Value of modified qSOFA, glucose and lactate in predicting prognosis in children with sepsis in the PICU

The purpose was to investigate how well age-adjusted modified quick Sequential Organ Failure Assessment (qSOFA) scores paired with blood glucose and lactate levels predict the outcomes of septicemic children in the pediatric intensive care unit (PICU). One hundred children who were diagnosed with sepsis and septic shock in the PICU of Henan Children's Hospital were eligible, and other 20 patients in the same hospital at different times were selected as a validation set. Respiratory rate (RR), heart rate (HR), capillary refill time (CRT), and Alert, Voice, Pain, Unresponsive (AVPU) scale were included in the age-adjusted modified qSOFA scoring criteria for scoring. The primary outcome was 28-day all-cause mortality. The predictive values were evaluated by the ROC curve. In the sepsis group, 50 patients were male, and 50 patients were female. The 28-day all-cause mortality rate was 52%. Fifty-one patients with age-adjusted modified qSOFA scores >1. The serum lactate level was 2.4 mmol/L, and the blood glucose level was 9.3 mmol/L. The AUCs for the age-adjusted modified qSOFA score, serum lactate and blood glucose levels for the prediction of 28-day all-cause mortality in children with sepsis were 0.719, 0.719 and 0.737, respectively. The cut-off values were one point, 3.8 mmol/L and 10 mmol/L, respectively. The AUC of the age-adjusted modified qSOFA score for the validation set of was 0.925. When the three indices were combined, the AUC was 0.817, the Hosmer-Lemeshow goodness-of-fit test showed χ2 = 2.428 and p = .965. When children with sepsis are admitted to the ICU, we recommend performing rapid scoring and rapid bedside lactate and glucose testing to determine the early prognosis.

Development and validation of an online dynamic nomogram system for pulmonary consolidation in children with Mycoplasma pneumoniae pneumonia

INTRODUCTION

The occurrence of pulmonary consolidation in children with Mycoplasma pneumoniae pneumonia (MPP) can lead to exacerbation of the disease. Therefore, early identification of children with MPP in combination with pulmonary consolidation is critical. The purpose of this study was to develop a straightforward, easy-to-use online dynamic nomogram for the identification of children with MPP who are at high risk of developing pulmonary consolidation.

METHODS

491 MPP patients were chosen and divided randomly into a training cohort and an internal validation cohort at a 4:1 ratio. Multi-factor logistic regression was used to identify the risk variables for mixed pulmonary consolidation in children with Mycoplasma pneumoniae (MP). The selected variables were utilized to build the nomograms and validated using the C-index, decision curve analysis, calibration curves, and receiver operating characteristic (ROC) curves.

RESULTS

Seven variables were included in the Nomogram model: age, fever duration, lymphocyte count, C-reactive protein (CRP), ferritin, T8 lymphocyte percentage, and T4 lymphocyte percentage. We created a dynamic nomogram that is accessible online ( https://ertong.shinyapps.io/DynNomapp/ ). The C-index was 0.90. The nomogram calibration curves in the training and validation cohorts were highly comparable to the standard curves. The area under the curve (AUC) of the prediction model was, respectively, 0.902 and 0.883 in the training cohort and validation cohort. The decision curve analysis (DCA) curve shows that the model has a significant clinical benefit.

CONCLUSIONS

We developed a dynamic online nomogram for predicting combined pulmonary consolidation in children with MP based on 7 variables for the first time. The predictive value and clinical benefit of the nomogram model were acceptable.

A new dynamic nomogram for predicting the risk of severe Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae pneumonia (MPP) is usually mild and self-limiting, but still about 12% of them will progress to severe Mycoplasma pneumoniae pneumonia (SMPP), which have poor survival rates and often require intensive medical resource utilization. We retrospectively collected clinical data from 526 children with MPP admitted to the Children's Hospital Affiliated to Zhengzhou University from June 2018 to February 2023 and randomly divided the data into a training cohort and a validation cohort at a ratio of 4:1. Univariate and multivariate logistic regressions were used to identify independent risk factors for SMPP. Age, AGR, NLR, CRP, ESR, MPV, coinfection, pleural effusion, primary disease, fever days ≥ 7 and wheeze are independent risk factors for SMPP in children. Then, we built an online dynamic nomogram ( https://ertongyiyuanliexiantu.shinyapps.io/SMPP/ ) based on the 11 independent risk factors. The C-index, ROC curve, DCA curve and calibration curve were used to assess the performance of the nomogram, which all showed that the dynamic nomogram has excellent clinical value. Based on age, AGR, NLR, CRP, ESR, MPV, coinfection, pleural effusion, primary disease, fever days ≥ 7 and wheeze, the first dynamic nomogram for accurately predicting SMPP was successfully established.

Impact of the COVID-19 outbreak and interventions on hand, foot and mouth disease in Zhengzhou, China, 2014-2022: a retrospective study

BACKGROUND

Since December 2019, COVID-19 has spread rapidly around the world, and studies have shown that measures to prevent COVID-19 can largely reduce the spread of other infectious diseases. This study explored the impact of the COVID-19 outbreak and interventions on the incidence of HFMD.

METHODS

We gathered data on the prevalence of HFMD from the Children's Hospital Affiliated to Zhengzhou University. An autoregressive integrated moving average model was constructed using HFMD incidence data from 2014 to 2019, the number of cases predicted from 2020 to 2022 was predicted, and the predicted values were compared with the actual measurements.

RESULTS

From January 2014 to October 2022, the Children's Hospital of Zhengzhou University admitted 103,995 children with HFMD. The average number of cases of HFMD from 2020 to 2022 was 4,946, a significant decrease from 14,859 cases from 2014 to 2019. We confirmed the best ARIMA (2,0,0) (1,1,0)12 model. From 2020 to 2022, the yearly number of cases decreased by 46.58%, 75.54%, and 66.16%, respectively, compared with the forecasted incidence. Trends in incidence across sexes and ages displayed patterns similar to those overall.

CONCLUSIONS

The COVID-19 outbreak and interventions reduced the incidence of HFMD compared to that before the outbreak. Strengthening public health interventions remains a priority in the prevention of HFMD.

Effects of Perineal Warm Compresses during the Second Stage of Labor on Reducing Perineal Trauma and Relieving Postpartum Perineal Pain in Primiparous Women: A Systematic Review and Meta-Analyses

Non-pharmaceutical midwifery techniques, including perineal warm compresses, to improve maternal outcomes remain controversial. The aims of this study are to assess the effects of perineal warm compresses on reducing perineal trauma and postpartum perineal pain relief. This systematic review included randomized controlled trials (RCTs). We searched seven bibliographic databases, three RCT register websites, and two dissertation databases for publications from inception to 15 March 2023. Chinese and English publications were included. Two independent reviewers conducted the risk of bias assessment, data extraction, and the evaluation of the certainty of the evidence utilizing the Cochrane risk of bias 2.0 assessment criteria, the Review Manager 5.4, and the online GRADEpro tool, respectively. Seven RCTs involving 1362 primiparous women were included. The combined results demonstrated a statistically significant reduction in the second-, third- and/or fourth- degree perineal lacerations, the incidence of episiotomy, and the relief of the short-term perineal pain postpartum (within two days). There was a potential favorable effect on improving the integrity of the perineum. However, the results did not show a statistically significant supportive effect on reducing first-degree perineal lacerations and the rate of perineal lacerations requiring sutures. In summary, perineal warm compresses effectively reduced the second-, third-/or fourth-degree perineal trauma and decreased the short-term perineal pain after birth.

