[Endometriosis-related recurrent unilateral hemorrhagic pleural effusion: a case report]

Hemorrhagic pleural effusion (PE) is common in clinical practice. According to the guidelines, the etiological diagnosis of PE should focus on the identification of common diseases. In most cases, the etiology of PE can be determined by clinical history, physical examination, laboratory and imaging examinations, and pleural biopsy or video-assisted thoracic surgery (VAST). We reported a rare case of a 32-year-old woman with recurrent unilateral hemorrhagic pleural effusion (highly correlated with menstrual cycle) and chest pain that was diagnosed as thoracic endometriosis syndrome (TES) by pathological biopsy and immunohistochemistry. Later she underwent surgery combined with hormone therapy. During the follow-up, the right PE decreased, and she had no chest pain. Therefore, women of reproductive age with regular unilateral bloody pleural effusions should be alert to TES.

Artificial kagome lattices of Shockley surface states patterned by halogen hydrogen-bonded organic frameworks

Artificial electronic kagome lattices may emerge from electronic potential landscapes using customized structures with exotic supersymmetries, benefiting from the confinement of Shockley surface-state electrons on coinage metals, which offers a flexible approach to realizing intriguing quantum phases of matter that are highly desired but scarce in available kagome materials. Here, we devise a general strategy to construct varieties of electronic kagome lattices by utilizing the on-surface synthesis of halogen hydrogen-bonded organic frameworks (XHOFs). As a proof of concept, we demonstrate three XHOFs on Ag(111) and Au(111) surfaces, which correspondingly deliver regular, breathing, and chiral breathing diatomic-kagome lattices with patterned potential landscapes, showing evident topological edge states at the interfaces. The combination of scanning tunnelling microscopy and noncontact atomic force microscopy, complemented by density functional theory and tight-binding calculations, directly substantiates our method as a reliable and effective way to achieve electronic kagome lattices for engineering quantum states.

[Comparison of the anorectal function before and after neoadjuvant radiotherapy in mid-low rectal cancer: a retrospective observational study from single center]

Objective: The aim of this study was to evaluate the impact of neoadjuvant radiotherapy on anorectal function of patients with mid-low rectal cancer by means of high-resolution anorectal manometry. Methods: A retrospective observational study was conducted. Information on patients with mid-low rectal cancer was collected from the prospective registry database of Rectal Cancer at Peking Union Medical College Hospital (PUMCH) from June 2020 to April 2023. Anorectal functions were detected using three-dimensional high-resolution manometry system. Logistic regression analysis was performed to identify the factors associated with the changed anorectal manometry. Results: A total of 45 patients with mid-low rectal cancer were included in the study. Thirty-two (71.1%) patients were male, 13 (28.9%) patients were female. The mean age was 60±11 years, and the mean BMI was 23.4±3.7 kg/m2. The mean distance between the lower edge of the tumor and the anal verge was 5.4±1.5 cm. The median size of the tumor was 3.4 (2.9-4.5) cm, and the median circumferential extent of the tumor was 66.0 (45.5-75.0) %. 41 (81.1%) patients were MRI T3-4 and 40 (88.9%) patients were MRI N positive. The resting pressure has a decreasing trend after neoadjuvant radiotherapy (55.3±32.0 mmHg vs. 48.0±28.5 mmHg, t=1.930, P=0.060). There was no significant change in maximum squeezing and the length of the high-pressure zone after neoadjuvant radiotherapy. All volumes describing rectal sensitivity (first sensation, desire to defecate, and maximum tolerance) were lower after neoadjuvant radiotherapy. And maximum tolerance was significantly lower (66.0 [49.0,88.0] ml vs. 52.0 [39.0,73.5] ml, Z=-2.481,P=0.013). Univariate analysis demonstrated that the downstage of N-stage was associated with the decrease in maximum tolerance (OR=6.533, 95%CI:1.254-34.051, P=0.026). Conclusion: Neoadjuvant radiotherapy damages anorectal function by decreasing the resting pressure and rectal sensory threshold of patients. The N-stage downstaging was associated with a decrease in maximum tolerance.

[Application value of CT examination of lymph node short diameter in evaluating cardia-left gastric lymph node metastasis in thoracic esophageal squamous cell carcinoma]

Objective: To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating cardia-left gastric lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC). Methods: A total of 477 patients with primary thoracic ESCC who underwent surgical treatment in the Affiliated Cancer Hospital of Zhengzhou University from January 2013 to December 2017 were collected. All of them underwent McKeown esophagectomy plus complete two-field or three-field lymph node dissection. Picture archiving and communication system were used to measure the largest cardia-left gastric lymph node short diameter in preoperative CT images. The postoperative pathological diagnosis results of cardia-left gastric lymph node were used as the gold standard. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of CT lymph node short diameter in detecting the metastasis of cardia-left gastric lymph node in thoracic ESCC, and determine the optimal cut-off value. Results: The median short diameter of the largest cardia-left gastric lymph node was 4.1 mm in 477 patients, and the largest cardia-left gastric lymph node short diameter was less than 3 mm in 155 cases (32.5%). Sixty-eight patients had cardia-left gastric lymph node metastases, of which 38 had paracardial node metastases and 41 had left gastric node metastases. The lymph node ratios of paracardial node and left gastric node were 4.0% (60/1 511) and 3.3% (62/1 887), respectively. ROC curve analysis showed that the area under the curve of CT lymph node short diameter for evaluating cardia-left gastric lymph node metastasis was 0.941 (95% CI: 0.904-0.977; P<0.05). The optimal cut-off value of CT examination of the cardia-left gastric lymph node short diameter was 6 mm, and the corresponding sensitivity, specificity and accuracy were 85.3%, 91.7%, and 90.8%, respectively. Conclusion: CT examination of lymph node short diameter can be a good evaluation of cardia-left gastric lymph node metastasis in thoracic ESCC, and the optimal cut-off value is 6 mm.

Identifying topological corner states in two-dimensional metal-organic frameworks

Due to the diversity of molecular building blocks, the two-dimensional (2D) metal-organic frameworks (MOFs) are ideal platforms to realize exotic lattice models in condensed matter theory. In this work, we demonstrate the universal existence of topological corner states in 2D MOFs with a star lattice configuration, and confirm the intriguing higher-order nontrivial topology in the energy window between two Kagome-bands, or between Dirac-band and four-band. Furthermore, combining first-principles calculations and scanning tunneling microscopy measurements, the unique topological corner state is directly identified in monolayer Ni3(HITP)2 (HITP = 2,3,6,7,10,11-hexaiminotriphenylene) grown on the Au(111) substrate. Our results not only illustrate the first organic topological state in the experiments, but also offer an exciting opportunity to study higher-order topology in 2D MOFs with the large insulating band gap.

