Prediction and clinical utility of a liver cancer risk model in Chinese adults: A prospective cohort study of 0.5 million people

China has made rapid progress in reducing the incidence of HBV infection in the past three decades, along with a rapidly changing lifestyle and aging population. We aimed to develop and validate an up-to-date liver cancer risk prediction model with routinely available predictors and evaluate its applicability for screening guidance. Using data from the China Kadoorie Biobank, we included 486 285 participants in this analysis. Fifteen risk factors were included in the model. Flexible parametric survival models were used to estimate the 10-year absolute risk of liver cancer. Decision curve analysis was performed to evaluate the net benefit of the model to quantify clinical utility. A total of 2706 participants occurred liver cancer over the 4 814 320 person-years of follow-up. Excellent discrimination of the model was observed in both development and validation datasets, with c-statistics (95% CI) of 0.80 (0.79-0.81) and 0.80 (0.78-0.82) respectively, as well as excellent calibration of observed and predicted risks. Decision curve analysis revealed that use of the model in selecting participants for screening improved benefit at a threshold of 2% 10-year risk, compared to current guideline of screening all HBsAg carriers. Our model was more sensitive than current guideline for cancer screening (28.17% vs 25.96%). We developed and validated a CKB-PLR (Prediction for Liver cancer Risk Based on the China Kadoorie Biobank Study) model to predict the absolute risk of liver cancer for both HBsAg seropositive and seronegative populations. Application of the model is beneficial for precisely identifying the high-risk groups among the general population.

[The predictive value of central venous-arterial CO2 difference/arterial-central venous O2 difference ratio for progressive organ dysfunction in patients with septic shock after resuscitation]

Objective: To study the predictive value of central venous-arterial CO₂ difference (Pv-aCO₂)/arterial-central venous O₂ difference (Ca-vO₂) ratio for progressive organ dysfunction in patients with septic shock after resuscitation. Methods: Septic shock patients receiving resuscitation in ICU were retrospectively enrolled from July 2018 to June 2019 at the First Affiliated Hospital Anhui Medical University. Hemodynamic and laboratory data were collected. Single and multivariate logistic regression model was constructed to explore the independent risk factors of progressive organ dysfunction. The predictive value of hemodynamic parameters to progression of organ dysfunction was determined using receiver operating characteristic (ROC)curve analysis. Results: A total of 99 patients were enrolled with 25 patients (25.25%) progressing to organ dysfunction. The norepinephrine dose [0.61 (0.27,1.42) μg·kg^-1·min^-1 vs. 0.91 (0.47,2.87) μg·kg^-1·min^-1], blood lactic acid [2.93 (1.77,5.88) mmol/L vs. 6.15 (2.56,8.59) mmol/L], Pv-aCO₂ [5.00 (3.98,7.85) mmHg(1 mmHg=0.133 kPa) vs. 7.00 (5.00,8.35) mmHg] and Pv-aCO₂/Ca-vO₂ [1.36(1.17,1.69) vs. 2.23 (1.83,2.78)] in patients with progressive organ dysfunction were significantly higher than those in patients without(P<0.05). Multivariate logistic regression analysis suggested that Pv-aCO₂/Ca-vO₂ (OR=20.48,95%CI 5.25-79.93,P<0.001) was independent risk factors for predicting organ dysfunction. The cutoff value of Pv-aCO₂/Ca-vO₂ was equal or more than 1.77 with a sensitivity of 80.00% and a specificity of 79.73%. Compared with those with Pv-aCO₂/Ca-vO₂<1.77, patients with Pv-aCO₂/Ca-vO₂≥1.77 had a greater probability of progressive organ dysfunction (47.37% vs. 8.20%, P<0.001). Conclusion: The progression of organ dysfunction in septic patients after resuscitation is associated with poor prognosis. Pv-aCO₂/Ca-vO₂ is a good indicator to evaluate oxygen metabolism and predict the progression of organ dysfunction.

