The role of payment sources in the continuation of rehabilitation therapy in tertiary hospitals for patients with traumatic spinal cord injury: a study in Southwest China

Medical security support for rehabilitation therapy in China is different from that in other countries. We investigated whether the discharge plan to continue rehabilitation therapy in tertiary hospitals for patients after traumatic spinal cord injury (TSCI) was influenced by payment sources or other conditions. This was a cross-sectional, observational study. Information was collected on the general condition, caregiver, types of payment sources for continued rehabilitation, American Spinal Injury Association Impairment Scale (AIS) scores, and discharge plans. In total, 135 patients with TSCI (107 male, mean age 41.00 ± 13.73 years, mean spinal cord injury duration 238.43 ± 345.54 days) were enrolled. Medical insurance (43%) and out-of-pocket payments (27.4%) were the primary payment sources. Although most patients were beyond the acute phase, 40% continued rehabilitation therapy at other tertiary hospitals. The caregiver, payment sources, injury level, AIS level, and complete urinary tract infection (UTI) were different due to discharge plans (p > .05). Patients seemingly consider a higher AIS level and co-UTI as the requirement for tertiary hospital therapy. In non-medical insurance payment source patients, the discharge plan also differed due to the AIS level and co-UTI (p > .05). However, in medical insurance patients, the discharge plan differed only in terms of TSCI duration (p > .05). The restricted duration of medical coverage restricted the continuation of rehabilitation therapy and influenced the discharge plan of most patients with TSCI.

CYP8B1 downregulation mediates the metabolic effects of vertical sleeve gastrectomy in mice

BACKGROUND AND AIMS

Although the benefits of vertical sleeve gastrectomy (VSG) surgery are well known, the molecular mechanisms by which VSG alleviates obesity and its complications remain unclear. We aim to determine the role of CYP8B1 (cytochrome P450, family 8, subfamily B, polypeptide 1) in mediating the metabolic benefits of VSG.

APPROACH AND RESULTS

We found that expression of CYP8B1, a key enzyme in controlling the 12α-hydroxylated (12α-OH) bile acid (BA) to non-12α-OH BA ratio, was strongly downregulated after VSG. Using genetic mouse models of CYP8B1 overexpression, knockdown, and knockout, we demonstrated that overexpression of CYP8B1 dampened the metabolic improvements associated with VSG. In contrast, short hairpin RNA-mediated CYP8B1 knockdown improved metabolism similar to those observed after VSG. Cyp8b1 deficiency diminished the metabolic effects of VSG. Further, VSG-induced alterations to the 12α-OH/non-12α-OH BA ratio in the BA pool depended on CYP8B1 expression level. Consequently, intestinal lipid absorption was restricted, and the gut microbiota (GM) profile was altered. Fecal microbiota transplantation from wild type-VSG mice (vs. fecal microbiota transplantation from wild-type-sham mice) improved metabolism in recipient mice, while there were no differences between mice that received fecal microbiota transplantation from knockout-sham and knockout-VSG mice.

CONCLUSIONS

CYP8B1 is a critical downstream target of VSG. Modulation of BA composition and gut microbiota profile by targeting CYP8B1 may provide novel insight into the development of therapies that noninvasively mimic bariatric surgery to treat obesity and its complications.

An in silico scheme for optimizing the enzymatic acquisition of natural biologically active peptides based on machine learning and virtual digestion

BACKGROUND

As a potential natural active substance, natural biologically active peptides (NBAPs) are recently attracting increasing attention. The traditional proteolysis methods of obtaining effective NBAPs are considerably vexing, especially since multiple proteases can be used, which blocks the exploration of available NBAPs. Although the development of virtual digesting brings some degree of convenience, the activity of the obtained peptides remains unclear, which would still not allow efficient access to the NBAPs. It is necessary to develop an efficient and accurate strategy for acquiring NBAPs.

RESULTS

A new in silico scheme named SSA-LSTM-VD, which combines a sparrow search algorithm-long short-term memory (SSA-LSTM) deep learning and virtually digested, was presented to optimize the proteolysis acquisition of NBAPs. Therein, SSA-LSTM reached the highest Efficiency value reached 98.00 % compared to traditional machine learning algorithms, and basic LSTM algorithm. SSA-LSTM was trained to predict the activity of peptides in the proteins virtually digested results, obtain the percentage of target active peptide, and select the appropriate protease for the actual experiment. As an application, SSA-LSTM was employed to predict the percentage of neuroprotective peptides in the virtual digested result of walnut protein, and trypsin was ultimately found to possess the highest value (85.29 %). The walnut protein was digested by trypsin (WPTrH) and the peptide sequence obtained was analyzed closely matches the theoretical neuroprotective peptide. More importantly, the neuroprotective effects of WPTrH had been demonstrated in nerve damage mouse models.

SIGNIFICANCE

The proposed SSA-LSTM-VD in this paper makes the acquisition of NBAPs efficient and accurate. The approach combines deep learning and virtually digested skillfully. Utilizing the SSA-LSTM-VD based strategy holds promise for discovering and developing peptides with neuroprotective properties or other desired biological activities.

Choosing the optimal target area for repeated transcranial magnetic stimulation in treating neuropathic pain in spinal cord injury patients: a comparative analysis

Objective

The specific target area of repeated transcranial magnetic stimulation (rTMS) in treating neuropathic pain resulting from spinal cord injury (SCI-NP) remains uncertain.

Methods

Thirty-four participants with SCI-NP were allocated into three groups, namely, the motor cortex (M1, A) group, the left dorsolateral prefrontal cortex (LDLPFC, B) group, and the control (sham stimulation, C) group. The intervention was administered totally 10 times. Outcome measures assessed pre-(T0) and post-(T1)intervention, including Numerical Rating scale (NRS), anxiety (SAS), depression (SDS), sleep quality (PSQI), brief pain inventory (BPI), and impression of change.

Results

All outcomes in groups A and B significantly changed after intervention (p < 0.05), and the delta value (T1-T0) also significantly changed than group C (p < 0.05). The delta value of SDS in the group B was better than the group A, and the change of pain degree in the group B was moderately correlated with the change in PSQI (r = 0.575, p < 0.05). Both patients in the groups A and B showed significant impression of change about their received therapy (p < 0.05).

Conclusion

Both targets are effective, but LDLPFC is more effective in reducing depression in SCI-NP. Healthcare providers might select the suitable area according to the specific attributes of their patients.

Cognitive and emotional impairment in stroke survivors: insights from a multi-center study on inpatient rehabilitation therapy

BACKGROUND

Individuals recovering from stroke often experience cognitive and emotional impairments, but rehab programs tend to focus on motor skills. The aim of this investigation is to systematically assess the change of magnitude of cognitive and emotional function subsequent to a conventional rehabilitative protocol administered to stroke survivors within a defined locale in China.

METHODS

This is a multicenter study; a total of 1884 stroke survivors who received in-hospital rehabilitation therapy were assessed on admission (T0) and discharge (T1). The tool of InterRAI was used to assess cognitive, emotional, and behavioral abnormality.

RESULTS

The patients aged >60 years, with a history of hypertension, and long stroke onset duration were more exposed to functional impairment (all p < 0.05). Both cognitive and emotional sections were significantly improved at T1 compared to T0 (p < 0.001). Initially, 64.97% and 46.55% of patients had cognitive or emotional impairment at T0, respectively; this percentage was 58.55% and 37.15% at T1.

CONCLUSION

Many stroke survivors have ongoing cognitive and emotional problems that require attention. It is essential to focus on rehabilitating these areas during the hospital stay, especially for older patients, those with a longer recovery, and those with hypertension history.

[Exploration of the method and efficacy of treatments for intractable pelvic pain caused by rectal or bladder fistula]

Objective: To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments). Methods: A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed. Results: Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment (P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments (P＜0.001). Conclusions: Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

Observation on efficacy and underlying mechanism of cheek acupuncture on ovulation induction for infertile women with PCOS: Case series

RATIONALE

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women of childbearing age and is the primary cause of anovulatory infertility, accounting for 70% to 80% of cases. Ovulation induction is the main treatment approach for infertile patients with PCOS. Commonly utilized medications for this purpose are clomiphene citrate (CC) and letrozole (LE). Clomiphene citrate administration results in an ovulation rate ranging from 60% to 85%, while the pregnancy rate is limited to 35% to 40%, and a further reduction is observed in live birth rates. Letrozole demonstrates a slightly higher pregnancy rate and live birth rate compared to clomiphene citrate, although challenges persist in terms of longer stimulation cycles, multiple pregnancies, and the risk of ovarian hyperstimulation syndrome (OHSS). Clinical reports indicate that acupuncture therapy shows promising efficacy in treating patients with PCOS-related infertility, despite a partially unclear understanding of its underlying mechanisms.