Antitumor studies evaluation of triphenylphosphine ruthenium complexes with 5,7-dihalo-substituted-8-quinolinoline targeting mitophagy pathways

Both ruthenium-containing complexes and 8-quinolinoline compounds have emerged as a potential novel agent for malignant tumor therapy. Here, three triphenylphosphine ruthenium complexes, [Ru(ZW1)(PPh3)2Cl2] (PPh3 = triphenylphosphine) (RuZ1), [Ru(ZW2)(PPh3)2Cl2] (RuZ2) and [Ru(ZW2)2(PPh3)Cl2]·CH2Cl2 (RuZ3) bearing 5,7-dichloro-8-quinolinol (H-ZW1) and 5,7-dichloro-8-hydroxyquinaldine (H-ZW2), have been synthesized, characterized and tested for their anticancer potential. We showed that triphenylphosphine ruthenium complexes RuZ1-RuZ3 impaired the cell viability of ovarian adenocarcinoma cisplatin-resistant SK-OV-3/DDP (SKO3CR) and SK-OV-3 (SKO3) cancer cells with greater selectivity and specificity than cisplatin. In addition, RuZ1-RuZ3 show higher excellent cytotoxicity than cisplatin towards SKO3CR cells, with IC50 values of 9.66 ± 1.08, 4.05 ± 0.67 and 7.18 ± 0.40 μM, respectively, in which the SKO3CR cells was the most sensitive to RuZ1-RuZ3. Depending on the substituent type, the antiproliferative ability of RuZ1-RuZ3 followed the trend: -CH3 > -H. However, RuZ1-RuZ3 have no obvious toxicity to normal cell HL-7702. Besides, RuZ1 and RuZ2 could induce mitophagy related-apoptosis pathways through suppression of mitochondrial membrane potential (ΔΨm), accumulation of [Ca2+] and reactive oxygen species (ROS), and regulation of LC3 II/LC3 I, Beclin-1, P62, FUNDC1, PINK1, Parkin, cleaved-caspase-3, caspase-9 and cytochrome c signaling pathway, and hindering the preparation of mitochondrial respiration complexes I and IV and ATP levels. Mechanistic study revealed that RuZ1 and RuZ2 induce apoptosis in SKO3CR cells via mitophagy related-apoptosis pathways induction and energy (ATP) generation disturbance. Taken together, the studied triphenylphosphine ruthenium complexes RuZ1-RuZ3 are promising chemotherapeutic agents with high effectiveness and low toxicity.

[The comparison between endoscopic and surgical treatment of delayed iatrogenic bile duct injury by propensity score matching]

Objective: To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2. Methods: The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged (M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test,χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results: There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675,P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group(P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%,P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups(P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups(P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5,P=0.037). Conclusions: For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.

[Comparison between laparoscopic-assisted natural orifice specimen extraction surgery and conventional laparoscopic surgery for left colorectal cancer: 5-year follow-up results of a randomized controlled study]

Objective: To evaluate the long-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using Cai tube for treating left-sided colorectal cancer. Methods: This was a randomized controlled trial. Inclusion criteria were as follows: preoperative pathological diagnosis of left-sided colorectal adenocarcinoma (rectal, sigmoid colon, descending colon, or left transverse colon cancer with the caudad margin ≥8 cm from the anal margin); preoperative abdominal and pelvic computed tomography (or magnetic resonance imaging) showing maximum tumor diameter <4.5 cm; and BMI <30 kg/m2. Patients with synchronous multiple primary cancers or recurrent cancers, a history of neoadjuvant chemoradiotherapy, preoperative evidence of significant local infiltration, distant metastasis, or complications such as intestinal obstruction and intestinal perforation, or who were not otherwise considered suitable for laparoscopic surgery were excluded. A random number table was used to randomize sequential patients to NOSES surgery using Cai tube (non-assisted incision anal sleeve: patent number ZL201410168748.2) (NOSES group) or traditional laparoscopic-assisted surgery (CLS group). Relevant clinical data of the two groups of patients were analyzed, the main outcomes being disease-free survival, overall survival, overall recurrence rate, and local recurrence rate 5 years after surgery. Results: Patients in both study groups completed the surgery successfully with no requirement for additional surgery. After mean 70 (7-83) months postoperative follow-up, the 5-year overall postoperative survival in the NOSES and CLS groups was 90.0% and 83.3%, respectively (P=0.455); disease free survival was 90.0% and 83.3%, respectively (P=0.455); overall recurrence rate 6.6% and 10.0%, respectively (P=0.625); and local recurrence rate both were 3.3% (P=0.990), respectively. None of these differences was statistically significant. Conclusions: NOSES and CLS have similar long-term efficacy, and NOSES deserves to be used in clinical practice.

[Specimen extraction through natural orifices with Cai tubes in gastrointestinal surgery: a single-institute series of 234 cases]

Objective: To investigate the feasibility of Cai tube-assisted natural orifice specimen extraction surgery (NOSES) in gastrointestinal surgery. Methods: This was a descriptive case-series study. Inclusion criteria: (1) colorectal or gastric cancer diagnosed by preoperative pathological examination or redundant sigmoid or transverse colon detected by barium enema; (2) indications for laparoscopic surgery; (3) body mass index <30 kg/m² (transanal surgery) and 35 kg/m² (transvaginal surgery); (4) no vaginal stenosis or adhesions in female patients undergoing transvaginal specimen extraction; and (5) patients with redundant colon aged 18-70 years and a history of intractable constipation for more than 10 years. Exclusion criteria: (1) colorectal cancer with intestinal perforation or obstruction, or gastric cancer with gastric perforation, gastric hemorrhage, or pyloric obstruction; (2) simultaneous resection of lung, bone, or liver metastases ; (3) history of major abdominal surgery or intestinal adhesions; and (4) incomplete clinical data. From January 2014 to October 2022, 209 patients with gastrointestinal tumors and 25 with redundant colons who met the above criteria were treated by NOSES utilizing a Cai tube (China invention patent number:ZL201410168748.2) in the Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University. The procedures included eversion and pull-out NOSES radical resection in 14 patients with middle and low rectal cancer, NOSES radical left hemicolectomy in 171 patients with left-sided colorectal cancer, NOSES radical right hemicolectomy in 12 patients with right-sided colon cancer, NOSES systematic mesogastric resection in 12 patients with gastric cancer, and NOSES subtotal colectomy in 25 patients with redundant colons. All specimens were collected by using an in-house-made anal cannula (Cai tube) with no auxiliary incisions. The primary outcomes included 1-year recurrence-free survival (RFS) and postoperative complications. Results: Among 234 patients, 116 were male and 118 were female. The mean age was (56.6±10.9) years. NOSES was successfully completed in all patients without conversion to open surgery or procedure-related death. The negative rate of circumferential resection margin was 98.8% (169/171) with both two positive cases having left-sided colorectal cancer. Postoperative complications occurred in 37 patients (15.8%), including 11 cases (4.7%) of anastomotic leakage, 3 cases(1.3%) of anastomotic bleeding, 2 cases (0.9%) of intraperitoneal bleeding, 4 cases (1.7%) of abdominal infection, and 8 cases (3.4%) of pulmonary infection. Reoperations were required in 7 patients (3.0%), all of whom consented to creation of an ileostomy after anastomotic leakage. The total readmission rate within 30 days after surgery was 0.9% (2/234). After a follow-up of (18.3±3.6) months, the 1-year RFS was 94.7%. Five of 209 patients (2.4%) with gastrointestinal tumors had local recurrence, all of which was anastomotic recurrence. Sixteen patients (7.7%) developed distant metastases, including liver metastases(n=8), lung metastases(n=6), and bone metastases (n=2). Conclusion: NOSES assisted by Cai tube is feasible and safe in radical resection of gastrointestinal tumors and subtotal colectomy for redundant colon.

