Association between a body shape index and prostate cancer: a cross-sectional study of NHANES 2001-2018

OBJECTIVE

Abdominal obesity, especially visceral fat, may have negative effects on the development and progression of prostate cancer (PCa). A body shape index (ABSI) can more accurately measure visceral fat accumulation. This study aimed to investigate the association between ABSI and PCa in US adults.

METHODS

11,013 participants were enrolled in the National Health and Nutrition Examination Survey from 2001 to 2018. Weighted multivariate logistic regression analyses were employed to explore the independent relationship between ABSI and PCa. Moreover, restricted cubic spline (RCS) analysis, subgroup analysis, and interaction tests were performed.

RESULTS

ABSI was positively associated with the presence of PCa. When comparing the second, third, and fourth ABSI quartile to the lowest quartile, the adjusted odds ratios (95% confidence intervals) for PCa risk were 1.34 (0.77, 2.31), 1.75 (1.03, 3.00), and 1.91 (1.12, 3.27), respectively (p for trend = 0.011). The restricted cubic spline regression analysis did not reveal a non-linear correlation between ABSI and PCa (p for non-linearity = 0.076). Subgroup analysis showed a significant interaction effect in subgroups of different BMI (p for interaction = 0.01).

CONCLUSIONS

Elevated ABSI is significantly associated with an increased risk of PCa, particularly among individuals who are under/normal weighted or obese.

Comparison of the Measurement Properties of EQ-5D-5L and SF-6Dv2 in COVID-19 Patients in China

BACKGROUND AND OBJECTIVES

There are limited studies comparing the health utility values of EQ-5D-5L and SF-6Dv2 within the same patient cohorts. The widespread transmission and recurring infections associated with Omicron variants amid the COVID-19 pandemic have resulted in substantial health detriments and increased utilisation of health care resources. This highlights the crucial need to assess the loss in quality-adjusted life years (QALYs). Therefore, this study aims to compare the ceiling and floor effects, agreement, correlation and responsiveness between EQ-5D-5L and SF-6Dv2 based on COVID-19 patients during the Omicron outbreak in China.

METHODS

We recruited 694 COVID-19 patients across mainland China to participant in an online questionnaire survey from January to February 2023. The questionnaire encompassed queries concerning the sociodemographic and health details of the participants, who were requested to recollect their health status during and after experiencing COVID-19 using the EQ-5D-5L and SF-6Dv2 questionnaires. Epanechnikov kernel density plots were used to visualise the ceiling and floor effects for both instruments. Agreement was assessed by Bland-Altman graph and intraclass correlation coefficient (ICC). Correlation was evaluated using linear regression, Pearson's correlation and Spearman's correlation. The standardised response mean (SRM) and relative efficiency (RE) were used to examine the responsiveness of EQ-5D-5L and SF-6Dv2 at detecting the health improvement after COVID-19 infection and the difference in dichotomous health indicators.

RESULTS

In total, 648 valid responses from patients aged 35.6 ± 15.0 years were involved in analysis. The EQ-5D-5L utility indices were 0.58 ± 0.33 and 0.92 ± 0.14 during and after COVID-19 infection, respectively, which were significantly higher than indices of the SF-6Dv2 utility (0.43 ± 0.31 and 0.81 ± 0.19, p < 0.001). A ceiling effect of EQ-5D-5L larger than that of SF-6Dv2 was observed during COVID-19 infection (49.5% vs 21.6%). Intraclass correlation coefficients between EQ-5D-5L and SF-6Dv2 during and after COVID-19 infection were 0.69 and 0.55, respectively. The utility indices of EQ-5D-5L and SF-6Dv2 were highly correlated, with Pearson's correlation coefficients of 0.76 and 0.70 (p < 0.001) during and after COVID-19 infection, respectively. The spearman's correlations were moderate to high between dimensions of EQ-5D-5L and SF-6Dv2 (p < 0.01). Both EQ-5D-5L and SF-6Dv2 were responsive to detect health improvement after COVID-19 and the differences in dichotomous health indicators.

CONCLUSIONS

The utility indices generated by EQ-5D-5L and SF-6Dv2 in COVID-19 patients demonstrate strong correlation and responsiveness. However, the agreement between these two instruments does not reach a satisfactory level. Consequently, these two measures cannot be used interchangeably. In situations where apprehensions about ceiling effects affecting outcome measurement arise, it is advisable to consider SF-6Dv2 as a preferable outcome measure for studies on patients with COVID-19.

Novel Circular RNA CircUBAP2 Drives Tumor Progression by Regulating the miR-143/TFAP2B Axis in Prostate Cancer

BACKGROUND

More and more investigations reveal that circular RNAs (circRNAs) are involved in cancer progression. CircRNA UBAP2 was closely related to prostate cancer. However, the biological function and specifical mechanism of circUBAP2 are still poorly discovered in prostate cancer (PCa).

OBJECTIVES

This study aims to explore the biological function and mechanism of circUBAP2 in PCa.

METHODS

The levels of mRNA and proteins were assessed by qRT-PCR assay and Western blot, respectively. Cell growth, migration, and invasion ability were measured using CCK-8 assay and Transwell assay. Apoptosis was assessed using flow cytometry. The interactions between circUBAP2, miR-143, and TFAP2B were determined by luciferase report assay. The tumor growth was determined by in vivo tumor formation assay. The tumor morphology was assessed using H&E staining assay, and immunohistochemistry assay was conducted to assess the level of KI67.

RESULTS

We found circUBAP2 and TFAP2B were notably elevated, while miR-143 was largely attenuated in prostate cancer cells and tissues. CircUBAP2 was found to affect cell viability, metastasis and EMT, while attenuating the apoptosis rate of prostate cancer cells. CircUBAP2 directly targeted miR-143, and miR-143 inhibitor could reverse the effects that circUBAP2 interference-induced in prostate cancer cells. TFAP2B is directly bound to miR-143, and overexpression of TFAP2B could attenuate the influences that miR-143-induced in prostate cancer cells.

CONCLUSION

CircUBAP2 promoted prostate cancer progression via miR-143/TFAP2B axis.

Immunogenicity and Safety of One versus Two Doses of Quadrivalent Inactivated Influenza Vaccine (IIV4) in Vaccine-Unprimed Children and One Dose of IIV4 in Vaccine-Primed Children Aged 3-8 Years

Two doses of the inactivated influenza vaccine (IIV) are generally recommended for children under 9 years old. This study assessed the necessity for a second dose of quadrivalent IIV (IIV4) in children aged 3-8 years. In this randomized, open-label, paralleled-controlled study, 400 children aged 3-8 years who were vaccine-unprimed were randomly assigned at a 1:1 ratio to receive a two-dose (Group 1) or one-dose (Group 2) regimen of IIV4, and 200 who were vaccine-primed received one dose of IIV4 (Group 3). A serum sample was collected before and 28 days after the last dose to determine the hemagglutination inhibition (HI) antibody level. Adverse events were collected within 28 days after each dose. One-dose or two-doses of IIV4 were well tolerated and safe in children aged 3-8 years, and no serious adverse events related to the vaccine were reported. The seroconversion rates (SCRs) of HI antibody ranged from 61.86% to 95.86%, and the post-vaccination seroprotection rates (SPRs) were all >70% in three groups against the four virus strains. The two-dose regimen in vaccine-unprimed participants (Group 1) achieved similar SPRs in comparison with the one-dose in the vaccine-primed group (Group 3), and the SPRs in Group 1 and Group 3 were higher in vaccine-unprimed participants of the one-dose regimen (Group 2). The present study supports the recommendations of a two-dose regimen for IIV4 use in children aged 3-8 years.

First-principles molten salt phase diagrams through thermodynamic integration

Precise prediction of phase diagrams in molecular dynamics simulations is challenging due to the simultaneous need for long time and large length scales and accurate interatomic potentials. We show that thermodynamic integration from low-cost force fields to neural network potentials trained using density-functional theory (DFT) enables rapid first-principles prediction of the solid-liquid phase boundary in the model salt NaCl. We use this technique to compare the accuracy of several DFT exchange-correlation functionals for predicting the NaCl phase boundary and find that the inclusion of dispersion interactions is critical to obtain good agreement with experiment. Importantly, our approach introduces a method to predict solid-liquid phase boundaries for any material at an ab initio level of accuracy, with the majority of the computational cost at the level of classical potentials.