PATIENT CONCERNS

In this study, one patient did not achieve pregnancy despite more than a year of ovulation induction using clomiphene citrate and letrozole. However, after 3 months of receiving cheek acupuncture therapy, she successfully conceived and gave birth to a liveborn baby. Another patient achieved natural conception and live birth after 2 months of exclusive cheek acupuncture therapy.

DIAGNOSIS

PCOS.

INTERVENTIONS

Cheek acupuncture therapy.

OUTCOMES

Both of them successfully conceived and gave birth to a liveborn baby.

LESSONS

These findings suggest that cheek acupuncture therapy can effectively stimulate follicle development and ovulation, potentially improving endometrial receptivity. According to holographic theory, there is a biologically holographic model within the cheek region that shares a homology with the human body structure. This model provides an explanation for the regulatory effects of cheek acupuncture point stimulation on the Hypothalamic-Pituitary-Ovarian axis (HPO), which subsequently influences follicle development and ovulation in patients. Consequently, when cheek acupuncture therapy is applied alone or in combination with ovulation induction medication, patients have the ability to achieve successful pregnancy and experience a smooth delivery.

Edge State, Band Topology, and Time Boundary Effect in the Fine-Grained Categorization of Chern Insulators

We predict novel topological phases with broken time-reversal symmetry supporting the coexistence of opposite chiral edge states, which are fundamentally different from the photonic spin-Hall, valley-Hall, and higher-order topological phases. We find a fine-grained categorization of Chern insulators, their band topologies characterized by identical Chern numbers are completely different. Furthermore, we prove that different topologies cause zeros in their Bloch wave function overlaps, which imprint the band gap closing and appear at the degenerate points of topological phase transition. The Bloch wave function overlaps predict the reflection and refraction at a topological time boundary, and the overlap zeros ensure the existence of vanishing revival amplitude at critical times even though different topologies before and after the time boundary have identical Chern numbers. Our findings create new opportunities for topological metamaterials, uncover the topological feature hidden in the time boundary effect as a probe of topology, and open a venue for the exploration of the rich physics originating from the long-range couplings.

Effects of an Akt-activating peptide obtained from walnut protein degradation on the prevention of memory impairment in mice

Akt acts as a central protein influencing multiple pathologies in neurodegenerative diseases including AD and PD, and using Akt activators is a promising management strategy. The current study characterized the effects of an Akt-activating peptide (Glu-Pro-Glu-Val-Leu-Pro, EPEVLR) obtained from walnut protein degradation on D-gal-induced memory impairment in mice. EPEVLR was obtained by hydrolysis of walnut proteins, identification of peptide sequences, and screening for molecular docking sequentially. The MWM test in mice indicated that the oral administration of EPEVLR (80, 200 and 400 mg per kg per day) significantly (p < 0.05) reversed D-gal-induced memory impairment. WB tests of the mouse hippocampus confirmed that EPEVLR could activate Akt by promoting its phosphorylation. In addition, further characterization (including TEM, ELISA, and immunohistochemistry) related to Akt phosphorylation showed lower Aβ and p-tau levels, as well as more autophagosomes than those in the model group. Moreover, the EPEVLR treatment significantly increased Lactobacillus abundance and reduced Helicobacter abundance in the gut microbiome and caused up-regulation of SCFAs and down-regulation of LPS of serum metabolites. Therefore, EPEVLR ingestion reversed cognitive impairment symptoms, possibly related to the activation of Akt and regulation of the intestinal flora pathway. Consumption of an EPEVLR-containing diet is beneficial for treating cognitive dysfunction.

[Clinical study of 15 cases of primary non-immunodeficient central nervous system lymphoma in children]

Clinical data of 15 primary central nervous system lymphoma (PCNSL) children aged ≤18 years admitted to our hospital between May 2013 to May 2023 were retrospectively analyzed. Our goal was to summarize the clinical features of children and investigate the therapeutic effect of a high-dose methotrexate (HD-MTX) based chemotherapy regimen on this disease. The male-to-female ratio was 2.7∶1, and the median age was 7.2 (2.3-16.4) years at diagnosis. The initial clinical symptoms were primarily cranial hypertension, with imaging findings revealing multiple lesions. Pediatric PCNSL with normal immune function has a favorable prognosis with HD-MTX-based chemotherapy. Patients with a stable disease can be treated with minimal or no maintenance. HD-MTX-based chemotherapy remains effective when the disease progresses or recurs after an initial course of non-HD-MTX-based chemotherapy.

Pharmacological profiling of a berbamine derivative for lymphoma treatment

ABSTRACT

Ca2+/calmodulin-dependent protein kinase II γ (CAMKIIγ) has been identified as a potential target for treating cancer. Based on our previous study of berbamine (BBM) as a CAMKIIγ inhibitor, we have synthesized a new BBM derivative termed PA4. Compared with BBM, PA4 showed improved potency and specificity and was more cytotoxic against lymphoma and leukemia than against other types of cancer. In addition to indirectly targeting c-Myc protein stability, we demonstrated that its cytotoxic effects were also mediated via increased reactive oxygen species production in lymphoma cells. PA4 significantly impeded tumor growth in vivo in a xenograft T-cell lymphoma mouse model. Pharmacokinetics studies demonstrated quick absorption into plasma after oral administration, with a maximum concentration of 1680 ± 479 ng/mL at 5.33 ± 2.31 hours. The calculated oral absolute bioavailability was 34.1%. Toxicity assessment of PA4 showed that the therapeutic window used in our experiments was safe for future development. Given its efficacy, safety, and favorable pharmacokinetic profile, PA4 is a potential lead candidate for treating lymphoma.

[Development of dental robot implantation technology]

With the advancement of technology, intelligent technology has achieved unprecedented progress and breakthroughs in various fields. Dental implant robots represent a significant leap in the field of dental medical technology. This article aims to review the development of dental robot implantation technology both domestically and internationally, to compare the similarities and differences between existing dental implant methods and robotic implantation, to analyze the characteristics and current applications of robotic implantation technology, and to provide a forward-looking perspective. This review summarized 63 literatures and compared 1 176 implants, dental robot implantation demonstrates significant advantages in terms of precision, efficiency, and minimally invasive procedures. It effectively addresses issues such as implant position deviation, limited surgical visibility, and restricted operating space associated with traditional implantation methods. With widespread adoption in the future, it may reduce the overall technological expenses, and optimize its advantages and potential benefits.

Sanji Peiyuan decoction combined with dydrogesterone in the treatment of massive subchorionic hematoma: A case report

RATIONALE

Subchorionic Hematoma, often referred to as Bruce hematoma, can lead to serious obstetric complications such as intrauterine growth restriction and fetal death, as well as early and late pregnancy miscarriage, placental abruption, and premature rupture of membranes, posing great harm to both mother and fetus.

PATIENT CONCERNS

At present, Western medical treatments have not shown satisfactory results, necessitating the discovery of more effective clinical treatment methods.

DIAGNOSES

Threatened miscarriage, Subchorionic hematoma, Iron deficiency anemia (mild).

INTERVENTIONS

Sanji Peiyuan decoction combined with dydrogesterone.

OUTCOMES

Following 17 days of treatment with Sanji Peiyuan decoction and oral dydrogesterone tablets, the hematoma was no longer detectable by ultrasound. The patient experienced no symptoms such as abdominal pain, bloating, or vaginal bleeding. She successfully gave birth around her due date, with both the mother and child in good health.

LESSONS

The combination of Sanji Peiyuan decoction and oral dydrogesterone tablets shows promising clinical efficacy in treating Massive Subchorionic Hematomas. This method merits further clinical research.

