Opportunities and challenges in perovskite-organic thin-film tandem solar cells

Efficiency is paramount in enhancing the performance and cost-effectiveness of solar cells. Recent advancements in single-junction perovskite solar cells (PSCs) have yielded an impressive efficiency of 26.1%, nearing their theoretical limit. Meanwhile, multi-junction tandem solar cells exhibit a remarkable efficiency potential exceeding 42%, surpassing the 33% limit of single-junction cells, thereby opening avenues for ultra-high-efficiency solar cells. Tandem solar cells (TSCs) represent a groundbreaking photovoltaic technology, offering high efficiency, low cost, and a simple fabrication process. Among various TSCs, perovskite-organic TSCs (PO TSCs) are particularly promising due to their ability to leverage the complementary strengths of PSCs and organic solar cells (OSCs). PO TSCs are poised to outperform existing TSCs in terms of device performance, manufacturing cost, and diverse applications. The introduction of Y6-series non-fullerene acceptors (NFAs) over the past three years has significantly advanced the development of OSCs, leading to remarkable progress in PO TSCs. This paper commences by elucidating the advantages and potential of OSCs as bottom sub-cells in PO TSCs, followed by an in-depth review of mainstream interconnection layer (ICL) design. It then addresses key challenges in wide bandgap PSCs, including phase segregation, photovoltage loss, energy loss, and long-term stability. The paper concludes by examining critical factors influencing the future development of PO TSCs.

Heat-resistant super-dispersed oxide strengthened aluminium alloys

Oxided-dispersion-strengthened (ODS) alloys are promising high-strength materials used in extreme environments such as high-temperature and radiation tolerance applications. Until now, ODS alloys have been developed for reducible metals by chemical processing methods, but there are no commercially available ODS alloys for unreducible metals, namely, Al, Mg, Ti, Zr and so on, owing to the challenge of uniformly dispersing oxide particles in these alloys by traditional techniques. Here we present a strategy to achieve ODS Al alloys containing highly dispersive 5 nm MgO nanoparticles by powder metallurgy, using nanoparticles that have in situ-grown graphene-like coatings and hence largely reduced surface energy. Notably, the densely dispersed MgO nanoparticles, which have a fully coherent relationship with an Al matrix, show effective suppression of interfacial vacancy diffusion, thus leading to unprecedented strength (~200 MPa) and creep resistance at temperatures as high as 500 °C. Our processing approach should enable the dispersion of ultrafine nanoparticles in a wide range of alloys for high-temperature-related applications.

High-Pressure-Field Induced Synthesis of Ultrafine-Sized High-Entropy Compounds with Excellent Sodium-Ion Storage

Emerging high entropy compounds (HECs) have attracted huge attention in electrochemical energy-related applications. The features of ultrafine size and carbon incorporation show great potential to boost the ion-storage kinetics of HECs. However, they are rarely reported because high-temperature calcination tends to result in larger crystallites, phase separation, and carbon reduction. Herein, using the NaCl self-assembly template method, by introducing a high-pressure field in the calcination process, the atom diffusion and phase separation are inhibited for the general formation of HECs, and the HEC aggregation is inhibited for obtaining ultrafine size. The general preparation of ultrafine-sized (< 10 nm) HECs (nitrides, oxides, sulfides, and phosphates) anchored on porous carbon composites is realized. They are demonstrated by combining advanced characterization technologies with theoretical computations. Ultrafine-sized high entropy sulfides-MnFeCoCuSnMo/porous carbon (HES-MnFeCoCuSnMo/PC) as representative anodes exhibit excellent sodium-ion storage kinetics and capacities (a high rating capacity of 278 mAh g-1 at 10 A g-1 for full cell and a high cycling capacity of 281 mAh g-1 at 20 A g-1 after 6000 cycles for half cell) due to the combining advantages of high entropy effect, ultrafine size, and PC incorporation. Our work provides a new opportunity for designing and fabricating ultrafine-sized HECs.

Regulating Metal Centers of MOF-74 Promotes PEO-Based Electrolytes for All-Solid-State Lithium-Metal Batteries

Poly(ethylene oxide) (PEO)-based electrolytes have been extensively studied for all-solid-state lithium-metal batteries due to their excellent film-forming capabilities and low cost. However, the limited ionic conductivity and poor mechanical strength of the PEO-based electrolytes cannot prevent the growth of undesirable lithium dendrites, leading to the failure of batteries. Metal-organic frameworks (MOFs) are functional materials with a periodic porous structure that can improve the electrochemical performance of PEO-based electrolytes. However, the enhancement effect of MOFs with different metal centers and the interaction mechanism with PEO remain unclear. Herein, MOF-74s with Cu or Ni centers are prepared and used as fillers of PEO-based electrolytes. Adding 15 wt % of Cu-MOF-74 to the PEO-based electrolyte (15%Cu-MOF/P-Li) effectively improves the ionic conductivity, lithium transference number, and mechanical strength of the PEO-based electrolyte simultaneously. Furthermore, the ordered pore channels of Cu-MOF-74 provide uniform Li-ion transport pathways, facilitating homogeneous Li+ deposition. As a result, the lithium symmetric cell with 15%Cu-MOF/P-Li shows stable cycles for 1080 h at 0.1 mA cm-2 and 0.1 mAh cm-2, and the Li | 15% Cu-MOF/P-Li | LFP full cell exhibits a long cycle life up to 200 cycles at 60 °C and 0.5 C, with a capacity retention rate of 89.7%.

The Synthesis of Three-Dimensional Hexagonal Boron Nitride as the Reinforcing Phase of Polymer-Based Electrolyte for All-Solid-State Li Metal Batteries

Powdery hexagonal boron nitride (h-BN), as an important material for electrochemical energy storage, has been typically synthesized in bulk and one/two-dimensional (1/2D) nanostructured morphologies. However, until now, no method has been developed to synthesize powdery three-dimensional (3D) h-BN. This work introduces a novel NaCl-glucose-assisted strategy to synthesize micron-sized 3D h-BN with a honeycomb-like structure and its proposed formation mechanism. We propose that NaCl acts as the template of 3D structure and promotes the nitridation reaction by adsorbing NH3 . Glucose facilitates the homogeneous coating of boric acid onto the NaCl surface via functionalizing the NaCl surface. During the nitridation reaction, boron oxides (BO4 and BO3 ) form from a dehydration reaction of boric acid, which is then reduced to O2 -B-N and O-B-N2 intermediates before finally being reduced to BN3 by NH3 . When incorporated into polyethylene oxide-based electrolytes for Li metal batteries, 5 wt % of 3D h-BN significantly enhances ionic conductivity and mechanical strength. Consequently, this composite electrolyte demonstrates superior electrochemical stability. It delivers 300 h of stable cycles in the Li//Li cell at 0.1 mA cm-2 and retains 89 % of discharge capacity (138.9 mAh g-1 ) after 100 cycles at 1 C in the LFP//Li full cell.

Notch signaling regulates Th17 cells differentiation through PI3K/AKT/mTORC1 pathway and involves in the thyroid injury of autoimmune thyroiditis

PURPOSE

Autoimmune Thyroiditis (AIT) is the most common thyroid disease; however, there were no measures to prevent the progression of the disease. The present study attempts to identify that Notch signaling regulates the differentiation of T helper 17 (Th17) cells by activating downstream Phosphatidylinositol-3 kinase/protein kinase/mechanistic target of rapamycin complex 1 (PI3K/AKT/mTORC1) pathway participating in the thyroid injury of the experimental autoimmune thyroiditis (EAT).

METHODS

In vivo experiments, mice were randomly divided into 4 groups: a control group, an EAT group, and two groups with LY294002 treatment (pTg plus 25 mg/kg or 50 mg/kg LY294002, respectively). The degrees of thyroiditis were evaluated, and the percentage of Th17 cells, expression of interleukin-17A (IL-17A), and the main components of the Notch-PI3K signaling pathway were detected in different groups. In vitro experiments, two different dosages of LY294002 (25 and 50 μM) were used to intervene splenic mononuclear cells (SMCs) from EAT mice to further evaluate the regulatory effect of Notch-PI3K pathway on Th17 cells.

RESULTS

Our data demonstrate that the infiltration of Th17 cells and the expressions of IL-17A, Notch, hairy and split 1 (Hes1), p‑AKT (Ser473), p‑AKT (Thr308), p‑mTOR (Ser2448), S6K1, and S6K2 increased remarkably in EAT mice. After PI3K pathway was blocked, the degrees of thyroiditis were significantly alleviated, and the proportion of Th17 cells, the expression of IL-17A, and the above Notch-PI3K pathway-related molecules decreased in a dose-dependent manner. Additionally, the proportion of Th17 cells was positively correlated with the concentration of serum thyroglobulin antibody (TgAb), IL-17A, and Notch-PI3K pathway-related molecules mRNA levels.

CONCLUSIONS

Notch signal promotes the secretion of IL-17A from Th17 cells by regulating the downstream PI3K/AKT/mTORC1 pathway through Hes-Phosphatase and tensin homolog (PTEN) and participates in thyroid autoimmune damage, and the PI3K pathway inhibitor may play important effects on AIT by affecting Th17 cells differentiation.

Active Suppression of Quantum Dephasing in Resonantly Driven Ensembles

We have used quantum control to suppress the impact of random atom positions on coherent population transfer within atom pairs, enabling the observation of dipole-dipole driven Rabi oscillations in a Rydberg gas with hundreds of atoms. The method exploits the reduced coupling-strength sensitivity of the off-resonant Rabi frequency, and coherently amplifies the achievable population transfer in analogy to quasi-phase-matching in nonlinear optics. Simulations reproduce the experimental results and demonstrate the potential benefits of the technique to other many-body quantum control applications.