[Role of liver sinusoidal endothelial cell damage in the developmental process of hepatic sinusoidal obstruction syndrome: a focus on the research progress of immune inflammatory mechanisms]

Hepatic sinusoidal obstruction syndrome (HSOS) is a type of secondary vascular disease of the liver that is mainly associated with the ingestion of pyrrole alkaloids (PAs) and hematopoietic stem cell transplantation (HSCT) treatment, resulting in severe liver dysfunction, multiple organ failure, and even death. Hepatic sinusoidal dilatation and obstruction, hepatocyte coagulative necrosis, and hepatic lobular inflammation are the main pathological manifestations of HSOS. The key initiating process for the pathogenesis of HSOS is damage to liver sinusoidal endothelial cells (LSECs). Currently, it is believed that LSECs are damaged by the involvement of multiple etiologies and mechanisms, and secondary coagulation and fibrinolysis disorders, oxidative stress, and inflammatory responses are the occurrence contributors to HSOS; however, the mechanism has not been fully elucidated. Therefore, the role of immune-inflammatory mechanisms has received increasing attention in LSEC damage. This article provides an overview of the epidemiology, etiology, and pathological changes of HSOS and reviews the physiological functions, common etiological damage mechanisms, and the key role of LSEC damage in the pathogenesis of HSOS, with a special focus on the role and research progress of immune-inflammatory mechanisms for LSEC damage in recent years. Furthermore, we believe that in-depth study and elucidation of the role of immune-inflammatory mechanisms in LSEC damage and the pathogenesis of HSOS and diagnosis will provide feasible research and development ideas for the screening and identification of new markers and drug treatment targets for HSOS.

Analysis of clinical characteristics and risk factors for death due to severe influenza in children

OBJECTIVE

The study analyzed the clinical features of children who had severe influenza and discussed on the risk factors associated with death in this population.

METHODS

A total of 167 children with severe influenza admitted to the intensive care unit of our hospital from January 2018 to August 2023 were selected and divided into the death group (27 cases) and the survival group (140 cases). Demographic characteristics and clinical data were collected and compared between the two groups. Logistic regression analysis was used to explore the risk factors for death in children with severe influenza.

RESULTS

The male-to-female ratio of the 167 children with severe influenza was 2.21:1, the median age was 3 years, and influenza A accounted for 70.66%. The CD4+ T cells percentage and CD4/CD8 were lower in the death group; the percentage of comorbid underlying diseases, mechanical ventilation, other systemic involvement, comorbid associated encephalopathy or encephalitis, and red blood cell distribution width (RDW), lactate dehydrogenase, activated partial thromboplastin time (APTT), and interleukin 6 were higher in the death group. The mechanical ventilation, associated encephalopathy or encephalitis, RDW, APTT, and CD4/CD8 were the independent risk factors for death.

CONCLUSION

Mechanical ventilation, comorbid encephalopathy or encephalitis, increased RDW, prolonged APTT, and decreased CD4/CD8 are independent risk factors for death in children with severe influenza.

Clinical Characteristics of Lung Consolidation with Mycoplasma pneumoniae Pneumonia and Risk Factors for Mycoplasma pneumoniae Necrotizing Pneumonia in Children

INTRODUCTION

Mycoplasma pneumoniae necrotizing pneumonia (MPNP) is an uncommon but increasingly recognized severe complication of pneumonia, and the delayed diagnosis and treatment are prone to pulmonary sequelae. The aim of this study is to explore independent risk factors for MPNP in children with lung consolidation.

METHODS

A retrospective observational study was conducted on 118 children with MPNP (MPNP group) and 184 children with lung consolidation of Mycoplasma pneumoniae pneumonia (MPP) (control group) admitted to Children's Hospital Affiliated to Zhengzhou University from June 2018 to August 2023. Clinical manifestations and laboratory data were analyzed and the independent risk factors for MPNP in children were analyzed by multivariate logistic regression.

RESULTS

The age of onset, hospitalization days, fever days, proportion of dyspnea, chest pain, complications, and need for fiberoptic bronchoscopic alveolar lavage (FBAL) were higher than those in the control group, and the difference was statistically significant (P < 0.05). The levels of white blood cells (WBC), platelets, neutrophil percentage (N%), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), fibrinogen (Fbg), D-dimer (D-D), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), γ-glutamyl transpeptidase (γ-GGT), globulin, lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), urea, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), complement component 3, antistreptolysin O (ASO), serum ferritin, and interleukin-6 (IL-6) in the MPNP group were higher than those in the control group. Red blood cell (RBC), lymphocyte percentage (L%), activated partial thromboplastin time (APTT), alkaline phosphatase (ALP), total protein, albumin, albumin-to-globulin ratio (AGR), creatine kinase (CK), uric acid, natrium, chlorine, calcium, and complement C4 in the MPNP group were lower than those in the control group, and the difference was statistically significant (P < 0.05). The results of multivariate logistic regression analysis showed that age ≥ 83.50 months, fever days ≥ 10.50, ALT ≥ 15.25 U/l, IgM ≥ 1.46 g/l, complement C3 ≥ 1.47 g/l, Fbg ≥ 3.93 g/l, dyspnea and needing FBAL were independent risk factors for MPNP in children.

CONCLUSIONS

Age, fever days, ALT, IgM, complement C3, Fbg, dyspnea, and needing FBAL were independent risk factors for MPNP in children. For children suspected of MPNP, pediatricians should pay close attention to the above indicators, strive for early diagnosis and treatment, and improve prognosis.

A centromere-derived retroelement RNA localizes in cis and is a core element of the transcriptional landscape of Drosophila centromeres

Centromeres are essential chromosomal landmarks that dictate the point of attachment between chromosomes and spindle microtubules during cell division. The stable transmission of the centromere site through generations is ensured by a unique chromatin containing the histone H3 variant CENP-A. Previous studies have highlighted the impact of transcription on promoting CENP-A deposition. However, the specific sequences undergoing this transcription and their contribution to centromere function in metazoan systems remain elusive. In this study, we unveil the centromeric transcriptional landscape and explore its correlation with CENP-A in D. melanogaster, currently the only in vivo model with assembled centromeres. We find that the centromere-enriched retroelement G2/Jockey-3 (hereafter referred to as Jockey-3) is a major driver of centromere transcription, producing RNAs that localize to all mitotic centromeres, with the Y centromere showing the most transcription. Taking advantage of the polymorphism of Jockey-3, we show that these RNAs remain associated with their cognate DNA sequences in cis. Using a LacI/lacO system to generate de novo centromeres, we find that Jockey-3 transcripts do not localize to ectopic sites, suggesting they are unlikely to function as non-coding RNAs with a structural role at centromeres. At de novo centromeres on the lacO array, the presence of CENP-A augments the detection of exogenous lacO-derived transcripts specifically in metaphase. We propose that Jockey-3 contributes to the epigenetic maintenance of the centromere by promoting chromatin transcription, while inserting in a region that permits its continuous transmission. Given the conservation of retroelements as centromere components across taxa, our findings have broad implications in understanding this widespread association.