Ethanol Embolization of Chest Wall Arteriovenous Malformations: Four-Year Findings

OBJECTIVES

To summarize the clinical characteristics and investigate the efficacy of ethanol embolotherapy in the treatment of chest well arteriovenous malformation (AVM). Treatment-associated complications were also explored.

MATERIALS AND METHODS

Between March 2017 and August 2021, 32 consecutive patients (mean age, 23.7 years; age range, 5-54 years) who underwent ethanol embolotherapy for chest well AVMs under general anesthesia were included in this study. Embolization was performed through a direct puncture, transarterial catheterization, or a combination of the 2 procedures. The mean follow-up duration after the last treatment was 18.0 months (range, 3-42 months). The degree of devascularization on follow-up (assessed using angiography or computed tomography), and the clinical signs and symptoms of AVMs were evaluated as the therapeutic outcomes. The major and minor complications associated with the procedures were recorded.

RESULTS

A total of 103 embolization procedures (mean, 3.2; range, 2-7) comprising 101 ethanol embolization and 2 coil embolizations were performed on 32 patients with chest wall AVMs. The AVM nidus was accessed through the transarterial approach alone in 4 patients, by direct puncture in 11, and a combined procedure in 17 patients. Overall, more than 80% of the procedures were performed using the combined approach. Complete AVM devascularization was achieved in 12 (37.5%) patients. Moreover, 76% to 99% AVM was achieved in 18 patients (56.3%), and 50% to 75% in 2 patients (6.3%). Bleeding, pain, heart failure, and cosmetic deformities were the indications for treatment. For 3 patients (3/32, 9.4%) who had bleeding, the treatment stopped the hemorrhage. Complete pain relief was reported in 8 patients (8/32, 25.0%), whereas complete relief from congestive heart failure post-embolization was observed in 5 of the 6 patients with congestive heart failure (5/6, 83.3%). Complete correction of cosmesis deformities after embolization was achieved in 10 patients (10/32, 31.3%). Two patients who underwent surgery to correct persistent deformity after embolization only showed insignificant improvement. In addition, 6 (18.8%) patients developed 13 complications including blister, necrosis, hemothorax, transient hemoglobinuria, and transient pulmonary artery hypertension.

CONCLUSIONS

Ethanol embolotherapy is a safe and effective procedure for chest well AVMs. Surgery is required for some patients with residual cosmesis deformity.

CLINICAL IMPACT

Currently, there is no standard treatment for chest well AVMs due to their rarity and high heterogeneity. The present study shows that thanol embolotherapy is a safe and clinically effective treatment procedure for the chest well AVMs. Transarterial embolization in combination with direct puncture embolization can reach the AVM nidus. Ethanol embolotherapy can achieve complete obliteration of the AVM nidus in the majority of patients. Surgery may still be needed to correct cosmetic deformity after embolization. The present study provides valuable evidence to inform clinical decision-making.

[Analysis of the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 for intrahepatic parenchymal substantial lesions ≤3.0 cm]

Objective: To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm. Methods: A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results: The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively. Conclusions: LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.

[Comparison between laparoscopic-assisted natural orifice specimen extraction surgery and conventional laparoscopic surgery for left colorectal cancer: a randomized controlled study with 3-year follow-up results]

Objective: To evaluate the mid-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using the Cai tube in the treatment of left colorectal cancer. Methods: A prospective randomized control trial (China Clinical Trials Registration Number: ChiCTR-OOR-15007060) was performed. Sixty patients with left colorectal cancer at Department of Gastrointestinal Surgery of Zhongshan Hospital from September 2015 to August 2017 were prospectively enrolled. Case inclusion criteria: (1) left colorectal adenocarcinoma (rectal cancer with distance ≥ 8 cm from tumor low margin to anal edge, sigmoid colon cancer, descending colon cancer and left transverse colon cancer) confirmed by preoperative pathology; (2) satisfactory conditions of conventional laparoscopic surgery; (3) maximum diameter of the tumor < 4.5 cm confirmed by preoperative abdominal and pelvic CT or MRI; (4) BMI < 30 kg/m². Case exclusion criteria: (1) benign lesions, mucinous adenocarcinoma, signet-ring cell carcinoma and other special pathological types of tumors confirmed by preoperative pathological examination; (2) multiple or recurrent cancers; (3) with a history of neoadjuvant chemoradiotherapy; (4) obvious regional infiltration or distant metastasis indicated by preoperative imaging examination; (5) intestinal obstruction, intestinal perforation, etc. Participants were randomly assigned to NOSES group (using the Cai tube) and conventional laparoscopy (CL) group by random number table method. Clinical data between two groups were compared and analyzed, including perioperative conditions, tumor exfoliation cell detection and bacterial culture results of intraperitoneal lavage fluid, postoperative complications (Clavien-Dindo grading), postoperative pain [visual simulation scoring (VAS) assessment], anal function (Kirwan anal function grading assessment), and postoperative 3-year disease-free survival (DFS), overall survival (OS), overall recurrence rate, and local recurrence rate. Results: A total of 60 patients were enrolled, with 30 in the NOSES group and 30 in the CL group. All the patients in the NOSES group successfully completed operation with Cai tube. Baseline data between the two groups were not significantly different (all P>0.05). There were no statistically significant differences between two groups in conversion rate to open surgery, number of lymph node harivested, proximal and distal resection margin of tumor, negative rate of circumferential margin, operation time, blood loss, inflammatory indexes, postoperative anal function, postoperative hospital stay, hospitalization cost, morbidity of postoperative complications (Clavien-Dindo grade II or above) (all P>0.05). Compared to the CL group, the NOSES group had lower maximum postoperative VAS score (2.5±0.3 vs. 5.1±0.4, t=3.187, P<0.01), and fewer use of additional postoperative analgesia [6.7% (2/30) vs. 33.3% (10/30),χ²=6.670, P=0.02]. The postoperative time to gas passage was shorter in the NOSES group [(2.2±1.4) days vs. (3.1±1.2) days,P=0.026]. No tumor cells and bacterial contamination were found in abdominal lavage fluid before and after operation in either group. The anal function at postoperative 3-month of all the patients in the NOSES group was Kirwan grade I to II, while in the CL group, anal function of 2 cases (6.7%) was Kirwan grade III, and of 28 cases was also Kirwan grade I to II, whose difference was not statistically significant (P>0.05). In the NOSES group and the CL group, 3-year DFS was 96.7% and 83.3% (P=0.090), OS was 100% and 90% (P=0.096), overall recurrence rate was 3.3% and 10.0% (P=0.166), and local recurrence rate was 3.3% and 3.3% (P=0.999), respectively, whose differences were not statistically significant (all P>0.05). Conclusions: In the treatment of left colorectal cancer, compared with conventional laparoscopic colectomy, NOSES colectomy using Cai tube exhibits less scar, less postoperative pain, shorter recovery of gastrointestinal function, and similar mid-term outcomes. Given proper surgical indications, the surgical procedure is safe and feasible.