Room-Temperature Salt Template Synthesis of Nitrogen-Doped 3D Porous Carbon for Fast Metal-Ion Storage

The water-soluble salt-template technique holds great promise for fabricating 3D porous materials. However, an equipment-free and pore-size controllable synthetic approach employing salt-template precursors at room temperature has remained unexplored. Herein, we introduce a green room-temperature antisolvent precipitation strategy for creating salt-template self-assembly precursors to universally produce 3D porous materials with controllable pore size. Through a combination of theoretical simulations and advanced characterization techniques, we unveil the antisolvent precipitation mechanism and provide guidelines for selecting raw materials and controlling the size of precipitated salt. Following the calcination and washing steps, we achieve large-scale and universal production of 3D porous materials and the recycling of the salt templates and antisolvents. The optimized nitrogen-doped 3D porous carbon (N-3DPC) materials demonstrate distinctive structural benefits, facilitating a high capacity for potassium-ion storage along with exceptional reversibility. This is further supported by in situ electrochemical impedance spectra, in situ Raman spectroscopy, and theoretical calculations. The anode shows a high rate capacity of 181 mAh g-1 at 4 A g-1 in the full cell. This study addresses the knowledge gap concerning the room-temperature synthesis of salt-template self-assembly precursors for the large-scale production of porous materials, thereby expanding their potential applications for electrochemical energy conversion and storage.

The diagnostic efficiency of diffusion-weighted imaging in placenta accreta spectrum: a systematic review and meta-analysis

OBJECTIVE

This study aims to evaluate the diagnostic efficiency of diffusion-weighted imaging (DWI) in patients with placenta accreta spectrum (PAS).

MATERIALS AND METHODS

The present study searched on PubMed, Embase, OVID, Cochrane, Scopus and CNKI, Chinese Bio-Medical Literature, VIP, Wanfang, Duxiu, databases for studies related to the diagnostic performance of DWI for PAS from inception to December 2022. The pooled sensitivity, the pooled specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnosis odds ratios (DOR) were calculated by Meta-disc 1.4 and STATA 16.0.

RESULTS

A total of 11 studies met the criteria and were included in the meta-analysis. The effect indexes of DWI in combined PAS were as follows. The pooled sensitivity was 0.670 (0.619-0.719). The pooled specificity was 0.720 (0.661-0.773). The pooled LR+ was 2.161 (1.454-3.211). The pooled LR- was 0.413 (0.280-0.609). The pooled AUC was 0.7841, and Q* was 0.7221. The pooled diagnostic ratio DOR was 6.713 (2.981-15.118). Subgroup analysis showed that four studies used T2-weighted imaging (T2WI) + DWI to diagnose PAS, and the pooled AUC was 0.9822.

CONCLUSIONS

The results showed that DWI had high sensitivity and specificity in the diagnosis of PAS. Furthermore, T2WI+DWI has higher diagnostic efficacy than DWI alone in the diagnosis of PAS. Therefore, it is necessary to set T2WI+DWI as a routine sequence for PAS, and T2WI+DWI should be a routine method for the daily diagnosis of PAS.

Huangqin Tea Total Flavonoids-Gut Microbiota Interactions: Based on Metabolome and Microbiome Analysis

Huangqin tea (HQT), a Non-Camellia Tea derived from the aerial parts of Scutellaria baicalensis, is widely used in the north of China. The intervention effects of HQT on intestinal inflammation and tumors have been found recently, but the active ingredient and mechanism of action remain unclear. This study aimed to investigate the interactions between the potential flavonoid active components and gut microbiota through culture experiments in vitro combined with HPLC-UV, UPLC-QTOF-MS, and 16S rDNA sequencing technology. The results showed that the HQT total flavonoids were mainly composed of isocarthamidin-7-O-β-D-glucuronide, carthamidin-7-O-β-D-glucuronide, scutellarin, and others, which interact closely with gut microbiota. After 48 h, the primary flavonoid glycosides transformed into corresponding aglycones with varying degrees of deglycosylation. The composition of the intestinal microbiota was changed significantly. The beneficial bacteria, such as Enterococcus and Parabacteroides, were promoted, while the harmful bacteria, such as Shigella, were inhibited. The functional prediction results have indicated notable regulatory effects exerted by total flavonoids and scutellarin on various pathways, including purine metabolism and aminoacyl-tRNA biosynthesis, among others, to play a role in the intervention of inflammation and tumor-related diseases. These findings provided valuable insights for further in-depth research and investigation of the active ingredients, metabolic processes, and mechanisms of HQT.

[Efficacy observation and compliance analysis of pollen allergen drops in seasonal allergic rhinitis]

To study the efficacy and compliance analysis of pollen allergen drops in the treatment of allergic rhinitis. The method of single-center controlled was used to analyze the dates' results. From July 2021 to September 2021, 80 patients with seasonal allergic rhinitis were referred to the clinic of otorhinolaryngology in First Hospital of Shanxi Medical University.40 patients received sublingual immunotherapy (SLIT group), and the other 40 patients received symptomatic drug treatment as the control group. The total rhinoconjunctivitis symptom score (TRSS), the visual analogue scale(VAS), total medication score (TMS) and combined scores of medication and rhinoconjunctivitis symptoms (CSMRS) of the patient before the start of the treatment and after the first year of the treatment were compared to assess the efficacy of sublingual immunotherapy of Artemisia pollen. Follow the shedding during the study, the safety of the drug and the causes for compliance analysis were analyzed and recorded. The results of comparison with TRSS, VAS, TMS and CSMRS in two groups in the period of pretherapy were as follows: TRSS(12.393±3.023, 12.450±3.029, t=-0.077, P=0.939), VAS(8.357±1.026, 8.400±0.982, t=-0.173, P=0.862), TMS(3.214±0.568, 3.175±0.501, t=0.301, P=0.764), CSMRS (5.286±0.680, 5.253±0.677, t=0.199, P=0.843), there was no significant difference (P>0.05); lower observed symptom scores were got in the post-treatment pollen peak SLIT group compared to the control group, TRSS(3.964±1.551, 7.750±2.169, t=-7.918, P<0.05), VAS(2.893±0.956, 5.175±1.481, t=-8.286, P<0.05), TMS (1.821±0.863, 3.175±0.501, t=-8.163, P<0.05), CSMRS (2.489±0.921, 4.468±0.601, t=-10.723, P<0.05), and the differences between the groups were statistically significant (P<0.05); the SLIT group significantly reduced all symptom scores at the first peak compared to the starting, TRSS(12.393±3.023, 3.964±1.551, t=20.576, P<0.05), VAS (8.357±1.026, 2.893±0.956, t=30.070, P<0.05), TMS (3.214±0.568, 1.821±0.863, t=7.151, P<0.05), CSMRS(5.286±0.680, 2.489±0.921, t=14.533, P<0.05) and there was statistical difference (P<0.05). No significant adverse reactions occured during medication in the SLIT group. A total of 12 cases were shed in the SLIT group, so the compliance rate was 70%. The four reasons were that patients considered the course was long (4 cases, 33%); the drugs were expensive (3 cases, 25%); patients were busy with their work and life (3 cases, 25%); patients were affected by the outbreak (2 cases, 17%). In summary, Artemisia pollen sublingual drops may improve the symptoms of the patients who got allergic rhinitis caused by Artemisia pollen after the treatment for one year. However, due to the lack of sufficient understanding of immunotherapy or the difficulty in adhering to standardized medication, the compliance with sublingual immunotherapy is still poor, the compliance with sublingual immunotherapy needs to be further improved through patient education.

A Universal Cross-Synthetic Strategy for Sub-10 nm Metal-Based Composites with Excellent Ion Storage Kinetics

The sub-10 nm metal-based nanomaterials (SMNs) show great potential for the electrochemical energy storage field. However, their ion storage capacity and stability suffer from severe agglomeration and interface problems. Herein, a universal strategy is reported to synthesize a wide range of SMNs (e.g., metal, nitride, oxide, and sulfides) embedded in free-standing carbon foam (SMN/FC-F) composite electrodes by crossing the interfacial confinement of NaCl self-assembly with the thermal-mechanical coupling of powder metallurgy. The pressure-enhanced NaCl self-assembly interfacial confinement is greatly beneficial to preventing SMN agglomeration and promoting SMNs embedded in FC-F which originate from the welding of carbon nanosheets. They are confirmed via a series of advanced characterizations including X-ray photoelectron spectroscopy, and spherical aberration-corrected scanning transmission electron microscopy, with theoretical computations. Benefiting from the unique structure, SMNs/FC-F delivers ultrafast and stable ion-storage kinetics. As a proof-of-concept demonstration, the MoS2 /FC-F shows excellent ion storage kinetics and superior long-term cycling performance for ion storage (e.g., Na3 V2 (PO4 )2 O2 F/C//MoS2 /FC-F sodium-ion batteries exhibit a high reversible capacity of 185 mAh g-1 at 0.5 A g-1 with a decay rate of 0.05% per cycle.). This work provides a new opportunity to design and fabricate promising SMN-based free-standing working electrodes for electrochemical energy storage and conversion applications.

