU), residual neural network (ResNet), and autoencoder (AE). In this period, CNN obtained the best popularity in both MI detection and localization, and the highest performance has been obtained from CNN and ResNet model. The reported maximum accuracies of the six different methods are all beyond 97%. Considering the usage of different datasets and ECG leads, the network that trained on 12 leads ECG data of PTB database has obtained higher accuracy than that on smaller number leads data of other datasets. In addition, some limitations and challenges of the DL techniques are also discussed in this review.

Value of contrast-enhanced ultrasound in predicting early lymph-node metastasis in oral cancer

OBJECTIVES

To explore the value of contrast-enhanced ultrasound (CEUS) in predicting early lymph node metastasis in clinically node-negative oral cancer patients.

METHODS

We recruited 42 patients (a total of 70 lymph nodes) with clinically node-negative oral cancer in the study. All of them received both conventional ultrasound (B-mode and power Doppler) and CEUS before operation and then they were taken for pathological examination to analyze the diagnostic accuracy. And their CEUS data were analyzed qualitatively and quantitatively.

RESULTS

The sensitivity and specificity of CEUS in the diagnosis of cervical lymph node metastasis of oral cancer were 82.7 and 82.9%, respectively. The accuracy of conventional ultrasound was only 67.1% while that of CEUS was up to 82.9%. The area under the cure (AUC) of CEUS in detecting lymph node metastasis was 0.828, which was higher than the 0.614 by conventional ultrasound, with statistically significant differences observed (p < 0.05). Most of the metastatic lymph nodes were characterized by inhomogeneous enhancement and the peak intensity (PI) of the metastatic group was lower than that of the non-metastatic group (p < 0.05).

CONCLUSIONS

Compared with conventional ultrasound, CEUS may have higher clinical value for predicting early lymph node metastasis in clinically node-negative oral cancer patients. And quantitative parameters obtained from CEUS may provide valuable information in the diagnosis of cervical lymph node metastasis.

A flagship species-based approach to efficient, cost-effective biodiversity conservation in the Qinling Mountains, China

Prioritizing threatened species protection has been proposed as an efficient response to the global biodiversity crisis. We used in-situ conservation data to predict the potential habitat area of four flagship species: the giant panda (Ailuropoda melanoleuca), golden monkey (Rhinopithecus roxella quinlingensis), takin (Budorcas taxicolor bedfordi), and crested ibis (Nipponia nippon). We then designed systematic conservation planning schemes for various scenarios given species habitat preferences and anthropogenic activities and conducted a cost-effectiveness assessment. Broadly, the geographical distributions of suitable habitats for giant pandas, golden monkeys, and takins exhibited high spatial congruence (correlation coefficients of 0.59-0.90), and areas of high congruence were concentrated in the northern portion of the Qinling Mountains at high elevation (>1500 m). By contrast, the crested ibis was negatively correlated in space with its sympatric species (-0.47 to -0.29). Crested ibis habitats were clustered in the southern portion of the region at low elevation (<1500 m). A hypothetical conservation priority area (CPA) based on the giant panda, golden monkey, and takin included 39.64% of the Qinling Mountains and 100%, 99.99%, 99.59%, and 7.84% of the suitable habitats for giant pandas, golden monkeys, takins, and crested ibises, respectively. The same area included 99.07%, 70.87%, and 39.96% of the highly important areas for the ecosystem services of biodiversity conservation, water supply, and soil retention, respectively, and only 4.62%, 16.83%, and 13.4% of the area were associated with high-density residential area, impervious surfaces, and cropland, respectively. Therefore, we conclude that a CPA approach based on the specialist species could result in effective, low-cost biodiversity conservation in the Qinling Mountains. However, we note that existing protected areas account for only 26.52% of the CPA. We recommend that the main area of the proposed Qinling National Park should be based on the CPA developed here.

Adsorption removal of ibuprofen and naproxen from aqueous solution with Cu-doped Mil-101(Fe)

Due to the excellent anti-inflammatory effect, ibuprofen and naproxen have been widely used in the people's daily life, which inevitably leads to their pollution in natural water environment. The removal of these chemicals from water has drawn great interests. Here, a new Cu-doped Mil-101(Fe) was synthesized through a one-step solvothermal method and successfully applied for the adsorption removal of ibuprofen and naproxen from water. A series of characterization techniques (FESEM, TEM, N₂ adsorption-desorption analysis, XRD and FT-IR) were applied to explore the physicochemical properties of the prepared Cu-doped Mil-101(Fe). The adsorption performances of the Cu-doped Mil-101(Fe) for ibuprofen and naproxen, including the adsorption kinetics and isotherms, and effects of diverse influencing factors (pH, ionic strength, and natural organic matter) were examined through batch experiments. The adsorption kinetics and isotherms of ibuprofen and naproxen on the Cu-doped Mil-101(Fe) fitted well with the pseudo-second-order model and Langmuir model, respectively. The maximum adsorption capacities of Cu-doped Mil-101(Fe) were 497.3 and 396.5 mg/g for ibuprofen and naproxen, respectively. The pH of solution in a range of 3-9 exerted no significant effects on the adsorption process. The adsorption was almost unaffected by the ionic strength and humic acid. The π-π interaction and hydrogen bond interaction between the adsorbent and adsorbates were found to be accountable for adsorption. The Cu-doped Mil-101(Fe) was readily regenerated by ethanol and could be repeatedly used.