The Change in Whole-Genome Methylation and Transcriptome Profile under Autophagy Defect and Nitrogen Starvation

Through whole-genome bisulfite sequencing and RNA-seq, we determined the potential impact of autophagy in regulating DNA methylation in Arabidopsis, providing a solid foundation for further understanding the molecular mechanism of autophagy and how plants cope with nitrogen deficiency. A total of 335 notable differentially expressed genes (DEGs) were discovered in wild-type Arabidopsis (Col-0-N) and an autophagic mutant cultivated under nitrogen starvation (atg5-1-N). Among these, 142 DEGs were associated with hypomethylated regions (hypo-DMRs) and were upregulated. This suggests a correlation between DNA demethylation and the ability of Arabidopsis to cope with nitrogen deficiency. Examination of the hypo-DMR-linked upregulated DEGs indicated that the expression of MYB101, an ABA pathway regulator, may be regulated by DNA demethylation and the recruitment of transcription factors (TFs; ERF57, ERF105, ERF48, and ERF111), which may contribute to the growth arrest induced by abscisic acid (ABA). Additionally, we found that DNA methylation might impact the biosynthesis of salicylic acid (SA). The promoter region of ATGH3.12 (PBS3), a key enzyme in SA synthesis, was hypomethylated, combined with overexpression of PBS3 and its potential TF AT3G46070, suggesting that autophagy defects may lead to SA-activated senescence, depending on DNA demethylation. These findings suggest that DNA hypomethylation may impact the mechanism by which Arabidopsis autophagy mutants (atg5-1) respond to nitrogen deficiency, specifically in relation to ABA and SA regulation. Our evaluation of hormone levels verified that these two hormones are significantly enriched under nitrogen deficiency in atg5-1-N compared to Col-0-N.

Temporal contexts for motion tracking in ultrasound sequences with information bottleneck

BACKGROUND

Recently, deep convolutional neural networks (CNNs) have been widely adopted for ultrasound sequence tracking and shown to perform satisfactorily. However, existing trackers ignore the rich temporal contexts that exists between consecutive frames, making it difficult for these trackers to perceive information about the motion of the target.

PURPOSE

In this paper, we propose a sophisticated method to fully utilize temporal contexts for ultrasound sequences tracking with information bottleneck. This method determines the temporal contexts between consecutive frames to perform both feature extraction and similarity graph refinement, and information bottleneck is integrated into the feature refinement process.

METHODS

The proposed tracker combined three models. First, online temporal adaptive convolutional neural network (TAdaCNN) is proposed to focus on feature extraction and enhance spatial features using temporal information. Second, information bottleneck (IB) is incorporated to achieve more accurate target tracking by maximally limiting the amount of information in the network and discarding irrelevant information. Finally, we propose temporal adaptive transformer (TA-Trans) that efficiently encodes temporal knowledge by decoding it for similarity graph refinement. The tracker was trained on 2015 MICCAI Challenge on Liver Ultrasound Tracking (CLUST) dataset to evaluate the performance of the proposed method by calculating the tracking error (TE) between the predicted landmarks and the ground truth landmarks for each frame. The experimental results are compared with 13 state-of-the-art methods, and ablation studies are conducted.

RESULTS

On CLUST 2015 dataset, our proposed model achieves a mean TE of 0.81 ± 0.74 mm and a maximum TE of 1.93 mm for 85 point-landmarks across 39 ultrasound sequences in the 2D sequences. Tracking speed ranged from 41 to 63 frames per second (fps).

CONCLUSIONS

This study demonstrates a new integrated workflow for ultrasound sequences motion tracking. The results show that the model has excellent accuracy and robustness. Reliable and accurate motion estimation is provided for applications requiring real-time motion estimation in the context of ultrasound-guided radiation therapy.

[Analysis of clinicopathological and molecular abnormalities of angioimmunoblastic T-cell lymphoma]

OBJECTIVE

To analyze the clinicopathological features, molecular changes and prognostic factors in angioimmunoblastic T-cell lymphoma (AITL).

METHODS

Sixty-one cases AITL diagnosed by Department of Pathology of Peking University Cancer Hospital were collected with their clinical data. Morphologically, they were classified as typeⅠ[lymphoid tissue reactive hyperplasia (LRH) like]; typeⅡ[marginal zone lymphoma(MZL)like] and type Ⅲ [peripheral T-cell lymphoma, not specified (PTCL-NOS) like]. Immunohistochemical staining was used to evaluate the presence of follicular helper T-cell (TFH) phenotype, proliferation of extra germinal center (GC) follicular dendritic cells (FDCs), presence of Hodgkin and Reed-Sternberg (HRS)-like cells and large B transformation. The density of Epstein-Barr virus (EBV) + cells was counted with slides stained by Epstein-Barr virus encoded RNA (EBER) in situ hybridization on high power field (HPF). T-cell receptor / immunoglobulin gene (TCR/IG) clonality and targeted exome sequencing (TES) test were performed when necessary. SPSS 22.0 software was used for statistical analysis.

RESULTS

Morphological subtype (%): 11.4% (7/61) cases were classified as type Ⅰ; 50.8% (31/61) as type Ⅱ; 37.8% (23/61) as type Ⅲ. 83.6% (51/61) cases showed classical TFH immunophenotype. With variable extra-GC FDC meshwork proliferation (median 20.0%); 23.0% (14/61) had HRS-like cells; 11.5% (7/61) with large B transformation. 42.6% (26/61) of cases with high counts of EBV. 57.9% (11/19) TCR⁺/IG^-, 26.3% (5/19) TCR⁺/IG⁺, 10.5% (2/19) were TCR^－/IG^－, and 5.3% (1/19) TCR^－/IG⁺. Mutation frequencies by TES were 66.7% (20/30) for RHOA, 23.3% (7/30) for IDH2 mutation, 80.0% (24/30) for TET2 mutation, and 33.3% (10/30) DNMT3A mutation. Integrated analysis divided into four groups: (1) IDH2 and RHOA co-mutation group (7 cases): 6 cases were type Ⅱ, 1 case was type Ⅲ; all with typical TFH phenotype; HRS-like cells and large B transformation were not found; (2) RHOA single mutation group (13 cases): 1 case was type Ⅰ, 6 cases were type Ⅱ, 6 cases were type Ⅲ; 5 cases without typical TFH phenotype; 6 cases had HRS-like cells, and 2 cases with large B transformation. Atypically, 1 case showed TCR^－/IG^－, 1 case with TCR^－/IG⁺, and 1 case with TCR⁺/IG⁺; (3) TET2 and/or DNMT3A mutation alone group (7 cases): 3 cases were type Ⅱ, 4 cases were type Ⅲ, all cases were found with typical TFH phenotype; 2 cases had HRS-like cells, 2 cases with large B transformation, and atypically; (4) non-mutation group (3 cases), all were type Ⅱ, with typical TFH phenotype, with significant extra-GC FDC proliferation, without HRS-like cells and large B transformation. Atypically, 1 case was TCR^－/IG^－. Univariate analysis confirmed that higher density of EBV positive cell was independent adverse prognostic factors for both overall survival (OS) and progression free survival(PFS), (P=0.017 and P=0.046).

CONCLUSION

Pathological diagnoses of ALTL cases with HRS-like cells, large B transformation or type Ⅰ are difficult. Although TCR/IG gene rearrangement test is helpful but still with limitation. TES involving RHOA, IDH2, TET2, DNMT3A can robustly assist in the differential diagnosis of those difficult cases. Higher density of EBV positive cells counts in tumor tissue might be an indicator for poor survival.