A Non-Invasive Hemoglobin Detection Device Based on Multispectral Photoplethysmography

The measurement of hemoglobin is a vital index for diagnosing and monitoring diseases in clinical practice. At present, solutions need to be found for the soreness, high risk of infection, and inconvenient operation associated with invasive detection methods. This paper proposes a method for non-invasively detecting hemoglobin levels based on multi-wavelength photoplethysmography (PPG) signals. AFE4490 and TMUX1109 were used to implement the low-cost collection of an eight-LED transmissive PPG signal. We used seven regular LEDs and one broadband LED (Osram SFH4737) as light sources. Additionally, a finger clip integrating multiple sensors was designed and manufactured via 3D printing to simultaneously monitor the LED-sensor distance and the pressure from the tester's finger during PPG signal acquisition. We used a method to extract features from PPG signals using a sliding-window's variance and an evaluation metric for PPG signals based on the AdaCost classification. Data were gathered from 56 participants from the Nephrology department, including 16 anemic patients. Pearson correlation analysis was conducted on the collected data to remove any data with a weak correlation. The advantage of using a broadband LED as a light source was also demonstrated. Several non-invasive hemoglobin regression models were created by applying AdaBoost, BPNN, and Random Forest models. The study's results indicate that the AdaBoost model produced the best performance, with a mean absolute error (MAE) of 2.67 g/L and a correlation coefficient (R2) of 0.91 The study results show that the device we designed and manufactured can achieve effective non-invasive hemoglobin detection and represents a new methodological approach to obtaining measurements that can be applied in a clinical setting.

Effective measures to improve influenza vaccination coverage among healthcare workers during and after COVID-19

The influenza vaccine is the most effective measure to prevent influenza. The aim of this study was to evaluate the impact of measures taken by the hospital on the influenza vaccination coverage of medical staff after implementation. We collected and compared the influenza vaccination of staff in key departments from 2018 to 2022. As the results, in 2018 and 2019, the influenza vaccination rates of staff in key departments in our hospital were generally as low as 10.3% and 11.6%, respectively. After the policy of free vaccination for staff in key departments was adopted in 2020 and other incentive measures, the overall influenza vaccination rates of key departments from 2020 to 2022 were 77.2%, 71.4%, and 81.3%, respectively, which were significantly higher than the pre-2020 vaccination rates in our hospital and healthcare workers in most regions of China. In conclusion, with the implementation of several measures to promote influenza vaccination, the rate of influenza vaccination among medical staff has significantly increased.

Development of an Efficient On-Tissue Epoxidation Reaction Mediated by Urea Hydrogen Peroxide for MALDI MS/MS Imaging of Lipid C═C Location Isomers

Unsaturated lipids containing different numbers and locations of C═C bonds are significantly associated with a variety of cellular and metabolic functions. Although matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) has been used to visualize the spatial distribution patterns of various lipids in biological tissues, in situ identification, discrimination, and visualization of lipid C═C location isomers remain challenging. Herein, an efficient and fast on-tissue chemical derivatization (OTCD) approach was developed to pinpoint the locations of C═C bonds in complex lipids in situ via methyltrioxorhenium (MTO)-catalyzed epoxidation of C═C with a urea hydrogen peroxide (UHP)/hexafluoroisopropanol (HFIP) system. The efficiency of OTCD could reach 100% via one-step spray deposition of the solution mixture of MTO/UHP/HFIP at room temperature. The developed OTCD method provided rich structural information on lipid C═C location isomers, and their accurate spatial distribution patterns were resolved in mouse brain tissues. Tissue-specific distributions and changes of lipid C═C location isomers in the liver sections of obese ob/ob and diabetic db/db mice were further investigated, and their correlation in two animal models was revealed. The simplicity and high efficiency of the OTCD method developed for MALDI tandem MSI of lipid C═C location isomers possess great potential for functional spatial lipidomics.

The Effect of MDSC-Derived Exosomes Played in Esophageal Squamous Carcinoma Cells after Ionizing Radiation

PURPOSE/OBJECTIVE(S)

Radiotherapy is the main treatment for esophageal cancer. Previous studies have shown that radiotherapy not only kills tumor cells directly, but also reshapes the immune microenvironment of the tumor. It has been reported an increase in the recruitment of myeloid-derived suppressor cells (MDSC) can occur in tumor tissue after ionizing radiation. Exosomes are mediators of intercellular information exchange and are also involved in the regulation of the tumor microenvironment. In this study, we wanted to understand whether MDSC in esophageal cancer tissue are involved in the regulation of tumor cell response to ionizing radiation via exosomes.

MATERIALS/METHODS

KYSE-150 was used to construct a subcutaneous transplantation tumor model in nude mice. And then mice irradiated with 5 Gy×5fx and 0 Gy×5fx respectively. After irradiation, the spleens of the mice were used to isolate MDSC, and collect the cell supernatants to extract the exosomes. Based on the exosomes, we divided the experiment into three groups (control, exosomes, exosomes+radiation). Exosomes were injected into a nude mouse model of esophageal cancer via the tail vein or co-cultured with KYSE-150 cells. Mice were irradiated with a 5 Gy×5fx after completion of injection, and KYSE-150 cells were irradiated with a single dose 4 Gy. After radiation, KYSE-150 cells were used to detect cell cloning, apoptosis and cell cycle by flow cytometry, cell proliferation by CCK 8. XRCC4,XRCC5,XRCC6,γH2AX,ATM expression in cells and tumor tissue were measured by Western blot and RT-PCR.

RESULTS

The tumor volume was significantly reduced after 5 Gy x 5fx radiation. When exosomes co-cultured with KYSE-150 cells, decrease in apoptosis and increase in cell cloning and cell proliferation were found in the exosomes+radiation group and exosomes group after radiation when compared with the control group, with this change being more pronounced in the exosome+radiation group. The results of the cell cycle assay showed that after ionizing radiation, the proportion of cells in the G0/G1 phase was significantly lower, and the proportion of cells in the S and G2/M phases were significantly higher in the exosomes+radiation group and exosomes group when compared to the Control group. The protein and mRNA expression of XRCC4,XRCC5,XRCC6,γH2AX,ATM in cells were increased in exosomes+radiation group and exosomes group after radiation when compared with the control group, with this change being more obvious in the exosome+radiation group. After irradiation, tumor volumes were measured in nude mice and the results showed that exosomes+radiation group tumors were the largest in volume, while the control group regressed most significantly after irradiation.

CONCLUSION

MDSC-derived exosomes have a tumor growth-promoting effect in esophageal squamous carcinoma, which is enhanced by ionizing radiation, and this may be related to the accelerated repair of damage in tumor tissue after radiation.

Formation of oil-particle aggregates in the presence of marine algae

After an oil spill, the formation of oil-particle aggregates (OPAs) is associated with the interaction between dispersed oil and marine particulate matter such as phytoplankton, bacteria and mineral particles. Until recently, the combined effect of minerals and marine algae in influencing oil dispersion and OPA formation has rarely been investigated in detail. In this paper, the impacts of a species of flagellate algae Heterosigma akashiwo on oil dispersion and aggregation with montmorillonite were investigated. This study has found that oil coalescence is inhibited due to the adhesion of algal cells on the droplet surface, causing fewer large droplets to be dispersed into the water column and small OPAs to form. Due to the role of biosurfactants in the algae and the inhibition of algae on the swelling of mineral particles, both the oil dispersion efficiency and oil sinking efficiency were improved, which reached 77.6% and 23.5%, respectively at an algal cell concentration (Ca) of 1.0 × 106 cells per mL and a mineral concentration of 300 mg L-1. The volumetric mean diameter of the OPAs decreased from 38.4 μm to 31.5 μm when Ca increased from 0 to 1.0 × 106 cells per mL. At higher turbulent energy, more oil tended to form larger OPAs. The findings may add knowledge about the fate and transport of spilled oil and provide fundamental data for oil spill migration modelling.

