[Progressive necrotizing xanthogranuloma in both eyes: a case report]

A 55-year-old male patient presenting with 6 months of bilateral difficulty in eye opening was referred to the ophthalmology department. Upon examination, multiple yellowish tumor-like plaques and nodules were observed on the eyelids and chest of the patient, accompanied by keratitis and iridocyclitis. Histopathological examination of the skin lesions on the chest revealed dermal xanthomatous granulomas with progressive necrosis. Bone marrow biopsy showed mantle cell lymphoma. Based on the medical history, the diagnosis of progressive necrotizing xanthogranuloma with mantle cell lymphoma was confirmed. After 6 months of treatment with bendamustine combined with rituximab, there was partial alleviation of ocular symptoms in the patient.

The effect of virtual simulation technology applied to undergraduate teaching of periodontal probing

INTRODUCTION

The rise of virtual simulation technology and dental simulators has created a new pedagogical approach for undergraduate medical education. The purpose of this study is to evaluate the effect of virtual simulation (VS) technology on improving the students' comprehensive abilities in periodontal probing teaching in pre-practicum periodontology, such as increasing the accuracy of probing, tactile perception and performance on force control.

MATERIALS AND METHODS

Twenty students were randomly selected among the fourth-year students and equally divided into VS technology teaching group (VS group) and traditional teaching group (TT group) by drawing half lots. One day later, students were required to probe the periodontal pathology model. The consistency rate between PD measurements and PD reference values, time consumption and final exam scores were recorded and statistically analysed using an unpaired Student's t test and p < .05 was considered statistical significance. Finally, questionnaires relating to teaching methods evaluation and the fidelity of the digital VS training system were distributed to students and teachers.

RESULTS

VS group had a significantly higher consistency rate (72.976 ± 6.811%) than TT group (64.107 ± 4.988%, p = .004). To specify, the difference of consistency rates between the two groups in posterior teeth was larger than anterior teeth. Similarly, a larger difference was also found in proximal surfaces compared with buccal-lingual surfaces. As the pocket depth increased, the difference between the two groups increased too. These results indicated that VS is more efficient in complicated parts of periodontal probing teaching. In addition, students in VS group spent less time and gained a higher score than TT group (p < .05). The overall satisfaction rating in VS group was significantly higher than TT group. Lastly, teachers gave significant lower scores than students concerning the fidelity of VS system.

CONCLUSION

Although there are much to improve, VS technology has obvious advantages in periodontal probing teaching in pre-practicum periodontology.

[Pancreaticoduodenectomy combined with longitudinal pancreaticojejunostomy in the treatment of chronic pancreatitis: initial experience in 11 cases]

Objective: To investigate the surgical strategy for chronic pancreatitis complicated with suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. Methods: This is a retrospective cohort study. Clinical data from 11 patients with chronic pancreatitis who underwent pancreaticoduodenectomy combined with longitudinal pancreaticojejunostomy(PD-L) were retrospectively collected(PD-L group) from the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University between December 2021 and September 2023. All patients were male with an age of (49.0±11.2) years(range:32 to 70 years). Their primary preoperative diagnoses included pancreatic lesions, chronic pancreatitis, pancreatolithiasis, and dilatation of the pancreatic duct. Data from 248 patients who underwent pancreaticoduodenectomy(PD) during the same period were retrospectively collected(PD group). There were 157 males and 91 females in the PD group, with an age of (61.5±10.8) years(range:27 to 82 years). Among them, 87 cases were diagnosed as pancreatic cancer or chronic pancreatitis. The propensity score matching method was used to reduce confounding bias between the two groups. The caliper value of 0.1 was used and the 1∶4 nearest neighbor matching method was used for the matching. Comparisons between the two groups were made using the independent sample t test, Mann-Whitney U test or χ2 test,respectively. Results: After complete excision of the specimen during pancreaticoduodenectomy, the key surgical step of PD-L was longitudinal pancreaticojejunostomy in the remaining pancreas. Intraoperative blood loss in the PD-L group was lower than that in the PD group [M(IQR)](300(200)ml vs. 500(500)ml, respectively; P<0.05). Similarly, hospitalization days(21.0(7.0)days vs. 25.0(8.5)days) and postoperative hospitalization days(13.0(8.0)days vs. 17.0(5.0) days) were also lower in the PD-L group compared to the PD group (P<0.05). There were no significant differences in the operation time and postoperative complication rate between the two groups(P>0.05). In the PD-L group, the postoperative follow-up time was 5(5)months(range: 3 to 21 months). One case was lost for follow-up. Abdominal pain was relieved in 10 patients. Additionally, abdominal distension and steatosis were alleviated in 8 cases. Furthermore, 5 cases of diabetes mellitus showed improved control of HbA1c and fasting blood glucose levels after surgery. Conclusions: PD-L treatment can be used to treat chronic pancreatitis complicated by suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. PD-L also has advantages in removing stones from the pancreatic duct and evaporation of pancreatic fluid. However, due to the single-center design and the small sample size of this study, further practice and long-term follow-up are still necessary.

Enhanced brain distribution of Ginsenoside F1 via intranasal administration in combination with absorption enhancers

Ginsenoside F1 (GF1) is a potential drug candidate for the treatment of Alzheimer's disease. Nevertheless, its low oral bioavailability and poor solubility limit clinical application. By utilizing either a direct or indirect approach, intranasal administration is a non-invasive drug delivery method that can deliver drugs to the brain rapidly. But large molecule drug delivered to the brain through intranasal administration may be insufficient to reach required concentration for therapeutic effect. In this study, using GF1 as a model drug, the feasibility of intranasal administration in combination with absorption enhancers to increase brain distribution of GF1 was explored. First of all, the appropriate absorption enhancers were screened by in situ nasal perfusion study. GF1-HP-β-CD inclusion complex was prepared and characterized. Thereafter, in vivo absorption of GF1 after intranasal or intravenous administration of its inclusion complex with/without absorption enhancers was investigated, and safety of the formulations was evaluated. The results showed that 2% Solutol HS 15 was a superior absorption enhancer. HP-β-CD inclusion complex improved GF1 solubility by 150 fold. Following intranasal delivery, the absolute bioavailability of inclusion complex was 46%, with drug brain targeting index (DTI) 247% and nose-to-brain direct transport percentage (DTP) 58%. Upon further addition of 2% Solutol HS 15, the absolute bioavailability was increased to 75%, with DTI 315% and DTP 66%. Both nasal cilia movement and biochemical substances (total protein and lactate dehydrogenase) leaching studies demonstrated 2% Solutol HS 15 was safe to the nasal mucosa. In conclusion, intranasal administration combining with safe absorption enhancers is an effective strategy to enhance drug distribution in the brain, showing promise for treating disorders related to the central nervous system.

Small extracellular vesicles facilitate epithelial-mesenchymal transition in chronic rhinosinusitis with nasal polyps via the miR-375-3p/QKI axis

BACKGROUND

Epithelial-mesenchymal transition (EMT) plays a crucial role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, the involvement of small extracellular vesicles (sEVs) in EMT and their contributions to CRSwNP has not been extensively investigated.