Cell nucleus localization and high anticancer activity of quinoline-benzopyran rhodium(III) metal complexes as therapeutic and fluorescence imaging agents

Four novel rhodium(III) complexes, [Rh^III(QB1)Cl₃(DMSO)] (RhN1), [Rh^III(QB2)Cl₃(CH₃OH)]·CH₃OH (RhN2), [Rh^III(QB3)Cl₃(CH₃OH)]·CH₃OH (RhS), and [Rh^III(QB4)Cl₃(DMSO)] (RhQ), bearing quinoline-benzopyran ligands (QB1-QB4) were synthesized and used to develop highly anticancer therapeutic and fluorescence imaging agents. Compared with the QB1-QB4 ligands (IC₅₀ > 89.2 ± 1.7 μM for A549/DDP), RhN1, RhN2, RhS and RhQ exhibit selective cytotoxicity against lung carcinoma cisplatin-resistant A549/DDP (A549CDDP) cancer cells, with IC₅₀ values in the range of 0.08-2.7 μM. The fluorescent imaging agent RhQ with the more extended planar QB4 ligand exhibited high anticancer activity in A549CDDP cells and was found in the cell nucleus fraction, whereas RhS had no fluorescence properties. RhQ and RhS may trigger cell apoptosis by causing DNA damage and initiating the mitochondrial dysfunction pathway. Furthermore, RhQ has a higher antitumor efficacy (ca. 55.3%) than RhS (46.4%) and cisplatin (CDDP, 33.1%), and RhQ demonstrated significantly lower toxicity in vivo than CDDP, making it a promising Rh(III)-based anticancer therapeutic and fluorescence imaging agent.

Complexes of Zn(II) with a mixed tryptanthrin derivative and curcumin chelating ligands as new promising anticancer agents

In this study, two novel curcumin (H-Cur)-tryptanthrin metal compounds-[Zn(TA)Cl₂], i.e., Zn(TA), and [Zn(TA)(Cur)]Cl, i.e., Zn(TAC)-were synthesized and investigated using 5-(bis-pyridin-2-ylmethyl-amino)-pentanoic acid (6,12-dioxo-6,12-dihydro-indolo[2,1-b]quinazolin-8-yl)-amide (TA) and H-Cur as the targeting and high-activity anticancer chemotherapeutic moieties, respectively. They were then compared with the di-(2-picolyl)amine (PA) Zn(II) complex [Zn(PA)Cl₂], i.e., Zn(PA). When compared with Zn(PA) and cisplatin, the IC₅₀ values of Zn(TA) and Zn(TAC) indicated that the compounds had high cytotoxicity against A549/DDP cancer cells, implying that the H-Cur-tryptanthrin Zn(II) compounds have the potential for use as anticancer drugs. We propose the use of synthesized theragnostic H-Cur-tryptanthrin Zn(II) complexes with nuclear-targeting and DNA-damaging capabilities as a simple therapeutic strategy against tumors. The Zn(TA) and Zn(TAC) complexes could be traced via red fluorescence and were found to accumulate in the cell nuclei and induce DNA damage, cell cycle arrest, mitochondrial dysfunction, and cell apoptosis both in vitro and in vivo. In addition, Zn(TAC) exhibited a higher antiproliferative effect on A549/DDP than Zn(TA) and Zn(PA), which was undoubtedly associated with the key roles of the novel tryptanthrin derivative TA and H-Cur in the Zn(TAC) complex.

Discovery of thirteen cobalt(II) and copper(II) salicylaldehyde Schiff base complexes that induce apoptosis and autophagy in human lung adenocarcinoma A549/DDP cells and that can overcome cisplatin resistance in vitro and in vivo

In this study, 13 transition metal complexes, namely, [Cu(L¹H)(H₂O)₂]·(H₂O)·NO₃ (1), [Cu(LⁿH₂)₂]·(NO₃)·(H₂O)₂ (2, n = 2; 3, n = 3; 4, n = 4; 5, n = 5), [Co(LⁿH)₂]₂·(H₂O)_0.5 (6, n = 2; 7, n = 3; 8, n = 4; 9, n = 5), [Cu(L⁶H)_0.5(L¹⁰H)_0.5(phen)]·(CH₃OH)_0.25 (10), [Cu(L¹¹H) (phen)]₄·(H₂O)₉ (11), [Cu(L⁸H)_0.27(L¹²H)_0.73(phen)]₄·(H₂O)_5.5(CH₃OH) (12), and [Cu(L⁹H) (phen)]₃·(H₂O)₇·(CH₃OH) (13), were synthesized using Schiff base ligands and characterized by elemental analysis (EA), infrared spectroscopy (IR), and single-crystal X-ray diffraction (SC-XRD). Compared with complexes 1-9, complexes 10-13 displayed stronger cytotoxic activities against the tested A549/DDP cancer cells (IC₅₀ = 0.97-3.31 μM), with differences greater than one order of magnitude. Moreover, complexes 11 and 13 could induce apoptosis and autophagy in A549/DDP cells via the mitochondrial dysfunction pathway that affects the regulation of autophagy- and mitochondrial-related proteins. Importantly, the results indicate that the two novel salicylaldehyde Schiff base analogs, 11 and 13, exhibited pronounced and selective activity against A549/DDP xenografts in vivo.