Metal-Insulator Transition of Single-Crystal V2O3 through van der Waals Interface Engineering

Strongly correlated electron materials harbor interesting materials physics, such as high-T_c superconductivity, colossal magnetoresistance, and metal-insulator transition. These physical properties can be greatly influenced by the dimensionality and geometry of the hosting materials and their interaction strengths with underlying substrates. In a classic strongly correlated oxide vanadium sesquioxide (V₂O₃), the coexistence of a metal-insulator and paramagnetic-antiferromagnetic transitions at ∼150 K makes this material an excellent platform for exploring basic physics and developing future devices. So far, most studies have been focused on epitaxial thin films in which the strongly coupled substrate has a pronounced effect on V₂O₃, leading to the observations of intriguing phenomena and physics. In this work, we unveil the kinetics of a metal-insulator transition of V₂O₃ single-crystal sheets at nano and micro scales. We show the presence of triangle-like alternating metal/insulator phase patterns during phase transition, which is drastically different from the epitaxial film. The observation of single-stage metal-insulator transition in V₂O₃/graphene compared to the multistage in V₂O₃/SiO₂ evidence the importance of sheet-substrate coupling. Harnessing the freestanding form of the V₂O₃ sheet, we show that the phase transition of V₂O₃ sheet can generate a large dynamic strain to monolayer MoS₂ and tune its optical property based on the MoS₂/V₂O₃ hybrid structure. The demonstration of the capability in tuning phase transition kinetics and phase patterns using designed hybrid structure of varied sheet-substrate coupling strengths suggests an effective knob in the design and operation of emerging Mott devices.

[Synchronization isolation method for multiple types of cells from mouse liver]

Objective: To explore a simple and feasible method for the isolation and purification of hepatocytes, hepatic stellate cells (HSC), and lymphocytes from mice. Methods: The cell suspension was obtained from male C57bl/6 mice by hepatic perfusion through the portal vein digestion method and then isolated and purified by discontinuous Percoll gradient centrifugation. Trypan blue exclusion was used to determine cell viability. Glycogen staining, cytokeratin 18, and transmission electron microscopy were used to identify hepatic cells. Immunofluorescence was used to detect α-smooth muscle actin combined with desmin in HSCs. Flow cytometry was used to analyze lymphocyte subsets in the liver. Results: After isolation and purification, about 2.7×10(7) hepatocytes, 5.7×10(5) HSCS, and 4.6×106 hepatic mononuclear cells were obtained from the liver of mice with a body weight of about 22g. The cell survival rate in each group was > 95%. Hepatocytes were apparent in glycogen deposited purple-red granules and cytokeratin 18. Electron microscopy showed that there were abundant organelles in hepatocytes and tight junctions between cells. HSC had expressed α-smooth muscle actin and desmin. Flow cytometry showed hepatic mononuclear cells, including lymphocyte subsets such as CD4, CD8, NKs, and NKTs. Conclusion: The hepatic perfusion through the portal vein digestion method can isolate multiple primary cells from the liver of mice at once and has the features of simplicity and efficiency.

High-throughput manufacturing of epitaxial membranes from a single wafer by 2D materials-based layer transfer process

Layer transfer techniques have been extensively explored for semiconductor device fabrication as a path to reduce costs and to form heterogeneously integrated devices. These techniques entail isolating epitaxial layers from an expensive donor wafer to form freestanding membranes. However, current layer transfer processes are still low-throughput and too expensive to be commercially suitable. Here we report a high-throughput layer transfer technique that can produce multiple compound semiconductor membranes from a single wafer. We directly grow two-dimensional (2D) materials on III-N and III-V substrates using epitaxy tools, which enables a scheme comprised of multiple alternating layers of 2D materials and epilayers that can be formed by a single growth run. Each epilayer in the multistack structure is then harvested by layer-by-layer mechanical exfoliation, producing multiple freestanding membranes from a single wafer without involving time-consuming processes such as sacrificial layer etching or wafer polishing. Moreover, atomic-precision exfoliation at the 2D interface allows for the recycling of the wafers for subsequent membrane production, with the potential for greatly reducing the manufacturing cost.

[Clinicopathological features and prognosis of anorectal melanoma: A report of 68 cases]

OBJECTIVE

To investigate the clinicopathological characteristics of anorectal mucosal melanoma (ARMM), and to evaluate the prognostic factors.

METHODS

A total of 68 primary ARMM surgical specimens from 2010 to 2018 were retrospectively studied. Slides were reviewed to evaluate pathological features. Slingluff staging method was used for staging.

RESULTS

(1) Clinical features: The median age at diagnosis in this group was 61.5 years, with a male-to-female ratio 1 ∶1.62. The most common complaint was blooding (49 cases). For anatomic site, anorectum was the prevalent (66.2%), followed by rectum (20.6%). At the time of diagnosis, 28 cases were stage Ⅰ (localized stage, 41.2%), 25 cases were stage Ⅱ (regional lymph node metastasis, 36.8%), and 15 cases were stage Ⅲ (distant metastasis, 22.1%). Five patients underwent wide local excision, the rest abdominoperineal resection, and 48 patients received adjuvant therapy after surgery. (2) Pathological features: Grossly 88.2% of the tumors were exophytic polypoid masses, with the median tumor size 3.5 cm and the median tumor thickness 1.25 cm. Depth of invasion below lamina muscularis mucosae ranged from 0-5.00 cm (median 1.00 cm). The deepest site of tumor invasion reached muscular layer in 27 cases, and perirectal tissue in 16 cases. Melanin pigmentation was absent or not obvious in 67.6% of the cases. The predominant cytology was epithelioid (45 cases, 66.2%). The rate for ulceration, necrosis, lymphovascular invasion, and perineural invasion was 89.7%, 35.3%, 55.9%, and 30.9%, respectively. The median mitotic count was 18/mm². The positive rate of S100, HMB-45 and Melan-A were 92.0%, 92.6% and 98.0%, respectively. The median of Ki-67 was 50%. The incidences of mutations within CKIT, BRAF and NRAS genes were 17.0% (9 cases), 3.8% (2 cases) and 9.4% (5 cases), respectively. (3) Prognosis: Survival data were available in 66 patients, with a median follow-up of 17 months and a median survival time of 17.4 months. The 1-year, 2-year and 5-year overall survival rate was 76.8%, 36.8% and 17.2%, respectively. The rate of lymphatic metastasis at diagnosis was 56.3%. Forty-nine patients (84.5%) suffered from distant metastasis, and the most frequent metastatic site was liver. Univariate analysis revealed that tumor size (>3.5 cm), depth of invasion below lamina muscularis mucosae (>1.0 cm), necrosis, lymphovascular invasion, BRAF gene mutation, lack of adjuvant therapy after surgery, deep site of tumor invasion, and high stage at diagnosis were all poor prognostic factors for overall survival. Multivariate model showed that lymphovascular invasion and BRAF gene mutation were independent risk factors for lower overall survival, and high stage at diagnosis showed borderline negative correlation with overall survival.

CONCLUSION

The overall prognosis of ARMM is poor, and lymphovascular invasion and BRAF gene mutation are independent factors of poor prognosis. Slingluff staging suggests prognosis effectively, and detailed assessment of pathological features, clear staging and genetic testing should be carried out when possible. Depth of invasion below lamina muscularis mucosae of the tumor might be a better prognostic indicator than tumor thickness.

Succession of Bacteria Attached to Microplastics After Transferring from a Mariculture Area to a Seagrass Meadow

Microplastics have been recognized as a novel niche for bacteria. However, studies have characterized the plastisphere microbial community in situ without exploring the microbial changes after transferring to other ecosystems. Here we focus on bacterial succession on typical microplastics (polypropylene and expanded polystyrene) and natural substrates (wood) after transferring from mariculture area to seagrass meadows system. Using high-throughput sequencing of 16 S rRNA, we found that alpha diversity significantly reduced after transferring and microplastics especially PP had significant separations on PCoA plots at different succession stages. The abundance and metabolic pathways of potential pathogen-associated microorganisms are significantly decreased. The relative abundance of xenobiotics biodegradation pathways was significantly lower and of energy metabolism pathways was significantly higher by comparing before and after transferring. Main environmental factors affecting microbial communities changed from nutrient characteristics to basic physicochemical properties after transferring. The succession times of the microbial communities of the three materials were different.