Histological analysis of spermatogenesis and the germ cell seasonal development within the testis of domesticated tree shrews (Tupaia belangeri chinensis)

This study aimed to address the lack of information on the male germ cell seasonal development of domesticated tree shrews (Tupaia belangeri chinensis). Testicular tissues were collected from 60 tree shrews (n=5 per month). The ultrastructures of the testes and spermatids were examined via transmission electron microscopy. Apoptosis of spermatogenic cells was measured through terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. The expression of proliferation factors, namely, proliferating cell nuclear antigen (PCNA) and Ki67, in testicular tissues was assayed through immunohistochemistry. Spermatids ultrastructure showed seasonal differences, and spermatogenesis was relatively active in June and July and relatively stagnant from October to November. The percentage of TUNEL-positive germ cells was less during October and November, while greater in July than other phases. The number of PCNA-nucleus-positive germ cells was most in June and July, but with cytoplasm staining from October to November. Ki67 presented positive expression in the testes from April to September, with highest expression in June, but with no expression from October to March. In summary, there are seasonal differences in tissue morphology related to spermatogenesis in domesticated tree shrews. PCNA expression and Ki67 expression are good indicators of seasonal differences in male germ cells.

Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies

BACKGROUND

Spinal anesthesia is the standard for elective cesarean section but spinal anesthesia-induced hypotension remains an important problem. Accurate prediction of hypotension could enhance clinical decision-making, alter management, and facilitate early intervention. We performed a systematic review of predictors of spinal anesthesia-induced hypotension and their predictive value during cesarean section.

METHODS

PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases were searched for prospective observational studies assessing the diagnostic accuracy of predictors of spinal anesthesia-induced hypotension in elective cesarean section. The quality of studies was assessed and predictors were grouped in domains based on the type of predictor.

RESULTS

Thirty-eight studies (n=3086 patients) were included. In most studies, patients received 500-1000 mL crystalloid preload or 500-2000 mL crystalloid coload. Vasopressors for post-spinal hypotension were boluses of ephedrine 5-15 mg and/or phenylephrine 25-100 µg in most studies. The hypotension rate varied from 29% to 80% based on the definition. For analysis, >30 predictors were classified into seven domains: demographic characteristics, baseline hemodynamic variables, baseline sympathovagal balance, postural stress testing, peripheral perfusion indices, blood volume and fluid responsiveness indices, and genetic polymorphism.

CONCLUSIONS

Environmental and individual factors increased outcome variability, which restricted the value of the autonomic nervous system and peripheral perfusion indices for prediction of spinal anesthesia-induced hypotension. Supine stress tests may reflect parturients' cardiovascular tolerance during hemodynamic fluctuations and may optimize the predictive value of static state predictors. Future research for predicting spinal anesthesia-induced hypotension should focus on composite and dynamic parameters during the supine stress tests.

Transfacial lithotomy approach to intraparenchymal stones in the submandibular gland: our primary exploration

The article describes our exploration of a sialendoscopy-assisted transfacial sialolithotomy approach to intraparenchymal stones in the submandibular gland with gland preservation. Five patients with large intraparenchymal stones in the submandibular gland were included. Ultrasonography and computed tomograms (CT) were performed to locate the stones. As the large stones failed to be retrieved during endoscopy, patients were treated by a transfacial lithotomy approach with sialendoscopy. The glands were preserved in all cases. This approach can be considered an optional technique for the treatment of large intraparenchymal stones in the submandibular gland that fail to be removed during a transoral procedure.

Dietary pectic substances enhance gut health by its polycomponent: A review

Pectic substances, one of the cell wall polysaccharides, exist widespread in vegetables and fruits. A surge of recent research has revealed that pectic substances can inhibit gut inflammation and relieve inflammatory bowel disease symptoms. However, physiological functions of pectins are strongly structure dependent. Pectic substances are essentially heteropolysaccharides composed of homogalacturonan and rhamnogalacturonan backbones substituted by various neutral sugar sidechains. Subtle changes in the architecture of pectic substances may remarkably influence the nutritional function of gut microbiota and the host homeostasis of immune system. In this context, developing a structure-function understanding of how pectic substances have an impact on an inflammatory bowel is of primary importance for diet therapy and new drugs. Therefore, the present review has summarized the polycomponent nature of pectic substances, the activities of different pectic polymers, the effects of molecular characteristics and the underlying mechanisms of pectic substances. The immunomodulated property of pectic substances depends on not only the chemical composition but also the physical structure characteristics, such as molecular weight (M_w ) and chain conformation. The potential mechanisms by which pectic substances exert their protective effects are mainly reversing the disordered gut microbiota, regulating immune cells, enhancing barrier function, and inhibiting pathogen adhesion. The manipulation of pectic substances on gut health is sophisticated, and the link between structural specificity of pectins and selective regulation needs further exploration.