Ethanol Embolization of Nasal Arteriovenous Malformations: A 10-Year, Single-Institution Experience

PURPOSE

To summarize a 10-year, single-institution experience with ethanol embolization of nasal arteriovenous malformations (NAVMs) in 52 patients.

PATIENTS AND METHODS

The present work was a retrospective study of 52 patients (aged between 1 and 67 years) with NAVMs who were treated with ethanol embolization between August 2009 and August 2019. The diagnosis of NAVMs was established based on clinical and imaging studies including ultrasound, computer tomography angiography, and digital subtract angiography. Embolization techniques used in the current study included transarterial, direct puncture, and a combination of both. The clinical and angiographic features, treatment methods, clinical outcomes, and complications were assessed within the mean period of 55.2 months (range, 1-119 months) after the last embolization.

RESULTS

The total number of embolization sessions (140 embolization procedures in 52 pts) included transarterial approach (1 pt), direct puncture (2 pt), and a combination of transarterial and direct puncture (49 pts). There was a positive correlation between nidus size and treatment sessions (r = 0.780, P = 0.0005) and the amount of ethanol injected (r = 0.840, P = 0.0004). Results of the current study showed that the therapeutic outcomes were complete response in two patients (3.8%) without recurrence throughout the follow-up period (range, 1-119 months; mean, 55.2 months), and partial response in 50 patients (96.2%). A total of seven patients (13.5%) experienced one or more complications, including skin necrosis in one patient (1.9%), transient hemoglobinuria in five patients (9.6%), and skin blister in five patients (9.6%).

CONCLUSION

The reported single-institution experience evidently indicated that ethanol embolotherapy has the potential to successfully devascularize NAVMs and also significantly improve symptoms and signs. Further, it was evident that the use of a combination of transarterial and direct puncture techniques has the potential to increase the rate of therapeutic response in patients with NAVMs.

A new class of nickel(II) oxyquinoline-bipyridine complexes as potent anticancer agents induces apoptosis and autophagy in A549/DDP tumor cells through mitophagy pathways

A new class of nickel(II) oxyquinoline-bipyridine complexes, namely, [Ni(La1)2(Lb6)] (Ni1), [Ni(La1)2(Lb2)] CH3OH (Ni2), [Ni(La7)2(Lb11)]2H2O (Ni3), [Ni(La1)2(Lb9)] (Ni4), [Ni(La1)2(Lb8)] (Ni5), [Ni(La2)2(Lb1)] (Ni6), [Ni(La2)2(Lb6)]CH3OH (Ni7), [Ni(La2)2(Lb11)]CH3OH (Ni8), [Ni(La2)2(Lb3)] (Ni9), [Ni(La2)2(Lb2)]CH3OH (Ni10), [Ni(La2)2(Lb5)]CH3OH...

[Effect of platelet reactivity on clinical events in patients using bivalirudin in selective percutaneous coronary intervention]

Objective: To investigate the effect of platelet reactivity and other clinical factors on the postoperative 1-year adverse clinical events in patients who underwent selective percutaneous coronary intervention (PCI) anticoagulated with bivalirudin. Methods: This is a multicenter, retrospective and observational study, enrolling 632 patients at high risk of bleeding adjudicated by operators who underwent selective PCI anticoagulated with bivalirudin and had preoperative thrombelastography (TEG) test results in Fuwai Hospital, Northern Theater General Hospital and Xinxiang Central Hospital between January 2017 and August 2018. Platelet reactivity was tested by TEG and adenosine-induced maximal amplitude (MAADP) was recorded. According to MAADP patients were divided into three groups: low on-treatment platelet reactivity (LTPR) group (MAADP<31 mm, n=229), normal on-treatment platelet reactivity (NTPR) group (31 mm≤MAADP≤47 mm, n=207) and high on-treatment platelet reactivity (HTPR) group (MAADP>47 mm, n=196). The endpoints consisted of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events. The definition of MACCE was the composite of all-cause mortality, myocardial infarction, intrastent thrombosis, stroke and revascularization. Bleeding events were defined by bleeding academic research consortium (BARC) type 2, 3 and 5 bleeding. Using multivariate Cox regression to analyze the factors of MACCE and bleeding events in patients underwent selective PCI anticoagulated with bivalirudin. Results: A total of 632 patients were finally enrolled in the study with age of (68.3±10.0) years and there were 423 (66.9%) males. All of 632 patients finished one-year follow-up, and 48 (7.6%) patients occurred MACCE and 11 (1.7%) patients occurred bleeding events. There was not statistically significant difference in the incidence of MACCE (8.3% (19/229) vs. 6.3% (13/207) vs.8.2% (16/196), P=0.68) and bleeding events (1.8% (4/229) vs. 2.9% (6/207) vs. 0.5% (1/196), P=0.17) in LTPR, NTPR and HTPR group. Multivariate Cox regression showed that HTPR was not the independent factor of MACCE (HR=1.25, 95%CI 0.67-2.30, P=0.49), and the history of peripheral vessel disease was the independent risk factor of MACCE (HR=2.47, 95%CI 1.19-5.11, P=0.02). LTPR was not the independent factor of bleeding events (HR=1.35, 95%CI 0.39-4.66, P=0.64), and the independent factors of bleeding events were history of peripheral vessel disease (HR=3.95, 95%CI 1.03-15.22, P=0.05) and hemoglobin (HR=0.96, 95%CI 0.93-0.99, P=0.01). Conclusions: In patients undergoing selective PCI anticoagulated with bivalirudin, there is no significant association between platelet reactivity and postoperative 1-year MACCE or bleeding events. History of peripheral vessel disease is an independent risk factor of MACCE, and history of peripheral vessel disease and decreased hemoglobin are independent risk factors of bleeding events.