A multisite dynamic synergistic oxygen evolution reaction mechanism of Fe-doped NiOOH: a first-principles study

Changing the composition is an important way to regulate the electrocatalytic performance of the oxygen evolution reaction (OER) for metallic compounds. Clarifying the synergistic mechanism among different compositions is a key scientific problem to be solved urgently. Here, based on first-principles calculations, a Ni-O-Fe multisite dynamic synergistic reaction mechanism (MDSM) for the OER of Fe-doped NiOOH (NiFeOOH) has been discovered. Based on the MDSM, Fe/O/Ni are triggered as the active sites in turn, resulting in an overpotential of 0.33 V. The factors affecting the deprotonation, O-O coupling, and O2 desorption during the OER process are analyzed. The electron channels related to the magnetic states among Fe-O-Ni is revealed, which results in the decoupling between OER sites and the oxidation reaction sites. O-O coupling and O2 desorption are affected by ferromagnetic coupling and the instability of the lattice O during the OER process, respectively. The results give a comprehensive understanding of the active sites in NiFeOOH and provide a new perspective on the synergistic effects among different compositions in metal compounds during the OER process.

Single-cell RNA sequencing-guided fate-mapping toolkit delineates the contribution of yolk sac erythro-myeloid progenitors

Erythro-myeloid progenitors of the yolk sac that originates during early embryo development has been suggested to generate tissue-resident macrophage, mast cell, and even endothelial cell populations from fetal to adult stages. However, the heterogeneity of erythro-myeloid progenitors (EMPs) is not well characterized. Here, we adapt single-cell RNA sequencing to dissect the heterogeneity of EMPs and establish several fate-mapping tools for each EMP subset to trace the contributions of different EMP subsets. We identify two primitive and one definitive EMP subsets from the yolk sac. In addition, we find that primitive EMPs are decoupled from definitive EMPs. Furthermore, we confirm that primitive and definitive EMPs give rise to microglia and other tissue-resident macrophages, respectively. In contrast, only Kit+ Csf1r- primitive EMPs generate endothelial cells transiently during early embryo development. Overall, our results delineate the contribution of yolk sac EMPs more clearly based on the single-cell RNA sequencing (scRNA-seq)-guided fate-mapping toolkit.

Interfacial engineering of transition metal dichalcogenide/carbon heterostructures for electrochemical energy applications

To support the global goal of carbon neutrality, numerous efforts have been devoted to the advancement of electrochemical energy conversion (EEC) and electrochemical energy storage (EES) technologies. For these technologies, transition metal dichalcogenide/carbon (TMDC/C) heterostructures have emerged as promising candidates for both electrode materials and electrocatalysts over the past decade, due to their complementary advantages. It is worth noting that interfacial properties play a crucial role in establishing the overall electrochemical characteristics of TMDC/C heterostructures. However, despite the significant scientific contribution in this area, a systematic understanding of TMDC/C heterostructures' interfacial engineering is currently lacking. This literature review aims to focus on three types of interfacial engineering, namely interfacial orientation engineering, interfacial stacking engineering, and interfacial doping engineering, of TMDC/C heterostructures for their potential applications in EES and EEC devices. To accomplish this goal, a combination of experimental and theoretical approaches was used to allow the analysis and summary of the fundamental electrochemical properties and preparation strategies of TMDC/C heterostructures. Moreover, this review highlights the design and utilization of the interfacial engineering of TMDC/C heterostructures for specific EES and EEC devices. Finally, the challenges and opportunities of using interfacial engineering of TMDC/C heterostructures in practical EES and EEC devices are outlined. We expect that this review will effectively guide readers in their understanding, design, and application of interfacial engineering of TMDC/C heterostructures.

[Clinical characteristics and analysis of risk factors for heart injuries in 55 patients with lightning injury on plateau in Tibet Autonomous Region]

Objective: To explore the clinical characteristics and treatment outcomes of patients with lightning injury on plateau in Tibet Autonomous Region, and to analyze the risk factors for heart injuries in these patients. Methods: A retrospective case series study was conducted. From January 2008 to July 2023, 55 patients with lightning injury who met the inclusion criteria were admitted to the General Hospital of PLA Tibet Military Area Command. The gender, age, ethnicity, time of injury, location of injury (average altitude), activity at the time of injury, the occurrence of thermal burns on the body surface, the occurrence of complication, the occurrence of combined injury, underlying disease or physiological process before injury, length of hospital stay, treatment outcome, and effective rate of treatment were recorded. The patients were divided into juvenile group (11 cases), young group (28 cases), middle-aged group (14 cases), and elderly group (2 cases) according to age bracket, then the gender and ethnicity distribution of patients in the 4 groups were compared. According to the occurrence of heart injuries at admission, the patients were divided into heart injury group (44 cases) and non-heart injury group (11 cases), then the gender, age, ethnicity, average altitude of location of injury, length of hospital stay, the occurrence of complication, the occurrence of combined injury, site of thermal burns on the body surface, and area of thermal burns on the body surface in patients were compared between the two groups. Data were statistically analyzed with Mann-Whitney U test, chi-square test, or Fisher's exact probability test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for heart injury in patients with lightning injury. Results: Among the 55 patients aged 10-68 years, 39 were male and 16 were female, including 47 Tibetans and 8 Hans. There were no statistically significant differences in gender or ethnicity distribution of patients among the 4 groups with different age brackets (P>0.05). Lightning injuries occurred from May to September, which mostly occurred in June and July. The incidence of lightning injury was higher in Chengguan District of Lhasa City (average altitude of 3 650 m) and Baqing County of Naqu City (average altitude of 4 500 m), being 20.0% (11/55) and 16.4% (9/55), respectively. A total of 96.4% (53/55) of the patients were engaged in outdoor activities when injured, such as grazing, digging Cordyceps, and harvesting highland barley. Among the 55 patients, 46 (83.6%) cases had thermal burns on the body surface, with burn area mainly being not more than 10% total body surface area and burn depth mainly being deep partial-thickness. Fifty-two (94.5%) patients had complications, with heart injury being the most common complication (44 cases, 80.0%). Twenty-two (40.0%) patients had 11 combined injuries, and traumatic brain injury was the most common combined injury. Seventeen (30.9%) patients had 11 underlying diseases or physiological processes before injury. The length of hospital stay of patients was 9 (5, 17) d. Among the 55 patients, 14 cases were cured and discharged, 40 cases were improved, and 1 case died, with effective rate of treatment of 98.2%. Compared with those in non-heart injury group, the proportion of complication occurrence (χ2=12.28), the proportion of trunk burns (χ2=5.15), and the average altitude of location of injury (Z=-2.38) of patients in heart injury group were increased significantly (P<0.05), while there were no significant changes in the other indicators (P>0.05). Multivariate logistic regression analysis showed that the average altitude at the location of injury was the independent risk factor for heart injury in patients with lightning injury (with odds ratio of 3.28, 95% confidence interval of 1.35-7.99, P<0.05). Conclusions: Lightning injuries on plateau in Tibet Autonomous Region mainly occur from May to September, with an average altitude of 4 500 m at the location of injury. Patients with lightning injury are injured when participating outdoor activities, and the affected patients are mainly mainly young male Tibetans. Most of the injuries are mild burns. Lightning injuries are complex and have many complications, with heart injury being the most common one. The average altitude at the location of injury is the independent risk factor for heart injury in patients with lightning injury.

Comprehensive comparison of different parts of Paeonia ostii, a food-medicine plant, based on untargeted metabolomics, quantitative analysis, and bioactivity analysis

Introduction

Paeonia ostii T. Hong & J.X. Zhang (s.s.) (Chinese name, Fengdan) is a widely cultivated food-medicine plant in China, in which root bark, seed kernels, and flowers are utilized for their medicinal and edible values. However, other parts of the plant are not used efficiently, in part due to a poor understanding of their chemical composition and potential biological activity.

Methods

Untargeted ultra-performance liquid chromatography-quadrupole time of flight-mass spectrometry (UPLC-Q-TOF-MS) metabolomics was applied to characterize the metabolic profiles of 10 different parts of P. ostii.

Results and discussion

A total of 160 metabolites were alternatively identified definitely or tentatively, which were significantly different in various plant parts by multivariate statistical analysis. Quantitative analysis showed that underutilized plant parts also contain many active ingredients. Compared with the medicinal part of root bark, the root core part still contains a higher content of paeoniflorin (17.60 ± 0.06 mg/g) and PGG (15.50 ± 2.00 mg/g). Petals, as an edible part, contain high levels of quercitrin, and stamens have higher methyl gallate and PGG. Unexpectedly, the ovary has the highest content of methyl gallate and rather high levels of PGG (38.14 ± 1.27 mg/g), and it also contains surprisingly high concentrations of floralalbiflorin I. Paeoniflorin (38.68 ± 0.76 mg/g) is the most abundant in leaves, and the content is even higher than in the root bark. Branches are also rich in a variety of catechin derivatives and active ingredients such as hydrolyzable tannins. Seed kernels also contain fairly high levels of paeoniflorin and albiflorin. Fruit shells still contain a variety of components, although not at high levels. Seed coats, as by-products removed from peony seeds before oil extraction, have high contents of stilbenes, such as trans-gnetin H and suffruticosol B, showing significant potential for exploitation. Except for the seed kernels, extracts obtained from other parts exhibited good antioxidant activity in DPPH, ABTS, and ferric ion reducing antioxidant power (FRAP) assays (0.09-1.52 mmol TE/g). Five compounds (gallic acid, PGG, trans-resveratrol, kaempferol, and quercitrin) were important ingredients that contributed to their antioxidant activities. Furthermore, P. ostii seed cakes were first reported to possess agonistic activity toward CB1/CB2 receptors. This study provides a scientific basis for the further development and utilization of P. ostii plant resources.

