IL-13 facilitates ferroptotic death in asthmatic epithelial cells via SOCS1-mediated ubiquitinated degradation of SLC7A11

Th2-high asthma is characterized by elevated levels of type 2 cytokines, such as interleukin 13 (IL-13), and its prevalence has been increasing worldwide. Ferroptosis, a recently discovered type of programmed cell death, is involved in the pathological process of Th2-high asthma; however, the underlying mechanisms remain incompletely understood. In this study, we demonstrated that the serum level of malondialdehyde (MDA), an index of lipid peroxidation, positively correlated with IL-13 level and negatively correlated with the predicted forced expiratory volume in 1 s (FEV1%) in asthmatics. Furthermore, we showed that IL-13 facilitates ferroptosis by upregulating of suppressor of cytokine signaling 1 (SOCS1) through analyzing immortalized airway epithelial cells, human airway organoids, and the ovalbumin (OVA)-challenged asthma model. We identified that signal transducer and activator of transcription 6 (STAT6) promotes the transcription of SOCS1 upon IL-13 stimulation. Moreover, SOCS1, an E3 ubiquitin ligase, was found to bind to solute carrier family 7 member 11 (SLC7A11) and catalyze its ubiquitinated degradation, thereby promoting ferroptosis in airway epithelial cells. Last, we found that inhibiting SOCS1 can decrease ferroptosis in airway epithelial cells and alleviate airway hyperresponsiveness (AHR) in OVA-challenged wide-type mice, while SOCS1 overexpression exacerbated the above in OVA-challenged IL-13-knockout mice. Our findings reveal that the IL-13/STAT6/SOCS1/SLC7A11 pathway is a novel molecular mechanism for ferroptosis in Th2-high asthma, confirming that targeting ferroptosis in airway epithelial cells is a potential therapeutic strategy for Th2-high asthma.

Electroencephalography-based biological and functional characteristics of spinal cord injury patients with neuropathic pain and numbness

Objectives

To identify potential treatment targets for spinal cord injury (SCI)-related neuropathic pain (NP) by analysing the differences in electroencephalogram (EEG) and brain network connections among SCI patients with NP or numbness.

Participants and methods

The EEG signals during rest, as well as left- and right-hand and feet motor imagination (MI), were recorded. The power spectral density (PSD) of the θ (4-8 Hz), α (8-12 Hz), and β (13-30 Hz) bands was calculated by applying Continuous Wavelet Transform (CWT) and Modified S-transform (MST) to the data. We used 21 electrodes as network nodes and performed statistical measurements of the phase synchronisation between two brain regions using a phase-locking value, which captures nonlinear phase synchronisation.

Results

The specificity of the MST algorithm was higher than that of the CWT. Widespread non-lateralised event-related synchronization was observed in both groups during the left- and right-hand MI. The PWP (patients with pain) group had lower θ and α bands PSD values in multiple channels of regions including the frontal, premotor, motor, and temporal regions compared with the PWN (patients with numbness) group (all p < 0.05), but higher β band PSD values in multiple channels of regions including the frontal, premotor, motor, and parietal region compared with the PWN group (all p < 0.05). During left-hand and feet MI, in the lower frequency bands (θ and α bands), the brain network connections of the PWP group were significantly weaker than the PWN group except for the frontal region. Conversely, in the higher frequency bands (β band), the brain network connections of the PWP group were significantly stronger in all regions than the PWN group.

Conclusion

The differences in the power of EEG and network connectivity in the frontal, premotor, motor, and temporal regions are potential biological and functional characteristics that can be used to distinguish NP from numbness. The differences in brain network connections between the two groups suggest that the distinct mechanisms for pain and numbness.

[Antioxidant activity of Euryale ferox seed shell extract and its therapeutic effects on oral ulcer in rats]

OBJECTIVE

To investigate the therapeutic effect of Euryale ferox seed shell extract on oral ulcer in rats and its underlying mechanism.

METHODS

The contents of polyphenols and flavonoids in Euryale ferox seed shells were determined by Folin-phenol assay and aluminum nitrate colorimetry, respectively. DPPH·, ABTS+·, ·OH and·O2- scavenging experiments were performed to evaluate the antioxidant activities of Euryale ferox seed shell extract in vitro. In a rat model of oral ulcer induced by burning with glacial acetic acid, the therapeutic effect of Euryale ferox seed shell extract was assessed by detecting changes in serum levels of oxidative factors by enzyme-linked immunosorbent assay (ELISA) and observing pathological changes of the ulcerous mucosa using HE staining; the therapeutic mechanism of the extract was explored by detecting the expression levels of Keap1, Nrf2, Nes-Nrf2 and HO-1 proteins in ulcerous mucosa using Western blotting.

RESULTS

The ethyl acetate extract of Euryale ferox seed shells contained 306.74±1.04 mg/g polyphenols and 23.43±0.61 mg/g flavonoids and had IC50 values for scavenging DPPH· and ABTS+· free radicals of 3.42 ± 0.97 μg/mL and 3.32 ± 0.90 μg/mL, respectively. In the rat models, the ethyl acetate extract significantly ameliorated oral mucosal ulcer, increased serum CAT level, and decreased serum MDA level. The protein expression levels of Nes-Nrf2 and HO-1 were increased and Keap1 protein expression was lowered significantly in the ulcerous mucosa of the rats after treatment with the extract (P<0.05 or 0.01).

CONCLUSION

The therapeutic effect of Euryale ferox seed shell extract on oral ulcers in rats is mediated probably by activation of the Keap1/Nrf2/HO-1 signaling pathway.

[Clinical and electrophysiological characteristics and treatment outcomes of anti-neutrophil cytoplasmic antibody ANCA-associated vasculitic neuropathy]

Objective: To investigate the clinical and electrophysiological characteristics of ANCA-associated vasculitic neuropathy (VN) and analyze the predictors of treatment outcomes. Methods: Retrospective case series. In all, 652 consecutive patients with ANCA-associated vasculitis were admitted to the First Medical Center of the Chinese PLA General Hospital between January 2006 and December 2022. Peripheral neuropathy occurred in 91 patients. Patients were excluded if other known causes of neuropathy were present. Sixty-one patients were eventually enrolled, including 17 with eosinophilic granulomatosis with polyangiitis (EGPA), 11 with granulomatosis polyangiitis (GPA), and 33 with microscopic polyangiitis (MPA). Their clinical data were collected and clinical characteristics, VN manifestations, electrophysiological findings (including interside amplitude ratio [IAR]), and treatment outcomes were compared among the three subsets of AAV. Then, factors influencing the treatment outcomes were analyzed using multivariable logistic regression analysis. Results: Peripheral neuropathy occurred in 62.1%(18/29) of EGPA, 8.3%(15/180) of GPA, and 13.1%(58/443) of MPA patients. The age at onset and examination was higher in patients with MPA than those with EGPA or GPA (P<0.01). The occurrence of VN was later in patients with GPA than those with EGPA (P<0.01), and the GPA group had fewer affected nerves than the other two groups (P<0.016). The abnormal IARs of motor nerves in lower limbs were more detected in the EGPA than the MPA group (P<0.01). Logistic regression analysis suggested that higher Birmingham vasculitis activity score-version 3 (BVAS-V3) (OR=6.85, 95%CI 1.33-35.30) was associated with better treatment outcomes of VN. However, central nervous system involvement was a risk factor for poor treatment outcomes (OR=0.13, 95%CI 0.02-0.89). Conclusions: The clinical and electrophysiological characteristics of VN were slightly different among subsets of AAV. Patients with GPA often presented with polyneuropathy and had fewer nerves affected; mononeuritis multiplex was more common in EGPA than GPA and MPA. Higher BVAS-V3 and central nervous system involvement might predict the treatment outcome of VN.