Advection-Dispersion Behavior for Simulation of H-3 and Pu-238 Transport in Undisturbed Argillaceous Shale of a Near-Surface Repository

In this study, a column experiment was employed to evaluate the nuclide migration behavior in the surrounding rock medium of a near-surface disposal site in China and to investigate the advection-dispersion behavior of tritium (H-3) and plutonium-238 (Pu-238) in highly weathered argillaceous shale. A reasonable numerical model was selected to fit the experimental breakthrough curves (BTCs) and to obtain the relevant migration parameters. The results show the following: (1) the internal structure of the highly weathered argillaceous shale exhibited heterogeneity, and the nuclide migration BTC showed characteristics of a "curve peak moving forward" and a "tail curve trailing"; (2) compared with other models, the stream tube mode could better fit the BTCs and obtain the average dispersion coefficient <D>, average distribution coefficient <K_d>, and other parameters; (3) compared to the results of the batch experiment, the distribution coefficient K_d obtained from the column experiment was smaller than that obtained from the batch experiment, which is speculated to be due to the influence of contact time and the contact area between the nuclide and the medium.

Dual-Modal Information Bottleneck Network for Seizure Detection

In recent years, deep learning has shown very competitive performance in seizure detection. However, most of the currently used methods either convert electroencephalogram (EEG) signals into spectral images and employ 2D-CNNs, or split the one-dimensional (1D) features of EEG signals into many segments and employ 1D-CNNs. Moreover, these investigations are further constrained by the absence of consideration for temporal links between time series segments or spectrogram images. Therefore, we propose a Dual-Modal Information Bottleneck (Dual-modal IB) network for EEG seizure detection. The network extracts EEG features from both time series and spectrogram dimensions, allowing information from different modalities to pass through the Dual-modal IB, requiring the model to gather and condense the most pertinent information in each modality and only share what is necessary. Specifically, we make full use of the information shared between the two modality representations to obtain key information for seizure detection and to remove irrelevant feature between the two modalities. In addition, to explore the intrinsic temporal dependencies, we further introduce a bidirectional long-short-term memory (BiLSTM) for Dual-modal IB model, which is used to model the temporal relationships between the information after each modality is extracted by convolutional neural network (CNN). For CHB-MIT dataset, the proposed framework can achieve an average segment-based sensitivity of 97.42%, specificity of 99.32%, accuracy of 98.29%, and an average event-based sensitivity of 96.02%, false detection rate (FDR) of 0.70/h. We release our code at https://github.com/LLLL1021/Dual-modal-IB.

Separation and characterization of the components and impurities in policresulen solution using LC-Q-TOF MS

Background:

As an external medicine, policresulen solution didn't get much attention throughout the world. From the paper which had been published yet, there has been no report concerning other unknown impurities in the policresulen solution. Four known components have been identified as well as quantified, however, as long as people’s concern for drug safety increases rapidly, there still remain impurities to be studied.

Objective:

This paper focuses on the separation and characterization of the impurities in the policresulen solution, which is critical for controlling the production of this drug.

Methods:

The components and impurities in the policresulen solution were separated and characterized using HPLC coupled with Q-TOF mass spectrometry. An ACE EXCEL 5 C18-PFP column (4.6 mm×250 mm, 5 μm) was used, and the mobile phases were 0.01 M ammonium acetate solution and methanol.

Results:

21 previously unknown impurities were separated and characterized in a policresulen solution, and the structures were proposed based on the MS/MS fragmentation data.

Conclusions:

Based on the characterization of impurities, this study showed that there remain lots of oligomers in the policresulen solution, apart from four known components. This study could be used for further analytical analysis of the policresulen solution, which could improve the quality control of the policresulen solution and other preparations recommended in pharmacopoeias.

[Investigation for pathological interpretation criteria and its prognostic value for P53 expression in Chinese diffuse large B-cell lymphoma]

Objective: To explore the feasibility of predicting TP53 mutation risk by immunohistochemical staining (IHC) pattern of P53 in Chinese diffuse large B-cell lymphoma (DLBCL) and its correlation with a prognostic difference. Methods: Between January 2021 and December 2021, 51 DLBCL cases at Beijing Boren Hospital were gathered. These cases had both IHC and next-generation sequencing (NGS) results. IHC classified the P53 protein expression pattern into a loss (<1% ) , diffuse (>80% ) , and heterogeneous (1% -80% ) . The sensitivity and specificity of the predicting TP53 mutation by IHC were assessed by comparing the results of the NGS, and the TP53 high mutation risk group included both loss and diffuse expression of P53. From June 2016 to September 2019, Peking University Cancer Hospital collected 131 DLBCL cases with thorough clinicopathological and follow-up data. From their tumor blocks, tissue microarray blocks were made for IHC evaluation of P53 expression pattern, and prognosis effect of P53 studies. Results: Among 51 cases with both IHC and NGS results, 23 cases were classified as TP53 high mutation risk (7 cases loss and 16 cases diffuse) , 22/23 cases were proved with mutated TP53 by NGS. Only 1 of the 28 cases classified as TP53 low mutation risk was proved with mutated TP53 by NGS. IHC had a sensitivity and specificity of 95.7% and 96.4% for predicting TP53 mutation. NGS identified a total of 26 TP53 mutations with a mutation frequency of 61.57% (13.41% -86.25% ) . In the diffuse group, 16 missense mutations and 2 splice mutations were detected; 6 truncating mutations and 1 splice mutation were detected in the loss group; 1 truncating mutation was detected in the heterogeneous group. Multivariate analysis demonstrated that TP53 cases with high mutation risk have impartial adverse significance for the 131 patients included in survival analysis (HR=2.612, 95% CI 1.145-5.956, P=0.022) . Conclusion: IHC of P53 exhibiting loss (<1% ) or diffuse (>80% ) pattern indicated TP53 high mutation risk, IHC can predict TP53 mutation with high specificity and sensitivity. TP53 high mutation risk is an independent predictor for adverse survival.

Enhanced activity of NLRP3 inflammasome and its proinflammatory effect in influenza A viral pneumonia

Aim: The aim of this study was to investigate the activity of NLRP3 inflammasome and its effect on inducing severe pneumonia 1 week after influenza A virus (IAV) infection. Materials & methods: The expression levels of NLRP3, caspase-1 and IL-1β were assessed in murine macrophages stimulated with IAV. And the severity of viral pneumonia in mice was explored. Results & conclusion: The data showed that although the expression of NLRP3 diverged, activity of NLRP3 inflammasome was enhanced 1 week after IAV infection, and more severe viral pneumonia was associated with IL-1β in serum. It infers that enhanced activity of NLRP3 inflammasome induces augmented expression of IL-1β and severe pneumonia in a NLRP3-independent way, 1 week after IAV infection.

Immunogenicity and safety of BNT162b2 mRNA vaccine in Chinese adults: A phase 2 randomised clinical trial

BACKGROUND

BNT162b2, an mRNA vaccine against COVID-19, is being utilised worldwide, but immunogenicity and safety data in Chinese individuals are limited.

METHODS

This phase 2, randomised, double-blind, placebo-controlled trial included healthy or medically stable individuals aged 18-85 years enrolled at two clinical sites in China. Participants were stratified by age (≤55 or >55 years) and randomly assigned (3:1) by an independent randomisation professional to receive two doses of intramuscular BNT162b2 30 μg or placebo, administered 21 days apart. Study participants, study personnel, investigators, statisticians, and the sponsor's study management team were blinded to treatment assignment. Primary immunogenicity endpoints were the geometric mean titers (GMTs) of neutralising antibodies to live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and seroconversion rates (SCR) 1 month after the second dose. Safety assessments included reactogenicity within 14 days of vaccination, adverse events (AEs), and clinical laboratory parameters. Randomised participants who received at least one dose were included in the efficacy and safety analyses on a complete case basis (incomplete/missing data not imputed). Results up to 6 months after the second dose are reported.