[Diagnostic value of nasal nitric oxide for children with primary ciliary dyskinesia]

Objective: To evaluate the value of nasal nitric oxide (nNO) measurement as a diagnostic tool for Chinese patients with primary ciliary dyskinesia (PCD). Methods: This study is a retrospective study. The patients were recruited from those who were admitted to the respiratory Department of Respiratory Medicine, Children's Hospital of Fudan University from March 2018 to September 2022. Children with PCD were included as the PCD group, and children with situs inversus or ambiguus, cystic fibrosis (CF), bronchiectasis, chronic suppurative lung disease and asthma were included as the PCD symptom-similar group. Children who visited the Department of Child health Care and urology in the same hospital from December 2022 to January 2023 were selected as nNO normal control group. nNO was measured during plateau exhalation against resistance in three groups. Mann-Whitney U test was used to analyze the nNO data. The receiver operating characteristic of nNO value for the diagnosis of PCD was plotted and, the area under the curve and Youden index was calculated to find the best cut-off value. Results: nNO was measured in 40 patients with PCD group, 75 PCD symptom-similar group (including 23 cases of situs inversus or ambiguus, 8 cases of CF, 26 cases of bronchiectasis or chronic suppurative lung disease, 18 cases of asthma), and 55 nNO normal controls group. The age of the three groups was respectively 9.7 (6.7,13.4), 9.3 (7.0,13.0) and 9.9 (7.3,13.0) years old. nNO values were significantly lower in children with PCD than in PCD symptom-similar group and nNO normal controls (12 (9,19) vs. 182 (121,222), 209 (165,261) nl/min, U=143.00, 2.00, both P<0.001). In the PCD symptom-similar group, situs inversus or ambiguus, CF, bronchiectasis or chronic suppurative lung disease and asthma were significantly higher than children with PCD (185 (123,218), 97 (52, 132), 154 (31, 202), 266 (202,414) vs. 12 (9,19) nl/min,U=1.00, 9.00, 133.00, 0, all P<0.001). A cut-off value of 84 nl/min could provide the best sensitivity (0.98) and specificity (0.92) with an area under the curve of 0.97 (95%CI 0.95-1.00, P<0.001). Conclusions: nNO value can draw a distinction between patients with PCD and others. A cut-off value of 84 nl/min is recommended for children with PCD.

En-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer: A meta-analysis

INTRODUCTION

We performed a meta-analysis to evaluate the effect of en-bloc transurethral resection vs. conventional transurethral resection for primary non-muscle invasive bladder cancer.

METHODS

A systematic literature search up to January 2022 was done and 28 studies included 3714 primary non-muscle invasive bladder cancer subjects at the start of the study; 1870 of them were en-bloc transurethral resection, and 1844 were conventional transurethral resection for primary non-muscle invasive bladder cancer. We calculated the odds-ratio (OR) and mean-difference (MD) with 95% confidence-intervals (CIs) to evaluate the effect of en-bloc transurethral resection compared with conventional transurethral resection for primary non-muscle invasive bladder cancer by the dichotomous or continuous methods with random or fixed-effects models.

RESULTS

En-bloc transurethral resection had significantly lower twenty-four-month recurrence (OR: 0.63; 95%CI: 0.50-0.78; p < 0.001), catheterization-time (MD: -0.66; 95%CI: -1.02-[-0.29]; p < 0.001), length of hospital stay (MD: -0.95; 95%CI: -1.55-[-0.34]; p = 0.002), postoperative bladder irrigation duration (MD: -6.06; 95%CI: -9.45-[-2.67]; p < 0.001), obturator nerve reflex (OR: 0.08; 95%CI: 0.02-0.34; p = 0.03), and bladder perforation (OR: 0.14; 95%CI: 0.06-0.36: p < 0.001) and no significant difference in the 12-month-recurrence (OR: 0.79; 95%CI: 0.61-1.04; p = 0.09), the operation time (MD: 0.67; 95%CI: -1.92 to 3.25; p = 0.61), and urethral stricture (OR: 0.46; 95%CI: 0.14-1.47; p = 0.0.19) compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects.

CONCLUSIONS

En-bloc transurethral resection had a significantly lower twenty-four-month recurrence, catheterization time, length of hospital stay, postoperative bladder irrigation duration, obturator nerve reflex, bladder perforation, and no significant difference in the twelve-month recurrence, operation time, and urethral stricture compared with conventional transurethral resection for primary non-muscle invasive bladder cancer subjects. Further studies are required.

Integration of network pharmacology, transcriptomics and molecular docking reveals two novel hypoglycemic components in snow chrysanthemum

Our previous studies uncovered the glucose-lowering properties of snow chrysanthemum tea, however, the active ingredients and underlying mechanisms were yet to be uncovered. Flavonoids are the most active and abundant components in snow chrysanthemum tea. In this study, we treated leptin-deficient diabetic ob/ob or high-fat diet (HFD)-induced C57BL/6 J obese mice with or without total flavonoids of snow chrysanthemum (TFSC) for 14 weeks. Results indicated that TFSC ameliorated dyslipidemia and fatty liver, thereby reducing hyperlipidemia. Further mechanism experiments, including RNA-seq and experimental validation, revealed TFSC improved glycolipid metabolism primarily by activating the AMPK/Sirt1/PPARγ pathway. Additionally, by integrating UPLC, network pharmacology, transcriptomics, and experimental validation, we identified two novel hypoglycemic compounds, sulfuretin and leptosidin, in TFSC. Treatment with 12.5 μmol/L sulfuretin obviously stimulated cellular glucose consumption, and sulfuretin (3.125, 6.25 and 12.5 μmol/L) significantly mitigated glucose uptake damage and reliably facilitated glucose consumption in insulin-resistant HepG2 cells. Remarkably, sulfuretin interacted with the ligand-binding pocket of PPARγ via three hydrogen bond interactions with the residues LYS-367, GLN-286 and TYR-477. Furthermore, a concentration of 12.5 μmol/L sulfuretin effectively upregulated the expression of PPARγ, exhibiting a comparable potency to a renowned PPARγ agonist at 20 μmol/L. Taken together, our findings have identified two new hypoglycemic compounds and revealed their mechanisms, which significantly expands people's understanding of the active components in snow chrysanthemum that have hypoglycemic effects.

NaCl sealing Strategy-Assisted synthesis CoO-Co heterojunctions as efficient oxygen electrocatalysts for Zn air batteries

Developing highly efficient, low-cost, and stable bifunctional oxygen electrocatalysts is essential for the wide popularization of rechargeable Zn-air batteries. Combining zero-dimensional metal nanoparticles with two-dimensional metal oxide nanosheets is an appealing strategy to balance performance and cost. However, the precise construction of these composites remains a great challenge, and their interaction mechanisms lack thorough study. Herein, a cobalt-oxide-based bifunctional oxygen electrocatalyst comprising a rich Co-CoO heterointerface (CoO/Co@NG) was synthesized via a NaCl sealing-assisted pyrolysis strategy. The NaCl crystals played the role of a closed nanoreactor, which facilitated the formation of a CoO-Co heterojunction. Experimental results and theoretical calculations confirmed that the ingeniously constructed heterojunction expedited the oxygen reduction reaction and oxygen evolution reaction kinetics, which is superior to Pt/C. When serving as the air electrode in an assembled liquid-state Zn-air battery, the battery shows high power density (215 mW cm^-2), specific capacity (710 mAh g_zn^-1), and outstanding durability (720 h at 10 mA cm^-2). This work provides an innovative avenue to design high-performance heterojunction electrocatalysts for perdurable Zn-air batteries.

[Lysosomal membrane protein Sidt2 knockout induces apoptosis of human hepatocytes in vitro independent of the autophagy-lysosomal pathway]

OBJECTIVE

To explore the regulatory mechanism of human hepatocyte apoptosis induced by lysosomal membrane protein Sidt2 knockout.

METHODS

The Sidt2 knockout (Sidt2^-/-) cell model was constructed in human hepatocyte HL7702 cells using Crispr-Cas9 technology.The protein levels of Sidt2 and key autophagy proteins LC3-II/I and P62 in the cell model were detected using Western blotting, and the formation of autophagosomes was observed with MDC staining.EdU incorporation assay and flow cytometry were performed to observe the effect of Sidt2 knockout on cell proliferation and apoptosis.The effect of chloroquine at the saturating concentration on autophagic flux, proliferation and apoptosis of Sidt2 knockout cells were observed.

RESULTS

Sidt2^-/- HL7702 cells were successfully constructed.Sidt2 knockout significantly inhibited the proliferation and increased apoptosis of the cells, causing also increased protein expressions of LC3-II/I and P62(P < 0.05) and increased number of autophagosomes.Autophagy of the cells reached a saturated state following treatment with 50 μmol/L chloroquine, and at this concentration, chloroquine significantly increased the expressions of LC3B and P62 in Sidt2^-/- HL7702 cells.

CONCLUSION

Sidt2 gene knockout causes dysregulation of the autophagy pathway and induces apoptosis of HL7702 cells, and the latter effect is not mediated by inhibiting the autophagy-lysosomal pathway.

Phenolic compounds, antioxidant activity and sensory evaluation of sea buckthorn (Hippophae rhamnoides L.) leaf tea

Sea buckthorn leaf tea, an emerging potential functional beverage product, has not yet had appropriate product standards and corresponding quality evaluation methods, and its poor taste directly affects the acceptance of the population, thus limiting its market consumption potential. In this study, two major packaging forms of sea buckthorn leaf tea available in the Chinese market were selected. The contents of total phenolics, total flavonoids, and 10 phenolic compounds, as well as the in vitro antioxidant capacity and sensory characteristics of sea buckthorn leaf tea were analyzed. Results showed that the quality of sea buckthorn leaf tea in the Chinese market varied widely. The total phenolic content, total flavonoid content, antioxidant activity, and consumer acceptance of bagged sea buckthorn leaf tea were higher than those of bulk sea buckthorn leaf tea. Multifactorial statistical analysis showed that the taste astringency of sea buckthorn leaf tea was closely related to ellagic acid and isorhamnetin-3-O-neohesperidin. Furthermore, isorhamnetin-3-O-neohesperidin had a greater effect on the antioxidant activity of sea buckthorn leaf tea. Therefore, ellagic acid and isorhamnetin-3-O-neohesperidin can be used as potential quality markers for sea buckthorn leaf tea. This work provides a reference for taste improvement and quality control of sea buckthorn leaf tea.

