Insight into the fate of nitrogen during char thermal conversion and the influence mechanism of potassium: A theoretical research

Nitrogen oxides (NOₓ) are primary pollutants produced during biomass combustion. During the devolatilization stage, char nitrogen (char(N)) is formed. In the subsequent char combustion stage, char(N) can decompose directly into NOx precursors or engage in heterogeneous reactions with O2 or NO to form NO and N2. Nonetheless, a comprehensive understanding of the reaction mechanisms and competitiveness of char(N) migration, especially the influence of the alkali metal potassium (K) present in biomass, remains incomplete. Building on the Zigzag char(N) models, the present study delves into the migration reactions of char(N), assessing their competitive dynamics through the integration of density functional theory, electronic structure analysis, and conventional transition state theory. Furthermore, it examines the impact of K on char(N) conversion. The competitiveness of the heterogeneous reactions follows the sequence: heterogeneous reduction of NO to N2 > heterogeneous oxidation of char(N) to NO > decomposition of char(N) to NOx precursors. Moreover, the formation of HCN is more favorable than NH₃ production. The successive conversion from char(N) to NO and then to N2 is the predominant migration route for char(N), with NO generation as the pivotal step. The less preferred char(N) migration route involves decomposition to NH3/HCN, followed by oxidation to NOx within the main combustion zone, which cannot be mitigated by char. K can accelerate NO generation and sustain the primacy of the heterogeneous NO reduction, consequently enhancing the oxidation-reduction process of char(N). As a result, K plays a constructive role in managing NOx emissions during the thermal conversion of char.

Comparison contrast-enhanced CT with contrast-enhanced US in diagnosing combined hepatocellular-cholangiocarcinoma: a propensity score-matched study

OBJECTIVES

To develop and compare noninvasive models for differentiating between combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and HCC based on serum tumor markers, contrast-enhanced ultrasound (CEUS), and computed tomography (CECT).

METHODS

From January 2010 to December 2021, patients with pathologically confirmed cHCC-CCA or HCC who underwent both preoperative CEUS and CECT were retrospectively enrolled. Propensity scores were calculated to match cHCC-CCA and HCC patients with a near-neighbor ratio of 1:2. Two predicted models, a CEUS-predominant (CEUS features plus tumor markers) and a CECT-predominant model (CECT features plus tumor markers), were constructed using logistic regression analyses. Model performance was evaluated by the area under the curve (AUC), sensitivity, specificity, and accuracy.

RESULTS

A total of 135 patients (mean age, 51.3 years ± 10.9; 122 men) with 135 tumors (45 cHCC-CCA and 90 HCC) were included. By logistic regression analysis, unclear boundary in the intratumoral nonenhanced area, partial washout on CEUS, CA 19-9 > 100 U/mL, lack of cirrhosis, incomplete tumor capsule, and nonrim arterial phase hyperenhancement (APHE) volume < 50% on CECT were independent factors for a diagnosis of cHCC-CCA. The CECT-predominant model showed almost perfect sensitivity for cHCC-CCA, unlike the CEUS-predominant model (93.3% vs. 55.6%, p < 0.001). The CEUS-predominant model showed higher diagnostic specificity than the CECT-predominant model (80.0% vs. 63.3%; p = 0.020), especially in the ≤ 5 cm subgroup (92.0% vs. 70.0%; p = 0.013).

CONCLUSIONS

The CECT-predominant model provides higher diagnostic sensitivity than the CEUS-predominant model for CHCC-CCA. Combining CECT features with serum CA 19-9 > 100 U/mL shows excellent sensitivity.

CRITICAL RELEVANCE STATEMENT

Combining lack of cirrhosis, incomplete tumor capsule, and nonrim arterial phase hyperenhancement (APHE) volume < 50% on CECT with serum CA 19-9 > 100 U/mL shows excellent sensitivity in differentiating cHCC-CCA from HCC.

KEY POINTS

1. Accurate differentiation between cHCC-CCA and HCC is essential for treatment decisions. 2. The CECT-predominant model provides higher accuracy than the CEUS-predominant model for CHCC-CCA. 3. Combining CECT features and CA 19-9 levels shows a sensitivity of 93.3% in diagnosing cHCC-CCA.

Effect of Pericapsular Nerve Group Block with Different Concentrations and Volumes of Ropivacaine on Functional Recovery in Total Hip Arthroplasty: A Randomized, Observer-Masked, Controlled Trial

Purpose

The pericapsular nerve group (PENG) block provides satisfactory postoperative analgesia without hampering motor function for total hip arthroplasty (THA); however, unexpected motor block has been observed clinically. It is unknown whether this motor block is related to the dose of ropivacaine. We aimed to conduct a prospective randomized trial to test whether reducing the volume or concentration of ropivacaine was better for less motor block after PENG block.