[The enlightenment of foreign MD-MPH double degree program to the cultivation of high-level applied public health talents in China]

Objective: To understand the current status of foreign dual-degree programs of Medical Doctor (MD) and Master of Public Health (MPH) and provide evidence-based decision-making reference for promoting the education of high-level applied public health talents in China. Methods: The list of involved institutions and information of foreign MD-MPH dual-degree programs was collected through literature retrieval, online information searching, and additional survey of key figures. We extracted the details of each project regarding professional fields, core competence, length of schooling, teaching and learning arrangement, internship eligibility, and graduation assessment. Python 3.8.0 was used for data cleaning, and the occurrence frequency of related items in each dimension was calculated. Results: A total of 99 MD-MPH programs from 104 foreign institutions were included, among which 97.1% of them were implemented in universities from the United States. The School of Public Health provided 42.4% (42/99) of the programs. Epidemiology was the major discipline set up among most programs, accounting for 12.0% (29/241) of all the specialties involved. Epidemiological research methods, health policy management and practice, and public health practice were the top 3 core competencies to be mastered. Of the 99 programs, 87 gave information on the length of the program, of which 74.7% (65/87) were five years, 6.9% (6/87) were four years, and 18.4% (16/87) included both 4-year and 5-year programs. Conclusions: The international MD-MPH programs were sophisticated and mainly organized by the School of Public Health alone or in conjunction with the School of Medicine. Epidemiology is the core course and competence objective, with a length of 4-5 years. Through learning experience from international MD-MPH programs and the Chinese unique medical development background, China should optimize its medical education system to develop a suitable talent training strategy for MD-MPH dual-degree programs in the new era.

[The effect of visualized saphenous nerve block through minimally invasive far medial-subvastus approach on the analgesia after total knee arthroplasty]

Objective: To report a method of visualized saphenous nerve block (VSNB) through minimally invasive far medial-subvastus approach distal to the adductor canal in total knee arthroplasty (TKA), and investigate the effect of VSNB in this way on postoperative pain relief. Methods: A total of 100 patients with knee osteoarthritis were prospectively included from June 2018 to October 2019, 29 males and 71 females, aged 50-87(70±8) years. All patients undergoing TKA through minimally invasive far medial-subvastus approach were randomized to visualized saphenous nerve block combined with periarticular infiltration analgesia group (Group VSNB+PIA) or only periarticular infiltration analgesia group (Group PIA),50 cases in each group. The visual analogue scale (VAS) was used to evaluate the pain degree of patients. Furthermore, the scores of VAS in resting and active state at 4, 8, 12, 24, 48, 72 hours after operation and the proportion of patients receiving parecoxib within 72 hours after operation were compared between the two groups. Results: There was statistically significant difference between the two groups in terms of VAS scores in resting state after surgery(F=15.295,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at resting state were 1.3±0.8, 1.4±0.7, 1.7±0.8, 3.1±0.8 respectively, which were all significantly lower than those of Group PIA (1.6±0.9, 1.8±0.8, 2.3±0.9, 3.6±0.8) (P<0.05). The overall difference in terms of VAS scores at active state after surgery was statistically significant between the two groups(F=18.532, P<0.05). The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at active state were 2.0±0.8, 2.2±0.7, 2.7±0.6, 3.7±0.7 respectively, which were all significantly lower than those of Group PIA (2.3±0.8, 2.7±0.7, 3.3±0.8, 4.4±0.7)(P<0.05). Fourteen percent of patients (7/50) in VSNB+PIA group accepted parecoxib within 72 hours after surgery, which was significantly lower than that in PIA group (34%, 17/50) (P<0.05). Conclusions: It is easy to expose the saphenous nerve beyond the adductor canal through minimally invasive far medial-subvastus approach. The Combination therapy of VSNB+PIA is more effective than the simple per-articular infiltration analgesia in providing pain relief after total knee arthroplasty.

[Characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease patients of different age groups]

Objective: To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease (GERD) patients of different age groups. Methods: This was a case-control study. Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups: elderly group (≥60 years old) and young and middle-aged group (<60 years old). Characteristics of gender, disease course, clinical symptoms, esophageal motility, gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed. Results: A total of 250 patients met the inclusion criteria, with 61 patients in elderly group and 189 in young and middle-aged group. There were no significant differences in gender ((male/female: 24/37 vs 78/111, P>0.05) and disease course((4.9±4.2) years vs(4.5±3.8)years, P>0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43, P<0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg, P<0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),P<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0), P<0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); both P<0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(r=-0.145, P<0.05), while there was a positive correlation between the LES length and age (r=0.129, P<0.05). Conclusion: Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients.

[Epidemiological characteristics and outcome analysis of inhalation injury patients combined with burn area less than 30% total body surface area in a single center from 2008 to 2016]