[Respiratory virus infection and its influence on outcome in children with septic shock]

Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

[Different methods in predicting mortality of pediatric intensive care units sepsis in Southwest China]

Objective: To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China. Methods: This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis. Results: Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) (Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS (Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion: Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Comprehensive genomic profiling to identify actionable alterations for breast cancer brain metastases in the Chinese population

BACKGROUND

Breast cancer brain metastasis (BCBM) is a crucial issue in the treatment of breast cancer and is associated with poor prognosis. Therefore, novel therapeutic targets are urgently needed in clinical practice. In this study, we aimed to identify potential actionable targets in brain metastases (BMs) utilising the FoundationOne® CDx (F1CDx).

PATIENTS AND METHODS

Formalin-fixed paraffin-embedded archived specimens including 16 primary breast tumours (PTs), 49 BCBMs and 7 extracranial metastases (ECMs) from 54 patients who underwent surgery for BCBM were tested using F1CDx. Tumour-infiltrated lymphocytes (TILs) of BMs were also tested using haematoxylin-eosin staining.

RESULTS

The median tumour mutational burden (TMB) and TILs in BMs were 5.0 (range 0-29) mut/Mb and 1.0% (range 0%-5.0%), respectively. High TMB (≥10 mut/Mb) was detected in four cases (8%). Genomic alterations (GAs) were detected in all samples. The top-ranked somatic mutations in BMs were TP53 (82%), PIK3CA (35%), MLL2 (22%), BRCA2 (14%) and ATM (14%) and the most prevalent copy number alterations were ERBB2 (64%), RAD21 (36%), CCND1 (32%), FGF19 (30%) and FGF3 (30%). The most prevalent GAs were relatively consistent between paired PTs and BMs. Actionable GAs were detected in 94% of all BMs. Consistent rate in actionable GAs was 38% (6/16) between paired PTs/ECMs and BMs. Compared to matched PTs/ECMs, additional actionable GAs (BRAF, FGFR1, PTEN, KIT and CCND1) were discovered in 31% (5/16) of the BMs.

CONCLUSIONS

TMB and TILs were relatively low in BCBMs. Comparable consistency in actionable GAs was identified between BCBMs and matched PTs/ECMs. It was, therefore, logical to carry out genomic testing for BCBMs to identify potential new therapeutic targets when BCBM specimens were available, as ∼31% of samples carried additional actionable GAs.

Variation in brain connectivity during motor imagery and motor execution in stroke patients based on electroencephalography

Objective

The objective of this study was to analyze the changes in connectivity between motor imagery (MI) and motor execution (ME) in the premotor area (PMA) and primary motor cortex (MA) of the brain, aiming to explore suitable forms of treatment and potential therapeutic targets.

Methods

Twenty-three inpatients with stroke were selected, and 21 right-handed healthy individuals were recruited. EEG signal during hand MI and ME (synergy and isolated movements) was recorded. Correlations between functional brain areas during MI and ME were compared.

Results

PMA and MA were significantly and positively correlated during hand MI in all participants. The power spectral density (PSD) values of PMA EEG signals were greater than those of MA during MI and ME in both groups. The functional connectivity correlation was higher in the stroke group than in healthy people during MI, especially during left-handed MI. During ME, functional connectivity correlation in the brain was more enhanced during synergy movements than during isolated movements. The regions with abnormal functional connectivity were in the 18th lead of the left PMA area.

Conclusion

Left-handed MI may be crucial in MI therapy, and the 18th lead may serve as a target for non-invasive neuromodulation to promote further recovery of limb function in patients with stroke. This may provide support for the EEG theory of neuromodulation therapy for hemiplegic patients.

Detection of dynamic changes of electrodermal activity to predict the classroom performance of college students

It is emphasized in the Self-regulated learning (SRL) framework that self-monitoring of learning state is vital for students to keep effective in studying. However, it's still challenging to get an accurate and timely understanding of their learning states during classes. In this study, we propose to use electrodermal activity (EDA) signals which are deemed to be associated with physiological arousal state to predict the college student's classroom performance. Twenty college students were recruited to attend eight lectures in the classroom, during which their EDA signals were recorded simultaneously. For each lecture, the students should complete pre- and after-class tests, and a self-reported scale (SRS) on their learning experience. EDA indices were extracted from both time and frequency domains, and they were furtherly mapped to the student's learning efficiency. As a result, the indices relevant to the dynamic changes of EDA had significant positive correlations with the learning efficiency. Furthermore, compared with only using SRS, a combination with EDA indices had significantly higher accuracy in predicting the learning efficiency. In conclusion, our findings demonstrate that the EDA dynamics are sensitive to the changes in learning efficiency, suggesting a promising approach to predicting the classroom performance of college students.

Testosterone promotes the migration, invasion and EMT process of papillary thyroid carcinoma by up-regulating Tnnt1

PURPOSE

To explore the key genes and molecular pathways in the progression of thyroid papillary carcinoma (PTC) promoted by testosterone using RNA-sequencing technology, and to provide new drug targets for improving the therapeutic effect of PTC.

METHODS

Orchiectomy (ORX) was carried out to construct ORX mouse models. TPC-1 cells were subcutaneously injected for PTC formation in mice, and the tumor tissues were collected for RNA-seq. The key genes were screened by bioinformatics technology. Tnnt1 expression in PTC cells was knocked down or overexpressed by transfection. Cell counting kit-8 (CCK-8), colony formation assay, scratch assay and transwell assay were adopted, respectively, for the detection of cell proliferation, colony formation, migration and invasion. Besides, quantification real-time polymerase chain reaction (qRT-PCR) and western blot were utilized to determine the mRNA and protein expression levels of genes in tissues or cells.

RESULTS

Both estradiol and testosterone promoted the growth of PTC xenografts. The key gene Tnnt1 was screened and obtained by bioinformatics technology. Functional analysis revealed that overexpression of Tnnt1 could markedly promote the proliferation, colony formation, migration, invasion, and epithelial-to-mesenchymal transition (EMT) process of PTC cells, as well as could activate p38/JNK pathway. In addition, si-Tnt1 was able to inhibit the cancer-promoting effect of testosterone.

CONCLUSION

Based on the outcomes of bioinformatics and basic experiments, it is found that testosterone can promote malignant behaviors such as growth, migration, invasion and EMT process of PTC by up-regulating Tnnt1 expression. In addition, the function of testosterone may be achieved by activating p38/JNK signaling pathway.

Multilevel Laser-Induced Pain Measurement with Wasserstein Generative Adversarial Network - Gradient Penalty Model

Pain is an experience of unpleasant sensations and emotions associated with actual or potential tissue damage. In the global context, billions of people are affected by pain disorders. There are particular challenges in the measurement and assessment of pain, and the commonly used pain measuring tools include traditional subjective scoring methods and biomarker-based measures. The main tools for biomarker-based analysis are electroencephalography (EEG), electrocardiography and functional magnetic resonance. The EEG-based quantitative pain measurements are of immense value in clinical pain management and can provide objective assessments of pain intensity. The assessment of pain is now primarily limited to the identification of the presence or absence of pain, with less research on multilevel pain. High power laser stimulation pain experimental paradigm and five pain level classification methods based on EEG data augmentation are presented. First, the EEG features are extracted using modified S-transform, and the time-frequency information of the features is retained. Based on the pain recognition effect, the 20-40[Formula: see text]Hz frequency band features are optimized. Afterwards the Wasserstein generative adversarial network with gradient penalty is used for feature data augmentation. It can be inferred from the good classification performance of features in the parietal region of the brain that the sensory function of the parietal lobe region is effectively activated during the occurrence of pain. By comparing the latest data augmentation methods and classification algorithms, the proposed method has significant advantages for the five-level pain dataset. This research provides new ways of thinking and research methods related to pain recognition, which is essential for the study of neural mechanisms and regulatory mechanisms of pain.

