A Note on Stronger Forms of Sensitivity for Non-Autonomous Dynamical Systems on Uniform Spaces

This paper introduces the notion of multi-sensitivity with respect to a vector within the context of non-autonomous dynamical systems on uniform spaces and provides insightful results regarding N-sensitivity and strongly multi-sensitivity, along with their behaviors under various conditions. The main results established are as follows: (1) For a k-periodic nonautonomous dynamical system on a Hausdorff uniform space (S,U), the system (S,fk∘⋯∘f1) exhibits N-sensitivity (or strongly multi-sensitivity) if and only if the system (S,f1,∞) displays N-sensitivity (or strongly multi-sensitivity). (2) Consider a finitely generated family of surjective maps on uniform space (S,U). If the system (S,f1,∞) is N-sensitive, then the system (S,fk,∞) is also N-sensitive. When the family f1,∞ is feebly open, the converse statement holds true as well. (3) Within a finitely generated family on uniform space (S,U), N-sensitivity (and strongly multi-sensitivity) persists under iteration. (4) We present a sufficient condition under which an nonautonomous dynamical system on infinite Hausdorff uniform space demonstrates N-sensitivity.

Asthma and clinical outcomes of COVID-19 in a community setting

OBJECTIVES

The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19.

STUDY DESIGN

A case-control study based on a surveillance cohort in Harris County, Texas.

METHODS

Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing.

RESULTS

In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease.

CONCLUSIONS

The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.

[Analysis of clinical characteristics and treatment status of atopic dermatitis in a children's hospital in Beijing from 2015 to 2019]

To analyze the clinical characteristics and treatment status of atopic dermatitis (AD) in children in the outpatient department of a children's hospital in Beijing from 2015 to 2019. This study used a cross-sectional study method to retrospectively analyze the data of AD patients who visited the Dermatology outpatient department of Beijing Children's Hospital, Capital Medical University, from April 2015 to April 2019. A total of 1 926 AD patients aged 0-17.5 years old living in Beijing and its surrounding areas were included, and the general situation, severity and distribution of AD disease, clinical characteristics and severity of AD, relevant influencing factors of AD onset, AD disease prognosis and treatment status were recorded. SAS 9.4, SPSS19.0, and R software were used for data processing, and descriptive statistical analysis, Chi-square test, Analysis of Variance, and correspondence analysis were used for statistical analysis. The results showed that the male to female ratio of AD patients in children included in this study was 1.4∶1; 79.0% (1 522/1 926), 86.1%(1 658/1 926), 91.3%(1 758/1 926), and 97.3%(1 907/1 926) of AD onset at the age of 6 months, 1 year, 2 years, and 5 years, respectively; mild of AD patients accounted for 13.2% (255/1 926)(SCORAD score 0-24), moderate of AD patients accounted for 50.1%(965/1 926) (SCORAD score 25-50), and severe of AD patients accounted for 36.7% (706/1 926)(SCORAD score>50).The age of severe AD patients were younger than mild and moderate AD patients. The face, head, trunk, and lower limbs were common areas of onset for moderate to severe AD, while the hands, feet, and ears were common areas of onset for severe AD patients. Temperature changes, hot water factors, mental and emotional states, and spring and winter were the main aggravation factors of AD;35.2% (678/1 926) aggravated and 61.8% (1 191/1 926) persistent. The more frequent bathing, the less severity of AD disease (χ2=29.791,P<0.001); 28.0% (520/1 856) of AD patients have no moisturizing habits, which were correlated with the severity of AD disease (χ2=15.908, P<0.05); the proportion of combined treatment medications in children with moderate to severe AD was significantly higher than mild AD patients. In conclusion, the patients with AD who went to specialist clinics were mainly moderate to severe patients and developed disease before the age of 5 years from 2015 to 2019.The severity of AD were mainly moderate to severe, and most of these patients had poor disease control. Traditional treatment plans had limitations. Identifying the clinical characteristics and treatment status of childhood AD would help us to carry out more targeted prevention and management work.

Simultaneous immobilization of ammonia and phosphorous by thermally treated sediment co-modified with hydrophilic organic matter and zeolite

The use of calcined sediments (CS) for thin-layer capping is an environment-friendly technology for controlling nitrogen (N) or phosphorus (P) release. However, the effects of CS derived materials and efficiency in controlling the sedimentary N/P ratio have not been thoroughly investigated. While zeolite-based materials have been proven efficient to remove ammonia, it is limited by the low adsorption capacity of PO₄^3-. Herein, CS co-modified with zeolite and hydrophilic organic matter (HIM) was synthesized to simultaneously immobilize ammonium-N (NH₄⁺-N) and remove P, due to the superior ecological security of natural HIM. Studies on the influences of calcination temperature and composition ratio indicated that 600 °C and 40% zeolite were the optimal parameters leading to the highest adsorption capacity and lowest equilibrium concentration. Compared with doping with polyaluminum chloride, doping with HIM not only enhanced P removal but also achieved higher NH₄⁺-N immobilization efficacy. The efficiency of zeolite/CS/HIM capping and amendment in prohibiting the discharge of N/P from sediments was assessed via simulation experiments, and the relevant control mechanism was studied at the molecular level. The results indicated that zeolite/CS/HIM can reduce 49.98% and 72.27% of the N flux and 32.10% and 76.47% of the P flux in slightly and highly polluted sediments, respectively. Capping and incubation with zeolite/CS/HIM simultaneously resulted in substantial reductions in NH₄⁺-N and dissolved total P in overlying water and pore water. Chemical state analysis indicated that HIM enhanced the NH₄⁺-N adsorption ability of CS owing to its abundant carbonyl groups and indirectly increased P adsorption by protonating mineral surface groups. This research provides a novel strategy to control sedimentary nutrient release by adopting an efficient and ecologically secure remediation method to rehabilitate eutrophic lake systems.

The evolution of a typical plateau lake from macrophyte to algae leads to the imbalance of nutrient retention

Long-term anthropogenic nitrogen (N) and phosphorus (P) inputs have led to lake eutrophication and decreased environmental quality. However, the imbalance in nutrient cycling caused by ecosystem transformation during lake eutrophication is still unclear. The N, P, organic matter (OM) and their extractable forms in the sediment core of Dianchi Lake were investigated. Combining ecological data and geochronological techniques, a coupling relationship between the evolution of lake ecosystems and nutrient retention was established. The results show that the evolution of lake ecosystems promotes the accumulation and mobilization of N and P in sediments, leading to an imbalance in nutrient cycling in the lake system. From the "macrophyte-dominated" period to the "algae-dominated" period, the accumulation rates of potential mobile N and P (PMN, PMP) in sediments have significantly increased, and the retention efficiency of total N and P (TN, TP) has decreased. The increased TN/TP ratio (5.38 ± 1.52 ‒ 10.19 ± 2.94) and PMN/PMP ratio (4.34 ± 0.41 ‒ 8.85 ± 4.16), as well as the reduced humic-like/protein-like ratio (H/P, 11.18 ± 4.43 ‒ 5.97 ± 3.67), indicated an imbalance in nutrient retention during sedimentary diagenesis. Our results show that eutrophication has resulted in the potential mobilization of N in sediments exceeding P, providing new insights for further understanding the nutrient cycle in the lake system and strengthening lake management.

