CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom

BACKGROUND

The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.

METHODS

In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).

RESULTS

Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.

CONCLUSIONS

This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.

[Revelation of the list of occupational diseases and diagnostic criteria for occupational diseases]

The list of occupational diseases reflecting the latest advances in the identification and recognition of occupational diseases, and providing guidance on the protection of workers' health rights and interests and the prevention, recording, notification and compensation of related occupational diseases. Diagnostic criteria for occupational diseases are an important basis for making diagnoses attributable to occupational diseases, and provide a theoretical basis for health monitoring of occupational groups and occupational hygiene supervision. This thesis starts with the definition of the occupational disease elaborates in detail the development history of list of occupational diseases in International Labour Organization (ILO) , compares the list of occupational diseases in China (2013 version) with the list of occupational diseases in international (2010 version) , and then introduces in detail the latest diagnostic standards of the major occupational diseases. And finally, it puts forward relevant suggestions on the list and diagnostic level of China's occupational diseases, so as to provide certain insights for the further improvement of the list and diagnostic standards of occupational diseases.

Poly-β-cyclodextrin strengthen Pr6O11 porous oxidase mimic for dual-channel visual recognition of bioactive cysteine and Fe2

To conveniently monitor bioactive cysteine (Cys) and Fe2+ in practice, a kind of poly-β-cyclodextrin strengthen praseodymium oxide (Pr6O11) porous oxidase mimic (p-β-CD@Pr6O11) was constructed by virtue of the strong coordination between nano Pr6O11 and poly-β-cyclodextrin substrate. After its microstructure and physicochemical property were characterized in detail, it was noted that porous p-β-CD@Pr6O11 exhibited excellent enzyme-like catalytic activity to accelerate the oxidation of 3,3',5,5,'-tetramethylbanzidine (TMB) and 2,2'-azinobis (3-ethylbenzo-thiazoline-6-sulfonic acid) ammonium salt (ABTS) with significant color-enhancement effect in the air. Based on the signal amplification, trace Cys could exclusively deteriorate the UV-vis absorbance at 653 nm of p-β-CD@Pr6O11-TMB and Fe2+ alter the one at 729 nm of p-β-CD@Pr6O11-ABTS with visual color changes. Under the optimized conditions, the proposed p-β-CD@Pr6O11-TMB and p-β-CD@Pr6O11-ABTS systems were successfully applied for dual-channel monitoring of Cys in Cys capsules and fetal bovine serum and Fe2+ in agricultural products with quite low detection limits, i.e., 7.8×10-9 mol·L-1 for Cys and 6.93×10-8 mol·L-1 (S/N=3) for Fe2+, respectively. The synergetic-enhancement detection mechanisms to Cys and Fe2+ were also proposed.

Development and validation of a nomogram for 30-day readmission after hip fracture surgery in geriatric patients

OBJECTIVE

30-day readmission after hip fracture surgery in the elderly is common and costly. A predictive tool to identify high-risk patients could significantly improve outcomes. This study aims to develop and validate a risk nomogram for 30-day readmission after hip fracture surgery in geriatric patients.

PATIENTS AND METHODS

We retrospectively analyzed 1,249 geriatric hip fracture patients (≥60 years) undergoing surgery at Dandong Central Hospital from October 2011 to October 2023. Using a 7:3 ratio, patients were randomly divided into training (n=877) and validation (n=372) sets. Independent risk factors for 30-day readmission were identified using LASSO regression and logistic regression in the training set. A nomogram was constructed using the identified predictors. Finally, the C-index, ROC curve, calibration curve, and decision curve analysis were used to validate the model in the training and validation sets respectively.

RESULTS

The nomogram was developed based on the 8 predictors of age, prior stroke, chronic liver disease, treatment, uric acid (UA), total protein (TP), albumin (ALB), and pneumonia that were found to be independently associated with 30-day readmission. The nomogram showed good discrimination with a C-index of 0.88 in the training set and 0.84 in the validation set. Calibration curves exhibited good agreement between predicted and observed outcomes. Decision curve analysis demonstrated clinical utility.

CONCLUSIONS

We developed and validated a nomogram incorporating eight clinical variables to accurately predict the individualized risk of 30-day readmission after hip fracture surgery in elderly patients. The model demonstrated favorable discrimination, calibration, and clinical utility. It can help to identify high-risk patients needing additional interventions to prevent avoidable hospital readmissions.

Assessment of groundwater reservoir and the influence of its characteristics on water dynamic control

Groundwater reservoirs play an important role in regional water volume balance. In order to ensure the efficiency of a groundwater reservoir and obtain its maximum value, it is necessary to figure out its characteristics, such as minimum water level, normal water level, and maximum water level. The characteristics not only determined the storage capacity but also influenced the water allocation and utilization. Therefore, this paper took a groundwater reservoir built in an alluvial fan as an example to assess its storage capacity and the influence on water dynamic control. The alluvial fan was located in the front of Lao River, where there were an alluvial-diluvial fan, groundwater storage space, and natural impervious boundary. Therefore, it was an ideal place for constructing a groundwater reservoir. Through theoretical analysis and numerical simulation, the storage capacity was determined, and the influence of groundwater reservoir characteristics on water dynamic control was analyzed. On this basis, the water-supply method in the research area was confirmed. This paper will present a new method for repairing the groundwater system and protecting the ecological environment.