Food packaging films based on ionically crosslinked konjac glucomannan incorporating zein-pectin nanoparticle-stabilized corn germ oil-oregano oil Pickering emulsion

This study addresses the limitations of konjac glucomannan (KGM) films in mechanical properties, hydrophobicity and antibacterial activities. For the first time, a zein-pectin nanoparticle-stabilized corn germ oil-oregano essential oil Pickering emulsion (ZPCEO) was incorporated into KGM, with the resulting film being further ionically crosslinked with Ca2+, Cu2+ or Fe3+. FTIR, SEM and EDS results showed that the metal ions were crosslinked with the hydroxyl and carbonyl groups of polysaccharides and uniformly distributed throughout the films (degree of crosslinking: Fe3+ > Cu2+ > Ca2+). Compared with pure KGM films, the ionic crosslinked ZPCEO/KGM (IL-ZPCEO/KGM) films have superior water resistance mechanical properties, and exhibit unique UV-blocking properties, antioxidant and antibacterial activities. The ZPCEO/KGM-Fe3+ film offered the best all-round properties, including the highest tensile strength, water resistance, UV-blocking capacity, and antimicrobial activity. Thus, ionic crosslinking of ZPCEO/KGM films can be applied to the preparation of food packaging for use in high humidity environments.

ARRDC5 deficiency impairs spermatogenesis by affecting SUN5 and NDC1

Sperm with normal morphology and motility are essential for successful fertilization, and the strong attachment of the sperm head-tail coupling apparatus to the nuclear envelope during spermatogenesis is required to ensure the integrity of sperm for capacitation and fertilization. Here, we report that Arrdc5 is associated with spermatogenesis. The Arrdc5 knockout mouse model showed male infertility characterized by a high bent-head rate and reduced motility in sperm, which led to capacitation defects and subsequent fertilization failure. Through mass spectrometry, we found that ARRDC5 affects spermatogenesis by affecting NDC1 and SUN5. We further found that ARRDC5 might affect the vesicle-trafficking protein SEC22A-mediated transport and localization of NDC1, SUN5 and other head-tail coupling apparatus-related proteins that are responsible for initiating the attachment of the sperm head and tail. We finally performed intracytoplasmic sperm injection as a way to explore therapeutic strategies. Our findings demonstrate the essential role and the underlying molecular mechanism of ARRDC5 in anchoring the sperm head to the tail during spermatogenesis.

[Application of autoregressive integrated moving average model to predict and analyze the incidence trend of mumps in Jiangxi Province]

Objective: To predict and analyze the incidence trend of mumps using the Autoregressive integrated moving average model (ARIMA) in Jiangxi Province. Methods: The ARIMA was used to model the number of mumps cases per month from 2015 to 2019 in Jiangxi Province. The number of mumps cases in 12 months was predicted and was compared with the actual reported cases in 2020, 2021, and 2022, respectively. Results: The optimal model was ARIMA (0,2,1)(1,2,0)12. The predicted number of cases was significantly higher than that reported in 2020, 2021 and 2022. The number of reported cases of mumps in 2020, 2021, and 2022 decreased by 54.02%, 63.40%, and 66.09% compared with the forecast. Conclusions: From 2020 to 2022, the reported incidence of mumps in Jiangxi Province was significantly lower than the predicted incidence. Considering that it was related to non-drug intervention measures and changes in immunization strategies, it was suggested to strengthen mumps surveillance further to better cope with the epidemic situation of mumps.

[Expressions of NLRP3, Caspase-1, and GSDMD in nasopharyngeal carcinoma tissue and association with recurrence and metastasis]

Objective: To investigate the expressions of Nod-like receptor protein 3 (NLRP3), cysteine-aspartic acid protease 1 (Caspase-1), and Gasdermin D (GSDMD) in nasopharyngeal carcinoma (NPC), and their relationships with the recurrence and metastasis of NPC. Methods: A retrospective study was conducted on 421 patients diagnosed with NPC between December 2014 and January 2020. The expressions of NLRP3, Caspase-1, and GSDMD in pathological specimens were examined with immunohistochemistry and multiplex immunofluorescence staining. Univariate and multivariate Cox regression analyses were applied to identify the factors influencing NPC recurrence and metastasis. In vitro experiments with NPC cell line HNE-2 were used to explore the functional mechanisms of NLRP3, Caspase-1, and GSDMD. Results: Multivariate Cox analysis revealed that tumor staging of Ⅲ-Ⅳ(HRrecurrence=2.74, 95%CIrecurrence: 1.61-4.65; HRmetastasis=1.90, 95%CImetastasis: 1.04-3.49) and pre-treatment plasma EBV-DNA levels≥1 500 copies/ml (HRrecurrence=1.91, 95%CIrecurrence: 1.13-3.23; HRmetastasis=2.07, 95%CImetastasis: 1.23-3.50)were independent risk factors for NPC recurrence and metastasis, while positive expression of NLRP3(HRrecurrence=0.17, 95%CIrecurrence: 0.08-0.35; HRmetastasis=0.30, 95%CImetastasis: 0.15-0.59), Caspase-1(HRrecurrence=0.32, 95%CIrecurrence: 0.18-0.59; HRmetastasis=0.43, 95%CImetastasis: 0.25-0.76), and GSDMD(HRrecurrence=0.48, 95%CIrecurrence: 0.25-0.91; HRmetastasis=0.96, 95%CImetastasis: 0.53-1.74) served as independent protective factors. Age (HR=1.02, 95%CI: 1.01-1.04) and intensity-modulated radiotherapy (HR=0.51, 95%CI: 0.30-0.88) were independent factors for NPC recurrence, whereas chemotherapy (HR=0.50, 95%CI: 0.29-0.88) acted as an independent protective factor for NPC metastasis (all P<0.05). NPC patients with positive expressions of the three proteins had higher locoregional recurrence-free survival, distant metastasis-free survival, and overall survival compared to those with negative expressions (all P<0.05). In vitro experiments revealed that the overexpression of NLRP3 activated the NLRP3/Caspase-1/GSDMD signaling pathway, as evidenced by Western Blot analysis. Enzyme-linked immunosorbent assay and scanning electron microscopy demonstrated that overexpression of NLRP3 promoted pyroptosis in HNE-2 cells. Cellular functional assays further confirmed that overexpression of NLRP3 significantly inhibited the proliferation, invasion, and migration of HNE-2 cells. Conclusion: Positive expressions of NLRP3, Caspase-1, and GSDMD serves as independent protective factors for recurrence and metastasis of NPC, potentially by promoting cell pyroptosis and thus inhibiting NPC cell proliferation, invasion, and migration.

[Standardized diagnosis results of suspected local anesthetics allergy]

To review and investigate the diagnosis results of local anesthetics (LA) allergy and improve the understanding of LA allergy in clinician. From March 2017 to February 2022, a total of 24 patients were investigated in Allergy Center of West China Hospital,Sichuan University on suspicion of LA allergy. Clinical data and results of skin tests and drug provocation tests (DPT) with the suspected drugs were retrospectively evaluated. The value of standardized diagnostic protocol in the LA allergy were analyzed. The results showed that 24 patients (3 men/21 women) were included with age range from 20 to 74 years. Three cases (12.5%) were positive in previous LA skin tests and proved to be tolerated through standardized tests. Twenty-one patients were initially diagnosed as "LA allergy" because of adverse reactions after previous use of LA, including 20 cases of immediate-type reaction and 1 case of delayed-type reaction. Three cases were considered LA allergy through standardized diagnosis approaches, including skin tests and DPT. One patient was diagnosed with anaphylaxis caused by chlorhexidine. Of the remaining 17 patients, 7 were considered as psychosomatic reactions (29.1%), 3 of sympathetic nervous system conditions (12.5%), 1 of spontaneous urticaria (4.2%), 2 of vasovagal syncope (8.3%), drug side effects (8.3%), skin irritation (8.3%), respectively. In conclusion, true allergic reactions to LA are rare. Through standardized skin tests and DPT, allergy can be ruled out in the vast majority of patients who complain of "LA allergy". For patients who are highly suspected of LA inducing anaphylaxis, other local anesthetics that can be used as safe alternatives should be determined by diagnostic tests according to future needs.