Heterogeneity of molecular-level and photochemical of dissolved organic matter derived from decomposing submerged macrophyte and algae

Aquatic macrophytes and algae are the most important sources of autochthonous dissolved organic matter (DOM), and their transformation and reuse significantly affect aquatic ecosystem health. In this study, Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) was used to identify the molecular features between submerged macrophyte-derived DOM (SMDOM) and algae-derived DOM (ADOM). The photochemical heterogeneity between SMDOM and ADOM by UV₂₅₄-irradiation and their molecular mechanism were also discussed. The results showed that the molecular abundance of SMDOM was dominated by lignin/CRAM-like structures, tannins, and concentrated aromatic structures (sum of 91.79%), while that of ADOM was dominated by lipids, proteins, and unsaturated hydrocarbons (sum of 60.30%). UV₂₅₄-radiation resulted in a net reduction of tyrosine-like, tryptophan-like and terrestrial humic-like, and conversely a net production of marine humic-like. The light decay rate constants obtained by the multiple exponential function model fitting revealed that both tyrosine-like and tryptophan-like components of SMDOM could be rapidly and directly photodegraded, while the photodegradation of tryptophan-like in ADOM depended on the production of photosensitizers. The photo-refractory fractions of both SMDOM and ADOM were as follows: humic-like > tyrosine-like > tryptophan-like. Our results provide new insights into the fate of autochthonous DOM in aquatic ecosystems where "grass-algae" coexist or evolve.

Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis

BACKGROUND AND PURPOSE

There is no clear association between plaque distribution and postoperative complications in patients with basilar artery atherosclerotic stenosis. The aim of this study was to determine whether plaque distribution and postoperative complications after endovascular treatment for basilar artery stenosis are related.

MATERIALS AND METHODS

Our study enrolled patients with severe basilar artery stenosis who were scanned with high-resolution MR imaging and followed by DSA before the intervention. According to high-resolution MR imaging, plaques can be classified as ventral, lateral, dorsal, or involved in 2 quadrants. Plaques affecting the proximal, distal, or junctional segments of the basilar artery were classified according to DSA. An experienced independent team assessed ischemic events after the intervention using MR imaging. Further analysis was conducted to determine the relationship between plaque distribution and postoperative complications.

RESULTS

A total of 140 eligible patients were included in the study, with a postoperative complication rate of 11.4%. These patients were an average age of 61.9 (SD, 7.7) years. Dorsal wall plaques accounted for 34.3% of all plaques, and plaques distal to the anterior-inferior cerebellar artery accounted for 60.7%. Postoperative complications of endovascular treatment were associated with plaques located at the lateral wall (OR = 4.00; 95% CI, 1.21-13.23; P = .023), junctional segment (OR = 8.75; 95% CI, 1.16-66.22; P = .036), and plaque burden (OR = 1.03; 95% CI, 1.01-1.06; P = .042).

CONCLUSIONS

Plaques with a large burden located at the junctional segment and lateral wall of the basilar artery may increase the likelihood of postoperative complications following endovascular therapy. A larger sample size is needed for future studies.

Effects of calcination on the environmental behavior of sediments by phosphorus speciation and interface characterization

Dredged sediments derived from eutrophicated lakes poses hardness of sludge disposal and ecological risks. The proper pretreatment and utilization of dredged sediments presented a challenge. In this study, Dianchi Lake sediments were dredged, thermally treated and utilized as particle capping material in batch experiments. The effects of calcination on phosphorus speciation and sediment-water interface environment as well as P immobility mechanism were predominantly explored. The microstructures and chemical compositions of calcined sediments were investigated, indicating the porosity and mineralization components were greatly enhanced. The fractional analysis of phosphorus revealed that the calcination process reduced the percentage of unsteady phosphorus, transforming into stable inert phosphorus fractions (Al-P, Ca-P and Res-P), respectively, thereby minimized its mobility and eutrophication risk. Interestingly, calcination temperatures of 700 °C and 800 °C resulted in smaller releasing potentials and equilibrium phosphorus concentrations, despite having lower adsorption capacities than 550 °C. Furthermore, the results of redox potential monitoring showed that the thermally treated Dianchi Lake sediments could enhance the redox potential and dissolved oxygen in the surface sediment, indicating the amelioration of interfacial environment. The practical monitoring experiments confirmed the capping depressed the DTP to 0.031 mg L^-1. The investigation of this study provided explicit evidence of Ca coupled P and aerobic Fe bound P strengthened the immobilization effects, and the development of sediment calcination demonstrates a promising strategy for alleviating the burden of endogenous pollution and improving aerobic environment, which are of great significance for lake ecological remediation.

Biogeochemical dynamics of particulate organic phosphorus and its potential environmental implication in a typical "algae-type" eutrophic lake

Organic phosphorus (P_o) plays a very important role in the process of lake eutrophication, but there is still a lack of knowledge about the internal cycle of P_o in suspended particulate matter (SPM) dominated by algal debris. In this study, the characterization of bioavailable P_o by sequential extraction and enzymatic hydrolysis showed that 45% of extracted TP was P_o in SPM of Lake Dianchi, and 43-98% of total P_o in H₂O, NaHCO₃ and NaOH fractions was enzymatically hydrolyzable P_o (EHP, H₂O-EHP: 31-53%). Importantly, labile monoester P was the main organic form (68%) of EHP, and its potential bioavailability was higher than that of diester P and phytate-like P. According to the estimation of P pools in SPM of the whole lake, the total load of P_i plus EHP in the H₂O extract of SPM was 74.9 t and had great potential risk to enhance eutrophication in the lake water environment. Accordingly, reducing the amount of SPM in the water during the algal blooming period is likely to be a necessary measure that can successfully interfere with or block the continuous stress of unhealthy levels of P on the aquatic ecosystem.

Thrombectomy Using the EmboTrap Clot-Retrieving Device for the Treatment of Acute Ischemic Stroke: A Glimpse of Clinical Evidence

BACKGROUND

The EmboTrap Recanalization Device is a novel stent retriever for thrombectomy in the setting of acute ischemic stroke due to large-vessel occlusion.

PURPOSE

Our aim was to summarize the safety and efficacy of the EmboTrap Recanalization Device in acute ischemic stroke-large-vessel occlusion through a systematic review and meta-analysis.

DATA SOURCES

Medline, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were searched up to April 2022.

STUDY SELECTION

Nine observational studies using the EmboTrap Recanalization Device were selected.

DATA ANALYSIS

We adapted effect size with 95% CIs for dichotomous data. P value <.05 was statistically significant.

DATA SYNTHESIS

The estimated rate of successful recanalization (modified TICI 2b-3) was 90% (95% CI, 86%-95%; I ² = 82.4%); 90-day favorable outcome (mRS 0-2), 53% (95% CI, 42%-63%; I ² = 88.6%); modified first-pass effect, 43% (95% CI, 35%-51%; I ² = 63.7%); and first-pass effect, 36% (95% CI, 29%-46%; I ² = 10.7%). The rate of any intracerebral hemorrhage was 19% (95% CI, 16%-22%; I ² = 0.0%); symptomatic intracerebral hemorrhage, 5% (95% CI, 1%-8%; I ² = 84.6%); and 90-day mortality, 14% (95% CI, 9%-19%; I ² = 79.3%). Subgroup analysis showed higher rates of complete recanalization for EmboTrap II than for the EmboTrap System.