Development and validation of a nomogram for urinary tract infection in geriatric patients with hip fracture: a retrospective study

OBJECTIVE

This study aims to develop and validate a risk nomogram for urinary tract infections (UTIs) in geriatric patients with hip fractures.

PATIENTS AND METHODS

A total of 900 geriatric patients who underwent hip fracture surgery at Dandong Central Hospital between June 2017 and June 2023 were systematically collected. The cohort was randomly divided into a training set (70%, n=632) and a validation set (30%, n=268) for model development and validation, respectively. Univariate and multivariate logistic regression analyses were conducted to identify the independent risk factors associated with UTIs. Based on the results of the multivariate analysis, a UTI nomogram prediction model was developed and evaluated in the training and validation sets using the C-index, ROC curve, calibration curve, and decision curve analysis to assess discrimination, calibration, and clinical utility, respectively.

RESULTS

Out of the 900 participants, 24.6% were diagnosed with UTIs. The nomogram was developed based on 9 predictors that were found to be independently associated with UTI. The area under the curve (AUC) for predicting UTI in geriatric patients with hip fractures was 0.829 in the training set and 0.803 in the validation set. Following internal verification, the modified C-index remained at 0.829. Furthermore, the nomogram's calibration plot and decision curve analysis demonstrated good performance in both the training and validation sets.

CONCLUSIONS

The established and validated nomogram provides a reliable and convenient tool for predicting UTI risk in geriatric patients with hip fractures. This model facilitates the early identification of high-risk patients and offers guidance for implementing targeted preventive interventions.

Development and validation of preoperative proximal and distal lower limb deep vein thrombosis nomograms in geriatric hip fracture patients

OBJECTIVE

This study aimed to develop and validate a risk nomogram for preoperative proximal and distal deep vein thrombosis (DVT) in geriatric patients with hip fractures.

PATIENTS AND METHODS

The 970 collected geriatric hip fracture patients were randomly divided into a training set (70%, n=682) and a validation set (30%, n=288). Multivariate logistic regression analyses were used to optimize the predictive risk variables for proximal and distal preoperative lower extremity DVT in the training set, respectively, and the selected variables were finally incorporated to establish preoperative DVT nomogram prediction models. Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were performed to validate the nomograms in the training and validation sets, respectively.

RESULTS

Among the 970 patients, 125 (12.88%) were diagnosed with preoperative DVT. The area under the curve (AUC) for predicting preoperative proximal DVT was 0.888 in the training and 0.792 in the validation sets. The AUC for predicting preoperative distal DVT was 0.907 in the training and 0.790 in the validation sets. The calibration plots and decision curve analysis for preoperative proximal DVT performed well in the training set and slightly worse in the validation set. The calibration plots and decision curve analysis for preoperative distal DVT performed well in both the training and validation sets.

CONCLUSIONS

To construct nomograms for predicting the risk of proximal and distal preoperative lower extremity DVT in geriatric hip fracture patients. For patients at high risk, as assessed by this model, clinicians should intervene and treat them promptly before surgery.

Priority list of potential endocrine-disrupting chemicals in food chemical contaminants: a docking study and in vitro/epidemiological evidence integration

Diet is an important exposure route of endocrine-disrupting chemicals (EDCs), but many unfiltered potential EDCs remain in food. The in silico prediction of EDCs is a popular method for preliminary screening. Potential EDCs in food were screened using Endocrine Disruptome, an open-source platform for inverse docking, to predict the binding probabilities of 587 food chemical contaminants with 18 human nuclear hormone receptor (NHR) conformations. In total, 25 contaminants were bound to multiple NHRs such as oestrogen receptor α/β and androgen receptor. These 25 compounds mainly include pesticides and per- and polyfluoroalkyl substances (PFASs). The prediction results were validated with the in vitro data. The structural features and the crucial amino acid residues of the four NHRs were also validated based on previous literature. The findings indicate that the screening has good prediction efficiency. In addition, the epidemic evidence about endocrine interference of PFASs in food on children was further validated through this screening. This study provides preliminary screening results for EDCs in food and a priority list for in vitro and in vivo research.