Quantifying the effectiveness of ultraviolet-C light at inactivating airborne Mycobacterium abscessus

BACKGROUND

Mycobacterium abscessus (MABS) group are environmental organisms that can cause infection in people with cystic fibrosis (CF) and other suppurative lung diseases. There is potential for person-to-person airborne transmission of MABS among people with CF attending the same care centre. Ultraviolet light (band C, UV-C) is used for Mycobacterium tuberculosis control indoors; however, no studies have assessed UV-C for airborne MABS.

AIM

To determine whether a range of UV-C doses increased the inactivation of airborne MABS, compared with no-UVC conditions.

METHODS

MABS was generated by a vibrating mesh nebulizer located within a 400 L rotating drum sampler, and then exposed to an array of 265 nm UV-C light-emitting diodes (LED). A six-stage Andersen Cascade Impactor was used to collect aerosols. Standard microbiological protocols were used for enumerating MABS, and these quantified the effectiveness of UV-C doses (in triplicate). UV-C effectiveness was estimated using the difference between inactivation with and without UV-C.

FINDINGS

Sixteen tests were performed, with UV-C doses ranging from 276 to 1104 μW s/cm². Mean (±SD) UV-C effectiveness ranged from 47.1% (±13.4) to 83.6% (±3.3). UV-C led to significantly greater inactivation of MABS (all P-values ≤0.045) than natural decay at all doses assessed. Using an indoor model of the hospital environment, it was estimated that UV-C doses in the range studied here could be safely delivered in clinical settings where patients and staff are present.

CONCLUSION

This study provides empirical in-vitro evidence that nebulized MABS are susceptible to UV-C inactivation.

Development and multicenter validation of a novel radiomics-based model for identifying eosinophilic chronic rhinosinusitis with nasal polyps

BACKGROUND

Reliable noninvasive methods are needed to identify endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) to facilitate personalized therapy. Previous computed tomography (CT) scoring system has limited and inconsistent performance in identifying eosinophilic CRSwNP. We aimed to develop and validate a radiomics-based model to identify eosinophilic CRSwNP.

METHODS

Surgical patients with CRSwNP were recruited from Tongji Hospital and randomly divided into training (n = 232) and internal validation cohort (n = 61). Patients from two additional hospitals served as external validation cohort-1 (n = 84) and cohort-2 (n = 54), respectively. Data were collected from October 2013 to May 2021. Eosinophilic CRSwNP was determined by histological criterion. The least absolute shrinkage and selection operator and the logistic regression (LR) algorithm were used to develop a radiomics model. Univariate and multivariate LR were employed to build models based on CT scores, clinical characteristics, and the combination of radiological and clinical characteristics. Model performance was evaluated by assessing discrimination, calibration, and clinical utility.

RESULTS

The radiomics model based on 10 radiomic features achieved an area under the curve (AUC) of 0.815 in the training cohort, significantly better than the CT score model based on ethmoid-to-maxillary sinus score ratio with an AUC of 0.655. The combination of radiomic features and blood eosinophil count had a further improved performance, achieving an AUC of 0.903. The performance of these models was confirmed in all validation cohorts with satisfying predictive calibration and clinical application value.

CONCLUSIONS

A CT radiomics-based model is promising to identify eosinophilic CRSwNP. This radiomics-based method may provide novel insights in solving other clinical concerns, such as guiding personalized treatment and predicting prognosis in patients with CRSwNP.

Dark tea: A popular beverage with possible medicinal application

Tea is a famous beverage that is produced from leaves of Camellia sinensis. Amongst the six major tea categories in China, dark tea is the only one that involves microbial fermentation in the manufacturing process, which contributes unique flavors and functions for the tea. In the recent decade, the reports about the biofunctions of dark teas have increased rapidly. Therefore it may be the proper time to consider dark tea as one potential homology of medicine and food. In this viewpoint, our current understanding of the chemical constituents, biological activities and possible health beneficial effects of dark teas were introduced. Some future directions and challenges to the development perspectives of dark teas were also discussed.

Novel active compounds and the anti-diabetic mechanism of mulberry leaves

Mulberry (Morus alba L.) leaves have long been considered beneficial in traditional Chinese medicine to treat infectious and internal diseases. Recently studies have discovered that the mulberry leaf’s total flavonoids (MLF) display excellent hypoglycemia properties. However, the active ingredients and their molecular mechanisms are still uncharacterized. In this study, we explored the hypoglycemic effects of MLF and mulberry leaf polysaccharides (MLP) on ob/ob mice, an animal model of type 2 diabetes mellitus (T2DM), compared with Ramulus Mori (Sangzhi) alkaloid (RMA). Network pharmacology was employed to identify the potential available targets and active compounds of MLF and RMA against hyperglycemia. Molecular docking, an insulin-resistant cell model and qPCR were employed to verify the antidiabetic activity of the critical compounds and the gene expression profiles of the top molecular targets. Here, the results showed that MLF and MLP improved glucose uptake in insulin-resistant hepatocytes. MLF, MLP and RMA alleviated insulin resistance and glucose intolerance in ob/ob mice. Unlike MLF and MLP, RMA administration did not influence the accumulation of intrahepatic lipids. Network pharmacology analysis revealed that morusin, kuwanon C and morusyunnansin L are the main active compounds of MLF and that they amend insulin resistance and glycemia via the PI3K- Akt signaling pathway, lipid and atherosclerosis pathways, and the AGE-RAGE signaling pathway. Moreover, 1-deoxynojirimycin (DNJ), fagomine (FA), and N-methyl-1-deoxynojirimycin are the primary active ingredients of RMA and target carbohydrate metabolism and regulate alpha-glucosidase activity to produce a potent anti-diabetic effect. The molecular docking results indicated that morusin, kuwanon C and morusyunnansin L are the critical bioactive compounds of MLF. They had high affinities with the key targets adenosine A1 receptor (ADORA1), AKT serine/threonine kinase 1 (AKT1), peroxisome proliferator-activated receptor gamma (PPARγ), and glycogen synthase kinase 3 beta (GSK3β), which play crucial roles in the MLF-mediated glucose-lowering effect. Additionally, morusin plays a role in amending insulin resistance of hepatocytes by repressing the expression of the ADORA1 and PPARG genes. Our results shed light on the mechanism behind the glucose-lowering effects of MLF, suggesting that morusin, kuwanon C, and morusyunnansin L might be promising drug leads for the management of T2DM.

[Clinical observation of microsurgical removal of the hemilateral tuberculum sellae meningiomas through contralateral eyebrow arch approach]

The current study aimed to investigate the clinical feasibility of microscopic resection of hemilateral tuberculum sellae meningiomas (TSM) via the contralateral eye brow arch approach. The clinical data of 34 patients with TSM who underwent microsurgery from January 2016 to June 2021 in the Neurosurgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and the First Affiliated Hospital of Henan University were collected and reviewed. The postoperative visual acuity improvement rate was 88.5% (23/26), and the total tumor resection rate was 88.2% (30/34); the postoperative visual acuity improvement in patients with total tumor resection was better than that of patients with partial resection [90.9% (20/22) vs 3/4]. Meanwhile, the postoperative visual acuity improvement in patients with the superior optic nerve and laterl-superior optic nerve was better than that of patients with the lateral optic nerve type (12/14, 8/8 vs 3/4). Supraorbital skin numbness occurred in 3 cases after operation, and the symptoms disappeared during follow-up; 2 cases had mild disturbance of hormone level, and urine output of 2 cases increased after operation, which returned to normal level after symptomatic treatment; 1 case had subcutaneous effusion which was absorbed after treatment. There were no complications such as olfactory disturbance and intracranial infection. During follow-up for 3-60 (33±6) months, recurrence occurred in 2 cases and reoperation was performed. For the hemilateral TSM, according to the preoperative evaluation of the origin of the TSM and the side with visual impairment, the contralateral eyebrow approach is selected to fully expose the tumor base below the optic nerve. It is beneficial to fully resect the tumor under direct vision, and the symptoms of postoperative visual impairment are significantly improved, indicating that the current surgical method can be used in the clinical setting.

Pharmacophylogenetic study of Scutellaria baicalensis and its substitute medicinal species based on the chloroplast genomics, metabolomics, and active ingredient

The genetic relationships among the species in Scutellaria genus remain unclear because of the variation in the number of species and complex trait. The usage of S. baicalensis and its four substitute medicinal species (S. amoena, S. hypericifolia, S. likiangensis, and S. viscidula) in traditional medicines make their specialized metabolism important in China, but interspecific genetic and chemical differences have rarely been reported for these species. In this study, the chloroplast genomes of four substitute species for S. baicalensis were assembled, and comparative and phylogenetic analyses were performed with these species and other Scutellaria relatives. In addition, metabolomics analyses were performed and the contents of the main active compounds were determined to reveal the interspecific chemical diversity of S. baicalensis and its four substitute species. The full lengths of their chloroplast genomes ranged from 151,574 to 151,816 bp with an average GC content of 38.34%, and a total of 113 genes were annotated. In the chloroplast genomes of S. baicalensis and its four substitutes, one hypervariable region (petA-psbL) is proposed as a potential DNA barcode. Phylogenetic analysis showed that the subdivision of the genus Scutellaria should be reconsidered. The metabolomics and content determination analyses showed that the four species exhibit a metabolism similar to that of S. baicalensis in different parts. Except for the roots of S. likiangensis, all parts of the substitute species showed high contents of baicalin. Genetic and chemical analyses of four substitute medicinal species for S. baicalensis were performed here for the first time, and their pharmacophylogenetic relationships were further explored, providing a scientific basis for the subsequent development of the medicinal value and resource utilization of Scutellaria.