Objective: To explore the epidemiological characteristics and treatment outcomes of inhalation injury patients combined with burn area less than 30% total body surface area (TBSA) admitted to the First Affiliated Hospital of Naval Medical University. Methods: Retrospective observational study with performed on medical records of 266 inhalation injury patients combined with burn area less than 30% TBSA who were admitted to the First Affiliated Hospital of Naval Medical University from January 2008 to September 2016 and met the inclusion criteria. The gender, age, injured site, injurious factors of inhalation injury, degree of inhalation injury, combined total burn area, way of tracheotomy, time of tracheotomy, whether conducted mechanical ventilation or not, whether in intensive care unit (ICU) or not, microbial culture results of bronchoalveolar lavage, total hospitalization days, ICU days, mechanical ventilation days, and whether respiratory infections occurred or not. Single factor and multivariate linear regression analysis was used to screen out the risk factors impacting the total hospitalization days, ICU days, and mechanical ventilation days of patients. Single factor and multivariate logistic regression analysis was used to screen out the risk factors impacting respiratory infections of patients. Results: The 266 patients included 190 males and 76 females, with the majority age of above and equal to 21 and below 65 years (217 patients). Confined space was the major injured site. Hot air was the major factor of inhalation injury. Mild and moderate inhalation injuries were commonly seen in patients. The combined total burn area was 9.00 (3.25, 18.00) %TBSA. In 111 patients who were conducted with tracheotomy, the most were conducted before admitted to the First Affiliated Hospital of Naval Medical University. The total hospitalization days of patients were 27 (10, 55) days. The ICU days of 160 patients were 15.5 (6.0, 40.0) days. The mechanical ventilation days of 109 patients were 6.0 (1.3, 11.5) days. A total of 119 patients were diagnosed with respiratory infections, with 548 strains including 35 types of pathogens were isolated, mainly of Gram-negative bacteria. Single factor linear regression analysis showed age, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the total hospitalization days of patients (95% confidence interval (CI)=-0.397－0.001, -0.395－-0.053, 0.015－0.028, 0.009－0.263, 0.008－0.319, -0.419－-0.176, 0.242－0.471, 0.340－0.555, P<0.1). Multivariate linear regression analysis showed smoke inhalation, mechanical ventilation, and respiratory infections were the independent risk factors impacting the total hospitalization days of patients (95% CI=-0.384－0.082, 0.022－0.271, 0.261－0.506, P<0.05 or P<0.01). Single factor linear regression analysis showed injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the ICU days of patients (95% CI=0.053－0.502, 0.006－0.010, -0.018－0.457, -0.022－0.428, -0.575－-0.241, -0.687－-0.018, 0.132－0.486, 0.369－0.678, P<0.1). Multivariate linear regression analysis showed that no tracheotomy and respiratory infections were the independent risk factors impacting the ICU days of patients (95% CI=-0.414－-0.084, 0.278－0.601, P<0.01). Single factor linear regression analysis showed injured site, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, and whether respiratory infections occurred or not were the risk factors impacting mechanical ventilation days of patients (95% CI=-0.565－-0.034, 0.145－0.946, 0.051－1.188, 0.001－0.009, 0.127－0.847, 0.436－1.162, -1.243－-0.229, 0.005－0.605, P<0.1). Multivariate linear regression analysis showed open space inhalation, smoke inhalation, severe inhalation injury, no tracheotomy, prophylactic tracheotomy, and respiratory infections were the independent risk factors impacting mechanical ventilation days of patients (95% CI=-0.588－-0.127, 0.138－0.560, 0.143－0.848, -0.909－-0.330, -1.008－-0.015, 0.007－0.519, P<0.05 or P<0.01). Single factor logistic regression analysis showed age, injured site, degree of inhalation injury, combined total burn area, way of tracheotomy, and whether conducted mechanical ventilation or not were the risk factors impacting respiratory infections of patients (95% CI=0.840－1.362, 0.641－1.044, 1.122－1.526, 1.028－1.661, 1.344－2.405, 1.460－2.612, 0.744－1.320, 0.241－0.424, 2.331－4.090, P<0.1). Multivariate logistic regression analysis showed prophylactic tracheotomy, no tracheotomy, and mechanical ventilation were the independent risk factors impacting respiratory infections of patient (95% CI=0.430－0.641, 0.290－0.511, 2.152－8.624, P<0.05 or P<0.01). Conclusions: The inhalation injury patients combined with burn area less than 30% TBSA are mainly young and middle-aged males. Confined space, smoke inhalation, mechanical ventilation, respiratory infection, and way of tracheotomy are influencing factors of the outcomes in hospital of inhalation injury patients combined with burn area less than 30% TBSA. Additionally, prophylactic tracheotomy shows its potential role in avoiding respiratory infection for patients with moderate or severe degree of inhalation injury.

Higher-Order Band Topology in Twisted Moiré Superlattice

The two-dimensional (2D) twisted bilayer materials with van der Waals coupling have ignited great research interests, paving a new way to explore the emergent quantum phenomena by twist degree of freedom. Generally, with the decreasing of twist angle, the enhanced interlayer coupling will gradually flatten the low-energy bands and isolate them by two high-energy gaps at zero and full filling, respectively. Although the correlation and topological physics in the low-energy flat bands have been intensively studied, little information is available for these two emerging gaps. In this Letter, we predict a 2D second-order topological insulator (SOTI) for twisted bilayer graphene and twisted bilayer boron nitride in both zero and full filling gaps. Employing a tight-binding Hamiltonian based on first-principles calculations, three unique fingerprints of 2D SOTI are identified, that is, nonzero bulk topological index, gapped topological edge state, and in-gap topological corner state. Most remarkably, the 2D SOTI exists in a wide range of commensurate twist angles, which is robust to microscopic structure disorder and twist center, greatly facilitating the possible experimental measurement. Our results not only extend the higher-order band topology to massless and massive twisted moiré superlattice, but also demonstrate the importance of high-energy bands for fully understanding the nontrivial electronics.

Prevalence of Alzheimer's Disease and Parkinson's Disease in China: An Updated Systematical Analysis

Background: Alzheimer's disease (AD) and Parkinson's disease (PD) are two major neurodegenerative diseases worldwide. Demographic aging is in rapid progress in China. Up-to-date estimates of AD and PD prevalence have not been provided.

Methods: Studies that reported the prevalence of AD and PD in China were identified via a systematic database search from 1985 to 2018. Meta-analysis, local polynomial regression and autoregressive integrated moving average model were used for analyses.

Results: A total of 99 studies were included in the study with populations of 385,312 and 227,228, respectively for AD and PD. The overall prevalence of AD and PD following age standardization was 3.20% [95% confidence interval (CI) = 3.17–3.23] and 1.06% (95% CI = 1.02–1.10), respectively in individuals over 60 years old. The rates increased drastically for every 10-years increment of age. The yearly prevalence of AD was predicted to increase from 3.81 to 6.17% in the next 5 years. Significant differences were observed between genders [male to female odds ratio (OR) for AD = 0.57, 95% CI = 0.51–0.64; OR for PD = 1.25, 95% CI = 1.06–1.46], and between education levels (Illiterate to non-illiterate OR for AD = 2.99, 95% CI = 2.38–3.75), but not between urban and rural settings.

Conclusion: Our results provide an updated insight into the epidemiology of AD and PD in China and their associated rates and ratios. The findings may facilitate China policy makers and health professionals mitigate the related health issues.

Imaging and therapeutic applications of Zn(ii)-cryptolepine-curcumin molecular probes in cell apoptosis detection and photodynamic therapy

Novel red Zn(ii) complex-based fluorescent probes featuring cryptolepine-curcumin derivatives, namely, [Zn(BQ)Cl₂] (BQ-Zn) and [Zn(BQ)(Cur)]Cl (BQCur-Zn), were developed for the simple and fluorescent label-free detection of apoptosis, an important biological process. The probes could synergistically promote mitochondrion-mediated apoptosis and enhance tumor therapeutic effects in vitro and vivo.

Two telomerase-targeting Pt(ii) complexes of jatrorrhizine and berberine derivatives induce apoptosis in human bladder tumor cells

Two novel Pt(ii) complexes, [Pt(B-TFA)Cl]Cl (Pt1) and [Pt(J-TFA)Cl]Cl (Pt2) with jatrorrhizine and berberine derivatives (B-TFA and J-TFA) were first prepared as desirable luminescent agents for cellular applications and potent telomerase inhibitors, which can induce bladder T-24 tumor cell apoptosis by targeting telomerase, together with induction of mitochondrial dysfunction, telomere DNA damage and cell-cycle arrest. Importantly, T-24 tumor inhibition rate (TIR) was 50.4% for Pt2, which was higher than that of Pt1 (26.4%) and cisplatin (37.1%). Taken together, all the results indicated that jatrorrhizine and berberine derivatives Pt1 and Pt2 show low toxicity and could be novel Pt-based anti-cancer drug candidates.