Hybrid CuSn nanosphere-functionalized Cu/Sn co-doped hollow carbon nanofibers as anode materials for sodium-ion batteries

To strengthen the electrochemical performance of anode materials for sodium-ion batteries, Cu/Sn co-doped hollow carbon nanofibers functionalized by hybrid CuSn nanospheres (CuSn/C@MCNF) were prepared by a simple electrospinning method. The microstructural characteristics of CuSn/C@MCNF confirmed the same doped elements and strong interactions in hybrid CuSn nanospheres and the hollow carbon nanofiber substrate. CuSn/C@MCNF has superior specific capacity, excellent conductivity and high cycling stability. In particular, the doped hollow carbon nanofiber substrate can facilitate Na+ transport and alleviate volume expansion during the process of sodium storage. When applied as an anode material for sodium-ion batteries, CuSn/C@MCNF can deliver a reversible capacity of 340.1 mA h g-1 at a large current density of 1 A g-1 for 1000 cycles and a high-rate capacity of 202.5 mA h g-1 at 4.0 A g-1, all superior to the corresponding Sn-SnOx@MCNF- and MCNF-based electrodes. This work provides a basic idea for future anode materials in high-performance sodium-ion batteries.

Threshold distribution of equal states for quantitative amplitude fluctuations

Objective. The distribution of equal states (DES) quantifies amplitude fluctuations in biomedical signals. However, under certain conditions, such as a high resolution of data collection or special signal processing techniques, equal states may be very rare, whereupon the DES fails to measure the amplitude fluctuations.Approach. To address this problem, we develop a novel threshold DES (tDES) that measures the distribution of differential states within a threshold. To evaluate the proposed tDES, we first analyze five sets of synthetic signals generated in different frequency bands. We then analyze sleep electroencephalography (EEG) datasets taken from the public PhysioNet.Main results. Synthetic signals and detrend-filtered sleep EEGs have no neighboring equal values; however, tDES can effectively measure the amplitude fluctuations within these data. The tDES of EEG data increases significantly as the sleep stage increases, even with datasets covering very short periods, indicating decreased amplitude fluctuations in sleep EEGs. Generally speaking, the presence of more low-frequency components in a physiological series reflects smaller amplitude fluctuations and larger DES.Significance. The tDES provides a reliable computing method for quantifying amplitude fluctuations, exhibiting the characteristics of conceptual simplicity and computational robustness. Our findings broaden the application of quantitative amplitude fluctuations and contribute to the classification of sleep stages based on EEG data.

Assistive Technology-Based Analysis of Students' Foreign Language Anxiety Using Distributed Machine Learning and Intelligent Affective Computing

Language learning anxiety is one of the most important affective variables affecting the effect of language learning. Sensor technologies involve devices that generate a digital output based on the detection of some physical phenomenon in terms of events or changes in a relevant environment. In this work, we propose an effective computing model. Through the research on the classification of emotions and dimensional space theory, combined with the actual learning emotions of learners in the flipped classroom teaching mode, it proposes the avoidance degree based on face detection and the concentration degree based on eyelid detection. Experiments show that our multi-task affective computing method can effectively characterize students' anxiety, and can even be extended to more emotions, outperforming single-task baseline models.

Racial differences in healthcare utilization among patients with suspected or diagnosed preeclampsia: A retrospective cohort study

OBJECTIVES

To analyze healthcare resource utilization and severe maternal morbidity (SMM) in Black and White patients with preeclampsia diagnosis versus signs/symptoms.

STUDY DESIGN

This was a retrospective cohort study analyzing data from the IBM® Explorys Database between 7/31/2012-12/31/2020. Demographic, clinical, and laboratory data were extracted. Healthcare utilization and SMM were analyzed during the antepartum period (20 weeks of gestation until delivery) among Black and White patients with signs/symptoms of preeclampsia, with a diagnosis of preeclampsia, or neither (control).

MAIN OUTCOME MEASURES

Healthcare utilization and SMM in those with a preeclampsia diagnosis or signs/symptoms of preeclampsia only were compared with a control group (White patients with no preeclampsia diagnosis or signs/symptoms).

RESULTS

Data from 38,190 Black and 248,568 White patients were analyzed. Patients with preeclampsia diagnosis or signs/symptoms were more likely to visit the emergency room compared to those without diagnosis or signs/symptoms. Black patients with signs/symptoms of preeclampsia had the highest elevated risk (odds ratio [OR] = 3.4), followed by Black patients with a preeclampsia diagnosis (OR = 3.2), White patients with signs/symptoms (OR = 2.2), and White patients with a preeclampsia diagnosis (OR = 1.8). More Black patients experienced SMM (SMM rate 6.1% [Black with preeclampsia diagnosis] and 2.6% [Black with signs/symptoms]) than White patients (5.0% [White with preeclampsia diagnosis] and 2.0% [White with signs/symptoms]). SMM rates were higher for Black preeclampsia patients with severe features than for White preeclampsia patients with severe features (8.9% vs 7.3%).

CONCLUSIONS

Compared with White patients, Black patients had higher rates of antepartum emergency care and antepartum SMM.