[Safety and feasibility of right colectomy via a transvaginal approach: early experience from a single center]

Objective: To investigate the safety and feasibility of performing right colectomy via a transvaginal approach. Methods: This was a retrospeltive cohort study. Data of 30 patients who had undergone transvaginal laparoscopic right colectomy (transvaginal group) and 23 women who had undergone laparoscopic right colectomy (laparoscopic group) from January 2019 to March 2022 in the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital were collected retrospectively. The inclusion criteria for the transvaginal group were as follows: (1) post-menopausal woman; (2) transverse diameter of the tumor < 6 cm; and (3) diagnosis of benign polyps that were unresectable by endoscopy, mucinous tumors of the appendix, or confirmed right colon cancer not requiring D3 lymphadenectomy. The inclusion criteria for the laparoscopic group were as follows: (1) pathologically confirmed adenocarcinoma or high-grade intraepithelial neoplasia; (2) lesion located from the cecum to the right third of the transverse colon; and (3) clinically stage T1-4NanyM0. The exclusion criteria for the laparoscopic group were as follows: (1) distant metastasis discovered during surgical exploration; (2) multiple organ resection required or R0 resection not possible; or (3) conversion to open surgery required. Safety was evaluated on the basis of intra- and post-operative complications. Feasibility was assessed by postoperative recovery and quality of operative specimen. The body mass index was lower in the transvaginal than the laparoscopic group (22.0±3.1 kg/m2 vs. 24.1±2.6 kg/m2, t=2.617, P=0.012). Results: Among the 30 transvaginal laparoscopic right colectomies, 26 were pure transvaginal surgeries, three required laparoscopic assistance because of difficulties with anastomosis (n=2) or abdominal adhesions (n=1), and one required conversion to laparoscopic surgery because of vascular injury. Compared with the laparoscopic group, the transvaginal group had a longer surgery time (175.0 [147.5, 216.3] minutes vs. 120.0 [100.0, 120.0] minutes, U=63.000, P<0.001) and more blood loss (30.0 [10.0, 50.0] ml vs. 23.0 [10.0, 20.0] ml, U=208.000, P=0.011). The incidence of intraoperative complications (16.7% [5/30) vs. 0, P=0.061] was comparable between the two groups. In the transvaginal group, the sites of intraoperative injuries were bladder (n=3), ileocecal artery (n=1), and right uterine artery (n=1). The incidence of postoperative complications (20.0% [6/30] vs. 17.4% [4/23], χ2<0.001,P>0.999) was also comparable between the two groups. Clavien-Dindo grade III postoperative complications occurred in two patients in the transvaginal group (one patient had a pelvic hematoma that required embolization; the other had a vesico-vaginal fistula that required surgery). Postoperative visual analogue scale scores were significantly lower (P<0.001) in the transvaginal group. Times to first flatus, ambulation, and first intake and duration of postoperative hospital stay were comparable between the two groups (P>0.05). The proportion of specimens of moderate quality was 83.3% (25/30) in the transvaginal group and 100% (23/23) in the laparoscopic group; this difference is not significant (P=0.061). Among patients who underwent D2 lymph node dissection, the number of lymph nodes examined was comparable between the transvaginal (n=23) and laparoscopic groups (n=7) (18 [15, 27] vs. 20 [16, 29], U=69.500, P=0.589). Conclusion: Transvaginal right colon surgery is associated with less postoperative pain than laparoscopic surgery, but is not yet the preferred alternative because of the incidence of surgical complications.

Anthropogenic activity and millennial climate variability affect Holocene mercury deposition of an alpine wetland near the largest mercury mine in China

Mercury (Hg) is a potentially toxic element that can be transported globally through the atmosphere, once deposited in the environment, has strong bioaccumulation and extreme toxicity in food webs, especially in wetland ecosystems. Anthropogenic Hg emissions have enhanced Hg deposition by 3-5 times since the industrial revolution, and the mining and smelting of Hg ore are important emission sources. However, the dynamics in Hg deposition around the largest Hg mine in China before the industrial revolution and their driving forces remain poorly explored. Here we reconstruct the atmospheric Hg depositional fluxes (named here Hg influx (Hg_influx)) during the Holocene using a 450-cm alpine wetland sediment core taken from the Jiulongchi wetland, which is only 65 km to the Wanshan Mercury Mine. Our record shows an abrupt rapid increase in Hg concentration since 2500 cal yr BP, suggesting that Hg mining in southwest China may have started before the establishment of the Qin dynasty. Two major Hg_influx peaks were found during the periods 10,000-6000 and 6000 - 3800 cal yr BP, with an increase in Hg deposition by a factor of 4-8. These two peaks are also found in other terrestrial archives from several sites across the Northern Hemisphere. We speculate that critical millennial-scale climate changes, i.e., the Holocene Climatic Optimum (HCO) and the Mid-Holocene Transition (MHT), were the potential triggers of these two Hg_influx peaks. This study highlights the importance of climatic variability and local Hg mining in controlling atmospheric Hg deposition during the Holocene.

Effects of perineal massage during childbirth on maternal and neonatal outcomes in primiparous women: A systematic review and meta-analysis

BACKGROUND

Perineal massage during childbirth has been recommended as an effective measure to prevent perineal injury. However, the overall effects of perineal massage during childbirth on maternal and neonatal outcomes in primiparous women remain inconclusive. Particularly, the effects of perineal massage begun during different stages of labor need to be further investigated.

OBJECTIVES

To comprehensively review the effects of perineal massage during childbirth on primiparous health outcomes, including perineal-related outcomes, duration of labor, hemorrhage and postpartum perineal pain, and neonatal outcomes, including Apgar scores and neonatal complications, and to further explore the effects of perineal massage begun during different stages of labor.

DESIGN

A systematic review and meta-analysis following the Cochrane Handbook guidelines and PRISMA2020.

METHODS

A systematic search strategy was developed following the three-phase search approach, and the literature search was conducted in electronic databases and clinical trial registers from inception to 7th January 2022. Study selection and data extraction were completed independently by two researchers. The updated Cochrane risk of bias 2.0 tool for randomized trials was chosen to evaluate the quality of included studies. Data analyses were conducted using the Revman5.4 software, and subgroup analyses were performed based on the different start times of perineal massage. Furthermore, the certainty of body of evidence for each outcome was assessed utilizing the GRADEpro online tool.

RESULTS

Seventeen randomized controlled trials involving 3248 primiparous women were included in the review. The pooled results of meta-analyses indicated that perineal massage begun during the second stage of labor significantly increased the occurrence of intact perineum (RR = 2.78, 95 % CI: [1.52, 5.05], P < 0.001), reduced the rate of second- and third-degree perineal lacerations (P < 0.05), and decreased the incidence of episiotomy (RR = 0.63, 95 % CI: [0.50, 0.79], P < 0.001), while perineal massage during the first stage of labor effectively shortened the duration of the first and second stages of labor (P < 0.05). The available evidence also suggests the potential role of perineal massage on hemorrhage and long-term postpartum perineal pain (P < 0.05). However, the aggregated results failed to demonstrate the beneficial effects of perineal massage on neonatal outcomes (P > 0.05).

CONCLUSIONS

Perineal massage begun during the second stage of labor effectively improves the perineal-related outcomes in primiparous women, while perineal massage during the first stage of labor significantly shortens the duration of labor. High-quality studies exploring the standardized procedure for perineal massage and the short- and long-term effects of perineal massage are warranted.

REGISTRATION NUMBER

CRD42022302336 (PROSPERO).

Stent pretreatment for internal carotid artery exposed to necrotic lesions in nasopharyngeal carcinoma

BACKGROUND

Post radiation nasopharyngeal necrosis (PRNN) invading the internal carotid artery (ICA) contributes to the death of 69.2-72.7% of PRNN patients. ICA occlusion is an effective treatment to avoid fatal bleeding, while some patients are intolerant. We present a novel method that allows for these patients without interrupting blood flow through the ICA.

METHODOLOGY

This study enrolled patients with PRNN-invaded ICA who were not suitable for ICA occlusion from April 2020 to November 2022. ICA stent pretreatment was performed in the 36 patients and followed the endoscopic nasopharyngectomy (ENPG) or conservative treatment for PRNN. We report the survival outcome and incidence of complications after stent implantation and compare the survival outcomes of ENPG and conservative treatment for PRNN followed by stent implantation.