Self-Supervised EEG Representation Learning with Contrastive Predictive Coding for Post-Stroke Patients

Stroke patients are prone to fatigue during the EEG acquisition procedure, and experiments have high requirements on cognition and physical limitations of subjects. Therefore, how to learn effective feature representation is very important. Deep learning networks have been widely used in motor imagery (MI) based brain-computer interface (BCI). This paper proposes a contrast predictive coding (CPC) framework based on the modified s-transform (MST) to generate MST-CPC feature representations. MST is used to acquire the temporal-frequency feature to improve the decoding performance for MI task recognition. EEG2Image is used to convert multi-channel one-dimensional EEG into two-dimensional EEG topography. High-level feature representations are generated by CPC which consists of an encoder and autoregressive model. Finally, the effectiveness of generated features is verified by the k-means clustering algorithm. It can be found that our model generates features with high efficiency and a good clustering effect. After classification performance evaluation, the average classification accuracy of MI tasks is 89% based on 40 subjects. The proposed method can obtain effective feature representations and improve the performance of MI-BCI systems. By comparing several self-supervised methods on the public dataset, it can be concluded that the MST-CPC model has the highest average accuracy. This is a breakthrough in the combination of self-supervised learning and image processing of EEG signals. It is helpful to provide effective rehabilitation training for stroke patients to promote motor function recovery.

Rhythmic temporal prediction enhances neural representations of movement intention for brain-computer interface

Objective.Detecting movement intention is a typical use of brain-computer interfaces (BCI). However, as an endogenous electroencephalography (EEG) feature, the neural representation of movement is insufficient for improving motor-based BCI. This study aimed to develop a new movement augmentation BCI encoding paradigm by incorporating the cognitive function of rhythmic temporal prediction, and test the feasibility of this new paradigm in optimizing detections of movement intention.Methods.A visual-motion synchronization task was designed with two movement intentions (left vs. right) and three rhythmic temporal prediction conditions (1000 ms vs. 1500 ms vs. no temporal prediction). Behavioural and EEG data of 24 healthy participants were recorded. Event-related potentials (ERPs), event-related spectral perturbation induced by left- and right-finger movements, the common spatial pattern (CSP) and support vector machine, Riemann tangent space algorithm and logistic regression were used and compared across the three temporal prediction conditions, aiming to test the impact of temporal prediction on movement detection.Results.Behavioural results showed significantly smaller deviation time for 1000 ms and 1500 ms conditions. ERP analyses revealed 1000 ms and 1500 ms conditions led to rhythmic oscillations with a time lag in contralateral and ipsilateral areas of movement. Compared with no temporal prediction, 1000 ms condition exhibited greater beta event-related desynchronization (ERD) lateralization in motor area (P< 0.001) and larger beta ERD in frontal area (P< 0.001). 1000 ms condition achieved an averaged left-right decoding accuracy of 89.71% using CSP and 97.30% using Riemann tangent space, both significantly higher than no temporal prediction. Moreover, movement and temporal information can be decoded simultaneously, achieving 88.51% four-classification accuracy.Significance.The results not only confirm the effectiveness of rhythmic temporal prediction in enhancing detection ability of motor-based BCI, but also highlight the dual encodings of movement and temporal information within a single BCI paradigm, which is promising to expand the range of intentions that can be decoded by the BCI.

[Tumor Mechanomedicine]

Malignant tumors represent a significant health challenge, critically impacting human well-being. Historically, the focus has been on leveraging the biochemical cues of tumors for both diagnosis and treatment. While valuable, this strategy does not capture the full complexity of tumor diagnosis and management. Recently, the integration of biomechanics and mechanobiology with oncology has highlighted the importance of mechanical cues, which have emerged as new hallmarks of tumors, opening potential novel routes for cancer diagnosis and therapeutic interventions. Despite the advances, a thorough literature review suggests a pronounced gap in our understanding of the mechanical properties of tumors. The clinical community has not yet completely recognized the diagnostic and therapeutic relevance of the mechanical cues of tumors. To bridge this knowledge gap, we propose and introduce the paradigm of "Tumor Mechanomedicine". We provide a comprehensive overview of the multi-scale mechanical characteristics of tumors, exploring their influence on tumor biology, from the aspects of tumor biomechanics, tumor mechanobiology, tumor mechanodiagnostics, and tumor mechanotherapeutics. By elucidating the diagnostic and therapeutic potential of these mechanical cues, we aim to furnish the oncology community with fresh insights, paving the way for innovative solutions to persistent clinical conundrums.

A Light Vehicle License-Plate-Recognition System Based on Hybrid Edge-Cloud Computing

With the world moving towards low-carbon and environmentally friendly development, the rapid growth of new-energy vehicles is evident. The utilization of deep-learning-based license-plate-recognition (LPR) algorithms has become widespread. However, existing LPR systems have difficulty achieving timely, effective, and energy-saving recognition due to their inherent limitations such as high latency and energy consumption. An innovative Edge-LPR system that leverages edge computing and lightweight network models is proposed in this paper. With the help of this technology, the excessive reliance on the computational capacity and the uneven implementation of resources of cloud computing can be successfully mitigated. The system is specifically a simple LPR. Channel pruning was used to reconstruct the backbone layer, reduce the network model parameters, and effectively reduce the GPU resource consumption. By utilizing the computing resources of the Intel second-generation computing stick, the network models were deployed on edge gateways to detect license plates directly. The reliability and effectiveness of the Edge-LPR system were validated through the experimental analysis of the CCPD standard dataset and real-time monitoring dataset from charging stations. The experimental results from the CCPD common dataset demonstrated that the network's total number of parameters was only 0.606 MB, with an impressive accuracy rate of 97%.

Multi-dimensional radiomics analysis to predict visceral pleural invasion in lung adenocarcinoma of ≤3 cm maximum diameter

AIM

To explore the value of radiomics analysis in preoperatively predicting visceral pleural invasion (VPI) of lung adenocarcinoma (LAC) with ≤3 cm maximum diameter and to compare the performance of two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) radiomics models.

MATERIALS AND METHODS

A total of 391 LAC patients were enrolled retrospectively, of whom 142 were VPI (+) and 249 were VPI (-). Radiomics features were extracted from 2D and 3D regions of interest (ROIs) of tumours in CT images. 2D and 3D radiomics models were developed combining the optimal radiomics features by using the logistic regression machine-learning method and radiomics scores (rad-scores) were calculated. Nomograms were constructed by integrating independent risk factors and rad-scores. The performance of each model was evaluated by using the receiver operator characteristic (ROC) curve, decision curve analysis (DCA), clinical impact curve (CIC), and calculating the area under the curve (AUC).

RESULTS

There was no difference in the VPI prediction between 2D and 3D radiomics models (training group: 2D AUC=0.835, 3D AUC=0.836, p=0.896; validation group: 2D AUC=0.803, 3D AUC=0.794, p=0.567). The 2D and 3D nomograms performed similarly regarding discrimination (training group: 2D AUC=0.867, 3D AUC=0.862, p=0.409, validation group: 2D AUC=0.835, 3D AUC=0.827, p=0.558), and outperformed their corresponding radiomics models and the clinical model. DCA and CIC revealed that the 2D nomogram had slightly better clinical utility.