Dynamics of Nanosecond Laser Pulse Propagation and of Associated Instabilities in a Magnetized Underdense Plasma

The propagation and energy coupling of intense laser beams in plasmas are critical issues in inertial confinement fusion. Applying magnetic fields to such a setup has been shown to enhance fuel confinement and heating. Here we report on experimental measurements demonstrating improved transmission and increased smoothing of a high-power laser beam propagating in a magnetized underdense plasma. We also measure enhanced backscattering, which our kinetic simulations show is due to magnetic confinement of hot electrons, thus leading to reduced target preheating.

Spectral Classification of Large-Scale Blended (Micro)Plastics Using FT-IR Raw Spectra and Image-Based Machine Learning

Microplastics (MPs) are currently recognized as emerging pollutants; their identification and classification are therefore essential during their monitoring and management. In contrast to most studies based on small datasets and library searches, this study developed and compared four machine learning-based classifiers and two large-scale blended plastic datasets, where a 1D convolutional neural network (CNN), decision tree, and random forest (RF) were fed with raw spectral data from Fourier transform infrared spectroscopy, while a 2D CNN used the corresponding spectral images as the input. With an overall accuracy of 96.43% on a small dataset and 97.44% on a large dataset, the 1D CNN outperformed other models. The 1D CNN was the best at predicting environment samples, while the RF was the most robust with less spectral data. Overall, RF and 2D CNNs might be evaluated for plastic identification with fewer spectral data; however, 1D CNNs were thought to be the most effective with sufficient spectral data. Accordingly, an open-source MP spectroscopic analysis tool was developed to facilitate a quick and accurate analysis of existing MP samples.

Chevrel Phase Mo6 S8 Nanosheets Featuring Reversible Electrochemical Li-Ion Intercalation as Effective Dynamic-Phase Promoter for Advanced Lithium-Sulfur Batteries

Modifying sulfur cathodes with lithium polysulfides (LiPSs) adsorptive and electrocatalytic host materials is regarded as one of the most effective approaches to address the challenging problems in lithium-sulfur (Li-S) batteries. However, because of the high operating voltage window of Li-S batteries from 1.7 to 2.8 V, most of the host materials cannot participate in the sulfur redox reactions within the same potential region, which exhibit fixed or single functional property, hardly fulfilling the requirement of the complex and multiphase process. Herein, Chevrel phase Mo₆ S₈ nanosheets with high electronic conductivity, fast ion transport capability, and strong polysulfide affinity are introduced to sulfur cathode. Unlike most previous inactive hosts with a fixed affinity or catalytic ability toward LiPSs, the reaction involving Mo₆ S₈ is intercalative and the adsorbability for LiPSs as well as the ionic conductivity can be dynamically enhanced via reversible electrochemical lithiation of Mo₆ S₈ to Li-ion intercalated Li_x Mo₆ S₈ , thereby suppressing the shuttling effect and accelerating the conversion kinetics. Consequently, the Mo₆ S₈ nanosheets act as an effective dynamic-phase promoter in Li-S batteries and exhibit superior cycling stability, high-rate capability, and low-temperature performance. This study opens a new avenue for the development of advanced hosts with dynamic regulation activity for high performance Li-S batteries.

Mapping the 3D position of battery cathode particles in Bragg coherent diffractive imaging

In Bragg coherent diffractive imaging, the precise location of the measured crystals in the interior of the sample is usually missing. Obtaining this information would help the study of the spatially dependent behavior of particles in the bulk of inhomogeneous samples, such as extra-thick battery cathodes. This work presents an approach to determine the 3D position of particles by precisely aligning them at the instrument axis of rotation. In the test experiment reported here, with a 60 µm-thick LiNi_0.5Mn_1.5O₄ battery cathode, the particles were located with a precision of 20 µm in the out-of-plane direction, and the in-plane coordinates were determined with a precision of 1 µm.

[Efficacy and safety of various doses of hybutimibe monotherapy or in combination with atorvastatin for primary hypercholesterolemia: a multicenter, randomized, double-blind, double-dummy, parallel-controlled phase Ⅲ clinical trial]