FINDINGS

Overall, 959 participants (all of Han ethnicity) who were recruited between December 5th, 2020 and January 9th, 2021 received at least one injection (BNT162b2, n=720; placebo, n=239). At 1 month after the second dose, the 50% neutralising antibody GMT was 294.4 (95% CI; 281.1-308.4) in the BNT162b2 group and 5.0 (95% CI; 5.0-5.0) in the placebo group. SCRs were 99.7% (95% CI; 99.0%-100.0%) and 0% (95% CI; 0.0%-1.5%), respectively (p<0.0001 vs placebo). Although the GMT of neutralising antibodies in the BNT162b2 group was greatly reduced at 6 months after the second dose, the SCR still remained at 58.8%. BNT162b2-elicited sera neutralised SARS-CoV-2 variants of concern. T-cell responses were detected in 58/73 (79.5%) BNT162b2 recipients. Reactogenicity was mild or moderate in severity and resolved within a few days after onset. Unsolicited AEs were uncommon at 1 month following vaccine administration, and there were no vaccine-related serious AEs at 1 month or 6 months after the second dose.

INTERPRETATION

BNT162b2 vaccination induced a robust immune response with acceptable tolerability in Han Chinese adults. However, follow-up duration was relatively short and COVID-19 rates were not assessed. Safety data collection is continuing until 12 months after the second dose.

FUNDING

BioNTech - sponsored the trial. Shanghai Fosun Pharmaceutical Development Inc. (Fosun Pharma) - conducted the trial, funded medical writing.

CLINICALTRIALSGOV REGISTRATION NUMBER

NCT04649021. Trial status: Completed.

Graphene nanopattern as a universal epitaxy platform for single-crystal membrane production and defect reduction

Heterogeneous integration of single-crystal materials offers great opportunities for advanced device platforms and functional systems¹. Although substantial efforts have been made to co-integrate active device layers by heteroepitaxy, the mismatch in lattice polarity and lattice constants has been limiting the quality of the grown materials². Layer transfer methods as an alternative approach, on the other hand, suffer from the limited availability of transferrable materials and transfer-process-related obstacles³. Here, we introduce graphene nanopatterns as an advanced heterointegration platform that allows the creation of a broad spectrum of freestanding single-crystalline membranes with substantially reduced defects, ranging from non-polar materials to polar materials and from low-bandgap to high-bandgap semiconductors. Additionally, we unveil unique mechanisms to substantially reduce crystallographic defects such as misfit dislocations, threading dislocations and antiphase boundaries in lattice- and polarity-mismatched heteroepitaxial systems, owing to the flexibility and chemical inertness of graphene nanopatterns. More importantly, we develop a comprehensive mechanics theory to precisely guide cracks through the graphene layer, and demonstrate the successful exfoliation of any epitaxial overlayers grown on the graphene nanopatterns. Thus, this approach has the potential to revolutionize the heterogeneous integration of dissimilar materials by widening the choice of materials and offering flexibility in designing heterointegrated systems.

Permeability‐Engineered Compartmentalization Enables In Vitro Reconstitution of Sustained Synthetic Biology Systems

In nature, biological compartments such as cells rely on dynamically controlled permeability for matter exchange and complex cellular activities. Likewise, the ability to engineer compartment permeability is crucial for in vitro systems to gain sustainability, robustness, and complexity. However, rendering in vitro compartments such a capability is challenging. Here, a facile strategy is presented to build permeability‐configurable compartments, and marked advantages of such compartmentalization are shown in reconstituting sustained synthetic biology systems in vitro. Through microfluidics, the strategy produces micrometer‐sized layered microgels whose shell layer serves as a sieving structure for biomolecules and particles. In this configuration, the transport of DNAs, proteins, and bacteriophages across the compartments can be controlled an guided by a physical model. Through permeability engineering, a compartmentalized cell‐free protein synthesis system sustains multicycle protein production; ≈100 000 compartments are repeatedly used in a five‐cycle synthesis, featuring a yield of 2.2 mg mL⁻¹. Further, the engineered bacteria‐enclosing compartments possess near‐perfect phage resistance and enhanced environmental fitness. In a complex river silt environment, compartmentalized whole‐cell biosensors show maintained activity throughout the 32 h pollutant monitoring. It is anticipated that permeability‐engineered compartmentalization should pave the way for practical synthetic biology applications such as green bioproduction, environmental sensing, and bacteria‐based therapeutics.

Study on Tritium and Iodine Species Transport through Porous Granite: A Non-Sorption Effect by Anion Exclusion

The safety of deep geological repositories is important in the disposal of high-level radioactive waste (HLW). In this study, advection−dispersion experiments were designed to build a transport model through a calibration/validation process, and the transport behavior of tritiated water (HTO) and various iodine species (iodide: I− and iodate: IO3−) was studied on a dynamic compacted granite column. Breakthrough curves (BTCs) were plotted under various flow rates (1−5 mL/min). BTCs showed that the non-sorption effect by anion exclusion was observed only in I− transport because the retardation factor (R) of I− was lower than that of HTO (R = 1). Moreover, equilibrium and nonequilibrium transport models were used and compared to identify the mobile/immobile zones in the compacted granite column. The anion exclusion effect was influenced by the immobile zones in the column. The non-sorption effect by anion exclusion (R < 1) was only observed for I− at 5.0 ± 0.2 mL/min flow rate, and a relatively higher Coulomb’s repulsive force may be caused by the smaller hydration radius of I−(3.31 Å) than that of IO3−(3.74 Å).

[Clinical outcomes of transoral endoscopic thyroidectomy vestibular approach assisted with submental mini-incision for early thyroid papillary carcinoma]

Objective: To investigate the efficacy of transoral endoscopic thyroidectomy vestibular approach (TOETVA) assisted with submental mini-incision in early thyroid papillary carcinoma. Methods: A total of 63 patients with early papillary thyroid carcinoma (cT1N0M0) were included who underwent TOETVA from December 2019 to May 2021 in Department of Thyroid Surgery of the Affiliated Hospital of Jining Medical University. There were 4 males and 59 females, aged from 17 to 46 years old. Of those 36 patients received traditional TOETVA as control and 27 patients accepted modified TOETVA assisted with submental mini-incision. The clinical outcomes of patients in two groups were compared. Chi-square test and t test were used in statistical analyses. Results: Compared to control group, modified TOETVA group had the less mean operation time [(146.63±38.62) minutes vs. (167.78±36.71) minutes, t=-2.21, P=0.031], the shorter time required for returning to normal diet after operation [(2.11±0.89) days vs. (2.72±1.16) days, t=-2.28, P=0.026], and the lower probability of mandibular numbness (0 vs. 16.67%, χ²=4.97, P=0.026). There was no significant difference between two groups in intraoperative blood loss, postoperative drainage volume, number of central lymph nodes dissection, and postoperative complications such as gas embolism, postoperative bleeding, postoperative infection, skin burns, subcutaneous effusion and so on(all P>0.05). After 6 months of operation, the thyroid ultrasound of the patients in two groups showed no recurrence, and the patients were satisfied with their surgical incision appearances. Conclusion: Both the modified and traditional TOETVA show similar efficacies for treatments of early thyroid papillary carcinoma, but the modified TOETVA can reduce the operation time and improve the quality of life.

Large-Area Uniaxial-Oriented Growth of Free-Standing Thin Films at the Liquid-Air Interface with Millimeter-Sized Grains

Manipulating materials at the atomic scale and assembling them into macroscopic structures with controlled dimensionalities and single-crystal quality are grand scientific challenges. Here, we report a general solvent evaporation method to synthesize large-area uniaxial-oriented growth of free-standing thin films at the liquid-air interface. Crystals nucleate at the solution surface and rotate into the same orientation under electrostatic interaction and then merge as large crystals and grow laterally into a large-area uniform thin film with millimeter-sized grains. The lateral dimension is confined only by the size of containers. The film thickness can be tuned by adjusting solvent evaporation rate (R) and solute diffusivity (D), and a characteristic length, L * ∼ D R , was derived to estimate the film thickness. Molecular dynamic (MD) simulations reveal a concentration spike at the liquid-air interface during fast solvent evaporation, leading to the lateral growth of thin films. The large-area uniaxial oriented films are demonstrated on both inorganic metal halides and hybrid metal halide perovskites. The solvent evaporation approach and the determination of key parameters enabling film thickness prediction are beneficial to the high throughput and scalable production of single crystal-quality thin film materials under controlled evaporation conditions.

Serum human epididymis secretory protein 4 correlates with sepsis-associated acute respiratory distress syndrome and 28-day mortality in critically ill patients

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a severe disease with high mortality, and its primary cause is sepsis. The aim of this study was to detect and evaluate the role of Human epididymis protein 4 (HE4) in sepsis-related ARDS.