Use of speckle-tracking echocardiography to stratify risk of atrial fibrillation-related stroke: comparison of left atrial and atrial appendage mechanics

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): the National Natural Science Foundation of China

onbehalf

Sir Run Run Shaw Hospital,Zhejiang University,School of Medicine

Background

Left atrial (LA) and appendage (LAA) dysfunction were associated with increased risk of stroke in atrial fibrillation. However, usefulness of LA and LAA mechanics has not been fully compared. Methods:201 AF patients were prospectively enrolled. 42(20.8%) had previous stroke/TIA.  Speckle tracking was used to measure LA and LAA peak postive strain. LA and LAA MD was defined as the SD of time to peak positive strain corrected by the R-R interval. Results:LA MD and LAA MD were independently associated with stroke/TIA. The model based on CHA2DS2-VASc score for discrimination of stroke was significantly improved by adding LA MD or LAA MD (P &lt; 0.01). Diagnostic value of LA MD was better than LAA MD in patients with normal LA volumes, while LAA MD was more useful in patients with LA enlargement.Conclusion:Both LA and LAA mechanics had incremental value over CHA2DS2VASc score. However, priorities of strain assessment depend on patients’ LA volume.

Variables Univariate analysis Multivariate analysis Model 1 Model 2 Model 3 OR (95% CI) P value OR (95% CI) P value OR (95% CI) p value OR (95% CI) P value Clinical parameters Age 1.09(1.04-1.14) &lt;0.001 1.11(1.04-1.17) 0.001 1.11(1.05-1.17) 0.001 1.11(1.04-1.17) 0.001 BMI 0.988(0.89-1.10) 0.84 1.07(0.92-1.25) 0.40 1.07(0.91-1.25) 0.40 CHA2DS2-VASc score 1.52(1.15-2.00) 0.003 1.08(0.67-1.74) 0.76 1.08(0.65-1.80) 0.77 1.10(0.69-1.76) 0.69 Persistent AF 1.88(0.94-3.74) 0.07 0.75(0.23-2.40) 0.63 0.87(0.27-2.81) 0.82 Therapeutic anticoagulation 0.56(0.28-1.11) 0.10 0.22(0.09-0.57) 0.002 0.23(0.09-0.59) 0.002 0.22(0.09-0.57) 0.002 LA parameters LAEF 0.96(0.94-0.99) 0.002 0.982(0.953-1.01) 0.26 iLAVmin 1.03(1.01-1.05) 0.006 0.98(0.94-1.02) 0.27 LA MD 1.22(1.10-1.36) &lt;0.001 1.16(1.02-1.32) 0.02 1.18(1.03-1.34) 0.02 1.16(1.02-1.32) 0.02 LA GLS 0.935(0.893-0.98) 0.005 1.0(0.953-1.14) 0.36 1.02(0.94-1.12) 0.59 1.02(0.94-1.10) 0.72 LAA parameters LAAEV 0.12(0.02-0.74) 0.02 3.34(0.31-36.06) 0.32 LAA EF 0.98(0.96-1.00) 0.06 1.01(0.98-1.04) 0.65 LAA GLS 0.85(0.77-0.94) 0.001 0.96(0.86-1.07) 0.46 0.97(0.87-1.08) 0.59 0.96(0.87-1.06) 0.44 LAA dense SEC/thrombus 3.12(1.39-6.99) 0.006 2.02(0.75-5.45) 0.167 LAA MD 1.19(1.09-1.29) &lt;0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 Univariable and multivariable logistic regression analyses of associations between clinical and echocardiographic covariates with stroke Abstract Figure.

[Development of a hyperkalemia risk assessment model for patients with chronic kidney disease]