METHODS

SEVs were isolated from nasal mucosa through ultracentrifugation. MicroRNA sequencing and reverse-transcription quantitative polymerase chain reaction were employed to analyze the differential expression of microRNAs carried by sEVs. Human nasal epithelial cells (hNECs) were used to assess the EMT-inducing effect of sEVs/microRNAs. EMT-associated markers were detected by western blotting and immunofluorescence. Dual-luciferase reporter assay was performed to determine the target gene of miR-375-3p. MicroRNA mimic, lentiviral, and plasmid transduction were used for functional experiments.

RESULTS

In line with the greater EMT status in eosinophilic CRSwNP (ENP), sEVs derived from ENP (ENP-sEVs) could induce EMT in hNECs. MiR-375-3p was elevated in ENP-sEVs compared to that in control and nonENP. MiR-375- 3p carried by ENP-sEVs facilitated EMT by directly targeting KH domain containing RNA binding (QKI) at seed sequences of 913-919, 1025-1033, and 2438-2444 in 3'-untranslated region. Inhibition of QKI by miR-375-3p overexpression promoted EMT, which could be reversed by restoration of QKI. Furthermore, the abundance of miR-375-3p in sEVs was closely correlated with the clinical symptom score and disease severity.

CONCLUSIONS

MiR-375-3p-enriched sEVs facilitated EMT by suppressing QKI in hNECs. The association of miR-375-3p with disease severity underscores its potential as both a diagnostic marker and a therapeutic target for the innovative management of CRSwNP.

The Application of Virtual Simulation Technology in Scaling and Root Planing Teaching

BACKGROUND

Virtual simulation (VS) technology has been widely utilised in various aspects of oral education. This study aimed to evaluate the impact of VS technology in a scaling and root planing (SRP) teaching programme and explore an effective teaching approach.

METHOD

A total of 98 fourth-year undergraduates from Guanghua School of Stomatology at Sun Yat-sen University were enrolled in this study and randomly assigned to either the VS teaching group or the traditional teaching (TT) group. All participants received SRP training before undergoing an operational examination. Subsequently, questionnaires were administered to both students and teachers involved in the programme to assess the teaching effect and fidelity of the VS training system. Unpaired Student t test was used to analyse the final test scores and residual rates amongst students.

RESULTS

The overall residual rate of the calculus in the VS group was significantly lower than that in the TT group (48.81% ± 13.50% vs 56.89% ± 13.68%, P<.01). The difference was particularly notable in posterior teeth, proximal surfaces, and deep pockets. Additionally, the VS group students achieved higher final grades compared to the TT group (86.92 ± 6.10 vs 83.02 ± 6.05, P<0.01). In terms of teaching effectiveness assessment, the VS group students provided higher scores than the TT group, except in the areas of mastery of position, finger rests, and efficiency.

CONCLUSIONS

The implementation of VS technology demonstrated improvements in students' performance in SRP teaching. Therefore, a novel integrated pedagogic approaches method that combines VS technology with traditional teaching approaches could be further explored in future training programmes.

"I Do Not Trust Health Information Shared by My Parents": Credibility Judgement of Health (Mis)information on Social Media in China

The surge of health misinformation on social media poses a threat to public health. This qualitative study reports how users process health misinformation from the dominant strong-tie social media, WeChat, in China. We conducted ten on-site focus groups involving 76 adult participants. Drawing on the apomediation theory and the dual processing model of credibility assessment, we found the heuristic approach to processing health information was the dominant route of engagement. We identified four categories of credibility assessment cues, including (1) expertise, authority, and commercial intent of original sources, (2) expertise of apomediaries (i.e. social media information sharers) and generational bias, (3) clickbait and sensational content versus objective scientific style, and (4) disconfirmation versus confirmation bias. We highlight that apomediaries are playing an increasingly important role in informing credibility judgment. Specifically, younger adults have formed a generational bias of deeming older apomediaries as cues of lower credibility.

Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Factors affecting neurodevelopmental outcome following surgical necrotising enterocolitis: a systematic review

Surgically treated necrotising enterocolitis (sNEC) is associated with significantly worse neurodevelopmental outcomes than that seen in premature infants without NEC. We aim to review the association between factors involved in the surgical treatment of NEC and subsequent neurodevelopmental outcomes to identify potential areas for improvement. The PubMed and Embase databases were interrogated for articles reporting neurodevelopmental outcomes in babies treated surgically for NEC using key terms including: "Infant", "Necrotising enterocolitis", "Surgical", "Neurodevelopmental" and "Outcomes". The search strategy yielded 1170 articles and after applying inclusion and exclusion criteria 22 studies remained and formed the review. A diverse range of neurodevelopmental outcomes were reported. Extreme prematurity and lower birth weight were associated with worse neurodevelopmental outcomes. The use of peritoneal drains and enterostomies were associated with worse outcomes. Modifications to surgical strategies in NEC may improve neurodevelopmental outcomes but the effect of confounding factors remains unclear. Further large scale studies are required to define the optimum strategies for treating NEC surgically and to develop a core outcome set for research into NEC.

A novel approach to evaluation of tumor response for advanced pulmonary adenocarcinoma using the intertumoral heterogeneity response score

Treatment response and prognosis estimation in advanced pulmonary adenocarcinoma are challenged by the significant heterogeneity of the disease. The current Response Evaluation Criteria in Solid Tumors (RECIST) criteria, despite providing a basis for solid tumor response evaluation, do not fully encompass this heterogeneity. To better represent these nuances, we introduce the intertumoral heterogeneity response score (THRscore), a measure built upon and expanding the RECIST criteria. This retrospective study included patients with 3-10 measurable advanced lung adenocarcinoma lesions who underwent first-line chemotherapy or targeted therapy. The THRscore, derived from the coefficient of variation in size for each measurable tumor before and 4-6 weeks posttreatment, unveiled a correlation with patient outcomes. Specifically, a high THRscore was associated with shorter progression-free survival, lower tumor response rate, and a higher tumor mutation burden. These associations were further validated in an external cohort, confirming THRscore's effectiveness in stratifying patients based on progression risk and treatment response, and enhancing the utility of RECIST in capturing complex tumor behaviors in lung adenocarcinoma. These findings affirm the promise of THRscore as an enhanced tool for tumor response assessment in advanced lung adenocarcinoma, extending the RECIST criteria's utility.

[Adjuvant therapy strategies for breast cancer based on the efficacy of neoadjuvant therapy]

With the advent of the precision cancer therapy era, neoadjuvant therapy has become the standard therapy for certain types of breast cancer. Neoadjuvant therapy is a fundamental treatment plan implemented at the time of disease diagnosis, and its efficacy can guide the formulation of subsequent adjuvant therapy strategies. Building on the efficacy of neoadjuvant therapy and medication regimens, in conjunction with evidence-based medicine and healthcare policy, developing adjuvant therapy strategies for breast cancer following neoadjuvant therapy has the benefit of providing more precise treatment options for patients.