METHODS

One hundred and twenty-three critically ill sepsis patients with/without ARDS and 102 healthy controls were enrolled in this study. Blood samples were collected upon admission for quantitative testing of HE4 by chemiluminescent microparticle immunoassay (CMIA). ROC curve analysis and Spearman's correlation analysis were conducted to determine the diagnostic and prognostic value of HE4.

RESULTS

Compared with controls, the serum HE4 concentrations of sepsis patients were elevated, and levels in sepsis patients with ARDS were significantly higher (all p < 0.0001). Moreover, HE4 concentrations were strongly correlated with the clinical severity characteristics of sepsis patients, and ROC curve suggested that the AUC of HE4 applied to discriminate sepsis-ARDS patients from sepsis patients was 0.903. HE4 was also found to be a prognostic biomarker of clinical severity and 28-day mortality among critically ill sepsis patients. Logistic regression analysis showed that HE4 was an independent factor for diagnosis of ARDS. Meanwhile, ROC curve analysis showed that the cut-off value of serum HE4 to discriminate 28-day mortality from sepsis patients (AUC: 0.782) was 646.5 pmol/L.

CONCLUSIONS

The concentration of serum HE4 in patients with sepsis-related ARDS was markedly increased and was significantly correlated with mortality, which suggests that serum HE4 could be a promising diagnostic and prognostic biomarker for ARDS in sepsis patients.

[Difficulties and challenges in pathological diagnosis of gastrointestinal pancreatic neuroendocrine tumors]

In the 5th edition of WHO Classification of Digestive System Tumours, the classification and designation of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) were updated, and G3 was redefined. Therefore, the differential diagnosis between well-differentiated neuroendocrine tumour G3(NETG3) and poorly differentiated neuroendocrine carcinomas (NEC) is both important and difficult, which has important clinical treatment and prognostic significance. Based on the latest WHO and 2020 Chinese consensus on pathological diagnosis of GEP-NEN, this paper proposed a comprehensive analysis on the differential diagnosis of gastrointestinal pancreatic neuroendocrine tumor from four aspects, including tumor morphological differentiation、tumor proliferative activity, gene change and disease progression. However, even with the above four diagnostic tools, there are still some difficulties and challenges in the work of pathological diagnosis. This paper briefly expounds and discusses them together, in order to improve the clinical application value.

Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.

Facile synthesis and self-assembly behaviors of biodegradable amphiphilic hyperbranched copolymers with reducible poly(caprolactone) grafts

A reducible hydrophobic macromonomer, HEMA-g-PCL, developed herein provides a facile yet robust strategy for biodegradable amphiphilic hyperbranched copolymers.

Disseminated Human Parvovirus B19 Infection Induced Multiple Organ Dysfunction Syndrome in an Adult Patient With Alcoholic Hepatitis Complicated by Hemolytic Anemia: A Case Report and Literature Review

Background

Human parvovirus B19 (B19) can cause acute hepatitis and is attributed to the high mortality of alcoholic hepatitis (AH). B19 infection is generally self-healing in previously healthy people, but it can cause fatal effects in some high-risk groups and increase its virulence and infectivity. Disseminated B19 infection-induced multiple organ dysfunction syndrome (MODS) in patients with AH has not been reported yet. Here, we described B19 viremia in an adult patient with AH accompanied by hemolytic anemia (HA), leading to disseminated infection and secondary MODS, as well as self-limiting B19 infections in seven nurses caring for him. Meanwhile, we reviewed the literature on AH and B19 infection.

Case Presentation

A 43-year-old male patient with AH accompanied by HA was transferred to the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, on March 31, 2021. After supportive treatment, his transaminase and bilirubin levels were reduced, but his anemia worsened. He received a red blood cell (RBC) infusion on April 9 for hemoglobin (Hb) lower than 6 g/dl. On April 13, he suddenly had a high fever. Under empirical anti-infection, his high fever dropped and maintained at a low fever level; however, his anemia worsened. On April 25, he was transferred to the medical intensive care unit (MICU) due to severe pneumonia, acute respiratory distress syndrome (ARDS), acute aplastic crisis (AAC), and hemophagocytic syndrome (HPS), which were subsequently confirmed to be related to B19 infection. After methylprednisolone, intravenous immunoglobulin (IVIG), empirical anti-infection, and supportive treatment, the lung infection improved, but hematopoietic and liver abnormalities aggravated, and systemic B19 infection occurred. Finally, the patient developed a refractory arrhythmia, heart failure, and shock and was referred to a local hospital by his family on May 8, 2021. Unfortunately, he died the next day. Fourteen days after he was transferred to MICU, seven nurses caring for him in his first two days in the MICU developed self-limiting erythema infectiosum (EI).

Conclusions

B19 infection is self-limiting in healthy people, with low virulence and infectivity; however, in AH patients with HA, it can lead to fatal consequences and high contagion.

One-Step Microfluidic Fabrication of Multi-Responsive Liposomes for Targeted Delivery of Doxorubicin Synergism with Photothermal Effect

Introduction

Cancer of the bladder is one of the most common and life-threatening. Compared with traditional delivery methods, intravesical administration reduces the amount of drugs required, increases the amount of drugs reaching the lesion site, and minimizes systemic exposure to therapeutic agents. To overcome the limitations of urinary voiding, low urothelium permeability, and intermittent catheterization for large dilution and irrigation of drugs in the bladder, magnetic and photothermal-responsive folate receptor-targeted thermal liposomes (FA-TMLs) were designed for the targeted delivery of doxorubicin (DOX) to bladder cancer cells.

Methods

Through a microfluidic mixer chip, the magnetic nanoparticles (MNPs), gold nanorods (GNRs) and DOX were encapsulated in folate-modified thermosensitive liposomes to form FA-TMLs@MNPs-GNRs-DOX. DLS, TEM, DSC, and magnetic hysteresis loop were used to characterize the construction of FA-TMLs@MNPs-GNRs-DOX.

Results

FA-TMLs@MNPs-GNRs-DOX had a size of about 230 nm and exhibited superparamagnetic properties with the saturation magnetization of 20 emu/g. The DOX loading capacity was as high as 0.57 mg/mL. Additionally, drug release of the FA-TMLs@MNPs-GNRs-DOX could be controlled by temperature change through the photothermal effect. A 980 nm laser beam was selectively irradiated on the FA-TMLs@MNPs-GNRs-DOX to trigger the structural changes of the FA-TMLs, and an average of 95% of the drug was released after 3 hours. The results of cell uptake experiments reveal indicated that FA-TMLs@MNPs-GNRs-DOX were able to specifically bind folate-receptor-positive cells and exhibited toxicity to bladder tumor cells.

Conclusion

The present results suggest FA-TMLs@MNPs-GNRs-DOX have a promising multifunctional response and can act as an ideal multifunctional drug delivery system (DDS) for the treatment of bladder tumors.

Interior Melting of Rapidly Heated Gold Nanoparticles

Normal melting invariably starts from surfaces or interfaces due to the weaker bonding constraints in these regions. However, we show that melting can be initiated from the interior of gold nanoparticles with high heating rates. We find that melting starts from the surface with the formation of a premelting layer, as usual, but that the premelting layer does not extend to the interior under certain conditions. Instead, liquid nucleation occurs in the core of the nanoparticle. This unexpected interior melting is connected to the slower melting kinetics, which is related to heat transfer near the premelted surface. The required conditions for interior melting are a suitable size of the nanoparticle and a sufficiently fast heating rate. The present results point to a novel melting regime in nanoparticles. We note that the time scales are now accessible using ultrafast tools such as X-ray lasers that can probe dynamical structure changes, suggesting opportunities for experiments.