LIMITATIONS

The included studies are single-arm without direct comparison with other stent retrievers. Some of the studies recruited had a small sample size and were limited by the retrospective study design. In addition, the uncertain heterogeneity among studies was high.

CONCLUSIONS

The EmboTrap Recanalization Device is safe and efficient in treating acute ischemic stroke due to large-vessel occlusion.

Responses of dissolved organic matter (DOM) characteristics in eutrophic lake to water diversion from external watershed

Eutrophication is an important water environment issue facing global lakes. Diversion of water from external watersheds into lakes is considered as effective in ameliorating eutrophication and reducing algal blooms. Nevertheless, the changes in lake water environment caused by external water diversion, especially the influence of water diversion on the characteristics of dissolved organic matters (DOM), are still poorly understood. We therefore used a combination of EEM-PARAFAC, Principal Component Analysis (PCA), and Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) to investigate the effects of water diversion from the Niulan River on DOM characteristics in Lake Dianchi. The results showed that the water diversion from the Niulan River significantly improved the water quality of Lake Dianchi, the concentrations of TN, TP, COD and Chla decreased rapidly, and the degree of humification of dissolved organic matter (DOM) increased, which was in sharp contrast with that of pre-implementation. Firstly, the diversion of water from the Niulan River mainly led to changes in the structure of pollution sources. The load of influent rivers and sewage treatment plants rich in lignin and tannins increased, and the input of terrestrial humus increased. Second, the improved water quality reduced algal enrichment and frequency of blooms, and reduced the release of lipid- and protein-riched algal-derived DOM. Finally, the hydraulic retention time of Lake Dianchi caused by water diversion was shortened, the hydrodynamic conditions were significantly improved, and the dissolved oxygen (DO) level gradually recovered, which played a positive role in improving the humification degree of DOM. Our findings provide new insights for exploring the improvement of eutrophic lake eco-environmental quality caused by water diversion projects.

Fabrication and characterization of Ti/polyaniline-Co/PbO2-Co for efficient electrochemical degradation of cephalexin in secondary effluents

The traditional interlayer of PbO₂ electrode possessed many problems, such as short service lifetime and limited specific surface area. Herein, a novel and efficient Ti/polyaniline-Co/PbO₂-Co electrode was conctructed employing cyclic voltammetry to introduce a Co-doped polyaniline interlayer and anodic electrodeposition to synthetize a β-PbO₂-Co active layer. Compared with pristine PbO₂ electrode, Ti/polyaniline-Co/PbO₂-Co exhibited more compact crystalline shape and higher active sites amounts. Pratically, the electrochemical degradation of 5 mg L^-1 cephalexin in real secondary effluents was effectively achieved by the novel anode with 87.42% cephalexin removal and 71.8% COD mineralization after 120 min of 15 mA cm^-2 electrolysis. The hydroxyl radical production and electrochemical stability were increased by 3.16 and 3.27 times respectively. The cephalexin degradation pathway was investigated by combining a density functional theory-based theoretical approach and LC-QTrap-MS/MS. The most likely cleavage point of the β-lactam ring was the O=C-N bond, whose attack would produce small molecular compounds containing the thiazole and 4, 6-thiazine rings. Further oxidation produced inorganic ions; quantitative investigations indicated the amino groups to undergo decomposition to form aqueous NH₄⁺, which was further oxidized to NO₃^-. The accumulation of NO₃^- and SO₄^2-, combined with a decrease in toxicity toward Escherichia coli, demonstrated the efficient mineralization of cephalexin on the Ti/polyaniline-Co/PbO₂-Co electrode.

Particle-scale understanding sorption of phenanthrene on sediment fractions amended with black carbon and humic acid

Black carbon (BC) and humic acid (HA) have been proposed to dominate the sorption behavior of phenanthrene in sediment. Nevertheless, little is known about the sorption mechanism that related to particle-scale by spiking of BC and HA in sediment particle size fractions. In this study, sorption isotherms for phenanthrene were determined in four particle-size sediment fractions (<2 μm, 2-31 μm, 31-63 μm and >63 μm) that amended with BC and HA, or not. The fitting results by Freundlich model indicated that the sediment particle size fractions amended with BC increased the sorption capacity and affinity for phenanthrene. Sediment coarser size fractions (31-63 μm and >63 μm) by spiking of BC contributed higher to sorption capacity factor (K_F) and nonlinearity factor (n) than the finer size fractions (2-31 μm and <2 μm). By contrast, the sediment particle size fractions amended with HA enhanced the sorption distribution coefficient (K_d), but reduced the sorption affinity for phenanthrene. All these phenomena are obviously affected by the distribution of heterogeneous organic matter that related to sediment particle-scale. Results of this work could help us better understand the impact of increased BC and HA content in sediments on the sorption of hydrophobic organic pollutants (HOCs) and predict the fate of HOCs in offshore sediments due to tidal action.

The adsorption-release behavior of sediment phosphorus in a typical "grass-algae" coexisting lake and its influence mechanism during the transition sensitive period

In the early stage of eutrophication, the coexistence of "grass and algae" in lakes is obvious. Understanding the P sorption-desorption behavior in natural sediments during the ecologically sensitive transition period has important scientific value for predicting the deterioration of lake ecosystems and formulating restoration measures, but the related mechanisms are still unclear. In this study, the analysis results of sedimentary dissolved organic matter (DOM) fractions, extractable Fe (hydr)oxide fractions and P adsorption experiments showed that sedimentary DOM fractions, especially the tyrosine-like protein fractions and microbial humic-like fractions, played a part in determining the EPC₀ and K_d values of sediments in the plateau lake environment. The compound effect of amorphous Fe (hydr)oxides and sedimentary OM affected the increase of sedimentary P adsorption. Interestingly, these phenomena were strongly correlated with water depth. Furthermore, the distribution of water depth to aquatic plants indirectly regulated the values of sedimentary EPC₀ and K_d. Meanwhile, the ability of submerged plants to control the sedimentary EPC₀andK_d values will be forced to shift shallowly, thereby forcing a significant reduction of areas with low EPC₀ and high K_d values. This not only enhanced the risk of endogenous P release in lakes, but also accelerated the further deterioration of aquatic ecosystems. Therefore, studying the long-term scale changes of sedimentary EPC₀ and K_d values can help to understand the duration of the lake ecological transition period and prevent the transitional deterioration of ecosystem.

442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy

Aim

Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP.

Method

We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality.

Results

Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (&gt; 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group.

Conclusions

According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.

Effect of dissolved organic matter and heavy metals ions on sorption of phenanthrene at sedimentary particle scale

Human activities significantly increase the input of offshore heavy metals and organic pollutants. Although particle-scale and heterogeneous organic matters are fundamentally important to the fate of hydrophobic organic compounds (HOCs), deep understanding of the adsorption mechanism of HOCs on soil/sediment particles under the influence of heavy metal and organic pollution input is needed. This study investigates the effects of exotic DOM and heavy metals ions on the phenanthrene adsorption on sediment fractions. The adsorption experiments demonstrated that exotic DOM increased phenanthrene adsorption amount of sediment, with the greatest enhancement on clay particles (<2 µm). Nevertheless, the mechanism was differentiated accordingly to particle dimensions in terms of increased binding coefficients and mobility of phenanthrene. Furthermore, the introduction of heavy metals considerably enhanced the nonlinear sorption of phenanthrene. The Freundlich exponent N reduced by 0.01-0.24 when adding Cu²⁺, Zn²⁺ and Pb²⁺, especially for coarse particles (31-63 µm) fraction. In comparison, the enhancement of nonlinearity adsorption by Cu²⁺ and Zn²⁺ is significantly lower than Pb²⁺ ions. To our knowledge, the particle-scale study broadens the horizon of environmental fate and ecological risk of HOCs in intertidal regions, which is significantly affected by tidal action.