Multi-channel synthetic aperture infrared imaging and experimental research

The synthetic aperture infrared radio imaging method based on laser local oscillator coherent detection has potential application value for astronomical observations. This paper studies the multi-channel synthetic aperture infrared imaging method and conducts experimental verification using a principle prototype. In the short-wave infrared band, five beam-expanding fiber collimators are used to build an observation structure of five laser local oscillator coherent detection channels at a near-field distance of 5 m to carry out physical experiments. The laser local oscillator wavelength is 1.55 µm, and the AD sampling rate is 4 GHz. For the infrared radiation source signal, the phase relationship of the infrared signals between channels acquired by the prototype principle is stable, and the five-channel synthetic aperture imaging results are consistent with the computer simulated results. The experiment verified the effectiveness of the laser local oscillator comprehensive aperture infrared radio imaging method.

Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

Anisotropic fluid flows in black phosphorus nanochannels

With the development of advanced micro/nanoscale technologies, two-dimensional materials have emerged from laboratories and have been applied in practice. To investigate the mechanisms of solid-liquid interactions in potential applications, molecular dynamics simulations are employed to study the flow behavior of n-dodecane (C12) molecules confined in black phosphorus (BP) nanochannels. Under the same external conditions, a significant difference in the velocity profiles of fluid molecules is observed when flowing along the armchair and zigzag directions of the BP walls. The average velocity of C12 molecules flowing along the zigzag direction is 9-fold higher than that along the armchair direction. The friction factor at the interface between C12 molecules and BP nanochannels and the orientations of C12 molecules near the BP walls are analyzed to explain the differences in velocity profiles under various flow directions, external driving forces, and nanochannel widths. The result shows that most C12 molecules are oriented parallel to the flow direction along the zigzag direction, leading to a relatively smaller friction factor hence a higher average velocity. In contrast, along the armchair direction, most C12 molecules are oriented perpendicular to the flow direction, leading to a relatively larger friction factor and thus a lower average velocity. This work provides important insights into understanding the anisotropic liquid flows in nanochannels.

Metal-Free Heterogeneous Photocatalysis for Carbocarboxylation of Alkenes: Efficient Synthesis of γ-Amino Carboxylic Derivatives

A metal-free heterogeneous protocol is established herein for the synthesis of value-added γ-amino acid scaffolds via carbocarboxylation of alkenes with CO2 and alkylamines under visible light irradiation. The protocol shows broad substrate scope under mild reaction conditions and good stability of the catalyst for recycle tests. Moreover, the methodology could be feasible to the late-stage derivatization of several natural products, enriching the chemical arsenal for practical application.

Effectiveness of typodont, quail egg and virtual simulation for ultrasonic periodontal scaling teaching among pre-clinical students: a randomized trial

BACKGROUND

This study aimed to compare the efficacy of three different techniques, namely virtual simulation technology (VS), traditional pathological typodont (TT), and quail egg (QE), in pre-clinical training of periodontal ultrasonic scaling. It also aimed to propose an integrated teaching approach for ultrasonic scaling teaching.

METHODS

This single-blind randomized multi-arm trial enrolled 108 fourth-year students from Guanghua School of Stomatology at Sun Yat-sen University. The participants were randomly, evenly assigned to VS, TT, or QE group. First, the participants received theoretical review on ultrasonic scaling and demonstrative teaching. Then in the 90-minute operation training by group, students used traditional typodont equipped in head-simulators, raw quail eggs, or scaling module of the UniDental VS system respectively. Then all participants practiced on pathological models for 30 min. In the final operation examination, participants were instructed to remove the supra- and sub-gingival calculi pre-set on designated teeth by ultrasonic scalers within 30 min. Their performances were evaluated by residual calculus rate and a multi-perspective scoring scale. After the examination, questionnaires were provided to assess the teaching effects of each method and the fidelity of VS. Statistical analysis was carried out using one-way, two-way ANOVA, and multiple t-test.

RESULTS

Students in VS group had significant higher total test scores than QE group (87.89 ± 6.81, 83.53 ± 8.14) and TT group (85.03 ± 6.81). VS group scored higher in several dimensional comparisons with the other two groups, especially in difficult situations. QE group had higher scores particularly in force application and supra-gingival scaling. TT group scored the highest in pivot stability practice and body position training. Students gave higher scores when assessing the fidelity of VS than experienced teachers.

CONCLUSION

The study highlights the importance of specialized pre-clinical training on ultrasonic scaling for dental students. The methods adopted in current study (VS, TT and QE) each offered unique advantages in education, which can be combined to create an integrative teaching procedure. This procedure aims to provide an effective, advisable and normative pre-clinical training procedure for ultrasonic scaling. By utilizing the strengths of each method, dental educators can deliver high-quality training and ensure that students are well-prepared for clinical practice.

Remnant cholesterol is associated with hip BMD and low bone mass in young and middle-aged men: a cross-sectional study

PURPOSE

Remnant cholesterol (RC) is a contributor to cardiovascular diseases, obesity, diabetes, and metabolic syndrome. However, the specific relationship between RC and bone metabolism remains unexplored. Therefore, we aimed to investigate the relationships of RC with hip bone mineral density (BMD) and the risk of low bone mass.

METHODS

Physical examination data was collected from men aged < 60 years as part of the Kailuan Study between 2014 and 2018. The characteristics of the participants were compared between RC quartile groups. A generalized linear regression model was used to evaluate the relationship between RC and hip BMD and a logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for low bone mass. Additional analyses were performed after stratification by body mass index (BMI) (≥ or < 24 kg/m2). Sensitivity analyses were performed by excluding individuals who were taking lipid-lowering therapy or had cancer, cardiovascular diseases, or diabetes.

RESULTS

Data from a total of 7,053 participants were included in the analysis. After adjustment for confounding factors, RC negatively correlated with hip BMD (β =  - 0.0079, 95% CI: - 0.0133, - 0.0025). The risk of low bone mass increased from the lowest to the highest RC quartile, with ORs of 1 (reference), 1.09 (95% CI: (0.82, 1.44), 1.35 (95%CI: 1.02, 1.77), and 1.43 (95% CI: 1.09, 1.89) for Q1, Q2, Q3, and Q4, respectively (P for trend = 0.004) in the fully adjusted model. Compared to RC < 0.80 mmol/l group, the risk of low bone mass increased 39% in RC ≥ 0.80 mmol/l group (P < 0.001). The correlation between RC and hip BMD was stronger in participants with BMI ≥ 24 kg/m2 group (β =  - 0.0159, 95% CI: - 0.0289, - 0.0029). The results of sensitivity analyses were consistent with the main results.

CONCLUSION

We have identified a negative correlation between serum RC and hip BMD, and a higher RC concentration was found to be associated with a greater risk of low bone mass in young and middle-aged men.

An Overview of Electrochemical Sensors Based on Transition Metal Carbides and Oxides: Synthesis and Applications

Sensors play vital roles in industry and healthcare due to the significance of controlling the presence of different substances in industrial processes, human organs, and the environment. Electrochemical sensors have gained more attention recently than conventional sensors, including optical fibers, chromatography devices, and chemiresistors, due to their better versatility, higher sensitivity and selectivity, and lower complexity. Herein, we review transition metal carbides (TMCs) and transition metal oxides (TMOs) as outstanding materials for electrochemical sensors. We navigate through the fabrication processes of TMCs and TMOs and reveal the relationships among their synthesis processes, morphological structures, and sensing performance. The state-of-the-art biological, gas, and hydrogen peroxide electrochemical sensors based on TMCs and TMOs are reviewed, and potential challenges in the field are suggested. This review can help others to understand recent advancements in electrochemical sensors based on transition metal oxides and carbides.