Objective: To investigate risk factors for hyperkalemia among chronic kidney disease (CKD) patients and establish a risk assessment model for predicting hyperkalemia events. Methods: Clinical data of CKD patients (stage 3 to 5) hospitalized between May 2017 and June 2020 from 14 hospitals were retrospectively collected and divided into training dataset and validation dataset through balanced random sampling. Multivariate logistic regression analysis was used to analyze risk factors for hyperkalemia in CKD patients and the factors were scored. Receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Meanwhile, the cut-off value with the best sensitivity and specificity were used to verify the accuracy of the model in validation dataset. Results: A total of 847 CKD patients were enrolled and further divided into training dataset (n=675) and validation dataset (n=172). There were 555 males and 292 females, with a mean age of (57.2±15.6) years. Multivariate logistic regression analysis showed that age, CKD stage, history of heart failure, history of serum potassium ≥5.0 mmol/L, diabetes, metabolic acidosis, and use of medications that increase serum potassium levels were risk factors for causing hyperkalemia in patients with CKD. Risk assessment model was established based on these risk factors. The AUC of the ROC curve was 0.809. Using 4 as the cut-off value, the sensitivity and specificity for predicting hyperkalemia events reached 87.1% and 57.0%, respectively. Conclusion: The model established in the current study can be used for predicting hyperkalemia events in clinical practices, which offers a new way to optimize serum potassium management in patients with CKD.

Testicular hypertrophy as predictor of contralateral nonpalpable testis among Chinese boys: An 18-year retrospective study

OBJECTIVE

To assess the accuracy of contralateral testis hypertrophy for predicting the fate of nonpalpable testis in Chinese boys at different ages.

METHODS

The data of patients who presented with unilateral impalpable testis and who underwent laparoscopy at the Children's Hospital of Chongqing Medical University between January 1, 2000 and January 1, 2018 were reviewed. The boys were divided into four groups: age-matched volunteers with no testicular abnormalities represented the control group (group I), boys with palpable undescended testis (group II), boys with nonpalpable testis (NPT)/viable testis (VT) (group III), and boys with NPT/non-viable testis (NVT) group (group IV). Scrotal testes were prospectively measured by ultrasonography for volume and size, and diagnostic laparoscopy was performed to determine the state of the cryptorchid testis.

RESULTS

The mean contralateral testicular volume and length in the boys with an absent testis was 0.78mL and 17mm compared with 0.67mL and 15mm in the boys with a testis present and 0.63mL and 15mm in the controls, respectively (P<0.05). The predictive accuracy, sensitivity, and specificity for an absent testis were 64.9%, 75%, and 49%, respectively, for volume and 64.2%, 56.3%, and 76.4%, respectively for length at the optimal cutoff value of 0.65mL volume and 16.55mm length. Contralateral testis volume was the most accurate in predicting monorchism in 0-2-year-olds (sensitivity: 75%, specificity: 70%, accuracy: 73.1%) and the contralateral testicular length was most accurate for 4-6-years-old (sensitivity: 68.6%; specificity: 77.8%; accuracy: 72.2%). We also included 29 patients with bilateral undescended testis (UDT) and with unilateral nonpalpable. Cutoff values for testicular volume and length were 0.6mL (sensitivity: 81.8%, specificity: 88.9%, accuracy: 86.2%) and 13.5mm (sensitivity: 63.6%, specificity: 77.8%, accuracy: 77.8%).

CONCLUSION

The present results exclusively obtained from laparoscopic exploration suggest that a testis volume of>0.65mL or a testis length of>16.55mm could predict monarchism with an accuracy of about 65%. In younger patients aged 0-2 years and 4-6 years, the overall predictive accuracy increases to about 73% but laparoscopic exploration is still required.

Highly Branched RG-I Domain Enrichment Is Indispensable for Pectin Mitigating against High-Fat Diet-Induced Obesity

Obesity is associated with gut microbiome dysbiosis. Our previous research has shown that highly branched rhamnogalacturonan type I (RG-I)-enriched pectin (WRP, 531.5 kDa, 70.44% RG-I, Rha/(Gal + Ara) = 20) and its oligosaccharide with less branched RG-I [DWRP, 12.1 kDa, 50.29% RG-I, Rha/(Gal + Ara) = 6] are potential prebiotics. The present study is conducted to uncover the impact of the content, molecular size, and branch degrees of RG-I on the inhibiting effect of high-fat diet (HFD)-induced obesity. The commercial pectin (CP, 496.2 kDa, 35.77% RG-I, Rha/(Gal + Ara) = 6), WRP, and DWRP were orally administered to HFD-fed C57BL/6J mice (100 mg kg^-1 d^-1) to determine their individual effects on obesity. WRP significantly prevented bodyweight gain, insulin resistance, and inflammatory responses in HFD-fed mice. No obvious anti-obesity effect was observed in either CP or DWRP supplementation. A mechanistic study revealed that CP and DWRP could not enhance the diversity of gut microbiota, while WRP treatment positively modulated the gut microbiota of obese mice by increasing the abundance of Butyrivibrio, Roseburia, Barnesiella, Flavonifractor, Acetivibrio, and Clostridium cluster IV. Furthermore, WRP significantly promoted browning of white adipose tissues in HFD-fed mice, while CP and DWRP did not. WRP can attenuate the HFD-induced obesity by modulation of gut microbiota and lipid metabolism. Highly branched RG-I domain enrichment is essential for pectin mitigating against the HFD-induced obesity.