Objective: To evaluate the efficacy and safety of hybutimibe monotherapy or in combination with atorvastatin in the treatment of primary hypercholesterolemia. Methods: This was a multicenter, randomized, double-blind, double-dummy, parallel-controlled phase Ⅲ clinical trial of patients with untreated primary hypercholesterolemia from 41 centers in China between August 2015 and April 2019. Patients were randomly assigned, at a ratio of 1∶1∶1∶1∶1∶1, to the atorvastatin 10 mg group (group A), hybutimibe 20 mg group (group B), hybutimibe 20 mg plus atorvastatin 10 mg group (group C), hybutimibe 10 mg group (group D), hybutimibe 10 mg plus atorvastatin 10 mg group (group E), and placebo group (group F). After a dietary run-in period for at least 4 weeks, all patients were administered orally once a day according to their groups. The treatment period was 12 weeks after the first dose of the study drug, and efficacy and safety were evaluated at weeks 2, 4, 8, and 12. After the treatment period, patients voluntarily entered the long-term safety evaluation period and continued the assigned treatment (those in group F were randomly assigned to group B or D), with 40 weeks' observation. The primary endpoint was the percent change in low density lipoprotein cholesterol (LDL-C) from baseline at week 12. Secondary endpoints included the percent changes in high density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (Apo B) at week 12 and changes of the four above-mentioned lipid indicators at weeks 18, 24, 38, and 52. Safety was evaluated during the whole treatment period. Results: Totally, 727 patients were included in the treatment period with a mean age of (55.0±9.3) years old, including 253 males. No statistical differences were observed among the groups in demographics, comorbidities, and baseline blood lipid levels. At week 12, the percent changes in LDL-C were significantly different among groups A to F (all P<0.01). Compared to atorvastatin alone, hybutimibe combined with atorvastatin could further improve LDL-C, TG, and Apo B (all P<0.05). Furthermore, there was no significant difference in percent changes in LDL-C at week 12 between group C and group E (P=0.991 7). During the long-term evaluation period, there were intergroup statistical differences in changes of LDL-C, TG and Apo B at 18, 24, 38, and 52 weeks from baseline among the statins group (group A), hybutimibe group (groups B, D, and F), and combination group (groups C and E) (all P<0.01), with the best effect observed in the combination group. The incidence of adverse events was 64.2% in the statins group, 61.7% in the hybutimibe group, and 71.0% in the combination group during the long-term evaluation period. No treatment-related serious adverse events or adverse events leading to death occurred during the 52-week study period. Conclusions: Hybutimibe combined with atorvastatin showed confirmatory efficacy in patients with untreated primary hypercholesterolemia, which could further enhance the efficacy on the basis of atorvastatin monotherapy, with a good overall safety profile.

[Pancreatic pseudocyst after pegaspargase treatment in six children]

Objective: To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children. Methods: The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively. Results: There were 4 males and 2 females, and their age of onset was 9.5 (5.8, 13.0) years. The total number of pegaspargase applications was 2.5 (2.0, 3.5) times. The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0 (9.0, 17.2) days, and 42.5 (35.0, 129.5) days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst. Abdominal pain was the most prominent manifestation of pancreatitis (6/6). All of the 6 children were asymptomatic when pancreatic pseudocyst was noted, and were treated conservatively at first, but one case later developed intermittent abdominal distension or nausea after eating. All the cases had pancreatic pseudocyst enlargement during the conservative treatment. Three children were treated with endoscopic ultrasound-guided transgastric drainage, and the cyst disappeared from 10 days to 4 months after the operation. The other 3 children received endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage, but one of them turned to surgery due to pancreatic duct stricture, and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively. Regarding safety issues, 1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis, which were improved after treatment, and the other 5 had no complications. Conclusions: Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage, and should be diagnosed with a history of pegaspargase treatment and timely imaging examination. Conservative treatment is the first choice for asymptomatic pseudocyst. When the pseudocyst enlarges, different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.

Development of A Multi-Modality Navigational Based Training System for Fetoscopic Surgical Therapy

Fetal surgery is regarded as a technically difficult and new field of research, requiring the use of fetoscopic and ultrasound (US) navigation to perform minimally invasive procedures within the amniotic cavity. The Surgical Apprenticeship Training model (SAT) centres around the subjective assessment of a surgical resident's cognitive competency and technical skills under proctorship using opportunity-based environments. The restrictiveness and rarity of fetal procedures limit the effectiveness of the SAT model, resulting in a slow learning curve (LC) and higher procedural complication rates. This paper aimed to investigate the use of optical tracking technology to construct a novel simulated training system and accompanying scoring assessment under the Proficiency-Based Training model (PBT), providing real-time positional feedback of surgical tools and a quantitative feedback assessment of a surgical resident's technical skills. Clinical Relevance- Clinical feedback deemed the system as valid and confirmed that this novel approach to surgical training will significantly benefit smaller clinics that lack opportunity-based environments. Clinical feedback also suggested that the training system could be adapted to provide access to complex surgical training across the world.

[Effect of underdilated stent on the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation]

Objective: To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results: During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE (P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups (P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95%CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion: Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.

Lattice B-doping evolved ferromagnetic perovskite-like catalyst for enhancing persulfate-based degradation of norfloxacin

Series of B-doped perovskite-like materials CeCu_0.5Co_0.5O₃ (B-C³O) were fabricated with unique ferromagnetic property due to partial substitution of non-magnetic 2p-impurities boron in the lattice. Then, B-C³O was used for activating peroxymonosulfate (PMS) for the degradation of norfloxacin (NOR), one kind of emerging pollutants with the concentration level up to mg/L in wastewaters. The results indicated that 5.0% B-C³O exhibited stable catalytic ability at pH 3.0-9.0 and high degradation efficiency in co-existing inorganic Cl^-, SO₄^2-, NO₃^-, H₂PO₄^- and organic humic acid. Non-radical ¹O₂, radicals •OH and SO₄^•-, as well as ClO^- were detected with synergy effect for NOR degradation. By quantifying free radicals, •OH with 0.52 µM and SO₄^•- with 10.91 µM were obtained at 180 min, verifying the leading role of SO₄^•-. The degradation process involved the defluorination and decarboxylation, as well as opening of quinolone and piperazinyl rings. Adopting alfalfa as the model plant, the toxicity effect before and after NOR degradation was finally evaluated with seed germination rate and chlorophyll content as the physiological indicators. In summary, non-metal B-doping not only provides a creative strategy for the development of ferromagnetic perovskite-like materials, but also affords excellent catalysts for aiding the advanced oxidation technology for removal of emerging pollutants in wastewaters.