Patients and Methods

Ninety-nine patients with fracture or femoral head necrosis scheduled for THA were randomly allocated to receive 20 mL 0.5% ropivacaine (Group A), 20 mL 0.25% ropivacaine (Group B), and 10 mL 0.5% ropivacaine (Group C). The primary outcome was the incidence of postoperative quadriceps motor block at 6 hours. Secondary outcomes were the incidence of postoperative quadriceps motor block at 0, 12, 24 and 48 hours; pain scores on the numeric rating scale (NRS) at all postoperative time points (0, 6, 12, 24, and 48 hours); the time to first walk; the incidence of rescue analgesia; side effects such as dizziness, ache, nausea, and vomiting; and patient satisfaction.

Results

Compared with Group A, Group C resulted in a lower incidence of quadriceps motor block at 0 hours, 6 hours and 12 hours postoperatively (P < 0.05), while Group B only resulted in a lower incidence of motor block at 12 hours postoperatively (P < 0.05). No intergroup differences were found in terms of postoperative pain scores, the incidence of rescue analgesia, adverse events or patient satisfaction (P > 0.05).

Conclusion

A higher incidence of motor blockade was observed when 20 mL of 0.5% ropivacaine was administered, which was mainly caused by the excessive volume. Therefore, we recommend performing PENG block with 10 mL 0.5% ropivacaine.

Febrile infection-related epilepsy syndrome with claustrum lesion: an underdiagnosed inflammatory encephalopathy

OBJECTIVE

To summarize the clinical characteristics and prognosis of febrile infection-related epilepsy syndrome with claustrum lesions (FIRES-C).

METHOD

Clinical data of FIRES-C patients were collected retrospectively. The study reviewed and analyzed their clinical manifestations, treatment strategies, and prognosis.

RESULT

Twenty patients were enrolled, including 13 females and 7 males, with a median onset age of 20.5 years. All patients developed seizures after fever, with a median interval of 5 days. Brain MRI showed symmetric lesions in the claustrum in all patients. The median interval from seizure onset to abnormal MRI signals detection was 12.5 days. All patients had negative results for comprehensive tests of neurotropic viruses and antineuronal autoantibodies. Seventy percent of cases had been previously empirically diagnosed with autoimmune encephalitis or viral encephalitis before. All patients received anti-seizure medicine. Eleven patients (55%) received antiviral therapy. All patients received immunotherapy, including glucocorticoids (100%), intravenous immunoglobulin (IVIg) (65%), plasma exchange (PLEX) (10%), tocilizumab (10%), rituximab (5%), and cyclophosphamide (5%). Sixty percent of patients received long-term immunotherapy (≥ 3 months). The median follow-up was 11.5 months;60% of patients were diagnosed with refractory epilepsy.

CONCLUSION

Bilateral claustrum lesion on MRI is a distinctive neuroimage feature for FIRES, which may serve as an indication for the initial clinical assessments. FIRES-C should be classified as a type of inflammatory encephalopathy characterized by a monophasic nature. Some FIRES-C patients respond to immunotherapy and antiseizure treatments but most experience refractory epilepsy as a long-term outcome.

The complete chloroplast genome sequence of Prunus salicina cultivar 'Zuili' (Rosaceae)

'Zuili' is a distinguished plum (Prunus salicina Lindley 1830) originating from Tongxiang City, Zhejiang Province, China, and a nationally recognized geographical indication product. In this study, we reported the complete chloroplast genome of P. salicina cultivar 'Zuili'. The genome has a circular structure of 157,935 bp containing a large single-copy (LSC) region of 86,133 bp, a small single-copy (SSC) region of 19,028 bp, and two inverted repeats (IRs) of 26,387 by each. It harbors 130 genes (111 unique genes), including 85 protein-coding genes (78 are unique), eight ribosomal RNA genes (four are unique), and 37 transfer genes (29 are unique). The phylogenetic analysis based on whole chloroplast genomes showed 'Zuili' was clustered with Prunus salicina cultivar 'Wuyuecui' (MW406461.1) and 'No. 2 Guofeng' (MW406472.1). This study provides valuable information that can contribute to the identification and further evolutionary analysis of Prunus salicina cultivar 'Zuili'.

METTL16 suppressed the proliferation and cisplatin-chemoresistance of bladder cancer by degrading PMEPA1 mRNA in a m6A manner through autophagy pathway

N6-methyladenosine (m6A) is important in the physiological processes of many species. Methyltransferase-like 16 (METTL16) is a novel discovered m6A methylase, regulating various tumors in an m6A-dependent manner. However, its function in bladder cancer (BLCA) remains largely unclear. In the present study, we found that low expression of METTL16 predicted poor survival in BLCA patients. METTL16 inhibited the proliferation and cisplatin-resistance function of bladder cancer cells in vitro and in vivo. In addition, METTL16 reduced the mRNA stability of prostate transmembrane protein androgen induced-1 (PMEPA1) via binding to its m6A site in the 3'-UTR, thereby inhibited the proliferation of bladder cancer cells and increased the sensitivity of cisplatin through PMEPA1-mediated autophagy pathway. Finally, we found that hypoxia-inducible factor 2α (HIF-2α) exerted its tumor-promoting effect by binding the METTL16 promoter region to repress its transcription. Taken together, High expression of METTL16 predicted better survival in BLCA. METTL16 significantly inhibited bladder cancer cell proliferation and sensitized bladder cancer cells to cisplatin via HIF-2α-METTL16-PMEPA1-autophagy axis in a m6A manner. These findings might provide fresh insights into BLCA therapy.