Importance of ammonia nitrogen potentially released from sediments to the development of eutrophication in a plateau lake

Sedimentary nitrogen (N) in lakes significantly influenced by eutrophication plays a detrimental role on the ecological sustainability of aquatic ecosystems. Here, we conducted a thorough analysis of the importance of N potentially released from sediments during the shift of "grass-algae" ecosystem in plateau lakes. From 1964 to 2013, the average total amount of sedimentary potential mineralizable organic nitrogen (PMON) and exchangeable N in whole Lake Dianchi were 5.50 × 10³ t and 3.44 × 10³ t, respectively. NH₄⁺-N was the main product (>90%) of sedimentary PMON mineralization. The PMON in sediments had great release potential, which tended to regulate the distribution of aquatic plants and phytoplankton in Lake Dianchi and facilitated the replacement of dominant populations. Moreover, NH₄⁺-N produced by sedimentary PMON mineralization and exchangeable NH₄⁺-N have increased the difficulty and complexity of ecological restoration in Lake Dianchi to a certain extent. This study highlights the importance of sedimentary N in lake ecosystem degradation, showing the urgent need to reduce the continuous eutrophication of lakes and restore the water ecology.

Water depth determines spatial and temporal phosphorus retention by controlling ecosystem transition and P-binding metal elements

Shallow lakes are more susceptible to eutrophication than deep lakes. The geochemical and biogeochemical mechanisms controlling the vulnerability to eutrophication for deep lakes and shallow lakes remain unknown. Therefore, we investigated the combined Phosphorus (P) retention mechanism with P fractions, water depth, distribution of P-binding metal elements, and macrophytes coverage in a degrading ecosystem of Erhai Lake. We concluded that different mechanisms control the P retention in deep-water areas and shallow-water areas. In shallow areas covered by macrophytes, the biogeochemical process manipulates the P retention by changing the total organic carbon (TOC), calcium (Ca) distributions and turbulence. In deep areas without macrophyte coverage, the aluminum (Al) and iron (Fe) distributions control the P retention by a physicochemical process. Manganese (Mn) was found to be a potential proxy in tracking the kinetic release and readsorb of redox-sensitive P (BD-P) in deep areas. The historical record and core sample indicate that the hydrological engineering induced water depth variation is a vital factor changing the ecosystem of Erhai Lake by forming a large area of intermediate area where macrophytes could only survive at low water level. The uplift of water level in the 1990s gradually changed the ecosystem of Erhai Lake from macrophyte-dominated to algal-macrophyte concomitant that reduced the accumulation of stable P fractions and their binding metals. Macrophytes were capable to preserve P in biomass in the macrophyte-dominated ecosystem, which released 150% and 72% of more labile organic P (NaOH25-nrP) and BD-P in the sediment after the deterioration than before, respectively. Therefore, water depth is a prerequisite to restoring the P preservation capacity of sediment and the macrophyte ecosystem. Further hydraulic engineering projects should consider the effect of water-level-variation-induced ecosystem transition.

Cardiovascular benefits outweigh risks in patients with atrial fibrillation in REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial)

Background/Introduction

REDUCE-IT, a multinational, double-blind trial, randomized 8179 statin-treated patients with controlled low density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 grams/day or placebo. IPE reduced the primary (CV death, myocardial infarction [MI], stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, MI, stroke) endpoints 25% and 26%, respectively (each p&lt;0.0001), and individual components including stroke (28%), MI (31%), cardiac arrest (48%), and sudden cardiac death (31%) (all p≤0.01). With IPE, bleeding was greater (11.8% vs 9.9%; p=0.006), serious bleeding trended higher (2.7% vs 2.1%; p=0.06), and atrial fibrillation/flutter (AF/F) hospitalization endpoints increased (3.1% vs 2.1%; p=0.004).

Purpose

To evaluate the effects of IPE on the risk of CV events and safety measures in patients by either history of AF/F or in-study occurrence of positively adjudicated AF/F hospitalization.

Methods

Conduct post hoc efficacy and safety subgroup analyses of patients with or without either baseline history of AF/F or in-study adjudicated AF/F hospitalization, including hospitalization for ≥24 hours; AF/F not meeting endpoint criteria were reported as adverse events.

Results

Patients with (n=751; 9.2%) AF/F history at baseline (vs without; n=7428; 90.8%) (Figure 1), or those with (n=211; 2.6%) positively adjudicated in-study AF/F hospitalization endpoints (vs without; n=7968; 97.4%) (Figure 2), had higher event rates of primary, key secondary, and fatal or nonfatal stroke endpoints, but relative risk reductions with IPE were not significantly different (all interaction p-values [pint]=ns). Similar reductions were observed with IPE across the prespecified endpoint testing hierarchy in patients with or without AF/F history or in-study hospitalization endpoints. Patients with baseline AF/F history had similar relative risk for in-study occurrence of AF/F hospitalization with IPE versus placebo (pint=0.21) but had greater absolute risk (12.5% vs 6.3%, IPE vs placebo) vs patients without baseline AF/F history (2.2% vs 1.6%, IPE vs placebo); i.e., recurrent AF/F in those with a prior history of AF/F was more prevalent than de novo AF/F. Serious bleeding trended higher regardless of AF/F history or in-study AF/F hospitalization endpoints (all pint=ns); absolute risk of serious bleeding was greater in patients with AF/F history at baseline (7.3% vs 6.0%) vs those without a baseline history of AF/F (2.3% vs 1.7%), and serious bleeding also trended higher in patients with in-study AF/F hospitalization (8.7% vs 6.0%) vs without (2.5% vs 2.0%) [all IPE vs placebo].

Conclusion

REDUCE-IT patients with AF/F history or in-study AF/F hospitalization endpoints had greater CV risk, but similar relative risk reduction in primary, key secondary, and fatal or nonfatal stroke endpoints with IPE.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amarin Pharma, Inc.

Historical changes of sedimentary P-binding forms and their ecological driving mechanism in a typical "grass-algae" eutrophic lake

With the transformation of lake ecosystem from "clear water" to "turbid water", the residual phosphorus (P) accumulated in sediments may slow down the process of aquatic ecological restoration, and the related mechanisms are complex and need to be better understood. In this study, high-resolution systematic investigation and analysis of P-binding forms in the sediments showed that Lake Dianchi, the largest plateau lake in Southwest China, was enriched with NaOH-rP, HCl-P and Res-P, but depleted in NH₄Cl-P, BD-P and NaOH-nrP. The BD-P, NaOH-nrP and NaOH-rP were the main contributors to potential P release from sediments, while the release potential of NH₄Cl-P was relatively weak (<1%). When the external P loading gradually decreased, the internal P loading of Lake Dianchi was estimated to be 522 mg P/(m²•a) in the past 30 years. The succession of "grass-algae" type in Lake Dianchi coincided with reduced absorption and transformation of potential mobile P and decreased accumulation of stable P, especially the Res-P. Meanwhile, the temporal variation of potential mobile P was a good predictor of ecological degradation and reduced ecosystem sustainability in Lake Dianchi.