Antimicrobial and anti-dust mite efficacy of Cinnamomum camphora chvar. Borneol essential oil using pilot-plant neutral cellulase-assisted steam distillation

Cinnamomum camphora chvar. Borneol essential oil (BEO) was efficiently extracted by using pilot-plant neutral cellulase-assisted steam distillation (NCSD). Borneol, β-cadinene and α-caryophyllene were identified as major components. Bacillus subtilis was the most sensitive bacteria to BEO with the lowest minimal inhibition concentration (MIC) and minimal bactericial concentration (MBC) at 1·75 and 3·50 mg ml^-1 , respectively. Antimicrobial activity of the BEO was also reasonably high against Salmonella typhimurium, Escherichia coli and Staphylococcus aureus, but not sensitive against two fungi, i.e. Aspergillus niger and Penicillium aurantiogriseum. Changes in permeability and integrity of cell membrane, damage of cell wall and further leakage out of metabolites and ions were determined as bactericidal mechanisms of BEO against the two gram-positive bacteria. The BEO showed a reasonably high repelling activity of dust mite, which achieved higher than 95% repelling dust mite activity after the treatment of BEO solution at 0·50 mg ml^-1 . When the concentration of BEO was higher than 0·50 mg ml^-1 , it was B-grade miticide with miticidal activity higher than 95%. Miticidal procedures were characterized as excitation, contraction, relaxation and lastly leading to the death of dust mite. It is speculated that the BEO would cause dehydration and death of dust mite as neuromuscular toxicity.

2D Co3O4 stabilizing Rh nano composites developed for visual sensing bioactive urea and toxic p-aminophenol in practice by synergetic-reinforcing oxidase activity

To enlarge the perspective of nanozyme, 2-dimensional Co₃O₄ stabilizing Rh nano composite (2D Co₃O₄@Rh NC) was identified and developed first by one-pot surfactant-aided oxido-reduction. By virtue of the synergetic-reinforcing oxidase activity between 2D Co₃O₄ substrate and Rh nano particles, the obtained 2D Co₃O₄@Rh NC could catalyze the oxidation of chromogenic substrate 3,3',5,5,'-tetramethylbenzidine (TMB) to blue oxTMB with quite a low Michaelis-Menten constant (K_m) of 0.018 mM and a quick v_max of 6.45 × 10^-8 M s^-1, expressing superior oxidase-like catalysis with a wide temperature range from 20 to 60 °C. Importantly, either bioactive urea or toxic p-aminophenol (p-Ap) could exclusively alter the existed state of oxTMB with differentiable color changes. Under the optimized conditions, 2D Co₃O₄@Rh NC was successfully applied for ratiometric colorimetric sensing urea and p-Ap in environmental water, soil and urine samples with low detection limits (1.1 μM for urea and 0.68 μM for p-Ap) and satisfactory recoveries (96.0-105.8%). The synergetic enhanced oxidase-like activity of 2D Co₃O₄@Rh NC and the different reaction mechanisms of the 2D Co₃O₄@Rh NC-TMB system to urea and p-Ap were investigated. Not only does the work provide an efficient way for sensing organic pollution of p-Ap, it will offer an efficient potential for diagnosing urea-related diseases on clinical medical testing in future.

Impact of the combined timing of PD-1/PD-L1 inhibitors and chemotherapy on the outcomes in patients with refractory lung cancer

Background

PD-1/PD-L1 inhibitors in combination with chemotherapy are widely used in clinical practice. However, the ideal combined timing of them has not been fully explored.

Methods

In this study, simulation experiments to explore the impacts of the combination of anti-PD-1 antibody (anti-PD-1 Ab) on the cytotoxic effects of chemotherapeutic drugs in peripheral blood mononuclear cells were performed. In addition, the effects of the combined timing of PD-1/PD-L1 inhibitors and chemotherapy on efficacy and safety were retrospectively analysed in patients with refractory lung cancer.

