Effects of umami substances as taste enhancers on salt reduction in meat products: A review

Sodium is one of the essential additives in meat processing, but excessive sodium intake may increase risk of hypertension and cardiovascular disease. However, reducing salt content while preserving its preservative effect, organoleptic properties, and technological characteristics poses challenges. In this review, the mechanism of salt reduction of umami substances was introduced from the perspective of gustation-taste interaction, and the effects of the addition of traditional umami substances (amino acids, nucleotides, organic acids(OAs)) and natural umami ingredients (mushrooms, seaweeds, tomatoes, soybeans, tea, grains) on the sensory properties of the meat with reduced-salt contents were summarized. In addition, the impacts of taste enhancers on eating quality (color, sensory, textural characteristics, and water-holding capacity (WHC)), and processing quality (lipid oxidation, pH) of meat products (MP) and their related mechanisms were also discussed. Among them, natural umami ingredients exhibit distinct advantages over traditional umami substances in terms of enhancing quality and nutritional value. On the basis of salt reduction, natural umami ingredients improve the flavor, texture, WHC and antioxidant capacity. This comprehensive review may provide the food industry with a theoretical foundation for mitigating salt consumption through the utilization of umami substances and natural ingredients.

Developing active and intelligent biodegradable packaging from food waste and byproducts: A review of sources, properties, film production methods, and their application in food preservation

Food waste and byproducts (FWBP) are a global issue impacting economies, resources, and health. Recycling and utilizing these wastes, due to processing and economic constraints, face various challenges. However, valuable components in food waste inspire efficient solutions like active intelligent packaging. Though research on this is booming, its material selectivity, effectiveness, and commercial viability require further analysis. This paper categorizes FWBP and explores their potential for producing packaging from both animal and plant perspectives. In addition, the preparation/fabrication methods of these films/coatings have also been summarized comprehensively, focusing on the advantages and disadvantages of these methods and their commercial adaptability. Finally, the functions of these films/coatings and their ultimate performance in protecting food (meat, dairy products, fruits, and vegetables) are also reviewed systematically. FWBP provide a variety of methods for the application of edible films, including being made into coatings, films, and fibers for food preservation, or extracting active substances directly or indirectly from them (in the form of encapsulation) and adding them to packaging to endow them with functions such as barrier, antibacterial, antioxidant, and pH response. In addition, the casting method is the most commonly used method for producing edible films, but more film production methods (extrusion, electrospinning, 3D printing) need to be tried to make up for the shortcomings of the current methods. Finally, researchers need to conduct more in-depth research on various active compounds from FWBP to achieve better application effects and commercial adaptability.

Roles of AhR/CYP1s Signal Pathway Mediated ROS Production in Uremic Cardiomyopathy

PURPOSE

Uremic cardiomyopathy (UCM) is the leading cause of chronic kidney disease (CKD) related mortality. Uremic toxins including indoxyl sulfate (IS) play important role during the progression of UCM. This study was to explore the underlying mechanism of IS related myocardial injury.

METHODS

UCM rat model was established through five-sixths nephrectomy to evaluate its effects on blood pressure, cardiac impairment, and histological changes using echocardiography and histological analysis. Additionally, IS was administered to neonatal rat cardiomyocytes (NRCMs) and the human cardiomyocyte cell line AC16. DHE staining and peroxide-sensitive dye 2',7'-dichlorofluorescein diacetate (H2DCFDA) was conducted to assess the reactive oxygen species (ROS) production. Cardiomyocyte hypertrophy was estimated using wheat germ agglutinin (WGA) staining and immunofluorescence. Aryl hydrocarbon receptor (AhR) translocation was observed by immunofluorescence. The activation of AhR was evaluated by immunoblotting of cytochrome P450 1s (CYP1s) and quantitative real-time PCR (RT-PCR) analysis of AHRR and PTGS2. Additionally, the pro-oxidative and pro-hypertrophic effects were evaluated using the AhR inhibitor CH-223191, the CYP1s inhibitor Alizarin and the ROS scavenger N-Acetylcysteine (NAC).

RESULTS

UCM rat model was successfully established, and cardiac hypertrophy, accompanied by increased blood pressure, and myocardial fibrosis. Further research confirmed the activation of the AhR pathway in UCM rats including AhR translocation and downstream protein CYP1s expression, accompanied with increasing ROS production detected by DHE staining. In vitro experiment demonstrated a translocation of AhR triggered by IS, leading to significant increase of downstream gene expression. Subsequently study indicated a close relationship between the production of ROS and the activation of AhR/CYP1s, which was effectively blocked by applying AhR inhibitor, CYP1s inhibitor and siRNA against AhR. Moreover, the inhibition of AhR/CYP1s/ROS pathway collectively blocked the pro-hypertrophic effect of IS-mediated cardiomyopathy.

CONCLUSION

This study provides evidence that the AhR/CYP1s pathway is activated in UCM rats, and this activation is correlated with the uremic toxin IS. In vitro studies indicate that IS can stimulate the AhR translocation in cardiomyocyte, triggering to the production of intracellular ROS via CYP1s. This process leads to prolonged oxidative stress stimulation and thus contributes to the progression of uremic toxin-mediated cardiomyopathy.

[Overexpression of tuftelin and KLF-5 and its clinicopathological features in hepatitis B virus-related hepatocellular carcinoma]

Objective: To analyze and evaluate the expressions and clinical value of tuftelin (TUFT1) and Krüppel-like factor 5 (KLF5) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) tissues. Method: KLF5 mRNA and TUFT1 mRNA transcriptional status in cancer and non-cancer groups were compared according to the Cancer Genome Atlas (TCGA) database. The differences and prognostic value between the groups were analyzed. Postoperative liver cancer and its paired pericancerous tissues, with the approval of the ethics committee, were collected to build tissue chips. The expression of KLF5 and TUFT1 and their intracellular localization were verified by immunohistochemistry. Tissue expression and clinicopathological characteristics were analyzed by immunoblotting. SPSS software was used to analyze the relationship between SPSS and patient prognosis. Results: The transcription level of TUFT1 or KLF5 mRNA was significantly higher in the HCC group than the non-cancer group (P < 0.001), according to TCGA data. Immunohistochemistry and Western blotting examination confirmed the overexpression of TUFT1 and KLF5 in human HCC tissues, which were mainly localized in the cytoplasm and cell membrane. The positivity rates of TUFT1 and KLF5 were 87.1% ( χ(2) = 18.563, P < 0.001) and 95.2% ( χ(2) = 96.435, P < 0.001) in HCC tissues, and both were significantly higher than those in the adjacent group. The expression intensity was higher in stage III-IV than stage I-II of the International Union Against Cancer standard (P < 0.01). The clinicopathological features showed that the abnormalities of the two were significantly related to HBV infection, tumor size, extrahepatic metastasis, TNM stage, and ascites. Univariate analysis was related to tumor size, HBV infection, and survival. Multivariate analysis was an independent prognostic factor for patients with HCC. Conclusion: TUFT1 and KLF5 may both be novel markers possessing clinical value in the diagnosis and prognosis of HBV-related HCC.

Sodium fluoride-induced autophagy of ameloblast-like cells via the p-ULk1/ATG13/LC3B pathway in vitro

OBJECTIVE

To investigate the effects of sodium fluoride on the ameloblast and reveal the mechanism of dental fluorosis.