Impact of PEGDA photopolymerization in micro-stereolithography on 3D printed hydrogel structure and swelling

3D printing complex architectures of responsive-hydratable polymers are enabled by stereolithography via photopolymerization. Yet, insufficient crosslinking leads to compromised structural integrity of the photopolymerized samples, which affects the functionality and reliability of hydrogel devices significantly. Here we investigate how curing parameters and ink formulation affect 3D printed PEGDA samples by using a combination of microfabrication, structural characterization, and reactive coarse-grained molecular dynamics simulation. Our findings show that the degree of curing exhibits a graded profile from confocal Raman spectroscopy and submicron pores from atomic force microscopy, both of which are also observed in our molecular simulations. Moreover, with environmental scanning electron microscopy, we probe the microscopic swelling and bending dynamics of 3D printed hydratable PEGDA structures as well as their structural integrity. Our in-depth characterization results reveal how hydrogel elasticity and irreversible densification due to pore formation highly depends on the exposure time, light intensity and the associated degree of crosslinking. This work provides new molecular insights into processing-structure relation in stereolithography 3D printing.

Member engagement in multi-sector health care alliances

Many communities are developing innovative forms of collaborative organizations such as multi-sector health care alliances (MHCAs) to address problems of misaligned incentives among providers, payers, and community stakeholders and improve health and health care. Member engagement is essential to the success of these organizations due to their dependence on volunteer members to develop and implement strategy and provide material and in-kind support for alliance efforts, yet relatively little research has examined how alliances can foster engagement. This study examined behavioral indicators of member engagement (e.g., recruitment and retention of organizational and individual members) and how they are related to two foundational dimensions of alliance functioning - alliance leadership and community centrality. Using three rounds of an internet-based survey of alliance members from 14 alliances, the study found that organizational recruitment and retention increased over time, from 26.6% to 41.5% and 56.0% to 65.2%, respectively. Recruitment of individuals increased over the study period (38.3% to 47.2%, while retention of individual members declined over the study period (61.0% to 53.2%). Alliance leadership was associated with lower levels of recruitment (both organizational and individual members) but higher levels of organizational retention (both organizational and individual members). Collectively, our findings suggest that behavioral aspects of alliances are more effective at retaining members than relatively stable characteristics such as size and positioning in the community. Contrasting relationships between recruitment and retention, however, suggest that different forms of leadership may be required to simultaneously attract new members while retaining existing ones.

A case of chlamydia psittaci caused severe pneumonia and meningitis diagnosed by metagenome next-generation sequencing and clinical analysis: a case report and literature review

Background

Psittacosis, which is also known as parrot fever, is Chlamydia psittaci (C. psittaci) caused infectious disease. The clinical manifestations vary from asymptomatic infection to severe atypical pneumonia or even fatal meningitis. Early recognition of psittacosis is difficult because of its nonspecific clinical manifestations. Culture and gene probe techniques for C. psittaci are not available for routine clinical use, which makes the diagnosis difficult too. Although psittacosis has increasingly been recognized and reported in recent years, cure of severe pneumonia complicated with meningitis, with etiologic diagnosis aided by the use of metagenomic next-generation sequencing (mNGS), is still uncommon. So, it is necessary to report and review such potentially fatal case.

Case presentation

This report describes a 54-year-old woman with C. psittaci caused severe atypical pneumonia and meningitis. She presented with symptoms of fever, dry cough and dyspnea, accompanied by prominent headache. Her condition deteriorated rapidly to respiratory failure and lethargy under the treatment of empirical antibacterial agents, and was treated with invasive mechanical ventilation soon. She denied contact with birds, poultry or horses, but unbiased mNGS of both the bronchoalveolar lavage fluid (BALF) and the cerebrospinal fluid (CSF) identified sequence reads corresponding to C. psittaci infection, and there was no sequence read corresponding to other probable pathogens. Combined use of targeted antimicrobial agents of tetracyclines, macrolides and fluoroquinolones was carried out, and the patient’s condition improved and she was discharged home 28 days later. Her status returned close to premorbid condition on day 60 of follow-up.

Conclusions

When clinicians come across a patient with atypical pneumonia accompanied by symptoms of meningitis, psittacosis should be taken into consideration. mNGS is a promising detection method in such condition and is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06205-5.

Host-Guest Interaction-Based Dual response core/shell nanoparticles as efficient siRNA carrier for killing breast cancer cells

How to overcome multiple obstacles to achieve the efficient and safe delivery of therapeutic genes is still the key to gene therapy. To address this issue, a cationic carrier consisting of polyamide-amine (HPAA-peptide-Fc) modified by an enzyme-responsive polypeptide as the core and hyperbranched polyglycerol derivative (CD-HPG) as the shell was synthesized by self-assembly. The obtained HPAA-peptide-HPG could form the compact nanocomplex with siPlk1, thus confirming the stable load of genes and subsequent targeted gene delivery. And the nanogenes could significantly induce apoptotic effect via the down-expression of Plk1 protein in breast cancer cells. Moreover, compared to polyethylenimine, HPAA-peptide-HPG exhibited superior biocompatibility through hemolysis and cell viability assays because of the shielding function of CD-HPG, thereby being beneficial to increasing the circulation time of the complex when administrated in vivo. Such an efficient and safe gene delivery complex (HPAA-peptide-HPG) presents a good example of rational design of cationic supramolecular vesicles for stimulus-responsive siRNA transport, which should be encouraged in cancer gene therapy.

Safety and immunogenicity of the SARS-CoV-2 BNT162b1 mRNA vaccine in younger and older Chinese adults: a randomized, placebo-controlled, double-blind phase 1 study

An effective vaccine is needed to end the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Here, we assess the preliminary safety, tolerability and immunogenicity data from an ongoing single-center (in Jiangsu province, China), parallel-group, double-blind phase 1 trial of the vaccine candidate BNT162b1 in 144 healthy SARS-CoV-2-naive Chinese participants. These participants are randomized 1:1:1 to receive prime and boost vaccinations of 10 µg or 30 µg BNT162b1 or placebo, given 21 d apart, with equal allocation of younger (aged 18-55 years) and older adults (aged 65-85 years) to each treatment group (ChiCTR2000034825). BNT162b1 encodes the SARS-CoV-2 spike glycoprotein receptor-binding domain (RBD) and is one of several messenger RNA-based vaccine candidates under clinical investigation. Local reactions and systemic events were generally dose dependent, transient and mild to moderate. Fever was the only grade 3 adverse event. BNT162b1 induced robust interferon-γ T cell responses to a peptide pool including the RBD in both younger and older Chinese adults, and geometric mean neutralizing titers reached 2.1-fold (for younger participants) and 1.3-fold (for the older participants) that of a panel of COVID-19 convalescent human sera obtained at least 14 d after positive SARS-CoV-2 polymerase chain reaction test. In summary, BNT162b1 has an acceptable safety profile and produces high levels of humoral and T cell responses in an Asian population.

Patient need and provider referrals to diabetes self-management education

OBJECTIVES

This study measured the likelihood of adult patients with diabetes being referred to diabetes self-management education (DSME) when "in need" according to clinical guidelines and identified which types of clinical need predict a greater likelihood of provider referral to DSME.

STUDY DESIGN

This repeated cross-sectional analysis utilized patient electronic health records (EHRs) and a statewide health information exchange database to examine a 7-year panel (2010-2016) of adult patients with diabetes. Our analytic sample included 8782 adult patients with diabetes with a total of 356,631 encounters.

METHODS

Fixed-effects linear probability models with clustered robust standard errors estimated the association between patients' need for DSME and likelihood of being referred to the service. Models controlled for patients' health status, prior utilization, encounter setting, comorbidity risk scores, the state's expansion of Medicaid, and the count of accredited DSME program sites in the community.

RESULTS

Most patient encounters indicated at least 1 type of need for DSME, but less than 7% of those encounters with a documented need resulted in a provider referral. In regression analysis, clinical indicators of need increased the likelihood that patients would be referred to DSME. Patients exhibiting multiple types of need were most likely to be referred to DSME.

CONCLUSIONS

Although findings indicate that patient need for DSME does improve the likelihood of being referred, provider referral rates were significantly lower than anticipated. Future research should explore barriers to clinical guideline adherence and whether clinical decision support in EHR systems can facilitate provider referrals.