Results

Experiments in vitro showed that administering the anti-PD-1 Ab 3 days after chemotherapy (represented by dicycloplatin) resulted in significantly weaker cytotoxic effects on lymphocytes, compared with administering the anti-PD-1 Ab before or concurrent with chemotherapy. Moreover, data from 64 lung cancer patients treated with PD-1/PD-L1 inhibitors plus chemotherapy as a second- or higher-line therapy were retrospectively analysed. The results showed that administering PD-1/PD-L1 inhibitors 1-10 days (especially 3-5 days) after chemotherapy was associated with longer overall survival [17.3 months versus 12.7 months; hazard ratio (HR) = 0.58, 95% confidence interval (CI) 0.28-1.19, P = 0.137 in univariate analysis; HR = 0.36, 95% CI 0.16-0.80, P = 0.012 in multivariate analysis] and a trend of improved progression-free survival (5.1 months versus 4.2 months; HR = 0.81, 95% CI 0.42-1.54, P = 0.512) compared with administering PD-1/PD-L1 inhibitors before or concurrent with chemotherapy.

Conclusion

Our findings suggest that administering PD-1/PD-L1 inhibitors 1-10 days (especially 3-5 days) after chemotherapy is superior to administering PD-1/PD-L1 inhibitors before or concurrent with chemotherapy in patients with refractory lung cancer, but this result needs to be further explored by prospective studies.

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The cytotoxic effects of chemotherapeutic drugs were positively correlated with the activation states of PBMCs.

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Administering the anti-PD-1 Ab 3 days after chemotherapy resulted in weaker cytotoxic effects on lymphocytes in vitro.

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Administering PD-1/PD-L1 inhibitors a few days after chemotherapy resulted in better survival in lung cancer patients.

Repair of facial scars using free and pedicle-expanded deltopectoral flaps

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled, expanded deltopectoral flaps with perforation of the internal thoracic artery to repair facial scars. This retrospective review was of 37 patients who presented between June 2013 and June 2019 with various types of facial scar. Ten patients received a free expanded deltopectoral flap and 27 a pedicled, expanded deltopectoral flap. During the stage-one operation, the expander was implanted into the deltopectoral area and fully expanded by normal saline injection. In stage two, the facial lesions were incised, and the free or pedicled flap transferred to reconstruct the defect. Flap necrosis did not occur in the 10 patients treated with free flaps. Two patients need to have the pedicle trimmed three months after surgery because it had become bloated. Distal necrosis occurred in five of 27 patients who received a pedicled, expanded deltopectoral flap. Healing by conservative treatment was noted in two cases and healing after skin grafting was documented in the other three. All 37 patients achieved satisfactory results. A pedicled, expanded deltopectoral flap appears to be a reliable and safe option for the treatment of facial scars.

[Effect of bone marrow mononuclear cell transplantation on miRNA-21 and miRNA-155 expression in mice with ulcerative colitis]

Objective: To investigate the effect of bone marrow mononuclear cell transplantation on the expression of miRNA-21 and miRNA-155 in mice with ulcerative colitis(UC). Methods: Healthy and clean KM mice aged 6-8 weeks were randomly divided into transplantation group, model group and normal control group with 15 mice in each group. In the transplantation group and model group, dextran sodium sulfate (DSS) was used to establish the model for 24 h. The mice in the transplantation group were injected with 0.4 ml of 4 ', 6-diaminol-2-phenylindole (DAPI) -labeled P3-BM-MNCs cell suspension (3.2×10(6) cells/ml), and the mice in the model group and the normal control group were injected with 0.4 ml phosphate buffer (PBS).UC disease activity index (DAI) was used to test the general condition of mice; HE staining was used to observe the pathological changes of colon tissue; Real-time quantitative PCR was used to detect the expression of miRNA-21 and miRNA-155 mRNA. Results: DAI scores of normal control group, model group and transplantation group were 0 (0,1), 3.1 (2.8,3.3) and 2.7 (2.4,3.1),respectively. Compared with normal control group, the DAI score of model group and transplantation group was higher (P<0.05), and the DAI score of transplantation group was lower than that of model group (P<0.05). The gross scores of tissue injury in normal control group, model group and transplantation group were 0 (0, 1), 3 (3, 4) and 1 (1, 2), respectively,and the pathological scores of tissue injury were 0 (0, 1), 16 (12, 16) and 6 (6, 8), respectively,compared with the normal control group. The tissue injury score of the model group and the transplantation group was higher (P<0.05), and the tissue injury score of the transplantation group was lower than that of the model group (P<0.05). The expression levels of miRNA-21 mRNA in normal control group, model group and transplantation group were 0.87±0.15, 2.38±0.29 and 1.59±0.32, respectively, and the expression levels of miRNA-155 mRNA were 1.87±0.46, 7.38±1.97 and 3.92±0.84, respectively, compared with the normal control group, the expression of miRNA-21 and miRNA-155 mRNA in the model group and transplantation group was higher (P<0.01), the expression of miRNA-21 and miRNA-155 mRNA in the transplantation group was lower than that of the model group (P<0.05). Conclusion: Bone marrow mononuclear cell transplantation can improve the histopathological and DAI scores of mice with UC, which may be related to the down-regulation of miRNA-21 and miRNA-155 mRNA expression.