CONCLUSION

The 2D radiomics model has a similar discrimination capability compared with the 3D radiomics model. The 2D nomogram performs slightly better for individual VPI prediction in LAC.

Treatment Outcomes of Concurrent Nimotuzumab with Intensity Modulated Radiotherapy in Advanced Nasopharyngeal Carcinoma Patients Unfit for Concurrent Chemoradiotherapy: A Single Institute Experience

PURPOSE/OBJECTIVE(S)

To assess the safety and efficacy of intensity-modulated radiotherapy (IMRT) combined with nimotuzumab for patients with locally advanced nasopharyngeal carcinoma (LA-NPC) medically unfit to receive concomitant chemotherapy.

MATERIALS/METHODS

From 2016.6 to 2020.9, 34 newly diagnosed patients with local-regional advanced NPC medically unfit for concurrent chemoradiation had undergone definitive radiotherapy and were retrospectively evaluated. All patients were treated with IMRT combined treatment modality of nimotuzumab with or without cisplatin-based induction chemotherapy. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Acute and late radiation-related toxicities were evaluated based on the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 during and after IMRT. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate prognostic analyses were performed by using the Cox proportional hazard model.

RESULTS

The median follow-up time for the entire group was 15 months (range 5 to 55 months). At the time of this analysis, a total of 2 cases developed loco-regional recurrence. In addition, 4 patients developed distant metastasis. There was a total of 5 deaths: 3 patients died from distant metastasis, 1 patient died from the progression of loco-regional disease after recurrence, and the causes of death for the additional 1 case was a nasopharyngeal ulcer and deadly bleeding. The 1-year OS rate of the whole cohort was 87.9%, and the 1-year LFFR, DFFR, and PFS rates were 100%, 91.0%, and 91.0%, respectively. During the period of concurrent nimotuzumab and IMRT, no grade 3-4 hematologic toxicities and dermatitis were observed. Grade 3-4 radiotherapy-related oral mucositis was reported in 7 patients (20.6%). No infusion reaction was observed. No acneiform eruptions were found among these patients. The most commonly observed late complication was xerostomia. The degree of dry mouth in most patients was mild-to-moderate at the time of the last follow-up. Finally, 7 patients developed either unilateral or bilateral hearing impairment. One female patient experienced a nasopharyngeal ulcer and deadly bleeding after 5 months of completion of radiotherapy.

CONCLUSION

Concurrent nimotuzumab with IMRT for the treatment of LA-NPC was well tolerated, with encouraging survival data, and it could be an effective treatment alternative for patients with LA-NPC medically unfit for concomitant chemotherapy. Further clinical trials are needed to confirm these findings.

Tumor Treatment Response Assessed During the Chemo-Radiotherapy for Locally Advanced NSCLC

PURPOSE/OBJECTIVE(S)

To evaluate the capability of assessing intratumoral treatment response distribution with using FDG-PET/CT during the chemoradiotherapy of locally advanced NSCLC.

MATERIALS/METHODS

Twelve of total 50 patients with stage III NSCLC were enrolled in the institutional protocol for concurrent chemoradiotherapy with treatment dose of 54-60 Gy in 27-30 fractions. For each patient, a pre-treatment FDG-PET/CT image (SUV0) and a mid-treatment image (SUVm) obtained within the treatment dose of 24 ∼ 46 Gy were obtained. Followed by deformable PET/CT registration between SUV0 and SUVm, the tumor voxel SUV reduction ratio was obtained to construct a tumor dose response matrix (DRM). Tumor SUVavid was also constructed by limiting tumor voxel SUVm > a given value. Spatial correlations of the tumor SUV0, SUVm, SUVavid and DRM were determined.

RESULTS

The mean and coefficient variation (CV) of the SUV0, SUVm and DRM for all tumors were 6.56(64%), 2.82(59%) and 0.52(70%) (Table contains the individual data), which were like those on the SUVs and the mean DRM of head-neck HPV- patients reported previously, but much larger on the DRM variation. The inter-tumoral CVs of SUV0 and DRM were 17% and 43%, which were much smaller than those of the intra-tumoral CVs 61% and 55%. Meanwhile, the intra-tumoral variations on both SUV0 and DRM were much larger than those of head-neck HPV- patients. There was a weak correlation between SUV0 and SUVm with the correlation coefficient 0.32, a medium correlation of -0.51 between SUV0 and DRM; 0.58 between SUVm and DRM. It implies that the rule of tumor dose response DRM on treatment modification decision cannot be fully replaced by either SUV0 or SUVm. The spatial correlation between tumor DRM and SUVavid was 0.23 with SUVavid value > 3, which was getting weaker when increasing SUVavid value.

CONCLUSION

Spatial dose response for NSCLC assessed using FDG-PET/CT feedback demonstrated high treatment resistant patterns, which had a large intra-tumoral variation. In addition, the medium correlations of DRM vs SUV0 and DRM vs SUVm imply that all these factors could be used to guide adaptive modification of NSCLC treatment.

Prognostic Significance of the Novel Nutrition-Inflammation Marker of Lymphocyte-C-Reactive Protein Ratio in Patients with Nasopharyngeal Carcinoma Receiving Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

Recent studies indicate that the novel lymphocyte-C-reactive protein ratio (LCR) is strongly associated with the survival of various tumors, but its prognostic value in nasopharyngeal carcinoma (NPC) is understudied. This study aimed to explore the relationship between the LCR and overall survival (OS) in NPC and to develop a predictive model.

MATERIALS/METHODS

A total of 841 NPC patients received concurrent chemoradiotherapy (CCRT) were retrospectively enrolled and randomly divided into training cohort (n = 589) and validation cohort (n = 252). Univariate and multivariate Cox analyses were performed to identify variables associated with OS and construct a predictive nomogram. The predictive accuracy of the nomogram was evaluated and independently validated.

RESULTS

The LCR score differentiated NPC patients into two groups with distinct prognoses (HR = 0.53; 95% CI: 0.32-0.89, P = 0.014). Multivariate analysis showed that age, T stage, N stage, EBV-DNA status, and LCR score were independently associated with OS and a predictive nomogram was developed. The nomogram had a good performance for the prediction of OS [C-index = 0.770 (95% CI: 0.675-0.864)] and outperformed the traditional staging system [C-index = 0.589 (95% CI: 0.385-0.792)]. The results were internally validated using an independent cohort.

CONCLUSION

The novel nutrition-inflammation marker of LCR could serve as a simplified, affordable, easy-to-obtain, non-invasive, and readily promotive prognostic marker for NPC patients received CCRT, and the LCR-based prognostic nomogram outperformed the conventional staging system in terms of predictive power.

[Chest hemorrhage after left total pulmonary resection for secondary rifampin-resistant tuberculosis:a case report]

The patient had received five courses of anti-tuberculosis treatment for recurrent tuberculosis. The drug sensitivity test results of the first three courses showed drug-sensitive pulmonary tuberculosis, and the fourth diagnosis was rifampin-resistant tuberculosis (RR-TB), complicated by chronic obstructive pulmonary disease, type Ⅱ respiratory failure, pulmonary heart disease, and heart failure (grade Ⅲ). The patient stopped taking the anti-tuberculosis drugs on his own in the eighth month of receiving the resistant treatment. After admission, the symptoms improved temporarily after receiving oxygen therapy, anti-infection, and anti-tuberculosis treatment. Because of hemoptysis, the patient underwent arterial embolization by catheterization, but a large amount of hemoptysis occurred shortly thereafter. Emergency left total lung resection and gauze packing for hemostasis were performed. After surgery, the patient's vital signs were maintained with mechanical ventilation and vasopressors. Forty-eight hours after surgery, the gauze was removed, and the patient underwent tracheotomy, enteral nutrition, and anti-tuberculosis treatment. After discharge, the patient underwent rehabilitative exercise and anti-resistant tuberculosis therapy. The patient's condition remained stable for more than six months of follow-up.