Integrating network pharmacology analysis and pharmacodynamic evaluation for exploring the active components and molecular mechanism of moutan seed coat extract to improve cognitive impairment

Paeonia suffruticosa (Moutan) is a traditional medicinal plant in China. Its seed coat is rich in resveratrol oligomer, especially suffruticosol B (SB). Previous studies had shown that the seed coat extracts of Paeonia suffruticosa (PSCE) had good cholinesterase inhibitory activity and neuroprotective effect, but the effective dose range was unknown, and the pharmacodynamic components and molecular mechanism of PSCE had not been discussed. The current study aimed to screen the pharmacodynamic components in PSCE and investigate the improvement effect of PSCE and the selected SB on scopolamine-induced cognitive dysfunction in mice and its mechanism. The results of high-throughput sequencing and bioinformatics analysis showed that suffruticosol B (SB) and trans-gnetin H (GH) might be the main active components of PSCE; PSCE might improve cognitive dysfunction through p53, HIF-1, MAPK, and PI3K-Akt signaling pathways, while SB and GH might improve cognitive dysfunction through HIF-1 signaling pathway. SB and GH had good molecular docking activity with the target of HIF-1 signaling pathway. The pharmacodynamic activities of PSCE and SB were further verified by behavioral experiments. PSCE and SB could improve the recognition ability of familiar and new objects and shorten the escape latency in the Morris Water Maze test (PSCE 120 mg∙kg-1, p < 0.05; SB 60 mg∙kg-1, p < 0.01); PSCE and SB could increase Ach and GSH levels, enhance the activities of ChAT, SOD and CAT, decrease the levels of IL-1β, IL-6, and TNF-α, and decrease the activity of AChE. In conclusion, the results indicated that PSCE might exert pharmacodynamic activity through multiple components, targets, and pathways, and SB and GH might be the main active components of PSCE. PSCE and SB might improve cognitive dysfunction by regulating cholinergic, antioxidant, and anti-inflammatory effects. These results indicated that PSCE and SB might be potential anti-AD drug candidates, providing a scientific basis for the development and utilization of Moutan bark.

[VIPR1 promoter methylation promotes transcription factor AP-2α binding to inhibit VIPR1 expression and promote hepatocellular carcinoma cell growth in vitro]

OBJECTIVE

To explore the transcriptional regulation mechanism and biological function of low expression of vasoactive intestinal peptide receptor 1 (VIPR1) in hepatocellular carcinoma (HCC).

METHODS

We constructed plasmids carrying wild-type VIPR1 promoter or two mutant VIPR1 promoter sequences for transfection of the HCC cell lines Hep3B and Huh7, and examined the effect of AP-2α expression on VIPR1 promoter activity using dual-luciferase reporter assay. Pyrosequencing was performed to detect the changes in VIPR1 promoter methylation level in HCC cells treated with a DNA methyltransferase inhibitor (DAC). Chromatin immunoprecipitation was used to evaluate the binding ability of AP-2α to VIPR1 promoter. Western blotting was used to assess the effect of AP-2α knockdown on VIPR1 expression and examine the differential expression of VIPR1 in the two cell lines. The effects of VIPR1 overexpression and knockdown on the proliferation, cell cycle and apoptosis of HCC cells were analyzed using CCK8 assay and flow cytometry. We also observed the growth of HCC xenograft with lentivirus-mediated over-expression of VIPR1 in nude mice.

RESULTS

Compared with the wild-type VIPR1 promoter group, co-transfection with the vector carrying two promoter mutations and the AP-2α-over-expressing plasmid obviously restored the luciferase activity in HCC cells (P < 0.05). DAC treatment of the cells significantly decreased the methylation level of VIPR1 promoter and inhibited the binding of AP-2α to VIPR1 promoter (P < 0.01). The HCC cells with AP-2α knockdown showed increased VIPR1 expression, which was lower in Huh7 cells than in Hep3B cells. VIPR1 overexpression in HCC cells caused significant cell cycle arrest in G2/M phase (P < 0.01), promoted cell apoptosis (P < 0.001), and inhibited cell proliferation (P < 0.001), while VIPR1 knockdown produced the opposite effects. In the tumor-bearing nude mice, VIPR1 overexpression in the HCC cells significantly suppressed the increase of tumor volume (P < 0.001) and weight (P < 0.05).

CONCLUSION

VIPR1 promoter methylation in HCC promotes the binding of AP-2α and inhibits VIPR1 expression, while VIPR1 overexpression causes cell cycle arrest, promotes cell apoptosis, and inhibits cell proliferation and tumor growth.

Utilizing an Oxygen-Rich Interface by Hydroxyapatite to Regulate the Linear Diffusion for the Stable Solid-State Electrolytes

Improving dissociation and diffusion of lithium ions is the key to solving the practical application of polymer-based solid-state electrolytes (SSE). Here, a low-cost three-dimensional hydroxyapatite (HAP) nanowire is used in polyethene oxide to obtain an enhanced lithium-ion electrolyte. The oxygen-rich interface of HAP provides an integrated dissociation-diffusion platform for lithium salts. The TFSI- anions tend to coordinate with calcium ions, which makes it easier for lithium ions to escape and stay in a free state. The lateral nucleus in the HAP polyethene electrolyte regulates the diffusion from spherical diffusion into linear planar diffusion, which is confirmed by chronoamperometry curves and in situ observation. The stability of the electrolyte at high voltages is improved by inhibiting the superoxide radicals of polyethene oxide chains, which is demonstrated by nuclear magnetic resonance and electron paramagnetic resonance spectroscopy methods. The initial specific charge capacity of the Li/SPE/LiFePO4 cell with HAP-modified polyethene oxide at 2 C is 148.8 mA h/g, and its initial Coulombic efficiency is 95.17%. After 100 cycles, the specific discharge capacity is 125.5 mA h/g with 99.91% retention per cycle. This oxygen-rich interface strategy would guide the discovery of novel materials for polymer-based SSE.

O-057 The pregnant outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities in infertile population: a prospective cohort study

Study question

What is the the pregnancy outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities and the factors related with natural pregnancy.

Summary answer

The natural pregnancy rate is 46.58% after laparoscopy and patients' age, duration time of infertility and concurrent number of abnormalities are related with natural pregnancy.

What is known already

Subtle distal fallopian tube abnormalities are a group of diseases that are characterized by subtle variations in tubal anatomy including fimbrial agglutination, tubal diverticula, accessory ostium, fimbrial phimosis, and accessory fallopian tube. The prevalence of subtle distal fallopian tube abnormalities is high in infertile women.This group of diseases is highly related to endometriosis, especially its early stage, and may indicate fimbrial abnormalities in endometriosis.

Study design, size, duration

This was a prospective cohort study conducted in the Reproductive Medicine Center of an university-affiliated teaching hospital from January 2017 to December 2018.

Participants/materials, setting, methods

234 patients with subtle distal fallopian tube abnormalities were included. Laparoscopies were performed by four senior reproductive surgeons who were familiar with the diagnostic criteria and surgery treatment for subtle abnormalities. The fallopian tube abnormalities were corrected and endometriosis was treated by either electrical ablation for peritoneal lesions or endometrioma excision.The participants were followed up by phone every 12 months for pregnancy outcome until 36 months after surgery.

Main results and the role of chance

167 patients conceived after surgery(clinical pregnancy rate 71.37%). 109 patients conceived naturally (natural pregnancy rate 46.58%) and 59 patients conceived after in IVF（One case conceived naturally after live birth after IVF, four cases conceived naturally twice) . The average time for natural conception after surgery is 8.36±7.47 months. 51.4% of natural pregnancy occurred within 6 months and 79.8% occurred within 12 months.Among the 109 naturally conceived patients, there were 94 cases of live birth, 13 cases of natural abortion (natural abortion rate 11.92%) and 2 cases of ectopic pregnancy (ectopic pregnancy rate 1.83%). No preterm birth, multiple pregnancy or birth defects were reported in this group.The patient age(HR = 0.917,95%CI 0.870-0.917,P=0.001), duration of infertility(HR = 0.846,95%CI 0.740-0.966,P=0.014) and concurrent number of subtle abnormalities (HR = 0.636,95%CI 0.416-0.970,P=0.036) are the factors associated with natural pregnancy. The type of subtle abnormalities, type of infertility, body mess index, concurrent endometriosis, uterine cavity abnormalities and myoma are not related with natural pregnancy.

Limitations, reasons for caution

Not all kinds of subtle distal abnormalities are included such as paratubal cyst is excluded from the study. Not all the patients had the test of ovarian reserve such as AMH, antral follicle count and FSH level, so we couldn’t evaluate the relationship between ovarian reserve and natural pregnancy.

Wider implications of the findings

This is the largest clinical study that investigated the pregnancy outcome of subtle fallopian tube abnormalities in the infertile population.Laparoscopy surgery is an effective treatment for infertility patients with subtle distal fallopian tube abnormalities, especially for the young, short duration time of infertility and ≤2 types of subtle abnormalities.