MATERIALS AND METHODS

Mouse ameloblast-like cell line (ALC) cells were treated with various concentrations of NaF, and subjected to Incucyte, fluorescence immunoassay, transmission electron microscopy, reverse transcription quantitative polymerase chain reaction (RT-qPCR), western blot for autophagy examination, alkaline phosphatase and alizarin red staining for mineralization after osteogenic induction.

RESULTS

NaF exerts a dose-dependent inhibitory effect on ALC cell growth. TEM and fluorescence immunoassay showed that 1.5 mM or higher concentrations of NaF could induce a fusion of lysosome and mitochondria, finally increasing the number of autophagosome. RT-qPCR and western blot showed that the upregulation of autophagy related gene 13 (ATG13), downregulation of phosphorylated Unc-51-like kinase 1 (p-ULK1) were found in NaF-induced autophagy of ALC cells. The knockdown of ATG13 could rescue it as well as the expression of p-ULK1 and LC3B. Besides, alizarin red staining showed that fluoride under these concentrations could promote the mineralization of ALC.

CONCLUSIONS

The data show that fluoride in higher concentration can induce autophagy via the p-ULk1/ATG13/LC3B pathway of ALCs than lower ones promote mineralization in vitro, which provides insight into the function of NaF in the autophagy and mineralization of ameloblast.

Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study

BACKGROUND

Cardiovascular diseases (CVD) is the leading cause of death among maintenance hemodialysis patients, with dyslipidemia being a prevalent complication. The paradoxical relationship between cardiovascular outcomes and established lipid risk markers, such as low-density lipoprotein cholesterol (LDL-C), complicates lipid management in this population. This study investigated Lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging biomarker known for its proinflammatory and proatherogenic properties, as a potential cardiovascular prognostic marker in this cohort. In this context, the association between Lp-PLA2 levels and cardiovascular outcomes was evaluated, with the aim to facilitate more accurate stratification and identification of high-risk individuals.

METHODS

From August 2013 to January 2014, 361 hemodialysis patients were prospectively enrolled. Lp-PLA2 activity and laboratory measures at baseline were quantified. Comorbidities and medications were recorded. All patients were followed until the end of April, 2022. The individual and combined effects of Lp-PLA2 activity and LDL-C on patient outcomes were examined. The association between Lp-PLA2 activity and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) was analyzed.

RESULTS

The median Lp-PLA2 activity was 481.2 U/L. In subjects with Lp-PLA2 activity over 481.2 U/L, significantly higher total cholesterol (4.89 vs. 3.98 mmol/L; P < 0.001), LDL-C (3.06 vs. 2.22 mmol/L; P < 0.001), and apolipoprotein B (0.95 vs. 0.75 mmol/L; P < 0.001) were observed. Over a median follow-up of 78.1 months, 182 patients died, with 77 cases identified as cardiovascular death, 88 MACEs happened. Cardiovascular mortality and MACEs, but not all-cause mortality, were significantly increased in the high Lp-PLA2 group. Cox regression analyses showed that high Lp-PLA2 activity was associated with cardiovascular mortality and MACE occurrence. After comprehensive adjustment, high Lp-PLA2 activity was independently associated with cardiovascular mortality(as a dichotomous variable: HR:2.57, 95%CI:1.58,4.18, P < 0.001; as a continuous variable: HR:1.25, 95%CI:1.10,1.41, P = 0.001) and MACEs(as a dichotomous variable: HR:2.17, 95%CI:1.39,3.40, P = 0.001; as a continuous variable: HR:1.20, 95%CI:1.07,1.36, P = 0.002). When participants were grouped by median Lp-PLA2 activity and LDL-C values, those with high Lp-PLA2 and low LDL-C had the highest CV mortality. The addition of Lp-PLA2 significantly improved reclassification (as a dichotomous variable NRI = 42.51%, 95%CI: 5.0%,61.33%; as a continuous variable, NRI = 33.32%, 95% CI: 7.47%,56.21%).

CONCLUSIONS

High Lp-PLA2 activity is an independent risk factor for cardiovascular mortality and MACEs occurrence in patients on hemodialysis. The combined measures of Lp-PLA2 and LDL-C help to identify individuals with a higher risk of cardiovascular death.

[A preliminary study on the establishment of a subcutaneous allergen-specific immunotherapy center]

Allergic diseases can notably affect a patient's quality of life. World Health Organization (WHO) has identified these diseases as one of the key areas for research and prevention in the 21st century. Currently, allergen-specific immunotherapy is viewed as a potential treatment approach that could modify the natural progression of allergic diseases, thus being recognized as a crucial tactic in their prevention and treatment. Nonetheless, the broad implementation of allergen-specific immunotherapy in clinical settings continues to confront challenges. One significant issue is the absence of standardized centers for subcutaneous allergen-specific immunotherapy. This article presents several perspectives and recommendations for establishing a standardized subcutaneous allergen-specific immunotherapy center.

Dose-related effects of early-life intake of sn-2 palmitate, a specific positionally distributed human milk fatty acid, on the composition and metabolism of the intestinal microbiota

sn2 Palmitate in human milk plays an important role in the physiological health of infants by reducing mineral loss, improving stool hardness, and relieving constipation. Also, sn-2 palmitate modulates intestinal microbiota. However, it remains unclear whether the effects of sn-2 palmitate on infant gut microbiota are dose-dependent. In this study, we investigated the effects of low, medium, and high doses (600, 1,800, and 5,400 mg/kg body weight, respectively) of sn-2 palmitate on the structure, composition, and metabolic function of intestinal microbes in mice. Our results showed that high doses of sn-2 palmitate significantly modulated α- and β-diversity of the intestinal microbiota. The relative abundance of Lachnospiraceae_NK4A136_group decreased with increasing doses of sn-2 palmitate. In contrast, the abundances of Bacteroidetes phylum, Bacteroides, uncultured_Lachnospiraceae, and uncultured_Muribaculaceae were positively correlated with sn-2 palmitate doses. The number of genes predicted encoding autophagy-yeast, phospholipase D signaling pathway, and pentose and glucuronate interconversion metabolic functions of intestinal microbiota increased with increasing doses of sn-2 palmitate. In addition, low and medium doses of sn-2 palmitate significantly upregulated the arginine and proline metabolic pathways, and high doses of sn-2 palmitate significantly increased purine metabolism. Our results revealed that the effects of sn-2 palmitate intake early in life on the composition and metabolism of the intestinal microbiota of mice showed dose-related differences. The study is expected to provide a scientific basis for the development of infant formulas.