REDUCE-IT: outcomes by baseline statin type

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) randomized 8,179 statin-treated patients with elevated triglycerides and increased cardiovascular (CV) risk to either icosapent ethyl (IPE), a pure, stable prescription form of eicosapentaenoic acid, 4g/day or placebo. IPE significantly reduced time to first occurrence of the primary composite endpoint of major adverse CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) (HR 0.75, CI 0.68–0.83) and key secondary endpoint events (composite of CV death, nonfatal MI, or nonfatal stroke) (HR 0.74, CI 0.65–0.83) versus placebo (all p&lt;0.0001). A modest reduction in placebo-corrected LDL-C was observed (−6.6%; p&lt;0.0001). The mechanisms for the CV benefit of icosapent ethyl are not fully understood.

Purpose

Explore the impact of statin type and lipophilic/lipophobic category on outcomes, and on LDL-C, to further consider the possible relevance of LDL-C pathways to the observed CV benefit of icosapent ethyl.

Methods

Primary and key secondary endpoint analyses and LDL-C changes from baseline were explored by individual statin type (atorvastatin, simvastatin, rosuvastatin, or pravastatin) at baseline, and then by categorizing these statins into lipophilic (i.e., hydrophobic: atorvastatin, simvastatin) and lipophobic (i.e., hydrophilic: rosuvastatin, pravastatin) statin groups; 96.1% of patients fell within these individual statin groups.

Results

CV outcomes were similar across statin types (interaction p=0.61) and lipophilic/lipophobic categories (interaction p=0.51) (Figure). Statin type and category had a similar lack of meaningful impact on the modest placebo-corrected median LDL-C changes from baseline to one year, which ranged from −5.8 to −8.4% (all p≤0.0003).

Conclusion

No meaningful treatment differences in the primary or key secondary endpoints across statin type or lipophilic/lipophobic category were observed. A similar lack of treatment difference was observed in LDL-C changes from baseline to one year. Therefore, the LDL-C changes and CV risk reduction in REDUCE-IT appear independent of the type of concomitant statin therapy. These data provide clinicians with additional insight regarding concomitant statin therapy considerations when prescribing icosapent ethyl and suggest there are important mechanisms of action for the substantial CV risk reduction observed with icosapent ethyl that are distinct from the LDL receptor pathway.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: accumulation of data across prespecified interim analyses to final results

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), an event-driven trial, randomized 8,179 statin-treated patients with elevated triglycerides (TGs) and increased cardiovascular (CV) risk to icosapent ethyl (IPE); pure, stable prescription eicosapentaenoic acid, 4g/day or placebo. 1,612 primary endpoint events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) projected 90% power to detect 15% relative risk reduction (5% 2-sided alpha). The key secondary composite endpoint was CV death, nonfatal MI, or nonfatal stroke. An independent data and safety monitoring committee (DMC) performed prespecified interim analyses (IAs) at ∼60% (IA1 31 May 2016 data cutoff; 2.9 y median primary endpoint follow-up) and ∼80% (IA2 01 May 2017; 3.7 y) of events; final analysis included 1,606 events (06 Sep 2018; 4.9 y median study follow-up).

Purpose

Explore REDUCE-IT efficacy and safety across prespecified IAs for insight into progression of robustness and consistency of conclusions.

Methods

The interim statistical analysis plan guided study continuation decisions by a prespecified decision-making process, including assessment of safety, treatment arm performance, primary composite endpoint formal analyses, and informal robustness analyses, with no futility or efficacy stopping requirements. Prior to DMC IA study continuation decisions, the need for a mature dataset to support the robustness of final efficacy and safety findings was discussed. Sponsor, Steering Committee, and Clinical Endpoint Committee were blinded throughout.

Results

Primary and key secondary endpoints achieved statistical significance at IA1 and IA2 that persisted at final analyses (p-value below final adjusted 2-sided alpha of 0.0437); hazard ratios also remained consistent and similar robustness was observed across individual endpoint components; clarity of findings across endpoints and subgroups improved with more events. Stopping for overwhelming efficacy was discussed at each IA; prior to IA study continuation recommendations, the DMC considered historical examples of failed CV outcome studies for TG-lowering and mixed omega-3 therapies, reflected on the potential for overestimating final demonstrated benefit using incomplete data, and weighed societal impacts of fuller datasets relative to patient therapy access.

Conclusions

Consistent, potent efficacy emerged early and persisted across the two prespecified interim and final analyses. The mature dataset demonstrated highly statistically significant reductions in the primary (25%; p=0.00000001) and key secondary (26%; p=0.0000006) endpoints and allowed robust analyses to support overall efficacy and safety conclusions. Allowing the REDUCE-IT dataset to fully mature provided clinicians with robust, consistent, and reliable data upon which to base clinical decisions for IPE in CV risk reduction.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: total ischemic events reduced across the full range of baseline LDL cholesterol and other key subgroups

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a study of 8,179 randomized statin-treated patients with elevated triglycerides (TG) and increased cardiovascular (CV) risk followed for a median of 4.9 years, demonstrated robust results. Icosapent ethyl (IPE), a pure and stable prescription form of eicosapentaenoic acid, 4g/day reduced both time-to-first and total primary endpoint ischemic events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) by 25% (HR 0.75; 95% CI 0.68–0.83; p&lt;0.0001) and 30% (rate ratio 0.70; 95% CI 0.62–0.78; p&lt;0.0001), respectively. Similar substantial reductions in first and total key secondary endpoint ischemic events (composite of CV death, nonfatal MI, or nonfatal stroke) were also observed. Demographic and baseline disease characteristics were generally balanced across treatment groups. Time-to-first event analyses showed robust and generally consistent benefit across subgroups. Previous total event analyses by baseline TG demonstrated large, consistent, statistically significant reductions across tertiles, suggesting the CV benefit of IPE is tied primarily to non-TG factors.

Purpose

Further explore the extent to which IPE reduced total primary and key secondary events across prespecified baseline demographic, disease, treatment, and lipid/lipoprotein/inflammatory biomarker subgroups.

Methods

Total events across subgroups were assessed with the prespecified negative binomial regression method. Main outcomes were total (first and subsequent) primary and key secondary composite endpoint events.

Results

Median baseline LDL-C levels in ascending tertiles were 58, 76, and 96 mg/dL; there were large, significant relative reductions in total primary endpoint events with IPE across tertiles (35%, 28%, and 27%, respectively; interaction p=0.62), with parallel substantial absolute risk reductions. Similar, significant relative reductions of 33%, 28%, and 24% in total key secondary endpoint events were observed, along with substantial absolute risk reductions. Total events analyses of prespecified subgroups also demonstrated robust and generally consistent findings for the primary and key secondary composite endpoints.