Inorganic-Ligand Quantum Dots Meet Inorganic-Ligand Semiconductor Nanoplatelets: A Promising Fusion to Construct All-Inorganic Assembly

By the reaction of inorganic-ligand CdS/Cd²⁺ quantum dots (QDs) with inorganic-ligand CdSe/CdS/S^2- nanoplatelets (NPLs), semiconductor CdS QDs were fused with CdSe/CdS NPLs to yield all-inorganic assemblies, accompanied by great photoluminescence-enhancement. These all-inorganic assemblies facilitate charge transport between each other and open up interesting prospects with electronic and optoelectronic nanodevices.

Barriers to using clinical decision support in ambulatory care: Do clinics in health systems fare better?

OBJECTIVE

We quantify the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examine whether CDS utilization and barriers differed based on clinics' affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic.

MATERIALS AND METHODS

Despite much discussion at the theoretic level, the existing literature provides little empirical understanding of barriers to using CDS in ambulatory care. We analyze data from 821 clinics in 117 medical groups, based on in Minnesota Community Measurement's annual Health Information Technology Survey (2014-2016). We examine clinics' use of 7 CDS tools, along with 7 barriers in 3 areas (resource, user acceptance, and technology). Employing linear probability models, we examine factors associated with CDS barriers.

RESULTS

Clinics in health systems used more CDS tools than did clinics not in systems (24 percentage points higher in automated reminders), but they also reported more barriers related to resources and user acceptance (26 percentage points higher in barriers to implementation and 33 points higher in disruptive alarms). Barriers related to workflow redesign increased in clinics affiliated with health systems (33 points higher). Rural clinics were more likely to report barriers to training.

CONCLUSIONS

CDS barriers related to resources and user acceptance remained substantial. Health systems, while being effective in promoting CDS tools, may need to provide further assistance to their affiliated ambulatory clinics to overcome barriers, especially the requirement to redesign workflow. Rural clinics may need more resources for training.

Assessment of Variation in Electronic Health Record Capabilities and Reported Clinical Quality Performance in Ambulatory Care Clinics, 2014-2017

IMPORTANCE

Electronic health records (EHRs) are widely promoted to improve the quality of health care, but information about the association of multifunctional EHRs with broad measures of quality in ambulatory settings is scarce.

OBJECTIVE

To assess the association between EHRs with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system that responded to the Healthcare Information and Management Systems Society Annual Survey and reported performance measures in 2014 to 2017. Statistical analysis was performed from July 10, 2019, through February 26, 2021.

MAIN OUTCOMES AND MEASURES

A composite measure of EHR capability that considered 50 EHR capabilities in 7 functional domains, grouped into the following ordered categories: no functional EHR, EHR underuser, EHR, neither underuser or superuser, EHR superuser; as well as a standardized composite of ambulatory clinical performance measures that included 3 to 25 individual measures (median, 13 individual measures).

RESULTS

In 2014, 381 of 746 clinics (51%) were EHR superusers; this proportion increased in each subsequent year (457 of 846 clinics [54%] in 2015, 510 of 881 clinics [58%] in 2016, and 566 of 932 clinics [61%] in 2017). In each cross-sectional analysis year, EHR superusers had better clinical quality performance than other clinics (adjusted difference in score: 0.39 [95% CI, 0.12-0.65] in 2014; 0.29 [95% CI, -0.01 to 0.59] in 2015; 0.26 [95% CI, -0.05 to 0.56] in 2016; and 0.20 [95% CI, -0.04 to 0.45] in 2017). This difference in scores translates into an approximately 9% difference in a clinic's rank order in clinical quality. In longitudinal analyses, clinics that progressed to EHR superuser status had only slightly better gains in clinical quality between 2014 and 2017 compared with the gains in clinical quality of clinics that were static in terms of their EHR status (0.10 [95% CI, -0.13 to 0.32]). In an exploratory analysis, different types of EHR capability progressions had different degrees of associated improvements in ambulatory clinical quality (eg, progression from no functional EHR to a status short of superuser, 0.06 [95% CI, -0.40 to 0.52]; progression from EHR underuser to EHR superuser, 0.18 [95% CI, -0.14 to 0.50]).

CONCLUSIONS AND RELEVANCE

Between 2014 and 2017, ambulatory clinics in Minnesota, Washington, and Wisconsin with EHRs having greater capabilities had better composite measures of clinical quality than other clinics, but clinics that gained EHR capabilities during this time had smaller increases in clinical quality that were not statistically significant.

Mandated Benefits for Diabetes Education and the Availability of Accredited Programs and Certified Diabetes Educators

States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of "flexible" reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.

Health information technology for ambulatory care in health systems

OBJECTIVES

The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs.

STUDY DESIGN

We analyzed a national sample of 17,861 ambulatory clinics affiliated with 1711 health systems, using longitudinal data (2014-2016) from the HIMSS Analytics annual surveys.

METHODS

We used descriptive analyses and linear probability models to examine the adoption of electronic health records (EHRs), as well as 16 specific functionalities, at the clinic level and the system level. We compared the differential trends of adoption by various characteristics of health systems.

RESULTS

We find that the adoption of an EHR certified by the Office of the National Coordinator for Health IT (ONC) increased from 73% to 91%. However, in 2016, only 38% of clinics reported having all 16 health IT functionalities included in this study. Small health systems lag behind large systems in ambulatory health IT adoption. Patient-facing functionalities were less likely to be adopted than those oriented toward physicians. Health information exchange capabilities are still low among ambulatory clinics, pointing to the importance of the ONC's recent Promoting Interoperability initiative.

CONCLUSIONS

The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.

Highly Selective, Defect-Induced Photocatalytic CO2 Reduction to Acetaldehyde by the Nb-Doped TiO2 Nanotube Array under Simulated Solar Illumination

The adsorption and activation of CO₂ molecules on the surface of photocatalysts are critical steps to realize efficient solar energy-induced CO₂ conversion to valuable chemicals. In this work, a defect engineering approach of a high-valence cation Nb-doping into TiO₂ was developed, which effectively enhanced the adsorption and activation of CO₂ molecules on the Nb-doped TiO₂ surface. A highly ordered Nb-doped TiO₂ nanotube array was prepared by anodization of the Ti-Nb alloy foil and subsequent annealing at 550 °C in air for 2 h for its crystallization. Our sample showed a superior photocatalytic CO₂ reduction performance under simulated solar illumination. The main CO₂ reduction product was a higher-energy compound of acetaldehyde, which could be easily transported and stored and used to produce various key chemicals as intermediates. The acetaldehyde production rate was over ∼500 μmol·g^-1·h^-1 with good stability for repeated long-time uses, and it also demonstrated a superior product selectivity to acetaldehyde of over 99%. Our work reveals that the Nb-doped TiO₂ nanotube array could be a promising candidate with high efficiency and good product selectivity for the photocatalytic CO₂ reduction with solar energy.

Effects of Maillard reaction on structural modification and potential allergenicity of peanut 7S globulin (Ara h 1)

BACKGROUND

Ara h 1 is a major food allergen in peanuts. Recently, many studies have revealed that the Maillard reaction (MR) affects the allergenicity of food proteins.

RESULTS

To investigate the influence of the MR on the allergenicity of Ara h 1, R-Ara h 1 was processed with glucose in dry heating conditions for different periods. The extent of the MR was assessed by four methods. The changes in secondary and tertiary structures were characterized through spectroscopy assays. Advanced glycation end products (AGE) structures were identified by protein sample dry heating for 60 min, indicating the formation of AGE-Ara h 1. Simulated gastric fluid (SGF) digestion analysis showed that AGE-Ara h 1 has higher resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model was also utilized to explore the effect of the MR on the allergenicity of Ara h 1, and the results showed that the Th2-type cytokines, antibodies, and histamine content increased, and there was a greater degree of degranulation of rat basophilic leukemia (RBL) cells in the AGE-Ara h 1 group compared with the R-Ara h 1 group.

CONCLUSION

During the process of dry heating, proteins participated in the MR with changes in secondary and tertiary structures. The condition applying a temperature of 100 °C for 60 min caused the formation of AGE-Ara h 1. Simulated gastric fluid digestion analysis showed that AGE-Ara h 1 had a greater resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model showed that AGE-Ara h 1 had more allergenicity, indicating that the MR could enhance the allergenicity of Ara h 1. © 2020 Society of Chemical Industry.