RESULTS

ICA stent pretreatment was performed in the 36 enrolled patients, among which 14 underwent ENPG, and 22 received conservative treatment. 27.8% patients died after a median follow-up of 15 months. The Kaplan-Meier estimates of overall survival were higher in the ENPG group than in the conservative treatment group. Karnofsky performance status (KPS) was significantly higher in the ENPG group than in the non-ENPG group.

CONCLUSIONS

The innovative application of ICA stents is a promising treatment to improve outcomes in patients with PRNN invading the ICA who are unsuitable for ICA embolization, especially when followed by endoscopic surgery. However, methods to avoid postoperative cerebral ischemia and nasopharyngeal hemorrhage still require further study.

Detection of Advanced Glycosylation End Products in the Cornea Based on Molecular Fluorescence and Machine Learning

Advanced glycosylation end products (AGEs) are continuously produced and accumulated in the bodies of diabetic patients. To effectively predict disease trends in diabetic patients, a corneal fluorescence detection device was designed based on the autofluorescence properties of AGEs, and corneal fluorescence measurements were performed on 83 volunteers. Multiple linear regression (MLR), extreme gradient boosting (XGBoost), support vector regression (SVR), and back-propagation neural network (BPNN) were used to predict the human AGE content. Physiological parameters which may affect corneal AGE content were collected for a correlation analysis to select the features that had a strong correlation with the corneal concentration of AGEs to participate in modeling. By comparing the predictive effects of the four models in the two cases of a single-input feature and a multi-input feature, it was found that the model with the single-input feature had a better predictive effect. In this case, corneal AGE content was predicted by a single-input SVR model, with the average error rate (AER), mean square error (MSE), and determination coefficient R-squared (R²) of the SVR model calculated as 2.43%, 0.026, and 0.932, respectively. These results proved the potential of our method and device for noninvasive detection of the concentration of AGEs in the cornea.

Free-Form Surface Partitioning and Simulation Verification Based on Surface Curvature

To address the problem of low overall machining efficiency of free-form surfaces and difficulty in ensuring machining quality, this paper proposes a MATLAB-based free-form surface division method. The surface division is divided into two stages: Partition area identification and area boundary determination. In the first stage, the free-form surface is roughly divided into convex, concave, and saddle regions according to the curvature of the surface, and then the regions are subdivided based on the fuzzy c-means clustering algorithm. In the second stage, according to the clustering results, the Voronoi diagram algorithm is used to finally determine the boundary of the surface patch. We used NURBS to describe free-form surfaces and edit a set of MATLAB programs to realize the division of surfaces. The proposed method can easily and quickly divide the surface area, and the simulation results show that the proposed method can shorten machining time by 36% compared with the traditional machining method. It is proved that the method is practical and can effectively improve the machining efficiency and quality of complex surfaces.

Recurrent atherosclerotic cardiovascular disease events preventable with guideline recommended lipid-lowering treatment following myocardial infarction

Background

The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline provides recommendations for lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent atherosclerotic cardiovascular disease (ASCVD) events in adults with established ASCVD. Many adults with ASCVD who are recommended to take statins, ezetimibe and/or PCSK9i do not receive these medications.

Purpose

To estimate the number of recurrent ASCVD events potentially prevented by population-wide use of guideline recommended LLT following a myocardial infarction (MI).

Methods

We simulated the population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline recommended LLT over 3 and 5 years among US adults with government health insurance through Medicare or commercial health insurance following hospital discharge for MI. We used data from patients with an MI hospitalization in 2018–2019 to estimate the percentage receiving guideline recommended LLT defined by having the medications available to take in the 30 days after their discharge date. We used data from patients with an MI hospitalization in 2013–2016 to estimate the 3 and 5-year cumulative incidence of recurrent ASCVD events (i.e., MI, coronary revascularization or ischemic stroke). The reduction in ASCVD events associated with guideline recommended LLT was estimated from a meta-analysis by the Cholesterol-Lowering Treatment Trialists Collaboration. We conducted a sensitivity analysis estimating the number and percentage of ASCVD events prevented if LLT recommendations from the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) cholesterol guideline were followed. We repeated all analyses with recurrent coronary heart disease (i.e., MI or coronary revascularization) and ischemic stroke events as separate outcomes.

Results

Among 279,395 adults with an MI hospitalization in 2018–2019 (mean age 75 years, 54% men, mean low-density lipoprotein cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With current lipid-lowering medication use, we estimated that 70,698 (95% CI: 70,311–71,077) and 89,255 (95% CI: 88,841–89,730) ASCVD events would occur in 3 and 5 years, respectively, after MI hospital discharge (Table, top panel). If all patients were to receive 2018 AHA/ACC guideline recommended LLT, the number of ASCVD events was estimated to be reduced by 21.6%, representing 15,264 (95% CI: 14,451–16,679) events prevented over 3 years and 19,271 (95% CI: 18,245–21,055) events prevented over 5 years. A higher number of recurrent ASCVD events were estimated to be averted following the LLT recommendations of the 2019 ESC/EAS cholesterol guideline (Table, bottom panel).

Conclusions

Population-wide implementation of guideline recommended LLT in adults with an MI hospitalization could prevent a substantial number of recurrent ASCVD events.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amgen Inc.

[Efficacy and safety of adalimumab in patients with Crohn's disease]

Objective: To assess the effectiveness and safety of adalimumab in Crohn's disease (CD) patients. Methods: We retrospectively reviewed the charts of 41 CD patients who received adalimumab in Zhongda Hospital Southeast University from January 2020 to August 2021. General clinical data, laboratory results, endoscopy and radiologic findings were collected, meanwhile, disease activity and safety events were evaluated at baseline and at 12, 24 and 48 weeks of administration. Adalimumab was given subcutaneously once every 2 weeks in doses of 160 mg for the first time, 80 mg for the second time, and 40 mg for each subsequent time. Results: The clinical remission rates at 12, 24, and 48 weeks of treatment were 43.9% (18/41), 60.6% (20/33), 60.9% (14/23), and the clinical response rates were 75.6% (31/41), 69.7% (23/33), and 56.5%( 13/23), respectively. The proportion of endoscopic remission at 12, 24 and 48 weeks were 4/14, 2/6, 1/4 in patients undergoing endoscopy, and 1/14 patients achieved mucosal healing at 24 weeks. Primary nonresponse rate (PNR) was 17.1% (7/41), loss of response (LOR) rate was 14.6% (6/41). The incidence of adverse reactions was 9.8%(4/41). Conclusion: Adalimumab can effectively relieve the clinical symptoms and intestinal disease activities of Crohn's disease, and deserves to be popularized clinically. Patients with disease course <2 years, first-line biologics, low baseline HBI score, and longer duration of medication may have better results.