An investigation study on the interpretation of ultrasonic medical reports using OpenAI's GPT-3.5-turbo model

OBJECTIVES

Ultrasound medical reports are an important means of diagnosing diseases and assessing treatment effectiveness. However, their professional terms and complex sentences often make it difficult for ordinary people to understand. Therefore, this study explores the clinical value of using artificial intelligence systems based on ChatGPT to interpret ultrasound medical reports.

METHODS

In this study, a combination of online and offline questionnaires were used to survey both physicians and non-medical individuals. The questionnaires evaluated ChatGPT's interpretation of ultrasound reports from both professional and comprehensibility perspectives, and the results were analyzed using Excel spreadsheets. Additionally, a portion of the research content was evaluated using the Likert Scale 5-point method in the questionnaire.

RESULTS

According to survey results, 67.4% of surveyed doctors believe that using ChatGPT for interpreting ultrasound medical reports can help improve work efficiency. At the same time, 69.72% of non-medical professionals believe it is necessary to enhance their understanding of medical ultrasound reports through ChatGPT interpretation, and 62.58% support the application of ChatGPT to ultrasound medical reports. The non-medical group's understanding of ultrasound medical reports significantly improved (p < 0.01) after implementing ChatGPT, However, 67.49% of the general public are concerned about ChatGPT's imperfect functionality, which may cause misleading information. This reflects that the public's trust in new technology is not high enough, and they are also worried about possible privacy leaks and security issues with ChatGPT technology.

CONCLUSIONS

The higher acceptance and support of non-medical individuals for the interpretation of medical reports by ChatGPT might be due to the system's natural language processing abilities that allow them to better understand and evaluate report contents. However, the expertise and experience of physicians are still irreplaceable. This suggests that the ChatGPT-based ultrasound medical report interpretation system has certain clinical value and application prospects, but further optimization is necessary to address its shortcomings in data quality and professionalism. This study provides a reference and inspiration for promoting the application and development of ultrasound technology and artificial intelligence systems in the medical field.

Study on the Mechanism of Levofloxacin Combined with Imipenem Against Pseudomonas aeruginosa

Pseudomonas aeruginosa can develop resistance. Therefore, it is necessary to design proper treatment for it. Pseudomonas aeruginosa can develop resistance against levofloxacin due to the development of efflux pumps. However, the development of these efflux pumps cannot develop resistance against imipenem. Additionally, the MexCDOprJ efflux system which is responsible for the resistance of Pseudomonas aeruginosa to levofloxacin is highly susceptible to imipenem. The objective of the study was to evaluate the emergence of resistance of Pseudomonas aeruginosa against 750 mg levofloxacin, 250 mg imipenem, and a combination of 750 mg levofloxacin and 250 mg imipenem. An in vitro pharmacodynamic model was selected for the evaluation of the emergence of resistance. Pseudomonas aeruginosa strain 236, Pseudomonas aeruginosa strain GB2, and Pseudomonas aeruginosa strain GB65 were selected. Susceptibility testing of both antibiotics was done by agar dilution methodology. A disk diffusion bioassay was performed for antibiotics. RT-PCR measurement was done for the evaluation of expressions of Pseudomonas aeruginosa genes. Samples were tested at 2 h, 4 h, 6 h, 8 h, 12 h, 16 h, 24 h, and 30 h. Levofloxacin and imipenem both individually reported a decrease in colony-forming unit per milliliter of strength in the initial stage but in the later stage both develop resistance individually. Levofloxacin with imipenem had no resistance to Pseudomonas aeruginosa during 30 h. Time after the start of development of resistance or decrease in clinical efficacy was higher for levofloxacin and imipenem combination in all strains. The concentration of Pseudomonas aeruginosa at the time after the start of development of resistance or decrease in clinical efficacy was fewer for levofloxacin and imipenem combination. Levofloxacin with imipenem is recommended for the treatment of infection due to Pseudomonas aeruginosa.