[The value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease]

Objective: To investigate the value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD). Methods: Fifty patients (22 males and 28 females; aged 16-61 years) who were diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) with/without asthma, and underwent NERD standardized diagnosis in the Allergy Centre of West China Hospital, Sichuan University from December 2021 to November 2022 were included in the study. The first step was asking about the history of exacerbation respiratory symptoms after intake of any non-steroidal anti-inflammatory drug, including aspirin; the second step was performing intranasal aspirin challenge (IAC); and the third step was performing oral aspirin challenge (OAC). The diagnosis of NERD was made if any of the above steps was positive, and the subsequent steps were not performed, otherwise the diagnosis was made to OAC. If OAC was negative, the diagnosis was non-NERD. All patients completed the sino-nasal outcome test 22 (SNOT 22) score, Lund-Kennedy score by nasal endoscopic, allergen skin prick test, blood routine and serum total IgE test. SPSS version 20.0 was used for statistical analysis. Results: The diagnosis of NRED was confirmed in 27 patients (27/50, 54%). Seven (7/50, 14%) of them were diagnosed by clinical history and 20 (20/50, 40%) were diagnosed by aspirin challenge tests, of which 17 (17/20, 85%) were positive to IAC and 3 (3/20, 15%) to OAC. Of the 43 patients who underwent IAC testing, only 2 (2/43, 5%) developed asthma attacks during challenge. Comparing the clinical characteristics of patients in NERD and non-NERD group, there were significant differences between the two groups in gender (P=0.001), hyposmia (P=0.003), history of repeated CRSwNP surgeries (P=0.028), comorbid asthma (P=0.013), SNOT-22 score (P=0.004) and the percentage of peripheral blood eosinophil (P=0.043). Conclusions: Patients may be underdiagnosed if the diagnosis of NERD is made only by medical history, and it is necessary to carry out aspirin challenge tests. IAC is an important means to diagnose NERD with high accuracy and good safety. However, If IAC is negative, further OAC is required.

[Efficacy of arteriovenous argatroban versus heparin flush anticoagulation after cardiovascular surgery]

Objective: To compare the effects of arteriovenous argatroban and heparin flushes on platelet count and assess the occurrence of heparin-induced thrombocytopenia (HIT) and other complications in patients undergoing cardiovascular surgeries. Methods: A single-center, prospective randomized control study was conducted. Patients who underwent cardiovascular surgery at Fuwai Hospital, Chinese Academy of Medical Sciences from March to December 2019 were randomly divided into the argatroban group (250 ml normal saline plus 2.5 mg of argatroban) and the heparin group (250 ml normal saline plus 10 mg of heparin). Platelet count, hemorrhage, and thrombosis were assessed. The 4T scores of HIT, the incidences of HIT and other complications were also evaluated. Results: A total of 491 patients (307 males and 184 females) were included in the study, with a mean age of (52.3±13.7) years. There were 245 cases in the argatroban group and 246 cases in the heparin group, respectively. There was no statistically significant difference in the preoperative platelet count between the argatroban and heparin groups [198.0 (161.0, 248.0)×10⁹/L vs 194.0 (157.2, 243.8)×10⁹/L, P=0.498]. Likewise, there were no statistically significant differences in the platelet count between the argatroban and heparin groups at 12 h, 1 day, and 5 days after operation [127.0 (100.0, 154.0)×10⁹/L vs 121.5 (90.2, 149.0)×10⁹/L, 126.0 (97.0, 162.0)×10⁹/L vs 123.5 (88.0, 151.0)×10⁹/L, 168.0 (130.0, 215.0) ×10⁹/L vs 161.0 (101.0, 210.5)×10⁹/L] (repeated measures ANOVA between groups: F=3.327, P=0.069; time comparison: F=532.523, P<0.001; time interaction between groups: F=0.675, P=0.512). The proportion of 4T scores of medium and high scores (≥4)[9.8% (24/245) vs 10.6% (26/246), P=0.777] and incidence of HIT antibody positive [1.63% (4/245) vs 1.63% (4/246), P=0.726] were similar between argatroban group and the heparin group. Mechanical ventilation time was shorter in the argatroban group than that in the heparin group [13.0 (11.0, 21.0) vs 15.5 (12.0, 21.0) h, P=0.020]. Conclusion: Compared with heparin, routine management with argatroban for arteriovenous flush in patients undergoing cardiovascular surgery does not affect the HIT incidence.

Epileptic EEG Classification via Graph Transformer Network

Deep learning-based epileptic seizure recognition via electroencephalogram signals has shown considerable potential for clinical practice. Although deep learning algorithms can enhance epilepsy identification accuracy compared with classical machine learning techniques, classifying epileptic activities based on the association between multichannel signals in electroencephalogram recordings is still challenging in automated seizure classification from electroencephalogram signals. Furthermore, the performance of generalization is hardly maintained by the fact that existing deep learning models were constructed using just one architecture. This study focuses on addressing this challenge using a hybrid framework. Alternatively put, a hybrid deep learning model, which is based on the ground-breaking graph neural network and transformer architectures, was proposed. The proposed deep architecture consists of a graph model to discover the inner relationship between multichannel signals and a transformer to reveal the heterogeneous associations between the channels. To evaluate the performance of the proposed approach, the comparison experiments were conducted on a publicly available dataset between the state-of-the-art algorithms and ours. Experimental results demonstrate that the proposed method is a potentially valuable instrument for epoch-based epileptic EEG classification.

Design and Test of Spatial Cognitive Training and Evaluation System based on Virtual Reality Head-mounted Display with EEG Recording

The field of spatial cognitive training and evaluation has rapidly evolved. However, the low learning motivation and engagement of the subjects hinder the widespread use of spatial cognitive training. This study designed a home-based spatial cognitive training and evaluation system (SCTES), which aimed to train subjects on spatial cognitive tasks for 20 days, and compared the brain activities before and after the training. This study also evaluated the feasibility of using a portable all-in-one prototype for cognitive training that combined a virtual reality (VR) head-mounted display with high-quality electroencephalogram (EEG) recording. During the course of training, the length of the navigation path and the distance between the starting position and the platform position revealed significant behavioral differences. In the testing sessions, the subjects showed significant behavioral differences in the time it took to complete the test task before and after training. After only four days of training, the subjects demonstrated significant differences in the Granger causality analysis (GCA) characteristics of brain regions in the δ, θ, α₁, β₂, and γ frequency bands of the EEG, as well as significant differences in the GCA of the EEG in the β₁, β₂, and γ frequency bands between the two test sessions. The proposed SCTES used a compact and all-in-one form factor to train and evaluate spatial cognition and collect EEG signals and behavioral data simultaneously. The recorded EEG data can be used to quantitatively assess the efficacy of spatial training in patients with spatial cognitive impairments.

[Enhance the management of cardiac arrest and improve the prognosis of the patients]

Cardiac arrest is one of the major public health problems with sudden onset, high mortality and high disability rate. The prevalence of cardiovascular disease continues to rise and the burden of cardiac arrest is increasing in China. It is of great significance to explore more effective prevention and treatment measures to improve the prognosis of patients with cardiac arrest. This article discusses the relevant progress on the treatment ability of emergency and critical cardiovascular diseases, medicines and technologies for cardiac arrest care, and registry studies of cardiac arrest, to further promote the effective improvement of key capacities at various stages of the prevention and treatment of cardiac arrest in China.