Conclusion

REDUCE-IT demonstrated substantial reductions in first and total primary and key secondary endpoint ischemic events, with robust and generally consistent results across baseline TG and LDL-C levels, as well as other prespecified baseline biomarker, demographic, disease, and treatment subgroups. These analyses provide useful insights for clinicians considering the range of patients who may benefit from IPE therapy and suggest that mechanisms beyond the lipid/lipoprotein/inflammatory pathways tested, including mechanisms beyond the LDL receptor pathways, may contribute to the observed substantial reductions in total ischemic burden with IPE therapy.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

1009 Sleep Apnea and Colorectal Adenoma in the Veteran Population: A Case-Control Study

Introduction

Colorectal cancer is the third most common cancer in the United States, with over half of colorectal cancers estimated to be the result of modifiable risk factors. Studies relating sleep apnea (SA) and colorectal adenoma (CRA) are limited and the findings are equivocal. The objective of this study was to examine the association between SA and risk of CRA.

Methods

This was a retrospective cross-sectional case-control study of data collected from 460 veterans, ages 50-79, seen in the colonoscopy clinic at the Michael E. DeBakey VA Medical Center between 2014 and 2018. Information on demographics, sleep history, and co-morbidities were obtained through lifestyle questionnaire. Self-reported SA was diagnosed by a prior sleep study. Cases consisted of 297 participants had pathologically confirmed adenoma (including 117 participants having advanced CRA with villous component or diameter of polyp &gt; 1 cm). Controls consisted of 173 polyp-free participants. The distribution of demographics and lifestyle factors were compared between CRA and non-CRA using the Student’s t or chi-square tests. Odds ratios (OR) and 95% confidence intervals (CI) of CRA in association with CRA were calculated using univariate and multivariate unconditional logistic regression models. The confounding factors included age, sex, ethnicity, obesity, smoking status, alcohol use, hypertension, and sleep duration.

Results

Compared with non-SA, the multivariable OR (95% CI) for CRA was 0.92 (0.58-1.48); for non-advanced CRA was 1.14 (0.68-1.91), and for advanced CRA was 0.61 (0.32-1.17) in SA participants. Adjustment of sleep duration in the model did not change the risk estimates.

Conclusion

Sleep-study diagnosed SA was not associated with development of CRA in this veteran population. Further studies are needed to confirm this observation and incorporate the severity and treatment of SA, and undiagnosed SA in risk assessment.

Support

This research is supported in part by the Gillson Longenbaugh Foundation, and Golfers Against Cancer organization (to LJ), the Cancer Prevention Research Institute of Texas (CPRIT) (RP#140767, to LJ).

Contamination profiles and risk assessment of per- and polyfluoroalkyl substances in groundwater in China

Per- and polyfluoroalkyl substances (PFASs) have attracted attention due to the potential risk they pose to ecosystems and human health. A total of 169 groundwater samples were collected from four representative regions in order to analyze PFASs concentrations in China. The total concentration of PFASs (∑PFASs) in groundwater ranged from 0.05 to 198.80 ng L^-1, with an average of 3.97 ng L^-1. All targeted PFASs were detected in the studied areas. The detection frequency and average concentration of perfluorooctanoic acid (PFOA) were the highest (79.29% and 1.61 ng L^-1, respectively). The contamination profiles of PFASs in each study area varied due to natural geographical conditions and human activities. According to the results of the potential source identification, the point sources of perfluorooctane sulfonate (PFOS) were mainly concentrated in Lanzhou, and the distribution of PFASs was slightly affected by atmospheric deposition in all the studied areas. The obtained concentrations of PFOA and PFOS may pose no threat to the residents due to water consumption.

Deriving aquatic life criteria for PBDEs in China and comparison of species sensitivity distribution with TBBPA and HBCD

Polybrominated diphenyl ethers (PBDEs) are important industrial brominated flame retardants. PBDEs have raised great concerns for their persistence, bioaccumulation, and harm to aquatic life and human health. Pentabromodiphenyl ether (PeBDE), octabromodiphenyl ether (OcBDE), and decabromodiphenyl ether (DeBDE) are three main commercial PBDEs congeners. In this study, published ecotoxicity data of these three PBDEs congeners for Chinese freshwater species were collected, and several acute and chronic toxicity tests for the three PBDEs congeners were performed. Using the derivation method for aquatic life criteria developed by the United States Environmental Protection Agency (USEPA), we determined that the criterion maximum concentration (CMC) for PeBDE, OcBDE and DeBDE for protection of freshwater organisms were 0.0492 mg/L, 0.197 mg/L and 0.239 mg/L, respectively. The criterion continuous concentration (CCC) for PeBDE, OcBDE and DeBDE were 0.0103 mg/L, 0.0224 mg/L and 0.0267 mg/L, respectively. The results provided a good reference for the derivation of PBDEs' water quality criteria and a basis for ecological risk assessment of PBDEs. In addition, the results of species sensitivity distribution comparison showed that the toxicity rank of five brominated flame retardants was TBBPA > PeBDE > OcBDE > DeBDE > HBCD.

[Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey]

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188.

Evolution of the Kondo lattice and non-Fermi liquid excitations in a heavy-fermion metal

Strong electron correlations can give rise to extraordinary properties of metals with renormalized Landau quasiparticles. Near a quantum critical point, these quasiparticles can be destroyed and non-Fermi liquid behavior ensues. YbRh2Si2 is a prototypical correlated metal exhibiting the formation of quasiparticle and Kondo lattice coherence, as well as quasiparticle destruction at a field-induced quantum critical point. Here we show how, upon lowering the temperature, Kondo lattice coherence develops at zero field and finally gives way to non-Fermi liquid electronic excitations. By measuring the single-particle excitations through scanning tunneling spectroscopy, we find the Kondo lattice peak displays a non-trivial temperature dependence with a strong increase around 3.3 K. At 0.3 K and with applied magnetic field, the width of this peak is minimized in the quantum critical regime. Our results demonstrate that the lattice Kondo correlations have to be sufficiently developed before quantum criticality can set in.

Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

BACKGROUND AND PURPOSE

Although the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications for Intracranial Atherosclerotic disease (ICAD) treatments with stent placement, some studies have shown that submaximal angioplasty with an undersized balloon limits the risks of perioperative complications, suggesting that intervention may remain an alternative option for ICAD if perioperative complications are minimized. We sought to evaluate clinical and angiographic outcomes after primary angioplasty without stent placement in patients with symptomatic, high-grade intracranial stenosis and poor antegrade flow who were refractory to medical therapy.

MATERIALS AND METHODS

All cases with high-grade, symptomatic intracranial stenosis and poor antegrade flow treated with intracranial angioplasty without stent placement at Xuanwu Hospital, Capital Medical University, from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. We also evaluated functional outcomes, stroke, and restenosis in patients on follow-up.

RESULTS

Thirty-five patients (mean age, 64.3 years) were included, and the mean follow-up time was 9.7 months. The average preprocedural stenosis was 88.4%. The immediate, average postprocedure stenosis rate was 25.3%, and the average postprocedural stenosis rate at last angiographic follow-up was 34.7%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The incidence of stroke or death at the last follow-up was 2.9%, which was superior to the results of the medical and stent-placement arms of the SAMMPRIS study. Severe restenosis was observed in 3 (3/25, 12%) patients but without any symptoms.

CONCLUSIONS

In this retrospective series, primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.