Development and validation of a sensitive UPLC-MS/MS analytical method for GFH009 in rat plasma and its application to toxicokinetics studies

GFH009 is a potent, highly selective, small molecule that targets and inhibits the activity of the CDK9/cyclin T1 regulatory complex of P-TEFb. This study aimed to develop and validate a highly selective and sensitive ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for precise quantification of GFH009 in rat plasma. This method was subsequently employed for conducting toxicokinetic studies of GFH009 in rats. Plasma was prepared using a simple protein precipitation method by acetonitrile. Chromatographic separation of the analytes was achieved on a BEH C18 analytical column with a rapid 3.0 min run time and a flow rate of 0.5 ml/min. The calibration curves for plasma samples exhibited excellent linearity over a wide concentration range of 1.0-1,000 ng/ml for GFH009. Intra- and inter-day accuracies were within 92.7-105.7%, and precisions were no more than 6.7%. Furthermore, the analyte demonstrated stability under four different storage conditions, with variations of <15.0%. This study pioneers a methodological innovation by introducing a highly reliable, specific and sensitive analytical method for GFH009 in rat plasma. The successful application of this method in toxicokinetic studies further underscores its significance, offering valuable insights for the methodology of clinical pharmacokinetic research.

Enhanced hemocompatibility and rapid magnetic anastomosis of electrospun small-diameter artificial vascular grafts

Background: Small-diameter (<6 mm) artificial vascular grafts (AVGs) are urgently required in vessel reconstructive surgery but constrained by suboptimal hemocompatibility and the complexity of anastomotic procedures. This study introduces coaxial electrospinning and magnetic anastomosis techniques to improve graft performance. Methods: Bilayer poly(lactide-co-caprolactone) (PLCL) grafts were fabricated by coaxial electrospinning to encapsulate heparin in the inner layer for anticoagulation. Magnetic rings were embedded at both ends of the nanofiber conduit to construct a magnetic anastomosis small-diameter AVG. Material properties were characterized by micromorphology, fourier transform infrared (FTIR) spectra, mechanical tests, in vitro heparin release and hemocompatibility. In vivo performance was evaluated in a rabbit model of inferior vena cava replacement. Results: Coaxial electrospinning produced PLCL/heparin grafts with sustained heparin release, lower platelet adhesion, prolonged clotting times, higher Young's modulus and tensile strength versus PLCL grafts. Magnetic anastomosis was significantly faster than suturing (3.65 ± 0.83 vs. 20.32 ± 3.45 min, p < 0.001) and with higher success rate (100% vs. 80%). Furthermore, magnetic AVG had higher short-term patency (2 days: 100% vs. 60%; 7 days: 40% vs. 0%) but similar long-term occlusion as sutured grafts. Conclusion: Coaxial electrospinning improved hemocompatibility and magnetic anastomosis enhanced implantability of small-diameter AVG. Short-term patency was excellent, but further optimization of anticoagulation is needed for long-term patency. This combinatorial approach holds promise for vascular graft engineering.

Silk Nanofiber Carriers for Both Hydrophilic and Hydrophobic Drugs to Achieve Improved Combination Chemotherapy

Combination chemotherapy is considered an effective strategy to inhibit tumor growth. Here, beta-sheet-rich silk nanofibers are co-loaded with hydrophilic doxorubicin (DOX) and hydrophobic paclitaxel (PTX) through a sequential physical blending-centrifugation-blending process. The ratio and amount of DOX and PTX on the nanofibers are regulated independently to optimize cooperative interaction. Both PTX and DOX are immobilized on the same nanofibers to avoid burst release problems. Besides the water-insoluble PTX, more than half of the DOX remained fixed on the nanofibers for more than 28 days, which facilitated the co-internalization of both DOX and PTX by tumor cells in vitro. Changing the ratio of co-loaded DOX and PTX achieved optimal combination therapy in vitro. The DOX-PTX co-loaded nanofibers are assembled into injectable hydrogels to facilitate in situ injection around tumor tissues in vivo. Long-term inhibition is achieved for tumors treated with DOX-PTX co-loaded hydrogels, superior to those treated with free DOX and PTX, and hydrogels loaded with only DOX or PTX. Considering the mild and controllable physical loading process and superior loading capacity for both hydrophilic and hydrophobic ingredients, these injectable silk nanofiber hydrogels are promising carriers to deliver multiple drug types simultaneously in situ, enhancing combination chemotherapies towards clinical applications.

Structure-Energy Relationship Prediction of the HZSM-5 Zeolite with Different Acid Site Distributions by the Neural Network Model

Zeolites are a very important family of catalysts. The catalytic activity of zeolites depends on the distribution of acid sites, which has been extensively studied. However, the relationship between the acid site distribution and catalytic efficiency remains unestablished. An onerous computational burden can be imposed when static calculations are applied to analyze the relationship between a catalyst structure and its energy. To resolve this issue, the current work uses neural network (NN) models to evaluate the relationship. By taking the typical HZSM-5 zeolite as an example, we applied the provided atomic coordinates to predict the energy. The network performances of the artificial neural network (ANN) and high-dimensional neural network (HDNN) are compared using the trained results from a dataset containing the identical number of acid sites. Furthermore, the importance of the feature is examined with the aid of a random forest model to identify the pivotal variables influencing the energy. In addition, the HDNN is employed to forecast the energy of an HZSM-5 system with varying numbers of acid sites. This study emphasizes that the energy of zeolites can be rapidly and accurately predicted through the NN, which can assist our understanding of the relationship between the structure and properties, thereby providing more accurate and efficient methods for the application of zeolite materials.