Treatment of lactational mastitis with Gualou Xiaoyong soup and painless lactation promoting technique: A case series

BACKGROUND

Lactational mastitis is a common and frequently disease in clinical practice, characterized by acute inflammation of the mammary ducts and surrounding connective tissues. The main manifestations are damage to the mammary gland acini, edema, and invasion of inflammatory cells. If not treated properly, it may lead to the formation of breast abscesses, or even sepsis, septic shock, and chronic inflammation of the breast, which may cause the disease to persist or recur multiple times, so that the patients suffer extreme pain, and the health of both the mother and child are directly affected. This disease not only causes suffering for women but also may result in the cessation of breastfeeding. Therefore, rapid and effective treatment is particularly important.

CASE SUMMARY

We report 3 cases of lactation mastitis patients showing good clinical efficacy after being treated with the Chinese medicine Gualou Xiaoyong soup and painless lactation promoting techniques. Gualou Xiaoyong soup combined with painless lactation promotion techniques can significantly reduce and eliminate the clinical symptoms of patients in the short term, and rapidly restore inflammatory indicators such as total white blood cells, neutrophils, C-reactive protein, and procalcitonin to normal levels. The patchy low echo area of the breast under B-ultrasound also disappears quickly. Therefore, we believe that this method is a good way to treat lactational mastitis and is worthy of clinical reference and research. However, this study has certain limitations: this study lacks a large sample of prospective controlled studies. Next, we will continue to collect relevant cases and conduct prospective case randomized controlled clinical studies.

CONCLUSION

The treatment of lactation mastitis with Gualou Xiaoyong soup and painless lactation promoting techniques can achieve good clinical results.

American Heart Association's new 'Life's Essential 8' score in association with cardiovascular disease: a national cross-sectional analysis

OBJECTIVE

The American Heart Association (AHA) has recently updated and enhanced the quantification of cardiovascular health by using the Life's Essential 8 (LE8) score. We intended to examine the correlation between cardiovascular health status, as measured by the new LE8 score, and cardiovascular disease (CVD) in US adults.

STUDY DESIGN

National cross-sectional study.

METHODS

A total of 24,730 individuals without pregnancy and with complete data from 2007 to 2018 enrolled in the study. The overall LE8 score was divided into low, moderate, and high groups. Multivariate logistic regressions were used to assess the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the LE8 score and the presence of CVD.

RESULTS

Overall, the high LE8 group had a younger age (20-59 years, 82.95%) and more females (60.09%) compared to the low LE8 group. Moderate and high LE8 correlated negatively with the presence of CVD (moderate, OR: 0.46, 95% CI: 0.39-0.54; high, OR: 0.26, 95% CI: 0.21-0.33). One standard deviation increment in the LE8 score correlated significantly with lower odds of CVD (OR: 0.64; 95% CI: 0.60-0.69). Further stratification analysis also detected a significant relationship between the new LE8 score and CVD, and the result was enhanced among the young and women (P-interaction<0.001).

CONCLUSIONS

Higher LE8 score correlated with lower odds of CVD, especially among the young and women.

Endothelial-dependent relaxation of α-pinene and two metabolites, myrtenol and verbenol, in isolated murine blood vessels

Epidemiological evidence shows that residential proximity to greenspaces is associated with lower risk of all-cause and cardiovascular mortality; however, the mechanism(s) underlying this link remains unclear. Plants emit biogenic volatile organic compounds such as α-pinene that could elicit beneficial cardiovascular effects. To explore the role of α-pinene more directly, we studied the metabolism and the vascular effects of α-pinene. We found that exposure of mice to α-pinene (1 ppm, 6 h) generated two phase I oxidation metabolites, cis- and trans-verbenol [(1R,2R,5R)-verbenol and (1 R,2S,5R)-verbenol)] and myrtenol [(1S,5R)-(+)-myrtenol] that were identified in urine by GC-MS. Precontracted naïve murine male and female aorta and superior mesenteric artery (SMA) were relaxed robustly (60% tension reduction) by increasing concentrations of α-pinene, myrtenol, and verbenol to 0.3 mM, whereas 1 mM α-pinene was vasotoxic. The SMA was six times more sensitive than the aorta to α-pinene. Both myrtenol and verbenol were equally potent and efficacious as parent α-pinene in male and female SMA. The sensitive portion of the α-pinene-, myrtenol-, and verbenol-induced relaxations in male SMA was mediated by 1) endothelium, 2) eNOS-derived NO, and 3) guanylyl cyclase (GC) activity. Moreover, α-pinene activated the transient receptor potential ankyrin-1 (TRPA1) channel whereas the metabolites did not. Endothelial-derived NO regulates blood flow, blood pressure, and thrombosis, and it is plausible that inhaled (and ingested) α-pinene (or its metabolites) augments NO release to mediate the cardiovascular benefits of exposure to greenness.NEW & NOTEWORTHY A common plant-derived biogenic volatile organic compound, α-pinene, and two of its metabolites, myrtenol and verbenol, stimulate vasorelaxation in murine superior mesenteric artery. Both α-pinene- and its metabolites induce vasorelaxation by activation of the endothelium, nitric oxide, and guanylyl cyclase. α-Pinene also activates the transient receptor potential ankyrin-1. Positive associations between greenness exposure and human cardiovascular health may be a result of the vascular action of α-pinene and its metabolites, a novel consideration.

SARS-CoV-2 HaploGraph: visualization of SARS-CoV-2 haplotype spread in Japan

Since the early phase of the coronavirus disease 2019 (COVID-19) pandemic, a number of research institutes have been sequencing and sharing high-quality severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes to trace the route of infection in Japan. To provide insight into the spread of COVID-19, we developed a web platform named SARS-CoV-2 HaploGraph to visualize the emergence timing and geographical transmission of SARS-CoV-2 haplotypes. Using data from the GISAID EpiCoV database as of June 4, 2022, we created a haplotype naming system by determining the ancestral haplotype for each epidemic wave and showed prefecture- or region-specific haplotypes in each of four waves in Japan. The SARS-CoV-2 HaploGraph allows for interactive tracking of virus evolution and of geographical prevalence of haplotypes, and aids in developing effective public health control strategies during the global pandemic. The code and the data used for this study are publicly available at: https://github.com/ktym/covid19/.

[Clinical study of mature B-cell lymphoma in 11 children with chromosome 11 long-arm abnormalities]

Objective: To explore the clinical, pathological, diagnostic, treatment, and prognostic features of children with mature B-cell lymphoma (MBCL) . Methods: This retrospective study included pediatric patients with MBCL with chromosome 11 long-arm abnormalities who were diagnosed and treated at our hospital from December 2018 to February 2023. Results: Among the 11 pediatric patients with MBCL, nine were male and two were female, with a median age of 9 (2-13) years and a median disease course of 1.8 (0.5-24) months. The clinical manifestations were cervical lymph node enlargement in four patients, nasal congestion and snoring in four patients, abdominal pain in two patients, and difficulty breathing in one patient. There were seven cases of Burkitt's lymphoma, two of follicular lymphoma, and two of advanced B-cell lymphoma according to the pathological morphology examination. No patients had central nervous system or bone marrow involvement, and no extensive metastasis was observed on B-ultrasound or positron emission tomography-computed tomography (PET/CT). One patient had a huge tumor lesion. The Revised International Pediatric Non-Hodgkin Lymphoma Staging System classified four patients as stage Ⅱ, five as stage Ⅲ, and two as stage Ⅳ. 11q probe detection showed five cases of 11q gain, three of 11q loss, and three of both gain and loss. FISH showed positive MYC expression in three patients, including eight with advanced B-cell lymphoma with 11q abnormalities and three with Burkitt's lymphoma with 11q abnormalities. According to the 2019 edition of the National Health Commission's diagnostic and treatment guidelines for invasive MBCL in children, one patient was classified as Group A, two as Group B, and eight as Group C. Early evaluation of the efficacy showed complete remission. After mid-term evaluation, the intensity of chemotherapy was reduced in Group B and Group C. Among two cases of chemotherapy, the remaining nine cases had a median follow-up of 32 (6-45) months, and none had event-related survival. Conclusion: The incidence of MBCL with 11q abnormalities in children is low, clinical symptoms are mild, and progression is slow. The absence of MYC, BCL2, BCL6 rearrangements, C-MYC negative and 11q abnormalities on FISH is an important diagnostic indicator, and reducing the intensity of chemotherapy can improve prognosis.