22-oxacalcitriol protects myocardial ischemia-reperfusion injury by suppressing NF-κB/TNF-α pathway

OBJECTIVE

The aim of this study was to explore whether 22-oxacalcitriol could protect inflammatory response induced by ischemia-reperfusion injury (IRI) in rats, and to investigate its underlying mechanism.

MATERIALS AND METHODS

24 male Sprague Dawley rats were randomly assigned into the sham group, the IRI group and the 22-oxacalcitriol group, with 8 rats in each group. Serum and heart samples of each rat were collected 10 days after the animal procedure. The serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) in each rat were detected by relative commercial kits. Pathological lesions in rat myocardium were observed by hematoxylin and eosin (HE) staining. Cardiomyocyte apoptosis in rat heart was accessed by TUNEL staining. Meanwhile, the serum levels of tumor necrosis factor-α (TNF-α), interleukin 1 beta (IL-1β), interleukin-6 (IL-6), and KC-GRO were detected by Real Time-quantitative Polymerase Chain Reaction (RT-qPCR). Also, the protein expression levels of NF-κB, TNF-α, VCAM-1, ICAM-1, and MCP-1 in rat myocardium were detected by Western blot and immunohistochemistry.

RESULTS

The serum levels of CK-MB and LDH in rats of the IRI group were significantly higher than those of the sham group. 22-oxacalcitriol treatment remarkably decreased the serum levels of CK-MB and LDH when compared with the IRI group. However, cardiomyocyte apoptosis of the 22-oxacalcitriol group was markedly less than the IRI group. The activities of SOD, GSH, CAT and T-AOC in the cardiac homogenate of the 22-oxacalcitriol group were significantly elevated than those of the IRI group. Meanwhile, malondialdehyde (MDA) and reactive oxygen species (ROS) levels were remarkably decreased by 22-oxacalcitriol treatment. Furthermore, the serum levels of TNF-α, IL-1β, IL-6 and KC-GRO were significantly downregulated in the 22-oxacalcitriol group. Western blot results showed that the protein expression levels of NF-κB, TNF-α, VCAM-1, ICAM-1 and MCP-1 in the 22-oxacalcitriol group were significantly lower than those of the IRI group.

CONCLUSIONS

22-oxacalcitriol inhibits the inflammatory response in the myocardium by suppressing NF-kB/TNF-α pathway, thereby protecting myocardial ischemia-reperfusion injury in rats.

The potential biological functions of circular RNAs during the initiation of atresia in pig follicles

The specific expression profile and function of circular RNAs (circRNAs) in mammalian ovarian follicles, especially during the atresia process, are unclear. In this study, genome-wide deep circRNA sequencing was applied to screen circRNAs in healthy and early atretic antral follicles in pig ovaries. A total of 40,567 distinct circRNAs were identified in follicles, among which 197 circRNAs (108 upregulated and 89 downregulated) were significantly shifted during the early atresia process. Most differentially expressed circRNAs (DECs) lacked protein-coding potential. Annotation analysis of the DECs revealed 162 known host genes, or noncoding RNAs, and 10 intergenic regions. The key pathways in which these host genes are involved include the focal adhesion-PI3K-Akt-mTOR signaling pathway, vascular endothelial growth factor A (VEGFA)-vascular endothelial growth factor receptor 2 signaling pathway and transforming growth factor-beta signaling pathway. Further comparison analysis between host genes of DECs and the differentially expressed linear messenger RNA transcripts revealed the cotranscription of circRNAs and their linear mRNAs in inhibin beta units (INHBA and INHBB), glutathione S-transferase (GSTA1), and VEGFA. In addition, we predicted 196 pairs of potential circRNA-micro RNA (miRNA) interactions among 77 DECs and 101 porcine miRNAs. We have identified 16 functional miRNAs by comparing the 101 miRNAs to the functional miRNAs reported in mammal ovarian follicle atresia and granulosa cell apoptosis studies. Our study adds new knowledge to circRNA distribution profiles in pig ovarian follicles, offers a valuable reference for transcriptomic profiles in the initiation of follicular atresia, highlights warranted circRNAs for further functional investigation, and provides possible biomarkers for ovarian dysfunctions.

Predicting pungency and understanding the pungency mechanism of capsaicinoids using TOPS-MODE approach

Quantitative structure-property relationship (QSPR) models were developed for predicting the pungency of a set of capsaicinoids. Multiple linear regression (MLR) coupled with topological substructural molecular descriptor (TOPS-MODE) approach was used. The best MLR model based on only five orthogonalized TOPS-MODE variables allowed us to obtain a coefficient of determination of 0.954 on the training set. The predictive power of the model was validated through a test set and several external validation parameters. This showed that the TOPS-MODE descriptors weighted by bond dipole moments, van der Waals atomic radii, and the total solute hydrogen bond basicity affected pungency. The contributions of certain bonds and fragments to pungency were used to understand the pungency mechanism of capsaicinoids. The selected model can more accurately predict pungency of capsaicinoids compared than those found in the literature, and especially bring insights into the structural features and chemical factors related to pungency.