Evolution of radiation-induced temporal lobe injury after intensity-modulated radiation therapy in nasopharyngeal carcinoma: a large cohort retrospective study

BACKGROUND

Previous studies have demonstrated conflicting findings regarding the initial MRI patterns of radiotherapy-induced temporal lobe injury (RTLI) and the evolution of different RTLI patterns. The aim of this study was to evaluate the initial MRI pattern and evolution of RTLI in patients with nasopharyngeal carcinoma (NPC) by means of a large cohort study.

METHODS

Data of patients with RTLI were retrospectively collected from two hospitals between January 2011 and December 2021. The injured lobes were categorized into three patterns based on initial MRI patterns: isolated white matter lesions (WMLs), isolated contrast-enhanced lesions (CELs), and combined WMLs and CELs. The latency period, MRI appearances, and temporal changes in WMLs and CELs were evaluated.

RESULTS

A total of 913 RTLI patients with 1092 injured lobes were included in this study. The numbers of isolated WMLs, isolated CELs, and combined WMLs and CELs identified at the first MRI detection were 7 (0.6%), 172 (15.8%), and 913 (83.6%), respectively. The evolution of bilateral RTLI was different in the same patient, and that of unilateral RTLI combined with WMLs and CELs also may occur asynchronously. The time intervals from the initial MRI detection of isolated WMLs, isolated CELs, combined WMLs and CELs to the last negative MRI scan were 8.6, 8.9 and 11.0 months, respectively. A significant difference was observed in the time intervals between the three patterns (H = 14.287, P = 0.001). And the time interval was identified as an independent factor influencing the initial MRI pattern of RTLI after Poisson regression (P = 0.002).

CONCLUSION

Both WMLs and CELs could be the initial and only MRI abnormalities in patients with RTLI. This study is of great significance in accurately diagnosing RTLI early and providing timely treatment options. Additionally, it provides clinical evidence for guidelines on NPC, emphasizing the importance of regular follow-up of NPC patients.

High indirect bilirubin levels as an independent predictor of postoperative myasthenic crisis: a single-center, retrospective study

Background

Thymectomy is an efficient and standard treatment strategy for patients with myasthenia gravis (MG), postoperative myasthenic crisis (POMC) is the major complication related to thymectomy and has a strongly life-threatening effect. As a biomarker, whether the bilirubin level is a risk factor for MG progression remains unclear. This study aimed to investigate the association between the preoperative bilirubin level and postoperative myasthenic crisis (POMC).

Methods

We analyzed 375 patients with MG who underwent thymectomy at Tangdu Hospital between January 2012 and September 2021. The primary outcome measurement was POMC. The association between POMC and bilirubin level was analyzed by restricted cubic spline (RCS). Indirect bilirubin (IBIL) was divided into two subgroups based on the normal upper limit of IBIL, 14 μmol/L.

Results

Compared with non-POMC group, IBIL levels were significantly higher in patients with POMC. Elevated IBIL levels were closely associated with an increased risk of POMC (p for trend = 0.002). There was a dose-response curve relationship between IBIL levels and POMC incidence (p for non-linearity = 0.93). However, DBIL levels showed a U-shaped association with POMC incidence. High IBIL level (≥14 μmol/L) was an independent predictive factor for POMC [odds ratio = 3.47, 95% confidence interval (CI): 1.56-7.8, p = 0.002]. The addition of high IBIL levels improved the prediction model performance (net reclassification index = 0.186, 95% CI: 0.039-0.334; integrated discrimination improvement = 0.0345, 95% CI: 0.005-0.065).

Conclusion

High preoperative IBIL levels, especially those exceeding the normal upper limit, could independently predict the incidence of POMC.

The Effects of Implantable Collamer Lens ICL Implantation in High Myopia Patients' Mental Health

Purpose

To investigate the psychological changes in patients pre and post implantable collamer lens (ICL, EVO) implantation surgery in the posterior chamber.

Patients and methods

Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the mental states of 43 patients who underwent ICL implantation surgery performed by the same surgeon between January 2021 and December 2022.

Results

Comparing the results before and one week after the operation, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). Similarly, when comparing the pre-operation and one-month post-operation results, there is also a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). However, when comparing the one-week post-operation and one-month post-operation results, there is no significant difference in either the SAS scale (P>0.05) or the SDS scale (P>0.05). Moving on to the comparison between the pre-operation results and the national norm level, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). When comparing the one-week post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). Similarly, when comparing the one-month post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05).