[Influence of two kinds of probiotics combined with bismuth quadruple therapy for Helicobacter pylori eradication]

Objective: To investigate the efficacy and safety of Compound Lactobacillus Tablets or Saccharomyces boulardii Sachets combining with bismuth quadruple therapy for Helicobacter pylori(H.pylori) eradication. Methods: A total of 360 H. pylori- infected patients were enrolled and randomly assigned into three groups. Group A received esomeprazole 20 mg bid+ bismuth potassium citrate 220 mg bid+ amoxicillin 1 000 mg bid+ furazolidone 100 mg bid for 10 days. Group B or group C received the same quadruple therapy for 10 days as group A, as well as Compound Lactobacillus Tablets 1 000 mg tid or Saccharomyces boulardii Sachets 500 mg bid for 14 days. Drug-related side effects and adverse reactions were collected during the therapy, and H. pylori eradication results were confirmed by (13)C/(14)C-UBT at least 4 weeks after cessation of therapy. Results: The H. pylori eradication rates in group A, B and C were 81.7%, 84.2% and 85.0% by ITT analysis (P=0.768) and 92.5%, 90.1% and 93.6% by PP analysis (P=0.770), respectively. The overall side effects and adverse reactions rates (P=0.008) and occurrence of diarrhea (P<0.001) were significantly lower in group B than group A. The overall side effect rates (P=0.003) and occurrence of diarrhea (P<0.001), abdominal distension (P=0.004) and constipation(P=0.002) were significantly lower in group C than group A. There was no significant difference in side effects and adverse reactions rates between the two probiotics groups. Conclusions: Both Compound Lactobacillus Tablets and Saccharomyces boulardii Sachets, combining with bismuth quadruple therapy, reduced the overall side effects and adverse reactions rates for H. pylori eradication. Moreover, the former can reduce the incidence of diarrhea, and the latter can reduce the incidence of diarrhea, abdominal distension and constipation.

Features and influencing factors of nitrogen and phosphorus diffusive fluxes at the sediment-water interface of Erhai Lake

Nitrogen and phosphorus diffusion at the sediment-water interface is vital to the water quality of lakes. In this paper, N and P diffusive fluxes at the sediment-water interface in Erhai Lake were studied using the sediment-pore water diffusive flux method. Characteristics of temporal and spatial variation of N and P diffusive fluxes were analyzed. Effects of the physicochemical properties of sediments and overlying water were discussed. Results showed that (1) the total N and P diffusive fluxes at the sediment-water interface of Erhai Lake are relatively low. The diffusive flux of ammonia nitrogen is 8.97~74.84 mgd^-1 m^-2, higher in the middle of the lake, followed by the northern and southern regions successively. The P diffusive flux is -0.007~0.050 mgd^-1 m^-2, higher in northern region of the lake, followed by middle and southern regions successively. The annual N diffusive flux has two peaks, and the higher peak is in September. The annual P diffusive flux shows a "V-shaped" variation, reaching the valley in July. N and P diffusive fluxes decrease with an increase of sediment depth. Overall, N and P diffusive fluxes at the sediment-water interface in Erhai Lake show different temporal and spatial variation. (2) Aquatic plants promote N and P diffusion at the sediment-water interface in Erhai Lake. The pH, DO, and SD of the overlying water are important influencing factors for the P diffusive flux. P diffusive flux is inversely proportional to the total phosphorous (TP) concentration of the overlying water. The physicochemical environment of overlying water slightly influences the N diffusive flux. The activity of sediments and the organic content are two main influencing factors of N diffusive flux, while P content and morphology of sediments are the main influencing factors of P diffusive flux. Iron and manganese ions are important elements that influence N and P diffusive fluxes at the sediment-water interface. (3) The P diffusive flux at the sediment-water interface in Erhai Lake is mainly affected by the physical and chemical properties of water, whereas the N diffusive flux is mainly influenced by the mineralization of organic matter in sediments. The P diffusive flux at the sediment-water interface is sensitive to the overlying water quality. Sediment transformation from "source" to "sink" was observed in 1 year. On the contrary, N diffusive flux is less sensitive to lake water quality. Endogenetic pollutant control in Erhai Lake should focus on P control.

[Effect and mechanism of silibinin on the inhibition of ALK positive NSCLC cells by sensitizing crizotinib]

Objective: To explore the synergistic effect of silibinin combined with crizotinib on anaplastic lymphoma kinase positive (ALK+ ) non-small cell lung cancer (NSCLC) cells and its mechanism. Methods: H2228 and H3122 cells were treated with silibinin, crizotinib alone or in combination. Cell proliferation was measured by 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation assay. Migration or invasion ability was tested by wound healing assay or transwell assay, respectively. Expressions of E-Cadherin and vimentin protein were examined by immunofluorescence staining. The protein expressions of ALK, p-ALK, E-Cadherin and Vimentin were detected by western blotting.The anti-cancer effect of silibinin combined with crizotinib in vivo was determined by subcutaneously injecting 2×10(6) H2228 cells into immunodeficient nude mice. Results: The result of MTT assay showed that the cell viability of H2228 or H3122 treated with 100 μmol/L silibinin was (88.38±4.10)% or (72.27±3.62)%, respectively, marginally decreased compared with that of the control. The 50% inhibitory concentration (IC(50)) of H2228 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (917.10±7.75) nmol/L or (238.73±7.67) nmol/L, respectively. The IC(50) of H3122 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (472.50±15.70) nmol/L or (206.10±12.01) nmol/L, respectively. The IC(50s) of H2228 and H3122 cells were significantly decreased by combined treatment of crizotinib and silibinin compared to crizotinib treatment alone (P<0.01). When compared with the control group, colony forming ratios of H2228 cells were (83.34±2.72)% in 100 μmol/L silibinin treatment group, (69.42±3.06)% in 400 nmol/L crizotinib treatment group and (27.32±1.42)% in combined treatment group. When compared with the control group, colony forming ratios of H3122 cells were (84.45±5.67)% in 100 μmol/L silibinin treatment group, (45.02±5.83)% in 400 nmol/L crizotinib treatment group and (17.43±3.83)% in combined treatment group. Silibinin combined with crizotinib treatment significantly inhibited the colony formation ability of H2228 and H3122 cells (P<0.01). Migration and invasion results showed that combined treatment of crizotinib and silibinin markedly inhibited the migration and invasion ability of H2228 cells (P<0.01). Western blot results indicated that treated with silibinin alone or in combination of crozitinib for 48 hours, the protein level of E-cadherin in H2228 cells was upregulated, while the expressions of p-ALK and vimentin were downregulated, without obvious alteration of ALK protein expression. In the xenograft model, the mean tumor weight was (9.40±2.58)g in crizotinib treatment group and (4.58±1.07)g in the combined treatment group. The inhibitory effect of tumor growth in vivo of combined treatment was significantly superior to that of crizotinib treatment alone (P<0.05). Conclusion: Silibinin enhances the inhibitory effect of crizotinib on ALK positive NSCLC cells, which may be associated with suppression of ALK activity and mesenchymal-epithelial transition.

Mo2C-Ni-modified nitrogen-doped carbon nanofiber toward efficient hydrogen evolution reaction

We have synthesized a fibroid electrocatalyst (Mo₂C-Ni@N-CNF) using a facile template-directed hydrothermal method which exhibited favourable hydrogen evolution reaction activity.