A novel visual brain-computer interfaces paradigm based on evoked related potentials evoked by weak and small number of stimuli

Introduction

Traditional visual Brain-Computer Interfaces (v-BCIs) usually use large-size stimuli to attract more attention from users and then elicit more distinct and robust EEG responses, which would cause visual fatigue and limit the length of use of the system. On the contrary, small-size stimuli always need multiple and repeated stimulus to code more instructions and increase separability among each code. These common v-BCIs paradigms can cause problems such as redundant coding, long calibration time, and visual fatigue.

Methods

To address these problems, this study presented a novel v-BCI paradigm using weak and small number of stimuli, and realized a nine-instruction v-BCI system that controlled by only three tiny stimuli. Each of these stimuli were located between instructions, occupied area with eccentricities subtended 0.4°, and flashed in the row-column paradigm. The weak stimuli around each instruction would evoke specific evoked related potentials (ERPs), and a template-matching method based on discriminative spatial pattern (DSP) was employed to recognize these ERPs containing the intention of users. Nine subjects participated in the offline and online experiments using this novel paradigm.

Results

The average accuracy of the offline experiment was 93.46% and the online average information transfer rate (ITR) was 120.95 bits/min. Notably, the highest online ITR achieved 177.5 bits/min.

Discussion

These results demonstrate the feasibility of using a weak and small number of stimuli to implement a friendly v-BCI. Furthermore, the proposed novel paradigm achieved higher ITR than traditional ones using ERPs as the controlled signal, which showed its superior performance and may have great potential of being widely used in various fields.

One-Dimensional Local Binary Pattern and Common Spatial Pattern Feature Fusion Brain Network for Central Neuropathic Pain

Central neuropathic pain (CNP) after spinal cord injury (SCI) is related to the plasticity of cerebral cortex. The plasticity of cortex recorded by electroencephalogram (EEG) signal can be used as a biomarker of CNP. To analyze changes in the brain network mechanism under the combined effect of injury and pain or under the effect of pain, this paper mainly studies the changes of brain network functional connectivity in patients with neuropathic pain and without neuropathic pain after SCI. This paper has recorded the EEG with the CNP group after SCI, without the CNP group after SCI, and a healthy control group. Phase-locking value has been used to construct brain network topological connectivity maps. By comparing the brain networks of the two groups of SCI with the healthy group, it has been found that in the [Formula: see text] and [Formula: see text] frequency bands, the injury increases the functional connectivity between the frontal lobe and occipital lobes, temporal, and parietal of the patients. Furthermore, the comparison of brain networks between the group with CNP and the group without CNP after SCI has found that pain has a greater effect on the increased connectivity within the patients' frontal lobes. Motor imagery (MI) data of CNP patients have been used to extract one-dimensional local binary pattern (1D-LBP) and common spatial pattern (CSP) features, the left and right hand movements of the patients' MI have been classified. The proposed LBP-CSP feature method has achieved the highest accuracy of 98.6% and the average accuracy of 91.5%. The results of this study have great clinical significance for the neural rehabilitation and brain-computer interface of CNP patients.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)]

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Hybrid Attention Network For Epileptic EEG Classification

Automatic seizure detection from electroencephalography (EEG) based on deep learning has been significantly improved. However, existing works have not adequately excavate the spatial-temporal information between EEG channels. Besides, most works mainly focus on patient-specific scenarios while cross-patient seizure detection is more challenging and meaningful. Regarding the above problems, we propose a hybrid attention network (HAN) for automatic seizure detection. Specifically, the graph attention network (GAT) extracts spatial features at the front end, and Transformer gets time features as the back end. HAN leverages the attention mechanism and fully extracts the spatial-temporal correlation of EEG signals. The focal loss function is introduced to HAN to deal with the imbalance of the dataset accompanied by seizure detection based on EEG. Both patient-specific and patient-independent experiments are carried out on the public CHB-MIT database. Experimental results demonstrate the efficacy of HAN in both experimental settings.

Risk prediction of second primary malignancies in primary colorectal neuroendocrine neoplasms patients: a population-based study

PURPOSE

In this study, we aimed to identify risk factors for developing second primary malignancies (SPMs) in colorectal neuroendocrine neoplasms (NENs) patients and develop a competing-risk nomogram to predict SPMs' probabilities quantitatively.

METHODS

Patients with colorectal NENs were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2000-2013. Potential risk factors for SPMs' occurrence in colorectal NENs' patients were identified by the Fine and Gray's proportional sub-distribution hazards model. Then, a competing-risk nomogram was constructed to quantify SPMs' probabilities. The discriminative abilities and calibrations of this competing-risk nomogram were assessed by the area under the receiver-operating characteristic (ROC) curves (AUC) and calibration curves.

RESULTS

We identified 11,017 colorectal NENs' patients, and randomly divided them into training (n = 7711 patients) and validation (n = 3306 patients) cohorts. In the whole cohort, 12.4% patients (n = 1369) had developed SPMs during the maximum follow-up of approximately 19 years (median 8.9 years). Sex, age, race, primary tumor location, and chemotherapy were identified as risk factors for SPMs' occurrence in colorectal NENs' patients. Such factors were selected to develop a competing-risk nomogram and showed excellent predictive ability for SPMs' occurrence (the 3-, 5-, and 10-year AUC values were 0.631, 0.632, and 0.629 in the training cohort and 0.665, 0.639, 0.624 in the validation cohort, respectively).

CONCLUSIONS

This research identified risk factors for SPMs' occurrence in colorectal NENs' patients. Competing-risk nomogram was constructed and proved to have good performance.

[Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome]

Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ²=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ²=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ²=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.

[Tumor necrosis factor-related apoptosis-inducing ligand gene polymorphism and its plasma phenotype in relation to Crohn's disease]

Objectives: To investigate the associations of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) gene polymorphism and plasma soluble TRAIL level (sTRAIL) with Crohn's disease (CD) and to retrospectively analyze the effects of TRAIL gene variants and plasma sTRAIL levels on clinical response to infliximab (IFX). Methods: From January 2012 to January 2021, 312 CD patients [205 males, 107 females, average age (33.9±9.8) years] and 514 age-and gender-matched healthy controls [304 males, 210 females, average age (34.9±9.4) years] were recruited from the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University. Among them, 72 patients with active CD who were ineffective or intolerant to traditional drug therapy regularly received IFX (5 mg/kg) treatment. According to the changes in the Harvey-Bradshaw index (HBI) and the Simplified Endoscopic Score for Crohn's Disease (SES-CD) in the 14^th week, these patients were classified into response group (a decrease in HBI≥3 or a decrease in SES-CD≥50%) and non-response group. TRAIL (rs1131568) gene polymorphism was analyzed by matrix-assisted laser desorption/ionization time of flight mass spectrometry technique. The plasma sTRAIL level was examined by enzyme-linked immunosorbent assay (ELISA). Based on the Montreal CD classification criteria, all CD patients were divided into different subgroups. Finally, a comprehensive analysis was performed to investigate the relationship between TRAIL (rs1131568) gene polymorphism, the plasma sTRAIL level and the risk of CD, the clinicopathological characteristics of CD patients, and the clinical response to IFX. Results: The recessive model analysis showed that the homozygous variant genotype (CC) was more prevalent in patients with moderately to severely active CD than in those with mildly active CD (45.34% vs 29.23%, P=0.005). Both variant allele (C) and homozygous variant genotype (CC) in patients with stricturing and penetrating CD were more frequent than those in patients with non-stricturing and non-penetrating CD (65.48% vs 57.53%, P=0.046; 49.21% vs 31.18%, P=0.001). The dominant model analysis showed that variant allele (C) and variant genotype (TC+CC) was higher in CD patients with perianal lesions than in those without perianal lesions (66.83% vs 58.17%, P=0.037; 92.31% vs 78.37%, P=0.002). The average plasma sTRAIL level was higher in CD patients than in healthy controls [(243.04±42.74) ng/L vs (194.16±31.14) ng/L, P<0.001]. Compared with the patients with mildly active CD, the plasma sTRAIL level was increased in those with moderately to severely active CD [263.47(242.09, 281.91) ng/L vs 231.13(211.11, 247.11) ng/L, P<0.001]. The same conclusion was also drawn for the patients with stricturing and penetrating CD in contrast to those with non-stricturing and non-penetrating CD [266.18 (246.68, 289.91) ng/L vs 227.19 (204.57, 249.59) ng/L, P<0.001]. The plasma sTRAIL level was also higher in patients with perianal disease than in those without perianal disease [(261.40±41.51) ng/L vs (233.86±40.41) ng/L, P<0.001]. Multiple linear regression analysis further showed that disease activity (β=22.640, P<0.001) and homozygous variant genotype (CC) (β=16.814, P<0.001) may be positively related to the plasma sTRAIL level in CD patients independently. At the 14^th week of IFX treatment, the plasma sTRAIL level in the response group was lower than that in the non-response group [205.98(190.72, 214.56) ng/L vs (238.33±29.38) ng/L, P<0.001]. Compared with week 0, the plasma sTRAIL level was decreased in the response group in the 14^th week [(205.98 (190.72, 214.56) ng/L vs (239.89±42.43) ng/L, P<0.001]. Non-conditional logistic regression analysis showed that variant allele (C) and variant genotype (TC+CC) were less frequent in the response group than in the non-response group (53.33% vs 70.83%, P=0.037; 70.00% vs 91.67%, P=0.036). Conclusions: The increased plasma sTRAIL level may be a risk factor for CD. TRAIL (rs1131568) gene variation and the increase of plasma sTRAIL level may be associated with the increased disease activity of CD and may be the risk factors for stenosis, penetration, and perianal lesions in CD patients. In addition, TRAIL (rs1131568) gene variation or the increase of plasma sTRAIL level may be related to no response to IFX treatment in CD patients.