Baseline C-reactive protein predicts efficacy of the first-line immune checkpoint inhibitors plus chemotherapy in advanced lung squamous cell carcinoma: a retrospective, multicenter study

AIMS

To investigate the predictive value of baseline C-reactive protein (CRP) levels on the efficacy of chemotherapy plus immune checkpoint inhibitors (ICI) in patients with advanced lung squamous cell carcinoma (LSCC).

MATERIALS AND METHODS

In this retrospective multicenter study spanning from January 2016 to December 2020, advanced LSCC patients initially treated with chemotherapy or a combination of chemotherapy and ICI were categorized into normal and elevated CRP subgroups. The relationship between CRP levels and treatment outcomes was analyzed using multivariate Cox proportional hazards models and multivariate logistic regression, focusing primarily on the progression-free survival (PFS) endpoint, and secondarily on overall survival (OS) and objective response rate (ORR) endpoints. Survival curves were generated using the Kaplan-Meier method, with the log-rank test used for comparison between groups.

RESULTS

Of the 245 patients evaluated, the 105 who received a combination of chemotherapy and ICI with elevated baseline CRP levels exhibited a significant reduction in PFS (median 6.5 months vs. 11.8 months, HR, 1.78; 95% CI: 1.12-2.81; p = 0.013) compared to those with normal CRP levels. Elevated CRP was identified as an independent risk factor for poor PFS through multivariate-adjusted analysis. However, among the 140 patients receiving chemotherapy alone, baseline CRP levels did not significantly influence PFS. Furthermore, within the combination therapy group, there was a notable decrease in the ORR (51% vs. 71%, p = 0.035), coupled with a significantly shorter OS (median 20.9 months vs. 31.5 months, HR, 2.24; 95% CI: 1.13-4.44; p = 0.033).

CONCLUSION

In patients with advanced LSCC, elevated baseline CRP levels were identified as an independent predictive factor for the efficacy of combination therapy with chemotherapy and ICI, but not in chemotherapy alone. This suggests that CRP may be a valuable biomarker for guiding treatment strategies.

Cerebrospinal fluid circulating tumor DNA contributes to the detection and characterization of leptomeningeal metastasis in non-small cell lung cancer

PURPOSE

Cerebrospinal fluid (CSF) has revealed the unique genetic characteristics of leptomeningeal metastasis (LM) from non-small cell lung cancer (NSCLC). However, the research in this area is still very limited.

METHODS

Patients with LM from NSCLC (n = 80) were retrospectively analyzed. Circulating tumor DNA (ctDNA) in CSF was tested by next-generation sequencing (NGS), with paired extracranial tissue or plasma samples included for comparison. An independent non-LM cohort (n = 100) was also analyzed for comparative purposes. Clinical outcomes were compared with Kaplan-Meier log-rank test and Cox proportional hazards methodologies.

RESULTS

An overwhelming 93.8% of patients carried druggable mutations in NSCLC LM, with EGFR (78.8%) being the most prevalent. Notably, 4 patients who tested negative for driver genes in extracranial samples surprisingly showed EGFR mutations in their CSF and subsequently benefited from targeted therapy. There was a clear difference in genetic profiles between CSF and extracranial samples, with CSF showing more driver gene detections, increased Copy Number Variations (CNVs), and varied resistance mechanisms among individuals. Abnormalities in cell-cycle regulatory molecules were highly enriched in LM (50.9% vs 31.0%, p = 0.017), and CDKN2A/2B deletions were identified as an independent poor prognostic factor for LM patients, with a significant reduction in median OS (p = 0.013), supported by multivariate analysis (HR 2.63, 95% CI 1.32-5.26, p = 0.006).

CONCLUSIONS

CSF-based ctDNA analysis is crucial for detecting and characterizing genetic alterations in NSCLC LM. The distinct genetic profiles in CSF and extracranial tissues emphasize the need for personalized treatment approaches.

[Molecular epidemiological characteristics of newly diagnosed HIV-1 cases in Fujian Province in 2020]

OBJECTIVE

To investigate the HIV-1 genotype and distribution of newly diagnosed HIV-1 cases in Fujian Province in 2020, so as to provide insights into formulation of the precise AIDS control strategy in the province.

METHODS

Newly diagnosed HIV-1 cases without antiretroviral therapy (excluding AIDS patients) were randomly sampled from each city of Fujian Province in 2020 at a proportion of 50% of the mean number of HIV-infected cases reported across 9 cities of Fujian Province during the past three years. Subjects' demographic and epidemiological data were collected and blood samples were collected. The HIV-1 pol gene was amplified using nested reverse-transcription PCR assay, and the gene sequences were used for HIV-1 genotyping and phylogenetic analysis. The gene sequences were uploaded to the HIV Drug Resistance Database (http://hivdb.stanford.edu) for genotypic drug resistance assays, and the scores and level of HIV drug resistance were estimated using the HIVDB Algorithm version 9.5.

RESULTS

A total of 1 043 newly diagnosed HIV-1 cases were reported in Fujian Province in 2020, and 936 gene sequences were successfully obtained following sequencing of blood samples. There were 9 HIV-1 genotypes characterized in blood samples from 936 newly diagnosed HIV-1 cases, with CRF07_BC (52.1%) and CRF01_AE (30.4%) as predominant subtypes, followed by CRF08_BC (4.9%), CRF55_01B (3.0%), subtype C (2.5%), subtype B (2.1%), CRF85_BC (1.7%), CRF59_01B (0.3%) and CRF65_CPX (0.1%), and unidentified subtypes were found in 26 blood samples. HIV-1 drug resistance was detected in 43 out of the 936 newly diagnosed HIV-1 cases, with 4.6% prevalence of HIV-1 drug resistance prior to therapy, and the highest drug resistance was found in the HIV CRF59_01B subtype, followed by in CRF08_BC, B, C, CRF01_AE, CRF07_BC and other subtypes, with a significant difference in the genotype-specific prevalence of HIV-1 drug resistance (χ2 = 45.002, P < 0.05).

CONCLUSIONS

There was a HIV-1 genotype diversity in Fujian Province in 2020, and emerging recombinant and drug-resistant HIV-1 strains were detected and spread across patients and regions. Monitoring of HIV-1 genotypes is recommended to be reinforced for timely understanding of the transmission and spread of novel recombinant and drug-resistant HIV-1 strains.

[Advances in oncolytic virotherapy for glioma]

In recent years, there has been significant progress in the research of oncolytic viruses for the therapy of gliomas. The latest clinical trial results related to the modification, effectiveness, and safety of oncolytic viruses have brought hope for the development of glioblastoma treatments. Modified oncolytic viruses, particularly those based on the herpes simplex virus, have gained approval in Japan. Clinical trials involving recombinant poliovirus have shown better-than-expected survival outcomes with a strong safety profile. Notably, the first-time report of adenovirus in combination with immune checkpoint inhibitors for glioblastoma has demonstrated promising survival benefits and safety. However, challenges remain, including the selection of administration routes and the sustainability of treatment effects during oncolytic virus therapy. Therefore, further preclinical and clinical studies are required to improve the effectiveness and optimize treatment strategy for glioblastoma using oncolytic viruses.