Trial registration number

ChiCTR2000029095

P-752 Fertility outcomes after hysteroscopic niche resection compared with expectant management in patients with a niche in the uterine cesarean scar

Study question

Whether hysteroscopic niche resection is suitable for patients with a niche in the uterine cesarean scar and with fertility desire compared with expectant management.

Summary answer

Hysteroscopic niche resection is a effective treatment for patients with fertility desire compared with expectant management and satisfactory obstetrical outcomes could be achieved.

What is known already

The specific treatment method for niche should be determined according to the patient’s symptoms, fertility desire and niche features,up to now, hysteroscopic niche resection has been shown effective to reduce abnormal uterine bleeding. However, similar to expectant treatment, hysteroscopic niche resection does not reconstruct the lower uterine segment, whether hysteroscopic niche resection affect fertility outcomes remains controversial.

Study design, size, duration

We designed a single-center retrospective cohort study. We included patients with desire to conceive that underwent hysteroscopic niche resection or expectant management between 2016.9-2020.12. The date of entry for each woman was the date of treatment or the date that the niche was diagnosed. The last day of analysis was the date of the first delivery or the last follow-up visit in women who remained non-livebirth.

Participants/materials, setting, methods

This study was conducted in a university-affiliated gynecology hospital. A total of 71 patients that underwent hysteroscopic niche resection and 97 patients that underwent expectant management were recruited. All women were followed up yearly until December 2021 for the occurrence of live birth. A Cox proportional hazards regression model with potential variables to identify predictors of pregnancy was also processed.

Main results and the role of chance

Baseline characteristics of age, gravidity, parity, previous cesarean section, and anatomical indicators of niche were not significantly different between the groups. However patients in the hysteroscopic niche resection had a longer menstruation duration (hysteroscopic niche resection vs expectant management as 12(10/14) vs 7(7/10), P &lt;0.001) and a longer infertility period before treatment(hysteroscopic niche resection vs expectant management as 48.00±36.28 vs 23.11±20.34, P = 0.014). The overall live birth rate was similar in both groups (hysteroscopic niche resection vs expectant management as 37/71 [52.11%] vs 40/97 [41.23%], P = 0.162). For the live births in the two groups, no uterine rupture occurred.The total pregnancy rate was higher in the hysteroscopic niche resection group (hysteroscopic niche resection vs expectant management as 50/71 [70.40%] vs 50/97 [51.54%], P = 0.014). What’s more, for patients with infertility before treatment,there was a statistically significant difference regarding time to pregnancy between the two groups (P = 0.049).

After adjustment for confounding factors including age, numbers of cesarean section, infertility peroid before treatment, anatomical indicators of niche and menstruation duration, cox proportional hazards analysis revealed that women underwent hysteroscopic niche resection were positively correlated to pregnancy (AHR = 1.646, 95% CI [1.081-2.506]).

Limitations, reasons for caution

This study was a single-center retrospective cohort study, to strengthen the conclusion, more prospective studies that include larger sample sizes and multiple centers should be conducted.

Wider implications of the findings

For asymptomatic cesarean scar defect patients whose residual myometrium thickness is sufficient, the expectant treatment is practical. However, for patients with abnormal uterine bleeding or infertility, hysteroscopic niche resection should be recommended.

Trial registration number

not applicable

P-744 Fertility intention for a second or third child among childbearing couple in Shanghai, China

Study question

What is the intention rate and related factors for a second or third child among childbearing couple?

Summary answer

Among couples with one child, 16.2% are willing to have a second child. Only 9.4% of couples with two children are pursuing third child.

What is known already

The decline in fertility is becoming an inevitable trend in most countries around the world. In the end of 1970s, the one-child policy was implemented. Since 21st century, China has gradually changed its fertility policy, from a selective two-child policy to a comprehensive two-child policy. Nevertheless, the number of total annual births in China has not shown an obviously increasing trend of growth. On August 20, 2021, the Chinese government amended the law to allow a couple to have three children. However, only a few studies have been conducted to evaluate fertility intention in the couples who already have kids.

Study design, size, duration

We conducted a cross-sectional survey in Shanghai from July to August in 2021. This study population was based on the female fertility database established between 2013 and 2017, which contains basic sociodemographic information and the reproductive intentions. We conducted this study to evaluate the fertility intention of the second or the third child and its related factors.

Participants/materials, setting, methods

From July to August in 2021, couples aged between 20 and 45 years old with one or two children was invited to participate in our study to give the information about “second/third births intention” and the factors that may probably related to it. Between the groups with and without second/third child intention, the chi-squared test and binary logistic regression was applied to compare the difference in the basic characteristics and relative factors.

Main results and the role of chance

Among couples with one child, 130 (16.2%) couples had intention to have a second child. Only 9.4% of couples with two children show the desire to have a third child. The ideal number of children for all our participants was 1.72±0.52. And the ideal number of children among couples with one child is 1.61±0.52. By contrast, the ideal number for couples with two kids was 2.06±0.34. The study showed great differences in Socioeconomic and personal factors between two groups. For second-child intention, the female age over 35 years, first child's age over 7 years, annual payment for the first child ranges from 70,000-100,000 RMB and children’s educational barriers were negatively associated with an intention to have a second child. Job with more free time makes it easier for couples to have a second child. Among couples with two children, parents with family financial constraints and children’s educational barriers are less likely to have a third child. Fertility-encouraged government policy can promote couples to pursue a second or third child. It is necessary to take measures to reduce the burden of raising children and increase free time for couples to relief parent’s pressure of rearing a child.

Limitations, reasons for caution

As this is a single-center study in Shanghai, the sample size is relatively small. Although our sample size still meets the basic statistical requirements and can detect a moderate effect size as significance, the results may not be applicable to some other regions.

Wider implications of the findings

The decision of fertility intention is influenced by female age, the first child’s age, family economic conditions, children’s education and national fertility policies. It is necessary to take measures to reduce the burden of raising children and increase free time for couples to relief parent’s pressure of rearing a child.

Trial registration number

ChiCTR2100045315

A High Throughput Cell-Based Screen Assay for LINE-1 ORF1p Expression Inhibitors Using the In-Cell Western Technique

Long interspersed nuclear element 1 (LINE-1) is a dominant autonomous retrotransposon in human genomes which plays a role in affecting the structure and function of somatic genomes, resulting in human disorders including genetic disease and cancer. LINE-1 encoded ORF1p protein which possesses RNA-binding and nucleic acid chaperone activity, and interacts with LINE-1 RNA to form a ribonucleoprotein particle (RNP). ORF1p can be detected in many kinds of tumors and its overexpression has been regarded as a hallmark of histologically aggressive cancers. In this study, we developed an In-Cell Western (ICW) assay in T47D cells to screen the compounds which can decrease the expression of ORF1p. Using this assay, we screened 1,947 compounds from the natural products library of Target Mol and Selleckchem, among which three compounds, Hydroxyprogesterone, 2,2':5′,2″-Terthiophene and Ethynyl estradiol displayed potency in diminishing LINE-1 ORF1p expression level. Further mechanistic studies indicated the compounds act by affecting LINE-1 RNA transcription. Notably, we demonstrated that the compounds have an inhibitory effect on the proliferation of several lung and breast cancer cell lines. Taken together, we established a high throughput screening system for ORF1p expression inhibitors and the identified compounds provide some clues to the development of a novel anti-tumor therapeutic strategy by targeting ORF1p.

[Primary ovarian squamous cell carcinoma: clinicopathological features and prognostic analysis of fifteen cases]

Objective: To assess the clinical features and treatment outcomes in patients with primary ovarian squamous cell carcinoma (POSCC). Methods: Fifteen patients with primary ovarian squamous cell carcinoma diagnosed from January 2009 to December 2018 in Cancer Hospital of the University of Chinese Academy of Sciences were collected. The expression of p16, hMLH1, hMSH2, hMSH6 and PMS2 in POSCC was detected by immunohistochemistry, and the status of high-risk human papillomavirus (HPV) by RNAscope test. Results: Squamous cell carcinoma with different degrees of differentiation was found in 15 cases, including three cases with high differentiation and 12 cases with medium to low differentiation. There were four cases with in situ squamous cell carcinoma, four cases with teratoma, one case with endometrial carcinoma/atypical hyperplasia, and one case with endometriosis. p16 was expressed in five cases (5/15), indicating coexisting high-risk HPV infection. There was no high-risk HPV infection in the remaining 10 cases, and p16 staining was negative. There was no deficient mismatch repair protein in all cases. The overall survival time (P=0.038) and progression free survival (P=0.045) of patients with high-risk HPV infection were longer than those without HPV infection. Conclusions: POSCC is more commonly noted in postmenopausal women and often occurs unilaterally. Elevated serological indexes CA125 and SCC are the most common finding. Morphologically, the tumors show variable degrees of differentiation, but the current data suggest that the degree of differentiation cannot be used as an independent prognostic index. High-risk HPV infection may be associated with the occurrence of POSCC, and that the prognosis of POSCC patients with HPV infection is better than that of patients without infection.