Relativistic ultrafast electron diffraction at high repetition rates

The ability to resolve the dynamics of matter on its native temporal and spatial scales constitutes a key challenge and convergent theme across chemistry, biology, and materials science. The last couple of decades have witnessed ultrafast electron diffraction (UED) emerge as one of the forefront techniques with the sensitivity to resolve atomic motions. Increasingly sophisticated UED instruments are being developed that are aimed at increasing the beam brightness in order to observe structural signatures, but so far they have been limited to low average current beams. Here, we present the technical design and capabilities of the HiRES (High Repetition-rate Electron Scattering) instrument, which blends relativistic electrons and high repetition rates to achieve orders of magnitude improvement in average beam current compared to the existing state-of-the-art instruments. The setup utilizes a novel electron source to deliver femtosecond duration electron pulses at up to MHz repetition rates for UED experiments. Instrument response function of sub-500 fs is demonstrated with < 100 fs time resolution targeted in future. We provide example cases of diffraction measurements on solid-state and gas-phase samples, including both micro- and nanodiffraction (featuring 100 nm beam size) modes, which showcase the potential of the instrument for novel UED experiments.

Rate-dependent stress-order coupling in main-chain liquid crystal elastomers

Liquid crystal elastomers (LCEs) exhibit significant viscoelasticity. Although the rate-dependent stress-strain relation of LCEs has already been widely observed, the effect of the intricate interplay of director rotation and network extension on the viscoelastic behavior of main-chain LCEs remains inadequately understood. In this study, we report real-time measurements of the stress, director rotation, and all strain components in main-chain nematic LCEs subjected to uniaxial tension both parallel and tilted to the initial directors at different loading rates and relaxation tests. We find that both network extension and director rotation play roles in viscoelasticity, and the characteristic relaxation time of the network extension is much larger than that of the director rotation. Interestingly, the gradual change of the director in a long-time relaxation indicates the director reorientation delay is not solely due to the viscous rotation of liquid crystals but also arises from its coupling with the highly viscous network. Additionally, significant rate-dependent shear strain occurs in LCEs under uniaxial tension, showing non-monotonic changes when the angle between the stretching and the initial director is large enough. Finally, a viscoelastic constitutive model, only considering the viscosity of the network by introducing multiplicative decomposition of the deformation gradient, is utilized to manifest the relation between rate-dependent macroscopic deformation and microscopic director rotation in LCEs.

Current status of rehabilitation services and problems in Yunnan Province, Southwest China: a general doctors' questionnaire-based study

OBJECTIVES

Community-based hospitals in China lack physicians, especially rehabilitation physicians. Recently, several financial resources have been developed to prepare general doctors for community-based hospitals. These doctors seem to be the best choices for assuming the role of a rehabilitation physician. However, their willingness and in-depth information from their perspectives have not been previously investigated.

MATERIALS AND METHODS

We conducted a general investigation of rehabilitation resources in Yunnan, a province located in Southwest China with a population of more than 40 million. Our investigation covered the entire Yunnan Province from December 2020 to May 2022. The questionnaire was administered to 670 general doctors in 112 community hospitals randomly selected in Yunnan Province based on their willingness to assume the role of rehabilitation physicians and obstructive factors to process the rehabilitation services. The reliability and validity of the questionnaire were evaluated, and items regarding their general condition were analyzed.

RESULTS

Cronbach's alpha and Kaiser-Meyer-Olkin values were 0.748 and 0.729, respectively. The measure comprises four factors: common disease, demand for training to improve skills, subjective/objective factors, and proactivity to recommend rehabilitation therapy. More than 20% of general doctors were unwilling to take on the role of rehabilitation physicians, and their willingness was related to satisfaction with their current job, comprehension of community-based rehabilitation, and comprehension of government support (p < .05).

CONCLUSIONS

From the perspective of general doctors, the reimbursement rate for medical insurance, which burdens patients, is the greatest problem in the process of developing community-based hospital rehabilitation services. Offering professional training to increase their capacity and developing common practices to increase doctors' proactivity to recommend rehabilitation therapy may help increase the future support of medical insurance and increase general doctors' willingness to take on the role of a rehabilitation physician.

[Early results of modified Bikini approach periacetabular osteotomy for the treatment of developmental hip dysplasia under 50 years of age]

Objective: To investigate the efficacy and safety of modified Bikini approach periacetabular osteotomy in the treatment of developmental hip dysplasia under 50 years of age. Methods: The clinical data of 39 patients with developmental hip dysplasia who underwent periacetabular osteotomy in the Department of Orthopedics, Guizhou Provincial People's Hospital from June 2016 to June 2021 were retrospectively analyzed.Among them, 20 patients (21 hips) underwent the improved Bikini approach (study group) and 19 patients (20 hips) underwent the improved Smith-Petersen approach (control group).In the study group, there were 3 males and 17 females, aged(M(IQR))27.5 (14.3) years (range:11 to 44 years).In the control group, there were 2 males and 17 females, aged 27.5 (19.3) years (range:17 to 47 years).Both groups were sutured in the same manner by the same physician.Incision length, operation time, intraoperative blood loss and complications were recorded.X-ray images, anterior central marginal angle (ACE), lateral central marginal Angle (LCE) and acetabulum tilt angle (Tonnis AI) were measured before and after the operation.The coverage rate of acetabulum to femoral head (AHI) was measured and calculated, and the healing time was observed.Harris Hip score, International Hip score (IHOT)-12 and visual analogue scale (VAS) were recorded before and after surgery.Vancouver Scar Scale (VSS) score and patient and observer scar assessment scale (POSAS) score were recorded 12 months after surgery.The independent sample t test,Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the clinical efficacy between the two groups. Results: All patients successfully completed the operation.There was no significant difference in operation time and intraoperative blood loss between the two groups (all P>0.05).The incision length of the study group was smaller than that of the control group, and the difference was statistically significant (10.5(5.0)cm vs.15.0(3.0),W=309.000,P=0.007).Patients were followed up for (19.1±11.1) months (range:12 to 60 months).Femoral nerve stretching injury occurred in 2 cases and sciatic branch fracture occurred in 1 case in the study group, all of which recovered to normal at 3 months follow-up, while no corresponding injury occurred in the control group.Lateral femoral cutaneous nerve injury occurred in 3 cases in the study group and 2 cases in the control group.Delayed wound healing occurred in 1 case in each of the two groups, and both healed after re-operation debridement and suture.Pubic branch nonunion occurred in 4 patients in the study group and 5 patients in the control group.There were no serious complications such as sciatic nerve and femoral blood vessel injury between the 2 groups, and there was no statistical significance in the incidence of complications between the 2 groups (52.4%(11/21)vs.40.0%(8/20),χ2=0.631,P=0.427).The clinical healing time of the patient was (4.5±1.3) months after surgery (range:3.0 to 8.0 months).There were no significant differences in ACE, LCE, Tonnis AI and AHI between the 2 groups (all P>0.05).At the last follow-up, there were no significant differences in VAS,Harris hip score and IHOT-12 score between the two groups (all P>0.05).The incision scars in the study group were smaller than those in the control group, and the differences in VSS and POSAS were statistically significant (all P<0.05). Conclusion: Compared with the improved Smith-Petersen approach, the improved Bikini approach has the same early clinical efficacy in the treatment of patients with developmental hip dysplasia under the age of 50, and has the advantages of smaller postoperative incision scars, more hidden and beautiful incision, and no serious complications, which is worthy of further study and promotion.

[Research progress and future trends on neurosurgical robots]

Brain surgery requires high flexibility,accuracy,safety,and stability.With radiographic imaging and navigation development,robots have been introduced into neurosurgery.Nowadays,domestic stereotactic surgical robots in China have made significant advancements,which are widely utilized in frameless stereotactic surgeries,including electrode implantation,intracranial biopsy and aspiration drainage.On the international front,classic stereotactic robots dominate the mainstream market.Additionally,emerging magnetic resonance-compatible robots incorporate intelligent techniques such as tremor filtering,motion scaling,obstacle avoidance,and force sensing.The specific future research in the field of neurosurgical robotics will focus on several key areas,such as precise perception,artificial intelligence,telesurgery,and magnetic resonance compatibility for space,materials,driving and imaging.