Emotional Appeals and Norms: How Normative Perceptions Moderate the Persuasive Impacts of Discrete Emotional Appeals within Tobacco Pictorial Warnings in China

Tobacco pictorial warnings could employ a variety of emotional appeals to enhance effectiveness; however, little research exists to guide the selection of discrete emotional appeals. Further, it remains unclear how contextual pro-smoking norms might influence the persuasive impacts of discrete emotional appeals within pictorial warnings, especially in China, where the overall smoking rate and social acceptance remain high. To fill these gaps, this study leveraged the largest set of pictorial warnings (K = 510) tested to date. Using a randomized large-K multiple-message design, we evaluated the impacts of disgust, fear, self-anger, contempt, shame, and hope appeals among Chinese adult male smokers (N = 2,306) on perceived message effectiveness (PME). Results showed that fear, self-anger, shame, and hope appeals significantly increased PME, while disgust and contempt appeals appeared less effective. Importantly, the PME of nearly all emotional appeals - except hope appeals - was weakened for Chinese adult male smokers with higher pro-smoking normative perceptions, highlighting the importance of considering local contextual influences when implementing pictorial warnings.

Clinical efficacy and safety of adjuvant immunotherapy (Tislelizumab) plus chemotherapy vs. adjuvant chemotherapy alone in lymph node-positive patients with gastric cancer after D2 radical resection: a prospective, 2-arm, phase II study

OBJECTIVE

This study aims to investigate the effectiveness and safety of adjuvant Tislelizumab (BeiGene China Co., Ltd, Changping District, Beijing, China) in combination with chemotherapy for patients with localized lymph node-positive disease following D2 (extended lymphadenectomy) radical gastrectomy for gastric cancer.

PATIENTS AND METHODS

Patients with lymph node-positive gastric cancer who underwent D2 radical gastrectomy at Yixing People's Hospital between April 2021 and June 2022 were selected and enrolled in the study. They were divided into the study group, which received immunotherapy (Tislelizumab) in combination with chemotherapy (XELOX regimen: Xeloda plus Oxaliplatin), or the control group, which received chemotherapy alone (XELOX regimen). Adverse events, disease-free survival (DFS), and overall survival (OS) were observed. This study was registered on ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT05844371).

RESULTS

The one-year disease-free survival (DFS) rate was 81.82% in the study group compared to 71.43% in the control group. Although the DFS rate tended to be higher in the study group, the difference did not reach statistical significance (p=0.388, HR=0.573, 95% CI: 0.161-2.032). Patients in both groups tolerated the treatment well. Both groups exhibited similar rates of neutropenia, hemoglobin depletion, gastrointestinal reactions, abnormal liver function, and peripheral neuritis. The majority of adverse events in both groups were grade 1-2, with only hypothyroidism showing a significant difference (p=0.021). The only statistically significant difference in grade 3-4 adverse events was thrombocytopenia (p=0.048). All adverse reactions were effectively managed with symptomatic treatment.

CONCLUSIONS

The addition of adjuvant PD-1 inhibitor (Tislelizumab) to XELOX therapy showed a favorable impact on the one-year disease-free survival (DFS) rate when compared to adjuvant XELOX chemotherapy alone in patients with regional lymph node-positive disease after D2 radical gastrectomy. Moreover, patients were able to tolerate the accompanying adverse effects, which were deemed safe.

Impacts of landscape pattern evolution on typical ecosystem services in Ganjiang River Basin, China

Understanding the response mechanism of ecosystem services (ES) to landscape patterns is important in regional landscape planning and sustainable development. In this study, the landscape index and InVEST model were used to quantitatively analyze the spatio-temporal evolution of landscape patterns and ES in the Ganjiang River Basin of China from 1990 to 2020. Furthermore, the bivariate Moran's I method and spatial error model were used to test the spatial correlation between landscape index and ES. The results showed that (1) cropland decreased and construction land increased, and the overall landscape tended to be fragmented, the patch shape complicated, and landscape diversity increased from 1990 to 2020. Water conservation (WC) and soil conservation (SC) capacity increased by 10.56 mm and 16.24 t hm-2 a-1, respectively, whereas carbon storage (CS) decreased by 1.22 t hm-2 a-1. (2) The responses of different typical ES to landscape patterns were different in the landscape index and response degree. Typical ES negatively responded to Shannon's diversity index and patch density. WC was sensitive to the Splitting Index, whereas SC and CS were more responsive to the average patch area. (3) The overall purpose of territorial spatial planning within a basin should be to reduce the fragmentation and heterogeneity of the landscape. According to four local aggregation patterns of landscape index and ES, corresponding measures can be taken according to local conditions in different regions. These results can provide a quantitative basis for landscape management and ecological construction in the Ganjiang River Basin and scientific guidance for the Yangtze River conservation strategy.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

Eggshell Biowaste-Derived Flexible and Self-Cleaning Films for Efficient Subambient Daytime Radiative Cooling

The management of the abundant eggshell biowaste produced worldwide has become a problematic issue due to the generated odor and microorganisms after direct disposal of the eggshell biowaste in landfills. Herein, we propose a new method to convert the hazardous eggshell biowaste to valuable resources for energy management applications. Eggshell-based films are fabricated by embedding eggshell powders into a polymer matrix to achieve highly efficient subambient daytime radiative cooling. Benefiting from the Mie scattering of the eggshell particles/air pores in the solar spectrum and the strong emission of the eggshell in the mid-infrared (mid-IR) range, the eggshell-based films present a high reflection of 0.96 in the solar spectrum and a high emission of 0.95 in the mid-IR range, with notable average temperature reductions of 4.1 and 11 °C below the ambient temperature during daytime and nighttime, respectively. Moreover, the eggshell-based films exhibit excellent flexibility and self-cleaning properties, which are beneficial for practical long-term outdoor applications. Our proposed design provides a new means for environmentally friendly and sustainable management of eggshell biowaste.

Learning Intention-Aware Policies in Deep Reinforcement Learning

Deep reinforcement learning (DRL) provides an agent with an optimal policy so as to maximize the cumulative rewards. The policy defined in DRL mainly depends on the state, historical memory, and policy model parameters. However, we humans usually take actions according to our own intentions, such as moving fast or slow, besides the elements included in the traditional policy models. In order to make the action-choosing mechanism more similar to humans and make the agent to select actions that incorporate intentions, we propose an intention-aware policy learning method in this letter To formalize this process, we first define an intention-aware policy by incorporating the intention information into the policy model, which is learned by maximizing the cumulative rewards with the mutual information (MI) between the intention and the action. Then we derive an approximation of the MI objective that can be optimized efficiently. Finally, we demonstrate the effectiveness of the intention-aware policy in the classical MuJoCo control task and the multigoal continuous chain walking task.