Imaging identification of primary mammary analogue secretory carcinoma and acinic cell carcinoma in major salivary glands

OBJECTIVE

The present study aimed to characterize and differentiate the ultrasonography (US) and computed tomography (CT) features of mammary analogue secretory carcinoma (MASC) and acinic cell carcinoma (AciCC).

METHODS AND PATIENTS

A total of 83 patients with clinically proven MASC and AciCC were analyzed. The following characteristics were assessed on US, CT, and magnetic resonance imaging: lesion size, shape, margin, echogenicity, echotexture, cystic components, posterior echo, vascularity, density, degree of enhancement, enhancement pattern, signal intensity (SI) on T1- and T2-weighted images (WI), hemorrhages, and lymph node enlargement.

RESULTS

Similarities were observed between the imaging performance of MASC and AciCC. Differences between the two characteristics of shape on US and cystic components on CT were statistically significant. The proportion of MASC to regular shape on US (p = 0.006) and cystic components on CT (p = 0.027) was significantly higher than that of AciCC. Regular shape on US had the highest sensitivity in the identification of MASC and AciCC, while regular shape on US + cystic component on CT had the highest specificity.

CONCLUSIONS

The shape on US and cystic components on CT are key characteristics for distinguishing MASC and AciCC.

Correlation Between Body Mass Index and Anterolateral Thigh Flap Thickness: A Retrospective Study From a Single Center in China

Background: During repair of oral and maxillofacial soft tissue defects, organ function is largely related to the amount of thickness of the flap. However, there are few studies on the influencing factors of the thickness of the flap. In this retrospective study, we aim to explore the correlation between body mass index (BMI) and anterolateral thigh (ALT) flap thickness by computed tomography (CT) and ultrasound and provide guidance for evaluating the ALT flap thickness before surgery. Methods: We selected three points A, B, and C on ALT flap and two skilled clinicians measured the thickness of these points. Age and gender as covariates and evaluated by the Chi-square analysis. Inter-group differences between the two BMI groups were examined by the student t test. Intra-group differences within each BMI group were tested by ANOVA. Linear regression analysis was performed to examine the relationship between BMI and ALT flap thickness. Results: One hundred sixty patients measured by CT were included in this study, and the ALT flap thickness measured by CT were 8.96 mm and 11.00 mm (P < 0.0001, t test) at point B in groups with BMI<24.0 and BMI≥24.0, respectively. The thicknesses at points A, B, and C were significantly correlated with the BMI (P < 0.001, correlation analysis, r = 0.462, 0.372, and 0.349 at the points A, B, and C, retrospectively, Pearson test). Conclusion: There was a significant correlation between the ALT flap thickness and BMI. A higher BMI was correlated with a thicker ALT flap.

Analysis, occurrence, toxicity and environmental health risks of synthetic phenolic antioxidants: A review

The continuous improvement of living standards is related to higher requirements for the freshness and taste of food. For example, synthetic phenolic antioxidants (SPAs) are added to fats and fried foods as food additives to minimize the oxidative rancidity of oils and fats. Hence, the global use of SPAs is increasing year by year. Dibutyl hydroxytoluene is one of the widely used SPAs, often in combination with butyl hydroxyanisole or gallate SPAs. The extensive use of these compounds makes them and their transformation products to be widespread in various environmental matrices, including indoor dust, wastewater, river water, sewage sludge, and sediment, as well as human samples, such as nails and urine, at concentrations varying from nanogram per gram (ng/g) to microgram per gram (μg/g). Animal experiments have shown that high-dose SPA exposure is toxic, which may lead to DNA damage and mismatches and the development of cancerous tumors. Since the biosphere shares the same set of genetic codes, humans and animals have many identical or similar feedback mechanisms and information pathways. Therefore, the damage of SPAs to animals may also threaten human health. This review discusses the properties, occurrence, analysis, and environmental health risks of typical SPAs, including butyl hydroxyanisole, dibutyl hydroxytoluene, tert-butylhydroquinone, propyl gallate, octyl gallate, and lauryl gallate, used as food additives. In addition, AO2246, which is used in food packaging bags, is also considered. Future research directions on SPAs and their transformation products (TPs) are identified and discussed.