Small RNA sequencing reveals miRNAs important for hypoxic adaptation in the Tibetan chicken

1. The Tibetan chicken, which is an indigenous breed living on the Tibetan Plateau, exhibits hypoxic adaptations to its high-altitude environment. However, the molecular mechanism behind this hypoxic adaptation is still unclear. This study aimed to investigate differentially expressed miRNAs involved in hypoxic adaptation through high-throughput RNA sequencing. 2. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the differentially expressed miRNAs and their target genes in chicken embryonic heart tissues and fibroblasts. Luciferase reporter assays were performed to confirm the relationship between miRNAs and target genes. 3. The study identified 37 differentially expressed miRNAs in Tibetan chicken embryonic heart tissues, including 20 up- and 17 down-regulated miRNAs, compared to those found in lowland chickens. Differentially expressed miRNAs were mainly involved in biological processes, such as cell cycle arrest, toll-like receptor signalling pathways, and I-kappa B kinase/NF-kappa B signalling. The data showed that gga-miR-34 c-5p was significantly upregulated in Tibetan chicken tissues and hypoxic fibroblasts, while EHHADH, a target gene of gga-miR-34 c-5p, was downregulated. Moreover, gga-miR-34 c-5p dramatically decreased the luciferase activity of the wild EHHADH, whereas no effect on the mutational EHHADH was found. 4. This study identified miRNA expression profiles in the Tibetan chicken and suggested that miR-34 c-5p acts as a novel miRNA associated with hypoxic adaptation. This facilitates the understanding of molecular mechanisms that underlie long-term exposure to hypoxia.

Hepatitis B virus infection and the risk of cancer among the Chinese population

The relationship between hepatitis B virus (HBV) and nonhepatocellular cancers remains inconclusive. This large case-control study aimed to assess the associations between HBV infection status and multiple cancers. Cases (n = 50 392) and controls (n = 11 361) were consecutively recruited from 2008 to 2016 at the First Affiliated Hospital of Nanjing Medical University. Multivariable adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression by adjusting age and gender. A meta-analysis based on published studies was also performed to verify the associations. Of these, 12.1% of cases and 5.5% of controls were hepatitis B surface antigen (HBsAg) seropositive. We observed significant associations between HBsAg seropositivity and esophagus cancer (aOR [95% CI] = 1.32 [1.13-1.54]), stomach cancer (1.46 [1.30-1.65]), hepatocellular carcinoma (HCC; 39.11 [35.08-43.59]), intrahepatic and extrahepatic bile duct carcinoma (ICC and ECC; 3.83 [2.58-5.67] and 1.72 [1.28-2.31]), pancreatic cancer (PaC; 1.37 [1.13-1.65]), non-Hodgkin lymphoma (NHL; 1.88 [1.61-2.20]) and leukemia (11.48 [4.05-32.56]). Additionally, compared to participants with HBsAg-/anti-HBs-/anti-HBc-, participants with HBsAg-/anti-HBs-/anti-HBc+, indicating past HBV-infected, had an increased risk of esophagus cancer (aOR [95% CI] = 1.46 [1.24-1.73]), stomach cancer (1.20 [1.04-1.39]), HCC (4.80 [3.95-5.84]) and leukemia (15.62 [2.05-119.17]). Then the overall meta-analysis also verified that HBsAg seropositivity was significantly associated with stomach cancer (OR [95% CI] = 1.23 [1.14-1.33]), ICC (4.05 [2.78-5.90]), ECC (1.73 [1.30-2.30]), PaC (1.26 [1.09-1.46]), NHL (1.95 [1.55-2.44]) and leukemia (1.54 [1.26-1.88]). In conclusion, both our case-control study and meta-analysis confirmed the significant association of HBsAg seropositivity with stomach cancer, ICC, ECC, PaC, NHL and leukemia. Of note, our findings also suggested that the risk of stomach cancer elevated for people whoever exposed to HBV.