[Safety and prognosis analysis of transanal total mesorectal excision versus laparoscopic mesorectal excision for mid-low rectal cancer]

Objective: To compare the short-term and long-term outcomes between transanal total mesorectal excision (taTME) and laparoscopic total mesorectal excision (laTME) for mid-to-low rectal cancer and to evaluate the learning curve of taTME. Methods: This study was a retrospective cohort study. Firstly, consecutive patients undergoing total mesorectal excision who were registered in the prospective established database of Division of Colorectal Diseases, Department of General Surgery, Peking Union Medical College Hospital during July 2014 to June 2020 were recruited. The enrolled patients were divided into taTME and laTME group. The demographic data, clinical characteristics, neoadjuvant treatment, intraoperative and postoperative complications, pathological results and follow-up data were extracted from the database. The primary endpoint was the incidence of anastomotic leakage and the secondary endpoints included the 3-year disease-free survival (DFS) and the 3-year local recurrence rate. Independent t-test for comparison between groups of normally distributed measures; skewed measures were expressed as M (range). Categorical variables were expressed as examples (%) and the χ(2) or Fisher exact probability was used for comparison between groups. When comparing the incidence of anastomotic leakage, 5 variables including sex, BMI, clinical stage evaluated by MRI, distance from tumor to anal margin evaluated by MRI, and whether receiving neoadjuvant treatment were balanced by propensity score matching (PSM) to adjust confounders. Kaplan-Meier curve and Log-rank test were used to compare the DFS of two groups. Cox proportional hazard model was used to analyze and determine the independent risk factors affecting the DFS of patients with mid-low rectal cancer. Secondly, the data of consecutive patients undergoing taTME performed by the same surgical team (the trananal procedures were performed by the same main surgeon) from February 2017 to March 2021 were separately extracted and analyzed. The multidimensional cumulative sum (CUSUM) control chart was used to draw the learning curve of taTME. The outcomes of 'mature' taTME cases through learning curve were compared with laTME cases and the independent risk factors of DFS of 'mature' cases were also analyzed. Results: Two hundred and forty-three patients were eventually enrolled, including 182 undergoing laTME and 61 undergoing taTME. After PSM, both fifty-two patients were in laTME group and taTME group respectively, and patients of these two groups had comparable characteristics in sex, age, BMI, clinical tumor stage, distance from tumor to anal margin by MRI, mesorectal fasciae (MRF) and extramural vascular invasion (EMVI) by MRI and proportion of receiving neoadjuvant treatment. After PSM, as compared to laTME group, taTME group showed significantly longer operation time [(198.4±58.3) min vs. (147.9±47.3) min, t=-4.321, P<0.001], higher ratio of blood loss >100 ml during surgery [17.3% (9/52) vs. 0, P=0.003], higher incidence of anastomotic leakage [26.9% (14/52) vs. 3.8% (2/52), χ(2)=10.636, P=0.001] and higher morbidity of overall postoperative complications [55.8%(29/52) vs. 19.2% (10/52), χ(2)=14.810, P<0.001]. Total harvested lymph nodes and circumferential resection margin involvement were comparable between two groups (both P>0.05). The median follow-up for the whole group was 24 (1 to 72) months, with 4 cases lost, giving a follow-up rate of 98.4% (239/243). The laTME group had significantly better 3-year DFS than taTME group (83.9% vs. 73.0%, P=0.019), while the 3-year local recurrence rate was similar in two groups (1.7% vs. 3.6%, P=0.420). Multivariate analysis showed that and taTME surgery (HR=3.202, 95%CI: 1.592-6.441, P=0.001) the postoperative pathological staging of UICC stage II (HR=13.862, 95%CI:1.810-106.150, P=0.011), stage III (HR=8.705, 95%CI: 1.104-68.670, P=0.040) were independent risk factors for 3-year DFS. Analysis of taTME learning curve revealed that surgeons would cross over the learning stage after performing 28 cases. To compare the two groups excluding the cases within the learning stage, there was no significant difference between two groups after PSM no matter in the incidence of anastomotic leakage [taTME: 6.7%(1/15); laTME: 5.3% (2/38), P=1.000] or overall complications [taTME: 33.3%(5/15), laTME: 26.3%(10/38), P=0.737]. The taTME was still an independent risk factor of 3-year DFS only analyzing patients crossing over the learning stage (HR=5.351, 95%CI:1.666-17.192, P=0.005), and whether crossing over the learning stage was not the independent risk factor of 3-year DFS for mid-low rectal cancer patients undergoing taTME (HR=0.954, 95%CI:0.227-4.017, P=0.949). Conclusions: Compared with conventional laTME, taTME may increase the risk of anastomotic leakage and compromise the oncological outcomes. Performing taTME within the learning stage may significantly increase the risk of postoperative anastomotic leakage.

Pulse chirp enhances the laser acceleration of neutral particles

Accelerating neutral atoms is challenging because such particles are not directly manipulated by electric and magnetic fields as charged particles. In our acceleration scheme, the excited atom requires a sufficiently high gradient acceleration force. The key challenge in laser acceleration experiments is that not only must the photon energy excite atoms to the Rydberg state, but also atoms must not be ionized in an intense laser field. In this Letter, we propose using a chirped laser pulse to achieve the objectives above. The enhancement effect of the pulse chirp on the laser acceleration of neutral particles is investigated via numerical simulation and analytical analysis.

[Analysis of hemagglutinin-neuraminidase gene characteristics of human parainfluenza virus type 3 among children with acute respiratory tract infection in Qingdao city]

The purpose was to discuss the infection status of human parainfluenza virus type 3 (HPIV-3) in children with acute respiratory tract infection(ARTI) in Qingdao, Shandong province, and to analyze the gene characteristics of HPIV-3 hemagglutinin-neuraminidase protein (HN). This study was a cross-sectional study. A total of 1 674 throat swab samples were collected randomly from children with ARTI, in the three hospitals (Qingdao Women and Children's Hospital, West Coast Branch of Affiliated Hospital of Qingdao University, Laoshan Branch of Affiliated Hospital of Qingdao University) from January 2018 to December 2019. Multiplex real-time fluorescence RT-PCR was performed to screen HPIV-3 positive specimens. For HPIV-3 positive specimens, nested PCR was used to amplify the full-length HN gene of HPIV-3. The HN gene was sequenced and compared with the representative strains of HPIV-3 in GenBank, and the phylogenetic tree was established. As results, this study collected 1 674 samples, in which there were 90 HPIV-3 positive samples showed and the detection rate was 5.37%. Among positive specimens, the number of samples from children under 6 years old was 88, accounting for 97.78%. HPIV-3 positive cases were mainly distributed in spring and summer. The full-length sequences of 44 HPIV-3 HN genes were obtained by nested PCR method. Sequence alignment and evolutionary analysis showed that the HPIV-3HN gene belonged to the C3a and C3b branches of C3 genotype, with 30 strains of subtype C3a and 14 strains of subtype C3b. The nucleotide and amino acid homology of the amplified 44 strains of the HPIV-3 HN gene in Qingdao were 97.0%-100.0% and 98.5%-100.0%, respectively. In conclusion, from 2018 to 2019, the C3a and C3b branches of HPIV-3 C3 genotype were circulating prevalent in Qingdao, Shandong province. HN gene variation rate was low, but showed certain regional characteristics in evolution.

Brain functional changes in individuals with bulimia nervosa: a protocol for systematic review and meta-analysis

INTRODUCTION

Bulimia nervosa (BN) is a disorder with high health and socioeconomic burdens that typically arises in late adolescence and early adulthood. Previous neuroimaging studies have found functional brain changes in patients with BN. This study aims to review the latest neurobiological evidence from studies of individuals with BN, examine the consistency of these findings and evaluate the food addiction hypothesis of the disease.

METHODS AND ANALYSIS

A systematic search will be performed using the Cochrane Library, PubMed, Embase and Web of Science databases, covering the period from database inception to 30 November 2021. Two researchers will be responsible for study selection, quality assessment and data extraction. The anisotropic effect size version of the signed differential mapping method will be used to conduct a coordinate-based meta-analysis. Publication bias will be examined with the Egger test. The quality of studies will be evaluated using the Newcastle-Ottawa Scale.

ETHICS AND DISSEMINATION

No ethics approval is required for this is a systematic review protocol and does not require the collection of primary data. Findings will be disseminated through peer-reviewed journal or related conferences.