Development and characterization of a new potato starch/watermelon peel pectin composite film loaded with TiO2 nanoparticles and microencapsulated Lycium barbarum leaf flavonoids and its use in the Tan mutton packaging

Reinforced edible film with active nanoparticles has been in increasing demand as a new technology to improve the quality and extend the shelf-life of muscle foods. The study aimed to fabricate and characterize a novel potato starch (Pst)/watermelon peel pectin (Wpp) composite film with the microencapsulated Lycium barbarum leaf flavonoids (MLF) and nano-TiO2 (Pst/Wpp/MLF/TiO2) and further apply the film in Tan mutton preservation. The moisture content, thickness and water vapor permeability (WVP) of the composite film were relatively increased with increasing the percentage of MLF, while nano-TiO2 had slight influence on the thickness, but leaded to a significantly decreased the moisture content and WVP. Also, the SEM images showed that the roughness and porosity were created on the film surface by adding MLF and nano-TiO2. FTIR revealed electrostatic and hydrogen bond interactions between the components in the film system. Meanwhile, MLF and nano-TiO2 effectively enhanced the mechanical strength, UV-barrier, controlled-release, thermal stability, antimicrobial and antioxidation properties of the Pst/Wpp film. Also, the composite film containing MLF and nano-TiO2 significantly inhibited the growth of microorganisms and chemical deterioration of mutton samples, which suggested that such film has potential as a prospective active packaging for preserving Tan mutton.

Weekend effect on the incidence and outcomes of cardiac surgery associated - acute kidney injury

BACKGROUND

The effects of surgical day (workdays or weekends) on occurrence and outcome of cardiac surgery associated -acute kidney injury (CSA-AKI) remains unclear. This study aimed to compare the incidence and short-term outcomes of CSA-AKI in patients undergoing surgery on workdays and weekends.

MATERIALS AND METHODS

Patients who underwent cardiac surgery from July 2020 to December 2020 were retrospectively enrolled in this study. These patients were divided into a weekend group and workday group. The primary endpoint was the incidence of CSA-AKI. The secondary endpoints included renal function recovery and in-hospital mortality. The logistic regression model was used to explore the risk factors for CSA-AKI. Stratification analysis was performed to estimate the association between CSA-AKI and weekend surgery stratified by emergency surgery.

RESULTS

A total of 1974 patients undergoing cardiac surgery were enrolled. The incidence of CSA-AKI in the weekend group was significantly higher than that in the workday group (42.8% vs. 34.7%, P = 0.038). Further analysis of patients with CSA-AKI showed that there was no difference in renal function recovery between the workday AKI group and weekend AKI group. There was no difference in in-hospital mortality between the weekend group and workday group (3.6% vs. 2.4%, P = 0.327); however, the in-hospital mortality of the weekend AKI group was significantly higher than that of the workday AKI group (8.5% vs. 2.9%, P = 0.014). Weekend surgery and emergency surgery were independent risk factors for CSA-AKI. The multiplicative model showed an interaction between weekend surgery and emergency surgery; weekend surgery was related to an increased risk of AKI among patients undergoing emergency surgery [adjusted OR (95% CI): 1.96 (1.012-8.128)].

CONCLUSIONS

The incidence of CSA-AKI in patients undergoing cardiac surgery on weekends was significantly higher compared to that in patients undergoing cardiac surgery on workdays. Weekend surgery did not affect the in-hospital mortality of all patients but significantly increased the mortality of AKI patients. Weekend surgery and emergency surgery were independent risk factors for CSA-AKI. Weekend emergency surgery significantly increased the risk of CSA-AKI.

[Chinese expert guidance on overall application of lenvatinib in hepatocellular carcinoma]

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4, 2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

Personalized music therapy combined with medication as treatment for tinnitus

OBJECTIVE

This study aimed to investigate the effects of personalized music therapy in combination with medication as a treatment for tinnitus.

PATIENTS AND METHODS

We retrospectively analyzed a total of 200 patients who were admitted to the Department of Otorhinolaryngology in our hospital from June 2018 to June 2019, with tinnitus as their primary complaint. Patients were divided into four groups based on their individual treatment methods: medication group (patients received medication only, n=40), tinnitus masking (TM) group (patients received medication plus TM, n=38), tinnitus re-training (TRT) group (patients received medication plus TRT, n=35), and personalized group (patients received medication plus personalized music therapy, n=30). The pure-tone audiometry (PTA), loudness visual analogue scale (VAS), and tinnitus handicap inventory (THI) for each patient were analyzed.

RESULTS

There were statistically significant differences in the THI and VAS scores of all groups before and after treatment (p<0.05). Following nine and twelve months of treatment, the THI and VAS scores of the TRT group and the personalized group were significantly lower than those of the other two groups (p<0.05). The THI and VAS scores of the personalized group were significantly lower than those of the TRT group (p<0.05). Additionally, THI and VAS scores were statistically different at various measurement time points in each group (p<0.05). The clinical effective rate (85.37%) of the personalized group was higher than that of the other three groups (p<0.05).

CONCLUSIONS

TM, TRT, or personalized music therapy, when combined with medication, are effective in treating patients with tinnitus. Among these methods, personalized music therapy may be the superior treatment after nine months of treatment.

[Prevalence rate and risk factor analysis of nonalcoholic fatty liver disease in 115 female patients with schizophrenia]

Objective: To investigate the incidence rate and risk factors of nonalcoholic fatty liver disease (NAFLD) in patients with schizophrenia (SCZ). Methods: The incidence rate of NAFLD in 115 females with SCZ over 40 years of age with complete clinical data was analyzed with the consent of the Ethics Committee of Nantong Fourth People's Hospital. A physical examination report of healthy subjects (n = 95, female, age 40 years old or older) was taken as the control group. Natural language processing technology was used to extract relevant data from the patient's electronic medical record system. Body mass index, alanine aminotransferase, triglycerides, low-density lipoprotein, leptin, and adiponectin were used to establish a human NAFLD-related model. Logistic regression analysis was used to evaluate the psychiatric symptoms, and physiological and biochemical indexes for the predictive value of NAFLD in female patients with SCZ. Results: The prevalence of NAFLD was significantly higher in the SCZ group (55.7%, 64/115) than that in the control group (26.3%, 25/95) (χ (2) = 18.335, P < 0.001). The prediction model showed that age, alanine aminotransferase, triglycerides, low-density lipoprotein, leptin, adiponectin, and body mass index were significantly correlated with NAFLD in females with SCZ. In the natural language processing search language model, arousal intensity (movements: uncontrolled running behavior) and emotional apathy were strongly linked to female patients with SCZ with NAFLD. Age, alanine aminotransferase, triglycerides, low-density lipoprotein, leptin, and body mass index were risk factors for SCZ to develop NAFLD, and adiponectin levels and uncontrolled running behavior were protective factors. Conclusion: The incidence rate of NAFLD is high in middle-aged and elderly females with SCZ. Natural language processing can help to automatically identify the risk factors for SCZ combined with NAFLD and has predictive and auxiliary diagnostic value.

Physicochemical and structural changes of myofibrillar proteins in muscle foods during thawing: Occurrence, consequences, evidence, and implications

Myofibrillar protein (MP) endows muscle foods with texture and important functional properties, such as water-holding capacity (WHC) and emulsifying and gel-forming abilities. However, thawing deteriorates the physicochemical and structural properties of MPs, significantly affecting the WHC, texture, flavor, and nutritional value of muscle foods. Thawing-induced physicochemical and structural changes in MPs need further investigation and consideration in the scientific development of muscle foods. In this study, we reviewed the literature for the thawing effects on the physicochemical and structural characters of MPs to identify potential associations between MPs and the quality of muscle-based foods. Physicochemical and structural changes of MPs in muscle foods occur because of physical changes during thawing and microenvironmental changes, including heat transfer and phase transformation, moisture activation and migration, microbial activation, and alterations in pH and ionic strength. These changes are not only essential inducements for changes in spatial conformation, surface hydrophobicity, solubility, Ca²⁺ -ATPase activity, intermolecular interaction, gel properties, and emulsifying properties of MPs but also factors causing MP oxidation, characterized by thiols, carbonyl compounds, free amino groups, dityrosine content, cross-linking, and MP aggregates. Additionally, the WHC, texture, flavor, and nutritional value of muscle foods are closely related to MPs. This review encourages additional work to explore the potential of tempering techniques, as well as the synergistic effects of traditional and innovative thawing technologies, in reducing the oxidation and denaturation of MPs and maintaining the quality of muscle foods.