Is There An Association Between Periodontitis And Non-Alcoholic Fatty Liver Disease? A Systematic Review and Meta-Analysis

BACKGROUND

Studies have reported varying relationships between periodontitis and non-alcoholic fatty liver disease (NAFLD). This review aimed to summarise evidence by pooling published data on the association between periodontitis and NAFLD.

METHODS

PubMed, CENTRAL, Web of Science, and Embase databases were searched for cross-sectional, case-control, or cohort studies published up to 20th June 2022. The PICO statement was: In the general Population does the presence of periodontitis (Intervention) as compared to no periodontitis (Comparison) lead to NAFLD (Outcome). All included studies were to report the association between periodontitis and NAFLD using odds ratios (OR) or risk ratios with 95% confidence intervals (CI). Random effects meta-analysis was conducted to obtain pooled OR with 95% CI.

RESULTS

Meta-analysis of seven studies with data of 192,815 participants found no association between periodontitis and NAFLD (OR: 1.04 95% CI: 0.97, 1.12). There was medium heterogeneity in the meta-analysis (I²=58%). The results did not change with the exclusion of any study. A small risk of NAFLD was noted in periodontitis patients on analysis of two cohort studies. Results were non-significant for other study types. Subgroup analysis based on the study population and diagnostic method for NAFLD also failed to find relationships.

CONCLUSION

Current evidence fails to demonstrate a link between periodontitis and NAFLD.

[Advances in brain-computer interface based on high-frequency steady-state visual evoked potential]

Steady-state visual evoked potential (SSVEP) has been widely used in the research of brain-computer interface (BCI) system in recent years. The advantages of SSVEP-BCI system include high classification accuracy, fast information transform rate and strong anti-interference ability. Most of the traditional researches induce SSVEP responses in low and middle frequency bands as control signals. However, SSVEP in this frequency band may cause visual fatigue and even induce epilepsy in subjects. In contrast, high-frequency SSVEP-BCI provides a more comfortable and natural interaction despite its lower amplitude and weaker response. Therefore, it has been widely concerned by researchers in recent years. This paper summarized and analyzed the related research of high-frequency SSVEP-BCI in the past ten years from the aspects of paradigm and algorithm. Finally, the application prospect and development direction of high-frequency SSVEP were discussed and prospected.

Probing a General Strategy to Break the C-C Bond of Benzene by a Cyclic (Alkyl)(Amino)Aluminyl Anion

The oxidative addition of C-C bonds in aromatic hydrocarbons by low valent main group species has attracted considerable attention from both theoretical and experimental chemists due to the big challenge in breaking their aromaticity. Herein, a general strategy to break the C-C bonds in benzene by cyclic (alkyl)(amino)aluminyl anion is demonstrated via density functional theory (DFT) calculations. The results suggest that the activation of the C-C bond of benzene by this anion is both kinetically and thermodynamically unfavorable whereas introducing electron-withdrawing groups makes such C-C bond activation becomes favorable both kinetically and thermodynamically. Such a sharp change on the kinetics and thermodynamics could be rationalized by the frontier molecular orbital theory by decreasing the lowest unoccupied molecular orbitals of the mono- and disubstituted benzenes. Aromaticity is found to stabilize the transition state for the ring open step. All these findings can help develop the chemistry of small-molecule activation.

Exploration of sleep function connection and classification strategies based on sub-period sleep stages

Background

As a medium for developing brain-computer interface systems, EEG signals are complex and difficult to identify due to their complexity, weakness, and differences between subjects. At present, most of the current research on sleep EEG signals are single-channel and dual-channel, ignoring the research on the relationship between different brain regions. Brain functional connectivity is considered to be closely related to brain activity and can be used to study the interaction relationship between brain areas.

Methods

Phase-locked value (PLV) is used to construct a functional connection network. The connection network is used to analyze the connection mechanism and brain interaction in different sleep stages. Firstly, the entire EEG signal is divided into multiple sub-periods. Secondly, Phase-locked value is used for feature extraction on the sub-periods. Thirdly, the PLV of multiple sub-periods is used for feature fusion. Fourthly, the classification performance optimization strategy is used to discuss the impact of different frequency bands on sleep stage classification performance and to find the optimal frequency band. Finally, the brain function network is constructed by using the average value of the fusion features to analyze the interaction of brain regions in different frequency bands during sleep stages.

Results

The experimental results have shown that when the number of sub-periods is 30, the α (8-13 Hz) frequency band has the best classification effect, The classification result after 10-fold cross-validation reaches 92.59%.

Conclusion

The proposed algorithm has good sleep staging performance, which can effectively promote the development and application of an EEG sleep staging system.

Coherence based graph convolution network for motor imagery-induced EEG after spinal cord injury

Background

Spinal cord injury (SCI) may lead to impaired motor function, autonomic nervous system dysfunction, and other dysfunctions. Brain-computer Interface (BCI) system based on motor imagery (MI) can provide more scientific and effective treatment solutions for SCI patients.

Methods

According to the interaction between brain regions, a coherence-based graph convolutional network (C-GCN) method is proposed to extract the temporal-frequency-spatial features and functional connectivity information of EEG signals. The proposed algorithm constructs multi-channel EEG features based on coherence networks as graphical signals and then classifies MI tasks. Different from the traditional graphical convolutional neural network (GCN), the C-GCN method uses the coherence network of EEG signals to determine MI-related functional connections, which are used to represent the intrinsic connections between EEG channels in different rhythms and different MI tasks. EEG data of SCI patients and healthy subjects have been analyzed, where healthy subjects served as the control group.

Results

The experimental results show that the C-GCN method can achieve the best classification performance with certain reliability and stability, the highest classification accuracy is 96.85%.

Conclusion

The proposed framework can provide an effective theoretical basis for the rehabilitation treatment of SCI patients.