Comparative genomics reveal the convergent evolution of CYP82D and CYP706X members related to flavone biosynthesis in Lamiaceae and Asteraceae

Distant species producing the same secondary metabolites is an interesting and common phenomenon in nature. A classic example of this is scutellarein whose derivatives have been used clinically for more than 30 years. Scutellarein occurs in significant amounts in species of two different orders, Scutellaria baicalensis and Erigeron breviscapus, which diverged more than 100 million years ago. Here, according to the genome-wide selection and functional identification of 39 CYP450 genes from various angiosperms, we confirmed that only seven Scutellaria-specific CYP82D genes and one Erigeron CYP706X gene could perform the catalytic activity of flavone 6-hydroxylase (F6H), suggesting that the convergent evolution of scutellarein production in these two distant species was caused by two independently evolved CYP450 families. We also identified seven Scutellaria-specific CYP82D genes encoding flavone 8-hydroxylase (F8H). The evolutionary patterns of CYP82 and CYP706 families via kingdom-wide comparative genomics highlighted the evolutionary diversity of CYP82D and the specificity of CYP706X in angiosperms. Multi-collinearity and phylogenetic analysis of CYP82D in Scutellaria confirmed that the function of F6H evolved from F8H. Furthermore, the SbaiCYP82D1^A319D , EbreCYP706X^R130A , EbreCYP706X^F312D and EbreCYP706X^A318D mutants can significantly decrease the catalytic activity of F6H, revealing the contribution of crucial F6H amino acids to the scutellarein biosynthesis of distant species. This study provides important insights into the multi-origin evolution of the same secondary metabolite biosynthesis in the plant kingdom.

Data-driven design and controllable synthesis of Pt/carbon electrocatalysts for H2 evolution

To achieve net-zero emissions, a particular interest has been raised in the electrochemical evolution of H₂ by using catalysts. Considering the complexity of designing catalyst, we demonstrate a data-driven strategy to develop optimized catalysts for H₂ evolution. This work starts by collecting data of Pt/carbon catalysts, and applying machine learning to reveal the importance of ranking various features. The algorithms reveal that the Pt content and Pt size have the greatest impact on the catalyst overpotentials. Following the data-driven analysis, a space-confined method is used to fabricate the size-controllable Pt nanoclusters that anchor on nitrogen-doped (N-doped) mesoporous carbon nanosheet network. The obtained catalysts use less platinum and exhibit better catalytic activity than current commercial catalysts in alkaline electrolytes. Moreover, the data formed in this work can be used as feedback to further improve the data-driven model, thereby accelerating the development of high-performance catalysts.

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Built a database of Pt/C catalysts for H₂ evolution

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Provided quantitative guidance for catalyst design by machine learning

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Developed a space-confined strategy to control the features of Pt/C composites

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Formed a closed-loop from data-driven design to catalyst evaluation

Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

Background

Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI).

Purpose

To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI.

Methods

We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a &gt;15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) &lt;50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis.

Results

The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P&lt;0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P&lt;0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002).

Conclusions

LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality.

Funding Acknowledgement

Type of funding sources: None. Association Between LLVR and outcomesKaplan-Meier Estimates of the Mortality

Predictive value of neutrophil percentage-to-albumin ratio for contrast-associated acute kidney injury in patients without chronic kidney disease undergoing elective percutaneous coronary intervention

Background

Although previous studies have demonstrated that neutrophil and albumin are biomarkers of inflammation and malnutrition, which are highly related with contrast-associated acute kidney injury (CA-AKI). However, there has been no study investigated the combined evaluation of neutrophil and albumin in predicting CA-AKI.

Purpose

To explore the predictive value of neutrophil percentage-to-albumin ratio (NPAR) for CA-AKI in patients undergoing elective percutaneous coronary intervention (PCI).

Methods

We prospectively observed 5083 consenting patients without chronic kidney disease (CKD) undergoing elective PCI from January 2012 to December 2018. NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The association between NPAR and CA-AKI was investigated by logistic regression analysis. The area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to make comparison for CA-AKI prediction.

Result

The incidence of CA-AKI was 5.6% (n=286). The median NPAR was 14.9 (13.0–17.1). According to the receiver operating characteristic curves (ROC), the best cut-off value of NPAR for predicting CA-AKI was 15.7 with 66.8% sensitivity and 61.9% specificity (C statistic=0.679; 95% CI, 0.666–0.691). NPAR displayed higher AUC value in comparison to neutrophil percentage (p&lt;0.001), but not albumin (P=0.063), as a predictor of CA-AKI. However, NPAR significantly improved the prediction of CA-AKI in the continuous NRI and IDI over neutrophil percentage (NRI: 0.353, 95% CI: 0.234–0.472, P&lt;0.001; IDI: 0.017, 95% CI: 0.010–0.024, p&lt;0.001) and albumin (NRI: 0.141, 95% CI: 0.022–0.260, P=0.020; IDI: 0.009, 95% CI: 0.003–0.015, p=0.003) alone. After adjusting for potential confounding risk factors of CA-AKI, multivariable logistic analysis showed that NPAR &gt;15.7 was a strong independent predictor of CA-AKI (OR=1.998, 95% CI, 1.511–2.643, p&lt;0.001).

Conclusion

NPAR is an independent predictor of CA-AKI, which significantly improved the prediction of CA-AKI over neutrophil and albumin alone in patients without CKD undergoing elective PCI.

Funding Acknowledgement

Type of funding sources: None. ROC for NPAR to predict CA-AKIPredictors of CA-AKI

The De-Ritis ratio is associated with contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention

Background

Preoperative liver dysfunction has been demonstrated as a poor prognostic factor after major surgery. Recent researches discovered that an increased De-Ritis ratio (aspartate aminotransferase-to-alanine aminotransferase ratio) reflects the liver dysfunction and was associated with adverse cardiovascular and renal outcomes. However, there is a lack of data exploring the predictive value of the De-Ritis ratio on contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective percutaneous coronary intervention (PCI).

Purpose

To evaluate the predictive value of the De-Ritis ratio for CA-AKI in patients undergoing elective PCI.

Methods

We conducted a prospective, observational study with 5780 consenting patients undergoing elective PCI from January 2012 to December 2018. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The relationship between the De-Ritis ratio and CA-AKI was investigated by logistic regression analysis. The predictive utility of the De-Ritis ratio was determined and compared using the area under the receiver-operating characteristic curve (AUC).

Result

CA-AKI developed in 363 (6.3%) patients. The median De-Ritis ratio was 1.00 (0.77–1.33). The De-Ritis ratio showed an AUC of 0.636 (95% confidence interval (CI): 0.624–0.649; P&lt;0.001) in predicting CA-AKI, which was significantly greater than aspartate aminotransferase (AST) (AUC: 0.636 vs 0.589, p=0.015) and alanine aminotransferase (ALT) (AUC: 0.636 vs 0.506, p&lt;0.001). The best cut-off value of the De-Ritis ratio for predicting CA-AKI was 1.30 with 47.1% sensitivity and 74.7% specificity. Multivariable logistic analysis showed that the De-Ritis ratio &gt;1.30 was a remarkable independent predictor of CA-AKI (OR=1.757, 95% CI, 1.385–2.229, p&lt;0.001) even after adjusting for other CA-AKI risk factors.

Conclusion

The De-Ritis ratio is an independent risk factor for predicting CA-AKI in patients undergoing elective PCI.

Funding Acknowledgement

Type of funding sources: None. ROC for De-Ritis ratio to predict CA-AKIPredictors of CA-AKI

Phase I/II study of single-agent lenvatinib in children and adolescents with refractory or relapsed solid malignancies and young adults with osteosarcoma (ITCC-050)☆

Background

We report results from the phase I dose-finding and phase II expansion part of a multicenter, open-label study of single-agent lenvatinib in pediatric and young adult patients with relapsed/refractory solid tumors, including osteosarcoma and radioiodine-refractory differentiated thyroid cancer (RR-DTC) (NCT02432274).

Patients and methods

The primary endpoint of phase I was to determine the recommended phase II dose (RP2D) of lenvatinib in children with relapsed/refractory solid malignant tumors. Phase II primary endpoints were progression-free survival rate at 4 months (PFS-4) for patients with relapsed/refractory osteosarcoma; and objective response rate/best overall response for patients with RR-DTC at the RP2D.

Results

In phase I, 23 patients (median age, 12 years) were enrolled. With lenvatinib 14 mg/m², three dose-limiting toxicities (hypertension, n = 2; increased alanine aminotransferase, n = 1) were reported, establishing 14 mg/m² as the RP2D. In phase II, 31 patients with osteosarcoma (median age, 15 years) and 1 patient with RR-DTC (age 17 years) were enrolled. For the osteosarcoma cohort, PFS-4 (binomial estimate) was 29.0% [95% confidence interval (CI) 14.2% to 48.0%; full analysis set: n = 31], PFS-4 by Kaplan–Meier estimate was 37.8% (95% CI 20.0% to 55.4%; full analysis set) and median PFS was 3.0 months (95% CI 1.8-5.4 months). The objective response rate was 6.7% (95% CI 0.8% to 22.1%). The patient with RR-DTC had a best overall response of partial response. Some 60.8% of patients in phase I and 22.6% of patients in phase II (with osteosarcoma) had treatment-related treatment-emergent adverse events of grade ≥3.

Conclusions

The lenvatinib RP2D was 14 mg/m². Single-agent lenvatinib showed activity in osteosarcoma; however, the null hypothesis could not be rejected. The safety profile was consistent with previous tyrosine kinase inhibitor studies. Lenvatinib is currently being investigated in osteosarcoma in combination with chemotherapy as part of a randomized, controlled trial (NCT04154189), in pediatric solid tumors in combination with everolimus (NCT03245151), and as a single agent in a basket study with enrollment ongoing (NCT04447755).

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The recommended phase II dose of lenvatinib in children with relapsed/refractory solid malignant tumors is 14 mg/m².

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This dose is equivalent to the recommended dose of 24 mg/day for single-agent lenvatinib in adults with DTC.

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Single-agent lenvatinib showed activity of interest in children and young adults with osteosarcoma.

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Based on this initial report, lenvatinib is currently being investigated in combination with chemotherapy in osteosarcoma.