Effect of angiography timing on acute kidney injury after cardiac surgery in patients with preoperative renal dysfunction

BACKGROUND

Cardiac surgery-associated acute kidney injury (AKI) is one of the common complications of cardiac surgery. Preoperative angiography helps assess heart disease but may increase the risk of AKI. Although more and more patients with preoperative renal dysfunction can undergo cardiac surgery with the advances in surgical techniques, there is little research on the effect of angiography on postoperative AKI in these patients. This study investigates whether angiography increases the risk of AKI after cardiac surgery in patients with preoperative renal dysfunction (15 ≤ eGFR < 60 ml/min/1.73m²).

METHODS

Patients with preoperative renal dysfunction (15 ≤ eGFR < 60 ml/min/1.73m²) who underwent angiography and cardiac surgery successively from January 2015 to December 2020 were retrospectively enrolled in this study. The primary outcome was postoperative AKI, defined as the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate analysis and multivariate regression were performed to identify the association between angiography timing and AKI.

RESULTS

A total of 888 consecutive eligible patients with preoperative renal dysfunction (15 ≤ eGFR < 60 ml/min/1.73m²) were enrolled in this study. The incidence of AKI was 48.31%. Male (OR = 1.903), the interval between angiography and surgery (0-2d OR = 2.161; 3-6d OR = 3.291), cross-clamp duration (OR = 1.009), were identified as predictors for AKI. The interval between angiography and surgery was also associated with AKI in the patients with 15 ≤ eGFR < 30ml/min/1.73m² (0-2d OR = 4.826; 3-6d OR = 5.252), 30 ≤ eGFR < 45 ml/min/1.73m² (0-2d OR = 2.952; 3-6d OR = 3.677), but not associated with AKI in patients with 45 ≤ eGFR < 60 ml/min/1.73m².

CONCLUSIONS

In patients with preoperative renal dysfunction, the interval between angiography and cardiac surgery (0-2d and 3-6d) was associated with AKI. For patients with poorer preoperative renal function, the interval between angiography and cardiac surgery is of great concern.

[Early antiviral treatment response in HBeAg-positive chronic HBV infected-patients with high viral load and normal ALT]

The diagnosis and treatment rates of hepatitis B virus (HBV) infection in China in 2020 were 22.1% and 15.0%, respectively, according to the Polaris Observatory HBV Collaborators report. This is still far below the World Health Organization's 2030 hepatitis B elimination target (90% and 80%, respectively, for the diagnosis and treatment rates). Although China has promulgated and implemented a series of policies to eliminate the hepatitis B virus, there are still many HBV infected patients who need to be detected and treated. It has been contoversial whether HBeAg-positive chronic HBV infected-patients with high viral load and normal alanine aminotransferase (ALT), also known as the "immune-tolerant phase," should receive anti-HBV therapy. Hepatologists should pay attention to the patient population known as "immune tolerant," as well as the continuous accumulation of evidence-based medical evidence for early antiviral therapy response. The current focus is on discussing the pros and cons of receiving and recommending anti-HBV therapy at this time for the management of these patients.

A comprehensive review of the principles, key factors, application, and assessment of thawing technologies for muscle foods

For years, various thawing technologies based on pressure, ultrasound, electromagnetic energy, and electric field energy have been actively investigated to minimize the amount of drip and reduce the quality deterioration of muscle foods during thawing. However, existing thawing technologies have limitations in practical applications due to their high costs and technical defects. Therefore, key factors of thawing technologies must be comprehensively analyzed, and their effects must be systematically evaluated by the quality indexes of muscle foods. In this review, the principles and key factors of thawing techniques are discussed, with an emphasis on combinations of thawing technologies. Furthermore, the application effects of thawing technologies in muscle foods are systematically evaluated from the viewpoints of eating quality and microbial and chemical stability. Finally, the disadvantages of the existing thawing technologies and the development prospects of tempering technologies are highlighted. This review can be highly instrumental in achieving more ideal thawing goals.

Edible films/coatings containing bioactive ingredients with micro/nano encapsulation: A comprehensive review of their fabrications, formulas, multifunctionality and applications in food packaging

Due to the consumer's pursuit of safe, nontoxic and nutritious foods, edible and/or biodegradable materials have stood out in food packaging and preservation. In this context, the preparation and application of micro/nano encapsulated active ingredients (M/N-E-BAIs) represent a step toward reinforcing the properties of sustainable and controllable food packaging, particularly for the successful incorporation of new substances and functionalities into traditional edible films/coatings. This review, from the preparation of M/N-E-BAIs, the fabrication of edible film/coating containing M/N-E-BAIs to their characterization of multifunction and the application in food, makes a systematic summary and in-depth discussion. Food-grade polymers can encapsulate bioactive ingredients (BAIs) by chemical, physicochemical and mechanical methods, thereby forming M/N-E-BAIs with suitable sustained-release and unique biological activities. Furthermore, M/N-E-BAIs is incorporated into biopolymer substrates by solvent casting, 3D printing or electrostatic spinning to obtain novel edible films/coatings. This advanced packaging material exhibits superior physicochemical and functional properties over traditional food films/coatings. Besides, their applications in foods as active and intelligent packaging can improve food quality, prolong shelf life and monitor food corruption. Even so, there are still many challenges and limitations in formulation, preparation and application of this new packaging technology that need to be addressed in the future.

[Regulatory mechanism and potential value of circular RNA in nonalcoholic fatty liver disease progression]

Nonalcoholic fatty liver disease (nonalcoholic fatty liver disease, NAFLD) or metabolic-associated fatty liver disease, has become the most common chronic liver disease worldwide. In recent years, the relationship between NAFLD and non-coding RNA (ncRNA) has attracted the attention of basic and clinical researchers. Circular RNA (circRNA) is a lipid metabolism-related non-coding RNA (ncRNA) that is highly conserved in eukaryotic cells and resembles but differs from linear ncRNAs at their 5'- and 3'-terminal ends. With tissue-specific and steady expression of endogenous ncRNA, miRNA binding sites are contained on closed and circular nucleoside chains, forming the circRNA-miR-mRNA axis or network with proteins, competing with endogenous RNA sponge-like mechanisms, playing a role in inhibiting or promoting the expression of related target genes, and participating in the progression of NAFLD. This paper reviews the circRNA regulatory mechanism, detection technology, and potential clinical value in NAFLD.

[Progress in research of Clostridium perfringens toxin]

Clostridium perfringens can produce many kinds of toxins and hydrolase, causing gas gangrene, enteritis and enterotoxemia in both human and animals. It is known that C. perfringens can produce more than 20 toxins and hydrolases. The different toxin types are associated with specific disease types. At present, molecular toxin-typing method by PCR has replaced the traditional serological typing method. In this study, we systematically summarize the types, basic characteristics, pathogenic mechanism and the relationship with disease of C. perfringens toxins to provide evidence for the establishment of rapid detection method, immune antigen screening, antibody preparation and research of related pathogenic mechanism.