Conclusion

After undergoing ICL implantation surgery, patients typically experience a notable decrease in anxiety (SAS) and depression (SDS) scales. These improvements gradually stabilize and enhance during the postoperative recovery period. However, it may require a significant amount of time for patients to fully restore their psychological well-being to levels comparable to the national norm, particularly in terms of anxiety levels.

New perspective on first-trimester serum uric acid level in predicting the risk of gestational diabetes mellitus

This study aimed to investigate the correlation between serum uric acid (UA) and gestational diabetes mellitus (GDM) during the first trimester and provide a new perspective for the prevention and treatment of GDM. Based on the diagnostic criteria of gestational diabetes of the International Association of Diabetes and Pregnancy Study Groups, 1744 and 4256 patients were enrolled in the GDM and normal glucose tolerance (NGT) groups. Four groups were constituted based on the quartile of first-trimester serum UA (UA) level, and the differences in each indicator between groups were compared. Logistic regression was used to analyze the effects of UA level on GDM risk. The rate of GDM in the UA quartile changed from low to high. Significant differences were also observed in fasting plasma glucose level, 1 h post glucose and 2 h post glucose levels, in all the groups (P < 0.05), which increased with the UA level. UA level were independent risk factors for GDM. The best threshold of GDM predicted by the first-trimester UA level was 226.55 μmol/L. The first-trimester UA level in patients with GDM was relatively higher and was an independent risk factor for GDM.

Sono-activated materials for enhancing focused ultrasound ablation: Design and application in biomedicine

The ablation effect of focused ultrasound (FUS) has played an increasingly important role in the biomedical field over the past decades, and its non-invasive features have great advantages, especially for clinical diseases where surgical treatment is not available or appropriate. Recently, rapid advances in the adjustable morphology, enzyme-mimetic activity, and biostability of sono-activated materials have significantly promoted the medical application of FUS ablation. However, a systematic review of sono-activated materials based on FUS ablation is not yet available. This progress review focuses on the recent design, fundamental principles, and applications of sono-activated materials in the FUS ablation biomedical field. First, the different ablation mechanisms and the key factors affecting ablation are carefully determined. Then, the design of sono-activated materials with high FUS ablation efficiencies is comprehensively discussed. Subsequently, the representative biological applications are summarized in detail. Finally, the primary challenges and future perspectives are also outlined. We believe this timely review will provide key information and insights for further exploration of focused ultrasound ablation and new inspiration for designing future sono-activated materials. STATEMENT OF SIGNIFICANCE: The ablation effect of focused ultrasound (FUS) has played an increasingly important role in the biomedical field over the past decades. However, there are also some challenges of FUS ablation, such as skin burns, tumour recurrence after thermal ablation, and difficulty in controlling cavitation ablation. The rapid advance in adjustable morphology, enzyme-mimetic activity, and biostability of sono-activated materials has significantly promoted the medical application of FUS ablation. However, the systematic review of sono-activated materials based on FUS ablation is not yet available. This progress review focuses on the recent design, fundamental principles, and applications in the FUS ablation biomedical field of sono-activated materials. We believe this timely review will provide key information and insights for further exploration of FUS ablation.

Appendiceal vesical fistula first presenting as giant bladder calculi: A case report and review of literature

A 34-year-old man was admitted to the hospital presenting repeatedly urinary urgency for 3 years and yellow-green lithotripsy foreign body in urine for 1 month. Initially, he was diagnosed with a giant bladder calculi. After a cystoscopy exam and a lithotripsy for bladder calculi, Appendiceal vesical fistula was finally diagnosed and treated with a laparoscopic surgery. We report a rare case of appendiceal vesical fistula，first presenting as giant bladder calculi，and successfully treated with minimal invasive surgery We report this case and reviewed literature to improve the understanding of this disease and reduce misdiagnosis and missed diagnosis.

Significance of Normalized Apparent Diffusion Coefficient in the Vesical Imaging-Reporting and Data System for Diagnosing Muscle-Invasive Bladder Cancer

BACKGROUND

Vesical Imaging-Reporting and Data System (VI-RADS) has been developed for assessing bladder cancer from multiparametric (mp) MRI but its performance in diagnosing muscle-invasive bladder cancer (MIBC) is suboptimal.

PURPOSE

To investigate associations between normalized apparent diffusion coefficient (NADC) and clinicopathological characteristics and to determine whether the inclusion of NADC can improve the performance of VI-RADS in diagnosing MIBC.

STUDY TYPE

Retrospective.

POPULATION

Two hundred seventy-five patients with pathologically confirmed bladder cancer (101 MIBC and 174 non-MIBC [NMIBC]) underwent preoperative mpMRI (233 male, 42 female).