[The impact of extended waiting time on tumor regression after neoadjuvant chemoradiotherapy for locally advanced rectal cancer]

Objective: To investigate the influence of extending the waiting time on tumor regression after neoadjuvant chemoradiology (nCRT) in patients with locally advanced rectal cancer (LARC). Methods: Clinicopathological data from 728 LARC patients who completed nCRT treatment at the First Affiliated Hospital, Naval Medical University from January 2012 to December 2021 were collected for retrospective analysis. The primary research endpoint was the sustained complete response (SCR). There were 498 males and 230 females, with an age (M(IQR)) of 58 (15) years (range: 22 to 89 years). Logistic regression models were used to explore whether waiting time was an independent factor affecting SCR. Curve fitting was used to represent the relationship between the cumulative occurrence rate of SCR and the waiting time. The patients were divided into a conventional waiting time group (4 to <12 weeks, n=581) and an extended waiting time group (12 to<20 weeks, n=147). Comparisons regarding tumor regression, organ preservation, and surgical conditions between the two groups were made using the t test, Wilcoxon rank sum test, or χ2 test as appropriate. The Log-rank test was used to elucidate the survival discrepancies between the two groups. Results: The SCR rate of all patients was 21.6% (157/728). The waiting time was an independent influencing factor for SCR, with each additional day corresponding to an OR value of 1.010 (95%CI: 1.001 to 1.020, P=0.031). The cumulative rate of SCR occurrence gradually increased with the extension of waiting time, with the fastest increase between the 10th week. The SCR rate in the extended waiting time group was higher (27.9%(41/147) vs. 20.0%(116/581), χ2=3.901, P=0.048), and the organ preservation rate during the follow-up period was higher (21.1%(31/147) vs. 10.7%(62/581), χ2=10.510, P=0.001). The 3-year local recurrence/regrowth-free survival rates were 94.0% and 91.1%, the 3-year disease-free survival rates were 76.6% and 75.4%, and the 3-year overall survival rates were 95.6% and 92.2% for the conventional and extended waiting time groups, respectively, with no statistical differences in local recurrence/regrowth-free survival, disease-free survival and overall survival between the two groups (χ2=1.878, P=0.171; χ2=0.078, P=0.780; χ2=1.265, P=0.261). Conclusions: An extended waiting time is conducive to tumor regression, and extending the waiting time to 12 to <20 weeks after nCRT can improve the SCR rate and organ preservation rate, without increasing the difficulty of surgery or altering the oncological outcomes of patients.

Clinical efficacy of Gualou Xiaoyong Decoction and painless lactation manipulation in treating lactation acute mastitis and breast abscess: An observational study

Information on the effects of Chinese medicine in the treatment of lactational acute mastitis and breast abscess is limited; thus, we conducted an observational study to analyze the clinical efficacy of Gualou Xiaoyong Decoction combined with painless lactation manipulation in the treatment of lactational acute mastitis and breast abscess. A total of 41 patients with lactational acute mastitis and breast abscess who were treated with Gualou Xiaoyong Decoction and painless lactation manipulation from October 2021 to October 2022 were included in this study. The age, fetal times(primiparous/multiparous), delivery mode (cesarean section/vaginal delivery), onset time, breast lump diameter, skin rash diameter, body temperature, visual analogue score, blood routine, C-reactive protein, procalcitonin, bacterial culture in milk, B ultrasound and other data of these patients were statistically analyzed. After treatment, the breast lump diameter of these patients decreased significantly, the skin rash diameter was reduced or disappeared, the body temperature decreased or returned to a normal range, and the visual analogue score also decreased. Besides, these patients had a decreased total number of white blood cells and a reduced percentage of neutrophils, C-reactive protein, and procalcitonin after treatment. In addition, bacteria in the milk of most patients disappeared, and there was no abnormality in B ultrasonic imaging. Except for 2 patients with breast abscess who stopped breastfeeding on the affected side for 1 day and 3 days respectively, all other patients continued to provide breast milk for their infants, and no adverse reactions were observed in these infants. The combination of Gualou Xiaoyong Decoction and painless lactation manipulation can achieve favorable clinical effects in the treatment of lactational acute mastitis and breast abscess. This combined therapy has good efficacy, short course of treatment, low costs, and great convenience with the avoidance of pain, hospitalization, influence on lactation, breast scar and other adverse outcomes.

Achieving tissue-level softness on stretchable electronics through a generalizable soft interlayer design

Soft and stretchable electronics have emerged as highly promising tools for biomedical diagnosis and biological studies, as they interface intimately with the human body and other biological systems. Most stretchable electronic materials and devices, however, still have Young's moduli orders of magnitude higher than soft bio-tissues, which limit their conformability and long-term biocompatibility. Here, we present a design strategy of soft interlayer for allowing the use of existing stretchable materials of relatively high moduli to versatilely realize stretchable devices with ultralow tissue-level moduli. We have demonstrated stretchable transistor arrays and active-matrix circuits with moduli below 10 kPa-over two orders of magnitude lower than the current state of the art. Benefiting from the increased conformability to irregular and dynamic surfaces, the ultrasoft device created with the soft interlayer design realizes electrophysiological recording on an isolated heart with high adaptability, spatial stability, and minimal influence on ventricle pressure. In vivo biocompatibility tests also demonstrate the benefit of suppressing foreign-body responses for long-term implantation. With its general applicability to diverse materials and devices, this soft-interlayer design overcomes the material-level limitation for imparting tissue-level softness to a variety of bioelectronic devices.

Bile Acids, Intestinal Barrier Dysfunction, and Related Diseases

The intestinal barrier is a precisely regulated semi-permeable physiological structure that absorbs nutrients and protects the internal environment from infiltration of pathological molecules and microorganisms. Bile acids are small molecules synthesized from cholesterol in the liver, secreted into the duodenum, and transformed to secondary or tertiary bile acids by the gut microbiota. Bile acids interact with bile acid receptors (BARs) or gut microbiota, which plays a key role in maintaining the homeostasis of the intestinal barrier. In this review, we summarize and discuss the recent studies on bile acid disorder associated with intestinal barrier dysfunction and related diseases. We focus on the roles of bile acids, BARs, and gut microbiota in triggering intestinal barrier dysfunction. Insights for the future prevention and treatment of intestinal barrier dysfunction and related diseases are provided.

Gell: A GPU-powered 3D hybrid simulator for large-scale multicellular system

As a powerful but computationally intensive method, hybrid computational models study the dynamics of multicellular systems by evolving discrete cells in reacting and diffusing extracellular microenvironments. As the scale and complexity of studied biological systems continuously increase, the exploding computational cost starts to limit large-scale cell-based simulations. To facilitate the large-scale hybrid computational simulation and make it feasible on easily accessible computational devices, we develop Gell (GPU Cell), a fast and memory-efficient open-source GPU-based hybrid computational modeling platform for large-scale system modeling. We fully parallelize the simulations on GPU for high computational efficiency and propose a novel voxel sorting method to further accelerate the modeling of massive cell-cell mechanical interaction with negligible additional memory footprint. As a result, Gell efficiently handles simulations involving tens of millions of cells on a personal computer. We compare the performance of Gell with a state-of-the-art paralleled CPU-based simulator on a hanging droplet spheroid growth task and further demonstrate Gell with a ductal carcinoma in situ (DCIS) simulation. Gell affords ~150X acceleration over the paralleled CPU method with one-tenth of the memory requirement.

Multi-dimensional deep learning drives efficient discovery of novel neuroprotective peptides from walnut protein isolates

Neurodegenerative diseases, such as Alzheimer's and Parkinson's, are multi-factor induced neurological disorders that require management from multiple pathologies. The peptides from natural proteins with diverse physiological activity can be candidates as multifunctional neuroprotective agents. However, traditional methods for screening neuroprotective peptides are not only time-consuming and laborious but also poorly accurate, which makes it difficult to effectively obtain the needed peptides. In this case, a multi-dimensional deep learning model called MiCNN-LSTM was proposed to screen for multifunctional neuroprotective peptides. Compared to other multi-dimensional algorithms, MiCNN-LSTM reached a higher accuracy value of 0.850. The MiCNN-LSTM was used to acquire candidate peptides from walnut protein hydrolysis. Following molecular docking, behavioral and biochemical index experimental validation eventually found 4 hexapeptides (EYVTLK, VFPTER, EPEVLR and ELEWER) demonstrating excellent multifunctional neuroprotective properties. Therein, EPEVLR performed the best and can be investigated in depth as a multifunctional neuroprotective agent. This strategy will greatly improve the efficiency of screening multifunctional bioactive peptides, and it will be beneficial for the development of food functional peptides.