[Analysis of upper airway morphology and laryngopharyngeal reflux in obese patients with OSA]

Objective: To investigate the morphological characteristics of upper airway and laryngopharyngeal reflux in obese patients with obstructive sleep apnea (OSA). Methods: A retrospective analysis was performed on the clinical data of 284 adult patients who underwent polysomnography (PSG) from April 2020 to April 2021 in the Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, including 83 males and 201 females, aged (32.70±7.74) years. Patients were divided into obese group (n=234) and non-obese group (n=50) according to body mass index (BMI). Patients were divided into mild OSA group, moderate OSA group, severe OSA group and extremely severe OSA group by PSG.The results of sleepiness and laryngopharyngeal reflux questionnaire, nasolaryngoscopy and polysomnography were compared in each group. SPSS (version 22.0) software was used in data analysis. Results: Compared with the non-obese OSA group, the lymphoid hyperplasia of tongue root was more heavy in the obese OSA group, and Mueller's maneuver showed that the left-right lateral collapse of the velopharyngeal plane was more serious. Meanwhile, the scores of reflux symtom index (RSI) and reflux finding score (RFS) in the obese OSA group were significantly increased, and the scores of RSI and RFS increased with the increase of OSA severity. The main respiratory events in obese patients with OSA were obstructive hypopnea, their apnea-hypopnea indices(AHI) during REM (AHI_REM) was significantly higher than non-REM (AHI_NREM), and they had lower average blood oxygen saturation. Yet, there was no significant difference in the lowest blood oxygen saturation between the two groups. Conclusions: Our study suggests that lateral pharyngeal wall stenosis in velopharyngeal plane and the lymphoid hyperplasia of tongue root in glossopharyngeal plane occurs more frequently in obese patients with OSA. Laryngopharyngeal reflux is significantly increased in obese patients, and OSA increases laryngopharyngeal reflux in obese patients.

Active edible films with plant extracts: a updated review of their types, preparations, reinforcing properties, and applications in muscle foods packaging and preservation

Currently, edible films have been increasingly explored to solve muscle food spoilage during storage, especially through the incorporation of plant extracts to develop edible packaging materials. Natural polymers matrices with plant extracts are befitting for fabricating edible films by casting methods. In the films system, the structure and physicochemical properties were strengthened via chemical interactions between active molecules in plant extracts and the reactive groups in the polymer chain. The antibacterial and antioxidant properties were dramatically reinforced through both physical and chemical actions of the plant extracts. Additionally, edible films imbedded with color-rich plant extracts could be considered as potential sensitive indicators to monitor the spoilage degree of muscle foods in response to change in gas or temperature. Furthermore, these films could increase sensory acceptability, improve quality and prolong the shelf life of muscle foods. In this article, the types, preparation methods and reinforcing properties of the edible films with plant extracts were discussed. Also, the applications of these films were summarized on quality maintenance and shelf-life extension and intelligent monitoring in muscle foods. Finally, a novel technology for film preparation achieving high-stability and sustained release of active compounds will become an underlying trend for application in muscle food packaging.

Aligning tumor mutational burden (TMB) quantification across diagnostic platforms: phase II of the Friends of Cancer Research TMB Harmonization Project

BACKGROUND

Tumor mutational burden (TMB) measurements aid in identifying patients who are likely to benefit from immunotherapy; however, there is empirical variability across panel assays and factors contributing to this variability have not been comprehensively investigated. Identifying sources of variability can help facilitate comparability across different panel assays, which may aid in broader adoption of panel assays and development of clinical applications.

MATERIALS AND METHODS

Twenty-nine tumor samples and 10 human-derived cell lines were processed and distributed to 16 laboratories; each used their own bioinformatics pipelines to calculate TMB and compare to whole exome results. Additionally, theoretical positive percent agreement (PPA) and negative percent agreement (NPA) of TMB were estimated. The impact of filtering pathogenic and germline variants on TMB estimates was assessed. Calibration curves specific to each panel assay were developed to facilitate translation of panel TMB values to whole exome sequencing (WES) TMB values.

RESULTS

Panel sizes >667 Kb are necessary to maintain adequate PPA and NPA for calling TMB high versus TMB low across the range of cut-offs used in practice. Failure to filter out pathogenic variants when estimating panel TMB resulted in overestimating TMB relative to WES for all assays. Filtering out potential germline variants at >0% population minor allele frequency resulted in the strongest correlation to WES TMB. Application of a calibration approach derived from The Cancer Genome Atlas data, tailored to each panel assay, reduced the spread of panel TMB values around the WES TMB as reflected in lower root mean squared error (RMSE) for 26/29 (90%) of the clinical samples.

CONCLUSIONS

Estimation of TMB varies across different panels, with panel size, gene content, and bioinformatics pipelines contributing to empirical variability. Statistical calibration can achieve more consistent results across panels and allows for comparison of TMB values across various panel assays. To promote reproducibility and comparability across assays, a software tool was developed and made publicly available.

[Clinical analysis of 16 cases of pulmonary epithelioid hemangioendothelioma]

Objective: To improve the diagnosis and treatment of pulmonary epithelioid hemangioendothelioma (P-EHE). Methods: Sixteen patients diagnosed with P-EHE in Fuzhou Pulmonary Hospital of Fujian Province from January 2009 to July 2020 were collected. Their gender, age, imaging findings, pathological characteristics, treatment protocols, survival and other clinical data were summarized and analyzed. Results: The ratio of male to female among the 16 patients was 1∶1; and the average age of onset was 47.75 years. Most cases of PEHE (9/16) were found by physical examination, while some cases developed respiratory symptoms such as cough, sputum, shortness of breath, hemoptysis, chest pain, etc. (7/16). In most patients the lesions were localized to the lungs (11/16), while bone metastasis (1/16), lymph node metastasis (1/16), and pleural metastasis (4/16) also occurred. The pathological tissues were obtained mainly through surgical thoracoscopy. Chest CT images showed multiple nodules in both lungs, with most of the nodules less than 2.0 cm in diameter, and calcifications were seen, while solitary nodules and masses were rare, and pleural metastases could be manifested as pleural thickening and pleural effusion. The pathological findings were well-defined eosinophilic nodules with irregularly arranged nest-like structures. Those eosinophilic nodules had few central cells and abundant peripheral cells, which extended into the alveolar cavity like papillae. The tumor cells were epithelioid with small atypia, and vacuoles and red blood cells could be seen in the cytoplasm of individual tumor cells. Immunohistochemically, the tumor cells were positive to CD34, CD31, Factor Ⅷ andvimentin (VIM). Follow-up of 0.5 to 11 years showed that four patients died, two lost to follow-up, and the rest of the patients were in good condition, with a median overall survival (OS) of 4.58 years. Conclusions: PEHE is a rare low-grade lung tumor with no specific clinical manifestations. It can be diagnosed with chest imaging and pathological immunohistochemistry. Moreover, there is currently no standard treatment for PEHE, and most patients have a good prognosis.