Knockdown of Long Noncoding RNA CCAT2 Suppresses Malignant Phenotype in Human Laryngeal Squamous Cell Carcinoma

This study aimed to explore the biological role and mechanism underlying the effects of colon cancer-associated transcript 2 (CCAT2), a long noncoding RNA (lncRNA) in human laryngeal squamous cell carcinoma (LSCC). CCAT2 expression levels in clinical LSCC samples and TU-212 cell line were evaluated by quantitative real-time PCR. The correlation of CCAT2 expression level with clinical-pathological characteristics of patients and their prognosis was analyzed. The functional role of CCAT2 in human LSCC was assessed by Cell Counting Kit-8, Transwell assay, flow cytometric analysis, and LSCC xenograft experiment in vivo. The expression of potential targeted proteins was detected by Western blotting and immunohistochemistry. We found that expression of CCAT2 was significantly elevated in LSCC tissues and TU-212 cells (p<0.05). Survival analysis showed that LSCC patients with high expression of CCAT2 had a shorter 5-year overall survival rate than those with low expression (p<0.05). In addition, CCAT2 silencing with short hairpin RNA significantly decreased the proliferative and invasive potential of TU-212 cells (p<0.05) and promoted their apoptosis. In Nude mice, CCAT2 knockdown suppressed the growth of tumor and decreased its volume and weight in comparison with the controls (p<0.05). In TU-212 cells, CCAT2 silencing with short hairpin RNA significantly down-regulated the expression of β-catenin and CDK8 (p<0.05). Thus, knockdown of CCAT2 suppresses proliferation and invasion of the cells and inhibits Wnt/β-catenin signaling pathway in LSCC, which indicates novel therapeutic targets and prognostic indicators in patients with LSCC.

Design of a High-Performance Titanium Nitride Metastructure-Based Solar Absorber Using Quantum Computing-Assisted Optimization

Metastructures of titanium nitride (TiN), a plasmonic refractory material, can potentially achieve high solar absorptance while operating at elevated temperatures, but the design has been driven by expert intuition. Here, we design a high-performance solar absorber based on TiN metastructures using quantum computing-assisted optimization. The optimization scheme includes machine learning, quantum annealing, and optical simulation in an iterative cycle. It designs an optimal structure with solar absorptance > 95% within 40 h, much faster than an exhaustive search. Analysis of electric field distributions demonstrates that combined effects of Fabry-Perot interferences and surface plasmonic resonances contribute to the broadband high absorption efficiency of the optimally designed metastructure. The designed absorber may exhibit great potential for solar energy harvesting applications, and the optimization scheme can be applied to the design of other complex functional materials.

[Diagnosis and treatment procedures and health management for patients with hereditary angioedema]

As a recognized rare and highly fatal disease, hereditary angioedema (HAE) is difficult to diagnose and characterized by recurrent edema involving the head, limbs, genitals and larynx, etc. Diagnosis of HAE is not difficult. However, low incidence and lack of clinical characteristics lead to difficulty of doctors on timely diagnosis and correct intervention for HAE patients. Therefore, it is crucial to improve the awareness of this disease and prevent its recurrence. for HAE patients. In view of absent cognition of doctors and the general public on HAE, patients often suffer from sudden death or become disabled due to laryngeal edema which cannot be treated in time. Thus, based on the Internet mobile terminal platform, the team set up an all-day rapid emergency response system which is provided for HAE patients by setting up "one-click help". The aim is to offer optimization on overall management of HAE and designed the intelligent follow-up management to provide timely assistance and specialized suggestion for patients with acute attacks.

Suppressing Dendrite Growth and Side Reactions via Mechanically Robust Laponite-Based Electrolyte Membranes for Ultrastable Aqueous Zinc-Ion Batteries

The development of aqueous zinc-ion batteries (AZIBs) faces significant challenges because of water-induced side reactions arising from the high water activity in aqueous electrolytes. Herein, a quasi-solid-state electrolyte membrane with low water activity is designed based on a laponite (LP) nanoclay for separator-free AZIBs. The mechanically robust LP-based membrane can perform simultaneously as a separator and a quasi-solid-state electrolyte to inhibit dendrite growth and water-induced side reactions at the Zn/electrolyte interface. A combination of density functional theory calculations, theoretical analyses, and experiments ascertains that the water activities associated with self-dissociation, byproduct formation, and electrochemical decomposition could be substantially suppressed when the water molecules are absorbed by LP. This could be attributed to the high water adsorption and hydration capabilities of LP nanocrystals, resulting from the strong Coulombic and hydrogen-binding interactions between water and LP. Most importantly, the separator-free AZIBs exhibit high capacity retention rates of 94.10% after 2,000 cycles at 1 A/g and 86.32% after 10,000 cycles at 3 A/g, along with enhanced durability and record-low voltage decay rates over a 60-day storage period. This work provides a fundamental understanding of water activity and demonstrates that LP nanoclay is promising for ultrastable separator-free AZIBs for practical energy storage applications.

Genomic characterisation of de novo EGFR copy number gain and its impact on the efficacy of first-line EGFR-tyrosine kinase inhibitors for EGFR mutated non-small cell lung cancer

BACKGROUND

Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation generally respond well to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). However, genomic characterisation of de novo EGFR copy number gain (CNG) and its impact on the efficacy of first-line EGFR-TKIs remains unclear.

METHODS

This multicenter, retrospective and real-world study included two cohorts that enroled EGFR mutant NSCLC patients. EGFR CNG was tested by next-generation sequencing of untreated tissue specimens. Cohort 1 detected the impact of EGFR CNG on first-line EGFR-TKIs treatment, and cohort 2 explored the genomic characterisation.

RESULTS

Cohort 1 enroled 355 patients from four cancer centres between January 2013 and March 2022. The patients were divided into three groups, included the EGFR non-CNG, EGFR CNG, and EGFR uncertain-CNG. No significant difference in progression-free survival (PFS) was found between the three groups (10.0 months vs. 10.8 months vs. 9.9 months, respectively, p = 0.384). Furthermore, the overall response rate was not statistically significant in the EGFR CNG group compared to the EGFR non-CNG or uncertain arm (70.3% vs. 63.2% vs. 54.5%, respectively, p = 0.154). Cohort 2 included 7876 NSCLC patients with 16.4% showing EGFR CNG. Gene mutations such as TP53, IKZF1, RAC1, MYC, MET, CDKN2A/B and alterations of the metabolic-related and ERK signalling pathway were significantly associated with patients with EGFR CNG compared to those without.

CONCLUSIONS

De novo EGFR CNG had no effect on the efficacy of first-line EGFR-TKI treatment in EGFR mutant NSCLC patients, and tumours with EGFR CNG had more complex genomic profiles than those without.

CLDN6 Suppresses Migration and Invasion of MCF-7 and SKBR-3 Breast Cancer Cells by Blocking the SMAD/Snail/MMP-2/9 Axis

The study examined the mechanisms of action of signal protein claudin 6 (CLDN6) on migration and invasion of breast cancer cell lines MCF-7 and SKBR-3. To this end, the signal proteins SMAD were blocked with their inhibitor SB431542, the genes CLDN6 and SNAIL were knocked down with short hairpin RNAs, and MMP2 and MMP9 were inhibited with TIMP-1. Expressions of MMP2 and MMP9 mRNAs were evaluated by reverse transcription PCR, Expressions of MMP-2, MMP-9, E-cadherin, N-cadherin, and vimentin were examined by Western blotting. Migration and invasion were analyzed by scratch test and Matrigel invasion assay. SB431542 inhibited expression of MMP2 and MMP9 in both cell lines. Single use of SB431542 inhibited expression of MMP-2/MMP-9 and corresponding mRNAs, but subsequent silencing of CLDN6 gene reversed this effect. TIMP-1 reversed down-regulation of E-cadherin, upregulation of N-cadherin and vimentin, facilitation of migration and invasion evoked by CLDN6 knocking down. Silencing of SNAIL gene inhibited migration and invasion, upregulated the expression of E-cadherin, and down-regulated expression of MMP2, MMP 9, N-cadherin, and vimentin. Thus, CLDN6 suppresses the epithelial-mesenchymal transition, migration, and invasion via blocking SMAD/Snail/MMP-2/9 signaling pathway in MCF-7 and SKBR-3 cancer cell lines.