FIELD STRENGTH/SEQUENCE

3-T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (free-breathing spin-echo), and dynamic contrast-enhanced imaging (gradient-echo).

ASSESSMENT

NADC was the mean ADC of tumor divided by that of the iliopsoas muscles in trans caput femoris plane. Associations between NADC and clinicopathological characteristics were evaluated. Models were established for differentiating MIBC and NMIBC: VI-RADS model; VN model (VI-RADS and NADC), Images model (significant variables from imaging associated with MIBC), LN model (Images model without NADC), and Full model (all significant variables associated with MIBC).

STATISTICAL TESTS

Variables for model development were based on logistic regression. Models were evaluated by receiver operating characteristic (ROC) curve. Comparison of the area under the curves (AUCs) for the models used DeLong's test. A P value <0.05 was considered statistically significant.

RESULTS

NADC was significantly lower in lesions with diameter ≥ 3 cm, MIBC, histological high grade, lymph node metastasis, and lymphovascular invasion. Compared with VI-RADS model, the AUCs for VN model (VI-RADS score and NADC), Images model (VI-RADS score, NADC and tumor size) and Full model (VI-RADS score, NADC, tumor size and histological grade) were significantly higher. No significant differences were observed between the AUCs for VN model and Images model (P = 0.051).

DATA CONCLUSION

NADC reflects information about the aggressiveness of bladder cancer. Combining VI-RADS with NADC can improve performance in diagnosing MIBC.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 2.

Effect of endogenous sodium and potassium ions in plants on the quality of alfalfa silage and bacterial community stability during fermentation

This study investigated the impact of endogenous sodium and potassium ions in plants on the quality of alfalfa silage, as well as the stability of bacterial communities during fermentation. Silage was produced from the fermented alfalfa, and the chemical composition, fermentation characteristics, and microbiome were analyzed to understand their interplay and impact on silage fermentation quality. The alfalfa was cultivated under salt stress with the following: (a) soil content of <1‰ (CK); (b) 1‰-2‰ (LP); (c) 2‰-3‰ (MP); (d) 3‰-4‰ (HP). The results revealed that the pH of silage was negatively correlated with the lactic acid content. With the increase of lactic acid (LA) content increased (26.3-51.0 g/kg DM), the pH value decreased (4.9-5.3). With the increase of salt stress, the content of Na+ in silage increased (2.2-5.4 g/kg DM). The presence of endogenous Na+ and K+ ions in plants significantly affected the quality of alfalfa silage and the dynamics of bacterial communities during fermentation. Increased salt stress led to changes in microbial composition, with Lactococcus and Pantoea showing a gradual increase in abundance, especially under high salt stress. Low pH inhibited the growth of certain bacterial genera, such as Pantoea and Pediococcus. The abundance of Escherichia-Shigella and Comamonas negatively correlated with crude protein (CP) content, while Enterococcus and Lactococcus exhibited a positive correlation. Furthermore, the accumulation of endogenous Na+ in alfalfa under salt stress suppressed bacterial proliferation, thereby reducing protein degradation during fermentation. The pH of the silage was high, and the LA content was also high. Silages from alfalfa under higher salt stress had higher Na+ content. The alpha diversity of bacterial communities in alfalfa silages showed distinct patterns. Desirable genera like Lactococcus and Lactobacillus predominated in silages produced from alfalfa under salt stress, resulting in better fermentation quality.

Correlation Between Neck Circumference and Gestational Diabetes

Purpose

The objective of this study was to explore whether neck circumference can serve as an early predictor of the risk of Gestational Diabetes (GDM).

Patients and Methods

A total of 318 singleton pregnant women who underwent routine prenatal examinations at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were selected and categorized into the GDM group and the normal glucose tolerance group (NGT) based on the results of the oral glucose tolerance test (OGTT) conducted during the second trimester. The general information and laboratory test results were compared and analyzed. Inter-group comparison was conducted using the t-test, and multivariate logistic regression analysis was employed to analyze the independent risk factors of GDM. The predictive threshold of various indicators for GDM occurrence during pregnancy was determined using the subject's work curve.

Results

The GDM group exhibited significantly higher levels of pre-pregnancy weight, pre-pregnancy BMI, neck circumference, waist circumference, hip circumference, triglycerides (TG), uric acid (UA), TG/HDL-C ratio, and waist-hip ratio compared to the NGT group. Additionally, HDL cholesterol (HDL-C) levels were significantly lower in the GDM group, and blood glucose levels at each point of the OGTT were markedly higher compared to the NGT group (P<0.05). Multivariate logistic regression analysis revealed that neck circumference (OR=1.239, P<0.001) and early pregnancy TG (OR=1.842, P<0.001) were independent risk factors for GDM. The receiver operating characteristic analysis demonstrated that the optimal critical value of neck circumference for predicting GDM was 32.6 cm, with a sensitivity of 50% and specificity of 74.3%.