[Association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid and preterm delivery in women]

OBJECTIVE

To explore the association between periconceptional supplementation of folic acid or multiple-micronutrients containing folic acid(MMFA) and risk of preterm delivery in women with natural conception, singleton pregnancy and vaginal delivery.

METHODS

A retrospective cohort study was performed based on the prenatal health care system and hospital information system of Tongzhou Maternal and Child Health Hospital of Beijing and the women who had their prenatal care in the hospital from January 2015 to December 2018 were included. The information of 16 332 women who conceived naturally, had a singleton pregnancy, and delivered vaginally was collected. Compliance scores were constructed based on the time of initiation and the frequency of taking nutritional supplements. The association between maternal periconceptional micronutrient supplementation, including pure folic acid (FA) pills or MMFA and the rate of preterm delivery was evaluated using Logistic regression models.

RESULTS

The preterm delivery rate (gestational week < 37 weeks) of the study population was 3.8%, and the mean (standard deviation) of gestational age was (38.98±1.37) weeks. A total of 6 174 (37.8%) women took FA during the periconceptional period, 8 646 (52.9%) women took MMFA, and 1 512 (9.3%) women did not take any nutritional supplements. The association between periconceptional supplementation of FA or MMFA and risk of preterm delivery in women was not statistically significant [adjusted odds ratio (aOR)=1.01, 95%CI: 0.74-1.37]. The associations with preterm birth were not statistically significant in further analysis by the type of nutritional supplements, time of initiation, and the frequency of supplementation. In addition, the association between the compliance score of taking supplements and the rate of preterm delivery was not statistically significant, either.

CONCLUSION

This study did not find an association between the risk of preterm delivery and the use of FA or MMFA during the periconcep-tional period in women with natural conception, singleton pregnancy, and vaginal delivery. In the future, multicenter studies with large-scale prospective cohort or population-based randomized controlled trials are warranted to confirm the association between taking FA or MMFA during the periconceptional period and preterm delivery among women.

Comparison of higher-order aberrations between implantable collamer lens V4c implantation and simulated spectacle correction in patients with high myopia

PURPOSE

To investigate the differences in higher-order aberrations between non-toric or toric implantable collamer lens (ICL or TICL) V4c implantation and simulated spectacle correction.

METHODS

Patients with high myopia who underwent ICL/TICL V4c implantation were enrolled. The "total no defocus" pattern of iTrace aberrometry to simulate the condition of spectacle correction was measured before ICL/TICL implantation, and higher-order aberrations in this condition were compared to those 3 months after surgery. Related factors with changes in coma were comprehensively analyzed.

RESULTS

A total of 89 right eyes of 89 patients were included. Compared to simulated spectacle correction, total-eye coma (P<0.0001 ICL, P<0.0001 TICL) and internal coma (P<0.0001 ICL, P<0.001 TICL) decreased in the ICL- and TICL-treated groups after surgery. Total-eye secondary astigmatism (P<0.0001 ICL, P=0.007 TICL) and internal secondary astigmatism (P<0.0001 ICL, P=0.009 TICL) were also decreased in both groups postoperatively. Spherical error showed positive correlations with variation in total-eye coma (r=0.37, P=0.004 ICL; r=0.56, P=0.001 TICL) and internal coma (r=0.30, P=0.02 ICL and r=0.45, P=0.01 TICL). Axial length revealed negative correlations with changes in total-eye coma (r=-0.45, P<0.001 ICL; r=-0.39, P=0.03 TICL) and internal coma (r=-0.28, P=0.03 ICL and r=-0.42, P=0.02 TICL).

CONCLUSIONS

Both ICL- and TICL-treated groups demonstrated a decrease in coma and secondary astigmatism after 3 months, postoperatively. ICL/TICL may confer a compensatory effect on coma aberration and secondary astigmatism. Patients with a higher myopia achieved a greater improvement in coma and may benefit more from ICL/TICL implantation than from spectacle correction implantation than from spectacle correction.

The safety of human embryos following long-term cryopreservation ( >6 years) on vitrification

BACKGROUND

Vitrification of embryos has become the basic means of assisted reproductive technology (ART) therapy in recent years. Concerns have also been raised about the safety of vitrification and the effect of cryopreservation time. Most of the previous studies were on the data within 6 years of cryopreservation.

OBJECTIVE

In this study, we aimed to evaluate the impact of long-term cryopreservation (>6 years) on pregnancy and neonatal outcomes.

MATERIALS AND METHODS

This research was a single-center, retrospective analysis, including 426 frozen-thawed embryo transfer (FET) cycles. Patients who participated in IVF-FET cycles between January 2013 to December 2020 were analyzed. Preferentially matched participants were divided into three groups according to storage time: group A (>72 months), group B (0-3 months, propensity score matching [PSM] according to the age of oocyte retrieval), and group C (0-3 months, PSM according to the age of embryo transfer).

RESULTS

Our results revealed that there were no significant differences in human chorionic gonadotropin [HCG] positive rate, clinical pregnancy rate, miscarriage rate, live birth rate, and neonatal outcomes when the embryo storage duration >72 months. But the proportion of high birth weight was higher in group A (>72 months) when matched according to age at embryo transfer.

CONCLUSION

The results of our study showed that long-term cryopreservation had no effect on the pregnancy and neonatal outcomes of vitrification. The results offer evidence for the safety of using long-term cryopreservation embryos after vitrification. DOI: 10.54680/fr23310110612.

High-throughput printing of combinatorial materials from aerosols

The development of new materials and their compositional and microstructural optimization are essential in regard to next-generation technologies such as clean energy and environmental sustainability. However, materials discovery and optimization have been a frustratingly slow process. The Edisonian trial-and-error process is time consuming and resource inefficient, particularly when contrasted with vast materials design spaces1. Whereas traditional combinatorial deposition methods can generate material libraries2,3, these suffer from limited material options and inability to leverage major breakthroughs in nanomaterial synthesis. Here we report a high-throughput combinatorial printing method capable of fabricating materials with compositional gradients at microscale spatial resolution. In situ mixing and printing in the aerosol phase allows instantaneous tuning of the mixing ratio of a broad range of materials on the fly, which is an important feature unobtainable in conventional multimaterials printing using feedstocks in liquid-liquid or solid-solid phases4-6. We demonstrate a variety of high-throughput printing strategies and applications in combinatorial doping, functional grading and chemical reaction, enabling materials exploration of doped chalcogenides and compositionally graded materials with gradient properties. The ability to combine the top-down design freedom of additive manufacturing with bottom-up control over local material compositions promises the development of compositionally complex materials inaccessible via conventional manufacturing approaches.

Pseudo-bistability of viscoelastic shells

Viscoelastic shells subjected to a pressure loading exhibit rich and complex time-dependent responses. Here we focus on the phenomenon of pseudo-bistability, i.e. a viscoelastic shell can stay inverted when pressure is removed, and snap to its natural shape after a delay time. We model and explain the mechanism of pseudo-bistability with a viscoelastic shell model. It combines the small strain, moderate rotation shell theory with the standard linear solid as the viscoelastic constitutive law, and is applicable to shells with arbitrary axisymmetric shapes. As a case study, we investigate the pseudo-bistable behaviour of viscoelastic ellipsoidal shells. Using the proposed model, we successfully predict buckling of a viscoelastic ellipsoidal shell into its inverted configuration when subjected to an instantaneous pressure, creeping when the pressure is held, staying inverted after the pressure is removed, and eventually snapping back after a delay time. The stability transition of the shell from a monostable, temporarily bistable and eventually back to the monostable state is captured by examining the evolution of the instantaneous pressure-volume change relation at different time of the holding and releasing process. A systematic parametric study is conducted to investigate the effect of geometry, viscoelastic properties and loading history on the pseudo-bistable behaviour. This article is part of the theme issue 'Probing and dynamics of shock sensitive shells'.