Molecular Alignment-Mediated Stick-Slip Poiseuille Flow of Oil in Graphene Nanochannels

The flow behavior of oil in nanochannels has attracted extensive attention for oil transport applications. In most, if not all, of the prior theoretical simulations, oil molecules were observed to flow steadily in nanochannels under pressure gradients. In this study, non-equilibrium molecular dynamics simulations are conducted to simulate the Poiseuille flow of oil with three different hydrocarbon chain lengths in graphene nanochannels. Contrary to the conventional perception of steady flows of oil in nanochannels, we find that oil molecules with the longest hydrocarbon chain (i.e., n-dodecane) exhibit notable stick-slip flow behavior. An alternation between the high average velocity of n-dodecane in the slip motion and the low average velocity in the stick motion is observed, with a drastic, abrupt velocity jolt of up to 40 times occurring at the transition in a stick-slip motion. Further statistical analyses show that the stick-slip flow behavior of n-dodecane molecules originates from the molecular alignment change of oil near the graphene wall. The molecular alignment of n-dodecane shows different statistical distributions under stick and slip motion states, leading to significant changes of friction forces and thus notable velocity fluctuations. This work provides new insights into the Poiseuille flow behavior of oil in graphene nanochannels and may offer useful guidelines for other mass transport applications.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

Photosynthetic Fixation of CO2 in Alkenes by Heterogeneous Photoredox Catalysis with Visible Light

Light-driven fixation of CO2 in organics has emerged as an appealing alternative for the synthesis of value-added fine chemicals. Challenges remain in the transformation of CO2 as well as product selectivity due to its thermodynamic stability and kinetic inertness. Here we develop a boron carbonitride (BCN) with the abundant terminal B/N defects around the mesoporous walls, which essentially enhances surface active sites as well as charge transfer kinetics, boosting the overall rate of CO2 adsorption and activation. In this protocol, anti-Markovnikov hydrocarboxylation of alkenes with CO2 to an extended carbon chain is achieved with good functional group tolerance and specific regioselectivity under visible light irradiation. The mechanistic studies demonstrate the formation of CO2 radical anion intermediate on defective boron carbonitride, leading to the anti-Markovnikov carboxylation. Gram-scale reaction, late-stage carboxylation of natural products and synthesis of anti-diabetic GPR40 agonists reveal the utility of this method. This study sheds new insight on the design and application of metal-free semiconductors for the conversion of CO2 in an atom-economic and sustainable manner.

[Enhanced endoplasmic reticulum RyR1 receptor phosphorylation leads to diaphragmatic dysfunction in septic rats]

OBJECTIVE

To explore the role of endoplasmic reticulum ryanodine receptor 1 (RyR1) expression and phosphorylation in sepsis- induced diaphragm dysfunction.

METHODS

Thirty SPF male SD rats were randomized equally into 5 groups, including a sham-operated group, 3 sepsis model groups observed at 6, 12, or 24 h following cecal ligation and perforation (CLP; CLP-6h, CLP-12h, and CLP-24h groups, respectively), and a CLP-24h group with a single intraperitoneal injection of KN- 93 immediately after the operation (CLP-24h+KN-93 group). At the indicated time points, diaphragm samples were collected for measurement of compound muscle action potential (CMAP), fatigue index of the isolated diaphragm and fitted frequencycontraction curves. The protein expression levels of CaMK Ⅱ, RyR1 and P-RyR1 in the diaphragm were detected using Western blotting.

RESULTS

In the rat models of sepsis, the amplitude of diaphragm CMAP decreased and its duration increased with time following CLP, and the changes were the most obvious at 24 h and significantly attenuated by KN-93 treatment (P < 0.05). The diaphragm fatigue index increased progressively following CLP (P < 0.05) irrespective of KN- 93 treatment (P>0.05). The frequency-contraction curve of the diaphragm muscle decreased progressively following CLP, and was significantly lower in CLP-24 h group than in CLP-24 h+KN-93 group (P < 0.05). Compared with that in the sham-operated group, RyR1 expression level in the diaphragm was significantly lowered at 24 h (P < 0.05) but not at 6 or 12 following CLP, irrespective of KN-93 treatment; The expression level of P-RyR1 increased gradually with time after CLP, and was significantly lowered by KN-93 treatment at 24 h following CLP (P < 0.05). The expression level of CaMKⅡ increased significantly at 24 h following CLP, and was obviously lowered by KN-93 treatment (P < 0.05).

CONCLUSION

Sepsis causes diaphragmatic dysfunction by enhancing CaMK Ⅱ expression and RyR1 receptor phosphorylation in the endoplasmic reticulum of the diaphragm.

[Genomic epidemiology of Vibrio parahaemolyticus from acute diarrheal patients in Shenzhen City from 2013 to 2021]

Objective: To characterize the prevalence and genomic epidemiology of Vibrio parahaemolyticus from acute diarrheal patients in Shenzhen City from 2013 to 2021. Methods: Based on the Shenzhen Infectious Diarrhea Surveillance System, acute diarrheal patients were actively monitored in sentinel hospitals from 2013 to 2021. Whole-genome sequencing (WGS) of Vibrio parahaemolyticus isolates was performed, and the genomic population structure, serotypes, virulence genes and multilocus sequence typing were analyzed. Outbreak clusters from 2019 to 2021 were explored based on single-nucleotide polymorphism analysis. Results: A total of 48 623 acute diarrhea cases were monitored in 15 sentinel hospitals from 2013 to 2021, and 1 135 Vibrio parahaemolyticus strains were isolated, with a positive isolation rate of 2.3%. Qualified whole-genome sequencing data of 852 isolates were obtained. Eighty-nine serotypes, 21 known ST types and 5 new ST types were identified by sequence analysis, and 93.2% of strains were detected with toxin profile of tdh+trh-. 8 clonal groups (CGs) were captured, with CG3 as the absolute predominance, followed by CG189. The CG3 group was dominated by O3:K6 serotype and ST3 sequence type, while CG189 group was mainly O4:KUT, O4:K8 serotypes and ST189a and ST189 type. A total of 13 clusters were identified, containing 154 cases. About 30 outbreak clusters with 29 outbreak clusters caused by CG3 strains from 2019 to 2021. Conclusion: Vibrio parahaemolyticus is a major pathogen of acute infectious diarrhea in Shenzhen City, with diverse population structures. CG3 and CG189 have been prevalent and predominant in Shenzhen City for a long time. Scattered outbreaks and persistent sources of contamination ignored by traditional methods could be captured by WGS analysis. Tracing the source of epidemic clone groups and taking precise prevention and control measures are expected to significantly reduce the burden of diarrhea diseases caused by Vibrio parahaemolyticus infection in Shenzhen City.