Heterotrimeric G protein signalling in plant biotic and abiotic stress response

Heterotrimeric G proteins act as molecular switches to participate in transmitting various stimuli signals from outside of cells. G proteins have three subunits, Gα, Gβ and Gγ, which function mutually to modulate many biological processes in plants, including plant growth and development, as well as biotic and abiotic stress responses. In plants, the number of Gγ subunits is larger than that of the α and β subunits. Based on recent breakthroughs in studies of plant G protein signal perception, transduction and downstream effectors, this review summarizes and analyses the connections between different subunits and the interactions of G proteins with other signalling pathways, especially in plant biotic and abiotic stress responses. Based on current progress and unresolved questions in the field, we also suggest future research directions on G proteins in plants.

LiCl Promotes Recovery of Radiation-Induced Oral Mucositis and Dysgeusia

Oral mucositis and taste dysfunction are frequently complained by patients with head and neck cancer receiving radiotherapy, challenging the clinical outcome of cancer treatment. Recent studies have indicated the protective role of Wnt/β-catenin signaling in radiation-induced oral mucositis (RIOM) and its pivotal role in the development and self-renewal of taste buds. The current study hypothesizes that lithium chloride (LiCl), a potent activator of the Wnt/β-catenin signaling pathway, can promote the postirradiation restoration of oral mucosa integrity and taste function. To validate this hypothesis, we established a RIOM mouse model and evaluated the treatment efficacy of LiCl on oral mucositis and taste dysfunction in comparison with keratinocyte growth factor (KGF), an agent approved by the US Food and Drug Administration for oral mucositis. The results showed that LiCl alleviated the weight loss and tongue ulceration of RIOM mice, promoted proliferation of basal epithelial cells, and inhibited epithelial-mesenchymal transition in tongue mucosa. More important, elevated taste bud renewal and dysgeusia recovery toward sweetness were observed in RIOM mice treated with LiCl as compared to those treated by KGF. Collectively, our data demonstrate that LiCl can mitigate oral mucositis and rescue taste alteration induced by irradiation, and activation of Wnt/β-catenin signaling may represent a promising therapy to improve the quality of life of patients receiving radiotherapy.

Development of a PET/EPRI combined imaging system for assessing tumor hypoxia

Precise quantitative delineation of tumor hypoxia is essential in radiation therapy treatment planning to improve the treatment efficacy by targeting hypoxic sub-volumes. We developed a combined imaging system of positron emission tomography (PET) and electron para-magnetic resonance imaging (EPRI) of molecular oxygen to investigate the accuracy of PET imaging in assessing tumor hypoxia. The PET/EPRI combined imaging system aims to use EPRI to precisely measure the oxygen partial pressure in tissues. This will evaluate the validity of PET hypoxic tumor imaging by (near) simultaneously acquired EPRI as ground truth. The combined imaging system was constructed by integrating a small animal PET scanner (inner ring diameter 62 mm and axial field of view 25.6 mm) and an EPRI subsystem (field strength 25 mT and resonant frequency 700 MHz). The compatibility between the PET and EPRI subsystems were tested with both phantom and animal imaging. Hypoxic imaging on a tumor mouse model using 18F-fluoromisonidazole radio-tracer was conducted with the developed PET/EPRI system. We report the development and initial imaging results obtained from the PET/EPRI combined imaging system.

Do sex hormone imbalances contribute to idiopathic condylar resorption?

Idiopathic condylar resorption (ICR) is an aggressive form of temporomandibular joint disease that most frequently presents in adolescent girls during the pubertal growth spurt. Although numerous studies have indicated that the etiopathogenesis of ICR may be related to estrogen deficiency, the decisive role of estrogens remains controversial, and other sex hormone disturbances have not yet been investigated in this regard. Therefore, the aim of this study was to ascertain the role of serum estrogen levels and also the roles of other sex hormones in the pathogenesis of ICR. Ninety-four ICR patients and 324 disc displacement (DD) patients, of both sexes, were enrolled. Information on menstruation and serum levels of follicle-stimulating hormone, luteinizing hormone, prolactin, 17β-estradiol (E2), testosterone, and progesterone were recorded and analyzed. The results showed that female ICR patients had normal puberty onset, within the average age range. Use of oral contraceptives and other menstruation-regulating pharmaceuticals was similar in the two groups. Of note, neither serum E2 levels nor those of the other sex hormones differed significantly between female ICR and DD patients. However, male ICR patients had significantly increased serum testosterone levels (P=0.002) and relatively higher E2 levels (P=0.095) compared to DD patients. This study found that reduced serum E2 did not contribute to ICR; instead, systemic testosterone disturbances were found to be related to ICR.

[Optimal timing of antiviral therapy for chronic HBV-infected patients with normal ALT]

Whether to initiate antiviral therapy in chronic hepatitis B virus (HBV) infected population with normal alanine aminotransferase (ALT) is hot and difficult issue. Improvements in drug availability and affordability have paved the way for more data, which may become a medium for confirming whether this population needs antiviral treatment. Regardless of whether HBeAg is positive or negative, there are still a considerable number of patients with chronic HBV infection with normal ALT, who have obvious liver inflammation, fibrosis or cirrhosis and need to start antiviral therapy. Liver biopsy or non-invasive techniques can be used as diagnostic tools to begin an early treatment in population with liver fibrosis and inflammation.

Effects of ET-1 and TNF-α levels on the cardiac function and prognosis in rats with chronic heart failure

OBJECTIVE

To investigate the effects of ET-1 and TNF-α levels on cardiac function and prognosis in rats with chronic heart failure (CHF), to provide reference for clinical practice.

MATERIALS AND METHODS

120 SD rats were randomly divided into healthy group (n=60) and heart failure group (n=60). Rats from heart failure group were made into CHF models by an intraperitoneal injection of adriamycin. According to the average serum levels of ET-1 and TNF-α, 30 rats with higher level were enrolled in high expression subgroup, while 30 rats with lower level were enrolled in low expression subgroup. The sandwich enzyme-linked immunosorbent assay (ELISA) was employed to determine the ET-1 and TNF-α in rats from healthy group and heart failure group. Doppler echocardiography was used to measure the left ventricular ejection fraction, heart rate, and aortic diameter. After the death of heart failure rats, the total heart mass and left ventricle mass were measured and compared with those of the healthy rats. The serum levels of ET-1 and TNF-α were monitored to explore the influence of ET-1 and TNF-α levels on the prognosis of rats from study group.

RESULTS

The total heart mass and left ventricle mass of the heart failure group were higher than those of healthy group (p<0.05). The total heart mass and left ventricle mass of the low expression subgroup were lower than those of high expression subgroup (p<0.05).

CONCLUSIONS

The serum levels of ET-1 and TNF-α are higher than those in healthy rats. CHF rats with higher serum levels of ET-1 and TNF-α have a worse heart function and survival. Serum levels of ET-1 and TNF-α can be used as predictors of cardiac function and prognosis in CHF rats, providing references for clinical practice.