Sensitive acid phosphatase assay based on light-activated specific oxidase mimic activity

Acid phosphatase (ACP) is a key marker in the diagnosis of many diseases. However, exploiting a simple and sensitive sensor for the real-time quantitative analysis of ACP is still challenging. Herein, we attempted to develop a sensitive colorimetric sensing strategy for the detection of ACP based on light-activated oxidase mimic property of carbon dots (CDs). The synthesized CDs were proved to be capable of intrinsic light-activated oxidase mimic activity, which could generate reactive oxygen species to oxidize chromogenic substrate under ultraviolet light stimulation. Interestingly, this light-activated oxidase mimic behavior would be effectively suppressed by the antioxidant ascorbic acid (AA), a product from the hydrolysis of 2-phospho-L-ascorbic acid trisodium (AAP) mediated by ACP. Based on the above property, a facile and sensitive colorimetric sensing method for ACP was developed. Under the optimal conditions, the linear range for ACP 0.1-5.5 U/L, and the detection limit was 0.056 U/L. Compared with conventional nanozyme based ACP assay systems, the catalytic activity of light-activated nanozyme could be conveniently regulated by switching the light on and off, which made it easier to precisely control the extent of the reaction and ensured the accuracy of the assay. In addition, the proposed sensing system would be readout directly by the naked eye or smartphone-based RGB analysis system, and have been successfully applied to analyze diluted in diluted fetal bovine serum and urine samples spiked with ACP. All these results indicated that this approach holds good promise for future applications in clinical analysis and point-of-care (POC) biosensor platforms.

[Advances in tumor regression patterns and safe distance of distal resection margin after neoadjuvant therapy for rectal cancer]

Neoadjuvant therapy has been widely applied in the treatment of rectal cancer, which can shrink tumor size, lower tumor staging and improve the prognosis. It has been the standard preoperative treatment for patients with locally advanced rectal cancer. The efficacy of neoadjuvant therapy for rectal cancer patients varies between individuals, and the results of tumor regression are obviously different. Some patients with good tumor regression even achieve pathological complete response (pCR). Tumor regression is of great significance for the selection of surgical regimes and the determination of distal resection margin. However, few studies focus on tumor regression patterns. Controversies on the safe distance of distal resection margin after neoadjuvant treatment still exist. Therefore, based on the current research progress, this review summarized the main tumor regression patterns after neoadjuvant therapy for rectal cancer, and classified them into three types: tumor shrinkage, tumor fragmentation, and mucin pool formation. And macroscopic regression and microscopic regression of tumors were compared to describe the phenomenon of non-synchronous regression. Then, the safety of non-surgical treatment for patients with clinical complete response (cCR) was analyzed to elaborate the necessity of surgical treatment. Finally, the review studied the safe surgical resection range to explore the safe distance of distal resection margin.

Gbb Regulates Blood Cell Proliferation and Differentiation through JNK and EGFR Signaling Pathways in the Drosophila Lymph Gland

The Drosophila lymph gland is an ideal model for studying hematopoiesis, and unraveling the mechanisms of Drosophila hematopoiesis can improve our understanding of the pathogenesis of human hematopoietic malignancies. Bone morphogenetic protein (BMP) signaling is involved in a variety of biological processes and is highly conserved between Drosophila and mammals. Decapentaplegic (Dpp)/BMP signaling is known to limit posterior signaling center (PSC) cell proliferation by repressing the protooncogene dmyc. However, the role of two other TGF-β family ligands, Glass bottom boat (Gbb) and Screw (Scw), in Drosophila hematopoiesis is currently largely unknown. Here, we showed that the loss of Gbb in the cortical zone (CZ) induced lamellocyte differentiation by overactivation of the EGFR and JNK pathways and caused excessive differentiation of plasmatocytes, mainly by the hyperactivation of EGFR. Furthermore, we found that Gbb was also required for preventing the hyperproliferation of the lymph glands by inhibiting the overactivation of the Epidermal Growth Factor Receptor (EGFR) and c-Jun N-terminal Kinase (JNK) pathways. These results further advance our understanding of the roles of Gbb protein and the BMP signaling in Drosophila hematopoiesis and the regulatory relationship between the BMP, EGFR, and JNK pathways in the proliferation and differentiation of lymph gland hemocytes.

Enhanced photocatalytic degradation of tetracycline by a H2O2-assisted Bi3NbO7/Bi2Sn2O7 composite under visible light

A Z-scheme BNO/BSO composite photocatalyst has been successfully prepared using an in situ solvothermal method. The phase component, microstructure and optical properties of the as-prepared samples were characterized using X-ray diffractometry, scanning electron microscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, photoluminescence spectroscopy and other means. The photocatalytic performance of the BNO/BSO composite was evaluated via the degradation of the typical antibiotic tetracycline (TC) under hydrogen peroxide assistance and visible light irradiation. The "cata + H₂O₂ + vis" system shows the best photocatalytic activity, and its apparent rate constant reaches 0.03164 min^-1, which is 4.9 times and 5.7 times that of the "cata + vis" system and the "cata + H₂O₂" system, respectively. Compared with pristine that of BSO alone, the reaction rate constant of the 15% BNO/BSO composite increases 1.8 times. The enhanced photocatalytic activity is attributed to the construction of a unique Z-scheme-type heterojunction, which effectively suppresses the recombination of electron-hole pairs. In addition, the addition of H₂O₂ promotes the generation of more active species. Moreover, a possible photocatalytic degradation mechanism is also further proposed.

Predictive value of peritumour radiomics in the diagnosis of benign and malignant pulmonary nodules with halo sign

AIM

To evaluate peritumour radiomics in predicting benign and malignant pulmonary nodules with halo sign.

MATERIALS AND METHODS

In this retrospective study, 305 pulmonary nodules with halo sign (benign, 120; adenocarcinoma, 185) were collected. Manual segmentation was used to mark the gross tumour volume (GTV) and the peritumour volume (PTV) was established by uniform dilation (1 cm) of the tumour area in three dimensions. The GTV and PTV radiomic features were combined to produce the gross tumour and peritumour volume (GPTV). The minimum-redundancy maximum-relevance (mRMR) feature ranking method and least absolute shrinkage and selection operator (LASSO) algorithm were used to eliminate redundant radiomic features. Predictive models combined with clinical features and radiomic signatures were established. Multivarible logistic regression analysis was used to establish the combined model and develop a nomogram. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the model.

RESULTS

In the testing cohort, the area under the ROC curve (AUC) of the GTV, PTV, and GPTV radiomic models was 0.701 (95% CI: 0.589-0.814), 0.674 (95% CI: 0.557-0.791) and 0.755 (95% CI: 0.643-0.867), respectively. The AUC of the nomogram model based on clinical and GPTV radiomic signatures was 0.804 (95% CI: 0.707-0.901).

CONCLUSION

The nomogram model based on clinical and GPTV radiomic signatures can better predict benign and malignant pulmonary nodules with halo signs, demonstrating that the model has potential as a convenient and effective auxiliary diagnostic tool for radiologists.

Downregulation of hepatic lncRNA Gm19619 improves gluconeogenesis and lipogenesis following vertical sleeve gastrectomy in mice

Long non-coding RNAs (lncRNAs) are emerging important epigenetic regulators in metabolic processes. Whether they contribute to the metabolic effects of vertical sleeve gastrectomy (VSG), one of the most effective treatments for sustainable weight loss and metabolic improvement, is unknown. Herein, we identify a hepatic lncRNA Gm19619, which is strongly repressed by VSG but highly up-regulated by diet-induced obesity and overnight-fasting in mice. Forced transcription of Gm19619 in the mouse liver significantly promotes hepatic gluconeogenesis with the elevated expression of G6pc and Pck1. In contrast, AAV-CasRx mediated knockdown of Gm19619 in high-fat diet-fed mice significantly improves hepatic glucose and lipid metabolism. Mechanistically, Gm19619 is enriched along genomic regions encoding leptin receptor (Lepr) and transcription factor Foxo1, as revealed in chromatin isolation by RNA purification (ChIRP) assay and is confirmed to modulate their transcription in the mouse liver. In conclusion, Gm19619 may enhance gluconeogenesis and lipid accumulation in the liver.