Complexes of oxoplatin with rhein and ferulic acid ligands as platinum(iv) prodrugs with high anti-tumor activity

We herein designed two new Pt^IV prodrugs of oxoplatin (cis,cis,cis-[PtCl₂(NH₃)₂(OH)₂]), [Pt^IVCl₂(NH₃)₂(O₂C-FA)₂] (Pt-2) and [Pt^IVCl₂(NH₃)₂(O₂C-RH)₂] (Pt-3), by conjugating with ferulic acid (FA-COOH) and rhein (RH-COOH) which have well-known biological activities. Three other Pt(iv) complexes of [Pt^IVCl₂(NH₃)₂(O₂C-BA)₂] (Pt-1), [Pt^IVCl₂(NH₃)₂(O₂C-CA)₂] (Pt-4) and [Pt^IVCl₂(NH₃)₂(O₂C-TCA)₂] (Pt-5) (where BA-COOH = benzoic acid, CA-COOH = crotonic acid and TCA-COOH = trans-cinnamic acid) were also prepared for the comparative study. Like most Pt^IV prodrug complexes, the cytotoxicity of Pt-3 containing the biologically active rhein (RH-COOH) ligand against lung carcinoma (A549 and A549/DDP) cells was higher than those of Pt-1, Pt-2, Pt-4, cisplatin and Pt-5. Moreover, the cytotoxicity of Pt-3 in HL-7702 normal cells was lower than those of Pt^IV derivatives bearing BA-COOH, FA-COOH, TCA-COOH and CA-COOH ligands. The highly efficacious Pt-2 and Pt-3 were found to accumulate strongly in the A549/DDP cells, with the prodrug Pt-3 showing highest levels of penetration into the mitochondria. The prodrug Pt-3 effectively entered the A549/DDP cells and caused mitochondrial damage, significantly greater than Pt-2. In addition, the prodrug Pt-3 exhibited higher antitumor efficacy (inhibition rates (IR) = 67.45%) than Pt-2 (28.12%) and cisplatin (33.05%) in the A549/DDP xenograft mouse model. Thus, the prodrug Pt-3 containing the rhein (RH-COOH) ligand is a promising candidate drug targeting the mitochondria.

Highly cytotoxic, cyclometalated iridium(iii)-5-fluoro-8-quinolinol complexes as cancer cell mitochondriotropic agents

Ir-3 and Ir-4 kill HeLa cells and trigger caspase-mediated mitochondrial dysfunction apoptosis pathways.

[Feasibility and safety of new "blind" axillary vein puncture technique in pacemaker implantation]

Objective: To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation. Methods: From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed. Results: There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle β was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax. Conclusion: The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.

Hourglass Fermion in Two-Dimensional Material

The hourglass fermion, as an exotic quasiparticle protected by nonsymmorphic symmetry, has excited great research interest recently. However, its bulk counterpart in two-dimensional (2D) solid-state materials has seldom been studied. In this Letter, we propose a 2D rectangular lattice made of p_{x} and p_{y} orbitals with glide mirror symmetry but without inversion symmetry to realize the hourglass fermion. The glide mirror symmetry guarantees a Dirac nodal line, while the Rashba spin-orbital coupling splits it into two Weyl nodal lines and generates two pairs of hourglass fermion located at the glide mirror plane. Furthermore, based on first principles calculations, we predict a surface-supported 2D material Bi/Cl-SiC(111) to realize our proposal, making a huge-bandwidth hourglass cone. Moreover, the hourglass fermion exhibits a spin-momentum locking spin texture and also sustains a giant spin Hall conductivity. Our results demonstrate a general routine for designing an hourglass fermion in 2D materials, which will be easily extended to other surfaces with different adatoms and lattice symmetries.

Two-Dimensional Quadrupole Topological Insulator in γ-Graphyne

Two-dimensional quadrupole topological insulator (2D QTI), as a new class of second-order topological phases, has been experimentally confirmed in various artificial systems recently. However, its realization in electronic materials has seldom been reported. In this work, we predict that the experimentally synthesized γ-graphyne is a large-gap (∼0.2 eV) 2D QTI. Three characterized features for 2D QTI are simultaneously observed in γ-graphyne: quantized finite bulk quadrupole moment, gapped topological edge states, and in-gap topological corner states. Intriguingly, we found that gapped topological edge states exist on armchair edge with C≡C (but not C-C) termination, and in-gap topological corner states exist at corner with 120° (but not 60°) termination, which can be explained by different edge-hopping textures and corner chiral charges. Moreover, the robustness of in-gap topological corner states is further identified by varying edge-disorder and system-size calculations. Our results demonstrate a realistic electronic material for large-gap 2D QTI, which is expected to draw immediate experimental attention.

High in Vitro and in Vivo Tumor-Selective Novel Ruthenium(II) Complexes with 3-(2'-Benzimidazolyl)-7-fluoro-coumarin

Three novel Ru(II) complexes, namely, (RuCl₂[L^a][DMSO]₂)·H₂O (Ru1), (RuCl₂[L^b][DMSO]₂) (Ru2), and (RuCl₂[L^c][DMSO]₂) (Ru3), which respectively contain 3-(2'-benzimidazolyl)coumarin (L^a), 3-(2'-benzimidazolyl)-7-fluoro-coumarin (L^b), and 3-(2'-benzimidazolyl)-7-methoxyl-coumarin (L^c), were first designed and characterized. Ru2 showed potent antitumor activity against NCI-H460 cells (IC₅₀ = 0.30 ± 0.02 μM) and high selectivity between NCI-H460 cancer cells and normal HL-7702 cells. Ru2 induced NCI-H460 apoptosis via telomerase inhibition, which involved DNA damage, cell-cycle distribution, and S phase-protein down-regulation. However, Ru1 did not demonstrate such effects in NCI-H460 cells, which is undoubtedly associated with the key regulatory role of the 7-fluoro substituted group in the L^b ligand of Ru2. Ru2 exhibited considerably higher anticancer efficacy (inhibition rate [IR] = 61.3%) compared with cisplatin (IR= 25.5%) in a NCI-H460 xenograft mouse model. Thus, this coumarin Ru(II) compound is a promising Ru2-targeting telomerase anticancer agent.

In vitro and in vivo activity of novel platinum(ii) complexes with naphthalene imide derivatives inhibiting human non-small cell lung cancer cells

3 induced NCI-H460 cell apoptosis via inhibition of the telomerase and dysfunction of mitochondria. Remarkably, 3 obviously inhibited NCI-H460 xenograft tumor growth in vivo.