Additional energy scale in SmB6 at low-temperature

Topological insulators give rise to exquisite electronic properties because of their spin-momentum locked Dirac-cone-like band structure. Recently, it has been suggested that the required opposite parities between valence and conduction band along with strong spin-orbit coupling can be realized in correlated materials. Particularly, SmB6 has been proposed as candidate material for a topological Kondo insulator. Here we observe, by utilizing scanning tunnelling microscopy and spectroscopy down to 0.35 K, several states within the hybridization gap of about ±20 meV on well characterized (001) surfaces of SmB6. The spectroscopic response to impurities and magnetic fields allows to distinguish between dominating bulk and surface contributions to these states. The surface contributions develop particularly strongly below about 7 K, which can be understood in terms of a suppressed Kondo effect at the surface. Our high-resolution data provide insight into the electronic structure of SmB6, which reconciles many current discrepancies on this compound.

Multiple quantum phase transitions and superconductivity in Ce-based heavy fermions

Heavy fermions have served as prototype examples of strongly-correlated electron systems. The occurrence of unconventional superconductivity in close proximity to the electronic instabilities associated with various degrees of freedom points to an intricate relationship between superconductivity and other electronic states, which is unique but also shares some common features with high temperature superconductivity. The magnetic order in heavy fermion compounds can be continuously suppressed by tuning external parameters to a quantum critical point, and the role of quantum criticality in determining the properties of heavy fermion systems is an important unresolved issue. Here we review the recent progress of studies on Ce based heavy fermion superconductors, with an emphasis on the superconductivity emerging on the edge of magnetic and charge instabilities as well as the quantum phase transitions which occur by tuning different parameters, such as pressure, magnetic field and doping. We discuss systems where multiple quantum critical points occur and whether they can be classified in a unified manner, in particular in terms of the evolution of the Fermi surface topology.

Two-Gap Superconductivity in LaNiGa_{2} with Nonunitary Triplet Pairing and Even Parity Gap Symmetry

The nature of the pairing states of superconducting LaNiC_{2} and LaNiGa_{2} has to date remained a puzzling question. Broken time reversal symmetry has been observed in both compounds and a group theoretical analysis implies a nonunitary triplet pairing state. However, all the allowed nonunitary triplet states have nodal gap functions but most thermodynamic and NMR measurements indicate fully gapped superconductivity in LaNiC_{2}. Here we probe the gap symmetry of LaNiGa_{2} by measuring the London penetration depth, specific heat, and upper critical field. These measurements demonstrate two-gap nodeless superconductivity in LaNiGa_{2}, suggesting that this is a common feature of both compounds. These results allow us to propose a novel triplet superconducting state, where the pairing occurs between electrons of the same spin, but on different orbitals. In this case the superconducting wave function has a triplet spin component but isotropic even parity gap symmetry, yet the overall wave function remains antisymmetric under particle exchange. This model leads to a nodeless two-gap superconducting state which breaks time reversal symmetry, and therefore accounts well for the seemingly contradictory experimental results.

DGT induced fluxes in sediments model for the simulation of phosphorus process and the assessment of phosphorus release risk

Diffusive gradients in thin films (DGT)-induced flux in sediments (DIFS) (DGT-DIFS) model for phosphorus (P) has been investigated to provide a numerical simulation of a dynamic system of the DGT-pore water-sediment in Dianchi Lake (China). Kinetic parameter-T C (33-56,060 s), distribution coefficient-K d (134.7-1536 cm(3)g(-1)), and resupply parameter-R (0.189-0.743) are derived by DGT measurement, the sediment/pore water test, and the DIFS model. The changes of dissolved concentration in DGT diffusive layer and pore water and sorbed concentration in sediment, as well as the ratio of C DGT and the initial concentration in pore water (R) and mass accumulated by DGT resin (M) at the DGT-pore water-sediment interface (distance) of nine sampling sites during DGT deployment time (t) are derived through the DIFS simulation. Based on parameter and curves derived by the DIFS model, the P release-transfer character and mechanism in sediment microzone were revealed. Moreover, the DGT-DIFS parameters (R, T C , K -1 , C DGT ), sediment P pool, sediment properties (Al and Ca), and soluble reactive P (SRP) in overlying water can be used to assess "P eutrophication level" at different sampling sites with different types of "external P loading." The DGT-DIFS model is a reliable tool to reveal the dynamic P release in sediment microzone and assess "internal P loading" in the plateau lake Dianchi.

Effects of organic matter content and composition on ammonium adsorption in lake sediments

The nature of the influence of organic matter (OM) on ammonium adsorption in lake sediments remains disputed. In this study, the kinetics and thermodynamics of ammonium adsorption were investigated on sediment samples with different OM contents (ignoring the effects of OM mineralization) previously collected from Lake Wuli, a northern bay of Lake Taihu, a shallow lake in southern China. The mechanisms of ammonium adsorption in these samples were characterized by Fourier transform infrared spectrometry and scanning electron microscopy. The results show that the ammonium adsorption capacity of the sediments is highly correlated with their OM content and with the humic content of the OM. The ammonium adsorption capacity of OM varies with its composition, i.e., with the surface properties of the different functional groups present. Indeed, humic acid was found to have a greater ammonium adsorption capacity by itself than when mixed with kerogen and black carbon, the mixture of the latter two components proving a better adsorbent than pure black carbon.

Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

BACKGROUND AND PURPOSE

On the basis of the high 1-month stroke and/or death (14.7%) rates associated with stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death.

MATERIALS AND METHODS

The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding perforator ischemic events) related to high-grade (70%-99% in severity) stenosis of a major intracranial artery. Patients were treated by using angioplasty and self-expanding stents 3 weeks after the index ischemic event at 1 of the 10 high-volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within 1 month after the procedure.

RESULTS

A total of 100 consecutive patients were recruited. The target lesions were located in the middle cerebral artery (M1) (n = 38, 38%), intracranial internal carotid artery (n = 17, 17%), intradural vertebral artery (n = 18, 18%), and basilar artery (n = 27, 27%). The technical success rate of stent deployment with residual stenosis of <50% was 100%. The overall 1-month stroke and/or death rate was 2% (95% confidence interval, 0.2%-7.0%). Two ischemic strokes occurred in the pontine region (perforator distribution) in patients following angioplasty and stent placement for basilar artery stenosis.

CONCLUSIONS

The results of this prospective multicenter study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the 1-month stroke and/or death rate following intracranial stent placement.

Multi-metals Measured at Sediment-Water Interface (SWI) by Diffusive Gradients in Thin Films (DGT) Technique for Geochemical Research

Diffusive gradients in thin films (DGT) technique was used to determine pore water profile and to assess remobilization character of metals at sediment/water interface. The remobilization of Mn was due to redox reaction in profile, which engendered two large peaks: one with DGT concentration of 1355 µg L(-1) at depth of -4.75 cm in sediment and the other with DGT concentration of 1040 µg L(-1) at depth of -3.25 cm in sediment pore water. Fe reduction zone had a large peak of Fe (3209 µg L(-1)) at depth of -4.75 cm in sediment. Fe DGT-profile also indicated the little peaks and low values of dissolved Fe concentration in Fe-reduction/S-reduction boundary zone in sediment. Detailed correspondence of trace metals with Fe or Mn features in DGT-profiles suggested that their release is related to the reductive dissolution of Fe- or Mn-oxide.

Pd nanoparticles supported on amino-functionalized magnetic mesoporous silica nanotubes: a highly selective catalyst for the catalytic hydrodechlorination reaction

Highly dispersed Pd nanoparticles supported on amine-functionalized magnetic mesoporous silica nanotubes are prepared. This catalyst exhibits remarkable catalytic performance for the HDC reaction.