Conclusion

The neck circumference during early pregnancy was found to be related to GDM, and the predictive cutoff point of 32.6 cm for neck circumference could be employed as a simple index to predict GDM in early pregnancy.

The pharmacodynamic and mechanistic foundation for the antineoplastic effects of GFH009, a potent and highly selective CDK9 inhibitor for the treatment of hematologic malignancies

To evade cell cycle controls, malignant cells rely upon rapid expression of select proteins to mitigate proapoptotic signals resulting from damage caused by both cancer treatments and unchecked over-proliferation. Cyclin-dependent kinase 9 (CDK9)-dependent signaling induces transcription of downstream oncogenes promoting tumor growth, especially in hyperproliferative 'oncogene-addicted' cancers, such as human hematological malignancies (HHMs). GFH009, a potent, highly selective CDK9 small molecule inhibitor, demonstrated antiproliferative activity in assorted HHM-derived cell lines, inducing apoptosis at IC50 values below 0.2 μM in 7/10 lines tested. GFH009 inhibited tumor growth at all doses compared to controls and induced apoptosis in a dose-dependent manner. Twice-weekly injections of GFH009 maleate at 10 mg/kg significantly prolonged the survival of MV-4-11 xenograft-bearing rodents, while their body weight remained stable. There was marked reduction of MCL-1 and c-MYC protein expression post-drug exposure both in vitro and in vivo. Through rapid 'on-off' CDK9 inhibition, GFH009 exerts a proapoptotic effect on HHM preclinical models triggered by dynamic deprivation of crucial cell survival signals. Our results mechanistically establish CDK9 as a targetable vulnerability in assorted HHMs and, along with the previously shown superior class kinome selectivity of GFH009 vs other CDK9 inhibitors, strongly support the rationale for currently ongoing clinical studies with this agent in acute myeloid leukemia and other HHMs.

Effects of irrigation and nitrogen application on soil water and nitrogen distribution and water-nitrogen utilization of wolfberry in the Yellow River Irrigation Region of Gansu Province, China

To address the problems of extensive field management, low productivity, and inefficient water and fertilizer utilization in wolfberry (Lycium barbarum L.) production, an appropriate water and nitrogen regulation model was explored to promote the healthy and sustainable development of the wolfberry industry. Based on a field experiment conducted from 2021 to 2022, this study compared and analyzed the effects of four irrigation levels [75%-85% θf (W0, full irrigation), 65%-75% θf (W1, slight water deficit), 55%-65% θf (W2, moderate water deficit), and 45%-55% θf (W3, severe water deficit)] and four nitrogen application levels [0 kg·ha-1 (N0, no nitrogen application), 150 kg·ha-1 (N1, low nitrogen application), 300 kg·ha-1 (N2, medium nitrogen application), and 450 kg·ha-1 (N3, high nitrogen application)] on soil water distribution, soil nitrate nitrogen (NO3 --N) migration, yield, and water-nitrogen use efficiency of wolfberry. The soil moisture content of the 40-80 cm soil layer was higher than those of 0-40 cm and 80-120 cm soil layer. The average soil moisture content followed the order of W0 > W1 > W2 > W3 and N3 > N2 > N1 > N0. The NO3 --N content in the 0-80 cm soil layer was more sensitive to water and nitrogen regulation, and the cumulative amount of NO3 --N in the soil followed the order of W0 > W1> W2 > W3 and N3 > N2 > N1 > N0 during the vegetative growth period. There was no evidently change in soil NO3 --N accumulation between different treatments during the autumn fruit. The yield of wolfberry under the W1N2 treatment was the highest (2623.09 kg·ha-1), which was 18.04% higher than that under the W0N3 treatment. The average water consumption during each growth period of wolfberry was the highest during the full flowering period, followed by the vegetative growth and full fruit periods, and the lowest during the autumn fruit period. The water use efficiency reached a peak value of 6.83 kg·ha-1·mm-1 under the W1N2 treatment. The nitrogen uptake of fruit and nitrogen fertilizer recovery efficiency of fruit first increased and then decreased with increasing irrigation and nitrogen application. The treatment of W1N2 obtained the highest nitrogen uptake of fruit and nitrogen recovery efficiency of fruit, which were 63.56 kg·ha-1 and 8.17%, respectively. Regression analysis showed that the yield and water-nitrogen use efficiency of wolfberry improved when the irrigation amount ranged from 315.4 to 374.3 mm, combined with nitrogen application amounts of 300.0 to 308.3 kg·ha-1. Additionally, the soil NO3 --N residue was reduced, making it an optimal water and nitrogen management model for wolfberry planting. The present findings contribute novel insights into the production of wolfberry with saving water and reducing nitrogen, which helps to improve the level of wolfberry productivity in the Yellow River irrigation region of Gansu Province and other areas with similar climate.