PROSPERO REGISTRATION NUMBER

CRD42022307233.

[Risk factors of postoperative surgical site infection in colon cancer based on a single center database]

Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.

Experimental investigations on the vertical distribution and properties of oil-mineral aggregates (OMAs) formed by different clay minerals

After oil spills, the floating oil may interact with suspended minerals to form the oil-mineral aggregates (OMAs) in turbulent environments. In this work, a flume was used in conjunction with a settling device to investigate the vertical distribution and properties of OMAs formed by different clay minerals. The density and size of OMAs depend on the density and surface properties of the constituent particles, which also affect the vertical distribution of dispersed oil. Density of oil-montmorillonite aggregates increased from 1165 to 1897 kg/m3 within 6 h test. Among the four minerals, montmorillonite displayed the highest affinity with dispersed oil and the most significant modification of oil-water interfacial tension. Oil dispersion efficiency was significantly greater and reached 39.3% in the presence of montmorillonite at 300 mg/L compared with the control group (17.6%). Particle concentration is the most important factor for the capture of oil and participation of particles during the OMA formation, while the zeta potential and hydrophobicity have nonsignificant effect on the two processes. Cation exchange capacity has a moderate effect on the sunken oil formation, which is also the second main factor governing the particle participation. Particle size plays a second leading role in governing the sunken oil formation but with a minor contribution of the particle participation.

Efficacy and safety of HDL/apoA-1 mimetics on human and mice with atherosclerosis: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Natural Science Foundation of China

Background

Low high-density lipoprotein cholesterol (HDL-C) level as a residual risk factor of cardiovascular disease (CVD) is still causing concern, although using chemical drugs for raising HDL-C level failed. The effect of high-density lipoprotein/ apolipiproteinA-1(HDL/apoA-1) mimetics on atherosclerosis is controversial.

Aim

In this meta-analysis we analyzed the effect of high-density lipoprotein/ apolipiproteinA-1(HDL/apoA-1) mimetics on atherosclerotic lesion both in human and mice.

Methods

We systematically searched PubMed, Cochrane, Web of Science and EMBASE databases up to June 6, 2020 for eligible studies using wide search terms and included all the publications meet the including criteria. The methodological quality of the human studies was assessed using Review Manager (RevMan) software (version 5.3.). The methodological quality of the mice studies was assessed by using stair list. WMD(SMD) with 95% CI was used as a measure of the association between HDL/apoA-1 mimetics and plaque regression in human (in mice), after pooling data across trials in a random effect model. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. STATA (version 14.0) was used to conduct all statistical analyses.

Results

We identified 15 randomized controlled trials in which 6 trails including 754 ACS (HDL/apoA-1 mimetics = 414, placebo = 340) patients used for efficacy analysis and all of 15 trails used for safety analysis and 17 controlled trials for animal study. The pooled results showed that the use of HDL/apoA-1 mimetics did not significant decreased the percent atheroma volume(p = 0.494) and total atheroma volume(p = 0.560) in patients with acute coronary syndrome (ACS). However, HDL/apoA-1 mimetics (or gene transfection) was significant associated with all of final percent lesion area, final lesion area and changes in lesion area (SMD, -1.75; 95% CI: -2.21∼-1.29, p = 0.000; SMD, -0.78; 95% CI: -1.18∼-0.38, p = 0.000; SMD: -2.06; 95% CI, -3.92∼-0.2, p = 0.03) in mice.

Conclusions

In human, HDL/apoA-1 mimetics cannot significantly improve atheroma volume in artery, although it is safe. However, in animal, the results suggest HDL/apoA-1 mimetics (or gene transfection) can decrease lesion area. So additional studies are needed to further investigate and explain the different efficacy of HDL/apoA-1 mimetic peptides between human and animal. Abstract Figure. Forest plots of human studies

Submicron 3,4-dihydroxybenzoic acid–TiO2 composite particles for enhanced MALDI MS imaging of secondary metabolites in the root of differently aged baical skullcap

This work provides a high-efficient organic-inorganic hybrid matrix for MALDI MSI of secondary metabolites in plant tissues.

Optical coherence tomography-defined vulnerable plaque characteristics in relation to functional severity of coronary stenoses stratified by quantitative flow ratio

Background

The functional severity and morphological features of epicardial lesions are both related to plaque vulnerability and adverse coronary events. However, their relationship remains controversial, especially in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Purpose

This study aimed to examine whether quantitative flow ratio (QFR), an angiography-based computation of fractional flow reserve, was associated with optical coherence tomography (OCT)-defined vulnerable plaques such as thin-cap fibroatheromas (TCFAs) in a board spectrum of population, including patients presenting stable angina and NSTE-ACS.

Methods

We identified patients who underwent OCT examinations from 2 prospective cohorts and then assessed interrogated vessels with QFR. Lesions were divided into tertiles: QFR-T1 (QFR &lt;0.85)&lt;qfr),&gt;, QFR-T2 (0.85 to 0.93) and QFR-T3 (QFR &gt;0.93).

Results

This post-hoc analysis included 83 lesions from 79 patients (mean age: 61.5±9.8 years, males: 58%). Patients with NSTE-ACS accounted for the majority of the population (67%). The median % diameter stenosis and median QFR value were 42% (36 to 49%) and 0.88 (0.83 to 0.95), respectively. The prevalence of OCT-TCFA was significantly higher in QFR-T1 (50%) than in QFR-T2 (14%) and QFR-T3 (19%) (p=0.003 and 0.018, respectively). Overall significant differences were observed among tertiles in maximum lipid arc, thinnest fibrous cap thickness (FCT), and minimal lumen area (MLA) (p=0.017, 0.040, and &lt;0.001, respectively). The Spearman's correlation analysis showed that QFR was significantly related to MLA (ρ = 0.537, p&lt;0.001), % area stenosis (ρ = –0.512, p&lt;0.001), maximum lipid arc (ρ = –0.360, p=0.002), lipid length (ρ = –0.242, p=0.038), lipid index (ρ = –0.333, p=0.004), and thinnest FCT (ρ = 0.315, p=0.006). In the multivariable analysis, QFR ≤0.80 remained as a significant determinant of TCFAs regardless of the presence of NSTE-ACS and the level of low-density lipoprotein cholesterol (adjusted odds ratio = 4.387, 95% confidence interval: 1.297 to 14.839, p=0.017). In addition, QFR demonstrated moderate predictive ability for OCT-TCFA (area under the curve = 0.72, 95% confidence interval: 0.58 to 0.86, p=0.003) with the best cutoff of ≤0.86 (sensitivity: 65%; specificity: 73%; negative predictive value: 85%; accuracy: 71%).

Conclusions

Lower QFR was related to OCT-TCFA and other vulnerable plaque characteristics in angiographically mild-to-intermediate stable lesions and culprit lesions from NSTE-ACS. The QFR might be a useful tool for ruling out high-risk, rupture-prone plaques without using any pressure wires or vasodilators.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Jiangsu Provincial Key Research and Development Program Flow diagram of patient selectionOCT findings according to QFR tertiles

Manganese promoted wheat straw decomposition by regulating microbial communities and enzyme activities

AIMS

This study investigated the dose-effect of manganese (Mn) addition on wheat straw (WS) decomposition, and explored the potential mechanisms of Mn involved in the acceleration of WS decomposition in regards to the soil microbial communities and enzyme activities.