[Clinical cure strategy for hepatitis B: immunomodulatory therapy]

Chronic hepatitis B virus (HBV) infection remains a major world public health problem. Current guidelines of chronic hepatitis B (CHB) suggest the clinical cure as the ideal thearapeutic goal. Although the optimization of the existing antiviral treatment can make some patients achieve clinical cure, but for most patients with chronic hepatitis B, it is difficult to achieve clinical cure according to the existing antiviral treatment plan. The medical community has begun to work together to seek new treatment strategies, especially the immune intervention measures aimed at restoring the immune response in the liver microenvironment. Notably, immune antiviral response plays a crucial role in HBV clearance, and the clinical cure of chronic hepatitis B is finally achieved through the optimized combination of antiviral and immunomodulatory drugs.

Acupuncture in addition to budesonide does not further improve RQLQ apart from the sleep domain

BACKGROUND: Acupuncture can effectively alleviate the nasal symptoms of allergic rhinitis (AR); however, the mechanism is unclear. Previous studies suggested it may be related to improve hypothalamus-pituitary-adrenal (HPA) axis dysfunction. MATERIALS and METHODS: The study was a randomised controlled trial including ninety patients with moderate to severe persis- tent AR. Subjects were randomised 1:1:1 to the 8-weeks treatment with mind-regulating acupuncture combined with intranasal glucocorticosteroids (INGC), conventional acupuncture combined with INGC and INGC alone (MA, CA, GC respectively). The primary outcome was the change from baseline in the Visual Analogue Scale (VAS) score of nasal symptoms. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was a key secondary outcome. The levels of corticotrophin releasing hormone (CRH), cortisol (COR) and adrenocorticotropic hormone (ACTH) were also analysed. RESULTS: MA, CA and GC reduced VAS score and total RQLQ by a similar degree, but the sleep domain of RQLQ significantly impro- ved in MA and CA compared to GC. Meanwhile, the COR and ACTH level increased, and CRH level decreased after treatment in MA and CA, but the changes showed no difference among the three groups after Bonferroni correction. CONCLUSIONS: Although acupuncture combined with INGC may have potential effect on sleep quality, the combination therapy cannot further improve nasal symptoms or RQLQ compared to INGC alone in AR patients. The influence of acupuncture on HPA axis needs to be further explored.

A Fatal Case of Pediatric Primary Myxoid Liposarcoma of the Orbit: A Rare Tumor in an Unusual Location Presenting with Widespread Metastasis

Introduction/Objective

A liposarcoma is a tumor derived from primitive mesenchymal cells undergoing adipose differentiation. Liposarcomas are uncommon in childhood, representing only about 2% of childhood sarcomas. Among liposarcomas, is a very rare subtype, the so-called ‘pleomorphic myxoid liposarcoma’ which has extensive myxoid changes and scattered pleomorphic cells. Here we report an autopsy case of an extensively metastatic pleomorphic myxoid liposarcoma.

Methods

A 12 year-old, African-American boy presented in the ED with ascites and shortness of breath, who later expired despite resuscitation. Autopsy finding showed a primary lesion in the left superior orbital fissure with diffuse metastasis to liver, replacing most of the liver parenchyma (liver weigh 8500 g). Metastatic foci are also present in gallbladder, pancreas, large intestine, bilateral lungs, and inner and outer surfaces of cranium. Histologically, tumor at all sites shows similar morphology, revealing scattered pleomorphic lipoblasts and a myxoid background with arborizing vasculature. Lipoblasts show indented and distorted nuclei and cytoplasmic vacuoles.

Immunohistochemically the tumor cells are immunoreactive for p16 (diffusely and strongly) (Figure, D) and S100 (weakly) and negative for AE1/AE3, myogenin, synaptophysin, GFAP, EMA, and CD34. FISH was negative for MDM2 and t(12;16)(q13;p11.2) FUS-DDIT3 rearrangement, ruling out conventional myxoid liposarcoma.

Conclusion

This case shows the aggressive nature of a poorly studied entity in an uncommon age group and emphasize the need to study childhood liposarcomas in more detail.

“Duodenal Submucosal Glandular Lesion with Brunner and Paneth Cell Differentiation”: A Variant of Pyloric Gland Adenoma? Morphologic and Immunohistochemical Similarities and Differences

Introduction/Objective

Duodenal epithelial polyps are reported in up to 3% of patients referred for upper endoscopy. Most include non-neoplastic lesions such as Brunner gland nodule/polyp and pancreatic or gastric heterotopia.

Neoplastic lesions such as pyloric gland adenomas (PGA) are less frequently encountered and have the propensity to progress to adenocarcinoma. Herein we report a duodenal submucosal glandular lesion that has a morphologic resemblance to PGA, but very different in several aspects. We compare and contrast the characteristics of these two lesions.

Methods

This was a 63-year-old man referred for an upper GI endoscopy for complaints of indigestion, dyspepsia, and weight fluctuation. Endoscopy showed a 13 mm polypoid lesion in the second portion of the duodenum, opposite to and separate from the ampulla. An en-bloc hot snare was used to resect the polyp. Histopathologic examination showed features reminiscent of PGA, namely a complex submucosal proliferation of tightly packed variably dilated glands and villous fronds lined by a monolayer of columnar cells with basally located round nuclei and prominent nucleoli. In contrast, however, the columnar cells in most of the lesion contained abundant mucinous cytoplasm resembling Brunner’s glands as well as areas of prominent paneth cell differentiation. The characteristic amphophilic ground glass cytoplasm of PGAs was only noted in a minor component of the lesion. MUC6 and MUC5AC, immunostains that are typically expressed in PGA, were negative. Additionally, p53 showed a wild-type pattern, beta- catenin showed normal membranous staining, and the Ki-67 index was low.

Results

After review of the literature and expert consultation, we were not able to fully classify this lesion under any documented entity, however, we believe that it could be akin to PGA. Authors hypothesized that PGAs may originate from stem cells within Brunner glands as a response to chronic injury. These cells may then differentiate upwards, forming gastric foveolar metaplasia or downwards giving rise to Brunner gland hyperplasia.

Conclusion

Based on this hypothesis, the proliferating cells are prone to mutations resulting in a hyperplasia/metaplasia to dysplasia sequence that leads to the formation of PGAs or lesions such as the one demonstrated here.

[The role of large-scale testing platform in the prevention and control of the COVID-19 pandemic: an empirical study based on a novel numerical model]

Objective: China adopted an unprecedented province-scale quarantine since January 23rd 2020, after the novel coronavirus (COVID-19) broke out in Wuhan in December 2019. Responding to the challenge of limited testing capacity, large-scale (>20 000 tests per day) standardized and fully-automated laboratory (Huo-Yan) was built as an ad-hoc measure. There is so far no empirical data or mathematical model to reveal the impact of the testing capacity improvement since quarantine. Methods: Based on the suspected case data released by the Health Commission of Hubei Province and the daily testing data of Huo-Yan Laboratory, the impact of detection capabilities on the realization of "clearing" and "clearing the day" of supected cases was simulated by establishing a novel non-linear and competitive compartments differential model. Results: Without the establishment of Huo-Yan, the suspected cases would increase by 47% to 33 700, the corresponding cost of quarantine would be doubled, the turning point of the increment of suspected cases and the achievement of "daily settlement" (all newly discovered suspected cases are diagnosed according to the nucleic acid testing result) would be delayed for a whole week and 11 days. If the Huo-Yan Laboratory could ran at its full capacity, the number of suspected cases could start to decrease at least a week earlier, the peak of suspected cases would be reduced by at least 44%, and the quarantine cost could be reduced by more than 72%. Ideally, if a daily testing capacity of 10 500 tests was achieved immediately after the Hubei lockdown, "daily settlement" for all suspected cases could be achieved. Conclusions: Large-scale, standardized clinical testing platform, with nucleic acid testing, high-throughput sequencing, and immunoprotein assessment capabilities, need to be implemented simultaneously in order to maximize the effect of quarantine and minimize the duration and cost of the quarantine. Such infrastructure, for both common times and emergencies, is of great significance for the early prevention and control of infectious diseases.

[Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure]

Objective: To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients. Results: Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs(P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion: HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

Design, evaluation and initial imaging results of a PET insert based on strip-line readout for simultaneous PET/MRI

We present the development of a PET insert system for potential simultaneous PET/MR imaging using a 9.4 T small animal MRI scanner to test our system. The detectors of the system adopt a strip-line based multiplexing readout method for SiPM signals. In this readout, multiple SiPM outputs in a row share a common strip-line. The position information about a hit SiPM is encoded in the propagation time difference of the signals arriving at the two ends of the strip-line. The use of strip-lines allows us to place the data acquisition electronics remotely from the detector module to greatly simplify the design of the detector module and minimize the mutual electromagnetic interference. The prototype is comprised of 14 detector modules, each of which consists of an 8x4 LYSO scintillator array (each LYSO crystal is 3x3x10 mm³) coupled to two units of Hamamatsu MPPC arrays (4x4, 3.2 mm pitch) that are mounted on a strip-line board. On the strip-line board, outputs of the 32 SiPMs are routed to 2 strip-lines so that 16 SiPM signals share a strip-line. The detector modules are installed inside a plastic cylindrical supporting structure with an inner and outer diameter of 60 mm and 115 mm, respectively, to fit inside a Bruker BioSpec 9.4 Tesla MR scanner. The axial field of view of the prototype is 25.4 mm. The strip-lines were extended by using 5-meter cables to a sampling data acquisition (DAQ) board placed outside the magnet. The detectors were not shielded in the interest of investigating how they may affect and be affected by the MRI. Experimental tests were conducted to evaluate detection performance, and phantom and animal imaging were carried out to assess the spatial resolution and the MR compatibility of the PET insert. Initial results are encouraging and demonstrate that the prototype insert PET can potentially be used for PET/MR imaging if appropriate shielding will be implemented for minimizing the mutual interference between the PET and MRI systems.

Scarless neck endoscopic thyroidectomy via the breast approach: A preliminary report of 45 cases with total or near-total thyroidectomy plus central compartment dissection

Background

There are various endoscopic techniques for thyroid carcinoma dissection but few reports regarding the scarless neck technique and central compartment dissection (CCD) via the breast approach, especially for bilateral CCD are available. In this study, we reported 45 cases with scarless neck endoscopic total or near-total thyroidectomy plus CCD via the breast approach.

Materials and Methods

Forty-five female patients with papillary thyroid carcinoma (PTC) were enrolled in the study, from January 2011 to March 2013. In brief, 5 mm ultrasonic coagulation device (Harmonic Scalpel, HS; Ethicon Endosurgery, USA) was used to perform thyroid vessel management and thyroidectomy. Twenty patients underwent total thyroidectomy and 25 underwent near-total thyroidectomy. CCD was performed in all 45 patients, including 13 with bilateral CCD and 32 with ipsilateral CCD.

Results

The procedure was successful for all 45 patients. Sixteen patients (35.6%) had lymph node metastases in central compartments. Postoperative transient adverse events included voice changes (9 patients) and hypocalcemia (18 patients), including 7 (21.9%) in the unilateral group and 11 (84.6%) in bilateral group. There was no permanent hypocalcemia or recurrent laryngeal nerve (RLN) palsy. None of the case were converted to open surgical procedure. All patients were satisfied with the cosmetic result of the scarless neck endoscopic thyroidectomy (SET). No evidence of residual or recurrent disease was found during a mean follow-up of 22.84 months (range, 12-34 months).

Conclusions

Experienced thyroid surgeons performed the scarless neck endoscopic total or near-total thyroidectomy plus unilateral or bilateral CCD via the breast approach for selected PTC patients. The procedure was safe and feasible with excellent cosmetic results.

The Aortic Calcification Index is a risk factor associated with anastomotic leakage after anterior resection of rectal cancer

AIM

Anastomotic leakage (AL) is one of the most feared postoperative complications after anterior resection (AR) of rectal cancer. An adequate blood supply at the anastomotic site is regarded as a prerequisite for healing. We hypothesize that the Aortic Calcification Index (ACI) might reflect the severity of atherosclerosis in patients, and thereby be a risk factor for AL.

METHOD

AL was investigated retrospectively according to the definition of the International Study Group of Rectal Cancer in 423 rectal cancer patients who underwent anterior rectal resection. The ACI was measured by preoperative abdominal CT scan. The cross-section of the aorta was evenly divided into 12 sectors, the number of calcified sectors was counted as the calcification score of each slice. Lasso logistic regression and multivariate regression analysis were used to identify risk factors for AL.

RESULTS

The percentage of AL after AR was 7.8% (33/423); the mortality of patients who sustained a leak was 3.0% (1/33). Patients with a high ACI had a significantly higher percentage of AL than patients with low ACI (11.2% vs 5.6%, P = 0.04). Among patients with AL, a higher ACI was associated with greater severity of AL (the ACI of patients with grade A leakage, grade B leakage and grade C leakage was 0.5% ± 0.2%, 11.5% ± 9.2% and 24.2% ± 21.7%, respectively; P = 0.008). After risk adjustment, multivariate regression analysis showed that a higher ACI was an independent risk factor for AL (OR 2.391, P = 0.04).

CONCLUSION

A high ACI might be an important prognostic factor for AL after AR for rectal cancer. Confirmatory studies are required.

Prostate specific antigen as a biomarker for breast cancer: a meta-analysis study

OBJECTIVE

To determine whether prostate-specific antigen (PSA) could serve as a biomarker for breast cancer.

MATERIALS AND METHODS

We performed an electronic search on Medline, PubMed, SPRINGER, John Wiley, Science Direct, EBSCO, CNKI and Wanfang Data to identify relevant studies for our meta-analysis. The search terms included ['prostate specific antigen' or 'PSA' (MESH)] and ['breast cancer' or 'breast carcinoma' (MESH)].

RESULTS

A comprehensive meta-analysis of 10 studies comprising of 770 cases and 799 controls were included. Among the studies considered, the sensitivity of the tPSA test for diagnosis was 0.718 (95% CI: 0.630, 0.792), the specificity was 0.528 (95% CI: 0.299, 0.746) and the diagnostic odds ratios (DOR) was 2.852 (95% CI: 1.021, 7.969). The sensitivity of fPSA test for diagnosis was 0.783 (95% CI: 0.541, 0.917), specificity was 0.679 (95% CI: 0.209, 0.944) and diagnostic odds ratio (DOR) was 7.668 (95% CI: 0.331, 177.451).

CONCLUSIONS

Serum PSA could be a useful biomarker for the diagnosis of breast cancer, and a biomarker for the differential diagnosis of breast cancer from benign breast tumors.

[Combined anluohuaxianwan and entecavir treatment significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection]

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman's rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion: Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.