[Femtosecond laser-assisted open astigmatic keratotomy versus non-open astigmatic keratotomy for astigmatism correction in cataract surgery]

Objective: To compare the effects of femtosecond laser-assisted astigmatic keratotomy (FSAK) with and without a manual opening for correction of low to moderate corneal astigmatism at the time of cataract surgery. Methods: It was a prospective cohort study. Patients undergoing cataract surgery from June 2021 to June 2022 at the Army Specialty Medical Center were consecutively enrolled. To correct low to moderate astigmatism, they had combined FSAK with the corneal epithelium manually opened or not according to their own decisions. Pentacam HR corneal topography was performed at 3 months after surgery. The main indicators were target induced astigmatism, surgically induced astigmatism, difference vector, correction index and angle of error. The independent samples t-test was used for continuous variables conforming to a normal distribution, the Mann-Whitney U-test for those not conforming to a normal distribution, and the Chi-square test for categorical variables. Results: There were 51 patients (61 eyes), including 27 patients (31 eyes) receiving combined open FSAK and 24 patients (30 eyes) with non-open keratotomy. No statistical difference was found between the two groups of patients in terms of age, gender and mean follow-up time (P>0.05). The target induced astigmatism was 1.10(0.80, 1.50) D in patients with open keratotomy and 1.30(0.98, 1.73) D in patients with non-open keratotomy (Z=1.729, P=0.084). The surgically induced astigmatism was 0.70 (0.59, 1.25) D and 0.42 (0.20, 0.66) D (Z=-3.571, P<0.001), the difference vector was (0.51±0.31) D and (1.21±0.44) D (t=-7.238, P<0.001), the correction index was 0.78±0.32 and 0.38±0.25 (t=5.386, P<0.001), and the angle of error was -1.08°±10.76° and 5.93°±46.98° (t=0.809, P=0.422) in the two groups, respectively. Conclusion: Open FSAK can achieve better astigmatism correction and less postoperative residual astigmatism than non-open FSAK in cataract surgery.

Modes and Mechanisms of Pacific Decadal-Scale Variability

The modes of Pacific decadal-scale variability (PDV), traditionally defined as statistical patterns of variance, reflect to first order the ocean's integration (i.e., reddening) of atmospheric forcing that arises from both a shift and a change in strength of the climatological (time-mean) atmospheric circulation. While these patterns concisely describe PDV, they do not distinguish among the key dynamical processes driving the evolution of PDV anomalies, including atmospheric and ocean teleconnections and coupled feedbacks with similar spatial structures that operate on different timescales. In this review, we synthesize past analysis using an empirical dynamical model constructed from monthly ocean surface anomalies drawn from several reanalysis products, showing that the PDV modes of variance result from two fundamental low-frequency dynamical eigenmodes: the North Pacific-central Pacific (NP-CP) and Kuroshio-Oyashio Extension (KOE) modes. Both eigenmodes highlight how two-way tropical-extratropical teleconnection dynamics are the primary mechanisms energizing and synchronizing the basin-scale footprint of PDV. While the NP-CP mode captures interannual- to decadal-scale variability, the KOE mode is linked to the basin-scale expression of PDV on decadal to multidecadal timescales, including contributions from the South Pacific.

TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia

Acute myeloid leukemia (AML) is classified into favorable-risk, intermediate-risk, and poor-risk subtypes. This study aimed to compare the serum proteomic signatures of the three AML subtypes and identify prognostic biomarkers for AML. Serum samples from patients with favorable-risk (n = 14), intermediate-risk (n = 19), and poor-risk AMLs (n = 18) were used for the analysis of tandem mass tag (TMT) labeling-based quantitative proteomics. Comparative analysis was performed to identify differentially expressed proteins (DEPs) between groups. Prognostic proteins were screened using binary logistics regression analysis. TMT-MS/MS proteomics analysis identified 138 DEPs. Fumarate hydratase (FH), isocitrate dehydrogenase 2 (IDH2), and enolase 1 (ENO1) were significantly upregulated in poor-risk patients compared with favorable-risk patients. ELISA assay confirmed that patients with poor-risk AMLs had higher levels of IDH2, ENO1, and FH compared with intermediate-risk AML patients. Logistics analysis identified that proteins 3-hydroxyacyl-CoA dehydrogenase type-2 (HADH, odds ratio (OR) = 1.035, p = 0.010), glutamine synthetase (GLUL, OR = 1.022, p = 0.039), and lactotransferrin (LTF, OR = 1.1224, p = 0.016) were associated with poor prognosis, and proteins ENO1 (OR = 1.154, p = 0.053), FH (OR = 1.043, p = 0.059), and IDH2 (OR = 3.350, p = 0.055) were associated with AML prognosis. This study showed that AML patients had elevated levels of FH, IDH2, ENO1, LTF, and GLUL proteins and might be at high risk of poor prognosis.

Investigating Partially Discordant Results in Phase 3 Studies of Aducanumab

OBJECTIVES

Efficacy and safety results from the EMERGE (NCT02484547) and ENGAGE (NCT02477800) phase 3 studies of aducanumab in early Alzheimer's disease (AD) have been published. In EMERGE, but not in ENGAGE, high-dose aducanumab demonstrated significant treatment effects across primary and secondary endpoints. Low-dose aducanumab results were consistent across studies with non-significant differences versus placebo that were intermediate to the high-dose arm in EMERGE. The present investigation examined data from EMERGE and ENGAGE through post-hoc analyses to determine factors that contributed to discordant results between the high-dose arms of the two studies.

DESIGN

EMERGE and ENGAGE were 2 phase 3, randomized, double-blind, placebo-controlled, parallel-group studies.

SETTING

EMERGE and ENGAGE were 2 global multicenter studies involving 348 sites in 20 countries.

PARTICIPANTS

Participants in EMERGE and ENGAGE were aged 50 to 85 years and had mild cognitive impairment or mild AD dementia with confirmed amyloid pathology. The randomized and dosed population (all randomized patients who received at least one dose of study treatment) included 1638 patients in EMERGE and 1647 in ENGAGE.

INTERVENTION

In EMERGE and ENGAGE, participants were randomized to receive low- or high-dose aducanumab or placebo (1:1:1) once every 4 weeks.

MEASUREMENTS

In this paper, 4 areas were investigated through post-hoc analyses to understand the discordance in the high-dose arms of the EMERGE and ENGAGE studies: baseline characteristics, amyloid-related imaging abnormalities, non-normality of the data, and dosing/exposure to aducanumab.

RESULTS

Post-hoc analyses showed that outcomes in the ENGAGE high-dose group were affected by an imbalance in a small number of patients with extremely rapid progression and by lower exposure to the target dose of 10 mg/kg. These factors were confounded and present in early enrolled patients but were not present in later-enrolled patients who were randomized to the target dosing regimen of 10 mg/kg after titration. Neither baseline characteristics nor amyloid-related imaging abnormalities contributed to the difference in results between the high-dose arms.

CONCLUSIONS

Results were consistent across studies in later enrolled patients in which the incidence of rapidly progressing patients was balanced across treatment arms.