METHODS AND RESULTS

A 180-day incubation experiment was performed to examine the decomposition of WS under four Mn levels, that is, 0, 0.25, 1 and 2 mg g^-1 . The effects of microbial communities and enzyme activities were evaluated using control (0 mg g^-1 ) and Mn (0.25 mg g^-1 ) treatments. Our results revealed that Mn (0.25 mg g^-1 ) addition significantly increased WS decomposition, and enhanced the release of carbon and nitrogen. Optimal Mn addition (0.25 mg g^-1 ) also caused significant increases in the activity of neutral xylanase (NEX), laccase (Lac), manganese peroxidase (MnP) and lignin peroxidase (LiP) within the incubation period. Mn (0.25 mg g^-1 ) addition also enriched some operational taxonomic units (OTUs) that, in turn, had the potential ability to decompose crop straw, such as secreting lignocellulolytic enzymes.

CONCLUSIONS

Mn (0.25 mg g^-1 ) could promote WS decomposition through enrichment of the microbial species involved in biomass decomposition, which enhanced the lignocellulose-degrading enzyme activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides evidence for Mn to promote WS biodegradation after Mn application, opening new windows to improve the utilization efficiency of crop residues.

[Artificial intelligence, radiomics and pathomics to predict response and survival of patients treated with radiations]

Artificial intelligence approaches in medicine are more and more used and are extremely promising due to the growing number of data produced and the variety of data they allow to exploit. Thus, the computational analysis of medical images in particular, radiological (radiomics), or anatomopathological (pathomics), has shown many very interesting results for the prediction of the prognosis and the response of cancer patients. Radiotherapy is a discipline that particularly benefits from these new approaches based on computer science and imaging. This review will present the main principles of an artificial intelligence approach and in particular machine learning, the principles of a radiomic and pathomic approach and the potential of their use for the prediction of the prognosis of patients treated with radiotherapy.

Performance of dispersed oil and suspended sediment during the oil-sediment aggregation process

Oil-sediment aggregation is an important transport and transformation process of spilled oil, which has been considered as a pathway of spill remediation. This work focused on the individual performance of dispersed oil and sediment during the aggregation process. Dispersion of three oils was first tested and validated in a water tank. An approach of estimating the mass variation of the sediment that has participated in forming the oil-sediment aggregates (OSAs) has been developed by density analysis. Results indicated that the density of the formed OSAs increases during the aggregation. In the context of remediation, it takes longer for sediment to reach equilibrium than for dispersed oil, especially under high mixing energy at a large sediment concentration, which results in the formation of dense OSAs, as well as high aggregation degree and rate. Roncador oil possesses a relatively high capability of capturing sediment to form dense OSAs, especially at an initial sediment concentration of over 150 mg/L. Oil sinking efficiency and the characteristic change rate of aggregated oil mass seem to be proportional to oil dispersion efficiency, and decrease with the mean size of dispersed oil droplets. The process of aggregation can further promote the dispersion of oil into water column. This study also provides fundamental data for the formation kinetics of OSAs.

Metastatic small bowel adenocarcinoma: role of metastasectomy and systemic chemotherapy

Background

Metastatic small bowel adenocarcinoma (SBA) has a poor prognosis. Due to its rarity, high-quality data are lacking to guide treatment. This retrospective analysis was conducted to help characterize the treatment options for patients with metastatic SBA while providing clinically meaningful prognostic information.

Patients and methods

In total, 437 patients who initially presented with or developed metastatic SBA between September 1977 and September 2019 were identified from the MD Anderson Tumor Registry. Clinical data were collected from review of the medical record. Overall response rates (ORR), time to progression (TTP), and overall survival (OS) were assessed across various treatments and treatment lines.

Results

The median OS from diagnosis of metastatic disease was 15.9 months [95% confidence interval (CI): 14.3-17.9]. Seventy-five patients (17.1%) underwent metastasectomy, which was associated with a median OS of 34.5 versus 17.1 months among patients who received chemotherapy alone (P < 0.001). Fluoropyrimidine plus platinum (n = 164) was the most common first-line chemotherapy, associated with an ORR of 59% and TTP of 8.1 months. Irinotecan with 5-FU (n = 101) was the most common second-line therapy associated with an ORR of 31% and TTP of 4.0 months. Twenty-two patients received immunotherapy; 5 of 6 patients with deficient mismatch repair (dMMR) responded, while 0 of 16 with proficient mismatch repair (pMMR) responded. Taxane-based chemotherapy was given to 34 patients with an ORR of 21% and a median TTP of 2.4 months. Among 11 patients who received anti-epidermal-growth-factor-receptor (EGFR) monotherapy, the best response was stable disease (SD) in 1 patient.

Conclusions

In well-selected patients with SBA, metastasectomy appears to be associated with improved OS. This improvement was seen across metastasectomy sites, including liver, lung and peritoneal. Anti-programmed cell death protein 1 (PD-1) based immunotherapy was active for dMMR SBA but not pMMR SBA. While taxane-based chemotherapy demonstrates therapeutic activity, the activity of anti-EGFR therapy was limited.

•

Metastasectomy for well-selected metastatic SBA patients was associated with improved OS.

•

Anti-PD1-based immunotherapy was active for dMMR SBA but not pMMR SBA.

•

Taxane-based chemotherapy demonstrated clinical activity in refractory SBA.

•

Anti-EGFR therapy demonstrated minimal activity in SBA.

Contributions of epiphytic microbiota on the fermentation characteristics and microbial composition of ensiled six whole crop corn varieties

AIMS

The present study is aimed to reveal the variations in epiphytic microbial composition among six whole crop corn (WCC) varieties and their contributions on ensiling characteristics and microbial composition of WCC silage.

METHODS AND RESULTS

Six WCC varieties (JS06, YS23, BS20, JS39, JS40 and JS26) were ensiled for 90 days. All WCC varieties were well fermented with low pH value (<4·0) and high LA (73·6-124 g kg^-1 DM, dry matter) concentration. Of six varieties, JS40 had the highest LA (124 g kg^-1 DM) concentration, which was supported by highest relative abundance of Lactobacillus. Pantoea was the most dominant epiphytic bacteria in all fresh WCC varieties; however, the secondary dominant genera among six WCC were absolutely difference. Lactobacillus became predominant genus in 90-day silages except YS23. YS23 kept the more bacterial genus from fresh to 90-day silages than other silages, meanwhile Acinetobacter and Enterobacter were the dominant bacteria in YS23 silages.

CONCLUSIONS

Among six WCC varieties, JS40 silage had the highest LA. The variations in epiphytic microbiomes among fresh WCC affected terminal microbial community of 90-day silages. There were differences in fermentation characteristics among six WCC varieties, which might be partly attributed to variations in epiphytic microbiomes among fresh WCC.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study not only enriches the research on microbial communities of plant phyllosphere but also provides theoretical basis for selecting WCC varieties and inoculants for the forage production.

Oil dispersion and aggregation with suspended particles in a wave tank

Suspended particulate matter (SPM) in marine environments plays an important role in determining the fate of spilled oil via the generation of oil-particle aggregates (OPAs). A series of mesoscale wave tank experiments and sedimentation tests were conducted to fill the knowledge gap on how the turbulent mixing, temperature, and oil type affect the dispersion of spilled oil and properties of OPAs. Generally, the oil dispersing efficiency was significantly enhanced by high wave energy, which also led to effective oil sinking, large size of OPAs and wide distribution of trapped oil. Nonlinear fitting results indicated that the oil sinking efficiency followed an exponential growth over time. The effect of temperature on oil dispersion and formation of OPAs is primarily attributed to its influence on oil viscosity and interfacial tension. Viscous oils are more likely to interact with particles above 25 °C. However, below 20 °C, a specific oil viscosity that will bring about the maximum OPAs exists. Excessive oil viscosity will lead to a weak binding between oil and SPM and a centralized distribution of trapped oil. Furthermore, spilled oil with a high asphaltene can interact more effectively with particles. Our finding suggested that early prevention of offshore oil sinking is key in summer.