Mechanics Underpinning Phase Separation of Hydrogels

This paper reveals the underpinning role of mechanical constraints and dynamic loading in triggering volume phase transitions and phase separation of hydrogels. Using the Flory-Rehner free energy that does not predict phase separation of hydrogels under equilibrium free swelling, we show that mechanical constraints can lead to coexistence of multiple phases. We systematically obtain the states of equilibrium for hydrogels under various mechanical constraints and unravel how mechanical constraints change the convexity of the free energy and monotonicity of the stress-stretch curves, leading to phase coexistence. Using a phase-field model, we predict the pattern evolution of phase coexistence and show that many features cannot be captured by the homogeneous states of equilibrium due to large mismatch stretch between the coexisting phases. We further reveal that the system size, quenching rate, and loading rate can significantly influence the phase behavior, which provides insights for experimental studies related to morphological patterns of hydrogels.

A Hemispherical Image Sensor Array Fabricated with Organic Photomemory Transistors

Hemispherical image sensors simplify lens designs, reduce optical aberrations, and improve image resolution for compact wide-field-of-view cameras. To achieve hemispherical image sensors, organic materials are promising candidates due to the following advantages: tunability of optoelectronic/spectral response and low-temperature low-cost processes. Here, a photolithographic process is developed to prepare a hemispherical image sensor array using organic thin film photomemory transistors with a density of 308 pixels per square centimeter. This design includes only one photomemory transistor as a single active pixel, in contrast to the conventional pixel architecture, consisting of select/readout/reset transistors and a photodiode. The organic photomemory transistor, comprising light-sensitive organic semiconductor and charge-trapping dielectric, is able to achieve a linear photoresponse (light intensity range, from 1 to 50 W m^-2 ), along with a responsivity as high as 1.6 A W^-1 (wavelength = 465 nm) for a dark current of 0.24 A m^-2 (drain voltage = -1.5 V). These observed values represent the best responsivity for similar dark currents among all the reported hemispherical image sensor arrays to date. A transfer method was further developed that does not damage organic materials for hemispherical organic photomemory transistor arrays. These developed techniques are scalable and are amenable for other high-resolution 3D organic semiconductor devices.

Mechanically robust stretchable semiconductor metallization for skin-inspired organic transistors

Despite recent remarkable advances in stretchable organic thin-film field-effect transistors (OTFTs), the development of stretchable metallization remains a challenge. Here, we report a highly stretchable and robust metallization on an elastomeric semiconductor film based on metal-elastic semiconductor intermixing. We found that vaporized silver (Ag) atom with higher diffusivity than other noble metals (Au and Cu) forms a continuous intermixing layer during thermal evaporation, enabling highly stretchable metallization. The Ag metallization maintains a high conductivity (>10⁴ S/cm) even under 100% strain and successfully preserves its conductivity without delamination even after 10,000 stretching cycles at 100% strain and several adhesive tape tests. Moreover, a native silver oxide layer formed on the intermixed Ag clusters facilitates efficient hole injection into the elastomeric semiconductor, which transcends previously reported stretchable source and drain electrodes for OTFTs.

Different Features of a Metabolic Connectivity Map and the Granger Causality Method in Revealing Directed Dopamine Pathways: A Study Based on Integrated PET/MR Imaging

BACKGROUND AND PURPOSE

Exploring the directionality of neural information in the brain is important for understanding brain mechanisms and neurodisease development. Granger causality analysis and the metabolic connectivity map can be used to investigate directional transmission of information between brain regions, but their differences in depicting functional effective connectivity are not clear.

MATERIALS AND METHODS

Using the Monash rs-PET/MR imaging data set, we conducted Granger causality and metabolic connectivity map analyses of the dopamine reward circuit in the brain. The dopamine reward circuit is a well-known system consisting primarily of the bilateral orbital frontal cortex, caudate, nucleus accumbens, thalamus, and substantia nigra. We validated these circuit pathways using Granger causality and the metabolic connectivity map for identifying effective connectivities against a priori knowledge by testing the significance of directed pathways (P < .05, false discovery rate-corrected).

RESULTS

We found 3 types of effective connectivities in the dopamine reward circuit: long-range, neighborhood, and symmetric. Granger causality analysis revealed long-range connections in the orbital frontal cortex-caudate and orbital frontal cortex-nucleus accumbens regions. Metabolic connectivity map analysis revealed neighborhood connections in the nucleus accumbens-caudate, substantia nigra-thalamus, and thalamus-caudate regions. Metabolic connectivity map analysis also found symmetric connections in each of the bilateral nucleus accumbens, caudate, thalamus, and orbital frontal cortex-caudate regions. Different patterns in directional networks of the dopamine reward circuit were revealed by Granger causality and metabolic connectivity map analyses.

CONCLUSIONS

Granger causality analysis primarily identified bidirectional cortico-nucleus connections, while the metabolic connectivity map primarily identified direct connections among neighborhood and symmetric regions. The results of this study indicated that investigations of effective connectivities should use an appropriate analysis method depending on the purpose of the study.

Tough-interface-enabled stretchable electronics using non-stretchable polymer semiconductors and conductors

Semiconducting polymer thin films are essential elements of soft electronics for both wearable and biomedical applications^1-11. However, high-mobility semiconducting polymers are usually brittle and can be easily fractured under small strains (<10%)^12-14. Recently, the improved intrinsic mechanical properties of semiconducting polymer films have been reported through molecular design^15-18 and nanoconfinement¹⁹. Here we show that engineering the interfacial properties between a semiconducting thin film and a substrate can notably delay microcrack formation in the film. We present a universal design strategy that involves covalently bonding a dissipative interfacial polymer layer, consisting of dynamic non-covalent crosslinks, between a semiconducting thin film and a substrate. This enables high interfacial toughness between the layers, suppression of delamination and delocalization of strain. As a result, crack initiation and propagation are notably delayed to much higher strains. Specifically, the crack-onset strain of a high-mobility semiconducting polymer thin film improved from 30% to 110% strain without any noticeable microcracks. Despite the presence of a large mismatch in strain between the plastic semiconducting thin film and elastic substrate after unloading, the tough interface layer helped maintain bonding and exceptional cyclic durability and robustness. Furthermore, we found that our interfacial layer reduces the mismatch of thermal expansion coefficients between the different layers. This approach can improve the crack-onset strain of various semiconducting polymers, conducting polymers and even metal thin films.

Body mass index and the risk of abdominal hernia: a Mendelian randomization study

PURPOSE

Abdominal hernia (AH) is one of the most common clinical diseases. A large number of observational studies have found that obesity is an important risk factor for AH. However, the causal relationship between obesity and AH cannot be determined because of the clinical studies on AH induced by obesity are relatively few and only have some small- or medium-scale observational studies. Observational studies have so many confounding factors and reverse causality due to their shortcomings. From an evidence-based medicine perspective, they are not sufficiently convincing. Therefore, there is still a lack of high-quality, evidence-based medical evidence supporting a causal relationship between obesity and AH. A causal relationship between obesity and AH is also almost impossible to confirm by randomized controlled trials (RCTs). Our study based on Mendelian randomization (MR) may provide a higher level of evidence-based medical support for the relationship between obesity and AH. Body mass index (BMI) is the most common measure used for defining obesity. Finally, we employed two-sample Mendelian randomization (TSMR) to explore the causal relationship between BMI and AH.

METHODS

AH-related single nucleotide polymorphisms (SNPs) data were obtained from the FinnGen Biobank (FB), and BMI-related single nucleotide polymorphisms (SNPs) data were obtained from the UK Biobank (UKB). Genetic loci are used as instrumental variables (IVs), methods such as inverse variance weighted (IVW) were used for two-sample Mendelian randomization analysis, and the odds ratio (OR) value was used to evaluate the causal relationship between BMI and AH.

RESULTS

The results of the horizontal pleiotropy test were calculated by Egger-intercept method: p = 0.34 > 0.05. The Cochran Q test of MR-Egger method and IVW method showed heterogeneity P = 0.03 < 0.05, so the IVW random effect model was used as the gold standard. We found a genetically determined 1-standard deviation (SD) increment of BMI causally increased a 66.0% risk of AH (N = 371 SNPs, OR = 1.66, 95% CI 1.46-1.89, p = 1.55E-14) based on the IVW random effect model which was almost consistent with the results of other seven methods.

CONCLUSIONS

Our MR found genetic evidence for BMI and AH. The risk of developing AH increases with the number of BMI. This finding provides further evidence that maintaining a healthy BMI can prevent the development of AH. In addition, clinicians may need to focus on the potential risk of AH on some high-BMI patients.